Medical Education Reform
Twenty-five years ago, Harvard Medical School (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. Since 2002, faculty and staff at HMS have been 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.
Beginning 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 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 medical ethics/professionalism, social medicine, clinical epidemiology and population health, and health policy that span the first year and that 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 entering HMS in fall, 2011 will 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 will provide time for completion of the scholarly project.
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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