University of New England

College: Osteopathic Medicine (COM)

Department: Osteopathic Medicine

Curriculum Objectives
The UNECOM curriculum is designed to educate osteopathic primary care physicians who are skilled in health promotion and illness prevention as well as the delivery of illness care.

To educate this type of physician, the basic and clinical science foundations of the curriculum are augmented by a strong program in human behavior and community medicine in the Essentials of Osteopathic Medicine and Clinical Principles and Practices courses. Hospital clerkships continue to emphasize these same concepts in the setting of inpatient care with its attendant special needs and requirements.

Graduate Competencies for the Twenty-first Century
Graduates will have the knowledge, skills, and professional perspective to meet: 

The seven UNECOM core competencies are:

1. Osteopathic Principles and Practice: The student will understand and apply osteopathic principles to patient care.
2. Patient Care: The student will have the knowledge, attitudes, and skills to provide compassionate, appropriate and effective patient care.
3. Medical Knowledge: The student will demonstrate knowledge of established biomedical, epidemiological, social, and behavioral sciences and their application to patient care.
4. Practice-Based Learning and Improvement: The student will demonstrate the ability to investigate and evaluate patient care practices using scientific evidence and apply these to patient care.
5. Interpersonal and Communication Skills: The student will demonstrate interpersonal and communication skills that result in effective interactions with patients, families, and colleagues.
6. Professional: The student will demonstrate a commitment to carrying our professional responsibilities in an ethical and sensitive manner.
7. System-Based Practice: The student will demonstrate an awareness of and responsive to the system of health care, to provide care that is of optimal value.

Curriculum Sections
The curriculum of the College of Osteopathic Medicine is under the direct supervision of the dean of the College via the Academic Affairs Committee and the Faculty Assembly. The curriculum is divided into two sections: the on-campus Basic and Clinical Sciences Curriculum and the Clinical Rotations (Clerkship) Training Curriculum.

Basic and Clinical Sciences Curriculum
2008-2009 marks the introductory/preliminary phase of the College's innovative and dynamic "Patient First Curriculum". The driving force for this model is the patient, and the driving force for the educational encounter is the outcome, the application of a skill, knowledge, and/or values, using the seven core competencies of the osteopathic profession as an overriding framework. There is an emphasis on early clinical experiences and physical diagnosis, and a gradual but increasing focus on continuity of care and longitudinal relationship-centered patient care. Above all, the graduates of UNE's College of Osteopathic Medicine are known for always putting the patient first.

The first year of the osteopathic medical curriculum contains a variety of biomedical, social, and clinical science courses. The first-year courses include: Essentials of Osteopathic Medicine, Osteopathic Principles and Practice, Anatomy, Biochemistry, Nutrition, Physiology, Pathology, Parasitology, Virology, Immunology, Bacteriology, Pharmacology, Medical Jurisprudence, Embryology, and Histology. 

The second year is organized into a Clinical Principles and Practices foundation course, the second year of the Osteopathic Principles and Practice course, and a series of eleven systems representing related organ-system groupings of the body; namely Neuroscience/Neurology, Psychiatry, Musculoskeletal, Respiratory, Hematology, Cardiovascular, Renal, Gastrointestinal, Endocrine, Dermatological and Reproductive systems. All systems are presented from a multi-disciplinary approach integrating lectures on biomedical science, internal medicine, pathology, surgery, radiology, pediatrics, family medicine, and social and population health sciences. Near the completion of the second year, students encounter the Clinical Decision Making course designed to prepare them for the transition into the following two years of clinical training experiences. 

The knowledge to conduct a careful and efficient medical interview (the medical history) and a thorough and skillful physical exam is perhaps the most important information acquired in the four years of medical training. At UNECOM, these  skills are developed during the Essentials of Osteopathic Medicine, Clinical Principles and Practices and the Clinical Decision Making courses, which encompass:

• Socio-psychological aspect of the patient interview
• Motor Skills
• History and Physical (H&P) Format; and Initial Differential Diagnosis

The precepts and concepts learned in these courses and systems along with Behavioral Medicine and Medical Humanities are applied in the clinical rotations of the third and fourth year. Interwoven throughout both didactic phases of the curriculum is the course on Osteopathic Principles and Practice. An attempt is made, where possible, to vertically integrate the material in this course with that of the ongoing systems of the second year.

The courses and systems taught each year are as follows. (Also see Course Descriptions)

Clinical Rotations (Clerkship) Program
The UNECOM student rotates through the clinical rotations during the final phase of his/her predoctoral education. The clinical clerkship experience has a broad and specific goal to provide a module of osteopathic medical education preparing the student to enter a residency training. Each clinical rotation is designed to fulfill a necessary step in the evolution of the UNECOM student to competency for graduation and entry into a residency training program. Cognitive, manual and psychomotor objectives are directed toward developing physician skills and attitudes of the student in preparation for residency training. Also during this time, the student is expected to complete the transition to adult learner, asking questions and independently seeking and synthesizing information.

