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SUNY Downstate College of Medicine Integrated Pathways Curriculum

Integrated Pathways Curriculum – Simple

Three phase structure of the four years of the new curriculum:

The curriculum for the class of students entering SUNY Downstate College of Medicine in August 2013 is divided into three curricular phases with four promotion Gateway points. All six of Downstate College of Medicine competencies are taught and assessed during the entire curriculum.

simple map of curriculum

Phase 1
Foundations of Medicine

Throughout this 18 month phase of the curriculum, students develop the foundational understanding and skills necessary to begin to care for patients on clerkships. Students begin to form their professional identity from day one as they learn clinical skills, foundational medical knowledge, and the skills needed to develop into life long learners.

Phase 2
Core Clinical Medicine

Paired clerkships during the 12 months of Core Clinical Medicine enhance interdisciplinary teaching across clerkships and support integration of relevant basic science knowledge.

Phase 3
Advanced Clinical Medicine

The 14 months of Advanced Clinical Medicine is designed to prepare students for post-graduate training and life long learning. Students are required to learn to care for complicated and/or unstable patients as well deepen their understanding of translational science.



Gateways 1, 2, 3, and 4

The Gateways are evaluation points located at the following points of the curriculum; before the second year of the Foundations of Medicine curriculum, before entering the Core Clinical phase, before the Advanced Clinical phase and in the last year of the curriculum. These are points in the curriculum at which students reflect on their mastery of the six competencies and the faculty certify that the students meet expectations in the competencies and are ready to proceed to the next portion of the curriculum, or in the case of Gateway 4, graduate.



Integrated Pathways Curriculum – Detailed

map

Foundations of Medicine: Year 1

The six interdisciplinary units in the Foundations of Medicine portion of the curriculum use a multidisciplinary, systems-based approach to teach the normal structure and function of the body while introducing students to basic clinical skills and abnormal structure and function. The disciplines (i.e., Gross Anatomy, Biochemistry, etc.) are integrated and organized into Units based either on foundational concepts (Units 1–3) or on organ systems (Units 4–6).

Each Unit incorporates multiple teaching modalities including lectures, case-based learning, team-based learning, Problem Oriented Patient Sessions (POPS), laboratories, and patient skill laboratories. Students begin to spend half days in physician's offices during Unit 2 continuing through the year. Students are expected to take responsibility for ensuring that they obtain a conceptual understanding of subject matter in addition to knowledge of factual information. Weekly formative assessments, similar to those used at the end of unit summative assessments, will help students track their progress.

Unit 1. Systems Overview: Human Structure and Function

The first Unit begins with an overview of major organ systems that allows students to begin learning and practicing clinical skills such as listening to heart and lung sounds, palpation of major organs and measuring pulse and respiration rates. Students begin to learn the structure of the human body by examining prosections and then performing dissections intended to demonstrate the musculoskeletal systems and consequences of injury to these systems. This learning will be supplemented by the use of medical imaging such as radiographs and ultrasound. Students also gain a grounding in concepts such as homeostasis.

This unit also includes: Introduction to the doctor-patient relationship, biopsychosocial model and patient-centered communications skills; the seven dimensions of a symptoms as part of the history of present illness; learning the physical exam and its correlation to anatomy, introduction to evidence-based medicine.

Unit 2. Molecules to Cells

In Unit 2 students develop an understanding of the biochemical, molecular, cellular, and genetic basis for disease. Progressing from a visual understanding of the musculoskeletal system they explore cell and tissue structure and function based on diseases with both genetic and environmental origins. Among topics to be covered are the expression of genetic information, differences in structure and function of differentiated cells, protein and enzyme structure and function, energy generation by metabolism of basic foodstuffs and the role of nutrition in health and disease, early embryonic development, the cellular basis of neoplasia, and the life cycle and function of red blood cells. Students will continue to practice and develop clinical skills related to the diseases under study.

This unit also includes: Taking a family history and a pedigree, medication history, empathy and building a doctor-patient relationship, introduction to medical ethics, biostatistics-probability, fundamentals of measurement, introduction to study design, principles of screening, public health; human development with focus on newborns and toddlers. Students begin to spend half days in doctor's offices.

Unit 3. Infection & Host Defense

Unit 3 introduces students to infectious diseases, the biology of the causative agents and the defense systems that protect against them both as defenders of the human body and as causes of disease when regulatory systems fail. Students extend their knowledge of blood cells by studying white blood cells and their role in defense against pathogens. They study the role of lymphocytes and antigen-presenting cells in humoral and cell-mediated immune responses along with understanding the body-wide distribution of lymphoid tissues and organs. Principles of neoplasia learned in Unit 2 will be extended by studying cancers of the lymphoid system, leukemias and lymphomas, and their treatment To understand the anatomical distribution of defense mechanisms and the sensitivity of respiratory passages to infectious agents, students will explore the anatomy of the head and neck and the susceptibility of these structures to infections by respiratory viruses. Diseases caused by disorders of the immune system such as allergies, inflammation, HIV infection, and auto-immunity will be examined in relation to specific diseases. The role the immune system plays in diseases of skin, muscles, bones and joints will also be a focus of this Unit.

This unit also includes: Taking a sexual history, making a problem list and summary, introduction to clinical reasoning, the hypothesis driven physical exam; study design; patient safety, public health, human development with a focus on pre-school and school age children. Students continue their experiences in the doctor's offices.

