The Future is Now: Medical education for the 21st century

So good afternoon, everyone Welcome Those who don’t know me, amazingly, I’m Jeff Flier And it’s great to see so many people here during the lunch hour to hear about some of the exciting things that we’re doing in the realm of education at Harvard Medical School And I want to point out that in addition to all of you, we’re screaming to countless– millions live streaming around the world We’ll find out maybe how many But probably a lot joining us from all over the globe We have a really terrific program today And it’s one of great interest I think everyone knows that it’s all about change, as we move into a new era of medical education, both on the quad as we expand the educational reach of HMS around the globe Many of you– and this is just a little side point– are probably too young to know about a firm that used to be called E.F. Hutton I think it was taken over by Citibank a bunch of years ago But people of my age remember seeing many commercials where someone would be doing something and saying something to someone about their brokers, E.F. Hutton, and then everyone around them stops to listen because when E.F. Hutton talks, people listen Well, this is an entree into one of the themes for Harvard Medical School when it does something related to education, whether it’s changing its curriculum or launching a brand new far reaching program regarding online education When we do this, the world does listen in a disproportionate way And the education communities around the world take note So what we do here not only is relevant to what we do here, but it’s relevant to the world So we take that responsibility very seriously I think everyone knows that the fields of biomedicine and biomedical research are changing at an incredibly rapid rate We feel the obligation to try to make sure that our students, broadly speaking, are as prepared as they can be, not only to be practitioners but to be leaders So the context is with that in the background, we’ve been working extremely hard– by we, I mean a lot of other people, many of whom are in the room– on first our medical education curriculum And I think as most of you know, this year early in August, we launched a major change to our medical curriculum in the program for medical education and dean for medical education, Ed Hundert, will be coming up in about two minutes to tell you about this exciting program, how it’s going, why it’s different, and why we’re so excited about it So another thing is that our educational aspirations today go far beyond the people who can sit in a particular auditorium at a point in time, whether it’s medical professionals, scientists, health care leaders around the world They’re really just ordinary citizens who want to know something more about health and medicine And they think we have a good way to be a trustworthy source of that information So with that in the background, in a couple of minutes, I’m going to be introducing David Roberts, who is our dean from external education He’ll tell you about some of the really exciting things that we are doing to provide education about health and medicine all over the world to many different kinds of groups So with that as the introduction, I’m going to take my seat and listen to Ed Hundert Thank you [APPLAUSE] Thank you very much, Jeff It is really a thrill to have a chance to talk to you about what’s happening in medical education– our efforts to bring the future into the present And thank you all for taking the time to be here When I was asked to do this, inevitably, one is asked to talk about philosophy of education and the pedagogical theories underlying the new curriculum But for me, it’s all about people So I wanted to start by just talking about the fact that everything that we’re doing in medical education at Harvard Medical School is about people And the first group of people most important are actually the patients Everything we do in education is actually, ultimately, to serve the mission that we have to alleviate human suffering, whether it is training the best clinicians to take direct care of patients, or training researchers who are going to discover the new cures for the future But you know, the people who most of us spend a lot of time talking about are the students The students here are second to none They’re absolutely extraordinary And the students at Harvard Medical School learn more from one another than they actually learn from us We always tell them that when they come they’re skeptical the first day, but then they realize it’s true And it’s one of the reasons why we put so much importance on the value of diversity– having a diverse class because it enhances the education of the students, one from the other And it’s also why I spend a surprising amount

of my time trying to raise support for scholarship aid, so that any student who’s talented enough to come here will be able to attend and not be crushed by a burden of crippling debt and have to turn down the offer So the students are obviously important The faculty are where we spend most of our time There is no issue in curriculum reform that isn’t actually a matter of faculty development That is no surprise that if you want to change the way the students are learning, you have to change what you’re doing And it’s therefore, no surprise that the entire curriculum reform effort was chaired by Rich Schwartzstein, who is here, who is also the director of our Academy, which is the faculty development arm of Harvard Medical School The two go hand in glove An important group of people are the staff When I started in my new role 11 months ago, I met with each curriculum design task force and each clerkship committee And of course, they all disagree on almost everything That’s the nature of what we do But the one thing they all agreed on is that before I left they said, just make sure whatever you do, we get to keep working with fill in the blank You know– Evan, Michelle, [INAUDIBLE], Sally– the person who actually makes it all happen And so this is a partnership with the staff There are many, many other groups that I could talk about There’s support from our alumni, our donors, and others– our fellow deans working with Dave Roberts, who you got to hear about It’s just one of most energizing things you can do But before I sort of get into the curriculum, I just have to give a shout out to Jeff Because Jeff’s support for what we’re