You’re an emergency medicine resident responding to a page. You step into an emergency department consultation room and see a 67-year-old Haitian American woman experiencing shortness of breath. You begin asking questions about what brought her to the hospital but realize the patient appears disoriented and is not responding coherently.
What do you do next?
First-year students pursuing their MDs at Harvard Medical School in the Harvard-MIT Health Sciences and Technology program (HST) played out this scenario as part of a new course this spring.
HST is a cross-university partnership that develops physician-scientists — individuals who study the causes of disease and apply that research to patient care. To prepare students even more thoroughly for the rigorous demands of the dual profession, HST leaders developed a new, longitudinal three-part series of core courses called Integrations and Innovation in Medical Sciences (I2MS).
Case-based and discussion-oriented, the classes meet weekly for three semesters to add clinical context to students’ learnings from concurrent courses in the science of the human body.
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This distinctive approach gets students thinking about how the underlying biomedical science of health and disease ties into the social factors of patient care earlier than in a traditional medical school curriculum, said Bernard Chang, dean for medical education at HMS.
In some MD programs, this integration might not take place until students’ third year, which is usually spent entirely in the clinical setting. I2MS courses are also intended to reduce the risk of students becoming a bit removed from considering the basic biology that drives their patients’ conditions during that clinical year, Chang said.
The I2MS simulated scenes play out in hospital wards, emergency rooms, and primary care and specialty practices, with students alternately playing the roles of physicians, residents, and medical students. Team-based care is emphasized throughout, with students considering how to interact with nurses, laboratory and radiology technicians, and others.
Students began taking the first I2MS course in fall 2024. The second, I2MS II, debuted this spring. I2MS III will launch in fall 2025.
Assessing the patient and connecting the coursework
As part of the ER scenario, small groups of students talked through how they would observe, physically examine, and note the patient’s physical condition. Lively conversations and thoughtful lulls rippled through the classroom. A discussion followed guided by Sanjat Kanjilal, the I2MS II instructor.
Presenting patients the way a clinician would encounter them in real life introduces these MD students to clinical reasoning skills, said Kanjilal. Through the lens of their patients’ illness, the students integrate what they are learning about organ systems, including how they function and what can go wrong. In this case, it was the circulatory and respiratory systems.
“We’re helping students see the big picture of how topics intersect,” said Michael Dougan, I2MS I course instructor and HMS associate professor of medicine at Massachusetts General Hospital. “Those concepts can be hard to see when you’re lost in the minutiae of studying a list of terms or anatomical functions.”
