Medicine (MD)

The Keck School of Medicine awards the Doctor of Medicine to enrolled students who have satisfactorily completed the four-year curriculum of the school. This curriculum integrates instruction in all departments of the school: Department of Anesthesiology, Department of Biochemistry and Molecular Biology, Department of Cell and Neurobiology, Department of Dermatology, Department of Emergency Medicine, Department of Family Medicine, Department of Medical Education, Department of Medicine, Department of Molecular Microbiology and Immunology, Department of Neurological Surgery, Department of Neurology, Department of Obstetrics and Gynecology, Department of Ophthalmology, Department of Orthopaedics, Department of Otolaryngology — Head and Neck Surgery, Department of Pathology, Department of Pediatrics, Department of Physiology and Biophysics, Department of Preventive Medicine, Department of Psychiatry and the Behavioral Sciences, Department of Radiation Oncology, Department of Radiology, Department of Stem Cell Biology and Regenerative Medicine, Department of Surgery and Department of Urology.

The sections that follow provide a synopsis of the emphases and organization of this four-year curriculum.

Years I–II (two academic years)

The curriculum is designed to enhance the students’ understanding of the basic sciences and their relevance to clinical medicine. The methodology used will improve students’ problem-solving and independent study skills. Curriculum themes are delivered in a case-centered format with the integration of small-group learning sessions, directed independent study and newer instructional technologies emphasized.

Year I–II begins in the first semester with Foundations of Medical Sciences followed by organ system review ending with Integrated Case Study section. There is an eight-week summer break between the first and second years. Students also take Clinical Translational Research (CTR), Evidence Based Medicine (EBM), Introduction to Clinical Medicine (ICM) and Professionalism and the Practice of Medicine (PPM).

Each week of the academic year is composed of approximately 20 hours of lecture and small group sessions with an additional 20 hours of independent directed study, CTR, EBM, ICM and PPM. Examinations in all systems throughout the first two years are graded Pass/Fail.

Foundations of Medical Sciences (FMS)

This 19-week introductory system provides the student with the fundamental knowledge necessary for the integrated study of the basic and clinical sciences in the human organ systems. Foundations of Medical Sciences is divided into three sections: FMS I, II and III. The overreaching goal for these sections is the use of knowledge of medical science to describe basic concepts relating to the structure and function of the human body in normal and diseased states, and thus, provide a foundation for comprehending the disease-specific content required to achieve the case-based objectives in subsequent organ systems.

Gross Anatomy

Cadaver dissection remains a unique teaching tool by which the three dimensional organization of the human body is studied. Gross Anatomy will begin in the Core Principles of health and disease system with the dissection of the body wall and major body cavities followed by head and neck dissection in the neurosciences system, limbs, dissection during the musculoskeletal system and pelvic cavity dissection in reproduction system. Continued study of gross anatomy by use of prosected anatomical specimens as well as computer programs, selected review lectures, and so on, continues throughout the integrated organ systems.

Introduction to Clinical Medicine (ICM)

ICM expresses the strongly patient-centered orientation of the medical school curriculum. The student is introduced to patients and is involved in patient care activities from day one. Students are introduced to the principles of patient care and management and examine what it means to be a physician and how one becomes a physician.

The major content areas of the course include communication in the setting of illness, the unified concept of health and disease (the biopsychosocial model), basic clinical skills and the correlation of basic science with clinical medicine.

ICM emphasizes the systematic acquisition of the clinical skills of interviewing, history taking, physical examination, elementary clinical problem solving and medical record keeping. Throughout the Year I–II continuum, the ICM clinical skills curriculum is integrated with basic science instruction. Students can therefore learn and apply basic science knowledge in the clinical setting. By encouraging a thorough understanding of the direct applications of basic science research to modern clinical medicine, instructors motivate the student to learn, use and retain more of the content and concepts presented in the basic science portions of the curriculum.

A group of five or six students spends from four to eight hours each week with an instructor from the clinical faculty who remains with the group for one to two years. As the group deals with basic medical themes (death, pain and helplessness) and issues (patient responsibility, learning to live with ambiguity and uncertainty), instructors help students to cope with their own feelings. This format opens the door for student-faculty interaction and improvement of student-faculty communication.

Instructors encourage students to take advantage of the learning experiences provided by their roles as helping and therapeutic persons. Students develop their ability to communicate with patients in the setting of illness and are guided by patient concerns to enhance their own growing knowledge, skills, abilities and responsibilities. Students are expected to acquire skills and habits of self-education and self-instruction that will prepare them for lifelong learning.

