Second Year (Academic Year 2013/2014)

The Art and Science of Medicine II

It is the mission of The Art and Science of Medicine (ASM) Courses (I and II) to provide pre-clinical medical students with the core knowledge, clinical skills and professional attitudes essential for a seamless transition into the clinical years. Fundamental to this mission is a vision of competent physicians who provide compassionate patient-centered care dedicated to a psycho-bio-social approach to health care delivery.

Building on the basic skills learned in ASM I, ASM II provides students with the skills necessary to gather clinical information accurately from the medical interview and physical examination that includes all relevant factors. It strengthens their skills in communicating accurately the information both orally and in writing. It provides them with consistency in clinical skills when they interact directly with patients and reliability in basic physical exam skills. It also trains them to differentiate normal findings from abnormal ones and identify new clinical problems. ASM II students are also acculturated to interact professionally with patients, caregivers, staff and other members of the patient care team. The ASM II component of the Longitudinal Clinical Experience facilitates students' continued understanding of health care delivery and advocacy issues from the perspective of a patient whom they have followed longitudinally over the course of ASM I and through the first half of ASM II.

Longitudinal Clinical Experience

The Longitudinal Clinical Experience (LCE) utilizes community-dwelling adults living with chronic illnesses as patient adjuncts in medical education. During the LCE program, medical students start to understand the primary provider's clinical reasoning and the team's patient-centered approach underlying the care of patients with chronic illnesses. It is during times of active teaching from the primary care provider and reflection with fellow students that they begin to learn about persons living with chronic illnesses and how their lives intersect with the current health care system. LCE partners a patient cared for by a Icahn School of Medicine faculty member with 2 first-year medical students and the program continues into the student's second year. Students establish a long-term relationship with these patients and their physician over the length of the course. They observe first-hand challenges faced by patients living with chronic illnesses, how their chronic medical conditions impact their quality of life and the coping mechanisms they have developed to live with the challenges their chronic illnesses pose.

Brain and Behavior

The nervous system is perhaps the most complicated human organ system and possessing basic knowledge and understanding of its anatomy, function and pathophysiology is essential for any physician. The interdisciplinary Brain and Behavior course addresses structural, functional, and biochemical aspects of the nervous system. The overall goal of the course is to help each student to gain knowledge about the anatomical organization and physiology of the central nervous system in order to understand how normal function occurs and compare this to disease states, both neurological and psychiatric. This is accomplished through lectures, neuroanatomy lab sessions, and patient-based small group discussions. The inclusion of such topics as child development, the aging brain, emotion, cognition, behavior, learning, and personality enables students to learn about normal functioning of the brain and mind. Students are subsequently introduced to neurologic and psychiatric illnesses commonly encountered in clinical practice, such as stroke, movement disorders, traumatic brain injury, dementia, and major depressive disorder.

Medical Genetics and Genomics

Medical genetics and genomics are amongst the most rapidly advancing fields of medicine, and understanding of its principles is now integral to all aspects of biomedical science. The Medical Genetics and Genomics course introduces students to the basic concepts and some major topics in human genetic medicine including genomics, cytogenetics, molecular genetics, biochemical genetics, pharmacogenetics, genetic testing and screening, developmental genetics, and dysmorphology.

Musculoskeletal Pathophysiology

The Musculoskeletal Pathophysiology course introduces students to a series of diseases that overlap the disciplines of Pathology, Radiology, Orthopedics and Rheumatology. The course bridges the gap between basic science and its clinical application to the diagnosis and treatment of connective tissue diseases. By the end of the course, students will have developed a rational, clinical approach to the patient with musculoskeletal complaints.

Pharmacology

The Pharmacology course presents an overview of the general principles governing the actions of drugs on the human body and on invading organisms, as well as the way drugs enter, are distributed in, and eliminated from the body. The therapeutic and adverse actions of major classes of clinically used drugs are discussed. The course goal is not to teach therapeutics per se, but the pharmacological basis for rational drug prescribing. Clinical case presentations and problem-solving sessions are conducted in intermediate to large group formats by basic science and clinical faculty.

Cardiovascular Pathophysiology

The Cardiovascular Pathophysiology course provides students with a clinically-oriented framework for understanding common pathophysiologic derangements of normal cardiac function. The course offers a comprehensive review of normal anatomy, hemodynamic function and electrophysiology. This is coupled with an in-depth study of cardiovascular diseases including cardiomyopathies, valvular heart disease, ischemic heart disease, vascular diseases, and congenital heart disease. The course is taught from a clinical perspective, focusing on a physiological understanding of the underlying pathophysiology, connecting pathophysiology to patient signs and symptoms, and understanding the role of various medical and procedural treatments to restore normal physiologic performance.

