Degree Programs

Students at the School of Medicine may be candidates for the degrees of Doctor of Medicine (M.D.) or Master of Public Health (M.P.H.). The School of Medicine, jointly with the Graduate School, administers two combined programs: one leading to the degrees of Doctor of Medicine (M.D.) and Doctor of Philosophy (Ph.D.), and another combined program leading to the degrees of Doctor of Medicine (M.D.) and Master of Health Science (M.H.S.). The School of Medicine administers a combined program leading to the Doctor of Medicine (M.D.) and Master of Public Health (M.P.H.) degrees. Special arrangements may be made with the appropriate associate deans to receive the combined Doctor of Medicine (M.D.) and Doctor of Jurisprudence (J.D.) degrees, the combined Doctor of Medicine (M.D.) and Master of Divinity (M.Div.) degrees, and the combined Doctor of Medicine (M.D.) and Master of Business Administration (M.B.A.) degrees. The School of Medicine also offers a program leading to a Physician Associate certificate combined with a Master in Medical Science degree.

Doctor of Medicine

The degree of Doctor of Medicine is conferred upon students who have satisfactorily completed the requirements stated below.

1. Pass all of the required basic science courses.
   
   
2. Pass all of the required clinical clerkships.
   
   
3. Pass the examinations of the United States Medical Licensing Examination (USMLE), Steps I and II.
   
   
4. Submit an approved dissertation by mid-March of the year of graduation.
   
   
5. Meet all of the requirements of the Progress Committee and Board of Permanent Officers concerning academic standing, moral and ethical character, emotional stability, and professional conduct.
   

Because of the heavy demands in terms of time and energy required for the study of medicine, the Yale School of Medicine discourages students from assuming extracurricular activities that may prove burdensome. Such extracurricular work and/or professional activity will not justify inadequate academic performance. Any student wishing to work or pursue a professional activity other than medicine that would consume a significant amount of time must have the permission of the associate dean for student affairs.

Admissions

The Yale University School of Medicine seeks to provide an education in the scholarly and humane aspects of medicine and to foster the development of leaders who will advance medical practice and knowledge. The Committee on Admissions, in general, seeks to admit students who seem best suited for the educational programs and aims of the School. In particular, the committee looks for intelligent, mature, and highly motivated students who show the greatest promise for becoming leaders and contributors in medicine. The Committee on Admissions also considers very carefully personal qualities necessary for the successful study and practice of medicine. These include maturity, integrity, common sense, personal stability, dedication to the ideal of service, and the ability to inspire and maintain confidence.

School of Medicine graduates must have the knowledge and skills to function in a broad variety of clinical situations and to render a wide spectrum of patient care. In addition to scholastic accomplishments and potential, applicants must have the physical capacities and personal characteristics to meet the full requirements of the School’s curriculum and to graduate as skilled and effective practitioners of medicine. The policy of the School of Medicine regarding nonacademic considerations in the admissions process is available upon request from the Office of Admissions.

The School also attempts to ensure adequate representation of women and all minority groups and a diversity of interests and backgrounds. All applications to the Yale University School of Medicine are given careful consideration without regard to sex, race, age, religion, national origin, sexual orientation, or financial status. In evaluating candidates, the committee takes into consideration many factors including academic record, MCAT scores, record of activities and accomplishments, recommendations from premedical committees and individual science teachers, and personal interviews.

It is recommended that students enter medical school after four years of study in a college of arts and sciences. Students holding advanced degrees in science or other fields are also considered. International students (other than Canadians) must have completed at least one year of study in an American college prior to application. Students who have been refused admission on three prior occasions are ineligible to apply for admission to the first-year class.

The minimum requirements for admission to the first-year class are:

1. Attendance for three academic years, or the equivalent, at an accredited college of arts and sciences or institute of technology.
   
   
2. Satisfactory completion of the following courses including laboratory work:
   
   General Biology or Zoology
   General Chemistry
   Organic Chemistry
   General Physics
   

(Acceptable courses in these subjects usually extend over one year and are given six to eight term hours credit.) These courses should be completed in a U.S. or Canadian college or university. Advanced courses may be substituted for introductory-level courses in each of these subjects.

The Committee on Admissions has no preference as to a major field for undergraduate study and leaves this decision to students, with the advice that they advance beyond the elementary level in the field of their choice rather than pursue an undirected program. A liberal education is the supporting structure for graduate study and must encompass understanding of the humanities, arts, and society as well as the scientific foundations of technology and civilization. The student of medicine enters a profession closely allied to the natural sciences and must be prepared to cope with chemistry and biology at the graduate level. Students entering college with a strong background in the sciences, as demonstrated by advanced placement, are encouraged to substitute advanced science courses for the basic requirements listed above.

Application Process

The Yale University School of Medicine participates in the “common” application process of the American Medical College Application Service (AMCAS). Applicants must first submit their AMCAS application, on which they indicate that they wish to apply to the Yale School of Medicine. After submitting the AMCAS application, applicants must complete the Yale Supplemental Application, which must be submitted online (see below for details).

Inquiries regarding AMCAS should be addressed to the American Medical College Application Service, 2501 M Street NW, Lobby 26, Washington dc 20037-1300. AMCAS can also be reached by telephone at 202.828.0600 or by e-mail at amcas@aamc.org. Extensive information can also be obtained at the AMCAS Web site: www.aamc.org.

Inquiries to the Yale School of Medicine regarding the degree of Doctor of Medicine should be addressed to the Office of Admissions, Yale University School of Medicine, Edward S. Harkness Hall, 367 Cedar Street, New Haven CT o6510. The e-mail address of the admissions office is medical.admissions@yale.edu. Information and a link to the Yale Supplemental Application can also be obtained online at http://info.med.yale.edu/education/admissions. Inquiries are welcome at any time.

AMCAS applications must be submitted no later than October 15 of the year prior to the fall in which enrollment is sought. Yale Supplemental Applications must be submitted online no later than November 15. Applicants seeking admission under the Early Decision Plan must submit the AMCAS application by August 1 and the Yale Supplemental Application by August 31. The number of students admitted each year for studies leading to the M.D. degree is approximately 100.

A complete application consists of the following components:

1. AMCAS application and all required components of the application (see 2 and 5 below).
   
   
2. Complete official transcripts from all colleges attended. Transcripts should be sent from the colleges directly to AMCAS.
   
