Lincoln American University (LAU)
The Medical Sciences training program is delivered over eleven semesters consisting of 160 weeks of extensive and rigorous training in the basic sciences and clinical disciplines.
The basic science curriculum is composed of four semesters, a total of 64 weeks in length, and is delivered at Lincoln American University in Guyana.
The 5th semester, encompassing a USMLE review course is dedicated to review students in preparation for the USMLE Step 1 exam. It consists of five core system based courses, supported by Kaplan materials and delivered in a classroom environment within one of our education facilities. Upon completion, students are certified for the Step 1 exam.
The Clinical Science program is 72 weeks in length and takes place within teaching hospitals or clinical centers located in the United States.
Associate Degree in Health Sciences (Pre Med Program)
LAU offers a 4 semester (16 month) Pre Med program for High School graduates to fulfill requisites for entering into MD program. Once students complete the program successfully, they are transferred to LAU 4 year MD program. Students are awarded “Associate Degree in Health Sciences” after graduating from Pre Med program and Doctor of Medicine (MD) degree after graduating from 4 year MD program.
This track is ideal for highly motivated graduating High School students who are committed to study medicine and are ready to begin their medical studies immediately after completing high school. It is also the path for non-traditional students who need to complete prerequisite courses before being accepted to the LAU MD program.
A 4-year MD program, for students who have completed Pre Med requisites.
Program starts with five semesters in the University and sixth semester in USA/ Canada. The first 2 years of curriculum focus on courses in Basic Sciences and their application to clinical medicine. Semesters begin in January, May and September, and students can begin their studies in any semester. In addition to didactic lectures, lab work and problem based learning; students make community and hospital visits, practice history taking and physical examinations with patients in Clinical Simulation Training rooms on our basic sciences campus. Upon successfully completing five semesters, students are given intensive training to pass US Medical Licensing Examination (USMLE Step 1) in our sixth semester with an option to receive this training at our Guyana campus or USA. Students are required to PASS USMLE Step 1 to enter into third year Clinical Sciences of MD Program.
Clinical Sciences program will take place in years 3 and 4. In these years students will get training in the care and study of patients in Hospitals. The training comprises 96 weeks of clinical rotation in both core and elective subjects. Once required clinical rotations are completed, students are required to PASS USMLE Step 2 CK and CS exams. After they complete year 3 and 4, students graduate with MD degree and successfully passing USMLE Step 1, 2 CK and CS, graduates receive ECFMG certification that makes them eligible to participate in the Residency Matching Process in the USA.
|BIOL 101||Biology I: Cell and Molecular Biology (w/lab)||04|
|ENV 152||Environmental Science||03|
|CHEM 121||General Chemistry I||03|
|CHEM 122||Organic Chemistry I||03|
|PHYS 101||College Physics I||03|
|ENG 103||English 1: Communication Studies||03|
|BIOL 102||Biology II: Organismal and Evolutionary Biology||03|
|CHEM 221||General Chemistry II (w/lab)||04|
|CHEM 222A||Organic Chemistry II (w/lab)||04|
|PHYS 202A||College Physics II (w/Lab )||04|
|PSY 205||Health Psychology||03|
|ENG 241||English II: Expository Writing||03|
|CHEM 222B||Organic Chemistry III(w/lab)||04|
|PHYS 202B||College Physics III (w/lab)||04|
|BIOCHEM 200||Principles of Biochemistry||03|
|BIOL 103||Biology III :Principles Of Biology||03|
|BIO 122||Nutrition through the Lifecycle||03|
|PSY 231||Abnormal Psychology||03|
|RMS 232||Research Methods||03|
|BLF 203||Aspects of Basic Life Support||03|
|ETH 204||Medical Ethics||03|
|BIOL 221||Medical Nutrition||03|
|ANAT 202||Introduction to Human Anatomy||03|
|PHYSIOL 133||Introduction to Human Physiology||03|
|MICROB 101||Introduction to Medical Microbiology||03|
Total Credits: 90
Curriculum Basic Sciences (MD Program)
The students who are admitted for the 4 year MD program attend the first two years Basic Sciences in the University by attending didactic lectures, laboratory exercises, and community health and hospital visits. The two year program six (6) semesters as follows:
|Human Anatomy I||04|
|Cells and Tissues||02|
|Communication Skills I||02|
|Practice of Medicine I||06|
|Human Body and Disease I||06|
|Human Anatomy II||04|
|Practice of Medicine II||06|
|Complementary Medicine I||02|
|Immunology and Disease||04|
|Human Body and Disease II||10|
|Complementary Medicine II||02|
|Practice of Medicine III||08|
|Human Body and Disease III||12|
|Practice of Medicine IV||10|
|Human Body and Disease IV||10|
|Psychiatry and Neuropharmacology||04|
|Practice of Medicine V||08|
|Communication Skills II||02|
|USMLE Step I Review:||14|
|Comprehensive Basic Sciences Examination USMLE Step 1 Examination||10|
Clinical Sciences (MD Program):
The period of clinical clerkship will take place in years 3 and 4. During this period, students will become directly involved in the care and study of patients. The training comprises 80 weeks of clinical rotations in both core and elective departments.
