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May 1, 1995
Vol. 52
No. 8

How Health Career Academies Provide Work-Based Learning

Properly structured jobs, whether paid or unpaid, can provide high school students with the opportunity to apply and extend what they have learned. Health-related occupations lend themselves readily to this career-related model of education.

In American high schools, the benefits of learning by doing have traditionally been reserved for students enrolled in vocational education courses. Each year, about half a million students participate in cooperative education or other arrangements where specific learning objectives are met through part-time employment in office occupations, retailing, and other vocational fields. Vocational classes also engage tens of thousands of students each year in school-based enterprises, where they build houses, run restaurants, repair cars, operate retail stores, staff child care centers, and provide other such services (Stern, Stone et al. 1994).
But major changes are now taking place in vocational education. Today's high school diploma provides access to fewer and fewer stable, high-paying jobs. Accordingly, more of the training for specific occupations is taking place in two-year colleges and post-secondary technical institutes.
At the high school level, new forms of career-related education are creating options for all students, from the developmentally disabled to the academically gifted. Among the new models are career academies, youth apprenticeships, and tech prep and career major programs. These models use work-related themes to focus the curriculum and prepare students for post-secondary education, including four-year colleges and universities. (The history of vocational education in this country shows that unless the four-year college option is kept open, it will be difficult to attract ambitious students and avoid acquiring a second-rate image.) These new options were supported by the 1990 Perkins Act and by the 1994 School-to-Work Opportunities Act, but successful implementation requires changes that go well beyond the traditional vocational departments of the high school.

The New Models

Work-based learning plays a key role in the new models of career-related education. Unlike cooperative education or school-based enterprises tied to vocational classes, however, the new programs also relate students' work experience to non-vocational subjects including math, English, science, and social studies. In many instances, the new models also ensure that students satisfy the course requirements for admission to four-year colleges and universities.
Health-related occupations lend themselves readily to the new career-related models. A high school curriculum that deals with health careers can provide a start for students who aspire to become doctors, nurses, or medical researchers, while at the same time preparing students who may want to enter a period of full-time employment immediately after high school as nursing assistants or emergency medical technicians. The health field also has a tradition of internship and work-based learning.
We recently studied four health career programs in California (Stern et al. 1994) that are based on the career academy model (Stern et al. 1992). In these programs, structured work-based learning for students begins during the junior year with a series of job shadowing assignments. Local hospitals, clinics, and medical offices then provide students with paid jobs between their junior and senior years. This is a standard feature of the career academy model. During the senior year, the rotations—which are mainly unpaid—continue. For some students, these senior year placements satisfy the clinical requirements for certification as nursing, hospital, or office medical assistants.
Although work-based learning is common practice in the health field, it is sometimes difficult to find internships for high school students, in part because the presence of so many other kinds of student trainees in health care settings strains the capacity of supervisors. Hospitals and clinics also worry about legal liability if a student should make a mistake. For these reasons, initial worksite placements usually consist of either pure observation or hands-on work in positions not involving direct patient care.
Even observation can be instructive and inspiring, however. For example, one student who plans to be a doctor was thrilled at the opportunity to see open heart surgery. And there are many positions where students can experience real responsibility. Non-patient-care jobs—including medical research, information services, and marketing—are plentiful in the health care field.
One student tells how he has gained from his experience in an office setting: I plan on becoming a medical doctor. And I think this gives me a chance to see what it's like working in a business setting. Doctors are not expected to only work with patients, but also to handle some other stuff, too. Despite this young man's enthusiasm, however, students indicate that, on average, they feel they learn more when they are involved in direct patient care.
Employer motivation for accepting high school trainees seems to be a combination of altruism and enlightened self-interest in creating opportunities for young people to enter the health care field. A manager who played an important part in implementing the placement program pointed out how working with students provides personal satisfaction to the employees who supervise them: It gives the supervisor another conduit to allow someone [else to develop] supervisory skills.... It's mutually beneficial from that perspective. The supervisors also see this as a chance to give back, where they have achieved ... their [own] success. They see this as an opportunity to be at the starting gate with somebody who in the next couple of years will be looking for regular employment.

