New course series connects core science classes with patient care.
Bobbie Collins | Harvard Medical School
You’re an emergency medicine resident responding to a page. You step into an emergency department consultation room and see a 67-year-old Haitian American woman experiencing shortness of breath. You begin asking questions about what brought her to the hospital but realize the patient appears disoriented and is not responding coherently.
What do you do next?
First-year students pursuing their MDs at Harvard Medical School in the Harvard-MIT Health Sciences and Technology program (HST) played out this scenario as part of a new course this spring.
HST is a cross-university partnership that develops physician-scientists — individuals who study the causes of disease and apply that research to patient care. To prepare students even more thoroughly for the rigorous demands of the dual profession, HST leaders developed a new, longitudinal three-part series of core courses called Integrations and Innovation in Medical Sciences (I2MS).
Case-based and discussion-oriented, the classes meet weekly for three semesters to add clinical context to students’ learnings from concurrent courses in the science of the human body.
Keys to becoming outstanding doctors, researchers, leaders, and innovators
This distinctive approach gets students thinking about how the underlying biomedical science of health and disease ties into the social factors of patient care earlier than in a traditional medical school curriculum, said Bernard Chang, dean for medical education at HMS.
In some MD programs, this integration might not take place until students’ third year, which is usually spent entirely in the clinical setting. I2MS courses are also intended to reduce the risk of students becoming a bit removed from considering the basic biology that drives their patients’ conditions during that clinical year, Chang said.
The I2MS simulated scenes play out in hospital wards, emergency rooms, and primary care and specialty practices, with students alternately playing the roles of physicians, residents, and medical students. Team-based care is emphasized throughout, with students considering how to interact with nurses, laboratory and radiology technicians, and others.
Students began taking the first I2MS course in fall 2024. The second, I2MS II, debuted this spring. I2MS III will launch in fall 2025.
Assessing the patient and connecting the coursework
As part of the ER scenario, small groups of students talked through how they would observe, physically examine, and note the patient’s physical condition. Lively conversations and thoughtful lulls rippled through the classroom. A discussion followed guided by Sanjat Kanjilal, the I2MS II instructor.
Presenting patients the way a clinician would encounter them in real life introduces these MD students to clinical reasoning skills, said Kanjilal. Through the lens of their patients’ illness, the students integrate what they are learning about organ systems, including how they function and what can go wrong. In this case, it was the circulatory and respiratory systems.
“We’re helping students see the big picture of how topics intersect,” said Michael Dougan, I2MS I course instructor and HMS associate professor of medicine at Massachusetts General Hospital. “Those concepts can be hard to see when you’re lost in the minutiae of studying a list of terms or anatomical functions.”
Meeting the whole patient and exploring social medicine
During I2MS II, the students follow a fictitious U.S. family of Haitian descent throughout the semester. As each family member experiences a different illness, the students discuss the patients’ culture as well as their wellness and health care — learning lessons they can carry forward into the communities in Boston and beyond where they will one day practice medicine.
“I chose to build a narrative involving the Haitian community as they are one of the most marginalized groups in Boston. It offers a mechanism for discussing the sorts of economic, logistical, and systemic barriers faced by people living in the shadow of one of the most well-resourced medical institutions in the world — and to think about solutions,” said Kanjilal, who is also HMS assistant professor of population medicine at Harvard Pilgrim Health Care Institute and an infectious disease doctor at Brigham and Women’s Hospital.
Understanding how social determinants such as poverty or education level can affect disease risk, prevention, and outcome helps students grapple with issues of health equity.
“Some of the biggest problems in medicine fall outside the realm of pure science and finding a diagnosis,” said Ally Questell, a first-year MD-PhD student in HST.
At the beginning of this particular class, students heard how nuances of the Creole language, such as inflections and layered meanings, can hinder or ease communication and trust between the patient and health care team.
Guest speakers often participate in the classes. They have included individuals from marginalized communities and those who work with them.
“We’re training to think about patients as whole people and how their family, community, and where they live relates to their health situations,” said Zoe Weiss, a first-year MD-PhD student in HST.
Ordering tests and puzzling things out
The cases are designed to have hypothetical patients describe common symptoms that are intentionally nonspecific and could indicate more than one illness. This stimulates the students to practice generating a differential diagnosis, where they come up with a list of diagnoses that can explain the patient’s presentation and narrow it down using clinical reasoning skills.
After assessing the disoriented ER patient, the students identified diagnostic tests such as bloodwork, swabbing for infection, and imaging to order, while Kanjilal steered them along. They then evaluated the results. When looking at an EKG, a graph that records the heart’s electrical activity, students who went to the front of the room to break down anomalies received supportive hurrahs.
Kanjilal emphasized that time is of the essence in the ER and urged the students to problem solve quickly while also promising that as they repeat this process hundreds of times throughout their schooling, their knowledge and confidence will increase.
The students are eager to take up the challenge.
“Part of what drew me to medicine was the challenge of working through a clinical puzzle to solve the mystery of a complicated case,” said Questell. “It’s really fun to think through the systematic framework we’ve been given, both algorithmically and creatively, to find a diagnosis.”
Finally, the class presented a diagnosis to their “attending physician.” Ultimately, with Kanjilal’s guidance, they concluded the patient was experiencing a crisis caused by critically high blood pressure — a condition that can cause organ damage and be life-threatening.
“She had stopped taking her hypertension medications, which precipitated a number of cardiovascular, respiratory, and cognitive symptoms,” said Questell. “This was probably one of the hardest cases we’ve seen so far.”
From the molecular level to the patient’s bedside
In their first semester in HST, students take science courses focused on cellular and molecular mechanisms, like genetics, biochemistry, and immunology. These courses were taught in parallel, but independently, in the past. Now, in I2MS I, the science courses are woven together and put into the context of patient care, including the perspectives of physicians and patients.
For example, one class session last fall focused on liver transplantation, said Weiss. For the first hour, students talked about how blood-type matching affects the body’s immune response. Then a liver transplant doctor spoke about assessing and treating patients. Finally, a transplant recipient shared their experience.
“While many medical schools are moving toward a case-based learning format, I don’t think there’s any place that does this kind of integration across the curriculum,” Dougan said.
Further connections
I2MS courses incorporate major medical advances, such as the new GLP-1 agonist drugs for type 2 diabetes and weight loss, and trace how basic science discoveries can lead to drug development and then clinical trials.
“We are fortunate at HMS and in Boston to hear directly from the people at the forefront of innovation,” said Questell.
Guest speakers address topics such as potential career paths, investment and entrepreneurship, climate change and environmental health, and the potential of AI tools for MD training and clinical care.
Patient communication skills are also stressed.
The third course in the Integrations and Innovations series will focus on pharmacology and bring all three I2MS courses into a cohesive whole.
“It feels special that our professors put in so much effort to teach us to the highest standard, expose us to different ideas, and get to know each of us as students and future doctors,” said Weiss. “This is why I’m here at HMS and in medicine.”
*Originally published in Harvard Medical School news and research.