To the Editor:
U.S. medical schools should implement course work in health systems and policy as a prerequisite for application to medical school. The goal of such instruction would be to foster understanding of the structure and organization of the U.S. health care delivery system and health care financing, as well as approaches to measuring and improving health care quality. With significant changes under way in the structure and organization of the U.S. health care system, an understanding of the social and financial forces influencing health care delivery would give future physicians greater insight into their chosen profession and prepare them better to be leaders within it.
A new requirement of health systems and policy knowledge would not take the place of incorporating more of such content into medical school curricula but, instead, would augment it and help entering students see the value of such content. The current approach to training students about the health care system—the occasional lecture, the brief, pass/fail course—is inadequate. The new premedical requirement we are advocating would be an important step forward, but only a piece of the broader medical education reform necessary to incorporate policy and systems education across all phases of medical education.
Implementing a new health systems premedical requirement would not be without its challenges. Many undergraduate schools do not offer the necessary course work, and other schools lack the faculty to teach such courses. In the early years of implementing this requirement, students might fulfill it by taking a preapproved summer course or completing an online module.
To make content about policy and systems broadly relevant to all of those pursuing careers in medicine, course work should be grounded in a clinical context. Those faculty who strive to educate future clinicians about these topics must know and respond to the core motivation that drives most students toward careers in medicine—clinical care—and work to demonstrate the relevance of sound knowledge of systems and policy to achieving that goal.
At the center of the decision to reform premedical requirements are two important and related questions: Whom do we attract into the medical profession? What skills, attitudes, and priorities do we equip them with? Premedical requirements that empower students with a deeper knowledge of the health care system’s structure and organization will increase the likelihood that we attract, select, and cultivate the physicians who are knowledgeable about our health care system and are primed to lead needed change.
Sachin H. Jain, MD, MBA
Resident physician, Brigham and Women’s Hospital,
Harvard Medical School, and senior institute associate, Institute for Strategy and Competitiveness,
Harvard Business School, Boston, Massachusetts;
Edward Miller, MD
Frances Watt Baker and Lenox D. Baker Jr. Dean,
Johns Hopkins University School of Medicine, and chief executive officer, Johns Hopkins Medicine,