Academics

Medical Program Curriculum

The Medical Sciences training program is delivered over ten semesters consisting of 134 weeks of extensive and rigorous training in the basic sciences and clinical disciplines.

The first two years of the curriculum are composed of four semesters, a total of 56 weeks in length, and is delivered at Caribbean Medical University campus on Curacao.

The USMLE review course is dedicated to review students preparation for USMLE Step 1 exam. It consists of five core system based courses, supported by Kaplan materials and delivered in a classroom environment. Upon completion, students are certified for the Step 1 exam.

The Clinical Science program is 72 weeks in length and takes place primarily at hospitals or clinical centers located in the United States.

Basic Medical Science

Gross Anatomy

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 achieve this objective, each student participates in the complete dissection of the body. Formal lectures are devoted to  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 this learning process  in addition to refer and read the recommended textbooks, anatomical atlases. In addition, a dissection guide with lectures and dissection of the human cadaver is also provided.

Laboratory

A unique peer-teaching program has been developed for the dissection laboratory. Each class is divided into  four or more groups with each group consisting of  four or five students and are  assigned as dissection teams to each cadaver in the laboratory. These teams dissect the cadaver on the designated  lab day and meet with  faculty members for a question/answer/tutorial/quiz sessions. Teams are expected to 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 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. Depending on the necessity, sometimes, and feasibility the sequence of dissection could be modified.

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. More emphasis is given to surgical anatomy. It is also planned to teach the clinical relevance of anatomy to various diseases as seen in the clinic.

Histology and Cell Biology

This course presents the structure and function of the human body as revealed by  microscopy and cell biological techniques. . The course commences with a discussion of the cell and its internal structures and  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. Molecular biological aspects of cell structure and function and their clinical relevance are emphasized.
Emphasis on the role of cells in tissue organization and function and the interactions between  cells, their organization to tissues, tissues to organs and various systems and their  interactions  with the external environment  (including gene-environment interaction)  are stressed so that the students have a firm understanding of the concept of  physiology, pathology and their relevance to various diseases.  A firm understanding of normal anatomy, physiology, and the structure and function of various cells and tissues and variations in their interaction with the environment is essential to become a complete and modern physician and the course is directed in this channel.
This emphasis on the cell in Histology and Cell Biology is important  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

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 taught to  have 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

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.
An  area of course with emphasis on the biological bases of behavior, involving a survey of those areas where behavior can be understood in terms of underlying genetics, neuroanatomy, or neurotransmitters is also taught. 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.

Medical Ethics

The fundamental concepts of law that relate to the medical profession are covered in this course. 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 & Molecular Biology

The course is structured to present and explore  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 particular attention  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 biochemical foundation on which students can build throughout their Preclinical Science, and can use later when they are qualified physicians.

Genetics

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.

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, a practicing clinician to anchor a comprehensive understanding of the pathogenesis and disease presents representative cases.

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.

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 faculty closely monitors the discussions 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 also 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 Laboratory

The 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.

Pharmacology

A profound knowledge of the Pharmacological basis of Therapeutics is  essential for  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.
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.

Physiology and Biochemistry

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. A faculty member assists each group.

Clinical Case Studies

Series of 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.

Semester V - USMLE REVIEW

This semester is devoted to review the subjects learned from semester I to IV and prepare the student to appear USMLE Step 1 exam with confidence.  This course is conducted in U.S. for the convenience of the students who are predominantly from United States and Canada, though organization of these classes on Curacao is not ruled out.

During this review course, cardiovascular, pulmonary, and hematology; neural and musculoskeletal system; renal and gastroenterology; endocrinology and reproductive biology; immunology, and microbiology subjects will be reviewed.

Major emphasis of these classes will be to familiarize the student to the pattern of questions that are asked in USMLE step I. The classes are not meant to review the subjects in depth but to integrate the knowledge gained from various Basic Science subjects and give an over view as to how to apply such knowledge in the clinic and to answer clinically relevant topics. For instance, anatomy, physiology, biochemistry, pharmacology and pathology (including immunology, microbiology, and molecular biology) as applied to each organ system will be reviewed rapidly and the relevant diseases pertaining to the system under discussion will be discussed. For example, while reviewing the endocrine system- anatomy of various endocrine organs, their physiological function, and biochemical aspects of the synthesis of various hormones will be discussed including embryology, and a brief mention of various endocrine diseases will be mentioned with emphasis on the pathological processes involved and their treatment including pharmacology of the drugs used in these diseases.  The same pattern will be followed for other organ systems and their diseases.

Since major emphasis in USMLE Step 1 examination is to ask questions that are clinically relevant, such a review covering various basic and clinical aspects of all the organ systems will familiarize the student as to how to prepare for the examination and, in turn, face the test with more confidence. In addition, such a preparation will teach the student as to how to apply knowledge of basic sciences to clinically relevant situations and arrive at the right decision both in making the correct diagnosis and applying right therapeutic

Clinical Rotations

The education program consists of 72 weeks of clinical training. Every student takes 48 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, family practice and psychiatry. In addition to the core rotations, all students must complete 24 weeks of electives or sub-internships.

Internal Medicine

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

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

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

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

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 Care in family medicine

For 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 (min 24 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 of Clinical Science. 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 of Clinical Science.
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 of Clinical Science.

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