Curriculum and Schedules

vMEDICAL EDUCATION CURRICULUMv

COURSE OF STUDY

Students enrolling at the University of North Dakota School of Medicine and Health Sciences generally receive their M.D. degree after four years of successful study. They complete the first two years on the Grand Forks campus. For the third year, the majority of the students are assigned to do their clerkship rotations on either the Fargo campus or the Bismarck campus. Six students remain at the Grand Forks campus and six-to-eight students participate in an intensive rural experience (Rural Opportunities in Medical Education, ROME) for seven months of their third year. In the fourth year, students study on one of the four clinical campuses at Grand Forks, Fargo, Bismarck or Minot. The curriculum for the four-year program of study is outlined below:

First and Second Years

Orientation: (1 week)

Students begin their medical education program with a one-credit course entitled "Orientation to Patient-Centered Learning." This course acquaints first-year medical students with small group learning and problem-solving principles used in the curriculum as well as serving as an introduction to clinical medicine, interpersonal and group dynamics, and computer skills.

Overview of PCL and IPC: (Eight 10-week blocks)

The basic science and clinical medicine content focuses on fundamental concepts that serve as the foundation for the more advanced concepts encountered in the later phases of the curriculum (Years 3 & 4). Integrated basic science and clinical medicine are taught in a series spanning throughout Blocks I and VIII via a combination of lectures and small group Patient-Centered Learning (PCL) and Introduction to Patient Care (IPC) activities. Each block includes eight weeks of instruction, one week of assessment and one week for special studies. The first year of the medical education curriculum is comprised of Blocks I-IV (40 weeks), arranged in a "systems approach." These four blocks include biological, behavioral, and social sciences; basic clinical skills; and integrative clinical correlations. Blocks V-VIII, the second year of the medical student curriculum, cover a 40-week period, focus on pathobiology, and include an ambulatory care experience.

Using the PCL format, small group learning sessions are designed to facilitate the integration of the basic sciences with clinically relevant cases. The small group sessions stress independent learning to strengthen individual problem-solving skills. Advanced biological, behavioral, and social concepts are presented throughout the curriculum. Emphasis is placed on instruction, the assessment of student performance, and development of independent learning skills necessary for establishing a personal commitment to the lifelong learning for all physicians.

The curriculum for Years 1 and 2 is designed to bridge the gap between the preclinical and clinical years by developing and fostering the students' understanding of clinical problems. The students begin interacting with patients during the first semester of the Introduction to Patient Care (IPC) courses. To be successful, students must synthesize large amounts of information, effectively apply science concepts to clinical problems, and integrate concepts across disciplines. They learn the dynamics of the doctor/patient relationship, how to interview patients, and how to conduct physical examinations.

Ambulatory Care Experience (ACE)

This is a clinical experience that begins in Year 1 with students "shadowing" physicians in the clinic and receiving basic instruction in interviewing and physical examination techniques. This is followed by ACE in the second year where the students spend in-depth sessions with clinical preceptors performing histories and physical exams on patients, writing up patient histories, presenting patients to faculty and students, and practicing clinical skills exams on peers. All of these components are coupled to faculty feedback and summative clinical skills assessment.

Assessment Week

Following the eight-week instruction period for each block, a week of assessment occurs. The components of assessment week include a multiple choice exam, a patient problem exercise, and a skills examination (e.g., physical examination, interviewing skills exercise, etc.) which varies dependent on the skills emphasized in a given block.

Special Studies Week

Failure of one component of assessment in an individual block results in an unsatisfactory grade for the block. Remediation of a single failed component can be accomplished during Special Studies Week. The details for the remediation process are tailored to the individual’s performance on the assessment component failed.

The academic curriculum for Years 1 and 2 is shown in chart format below.

