Stanford University (School of Medicine)

The School of Medicine is interested in identifying candidates who are committed to serving the needs of all members of society, and whose accomplishments reveal originality and a capacity for independent, critical thinking. Our students are best characterized by a strong desire to develop into exceptional clinicians, leaders of the profession, and innovators in biomedical science, public health and clinical care.

Any undergraduate major is acceptable for candidates to the school, but a great enthusiasm for your chosen area of interest is a prerequisite for admission. We value applications from students who have tested their desire to work in the health-care environment, in the laboratory and in community service – particularly with those in greatest need.

The Stanford School of Medicine is devoted both to promoting the health of our community and to the advancement of the frontiers of clinical medicine. As the oldest medical school in the western United States, we have an illustrious history of providing innovative, skilled patient care. Now with more than 600 full-time faculty in the life sciences and in virtually every specialty and subspecialty, our clinical science departments offer leading-edge diagnostics and therapies to patients. Intrinsic to our mission is the recognition that only through the early adoption of novel approaches to fundamental biological problems, such as cancer and vascular disease, can we offer the high level of care that our patients so richly deserve. Highlights of some of our breakthrough contributions to clinical care include:

* The first use of a linear accelerator in the Western
hemisphere to treat cancer
* The first successful human heart transplant in the
United States
* The first successful heart-lung transplant in the
world
* The first curative combination-chemotherapy
regimen for Hodgkin’s disease
* Development of genetically engineered vaccines to
enhance the immune response to some types of
lymphomas

Through collaborations with laboratory researchers, we also actively translate very basic discoveries into diagnostic and therapeutic applications at the bedside. Our biomedical scientists were the first to synthesize biologically active DNA in a test tube, setting the stage for the genetically engineered, biologically active therapies now used worldwide. More recently our bioscientists developed microarray technology that allows researchers to determine what genes are active in coding for diseases as diverse as cancer and rheumatologic disorders.

With an eye to the enormous promise of translating laboratory discoveries into treatments for patients, we are now establishing four institutes to facilitate collaboration between scientists and clinicians in the most crucial fields of human disease: stem cells and cancer; neurosciences; immunology, transplantation biology and infections; and cardiovascular disease. We expect to derive from these efforts the much-needed breakthroughs to cure the maladies that have plagued the world’s population for millennia.

The CAP directory provides an easy-to-use interface through which people-both inside and outside of the Stanford community-can learn about the far-ranging and innovative research taking place across the School of Medicine. This ever-evolving collection of profiles offers a comprehensive overview of the research interests of faculty and principal investigators, their publications, curricula vitae and more. By connecting researchers, clinicians, students and laypersons with common interests, CAP helps foster the interdisciplinary exchanges and break-through discoveries that will define the 21st century.

A robust research program has long been a defining element of the School of Medicine. CAP presently houses profiles for nearly 1200 researchers from 16 clinical and 11 basic science departments. Every day these individuals delve into unsolved problems in the basic and clinical sciences, engineering and other fields to expand human knowledge. Ongoing collaborations between scientists and clinicians are in turn transforming these discoveries into new technologies, treatments and policies to improve the health of children and adults worldwide.

Stanford has a tradition of recruiting students who have passionate interests and vast creativity. It is our mission to develop and direct our students’ skills and passion so they can become outstanding clinicians who improve the health of the world’s people through research, innovation, and leadership. We are committed to ensuring that each graduate has fully explored his/her potential as a student and a scholar. To this end, key goals of the curriculum are the melding of 21st century laboratory and medical sciences, and helping each student build in-depth expertise in an area of personal, scholarly interest. Following an intensive process to delineate the core knowledge every medical student requires, an exciting medical curriculum has been developed to meet these goals. The expansion of the information and learning environment at Stanford supports this curriculum as part of the transforming role of technology and information resources in academic medicine.

