HST Course Info

PRECLERKSHIP - Year I

HST Course Managers: Patricia CunninghamKarrol Altarejos
HST Senior Curriculum Manager: Catherine Hodgins

AUGUST

Introduction to the Profession

IN 555 Introduction to the Profession - August 5-9, Year I

Course Director: Kate Treadway
Course Manager: TBD

Course Description

A week-long course for incoming Harvard Medical students designed to introduce students to the duties and responsibilities of being a physician. Includes discussions of the intellectual, moral, emotional and professional growth that being a physician demands and which begins now as students become physicians in training. Activities include reflection, reading, class discussion and goal setting.

Course Objectives

  • Appreciate the concept of structural competence and the impact of cultural and socioeconomic factors on health care.
  • Appreciate the necessity of teamwork in providing effective care.
  • Become familiar with the following concepts: personal integrity, duty, altruism, patient confidentiality, and the role of mindfulness and self-reflection in the cultivation of professionalism.
  • Become familiar with the obligations and responsibilities of being a physician in training. Create a class oath outlining your responsibilities and aspirations as a student.
  • Discuss the following questions:
  • What does professionalism mean for you as a student?
  • What does "professional behavior" mean?
  • What does "professional attitudes" mean?
  • Explore the role of conscious and unconscious bias in health care.
  • Foster a non-competitive environment.
  • Recognize the barriers to effective communication that can exist based on cultural differences.
  • Recognize the role of effective communication in delivering compassionate care.
  • Understand the concepts of effective patient-doctor communication through the use of the Four Habits model.

Matlab for Medicine

HST 015 Matlab for Medicine

Course Director: Matthew Frosch

Course Description

A hands-on introduction to quantitative methods in medicine and health research. Each session will introduce a topic in quantitative techniques applying to medicine that will be modeled in MATLAB. Problem sets applying the lessons learned in this course will be assigned throughout the preclerkship curriculum. Download MATLAB before the course starts.

Course Objectives

  • Develop computational skills which will assist in evaluation and assessment of primary data either from their own laboratory experiences or from the literature.
  • Develop the skills necessary to translate biological, epidemiological and clinical questions into computationally tractable problems; develop the ability to analyze problems in a quantitative manner to support clinical decision making as well as to guide future research.
  • Treat fellow students and faculty with respect and commit to learning in order to prepare oneself for future patient care: prepare for class work to the best of one's ability, be timely in reporting for class sessions, and notify faculty in the event of absences from class.
  • Communicate effectively with fellow students and faculty with respect to medical and scientific information, articulate clearly one's thinking in the discussion of pathophysiologic processes, and work effectively as a member of a team.

Introduction to Biostatistics

HST 190 Introduction to Biostatistics

Course Directors: Sebastien HaneuseVictoria Liublinska

Course Description

This course will present the fundamentals of biostatistics and epidemiology with the aim of training students how to comprehend critique and communicate findings from the biomedical literature. In the first part of this course, students will learn how to assess the importance of chance in the interpretation of experimental data. Major topics covered include probability theory, normal sampling, chi-squared and t-tests, analysis of variance, linear regression and survival analysis, as well as how to perform elementary calculations using the statistical package STATA. In the second part of this course, students will learn how to identify and prevent bias in observational studies. Students will learn about causal inference, types of bias (confounding, selection and information bias), and key study designs (randomized trials, cohort and case-control studies).

Course Objectives

  • Comprehend, critique and communicate findings from the biomedical literature.
  • Conduct analyses of data, including summary statistics, confidence intervals, measures of risk and association, regression modeling, and Kaplan Meier.
  • Design experiments, including power calculations, sample size calculations, and effect size calculations for continuous, binary and survival outcomes.
  • Learn about clinical trials: their structure, requirements, design, and reporting.
  • Critically read the medical literature and properly interpret study design and analyses.
  • Use statistical methods to analyze data and to draw formal inferences from the data.
  • Become familiar with statistical measures that are useful for patient care, along with their limitations (e.g., predictive value).
  • Appreciate ethical aspects of clinical trials and human subjects research through discussion of concepts such as early stopping of clinical trials.
  • Work together in groups and acknowledge others and sources in written work.
  • Participate in class discussion on statistical material and ask and respond to questions that probe the material.
  • Develop effective presentations on data analyses in project work. 

FALL

Human Functional Anatomy

HST 010 Human Functional Anatomy

Course Director: Lee Gehrke

Course Description

Lectures, detailed laboratory dissections, and prosections provide a thorough exploration of the gross structure and function of the human body. Fundamental bioengineering principles are employed to promote analytical approaches to understanding the body's design. The embryology of major organ systems is presented with certain references to phylogenetic development as a basis for comprehending anatomical complexity. Correlation clinics stress both normal and abnormal functions of the body and present evolving knowledge of genes responsible for normal and abnormal anatomy. Lecturers focus on current problems in organ system research.

Course Objectives

  • Complete the dissection of a human cadaver, excepting the brain tissue.
  • Use anatomical terminology in precise and accurate descriptions of the human body.
  • Describe the embryologic basis for the formation of the major organ systems.
  • Accurately interpret images of normal anatomy presented as MRI, CT, ultrasound, plain film modalities.
  • Develop a learning paradigm that focuses on correlating structure and function over memorization of anatomical features.
  • Use clinical correlations to introduce and discuss both anatomical issues and the implications for patients and their general health.
  • Treat faculty and fellow students with respect, be honest in completing ones' own work in examinations, and show respect and professionalism in the use of cadaver materials for learning.
  • Work effectively and professionally as a member of a laboratory dissection team.
  • Engage in discussions that are more than point-counterpoint; listen to others' positions and respond thoughtfully.
  • Where relevant, include descriptions of basic social, economic, ethnic, and racial factors that can contribute to the development, diagnosis, and treatment of common human diseases.

Human Pathology

HST 030 Human Pathology

Course Directors: Richard N. MitchellRobert F. Padera

Course Description

Introduction to the functional structure of normal cells and tissues, pathologic principles of cellular adaptation and injury, inflammation, circulatory disorders, immunologic injury, infection, genetic disorders, and neoplasia, emphasizing clinical correlations and contemporary experimental biology. Includes laboratories with examination of microscopic and gross specimens, and autopsy case studies emphasizing modern pathology practice.

Course Objectives

  • Present normal structure and function of molecular elements (nucleic acids and proteins), subcellular organelles, cells, extracellular matrix, tissues, and organs. Students should be able to identify normal cell and tissue components, and the histology of normal organs; infer functionality based on cell or tissue structure; and identify normal morphologic variation and the effects on structure and function of normal physiologic stimuli (e.g., hormones, exercise, nutrition, etc.).
  • Present the morphology and mechanisms of general classes of disease, with specific illustrative examples, extrapolating from the level of molecular, subcellular, or cellular dysfunction to the pathology of tissues, organs, and the whole body. Students should be able to: articulate basic disease mechanisms including cell injury, acute and chronic inflammation, scarring, thrombosis, atherosclerosis, infarction, infectious disease, immune-mediated injury, and malignancy; identify targets for potential therapeutic intervention; recognize abnormal structures and organs both grossly and histologically; infer likely pathophysiologic consequences based on the nature of cell or tissue lesions; and suggest possible mechanisms that can underlie an identified pathology.
  • Present an introduction to the science and practice of pathology. Students should be able to describe the role of the pathologist in surgical and medical practice, the utility and logistical details of autopsies, and the role of pathologists in biomedical and clinical investigation.
  • Set a foundation for subsequent pathophysiology courses. Students should be able to describe the basic structure-function correlates in all tissues and the basic pathologic mechanisms that underlie human disease.
  • Demonstrate the ability to use analytical skills that focus on inductive reasoning in the application of knowledge to solve problems relevant to the basic pathobiologic processes in a variety of tissues and cell types.
  • Describe the relevant risk factors for and lifestyle interventions to minimize the risk of common diseases, and delineate some of the diagnostic and therapeutic interventions pertinent to common diseases.
  • Treat fellow students and faculty with respect and to commit to learning in order to prepare oneself for future patient care: prepare for class work to the best of one's ability, be timely in reporting for class sessions, and notify faculty in the event of absences from class.
  • Communicate effectively with fellow students and faculty with respect to medical and scientific information, articulate clearly one's thinking in the discussion of pathophysiologic processes, and work effectively as a member of a team.
  • Describe the basic social, economic, ethnic, and racial factors that can contribute to the development, diagnosis, and treatment of common human diseases.

Biochemistry and Metabolism

HST 146 Biochemistry and Metabolism

Course Director: Sudha Biddinger

Course Description

Intensive study of human biochemistry focusing on intermediary metabolism and structures of key intermediates and enzymes important in human disease for first-year students. Course provides basic understanding of human intermediary metabolism related to disease and therapeutic impact. Focus on four topics: lipids, amino acids, carbohydrates and nucleic acids, underscored with examples from diseases and clinical correlations. Sessions focus on the basics, then later delves into more advanced topics and patient correlates.

Course Objectives

  • Learn key biochemical principles. Students will be able to: demonstrate a basic understanding of enzyme kinetics; define and give examples of rate limiting steps in a metabolic pathway, and describe their significance; and give examples of how different pathways interact with one another.
  • Become familiar with major metabolic pathways, including glucose, lipid, amino acid, and nucleotide metabolism.
  • Understand how perturbations in biochemical pathways can lead to disease. Students will be able to: describe the specific defects underlying such disorders as diabetes, gout, urea cycle defects; and describe how cancer metabolism differs from normal metabolism.
  • Understand how biochemical pathways can be manipulated for therapeutic use.
  • Identify key problems in basic research and clinical care. Students will be able to: give examples of ongoing questions in metabolism; identify a specific problem in the field of biochemistry/metabolism, perform background research, and present some strategy for developing a solution.
  • Connect underlying metabolic defects to clinical phenotypes and treatments, and develop an understanding of how these can impact the lives of patients.
  • Facilitate transition between student and professional roles. Students will be encouraged to develop a sense of responsibility for moving forward some area of medicine, identify the barriers to progress in a particular area (clinical or research), and expected to exhibit punctuality and courteous behavior.
  • Develop effective presentation skills.
  • Give and receive constructive criticism.

Genetics in Modern Medicine

HST 160 Genetics in Modern Medicine

Course Directors: Sahar NissimSalil Garg

Course Description

This course will provide a firm foundation for understanding the relationship between molecular biology, developmental biology, genetics, genomics, bioinformatics, and medicine. The goal is to develop explicit connections between basic research, medical understanding, and the perspective of patients. During the course the principles of human genetics will be reviewed. Students will become familiar with the translation of clinical understanding into analysis at the level of the gene, chromosome and molecule, the concepts and techniques of molecular biology and genomics, and the strategies and methods of genetic analysis, including an introduction to bioinformatics. The course will extend beyond basic principles to current research activity in human genetics.

