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At least 19 recordsLinked to original sources
PubMed1989

Pathology in the new pathway of medical education at Harvard Medical School.

In 1985 Harvard Medical School initiated an experimental curriculum that incorporated many of the recommendations of the report on the General Professional Education of the Physician (GPEP). Key features are problem-based small group tutorials that emphasize active learning, with increased independent study time and a decreased number of lectures. Tutors serve as guides to their students and are not necessarily experts in the discipline of the cases studied. Learning skills are taught, including information acquisition and criticism and computer literacy. Knowledge is integrated from the beginning by interdisciplinary basic science courses, by earlier introduction of the clinical sciences, and by juxtaposition of the scientific and humanistic aspects of medicine. Preventive medicine, health maintenance, and ambulatory care are given more attention. The students are organized into societies that provide vertical integration and promote cooperation among students and closer contact with faculty. Pathology has proved to be a popular and key bridge in the new curriculum. The success of the early efforts at Harvard and several pioneering medical schools should encourage others to move toward more problem-solving, student-centered, integrative medical education.

Curriculum↗
PubMed2003

The Academy at Harvard Medical School: nurturing teaching and stimulating innovation.

The Academy at Harvard Medical School, established in 2001, was formed at a critical moment for medical schools in this country. Several decades of enormous growth in the biomedical research and clinical care activities of medical school faculty have resulted in great societal benefit. The unintended consequence has been a decline in faculty time and reward for the educational mission that is unique to a medical school. The impact of this decline is particularly felt now because the explosive growth in the science and technology relevant to medical practice, coupled with dramatic changes in the health care delivery system, calls for new models for the education of the next generation of physicians. The mission of the academy is to renew and reinvigorate the educational mission of Harvard Medical School (HMS). By bringing together a select group of some of the school's most talented and dedicated faculty and providing direct support for their work related to education, the academy has created a unique mechanism for increasing the recognition of teaching contributions of both academy members and the teaching faculty at large, fostering educational innovation, and providing a forum for the exchange of ideas related to medical education that cross departmental and institutional lines. The authors describe the academy's membership criteria, structure, governance, activities, institutional impact, and plans for long-term evaluation, and indicate challenges the academy will face in the future.

Curriculum↗
PubMed2001

The longitudinal primary care clerkship at Harvard Medical School.

The primary care clerkship (PCC) at Harvard Medical School was established in 1997. The goals are to provide students with longitudinal experiences with patients and to include modern themes in the curriculum: managing illness and clinical relationships over time; finding the best available answers to clinical questions; preventing illness and promoting health; dealing with clinical uncertainty; getting the best outcomes with available resources; working in a health care team; and sharing decision making with patients. The PCC, a required course in the clinical years, meets one afternoon a week for nine months. Students spend three afternoons per month in primary care practices, where they see three to five patients per session and follow at least one patient ("longitudinal patient") over time. Classroom sessions, in both large- and small-group formats, promote a common educational philosophy and experience, and reinforce habits of problem-based learning established in the preclinical years. The students rated 74% of their preceptors excellent, especially praising their ability to facilitate and support good interpersonal relationships with patients, their ability to encourage students' independent evaluation of patients (as opposed to shadowing), and their enthusiasm for teaching. Students saw their longitudinal patients a mean of 4.8 times; 83% saw their patients at least three times. The PCC complements the curriculum of block clerkships in hospitals, and because the two are offered concurrently, students are required to come to terms with two substantially different cultures within medicine. Other medical schools are beginning to develop longitudinal clerkships to ensure that students have essential educational experiences that are difficult to achieve in block, hospital-based clerkships.

Attitude of Health Personnel↗
PubMedDate not supplied

Administrative guidelines for response to an adverse anesthesia event. The Risk Management Committee of the Harvard Medical School's Department of Anaesthesia.

