Dec 15, 2017 Last Updated 5:32 PM, Dec 5, 2017
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Curriculum

The mission, goals and strategic priorities of the San Juan Bautista School of Medicine have been designed to offer an updated, interdisciplinary, and service -oriented academic program leading to the medical doctor (M.D.) degree. The School has an academic structure (Curriculum Committee) that allows for curricular design, revisions, management and implementation of curricular changes, in order to keep up with ongoing trends in medical education. The Office of the President/Dean, working in close collaboration with academic dean, chairs of departments, and faculty, has the responsibility of assuring that the curriculum stays attuned to the principles and values inherent in the School’s mission and in compliance with requirements of accreditation agencies. The curriculum is structured in a coherent and longitudinal sequence, through four years of study, in two phases: two years of Biomedical Sciences and two years of Clinical Sciences.

The two-year Biomedical Sciences program includes two semesters per year, with a minimum of seventeen (17) weeks of courses and approximately one week for remediation. One (1) credit is assigned to a course per each weekly hour of academic activities, and one (1) credit for every two (2) hours of laboratory activities (hands-on or virtual). The semesters extend from August to December and from January to May.

The Clinical Sciences program offers the clerkships throughout the academic year. During the third year, 6 clerkships are scheduled having six (6) to twelve (12) weeks’ duration each. During the fourth year, clerkships have a four (4) weeks’ duration. The electives program is offered during the fourth year and includes four (4) free elective clerkships and three (3) required elective clerkships and one (10 selective, of four (4) weeks each. The Fourth Year clerkships run continuously from July 1 to April 30 of each academic year. Certain electives may not be available every month. Students should contact the Intramural/Extramural/Electives Coordinator prior to the end of their third year, in order to schedule their elective clerkships.

The SJBSM is committed to attuning the curriculum to current trends in medical education, coordinating and integrating course contents within and among the biomedical sciences and clinical components.
Strengthening the students’ clinical skills, including research methodology, and making students and faculty an integral part of the community the School serves, are important aspects of the School’s mission.

As an integral part of the curriculum, the School has implemented several curricular emphases: Professionalism, Research and Information Literacy, Communication Skills, Development of Clinical Skills, and Community Medicine. These emphases were developed in congruence with the School’s mission and vision, and are integrated throughout the four years of study, to assure that graduates are not only knowledgeable physicians, but also respectful, honest, compassionate, sensitive to community health needs, and up-to-date in their active learning.

The curriculum includes a variety of teaching and learning strategies. Small-group discussions provide opportunities for close interaction between faculty and students. Facilities in which audiovisual and computer-aided technological resources are available enhance students’ opportunities for directed self-learning. Course syllabi, as well as a variety of medical software programs, course materials and other relevant information, are available on-line to students and faculty.

The Clinical Skills Lab has become one of the most useful tools for teaching and evaluating clinical skills competencies. Standardized patient encounters are used to teach and evaluate the following competencies: interviewing and history-taking; performing physical examinations; counseling; formulating a differential diagnosis; and establishing a management plan, among other skills.

MD Curriculum Educational Program Objectives

SJBSM General Competencies

The medical education curriculum at San Juan Bautista School of Medicine (SJBSM) is designed to prepare students with the essential knowledge, skills and attitudes necessary to provide effective, compassionate health care within a rapidly evolving health care environment. SJBSM requires students to achieve proficiency in eight competency domains: Patient Care, Knowledge for Practice, Problem Base Learning and Improvement, Interpersonal and Communication Skills, Professionalism, System Based Practice, Interprofessional Collaboration, and Personal and Professional Development. These competency domains were identifies by the Association of American Medical Colleges (AAMC) Physician Competency Reference Set (PCRS)to define the desired outcomes across the continuum of education, training, and practice of physicians and other health professionals. Thus, SJBSM requires students to achieve the following general competencies prior to graduation:

The medical education curriculum at San Juan Bautista School of Medicine (SJBSM) is designed to prepare students with the essential knowledge, skills and attitudes necessary to provide effective, compassionate health care within a rapidly evolving health care environment. SJBSM requires students to achieve proficiency in eight competency domains: Patient Care, Knowledge for Practice, Problem Base Learning and Improvement, Interpersonal and Communication Skills, Professionalism, System Based Practice, Interprofessional Collaboration, and Personal and Professional Development. These competency domains were identifies by the Association of American Medical Colleges (AAMC) Physician Competency Reference Set (PCRS)to define the desired outcomes across the continuum of education, training, and practice of physicians and other health professionals. Thus, SJBSM requires students to achieve the following general competencies prior to graduation:

  • Patient Care: Students must demonstrate willingness and ability to provide health care to patients that is compassionate, appropriate, and effective for treating health problems and promoting health.
  • Knowledge for Practice: Students must demonstrate the application of knowledge about established and evolving biomedical, clinical, epidemiological and social-behavioral sciences to the delivery of quality and safe patient care.
  • Practice-Based Learning and Improvement: Students must be able to investigate and evaluate patient care practices, appraise and assimilate scientific evidence, and continually improve their practice of medicine.
  • Interpersonal and Communication Skills: Students must demonstrate interpersonal and communication skills that result in effective information exchange and teaming with patients, patients’ families, and professional associates.
  • Professionalism: Students must demonstrate a commitment to developing a scientific mind, real world comprehensive knowledge, skills and knowledge for optimal patient care and professional behavior.
  • Systems-Based Practice: Students must demonstrate an awareness of and responsiveness to the larger context and systems of health care and the ability to call on system resources to provide care that is of optimal value.
  • Interprofessional Collaboration: Students must demonstrate the ability to engage in an inter-professional team in a manner that optimizes safe, effective patient and population-centered care.
  • Personal and Professional Development: Students must demonstrate the qualities required to sustain lifelong personal and professional growth.

