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Curriculum

The Virginia Commonwealth University M.D.-Ph.D. program is a seven to eight year program where students complete both medical and Ph.D. training. Although each phase focuses on its specific training, programs and coursework are integrated so that the medical student is well versed in relevant science and the graduate student stays in touch with clinical medicine. The new medical school curriculum that began with the entering class in 2013 offers multiple opportunities for the MD-PhD Program to innovate and adds more flexibility to the curriculum. The 2013 entering class was the first to be taught entirely in the new James W. and Frances G. McGlothlin Medical Education Center, our new medical school education building.

M.D.-Ph.D. students first complete their didactic medical school years (MS1, MS2a, MS2b) in December of their second year in the new curriculum and take the USMLE Step 1 board exam in March.

After successful completion of USMLE Step 1, MD-PhD students have four months before they begin their graduate or “G” phase in August. During this time they will take 8 weeks of M3 clinical clerkships beginning the third week of April (orientation) and extending until the second week of July. The remaining time (March – April and July – August) is elective and can be spent in outlining a thesis project or in finding an appropriate thesis lab if one has not already been chosen.

Once students enter the PhD or "G" phase in August they must successfully complete their required coursework, candidacy exams and Ph.D. defense.

Following successful defense of the Ph.D. thesis, students return to medical school to complete their clinical rotations. Rotation schedules are flexible for M.D.-Ph.D. students and may be personally tailored to their future clinical endeavors. Since students will have taken an 8 week clinical block before entering the G phase they will have more flexibility on reentry into M3, providing an approximate 3-month window after the usual April reentry date.

Specific faculty in both the M.D.-Ph.D. program and the curriculum office meet with students at each transition point to help devise the best option in relation to their career goals.

Program Timeline

Select program phase:

Pre-MS1: June-August

Each student will complete two, three-week rotations in laboratories of potential Ph.D. thesis advisers during the summer before they begin their M1 year. While three weeks is not enough time to finish any meaningful project, it gives the student a chance to feel the dynamics of the lab and to sample some of the techniques routinely used. Students can choose lab mentors by going to the web and looking at the list of faculty associated with the program, or they can suggest program areas and one of the M.D.-Ph.D. directors will provide names.

During these six weeks, there will be organized, weekly presentations by someone from each department and program in which they can do research. In addition, they are encouraged to talk to as many faculty as possible who are doing research in areas that interest them.

MS1: August-January

The first six months of the New Curriculum is called the Scientific Foundations of Medicine and focuses on the normal human structure, function, growth and development. View an outline of the MS1 curriculum. (link to MS1curriculum). In addition to the lecture courses, students participate in Physician, Patient and Society; Growth, Development and Aging; Population and Public Health; Genetics; and Practice of Clinical Medicine all of which run longitudinally throughout M1 and M2. The Practice of Medicine will teach students physical diagnosis and doctor-patient interactions and will make use of the new, state-of-the-art simulation center in the new medical school building. Throughout the new curriculum, students will be divided into smaller groups. All MD-PhD students will be in the same group and, where possible, their group education will focus more heavily on basic science than will the groups for the other medical students Every two weeks MD-PhD students will meet in the afternoon for 2 hours for a journal club. Basic science articles are chosen by faculty teaching in the curriculum ongoing at that time. All students are expected to read and discuss each article.

 

Summer between MS1-MS2a: Students complete two additional laboratory rotations in laboratories of their choice.

MS2a: January-June

In MS2a the curriculum shifts from the Scientific Foundations of Medicine taught in MS1 to the Applied Medical Sciences Curriculum. This curriculum is organ-system-based and emphasizes clinical manifestations of disease. The longitudinal courses and the MD-PhD journal clubs continue from MS1. View a list of the courses taught in the M2 year.

MS2b: August-January

The applied Medical Sciences Curriculum continues as do the longitudinal courses. An interactive course specifically designed for M.D.-Ph.D. students, called Science and Disease, is taught in the MS2b year. This course allows physician-scientist faculty members or a team of clinicians plus basic scientists to present a case patient. The patient is often brought into the classroom and then the faculty member discusses some aspect of the basic science behind the pathologic process in detail.

Board Study

Students take the USMLE Step I board exam in March and the time from January to March is designated as study time. However, it is also elective time and can be used for investigating additional thesis labs as well.

