Yet, the value of pedagogic methods designed to meet those goals is largely unproven. In 1. 98. 5, Harvard Medical School introduced the New Pathway program (NP), a preclinical curriculum that sought to promote a sound knowledge of basic science, facility in and positive attitudes toward active, self- directed learning, and competency in integrating psychosocial and humanistic concepts with biologic principles in patient care. This study followed up 50 Harvard Medical School (Massachusetts) students who participated in the New Pathway (NP) program, an innovative curriculum that stressed humanistic medicine, lifelong learning, and social learning.Problem- based learning (PBL)—pioneered at Mc. Master University—was adopted as the primary pedagogic method to meet these goals, but the new curriculum also included lectures, labs, weekly structured learning experiences focused on humanistic aspects of medicine, and clinical experiences designed to foster humanism and the doctor- patient relationship. All educational activities were coordinated with the tutorial cases to enhance integration, while active, student- directed learning aimed to encourage self- reliance. The clinical context facilitated motivation. The whole program took place in a highly social and interactive environment designed to promote humanistic skills and attitudes. The new curriculum was introduced to two consecutive classes as a randomized controlled trial. Program evaluation took place at the end of the students' second and fourth years of medical education, as well as four years after graduation. Search; Preclinical Year I. All students are expected to be familiar with the policies of Harvard Medical School and Harvard. Harvard University is accredited by the New England Association of Schools. Career Pathway Internship; Medical Program. At these times, the NP and control students demonstrated strong and consistent differences, with NP students more positive in the humanistic domain. No significant difference was observed in basic science knowledge or clinical problem solving. We report here a long- term follow up of these NP and control students, 1. We hypothesized that NP graduates would show more positive attitudes toward and behaviors related to humanistic medicine, lifelong learning, and issues related to learning in a social environment than would control graduates. METHODParticipants. The NP was conducted as an experiment in its first two years (1. Of 2. 80 entering students, 1. New Pathway (6. 3 students) or traditional curriculum (6. The students in the traditional curriculum served as controls for all phases of the evaluation. Participants provided informed consent to respond to all phases of the evaluation. In 1. 99. 8, we were able to locate 1. NP and control graduates. Nine (four NPs and five controls) declined or were too busy to be interviewed. We dropped one respondent from the study because he had switched programs after his first year. Non- respondents did not differ significantly from respondents in terms of program, graduating class, gender, or chosen specialty. Analyses are based on 1. NPs and 5. 0 controls (9. Survey. We developed survey items to measure attitudes and self- reported behaviors in three domains: humanistic medicine, lifelong learning, and social learning (List 1). While a few items from prior surveys were repeated (Domain 1: Behavior Item 1; Attitude Items 1 and 2), most items were developed to measure behaviors appropriate for physicians in practice. The survey was field tested and refined twice prior to its administration. The survey contained scalable items related to each of the three domains of interest and one final open- ended question. Attitudes were measured on 0- to- 1. Respondents were instructed to consider “5” a midpoint or neutral response. At the end of the survey, NP graduates were asked: “Looking back on it, can you describe two or three lasting effects that participating in the New Pathway during the first two years of medical school has had on you.” Traditional curriculum graduates were asked: “Looking back on it, can you describe two or three lasting effects that your education during the first two years of medical school has had on you.”Indices of humanistic orientation were choice of a specialty characterized by low technology and long- term relationships with patients, such as primary care (i. Indices of humanistic attitudes were perception of adequacy of educational preparation for practicing humanistic medicine, confidence in managing psychosocial problems, self- description as having a high psychosocial orientation toward the practice of medicine, attitudes towards social issues in medicine (ATSIM6), and relationships with patients as a source of career satisfaction. Indices of lifelong learning behaviors were participation in educational programs beyond residency training and frequency of use of evidence- based medicine (EBM). Indices of lifelong learning attitudes were desirability of consulting with other physicians and health professionals and confidence in using EBM. Indices of social learning were behaviors such as maintaining relationships with faculty, role models, and fellow students, collaboration with a variety of health professionals, and involvement in