The famed 1810 circular letter signed by Boston physicians James Jackson, MD, and John C. Warren, MD, said that, in addition to providing for the immediate needs of the sick and injured, the hospital they envisioned would have another goal. “The means of medical education in New England are at present very limited, and totally inadequate to so important a purpose,” they wrote, describing a hospital as “absolutely essential” to medical education.
At the time in the United States, the idea of systematically using a hospital to train would-be doctors was a relatively new one. Prior to the construction of Mass General, there were only two other hospitals in the whole country, in New York and Philadelphia. During the early 19th century, all three were dedicated to serving the poor. People who could afford it paid to be treated at home.
Rather than earning a degree and following a prescribed curriculum, a young person interested in becoming a doctor usually served an apprenticeship of sorts with an experienced physician. The quality of such training varied widely and could involve tasks as mundane as washing bottles and running errands. Medical students of means routinely went overseas to seek training in London, Paris and Edinburgh. Medical schools, many attached to universities, were springing up in this country, but education there revolved around medical students paying individual professors to hear their lectures.
Concerns about Practical Medical Experience
The effort to build Mass General was fueled, in part, by concerns that students from Harvard Medical School, founded in 1782, were not getting enough practical experience in the Boston’s poor house or its private homes. Not that the close educational ties that now exist between Harvard Medical and Mass General were always a given. Indeed, in its early days, medical students at Mass General were subject to stringent rules.
“On the regular days of visiting the pupils are not to remain at the Hospital longer than is absolutely necessary for the visits,” one 1824 mandate said. “They are not to converse with the patients or nurses. During operations and while in the wards they are to abstain from conversation with each other. They are not to walk about nor in any other way disturb either the medical officer or the patients.”
Through the years, of course, such restrictions faded as doctors-in-training began pursuing a more regimented academic curriculum and taking on broader responsibilities for care. Meanwhile, many Mass General physicians were appointed to the Harvard Medical faculty as well.
In addition to producing an array of medical breakthroughs during Mass General’s first two centuries, the hospital’s staff has also deeply influenced how medicine is taught and researched.
Probing Details of Complicated Cases
In the early 20th century, for instance, Richard C. Cabot, MD, a senior MGH physician, developed an educational exercise known as the “clinical-pathological conference,” or CPC. Still in use today, the CPC involves presenting the details of a complicated case to a senior physician for his or her diagnosis. It, then, is typically compared to the actual findings of a pathologist.
Appointed a professor of clinical medicine at Mass General in 1912, David Linn Edsall, MD, spearheaded dramatic changes in medical education at the hospital. Taking a leadership role, he bolstered opportunities for bedside teaching and provided residents with time, funding and encouragement to pursue research.
These days, Mass General is the largest of Harvard’s teaching hospitals, offering 20 residency and 86 fellowship programs. Through the MGH Institute of Health Professions, the hospital also offers educational programs for nurses and other professionals in the field.
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