Curriculum

Educational Objectives and Competencies for Graduates

The USCSOM‐Greenville educational program objectives are categorized according to the six core competencies promulgated by the ACGME, incorporate all of the recommendations from the AAMC Medical School Objectives Project, and include additional objectives particularly relevant for USCSOM-Greenville graduates in support of its mission, vision, and goals.

At the time of graduation, it is expected that every graduate will have demonstrated competency in each of the program learning objectives listed below. Evidence of performance will be collected and documented throughout the educational program.

Medical Knowledge

• Demonstrate knowledge of the normal structure and function of the body and of each of its major organ systems across the life span.
• Demonstrate knowledge of the molecular, biochemical, and cellular mechanisms that are important in maintaining the body’s homeostasis.
• Demonstrate knowledge of the various causes (genetic, developmental, metabolic, toxic, microbiologic, autoimmune, neoplastic, degenerative, and traumatic) of maladies and the ways in which they affect the body (pathogenesis).
• Demonstrate knowledge of the altered structure and function (pathology and pathophysiology) of the body and its major organ systems that are seen in various diseases and conditions.
• Demonstrate understanding of the power of the scientific method in establishing the causation of disease and efficacy of traditional and non‐traditional therapies.
• Demonstrate understanding of the scientific basis and interpretation of common diagnostic modalities, including: imaging, electrodiagnostics, laboratory studies, pathologic studies, and functional assessment tests.
• Demonstrate understanding of the indications, contraindications, and cost‐effectiveness of common diagnostic studies.

Patient Care

• Demonstrate the ability to elicit accurate comprehensive and focused medical histories that cover all essential aspects of the history, including issues related to age, gender, sexuality, and socioeconomic status, and the use of a medical interpreter.
• Demonstrate the ability to perform both a complete and focused organ system examination, including a mental status examination.
• Demonstrate the ability to perform routine technical procedures.
• Demonstrate the ability to interpret the results of commonly used diagnostic procedures.
• Demonstrate the ability to identify the most frequent clinical, laboratory, imaging, and pathologic findings of common maladies.
• Demonstrate the ability to reason deductively in solving clinical problems and formulating accurate hypotheses, and use information from patient histories, physical exams, and ancillary studies to test initial hypotheses.
• Demonstrate the ability to formulate and implement appropriate management strategies (both diagnostic and therapeutic) for patients with common conditions, including a comprehensive, multi‐disciplinary approach when indicated.
• Use knowledge of managed care systems in making patient treatment plans and health care maintenance plans to assure care coordination across the continuum.
• Demonstrate the ability to recognize patients with immediately life‐threatening cardiac, pulmonary, or neurological conditions regardless of etiology, and to institute appropriate initial therapy.
• Demonstrate the ability to recognize and outline an initial course of management for patients with serious conditions requiring critical care.

Systems‐Based Practice

• Demonstrate knowledge of the important non‐biological determinants of poor health and of the economic, psychological, social, religious, historical, and cultural factors that contribute to the development and/or continuation of maladies.
• Demonstrate knowledge of the epidemiology of common maladies within a defined population, and the systematic approaches useful in reducing the incidence and prevalence of those maladies.
• Demonstrate knowledge of the unique health care needs of ethnically diverse populations and communities.
• Demonstrate understanding of basic issues for promoting health and preventing disease, and apply this understanding to patient management and teaching patients the importance of preventative medicine, health promotion, and wellness.
• Demonstrate a commitment to provide care to patients who are unable to pay, and to advocate access to health care for members of traditionally underserved populations.
• Demonstrate knowledge of various approaches to the organization, financing, and delivery of health care and knowledge of the global health care delivery system in the community, including physicians, hospitals, outpatient centers, home health agencies, community agencies, and government agencies in that system.
• Demonstrate an understanding of the threats to medical professionalism posed by the conflicts of interest inherent in various financial, governmental, and organizational arrangements for the practice of medicine.
• Demonstrate the ability to apply principles of quality improvement to a medical system.
• Demonstrate the ability to evaluate and analyze actual or potential adverse events in a systematic fashion, especially to promote, measure, benchmark, and optimize patient safety and quality outcomes.

