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College of Medicine: Integrated Pathways Curriculum

  • Overview

    Students in class

    The primary goal of the College of Medicine is to graduate excellent physicians. Whether the student's ultimate goal is general or specialty practice, research, medical administration or academic medicine, the College provides a comprehensive educational experience for all students.

    The educational objectives of the curriculum are intended to provide students with the basics that they will need to embark upon graduate medical education in the field of their choice, and ultimately to become competent and compassionate physicians. To achieve these objectives, the College has set standards of knowledge and develops the skills and attitudes necessary to enable students to reach their goals.

    The Integrated Pathways Curriculum emphasizes learning across disciplines with an emphasis on understanding core principles. It is a competency-based curriculum designed to prepare our graduates to enter any field of medicine and will include attaining the knowledge, attitudes, and skills contained within the six Domains of Competence. These Domains of Competence, are modeled after the six competencies, which are followed by residency programs. Our curriculum will provide a form of continuity for our graduates into residency, and better prepare them for the next level in their careers.

    Integrated Pathways Curriculum

    Curricular Map

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    Four Year Curricular Map

    Curricular Map

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  • Goals of the Integrated Pathways Curriculum


    SUNY Downstate Medical School’s competencies state what skills, attitudes, and knowledge our graduates need to demonstrate to go on to residency training and to becoming independent physicians. This document:

    • Defines key terms associated with the competencies
    • Introduces the six domains of competence
    • Outlines the curricular goals associated with each domain of competence

    Key Terms and Definitions

    The Competencies are defined in five increasing levels of detail:

    Domains of Competence:

    These are six broadly defined groups of knowledge, skills, and attitudes required of all graduates at the end of 4 years as depicted in the following graphic. They are also referred to as the competencies.

    The Six Competencies

    Curricular Goals:

    Curricular goals are summary statements within each competency domain that represent the knowledge, skills and attitudes required of students at the end of the 4 year curriculum.

    Unit, Clerkship, and Rotation Goals:

    Unit, clerkship, and rotation goals are the measurable knowledge, skills, and observable behaviors that each student should be able to demonstrate as a result of successfully completing the curricular component.

    Learning Objectives:

    Learning objectives are what a student is required to know or do at the end of a learning activity. These are stated in terms of observable behaviors.


    Content is the term used for facts, pieces of a skill set, or other small pieces of data which are related to learning objectives.


    Benchmarks are used to evaluate progress in each of the competencies when determining promotion to the next portion of the curriculum. They are defined at four gateway points in the curriculum: end of first year, after the Foundations of Medicine portion, after Core Clerkship portion, and mid-way through the Advanced Clinical portion.

    Domain and Curricular Goals

    Each domain of competence is defined below. In addition, curricular goals associated with the domain of competencies are listed below the definition. Note that the domains are NOT presented in order of importance or priority. Each domain is equally as important as the other.

    1. Domain of Patient Care

    Graduates must be able to provide patient care that is compassionate, appropriate, and effective for the treatment of health problems and the promotion of health.

    1.1 Gather accurate complete and focused histories in a prioritized and organized fashion, appropriate to the clinical situation and the patient’s ability to communicate. (Medical History Taking)

    1.2 Conduct relevant, complete and focused physical examinations in patients of all age groups. (Physical Exam)

    1.3 Select and interpret common diagnostic and screening tests based on patient information and patient preferences, using evidence-based and cost-effective principles. (Clinical Testing)

    1.4 Demonstrate clinical reasoning in gathering focused information, formulating and prioritizing a differential diagnosis and integrating patient data to formulate an assessment. (Clinical Reasoning)

    1.5 Develop and carry out a management plan with preventive, therapeutic, and palliative interventions based on patient information and preferences, up-to-date scientific evidence, and clinical reasoning skills. (Management Plan)

    1.6 Formulate a prognosis and make shared decisions with patients. (Prognosis and Shared Decision Making)

    1.7 Assess the indications and necessity for medical and invasive procedures utilized in patient care. Perform general basic procedures of a physician. (Clinical Procedures)

    1.8 Document encounters and present patient information efficiently, accurately and concisely. (Clinical Information Management)

    2. Domain of Medical Knowledge

    Graduates must demonstrate knowledge of established and evolving biomedical, clinical, and cognate (e.g., epidemiological and social-behavioral) sciences and the application of this knowledge to patient care.

