100 REASONS 100 REASONS NE HUNDRED STUDENTS each year make Yale the most stimulating place in the world to study medicine. Each chooses Yale for a hundred di≠erent reasons; this book is about Oa few of them. Our class size of 100 allows us to nurture each student’s own interests, ambitions, and vision of how the art and science of medicine can contribute to the world. What’s your reason for choosing Yale? “MEDICINE 1AT YALE. IS ABOUT MORETHAN NUMBERS.” “The numbers tell us what an outstanding school we have: number of grants, number of applicants, number of awards, number of medical breakthroughs. But what makes us extraordinary is that we never lose sight of the whole person behind the numbers—whether that person is the patient, the doctor, or the student.” Robert J. Alpern, M.D. Dean and Ensign Professor of Medicine 4 5 The2. Yale SYSTEM Since it was More than 80 years ago, the Yale School on these tests are known only instituted in the of Medicine embarked on a new approach to the individual student, and 1920s, the Yale System has to education, based on the premise that there are no grade point aver- fostered a collegial educational “the medical student is a mature individual,” ages or class ranking. The rare environment that as a 1928 Curriculum Committee put it. student who fails to achieve produces leaders in medicine. Highly motivated and self-directed, students mastery has many options for were to take an active role in acquiring not assistance in getting up to speed. just a set of facts but habits of inquiry and a > Class attendance at lectures is not recorded, capacity for critical thinking that would last and students are expected to make responsible a lifetime. This approach was so distinctive decisions about the best use of their time. that it became known as “the Yale System.” > Students are encouraged to explore their own The Yale System has endured through interests in medicine and advance at their myriad changes in biomedical knowledge, own pace within the Yale curriculum. About M.D. the nature of clinical practice, and technol- half complete the program in four years, ogy, but it retains its reliance on student and half take an optional, tuition-free fifth initiative, its emphasis on scientific investi- year to pursue additional clinical electives, gation, its respect for individuality, and thesis-related research, or international medical its encouragement of cooperation rather experiences. Several students each year pursue than competition. dual-degree programs with other Yale schools and departments. What does all this mean in practice? M.D. The Yale System embodies the school’s > Every student must complete a thesis commitment to educating leaders who will that represents a substantial body of original advance the science and practice of medi- research. The thesis project teaches students to cine. Such leadership requires the ability wield the tools of scientific investigation and to think critically and creatively, to work places students in close, collegial contact with collaboratively with others, and to take faculty from day one. responsibility for lifelong learning. Judging > In the first two years, students track their own by both the satisfaction of our current progress through optional self-assessment tests students and the extraordinary success of midway through each course and mandatory our graduates, the system works. final examinations called qualifiers. The grades 6 7 GET TO4. KNOW YOUR NEW CLASSMATES IN THE GREAT OUTDOORS... LEssons6. From PATIENTS At Yale, “bedside manner” is not an add-on to physician training but an integral part of the concept of patients as The Medical Outdoor Orientation Trip is a whole people. From the very beginning, a Yale medical four-day hike on the education reminds students not to lose sight of the whole Appalachian Trail patient. In one first-year exercise, students are asked to just before first-year registration. interview a family member about a medical event and then to think about the psychosocial factors that came into play. At the end of the surgical clerkship, students must interview Anatomy students with lectures, study groups, consult course patients after surgery to gain a complete understanding and a wealth of web-based materials online of the experience. Classes build in discus- during a dissection. Before working in resources. Outcome meas- Yale uses a surgical 5. sions not just with medical experts but clinical settings, case model to ...OR IN students practice ures show that students are teach anatomy. with nurses, social workers, and chaplains. their history-taking SERVICE TO skills in a course 3. retaining more information This distinctively Yale approach to medical that employs YOUR NEW ANATOMY under the new model. training makes our graduates better, more actors to play the HOMETOWN role of patient. Rizzolo and his colleagues have pub- observant, more e≠ective doctors. CLASS lished on this unique approach and field inquiries