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School of Medicine
Programs
Anatomical Sciences
Behavioral Sciences
Biochemistry, Genetics and Nutrition
Department of Clinical Skills
Pathology/Microbiology
Pathophysiology, Pharmacology and Advanced Clinical Skills
Physiology and Neuroscience
Internal Medicine
Surgery
Obstetrics/Gynecology
Psychiatry
Pediatrics
Anatomical Sciences
Robert L. Jordan, PhD, Chairman
Gross Anatomy ANAT520
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 this end, each student, as a member of a team, participates in the complete dissection of the body. Formal lectures present 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 the reading of required/recommended textbooks, anatomical atlases, and a dissection guide with lectures and dissection of the human cadaver. A majority of lectures and audiovisual aids are available through the University web-site on Quickplace.
Laboratory
A unique peer-teaching program has been developed for the dissection laboratory. In this schema, the class is divided into four groups. Then sets of four or five students from each group are assigned as dissection teams to each cadaver in the laboratory. These teams dissect every other lab day and meet with senior faculty members for a question/answer/tutorial/quiz session. Teams demonstrate their dissection to the following set of student dissection teams.
A standard dissection sequence begins with the back, upper extremity, thorax and abdomen, the retention and comprehension of which is tested in the midterm examination. The sequence is completed with the pelvis, perineum, lower extremity, head and neck, which is tested in the final examination. Instructions for dissections are given in the course dissector and last two hours each. The dissections are observed and graded by faculty and fellow students, and account for a percentage of the final course grade.
The gross anatomy course is further highlighted by the presentation of sessions in Living Anatomy, where students learn to appreciate the intricacies of the human body through inspection, palpation, percussion, and auscultation of one another and through the daily presentation and discussion of relevant clinical cases. The anatomy curriculum is designed to enhance clinical integration of the basic sciences material
Histology and Cell Biology
This course presents the structure and function of the human body as revealed by light and electron microscopy and cell biological techniques such as immunocytochemistry. The course commences with a discussion of the cell and its internal structures. The 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.
Students’ mastery of cell structure and function leads to the organization of cells into the four basic tissues of the body. Each of these is presented with emphasis on the role of cells in tissue organization and function. The cellular nature of the tissues and the interactions of cells with the extracellular matrix are stressed so that the students have a firm understanding of the concept of a histological tissue. An understanding of the four basic tissues is paramount to the students becoming complete and modern physicians.
The basic tissues of the body are then arranged into the organs and organ systems. Once again the cellular aspects of organ structure and function are emphasized since cells in the various organs are the main contributors to the function of those organs.
This emphasis on the cell in Histology and Cell Biology cannot be overly stressed 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.
Embryology ANAT540
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 obtains 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.
Behavioral Sciences
David L. Brown, MD, PhD, Co-Chair
John Pettus, PhD, Co-Chair
Behavioral Sciences BEHS610
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.
A final area of course emphasis, the biological bases of behavior, involves a survey of those areas where behavior can be understood in terms of underlying genetics, neuroanatomy, or neurotransmitters. 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.
Biostatistics and Epidemiology BEHS620
The central theme of this course is the importance of accessing, evaluating and using information in health care delivery. The course includes lectures and exercises in health policy, biostatistics, and epidemiology. Systems of financing and delivering medical care are discussed, along with important current changes in insurance systems, cost containment, and models of medical practice. The effects of behavior, environment, and politics on health in different societies are also considered. Students apply the concepts of biostatistics and epidemiology to selected medical and public health problems, learn to read the literature critically, and learn to use the principles of evidence-based medicine.
Jurisprudence and Medical Ethics BEHS5630
The fundamental concepts of law that relate to the medical profession are covered in this course. The history and development of common law are discussed, and a comparison is made between the systems currently found in the United Kingdom, Grenada, and the United States. The fundamental concerns of society in the legislative, judicial, and administrative regulation of medical practice are emphasized. 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, Genetics and Nutrition
Robert Hansford, BSc, PhD, Chairman
Biochemistry BCHM550
The course is structured to present and explore the basic 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 attention being given 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 strong biochemical foundation on which students can build throughout their preclinical studies, and can use later when they are qualified physicians.
