University Hospitals Health System
The tertiary hub of University Hospitals Health System (UHHS) is University Hospitals of Cleveland (UHC). Founded in 1866, UHC is a 947-bed academic medical center serving northern Ohio and the nation through patient care, research and teaching, with a historic commitment to the health care needs of the community. UHC’s main campus includes the Alfred and Norma Lerner Tower, Samuel Mather Pavilion, and Lakeside Hospital for adult medical/surgical care; the nationally renown Rainbow Babies & Children’s Hospital; University MacDonald Women’s Hospital, Ohio’s only women’s hospital; University Ireland Cancer Center, a partnership with the university designated by the National Cancer Institute as a comprehensive cancer center (and the only NCI-designated cancer center in northern Ohio); University Psychiatric Center (Hanna Pavilion); skilled nursing and rehabilitation services; and The Research Institute of UHC. The primary affiliate of Case Western Reserve University, UHC and the university form the largest biomedical research center in Ohio. UHC enjoys some of the most prestigious centers of excellence in the country and the world. These include not only those most familiar to the public – cancer, pediatrics and women’s health – but also areas such as orthopaedics and spine, radiology and radiation oncology, neurosurgery and neuroscience, organ transplantation, infectious diseases, cardiology and cardiothoracic surgery, ophthalmology, dermatology, behavioral health, and the fast-emerging field of human genetics and genomics. UHC, along with its partner hospitals in UHHS, serves patients and families at more than 150 locations in northern Ohio. The system is the region’s broadest network of physicians, outpatient centers and hospitals; wellness programs, occupational health, behavioral health, skilled nursing, elder health, assisted living, rehabilitation services and home care; and managed care and insurance.

The MetroHealth System
The MetroHealth System has been serving the medical needs of the Cleveland community for more than 160 years. Today the hospital system is one of the largest, most comprehensive health care providers in Northeast Ohio.

The Henry Ford Health System
The academic and research programs of the Henry Ford Health Sciences Center are supported by the Henry Ford Health System (HFHS), a major integrated health services network in Southeastern Michigan and a recognized leader in patient care, research and education.

Cleveland Health Sciences Library
The Cleveland Health Sciences Library began operating in 1966 with an agreement between the Cleveland Medical Library Association and the University. CHSL operates in two locations, the Allen Memorial Medical Library, at the corner of Euclid Avenue and Adelbert Road, and the Health Center Library, in the east wing of the School of Medicine.

Communiqué is the calendar of events for the School of Medicine. It is published monthly in paper form and also is updated continuously on the Web.

The Medical Bulletin is a magazine for faculty, students, alumni, friends and media. Published three times a year, the Medical Bulletin contains feature articles highlighting research and education, as well as additional areas of interest. Articles provide a glimpse into the people behind the programs. Alumni receive an additional insert, Alumni News, which features class notes and obituaries as well as other news of interest to alumni. A stand-alone edition of Alumni News featuring reunion coverage is published once a year for alumni.

MedLines, a newsletter for faculty, staff, students, alumni, friends and media of the School of Medicine, is published six times a year. Its highlights news about research, education, and the people at the medical school.

The Admissions Committee
The School of Medicine admissions committee has a tough job to do. Each year, it receives thousands of applications from academically superior students with varied backgrounds. Each class is limited to 145 spots, however, so it’s impossible to interview or extend offers of admission to all applicants.

Admissions Criteria
Although the Admissions Committee considers grades and the score on the Medical College Admission Test (MCAT) in the admissions process, high grades and a high score on the MCAT alone are not sufficient criteria for admission (the MCAT is mandatory, however). Just as important are qualities such as integrity, interpersonal skills and leadership ability.

Minimum Academic Requirements
Students must have a solid foundation in the sciences needed to understand modern biomedical information. At a minimum, students should possess the following knowledge:

To Students Who Have Been Out of College a Year or More
Students who have been out of college for a year or more are encouraged to apply. Approximately half of the students at the School of Medicine have a year or more between the time they graduate from college and the time they enter medical school, and about 10 percent of them begin medical school when they are 30 years old or older.

M.D. Student Evaluation
The faculty of the School of Medicine is charged with evaluating all aspects of student performance, including knowledge, skills and personal characteristics, that are pertinent to the development of a responsible, competent and humane physician. This responsibility is delegated by the faculty to the Committee on Students, a standing committee of the faculty of medicine, with a majority of its members faculty-elected.

The School of Medicine of Case Western Reserve University long has been recognized as a national leader in curriculum innovation and development. The educational philosophy and guiding principles include organ systems teaching by interdisciplinary teams of basic science and clinical faculty, introduction to patients in the first year, student anonymity in grading examinations and pass/fail ("satisfactory" or "identified for remediation") evaluation in the first two years, elimination of class ranking, flexibly scheduled time, and student responsibility for self-education. These factors provide a stimulating and congenial learning environment, which is combined with large and diversified research programs and excellent facilities for patient care and clinical education.

The goal of the educational program is to develop responsible, competent and humane physicians with the capacity and motivation for continued learning and the flexibility to recognize, adapt to, and influence future changes in medicine, health care delivery and society.

EDUCATIONAL OBJECTIVES

The four years in medical school can be considered the general professional education of maturing students who, after graduation from medical school, will obtain training as specific preparation for their chosen careers in medical practice or scientific investigation. Therefore, one objective of the medical school phase of a physician’s education is to provide the basic knowledge and skills that are common to all physicians. Another objective is to enable students to develop habits of self-education, methods for solving unfamiliar problems, and enthusiasm for the continuing study of medical sciences. A third objective is to assist students in developing appropriate attitudes with respect to their responsibilities to their patients and to become skillful in meeting these responsibilities.

EDUCATIONAL AUTHORITY

Governance of the educational program resides in the Faculty of Medicine. Each class of students selects representatives who become voting members of the Faculty of Medicine. The faculty of the School of Medicine is responsible for the content, implementation and evaluation of the curriculum. The dean of the School of Medicine serves as its chief academic officer with overall responsibility to the university for the entire academic program. The vice dean for academic affairs carries the dean’s academic and administrative authority and has direct supervisory responsibility over the units that lead and support the curriculum.

