University of Pittsburgh (School of Medicine)

Chartered in 1886 as the Western Pennsylvania Medical College, a fee-standing school formed by local physicians, the School of Medicine sought university affiliation even in the early years of operations. In 1891 the School became affiliated with the Western University of Pennsylvania and, two decades later, was integrated into the newly designated University of Pittsburgh. Abraham Flexner, a renowned educator, published his first report, Medical Eductation in the U.S. and Canada, in 1910 after he had visited 155 medical schools, including the University of Pittsburgh School of Medicine. The Flexner Report, in effect, removed medical education from the apprenticeship era and laid the foundations for the integrated academic basic science and clinical curricula of today.

The new building, Scaife Hall, was completed in 1956 and vigorous recruitment of additional full-time faculty was begun. With increased facilities and faculty, the School of Medicine began to be recognized as a major center for research in a number of areas. In turn, the faculty of the School attracted appreciable support for research and training from the National Institutes of Health and other federal agencies. Moreover, the School became assured of financial support for medical education when, in 1967, the University became state related as part of the higher education system of the Commonwealth of Pennsylvania.

Today, the University of Pittsburgh School of Medicine continues to build upon the strong foundation of past leaders and dedicated physicians Clinical and basic research have grown remarkable and continue to attract support from federal institutions, private foundations, and corporations. The School's faculty is currently ranked among the top 20 nationwide in federal grant and contract support. Innovative ventures such as a new, expanded MD/PhD program, integrated curriculum, physician-investigator fellowship training program, organ transplant program, Pittsburgh Cancer Institute, and Pittsburgh NMR Institute, promise to keep the School at the forefront of progress in educational, research and patient care endeavors.

Medical school has always challenged the brightest and best-prepared minds. At the University of Pittsburgh School of Medicine, we created a curriculum to teach and train doctors to be better prepared to handle the realities of a new era in medicine.

Our curriculum places emphasis on both the science and the humanity of medicine throughout all four years of your study. It begins with a basic trust—that every patient is a person first, every student is a peer, and that healing demands a full and present response from everyone involved.

We sustain ourselves and our commitment to this revolutionary Person-to-Person approach by practicing on each other. You will find this mutual respect and shared sense of purpose to be both welcome and contagious.

As a medical student, you’ve accepted the challenge of learning a profession that’s fast reinventing itself. The goal is to master the art of learning itself. The study of medicine is the study of relationships. Each course, sequence and year builds on your growing understanding of the human body and its interrelationships at every level. Throughout your four years in medical school, you will read about and experience the connections between basic science concepts, clinical practice and a range of interventions and therapeutics. You will gradually learn to see, feel, hear and think medically in real-time, while you juggle the responsibility of tracking and treating patients.

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School of Medicine Medical School Location

School of Medicine Courses

YEAR ONE COURSES

FUNDAMENTALS OF BASIC SCIENCE BLOCK :

* Medical Anatomy : Section 1 of the Basic Science Block introduces major themes from anatomy, as well as providing an introduction to imaging and radiology. Instructional modalities in this intensive course include lecture, dissection and problem based learning exercises. There are written and laboratory examinations following each of the three segments of the course, and a comprehensive final examination.

* Cell & Tissue Physiology - Human Genetics - Fuel Metabolism : Section 2 of the Basic Science Block is a multidisciplinary section that covers molecular and cellular principles and concepts from cell biology, developmental biology and genetics. It introduces the major theme of transmission of information - between generations and between and among cells and cell systems. This section ends with the consideration of energy (metabolic) pathways essential to homeostasis. Lectures, workshops, laboratory exercises and small group problem-solving sessions comprise this section.

* Immunology in health & Disease - Medical Microbiology : Section 3 of the Basic Science Block begins with a segment that elucidates the systems of communication that are activated upon challenge by disease causing organisms and physiologic stressors (Immunology). The final course in this section is the study of disease-causing organisms, their occurrence, preferred hosts and the diseases they cause. Evaluation is based on laboratory exercises, problem-solving sessions and written examinations.

