Curriculum Medical Education Council The Medical Education Council (MEC) holds the overall responsibility for design, management, and evaluation of the College’s medical education program. Phases of the Curriculum Einstein’s curriculum is always on the move, blending innovative modern educational strategies with the best of traditional teaching methods. The preclerkship phase is designed to integrate basic, clinical and health system sciences. Although the pre-clerkship phase is devoted primarily to interdisciplinary biomedical science courses, we begin immersing students in patient-centered experiences within a few weeks after matriculation. We are adding more active instructional methods such as problem-based learning and team-based learning to maximize student knowledge, skills, and attitudes, and reducing the hours of passive lectures. The case-based, small-group conference is a dominant feature of pre-clerkship courses. Pre-clerkship electives include Current Topics in Biomedicine, Medical Mandarin, Medical Spanish, and Nutrition. Successful completion of any of these electives is noted on the student’s transcript. During the clerkship phase, students learn how to apply biomedical science knowledge and clinical skills to problems of human disease and illness in both inpatient and outpatient settings rotating through clerkships in foundational clinical disciplines. Required clerkships expose students to the gamut of medicine through Internal Medicine, Surgery, Pediatrics, Psychiatry/Neurology, Obstetrics and Gynecology, Family Medicine/Primary Care, , as well as small-group case-based conferences dealing with issues of structural determinants of health, disease prevention, ethics, and professionalism. The professional development phase is approximately 18 months and afford students the opportunity to hone in on a specialty. This phase consists of two required Acting Internships, as well as several selectives and clinical or classroom electives that students take either at a local affiliate, across the United States, or around the world. As inter-disciplinary and inter-professional medicine are critically important to effective healthcare delivery, Einstein has a longitudinal theme program, Population Health and the Practice of Medicine, that incorporates into all its courses and clerkships training on how to practice medicine in an ever changing and complex 21st century health care system. Our Health Systems Science and Health Equity course further focuses on essential topics of health care infrastructure and delivery as well as the impact of structural determents of health and bias on patient experiences and outcomes of disease. As a requirement for graduation, all students must submit a scholarly paper based on mentor-guided research. This can be an opportunity to learn about a new field or to delve more deeply into an established area of interest. Students can write a research paper, a basic science review, a formal systematic review, a case report, or a paper based on a bioethical issue in medicine or research. These papers can be based on global health experiences, bench work, or library research resulting in a systematic review of existing medical literature. Under heading “Electives and Enrichment Programs”, replace Electives in Years 1&2 with Pre-Clerkship Electives. Remove “Cooking Healthily, Efficiently, and with Fresh Foods (CHEFF)” – we no longer offer this. Replace “Electives in Years 4” with Clinical Electives. Remove heading, “Longitudinal Curriculum Themes” and all the content following this heading. Since the Albert Einstein College of Medicine is also a premier biomedical research institution, most students devote a portion of their time at Einstein to research projects that range from as little as eight weeks to as much as an entire year. Some enroll in MPH or MS programs. Students also compete successfully in national fellowship programs such as those sponsored by the Howard Hughes Medical Institute or NIH. Visit the web pages of Einstein’s Office of Medical Student Research to find out more about the research opportunities available as well as the scholarly paper guidelines. Pre-Clerkship Curriculum To assist students in successfully achieving the Einstein Educational Competencies, the 18-month pre-clerkship phase delivers a curriculum consisting of formal and informal programs that nurture students’ human values. Einstein believes that medical education should try to simulate the real world of medicine by fostering an atmosphere of collegiality and cooperation. We try to remove competition by grading all courses on a pass/fail basis. The pre-clerkship education at Einstein provides students with the opportunity to acquire appropriate knowledge bases in biological and behavioral sciences, population sciences, and the mechanisms of disease. The program allows students to achieve competence in clinical examination and effective communication skills. Students learn how to apply knowledge and skills to diagnose, treat, and prevent human disease; to understand the importance of non-biological factors that influence health in diverse populations; and to advocate for patients. As inter-disciplinary and inter-professional medicine gains a foothold in the world today, Einstein is implementing a longitudinal theme program that incorporates into its courses current events and changes in the medical delivery system. The pre-clerkship curriculum structure consists of interdisciplinary courses that reflect major unifying themes and concepts of modern biology, linkages between different biomedical science disciplines, and applications of basic knowledge to diagnosis, prevention, and treatment of human disease as well as a rich exploration of health system science, health equity, and community service. For example, Molecular and Cellular Foundations of Medicine integrates concepts in cell biology, biochemistry, immunology, genetics, general physiology, and pharmacology. And Nervous System and Human Behavior brings together topics in neuroscience, neuropathology, psychopathology, and pharmacology of the central nervous system. Organ system courses integrate relevant organ system physiology, anatomic pathology, pathophysiology, pharmacology, radiology, and