The Duke University School of Medicine MD program

Patient FIRST stands for Foundations, Immersion, Research, Social/Structural Drivers and Transformation; the bulletin's version has Service in place of the drivers. Its guiding principles are integration, iteration and inclusion. Integration links the sciences with each other and with clinical medicine. Iteration means meeting the same material several times, with more complexity each time, until you master it.

In year 1 the science comes through one course, Foundations of Patient Care: Part 1 from late August to January, and Part 2 from February to June. Part 2 opens with the principles of immunology, microbiology, pathology and pharmacology, then teaches common diseases organ system by organ system.

Each unit starts and ends with sessions that frame the science around patients. End-of-unit cases use interactive videos that walk you through a patient encounter, both on your own and as a team. Technology delivers part of the core content, so class time goes to synthesis and team work. Pathologist assistant students take the biomedical sciences with you.

Required year 1 activities, including required videos and assignments, average no more than 40 hours a week, and you generally get a half-day a week of unstructured time. From year 2 the teaching moves into clerkships, while small-group courses in clinical skills, structural determinants of health and leadership carry on.

Gross anatomy, the study of body structures you can see without a microscope, is part of Foundations of Patient Care 1, from late August to January of year 1. It runs alongside microanatomy (tissues under the microscope), physiology and brain science, and the course also covers embryology. The current First Year page lists cadaveric dissection among the course's small-group labs, so you learn anatomy by dissecting a human body with your team.

An older version of the anatomy course website, last updated in 2019 according to its footer, gives more detail. It described 28 labs, with each team assigned to one cadaver and working from an online dissector, and CT scans of the team's own cadaver to study alongside. Team members took turns as the day's dissection captain and radiology captain, and radiology residents or fellows came into the lab to help. Treat these details as the course as it ran then.

Clinical skills start in your second week. The two-week Clinical Skills Training Immersion covers history-taking, physical examination, point-of-care (bedside) ultrasound and evidence-based medicine in small and large groups. Clinical Skills Foundation 1 small groups then continue through the year. Foundations of Patient Care adds standardized patients, patient visits on the wards and in clinics, and clinical correlations with patients.

Year 2 is fully clinical. You take your own patients' histories, examine them and draw up and carry out plans for their tests, as the primary provider within a team of several professions. On the medicine clerkship each student carries an average of two to four patients a day. Clinical duty hours are capped at 80 a week and you get one full day a week free, both averaged over four weeks, with no shift longer than 28 hours.

In the research year, the Third Year Clinical Experience, a weekly outpatient clinic, keeps you seeing patients unless you are exempt.

Grading changes by year. Year 1 courses are pass/fail and assessed mostly through objective tests. Year 2 clerkships moved from Honors, High Pass, Pass and Fail to Satisfactory or Unsatisfactory in 2020 and have stayed there, with assessment mostly through narrative evaluations. The research year is pass/fail, and year 4 sub-internships and electives return to Honors, High Pass, Pass or Fail.

Some clerkships end with an NBME shelf exam, a national multiple-choice subject exam from the National Board of Medical Examiners. The medicine clerkship adds a clinical performance exam, an ECG interpretation exam and an online case-based exam to its shelf exam. In 2026-27 the surgery clerkship requires a raw shelf score of at least 55 percent, plus a faculty oral exam, a suturing assessment and weekly quizzes.

An OSCE puts you through a series of standardized clinical cases. Duke's tests your approach to common complaints, covering history-taking, examination, communication and diagnostic reasoning, with cases spread across patient ages, organ systems and the clerkship specialties. You must pass it to graduate. Its course record, the MD program pages and the school's information pages place it at the end of year 2; the bulletin's requirements text puts it in the first month of year 3.

The USMLE is the three-step exam series whose results state medical boards use in licensing doctors. Step 1 tests the science behind medicine and has been reported only as pass or fail since January 26, 2022; Step 2 CK tests clinical medicine. For MD students, LCME accreditation is what establishes eligibility to sit them; students at accredited osteopathic (DO) schools and at schools outside the US can also take them.

To graduate, you must sit Step 1 and Step 2 CK before the last day of fourth-year classes. Duke treats licensure as your own responsibility, so passing is not required to progress, and its information page for residency programs lists passing as not required. You work out with your advisory dean when to take Step 1.

