By Keith L. Black, MD

The United States is often seen as a scientific, engineering society, from the Panama Canal and developing a polio vaccine to putting the first man on the moon and pioneering advances in neurosurgery, yet such generalizations often become dated. America's best and brightest used to go into science and medicine, but no longer.

The United States consistently ranks low in comparison to other developed countries on assessments of scientific literacy. "One-half of the American public does not know the earth goes around the sun once a year and believes that the earliest humans lived at the same time as the dinosaurs." [1] The 1996 Third International Mathematics and Science Study ranked U.S. eighth-grade students 17th out of 41 countries. In 2000, the same study found no change in the United States' ranking. U.S. students even fail to meet U.S. standards. A 1996 National Assessment of Educational Progress survey found that 43 percent of high school seniors did not meet basic standards for science knowledge.

Part of the problem may be that rote memorization and cramming of concepts has assumed a greater role in education as the emphasis on tests has increased. Beyond being less interesting and challenging, studies have found that teaching to tests causes students to gain only the "most elementary knowledge and skills" but with far "less of a deep understanding of even a few topics." [2] This argument is supported by the finding that when new tests are administered, previously tested skills and knowledge do not transfer and test scores plummet. [3] This "teaching-to-the-test" is one of the reasons cited for the United States' poor showing in international science achievement tests. [4]

This data does not portend well for the future. Native-born Americans are not learning about science and, if they do not, they will not enter science and medical programs as much as they once did. If native-born Americans are not going into the sciences and medicine, some argue that a continuing influx of foreign students will provide the scientists, doctors and medical researchers of the future. There is, however, rising competition for the best and brightest from around the world. In the 1990s, foreign students flooded into graduate programs in the United States. During the decade of the 1990s, the United States awarded about 62,000 doctorates to foreign students on temporary visas. In 2000, immigrants made up 38 percent of science and engineering employees with doctorates and 29 percent of master's degrees.

The influx, however, may be slowing. After September 11, 2001, immigration to the United States has become much more difficult, even as other developed nations are developing their own science and technology programs to attract their brightest citizens. Many foreign graduate programs are flourishing, with 24 nations awarding a higher percentage of science and engineering degrees than the United States. In 2000, the United States awarded 5.7 science degrees per 100 24-year-olds, while Finland, which awarded the highest proportion, awarded 13.2 per 100. Even worse, many of those who entered science, engineering and medicine during the boom of the 1960s and 1970s are now nearing retirement age. Without changes to science education in the United States that attracts more American young people, the United States may face an economically damaging shortage of physicians, medical researchers, engineers and technicians.

The United States has led the world in science. Bronx Science High School has produced more Nobel Prize winners than any other high school in the world (five, all in physics), and the United States has won more Nobel Prizes than any other nation. In part this record is on the strength of its immigrants, but it is also based on the strength of its education system. Science education must be taught creatively, allowing students to experience the wonder, challenge and rewards of addressing basic questions in science, engineering and medicine. Rote-learning is needed for fundamental knowledge, but to produce the Nobel Prize winners of tomorrow, creativity and a passion for science must be fostered or the United States soon will be far from leading the world into the frontiers of science, medicine and technology. If the United States fails, one day in the future you might visit your doctor and be seen, via video-conferencing, by a doctor in Tokyo, Bangalore or Kiev.

To encourage young people to enter the challenging and rewarding world of science and medicine, each year the Maxine Dunitz Neurosurgical Institute (MDNSI) hosts Brainworks. The day long, educational program brings seventh and eighth grade students to Cedars-Sinai Medical Center (CSMC). The students have the opportunity to have their passion fired by a series of hands-on experiences. They perform simulated brain surgery using a teaching tool developed by a manufacturer of computer-assisted, surgical navigation equipment, observe laboratory technicians prepare tissue samples for testing, and examine sheep's brains. Students also can experience how patients undergoing rehabilitation therapy feel when they are restricted to wheelchairs, have vision or hearing difficulties, or lose the use of a hand or arm. The students also have the opportunity to meet Cedars-Sinai's only four-legged volunteers - the hospital's canine pet therapists.

MDNSI developed the idea of Brainworks in 1997 to help young people discover the excitement that comes from scientific research, the reward of applying research skills to solving medical problems and the satisfaction that comes from helping patients. Surgeons, scientists, social workers, physicians, therapists, nurses and other members of the team from the MDNSI and several Cedars-Sinai Medical Center departments share aspects of their work with students and attempted to inspire them to pursue careers in medical research, patient care and surgery.

For older students, the CSMC Division of Neurosurgery offers the Pauletta and Denzel Washington Family Gifted Scholars Program in Neuroscience for undergraduate, graduate and medical students. It is designed to mentor and encourage young, potential scientists and physicians to pursue neurological research. The Washingtons want to support the dreams of young adults in the sciences, and the MDNSI has committed itself to providing educational programs. The Award further demonstrates the Institute's strong commitment to support the development of future neuroscientists.

Each year, one undergraduate student receives a $2,000 monthly stipend and one graduate or medical student will receive a $2,500 monthly stipend. Awardees continue to be mentored by Dr. Keith Black, MDNSI Director, after their fellowship. Awardees conduct research in the Institute's laboratory during the summer and then submit a research paper or abstract to a conference. If accepted, the Institute covers travel expenses to present their work at the meeting.

Through such programs, the MDNSI seeks to encourage young people to enter science and medicine, filling the looming gap in researchers that could greatly harm the United States in the near future if more of our best and brightest opt for careers in other fields.

1. NSF, Science and Engineering Indicators 1996, 3-21. Washington, DC: U.S. Government Printing Office, p.8.
2. Stake, R.E. (1991) The Teacher, Standardized Testing and Prospects of Revolution. Phi Delta Kappan, pp.243-247 (citation p.246).
3. Bracey, G.A. (2000) The 10th Bracey Report on the Condition of Public Education. Phi Delta Kappan. pp.133-144.
4. McKnight, C., Crosswhite, F., Dossey, J, Kifer, E., Swafford, S., Traver., K., Cooney, T., (1987). The Underachieving Curriculum: Assessing U.S. School Mathematics from an International Perspective. Champaign, IL: Stipes.