BASIC MEDICAL SCIENCE
GROSS ANATOMY AND EMBRYOLOGY
The course in human gross anatomy consists of approximately 160 scheduled class hours devoted to the development and understanding of a three-dimensional visual image of the human body. To achieve this objective, each student participates in the complete dissection of the body. Formal lectures are devoted to general, applied, radiological, and clinical aspects of anatomy, as well as an overview of each region to be dissected. A Course Companion, consisting of specific learning objectives and notes for each lecture/lab session, is provided to facilitate and coordinate this learning process in addition to refer and read the recommended textbooks, anatomical atlases. In addition, a dissection guide with lectures and dissection of the human cadaver is also provided.
The study of embryonic and fetal development, organogenesis, and congenital malformations is the substance of this one-term course. Gametogenesis, fertilization, and the formation of the placenta are examined in detail. The progressive development during the first eight weeks is explored extensively, with a description of the growth and tissue organization of the embryo from the undifferentiated condition to the human-like fetus. Organogenesis, the origin and formation of all organ systems in the human, constitutes the major part of the course. The various congenital anomalies are explained as deviations from normal development. The student thus taught to have an understanding of the normal development of the human organism and learns to recognize the various congenital deviations that will be encountered in clinical practice.
HISTOLOGY AND FUNCTIONAL CYTOCHEMISTRY & CYTOGENETICS
This course presents the structure and function of the human body as revealed by microscopy and cell biological techniques. . The course commences with a discussion of the cell and its internal structures and students are introduced to the concepts of how cells interact with each other and with their external environment. Cell signaling, cell secretion, the cell cycle and the extra-cellular matrix are some of the topics presented in the analysis of cell structure and function. Molecular biological aspects of cell structure and function and their clinical relevance are emphasized.
Emphasis on the role of cells in tissue organization and function and the interactions between cells, their organization to tissues, tissues to organs and various systems and their interactions with the external environment (including gene-environment interaction) are stressed so that the students have a firm understanding of the concept of physiology, pathology and their relevance to various diseases. A firm understanding of normal anatomy, physiology, and the structure and function of various cells and tissues and variations in their interaction with the environment is essential to become a complete and modern physician and the course is directed in this channel.
This emphasis on the cell in Histology and Cell Biology is important since all diseases occur at the cellular level and thus students must understand the basic science of the cell and its mechanisms before they can understand how pathologies work. In addition, cell structure and function as presented in the Histology and Cell Biology course serve as preparation for the elaboration of these concepts in the Physiology and Pharmacology courses and indeed will prepare students as life-long learners of medicine. The students are thus learning skills and gaining knowledge about information that is an absolute necessity for the modern physician.
BEHAVIORAL AND SOCIAL SCIENCE
This course is designed to introduce the student to the fundamental principles of human behavior. Data and theories that contribute to the understanding of normal development and psychopathology are examined. In addition to providing the factual and conceptual basis for psychiatry, the course emphasizes psychological aspects of patient care within the general medical setting. The importance of the bio-psychosocial model in the understanding and treatment of illness is stressed in lecture and in case-based, small group discussion.
The course focuses initially on two major psychological theories of human behavior: psychoanalysis and learning theory. Exposition of these systems leads to discussion of psychotherapy, behavior modification, behavioral medicine, the doctor-patient relationship, development through the life cycle, psychological testing, human sexuality, and family therapy. Special attention is given to such life-disrupting disorders as substance abuse and child abuse, including detection and treatment.
An area of course with emphasis on the biological bases of behavior, involving a survey of those areas where behavior can be understood in terms of underlying genetics, neuroanatomy, or neurotransmitters is also taught. This section compares the laboratory studies of stress and coping mechanisms with the related clinical syndromes. The foundations of the somatic therapies – psychosurgery, electroconvulsive therapy, and psychopharmacology – are also discussed.
The fundamental concepts of law that relate to the medical profession are covered in this course. An overview is provided of the current and probable future expansion of society’s role in the regulation of the practice of medicine. The basic principles of malpractice, including the definition of negligence and the measure of damages, are stressed. The particular topics of informed consent, medical ethics, and confidentiality of medical records are presented. The course surveys the history of medical ethics, and compares the major views on such issues as the conflicts between different types of benefits to patients, the duties of a physician, patient autonomy, social ethics, and rationing of services.
BIOCHEMISTRY, MOLECULAR BIOLOGY AND GENETICS
The course is structured to present and explore principles of biochemistry necessary for the practice of medicine and for the understanding of other pre-clinical disciplines. The mechanisms of biochemical reactions involved in energy production, biosynthesis, and degradation are covered, with particular attention to their role in disease. The biochemical roles of the major organs of the body are studied together with an overview of the metabolic interplay between organs. The mechanisms by which major pathways are regulated are examined in depth.
