Preparing Students for Health Care Careers

By Angela Young 12 months ago

In the June issue of the Health Care Careers e-Letter, the following question was asked, " To help college freshmen get a jump on their health care education, what should the model curriculum of a high school health science look like? What content should be included? What are the current gaps in learning that need to be addressed?” (These questions were also disseminated to members of the listserve of the National Association of Advisors for the Health Professions [NAAHP].)

In response, we received the following feedback from readers; identifying information has been removed. (Note: These views may not necessarily reflect those of the AMA.)

At our state university, we would see the ideal high school science program as one that produces basic math competency. All of our basic science course have shown that math preparation as measured by the ACT subscores is the main predictor of success, and our data indicate that students who are not fairly well prepared in math rarely even take the MCAT and uniformly do poorly if they do. 

Of course in my other life as a community college remedial math instructor I find that the premature introduction of calculators (which apparently now occurs somewhere in early/middle elementary school) results in a body of students that have no sense if results are close and no idea about the mechanics of solving basic problems and therefore no basis to begin learning algebraic manipulations.

For physics I would like to make sure that conceptual ideas are conveyed rather than just "plug and chug" mathematical questions.  That would certainly be better for the MCAT.

I would suggest bioethics. It would be good for high school students to grapple with the questions about the ethics of health science technology. I'm working to introduce palliative care/end of life discussions to young students in college and am finding that they've never thought of the importance of deciding not to turn to technology in end-of-life care.

I believe 16 year olds who say they want to go into health care need exposure to the realities and many different career options in the health sciences. To address this, I teach a health sciences exploration course.

A number of my students point to clinical rotations classes they took in high school as formative experiences in their pre-med journeys. Virtually all who took such classes seemed to get a lot out of them. Of course, it may be that only students with pre-med leanings ever take such classes, and of course I don't hear from students who took those classes and then decided not to pursue medicine.
Still, I'm fully in favor of high school clinical classes. Without them, many students will be a year or two into college medical preparation before they step foot in a hospital or clinic to see how medicine is actually practiced.

I took AP Biology and Chemistry in high school (scoring 3 on both AP tests—I wasn't a stellar student), 10 years ago, and haven't taken a hard science class since. In college, I studied psych, literature, and education. I've always tended to be "nerdy"—I still read Discover and the Sci/Tech news articles—but I otherwise have no background in advanced bioscience.

I took a practice MCAT this year, from the AAMC web site, just to experience the test and offer better advising to students. I only scored in the 20th percentile on biological sciences. However, that score means that 20% of MCAT takers—mostly junior bioscience majors, I presume—scored lower than I did, based on my high school AP classes from 10 years ago.

Accordingly, I would not hesitate to recommend any number of AP or IB classes to pre-health students.

Gaps in science preparation are a huge problem in college and in medical school.

From my read on the ACT 2007 report, including state data:

• Each tough science course taken in high school raises the ACT science component score 1-2 points
• Only about three percent to 10 percent of Native American and African American students are prepared to make an A or B in a college biology course, compared to about 30 percent for white or Asian students.
• Students not taking tougher science courses (and math) are going to be behind and have lower grades in freshman and sophomore years

Sadly, these students with slightly lower scores and then lower grades are going to be funneled away from medical school paths by a number of internal and external mechanisms.

Science preparation must begin early, in elementary school--and we have to pay attention to birth to age 6 child development as well, which is the real factor behind top standardized test scores that set all of one's future in motion.

Over the years I have had several students who participated in a high school health occupations program run by the county public school system. The program included a shadowing/internship experience, such that students consistently had a very realistic understanding of the career that they wanted to follow and had been encouraged to think outside the box--as illustrated most dramatically by the student who said as a freshman that she wanted to be a manager of medical research lab. She went on to get a master's degree and has been working as a lab manager for several years.

To begin with, I suggest we clearly differentiate between "vocational" programs (eg LPN) and "pre-professional" programs that require undergraduate, and even graduate, education.

I am not happy with either of the above labels. Brain surgery is a vocation, but most people think of "vocational" as training that prepares students to enter the workforce at age 18. An LPN is a professional, too, but the training given to LPNs does not typically prepare them well for college classwork. I assume that most people on this list would be involved with "pre-professional" education rather than "vocational" education.

If I could deliver a message to high school students whose goals are to attend college and there prepare for health careers ranging from occupational therapy, physical therapy, physician assistant, medical technology, and nursing to pharmacy, medicine, dentistry, etc, that message would include:

• Study as many different sciences as you can (a year each of biology, chemistry, physics and geology)
• Take as much mathematics as you can
• Study a foreign language as many years as you can
• Develop as many computer skills as you can

At least here in Ohio, the most neglected math discipline is trigonometry, with some high schools not teaching it at all, and some schools folding it in as a small component of "advanced math." Over half of the "pre-med" and "pre-allied health" students we accept end up having to take remedial trig in college.

We use a self-paced modular format to teach our medical assisting and associated programs. Small groups, one-on-one teaching, hands-on as well as online courses. We use multiple techniques including technology to reach all learning styles.

Teaching a student to become a life-long independent learner, with intense support and encouragement in a nontraditional format, increases success--especially for those who were less successful in the traditional high school educational format, where one must fit the square peg in a round hole, so to speak.

For a course in high school dealing with health care, the student should be knowledgeable in the following:

• First aid and preventive medicine (for adults and children)
• Understanding of basic lab tests and what is normal, including Hgb, HCT, WBC, and cholesterol (HDL, LDL and Triglycerides)
• Know how to give a shot, how to take blood pressure, and (since home care is becoming so important in the US now) how to change IV bags

Even if the student does not pursue a career in health care, these skills will help them better handle situations that life may present.

Many high school health care career hopefuls are focused mainly on becoming pediatricians or nurses, and the allied health occupations are not within their interest levels. High school instructors would be advised to offer an objective overview of all opportunities in health care, rather than just emphasizing physicians and nurses.

Also, the service learning component is a splendid way for students to capture real-life experiences. My students are required to perform 97 hours of service learning during their 12-month program. Responses are very positive. 

For more information on high school health science curricula, educators should check out the National Consortium on Health Sciences and Technology Education. This very active group of high school educators has developed national foundation standards for high school health science education.

What we find to be the most helpful asset in applicants for our graduate programs in school counseling, school psychology, and community mental health counseling is experience. Any and allrelated experience that an applicant has, whether volunteer or paid, part time or full time, helps us to know that the applicant has taken the time to fully explore the field and is knowledgeable about the career choice being made.

In addition, we love to see that our applicants have spent time interviewing and shadowing some professionals in their field of interest: For example, spending a day with a school counselor at the middle school level and then another day with either a high school or elementary school counselor. We like them to be able to tell us what a typical day for a person in this profession is and why that fits with who they are and their future goals.

On the flip side, nothing decreases our interest faster than applicants who tell us that they will work really hard because they really want this job because they want to help people and yet they can tell us nothing about what a person in their field of interest actually does, and they have never taken the time to find out.

Speaking as faculty director of a health professions advising office, we need students who have been exposed to the myriad variety of professions in the health care field. Too many are only familiar with the physician and nurse as career opportunities. As a result, the nursing department is inundated, and those who are pre-med are not aware of viable alternative careers.

Many of the minorities who we would like to recruit into medical careers see the sciences as too difficult and do not have adequate skills in basic math and English. To help solve this issue, we work closely with community college advisors and collaborate with a health careers charter school and local high school health career clubs. However, time, money, and student motivation are persistent issues.

Although we are behind in this effort compared to most states, we are working in Texas to develop dual college-high school credit courses and implement Tech Prep models into programs of study under the US Department of Education health cluster. We have also developed new high school exit outcomes, which are posted on the Texas Higher Education Coordinating Board Web site.

One mechanism we use in our state is Marketable Skills Achievement Awards, such as EMT-Basic, certified nurse aide, medical office assistant, and central processing tech, which can be started in high school and completed during the summer after graduation from high school. These awards are 7 to 14 semester credit hours and afford the student workforce skills. The students can work part-time and continue college work on an associate degree.

Our health science and emergency services programs are using simulation with high-tech mannequins in campus labs in which students must employ critical thinking to care for a patient in a specific case scenario. Debriefing after the exercise is the most important part. Since we are a community college and don't have physician assistant or medical education, we encourage our program medical directors to come in and play the physician part when ever they can. We film the simulation and pipe it into a classroom nearby or can it for online use.

We have also found that interdisciplinary simulations involving students from multiple programs (such as nursing, paramedic, and respiratory therapy) provide more benefits to learning, and we hope such education will help to break down the silos within the health care teams with which our graduates will work.

Finally, I would mention the Institute of Medicine's Health Professions Education: A Bridge to Quality (2003), which recommends five core competencies for all health professions, one of which is high-performance work teams. The report also recommends moving away from didactic lectures and instituting more interactive teaching strategies, such as problem-based learning. 

The single most important step we can take is to encourage middle-school students to enroll in rigorous math and science courses. Students who take only the minimum requirements in middle- and high school have seriously limited their options for careers in the health professions.

Our youth need more opportunities to explore the many careers in health care as part of their regular school day. Some places are doing just that, but teachers have so many objectives to meet that exposing kids to careers in science, health, and even medicine may be given less attention.

When children are exposed to science through gross human anatomy, it stimulates interest in the microanatomy, (biology, histology, and chemistry, to name a few). Children are intimidated by the details of any subject matter, and if they are not "gifted or talented" they may not be encouraged to challenge themselves. After all, the smartest and brightest typically get the attention of educators. But there are students in the other 80 percent that have enough interest, desire, and curiosity to become a member of our future health care workforce.