It should be no surprise that Bernard Chang, the new dean for medical education at Harvard Medical School, is passionate about medicine and teaching — and believes there is no better place to learn to be a doctor than at HMS.
Less well known is that Chang also trained in classical piano, once played on the stage at New York City’s Carnegie Hall, and thought about majoring in music.
The decision to pursue a science career rather than follow his musical calling was not easy, he said. But he believes that being a musician has enhanced his skills as a medical educator, such as recognizing the performance aspect of lecturing.
“The intonation of your voice, the variations in tone and delivery over the arc of the lecture, are important for making a dry subject like cerebellar circuitry engaging,” he said, having taught neuroanatomy for many years.
Much like musicians in an orchestra, medical educators must work together and complement one another — and both teams have a leader guiding them to achieve a shared purpose.
Chang raised the baton before the HMS Program in Medical Education on July 31, when the Class of 2027 arrived on campus. He follows Edward Hundert, who served as dean for medical education for nine years.
Harvard Medicine News interviewed Chang about the daunting, but exciting, challenge of training physicians who will become leaders in myriad fields of medicine and reflect the diversity of patients they will serve.
HMNews: Congratulations! How does it feel to be the new HMS dean for medical education?
Chang: It’s both exciting and daunting. It’s exciting because we have a great opportunity to lead nationally and internationally in shaping the future of medical education. There are many things that we have done extraordinarily well that we need to continue.
But there are other things we’ve done that should probably grow and change. And we’re not doing this in a static, neutral environment. Many of the bedrock principles and methods we’ve used in medical education are under threat. We need to find new ways to ensure that we have a diverse and inclusive class. We need to find new ways to make sure that our students, in their clinical environments, are getting the best type of learning from faculty.
Our clinical affiliates have just been through a once-in-a-century crisis in terms of the COVID pandemic. Our teaching faculty are facing pressures from their hospital networks to a degree that we’ve never seen before. And access to health care is a huge pressure point. Those are the daunting parts.
HMNews: HMS’ Program in Medical Education has expanded to include an anti-racism task force and LGBTQ+ material integrated throughout the curriculum so that it is more inclusive of populations that haven’t been adequately served by health care. What are your priorities for centering health equity in the curriculum?
Chang: This is so important and is one of my highest priorities going forward. It’s not lost on me that the mission statement of Harvard Medical School says that part of what we’re doing is improving health and well-being for all. Those two words — “for all” — emphasize succinctly that part of our goal is to make sure that all of the best things about the profession of medicine really are accessible to everybody, to all of our patients, to all of our communities. We’ve made great strides here at HMS, but there are still many more things to be done.
Specifically with regard to health equity, the PME anti-racism task force created a 75-page, comprehensive document outlining key recommendations. Now, an anti-racism subcommittee of our highest-level curricular governance committee, the Educational Policy and Curriculum Committee, is focused on implementing those recommendations.
It’s a great start, but we need to make sure that in the coming years we tackle all the elements that will reduce inequities.
Part of it is having the right students here. Part of it is having the right faculty in front of those students — making sure that our teaching physicians, including in the preclerkship classroom, represent the broadest and most inclusive community possible. Part of it is making sure our clinical environments allow students to work with patients from many different communities and backgrounds, which is going to be required of them in their future careers.
There is a lot to do, and it won’t be easy, because if it were easy, we would’ve already accomplished it. But I look forward to engaging with the anti-racism subcommittee and following the task force’s blueprint.
HMNews: You’ve said that HMS medical education should extend well past the usual curricular milestones and competencies. How do you propose to accomplish that vision, given how much the program currently demands of its students?
Chang: There are a lot of ways to be a successful doctor, and there are a lot of ways to be a successful graduate of Harvard Medical School. But I think it should be our goal and mission to prepare students to be leaders in medicine going forward.
Leadership can be defined in different ways. A leader might be a physician-scientist in the laboratory making a groundbreaking discovery. A leader might be an advocate passionately speaking out about reducing health care disparities and increasing access to health care in our polarized and unequal society. A leader might be somebody who has an educational position helping to train the next generation of physicians. A leader might be somebody who, in their neighborhood primary care practice, is helping to innovate the way care is delivered to make it more equal, more accessible, more efficient.
So it’s a formidable challenge to train future leaders in all of these areas. We have to continue to make sure that during our students’ time here at Harvard Medical School, they are engaging with medicine in a way that prepares them for all of these potential ways of becoming leaders — to engage with the science, delivery of care, education, and advocacy. Not because they’re each going to do all of these things in the future, but because part of being in school is getting exposed to the different skills and possibilities that might be critical to their individual careers going forward.
I think we do a great job of that already, but we need to proactively adjust our curriculum, our environment, and our expectations to best prepare our students for the future of medicine.
HMNews: What is your central idea for the mission of the program in medical education?
Chang: Of course, we need to be outstanding in imparting the core body of knowledge, skills, and behaviors that all doctors need to have. Then we need to go beyond that and ask our students to meet the demands of a higher level of inquiry, of discovery and scholarship — because these will help them be successful leaders.
We need to give them the analytical and critical skills that will help when they encounter the unknown down the road — when the things we thought we understood turn out not to be the case, when the same kinds of skills that work now are no longer so successful in the future.
I want to make sure we impart to our students the critical abilities to be flexible, ready to change, and able to shape where health care is going, and not just be comfortable with where it is now.
HMNews: What do you see as the biggest challenges to training physicians? How do you see yourself leading the program in medical education to prepare medical and dental students in becoming expert, compassionate physicians?
Chang: Right now, in 2023, one of our major challenges is ensuring that the clinical learning space for our students remains optimal. While they’re here at HMS, most of our students spend more than half of their time not in classrooms but at our affiliated hospitals, on the wards and in the clinics with patients, families, residents, and attending physicians. And that environment has been under threat. It has changed.
That’s not a challenge unique to HMS. Other medical schools face the same issue. But if we can lead on redefining how medical student education should work in the contemporary world of hospital systems, it would be valued by our peers across the country.