SJBSM Educational Program Objectives

For each competency, a set of objectives defines the expected progress throughout medical school and upon graduation. The SJBSM educational program objectives encompass the knowledge, skills, behaviours, and attitudes students are expected to exhibit as evidence of their achieving competencies necessary for graduation and receipt of the Doctor of Medicine (MD) degree. In addition to guiding student learning, the SJBSM competencies and objectives will also guide curriculum design, innovation and ongoing faculty development. The following table links the SJBSM educational program objectives to general competences expected of SJBSM graduates and identifies the outcome measures that indicate achievement of each listed objective.

Patient Care
Knowledge for Practice
Practice-Based Learning and Improvement
Professionalism
Systems-Based Practice
Interpersonal and Communication Skills
Interprofessional Collaboration
Personal and Professional Development

Competencies

Medical Education Program Objectives

Outcome

Measures

Knowledge, Reasoning and Problem Solving (K)
Knowledge and application of the stablished and evolving biomedical, clinical and socio-behavioral sciences relevant to patient care X X NBMEs, USMLE Steps 1 and 2 CK and CS, OSCEs, CPE
Knowledge of the epidemiology, public health, health economics, and health management systems and application to the identification of health problems, risk factors, treatment strategies, and disease prevention/ health promotion efforts for patients and populations X X NBMEs, USMLE Steps 1 and 2-CK, OSCEs
Ability to problem solve clinical issues X X X X X X X X NBMEs, USMLE Steps, OSCEs, CPE
Ability to locate, assimilate and explain evidence from scientific studies related to patients’ health problems. X Performance on: Research courses and Community Health I and II
Ability to retrieve, manage and use biomedical information for problem solving and medical decision making X X X X X NBMEs, USMLE Steps, CPE
An understanding of the role of community resources for patient care and support, such as, skilled nursing and extended-care facilities, public and non-public family support programs, and other service programs X X X X X X Performance on: Research courses and Community Health I and II
Clinical Skills (S)
Ability to obtain an accurate medical history that covers all essential aspects X X X X OSCEs, CCE, CPX, CPE
Ability to perform and complete a physical examination including the mental health status examination X X X X USMLE Step 2-CS, OSCEs, CPX, CPE
Ability to communicate effectively, both orally and in writing with patients, patient's families, colleagues, and other individuals with whom the physician must exchange information X X X X CPE, CPX
Ability to document encounters in an accurate, complete, timely, and accessible manner X X X OSCEs (patient note), CPE
Ability to interpret the results of the most commonly used diagnostic  procedures to define the nature of a medical problem using principles of evidence based medicine X X X CPX, CPE
Ability to construct and perform appropriate diagnostic and therapeutic strategies for patients with acute and chronic conditions X X X X OSCEs, CPX, CPE
Ability to recognize patients with life-threatening emergencies and initiate appropriate therapy. X X X X X X X X OSCEs
Ability to timely evaluate and manage health problems in an effective, and ethical manner X X X OSCEs, CPX
Ability to adapt to advances in healthcare in the interest of meeting the needs of patients and communities X X X X X CPE
Ability to provide education on disease management and prevention to patients, and on healthy lifestyles to individuals and community groups.             X X X X X OSCEs
Attitudes and Behaviors (A/B)
Knowledge of elements and values of the medical profession, ethical and legal principles X Performance on Professionalism courses
An understanding of the need for continuous self-improvement and life-long learning X X SGR
Capacity to work collaboratively with and learn from other professionals to establish and maintain a climate of respect, dignity, diversity, ethical integrity, and trust X X X X X X CPE, SGR
Ability to appreciate the importance of coordinated cross-team work around a patient on a care pathway X X X X X X CPE
Commitment to practice patient centered medicine with a social awareness X X X Presentations for Clerkships
An understanding of the threats to medical professionalism presented by conflict of interest pertaining to financial and organizational arrangements in medical practice X X Presentations for Clerkships and Professionalism
Kindness and empathy in treating patients and respect for their privacy and dignity X X OSCEs, CPX, CPE
An understanding and respect for patients, families and colleagues with different cultural and ethnic backgrounds X X X X X CCE, CPX
Awareness and understanding of relevant medico-legal and ethical issues in performance X X Presentations for Clerkships and Professionalism
Appreciation of the role and importance of research and investigation in the care of patients and community health X X NBMEs, Research and Community Health courses
An understanding of the ethical principles involved in research X X X X Performance on Research and Professionalism courses
Appreciation for the practical application of  service learning activities to assess and meet community health needs X X X X Performance on Community Health courses
Outcome Measures for Competencies NBMEs Step 2 CK and CS, OSCEs, CCE, CPX, CPE  NBMEs, Step 1 and 2CK, OSCEs CPE, Res and Comm. Health Course OSCEs, CPE, CCE, CPX Step 2 CS, OSCEs, CPE, CCE, CPX OSCEs, CPE, CCE, CPX, Professionalism Courses OSCEs, CPE, Comm Health Courses CPE CPE, SGR
NBMEs – National Board of Medical Examiners (Customized Assessment Exams and Subjects Exams); OSCE - Objective Structured Clinical Examinations; CPE – Clinical Performance Evaluation for Clerkships; CCE – Clinical Competence Exam; CPX – Clinical Performance Exam; SGR – Student Generated Reports

 

General Curricular Scheme

First Year

1 st Semester

Course Name Credit Hrs
113 Developmental and Clinical Anatomy I 4
115 Histology and Cell Biology I 2
117 Introduction to Research 1
118 Professionalism I 1
124 Introduction to Clinical Skills I 2
166 Biochemistry and Genetics in Medicine 8
175 Medical Physiology I 4
TOTAL CREDIT HOURS 22

