title: Facilitating the transition from physiology to hospital wards through an interdisciplinary case study of septic shock.
abstract: BACKGROUND
  In order to develop clinical reasoning, medical students must be able to integrate knowledge across traditional subject boundaries and multiple disciplines. At least two dimensions of integration have been identified: horizontal integration, bringing together different disciplines in considering a topic; and vertical integration, bridging basic science and clinical practice. Much attention has been focused on curriculum overhauls, but our approach is to facilitate horizontal and vertical integration on a smaller scale through an interdisciplinary case study discussion and then to assess its utility.
  
  
  METHODS
  An interdisciplinary case study discussion about a critically ill patient was implemented at the end of an organ system-based, basic sciences module at New York University School of Medicine. Three clinical specialists-a cardiologist, a pulmonologist, and a nephrologist-jointly led a discussion about a complex patient in the intensive care unit with multiple medical problems secondary to septic shock. The discussion emphasized the physiologic underpinnings behind the patient's presentation and the physiologic considerations across the various systems in determining proper treatment. The discussion also highlighted the interdependence between the cardiovascular, respiratory, and renal systems, which were initially presented in separate units. After the session students were given a brief, anonymous three-question free-response questionnaire in which they were asked to evaluate and freely comment on the exercise.
  
  
  RESULTS
  Students not only took away physiological principles but also gained an appreciation for various thematic lessons for bringing basic science to the bedside, especially horizontal and vertical integration. The response of the participants was overwhelmingly positive with many indicating that the exercise integrated the material across organ systems, and strengthened their appreciation of the role of physiology in understanding disease presentations and guiding appropriate therapy.
  
  
  CONCLUSIONS
  Horizontal and vertical integration can be presented effectively through a single-session case study, with complex patient cases involving multiple organ systems providing students opportunities to integrate their knowledge across organ systems while emphasizing the importance of physiology in clinical reasoning. Furthermore, having several clinicians from different specialties discuss the case together can reinforce the matter of integration across multiple organ systems and disciplines in students' minds.
authors.forename: Albert S
authors.initials: AS
authors.lastname: Li
authors.forename: Kenneth I
authors.initials: KI
authors.lastname: Berger
authors.forename: David R
authors.initials: DR
authors.lastname: Schwartz
authors.forename: William R
authors.initials: WR
authors.lastname: Slater
authors.affiliation: Nephrology Section, VA New York Harbor Health Care System, New York, NY, USA. david.goldfarb@va.gov.
authors.forename: David S
authors.initials: DS
authors.lastname: Goldfarb
mesh_terms: D003479:Curriculum; D004501:Education, Medical / Q000379:methods*; D006801:Humans; D058025:Interdisciplinary Studies; D018794:Problem-Based Learning; D012772:Shock, Septic / Q000175:diagnosis / Q000503:physiopathology* / Q000628:therapy
references.citation: Med Educ. 2003 Nov;37(11):966-74
references.pmid: 14629409
references.citation: Physiol Rev. 1955 Jan;35(1):123-9
references.pmid: 14356924
references.citation: Clin Anat. 2002 May;15(3):233-5
references.pmid: 11948961
references.citation: Acad Med. 2008 Jul;83(7):662-9
references.pmid: 18580085
references.citation: Med Teach. 2002 May;24(3):286-8
references.pmid: 12098415
references.citation: Med Teach. 2002 May;24(3):280-5
references.pmid: 12098414
references.citation: Med Teach. 2007 Feb;29(1):e32-6
references.pmid: 17538830
references.citation: Med Teach. 2009 Sep;31(9):834-41
references.pmid: 19811189
references.citation: BMC Med Educ. 2012 Jul 02;12:50
references.pmid: 22747781
references.citation: Acad Med. 2011 Sep;86(9):1130-6
references.pmid: 21785316