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Pediatrics / Education & Training / Medical Student Educational Programs / First & Second Year Primary Care Clerkship

First & Second Year Primary Care Clerkship

Year One

Mastering Medical Information. MMI provides opportunity for learners to begin developing their knowledge, skills and experience with finding, evaluating, integrating and communicating medical evidence into processes of patient level and population level clinical reasoning. Content includes biostatistics, epidemiology, clinical testing & population health. The course is taught through lectures, problem based learning, debate and “teach back” small group exercises.

Introduction to Clinical Medicine. ICM takes place during the first 18 weeks of year one. Students learn to acquiring information in the clinical setting—the patient interview and physical exam. Applying principles of the biopsychosocial model, students learn how to interact with diverse patients, preparing them for the clinical courses that follow. The course is taught through lectures and small group instruction with standardized patients.

Human Structure and Function. HSF is a 14-week course that follows MMI. It is an integrated course that teaches gross anatomy, histology, embryology, and physiology. During HSF, ICM is organized so that the physical examination and focused history for each body system are learned as that system is studied and dissected. The course is taught through lectures, large group interactive discussion sessions, problem-based learning cases, and laboratory experiences (gross anatomy, physiology and histology) and physiology problem set conferences.

Molecules to Cells. MTC starts the second semester of year one continuing with the basic science strand. MTC is a I0-week course that provides the foundations in biochemistry, genetics and cell biology curriculum. It is organized into seven theme blocks: biochemical basics and systems integration; intermediary metabolism; molecular genetics and cell biology; cell growth control, development, cancer and aging; medical genetics; genetic-environmental interactions; nutrition. The course is taught through lectures, problem-based learning cases and patient encounters. Theme content of the Double Helix Curriculum is also tightly woven into the course.

Skills in Complete Patient Evaluation. SCOPE begins the clinical strand in January of the first year by exposing students to patients across the lifespan from pediatrics to geriatrics and in a variety of care settings, while reinforcing skills learned in the ICM course during the fall. This includes evaluation of diverse patient populations including those with chronic illness and disability. This 10 week course is taught through lectures and small group sessions. Additionally, a major portion of the course is direct patient interactions. Students spend four half-days in pediatric settings, physical medicine and rehabilitation settings, the acute hospital and nursing homes.

Host Defense. HD is the final basic science course of year one. It is a 7-week course that introduces immunology, inflammation, microbiology, dermatology (skin is taught as a Host Defense organ). Within microbiology, bacteriology, virology, mycology and parasitology are key topics. The course is taught through lectures, problem-based learning cases and on-line independent virtual laboratory sessions.

Addressing Disparities in Healthcare (ADH). ADH is a one-day interprofessional (nursing and medical students) educational module that introduces students to the impact of community health and bioethics in addressing disparities in healthcare delivery. Within care teams, students explore how socio-economic disparities based on zip code, living conditions and access, impact health in families. Students will reflect on their own biases and knowledge of the principles of bioethics as they apply them to case scenarios with family members.

Pharmacology. Pharm is a 2-week course that provides students with a solid foundation in pharmacokinetics, pharmacodynamics and receptor mechanisms. It also gives a broad background in autonomic pharmacology, cancer chemotherapy, antihypertensives, cardiac pharmacology, and anesthesia. The course is taught through lectures, small group problem sessions and a mannequin simulation. Many of the specific areas of pharmacology are integrated into other courses, particularly DPT. Assessment is through a written exam.

Year One to Year Two

Medical Humanities Seminars. Students are required to select at least two Medical Humanities Seminars (MHS) during the first two years (one in the second semester of year one and one in the first semester of year two). Seminars are two hour session once a week for 8 weeks. Topics have included bioethics and law, philosophy, medical history, visual arts, literature and narratives in medicine, disability, spirituality, social and environmental perspectives in healthcare, complementary and alternative medicine, national healthcare reform, Latino health, deaf health, and others.