Genetics BCHM590
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.
Basic and Clinical Nutrition BCHM691
Nutrition focuses on the relevance of nutrition in prevention and treatment of disease. Presented in this course are those components of human pathophysiology in which diet, on the basis of current knowledge, is believed to be important in either a causative or contributory way. The application of dietary knowledge to prevention of disease, and the management of established disease are also discussed. Also addressed are clinical topics such as infant, maternal, and geriatric nutrition, problems of obesity and related subjects, and the principles of the management of diseases such as diabetes mellitus, renal failure and atherosclerosis.
Department of Clinical Skills
Patrick Rooney, MD, FRCP, Chair
Clinical Skills (cc-continuing course) CLSK545
The course introduces students to patient contact from the first term of the medical program in order to foster student collaboration and communication skills in a formalized way in a small group setting. In the first term, emphasis is placed on an introduction to bioethics and on straightforward clinical patient problems firmly based on the anatomical sciences. In the second term, student experience is expanded by presentation of more complicated clinical cases and more difficult patient presentations and moods (anger, over-talkativeness, depression, etc.). These small group patient sessions are supplemented during both terms by a series of 16 lectures on bioethics and on patient and professional communication. All patients presented are trained Standardized Patients.
The Basic Science Foundations of Clinical Medicine (BSF) is a new teaching component of the Clinical Skills program. This module presents the students with the challenge of learning how to learn independently, just as they will do later as practicing physicians. The module is directed by Monica Greuner, MD, and has as its focus panel presentations of clinical presentations. For instance, the presentation of the onset of diabetes in a teenaged girl is discussed. Then, in later panels, further progress of the case is discussed from the perspectives of her problems as a college student, with her pregnancy, and with later complications involving the heart and kidney.
The students will receive instruction in library research, including computer-based literature review, and will keep a notebook log of their study of the clinical cases. Their individual progress as evidenced by their notebook material and knowledge of the clinical cases will be assessed by clinical instructors in small group sessions and one-on-one advisory sessions. The visiting professors will participate in these evaluations and mentoring sessions.
Advanced Clinical Skills CLSK650
In the fourth term, physical examination skills are taught in 20 lectures and 32 two-hour laboratory sessions. The laboratory groups consist of five to eight students and the techniques of physical examination are taught by videotape demonstration, live demonstration, and supervised practice on fellow students and patients from St. George’s General Hospital. The more intimate examination areas (breast and genitalia) are taught on inanimate models. The fifth and sixth term courses are taught in small groups (five to six students) in the hospital or office setting, as well as on campus, using real volunteer patients.
The clinical basic skills experience ends with an OSCE examination, which is given near the end of the sixth term. The overall objective of the clinical skills course is to ensure that the students develop sufficient interpersonal and clinical skills in order to integrate rapidly into the clinical hospital setting during the third and fourth years of the program. Students will undergo a four week course in Advanced Clinical Training during their 3rd and 4th year rotations.
Selectives
Selectives are offered to basic science students during the first two years of the MD program. The objective is to provide a structured learning experience in diverse clinical and scholarly areas. They give students the opportunity to integrate their basic sciences knowledge into clinical areas and provide an easier transition into clinical medicine. Selectives are offered by various departments.
1. The Prague Experience in Medicine
Martin Stransky, MD
This popular one-credit selective takes place in Prague, in the Czech Republic, during the last three weeks of July. Students are exposed to three teaching hospitals as well as a private practice clinic with 25 physicians. The students gain exposure to both adult and pediatric settings and participate in team discussions, teaching rounds, lectures, and direct patient interaction. The thinking process that clinicians use when examining patients is introduced and discussed. Students assess the medical, cultural, and economic forces impacting different medical systems. After this selective, students develop an increased awareness of the globalization of medicine and expand their perspective and knowledge base in patient care.
