Columbia University (College of Physicians and Surgeons)

The College of Physicians and Surgeons is guided by the principle that medical education is university education. The acquisition of knowledge and skills is important in professional education, but far more vital is a profound understanding of the science, the art, and the ethic within which both knowledge and skill are applied. As a part of Columbia University, the College builds its curriculum, selects its officers of instruction, and marshals its enormous resources of equipment and clinical experience to develop in the student this understanding of medicine. Within the curriculum for the M.D. degree is the fundamental knowledge from which the natural bent is discovered toward general or special practice, research, teaching, or administration. The postgraduate programs of the College provide training in the specialties, help the graduate physician to keep abreast of new knowledge and support the research from which the physician's knowledge develops.

Columbia University began as King's College, which was founded in 1754 by royal grant of George II of England "for the instruction of youth in the Learned Languages, and the Liberal Arts and Sciences". The American Revolution interrupted its program, but in 1784 it was reopened as Columbia College. In 1912 the title was changed to Columbia University in the City of New York.

King's College organized a medical faculty in 1767, and was the first institution in the North American Colonies to confer the degree of Doctor of Medicine. The first graduates in medicine from the College were Robert Tucker and Samuel Kissarn, who received the degree of Bachelor of Medicine in May 1769, and that of Doctor of Medicine in May 1770 and May 1771, respectively. Instruction in medicine was given until interrupted by the Revolution and the occupation of New York by the British, which lasted until November 25, 1783. In 1784 instruction was resumed in the academic departments, and in December of the same year the medical faculty was reestablished. In 1814 the medical faculty of Columbia College was merged with the College of Physicians and Surgeons, which had obtained an independent charter in 1807. In 1860,by agreement between the Trustees of the two institutions, the College of Physicians and Surgeons became the Medical Department of Columbia College, from that time on the diplomas of the graduates were signed by the President of Columbia College as well as by the President of the College of Physicians and Surgeons. The connection was only a nominal one, however, until 1891, when the college was incorporated as an integral part of the University. Since September 1917, women have been admitted to the College on the same basis as men.

Institutes and Centers: Center for Geriatrics and Gerontology; Center for Molecular Recognition; Center for Neurobiology; Center for Psychoanalytic Training and Research; Center for Radiological Research; Center for NMR Spectroscopy; Center for the Study of Society and Medicine; Columbia-Presbyterian Cancer Center; Gertrude H. Sergievsky Center; Howard Hughes Medical Institute Program in Molecular Neurobiology; Howard Hughes Medical Institute Program in Structural Biology; International Institute for the Study of Human Reproduction (includes Center for Population and Family Health and Center for Reproductive Studies); Institute for Comparative Medicine; Institute of Cancer Research; Institute of Human Nutrition; Irving Center for Clinical Research; Richard and Hinda Rosenthal Center for Alternative/Complementary Medicine.

The P&S experience goes well beyond classroom learning and clinical training. Part of your transformation from medical student to well-rounded physician involves pursuing interests outside of medicine. As a P&S student you are a member of the extensive and dynamic Columbia University Community.

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College of Physicians and Surgeons Medical School Location

College of Physicians and Surgeons Courses

FIRST YEAR

Tomorrow's doctors must possess a solid foundation in the fundamentals of basic science to keep pace with the rapid growth of knowledge and provide their patients with the highest quality care. In your first year you accumulate the vocabulary and basic concepts of medical science and begin to explore the humanistic side of the practice of medicine. Many Year I curriculum materials are also available online, allowing you to augment your learning activities whenever and wherever you wish.

COURSES

* Sciences Basic to the Practice of Medicine I : Explain and give examples of the structure and function of cells will form the basis for understanding the structure and function of the systems of the body.

* Sciences Basic to the Practice of Medicine II : Science Basic to the Practice of Medicine (SBPM) provides students with an understanding of fundamental molecular and cellular biology. Knowledge of the structure and function of cells will form the basis for understanding the structure and function of the systems of the body. Emphasis is placed on using this knowledge to solve clinical and scientific problems.

