The University of Miami Miller School of Medicine currently offers a complete four year medical curriculum at the Miami/Jackson Memorial Hospital Medical Center campus and also at the regional medical campus at Florida Atlantic University in Boca Raton, Florida, which is 45 miles north of Miami. Each campus offers its own unique learning experiences and areas of emphasis, however all students will graduate from the University of Miami Miller School of Medicine having mastered the same educational objectives and core competencies.

Educational Mission Statement

The Educational Mission Statement of the University of Miami Miller School of Medicine at both campuses is: To provide our students with a learner-centered, humane and contemporary curriculum that prepares our graduates to pursue successful careers in clinical care, biomedical research and community service in the 21^st Century.

Goals of the Medical Curriculum

The goals of the medical curriculum at the Miller School of Medicine in both Miami and in Boca Raton are to provide all graduates with:

• A broad knowledge of the biomedical and behavioral sciences appropriate for all physicians
• Competence in clinical skills to include eliciting a medical history, performing a physical examination, performing basic technical procedures, and practicing preventive medicine
• The ability to apply knowledge and skills effectively in the daily practice of medicine, as evidenced by the ability to formulate an accurate problem list, an appropriate set of competing hypotheses to explain the problems, and diagnostic and therapeutic plans
• Training in the scientific method and the opportunity and encouragement to participate in research
• The ability to be an effective life-long learner and to conduct critical analyses of new knowledge
• Knowledge and skills in the use of information technology to manage information optimally in order to meet the clinical, research, and educational demands of the future
• The highest ethical standards
• The ability to communicate effectively and humanely with patients, colleagues, and others
• An understanding of the role and responsibilities of the physician in the health care delivery system and society

Guiding Principles in Curriculum Development

The curriculum has been developed and is continually being improved using the following three guiding principles:

1. Integrate teaching of the health sciences

The UMMSM curriculum integrates courses and learning at three levels: a) integrate the basic sciences; b) integrate the basic sciences and clinical sciences; and c) integrate the study of normal structure and function with the study of abnormal, disordered structure and function

2. Incorporate modern educational methodologies

In the traditional medical curriculum, the first two years of medical school usually rely on large lecture-based classes, a learning methodology which does not meet many of the educational and evaluation needs of students and faculty. The UMMSM curriculum addresses these limitations by:

• Decreasing lecture time
• Implementing small group learning opportunities using clinical cases with explicit learning objectives
• Promoting contextual learning where basic science concepts are given clinical relevance by being introduced and assimilated in the context of common diseases
• Evaluating students in important professional qualities, attitudes, and behaviors in addition to knowledge acquisition
• Implementing competency-based learning and evaluation in some courses especially the longitudinal themes comprising the Doctoring Program
• Supporting the role of technology in the educational process, including web-based resources and distance-learning facilities to assist students, faculty, and administrators
• Facilitating formal, systematic faculty development opportunities and regular peer review of faculty teaching

 

3. Incorporating new content and experiences

Physicians practicing in todays health care system must have skills and knowledge not found in the traditional medical curriculum. The UMMSM curriculum incorporates non-traditional material in the longitudinal themes of the Doctoring Program. Some examples of these new content areas are: professionalism, medical humanities, community and population medicine, public health, health care delivery systems, quality improvement and outcomes assessment, medical errors and safety, working with underserved populations, international health, physician teams and leadership, and complementary and alternative medicine.

 

The Curriculum at the Miami campus

An over-arching longitudinal theme throughout all four years of the curriculum is the acquisition and refinement of clinical skills through expert teaching and patient interactions. This starts in the first weeks of the first year when students begin the Clinical Skills Program and start developing their clinical skills under the personal tutelage of a faculty physician, either in a private office setting or in a hospital. The Clinical Skills Program lasts for two years and over 170 clinical sites are available to students on the medical campus and throughout the metropolitan area. Six hospitals and more than 40 specialty clinics containing nearly 3,000 teaching beds are located on the medical campus and provide unparalleled opportunities for clinical training in the third and fourth years. In fact, the UM-Jackson Memorial Hospital Medical Center is the second busiest medical center in the United States with nearly 60,000 admissions, 12,000 surgeries, 7,000 deliveries, 102,000 emergency cases, and more than 500,000 adult outpatient visits per year.

