Phase 1 of the ForWard Curriculum focuses on basic science while fully integrating clinical science and public health and is completed within 18 months of matriculation.

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.

In week 2, you explore how patients’ culture, community, religion and spirituality impact their health and experience of illness. You learn how the social and family history can illuminate those factors during the medical interview.

In week 3, you consider the various health-related systems that can impact a person's health and illness, including 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.

The block finishes in week 4 by contemplating the importance of each individual physician in health promotion. The first anatomic dissection 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.

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.

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.

Next, 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, 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.

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 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.

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 around vaccination and public health/ethics in research and clinical trials. Clinical skills include oral reporting and the head and neck physical exam.

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 effect these systems.

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.

Centrally, your focus will include the spinal column, spinal cord, brain, skull base, intracranial vessels and special senses. In this 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.

The final subsection of the course includes 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.  

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