Registration for courses offered in the School of Medicine is limited to medical and graduate students enrolled in School of Medicine programs and to other students who have the written consent, first, of the appropriate School of Medicine department chair, then of the School of Medicine assistant dean for graduate studies, and then of the School of Medicine assistant dean for preclinical curriculum.

Guiding Principles

The medical education program in the School of Medicine is conducted in accordance with a set of guiding principles. These principles, as follows, are based upon a commitment to meeting societal expectations regarding the attributes of practicing physicians and can be used as a screen for periodic review and renewal of the medical education program. The educational program in the School of Medicine should:

1. be centrally coordinated by the Curriculum Committee;

2. foster interdisciplinary and interdepartmental collaboration;

3. promote curricular flexibility;

4. respond to changing societal needs and conditions;

5. recognize students' individual talents, interests, and needs;

6. foster students' abilities to be independent and lifelong learners;

7. promote a cooperative, collegial, and mutually respectful environment;

8. prepare students for the ethical challenges of medical practice.

Program Objectives

A set of coherent and comprehensive objectives has been established for the medical education program in the School of Medicine. The educational program in the School of Medicine shall:

1. ensure the horizontal and vertical integration of basic and clinical sciences;

2. promote students' mastery of both scientific and clinical knowledge;

3. provide an understanding of the biopsychosocial model of health care;

4. ensure the modeling of cost-effective, evidence-based medicine to students;

5. encourage students' personal and professional development;

6. foster team-building through student self and peer evaluation;

7. foster students' acquisition of necessary clinical, communication, and problem-solving skills;

8. utilize a variety of learning formats;

9. provide a variety of clinical settings with diverse patient populations;

10. nurture students' collaboration with other health care team members;

11. set appropriate and realistic performance standards for students;

12. utilize both formative and summative evaluation methods for students;

13. increase the use of competency-based student assessments;

14. promote students' interest in scientific exploration;

15. provide a range of elective opportunities for students;

16. educate generalist physicians who are potentially eligible for practice in South Carolina;

17. prepare altruistic, knowledgeable, skillful, and dutiful physicians;

18. graduate physicians who attend equally well to all aspects of health care.

Educational Objectives for Graduates

A set of educational objectives has been established for students of the School of Medicine. After completion of the four-year medical education program in the School of Medicine, a graduate shall have demonstrated to the satisfaction of the faculty the following knowledge, skills, and attitudes and behaviors.

1. Knowledge:

a. knowledge of the normal structure and function of the body and its major organ systems;

b. knowledge of the molecular, biochemical, and cellular mechanisms that are important in maintaining the body's homeostasis;

c. knowledge of the various causes (genetic, developmental, metabolic, toxic, microbiologic, autoimmune, neoplastic, degenerative, psychosocial, and traumatic) of maladies and of the pathogenesis of maladies;

d. knowledge of the altered structure and function (pathology and pathophysiology) of the body and its major organ systems seen in various diseases and conditions;

e. knowledge of the frequent clinical, laboratory, roentgenologic, and pathologic manifestations of common maladies;

f. knowledge of the important non-biological determinants of health and of the economic, psychological, social, and cultural factors that contribute to the development and/or continuation of maladies;

g. knowledge of the epidemiology of common maladies within a defined population and systematic approaches to reduce the incidence and prevalence of those maladies;

h. knowledge of various approaches to, and implications of, the organization, financing, and delivery of health care;

i. knowledge of the theories and principles that govern ethical decision-making and of the major ethical dilemmas encountered in medical practice, particularly at the beginning and end of life and resulting from the rapid expansion of knowledge in genetics;

j. knowledge about relieving pain and ameliorating the suffering of patients;

k. knowledge of the threats to medical professionalism posed by the conflicts of interest inherent in various financial and organizational arrangements for medical practice.

