The Future is Now: Medical education for the 21st century

Our understanding of how people learn is changing as rapidly as the field of medicine itself. How is Harvard Medical School leading the way? Edward Hundert and David Roberts will discuss the innovative teaching methods being introduced to support new ways of learning at HMS—and beyond.
So good afternoon, everyone. Welcome. Those who don't know me,
amazingly, I'm Jeff Flier. And it's great to see so many
people here during the lunch hour to hear about some
of the exciting things that we're doing in
the realm of education at Harvard Medical School. And I want to point out that
in addition to all of you, we're screaming to
countless– millions live streaming around the world. We'll find out maybe how many. But probably a lot joining
us from all over the globe. We have a really
terrific program today. And it's one of great interest. I think everyone knows
that it's all about change, as we move into a new
era of medical education, both on the quad as we expand
the educational reach of HMS around the globe. Many of you– and this is
just a little side point– are probably too young
to know about a firm that used to be called E.F. Hutton. I think it was taken over by
Citibank a bunch of years ago. But people of my age remember
seeing many commercials where someone would be doing
something and saying something to someone about their
brokers, E.F. Hutton, and then everyone around
them stops to listen because when E.F. Hutton
talks, people listen. Well, this is an entree
into one of the themes for Harvard Medical School
when it does something related to education, whether it's
changing its curriculum or launching a brand new far
reaching program regarding online education. When we do this, the
world does listen in a disproportionate way. And the education communities
around the world take note. So what we do here not only is
relevant to what we do here, but it's relevant to the world. So we take that
responsibility very seriously. I think everyone
knows that the fields of biomedicine and
biomedical research are changing at an
incredibly rapid rate. We feel the obligation
to try to make sure that our students,
broadly speaking, are as prepared as they can be,
not only to be practitioners but to be leaders. So the context is with
that in the background, we've been working
extremely hard– by we, I mean a lot of other
people, many of whom are in the room– on first our
medical education curriculum. And I think as most of you
know, this year early in August, we launched a major change
to our medical curriculum in the program for
medical education and dean for medical
education, Ed Hundert, will be coming up
in about two minutes to tell you about this exciting
program, how it's going, why it's different, and why
we're so excited about it. So another thing is that our
educational aspirations today go far beyond the people who can
sit in a particular auditorium at a point in time, whether
it's medical professionals, scientists, health care
leaders around the world. They're really just
ordinary citizens who want to know something
more about health and medicine. And they think we
have a good way to be a trustworthy source
of that information. So with that in the background,
in a couple of minutes, I'm going to be introducing
David Roberts, who is our dean from
external education. He'll tell you about some of
the really exciting things that we are doing to provide
education about health and medicine all over the
world to many different kinds of groups. So with that as
the introduction, I'm going to take my seat
and listen to Ed Hundert. Thank you. [APPLAUSE] Thank you very much, Jeff. It is really a thrill
to have a chance to talk to you about
what's happening in medical education–
our efforts to bring the future into the present. And thank you all for
taking the time to be here. When I was asked to do
this, inevitably, one is asked to talk about
philosophy of education and the pedagogical theories
underlying the new curriculum. But for me, it's
all about people. So I wanted to start by
just talking about the fact that everything that we're
doing in medical education at Harvard Medical
School is about people. And the first group of
people most important are actually the patients. Everything we do in education
is actually, ultimately, to serve the
mission that we have to alleviate human suffering,
whether it is training the best clinicians to take
direct care of patients, or training researchers
who are going to discover the new cures for the future. But you know, the
people who most of us spend a lot of time talking
about are the students. The students here
are second to none. They're absolutely
extraordinary. And the students at
Harvard Medical School learn more from one another than
they actually learn from us. We always tell
them that when they come they're skeptical
the first day, but then they realize it's true. And it's one of the reasons
why we put so much importance on the value of
diversity– having a diverse class
because it enhances the education of the
students, one from the other. And it's also why I
spend a surprising amount of my time trying to raise
support for scholarship aid, so that any student who's
talented enough to come here will be able to attend
and not be crushed by a burden of
crippling debt and have to turn down the offer. So the students are
obviously important. The faculty are where we
spend most of our time. There is no issue
in curriculum reform that isn't actually a matter
of faculty development. That is no surprise
that if you want to change the way the
students are learning, you have to change
what you're doing. And it's therefore, no surprise
that the entire curriculum reform effort was chaired
by Rich Schwartzstein, who is here, who is also the
director of our Academy, which is the faculty development
arm of Harvard Medical School. The two go hand in glove. An important group of
people are the staff. When I started in my
new role 11 months ago, I met with each curriculum
design task force and each clerkship committee. And of course, they all
disagree on almost everything. That's the nature of what we do. But the one thing
they all agreed on is that before I left they said,
just make sure whatever you do, we get to keep working
with fill in the blank. You know– Evan, Michelle,
[INAUDIBLE], Sally– the person who actually makes
it all happen. And so this is a
partnership with the staff. There are many, many other
groups that I could talk about. There's support from our
alumni, our donors, and others– our fellow deans working
with Dave Roberts, who you got to hear about. It's just one of most
energizing things you can do. But before I sort of
get into the curriculum, I just have to give
a shout out to Jeff. Because Jeff's support
for what we're doing is actually one of the single
most important ingredients. And this is not just a
kissing up here by the way. But you know,
there are few deans of huge, research-intensive
medical schools who give the care and
time and attention to the medical student
mission that Jeff Flier does. He comes to the MedEd
retreats every single year and sits through them during
the planning of the curriculum. He attended every single
task force meeting of each of the
developing courses. And not just to sort of
listen in, but to pushback and exchange ideas. And I think that kind of
commitment from the top is what it takes to do
something as bold as we are trying to pull off right now. And I also just–
since it only happened in the last few hours–
have to point out that he just became a
grandfather again this morning. And so– [APPLAUSE] Congratulations. So we have a tradition
at Harvard Medical School that when
we admit our class, we have to revisit weekend. And all of the admitted students
come and they spend a week and we tell them about what
we're going to be doing, so that they refuse to turn
down the other offers from all the other top schools
that they also get in to. And this year, of
course, revisit was a little different because
we completely overhauled the curriculum. And so we're trying to tell
them about all the change. And I was talking
about the new pedagogy and how we're teaching, what
we're teaching is different, and how we're
teaching is different, the [INAUDIBLE] teaching
it, all of these things. And at the end of this talk,
one of the admitted students came up to me and sort of
sheepishly looked at me and said, Dr.
