University of Wisconsin School of Medicine and Public Health Innovations in Medical Education

Year 1

The first year of medical education advances student knowledge and understanding of the biology of the normal human individual and at the same time begins to place this knowledge in the larger social context of medicine. This creates a scientific foundation and broad perspective for students to build on as they expand their knowledge and clinical experience in subsequent years of medical training.

1.      Medical Knowledge

Medical knowledge is gained through the integrated study of the basic sciences including courses such as anatomy, histology, biochemistry, molecular biology, physiology, genetics and psycho-neuroscience. Students are introduced to basic concepts in public health and epidemiology and to the role of behavioral, psychosocial and cultural factors in health. They begin to recognize how medical ethics dilemmas arise and are addressed.

 

2.      Problem Solving and Clinical Skills (Patient Care)

The strong focus is on learning basic clinical skills, particularly the patient interview and physical exam performed in a culturally sensitive manner. Students are also introduced to the medical literature.

 

3.      Lifelong learning (Practice Based Learning and Improvement)

Coursework underscores that the medical knowledge base constantly changes and that medical education requires a commitment to lifelong learning. Skills of life-long learning are taught by incorporating the teaching methods of Continuing Professional Development (CPD). This includes a focus on developing the three “I’s”: independent learning, interactive learning, and self initiative. The importance of lifelong self care and self growth is also emphasized through reflective practices on one's own culture and life experiences and how these influence interactions with others, including patients.

 

4.      Systems Based Practice

The curriculum reflects a broad, systems approach to patient wellbeing. This includes an introduction to the impact of the health care system on patient health, including health care financing and other economic and organizational factors.

 

5.      Professionalism

Students learn the skills, values, and attitudes of a physician. Respect for persons begins with their cadaver and is reinforced and modeled throughout the coursework and activities. Other elements of professionalism that students exhibit include: timeliness, respect for self and others, appropriate communication, attendance, and responsiveness to feedback. These are developed through various learning experiences and demonstrated via interactions with patients, peers, instructors and other health professionals. Students participate in service learning.

 

6. Interpersonal and Communication Skills

Students are introduced to the roles of others on the health care team. They gain communication skills through a variety of learning experiences including oral presentations, interviewing and history-taking, small group discussion, and written work. Students also focus on identifying their own communication styles and the strengths and weaknesses of these preferences in order to develop skills for more effective communication.

Year 2

The second year builds on the first year with a new focus on disease processes, the science of medical intervention (including the nature of healing and pharmacologic principles), and clinical thinking. The students learn pathophysiology in the context of the whole person and the multifactorial nature of health and disease. The work integrates past and concurrent learning, equipping students with an adequate knowledge base and professional skills for the transition into the clinical years and Step 1 of the USMLE.

 

1.      Medical Knowledge

Students concentrate on the clinical sciences, including core concepts of therapeutics and clinical intervention in the disease process. They learn pathophysiology in the context of the whole patient and the society in which that patient lives. This entails study of epidemiology and health disparities with full regard for the patient who has the disease and the impact of psychological, social, and cultural issues on disease and illness.

 

2.      Problem Solving and Clinical Skills (Patient Care)

Students begin to think like clinicians. They move from the more black and white approach of the basic sciences to understanding a more probability-based clinical approach with its systematic sorting through of alternative diagnoses and treatments and its grey areas. They build on their basic science foundation and the medical model to an appreciation of how art and science meld in the practice of medicine. They expand their skills in physical diagnosis, recognition of clinical ethical issues, and competence with diverse populations. Consistent with current and emerging models of medical practice, students engage in consultative, collaborative approaches to problem solving. They expand their skills in physical diagnosis, recognition of clinical ethical issues, and competence with diverse populations.

 

3.      Lifelong Learning (Practice Based Learning and Improvement)

Students become skillful and resourceful in pursuing information not taught in the classroom and integrating it into their knowledge base and clinical experiences. They become familiar with how the evolving resources and technologies can supplement their education and help them manage information. Students demonstrate increased initiative and independence as learners. They also reflect on their own learning experiences, across courses and extracurricular activities, becoming adept at ongoing self assessment that enables them to learn more.

 

4.      Systems Based Practice

Students begin to develop a clinical perspective that recognizes the impact of systems of care on the health of the patient and how to use resources to provide optimal care.

 

5.      Professionalism

Students demonstrate respect for and interest in the patient, not just the disease. They enter their third-year clerkships with a deep and enduring respect for the doctor-patient relationship. They also exhibit self-respect by identifying and addressing personal issues that affect their ability to fulfill the professional responsibilities of being a doctor.

 

6. Interpersonal and Communication Skills

Students have effective information exchanges and interactions with patients and other students and health professionals. They recognize some of the complexities and subtleties in doctor-patient communication, including how patients vary in their communication styles and preferences. Across the curriculum, they are exposed to models of effective communication.