from other medical schools that would like to explore it. The sum of Yale has turned anatomy on its head. medical knowledge increases rapidly, but Traditional anatomy courses begin with the time students spend in medical school comprehensive lectures, overly detailed dis- is a constant. More e∞cient ways to learn sections and long nights memorizing terms. are essential. The case-based approach A four-day orientation to It all seems rather abstract until students does not only teach basic anatomy more the City of New Haven, see patients. So why not start with the patients? e≠ectively; students are simultaneously community service, and That’s what course director Lawrence J. practicing clinical reasoning skills, gaining fellow first-years, S.A.Y. P D. (Service at Yale) New Rizzolo, h. , associate professor of anatomy experience reading images, and negotiat- Haven sends crews and experimental surgery, asked himself. ing the complexities of working in teams. of volunteers to a variety He redesigned the course and made Yale the Experience with the cadavers is also an early of organizations, from Habitat for Humanity first medical school to teach anatomy using and important opportunity for students to Student Sight Savers, a surgical case model. Students begin the to address the issues of death and dying a glaucoma screening course by performing actual operations on that they’ll confront throughout their project at Yale-New their cadavers under the guidance of faculty careers. The course culminates in a Service Haven Hospital. surgeons. For example, they learn about the of Gratitude for the cadaver donors, heart’s structure by performing heart trans- who, through a final act of generosity, plants. Hands-on learning is supplemented became great teachers themselves. 8 9 7. SIZEMATTERS “With only 100 students in a class, every student is an individual. There’s not just one model of success. Students are encouraged to be themselves, and to find out who they want to be in the future.” Nancy Angoff, M.D., M.P.H. Associate Dean for Student Affairs Students have the opportunity both to listen and discuss their ideas during lectures and small group discussions, such as this class in global health. 10 11 Visiting students from Yale talk with the of global health presents lectures on families of patients, subjects ranging from maternal mortal- left, and explore the area surrounding ity to the political uses of psychiatry. The Makarere University course is codirected by students and meets in Kampala. biweekly over dinner. Another elective, THE Introduction to Research Methods in Global Health, focuses on field-based 8. research in low-resource countries. This WORLD workshop is particularly relevant for students who are planning to apply for Downs Fellowships (see #9), which fund When you study medicine at Yale, New summer research projects abroad. Haven is a gateway to the world. You don’t First summer. walk through that gateway alone. The O∞ce First-year students may of International Medical Student Education apply for Downs Fellowships to conduct in 13 organs or systems. Included is discus- they’ve learned at Yale in di≠erent settings. oversees an integrated global health cur- research abroad during the following sion of illnesses that you would not find They’ll be seeing patients with di≠erent riculum that runs throughout your time in summer. Many of the projects become in New Haven. Students may also choose presentations of illness. They’ll develop an medical school. Like the rest of your Yale the basis for the thesis. clinically oriented elective courses in tropical awareness of the social and political factors in medical education, the study of global health A Russian physician medicine, pediatrics, and mental health. health and disease. They learn a basic cultural Second year. working with Yale issues is deliberately planned to keep the focus Throughout residents and competency.” Most students receive financial medical students Third year. on both patients and doctors as whole people. your second year at Yale, looks over an X-ray During their clinical clerkships, support for travel and living expenses associ- you participate in a course while on rounds at you will encounter patients whose paths to ated with international clinical electives. First year. Mulago Hospital in A year-long elective on the called The Modules, study- Kampala, Uganda, New Haven began in many varied parts of social, political, and economic determinants ing mechanisms of disease in 2007. the world. The New Haven area is a diverse enough community that students can gain exposure to a panoply of global health issues without leaving the city. 9. DOWNS Fourth and fifth years.Clinical electives in Argentina, China, England, Peru, South FELLOWSHIPS Africa, Thailand, Uganda, and Zambia take students out of their comfort zone and put Each year, the Wilbur who serve as mentors them into “one of the most intense and Downs International during their time abroad.