2. Skills:

a. the ability to obtain an accurate and complete medical history, with special attention to issues related to age, gender, and socio-economic status;

b. the ability to perform both a complete and organ-specific examination, including a mental status examination;

c. the ability to perform routine technical procedures;

d. the ability to interpret the results of commonly used diagnostic procedures;

e. the ability to communicate effectively, orally and in writing, with patients and their families, colleagues, and others with whom physicians must exchange information in carrying out their responsibilities;

f. the ability to retrieve, manage, and utilize information for solving problems and making decisions relevant to the care of individuals and populations;

g. the ability to identify factors placing individuals at risk for disease or injury, select appropriate tests for detecting patients at risk for specific diseases or in the early stage of diseases, and determine appropriate response strategies;

h. the ability to construct appropriate management strategies, both diagnostic and therapeutic, for patients with common acute and chronic medical and psychiatric conditions, surgical conditions, and conditions requiring short- and long-term rehabilitation therapy;

i. the ability to recognize and institute appropriate initial therapy for patients with immediately life-threatening cardiac, pulmonary, or neurological conditions, regardless of causation;

j. the ability to recognize and outline an initial course of management for patients with serious conditions requiring critical care;

k. the ability to reason deductively in solving clinical problems;

l. the ability to access and evaluate critically medical literature;

m. the ability to understand the power of the scientific method in establishing the causation of disease and efficacy of traditional and non-traditional therapies.

3. Attitudes and Behaviors:

a. compassionate treatment of patients and respect for their privacy and dignity;

b. honesty and integrity in all interactions with patients and their families, colleagues, and others with whom physicians must interact in their professional lives;

c. commitment to advocate at all times for the interests of patients over personal interests;

d. commitment to provide care to patients unable to pay for medical services and to advocate for access to health care for members of traditionally underserved populations;

e. commitment to engage in life-long learning in order to stay abreast of relevant scientific advances;

f. the capacity to recognize and accept limitations in one's knowledge and clinical skills and a commitment to improve that knowledge and ability;

g. understanding of, and respect for, the roles of other health care professionals and of the need for collaboration with them in caring for patients and promoting the health of defined populations.

Technical Standards Attainment Document

Medical students must demonstrate mastery of all required clinical skills enumerated in the Technical Standards Attainment Document (TSAD) prior to graduation from the School of Medicine. Demonstration of mastery of some of these clinical skills is required for a passing grade in the second-year Introduction to Clinical Medicine course (see "Interdisciplinary Courses" section), while demonstration of mastery of other clerkship-specific clinical skills is required for successful completion of each third-year clinical clerkship (see "Clinical Sciences" section). In addition, students must demonstrate mastery of required non-departmental clinical skills during the third and fourth years of medical education such as a lumbar puncture and placement of an intravenous line.

Basic Sciences

Biochemistry Section (Department of Chemistry and Biochemistry)

CHEM D650 Medical Biochemistry I

is a four-credit-hour, fall semester, first-year course that covers human biochemistry at the molecular, cellular, and whole-body levels, including information about amino acids, proteins, and enzymes; the general principles of bioenergetics and metabolism; and the biochemistry and metabolism of carbohydrates and lipids. Clinical correlation conferences on specific diseases and disorders illustrate the clinical relevance of biochemical concepts covered in lecture.

Primary methods of instruction include lectures and clinical correlations. Modes of assessment include departmental multiple choice examinations.

CHEM D651 Medical Biochemistry II

is a four-credit-hour, spring semester, first-year course that is a continuation of Medical Biochemistry I. The course covers the metabolism of amino acids and nucleic acids; the structure and function of DNA and RNA; protein synthesis and gene regulation; and the biochemistry of selected hormones. Emphasis is placed on unique aspects of the metabolism of specific organs and integration of metabolism within and between organs. Clinical correlation conferences on specific diseases and disorders illustrate the clinical relevance of biochemical concepts covered in lecture.

Primary methods of instruction include lecture and clinical correlations. Modes of assessment include NBME subject examination and a departmental multiple choice/essay examination.

Department of Cell and Developmental Biology and Anatomy

CDBA D602 Medical Microscopic Anatomy

is a five-credit-hour, fall semester, first-year course in which the structure of cells, tissues, and organs is studied and the functional significance of their morphological features is presented. Students observe, firsthand, histological structures in human tissues through the study of microscopic slides, digitized images, and electron micrographs in the laboratory. Students integrate basic concepts and principles of microscopic structures as they pertain to clinical medicine. Web-based instructional methods and videodisc databases are used to present images and other supporting information relating to overall course content, primarily during laboratory sessions. The goal of laboratory sessions is to facilitate critical thinking skills and correlation of basic science information with clinical problems. The course provides the structural basis for understanding principles to be learned in biochemistry, physiology, and pathology.