   
3. Yale Supplemental Application submitted online no later than November 15. The Supplemental Application may be found at http://info.med.yale.edu/education/admissions.
   
   
4. An evaluation from the applicant’s Premedical Advisory Committee, or individual letters from three of the applicant’s teachers, two of whom should be in science fields. These evaluations must be sent directly to Yale.
   
   
5. Scores from the Medical College Admission Test (MCAT) must be submitted in conjunction with the AMCAS application. For information on the MCAT, applicants should communicate directly with the MCAT Program Office, PO Box 4056, Iowa City IA 52243. Information on the MCAT can also be obtained online at www.aamc.org. Scores of tests taken earlier than three years prior to submitting an application will not be accepted.
   
   
6. A fee of $85 or an AMCAS fee waiver must accompany the Yale supplemental application. The fee is not refundable.
   

During the course of the admissions process, selected applicants will be invited for personal interviews with members of the Committee on Admissions at Yale. Regional interviews can be arranged when necessary.

Early Decision Plan

The Yale School of Medicine offers an Early Decision Plan (EDP). Under this plan, a student may make a single early application to the school of his or her first choice and is guaranteed a prompt decision by the school. AMCAS applications for the EDP program must be submitted by August 1. Yale Supplemental Applications must be submitted by August 31. EDP applicants will be notified of the decision of the Committee on Admissions no later than October 1.

Admission to Advanced Standing (Transfer Admissions)

Because of a limited number of available positions, the Yale University School of Medicine does not routinely consider requests for transfer with advanced standing. The only exception to this policy is that the School will consider applications into the second-year or third-year class from students who are enrolled in LCME-accredited medical schools in the United States or Canada and who have a compelling personal need to be at Yale.

The following three circumstances constitute “compelling personal need” under this policy:

1. The applicant’s spouse holds, or has been accepted for, a position in the Yale-New Haven Medical Center community as a student, a member of the house staff at Yale-New Haven Hospital, a postdoctoral fellow, or a faculty member.
   
   
2. There is a serious illness in the immediate family of the applicant, requiring the ill person to be in New Haven for treatment and the applicant to be in New Haven as the primary supportive member of the family during the time of the illness.
   
   
3. In collaboration with a faculty member of the Yale School of Medicine, the applicant has completed exceptional biomedical research, which both the applicant and the faculty member wish to continue. Completing medical studies at Yale would enable the applicant to pursue this collaborative research and achieve important and unique educational and scientific objectives that would not be possible at the original medical school.
   

The distance of the applicant from New Haven will also be taken into consideration. Regardless of other factors, students attending medical school in New York City, Connecticut, or Rhode Island will not normally be eligible to apply for advanced standing.

Transfer into the second-year class is possible only from medical schools with a basic science curriculum compatible with that at Yale. Transfer into the third-year class is contingent upon passing Step I of the United States Medical Licensing Examination (USMLE). An applicant who fails USMLE Step I will not be considered for admission under any circumstances. Transfer into either the second- or third-year class is also contingent upon successful completion of courses being taken at the current medical school and upon the availability of space at Yale.

Eligible applicants will be evaluated competitively by the School’s Committee on Admissions, with decisions based on academic credentials, supporting material, interviews, and the urgency of the personal need to transfer. Overall qualifications are expected to be comparable to those of Yale students admitted through the regular admissions process.

All accepted applicants must matriculate in the year accepted. Applicants whose eligibility is established by marriage must be married at the time of matriculation, and the applicant’s spouse must be in residence in New Haven and holding a position in the Yale-New Haven Medical Center community. Transfer students must complete all required clinical clerkships (including the fourth-year Primary Care Clerkship and the Integrative Clinical Medicine Clerkship) and the thesis requirement at the Yale University School of Medicine. If a transfer student wishes to spend an extra (fifth) year at Yale, one-half of the tuition for that year will be waived.

Completed transfer applications consist of Yale School of Medicine application forms, letters of recommendation, MCAT scores, college transcripts, a transcript from the current medical school, and a letter from the dean of students (or comparable official) at the current medical school. Inquiries regarding transfer applications should be addressed to the Office of Admissions, Yale University School of Medicine, 367 Cedar Street, New Haven CT 06510 or medical.admissions@yale.edu. Transfer applications, including all supporting credentials, must be submitted by April 1 of the year the student wishes to enter Yale.

Educational Objective

The mission of Yale University School of Medicine is to educate and inspire scholars and future leaders who will advance the practice of medicine and the biomedical sciences. The educational program is designed to develop physicians who are highly competent and compassionate practitioners of the medical arts, schooled in the current state of knowledge of both medical biology and patient care. It is hoped that Yale-trained physicians will establish a lifelong process of learning the medical, behavioral, and social sciences by independent study. The aim is also to produce physicians who will be among the leaders in their chosen field, whether it be in the basic medical sciences, academic clinical medicine, or medical practice in the community. Belief in the maturity and responsibility of students is emphasized by creating a flexible program through anonymous examinations and the elimination of grades in pre-clinical courses, and by encouraging independent study and research.

Educational Philosophy: The Yale System

The Yale System of Medical Education remains unique among medical schools. It has been an important part of life at the Yale School of Medicine since 1931. Although it has undergone minor modifications in the intervening years, its essential spirit has remained intact, and it is a major reason why many students choose to come to Yale for their medical education.

The fundamental element of the system is the concept that Yale medical students are mature individuals, strongly motivated to learn, requiring guidance and stimulation rather than compulsion or competition for relative standing in a group. The corollary of this concept is that students must assume more than usual responsibility for their education. Students should be considered adults in a graduate school and be permitted to enjoy as much freedom as is consistent with the fulfillment of requirements for the degree of Doctor of Medicine. Memorization of facts should be far less important than a well-rounded education in fundamental principles, training in methods of investigation, and the acquisition of the scientific habit of mind.

During the pre-clinical years, the students acquire knowledge and develop clinical skills. Attendance in basic science courses is not taken, lectures are held to a minimum, and much instruction occurs in small-group seminars or conferences. Students evaluate themselves through anonymous examinations. Their performance is assessed by the faculty through participation in seminars, by an anonymous qualifying examination at the end of each course, and by passing of the United States Medical Licensing Examinations. Student attendance is expected in all skill-building sessions, and competency in performing a complete history and physical examination is assessed at the end of the second year, utilizing standardized patients.

