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Education


The College of Medicine
School of Graduate Studies
College of Nursing
College of Health Related Professionals

Change. Innovation. Experimentation. None of these are unfamiliar to the State University of New York Health Science Center at Brooklyn. Education at SUNY Downstate has been rooted in experiment since the day in 1860 when its medical students were for the first time brought out of the lecture hall and into the hospital ward, in a radical break with educational norms of the time.

The exigencies precipitating change at SUNY Downstate today are the same as those affecting health-care institutions everywhere. The effort to control health-care costs and the related emphasis on preventive care have shifted the locus of care delivery to out-patient settings and created opportunities for new classes of primary-care practitioners. At the same time, advances in medical knowledge and the rapid development of new health-care delivery technologies are changing the practice of medicine and how it must be taught.

At SUNY Downstate, we are making significant revisions to the curricula of all four colleges. The College of Medicine curriculum introduced in fall 1998 is a radical departure from the past, reconfiguring the presentation of material to erase the formerly clear demarcation between “basic science study” and the “clinical” years. Changes being introduced in the School of Graduate Studies are similarly epochal. The program being phased in will offer fewer options for concentration, but will prepare students to be flexible in today’s changing research environment.

By mid-1997, the College of Nursing had already phased out its generic undergraduate nursing program. For the immediate future, the College will offer an undergraduate program for registered nurses, an advanced nursing practice program, and specialty training programs leading to a master’s degree. Program curricula of the College of Health Related Professions have incorporated new courses and technologies in teaching and practice, expanded their community focus, and concentrated on increasing interaction across disciplinary boundaries.

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The College of Medicine (COM)



Patient with internsDuring the Charter for Change process of the mid-1990s, leaders in the College of Medicine and SUNY Downstate administration realized it was time to make a critical decision: whether to continue modifying the medical curriculum piecemeal, or to conduct a major overhaul.

The curriculum had actually been evolving for some years. In the mid-1980s we helped pioneer a trend toward more holistic approaches to patient-centered care and made continuity of care from one care setting to another central in our teaching in all four colleges and in our clinical practice. In the early 1990s, we pioneered the use of computer-based instruction, small-group learning, and case-based teaching approaches. Students and faculty alike found these new methods stimulating, giving students a “feel” for medicine early on in their education and encouraging them to collaborate in solving patient problems.

In 1994 the College of Medicine also began offering an optional primary-care track with concentration in family practice, and by 1995 we began offering electives in clinical care to all medical students, beginning in their first two years. The success of these changes—along with the explosion of new scientific and clinical information--encouraged us to rethink the entire curriculum. Among our goals in redesigning the curriculum are to integrate the basic sciences with clinical education across all four years of study, to nurture an appreciation of the rigors and rewards of primary care medicine, and to spark students’ intellectual curiosity so that they become life-long learners with a quest for evidence-based medicine and a desire to provide the best for their patients.
Working through task forces of faculty, students, and administrators, we are sequentially modifying all four years of the curriculum. The first year of the curriculum has been changed from the traditional departmental-based approach to a multidisciplinary, systems-based curriculum.

In their first year, students will study ten different units—from genes and cells to the cardiovascular system and neuroscience. A team of basic scientists, physicians, and students is developing each unit.

Students will be introduced to each unit through an actual medical case. Whenever possible, we would like to have the patient present or to have a videotape of the patient shown at the beginning of the unit.

The curriculum is designed to be integrated between units and between years, and with a weekly “doctoring experience,” in which students explore the human dimensions of medicine through contact with patients in a hospital or ambulatory setting.

Although the new curriculum introduces students to real-life clinical problems earlier than in a traditional medical curriculum, it will not do so at the expense of basic science concepts. An important goal of curriculum reform is to make the study of the basic sciences as intellectually rigorous as possible and to show how they provide the foundation for clinical medicine.

During their third and fourth years when, traditionally, clinical training is emphasized, our students will also be tackling advanced concepts in basic science. A student interested in surgery, for instance, may choose to assist a professor teaching Gross Anatomy.

We are excited by the changes in the curriculum and believe they will help our graduates develop a deep understanding of medicine’s scientific and human dimensions.

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The College of Medicine
School of Graduate Studies
College of Nursing
College of Health Related Professionals






















School of Graduate Studies



In the laboratoryChanges in the Graduate School curriculum are linked to several recent trends in research practices and to the new emphases of funding agencies.