    2.1 Demonstrate an understanding of molecular, cellular, organ and system processes, fundamental biologic principles, and structure-function relationships in normal and disease states. (Biologic Structures, Processes, and Principles)

    2.2 Explain the underlying mechanisms and causes of disease and disability, and analyze how these processes contribute to clinical presentation. (Causes of Disease and Disability)

    2.3 Apply the principles of diagnosis to identify system-specific and cross-system diseases and disorders. (Principles of Diagnosis)

    2.4 Apply the principles of pharmacology and therapeutics in therapeutic decision-making and disease management. (Pharmacology, Therapeutics, and Decision Making)

    2.5 Demonstrate an integrated knowledge of the cognitive, social, and physical aspects of human development in assessing clinical presentation and in formulating treatment plans for patients at all stages of the life cycle. (Human Development and Lifespan)

    2.6 Assess the impact of genetic, nutritional, occupational, environmental, epidemiologic, and social-behavioral factors on health maintenance and wellness, and on disease prevention. (Health Maintenance)

    2.7 Explain how scientific investigation advances biomedical knowledge, assess the limits of current knowledge, and evaluate the impact of emerging data on disease diagnosis and therapy. (Scientific Investigation)

    3. Domain of Practice-Based Learning and Improvement

    Graduates must be able to investigate and evaluate their patient care practices, appraise and assimilate scientific evidence, and improve their patient care practices.

    3.1 Use patient care experience to continually improve ability to care for patients through ongoing self-directed learning and self-reflection. (Life-long Learning)

    3.2 Use information technology to manage information and access on-line medical information to support one's own education and provide the best care for patients. (Critical Appraisal and Informatics)

    3.3 Make informed decisions about diagnostic and therapeutic interventions based on best evidence; critically appraise the biomedical literature. (Evidence Based Medicine)

    4. Domain of Interpersonal and Communication Skills

    Graduates must be able to demonstrate interpersonal and communication skills that result in effective information exchange and teaming with patients, patients' families, and professional associates.

    4.1 Create and sustain a therapeutic and ethically sound relationship with patients of all ages. (Doctor-Patient Relationship)

    4.2 Communicate effectively and demonstrate caring and respectful behaviors when interacting with patients and their families. (Patient-Centered Communication)

    4.3 Use effective verbal communication with colleagues to exchange information for patient care. (Communicating with Colleagues)

    4.4 Work effectively with others as a member or leader of a health care team or other professional group. (Team Skills)

    5. Domain of Professionalism

    Graduates must demonstrate a commitment to carrying out professional responsibilities, adherence to ethical principles, and sensitivity to a diverse patient population. Graduates must also assess personal values and priorities in order to maintain an appropriate balance of personal and professional commitments.

    5.1 Demonstrate commitment to excellence in personal/professional development; respect, compassion, integrity and altruism; demonstrate accountability to patients, society, and the profession. (Professional Development)

    5.2 Demonstrate a commitment to ethical principles pertaining to all aspects of medical practice. (Medical Ethics)

    5.3 Demonstrate sensitivity and responsiveness to patients' culture, age, gender, socioeconomic status, education level, sexual orientation and disabilities, among other elements of diversity. (Cultural Competence)

    6. Domain of Systems-Based Practice

    Graduates must demonstrate an awareness of the relationship between themselves and the patient, community, and healthcare system as well as recognize the impact on optimizing patient care.

    6.1 Recognize the impact of financial, organizational, linguistic, and other social factors on the ability of patients to participate in their health care. (Patient Participation in Health Care)

    6.2 Explain the appropriate behaviors of a physician for the regulatory and financial environment of hospitals and other practice settings. (Health Care Delivery Systems)

    6.3 Incorporate fundamental principles of patient safety into clinical care across healthcare systems and settings of care. (Patient Safety)

    6.4 Describe the biological, social and environmental determinants of prevalent health conditions and health inequities locally and globally. (Determinants of Health)


    Both clinical medicine and foundational basic science will be taught over the entire four years in a three phased curriculum

    Foundations of Medicine 18 months
    Core Clinical Medicine (Clerkships) 12 months
    Advanced Clinical Medicine 14 months
  • Foundations of Medicine — 18 Months

    There are six major interdisciplinary units in the Foundations of Medicine that promote learning in all six competencies and integrate learning normal and abnormal structure and function. Students will begin practicing clinical skills from the beginning of the curriculum allowing them to develop their mastery of basic techniques over an 18-month period prior to entry into Core Clerkships.