Primary methods of instruction include lecture, computer-assisted instruction, problem-solving exercises, clinical correlations, laboratory, independent learning experiences, and small-group discussion.

Modes of assessment include departmental written multiple choice examinations, and laboratory practical examinations.

CDBA D601 Medical Embryology and Gross Anatomy

is an eight-credit-hour, fall semester, first-year course involving the combined comprehensive study of the gross and developmental anatomy of the human body, taught in a collaborative learning atmosphere, by which the student learns the names, relationships, and basic functions of body structures. The course relies significantly on a commitment to rigorous independent study.

Primary methods of instruction include lecture, case-based discussion/presentation, clinical correlations, laboratory dissections, independent learning experiences, and student-led laboratory teaching sessions.

Modes of assessment include departmental written multiple choice/essay examination, laboratory practical examination, detailed oral examination/presentation, and research paper.

Cell and Developmental Biology and Anatomy Electives, M-IV.

Tissue Culture: A Research Tool for the Physician; Clinical Anatomy.

Department of Pathology, Microbiology, and Immunology

PAMB D641, D642 Medical Pathology

is a two-semester, five-credit-hour (fall) and five-credit-hour (spring), second-year course that provides students with an understanding of the basic mechanisms of diseases, the body's response to these diseases, and the manifestation of these changes in patient signs, symptoms, and tests in specific organ systems.

Primary methods of instruction include lecture, case-based discussion/presentation, problem-solving exercises, clinical correlations, laboratory, and small-group discussion.

Modes of assessment include NBME subject examination and departmental multiple choice examination.

PAMB D650 Medical Microbiology

is a seven-credit-hour, fall semester, second-year course covering fundamental and clinical aspects of microbiology and immunology as they relate to bacteria, viruses, fungi, and parasites. Infectious agents are discussed in relation to their morphology, biology, epidemiology, and pathogenesis. The role of the specific and nonspecific immune systems in defense against infection and disease, as well as in the causation of disease (immunopathogenesis), is emphasized. A section of the course is devoted to special topics in infectious diseases.

Primary methods of instruction include lecture, case-based discussion/presentation, patient-oriented problem-solving exercises, clinical correlations, and laboratory.

Modes of assessment include departmental written multiple choice/essay examination and an assessment of participation in problem-solving exercises, case study discussions, and computer simulated laboratory exercises.

Pathology and Microbiology Electives, M-IV.

Anatomic and Clinical Pathology at Palmetto Health Richland and the Dorn Veterans Affairs Medical Center; Research in Microbiology and Immunology; Special Topics in Immunology.

Department of Pharmacology, Physiology and Neuroscience

PHPH D631 Medical Pharmacology

is a seven-credit-hour, spring semester, second-year course covering the major areas of medical pharmacology, including principles of drug action; autonomic, renal, cardiovascular, CNS, and endocrine pharmacologies; chemotherapy; and toxicology. Emphasis is placed on the effects of drugs on pathological and physiological processes, as well as on the biochemical mechanisms by which drugs act.

Primary methods of instruction include lecture, case-based discussion/presentation, problem-solving exercises, clinical correlations, conferences, and small-group discussion.

Modes of assessment include departmental written multiple choice/essay examination.

PHPH D621 Medical Physiology

is an eight-credit hour, spring semester, first-year course that integrates essential concepts and facts about human physiology. This course covers the major areas of physiology, including neuromuscular, respiratory, renal, cardiovascular, and gastrointestinal physiologies; the nervous system; endocrinology; and reproduction. Emphasis is placed on basic physiological processes and homeostatic regulation.

Primary methods of instruction include lecture, computer-assisted instruction, problem-solving exercises, clinical correlations, and small-group discussion. Students gain a deeper understanding of physiological processes by performing laboratory exercises.

Modes of assessment include self-assessment exams, NBME subject examination, departmental multiple choice/essay examination, and laboratory reports.

PHPH D603 Medical Neuroscience

is a three-credit-hour, spring semester, first-year course that provides a foundation in the functional anatomy of the human nervous system needed to understand the signs and symptoms of neurological injury and to localize it accurately. Students study the human spinal cord, brain stem, and cerebral hemispheres in the laboratory. They also study sensory (auditory, vestibular, visual, olfactory, gustatory, and somesthetic) and motor (pyramidal, extrapyramidal and cerebellar mechanisms, ocular movements, and visual reflexes) systems, as well as the cerebral circulation and ventricular system. Consideration is given to the dorsal thalamus, hypothalamus, and limbic system, with special attention devoted to higher cortical function. Highly interactive, state-of-the-art, computer-assisted instructional programs that include anatomical components, functional organization, and clinical correlations, as well as dynamic three-dimensional reconstructions, magnetic resonance imaging scans, and simulations of neurological disorders, are available for student use.

