March 7, 2025 • 19 mins
On this episode of “Lab Medicine Rounds,” Justin Kreuter, M.D., speaks with senior associate dean of academic affairs for Mayo Clinic Alix School of Medicine, Joseph Maleszewski, M.D., on the future of basic sciences in medical education.
Discussion includes:
· Challenges of basic science in medical education.
· Differing perspectives about basic science in medical education.
· Ideas of exploration for the future.
Mark as Played
Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Dr. Kreuter (00:07):
This is Lab Medicine Rounds, a curated
podcast for physicians,laboratory professionals, and
students. I'm your host, JustinKreuter, a transfusion medicine
pathologist and assistantprofessor of laboratory medicine
and pathology at Mayo Clinic.Today, we're rounding with
doctor Joseph Maleszewski,professor of laboratory medicine
and pathology, as well as seniorassociate dean for academic
(00:31):
affairs at the Mayo Clinic AlixSchool of Medicine to talk about
the future of basic science inthe medical school curriculum.
Thanks for joining us today,doctor Maleszewski.
Dr. Maleszewski (00:41):
All the pleasure is all mine, Justin.
Always great to be here withyou.
Dr. Kreuter (00:44):
I got to see you talk about this topic in a in a
different forum, and I thoughtthis would be a really great one
to bring to our audience, ourour mix of pathologists,
laboratory professionals,clinicians, and also students.
So maybe let's kick off with,you know, why is it important to
talk about the future of basicscience in medical school now?
Dr. Maleszewski (01:10):
Well, Justin, it's always a great time to talk
about the basic sciences. Right?In full disclosure, this phase
of the curriculum isparticularly near and dear to my
heart. It's the place where Ifirst encountered my calling,
pathology, probably kinda whereyou did too. And I think it's
really a place that bridges thedivide between the classroom and
the clinic.
It's a transition, andtransitions are naturally
(01:30):
exciting, and it's where a lotof growth tends to happen for
our students. Anyway, back toyour question. I think it's
particularly timely to talkabout the basic sciences now
having just passed the threeyear anniversary of when step
one switched from being areported score to being in a
pass fail model. All schoolsacross the country now are
starting to adjust to this newparadigm, kind of settling into
(01:53):
their new groove, if you will.Because of this, I think there
are very real questions that arenow arising as to what the role
of the basic sciences are inmedical education.
Most schools have shortened thebasic sciences from two years
down to eighteen months. That'snow kind of the standard. Some
have even gone even moreaggressively and trimmed it down
(02:15):
to sixteen months or even twelvemonths. There's even some
discussion about getting rid ofthem altogether, especially as
more schools are looking at andshifting to a three year model.
I think further reduction,especially elimination, would be
tragic.
And I would think it would causeirreparable harm to not only the
physician profession, but reallymedicine at large and ultimately
(02:37):
the care of patients. So whenyou look at the curricula for
training of health careprofessionals, the biggest
differentiator between an MDcurriculum and, say, a PA
curriculum and even to someextent an NP program, it's the
basic sciences. That's thedifferentiator. That's what
distinguishes the MD curriculumfrom those other curricula that
are also very clinicallycentric. In the flexinarian
(02:59):
model, the thought's always beenthat that foundational content
that was taught in the basicsciences allowed physicians to
think in deeper ways aboutproblems and to troubleshoot the
most challenging of cases.
And I think that's important asphysicians are the leaders of
these, treating teams andoftentimes advanced practice
providers bring complex andchallenging cases and bring them
(03:22):
up to the level of the physicianand expect that degree of deeper
thinking. But I don't think it'slimited to that. I think it it's
deeper than that because havingthat four foundational sciences
as that foundation, as your rootthere, allows physicians to
innovate and move medicineforward in a way that other
providers are simply notprepared to do. So I think we're
(03:44):
at a critical moment for thebasic sciences, and I think that
we have to really make the casefor them if we're to keep a
physician curriculum unique andvalue added.
Dr. Kreuter (03:53):
What you're saying here is this really resonates
with me. As I'm constantly I Ifeel like talking with
colleagues and learners on theclinical side, a lot of times we
have anesthesia and heme/oncrotate with us in transfusion
medicine, emphasizing you mighthave complex patients, and so
you're gonna have sometimes youknow, conflicts between
(04:15):
different criteria or patientcare guidelines. And I think
it's the basic sciences that alot of times help us to be able
to sort out what makes sense inthis particular context. I'm
curious. Because of yourleadership role and which also
really kinda spans thecurriculum, what are a few of
(04:35):
the different perspectives thatyou're hearing from other
administrators, clinicalfaculty, basic science faculty?
