This curriculum phase of the study is defined as the first 18 months of medical school with a focus on the eight basic sciences core courses, Doctor & Patient/Societies course, and the Clinical Reasoning course, including all longitudinal curriculum sessions intertwined throughout the core courses.  

Foundations: The six-week Foundations block fosters the development of skills in evidence-based decision making, self-directed learning, communication and professionalism, while also addressing medical-based science topics, including cell biology, genetics, embryology, biochemistry, histology, pathology, the immune system, microbiology, pharmacology and biostatistics.

Musculoskeletal System: The six-week Musculoskeletal System block provides a basic understanding of the musculoskeletal system designed to help students approach its clinical presentation in their future clinical practice. The block discusses the location and function of bones, muscles, peripheral nerves and vessels of the limbs; and the structure and physiology of the basic tissues of the musculoskeletal system (cartilage, bone, joint and muscle). Students are taught to use knowledge of anatomy and the tissues to approach musculoskeletal disease and injuries. Many diseases of the musculoskeletal system overlap with diseases of other systems, such as neurological and immunological disorders; therefore, this block builds upon material learned in the Foundations and Nervous System blocks and lays the foundation for material that will be encountered in subsequent blocks. In addition, the Musculoskeletal System block covers most aspects of skin required for USMLE Step 1, including normal structure and function, as well as common skin lesions. Finally, because many musculoskeletal diseases require chronic care, material in the block addresses issues of health care delivery for disability and chronic care.

Nervous System: The nine-week Nervous System block is a comprehensive overview of general principles in neuroscience, neuropathology, neurology, neuropharmacology, psychiatry and social/behavioral sciences. The overarching goals are to introduce students to the structure and function of the human nervous system while integrating related histology, pathology, clinical applications in neurology, relevant psychiatry, psychopathology, pharmacological treatments, and gross anatomy of the central nervous system, head and neck. The course also introduces concepts of rehabilitation, nutrition, exercise, ethical scenarios in cases of terminal genetic diseases, and the use of narcotics.

Cardiovascular, Pulmonary and Renal Systems: The 11-week Cardiovascular, Pulmonary and Renal Systems block is designed to provide students with an in-depth study of the cardiovascular, lymphatic, respiratory, renal and urinary systems using an integrated approach encompassing molecular and cellular biology, anatomy, histology, physiology, pathology, pharmacology and clinical medicine.

Through the use of small group case-based exercises and team-learning formats, students are provided background knowledge in the basic and clinical sciences, physical examination, and laboratory and imaging findings needed to determine general priorities for basic diagnostic and treatment strategies, and the use of evidence-based approaches to evaluate clinically relevant information.

Students will also be exposed to issues of age, gender, socio-economic status, ethnicity and culture in patient care decisions, as well as the epidemiology and statistics relevant to cardiovascular, pulmonary and renal disease. Students in the Cardiovascular, Pulmonary and Renal Systems block are expected to use technology, including medical databases, to advance their medical knowledge and practice-based learning.

Digestion, Metabolism and Hormones: The nine-week Digestion, Metabolism and Hormones block offers an integrated presentation of topics focusing on digestion and absorption of food (carbohydrates, lipids and protein), water, vitamins and some minerals, nutritional aspects of macronutrients and micronutrients, fuel metabolism and storage, and the role of hormones in controlling physiological and biochemical functions in humans. The block covers:

• Functions of key digestive tissues, including salivary, stomach, intestine, pancreas, gall bladder and liver
• Metabolic pathways in the liver and adipose tissue that are important in fuel storage and mobilization and regulation of these systems
• Pathophysiology associated with malabsorption and the digestive tissues
• Integration of the anatomy, histology, physiology, biochemistry, pathology and pharmacology of the gastrointestinal system
• Histology, biochemistry, physiology, pathology and pharmacology as they relate to the endocrine system
• Normal nutritional requirements using this information to discuss the role of nutrition in metabolism and to evaluate the consequences of nutritional deficiencies