Primary Care Clerkship (PCC). PCC forms the clinical strand from March of year 1 through May of year 2, meeting three afternoons per week. During the first year of PCC, learning objectives are focused primarily on prevention, screening and wellness. Students practice advanced interviewing competencies, with a focus on health behavior change. Year Two turns to Primary Care management of acute and chronic illnesses, organized around common outpatient conditions (e.g. chest pain) presented in the context of organ system pathophysiology being taught in DPT (e.g. cardiovascular system). Physical diagnosis sessions early in year 2 reinforce and add to earlier learning of the physical exam, with attention to identifying and interpreting abnormal findings. Clinical preceptorships in adult and pediatric primary care office settings begin in year 1. During the second year course, students have two longitudinal preceptorships: 28 weeks with an adult primary care physician, and 10 weeks with a primary care pediatrician. Assessment methods include preceptor evaluations, course exams, standardized patient encounters, graded clinical notes, and the NBME Family Medicine shelf exam.

Year Two

Mind/Brain/Behavior. MBB is a 10-week course that introduces the principles of neuroscience, neuropathology, neuropharmacology, psychopathology and psychopharmacology. Nine PBL cases integrate these basic sciences with the clinical disciplines of neurology and psychiatry. In addition, fourteen laboratory sessions reinforce neuroanatomy, neuroradiology and neuropathology through gross brain dissections and a review of neuroimages and gross and microscopic pathologic specimens.

Disease Processes & Therapeutics. DPT spans 17 weeks and is taught in a block model utilizing lectures, problem based learning, laboratory, team based learning and other methods. Content covers the relevant pathology, pathophysiology, pharmacology and other therapeutics of disease. The two semesters cover the fields of Gastroenterology, Infectious Diseases, Endocrinology, Renal/Urology, Pulmonary/ENT, Cardiology, Hematology and Rheumatology. Assessment is through written examinations, an oral exam, and performance in small group/PBL activities.

Women’s Health Course. WH is a 2-week course that follows DPT and provides a foundation for understanding women's reproductive disorders across the life stages. Each topic will be approached by reviewing the normal state before exploring the disorders. Topics covered will include sexual development, puberty, menstruation, reproduction, pregnancy, gynecologic disorders, breast disorders and menopause. Topics will be explored using flipped classroom exercises, lectures, pathology labs, team based learning exercises and a simulation experience for labor and delivery. Students will perform self-assessment through multiple choice questions provided on each topic and will complete a comprehensive multiple choice exam.

Comprehensive Assessment. At the conclusion of DPT, students spend 2 weeks in the Comprehensive Assessment (CA), a one and a half week formative assessment of knowledge, skills, and attitudes using multiple formats, including OSCEs, multi-source feedback, small and large group discussions, peer- and self-assessments, tests of basic and clinical science knowledge, and a 4 hour mock-NBME Step 1 exam. The Comprehensive Assessment guides students to discover their strengths and weaknesses in the domains of information gathering, interpersonal communication, medical knowledge, and professionalism. They come away from these ten days with a well-developed preliminary "Individualized Learning Plan", naming realistic and meaningful goals and both the means and time frames to their achievement.

Quality, Safety, and Inter-professional Communication Module. QSICM begins a longitudinal experience bringing medical and nursing students together to learn the science of safety and the importance of teamwork in providing safe and high quality patient care. The module begins with a two day experience of didactic lectures and workshops exploring the root causes of medical errors, the role for human factors engineering and safety culture in preventing medical errors, and several team communication strategies. The following year, students meet again and participate in a facilitated debriefing of real life safety concerns from their clinical rotations.

Disorders of Childhood. DOC is a 2-week course focusing on illnesses and anomalies that specifically present in or are confined to childhood. Using a systematic approach and illustrative examples, the course will focus on developing knowledge and understanding of key concepts regarding how growth and development, embryonal through adolescence, relate to the occurrence of disorders, treatment decisions, and long term outcomes. Team based and individual learning exercises will complement the lectures and labs.

Stress, Adaptation and Transition. SAT is the final basic science course in Year 2. This course has two major purposes: Using the stress response and the (mal)adaptation that chronic stress engenders as a basis for combining the basis sciences in an integrated fashion, and continuing to prepare students for their upcoming clerkships. To this end, the course is organized around seven basic patient scenarios that students (in small groups) manage while using the hospital information system to enter orders and retrieve data. This is supplemented by limited large group sessions and a joint integrative simulation exercise along with students from the Graduate School of Nursing.