doing is actually one of the single most important ingredients And this is not just a kissing up here by the way But you know, there are few deans of huge, research-intensive medical schools who give the care and time and attention to the medical student mission that Jeff Flier does He comes to the MedEd retreats every single year and sits through them during the planning of the curriculum He attended every single task force meeting of each of the developing courses And not just to sort of listen in, but to pushback and exchange ideas And I think that kind of commitment from the top is what it takes to do something as bold as we are trying to pull off right now And I also just– since it only happened in the last few hours– have to point out that he just became a grandfather again this morning And so– [APPLAUSE] Congratulations So we have a tradition at Harvard Medical School that when we admit our class, we have to revisit weekend And all of the admitted students come and they spend a week and we tell them about what we’re going to be doing, so that they refuse to turn down the other offers from all the other top schools that they also get in to And this year, of course, revisit was a little different because we completely overhauled the curriculum And so we’re trying to tell them about all the change And I was talking about the new pedagogy and how we’re teaching, what we’re teaching is different, and how we’re teaching is different, the [INAUDIBLE] teaching it, all of these things And at the end of this talk, one of the admitted students came up to me and sort of sheepishly looked at me and said, Dr Hundert, you do know that you’re like a top ranked medical school already? Why are you doing all this? I thought well, that’s a great question And in fact, there are many, many reasons that our faculty got together three years ago and started working on this One is that the practice of medicine itself is changing What we are preparing students to do is to do something quite different than they used to do There’s a huge amount of research on adult learning that suggests that the way we teach needs to change And particularly, for these new millennials, the outcomes is all showing that we really have to take advantage of the way that young people now acquire and navigate through information They don’t actually think about having information, because of having their hand held And indeed, educational technology change is another reason When we started the new pathway in the 1980s, I remember you’d be in a [INAUDIBLE] room And if a student said, well, I’m not sure about the anatomy of this or that, they would say well, let’s write that on the board as a learning objective to go home and study and come back in two days knowing Now, if they don’t know that, they pull up their handheld in about two seconds say oh, here is the anatomy Let’s keep working through the problem So the opportunity to do this flipped classroom idea of using really using time in the class to solve problems possible because of the technology But the number one reason for changing the curriculum really is the fact that we need to take seriously after all these years of talking about it, that the goal of medical education is not to learn medicine It’s to learn how to learn medicine for a lifetime Right? We welcome the students and we say, look, about half of what we teach you is going to turn out to be wrong or at least irrelevant by the time you retire from practice The trouble is we don’t know which half Right? So the goal of a medical education

has to be to learn how to spend your life learning which half And so it’s with all of that in mind, that our faculty started forming all of these task forces, committees about three years ago And what emerged was not one curriculum reform, because any med school could have a curriculum reform They actually ended up with what I would say are four curriculum reforms happening simultaneously And seriously, many other leading medical schools have done just one of these and touted this is a major curriculum reform But we’re trying to do all of these at once And the first of them is what I would call a structural curriculum reform And a structural curriculum reform is a frame shifting of the order of the experiences that the students go through And so in a typical curriculum, there’s this idea that goes back to the Flexner report of 1910 that says you have to learn all the basic sciences you need to know before you can start seeing patients And actually, there’s a certain amount of common sense to that You want to know what you’re doing when you start seeing patients But what we’ve done is take that sort of bimodal model of the pre-clinical and t hen clinical curriculum, which we still largely have had, and change it to what I would call a three phase model of education We want you to in the first phase learn all the science and clinical skills you need in order to go into the hospitals and clinics and start to learn medicine But by frame shifting that second phase early, be able to come back in the post clerkship phase of the curriculum and return to advanced basic science Now, engaging the science faculty– and many quad based faculty are getting very energized about the new developmental moment that these students will be in, where they’ll actually have seen patients with cancer, with heart disease Now we say, now, if I can teach them about the genetics of this and the [INAUDIBLE] of this neurobiology, then that would be a very interesting group And so the chance to iterate back and forth between basic and clinical is a really important and major structural change in the curriculum For us, it actually has a really important effect, because for the past four years, the students at HMS have had a scholarly project requirement They all have to do some research before they graduate And the trouble with our curriculum was the only time for them to do that was in the summer after their first year So they would arrive They’d feel this pressure to get mentored, do a research project in the summer after their first year And then sometime in their third and fourth year, they’d say well, you got to write that up to meet this requirement And the vast majority then would say oh, when I did that I still thought I was going to be a surgeon Now, I’ve decided to become a pediatrician Right? They were doing it too early So by frame shifting the core clerkship year earlier, we have room