* Human Development : Human development is a continuous process that begins when an ovum is fertilized by a sperm. Cell division, growth, migration, differentiation, and even cell death, transform the fertilized ovum into a multicellular human being. Although important maturational changes continue to occur during infancy, childhood, adolescence and even adulthood, most developmental changes occur during the prenatal period, between fertilization and birth. An understanding of human development is vital to the appreciation of normal human anatomy and physiology and also permits a proper understanding of malformations that result in congenital birth defects. Clinical practice in a variety of specialties, especially the obstetric and pediatric specialties require an understanding of normal and abnormal development.

* Clinical Practice I : Students will learn to appreciate patient care in the context of that patient’s developmental stage and life experience, racial and cultural background, motivation for change, means of paying for health care, and barriers to health. Illustrating the importance of professionalism and ethical behavior in clinical practice, the course will assist students in refining their vision toward becoming effective and compassionate clinicians.

* Neural Science : The Neural Science Course has lecture and lab components. All students take the lecture component. Some of the regular lectures and all of the clinical correlation lectures and clinical demonstrations are mandatory only for medical students, but others are welcome to attend. Medical students take a semester-long neuroanatomy wet lab. Dental students have a shorter neuroanatomy tutorial component.

* Psychiatric Medicine I : This course will introduce you to some of the major psychiatric disorders. Over the next eight weeks you will hear lectures about psychiatric symptoms and syndromes and observe videotapes of patients. You will also meet in small groups with a preceptor to interview psychiatric patients. While Psychiatric Medicine I is not designed to be a course in interviewing, it will provide many of you with your earliest opportunities to interview and observe patients. All interactions with patients must be considered confidential. Patients can be discussed among yourselves, but their identity should not be revealed and such discussions should never take place in public.

SECOND YEAR

Year II is a bridge between the core of information acquired in Year I and the clinical experiences of Years III and IV. Through an introductory clerkship in Physical Diagnosis second-year students learn how to obtain a complete medical history and perform a basic physical examination. You also gain a greater understanding of the interpersonal aspects of the doctor-patient relationship. Clinical Practice II introduces advanced interviewing techniques, and psychological disorders and development are explored in Psychiatric Medicine II.

COURSES :

* Pathophysiology I : The Pathophysiology Course is an important component of this transition, building on the knowledge acquired in first year to develop an understanding of the nature of human disease.
The course is structured with a series of lectures, laboratory exercises and small group sessions. These elements are designed to complement one another. The written material to support the course is found in the syllabus as well as in the required textbooks and in files posted on the Curriculum Web Site.
The Pathophysiology Course represents a collaborative effort on the part of many Faculty from several Departments including Medicine, Pathology (Dr. Jay Lefkowitch, Associate Course Director), and the Division of Tropical Medicine (Parasitology) of the School of Public Health. The course in Pharmacology under the direction of Dr. Andrew Wit, runs concurrently and in correlation with the Sections in pathophysiology.

* Pharmacology : Discuss the underlying alterations in body function that cause the manifestations of the disease that they will treat with drugs. Describe how the abnormal system function in disease states should be modified by drug therapy and how this modification would best alleviate the symptoms of the patient.

* Clinical Practice II : Recognize and articulate key aspects of psychological development that affect communication between doctor, patient, and patient’s family or support system. Identify key issues in health policy, health economics, access to care and disparities in care, and recognize their impact on effective patient care.

* Psychiatric Medicine II : Describe the characteristics of the developmental, mood, anxiety, psychotic, and conduct disorders most common in children and adolescents.

* Physical Diagnosis : The Physical Diagnosis course consists of several components, including lectures, demonstrations, seminars, and small group sessions. Most of the sessions are taught in groups of two to four students. The course is taught by many faculties of Columbia University, including the Departments of Medicine, Gynecology, Urology, Otolaryngology, Ophthalmology, and Emergency Medicine. Given the number and geographic variation of the small group sessions, the logistics of the course are complicated. The Syllabus section of the website details the course schedule and location of each session. Please review the course schedule regularly to ensure that you attend the assigned sessions. Attendance is mandatory. You will not be able to make up missed sessions. Absences are excused for emergencies only.