Course Objectives

  • Understand the molecular basis for genetic disorders: review chromosome structure and segregation during meiosis and mitosis, and give examples of diseases in which these processes go awry; explain how the molecular sequelae of mutations in DNA (including point mutations, copy-number variants, repeat expansions) lead to defects in transcription, translation, protein function, and other processes in molecular biology; explain the basics of epigenetics, including the role of DNA methylation in imprinting diseases; explain the principles of somatic and/or inherited mutations leading to cancer; and introduce the most common types of inherited cancer syndromes.
  • Understand the origins and implications of genetic variation in a population: describe common mutational mechanisms, and review and provide examples for a spectrum of genetic variants from rare variants of high effect size to common variants with low effect size.
  • Appreciate phenotypic complexity in human genetic disorders: understand basic modes of genetic inheritance (autosomal/sex-linked, dominant, recessive); understand the genetic concepts of incomplete penetrance, variable expressivity, epistasis, locus heterogeneity, and mosaicism; and appreciate the wide range of clinical features (and their diagnostic utility) that are associated with rare human genetic syndromes.
  • Identify causal genetic variants: describe methodologies to identify causal variants, including linkage analysis, whole genome sequencing analysis, and Genome Wide Association Studies; introduce complementary approaches to validate gene function including animal models; demonstrate knowledge of the principles of genetic linkage and calculate a significant LOD score; evaluate and interpret data from current genomic technologies, including whole-genome and exome sequencing; explain the principles of genome-wide association studies and identify the scenarios in which these studies are appropriate, including a consideration of the heritability of a disease phenotype.
  • Apply the principles of genetics to common clinical scenarios: counsel a theoretical patient as to their risk of having a child affected with various genetic diseases; explain the rationale for the national newborn screening program and which genetic diseases are included in the newborn screening panel and why; counsel a theoretical patient on the rationale for genetic testing to evaluate their risk of developing various types of cancer, based on their family history and personal risk factors; understand the essential clinical consequences of selected genetic diseases; understand the potential for personalized medicine with specific examples including cancer treatment and pharmacogenetics; understand the challenges in universal and commercial genetic testing.
  • Establish a foundation of skills for understanding genetics publications and future genetics coursework: understand common methodologies in genetics including Southern/Northern blot, PCR / RT-PCR, DNAse hypersensitivity, ChIP / RNA-Seq, and Sanger / next generation sequencing; demonstrate the use of internet resources for understanding and investigating genetic diseases, such as the NCBI and UCSC genome browser; demonstrate the ability to interpret and critically evaluate current primary literature related to genetic disease and treatment.
  • Demonstrate the ability to use analytical skills in the application of knowledge to: critically read primary literature; interpret genetic testing information; propose approaches to characterizing clinical problems based in genetics.
  • Gain experience in the interpretation of genetic testing results and issues in patient counseling.
  • Treat fellow students, faculty, and invited lecturers and patients with respect, and to commit to learning in order to prepare oneself for future patient care: prepare for class work to the best of one's ability, be timely in reporting for class sessions, and notify faculty in the event of absences from class.
  • Communicate effectively with fellow students, faculty, and invited lecturers and patients: articulate clearly one's thinking in the discussion of primary literature and teaching cases, work effectively as a member of a team, communicate with invited patients with empathy and professionalism.
  • Understand ethical, social, economic, ethnic, and racial factors that may impact the use and interpretation of genetics in clinical medicine.

Molecular Diagnostics and Bioinformatics

HST 162 Molecular Diagnostics and Bioinformatics

Course Directors: Georg K. GerberLong P. Le

Course Description

Introduction to molecular diagnostic methods in medicine and relevant bioinformatics methods. Discussion of principles of molecular testing for diagnosis of somatic and germline diseases using FISH, genotyping, array CGH, next generation sequencing, and other technologies. Case conferences emphasize clinical correlation and integration of information from multiple diagnostic tests. Lectures, problem sets, and laboratory sessions will introduce key concepts in biological sequence analysis and provide experience with bioinformatics tools.

Course Objectives

  • Present computational and quantitative methods needed to analyze and interpret molecular diagnostic data. Students should be able to: understand fundamental concepts of key bioinformatics algorithms including sequence alignment and phylogenetic tree methods; correctly interpret results generated by the algorithms; assess limitations of algorithms and how this may affect interpretation of results used in making diagnoses.
  • Present an introduction to the science and practice of molecular pathology. Students should be able to describe the role of molecular pathology in surgical and medical practice.
  • Demonstrate the ability to use analytical skills that focus on inductive and quantitative reasoning in the application of knowledge to solve problems relevant to the molecular basis of disease.
  • Delineate molecular diagnostic approaches to germline and somatic diseases.
  • Treat fellow students and faculty with respect and to commit to learning in order to prepare oneself for future patient care.
  • Prepare for class work to the best of one’s ability.
  • Be timely in reporting for class sessions.
  • Notify faculty in the event of absences from class.
  • Communicate effectively with fellow students and faculty with respect to medical and scientific information; articulate clearly one's thinking in the discussion of molecular pathology and use of computational algorithms needed to interpretation analyze molecular diagnostic data; work effectively as a member of a team.
  • Understand practical aspects of deploying molecular testing within the larger healthcare system.

Cellular and Molecular Immunology

HST 175 Cellular and Molecular Immunology

Course Directors: Shiv S. PillaiBobby J. Cherayil

Course Description

Cells and tissues of the immune system, lymphocyte development, structure and function of antigen receptors, cell biology of antigen processing and presentation including molecular structure and assembly of MHC molecules, lymphocyte activation, the biology of cytokines, leukocyte-endothelial interactions, and the pathogenesis of immunologically mediated diseases. Consists of lectures and tutorials in which clinical cases are discussed with faculty tutors. Details of each case covering a number of immunological issues in the context of disease are posted on a student website.

Course Objectives

  • Obtain an understanding of how the immune system protects us from pathogens and cancer. Students should understand: the fundamentals of innate immunity including inflammation, innate sensors, complement, cytokines, chemokines, leukocyte migration, and the anti-viral response, including the role of nucleic acid sensors, Type I interferons and NK cells; the biology of lymphocyte development, the generation of diversity, immunological tolerances and the anatomy of the immune system; the underlying principles of humoral adaptive immunity in terms of the functions of antibodies and B lymphocytes, the biology of the germinal center response; and the principles of cellular immunity including the role of helper T cells, T cell activation, T helper cell subsets, regulatory T cells and cytotoxic T cells.
  • Appreciate how most common diseases are linked to dysfunction of the immune system and have in-class interactions with patients with a number of immune-related disorders, including disorders of innate immunity; disorders of lymphocyte development, primary immunodeficiencies and lessons from common immunological diseases; vaccination and infectious diseases; HIV; autoimmune disorders and chronic inflammatory diseases; and allergic disorders.
  • Demonstrate the ability to read, analyze and critically discuss research articles in the field of immunology.
  • Understand the pathogenesis of immunological disorders and discuss with a clinician preceptor in a small group setting how one evaluates a clinical case.
  • Interact with patients with immunological disease and discuss clinical issues with both the patient and the physician presenting the case.
  • Demonstrate punctuality and participate in small group sessions, notify faculty in the context of absences, and prepare for class. especially for flipped classroom sessions.
  • Create write-ups for tutorials. Participate in discussion and give presentations in class, in tutorials and in paper-discussion sections. Interact with fellow students in small group sessions.
  • Discuss social, ethnic and cultural factors that contribute to immunological disease including but not limited to HIV and to attitudes on vaccination in a world-wide context.

JANUARY

Musculoskeletal Pathophysiology

HST 020 Musculoskeletal Pathophysiology

Course Directors: Mary L. BouxseinLaura Tarter

Course Description

Growth and development of normal bone and joints, the process of mineralization, the biophysics of bone and response to stress and fracture, calcium and phosphate homeostasis and regulation by parathyroid hormone and vitamin D, and the pathogenesis of metabolic bone diseases and disease of connective tissue, joints, and muscles, with consideration of possible mechanisms and underlying metabolic derangements.

Course Objectives

  • Present normal structure, function and anatomy of the bones, joints and muscles that give rise to the tissue properties of the musculoskeletal system.
  • Present the consequences of diseases, conditions and injuries (including inflammatory processes) affecting the integrity of the musculoskeletal system and discuss treatments for these disorders, as well as their psychosocial impact.
  • Demonstrate the ability to use analytical skills that focus on inductive reasoning in the application of knowledge to solve problems relevant to the basic pathobiologic processes in a variety of tissues and cell types in MSK.
  • Describe the relevant risk factors for and lifestyle interventions to minimize the risk of musculoskeletal and rheumatic diseases; delineate some of the diagnostic and therapeutic interventions pertinent to these diseases; and have a basic knowledge of treatments for common musculoskeletal and rheumatic conditions, disorders, and diseases.
  • Treat fellow students and faculty with respect and to commit to learning in order to prepare oneself for future patient care: prepare for class work to the best of one's ability, be timely in reporting for class sessions, notify faculty in the event of absences from class, and display appropriate business dress and attentiveness when patient visits are conducted in class.
  • Treat fellow students and faculty with respect and inclusivity in all communications, communicate effectively with fellow students and faculty with respect to medical and scientific information, articulate clearly one's thinking in the discussion of pathophysiologic processes, and work effectively as a member of a team.
  • Describe the basic social, economic, ethnic, and racial factors that can contribute to the development, diagnosis, and treatment of common human MSK diseases.

Principles of Biomedical Imaging

HST 164 Principles of Biomedical Imaging

Course Directors: Susie Y. HuangDavid E. Sosnovik

Course Description

HST 164 reviews the fundamental principles and techniques underlying biomedical imaging and their application in modern medicine. Emphasis is placed on magnetic resonance but ultrasound, computed tomography, positron emission tomography and optical techniques are covered as well. The course focuses on the quantitative aspects of biomedical imaging and requires a knowledge of differential equations, MATLAB, and intermediate-level physics.

Course Objectives

  • Understand the basis of modern biomedical imaging techniques and how they can be used to elucidate biological processes in the human body. The modalities studied will include: magnetic resonance (imaging and spectroscopy), computed tomography, x-ray, ultrasound, positron emission tomography and single-photon emission computed tomography.
  • Understand how fundamental processes in the generation of medical images can be manipulated to assess human physiology and pathophysiology.
  • Learn how basic concepts in biomedical imaging can be applied to answer questions in clinical medicine.
  • Critically apply a basic knowledge of imaging principles to optimize the detection and management of disease.
  • Understand why certain imaging modalities are better suited to the detection of specific disease processes and how to apply this in a clinical scenario.
  • Be familiar with the fundamental limitations of the various imaging modalities, the implications of these limitations and how they might be overcome.
  • Understand the risks and benefits of different imaging modalities.
  • Determine the most appropriate imaging modality for the diagnosis and management of common diseases.
  • Treat fellow students and faculty with respect and to commit to learning in order to prepare oneself for future patient care.
  • Prepare for lectures and lab sessions to the best of one's ability.
  • Be timely in reporting for class sessions.
  • Notify faculty in the event of absences from class.
  • Learn the terminology specific to imaging technology and how to use it in verbal and written communication with patients, families, and colleagues.
  • Articulate clearly one's thinking regarding imaging principles.
  • Work effectively as a member of a team during lab sessions.
  • Describe the social, economic factors that affect access to imaging tests.

Medical Decision Analysis and Probabilistic Medical Inference

HST 192 Medical Decision Analysis and Probabilistic Medical Inference (elective)

Course Directors: M. Brandon WestoverPooyan Kazemian

Course Description

Teaches the essentials of quantitative diagnostic reasoning and medical decision analysis. Guides participants through the process of choosing an appropriate contemporary medical problem in which risk-benefit tradeoffs play a prominent role, conducting a decision analysis, and ultimately publishing results in a medical journal. Topics include decision trees, influence diagrams, Markov decision models and Monte Carlo simulation, methods for quantifying patient values, Bayesian inference, decision thresholds, and the cognitive science of medical decision making.

Essentials of the Profession

PWY 120 Essentials of the Profession – January, Year I

 

Course Director: Ateev Mehrotra
Course Manager: Rob McCabe


Course Description

Social and population science relevant to the practice of medicine: clinical epidemiology, population health, health care policy, social medicine, medical ethics, and professionalism.

Course Objectives

  • Apply multiple perspectives to understand the social, economic, and political forces that affect both the burden of disease for individuals and populations and the ability of the health system to ameliorate them.
  • Become grounded in the ethical principles that underlie clinical care, research, and professionalism generally, with the facility to recognize and analyze ethical issues in practice.
  • Critically evaluate evidence and use it appropriately in clinical decisions and population health management. Understand the health policy context in which they will practice.

SPRING

Endocrinology

HST 060 Endocrinology

Course Directors: David T. BreaultWilliam M. Kettyle

Course Description

Physiology and pathophysiology of the human endocrine system. Three hours of lecture and section each week. Topics include assay techniques, physiological integration, etc. At frequent clinic sessions, patients are presented who demonstrate clinical problems considered in the didactic lectures.

