Pathways Course Info

PRECLERKSHIP

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.

Practice of Medicine

POM 100 Practice of Medicine (POM) – Weekly, September Year I – July Year II

 

Course Directors:  Anita Vanka, Katherine T. Johnston

Course Manager: TBD
 

Course Description

Training in communication skills, physical exam, clinical reasoning, clinical teamwork, diagnosis, and professional reflection designed to prepare students for their clinical clerkships and Principal Clinical Experience (PCE) in October of Year II. POM is designed to be integrated with a concurrent sequence of foundational basic and social sciences courses that together prepare students for entering the clinical clerkships and the Principal Clinical Experience (PCE) in October of Year II. Students entering HMS are assigned to one of our affiliated hospitals (BIDMC, BWH, Cambridge Health Alliance, or MGH). To foster continuity in education and establish meaningful relationships and mentorship, students stay at the same hospital for their second year to complete the PCE.

The POM offers students the opportunity to learn clinical medicine with a multifaceted approach focused on 1) interview & communication skills; 2) physical exam, clinical reasoning and diagnostic skills; 3) ambulatory care and inter-professional education; and 4) professional development and reflection. Guided by core faculty at each clinical site, students participate weekly in morning and afternoon sessions that alternate between inpatient and outpatient settings.

Course Objectives

  • Demonstrate professional, compassionate behavior.
  • Communicate with patients and families and develop the communication skills and attitudes fundamental to the patient-doctor relationship.
  • Master patient-oriented history taking skills and be able to incorporate knowledge of pathophysiology into the process of history taking.
  • Learn to work and communicate in interprofessional teams.
  • Perform a comprehensive and, when appropriate, a hypothesis-driven physical examination appropriate for a variety of clinical settings.
  • Differentiate and understand how clinical care is delivered in different settings (ambulatory vs. hospital)
  • Solve basic clinical problems using appropriate medical knowledge and scientific evidence.
  • Understand the basic tenants of clinical care within the context of the patient’s psychosocial and financial determinants of health and be exposed to challenging medical and psychosocial clinical situations.
  • Learn to differentiate the basic elements of the history and physical exam as they relate to pediatric and geriatric patients and be exposed to patients in different clinical settings (e.g., surgical, geriatric, pediatric).
  • Identify and characterize major signs and symptoms and abnormal physical findings and begin to understand their pathophysiologic basis and clinical significance.
  • Present clinical information and formulations about a patient’s illness to colleagues in a clear, efficient, and organized manner, in both oral and written formats in comprehensive and focused manner.
  • Formulate an accurate problem list and begin to formulate a differential diagnosis and case discussion that reflect a pathophysiologic understanding of the clinical situation.
  • Utilize reflection and introspection as you proceed through the different stages of clinical and professional development.
  • Recognize the role and value of other healthcare professionals, and how they contribute to the care of patients.

 

Foundations

PWY 100 Foundations – August – October, Year I

Course Director: Randy King
Course Manager: Kelly Ho

Course Description

Integrates three discipline-specific themes: Molecular, Cellular and Genetic Basis of Medicine (cell biology, biochemistry, genetics, and pharmacology); Structure and Function of the Human Body (anatomy, histology, developmental biology); and Mechanisms of Defense and Disease (pathology, immunology, microbiology). Each discipline introduces disease-specific themes, including Cancer, Infectious Disease, and Atherosclerosis.

Course Objectives

  • Be introduced to the social, economic, ethnic, and racial factors that play a role in the development, diagnosis, and treatment of disease, in patient clinics.
  • Communicate effectively with fellow students and faculty with respect to medical and scientific information, articulate clearly one’s thinking in the discussion of problems, and work effectively as a member of a team.
  • Demonstrate the ability to apply the language and knowledge of each discipline to discuss and solve basic science and clinical problems.
  • Develop a framework for understanding the relevant risk factors for disease that are relevant to prevention; apply the understanding of each discipline as it pertains to the diagnosis and treatment of disease.
  • Treat fellow students and faculty with respect and 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.
  • Understand the foundational concepts relevant to anatomy, histology, developmental biology, biochemistry, cell biology, genetics, pharmacology, pathology, immunology and microbiology.

