Duke University (School of Medicine)

Since it opened in 1930, Duke University Medical Center has earned a reputation as one of the world's foremost patient care and research institutions, with a School of Medicine consistently ranked one of the very best in the country.

But when you're choosing a medical school, you need to know more than a famous name. You need to know what makes a school different from the rest--because that's how you'll find the place that fits you best.

From beginning to end, Duke's curriculum is surprisingly different than that of most other medical schools. Our students study basic science for one year instead of two. They care for patients a full year earlier than their peers across the nation. They devote an entire year to independent scholarship--something most medical students have to carve out their summers or add a year to their studies to do.

Why the difference? Duke believes that medical school will be just the beginning of your career as a student of medicine. Physicians in the future will need to grow as medicine grows, to be able to grapple with new ethical issues, evaluate incredibly complex treatments, and shape health care policy for a new millennium.

Because it's impossible to teach everything you'll ever need to know, our curriculum isn't designed to be the final word. Instead, it's a springboard into a lifetime of learning. Yes, we teach students the fundamentals of medicine and patient care, but we also teach them how to teach themselves. And it's this education that makes Duke graduates leaders--creative thinkers who will push medicine into new territories.

The mission of the Duke University School of Medicine is:
* To prepare students for excellence by first assuring the demonstration of defined core competencies.
* To complement the core curriculum with educational opportunities and advice regarding career planning which facilitates students to diversify their careers, from the physician-scientist to the primary care physician.
* To develop leaders for the twenty-first century in the research, education, and clinical practice of medicine.
* To develop and support educational programs and select and size a student body such that every student participates in a quality and relevant educational experience.

Physicians are facing profound changes in the need for understanding health, disease, and the delivery of medical care—changes which shape the vision of the medical school. These changes include: a broader scientific base for medical practice; a national crisis in the cost of health care; an increased number of career options for physicians, yet the need for more generalists; an emphasis on career-long learning in investigative and clinical medicine; the necessity that physicians work cooperatively and effectively as leaders among other health care professionals; and the emergence of ethical issues not heretofore encountered by physicians. Medical educators must prepare physicians to respond to these changes. The most successful medical schools will position their students to take the lead addressing national health needs. Duke University School of Medicine is prepared to meet this challenge by educating outstanding practitioners, physician scientists, and leaders.

Continuing at the forefront of medical education requires more than educating Duke students in basic science, clinical research, and clinical programs for meeting the health care needs of society. Medical education also requires addressing such concerns as national science and health policy, meeting the health care needs of society, providing medical care for the disadvantaged, and applying basic science discoveries to clinical medicine. As health care practices at the federal, state,
institutional, and individual levels evolve, these endeavors need input from physicians uniquely
prepared to assume guiding roles.

Duke University's role as a leader in medical education is built upon its internationally recognized tradition of fostering scientific scholarship and providing excellent preparation for the practice of medicine. The curriculum promotes creativity, scholarship, leadership, and diversity. It integrates the basic and clinical sciences and prepares students to pursue the spectrum of options available to modern physicians, from basic science to primary care. Duke University Medical
School produces at least three prototype physicians; the physician scientist, the clinicianinvestigator, and the practitioner (either generalist or specialist).

The Duke faculty enhance the Medical School's curriculum by continually embracing new methods of education and evaluation to improve the medical education experience. Attention to curricular development assures Duke graduates that they are grounded in basic biomedical sciences, competent and caring clinicians, prepared to pursue a lifetime of continuing education, and capable of participating in local, national, and international discussions about the delivery of health care now and in the future.

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School of Medicine Medical School Location

School of Medicine Courses

FIRST YEAR

The first year introduces students to the building blocks of medicine--the basic sciences. Duke pares these subjects down to the essentials you'll need in medical practice.
Basic science content is integrated into three interdisciplinary courses enabling students to learn the material within the appropriate context. Related materials are taught together – for example, you might study anatomy and physiology of the heart at the same time--for example, you might study anatomy and physiology of the heart at the same time. Classes are designed to suit all learning styles, ranging from lecture formats to case presentations to seminars, small groups, and computer-based learning. We also assign students to lab teams of 12 with whom you'll work throughout the year.
Is one year enough time to absorb all the basic sciences? Consider Duke students' performance on the United States Medical Licensing Examination (USMLE) basic science exam: Virtually every student passes; in fact, our students outstrip the national average score year after year.

