20 years of the BHSc Program: A retrospective and look into the future

The Bachelor of Health Sciences (BHSc) program at McMaster is celebrating its 20th anniversary this year with the Class of ’23 entering the program this fall. In the first of a series of interviews to commemorate this milestone, I sat down with Professor Patangi K. Rangachari – or “Chari” as he is known to his colleagues and students – to ask about his experience with the program over the past 20 years, his perspective on the unique nature of the curriculum and teaching style, and his insights into the future of BHSc. 

The BHSc program at McMaster is unique among undergraduate health sciences programs in both its inquiry-based method of learning and interdisciplinary approach to the study of health and wellness. What prompted the creation of the BHSc program?  

PK Rangachari: In many ways, it was the undergraduate MD program that set the tone for student-centred, active learning. The original program was radically different from many other programs and firmly placed McMaster on the global education map.  The first non-professional undergraduate program that had inquiry-based learning as its core was the Arts and Science program. In relation to health sciences, there was actually an earlier undergraduate program, the Biology- Pharmacology Co-Op program that was established between the Faculty of Health Sciences and the Department of Biology. It was unique in that the pharmacology courses were taught in the PBL format whereas all other courses were taught in the standard didactic mode and was thus a hybrid program. The co-op component was also a unique feature at that time. I was the director of that program at the time the BHSc program was set up. It was over 20 years ago, so my memory may be a bit faulty, but as far as I recall, Dr. Jack Gauldie, who was an immunologist, wrote an application for a major grant. And somewhere in that proposal there was a statement about a possible undergraduate program in Health Sciences. Dr. Susan Denburg picked up on that and thought it was a  good idea. She co-opted Dr. Glenda MacQueen who was then in the Department of Psychiatry who did all the initial spade-work to make it all happen. So really Drs. Denburg and MacQueen who should get the credit for setting it in motion. A number of us made some suggestions but we were all really bit players then. When Dr. Harnish was appointed to head the Program, he took charge and set it all up.So, in a sense it was really his vision that was important.

At the core of the BHSc program is the concept of inquiry with the goal of educating for capability. What do you believe are the most important skills that students should learn over the course of the program?  

PKR: As I mentioned earlier, at the non-professional level, the first program [that] really instituted the inquiry approach was the Arts and Science program. Though people wax eloquent about the inquiry approach, it really is nothing new. In fact, it is part and parcel of normal human behaviour. It is our school system that, having destroyed our natural instincts, rediscovered it to make a fuss about it. None of us are blank slates. We all approach new situations with prior information, intuition, prejudices. When faced with that situation we draw upon existing resources to make sense of it and when that fails learn, we learn something new to deal with the problems at hand. So, the situation guides inquiry. You can’t just get up and say, “I want to inquire.” What will you inquire about? Content-free inquiry is utter nonsense. Navel-gazing may help you get nirvana in the next world but is pretty useless in this one.  You’ve got to inquire about something. That’s what makes the problem-based approach so relevant. It is a subset of inquiry-based learning. But the great advantage of the problem-based approach is that it provides a focus for inquiry. There has to be something to be curious about. John Dewey describes it very well in his “The Logic of Inquiry.” You start with a situation that’s incomplete and you try to figure out how to complete it. It may never be complete. Yet when you get to a certain point, you can look back and say, “I started there, I’m now here. I know this now which I did not know before and this is how I know what I know.” Dewey used the term “warranted assertibility.” So, you can say with confidence, that I know this, because I’ve done it. But it’s never complete because there’s always one more step to go. Inquiry is a series of steps. That term “warranted assertibility” is the key. It means that you can state what you have learned with confidence. I can find this information, have these skills and so on. Having got this information, I know whether it’s valid or not. And then I can ask the next question”. That’s the key point. Properly conducted inquiry should provide you the confidence to justify your assertions. And you can only get that confidence if there is an objective that guides you. Essentially, all of us work on what I would like to call an intuitive Bayesian approach, we all have some notions based on prior knowledge, intuition, prejudice and some expectations. New information changes those expectations and gives us a better basis for further exploration. So that’s a self-correcting procedure. The process is natural. The only advantage of having a proper program in inquiry is that it enhances your self-correction abilities.

As a first-year student in your Cell Biology class this year, I was excited that we were asked to read an Agatha Christie story to learn about neurotoxins.  There are also several BHSc courses which bring together the fields of health science and the humanities. How has an appreciation for the importance of integrating science and the humanities influenced the BHSc curriculum and/or your own teaching philosophy?

PKR:  You are right, there are several courses in the program which permit students to move beyond the sciences and explore the arts and humanities, for instance the ones taught by Hartley, Chelsea, Bob Spree and Manjit. Personally, I firmly believe that any proper university must have strong teaching programs in the arts, humanities and sciences, otherwise they are mere teaching shops.  There’s a lovely poem by James Elroy Flecker, “To a Poet a Thousand Years hence” that captures that sentiment beautifully. There are different ways of knowing but all are an expression of the human desire to explore. The arts and the humanities look at behaviour in a slightly different way than scientists do. But the end goal is still the same to understand. We understand it in molecular terms; they understand it in other ways. But merging the two is actually [what] makes us really human. I think part of the perceived conflict between humanities and the sciences is that we don’t understand each other’s ways of thinking. And I think part of the problem lies in that nebulous, irritating, annoying word called “evidence”. We talk about evidence-based [but] what is really an evidence base? If you think seriously about it, all actions are to some extent based on evidence. Take literature for instance. In most novels that are meaningful, there’s always an undercurrent of misunderstanding of some kind and these really drives the actions that we find so compelling. Anger and jealousy fuel  a lot of novels and in most instances, these stem from protagonists looking differently at evidence or lack of it in their own personal ways. To give just two examples, there is the issue of Desdemona’s handkerchief that propels Othello’s misunderstanding and Brutus kills Caesar for what he may become rather than what he has done. It is that lack of evidence that lies at the heart of Antony’s funeral speech where he is able to sway the crowd. So, one could argue that literature too is evidence-based; it’s not just science. It’s just that they look on evidence very differently. So, to make distinctions between the humanities and the sciences is artificial.