Immunity in Defense and Disease

PWY 110 Immunity in Defense and Disease (IDD) – November-December, Year I

Course Director: Julia Charles, Ruth Ann Vleugels
Course Manager: Caitlin Hoey

Course Description

Dermatology, rheumatology, and immunopathology as they relate to immune/inflammatory disease mechanisms, autoimmune disease, acquired immunodeficiency, allergic disease, skin cancer, sepsis, and arthritis.

Course Objectives

  • 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.
  • Delineate the diagnostic and therapeutic interventions pertinent to common diseases affecting the immune system, skin, and joints.
  • Demonstrate the ability to use analytical skills that focus on inductive reasoning in the application of knowledge to solve problems relevant to: atopic disorders (asthma, food allergies, anaphylaxis, urticaria); systemic infectious diseases (sepsis, HIV/AIDS, TB); skin diseases (infectious, inflammatory, neoplastic); joint diseases (degenerative, inflammatory and infectious); and systemic disorders that affect skin, joints, and other organs (systemic lupus erythematosus, rheumatoid arthritis, psoriasis, and vasculitides).
  • Describe the basic clinical manifestations, diagnosis and treatment of common exemplar atopic/immediate hypersensitivity disorders, including asthma, food allergies, drug reactions, and anaphylaxis.
  • Describe the basic clinical manifestations, diagnosis and treatment of exemplar inflammatory, infectious, and neoplastic skin diseases.
  • Describe the basic concepts relevant to how the immune system is normally regulated, self-tolerance is maintained, and how dysregulation or deficiencies of immunity lead to diseases.
  • Describe the basic concepts relevant to how the immune system responds to tumors and allografts, and how these responses are therapeutically manipulated.
  • Describe the basic concepts relevant to the healthy physiology of joints, and the basic clinical manifestations, diagnosis and treatment of exemplar degenerative, inflammatory, and infectious disorders of joints.
  • Describe the basic concepts relevant to the healthy physiology of the skin, how the skin functions as an immune organ and the pathophysiology of inflammatory skin diseases, skin infections, and skin cancers.
  • Describe the basic concepts relevant to the pathophysiology, diagnosis and treatment of exemplar systemic inflammatory/autoimmune diseases that affect skin, joints, and other organs, including systemic lupus erythematosus, rheumatoid arthritis, psoriasis, and vasculitides.
  • Describe the basic pathophysiology, diagnosis and treatment of systemic infectious diseases associated with immune deficiency, including sepsis, HIV/AIDS, and Mycobacterium tuberculosis.
  • Describe the relevant risk factors for and lifestyle interventions to minimize the risk of common diseases affecting the skin and joints, and systemic infectious diseases.
  • Describe the social, economic, ethnic, and racial factors that play a role in the development, diagnosis, and treatment of skin diseases, joint disease, atopic diseases, systemic immune-mediated diseases and selected infectious diseases.
  • Treat fellow students and faculty with respect and 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.

Professional Development Weeks

PDW 101, PDW 102 & PDW 103 Professional Development Weeks - August, December, April Year I/II

Course Directors: John L. Dalrymple, Fidencio Saldaña
Course Manager: Gilianne Jawahir

Course Description

Professional Development Weeks (PDWs) are required week-long intersessions that occur at three spaced intervals during the Pathways preclerkship phase. PDWs are designed to build on the Professional Development Orientation (PDO) sessions in the first month of the Pathways MD curriculum and to encompass “professional development” in a broad sense: from self-reflection and self-assessment, to feedback, advising and planning, to consolidation and assessment of learning and for learning. Students participate in a Standardized Patient Encounter/OSCE, as well as workshops and large group sessions. By bringing together material from preceding courses and relating basic and social science to clinical skills, the goals of the PDWs are to consolidate and apply knowledge and skills, afford time and space to reflect, and provide opportunities to explore personal and professional interests.