    Foundations of Medicine: Year 1

    The Foundations of Medicine uses a multidisciplinary, systems-based approach to teach the normal structure and function of the body while introducing students to basic clinical skills and abnormal structure and function. The disciplines (i.e., Gross Anatomy, Biochemistry, etc.) are integrated and organized into Units based either on foundational concepts (Units 1–3) or on organ systems (Units 4–6).

    Each Unit incorporates multiple teaching modalities including lectures, case-based learning, team-based learning, Problem Oriented Patient Sessions (POPS), laboratories, and patient skill laboratories. Students are expected to take responsibility for ensuring that they obtain a conceptual understanding of subject matter in addition to knowledge of factual information. Weekly formative assessments, similar to those used at the end of unit summative assessments, will help students track their progress.

    Unit 1. Systems Overview & Musculoskeletal System

    The first Unit begins with an overview of major organ systems as well as principles of physiology and pharmacology. Students will begin learning and practicing clinical skills such as listening to heart and lung sounds, palpation of major organs, measuring pulse and respiration rates and examining the muscuolskeltal system. Students will also begin to learn the structure of the human body by examining prosections and then performing dissections intended to demonstrate the musculoskeletal systems and consequences of injury to these systems. This learning will be supplemented by the use of medical imaging such as radiographs and ultrasound.

    Unit 2. Molecules to Cells

    In Unit 2 students will develop an understanding of the biochemical, molecular and cellular biological and genetic basis for disease. During this Unit, students continue to practice and develop clinical skills introducing elements related to the diseases under study and begin to work with physician preceptors in ambulatory offices. Among topics to be covered in the medical knowledge portion will be the expression of genetic information, differences in structure and function of differentiated cells, protein and enzyme structure and function, energy generation by metabolism of basic foodstuffs and the role of nutrition in health and disease, early embryonic development, the cellular basis of neoplasia and the life cycle and function of red blood cells, as well as an introduction to immunology. Students will also study cancers of the lymphoid system, leukemias and lymphomas, and their treatment.

    Unit 3. Infection & Host Immunity

    Unit 3 introduces students to infectious diseases, the biology of the causative agents and the defense systems that protect against them both as defenders of the human body and as causes of disease when regulatory systems fail. Students will first extend their knowledge of immunology by studying white blood cells and their role in defense against pathogens. They will study the role of lymphocytes and antigen-presenting cells in humoral and cell-mediated immune responses along with understanding the body-wide distribution of lymphoid tissues and organs. To understand the anatomical distribution of defense mechanisms and the sensitivity of respiratory passages to infectious agents’ students will explore the anatomy of the head and neck and the susceptibility of these structures to infections by respiratory viruses. Diseases caused by disorders of the immune system such as allergies, inflammation, HIV infection, and auto-immunity will be examined in relation to specific diseases. The role the immune system plays in diseases of skin, muscles, bones and joints will also be a focus of this Unit. Concepts developed during this Unit will also be applied to further development of clinical skills.

    Unit 4. Gastrointestinal, Endocrine and Reproductive Systems

    Unit 4 is the first of three units focused on defined organ systems. Fundamental knowledge acquired in Units 1 to 3 will be applied to disorders and diseases that affect the gastrointestinal, endocrine and reproductive systems. Initially students will explore the structure of the gastrointestinal tract through anatomic dissection and the physiology and pathophysiology underlying its normal function and disorders that arise, as well as pharmacologic treatment of these disorders. Imaging techniques will help students relate the anatomy of the organs to their microscopic structure and the mechanisms underlying functionality. Inter-relationships between organs will be explored to understand digestion and uptake of nutrients and the role of nutrition in normal health or disease. In the endocrine section, normal function and diseases of the endocrine glands, including diabetes will be covered. Students will learn diagnostic techniques and treatments and imaging will be used to reinforce concepts. Later, students will examine the structure and function of male and female reproductive systems and the control mechanisms that regulate their functioning. In an integrated fashion student will become familiar with diseases and disorders that affect these systems including cancers and dysfunctions of the endocrine systems that regulate such organs. Disorders of the breast, and normal and abnormal pregnancy are also covered in this section. Students continue to practice taking histories, doing physical exams and applying the information they gather to making diagnoses.