In the first two years there are no grades, and there is no class ranking throughout medical school. While grades are not given and rank order not established, evaluation of students is an important part of the educational process. The faculty considers small-group teaching with interchange between faculty and students to be the most effective means of teaching and evaluation. Students should expect direct questioning at seminars and labs as an important adjunct to the evaluation process. The final decision of acceptable performance for a given course or clerkship will remain with the course/clerkship director of each course or clerkship. Freed from the usual anxieties provoked by examinations, students tend to learn for their future rather than for tests. Competition for grades is eliminated and students are eager to help one another. Class spirit is remarkably high year after year. Upon completing a course, all students are strongly encouraged to submit an evaluation so that course directors can make changes based on student feedback, which is taken very seriously.

Finally, the Yale System requires each student to engage in a form of research activity, designed to foster development of a lifelong commitment to learning (see Required Thesis).

Curriculum Management

Educational Policy Committee (EPC)

The EPC advises the deputy dean for education on policy issues of school-wide importance, including matters related to admissions, graduation requirements, progress of students, joint-degree programs, student research and thesis, and multicultural affairs. The deliberations and recommendations of the EPC are guided by the school’s Educational Mission and School-Wide Objectives as well as the principles embodied in the Yale System of Education. For example, the EPC might examine and advise the deputy dean for education about the impact of curriculum proposals and other medical school issues that:

• affect, modify, or change school policy regarding education
• fundamentally change or potentially disrupt the current curriculum’s structure, schedule, content, or allocation of time
• potentially impact, challenge, or change the School’s fundamental principles and core values as embodied in the Yale System of Education, the School-Wide Educational Objectives, or the Educational Mission Statement

Curriculum Committee (CC)

The CC provides careful and thorough oversight of the curriculum review process. The CC considers recommendations for curriculum change made by its review committees as well as suggestions from students, faculty, and departments. The CC might also form ad hoc working groups to study and promote integration within related areas of learning and across various disciplines and time periods in the curriculum. The CC improves the curriculum by considering new ideas, developing specific proposals, and implementing changes that promote:

• integration and coordination across and throughout the curriculum
• a curriculum designed to achieve the school-wide educational objectives
• assessment of the curriculum based on analysis of reliable outcome measures
• improvement in the quality of education based on new teaching approaches and modern methods of pedagogy
• adherence to existing and new accreditation standards

Curriculum Review Committees

Courses Review Committee
Modules Review Committee
Clerkships and Electives Review Committee

The Curriculum Review Committees work collaboratively with department-based course, module, clerkship, and electives directors to review and improve individual courses, modules, and clerkships/electives. This includes gathering information, reviewing and analyzing data, and making recommendations that promote:

• course, module, and clerkship/elective content based on specific learning objectives
• congruence of course, module, and clerkship/elective objectives with overall School-Wide Objectives
• use of the most effective teaching methods to achieve the learning objectives
• effective use of formative, summative, and self-assessment methods
• use of student evaluations and performance outcome data to improve the curriculum
• use of reliable outcome measures to evaluate student achievement of the learning objectives

The Review Committees, through their chairs, will report on their activities to the CC on a regular basis. Recommendations of the Curriculum Review Committees for changes in the content or teaching methodology within a course, module, clerkship, or elective based on these reviews can be directly implemented by the course, module, clerkship, or elective director. However, changes that have broader impact across the curriculum must be brought to the CC for consideration and implementation.

Thesis Committee

The Thesis Committee provides oversight of and recommends policy for all aspects of the medical student thesis program. This includes:

• setting rules and regulations for the thesis requirement
• establishing thesis deadlines
• determining the guidelines and processes for the awarding of thesis honors and graduation prizes, and choosing the recipients
• determining the selection of oral presentations given on Student Research Day

The Thesis Committee regularly reviews the curriculum to assure that there is adequate time available for thesis research, evaluates the participation and effectiveness of faculty mentors, assesses the quality of the student’s research experience, and makes stipend-supported research fellowships available.

A more detailed description of these committees including the membership is available on the Office of Education Web site.

Pre-Clinical Curriculum

The first two years of the curriculum at Yale School of Medicine focus on providing students with a foundation in the science and art of medical practice. In the first year, the science of normal human biology is explored in four major areas. The structure of the human body is taught in Principles of Human Anatomy and Development, via dissections, and in Diagnostic Imaging. The normal function of the human body is taught in the Molecules to Systems Integrated Curriculum, which includes three departmental courses: Molecular Foundations of Medicine, Cell Biology and Histology, and Medical Physiology. The structure and function of the brain and nervous system are taught in the Neurobiology and Biological Basis of Behavior courses. Teaching of the art of medicine begins with the first day of school, which is devoted to the discussion of the importance of understanding the patient’s and physician’s culture in practicing medicine. The Pre-Clinical Clerkship (PC) introduces students to the principles and skills of medical interviewing and physical examination. PC course sessions and tutorials meet weekly and provide opportunity for students to observe and develop clinical skills. In addition to didactic sessions, this course provides weekly opportunities throughout the first two years for students to see patients and practice skills under the observation of a Clinical Tutor. During clinical tutorials, groups of four students work closely with a clinician to practice performing clinical histories and physical exams. Further understanding of the patient is achieved in Aspects of Child and Adolescent Development in the Practice of Medicine, which presents a developmental approach to human behavior. The Professional Responsibility course is an opportunity to discuss the attitudes and behaviors of caring and ethical physicians who practice in this complex era of managed care. Integrating the art and science in medical practice requires problem-solving skills, which are developed in the Medicine-Based Evidence course. A major focus of this effort is discussing how to assess the value of information in the medical literature by understanding and applying the basic principles of biostatistics. Throughout the year, students can hear various talks on the History of Medicine, which add depth and texture to the curriculum as well as provide some insight into the time continuum within which the practice of medicine exists.

