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

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.