Harvard Medical School

Curriculum Management and Governance Structure ♦ The Curriculum Committee, a Standing Committee of the Faculty of Medicine, provides an interdisciplinary forum for faculty oversight of the curriculum, functioning primarily as a deliberative and legislative body (see Figure 1).FIGURE 1:: Curriculum Governance♦ The Curriculum Committee addresses the full scope of educational policy issues, fostering integration and innovation; proposes, sets, interprets, and enforces policies concerning curriculum development, implementation, management, operation, and evaluation; determines course requirements and credits for all New Pathway courses and all clerkships leading to the MD degree. ♦ The two-year preclinical Health Sciences and Technology (HST) curriculum is governed by a parallel but separate process; the chair of the HST Curriculum Committee is a member of the HMS Curriculum Committee, and vice versa. ♦ The Curriculum Committee is chaired by the Dean for Medical Education. Membership on the committee includes representatives of the primary components of the curriculum, including Fundamentals of Medicine (basic science, patient–doctor, population medicine/social science), Principal Clinical Experience (site directors and clerkship committee chairs, rotating), advanced experiences, Scholarship in Medicine. ♦ The directors of the Center for Evaluation and the Academy; the Masters of the Academic Societies; the Dean for Students; the Associate Dean for Medical Education Planning and Administration; the Registrar; and the Executive Director of Curriculum Programs are ex-officio members. ♦ Students from each year are selected through the Student Council to serve as members for one renewable year. ♦ Members are appointed for three-year renewable terms. ♦ The Curriculum Committee is managed by an executive planning committee composed of the Dean for Medical Education, the Vice Chair of the Curriculum Committee, the Associate Dean for Medical Education Planning and Administration, and the Executive Director of Curriculum Programs. ♦ The Executive Planning Committee identifies issues for consideration by the Curriculum Committee and sets agendas for the Committee's monthly meetings; oversees the operating and faculty compensation budgets for required courses; reviews proposals for curricular innovations or other changes in preparation for review by the Curriculum Committee; and drafts curricular policies for discussion and approval by the Curriculum Committee. ♦ A Curriculum Integration Committee, composed of the PME Executive Committee and leaders of the major components of the curriculum (Fundamentals of Medicine, Principal Clinical Experience, Advanced Experiences and Electives, and Scholarship in Medicine), meets quarterly to ensure vertical integration across the four+-year curriculum. ♦ Subcommittees of the Curriculum Committee are as follows: Subcommittee on Assessment of Students. Subcommittee on Review and Evaluation of Courses and Clerkships. Fundamentals of Medicine (FOM) Steering Committee, which oversees the curriculum of Years I and II. Principal Clinical Experience (PCE) Executive Committee, which oversees the longitudinal components of the PCE, ensuring cross-site comparability of experiences, and develops and implements policies that affect students and faculty at the PCE sites. Year III Steering Committee composed of the chairs of the core clerkship committees, the director of the Patient–Doctor-III course, and the members of the PCE executive Committee is responsible for vertical and horizontal integration of the core clinical curriculum. Core Clerkship Committees in medicine, surgery, pediatrics, OB/GYN, neurology, primary care, psychiatry, and radiology represent the clerkships at all hospital sites and focus on maintaining the comparability of clerkship experiences, didactics, and assessment across sites. A similar committee oversees and coordinates the Patient–Doctor-III course across sites. Subcommittee on Advanced Experiences and Elective Courses, focused primarily on the final year of medical school, reviews and approves all elective clerkships and courses. Faculty Committee on Scholarship in Medicine oversees and advises students in the planning and implementation of faculty-mentored scholarly projects in biological and patient-oriented research and in scholarly projects in population sciences, health policy, and health. HST Curriculum Committee oversees the first and second-year MD curriculum of the Harvard-MIT Program in Health Sciences and Technology. Office of Education ♦ The Program in Medical Education (PME) is the organizational structure housing all educational programs leading to the MD degree. ♦ Under the leadership of the Dean for Medical Education and the Associate Dean for Medical Education Planning and Administration, the offices of the PME are responsible for all aspects of the educational plan and