Harvard University has again been named No. 1 in the U.S. News and World Report annual ranking of the nation’s best medical schools for research, with the Harvard Medical School Center for Primary Care vaulting into the top 10 among all schools surveyed.
The data for the rankings comes from statistical surveys of more than 2,081 programs and from reputation surveys sent to more than 24,603 academics and professionals, all of which were conducted in fall 2019 and early 2020.
Objective measures of professional schools, according to U.S. News methodology, are based on peer and recruiter opinions about program excellence, with statistical indicators—such as student-teacher ratio and job-placement success upon graduation—that measure the quality of a school's faculty, research and students taken into account.
U.S. News has released specialty rankings for medical schools, based on ratings by medical school deans and senior faculty from all the schools surveyed. Harvard placed first in psychiatry; second in anesthesiology, pediatrics, radiology and obstetrics and gynecology; and third in internal medicine and surgery.
HMS Primary Care on the move
This was the first time since 2001 that HMS ranked in U.S. News and World Report’s top 10 medical schools for primary care. Primary care focuses on whole-person care, with an emphasis on relationships, continuity, access and comprehensiveness.
The HMS Center for Primary Care works to provide robust and engaging learning opportunities for students considering this area of work. The center is made up of staff and faculty who are focused on improving primary care education and training for students.
In addition to its work educating and training the future primary care workforce, the center has established a reputation for its work on practice redesign, leadership training for current care providers, innovation and entrepreneurship in primary care, and research on the value of primary care and its services.
Since its creation in 2011, the center has produced 17 original research cases and 43 peer-reviewed publications. Research accomplishments include studies showing that greater primary care physician supply is associated with increased life span and research that indicates primary care investment reduces overall medical costs.
“Harvard Medical School understands the importance of primary care as the foundation of our health system, and its critical role in preserving and extending patients’ lives while controlling costs and improving quality of care,” said Russell Phillips, director of the center.
“We are investing in primary care and continually working to improve primary care training, as reflected by our national ranking,” said Phillips, the William Applebaum Professor of Medicine and a primary care physician at Beth Israel Deaconess Medical Center. “During the current [COVID-19] pandemic, primary care is especially important as our patients’ first point of access to the system is their trusted primary care doctors and nurses.”
Curricular reform
“Harvard Medical School is deeply invested in providing a foundational education in the principles of primary care to all of its medical students,” said the center’s Sara Fazio, HMS professor of medicine and a primary care physician at Beth Israel Deaconess.
Significant curricular changes in primary care education have taken place over the past decade, including the introduction of the Pathways curriculum, which brings HMS students into a primary care clinic setting during their first month of medical school, said Fazio, who is an advisory dean and director of the Walter Bradford Cannon Society at HMS.
Students are paired with a preceptor during the clinical experience, called the Foundational Continuity Clinic, where they practice medical interviewing skills, physical exams and clinical reasoning throughout the year—all while learning foundational elements of primary care, she said.
“This allows students very early on to develop appreciation not only for primary care in general, but also for the development of longitudinal relationships with both their preceptor and the patients,” said Katherine Miller, center faculty member and HMS assistant professor of medicine and a family physician at Cambridge Health Alliance.
After 14 months, students enter the core clinical year where they participate in a nine-month Primary Care Clerkship, an experience where students are paired with a preceptor in the same care practice and work with them in clinic one half-day per week.
“These students are also introduced to team-based care, working closely with medical assistants, nurses and other allied health professionals. The course is evaluated every year to optimize content,” said Miller.
“In this setting, [students] have much more independence and are learning more of the clinical aspects of primary care. Additionally, all students spend one month in the ambulatory setting during their core medicine rotation, during which time they work in much greater depth with a primary care clinician and have ambulatory exposure during their pediatrics clerkship,” Fazio said.
In an effort to continue to augment the School’s curriculum, a group of center faculty and staff developed a blueprint for an undergraduate primary care curriculum in 2016, which HMS adopted for the preclinical and core clinical phases of student training.
The missing link: Family medicine
“The most powerful way to prioritize primary care education is to increase the presence of family medicine, the only specialty where more than 95 percent of residency graduates will practice primary care medicine,” said Miller.
Increasing student exposure to family medicine is another core function of the Center for Primary Care, which launched Harvard Home for Family Medicine (HHFM) in 2016 to provide additional resources to students interested in the field.
The HHFM is a forum for family medicine doctors to provide valuable guidance and educational opportunities to students, connecting them with family medicine mentors in their first year, their primary clinical experience or their electives.
Miller co-leads the HHFM, which is actively engaged with leadership for the Primary Care Clerkship and Foundational Continuity Clinic, the two main primary care experiences at HMS, to bring more family physicians into teaching roles and to provide resources and education to students around the specialty.
“The FMIG [Family Medicine Interest Group], along with the HHFM, creates programming throughout the year on topics ranging from the current state of family medicine in the U.S. to working with interdisciplinary teams to address concerns about the social determinants of health—all from the perspective of family medicine,” said Miller.
“In the future we aspire to have all HMS students participate in a clinical family medicine rotation and plan to include more family medicine and primary care programming in the early years of medical school, when many students will establish mentorship relationships that will guide them through their medical school experience,” she said.
In recognition of her contribution to improved student experience, professional development and career advancement, Miller was selected as a recipient of the HMS 2020 A. Clifford Barger Excellence in Mentoring Award.
Student Leadership Committee
The Center for Primary Care is also home to the Student Leadership Committee (SLC), which empowers and trains HMS students to become leaders in primary care practice, education, research, advocacy and community engagement.
“The Center was a critical part of my decision to come to Harvard Medical School,” said Erin Plews-Ogan, HMS student and SLC co-leader. “The Center’s work, and its voice on campus, signaled to me that my interest in primary care would have a home here. And it has indeed found a home.”
“As I felt the pushes and pulls of various clinical experiences, the center and the SLC provided steady mentorship and a community of people who kept my passion for primary care alive and growing,” she said. “The staff and faculty at the center taught me a great deal about being a leader, and fellow SLC members inspired me constantly.”
Currently, Fazio is working with members of the SLC to survey HMS students from each of three phases that comprise the Primary Care Clerkship to assess strengths and weaknesses of the primary care curriculum. Information from the survey will be used to improve the way that primary care competencies are taught.
“HMS is also currently embarking upon a curricular reform for the core clinical year that will include more longitudinal ambulatory experiences, many of which will be embedded within high-functioning primary care practices,” Fazio said.
The HMS Center for Primary Care continues to advance the medical school’s primary care curriculum and provide valuable training opportunities for the future physician workforce. It urges others to join in its commitment to improving care around the world.
Subscribe to the center’s bi-weekly newsletter to join the primary care movement.
Image: John Soares
