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FORUM
Medical Ed Day Sees Curriculum in Motion
In addition to workshops on technology, evidence-based medicine, and techniques for care and teaching, the day included five faculty presentations and a keynote address by Malcolm Cox, dean for medical education. A talk on a Web-based multimedia procedure manual by Gary Setnik, HMS assistant professor of medicine at Mt. Auburn Hospital, demonstrated an animated reference tool that is superior to print for illustrating step-by-step clinical techniques. A compensation method for supporting teaching was described by Richard Marshall, HMS clinical instructor in pediatrics at Children's Hospital and a member of Harvard Vanguard Medical Associates. Based on relative value units, RVUs, the method reimburses physician-teachers for productivity lost due to teaching at Harvard Vanguard. Other faculty talks addressed evidence-based medication use, presented by Charles Morris, HMS instructor in medicine at Brigham and Women's Hospital; integration of videotaped patient narratives into basic-science coursework, presented by Graham McMahon, HMS research fellow in medicine at BWH; and development of a neurogenetics curriculum using MyCourses, by Patricia Greenstein, HMS assistant professor of neurology at Beth Israel Deaconess Medical Center. Integrating Science, Clinical CareIn his keynote address, Cox discussed the need to restructure HMS's medical education program, last revamped 20 years ago with the advent of the New Pathway. "The application of science to medicine is going to be increasingly--not decreasingly--important," he said. "And certainly at a place like Harvard, it seems that we ought to be leading ways of thinking about how to more effectively integrate science into the curriculum."One of the major themes of the reform effort is the integration of basic science and clinical medicine throughout medical training. "I think we can't do that," Cox explained, "unless we break down the boundaries between the different faculty constituencies." Cox also considered how to bring together students in the divergent PhD, MD, and MD-PhD programs. His goal is to increase the overlap among these areas of study so there are more concerns and educational activities shared by the three groups. "It's going to require space changes, programmatic changes, and really an entirely different way of thinking," Cox said. More emphasis on integrative sciences is needed, he explained, including basic biomedical sciences like physiology and pharmacology, population sciences like epidemiology and medical informatics, and behavioral sciences like psychology, sociology, and systems science. The School needs educational programs that cross the entire spectrum of research and clinical enterprises. "That really is the goal more than anything else in medical education reform," he said. Reform LeadersThe two committees organizing the reform effort are the executive committee, chaired by HMS dean Joseph Martin and including senior School, hospital, and University leaders, and the steering committee, chaired by Cox and made up of working-group chairs, senior School leaders, representatives from graduate medical education, and students.There currently are 11 working groups in the curriculum reform effort, whose content areas and chairs are the following: curriculum blueprint and themes, Ronald Arky; integration of science and clinical medicine, Alan Ezekowitz; faculty-student relationships, Jonathan Borus; new models for clinical education, David Hirsh and Dana Stearns; faculty compensation, Robert Moellering; faculty promotion and evaluation of teaching, Steven Weinberger; faculty development, Charles Hatem and David Hackney; pedagogy, David Cardozo and Jo Shapiro; admission requirements, Dennis Ausiello; educational technology, John Halamka and Kitt Shaffer; and assessment of student performance, Sara Fazio and David Todres. "Where we really need to get to work is on resource realignment and being creative," Cox said. Part of this process is valuing teaching of medical students as a primary priority of the Medical School. More generally, it is important for HMS to identify itself as a medical school and not only as a research institution. "The educational mission can no longer be marginalized relative to the research mission," Cox asserted. The tools he identified to move the HMS culture toward stronger support of education are appropriate compensation for teaching, a greater emphasis on teaching in faculty promotion, the evaluation of teaching effort and quality, and greater attention to faculty development, especially educational development. The preliminary timeline for medical education reform slates pilot programs to begin as early as next July. --Robert Neal |
