Medical Education at Harvard

The New Pathway MD Program

The curriculum of Harvard Medical School integrates the biological, social, behavioral, and clinical sciences over a four-year period. During the first two years, emphasis is placed upon the biological sciences, which are closely correlated with the social and behavioral sciences. As the student progresses, the clinical sciences come to the fore, and the venue of education transfers from the School��s Tosteson Medical Education Center (TMEC) to the multiple hospitals, clinics, and medical care facilities affiliated with the School.

In the summer of 2006, HMS began the implementation of the New Integrated Curriculum (NIC), representing a major reform of the MD program with the following goals: 1) to increase the rigor of the teaching of basic biologic and population sciences and to integrate the teaching of science and clinical medicine throughout the entire student experience; 2) to engage the faculty, including the most senior faculty, as teachers, mentors, and guides for Harvard medical students; 3) to develop a new model of clinical education that is based on the educational and developmental needs of the student and that offers longitudinal continuity of patient experience, cross-disciplinary curricular content, faculty mentoring, and student evaluation; and 4) to provide opportunities for all Harvard medical students to acquire in-depth knowledge in one area of inquiry and produce a scholarly product in their area under the guidance of an expert faculty member (NB: the scholarly project requirement is slated to be implemented for the class matriculating in August 2011).

In the first and second years, the focus is on the Fundamentals of Medicine (FOM), the introductory biological, population, and social sciences and clinical experiences that prepare students for the study of clinical medicine. Laboratories, conferences, and lectures complement a problem-based approach that emphasizes self-directed learning in small-group tutorials facilitated by a faculty tutor. The tutorials offer an essential opportunity for learning by allowing students to identify their own strengths and weaknesses in various subject areas and to benefit from the talents and perspectives offered by others in the group. Students are expected to analyze problems, locate relevant material in library and computer-based resources, generate hypotheses, and develop lifelong habits of learning and independent study. In addition, students are expected to assume responsibility for their own learning and to contribute to the education of their colleagues. All students are expected to participate actively in the tutorial learning process.

Fundamentals of Medicine
Curricular design at Harvard Medical School emphasizes content integration within and across many of our courses. The first-year curriculum is designed to build from molecules to cells to organisms, beginning with a molecular framework that integrates seamlessly with the transition to anatomy. In the second year, the teaching of pathophysiology is presented in an integrated way that incorporates aspects of pharmacology, pathology, and nutrition associated with individual systems. In addition, a sequence of courses in medical ethics/professionalism, social medicine, clinical epidemiology, scholarship in medicine, and health policy are integrated with the teaching of the basic biological sciences and with introductory clinical exposures.

Introduction to the Profession, the first course required for all entering medical and dental students, is designed to provide a broad overview of the profession from a variety of perspectives; to introduce students to problem-based, collaborative learning; and to clarify the goals, expectations and demands placed upon students as they make the transition to physicians-in-training.

Biomedical sciences are presented through a sequence of block courses extending through the first year and most of the second year. These courses encompass the following areas: The morphological sciences; the biochemical, pharmacological and physiologic sciences; the developmental and molecular biological sciences; pathological, microbiological and immunological sciences, and the neurosciences.

Social and Population sciences are learned through a sequence of required first-year courses in social and population-based medicine. This sequence, which addresses important issues confronting physicians in the 21st century, includes Introduction to Social Medicine and Global Health, Clinical Epidemiology and Population Health, Introduction to Health Care Policy, and Medical Ethics and Professionalism. These courses present students with an introduction to the social factors that influence health and disease both domestically and globally, the principles of clinical epidemiology and biostatistics required for the evidence-based practice of medicine and critical appraisal of medical literature, an overview of health care policy issues and options, and the ethical dimensions of medical decision-making.

Pathophysiology is presented throughout most of the second year in Human Systems, a course organized around organ systems. This course is designed to provide close correlation between structural and functional changes in disease and the ways in which these changes become manifest at the clinical level. A focus on the pharmacology, nutrition, and pathology of individual systems is integrated into the study of each organ system and its physical examination.

