Low-Lift, High-Yield: Integrating Aquifer into Preclinical Curricula

Health professions education is undergoing a transformation. As institutions work to prepare learners for real-world clinical practice earlier in their training, bridging the gap between the preclinical and clinical phases has become a top priority. For faculty navigating this challenge, Aquifer offers a powerful solution: case-based virtual patient encounters that foster early clinical reasoning, contextual understanding, and confidence in a safe, structured environment.

During a recent Aquifer Office Hour, health professions faculty from institutions across the country shared their strategies for integrating Aquifer into the preclinical curriculum. Their insights provide practical, tested approaches to enriching early health professions education and preparing students for success in clinical training.

Why Use Aquifer in the Preclinical Phase?

Aquifer is a nonprofit organization that provides peer-reviewed, evidence-based virtual patient cases, simulating real-life clinical encounters. These cases are developed and maintained by a national Consortium of over 100 academic educators, ensuring alignment with national curricula and up-to-date best practices. For early learners, this means a chance to “see” patients, long before they enter clinical spaces, in a safe, standardized, and structured environment.

Aquifer is increasingly being adopted in preclinical settings to:

• Introduce clinical reasoning early
• Reinforce foundational sciences with clinical context
• Provide equitable, consistent learning experiences
• Supplement faculty time and resources

As Dr. Lauren Azevedo, Director of Pre-Clerkship Clinical Skills at Michigan State University College of Osteopathic Medicine, noted:

“Aquifer helps provide early clinical exposure in a way that is both logistically feasible and pedagogically sound. It grounds the ‘why’ behind the science.”

Educator Strategies for Implementation

Educators highlighted several innovative and practical ways to implement Aquifer into preclinical education:

1. Weekly Case-Based Learning with In-Class Debriefs
   
   Kelsey Dougherty, PA-C, Assistant Professor from the University of Colorado School of Medicine Child Health Associate Physician Assistant Program, shared how her PA program includes a three-hour "case time" weekly, with students completing Aquifer cases before class. These sessions follow a structured debrief process.
   
   

   • Pre-work: Students complete Aquifer cases independently, including writing a Summary Statement.

   • In-class debrief: Faculty use a flexible guide to lead discussion, emphasize differential diagnosis, management planning, and connect back to core science.

    

   This method has not only enhanced clinical reasoning but also provided faculty with tools to identify struggling learners early by reviewing their summary statements.  “Those who can’t write a solid summary statement are often struggling elsewhere too. It’s a great diagnostic tool for us,” Dougherty explained.
   
   

2. Pairing Virtual Cases with Real Patient Encounters
   
   Dr. Azevedo described a powerful learning experience where students worked through an Aquifer case, followed by interaction with a real patient presenting with a similar condition.
   
   

   • Aquifer provided foundational knowledge and a safe simulation.

   • Meeting a real patient reinforced empathy, communication, and contextual relevance.

   
   

   "It added layers of context. The students told us it made the science feel real,” she said. This approach brings case-based learning to life and supports longitudinal skill development.
   
   

3. Asynchronous Learning & Assessment Support
   
   Tina Hockenberry, DO, a hospitalist associated with Geisinger Commonwealth School of Medicine, emphasized the value of Aquifer in self-paced learning and foundational review. Her institution integrates Aquifer as:

   • Preparatory material for clinical skills labs and patient presentations

   • A review tool to align with block exams and reinforce basic sciences

   
   Aquifer supports flipped classroom models, allowing in-person time to be used for skill practice and deeper discussion.
   
   

Tools That Support Learning

Aquifer includes several built-in tools that further enhance learning and assessment:

Educators report that these tools make learning visible and provide both students and faculty with meaningful data.

Addressing Common Challenges

“What if students push back on pre-work?”

Faculty have found success in managing student workload by clearly integrating Aquifer into existing courses and emphasizing its relevance to students. At Michigan State University College of Osteopathic Medicine, a school-wide culture of flipped classroom learning made this easier. “We position Aquifer not as extra, but as a foundational tool. Students engage better when they see the payoff,” Azevedo said.

“What if I don’t know where to start?”

Start small. Aquifer’s Educator Resources include case guides, discussion prompts, and templates that can be adapted for different settings. Faculty also suggest reviewing one or two cases that align with your current curriculum and building from there. “Don’t reinvent the wheel. Aquifer likely already has the content you need,” said Dougherty.

Clinical Integration & Longitudinal Value

Many programs use Aquifer throughout the curriculum, not just in preclinical years. Aquifer supports:

• Remediation for students needing additional help
• Preparation for clinical rotations via capstone courses
• Flexible learning during missed clinic time

As Michelle Dumas, PA-C, Philadelphia College of Osteopathic Medicine noted, “We assign Aquifer when students are out sick or miss clinical time. It’s an efficient, trusted substitute that keeps them engaged.” Others, such as Dr. Corki Lehmann, Pediatric Clerkship Director at the University of Cincinnati College of Medicine, use Calibrate to assess learning before and after clinical rotations, helping students develop self-directed learning plans.

Preparing for Clinical Success

When used strategically, Aquifer helps students:

• Build confidence in history taking and diagnosis
• Understand the clinical relevance of basic sciences
• Develop communication skills via summary statements and oral presentations
• Practice decision-making in a low-risk setting

Programs have also found success using Aquifer in capstone courses and as part of remediation efforts, reinforcing its adaptability across the educational continuum.

Take the Next Step

Whether you're looking to enhance your preclinical curriculum, prepare students for transitions, or improve clinical reasoning, Aquifer offers practical tools and evidence-based resources to help.

Looking for more guidance? Schedule a Curricular Consult to receive tailored advice and strategies for your program.