Hundert, you do know that you're like a top ranked
medical school already? Why are you doing all this? I thought well, that's
a great question. And in fact, there
are many, many reasons that our faculty got
together three years ago and started working on this. One is that the practice of
medicine itself is changing. What we are preparing
students to do is to do something quite
different than they used to do. There's a huge amount of
research on adult learning that suggests that the way
we teach needs to change. And particularly, for
these new millennials, the outcomes is all
showing that we really have to take
advantage of the way that young people now
acquire and navigate through information. They don't actually think
about having information, because of having
their hand held. And indeed, educational
technology change is another reason. When we started the new
pathway in the 1980s, I remember you'd be
in a [INAUDIBLE] room. And if a student
said, well, I'm not sure about the anatomy
of this or that, they would say well, let's write
that on the board as a learning objective to go home
and study and come back in two days knowing. Now, if they don't know that,
they pull up their handheld in about two seconds say
oh, here is the anatomy. Let's keep working
through the problem. So the opportunity to do
this flipped classroom idea of using really using
time in the class to solve problems possible
because of the technology. But the number one reason for
changing the curriculum really is the fact that we
need to take seriously after all these years
of talking about it, that the goal of
medical education is not to learn medicine. It's to learn how to learn
medicine for a lifetime. Right? We welcome the students and we
say, look, about half of what we teach you is
going to turn out to be wrong or at
least irrelevant by the time you
retire from practice. The trouble is we
don't know which half. Right? So the goal of a
medical education has to be to learn how to spend
your life learning which half. And so it's with
all of that in mind, that our faculty
started forming all of these task forces, committees
about three years ago. And what emerged was not
one curriculum reform, because any med school could
have a curriculum reform. They actually ended
up with what I would say are four
curriculum reforms happening simultaneously. And seriously, many other
leading medical schools have done just one of
these and touted this is a major curriculum reform. But we're trying to do
all of these at once. And the first of them
is what I would call a structural curriculum reform. And a structural
curriculum reform is a frame shifting of the
order of the experiences that the students go through. And so in a typical
curriculum, there's this idea that goes back to
the Flexner report of 1910 that says you have to learn
all the basic sciences you need to know before you
can start seeing patients. And actually, there's a certain
amount of common sense to that. You want to know
what you're doing when you start seeing patients. But what we've done
is take that sort of bimodal model
of the pre-clinical and t hen clinical curriculum,
which we still largely have had, and change it to
what I would call a three phase model of education. We want you to in
the first phase learn all the science
and clinical skills you need in order to go into
the hospitals and clinics and start to learn medicine. But by frame shifting
that second phase early, be able to come back
in the post clerkship phase of the
curriculum and return to advanced basic science. Now, engaging the science
faculty– and many quad based faculty are getting
very energized about the new
developmental moment that these students will be
in, where they'll actually have seen patients with
cancer, with heart disease. Now we say, now,
if I can teach them about the genetics of
this and the [INAUDIBLE] of this neurobiology,
then that would be a very interesting group. And so the chance to
iterate back and forth between basic and clinical is
a really important and major structural change
in the curriculum. For us, it actually has a
really important effect, because for the past four
years, the students at HMS have had a scholarly
project requirement. They all have to do some
research before they graduate. And the trouble
with our curriculum was the only time for
them to do that was in the summer after
their first year. So they would arrive. They'd feel this pressure
to get mentored, do a research project in the
summer after their first year. And then sometime in their
third and fourth year, they'd say well, you
got to write that up to meet this requirement. And the vast majority
then would say oh, when I did that I still thought
I was going to be a surgeon. Now, I've decided to
become a pediatrician. Right? They were doing it too early. So by frame shifting the
core clerkship year earlier, we have room in the
post clerkship phase for students now being
more differentiated and having some idea what
sort of medicine they want to do to choose a research
project that they might be able to take on into
their residency, indeed, on into the rest
of their career. And that's the goal of
Harvard Medical School– to train these great physicians,
scientists, humanists, leaders of the next generation
that can put all of that together. It's because of the flexibility
of that post clerkship phase that we chose the name
Pathways, because the image is that for 165
students there should be 165 different pathways
through that third and fourth year of the curriculum. So that's one curriculum reform. Second curriculum
reform is the one we're most focused on right now,
because we're just rolling it out, which is the pedagogical
curriculum reform. That is to say, this the
whole sort of Khan-Academy, flipped-classroom idea that the
time you spend with the faculty shouldn't be
transmitting information. If you want to download
a bunch of information, don't stand in an
amphitheater like this and give a lecture about
the pathway of biochemistry that you're trying to teach. Have the students learn
about that the night before, make a concept video,
have them watch that, have them read an article,
and then come to class and work through
problems together. And if you walk through
the first or third floor of the TMEC building during