2nd Semester

Course Name Credit Hrs
122 Developmental and Clinical Anatomy II 5
119 Professionalism II 1
116 Histology and Cell Biology II 2
125 Introduction to Clinical Skills II 2
142 Neurosciences 6
156 Immunology II 3
176 Medical Physiology II 4
173 Community Health I 2
TOTAL CREDIT HOURS 25
 

Second Year

1 st Semester

Course Name Credit Hrs
204 Community Health II 3
211 Professionalism III 1
213 Pathophysiology I 7
260 Medical Microbiology I 4
273 Pharmacology and Therapeutics I 4
290 Clinical Diagnosis I 4
TOTAL CREDIT HOURS 23

2nd Semester

Course Name Credit Hrs
212 Professionalism IV 1
214 Pathophysiology II 7
261 Medical Microbiology II 3
275 Pharmacology and Therapeutics II 3
279 Behavioral Medicine 5
292 Clinical Diagnosis II 4
295 Translational Research 1
TOTAL CREDIT HOURS 24
 

Third Year

Clinical Clerkships

Course Name Credit Hrs Weeks
320 Psychiatry 6 6
323 General Surgery 7 6
325 Obstetrics and Gynecology 7 6
326 Internal Medicine 12 12
329 Pediatrics 6 6
330 Family Medicine 6 6
TOTAL CREDIT HOURS 44 42

*Radiology core knowledge will be covered as part of each clinical clerkship.
**Anesthesiology core knowledge will be covered during the Surgery and Obstetrics/Gynecology clerkships

Fourth Year

Clinical Clerkships

Course Name Credit Hrs Weeks
416/460 Primary Medicine (Sub-I)*** 6 4
419 Research 6 4
457 Emergency Medicine 6 4
467 Elective 4 4
468 Elective 4 4
470 Elective 4 4
471 Elective 4 4
472 Required Selective**** 6 4
TOTAL CREDIT HOURS 40 40

*** Selection: Internal Medicine or Pediatrics
****Selection: Internal Medicine, Surgery, Pediatrics, Ob-Gyn, Pediatrics in Emergency Room, and Psychiatry among others

 

Degree Requirements

The Board of Trustees will grant the degree of Doctor in Medicine, after recommendation by the faculty. The requirements to obtain a Doctor in Medicine degree are:

  1. Completion of the Biomedical Sciences courses with a minimum grade point average of 2.50
  2. Completion of the Clinical Sciences courses established in the curriculum (both in the cognitive aspects as well as in the clinical skills, and professional behavior/attitudes) with a minimum grade point average of 2.50
  3. Passing the United States Medical License Examination (USMLE) Step 1, and Step 2 (CK)
  4. Passing a Clinical Performance Examination (CPX) during the fourth year of study and taking the Step 2 (CS)
  5. Demonstration of acceptable moral, ethical and professional standards at all times during the course of their study program.
  6. Completion of all financial and administrative obligations contracted with the School, including return of all borrowed library resources and completion of all documents in the academic file
  7. Completion of all medical records 8. Minimum overall grade point average of 2.50

Courses and Clerkships

First Year - BIOMEDICAL SCIENCES

113-122 Developmental and Clinical Anatomy

113 Dev elopmental and Clinical Anatomy I 4 credit hours
122 Dev elopmental and Clinical Anatomy II 5 credit hours

 

Gross Anatomy and Embryology were integrated into one course. The course is aligned with Histology and Cell Biology, Medical Physiology, Introduction to Clinical Skills, Neuroscience, and Professionalism. The course is offered in two semesters and is designed for the student to learn the characteristics, development, functions, and clinical aspects of the human body. The course prepares the students to apply their knowledge of macroscopic and developmental anatomy to resolve clinical cases that will be encountered throughout their career as medical doctors. In the dissecting laboratory, the students reaffirm the knowledge conveyed in the lectures and other related educational activities. The modern anatomical-clinical approach with the use of diagnostic imaging techniques, guarantees the complete development of our students. In the laboratory, the students are responsible for the dissection of the human body with the direct supervision of the Anatomy faculty.

 

115-116 Histology and Cell Biology

115 Histology and Cell Biology I 2 credit hours
116 Histology and Cell Biology II 2 credit hours


This course presents the structure and function of the cell and the characteristics of basic tissues in human biology. It also addresses the interaction between the tissues that make up the body’s organs and systems.

Histology/Cell Biology I covers basic concepts of Histology and Cell Biology such as cell organelles, epithelia and specific types of tissues.

Teaching methodology include but are not limited to lectures, conferences, case presentations, virtual laboratory sessions, journal articles and Formative/Summative Integrated Activities. Histology and Cell Biology includes a virtual laboratory where students will be able to study and identify structures in microscopic slides and/or computer interactive programs.
Histology and Cell Biology is integrated with other courses such as Biochemistry and Genetics, Medical Physiology, Developmental and Clinical Anatomy, and Clinical Skills. Case study presentations and journals are included to illustrate the pivotal role of cell biology in medicine.

 

117 Introduction to Research

117 Introduction to Research 1 credit hour

 

This course provides medical students with the basic information regarding methods and principles of conducting research. Students will be introduced to the scientific method, gain practical skills in biostatistics, use of information and data systems, learn to critically analyze scientific literature, become familiarized with the ethical principles of research, access resources available for funding scientific research, analyze and interpret data and initiate the development of a research proposal.

