Curriculum

Doctor of Osteopathic Medicine

College: Osteopathic Medicine (COM)

Department: Osteopathic Medicine

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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 DOctoring courses. Hospital clerkships continue to emphasize these same concepts in the setting of inpatient care with its attendant special needs and requirements.

UNECOM has adopted the American Osteopathic Association Core Competencies, which 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 out professional responsibilities in an ethical and sensitive manner.
7. System-Based Practice: The student will demonstrate an awareness of and responsiveness to the system of health care, to provide care that is of optimal value.

Curriculum Sections
Both the on-campus Basic and Clinical Sciences Curriculum and the Clinical Rotations (Clerkship) Training Curriculum are under the direct supervision of the Associate Dean for Academic Affairs via the Committee on Educational Programs.

Curriculum
The curriculum of  UNECOM is divided into four phases described below. Each of these is designed to complement the development of increasingly complex and integrated concepts of knowledge, attitude and skill as the learner advances through the curriculum. The curriculum’s centrality is the driving force of medicine – the patient.  The "Patient First Curriculum" develops 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 phase of the osteopathic medical curriculum contains a variety of biomedical, social, and clinical science courses during the first year and includes DOctoring I, II, and III, Osteopathic Principles and Practice I, Human Structure I and II, Human Function: Cellular & Organ System Physiology I and II, Human Function: Biochemistry & Molecular Biology I and II, Nutrition, Pathology, Parasitology, Virology, Immunology, Bacteriology, Pharmacology, and Medical Jurisprudence. Small group and case based instruction are used where possible. Early observerships occur during the preceptor program embedded in the DOctoring course and the clinical performance center activities with standardized patient encounters which emphasize humanistic patient-physician relationship building and the demonstration of physical examination skills.

The second phase in year two builds on the concepts presented in the first year and is organized into a DOctoring IV 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: the 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 Transitional Clerkship course designed to prepare them for the transition into the following two years of clinical training experiences. Clinical observerships continue and practice at the clinical performance center, utilized to practice and assess the application of year one skills to case-based and system-related clinical encounters with standardized patients and simulations.

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 DOctoring I, II, III and IV and the Transitional Clerkship courses, which encompass:

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

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.

Phase three of the curriculum occurs at the affiliated clinical campuses throughout the northeast. Students rotate through clinical experiences in Family Medicine, Psychiatry, Pediatrics, Surgery, Internal Medicine, Obstetrics/Gynecology and Community Health at hospitals, clinics and outpatient sites. These rotations emphasize independent learning in clinical practice within the context of the curriculum with guided learning, end of service examinations and a summative evaluation at the end of year three at the campus clinical performance center. This summative evaluation utilizes standardized patients and cognitive assessment tools concentrating on the retention and application of knowledge and skills to the patient encounter emphasizing the application of knowledge to the performance of the history and physical and the development of diagnosis and treatment plans. The precepts and concepts learned in the courses and systems of year one and two along with behavioral medicine and medical humanities are applied in the clinical rotations of the third and fourth year.

Intersession Clinical Colloquium, Course Number: 801
This course is intended to provide a summative evaluation in selected skills in the physician/patient clinical interaction within a clinical skills assessment process while preparing students for the COMLEX-PE exam.  Principles of critical care, utilizing a prescribed standardized course from the Society of Critical Care Medicine, are presented in anticipation of specialty and emergency medicine clerkships.  Activities to assist students understanding of the residency interview process and the postgraduate match are included as are activities to insure compliance with certain college and professional regulatory matters.

Phase four continues the clinical experiences curriculum in year four with selective and elective clinical rotations. Students complete selectives, which are additional required services, at sites of their choosing. These include Surgery, Emergency Medicine, Internal Medicine, Community Health and Osteopathic Manipulative Medicine. Students also have elective time that may be used to complement their professional interests, expand their learning options and explore postgraduate residency opportunities within the guidelines established by the college.

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

 