    Foundations of Medicine Year 2

    Unit 5. Cardiovascular, Respiratory & Renal Systems

    After the summer, this Unit begins the second year of Foundations. Students will learn about the structure and function of the cardiovascular system and the effect of various diseases affecting it such as valvular disease and myocardial infarction, as well as pharmacologic treatment. Later, students will explore the functioning of the lungs and kidneys and their roles in maintaining homeostasis together with the consequences of diseases affecting these organs and their treatment. Since these organs act together to regulate normal conditions within the body, students will learn how their functions are integrated and what happens when this normal state is disrupted. Throughout the Unit students will apply their clinical skills and incorporate new information related to examination of the patient including EKG data interpretation and imaging techniques. In this unit, students begin to interview and examine patients in the hospital setting to refine their clinical skills and to practice the fundamentals of clinical reasoning.

    Unit 6. Brain, Mind & Behavior

    Unit 6 is the last component of the Foundations of Medicine and is focused on understanding the central nervous system as well as psychiatric disorders. Initially students will examine the gross and microscopic structures of the various regions of the human brain using prosections, imaging and virtual microscopy. These studies will be combined with recognizing the effects of tumors and infections on the brain. Students will then learn to apply concepts of central neural pathways to the neurological aspect of the physical examination together with the effect of disorders such as epilepsy and stroke and demyelinating diseases. Finally, students will explore how the brain determines aspects of human behavior and consciousness and the consequences of defects that lead to abnormal function and behavior (dementia, delirium, psychosis and anxiety or depression). Students continue to practice their clinical skills in order to prepare them for their Core Clinical, or clerkship year.

    Following the assessment week for Unit 6, students will have an interval to study for and pass the Step 1, United States Medical Licensing Exam (USMLE), one of the three exams required for licensure.

  • Clinical Medicine

    Core Clinical Medicine (Clerkships) — 12 months

    The Core Clinical Medicine year includes paired clerkships which serve to enhance interdisciplinary teaching and support integration of relevant basic science knowledge

    Advanced Clinical Medicine — 14 months

    The Advanced Clinical Medicine period requires students to take at least 4 weeks of a directed research experience, a Diagnostic Imaging rotation, a Critical Care rotation, an Emergency Medicine rotation, four weeks of Geriatrics and Palliative Care, and a Sub-Internship in either Medicine, Surgery or Pediatrics. Students will have approximately 4 months of elective time and a 4 month period that includes time for vacation, Step 2 studying, and residency interviews.

    Third and Fourth Year Curriculum

    The requirements for graduation are as follows:

    Core (3rd-year) Clerkships Number of Weeks in Rotation
    Transition to Clerkship 1
    Internal Medicine 8
    Surgery 8
    Anesthesiology 2
    Pediatrics 6
    Women's Health 6
    Psychiatry 6
    Neurology 4
    Primary Care/Family Medicine * 4

    * The Primary Care/Family Medicine clerkship extends one half-day per week, through the Medicine and  Surgery clerkships, to allow students a longitudinal ambulatory care experience.

    The third year includes 4 weeks of elective time that can also be used as flexible time or vacation as long as the total clinical time requirements are met by graduation. In the spring of the third year students are required to successfully pass a mandatory standardized patient experience, which is designed to be preparation for the Clinical Skills, United States Medical Licensing Exam (Step 2CS, USMLE).

    Advanced Year (4th-year) Rotations Number of Weeks in Rotation
    Emergency Medicine 4
    Geriatrics/Palliative Care 4
    Critical Care 2
    Subinternship (Medicine, Surgery or Pediatrics) 4
    Diagnostic Imaging 4
    Research Experience Project (REP) 4
    Clinical electives 16
    Total Clinical Requirement 85
    Number of “Unscheduled” Weeks 22

    In addition to the clinical requirements listed above, students are required to take the USMLE Step 2CK and USMLE Step 2CS examinations no later than October 31 of their fourth year and to pass them prior to graduation. 