for development and review of educational policies. ♦ Six academic units report to the Dean for Medical Education, who also serves as chair of the Curriculum Committee. These units include the Academic Societies; the Curriculum Committee; the Center for Evaluation; Student Affairs; the Academy; and Admissions. ♦ A parallel administrative structure is overseen by the Associate Dean for Medical Education Planning and Administration, who has responsibility for all administrative functions in the PME, including Financial Administration, Curriculum Programs, Admissions, Financial Aid, the Registrar's Office, and the Academy, as well as the Medical Education Reform Initiative (MER). ♦ Reporting to the Associate Dean is a team of senior administrative staff who work together to facilitate communication throughout the PME, develop administrative policies and procedures, and plan events or programs. ♦ The Office of Curriculum Services provides course management support to required preclinical courses and clerkships. ♦ The Center for Evaluation is responsible for oversight of assessment of students, including a required second-year OSCE and an end-of-third-year Comprehensive OSCE, which must be passed to graduate; student evaluation of courses and faculty as teachers; and program evaluation, including evaluation of the recent medical education reform initiative. The Center includes a PhD-level director, two professional staff, and two support staff. ♦ The Academy Center for Teaching and Learning is responsible for creating, implementing, and evaluating educational faculty development programs and supporting the faculty's educational endeavors as a recognized element in academic advancement. The Center includes a part-time MD director, a half-time PhD educator, a manager, and two support staff. Financial Management of Educational Programs ♦ In academic year 2009–10, we reduced our Program in Medical Education operating budget by 10% per the budget guidance of the School. ♦ Our general operating principle was to make cuts that would have the least impact on students—not only on their educational activities but also on student life. We accomplished this by making substantial cuts in the following areas: catering, travel, salary bonuses, and printing (an increase in course materials available online only). ♦ In addition, the School eliminated salary increases for all exempt staff and faculty. Valuing Teaching ♦ In AY08, Harvard Medical School instituted a new model for tracking teaching contributions of individual faculty in preclinical courses and compensating faculty for teaching in core courses and clerkships. In this model, uniform criteria for teaching compensation are employed, and the funding for teaching by faculty has been substantially increased. Harvard Medical School, Harvard University, the affiliated hospitals, and the clinical departments all contribute to the funding of medical student teaching. ♦ In 2008, Harvard Medical School and the Harvard School of Dental Medicine adopted new criteria for faculty promotion and appointment. As part of the new criteria, teaching was elevated to a new level. ♦ Every faculty member is expected to teach, and promotion credentials are expected to begin with the faculty's teaching roles. ♦ An emphasis on teaching medical students in the promotion criteria provides a strong message to the faculty about the importance of teaching medical students. ♦ In the new promotion criteria, the Medical School abandoned its previous, rigid academic tracks (investigator, clinician–teacher) and replaced them with “areas of excellence,” one of which is “teaching and educational leadership,” a strong recognition of the value placed on education in academic promotions. ♦ By allowing the sum total of each faculty member's contributions and achievements to be considered in the evaluation for promotion, these new criteria provide many different paths to academic advancement for our extraordinary faculty. Curriculum Renewal Process ♦ A major curriculum renewal process was initiated in 2003 and implemented in the fall of 2006. ♦ The key objectives for the curriculum renewal process included engage the faculty, including the most senior faculty, as teachers, mentors, and guides for Harvard medical students. increase the rigor of the teaching of science (basic biologic, social, and population sciences) at HMS and truly integrate the teaching of science and clinical medicine throughout the entire student experience at HMS. develop a new model of clinical education that is based on the educational and developmental needs of the student and that offers continuity for patient experience, faculty mentoring, and student evaluation. provide the opportunity for all Harvard medical students to acquire in-depth knowledge in one area of inquiry and to produce a scholarly product under the guidance of an expert faculty member. ♦ The medical education