Given the rapidly increasing importance of computers and technology in medicine, students are required to have access to a computer and to the Internet. To facilitate this, the Glaser Student Computer laboratory is open 24/7 and Internet access via wireless technology is available throughout the medical campus.

Each of the medical students at the Miami campus is a member of an Academic Society. There are twelve Academic Societies and they play unique roles in the curriculum by emphasizing cooperation in the learning process, fostering leadership, and by providing a collegial environment in which faculty and more advanced students mentor newer students in the basic sciences, the art of medicine, medical decision-making, and the acquisition of diagnostic skills through patient interactions. The mentoring process is four years long, extending from the first days of medical school right through the residency application and matching process in the fourth year.

The first two years of the curriculum has three sequential blocks: 1) Core Principles of the Biomedical Sciences (23 weeks), 2) Integrated Organ System Modules (47 weeks), and 3) a Transition Block (5 weeks). A competency assessment week is the final week at the end of the first year and again at the end of the second year curriculum. The third and fourth years have been merged into a fourth block. Requirements for clinical courses have been modified, allowing students to pursue elective course work as early as the third year, before completing all core clerkships.

First two years

The first two years of the curriculum are actually a continuum separated by the usual summer break. This part of the curriculum requires continuous mastery of increasingly complex information and its application to disease states and processes.

Core Modules

The first year begins with the Core Principles of the Biomedical Sciences. The goal of the Core is to introduce the fundamental principles and vocabulary for each of the sciences basic to the practice of medicine. This is not the entire course time for these scientific disciplines as each discipline has an important role in the integrated organ systems modules. The discipline coordinator for each of the basic sciences in the Core have worked with faculty to integrate the core concepts in their organ modules.

Molecular Basis of Life (cell biology, medical genetics, Biochemistry)	5 weeks
Host Defenses and Pathogens (immunology and Microbiology)	5 weeks
Human structure and Adaptation to Disease (embryology, Histology, gross anatomy, introduction to pathology)	9 weeks
Cellular Function and Regulation (cellular biophysics And introduction to pharmacology	4 weeks

 

Integrated Organ Systems Modules

The second half of the first year and the first half of the second year are organized into integrated organ systems and modules. The organ system modules feature integrated teaching of basic molecular, cellular, and organ systems processes in conjunction with mechanisms of disease. Sophisticated scientific information is introduced in a clinical context, illustrating its clinical relevance, and enhancing the students learning. Each module begins with a brief review of micro and gross structure and progresses through physiology, pathophysiology, radiology, pathology, and pharmacology of disorders of the subject organ system. The learning methodologies include group discussions, demonstrations, workshops, self-study, and lectures. These modules collectively last for a total of 47 weeks.

Neuroscience and Behavioral Sciences	8 weeks
Cardiovascular system	8 weeks
SUMMER BREAK 6 WEEKS
Epidemiology	2 weeks
Respiratory System	4 weeks
Renal System	6 weeks
Ophthalmology and Dermatology	2 weeks
Gastroenterology and Nutrition	6 weeks
Hematology and Oncology	4 weeks
Endocrine and Reproductive Systems	5 weeks
Rheumatology	2 weeks

 

Transition Block

There are two Problem Based Learning (PBL) blocks. In the PBL blocks, students work in groups of 6-8, with a faculty tutor. The first PBL block occurs in the middle of the second year and is 4 weeks long. Selected cases are presented weekly and are designed to review and re-emphasize important curricular content and to reinforce information gathering and problem-solving skills fundamental to clinical medicine. The other PBL block, the Transition Block, is 5 weeks long and occurs at the end of the second year. The Transition Block is designed to prepare students for advancement to the clinical phase of their training by emphasizing case-based learning, team learning, and diagnostic reasoning. Practice examinations are used during the Transition Block to guide students in their studies and to help prepare for the USMLE Step 1 licensing examination.

Competency Assessment Weeks

At the end of the first and second years, all students must complete a series of competency assessments including standardized patient encounters, critical review by peers and faculty of videotaped patient interactions, written exercises, peer and self-evaluation exercises, and review of an individualized learning plan with a faculty mentor.

