[The following notes were generated by Sandra Haudek, PhD.]

The Winter 2022 IAMSE Webinar Seminar Series, titled “How Science Educators Still Matter. Leveraging The Basic Sciences for Student Success” ended with its fifth seminar on Thursday February 3, 2022, titled “Rethinking Assessment Strategies in the Basic Sciences as Step 1 Goes Pass/Fail”. This seminar was presented by Dr. David Harris, Associate Professor of Physiology at the University of Central Florida (UCF), College of Medicine. Dr. Harris discussed alternative strategies to assess basic science content, specifically the new assessment strategies recently implemented at his institution.

Dr. Harris started with describing UCF’s current medical school curriculum (120 students per class). The first year focuses on the normal basic sciences; the second year builds on the pathology, pathophysiology, pharmacology, and management of different organ systems. Over the first 7 months, two courses cover most of the traditional basic sciences. He stated that the herein described changes targeted the assessment strategies during this first 7-month period. He cautioned that these changes were still work in progress as they continuously adapt to feedback. He also mentioned upfront that a particular challenge they faced was UCF’s use of letter grades.

Dr. Harris cited external recourses frequently used by students during their early study of basic sciences, such as Anki, Aquifer, and Boards & Beyond. While many of these resources are well constructed with practice questions, feedback, and links to reliable sources, he stated that students struggle with how to effectively include these resources into their studies. Nevertheless and probably further driven by the COVID-19 pandemic, students accelerated their use of such outside resources. Thus, the role of faculty also changed from traditional textbook teaching to include other teaching modalities. Citing work by Simpson (Simpson, JGME 2018), Dr. Harris listed expected roles of a medical educator in 2025. Dr. Harris proposed that, due to the COVID-19-induced drastic changes in pedagogy, these role changes will happen more quickly than originally expected.

Dr. Harris then specifically discussed the role of the medical educator as “assessor” using his own experience at UCF. He reviewed that most assessments to test basic science content were multiple-choice questions (MCQ). However, he argued that, while MCQ work well to assess content knowledge, they do not assess how learners apply what they memorized. He emphasized on other skills and attributes needed for being a ”good doctor”. Such attributes include critical thinking, good communication skills, and life-long learning. In addition, he mentioned that students with disabilities and specific learning difficulties should not be disadvantaged by the assessment method (disability inclusion). Dr. Harris specifically outlined how faculty will have to adapt to roles of being an “assessor” and “coach” to provide feedback for skills that cannot be fostered by outside resources or tested in MCQs.

Dr. Harris continued with stating UCF’s goals that guided their changes in assessment strategies: (1) USMLE STEP 1 going pass/fail, (2) emphasis on communication, critical thinking, and self-regulation, (3) limit use of MCQ, and (4) provide opportunities for cognitive integration early in the curriculum. With these goals in mind, UCF focused their efforts on four areas: (1) concept mapping, (2) high fidelity patient simulations, (3) team-based learning sessions, and (4) case-based learning. At this point, the fourth focus has not been implemented since this requires uniforming the use of case presentations (for delivering new content, highlighting applications, or reviewing old content) and thus will not be discussed in this seminar.

Dr. Harris explained how UCF integrated concept mapping exercises at various points (once a month) during the first 7 months of their preclinical curriculum. Some were used for formative assessments; others were designed as summative assessments. For each exercise, students received the following: The overall objective of the activity (“terminal” objective), several specific objectives (“enabling” objectives) each of which had to be addressed, a set of instructions including rules for which resources can be used, a clinical vignette, a list of facts they memorized from text books (e.g., Ohm’s Law), a starter map, tools to build and change the map, and the rubric by which they will be assessed (number grading). Students worked in groups of 6, applying their knowledge of foundational content and using available technology; faculty acted as facilitators. The final concept maps (created with “Cmap” software) were due within 2 hours. Dr. Harris noted that several of these steps were adjusted over time. Grading/assessment was performed by content and non-content experts. Several challenges arose: Non-content experts needed too long to finish grading, contributed to high variability in grading, and were unable to provide in-depth content feedback (solved by only involving content experts, using a speed-grading feature). The inability to comment directly in the Cmap file (solved by converting file to pdf files). Other challenges pertained to the grading mechanisms, faculty time, and reducing student stress.