Course Objectives

  • Build a solid foundation in endocrine physiology: recount the basic concepts of signal transduction; describe and discuss feedback control mechanism over a wide range of endocrine systems; relate the mechanism of action of hormones at the cellular level and, when possible, at a molecular level; identify and integrate the time courses of hormonal events – half-lives of hormones, response times; and recount and integrate the endocrine systems that support blood levels of glucose, calcium, sodium and potassium.
  • Relate basic science to clinical medicine in a bi-directional fashion: identify and define the pathophysiology of endocrine disorders from a clinical and, when possible, molecular basis; describe the pathophysiologic mechanisms of endocrine disorders -- including hyper- and hypo- function of the thyroid and the adrenal axes; discuss in some detail the concepts of tissue resistance to hormone action and recount the pathophysiologic consequences; explain the concept of disuse atrophy; and compare and contrast different forms of diabetes mellitus.
  • Sharpen skills in the realm of problem identification and definition: recognize that problem solving requires problem identification and definition, appreciate clinical realities, and frame clinical and research questions.
  • Expose students to clinical encounters that provide opportunities to utilize their understanding of endocrine physiology and pathophysiology. Provide experiences in patient-centered information collection (patient interviews, problem set discussions, and "between classes" discussions).
  • Expose students to potential role-models: scientists, clinicians and clinician-scientists. All course participants are encouraged to share their approaches to their professional activities, disclosing possible conflicts of interest. All course participants are encouraged to share their career trajectories and are encouraged to be available for continuing dialogues. Selected students introduce lecturers and encourage participating teachers to share their career development.
  • Foster individual learning, team problem solving and development of communications skills: present problem set solutions to the class and conduct interviews of patients who attend class sessions.
  • Build appreciation of age, gender, ethnical and cultural issues related to endocrinology: recognize and recount the important differences that exist in the prevalence and severity of endocrine disorders among various populations.

Hematology

HST 080 Hematology

Course Directors: Nancy BerlinerEdward J. Benz Jr.

Course Description

Intensive survey of the biology, physiology and pathophysiology of blood with systematic consideration of hematopoiesis, white blood cells, red blood cells, platelets, coagulation, plasma proteins, and hematologic malignancies. Emphasis given equally to didactic discussion and analysis of clinical problems.

Course Objectives

  • Explore the process of hematopoiesis and the cytokine and transcriptional networks governing hematopoietic cell commitment, differentiation, and maturation.
  • Present the evaluation and approach to diseases associated with cytopenias (anemia, neutropenia, thrombocytopenia, pancytopenia).
  • Discuss inherited disorders of the hematologic system, including hemoglobinopathies, congenital bleeding disorders, and inherited bone marrow failure syndromes.
  • Outline the range of hematologic malignancies and recognize the ways in which they relate to the disruption of normal hematopoiesis.
  • Demonstrate the ability to apply concepts from the lecture material to the analysis of clinical cases presented in small group sessions.
  • Demonstrate through case discussions the ways in which the understanding of hematology concepts translate to patient care.
  • Hear directly from patients about their experience with their diseases to better understand the impact on their lives.
  • Prepare for class work to the best of one's ability.
  • Attend all class sessions.
  • Notify faculty in the event of absences from class.
  • Communicate effectively with students in small group sessions.
  • Demonstrate the ability to convey your understanding of pathophysiology as it applies to clinical cases.
  • Work effectively as a group with classmates.
  • Understand the unintended ethical consequences of interventions in hematologic diseases (complications of growth factor therapy, infectious complications of factor concentrates, growing cost of novel drugs to treat hematologic diseases).
  • Explore relevant risk factors for hematologic diseases.
  • Examine ethical considerations surrounding hematology care

Cardiovascular Pathophysiology

HST 090 Cardiovascular Pathophysiology

Course Director: Elazer R. EdelmanSteven P. Keller

Course Description

The course covers normal and pathologic physiology of the heart and vascular system. Instruction will emphasize the quantitative and molecular biological aspects of cardiovascular hemodynamics, electrophysiology, gross pathology and clinical correlates of cardiovascular function in health and a variety of disease states. Special attention will be given to congenital, valvular, myocardial, and arteriosclerotic coronary heart disease. The case method is emphasized in tutorial sessions.

Course Objectives

  • Present normal structure and function of the cardiovascular system. Students should be able to: describe normal gross structure of myocardium, valves, and vessels, and normal cardiac development; describe normal physiology of the conduction system, myocardium, valves, and vessels; infer functionality based on tissue structure or physiologic perturbation; and identify normal morphologic variation and the effects on structure and function of normal physiologic stimuli (e.g., hormones, exercise, nutrition, etc.).
  • Present the morphology and mechanisms of general classes of cardiovascular disease, with specific illustrative examples, extrapolating from the level of molecular, subcellular, or cellular dysfunction to the pathophysiology. Students should be able to: articulate basic disease mechanisms underlying atherosclerosis, infarction, heart failure, hypertension, valvular heart disease, and electrophysiologic abnormalities; recognize abnormal structures grossly and infer the clinical manifestations; recognize clinical manifestations of disease and be able to infer likely pathophysiologic causes; infer likely pathophysiologic consequences based on the nature of cell or tissue lesions; suggest mechanisms that can underlie an identified pathology; and articulate targets for potential therapeutic intervention.
  • Learn how to think about and address problems in cardiovascular medicine and research. Develop a broad, integrative picture of cardiovascular structure, normal function, pathophysiological mechanisms, pathology, clinicopathological correlations, and treatment modalities. Understand general concepts and mechanistic underpinnings over memorization of the specifics or lists of diseases, genes and molecules of signaling pathways, and pharmacologic treatments.
  • Prepare materials in advance, and attend and participate in class.
  • Spend a significant amount of time learning and thinking about material before class, such that the lecture can be geared toward more complex questions and issues. Be prepared to answer and discuss questions and fully participate in the lecture. Required preparation includes reading assigned citations from selected texts or journal articles, and completing and handing in sets of questions and discussion points provided for each lecture.

Respiratory Pathophysiology

HST 100 Respiratory Pathophysiology

Course Directors: C. Corey HardinEllen Roche

Course Description

This course is designed as a first course in pulmonary biology in health and disease. The functional structure of the respiratory system and its physiology will be developed with the aid of quantitative models with relevance to human disease. The molecular basis of human disease, when known, will be reviewed and placed in the context of the aforementioned models. The use of diagnostic aids to establish the locus, type and magnitude of pathological processes will be examined.

Course Objectives

  • Understand the basics of lung biology and physiology in a descriptive and quantitative manner.
  • Understand how normal physiology fails in disease settings based on reasoning from data that can be gathered clinically.
  • Understand how specific patterns of respiratory system failure arise and how to recognize the basis for these failure states.Understand how physiological failure is manifested as disease and how it is reflected in clinical presentations.
  • Understand how professional behavior is needed to address life and death issues in clinical care.
  • Produce written responses to case problems which include both quantitative and written exposition.
  • Understand the impact of environmental and social factors on lung biology and physiology.

Renal Pathophysiology

HST 110 Renal Pathophysiology

Course Directors: Megan ProchaskaMelissa Yeung

Course Description

The normal physiology of the kidney and the pathophysiology of renal disease. Emphasis on renal regulation of sodium, potassium, acid, and water balance along with the mechanism and consequences of renal failure. Included also are the pathology and pathophysiology of clinical renal disorders such as acute and chronic glomerulonephritis, pyelonephritis, and vascular disease. New molecular insights into transporter mutations and renal disease are discussed.

Course Objectives

  • Obtain an understanding of the basic physiologic processes of the human kidney, including the following concepts: structure and function of the human kidney, glomerular filtration, clearance, tubular transport, osmoregulation and disorders of water balance, sodium balance and disorders of volume regulation, diuretics, acid-base physiology and acid-base disorders, potassium homeostasis and disorders, regulation of calcium and phosphorus homeostasis.
  • Obtain an understanding of the pathology and pathophysiology of human renal disease, including: acute kidney injury, chronic kidney disease, proteinuria and hematuria, nephrotic syndrome, nephritic diseases (immune complex diseases, rapidly progressive glomerulonephritis, asymptomatic hematuria/proteinuria syndromes), tubulointerstitial disease, vascular disease, systemic diseases, kidney stones.
  • Demonstrate the ability to use analytical skills that focus on inductive reasoning in the application of knowledge to solve problems relevant to the basic physiologic and pathophysiologic processes of the kidney.
  • Identify and describe the clinical presentation of common diseases of the kidney.
  • Understand the diagnostic testing that is relevant to the diagnosis of common diseases of the kidney.
  • Obtain a basic understanding of the overall treatment strategy of common diseases of the kidney.
  • Treat fellow students and faculty with respect and to commit to learning in order to prepare oneself for future patient care, including: preparing for class work to the best of one's ability, being timely in reporting for class sessions and notifying faculty in the event of absences from class.
  • Communicate effectively with fellow students and faculty with respect to medical and scientific information, articulate clearly one's thinking in the discussion of pathophysiologic processes and work effectively as a member of a team.
  • Describe the basic social, economic, ethnic, and racial factors that can contribute to the development, diagnosis, and treatment of common diseases of the kidney.

Introduction to the Care of Patients

HST 220 Introduction to the Care of Patients

Course Director: Howard Heller

Course Description

Introduction to the care of patients through observation and participation in doctor-patient interaction in an outpatient, office-based environment and through patient-oriented seminars. Topics include basic interviewing, issues of ethics and confidentiality, and other aspects of the doctor-patient relationship. Requirements include regular attendance andn a short paper on patient care.

Course Objectives

  • Provide students with the anatomy of the clinical encounter. By end of experience, students will have learned the following: the goals of the patient interview; how to get information; how to identify problems and issues; the beginnings of a diagnosis; the beginnings of therapy; how to build a relationship; how to act in a professional manner, including dress, body language and behaviors.
  • Clinical preceptors will introduce students to their research programs as part of the longitudinal experience.
  • Provide students with clinical exposure to patients and physicians within the introduction and the 4-month longitudinal preceptor experience.
  • Introduce students to standards of professional care, including: attendance, appropriate dress, appropriate behavior towards patients, appropriate behavior in a medical team setting, and appropriate behavior towards one another.
  • Introduce students to the care of the patient, fostered by longitudinal interactions with clinical preceptor over a period of 4 months.
  • Introduce students to wider social context of medicine via meetings with patients in academic healthcare setting (MIT Medical).

 

PRECLERKSHIP - Year II

HST Course Managers: Patricia CunninghamKarrol Altarejos
HST Senior Curriculum Manager: Catherine Hodgins

FALL

Mechanisms of Microbial Pathogenesis

HST 040 Mechanisms of Microbial Pathogenesis

Course Directors: Clyde S. CrumpackerHarvey B. Simon

Course Description

The course will deal with the mechanisms of pathogenesis of bacteria, Mycoplasma, Chlamydia, viruses and the fungi. Special emphasis will be placed on events at the molecular level. Topics have been selected for intrinsic interest and will cover the demonstrated spectrum of pathophysiologic mechanisms.

Course Objectives

  • Present structure and function of bacterial calls, viruses and parasites, such as malaria, indicating their role in replication of the organism and in causation of human disease. Students should be able to identify structures which are important antigens for vaccines, bacterial toxins, and targets for antibiotics, antiviral therapy and anti-malarial therapy, including resistance to drug therapy.
  • Understand the role of the human immune system in providing a defense against infectious agents and the importance of vaccines in prevention of infectious diseases.
  • Understand the role of organisms and the structures in mechanisms of human pathophysiology caused by infectious diseases.
  • Learn the principles of diagnosis and treatment of human infectious diseases.
  • Demonstrate ability to read and analyze research articles on infectious disease and apply this to understand mechanisms of human infectious diseases pathogenesis.
  • Understand pathogenesis of infectious disease with a clinician preceptor and a pathologist in a small group setting of how one evaluates a clinical case.
  • Participate as teammates in small group session to solve as a team, unknown clinical cases in infectious diseases. Prepare for class by reading assignments. Notify faculty regarding absences.
  • Interact with fellow students in laboratory sessions and discussions. Work in small groups to solve computational problem set.
  • Understand the role of: addiction to opiates and heroin in development of infectious diseases like endocarditis, heterosexual transmission of HIV and transmission of HIV in men having sex with men, the use of antiretroviral therapy to prevent HIV infection of a sexual partner, pharmaceutical companies in establishing fair prices for antibiotics and antiviral drugs, and hand washing and isolation to prevent transmission of infection in a hospital setting.

Human Reproductive Biology

HST 070 Human Reproductive Biology

Course Directors: Anastasia H. KoniarisDavid C. PageTrevin C. Lau

Course Description

This course is designed to give the student a clear understanding of the pathophysiology of the menstrual cycle, fertilization, implantation, ovum growth development, differentiation and associated abnormalities. Disorders of fetal development including the principles of teratology and the mechanism of normal and abnormal parturition will be covered, as well as ethical issues in reproductive science and significant medical issues affecting pregnant women such as pre-eclampsia and diabetes. Fetal asphyxia and its consequences will be reviewed with emphasis on the technology currently available for its detection. In addition the conclusion of the reproductive cycle, menopause, and the use of hormonal replacement will be covered. Emphasis on quantitative techniques, when applicable, including modern approaches to fetal surveillance and in vitro fertilization as well as prenatal diagnosis will be employed. Each lecture will be complemented by a brief clinical pathologic conference emphasizing relevant clinical applications of basic principles discussed in the lectures. Weekly thought questions will be assigned and a multiple choice final examination is given.