COURSES :

* Molecules and Cells : Biochemistry, Genetics, Cell Biology : A course designed for first year medical students that focuses on the molecular and cellular principles of human disease. The course has four components, which are tightly integrated: biochemistry, cell biology, genetics, and a series of clinical
correlations. The biochemistry component e-emphasizes the relationship between structure and function of the major classes of macromolecules in living systems including proteins, carbohydrates, lipids,
and nucleic acids. The metabolic interrelationships and control mechanisms are discussed as well as
the biochemical basis of human diseases. The cell biology component emphasizes the structure and
function of the cells and tissues of the body. The laboratory provides practical experience with light microscopy studying and analyzing the extensive slide collection of mammalian tissues. The genetics
component emphasizes molecular aspects of the human genome, the structure of complex genes, regulation
of gene expression, experimental systems for genetic analysis, human genetics -- including population genetics and genetic epidemiology, the use of genetic analysis for the identification of disease causing genes, cytogenetics, cancer genetics, and genetic diagnosis and counseling. The series of clinical correlations links the material covered in the basic science lectures to clinical problems. Many of the correlations include an interview with a patient.

* Normal Body : Gross Anatomy, Physiology, Neurobiology, Human Behavior : This core course of the preclinical curriculum is intended to present the scientific principles underlying the structure and function of the normal body, thereby providing the foundational knowledge for the practice of medicine and facilitating the incorporation of the new scientific knowledge thorough out the medical career. To accomplish this end, the goals of the Normal Body component are to ensure that all students possess a conceptual model of the structure and integrated function of the human body (as an intact organism) and each of its major organ systems, emphasizing their role in the maintenance of the body's homeostasis.

* Body and Disease : Microbiology, Immunology, Pathology, Pharmacology : This core course is presented from February through June of the first year. The course begins with fundamental principles of the four basic sciences most directly related to human disease: immunology, microbiology, pathology and pharmacology. This component is followed by an integrated presentation of the most common human diseases organized sequentially by organ system. Teaching modes include lectures, a variety of small group activities guided by faculty, and clinically-oriented disease workshops.

* Neurobiology and Human Behavior : The goal of Neurobiology and Human Behavior is to present the scientific principles underlying the structure and function of the human nervous system as well as their dysfunction in certain neurological disorders. This course thus provides foundational knowledge for the practice of medicine and will facilitate the incorporation
of new scientific knowledge throughout the medical career. Additionally, topics in normal and disordered
human behavior will be incorporated into the curriculum to promote initial awareness of their anatomical
and physiological substrates. Core material is presented through a synergistic combination of didactic lectures, scientific readings, laboratory exercises, and clinical case problem-solving.

SECOND YEAR

Duke students begin seeing patients full-time during the second year--a year earlier than at traditional medical schools.
The year begins with a two-week Orientation to the Clinical Year (OCY), followed by the first of five one-week Intersession. Intersessions occur before each rotation period and are designed to teach:
* Clinical reasoning skills
* Healthcare team functions
* Interdisciplinary topics
* Basic science
* Clerkship-specific skills
Students are well prepared by the time they start their clinical clerkships (see link). Principles learned in the first year basic science courses will come to life and be continually reinforced as you work with a variety of patients.
There also are three elective periods in the second year. Second year rotations and second year electives give you a taste of the major patient care disciplines, and of different care settings – you’ll see patients not only in hospitals, but in outpatient clinics.
The first year overview of basic science, the Intersessions, and the clinical rotations and electives all combine to enable you to make thoughtful decisions about the path you want to pursue during the elective third and fourth years.

COURSES :

* Internal Medicine : During the second year clerkship in medicine, students each will be assigned two four-week blocks to a team taking care of patients on the Internal Medicine Wards at Duke Hospital, Durham Regional Hospital or the Durham Veterans Administration Hospital. The Internal Medicine Clerkship is an opportunity for the student to consolidate knowledge from the first year and apply it to the study of his or her "own" patients. Functioning within teams consisting of an intern, a resident, and an attending allows students to observe, practice, acquire, and refine basic humanistic and clinical skills while acquiring some of the
factual information used in the practice of medicine. Since it is not possible to systematically cover the
vast body knowledge comprising Internal Medicine during an eight-week rotation, students are assigned
patients to evaluate and follow; these patients become representative learning experiences in a case-study model.