In August 2026 the USMLE program announced a move to designated testing dates from January 2029, with Step exams offered less often each year. Its June 2026 announcement had named 2028. On the current schedule and a four-year track, a 2027 entrant starts the research year in August 2029 and must sit Step 2 CK before fourth-year classes end in spring 2031. If you sit Step 1 in the research year, both exams fall after the change, though some students may sit Step 1 earlier.

• Dedicated Step study time sits in the research year: six weeks timed with your mentor, on the Third Year pages and February 2026 graphic. The mentor guidance allows up to six weeks in total for Steps 1 and 2; the bulletin gives four weeks of Step 1 study on the ten- and eleven-month tracks.
• Courses and clerkships of four weeks or more give you formal feedback at the midpoint and include a written narrative of your performance.
• You get one retake of a failed exam. All year 1 courses must be passed before clerkships start, and retakes of clinical exams must happen within 12 months.
• Failing a course places you on academic probation. Failing two final exams, including shelf exams, brings review by the Promotions Committee, and failing two courses or the same course twice leads to a recommendation for dismissal.
• The dean's letter sent to residency programs contains no ranking, and nothing from pass/fail courses that could be used to rank you.
• The LCME directory lists Duke's MD as fully accredited, with the next survey in 2032-33; Duke reports a full eight-year term after its October 2024 visit.

Clinical training is based in Duke's own hospitals and clinics and at the Durham VA. The bulletin lists hospitals with cooperative teaching programs for medical students. They include Duke University Hospital, Duke Regional Hospital, Duke Raleigh Hospital (a campus of Duke University Hospital), the Durham VA Medical Center and Central Regional Hospital. Pediatrics adds Duke Children's Hospital, and family medicine uses community practices across the Triangle, the Durham, Raleigh and Chapel Hill area.

Clinical course directors assign sites, all within a 50-mile radius of Duke. You can ask for an alternative site by emailing the clerkship director and coordinator at least a week before the course starts. Requests can be granted if there is space and the site meets the course objectives. Every student should expect assignments outside Durham in year 2, and with limited public transport the school expects you to have a car or use ride services.

Medicine students rotate through two of Duke University Hospital, Duke Regional and the Durham VA. Surgery places you on two services of 3.5 weeks each, with site directors at Duke Raleigh, Duke Regional and the VA, plus one overnight trauma shift at Duke University Hospital. Pediatrics uses Duke Children's Hospital and the Duke Regional nursery, and psychiatry spans inpatient services at three hospitals. Family medicine asks for your site preferences on a form before year 2.

The four-year Primary Care Leadership Track (PCLT), launched in 2011, builds year 2 around a seven-month longitudinal integrated clerkship (LIC), where you follow patients across specialties over months instead of in blocks. You choose the PCLT on your Duke MD application, selecting it when you set up your Duke applicant account, and PCLT decisions arrive with MD admissions decisions. PCLT students work in outpatient family medicine, pediatrics, general internal medicine and gynecology clinics, serve a community agency a half-day a week and follow pregnant patients through group prenatal care.

The 2026-27 bulletin still describes a separate LIC route that students apply for in year 1, with a 12-month second year built around a seven-month longitudinal component. The MD program's current pages describe the LIC as the model for PIONEER and as the PCLT's clinical year. The Dual Degrees and Specialty Tracks page still mentions a longitudinal-care track without describing it, so ask whether a separate LIC route will run for your class.

Selectives are short required slots where you choose the subject. In year 2 you take two two-week selectives from about 30 options, in subspecialties the clerkships do not cover, graded credit/no credit with no exams. Examples include A Taste of Palliative Care, Child Abuse and Family Violence, Prenatal Diagnosis, Neurocritical Care, and Trauma and Acute Care Surgery.

Electives are courses you pick. In year 1 you can join Advanced Clinically Centered Education in Spanish, capped at 20 students with intermediate or advanced Spanish, or audit one non-clinical course a semester. Most elective time falls in year 4.

Away rotations are electives at other medical schools, arranged through the Association of American Medical Colleges' Visiting Student Learning Opportunities service and a Duke study-away application. If you passed all of years 1 and 2 with strong performance, you can earn up to 12 credits from three approved away rotations. The sub-internship and critical care elective must be done at Duke. Classmates' anonymized feedback on away rotations is available on a dashboard.

