Doctor of Medicine (MD) Degree Program Curriculum

Course Descriptions  |  Clinical Clerkships  |  Graduation  |  Residency



The Foundations of Medicine

Title of course	Credits
Term I
Introduction to Clinical Medicine I	3
Medical Biochemistry I	4
Integrated Clinical Anatomy I	3
Histology	2
Medical Physiology I	3
Total:	15 Credits

Term II
Introduction to Clinical Medicine II	2
Medical Biochemistry/Genetics II	3
Integrated Clinical Anatomy II	3
Medical Physiology II	3
Intro to Pharmacology	1
Neuroscience	3
Integrated Basic Science I	1
Total:	16 Credits

Term III
Introduction to Clinical Medicine III	1
Medical Microbiology	3
Pathology I	6
Medical Pharmacology I	3
Behavioral Sciences	3
Integrated Basic Science II	1
Total:	17 Credits

Term IV
Introduction to Clinical Medicine lV	1
Medical Microbiology II	3
Pathology II	8
Medical Pharmacology II	3
Integrated Basic Science III	1
Total:	16 Credits

Term V
Introduction to Clinical Medicine V	1
Basis of Diseases	12
Clinical Therapeutics	2
Integrated Basic Science IV	2
Total:	17 Credits

Course Descriptions

Integrated Clinical Anatomy I
The course features a structured approach to the human body, starting with essential terminology, and then progressing regionally throughout the body. Our journey starts with the axial skeleton from which we travel down the upper and lower limbs from proximal to distal comparing and contrasting the osteology & myology of the appendicular skeleton. Emphasis is placed on relating anatomy to the presentation and management of trauma and sporting injuries. Next comes the thorax and with it the anatomy of the lungs & mediastinum whose subdivisions contain the heart and great vessels. Of clinical relevance is the anatomical basis of physical diagnosis and procedures such as central venous catheterization & chest tube placement.

Integrated Clinical Anatomy II
The second installment of anatomy starts where our previous journey left off, moving down from the thoracic esophagus into the abdomen. We then follow the alimentary tract over its considerable course via the stomach, small intestine & colon into the pelvis. Along the way we consider the anatomy of the liver, pancreas, spleen & kidneys whose ureters are also followed into the pelvis. Emphasis at this stage is placed on the anatomical basis of hernias and surgical approaches to both intra-abdominal &retroperitoneal structures. We now move onto the pelvis considering the functionally important sex-differences and the remarkable process of childbirth. Another element of Term II is a two week study of systems based embryology again with an emphasis on what is clinically relevant.

Medical Biochemistry I
The goal of this course is to provide the foundations of biochemistry relevant to human metabolism and clinical medicine. Medical biochemistry is a 4 credit hour course that focuses on the study of human metabolism in health and disease. Studying the metabolism of molecules is essential to the understanding of their significance in human metabolism (function) and clinical medicine in health and disease including the impact that nutrition has on these molecules. It is of increasing relevance nowadays as more and more drugs are being designed to target specific areas of metabolism.

Medical Biochemistry and Genetics II
The goal of this course is to provide a foundation of the principles of human genetics as applied to clinical medicine. The emphasis is chiefly on mechanisms, diagnosis and treatment of genetic disorders. Medical genetics is a 3 credit course in a rapidly evolving area of modern medicine. Molecular genetics is now integral to all aspects of biomedical sciences. Knowledge of the principles of Genetics and their application is required to be able to successfully practice medicine today.

Histology
Histology provides a survey of the basic microscopic anatomy and ultra structure of the major tissue types using both light and electron microscopy. This is followed by an organ/systems review of the body with an emphasis on normal structure and function of cells and tissues. Using didactic and laboratory sessions, the course is preparatory to the study of abnormal cells and tissues in Pathology I & II. The course uses didactic sessions, small group and laboratory reviews and discussions of cells and tissue with a preview of how they may be altered by disease.

Medical Physiology I
Medical Physiology I introduces the student to the basics of normal human Physiology or the study of function, activities, and processes of the human body. The course proceeds with an in depth introduction to a systems/organ system study of medically pertinent Physiology. Teaching is done by incorporating lectures, clinical correlations, laboratories, problem based learning, and case studies that cover general and cell physiology, muscle physiology, cardiovascular, renal, and respiratory physiology. As the student is introduced to normal physiology, concepts of pathophysiology are presented to prepare the student for the Pathology and Pathophysiology (“Basis of Diseases”) courses.

