Friday, February 10, 2006

The importance of basic science in medical education

In the traditional medical school curriculum the first two years of study are devoted to basic sciences such as anatomy, biochemistry, physiology and pathology with relatively little patient teaching. Although many problem based models have changed this structure by integrating patient contact across all four years of study, an emphasis on basic science remains. This is as it should be.

So I must respectfully disagree with The Patient’s Doctor who asserts that most of what they teach medical students is useless. A grasp of basic science is an essential foundation for the understanding of health and disease. It prepares us for lifelong learning because it provides a conceptual framework with which to organize new information. It also gives us the tools we need to critically appraise information, all of which translates into better patient care.

Basic biochemistry, for example, teaches the economy of energy, from substrate metabolism to the generation of high energy phosphate bonds, helpful principles for critical analysis of so many dubious “energy healing” claims.

Basic sciences often translate directly into patient care. Without a grasp of biochemistry and physiology the clinician becomes a slave to the Internet or resorts to rote memorization, an approach which invites error in those patients who forget to read the textbooks. Diabetic ketoacidosis is one of my favorite examples of this.

Bedside diagnostic skills also rely on the foundation of basic science. If this were not so, a junior high school student could be taught physical diagnosis in a few sessions. The most obvious example is the requisite knowledge of neuroanatomy for the competent performance of the neurologic exam. Similarly, an understanding of cellular electrophysiology is essential if ones skills in electrocardiography are to exceed simple pattern memorization.

I do agree with patient’s doctor on one thing—we forget much of the basic science we’re taught. That’s why I’ve bookmarked a few basic science resources for review:

The Pathology Guy This is an eclectic site containing elements of religion, humanities and cultural studies, but there’s plenty of good basic science stuff here including a collection of lecture handouts for the author’s second year pathology course.

Advances in Physiology Education This publication of the American Physiological Society contains articles about teaching methods and theories for medical school physiology. It’s also a nice refresher.

McGill medical student resources Lots of good stuff here.


Anonymous said...

A knowledge of basic sciences is the primary difference between physicians and physician wannabes (NP's, PA's, etc.). I'm not putting down the valuable work done by physician extenders, but their work tends to be based upon checklists, protocols, and things that they are told to do. Even if we don't remember a lot of the specifics involved in basic sciences, it's easy to refresh our memories when needed, and the critical thought processes developed in learning the basic sciences provides the basis for advances in medicine.

Anonymous said...

The basic science curriculum in medical is a complete waste of time! While you do learn important disease processes in physiology, pathology, and microbiology and then how to treat such conditions with pharmacological agents, courses like biochemistry, genetics, and immunology are absolutely useless for student wishing to pursue clinical careers as opposed to being lab monkeys.

The reason why a basic science curriculum exists is to prepare for the USMLE Step 1 exam, which is also a useless exam. The true quality of a physician or surgeon lies in their clinical prowess in dealing with patients in real-life conditions.