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Editor's Note: This is the second of a two-part series on the New Pathway curriculum at Harvard Medical School.
Luanda P. Grazette was doing one of the most stressful things a first-year student at Harvard Medical School has to do. She was conducting her first interview with a patient.
This rite of passage puts most medical students on edge because it is the first time they put their specialized knowledge to use and because their supervisors are usually watching over their shoulders.
But for Grazette now in her fourth year at the Med School, there was an added stress. As a student in Harvard's "New Pathway" program, she was being filmed by a television crew for a documentary on the curriculum.
Producers for the public television program NOVA are tracking the lives of Grazette and six of her classmates as they pass through Harvard's revolutionary program in order to see how it prepares them for a career in medicine. The drawback, Grazette says, is that she knows every mistake of her training will be forever recorded.
"You're always sort of afraid that the TV cameras will be there when you say the most idiotic thing of your entire life," Grazette says.
The NOVA series is following the first class of students to graduate from new Pathway for 10 years, from their first year of medical school in 1987, through residency, and into the early years of their professional careers.
The episode Grazette was being filmed for--the first of four--was aired in 1988. The second episode, which covers the students' third and fourth years, is being put together now and will be aired next fall.
"The idea is to see how they change as they go through their training, how the New Pathway has affected their education," says Peter Frumkin, associate producer of the series.
Implemented under the supervision of Med School Dean Daniel C. Tosteson '44, the New Pathway emphasizes small group tutorials over large lectures, less rote memorization of medical facts and more discussion of case studies.
New Pathway also brings a new focus on some of the more practical aspects of being a physician, such as doctor-patient relationships.
The Public Perception
Despite the discomfort the students faced in the filming of the hour-long documentary, the students interviewed say they are glad that the program was made.
One of the good things about being in the NOVA series is that it is a chance to help educate the public about what medical school is really like, says Tom A. Tarter, one of the students being tracked by the show.
Tarter says that in the past, people have put doctors on a pedestal, and their realization that physicians are not perfect has caused their disillusionment with the entire profession. After seeing the show, people will find out what it is actualy like to be a doctor, he says.
Cheryl L. Dorsey '85 also says she believes the show has done a service for the show's viewers. She says she has been called and even stopped on the street by people considering the medical profession who saw her on television and asked her questions.
"It's reached a fair number of people. I really thought that only my immediate family would be watching," Dorsey says.
And Grazette says she likes the idea of being in the show because in the future, she will be able to look back on her early medical school experiences.
"I thought it would be sort of interesting to have a time capsule of what I was thinking about at the time," she says.
The students says making the show has also encouraged them to take a step away from their studies to reflect on their careers and their training.
"We ask fairly probing questions about what they want to do about their futures, and how they are enjoying things, and some are more open about it than others," Frumkin says.
Grazette says that it is good to stop occasionally and think about such questions, since she might not otherwise do so.
"The nature of the questions they ask are things that are good to think about, but don't necessarily come to mind," she says.
But despite the stress and inconvenience of making the documentary, the students say that the producers of the show have been extremely considerate and understanding of what they are going through.
"They have bent over backwards to make everyone happy," Tarter says. "I think these people have really realized how tough and what an imposition it is."
However, Tarter adds that if asked to do it again, he would have to say "no."
Dorsey says she is not sure if she would do it if asked again, but has not found it an imposition at all on her medical school experience. She points out that the camera crew only has to film about two or three times a year.
"It hasn't been disruptive at all. If anything, it's made me a bit more reflective on my experiences," she says.
While the medical students have had their share of stress along with the excitement of being on being on television, the producers of the show say that they have run into their fair share of challenges in putting together the series.
They have run into the most resistance to their projects from some of the smaller Harvard-affiliated hospitals, where they had to film for the second episode, says Michael Barnes, the series producer. In order to film there, he says, they had to make arrangements with the hospital's public relations staff, which was not always cooperative.
Of course, it is understandable, Barnes says, that a hospital would be concerned about such issues as patient confidentiality when a crew of television cameras rolls through the hospital's front doors.
But by spending a lot of time getting to know the hospital staff, Barnes says he hopes to build up trust between the film crew and the hospitals, which is crucial for such a long-term project.
Barnes also says that he ran into an obstacle in the first year of filming when people felt uncomfortable talking about the curriculum on camera because it was so new.
"It was very difficult to get anyone to speak about whether they liked or didn't like the New Pathway," he says.
A common criticism of the NOVA project is that it is impossible to portray such a complex program fully in an hour of television.
"Any show just really can't capture what it's like to go to medical school," Dorsey says.
In an article in the spring 1990 issue of the Harvard Medical Alumni Bulletin, Dorsey lamented the fact that "the cameras are unable to capture every moment of a medical student's career, which makes the choice and the timeliness of their periodic appearances even more crucial."
However, grazette says she was pleased with the final product of the first show, considering all the difficulties involved in production.
"We felt like it was a really good representation of what our first year was like," she says.
Frumkin says the feedback he has gotten from Harvard administrators, as well as the general public, has been positive.
"[The viewers] like to see the fact that the students are people, and have a hard time with some of this stuff," he says.
And when people do criticize the show, frumkin says, it is hard to distinguish whether they are criticizing the film or the New Pathway.
The series has received its dose of scrutiny from the Harvard administration. When Barnes proposed the idea to the Medical School in May of 1987, it took four months of negotiation and discussion with the school's Faculty Council before he was granted provisional permission to begin filming, which was not made permanent for another three months, he says.
Tosteson says that some faculty were concerned that the series would not be able to portray the curriculum accurately. He says he supported the project, and was fairly pleased with the first show.
"I thought that in many ways it was a very constructive evocation of what happened. It captured very well the enthusiasm and energy and intelligence of our students," Tosteson says.
His only complaint, he says, is that "I thought it missed completely the excitement and the importance of discoveries in modern science for medical education," an essential part of the New Pathway. Tosteson says he hopes future episodes will capture this aspect more successfully.
After getting the go-achead from the Medical School to begin filming, Barnes and his crew were still not free from the scrutiny of the Harvard administration. The faculty set up a three-person committee to act as a liaison between the producers and the Medical School.
Dean for Students and Alumni Daniel D. Federman '49, who sits on the committee, says they have had to prohibit filming in a couple of cases, such as when the students were taking an exam, and when they arrived the first day, before they were informed about the show.
But overall, Federman says the committee members were pleased with the project once they got to know the producers.
"On the whole, I would say [the first show] was pretty good," he says.
Federman says the difficulty lies in the fact that the New Pathway does not lend itself to this kind of documentary, and that following only seven students does not convey the best picture of the class's diversity.
The third episode in the series will follow the students through their first year of residency, which they will begin this summer. The show will examine how they deal with the enormous responsibilities now thrust upon them.
"It may well be the worst year of their medical education, as well as their lives," Frumkin says.
The final show, which will take place a full 10 years after the first, will see how and what the students do after their residency, such as setting up a private practice.
"I like the idea of seeing people change over time," Barnes says.
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