Is there hearing this importantdriver that we really have to
make the case for basic science?
Dr. Maleszewski (04:50):
Yeah. And perspectives, as you can
imagine, vary widely. If westart with our students and kind
of consider the perspective thatthey bring to the table, they
often feel very different thingsabout the basic sciences
depending on where they're at inthe continuum of the curriculum
or even into practice. Whilethey're in the basic sciences,
they often think this is reallyhard. It's somewhat similar to
(05:10):
college, but it's ramped up.
It's more difficult. It's leftnext level, if you will. It's
often delivered in a lecturebased model, which students
pretty uniformly at this pointdislike or even venture to use
the word hate in manycircumstances. And the
educational literature, by theway, is also pretty clear about
the limited effectiveness ofthat lecture based model to
(05:32):
their point. They also tend tofeel like they can probably get
enough information in the quote,unquote parallel curriculum,
including resources like UWorld,Pathoma, Sketchy, and those
types of things to get that passon step one, which is all they
need to get now because, again,there's no score reporting
there.
When students are in the basicsciences, they also often tend
(05:56):
to feel like it's a littledisconnected. Like, they don't
necessarily draw all the linesbetween the dots that show how
they're related to patient care,and that can also lead for that
lead them to feel like, I don'treally know what I'm doing here.
I don't see why I'm sittingthrough all this these kind of
lecturey things, or I don't seehow this is gonna be important
or germane to what I plan to dowith my career. So, again, those
(06:19):
lines are just not clear on howwhat they're learning is going
to affect their care of patientsone day. With that said, after
the basic science is over andthey move out into the clinic,
then they start appreciatingthat, then they start connecting
the dots.
And certainly, by the timethey're out in practice and
residency or as attendingphysicians somewhere, they start
to look back on the basicsciences with a really different
(06:39):
light. In fact, it's not at alluncommon for us to talk to
colleagues or hear attendings,say things like, gosh, If I
could go back and do those firsteighteen months or those first
two years now, I would look atthat content through really
different eyes. I'd learn a ton.And I think that's important.
It's important for us to knowthat that's one thing that can
(07:00):
paint the way that our studentsfeel while they're going through
things.
I think that's a challenge forus to potentially change that,
and we can talk about that injust a few minutes. One thing
that doesn't change depending onwhere a student's at though is
they really dislike that lecturebased format that I was talking
about before, and they reallywish it was delivered in kind of
a better way. In terms of otherstakeholders that you brought
(07:21):
up, I think the faculty,particularly the basic science
faculty, they, of course, holdthese courses very near and dear
to their hearts, which is great.Although sometimes that can be a
challenge because when you holdthings that near and dear to
your heart, you don'tnecessarily wanna change them
and you don't wanna revisitthem. You kinda think they're
perfect all in their own rightand that rigidity, particularly
(07:42):
in the face of unpopulardelivery strategies that we
talked about, I think that willlikely hasten the downfall of
the basic sciences.
So we have to be flexible andencourage our colleagues in the
basic sciences to embrace newand different approaches here.
Among the clinical faculty, Ithink the opinions of the basic
sciences vary quite a bit. Ithink there are folks,
(08:04):
particularly surgeons, they lookat some elements of the basic
science curriculum like anatomyand pathology as important. They
see it every day. They know howimportant it is.
Certainly, infectious diseasedocs, folks like that look at
microbiology in the basicsciences and think, wow. That's
something that really needs tostay in there, and they're
really strong advocates for thatin pharmacology and those types
(08:25):
of things. Primary care folks,on the other hand, they tend to
not have a lot of regular directone on one interaction with
laboratory professionals andother medical professionals who
are who are more rooted in thebasic sciences. And I think they
can sometimes be the morehardened advocates for
eliminating or reducing thebasic sciences. I can recall,
(08:48):
for instance, a dean at my almamater where I graduated from
medical school.
He was an internist. And Iremember he came up to me just
before graduation, and he said,you're so talented. Why are you
throwing all it all away in afield that's gonna be dead in a
few years? Viewer will bereplaced by machines, and you
don't see patients and all this.And it was it was really jarring
and almost kinda hurtful to tohear something like that from
(09:10):
somebody that I clearlyrespected so much.
