Medical schools have traditionally trained doctors through a combination of cramming and clinicals. But Harvard Medical School, like Harvard Law School, has recognized the value of the problem solving pedagogy and participatory learning. Since 1985, HMS has incorporated case-based tutorials into the “New Pathway” curriculum.
The tutorials at HMS are ungraded discussion groups that analyze patient stories as they unfold, explains HBS Professor David A. Garvin in his review of case-based learning at Harvard. The multi-part cases systematically review symptoms, physical examinations, lab tests, diagnosis, treatment, and the patient’s health over time. For each part, students work together to fill in knowledge gaps and set learning goals that lead them closer to answers. Ultimately, students present their findings in a group discussion before moving to the next part of the case.
Tutors ensure that the learning comes from the students, asking students to articulate their logic, consider substantive dimensions, and investigate further. Tutors do not manage, steer, or orchestrate, says Garvin; instead, tutors redirect conversation during points of confusion.
The teaching philosophy at HMS is a case study in its own right, offering to educators a healthy caveat against overly sculpted lesson plans and micromanaged discussion. Preliminary studies suggest that the New Pathway curriculum meets its objective to “foster a true spirit of inquiry.”
One study of HMS students showed that compared to traditional lecture- and lab-based education, the New Pathway curriculum encouraged more students to pursue primary care or psychiatry. New Pathway students felt better prepared to practice “humanistic medicine” and handle “psychosocial problems,” said the report.
In another study, New Pathway students reported more engagement with the material and stronger relationships with faculty, but found it stressful to navigate tutorial relationships and the vast body of medical knowledge. The authors of the report concluded, “These experiences are similar to challenges that successful clinicians must overcome during their professional socialization. Uncomfortable though these experiences may be, students exposed to them during medical school may arguably be better prepared for life-long learning and the strains of teamwork.”
Despite the stress of uncertainty, New Pathway students rivaled students of traditional medical education on measures of problem solving skill and biomedical knowledge. Self-directed learning, it seems, can adequately prepare students for the medical profession. And the value of the problem solving approach lies not in a competitive edge, but in the culture it produces: a fulfilling, emboldening learning environment realistic about the challenges ahead.
For a history of case-based learning across the university, see “Making the Case” in Harvard Magazine. Written in 2003, this article shows how the cross-pollination of ideas transformed the case method, which, years later, returned to Harvard Law School as the case study method our program uses today. Click here to read more about how law schools can learn from the medical school model.