Teaching Health Policy in Medical School

In a column published in the New England Journal of Medicine, a physician at the University of Pennsylvania School of Medicine addressed a major issue facing medical students. Although their training is focused on learning about medicine in medical school, these students spend very limited class time learning about the real life obstacle course of the health care system which every one of their patients must learn to navigate.

Mitesh S. Patel, MD, MBA, a second year internal medicine resident, equates the dilemma to having a car fixed by someone who has no knowledge of what it is like to drive. “As a resident, I routinely care for patients who cannot afford their medications or don’t have access to regular medical care,” said Patel, who is 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 said in a press release. “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 US medical students have far less confidence in their knowledge about the health care system than in their knowledge of clinical issues, leaving them without insights and abilities that can help in their care of patients. 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.

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.

“Unless medical schools and residency programs embrace new educational initiatives in health policy, health care reform will not be able to achieve its greatest possible impact—and this failure may well have unfortunate consequences for both physicians and their patients,” the authors wrote.

For more:

• Call for Medical Schools to Teach Students Health Policy Issues Facing Patients
• Advancing Medical Education by Teaching Health Policy (NJEM)
• The State of Health Policy Education in U.S. Medical Schools (NEJM)