Course Objectives

To provide students time for:

  • Consolidation, integration and application of learning
  • Assessment of learning, and for learning to include:
    •  Self-reflection and self-assessment
    • Peer-feedback
    • Formative feedback
  • Advising and planning
  • Personal and professional growth, exploration and development

Essentials of the Profession

PWY 120 Essentials of the Profession – January, Year I

 

Course Directors:  Tony Breu, Laura Garabedian
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.

Homeostasis I

PWY 130 Homeostasis I – February-March, Year I

Course Director: Barbara Cockrill
Course Manager: Kelly Ho                        

Course Description

The support of aerobic metabolism via gas exchange, oxygen delivery, and utilization. Major themes, respiratory, cardiovascular, and hematological systems, will integrate anatomy, histology, physiology, pathophysiology, pharmacology, pathology, and radiology. To support a pedagogical approach that emphasizes inductive reasoning, analytical thinking, and problem-solving, the course content emphasizes a series of questions, the answers to which require students to apply knowledge in a range of clinical contexts.

Course Objectives

  • 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.
  • Demonstrate the ability to identify learning gaps and create strategies for enhancing one's own knowledge and skills.
  • Demonstrate the ability to use analytical skills that focus on inductive reasoning in the application of knowledge to solve problems relevant to the respiratory, cardiovascular, and hematologic systems.
  • Describe the basic concepts relevant to the anatomy, histology, physiology, and pathology of the normal respiratory, cardiovascular and hematologic systems, and the basic diagnosis and treatment of common exemplar diseases within each system pertinent to: gas exchange, respiratory mechanics, respiratory control, pulmonary function testing, obstructive lung disease, restrictive lung disease, pleural disease, lung cancer, hemodynamics, electrocardiography, heart failure, cardiac ischemia, pulmonary vascular disease, anemia, clotting disorders, leukemia, and lymphoma.
  • Describe the relevant risk factors for and lifestyle interventions to minimize the risk of common diseases afflicting the respiratory, cardiovascular, and hematologic systems; and delineate the diagnostic and therapeutic interventions pertinent to common diseases affecting the respiratory, cardiovascular and hematologic systems.
  • Describe the social, economic, ethnic, and racial factors that play a role in the development, diagnosis, and treatment of respiratory, cardiovascular, and hematologic diseases.
  • Treat fellow students and faculty with respect and 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.

 

Homeostasis II

PWY 131 Homeostasis II – April-June, Year I

Course Director: Melanie Hoenig
Course Manager: Rob McCabe

Course Description

How the body maintains a steady state and how form dictates function in gastroenterology, nephrology, endocrinology, and reproductive endocrinology. These topics will integrate anatomy, histology, physiology, pathophysiology, pharmacology, pathology, and radiology.

Course Objectives

  • 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.
  • Demonstrate the ability to use analytical skills that focus on inductive reasoning in the application of knowledge to solve problems relevant to the renal, gastrointestinal and endocrinologic systems.
  • Describe the basic concepts relevant to the anatomy, histology, physiology, and pathology of the normal renal, gastrointestinal and endocrinologic systems, and the basic diagnosis and treatment of common exemplar diseases within each system pertinent to: renal clearance and tubular function; volume homeostasis; acid base homeostasis; osmoregulation; potassium homeostasis; glomerular diseases; acute kidney injury and chronic kidney disease; urinary obstruction; urinary tract infection and sexually transmitted infections; hypothalamic/pituitary axis; normal thyroid axis and thyroid disorders; normal adrenal gland axis and adrenal disorders; normal endocrine pancreatic function; diabetes mellitus and its complications; calcium homeostasis, bone formation, and osteoporosis; normal and disordered growth; puberty and reproductive endocrinology; pregnancy; abdominal pain; disorders of the esophagus and stomach; gastrointestinal motility; nutrient digestion; diarrhea; inflammatory bowel disorders; colon cancer; normal liver function, acute hepatic failure and cirrhosis.
  • Describe the relevant risk factors for and lifestyle interventions to minimize the risk of common diseases afflicting the renal, gastrointestinal and endocrinologic systems; and delineate the diagnostic and therapeutic interventions pertinent to common diseases affecting the renal, gastrointestinal and endocrinologic systems.
  • Describe the social, economic, ethnic, and racial factors that play a role in the development, diagnosis, and treatment of renal, gastrointestinal and endocrinologic diseases.
  • Treat fellow students and faculty with respect and 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.