Practice‐Based Learning and Improvement

• Demonstrate the ability to retrieve (from electronic databases and other resources), manage, and utilize biomedical information for solving problems and making decisions that are relevant to the care of individuals and populations.
• Demonstrate an understanding of evidence‐based medicine with respect to formulating patient-based questions, efficiently searching literature databases, appraisal of quality of studies, applying the results of a literature search, and use of information about their own population of patients to direct patient care and assess comparative effectiveness of interventions.
• Demonstrate an understanding of the principles and method of Practice‐Based Learning and Improvement that involves investigation and evaluation of one’s own patient care, appraisal and assimilation of scientific evidence, and improvements in the continuum of patient care.
• Demonstrate an understanding of the need and commitment to engage in lifelong learning to stay abreast of relevant scientific advances, especially in the disciplines of genetic and molecular biology.

Professionalism

• Demonstrate knowledge of the theories and principles that govern ethical decision making, and of the major ethical dilemmas in medicine.
• Provide compassionate treatment to patients and respect for their privacy, dignity, and personal beliefs.
• Demonstrate honesty and integrity in all interactions with patients and their families, colleagues, and others with whom physicians must interact in their professional lives.
• Advocate at all times the interests of one’s patients over one’s own interests.
• Demonstrate an understanding of, and respect for, the roles of other health care professionals, and of the need to collaborate with others in caring for individual patients and in promoting the health of defined socioeconomic, ethnic, and at‐risk populations.
• Demonstrate the capacity to recognize and accept limitations in one’s knowledge and clinical skills and commit to continuously improve one’s abilities through life‐long learning, selfevaluation, acceptance of constructive feedback, moral reflection, and ethical reasoning.
•  Demonstrate commitment to a self‐directed, lifelong engagement in the responsible, compassionate, and ethical practice of medicine.

Interpersonal and Communication Skills

• Demonstrate the ability to convey presence, build rapport, and employ active listening to communicate compassionately, effectively, and in culturally and emotionally appropriate ways, both verbally and in writing, with patients, their families, colleagues and others with whom physicians must exchange information in carrying out their responsibilities.
• Demonstrate the ability to compassionately and effectively listen to, and communicate with, patients and their families to establish caring relationships that are emotionally and culturally appropriate.
• Demonstrate the ability to responsibly and respectfully work with all members of the health care team, with a goal to establish supportive relationships that show honor to fellow colleagues.

Curriculum

The educational program at the University of South Carolina School of Medicine‐Greenville integrates the basic and clinical sciences with a graduated increase in clinical skills and responsibilities across the four years of the curriculum. The curriculum is designed to provide students with a solid understanding of the biomedical, psychosocial, and professional foundations for the practice of medicine that will prepare them to continue on the path of life‐long learning and practice as integral members of the health care delivery team. Thus, the educational program at the USCSOM‐Greenville lays the foundation for advancement across the continuum from undergraduate medical education to graduate residency training

The curricular design begins with an introduction to core clinical skills in Basic EMT training. Through this training, students will begin their career in medical education as a vital, active member of a health care team. EMTs work in an environment requiring skills in communication, focused patient assessment, documentation, and patient safety. Their role necessitates an understanding and ability to function as a member of a larger health care team; an essential quality for successful physicians. This early clinical training serves as a practical approach for students to actively contribute to patient care. Throughout the program, students will be required to keep patient logs and reflect on their experiences within the framework of the objectives of the Medicine and Society modules, which will expand their knowledge and skills in patient care towards competency as physicians. Furthermore, the early and ongoing experience as EMTs will provide students the exposure and awareness of the many challenges and issues facing health care delivery, and serve as an experiential basis for proposing a comparative effectiveness research project to be completed by graduation.

Following the initial phase of Basic EMT training, students will begin their foundational studies of the scientific basis of medicine, which is also perceived as a graduated learning experience. In the M1 year, students will primarily focus on the normal human body, beginning with an understanding of the biochemical, molecular, and cellular basis of the human body, advancing to how cells communicate and form tissues; tissues develop into systems; function of the systems is dependent on defined structural organization; and ultimately to how the body responds and defends against disease. Clinical scenarios will punctuate and emphasize how alterations of normal processes lead to illness and disease. Concurrent with the increasing basic science knowledge, students will proceed through the continuum of clinical skills in a fully integrated approach. For example, as they learn about genetics and the inherited basis of disease in the Foundations module, in the Medicine and Society module they will learn to take a genetic history, develop a genetic pedigree, predict risk for a patient, and deliver this difficult news. While learning about cardiac physiology and anatomy in the Structure and Function module, in the Medicine and Society module they will practice the cardiac exam, listen to abnormal heart sounds, and take and read EKGs in the Clinical Skills and Simulation Center. Students will then apply and practice these skills with real patients in supervised, defined clinical sessions within the Greenville Hospital System, with a specific half‐day, for example, devoted to taking and reading patient EKGs, or listening to and identifying abnormal heart sounds.

