Pre-Clerkship Units/Courses
This medical program is meticulously structured to equip medical students with the foundational knowledge and practical skills necessary for excelling in primary care diagnosis and beyond. The pre-clerkship curriculum is designed to progressively build competence, starting with basic sciences and culminating in clinical application.
Population Health and Profession of Medicine (First Year, 3 Weeks)
The initial phase immerses medical students in the crucial domain of population health. This course lays the groundwork for understanding healthcare delivery systems, particularly within the U.S. context, while emphasizing health equity and cultural competency. Students are introduced to epidemiology and biostatistics, essential tools for primary care diagnosis help as they learn to interpret health data and understand disease patterns within populations. The curriculum stresses preventative medicine and healthcare economics, crucial aspects of primary care practice. Interactive learning methods, including community engagement in Boston neighborhoods, allow students to apply theoretical knowledge to real-world scenarios, fostering a practical understanding of how social determinants of health impact patient care and primary diagnosis in diverse communities. Team-based learning activities using clinical cases further solidify these concepts, preparing students for patient-centered care.
Teaching format: Interactive lectures, flipped classrooms, small group case-based sessions, large group discussions, community field experiences, team-based group exercises, group projects
Scientific Foundations of Medicine Unit (SFM) (First Year, 11 Weeks)
The Scientific Foundations of Medicine Unit (SFM) is the cornerstone of the first year, providing an intensive 11-week exploration of the basic sciences. Delivered through two synchronized courses, Molecules to Tissues (MTT) and Microbes, Infectious Disease and the Immune System (MIDIS), SFM is divided into four thematic sections, each culminating in a patient case presentation to integrate learning. This structure ensures students grasp the fundamental scientific principles underpinning medical practice, directly applicable to primary care diagnosis.
Teaching format: Interactive lectures, flipped classrooms, small group case-based sessions, large group problem solving sessions, team-based learning, patient presentations, and microbiology laboratories.
Molecules to Tissues (MTT)
Molecules to Tissues (MTT) is critical for building a robust understanding of the molecular and cellular basis of health and disease. It integrates biochemistry, cell biology, medical genetics, histology, core pathology, and core pharmacology. A strong foundation in biochemistry is essential for understanding physiological processes and interpreting laboratory results, both vital for accurate primary care diagnosis. Cell biology sessions elucidate cellular mechanisms in health and disease, preparing students for organ-based systems and enhancing their diagnostic reasoning. Medical genetics introduces genetic principles relevant to clinical medicine, including inheritance patterns and diagnostic methods, increasingly important in primary diagnosis and personalized medicine. Histology sessions emphasize the structure-function relationship at the microscopic level, crucial for understanding tissue changes in disease. Core pathology introduces cellular and tissue alterations caused by disease stimuli, forming the basis for organ-specific pathology and enhancing diagnostic acumen. Core pharmacology sessions cover basic pharmacokinetics and pharmacodynamics, essential for understanding drug actions and informing treatment decisions in primary care diagnosis and management.
Microbes, Infectious Disease and the Immune System (MIDIS)
Microbes, Infectious Disease and the Immune System (MIDIS) provides a comprehensive understanding of microbiology, infectious diseases, immunology, and antimicrobial pharmacology. Immunology sessions are crucial for understanding the body’s defense mechanisms and immune-related diseases, frequently encountered in primary care diagnosis. Microbiology sessions cover the biology of bacteria and viruses as causative agents of human disease, focusing on mechanisms of pathogenesis and therapeutic targets. This knowledge is fundamental for diagnosing and managing infectious diseases in primary care. Infectious Disease sessions present the pathobiology of organisms and the clinical syndromes they cause, emphasizing physical signs, symptoms, diagnostic strategies, and treatment overviews. This section directly enhances students’ ability to approach primary care diagnosis of infectious conditions, a common presentation in primary care settings.
Organ Systems
The organ systems curriculum represents a significant step towards clinical application, integrating organ-specific anatomy (cadaveric and virtual), histology, physiology, pathology, pathophysiology, infectious disease, imaging, clinical laboratory, pharmacology, therapeutics, ethics, and the Perspectives in Medicine threads. Each organ system unit follows a pattern: normal structure and function, pathophysiologic basis of disease, and finally, disease prevention, diagnosis, and treatment. This systematic approach is designed to refine students’ primary care diagnosis help skills by contextualizing disease within specific organ systems. Case-based sessions are heavily emphasized, focusing on common symptoms, signs, and laboratory/imaging abnormalities, all essential for primary diagnosis in a clinical setting. The Perspectives in Medicine themes are woven throughout, emphasizing population health, social determinants of health, healthcare disparities, and ethical considerations, all critical for comprehensive primary care diagnosis and patient management.
