A new conceptual framework for preclinical departments in schools of medicine: Maximizing groundbreaking work through thematic breadth

Basic sciences form the foundation of medical knowledge and practice in medical schools. Since the 1910 Flexner Report, which led to the establishment of multiple basic science departments, faculty in these departments have been responsible for preclinical courses in the first 2 years of medical education. The basic science disciplines and their associated faculty have been crucial to medical education, fostering critical thinking and preparing physicians for rapid advancements in medicine. Importantly, they have grown as engines of innovation and influence to comprise hubs for fundamental and translational research. More recently, a convergence of influences, including the adoption of integrated curricula and other changes in the traditional medical education structure, as well as financial pressures and ongoing changes in research funding, has prompted many institutions to re-evaluate the organization of basic sciences, leading to a wave of departmental consolidations. While this may seem administratively and financially attractive, it could have the unintended consequence of consolidating scientific thought, with an attendant stifling of innovation. To sustain the institutional capacity for making the paradigm-shifting discoveries essential for transforming medicine in a shifting research landscape, we propose a new rationale for maintaining or even expanding the multi-departmental structure. Our model builds on recent research suggesting that thematic diversity and inter- and trans-disciplinary teams are fundamental features crucial for innovation. We propose a novel approach that involves the establishment of an institution-wide strategic theme, layered over a multi-departmental structure in which individual department chairs are recruited based on the extent to which their research agenda aligns with the strategic theme. This broad institutional strategy preserves the unique contributions of individual disciplines while fostering interdisciplinary collaboration, thereby maximizing thematic breadth and synergy. By balancing administrative efficiency with the imperative for innovative research, medical schools can establish a unique identity with an associated future vision. Importantly, the existing strengths that foster this vision provide the basis for explosive growth, with the capacity to shape the future of medical education while creating an environment conducive to groundbreaking discoveries and advancements in medical science.