The Curriculum Leadership Council is composed of the Curriculum Leadership Council chair and the basic science and clinical faculty teaching leadership of the first two years. The council is responsible for the strategic planning, content, design, selection of teaching leadership, and oversight of the Core Academic Program, and its members jointly oversee integration and coordination within the first two years of the curriculum.

The Clinical Rotation Development Council parallels the Curriculum Leadership Council for the clinical year. It is composed of the Clinical Rotation Development Council chair and all core clerkship directors. The council’s steering committee has representation from each core clerkship discipline, the Primary Care Track, and the school administration.

The Flexible Program Council is composed of the Flexible Program chair, faculty representatives, and curricular leaders participating in the program. An advisory committee assists the council’s planning and implementation of the Flexible Program.

The faculty’s Committee on Medical Education evaluates, reviews and makes recommendations concerning the major units of the medical education program. Acting for the faculty, the Committee on Medical Education evaluates the achievement and outcomes of curricular objectives and reviews the curriculum as a whole. The majority of the members of the Committee on Medical Education are elected by the faculty; student representatives also serve on this committee and its various subcommittees.

EDUCATIONAL APPROACH

Great emphasis is placed on the creation of a graduate school intellectual environment in which students have the opportunity to demonstrate initiative and to assume a large measure of responsibility for their own education. Much value is attached to personal and informal communication between students and instructors, which is facilitated by small group teaching. During the first two years, lectures are used for approximately half of the teaching activities; small group conferences, multidisciplinary laboratories carried out in integrated teaching areas, clinical correlations, and symposia are other educational approaches used. The medical school program is distinguished by traditions of openness and collegiality as well as by its process of continuing self-renewal.

THE CURRICULUM

The four-year curriculum is composed of three interrelated components: the Core Academic Program, the Patient-based Program, and the Flexible Program. The Core Academic Program of Years I and II provides foundational training in the basic biomedical sciences and organ system pathophysiology, and introduces students to the social, economic and interpersonal dimensions of the doctor-patient relationship. The Patient-based Program extends throughout the four years and prepares students in the skills, knowledge and attitudes necessary to provide supervised patient care during graduate training. The Flexible Program provides students with elective opportunities for enrichment, research and individualized study as well as dual degrees. Students must demonstrate satisfactory performance in all three components of the program to be eligible for graduation.

Core Academic Program
The 1999-2000 academic year represented an exciting new phase in the evolution of medical education at the School of Medicine. Fifty years have passed since Case Western Reserve pioneered cross-disciplinary integration in the teaching of basic medical sciences, an idea considered revolutionary at the time and since adopted by medical schools throughout the world.

The revised Core Academic Program curriculum, introduced in August 1999 with the entering Class of 2003, builds on this successful foundation, incorporating new approaches to integration both within the basic science components of the teaching program and between the basic and clinical sciences. In addition, the learning environment continues to be enhanced by a major initiative to develop the use of electronic learning tools, including an electronic syllabus, to facilitate self-directed learning and exploration.

The latest reforms build on the principles of cross-disciplinary integration in the basic sciences and early exposure to clinical experiences that have been hallmarks of the University’s curriculum since the 1952 "revolution." Whereas the 1952 reform focused on integrating disciplines (for example, anatomy and physiology) within each organ system, this new effort focuses on integrating learning across organ systems and in the context of biological and social factors that influence patterns of disease expression, treatment strategies and outcomes in individuals and communities.

To graduate physicians who are able to effectively integrate cutting-edge science, medical and information technology, and comprehensive, humanistic care, such integration must be the very fabric of the medical school curriculum. The revised curriculum reflects this vision. Major changes:

The Core Academic Program consists of consecutive learning modules, or subject committees, representing the major content areas in basic and clinical medical science. Some subject committees are grouped together thematically into sections.

In Year I, these content areas are Cellular and Molecular Biology and Genetics, Integrative Human Biology, Fundamentals of Therapeutic Agents, and Biological Basis of Disease I.

In Year II, the content areas are Organ System Pathophysiology, Drug Action and Biodisposition, Hematology, and Mechanisms of Infection.

Running concurrently with these modules in Year I is Introduction to Clinical Medicine (ICM), a program of small group, case-based, problem-solving workshops and lectures that engage students and faculty in topics ranging from the social and economic context of medicine, epidemiology and biostatistics, to developing the tools of clinical decision-making, such as the critical evaluation and application of information (also known as evidence-based medicine). In addition, ICM workshops focus on dealing with issues that can challenge the doctor-patient relationship, such as death and dying, substance abuse and sexuality. Self-directed learning skills, peer education, self-assessment and peer assessment, and the promotion of student-student and student-faculty collegiality are emphasized throughout the ICM program. The Year I curriculum begins with an introduction to the ICM program called Fundamentals of Medical Decision-Making.

The annual Curriculum Handbook of the School of Medicine provides a detailed description of the subject committees and sections in the Core Academic Program.

Patient-based Program
The Patient-based Program is a four-year continuum. It begins with early involvement with patients in the pre-clerkship activities of the first two years and builds toward intensive clinical experience in the core clerkships of the third year and clinical electives of the fourth year. The emphasis of the Patient-based Program in the first two years is concurrent progress in professional maturation in acquiring clinical skills, knowledge and attitudes. An essential foundation for supervised responsibility for patient care in graduate training, it reinforces and builds on the information base introduced in the Core Academic Program and is complemented by the Flexible Program. The ICM program provides a unique link among these activities.

Preclerkship Years I and II
The three components of the Clinical Science Program are: the lecture series/preceptor groups (which are part of the ICM), the Family Care Program, and the Interviewing Program. Physical Diagnosis completes the pre-clerkship portion of the Patient-based Program.

Year I features all three components of the Clinical Science Program.

Year II focuses on Physical Diagnosis, but activities of the other three components continue.

The process of professional maturation requires developing skills, attitudes and behavior consistent with being a competent, humane and open-minded physician. This process continues throughout the four-year continuum, but the primary focus of the Clinical Science Program and Physical Diagnosis in the first two years is on the various perspectives involved in becoming a professional.