Mind, Brain and Behavior

PWY 140 Mind, Brain and Behavior (MBB) – July-August, Year I/II

Course Director: Tamara Bockow Kaplan
Course Manager: Caitlin Hoey                        

Course Description

Integrated course on the nervous system, behavior, and development. Study areas include brain anatomy, psychiatric interviewing, and cognitive and emotional development. Students learn using hands-on dissection of human specimens, close study of anatomical models, and exercises in clinical neurology; they learn the approach to psychiatric interviewing through both didactic sessions and small-group visits to mental health facilities led by clinical preceptors; and they learn about cognitive and emotional development through interactive exercises with pediatric specialists and children. Weekly integration sessions are by lead faculty members from each discipline discuss a clinical case together from a multidisciplinary perspective.

Course Objectives

  • Appreciate the importance of delivering mental and behavioral health care as part of an effective team of health professionals.
  • 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.
  • Demonstrate effective skills in the interview and mental status examination of patients with psychiatric disorders.
  • Demonstrate the ability to use analytical skills that focus on inductive reasoning in the application of knowledge to solve problems relevant to the nervous system, including psychiatric disorders.
  • Demonstrate the highest standards of responsibility in patient care settings, including mental health facilities.
  • Describe the basic concepts relevant to the anatomy, biology, physiology, and pathology of the nervous system, and the basic diagnosis and treatment of common exemplar diseases within this system.
  • Describe the basic concepts relevant to the pathogenesis of psychiatric disorders, and the basic diagnosis and treatment of common exemplar diseases within the fields of mental and behavioral health.
  • Describe the relevant risk factors and preventative measures for common exemplar diseases affecting the nervous system, including psychiatric disorders, and delineate the diagnostic and therapeutic interventions pertinent to these conditions.
  • Describe the social, economic, ethnic/racial, culture, gender, and sexual orientation-related factors that play a role in the development, diagnosis, and treatment of disorders of the nervous system, including psychiatric illnesses.
  • Treat fellow students and faculty with respect and commit to learning in order to prepare oneself for future patient care.
  • Understand the ways in which disorders of the nervous system lead to mental and physical disability and the degree to which the social and economic context affect patients' ability to function with such disability.

 

Transition to the PCE

PWY 150 Transition to the PCE – August-September, Year II

Course Director: Cindy Cooper, Celeste Royce
Course Manager: Rob McCabe

Course Description

Consolidates learning during Year I with an emphasis on experiences that further develop skills necessary for success in the clerkships, with a focus on critical thinking, strengthening teamwork, applying medical knowledge to patient care, and understanding how to navigate potentially stressful encounters. Focused individualized learning sessions provide opportunities for students to strengthen knowledge and skills or to pursue advanced study of a topic of interest.