Teaching format: Interactive lectures, flipped classrooms, problem solving sessions, clinicopathological conferences, small group case-based sessions, team-based learning, patient presentations, laboratories.
First Year Organ Systems
Gastrointestinal (First Year, 6 weeks): This course covers the gastrointestinal system from oral cavity to pancreas, integrating physiology, histology, anatomy, pathology, pathophysiology, and pharmacology. The case-based approach, co-taught by gastroenterologists and pathologists, uses clinicopathologic conferences to bridge pathophysiology with pathology, crucial for primary care diagnosis of common gastrointestinal issues. Common disorders like allergic, autoimmune, inflammatory, infectious, and neoplastic conditions are reviewed, providing a broad understanding of GI pathology relevant to primary care.
Nutrition (First Year, 6 weeks): This course emphasizes the profound impact of nutrition on health and disease. It focuses on nutritional issues commonly encountered in clinical practice, including assessment of nutritional status, nutritional support, and counseling. Understanding nutritional aspects is increasingly important in primary care diagnosis and management of chronic diseases, as diet plays a significant role in many common primary care conditions. Topics include obesity, malnutrition, micronutrient deficiencies, and nutritional support, all relevant to primary care practice.
Musculoskeletal (First Year, 7 weeks): This course covers muscle, nerve, cartilage, bone, joints, and synovium, integrating physiology, histology, anatomy, pathology, and pathophysiology. Cadaveric anatomy sections enhance spatial understanding. The course addresses skeletal homeostasis, metabolic bone disorders, orthopedics, orthopedic emergencies, osteoarthritis, rheumatoid arthritis, Lyme disease, and musculoskeletal tumors, equipping students with knowledge for primary care diagnosis of musculoskeletal complaints, a frequent presentation in primary care. Pharmacology sessions focus on antirheumatic agents, NSAIDs, opioids, and local anesthetics, essential for managing musculoskeletal pain in primary care.
Renal (First Year, 4 weeks): This course focuses on the kidneys’ role in maintaining homeostasis and their function as an excretory and endocrine organ. It explores disorders arising from primary kidney defects and responses to extra-renal disturbances. Understanding renal physiology and pathology is important for primary care diagnosis and management of conditions like hypertension, electrolyte imbalances, and chronic kidney disease, all common in primary care. Anatomic dissection enhances structure-function correlation.
Respiratory (First Year, 5 weeks): This course provides a strong foundation in respiratory physiology, histology, anatomy, pathophysiology, pharmacology, and pathology. It covers a broad spectrum of respiratory diseases, including obstructive, restrictive, infectious, and neoplastic conditions. Interpreting pulmonary function tests, chest radiology, and arterial blood gases is emphasized, critical skills for primary care diagnosis of respiratory illnesses. Clinical correlation is stressed, linking symptoms and signs to underlying pathophysiology, essential for effective diagnosis in primary care.
Cardiovascular (First Year, 4 weeks): This course takes an integrated approach to cardiovascular diseases, aiming to develop analytical skills for transitioning from basic physiology to patient care. It covers hemodynamics in shock, heart failure, and valvular heart diseases. Epidemiology, risk factors, clinical manifestations, and management of coronary artery disease are reviewed. Understanding electrocardiography and arrhythmias is crucial. This course equips students with the foundational knowledge for primary care diagnosis and management of cardiovascular conditions, major contributors to morbidity and mortality in primary care populations.
Second Year Organ Systems
Dermatology (Second Year, 2 weeks): This course introduces dermatology, focusing on proper description of skin lesions, differential diagnosis development, pathogenesis of common dermatologic diseases, and treatment. Understanding dermatologic lexicon and bedside diagnostic testing is emphasized. Common conditions like acne, psoriasis, eczema, and skin cancer are covered. Dermatologic conditions are frequently encountered in primary care diagnosis, making this course highly relevant. Infectious disease topics, including approach to febrile patients and sexually transmitted diseases, are also included, further enhancing primary care diagnosis help skills.
The Brain (Second year, 8 weeks): This comprehensive module integrates Neuroscience, Principles of Addiction Medicine, and Introduction to Clinical Psychiatry.
Neuroscience: This section presents neuroanatomy from spinal cord to cerebral cortex, relating anatomy to lesion localization and neurological diseases. Clinical and pathologic features of diseases like Parkinson’s, Alzheimer’s, multiple sclerosis, epilepsy, stroke, and brain tumors are covered. Developing a clinical approach to patients with common neurologic symptoms is emphasized. Clinical-anatomic correlations are reinforced through problem-solving sessions and anatomy labs. Neurological examination skills are taught, essential for primary care diagnosis of neurological conditions presenting in primary care.
