State University of New York at Brooklyn (Downstate College of Medicine)

The State University of New York (SUNY) Downstate Medical Center, is a major provider of medical education, health care, and research in the New York City region. Located on an urban campus in Brooklyn, SUNY Downstate Medical Center includes a College of Medicine, College of Health Related Professions, College of Nursing, School of Graduate Studies, and the 372 bed University Hospital of Brooklyn. Approximately 1500 students pursue certificates, Bachelor of Science, Master of Science, Ph.D. and M.D. degrees.

The Center is heir to a tradition that began more than a century ago, with the founding in 1860 of the Long Island College Hospital - this country's first teaching hospital and the prototype for all subsequent medical centers. SUNY Downstate Medical Center has a three-fold mandate: education to train physicians, nurses, research scientists and allied health professionals; research in the medical sciences; and the provision of clinical care to the population of New York State.

This complex organization serves the needs of a larger and more diverse urban constituency than any other such center in the country. It upholds a special responsibility to solve difficult problems found primarily in urban areas, and to serve those who are underserved.

SUNY Downstate's College of Medicine, Health Related Professions, Nursing and its School of Graduate Studies offer students a broad professional education that will prepare them for practice or careers in any location and community. This education provides exceptional opportunities for those students with a commitment to promoting health in urban communities and addressing the complex challenges of investigating and preventing diseases that confront clinicians, educators, and researchers in such an environment. This special aspect of Downstate's unique mission is reflected in the students it attracts and selects, the vast majority of whom are drawn from the New York City Metropolitan area. Many of these students are members of minority and cultural groups underrepresented in the health professions, and/or come from families of first-generation immigrants or from economically disadvantaged backgrounds.

The differences in the background and outlook that students bring with them can enhance the quality of the educational experience of all students at SUNY Downstate. The belief that diversity adds an essential ingredient to the educational process is one of the tenets of SUNY Downstate. Many factors, such as race, ethnic or cultural background, academic achievement, geographic location, diversity of experiences, leadership roles, and socioeconomic background, are taken into consideration in the admissions process. A diverse health care work force will be better equipped to provide culturally competent care to an increasingly diverse population.

SUNY Downstate Medical Center has many facilities for education and training students. Students receive a well-rounded didactic and clinical experience which will prepare them for whatever field of expertise they choose to enter.

The Health Science Education Building (HSEB) houses classrooms, laboratories, a 500 seat auditorium, and the Medical Research Library of Brooklyn. Included in the HSEB are two floors of study carrels, which serve as "home base" for medical students during their first two years. The carrels are located in multidisciplinary laboratory sites. The arrangement fosters small-group learning. The carrels, with lockable storage and two computers, are equipped with power and data lines, which can enable students to connect computers to the library's computerized data bases.

The primary goal of the College of Medicine is to graduate excellent physicians who will take their place in one of the many facets of medicine. Whether the student's ultimate goal is general or specialty practice, research, medical administration or academic medicine, the College provides a comprehensive educational experience for all students.

The educational objectives of the curriculum are intended to provide students with the basics that they will need to embark upon graduate medical education in the field of their choice, and ultimately to become competent and compassionate physicians. To achieve these objectives, the College has set standards of knowledge and develops the skills and attitudes necessary to enable students to reach their goals.

Many factors have stimulated the College of Medicine to revise its curriculum, including the change in the organization and practice of medicine; the explosion of new scientific and clinical information; the desire to integrate basic and clinical science throughout the four years of medical training; the need for an earlier exposure to patient care and environments where health care is delivered; the need to foster a team approach with other health care professionals; the need for more small- group and student-based learning; and the desire for medical education to stimulate curiosity and questioning and maintain altruism and idealism.

Medical students in their final two years receive part of their clinical training at University Hospital-Kings County Hospital Center, and part at affiliated institutions in the surrounding area. University Hospital, operated by the State University of New York Downstate Medical Center, is a major open heart referral center and has one of the largest kidney transplant programs in the eastern United States. It is also a major referral center for pediatric surgery, neonatal intensive care, high risk obstetrics, oncology services and the neurosciences. Kings County Hospital Center (KCHC) is one of the largest acute care hospitals in the country and the largest municipal hospital in New York City, with 43 acres and 23 buildings. The hospital is a designated Trauma Center - only one of two serving the borough of Brooklyn - and has eight Intensive Care Units and a large Renal Dialysis Unit.

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Downstate College of Medicine Medical School Location

Downstate College of Medicine Courses

FIRST YEAR

In the first year, the curriculum uses a multidisciplinary systems-based approach to teach the normal structure and function of the body. In addition to instruction in the basic sciences, the curriculum includes one day of clinical experience each week. The disciplines (i.e. Gross Anatomy, Biochemistry, etc.) have been integrated and organized into blocks based on organ systems. Each block incorporates various teaching modalities, including lectures, case-based learning, laboratories and conferences.