2. Community Health Selective
Chamarthy Subbarao, MBBS
This two-credit hour selective exposes students to clinical cases in community health clinics throughout Grenada for six weeks under the guidance of the District Medical Officer. It provides students with the opportunity to learn about different services like antenatal, pediatric, immunization, chronic diseases, etc., provided in the community clinics. Clinical cases are discussed by clinical tutors in relation to the basic science subjects involved. After completing this selective the students are able to understand and use their basic science knowledge in the evaluation of clinical cases.
3. Surgery Selective
Chamarthy Subbarao, MBBS
This one-credit hour selective takes place in the General Hospital in Grenada, as well as the outpatient clinic, wards, and operating theater. The program is based on the problem solving method. Students learn how to perform patient interviews and physical examinations. An accurate history and thorough physical examination remain the most important resources for correct diagnosis of surgical disorders.
4. Integrated Approach of Basic Science Related to the Head and Neck Area
Robert Hage, MD, PhD, DLO, MBA
This one credit selective is offered twice a year. The student will have 2 sessions per week for 5 weeks at the beginning of each semester. Visits to outside institutions are arranged during the semester according to preference and availability. Each student will receive a total of 5 case studies by e-mail and is expected to attempt to solve the problem before these cases are presented on Monday afternoons. On Thursday afternoons there will be sessions covering maxillo-facial surgery, radiology, examination technique and demonstrations. Visits to the General Hospital operating room, radiology department, School for the Deaf, ENT clinic and special homes are opportunities for the student to gain valuable experience. A CD/ZIP disk must be provided by each student so that material related to the selective (clinical pictures, video clips, text) can be made available for home study.
5. International Health and Human Rights Selective in Honduras
David Lambert, MD
This is a one credit hour selective that takes place in Honduras. As there are fundamental differences between health care provision in the developed and underdeveloped countries, a recognition and understanding of some of these issues should help to build partnerships and support international health efforts. Human Rights are essential to the full attainment of health. Most traditional medical curriculums are devoid of this subject. This selective is designed to give students a better understanding of the global aspects surrounding Health and Human rights. This selective is designed to promote a better understanding of the broad determinants of individual and population health which can be applied to issues in Honduras, regionally to other developed countries. The core of the selective will be facilitated in Honduras by our relationship with ASONOG (Associate of Non-Governmental Associations), a non-profit organization, which works throughout Honduras. ASONOG was founded in 1988 and works on coordinating objectives of strengthening primary health services and developing local capacities in the prevention of illnesses and health promotion.
6. Complementary Medicine Selective
Jacqueline Stanley, PhD
This is a one credit hour Pass/Fail Complementary Medicine Selective that provides a comprehensive survey in various areas of complementary medicine. The primary goals and underlying methodologies of each of the complementary health care areas are addressed. In addition, the strengths/weaknesses and the risk/cost of each area from a patient and health care point of view are examined. An important aspect of this complementary medicine selective is to have students understand how these health care areas can interact with, and “complement” conventional medicine for optimal patient care. This selective relies heavily on visiting professors as well as local practitioners to deliver the material in a cohesive manner based on their own experiences in the various areas. Dr. Steven Rosenblatt, MD, PhD has organized the selective topics and is a regular participant in the delivery of this selective. The selective consists of three consecutive modules. Although each module is open to everyone, students who wish to receive credit on their transcript for this selective must register and attend three full modules. Each module consists of four lectures in the morning and two different afternoon workshops. Furthermore, registered students must pass a short quiz that will be given at the end of each day.