 

142 Neurosciences

142 Neurosciences 6 credit hours

 

This course provides basic knowledge of the structure and functions of the human nervous system. It is designed to cover information in the areas of neuroanatomy, neurophysiology, neuropharmacology, neurological imaging techniques, as well as complex brain functions and disorders. Lectures, laboratories and clinical correlations are offered jointly by the Departments of Anatomy and Physiology/Pathology, as well as by visiting professors. Teaching methodologies include lectures that incorporate clinical conditions; laboratory exercises using human brain specimens; models; DVD of the anatomy of the human nervous system; and clinical case presentations and discussion by students. The concepts learned in this course will provide students with a necessary foundation in understanding the functions of the human nervous system.

 

118-119 Professionalism

118 Professionalism I 1 credit hour
119 Professionalism II 1 credit hour

 

These courses provide students with the foundation, knowledge and skills in ethics and professional behavior required to the medical practice. These courses are the first part of a four–year axis in Professionalism, includes medical ethics, effective communication skills, public health and cultural diversity. The course begins with the “White Coat Ceremony” in which students for the first time wear the white coat. This ceremony makes students aware of what the white coat represents, reminding them as future physicians of their professional obligation as clinician and representatives of a trusted profession.

 

156 Immunology

156 Immunology I 3 credit hours

 

The Immunology I course includes the basic aspects of cellular and molecular immunology that allow understanding the normal immune responses and the consequences of alterations in these responses. The normal structure and function of the immune system, the methods used in diagnosis and research related to that system, are significant components of this course.

The Immunology II course is devoted to applications of immunology concepts in medicine. It includes the study of the immune system’s intervention in the physiology of other organs and systems. All of these elements are of most significance in a diversity of applied biomedical/technological interventions, such as: vaccines, organ transplantation, cancer immunotherapy, immunological therapies for various pathologies and immuno-diagnosis. Also, a special attention in the course is given to the Acquired Immunodeficiency Syndrome (AIDS), because of its significant implications in today’s medical practice and its relevance in our particular community.

Modern teaching methodology and learning strategies are used, with active student participation. Teaching strategies include lectures, clinical case presentations and interactive discussion. This course is aligned with the other first year courses

 

166 Biochemistry and Genetics in Medicine

166 Biochemistry and Genetics in Medicine 8 credit hours

 

The Biochemistry and Genetics in Medicine course has been designed to integrate the development of a broad and thorough understanding at the cellular and molecular level of the metabolic and regulatory events that control the functioning of normal cells, tissues and organs and how these processes are altered by disease as well as the fundamental concepts and technological advances in the study of human genetics as they pertain to the medical practice.

The course covers carbohydrates and energy metabolism, metabolic pathways of small molecules, molecular biology, molecular endocrinology, cytogenetic, molecular genetics, biochemical genetics, clinical genetics, and genetic counseling among other topics and is aligned with the courses of Histology and Cell Biology, Immunology and introduction to Research. The teaching methodologies incorporate new methodologies combining lectures, interactive lectures, case discussion and Formative/Summative Integrated Activities with other evaluative activities.

 

175-176 Medical Physiology

175 Medical Physiology I 4 credit hours
176 Medical Physiology II 4 credit hours

 

These courses emphasize the basic concepts of normal human function that provide the foundation for further development during the Biomedical and Clinical Sciences. Medical Physiology I & II are aligned with Developmental and Clinical Anatomy, Histology and Cell Biology, Immunology, Introduction to Clinical Skills and Professionalism courses, to aid students with integration of functional units and systems. All systems incorporate Pediatric and Geriatric concepts.

Medical Physiology I, starts with an introduction covering all aspects of normal cell function including Neurophysiology. This is then followed by the Physiology of the Muscular-Skeletal System, Autonomic System, Cardiovascular System and Respiratory System. Medical Physiology II, continues with the Physiology of the Gastrointestinal System, Renal System, Endocrine and Reproductive system.

Teaching methodology include, but is not limited to, lectures with clinical correlations, directed self-study sessions, assignments, laboratory sessions, computer tutorials and participation in integrative activities such as Academic Competence Enhancement (ACE).

 

173 Community Health I

173 Community Health I 2 credit hours

 

This course provides the student a basic understanding of the historical roots, evolution, and future of Community and Public Health. An opportunity to recognize the structure and function of the local, national and international organizations that help shape community health and health care systems, the course provides students with an appreciation of the principles and methods of descriptive and analytic epidemiology, including: commonly used measures of disease frequency; sources of data; crude, specific and adjusted rates; cohort analysis of mortality; standardization; cause-effect relationships; the roles of chance, bias and confounding. Students will be exposed to the community early in their career as educators, presenting different health issues through group and individual projects in collaboration with the Community Medicine Program. Student research proposal started during the Introduction to Research 117 is further expanded.

 

124-125 Introduction to Clinical Skills

124 Introduction to Clinical Skills I 2 credit hours
125 Introduction to Clinical Skills II 2 credit hours

 

This course provides students with an early exposure to basic clinical skills and professional issues which are essential for success during their clinical clerkship. These skills include, among others, communication skills and interviewing techniques. Students begin by obtaining a complete medical history and physical examination techniques considering age variations. These skills are learning through lectures, workshops, standardize patients and in Community Preceptorship experiences.

 

Second Year - BIOMEDICAL SCIENCES

213-214 Pathophysiology

213 Pathophysiology I 7 credit hours
214 Pathophysiology II 7 c redit hours

 

This course is a one year course designed to study the macroscopic, microscopic, molecular and functional abnormalities of tissue and organ diseases by systems. Diseases are discussed integrating pathological processes with histopathology, microbiology, pharmacology and therapeutics, and clinical diagnosis approach. Students are taught by lectures, guided laboratory practice, small group discussions, self directed studies, clinical correlations, standardized and computer designed patients. Strategies as Formative/Summative Integrated Activities and service are included. Also, students have the opportunity to visit and observe autopsies at the Forensic Science Institute of Puerto Rico during the second semester.