I now realize, again, with, withhindsight and and kinda some
years behind me that that wasreally more of an indictment
about his naivete about thevalue that pathologists bring to
patient care more than it wasreflective of the discipline
itself, pathology. So all thisis to say that I think we we
really need a bit of arevolution in the basic sciences
(09:34):
to show in a real and tangibleway how they're foundational to
the practice of medicine and howthey actually do allow you to
better care for patients. And Ineed think we need it so that
the students understand it, thatour faculty, colleagues all
understand it, and everybody'ssinging from the same hymnal, if
you will, about how importantand integral the basic sciences
(09:55):
are.
Speaker 3 (10:01):
For more laboratory education, including a listing
of conferences, webinars, and ondemand content, visit
mayocliniclabs.com/education.
Dr. Kreuter (10:21):
What are the
some of those thoughts that youhave about how basic science
should be thinking about thesechallenges? You've talked about
we need to have a revolution,and some initial thoughts that
go through my mind is thinkingabout how are we teaching this
information, how are weconnecting it. But I'm also
thinking about what's the roleof kind of professional identity
(10:43):
formation, kind of getting theminto the mindset of thinking
like a physician. What are yourthoughts on how we should be
thinking some things to throwsome chum in the water for the
audience?
Dr. Maleszewski (10:55):
It's a great question, Justin. And this is
one I I spent a lot of timethinking about, and I've kind of
maybe alluded to a fewstrategies in answering your
other questions. I'll kinda hitit more directly now, I think.
There's one approach that I'vebecome particularly fond of as
I've reflected on this problemover the years. And it relates
to the fact that when we talk tomedical students, especially
(11:16):
when they're approaching the endof of medical school, I spend a
lot of time with fourth yearstalking to them about what their
experience was like and whatthey would improve, what things
were good, what things were bad,that type of thing.
When I asked them about whattheir most impactful part of
medical school was, almostuniversally, the vast majority
point to something in theclerkship phase, either a
(11:37):
specific anecdote or morebroadly the experience. They
love the rotations. They seeevery day how their work impacts
real people. They feel likethey're part of a team. They're
actively learning.
Their hands are dirty. They'rein it. They love it. They feel
alive, and they feel likedoctors, you know, for the first
time in their life, and they'rethey're sort of treated like one
in the clerkship phase as well.I would submit to you that I
(11:59):
think we need the basic sciencesto make students feel that way.
And I've been toying around withthis idea of potentially
leveraging our labs, and we havean enormous laboratory footprint
here at Mayo Clinic. So I thinkwe're uniquely suited to be able
to do this, but I think thiscould be done on some scale at
most large academic centers. Andit would be the idea to use
(12:21):
those labs to create a clerkshiplike feel to the content. You'd
be learning about antigenantibody interactions in the
blood bank where those problemsand and that issue is dealt with
nearly every minute of everyday. That's an example that's
clearly close to your home.
Right? You'd be learning aboutmicrobiology sitting alongside
(12:41):
amazing microbiology techs whoare plating and setting up
cultures and kind of readingresults and doing gram stains
and, again, seeing the actualvalue of that as they report
things out and call theproviders to let them know about
these results. Learning anatomyin either radiology or surgical
pathology where clinicallyrelevant anatomy is addressed
and referenced all the time,every day there as well.
(13:04):
Pharmacology with pharmacistslooking at metabolic curves,
looking at mechanisms ofactions, drug interactions. All
of those basic sciences arerooted in those areas.
And so we would still need todeliver core content, but
increasingly, our students arewanting and getting that content
asynchronously. So I wouldsuggest maybe we stop resisting
(13:28):
that so much and kind of giveinto it and allow that content
to be delivered asynchronouslyand use the time that they spend
with us in a way that shows themhow the sciences, the basic
sciences are used in the serviceof patients every day. And in
addition to getting them to seethe relevance of it, getting
(13:49):
them excited in kind of a newformat and in a new delivery
model, it would also have thisgreat side product of getting
them to see how sometimes hiddenmedical professionals are
working and what they do. Thosestudents would have a much
better appreciation for theteams that they're going to be
eventually leading as wementioned earlier. And it's a
great opportunity to givestudents a window into the
(14:10):
expertise these folks bring tothe table and how they can
leverage that when they're oneday leading the teams and taking
care of patients.
And so I think there's a ton ofopportunity here, and I think
there's lots of creative ways tothinking about this. There are
other people who have reallygreat ideas too, but that's one
of the things I'd like to tokind of send trial balloons up
(14:32):
and and and give a whirl overthe next few years, I think.
Dr. Kreuter (14:35):
I really appreciate how you're talking about that.
And certainly, it seems toconnect a lot to the why and
helping somebody see what roleis this playing in patient care.
Are there any people talkingabout where this integration
might be, where we might see,like, basic sciences kind of
boomerang back into playing arole in third and fourth year?