The Risk Management Committee of the Harvard Medical School's Department of Anaesthesia developed a set of guidelines recommending administrative actions that should be taken immediately following an adverse anesthesia event. The guidelines are intended to limit patient injury from a specific event associated with anesthesia and to ensure that the causes of the event are identified to prevent recurrence. The guidelines direct the primary anesthetist to concentrate on continuing care but quickly notify someone in a leadership position, who would become the "incident supervisor." The incident supervisor would be knowledgeable of the details of the protocol and direct activities for ensuring appropriate medical care, sequestration of equipment, documentation of information, and contact of other appropriate administrative personnel. Experience with the guidelines has shown that they can be effective if applied but that it is difficult to do that consistently in our large medical centers.

Anesthesia↗
PubMed1995

A promotion ladder for teachers at Harvard Medical School: experience and challenges.

The authors describe the development, implementation, and institutionalization at Harvard Medical School of a promotion ladder that recognizes the teaching and scholarly contributions of full-time clinical faculty. They also discuss the challenges that arose during this process, for example, how to make the new track creditable and attractive to both the appointed faculty and the faculty at large. The criteria developed for promotion focus on a candidate's skills and accomplishments in teaching, scholarship, clinical work, and departmental service. The authors present the elements of these criteria for the three professional levels of the ladder and outline the appointment process, including the steps for consideration of a given promotion. The development of this teacher-clinician ladder has had a positive influence on faculty who are committed to teaching by allowing recognition of their contributions in a track held to be the equal of the other full-time tracks in a medical faculty traditionally committed to research and patient care. Data are given for the 70 faculty who were promoted over the five years from 1989 to 1994. The true success of this promotion ladder will be measured only over time through its impact on the educational enterprise within the medical school and its hospitals, and its capacity to both successfully advance the careers of qualified medical educators and further the development of the field of medical education.

Career Mobility↗
PubMedDate not supplied

Standards for patient monitoring during anesthesia at Harvard Medical School.

As part of a major patient safety/risk management effort, the Department of Anaesthesia of Harvard Medical School, Boston, has devised specific, detailed, mandatory standards for minimal patient monitoring during anesthesia at its nine component teaching hospitals. Such standards have not previously existed, and resistance to the concept was anticipated but not seen. The standards are technically achievable in all settings and affordable in terms of effort and cost. Early detection of untoward trends or events during anesthesia will result in prevention or mitigation of patient injury; this, in turn, may also help counter the explosive increases in anesthesia-related malpractice actions, settlements, judgments, and insurance premiums. The committee process used is applicable to the promulgation of standards of practice for all medical specialties and any organized group of medical practitioners.

Anesthesia↗
PubMed1988

IAIMS development at Harvard Medical School.

The long-range goal of this IAIMS development project is to achieve an Integrated Academic Information Management System for the Harvard Medical School, the Francis A. Countway Library of Medicine, and Harvard's affiliated institutions and their respective libraries. An "opportunistic, incremental" approach to planning has been devised. The projects selected for the initial phase are to implement an increasingly powerful electronic communications network, to encourage the use of a variety of bibliographic and information access techniques, and to begin an ambitious program of faculty and student education in computer science and its applications to medical education, medical care, and research. In addition, we will explore means to promote better collaboration among the separate computer science units in the various schools and hospitals. We believe that our planning approach will have relevance to other educational institutions where lack of strong central organizational control prevents a "top-down" approach to planning.

Boston↗
PubMed1994

The development of neuropathology at the Massachusetts General Hospital and Harvard Medical School.

Few institutions have shaped neuropathology as a discipline as profoundly as Massachusetts General Hospital (MGH) and Harvard Medical School. Their fascination over many decades is due to a unique accumulation of excellent, intellectually stimulating neurologists with a sincere interest in the morphologic and pathogenetic basis of nervous system diseases. Their approach was strictly case oriented and clinico-pathological conferences were developed to the highest standard. In this review, the foundations of neuropathology in Boston are recounted.

History, 20th Century↗
PubMed2005

Influence of new educational technology on problem-based learning at Harvard Medical School.