COURSES :

* Genes to Cells : This is the introductory block of the first year. Basic aspects of cell and molecular biology that apply to all tissues and organ systems are covered together with genetics. The block covers protein and gene structure, transcription of mRNA and its translation into proteins, cell structure, signaling and mechanisms of inheritance.

* Skin & Connective Tissue : This block uses the structure and function of epithelium and connective tissue as a foundation for the discussion of skin. It integrates material from biochemistry, cell biology and histology and includes lecture material concerned with the cell biology of cytoskeleton, secretion and intercellular junctions. The accompanying laboratories are on epithelium, connective tissue and skin.

* Musculoskeletal System : In this block the students learn about the structure, function and interrelationship of muscle, nerve, bone and the normal structure and function of joints. In the histology laboratories they learn about the structure of muscle and nervous tissue. In the gross anatomy labs the students examine and dissect the extremities.

* Blood/Lymphoid/Head & Neck : The students study the basic elements of blood and blood cell development, along with the mechanisms that are involved in blood clotting and gas exchange at both the structural and biochemical levels. Structure and function of the immune system is discussed with an emphasis on the cellular aspects of immunology. The histology laboratories are concerned with identification of blood cells, hematopoiesis and the immune system. This block also focuses on the gross anatomy of the head and neck.

* Cardiovascular System : This block presents an integrated case-based view of the anatomy, histology, physiology, and cell biology of the cardiovascular system. It emphasizes electrophysiology of the heart, histology and cell biology of cardiac muscle, hemodynamics of the circulation, structure/function of smooth muscle, microcirculation, and the overall regulation and control of the cardiovascular system. Discussions also include the genetic basis of cardiovascular diseases and the emerging tool of gene therapy.

* Respiratory System : This block covers the normal structure and function of the airways and lungs. It also includes the role of other structures that help regulate breathing and the exchange of oxygen and carbon dioxide at both the periphery and in the lungs.

* Gastrointestinal System/Intermediary Metabolism : This block has three distinct components. The GI tract segment presents the gross anatomy, histology, physiology and some radiological aspects of the GI tract. The abdomen is presented at the gross anatomy level. In the intermediary metabolism segment, the synthesis and degradation of small biomolecules such as carbohydrates, lipids, amino acids and nucleotides are discussed. The utilization of these small molecules in the generation of energy for cells is particularly emphasized, as are the energy contributions and requirements of various organs in the body.

* Renal/Urinary System : By means of lectures, histology laboratories and case-based learning, this block covers the physiology, histology and cell biology of the Urinary System, with an emphasis on how certain aspects of the body's extracellular fluid are maintained constant, namely, the concentrations of major electrolytes, the pH, and the osmolarity and volume.

* Endocrine and Reproduction Systems : The histology, cell biology, physiology and biochemistry of the endocrine and reproductive organs is introduced, using a combination of lectures and small group case-based learning sessions. Both basic science and clinical faculty contribute, to give students fundamental information with a clinical perspective. Laboratory sessions are used to introduce students to the histology of the endocrine and reproductive system organs.

* Neuroscience : This block focuses on the anatomy and physiology of the central nervous system, including organizational principles, major systems and brain-behavior relationships. Both cellular and systems level organization are presented. Discussions on the neurological basis of disease are used to reinforce principles of neuroscience and to introduce clinical material.

* Preventive Medicine : This block focuses on some of the methods used in Public Health to study the etiology of disease and the effectiveness of medical interventions. Specifically, methods of biostatistics, randomized trials, case-control studies, and evaluation of diagnostic testing are taught. Principles are illustrated through lectures and case-based conferences which cover issues such as:
1. smoking and lung cancer,
2. healthcare worker protection,
3. food poisoning, and
4. evidence-based medicine.

* Essentials of Clinical Medicine I : The primary goal of the first year is to acquire basic competency in communicating with patients. Within this context, the student will: a) develop fundamental medical interviewing and limited physical assessment skills (vital signs and breast exam); and b) demonstrate the ability to incorporate knowledge of behavioral science and ethics in the communication process.
The student will begin to develop a professional identity through exposure to and feedback from small group preceptors and clinical mentors. Also, the student will begin to develop skills in retrieval, organization and use of information in support of the course goals.

SECOND YEAR

The second year of the College of Medicine curriculum uses an integrated approach to the teaching of the major disciplines. Material is taught in blocks that use case-based learning, problem-solving sessions, laboratories, conferences, and lectures.

