Biology

Approaching basic science can be daunting. Without clinical experience to offer perspective, the novice student must acquire, assimilate, and apply information within a near vacuum. And yet it must be done. As the word “basic” implies, this is a body of fundamental knowledge that must be mastered before you move on to advanced topics. So how can one effectively master basic science?

The best first step is reading. Some educators recommend reading a little every day; others advocate reading in continuous thematic chunks. Whichever method you choose, the key is to make reading a constant part of your learning schedule, even when clinical responsibilities dominate your days. An excellent first source is a textbook that provides a good general overview supported by illustrative details. This should then be supplemented with more specialized texts and journal articles, particularly reviews.

Reading is only the first step; not all will be clear after the first pass through the material or even a second. The goal of reading is to give yourself a “prepared mind” (as Louis Pasteur put it), to make you ready for the real learning encounter: taking care of patients. As you progress through your clinical training, form connections between patient scenarios and basic scientific causes. After examining patients, reinforce your clinical observations by rereading basic science material.

You may, for example, see a patient with osteoarthritis of the knee. Observe that he is slightly bowlegged (a varus deformity), and note that his radiograph shows a white line in the tibia near the joint on the medial side, a finding that indicates subchondral sclerosis. Your reading will remind you that radiographs record density and that this white line therefore indicates an area of additional bone formation. Your basic science reading will also remind you of Wolff’s law: that bone grows in response to mechanical stress. Consequently, by recognizing the connection between varus alignment, abnormally high loads, and new bone formation, you can infer that the appropriate treatment for isolated medial compartment arthritis may be to unload that stress with a brace or surgical realignment of the bone perhaps. As this example illustrates, clinical observations reinforce basic science reading, which in turn helps explain the clinical findings.

How much should you memorize? It’s hard to say. Because medicine is a practical art, you must collect facts. But go beyond that. Strive to discern relationships among facts and thereby identify patterns. For a useful and satisfying mental exercise, write a list of four or five topics on a blank sheet of paper and attempt to establish meaningful relationships among the entities based on scientific or clinical principles. Try, for instance, this list: osteoporosis, stress fractures, compartment syndrome, and long bone fractures. After reading, you may see the connection between osteoporosis and stress fractures (both are characterized by perturbations of bone remodeling); stress fractures and compartment syndrome (both are conditions that can cause leg pain); compartment syndrome and long bone fractures (compartment syndrome being a dreaded complication of fractures, typically from bleeding into the soft tissues); and last, fractures and osteoporosis (osteoporosis is a prime cause of fractures, especially of the hip, wrist, and spine). Challenging yourself to make these connections will enhance your comprehension.

You may ask yourself the relevance of the basic science. A glib response is that your enlightenment begins when relevance is no longer in question. But until that point, it is fair to wonder whether the study of organs, cells, and molecules has much to do with clinical practice. The short answer is that almost every major improvement in prevention, diagnosis, and treatment has come from the translation of basic science into clinical medicine. So tackle the basic science section of this book with gusto. Even if you don’t fancy yourself a scientist, the basic science you study today may well be the basis of the clinical science you apply later in your career.

—Jaimo Ahn, PhD

—Joseph Bernstein, MD, MS