any morning except Wednesday, you will see students in
small groups of four working through problems with
faculty walking around in this highly
energized sort of space. And to me, that's actually
the important moment. I was a math major in college. And I can tell you that
when I would be given a math problem, if I could
just solve it like that, wasn't very interesting. But if I was given a
really good problem that I couldn't solve in an
hour, sometimes not even a day, a week, sometimes it
would take a month. What was interesting
is at the end of that process was not that
I had solved the problem, but that I was
different for having gone through that process. Right? That's what we're
trying to achieve. It's not so much
about the students grasping the problems, as the
problems gripping the students, holding their
attention, and forcing them to integrate across
a lot of different areas of basic and clinical science. So I always like to say a
good problem solves you. And that's actually what
we're trying to achieve with the new pedagogy. The third curriculum reform
happening at the same time actually is a more radical
kind of integration of basic and clinical
sciences together. Because not only are
we sort of iterating back and forth 14
months of basic science, 12 months of clinical
skills, back and forth between basic and clinical
through the third and fourth year, but each week is
actually organized in a way to integrate why you're
learning all this, which is in the
service of the patient. So remarkably, the
basic science faculty who put this together
organized the schedule so that all of these courses
at the beginning of these flipped classroom courses
that we're talking about are held on Monday, Tuesday,
Thursday, and Friday, and all day Wednesday from the
first week of medical school as a clinical day. The students are
actually in the clinics. They're in the hospital. They're each assigned to a
primary care office, where every other Wednesday morning
from the beginning of med school they start to see
primary care patients. And what's interesting,
since this has just started– we're two
months into it already– is the way in which those
clinical experiences are truly creating a context
for the students to be hungry to learn the
science and the rest– even if that patient
didn't happen to have the disease that
they were learning about, the idea that it's going to
be important to learn this and that the sort of getting
past the delayed gratification of the old system of
medical education– I need to learn this. Why? It might be on the test. Why? I might kill a patient some
day if I don't know it. why? It'll be on the board. Now, it's like, just yesterday I
saw this patient with diabetes. I got to actually understand how
the cell biology works in order to help patients. And so it's an incredibly
gratifying thing to see the students learning
for the right reasons. And it's very motivating
for both the students and the faculty. I guess the final
curriculum reform element that I
wanted to mention has to do with advising
and mentoring. We have the academic societies. If you've ever
been in the Atrium, you know we have the master's
and associate master's faculty who are supported to give advice
and support to our students. And this new curriculum
is much more challenging. The students really
have a high level of expectation of preparation. They're working
harder than they ever have and they're loving it. But I would like to
say that education arises from some ingenious
balance of support and challenge. Right? We can all think of times
when our own education where we weren't learning
as much as we could because we had
too much support and not enough challenge. There were times where we had
too much challenge and not enough support. So if you want
students to optimize learning in this
kind of environment, and you're going to give
them more challenge, you have to give
them more support. And so the faculty has
really rallied around this. Our students in
the new curriculum literally have a scheduled
meeting with their advisees at least every two months
through this process to stay on top of what's
happening, how can we help you, do you need extra support,
what sort of career advice do you want, are you
starting to think about going into a
research lab, doing an international experience,
doing some community based project, all of that
sort of detail trying to have these 165
different pathways depends on this strong advising system. So that's been
the last component that I wanted to talk about. I want to leave plenty of time
for discussion at the end. So in just a couple of closing
comments about the big picture. So you know, I was asked to talk
about philosophy of education. To me, philosophy of
education– medical education is about is not about the
transmission of information. It's about the
transformation of learners. So that's where I start. Medical education is not
about the transmission of information. It's about the
transformation of learning. How do we transform learners? What you need is a powerful,
transformative environment. The interesting
thing to me about the transformative
environment of Harvard Medical School for a student
coming here is not just that we invested in
the new classrooms, tab of form function correspondents
for what we're doing, and all the IT systems
we've invested in, and everything else. To me, the interesting
thing about a transformative environment is
it transforms everybody in it and that includes us,
the faculty and staff. So one of the outcomes that
we're studying– because we're doing a big study
of all of this– is to see how does it affect
us, the faculty and staff, who are here to support the
students in their journey? So how would you
capture a philosophy? Very often I'm asked– now, I've
been in this job 11 months– and I'm often asked
by people well, what do you tell the faculty is
our approach to education? And I always think of one of my
great mentors, Dan Fetterman, who when asked, what makes
a great clinical educator? He'd always say well,
it's not that complicated. Three things. Think out loud. Stick to the basics. And be kind. It's not bad. Right? It's pretty good. Mine– when people
ask me– my wife and I have this deep interest
in comparative religions. And we travel around, go
on our vacation trying to learn about world
