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Medical Education
Bridges Curriculum

F1: Foundational Sciences Blocks

World Health Organization’s major causes of morbidity and mortality are used as an organizational framework. Students will select from the top Bay Area population examples (The UCSF 49) of diseases, signs and symptoms, diagnostics and therapeutics, and salutatory strategies, for a deeper exploration in each block. Students will take the following Foundational Science blocks in sequence:

  1. The Ground School Block

  2. The ABC Block - Airways, Blood, and Circulation

  3. Health and the Individual

  4. The REGulationN Block - Renal, Endocrine, GI, and Nutrition

  5. The Health & Society Block

  6. The Pathogens & Host Defense Block - PHD

  7. The Life Stages Block

  8. The Brain, Movement, & Behavior Block - BMB

  9. Data and Reasoning Block - DR

1. The Ground School Block

(6 weeks starting August through mid-September)

MS1s will experience the three elements of Bridges (Foundational Sciences, Inquiry, and Clinical Microsystems Clerkship (CMC, which includes quality improvement and systems sciences)) from the beginning of this block. Foundational Sciences sessions in the first three weeks of the block will focus on core principles of structure (anatomy focused on the musculoskeletal system, embryology, and histology), organ and tissue function (cell biology, physiology) and regulation (physiology, genetics). The second three weeks of the block begin with one week of full-time workplace immersion during CMC. From then on, students will spent one day a week in their workplace (aka clinical microsystem) throughout F1.

The last two weeks of the block focus on alterations to normal and on principles of pharmacokinetics. Students will explore major categories of disease, including neoplasia, inflammation, and circulatory/vascular disease. During each week of Ground School, the Inquiry component will present core scientific reasoning and analytic skills(e.g,. how to read a scientific paper), will introduce research methods for critical analysis of the cutting edge of medical knowledge, and will delve into case-based inquiry. Learning in Ground School takes place in small group sessions, laboratories, interactive large group settings, online and live lectures, and in-class team activities. Starting in Ground School and throughout Bridges F1, students have designated Independent Learning Time (afternoons or mornings to study, complete required weekly formative quizzes and pursue activities that fit their interests, such as shadowing, electives, independent research, and self-care)

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2. The ABC Block - Airways, Blood, and Circulation

(7 weeks from mid-September to mid-November)

This block will introduce cardiovascular/pulmonary physiology and red blood cell/ platelet function and dysfunction (hematopoiesis, anemias, coagulation, and hemostasis). Relevant pharmacology will be included. Key cardiovascular/pulmonary diseases (arrhythmias, valvular heart disease, ischemic heart disease, CHF, hypo/hypertension, asthma, COPD, restrictive lung disease, pleural diseases, cystic fibrosis, and lung cancer) will be presented. Key microcytic, normocytic, macrocytic anemias as well as common coagulation disorders will be presented. Students will also have skills sessions in ECG reading, basic ABG analysis and will participate in 2 unknown scenarios in Simulation settings.  Specific topics such as Congenital Heart Disease will be introduced in F2, while other diseases such as complex management of heart failure will be revisited in FS2 with a focus on differential diagnosis of causes and multi-modality treatment in FS2. The block will be mindful of the content of CMC running concurrent to this course. This block will primarily focus on the Biomedical and Clinical science domains.

Goals:

To prepare first year medical students with the knowledge and skill necessary to start clerkships and pass both Step 1 and Step 2 boards and take care of patients and apply this knowledge to patient care in their clerkships.

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3. Health and the Individual

(4 weeks from mid-November until mid-December)

This block focuses on the experience of health and illness from the individual, family, and provider perspective through the social and behavioral sciences. This includes a focus on psychology, health behaviors, identity, bias, palliative care, and integrative medicine. This block will also cover emerging wellness concepts including mindfulness and resilience---for both patients and  healthcare professionals--to be included as part of the block content. This block will focus primarily on the Social and Behavioral domain of science.

Goals:

To prepare first-year medical students with the knowledge and skill necessary to start clerkships and pass both Step 1 and Step 2 boards and take care of patients and apply this knowledge to patient care in each individual clerkship.

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4. The REGulationN Block - Renal, Endocrine, GI, and Nutrition

(7 weeks from mid-January to end of February/early March)

This block will focus primarily on the Clinical and Biomedical domains of science. This block introduces the gastrointestinal, endocrine, and renal systems. Core nutrition and metabolic biochemistry themes remain in the course, integrated with obesity and diabetes mellitus. Additional important topics include electrolyte imbalances and acid-base disorders, weight management, calcium homeostasis, and a brief intro to inborn errors of metabolism.

We will not be able to cover every disease and physiologic process relevant to gastroenterology, endocrinology, and nephrology within the span of REGulatioN. Therefore, we will focus on processes and diseases that are most pertinent to our first-year medical student audience. We will focus on topics that are relevant to important sources of morbidity and mortality in the United States and global populations, those that illustrate important pathophysiological processes, and those that students are likely to encounter on the boards, on the wards, and as future physicians. Due to time constraints in REGulatioN, we do not anticipate being able to fully cover some SBS-related objectives related to ethics of transplant and tube feeding, and psychological factors related to obesity and weight loss. We envision these as being more appropriate for Context of Health & Healthcare and Individual Experience of Health & Illness.

Goals:

To prepare first year medical students with the knowledge and skill necessary to start clerkships and pass both Step 1 and Step 2 boards and take care of patients and apply this knowledge to patient care in each individual clerkship.