|Obstetrics & Gynecology||06|
Elective rotations: 32 weeks
Note: The elective rotations will revolve around the recommended areas: Dermatology, Family medicine, Radiology, Pathology, Ophthalmology, Infectious diseases, Neurology, Oncology, Cardiology, Nephrology, Emergency medicine, Rheumatology, Orthopedic surgery, Endocrinology, Gerontology, Anesthesiology, Allergy and Immunology.
24 weeks are spent in the elective rotations. The duration of time in each elective rotation may vary, but a minimum of 4 weeks will be spent in each. A partial list of the possible elective rotations is included below:
|Hematology and Oncology||Orthopaedic Surgery|
|Immunology and Allergy||Otolaryngology (ENT)|
|Emergency Medicine||Cardiology (PEDS Focus)|
The final 12 weeks of clinical rotations are known as hospital rotations, or sub-internships. A student will generally select an elective sub-internship, where they will perform the role of an intern or first-year medical graduate, under the supervision of senior staff and attending physicians. These rotations are generally pursued in the field appropriate to career interest.
|Sub-internship (specialty of choice)||4 weeks|
|Sub-internship (specialty of choice)||4 weeks|
|Hospital-based rotation||4 weeks|
|Total Clinical Rotations||84 weeks|
The program is structured in such a manner as to allow a student to gain licensure in most of the United States. Each of a student’s core rotations is spent at a hospital which hosts an Accreditation Council for Graduate Medical Education (ACGME)-approved residency program in the respective core specialty. Every site is held to comparable standards of teaching, evaluation, faculty development, and study resources. A student will gain all the knowledge and skills necessary to pass Step 2 of the United States Medical Licensing Examination (USMLE) and compete for any coveted United States residency position.
Details of curriculum
The pre-medical curriculum emphasizes biology and chemistry as it relates to medicine while integrating math, physics, and behavioral sciences. The curriculum is consistent with integrated medical curriculum, and will ease the transition from pre-medical science into basic science. It presents fundamental scientific concepts from a medical perspective and incorporates USMLE Step 1 familiarization from Day 1.
Pre Medical 1st Semester
- Cells and Cellular Processes – This course will focus on the fundamentals of cellular biology and genetics. The course takes students on a journey through the cell starting with biological molecules, through organelles, and finally, cellular processes. In addition to gaining a foundation in cellular biology, students will be introduced to the scientific method and the manner in which questions are asked and answered in medicine and science. Both animal and human biological systems will be covered to give students an overview of the different biological strategies employed on earth for survival and reproduction.
- Introduction to Chemical Properties of Matter – The course aims to prepare tomorrow’s doctors by setting the foundation of chemistry concepts and emphasizing how to utilize the information, and how to incorporate into medical training. This course introduces basic chemistry concepts such as types of chemical reactions, thermodynamics, orbitals, chemical bonds, and chemical calculations.
- Energy and the Universe – This course will expose students to college level mathematics followed by some exciting areas of Physics such as Kinematics, Dynamics, Thermodynamics, Optics, Vibration, Waves, Electromagnetism Quantum Mechanics, and Fluid Mechanics.
- Medical Communications – The purpose of the medical communications course is to provide the student with an understanding of the role of communication skills and the ability to apply this knowledge to diagnosis, prevention and treatment of infectious diseases. Medical Communications is the study of communicating within the medical community while obtaining better usage and style within the English language. This course will explore the bio-psychosocial needs of patients, families, and the multidisciplinary team.
Pre Medical semester 2
- Organ Structure and Function I – This course consists of fundamental concepts, musculoskeletal, and the renal systems. Each system will cover the fundamentals of normal structure and function with an introduction to clinical concepts and abnormal structure and function. Instructional methods will include lecture, small-group sessions, problem-based learning (PBL), laboratory work, self-study and clinical experience with real and simulated patients.
- Basic Principles of Chemical Reactivity – This is the second half of a two-semester sequence designed for the non-chemistry major to gain a basic understanding of general chemistry. It is the continuation of Introduction to Chemical Property of Matter. Basic Principles of Chemical Reactivity introduces additional fundamental chemistry concepts such as kinetics, acids and bases, and nuclear reactions. This course also introduces the student to some Organic Chemistry concepts such as nomenclature and structures.
