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Clinical Curriculum Component III

The third year of Medical School is an exciting time for students as they formally enter the clinical phase of their education.Component III consists of four twelve-week blocks that are spent on required clerkships within the University's core system, including the University of Michigan Hospitals, Ann Arbor Veteran's Hospital, St. Joseph Mercy Health System, William Beaumont Hospital, and the Oakwood Healthcare System.

The third-year schedule is uniform for all students in terms of experiences, however, students may rank their preferences for the order in which they take the clerkships (there are four possibilities; see diagram), for their surgical subspecialty rotation, and for different locations within the core system.

The class comes together for the weekly Seminars in Medicine which integrate clinical information and generate discussion on topics of ethical and professional concern.

Students receive information from each of the departments on expectations, clinical experiences, and how they will be evaluated. The full grading scale—Honors, High Pass, Pass and Fail—is used for the Component III clerkships.

Family Medicine: (4 weeks). As the health care system continues to change, the family practitioner is becoming an increasingly integral part of every patient's experience with medical care. All UM medical students are required to rotate through a four-week Family Medicine experience. Assigned to various private practices and community clinics throughout southern Michigan, students gain broad experience in the comprehensive care of individuals and their families in the context of their psychosocial, economic and community environments.

Internal Medicine: (12 weeks). Students gain broad experience in obtaining a thorough history and performing a physical examination, focusing thereafter on the essentials of diagnosis and gaining an introduction to the management of medical problems. Experiences include inpatient exposure on general medicine wards, and experiences on the pulmonary, gastrointestinal, liver, rheumatology, nephrology, cardiology, hematology and oncology services. Many students also spend one month in outpatient clinics, rotating through general medicine and all the subspecialty clinics. The types of pathology students gain exposure to varies widely with the services they experience, however, every student will inevitably work with patients with heart disease, diabetes, asthma and the multiple disease states associated with smoking, alcoholism and obesity. Students gain exposure to x-ray reading in a weekly lecture, use computer models to assess a broad array of diagnostic problems and take part in a simulated patient exercise to practice the methods of producing behavioral change (persuading patients to stop smoking). Daily teaching rounds and textbook reading complete the student's experience.

Neurology: (4 weeks). Students master a detailed neurologic examination through experiences in the inpatient and outpatient settings. Neurologic diseases such as multiple sclerosis, stroke, myasthenia gravis, migraine and diabetic neuropathy are all commonly encountered, in addition to brain tumors and many less common entities. Daily teaching rounds accompany textbook reading.

Obstetrics/Gynecology: (6 weeks). Students assigned to different locations have a range of diverse experiences centered on providing a consistent core fund of knowledge. Several weeks are devoted to obstetrics, where students learn the prepartum care of both routine and complicated pregnancies. Students get hands-on experience in routine vaginal deliveries and Caesarean sections. They then follow the mothers until discharge to learn about postpartum issues. Exposure to infertility, teen pregnancy, diabetes and high-risk pregnancy all occur in the Obstetrics/Gynecology clerkship. Students master the routine pelvic exam, learn to identify basic pathology and assist in gynecologic surgery. Some students are also assigned to a week of gynecologic oncology. Clinical experience is complemented by a daily lecture series, mentoring by an assigned faculty member and textbook reading.

Pediatrics: (6 weeks). Students spend one week in neonatology and the rest of the time is divided between inpatient and outpatient pediatrics. In addition to a focus on general pediatrics in the ambulatory setting, students also receive exposure to clinics in pediatric cardiology, nephrology, hematology-oncology, rehabilitation, adolescent medicine, and child abuse. On the inpatient service, students participate directly in the initial work-up of the child and the day-to-day management. As full members of the health care team, students gain broad experience in the often difficult task of the physical exam of the child. Students often build trusting relationships with children and their parents. Clinical experience is supplemented with daily teaching rounds and lectures, an extensive syllabus, textbook reading and a brief paper on a pediatrics topic chosen by the student.

Psychiatry: (4 weeks). Through exposure to inpatient, outpatient and ER settings, students learn to recognize common psychiatric illnesses in their patients including depression, anxiety disorders, schizophrenia and autism. A basic familiarity with psychiatric medications is acquired and students generally become more comfortable working with mentally ill individuals. Teaching rounds and textbook reading serve as the basis of formal learning and are complemented by a simulated patient experience focusing on alcoholism.

Surgery: (12 weeks). Students learn to recognize the “potentially surgical patient” and learn the appropriate method of diagnosis and evaluation of the surgical problem. Students spend the majority of time on the inpatient service, following patients preoperatively, assisting in the operation and then following patients postoperatively until their discharge. General Surgery lasts eight weeks and includes two month-long rotations in either general surgery or pediatric, vascular, trauma, oncology, endocrine or gastrointestinal surgery. A third month is a surgical selective. Students may choose from neurologic, orthopedic, plastic, thoracic or urologic surgery, in addition to anesthesiology, emergency room, ophthalmology and otolaryngology. Daily lectures and textbook reading complement experiences on the wards and in the operating room.

Seminars in Medicine: These are two-hour conferences that occur almost every Friday afternoon during the third year. They are designed to enhance patient-based learning and introduce issues in the legal, ethical, social and economic fields, and they also emphasize concepts spanning all of clinical medicine such as reading the EKG and managing IV fluids. Other examples of seminars offered include The Addicted Professional, Adolescent Risk-Taking Behavior, and Medical Malpractice.

Medical students have prepared the following descriptions of Component III clerkships and experiences.

Component III

Component IV