in the post clerkship phase for students now being more differentiated and having some idea what sort of medicine they want to do to choose a research project that they might be able to take on into their residency, indeed, on into the rest of their career And that’s the goal of Harvard Medical School– to train these great physicians, scientists, humanists, leaders of the next generation that can put all of that together It’s because of the flexibility of that post clerkship phase that we chose the name Pathways, because the image is that for 165 students there should be 165 different pathways through that third and fourth year of the curriculum So that’s one curriculum reform Second curriculum reform is the one we’re most focused on right now, because we’re just rolling it out, which is the pedagogical curriculum reform That is to say, this the whole sort of Khan-Academy, flipped-classroom idea that the time you spend with the faculty shouldn’t be transmitting information If you want to download a bunch of information, don’t stand in an amphitheater like this and give a lecture about the pathway of biochemistry that you’re trying to teach Have the students learn about that the night before, make a concept video, have them watch that, have them read an article, and then come to class and work through problems together And if you walk through the first or third floor of the TMEC building during any morning except Wednesday, you will see students in small groups of four working through problems with faculty walking around in this highly energized sort of space And to me, that’s actually the important moment I was a math major in college And I can tell you that when I would be given a math problem, if I could just solve it like that, wasn’t very interesting But if I was given a really good problem that I couldn’t solve in an hour, sometimes not even a day, a week, sometimes it would take a month What was interesting is at the end of that process was not that I had solved the problem, but that I was different for having gone through that process Right? That’s what we’re trying to achieve It’s not so much about the students grasping the problems, as the problems gripping the students, holding their attention, and forcing them to integrate across a lot of different areas of basic and clinical science So I always like to say a good problem solves you And that’s actually what we’re trying to achieve with the new pedagogy The third curriculum reform happening at the same time actually is a more radical kind of integration of basic and clinical sciences together

Because not only are we sort of iterating back and forth 14 months of basic science, 12 months of clinical skills, back and forth between basic and clinical through the third and fourth year, but each week is actually organized in a way to integrate why you’re learning all this, which is in the service of the patient So remarkably, the basic science faculty who put this together organized the schedule so that all of these courses at the beginning of these flipped classroom courses that we’re talking about are held on Monday, Tuesday, Thursday, and Friday, and all day Wednesday from the first week of medical school as a clinical day The students are actually in the clinics They’re in the hospital They’re each assigned to a primary care office, where every other Wednesday morning from the beginning of med school they start to see primary care patients And what’s interesting, since this has just started– we’re two months into it already– is the way in which those clinical experiences are truly creating a context for the students to be hungry to learn the science and the rest– even if that patient didn’t happen to have the disease that they were learning about, the idea that it’s going to be important to learn this and that the sort of getting past the delayed gratification of the old system of medical education– I need to learn this Why? It might be on the test Why? I might kill a patient some day if I don’t know it why? It’ll be on the board Now, it’s like, just yesterday I saw this patient with diabetes I got to actually understand how the cell biology works in order to help patients And so it’s an incredibly gratifying thing to see the students learning for the right reasons And it’s very motivating for both the students and the faculty I guess the final curriculum reform element that I wanted to mention has to do with advising and mentoring We have the academic societies If you’ve ever been in the Atrium, you know we have the master’s and associate master’s faculty who are supported to give advice and support to our students And this new curriculum is much more challenging The students really have a high level of expectation of preparation They’re working harder than they ever have and they’re loving it But I would like to say that education arises from some ingenious balance of support and challenge Right? We can all think of times when our own education where we weren’t learning as much as we could because we had too much support and not enough challenge There were times where we had too much challenge and not enough support So if you want students to optimize learning in this kind of environment, and you’re going to give them more challenge, you have to give them more support And so the faculty has really rallied around this Our students in the new curriculum literally have a scheduled meeting with their advisees at least every two months through this process to stay on top of what’s happening, how can we help you, do you need extra support, what sort of career advice do you want, are you starting to think about going into a research lab, doing an international experience, doing some community based project, all of that sort of detail trying to have these 165 different pathways depends on this strong advising system So that’s been the last component that I wanted to talk about I want to leave plenty of time for discussion at the end So in just a couple of closing comments about the big picture So you know, I was asked to talk about philosophy of education To me, philosophy of education– medical education is about is not about the transmission of information It’s about the transformation of learners So that’s where I start Medical education is not about the transmission of information It’s about the transformation of learning How do we transform learners? What you need is a powerful, transformative environment The