THE MEDICAL SCHOOL faculty feels threatened. One-hundred five students in the School's class of '78 have laid their academic careers on the line against a three-year-old faculty rule requiring students in the class, and in all later classes, to concentrate in some area of medicine. If students and faculty both stand by their recently-stated commitments, three-fourths of the class of '78 will not return to the school this fall.
The concentration requirement is new to the School and represents a step few other medical schools have taken. The general terms of the requirement, adopted in 1974, arose from the same faculty discussion that had led the school to drop the fairly structured curriculum, adopted in 1968, only five years later. That curriculum, organized around human body systems, had apparently resulted in a decline in students' scores on the National Board exams, a set of tests oriented toward basic science on which Harvard students have traditionally shone. The Med School faculty was not happy about that drop and voted to return to a basic science curriculum for students' first two years.
That curriculum gave students too much flexibility to allow many faculty members to rest easy. In 1973, Dr. Alexander Leaf, Jackson Professor of Clinical Medicine and then chairman of the faculty's curriculum committee, called the elective system offered for students' last two years "a frivolous berry-picking operation." The frivolity had to go. Dr. Robert H. Blacklow '55, associate dean of the Medical School, said last week in defense of the concentration requirement, "The philosophy of education is not all hedonistic. Education is not all pleasure." In the spring of 1974, after the current third-year class had accepted their places at the Med School, the faculty decided that students in that class would have to concentrate in one of twelve areas, ranging from Immunology to Social Medicine and Medical Humanities.
The class of '78 became aware of the requirement during the summer before they matriculated. But the concentration requirement applied to clinical training--the last two years of their time at the Med School. The class spent its first two years at the school studying the basic medical sciences, and some of its members spent time discussing with faculty the eventual form the concentration requirements might take. The specifics had not been included in the faculty's spring 1974 resolution.
Last March, at the end of the class's first two years, students approached the faculty with a petition calling for a one-year delay in the implementation of the concentration requirement. The Class of '78 asked the faculty to leave the program optional until the full details of each area's requirement could be worked out. But the faculty, bent on imposing more structure, voted not to heed the students' request.
IN THE FALL of this academic year, the current third-year class returned to face concentration requirements that were still tentative. When the finalized requirements for the second- and third-year classes came out this February, most third-year students had already scheduled their course programs through the end of June. That leaves one year, not two, for the Class of '78 to fulfill the new requirements. While many students probably have unwittingly fulfilled the requirements already, it was only this spring that the requirements have been clear enough for the administration to require a concentration form specifying which courses students will use to fulfill their concentration requirements. And that form is due May 2, along with third-year students' study cards for the next academic year.
It was only one week ago that Dr. Robert H. Ebert, dean of the Medical School, wrote to students that "time-scheduling of special courses for the concentration areas has now been completed," enabling all students to complete study plans that will meet some areas' concentration requirements. Ebert's letter says, "Only students who have submitted an approved concentration program will be permitted to matriculate in September, 1977." As Ebert mailed out that statement, Gary Greer, a second-year medical student and chairman of the school's closest approximation to student government, was preparing to reveal that he had collected statements from three-fourths of the third-year class saying that they will not file concentration plans.
With the requirements spelled out and the deadline for students to commit themselves drawing near, the student-faculty controversy has become polarized. Students no longer argue that the concentration program is ill-defined. It is now apparent that students do not want any kind of concentration requirement at all.
The school has reached its present stalemate largely because the faculty failed to articulate its general resolution of 1974 sooner. The faculty kept the reasoning behind the resolution--as well as the concentration requirements' eventual form--vague for two and a half years. But while the specific requirements are spelled out in a booklet issued in February, the reasoning behind them is still unclear. The concentration booklet offers only a tautology to justify the new system: "The concentration requirement is intended to insure that each student give thought to at least one area of medicine in reasonable depth prior to graduation." It is a statement of what the requirement entails, not an explanation of why it should exist. Faculty members offer little more explanation than the booklet--they only add vague notions that by concentrating students will "come to grips with fundamentals." Faculty members insist they do not intend the requirement to get Med students into specialties early, although it may certainly have that effect. The faculty's real motivation seems to be suggested by Associate Dean Blacklow: they think students would just enjoy their education too much without the requirement. And now that they are aligned squarely behind the concentration requirement, they hardly have the humor to back off in the face of student pressure, however great.