Integrating the Basic and Clinical Sciences Throughout the Medical Curriculum: Contemplating the Why, When and How

A safe, effective clinician should have the ability to reason through any case they encounter—some of which may be unusual presentations or complex cases which may not fully match standard clinical practice guidelines. When faced with a situation that does not match a known pattern, a solid foundation in the underlying principles of the scientific basis of medicine would be needed to correctly reach the most probable diagnosis and choose the most appropriate treatment strategy. The ability to do this requires the clinician to be able to integrate relevant pieces of related knowledge from both the basic and clinical sciences. However, these two elements are often taught in a dissociated manner in medical school. This often results in students struggling to see connections between the two, and often perceiving the basic sciences as being not relevant to the practice of clinical medicine. The need for better integration of the curriculum has been recognized and many medical schools have attempted to implement an integrated curriculum to varying degrees. This article attempts to summarize the theoretical basis and available evidence supporting a fully integrated spiral curriculum as an effective model for medical curriculum development in order to train safe, effective clinicians. We also briefly discuss some challenges to this and some possible strategies to overcome them.