by Lowell Tong, MD

“I’m going to med school!” conjures up images of an excited, idealistic, humanistic and very smart college senior or recent graduate, a proud family, long hours of studying, memorizing vast amounts of information, human cadavers in anatomy lab, white coats, a new doctor’s bag and a stethoscope. It’s all true, except 1) there is a greater emphasis on learning concepts than memorizing facts, and 2) variations on the bike messenger’s bag have replaced the black leather doctor’s bag.

At UCSF, that entering medical student is likely to be:

• 24 years old
• from either Cal, Stanford, UCLA, UC Davis, Harvard or Yale
• 60% likely to be a woman
• 60% likely to represent a mixed or minority ethnicity
• and 80% likely to be a California resident.

Her laptop will access iROCKET, the UCSF electronic curriculum over UCSF’s wireless network in her classrooms, library and student lounge.

Within the first few weeks of medical school, this new med student will have:

• interviewed her first patient,
• witnessed a live demonstration of a medical emergency,
• learned how to measure blood pressure, and
• used her eyes, ears, hands and stethoscope to examine the human heart and lungs.

She will be in lecture halls no more than two hours each day, since most of her coursework uses small group learning, laboratories, computers and practical experiences with an office-based physician. And for all this she will budget more than $40,000 per year for tuition, fees, equipment, supplies and San Francisco living costs.

First year begins in September with the celebratory “White Coat Ceremony” where families are invited to watch their child, parent,
sibling, partner or spouse get “coated” by a medical school college advisor and take their first professional oath. You can always tell the first year medical students apart from their more senior student colleagues: they are wearing spotlessly clean, stiff, creased white coats in clinical settings.

Introducing psychiatry

First- and second-year courses provide the scientific foundations for learning about the human body and function, medical disorders and their treatment. Students learn most about psychiatry in a course called “Brain, Mind and Behavior” at the end of first year. Psychiatry is also one of four medical departments sponsoring a unique course
which gives beginning students the foundations for developing the right kinds of relationships with patients, learning the clinical reasoning process, performing physical and mental status
examination skills, and professionalism standards.

This “doctoring” course includes preceptorships, where students spend half a day about every three weeks with a physician mentor right in the doctor’s own office. UCSF and Bay Area community-based
physicians have a very collaborative relationship – each year about 500 dedicated physicians volunteer their time to teach our medical students either by opening their offices or by coming to campus.

Psychiatry clerkships in third year

Third year, all students take required clinical clerkship courses
in each core clinical department. This includes the psychiatry core clerkship, which comprises a four-week rotation with an inpatient or consultation-liaison psychiatry team of residents and faculty taking
care of patients directly, as well as an eight-week rotation in a half-day psychiatry clinic.

The psychiatry clerkship is paired closely with the neurology clerkship, and we have developed a number of successful joint learning activities such as clinical case conferences, a neuroanatomy
review and web-based learning modules. The psychiatry and neurology clerkship is offered at four sites: the Parnassus campus, San Francisco General Hospital, San Francisco Veterans Affairs Medical Center, and UCSF/Fresno.

By the end of third year, students have transformed from “student” into “health professional;” those well-worn white coats are no longer as bright, stiff or spotless.

Senior psychiatry electives

Fourth year is when students concentrate on a scholarly area, such as research, medicine and the humanities, international health or medical education. The senior students also take clinical electives as they decide which specialty to enter.

Many medical students from other schools across the U.S. and Canada apply to our department to take a senior psychiatry elective. Each year we accommodate about 20 visiting students, in addition to many more of our own.

“Residency Match Day” in mid-March is a very exciting day: news of who is going to which residency is delivered to students via thousands of sealed envelopes distributed simultaneously in every
medical school across the country. Students rank the programs they’ve applied to and visited, residency programs rank the applicants, and a computer is the matchmaker.

Finally, Graduation Day

In June, the UCSF School of Medicine holds its graduation ceremony in the Masonic Auditorium on Nob Hill, since no indoor space on campus is large enough to accommodate all the students, families, friends and faculty. At the festivities, white coats are exchanged for graduation gowns, and the dark green velvet hood announces that the student is about to become a doctor of medicine.

The hall is always filled with an enormous amount of pride, happiness, noise, and a sense of awesome accomplishment at the words:

“Ladies and Gentlemen, may I present to you the graduating UCSF medical school class. Congratulations doctors!”