Clinical skills and the patient-doctor relationship are addressed in a three-year sequence. Instruction in history-taking and physical examination is presented in the first and second years. Economic, social, and ethical aspects of patient care in the context of the clinical clerkship experience are examined in the third year.

Scholarship in Medicine. In January of Year I, students who plan to apply for HMS funding for a Summer Research or Global Health/Community Project are required to enroll in one of two courses designed to provide the conceptual tools that are fundamental to producing a scholarly project. The Scholarship in Medicine (SIM) course focuses on biological and patient-oriented research, while the Physician in Community (PIC) course focuses on medicine in society (e.g., community or international scholarship). Students anticipating doing a funded research project will be required to take the SIM course, while students planning to do community or international summer project will be required to take the PIC course. These courses are elective for students who do not plan to apply for HMS funding for a project in the summer following Year I.

The Principal Clinical Experience
The core clinical curriculum in the third year provides a clinical base for exposure to the broad disciplines of medicine and experiences essential to credentialing as a licensed physician. During this year, students often make decisions about career choice. In May 2008, HMS implemented the Principal Clinical Experience (PCE), an integrated approach in which the clinical year occurs primarily at a single site (Beth Israel Deaconess Medical Center, Brigham and Women��s Hospital, Cambridge Health Alliance, or Massachusetts General Hospital; for the Beth Israel Deaconess and Brigham and Women��s Hospital PCEs, Children��s Hospital provides the pediatrics experience). The PCE is a 12-month integrated program of study (running from May of Year II through April of Year III) comprised of 1-month to 3-month clerkship rotations supplemented by a longitudinal multidisciplinary curriculum that incorporates mentoring, assessment, and ambulatory care experiences. All students are required to complete the 3-month Medicine, Surgery, and Pediatrics and Obstetrics and Gynecology (formerly Women��s and Children��s Health) Clerkships and the 1-month Neurology, Psychiatry, and Radiology clerkships during this 12-month period. Students are also required to complete the longitudinal components of the PCE, which run in tandem with the block clerkships and include the multidisciplinary PCE course, the Primary Care Clerkship, which runs from September to April, and Patient-Doctor III. Students at Cambridge Health Alliance are enrolled in the Cambridge Integrated Clerkship and follow panels of patients rather than learning clinical subjects in departmental block clerkships.

Advanced Experiences in Clinical Medicine and Basic Science
The 12-month period comprising Advanced Experiences starts in May of Year III and ends in April of Year IV. Because the December-January period in Year IV is traditionally devoted to residency interviews and completion of Step II of the National Boards, approximately 10 months remain for student course work. During this period, students must complete a set of academic requirements, as defined below:

Required subinternship: Following the PCE, students are required to complete a Medicine II or Advanced Pediatrics clerkship prior to March of Year IV. This required subinternship must be taken at an HMS site other than the site to which the student was assigned for the Principal Clinical Experience. A second subinternship in a surgically-oriented discipline is highly recommended but not required.

Elective experiences include more specialized clerkships (e.g., hematology, emergency care, dermatology); advanced courses in pathophysiology (e.g., oncology or infectious diseases); laboratory and field research. At HMS alone, approximately 200 electives are offered each year. Students also have access to courses offered by other faculties at Harvard University and at Massachusetts Institute of Technology. Courses drawn from any, or all, of these faculties or institutions may be chosen to make up the elective program and to fulfill the course distribution described under Graduation Requirements as long as these courses pose no conflict with clinical clerkships in which the student is enrolled. During this year, courses may also be taken at other medical schools and medical centers in a chosen specialty, and students may participate in global health electives abroad, scientific research, and other educational experiences. (N.B.: Course credit will be awarded for no more than two similar electives in the same discipline.)

Capstone course: This course, which will be required for the class graduating in 2013, will review and reinforce the skills necessary to manage common medical problems and procedures, refocus students on the importance of professionalism and compassion in caring for patients, and help students transition to the demands of internship/residency training. (NB: A pilot capstone course, which will be elective, will be offered prior to 2013; students will be notified of the availability of this course during AY11.)