Primary methods of instruction include lecture, computer-assisted instruction, problem-solving exercises, clinical correlations, and hands-on laboratory sessions that may include clinical correlation with MRI and CT scans.

Modes of assessment include departmental multiple choice/essay examination and laboratory practical examination.

Pharmacology, Physiology and Neuroscience Electives, M-IV.

Special Topics in Neuroanatomy; Neuroanatomical Research.

Interdisciplinary Courses

Introduction to Clinical Medicine Course Continuum.

This four-semester course continuum is presented by faculty members in the Departments of Family and Preventive Medicine, Medicine, Neuropsychiatry and Behavioral Science, and Radiology in collaboration with faculty members in other clinical departments. It incorporates relevant clinical material into an appropriately ordered, interdepartmental, and interdisciplinary sequence. The format of the continuum permits an emphasis on small-group interaction between faculty members and students, clinical problem-solving, self-instruction, independent learning, problem-based learning, and correlation of basic science and clinical science course content.

DMED D601, D602 Introduction to Clinical Medicine I

is a two-semester, two-credit-hour (fall) and five-credit-hour (spring), first-year course consisting of an introduction to the medical profession and to doctor-patient and doctor-community relationships, community and preventive medicine concepts, information about the components of health care delivery systems, and basic philosophical principles underlying bioethical decision-making. The stages of normal growth and development are also demonstrated to ensure that students acquire a basis for exploring the life history of the patient with an awareness of issues relevant to different age periods. Information about gender and sexuality is presented, followed by a discussion of sexual disorders and dysfunctions. Students are introduced to the basic skills of medical interviewing and the mental status examination. In addition, beginning in the spring semester, each student will be assigned a senior mentor with whom they will practice the medical interviewing skills as well as discuss normal aging.

Primary methods of instruction include lecture, problem-based learning, standardized/simulated patients, and small-group discussion.

Modes of assessment include written multiple choice/essay examination, and assessment of performance in the medical interview and the mental status examination and of participation in small-group discussion and problem-based learning.

DMED D603, D604 Introduction to Clinical Medicine II

is a two-semester, eight-credit-hour (fall) and eight-credit-hour (spring), second-year course consisting of an introduction to the fundamentals of physical examination and physical diagnosis and the use of various models to assist in the conceptualization of psychopathological behavior, with an emphasis on the relationship of emotional factors to physical illness. Developmental problems of children, adolescents and adults, addictive problems, sleep disorders, and organic mental disorders are discussed. The course emphasizes the use of population-based data in making sound judgments regarding the clinical care of individual patients and interventions at the community level. Bioethical issues in the care of patients and techniques of prevention are presented and discussed, as are the most frequently encountered primary care clinical problems. The course includes information about frequently used radiologic and clinical laboratory studies and their value and limitations in the context of the pathophysiology of various disease states. The course utilizes an organ system approach and integrates with the medical pathology course, physical diagnosis, and radiology. A portion of the spring semester is devoted to a series of problem-based learning exercises designed to integrate information from the Introduction to Clinical Medicine course continuum with knowledge gained from first and second-year basic science courses and to prepare students for the transition to the clinical environment in the third and fourth years.

Primary methods of instruction include lecture, problem-based learning, self-instruction modules, standardized/simulated patients, and small-group discussion.

Modes of assessment include written multiple choice/essay examination, assessment of participation in small-group discussion and problem-based learning, Objective Structured Clinical Evaluations, a Community Medicine Project poster preparation and presentation, and the NBME Introduction to Clinical Diagnosis subject exam.

Demonstration of mastery of the following minimum clinical skills is required for successful completion of this course: performance of a clinical breast examination; demonstration of basic cardiac life support (BCLS) skills and provision of documentation of same; completion of Columbia Free Medical Clinic experience; demonstration of complete history and physical examination; completion of shadowing experience with third-year student; and performance of computer literature search and completion of assignments related to the care and assessment of community-dwelling elders.