Family Care Program. Early in the first year of medical school, each student is assigned to follow a pregnant woman. (The alternative of a geriatric patient is available for a small number of students.) The student has both an opportunity and a responsibility. The opportunity to observe and support the patient through her antepartum course, delivery, and the later care of her child is accompanied by a responsibility to be accessible to the patient. The student is the principal liaison to the physicians caring for the patient and as such is a part of the patient’s health care team. The process of physical examination begins in this setting. The student attends each clinic visit with the pregnant mother and is with her throughout labor and delivery. The student attends the well-child care visits of the baby through the second year of medical school. Workshops conducted by the medical directors of the family clinics during the first four weeks of medical school help prepare students for the Family Care experience. Workshop topics include the physical examination of the pregnant woman, the physiology and psychology of pregnancy, labor and delivery, and interviewing.

Interviewing Program. This component of the ICM is designed to provide opportunities for students to receive instruction in and practice effective doctor/patient communication skills. Students complete two observational and two videotaped patient interviews during their first year. Each interview is observed by a preceptor and a student partner and followed by a structured feedback session to review the tape and analyze the student’s interviewing strengths and weaknesses. The patient also participates in the feedback session. Each session is preceded by a goal-setting session wherein the student identifies different skills to practice in each interview. An interviewing skills checklist is used to record the student’s progress in mastering the skills. Skills practice in self-assessment, the medical write-up, oral presentation skills, how to deliver effective feedback to a colleague, and consultation skills also are integral components of this program.

In Year II, students participate in two observational and two interview sessions with standardized patients to practice the specific interviewing skills of sexual history-taking and how to assess a patient’s readiness for behavioral change. They continue practicing self-assessment skills, oral presentation skills, preparing and delivering feedback, and consult skills. Goal setting before the interview and structured feedback session after each interview continue. In addition to being evaluated on the actual skills practiced, students are assessed in their professional development in the areas of responsibility in making and keeping appointments, receptiveness to feedback, and respectful demeanor to patients and colleagues.

Physical Diagnosis. In a series of didactic lectures, demonstrations and small group sessions during Years I and II, students learn the basics of interviewing and physical exam methodology. Part One of the course focuses on basic techniques and normal physiology. Part Two focuses on abnormal findings. These teaching sessions consist of the demonstration of a regional physical exam technique and medical history-taking skill followed by supervised practice of the interview and examination with a student partner, hospital-based patient and/or standardized patient. To support clarity and integration, each regional examination is coordinated whenever possible to the regions/organ systems being taught simultaneously in the Core Academic Program curriculum. Afternoon lectures and subspecialty-oriented physical diagnosis laboratories supplement the material presented in small group format.

Following completion of this introductory course, students are assigned to individual internal medicine or family medicine faculty mentors from various affiliated hospitals to perform a series of at least six complete histories and physical examinations on either hospital inpatients or patients in the ambulatory setting.

The Year II physical diagnosis experience includes a three-week pediatric physical diagnosis component emphasizing the unique aspects of the examination of the newborn, toddler and adolescent.

Assessment of the students’ skills is measured by tracking their progress on the physical diagnosis checklist and the medical history-taking checklist, as well as by verbal feedback from their instructors. Final assessment for the course is via a physical diagnosis objective structured clinical examination (OSCE) at the end of Year II.

CORE CLERKSHIPS

General Educational Goals and Process
The primary goal of the clerkships is for the student to acquire the skills to solve clinical problems scientifically, humanistically and to the objective benefit of the patient. The student learns by case study method the collection of information for a comprehensive database, identification of problems, development of appropriate methodology for solution of the problems, and participation in treatment and observation of the course of the patient’s illness. The student learns to care for patients as human beings in whom organic or psychologic illness may have a profound socioeconomic and emotional impact. The student must learn to work harmoniously with all members of the health profession team to solve these broad patient problems. These fundamental skills can be augmented in graduate training.

The clinical faculty provide the framework for care to patients, in which students participate under supervision. Implicit in this relationship is acceptance of responsibility for the care of patients to a degree appropriate to the individual student’s level of training and the specific clinical situation. This is a new dimension in education for most students and may initially be a source of anxiety. The clinical faculty members are prepared to lend support when necessary. Experience indicates that the majority of students quickly acclimate to involvement in patient care.

In the majority of clerkships, the resident physicians, with the strong support of the clinical faculty, fill an important teaching role in the case study method by direct supervision of students in history-taking, physical examination, laboratory evaluation and problem formulation. The faculty also are responsible for ensuring the proper balance between learning experiences and service functions, and for the quality of supervision provided to students by the resident staff.

Evaluation of student performance in core clerkships also differs from the written examination format used in the core curriculum. Continuous accumulation of information and development of clinical skills are required in the case study method of learning. Students’ acquisition of information, application of knowledge, and development of clinical skills generally are assessed by faculty and house officers’ observations and questioning in the clinical setting. In all clerkships, written and/or oral examinations also are administered and must be passed.

An equally important component of evaluation of clerkship performance concerns behavioral characteristics of students as physicians-in-training. In particular, it is expected that students’ behavior reflects a high level of responsibility and commitment to their patients and colleagues, including an awareness of the necessity for some degree of personal sacrifice in caring for the ill. This includes the daily interpersonal relationships necessary for working in the team situation that characterizes contemporary health care delivery. Excellence in the fundamentals of medical knowledge is never sufficient to outweigh behavioral characteristics detrimental to considerate and ethical human relationships. It is the responsibility of the faculty to inform the student of his or her clerkship performance.

Core Clerkship Year III
The 48-week core clerkship third year was implemented in July 2000 with the Class of 2002. Core clerkships are offered at approximately 21 clinical services in affiliated hospitals and practices. Required rotations through medicine, surgery, pediatrics, obstetrics/gynecology, psychiatry, family medicine, and neurosciences must be taken at one of these affiliates.

Each student is required to take the following in block format:

Block No. 1
Neurosciences (4 weeks)

Block No. 2
Inpatient Medicine (8 weeks)

Block No. 3
Obstetrics/Gynecology (7 weeks)

Each clerkship is directed by a University faculty member who is responsible for certifying to the School of Medicine that each student has achieved the educational goals stated for that clerkship. In this role, the clerkship directors represent the service directors of the affiliated hospitals in their teaching relationship with the School of Medicine. Additionally, the clerkship directors work with the Patient-based Program coordinator, who is responsible for administration of the clinical programs, and the chair of the Clinical Rotation Development Council. The Committee of Clerkship Directors, with representation from all clerkships at all sites, determines the general goals and monitors the educational processes of the required clerkships.

