Health care reform won’t be successful unless students and physicians are trained in health insurance policies, system

U-M physicians call for national curriculum in health policy at medical schools in New England Journal of Medicine article

Ann Arbor, Feb. 2011: Changing medical student and resident education to include instruction in how health care systems function is critical, especially with the implementation of national health care reforms, University of Michigan physicians say.

In an article published Feb. 24 by the New England Journal of Medicine, two U-M physicians and a U-M Medical School graduate argue for a national curriculum in health policy for medical students and residents.

“Without education in health policy and the health care system, physicians are missing critical tools in their professional toolbox,” says Matthew M. Davis, M.D., M.A.P.P., associate professor at U-M in Pediatrics and Communicable Diseases, Internal Medicine and Public Policy and a co-author of the NEJM article.

 

In previous research, Davis found that less than half of graduating medical students in the U.S. say they received adequate training in understanding health care systems and the economics of practicing medicine.

  “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, M.D., M.B.A., a 2009 U-M Medical School graduate and lead author of the article.

“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,” says Patel, who is currently a second year internal medicine resident at the University of Pennsylvania School of Medicine.

Physicians who don’t understand the health care system or health insurance policies do a real disservice to their patients, says Monica Lypson, M.D., M.H.P.E., assistant dean of Graduate Medical Education at U-M and a co-author on the article.

“The health care system is complicated, but it’s no more complicated than the other things we expect  medical students and residents to learn,” Lypson says.
“Regardless of partisan persuasion or political beliefs, physician trainees and medical doctors in general should have the knowledge needed to engage in meaningful discussions regarding health policy,” she adds.

At U-M, the Medical School has added an elective course in health care policy, which Davis teaches.
“It is enrolled to the maximum,” Davis says. “The students were hungry to learn more. We have to find the best ways to teach medical students to be the best navigators of the health care system for their patients.”

In the article, authors call for a common national curriculum -- with content tailored to regional and local needs. The 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.

The authors call for implementing the new curriculum without jeopardizing other topics. Davis says policy discussions can and should be integrated with clinical instruction and permeate the educational training. They advocate for a multidisciplinary faculty to conduct the health policy training, including experts in health economics, sociology, business, and psychology.
Lypson adds that patients are demanding this kind of knowledge from their physicians.

“We don’t expect them to learn to practice medicine simply by saying, ‘Go take care of patients now’,” Lypson says. “That doesn’t work for clinical knowledge, and it doesn’t work for policy knowledge, either.”

About the University of Michigan Medical School: The School, which opened its doors in 1850, is consistently ranked among the top Medical Schools in the nation. Our 19 clinical and six basic science departments are committed to a single mission: to educate students, physicians and biomedical scholars and to provide a spectrum of comprehensive knowledge, research, patient care and service of the highest quality to the people of the state of Michigan and beyond.

La reforma del sistema de salud no tendrá éxito a menos que los estudiantes y médicos reciban instrucción acerca de las políticas de las empresas y el sistema de seguros de salud

Los médicos de la UM abogan por un currículo nacional sobre política de salud en las escuelas de medicina

ANN ARBOR: Un cambio en la educación de los estudiantes de medicina y los médicos residentes que incluya la instrucción sobre la forma en que funcionan los sistemas del cuidado de la salud es crucial, especialmente con la puesta en marcha de las reformas del sistema nacional de cuidado de la salud, indicaron los médicos de la UM.

    En un artículo que se publica el 24 de febrero en la revista New England Journal of Medicine, dos médicos de la UM y un graduado de la Escuela de Medicina de la UM abogan por un currículo nacional sobre política de salud para los estudiantes de medicina y los residentes.

    “Sin educación acerca de política de salud y el sistema de cuidado de la salud los médicos carecen de herramientas que son muy importantes en su trabajo”, dijo Matthew M. Davis, profesor asociado de Pediatría y Enfermedades Contagiosas, de Medicina Interna, y de Política Pública en la UM y coautor del artículo en NEJM.

    En una investigación anterior Davis había encontrado que menos de la mitad de los estudiantes graduados de medicina en la UM indica que han recibido una capacitación adecuada para entender los sistemas de cuidado de la salud y los aspectos económicos de la práctica de la medicina.

    “Como residente, de manera rutinaria yo cuido a pacientes que no pueden pagar por sus medicamentos o no tienen acceso a un cuidado médico regular”, dijo Mitesh S. Patel, graduado en 2009 de la Escuela de Medicina de la UM y autor principal del artículo.

    “Estos aspectos tienen un impacto mayor en la provisión y los costos del cuidado de la salud. Sin embargo es muy poco lo que se habla de ellos en las disertaciones educativas o durante las jornadas de enseñanza”, añadió Patel quien actualmente cursa el segundo año como residente en medicina interna en la Escuela de Medicina de la Universidad de Pennsylvania.

    Los médicos que no entienden el sistema de cuidado de la salud o las políticas de las compañías de seguro en realidad dan un servicio deficiente a sus pacientes, dijo Monica Lypson, decana asistente de Educación de Médicos Graduados en la UM y coautora del artículo.

    “El sistema de cuidado de la salud es complicado, pero no es más complicado que las otras cosas que esperamos que aprendan los estudiantes de medicina”, añadió Lypson. “Sean cuales sean la inclinación partidista o las creencias políticas los estudiantes de medicina y los médicos en general deberían tener el conocimiento necesario para involucrarse en discusiones significativas relacionadas con la política de salud”.

    En la UM la Escuela de Medicina ha añadido un curso electivo sobre política del cuidado de la salud, y Davis es quien dicta la enseñanza.

    “Está matriculado al máximo”, dijo Davis. “Los estudiantes estaban ansiosos por saber más. Debemos hallar la mejor forma de enseñar a los estudiantes de medicina cómo pueden navegar mejor el sistema de cuidado de la salud para sus pacientes”.

    En el artículo los autores abogan por un currículo nacional común, cuyo contenido se adapte a las necesidades regionales y locales. Los autores recomiendan proyectos pilotos iniciales que sean precursores de un currículo nacional estandarizado, y proponen un enfoque en cuatro aspectos principales: sistemas de cuidado de la salud, calidad del cuidado de la salud, valor y equidad, y políticas y ley de la salud.

    Los autores proponen la aplicación del nuevo currículo sin que disminuya otros aspectos. Davis dijo que las discusiones sobre políticas pueden y deben integrarse con la instrucción clínica y deben estar presentes en toda la capacitación educativa. En el artículo sus autores abogan por un cuerpo docente multidisciplinario que conduzca la instrucción sobre políticas de salud y que incluya aspectos de economía, sociología, empresas y psicología.

    Lypson añadió que los pacientes demandan este tipo de conocimiento por parte de sus médicos.

    “No esperamos que aprendan la práctica de la medicina simplemente diciéndoles ‘Ahora vayan y cuiden a los pacientes’”, añadió Lypson. “Eso no funciona en lo que respecta al conocimiento clínico y tampoco funciona en lo que hace al conocimiento de las políticas”.

Acerca de la Escuela de Medicina de la Universidad de Michigan: La Escuela, que abrió sus puertas en 1850, figura de manera constante entre las diez mejores escuelas de medicina en el país. Nuestros diecinueve departamentos clínicos y seis departamentos de ciencia básica están comprometidos con una única misión. Educar a los estudiantes, los médicos y los académicos biomédicos y proporcionar una gama de conocimiento integral, investigación, cuidado de pacientes y servicios de la calidad más alta a la población del Estado de Michigan y más allá.
   

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