The first year ends with a focus on the mechanisms of disease: Pathology, Genetics, and Immunobiology. The second year emphasizes abnormal human biology. During the fall term the major courses are Microbiology and Pharmacology; Epidemiology and Public Health is scheduled for the spring term. Beginning in September and continuing throughout the year, students participate in The Modules, a large interdisciplinary course. Content traditionally taught in the separate disciplines of pathology, pathophysiology, pharmacology, clinical examination, laboratory medicine, and diagnostic radiology is organized according to organs or systems. The individual modules are: Blood, Cardiovascular, Clinical Neurosciences, Clinical Sciences of Psychiatry, Endocrine System, Digestive, Respiratory, Musculo-skeletal, Oncology, Renal and Urinary Tract, Reproduction, Ophthalmology, and Skin. Teaching the art of medicine continues throughout the year in the Pre-Clinical Clerkship, which emphasizes developing greater skills in history taking and physical examination. Students continue to meet in small groups with their Clinical Tutors. In the second year, students are given the opportunity to assess their acquired clinical skills in the Standardized Patient Program at the University of Connecticut School of Medicine.

Pre-Third Year Requirements

In order to proceed to the third year, a student must satisfy the following requisites:

1. Pass the mandatory qualifying examinations for all first- and second-year courses.
   
   
2. Pass the Pre-Clinical Clerkship course.
   
   
3. Achieve clinical competence (as ascertained by the clinical tutors).
   
   
4. Have a minimum of five commentaries from different required basic science courses in his/her evaluation folder.
   
   
5. Comply with all immunization requirements.
   

In addition, students are strongly encouraged to evaluate all of the basic science required courses.

The Third Year

Clinical Clerkships

The third year is devoted almost entirely to clinical clerkships. The required clinical clerkships that must be taken in the third year are:

Internal Medicine	8 weeks
Ambulatory Medicine	4 weeks
Surgery	10 weeks
Anesthesiology	2 weeks
Pediatrics	8 weeks
Clinical Neuroscience	4 weeks
Obstetrics and Gynecology	6 weeks
Psychiatry	6 weeks

Clerkship scheduling will be arranged through the Office of Student Affairs. There is no required order for taking clerkships, and there is no advantage to any particular order. It is to the student’s advantage to complete as many required clerkships as possible during the third year. In order to change a clerkship schedule after it is assigned, students must (1) fill out a clerkship/elective change form giving reasons for the change and (2) meet with the registrar. Changes are not guaranteed, and no change except in the case of a legitimate emergency will be considered less than four weeks before the start of the scheduled clerkship. Students may receive a lower priority for rescheduling these postponed clerkships in their fourth year than new third-year students. All changes must be approved by the associate dean for student affairs.

USMLE Step 1

All students are required to sit for Step I of the United States Medical Licensing Examination for the first time by the end of December of the third year in medical school (even if the third year is an extended study year), but students are strongly encouraged to take it before starting clinical clerkships. The United States Medical Licensing Examination (USMLE) Steps I, II Clinical Knowledge, and III are computer-administered at Prometric Testing Centers. This system has given students considerable flexibility over choice of test time and place. Students should consult the USMLE Web site for more information (www.usmle.org).

The Office of Student Affairs holds an informational session in February. Applications may be downloaded from the NBME (National Board of Medical Examiners) Web site at www.nbme.org. Students should return their completed applications for Step I to the Office of Student Affairs, which will certify and mail them directly to the NBME for processing. The application form must be accompanied by one passport photo and payment, by check made out to the NBME or by credit card, in the amount of $455. The student must also indicate one of the three-month periods during which he or she wishes to sit for the exam. Within two weeks, the student will receive a scheduling permit in the mail with a student identification number. The student can then call any Prometric test site in the world to schedule a specific test day.

Failure of USMLE Step 1

If a student fails Step I, he or she may reschedule it at any time before May of the third year. Three failures of Step I will require consultation with the Progress Committee, and only in extraordinary circumstances will the student receive permission to take it a fourth time. In the absence of that permission, the student will be dismissed from the School of Medicine. In some cases where a student may be having other academic problems, failing Step I once or twice will be enough to require consultation with the Progress Committee. In some unusual cases, students will not be allowed multiple retakes, for example, if the student is unable to progress satisfactorily in the clerkships or behaves in repeatedly or egregiously unprofessional ways. (See Progress Committee.) If Step I is failed more than once, the student may be asked to discontinue clinical rotations until he or she takes and passes the exam.

The Fourth Year

The fourth-year curriculum includes a required clerkship and course as follows:

The Office of Student Affairs holds a meeting in the spring of the third year to discuss the fourth year. The meeting is focused on the National Residency Matching Program, residency applications, and the Medical Student Performance Evaluation (MSPE), also known as the dean’s letter, but issues of scheduling subinternships, electives, and the thesis requirement are also addressed.

Graduating students are required to submit a thesis plan to the Office of Student Research prior to fall registration of the final year. Students must provide a tentative thesis title as well as identify their thesis adviser.

A required Primary Care Clerkship is generally completed during the fourth year. This four-week clerkship provides students with an opportunity to experience primary care in an outpatient or office setting. Many students also take a number of clinical electives, including a subinternship in some clinical discipline. The residency application process and completion of the thesis are also major activities of the fourth year.

In the spring, students attend one final required course, entitled Integrative Clinical Medicine: The Biological, Social, and Behavioral Bases of Clinical Medicine. This three-week course provides an opportunity for graduating students to come together one last time before leaving for internships and residencies, and serves to integrate basic and clinical science knowledge with the social and behavioral sciences. The course devotes one week to each of two clinical case studies, the complexity of which gradually unfolds as the week progresses. The third week includes daily workshops on the occurrence of mistakes in medicine, working with difficult patients, genomics, and professionalism. The course employs small-group and large-group formats, and independent research with group decision making and consensus. It runs concurrently with a course led by the Emergency Medicine section, which focuses on preparatory skills for internship. This course also includes advanced training in sexuality issues, social and ethical problems in medicine, and the latest medical informatics.

USMLE Step II

Passing USMLE Step I and both parts of Step II is required for graduation from Yale School of Medicine.

The written Step II exam is now called Step II Clinical Knowledge (Step II CK). Step II CK must be taken by December 31 of the final year, and it is strongly recommended that students take it early in the fourth year immediately after completing the clinical clerkships, when the information is fresh.

