Med Ed Day Sees Progress In Curriculum Reform

Photos by Steve Gilbert Arpana Vidyarthi (top), and Jules Dienstag (bottom) were two of the speakers who discussed strategies to improve medical training at the annual Medical Education Day.

Medical education at HMS is dynamic, and while the administration works on major curriculum reform, smaller projects are under way to find better methods to teach and inspire medical students. Both these smaller projects and HMS’s larger educational reform goals were highlighted at the fourth annual Medical Education Day on Nov. 1 through workshops, a poster session, and presentations.

In its explorations of medical education reform, HMS has often worked with the medical school at the University of California, San Francisco, which is pursuing a similar reorganization. Delivering a guest presentation, Arpana Vidyarthi, assistant professor of medicine at UCSF, spoke about research she had recently completed on the effect of duty-hour limits on residents’ educational satisfaction.

Time Limits
In 2003 the Accreditation Council for Graduate Medical Education approved requirements limiting residents to 80 duty hours per week. Vidyarthi studied the differences in the educational satisfaction and well-being of internal medicine residents before and after the new requirements went into effect in July 2003. Her study surveyed 164 residents at three hospitals and found that while the decrease in duty hours did not improve education satisfaction or increase the amount of time that students spent in educational activities outside of formal training, it did improve the residents’ overall well-being.

When time is cut from residents’ schedules, Vidyarthi explained, the only parts of their work that can be taken away are education and patient care—administrative duties, which need to be completed and take a discrete amount of time, remain. Future efforts to strengthen residency training should therefore focus on making systemic changes to residents’ administrative responsibilities, she suggested.

Path of Progress
After Vidyarthi’s presentation, Jules Dienstag, HMS dean for medical education, outlined the progress of the Medical Education Reform Initiative over the past year. He said that this year marks the 20th anniversary of the New Pathway program, and while it has helped many medical students, particular aspects are open to improvement in the coming years. He cited as an example that New Pathway goals are confined to the first two years of medical school and are not reinforced as a student’s education progresses. In addition, he said, there have been changes in the environment in which clerkships take place: there has been a shift to outpatient care and “inadequate time and resources to focus on the scientific underpinnings of clinical medicine.” Dienstag said, “When I was in medical school, I got to see the whole thing.... Our students only get a glimpse.” He offered a description of the proposals the five design groups have made so far that will be integrated into medical education from 2006 to 2009. The groups are working on Introduction to the Profession, Fundamentals of Medicine, Principal Clinical Experience, Advanced Experiences in Clinical Medicine and Science, and In-depth Educational Experience.

Medicine in the Community
Other presenters included Elizabeth Miller, HMS instructor in pediatrics at Massachusetts General Hospital, who described the new Physician in Community service-learning course. The class introduces topics and techniques central to service-learning work and community service, and includes either four-hour sessions at a local community project for much of the year or a summer-long local or international service-learning project. Commenting after Miller’s presentation, one listener said wistfully, “I wish that I was in
medical school.”

Virtual Physiology Classrooms
Sarah Henrickson, a fourth-year medical student, discussed a system of online tutorials that she and others have developed to help students grasp the concept of glomerular filtration. The tutorials used images and audio in their presentation of the topic, provided multiple-choice responses, and gave feedback to the instructor on which topics left students struggling. Students who used the tutorials showed increased comprehension of the material, although they spent an equal amount of time working on it.

A Record that Follows You
Barbara Gottlieb, HMS associate professor of medicine at Brigham and Women’s Hospital and HSPH assistant professor of society, human development, and health, spoke on the use of student portfolios as a tool for documenting clinical experiences and learning in a variety of settings.

Students Become Teachers
Holly Khachadoorian, HMS clinical fellow in obstetrics, gynecology and reproductive biology, described the Ob/Gyn Resident as Teacher Program, which uses lectures and videotaped role-playing between residents and medical students to help Ob/Gyn residents develop their teaching skills. “Essentially, one day we are the students and the next we are teachers,” explained Khachadoorian about the transition from medical student to resident.

— Rebecca Tinkelman

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