Electronic Thesis and Dissertation Repository

Thesis Format

Monograph

Degree

Doctor of Philosophy

Program

Anatomy and Cell Biology

Supervisor

Rogers, Kem A.

2nd Supervisor

Martin, Charys M.

Co-Supervisor

Abstract

Basic sciences are a cornerstone of undergraduate medical education (UME), upon which the clinical sciences are built, however, research indicates that students’ basic science knowledge is not well retained. Additionally, UME curricula vary with respect to which basic science content is delivered, the depth in which it is taught, and the employed instructional methods, which could influence trainees’ knowledge retention. Thus, there is a need for an educational model that ensures students are competent in the fundamentals prior to entering a clinical setting. This investigation provides insights into current strengths and potential areas for improvement with respect to basic science pre-clerkship curricula.

The aims of this research were to: i) determine clerkship directors’ perceptions of necessary basic science concepts, along with strengths and areas for improvement, with respect to students’ basic science knowledge; ii) assess medical students’ knowledge retention of the identified basic science concepts; iii) determine where, when, how, or if, the identified basic science concepts were taught during pre-clerkship; and iv) assess medical students’ knowledge reinforcement levels of the identified basic science concepts during clerkship.

We established that students are expected to have some knowledge of every basic science prior to clerkship, and the identified concepts mapped to each systems-based pre-clerkship course. Additionally, directors’ perceptions of potential areas for improvement outweighed strengths. On average, students retained ≥60% of relevant basic science knowledge from pre-clerkship, and reinforced concepts during each clerkship rotation. Mapping the concepts to curricular content revealed that where, when, how, or if, the concept was delivered during pre-clerkship did not influence students’ basic science knowledge, nor did clerkship group or rotation order. Interestingly, even though lower-performing students demonstrated the greatest post-test improvement, they still left each rotation with knowledge deficits compared to their highest-performing peers. Thus, while they did not catch up to their highest-performing peers, the clinical experience of clerkship appears to be most beneficial for lower-performing students. This may suggest that earlier integration of clinical learning with the basic sciences could foster students’ basic science knowledge, thereby ensuring that all trainees are well-equipped with the necessary knowledge prior to clerkship.

Summary for Lay Audience

Basic sciences are essential in undergraduate medical education (UME), as they provide a framework upon which clinical concepts are built, however, research demonstrates that medical students’ basic science knowledge is not well retained. Additionally, basic science education varies across UME programs, which may influence students’ basic science knowledge. With a strong basic science foundation being necessary for the successful practice of medicine, there is a need for an educational model that ensures students are competent in the fundamentals prior to clinical training. Thus, the goal of this research was to provide insights into current strengths and potential areas for improvement with respect to UME basic science education.

During this investigation, clinical educators were interviewed to determine which basic science concepts they expect students to know prior to entering clinical training, along with their perceptions of strengths and areas for improvement, with respect to students’ basic science knowledge. Students’ knowledge levels of the concepts deemed necessary by clinical educators were analyzed prior to (pre-test) and at the completion (post-test) of each clinical rotation. The timing in which the content was delivered and the instructional methods used were also evaluated to determine if they impacted students’ knowledge levels.

Students are expected to have knowledge of every basic science prior to clinical training, and clinical educators’ perceptions of potential areas for improvement outweighed strengths. Students, on average, retained ≥60% of their basic science knowledge, and reinforced concepts during each clinical rotation. Additionally, students’ knowledge levels were not influenced by the timing of content delivery nor the instructional methods used. Interestingly, even though students who achieved lower scores on the pre-test demonstrated the greatest improvement on the post-test, they still left each rotation with knowledge deficits compared to their higher-performing peers. Therefore, while clinical experience does benefit students’ learning, it is not sufficient to enable lower-performing students to catch up to higher-performing students. With the basic sciences underpinning the clinical sciences, these findings may suggest that earlier integration of clinical learning could help foster students’ basic science knowledge levels, and help ensure that all trainees are confident in the fundamentals prior to clinical training.

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