Medical schools across the country are offering courses that take students out of large lectures and turn them from doodlers into detectives following a model designed by Harvard Medical School (HMS) over a decade ago.

HMS's New Pathway program is perhaps the most comprehensive example of "problem-based learning"-a philosophy of teaching that has students work in small groups to solve specific clinical "cases."

HMS assembled this program in the mid-80s and has used it for about 60 percent of its instruction since.

Now, more and more medical schools are using similar programs-encouraged by what HMS officials say is a high rate of satisfaction among students.

According to HMS Dean for Medical Education Daniel D. Federman '49, HMS developed the new curriculum in the early 80s by combining elements of problems-based learning programs at other schools.

"We did not invent a single element, but we did put together the whole package," Federman says.

The result was named the New Pathway tested in 1985 and 1986 and set in place permanently in 1987.

Learning by Doing

Students who learn medicine from the New Pathway take an active role in their own education, Federman says.

A traditional medical school has students spend two years in lecture courses and then two years in clinical training during which students follow doctors in area "teaching hospitals."

In the New Pathway program, the first two years are spent predominantly in eight-person groups headed by a tutor.

Within these groups, the students are presented with a "case"-a hypothetical patient with a disease, often modeled on real patients. The students investigate these cases by looking up medical texts on their own and discussing the results of their research in class.

"The purpose is not to diagnose or learn to treat the patient, but to understand the science... that underlies the problem," Federman says.

For instance, given the case of a patient with lung cancer complaining of a cough, students must learn how cancer develops and spreads in cells in order to understand the biology behind the disease.

About 60 percent of HMS' first two years is taught in small-group tutorials, with the other 40 percent being done in traditional lecture courses. But Federman says that students spend 80 percent of their studying time on their problem based learning courses.