Medical School Overhauls Curriculum With Major Redesign

Harvard Medical School launched this summer the first major redesign of its early curriculum since the 1980s, integrating multiple disciplines into single courses and introducing earlier clinical immersion and flipped classrooms.

Harvard Medical School. By Kevin H. Lin

Medical professors who conceived the overhaul of the curriculum, which is called “Pathways” and has been in the works since 2012, say it will require medical students to learn more actively, rather than cram and memorize material, and that it seeks to reflect how medicine has changed over the last 30 years. It focuses on the first two years of medical school, termed “preclerkship,” and is now in effect for the school’s first-year students.

One facet of the redesign involves course content. Under the new curriculum, individual courses now survey multiple topics and disciplines, rather than focus on one area of study, so they are “more integrated,” said Richard M. Schwartzstein, a Medical School professor who chaired the task force on the curriculum redesign.

For example, one course, the “Foundations of Medicine” run by cell biology professor Randall W. King, covers disciplines including pathology, cell biology, and microbiology. Previously, those subjects were taught separately; the new course “takes elements of those old courses and weaves them together,” King said.

The curriculum redesign has also overhauled how Medical School professors teach their students. While Medical School courses were previously run in a traditional lecture format, under the new curriculum, they will use flipped classroom model, in which students watch lectures on video outside of class and then apply the concepts they cover in class and clinic.

To Schwartzstein, this change means that students will no longer be able to succeed through just last-minute studying for exams. It will require more active engagement, he said.

“The notion of cramming for an exam and forgetting shortly afterwards, which many of our students have done in college, will not work for this new curriculum,” Schwartzstein said. “The old method of cram, regurgitate it on the exam, and forget, is not an appropriate way to prepare yourself for a career that will span 30 to 40 years.”

The third major facet of the redesign is a change in when students begin their clinical rotations, or “core clerkships.” Students will now begin clinical rotations 14 months into their time at the school, rather than nearly 18 months, a change professors say means students will now practically apply the skills they learn in the classroom earlier.

“We think this will help motivate students and make them feel like they’re on their way to becoming doctors,” Schwartzstein said. “It will allow them to view correlations between what they’re learning in the classroom and what they’re learning at the bedside.”

“On the structural level what matters is that students are getting more intensive clinical experiences early,” King said.

The new curriculum represents a major change in Harvard’s fundamental approach to medical education, which has remained largely constant for more than two decades, other than a 2006 curriculum change that targeted third-year students.

Technological advances, in particular the advent of the internet, necessitated a change, according to Schwartzstein. Because factual information is now so much more accessible, it can be taught more efficiently than in a classroom lecture, he said.

“The existing curriculum, which has largely been in place since the late 1980s, just was not adequate enough to the way medicine was being practiced and given the technological advances that have occurred over the last 30 years,” Schwartzstein said.

Government policy, too, has changed the field of medicine in the years since Harvard adopted its most recent medical curriculum. Under the new curriculum, students will study recent developments in health care, including the Affordable Care Act, according to Haiden A. Huskamp, a professor in health care policy who co-directs a health policy course.

“There’s been tremendous change in the last few years with the ACA,” Huskamp said. “We want students to understand what the system that they’re going to operate within, what kind of incentives that creates, how it will affect their patients and how it will affect them, and the goal is that we want them to deliver the best care possible to their patients.”

For Huskamp, who has been at the Medical School for just under 20 years, the curriculum change is a push to keep medical education useful and up-to-date.

“Medical practice is changing, the health policy environment is changing; so much has changed,” Huskamp said. “It’s such a dynamic system that we want to make sure that we are teaching in a way that will really empower students when they’re out.”

Bernard S. Chang, a professor on the curriculum redesign task force who is leading the design team in a course on “Mind, Brain Behavior, and Development,” suggested that Harvard needs to respond to that ever-changing nature of the field.

“The pace of change in medical science and practice can be overwhelming at times, and it is our responsibility at HMS to maintain a curriculum that is reflective of this dynamism, responsive to student needs, and centered on patient care skills,” Chang wrote in an email.

The new curriculum is not yet fully finalized, according to Schwartzstein, who said the curriculum redesign task force is still working on specific details for 2016 course material.

According to Schwartzstein, the Medical School received a $200,000 grant from the Harvard Initiative for Learning and Teaching to track the relative success of the new curriculum, to be used over two years. Schwartzstein said the study will examine student experience through surveys and performance evaluations, comparing the first class under the new curriculum and the last class under the old curriculum.