The following goals for the MD degree program of the Stanford University School of Medicine were revised and approved by the Medical School Faculty Senate on June 14, 2000, reflecting a commitment to educate future physicians and foster their capacity to make discoveries and lead innovation in the science and practice of medicine:

1.To assure excellence in clinical medicine with
emphasis on:
• Understanding the traditional and emerging areas of
biomedical and clinical sciences, including the
etiology, prevention, diagnosis, and treatment of
disease
• Understanding the scientific theory and methodology
that form the basis of medical discoveries
• Utilizing opportunities to explore research and
teaching, both broadly defined, in various branches
of medicine, with access to the full resources of
Stanford University
• Using technology to manage information and
knowledge effectively and efficiently

2. To develop effective communication skills with
patients, colleagues, and the public

3. To promote leadership training in the various
branches of medicine

4. To promote ethical and moral behavior, the humane
and caring practice of medicine, and a sense of
obligation to improve the health of the public

5. To promote delivery of health care that appropriately
responds to the social, cultural, and health system
context within which the care is delivered

6. To teach the skills necessary to sustain a lifetime of
learning

The Stanford MD curriculum integrates basic science and clinical experience with in-depth study and independent research throughout the years of medical school. Other major themes of the new curriculum include:

* Integration
o Streamlined content and optimized course
sequence
o Melding of basic science and clinical concepts
throughout the curriculum
* Individual Opportunities
o Blocks of unscheduled time for individual or group
study, elective coursework, and research
o Option of a fifth or sixth year of study and
opportunities for earning joint degrees
*Scholarly Concentrations
o Area of academic focus, or "major," designed to
ground the student's education in an area of
passionate interest
o Enhance student satisfaction with the study of
medicine and foster a lifelong commitment to
investigation and cross-disciplinary thinking
* Strengthening of doctor-patient communication and
clinical skills instruction
o Broad clinical science education in the first two
years with early exposure to patient care and the
practice of medicine
o Early entry into clinical clerkships
o Broader emphasis on doctor-patient
communication, ethics, and the art of medicine
* Advising and Mentoring
o Mentors for each student help develop the
student's personal and professional goals
o An enhanced advising program to proactively
assist students through the rigors of medical
school and career planning

Basic and clinical sciences and scholarly work are woven together throughout all years of medical education. The barriers among these disciplines are broken down by mixing elements of investigation, basic science, and clinical practice within individualized educational blocks called scholarly concentrations.

The Stanford School of Medicine is an integral part of a vibrant university community that offers a remarkable array of intellectual, cultural and recreational opportunities. Gathered together on one campus, the world-renowned schools of Medicine, Business, Law, Earth Sciences, Education, Engineering, and Humanities & Sciences share more than lecture auditoriums and research labs, but also cafes, gyms, bike paths, horse stables, museum exhibits and music halls.

The university's student body of more than 14,000 (split almost evenly between undergraduate and graduate students) and its distinguished faculty of over 1,700 enjoy a spirit of creative collaboration that promotes outstanding academic and artistic achievement. Volunteerism is also an important part of Stanford life, and many students seek or create service opportunities outside the campus to address the needs of local communities.

The School of Medicine has many partners, both on and off campus, with whom we develop and present challenging opportunities:

* The hospital and clinics of the prestigious Stanford Medical Center, as well as nearby Palo Alto Veterans Affairs Health Care System and county medical facilities, provide unparalleled opportunities in clinical patient care.
* Physician-scholars undertake scientific investigation in some of the country’s top graduate biomedical research programs at the medical school and on Stanford’s main campus
* Students may pursue concurrent graduate degrees at other schools at Stanford or through programs at other universities.
* Stanford’s Learning Tech team leads the nation in developing cutting-edge technologies for biomedical education.

The hallmark of the new curriculum is the Scholarly Concentration, a curriculum component similar to a major, that is designed to promote integration of biomedical science, clinical medicine, and applied investigation while validating each student’s reasons for choosing medical school (i.e., scientific discovery, patient advocacy, clinical leadership, community service). Although this central element is new, it is only one of many revised curricular elements. The new curriculum also incorporates new defined learning blocks, each of which is designed to integrate basic and sciences from the beginning through to the end of the medical school years, improves course sequencing, increases time spent in direct patient-oriented learning, and ensures in-depth coverage of important, cross-disciplinary clinical elements (cultural competence, ethics, substance abuse, geriatrics, death and dying, etc.).

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School of Medicine Medical School Location

School of Medicine Courses

FIRST YEAR COURSES

FOUNDATIONS OF MEDICINE I :
• Cells to Tissues :Focuses on the cell biology and structural organization of human tissues as self-renewing systems. Topics include identification and differentiation of stem cells, regulation of the cell cycle and apoptosis in normal and cancerous cells, cell adhesion and polarity in epithelial tissues, intracellular transport, and cell migration. Histology laboratory sessions examine normal and abnormal samples of blood, epithelia, skin, connective tissue, muscle, bone and cartilage. Patient presentations and small group discussions of current medical literature illustrate how cell biology influences medical practice.

