Medical Doctor Program of Study
The four years of the medical curriculum comprise two years of pre-clerkship foundational instruction and two years of clinical clerkships. Our curriculum is linked to our Netter Educational Program Objectives, which fit into nine categories: Care of Individual Patients, Knowledge and Scholarship, Inter-professional Collaboration, Interpersonal and Communication Skills, Professionalism, Practice-Based Learning and Improvement, Systems-Based Practice, Citizenship and Service, and Concentrated and Independent Learning.
During the first two years, the curriculum consists of three integrated courses: Foundations of Medicine (FOM), Clinical Arts and Sciences (CAS) and the Scholarly Reflection and Concentration/Capstone course (SRCC). During the clerkship years, students clinical learning is organized around the six ACGME Competencies: Medical Knowledge, Patient Care, Interpersonal and Communication Skills, Professionalism, Practice Based Learning and Improvement and Systems Based Practice.
For a visual depiction of the curriculum, see this Curriculum Map.
Pre-Clerkship Years
Year 1
MED 811 - Foundations of Medicine I
Course Goal: The goal of Foundations of Medicine (FOM) I is for medical students to achieve foundational knowledge in the basic medical sciences, with an emphasis on gaining a detailed understanding of common and representative illnesses. By the end of year one, students are knowledgeable in human biology and the impact that psychological, social, cultural and economic forces have on human health. They are able to discuss the epidemiology and prevention of major medical conditions. Knowledge gained in FOM I will be revisited and expanded the following year in FOM II.
The course is divided into foundational and organ system blocks with horizontal and vertical integration across the blocks and with the other courses. The School of Medicine’s longitudinal themes of pharmacology, nutrition, behavioral and social sciences, biomedical ethics and epidemiology also are integrated throughout the curriculum as they relate to specific organs and diseases throughout each block.
The course is taught through a variety of teaching methods including lectures and small group events that employ case-based learning activities. Dissection-based anatomy is integrated across all of the organ system blocks in the first year.
MED 812 - Clinical Arts and Science I
Clinical Arts and Sciences (CAS) I is an innovative introduction to clinical medicine course that aims to teach foundational clinical skills in a safe, collaborative environment incorporating experiential learning in both simulated and real clinical settings. CAS has two sections providing up to 6-8 hours of curricular activity each week.
Foundations of Clinical Care (FCC): This section is dedicated to teaching clinical skills, predominantly in a small group setting of eight students and two experienced physicians. Students learn patient-centered interviewing, history taking, communication and physical examination. Medical documentation and oral presentations are emphasized throughout the academic year. Clinical reasoning and advanced communication skills are introduced in semester two. Basic procedural skills training, telemedicine training, and interprofessional activities centered around ultrasound training also provide significant experiential learning opportunities.
Simulated practice with standardized patients (SPs) is one of the predominant features of this section of the course. Student knowledge of clinical skills is assessed via formative objective structured clinical examinations (OSCEs) on a monthly basis and with a summative OSCE at the end of the academic year. Faculty complete a summative evaluation of student performance each semester. The course also encourages learners’ understanding of professionalism and professional identity formation with self-assessments such as video review and goal setting opportunities, in addition to peer feedback and feedback from the SPs and faculty.
Medical Student Home (MeSH): This section pairs a medical student with a practicing community physician with the purpose of providing each medical student with a supervised environment to practice the foundational clinical skills learned in FCC. Students spend one afternoon a week, 4 hours at a time, in the physician’s office-based practice. Physicians directly observe students interview and examine patients. Physicians provide formative feedback through a workplace-based assessment program. A summative faculty evaluation of students is also completed.
MED 813 - Scholarly Reflection & Concentration Capstone I
Course Goal: Scholarly Reflection and Concentration/Capstone (SRCC) is a four-year course focused on seven core domains: Evaluating Information Sources, Critical Appraisal of Literature, Interacting with and Interpreting Data, Self-Reflection, Personalized Curriculum, Responsible Research Practice, and Scholarship.
SRCC allows learners to personalize their curriculum and prepare for scholarly endeavors during residency and future practice. They self-design and execute a capstone project in an area they are passionate about. Learners use narrative medicine and mentoring to develop personally and professionally. They gain both conceptual understanding and practical skills in research methods, epidemiology, medical informatics, biostatistics, evaluating information sources, and critical appraisal of medical literature. The information presented in this course is integrated whenever possible with material in the Foundations of Medicine and the Clinical Arts and Sciences courses, to enable learners to apply biostatistics, epidemiology, and medical informatics to community and public health, medical literature interpretation, and clinical decision-making.
