This is Lab Medicine Rounds, a curated podcast for physicians, laboratory professionals, and students. I'm your host, Justin Kreuter, a transfusion medicine pathologist and assistant professor of laboratory medicine and pathology at Mayo Clinic. Today, we're rounding with doctor Joseph Maleszewski, professor of laboratory medicine and pathology, as well as senior associate dean for academic affairs at the Mayo Clinic Alix School of Medicine to talk about the future of basic science in the medical school curriculum. Thanks for joining us today, doctor Maleszewski.
Dr. Maleszewski:All the pleasure is all mine, Justin. Always great to be here with you.
Dr. Kreuter:I got to see you talk about this topic in a in a different forum, and I thought this would be a really great one to bring to our audience, our our mix of pathologists, laboratory professionals, clinicians, and also students. So maybe let's kick off with, you know, why is it important to talk about the future of basic science in medical school now?
Dr. Maleszewski:Well, Justin, it's always a great time to talk about the basic sciences. Right? In full disclosure, this phase of the curriculum is particularly near and dear to my heart. It's the place where I first encountered my calling, pathology, probably kinda where you did too. And I think it's really a place that bridges the divide between the classroom and the clinic.
Dr. Maleszewski:It's a transition, and transitions are naturally exciting, and it's where a lot of growth tends to happen for our students. Anyway, back to your question. I think it's particularly timely to talk about the basic sciences now having just passed the three year anniversary of when step one switched from being a reported score to being in a pass fail model. All schools across the country now are starting to adjust to this new paradigm, kind of settling into their new groove, if you will. Because of this, I think there are very real questions that are now arising as to what the role of the basic sciences are in medical education.
Dr. Maleszewski:Most schools have shortened the basic sciences from two years down to eighteen months. That's now kind of the standard. Some have even gone even more aggressively and trimmed it down to sixteen months or even twelve months. There's even some discussion about getting rid of them altogether, especially as more schools are looking at and shifting to a three year model. I think further reduction, especially elimination, would be tragic.
Dr. Maleszewski:And I would think it would cause irreparable harm to not only the physician profession, but really medicine at large and ultimately the care of patients. So when you look at the curricula for training of health care professionals, the biggest differentiator between an MD curriculum and, say, a PA curriculum and even to some extent an NP program, it's the basic sciences. That's the differentiator. That's what distinguishes the MD curriculum from those other curricula that are also very clinically centric. In the flexinarian model, the thought's always been that that foundational content that was taught in the basic sciences allowed physicians to think in deeper ways about problems and to troubleshoot the most challenging of cases.
Dr. Maleszewski:And I think that's important as physicians are the leaders of these, treating teams and oftentimes advanced practice providers bring complex and challenging cases and bring them up to the level of the physician and expect that degree of deeper thinking. But I don't think it's limited to that. I think it it's deeper than that because having that four foundational sciences as that foundation, as your root there, allows physicians to innovate and move medicine forward in a way that other providers are simply not prepared to do. So I think we're at a critical moment for the basic sciences, and I think that we have to really make the case for them if we're to keep a physician curriculum unique and value added.
Dr. Kreuter:What you're saying here is this really resonates with me. As I'm constantly I I feel like talking with colleagues and learners on the clinical side, a lot of times we have anesthesia and heme/onc rotate with us in transfusion medicine, emphasizing you might have complex patients, and so you're gonna have sometimes you know, conflicts between different criteria or patient care guidelines. And I think it's the basic sciences that a lot of times help us to be able to sort out what makes sense in this particular context. I'm curious. Because of your leadership role and which also really kinda spans the curriculum, what are a few of the different perspectives that you're hearing from other administrators, clinical faculty, basic science faculty?
Dr. Kreuter:Is there hearing this important driver that we really have to make the case for basic science?
Dr. Maleszewski:Yeah. And perspectives, as you can imagine, vary widely. If we start with our students and kind of consider the perspective that they bring to the table, they often feel very different things about the basic sciences depending on where they're at in the continuum of the curriculum or even into practice. While they're in the basic sciences, they often think this is really hard. It's somewhat similar to college, but it's ramped up.
