Curriculum

• MD/PhD Student Handbook (3^rd Edition, Spring 2009)

The First Year (Medical School)

MD/PhD students at the University of Rochester have the option of starting a laboratory rotation in the summer preceding the beginning of medical school. Students taking this option will receive a stipend during the summer. It is critical that such students identify themselves soon after acceptance in order to make the necessary arrangements.

A day-long retreat is scheduled for all MD/PhD students and a subset of faculty involved in the program at an off campus site early in the academic year, typically the Friday prior to the day medical school starts. Planned by the MD/PhD Student Council, this event welcomes new students to the program and consists of a balance of research presentations (students and an invited scientist) and social activities.

MD/PhD students participate in the full first-year medical school Double Helix Curriculum, including all lectures, laboratories, Problem-Based Learning (PBL) sessions, Introduction to Clinical Medicine (ICM), and the Ambulatory Care Clerkship (ACE). For some classes (e.g. Molecules to Cells), MD/PhD students share the same PBL group. This creates an opportunity to delve into basic science issues together.

All MD/PhD students participate in an additional class, Scientific Reasoning in Medicine (SRM), that meets for 8 sessions each semester. Each session consists of a presentation on research issues with clear clinical relevance led by faculty chosen from a variety of disciplines and a student-led journal club, which provides a forum for critical evaluation of primary scientific literature related to the research topic. SRM is also required of students in the second year of the program. Thus students are introduced to the science of more than 30 faculty members in their first two years.

Other opportunities for learning about faculty research interests include regular departmental seminars, MD/PhD organized seminars, interactions with faculty who teach in the medical curriculum, and student-initiated meetings with graduate program advisors and individual faculty. These last mechanisms are particularly important for determining summer rotation options and ultimately, graduate department affiliation and thesis advisor. Regular student meetings with the Physician-Scientist Advisor and MD/PhD Advisory Directors help to gauge the progress of these important decisions as well as provide additional opportunities for advice about research options.

During the summer following the first year of Medical School, MD/PhD students typically engage in a laboratory rotation of 8 to 10 weeks duration. Laboratory rotations provide outstanding opportunities for learning new systems and techniques, familiarizing oneself with specific laboratory and departmental environments, and establishing ties with potential thesis research mentors. Thus students are encouraged to participate in two or three rotations prior to settling into a thesis laboratory. It is important to note that some graduate programs (e.g. Chemistry) do not have a formal rotation mechanism while those programs grouped under Health and Population Sciences (Epidemiology, Health Services Research, and Biostatistics & Computational Biology) offer other summer experiences.

The Second Year (Medical School)

MD/PhD students enter the second year with their medical school colleagues and participate in a modified Double Helix Curriculum as detailed below. The major benefit is completion of most curricular requirements by the end of March, allowing students to take their Step 1 Board Exams early and progress into the graduate training phase.

Students

• Participate in all aspects of Mind Brain Behavior (MBB) I (here they are again placed together in a PBL group lead by an MD/PhD Neurologist), the two week Phamacology Block and Disease Processes and Therapeutics (DPT), Modules 1 and 2.
• Take two Medical Humanities Electives. One of these electives is a special session of the course IND501 Ethics and Professional Integrity which must be completed by all MD/PhD students and fulfills requirements for training in the Responsible Conduct of Science.
• Take the Comprehensive Assessment in late March.
• Are exempt from Case Seminars.
• Participate in ACE Year 2 with some modifications in late March to May.
• Take SRM for the full year.

Years 3, 4, 5 (and 6) (Graduate School)

The transition from medical school to graduate school is aided by familiarity with graduate training and graduate faculty gained during the first two years of the program and by rotation experience(s). The late spring and summer following the second year provides an outstanding opportunity for students to finalize their choices for graduate degree program and thesis mentor. The extra time afforded by shortening the second year and the relatively late start of the graduate school calendar (September) allows students the option of completing two rotations, if desired. Alternatively, students who establish their mentor early can initiate studies leading to their thesis. Advising efforts are directed at helping students make program and mentor choices in order to efficiently take advantage of graduate courses starting in the fall. Indeed, MD/PhD students are expected to declare an area by the beginning of the Fall Semester, and a thesis advisor by January of that year (students can elect to do an additional rotation during the Fall Semester to help in this decision), although many declare earlier. Early planning, seeking advice, and multiple meetings with graduate program directors and potential thesis advisors are critical to this process.