Principles of Addiction Medicine: This section addresses the mechanisms of action of drugs of abuse, their effects on neurotransmitter systems, and clinical practice of addiction medicine. Topics range from diagnosing drug-associated toxidromes to patient interviewing and addiction recovery programs. Understanding addiction is increasingly important in primary care, and this course provides valuable primary care diagnosis help for patients with substance use disorders.
Introduction to Clinical Psychiatry: This section focuses on neurobiological aspects of psychopathology and treatment. It introduces diagnosis and phenomenology of major psychiatric conditions, including depression, bipolar disorder, anxiety disorders, and schizophrenia. Psychopharmacology is integrated. Developing a clinical approach to patients with psychiatric symptoms is emphasized. Mental health is integral to primary care, and this course provides essential primary care diagnosis help in recognizing and managing mental health conditions in primary care settings.
Hematology-Oncology (Second Year, 5 weeks): This course covers normal blood physiology, malignant blood and bone marrow diseases, and a framework for understanding non-hematologic malignancies. It integrates hematology and oncology pharmacology, pathologic diagnosis, and transfusion medicine. Understanding hematologic and oncologic conditions is relevant to primary care diagnosis, particularly in identifying early signs and symptoms and managing patients with cancer-related issues.
Endocrine (Second Year, 4 weeks): This course provides an integrated overview of endocrine systems, focusing on normal physiology and disease states. It covers adrenal, thyroid, parathyroid/calcium, endocrine pancreas, and pituitary glands. For each gland, normal physiology, hyperfunction, hypofunction, and neoplasia are discussed, with a clinical approach to diagnosis and treatment. Endocrine disorders like diabetes, thyroid disease, and osteoporosis are highly prevalent in primary care, making this course critical for primary care diagnosis and management.
Reproductive (Second Year, 4 weeks): This course begins with normal reproductive tract development and moves to structural abnormalities and genetic disorders. It covers the hypothalamic-pituitary-gonadal axis, menopause, puberty, contraception, pregnancy, pelvic pain, genital infections, infertility, sexual dysfunction, and abuse. Pathology of breast, cervix, ovary, uterus, and male reproductive tract is taught. Reproductive health is a significant component of primary care, and this course provides essential knowledge for primary care diagnosis and management of reproductive health issues in both men and women.
Foundations of Patient Care
This section focuses on developing essential clinical skills for patient interaction and care, directly enhancing students’ ability to provide primary care diagnosis help.
Medical Interviewing and the Doctor-Patient Relationship (MIDPR) (First Year, 12 weeks)
Medical Interviewing and the Doctor-Patient Relationship (MIDPR) is initiated early in the first year to introduce students to the art and science of medical interviewing. It aims to develop skills in doctor-patient communication, basic interviewing and history-taking techniques, understanding patient experiences of illness, clinical documentation, and discussing sensitive topics. Developing rapport and empathy is emphasized. Practical experience is gained through interviewing patients in hospitals and elderly housing sites, as well as simulated patients in the Clinical Skills and Simulation Center (CSSC). This course is foundational for effective primary care diagnosis as accurate history taking is crucial for arriving at the correct diagnosis.
Teaching format: Interactive sessions, patient presentations and demonstration interviews, small groups in clinical settings, standardized (simulated) patient interviews in the CSSC.
Physical Diagnosis (First Year, November to May)
The Physical Diagnosis Course teaches the clinical skills of basic and normal physical examination, serving as an introduction to abnormal findings. It is integrated with the organ-system units. Students learn systematic physical examination techniques for all body regions. Lectures emphasize basic techniques and clinical correlations. Evening sessions in the CSSC provide demonstrations and practice under faculty supervision, using simulation task trainers and standardized patients. Ultrasound is incorporated into many sessions. Mastery of physical examination is fundamental for primary care diagnosis, as physical findings often guide diagnostic pathways.
Teaching format: interactive lectures, case presentations, physical exam demonstrations, small groups in the CSSC, standardized patient practice sessions, and ultrasound.
Competency-based Apprenticeship in Primary Care (CAP) (Second Year, 18 weeks)
The Competency-based Apprenticeship in Primary Care (CAP) course builds on interviewing and physical diagnosis skills. Students work in pairs one day a week in outpatient clinics in Family Medicine, General Internal Medicine, or Pediatrics. This longitudinal experience, starting in the first year and continuing into the second, allows students to refine clinical skills in history taking, physical examination, differential diagnosis, patient counseling, and clinical documentation. Concepts learned in organ-system units are applied in the clinical setting. Workshops supplement the ambulatory experience, covering office procedures, lifestyle modification counseling, breast and pelvic examination, and advanced communication. CAP provides direct, hands-on experience in primary care diagnosis and patient management, solidifying skills in a real-world setting.
