Training Venture Unveiled at HMS

In a new venture announced last week called the Harvard Medical School-Beth Israel Health Care Research and Education Foundation, Harvard Medical School and Beth Israel Hospital have joined forces to find better ways to train doctors.

Changes in health care have changed the population at hospitals--patients are sicker and stay for a shorter time--and those changes are affecting medical students.

"Patients are in the hospital for much shorter stays, and they are much sicker," said Dr. Daniel C. Tosteson '44, dean of Harvard Medical School. "It's not a good place for the student to encounter his or her first heart attack."

As hospital stays become shorter and patients' conditions more chronic, it is less useful to have professors lecture about diseases and treatments to medical students gathered around a patient's bed, according to Tosteson.

"While hospital rounds for interns are far from obsolete...one has to develop new ways for training," Harvard President Neil L. Rudenstine said in an interview with The Crimson last week.

Medical schools must find ways to place students in clinics, doctors' offices and even in patients' homes to learn how medicine is practiced today, Tosteson said.

Tosteson and Mitchell Rabkin, president Beth Israel Hospital, said the education of medical students once fit in with the way medicine was practiced in hospitals.

The heads of specialty departments controlled revenue from patients care and allocated some of it for doctor training, they said.

However with managed care and other changes, less of that money is going toward teaching programs, Tosteson said.

Faculty members feel they are under economic pressure, torn between their mission of being teachers and watching the bottom line, said Dr. Benjamin Sachs, head of obstetrics and gynecology at Beth Israel and clerkship director for medical education at Harvard.

With doctors pressed to treat more patients in less time, "teaching slows you down and takes up space if the student wants to see a patient," he said.

The new foundation "seeks to counteract this trend, balancing the intensifying business pressures with a renewed emphasis on the academic mission that has kept Harvard and Boston's Beth Israel at the leading edge of medicine," Tosteson and Rabkin said in a statement.

"Since Beth Israel is such an exceptional place, it is very well positioned to try this kind of experiment," Rudenstine said. "It also forms an interesting model for how to both formalize and stabilize the support for medical education and related research in a learning environment."

This story was compiled with Associated Press wire dispatches.