Health illiteracy is rampant in the United States, as practicing physicians know all too well. This problem is fueled in part by the severe lack of a suitable curriculum on common human diseases in K-12 education in U.S. schools.
In response to this problem, two nationally noted professors at the University of Arizona College of Medicine-Tucson successfully have implemented an innovative pilot project that introduces high school, and now middle school, students to graduate-level medical science coursework.
Dr. Ronald S. Weinstein, a national award-winning medical educator and innovator and founding director of the Arizona Telemedicine Program, says, "We are not adequately preparing U.S. students to take life-long responsibility for their own health care."
Weinstein and Dr. Anna R. Graham, UA professor emeritus of pathology, recently introduced two medical science courses for K-12 students, one for 12th grade students at BASIS Tucson North school and the second for eighth- and ninth-grade students at BASIS Oro Valley school. Both professors are UA College of Medicine Basic Science Teacher-of-the-Year Lifetime Award winners.
"The lack of standardized K-12 coursework on our most-common life-threatening diseases, such as heart disease, cancer, stroke and diabetes, in our K-12 schools is at cross purposes with the Federal Affordable Health Act's assumption that patients will take more responsibility for their own health care," Weinstein said. "I think we're headed for a national crisis, generated by misconceptions about what American patients currently know about their own diseases. Small numbers of K-12 students are getting a smattering of exposure to medical science but it's not nearly enough.”
Since 2008, the Arizona Telemedicine Program's T-Health Institute in Phoenix has been offering components of a medical science curriculum to high school students. Early versions of the curriculum were offered in Phoenix and Tucson as a six-week Sir William Osler Summer Fellowship Program at the T-Health Institute's videoconferencing facilities at the UA College of Medicine-Phoenix. The following year, this medical science curriculum was delivered as a year-long lecture series for students at the Phoenix Union Bioscience High School. This year, the curriculum is being incorporated as a one-trimester course into the curriculum of two BASIS schools in the Tucson area.
"Our decision to offer our T-Health Institute's Sir William Osler medical science course as a regular school course at BASIS Tucson North was easy," Graham said. "We found BASIS teachers receptive to innovation and they cut through red tape. The BASIS students we work with have a wonderful work ethic and they are fully engaged in classroom activities. They know how to ask great questions and they want to learn everything we can teach them."
The Osler medical science course was introduced as a 12th-grade capstone course at BASIS Tucson North last fall. All of the students passed this single-trimester course. Currently, the medical science course is being given as an eighth- and ninth-grade course at BASIS Oro Valley.
Weinstein has been wrestling with the health literacy issue since 1975 when he was named Harriet Blair Borland Professor and chairman of pathology at Rush Medical College in Chicago. At Rush, he established an open-door policy and encouraged families of deceased patients to come to Rush-Presbyterian St. Lukes' Medical Center, Rush's flagship teaching hospital, to discuss autopsy results of any deceased family member with him.
Weinstein had intensive training in autopsy pathology in Boston and knew the potential benefits that could come from discussing autopsy findings directly with family members. Although many families took him up on his offer over the years, Weinstein found that patients' family members often lacked a rudimentary understanding of the mechanisms of diseases, despite its coverage in newspapers and magazines. Therefore, he began to explore the root causes of the low level of health literacy among patients in the United States.
Weinstein traced this low level of U.S. health literacy back to recommendations made years earlier, in the highly influential 1910 Flexner Report. Although unknowable at the time, the Flexner Report's recommendations inadvertently discouraged teaching U.S. high school and college students about human diseases years later, by encouraging that courses on human disease, including pathology, be taught exclusively in medical schools.
"Today, a college journalism student would be hard-pressed to find coursework on human diseases on our state university campuses, despite an interest in medical reporting," Weinstein notes.
Throughout the United States, pre-medical students can graduate from college knowing little about disease processes.
Weinstein and Graham believe their medical science courses can elevate the level of health literacy for future patients and their families.