Patho-physiology I and II courses are aligned with Microbiology, Clinical Diagnosis, and Pharmacology and Therapeutics to assist students with integration of functional units and systems.

The Patho-physiology I course offers an introductory section covering all aspects of normal cell function including cell death. In addition, topics in immunology, genetics, inflammation, cancer biology, fluids and electrolytes as well as acid/base balance are reviewed. Once the introductory section is completed the course is then divided in systems. The systems emphasized during this course are: Cardio-Vascular System, Hematology/Oncology, Head & Neck with Respiratory System, Male & Female Genital-Urinary Tract System.

The systems emphasized in the Patho-physiology II course are Gastro-Intestinal System, Endocrine & Reproductive Endocrinology System, Dermatology & Muscular-Skeletal System with Bone & Joints Diseases, Eye & Central Nervous System.

All systems include a Pediatric and Geriatric approach to related diseases.

 

204 Community Health II

204 Community Health II 3 credit hours

 

The concepts acquired during the first year in the Community Medicine and Research I course are expanded in this course. This course explores the principles, concepts and methods employed in epidemiologic research, with examples from the literature in communicable and non-communicable diseases. Community health focuses on the health of population or groups.

The class will cover a broad range of community health issues and will focus on strategies to improve the health of a population with emphasis on health principles and acquire in-depth of specific health topics through group and individual projects in collaboration with the Community Medicine Program.

 

290-292 Clinical Diagnosis

290 Clinical Diagnosis I 4 credit hours
292 Clinical Diagnosis II 4 credit hours

 

These courses are designed to introduce the second year medical student to the clinical sciences, with the goals of achieving proficiency in clinical skills and the ability to apply basic science information to solving problems and making decisions in clinical medicine.

The didactic portion of the course is designed to teach the student basic concepts pertaining to human disease covering an introduction to the clinical disciplines. Material is organized and presented by organ systems. The systems emphasized in the Clinical Diagnosis I course are: Cardio-Vascular System, Hematology/Oncology, Head & Neck with Respiratory System, Male & Female Genital-Urinary Tract System. The systems emphasized in the Clinical Diagnosis II course are: Gastro-Intestinal System, Endocrine & Reproductive Endocrinology System, Dermatology & Muscular-Skeletal System with Bone & Joints Diseases, Eye & Central Nervous System.
The teaching of clinical science related to each system is aligned with the teaching of the Pathophysiology, Pharmacology and therapeutics, Microbiology to promote the integration of concepts related to each system.

Students are taught by lectures, small group discussions, clinical correlations, standardized and computer designed patients, Preceptorship, workshops, integration activities such as Formative/Summative Integrated Activities and service learning.

The practical portion of the course emphasizes practical aspects of being a physician. The sessions are designed to teach students history taking, physical examination, interpretation of findings, skills and knowledge required to pursue diagnostic investigations.

There is an emphasis on “abnormal” findings. Students will learn to interpret the meaning of these examinations, and to organize and utilize the information obtained from their data-gathering activities for the diagnosis and treatment of human.

 

260-261 Medical Microbiology

260 Medical Microbiology I 4 credit hours
261 Medical Microbiology II 3 credit hours

 

The Microbiology courses use an organ system organization to present the topics. These courses are aligned with Pathophysiology, Clinical Diagnosis, and Pharmacology & Therapeutics; which together, runs for the full academic year. Emphasis is placed on etiology, epidemiology, clinical manifestations, host response, diagnosis and control. One advantage of this approach is that students begin developing clinical reasoning skills based on clinical signs and symptoms, and other epidemiological clues. Another advantage is that organisms that cause disease in multiple organ systems are covered in multiple modules, reinforcing the learned concept. Lectures are complemented with laboratory exercises, case discussions Formative/Summative Integrated Activities and, service learning activities The Medical Microbiology I course begins with an introductory module. Here, basic aspects of Microbiology are presented; including an overview of bacteriology, virology, mycology, parasitology, pathogenesis, bacterial genetics, vaccines and anti-microbial immunity. Then, the course continues with the following system modules: Cardio-Vascular, Hematology/Oncology, Head & Neck with Respiratory System and Genital-Urinary Tract System.

The Medical Microbiology II course is the continuation of the Micro II course taught in the 1st Semester. The system modules included in the Medical Microbiology II course are: Gastro-Intestinal System, Dermatology & Muscular-Skeletal System including Bone & Joints diseases, Eye and Central Nervous System. Also, a special module in which topics such as: biological agents of warfare and terrorism, mutisystemic zoonosis and vector-borne infections are also covered.

 

279 Behavioral Medicine

279 Behavioral Medicine 5 credit hours

 

This course is the first of a longitudinal experience in behavioral sciences. It comprises the study of human behavior from the normal and healthy perspective, as a basis to understand the onset and development of mental illness throughout the different stages of the life cycle. The first aim of this course is to differentiate the NORMAL functioning of the mind and its interaction with body, so as to distinguish what is NOT NORMAL or ABNORMAL.

Another goal of this course is to expose the medical students to basic concepts of psychiatry that will be used in the medical field. Psychiatry includes everything that cannot be categorized in one of the traditional basic sciences. It encompasses areas that are fundamental to modern medical practice, including brain behavior correlation, ethical issues and the economic forces affecting the future of medicine. Its covers not only the psychiatric history but also the emotional development of people throughout their life cycle, including biological and psychological aspects, the development and meaning of symptoms; reaction to sickness, and treatment, including psychological, somatic and interdisciplinary modalities. Therapeutic techniques including psychopharmacology, psychotherapy, hypnosis, emergency techniques and crisis intervention will also be discussed.

