Washington University (School of Medicine)

FIRST YEAR The first-year curriculum focuses on the acquisition of a core knowledge of human biology, as well as on an introduction to the essentials of good patient care. Diversity among matriculants in undergraduate background, and in approaches to learning, is recognized and fostered. The courses are graded Pass/Fail, and a variety of didactic means are made available including lectures, small groups, extensive course syllabi, clinical correlations, and a Lotus Notes computerized curriculum database. The Practice of Medicine I uses regular patient interactions and integrative cases to teach students to skillfully interview and examine patients, as well as the fundamentals of bioethics, health promotion/disease prevention, biostatistics, and epidemiology. An optional summer research program between the first and second year provides an opportunity for students to explore various areas of basic science or clinical research. COURSES : * Cell and Organ Systems Biology : The structure of cells, tissues and organs is studied with regard to the functional significance of the morphological features. Lectures integrate histology with cell biology and physiology. The laboratories consist of the study of prepared slides, electron micrographs, and digital images. A dual view microscope will be provided for each pair of students. Limited space is available for non-medical students with instructor's permission. This course is cross-listed in Department of Cell Biology and Physiology. * Human Anatomy and Development : The course is based largely on the dissection of the human body. Lectures on functional and topographic anatomy emphasize the principles of organization of the various systems of the body. Lectures on developmental anatomy stress organogenesis as an adjunct to understanding the normal and abnormal anatomy. An extensive museum of labeled dissected specimens is housed in the dissecting room for ready reference by students who encounter abnormalities or variations in their dissections. Frequent use of CT and MRI scans, radiographs and cross-sections aid in the synthesis of knowledge gained through dissection into clinically useful information. Radiologic anatomy and clinical correlation conferences further aid in this process. * Immunology : This course consists of lectures, laboratories, laboratory exercises and small group discussions. It covers all aspects of the immune response � general properties of the immune system, effector molecules, cells and their function, cellular interactions, and immunological diseases. The Immunology course requires a strong background in biochemistry, genetics and cell biology. Some of the basic concepts from these fields should be reviewed during the course. There are two laboratory sessions. These will cover the areas of blood typing/blood banking and allergy. In these laboratories, students will type their own blood and be tested for allergies. POPS (Patient Oriented Problem-Solving System in Immunology) will also be utilized; they contain a clinical problem that is analyzed and solved during the session. There are five hours of small group clinical discussion sessions. In these sessions, students meet with physicians to discuss the role of immunology and a particular human disease. The Immune System (second edition) by Peter Parham is used. For the small group clinical sessions, the latest edition of the textbook Case Studies in Immunology: A Clinical Companion (fourth edition) by Rosen and Geha will be used. There will be two formal exams (consisting of multiple choice and true and false questions) and one take-home exam (consisting of essay questions) on the topics described in the lectures and in the laboratory sessions. This course is restricted to medical students only. * Medical Genetics : This course focuses on the fundamentals of genetics including the basic structure of genes, gene expression and regulation, patterns of inheritance, types of mutations, the consequences of mutations, and molecular diagnostic strategies. Discussion includes the structure of DNA and its means of replication, the organization and packaging of eukaryotic genomes, chromatin structure and the nucleosome, the processing of their primary transcripts, and the molecular basis for transcriptional and translational regulation including the use of transgenic mice to study cell-specific gene regulation, and how these concepts can be applied to an understanding of medical genetics through discussion of principles of Mendelian genetics, the molecular basis for various inborn errors of metabolism, their diagnosis and prenatal screening, and the genetics of cancer. Ethical issues raised in diagnostic and prognostic efforts are also discussed. * Microbes and Pathogenesis : The challenge of this course is to emphasize the importance of understanding molecular and cellular paradigms of how pathogenic microbes interact with their hosts and cause disease. Selected pathogenic microbes, including bacteria, viruses, parasites and fungi, will be utilized as models to explain general principles of host-pathogen interactions and their consequences. Mechanisms by which microbes evade host defenses to cause acute and chronic infections will be highlighted. Problems facing