A clinical skills exam became part of the USMLE in mid-2004, starting with students who graduated in 2005. This new exam, Step II Clinical Skills (Step II CS), is a separate, required component of Step II and must be taken by December 31 of the final year as well; but again, it is to the student’s advantage to take it as soon as possible after completing the clinical clerkships. Utilizing standardized patients, this exam is administered at regionally located centers operating year-round. Test sites include Philadelphia, Atlanta, Los Angeles, Chicago, and Houston.

The cost of Step II CK is $455. Step II CS costs $975, but students who may have to travel a distance and stay in a hotel the night before the exam may incur increased expenses. Students who feel that lack of money is preventing them from taking the exam should speak with the associate dean for student affairs as early as possible. Students will go to the University of Connecticut early in their fourth year to complete a standardized patient exercise similar to USMLE Step II CS. They will receive feedback on their performance, and remediation will be offered if necessary. This exercise may be completed prior to Step II CS as a way of ensuring readiness to take the exam.

Failure of USMLE Step II

The reason that USMLE Step II must be taken before December 31 of the fourth year is to give anyone who fails the opportunity to retake the exam and get a passing score in time to graduate. In order to be certain that students have taken it or have plans to take it before that date, proof in the form of a score or a ticket will be required before the dean’s letter is sent out on November 1. Disregarding this requirement is considered an unprofessional response and may be considered by the Progress Committee in deciding whether a student has satisfactorily completed the requirements to graduate.

The names of any students who subsequently postpone their date to after December 31 will be sent to the dean. Students may have three attempts to pass Step II before being dismissed from the School of Medicine.

Course Schedules

First Year

Biological Basis of Behavior
Cell Biology and Histology (component of Molecules to Systems Integrated Curriculum)
Child and Adolescent Development in the Practice of Medicine
History of Medicine is incorporated into relevant courses during the first two years
Human Anatomy and Development including Diagnostic Imaging
Human Genetics
Immunobiology
Medical Physiology (component of Molecules to Systems Integrated Curriculum)
Medicine-Based Evidence
Molecular Foundations of Medicine (component of Molecules to Systems Integrated Curriculum)
Neurobiology
Pathology
Pre-Clinical Clerkship
Professional Responsibility
Basic Life Support

Second Year

Epidemiology and Public Health
Medical Microbiology
Pathology: Tutorials
Pre-Clinical Clerkship
Pharmacology: Mechanisms of Drug Action
Advanced Cardiac Life Support
Universal Precautions
The Modules*

Blood/Hematology
Cardiovascular System
Clinical Neurosciences
Clinical Science of Psychiatry
Digestive Diseases
Endocrine Systems
Musculo-Skeletal System
Oncology
Ophthalmology
Renal/Urinary Tract (including Male Reproductive System)
Reproduction
Respiratory Diseases
Skin

Third Year

* Including Clinical Examination, Diagnostic Radiology, Laboratory Medicine, Pathology, Pathophysiology, and Pharmacology.

Required Thesis

Yale is the only medical school with a long tradition requiring a dissertation based on original research. The M.D. thesis, a requirement since 1839, is an essential part of the curriculum, designed to develop critical judgment, habits of self-education, and applica-tion of the scientific method to medicine. The thesis requirement gives students the opportunity to work closely with faculty who are distinguished scientists, clinicians, and scholars. The investigation may have its origins in basic science or in clinical, laboratory, or environmental medicine. A hypothesis must be defined, experimental methods developed, and data gathered to prove or disprove the hypothesis. Stipends are provided for summer and all other short-term research periods (four deadlines throughout the year). In addition there are many national (Howard Hughes Medical Institute, National Institutes of Health, Doris Duke Charitable Foundation, Sarnoff Foundation, American Heart Association) and Yale-sponsored one-year research fellowships available. Conduct of the research is continued during free periods in the third and fourth years and often over summer vacations. A significant percentage of students (currently 50 percent of Yale medical students) elect to take an additional year of medical school to pursue their research projects in greater depth, but this is not a requirement. These students are eligible for a joint M.D.–Master of Health Science (M.H.S.). A doctoral dissertation in the biological sciences that has previously been accepted as a part of the requirements for the Ph.D. degree may be submitted in lieu of a School of Medicine dissertation at the discretion of the director of the Office of Student Research and the Thesis Committee. Information about the thesis and research opportunities may be obtained from the Office of Student Research, 203.785.6633.

Joint Academic Programs

Students from the Yale School of Medicine accepted into another Yale degree program will be considered to be participating in a “Joint-Degree Program” and will receive the benefit of sharing tuition between the medical school and the other program’s school so that each program gives up a half-year of tuition. For example, a student accepted to the M.D./J.D. Program will pay three and one-half years’ tuition to the School of Medicine and two and one-half years’ tuition to the Law School, completing seven years of school in six. This arrangement holds for Yale schools only. A student wishing to create such an arrangement at a school outside of Yale must receive permission from the associate dean for student affairs at the School of Medicine and, of course, must have the consent of the other school.

School of Medicine students enrolled in a joint-degree program or in a program to obtain a degree at another school must complete three years in the School of Medicine and pass Steps I and II of the USMLE before beginning in the other program.

M.D./PH.D. Program

A limited number of highly qualified students will be admitted into the M.D./Ph.D. Program each year. Students accepted into this program have an excellent academic record and a strong motivation toward a career in academic medicine and the biomedical sciences, and will have had previous research experiences of a high caliber.

The goal of the M.D./Ph.D. Program at Yale University School of Medicine is to train physician-scientists and provide them with a broad exposure to human biology and medicine and to an in-depth and rigorous training in one of the scholarly disciplines relevant to medicine. It is expected that these individuals will develop into academic physicians capable of assuming faculty positions in either basic science or clinical departments of schools of medicine, and in these positions will provide leadership in academic medicine and in research related to medicine and human welfare.

The joint-degree program is intended for students who wish to obtain a research degree in an established Ph.D. program. Departments participating in the M.D./Ph.D. Program are Biomedical Engineering; Cell Biology; Cellular and Molecular Physiology; Chemistry; Epidemiology and Public Health; Experimental Pathology; Genetics; Immunobiology; Microbiology; Molecular Biophysics and Biochemistry; Molecular, Cellular, and Developmental Biology; Neurobiology; Neuroscience; and Pharmacology. Students interested in taking the joint degree in another department may do so, provided they can work out, in advance, a program that is approved by the department concerned, the director of the M.D./Ph.D. Program, the dean of the School of Medicine, and the dean of the Graduate School.

