The curriculum is dynamic and designed to provide students with a strong scientific foundation, a comprehensive, integrated approach to clinical skills and patient care, opportunities to explore various career interests and broaden students’ perspective of medicine and the world in which physicians function.
A defined set of medical school program objectives and core course requirements to meet these curricular objectives provides the framework for the MD program. Since the field of medical science is constantly changing, the graduation requirements for the MD program set forth at matriculation may undergo modifications that will apply to students already enrolled as long as there is adequate time to complete the requirements within the students’ anticipated date of graduation.
Foundations Phase Curriculum
The format of each block course is designed to emphasize active learning processes and minimize the number and length of lectures. Small group sessions and independent learning receive greater emphasis in the curriculum. Learning to work effectively in a small group is an important skill. Each student is expected to share in the responsibility of fostering a productive learning environment in the small group in which a diversity of knowledge and experience can be joined for the common good.
Patient Care Phase and Explore & Focus Phase Curriculum
The Patient Care Phase curriculum emphasizes active student participation on patient care teams and increased responsibility for patient management as the student progresses through the clinical phases of the curriculum. Students are expected to actively engage in independent learning/study about diseases encountered and to attend and participate in conferences. The professional development of students as patient care providers and team members is an essential component of teaching and role modeling within the clinical curriculum.
Students are expected to gain broad educational experience utilizing both the wide-range of primary care and specialty clerkships in clinic and hospital settings across the WWAMI region. Longitudinal clinical experiences within WWAMI underserved rural and urban settings must meet educational requirements equivalent to the standard clinical curriculum.
Online Learning Environment
Foundations Phase blocks use several technologies to facilitate student learning. The School of Medicine uses the Canvas learning management system as the gateway to these resources:
- Course information, syllabus, presentation materials, etc.: All currently enrolled medical students, including those on leave or pursuing concurrent degrees, should have access to the most up-to-date version of a particular course at any WWAMI site.
- Discussion boards for discussion with classmates outside of class: In some courses, faculty may actively participate in discussions.
- Grades: Students will only see their own scores and grades for the course, and access is specific to the course/site in which the student is enrolled.
- Video recordings: Pre-class assignments often include brief video modules prepared by faculty for students at all sites. Some sites also provide recordings of in-class sessions. In-class recordings from Seattle-based courses are accessible by students at all WWAMI sites.
- Course-specific tools such as online exams, virtual microscopy, anatomy atlases, etc.: Access beyond the specific course/site offering is dependent on the nature of the resource and any licensing restrictions.
The School of Medicine continually monitors emerging technologies to facilitate student learning and welcomes student input on the evaluation, selection, and adoption of new tools.
All students are required to complete the Clinical Immersion at the start of medical school. Clinical Immersion is a full-time multi-week component of Foundations of Clinical Medicine that focuses on learning basic clinical skills and covering topics relevant to a career in medicine, such as professionalism and patient-centered care.
Foundations Phase Curriculum
The Foundations Phase curriculum is composed of three terms over an 18-month period consisting of nine integrated blocks, two longitudinal programs, and a scholarly/research project. All blocks are designed to integrate basic, clinical, and social sciences. Content in cross-cutting scientific areas, such as pathology/histology, anatomy and embryology, and pharmacology are weaved throughout. Blocks and courses are taught by faculty from the basic sciences and clinical disciplines.
During the Foundations Phase, students must complete the following required blocks as a full-time, intact, continuous curricular schedule:
- Fundamentals of Medical Science & Research
- Infections & Immunity
- Cancer, Hormones & Blood
- Muscles, Joints, Bones & Skin
- Cardiovascular System
- Respiration & Regulation
- Head, Neck & Gut
- Mind, Brain, & Behavior
Beginning in Immersion and Orientation, the Foundations of Clinical Medicine (FCM) course is a longitudinal clinical training program focused on clinical skills, primary care, and continuity of care. Students work with physicians, faculty, and other health professionals in outpatient clinical settings, clinical skills workshops, and simulation experiences one day a week in the Foundations Phase. They also participate in hospital tutorials with College faculty and their College mentor group.