Dr. Maleszewski (15:00):
Yeah. There there are, in fact. And some
folks have kind of talked abouta model, kind of a more of a
sandwich model where you deliversome basic sciences upfront,
then you kinda do thetraditional clerkship thing and
all that. And then you revisitthem at the end in the form of a
an advanced science curriculumthat gives them that
perspective. And I think there'sa lot of merit to having that
(15:20):
conversation as well because,again, it gets at what we were
talking about earlier of, again,in hindsight, you start thinking
about, like, wow.
If I could go back and look atthat content with new eyes and
new information and know how Iwould let it boy, I'd pay more
attention to x or y, or I'dthink about it in this way
that'd be different than the wayI approached it the first time.
So I think that would be a lotof fun to try out too, and I
(15:42):
think there'd be value in that.
Dr. Kreuter (15:43):
Yeah. Absolutely. That resonates. And in my
experience with anesthesia isthey come through transfusion
medicine. Right?
They come on and they've hadexperiences late. They've lived
it. Not only are they verykeenly on the edge of their
seat, but like you're saying,they have really astute
questions that demonstrate, say,they understand how this is
getting, playing out in theclinical practice.
Dr. Maleszewski (16:06):
Exactly.
Dr. Kreuter (16:07):
Kind of last question. I just want to kind of
maybe transition a little bit ofadvice, thinking about your role
as a Dean for Academic Affairs.You know, maybe we have some of
your colleagues listening tothis podcast. Maybe there are
some of us that are interestedin taking on leadership roles
and thinking how can they helpother colleagues. And so that's
(16:28):
kind of my question is, how canwe best advise listeners who may
be involved in the basic sciencecurriculum or who may be playing
a supporting colleague role?
How can we help to kind of sparkthis transition we're talking
about?
Dr. Maleszewski (16:46):
Yeah. Another great question. And and I think
it starts with advocation. Aslab professionals like you just
noted, we have a special footingin the basic sciences. We have a
real special and tightrelationship with them.
Right? Showing and telling ourcolleagues how the basic
sciences are critical to ourwork and the answers that we
provide our colleagues with thatallow them to directly care for
(17:06):
patients, that's where it allstarts. That's kind of a
linchpin, I think. Then I thinkafter that advocation, being a
willing partner. Being willingto teach, try new things,
develop different strategies,test them out, develop rigorous
pedagogical and educationalmodels, good assessments that
show that the things that you'retrying and the things that
you're advocating for are valueadded and impactful and improve
(17:29):
outcomes, that's absolutelycritical.
Both you and I know that medicaleducation, it's more than fun.
Right? It's a blast when you'reinvolved in it. And I worry that
for some of our colleagues, it'soften seen as it's just another
ask in their crazy busy days. Useducators really need to remind
our colleagues about howrecentering and rejuvenating an
(17:52):
important education is forprofessional satisfaction and
not to give into the tides thatwould essentially wind up
cutting the basic sciences outof the MD curriculum entirely.
And I think that would be veryeasy for us to do because,
again, we're all super busyprofessionals, and this is just
another thing on the to do list.In the end, though, I think it
would be nothing short ofcalamitous to many of our
(18:15):
disciplines in the basicsciences to getting students in
the next generation excitedabout these disciplines if
they're not exposed to it. But Ialso think more importantly
perhaps than even that, I thinkit will be a disservice to
patients if those basic sciencesare deemphasized or go away
entirely. We will not be able tocare for patients if we aren't
(18:37):
producing physicians who havethat really fundamental and
foundational knowledge and thatmindset to the basic sciences.
So I think this is not withoutchallenges, certainly.
And I think there's a lot oftough headwinds that we are
facing into. But I think there'sa a lot of promise here too. And
there's a lot of things that wecan do in a lot of ways that I
(19:01):
think other areas of thecurriculum are perhaps opening
up a little bit that will giveus places to insert ourselves.
So I think there's a lot to behopeful about too.
Dr. Kreuter (19:10):
We've been rounding with doctor Maleszewski talking
about basic science, the medicalschool curriculum. I really
appreciate you taking the timeto talk with us and really
challenge us with this, doctorMaleszewski.
Dr. Maleszewski (19:21):
The pleasure is all mine, Justin.
Dr. Kreuter (19:22):
And to our listeners, thank you for joining
us today. We invite you to shareyour thoughts and suggestions
via email to mcleducationmayodot edu. If you've enjoyed this
podcast, please subscribe. Anduntil our next rounds together,
we encourage you to continue toconnect lab medicine and the
clinical practice throughinsightful conversations.
