Thursday 4 April 2013

My time at Harvard Medical School


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.


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.


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.


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.


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.


[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.]


dearieme said...

It's fascinating that America was so rich for so long that it could afford to throw away so many years of the life of its ablest people - years in High Schools that turned out people who were "literate but not educated" and then years fannying about as undergraduates studying stuff that they should have learned at school, or need never have learned at all. Then suddenly, at twenty-two, they'd be permitted to engage with Proper Stuff. A friend of mine went to MIT in the 50s and was amused to meet Master's Engineering students enthusing about Shakespeare, until he realised that they'd never before been exposed to such Proper Stuff. By golly, wealth can cover a multitude of sins.

Bruce Charlton said...

@d - Indeed. And now the UK has adopted the worst of both worlds.

Interestingly, when the University of Durham founded its medical school (i.e. Newcastle) in 1852, it was the first in England to offer what we would now recognize as undergraduate medical degrees (the MD was a higher doctorate, and most medical students did non-degree qualifications for the colleges of physicians - e.g. LRCP, surgeons - MRCS and apothecaries - LMSSA) - and these degree students were initially supposed to have an undergraduate degree in the Arts (BA/ MA) before medical school - rather in the US style.

But English people couldn't or wouldn't do this, so it was scaled back to evidence of having already studied the Arts at school, which ended up meaning having studied some Arts (e.g. Latin) as part of the (lower) School Certificate (equivalent to O-levels, done at age sixteen).

dearieme said...

"And now the UK has adopted the worst of both worlds": well, you know the Zeroth Law of the United Kingdom - copy only the Bad Stuff from the USA, never the Good.

JRRT Reader said...

As an American, I would venture this guess. Our high school level education is set low on the quality scale so that just about anyone of mediocre or less capability can complete it. That way, we can say that everyone has access to education and all that. At university, we then try to get the (ever so slightly) more qualified and capable students up to speed to where they ought to be. At the graduate level, something like an actual serious education starts.

The left especially thinks everyone ought to have a liberal arts/academic education at the high school level. While career and technical high schools *do* exist stateside, they do not have the same currency as they do in, say, Europe, or the Commonwealth. Again, the left would object that such schools "perpetuate socioeconomic class divisions" or "force the young into a predetermined place for life". You know the jargon. What they won't say, inter alia, is that they actually consider working a trade to somehow be shameful or "undesirable". It's a upper and middle class liberal fantasy that everyone ought to be "rescued" from such shame as being a working man, and that something white-collar is more "ideal"