    Clinical Affiliates

  • Learning Methods

    The new curriculum emphasizes methods that will prepare students for the type of learning they will need to engage in as physicians. Teaching methods have been selected which promote student centered, active learning and promote problem solving and clinical reasoning, rather than rote memorization.

    The curriculum supports active learning through a variety of learning methods described below that promote learning in groups and are linked to frequent feedback via formative assessments allowing both students and faculty members to monitor progress. These methods are chosen to promote learning at an application level with long-term retention.

    Watch an example video: Radiology Rotating Exhibit

    Students will continually receive feedback on their progress in the six competencies so that they and faculty members can ensure that they become the finest physicians possible

    Interactive Lecture

    Lectures are used to ensure conceptual understanding of difficult material, emphasize key concepts and principles and provide an organizational structure on which to build new learning. Lectures are meant to be interactive—that is, they will involve students in problem solving, demonstrations, or discussion.

    Laboratory-Based Exercises

    These exercises require students to learn directly from biological materials, such as dissecting cadavers. In addition to the acquisition of medical knowledge, students in laboratory-based exercises learn to work in teams and can practice communication skills by presenting results of their work to other students and to faculty.

    Virtual Microscopy Exercises

    These exercises require students to learn about the normal structure of human tissues and the pathologies affecting them using state of the art technology both in groups and by students on their own.

    Problem Based Learning

    Students work in groups of 9 or 10 with a facilitator, developing research questions based on a patient case. Cases might begin with students gathering case information from a standardized patient to practice patient interviewing skills. Students will derive research questions from the case by group discussion. After working on the research questions, groups will meet in the following sessions to present their findings. This mode lends itself to integrating learning of medical knowledge with clinical skills and mirrors the “discovery learning” skills needed by physicians for a lifetime of learning.

    Patient Oriented Problem Solving (POPS)

    Students work in teams of 4, discussing a set of 4 cases that relate to the topics they have been learning. One student is provided with the answers to questions regarding the cases, and student help each other in discovery learning. A subject expert Facilitator is available for clarification of difficult concepts.

    Facilitated Small Group Clinical Skills Training

    Students work in small groups with a faculty member to learn basic clinical skills. They will develop their command of these skills by practicing on each other, on patients in clinics or doctors’ offices or by working in the Simulation Center with standardized patient actors or teaching associates.

    Team Based Learning (TBL)

    Team based learning occurs throughout the curriculum, including both the Foundations and Clinical Years and is an example of a “flipped classroom” approach to education. Students are expected to familiarize themselves with topics assigned prior to the session. They are assigned to teams in class. The session begins with a pre-test, which is taken by the individual student, and then repeated by the team. The teams then address a problem or problems to solve regarding specific topics and asked to answer questions. All teams come together and discuss their rationale for answer choices and a subject matter expert is present to help facilitate the discussion of confusing concepts.

    Patient Care Centered Learning

    Students will work with patients during all four years but learning from patients is most intense in the Core and Advanced Clinical Medicine years. Students will learn medicine in the office and at the bedside during clerkships, other clinical rotations and electives. Standardized patients will be used during the Core Clinical Year to help students refine their clinical skills and to prepare them for the Step 2 Clinical Skills exam.


  • Assessment (Grading)

    Foundations of Medicine utilizes a Pass/Fail grading system. The Core Clinical Medicine and the Advanced Clinical Medicine utilizes a five (5) tier grading system (Honors, High Pass, Pass, Conditional, Fail).

    Formative assessments are designed to prepare students for summative assessments at the end of units or clerkships. The use of assessment methods other than multiple-choice tests includes essays, laboratory practicals, objective structured clinical examinations (OSCEs), and other methods.

    All six competencies are represented in the learning objectives and assessment outcomes for each unit and clerkship. Students are not allowed to progress to the next phase of the curriculum without satisfying the requirements for each competency.

  • Pathways 


    Click here to review the Policy on Academic pathways