MEDICAL SCHOOLS: Curricula Adapt to Managed Care

      In the face of managed care, medical education is undergoing what could possibly be the biggest shift "in decades ... and maybe since the early part of the century," Sunday's Boston Globe reports. Increasingly, schools are adding business, economic and ethics courses to traditional curricula. At Harvard Medical School, for example, "health policy training" and ethics are emphasized because "today's doctors routinely have to weigh costs against benefits in ways that previous generations did not." In one "telling departure from the past," the Globe explains, medical students are now taught "to document their decisions and actions in detailed ways" to prepare them for insurers' scrutiny. The "most dramatic changes," however, involve moving more practical learning experiences from the inpatient to the outpatient setting, and requiring students to spend part of their residencies in managed care offices or primary care centers.

Not in Kansas Anymore
      The transformation, observers say, "will not only change the way patients are treated, but also will likely ensure the continued growth of managed care," because new doctors accept that managed care is "a given rather than [just] one method of doing business." Administrators say students want to know how to work in managed care settings. "The students coming in today understand there is a shifting and expanded role for the physician. ... We have a responsibility to ... get them thinking about what ideal managed care should be," says Mary Lee, dean of educational affairs at Tufts University Medical School's Managed Care Institute.

Trade Off?
      Critics, however, warn that "residents with too little hospital training might be less adept at diagnosing some problems and conducting some procedures." In addition, physicians told the Globe that "they already encounter residents who give more weight to financial consideration than to possible life-prolonging treatments." David Himmelstein, an associate professor at Harvard, lamented: "I'm disturbed that we're now hatching a generation of doctors trained under the aegis of corporate greed, whose education is based on the principle 'first, make a profit'" (Pertman, 3/7).