MD Curriculum Phases

This curriculum phase of the study is defined as the first 18 months of medical school with a focus on the eight basic sciences core courses (i.e., blocks), Doctor & Patient/Societies course, and the Clinical Reasoning course, including all longitudinal curriculum sessions intertwined throughout the core courses.

Foundations

The 6-week Foundations Block fosters the development of skills in evidence-based decision-making, self-directed learning, communication, and professionalism, while also addressing medical-based science topics, including cell biology, genetics, embryology, biochemistry, histology, pathology, the immune system, microbiology, pharmacology, and biostatistics.

Musculoskeletal System

The 6-week Musculoskeletal System Block provides a basic understanding of the musculoskeletal system designed to help students approach its clinical presentation in their future clinical practice. The block discusses the location and function of bones, muscles, peripheral nerves and vessels of the limbs, and the structure and physiology of the basic tissues of the musculoskeletal system (cartilage, bone, joint, and muscle). Students are taught to use knowledge of anatomy and tissues to approach musculoskeletal disease and injuries. Many diseases of the musculoskeletal system overlap with diseases of other systems, such as neurological and immunological disorders; therefore, this block builds upon material learned in the Foundations Block and lays the foundation for material that will be encountered in subsequent blocks. In addition, the Musculoskeletal System block covers most aspects of skin required for USMLE Step 1, including normal structure and function as well as common skin lesions. Finally, because many musculoskeletal diseases require chronic care, material in the block addresses issues of health care delivery for disability and chronic care.

Nervous System

The 9-week Nervous System Block is a comprehensive overview of general principles in neuroscience, neuropathology, neurology, neuropharmacology, psychiatry, and social/behavioral sciences. The overarching goals are to introduce students to the structure and function of the human nervous system while integrating related histology, pathology, clinical applications in neurology, relevant psychiatry, psychopathology, pharmacological treatments, and gross anatomy of the central nervous system, head, and neck. The course also introduces concepts of rehabilitation, nutrition, exercise, ethical scenarios in cases of terminal genetic diseases, and the use of narcotics.

Cardiovascular, Pulmonary and Renal Systems

The 11-week Cardiovascular, Pulmonary, and Renal Systems Block is designed to provide students with an in-depth study of the cardiovascular, lymphatic, respiratory, renal, and urinary systems using an integrated approach encompassing molecular and cellular biology, anatomy, histology, physiology, pathology, pharmacology, and clinical medicine.

Using small-group case-based exercises and team-learning formats, students receive background knowledge in the basic and clinical sciences, physical examination, and laboratory and imaging findings needed to determine general priorities for basic diagnostic and treatment strategies, and the use of evidence-based approaches to evaluate clinically relevant information.

Students are also exposed to issues of age, gender, socio-economic status, ethnicity, and culture in patientcare decisions, as well as the epidemiology and statistics relevant to cardiovascular, pulmonary, and renal disease. Students in the Cardiovascular, Pulmonary, and Renal Systems Block are expected to use technology, including medical databases, to advance their medical knowledge and practice-based learning.

Digestion, Metabolism, and Hormones

The 9-week Digestion, Metabolism, and Hormones Block offers an integrated presentation of topics focusing on digestion and absorption of food (carbohydrates, lipids, and protein), water, vitamins and some minerals, nutritional aspects of macronutrients and micronutrients, fuel metabolism and storage, and the role of hormones in controlling physiological and biochemical functions in humans. The block covers:

• Functions of key digestive tissues, including salivary, stomach, intestine, pancreas, gall bladder, and liver
• Metabolic pathways in the liver and adipose tissue that are important in fuel storage and mobilization and regulation of these systems
• Pathophysiology associated with malabsorption and the digestive tissues
• Integration of the anatomy, histology, physiology, biochemistry, pathology, and pharmacology of the gastrointestinal system
• Histology, biochemistry, physiology, pathology, and pharmacology as they relate to the endocrine system
• Normal nutritional requirements and using this information to discuss the role of nutrition in metabolism and to evaluate the consequences of nutritional deficiencies

Life Cycle

The 7-week Life Cycle Block focuses on the biology and medicine of human reproduction and sexuality and normal and abnormal development throughout the life cycle. Life Cycle is designed to address reproductive anatomy, histology, and physiology through the life span from conception to pregnancy, birth, infancy, childhood, adolescence, adulthood, aging, and end of life. Life Cycle also presents the cancers of the male and female organs of reproduction.

