Revised October 2008

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 highly professional and mutually respectful learning environment;

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

9. recognize the educational importance of diversity within the student population and the faculty.

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.

Physician Competencies

1. Patient Care:  ability to provide patient care that is compassionate, appropriate, and effective for the treatment of health problems and the promotion of health;

2. Medical Knowledge:  demonstrate knowledge of established and evolving biomedical, clinical, epidemiological, and social-behavioral sciences, as well as the application of this knowledge to the patient;

3. Practice Based Learning and Improvement:  investigate and evaluate the care of patients, appraise and assimilate scientific evidence, and to continuously improve patient care based on constant self evaluation and life-long learning;

4. Systems Based Practice:  demonstrate an awareness of and responsiveness to the larger context and system of health care, as well as the ability to call effectively on other resources in the system to provide optional health care; 

5. Professionalism:  demonstrate a commitment to carry out professional responsibilities and an adherence to ethical principles;

6. Interpersonal Skills and Communication:  possess skills that are effective in the exchange of information and collaboration with patients, their families, and health professionals.

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; Medical Knowledge, Patient Care

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

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; Medical Knowledge, Patient Care

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; Medical Knowledge, Patient Care

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

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; Medical Knowledge, Patient Care, Systems Based Practice

g. knowledge of the epidemiology of common maladies within a defined population and systematic approaches to reduce the incidence and prevalence of those maladies; Medical Knowledge, Patient Care, Systems Based Practice

h. knowledge of various approaches to, and implications of, the organization, financing, and delivery of health care; Patient Care, Systems Based Practice

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; Patient Care, Professionalism

j. knowledge about relieving pain and ameliorating the suffering of patients; Medical Knowledge, Patient Care

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

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; Medical Knowledge, Patient Care, Interpersonal Skills and Communication

b. the ability to perform both a complete and organ-specific examination, including a mental status examination; Medical Knowledge, Patient Care, Interpersonal Skills and Communication

c. the ability to perform routine technical procedures; Medical Knowledge, Patient Care

d. the ability to interpret the results of commonly used diagnostic procedures; Medical Knowledge, Patient Care

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; Patient Care, Interpersonal Skills and Communication

f. the ability to retrieve, manage, and utilize information for solving problems and making decisions relevant to the care of individuals and populations; Medical Knowledge, Patient Care, Practice Based Learning and Improvement

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; Medical Knowledge, Patient Care

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; Medical Knowledge, Patient Care

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

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

k. the ability to reason deductively in solving clinical problems; Medical Knowledge, Practice Based Learning and Improvement

l. the ability to access and evaluate critically medical literature; Medical Knowledge, Practice Based Learning and Improvement

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. Practice Based Learning and Improvement

3. Attitudes and Behaviors:

a. compassionate treatment of patients and respect for their privacy and dignity; Professionalism, Interpersonal Skills and Communication

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

c. commitment to advocate at all times for the interests of patients over personal interests; Systems Based Practice, Professionalism

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; Systems Based Practice, Professionalism

e. commitment to engage in life-long learning in order to stay abreast of relevant scientific advances; Practice Based Learning and Improvement

f. the capacity to recognize and accept limitations in one's knowledge and clinical skills and a commitment to improve that knowledge and ability; Medical Knowledge, Practice Based Learning and Improvement, Professionalism

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. Systems Based Practice, Interpersonal Skills and Communication

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.

Guidelines for Conduct in Teacher/Learner Relationships

I. Statement of Philosophy

The University of South Carolina School of Medicine is committed to fostering an environment that promotes academic and professional success in learners and teachers at all levels.  The achievement of such success is dependent on an environment free of behaviors which can undermine the important mission of our institution.  An atmosphere of mutual respect, collegiality, fairness, and trust is essential.  Although both teachers and learners bear significant responsibility in creating and maintaining this atmosphere, teachers also bear particular responsibility with respect to their evaluative roles relative to student work and with respect to modeling appropriate professional behaviors.  Teachers must be ever mindful of this responsibility in their interactions with their colleagues, their patients, and those whose education has been entrusted to them.

