The Medical Sciences training program is delivered over 12 trimesters consisting of 134 weeks of extensive and rigorous training in the basic sciences and clinical disciplines.
The first two years of the curriculum are composed of 6 trimesters, a total of 56 weeks in length, and is delivered at Caribbean Medical University campus on Curacao.
The Clinical Science Training program is 80 weeks in length and takes place at our CMU SOM Clinical Medicine Centers located in the United States.
The education program consists of 80 weeks of clinical training. Every student takes 48 weeks of core clinical rotations in the five major specialty areas – 12 weeks of internal medicine, 12 weeks of surgery, and six weeks each of obstetrics/gynecology, pediatrics, family practice and psychiatry. In addition to the core rotations, all students must complete 24 weeks of electives or sub-internships.
The 12 weeks of the internal medicine rotation are designed to expose the student to a wide variety of medical problems. The student is expected to develop a logical approach to the diagnosis and treatment of patients’ complaints. Some of the skills that must be acquired and refined are: how to elicit and assess patient information, how to perform a complete and accurate physical examination, how to formulate a differential diagnosis and problem list, how to construct a diagnostic workup and a plan of management, and how to write up and present cases.
The student thoroughly studies at least two new patients per week, presents them on teaching rounds, follows them throughout their hospital stay, and uses his or her patients’ problems as a basis for reading. A large amount of experience-based knowledge should be accumulated by the end of the rotation since the student is assigned cases in various major areas of medicine such as cardiology, gastroenterology, and endocrinology. Self-learning techniques, as well as compulsory attendance at lectures, conferences, teaching rounds, and careful study of patients, should foster a sound pathophysiologic approach to medical disease and a concern for and awareness of the patient’s needs.
The goal of the surgery rotation is to acquaint the student with those clinical problems that require surgery as part of the therapeutic management. The emphasis of this rotation is not primarily on surgical technique, but on the understanding of the pathophysiology of surgical disease and the management of preoperative and postoperative therapy. Besides the many short histories and physical examinations done during this rotation, a student is required to perform detailed histories and physical examinations on at least two patients admitted to the surgical service each week, and to follow these patients through surgical and postoperative therapy.
Attendance in the operating room is required when surgery is performed on a patient for whom a student obtained an admission history and performed a physical examination. The student must assist in the operating room to gain an understanding of basic surgical techniques, surgical discipline in relation to asepsis, and care of the unconscious patient. The more common postoperative complications must be recognized. Student follow-up of patients is required (i.e., pathology, radiology, rehabilitation medicine). Procedures that involve manual skills, such as venipuncture, placing and removing sutures, and urethral catheterization, are incorporated into the surgical rotation. Initially, students are under direct supervision. After demonstrating proficiency, they are indirectly supervised.
The goals of the clinical rotation in obstetrics/ gynecology are to provide the student with knowledge and experience in managing the normal and abnormal changes that occur during pregnancy, labor, delivery, and the puerperium, as well as in diagnosing and treating gynecologic disorders. Students become proficient in taking a history from and examining such patients, learning to perform pelvic examinations, including how to pass a speculum and obtain a cervical smear, and attending to their patients in the operating and delivery rooms. Additional student experiences include the observation of labor, delivery of cases, installation of intravenous infusions, recording of partograms, helping with problems of anesthesia, and attendance at special clinics, such as pre and post-natal care, family planning, infertility, and high-risk cases. Students attend conferences, lectures, and teaching rounds; to follow their patients carefully; to read textbooks and literature referable to their patients’ problems; and to pay special attention to public health aspects of reproductive medicine, especially as they relate to maternal and perinatal morbidity and mortality, sexually transmitted disease, cancer detection, and human sexuality.