• Molecular Foundations of Medicine : Topics include: DNA structure, replication, repair, and recombination; chromosome structure and function; gene expression including mechanisms for regulating transcription and translation; and methods for manipulating DNA, RNA, and proteins. Patient presentations illustrate how molecular biology affects the practice of medicine.

• Genetics : Theoretical and experimental basis for the genetics of human health and disease. Molecular, chromosomal, biochemical, developmental, cancer, and medical genetics, emphasizing the last. Clinical case discussions. Prerequisites: biochemistry; basic genetics.

• Development & Disease Mechanisms : Mechanisms that direct human development from conception to birth. Conserved molecular and cellular pathways regulate tissue and organ development; errors in these pathways result in congenital anomalies and human diseases. Topics: molecules regulating development, cell induction, developmental gene regulation, cell migration, programmed cell death, pattern formation, stem cells, cell lineage, and development of major organ systems. Emphasis on links between development and clinically significant topics including infertility, assisted reproductive technologies, contraception, prenatal diagnosis, multiparity, teratogenesis, inherited birth defects, fetal therapy, adolescence, cancer, and aging.

• Practice of Medicine I : The Practice of Medicine extends throughout the first two years of medical school, interweaving core skills training in history-taking and the physical examination with four major threads addressing the context of medical practice: computers in the medical environment, nutrition principles, quantitative medicine, and the physician in society. Throughout the curriculum, clinical correlations map directly back to the basic science content, whether in gross anatomy, molecular foundations of biology, or physiology. In the second year, problem-based learning cases apply the anatomy, biochemistry, pharmacology, and physiology to clinical scenarios. Computers in the medical environment introduces students to informatics and knowledge management in its practical and theoretical applications. Designed to support research in the scholarly concentrations and information needs in clinical experiences, the curriculum includes traditional information retrieval-management instruction, introduction to biomedical informatics, evidence based medicine searching, and knowledge management. Nutrition principles are acquired through web-based instruction for self-paced learning. Quantitative Medicine focuses on clinical and epidemiological studies. Students learn how to critically read a journal article and how to recognize and understand the concepts behind different clinical study designs. Topics include bias, confounding, diagnostic testing and screening, and "how statistics can lie." Additional emphasis is placed on topics pertaining to the physician's role in society, including basic principles of health care policy, covering such topics as costs, access, measurement and improvement of quality, regulation and health care reform, bioethics of confidentiality, informed consent, constrained resources, rationing of care, cost containment, and patient advocacy.

FOUNDATIONS OF MEDICINE II
• The Nervous System : Introduction to the structure and function of the nervous system, including neuroanatomy, neurophysiology, and systems neurobiology. Topics include the properties of neurons and the mechanisms and organization underlying higher functions. Framework for general work in neurology, neuropathology, clinical medicine, and for more advanced work in neurobiology. Lecture and lab components must be taken together. MD, PhD, and undergraduate students enroll for 8 units. PhD students meeting certain prerequisites can, with permission of the instructor, enroll for 7 units.

• Immunology : Basic concepts of adaptive and innate immunology and the role of the immune system in a variety of human diseases. Emphasis is on application of the fundamental concepts of human immunology. Case presentations of diseases including autoimmune diseases, infectious disease, transplantation, genetic and acquired immunodeficiencies, hypersensitivity reactions, and allergic diseases. Problem sets based on lectures and current clinical literature. Laboratory in inflammation and histology of lymphoid organs. (Medical students enroll in IMMUNOL 205 for the required 4 units.)

• Gross Anatomy of Head & Neck : Surgery 203B continues the introduction to human structure and function, introduction to the physical examination and information on frequently-used medical imaging techniques. Information is presented from a medical perspective, and is meant to prepare students to move onward in the medical curriculum. Students are required to attend lectures, actively participate in seminar groups, and engage in dissection of the human body in the anatomy laboratory. Surgery 203B presents structure of the head, neck and back.

• Practice of Medicine II : History-taking and physical examination, computers in the medical environment, nutrition principles, quantitative medicine and the physician in society are covered. S

HUMAN HEALTH & DISEASE I : Structure, function, disease, and therapeutics of the Cardiovascular System and Part 1 of the Respiratory System are covered.

• Practice of Medicine III : History-taking and physical examination, computers in the medical environment, nutrition principles, quantitative medicine and the physician in society are covered.