This is Lab Medicine Rounds, a curated
podcast for physicians,laboratory professionals, and
students. I'm your host, JustinKreuter, a transfusion medicine
pathologist and assistantprofessor of laboratory medicine
and pathology at Mayo Clinic.Today, we're rounding with
doctor Joseph Maleszewski,professor of laboratory medicine
and pathology, as well as seniorassociate dean for academic
(00:31):
affairs at the Mayo Clinic AlixSchool of Medicine to talk about
the future of basic science inthe medical school curriculum.
Thanks for joining us today,doctor Maleszewski.
Dr. Maleszewski (00:41):
All the pleasure is all mine, Justin.
Always great to be here withyou.
Dr. Kreuter (00:44):
I got to see you talk about this topic in a in a
different forum, and I thoughtthis would be a really great one
to bring to our audience, ourour mix of pathologists,
laboratory professionals,clinicians, and also students.
So maybe let's kick off with,you know, why is it important to
talk about the future of basicscience in medical school now?
Dr. Maleszewski (01:10):
Well, Justin, it's always a great time to talk
about the basic sciences. Right?In full disclosure, this phase
of the curriculum isparticularly near and dear to my
heart. It's the place where Ifirst encountered my calling,
pathology, probably kinda whereyou did too. And I think it's
really a place that bridges thedivide between the classroom and
the clinic.
It's a transition, andtransitions are naturally
(01:30):
exciting, and it's where a lotof growth tends to happen for
our students. Anyway, back toyour question. I think it's
particularly timely to talkabout the basic sciences now
having just passed the threeyear anniversary of when step
one switched from being areported score to being in a
pass fail model. All schoolsacross the country now are
starting to adjust to this newparadigm, kind of settling into
(01:53):
their new groove, if you will.Because of this, I think there
are very real questions that arenow arising as to what the role
of the basic sciences are inmedical education.
Most schools have shortened thebasic sciences from two years
down to eighteen months. That'snow kind of the standard. Some
have even gone even moreaggressively and trimmed it down
(02:15):
to sixteen months or even twelvemonths. There's even some
discussion about getting rid ofthem altogether, especially as
more schools are looking at andshifting to a three year model.
I think further reduction,especially elimination, would be
tragic.
And I would think it would causeirreparable harm to not only the
physician profession, but reallymedicine at large and ultimately
(02:37):
the care of patients. So whenyou look at the curricula for
training of health careprofessionals, the biggest
differentiator between an MDcurriculum and, say, a PA
curriculum and even to someextent an NP program, it's the
basic sciences. That's thedifferentiator. That's what
distinguishes the MD curriculumfrom those other curricula that
are also very clinicallycentric. In the flexinarian
(02:59):
model, the thought's always beenthat that foundational content
that was taught in the basicsciences allowed physicians to
think in deeper ways aboutproblems and to troubleshoot the
most challenging of cases.
And I think that's important asphysicians are the leaders of
these, treating teams andoftentimes advanced practice
providers bring complex andchallenging cases and bring them
(03:22):
up to the level of the physicianand expect that degree of deeper
thinking. But I don't think it'slimited to that. I think it it's
deeper than that because havingthat four foundational sciences
as that foundation, as your rootthere, allows physicians to
innovate and move medicineforward in a way that other
providers are simply notprepared to do. So I think we're
(03:44):
at a critical moment for thebasic sciences, and I think that
we have to really make the casefor them if we're to keep a
physician curriculum unique andvalue added.
Dr. Kreuter (03:53):
What you're saying here is this really resonates
with me. As I'm constantly I Ifeel like talking with
colleagues and learners on theclinical side, a lot of times we
have anesthesia and heme/oncrotate with us in transfusion
medicine, emphasizing you mighthave complex patients, and so
you're gonna have sometimes youknow, conflicts between
(04:15):
different criteria or patientcare guidelines. And I think
it's the basic sciences that alot of times help us to be able
to sort out what makes sense inthis particular context. I'm
curious. Because of yourleadership role and which also
really kinda spans thecurriculum, what are a few of
(04:35):
the different perspectives thatyou're hearing from other
administrators, clinicalfaculty, basic science faculty?
Is there hearing this importantdriver that we really have to
make the case for basic science?
Dr. Maleszewski (04:50):
Yeah. And perspectives, as you can
imagine, vary widely. If westart with our students and kind
of consider the perspective thatthey bring to the table, they
often feel very different thingsabout the basic sciences
depending on where they're at inthe continuum of the curriculum
or even into practice. Whilethey're in the basic sciences,
they often think this is reallyhard. It's somewhat similar to
(05:10):
college, but it's ramped up.
