Course objectives

Upon successful completion of this course, the student will be able to:

1. Identify anatomical structures by their location, dimensions, relationship to other structures, surface projections and functions.
2. Identify the nerve supply of anatomical structures.
3. Identify the vascular supply of anatomical structures.
4. Describe the relationship between morphology and function.
5. Describe the embryological development of the adult structures.
6. Apply anatomical knowledge to clinical scenarios.

Upon successful completion of this course, the student will be able to:

1. Describe the microscopic structure of the organ systems.
2. Relate system structure to its basic physiological function.
3. Identify structures on micrographs noting the information revealed by various staining techniques.
4. Relate basic histopathology to the etiology of disease states.
5. Correlate microscopic tissue structure with Cell and Molecular Biology and Gross and Developmental Anatomy.

Upon successful completion of this course, the student will be able to:

1. Identify the basic structures and functional components of proteins, nucleic acids, lipids, and carbohydrates, and to understand how these macromolecules function within a living cell.
2. Identify cellular structures in cellular schematics and electron micrograph images, interpret these structures and organelles with respect to their function, and apply that knowledge to the molecular basis of human disease.
3. Demonstrate comprehension of DNA structure, replication, packaging, rearrangement and exchange, as well as of the processes of transcription and translation. Explain how gene expression, epigenetic mechanisms and replication are involved in human health and disease.
4. Demonstrate comprehension of molecular-based techniques used in vitro and in vivo to analyze and manipulate nucleic acids and proteins, and to interpret results generated by these techniques.
5. Identify and describe membrane constituents and how they regulate membrane structure and function.
6. Demonstrate comprehension of cell signaling pathways responsible for regulating metabolism, gene expression, cell proliferation, immune response, survival and differentiation, and explain how dysregulation of these processes contribute to the development of disease in humans.
7. Demonstrate comprehension of the cell cycle (including mitosis and meiosis) and cell cycle regulation, apoptosis and differentiation, and explain how dysregulation of these processes contribute to the development of disease in humans.
8. Demonstrate understanding of the molecular basis of genomic instability, DNA damage and repair, and explain how dysregulation of these processes contribute to the development of disease in humans.
9. Demonstrate comprehension of the molecular basis of neoplasia and cancer susceptibility.
10. Utilize online resources to obtain and synthesize information essential to the process of evidence-based practice of medicine and to develop a better appreciation of abnormal molecular mechanisms involved in the origins of human disease.

Upon successful completion of this course, the student will be able to:

1. Determine the importance of comprehensive and focused history taking.
2. Obtain a complete medical history from the patient and or informant.
3. Identify and demonstrate the various verbal and non-verbal communication skills while conducting the patient interview.
4. Recognize and demonstrate professionalism while interacting with patient, family, peers and teachers.
5. List the various parameters of vital signs and should be able to obtain vital signs.
6. Identify the various steps in examining the cardiac, respiratory and musculo-skeletal system.
7. Demonstrate the skills in performing the physical examination of Cardiac, respiratory and musculo-skeletal systems.

Upon successful completion of this course, the student will be able to:

1. Describe the fundamental mechanisms underlying normal function of cells, tissues, organs, and organ systems of the human body, commensurate with the requirements for a physician providing care to patients.
2. Explain the basic mechanisms of homeostasis by integrating the functions of cells, tissues, organs, and organ systems.
3. Apply knowledge of functional mechanisms and their regulation to explain the pathophysiology underlying common diseases.
4. Describe the molecular and cellular mechanisms of physiological processes that are the basis for therapeutics and drug targets that are introduced later in the curriculum.
5. Effectively solve basic problems in Physiology and Pathophysiology, working independently and in groups.