- Fundamentals of Heat and Electromagnetic Energy – This course is a pre-medical course in physics, specifically as it relates to the human body and medicine. The concepts of physics, such as linear acceleration, fluid dynamics, vectors, and nuclear power, will be taught with an eye towards preparing students to use this information during their medical studies. In addition, the course will teach students to think logically, problem solve, and think in regressive patterns such as those involved in diagnostics. The course work will include identifying, translating, and solving mathematical physics problems as they relate to the science of medicine.
Pre Medical semester 3
- Organ Structure and Function II – This course consists of gastrointestinal, cardiovascular, and the respiratory systems. Each system will cover the fundamentals of normal structure and function with an introduction to clinical concepts and abnormal structure and function. Instructional methods will include lecture, small-group sessions, PBL, laboratory work, self-study and clinical experience with real and simulated patients.
- Inheritance and Evolution – This course will continue with classical and molecular genetics processes learned in Cells and Cellular Processes, and explore how genes relate to disease. The relationship between genes, transcripts, and proteins, and how it affects an individual’s health will be explored. A critical component will be, understanding the inheritance mechanisms of genes through utilization of human pedigrees. In addition, the course will look at micro and macro evolution.
- Ethics and Behavioral Sciences I – This course, along with Ethics and Behavioral Sciences 2, is a broad survey of the history and theory underlying behavioral science and psychology, and medical ethics. This course is a preparatory course designed to prepare the student for the study of Medical Psychology and Ethics in the medical curriculum. Specific topics covered will include an overview of those ethical principles which will govern all medical practice, with specific application to ethics in the practice of psychiatric and behavioral medicine. Additionally, this course will cover the history of psychology and psychological research, lifespan development, sensation, learning, consciousness and cognition, all as they relate to human behavior in the medical setting. The course will conclude with an overview of the primary psychiatric pathologies that students will be studying in the medical curriculum, as well as those which will most often be encountered during clinical training in preparation for Step 1 of the USMLE .
Pre Medical semester 4
- Organ Structure and Function III – This course consists of nervous, endocrine and reproduction, and the immune systems. Each system will cover the fundamentals of normal structure and function with an introduction to clinical concepts and abnormal structure and function. Instructional methods will include lecture, small-group sessions, PBL, laboratory work, self-study and clinical experience with real and simulated patients.
- Biostatistics – This course provides an introduction to the basic concepts of statistics and how they are used in medicine and the biological sciences.
- Ethics and Behavioral Sciences II – This course is a continuation of Ethics and Behavioral Sciences 1. It is a broad survey of the history and theory underlying behavioral science and psychology, and medical ethics. This course is a preparatory course designed to prepare the student for the study of Medical Psychology and Ethics in the medical curriculum. Specific topics covered will include an overview of those ethical principles which will govern all medical practice, with specific application to ethics in the practice of psychiatric and behavioral medicine. Additionally, this course will cover the history of psychology and psychological research, lifespan development, sensation, learning, consciousness and cognition, all as they relate to human behavior in the medical setting. The course will conclude with an overview of the primary psychiatric pathologies that students will be studying in the medical curriculum, as well as those which will most often be encountered during clinical training in preparation for Step 1 of the USMLE .
Grand Total: 90 Credits
All of our school’s Pre-Med students, after successfully completing the Pre-Med Program will automatically gain advancement into the Basic Science Component of our MD program.
The students who are admitted for the 4 year MD program attend the first two years Basic Sciences in the University by attending didactic lectures, laboratory exercises, and community health and hospital visits. The two year program six (6) semesters as follows:
The course in human gross anatomy consists of approximately 160 scheduled class hours devoted to the development and understanding of a three-dimensional visual image of the human body. To achieve this objective, each student participates in the complete dissection of the body. Formal lectures are devoted to general, applied, radiological, and clinical aspects of anatomy, as well as an overview of each region to be dissected. A course companion, consisting of specific learning objectives and notes for each lecture/lab session, is provided to facilitate and coordinate this learning process in addition to refer and read the recommended textbooks, anatomical atlases. In addition, a dissection guide with lectures and dissection of the human cadaver is also provided.
A unique peer-teaching program has been developed for the dissection laboratory. Each class is divided into four or more groups with each group consisting of four or five students. They are assigned as dissection teams to each cadaver in the laboratory. These teams dissect the cadaver on the designated lab day and meet with faculty members for question/answer/tutorial/quiz sessions. Teams are expected to demonstrate their dissection to the following set of student dissection teams.
A standard dissection sequence begins with the back, upper extremity, thorax and abdomen, the retention and comprehension of which is tested in the examination. The sequence is completed with the pelvis, perineum, lower extremity, head and neck, which is tested in the final examination. Instructions for dissections are given in the course dissector and last two hours each. The dissections are observed and graded by faculty and fellow students, and account for a percentage of the final course grade. Depending on the necessity, sometimes, and feasibility the sequence of dissection could be modified.