Dr. Harris then discussed the “high fidelity patient simulations” in his basic science course. The goal was to highlight important physiology concepts underlying various diseases. He explained that students started in the classroom with an introduction (10 min), then entered the simulation center (20 min), then came back to the classroom for debriefing (30 min). To increase student engagement, students needed to answer (individually or in teams) specific essay questions on which they receive feedback from faculty. Students were then asked to self-reflect on their simulation experience on which faculty again provided narrative feedback (to foster self-regulation skills). Dr. Harris stated that the advantages (e.g., engaging, clinical application) and disadvantages (e.g., resource and time extensive) of this process were still under debate.

Lastly, Dr. Harris addressed team-based learning. After briefly explaining the general process of team-based learning, Dr. Harris pointed out the changes UCF made: all parts were made summative, MCQ questions were replaced with other question types, the grading scale was modified, and peer evaluation was added.

Dr. Harris concluded with his take home message: (1) Modify what you have or is available to you. (2) Recognize the “cultural” shift for students and faculty roles. (3) Focus on what you want the students to be able to do, what you value, and measure those.

The presentation lasted about 40 minutes and a rich discussion followed. Among other topics, questions from the audience addressed: How to prepare students on how to do concept mapping and using the software? What was their response to the mapping exercise? How (and why) can students be limited in their use of resources? How big is inter-rater variability? Recruitment and training of faculty? More information on the grading scale? Do student groups rotate?

[The following notes were generated by Sandra Haudek, PhD.]

The Winter 2022 IAMSE Webinar Seminar Series, titled “How Science Educators Still Matter. Leveraging The Basic Sciences for Student Success” continued with its fourth seminar on Thursday January 27, 2022, titled “Identity Shape Shifting: How basic science teaching practices can foster identity transformation from medical student to medical professional”. This seminar was presented by Dr. Michelle Lazarus and Dr. Shemona Rozario, both from Monash University in Melbourne, Australia. Dr. Lazarus is the Director of the Centre of Human Anatomy Education and leader of the Centre for Scholarship in Health Education Curriculum Integration Network. Dr. Shemona Rozario is a physician and PhD student in Dr. Lazarus’ research group. They presented an overview of what professional identity (PI) is, mechanisms of professional identity development (PID), ways foundational medical sciences can impact PID, and applied teaching practices basic science educators can implement to help support medical student PID.

Dr. Lazarus and Dr. Rozario introduced themselves by telling us their journey of PI formation from basic scientist / physician to medical researcher. Dr. Lazarus started the presentation with discussing the historical apprentice model, in which trainees watched and learned in a didactic fashion. In the present, medical curricula integrate simulation opportunities. Future curricula will be full with technology including artificial intelligence (AI) and PID must shift alongside this development.

Dr. Rozario quoted Rees & Monrouxe “How we perceive ourselves as professionals is based on our attributes, beliefs, values, motives, and experiences in relation to our profession, providing us with ethical frameworks and values”. She provided an example from the Australian Medical Association: https://www.ama-assn.org/residents-students/specialty-profiles/what-it-s-specialize-emergency-medicine-shadowing-dr-clem, concluding that PI comes from “What we do influences how we view ourselves”. She explained that our identity development includes the formation of personal and professional identities that both develop through social interactions over our life span. Pre-determined factors (genetics) are unchangeable. During childhood, we are most malleable to social construction of identity formation and the results are most resistant to changes. The dynamic social construction of identity occurs in adult life when we interact more formally with our environment, individuals, and community (religion, culture, socioeconomics, status, personal relationships).

Dr. Rozario quoted work by Monrouxe & Poole who compared the structure of identify with the structure of an onion (core = internal identity, inner layer = internal identity, outer layer = constructed identity). As we grow and interact more widely with others, we add more layers (complexity) to our identity. Identity dissonance occurs when professional and personal identities clash while growing. Pratt and colleagues described identity dissonance in a study investigating identity construction of medical residents in different specialties over a 6-year period. They found that radiology residents spent more time on attending lectures and thus developed a parallel identity as medical educators since their work did no match their expectations of the roles and responsibilities of a physician (identity splinting). Similarity, surgery residents spent more time on paperwork and thus developed a parallel identity as general physicians (identity patching). By contrast, primary care residents experienced only minor violations and thus were reinforced of their current identity (identity enriching).