the medical community in the 21st century such as rising antibiotic resistance and tropical diseases will be addressed. The main objective of this course is to teach students how to think about microbial pathogenesis in a way that will provide them a conceptual framework that relates mechanisms of pathogenesis to symptomology and pathophysiology. * Molecular Foundations of Medicine : This course is designed primarily for medical students and will cover fundamental aspects of biochemistry and cell biology. The course begins with a treatment of protein structure and the function of proteins in the cytoskeleton and cell motility. The principles of enzyme kinetics and regulation are then discussed and basic pathways for the synthesis and metabolism of carbohydrates and lipids are introduced. This leads into a discussion of membrane structure and the function cellular organelles in biological processes including energy production, protein degradation and protein trafficking. * Neural Sciences : Neural Sciences is an intensive seven-week course that covers the structure, function and development of the nervous system as seen from molecular, cellular and systems-oriented perspectives. The emphasis is on the organization and function of the nervous system in health, but there is frequent reference to the clinical relevance of material presented. The course includes regular lectures, conference sessions and laboratories, plus a number of clinically oriented presentations. Computer-aided instructional programs, accessible from a variety of locations, provide auxiliary modes of self-paced learning and review. The midterm and final emphasize the core body of important facts and principles presented in lectures and laboratories. * The Practice of Medicine I : This course employs a variety of teaching techniques, instructors, and venues. Some, like lectures, will be familiar. Others, such as one-on-one interviews in the hospital, will be new. Some course material is easily formatted into solid blocks such as the teaching of statistical methods. Other content streams throughout the course, like interviewing techniques and history interpretation. Particular areas may be stimulating and rewarding, and other areas may seem irrelevant or overemphasized. As with patients, each of you comes with a unique past and active history, previously formed interests, and individual goals. Your prior contacts and personal experiences in science or medicine also influence you. It is impossible to account for all of these unique features so we designed the course to accommodate a variety of learning interests and styles. Some will resonate with you; others may not. We hope to provide an opportunity for you to hone the skills that you already possess and acquire new skills necessary and important to the practice of medicine. * Selectives SECOND YEAR The second-year curriculum is focused on human pathophysiology and pathology. Through lectures, small group discussions, laboratory exercises and independent study, students acquire broad, detailed knowledge of mechanisms of disease pathogenesis, clinopathological relationships and fundamental principles of therapy. The Practice of Medicine II continues students� introduction to the fundamentals of patient care, and emphasizes organizing and interpreting clinical information to form a problem list, differential diagnosis, and treatment plan. Students also learn how to accurately document and concisely present clinical information. Supervised clinical experiences and small group discussions further engender development of the professional attitudes and high ethical standards required for the third-year clinical clerkships. COURSES : * Cardiovascular Disease : The purpose of this course is to consider the mechanisms and manifestations of acquired and congenital cardiovascular disorders as well as their pharmacologic treatment. Lectures and small group discussions that emphasize the major areas of cardiac pathophysiology and pharmacology are provided. * Dermatology : The Dermatology second-year course is designed to teach medical students how to describe skin lesions and the pathophysiological basis and clinical characteristics of major dermatologic diseases. Major categories of clinical skin diseases and their most prominent constituents will be discussed, including papulosquamous diseases, blistering diseases, infec-tious diseases, and benign and malignant neoplasms. * Diseases of the Nervous System : The goal of this course is to provide an introduction to diseases of the central and peripheral nervous systems, including their clinical manifestations, pathology, pathophysiology and pharmacotherapy. The course includes reading assignments, lectures, laboratories, conferences and clinical presentations. This course emphasizes the diagnosis of major psychiatric illnesses in adults and children. Psychiatric diseases are described in terms of epidemiology, clinical presentation, natural history, genetics, differential diagnosis and clinical management. Interviewing techniques and performance of the mental status exam will be demonstrated by patient interviews. * Clinical Topics in Otolaryngology : This course consists of eight introductory lectures on common diseases of the head and neck, including head and