Clinical Sciences

Department of Family and Preventive Medicine (FPMD)

FPMD D605 Family Medicine Clerkship

is an eight-week, eight-credit-hour required clerkship in the third year. Students care for ambulatory patients under the supervision of faculty members and residents for two weeks in the Family Practice Center of Palmetto Health Richland or the Center for Family Medicine of Greenville Memorial Hospital. They also participate for two weeks as integral members of a team that provides care to hospitalized patients on the family practice inpatient service. In these settings, students perform initial work-ups on new patients and care for patients with established problems; they also have the opportunity for collaboration with nurses, nurse practitioners, and other health professionals. In addition, all students spend four weeks in the office of a practicing physician where they experience health care delivery as it is provided in a community family practice. For students who express an interest in primary care practice in the rural setting, community primary care experiences are available through the Deans' Rural Primary Care Clerkship in Winnsboro and Kershaw, SC. At these sites, students work closely with students in other health profession programs (nursing, social work, pharmacy, and public health) and employ a multi-disciplinary approach to health care for patients, their families, and the community.

Primary methods of instruction include lecture, case-based discussion/presentation, computer-assisted instruction, clinical preceptorship, problem-solving exercises, community project, conferences, standardized/simulated patients, small-group discussion, and teaching rounds.

Modes of assessment include NBME subject examination, clinical evaluation, oral examination/presentation, and Objective Structured Clinical Evaluation (OSCE).

Demonstration of mastery of the following minimum clinical skills is required for successful completion of this clerkship: performance of an outpatient-oriented, problem-focused history and directed physical examination; performance of a comprehensive inpatient history and physical examination; participation in a well-child visit and a discussion of pediatric developmental milestones; participation in the assessment of a nursing home patient; and performance of a gynecologic screening examination (Pap smear and breast examination).

Demonstration of mastery of the following clinical skills is strongly recommended during this clerkship: participation in the nutritional assessment of a patient; participation in a family-centered prenatal visit; observation and performance of outpatient dermatologic procedures; observation of a colposcopy and endometrial biopsy; observation of exercise stress testing; observation of a nasopharyngoscopy; observation of a flexible sigmoidoscopy; and observation of an individual or family psychotherapy session.

Family and Preventive Medicine Electives, M-IV.

Preventive Medicine and Public Health; Family Practice Preceptorship; Short-Term Psychotherapy in Primary Care; and Rural Family Medicine.

Department of Medicine (MEDI)

MEDI D605 Internal Medicine Clerkship

is an eight-week, eight-credit-hour required clerkship in the third year consisting of a six-week inpatient block and a two-week ambulatory block. During the inpatient block, students perform as active members of the student/housestaff/attending physician team. Students are assigned patients, obtain medical histories, perform physical examinations, evaluate laboratory data, and analyze the information in order to define patients' problems. Performance is reviewed both during specific preceptor-student contacts and during student presentations on actual ward rounds with the team. During the outpatient block, students work closely with preceptors, discussing each patient encounter in depth and participating in case conferences and other didactic sessions. Students become familiar with concepts of time management and performance of focused patient assessments. Emphasis is placed on the interpretation of clinical findings in terms of the pathophysiologic mechanisms of disease and the subsequent translation of this information into rational decisions about management. The clerkship provides students, through active participation, with opportunities to observe the diagnostic process as it unfolds and to develop competence in evaluating broad clinical problems.

Primary methods of instruction include lecture, case-based discussion/presentation, clinical preceptorship, conferences, standardized/simulated patients, small-group discussion, and teaching rounds.

Modes of assessment include NBME subject examination, clinical evaluation, and Objective Structured Clinical Evaluation (OSCE).

Demonstration of mastery of the following minimum clinical skills is required for successful completion of this clerkship: eight histories and physical examinations; writing of adequate progress notes; presentation of a selected topic; interpretation of basic chest radiographic findings; interpretation of basic electrocardiographic findings; and an observed history and physical examination.

MEDI D607 Internal Medicine Clerkship

is an eight-week, four-credit-hour required clerkship in the fourth year consisting of a general internal medicine rotation and one to two subspecialty rotations. Students may do an "acting internship," participate in outpatient clinics, and do inpatient and outpatient subspecialty consultations and routine follow-up care.