The purpose of the rotation is to convey psychiatric concepts, attitudes, and skills that are needed by all students, regardless of their future career plans. By the conclusion of the rotation, the student should be able to elicit, organize, and present a full psychiatric history; perform a mental status examination as well as a differential diagnosis; and suggest methods of treatment. Students will have improved their ability to establish a physician-patient relationship and will have acquired knowledge of psychological factors in physical illness. The student will also demonstrate improved interviewing skills; know the major indications, uses, and side effects of commonly used psychotropic drugs; become familiar with the major psychiatric syndromes in children and adolescents, as well as the effects on the child/adolescent/family of the life-disrupting syndromes of child abuse and substance abuse; learn detection and treatment of these syndromes; learn to evaluate and manage psychiatric emergencies; feel more comfortable with psychiatric patients; and, ultimately, possess an understanding of biological, psychological, and social determinant behavior. Each student must fully work up at least one patient a week. The history and mental status examination are presented to the preceptor and the case is discussed. The student must follow each patient’s progress throughout the duration of the rotation. A student must attend ward rounds and outpatient sessions. Attendance will be expected at case conferences and seminars.
Special experiences are recommended. They are:1. Attendance at Alcoholics Anonymous meetings; 2. Visits to local mental health facilities, county and/or state hospitals, addiction programs, and any other special programs in the vicinity of the hospital; and 3. Observation and participation in group therapy and predischarge and postdischarge group management.
The goal of the rotation in Pediatrics is to allow the student to acquire the basic knowledge of the normal physical, mental, and emotional development of children; to learn how this development is influenced by medical, social, and educational factors; to understand the common disorders and diseases of childhood, especially their diagnosis, management, and prevention; and to be aware of the special needs of the newborn, the handicapped child, and the adolescent.
An integral part of the rotation is the opportunity to acquire the necessary skills of taking a pediatric history, to examine children of all ages, and to acquire experience in evaluating the essential clinical information so that a coherent plan of management can be formulated and explained to the parents and, as appropriate, to the child. The student learns to appreciate the value of a confident, but sympathetic, approach to the child and the family, while recognizing and accepting the limits of their expectations and understanding. The student’s reading is structured during the six weeks so that he or she first becomes acquainted with the normal child, and then learns history taking and physical examination, reactions of children to illness and hospitalization, and the principles of infant feeding and fluid and drug therapy.
PRIMARY CARE IN FAMILY MEDICINE
For the primary care rotation, students formally experience full-time outpatient medicine in a variety of settings. The exact format of the four-week period is determined by the amount of outpatient experience the student has had during core rotations and by his or her personal interests. Rotations can take place at community-based outpatient clinics in medicine, family medicine, pediatrics, emergency departments, and operating rooms. The student learns to obtain pertinent history and to perform a problem-oriented physical examination, as well as to order cost-effective diagnostic tests generally available to outpatient practitioners. The student works closely with the attending physician, allied health professionals, and the social service agencies available in the community.
A subinternship in any of the disciplines continues the educational goals and objectives of the core rotation, but at a higher level of responsibility. The subintern shares patient responsibility and participates in regularly scheduled night and weekend calls. The subintern follows a limited number of patients very closely throughout the diagnostic workup and management. In this way, the subinternship prepares the student for his or her internship or first postgraduate year. Subinternships may be taken only after completion of the corresponding clinical core rotations. A four-week medicine subinternship, 4 week medicine selective and a four-week pediatric subinternship are mandatory for all students.
THE ELECTIVES (MIN 24 WEEKS)
Numerous varied electives are offered at the University’s affiliated hospitals. Additional electives are available at unaffiliated hospitals, but these are subject to the review and the approval of the Dean of Clinical Science. The student who seeks licensure in the US should carefully note that the licensing boards of some states require that students take electives only at affiliated hospitals. This may also be true in other countries. Some states require that each clerkship (whether core or elective) be completed at a hospital with an ACGME-approved residency in that specialty. Since licensing regulations may vary from state to state and from one year to the next, this matter must be considered as the student devises an elective program. Each elective is usually at least four weeks long, and electives of perhaps less than four weeks, such as ophthalmology and dermatology, require the specific review and written approval of the Dean of Clinical Science.
The principal objective of the elective program is to provide the best preparation for the student’s career choice, while coordinating a balanced, yet broad clinical experience. In recognition of the individual plans and needs of each student, choices of both subject matter and course location are made by the student, with advice from supervising clinical teachers and with the approval of the Dean of Clinical Science.