Course Objectives

  • 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.
  • Communicate effectively with patients in core clerkship experiences.
  • Demonstrate appropriate clinical reasoning and care of simulated patients.
  • Demonstrate the ability to use analytical skills that focus on inductive reasoning in the application of knowledge to develop relevant differential diagnoses, and an initial care plan for common clinical presentations.
  • Describe the basic concepts relevant to clinical care of patients, including: use of medical literature to support clinical care; use of clinical tests including EKG, ultrasound, radiology; clinical anatomy; addiction medicine; non-adherence; professional boundaries; clinical pharmacology; and clinical written and oral communication.
  • Describe the social, economic, ethnic, and racial factors that play a role in disorders of addiction and patient non-adherence.
  • Treat fellow students and faculty with respect and 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.

 

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: TBA

Cambridge Health Alliance

PCE Director: David Alan Hirsh
CIC Coordinator: Erin Reilly

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

 

Post-PCE

October, Year III–April, Year IV

 

One of the greatest features of the Pathways curriculum is the opportunity for students to customize their route through Years III and IV to prepare optimally for whatever aspect of the profession of medicine that has attracted their curiosity and passion. While rigorous demands and high expectations will be set for students in Years III and IV, the expanded time following the PCE allows for considerable flexibility as students pursue advanced integrated science courses, clinical and non-clinical electives, and scholarly research projects, and take advantage of myriad opportunities across Harvard University and around the world.

Post-PCE Components

AISCs (Advanced Integrated Science Courses)

Overview

Scientific research is at the core of evidence-based medicine, and is transforming medical care at an increasingly rapid pace. Physicians have to evaluate new research advances, incorporate them judiciously into clinical practice, and provide leadership for new research into the most urgent patient needs.

The goal of the Advanced Integrated Science Courses (AISCs) is to provide students with a generalizable skill set to engage with research at the boundary of the known and unknown, and its relationship with clinical medicine.

1. Generalizable Skills

  • Find and critically evaluate research information
  • Communicate science to peers or patients
  • Recognize how research influences patient care
  • Formulate questions and ideas for research and innovation

AISCs don’t aim to cover the content of a field, instead the goal is to use examples from the AISC subject area to develop these generalizable skills.

2. Research and Innovation at the Frontier

Each course represents a major field of current frontier research linked to major unsolved problems in patient care. Whereas the pre-PCE phase focuses on science that is known, AISCs engage at the boundary of the known and the unknown, where there are controversies, gaps, and unmet needs, which students explore with course faculty and other HMS experts in the field.

3. Active Learning in the Classroom, Combined with Experiential Activities

AISCs use flipped-classroom and other active learning methods as in the pre-PCE phase, with an increasing emphasis on self-directed learning. Additionally, each AISC includes experiential learning activities, in clinical or other settings, which serve to illustrate underlying science principles and promote the development of scientific questions. Students actively participate in scientific inquiry, culminating in a final product at the end of the course, working with faculty mentorship to identify and explore unsolved questions that interest them.

Video: AISCs Overview

Requirements & Courses

Requirements

Students are required to take two AISCs of their choice (see course selection process), at least one during Year III. Each AISC is offered once per year in either January, February, March or April.

AISCs are full-time courses, four weeks in length. Classroom time and unscheduled time are built-in for each course. Unscheduled time is critical for preparation, self-directed exploration and development of original questions and work products.

Requirement Note: AISC courses are not required for MD-PhD students, who may choose to take them as electives if they wish.

Course Selection Process

AISC placements are made via the OASIS lottery process. During the lottery, students rank their top AISC course preferences. The lottery maximizes preferences and assignments are made. Each course has an enrollment cap.

In past years, about 85 - 90% of students have received their first choice, and almost all students have received at least their second choice based on submitted selections. Add/drop changes for AISCs may be completed by self-service up to 45 days in advance of the start date of each course.

Video: How do I Choose an AISC?

Courses:

The following courses are planned for 2021.

Note: Months are based on the 2020 schedule and may change in future years.

January

February

March

April

What to Expect

Full-Time Commitment

During each course, students should plan to devote their full-time effort for classroom and experiential activities, as well as unscheduled time for course preparation.