neck carcinoma, hearing loss and dizziness, otitis media, sinusitis, otolaryngologic emergencies, and facial fractures. Each lecture is highlighted by case presentations and treatment options in addition to pathophysiology. This course follows the physical examination practicum given earlier in the academic year. * Endocrinology and Metabolism : This course aims to develop understanding of the pathophysiology, clinical manifestations and diagnosis of common endocrine disorders. History, physical examination and interpretation of diagnostic laboratory tests are emphasized. Principles of treatment of endocrine disorders and pharmacology of relevant drugs also are discussed. Students are expected to apply their knowledge in clinical case discussions. * Gastrointestinal and Liver Diseases/Nutrition : This course discusses the pathophysiologic mechanisms related to the diseases of the gastrointestinal tract including esophagus, stomach, small and large intestines, liver, gallbladder and pancreas. The emphasis is on changes that occur in normal physiology, biochemistry, anatomy, immunology and cell biology that result in human gastroenterologic diseases. Included also are lectures on the pharmacology of gastrointestinal drugs and basics of human nutrition in clinical practice. Lectures are supplemented by group seminars that focus on clinical case presentations. * Hematology and Oncology : The hematology and oncology pathophysiology course exposes students to common hematologic disorders and hematologic malignancies. The course utilizes lectures, clinical case discussions and practical sessions involving microscopy. * Infectious Diseases : The infectious disease pathophysiology course emphasizes both organism-specific and organ-specific approaches to diseases caused by microbes. The course expands on material presented briefly in the first year concerning bacteria, viruses, fungi and parasites, and their involvement in human disease. Mechanisms of disease production, clinical manifestations and therapy are discussed, along with public health implications. In addition to lectures, small group case discussions enable students to apply the information they learn to clinical situations. * Obstetrics/Gynecology : The obstetrical component of this course emphasizes the physiologic basis of normal pregnancy, parturition, and labor and delivery, and adaptations of other organ systems to pregnancy. Pathophysiology of pregnancy and deviations from normal labor will also be introduced. The gynecologic component of the course reviews embryology and includes the topics pediatric and adolescent gynecology, amenorrhea, abnormal uterine bleeding, menopause, surgical anatomy, and diagnosis and treatment of gynecologic neoplasms. * Pathology : This course provides a comprehensive survey of the biology and morphology of human disease through a combination of lectures and laboratory/case study sessions. The year begins with a review of basic disease mechanisms at the cellular and molecular level. Subsequently, the pathogenesis and characteristics of important diseases involving each organ system of the body are presented. Considerable emphasis is placed on learning the �language� of human disease. During the year, students become familiar with the methods of contemporary pathologic analysis. They also learn how the results of pathologic studies are used in the clinical setting to establish diagnoses, to assess prognosis and response to therapy, and to evaluate the quality of patient care. * Pediatrics : Students are introduced to pediatrics and to the faculty through a series of lectures and symposia designed to acquaint them with the concepts of human growth and development and the effects of age and maturity on reactions to injury and disease. The unique aspects of the physical examination of the infant and child are presented in the Introduction to Clinical Medicine course. Members of the faculty are active participants in the second-year Pathophysiology course. * The Practice of Medicine II : The goal of The Practice of Medicine course (POM) is to provide students with a set of knowledge, skills and attitudes essential to patient care regardless of specialty. POM II is a continuation of POM I and will continue to address various interfaces between patients, physicians and society and will also introduce approaches to clinical thinking and decision-making in the context of today�s socio-economic and cultural environment. The sections of POM II include Advanced Physical Examination, Case Development, Communication, Ethics and Health Policy, Health Promotion/Disease Prevention, Interpreting Illness, Ophthalmology, Patient Sessions, Radiology and Scientific Methods. The learning objectives for each section of POM II emphasize topics and skills utilized in all fields of medicine, and the majority of the coursework will be taught in small groups or through clinical experiences. * Selectives THIRD YEAR The overall goal of the third year is implementation of fundamental interactive clinical skills necessary for the practice of medicine at the highest possible level of excellence. Students achieve this goal by participating in intensive, closely supervised training experiences in the core clinical clerkships involving inpatient and ambulatory