It's more difficult. It's leftnext level, if you will. It's
often delivered in a lecturebased model, which students
pretty uniformly at this pointdislike or even venture to use
the word hate in manycircumstances. And the
educational literature, by theway, is also pretty clear about
the limited effectiveness ofthat lecture based model to
(05:32):
their point. They also tend tofeel like they can probably get
enough information in the quote,unquote parallel curriculum,
including resources like UWorld,Pathoma, Sketchy, and those
types of things to get that passon step one, which is all they
need to get now because, again,there's no score reporting
there.
When students are in the basicsciences, they also often tend
(05:56):
to feel like it's a littledisconnected. Like, they don't
necessarily draw all the linesbetween the dots that show how
they're related to patient care,and that can also lead for that
lead them to feel like, I don'treally know what I'm doing here.
I don't see why I'm sittingthrough all this these kind of
lecturey things, or I don't seehow this is gonna be important
or germane to what I plan to dowith my career. So, again, those
(06:19):
lines are just not clear on howwhat they're learning is going
to affect their care of patientsone day. With that said, after
the basic science is over andthey move out into the clinic,
then they start appreciatingthat, then they start connecting
the dots.
And certainly, by the timethey're out in practice and
residency or as attendingphysicians somewhere, they start
to look back on the basicsciences with a really different
(06:39):
light. In fact, it's not at alluncommon for us to talk to
colleagues or hear attendings,say things like, gosh, If I
could go back and do those firsteighteen months or those first
two years now, I would look atthat content through really
different eyes. I'd learn a ton.And I think that's important.
It's important for us to knowthat that's one thing that can
(07:00):
paint the way that our studentsfeel while they're going through
things.
I think that's a challenge forus to potentially change that,
and we can talk about that injust a few minutes. One thing
that doesn't change depending onwhere a student's at though is
they really dislike that lecturebased format that I was talking
about before, and they reallywish it was delivered in kind of
a better way. In terms of otherstakeholders that you brought
(07:21):
up, I think the faculty,particularly the basic science
faculty, they, of course, holdthese courses very near and dear
to their hearts, which is great.Although sometimes that can be a
challenge because when you holdthings that near and dear to
your heart, you don'tnecessarily wanna change them
and you don't wanna revisitthem. You kinda think they're
perfect all in their own rightand that rigidity, particularly
(07:42):
in the face of unpopulardelivery strategies that we
talked about, I think that willlikely hasten the downfall of
the basic sciences.
So we have to be flexible andencourage our colleagues in the
basic sciences to embrace newand different approaches here.
Among the clinical faculty, Ithink the opinions of the basic
sciences vary quite a bit. Ithink there are folks,
(08:04):
particularly surgeons, they lookat some elements of the basic
science curriculum like anatomyand pathology as important. They
see it every day. They know howimportant it is.
Certainly, infectious diseasedocs, folks like that look at
microbiology in the basicsciences and think, wow. That's
something that really needs tostay in there, and they're
really strong advocates for thatin pharmacology and those types
(08:25):
of things. Primary care folks,on the other hand, they tend to
not have a lot of regular directone on one interaction with
laboratory professionals andother medical professionals who
are who are more rooted in thebasic sciences. And I think they
can sometimes be the morehardened advocates for
eliminating or reducing thebasic sciences. I can recall,
(08:48):
for instance, a dean at my almamater where I graduated from
medical school.
He was an internist. And Iremember he came up to me just
before graduation, and he said,you're so talented. Why are you
throwing all it all away in afield that's gonna be dead in a
few years? Viewer will bereplaced by machines, and you
don't see patients and all this.And it was it was really jarring
and almost kinda hurtful to tohear something like that from
(09:10):
somebody that I clearlyrespected so much.
I now realize, again, with, withhindsight and and kinda some
years behind me that that wasreally more of an indictment
about his naivete about thevalue that pathologists bring to
patient care more than it wasreflective of the discipline
itself, pathology. So all thisis to say that I think we we
really need a bit of arevolution in the basic sciences
(09:34):
to show in a real and tangibleway how they're foundational to
the practice of medicine and howthey actually do allow you to
better care for patients. And Ineed think we need it so that
the students understand it, thatour faculty, colleagues all
understand it, and everybody'ssinging from the same hymnal, if
you will, about how importantand integral the basic sciences
(09:55):
are.
Speaker 3 (10:01):
For more laboratory education, including a listing
of conferences, webinars, and ondemand content, visit
mayocliniclabs.com/education.
