Yale University (School of Medicine)

The Yale University School of Medicine is known throughout the world as one of the leading centers for biomedical research, education and advanced health care. Founded in 1810, the School of Medicine has grown to include every modern medical discipline. Its faculty includes some of the world's most respected scholars in medicine, public health and biomedical science.

Yale consistently ranks among the handful of leading recipients of research funding from the National Institutes of Health and other organizations supporting the biomedical sciences. The school's unique curriculum, known as the Yale System, promotes teaching in small seminar, conference and tutorial settings, and requires student self-evaluation, independent thinking and investigation.

Since 1839, Yale has required that each student complete a thesis based on original research prior to graduation. Graduates of the school have gone on to significant leadership positions in virtually every medical field, as well as many nonmedical areas.

The Yale University School of Medicine has long attracted students who have more than top grades and test scores; they have a vision of what medicine can achieve and a commitment to exploring the edges of medical knowledge. The school rewards them with respect and support, knowing they will set themselves the toughest challenges and test themselves against the highest standards without needing conventional grades, class rankings, or rigid time constraints to spur them on.

Their experience at Yale is not always cheerful–after all, they have chosen to confront the failings of the human body head on–but it is deeply satisfying and often exhilarating. They find friendship instead of competition, freedom instead of standardization. Yale is a great place to study medicine.

Faculty, too, work in a uniquely collegial atmosphere that integrates clinical and biological research and stresses collaboration across traditional boundaries. The days are gone when any one aspect of a great university could successfully exist without a passionate interaction of all the parts within the whole: the basic science departments and the clinical departments; the health system, the hospital, and the medical school; the community physicians and the full-time faculty; the School of Public Health and the School of Medicine; and the School of Medicine within Yale University.

Medicine at Yale is a complex enterprise that takes place twenty-four hours a day, seven days a week. This book presents one week at Yale from many perspectives, beginning with a difficult childbirth on Saturday morning and ending with a student-faculty conversation on Friday afternoon.

Students at the School of Medicine may be candidates for the degrees of Doctor of Medicine (M.D.), Master of Public Health (M.P.H.), or Doctor of Public Health (Dr.P.H.).

The School of Medicine, jointly with the Graduate School, administers a combined program leading to the degrees of Doctor of Medicine (M.D.) and Doctor of Philosophy (Ph.D.). In addition, the School of Medicine administers a combined program leading to the degrees of Doctor of Medicine (M.D.) and Master of Public Health (M.P.H.).

Special arrangements may also be made to receive the combined Doctor of Medicine and Doctor of Jurisprudence (M.D./J.D.), the combined Doctor of Medicine and Master of Divinity (M.D./M.DIV.), the combined Doctor of Medicine and Master of Public Health (M.D./M.P.H.), and the combined Doctor of Medicine and Master of Business Administration (M.D./M.B.A.) degrees. There is also a Physician Associate program leading to a Master of Medical Science (M.M.S.) degree.

Halfway through the medical school’s student/faculty squash tournament, the students have won only five out of eleven matches. The students have the advantage of youth, but most of them stayed up pretty late last night–on clinical rotations, studying for basic science qualifying exams, or dancing at GPSCY, the Graduate Professional Student Center at Yale–and the professors are seasoned competitors, with years of practice on Yale’s many squash courts.

The tournament itself is taking place in the new Brady Squash Center, part of a $3 million renovation of Payne Whitney Gymnasium, Yale’s famous “Cathedral of Sweat.” Medical students and faculty can be found there every day, playing squash or basketball, running on the beautiful indoor track, swimming laps, pumping iron, taking classes in ballet or jazz dance or judo or yoga. Beyond the gymnasium, sports facilities include tennis courts, hundreds of acres of intramural athletic fields, rowing and sailing centers, and a golf course ranked by the PGA among the 100 best in the world.