epidemiology. The Infectious Diseases course provides an integrated view of microbial biology and disease together with an understanding of pharmacologic interventions; anatomic pathology correlates of certain infectious diseases have also been incorporated into the course. Foundations for Epidemiology and Biostatistics introduces students to concepts and problems in population health, epidemiology, and clinical epidemiology, as well as offering a bootcamp in Biostatics. The Health Systems Sciences and Health Equity course provides students with the skills to understand the communities they work in and the medical training they will receive in the context of broader social, environmental, and institutional lenses. Service learning within our communities will further foster students’ knowledge of the structural determinants adversely affecting the wellness and access to care by the diverse individuals in the Bronx. The pre-clerkship curriculum process focuses on case-based conferences, with group sizes ranging from 10 to 25, in almost all courses. Although conducted in different ways ranging from the problem-based to team-based learning to case method approach, all case conferences require students to prepare, collaborate, and participate. The aim is for students to work cooperatively toward the solution of clinical problems of varying complexity, with assistance from faculty facilitators, when necessary, and in so doing acquire and hone skills needed for lifelong self-directed learning. About half of the pre-clerkship curriculum consists of case conferences, clinical encounters, and other interactive educational strategies. The mix of lecture- and student-centered strategies is a reasonably balanced one, providing individual students the opportunity to express their own learning style and achieve course objectives through the utilization of different learning approaches. Although all our pre-clerkship courses expose students to clinical issues and problems in varying degrees, it is in the Introduction to Clinical Medicine (ICM) program where students specifically focus on acquiring the knowledge and skills needed for effective interaction with the patient and the health care system. Hallmarks of the course are the clinical experiences and small-group discussions that enable students to develop an integrated approach to history-taking, interviewing skills, and the clinical examination. In addition to teaching knowledge and skills, the ICM program aims to nurture attitudes needed for respectful and compassionate interaction with patients and their families, help students to understand and appreciate the sociocultural context of illness and disease, and teach students the principles and concepts needed to deal effectively with issues and dilemmas in medical ethics. Clinical Curriculum Transition to Clerkships The transition from the pre-clerkship experience to patient care is facilitated by a structured program. The five-week curriculum includes instruction in clinical radiology, active learning in high yield content areas in the core clerkships, coaching in note writing, clinical reasoning, effective use of the electronic medical record, cultural competency, and more. The tools learned during the transition curriculum enhance student success in clerkships. Clerkships The clerkship phase of the curriculum is currently constructed to allow students to take United States Medical Licensing Examination (USMLE) Step 1 prior to, or immediately after, their clerkship experience. However, we will be shifting the USMLE series to after clerkships once the Step 1 changes to Pass/Fail scoring. The core clerkships are internal medicine, general surgery, pediatrics, psychiatry and neurology, obstetrics and gynecology, and family medicine and primary care. During this important phase of medical education, the students become virtually nearly full-time inhabitants of the various public and private health care affiliates of Einstein where they learn to take responsibility for patient care - under supervision - and interact with attending physicians, residents, nurses, social workers, and physician assistants, as part of the learning process. Learning experiences during clerkship training are diverse and include conferences, seminars, lectures, demonstrations, ward rounds and grand rounds. But the essence of this training is, above all, interaction with patients in both inpatient and ambulatory patient environments. It is primarily through direct encounters with patients that students learn a systematic approach to patient care based upon accurate and comprehensive histories, thorough physical examinations, proper analysis and interpretation of laboratory and imaging data, understanding of disease mechanisms, formulation of rational therapeutic goals, and careful evaluation of treatment effectiveness. While attending to the patient's medical problems, the students are also expected to be considerate and compassionate, appreciate the influence of sociocultural and economic factors on the patient and family, acquire understanding of ethical issues in clinical decision-making, and practice high standards of professional behavior. Each clerkship is 6 weeks in duration and there are 4 vacation periods that are the same for all students: a week in the fall, a two week vacation around New Year’s, a week in late winter/spring, and a week after the last clerkship. At the end of year three, all students participate in a six-hour Clinical Skills Assessment, where faculty review each student's encounter and provide formative feedback. Professional Development Phase During the professional development phase, all students are required to complete two 4-week acting internships. Functioning as an integral member of the patient-care team, the acting intern assumes many of the responsibilities of a first-year resident under supervision of the resident and attending physician staff. One of the acting internships must be in internal medicine or pediatrics and the second can be in internal medicine, obstetrics, pediatrics, or surgery. Students pursuing family medicine training can perform acting internships in in patient family medicine. A major part of the senior year is the elective