To the Editor:
The recent suggestion1 to make accommodations for basic scientists resisting the transition to teaching their disciplines in the context of “clinical relevance” ensures perpetuation of the wrong curriculum and development of the wrong faculty. The appropriate disciplines for a medical education are the clinical disciplines (branches of medicine having American Board of Medical Specialties certification)2 taught in a planned, organized program by physicians and integrated ultimately by students through participation in authentic professional activities. No matter what type of practice students enter, they need to become conversant about the problems and principles of these disciplines such that they are able to discuss any type of case intelligently with any physician and to explain to patients the issues and expectations pertaining to their situations. Thus, contrary to Hopkins and colleagues’ belief, it is at the level of curriculum structure that transformative change must occur. Rather than repackaging the same bolus of basic science information in the first years, we must move toward actually organizing the medical school experience around medicine. The scientific basis of medicine is encapsulated in the clinical disciplines, and academic physicians who practice these disciplines can unpack and elaborate on the essential ideas as needed for teaching. Restructuring the curriculum around clinical disciplines reorders priorities away from the concerns of Hopkins and colleagues toward those needed to overcome the significant barriers to physician participation in the educational program,3,4 and those needed to ensure meaningful participation by students in clinical activities.5 Failing this, we will have to face the disturbing truth that we teach basic science instead of medicine because that is the faculty available, and we try to integrate the faculty and the curriculum content because we are unable to provide experiences that help students integrate knowledge of medicine.
Paul F. Shanley, MD
Professor, Department of Pathology, SUNY Upstate Medical University, Syracuse, New York; [email protected]
1. Hopkins R, Pratt D, Bowen JL, Regehr G. Integrating basic science without integrating basic scientists: Reconsidering the place of individual teachers in curriculum reform. Acad Med. 2015;90:149153.
2. American Board of Medical Specialties. ABMS guide to medical specialties. Revised May 2015. http://www.abms.org/media/84812/guide-to-medicalspecialties_05_2015-2.pdf
. Accessed March 18, 2016.
3. Barzansky B, Kenagy G. The full-time clinical faculty: What goes around, comes around. Acad Med. 2010;85:260265.
4. DaRosa DA, Skeff K, Friedland JA, et al. Barriers to effective teaching. Acad Med. 2011;86:453459.
5. Massey PR, Anderson JH. Resuscitating inpatient clinical clerkships: A medical student perspective. JAMA Intern Med. 2014;174:14401441.