during the sophomore year are pathology,
microbiology, pharmacology, physical diag-
nosis, clinical laboratory procedures, and
introductions to certain specialty fields such as
public health and psychiatry.
Pathology is probably the keystone course of the
sophomore year. It provides an
introduction to the essential nature of disease
and, in particular, the structural and func-
tional changes that cause or are caused by
disease. During the second semester, the more
common diseases of each organ system and each
organ are studied. The teaching
process in pathology involves formal lectures,
clinical pathological conferences, and
laboratory exercises in pathological
histology.
Microbiology provides an introduction to
disease processes. It involves a study of
the microorganisms that invade the body. The
basis of mechanisms of infection and
immunity is analyzed. One of the most effective
means of combating disease is through
drugs. Pharmacology concerns itself with the
chemistry of the natural and synthetic
drugs and their action in the healthy and
diseased human body. The full impact of this
subject comes to the forefront during the
lengthy laboratory exercises in which experi-
mental animals are frequently used to measure
the effects of drugs.
The groundwork provided by the aforementioned
courses, together with those com-
pleted during the first year, provide a great
deal of fundamental information about the
human body in illness and in health. The next
step is to become familiar with the practi-
cal techniques required to determine the nature
of a patient's illness. An introduction to
this procedure is provided by the course in
physical diagnosis. This phase of preclinical
study gives one a strong psychological lift.
The student learns the art of taking a medical
history and examining a sick patient. The
sophomore year ends with a framework for
the clinical years well
established.
The Third Year
While the junior year is highlighted by
considerable exposure to clinical experience, the
formal educational process continues during
this period with lectures, conferences, and
seminars in medicine, surgery, pediatrics,
obstetrics, and gynecology, as well as other
specialties and subspecialties. The educational
process is usually closely integrated with
presentation of relevant patient cases. The
emphasis in this early clinical training period
is on the diagnosis of disease. The principles
of treatment noted will be emphasized later.
Juniors are assigned various patients for a
"workup," obtaining a history and physical
examination. To carry out the former, the
junior medical student learns to interrogate the
patient so as to elicit and organize the
chronological story of his or her present illness,
obtain information as to the general state of
his or her past and present health, secure vital
data concerning the patient's family history,
occupation, and social life. Supplementing
this is a physical examination using manual
manipulative and instrumental aids (stetho-
scope and ophthalmoscope). All the information
is then integrated to provide preliminary
diagnosis. The student then decides whether
laboratory tests, X-rays, or special studies
are needed. A faculty member reviews the entire
"workup" and makes adjustments or
confirms the order for diagnostic tests. This
preliminary stage of clinical training, like all
initial educational experiences, is of special
importance. It helps develop a critical
approach that tends to avoid the hazards that
result from insufficient gathering of infor-
mation, careless observation, or improper
evaluation of the obtained data.
The initial diagnostic training is provided as
part of service in the outpatient clinics
and in the hospital wards. Later in the year,
having attained proficiency in working up
new patients, the student serves as a full-time
clinical clerk in various clinical depart-
ments and in their outpatient clinics. As an
apprenticing diagnostician, he or she is intro-
duced to a variety of specialties. The aim of
these experiences is not only to introduce
the student to possible areas of
specialization, but to teach the techniques of
detecting
all kinds of illness, regardless of
specialization. Generally, the student will spend one
quarter on medicine, another on surgery, a
third on obstetrics-gynecology and pediatrics,
and a fourth on electives.
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