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Phase 1 – MD Curriculum

Phase 1 of the ForWard Curriculum focuses on basic science while fully integrating clinical science and all curriculum threads. This phase is completed within 18 months of starting medical school. A primary feature of Phase 1 is small group case-based learning through Patient-Centered Education (PaCE) Cases.

Phase 1 Blocks

Patients, Professionalism and Public Health

Patients, Professionalism and Public Health establishes a strong foundation for a student’s professional identity formation as a physician. The course begins with “Faces of Patients,” where you see the impact of illness on the lives of patients and their loved ones. The concept of patient-centered care is introduced and practiced through real and standardized patient interviews. You will be asked to look beyond immediate measures of health toward the many upstream determinants of health that impact your patients’ lives.

You are introduced to the concept of health equity, which is the goal of providing everyone a fair shot at being as healthy as possible. You will learn how racism, bias and structural inequities threaten that goal, and ways you as a physician can work to overcome those obstacles. You will explore how patients’ culture impacts their health and how the social history can illuminate those factors during the medical interview.

You consider the various health-related systems that can impact a person’s health and illness, including their community, the health care system, the public health systems and the role of quality improvement. Students see how effective health care can only be delivered by working as a part of an interdisciplinary team.

Finally, you will contemplate the importance of each individual physician in health promotion. Your first encounter with human anatomy as a medical student allows further exploration of the sacred role of physician and the unique privilege and responsibilities of the profession. The course ends with “Faces of Physicians,” where you will delve into the myriad ways that physicians can advocate for health, whether it be for a single patient or for an entire population.

Learning Objectives
  • Demonstrate appropriate communication skills while obtaining the medical history and taking vital signs, including the social and spiritual factors that affect a patient’s experience of illness
  • Recognize the role that culture, identity and community play in health and health care both at a systemic and individual level
  • Identify and demonstrate effective methods for giving and receiving feedback
  • Justify an interdisciplinary team approach to health care and effectively communicate your role to patients, families and other team members
  • Apply key ethical principles and approaches to confidentiality, the use of health records and common clinical scenarios
  • Describe how upstream determinants impact health generally and as applied to patients with diabetes and opioid use disorders
  • Describe importance of scientific inquiry and the role of epidemiology as a basic science for medical research, evidence-based clinical practice, and public health practice
  • Describe strategies to identify and address community health needs and health disparities
  • Explain the basic features of the U.S. health care and public health systems
  • Justify the dual roles that physicians play in advocating for both individual and population health
  • Demonstrate professional behaviors that foster positive relationships and explain how a lack of these behaviors can negatively impact learning and patient care
  • Identify areas for personal improvement and set goals to affect change in those areas, tracking progress toward attainment of goals
  • Demonstrate effective teaching when instructing peers
  • Integrate concepts across multiple domains using guided inquiry to identify gaps in knowledge and find appropriate resources to address those gaps
  • Describe fundamental basic science concepts related to tissue and tissue injury and demonstrate appropriate techniques in the dissection of the skin and breast
  • Describe how wellness and learning through reflection impact a physician’s ability to care for patients

Body in Balance

Body in Balance covers the key processes involved in maintaining internal balance in the body. In this course, you will follow the path of the red blood cell and will pause to review normal function and disease at each step of the journey.

You will begin with the birth of the red blood cell in the bone marrow and a discussion of anemia. Then there will be an introduction to the processes involved in bleeding and clotting followed by a discussion of hemostatic and thrombotic disorders. Following our red blood cell through the circulation, you will stop to review the mechanical and electrical functions of the heart and will learn about the dynamic control of vascular function, along with the importance of the lymphatic system.

Atherosclerosis is introduced as the underlying process of cardiovascular disease, and the rupture of a coronary plaque allows for you to see the clotting cascade in action. We then find our red blood cell in a heart that has gone awry. You will discuss etiologies and treatments of electrical disturbances, cardiac inflammatory diseases, valvular dysfunction and heart failure.

Next, you will follow our red blood cell as it travels through the pulmonary circulation, where it participates in gas exchange as you review lung function and common lung diseases.