Medical Physiology II
Medical Physiology II continues the study of human physiology addressing endocrinology, reproduction, gastrointestinal, integrative physiology, and review sessions that are designed to integrate human physiology. Introduction to neurophysiology is taught in either Term I or II and functions as an introduction to the Neuroscience course taught in Term II. As the course develops, lectures have a dual emphasis on both basic and integrative physiology and pathophysiology. Problem Based Learning cases will complement the lecture content and provide a clinically relevant context for basic science principles.

Neuroscience
The Neuroscience Block integrates the anatomy, physiology, and clinical correlates of the central and peripheral nervous system. The principles that underlie the anatomical structures of each system are correlated with its physiology and relevant clinical applications, including behavioral aspects. Emphasis is placed on the function of the nervous system in health and sickness. Modern principles of neuronal circuits and synaptic transmission including the function of the eye are introduced. Teaching methodologies included didactic sessions, laboratory instruction with detailed brain examination/dissection in combined laboratories with our Anatomy and Clinical Neurology Faculties, exposure to neuro-imaging modalities, and instruction in the principles of neurological examinations as applied with patients in our clinical laboratory setting.

Medical Microbiology and Immunology I
Medical Microbiology and Immunology I is divided into two nearly equal halves, the first half for the subject of Immunology and the latter for Basic Microbiology, including the fundamentals of Bacteriology, Virology, Mycology and Parasitology. The Immunology component considers such topics as the differences between innate and adaptive immunity, the cellular basis of Immunology, how these cells interact, and the mechanisms and products used by these cells (complement, immunoglobulins, cytokines) to provide resistance to infectious organisms. Dysfunctional aspects of immunity resulting from immunodeficiency conditions, hypersensitivity, autoimmunity and transplant and tumor immunity are also presented. Included within the Basic Microbiology section are the structure, growth, replication, genetic versatility, virulence attributes, antimicrobial resistance and sensitivity and other basic aspects of the fundamental nature of bacteria, viruses, fungi and the animal parasites.

Medical Microbiology and Immunology II
Medical Microbiology and Immunology II is an organ based examination of infectious diseases caused by bacteria, viruses, fungi, and animal parasites. Major tissues to headline the orientation of the course are those of upper respiratory and lower respiratory systems, sexual and genitourinary tissues, the central nervous system, digestive and gastrointestinal, skin, hair and nails, and other similar topics. Special consideration will also be given to nosocomial diseases, arthropod borne diseases, zoonotic diseases, emerging diseases, and other subjects of current interest such as prion based diseases. Each organ based lecture will include a general description of diseases of that organ followed by a discussion of the bacteria, viruses, fungi, and parasites attacking that organ. For each etiologic subgroup the basic characteristics of the pathogen, its habit and means of transmission, virulence attributes, disease description, diagnostic methods, vaccine and other aspects of the immune response to the pathogen and an indication of accepted antimicrobial or related treatment of the disease will be emphasized.

Pathology I
The course is designed as an introduction to the study of Pathology. The subject of Pathology is divided into General and Systemic Pathology with the aim of the General Pathology course being to familiarize the student with the nomenclature and definitions used in Pathology. Diseases are discussed with a focus on the role of etiology and pathogenesis. The importance of morphologic examination, both gross and microscopic, is highlighted. The clinical course, prognosis and complications of diseases are taught thereafter. The objective of the course is therefore to convey that every disease has a pathologic basis.

Pathology II Systemic and Organ System
The course of organ system pathology is designed to understand the alterations in specialized organ systems and tissues that are responsible for the disorders that involve those organs. The acquired skills of general pathology such as inflammation, ischemia, infarction and necrosis will be applied to specific organ systems. This course helps the students to understand the etiology, pathogenesis, morphologic and clinical features, pathologic diagnosis and prognosis of common diseases affecting cardiovascular, respiratory, hepato-biliary, gastro-intestinal, renal, nervous, dermatological, male and female reproductive systems. The course will achieve the above objectives through power point presentations, digital pictures, and interactive laboratory sessions. Thus the main goal of the course is to develop a sound knowledge of all common diseases so that the student can apply the learned skills in clinical practice.

Intro to Pharmacology
The Introduction to Pharmacology Course of term II provides an overview of principles and basics, divided into Pharmacokinetics (how does the human body handle drugs) and Pharmacodynamics (how do drugs affect the human body), and is concluded by a brief overview of Autonomic Nervous System Pharmacology. The close relationship of these topics with Biochemistry/Molecular Biology provides the opportunity for integrative teaching and consolidation of Medical Basic Science knowledge. The Autonomic Nervous System Pharmacology integrates most significantly with Anatomy and Physiology.