The gross anatomy course is further highlighted by the presentation of sessions in Living Anatomy, where students learn to appreciate the intricacies of the human body through inspection, palpation, percussion, and auscultation of one another and through the daily presentation and discussion of relevant clinical cases. The anatomy curriculum is designed to enhance clinical integration of the basic sciences material. More emphasis is given to surgical anatomy. It is also planned to teach the clinical relevance of anatomy to various diseases as seen in the clinic.
Histology and Cell Biology
This course presents the structure and function of the human body as revealed by microscopy and cell biological techniques. The course commences with a discussion of the cell and its internal structures and students are introduced to the concepts of how cells interact with each other and with their external environment. Cell signaling, cell secretion, the cell cycle and the extra-cellular matrix are some of the topics presented in the analysis of cell structure and function. Molecular biological aspects of cell structure and function and their clinical relevance are emphasized.
Emphasis on the role of cells in tissue organization and function and the interactions between cells, their organization to tissues, tissues to organs and various systems and their interactions with the external environment (including gene-environment interaction) are stressed so that the students have a firm understanding of the concept of physiology, pathology and their relevance to various diseases. A firm understanding of normal anatomy, physiology, and the structure and function of various cells and tissues and variations in their interaction with the environment is essential to become a complete and modern physician and the course is directed in this channel.
This emphasis on the cell in Histology and Cell Biology is important since all diseases occur at the cellular level and thus students must understand the basic science of the cell and its mechanisms before they can understand how pathologies work. In addition, cell structure and function as presented in the Histology and Cell Biology course serve as preparation for the elaboration of these concepts in the Physiology and Pharmacology courses and indeed will prepare students as life-long learners of medicine. The students are thus learning skills and gaining knowledge about information that is an absolute necessity for the modern physician.
The study of embryonic and fetal development, organogenesis, and congenital malformations is the substance of this one-term course. Gametogenesis, fertilization, and the formation of the placenta are examined in detail. The progressive development during the first eight weeks is explored extensively, with a description of the growth and tissue organization of the embryo from the undifferentiated condition to the human-like fetus. Organogenesis, the origin and formation of all organ systems in the human, constitutes the major part of the course. The various congenital anomalies are explained as deviations from normal development. The student thus taught to have an understanding of the normal development of the human organism and learns to recognize the various congenital deviations that will be encountered in clinical practice.
This course is designed to introduce the student to the fundamental principles of human behavior. Data and theories that contribute to the understanding of normal development and psychopathology are examined. In addition to providing the factual and conceptual basis for psychiatry, the course emphasizes psychological aspects of patient care within the general medical setting. The importance of the bio-psychosocial model in the understanding and treatment of illness is stressed in lecture and in case-based, small group discussion.
The course focuses initially on two major psychological theories of human behavior: psychoanalysis and learning theory. Exposition of these systems leads to discussion of psychotherapy, behavior modification, behavioral medicine, the doctor-patient relationship, development through the life cycle, psychological testing, human sexuality, and family therapy. Special attention is given to such life-disrupting disorders as substance abuse and child abuse, including detection and treatment.
An area of course with emphasis on the biological bases of behavior, involving a survey of those areas where behavior can be understood in terms of underlying genetics, neuro anatomy, or neurotransmitters is also taught. This section compares the laboratory studies of stress and coping mechanisms with the related clinical syndromes. The foundations of the somatic therapies – psychosurgery, electroconvulsive therapy, and psychopharmacology – are also discussed.
The fundamental concepts of law that relate to the medical profession are covered in this course. An overview is provided of the current and probable future expansion of society’s role in the regulation of the practice of medicine. The basic principles of malpractice, including the definition of negligence and the measure of damages, are stressed. The particular topics of informed consent, medical ethics, and confidentiality of medical records are presented. The course surveys the history of medical ethics, and compares the major views on such issues as the conflicts between different types of benefits to patients, the duties of a physician, patient autonomy, social ethics, and rationing of services.
Biochemistry & Molecular Biology
The course is structured to present and explore principles of biochemistry necessary for the practice of medicine and for the understanding of other pre-clinical disciplines. The mechanisms of biochemical reactions involved in energy production, biosynthesis, and degradation are covered, with particular attention to their role in disease. The biochemical roles of the major organs of the body are studied together with an overview of the metabolic interplay between organs. The mechanisms by which major pathways are regulated are examined in depth.
In the first half of the course, students are introduced to the principles of acids and bases, followed by the structure and function of proteins, particularly enzymes. The course continues with an introduction to energy production in the cell and carbohydrate biochemistry. In the second half of the course, lipid and amino acid biochemistry are taught, together with molecular biology (including structure, function, and biosynthesis of RNA and DNA, protein biosynthesis, and modern gene cloning methods).
