Using Integrated Illness Scripts: Three Integration Stories
May 27, 2021
May 27, 2021

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Aquifer Integrated Illness Scripts are new teaching and learning tools designed to link basic science and clinical knowledge and drive cognitive integration for medical and health professions students. Integrated Illness Scripts (IIS), which include Mechanism of Disease Maps (MOD Maps), have application opportunities in both the classroom and the clinic for learners of all levels. Whether you’re adding clinical context to a pre-clinical course, or developing clinical decision-making skills in clinical students, our beta set of Integrated Illness Scripts provides a novel, truly integrated mental model for learners to scaffold their knowledge.

At our recent webinar, Integrating Basic and Clinical Sciences: Why It’s Important and Tools to Support You, we heard from several faculty from the Aquifer Sciences Leadership Team who have already implemented Integrated Illness Scripts (IIS) and Mechanism of Disease Maps (MOD Maps) in their clinical and pre-clinical courses across the curriculum. Explore the methods they are using to support cognitive integration with pre-clinical and clinical students, and find out how Integrated Illness Scripts can make an impact across your curriculum.

Justifying Diagnostic Decisions with Clinical Students

The Approach

At Case Western Reserve University, Amy Wilson-Delfosse, PhD, Associate Dean for Curriculum, has implemented Integrated Illness Scripts with clerkship students in an afternoon didactic session. The goal of the course is to build better clinical thinkers by engaging students around the work of integrating basic, clinical, and health systems sciences to diagnose and justify care delivery to an undifferentiated patient. Clinical students from mixed clerkships meet in small groups facilitated by a clinician educator on Friday afternoons, and are introduced to an undifferentiated patient in the exam rooms of the simulation center. Once the group works through the differential diagnosis as a team and establishes the top two to three most-likely conditions, they collaborate to create Integrated Illness Scripts and Mechanism of Disease Maps for those diagnoses. Dr. Wilson-Delfosse notes that “By comparing the MOD Maps, the students are generally able to justify their top diagnosis and begin to consider good choices about options for further work-up and treatment.”

Early Wins

“While it can be a challenge sometimes for students to appreciate the value of curriculum in real time, it is nice to see that as our learners move on in their clinical training, the benefits of integrating basic science and clinical education emerges in their path toward clinical mastery and independence,” said Dr. Wilson-Delfosse. “One of our fourth-year students commented that it forced him to really justify why each condition he was testing for made sense, and why it deserved to be tested for.  That is the kind of thinking we need our future clinicians to employ to avoid harm and provide high value care.” Another positive outcome is that faculty enjoy teaching in this integrated program, commenting that the experience allows them to engage their clinical expertise and consider along with the students how basic science can improve clinical decisions. After the first year, Case Western increased the number of small groups by 10% in order to accommodate all the clinician educators who wanted to facilitate.

Synthesizing Pre-Clinical Learning by Building & Comparing IIS

The Approach

At Dartmouth’s Geisel School of Medicine, Dr. Leslie Fall, Adjunct Professor and Aquifer CEO, created a second-year selective during the cardio-pulmonary semester that focused on applying knowledge gained from lectures and problem-based learning sessions to a single patient presentation and diagnostic decision. The goal of the course was a common one–to help pre-clerkship students to integrate and clinically apply what they have learned. “To establish the curriculum, I collaborated with the pre-clinical dean to identify six common conditions that are being taught in the cardio-respiratory block and associated problem-based learning sessions. I then developed a short patient vignette for which these six conditions would reasonably be either the leading diagnosis or on the differential diagnosis,” said Dr. Fall. Working in six teams, the students developed an IIS and MOD map for their given condition across six evening sessions during the semester. In the final session, the students–collaborating with all of the material as a ‘common mind’–applied the scripts and maps by comparing and contrasting them to defend a leading diagnosis and a prioritized differential diagnosis for the patient with chest pain and dyspnea in the vignette.

Early Wins

The students found the experience of building IIS and MOD maps, and applying them to a clinical scenario valuable–even in their already packed schedules. Course evaluations showed that students enjoyed the learning experience (4.8 out of 5), with the course earning a 4.6 out of 5 excellence ranking in the overall evaluation.

“I learned how to think about the basic science behind clinical presentations, and that even the most complex disease can be understood by considering basic science principles that underlie the disease process.”

  • Second-year student

“This selective gave me valuable tools to use moving forward in the remainder of my medical education. I’ve already been able to put them to use in my preceptorship and in preparing for my most recent round of final exams. I believe my strong performance was partially due to this method.”

  • Second-year student

Reinforcing Cognitive Integration Across the Curriculum

The Approach

At Loma Linda University School of Medicine, Khiet Ngo, DO, MS, has built Integrated Illness Scripts into all four years of the institution’s new Discovery Curriculum. When designing the curriculum, faculty wanted students to go beyond consuming knowledge, but also to build skills of deconstructing, analyzing, and building their own conceptual understanding. They faced the challenge of providing ways for students to practice cognitive integration in a way that faculty could “see” and support. “After discovering Aquifer’s Integrated Illness Scripts, it became clear to us that these were truly boundary-crossing tools that can be used for teaching, learning, and most importantly, clinical practice at any level of learner, faculty, or health care provider in clinical practice,” notes Dr. Ngo. “In order to promote repetition and reinforcement, we integrated IIS and Mechanism of Disease Maps across all four years of the curriculum, building activities around creating IIS and MOD maps, and applying them in problem-based and case-based learning activities throughout.”

For the full story on Loma Linda University’s approach from M1 to M4, be sure to read Dr. Ngo’s blog post: ”Building On Basic Science: Integrated Illness Scripts As A Foundational Boundary-Crossing Curricular Tool”.

Early Wins

Assigning students to create IIS and MOD Maps builds in repetitive practice applying their cognitive integration framework, and generates concrete work that reveals what was once hidden in the minds of learners. Faculty have noted that it is really rewarding to see the progress of student work, and have the opportunity to offer feedback and coaching as students work through the process. “Universally, from first years to fourth year, students find the activity challenging and note that it has been very useful on a clinical level,” said Dr. Ngo. “We’ve had success using authentic synthesis essay questions on exams, which have been helpful in assessing cognitive integration.”

“My attending was surprised when I was able to describe the pathophysiology of diabetes as a first year student.” 

  • First-year student

“One of the most difficult things I’ve done in medical school, but it’s an activity that I wish I had done earlier.”

  • Fourth-year student commenting on how this would have helped him better develop clinical reasoning skills during his training

Accessing Integrated Illness Scripts

Aquifer’s beta set of Integrated Illness Scripts will be available to curricular partners on July 1, 2021. View a demo script, or learn more about Integrated Illness Scripts here.

Integrating Basic Science