The third year is typified by graduate program coursework and initiation of thesis research. Specific course requirements and other guidelines established for each degree program are provided in the MD/PhD Student Handbook. Components common to all guidelines include granting MSTP students 30 hours of credit toward coursework accomplished in the Double Helix Curriculum, core and advanced graduate courses specific to each program, and required participation in graduate student seminar series, journal clubs, and departmental/program seminar series. Teaching requirements within most graduate programs are waived for MD/PhD students, though students may elect to participate, and outstanding opportunities for teaching exist in most programs.

Participation in all graduate student activities and required steps for obtaining the PhD degree, including qualifying examinations, ensures that MD/PhD students have regular opportunities for presentation of their work and evaluation of their progress. In addition to graduate student seminars and presentations at national scientific meetings, our students present their work at MD/PhD specific events, including our chalk talk series and poster or oral presentations at our Annual Retreat, Revisit Day, the Upstate New York MD/PhD Student Conference, and the National MD/PhD Student Conference.

The Longitudinal Clinical Experience

During graduate training, all MD/PhD students spend one-half day per week for four semesters engaged in clinical activities. Typically started in the fall of their third year, the goal of the Longitudinal Clerkship is to maintain clinical skills, to explore unique areas of interest and mentorship, and experience research and clinical roles at the same time. Our students view this unique opportunity as a highlight of the program and feel that it complements their research experience. Students receive two weeks of elective clinical credit per semester, reducing overall requirements in the clinical phase. Each semester is typically spent with a different Preceptor, chosen on the basis of the student's research and career interests. Students can elect to spend two semesters with one preceptor.

Later years are filled with ongoing research towards the student's thesis and engagement in laboratory and departmental activities. For students in Health and Population Sciences there may be additional coursework during this time. Because of the nature of the research, students earning a degree in Epidemiology may complete the 3^rd and 4^th year of medical school while their data matures, returning in the last year to write up results.

MD/PhD students continue to participate in MD/PhD seminars, social events, MD/PhD Student Council service, and program retreats. Indeed, interaction between students at all phases in the program is a critical aspect of the training process. Students are also called upon to help with admissions and recruiting efforts, including conducting applicant interviews for the program.

Transition to Clinical Years

There is significant flexibility in entering the third and fourth year medical school clinical phases of training. Coordination for reentry is accomplished in consultation with Dr. O'Banion, Medical School Advisory Deans, thesis committees, and the Medical School Registrar. Individual plans are established for each student based on their needs and status with regard to thesis completion. For students completing their thesis in the summer or early Fall, Core Clerkships (see below) can be initiated at several time points starting in July or October. Although it is possible to start Core Clerkships as late as January and still complete all requirements for graduation, this should only be attempted by students with very clear ideas about residency choices, so that proper sequencing of clerkships can be accomplished. Students who plan to enter residencies with early match may be at a particular disadvantage if they start after October.

Dr. Lambert, representing the Medical School Advisory Deans, and Dr. O'Banion meet with all students in years 5 and 6 as a group in early spring to discuss possible strategies, coordinate efforts, and offer individualized opportunities for these students to sharpen their skills for hospital-based medicine prior to entering the Core Third Year Clerkships. Specific opportunities in place include participation with third year students in a week-long general orientation session, attendance at intern morning report, and small group (3 students) exercises with an internist that allows for an observed history and physical, and case presentation. Most MD/PhD students take advantage of one or more of these experiences in preparation for reentry into Core Clinical Clerkships.

Years 6 & 7 or 7 & 8 (Medical School)

Core Clinical Clerkships occur over a one-year period and include integrated clerkships in Women and Children's Health (5 weeks each Ob/Gyn and Pediatrics); Mind/Brain/Behavior II (4 weeks each of Neurology and Psychiatry); and Adult Inpatient Care (8 weeks of Medicine and 5 weeks of Surgery). These are organized as twelve-week blocks with two weeks in each block devoted to Advanced Basic Science topics (3 total). These topics are explored in lecture/discussion and small group laboratory, journal-club, and PBL sessions, and generally cover cutting edge examples of translational research. Advanced Basic Science sessions offer additional opportunities for MD/PhD students to explore topics of special interest and meet scientists and clinicians actively engaged in translational research.

Interspersed in the core clerkship schedule are 3 elective periods ranging from 2 to 5 weeks duration. Students generally use these times to pursue other required and elective clerkships. MD/PhD students can easily meet all clinical requirements in a 1.5 year period and can receive up to 6 weeks elective credit for research conducted during their thesis preparation if needed. Thus there is ample opportunity for conducting residency interviews. In addition, students can elect to return to the laboratory in their last year to pursue additional research.