Tutorials are part of the DNA of Harvard medical education. But it is not unfair, according to David Cardozo, to say that they expect too much free association from students—self-propelled learning in a system lacking structure.
“Students would take a paper case of a clinical problem, read it out loud, and investigate different aspects of it,” said Cardozo, an HMS assistant professor of neurobiology. “The style of the tutorials was unchanged, from the very first case students saw in the first year to the last case they saw in the second year. But the students’ knowledge and skill set had evolved significantly during that time.” The static tutorials did not boost the intellectual challenge in recognition of those higher abilities.
The result? Student assessments reported boredom with tutorials. Moreover, too much was left to student taste in terms of study topics. Recognizing the problem, instructors tinkered with tutorials in recent years. Students and tutors both gave the new approaches an enthusiastic thumbs-up, leading to a group—Cardozo, Julian Seifter, Thomas Aretz, Michael Parker, and Benjamin White—that developed the more structured “developmental tutorials,” which are being vetted with course directors in advance of a hoped-for debut in the 2008–09 academic year.
The group proposes to replace or augment paper cases with videotapes of real patients. More importantly, tutorials will be integrated under thematic canopies. The tutorials for all courses will touch on the same themes, but grow increasingly challenging as students progress through the first and second years, in acknowledgment of the students’ advancing skills.
The first change will be more clearly defined learning goals. Students will get a blueprint at the start of their first year, explicitly laying out the themes, the steps to be taken in considering these themes, and the expectations along the way for student proficiency. One theme will be group dynamics and teamwork. Tutorials initially will emphasize being comfortable working with and speaking before a team. Then they will focus on ways to contribute effectively when a student is solely responsible for a particular aspect of the case. By the end, the students will learn how to lead a tutorial group.
Another theme will focus on researching medical literature. “You have to learn, first, how to find information in assigned textbook readings,” Cardozo said. “Then you move up to getting the information from review articles and conducting literature searches. Ultimately, students will get to the point of being able to compare information from primary research articles that show conflicting results.” Yet another theme will be “cross-cultural care,” in which students consider how social and economic differences among patients can lead to disparate disease occurrence, treatment, and compliance with treatment.
First-year tutorials, oriented around basic science, will give way in the second year to a focus on clinical decision-making. The idea is to build students’ confidence to the point that they will be asked to bring in their own cases for study from their Patient–Doctor coursework, said Cardozo.
All of these changes will require tutors to make multiyear commitments to running tutorials, another change from the old system.
News & Research