Under a reciprocal agreement you can also take electives at UNC, Wake Forest or East Carolina University's Brody School of Medicine, usually for courses Duke does not offer. Further afield, a four-credit externship places students on the medicine and surgical wards of Teaching Hospital Karapitiya and Teaching Hospital Mahamodara in Galle, Sri Lanka.

The research year is a requirement of the Duke MD, and the school says it has been part of the curriculum for more than 60 years. You can browse approved mentors in DMAST, a searchable database; each mentor takes at most two third-year students a year, and weekly one-on-one meetings are recommended. Most research scholarships need a full 12 months, and with approval you can study at another institution for up to 36 credits.

Duke-NUS Medical School in Singapore, a partnership with the National University of Singapore (NUS), is a separate graduate-entry school whose graduates receive a joint MD from Duke and NUS. Durham students can spend a 10-month research year there, giving at least 80 percent of their time to research and 6 to 8 hours a week to mentoring Duke-NUS students.

About 40 percent of Duke medical students graduate with two degrees, and dual degrees are built around the research year. The MD/MPH is most often taken at UNC's Gillings School of Global Public Health and typically takes four to five years in all. The MD/MBA at Duke's Fuqua School of Business and the MD/MPP at the Sanford School of Public Policy typically take five, and the MD/JD six.

Other options include master's degrees in clinical research, global health, population health sciences, clinical informatics (MD/MMCi) and engineering (MD/MEng). There are also degrees in bioethics and science policy, liberal studies and theological studies, plus informatics and library science at UNC. If your second degree is at another institution, you take a leave of absence from Duke and return to complete the research-year requirements.

The Medical Scientist Training Program (MSTP), Duke's MD/PhD, began in 1966 and typically takes seven to eight years. After years 1 and 2 you spend about four years in a PhD program, which counts as your research year, then return for the final clinical year. If you already hold a recent quantitative biomedical PhD when you enter, you can apply in year 1 to waive the research year and finish the MD in three years.

You can also extend research with the same mentor for up to three semesters. Duke's September 2026 information page for residency programs puts the average time from matriculation to graduation at 4 years 9 months, up from 4 years 7 months in the 2025 edition.

The Trent Semans Center for Health Education houses the Clinical Skills Lab on its fifth floor, with ten simulated clinic rooms and two simulated hospital rooms, each with clinical tools and a computer. The LearningSpace system records encounters so faculty and students can review them online. The Office of Student Affairs, home of the advisory deans, is on the building's fourth floor.

The Standardized Patient Program, set up in 1991, employs more than 70 actors. The Medical Center Library and Archives, in the Seeley G. Mudd Building connected to the Trent Semans Center, has bookable group study rooms and a recording studio. Surgical skills sessions run in the Surgical Education and Activities Lab, and the anesthesia clerkship adds hands-on practice in the Patient Safety Center, a simulation center.

Advising runs through the Office of Student Affairs, where five advisory deans, three staff members and an academic resources consultant follow students through medical school. You are assigned a dean when you start, though you can see any of them. The system dates to the 1980s and covers academic progress, course choices, residency applications, disability accommodations, leave and personal difficulties.

In year 1 your dean meets your lunch group of 12 advisees each week, on Tuesday or Thursday at noon, for informal talk about ethics, careers and current events, plus individual meetings. In year 2 your dean's group has dinner once every clerkship block. In years 3 and 4 you meet one-on-one several times to plan research, electives and your residency application.

A Progress Committee reviews every student's performance through the year to offer early support to anyone who needs it, and a learning support specialist works with students on a learning plan. Under the 2026-27 plan, entering students get a three-year subscription to UWorld, a commercial question bank, for Step 1 and Step 2 CK. Second-years get an NBME practice self-assessment for each clerkship with an NBME exam.

The Office of Learning Environment and Well-Being (Le Well) has a full-time Well-Being Navigator, a licensed clinical social worker. Counselors from Duke's Counseling and Psychological Services hold free, confidential hours in the Medical Center Library on Tuesdays and Wednesdays. Anyone who treats you is kept out of your assessment and promotion, and mistreatment can be reported anonymously.