Course Objectives

HST070, Human Reproductive Biology, explores:

  • The Germ Line and Totipotent Circle of Life:300 million years ago (and many times since then) sex chromosomes evolved. We study how human sex chromosomes impact sex determination, fertility, male/female readings of the genome, and sex differences in health and disease.
  • The Placenta: at a 16-cell stage, the outer cells of a human conceptus begin to form this specialized organ, which helps baby develop, and then minutes after baby’s birth separates from the uterus like a postage stamp.
  • Male and Female Reproductive Systems across the Lifespan:urogenital development, anatomy, normal physiology, and pathology.
  • Hypothalamic-pituitary-gonadal signaling axes: drive sex steroid and gamete production, thus impacting development, physiology, pathology, and pharmacology.
  • Pregnancy: physiology, prenatal care, pathophysiology, delivery .
  • Reproductive medicine offers many opportunities for critical thinking and inquiry. This is encouraged throughout the HST070 course.
  • One of the lecturers in HST070, Dr. Pomerantz, has brought one of his patients who has survived testicular cancer with him to class in recent years. Otherwise, HST070 uses case vignettes to “simulate” patient care.
  • Topics such as contraception or amenorrhea are especially amenable to simulating patient care in the classroom.  Pathological emergencies, eg post-partum hemorrhage, or eclamptic seizure, are reviewed in this class, but perhaps less accessible in a classroom (versus clinical) setting. Some students elect to read literature related to a patient’s or family’s experience, for example, these books: The Immortal Life of Henrietta Lacks, or Middlesex, or The Chamberlen’s Secret: How a Century of Women Were Robbed of Safe Childbirth.
  • To engage in course learning as mature professionals.
  • About 30 students take HST070 each year, usually the students are starting their second year of HST and so they already know one another. The class is small enough that students have the opportunity to learn with and from each other.
  • Several HST070 lectures relate directly to organizational and social health care determinants:
    • Roger Shapiro reviews his work in Botswana, researching medication protocols to prevent maternal to child HIV transmission
    • Pat Donahoe reviews congenital adrenal hyperplasia and other disorders of sexual differentiation
    • Amitabh Chandra is on sabbatical in 2017, but in recent years, he has taught the class about our US malpractice system
    • About 2/3rds of HST students in past years chose to read literature related to reproductive medicine topics, and often these literary works focus on social determinants of health care. 

Gastroenterology

HST 120 Gastroenterology

Course Directors: Anna RutherfordSarah Flier

Course Description

The most recent knowledge of the anatomy, physiology, biochemistry, biophysics, and bioengineering of the gastrointestinal tract and the associated pancreatic, liver and biliary tract systems is presented and discussed. Gross and microscopic pathology and the clinical aspects of important gastroenterological diseases are then presented, with emphasis on integrating the molecular, cellular and pathophysiological aspects of the disease processes to their related symptoms and signs. The course is highlighted by selected patient presentations in clinic and mini-case format which demonstrate how an understanding of the basic and clinical sciences of gastroenterology is essential to rational diagnosis and therapeutic decisions. Throughout the course, formal lectures are given by the core faculty with some guest lectures by local experts. Selected seminars are conducted by students with supervision by faculty members.

Course Objectives

  • Familiarize students with the most common physiologic and pathologic processes in the gastrointestinal tract, including the luminal tract, pancreas, biliary tract and liver.
  • Demonstrate the ability to analyze and critically discuss pathophysiology and clinical disorders in the field of gastroenterology and hepatology.
  • Understand the pathogenesis of gastrointestinal and hepatic disorders and be able to discuss with a clinical teaching fellow in a small group how one evaluates a clinical case.
  • Interact with patients with gastrointestinal disease and discuss clinical issues with both the patient and physician presenting the case.
  • Exhibit punctuality, good behavior and participation in small and large group sessions; notifiy faculty in the context of absences; and prepare for class, in particular the 7 clinical case sessions.
  • Participate in large group and small group sessions. Interact with patients in clinical sessions. Interact with fellow students in small group sessions.
  • Participate in classroom discussions in small and large group setting on the social, ethnic and cultural factors in gastrointestinal and hepatic disease.

Neuroscience

HST 130 Neuroscience

Course Directors: John A. AssadMatthew P. Frosch

Course Description

Comprehensive introductory course in neuroscience. Basic principles of organization and function of the nervous system will be discussed with frequent reference to pathophysiology of neurological and psychiatric disorders. Combining pathophysiology with basic neuroscience should provide physician/scientists and Ph.D. candidates with a dynamic picture of the rapidly evolving field of neuroscience and the experimental process from which the picture is derived, and all students should emerge with a greater awareness both of the applications of their work in alleviating disease, and of the ways that disease can provide insight into basic scientific questions. The course will span modern neuroscience from molecular neurobiology to perception and cognition, and will include the following major topics: Anatomy and Development of the Brain; Cell Biology of Neurons and Glia; Ion Channels and Electrical Signaling; Synaptic Transmission, Integration, and Chemical Systems of the Brain; Sensory Systems, from Transduction to Perception; Motor Systems; and Higher Brain Function (Memory, Language, Affective Disorders).

Course Objectives

  • Present normal structure and function of cellular element of the nervous system (neurons, astrocytes, oligodendrocytes, microglia, ependymal, meninges). Students should be able to: define and identify the cellular components of the nervous system; define and illustrate the specific structural specifications of neurons (dendrites, spines, axons); discuss the passive and active electrical properties of neurons including the kinetics of ion; channels and axons propagation; and discuss the structure of synaptic connections, including the implications of synapse location, fine structures, transmitter/receptor phenotypes and aspects of synaptic integration and plasticity.
  • Demonstrate understanding of the structural organization of the central nervous system, including anatomic names, relative locations, functions and critical connections. Students should be able to: draw, label and discuss structures across the neuro-axis; identify functional associations between structures; understand the relationship between neuroanatomic structures and imaging findings; demonstrate the ability to localize lesions across the neuro-axis through combination of clinical signs and symptoms with neuroanatomic knowledge.
  • Integrate cellular function with neuro-anatomic organization. Students should be able to: discuss the functional organization of sensory systems within the central nervous system, including visual, auditory, vestibular, somatosensory and pain; and discuss the functional organization of motor systems within the central nervous system.
  • Demonstrate understanding of the development and plasticity of the central nervous system. Students should be able to: discuss critical events during development from early embryogenesis through post-natal life; explain the relationships between malformations and developmental events; discuss the similarities and distinctions between adult plasticity and developmental processes; and discuss the potential implications of developmental insights into the design and implementation of future therapeutics.
  • Demonstrate the use analytical skills and reasoning for the application of rich fund of knowledge to solve problems relevant to the normal and abnormal function of the nervous system.
  • Delineate some of the diagnostic and therapeutic interventions pertinent to common diseases.
  • Understand the functional and neuro-anatomic basis for the neurologic examination and localization.
  • Understand the role of imaging in the assessment of patients.
  • Describe the relevant risk factors for and lifestyle interventions to minimize the risk of common diseases.
  • Cover principal disorders including: demyelinating diseases; epilepsy; cerebrovascular diseases; neurodegenerative diseases (including dementias, movement disorders, and others); sleep disorders; developmental disorders (including autism/PDD as well as malformations); neoplastic disorders; traumatic brain injury and sequalae.
  • Treat fellow students and faculty with respect and to commit to learning in order to prepare oneself for future patient care: prepare for class work to the best of one's ability; be timely in reporting for class sessions; and notify faculty in the event of absences from class.
  • Communicate effectively with other students (from both MD and PhD programs) and faculty with respect to medical and scientific information.
  • Articulate clearly one's thinking in the discussion of normal and abnormal structure and function of the nervous system.
  • Work effectively as a member of a team in small group sessions.
  • Understand how differences in gender, age and socioeconomic status relates to neurological disorders.
  • Articulate clearly one's thinking about how basic treatment of neurological illness relates to ethnicity, culture and sexual orientation.

Molecular Medicine

HST 140 Molecular Medicine (elective)

Course Directors: Vijay SankaranSuneet Agarwal

Course Description

Seminar studying a variety of human diseases and the underlying molecular, genetic, and biochemical basis for pathogenesis and pathophysiology. Lectures by faculty and seminars conducted by students, with tutorials and supervision by faculty. Patients presented when feasible. Appropriate for students who have had a course in biochemistry and/or molecular biology.

Clinical Reasoning through CPCs

HST 312 Clinical Reasoning through CPCs (elective)

Course Director: Thomas N. Byrne

Course Description

Seminar studying a variety of human diseases and the underlying molecular, genetic, and biochemical basis for pathogenesis and pathophysiology. Lectures by faculty and seminars conducted by students, with tutorials and supervision by faculty. Patients presented when feasible. Appropriate for students who have had a course in biochemistry and/or molecular biology.

WINTER/SPRING

Principles of Pharmacology

HST 150 Principles of Pharmacology

Course Directors: Carl E. RosowStuart A. Forman

Course Description

Introduction to pharmacology. Mechanisms of drug action, dose-response relations, pharmacokinetics, drug delivery systems, drug metabolism, toxicity of pharmacological agents, drug interactions, and substance abuse. Selected agents and classes of agents examined in detail. The object of the course is to teach students an approach to the study of pharmacologic agents. It is not intended to be a review of the pharmacopoeia. The focus will be on the basic principles of biophysics, biochemistry and physiology, as related to the mechanisms of drug action, biodistribution and metabolism. The course will consist of lectures and student-led case discussions. Selected agents and classes of agents will be examined in detail.

Course Objectives

  • Learn core principles and applications of clinical pharmacology, broadly including pharmacodynamics (receptors, dose-response, concentration-response, toxicology) and pharmacokinetics (absorption, distribution, metabolism, and elimination) and pharmacogenomics. Learn clinical indications, usage, and limitations of specific drug classes, including cardiovascular drugs, antidysrhythmics, local and general anesthetics, antibiotics, diabetes, anti-inflammatories, opioids, immunosuppressants, cancer chemotherapy, and neuropsychopharmacology.
  • Actively participate in the learning process by applying pharmacological principals in self-directed and group-based learning, as well as leading their peers in the learning process through clinical case presentations. Quantitative modeling applications will also be employed to solidify understanding.
  • Study specific cases in-depth, and present their analysis of relevant principles and rationale for practical applications of drug therapy. Participate in a clinical exercise in the MGH operating rooms where they will learn how principles of pharmacokinetics apply to anesthetic drugs.
  • Discuss the drug-development pathway from discovery to post-approval monitoring. Ethical considerations regarding the placebo effect and how the pharmaceutical industry influences study design, prescription practices, and outcome reporting are covered. Students will interact with patients and care teams during the MGH operating room exercise.
  • Participate in classroom discussions with peers and faculty; work together in teams on a Matlab exercise and in pairs on clinical case presentations.
  • Consider pharmacogenomics and pharmacoepidemiology in relation to issues of racial differences in drug effects as well as the impact of education and social status on compliance and effectiveness. Consider how the pharmaceutical industry influences drug utilization through marketing to doctors and patients, and through influence on clinical trial design and reporting.

Clinical Epidemiology: Methods for Clinical Research

HST 194 Clinical Epidemiology: Methods for Clinical Research

Course Director: Miguel Hernan

Course Description

Clinical research is used to describe, predict, and make causal inferences. This course introduces the methods for the generation, analysis, and interpretation of data for clinical research. Major topics include the design of surveys, predictive models, randomized trials, clinical cohorts, and analyses of electronic health records. Students will learn to formulate well-defined research questions, to design data collection, to evaluate algorithms for clinical prediction, to design studies for causal inference, and to identify and prevent biases in clinical research. Familiarity with regression modeling and basic statistical theory is a pre-requisite. The course emphasizes critical thinking and practical applications, including daily assignments based on articles published in major clinical journals and the discussion of a case study each week. A key goal of the course is training students to comprehend, critique, and communicate findings from the biomedical literature.

