SCHOOL OF MEDICINE STUDENT HANDBOOK

WESTERN RESERVE2 CURRICULUM

THE UNIVERSITY PROGRAM

Also see Appendix VI: Educational Objectives

• Curricular Composition
• Foundations of Medicine and Health
• Research and Scholarship
• Clinical Experiences
• Advanced Clinical And Scientific Studies
• The Electronic Curriculum

The Western Reserve2 Curriculum (WR2) creates a system of learning that integrates the fields of health and medicine into a single, program of study. 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 Reserve 2 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 are divided into four major components, each of which focuses on health as well as disease, and on the health of populations in addition to the health of individual patients.

1. Foundations of Medicine and Health: 

• This component is made up of six integrated course blocks

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  The first block – Becoming a Doctor - is five weeks in duration, and gives students an understanding of population health and the doctor’s responsibility to individuals and to 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. 

• The next five blocks in the Foundations of Medicine and Health focus on basic science in the context of clinical cases.  Subject matter is integrated across entire biological systems with normal and abnormal processes taught in concert.  Each block is complemented by clinical immersion experiences, early contact with patients in clinical preceptorships and simulated clinical experiences. Some themes stretch longitudinally across these blocks, including anatomy, histopathology and radiology, as well as pharmacology and clinical mastery. 

  The second block - Human Blueprint - Is comprised of endocrine, reproductive development, genetics, molecular biology, and cancer biology.

  The third block - Food to Fuel -: encompasses gastro-intestinal system, nutrition, energy, metabolism and biochemistry.

  The fourth block - Homeostasis - includes cardiovascular system, pulmonary system, renal system, cell regulation, and pharmacology.

  The fifth block - Host Defense and Host Response - focuses on host defense, microbiology, blood, skin, and the auto-immune system.

  The sixth block - Cognition, Sensation and Movement - is comprised of neurosciences, mind, and the musculoskeletal system.

   

  Blocks 2-6 follow a common pattern. Each block has a Clinical Immersion Week and each has a Reflection and Integration Week. 

  ·        Clinical Immersion Week: During this 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. 

  ·        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 review 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 basic science, clinical investigation, and population-based 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 has 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 the Rotating Apprenticeships in Medical Program (RAMP).  They rotate through a variety of patient care experiences, observing the practice of health care across many different settings.
  • Community Patient Care Preceptorship (CPCP):  After completing RAMP, students select a clinical setting and a physician preceptor with whom they will work for a semester.  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. Core Clinical Rotations:   The Core Clinical rotations that begin in the spring of the 2nd year are a part of the joint clinical curriculum that is shared by both the University and College Programs.

• Basic Core Clinical Rotations: Beginning in March of their second year, students undertake their core clinical rotations: Basic Core I (Internal Medicine, and Surgery), Basic Core II (Pediatrics, OB/Gyn, and Family Medicine), and Basic Core III (neuroscience and psychiatry).Basic Cores I and II are 16 weeks and Basic Core III is 8 weeks.. 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).
• Advanced Core Rotations: These consist of 2 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 1) Aging and Society and 2) 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 the breadth and depth of health and disease, with opportunities to reinforce, build upon, and transfer knowledge and skills.  Clinical learning is integrated across disciplines whenever possible, and the roles of basic science, civic professionalism, scholarship, and population health in clinical care are addressed. Students have patient care responsibilities that are progressive in complexity and increase as their level of clinical skill and knowledge increases.   Learning objectives and assessment methods are the same for a given rotation, regardless of the clinical site.

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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.

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THE ELECTRONIC CURRICULUM

The School of Medicine has developed an 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.