Over the past three decades, the field of medicine has seen dramatic advancements. However, for the 233 year-old Harvard Medical School, its basic curriculum remained relatively unchanged from the 1980s. Medical students spent their first two years primarily in lectures and late-night cram sessions for exams.
“In the good old days, we required a med student to essentially do two more years of pre-med,” Nancy E. Oriol, Dean of Students at the Medical School, said.
Last year, however, the Medical School uprooted its old curriculum, debuting the new “Pathways” programs after three years of planning.
The new curriculum streamlines clinical experiences for students, while placing the impetus on them to do a large part of their learning before entering the classroom.
Now six months into the new curriculum, students and professors alike said that although the demands outside the classroom have increased, the education at the Medical School better prepares students for future medical careers.
“The fact that we get clinical exposure, learning how to interview patients, do physical exams, and learning other clinical skills from essentially day one of Medical School first year, is already positioning us well to become more thoughtful capable physicians down the road,” Khin-Kyemon Aung ’14, a first year medical student at HMS, said.
“It really has been incredibly well received by the students,” Medical School professor Richard M. Schwartzstein, who led the committee that changed the curriculum, said. “As best I can tell, we’re actually achieving a lot of the goals we set out to.”
In addition to the curriculum change, an increase in student feedback has led to greater awareness for the mental health and wellness of medical students, whose daily lives are notoriously stressful and rigorous. Administrators are also working to adapt mentorship programming to aid new students seeking inter-year relationships despite different curricular experiences.
“The Curriculum of the Future”
The driving force behind the curriculum change was placing a larger emphasis on active learning and hands-on involvement, according to Schwartzstein.
“It was several years of work on the part of the faculty trying to improve the level of engagement of the students with the curriculum, the level of preparation, the sense that we wanted people to spend more time problem solving and application of the material they were learning rather than transfer of content,” he said.
Classes are now more focused on learning through a case-based collaborative environment. Professors expect students to prepare by spending time outside of the classroom learning the concepts. There’s an “expectation that you come to the sessions prepared to work,” Dayton McMillan, a first year student at HMS, said. Upon entering the classroom, students study and apply those concepts to real cases.
“Overall, it’s been amazing. It’s really maximized the amount of learning and I think it’s done it in a very efficient way so there’s a lot of retention,” Perry S. Choi ’15, another HMS first year student, said. He added that he was surprised by how much the new method taught him about the importance of collaboration.
Because the conventional "learning" time has been pushed outside the classroom in the flipped classroom manner, students report there is more work outside of class than in previous years.
“[Upperclass students] see our curriculum and think, ‘Wow this is so much more intense,’ and for us, we don’t really have that frame of reference,” Choi said.
Regardless of the increased work outside the classroom, both Choi and Aung said they have heard few complaints from their peers.
“We were convinced of the efficacy of that increased intensity: more efficient learning and better retention, and also more fun learning where you're not just sitting around listening to people,” Choi said.
Schwartzstein said he hopes the new program utilizes the school’s resources efficiently.
“The most valuable resource a university has are the faculty, and faculty time and faculty time interacting with students,” Schwartzstein said. “So if you have a person standing in front of a large class of students —160 in the case of the Med School or so—talking at them, that’s actually not a great use of time.”
According to Dean of Medical Education Edward Hundert, the new method has been effective in encouraging collaboration between students and professors.
“The students are more engaged than ever, an outcome we attribute to the creation of a culture where the students and faculty are truly partners in the ongoing development and continuous improvement of the curriculum,” Hundert wrote in an email.
The feedback from the new curriculum, gauged in a survey last semester, has thus far been positive, professor Randall W. King said.
Professors too, have noticed a change in their students. Schwartzstein said in his own class he has seen that students are more motivated because they are able to see how their education directly applies to patients, and their ability to engage in problem solving is “vastly different” and “much better than it was in the old curriculum.”
Though the new curriculum comes with drastic changes, the transition to medical school remains difficult.