Core Clerkship Descriptions

Medicine
The medicine clerkship builds on the knowledge of human biology and pathophysiology developed in the Core Academic Program and the basic interviewing and physical diagnosis skills acquired by students in the Clinical Science Program and Physical Diagnosis. The goals of the core medicine clerkship are that the student:

This clerkship consists of inpatient and ambulatory experiences. During these rotations, students participate as active members of the health care team.

Neurosciences
In this four-week rotation, students learn to perform and understand the neurologic examination, use a clinical database to localize lesions within the nervous system, and characterize the disease process in terms of pathogenic mechanisms. They also actively diagnose and manage inpatient and outpatient neurological and neurosurgical diseases under the supervision of neurology and neurosurgery house officers and attendings. Students participate in outpatient clinics and as members of the inpatient ward team on the neurology or neurosurgery service. Those choosing the neurosurgical clerkship become familiar with the techniques involved in common surgical procedures as well as neurological intensive care.

Obstetrics/Gynecology
The goal of this clerkship is to teach the basic principles of obstetrics and gynecology and to apply these principles involved in health care for women. The emphasis is on the pathophysiology of the reproductive tract. Students are expected to gain an understanding of normal reproductive physiology and the medical and surgical complications of pregnancy. Students also gain experience in the diagnosis and treatment of common gynecological problems, insight into the meaning of pelvic disease, and exposure to a major patient care field as a possible career choice.

Students participate in ambulatory and inpatient services as well as in operating and delivery room activities. Roughly half of the time on the clerkship is spent in obstetrics and the other half in gynecology.

Pediatrics
The goals of the pediatrics clerkship are to provide an introduction to the field of pediatrics and to promote an awareness of the concept of disease in a rapidly growing person. The clerkship emphasizes developing the student’s competence in the skills necessary for the case study method of patient care, namely, effective data collection through the history and physical examination, synthesis and presentation of information, problem-solving, patient management, and communication with patients and their families.

Students are exposed to the complete range of pediatric experiences (infancy through adolescence), problems of normal growth and development, ambulatory practice, and tertiary inpatient care. Students work as members of the ward team and are directly involved, with the appropriate supervision, in managing patients.

Family Medicine
This four-week clerkship enables the student to work with a continuity preceptor to gain experience with comprehensive diagnosis, assessment and management of patients of all ages with undifferentiated problems commonly encountered in the broad spectrum of primary care. This allows the student to structure his or her experience from the general to the specific.

This clerkship combines comprehensive office practice with interactive learning experiences in an individually tailored program for third-year students. Students work side-by-side with a community or residency family doctor.

Psychiatry
This clerkship provides intensive clinical experience on the inpatient service, in outpatient clinics, and/or on the consultation liaison service. Clerkship didactics and clinical work build on the didactics, group and interview experiences from the second year Mind Subject Committee.

The objectives of the psychiatry clerkship are to develop the skills and knowledge essential to the psychiatric evaluation, the mental status examination, interviewing techniques, and selection and implementation of treatment modalities. Emphasis is placed on descriptive characteristics of psychiatric disorders and therapies, the rationale for the use of a variety of psychiatric therapies, psychopharmacology, the major psychodynamic mechanisms, and unconscious processes and their applications in clinical situations. Students acquire the clinical experience needed to make accurate psychiatric diagnoses, gain a working knowledge of psychopharmacology, learn principles of treatment sufficient to make referrals, and expand their own understanding of the psychological effects of illness.

Surgery
The goal of this clerkship is to provide students with a broad clinical experience in which to develop diagnostic and management skills, improve their skills for the collection, organization, integration and presentation of data; procedural skills, recognition of treatment priorities; and management of emergencies. The emphasis in this clerkship is on problems unique to the surgical discipline and on participation in frequently used surgical therapeutic methods. At the same time, it becomes clear that surgical judgment and technical approaches require a broad background knowledge of the basic sciences as well as firm clinical knowledge from the non-surgical fields.

Objectives of this clerkship are to acquaint students with surgery as a discipline and to give them an appreciation for working with other members of the team. Students find this a useful time to review basic anatomy and physiology and are expected to acquire a basic understanding of the pathophysiology of surgical disease and the rationale for surgical treatments.

The annual Year III Core Clerkship Catalog of the School of Medicine provides more detail about the core clerkships.

FLEXIBLE PROGRAM

The Flexible Program encompasses the electives of the first two years, which mainly are short courses offered during the afternoons (Type A) and the clinical electives of one month or longer typically taken in the fourth year (Type B). Catalogs of both Type A and Type B electives are published and distributed to the students annually. Students may take an Area of Concentration (AoC) or take a broad range of electives in the Diversified Medical Sciences. The objectives of the Flexible Program are to:

The content of the Flexible Program is designed to complement the Core Academic Program and the Patient-based Program, to extend them, and to promote integration across the usual disciplinary boundaries.

Components of the Flexible Program
The Flexible Program includes two pathways: Areas of Concentration and Diversified Medical Sciences.

Areas of Concentration
All students are required to participate in the Flexible Program, and the minimum course requirement is the same for all students. Within the Flexible Program and within the minimum course requirements, Areas of Concentration (AoCs) are offered to those students who wish to pursue them. Pursuit of an AoC is intended to allow the student to choose a single area and pursue this area in depth. We believe that scholarship of this type is of value for medical students and will establish patterns of study for physicians who must continue their own self-education throughout their lives. Additionally, the collegiality that results from faculty and students working together in areas of common interest adds much to the academic environment of this medical school. The following points describe the basic features on an AoC. They are modified from the guidelines used by the faculty in developing AoCs.

The student’s completion of an Area of Concentration is recognized by notation on the official transcript. Students achieving excellence in an Area of Concentration are awarded distinction in the Area of Concentration. This award is granted by February of the fourth year, is recognized at commencement, and is noted also on the official transcript. Nomination for distinction is made by the Area of Concentration faculty. This nomination is then reviewed and the award made by an ad hoc faculty committee.

