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The Yale system—91 years and counting …

Yale Medicine Magazine, 2016 - Autumn


An experiment in medical education followed “a very wise direction.”

On his first day as an intern at the Hospital of the University of Pennsylvania, Antony Chu, M.D. ’02, had to borrow another doctor’s white coat bearing that doctor’s name. An observant colleague noticed the embroidered misnomer. “Who are you, and where are you from?” asked Mindy G. Schuster, M.D. ’87, now a professor of medicine at the hospital, during a shared elevator ride. After his reply, she smiled and told Chu the story of that time when 17 Yale students failed Step 1 of their national board exams. “That was my class,” Schuster said. Despite a generation gap, she and Chu bonded immediately over their Yale system experiences. (The board failures caused deep concern among basic science faculty, and the subsequent implementation of mandatory anonymous qualifying exams meant that a mass failure never happened again.)

Chu, now a cardiologist at Brown University’s Warren Alpert Medical School, said the Yale system fostered collegiality to a degree he has not experienced since med school. “One of my classmates was interested in climbing Mount Everest, and the faculty worked with him to create studies around high-altitude medicine,” Chu said.

The Yale system has undergone some changes throughout its nearly 100-year history, but for years it has been one of the main reasons students study medicine at Yale. Daniel Barson and Abigail Greene, both third-year M.D./Ph.D. students, chose Yale because of it. “To me, the Yale system is the option of what to study, when to study, and how to study without the stress of a test to pass in one week,” Barson said. During her first two years, Greene went to “every class and every workshop—which isn’t totally the norm,” she said. Even with packed schedules, Barson and Greene found time for lab experiments and behind-the-scenes roles in the Second-Year Show, the students’ annual spoof of faculty. As a result of such independence, Yale medical students must look inward to understand what motivates them to learn, Greene said. “It’s a really valuable skill, and an enjoyable way to learn medicine, keeping us grounded, happy, engaged, and passionate.”

“In the early days,” said Robert H. Gifford, M.D., HS ’67, professor emeritus of medicine, and the school’s first deputy dean for education, “you didn’t have to go to class if you felt you knew the material. You were responsible for your education.”

What is accepted as a given today began as a pedagogical experiment spearheaded by Dean Milton C. Winternitz, M.D., in the 1920s. About that time, medical faculty across the country were following the model laid out in the Flexner Report of 1910, which recommended two years of basic science followed by two years of clinical instruction. Winternitz added additional core concepts to Yale’s approach: fewer required classes, a senior thesis, optional lecture attendance, no grades, and no individual course exams. Winternitz believed students needed to show mastery of material, but should be treated as scholarly adults and not forced to regurgitate facts or repeat science experiments as expected of their vocational school counterparts. Writing in the Journal of the American Medical Association in 1926, Charles R. Stockard, M.D., Ph.D., of Cornell University, said “The country at large owes its thanks to the faculty of the Yale medical school for having taken a definite step in what is probably a very wise direction.”