The final stop on the circulatory tour is through the kidneys, which function in waste disposal as well as regulation of hemodynamics, water and electrolyte balance, and acid/base status. The close coordination of the cardiovascular and renal systems as long-term regulators of blood pressure is highlighted via discussion of congestive heart failure and hypertension. The course closes with a discussion of various causes and manifestations of renal dysfunction.

Examples of integrated longitudinal threads include a discussion of the ethics and stewardship of transplantation in chronic kidney disease, randomized controlled trials involving treatments in stroke prevention, and environmental health and its impact on disease states such as obstructive lung disease.

Learning Objectives
  • Describe hematopoiesis and normal red blood cell biology, composition and function, and describe the underlying pathologic processes, clinical features, and management of anemias
  • Describe the normal structure and function of the cardiac system
  • Describe the underlying pathologic processes, clinical features and management of disorders of the cardiac system
  • Describe the normal structure and function of the vascular system
  • Describe the underlying pathologic processes, clinical features and management of disorders of the vascular system
  • Describe normal platelet biology including the role of platelets in hemostasis and thrombosis, and describe the underlying pathologic processes, clinical features and management of various thrombotic and bleeding disorders
  • Describe the normal structure and function of the respiratory system
  • Describe the underlying pathologic processes, clinical features and management of disorders of the respiratory system
  • Describe the normal structure and function of the renal system
  • Describe the underlying pathologic processes, clinical features and management of disorders of the renal system
  • Describe normal acid-base balance and the normal handling of water and electrolytes
  • Describe the underlying pathologic processes, clinical features and management of acid-base disturbances and water and electrolyte imbalances
  • Describe basic principles of pharmacology and pharmacokinetics
  • Describe and critique various approaches for generating a differential diagnosis
  • Analyze and critique study design and issues of interpretation in clinical research, analyze biostatistics reported in clinical trials and describe an overarching framework for evidence-based medicine
  • Demonstrate appropriate clinical skills in the evaluation of cardiovascular and pulmonary conditions
  • Analyze principles of screening and interpretation of diagnostic test results
  • Explain the importance of stewardship and the ethical implications of rationing and the right of refusal of care in the health care system
  • Demonstrate effective teaching when instructing peers
  • Identify and demonstrate effective methods for giving and receiving feedback
  • Demonstrate professional behaviors that foster positive relationships and explain how a lack of these behaviors can negatively impact learning and patient care
  • Identify areas for personal improvement and set goals to affect change in those areas, tracking progress toward attainment of goals
  • Integrate concepts across multiple domains using guided inquiry to identify gaps in knowledge and find appropriate resources to address those gaps
  • Provide examples of how the social determinants of health affect individuals, families and communities, thus contributing to health disparities
  • Demonstrate behavior that fosters effective communication and collaborative relationships with an interprofessional team while respecting diverse perspectives and roles
  • Provide examples and explain outcomes of clinical practices and public health programs that aim to reduce detrimental environmental exposures in order to educate and protect patients and populations
  • Describe key concepts related to health care costs and health care payers in the U.S.
  • Discuss ethical issues in the setting of human-studies research

Food, Fasting and Fitness

Food, Fasting and Fitness explores the chain of events by which food is converted to energy, highlighting the key role of nutrition and exercise in the maintenance of optimal health. Starting with food on a plate, you will learn the importance of the various macro- and micronutrients and healthy food choices. You will explore the role of nutrition in maintaining the health of individuals as well as the health of communities.

You will learn about the digestive system and the processes that allow food to become nutrients in the bloodstream. The absorption of these nutrients is sensed, prompting endocrine signals that inform cells that nutrients are available for uptake and use. You will learn about these signals and also the cellular biochemical processes involved in the burning and storing of energy by cells.

Following this, you will compare and contrast the fed state with processes that are instituted by the body to allow survival in between meals and with prolonged fasting. Understanding of these mechanisms underpins discussion of the increasing health threat of metabolic disorders such as diabetes, obesity and lipid disorders. You will explore the metabolic changes that occur with exercise and the role of exercise and fitness in good health. Finally, discussion of the removal of waste products and toxins completes an integrated picture of metabolism.

Examples of integrated longitudinal threads include advocacy surrounding nutrition in communities, public health related to impact of climate change on food, use of the electronic medical record and quality improvement in medical care, discussion of health literacy in the setting of diabetes care and exploring fundamental principles of scientific inquiry via critical examination of nutrition guidelines.

