Foundations of Medicine

map of foundation structure - 2

Foundations of Medicine: Year 1

UNIT 1: SYSTEMS OVERVIEW: HUMAN STRUCTURE AND FUNCTION 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, palpating major organs, and measuring pulse and respiration rates. Students begin to learn the structure of the human body by examining prosecutions 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 will also gain a grounding in concepts such as homeostasis.

This unit also includes: introduction to the doctor-patient relationship, the 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; and introduction to evidence-based medicine.

Unit 1 Director: Antonia Quinn, DO

Unit 2: Molecules to Cells is divided into 5 subunits that present 5 different areas of biomedicine that share common points of integration.  The first subunit, Metabolism, introduces the biochemical pathways used to generate energy and cellular components from carbohydrates, lipids, and proteins.  Metabolic disorders such as type 1 diabetes, nutritional deficiencies and starvation, and inborn (genetic) errors in metabolism are also presented.

The second subunit, Molecular Biology and Genetics, focuses on how the genetic information in a cell’s DNA is processed from DNA to RNA to proteins, and how the expression of this information can be directly influenced by signaling between cells.  For genetics, we discuss Mendelian and Non-Mendelian genetics, cytogenetics, and population as well as multifactorial genetics.

The third subunit is Neoplasia in which we look at the molecular origins of cancer through the prism of the so-called Six Hallmarks of Cancer --- the six properties that a normal cell must acquire for it to become neoplastic.  We also discuss the environmental causes, clinical diagnosis, and treatment of cancer, as well as specific cancers such as skin, bone, and cartilage cancer.

The fourth subunit, Hematology, focuses on the molecules and cells that aid in bringing oxygen to tissues, as well as in maintaining the homeostasis of the circulatory system.  We discuss the genetic mutations that lead to malfunctions in hemoglobin, the anemias that arise from this as well as from physiological perturbations, and the blood clotting processes that, when perturbed, lead to various bleeding and thrombotic disorders.

The last subunit is Immunology in which we discuss the various molecules and cells in the immune system that together work to bring about an immune response to foreign pathogens or cancerous cells.  We explore the innate and adaptive immune systems responsible for providing this protection and also discuss various cancers arising from lymphocytic and myeloid cells.

Running in parallel are Clinical Skills activities that introduce the student to various competencies that they will need to become a functioning physician.  These include immersive studies in Evidenced Based Medicine, Social Determinants of Health that focuses on health disparities, medical ethics, biostatistics, and training in the taking of a medical history and the performance of a physical exam.  How to write and organize research papers for publication is also provided in anticipation of research activities later in Foundations.

Unit 2 Director: Michael Wagner, PhD

UNIT 3: INFECTION AND HOST DEFENSE introduces students to diseases & syndromes caused by disorders of the immune system and by microbial infection. This course starts in Subunit 1 by continuing the detailed study of white blood cells and the different types of antimicrobial immune and inflammatory processes they orchestrate that began in Unit 2. Relatedly, in Subunit 2, the microbiology of bacteria, viruses, fungi, and parasites will be explored in detail, including their diagnostic growth properties, inflammatory- and disease-causing mechanisms, and antimicrobials used to treat them.  It then applies knowledge of the immune system and host defense to explain the causes of disease when immune regulatory systems fail.   Allergies, autoimmunity, and other types of chronic inflammation, and primary and secondary immunodeficiencies - a prominent example of the latter being HIV/AIDS - are examined through disease paradigms in this Unit. 

Subunits 3-5 apply the basic biomedical knowledge of the first two subunits to in depth exploration of three clinical topics: upper respiratory tract disease rheumatologic disease and public health implications of infectious disease. To understand the anatomical distribution of defense mechanisms and the sensitivity of respiratory passages to infectious agents, in Subunit 3 students will explore the anatomy of the head and neck, including the eye, and the susceptibility of the upper respiratory structures and other mucosal surfaces to infections by viruses and bacteria.  How inflammatory processes, trauma, developmental abnormalities and malignancies manifest in the head and neck and impact the airway and cranial nerve function are discussed. Physical exam of normal and abnormal structure and function of the head, eye, ear nose and throat is integrated with interpretation of radiologic and ultrasound imaging of the region.

The role the immune system and inflammation play in diseases of skin, muscles, bones and joints will be the overarching focus of Subunit 4 focused on Rheumatic Disease.  Physical exam, differential diagnoses, prophylaxis and treatments for these diseases, including pharmacological agents, will be examined.  

This unit includes new clinical skills: Taking a sexual history, making a problem list and summary, introduction to clinical reasoning, the hypothesis driven physical exam; HEENT; study design; patient safety & public health including LGBTQ+ health, human development with an emphasis on disparities throughout the lifespan, and special sessions with patients who share their experiences living with some of the different clinical syndromes discussed. 

Unit 3 Director: Christopher Roman, PhD

UNIT 4: GASTROINTESTINAL, ENDOCRINE, AND REPRODUCTIVE SYSTEMS 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 system, endocrine, and reproductive systems. Initially, students explore the structure and physiology of the gastrointestinal. Imaging techniques will help students relate the anatomy of the organs to their microscopic structure and the mechanisms underlying functionality. Interrelationships 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 students 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; review of systems and relevant physical exam for endocrine, gastrointestinal, and reproductive systems; study design; statistical measurement; medical ethics, and Journal Club. Students continue experience in doctors’ offices.

Unit 4 Director: Janet Schneller, MD

Foundations of Medicine: Year 2

UNIT 5: CARDIOVASCULAR, RENAL, RESPIRATORY SYSTEMS begins the second year of Foundations. Students will learn about the structure and function of the cardiovascular system and the diseases that can affect it. Later, students will explore the functioning of the lungs and kidneys and their roles in maintaining homeostasis, as well as the consequences and treatment of diseases affecting these organs. Students will learn how these organs act together to regulate normal conditions within the body 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.

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

Unit 5 Director: Raj Wadgaonkar, PhD

UNIT 6: BRAIN, MIND AND BEHAVIOR 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 apply concepts of central neural pathways to the neurological aspect of the physical examination and the effect of disorders, such as epilepsy, 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 (e.g., 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, evaluating therapeutic literature, search strategies, oral presentations, shared decision making, and diagnostic strategies. Students go to inpatient settings to take medical histories, perform physical exams, and prepare 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.

Unit 6 Director: Lisa Merlin, MD