Medical Schools, Students See Gaps in Policy Education

Should health policy be a bigger part of medical students' education?

While most medical students feel obligated to put the Patient Protection and Affordable Care Act into practice, they don't understand much about it, a study shows.

The study's survey results, published in the Archives of Internal Medicine, are from a January 2011 survey of all medical students in Minnesota, asking three things about the PPACA:

• Did students understand the PPACA;
• Did they support it;
• Were they obligated to help implement it?

More than half, 69%, said they did feel obligated to help implement the ACA. But, only 48% said they understood the basic components of it.

Students were surveyed just nine months after the President signed healthcare reform into law. The study's author, Tyler Winkelman MD, of the University of Minnesota, says even now, a year and a half later, he doesn't think the results would change.

"When we surveyed those students, the ACA was all over the news. I obviously don't have any evidence, because there hasn't been another survey like ours, but I don't think the results would be much different."

Winkelman's results mirror a similar survey of medical school deans in the U.S. in 2010 who said that their schools didn't offer enough health policy education. In that study, published in the New England Journal of Medicine in March 2011, 52% of schools said they were increasing health policy courses.

One issue, says Barbara McNeil MD, PhD, founding head of the Department of Health Care Policy at Harvard Medical School, is time. 

"During their first year, medical students are required to take a course in health policy. It's a good time to give them a general background. But, for most medical students, it's very hard to put something in that's a required course during the clinical years. It's just the nature of the way the curriculum works."

McNeil also says scrutinizing the details of healthcare policies doesn't serve medical students well.

"Our goal is not to get into the nitty gritty of every little regulatory aspect. That's not appropriate for medical students. They need to think bigger picture."

Students at Harvard did start thinking about the broader issue of healthcare policy nearly ten years ago. That's when they launched the website, improveyourhealth.org. It supplements the policy issues that they don't get covered in the classroom or in residency.

This year, Harvard medical students have added something called "journal clubs," a small gathering of about 20-50 students who get together to discuss case studies on health policy.

Joanne Conroy MD, Chief Health Care officer for the Association of American Medical Colleges, says it's time to step up healthcare policy education at medical schools. 

"Everybody's doing things within their own institutions, and there's probably a place for a very thoughtful curriculum to help educate future health professionals."

The AAMC is looking into forming a working group to address the issue, and Conroy believes they're close to coming up with a formal proposal for curriculum that could work during residency.