Block 1			Block 2
8 Weeks	1 Week	1 Week	8 Weeks	1 Week	1 Week
PCL – Functional Biology of Cells & Tissues Genes and chromosomes; proteins, metabolism, replicative behavior of cells; intercellular and intracellular communication; architecture of cells and tissues	Assessment Week	Special Studies Week	PCL – Biology of Organ Systems I Cardiovascular biology; air conduction and respiration; immune system; musculoskeletal system; peripheral nervous system	Assessment Week	Special Studies Week
IPC – Interviewing & Professionalism Medical terminology; interviewing; doctor/patient relationship; ethics; biostatistics			IPC – The Physical Examination Basic examination of all major body regions/organ systems, organ systems, and pediatric exam

Block 3			Block 4
8 Weeks	l Week	1 Week	8 Weeks	1 Week	1 Week
PCL – Biology of Organ Systems II GI tract; liver and biliary system; exocrine pancreas; renal and urinary system; reproduction; endocrine	Assessment Week	Special Studies Week	PCL – Biology of the Nervous System Central nervous system; peripheral nervous system revisited; biology of special sensory structures	Assessment Week	Special Studies Week
IPC – Human Life Cycle I Human life cycle biopsychosocial aspects; biostatistics; weekly rotating clinical experience			IPC – Human Life Cycle II Human life cycle biopsychosocial aspects; weekly rotating clinical experience

Block 5			Block 6
8 Weeks	l Week	1 Week	8 Weeks	1 Week	1 Week
PCL – Introduction to Pathobiology Reaction to injury (cell injury, cell death); inflammation; repair and regeneration; fluid imbalance; disorders of inheritance; disorders of immunity; neoplasia; infection	Assessment Week	Special Studies Week	PCL – Pathobiology I Disorders of red cells and bleeding disorders; disorders of white cells; lymph nodes and spleen; Cardiovascular I – vascular system; Cardiovascular II – heart; respiratory tract; ear, nose and throat	Assessment Week	Special Studies Week
IPC – Evidence-based Medicine Evidence-based medicine; ambulatory care experience (ACE)			IPC – The Doctor and Society Stress management for physicians; medical marriages; lifestyle balance; changing health care system; ambulatory care experience (ACE)

Block 7			Block 8
8 Weeks	l Week	1 Week	8 Weeks	1 Week	1 Week
PCL – Pathology II GI tract; liver and biliary system; exocrine pancreas; Renal I – glomerular disease; Renal 2 - tubular and interstitial disease; lower urinary tract; male reproduction system; female reproductive system; breast;	Assessment Week	Special Studies Week	PCL – Pathobiology III Diabetes mellitus, endocrine other than diabetes mellitus; skeletal system and soft connective tissue; skin; peripheral nervous system and skeletal muscle; central nervous system and special senses; environmental and nutritional diseases	Assessment Week	Special Studies Week
IPC – Prevention and Clinical Skills Prevention; nutrition; charting, oral case presentations; writing orders; writing prescriptions; basic procedural skills, refresher on physical examination; ambulatory care experience (ACE)			IPC – Psychopathology and Substance Abuse Discussions of clinical psychiatric syndromes and their underlying neurobiologic dysfun ctions; substance use disorders; and ambulatory care experience (ACE)

Third and Fourth Years

Students are taught in traditional clerkship clinical settings throughout the third and fourth years. These experiences provide students exposure to clinical milieus ranging from physician practices in a rural health care system to urban medical centers. The curriculum model provides students a strong generalist base, regardless of their final career choice. Some third-year students are selected to participate in a rural educational experience which is described below.

Rural Opportunities for Medical Education (ROME) is an seven-month interdisciplinary experience in a rural primary care setting open to third-year students. Students live and train in a non-metropolitan community under the supervision of physician preceptors. A goal for the ROME program is to expose students to practicing medicine in rural areas throughout the state. Following the ROME experience, four one-month rotations in Medicine, OB/GYN, Pediatrics, and Psychiatry are completed at a more urban center.

