In medical school, learning takes on an entirely new personality and philosophy. It becomes more important. In fact, I would argue that long-term learning becomes paramount. While this is certainly similar for other professional degrees, what’s different is that once we hit the wards, the learning curve involves people’s lives. This makes learning in medical school is a lot different than learning calculus or physics because of the ways in which we must learn and study. Further, it’s different because of the sheer volume of information out there, which is not particularly well synthesized into bite-sized chunks. Thus, we learn what our professors think is “most important” and ignore the things that are merely “important.” So, then how do we gain confidence that we have the skills to put the pieces of the diagnoses and treatment puzzle together? At Harvard (and many other schools), the answer is something we call tutorial.
Tutorial, sometimes called small group learning, is a significant segment of every course we take. In my anatomy course, for instance, for every hour of traditional didactic lecture, we have about 50 minutes of regular tutorial, 1.5 hours of cadaver dissection (in small groups), and 1 hour of histology lab (again in small groups). Thus, the vast majority of our learning is in small groups, where we learn by doing. The key to this process is that the students do virtually all of the teaching and analysis. The “tutors,” professors, say very little during the discussion unless they are asked questions directly. Even then, they often redirect to the group. We go through real medical cases, wherein we have to come up with a complete differential diagnosis and subsequent treatment plan. What’s truly amazing is that as a group of eight or nine first-year medical students, we typically have the collective knowledge to solve most cases that we are given. Integration of the information into real cases is so important for solidifying understanding and promoting long-term learning.
We also use tutorial as half of the class time in our social medicine course, as we do in many of our courses. In this course, we might focus on social determinants of disease or on patient adherence to treatment regimens. One week, we were even tasked with designing a new health care system in a developing country. We come up with creative solutions to complex problems. This reinforces the idea that regardless of the innumerable barriers to health care treatment success, we have what it takes to devise solutions and deliver care. In any case, I feel I’m learning what it takes to be the kind of physician I want to be—well-rounded, compassionate, and thoughtful.
Despite the never ending databases of medical literature, we will learn what we need to learn. Participating in these small group tutorials makes me extremely confident in that. It is true that the biggest strength of any medical school is the student body. Learning from these people only makes sense in the inherently collaborative nature of our profession. One day, we will be making big decisions, and medical school will prepare us for that. As the days pass, we get better – I get better.