The course provides a biochemical foundation on which students can build throughout their Preclinical Science, and can use later when they are qualified physicians.
This course reviews basic genetics and its application to the study of inherited disorders. It begins with a study of the chromosomes and the disorders that result from their aberrations. Exploration of Mendelian and polygenic inheritance follows, illustrated by representatives of the major heritable disorders of man. There is coverage of molecular and clinical genetics, including prenatal diagnosis and genetic screening. The course concludes with introductions to growth points in modern genetics, cancer genetics, gene therapy, and the Human Genome project.
The course introduces students to patient contact in order to foster student collaboration and communication skills in a formalized way in a small group setting. Emphasis is placed on an introduction to bioethics and on straightforward clinical patient problems firmly based on the anatomical sciences. Student experience is expanded by presentation of more complicated clinical cases and more difficult patient presentations and moods (anger, over-talkativeness, depression, etc.). These small group patient sessions are supplemented during both terms by a series of lectures on bioethics and on patient and professional communication. The Basic Science Foundations of Clinical Medicine (BSF) presents the students with the challenge of learning how to learn independently, just as they will do later as practicing physicians. The module has as its focus panel presentations of clinical presentations.
The students will receive instruction in library research, including computer-based literature review, and will keep a notebook log of their study of the clinical cases. Their individual progress as evidenced by their notebook material and knowledge of the clinical cases will be assessed by clinical instructors in small group sessions and one-on-one advisory sessions. The visiting professors will participate in these evaluations and mentoring sessions.
Advanced Clinical Skills
In the fourth term, physical examination skills are taught by way of lectures and laboratory sessions. Students are taught the techniques of physical examination by videotape demonstration, live demonstration, and supervised practice on fellow students and patients. The more intimate examination areas (breast and genitalia) are taught on inanimate models. The fifth and sixth term courses are taught in small groups (five to six students) in the hospital or office setting, as well as on campus, using real volunteer patients.
The clinical basic skills experience ends with an examination at the end of the term. The overall objective of the clinical skills course is to ensure that the students develop sufficient interpersonal and clinical skills in order to integrate rapidly into the clinical hospital setting during the third and fourth years of the program.
This course is designed to provide the student with an understanding of the major principles and mechanisms underlying the elements of the immune system. There is an emphasis on the interaction between innate and acquired immunity in the response to infection. Mechanisms by which immunological compartments interact and clinically related topics are also emphasized. In addition to classroom instruction, students spend 10 hours in solving patient-oriented clinical simulations, including small group discussions.
The microbiology and pathology courses are presented simultaneously and are closely integrated with each other. Microbiology appears as a balanced combination of formal classroom instruction, practical laboratory experience, and case-based exercises. The didactic portion is divided into two consecutive sections. The first of these covers the basic principles of microbiology, including classification and taxonomy, microbial physiology and genetics, genetic engineering, control of microorganisms through the use of physical and chemical agents, antibiotics, host-parasite relationships, and epidemiological concepts. Bacterial, fungal, and viral infectious organisms are all represented in this series.
In the second section, the pathogens are discussed according to the human organ system where they most often cause clinical disease. Clinical vignettes are used to illustrate the epidemiology, pathogenesis, virulence properties, symptoms, laboratory diagnosis, and therapy of the various agents. The presentation is coordinated with the concurrent pathology course, so that the organ systems are dealt with in a fully integrated fashion. After each organ system, a practicing clinician to anchor a comprehensive understanding of the pathogenesis and disease presents representative cases.
During the laboratory sessions, the students are given problem-solving experience with pathogenic microorganisms. The laboratory work includes the practical application of staining techniques, antisepsis and disinfection, and isolation and identification of infectious agents from clinical specimens, along with the determination of appropriate chemotherapeutic agents. Additionally, students are given a case history along with a relevant clinical specimen, and from these they isolate and identify the microorganism, perform antibiotic sensitivity tests, and report their results. Case-based instruction founded on medical vignettes of infectious disease is considered in small group discussions several times each term. Near the end of the laboratory portion of the course, clinical conferences are presented by visiting infectious disease specialists. Computer-assisted case presentations are used throughout the laboratory portion of the course.
The pathology course is taught in two segments – General and Systemic Pathology. The main emphasis of the course is on active learning by the students based on clinically oriented lectures and daily clinical problem solving by students in groups of ten during the lab hours. This is accomplished by targeted discussions using pathology images (about 500) representing patients and clinical vignettes with built in questions. The images are posted on the website and made freely available on CD’s to students. Periodically, gross specimens and glass slides from current hospital material are also discussed. The faculty closely monitors the discussions and each student is evaluated on a daily basis.
