MEDICAL-STUDENT EDUCATION IN MANAGED CARE SETTINGS - BEYOND HMOS

Objective.-To describe the educational experiences of students in mana ged care settings and to compare these with recommendations for prepar ing physicians to practice in managed care. Design.-We searched MEDLIN E using the keywords ''medical education,'' ''managed care, ''health m aintenance organization, and others; we manually checked the reference lists of identified articles and reports from 1969 to 1996. Survey in formation was obtained from all US medical schools in 1995 and 1996. S ite visits were made to 6 managed care organizations selected accordin g to size, geographic region, and involvement in education. Main Outco me Measures.-The extent to which schools use managed care settings for clinical education, the types of settings used, and the kinds of educ ational programs experienced. Results.-In 1995 and 1996, an average of 16% of schools required all students to have clerkships or other clin ical experiences in a group/staff model HMO, and some students from an other 46% of schools spent time in an HMO for clerkships or physical d iagnosis/introduction to clinical medicine courses. About 85% of schoo ls 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 explic itly address features unique to managed care such as cost containment and disease prevention. Conclusion.-The selection of managed care sett ings for undergraduate education is based on general clinical objectiv es rather than explicit goals tied to managed care. Whether these expe riences in managed care settings help students to develop competencies for future practice in a managed care environment has not been demons trated. While the feasibility of medical education in nonprofit group/ staff model HMOs is well documented, it is not certain whether these m odels can be adapted to for-profit managed care settings.