Teaching format: clinical work in primary care setting, interactive workshops, standardized patient sessions, self-directed learning
Foundations of Evidence-based Medicine and Clinical Reasoning
This section focuses on developing critical thinking and evidence-based practice skills, essential for effective primary care diagnosis help.
Epidemiology and Biostatistics (First Year, 3 weeks)
Epidemiology and Biostatistics aims to equip students with the skills to critically evaluate medical literature. It covers descriptive epidemiology, study designs (randomized controlled trials, cohort studies, case-control studies), validity, bias, confounding, and biostatistics. Small group sessions reinforce concepts and analyze medical literature examples. Students learn to critique research papers, identifying biases, assessing validity, and evaluating causal associations. This course provides the foundation for evidence-based medicine, essential for informed primary care diagnosis and treatment decisions.
Teaching format: small groups
Problem-Based Learning (PBL) (First Year, 18 weeks)
Problem-Based Learning (PBL) utilizes small group learning to introduce medical evidence and clinical reasoning. Virtual patient cases with embedded basic science principles are explored. Students collaboratively discuss, explore, and understand clinical issues in common health problems. This active learning environment fosters the acquisition of new knowledge, skills, and professional attitudes. PBL emphasizes self-directed learning, collaborative teamwork, and effective communication, all crucial for ongoing professional development and effective primary care diagnosis in complex cases.
Teaching format: small groups case-based discussions, independent research, self-directed learning
Introduction to Clinical Reasoning (ICR) (First and Second Year, January of first year to January of second year)
Introduction to Clinical Reasoning (ICR) builds on epidemiology and biostatistics, starting with evidence-based medicine principles. It uses team-based learning to teach the difference between disease-oriented and patient-oriented evidence. Students gain experience in critically evaluating research on treatments and diagnostic tests, clinical practice guidelines, and meta-analyses. Bayes’ theorem and dual process theory are introduced to prepare students for clinical reasoning. The course emphasizes the dual process model: non-analytic reasoning (pattern recognition) and analytic reasoning (hypothetico-deductive). Symptom-based weeks (e.g., chest pain, dyspnea, fever) are used. For each symptom, students complete cases to recognize illness scripts and review differential diagnoses. Diagnostic error causes and heuristics are discussed, promoting metacognition and reflection on diagnostic processes. Analytic reasoning components involve estimating pre-test probabilities and applying likelihood ratios. ICR directly focuses on developing primary care diagnosis help skills by teaching systematic approaches to diagnostic reasoning and evidence utilization.
Teaching format: team-based learning, small group case-based discussion, online cases, self-directed learning.
Required Core Clerkships
Core clerkships are designed to refine clinical skills, clinical reasoning, and professional identity formation. They emphasize using history and physical exam to generate differential diagnoses and evidence-based diagnostic and therapeutic plans. Students strengthen skills in interpreting diagnostic tests, documenting encounters, delivering oral presentations, and care transitions. Interprofessional collaboration is integrated into each rotation. Advanced communication skills are further developed. The clerkships culminate in a 12-station OSCE. These clerkships provide immersive clinical experiences essential for honing primary care diagnosis abilities in diverse settings.
Family Medicine (6 weeks)
The Family Medicine Clerkship is an ambulatory experience exposing students to a diverse patient population with a broad range of clinical issues. Students work closely with a family medicine preceptor four days a week in an ambulatory setting. One day a week is spent on campus for case-based discussions and workshops covering sports medicine, dermatology, women’s health, geriatrics, and underserved populations. Virtual cases cover required clinical entities. Students learn to assess patients, formulate differential diagnoses, and propose patient-centered management plans for common acute presentations. They manage chronic illnesses and develop evidence-based health maintenance plans. This clerkship provides direct, focused experience in primary care diagnosis and management within the family medicine context.
Medicine (8 weeks)
The Medicine core clerkship is an inpatient experience providing a basic understanding of common internal medicine problems. Students encounter a wide array of illnesses and interact with various medical specialties. The clerkship ensures students learn common symptoms, signs, and laboratory findings interpretation; differential diagnosis and management of common internal medicine problems; effective communication; discharge planning; ethical issues; documentation; and professionalism. Clinical reasoning skills are heavily emphasized. Virtual (“SIMPLE”) cases ensure exposure to important case types. Many sites include simulation center sessions. This inpatient experience broadens students’ diagnostic skills applicable to a wide range of medical conditions, contributing to their overall primary care diagnosis help capabilities.