The unified concept of health and disease presented in this course enables students to comprehend the human organism in all its complexity. Using their clinical experiences as a teaching model, students are taught to consider the patient as an integrated whole and to view the patient’s illness or disease as more than simply a disruption of physiologic processes or a collection of physical findings.

Additional learning experiences occur through workshops and focus experiences. ICM workshops provide standardized instruction in history taking and physical examination, as well as integrated instruction in areas that cross disciplines. These include physician well-being, substance abuse, domestic violence, and ethics. Through focus experiences, students are encouraged to explore a variety of practice environments as well as community-based health and social services. For example, students may visit outpatient clinical settings, a geriatrics long term care facility, a hospice care facility or homeless services organizations.

Professionalism and the Practice of Medicine (PPM)

The purpose of the PPM course is to create a community and social context to provide, identify and facilitate learning from professional role models for students throughout the first two years of the medical school curriculum, as well as to help students gain skills and competence in the areas of communication, the social and community context of health care, ethical judgment, self-awareness and reflection, self-care and personal growth, professionalism, cultural competence, and lifelong learning. The curriculum is dynamic and interactive, allowing for much small-group discussion and participation. Students are encouraged to work collaboratively and enhance small-group skills, in order to improve their participation in Introduction to Clinical Medicine (ICM), Gross Anatomy, MDL laboratories and large-group sessions, as well as to prepare them for the team work of their clinical years.

The PPM course sessions meet on Monday afternoons, typically for two hours per session. The students meet in groups with two faculty members, who serve as their mentors throughout the first year of their pre-clinical education; at least one mentor is a clinician. The clinical faculty comes from multiple disciplines within Keck and the local community. While the course features large lectures, there is a great emphasis on small-group learning acquired from community leaders, faculty-mentored small-group discussions, student presentations and student-led sessions.

The students participate in a core curriculum in Year I, which includes general topics such as cultural competence, ethics, health care policy and finance, professionalism, and empathy. In Year II, the students are allowed to select from nine different areas of interest (selectives), and meet in groups with faculty having expertise in the given area. Examples of selectives presented include advanced ethics, medicine and the mind, spirituality and medicine, medical arts and humanities, global health, complementary and alternative medicine, medicine’s intersection with technology, physicians operating outside their comfort zones, and the future of health care.

The PPM course provides students with an opportunity to build a professional identity, develop relationships with faculty mentors, and increase team-building and community-building skills. Students receive an introduction to the concepts of professionalism and ethics, with a better understanding of their real-world implications. The PPM course encourages leadership while engaging in the process of learning, characterized by presentations within both small and large groups, as well as professional development through exposure to multiple professional, ethical, and cross-cultural scenarios, cases, and providers. Evaluation is provided through student submission of portfolios containing written self-reflections, responses to faculty and peer feedback, and evaluations completed over the course of a two-year longitudinal curriculum. Finally, PPM hones sensitivity and skills relevant to medical professionalism to better prepare students for their transition into the clinical years of the medical school curriculum.

Clinical Translational Research

This course, a series of on-line lectures accompanied by small group discussion sessions, is intended to introduce students to the methods of clinical and translation research (CTR) and prepare them for carrying out research as medical students. Students are required to complete a Required Scholarly Project (RSP) and this course will provide students with the basic skills and competencies needed to plan, conduct, and complete their RSP. Regardless of a student’s future career path, the practice of medicine will be driven by the findings of CTR. Rapid advances in basic sciences, driven to new technologies such as genomics, have brought exciting new possibilities for identifying people at risk for disease, for identifying disease in its earliest stages, and in targeting therapies on an individual basis. On the verge of a new era of “personalized medicine”, healthcare provision is driven by what is known about the characteristics of each individual and of the diseases that they may have.

CTR represents the research approach for moving from basic discovery in the laboratory to application in individual patients and in making populations healthier. Medical researchers have long carried out patientoriented or clinical research. The term CTR is more recent, coming into use over the last decade in recognition of the research continuum from basic discovery in the laboratory to application in patients and on to populations. One problem in bringing discoveries into practice has been a gap between the work of laboratory researchers and clinical investigators; CTR bridges that gap.