Hematology Pathophysiology

Hematology is the study of the blood. In the Hematology Pathophysiology course, students are taught about the normal physiologic production and regulation of red blood cells, white blood cells, platelets, and about the normal system of blood coagulation. Students learn about the pathophysiologic events leading to disruption of the normal blood system, resulting in hematologic diseases. Through lectures, case-based small group sessions, "virtual" and "actual" morphology sessions they are taught to recognize the presence of hematologic abnormalities, understand the pathophysiology of the clinical manifestations, formulate a differential diagnosis, and develop a strategy for investigating these diagnoses. Although primary hematologic diseases, like acute leukemia, are quite rare, hematologic complications of other medical conditions are extremely common. Students will develop the knowledge and skills to enhance their skills in evaluating patients with hematologic problems.

Gastrointestinal-Liver Pathophysiology

The Gastrointestinal-Liver Pathophysiology course provides an overview of diseases affecting the digestive system. Emphasis is placed on understanding the mechanistic basis of digestive diseases, with a strong underpinning in pathology. This fosters skills in developing appropriate differential diagnoses and gaining an appreciation of the diagnostic evaluation of patients. Students will learn how diseases of the gastrointestinal tract and liver interface with other systemic conditions. Approaches to treatment are discussed to reinforce pathophysiologic principles.

Obstetrics and Gynecology Pathophysiology

The Obstetrics and Gynecology Pathophysiology course introduces students to the fundamental issues of female sexual and reproductive health, and provides a foundation for their understanding of the pathophysiology of obstetrics and gynecology. This clinically-oriented course conducts a case-based tour of the female genital tract, using patient-centered cases that include symptoms, work-up and procedures, pathology findings, and outlook. Students are exposed to viewpoints of obstetricians, gynecologists, specialty pathologists, and patients. Laboratories and small group discussion sessions help to integrate major course themes and introduce concepts of patient management.

Endocrine Pathophysiology

Endocrinology refers to the communication between tissues by chemical mediators called hormones. The Endocrine Pathophysiology course reviews general endocrine physiology and explores the pathophysiology of endocrine diseases such as diabetes mellitus, osteoporosis, thyroid diseases, and other disorders of hypo- and hyper- function of various endocrine tissues. Students become familiar with the signs and symptoms of endocrine diseases and learn to formulate a differential diagnosis and a diagnostic workup to rule in or rule out endocrine disorders in patients.

Dermatology Pathophysiology

The Dermatology Pathophysiology course introduces students to the basic pathophysiology and myriad expressions of skin disorders. The key topics addressed are skin structure and function, descriptions of skin lesions and dermatology-related pharmacology. Students take a pictographical journey through skin related infectious, immunologic, and neoplastic diseases.

Renal and Genitourinary Pathophysiology

The Renal and Genitourinary Pathophysiology course introduces students to the kidneys' remarkable ability to maintain homeostasis, as manifested in the myriad of disorders arising in the disease state. The course covers pathophysiology of electrolyte disorders, acid-base disorders, glomerular disease, tubulo-interstitial disease, acute renal failure, chronic kidney disease, basic concepts of renal replacement therapies, and urology. Lectures are integrated with clinical and pathology small groups to reinforce learning.

Pulmonary Pathophysiology

The Pulmonary Pathophysiology is geared toward an understanding of basic respiratory pathophysiology and its application to patient care. Students are introduced to the concepts at distinct clinical entry points (i.e. dyspnea, cough, fever, etc.). Teaching modalities include lectures, which form a foundation for clinical case-based seminars, pathology lab sessions and patient presentations. The course culminates in a combined clinico-pathologic conference where students participate in panel discussions under the guidance of faculty from both the Pulmonary and Renal-Genitourinary pathophysiology courses.

Courses Without Walls (CWW)

Courses Without Walls refer to essential themes in medical education. At the Icahn School of Medicine, these threads are woven throughout the core curriculum. Topics are taught and reinforced in depth and breadth as students advance in their training. Ultimately, the CWW themes build into a matrix that is horizontally and vertically integrated over the four-year core curriculum, and is represented in the content and assessments of many host courses. CWW themes include Ethics, Sexual and Reproductive Health, Diagnostic Radiology, Palliative Care, Clinical Laboratories, Global Health, Population Health including evidence-based medicine, medical informatics and library science, Nutrition, Cultural Competency, and Health Policy.

Comprehensive Assessment (COMPASS) 1

Toward the end of second year, COMPASS 1 is a two-part clinical skills evaluation designed to assess students' ability to: (1) perform medical interviews and physical examination skills in Standardized Patient (SP) encounters; (2) to communicate effectively with patients in a patient-centered, culturally competent manner and; (3) to communicate effectively through the written documentation and oral presentation of the patient encounter. Faculty preceptors review and provide feedback on each student's diagnostic, written documentation and oral case presentation skills. COMPASS 1 also includes a Clinical Moral Reasoning Exercise which assesses students' ability to recognize ethical issues in clinical scenarios, identify a physician's professional responsibility and apply ethical principles in their communication with patients.