Dr. Kreuter (10:21):
What are the
some of those thoughts that youhave about how basic science
should be thinking about thesechallenges? You've talked about
we need to have a revolution,and some initial thoughts that
go through my mind is thinkingabout how are we teaching this
information, how are weconnecting it. But I'm also
thinking about what's the roleof kind of professional identity
(10:43):
formation, kind of getting theminto the mindset of thinking
like a physician. What are yourthoughts on how we should be
thinking some things to throwsome chum in the water for the
audience?
Dr. Maleszewski (10:55):
It's a great question, Justin. And this is
one I I spent a lot of timethinking about, and I've kind of
maybe alluded to a fewstrategies in answering your
other questions. I'll kinda hitit more directly now, I think.
There's one approach that I'vebecome particularly fond of as
I've reflected on this problemover the years. And it relates
to the fact that when we talk tomedical students, especially
(11:16):
when they're approaching the endof of medical school, I spend a
lot of time with fourth yearstalking to them about what their
experience was like and whatthey would improve, what things
were good, what things were bad,that type of thing.
When I asked them about whattheir most impactful part of
medical school was, almostuniversally, the vast majority
point to something in theclerkship phase, either a
(11:37):
specific anecdote or morebroadly the experience. They
love the rotations. They seeevery day how their work impacts
real people. They feel likethey're part of a team. They're
actively learning.
Their hands are dirty. They'rein it. They love it. They feel
alive, and they feel likedoctors, you know, for the first
time in their life, and they'rethey're sort of treated like one
in the clerkship phase as well.I would submit to you that I
(11:59):
think we need the basic sciencesto make students feel that way.
And I've been toying around withthis idea of potentially
leveraging our labs, and we havean enormous laboratory footprint
here at Mayo Clinic. So I thinkwe're uniquely suited to be able
to do this, but I think thiscould be done on some scale at
most large academic centers. Andit would be the idea to use
(12:21):
those labs to create a clerkshiplike feel to the content. You'd
be learning about antigenantibody interactions in the
blood bank where those problemsand and that issue is dealt with
nearly every minute of everyday. That's an example that's
clearly close to your home.
Right? You'd be learning aboutmicrobiology sitting alongside
(12:41):
amazing microbiology techs whoare plating and setting up
cultures and kind of readingresults and doing gram stains
and, again, seeing the actualvalue of that as they report
things out and call theproviders to let them know about
these results. Learning anatomyin either radiology or surgical
pathology where clinicallyrelevant anatomy is addressed
and referenced all the time,every day there as well.
(13:04):
Pharmacology with pharmacistslooking at metabolic curves,
looking at mechanisms ofactions, drug interactions. All
of those basic sciences arerooted in those areas.
And so we would still need todeliver core content, but
increasingly, our students arewanting and getting that content
asynchronously. So I wouldsuggest maybe we stop resisting
(13:28):
that so much and kind of giveinto it and allow that content
to be delivered asynchronouslyand use the time that they spend
with us in a way that shows themhow the sciences, the basic
sciences are used in the serviceof patients every day. And in
addition to getting them to seethe relevance of it, getting
(13:49):
them excited in kind of a newformat and in a new delivery
model, it would also have thisgreat side product of getting
them to see how sometimes hiddenmedical professionals are
working and what they do. Thosestudents would have a much
better appreciation for theteams that they're going to be
eventually leading as wementioned earlier. And it's a
great opportunity to givestudents a window into the
(14:10):
expertise these folks bring tothe table and how they can
leverage that when they're oneday leading the teams and taking
care of patients.
And so I think there's a ton ofopportunity here, and I think
there's lots of creative ways tothinking about this. There are
other people who have reallygreat ideas too, but that's one
of the things I'd like to tokind of send trial balloons up
(14:32):
and and and give a whirl overthe next few years, I think.
Dr. Kreuter (14:35):
I really appreciate how you're talking about that.
And certainly, it seems toconnect a lot to the why and
helping somebody see what roleis this playing in patient care.
Are there any people talkingabout where this integration
might be, where we might see,like, basic sciences kind of
boomerang back into playing arole in third and fourth year?
Dr. Maleszewski (15:00):
Yeah. There there are, in fact. And some
folks have kind of talked abouta model, kind of a more of a
sandwich model where you deliversome basic sciences upfront,
then you kinda do thetraditional clerkship thing and
all that. And then you revisitthem at the end in the form of a
an advanced science curriculumthat gives them that
perspective. And I think there'sa lot of merit to having that
(15:20):
conversation as well because,again, it gets at what we were
talking about earlier of, again,in hindsight, you start thinking
about, like, wow.