Finally, the basic concepts of psychiatry will be discussed, beginning with the various models that try to understand psychopathology. Mental mechanisms of defenses, symptoms and disorders are discussed throughout the semester. A thorough analysis of the development of the DSM-IV-TR (and DSM-IV) will be presented, together with study of mental diseases it includes and its approach to the formulation of differential diagnosis. Basic psychopharmacology and principles of psychotherapy will be presented, together with basic principles involved in therapeutic hypnosis, electroshock and other psychological and physical treatment. Special emphasis will be given to substance abuse, including alcohol, the substance induced disorders and the developmental disorders, the etiology and pathophysiology of mental illness, the care of mentally retarded, geriatric patients, children born infected from HIV virus, dying patients, and in the increasing specified and effectiveness of the various psychiatric therapies. At the end of the course, the medical student should be prepared to encounter patients, interview them, write psychiatric histories, diagnose and propose a treatment plan.

 

273-275 Pharmacology and Therapeutics

273 Pharmacology and Therapeutics I 4 credit hours
275 Pharmacology and Therapeutics II 3 credit hours

 

Pharmacology and Therapeutics is a one year course designed to provide an understanding of drug action in the framework of human physiology, biochemistry, microbiology and pathophysiology and thus, to familiarize second year medical students with the fundamental principles of drug action and disposition, adverse effects, drug-drug interactions, and contraindications in the context of drug classes so as to perform well on the Step 1 Board exam and to obtain a foundation for future clinical decision-making with respect to medical therapies.
Students will learn pharmacology in a conceptual framework that fosters mechanism-based learning rather than rote memorization, and that allows for ready incorporation of new drugs and drug classes into the student's fund of knowledge.

Pharmacology builds on key concepts of physiology, biochemistry, microbiology and pathology to explain the mechanisms, uses, and adverse effects of pharmaceuticals used in clinical medicine. In our course to learn pharmacology we use a format that integrates the actions of drugs from the level of an individual molecular target to the level of the human patient. The primary objective is to provide future physicians with a strong knowledge base of fundamental aspects of pharmacology and therapeutics that will: 1) permit them to optimally benefit from the clinical years of instruction; and 2) allow them to continue building proficiency in pharmacology throughout their careers. This is achieved by stressing basic principles of drug action, pharmacokinetics, pharmacodynamics and toxicity.

Also, the pharmacology of a particular physiologic or biochemical system is presented, such as the inflammation cascade and the Immune System. Subsections present the pharmacology of a particular aspect of that system, such as vascular tone or eicosanoids. Each subsection presents a clinical vignette illustrating the relevance of the system under consideration; then discusses the biochemistry, physiology, and pathophysiology of the system; and finally presents the drugs and drug classes that activate or inhibit the system by interacting with specific molecular and cellular targets. In this scheme, the therapeutic and adverse actions of drugs are understood in the framework of the drug's mechanism of action. Contemporary directions in molecular and human pharmacology are introduced in subsection on modern methods of drug discovery, drug delivery and pharmacogenomics.

Pharmacology and Therapeutics I course offers the general aspects of pharmacokinetics, pharmacodynamics, and pharmacology of autonomic nervous system, general principles of pharmacology of Immune system, and principles of antineoplastic therapy. The following sections by systems are included in this first course: Cardiovascular pharmacology, Hematologic pharmacology, and pharmacology of respiratory system.

The systems included in Pharmacology and Therapeutics Course II are: Gastrointestinal, Endocrine & Reproductive, Dermatology Pharmacology of Inflammation, Pharmacology of eye, and Central Nervous system pharmacology. Special Topics of Toxicology, Pharmacogenomics, Protein Based Therapies, Drug delivery modalities, Botanic medications and Nutritional Supplements, Special Aspects of Perinatal, Pediatric and Geriatric Pharmacology, are also included.

Lectures are complemented with clinical case discussions, integration activities such as Formative/Summative Integrated Activities and service learning.

 

295 Translational Research

295 Translational Research 1 credit hour

 

The Clinical Research Course include the following objectives: gaining knowledge on the appropriate methods applied in the clinical research; the main aspects of the Evidence Based Medicine strategy; the basics of translational research and its relevance to clinical practice; demonstrate awareness and understanding of the ethical aspects of clinical and basic research and its application to medical practice; demonstrate an ability to apply appropriate research methods in the clinical setting; recognize the limitation of clinical and basic research; identify their own and team members’ contribution to the research outcome (e.g., interdisciplinary research); identify and utilize effectively a wide range of sources of information; demonstrate competence in literature and web searching, demonstrate awareness and understanding of contemporary challenges in clinical and basic research; demonstrate proficiency in the use of epidemiological software; demonstrate awareness and understanding of contemporary challenges in clinical and basic research and demonstrate proficiency in applying the evidence based medicine in clinical decision making process. Also, covers a broad range of health issues which discussion has been integrated through the different human body systems.

 

211-212 Professionalism

211 Professionalism III 1 credit hour
212 Professionalism IV 1 credit hour

 

The Professionalism courses include the following objectives: understanding both patients’ and physicians’ rights; familiarizing with the ethical, cultural and legal issues and consequences of a medical practice; measuring, evaluating, and reducing hospital mortality rates; engaging physicians in a shared quality agenda and improving the Reliability of Health Care. The course uses a variety of teaching/learning methodologies and integrated several activities with other courses of the medical program.

 

Third Year - CLINICAL SCIENCES CLERKSHIPS

Education during the clinical years includes experiences in primary care, aspects of preventive medicine, and care of patients with acute and chronic medical conditions. These clinical experiences, which occur in both inpatient and ambulatory settings, will teach and train students to provide patient-centered care as members of an interdisciplinary health team. During the required and elective clerkships, students will be exposed to the types of patients they are most likely to encounter during their future practice as medical doctors.