interesting thing to me about the transformative environment of Harvard Medical School for a student coming here is not just that we invested in the new classrooms, tab of form function correspondents for what we’re doing, and all the IT systems we’ve invested in, and everything else To me, the interesting thing about a transformative environment is it transforms everybody in it and that includes us, the faculty and staff So one of the outcomes that we’re studying– because we’re doing a big study of all of this– is to see how does it affect us, the faculty and staff, who are here to support the students in their journey? So how would you capture a philosophy? Very often I’m asked– now, I’ve been in this job 11 months– and I’m often asked by people well, what do you tell the faculty is our approach to education? And I always think of one of my great mentors, Dan Fetterman, who when asked, what makes a great clinical educator? He’d always say well, it’s not that complicated Three things Think out loud Stick to the basics And be kind It’s not bad Right? It’s pretty good Mine– when people ask me– my wife and I have this deep interest in comparative religions And we travel around, go on our vacation trying to learn about world religions, and on one

of our trips to India to learn about Hinduism, we had a very interesting guide and teacher, who noted that we have three daughters And he was talking about how when you believe in reincarnation, you have some interesting philosophy about how to raise your daughter And this comes from the idea that it’s not unlikely– in fact, throughout most of history it’s probably true– that you could die while your daughter was of childbearing age Right? So in theory, you could be reincarnated in your daughter’s womb Right? So this gives rise to a philosophy of how do you raise your daughter? The answer is you should raise your daughter as if you might be raising your own mother Rather mind blowing concept, I grant you It’s sort of interesting So when people ask me like how should we teach our students? I say well, we should teach our students as if we might be teaching our own doctor OK? Now, I don’t actually know about reincarnation But I do know that given the relative ages of us and the students like they will, in fact, be at the peak of their career when many of us are having our final terminal illnesses And so we have to take this very personally So I sort of actually end where I started with it’s about people And for me, the bottom line is that the future of medical education at its core isn’t actually different from the past, and that is, that you have to take it personally to do it right So let me stop there and thank you very much for your attention [APPLAUSE] Thank you, Ed And thank you, Jeff It’s great to see so many people here today That was fantastic and inspiring And that is sort of the connection to what we’re about to talk about now for the next few minutes I’m going to try to show you some of the things that we’re doing in external education And I hope that some of these things are exciting, new Some of them may take your breath away, some of the may make you say, what are they doing at Harvard Medical School? And I know that there are many people listening in from afar And I just want to know that the room here is filled to capacity– the standing room only And that shows how much people care about medical education here It’s really important, and again, thanks to Jeff for having the vision to create this And it’s really exciting to share some of what we’re doing with you today So I’m going to take you on a little bit of a whirlwind here We sit at a very interesting perspective, both in terms of time and place and our community And I think that most of us think about medical education as an either/or sort of thing Think of when either you trained or when you were growing up, you were either a medical student or you weren’t You were either on campus or you weren’t And I’m going to tell you that those lines have blurred, or gotten much more complicated So here’s what we do in external education We’re trying to figure out, how do we bring really fantastic, high quality education around the world? Right? A spectrum of learners across the globe in all sorts of new ways We’re thinking about both medicine, health, science, and we’re trying to do this in the smartest way possible using technology, which as you just saw– a great example Ed spoke without slides, without technology, and technology is a tool But good teaching is about good content And this tool of technology just helps you do it better So I think of the world in a slightly different way These days there are these kind of three axes of learning And we need to be able to provide great, educational content for people wherever they are on these axes Do you want to be solely on campus or do you want to be solely online or anything in between? Do you want to learn just a few seconds, or do you want to learn to the level of hours, or degrees? Do you want to learn at the basic level of what everybody might want to know, or do you want to learn at the professional level? And so figuring out where people are at on the spectrum and having content that can reach them is what we’re aiming to do I’m going to spend most of my time talking about online learning and a platform called HMX, which is a new digital platform for delivering content But I just want to let you know that external education has

these other areas– global and continuing education, training physicians, both here and around the world, and all sorts of important content relating to clinical medicine, improving their careers, faculty development, and HHP, which is a trusted resource for information for everyone in the world– the idea of important content for a lay audience We are just about to start an executive education program, and I think that’s something that I’ll hopefully share with you more in the future But for now, let’s spend most of our time talking about online learning Think about your daily lives There are incredible examples of how you get content, you learn information every day Think about it If I asked some people would say, I read the New York Times on my phone, or I stay in touch via Facebook, or I’ve taken an online course, or 1,000 other different ways that you get information But we need to think about how does your brain work? How do you see new information? How do you acquire that? And what are