Boston University School of Medicine has a proud history of placing medical education in the context of each patient’s life, his or her neighborhood, and the larger community. This focus begins the first week of medical school, when students begin patient care (in introduction to clinical medicine), their own professional identity and development (professionalism lectures and exercise in human behavior in medicine). At the same time they begin their study of Essentials of Public Health. In addition to patient care and lectures, students also begin focused learning in small groups in their integrated problem solving course, which is also incorporated into the early curriculum.
In the curriculum reform initiative we began in 2005, there is vertical and horizontal integration of the curriculum across all years: bringing clinical cases and challenges into the early, traditionally preclerkship years, and by revisiting anatomy, pharmacology and genetics in the later clerkship years of formal clinical training.
Boston Medical Center is the primary teaching hospital for the school of medicine and was created by the formal merger of Boston City Hospital and Boston University Medical Center Hospital (BUMCH) in 1996. BCH was founded in 1855, and BUMCH in 1864. It has the largest trauma center in New England, and the Emergency Department had more than 129,000 visits in 2008.
The BMC Mission is “Exceptional Care without Exception” and we live that mission in the care of our underserved patients, 30% of whom do not have English as their primary language. Medical students see the comprehensive care of our patients aided by our unique ancillary services: the only hospital based food pantry in the country, legal partnerships to aid in the medical care of our patients, and the center for refugee health and human rights to name a few.
Our clinical skills center is also an integral part of each student’s evolution into a clinician. In this center, students get feedback on their history and physical’s on “standardized patients” in videotaped encounters, and formal assessment in end of 1st year and end of 2nd year exams. These structured encounters allow students autonomy in an educational setting. The students continue in the center in their 2nd and 3rd years, culminating in an end of 3rd year exam, structured to provide feedback in preparation for the USMLE clinical exam.
Students may choose the Alternative Curriculum, spreading the requirements of a single curricular year over two academic years, paying half-tuition for each of those years. This can allow a student to decompress the program or to pursue research opportunities. In addition, combined degree programs are available for individuals who wish to pursue a course of study leading to the MD-PhD, MD-MPH, or MD-MBA. A student may apply to enter these combined degree programs at any time, before or after matriculation.
The first year curriculum has a traditional focus on the core building blocks of medical education: Gross Anatomy, Histology, Human Behavior in Medicine, Biochemistry, Physiology, Genetics, Neuroscience, Endocrinology, and Immunology. Clinical content is integrated into all of these courses, including medical imaging in anatomy, and case-based discussions in lectures and small groups. Many of the basic scientific principles introduced in these “preclerkship courses” are revisited in the clerkship curriculum during the 3rd and 4th years
In ICM students interview patients in groups in the fall; in the spring, students start learning PE skills and go to a practice 1:1 to shadow and practice interviewing and skills.
The summer after the first year allows the opportunity to participate in clinical or basic science research on campus, to join a family medicine internship program or work in the hospital on the wards.
The international health program allows clinical, public health, research and cultural/language immersion experiences abroad to broaden students’ perspective on health and human illness in diverse, underserved healthcare systems. These opportunities begin after the first year and continue throughout medical school.
In 2008, a new 2nd year curriculum was implemented, in which the pathophysiology and treatment of disease is taught in a year-long, integrated, organ-based course called “Disease and Therapy” (DRx). Introduction to Clinical Medicine and Integrated Problems continue from the 1st year and are integrated with DRx content.
Highlights of DRx include:
Course is co-taught by clinical and preclinical faculty
Integrated sessions on Health Law and Health Policy
Lots of case-based discussions and workshops with clinical faculty
Discussions with patients
On-line case-based exercises
Gross pathology demos
Introduction to Clinical Medicine:
• Clinical skills training throughout BUSM 1 and 2 at BMC and other clinical sites. This takes advantage of the richly diverse patient populations represented throughout the Boston Medical Center community
• Students learn: patient interview, history-taking, physical examination.
• End-of-year evaluations with faculty observation & feedback and standardized patients in the Clinical Skills Center
• Preparation for BUSM 3 and OSCEs (Objective Structured Clinical Exams)
Spring of 2nd year:
• USMLE Step 1 review program
Clinical Curriculum Strengths:
• Excellence in student clinical experiences and knowledge base are our priority
• Clinical training is organized around graded increases in supervised decision-making responsibility, each student ‘s confidence and opportunity for autonomy culminating during their subinternship, functioning under supervision as an intern
• Represents commitment to recommendations of students and faculty and open attitudes toward innovation and change
• Each student benefits from the diverse and rich clinical experience at Boston Medical Center
• Allows every student to individualize their schedule to their interests, strengths and career path