Course and Examination Requirements for the MD Degree

Course Requirements in Years I and II

New Integrated Curriculum (NIC) of the New Pathway Program (Cannon, Castle, Holmes, Peabody)
The following courses must be passed by students who matriculated in August 2006 or later. If you matriculated prior to August 2006 and have questions about your preclinical curriculum course requirements, please contact the Registrar's office (registrar_hms@hms.harvard.edu).

Fundamentals of Medicine Course Requirements
Year I
IN555.0 Introduction to the Profession
IN751.0 The Molecular and Cellular Basis of Medicine
IN753.0 The Human Body
IN755.0 Human Genetics
IN759M.J Patient-Doctor I
SM750.0 Introduction to Social Medicine and Global Health
AC511.0 Clinical Epidemiology and Population Health
HC750.0 Introduction to Health Care Policy
SIM 501 Scholarship in Medicine (SIM)*
PIC 503 Physician in Community (PIC)*
IN752.0 Integrated Human Physiology
IN754.0 Immunology, Microbiology & Pathology
MA701.0 Medical Ethics and Professionalism

* Students who plan to apply for HMS funding for a Summer Research or International/Global Health/Community Project are required to select either SIM 501 or PIC 503; these courses are elective for all other students.

Year II
IN757.0 Human Systems
IN731.0 Human Development
PS700M.J Psychopathology & Introduction to Clinical Psychiatry
IN761.M Patient-Doctor II

In order to proceed to the Principal Clinical Experience all students must complete certified training sessions in Mask Fitting and Basic Life Support, HIPAA and OSHA requirements, and an annual TB test, and required immunizations must be up-to-date.

Principal Clinical Experience (PCE) Course Requirements
Year III
Medicine I (12 weeks)
Surgery (12 weeks)
Obstetrics and Gynecology (6 weeks)
Pediatrics (6 weeks)
Neurology (4 weeks)
Psychiatry (4 weeks)
Radiology (4 weeks)
Patient-Doctor III (longitudinal)
Primary Care Clerkship (longitudinal)
Principal Clinical Experience course (longitudinal)

Students whose entry to the PCE is delayed beyond May should consult with their Academic Society and the HMS Registrar regarding their PCE schedule and plan for fulfilling their requirements for the MD degree.

For students who are unable to start their PCE clerkship rotations in May (e.g., HST students or students who have permission to delay USMLE Step 1), attendance at the longitudinal sessions is required beginning in May (starting with the transition days and including the multidisciplinary course). It is anticipated that all students will complete the PCE core clerkships prior to entering the Advanced Experiences in Clinical Medicine and Basic Science curriculum.

Students who start PCE clerkships after the May rotation may request permission to take advanced electives before completing the core clerkships when there is a compelling academic reason to do so. This request will be subject to the approval of the Academic Society, the PCE Director, and the HMS Registrar. To qualify for this exception, a student must have completed the equivalent of 12 months of PCE longitudinal experiences and 10 months of core clerkship experiences. In this case students will be required to complete one of the two remaining one month core clerkships no later than June following the PCE and the other one month core clerkship no later than November following the PCE. PCE core clerkships are the prerequisites to advanced electives; in the rare instance a student is missing a core clerkship, he/she will be required to complete the core prior to enrolling in the advanced elective (i.e., core psychiatry is a prerequisite to any of the advanced psychiatry electives).

Because the PCE is designed as a continuous, longitudinal block, every effort will be made by the faculty to help students complete the full 12-month course in sequence. Occasionally, however, students may have academic or personal difficulties that result in interruption of the PCE. In such cases, the following guidelines apply:

Students are required to complete the Primary Care Clerkship and all components of the PCE longitudinal curriculum. Arrangements for meeting these requirements will depend on the length and timing of the interruption and will be made in conjunction with the PCE director and the HMS Registrar.

