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Originally posted by MacGyver
One of the problems is that Harvard's "affiliations" with those hospitals are very loose.
I read an article in the Boston Globe awhile back which stated many Harvard med students were unhappy with their clinical training because the hospital sites were focusing more on patient care instead of teaching.
Unlike Hopkins, Harvard Med School has ZERO control over its hospital affiliates. Harvards hospitals can do whatever the hell they want, and Harvard Med cant do a thing about it. If the faculty at MGH decided that they dont want to teach students anymore, theres not a damn thing Harvard Med can do.
Hopkins on the other hand, has an integrated environment in which the med school calls the shots. The hospital has a vested interested in keeping the med school happy, because their finances are linked. There is a CEO in charge of the entire Johns Hopkins medical system, who runs both the med school and the hospitals. Most schools, especially Harvard which has many of its clinical sites on the other side of town and and nowhere near the med school by comparison have poor control over their hospital affiliates.
Unfortunately, many institutions (Harvard and Hopkins included), teaching isnt seriously considered a factor in tenure -- faculty could ignore you and the admin couldnt do very much. Last year at Hop, no students got placed in derm and and another specialty that escapes me, and there was quite a bit of lip service but thats about it. I'm not trying to bash my alma mater, but to raise the point that these things are endemic everywhere. Moreover, any small comment brought up at Harvard makes it in the globe.. their minor admissions policy changes, etc. The Globe is a very Harvard-centric paper. (A few years ago, a Boston Globe reporter wrote a best-selling book: Harvard Med: America's Premier Medical School.) I would take those articles both in the positive and negative with a grain of salt.
While control is even more decentralized at Harvard than some other institutions, faculty still get an appointment from the medical school, and the med school has the authority to make decisions about hiring/tenure. Again the issue here is teaching truly weighted as it should in these decisions. These problems are typically endemic in a lot of med schools, but manifest themselves a bit differently in different models of organization.
This level of independence among 17 teaching hospitals has a tremendous upside as well.. Each hospital can focus appropiately on its strengths, and reinforce them among its medical students. However, it's left up to the student to recognize this and make the right choices. At a place like Hopkins, this is a lot easier since u pretty much have JHH and Bayview. However, you are constrained in your choices.
Wash U solves the teaching problem very nicely, by stating that teaching isnt considered in tenure.. thus those who decide to teach truly want to do it out of the bottom of their heart.. in a way its a self-selection. But the downside is there's no reason to improve other than an individual's drive to do so.
At Hopkins, I heard the expression, "treat med students like gold and residents like s**t." That's very commendable that an institution can adopt that attitude. However, some faculty and students complain that this mentality contributes to a sense of coddling (usually the elder faculty from the good old days..). (Residents can't ask you to stay after hours or something -- that's an awesome stance but the secret gunner in me kinda feels thats a lost opportunity)
Ok, I've been writing way too much and I must get back to the beach. I havent written this to be partisan, or appeal to any particular school pride like some others.. ahem. Just wanted people to broaden their thoughts (both pro and con) on issues beyond school pride and propaganda.
-Bill
Please let's got off this subject and move on.. In hindisght, I kinda feel that this whole thread has turned into a dickswingingg /grass is greener contest.