Course Objectives

  • Introduce the methods of clinical epidemiology for the generation, analysis, and interpretation of data for clinical research. Students should be able to: recognize, classify, and formulate well-defined questions in clinical research; design data collection for descriptive and predictive studies; evaluate algorithms for clinical prediction; and discuss the use of randomized trials and observational studies for causal inference.
  • Comprehend, critique, and communicate research findings from the medical literature. Specifically, students should be able to outline critical evaluations of the clinical literature.
  • Describe the methods of evidence-based medicine, including how to generate and interpret data to quantify disease burden, identify risk factors, and determine that an intervention is effective for the treatment or prevention of disease.
  • Discuss clinical questions from several areas, including cardiology, rheumatology, neurology infectious disease, and pediatrics.
  • Treat fellow students and faculty with respect.
  • Come prepared for class discussions and class studies.
  • Be an active participant in group assignments.
  • Turn in individual assignments in a timely way.
  • Articulate research questions clearly, communicate methods and research strategies effectively, develop sound critiques of research studies, and work as a member of a team.
  • Discuss social, economic, ethnic, and cultural factors that impact research findings and are relevant to study design and data analysis.

Introduction to Clinical Medicine

HST 200 Introduction to Clinical Medicine

Course Directors: Wolfram GoesslingDouglas A. Rubinson

Course Description

This course teaches the necessary skills for acquiring a complete patient history and performing a thorough physical examination. Emphasis is placed on communicating patient findings, both in written form and oral presentations. Much of the instruction in this course is at the bedside. Lectures are oriented towards presenting the clinical findings associated with diseases, and are kept to a maximum of four per week, after the introductory module in Neuro-Psychiatry. Medical and Surgical Preceptors are assigned to their students for the entire semester. Students are evaluated by observed history-taking and physical examinations on patients. Human physiology is a course requirement.

Course Objectives

  • Gain a first experience in the care patients with a variety of diseases through hands-on bedside experiences, clinical demonstrations, case discussions and lectures.
  • Acquire the relevant skills involved in the examination of a patient and that are introduced in history-taking and patient interviews.
  • Interact with patients and acquire the necessary skills to complete a patient history and physical examination and organize and present the information so that a differential diagnosis and treatment plan can be formulated.
  • Attendance and timeliness to all lectures and clinical experiences are expected. If time off is required it must be requested for approval. In the event of an unexpected absence or tardiness students must notify course administrator and relevant faculty.
  • Professionalism and engagement are assessed regularly. Participation and conduct during lectures, clinics, and special rounds is expected.
  • Treat patients, members of the care team, fellow students, faculty, and administrators with utmost respect.
  • Written patient note on both surgical and medical patients seen throughout the course.
  • Build strong presentation skills that can be tailored to particular situations and the specialist that student is working with.
  • Develop effective communication skills for delivering difficult news to a patient and their family.
  • Didactic and highly interactive lectures that are focused on effectively interacting with patients of various demographic backgrounds and social/ cultural factors.
  • Students must appropriately elicit pertinent facts about a patient’s family and social history.

Psychopathology

PS 700M.J Psychopathology

Course Directors: Steven SchlozmanJoshua Roffman

Course Description

Introduction to the clinical features, scientific understanding, and most effective treatments of the major mental health disorders that characterize medical practice. Psychiatric disorders such as mood disorders, schizophrenia, anxiety disorders, trauma and personality disorders will be discussed in depth in both lecture formats and in small group discussions. Sessions will alternate with smaller group sessions at Departments of Psychiatry clinical sites, where students will learn to assess patients with a range of psychiatric disorders.

Course Objectives

  • To understand the fundamental principles of clinical psychiatry, students should understand: the definition of the medical specialty called psychiatry; the principles that separate concepts of mental health from mental illness; an appreciation for the role of psychological development in determining psychiatric diagnoses; the ability to formulate a diagnosis and treatment plan for a patient with psychiatric illness; an appreciation for the role that investigations and advancements in basic science and neuroscience play in the furthering the understanding of psychiatric disease; an appreciation for the role that investigations and advancements in neuroscience and basic science play in the furthering the success of psychiatric interventions; an appreciation for the role of advocacy in the care of patients with psychiatric challenges.
  • Epistemology of Psychiatric Nosology and Clinical Evaluation in Psychiatry: students can explicate the reasons for potential shortcomings in psychiatric nosology and psychiatric evaluation, and defend current practices in psychiatric nosology and evaluation.
  • Psychiatric Evaluation: students can perform a psychiatric interview and mental status exam; students can formulate a psychiatric diagnosis; students can formulate a psychiatric treatment approach including both somatic and non-somatic therapies.
  • Student Doctors: students dress appropriately for class and for site visits; students recognize and respect the special need for privacy and confidentiality when interviewing psychiatry patients; students understand the role of advocacy in caring for psychiatrically ill patients and in combating stigma towards mental illness.
  • Students can: engage in clear, coherent and nuanced discussions of course material with faculty; engage in clear, coherent and nuanced discussions of psychiatric inquiries with patients and families including explanations and patient education; understand how to explain basic and translational science investigations that further psychiatric knowledge and understanding.
  • Students can understand and explain: the impediments that negative biases toward fundamental concepts of mental health create in delivering excellent psychiatric health care ; the relationship of psychiatric health to overall medical health; the importance of advocacy in order to prevent cultural misperceptions of psychiatric suffering; the importance of basic and translational science investigations to improve the well-being psychiatric patients.

 

PCE (PRINCIPAL CLINICAL EXPERIENCE) 

A year-long clinical immersion experience that exposes students to the medical disciplines and experiences essential to becoming a physician. The year consists of 1-month to 3-month clinical rotations in medicine, surgery, pediatrics, obstetrics and gynecology, neurology, psychiatry, and radiology at a single site, supplemented by mentoring and assessment. Students also complete the longitudinal experiences: the multidisciplinary PCE case conferences, the Primary Care Clerkship, and the Developing Physician course.

SITE INFORMATION

Beth Israel Deaconess Medical Center

PCE Director: Katharyn Meredith Atkins
PCE Manager: Lidia Graziano—lgrazian@bidmc.harvard.edu

Boston Children's Hospital - Pediatrics for BIDMC and BWH

PCE Director:  Katie O’Donnell
PCE Coordinator: Winnie (Su Wen) YuSuWen.Yu@childrens.harvard.edu 

Brigham and Women's Hospital

PCE Director: Erik Karl Alexander
PCE Manager: Britt Simonson—bsimonson1@partners.org

Cambridge Health Alliance

PCE Director: David Alan Hirsh
CIC Coordinator: TBD

Massachusetts General Hospital

PCE Director: Alberto Puig
PCE Manager: Lisa Neville—lmneville@mgh.harvard.edu

PCE Clerkship Objectives & Clinical Requirement Checklists

Medicine Clerkship

Course Objectives

  • CAREERS IN MEDICINE: Learn how your interests, strengths and weaknesses are suited to different fields.
  • COMMUNICATION I: Present patient information concisely, accurately, and in timely fashion to members of a health care team in a variety of settings and formats including verbally and in writing.
  • COMMUNICATION II: Keep patient and family involved and informed.
  • CULTURAL COMPETENCE: Utilize understanding of cultural, socioeconomic, gender, and age are related issues in patient interactions and clinical decision-making.
  • DATA ANALYSIS: Interpret data from laboratories and radiology demonstrating knowledge of pathophysiology and evidence from the literature.
  • DIAGNOSIS I: Articulate a cogent, prioritized differential diagnosis based on initial history and exam.
  • DIAGNOSIS II: Design a diagnostic strategy to narrow an initial differential diagnosis demonstrating knowledge of pathophysiology and evidence from the literature.
  • MANAGEMENT: Design a management strategy for life-threatening, acute, and chronic conditions demonstrating knowledge of pathophysiology and evidence from the literature.
  • MODELS OF HEALTH CARE DELIVERY: Understand various models of organizing, financing, and delivering health care.
  • PATIENT CENTERED CARE: Understand illness in the context of a patient’s life circumstances, and understand how to ensure patient engagement in care to extent possible.
  • PHYSICAL EXAM: Perform and interpret findings of a focused and thorough physical exam guided by clinical reasoning.
  • PROCEDURES: Perform routine technical procedures.
  • PROFESSIONALISM I: Be selfless, reliable, honest, and respectful of patients, colleagues and staff.
  • PROFESSIONALISM II: Take initiative and responsibility for learning, achieving personal growth and improvement, and supporting the learning objectives of others.
  • PROFESSIONALISM III: Demonstrate knowledge and affirmation of ethical standards.

Requirement Checklist

TOPIC/SKILL

STUDENT LEVEL OF PARTICIPATION

SETTING

Medicine Topic: Abdominal Pain

OB or AP

Inpatient or outpatient

Medicine Topic: Anemia

OB or AP

Inpatient or outpatient

Medicine Topic: Chest Pain

OB or AP

Inpatient or outpatient

Medicine Topic: Common Cancers

OB or AP

Inpatient or outpatient

Medicine Topic: Coronary Artery Disease

OB or AP

Inpatient or outpatient

Medicine Topic: Diabetes Mellitus

OB or AP

Inpatient or outpatient

Medicine Topic: Dyslipidemias

OB or AP

Inpatient or outpatient

Medicine Topic: Dyspnea

OB or AP

Inpatient or outpatient

Medicine Topic: Fever

OB or AP

Inpatient or outpatient

Medicine Topic: Fluid, Electrolyte and Acid-Base Disorders

OB or AP

Inpatient or outpatient

Medicine Topic: Health Promotion, Disease Prevention and Screening

OB or AP

Inpatient or outpatient

Medicine Topic: Heart Failure

OB or AP

Inpatient or outpatient

Medicine Topic: Hypertension

OB or AP

Inpatient or outpatient

Medicine Topic: Liver Disease

OB or AP

Inpatient or outpatient

Medicine Topic: Musculoskeletal Disorders & Back Pain

OB or AP

Inpatient or outpatient

Medicine Topic: Rash

OB or AP

Inpatient or outpatient

Medicine Topic: Renal Disease

OB or AP

Inpatient or outpatient

Medicine Topic: Venous Thromboembolism

OB or AP

Inpatient or outpatient

Medicine Skill: Observed by faculty member taking history and performing physical exam

AP

Inpatient or outpatient

 

AP (active participation) = The student participated in components of the history/physical exam, engaged in clinical reasoning, or performed/assisted in performance of a specific skill

OB (observation) = The student observed other team members engaged in patient care around a clinical issue or performance of a specific skill.

 

 

Neurology Clerkship

Course Objectives

  • COMMUNICATION I: Present patient information concisely, accurately, and in timely fashion to members of a health care team in a variety of settings and formats including verbally and in writing.
  • COMMUNICATION II: Keep patient and family involved and informed.
  • CULTURAL COMPETENCE: Utilize understanding of cultural, socioeconomic, gender, and age-related issues in patient interactions and clinical decision-making.
  • DATA ANALYSIS: Interpret data from laboratories and radiology demonstrating knowledge of pathophysiology and evidence from the literature.
  • DIAGNOSIS I: Articulate a cogent, prioritized differential diagnosis based on initial history and exam.
  • DIAGNOSIS II: Design a diagnostic strategy to narrow an initial differential diagnosis demonstrating knowledge of pathophysiology and evidence from the literature.
  • MANAGEMENT: Design a management strategy for life-threatening, acute, and chronic conditions demonstrating knowledge of pathophysiology and evidence from the literature.
  • MODELS OF HEALTH CARE DELIVERY: Understand various models of organizing, financing, and delivering health care.
  • PHYSICAL EXAM: Perform and interpret findings of a complete and neurological exam guided by clinical reasoning.
  • PROFESSIONALISM I: Be selfless, reliable, honest, and respectful of patients, colleagues and staff.
  • PROFESSIONALISM II: Take initiative and responsibility for learning, achieving personal growth and improvement, and supporting the learning objectives of others.
  • PROFESSIONALISM III: Demonstrate knowledge and affirmation of ethical standards.

Requirement Checklist

TOPIC/SKILL

STUDENT LEVEL OF PARTICIPATION

SETTING

Neurology Topic: Change in Mental Status

OB or AP

Inpatient or outpatient

Neurology Topic: Change in Sensation

OB or AP

Inpatient or outpatient

Neurology Topic: Change in Strength or Movement

OB or AP

Inpatient or outpatient

Neurology Topic: Change in Vision

OB or AP

Inpatient or outpatient

Neurology Topic: Headache or Neurogenic Pain

OB or AP

Inpatient or outpatient

Neurology Topic: Neurologic Exam

OB or AP

Inpatient or outpatient

Neurology Skill: Observed by faculty member taking history and performing physical exam

AP

Inpatient or outpatient

AP (active participation) = The student participated in components of the history/physical exam, engaged in clinical reasoning, or performed/assisted in performance of a specific skill

OB (observation) = The student observed other team members engaged in patient care around a clinical issue or performance of a specific skill.