7. Microbiology Selective
Ateef Qureshi, Phd Joanna Rayner, PhD
The laboratory component of the Medical Microbiology (570) course is the minimum required for future physicians who intend to practice in developed countries with automated, professional laboratory support. Students planning to serve in developing nations will benefit from the extra laboratory experience that will be provided by this two-credit hour course. Students who have an interest in infectious disease and diagnostic microbiology will also benefit from this course. The objectives of the course are to provide extensive practical hands-on laboratory-based experience and foster an appreciation of the safe handling of infectious materials and/or microorganisms. Students must have a minimum GPA of 3.0 and either Biology 401 or Medical Microbiology 570 (Pre or Co-requisite) and permission of both the Course Director and Dean of Students. A minimum of 4 to 5 students should register for the course to be offered.
8. American Sign Language Selective
Robert Hage, MD, PhD, DLO, MBA
This one credit-hour selective is offered once a semester and will fall within the start/stop dates of the first term semester. Ten (10) sessions are scheduled per semester. Students are expected to attend and actively participate twice a week in a one-hour session where a teacher from the School for the Deaf will teach American Sign Language (ASL). Guest speakers will cover topics like speech training, cause of deafness, prevention of deafness and knowledge about hearing aids. This will add to each session an element of theory and practical information related to deafness. Students are expected to practice their acquired sign language skills with each other between sessions and demonstrate some of their skills during each session. Video cassettes are available for viewing in the library. Visits to the School for the Deaf are recommended.
9. Medical Spanish for Health Care Professionals
Debbi Johnson, MA
This one credit-hour course will meet once a week for the entire term, and is designed primarily to meet the needs of medical students who anticipate contact with Spanish-speaking patients in their future. In the United States particularly, it has become an absolute necessity for health care providers to have at least a minimal understanding of the Spanish language, in order to minimize frustrations stemming from the lack of ability to communicate with the nation's fastest-growing non-English speaking group. In addition to the significant lack of control that health care providers feel at not being in command of the language of their patients, the predicament of non-English patients in need of medical care is a crucial concern as well. The course, which will be offered at the University's main campus, will provide students with a basic introduction to Spanish grammar and sentence structure, as well as an overview of vocabulary for specific medical purposes. Students will be expected to have had some exposure to Spanish language instruction, as well as be in good academic standing, in order for the more specialized Medical instruction to be beneficial. The course will cover such topics as basic grammar skills, emergency medicine, a visit to the family practitioner, basic anatomy and dealing with sensitive cultural issues.
10. Regional Anatomical Dissection
Robert L. Jordan, PhD
This one term, two credit-hour course will give participants the opportunity to undertake detailed regional dissections of the human body. These regions include: (1) Head and Neck, (2) Back and Thorax, (3) Extremities, and (4) Abdomen, Pelvis and Perineum. Each regional dissection will be limited to the appropriate area but need not be a complete dissection of all the structures within the topic area. The ultimate objectives are to give students the opportunity to dissect regions of the human body of particular interest; to obtain a deeper understanding of the anatomy of selected areas; and for detailed anatomical preparation for future clinical aspirations.
11. Anatomical Education and Multimedia Development
Craig Goodmurphy, MSc
The key objective of this one term, two credit-hour course is furthering the development and enhancement of online and offline anatomical sciences education multimedia materials. The primary goal is to expand the competency of the students involved by allowing them to sharpen both their computing and their anatomy skills. Participants may produce educational materials for any of the core anatomical sciences courses including gross anatomy, histology, embryology, undergraduate anatomy or a combination thereof.
12. Radiological Anatomy
C. Vishnu Rao, PhD
This two credit-hour course will give participants the opportunity to review the normal gross anatomical structure of the human body as seen in various radiological films such as X-Ray film, MRI and CT scans. A major emphasis will be placed on the clinical application of gross anatomy as it is related to the various imaging methods. Ultimately, the students’ overall knowledge of clinical anatomy will be enhanced.
