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Revisions focus on basic science

Basic science faculty members have so far expressed enthusiasm for the School of Medicine's upcoming curriculum revision, but they are also indicating wariness over the potential to sacrifice depth in basic science education for more clinical applications.

Scheduled for implementation in fall 2005, the revised curriculum will blend subject matter between the medical school's current first and second years - which teach basic and clinical science, respectively - and will attempt to teach basic science with consistent reference to the topics' relevance to medicine. Also, the 14 existing classes in the first year will be combined into three large, integrated classes.

The revisions aim to end student perception that basic science is too esoteric, while improving student knowledge of clinical practice, said Associate Dean of Curriculum Assessment Dr. Emil Petrusa.

When medical students learn the cell biology of the heart, for example, they could simultaneously learn how certain heart diseases operate and how drugs combat the disorders.

Inevitably, some depth in basic science education will be lost, Petrusa said. "The basic scientists see it as a loss. The clinical people will see it as a gain and an improvement to clinical care," he said.

Basic science faculty members favor the push to more interdisciplinary education, but defended the need for a rigorous basic science grounding.

"I believe that we have an obligation and a responsibility to teach medical students not only what they need to know to be doctors, but what research is about," said Jo Wright, the medical school's vice dean of basic sciences. "There's a way of thinking about research that's different from other health-related things, like practicing medicine."

Professor of Pharmacology and Cancer Biology Dr. Victor Nadler pointed to a special problem: Duke is unique among national medical schools for teaching basic science in one year instead of two, meaning time is already stretched to its limits.

"Right now, what we teach [in pharmacology] is about the minimum that we can get away with," Nadler said. He predicted that instead of losing subject matter, basic science would become more integrated and efficient.

Associate Professor of Neurobiology Richard Mooney agreed that instead of being reduced in depth, basic science education should be streamlined by combining related subjects. The intricate concept of signaling could be taught at once, he explained, instead of both in the context of cells and the brain.

"Considering the importance of a firm basic science grounding and the varied expertise of incoming students, I think that [losing depth] would be a misdirection," Mooney said. "My sense is that the students definitely need a rigorous introduction to cell biology and neurobiology.... I see the basic sciences as being very important to them."

Professor of Cell Biology Tom McIntosh and Associate Research Professor of Cell Biology Mimi Jakoi, the two professors whom Wright described as being most knowledgeable of the curriculum changes' impact on basic science, declined to comment.

Associate Dean of Curriculum Development Dr. Edward Buckley noted the general direction of curriculum change is set, but details are not. "[Blending of the first and second years] has definitely got to happen. The question now is how to do that, and in what proportions and what material is considered key," he said.

The goal is to keep the amount of time devoted to each subject approximately the same, Buckley said. Loss of depth in first-year basic science material could possibly be supplemented by returning to the subject in the second year, when it is relevant to a medical concept.

"There's no doubt you need a certain amount of infrastructure to understand clinical medicine," Buckley said. "We look at the M.D. degree as a scholarly degree, and not a technical degree, which means you really need to understand the science behind what you do."

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