religions, and on one of our trips to India
to learn about Hinduism, we had a very interesting
guide and teacher, who noted that we have three daughters. And he was talking
about how when you believe in
reincarnation, you have some interesting
philosophy about how to raise your daughter. And this comes from
the idea that it's not unlikely– in fact,
throughout most of history it's probably true–
that you could die while your daughter
was of childbearing age. Right? So in theory, you
could be reincarnated in your daughter's womb. Right? So this gives rise to
a philosophy of how do you raise your daughter? The answer is you should raise
your daughter as if you might be raising your own mother. Rather mind blowing
concept, I grant you. It's sort of interesting. So when people ask me like how
should we teach our students? I say well, we should
teach our students as if we might be
teaching our own doctor. OK? Now, I don't actually
know about reincarnation. But I do know that given
the relative ages of us and the students like
they will, in fact, be at the peak of their
career when many of us are having our final
terminal illnesses. And so we have to take
this very personally. So I sort of
actually end where I started with it's about people. And for me, the bottom
line is that the future of medical education at its
core isn't actually different from the past, and that is, that
you have to take it personally to do it right. So let me stop
there and thank you very much for your attention. [APPLAUSE] Thank you, Ed. And thank you, Jeff. It's great to see so
many people here today. That was fantastic
and inspiring. And that is sort
of the connection to what we're about
to talk about now for the next few minutes. I'm going to try to show
you some of the things that we're doing in
external education. And I hope that some of these
things are exciting, new. Some of them may take your
breath away, some of the may make you say, what are
they doing at Harvard Medical School? And I know that there are many
people listening in from afar. And I just want to
know that the room here is filled to capacity–
the standing room only. And that shows how much people
care about medical education here. It's really important,
and again, thanks to Jeff for having the vision
to create this. And it's really exciting
to share some of what we're doing with you today. So I'm going to take you on a
little bit of a whirlwind here. We sit at a very
interesting perspective, both in terms of time and
place and our community. And I think that most of us
think about medical education as an either/or sort of thing. Think of when either you trained
or when you were growing up, you were either a medical
student or you weren't. You were either on
campus or you weren't. And I'm going to tell
you that those lines have blurred, or gotten
much more complicated. So here's what we do
in external education. We're trying to
figure out, how do we bring really fantastic,
high quality education around the world? Right? A spectrum of learners
across the globe in all sorts of new ways. We're thinking about both
medicine, health, science, and we're trying to do this
in the smartest way possible using technology, which as you
just saw– a great example. Ed spoke without slides,
without technology, and technology is a tool. But good teaching is
about good content. And this tool of technology
just helps you do it better. So I think of the world in
a slightly different way. These days there are these
kind of three axes of learning. And we need to be
able to provide great, educational
content for people wherever they are on these axes. Do you want to be
solely on campus or do you want to be solely
online or anything in between? Do you want to learn
just a few seconds, or do you want to learn to the
level of hours, or degrees? Do you want to learn at the
basic level of what everybody might want to know,
or do you want to learn at the
professional level? And so figuring out where
people are at on the spectrum and having content
that can reach them is what we're aiming to do. I'm going to spend
most of my time talking about online learning
and a platform called HMX, which is a new
digital platform for delivering content. But I just want to let you know
that external education has these other areas– global
and continuing education, training physicians, both
here and around the world, and all sorts of
important content relating to clinical medicine,
improving their careers, faculty development,
and HHP, which is a trusted resource for
information for everyone in the world– the idea
of important content for a lay audience. We are just about to start an
executive education program, and I think that's something
that I'll hopefully share with you more in the future. But for now, let's spend
most of our time talking about online learning. Think about your daily lives. There are incredible examples
of how you get content, you learn information every day. Think about it. If I asked some
people would say, I read the New York
Times on my phone, or I stay in touch
via Facebook, or I've taken an online course, or
1,000 other different ways that you get information. But we need to think about
how does your brain work? How do you see new information? How do you acquire that? And what are all
the different ways that we could provide that
kind of information to you? If, from our perspective,
what we see as the key trends are all these
things listed here. It has to be mobily available. It has to be available
for you on your phone, because it turns out
a lot of the world uses that as their
primary device. It has to be social–
means that there is value in the community of learners. And that's really
hard to do solely online without finding some way
to interact with each other. But what we have here
in this room, when I look into your eyes, I can see
that the question is how do you do that leveraging the power
of technology at a distance? And there are ways to do that. Most of you probably
watch shows. How many people wait around
for Tuesday at 9 o'clock for your show? Very few these days. How many of you binge watch? Probably many of you,
if not most of you. Right? So whatever we do has to be
available when you want it, how you want it. And each of these things has to
be available around the world. Modular means that it has
