title: Cognition before curriculum: rethinking the integration of basic science and clinical learning.
abstract: OBJECTIVE
  Integrating basic science and clinical concepts in the undergraduate medical curriculum is an important challenge for medical education. The health professions education literature includes a variety of educational strategies for integrating basic science and clinical concepts at multiple levels of the curriculum. To date, assessment of this literature has been limited.
  
  
  METHODS
  In this critical narrative review, the authors analyzed literature published in the last 30 years (1982-2012) using a previously published integration framework. They included studies that documented approaches to integration at the level of programs, courses, or teaching sessions and that aimed to improve learning outcomes. The authors evaluated these studies for evidence of successful integration and to identify factors that contribute to integration.
  
  
  RESULTS
  Several strategies at the program and course level are well described but poorly evaluated. Multiple factors contribute to successful learning, so identifying how interventions at these levels result in successful integration is difficult. Evidence from session-level interventions and experimental studies suggests that integration can be achieved if learning interventions attempt to link basic and clinical science in a causal relationship. These interventions attend to how learners connect different domains of knowledge and suggest that successful integration requires learners to build cognitive associations between basic and clinical science.
  
  
  CONCLUSIONS
  One way of understanding the integration of basic and clinical science is as a cognitive activity occurring within learners. This perspective suggests that learner-centered, content-focused, and session-level-oriented strategies can achieve cognitive integration.
authors: Mr. Kulasegaram is a PhD candidate, Clinical Epidemiology and Biostatistics Program and Program for Education Research and Development, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada. He is also a Wilson Centre Fellow, University of Toronto, Toronto, Ontario, Canada. Dr. Martimianakis is director of scholarship, assistant professor, Department of Paediatrics, and scientist, Wilson Centre, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada. Dr. Mylopoulos is assistant professor of paediatrics, University of Toronto, scientist, Learning Institute, Sick Kids Hospital, and scientist, Wilson Centre, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada. Dr. Whitehead is vice chair for education, associate professor, Department of Family and Community Medicine, scientist, Wilson Centre, and education scientist, Centre for Ambulatory Care Education, Women's College Hospital, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada. Dr. Woods is assistant professor, Department of Surgery, and education scientist, Wilson Centre, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.
authors: Kulamakan Mahan
authors: KM
authors: Kulasegaram
authors: Maria Athina
authors: MA
authors: Martimianakis
authors: Maria
authors: M
authors: Mylopoulos
authors: Cynthia R
authors: CR
authors: Whitehead
authors: Nicole N
authors: NN
authors: Woods
mesh_terms: D001690:Biological Science Disciplines / Q000193:education*; D003071:Cognition; D003479:Curriculum; D004504:Education, Medical, Undergraduate / Q000379:methods*; D006801:Humans