Third and Fourth years

The traditional boundary between the third and fourth years is not present in the UMMSM curriculum at Miami. Instead, there are 48 weeks of core clinical clerkships, 20 weeks of required clerkships (with some selectives), and 14 weeks of open electives. A passing score on USMLE Step 1 is required for promotion to the third year. Clinical electives and research may begin before all core clerkships have been completed, according to prerequisites established by course coordinators and the curriculum committee. This allows students to work in clinical services that are traditionally delayed until the fourth year. Core clerkships must be completed by early October of the fourth year so that grades and evaluations are available when transcripts are sent to residency programs on November 1^st.

The core clerkships which are usually taken during the third year are shown below.

Core Clerkships

Internal Medicine	8 weeks
Surgery	8 weeks
Pediatrics	6 weeks
Generalist-Primary Care	4 weeks
OB/GYN	6 weeks
Family Medicine-Geriatrics	6 weeks
Psychiatry	6 weeks
Neurology	4 weeks

The fourth year of the curriculum consists of 34 weeks of clinical rotations and coursework. Students may choose from a variety of ward experiences and consultation services that provide more advanced training in their specific areas of interest. Students may also participate in teaching and research electives. With the consent of the Associate Dean for Student Affairs, up to three months may be spent at other medical schools doing clinical externships.

Required Clerkships

Ward Service/Sub-Internship	4 weeks
Surgery Sub-Internship	4 weeks
Anesthesiology	2 weeks
Geriatrics II	2 weeks
ER/ICU	4 weeks
Radiology	4 weeks
Open Electives	14 weels

 

The Curriculum at the Boca Raton regional campus

The University of Miami Miller School of Medicine plans to offer students a unique educational track at the UMMSM regional medical campus at Florida Atlantic University in Boca Raton, Florida, 45 miles north of Miami in Palm Beach County. The demographics of the general population and the health care delivery system in Palm Beach County afford educational and clinical opportunities not available at the Miami campus. The regional campus is supported by the State of Florida and is fully accredited under the accreditation granted to the University of Miami Miller School of Medicine by the Liaison Committee on Medical Education (LCME). It is a unique collaborative effort between an established, nationally recognized private medical school and a large public university that is part of the State of Florida University System. FAU has more than 25,000 undergraduates and graduate students enrolled in a variety of programs, including high-tech biomedical programs supported by funding from the National Institutes of Health and private industry. FAU and the world-renowned Scripps Institute have recently formed a partnership to explore common research interests and establish cooperative research ventures.

In all aspects of the curriculum, the Boca Raton educational track will emphasize the centrality of collaborative relationships to successful learning and in the delivery of the highest quality health care. The curriculum will place a priority on active, collaborative, learner-centered methodologies and will use a chronic illness model to prioritize the knowledge, skills and attitudes required of physicians to practice in todays health care system. Clinical experiences will emphasize interdisciplinary, team-based, complex disease management with a major focus on continuity care, health maintenance and disease prevention. Throughout the four years of study, this innovative curriculum will be anchored by two courses, the Integrated Patient Care course, an experience wherein students are assigned to a community primary care clinic, and the Physicianship Skills course that provides learning opportunities in the non-traditional competency areas that are fundamental to a modern physicians skill-set. Each student will follow a patient panel, beginning in the first year, throughout all four years of the curriculum. Students will form learning communities of approximately 8 students each who share and learn from each others patients and clinical experiences. The required coursework will be arranged to allow students extended opportunities to pursue specialized areas of study including masters degrees in public health or business administration, or certificates of achievement in biomedical research. In addition to a community physician preceptor, each student will be assigned two faculty mentors, one basic scientist and one clinician, who work collaboratively with their student throughout the four years of study.

The educational track and environment on the regional medical campus will aim to foster and promote collegial and collaborative behaviors among students, faculty, physicians and patients. Throughout the curriculum, students will assume increasing responsibility for their education. Students will be assessed throughout each year to determine the extent to which they have mastered the core program content and critical skills necessary to become an effective physician.

The regional campus is a patient-centered learning environment that emphasizes patient involvement and positive patient outcomes, especially patient safety and satisfaction, throughout the curriculum.