In the first half of the course, students are introduced to the principles of acids and bases, followed by the structure and function of proteins, particularly enzymes. The course continues with an introduction to energy production in the cell and carbohydrate biochemistry. In the second half of the course, lipid and amino acid biochemistry are taught, together with molecular biology (including structure, function, and biosynthesis of RNA and DNA, protein biosynthesis, and modern gene cloning methods).
The course provides a biochemical foundation on which students can build throughout their Preclinical Science, and can use later when they are qualified physicians.
This course reviews basic genetics and its application to the study of inherited disorders. It begins with a study of the chromosomes and the disorders that result from their aberrations. Exploration of Mendelian and polygenic inheritance follows, illustrated by representatives of the major heritable disorders of man. There is coverage of molecular and clinical genetics, including prenatal diagnosis and genetic screening. The course concludes with introductions to growth points in modern genetics, cancer genetics, gene therapy, and the Human Genome project.
The pathology course is taught in two segments – General and Systemic Pathology. The main emphasis of the course is on active learning by the students based on clinically oriented lectures and daily clinical problem solving by students in groups of ten during the lab hours. This is accomplished by targeted discussions using pathology images (about 500) representing patients and clinical vignettes with built in questions. The images are posted on the website and made freely available on CD’s to students. Periodically, gross specimens and glass slides from current hospital material are also discussed. The faculty closely monitors the discussions and each student is evaluated on a daily basis.
The General Pathology segments deals with how tissues respond to injury, cell death, inflammation, ischemia, thrombosis, embolism, infarction, etc. It also deals with response to infections, environmental pollutants and disease states related to abnormal immune responses. Mechanisms of tumor development and how they spread are studies under neoplasia. This is followed by a special course on Molecular Pathology techniques as applied to clinical practice.
The Systemic Pathology segment involves similar principles but applied in detail to individual organ systems like-Cardiovascular, Respiratory etc. It would also include interpretation of laboratory data for some of the major disease processes. A short course on Forensic Pathology is taught in the Systemic Pathology module. Several clinicopathological conferences, including difficult case seminars are also discussed by students.
Students are mandated to draw concept maps each week and submit for evaluation. A total of 470 test items are administered through 3 quizzes and 3 exams-including 90 based on images. All the questions are clinical problem solving MCQ’s.
The microbiology and pathology courses are presented simultaneously and are closely integrated with each other. Microbiology appears as a balanced combination of formal classroom instruction, practical laboratory experience, and case-based exercises. The didactic portion is divided into two consecutive sections. The first of these covers the basic principles of microbiology, including classification and taxonomy, microbial physiology and genetics, genetic engineering, control of microorganisms through the use of physical and chemical agents, antibiotics, host-parasite relationships, and epidemiological concepts. Bacterial, fungal, and viral infectious organisms are all represented in this series.
In the second section, the pathogens are discussed according to the human organ system where they most often cause clinical disease. Clinical vignettes are used to illustrate the epidemiology, pathogenesis, virulence properties, symptoms, laboratory diagnosis, and therapy of the various agents. The presentation is coordinated with the concurrent pathology course, so that the organ systems are dealt with in a fully integrated fashion. After each organ system, a practicing clinician to anchor a comprehensive understanding of the pathogenesis and disease presents representative cases.
During the laboratory sessions, the students are given problem-solving experience with pathogenic microorganisms. The laboratory work includes the practical application of staining techniques, antisepsis and disinfection, and isolation and identification of infectious agents from clinical specimens, along with the determination of appropriate chemotherapeutic agents. Additionally, students are given a case history along with a relevant clinical specimen, and from these they isolate and identify the microorganism, perform antibiotic sensitivity tests, and report their results. Case-based instruction founded on medical vignettes of infectious disease is considered in small group discussions several times each term. Near the end of the laboratory portion of the course, clinical conferences are presented by visiting infectious disease specialists. Computer-assisted case presentations are used throughout the laboratory portion of the course.
GENERAL PATHOLOGY LABORATORY
The laboratory consists of a collection of about 400 colored transparencies arranged in a series of modules. Students study these during assigned laboratory periods. An audiocassette accompanies each module, which is arranged in the same order as the lecture topics. The modules contain not only colored transparencies of gross and microscopic changes, but also a number of electron photomicrographs.
A profound knowledge of the Pharmacological basis of Therapeutics is essential for a productive clinical career in all medical disciplines. This will allow the physician to keep abreast of new developments in drug therapy. The Pharmacology courses start with an introduction to principles and basics, including pharmacokinetics (in which ways does the human body handle drugs) and pharmacodynamics (in which ways do drugs affect the human body). Comprehensive Therapeutic Issues Lectures focus on treatment strategies (e.g. so-called Consensus Recommendations) for some major diseases.