Upon successful completion of this course, the student will be able to:

1. Have a clear understanding of the subcellular organelles, various cellular proteins and signaling mechanism that they have studied in cell and molecular biology with the biochemical functions that goes on in each cell. Students will have a thorough understanding of the fundamental principles of biochemistry, especially in relation to various metabolic pathways that are important in understanding a medical disorder. Students will be able to integrate various metabolic pathways for overall understanding of the metabolic processes that go on in our cells.
2. Have a better understanding of the fate of various macro and micronutrients that we take in the diet. Students will have a better understanding of the digestion and absorption process of all these molecules, and of the abnormalities that can occur during these processes. Students will be able to connect the role of various vitamins and minerals in the metabolic pathways, and the abnormalities that can occur when these micronutrients are deficient or in excess. This will eventually enable students to understand the treatment and monitoring of these disorders.
3. Integrate metabolic processes with clinical disorders and applied physiological aspects. This kind of integration will assist students with better understanding of physiological changes that will go on in the body according to the physiological status of the cell. Constant integration of clinical disorders is done throughout the course so that students will have a better understanding of a disorder at the molecular level. This will assist students in clinical diagnosis, modes of treatment, monitoring and prognosis of a disorder, along with helping to determine the differential diagnosis for disorders which share similar phenotype.
4. Have a better understanding of normal biochemical functions of various enzymes, which will assist them in understanding the disorder when there is an abnormality in any of these enzymes. With the thorough background of enzymes and biochemical process, students will have a better understanding of the rationale for using various medications in disorders affecting metabolic pathways.
5. Have sufficient exposure to all the high yield concepts and questions for their preparation towards USMLE Step 1 exam and beyond. 

Upon successful completion of this course, the student will be able to:

1. Understand the molecular mechanisms of how chromosomal abnormalities and genetic mutations lead to aneuploidies, genomic disorders, single gene diseases, and complex disorders.
2. Understand the strategy and technology used for gene mapping and disease gene identification.
3. Describe the current approaches for the treatment of genetic disease including gene therapy.
4. Understand the recent advances in prenatal diagnosis, cancer genetics, and pharmacogenetics.
5. Other skills learned by the students will be evaluation of pedigrees, calculating recurrence risk, and using Hardy-Weinberg to determine mutation frequencies in populations.

Upon successful completion of this course, the student will be able to:

1. Understand the basic concepts and principles of epidemiology.
2. Identify the basic strategies for observational and experimental studies.
3. Use the epidemiologic approach to define and measure the occurrence of disease and health in populations.
4. Identify data needs for calculating standard epidemiological measures.
5. Understand collection of scientific data, appropriate analysis using statistical tests and results interpretation.
6. Distinguish the roles of epidemiology and biostatistics in the prevention of disease and the improvement of health.

Upon successful completion of this course, the student will be able to:

1. Describe the cells and tissues involved with innate and adaptive immunity.
2. Know the molecular and cellular mechanisms employed in innate immune responses, and those used in the humoral and cell-mediated arms of adaptive immunity.
3. Know the details of antigen processing and presentation by antigen presenting cells and the central role of MHC molecules in this process.
4. Understand the maturation and selection of B and T lymphocytes and how gene rearrangement generates the diverse antigen receptors required for lymphocyte activation.
5. Understand how activated lymphocytes carry out different effector functions and produce memory during a humoral or cell-mediated adaptive response.
6. Understand the clinical aspects of immunology including tolerance and autoimmunity, transplantation and immunosuppression, immunotherapy strategies against tumors, hypersensitivity reactions, and the consequences of congenital immunodeficiencies.

Upon successful completion of this course, the student will be able to:

1. Understand, identify, and describe the changes that happen in cell injury and adaptation. Students must be able to solve clinical problems by explaining underlying pathology.
2. Define acute and chronic inflammation, identify various types’ cells in inflammation, and explain the role of chemical mediators. Students must be able to analyze lab reports pertaining to inflammatory diseases.
3. Describe the various types of hemodynamic disorders, identify the structural changes, and explain the underlying pathology.
4. Name various benign, and malignant tumors, understand the differences between benign and malignant tumors, explain the biology of tumors, identify correctly histological features and have an overview of important cancers.
5. Explain the immune basis of primary immune deficiency, and autoimmune disorders, describe various changes seen in the organs affected, and are able to interpret lab reports.
6. Define, explain, and draw an algorithm to explain various types of anemia. Students should be able to evaluate cases of anemia, and interpret lab reports.
7. Describe various types of reactive conditions associated with white cell abnormalities, discuss the various types of hematological malignancies based on pathogenesis, and be able to interpret lab investigations.
8. Understand the pathogenesis of tumors involving renal, and prostate. Students must be able to identify histological features, interpret investigations, and explain clinical features of renal and prostate tumors.
9. Identify, and distinguish testicular tumors. Discuss the morphological features, and clinical presentations of major testicular tumors.
10. Differentiate, and describe various skin disorders of immune, infectious, and neoplastic origin.
11. Define, describe, and identify diseases affecting the CNS. Students should be able to explain the pathogenesis of various developmental, demyelinating, dementia, and tumors affecting the CNS.

Upon successful completion of this course, the student will be able to:

1. Determine the location and type of spinal cord injuries.
2. Evaluate the status of a neurological patient.
3. Perform the neurological exam.
4. Identify problems via neuro imaging techniques.
5. Discuss site, level, and type of injury.

Upon successful completion of this course, the student will be able to:

1. Identify the common etiologic agents of the disease and be able to determine the causative agent of the particular case from case clues.
2. Classify general characteristics regarding disease or organism, predisposing conditions, epidemiology, mechanisms of pathogenicity, and major tests used in identifications.
3. Describe mechanisms of virulence and pathogenesis for microorganisms.
4. Identify the appropriate therapies, drug mechanism of action and resistance mechanisms for antimicrobials, antivirals, antifungals and antiparasitics.

Upon successful completion of this course, the student will be able to:

1. Describe the progression through the life cycle and recognize the major milestones from conception to death.  
2. Explain the psychological and social factors influencing patient behavior, noting how those factors contribute to unhealthy behavior, disease, and compliance or resistance to treatment.           
3. Describe and demonstrate patient interviewing skills, peer consultation, and interactions with the family.         
4. Describe the normal processes and pathophysiology of the central and peripheral nervous systems (brain stem, brain, motor systems, and the autonomic nervous systems) as they relate to mental and emotional disorders.           
5. Construct a differential diagnosis and demonstrate the ability to diagnose disorders according to the DSM-5 criteria. 
6. Recognize the signs and symptoms of psychopathological disorders and describe the disorders, their signs, and symptoms using proper terminology.           
7. Describe the general principles of psychotherapy and psychopharmacology, including the basic indications and contraindications.           
8. Recognize the gender, ethnic, and behavioral (i.e., biopsychosocial) considerations affecting disease treatment and prevention (including psychosocial, cultural, occupational, and environmental), and construct basic interventions to improve patient compliance to treatment.
9. Demonstrate an understanding of the four pillars of ethics and how they influence clinical practice. 
10. Demonstrate understanding of the AMA stance on doctor/patient relationships, conflict of interest, professional boundaries, informed consent, advanced directives, ethical research, and end-of-life care.       
11. Incorporate guidelines of HIPAA, the AMA and ethics committees, as well as local laws and regulations, in analyzing and resolving ethical dilemmas.

Upon successful completion of this course, the student will be able to:

1. Describe the etiology, pathogenesis, structural and functional manifestations of disease, and have the ability to use this knowledge to solve appropriate problems.
2. Understand the biological principles which govern changes in cells and tissues as a response to abnormal stimuli, and the functional consequences and clinical significance of morphologic changes.
3. Understand how these changes alter during the course of the medical and surgical therapy and the differential diagnosis.
4. Describe various specific changes which occur in specialized organs due to harmful pathogens and other agents.
5. Recognize disease at the gross, microscopic and ultrastructural level.
6. Understand the various pathological, molecular and immunologic techniques used to reach the diagnosis.
7. Understand the dynamics of disease and be aware of the natural course of specific disease states and the result of intervention by a physician.
8. Interpret the various pathology reports of various branches.
9. Understand how Pathology as a medical specialty relates and contributes to clinical medicine.