period. Students choose from a wide selection of electives offered by nearly every department. Through the elective program, a student may choose to obtain additional acting internship experiences, further training in ambulatory medicine and primary care, or participate in a research project. Electives in clinical specialties such as cardiology, infectious disease, endocrinology, dermatology, nephrology, gastroenterology, pulmonary medicine, and emergency medicine are very popular. Also available are programs in community medicine, drug abuse, alcoholism, and geriatrics. Students may arrange to take the elective in other medical schools in the United States or abroad. Funding may be available for students to travel abroad to participate in exchange programs with overseas medical schools or obtain clinical or research experience in less developed nations. Students also complete USMLE Step 2 Clinical Knowledge and Step 2 Clinical Skills. Highlights of the clinical curriculum include: During clerkship rotations in the third year, students from different clerkships gather together in small groups to participate in case-based discussions of topics and issues in prevention, professionalism, and ethics in Patients, Doctors, and Communities course. Seminars and conferences on topics at the cutting edge of the scientific foundations of medicine are scheduled during third year clerkships. There is enhanced emphasis on learning the fundamental skills of the physician-patient interaction, ensuring that students are adequately observed during the clinical encounter and assessing students' competence in this encounter. A Population Health and Practice of Medicine theme curriculum has integrated concepts of community medicine, health economics, health care systems, inter-professional team care, practice management, quality improvement, and safety sciences into clerkships. Electives and Enrichment Programs The Albert Einstein College of Medicine encourages its students to become involved in projects and programs that improve the health of communities and promote appreciation for the social role and responsibilities of practicing physicians. For additional information about student clubs and organizations, visit Student Organizations (Einstein Umbrella). Electives in the Pre-Clerkship Phase Medical Spanish Program The large and still growing population of Spanish speaking persons in this nation, particularly in many of its largest cities, compels all US medical schools to provide future physicians with at least a basic level of competence in conversational Spanish. The Medical Spanish program at Einstein has been evolving over a period of more than 25 years, and is still changing to meet students’ needs. In the current program, students begin language classes in the first year and continue to practice and expand language-building skills throughout the second year. Classes are offered at beginning, intermediate and advanced levels. Medical Mandarin Program There is a large and ever-growing population of Mandarin speaking persons in the Bronx as well as at several of Einstein’s clinical affiliates. To meet this need, Einstein offers a one-semester elective in Medical Mandarin. The student must have a conversational knowledge of the language since the 19-session course immerses immediately into medical terminology and interviewing techniques. Implicit Bias Recognition and Management Students who are interested in learning how to recognize and manage our implicit biases (the unintentional, unconscious assumptions we all make) in both clinical and nonclinical interactions should sign up for this course. Instructional strategies include interactive didactics, video review and discussion, role-playing with structured debrief, and instruction in delivering feedback to improve innovations. Nutrition and Health: Patients and Populations This elective provides students with an understanding of the USDA Dietary Guidelines, nutrition assessment and effectiveness of popular diets. Other topics include integration of motivational interviewing in discussions of nutrition & lifestyle issues with patients. Students also learn how to discuss the Nutrition Facts labels with patients with limited English literacy. Cooking Healthily, Efficiently, and with Fresh Foods (CHEFF) This elective is a six-session cooking course intended to help medical students become better and healthier cooks as well as give them the tools to help their patients create healthier lifestyles. Quality Improvement 101: Using the Model for Improvement to Self-Improve This three session elective will teach first-year medical students the Model for Improvement, which is the cornerstone of all quality improvement work. Students will use their own experiences and desire to self-improve as models to learn and understand the Model for Improvement and other quality improvement tools. Students will also plan a personal quality improvement project, collect data, carry out PDSA cycles and workshop ways to improve their own processes and systems. These skills will leave students better positioned to perform quality improvement throughout their careers as physicians and ensure they deliver high quality care to every patient, every time. Current Topics in Biochemistry, Genetics, Pathology, and Pharmacology: A student-directed independent learning course “Current Topics” is intended to encourage students to pursue topics of their interest and to share their findings and receive feedback from peers and selected faculty. Any topic involving science and medicine is possible, such as: precision medicine; drug development; cancer immunotherapy; the human-microbiome ecosystem in health and disease; and epigenetics. Electives in the Professional Development Phase Einstein offers a comprehensive selection of fourth-year electives for its students as well as for visiting students. The listing includes a description of the program and registration procedures. Enrichment Programs The Einstein Community Health Outreach (ECHO) is a free clinic staffed by Einstein student volunteers under the supervision of board-certified physicians specializing in Family Medicine or certified Family Nurse Practitioners. The ECHO Free Clinic provides