Instruction methods include lectures, case-based discussion, student presentations, clinical preceptorship, grand rounds, noon conferences, seminars, and small group discussion.

Assessment involves clinical evaluation, a written case report, student presentations, and conference and seminar participation.

Medicine Electives, M-IV.

Clinical Cardiology; Clinical Hematology/Oncology; Dermatology; Digestive Disease and Nutrition; Endocrinology; Geriatrics; Infectious Diseases; Pulmonary Diseases; Nephrology; Renal Disease/Electrolyte Disorders/Hypertenstion; Rheumatology; and International and Underserved Health.

Department of Neuropsychiatry and Behavioral Science (NPSY)

NPSY D605 Clinical Psychiatry Clerkship

is an eight-week, eight-credit-hour required clerkship in the third year in which the evaluation and treatment of patients with neuropsychiatric disorders, particularly as applicable to general medical practice, are reviewed in detail. Skills and knowledge in psychopharmacology, differential diagnosis, treatment planning, and the doctor/patient relationship are developed. A variety of clinical rotation sites is available. Required clerkship components include attendance at an Alcoholics Anonymous meeting and at a probate court hearing, and a videotaped interview.

Primary methods of instruction include lecture, case-based discussion/presentation, clinical preceptorship, conferences, small-group discussion, and teaching rounds.

Modes of assessment include NBME subject examination, clinical evaluation, and Objective Structured Clinical Evaluation (OSCE).

Demonstration of mastery of the following minimum clinical skills is required for successful completion of this clerkship: performance and presentation of results of three separate mental status examinations, completion of an observed interview and an on-line nutrition case study.

NPSY D651 Clinical Neurology Clerkship

is a four-week, four-credit-hour required clerkship in the fourth year during which students are assigned to one of the clinical teaching services and are assigned new patients and selected follow-up patients by the teaching staff in the inpatient and ambulatory care settings. Emphasis is placed on students' acquisition of skills in the use of the medical history and physical and neurological examinations to localize accurately disorders of the nervous system and to plan comprehensive diagnostic and therapeutic programs for patients.

Primary methods of instruction include lecture, clinical preceptorship, conferences, small-group discussion, and teaching rounds.

Modes of assessment include NBME subject examination and clinical evaluation.

Demonstration of mastery of the following minimum clinical skills is required for successful completion of this clerkship: performance of a history and neurological examination; identification of normal anatomy on brain computerized tomogram; identification of normal anatomy on brain magnetic resonance image; demonstration of knowledge and use of nerve conduction velocity testing; demonstration of knowledge and use of electromyographic testing; demonstration of knowledge and use of electroencephalographic testing.

Neurology Electives, M-IV.

A limited number of students may elect to study subspecialty areas of neurology or to participate in clinical research in neurology.

Neuropsychiatry and Behavioral Science Electives, M-IV.

Outpatient Child and Adolescent Psychiatry; Consult-Liaison Psychiatry; Introduction to Psychotherapy; Research in Child and Adolescent Psychiatry; Adolescent Psychiatry; Children's Unit; and Outpatient Forensic Psychiatry.

Department of Obstetrics/Gynecology (OBGY)

OBGY D605 Obstetrics/Gynecology Clerkship

is an eight-week, eight-credit-hour required clerkship in the third year that introduces students to the care of female patients through a variety of inpatient and outpatient experiences. Four weeks of the clerkship is devoted to obstetrics and four weeks is devoted to gynecology. Students are exposed to the specialized divisions of obstetrics and gynecology (e.g., maternal-fetal medicine). Students participate in a limited rotating call schedule to experience first-hand unique aspects of the practice of obstetrics and gynecology. The clerkship provides students with both a broad-based education useful to physicians in general, as well as detailed knowledge about practice in obstetrics and gynecology.

Primary methods of instruction include lecture, case-based discussion/presentation, conferences, and teaching rounds.

Modes of assessment include NBME subject examination and Objective Structured Clinical Evaluation (OSCE).

Demonstration of mastery of the following minimum clinical skills is required for successful completion of this clerkship: tracking of number of deliveries, vaginal and Caesarean section; performance of a pelvic examination; performance of a vaginal delivery; observation and discussion of a colposcopy; performance of a breast examination; teaching of a breast self-examination; evaluation of vaginitis; observation and discussion of a laparoscopy; observation and discussion of a hysterectomy; performance of contraceptive counseling; and the obtaining of a sexual history.