"The Flexner Report, published over a century ago, effectively linked science to both medical education and best practices in health-care delivery. The idea of introducing medical science coursework into middle schools and high schools, a century later, might have delighted Flexner, one of the great thought leaders of his time."
About Dr. Ronald S. Weinstein
Weinstein is a national award-winning visionary who has created transformational innovations in education, science and health-care delivery systems. He is a Massachusetts General Hospital-trained pathologist and former chair of the UA department of pathology. Weinstein has received many honors and awards. He was the first UA physician to receive the College of Medicine's Basic Science Teacher-of-the-Year Lifetime Teaching Award in 1996, and he received the UA's "2012 Technology Innovator-of-the-Year" award. He has been the recipient of the Arizona Medical Association's Distinguished Service Award for his pioneering work in telemedicine in Arizona; the Association of Pathology Chairs Distinguished Service Award, for his leadership on modernizing medical school and pathology resident curriculum; and the Association for Pathology Informatics' Lifetime Achievement Award for his work leading to the creation of telepathology services around the globe (remote laboratory diagnostics). Weinstein often is referred to as the "father of telepathology" for inventing, patenting and then commercializing robotic telepathology, a technology that has benefited tens of thousands of patients on five continents. He has been president of six medical organizations, including the U.S. and Canadian Academy of Pathology and the American Telemedicine Association. Weinstein has more than 540 professional publications on topics ranging from cancer biology to distance education. In 2011, he co-chaired an international meeting, Collaborating Across Borders III (CAB III), which was the largest meeting on interprofessional education and collaborative medical practice to date. CAB III was held in Tucson and had 750 attendees from 11 countries. Weinstein is founding director of the Arizona Telemedicine Program, headquartered at the Arizona Health Sciences Center in Tucson and is executive director of the T-Health Institute at the UA College of Medicine-Phoenix.
About Dr. Anna R. Graham
Graham is a UA professor emerita of pathology and is scholar-in-residence in the Arizona Telemedicine Program. A graduate of the UA College of Medicine, Graham has had a distinguished career in medical education and as a leader in both organized pathology and organized medicine. She is the co-author of hundreds of professional publications and has co-authored seminal papers in the field of telepathology. Nationally, Graham was president and interim-CEO of the American Society for Clinical Pathology, the largest pathology organization in the world. She has had a career-long interest in innovations in education.
About BASIS schools
BASIS schools are a network of schools that originated in Tucson, Ariz., in 1998. They are open-enrollment public charter schools that have no entrance examinations and charge no tuition. BASIS schools are highly goal oriented, seeking to ensure all students have mastered material they will need for success in future years by implementing comprehensive exams and comprehensive external benchmarking systems. The BASIS curriculum is consistent with the highest international academic standards and is designed to help students develop academic and organizational skills, as well as a deep knowledge base. The BASIS schools' goal is to motivate students to reach their highest academic potential and prepare them for the demands of college and the workforce. The BASIS schools are at or near the top in most surveys of American public schools. At BASIS schools, the Sir William Osler medical science courses are offered as elective, single-trimester courses. UA faculty members teach these courses as BASIS school volunteer faculty members. The Sir William Osler medical science courses evolved from earlier medical science courses developed by Weinstein's medical school faculty members specifically for high school and college students from dozens of institutions over a 35-year period.
About the Flexner Report
Published in 1910, the Flexner Report is a book-length study of medical education in the United States and Canada written by a former high school teacher, Abraham Flexner. Many aspects of today's medical profession can be traced back to the Flexner Report, which called on medical schools to enact higher admission and graduation standards, and to adhere to evidence-based science protocols in their research, teaching and medical practices.
About Sir William Osler
Sir William Osler (1849-1919) was one of the legendary "Big Four" founding professors of Johns Hopkins Medical School and its first professor of medicine. He has been called the "father of modern medicine." Dr. Osler was a multifaceted physician, functioning as a medical practitioner, educator, author and pioneer in medical ethics. At the time of his death, he was one of the world's most influential physicians, best known for his innovations in medical education and his pithy aphorisms.