settings and interactions with patients who present a spectrum of emergent, urgent, routine and chronic clinical problems. Through these experiences, students exhibit growth and maturation in their abilities to take medical histories, perform complete physical examinations, synthesize findings into a diagnosis, formulate treatment plans, and document and present information in a concise, logical and organized fashion. During the clinical clerkships, students learn to use the biomedical literature and other educational resources in the service of their patients and in self-directed learning. Students also use their personal experiences and rapidly expanding knowledge of human behavior and ethnic, cultural, socioeconomic and other social factors to develop their own personal standards of compassionate, respectful and ethical behavior in the practice of medicine. COURSES : * Integrated Surgical Disciplines Clerkship : During the 12-week surgery clerkship, students are assigned to three separate rotations. Each student is assigned to a required general surgery rotation at Barnes-Jewish Hospital, Christian Northeast Hospital, or the Veterans Administration Medical Center. In addition, each student selects elective rotations in other general surgical fields, surgical subspecialties and related disciplines of critical care. The student is an active participant in the daily care of patients on each service and attends the service teaching conferences and rounds. For the duration of the 12-week rotation, there are weekly small-group tutorial sessions with faculty members and a biweekly lecture series. * Medicine Clerkship : The medicine clerkship provides supervised study of patients in both inpatient and ambulatory settings. The 12 week clerkship is divided into 3 4-week rotations, 2 inpatient and 1 outpatient. For the inpatient rotations, students are assigned as clinical clerks to patients admitted to the cardiology and general medical teaching services of Barnes-Jewish Hospital and the John Cochrane Veterans Administration Medical Center. For the outpatient rotations, students are placed with community-based internal medicine or family practice physicians. Teaching is provided by the chief of service, attending physicians, house staff, consultants, chief residents, community-based preceptors and regularly scheduled conferences. Formal instruction is given regarding core internal medicine topics during the clerkship. Teaching activities include Chief Resident Rounds, Core Lecture Series, Physical Diagnosis Rounds, Radiology Rounds, Professor�s Rounds, and other departmentally based conferences. * Neurology Clerkship : A full-time, four-week clerkship is provided on the inpatient neurology services at Barnes-Jewish Hospital south. Patients are assigned to students who evaluate and follow them with the resident staff and discuss them regularly in conferences with the senior neurological staff. Students also work in the neurology clinic under staff supervision and attend a series of lectures on neurosurgical problems. The goal of this rotation is to gain expertise in the evaluation and treatment of patients with neurologic diseases. Up to two students may elect to obtain their clerkship experience on the neurosurgery service. Up to two students may elect a two-week experience in outpatient pediatric neurology. Students participate in the neurology specialty clinics at St. Louis Children�s Hospital, working under the supervision of pediatric neurology fellows and senior staff. * Obstetrics/Gynecology Clerkship : Comprehensive study of the reproductive health needs of women is the focus of the curriculum. Opportunity for supervised active participation is emphasized in outpatient clinics, routine and high-risk obstetrics, care of the infertile and oncology patient, including surgical case management. Students are assigned as clinical clerks to rotations at Barnes-Jewish Hospital and Missouri Baptist Hospital. Faculty, house staff and nurse practitioners provide teaching for this rotation. Students participate in all teaching conferences offered by the department; core curriculum topics are presented in a seminar series and in small group sessions with faculty preceptors. * Pediatrics Clerkship : This six-week curriculum emphasizes pediatric pathophysiology and normal growth and development from birth through adolescence. This rotation consists of three two-week combinations of the following: Regular or special-care nurseries at Barnes-Jewish or Missouri Baptist hospitals spent assessing newborns, seeing patients in the pediatric emergency department and Hematology/Oncology outpatient service and in St. Louis Children�s Hospital on a variety of inpatient services. Emphasis is on performing a pediatric history and physical examination and developing an appropriate differential diagnosis. Daily rounds with house staff and attending physicians, as well as weekly case management conferences and grand rounds, further this emphasis. A core lecture series also is offered on Mondays and Thursdays during this six-week clerkship. * The Practice of Medicine III : In this course, themes and topics introduced in POM I and II are revisited and refocused on the students� ongoing clinical experiences. The course has quarterly sessions. Each session