The medical school community partakes of Yale’s enormous wealth of resources. The University’s art galleries, museums, theaters, religious organizations, cultural centers, and libraries are as magnificent and easily accessible as its athletic facilities. Perhaps the most exciting resource of all is the student population: 11,000 men and women from around the world are enrolled in Yale College, the Graduate School of Arts and Sciences, and ten professional schools. They form a large, vibrant, and remarkably diverse community that complements the intense intimacy of the School of Medicine.

In the end, the faculty claim a narrow victory on the squash courts. The students intend to regroup for next year, vowing to spend more time at the gym.

Yale-New Haven Hospital, the primary teaching hospital affiliated with the School of Medicine, is the fifth oldest hospital in the country. All medical and surgical specialties are represented at the hospital, and it is home to some of the foremost advanced clinical centers in the world, from the Newborn Special Care Unit to the Cardiac Nuclear Imaging Laboratory. Each year, the hospital treats around 40,000 inpatients and has nearly 400,000 outpatient visits. The Children’s Hospital at Yale-New Haven provides comprehensive inpatient and outpatient pediatric services, a high-risk maternity unit, newborn units, and a rooftop helipad.

Yale-New Haven Hospital is the flagship hospital of Yale New Haven Health System, an integrated healthcare delivery system comprising three local systems anchored by major hospitals in New Haven, Bridgeport, and Greenwich, Connecticut. It is among the 50 largest health systems in the nation.

The hospital shares many facilities with the School of Medicine, and all full-time faculty in the medical school’s clinical departments–about 600 physicians in more than 100 specialty areas–are part of the Yale Medical Group, a multispecialty, academic group practice that supports the educational and clinical research work of the school and provides the highest level of care to hundreds of thousands of patients each year.

At the beginning of the 1900s, training at all top medical schools was centered on the acquisition of skills, generally imparted to students exclusively in large lecture and demonstration settings. In the 1920s, Milton Winternitz, dean of the Yale School of Medicine, launched a revolutionary effort to transform medical instruction into an education in biomedical science and critical thinking, which he saw as the best foundation for clinical practice, scientific research, and medical leadership. Students would no longer be passive recipients of knowledge; they would be engaged, questioning innovators–as they would need to be once they were doctors.

The Yale System has evolved along with the field of medicine. Today, the Dean’s Committee on Medical Education–composed of faculty, students, and deans–holds a broad mandate to keep the system flexible and responsive to current needs. The committee has recently recommended a forward-looking set of measures to increase integration across disciplines, across the four years of medical training, and across the realms of basic science and clinical practice.

Yale stands out among medical schools in its commitment to student independence, exploration, and educational responsibility. All students are admitted without regard to financial circumstances, and generous financial aid enables any accepted student to come to Yale. Once here, each student makes his or her own choices about how best to use the opportunities Yale offers while mastering the clinical skills and developing the scientific framework necessary for a fruitful life in medicine. In turn, Yale devotes exceptional effort and resources in support of students. The combination of a carefully constructed curriculum, innovative educational philosophy, and supportive academic culture has nurtured thousands of physicians who have gone on from Yale to become leaders in many fields throughout the world.

Yale University itself is a major cultural institution, drawing world-renowned musicians, actors, artists, and writers. And all these opportunities are virtually around the corner–a five-minute walk from the medical campus–making New Haven an intensely livable city.

New Haven is also special for its location on the shoreline of southern Connecticut, and Yale students quickly learn to make themselves at home in the area. Towns such as Guilford and Durham offer postcard images of New England, and they’re only a twenty-minute drive from downtown New Haven.

If you’d rather, you can hike up Sleeping Giant Mountain for views all the way to Long Island; you can take out a boat from the Yale sailing club in Branford, ten minutes up along the Connecticut coast; you can pick apples or berries at a nearby orchard; you can catch a train to New York or Boston – both Amtrak and Metro-North trains run out of Union Station, a few blocks from the medical school. But you will always come back for real New Haven pizza, widely acknowledged to be the best in the world outside Italy!

