Peer Review

Essential Outcomes, Essential Inputs

The 2009 AAMC–HHMI Scientific Foundations for Future Physicians report (SFFP) broke new ground in proposing a realignment of premedical and medical education around specific scientific competencies needed for medical practice. A competency-based approach has exciting implications not only for improving premedical education, but also opportunities for transforming undergraduate science education generally. If premedical course prerequisites and MCAT preparation have historically been viewed as restricting the flexibility of curricular revision efforts, the current discourse contributes to a more receptive context for broader reform across the science disciplines. The impact of the SFFP on premedical education lies in the potential of its recommendations to inform curricular reform in undergraduate science education and facilitate pedagogical innovation.

Several indicators suggest that the landscape is conducive to reform. Medical schools are beginning to examine current standards for admission in response to recommendations to create less-restrictive pathways for students to acquire premedical competencies. Increased flexibility for pre-medical students, who comprise the majority of students in introductory science courses at many institutions, may provide leeway for undergraduate programs to explore new ways to implement competency-based science education for all students. Finally, the revised MCAT itself provides leverage for undergraduate science programs to adopt competency-based approaches to prepare their students: the MCAT2015 will include more questions designed to assess higher order thinking skills aligned with SFFP recommendations.

The SFFP blueprint identifies two specific challenges for premedical education reform that should be addressed by science departments and faculty. First is how to establish curricula to develop student knowledge and skills across traditional disciplinary borders. The SFFP argues that “the need for increased scientific rigor and its relevance to human biology is most likely to be met by more interdisciplinary courses.” For instance, how might students best develop the ability to “apply basic physical principles to understand living systems,” when “basic physical principles” and “living systems” are typically taught in separate courses controlled by different departments? Interdisciplinary approaches will involve cross-departmental faculty conversations, as well as institutional support to develop new connections, perhaps even new courses that span traditional departmental boundaries.

Second is how to develop appropriate assessments to evaluate student competency development. Developing learner competency means providing opportunities for students to practice and demonstrate the skills and habits of mind appropriate to science, that is, an authentic science context. Standard assessment practices prevalent in large introductory lecture courses tend to rely on summative multiple choice exams. Such assessments are mostly limited to content acquisition and lower-order thinking skills and are ill-suited for measuring competency. Competency-based education requires formative assessments that provide ongoing feedback to learners and educators about their progress, approaches with which not all faculty are familiar. Faculty development in learning assessment is a critical element of institutional support for science education reform.

Undergraduate programs are positioned to play a lead role in improving the scientific preparation of future physicians for medical practice. Many educators are already pursuing interdisciplinary approaches and designing learning outcomes aligned with competency development. These pioneering efforts contribute models for other institutions to consider as they seek to implement effective strategies in their classrooms. Sustaining these efforts on the ground depends on strong institutional commitment to improve not only premedical education, but the education of all science students. Taking up the charge means reforming established departmental structures and curricular assessments that have typically focused on discipline-specific knowledge acquisition. More than ever, departmental leaders must acknowledge the need for science education reform and must embrace curricular innovations to improve undergraduate instruction. There is no better time than now.

Cynthia Bauerle is the assistant director of Precollege and Undergraduate Science Education at Howard Hughes Medical Institute; David Hanauer is an evaluation consultant for the PHIRE project at the University of Pittsburgh, and Professor of English at Indiana University of Pennsylvania.

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