Diversified Medical Sciences
Students who do not choose an Area of Concentration participate in the Diversified Medical Sciences pathway. This path is intended to appeal to those students whose interests have not been refined to the point where they feel comfortable in committing themselves to the in-depth pursuit of a single area. Distribution requirements are imposed for the Type A unit requirements of the first two years as outlined in the Flexible Program Catalog of Type A Electives.

More information about the Flexible Program is available in the annual Type A Catalog and Type B Catalog of the School of Medicine.

THE ELECTRONIC CURRICULUM

The School of Medicine has developed an integrated electronic curriculum that contains a list of learning objectives for every hour of the core curriculum, as well as the resources that allow the students to achieve the objectives. These resources include references to traditional textbooks and journal articles, original textual material, PowerPoint files, illustrations, animations, videos, audio files, and links to Internet-based learning resources (including original journal articles in electronic format). These resources are made available on the Internet by an NT/Internet server system.

An electronic testing system (using an SQL server) has been developed to administer multiple-choice examinations on the student desktop computers over CWRUnet, automatic grading of the examinations, and e-mail feedback to the students that includes the test score, a short descriptive phrase that describes the concepts that the student did not answer questions on correctly, and links to the places in the electronic curriculum where these concepts are introduced and explained. The electronic curriculum is being developed for the core clerkships and the Flexible Program.

Each student is given a notebook computer at the time of matriculation and is provided a series of computer orientation sessions. Students have access to the Internet and the electronic curriculum from their assigned personal desks via fiber optic Ethernet connection to CWRUnet. When off campus, access is through modem.

THE PRIMARY CARE TRACK (PCT)

School of Medicine
Room E-414
Program Coordinator: Pamela B. Glover, M.Ed.
Phone 216-368-5966
Website: http://mediswww.cwru.edu/dept/pct

In 1994, as part of the Robert Wood Johnson Generalist Physician Initiative, Case Western Reserve launched the Primary Care Track (PCT), a program within the School of Medicine. The focus is on general pediatrics, general internal medicine, and family medicine, but the program provides a strong foundation for students regardless of what medical discipline they eventually pursue. Students will find the Primary Care Track a program focused on their educational needs as well as the needs of the future health care system.

Students may apply for admission to the Primary Care Track early in the first semester of the first year of medical school. Students in this program have several advantages beginning in the first year of medical school:

PCT students have a home base during the third year at one of three affiliated teaching sites: MetroHealth Medical Center or University Hospitals of Cleveland/Louis Stokes Cleveland Department of Veterans Affairs Medical Center, and Henry Ford Health System in Detroit. Their clerkships in the primary care disciplines of medicine, pediatrics and family medicine are all completed at their home base sites. In addition, PCT students pursue a longitudinal continuity preceptorship throughout the third year and participate in small-group activities organized around primary care topics that take advantage of educational strategies such as problem-based learning.

The PCT is designed to continue across the seven years of medical training (school and residency). PCT students in their fourth year of medical school are given considerable autonomy in choosing their courses, but are required to complete a one-month health policy experience. PCT students have the option of taking electives designed especially for the program, such as a pediatric or medicine subspecialty electives, or self-directed electives in international health, adolescent medicine and women’s health. Another option for PCT students is to pursue an integrated fourth year at the Henry Ford Health System.

The PCT’s influence continues into the residency programs in general internal medicine, general pediatrics and family medicine at the affiliated teaching sites. Faculty development programs have been implemented to teach residents to become better teachers.

OTHER DEGREE PROGRAMS

The degree programs listed in this section may require admission to another school at the university in addition to or instead of the School of Medicine. Each school may have different deadlines and requirements for admissions. Please contact the other schools separately using information provided under that school’s listing in this publication. Please see departmental listings in this section of the General Bulletin for information about additional degree programs offered through the medical school’s departments.

CLINICAL RESEARCH SCHOLARS PROGRAM (CRSP)

A program leading to a master of science in clinical research degree, the Clinical Research Scholars Program (CRSP) aims to develop a new generation of clinical investigators in leadership roles in academia and industry.

The program resides in the Center for Academic Clinical Research in the Division of General Medical Sciences of the School of Medicine. Students are individuals who have completed their clinical training and want to develop a professional career based on clinical investigation. A prerequisite for consideration for admission is a degree in medicine, dentistry, nursing, or an allied science such as pharmacy or biomedical engineering, along with postgraduate training in health care provision or similar clinical applications of the applicants’ basic discipline.

The CRSP consists of formal didactic course work, a longitudinal seminar series, and an intensive mentored experience centered on a specific clinical research problem. The curriculum makes use of existing didactic material offered throughout the University’s medical, nursing and dental schools as well as offerings specifically designed for CRSP students.

The program has a two-year curriculum requiring 36 credit hours. A total of 15 hours are accumulated in five required courses common to all fields of clinical investigation. Specialty tracks provide maximum flexibility and can be adapted to meet a wide array of clinical research career goals. Completion of a formal thesis is required for the awarding of the master of science in clinical research degree.

Some financial support may be available based on merit and need.

For more information, see http://mediswww.cwru.edu/CRSP/ or contact Carol Tolin, Program Coordinator, CWRU Clinical Research Scholars Program, c/o MetroHealth Medical Center - Bell Greve 3-45, 2500 MetroHealth Dr., Cleveland OH 44106-1998; e-mail: ctolin@metrohealth.org

Clinical Research Scholars Program (CRSP)

Graduate Courses

CRSP 401. Introduction to Clinical Research Summer Series (3)
This course is designed to familiarize one with the language and concepts of clinical investigation and statistical computing, as well as provide opportunities for problem-solving, and practical application of the information derived from the lectures. The material is organized along the internal logic of the research process, beginning with mechanisms of choosing a research question and moving into the information needed to design the protocol, implement it, analyze the findings, and draw and disseminate the conclusion(s). Prereq: M.D., R.N. Ph.D. or Doctor of Nursing, D.D.S., or doctorate prepared health professionals.

CRSP 651. Clinical Research Scholars Thesis (1-18)
CRSP Thesis M.S. Prereq: Permission of program faculty.