	College	Course number	Course Title	Credit Hours
			Year 1
	COM	507	Human Structure I	8
	COM	508	Human Structure II	8
	COM	535	Human Function: Cellular & Organ System Physiology I	3
	COM COM	536 515	Human Function: Cellular & Organ System Physiology II Human Function: Biochemistry & Molecular Biology I	3 3
	COM	516	Human Function: Biochemistry & Molecular Biology II	3
	COM	514	Nutrition	1
	COM	523	Medical Immunology	1
	COM	524	Medical Virology	1
	COM	526	Medical Bacteriology/Mycology	3
	COM	529	Medical Parasitology	1
	COM	542	Medical Pharmacology	2
	COM	552	Introduction to Pathology	3
	COM	568	Medical Jurisprudence	1
	COM	581	DOctoring I	2
	COM	582	DOctoring II	2
	COM	584	DOctoring III	2
	COM	586	Basic Life Support	0
	COM COM	593 596	Osteopathic Principles & Practices I, Section I Osteopathic Principles & Practices I, Section II	3 3
			Year 2
	COM	601	Neuroscience/Neurology System	8
	COM	605	Psychiatry System	2
	COM	611	Musculoskeletal System	4
	COM	623	Respiratory System	3
	COM	633	Hematology System	3
	COM	642	Cardiovascular System	5
	COM	652	Renal System	3
	COM	660	Endocrine System	2
	COM COM	662 632	Gastrointestinal System Dermatology System	3 2
	COM	664	Reproductive System	5
	COM	668	Advanced Cardiac Life Support (ACLS)	1
	COM	673	DOctoring IV	2
	COM	675	Essentials of Pediatrics	2
	COM	677	Essentials of Geriatrics	2
	COM	687	Pharmacology and Therapeutics I	2
	COM	688	Pharmacology and Therapeutics II	2
	COM COM	695 696	Osteopathic Principles & Practice II, Section I Osteopathic Principles & Practice II, Section II	3 3
	COM	694	Pre-Clinical Transitional Clerkship	2

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  residency training. Each clinical rotation is designed to fulfill a necessary step in the evolution of the COM student to competency for graduation and entry into a residency training program. Cognitive, manual and psychomotor objectives are directed toward developing the student's physician skills and attitudes. Also during this time, the student is expected to complete the transition to adult learner, asking questions and independently seeking and synthesizing information.

It is expected that the future physician will consistently adhere to the osteopathic philosophy and concepts 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 a physician 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.

Clinical services are arranged to meet UNECOM's core, selective and elective requirements for graduation. Utilizing our Clinical Campuses, 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 practice 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, are assigned by the Office of Clinical Education at our clinical campuses. The core rotations include Internal Medicine, Surgery, Obstetrics/Gynecology, Pediatrics, Family Medicine, Psychiatry and Community Health. Required selective rotations include Internal Medicine, Surgery, Emergency Medicine, Osteopathic Manipulative Medicine, and Community Health. The student selects the sites, subject to Clinical Education Office approval, at which these clinical rotations 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. This rotation 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.  Training sites located in Maine are affiliated with the Maine Area Health Education Center (AHEC) Network.

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 must be BLS (Basic Life Support) and ACLS (Advanced Cardiac Life Support) certified prior to this service. BLS is offered during the first-year curriculum and ACLS 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 rotation. 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 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 in general Internal Medicine at their assigned Clinical Campus and one selective clerkship in an IM subspecialty at a medical facility of the student's choosing. Internal Medicine clerkships are conducted as predominantly hospital-based experiences and are intended to provide practical clinical exposure and learning designed to apply the 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.

Pediatrics
Students are required to complete one core clerkship in Pediatrics. This 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 educate 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
The required Psychiatry core clerkship is intended to apply the concepts of diagnosis and management presented during  preclinical course work. The recognition of key target symptoms of common mental illnesses is emphasized with the Mental Status Examination providing a basis for 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.

Colloquium Course Clinical Performance Examinations (CPX)
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 appropriate paperwork, e.g., differential diagnosis list, answers to multiple choice questions or a written progress note.

Affiliate Hospitals
The affiliate hospitals of the College of Osteopathic Medicine 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 the new generation of osteopathic physicians who follow them.  A list of the affiliate hospitals is available on the department website.

Graduate Educational Affiliations
University of Connecticut School of Medicine: IM Residency and Internship
UMass/Fitchburg Family Practice: FP Residency
Berkshire Medical Center: IM Residency and Internship
Maine-Dartmouth Family Medicine Residency: FP Residency and NMM+1 Residency
Eastern Maine Medical Center: FP Residency and NNM+1 Residency
Central Maine Medical Center: FP Residency
Saint Michael's Medical Center: EM Residency, IM Residency, and Internship
St. Joseph's Regional Medical Center:  EM Residency, FP Residency, General Surgery Residency, and Internship
Albany Medical Center: FP Residency and Internship
St. Elizabeth Family Medicine Residency Program: FP Residency and Internship
Samaritan Medical Center: FP Residency, IM Residency, and Internship
Kent Hospital: EM Residency, FP Residency, IM Residency and Undersea and Hyperbaric Medicine (UHM) Fellowship
University of New England College of Osteopathic Medicine Residency Program: NMM Residency and NMM+1 Residency