teaching, especially tutoring small groups of students. Indices of positive attitudes in this domain were the perception that faculty continued to influence their thinking, an enduring positive attitude about how they had learned in medical school, confidence in managing social issues in the workplace, and teaching as a source of career satisfaction. Procedure. The NP and control graduates received letters to inform them of the purpose of the study and to request their participation. Through follow- up letters and phone calls, we confirmed the respondents' whereabouts and willingness to participate. During the summer and fall of 1. Analyses. Principal- components analyses were conducted to confirm the cohesion of domains and to form composite variables (List 1). Items with low inter- item correlation were analyzed as univariates. To ensure comparability of responses across composites, we divided the total scores by the numbers of items composited. Thus, indices of attitudes and some behaviors are expressed on scales ranging from 0 to 1. We conducted descriptive analyses of the effect of educational program (NP versus traditional curriculum) on attitudes and practice behaviors of the graduates. To determine whether variation in responses was associated with educational program, we conducted chisquare analyses (in the case of categorical responses) and one- way analyses of variance (in the case of continuous responses). All differences cited are statistically significant at the p <. Respondents' perceptions of the lasting effects of the first two years of medical school were stripped of respondent identifiers and language that overtly refferred to the NP or traditional program. Three of the authors independently conducted content analyses. Then, matching comments to respondents, we identified the frequencies of categorized responses by program. The content analysts identified the following themes: lifelong learning, humanism, basic science foundations, group work, and friendships. We agreed to collapse the last two into “social outcomes of the pedagogic program,” to conform to the social learning domain. RESULTSThe NP graduates and traditional graduates differed significantly on one of the three measures of humanistic behaviors and on two of the five measures of humanistic attitudes. Forty percent of the NP graduates and 1. However, less than 5% of either group were employed in community clinics, and the two groups did not differ in the percentages of time they volunteered to community service (2. The NP graduates rated their preparation in the first two years of medical education to practice humanistic medicine 7. The NP graduates also felt significantly more confident than did the traditional graduates in their ability to manage patients with possible psychosocial problems (5. Three fourths of the NP and 5. The groups did not differ on the ATSIM items (7. NPs versus 6. 9. 1 traditionals). Both groups ranked relationships with patients first among sources of work satisfaction. Lifelong Learning (Table 2)There was no statistically significant difference between NP and traditional graduates' behaviors or attitudes in this domain. The two groups were equally likely to have received fellowships or other graduate degrees after the MD (6. NPs versus 3. 8. 0% traditionals) (data not tabled). Indices of use of EBM in clinical practice did not differ by group; both were equally likely to agree that they “frequently look up information in textbooks and journals” (6. NPs versus 7. 0. 2 traditionals; where 1. The NP graduates reported spending, on average, 4. On average, the NP graduates said they found medical information through electronic sources 1. The NP and traditional graduates were equally likely to agree about the desirability of consulting other physicians and health- related personnel about clinical decisions (6. Confidence in their ability to use EBM was also similar for both groups (6. NPs versus 5. 9. 5 traditionals; where 1. Social Learning (Table 3)There was no significant difference between the two groups in terms of behaviors designed to measure the effects of social learning; however, the NP graduates' attitudes relative to social learning were significantly different from the traditional graduates' on two of the five measures. On average, NP and traditional graduates had the same number of ongoing relationships with students and faculty they had met during the first two years of medical school (5. They spent the same amount of their work time teaching (1. Approximately one third of each group tutored small groups (3. As for attitudes, the NP graduates were significantly more likely than their traditional peers to agree that faculty they had met in the first two years of medical school had influenced their current clinical thinking, personal attitudes, and research thinking (6. While there was no difference between the groups' overall ratings of their first two years of medical school (6. NP graduates were significantly more likely to disagree with the statement, “There is a better way for students in the first two years of medical school to learn than the way I learned” (4. NPs versus 6. 0. 2 traditionals; where 0 = total disagreement; p <.
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