The General Pathology segments deals with how tissues respond to injury, cell death, inflammation, ischemia, thrombosis, embolism, infarction, etc. It also deals with response to infections, environmental pollutants and disease states related to abnormal immune responses. Mechanisms of tumor development and how they spread are studies under neoplasia. This is followed by a special course on Molecular Pathology techniques as applied to clinical practice.
The Systemic Pathology segment involves similar principles but applied in detail to individual organ systems like-Cardiovascular, Respiratory etc. It would also include interpretation of laboratory data for some of the major disease processes. A short course on Forensic Pathology is taught in the Systemic Pathology module. Several clinicopthological conferences, including difficult case seminars are also discussed by students.
Students are mandated to draw concept maps each week and submit for evaluation. A total of 470 test items are administered through 3 quizzes and 3 exams-including 90 based on images. All the questions are clinical problem solving MCQ’s.
General Pathology Laboratory
The laboratory consists of a collection of about 400 colored transparencies arranged in a series of modules. Students study these during assigned laboratory periods. An audiocassette accompanies each module, which is arranged in the same order as the lecture topics. The modules contain not only colored transparencies of gross and microscopic changes, but also a number of electron photomicrographs.
A profound knowledge of the Pharmacological basis of Therapeutics is essential for a productive clinical career in all medical disciplines. This will allow the physician to keep abreast of new developments in drug therapy. The Pharmacology courses start with an introduction to principles and basics, including pharmacokinetics (in which ways does the human body handle drugs) and pharmacodynamics (in which ways do drugs affect the human body). Comprehensive Therapeutic Issues Lectures focus on treatment strategies (e.g. so-called Consensus Recommendations) for some major diseases.
Our aim is to emphasize the interdisciplinary position of Pharmacology in Medicine and to utilize students’ enormous motivation to learn what is clinically relevant. Throughout the course students will be alerted to the clinical relevance of drug classes discussed. Of special interest are precautions in drug treatment especially in childhood, old age, during pregnancy and lactation. Ultimately, students will be introduced to the delicate process of therapeutic decision-making.
For advanced discussion of selected topics, the class will be divided into small groups, each assigned to a tutor. Pharmacology Small Group sessions use a series of short, simplified therapeutic scenarios to elaborate on the Clinical Pharmacology of drugs addressed in preceding lectures. Case of the Week provides insight to principles of Evidence Based Medicine by means of a detailed case scenario and reading of some assigned peer reviewed clinical publications. This is a joint program with Pathophysiology. Under the auspices of Pathophysiology faculty, each series of group sessions is concluded by a plenary Case of the Week discussion.
Physiology and Biochemistry
The aim of this course is to provide each student with a clear understanding of the most important concepts and principles of medical physiology. The course has three principal components – lectures, laboratories, and clinical cases. The lectures provide the information base, while the laboratories and case studies provide the student with an opportunity to assimilate and integrate the material within a small group setting. The course is divided into two equal sections. The first half covers cardiovascular, endocrinology, and reproductive physiology. The second half covers gastrointestinal, renal, pulmonary, and integrative physiology. The integrative component consists of acid-base regulation, temperature regulation, and exercise physiology. Appropriate clinical perspectives are presented throughout the course. Review sessions are scheduled on a regular basis.
Four human laboratory exercises pertaining to cardiovascular, respiratory, and exercise physiology are included in the course. Computer-assisted applications are regularly used. For each of the laboratories, students work in groups of twelve to fifteen. A faculty member assists each group.
Clinical Case Studies
Series of clinical case studies pertaining to cardiovascular, endocrine, respiratory, renal, and acid-base regulation are included in the course. For this portion of the program, classes are broken up into small discussion groups of twelve to fifteen students.
This course is an interdisciplinary study of the function of the nervous system, entailing almost simultaneously its anatomy, histology, physiology, biochemistry, and some pharmacology and pathophysiology. Whenever feasible, the course presents concomitantly, rather than sequentially, the basic structures, mechanisms, and functions of the various interrelated neural systems. Neurological case studies presented as disorders of normal function are included as an integral component wherever possible. Neuropathology is introduced at the end of the course, after the discussion of normal function has been completed. A detailed presentation of neuropathology, however, is deferred to the systemic pathology course. The first few weeks of the course include a general overview of basic elements, gross structure, and basic vocabulary. The systems and functions presented cursorily at first are reintroduced and dealt with in a more rigorous fashion, covering the basic electrical properties of cells, developing from membrane potentials through myoneural and synaptic transmission. They are followed by the study of contractile tissues, motor systems, sensory systems, higher telencephalic functions, and neuropathology.
The lectures are supplemented by laboratory sessions that include considerations of the human gross brain, brain stem sections, and microscopic slides. A relevant clinical case study is discussed within each laboratory session.