If a student misses up to 3 months of the PCE, generally (and with the permission of the PCE Director), he/she can re-enter the PCE with his/her class. The months of clerkships missed (but not the longitudinal curricular components of the PCE) will be made up at the end of the PCE, preferably at the original PCE site, if space is available. If the interruption occurs during a four-week or six-week clerkship, the entire clerkship must be repeated. If the interruption occurs during a 12-week clerkship, the student will re-enter at the beginning of a 4-week block of the 12-week clerkship, depending on when the interruption occurred. For example, if the interruption occurs during the second 4-week block, the student would re-enter at the beginning of the second 4-week block.

If a student misses 4-5 months of the PCE, a committee of PCE leadership will consider the optimal approach for the student to fulfill core clerkship and PCE requirements and will design an alternative schedule that ensures fulfillment of the educational requirements for the MD degree. The guidelines for up to 3 months will apply.

If a student misses more than 5 months of the PCE, re-entry is not an option, and the student will be required to restart the longitudinal components of the PCE during the next class cycle. Clerkships that were completed before the interruption need not be repeated unless there is an academic reason to do so. The guidelines for up to 3 months will apply in such cases as well.

Advanced Experiences in Clinical Medicine and Basic Sciences Course Requirements
Year IV or final year
Medicine II or Advanced Pediatrics (4 weeks) [must be completed by March of Year IV]. A second Subinternship in a surgically-oriented discipline is highly recommended but not required.
Clinical Elective (CE) (8 weeks)
Unspecified (CE or nonclinical elective [NCE]) (20 weeks)

Beginning with the advanced electives (Year IV), full-time status requires a minimum of twelve-week equivalents (generally, this is three 4-week equivalent clerkships) per semester. See Section 2.07 for more information about requirements for full-time status.

NB: students are limited to no more than two clinical electives representing the same course in the same medical/surgical discipline. Students who choose to take more than two will not receive additional academic credit.

Examination Requirements for Graduation
The following examinations must be passed to receive the MD degree:
HMS Patient-Doctor II Objective Structured Clinical Exam (OSCE) [Year II]
HMS Comprehensive Examination [June following PCE]
United States Medical Licensing Examinations (USMLE):* Step 1, Step 2 Clinical Knowledge (CK), and Step 2 Clinical Skills (CS)
*USMLE examinations are scheduled by, and are entirely the responsibility of, the individual student.

USMLE Step 1
Students are required to take USMLE Step 1 prior to entering the Principal Clinical Experience. Students who are unable to complete this requirement must obtain prior approval from their Society Master or Associate Master and the Office for Advising Resources. Students entering a PhD program after Year II are required to take Step 1 prior to starting their PhD.

USMLE Step 2 - Clinical Knowledge and Clinical Skills
Students are required to pass both parts of Step 2 in order to graduate. Because of limitations in the availability of test slots and the extended reporting timeline for Step 2 test results, students are required to complete Step 2 Clinical Skills by November 1 and Step 2 Clinical Knowledge by December 31 of their final year. Test scores must be reported to the HMS Registrar in order to receive an MD degree. If a student's passing scores are not reported to the HMS Registrar before graduation, that student will not receive an MD degree at graduation. Because failure to receive an MD degree will have an impact on a student��s ability to start postgraduate training, the Academic Societies require students to confirm their test schedules as they prepare the Dean's Letter; failure to schedule the test before the HMS deadline will be noted in the Dean��s Letter. To learn more about resources available to help with study strategies, exam taking, etc., see Section 3.03, Office of Advising Resources.

Students should be aware that some residency programs may require that students have passing scores available for all parts of USMLE, including Step 2CS, by the rank order deadline for the residency match (late February) in order to be considered for ranking by the program. Therefore, HMS now requires students to take CS by early November to ensure the results will be posted prior to rank. Students should check directly with the residency programs for specific requirements.

For the USMLE CS Reporting Schedule, please refer to link here.

Please click here for the Course Catalog.