II. Responsibilities in the Teacher/Learner Relationship

A. Responsibilities of Teachers

1. Treat all learners with respect and fairness;

2. Treat all learners equally regardless of age, gender, race, ethnicity, national origin, religion, disability, or sexual orientation;

3. Provide current material in an effective format for learning;

4. Be on time for didactic, investigational, and clinical encounters;

5. Provide timely feedback with constructive suggestions and opportunities for improvement/remediation when needed.

B. Responsibilities for learners

1. Treat all fellow learners and teachers with respect and fairness;

2. Treat all fellow learns and teachers equally regardless of age, gender, race, ethnicity, national origin, religion, disability, or sexual orientation;

3. Commit the time and energy to your studies necessary to achieve the goals and objectives of each course;

4. Be on time for didactic, investigational, and clinical encounters;

5. Communicate concerns/suggestions about the curriculum, didactic methods, teachers, or the learning environment in a respectful, professional manner.

III. Behaviors Inappropriate to the Teacher-Learner Relationship

These behaviors are those which demonstrate disrespect for others or lack of professionalism in interpersonal conduct.  Although there is inevitably a subjective element in the witnessing or experiencing of such behaviors, certain actions are clearly inappropriate and will not be tolerated by the institution.  These include, but are not limited to, the following:

• Unwanted physical contact (e.g. hitting, slapping, kicking, pushing) or the threat of the same;

• sexual harassment (including romantic relationships between teachers and learners in which the teacher has authority over the learner's academic progress) or harassment based on age, gender, race, ethnicity, national origin, religion, disability, or sexual orientation;

•  loss of personal civility including shouting, personal attacks or insults, displays of temper (such as throwing objects), use of culturally insensitive language;

• discrimination of any form including in teaching and assessment based upon age, gender, race, ethnicity, national origin, religion, disability, or sexual orientation;

• requests for another to perform inappropriate personal errands unrelated to the didactic, investigational, or clinical situation at hand;

• grading/evaluation on factors unrelated to performance, effort, or level of achievement.

IV.  Avenues for Addressing Inappropriate Behavior in the Teacher/Learner Context

A. Learners' Concerns

Learners may address situations in which they feel that they have been the object of inappropriate behavior at various levels.  At the most basic level, the most effective way to handle a situation may be to address it immediately and non-confrontationally.  Oftentimes, a person is simply unaware that his/her behavior has offended someone, or even if aware, will correct the behavior appropriately if given the opportunity to do so in a way that is not threatening.  The way to raise such an issue is to describe the behavior factually ("When you said..."), describe how the behavior made you feel ("I felt..."), and state that the behavior needs to stop or not be repeated ("Please, don't do that again.").

Sometimes, such a request is not successful, or the person repeats the behavior, or the learner does not feel comfortable speaking directly to the teach about his/her behavior.  In those cases, it may be helpful to discuss the behavior with course/clerkship directors, laboratory mentors, program directors, or department chairs.  Students may also elect to speak to any one of the assistant deans or the assistant dean for minority affairs, the director of student services, or one of the School of Medicine's three ombudspersons for informal advice and counsel about these issues.  These individuals may offer additional suggestions for resolving the matter informally, such as, for example, speaking to the individual on the learner's behalf or on behalf of an entire class, raising the general issue in a faculty meeting, assisting the learner with writing to the individual teacher or even direct intervention to get the behavior to stop.

If no satisfactory resolution is reached after these discussions or the learner does not feel comfortable speaking to these individuals, he/she may bring the matter formally to the attention of the School of Medicine administration.  The avenues for this more formal reporting vary depending upon the status of the reporting individual.  In either case the learner always has the option of submitting a formal complaint to the University's Student Grievance Committee through the procedure outlined in the Carolina Community. http://www.sa.sc.edu/carolinacommunity/housing.htm#grievance%20policy%-%20non-academic

1. If the person reporting the behavior is a medical student:

The student should speak with the director of student services, the associate dean for medical education and academic affairs, or one of the school's ombudspersons.

2. If the person reporting the behavior is a graduate student or MD/PhD student pursuing their graduate studies:

The student should speak with the director of student services or the director of graduate studies program.

B. Teachers' Concerns

If a teacher feels that a learner has engaged in inappropriate behavior, it is likewise most effective to address the situation immediately and non-confrontationally.  If the matter is not resolved satisfactorily, the teacher should contact the course/clerkship director, program director, or laboratory mentor to discuss the matter.  If the teacher wishes to make a formal allegation of misconduct, they should contact the following members of the administration:

1. If the matter involves a medical student, contact one of the assistant or associate deans in the Office of Medical Education and Academic Affairs.