Dr. Maleszewski:It's more difficult. It's left next level, if you will. It's often delivered in a lecture based model, which students pretty uniformly at this point dislike or even venture to use the word hate in many circumstances. And the educational literature, by the way, is also pretty clear about the limited effectiveness of that lecture based model to their point. They also tend to feel like they can probably get enough information in the quote, unquote parallel curriculum, including resources like UWorld, Pathoma, Sketchy, and those types of things to get that pass on step one, which is all they need to get now because, again, there's no score reporting there.
Dr. Maleszewski:When students are in the basic sciences, they also often tend to feel like it's a little disconnected. Like, they don't necessarily draw all the lines between the dots that show how they're related to patient care, and that can also lead for that lead them to feel like, I don't really know what I'm doing here. I don't see why I'm sitting through all this these kind of lecturey things, or I don't see how this is gonna be important or germane to what I plan to do with my career. So, again, those lines are just not clear on how what they're learning is going to affect their care of patients one day. With that said, after the basic science is over and they move out into the clinic, then they start appreciating that, then they start connecting the dots.
Dr. Maleszewski:And certainly, by the time they're out in practice and residency or as attending physicians somewhere, they start to look back on the basic sciences with a really different light. In fact, it's not at all uncommon for us to talk to colleagues or hear attendings, say things like, gosh, If I could go back and do those first eighteen months or those first two years now, I would look at that content through really different eyes. I'd learn a ton. And I think that's important. It's important for us to know that that's one thing that can paint the way that our students feel while they're going through things.
Dr. Maleszewski:I think that's a challenge for us to potentially change that, and we can talk about that in just a few minutes. One thing that doesn't change depending on where a student's at though is they really dislike that lecture based format that I was talking about before, and they really wish it was delivered in kind of a better way. In terms of other stakeholders that you brought up, I think the faculty, particularly the basic science faculty, they, of course, hold these courses very near and dear to their hearts, which is great. Although sometimes that can be a challenge because when you hold things that near and dear to your heart, you don't necessarily wanna change them and you don't wanna revisit them. You kinda think they're perfect all in their own right and that rigidity, particularly in the face of unpopular delivery strategies that we talked about, I think that will likely hasten the downfall of the basic sciences.
Dr. Maleszewski:So we have to be flexible and encourage our colleagues in the basic sciences to embrace new and different approaches here. Among the clinical faculty, I think the opinions of the basic sciences vary quite a bit. I think there are folks, particularly surgeons, they look at some elements of the basic science curriculum like anatomy and pathology as important. They see it every day. They know how important it is.
Dr. Maleszewski:Certainly, infectious disease docs, folks like that look at microbiology in the basic sciences and think, wow. That's something that really needs to stay in there, and they're really strong advocates for that in pharmacology and those types of things. Primary care folks, on the other hand, they tend to not have a lot of regular direct one on one interaction with laboratory professionals and other medical professionals who are who are more rooted in the basic sciences. And I think they can sometimes be the more hardened advocates for eliminating or reducing the basic sciences. I can recall, for instance, a dean at my alma mater where I graduated from medical school.
Dr. Maleszewski:He was an internist. And I remember he came up to me just before graduation, and he said, you're so talented. Why are you throwing all it all away in a field that's gonna be dead in a few years? Viewer will be replaced by machines, and you don't see patients and all this. And it was it was really jarring and almost kinda hurtful to to hear something like that from somebody that I clearly respected so much.
Dr. Maleszewski:I now realize, again, with, with hindsight and and kinda some years behind me that that was really more of an indictment about his naivete about the value that pathologists bring to patient care more than it was reflective of the discipline itself, pathology. So all this is to say that I think we we really need a bit of a revolution in the basic sciences to show in a real and tangible way how they're foundational to the practice of medicine and how they actually do allow you to better care for patients. And I need think we need it so that the students understand it, that our faculty, colleagues all understand it, and everybody's singing from the same hymnal, if you will, about how important and integral the basic sciences are.