SECOND YEAR COURSES

HUMAN HEALTH & DISEASE II : Structure, function, disease, and therapeutics of :
• Renal/Genitourinary
• Gastrointestinal/Liver
• Endocrine/Reproductive

• Practice of Medicine IV : History-taking and physical examination, computers in the medical environment, nutrition principles, quantitative medicine and the physician in society are covered.

HUMAN HEALTH & DISEASE III : Structure, function, disease, and therapeutics of :
• Brain and Behavior
• Hematology
• Multi-Organ System

• Practice of Medicine IV : History-taking and physical examination, computers in the medical environment, nutrition principles, quantitative medicine and the physician in society are covered.

THIRD AND FOURTH YEARS

CLINICAL CLERKSHIPS :
• Internal Medicine : Teaches the natural history, pathophysiology, diagnosis, and treatment of medical illness. Emphasis is placed on acquiring the understanding, skills, and attitudes desirable in a scientific and compassionate physician. Students record histories, physical examinations, and laboratory data for patients for whom they are responsible and present their findings, together with their diagnoses and treatment plans, at rounds and conferences. Developing sound clinical reasoning skills is continuously emphasized. An essential aspect of the clerkship is the students’ gradual assumption of direct responsibility for, and full-time involvement in, patient care with the house staff and faculty team. To take advantage of the differences in patient populations and teaching staffs of the four hospitals, students spend four weeks at either SUMC or PAVAMC, and four weeks at either SCVMC in San Jose or KPMC in Santa Clara. The resulting eight week experience is an integrated curriculum designed to cover the essentials of internal medicine. The Department of Medicine supervises a random draw-based assignment to two of the four locations shortly before the beginning of each odd-numbered clerkship period. A passing grade will require a satisfactory performance at both clinical sites and standardized testing.

• Obstetrics & Gynecology : Provides the student with skills and knowledge needed to care for patients with common gynecological problems, the well-woman examination, and pregnancy from prenatal care through delivery and postpartum. The clerkship is a full-time, 6-week rotation at one of the 3 sites: Stanford University Medical Center & satellite clinics, Santa Clara Valley Medical Center, and Kaiser Santa Clara. Emphasis is placed on history and physical examination skills in the evaluation and management of pregnancy, vaginal delivery, and both office gynecology and gynecologic surgical procedures through exposure to a large number of patients in the outpatient clinics, Labor and Delivery, and the operating room. The student participates in all the academic functions of the department including conferences, grand rounds, daily lectures, and weekly case studies. A one day orientation is held at the beginning of the clerkship. A passing grade will require a satisfactory performance as well as a passing grade on the NBME exam.

• Family Medicine : Teaches the management of diseases commonly encountered in the ambulatory care setting. Emphasis is placed on efficient, cost-effective medical care of men, women and children of all ages in a variety of settings. Prevention, managed care, and cultural competence will be stressed. Didactic workshops will be conducted at SUMC and clinic sessions will be spent attending patients of one ambulatory site.

• Ambulatory Practice : The Ambulatory Medicine clerkship (AMC) combines clinic sessions in both general internal medicine and subspecialty medicine. It includes assigned readings, small group discussions, computer-assisted drills, posing and answering clinical questions with critical appraisal of the literature, and problem-based cases to reinforce principles and complexities of diagnosis and management. The didactics emphasize preventive medicine, cardiovascular, respiratory, and endocrinological disorders, and common clinical presentations in outpatient practice. * Effective P11 (2004-05), the AMC will become a required clerkship for all students by the time of graduation.

• Pediatrics : The core clerkship in pediatrics is an eight-week experience divided into four weeks on an inpatient service and four weeks in an ambulatory pediatric setting. Students spend four weeks at Lucile Packard Children's Hospital or Kaiser Santa Clara and four weeks at Santa Clara Valley Medical Center. The clerkship is designed to offer students an introduction to a wide range of clinical problems in pediatrics and a handful of basic skills needed to work with children and families. The NBME Subject Exam in Pediatrics is a required component of the clerkship.

