Open Access Highly Accessed Research article

Facilitating the transition from physiology to hospital wards through an interdisciplinary case study of septic shock

Albert S Li1, Kenneth I Berger23, David R Schwartz2, William R Slater4 and David S Goldfarb56*

Author Affiliations

1 NYU School of Medicine, New York, NY, USA

2 Division of Pulmonary, Critical Care, and Sleep Medicine, NYU School of Medicine, New York, NY, USA

3 André Cournand Pulmonary Physiology Laboratory, Bellevue Hospital, New York, NY, USA

4 Leon H. Charney Division of Cardiology, NYU School of Medicine, New York, NY, USA

5 Nephrology Section, VA New York Harbor Health Care System, New York, NY, USA

6 Division of Nephrology, NYU School of Medicine, New York, NY, USA

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BMC Medical Education 2014, 14:78  doi:10.1186/1472-6920-14-78

Published: 12 April 2014

Abstract

Background

In order to develop clinical reasoning, medical students must be able to integrate knowledge across traditional subject boundaries and multiple disciplines. At least two dimensions of integration have been identified: horizontal integration, bringing together different disciplines in considering a topic; and vertical integration, bridging basic science and clinical practice. Much attention has been focused on curriculum overhauls, but our approach is to facilitate horizontal and vertical integration on a smaller scale through an interdisciplinary case study discussion and then to assess its utility.

Methods

An interdisciplinary case study discussion about a critically ill patient was implemented at the end of an organ system-based, basic sciences module at New York University School of Medicine. Three clinical specialists—a cardiologist, a pulmonologist, and a nephrologist—jointly led a discussion about a complex patient in the intensive care unit with multiple medical problems secondary to septic shock. The discussion emphasized the physiologic underpinnings behind the patient’s presentation and the physiologic considerations across the various systems in determining proper treatment. The discussion also highlighted the interdependence between the cardiovascular, respiratory, and renal systems, which were initially presented in separate units. After the session students were given a brief, anonymous three-question free-response questionnaire in which they were asked to evaluate and freely comment on the exercise.

Results

Students not only took away physiological principles but also gained an appreciation for various thematic lessons for bringing basic science to the bedside, especially horizontal and vertical integration. The response of the participants was overwhelmingly positive with many indicating that the exercise integrated the material across organ systems, and strengthened their appreciation of the role of physiology in understanding disease presentations and guiding appropriate therapy.

Conclusions

Horizontal and vertical integration can be presented effectively through a single-session case study, with complex patient cases involving multiple organ systems providing students opportunities to integrate their knowledge across organ systems while emphasizing the importance of physiology in clinical reasoning. Furthermore, having several clinicians from different specialties discuss the case together can reinforce the matter of integration across multiple organ systems and disciplines in students’ minds.

Keywords:
Integrated curriculum; Problem-based learning; Undergraduate medical education; Physiology