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Faculty examine academic core, health services

A task force chaired by Robert J. Silbey, dean of the School of Science, has been conducting a comprehensive review of the common undergraduate educational experience that will likely result in the first changes in the General Institute Requirements (GIRs) since 1991. The task force presented a progress report at the Nov. 16 faculty meeting, which was held in Room 32-141 of the Stata Center.

Faculty also heard another task force recommend keeping the basic model of services provided by the MIT Medical Department.

Some of the changes that may be in store when the review of the Undergraduate Educational Commons is complete include: expanding the scope of required courses with project-based experiences; giving students more individual choice; including engineering as well as science subjects in the core; and making the humanities, arts and social science (HASS) requirements simpler and more focused.

Faculty and students do not understand the goals of the science-engineering core, Silbey said.

"We think these GIRs could be changed," Silbey told the faculty. "We believe the GIRs are taught well and the subject matter is appropriate. The question raised is, why this set of GIRs and not a different set of GIRs?" The committee, he said, is taking a "completely new look" at the content and goals of an MIT education.

Under the proposed recommendations, undergraduate students would be required to take eight subjects in mathematics, physical sciences, life sciences, chemical sciences, computation and engineering, instead of the present six required subjects plus two Restricted Electives in Science and Technology (REST). Silbey said the task force's "design challenge is how to organize these eight classes into a menu that broadens the core but takes departmental programs into account. We will need a strong oversight committee to make this work."

In addition to the current science core, students are required to take eight HASS classes. Silbey said the committee has heard from students that they tend to sign up for their science core classes and classes in their major first and then take whatever HASS classes fit their schedules. "This gives students exactly the wrong message," he said. The task force is working on a way to make the HASS requirement "simpler and less diffuse."

Meanwhile, Silbey said the current lab requirement may be "a white elephant. Every science and engineering major requires enough labs for us to be satisfied. And those courses that do not require a lab would have a capstone experience of some sort."

Given that no school can teach students "everything they need to know" for a lifetime, Silbey said the "goals of an MIT education should be made more explicit. An MIT education should ignite a passion for learning and give students the tools for lifelong learning," he said. In addition, "some time for reflection" should be built into the curriculum, and students should be given more choices while maintaining the ability to change majors and still meet all the requirements.

Silbey acknowledged the difficulty of working out all these changes while also achieving agreement from all the departments on what an MIT graduate should know. "There is not complete agreement around MIT, but this is a time when we can do something different with our core. We believe it will be the right thing to do," he said. The task force plans to make specific recommendations to the faculty and President Susan Hockfield in the spring, with changes probably taking effect for the 2008-2009 academic year.

A model for medical care

Paul L. Joskow, the Elizabeth and James Killian Professor of Economics, presented the final report of the Task Force on Medical Care for the MIT Community. Created by then-President Charles Vest in 2004, the committee completed its work last month and has posted its 120-page report on the web.

The task force was charged with reviewing issues of access, quality and cost for all health care and health insurance programs available to students, employees, retirees and postdocs. The report concludes that the basic model of on-campus health care for the community, combined with the outside health insurance options available to employees and retirees, has served MIT well.

The final report makes more than 40 recommendations to improve the quality of care and the value of insurance options and to reduce costs. It urges strengthened support for the MIT Medical Department and changes in health insurance programs. Hockfield has indicated the administration's intent to retain the basic model and said that she has asked Sherwin Greenblatt, MIT's interim executive vice president, to analyze the financial and operational implications of the report's specific recommendations.

In a project that "turned out to be bigger than anyone thought," Joskow said the committee took a broad look at an on-campus health care center that works on a model shared by only a handful of other universities. While most universities operate student health services that provide only primary care to students, the MIT Medical Department also provides or manages health care for employees choosing one of the MIT Health Plans, as well as hospitalization and extended-care insurance to students requiring such coverage, and optional care to retirees. Fifty-five percent of MIT's Cambridge campus employees, including 78 percent of the faculty who subscribe to one of the MIT Health Plans, and about 25 percent of retirees, including 80 percent of faculty retirees, receive medical care through the MIT Medical Department. The rest of MIT's employees have chosen health insurance options administered by Blue Cross/Blue Shield or the Tufts Health Plan. MIT self-insures all of its health care and self-insurance options.

"MIT is effectively a $100 million insurance company," Joskow said.

Budget cuts imposed on the Medical Department have led to extended waiting times and the perception that the quality of care provided has been diminished and that physicians are less available and more rushed, the report said. The report recommends that some resources be restored to the Medical Department in order to ameliorate the problems caused by staff shortages.

Joskow said, "This is not a recommendation to 'return to the past.' The Medical Department must continue to pursue opportunities to increase productivity." The report identifies a number of areas where cost-saving opportunities should be explored. In particular, it recommends improving the MIT administration's budgeting and financial management protocols for the Medical Department and making complementary enhancements to the Medical Department's own financial management capabilities.

The task force found that MIT Health Plan costs are competitive with providers such as Tufts Health Plan and Blue Cross/Blue Shield, around $239 per patient month for MIT compared with $276 for the outside insurance options available to employees. "If all employees were moved to Blue Cross/Blue Shield and the Tufts Health Plan, we wouldn't save any money," Joskow said.

"To attract and retain the best faculty and students, high-quality medical care at a reasonable cost is important to the community," Joskow said. "The MIT-Harvard-Yale model continues to be in the best interest of MIT as long as we can manage it properly so it continues to provide high-quality and cost-effective care."

Among the task force's 40 recommendations are: looking into a high-deductible and co-payment option; expanding the use of technology for a digital medical records system; expanding wellness and other education and support programs; expanding use of information technology to facilitate exchanges of medical information; creating a closer partnership with one or two of Boston's major hospital groups; bringing retiree medical care into fiscal balance and developing a long-term retiree care strategy; evaluating mental health care services provided to MIT Health Plan subscribers in light of the increase in students being served following the recommendations of the Mental Health Task Force; and changes to the way all of MIT's health insurance options are priced and structured.

The task force also recommended putting a "highly skilled professional" in charge of the community's medical care -- someone who would develop health-care strategies and policies that "advance MIT's mission in a comprehensive and sustainable way."

A version of this article appeared in MIT Tech Talk on November 30, 2005 (download PDF).

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