Year 2
MED 821 - Foundations of Medicine II
Course Goal: Building on the foundation provided by the FOM I curriculum, the goal of FOM II is for medical students to attain essential knowledge and skills related to the pathophysiology and epidemiology of diseases. In addition, students develop a broad understanding of treatment paradigms for common medical disorders. The longitudinal themes of behavioral and social sciences, biomedical ethics, epidemiology, pharmacology and nutrition are interwoven into curricular content in FOM II.
Problem Based Learning (PBL) is a major instructional component in FOM II and integrates active and self-directed learning with the development of clinical reasoning skills in the assessment of patient symptoms, signs and laboratory findings. Collaborative and professional participation in this activity are essential components of PBL.
MED 822 - Clinical Arts and Science II
Clinical Arts and Sciences (CAS) II is an innovative introduction to clinical medicine course that aims to teach foundational clinical skills in a safe, collaborative environment incorporating experiential learning in both simulated and real clinical settings. CAS has two sections providing up to 6-8 hours of curricular activity each week.
Foundations of Clinical Care (FCC): This section is dedicated to teaching clinical skills, predominantly in a small group setting of eight students and two experienced physicians. Students build upon the skills they learned in CAS I. Clinical reasoning becomes a central component of the course in year two, with monthly instructional sessions that are well integrated with the foundational topics being covered in the FOM course. Sessions are also dedicated to advanced physical examination techniques as well as advanced communication skills such as delivering unwelcome news and sharing medical information. Medical documentation and oral presentations continue to be emphasized throughout the academic year with a focus on assessment and plan in CAS II. Basic procedural skills training, telemedicine and interprofessional activities centered around ultrasound training also provide significant experiential learning opportunities.
Simulated practice with standardized patients (SPs) is one of the predominant features of this section of the course. Student knowledge of clinical skills is assessed via formative objective structured clinical examinations (OSCEs) on a monthly basis and with a summative OSCE at the end of the academic year. Faculty complete a summative evaluation of student performance each semester. The course also encourages learners’ understanding of professionalism and professional identity formation with self-assessments such as video review and goal setting opportunities, in addition to peer feedback and feedback from the SPs and faculty.
Medical Student Home (MeSH): This section pairs a medical student with a practicing community physician with the purpose of providing each medical student with a supervised environment to practice the foundational clinical skills learned in FCC. Students spend one afternoon a week, 4 hours at a time, in the physician’s office-based practice. Physicians directly observe students interview and examine patients. Physicians provide formative feedback through a workplace-based assessment program. A summative faculty evaluation of students is also completed.
MED 823 - Scholarly Reflection & Concentration Capstone II
Course Goal: Scholarly Reflection and Concentration/Capstone (SRCC) is a four-year course focused on seven core domains: Evaluating Information Sources, Critical Appraisal of Literature, Interacting with and Interpreting Data, Self-Reflection, Personalized Curriculum, Responsible Research Practice, and Scholarship.
SRCC allows learners to personalize their curriculum and prepare for scholarly endeavors during residency and future practice. They self-design and execute a capstone project in an area they are passionate about. Learners use narrative medicine and mentoring to develop personally and professionally. They gain both conceptual understanding and practical skills in research methods, epidemiology, medical informatics, biostatistics, evaluating information sources, and critical appraisal of medical literature. The information presented in this course is integrated whenever possible with material in the Foundations of Medicine and the Clinical Arts and Sciences courses, to enable learners to apply biostatistics, epidemiology, and medical informatics to community and public health, medical literature interpretation, and clinical decision-making
Clerkship Years
Year 3
In July 2020, the Netter School changed its clerkship model for third-year students to a LMC. Most of the student will participate in this model; a select group of students will have the option to participate in a longitudinal integrated clerkship in Maine (see MED 837).
MED 839 - Longitudinal Multi-specialty Clerkship (LMC)
The LMC is designed to ensure a robust, flexible learning experience by combining core specialties into "clinical clusters" with shared academic half days. There is also an integrated block, where students get additional clinical experiences in each core specialty as well as exposure to areas such as radiology, anesthesiology, neurology, outpatient medicine and other subspecialty electives. Students also have dedicated time for their Capstone scholarly project in this block. The LMC model includes a longitudinal curriculum of didactics that covers the core content for each specialty along with cross-cutting curricula in narrative medicine, clinical reasoning and health systems science, including health equity.