13. Gross Anatomy Special Dissection
Robert L. Jordan, PhD
This one term, two credit-hour course will give participants the opportunity to undertake detailed, professional quality dissections of the human body. The ultimate objectives are to allow students to dissect specific regions and/or organs of the human body in order that “museum quality” specimens can be created for teaching purposes. In so doing, students will learn the various techniques involved in the preparation of cadaveric material for display and teaching. These include dry bone/ligamentous preps, plastic embedding and various plastination procedures. Ultimately, the students overall knowledge of anatomy will be enhanced.
Pathology/Microbiology
Shivayyogi Bhusnurmath, MD, FRCPATH, Chair
Immunology
This course 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.
Microbiology
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, representative cases are presented by a practicing clinician to anchor a comprehensive understanding of the pathogenesis and disease.
Laboratory
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.
A student who engages in an approved research program under the supervision of the staff can gain a selective in research microbiology and one or two academic credits per term. Registration requirements for this course are determined by the instructor. At the present time, research is being conducted in the area of antibiotic-resistant microorganisms, microorganisms in the local environment, and epidemiological studies in bacteriology, virology, and parasitology. The average amount of work required per one credit hour is based on attitude, quality of work, reliability, technique, and adherence to laboratory protocol, effort, and results.
Parasitology
Emphasis is balanced between parasitic infections that frequent the tropics and those that are being increasingly recognized in the temperate zones. Approximately half of the course deals with medical protozoology, including the amoebas, flagellates, ciliates, and sporozoa that are capable of infecting living human tissue. The second part of the course covers medical helminthology: the Nematoda, Platyhelminthes, and Acanthocephala. Arthropods of medical significance are also discussed. Presentations of the various organisms emphasize the epidemiology, symptomatology, pathogenesis, laboratory diagnosis, and treatment of each.
Laboratory
Lectures are supplemented by laboratory sessions that include stool examinations for ova and cysts of the parasites. Slide presentations are used extensively in the consideration of all of the parasites.
Pathology
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 discussions are closely monitored by the faculty 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 walso 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 clinicopthological 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.
General Pathology LaboratoryThe 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.
Systemic Pathology Laboratory
Laboratory sessions in systemic pathology consist of a series of microscopic slides that coincide with the lecture material and demonstrate the microscopic changes in the various disease states. A large number of fixed gross specimens, arranged by systems, is available each laboratory period so that the student can correlate gross and microscopic changes. When possible, fresh gross specimens are also brought from the Grenada General Hospital for study. Additionally, several laboratory periods are assigned for the performance of clinical laboratory tests, such as hemoglobin, hematocrit, red blood and white blood cell counts, blood glucose, serum enzymes, urinalysis, etc.
Pathophysiology, Pharmacology and Advanced Clinical Skills
Grady Hendrix, MD, Chair
Pathophysiology I PATH670
Pathophysiology II PATH671
Pathophysiology I and II, offered in the fifth and six terms are amalgamated into eighteen uninterrupted weeks of study. The objectives of the courses are structured to explore why and how diseases occur as well as developing a student’s deductive reasoning and synthesis of information skills. Understanding the process by which one approaches disease(s) and arrives at a diagnosis based upon clinical information and then applies this information to the institution of appropriate therapeutic interventions is the major goal. By presenting the course concomitantly with Pharmacology and Advanced Clinical Skills in an integrated fashion the goals and objectives of the course are achieved. This integration is further achieved by the presentation of the “Case of the week” The “cases” are prepared by the Department Faculty with the assistance of Visiting Professors. Students meet in small groups to discuss specific questions relative to each case. An exit session is then held by the joint Pathophysiology, Pharmacology and Clinical Skills faculty to resolve student questions and stress important concepts.
The courses are divided into three six-week sections with an exam at the end of each. An organ systems (Cardiology, Pulmonary, Gastroenterology, Nephrology, Hematology, Endocrinology, Dermatology, Neurology, Ophthalmology) and Interdisciplinary (Clinical Immunology, Rheumatology, Infectious Diseases, Psychiatry, Pediatrics, Obstetrics and Gynecology, Sexuality, Clinical Nutrition, and Oncology) approach is used. Lectures are delivered by Visiting Professors or Full-time faculty who are outstanding clinician/academicians in their field. These lectures present a cohesive Pathophysiology course which is preparatory to the students’ entry into the clinical years.