Medical Pharmacology I & II
The vast array of options for clinical drug therapy is presented to students in a drug-class based systematic approach. Students will be coached in mastering the substantial amount of complex information by using various teaching modalities, including therapeutic issues lectures, Joint Lectures, and small group activities. Throughout the courses, students will be alerted to the clinical use of the drugs and drug classes discussed. Ultimately, students will receive an introduction to the delicate process of therapeutic decision making.

Behavioral Sciences
This course is divided into three sections. The first (2 weeks) introduces the bio-psycho- social model of medicine. This model is then applied to the life-cycle from conception to death with emphasis on the psychological, social and cultural determinants of health. In addition, specific lectures are given on sexual development and function, cognition and its assessment, memory function and its assessment, personality, and stress and coping. The objectives of this section are 1) to familiarize the student with the milestones of normal development, 2) to make the student aware of non-biological factors that affect health, and 3) with these insights have a better understanding of their patients. The second section (one week) focuses on doctor/patient relationships. Medical ethics, difficult issues (e.g., death and dying) and models of interaction are presented and discussed with the students. The overall objective of this section is to make good doctors better doctors. The third section (1 week) introduces the student to the basic tools needed for using and applying quantitative measures to medicine including reading the medical literature and devising epidemiologic studies.

Introduction to Clinical Medicine I
ICM 1 introduces the important principles of patient-physician relationships and the skills that are needed for successful clinical interactions. Students will be taught the skills of history taking and practice the art of communication during patient encounters. Imparting an understanding of symptomatology will facilitate the ability to gather information during the patient interview. As an integral part of this course, students will have the opportunity to interview patients under the supervision of clinical and ICM faculty in the laboratory and during hospital and clinic visits. Students will be introduced to important concepts of Medical Ethics (including HIPAA guidelines), Culturally Competent Care, and Blood borne Pathogen (OSHA guidelines) and Respiratory Pathogen (including tuberculosis and influenza) prevention and safety guidelines.

Introduction to Clinical Medicine II
In ICM 2 continues with further development of history taking skills and introduction to the physical examination in an organ system approach. Students will continue to have hands on experience in obtaining patient histories as they initiate their practice of the general and focused physical examination. Lectures, videos, clinical demonstrations and practice of interview and examination techniques will be experienced by the student under the mentorship of the experienced clinical and basic science faculty. The course concludes with an OSCE (Objective Structured Clinical Examination) examination.

Introduction to Clinical Medicine III
ICM 3 allows for further mastery of the skills of history and physical examination in the clinical setting. As they continue clinical rotations students will formally present and discuss their cases with the clinical professors. Integration of their developing knowledge of the basic sciences in a clinically relevant setting will assist the student in establishing excellent patterns of learning in medicine.

Introduction to Clinical Medicine IV
ICM 4 continues practice of clinical skills with bedside case presentations and discussion of differential diagnosis both in the clinical and classroom setting. The objective is to further prepare the student for excellent medical communication and formulation of a sound differential diagnosis during their clinical clerkships and a life in medicine. This course concludes with an OSCE exercise.

Introduction to Clinical Medicine V
ICM 5 further continues integrating Clinical Medicine with the basic sciences taught in the Term V Basis of Diseases (BOD) course. Each week the Visiting and full time Faculty of the BOD course join the students at the Milton Cato Memorial Hospital where the students present their cases during a bedside chief of service rounds. The overarching objective is to enhance the student’s ability to evaluate and present their findings in a formal setting where they develop their skills of communication, differential diagnosis and management.

Basis of Diseases
The Basis of Diseases course comprehensively integrates and builds upon the basic sciences previously learned in the Foundation of Medicine courses. The objective of the course is to further the successful transition of the student from the basic sciences into the introductory stages of clinical medicine, preparing them for clinical clerkships and a life of learning in the “healing arts”. By initiating the course with an organ systems approach followed by the systemic diseases, the student is prepared to acquire skills in critical analysis of problems with integration of information to develop a well founded clinical hypothesis and a sound differential diagnosis. The course is closely integrated with clinical therapeutics and advanced clinical skills so as to further develop the major core clinical competencies necessary for mastering the foundations of a successful practice of medicine. The students will continue to gain integrated experience in collecting and relating patient information both orally and in appropriate written formats. The methodologies used to achieve these goals for the student will include: didactic lectures; case presentations; small group sessions; Problem Based Learning (PBL) sessions; journal clubs; and clinical rotations linked with grand rounds and chief of service rounds led by Physician/Practitioners who are accomplished in their fields.

