Practice of Medicine Program (POM)

An innovative change was introduced to the MD curriculum beginning in the fall of 1993.A major part of this change involved the creation of a new course entitled "The Practice of Medicine" (POM). This longitudinal course integrates the building blocks of a traditional medical education --a strong foundation of basic and clinical sciences -- by interweaving them throughout the four-year curriculum. The conventional division of the curriculum into two years of basic sciences followed by two years of patient care is gone. The students are introduced to the clinical setting in the first two years while learning the basic sciences and, in the final two years, they "revisit" the basic sciences as they progress through their clinical experiences. The POM course enables and encourages the students to integrate basic science and clinical knowledge while developing their skills in scientific and clinical reasoning.

The POM course for Years I and II consists of three segments running through both years. In one segment the students, working in small groups with a mentor, are taught clinical assessment skills, such as history taking, the core physical examination, critical reading of the literature, epidemiologic methods and clinical decision making. This forum is also used to introduce and discuss a variety of important issues for the developing physician. Topics range from government involvement in health care, legal and ethical considerations in patient management to more personal issues, such as death and dying, aging and personal problems encountered by physicians and their families.

Another segment of this course is the clinical apprenticeship. At the beginning of the first semester each student is assigned to a physician. Throughout the first two years the student spends time with that physician in his primary care office. This experience exposes students to the office setting where they can observe the practice of medicine first hand. They can also begin to integrate what they are learning in the other segments of the POM course and the basic science courses to clinical practice.

The third segment of POM is the problem-based learning (PBL) cases. The PBL cases focus on common diseases and disorders and illustrate how illness affects not only a person's biologic health, but also their psychologic and social well-being. The cases provide an academic setting in which students, working in small groups with a faculty tutor, integrate basic biomedical science with patient care, to individually develop their clinical problem-solving skills and to discover the relevance of their education to the demands of modern medical practice. Beginning in the fall of 1995, PBL cases were expanded making POM the largest course in the first year.

POM runs concurrently with core basic science courses in the first year.

In the second year, students remain with their original primary care preceptors developing their clinical skills and their mentor groups progress, and PBL cases continue to be explored.

Incorporation of POM into the Year III curriculum includes one day of instruction addressing clinical topics, professionalism, ethics, and medical decision making.

Year IV POM consists of individualized non-clinical coursework. In addition to covering advances in basic sciences and clinical application, this course will serve as a continuation of Year III POM's integration and reinforcement of basic science material. No medical education would be complete without exploring and approaching the patient in a comprehensive manner, using the biopsychosocial model. In disciplinary courses and the POM, we constantly emphasize that illness occurs in people who live in families, who are parts of groups and who experience the world through the tinted lenses of culture and tradition. Throughout this learning experience, we also stress education through cooperation and collaboration -- not through competition -- and ongoing development of the ability to work with groups of colleagues and co-workers.

Our curriculum prepares well trained, developing physicians who can choose primary care or specialty areas of concentration. With the implementation of POM and early exposure to patient care, especially in the context of primary care, it is our hope that we will help to satisfy the national need for more primary care physicians.