2. If the matter involves a graduate student, contact the director of the graduate studies program.

These allegations will be handled on an individual basis by the appropriate School of Medicine official in consultation with the dean and where applicable according to established School of Medicine and University policies.

V. Procedures for Handling Allegations of Inappropriate Behavior in the Teacher/Learner Context

A. Upon being notified of alleged inappropriate behavior, the associate/assistant dean or program director will notify the dean and other appropriate senior administration officials in a written report within five business days of the allegation.

If the complaint is lodged against a faculty member, other than those matters referred to the Office of Equal Opportunity Programs, the matter will be handled by the dean in consultation with the appropriate associate dean and department chair and, where established, the appropriate School of Medicine and University policies.  The dean may also choose to appoint an ad hoc committee to investigate the complaint.

B. If the behavior involves unlawful discrimination or sexual or other forms of unlawful harassment, the matter will be referred to the Office of Equal Opportunity Programs and be handled through University policies established for that office.  The student may also directly contact that office.

C. If the behavior involves unwanted physical contact or other forms of violent or threatening acts, the matter may be referred to the University's campus police or appropriate security.

D. The School of Medicine is committed to the fair treatment of all individuals involved in this process.  All efforts will be made to maintain the confidentiality of the resolution process to the extent possible and subject to the overriding concern of a prompt fair investigation and/or resolution of the complaint.

E. The School of Medicine will not tolerate any form of retaliatory behavior toward learners who make allegations in good faith.  Individuals who believe that action has been taken against them in retaliation for raising concerns under this policy, may address those concerns through the procedures described in this policy or through the Student Grievance Committee.

F. Records of all communications as well as written reports of the associate/assistant deans, program directors, and any ad hoc committee (if formed) will be kept in the dean's office.

G. If it is determined that the allegations from the complainant were not made in good faith, the student will be referred for disciplinary action to the Student Academic Responsibility Committee.

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 departmental multiple choice examinations and the NBME Biochemistry Subject Examination as the final exam.

Department of Cell 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 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 examination and an assessment of participation in problem-solving exercises, case study discussions, and computer simulated laboratory exercises.

Pathology, Microbiology, and Immunology 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.

Pathology, Microbiology, and Immunology Electives, M-III.

Anatomic and Clinical Pathology at Palmetto Health Richland and the Dorn Veterans Affairs Medical Center.

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 a seven-credit hour, spring semester, first-year course that integrates essential concepts and facts about human physiology. This course covers the following areas of physiology:  biophysics, neuromuscular, endocrine, autonomic, cardiovascular, renal, gastrointestinal, respiratory, and reproduction.  Emphasis is placed on understanding and applying physiological processes and concepts.

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 departmental multiple choice examinations, self-assessment exams, NBME subject examination, and laboratory reports.

PHPH D603 Medical Neuroscience

is a four-credit-hour, spring semester, first-year course that provides a foundation in the anatomy and physiology of the human nervous system needed to understand the signs and symptoms of neurological injury and to localize such injuries 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 somatosensory) and motor (upper and lower motoneurons, the basal ganglia and cerebellum) systems, ocular movements, and visual reflexes, as well as the cerebral fiber systems, blood supply, and ventricular system. Other important topics studied include the  thalamus, hypothalamus, and limbic system, with special attention devoted to higher cortical function. 

Primary methods of instruction include lectures, hands-on laboratory sessions using human material, sections through the brain and spinal cord correlated with MRI images, laboratory based problem-solving exercises, and clinical correlations presented by practicing physicians in neurology, neurosurgery, neuro-ophthalmology, and neuro-otology.

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

Pharmacology, Physiology and Neuroscience Electives, M-IV.

Special Topics in Neuroanatomy; Medical Neuroscience Teaching Assistant..

Interdisciplinary Courses

Introduction to Clinical Medicine Course Continuum.

This four-semester course is presented by faculty members in the Departments of Family and Preventive Medicine, Internal 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 course 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 discussed 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 through the use of standardized patients and through participating both semesters in a clinical preceptorship. 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 multiple choice examinations, senior mentor and clinical preceptorship reflection papers, assessment of performance in the medical interview and the mental status examination and by 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, ultrasound, and radiology with the medical pathology course.  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, 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; 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 a six-week, six-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 Medicine Center at Palmetto Health Richland or the Center for Family Medicine at Greenville Memorial Hospital.  Ultrasound technology is available at both campuses and is utilized during this part of the clerkship.  Students participate for two weeks as integral members of a team that provides care to hospitalized patients on the family medicine inpatient service. In these settings, students perform initial work-ups on new patients and care for patients with acute and chronic problems; they also have the opportunity for collaboration with nurses, nurse practitioners, and other health professionals. In addition, all students spend two weeks in the office of a practicing physician where they experience health care delivery as it is provided in a community family practice.  A variety of setting are utilized from rural sites to suburban and urban sites.