ORGAN SYSTEMS PATHOPHYSIOLOGY BLOCK :

* Neuroscience - Introduction to Psychiatry : This first course of the organ systems block, Neuroscience, provides a detailed, comprehensive survey of nervous system structure, function and dysfunction. Topics include sensory and motor systems, learning and memory, language, sleep and epilepsy, as well as brain imaging methods, vascular disorders, neoplasms, and infections of the central nervous system. Material is integrated across multiple disciplines including neurophysiology, neurology, pharmacology, neuropathology and neuroradiology. The goal is to provide a mechanistic understanding of normal and pathological brain function, and to teach methods of identifying and localizing major disease processes. The learning formats are lectures, laboratories, PBLs, case-based neurology conferences and self-study. Student evaluation is based on two written exams and PBL participation.
The second course in this section, Introduction to Psychiatry, introduces students to common psychiatric illnesses and their assessment and treatment. There is a written exam and a final paper or presentation due at the end of the course. Student group attendance and small group participation are also included in the overall course grade.

PATIENT, PHYSICIAN AND SOCIETY BLOCK :

* Introduction to being a Physician - ethics, Law & Professionalism : This first section of this block consists of two courses: 1) Introduction to Being a Physician has case problems on public health and medicine, breast cancer, cystic fibrosis, Geriatrics and HIV/AIDS with patient interviews, group exercises, lectures, independent study and self-directed learning; 2) Ethics, Law and Professionalism addresses the basic concepts and methods for analysis of ethical and legal issues in the physician-patient relationship. The sessions in this course are structured as seminars with both didactic and interactive components. Videotapes, email case discussions, and debate complement the lectures. Readings are assigned and there is a final examination at the end of the course.

* Behavior, Illness & Society : Section 2 of this block consists of the course - Behavior, Illness and Society, which teaches etiology and treatment of physical illness from the perspective of patient and physician behavior. The course covers topics of wellness, adaptation to stress, personal inventories and is based on case studies to introduce each topic. The case studies are introduced in one of the following formats – presentation of a patient, video/movie illustrating the issue, and/or a panel discussion. Online, interactive cases and discussions are an integral part of this course.

SCIENTIFIC REASONING IN MEDICINE BLOCK :

* Introduction to Medical Decision Making : The first course of this block, Introduction to Medical Decision Making, teaches critical thinking regarding diagnosis, treatment and prevention of disease as well as statistical methods applicable to clinical studies. This course uses lecture, small group problem solving sessions, and final, individual presentations by students. There is a written examination at the end of the course.

* Methods & Logic in Medicine 1 : The second section of this block is the first part of a two-year course intended to provide students with the skills needed to read and use medical literature. These skills will also contribute to their own studies conducted during their mentored, scholarly project. In this segment, students will use the tools and skills obtained during the preceding course to analyze seminal literature in science and medicine. Evaluation is based on student critiques of assigned papers as well as on a formal presentation, to their small group, of a problem of interest to them, methods of approaching it and feasibility of their proposed approach.

INTRODUCTION TO PATIENT CARE BLOCK :

* Medical Interviewing - Introduction to Physical Examination : The first course in this section, Medical Interviewing, develops medical interviewing skills using standardized patients (SPs). The second course, Introduction to Physical Examination, is designed to provide the first introduction to the techniques of performing a physical examination. By practicing on peers, students learn the skills of a normal physical examination and how to conduct an exam in an orderly fashion. Emphasis is on technique and normal findings with very little discussion of pathophysiology. Use of the stethoscope, oto-ophthalmoscope, reflex hammer and tuning fork are demonstrated and practiced. The goal is to familiarize students in the use of their instruments and prepare them for experiences in physician offices during the remainder of the first year.

* Advanced Physical Examination 1 - Clinical Experience 1 : The Advanced Physical Examination Course of the Introduction to Patient Care Block is an extension of the Introduction to Physical Examination course. During this course, which spans the first two years, students will expand their knowledge of history taking and physical examination skills by examining patients both in adult medicine and in the pediatric setting. Pathophysiology and its correlation to history and physical examination skills are stressed. Students are also expected to record and synthesize the information collected during the clinical encounter as a written history, physical exam, and patient assessment. The goal is to prepare students to do complete and accurate history-taking and physical examinations during their clerkships. This course is integrated with the Clinical Experience Course. There are seven, month-long sessions, four of which will be physical examination sessions and three will be the Clinical Experience rotations described below. There is a written examination, a clinical performance grade from instructors, and a required performance-based assessment at the end of the course.
The Clinical Experiences Course is designed to familiarize students with how physicians practice medicine in their offices and to expose students to the various aspects of health care delivery in the community. Each student will be scheduled for three, month-long rotations, one month of one afternoon a week in a physician's office, one month of once a week afternoon visits to an assigned community site for underserved populations, and one month with a student-selected ambulatory sub-specialty office or an additional month at a primary care physician’s office. There will also be full class sessions on health care disparities, alcohol and substance abuse, and health care to the underserved. No textbook is required but a syllabus is provided. Completion of weekly Teaching and Learning logs is required. Grading is determined by attendance and passing the Final Examination.

YEAR 2

PATIENT PHYSICIAN AND SOCIETY BLOCK :

* Basic Science of Care : This course will focus on health systems and the delivery of health care and health care finance, quality control. Major objectives will examine a.) How the health care system works-or doesn’t; b.) Patient safety; c.) Quality; and d.) Information technology and communications. Each segment of the course will consist of lectures, followed by small-group, problem-solving sessions. Educational formats include lectures, panel discussions, group exercises and invited speakers. Evaluation will be based on a written examination and on the presentation given in the small group exercise.

SCIENTIFIC REASONING IN MEDICINE BLOCK :

* Methods and Logic in Medicine 2 : The third section of this block is the second part of a two-year course intended to prepare students for their four-year, mentored scholarly project. In this segment, students will use the tools and skills obtained during the preceding course to analyze seminal literature in science and medicine. Evaluation will be based on student critiques of assigned papers as well as on a formal presentation, to their small group, of a problem of interest to them, methods of approaching it and feasibility of their proposed approach.

ORGAN SYSTEM PATHOPHYSIOLOGY BLOCK :

* Introduction to Pathobiology - Body Fluid Homeostasis : This second section of the Organ Systems Pathophysiology Block consists of four segments: a computer-based introduction to principles of pathology, followed by courses on the cardiovascular, renal, and pulmonary systems. The course is interdisciplinary. In addition to the basic science components, the subject matter includes clinical aspects of diseases and their medical management. The learning format is in small groups, laboratories, lectures, tutorials/conferences and self-study. Student evaluation is based on written exams and small group problem-solving participation.

* Digestion & Nutrition - Hematology - Endocrine - Reproductive and Developmental Biology : This third section of the Organ Systems Pathophysiology Block consists of four segments: Endocrine and Digestion and Nutrition cover normal structure and function of the digestive and endocrine systems as well as introduction to diseases of both systems. Reproductive and Developmental Biology covers material in a chronological fashion from fertilization through aging. Hematology covers the physiology of the major blood forming organs and an introduction to common hematologic diseases. The learning format is small groups, clinical pathologic correlation sessions, laboratories, lectures, tutorials/conferences and self-study. Student evaluation will be based on written exams and small group problem-solving participation.

* Pharmacology : This course will begin with the cardiovascular segment OS 2 and run through all of the courses in Organ Systems 2 and 3. At appropriate times in those courses, basic mechanisms of pharmacologic agents will be taught in the context of each organ system. This course will cover classes of agents, mechanisms and drug targets as well as potential side effects and future developments. The format will be primarily lecture with some workshops, as well as material incorporated into problem-based learning sessions.