Through the four-year longitudinal Medicine Health & Society course, students receive education in theme areas important to the practice of medicine such as health systems, quality and safety, population health, global health, social determinants of health/health equity, diversity, professionalism, ethics, interprofessional care, communication, and more.
Students will come together for seven Integration Weeks throughout the four-year curriculum to develop a holistic framework of basic science, revisit and integrate previous topics, reflect on professional identity formation, practice approaches for self-care, sustainability, life-long learning, and more.
After the first three terms, students complete a three-month Consolidation course in which they prepare for the USMLE Step 1 examination through a combination of structured and independent study, finish their research requirement and complete a Transition to Clerkships series to prepare them for the Patient Care Phase of the curriculum.
Independent Investigative Inquiry (III or Triple I)
All students earning the MD degree are required to complete an independent research or community-based project. This may be met through a data-gathering/hypothesis-driven inquiry, critical review of the literature, experience-driven inquiry, or a special simulation project overseen by a faculty sponsor with whom the student collaborates. The student must be the sole author of the final paper or project, which must be completed on an agreed-upon timeline.
An exception in the Triple I timeline is given to those in the Medical Scientist Training Program (MSTP), for whom a thesis or dissertation in a medical or medically-related field fulfills the III requirement. The thesis or dissertation must be completed during the graduate portion of the program and prior to entering the Patient Care Phase of the curriculum.
Students who received Master’s or PhD degrees with completion of a thesis or dissertation or those who are first authors of published papers in peer-reviewed journals in disciplines basic to medicine may petition for a waiver of the III requirement. Abstracts and papers used to fulfill requirements other than those noted above do not meet criteria. Only a dissertation or thesis is sufficient. Contact the Curriculum Office during your first-year to inquire about waiver requests at email@example.com and visit the Medical Student Scholarship webpage.
Transition to Clerkships
The Transition to Clerkships course serves as a preparation for clinical clerkships. Completion of Transition to Clerkships is required for graduation.
Patient Care Phase
The Patient Care Phase is 12-months and students complete six required clinical clerkships including Internal Medicine, Family Medicine, Obstetrics and Gynecology, Pediatrics, Psychiatry and Surgery. Students must also complete the second portion of the longitudinal Themes in Medicine course.
Students should expect to complete a minimum of 24 weeks of clerkships outside of the Seattle area during the Patient Care Phase, and a minimum of 8 weeks of clerkships in Seattle at one of the following hospitals: UW Medical Center, Harborview Medical Center, Seattle Children’s, or Puget Sound VA. (see Time in Seattle Policy for COVID-19 related changes). Additional time is available during the Patient Care Phase to complete clinical electives, intersessions, the Patient Care Phase OSCE, and the USMLE Step 2 examination.
Explore & Focus Phase
The Explore and Focus Phase is 15-months long and designed to allow students to explore potential specialty careers through a combination of required and elective clinical clerkships. Required clerkships include Emergency Medicine, Neurology/Neurosurgery, and two advanced patient clerkships, one of which must be a subinternship. Students are required to complete 40 credits, or 20 weeks, of clinical electives.
Transition to Residency
At the end of the fourth year, prior to the Physician’s Oath and Hooding Ceremony, students return to Seattle to participate in the Transition to Residency course, which is an academic- and skills-based course that prepares students for entering residency training.
Objective Structured Clinical Examinations (OSCEs)
Objective Structured Clinical Examinations (OSCEs) are clinical simulations, administered periodically throughout the curriculum, to assess the level of knowledge and clinical skills of students. The exams are given at the end of the Foundations and Patient Care phases. If minimum performance standards are not met in any of the OSCEs designed to assess knowledge and skills, the student must successfully complete the recommended remediation plan in order to be approved to continue in the curriculum.
A practice OSCE is administered part way through the Foundations Phase to determine a student’s progress and formative feedback is provided. The summative Foundations Phase OSCE must be completed at the end of the Foundations Phase. The Patient Care Phase OSCE must be completed at the end of the Patient Care Phase irrespective of the student’s plans to expand the fourth year. The Associate Dean of Student Affairs may make exceptions to the timing of the OSCE in individual circumstances.
Failure to successfully complete either exam will require remediation, potentially delaying the student’s progress in the curriculum, and will result in the student’s record being referred to the Student Progress Committee (SPC). The student’s completion status of the OSCEs is noted in the Medical Student Performance Evaluation (MSPE).