high-quality, comprehensive health care to the uninsured population of the Bronx. ECHO embraces the spirit of volunteerism and service embodied in our health care professionals and student volunteers. The clinic is open on Saturdays throughout the year, and students at all levels of their medical education volunteer to assist in patient care. For information about volunteer opportunities, please visit Einstein Community Health Outreach (ECHO). The Service Learning Program oversees Einstein’s Community Action Network (CAN), a collaboration of Einstein medical students, faculty, and communities in the Bronx. Einstein CAN groups promote services and provide advocacy for vulnerable populations in the Bronx. We support our students who want to make a difference in the community by serving as a clearinghouse for information and opportunities, providing guidance, assisting with logistical issues, and offering training, workshops, and seminars to develop leadership and other skills necessary for community engagement. For information about volunteer opportunities, please visit Service Learning. Social Medicine Course - Since 1998, students have planned and organized this annual winter-spring elective lecture series inviting speakers from Einstein and elsewhere to inform students about current issues in medical ethics, health economics, health policy and various other topics dealing with health and disease from a socio-economic perspective. Topics covered in the course have included: the practice of social medicine, correctional health, community-based clinics, the ethics of stem cell research, medical waste, drug policy in the US, no free lunch, healthcare for people with disabilities, the politics of abortion, gun violence, elder abuse, race/ethnicity and unequal treatment, refugee health, liberation medicine, and war as a public health problem. The lectures aim to encourage discussion and a sharing of ideas among those in attendance. The course welcomes student volunteers from all classes. Healer’s Art Course - This annual winter elective planned especially for first-year students addresses the hidden crisis in medicine: the growing loss of meaning and commitment experienced by physicians nationwide under the stresses of today’s health care system. The Healer's Art is a process-based curriculum that enables the formation of a community of inquiry between students and faculty helping students perceive the personal and universal meaning in their daily experience of medicine. The course consists of five three-hour evening sessions spaced roughly two weeks apart, each divided into large-group presentations, small-group discussions, and exercises. The Healer’s Art curriculum was designed by Rachel Naomi Remen, M.D., Director of the Institute for the Study of Health and Illness at Commonweal, and Professor of Family and Community Medicine at the University of California, San Francisco (UCSF) School of Medicine. Longitudinal Curriculum Themes Thematic curricula are not distinct courses or clerkships. These critical topics in health care are integrated into existing courses and clerkships across all four years of training. The content is taught as part of didactics, small group discussions, case-based learning, or team-based learning sessions. Student competencies related to these special subjects are also assessed within the existing educational programs. Population Health and The Practice of Medicine (PHPM) Medicine and the U.S. health care system are rapidly transforming. Today’s physicians must achieve competencies beyond the knowledge of basic science principles, sound clinical reasoning, and effective communication skills. Modern doctors must be prepared to achieve competencies on the population aspects of medical practice. Doctors must identify strategies that benefit from the integration of public health and clinical medicine approaches, such as the prevention and surveillance of chronic conditions. Physicians must work collaboratively with individuals from other health professions to provide more efficient, safe, equitable, and cost-effective team-based care. Physicians must also practice behaviors that decrease inflated health care costs to patients, families, and society. The Population Health and the Practice of Medicine (PHPM) theme curriculum was developed to train Einstein medical students to practice in an evolving and complex 21st century health care system. The PHPM Educational Goals: The student will: Understand the role of psychological, socioeconomic, environmental, cultural, and other social factors in determining the health status and health care of individuals and populations. Understand the role of public health and innovative public health interventions in promoting population health. Apply relevant principles and methods of public health to the practice of medicine. Access public health, social services, and community-based resources needed to address both health and psychosocial needs of patients. Apply fundamental approaches to quality improvement and patient safety in health care. Discuss healthcare economics and financing. Be aware of their responsibility in practicing value-added care (e.g., evidence-based, cost effective, patient-centered). Work effectively as a member of inter-professional health care teams to improve health care outcomes. Explore the legal, regulatory, and business realities of modern medical practice. This four-year theme curriculum is organized under ten PHPM sub-domains: Public Health and Medicine Health Disparities and Determinants of Health Community, Occupational and Environmental Health Health Care and Quality Improvement Enhancing Patient Safety in Medicine Inter-professional (IP) Team Health Care and Training Medical Economics Health Care Systems Practice Management Law and Medicine The aim of the PHPM curriculum is to produce future physicians who can meet their societal obligations to promote health and prevent disease, and advocate for patients and families. The PHPM theme curriculum will enable Einstein students to provide care not just in their individual practices, but also at community, society, and global levels. Students will be able to navigate patients and communities through health system complexities.