During the M2 year, students will continue learning the scientific basis of medicine in an organ‐system based approach, focused more on pathophysiological and pathological disease processes, diagnostic testing, and fundamentals of treatment. Again, concurrent with the increasing fund of knowledge, students will increase their repertoire of clinical skills in the Medicine and Society module by performing focused history and physical exams, developing differential diagnoses, and proposing treatment and management plans. Progression of learning and practice of these skills from the Clinical Skills and Simulation Center, to directed, applied, supervised experiences with real patients will continue throughout the second year. Embedded in this progress of clinical skills is the understanding and utilization of the tools and systems of medical practice, including electronic health records and writing SOAP notes.

Through this graduated continuum of integrated knowledge and skills, students enter the clerkship years prepared to perform as active members of the health care delivery team, while continuing on their path of medical education. The M3/M4 years will continue to develop their clinical skills, reinforce the biomedical science foundations of medicine, and emphasize their roles as team members in the delivery of health care, and provide students a breadth of clinical experiences that will enable them to make informed career choices.

Electives

First-year students may take noncredit elective courses that provide supplemental educational experiences in areas of special interest. Electives must be approved by the Associate Dean for Education and the Associate Dean for Student Affairs.

Second year students may take elective courses for credit at the end of their M2 year. Electives must be approved by the Associate Dean for Education and the Associate Dean for Student Affairs. The list of second year electives is currently under development and is intended to provide students early opportunities to explore career options available through the national residency match program that are not typically offered until later in an academic program.

Electives for third and fourth-year students are currently under development and discussion for the University of South Carolina School of Medicine Greenville, and will be listed in an elective catalog as they are approved. National and international elective programs are also available and encouraged. For more information on third and fourth year electives, please contact the Office of Student Affairs.

Module/Clerkship Titles, (Credit Hours), Numbers, and Course Directors

M-1

M-2

Clerkship Responsibilities

USCSOM‐Greenville has developed the requirements for completing each required clerkship with corresponding levels of student responsibility. The requirements are delineated in the Student Handbook and students are required to log their clinical experiences in their student portfolios.

Guidelines for Conduct in Teacher/Learner Relationships

I. Statement of Philosophy

The University of South Carolina School of Medicine‐Greenville is committed to fostering an environment that promotes academic and professional success in learners and teachers at all levels. The achievement of such success is dependent on an environment free of behaviors which can undermine the important mission of our institution. An atmosphere of mutual respect, collegiality, fairness, and trust is essential. Although both teachers and learners bear significant responsibility in creating and maintaining this atmosphere, teachers also bear particular responsibility with respect to their evaluative roles relative to student work and with respect to modeling appropriate professional behaviors. Teachers must be ever mindful of this responsibility in their interactions with their colleagues, their patients, and those whose education has been entrusted to them.

II. Responsibilities in the Teacher/Learner Relationship

1. Responsibilities of Teachers

• Treat all learners with respect and fairness
• Treat all learners equally regardless of age, gender, race, ethnicity, national origin, religion, disability, or sexual orientation.
• Provide current material in an effective format for learning.
• Be on time for didactic, investigational, and clinical encounters.
• Provide timely feedback with constructive suggestions and opportunities for improvement/remediation when needed.

2. Responsibilities of learners

• Treat all fellow learners and teachers with respect and fairness.
• Treat all fellow learners and teachers equally regardless of age, gender, race, ethnicity, national origin, religion, disability, or sexual orientation.
• Commit the time and energy to your studies necessary to achieve the goals and objectives of each course.
• Be on time for didactic, investigational, and clinical encounters.
• Communicate concerns/suggestions about the curriculum, didactic methods, teachers, or the learning environment in a respectful, professional manner.

III. Behaviors Inappropriate to the Teacher‐Learner Relationship

Inappropriate and unacceptable behaviors are those which demonstrate disrespect for others or lack of professionalism in interpersonal conduct. Although there is inevitably a subjective element in the witnessing or experiencing of such behaviors, certain actions are clearly inappropriate and will not be tolerated by the institution. These include, but are not limited to, the following:

• unwanted physical contact (e.g. hitting, slapping, kicking, pushing) or the threat of the same;
• sexual harassment (including romantic relationships between teachers and learners in which the teacher has authority over the learner’s academic progress) or
• harassment based on age, gender, race, ethnicity, national origin, religion, disability, or sexual orientation;
• loss of personal civility including shouting, personal attacks or insults, displays of temper (such as throwing objects), use of culturally insensitive language;
• discrimination of any form including in teaching and assessment based upon age, gender, race, ethnicity, national origin, religion, disability, or sexual orientation;
• requests for another to perform inappropriate personal errands unrelated to the didactic, investigational, or clinical situation at hand;
• grading/evaluation on factors unrelated to performance, effort, or level of achievement.

