Program gives laypeople abridged medical education

ST. LOUIS -- A businesswoman dons latex gloves and tentatively touches a finger to a human kidney. The teenage boy next to her lifts the organ, registering its heft, and turns it for a panoramic view.

It's bean-shaped and bleached gray from a long formaldehyde bath. Even to the untrained observer, it looks normal when compared with the cyst-riddled specimen being passed on a second tray.

Dr. Stephen Miller, a nephrologist and chief of medicine at Barnes-Jewish Hospital, is using the organs as props in his lecture on kidney disease to a Mini-Medical School class, a Washington University program that's open to all comers ages 15 and up.

Miller promises to teach the class enough nephrology in the next hour to impress their friends at the next bridge party.

He reels the audience in.

"Part of being a teacher is finding a hook to your audience," he said later. "We in health care have a phenomenal advantage. People's interest in their own bodies and health care is enormous."

No prerequisites

You need look no further than the packed lecture hall at the Mini-Medical School for proof. Since the inaugural course in 1999, the program and its spinoffs have filled by word of mouth.

There's no academic prerequisite. Hypochondriacs might want to steer clear. Students might find a strong stomach to be an asset because some of the visual aids are explicit.

Sue Gallop, 65, of Ladue, attended a Mini-Medical School lecture on eye disease last fall, three days before her cataract surgery. She had not planned it that way. She just got lucky.

Dr. Russell Van Gelder, an assistant professor of ophthalmology, gave a class on the anatomy of the eye and causes of blindness. He narrated a video that showed a blade slicing into an eye and a surgeon using a tool that shatters and vacuums the cloudy lens.

"I found it fascinating; my friend couldn't look. She knew I was having the surgery," said Gallop, who along with friend Joyce Lewin took the class to be better advocates in their health care. "You have to take charge. Doctors are very busy. You need to speak up for yourself."

Dr. Cynthia Wichelman, the course organizer, said she has had only one casualty in five years of offering the class: A graduation-night guest who did not hear a warning about the content of a plastic-surgery video fainted.

"The majority of people who take the class are not going to be the queasy type," she said.

The fall class of Mini-Med I included housewives, engineers, lawyers, real estate agents, students considering careers in medicine, elementary and college teachers, active and retired executives, and a retired doctor and nurse. Women outnumbered men by a 2-to-1 ratio.

The program's graduates include musicians, trades people, massage therapists, hairstylists, pilots, venture capitalists, accountants, politicians, and hospital and university board members. Husbands and wives, mothers and sons, fathers and daughters have taken the class together.

Wichelman, an emergency medicine specialist and the program's founder, enlists heavyweights in academic research, clinical practice and health-care administration as speakers. She charms night-school commitments from professionals whose days start before sunrise.

Since the first Mini-Medical School class convened at the University of Colorado in 1990, about 80 other programs have been launched nationwide.

Unlike a regular medical-school course, where classmates share a basic knowledge of anatomy and cell biology, the Mini-Medical School mixes people with solid science backgrounds and people whose medical knowledge is limited to their experience on the cold end of the stethoscope.

Wichelman said she asks lecturers "to structure for the audience, but not to dumb down the material."

When Washington University announced the start of its program in a modest advertisement five years ago, it got 900 applicants for about 110 slots.

Graduates clamored for more. Wichelman developed Mini-Med II and Mini-Med III in response. Each class meets two hours weekly for eight weeks. The classes are designed to be taken in sequence.

"If you do all three, you come out with a remarkable volume of medical knowledge," Wichelman said. Graduates are able to talk better with their physicians, which "leads to more sound health care. That is a tremendous payback."

Mini-Med I, held in the spring and fall, focuses on the symptoms and treatment of disease. Mini-Med II, offered only in the spring, has an emphasis on diagnosis. Mini-Med III, offered only in the fall, focuses on treatment as well as the relationship between physician and patient. All the courses have a changing roster of campus stars and senior executives.

On lab night in Mini-Med I, students slip into paper surgical scrubs before testing their dexterity in a laparoscopic surgery lab. Students peer into two-dimensional viewers as they make mechanical arms fish for gumball-machine-size toys. In another staging area, surgical residents guide class members in clumsy attempts to suture rubber membrane.

Mini-Med II enrollees use otoscopes and stethoscopes to examine actors posing as patients. They can handle a spleen and a liver and get certified in cardiopulmonary-pulmonary resuscitation. In Mini-Med III, doctors describe their work and bring in patients who talk about their diseases and treatments.

Stacy Wagenblast, 44, presents at the Mini-Medical School as a patient of Dr. Ralph Dacey Jr., chairman of neurosurgery. Dacey removed a nonmalignant tumor from the membrane surrounding Wagenblast's brain. Wagenblast, a Christian Hospital Northeast radiation therapist, said her first symptom was a doozy. A brain seizure felled her outside a grocery, and she woke up in an ambulance. She told everyone who came to see her at the hospital that she'd be dead in six months.

The radiation oncologist she worked for called Dacey. He performed a six-hour surgery on Wagenblast at Barnes-Jewish in March 2001.

"I just came out perfect," Wagenblast said. "I don't really like to speak in public, but I would do anything for this man."

Miller, chief of medicine at Barnes-Jewish, said he structures his lecture so everyone in the class can learn something, irrespective of their foundation in cell biology and grasp of human anatomy or medical technology. He said he volunteers his time to the Mini-Medical School program because he loves to teach and he believes the effort will nurture goodwill between doctors and future patients.

"Right now, there is a lot of dissatisfaction with health care in the United States. The payers aren't happy. The patients aren't happy and the providers aren't happy," Miller said, adding that Mini-Medical School links providers to members of the public and builds a foundation of trust.