Given that the majority of students in the BHSc program are interested in pursuing careers in healthcare-related fields, how have the unique features of the program impacted student success and career satisfaction following graduation?

PKR:  A number of factors enter the mix. They come in with very high grades from high school. That makes them strategic learners par excellence. They are able to size up a situation, know exactly what to do to get high marks and this gives them a head start, since most medical schools sadly believe that high grades predict good doctors. Also, many of the courses are essentially tailor made to help them to that end. For instance, they learn to interview standardised patients. Why patients in an undergraduate non-professional program? IF you are teaching them to communicate effectively, why not just call them subjects, rather than patients or clients.  That sets a tone. Look at all the people who have graduated. Precious few have actually done anything other than go to medical school. There are some, but they’re very, very few compared to other programs. You contrast what’s happened to the Arts and Science students, versus Health Sciences, and the proportion of students there who have done different things. So really, the courses are, to be brutally honest, simply pre-med courses. So, the structure of the program, helps them in so far as they cannot think of doing anything else. It gives them tunnel-vision. In a sense, overall, it’s has a negative impact that way. I think it helps them because of the marks they get that furthers their careers, but it doesn’t really help them because it doesn’t broaden their minds. So, IF getting admission to medical school is a measure of success, the program is extra-ordinarily successful.

A lot has changed in the worlds of health science and education over the past two decades. How has the program evolved since its inception? 

PKR: Dr. Harnish the chief architect of the program believed strongly in student centred learning. He wanted to preserve that at all costs. He was a visionary. I say that not because he was a close friend, but he was a genuine idealist.  He felt strongly that students should decide what they wanted to learn and so set up a program that gave students lot of choices in charting their ways. In many ways it is close to an ideal program. As far as I know, no other program gives students so much leeway to chart their own paths. Had his ideals been met, this would have been the best undergraduate program in the world, BUT and this is a huge but, ideals shatter on the bedrock of realities. So, over the years, the program has become what it was not really meant to be, merely a standard pre-med program where students have narrowed their focus to just one career path and consider all other options as failures. Students who may have other interests get conditioned to following the herd and do not want to come out of the closet.  A Co-op component from the outset may have provided serious opportunities to learn about and test alternatives. 

What do you think the BHSc program will look like in 20 years?  

PKR: Soothsayers often live in a fantasy world. Rarely can we look into the seeds of time and say which grain will grow and which will not. What the program will be like is uncertain. The students will, I believe, be a lot smarter and skilled. That’s inevitable. Every generation is smarter than the earlier one since they have better platforms to build on. Your class for instance is more tech savvy than the ones who  were here ten years ago. As a bunch, you are smart , delightful and a pleasure to teach. 

The problem lies somewhere else.  There are moments when I wonder whether Universities will continue to exist, other than as mere credentialising bodies. Given the penchant for podcasts, MOOCS, on-line courses, one can get certified on-line so why bother to attend a University at all? You can watch videos in your pyjamas, so why get up and sit in rooms where the acoustics are terrible, seats uncomfortable, air stifling?  Why should teachers bother, when they see students surfing the net and chatting with their chums through their laptops, while they stand in front laser-pointing at power-point slides? So, universities may just fade away as learning spaces. There’s a lovely poem by Philip Larkin, all of you should read it. It’s called Church Going. He walks into an empty church and sits there musing about such institutions. He wonders what will happen to them when people have stopped going. What will they turn into?  The whole poem is suffused with a melancholic glow, but the last stanza is particularly poignant. Get hold of it and read it. Aloud. Every time I read it, a feeling of infinite sadness creeps over me since I relate that to what may happen to Universities. I think of them as sacred spaces which preserve the richness of the past and propels students to dream of uncertain futures. But for all that to work, we need students to meet teachers, argue, discuss and dissent, not stare at videos, answer quizzes and feel happy that they have given the right answers to pre-set queries. Sports gamblers on Jeopardy win millions doing that sort of thing. I hate to think that the essence of a University, dissent, debate and irreverence will fade away. The future will be so boring then.

I spent decades of my research life working on membranes and ion transport, using Ohm’s law on a daily basis. The essence of that law is  the linkage between driving forces, flows and ease of flow. So, I am conditioned to think of fluxes. Social pressures drive actions and institutions either simply help or hinder. There is a wonderful Greek expression, attributed to Heraclitus—panta rhei, or everything flows. Universities may or may not exist, the world as we know it will be different. We should simply follow Hamlet’s advice and defy augury. The readiness is all.

Interview conducted by Sophie Zarb.


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