Re: The diagnostic skills of fourteen-year olds

Dear Sir

We read Dr. Hibbs’ Letter to the Editor in Medical Teacher (Hibbs 2015) describing a clinical diagnosis activity he ran with a group of 14–15 year old students from underfunded schools in the United Kingdom. The approach Dr. Hibbs took resonated with medical students and faculty leading the Doctors of Tomorrow program at the University of Michigan (UM), USA.

In the summer of 2013, Michigan’s state capital (Detroit) became the first USA city in history to file for bankruptcy. The subsequent budget cuts had a devastating impact on Detroit Public Schools, resulting in approximately 30 school closures. Reduced opportunities for the students in Detroit will only exacerbate socioeconomic and racial disparities in medical schools in Michigan and across the USA.

In response to this educational upheaval, the UM Doctors of Tomorrow (DoT) program was developed as a “pipeline” for Detroit students interested in the medical field. DoT students in their first year of high school (approximately 30 students per year) gain exposure to the medical field through monthly hands-on field trips to UM, longitudinal academic mentoring from medical students, and career development opportunities including volunteer experiences, physician shadowing and summer health internships.

With Dr. Hibbs’ support, we were able to recreate his clinical diagnosis activity across “the pond” with a group of 20 DoT students (ages 13–16). Students were grouped into teams and tasked with diagnosing a theoretical unresponsive ER patient. They received an EKG, chest X-ray, blood/sputum culture and arterial blood gas measurement as evidence, along with basic guides on how to interpret these studies. DoT students critically worked through medical knowledge, collaborated and problem-solved as teams, and were enthusiastically engaged. The success of this activity enabled expansion of the curriculum into a three-part mini-course on developing clinical diagnostic skills for senior high school students. This cross-national experiment in implementing clinical reasoning education in low-resource high schools as a means of fostering students’ interest in medical professions bodes well for continued adoption across diverse cultures and communities.

Declaration of interest: The authors report no declarations of interest.