* Surgery : The required course in surgery is given in the second year and consists of an eight week clinical clerkship. The primary goal is to provide a rich experience in the discipline of surgery while introducing students to the practice and principles of surgery. The objectives of this course are satisfied in a variety of ways. Students are actively incorporated into the surgical services.
Students are divided into two groups, one at Duke University and the other at the Veterans Administration
Medical Center, and each works with Duke Surgical residents and members of the surgical faculty in the traditional surgical disciplines and surgical specialties. Students are assigned patients on the surgical wards where they serve a crucial role in the care, diagnosis, management, and follow-up of their patients. Clinical rounds are made daily and provide real-time patient care experience and instruction.
The fundamental topics which form the foundation of surgical practice are presented at bi-weekly seminars with presentations by senior staff of the Duke University Department of Surgery. The subjects discussed include a broad range of topics in general, thoracic, transplant and vascular surgery in addition to the surgical specialties encompassing neurosurgery, orthopaedics, otolaryngology, plastic surgery, and urology/ Students are also given an opportunity to re-inforce their knowledge of anatomy and physiology.

* Obstetrics/Gynecology :Required of all second-year students. Consists of six weeks in general obstetrics and gynecology. Students attend lectures, work daily in the general and special outpatient clinics, and are assigned patients on the obstetric and gynecologic wards. Students share in patient care, teaching exercises, and in daily tutorial sessions with the faculty. Clinical conferences, a gynecologic-pathology conference, endocrine conferences, and correlative seminars and lectures are included.

* Pediatrics : The basic course in pediatrics for all students is a six-week clerkship in the second year. Its principal aim is to provide an exposure to the field of child health. The student has a varying series of experiences which should give a grasp of the concepts that underlie the discipline. Goals include acquiring familiarity and competence with the basic tools of information gathering (history, physical examination, and laboratory data) and developing an approach to the integration of this material for the solution of problems of health and illness in infancy, childhood, and adolescence.
This should be accomplished with continuing reference to the basic principles of pathophysiology encountered in the first year courses. Those patients to whom the student is assigned provide the focus for case studies. In addition to the careful history and physical examination which must be recorded, the student is expected to organize an appropriate differential diagnosis and to seek and read pertinent reference material relevant to each patient. The student should learn to present each case verbally in an organized and succinct fashion, to follow the patient's progress, and to interpret all studies which are performed.

* Dermatology : The elective in clinical dermatology is
designed to prepare students to perform an accurate skin examination, formulate appropriate differential
diagnoses, and choose relevant diagnostic or therapeutic interventions. This course is valuable to
any student interested in improving their ability and confidence in the cutaneous exam. Students in the
rotation spend two weeks working in the outpatient dermatology clinics, one week on the inpatient consult
service at Duke, and one week at the Durham VA Medical Center. The outpatient clinical experience
includes general dermatology clinics as well as a variety of specialty clinics such as pediatric dermatology, HIV dermatology, cutaneous oncology; clinic attendance can be tailored to the student's future career goals. Patient care is supplemented with lectures designed to provide the student with a foundation in dermatologic principles, and students are encouraged to attend weekly departmental teaching conferences. Student evaluations are based on the development of clinical skills as assessed by faculty and residents, and by a brief clinically oriented examination.

* Family Medicine : This basic course in family medicine consists of an four-week clinical clerkship in the second year. The course goal is to provide students with an understanding of the principles of family medicine and how these apply in community practice. The course emphasizes continuous and comprehensive health care for people of both sexes and all ages within the context of their social groups and communities. Particular attention is paid to the diagnosis and treatment of common medical problems and to health maintenance, ambulatory care, continuity of care, and the role of consultants in primary care. Other topics covered include social factors such as the doctor-patient relationship, the role of the physician in the community, and the economics of health care delivery. Students are placed with community-based faculty who are practicing family physicians in communities outside of Durham, principally within North Carolina. Most of these preceptorship sites are in rural communities, providing students with exposure to many issues of rural health care such as farming and other occupational injuries, transportation difficulties, and local customs. The
eight-week sites are scheduled based on the availability of the preceptors. These sites may not be available
every rotation. Students gain extensive experience in diagnosing and managing patient problems in an ambulatory care setting under the guidance of the department's faculty. In addition, the clerkship provides students with opportunities to see patients in a variety of other settings, including home, nursing home, and community hospital. There is also the opportunity for medical students to be paired with physician assistant students at a community practice site for the purpose of working with mid-level practitioners in a team practice setting.

