An integrated pre-clerkship curriculum to build cognitive medical schema: It's not just about the content

Both physiology and pathophysiology are essential disciplines in health professional education however, clinicians do not use this knowledge in isolation. Instead, physicians use inter-disciplinary concepts embedded within integrated cognitive schema (illness scripts) established through experience/knowledge that manifest as expert-level thinking. Our goal was to develop a pre-clerkship curriculum devoid of disciplinary boundaries (akin to the physician's illness script) and enhance learners' clerkship and early clinical performance. As well as developing curricular content, the model considered non-content design elements such as learner characteristics and values, faculty and resources and the impact of curricular and pedagogical changes. The goals of the trans-disciplinary integration were to develop deep learning behaviors through, 1) developing of integrated, cognitive schema to support the transition to expert-level thinking, 2) authentic, contextualization to promote knowledge transfer to the clinical realm 3) allowing autonomous, independent learning, and 4) harnessing the benefits of social learning. The final curricular model was a case-based approach with independent learning of basic concepts, differential diagnosis and illness scripting writing, and concept mapping. Small-group classroom sessions were team-taught with basic scientists and physicians facilitating learners' self-reflection and development of clinical reasoning. Specifications grading was used to assess the products (written illness scripts and concept maps) as well as process (group dynamics) while allowing a greater degree of learner autonomy. Although the model we adopted could be transferred to other program settings, we suggest it is critical to consider both content and non-content elements that are specific to the environment and learner.

Automated summary

Physiology and pathophysiology are important disciplines in health professional education, but clinicians integrate this knowledge with interdisciplinary concepts to develop expert-level thinking. Our goal was to create a pre-clerkship curriculum that breaks down disciplinary boundaries and enhances learners' clinical performance. The curriculum incorporated elements such as learner characteristics, faculty resources, and pedagogical changes to promote deep learning behaviors and the transfer of knowledge to clinical practice. The final model used case-based learning and independent study, supported by small-group sessions and specifications grading for assessment.