Dr. Lazarus continued with discussing how basic science educators can help students develop their PI by providing the right environment and right people. She reviewed work from Dr. Nicole Woods, a cognitive psychologist specializing on identity formation https://staff.ki.se/kiprime-podcast-episode-6-nicole-n-woods. She explained that expert physicians have encapsulated knowledge that leads to quick clinical reasoning, yet trainees work with isolated basic blocks. One goal of basic science educators is to help students encapsulate these blocks and thus nurture their PID. Teaching psychosocial skills without the sciences will lead to “empty capsules” and ineffectual integration of skills and knowledge.

Dr. Lazarus used the field of anatomy as an example to explain the impact of technology on anatomy curricula. Her group performed a metanalysis showing that anatomy content was taught at every medical school using different modalities, yet all students learned it equally well. She suggested to integrate AI into the anatomy curricula to deliver content more effectively and use the gained time to enhance critical thinking and thus increase PID. Her work demonstrated that AI technology increased student engagement and learner monitoring, but also developed a view that healthcare has singular logic, that individuals fit into categories, and that psychological skills have limitations. In another study, her group identified six themes that were linked to PID: Process, peer relationships, tutor relationships, ethics, tolerance of uncertainty, and exposure. Of those, the tolerance of uncertainly (= managing novelty effectively) was the only theme that negatively impacting PID in students. Using a clinical case, she illustrated the process of uncertainly tolerance: the physician’s response to a patient’s symptom (the uncertain stimulus) is moderated by cognitive (doubt/confidence), emotional (fear/curiosity), and behavioral (avoidance/decisions) influences. Her group stated that basic science education is a powerful moderator of uncertain times that can increase PID; it can increase job satisfaction, independence, creative solutions, and curiosity, and it can decrease burnout, requirement of supervision, difficulty in solving problems (insecurity), and disengagement.

Dr. Lazarus then listed how educators can stimulate students’ uncertainty in the classroom: (1) Transferring knowledge to a real-world example. (2) Gray cases in which parameters are changed. (3) Providing multifaceted perspectives from different specialists. (4) Questioning preconceptions, e.g., show same experiment with different outcomes. She suggested to bring different moderators into the classroom once students have been stimulated, including educator- and student-sourced moderators (e.g., self-reflection, discuss career value, give assessments with more than 1 correct answers, clinical cases without a diagnosis). She explained that it was important to know which moderator(s) to use at what time and what level.  She also listed three cultural literacy pedagogical components: critical incidents (case studies), destabilization (role-play, simulation), iso-immersion (work integrated learning, placements).

Dr. Lazarus concluded that appropriately build-in of PID in the basic science curriculum has advantages: (1) It prepares students better for the realities of their future careers. (2) By creating a classroom fostering uncertainty tolerance, it helps students manage future transitions to work. (3) Uncertainty tolerance will increase students’ ability to detect novelty and promote PID.

The presentation lasted about 40 minutes and a rich discussion followed. Among other topics, questions from the audience addressed: What is the level of PID? How can uncertainty tolerance be coordinated with the necessity of correct answers in USMLE step exams? How do we train faculty to teach uncertainty without undermining their expertise? How does this impact the ratio students to instructors?

1. Rees, C.E. and Monrouxe, L.V., “Who are you and who do you want to be? Key considerations in developing professional identities in medicine.” Medical Journal of Australia, 2018. 209(5): p. 202-203.
2. Monrouxe, L.V and Poole, G., “An onion? Conceptualizing and researching identity.” Medical Education 47.4 (2013): 425-429.
3. Pratt, M.G., Rockmann K.W. and Kaufmann J.B., “Constructing Professional Identity: The Role of Work and Identity Learning Cycles in the Customization of Identity among Medical Residents.” Academy of Management Journal 49 (2006): 235-262.

[The following notes were generated by Sandra Haudek, PhD.]

The Winter 2022 IAMSE Webinar Seminar Series, titled “How Science Educators Still Matter. Leveraging The Basic Sciences for Student Success” continued with its third seminar on Thursday January 20, 2022, titled “Integrating Basic Science in the Clerkships: Innovative Strategies and Persistent Challenges”. This seminar was presented by Dr. Michelle Daniel, Vice Dean for Medical Education at the University of California San Diego, School of Medicine and former Assistant Dean for Curriculum at the University of Michigan. She discussed the challenges of integrating basic and clinical sciences into core clerkship curricula to promote transfer of knowledge into practice, a main goal of many curricular reforms in medical education. She highlighted innovative instructional and assessment strategies designed to encourage the integration of the basic sciences during clerkships. She also discussed emerging data concerning learner perceptions of basic science integration, noting opportunities and barriers. Her presentation was based on two of her published studies (Academic Medicine, 96(8), 1125-1130; Kercheval et al., Teaching and Learning in Medicine, in press).

