Beloved of many alumni, the Yale System of Medical Education is approaching its 100th birthday. The much-celebrated near-centenarian is far from stagnant, however; the system is, perhaps more than anything else, one of adaptability and enduring versatility. At this year’s alumni reunion, graduates from years and decades past discussed changes that go beyond the campus’ architectural additions—right to the heart of the medical profession they trained for at Yale. “The answers are always changing,” a cardiologist reflected, referencing advances that constantly reshape the field. These alumni are scientists: innovators delighting in new discoveries—even as those discoveries obviate minutiae painstakingly memorized so long ago. These physicians are testament to a system that recognizes the medical field’s inevitable variability: the Yale system.
The Yale system came to be in the 1920s, largely thanks to the efforts of then-Dean Milton Winternitz, M.D. He believed that the School of Medicine should encourage collaboration with other schools—and among its own students. The flexible model that emerged from this vision was a split from the prevailing education system, which aimed to produce cookie-cutter sameness in its pupils and practitioners. The Yale system not only recognized student autonomy—it demanded it. “The student should not be disillusioned that by the deposit of a fee, he can transfer the weight of the burden of education to the faculty,” wrote Samuel Clark Harvey, Ph.D. 1907, M.D. 1911, then-chair of the department of surgery. He identified five essential attributes for successful physicians: integrity, intelligence, capacity for work, judgment, and skillful use of the scientific method. None, he argued, were best achieved by traditional education methods. From these philosophies, the Yale System was born.
In a panel discussion at this year’s reunion, alumni from varied career paths discussed how the system worked for them. Alexa Kimball, M.D. ’94, president and CEO of Harvard Medical Faculty Physicians at Beth Israel Deaconess Medical Center and professor of dermatology at Harvard Medical School, chose Yale before she knew about the system. “I chose it because of the outcomes,” she said. “I wanted a place that was going to give me the flexibility to think about not just my skills as a practitioner, but also how I would be having an impact in a broader setting.”
Kimball’s fellow panelists agreed—the Yale system is about developing the skills for continual learning, rather than a temporary memorization of facts. “An M.D. means you’re a scholar of medicine,” said Jerry Zeldis, M.D. ’78, Ph.D. ’78, currently medical officer and president of clinical research, regulatory, and drug safety at Sorrento Therapeutics. “If you don’t have an absolute commitment to lifelong learning, you shouldn’t be a doctor.”
The Yale system doesn’t come naturally to everyone. Brian K. Kobilka, M.D. ’81, a 2012 Nobel Prize laureate in chemistry and professor of molecular and cellular physiology at Stanford University, applied to 10 medical schools. He got into just two, “because all I did was study,” he said. Then, as now, medical schools valued a more diverse experience in their applicants. The Yale system was a foreign concept to Kobilka, at first. “Through intervention by my classmates and my wife,” he said, “I began to relax a bit… I began to enjoy the process of learning.”
Competitiveness disappears in the Yale system because its philosophy fosters collaboration—and the realization that there is space and opportunity for everyone to succeed, Zeldis said.
“There is no question that in the first two years, we taught each other,” added Kimball.
Reflecting on advances in medical knowledge, Lee Goldman, M.P.H. ’73, M.D. ’73, dean of the faculties of health sciences and medicine and chief executive of Columbia University Medical Center, said, “I tell students that half of what I learned in medical school I’ve forgotten, and half of what I learned in medical school was wrong. And I keep hoping it was the same half. … I think, now, most of what we teach our students is right, but it probably won’t still be the latest by ten years from now.”
For a field in constant flux, a system that favors understanding over memorization seems a natural fit. With the advent of smartphones and the proliferation of computers, “all that information that we used to memorize is at our fingertips,” Kimball said. “What we need to teach people to do is analyze, synthesize, evaluate, and start to bring information together.”
“Knowledge, I think, is transient,” Goldman said. “But the way we learn how to think? That’s durable.”
“The world is a different place today because of graduates of the Yale School of Medicine, and because of the Yale system,” said Dora Calott Wang, M.D. ’90, M.A., historian of the University of New Mexico School of Medicine and award-winning author.