SCHOOL OF MEDICINE STUDENT HANDBOOK

WESTERN RESERVE2 CURRICULUM

THE UNIVERSITY PROGRAM

Curricular Composition

• Scientific and Clinical Foundations of Medicine and Health
• Research and Scholarship
• Clinical Experiences
• Advanced Clinical And Scientific Studies

The Electronic Curriculum

The Western Reserve2 Curriculum (WR2) creates at Case a system of learning that reunites the disciplines of public health and medicine into a single, integrated program of study. The WR2 Curriculum has high expectations for self-directed learning, and seeks to train physician scholars who are prepared to treat disease, promote health and examine the social and behavioral context of illness.  It interweaves four themes of research and scholarship, clinical mastery, leadership and civic professionalism to prepare students for the ongoing practice of evidence-based medicine in the rapidly changing healthcare environment of the 21st century.

Scholarship and clinical relevance are the benchmarks for learning, and clinical experiences and biomedical and population sciences education are integrated across the four years of the curriculum.  The WR2 Curriculum also creates an independent, educational environment where learning is self-directed and where student education primarily occurs through:  1) facilitated, small-group student-centered discussions 2) large group interactive sessions such as Team Learning or didactic sessions that offer a framework or synthesis, 3) interactive anatomy sessions, 4) clinical skills training, and 5) patient-based activities.

Education throughout the four years is centered on:

1. Fostering experiential and interactive learning in a clinical context;

2. Stimulating educational spiraling by revisiting concepts in progressively more meaningful depth and increasingly sophisticated contexts;

3. Promoting integration of the biomedical and population sciences with clinical experience;

4. Transferring concepts and principles learned in one context to other contexts;  

5. Enhancing learning through deliberate practice, or providing learners with direct observation, feedback, and the opportunity to practice in both the clinical environment and in the Case School of Medicine’s Mt. Sinai Skills and Simulation Center.

The Western Reserve2 Curriculum has 10 guiding principles:

1. The core concepts of health and disease prevention will be fully integrated into the curriculum.

2. Medical education will be experiential and emphasize the skills for scholarship, critical thinking, and lifelong learning.

3. Educational methods will be chosen that stimulate an active interchange of ideas among students and faculty.

4. Students and faculty will be mutually respectful partners in learning.

5. Students will be immersed in a graduate school educational environment characterized by flexibility and high expectations for independent study and self-directed learning.

6. Learning will be fostered by weaving the scientific foundations of medicine and health with clinical experiences throughout the curriculum. These scientific foundations include basic science, clinical science, population-based science, and social and behavioral sciences.

7. Every student will have an in-depth mentored experience in research and scholarship.

8. Recognizing the obligations of physicians to society, the central themes of public health, civic professionalism and leadership will be longitudinally woven throughout the entire curriculum.

9. The systems issues of patient safety, quality medical care, and health care delivery will be emphasized and integrated throughout the curriculum.

10. Students will acquire a core set of competencies in the knowledge, mastery of clinical skills and attitudes that are pre-requisite to graduate medical education.  These competencies will be defined, learned and assessed and serve as a mechanism of assessment of the school’s success.

Western Reserve2 Curriculum Core Competencies:

1. Medical Knowledge
2. Patient Care
3. Interpersonal and Communication Skills
4. Professionalism
5. Life-long Learning and Personal Development
6. Research and Scholarship
7. Civic Professionalism and Leadership
8. Practice-based Learning and Improvement
9. Systems-based Practice

Curricular Composition

The four years of the WR2 Curriculum is divided into four major components, each of which will focus on health as well as disease, and the health of populations in addition to the health of individual patients.

1. Scientific and Clinical Foundations of Medicine and Health:  This component is made up of six blocks. 

• The first block – Becoming a Doctor I - is six weeks in duration, and gives students an understanding of the doctor’s role at the bedside and in society.  Typically students begin their medical education by studying basic science at the molecular level, and are often not fully aware of the relevance that this knowledge has in their future education as physicians or how it relates to the actual practice of medicine.   This curricular block focuses on how physicians can act as advocates for their patients in the health care system; how social and environmental factors impact health; and the importance of clinical research as the unifying principle between disease biology and the science of clinical practices.   This block also has a strong emphasis on the importance of critical thinking and rigorous methodologies in the measurement of clinical phenomena.
  
