Classroom Perspective

Weaving Basic Science into the Clinical Rotation


Good medical education requires a delicate balance between the classroom and the clinic. At Case Western Reserve University School of Medicine, students' lessons in scientific principles are supplemented with real-life applications in their first years, including reviews of clinical cases in small groups called IQ teams. The sessions give budding doctors the chance to see how their textbook lessons apply to patient care.

Students eagerly welcome the opportunity to put their basic-science knowledge to work in the clinic in the first years of medical school. But when students begin their clinical rotations in their third year, maintaining that balance to continually refresh and expand on basic-science skills is a challenge for medical educators.

"Taking students from clinical rotations to give them lectures on basic science just doesn't work," says Dan Wolpaw, MD, director of undergraduate clinical education and professor of medicine at Case Western Reserve University School of Medicine.

So an interdisciplinary group of faculty members has developed IQ+, an extension of the IQ group discussion sessions from students' first two years.

In IQ+, third-year students come together on Friday afternoons to meet in groups to reflect on their clinical experiences and explore new cases that feature various scientific principles. They also have the opportunity to develop and teach their own cases.

It's a more palatable way of dishing out science lessons to people who are beginning to feel more like physicians and less like students.

"It's a hard sell," Wolpaw says. "They're working as junior doctors. They feel like they'd rather be at the hospital."

Yet the lessons they learn in the required Friday gatherings of IQ+ are vital to their futures as physicians.

"As doctors become more accomplished and experienced, they develop automatic responses in thinking and doing that are critical to expert functioning. They don't need to think through and analyze every situation," Wolpaw says. "Students want to be able to do that. They want to develop that kind of expertise and that's appropriate.

"But there are times even experts recognize they need to be more analytical, to think it through, to slow down and shift from automatic mode, to go back to the pharmacology or genetics or other basics to figure out what's going on."

Third-year student Stephanie Cizek says that in their clinical work, students model the practices of the physicians they follow.

"We learn that for X patient, we treat with Y," Cizek says, "and it's easy to accept that as the truth of the field."

But it is important to understand why that treatment is the standard and whether it should apply to a particular patient.

Cizek says IQ+ sessions remind her to go through each case step-by-step, consider an individual's risk factors, as well as use statistics and research to make treatment decisions--and teach her how to explain those decisions to patients.

And, maybe most importantly, the Friday sessions give students a place to let down their guard and reflect on what they're doing.

"We're not with our attending physicians in a busy clinic," she says, "so we can debate a diagnosis and treatment plan with each other without feeling like we sound silly or too inexperienced."

That's just what Wolpaw is looking for--slowing down and revisiting the basics, recognizing that science is important and not just fodder needed to pass their board exams and move on.