* Integrated Case Studies : The course objective of this fifth section of the Organ Systems Block is to apply information acquired during the first two years to patient cases as presented on the computer, further developing independent active learning and data acquisition skills. In addition, the course serves as a bridge to the direct patient responsibilities of the final two years of medical school. The format is exclusively problem-based learning. There is no final examination. The course is honors/pass/fail based on small group participation.

INTRODUCTION TO PATIENT CARE BLOCK :

* Advanced Physical Examination 2 - Clinical Experience 2 : The Advanced Physical Examination Course of the Introduction to Patient Care Block is an extension of the Introduction to Physical Examination course. During this course, which spans the first two years, students will expand their knowledge of history taking and physical examination skills by examining patients both in adult medicine and in the pediatric setting. Patho-physiology and its correlation to history and physical examination skills are stressed. Students are also expected to record and synthesize the information collected during the clinical encounter as a written history, physical exam, and patient assessment. The goal is to prepare students to do complete and accurate history-taking and physical examinations during their clerkships. This course is integrated with the Clinical Experience Course. There are seven, month-long sessions, four of which will be physical examination sessions and three will be the Clinical Experience rotations described below. There is a written examination, a clinical performance grade from instructors, and a required performance-based assessment at the end of the course.
The Clinical Experience Course is designed to familiarize students with how physicians practice medicine in their offices and to expose students to the various aspects of health care delivery in the community. Each student will be scheduled for three, month-long rotations, one month of one afternoon a week in a physician's office, one month of once a week afternoon visits to an assigned community site for underserved populations, and one month with a student-selected ambulatory sub-specialty office or an additional month at a primary care physician’s office. There will also be full class sessions on health care disparities, alcohol and substance abuse, and health care to the underserved. No textbook is required but a syllabus is provided. Completion of weekly Teaching and Learning logs is required. Grading is determined by attendance and passing the Final Examination.

* Advanced Medical Interviewing - Clinical Procedures : The first four weeks of the final section of the Introduction to Patient Care Block will be the Advanced Medical Interviewing Course. This course is designed to move students from the basic patient interviewing skills that were introduced in the first year Medical Interviewing Course to a higher skill level in patient communication which will be required during the clinical clerkship years. Using standardized patients, and with guidance from a faculty facilitator and peers in small groups, students will learn and practice “hard to ask questions” and deal with specific “content-sensitive” cases (e.g., abuse, anger, drug use and sexuality).
The last four weeks of the Introduction to Patient Care block will consist of the Clinical Procedures Course, that introduces students to basic diagnostic, therapeutic, invasive, and non-invasive procedures commonly performed in clinical medicine. This course gives students the opportunity to practice clinical procedures in a laboratory setting, through interactive small-group sessions with the faculty, using equipment and supplies normally found on patient care units. The goal is to familiarize students with basic clinical procedures that they may be asked to perform on patients during their clinical rotations.

YEAR 3

* Adult Inpatient Medicine Clerkship : This course is an (8) eight-week interdisciplinary clerkship divided into two blocks of four (4) weeks each. During each block, the student is assigned to an inpatient rotation either at UPMC Montefiore Hospital, the Oakland VA Medical Center or UPMC Shadyside Hospital. On the first day of each block, the student is required to attend didactic sessions given by the faculty in Emergency Medicine and Geriatric Medicine. During this inpatient rotation students are assigned their own patients and are taught, under supervision, to apply their acquired skills to the clinical situation. Students learn how to take an accurate and pertinent history, conduct a physical examination, recognize patterns of illness and acquire approaches to disease management. The students will have four (4) sessions learning the techniques of Critical Care Medicine during the rotation.

* Combined Ambulatory Medicine and Pediatrics Clerkship : The eight (8) week Combined Ambulatory Medicine and Pediatrics Clerkship provides a combination of four week experiences in the disciplines of Internal Medicine and Pediatrics.
One half-day per week the students participate in a multi-faceted, interactive didactic session learning advanced skills and discussing issues common to both of these disciplines. Student’s clinical experiences in Internal Medicine and Pediatrics are at office or clinic sites where they will be exposed to the spectrum of care that is provided in the ambulatory setting. Sites may include hospital-based practices and community locations.