Learning Objectives
  • Describe the underlying risk factors, pathologic processes, clinical features, prevention and management of macro- and micro-nutrient deficiency and toxicity and malnutrition throughout the life cycle
  • Describe the normal structure and function of the digestive system
  • Describe the underlying pathologic processes, clinical features, and management of disorders of the digestive system
  • Describe the role of endocrine and biochemical pathways in normal metabolism and describe the underlying pathologic processes, clinical features, prevention and management of disorders of metabolism, including diabetes, obesity and obesity-related diseases
  • Describe the normal role of the various endocrine regulators of metabolism (including thyroid hormone, glucocorticoids and growth hormone) and describe the underlying pathologic processes, clinical features and management of disorders of these hormone systems
  • Discuss the role of exercise and fitness in health and disease prevention
  • Explain the mechanisms of removal of waste and toxins and how these enable accurate diagnosis and guide pharmacologic treatment
  • Identify and demonstrate effective methods for giving and receiving feedback
  • Demonstrate professional behaviors that foster positive relationships and explain how a lack of these behaviors can negatively impact learning and patient care
  • Identify areas for personal improvement and set goals to affect change in those areas, tracking progress toward attainment of goals
  • Demonstrate effective teaching when instructing peers
  • Integrate concepts across multiple domains using guided inquiry to identify gaps in knowledge and find appropriate resources to address those gaps
  • Describe how the health of a community can be assessed, including the contributors to and impact of health disparities
  • Explain the importance partnering with communities and describe the physician’s role as an advocate in promoting the health of patients, families and communities
  • Demonstrate appropriate clinical skills in the evaluation of nutritional, gastrointestinal and metabolic conditions, including the basics of informed consent and the use of the electronic medical record
  • Describe the importance of quality improvement and patient safety in health care systems and demonstrate behavior that fosters effective communication and collaborative relationships with an interprofessional team
  • Discuss the roles of scientific inquiry and evidence-based medicine in advancing knowledge to improve patient care and population health
  • Demonstrate communication skills that accommodate varying levels of health literacy and that facilitate relationship-building
  • Discuss concepts related to cost effectiveness in health care

Human Family Tree

Imagine that you are a new family medicine physician in a busy practice. Your 11 o’clock appointment is a young couple that recently moved to town. The couple wishes to establish a primary care medical home with you. During the visit, they inform you that they are hoping to start a family soon. Human Family Tree will follow your journey with this couple and their family, through the remainder of their life cycle.

You will explore the molecular, genetic, embryologic, hormonal, anatomical, and physiological factors that govern fertility, cell growth, fetal development, and pregnancy, as well as the congenital anomalies that can occur when those processes are aberrant.

Your journey with the family will continue through the birth of their child, when you will discuss lactation and newborn screening while later exploring childhood growth and development. You will grapple with difficult issues that can affect families such as domestic and child abuse. You will follow their child’s development into young adulthood and learn about the biological basis of puberty and discuss issues affecting adolescents and young adults. You will explore concepts important to ensuring inclusive and equitable treatment of those who identify as part of the LGBTQ+ community.

You will explore the genetic basis of human disease and how to screen the family for conditions that might impact their health and/or reproductive risk. You will learn about the hormonal and physiological changes in reproductive health with menopause and aging. You will also learn about the consequences of unregulated cell growth (cancer) to your patient and their family. And finally, you will support the family through end-of-life issues brought on by cancer in a family member.

Examples of integrated longitudinal threads include evidence-based medicine and health policy related to fertility treatments, health disparities in cancer prevention/screening, and reproductive ethics.