Clinical Therapeutics
This course runs in close coordination and integration with the Basis of Diseases course. In joint lectures, we discuss essentials of Clinical Therapeutics with BOD Visiting Faculty who are practicing clinicians. We review rational drug therapy in Therapeutic Issues lectures, and discuss actual patients' drug treatment plans and outcomes with the attending physicians at the Milton Cato Memorial Hospital. All activities of the Clinical Therapeutics course are designed for and aimed at consolidating Trinity medical students' solid command of basic Pharmacology. Overall, the sequence of Trinity Pharmacology courses above is designed to provide sufficient depth of material to prepare students to develop a foundation for a life of learning in medicine.

Integrated Basic Science I-III
Retention of acquired medical knowledge, integration with new study material, and consolidation into a well-rounded body of competences in medical basic science are the first and foremost ongoing challenge for all medical students. On the background of a constant influx of new and important facts on a daily basis, an integrative approach helps remember those items learned some weeks or months ago. The IBS courses provide guided modules of self-directed study on a 2 hour per week basis. Faculty members are available for discussion during these modules.

Integrated Basic Science IV
Term V of the Trinity Foundations of Medicine is the capstone term of Medical Basic Sciences. The guided, self-directed study approach of the IBS courses is continued as a weekly activity with Clinical and/or Basic Science faculty available for discussion. High yield summary and review materials, and access to external high-profile sample exam questions for the USMLE 1 are particularly effective additional components of the IBS 4 course.

back to top

Clinical Clerkships
Students are eligible to enter clinical clerkships in specific fields after passing the USMLE Step 1. Students are required to take 48 weeks of clinical core clerkships and 27 weeks of electives. The core clerkships in medicine, surgery, pediatrics, family medicine, obstetrics/gynecology and psychiatry are the basic areas of medical practice about which all physicians need to be knowledgeable. They are included in the curriculum of every medical school. Participation in these clerkships also provides students with an understanding of the various specializations in medicine.

Internal Medicine
In this clerkship, students learn the steps necessary for proper diagnosis and treatment of patients they see. Students learn how to take complete medical, personal and family histories in order to do a diagnostic “work up” and develop a plan for managing a patient's care. They participate in clinical conferences, where they learn to report their findings and conclusions logically and succinctly.

Surgery
In the surgery clerkship, students learn about conditions that require surgical intervention and have opportunities to observe how surgical patients are managed. In the process, they become familiar with policies and procedures followed in the operating room. Opportunities will be provided for direct practice of simple procedures such as suturing, debridement and wound care. Students will be expected to observe and assist during various procedures in the operating room and participate in follow-up and treatment of the post-surgical patient, as well as ambulatory practice settings.

Pediatrics
In this clerkship, students acquire an understanding of the principles of family medicine and how they apply in community practice. Emphasis is placed on continuous and comprehensive health care for people of both sexes and all ages within the context of their families, social groups and communities. Particular attention is paid to the diagnosis and treatment of common medical problems and to health maintenance, ambulatory care and continuity of care.

Obstetrics/Gynecology
During this clerkship, students learn about the changes that take place during pregnancy, labor, delivery and the post-partum period, both normal and pathologic. They also become familiar with diagnosis and treatment of major gynecological diseases and various methods of family planning.

Psychiatry
In this clerkship, students become familiar with the major categories of mental disorder, including diagnosis and some methods of therapy. In the process, they learn how to take a psychiatric history and to evaluate a person's mental state.

Electives
The additional 27 weeks are spent in elective clerkships. These must include eight additional weeks in medicine, which may be spent in general medicine or in medical subspecialties; and four additional weeks of surgery, which may be spent in general surgery or in surgical subspecialties.

Graduation
The Doctor of Medicine (MD) degree is awarded upon successful completion of the Foundations of Medicine curriculum, the Clinical Sciences Clerkships and the USMLE Step 1, USMLE Step 2 (CK) and (CS). The entire program consists of 10 fifteen (15) week terms.

The foundations of medicine program will be conducted at the Trinity School of Medicine campus in Kingstown, St. Vincent & the Grenadines. The 75 weeks of Clinical Clerkships will be offered at ACGME approved sites in the United States.

Residency Training
Graduating students will register for the National Residency Match Program (NRMP) or the Canadian Resident Matching Service (CaRMS) which is a paired choice system for matching applicants to available residencies. Students train in a residency program for two to five years during which time they sit for the USMLE Step 3. Upon completion of their residency (fellowship) and passing USMLE Step 3, candidate physicians are prepared for licensure.