* Obstetrics / Gynecology Clerkship : This four (4) week clerkship emphasizes the reproductive health issues important for all physicians. Students will rotate through outpatient services (emergency department, outpatient clinics), obstetrics (labor and delivery suite), and surgical gynecology (private service and university service). Daily schedules include teaching rounds, evaluation of outpatients, preparation of patients for surgery and assisting at surgery and deliveries, postoperative and postpartum care.
Specific objectives have been prepared for each of the services. All students at Magee-Womens Hospital participate in small group seminars with two faculty mentors to examine and discuss important topics expressed in a problem-based learning mode. At the end of the clerkship, students write a two hour examination. General Objectives are: 1) Understand and apply knowledge of the normal and abnormal menstrual cycle to clinical situations; 2) Learn to perform a competent gynecologic and obstetrical history and physical exam, with special reference to the pelvic exam, cytologic screening and appropriate cultures; 3) Understand and apply information about normal and abnormal pregnancies; 4) Become familiar with important issues in the care of postmenopausal women.

* Pediatric Inpatient Medicine Clerkship : This is a four (4) week clerkship, which introduces students to inpatient pediatric medicine. Most students will split the clerkship between two teams: a general pediatrics team (Red or Blue), the adolescent team (8 South), the Limited Stay Unit, or a subspecialty inpatient medicine team (Hematology/Endocrinology or Oncology). Students are required to participate in all aspects of patient care and management, including performing histories and physical examinations, writing progress notes and communicating with other members of the medical team, attending physicians, referring physicians, consultants, families and patients. Students are expected to read both the current literature and the standard pediatric textbooks in order to understand childhood growth and development, and major pediatric disease processes and therapy. In addition, students are expected to attend conferences, lectures and rounds that are held throughout the four-week (4) block. As part of the inpatient rotation, students work as part of the floor medical team and thus take call every fourth (4) evening (not overnight). Each student is expected to work two (non-consecutive) weekend days (8 am to 6 pm). Each student is expected to attend and present a patient at Student Morning Report (held on Tuesdays and Wednesdays). Each student is expected to work through formal web-based clinical cases (CLIPP cases). Each student is expected to turn in four (4) formal patient write-ups to their teaching attending for evaluation and feedback. At the end of the rotation, a three (3) hour, 100-question multiple choice exam is given.

* Clinical Neurosciences Clerkship : A combined Neuroscience Clerkship that integrates the teaching of Psychiatry, Neurology, Neurosurgery, Neuropathology and Neuroradiology. The clerkship is structured within an eight (8) week block of five (5) weeks devoted to Psychiatry and three (3) weeks dedicated to Neurology. Clinical teaching will be within the inpatient and ambulatory settings.
Students are also expected to attend neuropathology workshops, psychiatric emergency room visits, electroconvulsive therapy sessions, and an AA/NA meeting. Students will also attend integrated teaching sessions on Wednesday afternoons.
Teaching sessions will consist of psychiatry and neurology core material as supported by evidence-based medicine along with integrated case conferences, involving psychiatry and neurology topics that highlight clinical conditions common to these areas of medicine. More emphasis will be placed on performance-based evaluation of the student’s clinical performance.
Students will also be graded on both the Psychiatry and Neurology National Board of Medical Examiner’s shelf examination. Criteria for grading are explicitly provided to students at the beginning of each experience and to those faculty members responsible for their evaluation.