Learning Objectives
  • Apply knowledge of genetics and genetic disorders to the care of patients and families
  • Describe the molecular processes involved in cell replication and in human reproduction
  • Describe the normal structure and function of the male and female reproductive systems
  • Describe the underlying pathologic processes, clinical features, and management of disorders of the reproductive system
  • Describe the normal physiology and disorders of pregnancy, lactation, childhood growth, development, and puberty
  • Describe the underlying molecular and pathologic processes, clinical features, and management of cancers and other neoplasms, including the role of palliative care
  • Describe the events that occur during human embryological and fetal development
  • Identify and demonstrate effective methods for giving and receiving feedback
  • Demonstrate professional behaviors that foster positive relationships and explain how a lack of these behaviors can negatively impact learning and patient care
  • Identify areas for personal improvement and set goals to affect change in those areas, tracking progress toward attainment of goals
  • Demonstrate effective teaching when instructing peers
  • Integrate concepts across multiple domains using guided inquiry to identify gaps in knowledge and find appropriate resources to address those gaps
  • Demonstrate appropriate clinical skills in the evaluation of reproductive health and disorders of the reproductive system
  • Discuss key concepts and demonstrate skills related to caring for patients who have experienced sexual assault or intimate partner violence
  • Describe an overarching framework for EBM and the importance of identifying knowledge gaps and framing clinical questions
  • Discuss the impact of advocacy and of policy-based interventions on health outcomes
  • Analyze ethical issues related to pediatric care, reproductive health, and genetics
  • Describe the importance of quality improvement and patient safety in health care systems and demonstrate behavior that fosters effective communication and collaborative relationships with an interprofessional team

Invaders and Defense

Invaders and Defense covers material in the areas of microbiology, immunology, infectious disease, autoimmune disease, hematologic malignancy and dermatologic disease. You will first learn about the “foot soldiers” of innate immunity — those charged with handling routine invasions and threats, followed by the “special forces” of the adaptive immune system. The importance of the integumentary system as the “coast guard” will be discussed, with study of normal skin function and dermatologic pathology, infectious, inflammatory and neoplastic.

You will discuss the nature and clinical manifestations of the various types of biological invaders (bacteria, viruses, fungi and parasites), the clinical syndromes that they are associated with and mechanisms used to fight these infections.

The analogy continues to be helpful to understand the concepts of immune deficiency — where one or more elements of the normal defense system break down (or is purposely suppressed, such as in transplantation) — as well as autoimmunity, where normal tissues are attacked and damaged due to “bad intel” and “friendly fire.” Hematology malignancy presents as a “coup” — when some element of the immune system ceases to function within its role and overtakes and destroys normal immune function.

Examples of integrated longitudinal threads include shared decision-making and autonomy, focusing on the legal, ethical and public health aspects of vaccination. Clinical skills include oral reporting and the head and neck physical exam.

Learning Objectives
  • Identify and demonstrate effective methods for giving and receiving feedback
  • Demonstrate professional behaviors that foster positive relationships and explain how a lack of these behaviors can negatively impact learning and patient care
  • Identify areas for personal improvement and set goals to affect change in those areas, tracking progress toward attainment of goals
  • Demonstrate effective teaching when instructing peers
  • Integrate concepts across multiple domains using guided inquiry to identify gaps in knowledge and find appropriate resources to address those gaps
  • Describe how the normal innate and adaptive immune responses function and interact to promote microbial defense and repair of tissue injury
  • Apply knowledge of skin structure and function, innate and adaptive immunity, and microbiology to the explain the mechanisms, clinical and laboratory findings and treatments of dermatologic disorders and neoplasia
  • Apply basic knowledge of pathogenic and commensal microorganisms to explain the biologic mechanisms, clinical and laboratory features and potential therapeutic approaches to infectious diseases and syndromes
  • Apply knowledge of the normal immune system to explain the biologic mechanisms, clinical and laboratory features, and potential therapeutic approaches to systemic autoimmune (rheumatologic) disorders
  • Apply knowledge of the molecular basis of neoplasia to explain of the biological behavior, morphologic appearance, classification, diagnosis, prognosis and targeted therapy of hematologic neoplasms
  • Apply principles of public health and scientific-inquiry in the setting of infectious disease management and prevention
  • Discuss ethical issues surrounding governmental powers, individual autonomy and the population good
  • Demonstrate skills in evidence-based medicine, including the ability to effectively search for evidence and interpret randomized controlled trials
  • Demonstrate skills to promote quality improvement and patient safety in health care systems and demonstrate behavior that fosters effective communication and collaborative relationships with an interprofessional team
  • Demonstrate appropriate clinical skills, with a focus on communication skills, shared-decision making and patient safety/infection prevention, in both the inpatient and outpatient setting

Mind and Motion

The final Phase 1 block, Mind and Motion, brings together concepts in musculoskeletal, neurologic, ophthalmologic, and psychiatric medicine as well as basic science domains of anatomy, neuroscience, neuroanatomy, cell biology, and neuro- and psychopharmacology. This is accomplished through analysis of the structure and functions of the central nervous system, peripheral nervous system and musculoskeletal system, as well as study of the disease processes that affect these systems.