Semester V – USMLE REVIEW
This semester is devoted to review the subjects learned from semester I to IV and prepare the student to appear USMLE Step 1 exam with confidence.
During this review course, cardiovascular, pulmonary, and hematology; neural and musculoskeletal system; renal and gastroenterology; endocrinology and reproductive biology; immunology, and microbiology subjects will be reviewed.
Major emphasis of these classes will be to familiarize the student to the pattern of questions that are asked in USMLE step I. The classes are not meant to review the subjects in depth but to integrate the knowledge gained from various Basic Science subjects and give an over view as to how to apply such knowledge in the clinic and to answer clinically relevant topics. For instance, anatomy, physiology, biochemistry, pharmacology and pathology (including immunology, microbiology, and molecular biology) as applied to each organ system will be reviewed rapidly and the relevant diseases pertaining to the system under discussion will be discussed. For example, while reviewing the endocrine system- anatomy of various endocrine organs, their physiological function, and biochemical aspects of the synthesis of various hormones will be discussed including embryology, and a brief mention of various endocrine diseases will be mentioned with emphasis on the pathological processes involved and their treatment including pharmacology of the drugs used in these diseases. The same pattern will be followed for other organ systems and their diseases.
Since major emphasis in USMLE Step 1 examination is to ask questions that are clinically relevant, such a review covering various basic and clinical aspects of all the organ systems will familiarize the student as to how to prepare for the examination and, in turn, face the test with more confidence. In addition, such a preparation will teach the student as to how to apply knowledge of basic sciences to clinically relevant situations and arrive at the right decision both in making the correct diagnosis and applying right therapeutic.
The education program consists of 72 weeks of clinical training. Every student takes 48 weeks of core clinical rotations in the five major specialty areas – 12 weeks of internal medicine, 12 weeks of surgery, and six weeks each of family medicine, obstetrics/gynecology, pediatrics, and psychiatry. In addition to the core rotations listed above, all students are required to complete 24 weeks of elective rotations. Elective rotations are 4 weeks in length and will require the completion of 4-weeks cardiology, 4-weeks neurology, 4-weeks emergency medicine, and three 4-week electives at the student’s choice.
The 12 weeks of the internal medicine rotation are designed to expose the student to a wide variety of medical problems. The student is expected to develop a logical approach to the diagnosis and treatment of patients’ complaints. Some of the skills that must be acquired and refined are: how to elicit and assess patient information, how to perform a complete and accurate physical examination, how to formulate a differential diagnosis and problem list, how to construct a diagnostic workup and a plan of management, and how to write up and present cases.
The student thoroughly studies at least two new patients per week, presents them on teaching rounds, follows them throughout their hospital stay, and uses his or her patients’ problems as a basis for reading. A large amount of experience-based knowledge should be accumulated by the end of the rotation since the student is assigned cases in various major areas of medicine such as cardiology, gastroenterology, and endocrinology. Self-learning techniques, as well as compulsory attendance at lectures, conferences, teaching rounds, and careful study of patients, should foster a sound pathophysiologic approach to medical disease and a concern for and awareness of the patient’s needs.
The goal of the surgery rotation is to acquaint the student with those clinical problems that require surgery as part of the therapeutic management. The emphasis of this rotation is not primarily on surgical technique, but on the understanding of the pathophysiology of surgical disease and the management of preoperative and postoperative therapy. Besides the many short histories and physical examinations done during this rotation, a student is required to perform detailed histories and physical examinations on at least two patients admitted to the surgical service each week, and to follow these patients through surgical and postoperative therapy.
Attendance in the operating room is required when surgery is performed on a patient for whom a student obtained an admission history and performed a physical examination. The student must assist in the operating room to gain an understanding of basic surgical techniques, surgical discipline in relation to asepsis, and care of the unconscious patient. The more common postoperative complications must be recognized. Student follow-up of patients is required (i.e., pathology, radiology, rehabilitation medicine). Procedures that involve manual skills, such as venipuncture, placing and removing sutures, and urethral catheterization, are incorporated into the surgical rotation. Initially, students are under direct supervision. After demonstrating proficiency, they are indirectly supervised.
The goals of the clinical rotation in obstetrics/ gynecology are to provide the student with knowledge and experience in managing the normal and abnormal changes that occur during pregnancy, labor, delivery, and the puerperium, as well as in diagnosing and treating gynecologic disorders. Students become proficient in taking a history from and examining such patients, learning to perform pelvic examinations, including how to pass a speculum and obtain a cervical smear, and attending to their patients in the operating and delivery rooms. Additional student experiences include the observation of labor, delivery of cases, installation of intravenous infusions, recording of partograms, helping with problems of anesthesia, and attendance at special clinics, such as pre and post-natal care, family planning, infertility, and high-risk cases. Students attend conferences, lectures, and teaching rounds; to follow their patients carefully; to read textbooks and literature referable to their patients’ problems; and to pay special attention to public health aspects of reproductive medicine, especially as they relate to maternal and perinatal morbidity and mortality, sexually transmitted disease, cancer detection, and human sexuality.
