Two years ago, the spring issue of Yale Medicine included a feature story on an initiative by Dean David A. Kessler, M.D., to review the curriculum and examine the larger questions surrounding medical education at the start of the 21st century. The magazine also featured an interview with the school’s new education dean, Herbert S. Chase Jr., M.D., and a collection of alumni essays titled “Eight Decades of the Yale System.” Several issues earlier we had invited alumni to reminisce about what the Yale System meant to them and to their generation. The response we received was overwhelming, as was the obvious affection nearly every alumnus and alumna appears to have for the Yale System.

This past February, a new generation of Yale scholars brought the topic into focus once again with a statement and petition, mailed to alumni, seeking to prevent proposed changes to the second-year testing format. The nine medical students who circulated the petition felt that requiring certain qualifying exams was incongruous with the Yale System, conceived in the 1920s by then-Dean Milton C. Winternitz, M.D. His vision was to give students freedom to pursue knowledge in a graduate-school-like environment by eschewing grades, class rankings and required exams in favor of close mentoring relationships between students and faculty and the completion of a thesis based on original research.

The proposed second-year qualifiers have since been dropped, but not before the issue elicited a huge response from alumni. From their mailing to more than 4,000 addresses, the students received well over 400 replies, many echoing Stanford oncologist William M. Rogoway, M.D. ’61, who wrote: “The freedom to chart one’s own course with support and encouragement along the way (and few inhibiting rules) is a model for a professional career.”

As a course director at Columbia P&S in the mid-1990s, Chase
lobbied for the abolishment of grades for the first- and second-year courses, and he came to New Haven excited about Yale’s emphasis on intellectual independence. He thinks there are other, more serious threats to the Yale System: the incursion of managed care into teaching time, class sizes that are too large, an overstuffed schedule and incapacitating student debt. In response, the faculty has increased the number of small-group discussions and reduced class hours and the total number of qualifying exams. Chase is working on ways to boost financial aid and the rewards for teaching.

Following our initial coverage in 2000, we planned to revisit this topic as it evolved and will do so in depth in an upcoming issue. The intense interest of both current students and alumni reinforces the view that the Yale System is not only central to the experience of Yale medical students but also that it is here to stay.

Michael Fitzsousa
michael.fitzsousa@yale.edu