begins with a short talk or panel discussion. Faculty preceptors then facilitate small group discussions as students reflect on their recent clinical experiences and dilemmas. * Ambulatory - Emergency Medicine : The WUMS III Ambulatory Care Rotation takes place in the main emergency department of Barnes-Jewish Hospital. Three to five students at a time are assigned to this four-week rotation. Students will spend their first day in an orientation session that will include a brief survival in the ED introduction and a suture lab. Domestic violence is covered during this four-week rotation. A course "text" will be provided for the students on orientation day and is theirs to keep. On day two, students will begin primarily evaluating non-emergent patients in the emergency department (EM 2) and report directly to an attending or senior resident. There are four hours of mandatory conferences per week: 8-10 a.m. on Tuesdays and 8-10 a.m. on Wednesdays. There will be an opportunity to participate in EMS. Students can expect to gain a wide range of skills in evaluating a variety of complicated and non-complicated patients. At the end of their rotation, students should be familiar with the approach to complex medical conditions like heart attacks, undifferentiated abdominal pain, and complications of pregnancy as well as the "bread and butter" of complaints of ambulatory medicine such as lacerations, simple respiratory tract infections and minor trauma. * Ambulatory - Family Medicine : The Family Medicine clerkship offered in the third and fourth years allows medical students to work one-on-one with board-certified family physicians in outlying areas of Missouri and Illinois, and in other states. Students may review preceptor profiles and comments that previous students made about preceptors. The clerkship makes every effort to accommodate student preferences for working with specific preceptors. Most students will work with a single preceptor for the duration of the four-week rotation. Students may work with small groups, potentially including family medicine residents. The student will work closely with preceptors on a daily basis in the physician's office. Students often accompany their preceptor on nursing home visits, hospital rounds, medical conferences and other educational activities. Housing will be provided to students working outside the immediate St. Louis vicinity. Weekend call schedules are arranged with the preceptor: students can often return to St. Louis on the weekends. Each student will receive a description of the goals and objectives for the four-week rotation, a physical copy of the Manual of Family Practice textbooks, and handheld computers with additional commercial clinical reference materials to use during the rotation. Students maintain patient encounter logs on hand-held computers, and receive short email assignments during this rotation. Grades are calculated from preceptors� subjective evaluations (normalized for the preceptor), essay responses, and an evaluation of students� attention to primary care issues. * Psychiatry Clerkship : Up to 11 students spend four weeks on the inpatient psychiatry service of either Barnes-Jewish Hospital or Metropolitan St. Louis Psychiatric Center. At either site, students evaluate and treat patients under the supervision of house staff and an attending physician, attend teaching conferences, including small group sessions with a psychiatrist to learn psychiatric interviewing and the mental status exam, and complete other assigned learning experiences. * Dermatology Clerkship : The goal of the dermatology clerkship is to provide a guide for the student to appreciate dermatology within the broader perspectives of medicine and biology. The student will develop familiarity with dermatologic vocabulary, learn to recognize and initiate therapy of common dermatologic disorders and become cognizant of uncommon or complicated dermatologic problems that require specialty care. Emphasis will be placed on careful history taking and physical examination. Students will always work under the direction of the resident physician and the attending physicians in the clinic setting. The student will participate in outpatient care at the following hospitals and affiliated clinics: Barnes-Jewish Hospital, Children�s Hospital, Barnes-Jewish West County Hospital, the Veterans Administration Medical Center and Connectcare Hospitals. These hospital settings will provide the student with ample exposure to a diverse patient population. Students will attend all clinical teaching rounds and conferences in addition to the basic science and cutaneous histopathology conferences. Normal workday hours are 8 a.m. to 5 p.m. with no night or weekend on-call responsibilities. Each student is provided with copies of the two recommended textbooks, Principles of Dermatology by B. Looking and The Color Atlas and Synopsis of Clinical Dermatology by T. B. Fitzpatrick for use during the clerkship; the textbooks are returned to the clerkship coordinator at the end of the clerkship for use by other students rotating in the dermatology division. The rotation attending physician and the resident physician will submit an evaluation based on the student�s clinical skills, presentation, attitudes, overall