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A Tour of the Future at Harvard Medical School

By IHI Open School | Friday, June 12, 2015

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.

Control

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 video cameras.
  • 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 students’ shoes.

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 invaluable perspective.

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. 

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