With more than 100,000 items, from twelfth-century manuscripts to current journals of medical history, the Medical Historical Library is a unique resource. Its treasures inspired Nuland to write half a dozen books, including How We Die, for which he won the National Book Award in 1993, and most recently, The Mysteries Within: A Surgeon Reflects on Medical Myths. It allows Yale to offer a strong program in the history of medicine. The Historical Library is the loveliest part of the comprehensive, 410,000-volume Harvey Cushing/John Hay Whitney Medical Library.

In spite of its gracious architecture, the medical library is not really cloistered from “modern scientific technology”: in addition to its books and its nearly 2,600 current journals and 1,500 e-journals, a full range of advanced information systems provides access to the international medical literature and multimedia teaching systems. Virtually every medical publication in the world is available to Yale students and faculty.

The Cushing/Whitney Library belongs to the 1o million–volume Yale University Library system. Yale medical students and faculty make particular use of the Epidemiology and Public Health Library, which contains over 25,000 volumes and subscribes to 350 current journals and numerous computer databases, and the Kline Science Library, which has over 350,000 volumes and receives almost 2,000 current periodicals, many in the life sciences. In addition, collections ranging from the Lillian Goldman Law Library to the Beinecke Rare Book and Manuscript Library allow unlimited exploration of questions that cut across disciplines and span history.

Until very recently, women’s health was indeed a no-man’s-land. The absence of women as subjects in most medical studies and the lack of attention to gender differences severely limited knowledge of women’s health and the manifestation of diseases and responses to treatment.

The Women’s Health Program was organized in 1996 to bring Yale’s talent and expertise to bear on the challenge of finding new models for organizing woman’s care, conducting medical research that factors in gender, and training students and residents to consider gender in appropriate and useful ways.

In 1998, the Patrick and Catherine Weldon Donaghue Medical Research Foundation made a five-year, $6.5 million grant to Yale to create a premier program of interdisciplinary research on women’s health. The Ethel F. Donaghue Women’s Health Investigator Program at Yale brings together researchers from a wide range of scientific fields, each with a different perspective on how gender may factor into disease processes and health. Topics under investigation range from the genetics of breast cancer to the timing of surgery in relation to menstrual cycles, from patterns of domestic violence to the role of estrogen in memory after menopause. Yale’s powerful technological and intellectual resources allow research to proceed at many levels, from basic molecular biology to practical, clinical studies.

The Yale System is far less rigid and stressful than other approaches to medical education, but that doesn’t mean it’s haphazard. Human Anatomy and Development, for example, is a unique, thoughtfully constructed course using dissection, radiology, and computer activities to solve problems about spatial relationships, structure-function relationships, and the anatomical underpinnings of clinical diagnosis and pathogenesis. The course is fully integrated with an introductory course in radiology–a linkage that is unparalleled in other medical schools and that is enthusiastically praised by graduates.

In fact, anatomy at Yale is even more than training in problem solving. The faculty recognizes that dissection of a cadaver can be an emotional experience as well as an intellectual one, and they use the opportunity to discuss issues of objectivity, individuality, empathy, respect, and self-reflection. Hospital and university chaplains, social workers, and clinicians speak with the students about care for the seriously ill. The course serves as the introduction to a coordinated four-year effort to teach care of the dying patient.

Recognizing the cadaver as an individual’s gift to medicine, students begin to learn that they must never lose sight of the whole person. Rizzolo says, “About midway through the year, we encourage students to organize an end-of-year service of gratitude. Preparing this service is another way to promote self-reflection. Through prose, poetry, music, and art, these talented students express their joys, gratitude, self-doubt, anguish, and ethical conflicts. It is both brutal in its honesty and inspiring in its thoughtfulness.”

In the history of cancer research and treatment, Yale is perhaps best known as the place where chemotherapy was discovered and first administered. But that was only one milestone in Yale’s long and rich tradition of excellence in basic science leading to improved therapies. The Yale Cancer Center continues to exemplify that tradition.

