Basic Sciences in Medical Education: Why? How? When? Where?

At the beginning of the twentieth century, the medical education enterprise in the United States was in crisis. In the absence of clearly defined outcomes, proprietary medical schools enrolled large numbers of unqualified students who were not adequately prepared to practice medicine. These major inadequacies in medical training prompted Flexner’s (1910) landmark report, in which he insisted that medical education be university-based and that the curriculum should include rigorous instruction in basic science and that medical faculty should be heavily engaged in basic research (Weissmann 2008). As a result of this study, non-universitybased proprietary medical schools went out of business and university-based medical schools established research departments in basic biomedical sciences. Although the ‘‘scientific basis of medicine’’ was emphasized in curricula based on the Flexnerian model (Flexner 1910), this often led to a compartmentalization of preclinical and clinical studies. In 1940, the ‘‘Weiskotten Report’’ on medical education found dissatisfaction from preclinical education. Interestingly, it was noted that ‘‘in higher ranking schools the preclinical educational programs were less rigid and less formal than in the lower ranking schools’’ (Weiskotten et al. 1940). This observation shed light early on a possible future direction for basic sciences education. It was further reported that faculty in higher ranking departments believed ‘‘that the early appreciation of the various techniques as applied to clinical medicine detracted in no way from scientific value of these [basic science] courses’’ (Weiskotten et al. 1940). The 40 years following the ‘‘Weiskotten Report’’ (1940) are best characterized as an uncomfortable status quo. The lack of clinical relevance, lack of integration, and the division of preclinical and clinical instruction caused dissonance and dissatisfaction among preclinical teachers and students alike (McLaren 1980). Educators were most concerned about the learning and retention of basic science knowledge. Most of the preclinical medical science was taught in a passive, lecturebased format by basic scientists who felt uncomfortable trying to put their teaching into clinical contexts. This situation mirrored that of clinicians who also felt uncomfortable teaching basic science relevance in their clinical cases (McCrorie 2000). As time progressed, critics began to downplay the role of basic sciences in favor of other aspects of medical education (Boshuizen and Schmidt 1992; Whitcomb 2006), yet others became crusaders to preserve the essential role of basic sciences (Norman 2000). They expressed absolute confidence based on research evidence that basic science needed to remain a fundamental part of medical education (Norman 2007; Woods et al. 2007). Since the early 1990s, many medical curricula underwent