From the financing and delivery of health services to the development of new technologies in molecular biology and gene therapy, the practice of medicine is undergoing a monumental transformation. Society expects the physician to be both a skilled practitioner and a gifted communicator, intellectually driven and compassionate, sensitive to the needs of individuals and responsive to the needs of populations. In recognition of societal demands and rapid changes in medical practice, medical education is undergoing its first major evolution in a century. The educational program at UMMS similarly has undergone significant change.
The curriculum itself is the result of ongoing evaluation, review and renewal, with more than 20 curriculum committees, faculty groups and student-centered focus groups involved in its initial development. While traditional medical education models consist primarily of departmentally managed courses and clerkships, stressing retention of facts and specific knowledge, the school's process for curriculum reform and ongoing renewal has established an integrated model of curriculum design, with comprehensive integration and coordination across a four-year plan of study. The program emphasizes several principles:
Studies have shown that effective communication leads to improved patient compliance, decreased liability suits and ultimately, improved medical outcomes. Effective communication skills have, in fact, become so paramount that in 2002, medical students will have to demonstrate competency in communication to pass the National Board of Medical Examiners' licensure exam. As other medical schools rush to prepare their students, they may well turn for guidance to UMMS, already a recognized leader in teaching communication skills to health care providers.
As a public institution, UMMS also recognizes its obligation to the commonwealth to ensure an appropriate physician supply. Since current national and regional workforce needs call for generalists in family practice, internal medicine and pediatrics, the curriculum emphasizes the skills and intellectual basis for primary care medicine. However, we also expect approximately 50 percent of UMMS graduates to follow career paths in biomedical research, public health, and medical and surgical specialties. A diversely skilled and enthusiastic faculty provides opportunities for learning and training in these areas.
YEARS 1 AND 2
Students are immediately exposed to a blend of basic and clinical science, focusing on clinical correlation, interdisciplinary instruction and the doctor-patient relationship as the foundation of medical care. Beginning on their first day, students are placed in ambulatory-based medical practices as part of the Longitudinal Preceptorship Program. This early clinical exposure to patients provides an opportunity for learning the fundamental components for becoming an effective, empathetic physician, including developing skills in patient interviewing, physical diagnosis, clinical problem solving, continuity of care and the doctor-patient relationship. In concert with this, the curriculum in the pre-clinical sciences, while retaining the strengths of departmentally based courses such as anatomy and biochemistry, emphasizes thoughtful coordination across disciplines and new interdisciplinary courses.
Throughout the first two years, students will participate in weekly sessions in the Patient, Physician and Society (PPS) course, whose components include small group learning, where the principles of medical interviewing, clinical problem solving, public health and the social sciences are discussed; the Longitudinal Preceptorship Program (LPP) course, where students practice the skills they have learned in small groups by working with practicing physicians; and the Physical Diagnosis (PD) course, where students learn the skills of performing a normal physical examination. Both longitudinal courses are tightly integrated and coordinated with concurrent basic science disciplines.
YEARS 3 AND 4
The clerkship years comprise the third and fourth years of study. Required clerkships consist of clinical rotations in internal medicine, family practice, pedi-atrics, obstetrics and gynecology, psychiatry, neurology and surgery. Most clerkships are taken in the third year. Recognizing that medicine is chiefly practiced outside of the hospital, the clinical curricu-lum includes substantial modifications in clerkship training in ambulatory sites.
Nine day-long interclerkships are conducted for third-year students on various topics, guided by experts in social, clinical and biomedical sciences.
The fourth year consists of a required four-week clerkship in neurology and a four-week sub-internship in medicine, plus a minimum of an additional 24 weeks of electives. With the guidance and counsel of faculty members, students plan a balanced program of study appropriate to their field of interest, combining work in both basic science and clinical medicine. The possibilities for elective work include extended clinical experience in various disciplines, laboratory research in the clinical or basic sciences, library research, asso-ciation with a physician in private practice, work with a department of health or community health agency or study at another medical center.