PURPOSE: Computers with 50-inch, wall-mounted plasma screens and broadband Internet access were installed in all small group tutorial rooms at Harvard Medical School. This study examines how the introduction of this educational technology impacted on the problem-based learning tutorials. METHOD: A total of 37 tutorial groups, stratified by year of student, were observed at separate timepoints (autumn 2002, spring 2003) to document the patterns of use of the technologies. Based on these observations, end-of-course surveys were developed and distributed to students and tutors. Observational field notes and open-ended survey responses were qualitatively analysed for themes. RESULTS: Using a 5-point rating scale, both students and tutors indicated that the technologies had a positive impact on their tutorials. In autumn 2002, plasma screens were used for an average of 17.8 and 22.1 minutes per 1-hour observation in Year 1 and 2 tutorials, respectively; in spring 2003, usage declined to 6.9 and 5.9 minutes, respectively. Resources utilised included Internet sites (54% total use time), PowerPoint presentations by students (22%), and course-specific postings (24%). Marked course-specific variation in usage was noted. Observational and survey data revealed that the technologies interrupted the flow of tutorial discussion. Students and tutors expressed concerns that the plasma screens might be altering the process of problem solving in the tutorials. CONCLUSIONS: Both students and tutors reported that the introduction of computers and wall-mounted plasma screens had impacted positively on tutorials. Questions were raised as to how this technology might alter tutorial dynamics. Further research will be needed to investigate these pedagogical concerns.

Attitude↗
PubMed2006

Applying problem-based learning to the teaching of anatomy: the example of Harvard Medical School.

The introduction of problem-based learning techniques into the teaching of anatomy has been subject to great controversies. This paper debates the rationale behind this concept using the example of the curriculum of Harvard Medical School in which problem-based learning techniques have been used during the past 20 years. The anatomy curriculum is covered during the eight first weeks of the medical studies, and is an original combination of discussions of clinical cases in small groups, and work in gross anatomy, histology and radiology laboratories. The lectures are reduced to the minimum and emphasize general concepts. In this setting, the learning of anatomy is mostly led by students who have prepared for the different laboratory sessions and tutorials. The implementation of problem-based learning to the teaching of anatomy requires a close follow-up of each student with regular feedbacks on his work. Tutorials must be considered as a cornerstone between lectures and work in laboratories. Traditional aspects of the teaching of anatomy, such as work in dissection laboratories, are given an important role as they are aimed to clear-up misunderstood points. Further studies are required to compare at the long term the level of medical students who learned anatomy in a problem based versus traditional learning setting.

Anatomy↗
PubMedDate not supplied

Guidelines for sedation by nonanesthesiologists during diagnostic and therapeutic procedures. The Risk Management Committee of the Department of Anaesthesia of Harvard Medical School.

The increasing use of sedation to enhance patient comfort during diagnostic and therapeutic procedures has been noted by the Joint Commission of Accredited Healthcare Organizations, specialty societies, and the public. Although anesthesiologists, by virtue of training and experience, possess unique qualifications to provide such sedation services, their availability remains somewhat limited by primary commitments to the operating room, intensive care unit, or pain service. The Risk Management Committee of the Department of Anaesthesia of Harvard Medical School has made specific recommendations to the Harvard-affiliated hospitals for anesthesiologists who participate in institutional-level committees in setting guidelines for such services when they are provided by nonanesthesiologists. Specific consideration is given to facilities, backup emergency services, equipment, education and training, issues of informed consent, documentation, and release of patients from medical care. These recommendations emphasize the collaboration of the department of anesthesia and other departments that provide sedation services in formulating policies and procedures that reflect values intrinsic to the practice of anesthesiology.

Anesthesia↗
PubMed2000

Long-term outcomes of the New Pathway Program at Harvard Medical School: a randomized controlled trial.

