Evaluation of the Basic Science Pre-Clerkship Curriculum in Medicine at Western University

Basic sciences are a cornerstone of undergraduate medical education (UME), upon which the clinical sciences are built, however, research indicates that students’ basic science knowledge is not well retained. Additionally, UME curricula vary with respect to which basic science content is delivered, the depth in which it is taught, and the employed instructional methods, which could influence trainees’ knowledge retention. Thus, there is a need for an educational model that ensures students are competent in the fundamentals prior to entering a clinical setting. This investigation provides insights into current strengths and potential areas for improvement with respect to basic science pre-clerkship curricula. The aims of this research were to: i) determine clerkship directors’ perceptions of necessary basic science concepts, along with strengths and areas for improvement, with respect to students’ basic science knowledge; ii) assess medical students’ knowledge retention of the identified basic science concepts; iii) determine where, when, how, or if, the identified basic science concepts were taught during pre-clerkship; and iv) assess medical students’ knowledge reinforcement levels of the identified basic science concepts during clerkship. We established that students are expected to have some knowledge of every basic science prior to clerkship, and the identified concepts mapped to each systems-based pre-clerkship course. Additionally, directors’ perceptions of potential areas for improvement outweighed strengths. On average, students retained ≥60% of relevant basic science knowledge from pre-clerkship, and reinforced concepts during each clerkship rotation. Mapping the concepts to curricular content revealed that where, when, how, or if, the concept was delivered during pre-clerkship did not influence students’ basic science knowledge, nor did clerkship group or rotation order. Interestingly, even though lower-performing students demonstrated the greatest post-test improvement, they still left each rotation with knowledge deficits compared to their highest-performing peers. Thus, while they did not catch up to their highest-performing peers, the clinical experience of clerkship appears to be most beneficial for lower-performing students. This may suggest that earlier integration of clinical learning with the basic sciences could foster students’ basic science knowledge, thereby ensuring that all trainees are well-equipped with the necessary knowledge prior to clerkship