Science is fundamental: the role of biomedical knowledge in clinical reasoning.

CONTEXT Although training in basic science is generally considered a critical aspect of medical education, there is little consensus regarding its precise role in clinical reasoning. Whereas some reports suggest that biomedical knowledge is rarely used in routine diagnosis, other research has found that biomedical knowledge can become an integral part of the expert knowledge base. OBJECTIVE The purpose of the current paper is to present evidence in support of different views regarding the role of biomedical knowledge, including the two-world hypothesis, encapsulation theory and recent work on the role of biomedical knowledge in novice diagnosticians. The implications of these models for clinical teaching will be examined. DISCUSSION Recent work suggests that biomedical knowledge can help novices develop a coherent and stable mental representation of disease categories. As a result, learners are able to retain clinical knowledge over time and maintain diagnostic accuracy when faced with clinical challenges. This suggests that clinical teachers should attempt to make explicit connections between biomedical knowledge and clinical facts during training.