participate in preparing the patient for
surgery, and, in the operating room, can expect to
serve as third or fourth surgical assistant.
They may be assigned to keep watch over the
patient in the recovery room and be responsible
for routine postoperative check-ups
until the patient is discharged. The aim of the
limited surgical experience for the senior
student is not to secure specialized training,
but to gain diagnostic experience so as to
have a balanced insight into the usefulness of
surgical intervention in the process of
healing the sick. The exposure in surgery will
be very broad, ranging from tonsillec-
tomies to cardiac surgery.
In the block of surgical time devoted to
orthopedics, the senior is exposed to the
diagnosis and treatment of diseases of the
joints and vertebral column, as well as frac-
tures and deformities of the bones of the body.
In urology some surgical and medical
experience is gained by coming into contact
with patients suffering from diseases of the
kidney, bladder, prostate gland, and
reproductive organs.
The quarter devoted to clinical clerkship in
medicine is rather similar to that in
surgery; naturally, the nature of the patient's
illness and the method of treatment differ.
Nevertheless, for the fourth-year student,
there are workups to be made, tests to be
ordered, and diagnoses to be reached. Several
times a week students and their supervi-
sors will go on rounds and students will
participate in the discussions about the patients'
conditions, treatments, and prognoses. During
the clerkship period, seniors will be on
call 24 hours a day and must be ready to assist
in emergencies and to comfort patients
through periods of stress. Naturally,
throughout this period, the house staff--the resi-
dents--will bear the direct responsibilities
for prescribing treatment and directing emer-
gency care. But senior medical students
nevertheless gain firsthand insight into the
responsibilities that must be assumed by them
during postgraduate training.
THE CURRICULUM IN TRANSITION
Since the mid-1960s, there has been increased
pressure from medical students to intro-
duce greater flexibility into their courses of
study. In response to this criticism, most
schools have established committees (sometimes
including students) to periodically
reevaluate and update their curricula. In many
schools, new curricula have been intro-
duced that have modified the traditional
program using one or more of several different
approaches:
1. Determination of a core curriculum. This
approach places the emphasis on prin-
ciples rather than only on facts.
2. Greater correlation between basic and
clinical sciences. In the first year, the stu-
dent is exposed to some clinical experience by
seeing patients having illnesses
related to the subject being
studied.
3. Greater emphasis placed on function than
structure. This approach is reflected by
a decrease in the amount of time allotted to
morphological studies (anatomy, for
example) and by an integration of material
presented by different departments.
4. Introduction of multiple-track systems. This
offers students who have com-
pleted the core curriculum, which is the
required common experience of all stu-
dents, to choose one of several pathways having
different emphases, depending
upon their ultimate career goals. Thus, there
is a differentiation of exposure
depending upon interest, need, and
ability.
5. Use of interdisciplinary and
interdepartmental courses. These frequently replace
departmental offerings, especially in the basic
sciences. The combined viewpoints
of several basic medical sciences are presented
in an integrated fashion as each
organ system is discussed, rather than being
taught in the classical manner at var-
ied times through separate courses. The organ
systems are muscular, skeletal, ner-
vous, cardiovascular, respiratory,
gastrointestinal, hematopoetic, genitourinary,
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