Doctor of Medicine Program Mission Statement and the Medical Curriculum The mission of the Duke University School of Medicine is: To prepare students for excellence by first assuring the demonstration of defined core competencies. To complement the core curriculum with educational opportunities and advice regarding career planning which facilitates students to diversify their careers, from the physician-scientist to the primary care physician. To develop leaders for the twenty-first century in the research, education, and clinical practice of medicine. To develop and support educational programs and select and size a student body such that every student participates in a quality and relevant educational experience. Physicians are facing profound changes in the need for understanding health, dis- ease, and the delivery of medical care changes which shape the vision of the medical school. These changes include: a broader scientific base for medical practice; a national crisis in the cost of health care; an increased number of career options for physicians yet the need for more generalists; an emphasis on career-long learning in investigative and clinical medicine; the necessity that physicians work cooperatively and effectively as leaders among other health care professionals; and the emergence of ethical issues not heretofore encountered by physicians. Medical educators must prepare physicians to respond to these changes.The most successful medical schools will position their stu- dents to take the lead addressing national health needs. Duke University School of Med- icine is prepared to meet this challenge by educating outstanding practitioners, physician scientists, and leaders. Continuing at the forefront of medical education requires more than educating Duke students in basic science, clinical research, and clinical programs for meeting the health care needs of society. Medical education also requires addressing such concerns as national science and health policy, meeting the health care needs of society, providing medical care for the disadvantaged, and applying basic science discoveries to clinical medicine. As health care practices at the federal, state, institutional, and individual lev- els evolve, these endeavors need input from physicians uniquely prepared to assume guiding roles. Mission Statement and the Medical Curriculum 21 Duke University’s role as a leader in medical education is built upon its internation- ally-recognized tradition of fostering scientific scholarship and providing excellent preparation for the practice of medicine. The curriculum promotes creativity, scholar- ship, leadership, and diversity. It integrates the basic and clinical sciences and prepares students to pursue the spectrum of options available to modern physicians, from basic science to primary care. Duke University Medical School produces at least three proto- type physicians; the physician scientist, the clinician-investigator, and the practitioner (either generalist or specialist). The Duke faculty enhance the Medical School’s curriculum by continually embrac- ing new methods of education and evaluation to improve the medical education experi- ence. Attention to curricular development assures Duke graduates that they are grounded in basic biomedical sciences, competent and caring clinicians, prepared to pursue a lifetime of continuing education, and capable of participating in local, national, and international discussions about the delivery of health care now and in the future. Features of the four-year curriculum include: • Development of a core medical curriculum that is rigorous, efficient, integrative and forms a realistic base of knowledge for a physician; • Integration of basic, clinical, psychosocial, and population information and skills throughout the four years of medical education; • General introduction to basic and clinical science for one year each, followed by two years of individualized curricular options that promote professional diversity and personal development; • An elective third year which permits students to pursue their independent scholarly interest across a range of scientific disciplines from basic biomedical science to health policy; • Promotion of structured active learning that includes explicit experience in leadership and cooperative roles; • Mentorship of students by faculty in all facets of the learning process; • Implementation of a standardized and valid assessment of progress, carefully and thoughtfully evaluating the acquisition of knowledge, skills, and attitudes appropriate to the future goals of each student; • Incorporation of information technology and the use of computers into student learning and evaluation; • Research and implementation of new and improved methods of teaching. The curriculum, while offering a previously unattainable degree of flexibility to medical education and new opportunities for intellectual exploration, also makes heavy demands upon the student. It should be recognized that medical students at the Duke University School of Medicine are expected to maintain a consistent level of perfor- mance and to demonstrate qualities of initiative and dedication to their chosen profes- sion. A scholarly attitude toward medicine that continues throughout an entire career is an important objective of the medical school. The foundations of this attitude to learning should accompany the student upon entering. Students are expected to maintain a professional attitude toward patients at all times, to respect confidences, and to recognize that they are the recipients of privileged information only to be discussed within the context of scholarship and in circumstances that truly contribute to the educational process or to the care of the patient. This attitude involves consideration not only of speech and personal appearance but also of morality, honor, and integrity. Beginning in the fall of 1987, the School of Medicine greatly enlarged the focus on ethics and human values in the curriculum. In the face of major advances in medical technology and sciences, today’s medical student must be prepared to deal with new complexities of medical practice. These advances and complexities also make it of 22 Program Information paramount importance that medical education enable each student to grow in both depth and breadth as a human being. The Duke University School of Medicine is rising to this challenge. Doctor of Medicine Degree The degree of Doctor of Medicine is awarded, upon approval by the faculty of Duke University, to those students who have satisfactorily completed the academic curricu- lum; demonstrated the intellectual, personal, and technical competencies to function as a skilled physician; and demonstrated their fitness to practice medicine by adherence to a high standard of ethical and moral behavior. The faculty of Duke University School of Medicine have developed general guide- lines for technical standards for medical school admissions and degree completion. These are available on request from the school. The awarding of degrees is contingent upon payment of, or satisfactory arrange- ments to pay, all indebtedness to the university. In February, 1995, the Duke University School of Medicine was fully accredited for seven years by the Liaison Committee on Medical Education of the Association of Amer- ican Medical Colleges and the Council on Medical Education of the American Medical Association. The complete Self Study Review and LCME database is available for in- spection to anyone upon request to the Registrar’s Office, 125 Davison Building, phone 919/684-2304. Course Requirements—First Year. The student studies the principles of all the basic sci- ence disciplines. Rather than mastering an encyclopedic array of facts, the purpose is to ac- quire familiarity with the major principles of each subject. In addition, students are required to participate in a year-long course, Introduction to Clinical Care. This course, which also is offered throughout the second year as Ambulatory Care Clerkship, is designed to expand ambulatory, primary, and continuity care experience for Duke medical students. The course is a combined clinical curricular experience which emphasizes progressive knowledge and competencies. The course meets one afternoon per week with students beginning a super- vised clinic assignment in January. Thereafter, students are in the clinic every other week and in small and large group instruction in the alternating weeks. The first year consists of instruction in the following: Semester 1 Credit BAA 200 - Gross Human Anatomy 4 BCH 200 - Biochemistry 4 CBI 200 - Cell Biology 2 CBI 201 - Microanatomy 2 CBI 202 - Medical Physiology 4 GEN 200 - Genetics 2 IND 201 - Intro to Clinical Care 1 Total 19 Semester 2 Credit IMM 201 - Immunology 2 IND 201 - Intro to Clinical Care 2 MIC 200 - Microbiology 5 NBI 202 - Basic Neurobiology 4 PHR 200 - Pharmacology 4 PTH 200 - Pathology 5 Total 22 A vacation takes place after the conclusion of the first year. In addition, every class has Thanksgiving, Christmas, Martin Luther King, Jr. holiday, and spring break with the exact dates depending upon rotation and class schedules. Doctor of Medicine Degree 23 Course Requirements—Second Year. Satisfactory completion of the first year curricu- lum is a prerequisite to the second year curriculum. The second year provides an exposure to clinical science disciplines. This permits students early in their careers to become participants in the care of patients. The acquired appreciation of the