Dr. Daniel started with discussing the rationale for basic science integration in clerkships: Since the time of A. Flexner, the basic and clinical sciences have been taught in discreet consecutive blocks, which has led to the compartmentalization of knowledge. The resulting failure to transfer basic science principles into clinical practice negatively impacts diagnostic and management reasoning, as well as clinical outcomes. Over the last years, several institutions embarked on integrating the foundational and clinical sciences across all years of the medical school curriculum using different curricular models. Basic science education in the pre-clerkship years now commonly occurs in the context of clinical cases through a variety of pedagogies. However, incorporation of basic sciences instruction during the clinical years has proven very challenging to systematize. She quoted a 25-year old statement from H. Schmith underlining that this problem is very persistent until today.

Dr. Daniel explained that in medical education, “integration” usually refers to curricular integration that involves the organization of teaching materials in a manner that interrelates subjects frequently taught in separate academic courses or departments. She described three types of curricular integration: (1) Horizontal integration occurs between parallel disciplines, such as anatomy, physiology, and biochemistry that are typically taught in the same phase of the curriculum. (2) Vertical integration occurs between disciplines typically taught in different phases of the curriculum, such as the basic and clinical sciences. (3) Spiral integration refers to a combination of both horizontal and vertical integration that unites across both disciplines and time.

Dr. Daniel then emphasized that a key goal of curricular integration is cognitive integration. Cognitive integration occurs when individual learners appreciate the relationships between foundational science constructs and clinical care, when they understand the cause of mechanisms in context, and when they appreciate the relevance of basic science principles to clinical decision making. This occurs to a process known as conceptual coherence. It is important to understand that curricular integration alone may not achieve cognitive integration. She further cited work by R. Harden who described 11 types of curricular integration on a continuum between two extremes ranging from isolation to complete transdisciplinary teaching and learning. As one moves up the ladder, there is less emphasis on the role of disciplines and an increased requirement for centralized curricular control and collaboration. She mentioned that the strategies discussed in her presentation span multiple rounds on Harden’s ladder and were often developed centrally by curricular committees with input from clinicians and basic scientists.

Dr. Daniel continued with outlining instructional strategies to promote the integration of foundational sciences during clinical clerkships. She stated that such strategies include program level interventions, clerkship level interventions, bedside level interventions, and assessments. Referring to her study, she listed different strategies employed by 11 different medical schools illustrating that a multimodal approach to integration of clerkships is key. The table showed that a few strategies were used by almost all schools, such as emphasizing the basic science content in clerkship didactics, access to question banks purchased by institution, and administration of USMLE Step 1 exam post-clerkships.

First, Dr. Daniel discussed program level interventions, which are central curricular structural changes to increase emphasis on basic science education in the clerkships. These interventions typically require students to leave their clinical teams and return to the main medical school campus. There were 3 common types of program level interventions amongst the 11 medical schools in her study: (1) Multi-week transition to clerkship courses that focused on integrating basic and clinical science applied to patient care, (2) Longitudinal ½ or full day sessions, offered weekly or bi-weekly, dedicated to basic science content, and (3) Week-long science intensives interspersed between clerkships. As an example, Dr. Daniel introduced the Harvard Medical School 5-week pre-clerkship bootcamp that provides a second pass through foundational content while providing clinical context for standardized patient encounters in anticipation of patient care, thus allowing students to consolidate their knowledge and skills from the pre-clerkship curriculum. Clinical case-based instruction provides direct clinical application of basic science principles while demonstrating relevance. The University of Michigan, Vanderbilt University, and New York University offer similar transition courses of varying duration. As a second example, Dr. Daniel showed an overview of the University of California San Francisco’s Foundational Sciences course in which, every other week, all clinical students leave their clerkships and engage in a full day of basic science instruction. The morning session is attended by all clinical students, the afternoon sessions are clerkship specific. The sessions focus on high yield foundational science topics relevant to all clerkships such as shock, infection, pain, cancer, hemostasis & thrombosis, and aging. The University of Michigan, the University of Pennsylvania, Baylor College of Medicine, and Florida International University have similar longitudinal basic sciences curricula during their clerkships, yet their foci are slightly different ranging from emphasis on USMLE content, to application of the scientific methods, to evidence based medicine.