An Integrated Curriculum

An essential part of work-based learning is reflection. Students write about what they have seen and done in the workplace, and they discuss their writing in class. This process allows them to see how the problems they have confronted at work may relate to the subjects they have studied in school.
Because most real-world problems do not fit neatly within the bounds of any one subject area, the curriculum in these new career-oriented programs tends to be interdisciplinary. In the programs we studied, teachers in academic courses integrate the health care theme into their lessons. For example, the math teacher in one program encourages such projects as analyzing forces and angles in physical therapy, designing a building to house a health clinic, and determining how much money a medical assistant must save in five years in order to pay for full-time college attendance. Such thematic integration does not require any change in the basic high school schedule, where individual teachers are responsible for students during their own class periods.
A less common approach, which does alter the basic schedule, involves students in interdisciplinary projects. If students receive credit for a project in more than one course, teachers must share responsibility to some extent. As de Leeuw and colleagues say: The boundaries among disciplines [become] less important than the issues being analyzed, skills being mastered, concepts being understood. Ultimately, students in a highly integrated program would not even need to know which course they were in at any particular moment (1992, p.ii).
The simplest version of the integrated approach involves teachers working in pairs. For example, the biology teacher and the health technology teacher in one program teamed up to combine a study of the physiology of the heart with training in cardiopulmonary resuscitation. More far-reaching curricular integration would require significant restructuring to allow for common preparation periods and flexible course scheduling (Stern et al. 1992, Grubb et al. 1990).
In addition, if teachers are to participate effectively in career-related interdisciplinary programs that include work-based learning, they should have some familiarity with the field being studied. Some of the non-vocational teachers in the health career programs we studied found it beneficial to arrange their own summer placements in health care settings.

Post-Secondary Education

Teachers in the California health career academies are committed to offering programs for college-bound students as well as for those who are not. They have taken pains to create a curricular sequence that enables students to meet all of the University of California requirements for admission and at the same time provides students with practical work skills.
In addition, they have formed direct connections with local two-year colleges that offer a variety of related courses and programs. The tech prep model promoted by federal law in 1990 has provided impetus for combining the last two years of high school with two years of post-secondary study leading to an associate degree in a technical field.
One of the health career programs we studied was developing this type of tech prep sequence. In all four programs, some students had also enrolled in community colleges for particular courses such as medical terminology. Students who chose to enter community college after graduation from high school could count these courses toward an associate degree.

The Challenge

There is plenty of justification for expanding opportunities for work-based learning in American high schools. In addition to the benefits of learning in context, there is the simple fact that teenagers like the experience of being in the adult world of work (Hamilton 1990). Further, the health career programs we have described demonstrate that schools can arrange high-quality work experiences for students. Studies of other programs have come to the same conclusion (Pauly et al. 1994).
For work-based learning to be most beneficial, however, it should be connected to an interdisciplinary curriculum in which academic and occupational content are combined, and where students are prepared for post-secondary education as well as work. This is a tall order. Teachers, administrators, and counselors—in collaboration with employers and community members—must be prepared to invest a large amount of time and effort to make it happen.
  • Teachers of academic subjects should be equipped, and paid, to share the responsibility for supervising students' work-based learning. Participation by non-vocational teachers is essential if work-based learning is to be tied to an integrated curriculum. Additionally, most academic teachers will need some direct exposure—possibly in summer internships—to the industry in which their students are working.
  • Vocational and academic teachers need time to work together, and with representatives of employers and higher education, to develop integrated curriculums. Common preparation periods are crucial to the creation of interdisciplinary, project-oriented curriculums that provide active, hands-on learning opportunities for students.
  • It is important to preserve the student's option to attend a four-year college. This avoids limiting future career prospects, and helps prevent career-related programs from acquiring a second-best image.
Career-focused educational options that incorporate work-based learning experiences are important. After all, schools should be teaching students how to succeed not only in the classroom, but also in the world.
References

de Leeuw, D., C. Hertenstein, M. Jackson, J. Lum, S. O'Donoghue, M. Rahn, V. Rubin, D. Stern, and A. Whitehurst-Gordon. (1992). Examples of Integrated Academic and Vocational Curriculum from High School Academies in the Oakland Unified School District. Berkeley: National Center for Research in Vocational Education, University of California.

Grubb, W. N., D. Davis, J. Lum, J. Plihal, and C. Morgaine. (1990). “The Cunning Hand, the Cultured Mind”: Models for Integrating Vocational and Academic Education. Berkeley, Calif.: National Center for Research in Vocational Education, University of California.

Hamilton, S. F. (1990). Apprenticeship for Adulthood. New York: The Free Press.

Pauly, E., H. Kopp, and J. Haimson. (1994). Home-Grown Lessons: Innovative Programs Linking Work and High School. New York: Manpower Demonstration Research Corporation.

Stern, D., M. Raby, and C. Dayton. (1992). Career Academies: Partnerships for Reconstructing American High Schools. San Francisco: Jossey-Bass.

Stern, D., M. Rahn, and Y.-P. Chung. (1994). High School to Career. Berkeley, Calif.: California Policy Seminar, University of California.

Stern, D., J. Stone III, C. Hopkins, M. McMillion, and R. Crain. (1994). School-Based Enterprise: Productive Learning in American High Schools. San Francisco: Jossey-Bass.

David Stern has been a contributor to Educational Leadership.

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