Applicants to the M.D./Ph.D. Program must be U.S. citizens or permanent residents. All applicants selected for admission currently receive support from the program for stipend, tuition, and health fees for a maximum of six years. Funding is provided largely by the Medical Scientist Training Program (MSTP), a grant provided from the National Institute of General Medical Sciences. Continuing in the program is contingent on satisfactory progress in both the School of Medicine and the Graduate School. The average length of time students spend completing the requirements for the M.D./Ph.D. Program is seven and one-half to eight years.

Requirements of the M.D./PH.D. Program

Students may apply to the M.D./Ph.D. Program at the time of admission to the School of Medicine or no later than mid-November of their second year of study in the M.D. program. Applications for admission are reviewed by a special committee composed of faculty members from both schools.

Candidates for M.D./Ph.D. degrees will normally begin their thesis research after completing the first four and one-half terms of the School of Medicine curriculum. For example, students usually complete a series of clinical rotations at the end of the second year of medical school which will enable them to participate in longitudinal clinical experiences during their Ph.D. years; students following this schedule are expected to affiliate with a graduate program by the beginning of the third year of the program. During the first and second years of medical school, the majority of M.D./Ph.D. students take, for credit, graduate-level courses primarily designed for them. These courses supplement the core medical school curriculum and can be applied toward the course requirements of the student’s chosen Ph.D. program. The summer between the first and second years is spent in lab rotation(s), the purpose of which is to orient students in the selection of a thesis mentor and research area. However, students must request affiliation with a particular department in the Graduate School by the middle of their third year of study in the joint-degree program. Any exceptions must be approved by the director of the M.D./Ph.D. Program and the dean of the Graduate School.

A student admitted to the combined-degree program must satisfy the Graduate School Honors requirement by the end of the second year of study and must complete all remaining predissertation requirements within four terms of affiliation with the Ph.D. department. These include course requirements, teaching requirements if applicable, a departmental qualifying examination, and the submission of an approved prospectus. At that point, the student is then admitted to candidacy. Students in the M.D./Ph.D. Program must be admitted to candidacy one full year before they expect to be awarded the Ph.D. degree. An average of three to four years is spent completing the Ph.D. requirements.

The remainder of the program encompasses clinical clerkships and electives. This advanced clinical work is best incorporated in the first six months of the student’s third year and the last year of the program, after the doctoral dissertation has been submitted. Only under unusual circumstances will students be allowed to take more than six months of clerkships prior to the beginning of their Ph.D. work. Students are encouraged to take at least the eight-week Internal Medicine Clerkship and one other clerkship prior to beginning their research, which will enable them to participate in outpatient clinical activities during their dissertation work.

The Ph.D. dissertation will be accepted as the thesis requirement for the School of Medicine, providing the Ph.D. degree is received before or at the same time as the M.D. degree. If the M.D. degree is to be awarded before the Ph.D., an approved thesis must be submitted to the School of Medicine by May 1 in order to meet the School of Medicine thesis requirement for graduation. Students will be eligible for the M.D. and Ph.D. degrees providing the degree requirements for both the School of Medicine and the Graduate School have been fulfilled, usually at the end of seven years. If requirements have not been completed, additional time will be required.

Joint M.D.-Master of Health Science (M.D.-M.H.S.)

Yale University School of Medicine has established a joint degree, the M.D.-Master of Health Science (M.D.-M.H.S.) for students completing a competitively funded full fifth year of research and other requirements (see below). This program was approved by the Yale Corporation in January 2006.

There are two pathways to the M.D.-Master of Health Science degree for medical students: a clinical research pathway and a laboratory/translational research pathway. The M.D.-Master of Health Science degree is centered around a fifth-year pull-out supported by a fully funded one-year medical student research fellowship at Yale (currently funded by the Doris Duke Charitable Foundation, the Howard Hughes Medical Institute-Yale Program, Yale NIH T32 grant, NIH-NIDDK fellowships, and Yale Endowment Fellowships).

The independent research project in the fifth year is the centerpiece of the M.D.-Master of Health Science degree program. In addition the following requirements apply:

1. The project mentor and a three-person thesis committee must be approved by the Office of Student Research and the M.D.-Master of Health Science Advisory Committee.
   
   
2. Additional course work is required:
   
   1. Clinical research pathway—Courses: Principles of Clinical Research; Introduction to Biostatistics; Organization and Leadership; Ethical and Practical Issues in Clinical Investigation (during master’s year)
      
   2. Laboratory/translational research pathway—Courses: Intensive Pedagogical Experience in Techniques and Strategies for Laboratory Research or Functional Genomics in Translational Research; Organization and Leadership; Ethical and Practical Issues in Clinical Investigation (during master’s year)
      
      These courses can be taken prior to the research year or during the research year except the Ethical and Practical Issues in Clinical Investigation course and monthly seminars, which must be taken during the master’s year.
      
      
3. Participation in monthly seminars, journal clubs, Leadership in Biomedicine Lecture Series and dinners, and other announced activities throughout the master’s research year. Further information is available in the Office of Student Research.

M.D./M.P.H. Program

Students enrolled for the M.D. degree at the Yale School of Medicine may apply to the Department of Epidemiology and Public Health for admission to a combined program leading to the degrees of Doctor of Medicine and Master of Public Health. This program is designed for students with special interest in aspects of medicine dealing with biostatistics, epidemiology of acute or chronic disease, organization and management of health services, or aspects of preventive medicine and public health.

Normally the combined program requires five years of study. One thesis satisfies both degree requirements provided it is approved and carried out under the supervision of a faculty member of the Department of Epidemiology and Public Health and is in an appropriate subject area.

A medical student may carry out research and write a thesis under the supervision of Epidemiology and Public Health faculty without being a candidate for the combined degree.

Applications for this combined degree program are available at the EPH Office of Admissions and should be filed by February 1 of the calendar year for which admission is sought. Medical students interested in the joint-degree program should learn about the requirements of the joint program during their first year in the School of Medicine. Detailed information may be obtained from the associate dean for student affairs in the Department of Epidemiology and Public Health, from the director of medical studies in EPH, or from the associate dean for student affairs at the School of Medicine.