Speaker 3:For more laboratory education, including a listing of conferences, webinars, and on demand content, visit mayocliniclabs.com/education.
Dr. Kreuter:What are the
Dr. Kreuter:some of those thoughts that you have about how basic science should be thinking about these challenges? You've talked about we need to have a revolution, and some initial thoughts that go through my mind is thinking about how are we teaching this information, how are we connecting it. But I'm also thinking about what's the role of kind of professional identity formation, kind of getting them into the mindset of thinking like a physician. What are your thoughts on how we should be thinking some things to throw some chum in the water for the audience?
Dr. Maleszewski:It's a great question, Justin. And this is one I I spent a lot of time thinking about, and I've kind of maybe alluded to a few strategies in answering your other questions. I'll kinda hit it more directly now, I think. There's one approach that I've become particularly fond of as I've reflected on this problem over the years. And it relates to the fact that when we talk to medical students, especially when they're approaching the end of of medical school, I spend a lot of time with fourth years talking to them about what their experience was like and what they would improve, what things were good, what things were bad, that type of thing.
Dr. Maleszewski:When I asked them about what their most impactful part of medical school was, almost universally, the vast majority point to something in the clerkship phase, either a specific anecdote or more broadly the experience. They love the rotations. They see every day how their work impacts real people. They feel like they're part of a team. They're actively learning.
Dr. Maleszewski:Their hands are dirty. They're in it. They love it. They feel alive, and they feel like doctors, you know, for the first time in their life, and they're they're sort of treated like one in the clerkship phase as well. I would submit to you that I think we need the basic sciences to make students feel that way.
Dr. Maleszewski:And I've been toying around with this idea of potentially leveraging our labs, and we have an enormous laboratory footprint here at Mayo Clinic. So I think we're uniquely suited to be able to do this, but I think this could be done on some scale at most large academic centers. And it would be the idea to use those labs to create a clerkship like feel to the content. You'd be learning about antigen antibody interactions in the blood bank where those problems and and that issue is dealt with nearly every minute of every day. That's an example that's clearly close to your home.
Dr. Maleszewski:Right? You'd be learning about microbiology sitting alongside amazing microbiology techs who are plating and setting up cultures and kind of reading results and doing gram stains and, again, seeing the actual value of that as they report things out and call the providers to let them know about these results. Learning anatomy in either radiology or surgical pathology where clinically relevant anatomy is addressed and referenced all the time, every day there as well. Pharmacology with pharmacists looking at metabolic curves, looking at mechanisms of actions, drug interactions. All of those basic sciences are rooted in those areas.
Dr. Maleszewski:And so we would still need to deliver core content, but increasingly, our students are wanting and getting that content asynchronously. So I would suggest maybe we stop resisting that so much and kind of give into it and allow that content to be delivered asynchronously and use the time that they spend with us in a way that shows them how the sciences, the basic sciences are used in the service of patients every day. And in addition to getting them to see the relevance of it, getting them excited in kind of a new format and in a new delivery model, it would also have this great side product of getting them to see how sometimes hidden medical professionals are working and what they do. Those students would have a much better appreciation for the teams that they're going to be eventually leading as we mentioned earlier. And it's a great opportunity to give students a window into the expertise these folks bring to the table and how they can leverage that when they're one day leading the teams and taking care of patients.
Dr. Maleszewski:And so I think there's a ton of opportunity here, and I think there's lots of creative ways to thinking about this. There are other people who have really great ideas too, but that's one of the things I'd like to to kind of send trial balloons up and and and give a whirl over the next few years, I think.
Dr. Kreuter:I really appreciate how you're talking about that. And certainly, it seems to connect a lot to the why and helping somebody see what role is this playing in patient care. Are there any people talking about where this integration might be, where we might see, like, basic sciences kind of boomerang back into playing a role in third and fourth year?