* Surgery & Perioperative Care Clerkship : This is an eight (8) week rotation, possibly the most time-consuming of all third year rotations. Both disciplines of general surgery (six weeks) and anesthesiology (two weeks) will be covered during this time period. Students will be assigned to general surgery (three weeks each on two different services) and anesthesiology services at UMPC Presbyterian/Montefiore, Magee-Womens Hospital, the Veteran’s Administration Medical Center, UPMC-St. Margaret’s (Surgery only) , UPMC-Shadyside, Children’s Hospital, and Southside Hospital (Anesthesiology only).
Teaching with attending physicians and residents occurs in conferences, on rounds, in the operating room, at the bedside and in small groups. Teaching sessions in the Simulation Center are also included. The goals of the clerkship are to allow the participants to develop skills to evaluate patients in the perioperative period and optimize their medical conditions in preparation for surgery. Students will learn the natural history of common surgical diseases and the proper operative management and postoperative treatment of these diseases. To assist in the determination of correct diagnoses and management of surgical patients, radiology and pathology services will be utilized. Additional objectives include developing skills in management of acute pain and postoperative complications. Overall the course is primarily designed to prepare students to assume the role of primary care physician and familiarize themselves with the clinical presentations and management of common surgical problems. Students will be required to take service and trauma on-call nights throughout the eight (8) weeks. Two (2) exams will be given at the end of this rotation, a National Board subject exam for the Surgery portion and an in-house exam for the Anesthesiology portion.

* Specialty Care Clerkship : The Specialty Care Clerkship is a four (4) week rotation that includes a combination of one week experiences in the disciplines of ENT, Ophthalmology, Adult Emergency Medicine and Pediatric Emergency Medicine. In addition to four weeks of clinical time, students will also attend weekly lectures, workshops and lab activities.

* Family Medicine Clerkship : Family Medicine is a first contact, continuous primary care discipline that encompasses the comprehensive and longitudinal care of patients with a special emphasis upon care of individuals in the context of families and communities. As such, Family Medicine covers an extraordinary variety of problems and ages making for an interesting and challenging clerkship. Preventive health measures are stressed. The Family Medicine Clerkship has four components: Community-based Clinical Experiences; Whole Group Learning Sessions; Virtual Family Practice Classroom Exercises, and a required Family and Community Assessment. These components will be fully explained during orientation on the first day of the clerkship. Students are expected to read about clinical problems encountered while on the clerkship.
Rotation assignments are often located away from the Oakland campus. All clinical assignments may include experiences at multiple locations, including private offices, teaching clinics, outlying hospitals, nursing facilities, patient homes and other locations. Students will need to assure arrangements for transportation are made well in advance of the rotation.
Multiple evaluation tools will be used for assessing student performance during this rotation and assigning a grade for the rotation. Evaluation tools will be fully explained on the first day of the clerkship. Students are also responsible for keeping a log of patient encounters throughout the clerkship and completing a preceptor/community site evaluation the end of the clerkship.

YEAR 4 COURSES :

* Required Acting Internship : An acting internship (sub-internship) of four-week duration is required during the senior year. An A.I. is a clinical rotation offered on an in-patient service where one or more attending physicians have overall responsibility for coordinated patient care. The service will be structured with both attending staff and house staff. The acting internship should include the assignment to the student of specific groups of patients upon whom he/she completes an initial history and physical examination, constructs a differential diagnosis, formulates a treatment plan, writes orders and carries out necessary therapy, all under careful supervision. Acting Internships that fulfill this requirement are offered in FAMILY MEDICINE, (5401); INTERNAL MEDICINE (5401, 5402); PEDIATRICS (5401); and SURGERY(5401). Acting internships in other departments or out of the city will not fulfill the "AI" requirement.

* Required Integrated Life Science Course : This four week elective is designed to revisit the basic sciences through specially designed courses. All students are required to schedule one course from the following selections: MED 5710, 5715; NEURO 5730; OB/GYN 5725; PEDS 5720, SURG 5700, EMED 5735.

* Recommended electives : In order to provide diversity, it is strongly recommended that you take at least one elective in each of the following blocks:
A. Medicine or neurology;
B. Pediatrics, pediatric neurology, pediatric pathology, pediatric surgery;
C. Surgery or surgical subspecialties, obstetrics & gynecology;
D. Ambulatory care, community medicine or psychiatry

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