'Dr. Simon suggested that the number of hours should be 120 to 150. Dr. Orloff felt that the figures were far too low and should be between 300 and 350. Dr. Livingston asked whether clinical lab experience was in ICM and Dr. Orloff said that it was. Dr. Simon disagreed and said that lab diagnosis was handled elsewhere. Dr. Braunwald said that he didn't see how a student could be accepted into the third year without knowing how to do a sed rate or a blood count. Dr. Liebow pointed out that the students would not be doing blood counts on patients...'

And so it went, as twenty-five physician-educators, each one with unique and definite ideas on the best way to mold a competent physician, grappled with the learning gestalt known as curriculum.

No easy task, for these physicians had taken as their basic premise that the new school would serve as a forum for fresh ideas and techniques in medical education. They began with the most basic questions: How long should it take? Four years, three years, or ten? How about a thesis; does it whet critical inquiry, or is it meaningless tedium to the student who itches only to transplant a heart? Will electives create Renaissance doctors, or merely entangle the pursuit of medicine? Should summers be open for independent scientific endeavor, or will a student bound for June study at the Sorbonne cheat - be discovered swooping down the slopes of the Matterhorn? And what about grades: A through F, or Pass/Fail?

Dean Clifford Grobstein knew what they were all in for, and in his charge to the participants he pleaded with them not to "get hung up on details, intriguing or emotion-generating though they be... Curriculum is merely the faculty's way of organizing its efforts to maximize the effectiveness of its interaction with students..."

As for a "complete syllabus of what every medical student should grasp," Dr. Grobstein knew better. That was not agreed upon twenty-five years ago in the desert, it has not been agreed upon since, and it will doubtless receive no pure consensus in the future. And although the faculty-chosen Committee on Educational Policy (CEP) and its two subcommittees, the Core Curriculum Committee (CCC) and the Electives Committee (EC), reach conclusions (because they have to), the dialogue between status quo and change is sustained - as befits 400 chiefs schooled in the best Socratic traditions.

But the unavoidable fact that the subjects in the core curriculum you will encounter during your time here - which represents the minimum that every medical student must learn - have changed little testifies to the committees' essential nature. They are conservators, and will alter the core only after exhaustive study, debate, study, and then more debate. Insertion of new core necessarily means the death of other elements, a pronouncement made only after the sincerest scrutiny.

 Curriculum: The Never Ending Dialogue

The Core

For strip course, think strip-farming, a method of cultivation which sows knowledge over a given span of space and time, and which reaps its educational bounty little by little. The strip courses are ongoing inquiries that build through the semesters, along with the student's insight.

Follow us, then, through the towns and fields of a country called Core.
 

Cell Biology and Biochemistry

CBB is the first block course you will see, and it is the first building block in your professional career. It epitomizes the wisdom that a firm grounding in biological and biochemical mechanisms is crucial to the truly competent physician. The "readings" portion of CBB puts a small number of students together with a distinguished faculty member/biochemist for a dynamic exchange on the material just studied. If you have never experienced an undergraduate biochemical laboratory, you are strongly urged to enroll in the elective laboratory portion. From 1968 to the present, CBB has immersed the student in molecular and cellular principles, traversing the intact organism, down through the cell to the molecule, then back out again. Then you will look at the clinical correlates of these biologies.
 

Social and Behavioral Sciences

What do you say to patients who are ill or injured, highly suggestion-prone, overly helpful, ambiguous, and paranoid? How can you best ease the fright of these patients who have brought their suffering to you along with a variety of expectations, myths, stereotypes, and - perhaps most importantly - untapped emotions? During your first quarter at UCSD, you will begin to answer these questions through participation in exercises and small group discussions in the Doctor/Patient Relationship course, the first of four parts of the strip SBS sequence. SBS is a course which looks at the patient as a person, with all that implies, but also as a unique "biopsychosocial matrix," with a history and a future.

SBS will, in its many modes of delivery, stress (1) that the most fluid and evanescent of intangibles - the doctor/patient relationship - to a large extent shapes the patient's suffering and its amelioration; (2) that illness is disharmony at any of three levels - biological, psychological, or social - which in turn disrupts the other two levels; (3) that developmental stages are a good way to look at the changing dynamics in a patient, be it childhood, adolescence, or aging; and (4) that the milieu in which the 'healing arrangement' takes place - the myths and symbols of the culture, the way money is organized and distributed, how the society views its deviant members, death, and sex - incorporates interested parties who refuse to stay out in the waiting room. They must be examined, and accounted for.
 

Introduction to Clinical Medicine

This is a five-quarter course beginning in January of Year I. By the end of the first year, students will have learned to recognize symptoms and signs of disease and will have mastered a basic screening physical examination. Year II emphasizes basic skills of physicianship, including history taking, physical examination, complete patient write-ups, and oral case presentations.

ICM provides a living lab for students to nurture the art of interviewing and diagnosing common disease syndromes in closely supervised bedside work, demonstrations, lectures and conferences.
 

