Medical school

A school with a curriculum leading to a medical degree. The mission of every medical school includes medical teaching, research, and patient care. All medical schools share the goal of preparing students in the art and science of medicine, and providing them with the background necessary to enter the period of graduate medical education. The years of medical school preceding graduate medical education are typically divided into a preclinical phase and a clinical phase.

Although medical students have clinical experiences throughout medical school, the first two years are often called the “preclinical” phase. The preclinical phase typically occupies the first two years after matriculation. The normal structure and function of human systems are taught through gross and microscopic anatomy, biochemistry, physiology, behavioral science, and neuroscience. The educational focus then shifts to abnormalities of the body’s structure and function, disease, and general therapeutic principles through courses in microbiology, immunology, pharmacology, and pathology.

Throughout the first two years, the clinical significance of basic science material is stressed. The preclinical phase always includes a course introducing students to the concepts of physical examination and interviewing. Students often interview “standardized patients” (people with actual physical findings or people trained to simulate particular cases or findings) in their introduction to clinical medicine courses.

Lectures now account for less than half of the scheduled contact time at the majority of medical schools. Small-group discussion, self-instruction, laboratories, case studies and other educational experiences make up the remainder of the scheduled time. The use of computer technology and computer-assisted instruction in the preclinical phase of medical student education have also introduced new approaches to the delivery and acquisition of the sciences basic to medicine.

Most schools include small-group tutorial/discussion sessions organized around patient cases that emphasize problem solving. This approach requires students to take responsibility for obtaining information themselves and encourages students to become active learners. It also prepares them for continuous learning throughout their professional lives.

The clinical phase of the curriculum usually occurs during the last two years of medical school and is devoted to education in the clinical setting. The periods of instruction are called clerkships, and may range in length from approximately 4 to 12 weeks. During clerkships, students work with patients and their families in inpatient and outpatient settings.

Required “core” clerkships in all schools include internal medicine, pediatrics, psychiatry, surgery, obstetrics/gynecology, and family medicine. Depending on the school, required clerkships can also include family medicine, primary care, neurology, and community or rural medicine.

While in a hospital setting or a hospital clinic, students work under the supervision of physician faculty members (known as “attending physicians”) and residents, and work with other members of the health care team. Students frequently do “preceptorships” –that is, they are assigned to community physicians’ offices to gain first hand knowledge about how a practice of medicine functions.

Whether in a hospital or community setting, students are responsible for “working-up” a number of patient cases during the clerkship, by collecting relevant data and information from patients, and presenting the data to fellow students, attending physicians, faculty members and residents. Students are assigned to a medical team, and participate in the ongoing clinical care of patients, and they gain skills in clinical decision-making and patient management.

Ideally, students follow their patients over time, either during hospitalizations, in their preceptorships, or through the course of outpatient treatment. Standardized patients (SPs) are used during the clinical years to supplement the kinds of diseases and conditions the students observe. SPs are also used for assessment of student knowledge, attitudes and skills. Other teaching methods in the clinical phase include “rounds” (discussion of inpatient cases), bedside teaching, case-based lectures and small group discussions.

All accredited medical schools in the US and Canada are represented by the American Association of Medical Colleges (AAMC). Further information about medical school in the US and Canada may be obtained from the AAMC.