End of ITP & Thoughts on Learning Styles
Today marks the end of our two-week Introduction to the Profession (ITP) and the beginning of regular classes. The two programs, New Pathway and HST, will separate here and reunite only in third year when we begin working in the clinic.
I wanted to take this chance to reflect on case-based learning, the mainstay of New Pathway and most other medical schools in the country. A patient's clinical case is presented, usually with uncertainty about the underlying disease. Uncertain parts of the case - test results, symptoms, X-ray readings, family history - are split among students to research, and upon reconvening each student shares his research with everyone else. Gradually the case is clarified with help from a supervising group leader, usually a doctor.
For me, this system was inefficient for learning. An entire two-hour session could be distilled into a single sheet of paper that could be read in fifteen minutes. Our group would also often branch into unrelated tangents on minor details, bringing up interesting facts that were irrelevant to the case.
I am not suggesting that the problem-based learning model is without merit. The benefits of this system are clear - it resembles real clinical practice in that the patient's condition is often unknown and requires gradual steps to figure out. Furthermore,it encourages collaboration between students, building the type of collaborative spirit central to medical teams in hospitals.
Ultimately the question is whether medical school is about learning the facts or learning the skills of becoming a doctor. Of course, it should be about both. But in these cases, the only skills we practiced were researching a narrow part of the overall case and presenting information to other students, both of which you either already have or can develop quickly. Once these skills are developed, future cases become inefficient in the learning you do per amount of time.
I would rather first build a solid foundation of knowledge through efficient learning, then progress to case work when I am not as clueless.
Medical students - how do you feel about case based learning?
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Medical Fact of the Day – Respirators vs Surgical Masks
In medical school we learn all sorts of interesting facts, and I want to share them with you. I've started the Medical Fact of the Day to share some of the most interesting things I've learned. They won't necessarily come everyday (to avoid making this blog a lecture series) but they will be things I especially want to share.
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Today for Introduction to the Profession we were fitted for respirators, shown below:
This man kindly models proper wearing of the respirator.
These fit so snugly around the mouth that all the air breathed in is filtered through the mask. These respirators are meant to trap all particles in the air down to about 100 nanometers, or smaller than a bacterium and smaller than many viruses. For instance, we would wear them when seeing patients with drug-resistant tuberculosis to prevent being infected ourselves and passing it around the hospital.
I want to contrast these with surgical masks:
More fashionable than we see in the hospital.
You can see these worn around flu season. They were especially notable in Asia during the SARS epidemic and can be quite the fashion item.
These do NOT filter all the air you breathe. It is important to note that they do not protect all that well against inhalation of foreign particles. Instead, they prevent wearers from touching their noses and mouths, and they reduce the spread of droplets when the wearer coughs or sneezes.
For the general public, these can therefore help prevent transmission of disease, especially around flu season, but they are by no means failsafe.
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Two Doctors Walk Along a River
Today Katherine Treadway, one of the teachers at Introduction to the Profession, told a nice parable about two doctors walking along the Charles River, Boston's main body of water.
They're walking along chatting about their work when all of a sudden a man drifts by in the middle of the river, screaming for help. The doctors immediately spring into action, one doctor standing by the bank for support while the other dives into the river. He pulls the man, swims to shore, and they both climb out soaking wet.
The two doctors continue their stroll when a woman drifts by in the river again, just screaming for dear life. The doctors rush again, and they save the woman from drowning.
They walk further down the river until another man comes down the streaming river, at risk of drowning. One doctor immediately dives in, but this time the other doctor runs away up the river, inexplicably. The swimming doctor manages to save the man, and he waits by the side of the river for his friend to return.
When he does, the wet doctor asks, "Why in the world did you run away when I was trying to save him?"
The other doctor says, "I went upstream trying to see why so many people were falling in the river!"
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This is a cute story, but it also illustrates the multiple roles physicians can have in society. They can serve on the frontlines treating patients with what we currently know, or they can research the unknown about why diseases happen. Both are absolutely essential roles in medicine.
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White Coat Ceremony
The white coat ceremony at medical schools is meant to mark the transition from preclinical to clinical years. There has been an increasing trend to present the coats before the start of the first year as the curricula involve patient interactions well before the third year.
At some schools, the white coat ceremony is a huge ordeal. Parents are invited, tents are raised, tears are released. My parents attended my brother's white coat ceremony two years earlier.
At Harvard Medical School it is a little less overstated. We have five societies - Cannon, Peabody, Holmes, and Castle (named after venerable doctors from Harvard and following the New Pathway curriculum) and HST, the program I am in (now named the London society after its founder).
Each society held its own white coat ceremony closed to parents, which meant a cozier atmosphere and less hoopla. The white coat ceremony is a symbolic gesture meant to emphasize the increasing responsibility of the medical student. But I'm not sure that I feel any different having received it since those responsibilities have weighed heavily in my mind.
Here is a picture taken by a classmate of mostly HST students with our esteemed pathologist and teacher, Rick Mitchell to the right. I am standing second from the right.
Will those smiles be replaced by weary, blank stares in the near future?
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Introduction to the Profession
Harvard Medical School has two programs -New Pathway (NP), with 120 students, and Health Sciences & Technology (HST), with 30 students. NP follows a Problem-Based Learning philosophy in which students learn primarily by analyzing clinical cases, discussion, and self-research. HST is a collaboration between Harvard and MIT, and it's much more focused on frontiers research and lecture-based learning.
For the first two years of medical school, we take no courses together except for Introduction to the Profession, starting today and lasting for two weeks. The purpose of the course is to provide a relaxed introduction to coursework during which we learn to take vital signs, take a basic patient history, shadow doctors, and talk to patients.
HMS is one of the few schools that has a dual program like this, and I think it reflects its dual commitment to patient care and research well.
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