Top Medical Schools React to Harvard’s Curriculum Change

Following Harvard Medical School’s launch of its newly renovated curriculum, “Pathways,” deans and professors from peer medical schools commended Harvard’s change and said it mirrored in many cases their own curricular shifts.

The first major redesign of its early curriculum since the 1980s, Harvard’s change integrates multiple disciplines into single courses and introduces earlier clinical immersion and flipped classrooms.

The Medical School’s curriculum overhaul comes after some peer leading medical schools implemented their own curricular changes in recent years. One such medical school is Columbia’s College of Physicians and Surgeons. Lee Goldman, the school’s dean, said Columbia underwent a similar change in fall 2009, suggesting that the idea of introducing a more interactive medical school curriculum is not itself novel.

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A curriculum change can have a large impact on a student body. Representatives from peer schools that recently adjusted their own systems suggested that administrators must communicate closely with students to tailor and fine-tune a curriculum, stressing that their own changes were very much a team process, rather than a top-down decision.

According to Nancy C. Andrews, dean of the Duke University School of Medicine and a 1985 graduate of Harvard Medical School, Harvard’s curricular change is part of a broader shift in medical education from asking students to memorize material to emphasizing its application.

Harvard’s new curriculum, Andrews said, “looks a lot like Duke’s.”

“I think in the future and now already it’s much less about memorizing and more about learning concepts and learning to ask the right questions and find the details rather rote memorization,” she said. “We see our curriculum as being a way to develop critical thinking more than just doing an information download.”

Rajesh S. Mangrulkar, the University of Michigan’s associate dean for medical student education, suggested that students have responded positively to “this new direction.”

“Students seem energized by the changes and the opportunity to both contribute to the future of medical education, and be a recipient of it," Mangrulkar wrote in an email. “I think we all are appropriately anxious about dramatically transforming our program, but in many ways, the students have provided a lot of the courage and energy to the faculty to overcome this natural reluctance to dramatic change.”

According to Charles G. Prober, a senior associate dean of medical education at Stanford, most medical schools have been following the same general guidelines since the release of the Flexner Report in the early 20th century, which established standard requirements for students applying to medical school. The main components of Harvard’s curriculum change—shortening preclinical time and incorporating more flipped classrooms—mirror a larger trend across the country, Prober said.

Stanford launched its own medicine interactive learning initiative in recent years, introducing a collaborative series of videos and interactive sessions.

“They’re apples and oranges,” Prober said. “Stanford’s is a pedagogical approach that is a way to deliver content. The Harvard curriculum… [has]... looked across thoughtfully and said, 'How can we make the full package more effective?’ We’re all trying to accomplish the same thing.”

Robert J. Alpern, the dean of Yale Medical School, said Harvard’s curriculum change is similar to a revision at Yale that was released in August.

“The new curriculum seems excellent,” Alpern wrote in an email. “Moving away from individual discipline-based courses to more integrated teaching is where we all need to go. Many schools are moving in a similar direction.”

Nancy Hueppchen, associate dean for curriculum at Johns Hopkins School of Medicine, has observed increasing numbers of medical schools undergoing similar curricular changes. She hypothesized that the change was driven by “new innovations in medicine as well as new needs in medicine.”

“You have to have ways to teach translational medicine,” she said.

Still, peer school administrators did express some concerns about the curricular change. The University of Washington will implement a change to its medical school curriculum this semester, coinciding with the move at Harvard, and Suzanne M. Allen, Washington medical school’s vice dean, suggested that meeting academic needs while still allowing students freedom in their learning could pose a challenge. With a style of teaching that is new to both professors and students, there is the risk that both groups may be tempted to assume their traditional classroom roles, she said.

Prober suggested that collaboration and sharing ideas are central to medical school curricular reform moving forward.

“We’re constantly cherry-picking other people’s ideas,” Prober said. “I don’t think there will be another ‘Pathways’ that pops up immediately somewhere else. Elements may well pop up somewhere else. We’re all poaching on each other and I think that should be encouraged.”

—Staff writer Melanie Y. Fu can be reached at mfu@college.harvard.edu. Follow her on Twitter @MelanieYFu.