Generations of doctors have experienced the nightmarish rites of passage through medical school--eight-hour lecture days, and an insurmountable barricade of raw knowledge.

And despite widespread criticism, the conventional system of medical education--in which the first two years stress factual knowledge, while the last two emphasize clinical skill--has gone virtually unchanged for 30 years. Some critics have called it dehumanizing and disjointed, charging that too many physicians turned out through the traditional route have been insufficiently prepared to handle patients in a caring and effective way.

But the Harvard Medical School is out to challenge the critics, and this fall began a pioneering experiment that officials view as a better way to produce better doctors.

Instead of spending hours upon hours in lectures, and waiting two years to start clinical work, this fall 24 first-year students--almost a sixth of the Med School class of 1989--are participating in the school's New Pathway program. It is designed to allow students to start thinking clinically from the start of their studies, and decrease the amount of required memorization.

New Pathway "is aimed at trying to determine what kind of training all physicians should share, no matter what they do," said Professor of Anatomy Dr. M. Judah Folkman, one of the program's teachers.

Although the program is just two months old, plans to broaden it to include a larger proportion of each Med School class--and perhaps one day all medical students at Harvard--are already underway, according to Dr. Daniel C. Tosteson '44, who as dean of the Med School has led efforts to establish the program.

"We've been actively discussing [extending it] in various groups, but we have no set timetable," Tosteson said recently.

Students in the program spend five hours a week in six-person tutorials, each led by a faculty member experienced in the question-answer Socratic method. (For more on the tutorial experience, see accompanying story, Page One.)

They also spend 90 minutes in lab each day, and just six hours weekly in lectures, about one-quarter the typical amount. The lectures are designed to be more conceptual than those taught according to the traditional conception of medical education.

In addition, students spend four hours each week learning clinical skills, and about three hours weekly in "Patient/Doctor," a class which covers many of the interpersonal and moral aspects of medical life.

A Long Haul

The New Pathway was conceived three years ago as a radical new approach to training doctors, a seven-year plan that would have taken students after their sophomore year in college and carried them through one integrated chain encompassing the final two undergraduate years, four years of med school, and the first year of "residency," or hospital training.

But problems in persuading the Med School faculty to accept the full plan, and the realization that it would be difficult to fashion a comprehensive college-med school-hospital program, led organizers to settle for revamping the traditional four years of medical training for no more than 25 students in each class.

After the Med School faculty granted conditional approval to the plan two years ago, a variety of student-faculty committees began refining the curriculum, recruiting faculty, and raising money. Several million dollars and hundreds of agendas later, the first program participants were selected in the spring from among interested students admitted to the regular class.

While Tosteson and others still speak fondly of the grand seven-year proposal, most of their current efforts are aimed at insuring that the fledgling program survives its inaugural year.