Pre-G1

Following the board exam (mid-March) students will have until mid-April as elective time. This time can be spent getting started on the PhD thesis project or, if no lab or thesis mentor has yet been found, this time can be spent on additional rotation(s). M3 clerkship orientation begins mid to late April/early May, followed two weeks later by the first four-week clerkship. The two four-week clerkships should be completed by mid-July. There will be a month before the formal start of the G1 graduate phase (late August) which should be used to settle in to the research lab, choose a thesis committee and identify courses to be taken.

G1

Students choose a thesis committee, within the first two months and begin Ph.D. coursework.

Students have only a few required courses (e.g. Lab Safety and Scientific Integrity) during this phase. Courses are recommended by their thesis committees that do not duplicate the medical curriculum and are largely completed during the G1 year. Students are strongly encouraged to take courses in biostatistics and/or bioinformatics.

Students select a clinical mentor at this time who may also be a member of their thesis committee. This person should be a full-time School of Medicine faculty member who is seeing patients with diseases related to student’s area of research. Students should spend an average of one day per month seeing patients throughout the graduate phase but are encouraged to engage in a translational project that involves their clinical mentor and patient interactions.

G2-G4

Students successfully complete oral and written candidacy exams (qualifying exams), typically during the summer between G1 and G2. Successful completion adds $1,000 per year to their stipends for the duration of their time in the M.D.-Ph.D. program.

Students must write a grant as the basis of their oral exams and will submit this grant for funding to either the NIH (F30 or F31) or an appropriate foundation (e.g. American Heart Association or the American Cancer Society). If they are successful in getting their grant proposal funded they will get another $1000 added to their stipend for the duration of their time in the program.

The remainder of the G-phase is committed to relevant conferences, seminars, journal clubs, laboratory work, manuscript submission and work towards successful completion of the Ph.D. thesis.

M3

Orientation and M3 clerkships begin the middle of April but MD-PhD students who are returning will have a lot of flexibility in their return dates. In addition to already having completed 8 weeks of clerkships before entering the G phase, there is a lot of elective time built into the new curriculum. This elective time can be truncated to further shorten the required M3 clerkship rotations. Alternatively, students who enter on time in April – May can customize their M3 rotations to allow for specific electives either at VCU or away.

Transition

The transition from one phase of the program to another can be difficult and thus, the faculty and staff try to make the process as easy as possible. Specific faculty in both the M.D.-Ph.D. program and the curriculum office meet with students at each transition point (summer to M1; M2 to G1; G phase to M3; M4 to residency match) to help devise the best option for each transitioning student in relation to their career goals.

 

Transition can be particularly difficult between the G phase and returning to M3. While patient contact and patient examination skills should have been sustained by sessions with the clinical mentor throughout the G phase and clerkship dynamics and minutiae were experienced during the 8 weeks of rotations taken before entering G phase, there is usually a serious gap in the knowledge of clinical medicine. The last exposure to clinical problems and disease pathophysiology was 4 years before during MS2a and MS2b. Therefore, we have devised two preparation mechanisms for returning students. First, there is a week-long session before M3 orientation with faculty clinicians who present cases and review common clinical problems.

Reading is assigned for each session. Second, the Program purchases the Q bank of questions, taken from Step II USMLE board exams, to revive multiple choice exam skills that are essential for the shelf exams that end each clerkship and comprise a sizable chunk of the final grade.

M4

Each M4 MD-PhD student is expected to complete a senior research project. This project is outlined during the first month of the M4 year and is completed over the ensuing year. It is clinical/translational in nature; it may build on the PhD research thesis but does not have to; the mentor and project are chosen and outlined by the student; and it can be completed at another institution. There will be two to three consecutive months available during M4 when most of the project can be completed.

There are several required experiences for all medical students during the M4 year: study for and completion of the USMLE step II exam (completed during the summer); two acting internships (can be completed at VCU or as an away elective); and a month of ICU/emergency medicine. Other than these requirements the rest of the M4 year is elective and is devoted to the senior project, interviewing for residency and away electives.

Residency Advising

Residencies are increasingly competitive and it is important for MD-PhD students to get an idea of their chosen specialty as soon as possible, ideally before they enter M3 clerkships. We have students attend sessions with physician-scientists in each of the relevant specialties throughout the G phase so that they can get an idea of the what these faculty members’ days look like and what activities comprise the breadth of their specialty. This is intended to provide more focus to clinical activities and to allow students to arrange away electives at institutions or in labs that may be of interest to them, possibly even during M3 elective time. Advice from relevant physician-scientists will be available throughout the M3 and M4 years.