PHILADELPHIA -- How would you like your car to be fixed by someone who had no knowledge of what it was like to drive? That’s the dilemma facing medical students whose training is focused on learning about medicine in medical school, but spend practically no class time learning about the real life obstacle course of the health care system which every one of their patients must learn to navigate.
“As a resident, I routinely care for patients who cannot afford their medications or don’t have access to regular medical care,” says Mitesh S. Patel, MD, MBA, a second year internal medicine resident at the Perelman School of Medicine, and the author of a new column in the New England Journal of Medicine calling for a standardized core health policy curriculum to be collectively adopted by schools throughout the country. “These issues have a major impact on the delivery and cost of health care. However, they are rarely discussed in educational lectures or during teaching rounds.”
“The health care system is too complex to learn on the go,” he says. “Instead we need to begin learning about health policy and its impact on patients when we start learning the basics of anatomy, physiology, and pharmacology.” The piece follows the authors’ prior work in Academic Medicine from 2009, which was highlighted in the New York Times.
Patel’s earlier research found that U.S. medical students have far less confidence in their knowledge about the health care system than in their knowledge of clinical issues. This deficit leaves medical students without insights and abilities that can help in their care of patients in the complex U.S. health care system. Now, with national health care reform signed into law in 2010, he would like to see medical student education expanded to include more about health policy.
The call for a common national curriculum -- with content tailored for regional and local needs -- flows from the fact that after graduation medical students disperse to residency programs nationwide. Patel and his co-authors recommend early pilot projects as a precursor to a standardized national curriculum and propose a focus on four concentrations: health care systems, health care quality, value and equity, and health politics and law.
Penn’s School of Medicine (SOM) is among the leading medical schools in the nation to place a greater emphasis on teaching health policy issues. In a 2009 study by Patel of higher versus lower intensity curriculum in health care systems, Penn’s School of Medicine ranked among the schools with a higher intensity of available health care system studies. Since 1997, the SOM’s curriculum has included all of the four areas that Patel suggests as part of the core required curriculum.
Patel and his co-authors call for implementing the new curriculum without jeopardizing other topics. Patel said, “We know from our earlier research that policy topics can be intermixed with other parts of the curriculum.” They advocate a multidisciplinary faculty to conduct the health policy training, including experts in health economics, sociology, business, and psychology.
Patel's co-author, Monica Lypson, MD, an assistant dean of Graduate Medical Education at the University of Michigan adds, “Regardless of party affiliation or political beliefs, physician trainees and medical doctors in general should have the knowledge to engage in meaningful discussions about health policy.”