Kasuya, Richard T.

Melish, John S.

Nelson, M

eVols at University of Hawaii at Manoa

Medical School HotlineThe Integration of Clinical Skills and ClinicalAnatomy in Medical EducationRichard T. Kasuya MD, Marita Nelson Ph.D. andJohn Melish MD, University of HawaiiJohn A. Burns School of MedicineThe University of Hawaii John A. Burns School of Medicine hasanticipated and is meeting the needs of future physicians in aconstantly evolving, challenging environment. In 1992, the RobertWood Johnson Foundation Commission on Medical Educationrecommended that medical schools integrate basic and clinicalscience instruction and evaluation as one of five recommendationsfor medical education.’ JABSOM responded to this call for improved integration by designing a new course combining introductory clinical skills and clinical anatomy for the first-year curriculum. The primary goal was for students to develop an understandingof clinical anatomy in the context of the basic physical examinationsequence and diagnostic imaging. Other goals include learning thecomponents of the problem-oriented medical record, medical interviewing and effective physician-patient communication.The course is 14 weeks in length at the beginning of the first-year,with 6-8 hours of structured activity per week. This time is dividedbetween large group interactive demonstrations, dissections in theanatomy laboratory, and supervised practice of clinical skills. Sixafternoons are reserved for direct patient interactions under thesupervision of faculty and volunteer physicians throughout thecommunity. Students interview and examine select patients, discussand review pertinent clinical data, and receive feedback on theirinterview, physical examination and communication skills. Additionally, supplemental self-directed resources including videotapes,computer-based learning, self-study lab modules, and recommendedreadings are incorporated into the curriculum.The organization and sequencing of the course follow closely thesequence of the basic physical examination, as do the tutorial healthcare problems that are studied concurrently and serve as the foundation of the medical school’s problem-based learning (PBL) curriculum. For example, when students are focusing on the basicclinical skills, clinical anatomy and diagnostic imaging of the heartand vascular system, they are concurrently working through a healthcare problem on acute myocardial infarction in their tutorial sessions. The following week, the focus shifts to the clinical skills,clinical anatomy and imaging of the abdomen, and the relatedtutorial case covers acute viral hepatitis.As the first semester of the curriculum is designed as an introduction to the skills necessary for efficient and effective problemsolving, the health care problems, clinical skills and clinical anatomyare presented as an introduction to topics that will be re-visited indepth later in the curriculum.Students are required to pass an integrated laboratory examination, attend and satisfactorily complete all assigned course activities. They also complete entry and exit questionnaires that assesstheir appreciation of the value of, and interrelationships between,the various components of the course. The results of these questionnaires have indicated that students felt an improvement in theirunderstanding of clinical anatomy, clinical skills, elements of astrong physician-patient relationship, diagnostic imaging and human sexuality (p<O.O5). Their perception of the importance of eachcomponent was high both before and after the experience. Writtenfeedback from clinical preceptors indicated that students were ableto apply the materials from this course to their patient care experiences. Feedback from tutors in subsequent units indicates thatstudents are better prepared in anatomy and imaging aspects ofhealth care problems than previously.It is emphasized that this course represents a beginning of acontinuum of learning experiences that span the four years ofmedical student education at JABSOM. Clinical skills laboratoriesand preceptorship experiences continue weekly through the firsttwo years of the curriculum as a prelude to the more traditionalclinical clerkships of the third and fourth years. Supplemental toactual patient care experiences, standardized patients and videotaped exercises are utilized throughout the curriculum for bothlearning and evaluation. Similarly, this course represents the first ofmany opportunities for students to learn anatomy and imaging.Elective experiences in clinical anatomy are offered throughout thecurriculum, and continue to be emphasized in health care problemsand clinical clerkships. Moreover, diagnostic imaging, incorporated into health care problems throughout the first two years oftraining, is covered in the context of patient care in the third yearclerkships and offered as an elective for senior students.In summary, this course represents an effective integration ofintroductory clinical skills, clinical anatomy and imaging. Significant early patient care experience have been combined with a widevariety of other instructional strategies. Students feel that the courseis valuable and satisfying, and faculty also believe that the coursehelps students meet the desired behavioral objectives. This integrated course serves as a model for educational collaborationbetween basic science and clinical teachers in the context of aproblem-based learning curriculum and provides students with asolid foundation for future success as physicians.References1 Marston ROme Robert Wood Johnson Foundation Commission on Medical Education. The Sciencesot Medical Pracbce, Summary Report. JAMA 268(9): 1144-1145.2. Li, JTC Clinical Skills in the 21st Century. Arch Intern Med 154:22-24.HAWAII MEDICAL JOURNAL, VOL 56. APRIL 199789

The integration of clinical skills and clinical anatomy in medical education.

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The integration of clinical skills and clinical anatomy in medical education.

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