Unit 4. Gastrointestinal, Endocrine and Reproductive Systems

Unit 4 is the first of three units focused on defined organ systems. Fundamental knowledge acquired in Units 1 to 3 will be applied to disorders and diseases that affect the gastrointestinal, endocrine and reproductive systems. Initially students explore the structure of the gastrointestinal tract and the physiology and pathophysiology underlying its normal function and disorders that arise. Imaging techniques will help students relate the anatomy of the organs to their microscopic structure and the mechanisms underlying functionality. Inter-relationships between organs (e.g. bowel and liver) will be explored to understand digestion and uptake of nutrients and the role of nutrition in normal health or disease. The study of the endocrine system naturally follows learning about the gastrointestinal tract as student learn about diabetes, the thyroid and other hormonal systems. Finally, students will examine the structure and function of male and female reproductive systems and the control mechanisms that regulate their functioning. In an integrated fashion students will become familiar with diseases and disorders that affect these systems including breast and uterine cancer and dysfunctions of the endocrine systems that regulate such organs.

This unit also includes: Explaining and planning with patients; health literacy; Focus on the Review of Systems and relevant physical exam for endocrine, gastrointestinal, and reproductive systems; Study design, statistical measurement; Medical ethics, Journal Club. Students continue experience in doctors' offices.


Foundations of Medicine: Year 2

Unit 5. Cardiovascular, Renal, Respiratory Systems

After the summer, Unit 5 begins the second year of Foundations. Students will learn about the structure and function of the cardiovascular system and the effect of various diseases affecting it. Later, students will explore the functioning of the lungs and kidneys and their roles in maintaining homeostasis together with the consequences of diseases affecting these organs and their treatment. Since these organs act together to regulate normal conditions within the body, students will learn how their functions are integrated and what happens when this normal state is disrupted. Throughout the Unit students will apply their clinical skills and incorporate new information related to examination of the patient including EKG data interpretation and imaging techniques. Students will continue to practice and develop clinical skills related to the diseases under study and begin to practice taking a medical history and performing a physical exam in the hospital setting.

This unit also includes: Geriatric interview; behavior modification, motivational interviewing; focused history and physical exam relevant to cardiac, respiratory and renal diseases; problem lists incl. bio-psycho-social needs; preventive, and therapeutic plan of care; post-encounter notes; evaluate commercial pharmaceutical literature and diagnostic literature; fundamentals of study design; oral presentations. Students go to inpatient setting to practice taking medical histories, performing physical exams, preparing a differential diagnosis and an initial diagnostic and treatment plan for a hospitalized patient.

Unit 6. Brain, Mind & Behavior

Unit 6 is the last component of the Foundations of Medicine and is focused on understanding the central nervous system and its disorders. Initially students will examine the gross and microscopic structures of the various regions of the human brain using dissections, imaging and virtual microscopy. These studies will be combined with recognizing the effects of tumors and infections on the brain. Students will then learn to apply concepts of central neural pathways to the neurological aspect of the physical examination together with the effect of disorders such as epilepsy and stroke and demyelinating diseases. Finally students will explore how the brain determines aspects of human behavior and consciousness and the consequences of defects that lead to abnormal function and behavior (dementia, delirium, psychosis and anxiety or depression). Students will continue to practice and develop clinical skills related to the diseases under study.

This unit also includes: Patient-centered interviewing with the difficult patient; delivering bad news; palliative care and death and dying; focused history and physical exam relevant to neurology and psychiatric diseases; write-ups including assessment and plan; evaluate therapeutic literature; search strategies; oral presentations; shared decision-making and design diagnostic strategies. Students go to inpatient setting to practice taking medical histories, performing physical exams, preparing a differential diagnosis and an initial diagnostic and treatment plan for a hospitalized patient.

Following the assessment week for Unit 6, students will have an interval to study for and pass the Step 1, United States Medical Licensing Exam (USMLE), one of the three exams required for licensure and also required for promotion to our next level of Core Clinical Medicine.



Core Clinical Medicine (Clerkships) — 12 months

Paired clerkships during the Core Clinical Medicine year to enhance interdisciplinary teaching across clerkships and support integration of relevant basic science knowledge.

Transition to Clerkships 1 week (precedes clerkships)
   
Women's Health 6 weeks
Pediatrics 6 weeks
   
Psychiatry 6 weeks
Neurology 4 weeks
Career Exposure Elective 2 weeks
   
Internal Medicine 8 weeks
Primary Care Block 4 weeks
   
Perioperative Care, Anesthesia, & Surgery 10 weeks
Career Exposure Elective 2 weeks
   
Longitudinal Primary Care Rotation ½ day over 24 weeks of Medicine and Surgery Clerkships


Advanced Clinical Medicine — 14 months

Advanced Clinical Medicine year requires students to take the following:

Sub-Internship in Medicine or Pediatrics 4 weeks
Diagnostic Imaging Rotation 4 weeks
Translational science Selectives 4 weeks (two, 2 week selectives)
Critical Care Rotation 2 weeks
Geriatrics and Palliative Care 4 weeks
Emergency Medicine Rotation 4 weeks
Students will have 5 months of elective time and seven weeks for vacation and residency interviews.

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