Obstetrics/Gynecology Clerkship

Course Objectives

  • CAREERS IN MEDICINE: Learn how your interests, strengths and weaknesses are suited to different fields.
  • COMMUNICATION I: Present patient information concisely, accurately, and in timely fashion to members of a health care team in a variety of settings and formats including verbally and in writing. Obtain an accurate, efficient, appropriate, and thorough history. Specifically: obtain the chief complaint, present illness, menstrual history, obstetric history, gynecologic history, contraceptive history, sexual history, family history, and social history."
  • COMMUNICATION II: Keep patient and family involved and informed.
  • CULTURAL COMPETENCE: Utilize understanding of cultural, socioeconomic, gender, and age-related issues in patient interactions and clinical decision-making. Perform a complete ob/gyn medical history and a focused physical exam, while demonstrating empathetic and culturally sensitive care, and formulate an assessment and plan and communicate in a well-organized presentation.
  • DATA ANALYSIS: Interpret data from laboratories and radiology demonstrating knowledge of pathophysiology and evidence from the literature.
  • DIAGNOSIS I: Articulate a cogent, prioritized differential diagnosis based on initial history and exam.
  • DIAGNOSIS II: Design a diagnostic strategy to narrow an initial differential diagnosis demonstrating knowledge of pathophysiology and evidence from the literature.
  • MANAGEMENT: Design a management strategy for life-threatening, acute, and chronic conditions demonstrating knowledge of pathophysiology and evidence from the literature.
  • MODELS OF HEALTH CARE DELIVERY: Understand various models of organizing, financing, and delivering health care.
  • PATIENT CENTERED CARE: Understand illness in the context of a patient's life circumstances, and understand how to ensure patient engagement in care to extent possible.
  • PHYSICAL EXAM: Perform and interpret findings of a complete and organ-specific exam. Specifically: perform a comfortable ob/gyn examination as part of a general medical examination, including: breast exam, abdominal exam, pelvic exam, recto-vaginal exam.
  • PROCEDURES: Perform routine technical procedures. Specifically: sterile technique, suturing and foley catheter insertion.
  • PROFESSIONALISM I: Be selfless, reliable, honest, and respectful of patients, colleagues and staff.
  • PROFESSIONALISM II: Take initiative and responsibility for learning, achieving personal growth and improvement, and supporting the learning objectives of others.
  • PROFESSIONALISM III: Demonstrate knowledge and affirmation of ethical standards.

Requirement Checklist

TOPIC/SKILL

STUDENT LEVEL OF PARTICIPATION

SETTING

OB-GYN Topic: Abnormal Uterine Bleeding

OB or AP

Inpatient or outpatient

OB-GYN Topic: Acute Pelvic Pain

OB or AP

Inpatient or outpatient

OB-GYN Topic: Adnexal Mass

OB or AP

Inpatient or outpatient

OB-GYN Topic: Bleeding in Pregnancy

OB or AP

Inpatient or outpatient

OB-GYN Topic: Chronic Pain Management/Substance Abuse

OB or AP

Inpatient or outpatient

OB-GYN Topic: Family Planning

OB or AP

Inpatient or outpatient

OB-GYN Topic: Gyn Malignancy

OB or AP

Inpatient or outpatient

OB-GYN Topic: Hereditary Conditions, Birth Defects, and Genetic Screening

OB or AP

Inpatient or outpatient

OB-GYN Topic: High Risk Pregnancy

OB or AP

Inpatient or outpatient

OB-GYN Topic: Infertility

OB or AP

Inpatient or outpatient

OB-GYN Topic: Normal Pregnancy

OB or AP

Inpatient or outpatient

OB-GYN Topic: Pelvic/GUI Infections

OB or AP

Inpatient or outpatient

OB-GYN Topic: Screening breast disease and post-partum breast care

OB or AP

Inpatient or outpatient

OB-GYN Skill: OB/GYN Surgical Skills

AP

Inpatient or outpatient

OB-GYN Topic: Urogynecology

OB or AP

Inpatient or outpatient

OB-GYN Topic: Well Women's Care

OB or AP

Inpatient or outpatient

OB-GYN Topic: Intimate Partner Violence/Trauma Screening

OB or AP

Inpatient or outpatient

OB-GYN Skill: Observed by faculty member taking history and performing a breast and pelvic exam

AP

Inpatient or outpatient

AP (active participation) = The student participated in components of the history/physical exam, engaged in clinical reasoning, or performed/assisted in performance of a specific skill

OB (observation) = The student observed other team members engaged in patient care around a clinical issue or performance of a specific skill.

Pediatrics Clerkship

Course Objectives

  • Articulate a management plan based upon the patient's presentation, being mindful of chronic conditions and the larger care team.
  • Demonstrate intellectual curiosity, initiative, responsibility, reliability, and ethical behavior in patient care and self-directed learning.
  • Effectively and professionally communicate information about the patient, history and physical, diagnosis, and treatment plan to other caregivers and to the patient/family.
  • Formulate differential diagnoses and management plans; this process will include critical evaluation of the primary and secondary literature.
  • Perform an age-appropriate, focused pediatric physical exam tailored to the patient. Recognize common pediatric conditions.
  • Understand different models of delivering health care in a variety of settings, including the importance of the pediatric medical home.
  • Use an understanding of cultural, socioeconomic, gender, age and developmental related issues in patient and family interactions and clinical decision making.

Requirement Checklist

TOPIC/SKILL

STUDENT LEVEL OF PARTICIPATION

SETTING

Pediatrics Topic: Asthma

OB or AP

Inpatient or outpatient

Pediatrics Topic: CNS

OB or AP

Inpatient or outpatient

Pediatrics Topic: Chronic Illness

OB or AP

Inpatient or outpatient

Pediatrics Topic: Dermatologic

OB or AP

Inpatient or outpatient

Pediatrics Topic: Fever without Localizing Signs

OB or AP

Inpatient or outpatient

Pediatrics Topic: GI

OB or AP

Inpatient or outpatient

Pediatrics Topic: Neonatal Jaundice

OB or AP

Inpatient or outpatient

Pediatrics Topic: Respiratory (non-asthma)

OB or AP

Inpatient or outpatient

Pediatrics Topic: Well-child: Infant/Toddler

OB or AP

Outpatient

Pediatrics Topic: Well-child: Newborn

OB or AP

Inpatient or outpatient

Pediatrics Topic: Well-child: School-age/Adolescent

OB or AP

Outpatient

Pediatrics Skill: Observed by faculty member taking history & performing physical exam of newborn

AP

Inpatient or outpatient

AP (active participation) = The student participated in components of the history/physical exam, engaged in clinical reasoning, or performed/assisted in performance of a specific skill

OB (observation) = The student observed other team members engaged in patient care around a clinical issue or performance of a specific skill.

Primary Care Clerkship

Course Objectives

  • CAREERS IN MEDICINE: Learn how your interests, strengths and weaknesses are suited to different fields.
    • The PCC offers the opportunity to broaden student perspectives in making career decisions by providing a deeper understanding of the organization, delivery and economics of health care in general, and primary care specifically. Students have the unique opportunity to develop longitudinal relationships with patients, providing insight into this important aspect of clinical care. In addition, students spend 8 months working directly with an experienced faculty clinician, who can serve as a role model and mentor in considering how specific career paths unfold beyond residency training. Students are also able to observe how other specialties and consultants interact with primary care clinicians, gaining a broader view of the various career choices available.
  • COMMUNICATION I: Present patient information concisely, accurately, and in timely fashion to members of a health care team in a variety of settings and formats including verbally and in writing.
    • This clerkship will emphasize concise and focused verbal and written presentation of relevant data in the context of primary care office practice. Students will present each patient to their preceptor, with particular attention to differential diagnosis and the formulation of the assessment and plan. Students will learn to write concise, timely and accurate outpatient office visit notes, including subjective and objective data, as well as an assessment and plan. Students will have the opportunity to communicate with a variety of health care providers, including members of the staff within the primary care office in the course of day-to-day coordination of patient care. Students may also have the opportunity to communicate with consultants and adjunctive providers outside the primary care office with regard to the shared management of patients.
  • COMMUNICATION II: Keep patient and family involved and informed.
    • This clerkship will emphasize the development of advanced skills in communication with patients and families, with particular attention to counseling and shared decision-making. Students will learn to educate patients and families about potential diagnoses, planned evaluation, treatment plans and side effects, test results, and the proper use of medications, while demonstrating empathy, compassion, and respect for patient values. Students will be expected to assess patient understanding of evaluation and treatment recommendations, while taking into account educational background, language, health literacy, mental or physical impairments, and economic means.
  • CULTURAL COMPETENCE: Utilize understanding of cultural, socioeconomic, gender, and age related issues in patient interactions and clinical decision making. This clerkship will emphasize the importance of understanding the cultural context in which patients experience both illness and health. Students will interview patients while demonstrating sensitivity to the cultural, socioeconomic, gender and age issues that affect each patient’s perspective of his/her health. Students will learn to design management plans through a process of shared decision-making with each patient, incorporating the patient’s perspective into therapeutic plans. Students will learn to critically analyze relevant research, with attention to both research design and limitations of generalizability resulting from the scope of populations studied. Students will be encouraged to understand documented disparities in health care related to specific diseases and to consider ways to avoid perpetuating this disparity.
  • DATA ANALYSIS: Interpret data from laboratories and radiology demonstrating knowledge of pathophysiology and evidence from the literature. This clerkship will emphasize the interpretation of common tests performed in the primary care setting, including blood tests, growth charts, and radiologic studies. Students will become familiar with the sensitivity, specificity, and predictive value of common tests used in primary care. Students will understand the difference between a screening test and a diagnostic test, and will learn to use pre-test probability in deciding on the utility of a specific test in a given clinical context. Students will also become familiar with the costs of tests and procedures, and with the management of abnormal results and incidental findings.
  • DIAGNOSIS I: Articulate a cogent, prioritized differential diagnosis based on initial history and exam.
  • DIAGNOSIS II: Design a diagnostic strategy to narrow an initial differential diagnosis, demonstrating knowledge of pathophysiology and evidence from the literature.
    • This clerkship focuses on skills in the initial evaluation of symptoms and chronic illnesses that commonly present in the primary care setting. Students will learn to use the initial history and physical exam to articulate a cogent, prioritized differential diagnosis that provides the framework for appropriate and selective diagnostic testing. Students will also be expected to design a rational diagnostic strategy, based on knowledge of pathophysiology, as well as evidence from the literature, to narrow an initial differential diagnosis. The longitudinal nature of the PCC additionally affords students the opportunity to follow through on the stepwise evaluation and management of a presenting symptom or chronic illness in the stable ambulatory patient.
  • HISTORY TAKING: Obtain accurate, efficient, appropriate, and thorough history.
    • This clerkship will focus on development of skills in eliciting an appropriately focused history in the office setting and performing a physical exam tailored to each patients presenting concerns. Students will learn to use the history to guide their physical exam, and to focus their approach in order to address the specific acute or chronic conditions encountered with each patient. Students will also learn to incorporate history and physical exam components that are recommended for screening and prevention in patients of various ages.
  • MANAGEMENT: Design a management strategy for life-threatening, acute, and chronic conditions demonstrating knowledge of pathophysiology and evidence from the literature.
    • The PCC will focus on the development of management skills for common acute and chronic illnesses seen in the primary care setting. Students will learn to apply knowledge of relevant pathophysiology and evidence-based data in the design of a management plan for common acute illnesses and chronic conditions. Students will also learn to consider risks, costs, and efficacy in treatment options, and will become familiar with determining when a medical problem requires hospitalization for safe management. Students will learn to recognize causes of treatment failure, including non-adherence and adverse effects of medications. Students will learn to counsel patients about their illness and treatment and to include patients in the decision-making process.
  • MODELS OF HEALTH CARE DELIVERY: Understand various models of organizing, financing, and delivering health care.
    • This clerkship provides students the opportunity to work longitudinally with a primary care physician to recognize the influence of insurance status and health care system complexity on the ability of patients to obtain recommended care. Students also have the opportunity over the 8-month clerkship to become part of the health care team within a primary care office, thereby developing a better understanding of how multiple providers within and beyond the primary care office interact to provide comprehensive care for each patient.
  • PHYSICAL EXAM: Perform and interpret findings of a complete and organ-specific exam.
    • This clerkship will focus on refinement of physical exam skills in the outpatient setting, with particular emphasis on tailoring the physical exam to specific presenting problems. This clerkship will also emphasize the development of more advanced skills in specific components of the physical exam that may be more readily learned in the outpatient setting, including thyroid exam, breast exam, musculoskeletal exam, and genitourinary exam. Students will also learn to perform an age-appropriate screening physical exam.
  • PREVENTION: Plan a strategy for reducing incidence, prevalence, and impact of disease demonstrating knowledge of pathophysiology, clinical epidemiology, and evidence from the literature.
    • This clerkship will emphasize prevention of illness and promotion of health in patients presenting in the primary care setting. Students will learn to counsel patients regarding appropriate preventive care recommendations, based on the patient’s age, gender, and family history, with particular attention to immunizations and age-appropriate screening for cancer, cardiovascular risk, and safety.
  • PROCEDURES: Perform routine technical procedures. When relevant to the care of a patient seen in the office, students will learn to perform primary care office-based procedures, such as throat culture, Pap smear, STD cultures and microscopic examination, immunizations, suture removal, joint injection/aspiration.
  • PROFESSIONALISM I: Be selfless, reliable, honest, and respectful of patients, colleagues and staff.
    • This clerkship is unique among HMS clinical courses in offering the student direct observation and instruction by an individual faculty member weekly over an eight or nine month period. This allows the time for observation, reflection and growth to occur within the student, nurturing professionalism in a non-threatening environment. Students will be expected to demonstrate the humanistic values of honesty, integrity, compassion, altruism, and respect for oneself and others, including patients and coworkers. Students will demonstrate the required attendance, punctuality and skills of time management and will be well-groomed and appropriately attired. Students will be sensitive to patient needs, including being non-judgmental and respecting patient confidentiality.
  • PROFESSIONALISM II: Take initiative and responsibility for learning, achieving personal growth and improvement, and supporting the learning objectives of others.
    • This clerkship will emphasize self-directed learning and the evidence-based practice of medicine. Students will be expected to exhibit a commitment to ongoing self-education and to seek opportunities to deepen their clinical and factual knowledge. Students will be encouraged to read about their patients and will be expected to analyze the medical literature to guide decision-making in the course of patient care. Students should seek regular feedback from their preceptor and demonstrate personal openness to change.
  • PROFESSIONALISM III: Demonstrate knowledge and affirmation of ethical standards.
    • Students will be expected to demonstrate high ethical and moral standards, including sensitivity to the needs of patients and staff within the practice. Students will be expected to respect patient confidentiality, to counsel patients regarding treatment recommendations using language patients can understand, to include patients in the decision-making process, and to advocate for patients with limited resources or limited ability to advocate for themselves.

