Mike Briddon, IHI Open School Editorial Director, wrote the following post about a tour this week at Harvard Medical School — where he got a peek into the future of medical education.
I didn’t expect to be stressed. I didn’t expect my heart to
race or my palms to sweat. Or to hear a patient coughing and asking for help.
“Please,” the wheezy patient implored, “just do something!”
Mr. Jones, a life-like mannequin who could talk, blink, and
tell our untrained group how we were letting him die, was part of an impressive
tour of the
Clinical Skills Center at Harvard Medical School. Two members of the Open
School team — Laura Fink and I — made our way across the river to Boston,
Massachusetts, on Wednesday for a behind-the-scenes look at how medical
students at Harvard develop their clinical skills.
Our take-home message, it turns out, was the same: Wow, it’s
really hard to be a medical student.
First, a bit of background on the 7,500-square foot Clinical
Skills Center, which is located in the
Tosteson Medical Education Center:
- It opened in September of 2013 and cost
approximately $5 million to build.
- Harvard faculty use the center for teaching,
assessing clinical communication and physical exam skills, and delivering multi-station
objective structured clinical exams, or “OSCEs” as they call them. (More on
these in just a moment.)
- The center boasts 18 exam rooms and dozens of
- The center also includes an impressive control
room that makes you feel like you’re working for air traffic control (pictured above).
- Our tour opened with a short presentation about the
construction of the space and a short video about the daily activities inside
the center. We learned that the center is designed to teach both the science
and the art of medicine; students go there to learn technical skills, but also
how to connect with patients.
After the video, it was time to put ourselves in the
Our first stop was to see a student interviewing a
middle-aged, female patient about what it was like to care for her mother with
dementia. (The patient was an actress, but all the center’s “standardized
patients” are highly trained, and it showed.) We watched for about five minutes
as the future physician took a thoughtful history, asking the patient how she
was coping with her mother’s complicated daily life. The intense conversation
made us feel like we were witnessing an intimate exchange and ended with a
diagnosis of depression.
If class was actually in session, a faculty member would
have watched the interaction unfold for 15 minutes with a checklist of skills
in hand. Then, together, faculty member and student would review the video recording
and discuss the good and bad. The patient would provide feedback, too, and add an
From there, our small tour group watched a professor and a
student conduct a knee exam. In between bends, turns, and touches, we could see
the student’s mind race, hoping he’d remember the next move. The faculty member
taught with his voice and his hands and provided small corrections as the
student searched for fluid and tears.
Then, finally, we met Mr. Jones. After allowing us to merely
observe at the first two stations, the tour guide quickly ushered us into the
mannequin’s room and handed us stethoscopes.
“Listen to his chest. Look at the monitor. What do you think
we should do?” asked a faculty member.
“Um. Wow, this thing is really cool.”
“Right. What should we do?”
The patient chimed in: “Help. I can’t breathe.” It sounded like the patient, at least. Really, it was a faculty member behind a
whiteboard, talking into a microphone linked to a speaker near the mannequin.
When we finally realized it was up to us, our group gave the
patient some oxygen and some breathing treatments, which seemed to help. Still,
we were reeling from the pressure and felt a lot more comfortable when we returned
to normal “tour mode,” with an explanation of the pedagogy.
The tour lasted only an hour, but it was enough time to instill
some important reminders. First, just how challenging life as a medical student
can be. Students live in a high-pressure, demanding, competitive environment. And
that doesn’t even factor in the real-life version of Mr. Jones!
Second, how lucky we are to be part of the Open School and to
do what we do. We’re certain medicine wasn’t the path for us, but it’s an honor
to contribute to the education of future physicians.