The center’s thirteen research programs are linked by an infrastructure of shared resources, which enable investigators to conduct translational research of the highest order. With support from programs such as Critical Technologies or the DNA microarray, a cancer geneticist like Allen Bale, M.D., can use fruit flies to study the genetic predisposition to skin cancer, ovarian tumors, and brain tumors and apply new molecular techniques to clinical diagnosis of cancer predisposition syndromes. As understanding of cancer becomes increasingly subtle, collaborations among researchers and clinicians in diverse disciplines is crucial to progress against the disease.

Investigators at the Yale Cancer Center today are making chemotherapy a more narrowly targeted, far less debilitating treatment than it has been. They are discovering new drugs to prevent and treat cancer, and they are studying traditional regimens from herbal remedies to acupuncture. They are testing vaccines that stimulate a patient’s own immune system to attack tumors. They are transplanting bone marrow and stem cells to rebuild patients’ immune systems. In short, they are marshaling forces on all fronts–prevention, diagnosis, treatment, and improving the quality of life for patients.

The Yale Cancer Center is one of a select nationwide group of Comprehensive Cancer Centers designated by the National Cancer Institute. It brings to bear the resources of Yale-New Haven Hospital and the Yale University School of Medicine on patient care, research, cancer prevention and control, community outreach, and education. Under the direction of Vincent T. DeVita Jr., M.D., former head of the National Cancer Institute and discoverer of the first effective treatment for Hodgkin’s disease, the outstanding doctors and scientists of the Yale Cancer Center are helping to make cancer “one of the most curable chronic diseases in the country today.”

The Medical Student Council meets regularly in the historic Beaumont Room on such matters as student life, technology in medical education, and international initiatives. Dozens of other student organizations focus on more particular concerns, whether special interests, community service, or cultural issues. Joint student/faculty groups such as the Committee on the Well-Being of Students develop policy recommendations for the school; some have evolved into important administrative units, helping students deal with the challenges and maximize the opportunities of the School of Medicine.

Since 1988, the Office of Multicultural Affairs has provided support for minority students and worked to increase sensitivity to minority concerns in the medical school as a whole, recognizing that a diverse student body helps train doctors for the pluralistic world in which they will serve. Under the leadership of Forrester Lee, M.D., OMCA conducts recruitment, retention, and outreach programs. It provides educational support and serves as a touchstone for student groups such as the Yale Student National Medical Association (the 1999 and 2000 Chapter of the Year of the national SNMA), Asian Americans in Yale Medicine, and Boricua Latino Health Organization.

These groups provide forums for discussion, an organizational structure for service to the school and the New Haven community, and academic and social support programs for individual students. Other associations throughout Yale University–including cultural centers, religious organizations, and a wide variety of student societies–offer all students a wide network of contacts and support.

Students spend an average of 7.5 years completing the requirements for the M.D./Ph.D. program. They usually begin with the first four terms of the medical school curriculum; the summer between the first and second years is spent in lab rotations. Students must request affiliation with a particular department in the Graduate School by the middle of their third year of study. Advanced clinical clerkships and electives are generally incorporated in the first six months of the third year and the last year of the program, after the doctoral dissertation has been completed. Taking six months of clinical clerkships before beginning their research allows M.D./Ph.D. students to participate in outpatient clinical activities during their dissertation work.

A new route at Yale for physicians who are interested in research careers is the doctoral degree in Investigative Medicine–the first Ph.D. program anywhere to be administered by a clinical department. Unlike the M.D./ Ph.D. program, the Ph.D. in Investigative Medicine is for physicians who have already earned their medical degrees and completed two years of clinical training. “In this program, the candidates have decided substantially later in their careers to become physician-scientists,” says program director Keith Joiner, M.D., chief of the section of infectious diseases in the Department of Internal Medicine. “The program’s goal is to create an environment that constantly interfaces clinical medicine and investigation of disease.”

In addition to the M.D./Ph.D., joint degrees in medicine and law, divinity, business administration, or public health are offered. Each year, a number of medical students construct challenging interdisciplinary programs that take advantage of Yale University’s outstanding array of professional schools.

