“What is the mechanism?”: Cues, barriers, and opportunities to discuss foundational science during internal medicine rounds

Abstract

Background

Repeated application of foundational science (FS) during medical reasoning results in encapsulation of knowledge needed to develop clinical expertise. Despite proven benefit of educating learners using a FS framework to anchor clinical decision making, how FS is integrated on clinical rotations has not been well characterized. This study examines how and when FS discussion occurs on internal medicine teaching rounds.

Material and methods

We performed a convergent mixed method study. Six internal medicine teams at a quaternary hospital were observed during rounds and team members interviewed. Transcripts were analyzed using thematic analysis. Descriptive statistics provided a summary of the observations.

Results

Our study revealed that rounds used a teacher-centered model where FS knowledge was transmitted as pearls external to the clinical context. FS content arose primarily when the patient was complex. Barriers preventing FS discussion were lack of time and perceived lack of personal FS knowledge.

Conclusion

Our study describes scenarios that commonly elicit discussion of FS on inpatient medicine rounds highlighting a ‘transmission’ model of FS knowledge. We suggest a learner-centered model that engages students in the practice of integrating FS into clinical reasoning.

Keywords:

• Clinical teaching
• foundational science
• qualitative methods
• thematic analysis

Disclosure statement

The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the article.

Glossary

Foundational science: Is broadly defined as the organizational framework underlying clinical reasoning. In our definition, it is characterized domains which include biomedical science, clinical science, social and behavioral science, epidemiology and population science, educational science, and system science.

Clinical pearls: Are defined as free standing and clinically pertinent information based on experience when controlled data is limited.

Wards rounds: Is where a team goes from patient to patient and to discuss and make decisions about overall clinical care.

Funding

The author(s) reported there is no funding associated with the work featured in this article.

Additional information

Notes on contributors

Jonathan S. Pai

Jonathan S. Pai, MD, is a third-year resident in the Department of Internal Medicine at the University of Southern California and former medical education fellow for Foundational Science in Foundations 2.

Heidi E. Kirsch

Heidi E. Kirsch, MS, MD, is a Full Professor of Neurology and Radiology at the University of California San Francisco. She directs the Foundational Science in Foundations 2 in the UCSF School of Medicine Bridges Curriculum, where students integrate basic science principles into clinical reasoning.

Patricia S. O’Sullivan

Patricia S. O’Sullivan, MS, EdD, is a Full Professor of Medicine and Surgery at the University of California San Francisco and Director, Research and Development in the Center for Faculty Educators, School of Medicine. Her research focuses on application of theory to faculty development and workplace learning.

Patricia A. Cornett

Patricia A. Cornett, MD, is a Full Professor of Medicine at the University of California San Francisco. She is the faculty lead for Foundations 2 and Career Launch in the UCSF School of Medicine, the latter 2 phases of the Bridges Curriculum.