Medical Student Education

First Two Years

The Art and Science of Medicine

The Art and Science of Medicine (ASM), a course for 1st and 2nd year students, focuses on history-taking and physical diagnosis skills within a context of topics that include cultural competence, medical ethics, health care economics, communication skills, and an understanding of illness from the patient’s perspective. ASM runs through the entire first two years of medical school. Dr. Valerie Parkas, Assistant Professor in the Department of Medicine, is 1st year Course Director; Dr. Rainier P. Soriano is the 2nd year Course Director. Ms. Judith Quintana is the ASM Course Manager.

ASM I

Students meet weekly in small groups with 2 assigned preceptors (minimum, one physician and one member of the healthcare faculty). They also spend a significant amount of time gaining field experience and clinical exposure in the outpatient setting, either in a physician’s office or clinic to practice clinical skills (e.g., history taking and physical exam). Approximately 25% of its course content and over 25% of the preceptors are related to geriatrics and gerontology.

Some of the educational activities related to aging include “Impact of Illness,” a one hour introduction to the basic science of aging changes in vision and hearing followed by an interactive small group workshop on “Aging from the Outside In,” led by geriatrics faculty. The goals of the various exercises include sensitizing students to the diverse patterns of everyday living of older adults; understanding that some sensory changes are due to disease, not aging, and how such changes need to be considered in working with older adults; and an appreciation for how health care patterns and worries of older persons differ from their own. In another exercise, students were divided into 3 member teams (patient, caregiver, observer roles). The “patient” was assigned an ailment and then expected to perform a daily task (such as mailing a letter, going to a museum, picking up a prescription); many of these “ailments” were common to the geriatrics population (e.g., arthritis, blindness, stroke, wheelchair bound). Students also observe and discuss in small group settings a range of community and social health sites, including senior centers and senior day programs.

In addition, the course attempts to improve students’ understanding of the organization of the health-care delivery system. Students receive an overview of the history of the health-care system, with particular attention to Medicare and Medicaid. To stimulate discussion, case studies are used reflecting viewpoints of older and younger adults, as well as corporations, regarding access, cost, and quality of care.

Later during the first-year course, students learn the skills they will need to examine, respectively, their patients’ cardiovascular, pulmonary, and abdominal systems. Many modalities are used to introduce new techniques, including small group discussion, role-play, demonstrations, and practice sessions with student-to-student and student-to-patient examinations. At clinical sites, students practice skills learned in the classroom under the supervision of field preceptors. Students participate in physical examination rounds in the hospital and a standardized patient review session.

Towards the end of the first year of ASM, students are introduced to and practice taking a sexual history, including from an older adult, and students and preceptors discuss Professionalism, including communication and attitude concerns in the young physician-older patient relationship.

A start-stop video of 3 standardized patients (one young, one middle-aged, one elderly) is used for the mid-term exam to test students’ communication skills, history-taking skills, and recognition of what it feels like to be sick from the patient’s perspective.

ASM II

This second year of ASM has as its basis the continuation of the history and physical exam started in Year I. In ASM II, gender and phase-of-life (geriatrics) issues have been added to all lectures and small group discussions about the physical exam, and the difference in the exam of an older patient will be highlighted. Students examine older patients in the hospital setting, with a special emphasis on functional assessment during this second-year course.

Various other components are included to prepare students to be lifelong learners and physicians. A caregiver section is introduced early in the first semester to continue to emphasize the human component of disease, including panel discussions, small group discussions, and role plays around caregiving issues and the physician interactions with caregivers in a team setting. The middle portion of the year will focus on genetics (including ApoE4), complementing the students’ learning of history taking skills. The last portion of the year will focus on Ethics.