Becoming a Physician
The ability to heal is a special privilige. An art, it cannot be learned solely in the library, nor in the classroom. As an MD/PhD, the particular challenge is to integrate the science and art of medicine. Becoming a top-notch physician takes serious commitment, and remaining one takes a lifetime of work. Therefore, students maintain a level of clinical exposure during all years of the program. Patient contact, invigorating and illuminating, begins in the first quarter of instruction and continues until graduation.
Preclinical
The first two years in the program — the trainee's preclinical years — focus on core courses in the medical school's basic science curriculum. During two afternoons a week set aside for elective work, students pursue graduate or medical courses, preceptorships with physicians, work in the student-run free clinics, and "reading rotations" (independent study) with professors. Trainees follow the full medical school curriculum, taking all classes along with regular MD students. One distinctive feature of the UCSD curriculum is that Physiology is taught before Anatomy. Students thus understand the molecular functioning of identified structures while in the second-year Anatomy course. The preclinical medical years close with the United States Medical Licensing Exam, Step One — "the boards."
Graduate
MSTP students continue their medical education during the graduate years through participation in the student-run free clinic, physician-led preceptorships, and hospital-sponsored Grand Rounds. Clinical clerkships (done during the third and fourth years of medical school) are not prerequisites for these experiences. Preceptorships can be the same as those offered to preclinical medical students or novel ones, perhaps suggested by Drs. Insel and Glass to address specific interests. Students may design their own preceptorships with clinical faculty. Experience in preceptorships can vary, but is probably most useful when hands-on.
The most popular option is work in the UCSD student-run Free Clinic. Medical students, under close faculty supervision, provide clinical services and practice administration, health education and leadership. Students take histories, perform physical exams, present to attending physicians, discuss modalities of treatment, and carry out necessary therapy or referral. The free clinic operates three community-based sites: in downtown San Diego, in eclectic Pacific Beach, and close to the Mexican border at Baker Elementary School. Experience in the free clinic is a unique opportunity to learn about patient care, community social resources, clinical medicine, pharmacology, and basic lab skills. Moreover, it is a wonderful opportunity to provide care to people who otherwise would not receive care.
All are welcome to attend grand rounds on the major services at each hospital. Typically, Grand Rounds occur once a week. Postings of Grand Rounds in Surgery, Neurology, Internal Medicine, and Pediatrics are in the MSTP office.
Students should time their return to the wards (third year) for the beginning of summer, when the other third years are also new. The program requires the dissertation defense before heading off to the clinic. To prevent the sacrifice of essential clinical skills, students do not conduct bench research during time on the wards.
Clinical
The clinical (last two) years in the MSTP curriculum are the culmination of medical school training as a physician. Everything comes together, and one begins to feel a sense of relief and pride at approaching completion of the program. The end is in sight! Overall the third and fourth years together can take as little as a year and a half, but some time for vacations, additional electives, and trips to assess postgraduate opportunities is advisable.
For the clinical years, the standard clinical clerkship requirements from the School of Medicine apply. The "core rotations" of the third year of medical school are Medicine, Surgery, Pediatrics, Obstetrics/Gynecology, Psychiatry, and Neurology. Third year takes an entire year to complete (including the summer — and there are 6 months of required elective time (although more are permissible).
In the fourth year, students take electives which allow more extensive training in areas of interest, as well as generally useful training in areas such as Radiology, Dermatology, or Anesthesia. Part II of the Boards is taken in August or March. Although most students find that Step II is less intense than Step I, it still needs studying. The clinical practice exam, "CPX," is taken in July or January. Evaluation in the CPX is based on directed physical examination of 5-6 standardized patients.