Dr. Maleszewski:Yeah. There there are, in fact. And some folks have kind of talked about a model, kind of a more of a sandwich model where you deliver some basic sciences upfront, then you kinda do the traditional clerkship thing and all that. And then you revisit them at the end in the form of a an advanced science curriculum that gives them that perspective. And I think there's a lot of merit to having that conversation as well because, again, it gets at what we were talking about earlier of, again, in hindsight, you start thinking about, like, wow.
Dr. Maleszewski:If I could go back and look at that content with new eyes and new information and know how I would let it boy, I'd pay more attention to x or y, or I'd think about it in this way that'd be different than the way I approached it the first time. So I think that would be a lot of fun to try out too, and I think there'd be value in that.
Dr. Kreuter:Yeah. Absolutely. That resonates. And in my experience with anesthesia is they come through transfusion medicine. Right?
Dr. Kreuter:They come on and they've had experiences late. They've lived it. Not only are they very keenly on the edge of their seat, but like you're saying, they have really astute questions that demonstrate, say, they understand how this is getting, playing out in the clinical practice.
Dr. Maleszewski:Exactly.
Dr. Kreuter:Kind of last question. I just want to kind of maybe transition a little bit of advice, thinking about your role as a Dean for Academic Affairs. You know, maybe we have some of your colleagues listening to this podcast. Maybe there are some of us that are interested in taking on leadership roles and thinking how can they help other colleagues. And so that's kind of my question is, how can we best advise listeners who may be involved in the basic science curriculum or who may be playing a supporting colleague role?
Dr. Kreuter:How can we help to kind of spark this transition we're talking about?
Dr. Maleszewski:Yeah. Another great question. And and I think it starts with advocation. As lab professionals like you just noted, we have a special footing in the basic sciences. We have a real special and tight relationship with them.
Dr. Maleszewski:Right? Showing and telling our colleagues how the basic sciences are critical to our work and the answers that we provide our colleagues with that allow them to directly care for patients, that's where it all starts. That's kind of a linchpin, I think. Then I think after that advocation, being a willing partner. Being willing to teach, try new things, develop different strategies, test them out, develop rigorous pedagogical and educational models, good assessments that show that the things that you're trying and the things that you're advocating for are value added and impactful and improve outcomes, that's absolutely critical.
Dr. Maleszewski:Both you and I know that medical education, it's more than fun. Right? It's a blast when you're involved in it. And I worry that for some of our colleagues, it's often seen as it's just another ask in their crazy busy days. Us educators really need to remind our colleagues about how recentering and rejuvenating an important education is for professional satisfaction and not to give into the tides that would essentially wind up cutting the basic sciences out of the MD curriculum entirely.
Dr. Maleszewski:And I think that would be very easy for us to do because, again, we're all super busy professionals, and this is just another thing on the to do list. In the end, though, I think it would be nothing short of calamitous to many of our disciplines in the basic sciences to getting students in the next generation excited about these disciplines if they're not exposed to it. But I also think more importantly perhaps than even that, I think it will be a disservice to patients if those basic sciences are deemphasized or go away entirely. We will not be able to care for patients if we aren't producing physicians who have that really fundamental and foundational knowledge and that mindset to the basic sciences. So I think this is not without challenges, certainly.
Dr. Maleszewski:And I think there's a lot of tough headwinds that we are facing into. But I think there's a a lot of promise here too. And there's a lot of things that we can do in a lot of ways that I think other areas of the curriculum are perhaps opening up a little bit that will give us places to insert ourselves. So I think there's a lot to be hopeful about too.
Dr. Kreuter:We've been rounding with doctor Maleszewski talking about basic science, the medical school curriculum. I really appreciate you taking the time to talk with us and really challenge us with this, doctor Maleszewski.
Dr. Maleszewski:The pleasure is all mine, Justin.
Dr. Kreuter:And to our listeners, thank you for joining us today. We invite you to share your thoughts and suggestions via email to mcleducationmayo dot edu. If you've enjoyed this podcast, please subscribe. And until our next rounds together, we encourage you to continue to connect lab medicine and the clinical practice through insightful conversations.