Personalized Active Learning (PAL): The PAL four-week graduation requirement is designed to assist students in coordinating an experience to enhance their medical knowledge in an area of particular interest during the summer between their first and second year of medical school.  Students have a variety of pre-approved options that satisfy this graduation requirement, including:

• Global Health Distinction Track Field Experience
• Medical Student Research Program (MSRP)
• Rural Health Professions Program
• Remediation of a Course
• MD/PhD Summer Rotations

Students may also participate in a number of options not considered pre-approved with the guidance of their House Dean and the PAL Director. Examples of options not considered pre-approved is ongoing research, ongoing volunteer experience with a scholarly project, medical mission trip/volunteer experience not through the college that has a research focus, teaching experience, development of a new course/curriculum, etc. Each PAL plan must account for at least 160 hours over the course of the summer. The culmination of each student PAL plan will be a manuscript and can be written in a variety of formats, including personal reflection essays in which students will reflect on their summer experiences, to scientific write-ups such as a case report, letter to the editor or original research.

Life Cycle: The seven-week Life Cycle block focuses on the biology and medicine of human reproduction and sexuality and normal and abnormal development throughout the life cycle. Life Cycle is designed to address reproductive anatomy, histology and physiology through the life span from conception to pregnancy, birth, infancy, childhood, adolescence, adulthood, aging and end of life. Life Cycle also presents the cancers of the male and female organs of reproduction.

Immunity and Infection: The eight-week Immunity and Infection block is a presentation of microbiology, immunology and infectious disease, as well as public health and international health issues. Topics include:

• The basic elements of innate and adaptive immune system from the cellular to the systems level
• The mechanisms of immunity and infectious agents and their relationship to common diseases (including diseases involving multiple systems)
• The indications for use, mechanism of action, and side/adverse effects of medications used in the treatment of immunological and infectious diseases

Students will learn to link epidemiological, socioeconomic and cultural factors to infectious diseases and normal and abnormal functioning of the immune system, and to develop clinical hypotheses by organizing and summarizing evidence of pathophysiological function for the immune system, as well as evidence of involvement of multiple systems. Issues of environment, age, gender, socioeconomic status, ethnicity and cultural distinctiveness that impact individual patients with respect to common immunological disorders and infectious processes (e.g., HIV or staph infection) also are presented.

Advanced Topics: The three-week Hematology block focuses on benign and malignant hematologic disorders, oncologic pharmacology, hemostasis and transfusion medicine. The block emphasizes the integration of systemic pathology with clinical practice.

Basic Sciences Capstone: This six-week course is a comprehensive review of the basic sciences curriculum serving as a culminating and integrative experience to prepare students for the USMLE Step 1 exam and the clerkships.

Longitudinal Curriculum

Doctor & Patient / Societies:  The Doctor and Patient block (including the Societies Program) is an integrated program teaching clinical and professional skills and providing longitudinal clinical mentoring. The Societies Program enhances the medical school experience in the following ways:

• Early instruction, from the very first day, in the development of fundamental clinical skills, including communication, taking a medical history, the physical examination of patients and clinical thinking
• Early introduction to what it means to be a medical professional and the importance of professionalism in the practice of medicine
• Provision of an ongoing support system that emphasizes both peer support and the support of dedicated medical school faculty

Clinical Reasoning: The Clinical Reasoning course is longitudinal and runs throughout the pre-clerkship curriculum during the first 18 months of medical school. It is designed to complement the Blocks, the Doctor and Patient Course, and the Societies Program. Students meet for two hours every week with their Clinical Reasoning facilitator to practice the basic principles of clinical reasoning and prepare themselves for their clinical clerkships. The Clinical Reasoning course uses active learning to emphasize higher-level thinking and support independent thought by the students.

