하버드 의과대학 New Pathway 교육과정의 Long-term Outcome : 무작위대조연구

Long-term Outcomes of the New Pathway Program at Harvard Medical School: A Randomized Controlled Trial

Antoinette S. Peters, PhD, Rachel Greenberger-Rosovsky, Charlotte Crowder, MPH, Susan D. Block, MD, and Gordon T. Moore, MD, MPH

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목적 : New Pathway(NP) 프로그램이라는 혁신한 교육과정의 장기효과를 평가하기 위해서 인문의학, 평생학습, 사회적학습의 세 측면과 관련한 행동 및 태도를 보고자 했다.

Purpose. To evaluate the long-term effects of an innovative curriculum, the New Pathway (NP) Program, on behaviors and attitudes related to humanistic medicine, lifelong learning, and social learning. 

방법 : 무작위대조군연구에 참여한 하버드의과대학 졸업생을 장기 추적하였다. 100명(NP 50명, 전통적교육과정 50명) 에게 1998회의 전화인터뷰를 하여 descriptive study를 하였다. NP프로그램은 PBL을 기반으로 하여 공동강의와, 실험, 인문의학경험, 임상경험 등으로 구성되어 있다. 전통적 교육과정은 강의와 실험실 학습으로 이루어져 있다.

Method. Long-term follow-up of Harvard Medical School students who participated in a randomized controlled trial. Descriptive study using 1998 telephone interviews of 100 1989 and 1990 graduates (50 who had studied the NP curriculum, 50 who had studied the traditional curriculum). The NP Program consisted of problem-based learning tutorials, with coordinated lectures, labs, experiences in humanistic medicine, and clinical experiences; the traditional program consisted of basic science lectures and labs.

결과 : 22개의 척도중에서 NP와 TP학생은 다섯 개의 척도에서만 차이를 보였다. NP학생들 중 40%, TP학생 중 18%가 일차의료 혹은 정신과를 전공하고 있었다. NP학생들은 인문의학적 실천에 대한 준비가 더 잘 되어있다고 했고 환자의 심리사회적문제를 더 잘 다룰 수 있다는 자신감을 드러냈다. NP학생들은 첫 2년간 교육이 자신들의 사고에 영향을 더 주었다고 했고, NP학생들은 TP학생들보다 그 교육과정을 더 좋아했다. 평생학습적 측면에서는 차이가 없었다.

Results. Of 22 measures on the survey, NP and traditional students differed significantly on only five (three humanism; two social learning): 40% of NP students and 18% of traditional students went on to practice primary care or psychiatry. NP students rated their preparation to practice humanistic medicine higher than did traditional students and expressed more confidence in their ability to manage patients with psychosocial problems. NP students were more likely than were traditional students to believe that faculty from the first two years continued to influence their thinking. NP students liked the pedagogic approaches of their program more than traditional students did. There was no difference between the groups on measures of lifelong learning.

결론 : 의과대학기간과 레지던트 기간동안에 인문학적 영역에서 나타난 NP와 TP학생간의 차이는 수련 후 진료를 하는 기간에도 유지되었고, 이는 인문의학적인 측면을 가르치는 것, 배우는 것이 가능함을 의미한다.

Conclusions. Differences between NP and traditional students in the humanism domain first appeared during medical school and residency and remained significant well into practice, suggesting that humanistic medicine can be taught and learned.

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1985년 하버드 의과대학은 NP교과과정을 도입하였다. 이는 전임상실습과정의 교육과정으로 기초과학 지식을 잘 다지고, 능동적, 자기주도적 학습에 대한 긍정적 태도를 갖추며 환자진료에 대해서 통합적인 정신사회학적, 인문학적 개념을 갖추도록 하는 것을 추구하는 교육과정이었다.

In 1985, 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.1 

멕마스터대학에서 선두적으로 도입한 PBL은 이러한 목표를 달성하기 위한 기본적인 교수법으로 도입되었으나, 새로운 교육과정에는 여전히 강의, 실습, 의학의 인문학적 측면을 배우는 기간, 휴머니즘과 환자의사관계를 촉진시키기 위한 임상경험 등도 포함되어 있었다.

Problem-based learning (PBL)—pioneered at McMaster 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.2–4

모든 교육적 활동은 튜터리얼 사례와 함께 통합되었으며, 능동적 학생주도적 학습은 자립적인 태도를 키우고자 했다. 임상적 맥락은 동기부여의 목적이 있었다.

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.

새로운 교육과정은 2년간 무작위대조군연구와 같이 도입되었다. 프로그램 평가는 2년과 4년이 끝나는 시점, 그리고 졸업 후 4년이 되는 시점에서 이루어졌다. 이 때 NP와 기존 교과과정 학생들은 강하고 꾸준히 차이를 보였는데, NP학생들이 좀 더 인본주의적인 것에 긍정적 태도를 보였고, 기초의학지식이나 임상문제해결에는 차이가 없었다.

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. 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.5

METHOD

Participants

The NP was conducted as an experiment in its first two years (1985–86 and 1986–87). Of 280 entering students, 125 agreed to be randomized to the New Pathway (63 students) or traditional curriculum (62 students, matched for race and gender). The students in the traditional curriculum served as controls for all phases of the evaluation. 1 Participants provided informed consent to respond to all phases of the evaluation.

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.

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 10.

Respondents’ perceptions of the lasting effects of the first two years of medical school were stripped of respondent identifiers and language that overtly referred to the NP or traditional program. Three of the authors independently conducted content analyses7 to (1) identify broad themes and (2) evaluate the language used to discuss each theme (e.g., positive or negative). 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.

RESULTS

Humanism (Table 1)

The 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. 

Lifelong Learning (Table 2)

There was no statistically significant difference between NP and traditional graduates’ behaviors or attitudes in this domain

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.

Lasting Effects of the First Two Years of Medical School (Table 4)

Ninety-five percent of the graduates (46 NPs and 49 traditionals) reported at least one lasting effect of the first two years of medical education. Twenty-one NP and two traditional graduates reported that their programs had had lasting effects upon the way they approached and thought about patients.

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Acad Med. 2000 May;75(5):470-9.

Long-term outcomes of the New Pathway Program at Harvard Medical School: a randomized controlled trial.

Peters AS1, Greenberger-Rosovsky R, Crowder C, Block SD, Moore GT.

Author information

Abstract

PURPOSE:

To evaluate the long-term effects of an innovative curriculum, the New Pathway (NP) Program, on behaviors and attitudes related to humanistic medicine, lifelong learning, and social learning.

METHOD:

Long-term follow-up of Harvard Medical School students who participated in a randomized controlled trial. Descriptive study using 1998 telephone interviews of 100 1989 and 1990 graduates (50 who had studied the NP curriculum, 50 who had studied the traditional curriculum). The NPProgram consisted of problem-based learning tutorials, with coordinated lectures, labs, experiences in humanistic medicine, and clinical experiences; the traditional program consisted of basic science lectures and labs.

RESULTS:

Of 22 measures on the survey, NP and traditional students differed significantly on only five (three humanism; two social learning): 40% of NP students and 18% of traditional students went on to practice primary care or psychiatry. NP students rated their preparation to practice humanistic medicine higher than did traditional students and expressed more confidence in their ability to manage patients with psychosocial problems. NP students were more likely than were traditional students to believe that faculty from the first two years continued to influence their thinking. NP students liked the pedagogic approaches of their program more than traditional students did. There was no difference between the groups on measures of lifelong learning.

CONCLUSIONS:

Differences between NP and traditional students in the humanism domain first appeared during medical school and residency and remained significant well into practice, suggesting that humanistic medicine can be taught and learned.