Dr. Jo Shapiro, Chief of the Division of Otolaryngology at Brigham and Women's Hospital in Boston, MA and a major player in the medical education reform movement at Harvard Medical School, is not shy about emphatically stating her long-term goal: "to help radically improve the education of physicians."

Her dedication to this cause is evident from her leadership in many Harvard and Harvard-affiliate organizations devoted to improving medical education - for everyone from pre-medical undergraduates and medical students to residents and even seasoned physicians. However, the best indicator of her devotion to changing the face of American medical education is the fervor with which she speaks of how the next generation of physicians should be educated. Her take-home message for people at any stage of the journey towards a medical career is to discover what their gifts and passions are, and then find a place in the system and culture around them that fosters those gifts - a place that, in the words of former Harvard Medical School Dean Dan Tosteson, "lights the fire within." It is exactly that kind of place that Dr. Shapiro wants to make Harvard Medical School and nationwide medical education at all levels.

To Dr. Shapiro, improving education is an uphill battle in an academic climate within which "the critical teaching mission... has [often] been undervalued and under-supported." Promotions and pay for faculty clinicians are often based on research and clinical output, rather than teaching and mentoring ability. Leaders at Harvard Medical School and across the country have, she says, increasingly realized the urgency of the lack of "resource allocation and support for teaching," which is Dr. Shapiro's central concern and one voiced by faculty and students alike.

However, the reforms necessary to reshape medical education completely go beyond supporting and encouraging quality teaching. The ever-growing importance to successful medical practice of competencies rather than just medical knowledge - skills and abilities versus rote learning of science facts - necessitates a completely new approach to teaching and assessment.

Physicians must be skilled in interpersonal communication, in professionalism, in the accessing and evaluation of information, in delivery of medical care within a complex professional and societal framework, and most of all, in the ability to deliver "compassionate care". The latter is a crucial quality of good doctors, who go beyond fixing a diseased body the way a mechanic fixes a broken car, instead treating the whole patient with compassion and respect. However, like many competencies, it is impossible to assess on such multiple-choice tests as the Board Exams.

Furthermore, a curriculum based on "process" that specifies numbers of rotations and hours as the only measure of a good education is far worse at teaching these skills than a "competency-based curriculum" specifying what students must actually learn and be able to do. In a paradigm shift that will surely have widespread influence, Harvard Medical School will soon be switching to a competency-based curriculum including new methods of teaching and assessment to ensure that these competencies are not only taught, but also learned - a subtle but essential distinction.

Even premedical students may soon feel the effects of the new focus on education reform in influential institutions like Harvard Medical School and the American Association of Medical Colleges as even admissions requirements may be reevaluated. In Dr. Shapiro's opinion, shared by many others, rather than requiring more courses, undergraduate education should be changed to "give people the opportunity to craft a program suited to their interests and their passions." The changing demands of the medical field in response to the recent explosion in scientific research and the increased emphasis on compassionate care mean that premedical students too will need to begin developing their own interpersonal, learning, and problem-solving skills. Most of all, they too should identify and then strengthen the passion that leads them to a life in medicine, that lights their "fire within."

In addition to her position as Chief for the Division of Otolaryngology at Brigham and Women's Hospital, Dr. Shapiro serves as the Surgical Clerkship Director for Otolaryngology at Harvard Medical School. She is a Founding Scholar of the Academy at Harvard Medical School, Co-Chair of the Pedagogy Working Group for the Medical Education Reform Effort at Harvard Medical School, a member of the Medical Education Reform Steering Committee, and Associate Director of Graduate Medical Education for Partners Healthcare (a partnership of Massachusetts General Hospital and Brigham and Women's Hospital). She is married to an internist, and she is the mother of three teenage children.

Miya E. Bernson is an Associate Editor of the Next Generation and a member of the Harvard College Class of 2006.