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5. The Health & Society Block

(4 weeks from early March to early April)

H&S has been designed as the culminating 4 weeks of its sibling block, Health and the Individual, with a focus on the context in which individuals (patients and providers interacting within a larger system) experience health and healthcare. H&S will introduce a broad, sociological view, including an emphasis on health and healthcare disparities, health policy, and social epidemiology. This block will also include content related to bias in medicine, clinical ethics, and an introduction to public and global health theory and metrics. H&S will emphasize the Population/Public Health, Systems, and Social & Behavioral science domains.

Goals:

To provide first-year medical students with the knowledge and skills necessary to be well prepared for clerkships and, subsequently, pass the Step 1 and Step 2 boards.

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6. The Pathogens & Host Defense Block - PHD

(7 weeks from mid-April to end of May)

This block will provide the core foundational science content for immunology/rheumatology, microbiology/infectious diseases, and leukemia/lymphoma.

Goals:

To prepare first year medical students with the knowledge and skills in immunology/rheumatology, microbiology/infectious diseases, and leukemia/lymphoma necessary to continue to gain knowledge through the FS1 and FS2 curricula as well as start clerkships and begin to care for patients.

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7. The Life Stages Block

(6 weeks from early August to mid-September) *First course of second year of medical school

Overall the theme of this block will be "Health and Illness at Every Stage of Life" with a focus on health aging and development. This block will begin with a patient panel of older individuals to set the stage for thinking about the many factors that affect health at  every stage of life. We will move into the reproductive years, beginning with the anatomy of the male/female pelvis, the embryology of the reproductive organs, and male and female sexual function and reproduction. We will then cover clinical obstetrics, including prenatal care/screening, the physiology of pregnancy, complications of pregnancy, and the basics of labor and delivery. We will move into pediatrics, beginning with the neonatal transition at birth, neonatal disorders, normal growth and development of the  infant/child and adolescent (including puberty), and abnormalities of growth and development in childhood and adolescence.

Gynecologic disorders (bleeding, masses, pelvic pain), as well as cancers of the breast, ovary, uterus, cervix and prostate will be discussed next. Finally, the principles of geriatrics, including normal healthy aging, common diseases of aging, and relevant pharmacology will be discussed.

 

The block will also build on topics covered in previous blocks, such as ethical decision-making and issues of sexual and personal identity, as they apply to aspects of pregnancy/delivery, women's health, and development throughout infancy, childhood, adolescence, adulthood and old age.

Goals:

To help students view health needs and challenges as evolving along the human life cycle and prepare them to anticipate and address the health issues of patients at different stages of life in the clinical setting. To introduce students specifically to the fields of obstetrics, gynecology, pediatrics, urology and geriatrics. To provide students with a foundation of knowledge and skills in these disciplines sufficient to care for patients in their clerkships and on which to build proficiency to pass both Step 1 and Step 2 boards.

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8. The Brain, Movement, & Behavior Block - BMB

(6 weeks from beginning of September to mid-October during the second year of medical school)

This block will provide the basis of the normal anatomy, development, physiology, and radiological features of the human nervous system, and current concepts regarding consciousness, perception, emotion, and other aspects of the mind. This course will also cover major features (including clinical, pathological, and etiological) of common neurological, neuromuscular, neurosurgical, and psychiatric disorders. Relevant pharmacology and genetics will be included. This block will introduce the clinical assessment of the nervous system, including mental status with a focus on the function of both brain and mind.

Goals:

To provide medical students with foundational understanding of the basic science disciplines of neuroanatomy, neurophysiology, and neuropharmacology as well as applicable areas of social and behavioral science. Prepare medical students with the knowledge and skills necessary to function in clinical settings in the medical specialties of neurology, psychiatry, neurosurgery, neuropathology, and neuroradiology.

9. Data and Reasoning Block - DR

This block includes two intertwined threads: clinical reasoning at the individual patient level and critical thinking at the level of big data. Students will begin by focusing on how clinicians move from a patient's history and exam to a prioritized differential diagnosis, then move toward utilizing data science tools to move from diagnosis to management.

The course covers key concepts in clinical reasoning including:

  • a framework for understanding how doctors think
  • an approach to building clinical knowledge using schemas and compare/contrast strategies
  • an approach for communicating critical thinking to others and generating a prioritized differential diagnosis based on an effective problem representation
  • an appreciation of heuristics and biases which can lead to error, along with strategies to reduce this risk
  • the ability to utilize probabilistic reasoning, rooted in evidence-based medicine, to inform thresholds for diagnostic testing

Concepts of clinical reasoning will be viewed through the lens of patient-centered, high value care with an eye toward encouraging the early adoption of habits of mind that encourage reflection and self-improvement.

In the data science portion of the course, students will peek behind the monolithic machinery of the electronic health record to understand how it works and how to harness the data it churns out, setting the foundation for UCSF students to become healthcare leaders as medicine enters the second machine age—the incorporation of digital technologies—with the aim of improving individual and population health.

The culmination of the course will be a data-driven analysis of real-healthcare data from clinical microsystems or large datasets. To prepare    students for this work, they will learn how day to day clinical activity is encoded into data stored in electronic health records. Students will learn the concrete skills to extract that data to build datasets and statistically rigorous analysis that will help answer real clinical questions. Along the way, they’ll learn how the technical aspects of this work can affect the reliability and quality of analysis, allowing them to be appropriately skeptical of “Big Data” analysis but appreciative of the types of analysis that physician-scientists will be able to perform with this data. Rather than passive participants in the digitalization of medicine, students will emerge with the technical background necessary to work fruitfully as full partners with healthcare systems, technologists, and researchers.

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