all the different ways that we could provide that kind of information to you? If, from our perspective, what we see as the key trends are all these things listed here It has to be mobily available It has to be available for you on your phone, because it turns out a lot of the world uses that as their primary device It has to be social– means that there is value in the community of learners And that’s really hard to do solely online without finding some way to interact with each other But what we have here in this room, when I look into your eyes, I can see that the question is how do you do that leveraging the power of technology at a distance? And there are ways to do that Most of you probably watch shows How many people wait around for Tuesday at 9 o’clock for your show? Very few these days How many of you binge watch? Probably many of you, if not most of you Right? So whatever we do has to be available when you want it, how you want it And each of these things has to be available around the world Modular means that it has to come in little parts that we can put together in different ways Adaptive means that it has to change with you, and so that if you want to learn slightly differently than someone else, that’s an option Blended means part online, part on campus And those are the kinds of programs we’ve run already, and we’re thinking about that as well And scalable means we can’t just do this for a small group, but for lots and lots– tens of thousands of people around the world Now, there’s this famous proverb Right? When a big wind blows, some build walls, and some build windmills And we want to build fantastic windmills We want to leverage all those key trends that I just spoke about And when I think about what we’re doing and when Michael Parker and his whole team of seven individuals who’s here today thinks about this, they are building this, not only using spectacular technology and real creativity, but they’ve spent lot of time thinking about, how do we do this? Their goal is to raise the level of medical education around the world, not just here They are thinking about this in a way of how do we create the best environment online for learning these key concepts in medicine and health? That, I think, is what sets this apart What I’m about to show you is beautiful, spectacular, but it’s the thinking behind this that’s also so important Each of the elements that I’m going to show you has been designed for a particular purpose with the idea of how does this fit into the overall structure to maximize learning and to maximize engagement? We have some early data that shows that we’ve been very successful at reaching people and keeping them connected Again, one of the things that we wanted to do was bring the what’s special about being a person in training in the world of medicine into their rooms, into classrooms around the world by linking it to real situations and real life applications of what we’re doing And lastly, figure out what’s unique about online learning? What power do we have through the tool of technology? So how are we doing this? We’re trying to leverage the data that we generate Every keystroke, every click that someone does we capture

And we can then turn around and iterate that and kind of close the feedback loop so that we can speed up the process of learning We want to have a significant emphasis on research We want a link to what you just heard about, in terms of the philosophy underlying this curriculum reform and other curricular reforms around the world We want to figure out how do we leverage the best of the HMS 13,000 strong faculty? And understand that there is actually science Ed mentioned this– that there is science about how we teach and what we think we can do What do we mean by that? There’s a great book– if you’re interested in this– called Make It Stick It’s become a little bit of the Bible within medical education these days There are some very interesting principles There’s another paper from Doug Rohrer and Harold Pashler about this And I’ll summarize it as following this: when you work hard at learning something, that learning sticks better If it’s easy– Ed used the example of the math problem– if it’s easy, you’re probably not going to exert much brainpower and it’s not going to stick as well We know that pulling things out of your brain over and over again is important My colleague Rich up there uses a trick where he asks somebody in the front row give me your phone, looks up a phone number in their contact list, and says, tell me that phone number If you’ve added that phone number to your phone in the last 10 years, the chance of you knowing it is almost zero It used to be you know a zillion phone numbers, because you had to use them over and over again You had to pull them out of your brain over and over Each of these principles up here– new material in context through something called interleaving– bring it back over and over again These are the key And space repetition– the idea if I keep touching you with the information, that’s going to be So we tried to pull each of these principles into what we built So I’m going to switch and show you that here And so I’m going to show you a 55 second movie here [VIDEO PLAYING] I hear some hmm I thought they were very positive hmms What I’ve just shown you is a 55 second trailer of this, which captures many of the elements that I just told you about and truly is the incredible hard work of Michael Parker and his entire team up here And I would just say let’s take a second and give them a round of applause [APPLAUSE] Truly spectacular [APPLAUSE] So these are now the core of an ever-growing set of connections to make just the glimpse of what I just showed you happen, takes a lot of people working very creatively, not again, just on the content building, but on the thinking about how we design this and for what purpose So I’d like to actually show you the platform and show you a couple snippets from that to give you a sense of what we’re doing This is what’s called the splash page So if I pop back to the web here, the splash page is where you would come if you went to And I will tell you that right now as of now, you can’t log in So what I’m about to show you everybody try to remember really carefully So this is what a learner sees when they log in Right now, they see two courses– one in immunology and another in physiology And if I click on this, you get to a page that tells you about the lessons that are available And each of these starts with the idea of a scene or a concept that’s designed to pull people in and get them inspired, leverage their curiosity,