If I could go back and look atthat content with new eyes and
new information and know how Iwould let it boy, I'd pay more
attention to x or y, or I'dthink about it in this way
that'd be different than the wayI approached it the first time.
So I think that would be a lotof fun to try out too, and I
(15:42):
think there'd be value in that.
Dr. Kreuter (15:43):
Yeah. Absolutely. That resonates. And in my
experience with anesthesia isthey come through transfusion
medicine. Right?
They come on and they've hadexperiences late. They've lived
it. Not only are they verykeenly on the edge of their
seat, but like you're saying,they have really astute
questions that demonstrate, say,they understand how this is
getting, playing out in theclinical practice.
Dr. Maleszewski (16:06):
Exactly.
Dr. Kreuter (16:07):
Kind of last question. I just want to kind of
maybe transition a little bit ofadvice, thinking about your role
as a Dean for Academic Affairs.You know, maybe we have some of
your colleagues listening tothis podcast. Maybe there are
some of us that are interestedin taking on leadership roles
and thinking how can they helpother colleagues. And so that's
(16:28):
kind of my question is, how canwe best advise listeners who may
be involved in the basic sciencecurriculum or who may be playing
a supporting colleague role?
How can we help to kind of sparkthis transition we're talking
about?
Dr. Maleszewski (16:46):
Yeah. Another great question. And and I think
it starts with advocation. Aslab professionals like you just
noted, we have a special footingin the basic sciences. We have a
real special and tightrelationship with them.
Right? Showing and telling ourcolleagues how the basic
sciences are critical to ourwork and the answers that we
provide our colleagues with thatallow them to directly care for
(17:06):
patients, that's where it allstarts. That's kind of a
linchpin, I think. Then I thinkafter that advocation, being a
willing partner. Being willingto teach, try new things,
develop different strategies,test them out, develop rigorous
pedagogical and educationalmodels, good assessments that
show that the things that you'retrying and the things that
you're advocating for are valueadded and impactful and improve
(17:29):
outcomes, that's absolutelycritical.
Both you and I know that medicaleducation, it's more than fun.
Right? It's a blast when you'reinvolved in it. And I worry that
for some of our colleagues, it'soften seen as it's just another
ask in their crazy busy days. Useducators really need to remind
our colleagues about howrecentering and rejuvenating an
(17:52):
important education is forprofessional satisfaction and
not to give into the tides thatwould essentially wind up
cutting the basic sciences outof the MD curriculum entirely.
And I think that would be veryeasy for us to do because,
again, we're all super busyprofessionals, and this is just
another thing on the to do list.In the end, though, I think it
would be nothing short ofcalamitous to many of our
(18:15):
disciplines in the basicsciences to getting students in
the next generation excitedabout these disciplines if
they're not exposed to it. But Ialso think more importantly
perhaps than even that, I thinkit will be a disservice to
patients if those basic sciencesare deemphasized or go away
entirely. We will not be able tocare for patients if we aren't
(18:37):
producing physicians who havethat really fundamental and
foundational knowledge and thatmindset to the basic sciences.
So I think this is not withoutchallenges, certainly.
And I think there's a lot oftough headwinds that we are
facing into. But I think there'sa a lot of promise here too. And
there's a lot of things that wecan do in a lot of ways that I
(19:01):
think other areas of thecurriculum are perhaps opening
up a little bit that will giveus places to insert ourselves.
So I think there's a lot to behopeful about too.
Dr. Kreuter (19:10):
We've been rounding with doctor Maleszewski talking
about basic science, the medicalschool curriculum. I really
appreciate you taking the timeto talk with us and really
challenge us with this, doctorMaleszewski.
Dr. Maleszewski (19:21):
The pleasure is all mine, Justin.
Dr. Kreuter (19:22):
And to our listeners, thank you for joining
us today. We invite you to shareyour thoughts and suggestions
via email to mcleducationmayodot edu. If you've enjoyed this
podcast, please subscribe. Anduntil our next rounds together,
we encourage you to continue toconnect lab medicine and the
clinical practice throughinsightful conversations.
Popular Podcasts
Stuff You Should Know
If you've ever wanted to know about champagne, satanism, the Stonewall Uprising, chaos theory, LSD, El Nino, true crime and Rosa Parks, then look no further. Josh and Chuck have you covered.
24/7 News: The Latest
The latest news in 4 minutes updated every hour, every day.
The Joe Rogan Experience
The official podcast of comedian Joe Rogan.