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Medical Education Reform
A New Vision for the MD Curriculum
Beginning in June 2012, the Program in Medical Education has been working on a new vision for the MD curriculum, and we are pleased to update the Harvard Medical School (HMS) community on our progress and plans to date. If our current plans come to fruition, the new curriculum will be introduced for Cannon, Castle, Holmes and Peabody students entering in August 2015.
Current Curriculum Structure
Harvard Medical School’s current preclerkship curriculum, Fundamentals of Medicine (FOM), spans most of the first two years of the MD program, beginning in mid-August of Year I and ending in March of Year II, with a summer break between Years I and II. The FOM basic-science curriculum emphasizes normal processes in Year I and abnormal processes in Year II and is discipline-specific (i.e., structured as discrete courses in anatomy, biochemistry, genetics, physiology, etc.) in Year I. Students take USMLE Step 1 following the FOM curriculum in the month of April, which distracts their focus during more than half of Year II. The Principal Clinical Experience (PCE) begins in May, and after the PCE, students take a required subinternship and advanced electives. In the current format, students begin work on their required scholarly projects in the fall of Year I, after they have experienced only a minority of the preclerkship curriculum.
Reimagined Curriculum Structure
In June 2012, at the annual Medical Education Retreat, faculty leaders in the Program in Medical Education initiated a comprehensive review of the preclerkship FOM curriculum. In the fall of 2012, a Task Force on Redesign of the Preclerkship Curriculum was appointed and charged with reviewing what we teach; when we teach; how we teach; who teaches; where we teach; and how we assess our students’ learning. While HMS considered its approach to organizing and teaching preclerkship courses, many of our peer schools and newly established medical schools revised existing or implemented new innovative and forward-looking preclerkship curricula. At the same time, the university-wide Harvard Initiative on Learning and Teaching (HILT) has engaged all the schools of the University in the introduction and acceleration of innovative pedagogy.
History of Medical Education Reform
Nearly thirty years ago, HMS embarked on a major reform of the MD curriculum called the New Pathway. Harvard’s bold reform not only changed the way our own students learned medicine but also influenced the way medicine is taught in medical schools around the world. In 2002, faculty and staff at HMS engaged in a multi-phase initiative to revise the four-year MD program with the following goals:
- Develop a new model of clinical education that is based on the educational and developmental needs of the student and which offers continuity for patient experience, faculty mentoring, and student evaluation.
- Engage the faculty, including the most senior faculty, as teachers, mentors, and guides for Harvard medical students.
- Increase the rigor of the teaching of science (basic biologic, social, and population sciences) at HMS and truly integrate the teaching of science and clinical medicine throughout the entire student experience at HMS.
- Provide opportunities for all Harvard medical students to acquire in-depth knowledge in one area of inquiry and to produce a scholarly product in their area under the guidance of an expert faculty member.
In the fall of 2006, HMS launched another major revision of the MD curriculum in the New Pathway program – the New Integrated Curriculum. Highlights of the new curriculum are outlined below.
Students begin medical school in mid-August with a new course, Introduction to the Profession. The preclinical clerkship curriculum, called Fundamentals of Medicine, begins in September and includes the basic biological and population sciences that underlie clinical medicine as well as Patient-Doctor I and II, courses that introduce students to clinical medicine.
Much work has gone into increasing integration throughout the curriculum at all levels. The first-year curriculum is designed to build from molecules to cells to organisms, beginning with a molecular framework that integrates seamlessly with the transition to anatomy. In the second year, the teaching of pathophysiology is linked to introductory teaching of the physical examination and is presented in a more integrated way that incorporates aspects of pharmacology, pathology, and nutrition associated with individual systems. To address important issues confronting physicians in the 21st century, our students participate in a longitudinal sequence of courses in social medicine and medical ethics/professionalism that span the first year, and clinical epidemiology, population health, and health policy are taught in the January term of Year I. The social and population science courses are integrated with the teaching of the basic biological sciences and with introductory clinical exposures.
The third-year clerkships, now the Principal Clinical Experience (PCE), are taught as an integrated program at a single site and incorporate the many disciplines of medicine. The experience begins in May of Year II and incorporates longitudinal experiences, including a multidisciplinary curriculum, mentoring, assessment, and ambulatory care experience.
Students also complete a faculty-mentored, in-depth scholarly project – Scholars in Medicine – as a requirement for graduation. Beginning the 12-month PCE in May has created an expanded elective period in Year IV that provides more opportunities for exploring career options and time for completion of the scholarly project.
Medical Education Reform came about through a deliberate, painstaking, community-wide process, and it continues through active, continuous review and improvement of the curriculum, the education program, and the systems that support it.
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