gms | German Medical Science

Context: Reforms in undergraduate medical curricula tend to focus on early introduction of clinical material. Competency based assessments often reduce the place of basic sciences. This evolution is in part due to the feeling that basic science teaching in the first years of medical studies is encyclopedic, induces short time memory learning strategies, and is on the whole inefficient. Nevertheless this tendency has raised several types of concern. Debates remain as to how much of basic science knowledge remains necessary for students to understand medicine and the evolution of diagnosis and therapeutic procedures. Basic scientific knowledge is also a prerequisite for involvement in biological research, at the time where the construction of MD/phD curricula is clearly recognized as a priority.

Methods: The medical school of the University of Angers has recently implemented a reform of the curricula of the second and third years of medical studies. The choice has been that of designing a curriculum consisting in 70% of a core clinical-based curriculum, and 30% of additional courses to be chosen within one of the three following categories.

More basic sciences. This stream includes 6 modules : Biostatistics, Discovery of biological regulations, From the gene to the cell, Imaging the response to cancer therapy, Functional explorations, and a project. The objective is to allow students in-depth study of some fundamental biological mechanisms. The project is in most cases the literature review of a specific question and the first step to a personal research project conducted during the third year. The aim is to give students who are interested in science generic tools to understand medicine and develop a scientific approach. The teaching is mainly organised in small groups, using interactive methods and continuous assessment of student’s production rather than end of term tests.

Early patient contact. This stream includes further teaching on medical psychology, a module focused on the approach of patients with chronic diseases, a clinical approach of functional explorations, and bedside teaching. The assessment is in part based on ECOS.

More medical humanities. This stream includes tutorials and lectures dealing with a large scope of social sciences for medicine (Philosophy, sociology, psychology, law, economics, forensic medicine). The assessment is mainly based on an essay.

The students were asked to rank the options in order of preference and guaranteed to be enrolled in one of their two preferred options. Academic results were not considered for allocation. The maximum number of student in each stream was pre-determined.

Results: 176 students expressed their choice. The first choice was early clinical contact for 119, more basic sciences for 24, and more medical humanities for 24. Due to constraints in the number of students in each stream, 47 students were allocated to their second choice (medical humanities in 16 cases and basic science in 31 cases).

The program is currently running for the first edition. Both students and teachers seem to be satisfied with the format. Formal assessment is not yet available. Comparison of the academic results of the three groups on the core-curriculum modules will be performed.

Discussion/Conclusion: A large majority of second year medical students choose a more clinically oriented curriculum if they are offered the option. Among the other students, the interest for basic sciences and medical humanities is almost balanced. The influence of our first year curriculum which is almost exclusively basic sciences and takes place in a highly competitive context should be kept in mind when generalizing these conclusions to other systems.

Considering the poor level of evidence on which to rely in the design of curricular reforms, offering within the same institution different programs for different students can be preferable to a single policy.