Our aim is to emphasize the interdisciplinary position of Pharmacology in Medicine and to utilize students’ enormous motivation to learn what is clinically relevant. Throughout the course students will be alerted to the clinical relevance of drug classes discussed. Of special interest are precautions in drug treatment especially in childhood, old age, during pregnancy and lactation. Ultimately, students will be introduced to the delicate process of therapeutic decision-making.
For advanced discussion of selected topics, the class will be divided into small groups, each assigned to a tutor. Pharmacology Small Group sessions use a series of short, simplified therapeutic scenarios to elaborate on the Clinical Pharmacology of drugs addressed in preceding lectures. Case of the Week provides insight to principles of Evidence Based Medicine by means of a detailed case scenario and reading of some assigned peer reviewed clinical publications. This is a joint program with Pathophysiology. Under the auspices of Pathophysiology faculty, each series of group sessions is concluded by a plenary Case of the Week discussion.
PHYSIOLOGY, IMMUNOLOGY AND NEUROPHYSIOLOGY
The aim of this course is to provide each student with a clear understanding of the most important concepts and principles of medical physiology. The course has three principal components – lectures, laboratories, and clinical cases. The lectures provide the information base, while the laboratories and case studies provide the student with an opportunity to assimilate and integrate the material within a small group setting. The course is divided into two equal sections. The first half covers cardiovascular, endocrinology, and reproductive physiology. The second half covers gastrointestinal, renal, pulmonary, and integrative physiology. The integrative component consists of acid-base regulation, temperature regulation, and exercise physiology. Appropriate clinical perspectives are presented throughout the course. Review sessions are scheduled on a regular basis.
Immunology is designed to provide the student with an understanding of the major principles and mechanisms underlying the elements of the immune system. There is an emphasis on the interaction between innate and acquired immunity in the response to infection. Mechanisms by which immunological compartments interact and clinically related topics are also emphasized. In addition to classroom instruction, students spend 10 hours in solving patient-oriented clinical simulations, including small group discussions.
This course is an interdisciplinary study of the function of the nervous system, entailing almost simultaneously its anatomy, histology, physiology, biochemistry, and some pharmacology and pathophysiology. Whenever feasible, the course presents concomitantly, rather than sequentially, the basic structures, mechanisms, and functions of the various interrelated neural systems. Neurological case studies presented as disorders of normal function are included as an integral component wherever possible. Neuropathology is introduced at the end of the course, after the discussion of normal function has been completed. A detailed presentation of neuropathology, however, is deferred to the systemic pathology course. The first few weeks of the course include a general overview of basic elements, gross structure, and basic vocabulary. The systems and functions presented cursorily at first are reintroduced and dealt with in a more rigorous fashion, covering the basic electrical properties of cells, developing from membrane potentials through myoneural and synaptic transmission. They are followed by the study of contractile tissues, motor systems, sensory systems, higher telencephalic functions, and neuropathology.
TRIMESTER V – COMPREHENSIVE BASIC SCIENCE SYNOPSIS
This trimester is devoted to review the subjects learned from trimester I to IV and prepare the student to appear at the CBSE, NBME and USMLE Step 1 exams with confidence. This course is conducted in U.S. for the convenience of the students who are predominantly from United States, though organization of these classes on Curacao is not ruled out.
During this review course, cardiovascular, pulmonary, and hematology; neural and musculoskeletal system; renal and gastroenterology; endocrinology and reproductive biology; immunology, and microbiology subjects will be reviewed.
Major emphasis of these classes will be to familiarize the student to the pattern of questions that are asked in CBSE, NBME and USMLE step I. The classes are not meant to review the subjects in depth but to integrate the knowledge gained from various Basic Science subjects and give an over view as to how to apply such knowledge in the clinic and to answer clinically relevant topics. For instance, anatomy, physiology, biochemistry, pharmacology and pathology (including immunology, microbiology, and molecular biology) as applied to each organ system will be reviewed rapidly and the relevant diseases pertaining to the system under discussion will be discussed. For example, while reviewing the endocrine system- anatomy of various endocrine organs, their physiological function, and biochemical aspects of the synthesis of various hormones will be discussed including embryology, and a brief mention of various endocrine diseases will be mentioned with emphasis on the pathological processes involved and their treatment including pharmacology of the drugs used in these diseases. The same pattern will be followed for other organ systems and their diseases.
Since major emphasis in CBSE, NBME and USMLE Step 1 examination is to ask questions that are clinically relevant, such a review covering various basic and clinical aspects of all the organ systems will familiarize the student as to how to prepare for the examination and, in turn, face the test with more confidence. In addition, such a preparation will teach the student as to how to apply knowledge of basic sciences to clinically relevant situations and arrive at the right decision both in making the correct diagnosis and applying right therapeutic