because adults want to learn what they feel they need to know and where they’re curious So each of these scenes– and I’m just going to play you a little bit of this first one This is Andy Lichtman, one of your colleagues here, speaking in the background talking about how your immune system connects with the world around you –microbial world, which is amazingly diverse It includes bacteria and viruses and fungi And there are actually millions of species of all these types of organisms We live in peace with most of them But every now and then we breathe or eat or touch one of these microorganisms that is actually disease causing or a pathogen The subway that many of us take to work in the morning is a hotbed of microbial life You know where this is going –can release aerosolized passages into the air Viruses in those droplets– Oh, this is that moment And what you see here is that it morphs from a live actor basis into an animated scene And then it comes back out And we have our faculty member here speaking and sharing information with you And I think that the key to recognize is that is interesting It’s curiosity in a nutshell You want to know, why is it important that I learn this? How’s that connected? And similarly, we’ve spent a lot of time– what you saw in the movie– with these very important white board animation, where now someone is animating and discussing Now, someone is speaking and taking you through content step by step And this has been very beautifully designed to maximize engagement, and give people connection to the material Lastly– and I’m going to jump out back to the physiology course And Rich Schwartzstein is the lead faculty person who’s here in the audience and he’s done a spectacular amount of work with us on this We have taken, again, applications or concepts and tried to bring those into clinical scenarios So we all– So I’m going to skip ahead Here, we’re telling a story in this case about Max, who eats a pastromi sandwich, and then that night notes that after he drinks a lot of fluid, his legs swell And with this, once we jump ahead, he notices his legs swelling, and then Rich comes back to explain the key concept here at a very detailed level -meal including the salt and the water from his beverages moves along the small intestine Now, the whole idea here is that it’s linking back to the key foundational concepts and giving people a connection of why is this important How am I going to learn this? How am I going to apply this in the future? And can tie it back to the fundamental key concept, in a real life application sort of way Last thing I’m going to just show you is that I mentioned before, how can we leverage online as a different way to learn? What are the strengths of online learning that just could not be achieved in a textbook, for instance? So here, if we click on this animation, we can take this person– we’re teaching someone about partial pressures– which are impacted by going under the water So we can actually take this person down and look what happens in real time and in a dynamic fashion to the pressure and volume relationships within the lung– a very important concept So I have shown you just a touch There are assessment questions There is so much more But I’m just– in the interest of time, I’m showing you just a little bit of the platform here So I’m going to switch back and I’m going to show you some very quick information, and then we’ll have time for questions So with Ed’s new incoming class, we opened up this platform to them We invited– on a purely optional basis– we invited 229 students of a variety of different stripes to participate And a 197 of them turned this on and accessed this from around the world It turns out HMS students are in 80 different countries at least in the summer before they come here And they access this from around the world Most of them, interesting enough, accessed this on a desktop device And just one number here– 769 student

logins in the first few days We had over 4,000 students sessions and 23 minutes per session Now, in the world of online learning, we think that’s pretty spectacular 8,500 video views and 24,000 page views Some of the incredible things that we can get with this is data about was this successful? Did we engage learners? If one of our goals was to engage people, how do we measure that? What you’re seeing up here is the viewer stream, so an individual learner watching an individual video And what it shows is that people watch nearly the entirety of each of the videos They’re all brief And they’ve been designed specifically based on data from online learning to maximize engagement by having short videos Here’s another interesting way to look at this This is analyzing how did an individual video get watched and where there are hot spots of activity– where people stopped rewound, played it again, and again So we might say oh, look, there’s this interesting thing where three out of seven people watched this one video over and over again in a certain spot We need to go back and think about was that a particularly challenging concept? Was this something that we didn’t explain well? Was this particularly interesting? What’s going on there? It gives us the opportunity to change this and iterate through it very quickly I’ll just give you one example of student feedback This is from one of the clinical application pieces, again, showing people where they may be in a few years and why this information is so useful I’ll just highlight that it makes the science feel not just like pre-medical education, but like the actual practice of medicine that we have long been awaiting It makes everything so much more real and feel like experiential learning Now, isn’t that fascinating? They’re online Right? They’re online But it feels so connecting and so engaging So what have we learned from this? That students– our students at least– are very highly motivated to learn material which is for their future We think that, fortunately, their travel and summer schedules didn’t get in the way They watch videos in their entirety We think we’ve driven some of this by the short length of videos And Michael’s team edited this in a very particular way, again, thinking about those learning principles, about how we thought people wanted