Pathways of Health and Medicine: This curriculum runs parallel to the blocks during the first 18 months of medical school. The intent of this curriculum is to provide longitudinal behavioral, medical humanities and social sciences curricula, for the medical education program to ensure greater alignment between biomedical science training and the preparation of future physicians required for meeting broader social expectations.

For more information

Melinda Dávila
Assistant Director, Pre-clerkship Education
melindad@arizona.edu
520-626-1743

This curriculum phase of study is defined as the 12 months of eight core clerkship courses, including Intersessions, Transition to Clerkships, and an ambulatory medicine course.

Family and Community Medicine: This is a six-week clerkship that encompasses the comprehensive and longitudinal care of patients with a special emphasis on care of individuals in the context of families and communities. This is primarily an outpatient rotation, working with preceptors throughout the state. This clerkship provides an opportunity for students to learn about the diagnosis and management of patients with acute common problems, as well as chronic disease. Students will be expected to learn a comprehensive approach to the patient with these diagnoses that entails consideration of etiology, incidence, pathophysiology, clinical presentation, course, prognosis, treatment, the appropriate aspects of patient education, disease prevention and health promotion.

Medicine: The Medicine clerkship is an eight-week experience that includes in-patient and ambulatory exposure. Students are expected to achieve a level of responsibility in the in-patient and ambulatory setting appropriate for a third-year student, including independent data gathering, critical assessment of the data and communication of data to other health professionals.

Ambulatory Medicine: This four-week clerkship offers medical students a broad perspective on ambulatory medicine. Students will see new and established patients in various outpatient medicine clinics. Students have primary responsibility for evaluating the patient, formulating an assessment and implementing management under the close supervision of an attending internist. 

Neurology: This four-week Neurology clerkship is designed to teach medical students the principles and skills needed to recognize and manage the neurological diseases that a general medical practitioner is most likely to encounter in practice. Implicit in this is the ability to recognize the problems of the nervous system that require specialty neurological consultation. Students will learn to perform a thorough neurologic history and examination by the completion of this rotation.

Obstetrics and Gynecology: This six-week clerkship is an introductory experience in the provision of comprehensive medical care and counseling services to elderly, adult and adolescent female patients. The obstetrical conditions and gynecological problems commonly encountered by the physician provide the primary focus for this clerkship experience, but knowledge of serious or less common conditions is also available. Therefore, the basis for the clerkship is to introduce the clinical information thought to be fundamental in the education of all physicians.

Pediatrics: The six-week Pediatric clerkship is divided into two three-week blocks. Students spend three weeks on the inpatient service at Banner Children’s at Diamond Children’s Medical Center, and three weeks in an outpatient clinic, either at Banner University Medical Center (BUMC), BUMC Children’s Multispecialty Center (Wilmot Clinic), BUMC North Hills Clinic, BUMC Pantano Clinic, a private practice clinic site (dependent on site availability) or a rural clinic site (dependent on site availability). A newborn nursery experience will be part of the outpatient rotation and will occur at BUMC, no matter where the student is assigned for their outpatient rotation (with the exception of those at a rural site).

Psychiatry: In this six-week clerkship, the student will be able to demonstrate through oral or written communication with attending physicians or residents and staff through documentation in patient records, and in a manner judged by the attending physicians and staff as satisfactory, an understanding of:

• The purposes of the psychiatric interview
• The purpose and form of the psychiatric workup
• The major manifestations of psychosis, cognitive impairment and differential diagnosis of schizophrenia and substance-related, mood, anxiety and personality disorders
• The major groups of psychopharmacologic agents used in psychiatric care, including their indications, effects, side effects and contraindications, with particular reference to antipsychotics, anti-depressants, mood stabilizers, anti-anxiety agents, sedatives and stimulants. Additionally, required is knowledge of the uses of electroconvulsive therapy.
• An understanding of the major psychosocial interventions and their indications, including the use of psychotherapy, group therapy, couples’ therapy, family and social case work
• The legal and psychological principles of treating violent, suicidal, incompetent and uncooperative patients
• The major services available to the mentally ill and methods of referral to such services

