By Laura Krantz
Harvard Medical School has debuted a major set of changes to its curriculum that the school says will cater to a generation of technologically savvy students and will better prepare them for an ever-changing health care environment.
The changes, which began for first-year students this academic year, don’t alter the content of the classes so much as their order, and they transform how professors use time with students in the classroom.
Students for the first time will complete clinical rotations in a hospital earlier, in the second rather than third year of medical school. The school is also changing its pedagogical style.
Gone are the days when a professor stood at the front of a cavernous classroom, ticking through slides as students robotically annotated PowerPoint printouts. Students are now expected to memorize facts on their own time and come to class ready to think on their feet and work in groups, rather than listen to a lecture.
Harvard’s updated curriculum is designed for the smartphone generation of students, who take for granted the ability to find information quickly and are less apt to read dense textbooks, professors say.
“My job, in the time that we’re together, student and teacher, is to teach you what you can’t Google,” said Richard M. Schwartzstein, a Harvard professor who helped develop the new curriculum.
The steps are similar to those taken by several other top medical schools, including Vanderbilt University, the University of Oregon, and New York University, and are underway at many others, including Georgetown and Drexel universities.
The curriculum now features more videos created by professors to help students learn, and classroom time is for problem-solving in groups, interviewing patients, and thinking through complex situations that might arise in the ward.
Schwartzstein developed his own YouTube videos to describe biological processes students need to learn, which they are expected to watch outside the classroom. The videos are between five and eight minutes, he said, because students’ attention spans don’t last much longer.
“We are getting a sense from some students, anyway, that they don’t like to read, they prefer videos,” said Schwartzstein, who is also vice president for education at Beth Israel Deaconess Medical Center, a teaching hospital for Harvard Medical School.
The batch of first-year students who started on Harvard Medical’s Longwood campus this fall are the first to experience the changes.
Today, when first-year students such as Kirstin Scott arrive in class, they gather in smaller rooms, split into groups, and solve problems that require them to connect subjects and ideas across disciplines.
“It’s entirely different from anything I’ve gone through,” said Scott, who, with a doctorate in health policy, has lots of classroom experience.
The new “flipped classroom” format puts the onus on students to come prepared, but also on professors to run less-scripted classrooms. Teachers must use their time not to spout facts, but to prompt students to reason through problems and scenarios.
“It’s OK not to know; it’s not OK not to think,” Schwartzstein tells his students.
The new curriculum does not apply to returning students, like fourth-year Gregory Leya, who will complete his studies in the traditional format. Leya, who is working toward joint MD and MBA degrees, described traditional classes during his first two years as “siloed.”
“The lecture style didn’t always work best for all of the students,” he said.
Inevitably, by the end of the year, students discovered how to watch videos of the lecture on fast forward at home, and attendance dwindled. Leya thinks the changes will be good.
Students say YouTube videos are irreplaceable for demonstrating skills like how to tie a surgical knot or draw the brachial plexus, a network of nerves stemming from the spine.
In addition to pedagogical changes, students will start practical work much sooner. Every Wednesday, even in the first year, will give students hands-on time with patients, and in the second year — after 14 months of classwork — students will launch into clinical rotations, where they try many specialty fields, such as pediatrics or anesthesiology. In the past, students only began working with patients in the third year.
With a year of hospital experience under their belts, students will return to the classroom for the third year, where professors believe the more advanced classes will prove more valuable after students understand the practicalities of being a doctor.
The changes at medical schools were inspired by a 2010 book by a group of doctors and academics that made waves in the medical school community when it called for a new way to train doctors. At many schools, curriculums had changed little over the past century.
The book “Educating Physicians: A Call for Reform of Medical School and Residency,” by Molly Cooke, David Irby, and Bridget O’Brien, was an update of the Flexner Report, which was published 100 years earlier and radically changed how medicine was taught.
One thing is sure — the changes have not made Harvard a less-demanding medical school. If anything, it’s the opposite, Scott said.
“I’m optimistic that this is a really effective way to grapple with and struggle through very complex material,” she said.