In the three weeks since its release, President Bok's annual report to the Corporation, which this year focused on medical education and on Harvard Medical School in particular, has received widespread attention, and most reactions are either strongly positive or negative.
While many faculty of Harvard Medical School and other prominent medical schools said they were pleased with Bok's recommendations, which include a restructuring of medical curricula to deemphasize the basic sciences and an addition of more humanities and ethics courses, some added that their complaints lay in his suggestions for remedying the problems.
"He identifies where we want to be, but not how we're going to get there," Jerome L. Avorn, associate professor of Social Medicine and Health Policy, said yesterday. He echoed similar comments from other faculty that Bok did not provide a clear directive for action in "humanizing" medical education.
Generally, many faculty and administrators agreed that Bok had addressed the most significant issue now facing medical educators.
"I'm in total agreement with his identification of the problems," Dean of Cornell Medical College Dr. Thomas Meikle said this week, adding "[Bok's] recommendations for change and improvement were right on target."
The president's report focused on both the heavy pressure placed on undergraduate premed students by the competitive nature of medical school admissions, and on what is widely viewed as an overemphasis by medical education on the so-called "hard," or basic, sciences.
Bok's recommendations included fewer lectures and smaller classes in the first two years of medical school, and a call to add ethics to the general curriculum.
New Pathway
The report praised an alternative program the Medical School has been developing, designed to alleviate pressure on pre-meds and to integrate humanities and basic sciences. The "New Pathway," which will accept 25 students on an experimental basis in the fall of 1985, is a five-year program, extending into the first year of residency. Modeled on the progressive system at the McMaster University Medical School in Toronto, the program will be case-based, emphasizing the study of specific incidents rather than broad-based disease analysis, with lectures limited to one per day.
"Students will see patients practically from the first day of med school," said Eleanor McLoughlin, the Medical School's curriculum coordinator. She added that "ethics will be fundamentally incorporated" into the new program.
While many Harvard faculty agree that ethics ought to be taught in the classroom, some hasten to add that students can grapple with difficult issues best with day-to-day practice.
"Ethics shouldn't be taught in a formal course context," said Medical School Dean for Students and Alumni Daniel D. Federman.
"If I'm teaching, and one day we go to visit someone who has a difficult problem, we talk about it right then--whether or not there's been a lecture, there's been an ethical decision within a medical contest," he added.
But in an era of great technological advance that has given rise to difficult judgement questions, some educators are skeptical that any less than drastic changes will have a real impact on students' sensitivity to the growing problems of ethics.
Presley Professor of Psychiatry Leon Eisenberg said last week the "the central question is this: how much difference in physicians' behavior is determined by medical education, and how much by the conditions or practice, and the society in which they work?"