 

Year 3

The third year of medical school begins a transition for students as they move from classroom-based learning in the first two years to an apprenticeship model with clerkship experiences through a series of rotations in Madison and across the state. Students have their first extended exposure to the culture of medicine and the expectations of independent learning and critical thinking in a clinical setting. Owing to our statewide campus, students are given the opportunity to examine the unique health care needs of the diverse populations across Wisconsin. Required clerkships provide broad exposure to many aspects of medicine and public health. Part of the clinical learning experience involves documentation and self assessment of their learning across competency areas.

1. Medical Knowledge

In the third year, students demonstrate an ability to integrate and recall concepts learned in the first two years and develop a coherent and logical differential diagnosis. They learn that a single “correct answer” is not always readily available. They are able to integrate knowledge of social, cultural and behavioral factors and preventive measures to advance patient wellbeing. They have longitudinal experiences with patients which enable them to see the natural history and social/economic impact of illness over time.

 

2. Problem solving and Clinical Skills (Patient Care)

Students not only show compassion and provide solace to patients, but also extract information of clinical relevance using culturally competent patient interview techniques. They are able to think calmly, coherently and intelligently about the medical needs of the patient, integrating relevant clinical guidelines. They learn to perform key clinical skills (e.g. starting an IV).

 

3. Lifelong learning (Practice Based Learning and Improvement)

Students develop their skills in assembling and integrating the most current and relevant information from multiple sources to create a coherent assessment of the patient.

 

4. Systems Based Practice

Students gain familiarity with the medical hierarchy and how health care systems, regulation, and resources affect the patient’s health and health care. This includes, for example an understanding of systemic issues related to medical errors, the physician’s role as an advocate within a disjointed health care system, and how reimbursement and health care financing affect the delivery of care. They acquire an understanding of quality of care issues, including national and local quality improvement goals. Students are also introduced to systems issues in bioethics, such as problems of health care rationing and access to care, and industry-physician relations.

5. Professionalism

Patient interactions are challenging and students learn to shift their frame of reference and compartmentalize their emotional and intellectual effort on behalf of the patient. They appreciate that while in their previous education learning focused on them as students, in the clinical years the center of attention is the patient. They maintain their professionalism in an environment with a certain amount of chaos. They do not overstep their bounds and accept constructive feedback gracefully and apply it to improve their care of patients. They also demonstrate that they are reliable and responsible, always performing their duties in a timely, dependable manner.

6. Interpersonal and Communication skills

Students participate and communicate effectively in the physician-patient relationship and as members of an interdisciplinary clinical team. They recognize the contribution of other team members and show respect for them. They demonstrate a sensitivity and skill in communicating to patients and families with varying communication needs.

Year 4

The fourth year of medical school provides students with the opportunity to experience a community preceptorship where they are immersed in a community-based clinical environment in a one-on-one relationship with a physician mentor. During this experience, students develop a greater understanding of the value of community resources in patient care and insights into the relationships between clinical care, public health and health of the community. Students are able to tailor their education, through electives, research and extramurals, to their evolving interests and career choices as they move toward their specialty and residency decisions. Students take Step 2 during their fourth year to assess their application of medical knowledge, skills, and understanding of clinical science with emphasis on health promotion and disease prevention.

 

1. Medical Knowledge

Students’ clinical knowledge continues to build so that by the end of the fourth year they know how to use and interpret appropriate clinical and laboratory evaluation tools and suggest possible treatment options. Students deepen their knowledge in a field of special interest, such as international health, community health, research, integrative medicine or another area of choice.

2. Problem solving and Clinical Skills (Patient Care)

Preceptorship and elective experiences enable students to apply and integrate their patient care skills in diverse settings. As they gain clinical experience over the two years, they become more adept at identifying and resolving ethical issues.

 

3. Lifelong learning (Practice Based Learning and Improvement)

Students continue to develop their skills in acquiring and assimilating the latest evidence to diagnose and manage patients. They understand the role of researchers and clinicians in developing and integrating new data to improve care.

 

4. Systems Based Practice

Community preceptorships provide students with the understanding of cultural variations in patient attitudes and practices, and the interface between public health and clinical care,

They gain a further understanding of quality of care issues at a local community level.

 

5. Professionalism

Students prepare for residency having demonstrated respect, compassion, integrity and professional attitudes and behaviors in areas such as the doctor-patient relationship, ethical principles of the profession (i.e. confidentiality of patient information), and sensitivity to patients’ culture, age, gender, and disabilities. Students exhibit accountability to patients, society, and the profession; and a commitment to excellence, leadership, and lifelong professional development.

6. Interpersonal and Communication skills

Students continue to develop effective listening skills and elicit and provide information using nonverbal, explanatory, inquiring and written skills. They continue to work effectively and respectfully with others on the health care team.