A part of this goal is the expectation that the future physician will consistently adhere to the osteopathic philosophy and concept in the practical management of persons for maintenance of health and for the treatment of disease, acute and chronic. Further, the student will develop the ethical character expected of future physicians as a caring person skilled in problem solving, therapeutic management and interpersonal relations and with a social sense of fiscal accountability and responsibility toward health management.

During those months, clinical services are arranged to meet core and elective requirements of the clinical practicum. Utilizing the Clinical Training Centers (CTCs), affiliate hospitals, ambulatory care sites, and other clinical settings, students gain exposure to a scope and variety of clinical experiences appropriate to the preparation of the primary care physician. Students travel to a number of sites in the Eastern United States, experiencing health care delivery from the rural private practitioner to the inner city, tertiary care facility. Students may be required to travel or relocate to affiliate regions to complete this segment of training.

Core rotations, as determined by the Academic Affairs Committee, are assigned by the Office of Clinical Education from a list of affiliate sites. The core rotations include Internal Medicine, Surgery, Obstetrics/Gynecology, Pediatrics, Family Medicine and Psychiatry. Required selective rotations include Internal Medicine, Surgery, Emergency Medicine, Osteopathic Manipulative Medicine, and Community Health  (AHEC). The student selects the sites, subject to Clinical Education Office approval, at which these clinical rotationss will be done. Elective months are scheduled by the student with the approval of the Office of Clinical Education.

In order to begin clinical training, the student must be in compliance with all certifications, immunizations and medical tests as outlined in the UNECOM clinical rotations (clerkship) training manual and with such additional requirements as training sites may specify including, but not limited to, evidence of recent physical examination, criminal background check and drug screen.

To graduate, the student must successfully complete all required core, selective and elective clinical rotation assignments as specified in the clerkship manual and syllabi. Integral to this success is the maintenance of the highest levels of academic and professional behavior standards.

Community Health
The Community Health rotation emphasizes, but is not limited to, primary care of medically underserved populations, both urban and rural.  Students apply basic concepts and principles of medical care, often in the absence of sophisticated diagnostic tools. The service is designed to develop in the student an awareness of and appreciation for the unique challenges faced by the uninsured and the underinsured in our country with regard to access to health care. The student will participate in patient diagnosis protocols, health screening, preventive medicine and patient education

Emergency Medicine
An Emergency Medicine rotation is a required selective hospital experience where the UNECOM student will apply the concepts of diagnosis and management of patient problems presented during the preclinical years. Students are expected to be ACLS (Advanced Cardiac Life Support) certified prior to this service. ACLS is offered during the second-year curriculum. The practical experience of recognition, differential diagnosis and therapeutic management of the patient with surgical, medical or psychiatric problems requiring urgent care is emphasized in this requirement. The student will apply psychomotor skills in musculoskeletal injuries, vascular access, wound management and cardiovascular resuscitation while demonstrating concepts of patient evaluation and management. Students may schedule additional emergency medicine services during their elective time with the approval of the Office of Clinical Education.

Family Medicine
Students are required to complete one core clinical rotation in Family Medicine. The core Family Medicine clerkship is a hospital and/or ambulatory care experience where the student will apply basic concepts and skills presented during the preclinical years. By basing the experience in a community setting, the student is exposed to clinical resources united in a continuum of care, thus developing within the student an awareness of the physician's role in the total health care team. Emphasis is on the patient's reaction to illness, the physician/patient relationship, family dynamics in illness and health, and the careful and economical use of medical therapeutics, technology consultations, clinical laboratory investigation and hospitalization. Special attention is given to the patient interview, directed physical examination and patient education in the therapeutic use of the physician. In addition to training in the hospital setting, the student is likely to spend time in various clinics and the offices of individual physicians. Students may schedule additional Family Medicine experiences during their elective months with the approval of the Office of Clinical Education.

Internal Medicine
Students are required to complete two core clerkships at a clerkship training center and one selective clerkship in an Internal Medicine subspecialty and at a medical facility of the student's choosing. Internal Medicine clerkships are conducted as predominantly hospital-based experiences. The clerkships are intended to provide practical clinical exposure and learning designed for the application of concepts and principles presented during the preclinical years. Additional knowledge and practical experience are emphasized to identify the range of normal functioning, to identify, diagnose and manage patients with pathologic functioning and to predict the natural course of health and disease. Students may schedule additional general or subspecialty internal medicine experiences during their elective months with the approval of the Office of Clinical Education.

Obstetrics/Gynecology
Students are required to complete one core clerkship in Obstetrics and Gynecology. This clerkship is intended to provide practical clinical exposure in the diagnosis and management of the female patient with normal and pathologic obstetric and gynecologic processes. Gynecologic surgery, labor and delivery, preoperative evaluations and postoperative care are emphasized. Students are encouraged to participate in ambulatory care where appropriate. Students may schedule additional obstetrical and/or gynecologic clerkships during their elective months with the approval of the Office of Clinical Education.