Yale University has a 300-year tradition of public service, and today almost 70 percent of Yale medical students volunteer in community service activities. The School of Medicine supports these activities through funding, faculty involvement, and organization. The student Committee Overseeing Volunteer Services coordinates student-run programs, distributes funds and other resources, and provides training.

Robert Gifford, who retired in 1999 after three decades of teaching and administration at the Yale University School of Medicine, continues to be a preceptor in the clinic at Columbus House, the largest of the shelters served by Project HOPE. His public service activities have spanned four decades, from directing medical care in the Peace Corps in the 196os to teaching science to elementary- and middle-school children in New Haven since his “retirement.” A beloved and admired figure in the medical school community, he draws crowds as the auctioneer at the annual Hunger and Homelessness Auction, which raises over $25,000 each year from bids on items ranging from lunch with the secretary general of the United Nations to full attendance at a lecture by the second-year class.

Why does the Yale University School of Medicine have a thesis requirement? Every M.D. student has asked that question at least once, when the facts wouldn’t fit or the conclusions seemed too weak. But every M.D. who has graduated from Yale since 1839 has completed a thesis based on original research. And most have understood, in the end, why the thesis is central to the Yale System.

All physicians are scientists. Medicine requires lifelong study, because every field is constantly changing and every individual is different. By engaging in focused, advanced research–whether it’s actually in a laboratory or clinical science or in ethics, ethnography, or the history of medicine–students participate in the scientific process of investigation, attentive observation, interpretation of data, and critical evaluation of literature. These tools are as fundamental for a doctor making a diagnosis as for an investigator advancing the frontier of medicine.

More than 90 percent of Yale students begin their research by the end of their first year. All receive summer stipends to support their research. To pursue their investigations, some choose to travel to other institutions or to field sites, and many spend an extra year at Yale, without charge.

The Office of Student Research, directed by John Forrest, M.D., helps students identify faculty working in their field of interest and locate grants and fellowships. OSR itself provides about $735,000 in student research support annually, funding fellowships of one month to one year.

Students work closely with individual faculty members in laboratories, clinics, or other settings. At the end of the year, students who have completed their theses present their research findings to faculty, distinguished visiting scientists, and their fellow students at the annual Student Research Day. As part of a laboratory’s work, student findings are often published in peer-reviewed scientific journals. Research for the thesis frequently opens unanticipated career paths and sets the direction for lifelong pursuits.

From the first term at the Yale University School of Medicine, lectures are held to a minimum, and much basic science instruction occurs in small groups like Emile Boulpaep’s seminar on cell biology and physiology. Yale’s small size–about 100 M.D. students per class year–and long tradition of thoughtful pedagogy allow the school to engage every student in the process of becoming a life-long learner rather than a memorizer of facts.

The educational program is composed pre-clinical and clinical segments, each two-years in duration, and provides opportunities for students to master the knowledge, skills, and attitudes necessary to become accomplished and creative physicians with outstanding clinical skills. Throughout the four years is an emphasis on three interrelated theme: a rigorous core scientific and clinical curriculum (the science), a comprehensive clinical skill-building program (the art) and opportunities to engage in complex clinical reasoning (medical-decision-making).

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School of Medicine Medical School Location

School of Medicine Courses

PRE-CLINICAL YEARS (1 AND 2)

Yale’s curriculum begins with two years of basic science–normal biology and pathology– coupled with clinical tutorials. The last two years are primarily devoted to clinical clerkship rotations and work on the thesis. (The first two years are easier to outline than the second two, when the program becomes more individualized and thus more varied.) Students must demonstrate proficiency in all required courses before they begin clinical rotations.