Teaching Setting

The bulk of structured course time is spent in the classroom rather than in a clinical setting. The goals and objectives of AISCs differ significantly from those of clinical electives. The goal of the AISCs is to promote an understanding of scientific concepts and to encourage scientific inquiry, whereas the goal of a clinical elective is to promote a deeper understanding of clinical medicine.

For example, the goal of a cancer clinical elective is to learn about the diagnosis and treatment of various malignancies. In contrast, the goal of the cancer biology AISC is to develop a skill set to engage with frontier research, to explore how the scientific understanding of the cellular and molecular basis of cancer relates to clinical cancer care, to explore questions at the boundary between the known and unknown, and to consider how such questions might be answered. As such, the AISCs devote a significant amount of time to self-directed learning and deep exploration of a question of interest rather than teaching in depth about the diagnosis and treatment of cancer.

Experiential Activities

Typical of most AISCs, there are two half-day experiential activities per week, and three half-days in the classroom, though there are differences between the AISCs. The experiential activities vary by course. Typically, they are clinical experiences, and span a number of different specialties or sub-specialties within a single AISC. The goal of the clinical experiences is to identify unmet patient needs rather than focus on learning the clinical medicine of the field. Non-clinical experiences such as laboratory experiences or visits to industry are also utilized in some AISCs. Importantly, clinical experiences are integrated into the course through facilitated discussions at the clinical sites and at HMS focusing on the bidirectional interaction between basic science and clinical medicine.

Video: What is the Purpose of the Clinical and Other Experiential Components?

Basic Research Experience

The AISCs are designed to accommodate students at different levels of knowledge and experience in basic science research. Mechanisms for mentorship and feedback, as well as primers on the basic knowledge required for each course are built into the AISCs to enable students to explore a scientific topic and engage in the scientific process in an unfamiliar subject area. Performance evaluations take prior experience into account.

Video: What is the Value of AISCs to Students who may not go into Research?

Final Work Product

The AISCs aim to encourage self-directed study and independent thought. Each course has several work assignments including a creative final work product. Students choose their own topic, within the broad scope of the course, based on their clinical experiences and developing professional interests. The format of the work product is set by each course, and some courses offer more than one option.

Examples of final work products include a research proposal, an explanation for a patient about research relevant to their condition and clinical choices, a short review of progress and challenges in a research field, educational materials for students, or a newspaper article for the general public. Whatever the specific format, the work product provides an opportunity to develop and display the generalizable skills that the AISCs are designed to enhance.

Assessment

AISCs are graded on a satisfactory/unsatisfactory basis. A narrative assessment is provided to each student.  Each course has both a final product and one or more smaller intermediate products (written or oral presentations) that serve as the basis for assessment. The number and type of assignments vary by course. The formal learning objectives are the generalizable skills, placed in the context of the questions and approaches of the field of each AISC.

Attendance

The AISCs Absence Policy outlines procedures for a planned absence, residency interviews, illness or family emergency and religious observances.

Clinical Capstone

Course Directors: Meredith AtkinsKate Treadway
Course Manager: 

Capstone Description COMING SOON!

Course Listings

Essentials of the Profession II

Essentials of the Profession II

Course Director: Jennifer Kasper
Course Manager: Rob McCabe 

Course Description

Builds on the foundation of Essentials I and the Principal Clinical Experience to deepen students’ understanding of the social and population sciences and their relevance to clinical practice.

Scholarly Project

Scholarly Project

Scholarly Project Faculty Director: Jeffrey Katz
Scholarly Project Program Manager: Kari Hannibal

Project Description

The scholarly project is designed to provide students with an opportunity to pursue a mentored scholarly experience analyzing a health-related question, issue, or problem in depth. The student can approach the problem through any of a wide range of disciplines in the biomedical sciences, clinical sciences, humanities, arts, or other fields. For more info for students and faculty mentors click here.

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.

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

Last updated 3/26/2019