Obstetrical/Gynecological Electives, M-IV.

Rural Obstetrics and Gynecology.

Department of Ophthalmology (OPTH)

OPTH D620 Clinical Ophthalmology, M-IV.

This four-week, four-credit-hour elective rotation in the fourth year complements the previous ophthalmology course program presented in the physical diagnosis component of the second-year Introduction to Clinical Medicine course. This rotation presents in-depth information about basic ophthalmic subjects (anatomy and physiology) and common ocular diseases (e.g., cataracts, glaucoma, diabetic retinopathy). Emphasis is placed on ocular manifestations of systemic diseases, the relation of drugs and the eye, and on detailed instruction on the basic eye exam. Students are introduced to and learn about more sophisticated examining equipment—the slit lamp biomicroscope and tonometer. Students see a large number of patients with a variety of ocular conditions and observe ophthalmic microsurgery. Students attend clinical grand rounds weekly and any resident lectures that may be appropriate. This rotation is of particular interest to students who plan to train in any of the primary care specialties or other specialties (e.g., neurology and neurosurgery) where additional ophthalmology knowledge is essential. Students are assigned to a faculty member and work also with all the departmental residents. At the conclusion of the rotation, each student produces a two-page typewritten report on a subject of his or her choice from a selection of more than 20 clinical topics provided at the beginning of the rotation.

Primary methods of instruction include lecture, case-based discussion/presentation, clinical preceptorship, independent learning experience, conferences, and teaching rounds.

Modes of assessment include clinical evaluation and assessment of the quality of the required report.

Department of Orthopaedic Surgery (ORSU)

ORSU D620 Introduction to Clinical Orthopaedic Surgery, M-IV.

Designed for prospective orthopaedic residents and for students not planning orthopaedic specialization, but desiring extensive exposure to all phases of orthopaedic care, this four-week, four-credit hour elective rotation in the fourth year covers preventive aspects, preoperative evaluation, surgery, postoperative care, and rehabilitation of a wide gamut of orthopaedic conditions. Students are exposed to pediatric, adult, and geriatric patients with congenital, traumatic, and degenerative problems, as well as neoplasms and infections. Students work closely with the departmental resident staff under the supervision of faculty members. Students spend a significant amount of time in the emergency and operating rooms and on the orthopaedic wards, and they become acquainted with research activities in orthopaedics. Four to six hours of didactic instruction per week are required. Students participate in case presentations and discussions and may be requested to present an original paper.

Primary methods of instruction include lecture, case-based discussion/presentation, clinical preceptorship, and teaching rounds.

Modes of assessment include clinical evaluation and assessment of the quality of the original paper.

Orthopaedic Surgery Electives, M-IV.

Orthopaedic Aspects of Sports Medicine; and Orthopaedic Sports Medicine.

Department of Pediatrics (PEDI)

PEDI D605 Pediatric Clerkship

is an eight-week, eight-credit-hour required clerkship in the third year designed to provide a broad overview of general pediatrics. The clerkship consists of four weeks on a general pediatrics ward, including pediatric intensive care unit, and hematology/oncology service; two weeks in the outpatient pediatric clinic; one week in the newborn nursery and developmental pediatrics; and one week in subspecialty and community pediatrics. In the outpatient setting, students gain experience in the evaluation of patients with common pediatric disorders (e.g., pneumonia, behavioral problems, and gastroenteritis) and in the ambulatory management of complex pediatric disorders, as well as exposure to patients in the child abuse clinic. The inpatient setting provides experience in the full range of pediatric problems from routine pneumonia, croup, and dehydration to the rare and complex entities of congenital disorders and inborn errors of metabolism. In the newborn nursery, students develop skills in the basic newborn examination. During the developmental pediatrics rotation, students make home visits to families of children with special needs.

Primary methods of instruction include lecture, problem-based learning, case-based discussion/presentation, clinical preceptorship, problem-solving exercises, home visit, independent learning experiences, conferences, small-group discussion, and teaching rounds.

Modes of assessment include NBME subject examination, departmental written multiple choice/essay examination, clinical evaluation, oral examination/presentation, and Objective Structured Clinical Evaluation (OSCE).

