Introduction to the Culture and Practice of Medicine
Taught throughout the first year of medical school, Doctoring 1 is an integrated series of lectures, small-group discussions, simulated patient encounters, and clinical correlation exercises. The course provides instruction in fundamental clinical skills: taking a patient history, performing a physical examination of a normal adult, and basic case presentation. Doctoring incorporates elements of the integrated pre-clerkship curriculum, including healthcare disparities, cultural determinants of health, barriers to provision of effective healthcare, health care teams and interprofessional education, medical systems, the impact of healthcare policies, and patient safety. Professionalism and the student’s emerging role as a healthcare provider are addressed throughout the course. Activities are integrated with the basic science curriculum.
Clinical faculty members are assigned as mentors to small groups of students. Students meet regularly with their faculty mentors to review their progress in the course, practice the clinical skills taught in-patient instructor encounters, and rehearse their history-taking, examination, and professionalism skills with patients from the faculty member’s practice.
Overviews of clinical skills and patient management principles are presented in lectures or on-line tutorials, and rehearsed in small group, hands-on settings in the Clinical Simulation Center. Simulated patients, patient instructors, and high-fidelity patient mannequins are used extensively throughout the course. Students participate in formative Practice Clinical Encounters, after which they review and critique their performance with their faculty mentor. The course culminates in a multi-station Objective Structured Clinical Examination (OSCE).
Block 1 - Fundamentals of Anatomy
This course is taught primarily through laboratory sessions, independent study, peer-teaching and small group conferences. It is designed to promote student participation in group learning, self-directed learning and the development of good professional behaviors and attitudes. Students will learn the basic names, features, functions and relationships of anatomic structures and acquire skills of critical judgment necessary to develop the ability to use anatomical knowledge to evaluate the health of patients and solve clinical problems. In addition, students will participate in; 1) case-based clinical anatomy workshops, 2) the Temple Anatomy to Genomics workshop initiatives that involves cadaver exome sequencing, 3) the use of ultrasound for evaluation of thoracic and abdominal organs as a small group activity conducted in the Simulation Center, and 4) peer evaluation of professionalism.
Block 2 – Fundamentals of Medicine I
This course teaches fundamentals of medicine. It has two sections. Section 1 is about metabolism. Biochemical events sustain all body functions and the metabolism section of the block is designed to provide an understanding of metabolic pathways and the manner in which they are integrated and regulated. It also provides an understanding how diseases can alter these normal metabolic processes. In addition, an understanding of metabolic pathways provides a background to understand basic physiologic, pharmacologic and pathologic topics discussed in subsequent blocks.
Section 2 covers three major subjects: Molecular Biology, Genetics, and Cell Biology. Cellular macromolecules including DNA, RNA and proteins are critical to sustain cellular function and life processes in both eukaryotic and prokaryotic cells. This section of the block is designed to provide an understanding of the structure, synthesis, function and relationship between these macromolecules including the molecular mechanisms underlying the processes of DNA replication, recombination and repair, RNA transcription and protein translation. This section also provides an understanding of gene structure, how genetic material is inherited, and the effect of genetic variation and epigenetics on health and disease. In addition, fundamental aspects of basic eukaryotic and prokaryotic cell biology including mitosis/meiosis, cell cycle, membrane properties, and cell signaling will be discussed. An understanding of molecular biology, genetics and cell biology provides the necessary foundation to understand basic physiologic, pharmacologic, pathologic and microbiologic topics discussed in subsequent blocks and to understand the molecular/genetic basis of diagnosis and treatment of diseases.
Block 3 – Biological Systems I: Cardiovascular, Blood, Respiratory & Renal Systems
This course uses an integrated approach to provide students with the fundamental knowledge necessary to understand the microscopic organization, embryological development, and function of the cardiovascular, pulmonary, and renal systems. Students also learn basic principles of cell physiology including regulation of body fluids, membrane transport mechanisms, action potential generation on propagation in excitable cells, muscle physiology, and acid/base physiology. Basic principles of general pharmacology and epidemiology and biostatistics will be explored. While the focus of the block is on normal structure and function, examples of organ dysfunction will be discussed to demonstrate how physiology knowledge can be applied to understanding disease and monitor treatment outcomes. Material will be presented in the form of Lectures, Workshop, Clinical Reasoning Conferences, and Clinical Simulation Exercises.
Block 4 – Biological Systems II: Integumentary, Endocrine, Reproductive and Male and Female Reproductive Systems and Nutrition
The overall objective of this course is to provide an integrative understanding of the structure and functions of the integumentary, endocrine, male and female reproductive and the gastrointestinal systems. Students will identify how structure (embryology and microanatomy) integrates with function (physiologic mechanisms) while learning the necessary biochemistry required to appreciate the etiology and progression of disease. In addition, students will study the basics on the biochemistry of nutrients and the role of nutrition as a component of ‘preventative medicine’ and mechanisms contributing to absorption of nutrients into the body. For all systems, students apply their basic medical science knowledge to clinical problem solving. We use multiple teaching modalities to teach the basic science concepts and to sharpen and improve student’s skills in applying the basic science concepts to clinical problem solving.
Block 5 – Biological Systems III: Nervous System
This course is designed to provide students with the neuroanatomical, neurophysiological, and behavioral concepts necessary to (1) have a basic knowledge of normal brain function as it relates to the brain systems evaluated by the neurological and mental status exams, (2) adequately prepare students for neuroscience taught in year two and (3) adequately prepare students for their third and fourth year clinical rotations. Course content focuses on the aspects of anatomy, physiology and behavior assessed by the neurological and mental status exams and is delivered through a combination of lectures, laboratories and workshops. The laboratories and workshops constitute the majority of in-class time and use team-based activities to promote learning and application of course content.
Block 6 - BioSystems IV: Immunology and Inflammation
This course provides students with a strong basis for the understanding of immunology as it relates to the infectious process and immunologic disorders. This should serve as a foundation for future learning as well as give students confidence in making clinical judgments based upon an appreciation of this information. By the end of this block students should be able to demonstrate knowledge of: general principles of immunology, including components of the immune system and their interactions in immune responses and in diseases of the immune system; immunological methods to diagnose and treat diseases; general structure, physiology, metabolism, growth, genetic characteristics and classification of bacteria and viruses and the role of the microbiome in health; definitions, causes, cellular and molecular manifestations and consequences of basic immunologic processes in inflammation and transplantation; basic principles and clinical applications of immunopharmacology; basic principles of translational and clinical research used in identifying the links between fundamentals of microbiology and immunology and their application for diagnosis and treatment of diseases.
The block is based on lectures, case-based learning, discussions and self-study. Case-based learning (CBL) stress concepts considered in the lectures. Their purpose is to provide students with problem-solving experience and insight appropriate for implementing proper patient care. During CBL events students work in groups to answer questions related to the cases and prepare a presentation. Attendance at CBL events and workshops is required.