“The first year of medical school is always a challenge,” Oriol said. “You’re in a new world, the expectations are so totally different… All of a sudden for the first time in your life, you can’t work hard enough to know everything.”
Choi said student wellness was not discussed as often as he would have liked earlier in the year. However, he said he feels the discussion has increased, in part because HMS Student Council President Jessica Stuart focused her platform on the issue. He also said the faculty wants to know how the students are doing and how they balance their lives.
A program called Ed Reps was created to solicit feedback from students regarding the new curriculum. The Ed Reps are first year students who regularly meet with faculty to update them on students’ comments, according to first year HMS student Anna Morenz.
Morenz, who is a member of the Ed Reps, said students have driven discussions about mental health.
She also said the group worked with faculty to design a survey students took at the end of “Foundations of Medicine,” one of the first basic science courses students take at the Medical School..
King, who teaches the Foundations course, said it is difficult to gauge how students are able to manage the workload of classes.
“This year’s class can help us think about strategies we can help develop to next year’s class,” he said.
Despite the potential difficulties in achieving a work-life balance, many students seem to be satisfied with the new curriculum.
“If you look at the statistics, I guess on average people are somewhat stressed. I might be an outlier that I'm not really stressed, but I also think that people are happy with the curriculum in general. It's a good move forward,” Choi said.
Some changes have already been made to the new curriculum based on student feedback. For instance, early on students felt the lab manuals were very long, and there was not enough time to read them, according to Aung. After learning this, the course directors quickly shortened the manuals.
Oriol recounted how early in the year, quizzes were scheduled for Thursdays, but it turned out that it was “disruptive” to students, and so they were moved to Fridays.
“They’ve been particularly open to feedback. We have this amazing opportunity where we sort of have the ear of the faculty and so a lot of my class has been excited to go to them and give them feedback and help them find ways to improve,” Morenz said.
Morenz said the advising system at HMS helps students provide even further feedback. Each student has specific advisers to meet with once every two months, according to McMillan. Additionally, students are able to reach out to the dean of students, the dean of multicultural affairs, and professors for advice.
McMillan agreed there was very fast turn around for feedback.
“They’ve been very responsive,” he said. However, he added that he thinks the administration has almost asked for too much feedback.
Inter-Year Student Relationships
With the new curriculum comes not only academic change, but also changes in the student life and relationships between the first year medical students and older students at HMS. King said it is harder for second year students to give advice to the first years because of their different experiences under the new program.
Some second year students, who are not subject to the new curriculum, even look to it with envy.
Second year student Faith C. Robertson said some of her peers view themselves in much the same light as “neglected older sibling[s].”
“There’s been a lot of fluctuating animosity in my class towards the first years. Not at them, but the system. People were so frustrated. It created a divide,” Robertson said.
Despite this, Oriol said there is a potential new program in place to ensure students can still get to know their peers in other years.
Because of the new curriculum, third and fourth year students will be able to spend time on campus now. Previously, after the first two years, students would continuously spend their time at hospitals, hindering opportunities for relationships between younger and older students, Oriol said.
Now, after their core clerkship in hospitals, students have a year and a half when they finish basic science courses, apply to residency positions, and pursue individual projects, according to Schwartzstein.
The new curriculum, though, does have some tradeoffs when it comes to mentoring relationships between students of different years. In the past, there was a big sibling, little sibling program in place between first and second year students so that first year students would have a peer to turn to for advice, according to Oriol. However, with the new curriculum in place, this will not be possible because second year students will be involved in hospital work.
Since third and fourth year students under the new curriculum may have more time, Oriol said she expects a family program to replace the big sibling, little sibling program.
Another consequence of the new curriculum is the cancellation of the Second Year Show, which has always been a popular communal event for second year students. The show had to be curtailed because there is simply no time for second year students to accommodate it with the new curriculum, Oriol said.
In light of this change, the show will now be in the fourth year, according to Oriol. Aung said that although she was disappointed by the cancellation, she was willing to make certain trade-offs for the preparation the new curriculum offers.
“I think in the long term, the new curriculum will make us—I’m hoping—into better physicians,” Aung said.