An Evaluation of Medical School Curricula and Management Education for Physicians
Joan M. Kiel, Ph.D.
Presented by: Joan M. Kiel, Ph.D., Chairman, Health Management Systems, Duquesne University, 429 Fisher Hall, 600 Forbes Avenue, Pittsburgh, PA 15282-2241.Telephone: 412-396-4772 Fax: 412-396-5554 Email: kiel@duq2.cc.duq.edu.
Research Objective: A survey done by The Robert Wood Johnson Foundation on physician preparedness found that 80% of physicians rated "excellent or good" their clinical training, but less than 3% reported "excellent or good" their training to handle the business aspects of a practice. Not only are physicians transitioning from clinical roles to managerial roles, but even in daily office operations, management, information technology, and health policy knowledge is needed. Thus, the question must be asked, "do physicians have the requisite skills to be effective managers"? What is need now is a new model of medical education, the 21st Century Flexner Report, focusing in medical school curricula reform in terms of today’s current management, information technology, and health policy issues.
Study Design: To assess medical school education, telephone and Internet surveys were completed of the 126 United States medical schools. Using the Internet in this study distinguished it from prior studies and gave the most current information. The surveys focused on the inclusion of business, computer, and policy related courses in the standard medical school curricula and the opportunities that existed for students to take electives in these areas, either from the Medical School or the general college. There was a 100% response rate.
Principal Findings: The results revealed that less than 10% of medical schools require a business, computer, or policy course. Specifically, the data showed that of the 126 medical schools in the United States, only 8, (6.3%), offered a required business course within the curriculum. The business courses focused on health care issues
and policies and the cost of health care. Nine schools, (7.1%), required computer courses such as Computers in Medicine, Medical Informatics, and Health Information Resources. Nine schools, (7.1%), required students to take "mini courses" in computer usage. The mini courses ranged from an afternoon session in the library media
center to a few hours on a weekly basis until one felt proficient. Topics included word processing, spread sheet design, HTML, and the use of OVID and email. Although few schools had required courses, 38, (30.1%), allowed students to take electives in computers or business from either the Medical School or the general college. Of the
schools requiring business and information technology courses, only five also offered electives, and of the five, only one offered electives in both. The schools that have initiated these courses are located in urban, highly penetrated, managed care markets.
Conclusions: Physicians enter practice with limited knowledge of business practice operations, information technology, and health policy. This results in not being able to be the best advocate for the patient and in operating a practice at a lower level of efficiency which in turn can have greater policy implications such as increasing the
cost and utilization of healthcare.
Implications for Policy, Delivery, or Practice: This research provides a framework for medical school curricular changes to match the concurrent changes in the health care arena. The greater contribution will be to the restructuring of the practice of medicine whereby physicians will understand and be able to implement cost effective
models of care. With the projected surplus of physicians, especially in some urban areas, it behooves the medical community to take the individual responsibility to supplant their present knowledge base. Also having a management, technology, and health policy background may assist physicians to transition their careers from a
clinical role to a managerial role. Perhaps now is the time for the "updated Flexner Report" focusing on medical school reform in terms of today’s current management and policy issues which practicing physicians encounter.