to come in little parts that we can put together
in different ways. Adaptive means that it
has to change with you, and so that if you
want to learn slightly differently than someone
else, that's an option. Blended means part
online, part on campus. And those are the kinds of
programs we've run already, and we're thinking
about that as well. And scalable means we can't
just do this for a small group, but for lots and lots–
tens of thousands of people around the world. Now, there's this
famous proverb. Right? When a big wind blows,
some build walls, and some build windmills. And we want to build
fantastic windmills. We want to leverage
all those key trends that I just spoke about. And when I think
about what we're doing and when Michael Parker and his
whole team of seven individuals who's here today
thinks about this, they are building
this, not only using spectacular technology
and real creativity, but they've spent lot
of time thinking about, how do we do this? Their goal is to raise the
level of medical education around the world, not just here. They are thinking
about this in a way of how do we create the
best environment online for learning these key concepts
in medicine and health? That, I think, is
what sets this apart. What I'm about to show you
is beautiful, spectacular, but it's the thinking behind
this that's also so important. Each of the elements that
I'm going to show you has been designed for
a particular purpose with the idea of how does this
fit into the overall structure to maximize learning and
to maximize engagement? We have some early
data that shows that we've been very successful
at reaching people and keeping them connected. Again, one of the things
that we wanted to do was bring the what's
special about being a person in training in
the world of medicine into their rooms, into
classrooms around the world by linking it to real situations
and real life applications of what we're doing. And lastly, figure out what's
unique about online learning? What power do we have through
the tool of technology? So how are we doing this? We're trying to leverage
the data that we generate. Every keystroke, every click
that someone does we capture. And we can then turn around
and iterate that and kind of close the feedback loop
so that we can speed up the process of learning. We want to have a significant
emphasis on research. We want a link to what
you just heard about, in terms of the philosophy
underlying this curriculum reform and other curricular
reforms around the world. We want to figure out how do
we leverage the best of the HMS 13,000 strong faculty? And understand that there
is actually science. Ed mentioned this– that there
is science about how we teach and what we think we can do. What do we mean by that? There's a great book– if
you're interested in this– called Make It Stick. It's become a little bit of the
Bible within medical education these days. There are some very
interesting principles. There's another paper
from Doug Rohrer and Harold Pashler about this. And I'll summarize
it as following this: when you work hard
at learning something, that learning sticks better. If it's easy– Ed used the
example of the math problem– if it's easy, you're
probably not going to exert much
brainpower and it's not going to stick as well. We know that pulling things
out of your brain over and over again is important. My colleague Rich up
there uses a trick where he asks somebody in the
front row give me your phone, looks up a phone number in
their contact list, and says, tell me that phone number. If you've added
that phone number to your phone in
the last 10 years, the chance of you knowing
it is almost zero. It used to be you know
a zillion phone numbers, because you had to use
them over and over again. You had to pull them out of
your brain over and over. Each of these
principles up here– new material in context
through something called interleaving– bring
it back over and over again. These are the key. And space repetition–
the idea if I keep touching you with
the information, that's going to be. So we tried to pull
each of these principles into what we built.
So I'm going to switch and show you that here. And so I'm going to show
you a 55 second movie here. [VIDEO PLAYING] I hear some hmm. I thought they were
very positive hmms. What I've just shown you
is a 55 second trailer of this, which captures
many of the elements that I just told
you about and truly is the incredible hard
work of Michael Parker and his entire team up here. And I would just say
let's take a second and give them a
round of applause. [APPLAUSE] Truly spectacular. [APPLAUSE] So these are now the core of an
ever-growing set of connections to make just the glimpse of
what I just showed you happen, takes a lot of people working
very creatively, not again, just on the content building,
but on the thinking about how we design this and
for what purpose. So I'd like to actually
show you the platform and show you a couple
snippets from that to give you a sense of what we're doing. This is what's called
the splash page. So if I pop back
to the web here, the splash page
is where you would come if you went to And I will tell you that
right now as of now, you can't log in. So what I'm about to
show you everybody try to remember
really carefully. So this is what a learner
sees when they log in. Right now, they see two
courses– one in immunology and another in physiology. And if I click on
this, you get to a page that tells you about the
lessons that are available. And each of these starts
with the idea of a scene or a concept that's designed
to pull people in and get them inspired, leverage
their curiosity, because adults
want to learn what they feel they need to know
and where they're curious. So each of these
scenes– and I'm just going to play you a
little bit of this first one. This is Andy Lichtman,
one of your colleagues here, speaking in the
background talking about how your immune
system connects with the world around you. –microbial world, which
is amazingly diverse. It includes bacteria
and viruses and fungi. And there are actually millions
of species of all these types of organisms. We live in peace
with most of them. But every now and then we
breathe or eat or touch one of these microorganisms
that is actually disease causing or a pathogen.
