Purpose: Little is known about the effect of managed care on medical students' education. Because clerkship directors (CDs) are especially well positioned to observe any changes, this study surveyed CDs from six medical specialties about their perceptions of the effects of managed care on medical students' education.
Method: Anonymous questionnaires were mailed to 808 CDs from departments of six medical specialties at 125 U.S. allopathic medical schools between October 1997 and March 1998. Among other questions, respondents were asked whether they had observed changes in 19 different aspects of medical students' education, whether these changes were beneficial or detrimental, and whether they believed the changes were due to managed care and/or to other factors. Results were analyzed to determine perceptions of the overall magnitude and source(s) of changes, the perceived positive versus negative effect of managed care, and whether these outcomes were statistically associated with the perceived degree of managed care's market penetration.
Results: Five hundred questionnaires (61.9%) were returned. For full-time and voluntary faculty teaching, faculty availability for educational administration, directors' clinical responsibilities, and quality of professional life, the most common response was that managed care had an adverse effect. For faculty's enthusiasm for teaching, directors' administrative and educational duties, and clerkship training sites, the second most common response after “not changed” was that managed care had a negative effect. The majority of respondents held negative opinions of managed care and thought that medical students did not understand it.
Conclusions: CDs in six medical specialties perceived that managed care has negatively affected medical students' education. These perceptions may influence medical students' education. Measures must be taken to ensure excellent education through adequate resources and training in the context of high-quality medical care.
Dr. Brodkey is clinical associate professor, Department of Psychiatry, at the University of Pennsylvania, Philadelphia. Dr. Sierles is professor, Department of Psychiatry and Behavioral Sciences, at Finch University of Health Sciences/Chicago Medical School, Illinois. Dr. Spertus is assistant professor of clinical psychology, Department of Psychiatry, at Columbia University College of Physicians and Surgeons, New York. Dr. Weiner is in private practice of neuropsychology, New York, New York. Dr. McCurdy is professor and associate chair for education, Department of Pediatrics, University of Nebraska College of Medicine, Omaha.
Correspondence and requests for reprints should be addressed to Dr. Brodkey, Friends Hospital, 4641 Roosevelt Blvd., Philadelphia, PA 19124; telephone: (215) 831-7949; e-mail: 〈email@example.com〉.
At the time of writing this paper, Dr. Spertus and Dr. Weiner were graduate students in psychology at Finch University of Health Sciences, North Chicago, Illinois. Dr. Brodkey and Dr. Sierles (Association of Directors of Medical Student Education in Psychiatry) and Dr. McCurdy (Council on Medical Student Education in Pediatrics) are members of the Alliance for Clinical Education's Working Group on Managed Care and Medical Student Education.
The authors gratefully acknowledge the other members of the working group: Linton C. Hopkins, MD, Department of Neurology, Emory University (Consortium of Neurology Clerkship Directors); Diane M. Magrane, MD, Department of Obstetrics and Gynecology, University of Vermont (Association of Professors of Gynecology and Obstetrics); Louis Pangaro, MD, Department of Internal Medicine, Uniformed Health Services University (Clerkship Directors in Internal Medicine); and Ajit K. Sachdeva, MD, Director, Division of Education, American College of Surgeons (Association for Surgical Education).
For an article and two research reports on related topics, see pages 1069, 1121, and 1128.