Grappling with an issue that has confounded medical experts for decades, "Nova" tonight focuses on the dilemma of changing the way physicians are trained in an episode titled "Can We Make a Better Doctor?" It airs at 8 p.m. on Channels 28 and 15, and at 9 p.m. on Channel 50.
The question is one of the most worthwhile in the growing realization that the United States lacks a rational national health policy. Unfortunately, the show, produced by station WGBH in Boston, is more of a video press release for Harvard Medical School than probing journalism.
"Nova" reports on a Harvard experiment called the "New Pathway," in which the structure of the four-year medical school curriculum has been changed. In place of the first two years being devoted to instruction in basic science, Harvard rushes students into clinical experiences--examining and diagnosing real patients--almost as soon as they arrive.
Whether this will work is a question that preoccupies a great deal of the American medical education system today. But in its reportorial approach, "Nova" portrays something that seems like medical students playing doctor.
Dr. Daniel Tosteson, the school's dean and principal force behind the new curriculum, is never interviewed in the hourlong program. Only advocates of the curriculum either at or strongly tied to Harvard appear. Nowhere is there an authoritative voice with no direct stake in the outcome. The closest is in several snippets from Dr. Arnold Relman, editor of the New England Journal of Medicine, who is clearly sympathetic.
More significantly, the producers never clearly describe or effectively illustrate how the curriculum can possibly have its intended effect. The show focuses on the experiences of six first-year students, but the reactions of these young people themselves imply serious obstacles to the educational method that "Nova" clearly favors.
By the end of the hour, one student confides that he is drifting to a preference to be a surgeon--duplicating a process that has distorted American medicine by producing wastefully huge pools of surgeons at the expense of primary care doctors. And some students who had voiced commitments to practicing primary care medicine in the inner city agree that their student loans may necessitate something more lucrative.
So in the end, whatever it is that is different in the way these students are being trained remains elusive in terms of its possible effect.
"Nova" promises more programs, following these six students through all four years of medical school and into residency. But if the show's overwhelming acceptance of Harvard line is any indication of what is to come, this curriculum examination will never tell us what we most need to know.