PURPOSE: To evaluate the long-term effects of an innovative curriculum, the New Pathway (NP) Program, on behaviors and attitudes related to humanistic medicine, lifelong learning, and social learning. METHOD: Long-term follow-up of Harvard Medical School students who participated in a randomized controlled trial. Descriptive study using 1998 telephone interviews of 100 1989 and 1990 graduates (50 who had studied the NP curriculum, 50 who had studied the traditional curriculum). The NP Program consisted of problem-based learning tutorials, with coordinated lectures, labs, experiences in humanistic medicine, and clinical experiences; the traditional program consisted of basic science lectures and labs. RESULTS: Of 22 measures on the survey, NP and traditional students differed significantly on only five (three humanism; two social learning): 40% of NP students and 18% of traditional students went on to practice primary care or psychiatry. NP students rated their preparation to practice humanistic medicine higher than did traditional students and expressed more confidence in their ability to manage patients with psychosocial problems. NP students were more likely than were traditional students to believe that faculty from the first two years continued to influence their thinking. NP students liked the pedagogic approaches of their program more than traditional students did. There was no difference between the groups on measures of lifelong learning. CONCLUSIONS: Differences between NP and traditional students in the humanism domain first appeared during medical school and residency and remained significant well into practice, suggesting that humanistic medicine can be taught and learned.

Attitude↗
PubMed2006

Sleep deficit: the performance killer. A conversation with Harvard Medical School Professor Charles A. Czeisler.

Companies today glorify the executive who logs 100-hour workweeks, the road warrior who lives out of a suitcase in multiple time zones, and the negotiator who takes a red-eye to make an 8 A.M. meeting. But to Dr. Charles A. Czeisler, the Baldino Professor of Sleep Medicine at Harvard Medical School, this kind of corporate behavior is the antithesis of high performance. In fact, he says, it endangers employees and puts their companies at risk. In this interview, Czeisler describes four neurobiological functions that affect sleep duration and quality as well as individual performance. When these functions fall out of alignment because of sleep deprivation, people operate at a far lower level of performance than they would if they were well rested. Czeisler goes on to observe that corporations have all kinds of policies designed to protect employees- rules against smoking, sexual harassment, and so on-but they push people to the brink of self-destruction by expecting them to work too hard, too long, and with too little sleep. The negative effects on cognitive performance, Czeisler says, can be similar to those that occur after drinking too much alcohol: "We now know that 24 hours without sleep or a week of sleeping four or five hours a night induces an impairment equivalent to a blood alcohol level of .1%. We would never say, 'This person is a great worker! He's drunk all the time!' yet we continue to celebrate people who sacrifice sleep for work." Czeisler recommends that companies institute corporate sleep policies that discourage scheduled work beyond 16 consecutive hours as well as working or driving immediately after late-night or overnight flights. A sidebar to this article summarizes the latest developments in sleep research.

Administrative Personnel↗
PubMed1984

Charles Edouard Brown-Séquard: professor of physiology and pathology of the nervous system at Harvard Medical School.

Brown-Séquard's career as Harvard's first professor of the physiology and pathology of the nervous system is chronicled in a unique and previously unpublished series of his private letters and university archival material. At Harvard, Brown-Séquard tried to modernize the curriculum by adding laboratory exercises and animal experiments in the teaching of physiology. He dreamed of constructing a great physiologic institute to study fundamental problems in neurology, including epilepsy, paralysis, muscular atrophy, nerve injuries, and a wide variety of other problems. His letters reveal Brown-Séquard as a disarmingly "modern" professor who avoided faculty meetings, complained constantly about lecture schedules, his salary, and the improper care of his animals--and threatened to resign regularly!

History, 19th Century↗
PubMed2001

Design and Evolution of a Miniature Bcl-2 Binding Protein We thank the HHMI Biopolymer/Keck Foundation Biotechnology Resource Laboratory (Yale University School of Medicine, New Haven, CT) for oligonucleotide and peptide synthesis and amino acid analysis and Professor Jennifer Doudna (Yale University) for use of a Perseptive Voyager-DE (MALDI-TOF) mass spectrometer. We are grateful also to Dr. Junying Yuan and Dr. Alexi Degterev (Harvard Medical School) for a generous gift of Bcl-X(L)-His(6) and Stacey E. Rutledge for helpful comments. This work was supported by the National Institutes of Health.

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Journal Article↗