As the Miller School’s new NextGenMD curriculum takes shape, Dr. Richard M. Schwartzstein visited campus to talk about how Harvard Medical School created a new curriculum centered on case-based collaborative learning. Thanks to 22 enthusiastic student volunteers, he was also able to give UM educators a glimpse of how the new approach can accomplish its main goal: teaching the students how to think.
“We’re sharing a new model that really emphasizes thinking skills and application of knowledge to solve problems,” Dr. Schwartzstein said. “This is very different from traditional models of teaching – it puts a lot more emphasis on getting students to work together, it forces them to commit to learn the material in advance, and then they come into the classroom and immediately apply the information to clinical cases.”
The third- and fourth-year Miller School students who volunteered for the demonstration had received information about two patient cases the day before. For the session, which included an audience of faculty members, they were divided into groups of four to discuss questions from Dr. Schwartzstein about the cases and consider possible answers. The groups then shared their consensus in a discussion with the full group.
“What we have found is this is something the faculty and students have enjoyed quite a bit at Harvard,” said Dr. Schwartzstein, Ellen and Melvin Gordon Professor of Medicine and Medical Education and chief of the Division of Pulmonary, Critical Care and Sleep Medicine at Harvard’s Beth Israel Deaconess Medical Center. He led the steering committee that created the Pathways curriculum at Harvard in 2015.
Among many benefits of the case discussions is a direct application to patient care, Dr. Schwartzstein said. “You are much more able to put all these concepts into a very relevant use.”
The students were clearly engaged in the new process. They said they liked discussing the issues among themselves, rather than just answering an instructor’s questions. “It was an incredible learning opportunity,” said Jasmine Tomita-Barber, a third-year student. “I felt like I learned so much in this short two-hour time period.”
“You’re incentivized to learn the material up front, but then you had a different experience today,” said Sohil Desai, a third-year student. “I think it’s a very effective learning style.”
“I really liked the way Dr. Schwartzstein was very involved and walked around – he would ask all of us questions whether we raised our hand or not, which was great because it makes students be accountable,” said third-year student Manasa Narasimman.
“Some of this is based on peer instruction,” Dr. Schwartzstein said. “One of your classmates may have had the same problem. They’re often better at helping a fellow student than the instructor might be. So the students have loved the new format.”
And faculty members, after some initial anxiety, are enthusiastic as well. “It’s less scripted than classical teaching,” he said. “Every day is a little different and the interaction with the students is much more fulfilling. We’re finding out from faculty who deal with the students in the clinical realm that they’re thinking better, they’re reasoning better.”
That elevated level of engagement is a high priority for Alex J. Mechaber, M.D., the Miller School’s senior associate dean for undergraduate medical education, professor of medicine and Bernard J. Fogel Chair in Medical Education. “NextGenMD will be heavily predicated on case-based learning and a symptom-based approach to learning – students will come up with hypotheses and develop their thinking,” he said after the student demonstration. “When you learn basic and clinical sciences in a clinical context it stays with you.
“There’s a whole lot of excitement to do things a bit differently,” Dr. Mechaber added. “We have an excellent medical school, an excellent curriculum, and the faculty do a terrific job. What we’re trying to do is something transformative.”
In grand rounds presentations during his visit, Dr. Schwartzstein said the curricular reform process at Harvard, which took place between 2011 and 2015, was born of the faculty’s frustration that students did not always come prepared for lectures, and often didn’t attend at all.
“We realized we had to do something different,” Dr. Schwartzstein said. “We wanted to design a curriculum and a teaching format that prepares students to think, that gives them the skills they need to ponder questions.”
It is critical to emphasize that education is a joint responsibility of the teacher and the student, he said. Research has shown that active learning, and immediate use of learning to teach others, far exceeds the retention rates of information presented in a lecture. Student attendance, satisfaction and outcomes have all increased at Harvard with the new curriculum.
The Miller School will develop its own cases that are unique to the South Florida population, and faculty will be trained to facilitate the group sessions. Videos and other tools are being developed to help with the new learning process designed to stimulate thinking.
“This will also help faculty develop more meaningful relationships with the students,” Dr. Mechaber said.
Medicine is changing rapidly — so rapidly that “I’ve told my students in our case-based learning sessions that as we dissect the case, it’s not necessarily about getting the right answer,” Dr. Mechaber said. “It’s about the process. How do you get to that answer, how do you go through the problem-solving to figure it out? How do you generate hypotheses and test them to come to a conclusion?
“This is what it’s all about.”