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https://doi.org/10.29060/TAPS.2025-10-2/TT002

Neil Osheroff

Department of Biochemistry, Vanderbilt University School of Medicine, United States of America; Department of Medicine (Hematology/Oncology), Vanderbilt University School of Medicine, United States of America

Since the time of the Flexner report, it has been accepted that science is the foundation of clinical practice (Finnerty et al., 2010; Flexner, 1910; Grande, 2009; Haramati et al., 2024; Lindsley et al., 2024; Slivkoff et al., 2019; Weston, 2018; Woods et al., 2006). However, the methods traditionally used to teach sciences to medical students have been questioned in the post-Flexner era (AAMC-HHMI Committee, 2009; Cooke et al., 2010; Fulton et al., 2012; Slivkoff et al., 2019). For nearly 100 years, the foundational sciences were taught in a discipline-oriented fashion, primarily through passive learning approaches (lectures), and largely separated from clinical practice (AAMC-HHMI Committee, 2009; Flexner, 1910). Consequently, in the pre-clerkship phase, scientific details were often overtaught and disconnected from clinical applications. This approach frequently required students to “re-learn” their foundational sciences in the setting of patient care. The disconnect between science and medicine was further exacerbated in the later phases of medical training by physicians who taught in a manner that emphasized pattern recognition over scientific underpinnings. We have come to understand that these pedagogical approaches to medical education were neither efficient nor optimal.

Adult learning theory has provided strong evidence that medical trainees are better at learning, applying information to new circumstances, and making informed clinical decisions when the foundational and clinical sciences are taught side-by-side in an integrated fashion (Bandiera et al., 2018; Bucklin et al., 2021; Kulasegaram et al., 2015; Kulasegaram et al., 2013; Lisk et al., 2016; Mylopoulos & Woods, 2014). Learning is also heighted when active rather than passive approaches are employed. In the pre-clerkship phase, small group active learning sessions (problem-based learning, team-based learning, case-based learning, etc.) provide outstanding platforms for integrating foundational and clinical sciences (Bucklin et al., 2021). Similarly, in the clinical workplace, practitioners can integrate science and medicine by probing or explaining the underlying basis of disease and treatment or employing other forms of active learning (Dahlman et al., 2018; Daniel et al., 2021; Hashmi et al., 2024; Spencer et al., 2008).

Some have questioned the need for pre-clerkship science education in medical schools, professing that the heart of medical education is the clinical experience (Emanuel, 2020). However, in the post-genomic era, this perspective would seem to be the antithesis of modern medical practice (AAMC-HHMI Committee, 2009; Haramati et al., 2024). Now more than ever, to ensure the best quality of care for their patients, physicians need to understand the scientific underpinnings of their actions.

If we truly believe that science is the foundation of clinical practice, we should not teach either in isolation. As a first step, we need to stop thinking about foundational and clinical sciences as being separate. I would argue that they are both on the spectrum of “biomedical sciences,” represent two sides of the same coin, and should be taught in an integrated fashion across the entirety of the medical school curriculum. Although this integration has been (or is being) addressed in the pre-clerkship phases at most medical schools, it has proven more challenging in the clinical phases (Brauer & Ferguson, 2015; Pettepher et al., 2016; White & Ghobadi, 2022). While science and medicine are inherently intertwined, interactions between the two in the latter phases of training are often more casual than causal. It is time for the foundational and clinical sciences to be integrated across the continuum of medical training to ensure that future physicians have the skills necessary to provide the highest caliber of care for their patients.

Acknowledgements

Work in the author’s laboratory is funded in part by NIH grants R01 GM126363 and R01 AI170546. The author is grateful to Dr. Emily Bird for critical reading of the manuscript and insightful comments.

Declaration of Interest

The author declares no conflict of interest.

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