to be engaged with the content I think Rich and others would describe that it took a little while to change how we thought about giving a talk Most of you, if you get asked to give a talk, talk for an hour These are three minutes, five minutes, seven minutes It takes a while to reframe your concept of teaching into chunked material But it’s very important There are natural break points in here for assessment questions And we did one live session using a very interesting platform over at the business school that seemed to stir up a lot of enthusiasm for learning both before and after One of the most fascinating comments that we got– I really think that this online stuff– and there are sort of quotes around that– online stuff is the most meaningful and possibly paradigm-shifting educational innovation I’ve seen at HMS in 25 years This came from one of our faculty members who participated in this And initially, quite honestly, was a little skeptical about all this that we were doing So what’s coming next? We have lots of data We were fortunate Michael and Marshall were just fortunate to receive a grant to study the data that we have and the data that we’ll gather over time We’re building more content We’re thinking about how do we bring this to the world? We’re looking for institutions around the world who are interested in partnering with us on this And we’re hoping to launch this next summer, with thinking about ways that we can bring students to campus as well, and leverage the online material ahead of time So I will say that hopefully again, I have challenged some of you I have shown you some interesting things And my hope is that in the future things look a little different here with these windmills on all the buildings So thank you very much Happy to take questions [APPLAUSE] OK We’ll ask our two speakers to sit down And I will tell you that I’m– it’s a little bit of a battle– I’m about equally proud of the birth of my new grandson on Sunday morning and the birth of these new efforts, which are fantastic Maybe we can merge them at some point about 25 years from now, but we’ll see So let’s just open it up to questions if there are any

Yep Back there Hi, I’m Drew I’m one of the residents here at Beth Israel, in medicine So really great presentation, really interesting stuff that’s going on in the classroom But so far what I understood from the talk is really about how information and content is structured and delivered around scientific knowledge But there is other areas that are increasingly relevant, if you consider the next 30-50 years of a clinician’s practice The two that stand out to me are particularly management So like recently we’re going to be managing teams and [INAUDIBLE] primary care The second is really around data– understanding and interpreting statistical evidence and communicating that And the third, which is really important, which should be learning at all times, is around being an empathetic communicator– the art of being a doctor itself And if you could speak to one or all of those, it’d be interesting to see what’s going on about that Yeah So I’ll start by telling you a little bit about the pathways curriculum and how those are being handled Thank you for the questions They’re all the really important points And a lot of thought went into those elements of the structure of the curriculum So I mentioned that there is a course called the practice of medicine course every Wednesday from the beginning of medical school And that’s the course in which a number of the areas that you mentioned are focused So for example, empathic communication, teaching students the approach to the patient But importantly, it’s happening in a primary care office, where the students will be longitudinally not just for that first year to learn how to do a history and physical and approach the patient, but an office where they will be able to stay through the second year when they’re in their clerkships and do their primary care and clerkship when they actually will take care of patients So really, I think for the first time in our school’s history– and very few schools have even attempted such a thing– a student will be able to be in a primary care office for two years longitudinally– into the first two years of medical school So, in fact, our hope is that some of the learning objectives they have is to think about teams and systems into professional care, and that they still have two more years of medical school So our hope is that students will come back to those offices and do a quality improvement project on that practice You know, I’ve noticed that not everything works perfectly, maybe that will become my research project, or get involved in teaching students in that practice so that there will be a student as teacher module that students can take advantage of So from the perspective of the professionalism and the empathy and the systems development, there’s a number of courses and experiences for students that are meant to try to help achieve that The last thing I’ll say is about the computational part– the data driven part That’s really an important challenge for our students And one of the interesting things that’s happening in the curriculum is that we’re able to iterate back and forth from the basic to the clinical and back and forth again So in January of the first year, there’s a full month block that’s focused on the population and social science perspective on medicine So the clinical epidemiology and all of those are built into the first year, with a return in the third or fourth year for another month, thinking about data, thinking about population level thinking So you know, there’s a lot that I could tell you I don’t want to take too much time But you know, all of those are great challenges It’s not that I have ready answers for everything But the faculty who worked on this have really spent a lot of time on those elements as well I’m sorry I didn’t include them when I gave the overview And I can just add three very quick things All great points In terms of team related activities, this platform– the HMX platform– gives a truly unique opportunity to have different kinds of learners work together online simultaneously I’m not sure there would be a better example of true interdisciplinary learning to have a nursing student and a medical student and a pharmacy student and someone else all working together on the same case collaboratively online and interacting in real time Number two in terms of data science, absolutely We feel strongly about that and that is in our kind of hopper to do as one of these courses And lastly, in terms of empathy– I probably feel the strongest about this one– is that one of the most remarkable pieces of feedback that we got was this is so fantastic because you have real doctors with real patients with many times