Each clerkship has developed formative and summative teaching and assessment tools and activities to ensure that students are acquiring the knowledge, skills, attitudes and values deemed necessary for their level of training. Narrative evaluations are integral components of assessment within these clerkships.

320 Psychiatry

320 Psychiatry 6 credit hours

 

In this clerkship we study how biopsychosocial and environmental factors provoke different disorders in the human psyche. During the rotation, the student will learn how to obtain relevant information to make a diagnosis, in addition to the details and knowledge of the different emotional entities. The prevention, the psychological, psychopharmacological and behavioral treatment of such entities, their prognosis and corresponding dispositions to prevent relapses, will be studied. The psychopathology will be studied from DSM-IV (Diagnosis and Statistics of Mental Disorders-IV Handbook) perspective.

 

323 General Surgery

323 General Surgery 7 credit hours

 

During this clerkship, the student is introduced to the process of pre and post operation diagnosis and management of the most frequent cases of surgery. It offers the opportunity to the students to develop basic skills in taking medical records, physical examination, and discussion of differential diagnosis relevant to the field of general surgery.

 

325 Obstetrics and Gynecology

325 Obstetrics and Gynecology 7 credit hours

 

The goal of the clinical clerkship in obstetrics and gynecology is to provide students with a variety of learning experiences which will promote their understanding of normal reproductive transitions such as puberty, pregnancy, and menopause and their appreciation for the effects of reproductive tract problems on the overall physical and emotional health of women of all ages.

During this clerkship, the student is introduced to the normal conditions and complications of the pregnant patient during the prenatal, labor, and after birth (puerperium) periods. Particular attention is given to prevention aspects. Obstetrics surgical issues are discussed. During the Gynecology section, the students are exposed to different gynecological conditions and their management.

 

326 Internal Medicine

326 Internal Medicine 12 credit hours

 

This clerkship is designed to provide students with the knowledge, skills, and attitudes that will enable them to recognize, diagnose and manage the most common problems and diseases encountered in the field of general Internal Medicine. Students will be exposed to practical clinical experiences within inpatient and ambulatory settings. These experiences include patients with acute, chronic, and terminal conditions. Students participate in daily Morning Report sessions, attending rounds, lectures, and Grand Round activities as part of their didactic program.

 

329 Pediatrics

329 Pediatrics 6 credit hours

 

This clerkship is directed toward the formation of a general physician with the required knowledge, skills and attitudes to diagnose and manage the most common problems and diseases in pediatric patients, including adolescents. Issues of preventive medicine, such as immunizations and anticipatory guidance, are essential components of this clerkship. Supervised clinical experiences in both inpatient and outpatient services will allow the student to acquire and develop skills in identifying clinical problems, selecting the necessary diagnostic tests and procedures, and formulating the most appropriate plan of management for each condition.

Students will participate in patient care aspects as members of the health-care team in their assigned areas of rotation: Pediatric and Adolescent Ward, Nursery, Emergency Room, and Pediatric Clinics (OPD). Service learning activities are incorporated into this clerkship.

 

330 Family Medicine

330 Family Medicine 6 credit hours

 

Family medicine is the medical specialty which provides continuing, comprehensive health care for the individual and family. It is a specialty in breath that integrates the biological, clinical and behavioral sciences. The Scope of family medicine encompasses all ages, sexes, each organ system and every disease entity.

The family Medicine Clerkship is designed to provide third-year medical students with an introduction to the principles and practice of Family Medicine. The course exposes the students to the concepts, values and skills that are basic to this discipline and community patient care. The clerkship provides an understanding and appreciation for Family Medicine through exposure to a system of comprehensive and continuous medical health care for the entire family. As a result, students should understand an approach to care that has an orientation toward the health of the person as a whole.

When students complete the clerkship, they should have an appreciation of Family Medicine as a complex specialty that not only shares skills and knowledge with other branches of medicine but also has its own unique body of knowledge, skills and attitudes. The students should become aware of the fact that family physicians provide continuous primary care for the community regardless of age, sex or type of problem (biological, behavioral or social). The students should also understand that the family physician serves as the patient’s advocate and coordinator in health related matters, community epidemiology and diseases trends including those requiring the utilization of consultative and other community health resources.

 

Fourth Year - CLINICAL SCIENCES CLERKSHIPS

419 Research

419 Research 6 credit hours

 

This clerkship focuses on the infrastructure of clinical and/or basic research, including contracts, negligence, and product liability, as well as the regulatory framework of the state and federal governments. The clerkship will provide hands-on mentored fieldwork with a clinical or basic science investigator in the student’s area of interest. The first week provides the opportunity to integrate didactic content in research methods and statistics with developing concrete skills for the appropriate conduct of investigations. The course will culminate in a project which integrates research practice and theoretical knowledge pertinent to the individual student’s academic research focus. The project will vary with each student’s background and is determined by the faculty advisor/mentor based on a written project proposal.

 

416-460 Primary Medicine

416-460 Primary Medicine 6 credit hours

 

Internal Medicine clerkship is designed to provide the students with the knowledge, skills, and attitudes that will prepare them to recognize and handle correctly the most frequent problems and diseases found in the Internal Medicine field. Students will be exposed to practical clinical experiences and to the intensive care of patients, under the direct supervision of the faculty. The clinical subspecialties of neumology, gastroenterology and neurology will be part of these clerkships during the fourth year.