reform effort began with the work of two Blue Sky Committees, one on the entire four-year curriculum and the other focusing on the clinical curriculum. ♦ The work of these committees was followed by that of a Task Force for a New Curriculum and, then, Working Groups on Education Reform. ♦ The conclusions of these committees, task forces, and working groups were tempered by feedback and input from, and the engagement of, our talented educational community, particularly our faculty and students. ♦ From the deliberations of these groups, four general concepts and goals emerged, as outlined above. To translate these general concepts and the ideas of the committees into a new curriculum, we established five Curriculum Design Groups, which developed the following: Introduction to the profession: a two-week introductory course that provides an introduction to careers in medicine, highlights faculty role models (and introduces professionalism and responsibility), emphasizes the scientific approach to medicine, focuses on the importance of teamwork and collaboration, and presents an overview of the HMS curriculum. Fundamentals of medicine: includes all components (basic science, clinical, social science, population science) of the preclinical curriculum (with course-specific design groups to follow); fortifies and reinforces problem-based learning (PBL) and tutorials, which are central to the HMS curriculum; and creates more integration among courses and across years in the preclinical curriculum. The preclinical component of the curriculum ends by April of the second year and is more rigorous and more efficient in methods of teaching basic science courses and incorporating the relevant social sciences and population sciences that underlie contemporary medicine into the preclinical curriculum. Principal clinical experience (PCE): a 48-week integrated clinical core clerkship period. All or most core clerkships are taken at a single hospital site (Children's Hospital is the pediatrics site for both Longwood area general hospitals). To overcome the fragmentation and absence of pedagogical continuity of core clerkship experiences and the marginalization of students on clinical services, the traditional core clerkships, which have been preserved except in the Cambridge Integrated Clerkship, take place on one campus and are supplemented by a layering of longitudinal, preceptored ambulatory patient experience; longitudinal advising, mentoring, assessment, and feedback by senior faculty; and a longitudinal, multidisciplinary, PBL-based, on-site curriculum focusing on the scientific basis of medicine. Each affiliated hospital takes ownership of the PCE at its institution; designs a robust, creative program based upon their strengths and vision but fulfilling agreed upon HMS-wide goals and standards; and designs student-centered clinical learning that is uncoupled from internship preparation/audition. Advanced clinical and science experiences: advanced experiences incorporating science and clinical content in the postprincipal clinical year curriculum, a period devoted to intense, advanced immersion clinical experiences (one-month subinternships), exposure to Harvard hospitals other than the PCE site, and electives that integrate science and clinical medicine and that facilitate career choice exploration. In-depth Educational Experiences: develops plans for including a menu of in-depth experiences in the MD program, culminating in a scholarly work product and focusing on such areas as basic research, patient-related research, social medicine and global health, or self-structured experiences and a faculty advising structure to guide students. Learning Outcomes/Competencies ♦ Medical knowledge: about established and evolving biomedical, clinical, social, behavioral, and population sciences and the application of this knowledge to clinical problem-solving and scientific inquiry. ♦ Professionalism: as manifested through a commitment to maintaining the highest standards of our professional responsibilities, adherence to ethical principles, self-awareness and self-care, and moral reasoning in our interactions with patients, colleagues, allied professionals, and society. ♦ Interpersonal and communication skills: that result in effective verbal, nonverbal, and written information exchange in collaboration with patients, their families, colleagues, allied professionals, and coworkers in our missions of decision-making, clinical care, consultation, scientific discovery, and professional and public education. ♦ Patient care: that is compassionate, appropriate, and effective for the prevention, diagnosis, and treatment of illness and the promotion of health. ♦ Cultural, social, and community context of health care: as manifested by an awareness of and responsiveness to the interactions of a range of factors that impact health and illness, including cultural differences, spiritual