The Clinical Skills Steering Committee, chaired by the Assistant Dean for Clinical Curriculum, provides oversight of the OSCE program.
USMLE Step 1 and Step 2-Clinical Knowledge (CK)
All students are required to pass the following United States Medical Licensing Examination (USMLE) examinations in order to graduate: Step 1 and Step 2-Clinical Knowledge (CK). Successful completion of each Step must be accomplished on the timeline established by the Student Progress Committee in order to continue in the medical school curriculum. Failure to successfully complete the exams will result in the student’s record being referred to the Student Progress Committee for subsequent management.
The student’s completion status of the USMLE examinations is noted in the Medical Student Performance Evaluation (MSPE).
- Remediation of unsatisfactory Foundations Phase required coursework must be completed prior to taking USMLE Step 1.
- Step 1 must be completed in the second year prior to beginning clinical clerkships in the Patient Care Phase.
- Combined degree students and students entering into research fellowships must achieve a passing score on Step 1 prior to entering/continuing in their graduate/research program.
- If a student has had academic difficulty and/or marginal performances in the Foundations Phase, including the Comprehensive Basic Science Exam, the Student Progress Committee (SPC) may recommend or require that the student’s entry into the Patient Care Phase be delayed, allowing additional study time for Step 1. At the end of the Foundations Phase blocks, SPC will review students with thread remediation and/or Fail grades to determine if delaying the clerkship start date is necessary.
- Remediation of unsatisfactory Patient Care Phase required clerkships must be completed prior to taking Step 2-CK.
- Step 2-CK should be taken after completion of the Patient Care Phase and no later than June 30 of the third For students who complete their Patient Care Phase off-cycle from the projected timeline, Step 2-CK should be taken within 12 weeks of completing the required Patient Care clerkships.
- Successful completion of Step 2-CK will be noted on the MSPE. Delays in taking Step 2-CK beyond the deadline will be noted by the deficiency the exam is taken.
- Step 2-CK must be successfully completed with a passing score in order to participate in the residency match. Failure to complete either the exam on the established timeline, whether by failure or by delay, may prohibit the student from participating in the residency match.
Curricular Oversight & Improvement
The undergraduate medical school curriculum at the University of Washington School of Medicine (UWSOM) is designed to provide students with a strong scientific foundation and a comprehensive approach to clinical medicine.
The oversight and management of the curriculum, including the medical school program objectives and competencies, are the responsibility of Curriculum Committees, as established by the Dean for the School of Medicine.
The educational leadership, i.e., block, course and thread directors, teaching faculty, Associate Dean for Curriculum, and the Curriculum Committee and its subcommittees, have responsibility for developing and implementing a curriculum that is appropriate for the education and training of students for the practice of medicine. The curriculum is educationally equivalent at each Foundations site, and common examinations are given to ensure that all students achieve the same level of competence.
Processes are in place to ensure continuous quality improvement in the structure, content and processes of the curriculum. The Associate Dean for Educational Quality Improvement plays a key role in working with the Associate Dean for Curriculum, the Curriculum Committee, and other faculty involved in curriculum to ensure that continuous quality improvement is an ongoing priority.
WWAMI Medical Education Program
The University of Washington School of Medicine medical educational program is a regional, four-year MD program for residents of the states of Washington, Wyoming, Alaska, Montana, and Idaho (WWAMI). The UWSOM respects the universities housing the WWAMI program governance structures while maintaining program comparability and congruence across sites and meeting LCME standards.
The UWSOM’s Academic Affairs administration provides leadership and structure for ongoing communication and dialogue among faculty responsible for curriculum, student learning and evaluation at all sites. Common standards that apply to all WWAMI sites are expected for teaching faculty appointments, evaluation, and retention. Expectations of student participation and contribution to their learning in both coursework and patient care settings will be clearly communicated in a variety of settings. Each Foundation’s site structure is required to include a designated administrative position to manage all aspects of the delivery of the curriculum and support of its students in collaboration with the appropriate Academic Affairs Associate Deans.