The purpose of the rotation is to convey psychiatric concepts, attitudes, and skills that are needed by all students, regardless of their future career plans. By the conclusion of the rotation, the student should be able to elicit, organize, and present a full psychiatric history; perform a mental status examination as well as a differential diagnosis; and suggest methods of treatment. Students will have improved their ability to establish a physician-patient relationship and will have acquired knowledge of psychological factors in physical illness. The student will also demonstrate improved interviewing skills; know the major indications, uses, and side effects of commonly used psychotropic drugs; become familiar with the major psychiatric syndromes in children and adolescents, as well as the effects on the child/adolescent/family of the life-disrupting syndromes of child abuse and substance abuse; learn detection and treatment of these syndromes; learn to evaluate and manage psychiatric emergencies; feel more comfortable with psychiatric patients; and, ultimately, possess an understanding of biological, psychological, and social determinant behavior. Each student must fully work up at least one patient a week. The history and mental status examination are presented to the preceptor and the case is discussed. The student must follow each patient’s progress throughout the duration of the rotation. A student must attend ward rounds and outpatient sessions. Attendance will be expected at case conferences and seminars.
Special experiences are recommended. They are:
- Attendance at Alcoholics Anonymous meetings;
- Visits to local mental health facilities, county and/or state hospitals, addiction programs, and any other special programs in the vicinity of the hospital; and
- Observation and participation in group therapy and pre-discharge and post-discharge group management.
The goal of the rotation in Pediatrics is to allow the student to acquire the basic knowledge of the normal physical, mental, and emotional development of children; to learn how this development is influenced by medical, social, and educational factors; to understand the common disorders and diseases of childhood, especially their diagnosis, management, and prevention; and to be aware of the special needs of the newborn, the handicapped child, and the adolescent.
An integral part of the rotation is the opportunity to acquire the necessary skills of taking a pediatric history, to examine children of all ages, and to acquire experience in evaluating the essential clinical information so that a coherent plan of management can be formulated and explained to the parents and, as appropriate, to the child. The student learns to appreciate the value of a confident, but sympathetic, approach to the child and the family, while recognizing and accepting the limits of their expectations and understanding. The student’s reading is structured during the six weeks so that he or she first becomes acquainted with the normal child, and then learns history taking and physical examination, reactions of children to illness and hospitalization, and the principles of infant feeding and fluid and drug therapy.
Primary Care in family medicine
For the primary care rotation, students formally experience full-time outpatient medicine in a variety of settings. The exact format of the four-week period is determined by the amount of outpatient experience the student has had during core rotations and by his or her personal interests. Rotations can take place at community-based outpatient clinics in medicine, family medicine, pediatrics, emergency departments, and operating rooms. The student learns to obtain pertinent history and to perform a problem-oriented physical examination, as well as to order cost-effective diagnostic tests generally available to outpatient practitioners. The student works closely with the attending physician, allied health professionals, and the social service agencies available in the community.
A sub internship in any of the disciplines continues the educational goals and objectives of the core rotation, but at a higher level of responsibility. The sub intern shares patient responsibility and participates in regularly scheduled night and weekend calls. The sub intern follows a limited number of patients very closely throughout the diagnostic workup and management. In this way, the sub internship prepares the student for his or her internship or first postgraduate year. Sub internships may be taken only after completion of the corresponding clinical core rotations. A four-week medicine sub internship, 4 week medicine selective and a four-week pediatric sub internship are mandatory for all students.
The Electives (24 weeks)
Numerous varied electives are offered at the University’s affiliated hospitals. Additional electives are available at unaffiliated hospitals, but these are subject to the review and the approval of the Dean of Clinical Science. The student who seeks licensure in the US should carefully note that the licensing boards of some states require that students take electives only at affiliated hospitals. This may also be true in other countries. Some states require that each clerkship (whether core or elective) be completed at a hospital with an ACGME-approved residency in that specialty. Since licensing regulations may vary from state to state and from one year to the next, this matter must be considered as the student devises an elective program. Each elective is usually at least four weeks long, and electives of perhaps less than four weeks, such as ophthalmology and dermatology, require the specific review and written approval of the Dean of Clinical Science.
The principal objective of the elective program is to provide the best preparation for the student’s career choice, while coordinating a balanced, yet broad clinical experience. In recognition of the individual plans and needs of each student, choices of both subject matter and course location are made by the student, with advice from supervising clinical teachers and with the approval of the Dean of Clinical Science.