Integration: a Strategy for Turning Knowledge into Action

Within the last decade, there has been increasing interest in transforming undergraduate medical education through integrating basic, clinical, and social sciences. The Hofstra North Shore-LIJ School of Medicine, which graduated its first class in 2015, brought together a group of medical educators to develop a fully integrated curriculum. Here, we describe the “First 100 Weeks” of our curriculum and address the means by which we integrate at the program, course, session, and assessment level. We view integration as a strategy to train physicians to contextualize basic science through application to clinical medicine; to determine if this goal is met requires a novel approach to assessment. In our curriculum, students progress through a series of single courses. Each week’s theme is anchored to our problem-based/cased-based learning program, Patient-Centered Explorations in Active Reasoning, Learning and Synthesis (PEARLS), which raises learning issues in biomedical, clinical, and social sciences. All large- and small-group sessions are thoughtfully constructed and positioned to enhance learning from PEARLS without pre-empting or duplicating it. All sessions belong to one of three course components: Mechanisms of Health, Disease, and Intervention; Structure, an integrated anatomy, histology, pathology, imaging and physical diagnosis laboratory; and Patient-Physician and Society, comprised of weekly clinical experiences and skills development, and examination of societal drivers of healthcare. Students complete formative and summative case-based assessments. We describe the details of our curricular and assessment strategies as well as important lessons learned along the way. These include the value of aligning philosophy, organizational structure, integrated content, and assessments.