Breakthroughs in the fields of genetics and molecular biology, and advances in research technologies, have made research more complex than ever--and also more expensive to conduct. Until recently, funding for more costly projects was limited by the huge federal budget deficit. Good news, however, is on the horizon. The President and Congress have proposed doubling the National Institutes of Health budget for biomedical research over the next five years.

The priorities of the NIH and other funding agencies favor projects featuring clinical and basic science research collaborations that promise early clinical applications. In addition, private industry is now playing a more dominant role in financing research, and it, too, favors clinically relevant projects.

These trends forecast that scientists may have less leeway in the future in choosing the subjects of their research. Universities must provide students with a broad background allowing them the flexibility to move in a number of different directions, depending on opportunities.

In a recent self-evaluation process, faculty and administrators agreed that the School of Graduate Studies must be “leaner,” with fewer, but more focused programs. Dean Susan Schwartz-Giblin, Ph.D., who assumed direction of the School of Graduate Studies in August 1997, is presiding over this reconfiguration. In addition to preparing students for successful research careers, the curriculum redesign seeks to build on our strengths in several areas.

We are currently focused on building centers of excellence in molecular biology and neuroscience, along with their complementary disciplines of cell biology and behavioral science, respectively. Upon approval from the State Education Department, we also intend to reorganize the school from its traditional six-program structure to form two Ph.D.-granting programs that concentrate in these two broad areas.

Faculty must generate more grant support for their own research and for the graduate students and post-doctoral research fellows who are so critical to the work of their laboratories. We are increasing financial support to attract the most competitive students, but also directing students to finish their degrees in six years in order to open slots for the admission of new students. The total number of graduate students is being reduced from 100 to approximately 80.

The Graduate School curriculum will be strengthened through the addition of several new courses in neuroscience and in molecular and cell biology. Students will also have the opportunity to participate in more journal clubs and have more hands-on experience learning laboratory techniques.

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The College of Medicine
School of Graduate Studies
College of Nursing
College of Health Related Professionals






















College of Nursing



Nurse Possibly more than in any other field, the changes sweeping health care are altering roles for nurses. The shift of patient care to outpatient settings has decreased demand for hospital-based nurses, but the same trend has created new opportunities for professional nurses with more extensive education and experience.

The aging of the U.S. population and the technical advances that help people live longer have also created opportunities for nurses in home care, hospices, and nursing homes. Increasingly, advanced practice nurses are playing leadership roles in ambula- tory care settings and practicing on their own to provide preventive care and to diagnose and treat minor medical problems.

As a result of these developments, the College of Nursing has maintained its baccalaureate programs for registered nurses and expanded advanced practice programs leading to master’s degrees. This expansion was accompanied by curriculum revisions.

The graduate faculty revised the curriculum to ensure that all students are introduced to a common body of knowledge necessary for advanced nursing practice. At the same time, they acknowledged the unique contribution each advanced nursing role brings to health care.

For example, recognizing the need for the clinical nurse specialist to provide case management throughout the continuum of care, a new course was developed, “The Case Management Process in Continuity of Care for Adults and High-Risk Mothers and Infants.” This course focuses on the entire spectrum of issues pertinent to the nurse case manager in both hospital and ambulatory care settings.

The nurse practitioner program of study was also revised to require a course in management and leadership. Students in the program also complete a six-week interdisciplinary primary care clerkship in which nurse practitioner students, physician assistant students, and medical students work side-by-side in ambulatory care sites at Lutheran Medical Center.

Recently the college initiated two additional master’s degree programs: one for nurse anesthetists, the other in nurse-midwifery--a degree issued jointly by the College of Nursing and the College of Health Related Professions. Students in the midwifery master’s program do course work under both the College of Nursing and the College of Health Related Professions. Nurse practitioner certification is also now offered in certain specialties for nurses who already have a master’s degree in nursing.

The nurse anesthetist program was established to fill a need created by cost-containment programs. Studies have documented that advanced-practice nurses can deliver high-quality anesthesia administration and patient monitoring, reducing the need for physicians and residents. Nurses may work on their own in routine procedures, or with physicians in more complex cases.

Led by a new dean, Mary Ella Graham, Ed.D, who joined the Health Science Center in August 1996, the College of Nursing continues its emphasis on patient advocacy and empowerment while educating nurses to play leadership roles in multidisciplinary practice situations and in ambulatory settings. The college is proud of its record in educating nurses who are members of minority groups. About three-fourths of our students are minority-group members, and many are recent immigrants.

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The College of Medicine
School of Graduate Studies
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College of Health Related Professions



COURSES IN CUBADuring the 1997-98 academic year, the College of Health Related Professions became the first in the State University of New York to offer courses in Cuba. For eight weeks during the summer, faculty members and students from the Midwifery Program traveled throughout Cuba, studying its health-care system.