  Becoming a Doctor II – Capstone Experience:  During the fourth year of medical school, all students will be required to return to campus for two-three weeks of focused, shared experiences during which they revisit the social and behavioral determinants of health and disease and health system issues within the context of the basic science, clinical skills and evidence-based medicine they’ve learned since entering medical school.

The next five blocks in the Foundations of Medicine and Health are comprised of basic science education complemented by clinical immersion experiences, early contact with patients in clinical preceptorships and simulated clinical experiences.  Subject matter is integrated across entire biological systems, which permits faculty in the different disciplines to leverage teaching time to convey content and concepts common to their disciplines.  Content is divided into the following blocks:

• Human Blueprint:  Comprised of endocrine, reproductive development, genetics, molecular biology, and cancer biology.
  

• Food to Energy:  Encompasses gastro-intestinal system, nutrition, energy, metabolism and biochemistry.
  

• Homeostasis:  Includes cardiovascular system, pulmonary system, renal system, cell regulation, and pharmacology.
  

• Host Defense and Host Response:  Focuses on host defense, microbiology, blood, skin, and the auto-immune system.
  

• Cognition, Sensation and Movement:  Comprised of neurosciences, mind, and the musculoskeletal system.

Several themes stretch longitudinally across these blocks, including anatomy, histopathology and radiology, as well as clinical mastery.  Leadership, bioethics, and research methods are likewise incorporated longitudinally. 

• Blocks 2-6 follow a common pattern.  Each block has a Clinical Immersion Week and each has a Reflection and Integration Week.  During the Clinical Immersion Week, students leave the classroom and enter the clinical setting to see the relevance of the basic science they have been studying as the concepts are used in the setting of patient care. 

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• The Reflection and Integration week is the final week of blocks 2-6.  During this week, no new material is introduced.  Learning activities are planned to help students spiral back to concepts introduced earlier in the block by presenting these concepts again, sometimes in new contexts, and now integrated with other concepts previously learned.  End of block assessment takes place during the reflection and integration week. 

2. Research and Scholarship:  The WR2 Curriculum increases Case’s emphasis on research and scholarship to encourage student career development in the areas of clinical investigation and population research.  The practice of medicine is becoming increasingly evidence and science-based, and research teaches students a way of thinking that makes them better doctors.  The focus on research and scholarship provides medical students with opportunities to pursue individualized areas of interest in great depth.  Through this 16-week, mentored experience in research and scholarship (which can be taken at any point from March of the second year onward), students acquire the intellectual tools needed to formulate research questions, critically assess scientific literature and continue the life-long pursuit of learning that is a critical aspect in the careers of all physicians and physician/scientists.  The research project culminates in a thesis, which is written in the format of a manuscript of the leading journal in the particular area of interest.

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3. Clinical Experiences:  The clinical curriculum cuts across all four years of the medical school curriculum, and can be divided into three areas of involvement:

• A. Foundations of Clinical Medicine:  This segment of the clinical curriculum runs longitudinally through the Foundations of Medicine and Health, and is divided into three components:

  • Foundations of Clinical Medicine Seminars:  Beginning in “The Human Blueprint,” Block 2, students participate in weekly two hour Foundations of Clinical Medicine Seminars.  These seminars combine small group and large group teaching methods as they continue the themes introduced in “Becoming a Doctor.” 
  • RAMP:  Beginning in September of Year 1, groups of students participate in Rotating Apprenticeships in Medical Practice (RAMP), during which they each rotate through patient care encounters in multiple settings.
  • Community Patient Care Preceptorship (CPCP):  After completing RAMP, students select a clinical setting and a physician preceptor with whom they will work.  Students meet with these preceptors every week, and have the opportunity to practice clinical and communication skills while receiving feedback from their practicing physician mentor.

B. Basic Core Clinical Rotations:   Beginning in March of their second year, students undertake their core clinical rotations in 16-week blocks: Basic Core I (Family Medicine, Internal Medicine, and Surgery) and Basic Core II (Neurology, Pediatrics, OB/Gyn, and Psychiatry).Each of these clinical rotations is offered at all of the School of Medicine’s hospital affiliates (including University Hospitals of Cleveland, the Cleveland Clinic Foundation, MetroHealth Medical Center and the Louis Stokes VA Medical Center).

