With health care reform on the minds of millions of Americans, less than half of graduating medical students say they have an adequate understanding of the health care system, according to a recent study conducted by the University’s Medical School.

The study surveyed more than 58,000 graduating medical students across the nation from 2003 to 2007. Although the majority of students said they were more than confident with their clinical training, 40 to 50 percent said their knowledge of the health care system was lacking.

“Compared with the amount of time and effort spent to teach students the clinical knowledge and clinical skills they need to practice medicine, the amount of time and effort dedicated to teaching about health system issues and health policy is very small,” said Dr. Matthew Davis, senior author of the study and associate professor of pediatrics and internal medicine in the Child Health Evaluation and Research Unit at the Medical School.

“Teaching medical students about the health care system and why it works the way it does can help students become doctors who help their patients more effectively,” Davis said.

The curriculum for Medical School students seems to be consistent with the national trend.

Akash Goel, a second-year Medical School student, said although the Medical School is “slowly making strides towards having more faculty and encouraging more research in the humanitarian aspects of medicine, it does feel a little frustrating at times to see a lack of opportunity in those avenues.”

“Granted, medical school is not really focused on policy,” he said. “But I think that given the topical nature of health reform, I think that I am not more prepared to talk on health reform than anyone else and I am going to be dedicating my life to medicine.”

Owen Darr, a second-year Medical School student, said he feels that becoming well versed in health care policy is a key step on the way to becoming a good doctor.

“It’s something that patients are concerned with, and hospitals are concerned with,” Darr said. “That puts us right in the middle.”

Darr said he plans on taking elective courses on health care policy in the coming semester.

Faculty members at the School of Public Health, which offers classes on health care policy, have taken notice of the lack of opportunities for medical students to explore more social dimensions of medicine.

“If you want to treat patients you might want to know about what kind of health insurance they have,” said Richard Lichtenstein, associate professor of the Department of Health Management and Policy in the School of Public Health.

Lichtenstein, who teaches a course on the U.S. health care system, has found that the traditional medical school curriculum that focuses mainly on clinical matters leads many practicing doctors to return for additional schooling.

“The last class we had 34 people and 26 were physicians,” said Lichtenstein. “People start to develop this knowledge that they don’t know enough and want to learn more.”

Connections between the Medical School and the School of Public Health, which offers courses on health care policy, have been set up to provide opportunities for students to gain practical knowledge of how the health care system works, according to Dr. Paula Lantz, chair of the Department of Health Management and Policy at the School of Public Health.

“There are many opportunities for medical students, residents and fellows to get a degree in public health,” Lantz said. “For example, we have a joint program with the Medical School through which someone can get their M.D. and M.P.H. in five years.

“Given what is required to train people to be good physicians, there is not much time left for education regarding the health care delivery system, population health issues and health policy,” Lantz said.

Goel said that medical school students may benefit from a greater focus on the doctor-patient relationship in the school’s curriculum.

“There is a significant amount of material that we have to cover and a lot of the time I don’t feel we spend enough time on clinical medicine,” Goel said.

Time constraints aside, many professors, as well as doctors, still feel that knowledge of how health care works is an essential part of becoming a good doctor.

“Our patients depend on us to help them navigate the U.S. health care system, which can be very hard to understand,” Davis said. “Teaching medical students about the health care system and why it works the way it does can help students become doctors who help their patients more effectively.”

He added: “A systematic approach to teaching medical students and residents more about the health care system would enhance medical education and better prepare people for the practice of medicine.”

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