Demonstration of mastery of the following minimum clinical skills is required for successful completion of this clerkship: performance of a physical examination on a newborn infant; performance of a physical examination on an outpatient pediatric patient; performance of a physical examination on an inpatient pediatric patient; interpretation of the history of a newborn infant; obtaining a pediatric history on an inpatient pediatric patient; obtaining a pediatric history on an outpatient pediatric patient; performance of a written pediatric history and physical examination; the plotting of growth curves; calculation of parenteral fluid administration; demonstration of a working understanding of child abuse; and the accurate writing of a prescription.

Demonstration of mastery of the following minimum clinical skills is strongly recommended during this clerkship: visit to the home of a "special needs" child; interpretation of a typanogram; demonstration of understanding of immunization schedules; the obtaining of a pediatric blood pressure; participation in adolescent counseling; and performance of a lumbar puncture.

Pediatric Electives, M-IV.

Clinical Pediatrics; Developmental Pediatrics; Neonatal Medicine; Pediatric Endocrinology; Pediatric Hematology/Oncology; Pediatric Cardiology; Pediatric Emergency Medicine; Pediatric Outpatient; and Office Practice of Pediatrics.

Department of Radiology (RADI)

Radiology Electives, M-IV.

Radiology; Clinical Nuclear Medicine; and Radiation Oncology. Other subspecialty electives are available by special arrangement with the Department of Radiology, including Public Health Aspects of the Use of Ionizing Radiation and Use of the Digital Computer in Radiology.

Department of Surgery (SURG)

SURG D605 Surgery Clerkship

is an eight-week, eight-credit-hour required clerkship in the third year consisting of inpatient and outpatient experiences, under the supervision of attending staff physicians and residents, in general surgery, cardiothoracic surgery, pediatric surgery, vascular surgery, anesthesiology, trauma, and critical care. Students continue to develop skills in medical history-taking, physical examination, and the use of laboratory data in an organized fashion to understand surgical diseases. During this clerkship, students understand the metabolic and physiologic effects of injury and trauma; correlate disordered physiology with the surgical pathologic process; recognize surgical illness and the place of operative intervention in treatment of diseases; understand the impact of surgery on the patient and family, including the psychological and socioeconomic changes that result from an operation; and acquire surgical techniques and skills basic to all physicians, including wound care, suture technique, and the ability to assist in the operating room.

Primary methods of instruction include lecture, case-based discussion/presentation, suture laboratory, conferences, small-group discussion, and teaching rounds.

Modes of assessment include NBME subject examination, clinical evaluation, and Objective Structured Clinical Evaluation (OSCE).

Demonstration of mastery of the following minimum clinical skills is required for successful completion of this clerkship: performance of at least two histories and physical examinations per week; performance of a preoperative evaluation and the writing of orders; performance of a postoperative evaluation; performance of wound management techniques (dressing changes); evaluation of an acute surgical abdomen; evaluation of a groin hernia; and observation of a chest tube placement.

SURG D607 Surgery Clerkship

is a four-week, four-credit hour required clerkship in the fourth year consisting of exposure to surgical specialties and academic and clinical experiences in orthopaedic surgery, urology, ophthalmology, plastic surgery, cardiovascular surgery, otolaryngology, neurosurgery, and anesthesia. Both office and hospital-based experiences permit the study of disease processes unique to each of the special areas of surgery, the techniques of diagnosis, the understanding of pathophysiology, and therapy. Management of ambulatory patients is emphasized. During this clerkship, students diagnose the diseases particular to the selected surgical specialty and develop the techniques utilized for diagnosis; understand the pathophysiology and management of these disease processes; recognize indicated surgical therapy and expected results from the surgical procedures for these diseases; understand and decide when the patient should be evaluated by a surgical specialty related to the disease process; and understand the impact of surgical care on the patient and the family. Students complete a written report on a topic of interest.

Primary methods of instruction include clinical preceptorship, clinical correlations, and teaching rounds.

Modes of assessment include departmental written multiple choice/essay examination, clinical evaluation, and assessment of the quality of the written paper.

Surgery Electives, M-IV.

Honors General Surgery; Anesthesia; Emergency Medicine; Hyperbaric Medicine; Neurosurgery; Otolaryngology (head and neck surgery); Pediatric Surgery; Plastic and Reconstructive Surgery; Surgical Oncology; Trauma/Critical Care; and Wilderness and Environmental Medicine.