 

457 Emergency Medicine

457 Emergency Medicine 6 credit hours

 

The main objective of Emergency Medicine is to do a rapid and assertive patient stabilization to ensure an effective subsequent handling and care. During this clerkship, fourth year students will be guided and exposed to the patient in critical condition (true emergencies), and to patients with medical urgencies. This will enable the student, once the patient is well stabilized, to consult the corresponding specialist regarding the patient's admission, transfer to another San Juan Bautista School of Medicine or discharge. The students will acquire this knowledge by means of a thorough medical record and physical examination, visiting passes, where the cases will be discussed (differential diagnosis, treatment, among others), the assignment of related subjects, and medical lectures pertaining to emergency medicine. Students are at all times supervised by an assigned faculty member of the Department of Emergency Medicine. By its nature, the Emergency Room is an area where different medical disciplines interact (Pediatrics, Internal  Medicine, Surgery, and Obstetrics and Gynecology), where the students must expose themselves to, and which contributes to the enhancement of their professional training.

 

467-468-470-471 Free Elective Clerkships

467-468-470-471 Free Elective Clerkships 4 credit hours each

 

Students are allowed to take four (4) free elective clerkships. The fourth year medical students have the opportunity to enroll in clinical rotations in Puerto Rico or at the US mainland through the Visiting Student Application Service (VSAS) or directly with the Visiting Students Department.

The elective program has been designed to offer students the opportunity to select from a variety of areas in medicine that might be of special interest to them, and in this way, reinforce their medical knowledge and skills prior to graduation. Elective clerkships have a four-week duration. Some elective courses may not be available every month. Students must contact the Intramural/Extramural/Electives Coordinator for further information.

 

472-473 Required Electives

472-473 Required Selectives 6 credit hours each

 

In addition to the four (4) freely selected electives, students are required to select two (2) electives from among the following: Internal Medicine, Pediatrics, Surgery, Obstetrics-Gynecology, and Psychiatry. Students must contact the Coordinator of Electives for further information.

 

On-Duty Program (Shifts)

Third and fourth-year students will be required to be on-duty (shift) no more frequently than every third night. For third year students, the shift will be from 4:00 p.m. until 10:00 PM during weekdays. During weekends and holidays, shifts will be from 8:00 a.m. to 10:00 PM. During the fourth year, shifts will be from 4:00 p.m. until 8:00 a.m. during weekdays, and on a twenty-four-hour basis during weekends and holidays (8:00 a.m. to 8:00 a.m.). Fourth-year students will have the same limitation on duty-hours that applies to interns and residents, according to the Accreditation Council for Graduate Medical Education.

Curricular Innovations

Formative/Summative Integrated Activities

Integration has been accepted as an important educational strategy in medical education. In the process of curriculum review and renewal, the need to increase integration in the biomedical sciences courses was identified. To meet this requirement and strengthen other competencies, a series of activities and exercises was implemented.

Formative/Summative Integrated Activities are characterized by these principles: 1) are student centered; 2) promote self-learning; 3) facilitate integration (both vertical and horizontal using a multidisciplinary approach); 4) provide early exposure to clinical scenarios and experiences; 5) integrate technology in the learning process; 6) utilize diverse evaluation and assessment strategies; 7) reinforce values, attitudes and social responsibility in the practice of medicine; 8) include community-based medical education, and 9) incorporate information literacy and evidence-based medicine.

Using a small group work format, these activities encourage students to analyze, discuss, and propose solutions to health problems, integrating knowledge and skills from previous and current courses. In addition, elements of clinical clerkships are presented to strengthen vertical integration. Topics selected for these activities reflect current topics in medical education or global public health issues.

Service Learning

Service learning is an academic experience conducted in the community. Students participate in an organized community intervention to provide health services that meet identified community needs. Students have the opportunity to be part of a transdisciplinary healthcare team, thus gaining further understanding of community health, service structure and demand, patient behaviors, and fostering civic responsibility. Activities are conducted in partnership with primary care clinics, school health programs and Federally Sponsored community health centers.

Research and Information Literacy

Contemporary trends in medical education present many challenges to medical schools, such as preparing students to be independent learners and to be “information literate.” Students also must be introduced to epidemiology; biostatistics; evidence-based medicine; and basic, clinical, and translational research. To answer these challenges, the San Juan Bautista School of Medicine instituted several strategies relative to research and information literacy, consolidated as a curricular emphasis. Through their four years of study, students design and complete a research project dealing with a public health research question.

A comprehensive assessment process, including faculty and student satisfaction surveys, graduate questionnaires, academic progress analyses, and an inventory of student research participation allow assessment of expected outcomes.

Since 2000 all of the enrolled students have been participated in these initiatives. Satisfaction with the model and student research production has grown each year. Graduate questionnaires have evidenced significant change in the awareness of axis contents for the profession.

Professionalism

Medical scholars, leaders, physicians, patients and medical schools themselves have identified the need to reinforce and assure professionalism within the medical field, promoting just and humane values and actions within the profession.

San Juan Bautista School of Medicine has developed a four-year long axis of professionalism to address this need. This axis has different elements and strengths to be developed and implemented sequentially. In addition to the formal professionalism courses in the first and second years, this axis is a continuum throughout the third and fourth years.

During the clinical years, the professionalism axis is further developed through several teaching and learning strategies, including, for example:

  • Physician as role model
  • Hands-on experiences with patients and families
  • Case studies
  • Literature review
  • Self-learning activities
  • Health coworkers group interaction

All the above-mentioned strategies aim to reinforce values, attitudes and social responsibility within the practice of medicine.

The current approach to the assessment of professionalism in students’ is based on the following competencies: altruism, duty, responsibility, excellence, respect for others, honor and integrity.

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Education

 

The San Juan Bautista School of Medicine

 

Private U.S. medical school, located in Caguas, Puerto Rico. It formally opened its doors in 1978.

 

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