Medical student education in managed care settings - Beyond HMOs

Objective.-To describe the educational experiences of students in managed care settings and to compare these with recommendations for preparing physicians to practice in managed care. Design.-We searched MEDLINE using the keywords ''medical education,'' ''managed care, ''health maintenance organization, and others; we manually checked the reference lists of identified articles and reports from 1969 to 1996. Survey information was obtained from all US medical schools in 1995 and 1996. Site visits were made to 6 managed care organizations selected according to size, geographic region, and involvement in education. Main Outcome Measures.-The extent to which schools use managed care settings for clinical education, the types of settings used, and the kinds of educational programs experienced. Results.-In 1995 and 1996, an average of 16% of schools required all students to have clerkships or other clinical experiences in a group/staff model HMO, and some students from another 46% of schools spent time in an HMO for clerkships or physical diagnosis/introduction to clinical medicine courses. About 85% of schools potentially exposed students to other types of managed care during 1 or more required clinical experiences in ambulatory, community-based settings. The learning objectives of these experiences did not explicitly address features unique to managed care such as cost containment and disease prevention. Conclusion.-The selection of managed care settings for undergraduate education is based on general clinical objectives rather than explicit goals tied to managed care. Whether these experiences in managed care settings help students to develop competencies for future practice in a managed care environment has not been demonstrated. While the feasibility of medical education in nonprofit group/staff model HMOs is well documented, it is not certain whether these models can be adapted to for-profit managed care settings.