Advanced Professional M.P.H. Program

Yale School of Public Health is pleased to initiate its new Advanced Professional M.P.H. Program, which will provide rigorous public health training to individuals with a doctoral-level degree in a field related to public health (e.g., M.D., D.V.M., D.D.S., or Ph.D. in the biological, behavioral, or social sciences) and to medical students who have completed their third year in an accredited medical school in the United States. The program is designed for mature individuals with clear goals in public health. A student can enter the program to gain skills in clinical research methodology or to prepare to be the director of a community health center, a leader in a state or local health department, or a medical officer at the Centers for Disease Control and Prevention, among other goals. Physicians in preventive medicine or occupational medicine residency programs can enter the program to complete their M.P.H. degree requirement.

The Advanced Professional M.P.H. Program will begin in early July with an intensive seven-week summer session, followed by two semesters of full-time study. Students will concentrate in one of three tracks: Applied Biostatistics and Epidemiology, Social and Behavioral Sciences, or Health Policy and Administration.

Admission to the Advanced Professional M.P.H. Program is highly competitive, as the number of seats offered is limited. Applicants are encouraged to apply early. Individuals who are interested in the program must indicate this preference, along with their preferred track, at the time of application. This program replaces our One-Year M.P.H. Program.

M.D./M.Div. Program

Students who have been admitted to the Yale School of Medicine and are enrolled for the M.D. degree may apply to the Divinity School for admission to a combined program leading to the award of the degrees of Doctor of Medicine and Master of Divinity. Students who apply to the joint M.D./M.Div. program are expected to do so at the same time that they apply to the School of Medicine or by the end of their second year at the School of Medicine in order to qualify for the special tuition arrangement. Students enrolled in the program pay three and one-half years’ tuition to the School of Medicine and two and one-half years’ tuition to the Divinity School.

The joint program is tailored to the individual interests and needs of those students seeking professional education and training in a theological understanding of the self, society, and work; in bioethics; in international health and missions; in relating a ministry of healing to hospice or similar patient-care facilities; in a biblical understanding of person; or in academic work in teaching, counseling, and chaplaincy.

Six years are required for the combined M.D./M.Div. Program.

M.D./J.D. Program

The Yale School of Medicine has a formal relationship with the Law School to allow students to seek degrees from both schools. This can be done in six years instead of seven, as would be the case if these disciplines were studied separately. Students pay three and one-half years’ tuition to the School of Medicine and two and one-half years’ tuition to the Law School. Students interested in this program must confer early with the associate deans at both schools to plan curriculum and find out if they qualify for the special tuition arrangement.

Students who apply to the joint M.D./J.D. Program are expected to do so at the same time that they apply to the School of Medicine or by the end of their second year at the School of Medicine in order to qualify for the special tuition arrangement. Students must be found acceptable by both admissions committees. It is suggested that the student state on each application that he or she is applying to both schools in order to pursue the combined degree program.

M.D./M.B.A. Program

The purpose of the joint-degree program in medicine and management is to develop clinician-managers capable of pursuing careers that balance delivery of patient care with sound management in a changing health-care environment. The joint-degree program normally requires five years of study and simultaneous award of the degrees of Doctor of Medicine and Master of Business Administration at the conclusion of the five-year period. A joint-degree student pays three and one-half years’ tuition to the School of Medicine and one and one-half years’ tuition to the School of Management, in a pattern determined in advance by the two schools. Students interested in this program must discuss their intentions with the associate deans of student affairs at both schools and with Howard P. Forman, M.D., M.B.A., director of this joint-degree program.

Epidemiology and Public Health

The Department of Epidemiology and Public Health (EPH) is also an accredited school of public health where students may earn the Master of Public Health (M.P.H.) degree, and the Doctor of Philosophy (Ph.D.) and Master of Science (M.S.) degrees through the Graduate School of Arts and Sciences.

Master of Public Health Program

The M.P.H. program is a two-year, twenty-course program of study. The program consists of a required core curriculum, required curricula within divisions, and electives. The purpose of the core curriculum is to ensure that students master the skills and knowledge that are fundamental to the practice of public health. The divisions admitting master’s students are Biostatistics, Chronic Disease Epidemiology, Social and Behavioral Sciences, Environmental Health Sciences, Epidemiology of Microbial Diseases, Global Health, Health Policy, and Health Management.

The EPH core curriculum consists of a one-year sequence in statistical thinking and four other term courses, an internship, and a thesis or capstone course. The core courses are designed to provide skills in statistical methodology and data analysis as well as to introduce students to the breadth of the public health profession. This program ensures a solid grounding in the basic and applied sciences, and also provides students with learning experiences in the field or the laboratory. The final requirement is the thesis, except in the Health Policy and Health Management divisions, where the thesis is optional and the capstone course is a requirement.

Each of the divisions has its own required curriculum. Students are encouraged to take electives in divisions other than the one in which they are entered.

Four terms in residence are required.

Applications for the M.P.H. program are available online at www.sophas.org/. Completed applications must be submitted no later than January 15 of the calendar year for which admission is sought.

EPH requires the submission of all official undergraduate and graduate transcripts, MCAT scores, three letters of recommendation, a résumé or CV, and a personal statement as part of the application for admission.

Doctoral Program

The degree of Doctor of Philosophy (Ph.D.) is offered through the Graduate School of Arts and Sciences. There are five divisions in EPH in which doctoral students may choose a specialty: Biostatistics, Chronic Disease Epidemiology, Environmental Health Sciences, Epidemiology of Microbial Diseases, and Health Policy and Administration. Four or five academic years are usually needed to complete the Ph.D. degree. All doctoral candidates must pass comprehensive examinations and design and successfully execute a dissertation prospectus, approved by a dissertation advisory committee, before being admitted to candidacy. Each candidate is required to conduct research and write a dissertation that makes an original contribution to the field. The research protocol must be approved by the doctoral committee of the department and by the Human Investigation Committee if the research uses data derived from individual human subjects or individual records. Specific guidelines and statements of academic policies are distributed to all doctoral candidates.

Preliminary inquiries should be addressed to the Director of Graduate Studies, PO Box 208034, New Haven CT 06520-8034. Application should be made to the Graduate School of Arts and Sciences, Yale University. Applications should be filed by the first working day in January specifying interest in Epidemiology and Public Health. Admission is normally only in the fall. The GRE is required. The TOEFL is also required of foreign applicants whose native language is not English. Students may enter the program with a baccalaureate. Knowledge of a foreign language is not required for admission, although it may be needed in the course of study.

