A central part of the New Pathway curriculum is the tutorial, in which students have a chance to delve into a wide range of case studies and discuss them in a small-group format under the guidance of a faculty member.

Tutorials are a key element of a student's schedule. In their first two years, students participate in a tutorial and lab on alternate days, in addition to lectures, electives and a weekly "patient/doctor" class. The patient/doctor courses introduce students to patient-physician relationships and clinical medicine.

The third and fourth years are divided into clerkships that include rotations at the school's hospitals, as well as lectures, tutorials and more patient/doctor courses.

These third and fourth-year curricula are the most recently established parts of the New Pathway, and administrators say specific details are still undergoing revision.

LuAnn Wilkerson, the director of faculty development at the Med School, says the societies and their small group tutorials encourage students to think creatively about medical problems.

"Simulation is a powerful way for them to get to trust the method. They encourage students to see cases and how they fit into the full course structure," she says.

Wilkerson says that faculty members who have led tutorials have chosen to do so again. "The reason they come back is that they really enjoy working with new knowledge, skills and colleagues."

"There is a stronger faculty commitment with more teaching. That's energizing," says Armstrong, both faculty and students."

Tutorial leaders say their role is only to guide the discussion and make available their expertise in the field.

Assistant Professor of Medicine Steven L. Rabinowe, who leads an endocrinology tutorial, says that tutors act as "curbstones" in discussions to keep students thinking between correct lines. "Students generate their own discussion. We are also here to correct mistaken assumptions," he says.

Many times, Rabinowe says, current questions about a given case are asked, and the tutors, often experts in their fields, can answer them based on recent material that might not have appeared in textbooks.

"Students are more involved in the learning process. They think about the questions. There are plusses over memorization. You learn it better," he says. However, "it depends on student participation. Sometimes one or two students dominate a tutorial. The dynamics of the group are important. Our job is also to try to draw out quieter students."

Concerns Raised

Ramos acknowledges that serious concerns were raised, especially in its early stages, about New Pathway's ability to teach students essential medical knowledge.

She says that results of the Medical Board exams, which students nationwide must take after completing their second and fourth years, have been excellent, alleviating these fears.