The trip highlighted the emphasis on primary care and greater attention to the whole person that continues to lead curriculum changes in the College of Health Related Professions.

The Midwifery Program also recently graduated its second class of “direct entry” (non-nurse) midwifery students. This year-long program is the first in the country to offer midwifery training to non-nurses and was offered after New York State ended a requirement for practicing midwives to be registered nurses. A master’s degree program for the direct-entry track and a midwifery master’s for nurses with a BA or BS (rather than a BSN) degree were also implemented recently. The Physical Therapy Program offers a new master’s degree to meet the growing need for physical therapists prepared to practice outside of traditional institutional settings.

SUNY Downstate’s highly rated Diagnostic Medical Imaging (DMI) Program, which offers the only upper-division BS degree in the tristate area, recently expanded its curriculum in vascular ultrasound, reflecting significant advances in this rapidly developing field. Offerings in pediatric echo-cardiography also were expanded. The Occupational Therapy Program recently added a new assistive technology course to prepare students to work with clients using computers and other advanced technologies.

Another recent development was the launch of several interdisciplinary courses among the departments within CHRP to use resources more efficiently and to promote the exchange of ideas. Most prominent among these is the college-wide ethics seminar for junior- and senior-level students.

Recently the college expanded and updated an interdisciplinary research course and initiated interprogrammatic courses that bring together physician assistant students in a shared learning environment. Midwifery and physician assistant students attend joint pharmacology courses, and the DMI Program, in collaboration with the Midwifery Program, now offers a course in obstetrical ultrasound for midwives.

The Physician Assistant (PA) Program recently introduced an interdisciplinary case conference, in which students in several programs are introduced to the full spectrum of activities of other allied health professionals working with the same patient population. Also introduced was a six-week interdisciplinary primary care clerkship in which PA, nurse practitioner, and medical students are educated together in ambulatory care sites at Lutheran Medical Center.

The Health Information Management (HIM) Program has undergone an extensive curriculum redesign, with the introduction of new courses in computer data communications, database analysis and design, and research support. Changes are in response to the field’s rapid shift to computerized, “paperless” modes of information storage and retrieval, and the growing prevalence of new practice environments, including HMOs and small-group physician practices.

Increased community focus has been a particular hallmark of change in the College of Health Related Professions. The PA Program doubled its community service component, introducing new content into existing courses. Examples include expanded units on domestic violence, breast health, substance abuse, managed care, and health screening. In the Physical Therapy Program, the pioneering SAIL (student assisted independent living) service/learning course has completed several successful years. This program, offered in partnership with 11 community agencies, enables PT students to provide preventive and primary care services to geriatric patients in community-based settings. Occupational Therapy faculty have also been active in developing new community-based practice sites for students, with opportunities for field work with elderly persons, pediatric sickle cell patients, abused women, and people with AIDS.

Advances in technology are reflected in revisions in all CHRP programs. In occupational therapy, for example, developments in technology are opening new doors for people with disabilities. OT has acquired new state-of-the-art equipment, including a screen reading program for the blind, a speech synthesizer, and ergonomic keyboards. The DMI Program has acquired innovative new equipment including an ultrasound simulator allowing “hands on” experience performing ultrasound testing on a simulated human body. The Physician Assistant clinical curriculum was expanded to include computer-assisted instruction.

CHRP faculty have been resourceful in developing innovative approaches that help students learn more effectively, and they are constantly assessing these efforts to be sure they are working. In the Midwifery Program, a prospective research study is comparing outcomes for direct-entry and nurse-midwifery students. The DMI program has implemented “learning style” projects, allowing each DMI student and students in some other CHRP programs to assess his or her optimal learning approach. Students in the DMI program are also doing independent research projects, alone or in groups. Articles by three students were recently accepted for publication in the Journal of Diagnostic Medical Sonography.

Such innovations in CHRP programs are bringing success by many measures. Recent PA program graduates scored well above the 90th percentile in national board examinations—an outstanding outcome for a relatively young program with a high percentage (56 percent) of enrollees from minority or disadvantaged groups. Our HIM students—more than 60 percent minority group members--have an impressive record of success in finding job placements.

The quality of the programs in the College of Health Related Professions gives our graduates a head start in developing successful careers while providing the expertise society needs to meet changing health-care priorities.

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The College of Medicine
School of Graduate Studies
College of Nursing
College of Health Related Professionals