M.D./M.P.H. Program

For information on the combined M.D./M.P.H. Program, see above.

Epidemiology and Public Health
2007–2008 Academic Calendar

The Yale Physician Associate Program

The concept of a physician assistant (or Physician Associate) was first developed in 1965. Today the Physician Associate is a highly valued member of the health-care team. Physician Associates are distinguished from other advanced health-care practitioners by the extent to which they are given decision-making authority regarding patient care, diagnosis, and treatment. The twenty-seven-month Yale program, established in 1970, is committed to educating students for generalist medical practice. As of September 2006, the Yale Physician Associate Program has graduated 850 Physician Associates who are employed in a variety of settings throughout the nation. Graduates practice in rural as well as urban areas, in emergency rooms, health maintenance organizations, clinics, and solo and private practices. They possess a variety of skills, which enable them to take a medical history; perform a physical examination; diagnose illness and formulate patient treatment plans; counsel patients; perform medical procedures; and assist in surgery.

Mission of the Yale Physician Associate Program

The mission of the Yale School of Medicine Physician Associate Program is to educate individuals to become outstanding clinicians and to foster leaders who will serve their communities and advance the PA profession.

Curriculum Structure and Goals of the Yale Physician Associate Program

The program is divided into a didactic phase of twelve months and a clinical phase of fifteen months. The rigor of the studies often precludes student employment. As a result, students are encouraged to find alternate financial resources during their course of study. Tuition for the 2007–2008 academic year is $27,010; fees and other expenses are similar to those estimated for medical students. A Master of Medical Science degree is awarded upon completion of the program.

The Didactic Phase. The first calendar year is devoted to course work in basic and clinical sciences. Courses are listed below.

Anatomy (lecture and laboratory)
Clinical Genetics
Clinical Laboratory Medicine
Clinical Practicum   
Diagnostic Imaging
History-Taking and Physical Examination
Human Sexuality
Introduction to Research
Introduction to Surgical Skills
Medical Ethics
Medicine and Surgery (includes all specialty modules)
Medicine and the Law
Microbiology
Pathology
Pharmacology
Physiology
Preventive Medicine

The Clinical Phase. Each student completes fourteen four-week rotations, in a variety of medical specialties, in order to acquire broad experiences in primary, emergency, and surgical care. Two additional four-week blocks during the clinical phase are reserved as research/thesis months. Ten rotations are mandatory: Internal Medicine I, Internal Medicine II, General Surgery, Primary Care I, Primary Care II, Psychiatry, Pediatrics, Obstetrics and Gynecology, Geriatrics, and Emergency Medicine. The remaining four clerkships are reserved for subspecialty electives.

Although many rotations are in the New Haven area, the experience of the student is expanded by exposure to rotations in other geographic settings. Consequently, students entering the program should expect to spend at least four weeks in areas such as New York, Kentucky, Maine, or Massachusetts. Students should be prepared to provide their own transportation and housing for all rotations away from New Haven. Students may also choose to broaden their experience by selecting rotations abroad. In the past, students have chosen clerkships in Thailand, Uganda, Costa Rica, Tanzania, and England.

In order to graduate from the program, a student must successfully complete all rotations, summative evaluation using standardized patients, and a thesis proposal. The thesis must present a rationale for the topic of study, a comprehensive literature review, and a detailed description of the methodology to be used. A Yale School of Medicine faculty adviser serves as a thesis mentor to each student.

Mandatory Rotations

Emergency Medicine
General Surgery
Geriatrics
Internal Medicine I
Internal Medicine II
Obstetrics and Gynecology
Primary Care I
Primary Care II
Pediatrics
Psychiatry

Elective Rotations

Ambulatory Medicine
Anesthesiology
Cardiology
Cardiothoracic Surgery
Diagnostic Imaging
Gastroenterology
Hematology/Oncology
Hospice
Industrial and Occupational Medicine
Infectious Disease
Intensive Care
International Medicine
Interventional Radiology
Neonatology
Neurology
Neurosurgery
Ophthalmology
Orthopaedics
Otolaryngology
Pediatric Cardiology
Plastic Surgery
Rehabilitative Medicine
Rheumatology
Sports Medicine
Trauma Surgery

Admission to the Yale Physician Associate Program

The admissions process is highly selective and the competition each year is keen. Selection is based on three fundamental criteria: academic history, patient care experience, and interpersonal effectiveness. For additional information regarding admissions, please view our Web site at www.paprogram.yale.edu.

Academic. Students must have a baccalaureate degree prior to commencing the program. The Admissions Committee closely examines applicant records for evidence that individuals are capable of successfully completing graduate-level science work. An undergraduate science major is not required, but two semesters of biology or zoology with lab, two upper-level biology courses (one of which should be human or animal physiology), one semester of general chemistry with lab, and one semester of organic or biochemistry are prerequisites. A cumulative science grade point average of 3.0 is required. The program considers Graduate Record Exam (GRE) scores and performance in science courses as indicators of academic ability in light of applicants’ past records.

Experience. Applicants must have some awareness of the intricacies of medical care delivery as it exists today and demonstrate their commitment to a profession that helps the sick and injured. The majority of the program’s students have had one year of direct patient contact experience in a variety of health-care roles such as orderly, nurses’ aide, military corpsman, nurse, surgical technician, or emergency medical technician. Experience need not be in a hospital setting.

Interpersonal. The program values ability to work skillfully, thoughtfully, responsibly, and constructively with people. The Admissions Committee screens applicants to determine their career commitment, interpersonal skills, and willingness to work with the supervision of a physician.

In addition to scholastic potential and interpersonal skills, applicants must have the physical capacities and personal characteristics necessary to meet the full requirements of the program’s curriculum and to graduate as skilled and effective physician assistants. Policy on nonacademic considerations is outlined in our Technical Standards, which are available on the Web site.

The application deadline for the class entering in 2008 is September 1, 2007. Program information, in lieu of a printed catalogue, may be accessed on our Web site, www.paprogram.yale.edu. Applications for admission may be obtained by contacting the Centralized Application Service for Physician Assistants (CASPA) at www.caspaonline.org. The program currently does not require a supplemental application.

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