beliefs, environmental conditions, economic forces, political and legal processes, and alternative approaches to health care delivery. ♦ Practice-based learning and improvement: that involves ongoing life-long investigation, evaluation, and improvement of one's own patient care, appraisal and assimilation of scientific evidence, critical thinking, and self-reflection on personal and professional development. New Topics in the Curriculum Since 2000 ♦ A new course, Introduction to the Profession, at the beginning of Year I ♦ New required courses in population sciences (Introduction to Social Medicine, Medical Ethics and Professionalism, Health Care Policy) and revamped Clinical Epidemiology and Population Health ♦ A new course on Human Development ♦ A revamped course on Human Genetics ♦ New courses to introduce students to scholarship, Scholarship in Medicine, and to community service learning, Physician in Community ♦ Introduction of simulation into the curriculum (including team-based learning) (Introduction to the Profession, Integrated Human Physiology, Human Systems, Principal Clinical Experience, and so on) ♦ Conversion of clinical clerkships into a unified, single-site Principal Clinical Experience (PCE) ♦ Quarterly, half-day, central intersessions in Patient–Doctor-III during the PCE on such topics as Healthy and Dysfunctional Teams; Assuming Clinical Responsibility: Disclosure, Apology and Your Role as a Physician; Liability Prevention and Risk Management; How Do We Come To Terms With Mistakes, Adverse Events and Our Imperfections?; Assuming Clinical Responsibility: Disclosure and Apology Following Medical Error; Living at the Edge of Science: Ethical Issues in Decision-Making Under Uncertainty; Systems Failure ♦ A new joint MD–MBA Program with Harvard Business School Changes in Pedagogy The most visible change in pedagogy is the introduction of a new model for clinical education, the Principal Clinical Experience. Students complete all their core clinical clerkships at a single hospital site, and traditional clerkships and/or a designated panel of patients for each student are supplemented by a longitudinal cross-disciplinary, problem-based-tutorial curriculum, longitudinal faculty mentoring/advising, a longitudinal faculty-precepted ambulatory experience, and longitudinal assessment. The success of this revamping of clinical education was measured by prospective qualitative and quantitative assessments both during the pilot phase and after full implementation by the Center for Evaluation. Changes in Assessment ♦ Adoption of uniform course and clerkship on-line assessment format ♦ Year II OSCE required as a component of the Patient–Doctor II (New Pathway) and Introduction to Clinical Medicine (HST) courses for formative assessment ♦ Cross-course integration assessment weeks at the end of Year-I and of Year-II fall and spring semesters ♦ Introduction of core clinical clerkship shelf examinations ♦ Introduction of cross-site mini-CEX examinations in several clerkships ♦ End-of-Year III Comprehensive OSCE required for graduation Clinical Experiences The primary sites for clinical education are the following: Beth Israel Deaconess Medical Center Brigham and Women's Hospital Cambridge Health Alliance Children's Hospital Boston Massachusetts General Hospital In addition, clinical education opportunities are available to students at our other affiliated institutions, for example, Dana Farber Cancer Institute; Faulkner Hospital; Harvard Vanguard Medical Associates; Hebrew Senior Life; Massachusetts Eye and Ear Infirmary; McLean Hospital; Mount Auburn Hospital; Spaulding Rehabilitation Hospital; and Veterans Affairs Boston Healthcare System, as well as numerous community health centers and private physician offices. Highlights of the Program/School ♦ The New Pathway Program, with a focus on problem-based, small-group tutorials, revised in 2006 to provide more integration across courses and clerkships (the New Integrated Curriculum) ♦ A new model for clinical education, the single-site Principal Clinical Experience ♦ Academic Societies that serve as the organizational framework of each student's general medical education and provide individualized mentoring and advising ♦ The Harvard-MIT Health Sciences and Technology (HST) Program for students with a declared interest in careers in biomedical research and strong interests and backgrounds in physical or biological sciences ♦ An outstanding group of highly qualified, diverse students with a noteworthy record for achieving positions of leadership in academia, clinical medicine, government, industry, etc. ♦ Unparalleled clinical experiences at some of the most highly regarded teaching hospitals in the country ♦ Extraordinary depth and breadth of basic, translational, and clinical research opportunities (and funding) across the medical school, the university, and our affiliated academic teaching hospitals