The subway that many of us take to work in the morning
is a hotbed of microbial life. You know where this is going. –can release aerosolized
passages into the air. Viruses in those droplets– Oh, this is that moment. And what you see here is that it
morphs from a live actor basis into an animated scene. And then it comes back out. And we have our faculty member
here speaking and sharing information with you. And I think that
the key to recognize is that is interesting. It's curiosity in a nutshell. You want to know, why is it
important that I learn this? How's that connected? And similarly, we've
spent a lot of time– what you saw in the movie–
with these very important white board animation,
where now someone is animating and discussing. Now, someone is speaking and
taking you through content step by step. And this has been very
beautifully designed to maximize engagement,
and give people connection to the material. Lastly– and I'm
going to jump out back to the physiology course. And Rich Schwartzstein is
the lead faculty person who's here in the
audience and he's done a spectacular amount
of work with us on this. We have taken, again,
applications or concepts and tried to bring those
into clinical scenarios. So we all– So I'm going to skip ahead. Here, we're telling a story
in this case about Max, who eats a pastromi
sandwich, and then that night notes that after
he drinks a lot of fluid, his legs swell. And with this,
once we jump ahead, he notices his legs
swelling, and then Rich comes back to explain
the key concept here at a very detailed level. -meal including the salt and
the water from his beverages moves along the small intestine. Now, the whole idea
here is that it's linking back to the key
foundational concepts and giving people a connection
of why is this important. How am I going to learn this? How am I going to apply
this in the future? And can tie it back to the
fundamental key concept, in a real life
application sort of way. Last thing I'm going
to just show you is that I mentioned
before, how can we leverage online as a
different way to learn? What are the strengths
of online learning that just could not be achieved
in a textbook, for instance? So here, if we click
on this animation, we can take this person–
we're teaching someone about partial pressures–
which are impacted by going under the water. So we can actually
take this person down and look what
happens in real time and in a dynamic fashion
to the pressure and volume relationships within the lung–
a very important concept. So I have shown
you just a touch. There are assessment questions. There is so much more. But I'm just– in
the interest of time, I'm showing you just a little
bit of the platform here. So I'm going to
switch back and I'm going to show you some
very quick information, and then we'll have
time for questions. So with Ed's new incoming class,
we opened up this platform to them. We invited– on a
purely optional basis– we invited 229 students of a
variety of different stripes to participate. And a 197 of them turned
this on and accessed this from around the world. It turns out HMS students are in
80 different countries at least in the summer before
they come here. And they access this
from around the world. Most of them,
interesting enough, accessed this on
a desktop device. And just one number
here– 769 student logins in the first few days. We had over 4,000
students sessions and 23 minutes per session. Now, in the world
of online learning, we think that's
pretty spectacular. 8,500 video views and
24,000 page views. Some of the incredible
things that we can get with this is data
about was this successful? Did we engage learners? If one of our goals
was to engage people, how do we measure that? What you're seeing up
here is the viewer stream, so an individual learner
watching an individual video. And what it shows is that
people watch nearly the entirety of each of the videos. They're all brief. And they've been
designed specifically based on data from online
learning to maximize engagement by having short videos. Here's another interesting
way to look at this. This is analyzing how did an
individual video get watched and where there are hot
spots of activity– where people stopped rewound,
played it again, and again. So we might say
oh, look, there's this interesting thing where
three out of seven people watched this one video over and
over again in a certain spot. We need to go back and think
about was that a particularly challenging concept? Was this something that
we didn't explain well? Was this particularly
interesting? What's going on there? It gives us the opportunity
to change this and iterate through it very quickly. I'll just give you one
example of student feedback. This is from one of the
clinical application pieces, again, showing people where
they may be in a few years and why this information
is so useful. I'll just highlight
that it makes the science feel not just
like pre-medical education, but like the actual
practice of medicine that we have long been awaiting. It makes everything
so much more real and feel like
experiential learning. Now, isn't that fascinating? They're online. Right? They're online. But it feels so connecting
and so engaging. So what have we
learned from this? That students– our
students at least– are very highly motivated
to learn material which is for their future. We think that, fortunately,
their travel and summer schedules didn't get in the way. They watch videos
in their entirety. We think we've
driven some of this by the short length of videos. And Michael's team edited
this in a very particular way, again, thinking about
those learning principles, about how we thought
people wanted to be engaged with the content. I think Rich and
others would describe that it took a little
while to change how we thought about giving a talk. Most of you, if you get asked to
give a talk, talk for an hour. These are three minutes,
five minutes, seven minutes. It takes a while to reframe
your concept of teaching into chunked material. But it's very important. There are natural
break points in here for assessment questions. And we did one live session
using a very interesting platform over at the
business school that seemed to stir up
a lot of enthusiasm for learning both
before and after. One of the most
fascinating comments that we got– I really think
that this online stuff– and there are sort of quotes
around that– online stuff is the most meaningful and
possibly paradigm-shifting educational innovation I've
seen at HMS in 25 years. This came from one of
our faculty members who participated in this. And initially,
