Harvard School of Public Health Overhauls Curriculum

Harvard School of Public Health Dean Barry R. Bloom has long thought that public health programs lack one component central to the training of public health professionals: problem solving. But it is only towards the end of his tenure, which began in 1998 and will end this January, that Bloom began to translate his ideas into a viable curriculum, one that would satisfy the requirements of an accreditation council.

After a couple years of academic planning by Bloom’s associate deans, the School of Public Health rolled out an alternative, case-based core curriculum this fall for its first-year students. Already, about 40 percent of the 150 first-year students opted to study under the new curriculum.

“We have to train leaders to solve problems—that’s the first premise,” Bloom said in a wide-ranging interview last month. “The second premise is that an awful lot of the big problems are going to require interdepartmental, interdisciplinary, multidisciplinary collaborations. The big problems are not going to be solved by one discipline or by one person.”

All schools of public health must train their professional students in five public health disciplines: biostatistics, epidemiology, environmental health, health and social behavior, and health services administration. At Harvard, students have traditionally been required to satisfy the core requirements by taking introductory lecture courses during the fall semester.

But Bloom said that he felt this approach, though not without its merits, does not cater to the needs of students who hope to become practitioners after graduation.

Bloom said that School of Public Health professor Howard Koh, a former Massachusetts commissioner of public health, once told Bloom that when he was in medical school, he learned “absolutely nothing in public health” that would prepare him for his later position in government.

“If their [work] is solving problems,” Bloom said, “then we should give them a curriculum that really teaches them how to think.”

THE EXPERIMENT

A couple years ago, Bloom and his colleagues put their heads together to churn out a curriculum that would best enable students to attack big problems that require multidisciplinary solutions.

In applying the case method, long associated with business school instruction, to public health, Bloom and his faculty hoped to foster a culture that emphasized interactive problem solving over rote memorization.

“It’s not the most original concept in the world,” Bloom said. “But it is in public health.”

A steering committee of roughly 10 faculty members from each core discipline and led by Nancy Kane, one of the school’s two associate deans of educational programs, convened to create a case-based curriculum that would expose first year students to the five core areas.

The school developed a curriculum that featured five case studies that would run sequentially and take up one semester. The studies covered topics ranging from disease management to artificial turf fields, with each case incorporating some of the five skills required by the accreditation body.

Students will start their third case for the semester—the one on sex trafficking—next week, having already finished the ones on childhood obesity and fish consumption.

“They are already loving it, they are already more actively engaged in dialogue with teachers,” Bloom said. “Students are not just sitting there passively taking notes—they’re asking questions and finding answers.”

REAL-LIFE PROBLEMS

Michele R. Decker, who will be leading the case study on sex trafficking and HIV AIDS in South Asia, said that all courses taught under the alternative curriculum are entirely participatory and free of dreary PowerPoint presentations.

Since most of the School of Public Health faculty had never taught—or even studied—under the case-based method, several instructors teaching case-based courses this term attended a week-long crash course at Harvard Business School over the summer that was meant to introduce them to participatory teaching.

Decker, who has always taught lecture courses, said that though the textbook method teaches students to analyze cases under ideal conditions, the alternative allows students to tackle problems with the complications of real-life situations.

For example, Decker said, issues such as the feasibility and implementation of plans to help sex-trafficking victims are not taken into account in traditional public health training and research.

Classes dominated by discussions are led in a conference-style room, fitting 60 students in a semicircle facing the several faculty members who lead the cases together.

Marcia A. Testa has been teaching biostatistics at the School of Public Health for over 30 years, and she said that the biggest challenge in preparing the new course material was how to teach introductory material without formally introducing it.

Instead of teaching the theory behind probability or standard deviations, Testa shows the students how to apply these skills in the context of particular case studies, for example.

But in order to take higher-level biostatistics courses, students would need to build a solid foundation of basic theory and methods that only a traditional textbook-based course would provide, Testa said. For this reason, the faculty recommends that those pursuing doctoral degrees or hoping for positions in academia study under the more traditional curriculum.

Still, Testa said that she preferred teaching under the newer curriculum because she “get[s] to talk about real things that happened in real life.”

As an instructor, she said, it is hard to inspire students about material that is more stylized, such as the “little examples and problems” students are traditionally assigned in homework assignments.

“I suppose I can try to tell a lot of jokes at 8:30 in the morning when I teach biostatistics in lecture,” Testa said, chuckling. “Now I don’t have to.”

WAITING FOR THE RESULTS

Two weeks ago around mid-semester, Kane said that the committee charged with drafting the new curriculum conducted a Web-based survey asking students for feedback. The results were mostly positive, as students indicated that they enjoyed the case-based discussions and the diversity of the material presented in the courses.

The complaints the administration received consisted primarily of glitches in the logistics. For example, students requested more advance notice on assignments and more timely feedback on class participation, which now accounts for a more significant component of their grade, Kane said.

Apart from the 10 professors involved in the alternative curriculum, the rest of the faculty—about 150 professors—have largely withheld judgment on the experiment.

“They’re just waiting to hear how it will all end,” Testa said. “Many people have been very questioning, but they’re just waiting to see what the outcome is.”

Kane said that the time and effort required to prepare case studies may be a significant deterrent to interested faculty members under the current system. And because teaching is not a significant factor in tenure decisions, some department chairs even actively discourage junior faculty from investing time and effort in teaching since it is not perceived as “good” for their career, Kane said.

But with the support of the University, Kane said that she hopes active teaching and learning methods will gradually become part of the culture at the School of Public Health.

Jeffrey P. Koplan, a member of the school’s visiting committee and strong advocate of case-based teaching, said that he believed the school, with its strong faculty and resources, was in a position to undertake such an pedagogical experiment.

Koplan, who is the vice president for academic health affairs at Emory, said that though there will be some resistance from faculty and students wary of the new curriculum, Bloom’s plans have the potential to become the preferred mode of teaching for public health schools across the country.

“I think Barry Bloom will be remembered for many contributions to the Harvard School of Public Health,” Koplan said. “But I think that this approach to the curriculum will be a major one that will have a long-term impact on schools of public health in the country.”

—Staff writer June Q. Wu can be reached at junewu@fas.harvard.edu.