The Didactic Curriculum
“To study the phenomenon of disease without books is to sail an uncharted sea, while to study books without patients is not to go to sea at all.”
–Sir William Osler
This often quoted aphorism of Osler’s truly describes the emphasis our Program places on the paramountcy of the patient in the process of learning medicine. We believe passionately that the learning of medicine has to be an active process at the bedside and to that end our residents find themselves in a supportive environment ministering to an ethnically diverse population of patients and encountering as wide a spectrum of illness as can be encountered anywhere. Yet, we heed Osler’s wise counsel about attempting to study medicine without “books”. In the modern era the word “books” in the context of medical education carries a much broader connotation and extends beyond the written word. Our didactic curriculum, described here, is designed to cater to that need. Our residents sail a sea that is meticulously charted!
We hold two morning reports each day, one at Yale and one at the V.A., from Monday through Friday, thus ensuring learning in small groups. On one of these days, the reports are for the interns. In addition, one resident report is also run on Saturday mornings. It is the Yale tradition that report is run by the Chief Resident with core faculty always present to provide input when needed. On occasion an “expert” may also be invited.
Report frequently begins about a brief inquiry about codes, errors or near errors the previous day, often followed by a very short “teaser”, such as a blood smear, a picture of a skin rash, urine sediment, an imaging study or EKG, projected on the screen by the Chief Resident. The reports are run using one of two different formats. Occasionally short discussions are held on a number of patients admitted to the teams during the previous night. However, more frequently, after the patient’s houseofficer has presented pertinent clinical details about a patient pre-selected by the Chief Resident, a lively and interactive discussion ensues between the Chief Resident and the housestaff in attendance, with faculty only interjecting when they feel they have something of importance to add. The initial emphasis is on using clinical information in order to arrive at a differential diagnosis and then asking for further investigative data. At this point, as relevant, copies of EKGs may be distributed and blood smears, imaging studies, echocardiograms, etc. projected on the screen in order to enable the housestaff to arrive at a diagnosis. Thereafter, time permitting; evidence is sought from the patient’s resident in support of the treatment the patient received, or, about the pathophysiology of the disease in question.
Medical Grand Rounds:
The Department of Medicine at Yale prides itself in the quality of its Medical Grand Rounds. The following are broad categories of subjects generally selected:
- Patients admitted to housestaff teams in the recent past whose problems lent themselves to discussions by clinical faculty, chief residents or clinician scientists of:
- Dilemmas in diagnosis or management
- Science underlying the disease (often discussed by faculty whose scientific work is in that area)
- Ethical issues
- Issues related to access to Health Care in the U.S.
- Faculty experiences with clinical work or research in the developing world, often but not exclusively, with problems related to HIV
- Faculty experiences in disaster areas
- Medical errors and quality improvement – by local or visiting faculty
- Annual lecture given by a well known physician writer given on the same morning as the residents’ presentations of their work for the Writer’s Workshop
- Annual Ralph Horwitz lecture delivered by a young Yale faculty member who is a funded clinical investigator. The lecture is given on the morning of Resident Research Day, when residents present their research done in the Research-in-Residency Program.
- Other Annual Named Lectures:
- Paul Beeson Visiting Lectureship
- Samuel Their visiting Lectureship
- John Peters Lecture: given by an eminent visiting endocrinologist or nephrologists in alternate years
- Massimo Calabresi Lecture given each year by an eminent visiting cardiologist
- Paul Calabresi Lecture in Medical Oncology given by an eminent visiting endocrinologist
- Gerald Klatskin Lecture given each year by an eminent hepatologist
- Samuel Kushlan Lecture given each year by an eminent gastroenterologist
Summer Teaching Conferences:
These lectures are given four times a week at noon, during the summer covering a large number of topics. They are open to all housestaff but are specifically focused on the needs of new interns. They cover a vast array of topics which cover the nuts and bolts of subjects that it is felt new interns should become familiar with soon. These subjects include a talk of how to present patients during Work Rounds, important topics in every subspecialty in Internal Medicine including critical care medicine, problems in neurology, dermatology, psychiatry, medical ethics, legal aspects of medicine, quality assurance issues etc. They are held at Yale and at the V.A. and posted online for review afterwards.
These lectures are held at Yale and the V.A. three afternoons a week from September until June. They cover a curriculum.
Professors Weekly Conference:
These conferences are given at Yale once a week and provide yet another opportunity for housestaff to meet with physicians who are engaged in either basic science research or clinical investigation. The goal is to expose housestaff in relatively small groups to such faculty and to make the discussion interactive. To make that possible, two such sessions are held simultaneously in order to achieve “small group” teaching possible. Patients on the housestaff service are generally chosen, and the “Professor” talks about the patient presented by the housestaff; may touch upon diagnostic aspects, but concentrates as far as possible on pathophysiology, basic science aspects underlying the patient’s disease, epidemiology etc. as relevant. A fair bit of the curriculum is covered in this fashion.
Lectures in a larger forum include those on a number of different topics such as those related to:
- Laboratory medicine
- Adolescent Medicine
- Monthly ethics and end-of –life conferences
- Quality Improvement Curriculum
- Medical Errors – “matrix” presentations
- Legal aspects of Medicine
- Morbidity and mortality conferences (including some using the Matrix format)
- Autopsy conferences
- Peer teaching conferences: These are seminars given by third year residents on a subject of their choice as a part of their scholarly activity
- Journal Club: These journal clubs are focused mainly to teach housestaff to evaluate an article critically and a variety of different types of studies are chosen e.g. randomized control trials, longitudinal cohort studies, case control studies, cross sectional studies etc., quite apart from the subject the article deals with.
Ambulatory Medicine Lectures:
Topics in outpatient medicine are covered year as part of the Preclinic Conference held prior to Continuity Clinics each week. The topics are based on a formal curriculum provided to each resident on a CD-ROM (see section on Preclinic Conference under Ambulatory Education)