Obstetrics and Gynecology (6 weeks)
During the Obstetrics and Gynecology clerkship, students engage in a breadth of clinical experiences from prenatal care to gynecologic malignancy and end-of-life care. They interact with patients across the lifespan and care for women during significant life events. Students complete the clerkship at one of six clinical sites and cover a core curriculum of basic gynecologic and obstetric conditions. Both inpatient and outpatient experiences are included. Interprofessional collaboration is fostered through a half-day with a labor delivery nurse. While focused on OB/GYN, this clerkship enhances general clinical and diagnostic skills applicable across medical fields, indirectly contributing to primary care diagnosis help.
Pediatrics (6 weeks)
The Pediatrics core clerkship incorporates diverse clinical and teaching experiences in pediatric medicine. It includes both inpatient and outpatient experiences, with rotations in primary care pediatrics, inpatient pediatrics, newborn medicine, pediatric subspecialties, and pediatric emergency medicine. The online CLIPP cases are used as a standard curriculum. Pediatric clerkship objectives are adapted from the COMSEP curriculum. This clerkship provides specialized experience in diagnosing and managing pediatric conditions, a critical component of primary care diagnosis for family physicians and pediatricians.
Psychiatry (6 weeks)
The Psychiatry core clerkship offers clinical and didactic opportunities in psychiatry. It includes inpatient, consultation/liaison, and outpatient sites, working with adult and child patients with acute and chronic psychiatric conditions. Students learn psychiatric history, mental status examination, and therapeutic modalities. A didactic series introduces major psychiatric topics through case presentations. This clerkship provides specialized skills in psychiatric diagnosis and management, essential for comprehensive primary care diagnosis which often includes mental health aspects.
Surgery (8 weeks)
The Surgery Clerkship introduces students to a wide spectrum of surgical diseases and their management. Formal didactics include 18 case studies designed for core clerkship students, covering presentation, diagnosis, and management of common surgical illnesses. Experiential components include operative case participation, outpatient surgical evaluation, inpatient surgical team involvement, and on-call emergency consultations and operations. While focused on surgery, this clerkship sharpens general clinical and diagnostic reasoning skills transferable to primary care diagnosis, particularly in recognizing surgical conditions requiring referral or co-management.
Longitudinal Integrated Clerkship – Maine Track (9 months plus immersion experiences)
Maine Track students may complete a Longitudinal Integrated Clerkship (LIC) for nine months at one of eight sites. Students are assigned to sites in small groups and have weekly outpatient sessions in family medicine, medicine, OB/GYN, pediatrics, psychiatry, and surgery. LIC students care for a panel of patients, following them across care settings including hospital and operating room. Weekly emergency department shifts are included. Monthly didactic sessions are held. Immersion blocks of inpatient rotations precede the LIC. LIC provides a unique, integrated clinical experience that fosters deep understanding of patient care and enhances diagnostic skills in a longitudinal setting, significantly contributing to primary care diagnosis help over an extended period.
Perspectives in Medicine – Patients, Populations, and Systems Threads
Perspectives in Medicine is a longitudinal course addressing content beyond basic science and organ systems. It focuses on the patient experience of medicine, healthcare systems, population health, and personal and professional development. These threads, introduced in the Population Health and Practice of Medicine course, are woven throughout the curriculum, enriching students’ understanding of the broader context of medical practice and enhancing their approach to primary care diagnosis within a holistic framework.
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Healthcare Systems: Covers healthcare costs, delivery systems, quality and safety, quality improvement, interprofessional collaboration, advocacy, law, clinical informatics, chronic illness care, and team-based care. Understanding healthcare systems is crucial for effective and efficient primary care diagnosis and patient management within the system.
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Population Health: Focuses on structural health determinants, health disparities, public health, prevention, culturally competent care, care of the underserved, global health, and social justice. A population health perspective is essential for addressing health inequities and tailoring primary care diagnosis and prevention strategies to diverse populations.
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The Patient Experience: Covers advanced communication, shared decision making, impact of health on patient and family life, end-of-life care, palliative care, and pain and substance use disorder management. Emphasizing the patient experience is central to patient-centered primary care diagnosis and management, ensuring care is aligned with patient values and preferences.
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Personal and Professional Development: Addresses wellness, resilience, professionalism, ethical practice, evidence-based medicine, lifelong learning, inquiry, navigating uncertainty, professional identity formation, leadership, teaching, clinical skills, clinical reasoning, and advocacy skills. These aspects are crucial for developing well-rounded, competent physicians capable of providing excellent primary care diagnosis help and comprehensive patient care throughout their careers.
