Process of integration of 12 cross‐cutting themes

Context: In 2003, UCLA introduced a new, systemsbased, integrated curricular structure for first year medical students. The curriculum emphasises small group and independent learning, limiting lectures to 10 h per week. A problem-based learning (PBL) case presents the clinical theme of each week, and provides the framework for incorporating the basic science learning. The exemplary case: In an integrated curriculum organised around a clinical case, the ideal case simultaneously serves as an exemplar that assists students in integrating their knowledge, while teaching them about commonly encountered diseases. Fetal Alcohol Syndrome (FAS) was chosen as a commonly encountered clinical disorder, which was able to carry teaching about the basic sciences of embryology, neuroanatomy and brain development, and epidemiology, as well as other important clinical topics such as ethics and law, counselling, and health behaviour. During the portion of the curriculum covering the neurosciences, a week was designed to address ‘Nurture or Nature’ using FAS as an exemplar clinical case. A PBL case began the week with a webadministered presentation of a school-aged child with physical features and learning and behaviour problems potentially attributable to a number of prenatal (including alcohol, cocaine, and nicotine exposure) and postnatal factors. An evidence-based portion of PBL required students to investigate the literature to either research a related learning issue or to defend or refute the position that ‘It is safe for a woman to drink a little during pregnancy’. The PBL case ended with a discussion of the impact of fetal alcohol exposure on child development and ‘hands-on’ practice screening a child for FAS, including conducting a facial dysmorphology exam to assess physical features associated with prenatal alcohol exposure. In another exercise, small groups of students worked with a standardised patient case learning to screen adolescents for alcohol and drug use and practising a brief intervention to reduce binge drinking. A portion of a Law and Order television episode in which a woman is prosecuted for drinking while pregnant facilitated students’ consideration of legal and ethical issues as they formed juries and wrestled with a verdict. Evaluation: Results of assessments and course evaluations by the 146 students completing the FAS elements of the curriculum suggest increased awareness, knowledge and appreciation of the potential damage alcohol causes to the developing embryo and fetus and the consequences of FAS to the family and broader society. On a quiz testing knowledge of alcohol’s effect on the fetus, students completing the embryology lab had a mean score of 5.65 (maximum 1⁄4 6) and rated the lab’s effectiveness as 4.11 (maximum 1⁄4 5). Students attained a mean score of 4.31 (maximum 1⁄4 5) on the FAS items in the weekly quiz. Students’ end of course evaluations yielded mean ratings of 3.7 and 3.6 on the FAS-related PBL and standardised patient cases, respectively, using a 5-point scale (1 1⁄4 not effective; 5 1⁄4 very effective). These rating compared favourably to ratings of other first year cases in the curriculum.