The third year comprises in-depth clinical experiences in six core specialties: primary care, internal medicine, pediatrics, psychiatry, obstetrics and gynecology, and general surgery. Students receive training in both ambulatory and inpatient settings where they learn through direct patient care as well as teaching attending rounds, lectures and case discussions. Our principal hospital affiliates are St. Vincent’s Medical Center in Bridgeport, Connecticut, Waterbury Hospital and Connecticut Children’s and St. Francis Hospital in Hartford, Connecticut. We also have affiliations with several community hospitals and numerous outpatient practices in urban, suburban and rural settings. The variety of clinical settings enables students to see a broad range of patient presentations and determine where they envision practicing in their residency and beyond.
Assessment of students includes clinical evaluations, direct observation with feedback, teaching attending evaluations, national board exams, self-assessments, Objective Structured Clinical Exams, and additional specialty-specific assessments. Students receive regular feedback throughout each clinical cluster and take practice board exams. Students receive two weeks of dedicated study time at the end of each cluster to prepare for the specialty specific national exams. All students will take USMLE® Step 1 before starting their fourth year clinical rotations.
Cluster A
Internal Medicine/Primary Care/Surgery/Integrated Block
5 weeks each
Cluster B
Ob-Gyn/Pediatrics/Psychiatry/Integrated Block
5 weeks each
MED 837 - Longitudinal Integrated Clerkship
The Maine Longitudinal Integrated Clerkship is designed for students who are committed to the care of rural communities. A select group of third-year medical students complete an innovative curriculum of integrated clinical experiences that are designed to treat the whole patient and family across a continuum of care. They work at Northern Maine Medical Center, a modern, fully accredited, 49-bed hospital offering complete obstetric, surgical, pediatric and general medical services. It also provides a state-of-the-art, six-bed intensive care unit for critically ill patients and offers the only child, adolescent and adult inpatient psychiatric units in northern Maine. The center belongs to the 15,000 people in the hospital’s service area, the Upper St. John Valley and neighboring communities.
The flexibility and personalized nature of the Maine rural program enables students to tailor their learning. Building on a strong, mentoring foundation of faculty-to-student relationships makes it possible to create a customized patient care experience. Each week, the students have four days of structured and comprehensive educational content in various clinical formats that will address each of the six core clerkships: primary care, inpatient medicine, pediatrics, psychiatry, obstetrics and gynecology, and general surgery. They will also have a half day of didactics and a half day of open space for scholarship or personal needs, and regular clinical exposure in the emergency room setting.
Year 4
Students will complete a four-week required selective in emergency medicine or critical care, a sub-internship and electives. Students will also complete and present their Capstone project and take the USMLE® Step 2 Clinical Knowledge examination. There is ample time to meet with career advisers and work on residency applications and interviews during this year. At the end of the year, there is an optional residency prep course to ensure readiness for intern year.
MED 841 - Emergency Medicine
By the end of the four-week Emergency Medicine clerkship, students should be able to gather information, formulate differential diagnoses, and propose evidence-based management for patients with common presentations in an Emergency Room setting. They will learn to recognize emergent medical conditions and initiate stabilization plan as well as demonstrate proficiency with basic procedural skills. Students will demonstrate knowledge in managing the following conditions: chest pain, shortness of breath/respiratory distress, abdominal/GI emergencies, fever/infections/sepsis, endocrine/electrolyte emergencies, altered mental status, trauma, intoxication, psychosis/agitation, stroke/TIA, critical patients requiring ACLS, and pediatric acute concerns.
MED 842 - Critical Care
By the end of the four-week Critical Care clerkship, student should be able to gather information, formulate differential diagnoses, and propose evidence-based management for patients with common presentations in an intensive care setting. Students will learn to provide direct care to patients with critical illness and injury, including life threatening multi-system organ failure. By the end of this rotation, students should demonstrate knowledge in managing the following conditions: shock, acute respiratory failure, acute renal failure, acute GI hemorrhage, diabetic ketoacidosis/hyperosmolar hyperglycemic state, strokes/seizures, sepsis, healthcare associate infections, and end of life care/delirium. They will also learn the skills of resuscitation, laryngoscopy and intubation techniques, ventilator management and basic bedside procedures.