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

Modes of assessment include NBME subject examination, clinical evaluations, oral 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; performance of a gynecologic screening examination (Pap smear and breast examination); participation in a family-centered prenatal visit; ultrasound evaluation for AAA screening, post void residual and ankle pain; observation of an endoscopy; and participation in a community outreach activity.

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

Family and Preventive Medicine Electives, M-III.

Family Medicine Rural Medicine; Family Medicine Geriatrics; Family Medicine Outpatient Procedures.

Family and Preventive Medicine Electives, M-IV.

Short-Term Psychotherapy in Primary Care; Family Medicine Preceptorship; Primary Care Sports Medicine; Family Medicine Rural Medicine; Family Medicine Geriatrics; Family Medicine Outpatient Procedures.

Department of Internal Medicine (MEDI)

MEDI D605 Internal Medicine Clerkship

is an eight-week, eight-credit-hour required clerkship in the third year consisting of a eight weeks of  inpatient medicine, including a four-day Medical Intensive Care Unit experience. 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.  There is an optional ambulatory experience during which students have the opportunity to rotate through our resident clinic one afternoon per week.  During this ambulatory experience, students work closely with preceptors, discussing each patient encounter in depth and participating in didactic sessions. Students become familiar with concepts of time management and performance of focused patient assessments. Throughout this clerkship, 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 attending observed history and physical examination.

Internal Medicine Electives, M-III.

Clinical Cardiology; Dermatology; Geriatrics.

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 discussions, student presentations, clinical preceptorships, grand rounds, noon conferences, seminars, and small group discussion.

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

Internal 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; International and Underserved Health.

Department of Neuropsychiatry and Behavioral Science (NOSY)

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.

Neuropsychiatry and Behavioral Science Electives, M-III

Adolescent Psychiatry; Consult-Liaison Psychiatry; Forensic Psychiatry; Sexual Behaviors Evaluation, Research and Treatment.

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; Emergency Psychiatry; Outpatient Forensic Psychiatry.

Department of Obstetrics/Gynecology (OBGY)

OBGY D605 Obstetrics/Gynecology Clerkship

is an six-week, eight-credit-hour required clerkship in the third year that introduces students to the basic fundamental principles of obstetrics and gynecology through a variety of inpatient and out-patient experiences.  The rotation is divided into a three week obstetric block, and a three week gynecology block.  During the obstetrics portion of the rotation, students spend one week on the labor and delivery floor during the day and one week on the labor and delivery unit at night.  During these two weeks, students are exposed to normal labor and delivery patients, high risk antepartum patients, and postpartum patients.  The third week of the obstetrics block is dedication to gaining exposure to obstetric ultrasound and genetics, as well as spending a couple of more days on the labor and delivery unit.  Students are also exposed to maternal fetal medicine as well during these three weeks.  During the gynecology block, the students spend equal time in the operating room and the out-patient clinic.  The bulk of time in the operating room is spent observing benign surgical cases.  The students are also involved in the post operative care of the patient.  The students are also assigned to observe gynecologic oncology surgical cases and urogynecology surgical cases.  While the students are in the out-patient clinic, they are exposed to both obstetric and gynecologic patients, and are involved in colposcopy, endocrine, high risk pregnancy, and teen gynecology specialty clinics.  Additionally, students receive exposure to gynecologic ultrasound by spending time in the ultrasound unit.

Modes of instruction occur formally on teaching rounds which are always led by an attending physician, lectures occurring in a classroom, and conferences.

Modes of assessment include evaluation by house staff and faculty, the Objective Structured Clinical Evaluation (OSCE), and the NBME subject examination.

