HMS Tackles Curricular Review

Harvard Medical School (HMS) is overhauling its M.D. program for the first time in almost 20 years.

Just as the College is revamping its curriculum, HMS may siginficantly alter its pre-med requirements to better reflect the interdisciplinary nature of the new medical school curriculum.

The reform will center around two other changes—introducing fields of concentration so students can focus on a specific area of medicine and eliminating the traditional third-year rotation system, says HMS Dean Joseph B. Martin.

The final changes recommended by the curricular review will be phased in beginning fall 2006, Martin says.

The executive committee of the review, headed by Martin, is currently forming new committees to pore over each idea separately. Formal decisions about the final structure of the changes will be made in March.

“We’re now in the phase of broadening that circle [of people familiar with the review’s recommendations],” says Professor of Medicine George E. Thibault, director of the Academy at HMS and head of one of the committees that formulated recommendations. “There’s going to be initial misunderstanding or plain difference of opinion. We’re in that process now, going public with this.”

CHANGING COURSE

HMS administrators say that incoming medical students need to be familiar with a more integrated approach to science. A series of interdisciplinary life science courses may take the place of the traditional biology, physics and chemistry requirements.

The College’s curricular review is planning to introduce life sciences classes that will satisfy any changes to the pre-med requirements of HMS.

Currently in its second year, the College’s curricular review has been lock-step with HMS with regard to the changes in the pre-med requirements for undergraduates, say administration officials on both sides.

“There’s a whole discussion [with the College] of developing a series of integrated biology courses,” says Dean for Medical Education Malcolm Cox. “There’s a lot of exciting ways of putting that material together to enhance scientific literacy.”

Dean of the College Benedict H. Gross ’71 says that the College’s curricular review—which he leads—is taking HMS’s proposed revisions into account for the design of new courses.

“So far, we seem to be moving on similar tracks,” says Gross. “So I am hopeful that the new science courses we are considering will meet their admissions requirements.”

Martin stresses that the changes in the pre-med requirements are not designed to increase the pre-med load on undergraduates. The current requirements at Harvard comprise at least a quarter of a pre-med’s total course load.

“We will not necessarily increase requirements—we don’t want to make students even more pre-med conscious,” he says. “We want to make sure that the courses taught to pre-meds are appropriate.”

Because pre-med requirements are roughly uniform among medical schools, Martin says that Harvard will sponsor a spring meeting of college and medical school deans from across the country to discuss changing the requirements across the board.

“The pre-med requirements haven’t changed much in 50 years. There is very little emphasis on human biology, there is very little emphasis on genetics,” Martin says. “The idea is that there might be a reorientation of some of these requirements.”

“We will find a way to finance the meeting so it can be done here,” he adds.

Professor of Medicine Jules L. Dienstag, associate dean for academic and clinical programs at HMS, says that pre-meds should not worry that their current classes may not satisfy future requirements. Any changes would be phased in over a long period of time, he says.

Eugenie C. Shieh ’06, president of the Harvard Pre-Medical Society, thinks that requiring the study of populations will be helpful to undergraduates.

“Incorporating health policy and more relevant issues to medicine into the pre-medical curriculum would be more applicable to students years down the road,” Shieh writes in an e-mail.

Though medical students traditionally do not focus their studies on a specific subject, potential M.D.s will now be expected to. One of the proposed changes to the HMS curriculum is the addition of areas of concentration, such as health policy, global medicine, community medicine and clinical research.

Cox says many schools are adopting fields of specialization.

“Students will be able to study those areas of interest right through medical school,” says Martin. “The idea might be to make it required.”

Cox says that students, upon graduation, would have to produce a “scholarly product” relating to their concentrations, such as a thesis or long paper.

ROTATION REFORM

Administrators are also recommending major changes to the third year of the HMS curriculum.

During the “third clinical year,” as it is commonly called, students spend a year rotating among different hospitals, completing clerkships in various areas of medicine. HMS may now have students spend the year at a single hospital.

“That would allow them over a period of nine to 12 months to oversee patients and would allow them to develop a long-term mentoring relationship with a faculty member,” says Thibault. “[The students] would have a more meaningful assessment because they will be in one place long enough for them to be evaluated.”

“The general agreement is that the clerkship model is not serving our students now,” he adds.

James C. Rapley, a second-year student at HMS and president of the school’s Student Council, applauds the move to increase mentoring by faculty.

“We have 8,000 faculty but still we have trouble finding mentors for students,” he says. “It’s important we have mentors that can follow us through the four years.”

Despite the purported benefits of these changes to the third clinical year, Thibault says that it may be the “toughest” recommendation to implement.

“We as medical school faculty don’t control the clinical environment,” he says. “The idea of changes here and the pressures the faculty is under and the fiscal pressures the school is under will make this no easy matter. There are legitimate concerns about the feasibility of this reform.”

HMS projected a five-year deficit of $37 million this past July.

The review also calls for basic science courses to be added in the third clinical year—something currently made difficult by the rotation system. Thibault says that now administrators must decide how to fairly compensate and recognize faculty who will teach the additional courses and mentor students.

“It clearly requires more faculty time to do it, no question about it, we’re not trying to hide that,” he says. “The payoff is that it’s a much better educational experience for the student.”

Despite the administration’s attempts to include students in the review process, Rapley says that some students have felt excluded because the curricular review committee meetings were scheduled during class time.

“[The meetings] didn’t correspond well with our courses,” Rapley says. “If you had a meeting at a certain time as tutorial you couldn’t go...That’s a big concern, a lot of students have felt that we haven’t been involved.”

—Staff writer May Habib can be reached at habib@fas.harvard.edu.