The Academic Affairs and Regional Affairs educational leadership manage issues such as expansion of the number of students overall, number of students in Targeted Rural Underserved Track (TRUST), WWAMI Rural Integrated Training Experience (WRITE), city and state based tracks and other special programs, development of additional first year or clinical sites, and the scope of the MD program delivered at all sites. Protocol for establishing and retaining clinical educational sites, including the creation of unique longitudinal sites will be followed.
In addition, the Office of Academic, Rural and Regional Affairs provides individual state legislatures information regarding state funding and programs, such as paybacks, that affect a state’s students. A unified educational planning approach in collaboration with the legislative process will support the maintenance of the standards of the medical student program and assist in developing sound state initiatives aimed at increasing the number of healthcare providers within the WWAMI region.
Special Curricular Programs & Opportunities
The MD program provides a variety of clinical settings in which students can explore medicine as it is delivered in rural, urban, and underserved settings. The options may include summer programs, pathways, and longitudinal clinical programs. City and state-specific tracks permit students to complete the required clinical clerkships and a number of electives in their home states.
Pathways provide students an opportunity to take selected coursework with an emphasis on specific skill sets or specific populations:
- The Global Health Pathway provides medical students with the information and experiences necessary to practice in underserved communities It is designed for students interested in research or clinical practice in resource poor settings and with international communities.
- The Latinx Health Pathway provides medical students with experiences and educational opportunities in the area of Hispanic health. This pathway is designed for students interested in experience or clinical practice in urban or rural communities with a high Hispanic
- The Indian Health Pathway provides medical students with experiences and educational opportunities in the area of Native American health. The coursework includes health issues that affect American Indian and Alaska Native (AI/AN)’s and provides preceptorships in tribal and urban Indian health settings.
- The LGBTQ Health Pathway provides medical students with experiences and educational opportunities in the area of LGBTQ health. The coursework is designed to enable students to provide LGBTQ- competent healthcare.
- The Underserved Pathway provides medical students with a general introduction to communities with health disparities, such as rural, homeless and various racial and ethnic groups. This pathway is for students who are considering careers working with underserved patients and want a broad exposure to underserved populations and
- The Black Health Justice Pathway provides a curriculum that highlights the systemic oppression of Black people and its resulting socioeconomic and health sequelae. This pathway provides students with the foundational knowledge to assess health inequities through a critical lens. The pathway provides students with tools to advocate for health equity within the UWSOM, in Black communities throughout WWAMI, and in their future practices as physicians.
- The Humanities and the Arts Pathway provides a unique educational experience for students to thoughtfully and creatively engage with patient stories and the experience of becoming a physician using specialized modules, clinical experiences, reflection, and creative expression.
- The Spokane Leadership Pathway provides a foundation for students to be capable, effective physician-leaders within their organizations and communities.
- The Clinical and Translational Research Pathway introduces students to the key components and framework of designing, implementing and disseminating the results of clinical or translational research.
Targeted Rural and Underserved Track (TRUST)
The TRUST program is focused on training specially qualified and selected students to serve in underserved areas, including both rural and small city community health centers. Students participating in TRUST are required to complete the WRITE program during their Patient Care Phase. Application to the TRUST program occurs during the medical school admissions application cycle.
Community-focused Urban Scholars Program (CUSP)
CUSP is focused on training specially qualified and selected students to serve in urban underserved areas. Application to this program occurs between medical school acceptance and matriculation.
Rural/Underserved Opportunities Program (R/UOP)
R/UOP is a four-week, elective immersion experience in community medicine for students between their first and second years of medical school. When done in conjunction with a community-based scholarship project, R/UOP may be used to meet the III requirement. During the four-week rotation, students live in rural or urban underserved communities in the WWAMI region and work side-by-side with local physicians providing healthcare to underserved populations. Application to this program occurs in December of the student’s first year.
Area Health Education Centers (AHEC) Scholars Program
Beginning in the 1970s, the AHEC program was launched to develop a rural and urban underserved workforce, focused on addressing the needs of these communities. The University of Washington received the five-year HRSA grant for the WWAMI AHEC Scholars program in September 2017. The program targets health profession students who are seeking a degree or certificate, specifically targeting students from disadvantaged backgrounds. The purpose of the AHEC Scholars program is to develop a rural and urban underserved workforce that will be educated on core issues facing such communities. The program is based on interprofessional education (IPE) and meant to encourage team-based learning and clinical care. These objectives are the same as many of the School of Medicine’s special programs and will highlight the work these medical students are doing with this nationwide certificate. Students from disadvantaged backgrounds are particularly encouraged to participate although anyone in good standing can apply.