Successful completion of this clerkship requires a passing grade on the OSCE examination, the NBME subject examination, and the composite evaluation by faculty and house staff.  In addition, students are required to keep track of their clinical experience on a card (C-SAD).  This card contains 12 areas in which students must gain clinical experience:  Procedure/Skills, Personal Interaction/Communication Skills (with patient), Routine Gynecologic Care, Problem Gynecologic Care, Acute Gynecologic Care, Specialized Gynecologic Care, Preconception Care/Genetics Office, New OB Care, Prenatal Care, Acute Obstetrical Care, Intrapartum Care, and Postpartum Care.  Completion of this card is also essential to the passing of this clerkship.

Obstetrics/Gynecology Electives, M-III.

Maternal/Fetal Medicine.

Obstetrical/Gynecological Electives, M-IV.

Maternal/Fetal Medicine; Rural Obstetrics and Gynecology.

Department of Ophthalmology (OPTH)

OPTH D620 Clinical Ophthalmology, M-III and 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 (OURS)

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-III and M-IV.

Introduction to Clinical Orthopaedic Surgery; 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.

Pediatric Electives, M-III.

Pediatric Hematology/Oncology; Pediatric Cardiology.

Department of Radiology (RADI)

Radiology Electives, M-IV.

Radiology; Clinical Nuclear Medicine; Radiation Oncology. Other subspecialty electives are available by special arrangement with the Department of Radiology.

Radiology Electives, M-III.

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.   Students are offered a choice of two rotations exposing them to surgical specialties and academic and clinical experiences in anesthesia, cardiothoracic surgery, neurosurgery, ophthalmology, orthopaedic surgery, otolaryngology, pediatric surgery, plastic surgery, and urology.  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 emphasize.  During this clerkship, students diagnose disease particular to the selected surgical specialty and develop the techniques utilized for diagnosis.  In addition, students learn to 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 critical analysis for each rotation on a topic of interest.

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

Modes of assessment include a final examination which encompasses all subspecialties, clinical evaluation while on rotation by senior volunteer and clinical faculty, and assessment of the quality of the written paper by the course director.

Surgery Electives, M-IV.

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

Surgery Electives, M-III.

Trauma/Critical Care; Anesthesia; Emergency Medicine; Clinical Otolaryngology, Head and Neck Surgery; Plastic and Reconstructive Surgery; Emergency Medicine Ultrasound.

Acting Internships

Fourth year students are required to complete a four-week Acting Internship (AI) in one of the following: Internal Medicine, Family Practice, Pediatrics, Psychiatry, Obstetrics and Gynecology, or Surgery. This Acting Internship for senior students emphasizes basic generalist competencies. Inpatient plus or minus ambulatory clinical learning experiences are used to achieve mastery of these competencies. The student has primary and direct responsibility for the continuing care of patients in the community or in one of the University of South Carolina School of Medicine programs at Palmetto Health Richland, the Dorn Veterans Affairs Medical Center, or the Greenville Hospital System University Medical Center.

Acting interns are essential members of the ward teams, although students' patient loads can be adjusted according to their aptitude. All selectives must give students substantial inpatient experience. Assessment will focus on core clinical skills. All courses listed for the selective also are available as electives, so any student may take several School of Medicine acting internships.

DEPARTMENT OF FAMILY MEDICINE
Family Medicine  FPMD D615 - Columbia
Family Medicine  FPMD D615 - Greenville

DEPARTMENT OF INTERNAL MEDICINE
Medicine Inpatient  MEDI D615 - Columbia
Medicine Inpatient  MEDI D615 - Greenville
MICU-CCU  MEDI D616  VA - Columbia
MICU-CCU  MEDI D616  PHR - Columbia

DEPARTMENT OF NEUROPSYCHIATRY AND BEHAVIORAL SCIENCE
Psychiatry  NPSY D615 - Columbia
Psychiatry  NPSY D615 - Greenville

DEPARTMENT OF OBSTETRICS AND GYNECOLOGY
Obstetrics and Gynecology  OBGY D615 - Columbia
Obstetrics and Gynecology  OBGY D615 - Greenville

DEPARTMENT OF PEDIATRICS
Pediatric Inpatient/General Ward   PEDI D615 - Columbia
Pediatric Inpatient/General Ward   PEDI D615 - Greenville
Pediatric Critical Care  PEDI D616 - Columbia
Pediatric Critical Care  PEDI D616 - Greenville

DEPARTMENT OF SURGERY
Surgery  SURG D615 - Columbia
Surgery  SURG D615 - Greenville
Surgery  SURG D615 - Spartanburg