Glenn Regehr

The predominant structure of medical education is the “2+2” curriculum where students spend two years in a university learning the basic sciences, followed by two years of clinical training in hospitals. Students’ difficulty transferring what they learn in the classroom to the practical setting, however, has lead to years of effort to try and integrate the basic and clinical sciences, but with no major change to curricula being realized. What may be contributing to the ongoing struggle to integrate is the tendency of the medical education community to focus on the level of curricular structure when challenges more often concern the struggles of individual educators dealing with change. In order to bring light to the level of individual teachers the objective of this study was to use a phenomenological approach to understand what it was like for basic scientists (specifically anatomists) to transition to an integrated curriculum, and how the change impacted their teaching. Lillian Douglas School of Medicine (pseudonym) was used as a case study of an anatomy course that has successfully transitioned to an integrated curriculum. The primary investigator spent five weeks with the program during which she interviewed participants, observed lectures, seminars, and labs, and collected relevant documents Data was analyzed using the reiterative cycle of hermeneutics. The experience of transitioning to an integrated curriculum was like moving to a foreign country in that participants left the “home” and familiarity of their previous teaching, and took on the work of learning a new clinical language. Explanatory concepts characterizing the experience of basic scientists transitioning to an integrated curriculum included shifting from teacher-centered to student-centered teaching, adopting a “beginner’s mind”, maintaining control, and identity transformation. Implications for basic scientists include factors that may enable the transition to an integrated curriculum such as adopting an open mindset and being aware of how educators’ roles and identities may change in the new curriculum. Implications for leaders of reform include ways they might support basic scientists undergoing change such as facilitating collaboration between basic scientists and clinicians, as well as implementing strategies aimed at enhancing basic scientists feeling of control.

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