• Psychiatry : The clerkship is designed to solidify the knowledge of psychiatry students have acquired in the Practice of Medicine courses, as students gain practical skills in the application of this knowledge to clinical situations. The core clerkship experience focuses on interviewing skills, psychiatric evaluations, on refining diagnostic skills, and offers an overview of psychosocial and biological treatment modalities for the major psychiatric disorders. The clerkship consists of clinical work on inpatient units under the supervision of academic and clinical faculty, a weekly lecture series by academic faculty, interviewing seminars taught by voluntary clinical faculty, and attendance at Grand Rounds. Students are assigned to patient care settings at one of the six affiliated sites: a comprehensive medical psychiatry unit (G2), an inpatient general psychiatry ward (H2), a geriatric psychiatry unit, the consult-liaison service at Stanford Hospital, an inpatient research psychiatric ward specializing in the study of schizophrenia or an acute locked psychiatric ward at the PAVA. Students will be given the opportunity to express their preferences regarding assignment. The final rotation assignment will be determined by the department based on availability of sites. Students will be informed about the specific clerkship requirements at the orientation offered at the start of each clerkship period. They receive a course syllabus and a psychopharmacology textbook. Students are encouraged to visit the Psychiatry clerkship website (on CWP) which lists all information containing the syllabus and teaching materials. Students are expected to complete five cases on the CaseTool site and to record cases seen by diagnostic category. Requirements include mandatory attendance at seminars, weekly inpatient case history presentations and Emergency room experiences with residents/attending psychiatrists.

• Surgery : Provides students with clinical experience in the evaluation and treatment of a wide variety of surgical diseases. Emphasis is placed on teaching students to recognize and manage basic clinical problems. Students function as active members of the surgical team, and follow patients throughout their in-patient course. Outpatient clinics provide the student with the ability to participate in the initial work-up and care plan of pre-op patients. Didactic lectures are given by faculty during the clerkship, which cover pathophysiology of various diseases and principles of surgical management. Basic surgical skills are taught in the operating room and in the emergency department setting. The clerkship offers an opportunity for students to integrate their knowledge of anatomy, physiology and physical diagnosis into a treatment plan for patients with surgical diseases. Each student spends one four-week rotation at SHS or the PAVAMC and one four-week period at SCVMC or KPMC, Santa Clara. Rotation assignments are made on the first day of the clerkship. A one day orientation is held at the beginning of the eight week period.

• Neurology : The Neurology Clerkship will train students in the evaluation and treatment of neurological diseases and symptoms in a variety of potential settings. On the first day of the clerkship, students will select or be assigned to one of the following locations for Neurology training: Stanford Ward/consultation service; the Palo Alto Veterans Administration Ward/Consultation/Clinics service; Santa Clara Valley Medical Center Neurology consultation and clinic service; Stanford Clinic service; Stanford Pediatric Consultation and Clinic service; Neurology Intensive Care Unit Consultation service; Neurosurgery/Neurology inpatient and clinic Service; the Palo Alto Medical Foundation Clinic (not available all months). All of these venues will satisfy the core graduation requirement for Neurology. A description of the different venues can be found in the CWP-Fishbowl system online or by contacting the Clerkship Director's office (Dr. Fisher, Administrator Ms. Christine Hopkins at 725-6648 or [email protected]). Responsibilities will differ among the different clerkship venues, but a common core of teaching will be presented to all students. All participating students will be expected to attend the common core of teaching, except for Santa Clara Valley students, where teaching will be performed locally. By the end of the clerkship, the students will know how to do a screening neurological exam and will have increased practical knowledge of important conditions affecting the nervous system.

• Critical Care : This required clerkship provides experience managing patients in a critical care unit. Students learn how to optimize care for the acutely ill patient and the multidisciplinary approach to complex patients. Teaching emphasizes the review of basic organ physiology, the ability to determine the pathophysiologic mechanisms involved in critical illness, and the formulation of a physiologic based treatment plan. Students gain experience with the implementation of monitoring and therapeutic devices used in the intensive care units and begin to become adept at the evaluation, stabilization and management of the most critically ill patients expected to be encountered in today's acute care hospitals. Ward rounds, bedside evaluation and treatment, and individual interactions with attending, fellows and residents are part of the educational process. Students indicate their preference for either an adult or pediatric or neonatal critical care experience based on career interests by selecting either 306A for adult or 306P for pediatric or 306N for neonatal . Assignments will be made either to the Stanford Medical-Surgical ICU Service, Stanford Surgical ICU Service, Palo Alto Veterans Administration Hospital Medical-Surgical ICU Service, Packard Pediatric ICU Service or Packard Neonatal ICU Service. Students’ expressed desires as to location will be given consideration but cannot be guaranteed. Students must attend mandatory simulator course in order to receive passing grade for this clerkship.

• Subinternship

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