Evidence Based Medicine (EBM)

Evidence-based medicine (EBM) is the clear, conscientious, and prudent use of current best evidence in making patient care decisions. Evidence-based guidelines are considered to be the basis for decision-making in clinical practice, guiding screening, diagnosis and treatment. In a new era of health care reform, EBM will likely be given even greater weight and outcomes are tracked carefully in order to evaluate the effectiveness of guideline-driven care.

Evidence-based practice is primarily based on five well defined steps: 1) Asking Focused Questions: translation of uncertainty to an answerable question; 2) Finding the Evidence: systematic retrieval of best evidence available; 3) Critical Appraisal: testing evidence for validity, clinical relevance, and applicability; 4) Making a Decision: application of results in practice; and, 5) Evaluating Performance: auditing evidence-based decisions.

EBM foundational material is taught during Foundations of Medical Sciences I as part of the biostatistics and epidemiology curriculum. Along with the clinical and translational research series during the first year of medical school, this information lays the foundation for the EBM curriculum during the remaining years of instruction.

Organ System Review

A sequence of study presenting integrated basic and clinical science instruction involving human organ systems — skin, hematology and clinical immunology, neurosciences, musculoskeletal, cardiovascular, renal, respiratory, endocrine/metabolism, reproduction, gastrointestinal/liver — follows Foundations of Medical Sciences.

Integrated Case Study

This section completes the second year of the Year I–II continuum and emphasizes patient-centered problems that integrate the basic and clinical science presented in the preceding organ systems. Students will explore the multi-organ effects of disease processes and reinforce diagnostic reasoning skills. In addition, concepts of pathophysiology, evaluation and management that can be applied to any organ system will be included. This section will also reinforce the appropriate use of medical information resources, effective self-directed learning skills, and interpersonal and group communication skills.

Separate review sessions of the important basic science and clinical concepts covered during the previous two years also occur during this seven-week section. These sessions will assist students in preparing to take Step I of the United States Medical Licensing Examination (USMLE).

By early spring of the second year of the Year I–II continuum, students are expected to select their academic clinical advisers and to begin arranging the schedule of clerkships to be taken during Year III–IV. By the end of the fall semester, Year II, each student receives information that describes the curriculum requirements of Year III–IV. Students choose the area of medical practice that they are most likely to pursue and an adviser is assigned from that discipline. The adviser counsels the student on clerkships and opportunities in graduate medical education.

Required Scholarly Project

The Required Scholarly Project (RSP) is designed to provide medical students with the opportunity to become engaged in hypothesis-driven research to promote analytical thinking skills and ultimately, physician leaders. The aim of the RSP is to expose students to the process of scientific inquiry, teaching them how to formulate an answerable question and the requisite methodology in seeking appropriate answers. Each student undertakes a faculty mentored research project in a discipline of his or her choice. Viable disciplines encompass a wide spectrum to include: biomedical research, from discovery to application, and health care, i.e., basic science, clinical, educational, behavioral science, health services, community and epidemiological activities. The RSP is interwoven with the curriculum, which includes didactic instruction on topics such as study design and biostatistics. The RSP is a longitudinal experience throughout all four years of medical school, with successful completion being required for graduation. Students with projects deemed meritorious by the RSP steering committee will receive “Distinction in Research” recognition at graduation.

Year III–IV (two academic years)

The final two years of medical school are designed as a continuum of two calendar years, beginning in July at the end of Year II. During the spring of their second year, students schedule clerkship rotations to be taken during the two years. Each student’s program is designed with the assistance of faculty advisers and includes 50 weeks of required clerkships, 16 weeks of selective clerkships and 16 weeks of elective clerkships.

All degree candidates are required to take Step I of the United States Medical Licensing Examination (USMLE) prior to entering Year III or within six months of completion of Year II (whichever comes first). Students must pass Step I, II CK and CS of the USMLE as a graduation requirement.

During Year III–IV, each student may schedule up to 14 weeks of discretionary time for personal convenience, remedial work, funded research work and other non-curricular activities, such as investigating postgraduate training programs. Although every effort is made to provide flexibility in the scheduling of each student’s program, some inherent limitations are imposed by the maximum enrollment permitted for each clerkship. Students are a vital part of the university’s medical team, which provides health care for patients throughout the year. Vacations are therefore subject to some scheduling adjustments.

