Thursday, 4 April 2013

My time at Harvard Medical School

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I spent two months at Harvard Medical School - two psychiatry attachments - in the summer of 1980 as a part of my student 'elective'. It made an interesting comparison with my main medical training at the med school, University of Newcastle upon Tyne.

Both were good, but very different. The main difference was that they were trying to do different things.

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British medical schools take kids (mostly) straight from high school - aged about 18, while US medical schools are postgraduate institutions with entrants 22 plus years old. So that makes a difference.

I was able to compare year three of the UK with year three of the US - which was just about the only comparable point, being the first year of clinical training, when students who had been doing medical science type things for two years (anatomy, physiology, biochemistry etc) were rotated through the major medical specialties such as (internal) medicine, surgery, psychiatry, obstetrics and the like.

By the end of year three I had already completed a month rotation in psychiatry at Newcastle - and could compare it with two of the available one month rotations at Harvard.

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The main similarity is that at both places I was 'attached' to a particular ward and senior psychiatrist which I was supposed to attend on every working day, as an apprentice.

But the difference in aim and methods was striking.

At Newcastle we commenced with a series of mini-lectures at an introductory level and covering the whole of psychiatry, we worked mostly from a single large textbook, and the focus of activity was training us in the skill of interviewing and 'history taking' as a basis for diagnosis and treatment.

At Harvard there was no systematic coverage and no basics, but a series of specialized (often very up to date, topical) seminars with a variety of different psychiatrists, we worked from journal papers not a textbook (and were given unlimited, free photocopying facilities!), and the focus was upon being able to evaluate and discuss the research literature.

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So, Newcastle was mostly aiming to train us in the skills of psychological medicine underpinned by the full range (not depth) of basic knowledge required for this; while Harvard was more like a training in medical research, with a sampling of various specialties rather than a general coverage.

At Newcastle we seldom forgot we were going to be doctors, and that med school was a preparation for this - at Harvard this was ignored or taken for granted. Much of what we did as a clinical skills training in Newcastle while undergraduates - repeated practice at difficult tasks - was deferred to the specialized, post MD three year Residency training in the US system.

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As I say, I enjoyed both, and both were useful to me - mostly because Newcastle came first. And both were characteristic of the medical systems of which they were a part: the British still (at that time) with a premium on clinical skills (the Harvard students were astonished at my - quite normal, in the UK - ability to examine patients and elicit 'physical signs'), while the Americans clearly valued investigations and research more highly.

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[All this was three decades ago and does not now apply. The British systems has changed almost beyond recognition - and clinical skills have been almost abandoned. I have no idea what happened in the US.]
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