Presented By: Katherine Hyland, University of California, San Francisco
Co-Authors: Jill Bond, University of California, San Francisco
Sam Brondfield, University of California, San Francisco
Heidi Kirsch, University of California, San Francisco
Kelly O'Brien, University of California, San Francisco

Purpose 
Cognitive integration (CI) connects foundational science (FS) to clinical practice and improves reasoning. While evidence supports CI in medical training, the relevance of FS to clinical medicine is often obscure to students, and few learning materials exist to support CI during clerkships. Tools that effectively promote CI may improve clinical reasoning. Thus, we developed and evaluated a FS online lesson for clerkship students. 

Methods 
Based on prior student feedback regarding the relevance of F S during clerkships, we (an oncologist, a geneticist, and an instructional designer) applied the cognitive theory of multimedia learning to create a 45-minute Qualtrics online lesson (OL) with text, images, questions, and explanations grounded in the hallmarks of cancer (HoC), a key FS principle. To emphasize relevance, we included videotaped patient interviews. We implemented the OL in 2022 and compared feedback to older OLs that were videotaped lectures with interspersed self-assessment questions. 

Results 
Out of 138 HoC student views in 2022, 27 submitted feedback compared to 34 feedback submissions total across 16 older OLs from 2020 to 2022. Students rated the HoC OL higher than the older OLs: 1) balance of FS and clinical materials (4.74 vs 4.21, p=0.02); 2) helpfulness in clerkships (4.63 vs 4.21, p=0.08); 3) met learning goals (4.70 v s 4.03, p=0.01). Comments praised the HoC module ("best online lesson I've ever done"), its format ("engaging" and "easy to follow") and the patient videos ("impactful" and a way to "anchor knowledge"). 

Conclusion 
Authentic patient stories enhanced FS relevance. Content co-creation by a basic scientist and a clinician aligned with CI goals. Student feedback was highly supportive. This OL can serve as a model for the development of clerkship curricula that promote CI. Limitations include the need for funding, faculty bandwidth, and instructional design assistance. Clerkship-based outcomes were not examined.