Required Clerkships

• Family Medicine 6 weeks
• General Surgery 6 weeks
• Surgical Subspecialty 4 weeks
• Internal Medicine 6 weeks
• Internal Medicine Sub-internship 4 weeks
• Neurology 4 weeks
• Obstetrics and Gynecology 6 weeks
• Pediatrics 6 weeks
• Psychiatry 6 weeks
• Intersession 2 weeks (two, one-week sessions)

Intersession I and II

The Intersession curriculum is two, one-week sessions established for Year III students that will enable learners to pause, reflect and consolidate the many and varied clinical experiences that they encounter in their third year of medical school; to promote advanced clinical skills, professional development, health policy formulation and ethical decision-making, and patient safety; and to further prepare for the residency application process.

This individualized curriculum will allow students to revisit and focus basic-science topics through the prism of newly learned clinical material and to foster capacity for the analysis and formulation of health care policy in light of the political, economic, legal and social, and ethical dimensions of health care.

Students will be instructed in a systems-based approach to patient safety by stimulating the imagination, curiosity and skills of close observation and careful interpretation through engagement with the arts and humanities. Developing and building advanced clinical skills by acquiring, appraising and applying evidence in the context of individual patient decision-making, (i.e., Evidence Based Medicine) are two important goals of the Intersession curriculum.

Providing comprehensive, coordinated and consistent career advising along with fostering the continuing professional development of the learners in the frame of clinical practice are key components. Finally, the curriculum will provide ongoing instruction in the provision of culturally competent care and prepare learners for their required community project.

Selective Clerkships

Students are required to schedule 16 weeks of selective clerkships, chosen from a list of four-week clerkships approved by the Clinical Curriculum Committee. Selective clerkships are carried out at USC-affiliated hospitals and encompass virtually all specialty areas. Information is available at medweb.usc.edu.

Elective Clerkship

The elective period consists of 16 weeks, during which electives may be taken on campus, at USC-affiliated hospitals or at more distant medical schools or medical centers. Approved on-campus electives that are offered regularly are listed in the elective catalogue.

Proposals for other on-campus and off-campus electives are reviewed individually by a faculty adviser. All petitions must be submitted at least six weeks before the beginning of the rotation. Off-campus electives require documentation from the off-campus preceptor, endorsement of the student’s medical school adviser, and prior approval and review by the Clinical Curriculum Committee. Credit is not given for electives until an evaluation has been received from the preceptor. Students with an academic deficiency may not schedule off-campus electives.

Business of Medicine (BOM)

This course, designed for Year III medical students, will introduce students to the fundamentals of the business of medicine, including the nuts and bolts of medical business, practice management and law, physician leadership, health care finance, and health care quality and costs. The BOM course will be case-based and interactive, and facilitated by leaders in the fields of health care business and management.

Program in Medical Humanities, Arts and Ethics

This four-year curriculum begins with collaborative discourse about ethical problems to help students learn to identify, analyze and resolve clinical ethical problems. This exercise is followed by interim skill building/maintenance and by instructor-facilitated discussion of videotaped ethics cases.

In Year II, the program focuses on ethical discernment and action in simulated settings and the study of the human dimensions of medicine. Standardized patients interact with students to help teach the telling of bad news, and students also learn from the humanities about patients as persons. The program concludes with a forum theatre in which students must decide what action to take based on their own convictions.

Year III is devoted to ethics education by clinical role models and encompasses instruction in the core clerkship by ethical standard-bearers. Students also participate in home hospice care and pain management cases.

During Intersession, the program includes a series of sessions that focus on contemporary health care and the physician-in-society. The goal of the sessions is to provide students with the experience of integrating the principles, methods and bedside issues included in Years I–III of the program. Students practice applying the micro-level (individual/clinical) decisions to the ethical dilemmas and policy issues that face physicians at the mezzo-level (health care organizations), and to the macro-level (profession as a whole, state and nation). Topics include issues of professionalism; allocation of resources; the economics, organization and societal oversight of health care; and the care of dying patients.

Fifth-year Research Option and Dean’s Scholars

USC offers students the opportunity to take a full year of research experience with either a Keck School of Medicine faculty mentor or an approved faculty mentor at another institution. This program is open to any student in good academic standing who has completed his or her first year of medical school. Students interested in the option should identify a faculty preceptor and present a description of the proposed research program and funds available in support of the program to the director of the fifth-year research option. Application for this program is made through the Office for Student Affairs (KAM 100B) and will be supervised through the Office of the Senior Associate Dean for Student Affairs and Educational Affairs (KAM 100D). A stipend, comparable to that received by a graduate student at the postgraduate level, is available for selected dean’s research scholars pursuing this option.