Upon successful completion of this course, the student will be able to:

1. Understand the fundamental principles of drug-receptor interactions and identify how drugs alter cellular function through the study of pharmacodynamics.
2. Determine how the body handles drugs through pharmacokinetic processes such as absorption, distribution, metabolism, elimination, dose-response relationships, half-life, steady-state concentrations and volume of distribution and thereby affect therapeutic effectiveness.
3. Identify how specific patient characteristics and genetics can affect the response to a particular class of drugs.
4. Discuss the rationale behind designing different dosing regimens of particular drugs in specific patient populations.
5. Evaluate the scientific basis underlying how two different drugs can interact within the body and can have undesirable effects either on drug concentrations or drug clinical effects.
6. Identify and name the major classes of clinically important drugs which include drugs affecting the autonomic nervous system; anesthetics and analgesics; drugs to treat diseases of the cardiovascular system; drugs affecting the pulmonary system; antibiotics; drugs used to treat psychiatric disorders; drugs of abuse and drugs used to treat addiction; drugs that affect the immune system; drugs that affect the endocrine system; dietary supplements and herbal medications; antiviral drugs and chemotherapeutic drugs used in the treatment of cancer.
7. Provide specific examples, mechanisms of action, adverse effects, contraindications, and drug interactions for each drug or class of drugs.

Introduction to Clinical Medicine II is a course designed to introduce the students to the practice of medicine. The knowledge gained in the Basic Sciences will be integrated with the “art” of medicine. Students will sharpen their skills in history taking and physical diagnosis and learn how to formulate diagnosis and appropriate treatment plans. Patient communication and professionalism will be stressed throughout the course.

The learning experience will include classroom lectures and small group sessions emphasizing clinical presentation, diagnostic work up, differential diagnoses, treatment plans and case scenarios. Patient experiences will take place in both a virtual clinic setting and in preceptor offices with a practicing medical provider. Each week students will spend time in the Clinical Skills Lab for further “hands-on” experiences. The above will be supplemented with additional special lectures on topics including Ethics, EKG, Pediatrics, Geriatrics, Addiction Medicine, Obstetrics, Ophthalmology, Behavior Sciences, Genetics, Surgery, Vaccines & Travel Medicine, Palliative Care and Dermatology.

The Clinical Preceptor Program exposes students to direct patient care by having students work in offices, hospitals or operating rooms with physicians, physician assistants, or nurse practitioners and exposes other students to indirect patient care by having students work with Pathologists and Laboratory Technicians. The major emphasis in this section of the ICM II course is on the content of clinical medicine and on the grasping of the meaning and awesome responsibility inherent in being a physician. Each student will keep a journal of the clinical situations and or pathology lab experiences encountered making sure to adhere to HIPAA rules.

The goal of ICMII is to prepare students to enter clinical rotations with a skill set that allows them to comfortably and successfully interact with patients. Students will be prepared to practice evidence-based medicine and achieve the six core competencies as outlined by the ACGME. Preparation for Step 1 of the USMLE will also be important during the course.

Learning Objectives:

1. Review the clinical presentations of medical illnesses while incorporating the fundamentals taught during Basic Sciences
2. Further hone communication skills in patient interactions that were taught in ICM I
3. Learn the importance of appropriate professional behavior and appearance and its significance for good patient outcomes
4. Practice efficient, focused history taking
5. Practice efficient, focused physical exam skills
6. Learn to develop differential diagnoses based on symptoms and signs gathered from the focused history and physical exam
7. Learn the use of laboratory and radiologic investigations by balancing clinical benefit with costs and harms
8. Learn cost effective use of resources in the treatment of patients
9. Develop a plan of care integrating evidence-based, guideline-driven treatment plans
10. Learn to deliver efficient and concise patient presentations
11. Document the office visit using a focused SOAP note format
12. Practice commonly used medical procedures in a Clinical Lab setting