Osteopathic Manipulative Medicine
The Osteopathic Manipulative Medicine (OMM) selective is designed to provide hospital inpatient, nursing home and/or assisted living community, and outpatient practical (hands on) experiences. In addition, there is opportunity for attendance at Family Medicine and OMM didactics.

Pediatrics
Students are required to complete one core clerkship in Pediatrics. The required core clerkship in Pediatrics allows the student to extend the concepts and principles developed during the preclinical years through clinical work in a hospital, clinic, and/or office setting as designed by the clinical training site. Students will learn observational and interviewing skills related to parent and child and engage individual patients and families across cultural and social boundaries. Their scientific and clinical understanding of normal growth and development will prepare them to engage parents and caregivers in health promotion. Students will gain clinical experience in the diagnosis and management of primary care pediatric patients with normal or pathologic functioning as well as an understanding of the natural course of diseases and preventive care. Their direct experiences will help them become aware of the unique vulnerabilities of infants and children that may require special attention, consultation, and/or referral. During this clerkship, students will have the opportunity to demonstrate an investigatory and analytic thinking approach to clinical situations. Further, they will use published evidence to evaluate clinical practice guidelines as they apply in multiple patient care environments.

Students will have some exposure to intensive care and pediatric subspecialties, but the emphasis is on primary care of the newborn to the adolescent. Students are encouraged to design an additional Pediatric elective based on their own learning goals in either inpatient or ambulatory care settings, scheduled with the approval of the Office of Clinical Education.

Psychiatry
This Psychiatry core clerkship is intended to apply the concepts of diagnosis and management presented during the preclinical course work. The recognition of key target symptoms of common mental illnesses is emphasized with the Mental Status Examination providing a basis of differential diagnosis and therapy. The student will be given additional exposure in cognitive, psychomotor and affective development. Students may schedule additional clerkships in mental health and psychiatry during their elective months with the approval of the Office of Clinical Education.

Surgery
Students are required to complete one core clerkship at an affiliate hospital and one selective clerkship in general or subspeciality Surgery at a medical facility of the student's choosing, subject to approval by the Office of Clinical Education. Surgical clerkships are conducted as hospital and/or ambulatory-based experiences. The major goal of these clerkships is to provide an appreciation of the principles of surgical practice by expanding on the precepts learned in the classroom. It is intended that emphasis be placed on the totality of care from the presurgical visit through the surgical encounter and the postoperative recovery. Students may elect additional surgical clerkship time during their elective months with the approval of the Office of Clinical Education.

Electives
Students are afforded elective time during their clerkship training. With the approval and counseling of the Office of Clinical Education, students may pursue areas of special interest to complement the required core and selective services. International elective clerkships are available, with approval of the Office of Clinical Education. Students are encouraged to explore a wide range of options with an emphasis on the broad preparation of the general practice physician. Students are urged to pursue a course which will not narrow their career path but provide for a wider appreciation of the diversity of medicine. Specific specialty tracking during clerkships is not in keeping with the mission of UNECOM. This general preparation will provide a firm foundation for entry to internship and residency level training.

Clinical Skills Assessment (CSA)
This program uses trained actors/evaluators as standardized patients to test students' assessment skills and to provide feedback for students' future benefit. Each student sees several "patients" in established scenarios. Specific tasks are assigned for each scenario and may include interview, patient communication, physical assessment, ethical issue, interpretation of lab results, EKG or X-ray or any combination. Upon concluding the task, the student completes whatever paperwork is appropriate, e.g., listing of differential diagnosis, providing answers to multiple choice questions or writing a progress note.

Affiliate Hospitals
The following are major affiliate hospitals of the College of Osteopathic Medicine. They play a significant role in the clinical experience of our students. We appreciate the dedication of those physicians who provide their time and expertise for the education of those osteopathic physicians who follow them. In addition, they are staffed by dedicated physicians who provide their time and expertise to educate a new generation of osteopathic physicians.

Core Predoctoral Education Affiliates 2008-2009
UNECOM/Keystone Clinical Heart of Lancaster Lititz, Pennsylvania
St. Joseph Medical Center Reading, Pennsylvania

UNECOM/Leatherstocking Clinical Training Center
St. Elizabeth Hospital Utica, New York

UNECOM/Maine Clinical Training Center
Central Maine Medical Center Lewiston, Maine
Eastern Maine Medical Center Bangor, Maine
MaineGeneral Medical Center Augusta, Maine
Maine Medical Center Portland, Maine
Mercy Hospital and Portland Surgical Associates Portland, Maine
Penobscot Community Health Center Bangor, Maine
Shipman Pediatrics York, Maine
SMMC Pediatrics Biddeford, Maine
Southern Maine Medical Center and Coastal Surgical Associates Biddeford, Maine
St. Mary's Regional Medical Center Lewiston, Maine
University Health Care Saco, Maine
University Health Care for Kids Portland, Maine
Waterboro Village Pediatrics East Waterboro, Maine
York Hospital York, Maine