Ready to Reason: Integration of Clinical Education and Basic Science Improves Medical Students’ Self-Assessed Clinical Reasoning Before Clerkships

Introduction: Calls for reform of medical education encourage early integration of clinical medicine into the pre-clerkship curriculum, traditionally the domain of basic science. It is not known whether this early integration helps students develop clinical reasoning. Methods: As part of a comprehensive curriculum reform, our medical school instituted strategies to integrate basic science and clinical skills within a shortened pre-clerkship curriculum. We introduced “clinical correlations,” interactive lectures teaching a clinical skill by introducing a patient with a disease process students are studying in science. We connected the standardized patient environment and authentic clinical environment by ensuring longitudinal mentoring relationships in both settings. We adopted an integrated assessment structure for the pre-clerkship phase. To assess the effects of these innovations, we examined students’ perceptions of their clinical reasoning skills and assessed evaluations of clinical reasoning tasks in early clerkships. Results: Compared to the traditional curriculum, students in the integrated curriculum felt significantly better-prepared for six of seven clinical reasoning tasks, and they felt more clinically prepared overall. Students in both curricula received high ratings from clerkship directors for skills related to clinical reasoning, with no significant difference seen between the two groups on any clerkship. Conclusion: Our findings suggest that integrated basic science-clinical medicine curricula can improve student confidence in clinical reasoning. While the lack of improvement in clerkship director ratings could relate to poor sensitivity of these measures to detect changes in skills, further modification of the curriculum may be needed to impact student performance.