Acting Internships in Medicine and Surgery are required in the fourth year. Each internship is four-weeks and is designed to teach students how to function in the hospital setting at the level of a first-year intern. Students fine tune their skills for making the initial patient contact, taking a patient history, performing a physical examination, formulating problem lists, formulating a diagnostic plan, developing a therapeutic plan, writing orders, doing patient follow-up, writing progress notes and discharge notes. The student requires supervision of a committed senior resident or physician on site.

Six electives (four weeks each) are required. For specific elective listings for each campus, see Elective Guidelines (http://www.med.und.nodak.edu/elective/academic.htm).

The Dean’s Colloquium is offered just prior to graduation and may include, but is not limited to, such topics as professionalism, resident clinical teaching skills, evidence-based medicine, a pharmacology update including pharmacogenomics, the impaired colleague, how to survive residency, financial planning, credentialing, and loan repayment.

Completion of a Research Project is a requirement for graduation. Guidelines for doing a research paper are provided by the Department of Family Medicine.

Students are required to pass USMLE Step 1 and Step 2 for promotion/graduation.

First Year: Begins August; Duration: 41 weeks (includes Orientation Week); Scheduled hours per week: 28, not including Orientation, Assessment and Special Studies Weeks
	Hours
	Lecture	Small Group	Lab	Other*	Total
Orientation to Patient Centered Learning	5	20	0	15	40
Block I: Functional Biology of Cells & Tissues/Interviewing & Professionalism	104	80	32	88	304
Block II: Biology of Organ Systems I/The Physical Examination	104	80	32	88	304
Block III: Biology of Organ Systems II/ Human Life Cycle I	104	80	32	88	304
Block IV: Biology of the Nervous System/ Human Life Cycle II	104	80	32	88	304
Total:	419	340	128	367	1256

* Includes one week of assessment (Maximum: 40 hrs/block) and one week of special studies activities (Maximum: 40 hrs/block).

Second Year: Begins August; Duration: 40 weeks; Scheduled hours per week: 28, not including Assessment and Special Studies Weeks
	Hours
	Lecture	Small Group	Lab	Other*	Total
Block V: Intro to Pathobiology/Evidence-based Medicine	104	80	32	88	304
Block VI: Pathobiology I/The Doctor and Society	104	80	32	88	304
Block VII: Pathobiology II/Prevention and Clinical Skills	104	80	32	88	304
Block VIII: Pathobiology III/Psychopathology and Substance Abuse	104	80	32	88	304
Total:	416	320	128	352	1216

* Includes one week of assessment (Maximum: 40 hrs/block) and one week of special studies activities (Maximum: 40 hrs/block).

** Introduction to Patient Care (IPC) includes an ambulatory care experience (ACE).

Third Year: Begins July; Duration: 48 weeks

Option #1: Updated Traditional Model (UTM)

Required Clerkships Weeks

Medicine..................................................................................................................................... 8
Surgery....................................................................................................................................... 8
Pediatrics.................................................................................................................................... 8
Obstetrics/Gynecology................................................................................................................ 8
Psychiatry................................................................................................................................... 8
Family Medicine.......................................................................................................................... 8

Option #2: Rural Opportunities in Medical Education (ROME)

Rural Experience in Primary Care.............................................................................................. 28
Co-requisities (One month rotations in Internal Medicine, OB/GYN and Pediatrics and two months of Neuroscience) .......................................................................................................................... 20

Clinical Epidemiology (Two-credit, third-year longitudinal course required for both the traditional model and ROME)

Fourth Year: Begins July; Duration : 34 weeks

Required Acting Internship -- Medicine .................................................................................... 4
Required Acting Internship -- Surgery .......................................................................................4
(Acting Internships must be taken in the Fourth Year.)
Elective Program: Six 4-week electives are required) .............................................................. 24
Dean’s Colloquium .................................................................................................................... 2

Required Research Project

Interdepartmental Courses

MED 600. Orientation to Patient Centered Learning
1 credit. Prerequisites: None; Corequisites: None. This course acquaints first-year medical students with small group learning and problem-solving principles used in PCL and IPC.