quite honestly, was a little skeptical about
all this that we were doing. So what's coming next? We have lots of data. We were fortunate. Michael and Marshall were just
fortunate to receive a grant to study the data that we
have and the data that we'll gather over time. We're building more content. We're thinking about how do
we bring this to the world? We're looking for institutions
around the world who are interested in
partnering with us on this. And we're hoping to
launch this next summer, with thinking about ways
that we can bring students to campus as well, and leverage
the online material ahead of time. So I will say that
hopefully again, I have challenged some of you. I have shown you some
interesting things. And my hope is
that in the future things look a little different
here with these windmills on all the buildings. So thank you very much. Happy to take questions. [APPLAUSE] OK. We'll ask our two
speakers to sit down. And I will tell you that I'm–
it's a little bit of a battle– I'm about equally proud of
the birth of my new grandson on Sunday morning and the
birth of these new efforts, which are fantastic. Maybe we can merge them at some
point about 25 years from now, but we'll see. So let's just open it up to
questions if there are any. Yep. Back there. Hi, I'm Drew. I'm one of the residents here
at Beth Israel, in medicine. So really great presentation,
really interesting stuff that's going
on in the classroom. But so far what I
understood from the talk is really about how
information and content is structured and delivered
around scientific knowledge. But there is other areas that
are increasingly relevant, if you consider the next
30-50 years of a clinician's practice. The two that stand out to me
are particularly management. So like recently we're
going to be managing teams and [INAUDIBLE] primary care. The second is
really around data– understanding and interpreting
statistical evidence and communicating that. And the third, which
is really important, which should be
learning at all times, is around being an empathetic
communicator– the art of being a doctor itself. And if you could speak
to one or all of those, it'd be interesting to see
what's going on about that. Yeah. So I'll start by
telling you a little bit about the pathways
curriculum and how those are being handled. Thank you for the questions. They're all the really
important points. And a lot of thought went into
those elements of the structure of the curriculum. So I mentioned that
there is a course called the practice of medicine
course every Wednesday from the beginning
of medical school. And that's the course in which
a number of the areas that you mentioned are focused. So for example,
empathic communication, teaching students the
approach to the patient. But importantly, it's happening
in a primary care office, where the students will be
longitudinally not just for that first year to
learn how to do a history and physical and approach the
patient, but an office where they will be able to stay
through the second year when they're in their clerkships
and do their primary care and clerkship when they actually
will take care of patients. So really, I think for the first
time in our school's history– and very few schools
have even attempted such a thing– a student will
be able to be in a primary care office for two years
longitudinally– into the first two
years of medical school. So, in fact, our hope is that
some of the learning objectives they have is to think
about teams and systems into professional care, and
that they still have two more years of medical school. So our hope is that students
will come back to those offices and do a quality improvement
project on that practice. You know, I've noticed that
not everything works perfectly, maybe that will become
my research project, or get involved in teaching
students in that practice so that there will be a
student as teacher module that students can
take advantage of. So from the perspective
of the professionalism and the empathy and the
systems development, there's a number of
courses and experiences for students that are meant
to try to help achieve that. The last thing I'll say is
about the computational part– the data driven part. That's really an important
challenge for our students. And one of the
interesting things that's happening
in the curriculum is that we're able to iterate
back and forth from the basic to the clinical and
back and forth again. So in January of the
first year, there's a full month block
that's focused on the population
and social science perspective on medicine. So the clinical epidemiology
and all of those are built into the first
year, with a return in the third or fourth
year for another month, thinking about data, thinking
about population level thinking. So you know, there's a
lot that I could tell you. I don't want to
take too much time. But you know, all of those
are great challenges. It's not that I have ready
answers for everything. But the faculty
who worked on this have really spent a lot of
time on those elements as well. I'm sorry I didn't include
them when I gave the overview. And I can just add
three very quick things. All great points. In terms of team
related activities, this platform– the HMX
platform– gives a truly unique opportunity to have
different kinds of learners work together online
simultaneously. I'm not sure there
would be a better example of true
interdisciplinary learning to have a nursing student
and a medical student and a pharmacy student
and someone else all working together on the
same case collaboratively online and interacting
in real time. Number two in terms of
data science, absolutely. We feel strongly about that and
that is in our kind of hopper to do as one of these courses. And lastly, in
terms of empathy– I probably feel the
strongest about this one– is that one of the most
remarkable pieces of feedback that we got was this is so
fantastic because you have real doctors with real
patients with many times without a script, and you
would not believe the things that we captured. We captured a patient
speaking to a physician and having a moment where
her dementia got in the way, and the physician had
to adjust and speak to the patient's daughter
in a very thoughtful, complicated way. That moment is
incredibly powerful. Another one– a patient
shares with the camera that their daughter
has a genetic disorder. And they have to figure
out how to tell her that. These moments are captured
in a spectacular way– and whether it's at the
bedside or in a classroom, this material can be used
to teach those concepts. I'll just throw in one question. So give us a quick sense