Requirement Checklist

TOPIC

STUDENT LEVEL OF PARTICIPATION

SETTING

Primary Care Topic: Chronic disease management

OB or AP

Outpatient

Primary Care Topic: Developmental issues and life stages

OB or AP

Outpatient

Primary Care Topic: Evaluation of cardiovascular/respiratory symptoms

OB or AP

Outpatient

Primary Care Topic: Evaluation of dermatologic complaints

OB or AP

Outpatient

Primary Care Topic: Evaluation of gastrointestinal symptoms

OB or AP

Outpatient

Primary Care Topic: Evaluation of gynecologic/genitourinary symptoms

OB or AP

Outpatient

Primary Care Topic: Evaluation of musculoskeletal symptoms

OB or AP

Outpatient

Primary Care Topic: Evaluation of psychiatric symptoms

OB or AP

Outpatient

Primary Care Topic: Evaluation of systemic symptoms

OB or AP

Outpatient

Primary Care Topic: Preventive health counseling

AP

Outpatient

Primary Care Topic: Preventive health screening

AP

Outpatient

Primary Care Skill: Observed by faculty member taking history and performing physical exam

AP

Outpatient

AP (active participation) = The student participated in components of the history/physical exam, engaged in clinical reasoning, or performed/assisted in performance of a specific skill

OB (observation) = The student observed other team members engaged in patient care around a clinical issue or performance of a specific skill.

Psychiatry Clerkship

Course Objectives

  • Appreciate the epidemiology and course of the major psychiatric disorders.
  • Appreciate the personal, family and public health impact of psychiatric disorders alone and when comorbid with other medical conditions.
  • Appreciate the role of a focused physical exam, particularly in emergency department and inpatient settings and for outpatient consultation, as part of comprehensive assessment of psychiatric presentations for which underlying neurological or other non-psychiatric disorders may be responsible (e.g., mass lesions, endocrinopathies, CNS infection).
  • Appreciate the role of psychiatrists and psychiatric treatment in the health care system.
  • Be able to develop relationships with patients that are empathic and well-bounded, informed by knowledge of a patient's illness and experiences, and guided by the best interests of the patient.
  • Be attuned to the impact of cultural background on psychiatric symptom presentation and on treatment adherence.
  • Be aware of major hypotheses concerning pathophysiology of and risk factors for mood and anxiety disorders, psychosis and addictions.
  • Be aware of obstacles to access to mental health treatment.
  • Be aware of the empirical bases for the major psychotherapeutic treatments used in psychiatry.
  • Be familiar with putative mechanisms of action and empirical basis for use of the major psychopharmacological treatments.
  • Be familiar with the role of different levels and systems of care relevant to psychiatric disorders including outpatient, inpatient, partial hospital, and residential treatment programs, community mental health centers, and self-help/support groups.
  • Conduct a systematic and focused psychiatric diagnostic interview including a recent and past psychiatric history and general medical history (including a substance abuse history), family history of psychiatric and general medical illness, as well as a social and developmental history (cultural factors, educational and occupational background, social and intimate relationships and supports, and legal problems).
  • Demonstrate directed commitment to self-learning and team-learning through reading, active participation in didactic sessions and case conferences, seeking out informative clinical encounters, and soliciting and utilizing feedback for self-improvement.
  • Demonstrate integrity, reliability, responsibility and collegiality in psychiatric care settings. Identify and evaluate personal beliefs and attitudes toward patients with psychiatric disorders.
  • Interact with patients with psychiatric disorders, family members, and members of multidisciplinary teams respectfully, empathically and effectively.
  • Perform a comprehensive mental status exam including assessment of appearance, behavior, motor activity, speech, mood, affect, thought processes, thought content (including paranoia, suicidality, homicidality), perceptions (including hallucinations), cognitive exam (orientation, fund of knowledge, attention, memory, abstraction), insight and judgment.
  • Present a psychiatric case concisely with an emphasis on pertinent positives and negatives needed for a comprehensive differential diagnosis, risk assessment and treatment plan.
  • Understand the problem of stigma associated with mental illness and its impact in health care settings and in the community.
  • Write up a thorough psychiatric evaluation including all aspects of the diagnostic interview and mental status exam as well as a differential diagnosis with supporting evidence as well as a provisional DSM-IV 5 Axis diagnosis, biopsychosocial formulation and treatment plan.

Requirement Checklist

TOPIC/SKILL

STUDENT LEVEL OF PARTICIPATION

SETTING

Psychiatry Topic: Anxiety Disorders

OB or AP

Inpatient or outpatient

Psychiatry Topic: Depression

OB or AP

Inpatient or outpatient

Psychiatry Topic: Mania

OB or AP

Inpatient or outpatient

Psychiatry Topic: Medical Legal Issues

OB or AP

Inpatient or outpatient

Psychiatry Topic: Personality Disorders

OB or AP

Inpatient or outpatient

Psychiatry Topic: Psychosis

OB or AP

Inpatient or outpatient

Psychiatry Topic: Risk Assessment

OB or AP

Inpatient or outpatient

Psychiatry Topic: Substance Use Disorders

OB or AP

Inpatient or outpatient

Psychiatry Skill: Observed by faculty member taking history and performing mental status exam

AP

Inpatient or outpatient

AP (active participation) = The student participated in components of the history/physical exam, engaged in clinical reasoning, or performed/assisted in performance of a specific skill

OB (observation) = The student observed other team members engaged in patient care around a clinical issue or performance of a specific skill.

Surgery Clerkship

Course Objectives

  • MEDICAL KNOWLEDGE: Reinforce the understanding of the pathophysiology of inflammation, infection, ischemia, bleeding, oncogenesis and homeostasis.
  • MEDICAL KNOWLEDGE: Reinforce how the above contribute to the broad categories of problems that surgeons often treat:
    • Response to injury, including elective surgery and trauma, perioperative fluid shifts, pain management, hemostasis, nutrition, prophylaxis and management of perioperative complications.
    • Acute abdominal inflammation, including appendicitis, cholecystitis, diverticulitis, and pancreatitis.
    • Chronic gastrointestinal inflammation, including inflammatory bowel disease.
    • Solid tumors, including colorectal, biliary, pancreatic, breast, melanoma, sarcoma, and lung cancer.
    • Mechanical abdominal wall and diaphragmatic defects, including hernias, such as reducible, incarcerated, strangulated hernias, as well as gastroesophageal reflux disease (GERD).
    • Endocrine diseases, including hyperparathyroidism, diseases of the thyroid and adrenal glands.
    • Vascular disease, including acute and chronic ischemia, as well as arterial embolism, thrombosis, and aneurysms.
  • CLINICAL SKILLS: Perform history and physical examination. Compile relevant data from diagnostic and imaging studies.
  • CLINICAL SKILLS: Formulate an assessment and plan for the surgical patient with attention to:
    • Formulating a diagnosis
    • Recognizing indications for surgical treatment
    • Recognizing options among surgical treatments
    • Assessing the risk of the patient for surgical treatment
    • Assessing the urgency of the clinical condition
  • CLINICAL SKILLS: Demonstrate familiarity with technical skills including:
    • Aseptic technique
    • Wound dressing
    • Skin closure, including suturing and stapling
    • Venipuncture
    • Intravenous access
    • Foley catheter placement
    • Nasogastric tube placement
    • Airway management and intubation
    • Administration of local anesthesia, including dosage calculation
  • COMMUNICATION SKILLS: Continue to develop skills to communicate effectively with patients, families and colleagues, in both verbal and written formats, including:
    • Written admission and consult notes
    • Written daily progress notes
    • Written pre-op, operative and post-operative notes
    • Oral presentations
    • Verbal request for colleague consultation
    • Surgical and procedure consent forms
  • PROFESSIONALISM: Continue to develop professionalism
  • INDEPENDENT LEARNING SKILLS: Continued development of independent learning skills
  • UNDERSTANDING OF ASPECTS OF A SURGICAL CAREER:
    • Academic career pathways
    • Surgical training programs
    • Career-life balance and wellness

Requirement Checklist

TOPIC/SKILL

STUDENT LEVEL OF PARTICIPATION

SETTING

Surgery Topic: Acute Abdominal Pain

OB or AP

Inpatient or outpatient

Surgery Topic: Benign GI Diseases

OB or AP

Inpatient or outpatient

Surgery Topic: Breast & Axilla

OB or AP

Inpatient or outpatient

Surgery Topic: Geriatrics

OB or AP

Inpatient or outpatient

Surgery Topic: Hernia

OB or AP

Inpatient or outpatient

Surgery Topic: Malignant Solid Tumor

OB or AP

Inpatient or outpatient

Surgery Topic: Musculoskeletal

OB or AP

Inpatient or outpatient

Surgery Topic: Nutrition

OB or AP

Inpatient or outpatient

Surgery Topic: Pain Management

OB or AP

Inpatient or outpatient

Surgery Topic: Post-Op Management

OB or AP

Inpatient or outpatient

Surgery Skill: Foley Catheter Placement

OB or AP

Inpatient or outpatient

Surgery Skill: NG Tube Placement

OB or AP

Inpatient or outpatient

Surgery Skill: Airway Management

OB or AP

Inpatient or outpatient

Surgery Skill: Aseptic Technique

OB or AP

Inpatient or outpatient

Surgery Skill: Knot Tying/Suturing

OB or AP

Inpatient or outpatient

Surgery Skill: Skin Closure

OB or AP

Inpatient or outpatient

Surgery Skill: Staple Place/Remove

OB or AP

Inpatient or outpatient

Surgery Skill: Wound Dressing

OB or AP

Inpatient or outpatient

Surgery Topic: Surgical Infections

OB or AP

Inpatient or outpatient

Surgery Topic: Trauma

OB or AP

Inpatient or outpatient

Surgery Topic: Urological Disorders

OB or AP

Inpatient or outpatient

Surgery Topic: Vascular Disease

OB or AP

Inpatient or outpatient

Surgery Skill: Observed by faculty member taking history and performing physical exam

AP

Inpatient or outpatient

AP (active participation) = The student participated in components of the history/physical exam, engaged in clinical reasoning, or performed/assisted in performance of a specific skill

OB (observation) = The student observed other team members engaged in patient care around a clinical issue or performance of a specific skill.