COURSES :

* Infection & Host Defense : This block deals primarily with the scientific basis of infectious disease, including fundamental aspects of medical microbiology, human immunology, pharmacology of anti-microbial drugs, pathology of inflammation, and epidemiologic and public health issues relating to communicable disease. The block forms the basis for coverage of specific infections during the organ-system blocks occurring during the rest of the second year. Also covered are fundamental principles of drug therapy and of cellular pathology, which are the foundations of the pharmacology and pathology coverage throughout the year. Special emphases include immunopathology and AIDS.

* Skin & Musculoskeletal System : This block covers the pathology and pathophysiology of rheumatic diseases, and diseases of the skin and musculoskeletal system.

* Hematology/Neoplasia : This block addresses abnormal hematology and the pathophysiology of neoplasias.

* Cardiovascular System : This block covers both the pharmacology of the autonomic nervous system and the mechanisms of cardiovascular disease. Students are introduced to the pathology and pathophysiology underlying several cardiovascular conditions and their associated pharmacological treatments.

* Respiratory System : This block covers diseases of the respiratory system. The content includes pathology, microbiology, pharmacology and pathophysiology. Also, issues in epidemiology, public health and preventive medicine are presented. Case-based learning will be used for some material.

* Renal System : he goal of the second year renal-urinary block is to enable students to learn principles for regulation of fluid and electrolytes and principles of disease processes of the kidney and the urinary tract, so that they can better understand pathological conditions that involve this organ system and disorders of fluids and electrolytes.

* Endocrine & Reproductive Systems : The block covers disease processes involving these organ systems. The topics are taught through a multidisciplinary approach with the participation of pathologists, clinicians and pharmacologists. The pathology, pathophysiology, clinical manifestations and pharmacologic therapy of these diseased states are discussed. Specific women's health issues as well as fetal and neonatal diseases and infections will be addressed in the Reproductive portion. The block consists of a series of lectures and laboratories with sexually transmitted diseases taught through a case-based learning approach.

* Essentials of Clinical Medicine II : The second year of the Doctoring Experience is designed to help students acquire the knowledge, skills and attitudes to master seven competencies important to every physician. These competencies are:
1. prevention & screening,
2. medical history taking,
3. physical diagnosis,
4. health partnership with patients,
5. the healthcare team,
6. the healthcare system, and
7. using the literature.

The Essentials of Clinical Medicine II is arranged in two parts:
- Part I - Comprehensive Care Case Studies, a
component based on five cases each of which
offers exploration of several of these clinical
competencies, and
* Part II - Preparation for Clinical Medicine (PCM)
Interviewing and Physical Exam, a series of
sessions designed to help students develop history
and physical diagnosis skills.

* Gastrointestinal System : This block introduces second year medical students to the fundamental principles of GI medicine. It includes anatomic, pathologic, microbiologic, pharmacolgic and clinical aspects of digestive disease.

* Nervous System & Psychopathology : his second year block further aims to prepare the students for the clinical rotations by means of lectures, case-based learning, laboratories and clinical preceptorships. The subjects covered in these learning sessions include neuropathology, microbiology of the nervous system, psychopathology, neuro and psychopharmacology, and preparation for clinical neurology. Additionally, clinical and forensic pathology are taught in this section.

YEARS THIRD AND FOURTH

The third and fourth years are integrated into an 81-week unit. It consists of the required clerkships listed below, a fourweek subinternship in Medicine or
Pediatrics, a two-week course on emerging concepts in medicine, and 20 weeks of electives.

CLERKSHIPS :

* Transition to Clerkships : This mini-course provides an overview of skills, knowledge and attitudes required
for clinical clerkships. Through lecture and small group exercises, students learn about the continuum of care of patients from hospital admission through discharge
and follow-up, the medical student’s role in patient care, the learning habits and attitudes required to succeed
in clinical settings, and methods of assessment and evaluation used in the clinical years.

* Medicine Clerkship : Students are introduced to clinical medicine; develop skills and knowledge needed to evaluate patients; learn the principles underlying therapy; and develop an appreciation of their role as a member of a health-care team, a sense of responsibility
for the well-being of their patients, and an understanding of the effort and dedication required of a care-giver.

* Neurology Clerkship : This clerkship provides experience in the physical examination, diagnosis, and
management of patients with neurological diseases. Students are assigned patients for whom they assume responsibility under the supervision of resident and attending neurologists. Students participate in weekly clinical conferences and outpatient clinics, and are introduced to the use of neurological tests, such as EEG, EMG, CT scans, MRI scanning, cerebral angiography, and myelography.

* Women’s Health Clerkship : A wide variety of clinical experiences provide learning opportunities in the area of
women’s health from menarche to menopause and beyond. Students gain experience in procedures such as collecting and interpreting a cervical cytology,
participating in delivery and postpartum care, and counseling patients on health issues such as contraception, pregnancy, and breastfeeding. Both outpatient and inpatient experiences are used.