performance and the end-of-rotation written exam score. * Geriatrics Clerkship : The primary goal of the four-week clerkship in Geriatrics is to provide an opportunity for students to gain proficiency in the principles of geriatric evaluation, including the medical, psychological, social and functional assessments of older adults. Direct, hands-on experience with patients is a major feature of the clerkship. Students are expected to participate in the evaluation of three to five patients per week, in a variety of settings including the hospital Acute Care for the Elderly (ACE) unit on 3200 North Campus, the Older Adult Outpatient Assessment Program (Storz Building) and the Long Term Care Setting (Barnes Extended Care in Clayton). Students will also participate on the gerorehabilitation service, hospice and geropsychiatry rounds, and attend geriatric conferences while on the rotation. Students are assigned to a variety of attendings to enhance the experience. There is no night call or call on weekends. Participation on the hospital consult service will occur depending on volume. The day normally begins at 8 a.m. and is usually finished by 5 p.m. There will be time to read the detailed syllabus/bibliography. Students will be asked to present a brief topic of their choice at the end of the rotation and demonstrate knowledge of the geriatric screens and assessments. * Radiation Oncology Clerkship : The four-week clerkship in radiation oncology will provide students with an introduction to the evaluation and management of a broad range of patients referred for consultation regarding radiation therapy. Clerkship activities will take place entirely within the Barnes-Jewish Hospital/Siteman Cancer Center complex. Students will conduct inpatient and outpatient evaluations under the supervision of radiation oncology department residents and faculty. Students will also attend and participate in regularly scheduled departmental conferences at 12:00 noon Monday � Wednesday and 8:00 a.m. on Friday. Students will also have the opportunity to attend the appropriate multi-disciplinary conferences (such as pediatric neuro-oncology, cardiothoracic oncology, lymphoma, GYN oncology, neuro-oncology and ENT) pertaining to their rotation schedule. Instructional materials are available for students on the rotation. (Students are NOT expected to purchase any curricular materials for the clerkship). Student performance will be evaluated by faculty members who supervise the student over the course of the 4-week clerkship. * Selectives FOURTH YEAR The overall goals of the fourth year are to consolidate, enhance and refine the basic clinical skills developed during the clinical clerkships and to explore specialty areas within the field of medicine. This is accomplished by providing each student with optimal preparation for selecting and pursuing graduate medical education opportunities in his/her chosen field of medical practice and/or research. Students may select from a broad array of clinical rotations and research experiences and may arrange extramural experiences. To qualify for the Doctor of Medicine degree at Washington University School of Medicine, fourth-year students are required to participate in a minimum of 36 weeks of electives (full-time clinical or research courses). Two-thirds of the minimum required time for the Elective Year must be taken exclusively in residence in the Washington University School of Medicine elective course program. A complete listing of fourth-year elective offerings at Washington University School of Medicine is available through the Office of the Associate Dean for Medical Student Education. Students may participate in clinical electives of four weeks duration. If a student takes a research elective, that elective must be of at least six weeks� duration. A maximum of 12 weeks� credit is allowed for full-time elective coursework taken at other academic institutions. These may be clinical or research electives. Students desiring credit for work to be done at other institutions must petition the Associate Dean for Medical Student Education. Absolutely no credit will be granted for electives undertaken prior to approval from the appropriate administrative committees. Credit may be given for elective work done at any point in the standard four-year Doctor of Medicine degree program so long as participation conforms to current elective guidelines, and a) the student is a duly registered, full-time student for a minimum of three years and nine months, including scheduled vacation time, and tuition is paid for four complete academic years; or b) if transferring into the third-year class, the student is a duly registered, full-time student for a minimum of 22 months and tuition is paid for two complete academic years. Students are encouraged to take lecture-seminar elective courses, but such offerings are optional. Clock hours for the year total 1,386 (36 weeks). Remuneration for work done while participating in electives for credit is prohibited.

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School name: Washington University (School of Medicine)
Address: 660 S. Euclid Ave.
Zip & city: MO 63110 Saint Louis
Phone: 314-362-6858
Web: http://medinfo.wustl.edu

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