 

Radiology Clerkship

Course Objectives

  • CAREERS IN MEDICINE: Consider a career in radiology in as much as it applies to your interests, strengths and weaknesses.
  • COMMUNICATION: Communicate the relevant clinical presentation as it pertains to the request for and interpretation of radiological examinations.
  • CRITICAL THINKING I: For a clinical scenario, recognize the radiological examinations available, know relative appropriateness criteria (cost, radiation, sedation, time, complication(s), consent, limitations, and reimbursement where applicable), and devise a logical course of action to solve the clinical question.
  • CRITICAL THINKING II: Given a clinical scenario and radiological findings, generate an appropriate ordered differential diagnosis and a plan for management of the patient (next exam, treatment, consultation of a specialist).
  • CULTURAL COMPETENCE: Recognize aspects of patient autonomy in decision-making, communication, and cultural difference.
  • INTERPERSONAL: Become familiar with what it is that radiologists and radiological subspecialists do and how to interact with them as a clinical colleague.
  • MEDICAL KNOWLEDGE I: Review relevant anatomy, pathophysiology, technology and performance of examinations as it relates to the daily practice of radiology.
  • MEDICAL KNOWLEDGE II: Learn very basic plain film and CT interpretation and become familiar with sonography and MR.
  • MODELS OF HEALTH CARE DELIVERY: Become familiar with and begin to manage the digital aspects of modern radiology (PACS, PowerPoint, Internet, CD-ROMs, etc.), radiology terminology, and radiology interpretation and use in digital presentation/consultation of case material.
  • PATIENT CARE: Recognize the relevant clinical presentation as it pertains to the request for and interpretation of radiological examinations.
  • PATIENT CENTERED CARE: Understand illness in the context of a patient’s life circumstances, and understand how to ensure patient engagement in care to extent possible.
  • PROFESSIONALISM I: Exhibit professionalism in dealing with radiological staff and patients.
  • PROFESSIONALISM II: Recognize and reduce areas of potential error.
  • PROFESSIONALISM III: Recognize limitations in knowledge and understanding of radiological interpretation.

Requirement Checklist

TOPIC/SKILL

STUDENT LEVEL OF PARTICIPATION

SETTING

Radiology Topic: Abdomen diagnosis: GI tract obstruction

OB or AP

Inpatient or outpatient

Radiology Topic: Abdomen diagnosis: kidney stones

OB or AP

Inpatient or outpatient

Radiology Topic: Abdomen scenario: work-up of jaundice

OB or AP

Inpatient or outpatient

Radiology Topic: Abdomen scenario: work-up of pelvic pain

OB or AP

Inpatient or outpatient

Radiology Topic: Chest diagnosis: lung cancer

OB or AP

Inpatient or outpatient

Radiology Topic: Chest diagnosis: pneumonia

OB or AP

Inpatient or outpatient

Radiology Topic: Chest diagnosis: pneumothorax

OB or AP

Inpatient or outpatient

Radiology Topic: Chest scenario: pulmonary embolism

OB or AP

Inpatient or outpatient

Radiology Topic: Chest scenario: work-up of a palpable breast lump

OB or AP

Inpatient or outpatient

Radiology Topic: MSK diagnosis: arthritis

OB or AP

Inpatient or outpatient

Radiology Topic: MSK diagnosis: fracture

OB or AP

Inpatient or outpatient

Radiology Topic: MSK scenario: work-up of trauma patient

OB or AP

Inpatient or outpatient

Radiology Topic: Neuroradiology diagnosis: intracranial hemorrhage

OB or AP

Inpatient or outpatient

Radiology Topic: Neuroradiology scenario: work-up of acute stroke

OB or AP

Inpatient or outpatient

Radiology Topic: Radiation safety: Imagining Safety

OB or AP

Inpatient or outpatient

AP (active participation) = The student participated in components of the history/physical exam, engaged in clinical reasoning, or performed/assisted in performance of a specific skill

OB (observation) = The student observed other team members engaged in patient care around a clinical issue or performance of a specific skill.

*INTENTIONALLY DOES NOT HAVE AN ITEM FOR OBSERVED H&P

 

 

ANCHORING CLINICAL EXPERIENCE (ACE)

Mount Auburn Hospital

ACE Director: Alexandra V. Chabrerie

A two-month clerkship designed to ground the clinical skills learned in Introduction to Clinical Medicine for HST students doing a research project between their second and third years of medical school. The clerkship is divided into one month of outpatient/ambulatory medicine split between a primary care site as well as subspecialty clinics, and one month of inpatient medicine on the hospital wards. In addition to attending daily hospital based teaching conferences for internal medicine residents, students will have a case-based didactic curriculum that will focus on core topics in internal medicine. Students will be expected to complete a case presentation with a focus on applying primary basic science and clinical trials literature into a discussion of clinical reasoning and decision-making.

 

POST-PCE

Post-PCE Components

Clinical Capstone

Course Directors: Meredith AtkinsKate Treadway
Course Manager: 

Capstone Description COMING SOON!

Course Listings

Subinternships

About

Required Subinternship
Choose either Medicine or Pediatrics

ME 55o Medicine Core II Subinternship

Course Director: Alex Carbo
Course Manager: Sally Bartlett

Course Description

The overall goal of the Medicine Core II Subinternship is for students to continue to learn to deliver excellent medical care to patients. The clerkship is designed to allow students to evaluate and manage patients with complicated medical problems under the supervision of house staff and medical attending staff. Core II students are expected to function in a more independent manner than in Core I student and to assume more direct responsibility for patient care.

The majority of admissions are for the evaluation and subsequent management of acutely ill patients; some patients are admitted for diagnostic procedures. Each patient admitted has an identified attending physician who oversees that patient’s individual care. Students will be expected to interact with the resident and attending physician in all aspects of the care of that patient.

The broad range of common disorders (and the uncommon as well) represent rich opportunities for the trainee. Also vital is preparation of the subinterns for their future role as housestaff with course attention to the basic elements of teaching and the conduct of effective ward rounds. Students are integrated into the ward team and manage patients from admission to discharge under the direct supervision of the team resident. Bedside teaching also offers direct observation of student interviewing and examination skills. In addition to participating in the full range of conferences designed for the house staff, students will meet with faculty for seminar-based discussion of specific subintern curricular topics, as well as bedside rounds devoted to the interview, physical examination, review of primary data and problem formulation. Feedback will be provided to the students on a regular basis with a fixed mid-month review of performance. Evaluations will be based on input from housestaff and faculty. Students will meet individually with the course directors at the end of the rotation to review performance, achievements, and goals for the future.

SITE INFORMATION
Beth Israel Deaconess Medical Center
Brigham and Women's Hospital
Cambridge Health Alliance
Massachusetts General Hospital
Mount Auburn Hospital

PD 55o Pediatrics Core  Subinternship

Course Description (COMING SOON!)

SITE INFORMATION
Boston Children's Hospital
 

Course Listings

Medicine Course Objectives

  • H&P: Obtain a complete history in an efficient manner, reflecting hypothesis-driven data gathering.
  • H&P: Perform an accurate hypothesis-driven physical examination recognizing the specificity and limitations of exam findings.
  • DIAGNOSIS: Develop and prioritize a differential diagnosis.
  • DIAGNOSIS: Utilize laboratory and imaging tests effectively, including recognition of test limitations and costs.
  • MANAGEMENT: Develop and execute an effective therapeutic management plan.
  • MANAGEMENT: Prioritize and complete daily work tasks.
  • MANAGEMENT: Recognize patients requiring emergent evaluation, ask for help and initiate the evaluation.
  • MANAGEMENT: Reprioritize the problem list throughout the hospitalization.
  • MANAGEMENT: Effectively obtain informed consent and perform procedures such as venipuncture, arterial blood gas, paracentesis and lumbar puncture under supervision.
  • DISCHARGE: Create a discharge care plan that takes into account and addresses the social determinants of health and addresses heath care disparities.
  • DISCHARGE: Complete an accurate and complete discharge summary to facilitate transition of care.
  • COMMUNICATION: Document clinical encounters in a thorough manner which reflects hypothesis-driven data gathering and clinical reasoning.
  • COMMUNICATION: Deliver clear and concise patient presentations.
  • COMMUNICATION: Give and receive concise and accurate patient hand-overs in order to transition care responsibly.
  • COMMUNICATION: Communicate effectively and in a collaborative manner with all members of the interprofessional health care team.
  • COMMUNICATION: Communicate with patients and their families in a patient-centered, empathic manner without medical jargon seeking to incorporate patient preferences and cultural beliefs.
  • INQUIRY & EDUCATION: Form clinical questions and retrieve evidence to advance patient care.
  • INQUIRY & EDUCATION: Educate the team in the context of patient care.
  • INQUIRY & EDUCATION: Identify system failures and contribute to a culture of safety and improvement.

Pediatrics Course Objectives

  • H&P: Obtain a complete history in an efficient manner, reflecting hypothesis-driven data gathering.
  • H&P: Perform an accurate hypothesis-driven physical examination recognizing the specificity and limitations of exam findings.
  • DIAGNOSIS: Develop and prioritize a differential diagnosis.
  • DIAGNOSIS: Utilize laboratory and imaging tests effectively, including recognition of test limitations and costs.
  • MANAGEMENT: Develop and execute an effective therapeutic management plan
  • MANAGEMENT: Prioritize and complete daily work tasks.
  • MANAGEMENT: Recognize patients requiring emergent evaluation, ask for help and initiate the evaluation.
  • MANAGEMENT: Reprioritize the problem list throughout the hospitalization.
  • MANAGEMENT: Effectively obtain informed consent and perform procedures such as venipuncture, arterial blood gas, paracentesis and lumbar puncture under supervision.
  • DISCHARGE: Create a discharge care plan that takes into account and addresses the social determinants of health and addresses heath care disparities.
  • DISCHARGE: Complete an accurate and complete discharge summary to facilitate transition of care.
  • COMMUNICATION: Document clinical encounters in a thorough manner which reflects hypothesis-driven data gathering and clinical reasoning.
  • COMMUNICATION: Deliver clear and concise patient presentations.
  • COMMUNICATION: Give and receive concise and accurate patient hand-overs in order to transition care responsibly.
  • COMMUNICATION: Communicate effectively and in a collaborative manner with all members of the interprofessional health care team.
  • COMMUNICATION: Communicate with patients and their families in a patient-centered, empathic manner without medical jargon seeking to incorporate patient preferences and cultural beliefs.
  • INQUIRY & EDUCATION: Form clinical questions and retrieve evidence to advance patient care.
  • INQUIRY & EDUCATION: Educate the team in the context of patient care.
  • INQUIRY & EDUCATION: Identify system failures and contribute to a culture of safety and improvement.

Elective Courses

Visit the Course Catalog for more information on post-clerkship elective courses and contact information.

 

HST Thesis Requirement and HST Student Forum Presentation

HST Thesis Committee Chair: Richard N. Mitchell
HST Thesis Committee Coordinator: Karrol Altarejos

HST MD students are required to become actively involved in independent research under the direction of a faculty member. Such research may be conducted longitudinally throughout a student’s medical studies, if carefully planned. Students are also encouraged to slow the rate of progress through the formal curriculum and take an extra year in order to devote more time to research. As a requirement for graduation, every HST student must present evidence of original, scholarly and creative work in the form of a thesis based on laboratory research or clinical investigation. The thesis topic is to be chosen with the advice of a member of the Faculty, who agrees to act as the thesis supervisor. During their tenure, students are expected to present a poster of their research at the HST Student Forum, an annual event that celebrates the depth and breadth of HST student research effort and scholarly work.

Please note that the curriculum is undergoing continuous review and improvement and is subject to change at any time.

Last updated 2/27/2019