Vertical integration of clinical knowledge in preclinical medical education: assessing the impact on the first-year biology curriculum in a German medical school

Background In German medical curricula, the preclinical phase is often predominantly theoretical and only weakly connected to clinical practice. Patient contact is rare, which may limit the early development of illness scripts. Consequently, students may not fully appreciate the relationships between foundational biological knowledge, disease pathophysiology, diagnosis and treatment. In this study, we implemented clinical impulse lectures within first-semester biology classes and evaluated their association with knowledge, learning strategies and perceived preparedness for clinical practice. Material and methods First-semester medical students received the regular biology curriculum enriched with up to six clinical impulse lectures, including one session with patient contact. Data were collected using pre-intervention ( n = 227) and post-intervention ( n = 105) questionnaires assessing self-perceived biological and clinical knowledge. We also assessed learning motivation and strategy as well as students'' perceptions of the connection between theory and clinical practice. A 35-item multiple-choice question (MCQ) test was administered to objectively assess knowledge ( n = 71). Each clinical impulse was additionally evaluated using a short questionnaire. Results Students reported greater perceived preparedness regarding their biological knowledge after completing the biology course. Mean self-assessed biology knowledge improved from 2.9 to 2.3 ( p < 0.001; 1 = best grade), and self-assessed clinical impulse-related knowledge improved from 3.3 to 2.5 ( p < 0.001; 1 = best grade). The clinical impulses were perceived as highlighting the relevance of scientific foundations to clinical practice and as motivating integrated learning. Students who had attended more clinical impulses more frequently agreed with these statements. More than 80% supported the concept of vertical integration. In the objective MCQ assessment, students with greater exposure to clinical impulses achieved higher scores on biology questions; the difference in clinical impulse-related MCQ scores was not statistically significant. Conclusion Early clinical impulses were well accepted by first-semester medical students. Greater exposure was associated with stronger motivation and higher biology MCQ scores, whereas the difference in clinical impulse-related MCQ performance was not statistically significant. Given the unequal exposure groups and concurrent standard biology curriculum, these findings should be interpreted as preliminary evidence of an association rather than proof of a causal effect.