MED 844 - Internal Medicine Sub I
In the four-week Internal Medicine Sub-Internship, students will provide autonomous patient care to hospitalized patients to develop competence and readiness for clinical practice as an intern. Students will be an integral part of the team and will actively participate in care transitions for patients including admission, transfer between services, sign-outs between various teams, and discharge from the hospital, as well as cross-coverage roles. At the end of the Internal Medicine Sub-Internship clerkship, each student should be able to gather information, formulate differential diagnoses, and propose evidence- based management for patients with common conditions in an inpatient care setting, including but not limited to the following: atrial fibrillation, COPD/asthma exacerbation, acute/chronic/end stage renal disease, electrolyte disorders, community acquired pneumonia, GI bleed, stroke, and alcohol withdrawal.
MED 845 - Pediatric Sub I
The Pediatric Sub-Internship is a four-week inpatient experience that serves as a bridge between the Pediatric Clerkship and Pediatric Residency. During this rotation, students will learn to take a history in a more targeted manner than in third year, organize their work, formulate a differential diagnosis and a therapeutic plan and implement it while engaging in self-directed learning. By the end of the sub-internship, students should be able to describe the epidemiology, pathophysiology, clinical findings, diagnostic evaluation and management of common pediatric conditions that require hospitalization including but not limited to: surgery-requiring conditions, respiratory distress, gastrointestinal Illnesses, dermatological disease, endocrinological emergencies, electrolyte imbalance, sepsis/fever, and central nervous system disorders.
MED 846 - Surgery Sub I
The Surgery Sub-Internship is a four-week inpatient based experience to develop the skills required to diagnose and begin to manage surgical conditions as a surgical intern. The primary focus of the Surgery Sub-I is to foster student development through direct patient care, on the fly learning, exposure to increased complexity of patient conditions, and independent study. Students will formulate comprehensive assessments, diagnostic and therapeutic plans for common acute and chronic surgical conditions, demonstrate the ability to perform common and necessary surgical skills and work collaboratively to coordinate surgical patient care in a variety of health care delivery settings. The final grade for the rotation will be assigned by the clerkship director using the clinical assessment summary provided by the site director and in consultation with the supervising attending physicians.
MED 847 - Family Medicine Sub I
The Family Medicine Sub-Internship is a four-week long primarily in-patient experience, blended with a few half days of out-patient experience, to develop competence and readiness for clinical practice as a family medicine resident. Students actively participate in care transitions for hospitalized patients including admission, transfer between services, sign-outs between various teams, and discharge from the hospital, as well as cross-coverage roles. Students are expected to provide high-value, evidence-based care for patients with common family medicine conditions including but not limited to: abdominal pain, acute kidney injury, chest pain, congestive heart failure, diabetes mellitus, electrolyte imbalance, hypertension, sepsis, shortness of breath and urinary tract infections.
MED 861 - OB-GYN Sub I
The Obstetrics & Gynecology Sub-Internship is a four-week experience either on the Maternal Fetal Medicine (MFM) or the Gynecology Oncology service. Students will work in both inpatient and outpatient settings and participate as an integral member of the team. Students on the MFM service will learn about the care of high-risk ob-gyn patient conditions including but not limited to: gestational diabetes mellitus, fetal macrosomia, premature rupture of membranes, critical care in pregnancy, multifetal gestation, fetal aneuploidy and prenatal diagnosis of genetic disorders as well as learn ultrasound in pregnancy. Students on the Gynecology Oncology rotation will learn about the care of patients with gynecology malignancies including symptoms, presentation, and diagnosis; treatment and outcomes, including pelvic surgery, radiation and chemotherapy; and post-operative, inpatient, and outpatient management. Students will improve their basic procedural and surgical skills during this rotation to prepare them for internship.
MED 862 - Psychiatry Sub I
The Psychiatry Sub-Internship is a four-week experience designed to give medical students an opportunity to integrate their academic knowledge and clinical experience into practice on both the adult and child/adolescent inpatient units. The goal is to provide future physicians the opportunity to treat a variety of patients with a diverse range of mental illness to develop competence in diagnosing and treating mental illness across the spectrum. By the end of this sub-internship, students will be able to develop an empathic doctor-patient relationship, conduct a clinical interview and perform a complete mental status exam, apply basic science knowledge of neurobiology and psychosocial experiences in the pathogenesis and treatment of psychiatric illnesses, formulate a diagnosis based on DSM-V, understand the different treatment approaches of major psychiatric syndromes, and practice as an effective team member in a multi-disciplinary team.
Electives
Students take a minimum of 28 weeks of electives of their choice. Electives can be taken at the Netter School of Medicine or students can participate in away rotations—internationally or domestically as available and meeting criteria. Electives encompass diverse patient care experiences as well as skills development in areas such as teaching or leadership. Custom electives are also an option, subject to approval. Elective choices vary depending on site availability.