* Pathophysiology II : Second year marks the transition from the study of the science base of medicine and dentistry to the clinical courses of the last two years. The Pathophysiology Course is an important component of this transition, building on the knowledge acquired in first year to develop an understanding of the nature of human disease.
The course is structured with a series of lectures, laboratory exercises and small group sessions. These elements are designed to complement one another. The written material to support the course is found in the syllabus as well as in the required textbooks and in files posted on the Curriculum Web Site.
The Pathophysiology Course represents a collaborative effort on the part of many Faculty from several Departments including Medicine, Pathology (Dr. Jay Lefkowitch, Associate Course Director), and the Division of Tropical Medicine (Parasitology) of the School of Public Health. The course in Pharmacology under the direction of Dr. Andrew Wit, runs concurrently and in correlation with the Sections in pathophysiology.

* Dermatology : Use correct terminology to describe and classify the appearance of skin lesions. Recognize the appearance of common dermatoses including acne vulgaris, dermatitis, papulosquamous diseases and skin neoplasms.

* Radiology : Identify the following anatomic structures on plain radiographs: Chest: Lung lobes, fissures, trachea and carina, heart with the atrial and ventricular margins, pulmonary arteries, aorta – arch and descending portions, veins – superior vena cava and azygos, bones – spine, ribs, clavicles, scapulae, humeri, manubrium; lateral costophrenic angles. Abdomen: Normal colon, small bowel, liver and spleen, lumbar spine, ileac bones, sacroiliac joints. Upper extremity: humerus, radius, ulna, scapula, carpus, metacarpal bones, femur, tibia, fibula, tarsum, metatarsal bones. Scull: orbits, paranasal sinuses, mandible, maxilla.

THIRD YEAR: CLERKSHIPS

As you begin your third year at P&S, you make an important professional transition. Patient care becomes paramount in your life. In recognition of the significance of this milestone, P&S holds the Clinicians Ceremony. At this event, third-year students are welcomed formally into the culture of clinicians. Fourth-year students also attend the Clinicians Ceremony and present awards to house staff for excellence in teaching.

Third-year students navigate a steady stream of clinical experiences that prove both challenging and exhilarating. Working and learning in the midst of some of the nation's top specialists, you encounter and care for patients from a wide variety of racial, religious, and socioeconomic backgrounds. You may train at some – or all – of P&S's affiliated hospitals. From a rural hospital in upstate New York, to a municipal hospital in Harlem, to a primary care facility on a Native American reservation, our sites offer an unparalleled breadth of clinical experiences.

COURSES :

* Medicine : The clinical clerkship in Medicine is an intensive ten week introduction to internal medicine. You will spend five weeks at CUMC and five weeks at one of the affiliated hospitals: St Lukes, Roosevelt, Stamford, Harlem and the Allen Pavilion. At each site, in addition to your team of house officers and attendings you will have a preceptor who will be responsible for didactic sessions, feedback, the observed history and physical, and reading your write-ups.
The in-patient experience will allow you to see a wide variety of patients—not only your own, whom you will know in depth, but the others on your team, and those of the other students in your preceptor group. This will help you broaden your fund of knowledge even in these brief ten weeks. Even more importantly, every day will provide multiple opportunities to practice your interviewing and physical diagnosis skills, animate your knowledge of basic and clinical science, and experience your emerging identity as a physician as you apply yourself to the task of caring for sick patients. To fully integrate the knowledge, skills, and professional attitudes will take time, hard work and practice. Work with each of your patients closely. Let the patient teach you about the person and about the disease. Watch everyone ‑‑ medical staff, nursing staff, social workers, ward clerks, etc. Watch their interactions with patients and with each other. Select those approaches and presentations that you find most effective, appropriate and helpful in caring for your patients. It is normal to feel overwhelmed at first, but call for help, if you are having difficulty understanding your role and your priorities.
The clerkship is, in part, an apprenticeship. It is an opportunity to work with the patients and to learn from them with the luxury of not having direct, final responsibility for their management. It will not always be so, so take full advantage of the fact that you are still a student and take time to read, prepare your write-ups, and prepare for your preceptor group. You will need to balance two demands on your time and two sources of learning, your ward team and your preceptor.