The educational track breaks down traditional barriers between disciplines. In addition to integrating the basic and clinical sciences, the curriculum includes and integrates the behavioral and social sciences in all four years. The curriculum recognizes that an effective, modern practitioner requires a skills set that transcends the biological sciences and the treatment of disease. In addition to providing a strong foundation in the biomedical sciences, the curriculum at the regional campus in Boca Raton will place emphasis on these areas:

• Humanistic medicine
• Professionalism
• Reflective Practice and Self-Improvement
• Quality Improvement and Outcomes Management
• Patient Safety
• Information Management and Evidence Driven Decision Making
• Comprehensive Chronic Disease Management
• Inter-professional Care and Teamwork
• Population Based Medicine

Similar to the curriculum in place at Miami, the regional campus will employ a variety of modern educational methodologies that require students to be active and responsible learners. The curriculum will focus on faculty and student-led small group experiences wherein basic science concepts are introduced and assimilated in light of common disease states and clinical relevancy. These sessions are supported by lectures.

Also similar to the curriculum in place at Miami, an over-arching longitudinal theme throughout all four years of the curriculum at Boca Raton will be the acquisition and refinement of clinical skills through expert teaching and frequent patient interactions. Full time UMMSM clinical faculty, working with community-based faculty physicians at multiple Palm Beach County hospitals and clinics will provide the supervision and venues for clinical training. Among these sites are Boca Raton Community Hospital, Bethesda Memorial Hospital, and JFK Medical Center, and the Palm Beach County Department of Health.

Each of the students at the regional campus, like students at the Miami campus, is a member of an Academic Society. These societies play unique roles in the curriculum by emphasizing cooperation in the learning process, fostering leadership, and by providing a collegial environment in which faculty and upper classmen mentor newer students in the basic sciences, the clinical sciences, the art of medicine, medical decision-making, the acquisition of diagnostic skills through patient interactions. The mentoring process is four years long, extending from the first days of medical school right through the residency matching process in the fourth year.

A general description of the curriculum at the regional medical campus in Boca Raton is given below.

First year

The first year of the curriculum is the beginning of a four-year continuum where students begin the clinical experience through assignment to a community preceptor and a panel of patients to begin assimilating the concepts of continuity of care, and the skills and behaviors of physicians. In parallel, students are introduced to the fundamental concepts and vocabulary of the basic sciences and human organ systems using a combination of small group case-based learning exercises, supported by some didactic lectures. Independent study is included to develop the life-long learning skills needed by every physician.

Core Modules

Fundamentals of the Biomedical Sciences	30% of time
Introduction to Clinical Organ Systems	30% of time
Integrated Patient Care	20% of time
Physicianship Skills Course	20% of time

 

Second year

Students continue the clinical experience begun in year 1 with their preceptor and patient panel. Clinical disorders and the associated relevant basic sciences are presented in an integrated disease management framework which is in alignment with the clinical rotations of the third year. The first five modules comprise 40% of the second year curriculum.

Integrated organ System Modules and Clinical Care

Respiratory, Renal, Gastrointestinal and Nutrition, Hematology/Oncology, Endocrine and Reproductive, Rheumatology, Ophthalmology and Dermatology	40% of time
Integrated Patient Care	60% of time
Physicianship Skills Course

 

Third year

The integrated clinical rotations will allow students to follow their patients through their care and treatment and participate in the medical, surgical, diagnostic and therapeutic aspects of the care required for management of acute and chronic illnesses. Students continue to spend time with their Integrated Patient Care community preceptor following their patient panel and other patients presenting with acute and chronic illnesses. The first six clinical experiences account for about 70% of the students academic time during the third year.

Clinical Experiences

Integrated Clinical Experiences?will include experiences in: Internal Medicine, Surgery, Pediatrics, Obstetrics and Gynecology, Psychiatry, Neurology, Community Medicine and Primary Care, Geriatrics, Radiology, and Anesthesiology	70% of time
Integrated Patient Care	30% of time
Physicianship Skills Course

 

Fourth year

Students are required to complete advanced coursework appropriate for their selected area of study (population health, health care delivery systems, research). Students continue to spend time in their primary care practice settings following their patient panel and other patients who present to their mentors with acute and chronic illnesses.

Clinical Experiences

Electives	80% of time
Integrated Patient Care	20% of time