The Track program allows students to complete 24 weeks of the Patient Care phase and 12 weeks of the Explore and Focus phase required clerkships in one specific city or state in the WWAMI region. Students participating in this program are required to meet their minimum time of eight weeks of required clerkships in Seattle. Application to this program for the Patient Care Phase occurs during the spring of the student’s first year. Application to this program for the Explore and Focus Phase occurs during the spring of the student’s second year.
Greater Seattle Option
The Greater Seattle Option (GSO) allows students to complete 24 weeks of the Patient Care phase required clerkships in the greater Seattle area, including Everett, Renton, and the Eastside. It does not include Bremerton, Tacoma or Madigan. Application to this program occurs during the spring of the student’s first year. Interested students should contact the Curriculum Office, firstname.lastname@example.org, for more information.
WWAMI Rural Integrated Training Experience (WRITE)
The WRITE program provides a four to five-month opportunity to work with physicians in a rural area during the Patient Care Phase of the clinical curriculum. Application to this program occurs during the spring of the first year.
Olympia Longitudinal Integrated Clerkship (LIC)
The Olympia LIC program allows students to complete the majority of the Patient Care phase required clerkships in Olympia, Washington and its surrounding communities. Students participating in this program are required to meet their minimum time of eight weeks or required clerkships in Seattle during the Patient Care and Explore and Focus phases. Application to this program occurs during the spring of the students’ first year. Interested students should contact the Assistant Dean for Rural Programs, Dr. John McCarthy, email@example.com, for more information.
Any faculty who supervise and assess students must have a faculty appointment.
Requirements, Procedures and Guidelines
The faculty appointment process must be initiated prior to or at the time of a new site application. The process and criteria for appointment are determined by the sponsoring department.
Faculty instructors at WWAMI partner universities (Gonzaga University, University of Wyoming, University of Alaska Anchorage, Montana State University, and University of Idaho) who have a leadership role in the Foundations Phase for WWAMI medical students at their site are expected to have a University of Washington faculty appointment. Their primary faculty appointments are in their home departments, but they should also have affiliate faculty appointments in the appropriate department at the University of Washington School of Medicine. The process and criteria for affiliate appointments are determined by the sponsoring department. The Office of Academic, Rural and Regional Affairs provides oversight of the faculty appointment process for those involved in medical student education and is in charge of tracking faculty appointments for all regionally-based teaching faculty to ensure that faculty status is initiated or in place and is current.
Physicians who have a leadership role in student clinical education are expected to have affiliate faculty appointments in the appropriate department at the University of Washington School of Medicine or be appointed as University of Washington volunteer clinical faculty. Faculty with major teaching responsibility in clinical education are expected to have a University of Washington Faculty/Volunteer Clinical Faculty appointment as soon as possible after beginning their work with students. The process and criteria for affiliate and volunteer clinical faculty are determined by the sponsoring department.
While not all physicians who may interact with a student at a site are required to have a faculty appointment, the primary preceptor and any physicians who will evaluate a student will have a faculty appointment.
Approval of Clerkship Sites for Required & Elective Rotations
Additional training sites for medical students must be developed to accommodate increased class size, new hospital affiliations, and changing patterns of healthcare delivery. Clerkship directors, departments, regional WWAMI deans, and the Office of Academic, Rural and Regional Affairs should work together to determine and meet the need for new clerkship sites. The initial responsibility for reviewing a site’s adequacy as a trial site for a required or elective rotation lies with the department. If the site is outside Seattle, the WWAMI regional clinical dean is also involved in the process. A careful review of course objectives, resources, and general acceptability should be carried out and reported as a recommendation for approval of the new clerkship site.
Ongoing monitoring and oversight of clinical training sites is the responsibility of the Associate Dean for Curriculum, Departments, Regional Clinical Deans and the Curriculum Committee.
Gina Franco, Clinical Curriculum