Pharmacology I PHAR680
Pharmacology II PHAR681
A profound knowledge of the Pharmacological basis of Therapeutics will be essential throughout 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. Joint Lectures, a conference-style teaching format coordinated by Basic Science Professors in Grenada that will cross reference topics covered in previous terms with the current course materials, are being implemented.
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. Within the demanding schedule for students in their fifth and sixth term there is little room to discuss the massive public use of non-prescription drugs, folk remedies, and quackery. However, the students will not a draw blank when it comes to substance abuse, mood enhancing drugs, diet pills, or anti-baldness drugs, the concluding Pharmacology lecture addresses “Lifestyle Drugs”.
Advanced Clinical Skills CLSK650
The main objective of Advanced Clinical Skills is to ensure that students develop sufficient clinical and interpersonal skills by the completion of the Basic Sciences to quickly integrate into the third and fourth year clinical phase of the program where they will be interacting with staff, patients, community members and their peers.
During terms five and six this objective is achieved by developing skills in history taking, physical examination, interpretation of findings and arriving at a diagnosis for therapeutic decision making. Different approaches, ranging from discussion of case material and problems in group settings to independent search through text books, medical journals and research findings, are explored.
Advanced Clinical Skills presents students with two different methods of training in clinical skills. Using the first method, instruction occurs through college based teaching with clinical tutors and visiting professors. The students are taught in small groups of six to eight with a group leader assigned as facilitator, using real volunteer patients. Continuous evaluations are made to provide support and guidance in both academic and nonacademic areas.
The second method, hospital based teaching with hospital consultants, is conducted at the Milton Cato Memorial Hospital where students are assigned in groups of four or five to take patient histories and physicals along side hospital consultants (bedside teaching). The Objectively Structured Clinical Evaluation (OSCE) examination is given toward the end of the sixth term. This examination evaluates the student’s depth of knowledge as applied in a clinical setting and ensures that the student is prepared for the clinical phase of the program.
Physiology and Neuroscience
C. Randall House, DSc, FRSE, Chair
Physiology
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.
Laboratory
Four human laboratory exercises pertaining to cardiovascular, respiratory, and exercise physiology are included in the course. Computer-assisted applications are regularly used. For each of the laboratories, students work in groups of twelve to fifteen. Each group is assisted by a faculty member.
Clinical Case Studies
Six clinical case studies pertaining to cardiovascular, endocrine, respiratory, renal, and acid-base regulation are included in the course. For this portion of the program, classes are broken up into small discussion groups of twelve to fifteen students.
Neuroscience
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.
Laboratory
The lectures are supplemented by laboratory sessions that include considerations of the human gross brain, brain stem sections, and microscopic slides. A relevant clinical case study is discussed within each laboratory session.
The Clinical Curriculum
Clinical Rotations
The education program consists of 80 weeks of clinical training. Every student takes 42 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, and psychiatry. In addition to the core rotations, all students must complete four weeks of primary care, a four week medicine subinternship, a four week medicine selective and a four week pediatric sub-internship or selective. To complete the clinical requirements, every student takes 22 weeks of electives.
Internal Medicine
Daniel Ricciardi, MD, Chair
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.
Surgery
Gordon Lutchman, MD, Chair
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.
Obstetrics/Gynecology
Richard H. Schwarz, MD, Chair
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.
Psychiatry
Marvin Lipkowitz, MD, Chair
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.
Pediatrics
Thomas E. Potter, MD, Chair
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 CareFor 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.
Subinternships
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 (22 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, School of Medicine. 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, School of Medicine.
General Strategy- 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, School of Medicine.