The course will begin with an exploration of normal behavioral process and common psychiatric disorders including well-defined diagnostic criteria, use of the psychiatric interview to elicit signs and symptoms, and various therapies.

You will then shift your focus to the spinal column, spinal cord, brain, skull base, intracranial vessels and special senses. In this neurology course component, you will explore how lesions at specific locations along the neuraxis result in predictable neurologic symptoms for pathologic conditions including stroke, multiple sclerosis, trauma, intracranial hemorrhage, tumors and CNS infections, to name a few. The structure and electrical functions of neurons will be discussed, as well as their complex assembly into the brain and spinal cord nuclei and tracts.

Finally, you will explore several common musculoskeletal conditions (fractures, osteoarthritis, a variety of sports injuries, joint pain and nerve entrapment syndromes, among others). Through these common patient presentations, you will develop an understanding of limb anatomy and the specialized tissues of bone, muscle, tendon/ligament, cartilage and nerve.

Examples of integrated longitudinal threads include the ethics of informed consent and conflicts of interest in interactions with industry, in addition to cultural humility, determinants of health care cost, appraising evidence, quality improvement and interprofessional education.

Learning Objectives
  • Apply principles of embryogenesis in demonstrating the functional and structural organization in the normal and abnormal central nervous system (CNS), peripheral nervous system (PNS) and musculoskeletal system
  • Name and identify key anatomic structures of the CNS, PNS, joints and limbs on diagrams, gross photos, imaging studies and cadaveric specimens
  • Apply knowledge of the structure and function of specialized cells within the nervous and musculoskeletal systems and identify their role in common abnormal conditions
  • Use validated screening tools to diagnose musculoskeletal, neurologic and psychiatric diseases and synthesize information gathered during the history and physical examination to distinguish between normal and abnormal (common and dangerous) conditions
  • Map the major ascending and descending pathways of the central nervous system and relate them with associated physiologic and pathophysiological processes and apply this knowledge by localizing lesions based on a patient’s history and physical exam findings
  • List the categories of psychiatric illness and describe the major features of each category
  • Explain the neuroanatomical and physiologic basis for cognitive and emotional systems, including memory, attention and emotion regulation in response to stress
  • Describe the pathophysiology, epidemiology, presentation, course and prognosis of the major neurologic, orthopedic and psychiatric disorders
  • Recommend appropriate pharmacological and non-pharmacological therapies for major psychiatric, ophthalmologic, musculoskeletal and neurologic conditions, specifically considering major drug categories, basic mechanisms of action, anticipated side effects, contraindications, precautions and potential interactions with other drugs
  • Identify and demonstrate effective methods for giving and receiving feedback
  • Demonstrate professional behaviors that foster positive relationships and explain how a lack of these behaviors can negatively impact learning and patient care
  • Identify areas for personal improvement and set goals to affect change in those areas, tracking progress toward attainment of goals
  • Demonstrate effective teaching when instructing peers
  • Integrate concepts across multiple domains using guided inquiry to identify gaps in knowledge and find appropriate resources to address those gaps
  • Demonstrate appropriate clinical skills in the evaluation of psychologic, neurologic and musculoskeletal conditions, with a focus on motivational interviewing, reflective practice and how bias can impact diagnostic approaches
  • Participate in a team-based quality improvement project and discuss the current state of health care quality, safety and determinants of cost in the U.S. and worldwide
  • Analyze the impacts and potential conflicts of interest that exist in relationships between health care providers and industry
  • Analyze and reflect on the effects of race, class, religion and culture in health care
  • Analyze the process and ethical principles involved in obtaining informed consent or in mandating involuntary treatment
  • Use meta-analyses in the evidence-based care of patients