Immunity and Infection

The 8-week Immunity and Infection Block is a presentation of microbiology, immunology, and infectious disease as well as public health and international health issues. Topics include:

• The basic elements of innate and adaptive immune system from the cellular to the systems level
• The mechanisms of immunity and infectious agents and their relationship to common diseases (including diseases involving multiple systems)
• The indications for use, mechanism of action, and side/adverse effects of medications used in the treatment of immunological and infectious diseases

Students will learn to link epidemiological, socioeconomic, and cultural factors to infectious diseases and normal and abnormal functioning of the immune system, and to develop clinical hypotheses by organizing and summarizing evidence of pathophysiological function for the immune system as well as evidence of involvement of multiple systems. Issues of environment, age, gender, socioeconomic status, ethnicity, and cultural distinctiveness that impact individual patients with respect to common immunological disorders and infectious processes (e.g., HIV or staph infection) also are presented.

Advanced Topics

This 3-week transitional block provides a structured review and combines high-yield material from the prior organ systems blocks through question review, group discussion, and case discussion. The block concludes with a USMLE practice exam where the performance metrics establish a baseline for study and preparation for the USMLE Step 1 to ensure maximal success.

For more information
Melinda Dávila
Assistant Director, Pre-clerkship Education
melindad@arizona.edu
520-626-1743

Longitudinal Curriculum

Doctor & Patient / Societies

The Doctor and Patient course (including the Societies Program) is an integrated program teaching clinical and professional skills and providing longitudinal clinical mentoring. The Societies Program enhances the medical school experience in the following ways:

• Early instruction, from the very first day, in the development of fundamental clinical skills, including communication, taking a medical history, the physical examination of patients, and clinical thinking
• Early introduction to what it means to be a medical professional and the importance of professionalism in the practice of medicine
• Provision of an ongoing support system that emphasizes both peer support and the support of dedicated medical school faculty

Clinical Reasoning

The Clinical Reasoning course is longitudinal and runs throughout the Preclerkship Phase. It is designed to complement the blocks, the Doctor and Patient course, and the Societies Program. Students meet for 2 hours every week with their Clinical Reasoning facilitator to practice the basic principles of clinical reasoning and prepare themselves for their clinical clerkships. The Clinical Reasoning course uses active learning to emphasize higher-level thinking and support independent thought by the students.

Pathways of Health and Medicine

This curriculum runs parallel to the blocks during the Preclerkship Phase. The intent of this curriculum is to provide longitudinal behavioral, medical humanities, and social sciences curricula for the medical education program to ensure greater alignment between biomedical science training and the preparation of future physicians required for meeting broader social expectations.

This curriculum phase of study is defined as the 12 months of eight core clerkships as well as Transition to Clerkships and Intersessions.

Family and Community Medicine

This 6-week clerkship encompasses the comprehensive and longitudinal care of patients with a special emphasis on care of individuals in the context of families and communities. This is primarily an outpatient rotation, working with preceptors throughout the state. This clerkship provides an opportunity for students to learn about the diagnosis and management of patients with acute common problems as well as chronic disease. Students will be expected to learn a comprehensive approach to the patient with these diagnoses that entails consideration of etiology, incidence, pathophysiology, clinical presentation, course, prognosis, treatment, the appropriate aspects of patient education, disease prevention, and health promotion.

Medicine

This is an 8-week experience that includes in-patient and ambulatory exposure. Students are expected to achieve a level of responsibility in the in-patient and ambulatory setting appropriate for a third-year student, including independent data gathering, critical assessment of the data, and communication of data to other health professionals.

Ambulatory Medicine

This 4-week clerkship offers medical students a broad perspective on ambulatory medicine. Students will see new and established patients in various outpatient medicine clinics. Students have primary responsibility for evaluating the patient, formulating an assessment, and implementing management under the close supervision of an attending internist.

Neurology

This 4-week  clerkship is designed to teach medical students the principles and skills needed to recognize and manage the neurological diseases that a general medical practitioner is most likely to encounter in practice. Implicit in this is the ability to recognize the problems of the nervous system that require specialty neurological consultation. Students will learn to perform a thorough neurologic history and examination by the completion of this rotation.

Obstetrics and Gynecology

This 6-week clerkship is an introductory experience in the provision of comprehensive medical care and counseling services to elderly, adult, and adolescent female patients. The obstetrical conditions and gynecological problems commonly encountered by the physician provide the primary focus for this clerkship experience, but knowledge of serious or less common conditions is also available. Therefore, the basis for the clerkship is to introduce the clinical information thought to be fundamental in the education of all physicians.

Pediatrics

This 6-week clerkship is divided into two 3-week blocks. Students spend 3 weeks on the inpatient service at Banner Children’s at Diamond Children’s Medical Center and 3 weeks in an outpatient clinic, either at Banner University Medical Center (BUMC), BUMC Children’s Multispecialty Center (Wilmot Clinic), BUMC North Hills Clinic, BUMC Pantano Clinic, a private practice clinic site (dependent on site availability), or a rural clinic site (dependent on site availability). A newborn nursery experience will be part of the outpatient rotation and will occur at BUMC, no matter where the student is assigned for their outpatient rotation (with the exception of those at a rural site).