MASTER OF PUBLIC HEALTH (M.P.H.)

The master of public health program prepares students to enhance health in human populations through organized community effort. Graduates are qualified to work in local and state health departments, universities and colleges, hospitals, ambulatory medical centers, non-profit organizations, and the insurance and pharmaceutical industries.

The program seeks to attract a rich mix of students–those pursuing degrees in medicine, nursing, dentistry, law, social work, bioethics, management and other fields.

The program has tracks in adolescent health (the first in the country), health services research, urban health, health care policy and administration, health promotion/disease prevention, biostatistics, and epidemiology. The 36-hour program can be completed in two years. Students earn 15 credit hours through five required courses representing the fundamentals of public health: biostatistics, epidemiology, environmental health sciences, health services administration, and social and behavioral sciences. Also, students receive a total of nine credit hours for three courses in an area of concentration of their choice (adolescent health, biostatistics, epidemiology, health services research, health care administration, urban health, or disease prevention and health promotion), three credit hours for an elective course, and nine credit hours from a one-semester public health field practicum. In the practicum, students work on a project for a public agency and produce a report for the agency.

The M.P.H. program recently has introduced several new dual degree programs. Each program combines a master of public health degree with one of the following degrees: master of science in nursing degree, medical degree, master of business administration degree, juris doctorate degree, or master of arts/Ph.D. in anthropology.

Initial admission is through the University’s School of Graduate Studies. For more information, call (216) 368-3128, e-mail vxg6@po.cwru.edu, or visit http://epbiwww.cwru.edu/pages/mphprg.html on the Web.

Master of Public Health (M.P.H.)

Graduate Courses

MPHP 405. Statistical Methods in Public Health (3)
This one-semester survey course for public health students is intended to provide the fundamental concepts and methods of biostatistics as applied predominantly to public health problems. The emphasis is on interpretation and concepts rather than calculations. Topics include descriptive statistics; vital statistics; sampling; estimation and significance testing; sample size and power; correlation and regression; spatial and temporal trends; small area analysis; statistical issues in policy development. Examples of statistical methods will be drawn from public health practice. Use of computer statistical packages will be introduced.

MPHP 408. Public Policy and Aging (3)
(See EPBI 408.) Cross-listed as EPBI 408.

MPHP 411. Introduction to Behavioral Medicine (3)
Using a biopsychosocial perspective, an overview of the measurement and modeling of behavioral, social, psychological, and environmental factors related to disease prevention, disease management, and health promotion is provided. Cross-listed as EPBI 411.

MPHP 421. Health Economics and Strategy (3)
(See ECON 421.) Cross-listed as ECON 421 and HSMC 421.

MPHP 425. Community Health Advocacy (3)
The objective of this course is to acquaint students with basic theoretical and practical aspects of community health advocacy (including foundations, needs assessment, post assessment and priority setting, ethical issues, and approaches and strategies) and to explore the roles that they can play as health professionals. The course will be taught using an intensive weekend format.

MPHP 429. Introduction to Environmental and Occupational Health (3)
This course is designed to provide an overview of both environmental and occupational health. Students will be introduced to the basics of toxicology and exposure assessment. Topics considered will range from local to global. Socioeconomic, political and public health implications of environmental and occupational issues will be discussed. Students completing the course should be able to recognize environmental and occupational problems, access resources in these fields, and understand control and preventive measures. Core requirement for M.P.H. Degree.

MPHP 431. Statistical Methods I (3)
Application of statistical techniques with particular emphasis on problems in the biomedical sciences. Basic probability theory, random variables, and distribution functions. Point and interval estimation, regression, and correlation. Problems whose solution involves using packaged statistical programs. Cross-listed as EPBI 431.

MPHP 432. Statistical Methods II (3)
Methods of analysis of variance, regression and analysis of quantitative data. Emphasis on computer solution of problems drawn from the biomedical sciences. Design of experiments, power of tests, and adequacy of models. Prereq: MPHP 431. Cross-listed as BIOL 432 and EPBI 432.

MPHP 433. Community Interventions and Program Evaluation (3)
(See EPBI 433.) Cross-listed as EPBI 433.

MPHP 439. Public Health Management and Policy (3)
This course will include a description of the health care system, an understanding of population based health care, concept and methods of health management, current issues in health policy and the application of these concepts using case studies. Topics will include the role of the manager, organizational design and control, professionals in organizations, adaptation and accountability. This is a required course in the M.P.H. degree. Grades will be based on class participation and a paper.

MPHP 442. Biostatistics II (3)
This course deals with the basic concepts and applications of nonparametric statistics. Topics will include distribution-free statistics, one sample rank test, the Mann-Whitney and Kruskal Wallis tests, one sample and two sample U-statistics, asymptotic relative efficiency of tests, distribution-free confidence intervals, point estimation and linear rank statistics. Prereq: MPHP 432. Cross-listed as EPBI 442.

MPHP 445. Current Issues in Urban Public Health (3)
The objective of this course is to acquaint students with current issues arising in the urban health context. As such, the focus of the course will change from year to year. Topics to be addressed on a rotating basis include issues in LGBT (lesbian, gay, bisexual, and transgender) health, substance abuse and prevention, public health law, HIV/AIDS in the U.S. urban setting, women’s health, intentional injury, and environmental health and environmental justice.

MPHP 447. Sampling Finite Populations (3)
This course will discuss the basic concepts of sampling theory including simple random and systematic sampling, ratio and regression methods of estimation, stratified and cluster sampling, randomized response survey and their applications in health sciences. Prereq: MPHP 432. Cross-listed as EPBI 447.

MPHP 450. Clinical Trials and Intervention Studies (3)
(See EPBI 450.) Cross-listed as EPBI 450.

MPHP 451. Principles of Genetic Epidemiology (3)
(See EPBI 451.) Cross-listed as EPBI 451.

MPHP 455. Genetic Epidemiology of Complex Diseases (3)
(See EPBI 451.) Cross-listed as EPBI 455.

MPHP 456. Health Policy and Management Decisions (3)
(See HSMC 456.) Cross-listed as HSMC 456.

