Med School Data Support New Third-Year Curriculum

Early data on Harvard Medical School’s revamped third-year training program suggests that the new curriculum will turn out better doctors, four key architects of the reforms wrote in The New England Journal of Medicine yesterday.

“I believe it’s the most important experiment in clinical medical education reform in the United States, and it’s going to have a massive effect on clinical education,” said Walter Distinguished Professor of Medicine Malcolm Cox, who helped design the new curriculum as dean for medical education from 2003 to 2005.

Previously, the third year of medical school had consisted of brief rotations among affiliated local hospitals, which critics said made it difficult for students to form meaningful relationships with faculty and patients.

The new program places students in a single hospital for the duration of their third year, a policy that the curriculum’s designers believe better simulates professional medical practice.

Harvard’s transformation of the third-year curriculum makes the school one of only a few top American medical schools—such as the University of California, San Francisco School of Medicine—to implement a system where students remain in one setting for the entire year.

The change is currently being phased in through pilot programs at a number of Harvard-affiliated hospitals.

The article, which appeared in yesterday’s edition of The New England Journal of Medicine, cites preliminary data on improved student knowledge and clinical skills as evidence that the program is working. The authors could not divulge the data behind their findings because of an agreement with Academic Medicine, a journal that will publish the results this spring, Instructor in Medicine David A. Hirsh, a co-author, said.

“We published this article as a sounding board rather than a review article,” said Cox, who is also a co-author.

Hirsh and Cox said that the models at Harvard-affiliated hospitals are still works in progress and that other medical schools might require a different system.

But continuity of education, which allows students to develop relationships with both their teachers and patients, is critical for any program, the authors said.

“We are now exemplifying how any site in any location with any mission trains better when students have relevant interactions with the faculty and with their patients longitudinally,” said Hirsh, who also helped design Harvard’s third-year pilot program at Cambridge Hospital.

The new third-year program has met with some opposition from professors who say it is too organizationally complicated.

“I think it’s people’s sense that the logistics are overwhelming,” said Assistant Professor of Medicine Barbara Ogur, a co-author of the article and another architect of the Cambridge Hospital program. “It requires making sure that students follow patients across all the various gaps in the health-care system.”

But Ogur said that the reform’s benefits outweigh its logistical difficulties.

“What we see, educationally, makes the little bit of extra work worth it,” she said.

The new third-year clerkships are set to be fully implemented by the spring of 2008, according to the 2006-2007 Dean’s Report published by the Medical School.

The curriculum’s architects said they hope Harvard’s move will encourage other medical schools to implement similar reforms. But institutional resistance to change may prove to be a major barrier at other schools, the authors said.

“Once you’re doing something for a while, that’s just what you do,” Hirsh said. “What we forget is that our grandparents didn’t do that. They had real relevant longitudinal experiences. My dad tells the story of his training: mine was snapshots, his was a movie.”

—Staff writer Clifford M. Marks can be reached at cmarks@fas.harvard.edu.