* Pediatrics Clerkship : The pediatric clerkship is designed to provide students with the basic knowledge
and skills necessary to evaluate and manage patients from birth through adolescence. Students are expected to acquire an understanding of history taking skills
(including interviewing parents), basic procedures, and physical diagnosis techniques as they apply to pediatric patients of various ages. Students spend four weeks in an in-patient setting and two weeks in a combined nursery/ambulatory setting.

* Psychiatry Clerkship : Students work on in-patient psychiatric units in evaluation, treatment, and management of patients under supervision. In-patient work is supplemented with selected outpatient clinical experiences and a program of formal didactic instruction.

* Surgery Clerkship : The student follows patients on a variety of surgical services throughout their illnesses
and takes an active part in the therapy, including the performance of minor technical procedures, assisting at operations, and following results. Emphasis is placed on the clinical, rather than the technical, aspect of surgery. Instructional venues include rounds, teaching conferences, and an audiovisual laboratory in addition to clinical teaching at the bedside.

PRIMARY CARE CLERKSHIP I

* Interdisciplinary Primary Care I : Students spend six consecutive weeks in a functioning clinical ambulatory-care setting in either medicine, medicine/pediatrics, pediatrics, or family medicine.
Students expand existing skills in medical interviewing, and physical diagnosis while developing additional skills in differential diagnosis, health maintenance, patient
counseling, and follow-up. In addition to direct patient-care responsibility, smallgroup case discussions and topic reviews of particular importance to primary care form the core of the teaching. Students present an in-depth review of one primary- care topic during the course, and in addition may elect to do a special project
in ambulatory or community health to receive an Honors grade. Students spend one afternoon a week at the SUNY Downstate campus taking Essentials of Clinical Medicine III, which reemphasizes and extends skills and knowledge acquired in the first two years of the ECM sequence.

* Anesthesiology Clerkship : The anesthetized patient provides an excellent model for students to learn how
to recognize and treat individuals whose respiratory, cardiovascular, and central nervous system have been electively depressed. Students are able to apply
basic-science principles to understand the pathophysiology of the patient with CNS, cardiovascular, and respiratory depression.
Students become knowledgeable about the risks and hazards of anesthesia and the problems unique to the specialty. Students are expected to take an active part in the perioperative care of patients presenting for surgery and anesthesia. In addition to participating in clinical care, students attend rounds, conferences, and
lectures.

* Emergency Medicine Clerkship : The clerkship is designed to provide the student with an introduction to the appropriate diagnosis and management of patients requiring emergency and/or critical care. Students are expected to perform a thorough history and physical exam, monitor and assess vital signs, and generate
a differential diagnosis. Students are exposed to major trauma and medical resuscitations, early interventions that prevent mortality and morbidity, and electrocardiogram and radiographic interpretations.
The student is also introduced to the performance of basic emergency procedures under supervision such as phlebotomy, IV insertion, arterial blood gas, nasogastric tube insertion, suturing, and splinting. In addition, emergency medicine involves attention to the establishment of a relationship with the patient and the family, as they cope with the emotional trauma of emergencies, critical illness, dying, and death. In addition to clinical experience, a lecture series is provided.

* Primary Care II Clerkship-Geriatrics/Palliative Care : The curriculum ensures a foundation in attitudes, knowledge and skills required for competent and compassionate care of older patients. It is focused on acquiring
proficiencies in the attitudes, knowledge, and skills needed for elder care. Knowledge and experience are gained of the common geriatric syndromes including
altered mental status, iatrogenesis, mobility including falls, sensory deficits, failure to thrive, sleep disorders, pressure ulcers, incontinence, and nonspecific
presentation of disease. Risk-reduction and preventive care are emphasized. The Clerkship includes a lecture series on Palliative Care with emphasis on the EPEC, a site visit to Calvary Hospital, and direct clinical experiences at the individual sites. A palliative care website is available for student participation and will be an additional requirement for completion of this segment.

* Emerging Concepts in Medicine : Emerging Concepts in Medicine is a twoweek course that introduces graduating seniors to recent advances in medicine
that will impact their future practice. The faculty consists of speakers from Downstate and outside the institution
who are actively involved in translational research. The specific goals of the course are to expose the fourth year medical students to selected areas of medicine; how these fields are evolving and their anticipated
impact on the practice of medicine in the future.

* Transition to Residency : This brief fourth year course is focused on preparing students to take a different
and much more responsible role in care of patients and in self-directed learning. Topics include professional behavior (legal issues and responsibility to patients),
strategies for learning and teaching during residency, and changes in lifestyle (e.g., families and parenthood, debt management).

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