Second, Dr. Daniel discussed clerkship level interventions, which are departmentally based activities that highlight basic science as an integral part of clerkship education activities. The most common type is emphasizing basic science content in clerkship didactics. As an example, the University of Wisconsin uses case-based learning with online modules in which students are expected to review an online model prior to each case-based learning session and that focused on the basic science content underpinning the case. An interdisciplinary team of faculty developed over 300 new interactive electronic resources to support these sessions. Another school uses multidisciplinary clerkships dedicated to applied science. As a third example, Dr. Daniel described the 12-week surgery and applied science clerkship at the University of Michigan that is comprised of 4 weeks of general surgery, 4 weeks of a surgical subspecialty, and 4 weeks of pathology, radiology, advanced anatomy, and anesthesiology. Case-based teaching sessions are integrated across the 12 weeks with all the disciplines involved in their planning and implementation. The 4 weeks of applied science allows students to explore basic science linkages at a more relaxed pace while allowing added time to prepare for the surgical shelf exam. Dr. Daniel then showed a table that provided more details: In the anatomy portion, students return to the lab to engage in dissection. During the anesthesia portion, students spend time learning about cardio pulmonary physiology and pharmacology, including mechanisms of action of anesthetics and analgesic medications used for pain management. They also spend time in the operating room for asking questions and participating in patient care. In the pathology portion, students review normal histology, participate in clinical pathology sign outs and slide reviews, as well as observe an autopsy. In the radiology portion, students interpret clinical images in the reading room, including cardiothoracic, abdominal, neuro, and musculoskeletal plane fills, CT scans, and MRIs. They also observe interventional procedures.

Third, Dr. Daniel discussed bedside level interventions, which are point of care activities that directly connect caring for patients with basic science principles. She pointed out that faculty development and preparation was key, as practicing clinicians are often nervous about teaching basic science concepts because they feel they lack expertise or the are distant from the content. As an example, Dr. Daniel discusses the process at the University of Michigan: They encouraged clinicians to develop basic science teaching scripts. These are 5 to 10 minute, pre-prepared basic science chalk talks. The clinicians draw on then when appropriate. Today, APGO (www.apgp.org/basicscience) has a repository of OBGYN mini modules for pre and post USMLE step 1 questions that can either be used by educators as teaching scripts or by students for self-directed learning. As a second example, Dr. Daniel mentioned the Uniformed Services University of the Health Sciences, which introduced a form of self-directed learning component that encourages students to develop and research a clinically relevant question related to the basic sciences.

Dr. Daniel then continued with outlining assessment strategies to promote the integration of foundational sciences during clinical clerkships. Assessment strategies include low stakes formative and high stakes summative assessments. As an example, the New York University developed a clinical science inquiry mobile platform for integrating clinically relevant basic science concepts into the core clerkships. As a second example, the Uniformed Services University of Health Sciences developed an approach that leverages the principles of space based education, in which students receive basic science questions related to identified weaknesses that are repeated at random intervals until they are correctly answered twice. In general, most schools offer access to third party question banks for USMLE step 1 preparation. Summative assessments in the form of customized NBME basic science exams or comprehensive basic science exams were used by the University of Wisconsin, New York University, the University of Michigan, and the University of California San Francisco. All schools in this study placed USMLE step 1 after the clerkships to use the motivation of that major national assessment to help drive integration. As another example, Dr. Daniel detailed the clinical science inquiry platform used by the New York University. This platform was constructed based on principles of just-in-time learning and situated learning theories. Questions were curated by a team of clinicians and basic sciences scientists for each clerkship. The application sends students 2-3 questions per week based on their clerkship schedule. Each question begins with a clinical vignette and includes high quality graphical elements. Questions take about 10 minutes to answer, so they fit into the busy schedule of a clerkship student. Question completion is tracked centrally but responses do not contribute to a student’s formal grade.

Dr. Daniel then eluded to spaced repetition of assessment as an educational principle leveraged by homegrown question banks as well as numerous third-party vendors, which comprise a lot of the informal clerkship assessment system. These platforms are embraced for their value for learning basic science content related to USMLE step 1 performance and ease of use during busy clerkship rotations by students.

