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Monday, 2 January 2012

What Business Schools Can Learn from Medical Education

The January-February issue of the Harvard Business Review has a column - "What Business Schools Can Learn from the Medical Profession" - by Harvard Business School dean Nitin Nohria.

Dean Nohria praises the way medical education addresses the "knowing-doing" gap by fostering hands-on experience in medical school and residency. In that spirit, this month, for the first time, Harvard will send 900 first year students to developing markets, where they will work in teams of six with a multinational or local company to develop a new product or service offering. At the end of each day students will gather with faculty members to discuss their experience.

I agree with the Dean's sense that immersion in field experience can be enormously educative. But the end-of-day sessions with faculty also play a crucial role. For the past ten years I've had the privilege of co-facilitating the "Patient/Doctor" seminar in the residency in Primary Care and Population Health that my department sponsors with the Brigham and Women's Hospital and Harvard Vanguard Medical Associates. This longitudinal seminar meets over the course of the three year program. Relationships with patients, self-understanding, professionalism and medical ethics are central topics for us.

Albert Schweitzer taught that “example is not the main thing in influencing others…it is the only thing.” Not every influence is positive, and our discussions often focus on how to deal with challenging circumstances, such as difficult patients or consultants who treat colleagues, students and patients badly. The faculty role in the HBS program will be crucial for helping students "process" what is sure to be a powerful but often confusing field experience.

Last year I reviewed notes I made (and kept) from clinical supervision I received as a resident more than forty years ago. Here's part of the note I sent to one of my teachers:
I've been reviewing notes that I kept from my residency at MMHC [Massachusetts Mental Health Center] 1965 - 1968. My clinical notes on the treatment of an especially difficult patient are interlaced with my summaries of what "Dr. X" said in supervision, and I wanted to tell you how excellent your teaching was. You consistently focused my attention on the therapeutic alliance and being very clear for myself and with the patient what the work to be done was. What I took from your teaching was practical, empathic and deep. Reading notes from 45 years ago is a fascinating experience, for a view of myself as a 26 - 29 year old and for a view of what psychiatry looked like through the lens of MMHC in the late 1960s.
Excellent teaching stays with us through a lifetime. Thank you for being such an important teacher and friend to me during those formative years of residency!
Here are some excerpts from the note I got back from Dr. X, who was living in a retirement community:
Good morning Jim! You have made my day with that message...I hope that over the years my teaching has at least held its own and not corroded; what I do know is that teaching has been a mainstay of my life and that it will be the last thing I give up if I have any choice in it.  

...Practical, empathic, and deep--now that is a motto for a life.

Old teachers, like the moon, bask in reflected light from the achievements of their students.

Every good thing to you for 2011, and thank you very much for writing me this splendid note.
The field experience is sure to be an important educational opportunity for the 900 first year HBS students. But it will also be an important educational opportunity for the faculty, especially with regard to ethics education. Before he became dean, Professor Nohria proposed a code of ethics for business. But we know from centuries of medical education that codes don't shape behavior. I look forward to hearing from HBS faculty and students about the ways in which the new field experience program does, and does not, influence the values orientation of the planet's future business leaders.


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