Psychiatry

In this 6-week clerkship, the student will be able to demonstrate through oral or written communication with attending physicians or residents and staff through documentation in patient records, and in a manner judged by the attending physicians and staff as satisfactory, an understanding of:

• The purposes of the psychiatric interview
• The purpose and form of the psychiatric workup
• The major manifestations of psychosis, cognitive impairment, and differential diagnosis of schizophrenia and substance-related, mood, anxiety, and personality disorders
• The major groups of psychopharmacologic agents used in psychiatric care, including their indications, effects, side effects, and contraindications, with particular reference to antipsychotics, anti depressants, mood stabilizers, anti-anxiety agents, sedatives, and stimulants. Additionally, knowledge of the uses of electroconvulsive therapy is required.
• An understanding of the major psychosocial interventions and their indications, including the use of psychotherapy, group therapy, couples’ therapy, family and social case work
• The legal and psychological principles of treating violent, suicidal, incompetent, and uncooperative patients
• The major services available to the mentally ill and methods of referral to such services

Surgery

This 8-week clerkship introduce the student to the principles of caring for the surgical patient. This goal is accomplished by allowing the student to participate in the care of patients in the various stages of evaluation and treatment by surgeons. These stages include but are not limited to the preoperative office or clinic visit, inpatient admission, operative procedure, and inpatient/outpatient recovery. Through this exposure, the student will begin to understand the general process of the application of surgical therapy to patients in a wide variety of settings. Furthermore, by participating as a member of the surgical team, the student will observe the role of the surgeon as a member of the multidisciplinary team that provides care for the patient. The clerkship is structured upon the principle that learning is a process that can be accomplished only by active participation by the student. The role of the faculty and house staff is to provide guidance, stimulation, support, and example.

Transition to Clerkships

This 1-week course is delivered to students prior to entering their core clerkships. Medical students participate in a variety of educational experiences designed to prepare them to begin their clerkship curriculum. In addition to lectures on topics pertinent to patient care, students participate in simulations and performance exercises to learn and practice basic skills that will be required of them in the clerkship curriculum. Attendance at sessions and active participation is mandatory.

Intersessions I and II

Intersessions are opportunities for the whole class to come together during the clerkship year and learn the knowledge, skills, and attitudes that are fundamental to the practice of good medical care. Topics the students will be exposed to include patient safety and medical errors, quality of medical care, professionalism, ethics in medicine, medical legal issues, health care disparities, health care financing and resource use, wellness, and resilience. The students will also be able to learn some procedural skills, such as bedside ultrasound, as well as get early exposure to non-clerkship specialties such as diagnostic imaging and pathology. Intersessions also provide an opportunity for students to come together for collaborative and reflective time in the process of becoming a physician. Curricular formats and learning strategies vary to accommodate the variety of content and learning. They include simulation sessions, objective structured clinical examinations, lectures, and small-group projects and assignments.

For more information
clerkshipadmin@arizona.edu

This curriculum phase of study is defined as the final 14 months of clinical curriculum, including core sub-internship, electives, surgical subspecialty, Emergency Medicine/Critical Care clerkship, Applications of the Basic Sciences to Clinical Medicine, and transition to residency bootcamp selectives.

Emergency Medicine/Critical Care Clerkship

In this 4-week clerkship, students are given an overview of the principles and concepts of the specialty of emergency medicine, with emphasis on the common presenting complaints and procedures in the undifferentiated patient. Students additionally will experience how treatment in the Emergency Department affects the patient and subsequent hospitalization. Critical care concepts addressed at this level include ventilation management, hemodynamic monitoring and pressor management, critical care pharmacology, and social and behavioral concepts affecting patient management.

Application of the Basic Sciences to Clinical Medicine

This 4-week course prepares students for the foundational knowledge necessary to enter their residency programs. Students will review basic-science curriculum from the preclerkship curriculum and apply this knowledge translationally to their chosen clinical specialty. The course emphasizes the active learning approach for didactic sessions and small-group sessions for applied learning.

Preparation for Residency Bootcamp

This 2-week course prepares students for the clinical or surgical skills necessary to enter their residency programs. Students will participate in a 1-week shared curriculum, learning common skills for all careers (e.g., electronic health record, order entry, prescription writing, note writing, billing, etc.), followed by specialty-specific curriculum to practice skills necessary to enter residency at a high-functioning intern level. The course uses a combination of standardized patients, online avatar-based curricula, SIMS-based skills labs, small-group sessions, and objective structured clinical examination evaluations to support the students’ learning.

For more information
Travis Garner
Program Manager, Clinical Education
travisgarner@arizona.edu