The scientific basis of health and disease is taught in numerous courses during the first and second years. Complementing the core basic sciences curriculum are opportunities to explore the edge of science (Research @Yale seminar series) and master scientific reasoning (journal clubs and graduate courses). The art of medicine is taught in weekly small group skill-building sessions and meetings with clinical tutors. There are also several courses that prepare students for complex medical decision-making. Teaching methods include lectures, problem-based workshops, small group seminars, labs, and computer-based activities. Over half of all class time takes place in small-group activities.

FIRST YEAR

The first-year curriculum emphasizes normal biological form and function and has been designed to coordinate information from various disciplines. Anatomy is taught throughout the year and aligns its dissections and lectures with other courses. Courses include Principles of Clinical Reasoning, Cell Biology and Physiology, Biochemistry, Genetics, and the Biological Basis of Behavior. Throughout the first two years, courses grouped under the rubric of the Medicine, Society, and Public Health series introduce the history of medicine, professional responsibility, health policy and financing, and biostatistics. The Doctor-Patient Encounter, a two-year preparation in such basic clinical skills as taking a patient history and physical examination, provides weekly opportunities for students to see patients and meet in small groups with a clinical tutor.

SECOND YEAR

The second-year curriculum concentrates on disease. The year begins with a course called Mechanisms of Disease: Basic Principles, which integrates material in pathology, immunobiology, microbiology, and pharmacology. The course is taught as an in-depth investigation of a disease from all relevant basic science and clinical perspectives. Mechanisms of Disease: Systems/Organs begins eight weeks into the term and continues for the rest of the year. Content traditionally taught in separate medical disciplines is integrated into units such as Blood/Hematology, Neoplasms/Oncology, Lungs/Respiratory System, Clinical Neuroscience, and Psychiatry. The Medicine, Society and Public Health Series continues with the course Epidemiology and Public Health.

CLINICAL YEARS (3 AND 4)

Students first rotate through clerkships where they master the core knowledge and basic skills of each discipline (Internal Medicine, Ambulatory Medicine, Surgery, Anesthesiology, Pediatrics, Clinical Neuroscience, Obstetrics and Gynecology, Psychiatry, Primary Care, and Integrative Clinical Medicine). Medical decision-making and clinical skills are taught, developed, and assessed by rotating on hospital ward teams, in private offices, and meeting with senior clinical faculty preceptors, who mentor, teach, and assess their student charges. In the fourth year there is ample time for students to participate in electives and continue their thesis research project. Consistent with the Yale System is an unusual level of flexibility; students are encouraged to enroll in any elective of their choice, in any part of the world.

THIRD YEAR

All students are required to sit for Step 1 of the U.S. Medical Licensing Examination for the first time by the end of December of the third year. In addition to working on their thesis, students generally complete most of the required clinical rotations: Internal Medicine, Ambulatory Medicine, Surgery, Pediatrics, Clinical Neuroscience, Obstetrics and Gynecology, and Psychiatry.

FOURTH YEAR

At the end of the third year, a faculty tutor works with each student to develop an individual educational plan for the fourth year. The required Primary Care Clerkship is generally completed during the fourth year in an outpatient or office setting. Many students also take a number of clinical electives, including a subinternship in a clinical discipline, and students complete the residency application process and their thesis. In the spring, students come together for one final, required, three-week course entitled Integrative Clinical Medicine: The Biological, Social, and Behavioral Bases of Clinical Medicine. An intellectual capstone, this course provides an opportunity for graduating students to integrate basic science knowledge with social and behavioral sciences. Each week of the course is devoted to a clinical case study, employing small groups and large formats, independent research, and group decision-making.

FIFTH YEAR

Yale M.D. students can take advantage of Yale’s optional, tuition-free fifth year of medical school for extended research on their thesis topic, clinical work in far-flung venues, or exploration of areas outside the field they have chosen for specialization. The “fifth year” is generally taken before the fourth year; the School of Medicine encourages most students to end studies toward their M.D. with the fourth-year program.

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University of Connecticut (School of Medicine) PHASE I (YEARS 1 AND 2) Phase 1 constitutes the first two years, and is comprised of five courses, and electives. Each year has... Address: 263 Farmington Avenue