Dr. Daniel further explained that the post-clerkship administration of USMLE step 1 is an assessment strategy used by all 11 schools to attempt to facilitate cognitive integration. Delaying USMLE step 1 until after clerkships encourages students to review basic science concepts overtime directly connected to patient care. It also fosters cognitive integration during the USMLE step 1 study period after students have had more extensive exposure to patient care and have a cadre of illness scripts in their repertoire. Dr. Daniel explained that her group collaborated with the NBME to perform multiple studies evaluating the impact of post-clerkship USMLE step 1 administration: In their first study, they found that the mean USMLE step 1 scores increased and fewer students failed after moving the exam to post-clerkship. In their second study, they found that after rising national USMLE step 2 scores were accounted for, there were no significant differences in USMLE step 2 scores or failure rates. In their third study, they found that shelf scores decreased, particularly in medicine and neurology, while OBGYN and psychiatry shelf scores largely remained unchanged. They concluded that performance on clerkships taken earliest in the sequence were most affected and differences gradually disappeared with subsequent examination as students gain clinical experience. In summary, the outcomes of moving USMLE step 1 after the core clerkships demonstrate noninferiority when it came to USMLE step 1, step2, and CSE scores.

Dr. Daniel then debated the question if the post-clerkship USMLE step 1, or if curricular integration strategies during clerkships, or if both promote cognitive integration? To explore this question, her team engaged in another study in which they collected student perspectives on basic science integration, including barriers and facilitators. This study was performed at the University of Michigan and the University of California San Francisco with 33 students participating in 6 focus groups and a thematic analysis of their responses. They found that pulling students off their clerkships for full or half-day basic science instruction was not an effective integration strategy (longitudinal returns to basic science). Many students reported tuning out during these sessions and focusing on studying clinical materials instead. They also found that clerkship didactics and bedside teaching in which basic science was explicitly linked to patient care promoted cognitive integration and made content stick. Even a year after completing clerkships, students were able to recall multiple specific examples. Further, they found that clerkships with applied science components, as well as subspecialty rotations on medicine and surgery clerkships were quite effective at driving cognitive integration. Lastly, they found that the placement of USMLE step 1 after the core clerkships had mixed impacts on cognitive integration during clerkships. When students began their clerkships, they did not have the benefit of knowledge consolidation that often occurred during the USMLE step 1 study period. The students felt like their science foundation was on shaky ground, making learning more challenging. Later on however, students were poised to take advantage of the dedicated USMLE step 1 study period, having clinical experience to facilitate cognitive integration. In summary, their study showed that barriers included their tenuous basic science foundation as a result of both shorted pre-clerkship curricula well as the lack of the pre-clerkship USMLE step 1 to consolidate knowledge. Cognitive overload and demands on time during clerkships led students to prioritize clinical over basic science learning. Basic Science was often perceived as irrelevant to patient care due to lack of explicit connections by educators. Educators also focused on teaching clinical science to the exclusion of basic science, and longitudinal basic science curricula were often perceived as well intended but somewhat disconnected from clinical care. Facilitators of integration included basic science instruction explicitly linked to patient care, either at the bedside or via clerkship didactics. Some specialties or disciplines that demonstrated direct application of basic science to clinical care were valued. A post-clerkship USMLE step 1 exam with a dedicated study used as an opportunity to revisit basic science once a clinical foundation has been established was a facilitator of cognitive integration.

Dr. Daniel summarized: Integration can overcome compartmentalization of knowledge and facilitate transfer into clinical practice. A key goal of curricular integration is cognitive integration, yet one does not necessarily produce the other. Strategies to integrate basic science in the clerkship include program-, clerkship-, and bedside- level interventions as well as assessments. Longitudinal returns to basic science that pull learners off clerkships are largely ineffective. Students emphasize the value of explicit basic science teaching directly linked to patient care; and this is where we need a lot more investment. Students note the dedicated post-clerkship USMLE step 1 study period is an ideal opportunity for cognitive integration once a strong clinical foundation is established.

The presentation lasted about 35 minutes and a rich discussion followed. 4th-year student Nicole Mott, a leading collaborator of her study team, joined Dr. Daniel.  Among other topics, questions from the audience addressed: placement of transition courses to clerkships, how to better train faculty to integrate basic science better during clinical activities, how can basic science faculty be more effective, is there feedback from clerkship faculty on student performance, optimal timing of USLME step 2, how are basic science concepts bets integrated into post clerkship training, and transfer of basic science knowledge from one case to other cases.