* Psychiatry :This course is a required four-week clerkship in clinical psychiatry for second year medical students. Students assume limited responsibility with supervision for the diagnosis and treatment of patients with common and severe psychiatric illnesses. Educational settings include inpatient psychiatry services at four different hospitals, psychiatry outpatient clinics, and the psychiatry emergency rooms of two hospitals. Students participate in a series of core didactic lectures and didactic modules which expose them to basic psychopathologic entities, differential diagnosis of psychiatric symptoms, practical application of treatment modalities, and issues of cost effectiveness in diagnosis and treatment. Students also participate in lectures, rounds, and clinical case
conferences particular to their rotation site. Students are encouraged to observe psychotherapy and to
participate in supervised psychological treatments wherever appropriate opportunities can be provided.

THIRD YEAR

Duke's unique third year is a time of freedom to study an area of particular interest in depth--a time to gain special insight into your long-term career goals and mature your approach to medicine.
Faculty advisors will help you design a study program that will best meet your individual goals, whether it's identifying and cloning new genes at the laboratory bench, formulating public health policy with state legislators, beginning studies toward a second degree, or studying specific patient populations at Duke or even in another country. (See Study Tracks link above). Your advisors can also guide you to the appropriate faculty mentor, who will encourage your professional and scientific development over the course of your research.
Students spend 10-12 months in scholarly pursuit during the third year. Each student is expected to submit a thesis at the end of their 3rd year. Many third year students work with their mentors to submit papers for publication in peer-reviewed journals.

COURSES :

* Anesthesiology, Surgery, and Environmental Physiology : Investigate human physiology, pathophysiology and pharmacology using tools of cardiovascular/respiratory physiology, molecular pharmacology, neurobiology, and environmental science.

* Behavioral Neurosciences : Address problems in basic or clinical neuroscience that lead to improved understanding or treatment of mental illness.

* Biomedical Engineering and Medical Physics : Application of quantitative and analytical methods to study physiology of cells, tissues, organs, and organ systems.

* Biomedical Imaging and Medical Physics : Studies in radiology and biomedical imaging, with an emphasis on solving clinical challenges using quantitative and engineering methods.

* Cancer Biology : Studies in cancer research, including studies on molecular biology, treatment, or prevention of specific cancers.

* Cardiovascular Studies : Study animal and cell physiology and genetics as they apply to diseases of the cardiovascular system.

* Clinical Research : Undertake clinical research using methods and techniques of biostatistics and related disciplines.

* Epidemiology and Public Health : The Epidemiology and Public Health Study Program is designed to provide a foundation in public health, prevention, and assessment and management of the issues impacting the well-being of populations.

* Human Genetics : Investigate human genetic disease through molecular biology, gene therapy, experimental systems, or statistical modeling.

* Immunology : Undertake basic research in immunology for effective management of disease in many public health and clinical settings.

* Infectious Diseases : Explore molecular mechanisms of microbial pathogenesis or clinical aspects of infectious diseases.

* Medical Humanities : Offers a multidisciplinary opportunity for students to explore topics in medical history, ethics, theology, and other fields within the medical humanities.

* Neurosciences : Investigate basic and clinical neurosciences, including molecular/cellular neuroscience, neuroimaging, developmental neurobiology, systems/cognitive neuroscience, and neurobiology of disease.

* Ophthalmology and Visual Sciences : Study the bases and treatments of visual disorders using molecular and cell biology, animal models of ocular disease and prospective and retrospective clinical investigations.

* Pathology : Study disease through utilization of structural and functional changes to gain information about the human organism's response to injury.

* Pharmacology and Molecular Therapeutics : Investigate mechanisms of drug action and develop new targets for therapeutics against various human diseases.

FOURTH YEAR

Students complete 32 elective clinical science credits during the fourth year, including one sub-internship and one critical care elective. The year culminates with a four-week long Capstone course.
The course of study can be tailored according to each student's career goals (whether it's entering primary care or academia). Your advisory dean and personal faculty mentors can help you personalize a fourth-year program from among the more than 150 clinical electives Duke offers.
You may also opt to "audition" for a residency or gain a different perspective on a specialty by spending up to eight weeks on clinical rotations away from Duke.

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