MPHP 458. Statistical Methods for Clinical Trials (3)
(See EPBI 458.) Cross-listed as EPBI 458.

MPHP 460. Health Research Methods I (3)
This is a course in research methods focusing on practical issues in the conduct of health services research studies. Topics include: an overview of health services research; ethics in health services research; proposal writing and funding; the relationship between theory and research; formulating research questions; specifying study design and study objectives; conceptualizing and defining variables; validity and reliability of measures; scale construction; operationalizing health research relevant variables using observation, self and other report, and secondary analysis; formatting questionnaires; developing analysis plans; choosing data collection methods; sampling techniques and sample size; carrying out studies; preparing data for analysis; and reporting of findings. Cross-listed as EPBI 460.

MPHP 463. Survey Design and Data Collection in Health Research (3)
The purpose for this course is to provide hands-on experience in designing and conducting surveys in health research. The topics include sampling, types of surveys (e.g., interviews, mail, telephone, medical records), questionnaire design (i.e., multiple indicator models, index and scale construction, assessing psychometrics properties), field operations (i.e., data collection, editing and coding). Cross-listed as EPBI 463.

MPHP 467. Cost-Effectiveness Analysis in Health Care (3)
Evaluation of alternative medical treatments and drug therapies. Topics include cost-benefit, cost-effectiveness and cost-utility analysis. Measuring cost, benefits and health outcomes. Quality of life and other measures of effectiveness will also be addressed. Emphasis on case studies, course project, and evaluation of publications. Some decision analysis and policy implications will also be included. Cross-listed as EPBI 467.

MPHP 468. The Continual Improvement of Healthcare: An Interdisciplinary Course (3)
The focus of this course is on collaborative work for the benefit of patients and community. Seminar classwork is combined with a field project, in which interdisciplinary student teams apply what they have learned to the improvement activities of a local health care organization. Successful completion of the course depends on participation in seminar sessions and completion of the interdisciplinary student team project. Prereq: Consent of instructor. Cross-listed as EPBI 468.

MPHP 485. Adolescent Development (3)
(See ADHT 485.) Prereq: Consent of instructor. Cross-listed as ADHT 485.

MPHP 486. Adolescent Health Care Policies (3)
(See ADHT 486.) Prereq: Consent of instructor. Cross-listed as ADHT 486.

MPHP 487. Research and Evaluation in Adolescent Health (3)
(See ADHT 487.) Cross-listed as ADHT 487.

MPHP 488. Gender, Ethnicity, and Health Research (3)
The course is designed to acquaint students with the literature addressing the constructs of race, ethnicity, gender and social class; to examine critically the contexts in which these constructs are often applied; and to assess the relationship between each of these constructs and access to health care, quality of care, and health outcome. Cross-listed as EPBI 488.

MPHP 490. Epidemiology: Introduction to Theory and Methods (3)
Epidemiologic principles and methods needed to understand population-based statements of illness and health. Descriptive epidemiology, analytic epidemiology, and epidemiologic inference. Classification, morbidity and mortality rates, sampling, screening, epidemiologic models, field trials, controlled epidemiologic surveys, sources of bias, and causal models. Cross-listed as EPBI 490.

MPHP 491. Epidemiology: Application of Theory/Methods (3)
(See EPBI 491.) Cross-listed as EPBI 491.

MPHP 492. Epidemiology: Statistical Methods (3)
The course focuses on strategies for model building. Topics include the analysis of cohort and case-control studies where the emphasis is on risk estimation. Students are expected to analyze a database obtained from a cohort study of the effects of maternal alcohol drinking on outcomes of pregnancy and from a related nested case-control study. The analysis of survival data focuses on parametric and non-parametric techniques and utilizes data from an ongoing study of quality of life of patients on kidney dialysis. In addition to regular class assignments, students are expected to write a report on each of the databases and present results to the class. Prereq: MPHP 431 and MPHP 491. Cross-listed as EPBI 492.

MPHP 494. Infectious Disease Epidemiology (3)
(See EPBI 494.) Cross-listed as EPBI 494.

MPHP 495. Psychiatric Epidemiology (3)
(See EPBI 495.) Cross-listed as EPBI 495.

MPHP 499. Independent Study (1-18)
Cross-listed as EPBI 499.

MPHP 501. Graduate Seminar (0)
Students and faculty have the opportunity to meet on a weekly basis to discuss papers in the literature. Each week a paper is reviewed in detail by a graduate student in a formal presentation. Discussion of the strengths and weaknesses of the work gives insight into the complexities of investigations in the Public Health arena. Cross-listed as EPBI 501.

MPHP 502. International Health Practice (3)
(See FAMD 502.) Cross-listed as FAMD 502.

MPHP 504. Public Health Capstone Seminar (0)
Year-long, weekly seminar course offered in conjunction with the core requirement MPHP 652 Capstone Experience. The seminar provides a forum for preparing students to select and support development of the capstone experience and a "think tank" for discussion of public health issues that evolve as relevant in current capstone placements. The seminar features speakers from community based Capstone sites, student presentations on public health topics related to Capstone projects, and debriefing and problem-solving sessions for current capstone experiences.

MPHP 508. Ethics, Law, and Epidemiology (3)
This course is designed to provide epidemiology students with basic knowledge about the ethical and legal principles underlying epidemiological research. This is not a public health law class. Issue papers are assigned on a weekly basis. Each issue paper requires that the student analyze the situation depicted and apply the principles learned. Some issue papers may require that the student draft a proposed rule, a portion of legislation, or a document such as an informed consent form. Other exercises may require that students critique an existing agency rule or legislation. Prereq: EPBI 490 and EPBI 491. Cross-listed as EPBI 508.

MPHP 652. Public Health Capstone Experience (3-9)
The Public Health Capstone Experience consists of a public health field practicum, involving a placement at a community-based field site, and a Master’s essay. The field placement will provide students with the opportunity to apply the knowledge and skills acquired through their Master of Public Health academic program to a problem involving the health of the community. Students will learn to communicate with target groups in an effective manner; to order priorities for major projects according to definable criteria; to use computers for specific applications relevant to public health; to identify ethical, social, and cultural issues relating to public health policies, research, and interventions; to identify the process by which decisions are made within the agency or organization; and to identify and coordinate use of resources at the placement site. The Master’s essay represents the culminating experience required for the degree program and may take the form of a research thesis, an evaluation study, or an intervention study. Each student is required to formally present the experience and research findings. This course is available only to Master of Public Health students.

