Anatomy, histology and embryology classes all over again? Why should we reintroduce basic preclinical science along the medical school graduation?
Authors: Barros Mirna Duarte , Sampaio Carolina Garcia , Tuma Jorge Ferraz , Bennett Priscilla , Malfatti Vitor Davis Apostolakis , An Gabriela Soo Yeon 
Published: April 2020

INTRODUCTION

There is an ongoing discussion about whether medical curriculum should be discipline based or an integrated course. When it comes to medical education, integration can play an important role as it is widely known that basic science learning is present both in the context of clinical and professional practice. Vertical integration combines basic and clinical sciences, early clinical experience, clinician–scientist partnerships, and science incorporation in the later years of the course.

OBJECTIVE

Discuss the effectiveness of reviewing the morphology content through the preclinical disciplines throughout the 3rd and 4th years of Medical Course.

MATERIAL and METHODS

Santa Casa of São Paulo School of Medical Sciences comprises a curricular track in which the first two years contemplate the basic scientific principles, such as morphology, which is recovered and applied to the clinics in the integrated disciplines throughout the 3rd and 4th years.

Back in 2017 and in 2019, it was asked that the 4th year students undergoing the Cardiovascular and Urinary System integrated classes answered true or false affirmatives about the morphology class they were about to watch (pretest PR), and that they answered the same questions after watching the class (posttest PO), which should all be delivered anonymously to the professor at the end.

Based on the answers collected, it was calculated the mean of correct answers PR and PO, and the standard deviation of the results obtained. The analysis was made based on the combination of all students results, independently of the year taken, having a total of 263 pretests and 276 posttests.

RESULTS

Table
I shows the percentage of correct answers, average and standard deviations for the PR and the PO grades obtained for each class theme.

The PO averages were higher than PR in all classes analyzed (Figures
1A and 1B) with a decrease in the standard deviation value calculated for the PO average when compared to the PR.

DISCUSSION and CONCLUSION

Integration should promote retention of knowledge and acquisition of skills through repetitive and progressive development of concepts and their applications. Considering that these concepts had already been taught on the morphology classes through the 1st and 2nd years, the average of right answers, of approximately 60%, indicates a lack in retaining or understanding the foreseen subject.

The increase presented in the PO answers is an expected result but corroborates with the importance of repetition in content retention, as well as highlights the rapid and positive response of the group. In addition to the increase of assertiveness, the homogenization of the group’s knowledge is suggested by the decrease in the standard deviation values of the PO grades when compared to the PR grades.

Knowledge acquisition is an ongoing process and through that method the preclinical student has the opportunity to review basic themes, configuring it as a model that provides a great opportunity for students to understand a clinical problem through basic sciences, therefore allowing them to cognitively integrate all the knowledge domains.

The differences in PR and PO averages.

Figure 1

The total and the percentage of correct answers, average and standard deviations for the PR and the PO grades obtained for each class theme.

PR (N)

PO (N)

PR M

PO M

PR M %

PO M %

PO‐PR

PR st

PO st

Cardiovascular Anatomy (2019e/2017, 5 questions)

100

100

3,23

4,61

64,60%

92,10%

27,50%

1,03143926814

0,749427542222

Urogenital Histology (2019, 10 questions)

87

87

6,27

7,78

62,74%

77,79%

15,06%

1,38871027655

1,406969455172

Cardiovascular Embriology (2019, 5 questions)

15

20

2,86

3,90

57,23%

77,95%

20,72%

1,02573236390

0,658579899821

Urogenital Embriology 1 (2019, 5 questions)

9

9

2,77

3,66

55,55%

73,33%

17,78%

0,97182531580

0,866025403800

Urogenital Embriology 2 (2017, 5 questions)

27

34

3,03

4,11

61,48%

82,35%

20,87%

1,09127594600

0,728830773200

Cardiovascular Histology (4 questions)

5

17

2,60

2,88

65,00%

72,06%

7,06%

1,14017542510

1,111437860452

Cardiovascular Morphology (7 questions)

20

9

4,30

6,00

61,43%

85,71%

24,29%

1,17428589722

0,707106781187

total

263

276

3,58

4,70

62,70%

83,31%

19,04%

1,11763492753

0,889768245122