without a script, and you would not believe the things that we captured We captured a patient speaking to a physician and having a moment where her dementia got in the way, and the physician had to adjust and speak to the patient’s daughter in a very thoughtful, complicated way That moment is incredibly powerful Another one– a patient shares with the camera that their daughter has a genetic disorder And they have to figure out how to tell her that These moments are captured in a spectacular way– and whether it’s at the bedside or in a classroom, this material can be used to teach those concepts I’ll just throw in one question So give us a quick sense how the 6-8 weeks into it, how the new students are reacting to this on an emotional and personal level, and how these students who just finished with the other curriculum are thinking about what they didn’t get to do Right Yeah so– yeah, no That’s both really good points The first year class is just incredibly energized They were putting great faith in this It’s something new They’re the pioneer class The first couple of weeks there were inevitably some bugs and technological glitches, but in fact, it’s gone better than anybody expected Just yesterday we had a meeting of our curriculum cabinet, and we had formal feedback from Randy King, who’s the course director of the first big basic science course and from Kate Treadway, who teaches the introduction to the profession of course, and for [INAUDIBLE], who does that Wednesday practice medicine course And each of them reported that the students have risen to the occasion The level of preparation is really incredible how much time the students are putting in And so in a given morning, if they have three different 80 minute sessions– one in cell biology, one in the immunology, one in anatomy, whatever it is– they actually have prepped for each of those sessions that is in their syllabus And each of them comes in prepped for each session And they have reported that working in these small groups and reporting out to the larger groups, they are learning more than they’ve ever learned And these are some pretty high achieving learners I think that the second year of class and the third year class– the outgoing classes of the previous curriculum– actually are getting a lot of the benefit of this The faculty have been piloting a lot of these principals with those students And so I just was talking with Bernard Chang, who’s the head of the neuroscience course, which is meeting right now for the second year It’s the last iteration of the old version And he said he thinks it’s probably the single best iteration of that course they’ve ever done, partly because it’s not like well, we’re not doing this again In fact, they’re already trying out all of these things So those students have been very involved And we’re actually getting the second year class into some new opportunities that they’ve never had before in using simulation to learn and thinking about how their career development will go So I think they’re actually getting a better education than students have ever gotten as well Great Question? Yes Much respect and appreciation for all the work that’s been done It’s very impressive and very inspiring And a couple of things in the introduction– one was when E.F. Hutton speaks, the world listens And something else that struck me in the introduction is the importance of patience And that reminds me of Dr. King’s observation that of all of the forms of inequality, injustice in health is the most shocking and inhumane I would make a plea for a theme of educating patients to provide equitable care be part of these wonderful themes that you have, maybe even as a footnote, saying that all of this is direct in recognizing that science is extremely complex But in the final analysis, the benefit of health care is transmitted, and communications between the caregiver and the patient versus the disease So it’s just a plea not to try to rewrite anything, but I think to emphasize all the other important points– both domestically and globally It’s tremendously important from an economic point of view, as well as a humanitarian point of view So if we could put that theme in somewhere, I think it would really strengthen this wonderful work that you’ve done If I could just make a comment So the curriculum in addition to everything else I mentioned has a number of formal themes One of which is this cross-cultural care and health equity theme And interestingly, I just came the meeting before I had from the design team that’s working on this course called the central of the profession, which is this January course, which includes issues in social medicine,

health care policy, medical ethics, and so forth And we were talking about a logo for the course And someone brought in this incredible photo And it’s of three kids trying to watch a baseball game over a fence I don’t know if you’ve seen it But there are these three kids trying to see And one is very short, one is average height, and one is very tall And there are three sort of milk cartons that they’re standing on And on the left you see a version of it– they each have a milk carton and the short kid still can’t see the game at all, and the medium kid can just barely, and the tall kid can see it And on the left, the short kid has two milk cartons and the middle kid has one, and the other has none, and they can all watch the game And underneath it said equality and equity And that’s the visual that we want to start the course with for the student So I applaud what you said Thank you Another question? Well, I’ll have to ask one tough question– hasn’t been resolved yet What will happen to the second year show? Where will that go? Well, this is the most important question It’s funny, in the history of Harvard Med School, for many, many years there was a fourth year show And then over the last 35-40 years, we had a secondary show So we’re actually migrating back to a fourth year show All right So that’s the answer Everything has been solved Thank you very much [APPLAUSE]