MEDICAL SCIENTIST TRAINING PROGRAM (MSTP)

A combined M.D./Ph.D. in basic sciences program, the Medical Scientist Training Program (MSTP), is available for students desiring academic careers in medicine and related biosciences. This program takes seven to eight years to complete, depending on the time needed to complete the Ph.D. dissertation research.

Candidates must meet established prerequisites for admission to both the School of Medicine and the School of Graduate Studies. Criteria include demonstrated motivation for and participation in research, in addition to superior undergraduate academic credentials. Descriptive materials and applications can be obtained by contacting the MSTP program using the above contact information. Applicants must have either U.S. citizenship or permanent residency status to be considered for admission to the MSTP program.

The Ph.D. component is pursued under the aegis of a selected pre-clinical department or program of the medical school or the MSTP itself. Financial support includes stipend and full tuition support.

The first two years of the program are devoted to the medical school pre-clinical core curriculum, which occupies five mornings each week. Afternoons are available for graduate courses and/or research recommended by the pre-clinical department or program. The next three to four years are devoted to completion of graduate courses and Ph.D. thesis research. After the first research year, the MSTP student can choose to participate in a weekly clinical tutorial to enhance clinical skills. After the Ph.D. thesis is successfully defended, the student returns to medical school to complete clinical clerkships and to qualify for the M.D. degree.

The program is administered by the MSTP Steering Committee, which consists of faculty from both basic science and clinical departments. Its functions include selecting candidates for admission; designing and administering the program curriculum; advising students; evaluating and approving each trainee’s program, including the selection of a Ph.D. thesis advisor and the members of the thesis committee; appointing clinical advisors; and acting as liaison with the Faculty Council of the School of Medicine.

The MSTP director is Clifford V. Harding III, M.D., Ph.D., associate director is Sandra K. Lemmon, Ph.D., and program manager is Deidre J. Gruning.

For more information, write: Case Western Reserve University School of Medicine, Room W-378, 10900 Euclid Avenue, Cleveland, OH 44106-4936; call (216) 368-3404; visit the Website at http://mstp.cwru.edu; and/or e-mail mstp@po.cwru.edu.

M.D./J.D.

This program, offered in conjunction with University’s School of Law, may be completed in six years. Admission is through the School of Medicine and the School of Law. For more information about the J.D. portion of the program, call the law school admissions office at (216) 368-3600 or (800) 756-0036 or e-mail lawadmissions@po.cwru.edu.

M.D./M.A. IN BIOETHICS

The 27-credit-hour master of arts in bioethics program, including a 12-hour foundations course taken during the first year of medical school, emphasizes the interdisciplinary and interprofessional nature of the field. It is designed to provide advance training in bioethics for those who anticipate encountering ethical issues in the course of their primary careers. Medical school students complete the bioethics program while pursuing their medical degrees; no additional time is required. Admission for the master’s degree portion is through the School of Graduate Studies. For more information, please contact the Department of Bioethics at (216) 368-6196, e-mail xx245@po.cwru.edu, or see http://www.cwru.edu/med/bioethics/bioethics.html on the Web.

PH.D. IN BIOETHICS

At press time, Case Western Reserve is one of only two universities in the country to offer a pure bioethics doctorate program in addition to its master’s and joint degrees with medicine, nursing, law and genetics. Admission to the Ph.D. program is through the School of Graduate Studies. For more information, please contact the Department of Bioethics at (216) 368-6196, e-mail xx245@po.cwru.edu, or see http://www.cwru.edu/med/
bioethics/bioethics.html on the Web.

M.D./M.B.A.

This program, offered in conjunction with the University’s Weatherhead School of Management, may be completed in five to six years. For more information, visit http://weatherhead.cwru.edu/degree/experience/curriculum/mdmba.html on the Web, call the management school’s admissions office at (216) 368-2030 or (800) 723-0203, or e-mail questions@exchange.som.cwru.edu.

M.D./PH.D. IN BIOMEDICAL ENGINEERING

This unique program focuses on the creation of new devices or platform technologies for diagnosis and treatment. The program aims to produce students who can solve medical problems with engineering applications. Students focus on such things as development of artificial or tissue-engineered organs, implantable prosthetics, medical instrumentation, and microelectromechanical systems (MEMS) technology and related nanotechnology for clinical applications. Students, who have their tuition and fees paid and also receive a stipend, can complete the program in seven years. For more information, please contact the Department of Biomedical Engineering at (216) 368-4063 or e-mail bxh12@po.cwru.edu.

M.D./PH.D. IN HEALTH SERVICES RESEARCH

This program prepares students for careers in academic medicine, health policy, public health, and/or health care management in group practices, HMOs or health-related industries. The program’s focus is especially pertinent to candidates interested in the health and health care problems of urban and vulnerable populations.

Initial admission for the Ph.D. portion is through the University’s School of Graduate Studies, with the Ph.D. completed within the Department of Epidemiology and Biostatistics and its track in health services research. Students typically complete the Ph.D. by their fourth or fifth year after matriculation and the M.D. at the end of the sixth or seventh year.

For more information, contact Program Director Randall D. Cebul, M.D., at (216) 778-3901 or rdc@po.cwru.edu.

PH.D. IN GENETICS/M.A. IN BIOETHICS

The rapid pace of human genetic research has led to an ever-increasing number of complex ethical issues; accordingly, the need for combined training in genetics and bioethics is becoming increasingly important. This is the first joint degree program in Ohio to address this need.

The master of arts in bioethics degree program is a 27 credit hour program. Required courses include a 12-hour foundations course, a three-credit-hour clinical ethics rotation, and 12 hours of electives. Admission to the master’s degree portion is through the School of Graduate Studies. Admission to the Ph.D. in genetics program is a separate process.

For more information, please contact the Center for Biomedical Ethics at (216) 368-6196, e-mail xx245@po.cwru.edu, or see http://www.cwru.edu/med/bioethics/bioethics.html on the Web.