Surgery: The goal of the eight-week surgery clerkship is to introduce the student to the principles of caring for the surgical patient. This goal is accomplished by allowing the student to participate in the care of patients in the various stages of evaluation and treatment by surgeons. These stages include but are not limited to the preoperative office or clinic visit, inpatient admission, operative procedure and inpatient/outpatient recovery. Through this exposure, the student will begin to understand the general process of the application of surgical therapy to patients in a wide variety of settings. Furthermore, by participating as a member of the surgical team, the student will observe the role of the surgeon as a member of the multidisciplinary team that provides care for the patient. The clerkship is structured upon the principle that learning is a process that can be accomplished only by active participation by the student. The role of the faculty and house staff is to provide guidance, stimulation, support and example.

Transition to Clerkships: This one-week course is delivered to students prior to entering their core clerkships. Medical students participate in a variety of educational experiences designed to prepare them to begin their clerkship curriculum. In addition to lectures on topics pertinent to patient care, students participate in simulations and performance exercises to learn and practice basic skills that will be required of them in the clerkship curriculum. Attendance at sessions and active participation is mandatory.

Intersessions I and II: Intersessions are opportunities for the whole class to come together during the Clerkship year and learn the knowledge, skills and attitudes that are fundamental to the practice of good medical care. Topics the students will be exposed to include patient safety and medical errors, quality of medical care, professionalism, ethics in medicine, medical legal issues, health care disparities, health care financing and resource use, wellness and resilience. The students will also be able to learn some procedural skills, such as bedside ultrasound, as well as get early exposure to non-clerkship specialties such as diagnostic imaging and pathology. Intersessions also provide an opportunity for students to come together for collaborative and reflective time in the process of becoming a physician. Curricular formats and learning strategies vary to accommodate the variety of content and learning. They include simulation sessions, objective structured clinical examinations, lectures, and smaller group projects and assignments.

For more information
clerkshipadmin@arizona.edu

This curriculum phase of study is defined as the final 14 months of clinical curriculum, including core sub internship, electives, surgical subspecialty, emergency medicine/critical care clerkship, back-to-basics science and transition to residency bootcamp selectives.

Emergency Medicine-Critical Care Clerkship: In this four-week clerkship, students will be given an overview of the principles and concepts of the specialty of emergency medicine, with emphasis on the common presenting complaints and procedures in the undifferentiated patient. Students additionally will experience how treatment in the Emergency Department affects the patient and subsequent hospitalization. Critical care concepts, such as ventilation management, hemodynamic monitoring and pressor management, critical care pharmacology, and social and behavioral concepts affecting patient management at this level, will be addressed.

Applications of the Basic Sciences to Clinical Medicine: This four-week course takes place in the Transition to Residency phase of the medical student curriculum and is designed to prepare students for the foundational knowledge necessary to enter their residency programs. Students will review basic-science curriculum from the preclerkship curriculum and apply this knowledge translationally to their chosen clinical specialty. The course emphasizes the active learning approach for didactic sessions and small-group sessions for applied learning.

Preparation for Residency Bootcamp: This two-week course takes place in the Transition to Residency phase of the medical student curriculum and is designed to prepare students for the clinical or surgical skills necessary to enter their residency programs. Students will participate in a one-week shared curriculum, learning common skills for all careers (e.g., electronic health record, order entry, prescription writing, note writing, billing, etc.), followed by specialty-specific curriculum to practice skills necessary to enter residency at a high-functioning intern level. The course will use a combination of standardized patients, online avatar-based curricula, SIMS-based skills labs, small-group sessions and objective structured clinical examination evaluations to support the student’s learning.

For more information
Travis Garner
Program Manager, Clinical Education
travisgarner@arizona.edu