The M.D. Curriculum

From the first term at the Yale University School of Medicine, lectures are held to a minimum, and much basic science instruction occurs in small groups like Emile Boulpaep’s seminar on cell biology and physiology. Yale’s small size–about 100 M.D. students per class year–and long tradition of thoughtful pedagogy allow the school to engage every student in the process of becoming a life-long learner rather than a memorizer of facts.

Yale’s curriculum begins with two years of basic science–normal biology and pathology– coupled with clinical tutorials. The last two years are primarily devoted to clinical clerkship rotations and work on the thesis. (The first two years are easier to outline than the second two, when the program becomes more individualized and thus more varied.) Students must demonstrate proficiency in all required courses before they begin clinical rotations.

First Year. The first-year curriculum emphasizes normal biological form and function and has been designed to coordinate information from various disciplines. Anatomy is taught throughout the year and aligns its dissections and lectures with other courses. Courses include Principles of Clinical Reasoning, Cell Biology and Physiology, Biochemistry, Genetics, and the Biological Basis of Behavior. Throughout the first two years, courses grouped under the rubric of the Medicine, Society, and Public Health series introduce the history of medicine, professional responsibility, health policy and financing, and biostatistics. The Doctor-Patient Encounter, a two-year preparation in such basic clinical skills as taking a patient history and physical examination, provides weekly opportunities for students to see patients and meet in small groups with a clinical tutor.

Second Year. The second-year curriculum concentrates on disease. The year begins with a course called Mechanisms of Disease: Basic Principles, which integrates material in pathology, immunobiology, microbiology, and pharmacology. The course is taught as an in-depth investigation of a disease from all relevant basic science and clinical perspectives. Mechanisms of Disease: Systems/Organs begins eight weeks into the term and continues for the rest of the year. Content traditionally taught in separate medical disciplines is integrated into units such as Blood/Hematology, Neoplasms/Oncology, Lungs/Respiratory System, Clinical Neuroscience, and Psychiatry. The Medicine, Society and Public Health Series continues with the course Epidemiology and Public Health.

Third Year. All students are required to sit for Step 1 of the U.S. Medical Licensing Examination for the first time by the end of December of the third year. In addition to working on their thesis, students generally complete most of the required clinical rotations: Internal Medicine, Ambulatory Medicine, Surgery, Pediatrics, Clinical Neuroscience, Obstetrics and Gynecology, and Psychiatry.

Fourth Year. At the end of the third year, a faculty tutor works with each student to develop an individual educational plan for the fourth year. The required Primary Care Clerkship is generally completed during the fourth year in an outpatient or office setting. Many students also take a number of clinical electives, including a subinternship in a clinical discipline, and students complete the residency application process and their thesis. In the spring, students come together for one final, required, three-week course entitled Integrative Clinical Medicine: The Biological, Social, and Behavioral Bases of Clinical Medicine. An intellectual capstone, this course provides an opportunity for graduating students to integrate basic science knowledge with social and behavioral sciences. Each week of the course is devoted to a clinical case study, employing small groups and large formats, independent research, and group decision-making.

Fifth Year. Yale M.D. students can take advantage of Yale’s optional, tuition-free fifth year of medical school for extended research on their thesis topic, clinical work in far-flung venues, or exploration of areas outside the field they have chosen for specialization. The “fifth year” is generally taken before the fourth year; the School of Medicine encourages most students to end studies toward their M.D. with the fourth-year program.

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