Is Harvard too often cited as the example to emulate?

Is Harvard too often cited as the example to emulate?

Dear Sir

The fact is that the University of Harvard is very often cited as an example to follow. It is even the case by French academics (Flahault 2007). There is nothing surprising with that. Harvard has had an excellent reputation for several centuries. It produces researchers who are not just satisfied to enjoy researching, but who often find solutions to important problems and collect many Nobel Prizes.

I am concerned that Harvard admirers ipso facto also accept its teaching as being of high-quality. They believe that if the results are good it is because the Professors of Harvard are good teachers.

My persistent theory is that this relation does not apply there anymore than in any other University throughout the world. I have even the bad taste to think that the Nobel prizes are obtained in spite of the ambient teaching process rather than thanks to it.

A recent interview in the New York Times (Mazur 2007) brings water to my mill. Professor Eric Mazur, 52 years old, says he studied physics at the University of Leiden in Holland. He became ‘Gordon McKay Professor of Applied Physics’ at Harvard in 1980. At Harvard ‘We’re way too focused on facts and rote memorization and not on learning the process of doing science. In Holland, the lectures were deadening, frustrating. In my first year, we started out as 72 physics majors but only 11 graduated. Only those who could maintain themselves in rote memorization were able to continue’.

‘From what I’ve seen in the US, students in science classrooms throughout the country also depend on the rote memorization of facts. The students who score high do so because they have learned how to regurgitate information on tests. On the whole, they haven’t understood the basic concepts behind the facts. They can’t apply them in the laboratory. Or in life’.

‘When I started to teach at Harvard I didn’t ask myself such questions. I did what everyone else did: lecture. And the feedback was positive. My (undergraduate) students obtained good scores at examinations which I considered difficult. But when later I gave them a new ‘concept-based’ exam, about half had no clue as to what Newtonian mechanics were about’.

‘I used to get in front of my students and do all the science for them. I should have been showing them how to do it themselves. If they were studying the piano, would have I said ‘sit down, I’ll play the piano for you.’? That was the moment I fell out of my ivory tower. I began to consider new ways of teaching. At Harvard each teacher is free to teach its own way but there is not much cross pollination’.

‘At least for my students the individual study of the theoretical contents had then to be done before the course itself. During the course the discussion between the students relates to applications in every day's life and during sessions in small groups they use scientific concepts to solve a problem together. The examinations are <open book>, as in real professional life’.

Professor Mazur gives the impression that even Harvard students, like everywhere else, work for the exams, whatever their level of validity.

This is not the picture one gets when reading a welcome message from the Dean of Harvard College to undergraduate students (Lewis 2004). Even a short excerpt brings tears to the reader's eyes: ‘We will certainly give you grades and transcripts attesting to some of the things you have done here, but much of what you do will be recorded on no piece of paper you take with you, but only as imprints on your mind and soul’.

Even ‘Science’ (Enserink 2008) is delighted that ‘France takes its inspiration in Harvard School of Public Health’.

The question remains whether, in France and elsewhere, such a veneration of Harvard will lead their professors to continue to use inefficient straight lectures and tests with low validity.

Prof. J J Guilbert

15 avenue du Mail

Genève

CH - 1205

Switzerland

Following injuries of athletes on television as an adjuvant teaching tool in anatomy and other medical school classes

Dear Sir

In the pre-clinical years medical students increasingly are seeking clinical correlation to enhance basic science material (Euliano 2000). It has been a foundation of medical training for centuries–if not since the dawn of the subspecies–that clinical examples seen during clinical training (or practice) help students (practicing physicians) learn and retain material. Also, following patients in the short- and long-term provides valuable knowledge on the course of disease. However, interestingly, and ironically, due to recent and ever increasing rules on trainee work hours, concerns for patient privacy, and an increasing number of training sites, trainees in the clinical years often do not have time, or are even forbidden from following their own patients! Here I describe a weekly lecture course (∼8 weeks long) utilizing recent injuries to athletes in televised sports–for example a fall course in the United States to coincide with the American professional and college football seasons–to provide strong clinical correlation to complement the standard medical student anatomy course and to allow students to appreciate the short- and long-term course of the injuries being studied.

The distribution of injuries (e.g., Week One, 2007 Season http://www.nfl.com/injuries) is such that lecture ‘modules’ can be prepared ahead of time for most topics, so that real time preparation can be greatly minimized. Lecture topics would include anterior cruciate ligament (knee) injuries, medial/lateral ligament/meniscal (knee) injuries, ankle sprains, ‘turf toe’ (first metatarsalphalangeal joint sprain), rotator cuff injuries, concussions, spinal cord injuries and repetitive strain injuries and focal dystonias in performing artists. Lectures would start with a video clip of a recent injury. Next the lecture would cover anatomy and physiology of the affected joint, etiology of common injuries to the joint from sports injuries and other causes, examination of the joint–with hands on participation by students–and methods of treatment. Subsequent weeks would have the feature of being able to follow the injury with more clips of the player once the athlete has returned to play, or at least get an indelible sense of what the recovery period is for given injuries.

