The Harvard Medical School Pathways curriculum: A comprehensive curricular evaluation

Abstract

Purpose

The Harvard Medical School Pathways curriculum represents a major reform effort. Our goals were to enhance reasoning and clinical skills and improve the learning environment and students’ approach to learning via use of collaborative, case-based pedagogy; early clinical exposure; and enhanced approaches to teaching and evaluating clinical skills. We evaluated the impact of Pathways on key outcomes related to these goals.

Materials and methods

In this prospective, mixed-methods study, we compared the last prior-curriculum cohort (2014 matriculation, n = 135) and first new-curriculum cohort (2015 matriculation, n = 135). Measures included Likert-type surveys, focus groups, and test scores to assess outcomes.

Results

Compared with prior-curriculum students, new-curriculum students reported higher mean preclerkship learning environment ratings (Educational Climate Inventory, 62.4 versus 51.9, p < 0.0001) and greater satisfaction with the quality of their preclerkship education (88% versus 73%, p = 0.0007). Mean USMLE Step-1 and Step-2 scores did not differ between groups. At graduation, new-curriculum students rated their medical school experience higher in 6 of 7 domains, including ‘fostering a culture of curiosity and inquiry’ (4.3 versus 3.9, p = 0.006) and focus on ‘student-centered learning’ (3.9 versus 3.4, p = 0.002).

Conclusions

The new curriculum outperformed or was equal to the prior one on most measures of learning environment and perceived quality of education, without a decline in medical knowledge or clinical skills. Robust longitudinal evaluation provided important feedback for ongoing curriculum improvement.

Keywords:

• Evaluation
• learning outcomes
• methods

Disclosure statement

The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the article.

Glossary

Case-based collaborative learning (CBCL): Is a novel student-centered learning approach that borrows from team-based learning principles and incorporates elements of problem-based learning and case-based learning. CBCL includes a pre-class readiness assurance process and case-based in-class activities in which students respond to focused, open-ended questions individually, discuss their answers in small groups, and then reach consensus in a larger group facilitated by a faculty tutor.

Additional information

Funding

This work was supported by funding from the Harvard Initiative for Teaching and Learning Cultivation Grant, 2014, https://hilt.harvard.edu/funding-opportunities/previously-awardedprojects/projects/assessing-the-impact-of-an-innovative-curriculum-at-harvard-medicalschool-a-new-paradigm-for-medical-education/

Notes on contributors

Amy M. Sullivan

Amy M. Sullivan, EdD, is an associate professor of medicine, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA.

Edward Krupat

Edward Krupat, PhD, is an associate professor of medicine, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA.

Jules L. Dienstag

Jules L. Dienstag, MD, is professor of medicine, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA.

Jakob I. McSparron

Jakob I. McSparron, MD, is an associate professor of medicine, University of Michigan School of Medicine, Ann Arbor, MA.

Stephen R. Pelletier

Stephen R. Pelletier, PhD, is senior project manager, Office of Educational Quality Improvement, Harvard Medical School, Boston, Massachusetts.

Sara B. Fazio

Sara B. Fazio, MD, is professor of medicine, Department of Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts.

Thomas J. Fleenor

Thomas J. Fleenor, MEd, is a data analyst in the Office of Educational Quality Improvement, Harvard Medical School, Boston, MA.

John L. Dalrymple

John L. Dalrymple, MD, is a professor of obstetrics, gynecology and reproductive biology, Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts.

Edward M. Hundert

Edward M. Hundert, MD, is Dean for medical education and professor in residence of global health and social medicine and medical education at Harvard Medical School, Boston, Massachusetts.

Richard M. Schwartzstein

Richard M. Schwartzstein, MD, is a professor of medicine, Department of Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts.