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Author Notes:

Correspondence: Ronald S. Weinstein, Department of Pathology, College of Medicine, University of Arizona, Tucson, AZ, USA. Email: rweinstein@telemedicine.arizona.edu

Early phases of this work were carried out at Phoenix Union Biosciences High School, in downtown Phoenix, Arizona, and at the nearby T-Health Institute (eg, Institute of Advanced Telemedicine and Telehealth), the Phoenix division of the Arizona Telemedicine Program, located in downtown Phoenix.

The Arizona Telemedicine Program is headquartered in Tucson, Arizona.

Anna R. Graham, MD, Professor Emeritus in Pathology at the University of Arizona–Tucson, participated in early work on this project as Scholar-in-Residence in the Arizona Telemedicine Program and made major contribution to the design and testing of the gateway general pathology course for K-12 students.

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.


Research Funding:

The author(s) received no financial support for the research, authorship, and/or publication of this article.


  • Flexner 2.0
  • Flexner 3.0
  • Flexner 4.0
  • Second Flexner Century
  • health literacy
  • medical education
  • medical science

Second Flexner Century: The Democratization of Medical Knowledge: Repurposing a General Pathology Course Into Multigrade-Level "Gateway" Courses.


Journal Title:

Academic Pathology


Volume 4


, Pages 2374289517718872-2374289517718872

Type of Work:

Article | Final Publisher PDF


Starting in 1910, the "Flexner Revolution" in medical education catalyzed the transformation of the US medical education enterprise from a proprietary medical school dominated system into a university-based medical school system. In the 21st century, what we refer to as the "Second Flexner Century" shifts focus from the education of medical students to the education of the general population in the "4 health literacies." Compared with the remarkable success of the first Flexner Revolution, retrofitting medical science education into the US general population today, starting with K-12 students, is a more daunting task. The stakes are high. The emergence of the patient-centered medical home as a health-care delivery model and the revelation that medical errors are the third leading cause of adult deaths in the United States are drivers of population education reform. In this century, patients will be expected to assume far greater responsibility for their own health care as full members of health-care teams. For us, this process began in the run-up to the "Second Flexner Century" with the creation and testing of a general pathology course, repurposed as a series of "gateway" courses on mechanisms of diseases, suitable for introduction at multiple insertion points in the US education continuum. In this article, we describe nomenclature for these gateway courses and a "top-down" strategy for creating pathology coursework for nonmedical students. Finally, we list opportunities for academic pathology departments to engage in a national "Democratization of Medical Knowledge" initiative.

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© The Author(s) 2017

This is an Open Access work distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 International License (http://creativecommons.org/licenses/by-nc/4.0/).

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