Translational medicine in the first year: integrative cores.

Objective The intensity of the first year leaves many students pondering the wisdom of their career choice. In creating its new curriculum, Mount Sinai School of Medicine faced this issue of burnout by devoting the last three weeks of the first year to a course that links basic science concepts introduced at the bench to the clinical care of patients. The goal of "Bench to Bedside Selectives" is to reenergize students' career choice by allowing them to experience a multidisciplinary approach to translational medicine. Students participate in an in-depth study of a selected disease entity under the direction of a faculty core leader. Description In 2001, students selected either a research core (n = 57), which allowed them to expand their summer research time, or a disease-focused core (n = 48). Six diseasefocused cores were offered, each consisting of didactic sessions, exposure to basic research, diagnostic laboratory techniques, ethics, health policy, pharmacology, and clinical experiences. The cores were as follows: (1) Atherosclerotic Heart Disease: Integration of Basic Science and Clinical Medicine; (2) Translational Medicine in HIV: A Road to a Cure; (3) Gene Therapy: A Journey from Scientific Principles to Clinical Applications; (4) Solid Organ Transplantation: Defying Mother Nature; (5) The ABC's of Liver Disease; (6) The New Frontiers in Aging. Core leaders were responsible for developing and implementing their programs and recruiting faculty from many departments. All students completed an independent project tailored to their core. For example, the HIV core included modules on AIDS in Africa and needle-exchange programs, and the students' final project was a debate on whether "there will or will not be an effective HIV vaccine in the next 5 years." Students ranked their top three choices among the cores. Most (96%) were enrolled in their first or second choices, forming groups of six to eight. On the last day of core, students attended a focus group and filled out questionnaires about the strengths and weaknesses of their experience. Discussion There was overwhelming support for the core experience at the focus session. Most students commented that the program successfully overcame their end-of-first-year blues. All students felt that cores should be continued and recommended additional core selections. Weaknesses cited were inequality in the time and amount of work required for individual cores and an imbalance between excessive didactic material and insufficient clinical exposure in one core. Seventy-one percent of participants also completed the feedback questionnaires; 97% of them strongly agreed that the core successfully integrated material from previous courses; 88% strongly agreed that the clinical presentations demonstrated the relevance of content to medical practice; and 69% strongly agreed that the proportionate mix of lab, clinical, and small-group sessions was appropriate. Faculty were also enthusiastic about their experience. This program will be continued and expanded in 2002. We recommend this teaching format as an antidote to first-year burnout and a novel way to promote the development of physicians with an appreciation of the scientific basis of disease and the role ethics and health policy play in medicine.