Eric Lewin Altschuler, MD, PhD

Department of Physical Medicine and Rehabilitation

University of Medicine & Dentistry

University Hospital, B-403

150 Bergen Street

Newark, NJ 07103

Supporting students writing for community-based learning

Dear Sir

The use of assessments other than exams for community-based experiential learning challenges students unfamiliar with these learning styles. At Durham, our community placement scheme gives early years medical students practical experience working in a voluntary or statutory community organization for sixty hours in a calendar year. This experiential learning helps prepare students for future community-based, multidisciplinary team working and alerts them to the range of community-based services available to patients. Such settings, which are often non-clinical, can involve a ‘culture shock’ for students, one that increases their confidence in working with people from different or ‘hard to reach’ backgrounds while developing more general communication and time management skills and ethical awareness (Russell, in press). Participant-observation techniques are central to this assignment, intended to enhance students’ observational and reflective abilities. Students’ performance on placement is assessed by means of feedback from their host, and a 3000 word ethnographic report. Students from ‘hard science’ backgrounds are generally unfamiliar with this form of writing. Thus in 2006 we created two types of support services: a mediated electronic discussion board and weekly one-on-one drop-in sessions. About a third of the group attend a drop-in session each year but, despite extensive publicity, no-one has used the electronic discussion board. Students’ anxieties in the drop-in sessions inevitably revolved around three different types of writing issues: feeling they had nothing to write about, feeling that they had too much to write about, and/or uncertainty regarding the assessment criteria (i.e. conceptual issues). Students’ preference for one-on-one drop-in sessions over electronic discussion boards is noteworthy, and accords with other examples of preference for ‘real’ compared to electronic resources (e.g. McHarg et al. 2006). Such needs are likely to increase with the growth of community-based learning in undergraduate medical curricula. Adequate and appropriate mechanisms are essential to support students for whom particular forms of written assessment, such as ethnographic reports, are unfamiliar.

Lyn Brierley-Jones

[email protected]

Andrew Russell

[email protected]

Durham University

Assessment in the Foundation Programme: A qualitative study of consultants and junior doctors in the South West of England

Dear Sir

The Foundation Programme (FP) in August 2005 in the UK introduced a national curriculum for junior doctors’ training and structured, regular assessments of competence throughout the programme (http://www.hcat.nhs.uk/foundation/).

We explored the views and experiences of trainees and supervisors in the first full year of the FP though in depth semi-structured interviews with seven trainees and seven assessors from a single large acute hospital NHS Trust in the South West of England between May and August 2006. All interviews were carried out by the researcher (AS). The study was approved by the local research ethics committee. The data were analysed by the researcher using thematic content analysis.

Assessors and trainees agreed that the assessment system as a whole was straightforward to use. Trainees had however experienced difficulties with organising assessments and in particular securing the commitment of assessors. Whilst trainees and assessors both recognized the main potential benefit of FP assessment as the opportunity for giving and receiving feedback there was a lack of enthusiasm among the trainees, and scepticism among assessors about these benefits being realized.

The tools were seen to have face validity, in terms of capturing appropriate competencies for doctors at this stage of training. Both trainees and assessors were concerned that the full rating scale used in all tools (a range of scores from one to six, where one is ‘below expectations’ and six is ‘above expectations’) was rarely used. They feel the system encourages mediocrity and does not encourage people to excel. Both are concerned about the potential for bias from trainees being able to choose assessors for each assessment. Many feel that a ‘tick box’ attitude has potential to further undermine the value of the system.

Assessors displayed negativity towards assessment due to lack of interest, experience, training, or time. Assessors also reported that they did not spend sufficient time with individual trainees to allow them to form reliable judgements.

The potential benefits from the FP assessments are yet to be delivered in practice. Creating protected time for assessment, maintaining a dedicated list of assessors, more formal training of a wider range of assessors (including nurses and allied health professionals) and reducing the volume of assessments, possibly by combining the merging the Case-based discussion and the Mini-Clinical Evaluation Exercise, could help ensure the potential benefits are realised.

Selena Gray

Deputy Postgraduate Dean

Severn Deanery

Academic Centre

Frenchay Hospital

Beckspool Road

Frenchay

Bristol BS16 1LE, UK [email protected]

Kathy Feest Foundation Programme Director Severn Deanery

Abby Sabey Lecturer University of the West of England, Bristol