Medical Educators Changing Training

Article excerpt

Faced with the rapidly shifting, often harsh realities of managed care, medical educators across the nation are training more doctors outside of hospitals and adding new courses in economics, ethics, law, and even how to document treatment decisions.

The transformation, observers say, will not only change the way patients are treated, but also will likely ensure the continued growth of managed care as incoming physicians increasingly view it as a given rather than as one method of doing business.

"It's an interesting phenomenon because medical schools in the past have not generally been about economics and business," said John McCahn, associate dean of academic affairs at Boston University Medical School. "All of a sudden we have to deal with the notion that students cannot walk out of our doors totally naive about the world in which they will be working." Mary Lee, dean of educational affairs at the four-year-old Managed Care Institute of the Tufts University Medical School, said the change has a philosophical dimension as well. "The students coming in today understand there is a shifting and expanded role for the physician," she said. "We have a responsibility to... get them thinking about what ideal managed care should be, so they can go out and try to attain that goal." The changes take many forms. A course in public health at BU for first-year medical students, for instance, now includes a section on law and medicine taught by a researcher in health-care economics. At Harvard Medical School, among many other institutions, there is an emphasis on "health- policy training" and on teaching ethics because today's doctors routinely have to weigh costs against benefits in ways that previous generations did not. …