MED SCHOOL: Hard Grind For Future Harvard M.D.'s

Edwin Walter '63 is a third-year student at Harvard Medical School. As an undergraduate he was active in College drama and was a member of the Harvard-Radcliffe Orchestra. He plans to be a psychiatrist.

This is the second in a series on Harvard graduate Schools.--Ed.

Harvard Medical School, the nation's second Modest, was founded in 1782. It was the first institution to embrace what we might call modern concepts of medical education, and it is continued as a pioneer. Today it is a prestigious unit of the University, rich in tradition, widowed with millions of dollars worth of equipment and manpower, and much devoted its task of preparing men for the medical profession.

Two hundred years ago, one learned how to heat the sick by apprenticing oneself to a physician and watching how he did things. The best medical schools, Harvard included, simply corporated this system into a loose academic homework, supplementing it with some formal instruction. Apparently, this instruction was at very thorough; it ran four months of the year, and the final examinations (oral) were would to have been scandalously easy. Faculty members collected their salaries directly from students, who had to buy tickets for each course they took.

Across the River

Within twenty years of its creation, the Medical School had moved from Cambridge to downtown Boston in order to be near future capitals. Separation from the rest of the University encouraged further laxity: the Corporation took little interest in guiding the School, and the Medical Faculty strongly desired independence. All this (and much more) was changed in 1869 when Charles William Eliot assumed the Presidency of Harvard. At the first Faculty meeting after Eliot's inauguration, the president walked into the room, sat down at the head of the table, and called the meeting to order--an unheard-of action that left no doubt of his intention to assume command. There followed a revolution that set Harvard medicine (and American medicine) on its present course.

Eliot had taught chemistry at the Medical School for one year, and what he saw made him want to change the whole system of training physicians. Under his firm direction, the Faculty came to adopt the present view that effective medical practice must be based on comprehension of basic medical science. Instruction was made more rigorous and was extended through-out the academic year; the University took responsibility for the school's finances and began paying professors' salaries; laboratory work was added to the curriculum; examinations were toughened; appointments to the Faculty emphasized academic experience; and students were selected on the basis of their preparation. The climax of Eliot's efforts came in 1906 with the School's move to its present location in six imposing (but cheerless) buildings off Long-wood Avenue near the Fenway. The citation that went with Eliot's honorary M.D. of 1909 read, "You found the Medical School brick and left it marble."

The two factors that have done the most to shape Harvard Medical School have been its separation from Cambridge and its treatment of medicine as a science.

If you are admitted to the School from Harvard, do not expect to keep up the old Cambridge life that so many find delightful. When you enter as a first-year student (or an "HMS-1" as you will be known), you will find most of your day taken up by lectures and laboratories. Probably, you will live in Vanderbilt Hall, an enormous dormitory, done up outside as a sort of Spanish palace. It sports Boston's most elegant address--1007 Avenue Louis Pasteur. Regrettably, elegance vanishes a few steps beyond the front door: the hallways are done up as a sort of Spanish dungeon, and the dining hall's best efforts are about comparable to those of Central Kitchens. Unless you have a car, the trip to Cambridge will take you 40 minutes on the MBTA. (Last year, a much-needed limousine shuttle was put into operation between the Medical School and the Yard, but it doesn't run after dark.)

You will want to get out because there is nothing at all to do in the immediate vicinity of Avenue Louis Pasteur: once in the middle of a grassy field, the six original buildings now sit in the midst of some of the city's most depressing blocks. True, they are only a few minutes from Brookline's splendor, but the proximity of dreary Roxbury is much more evident. If you make loud enough inquiries, you will find you can use such facilities of the other-side-of-the-river as Lamont, Widener, Holyoke Center, and the IAB pool. You will have to inquire, however, since the School itself seems to think you should be content to spend all of your time around the Longwood Avenue Quadrangle.

Spiritual Deficiencies

Harvard Medical School is spiritually as well as physically removed from Cambridge. Most happy undergraduates love the College because of the tremendous freedom it allows them to explore Harvard's enchanted wood. No doubt, you would expect even more freedom when you embark on a graduate program at the Medical School. Not so. You are officially an undergraduate for all of the four years it takes you to get an M.D., and you will be treated accordingly. In place of the nonchalance of the College, you will encounter a regimentation reminiscent of high school. For its first two years, your class will march off to lectures, lunch, and laboratories like a group of campers. You will find it nearly impossible to meet Faculty members socially. You will have great difficulty pursuing outside interests in the face of quantities of required memory and busy work. You will be examined relentlessly. You will confront an administration that is offensively paternalistic. And you will probably feel you are not encouraged to do much thinking.

In fairness, medical students nearly every-where complain about the immaturity of much of their education. And, probably, Harvard manages to offer the incoming student a more interesting assortment of classmates than do most institutions.

Harvard's Medicine-As-Science philosophy has given it the reputation of a "research school," with the implication that it is not the place to go if you want to be a practicing doctor. In reality, what Harvard attempts to do is to give the student a thorough grounding in basic science so that he can go on to good research or good practice. By comparison, it is, indeed, a research school, since most medical schools lack teachers who can integrate contemporary developments in the life sciences into a medical curriculum. If you are the sort of person who can't wait to start saving lives, be warned: during your first two years, you will have to put with an immense amount of complicated, tedious "pure" science, which you will certainly find irrelevant and unbearable. It's not easy to generalize about whether students benefit from the indoctrination when they get into the clinic in their last two years: some do, some don't.

In the Beginning

The preclinical years cover normal and abnormal biology in a logical sequence. As an HMS-1, you study gross and microscopic anatomy, physiology, and biochemistry along with just a smidgin' of psychology. (Most aspiring psychiatrists feel cheated throughout their "undergraduate" years at the Medical School.) All of these courses demand your presence in long lectures and labs, two educational devices of questionable value in which Harvard has unending faith. Small-group instruction, when available, is usually effective; lectures, on the other hand, tend to obscure general principles of their subject and confuse students with welters of detail. In general, professors do not assign reading; students are expected to dig out basic concepts on their own. It is perfectly possible to succeed with one good book and without spending the whole day in class.

A well-received innovation in the curriculum has been the creation of "correlated areas of teaching" in the second semester of the first year. The areas are integrated presentations of whole body systems, so that, for example, one studies the Histology, biochemistry, and physiology of the endocrine glands all at once instead of in three separate courses. Clearly, a sensible plan, it often bogs down when the specialists who present the material are unable to do much correlating.

Onward and Upward

Second year, to the dismay of many, is, in form, a repetition of this lecture hall-laboratory existence, with even more of one's time taken up. Not until third year, does one really get into Harvard's teaching hospitals. But most students feel the wait is worth it, since the Medical School's wide variety of clinical facilities including such famous hospitals at the Peter Brigham, Massachusetts General, and Boston Lying-In) is likely the best in the world. Nearness to say, the Harvard M.D. that comes the fourth year is a most valuable credential.

In summary: Harvard Medical School offer an excellent education in medical science and clinical medicine. But those who hope to find at it a sort of general education in science, we want to be Renaissance Men, who hope to find on to their College ties, or who simply to have a good time learning to be physician thought to prepare for considerable frustration and difficulty in achieving their goals