* Neurology : The third year clinical clerkship in neurology is a five-week introduction to clinical neurology. The goals of the rotation are congruent with Accreditation Council of Graduate Medical Education (ACGME) guideline, and emphasize the 6 domains of medical education: Patient care, medical knowledge, communication skills, professionalism, practice-based learning, and systems-based practice. All of these elements form important parts of the educational experience in neurology, as well as the evaluation.
Neurology is the specialty of medicine devoted to diseases of the nervous system, and this rotation emphasizes the clinical tools that distinguish this discipline: the neurological history, the neurological exam, and special diagnostic testing relevant to the conditions under study, including neuroimaging. An important clinical challenge for students is to develop skill at clinical localization and problem-solving in neurology, based on the neurological history and examination.

* Obstetrics/Gynecology : At the end of this clerkship, students will be able to demonstrate competencies in the basic knowledge, skills and attitudes of an effective clinician in evaluating and caring for women through pregnancy and delivery and with gynecological problems. In some cases, students will demonstrate their abilities by participating under supervision in the context of the healthcare delivery team.

* Pediatrics : During this 5 week rotation, you will participate in direct patient care in both the ambulatory and inpatient setting. You will work on the general pediatric inpatient service, in the Pediatric Emergency department and in General Pediatric practices, & you will be exposed to common pediatric problems and conditions. You are given the responsibility of performing history and physical examinations, presenting patient cases, and carrying out management tasks under the supervision of residents and attendings.

* Primary Care : At the end of this clerkship, students will be able to demonstrate competencies in the basic knowledge, skills and attitudes of an effective clinician in evaluating and caring for primary care problems. In some cases, students will demonstrate their abilities by participating under supervision in the context of the healthcare delivery team.

* Psychiatry : All students are exposed to inpatient and outpatient services, including adult and child psychiatry and the psychiatric emergency room. While the acquisition of clinical skills is emphasized, seminars complement the clinical experience by enhancing the knowledge base necessary to master these skills. An emphasis will be placed on the following: conducting an interview to obtain a psychiatric history and mental status examination; organizing and presenting a psychiatric history and mental status examination, interpreting the findings and generating a differential diagnosis; gaining familiarity with the indications for, and the general approach to, psychiatric treatments, including medications and psychotherapy; making an initial assessment of psychiatric emergencies including suicidality; gaining familiarity with common childhood psychiatric disorders and their treatment; and improving interviewing skills and ability to establish and maintain a therapeutic doctor-patient relationship, with an understanding of the factors affecting that relationship.

* Surgery : At the end of this clerkship, students will be able to demonstrate competencies in the basic knowledge, skills and attitudes of an effective clinician in evaluating and caring for surgical problems. In some cases, students will demonstrate their abilities by participating under supervision in the context of the healthcare delivery team.

* Anesthesiology : At the end of this clerkship, students will be able to demonstrate competencies in the basic knowledge, skills and attitudes of an effective clinician in caring for problems encountered during the administration of anesthesia.

* Neurological surgery : Define cerebral perfusion pressure, and explain how it is used in the management of patients with elevated intracranial pressure.
Describe how blood gases, fluids, and electrolyte balance influence intracranial pressure.
Describe the clinical manifestations of acute brain herniation, including transtentorial, uncal, and subfalcine herniation syndromes.

FOURTH YEAR COURSES

Year IV gives you great freedom to customize your medical education. You can spend up to three months doing laboratory research, choose from a large number of one-month clinical electives that cover every area of medicine, and travel abroad to Europe, Asia, or South America to continue your training. Requirements include a one-month subinternship or advanced clinical clerkship, during which you independently care for acutely ill patients. You spend another month in one of three "Back to the Classroom" electives in which you revisit and re-think basic science as the language of medical decision making by working in small groups to devise treatment strategies. By choosing your fourth-year electives, you design a curriculum that is suited to your particular needs and interests.

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