Integrating basic and clinical science: The critical care module of the interdisciplinary foundations of medicine curriculum

Introduction: In an effort to better link the preclinical and clinical years, we designed a Critical Care Module (CCM) to underscore the dependence of clinical reasoning and decision making on basic science knowledge. Methods: A one-week module covered major topics introduced during the two preclinical years. These areas (sepsis, infectious disease, neural science, endocrine, renal, pulmonary, immunology, and cardiac) were explored using a case based format that linked clinical information to basic science topics. The cases highlighted how critical elements of the patient history, physical exam, laboratory and imaging data developed a decision tree. Each decision tree point was evaluated with regard to the basic science elements upon which it depended. After each case, basic scientists reviewed the basic science elements in detail. A summary of the critical elements of decision-making followed the review as a paradigm for patient evaluation. Students were surveyed before and after the CCM, and after the USMLE Step I to evaluate the CCM (rating scale 1=not helpful to 5=very helpful). Data (means ± SD or percents) were compared by Student's t-test; significance assumed for p<0.05(*). Results: Students (n=161 pre; n= 148 post) felt that the CCM helped them prepare for the USMLE (2.7±0.4 pre v 3.2±0.5 post), integrated basic and clinical science (2.9±0.6 pre v 3.9±0.2 post), and helped prepare them for the clinical years (2.8±0.9 pre v 4.1±0.4 post*). An increasing number thought that it was an excellent way to prepare for year three (48% pre v 72% post*). After the USMLE Step I, few students (7%* post v 54% pre-USMLE) believed that the CCM helped them prepare for the examination despite pre-examination expectation to the contrary. Conclusions: The concept of an integrative CCM was well accepted by students and faculty. The development of a bridging module strengthens the ties between the basic science and clinical faculty. The CCM is not useful as a test preparation tool in its current format. However, the CCM is a useful paradigm for linking basic science elements with clinical practice through the illustration of clinical reasoning.