• C. Advanced Core Rotations: These consist of 4 separate, required 4-week rotations that can be completed in any order at any of our partner hospitals listed above.  The domains for these experiences are: Chronic Illness, Aging in Men and Women, Peri-operative Critical Care and Pain Management, and Undifferentiated Care.  All rotations in a domain share the same learning objectives, but the specific content varies from site to site depending on clinical and educational strengths.
  
  

In all Core Clinical Rotations, students experience both breadth and depth in clinical care, and clinical experiences are developmental, with opportunities to reinforce, build upon, and transfer knowledge and skills.  Clinical learning is also integrated across disciplines whenever possible, and the roles of basic science, civic professionalism, scholarship, and population health in clinical care are evident throughout the clinical curriculum. Students likewise have patient care responsibilities that are progressive in sophistication and increasing in amount as their level of clinical skill and knowledge increases, and all core clinical competencies are addressed and assessed using common methods used at each clinical site at which rotations occur.

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4. Advanced Clinical and Scientific Studies: Advanced clinical and scientific studies have three components:  1) in-depth clinical preparation for internship through the selection of sub-internships; 2) in-depth scholarship through selection of areas of concentration that integrate clinical and basic science within a defined area of study; and 3) broad opportunities for further clinical and research electives. An area of concentration encompasses twelve weeks of elective clinical and scientific experiences designed by each student to provide her or him with a focused area of expertise.

A. Acting Internship (AI) Guidelines
1. Definitions

• Intensive, inpatient experiences featuring primary patient care responsibility and direct reporting relationships with faculty and upper level residents  (It should be noted that appropriately designed Emergency Room rotations represent an exception to the inpatient requirement).

• ‘Primary patient care responsibility’ includes interacting with patients and their families, writing patient notes and orders, helping direct management plans and having the opportunity to perform procedures as appropriate.

2. General Guidelines

• Students are required to do a minimum of two Acting Internships.
  

• Students are required to do one of the two acting internships at a Basic Clinical Core site in Cleveland, unless specifically approved by their program.
  

• One of the acting internships must be a traditional team-based AI.
  

• One of the acting internships must be in Internal Medicine, General Surgery or Pediatrics.
  

• It is suggested that students focus their first AI experience on their matching specialty and are encouraged to defer the second AI to later in the 4th year.  The required experience in Pediatrics, Internal Medicine, or Surgery could be accomplished at a later time if it does not correspond to the student’s area of interest.
  

• Intensive care unit (ICU) rotations can qualify as AIs as long as they are participatory and not observational experiences.  Services may want to consider requiring a ward AI as a prerequisite for an ICU AI rotation.
  

• Consult teams or observational experiences do not satisfy the criteria of acting internships.
  

• Acting internships must comply with ACGME duty hour requirements.
  

B. Area of Concentration

1. The Area of Concentration is an opportunity for students to develop expertise in a discipline or domain of medical science through guided organization of elected experiences. There is an expectation that insights from clinical medicine as well as basic science or other sciences basic to medicine (including disciplines such as ethics or epidemiology) will contribute to this effort.

2. The Area of Concentration will include 12 weeks of experience that incorporates clinical medicine, basic science and other sciences basic to medicine into a cohesive plan. Plans will be approved by Physician Advisors for CCLCM or designated faculty advisors for the University Program, and will have defined goals and learning objectives. Each student will be responsible for demonstrating depth of learning in this Area of Concentration.

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THE ELECTRONIC CURRICULUM

The School of Medicine has developed an integrated electronic curriculum for all four years of the medical curriculum that contains a list of learning objectives as well as the resources that allow the students to achieve the objectives. These resources include references to traditional textbooks and journal articles, original textual material, PowerPoint files, illustra­tions, animations, videos, audio files, and links to Internet-based learning resources (including original journal articles in electronic format). These resources are made available on the Internet by an NT/Internet server system.

Students have access to the Internet and the electronic curriculum from their assigned personal desks via fiber op­tic Ethernet connection to CWRUnet and via wireless access when away from their desks. When off campus, access is through a modem connection.