IV. Avenues for Addressing Inappropriate Behavior in the Teacher/Learner Context

1. Learners’ Concerns
   Learners may address situations in which they feel that they have been the object of inappropriate behavior at various levels. At the most basic level, the most effective way to handle a situation may be to address it immediately and non‐confrontationally. Oftentimes, a person is simply unaware that his/her behavior has offended someone, or even if aware, will correct the behavior appropriately if given the opportunity to do so in a way that is not threatening. The way to raise such an issue is to describe the behavior factually (“When you said…”) describe how the behavior made you feel (“I felt…”), and state that the behavior needs to stop or not be repeated (“Please, don’t do that again.”)
   
   Sometimes, such a request is not successful, or the person repeats the behavior, or the learner does not feel comfortable speaking directly to the teacher about his/her behavior. In those cases, it may be helpful to discuss the behavior with module/clerkship directors, laboratory mentors, program directors or department chairs. Students may also elect to speak to any one of the Assistant Deans or the Associate Deans in the Office of Educational Affairs and/or the Office of Student Affairs, the Assistant Dean for Diversity, the Director of Student Services, or one of the School of Medicine’s Ombudspersons for informal advice and counsel about these issues. These individuals may offer additional suggestions for resolving the matter informally, such as, for example, speaking to the individual on the learner’s behalf or on behalf of an entire class, raising the general issue in a faculty meeting, assisting the learner with writing to the individual teacher or even direct intervention to get the behavior to stop.
   
   If no satisfactory resolution is reached after these discussions or the learner does not feel comfortable speaking to these individuals, he/she may bring the matter formally to the attention of the School of Medicine administration. The avenues for this more formal reporting vary depending upon the status of the reporting individual. In either case the learner always has the option of submitting a formal complaint to the University’s Student Grievance Committee through the procedure outlined in the Carolina Community.
2. Teachers’ Concerns
   If a teacher feels that a learner has engaged in inappropriate behavior, it is likewise most effective to address the situation immediately and non‐confrontationally. The teacher may choose to document the situation with an Early Warning card. If the matter is not resolved satisfactorily, the teacher should contact the course/clerkship director, program director, or laboratory mentor to discuss the matter. If the teacher wishes to make a formal allegation of misconduct, they should contact the following members of the administration:
   
   If the matter involves a medical student, contact one of the Assistant or Associate Deans in the Offices of Educational Affairs or Student Affairs;
   
   These allegations will be handled on an individual basis by the appropriate School of Medicine official in consultation with the Dean and where applicable according to established School of Medicine and University policies.

V. Procedures for Handling Allegations of Inappropriate Behavior in the Teacher/Learner Context

1. Upon being notified of alleged inappropriate behavior, the Associate/Assistant Dean or Program Director will notify the Dean and other appropriate senior administration officials in a written report within 5 business days of the allegation. If the complaint is lodged against a faculty member, other than those matters referred to the Office of Equal Opportunity Programs, the matter will be handled by the Dean in consultation with the appropriate Associate Dean and Department Chair and, where established, the appropriate School of Medicine and University policies. The Dean may also choose to appoint an ad hoc committee to investigate the complaint.
2. If the behavior involves unlawful discrimination or sexual or other forms of unlawful harassment, the matter will be referred to the Office of Equal Opportunity Programs and be handled through University policies established for that office. The student may also directly contact that office.
3. If the behavior involves unwanted physical contact or other forms of violent or threatening acts, the matter may be referred to the campus security personnel.
4. The School of Medicine is committed to the fair treatment of all individuals involved in this process. All efforts will be made to maintain the confidentiality of the resolution process to the extent possible and subject to the overriding concern of a prompt fair investigation and/or resolution of the complaint.
5. The School of Medicine will not tolerate any form of retaliatory behavior toward learners who make allegations in good faith. Individuals who believe that action has been taken against them in retaliation for raising concerns under this policy, may address those concerns through the procedures described in this policy or through the University Student Grievance Committee.
6. Records of all communications as well as written reports of the Associate/Assistant Deans, Program Directors, and any ad hoc committee (if formed) will be kept in the Dean’s Office.
7. If it is determined that the allegations from the complainant were not made in good faith, the student will be referred to the Student Evaluation and Promotion Committee for any recommended action.