how the 6-8 weeks into it, how the new students
are reacting to this on an emotional
and personal level, and how these students
who just finished with the other curriculum
are thinking about what they didn't get to do. Right. Yeah so– yeah, no. That's both really good points. The first year class is
just incredibly energized. They were putting
great faith in this. It's something new. They're the pioneer class. The first couple of weeks
there were inevitably some bugs and
technological glitches, but in fact, it's gone
better than anybody expected. Just yesterday we had a meeting
of our curriculum cabinet, and we had formal feedback
from Randy King, who's the course director of the
first big basic science course and from Kate Treadway, who
teaches the introduction to the profession of course,
and for [INAUDIBLE], who does that Wednesday
practice medicine course. And each of them reported
that the students have risen to the occasion. The level of preparation is
really incredible how much time the students are putting in. And so in a given morning, if
they have three different 80 minute sessions–
one in cell biology, one in the immunology, one in
anatomy, whatever it is– they actually have prepped for
each of those sessions that is in their syllabus. And each of them comes in
prepped for each session. And they have reported that
working in these small groups and reporting out to
the larger groups, they are learning more
than they've ever learned. And these are some pretty
high achieving learners. I think that the
second year of class and the third year class–
the outgoing classes of the previous
curriculum– actually are getting a lot of
the benefit of this. The faculty have been piloting
a lot of these principals with those students. And so I just was talking
with Bernard Chang, who's the head of the neuroscience
course, which is meeting right now for the second year. It's the last iteration
of the old version. And he said he thinks it's
probably the single best iteration of that course
they've ever done, partly because it's
not like well, we're not doing this again. In fact, they're already
trying out all of these things. So those students have
been very involved. And we're actually getting
the second year class into some new opportunities
that they've never had before in using
simulation to learn and thinking about how their
career development will go. So I think they're actually
getting a better education than students have
ever gotten as well. Great. Question? Yes. Much respect and
appreciation for all the work that's been done. It's very impressive
and very inspiring. And a couple of things
in the introduction– one was when E.F. Hutton
speaks, the world listens. And something else that
struck me in the introduction is the importance of patience. And that reminds me of
Dr. King's observation that of all of the forms of
inequality, injustice in health is the most shocking
and inhumane. I would make a plea for a
theme of educating patients to provide equitable care be
part of these wonderful themes that you have, maybe
even as a footnote, saying that all of this
is direct in recognizing that science is
extremely complex. But in the final analysis,
the benefit of health care is transmitted,
and communications between the caregiver and the
patient versus the disease. So it's just a plea not to
try to rewrite anything, but I think to emphasize all
the other important points– both domestically and globally. It's tremendously important
from an economic point of view, as well as a humanitarian
point of view. So if we could put that
theme in somewhere, I think it would really
strengthen this wonderful work that you've done. If I could just make a comment. So the curriculum in addition
to everything else I mentioned has a number of formal themes. One of which is this
cross-cultural care and health equity theme. And interestingly, I
just came the meeting before I had from
the design team that's working on
this course called the central of the profession,
which is this January course, which includes
issues in social medicine, health care policy, medical
ethics, and so forth. And we were talking about
a logo for the course. And someone brought in
this incredible photo. And it's of three kids
trying to watch a baseball game over a fence. I don't know if you've seen it. But there are these
three kids trying to see. And one is very short,
one is average height, and one is very tall. And there are three
sort of milk cartons that they're standing on. And on the left you
see a version of it– they each have a milk carton
and the short kid still can't see the game at all, and
the medium kid can just barely, and the tall kid can see it. And on the left, the short
kid has two milk cartons and the middle kid has one,
and the other has none, and they can all watch the game. And underneath it said
equality and equity. And that's the
visual that we want to start the course
with for the student. So I applaud what you said. Thank you. Another question? Well, I'll have to ask one
tough question– hasn't been resolved yet. What will happen to
the second year show? Where will that go? Well, this is the most
important question. It's funny, in the history
of Harvard Med School, for many, many years there
was a fourth year show. And then over the last 35-40
years, we had a secondary show. So we're actually migrating
back to a fourth year show. All right. So that's the answer. Everything has been solved. Thank you very much. [APPLAUSE]

13 thoughts on “The Future is Now: Medical education for the 21st century”

  1. Just listening to first five minutes made my skin crawl. Patients need to advocate for themselves because physicians are owned by Big Pharma. Depopulation at its finest.

  2. Teaching what junior High school students already know. At HARVARD MEDICAL SCHOOL! Such as at 36:02. Pretty basic for college level physiology. Yes the online content is well done, as many videos that have been done before.

  3. A wonderful and and interesting, educational video. Dr Malik Naseem Ullah Khan, kakkay Zai. An ex medical student of quid I Azam medical college Bahawalpur, Punjab, Pakistan and an ex senior medical officer in DHQ Narowal city, Punjab, Pakistan. Now in Toronto, Ontario, Canada. My email [email protected]

  4. Am I to understand that some of this content is available to everyone "around the globe"? Do you have to be enrolled or can you access to it regardless?
    I love to see the direction HMS began taking the college experience.
    Is there someone available to answer questions about these learning modules?

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