Organ Physiology

This is a demanding course because the subject matter is completely new to most medical students. The course deals in turn with the lung, heart, kidney, and gastrointestinal systems and runs parallel with the pharmacology course. Students can get considerable help from the new edition of the physiology textbook that is largely written by faculty teaching the organ physiology course. In addition, Dr. Nora Laiken, who is in charge of tutoring, is ready with supplementary notes and a helping hand for those who need further clarification.

Principles of Pharmacology

Endocrinology-Reproduction-Metabolism

The touchstone of this course is the multi-faceted endocrine system and the hormones by which it regulates growth, sexual development, reproduction, reactions to stress, and many key metabolic processes. Metabolic disorders and poor diet patterns account for a great deal of disease in the U.S. This course covers obesity, diabetes mellitus, and hypercholesterolemia among the more prevalent such diseases. In addition to reproductive endocrinology, the course deals with basic physiology of reproduction, including conception, contraception, aspects of sexuality, and the physiology of pregnancy.
 

Basic Neurology

The brain is the center for our thinking and feeling. This course looks at everything from the fine structure of individual neurons to the complex anatomy and physiology of the human nervous system. Throughout the course, there is an ongoing consideration of the brain's higher functions (emotions, behavior) and of the disorders that interfere with the nervous system's normal performance (clinical neurology). To provide instruction of this scope, the course is managed by both basic and clinical neuroscientists.
 

Human Anatomy

Anatomy at UCSD's School of Medicine differs in several ways from the course of the same name traditionally found in America's med schools. First, it comes after students have already learned about bodily functions, after OP. Therefore, it can be taught as functional, practical anatomy, not only morphology. It is taught by a team of anatomists, surgeons, and radiologists in a setting that gives heightened emphasis to radiology. "It's important to use all the modern imaging methods to get a feeling for how the organs and tissues show up in those media, and to learn their relationships," says an involved faculty member.

Anatomy is also one of the most popular of all courses here, perhaps because of the close personal contact between instructors and students in the small group seminars and the laboratory.
 

Histology

Taught in conjunction with anatomy, this course is designed to teach the structural basis of normal and abnormal function at cellular and tissue levels. Emphasis is placed on microscopic study conducted in small laboratory groups under close faculty supervision.
 

Epidemiology/Biostatistics

This course describes uses and limitations of biostatistical techniques and of epidemiology and population versus patient data. It includes terminology, study design and analysis, measures of risk, causality, screening, and current knowledge about the epidemiology of selected diseases/conditions and medical interventions. Case studies are used to emphasize understanding of the principles behind statistical tests and understanding statistical jargon used in the medical literature.

Human Disease

This course provides the transition from the basic science curriculum to the clinical setting. It is designed to teach the principles of human disease and constitutes an integration of such separate subjects as pathology, pathophysiology, microbiology, and medical therapeutics.

The beginning phase of the course focuses on the general principles of human disease, and subsequently, the course covers diseases of organ systems.

Pathology and pathophysiology deal with causes, mechanisms, structure, and dynamics of diseases. Medical therapeutics addresses principles and some specifics of pharmacologic interventions that are helpful in altering the disease process. Microbiology, which rests on the assumption that living agents of disease are best studied in relation to reactions of the host, is closely coordinated with the same organ system approach.
 

Hematology

This course, taught in the second year fall quarter mini-block, consists primarily of small group discussions and laboratories centered around clinical cases. You will cover the physiology and pathophysiology of blood cells and blood cell-forming organs.
 

Laboratory Medicine

Electives

Many medical schools do not provide students the opportunity to choose any part of their curriculum in the first two years, but this is definitely not the case at UCSD. Time for electives has been an integral part of the schedule since the school was founded. Throughout the pre-clinical curriculum, two afternoons each week are completely free and may be used for elective courses. The elective curriculum is as unstructured as the core curriculum is structured; myriad opportunities exist to explore areas ranging from the most basic to the cutting edge of science and technology. Clinical preceptorships* are plentiful and popular elective choices. Many students participate in elective community outreach efforts such as DOC (Doctors Ought to Care), teaching middle and high school students about AIDS, alcohol and drugs, or, the UCSD student run free clinic. Others use their elective experiences to learn to speak Spanish or to learn to take a medical history in Mandarin Chinese. There are electives about the politics of medicine, alternative medicine, and the history of medicine. A course in anatomic drawing might also be appealing, but if none of the formal offerings pique students' interest, students may approach any faculty member and design a reading or laboratory course. UCSD students appreciate the freedom and breadth of the elective curriculum, and participation in these courses has led to many memorable experiences.
 

For a description of the Independent Study Project, which technically also is part of the elective curriculum, please see the Independent Study Page.
 

*In which students work with practicing physicians in specialties like family medicine, pediatrics, internal medicine, otolaryngology and cardiothoracic surgery.