On February 25, 2004, two days before rising third year study cards were due, students received an email from Dr. Malcolm Cox (Dean for Medical Education) and Terese Galuszka (Registrar) stating that the administration had “come to the decision that the one-month Neurology, Psychiatry and Radiology Core Clerkships must be completed before October 1 of your final year.” This new requirement means that the Class of 2006 and all future classes will now have twelve months of core requirements to complete in the fifteen months from July 1 of the third year to October 1 of the fourth year. In the past, Harvard medical students had six months to plan their elective rotations before residency applications were due, under the new ruling, current and future classes now only have a maximum of three flexible months to pursue elective rotations before applying for residencies.

Why does this reduction in the number of flexible months present a problem for students? Since applications for residencies are usually submitted in September and October of the fourth year (those for the early match specialties of Neurology, Neurosurgery, Ophthalmology, Otolaryngology/ENT, and Urology are due even earlier), students are now limited to three flexible months (as opposed to six) to make many important decisions about their future. The opportunities available during these months are essential for career decision making. There will now be fewer options available to aid students in choosing a career and assembling competitive applications.

How have Harvard medical students typically spent these flexible months? Many students enroll in clerkships that help them decide on specialties to pursue as careers. These include electives in Ophthalmology, Urology, and other specialties to which students get minimal exposure in the core rotations of medicine, surgery, pediatrics, and ob/gyn. Students have also participated in elective courses and research projects to strengthen applications for competitive residencies, registered for ‘away’ rotations at hospitals to which they intend to apply, and completed sub-internships in surgery and medicine. Medical students have always been under an intense time pressure to make significant decisions about their careers; this new clerkship requirement at HMS only exacerbates these demands.

Some reasons cited for this drastic change in clerkship requirements for the Class of 2006 were that the specialties of Neurology and Psychiatry are being marginalized by current medical students. Second, it has been argued that the core clerkships of neurology, radiology, and psychiatry are a vital component of any medical students’ clinical training. Finally, the new requirement of Step 2CS of the USMLE highlights the importance of communication in any clinical encounter, a skill which is honed during these clerkships. Students share these concerns and acknowledge the importance of the core clerkships. However, the same issues can be addressed without instituting an arbitrary deadline. Furthermore, the date of October 1, 2005 coincides with the deadlines for residency applications, while completion of USMLE Step 2 is not required until December 31 of the fourth year.

As discussed, this new clerkship requirement clearly limits our ability to take full advantage of opportunities to explore potential career paths and construct competitive residency applications for specialized and early match fields. The outstanding opportunities available to Harvard Medical students have always been regarded as a tremendous asset to the school and its curriculum. At HMS, we students have always been encouraged to independently pursue opportunities and be responsible for our own medical education. Much of the curriculum is focused around self-motivated and self-driven learning. Why then do we need a deadline for completion of clerkships that we acknowledge to be important for our clinical development as physicians and also for successful completion of Step 2CS of the USMLE? Even if such a deadline were necessary, why should it be placed at a time which limits our flexibility before residency applications are due? A more equitable timeline might coincide with the deadline for completion of Step 2 of the USMLE, namely, December 31 of the fourth year.

If you have any answers to these questions, seek the answers as I and my fellow classmates do, or would like some more information regarding the aforementioned issues and ongoing efforts to voice student concerns, please contact me at eugene_cha@student.hms.harvard.edu.

Food for thought:

Instead of crowding the period from July 1st of 3rd year until October 1st of 4th year, other efforts to de-marginalize Neurology and Psychiatry should be instituted during 2nd year or even 1st year (these would not even have to be rotation-based). The cultivation of clinical communication skills does not appear to be particular to the Neuro and Psych clerkships. Again, why not emphasize such skills even more in the 1st and 2nd-year curricula? Finally, the students’ sacrifice of flexibility with the new schedule should be met with a continued vigilance on the part of clerkship directors to make all rotations as time- and content-effective for learning as possible.