Universtiy of Miami Miller School of Medicine Medical School Education & Admissions

Years Three and Four

Poster Presentation: From left: Nadine Najjar and Ann Polcari (Both Class of 2018)

The clinical years three and four are conducted at the UMMSM regional medical campus in Palm Beach and Broward Counties. A combination of traditional format clerkships and integrated clerkships allow students to follow their patients through their care and treatment and participate in the medical, surgical, diagnostic and therapeutic aspects of the care required for management of acute and chronic illnesses. During the third year core clerkships, students will spend approximately one-half day each week in the Community and Public Health Practicum working with public health professionals. This practicum experience will allow students to see patients in the department of health’s community health clinics and to participate in public health research projects. There will also be a monthly seminar series in contemporary issues in public health. During the fourth year, all students will take the required four-week Public Health Clerkship. This clinical rotation will be based at the Palm Beach County Health Department and its affiliated clinics and service programs. The core required rotations in the fourth year, neurology, emergency medicine, geriatrics, and the public health clerkship must be taken at the Regional Medical Campus. Electives and the sub-internship may be taken at the clinical teaching sites on the Miami campus, if desired in the fourth year.

Year Three

Year three begins with a transition to clinical rotations course. The third year is comprised of a combination of traditional clerkships and integrated clerkships. Experiences during these clerkships take place at community sites throughout Broward and Palm Beach Counties. The traditional clerkships include six week experiences in the following disciplines: pediatrics, psychiatry, obstetrics-gynecology, and family medicine. Although traditional in the sense that the students cover one discipline in 6 weeks, the experience for the students is innovative and differs from the inpatient-focused model used in other medical schools. Students are provided individualized mentorship with their assigned attending physician, and will have a broad range of experiences including outpatient practice, inpatient rounds, labor and delivery, and the operating room. The Integrated Clerkships are comprised of two twelve week clerkships: Integrated Medicine and Integrated Surgery. Integrated Medicine combines the disciplines of internal medicine, radiology, geriatrics, and palliative care. Integrated Surgery combines the disciplines of surgery, radiology, and anesthesia. Integrated clerkships are a learner and patient-centered approach to medical education that allow for a greater amount of time for students to follow their patients through various sites of care. Transitions to residency is a longitudinal course delivered in the format of learning communities centered on preparing students for advanced clinical care.

UMMSM MD/ MPH Program: Third Year Core Clerkship Overview

Integrated Medicine (12 weeks): Integrates disciplines of Internal Medicine, Geriatrics, Palliative Care and Radiology

• Internal Medicine experiences include working with inpatient resident teams and one-on-one time with community faculty preceptor
• Geriatric experiences are spent on the VA geriatric unit, rehabilitation unit, wound care, interdisciplinary rounds, journal club, home visits, online modules, and geriatric consultation
• Palliative care experiences include hospice rounds, focus on end of life issues and pain management
• Radiology sessions include didactics sessions and working sessions with radiologists and radiology technicians in the areas of chest, neurologic and musculoskeletal systems

Integrated Surgery (12 weeks): Integrates disciplines of Surgery, Anesthesia, and Radiology

• Surgical experiences include working with the surgical attending and surgical residents in general surgery and vascular surgery, working one on one with the surgeon in operating room, hospital rounds, office visits
• Anesthesiology experiences include working with anesthesiologists and nurse anesthetists in the perioperative period
• Radiology incorporates didactic sessions and working with radiologists and radiology technicians in the areas of abdominal imaging, interventional and breast imaging and include didactic sessions

Family Medicine (6 weeks)

• Students are assigned to family medicine physicians and work in preceptor offices, round on preceptor’s admissions at local area hospitals, nursing home or hospice rounds

Obstetrics and Gynecology (6 weeks)

• Students assigned to individual preceptors providing high degree of exposure and involvement in the experience, including community practices and high risk OB center

Pediatrics (6 weeks)

• Includes experiences in the inpatient pediatric units, pediatric emergency room, newborn nurseries, and one-on-one with community based general pediatricians

Psychiatry (6 weeks)

• Clerkship experiences include a mix of different practice settings including county mental health clinic, VA hospital, private office

Public Health Practicum: Approximately one half day per week longitudinally throughout the third year with experiences that include:

• Continuity Clinic (UM Faculty preceptor)
• Department of Health Immersions include Environmental Health, Tooth Fairy, Emergency Response Team, Family Planning, HIV Mental Health (and others)
• Capstone Project Time
• Public Health Seminar Series

Transitions to Residency: Longitudinal learning in a community format.

This model also allows patients to receive increased continuity of care and students to receive enhanced mentorship and guidance from their attending physicians and residents. Each of the clerkships have approximately one-half day per week dedicated to didactic and small group sessions covering the core curriculum of the clerkship and themes from the Physicianship Skills course introduced in the first two years. MPH coursework will continue to be integrated throughout all clerkships with approximately one-half day per week dedicated to the completion of the Community and Public Health Practicum. This experience will include rotations through outpatient community-based clinics. This experience will include exposure to the public health residency program, a monthly seminar series, and time allotted for completion of a capstone special project in public health.

Year Four

The fourth year is comprised of a variety of required as well as elective clerkships. Required clerkships include neurology (4 weeks), geriatrics (2 weeks), emergency medicine (4 weeks), a sub-internship (4 weeks), and a public health clerkship (4 weeks). Students will have an enhanced role in the provision of care in their fourth year, particularly during their sub-internship. The sub-internship may be taken at either campus and allows for students to work alongside first year residents to admit their own panel of patients and act as the primary provider for these patients under the supervision of an attending physician. The public health clerkship will include experiences at an outpatient continuity clinic, public health didactics, experiences with the public health residency program, and a rotation through the various service units of the Palm Beach County health department including environmental health, public health preparedness, health promotion and education, WIC and nutrition services, communicable disease, Healthy Start and oral health. Elective clerkships may be completed at the regional campus in Broward and Palm Beach County, the main campus in Miami-Dade County, or at an approved outside institution. Students will complete their Capstone projects by midway through their fourth year under the mentorship of faculty and local public health professionals.

The CMC MD courses in the third and fourth years are:

MD Courses in Years Three and Four at Regional Medical Campus

Core Clerkships:

Internal Medicine/ Radiology/Geriatrics/Palliative Care (12 weeks)
Surgery/Radiology/Anesthesiology (12 weeks)
Pediatrics (6 weeks)
Obstetrics and Gynecology (6 weeks)
Family Medicine 6 weeks
Psychiatry (6 weeks)

Required Clerkships:

Community and Public Health Practicum (2 weeks)
Public Health Clerkship (4 weeks)
Geriatrics (2 weeks)
Emergency Medicine (4 weeks)
Neurology (4 weeks)
Sub-Internship (4 weeks)
Electives 14 weeks