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Recent years have seen an undeniable decline in relative enrollment in humanities majors in colleges around the country. The causes of this trend are multiple, but a tempting explanation is students’ increasing desire for a practical, pre-professional education that prepares for the world beyond.
Intuitively, medical schools seem to offer just this type of education. Medicine is a technical, knowledge intensive field that requires specific skills. The attendant style of education is similarly narrow.
This model of medical education was established after the 1910 publication of the Flexner Report, a 364 page-long landmark report that transformed medical education in the United States and Canada. Following the report’s recommendations, medical schools across the country adopted a “two plus two” model. For two years, students learn basic science in a classroom setting. Then, they spend the next two years rotating through clinical experiences. The resulting model is one that has dominated medical education for years.
Surprisingly, though, some medical schools, including Harvard Medical School, have recently eschewed this style of education. In 2015, HMS reformed its curriculum. Called “Pathways,” the new model of education at HMS shortened the initial classroom experience from twenty four to fourteen months. Instead of lectures and rote memorization, this initial “pre-clerkship” phase now teaches students how to think rigorously. Important medical knowledge is taught through videos and readings assigned outside of class, while class time involves groups of four to five students working together to solve difficult problems.
To learn more about this disruption of conventional medical education, I spoke to Elizabeth L. Roux ’19, an M.D. candidate at HMS.
“I think HMS teaches you [...] how to think,” she told me. “When I was applying, they made a big deal about that, where they were like, ‘We’re going to teach you how to clinically reason, and we’re going to less so teach you how to pass your board exams. We’re not going to teach to the test.’”
Of course, no amount of critical thinking exercises or classroom reforms are going to take away the element of specialized, intensive information absorption that is required for medical school. While it’s exciting to learn this material, Roux told me, “There’s a disinterest in it, because it doesn’t feel directly correlated to clinical care.”
“It’s hard to understand how important it is to learn that unless you’re interacting with patients a lot,” Roux said.
Perhaps as a way to preemptively address this complaint, HMS emphasizes patient exposure in its curriculum. During the pre-clerkship phase, HMS students spend every other Wednesday morning working at a primary-care office, giving them reason to value their more information-heavy classes. After pre-clerkship, HMS further facilitates these interactions with the Principal Clinical Experience phase. For 12 months, students participate in clinical rotations that expose them to a variety of medical fields.
“I think HMS really values having clinical experience pretty early on, so we get to see patients during our first week of school,” said Roux. “It’s very grounding, and perspective building, to get to have that clinical exposure up close.”
This mission of broad intellectual formation, as opposed to tedious absorption of information, has its parallel at the College. If you’re an undergraduate interested in working at Goldman Sachs after graduation, Harvard won’t allow you to major in finance as other schools might. Instead, curricular requirements at the College force finance-oriented students into a variety of fields, many of which may have nothing to do with their career aspirations.
Yet do students at the College graduate having learned “how to think” in the same way, per Roux’s assessment, that students at HMS do?
Two years ago, Harvard revamped its General Education program. Now, students must take one class in each of four categories: Aesthetics and Culture; Histories, Societies, Individuals; Science and Technology in Society; and Ethics and Civics.
Many of these classes are incredibly valuable. The two I’ve taken — “Justice” with Government professor Michael J. Sandel and “Evolving Morality: From Primordial Soup to Superintelligent Machines” with Psychology professor Joshua D. Greene — have been some of the most engaging and thought-provoking classes I’ve taken at Harvard thus far. Yet I’d be lying if I said they didn’t fall at the bottom of my class priority list each of those semesters.
Though many of these Gen Ed courses aim to offer accessible exposure to urgent problems and enduring questions, they often end up instead serving as padding classes that require relatively little work. The General Education program — the center of the College’s effort to provide a broad liberal arts education — has degenerated into an opportunity for students to take easy classes to boost their grade point average.
If the College wants to fulfill its mission of providing an intellectually transformative experience beyond narrow professional learning, it cannot be afraid to completely reform its curriculum á la HMS. The “cornerstone” of the Harvard College curriculum (as the Gen Ed program is officially presented) should not be experienced by undergraduates in the form of four lecture-based gems. Instead, each of these courses must truly encourage students to think critically and engage with the material.
How does the HMS curriculum accomplish this? It does so in three ways: shifting lecture-style information absorption outside of class time, emphasizing work in smaller groups, and relying on student motivation. The College should adopt all three of these approaches.
With its previous curriculum, HMS faculty noticed a failure in lecture style teaching. In a 2015 interview with Harvard Magazine, Richard Schwartzstein, a pulmonologist and professor at HMS, said that part of the inspiration for changing the HMS curriculum was a sense among faculty that students resisted the lecture format, choosing to memorize material by watching videos of the lecture at double speed rather than engaging critically and thoughtfully with the subject.
His account sounds eerily descriptive of many of the courses I’m taking right now. Instead of resigning to the belief that some information-dense courses must be taught through a lecture format, the College should follow the lead of HMS and work to move this memorization component outside of the classroom — a “flipped” approach to learning that some students have already begun to advocate for.
Secondly, when in class, HMS ensures everyone participates actively by prioritizing collaboration between small groups. Usually, teams of four to six students will work together to solve difficult problems and present their findings to the rest of the class. This emphasis on small group work forces students to actively engage with the content rather than nod off in the back of the lecture hall.
The College should follow suit. This could mean limiting the size of Gen Ed courses, as Columbia does with its Core Curriculum requirements. It could also mean prioritizing group or section-style exercises in class instead of lecturing.
Thirdly, HMS relies on student motivation. The shift to the new Pathways curriculum would have amounted to nothing if students didn’t have the motivation and intellectual curiosity to take advantage of the opportunities offered by professors and courses.
Likewise, any new curriculum that the College offers will be useless if we continue to game it for our own short term benefit. As others have pointed out, we need to find for ourselves the intrinsic value of learning. This means leaving our comfort zones and making the effort to take classes we find genuinely interesting rather than those that historically have required little work.
HMS should not necessarily be the model of a proper undergraduate education. Its situation is a unique one. The practice of medicine is an information-heavy and memorization-intense one; at the same time, it’s also inherently practical, personal, and outward-facing. It requires a unique style of education to adequately prepare students for work in such a field.
Yet there is still much we at the College can learn from medical education. Many of the problems HMS faced in the past are those that the College faces today. The College, both its administrators and its students, should not forget that secluded Longwood campus and the lessons it has to offer.
Manuel A. Yepes ’24, a Crimson Editorial Editor, is a Social Studies concentrator in Cabot House. His column, ‘The Postgraduate Way of Life,” runs on triweekly Thursdays.
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