Shrinking Curriculum
Historically, basic scientists taught medical students in the first two years of the medical school curriculum. The standard model was that a faculty member would give a few lectures and perhaps run a course in their area of expertise. Students learned information through lecturing, but most schools are now moving to models that involve team-based learning or a problems-based curriculum, and some schools have completely eliminated lectures. As a result, the medical student teaching justification for basic science faculty has diminished substantially, and some schools are shifting dollars from basic science departments to the medical student teaching program.
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July 2019Dr. McKinney added that teaching graduate students in the basic sciences continues to be an important role for basic science departments, a function supported by tuition dollars and by grants. However, attrition of faculty at some graduate schools means that programs are losing the critical mass of faculty necessary to sustain a basic science graduate program.
The lack of stable, long-term funding also makes it difficult to build and expand new programs and recruit and retain basic science faculty, Dr. Dubno said.
On the positive side, doctoral degree graduates in the biomedical sciences are very employable, Dr. McKinney said. The majority of them go into jobs that aren’t within academia, but rather in industry, government, or research.
Space Limitations
Departments also struggle with limited availability of high-quality space for clinical and basic science laboratories, Dr. Dubno said. Additionally, available space is rarely co-located with space designated for clinical faculty or basic science faculty who work in different sub-disciplines, which reduces opportunities for effective collaborations among clinicians and basic science faculty. Similarly, equipment, up-to-date technologies, and necessary renovations may be lacking due to limited intramural or extramural funding.
The Greater Impact
The balance among clinical care, education, and research is being tilted toward clinical care—which is the major source of income for a school and its affiliated hospitals. This results in a lower emphasis on and fewer funds invested in the basic sciences. “The intermediate to long-term risk is that academic basic science departments become more marginalized with fewer investigators,” Dr. Yarbrough said. “The erosion of academic pursuits in schools of medicine risks the leadership roles that schools have held and will ultimately slow innovation that would benefit patients.”
Dr. McKinney said that huge opportunities to improve care in hearing restoration and communications disorders will require more knowledge of how the brain processes acoustic signals at everything from the cellular level to the neuronal networks that respond and interpret the information. “But if basic science departments suffer, progress will be limited,” he said.
Because they have close relationships with basic science departments through collaborative research, shared faculty, and curricula that emphasize the intersection of basic and clinical knowledge, otolaryngology departments will face challenges for maintaining academic and educational missions. “Diminution of basic departments will make these challenges more acute,” Dr. Yarbrough said. “Strong basic science departments within medical schools are needed to train the next generation of otolaryngologists and to partner with otolaryngology faculty to advance our understanding and treatment of diseases of the upper aerodigestive tract.”