MED 601. Block I: Functional Biology of Cells and Tissues; Interviewing and Professionalism
11 credits. Prerequisites: MED 600; Corequisites: None. Topics for this course include: genes and chromosomes; proteins; metabolism; replicative behavior of cells; intercellular and intracellular communication; architecture of cells and tissues; early development; medical terminology; interviewing; doctor/patient relationship; ethics; and biostatistics.

MED 602. Block II: Biology of Organ Systems I; The Physical Examination
11 credits. Prerequisites: MED 600 and 601; Corequisites: None. Topics for this course include: cardiovascular biology; air conduction and respiration; the immune system; the musculoskeletal system; the peripheral nervous system; and physical examination.

MED 603. Block III: Biology of Organ Systems II; Human Life Cycle I
11 credits. Prerequisites: MED 600, 601 and 602; Corequisites: None. Topics for this course include: GI tract; the liver and biliary system; exocrine pancreas; the renal and urinary system; reproduction; endocrine; human life cycle biopsychosocial aspects; and biostatistics. The block also includes a weekly rotating clinical experience.

MED 604. Block IV: Biology of the Nervous System; Human Life Cycle II
11 credits. Prerequisites: MED 600, 601, 602 and 603; Corequisites: None. Topics for this course include: the central nervous system; the peripheral nervous system revisited; biology of special sensory structures; human life cycle biopsychosocial aspects. The block also includes a weekly rotating clinical experience.

MED 701. Block V: Introduction to Pathobiology; Evidence-based Medicine
12 credits. Prerequisites: MED 600-604 (Year 1); Corequisites: None. Topics for this course include: Reaction to Injury (cell injury, cell death); inflammation; repair and regeneration; fluid imbalance; disorders of inheritance; disorders of immunity; neoplasia; infection; evidence-based medicine; and ambulatory care experience (ACE).

MED 702. Block VI: Pathobiology I; The Doctor and Society
12 credits. Prerequisites: MED 600-604 (Year 1) and MED 701 (Year 2); Corequisites: None. Topics for this course include: Disorders of red cells and bleeding disorders; disorders of white cells; lymph nodes and spleen; Cardiovascular I -- vascular system; Cardiovascular II -- heart; respiratory tract; ear, nose, and throat; doctor and society; and ambulatory care experience (ACE).

MED 703. Block VII: Pathobiology II; Prevention and Clinical Skills
12 credits. Prerequisites: MED 600, 601-604 (Year 1) and MED 701-702 (Year 2); Corequisites: None. Topics for this course include: GI tract; liver and biliary system; exocrine pancreas, Renal 1 -- glomerular disease; Renal 2 -- tubular and interstitial disease; lower urinary tract; male reproductive system; female reproductive system; breast; prevention; nutrition; clinical skills; and ambulatory care experience (ACE).

MED 704. Block VIII: Pathobiology III; Psychopathology and Substance Abuse
12 credits. Prerequisites: MED 600, 601-604 (Year 1) and MED 701-703 (Year 2); Corequisites: None. Topics for this course include: Diabetes mellitus; endocrine other than diabetes mellitus; skeletal system and soft connective tissue; skin; peripheral nervous system and skeletal muscle; central nervous system and special senses; environmental and nutritional diseases; psychopathology; substance abuse; and ambulatory care experience (ACE).

MED 8101. Clinical Epidemiology
2 credits. A longitudinal course for third-year students which provides an introduction in biostatistics and epidemiology. The effect of disease on communities, rather than individuals, is emphasized.

MED 9502. Dean’s Colloquium
2 credits. Topics for this course may include, but are not limited to, the following: Evidence-based medicine; professionalism; update on drugs; clinical teaching skills; how to survive residency; the impaired colleague; medical licensure; credentialing; and financial planning. This course is redesigned each year to fit the students’ needs.

Note: For Acting Internship course descriptions, see listing under the Department of Medicine and the Department of Surgery in the University of North Dakota School of Medicine and Health Sciences Bulletin. Clerkship descriptions and course numbers are also found in the Bulletin.