The social security system as a topic in medical education. Own experiences and description of student's contribution

Introduction: The special subject "sociomedicine", as defined for medical s tudents in "items to which the written examination in the second part of th e medical examination can relate" has been taught by this department for 25 years as part of the course on medical ecology. There are 4 lectures (stru cture of the health care system; preventive care by doctors in the communit y and at the place of work; introduction to health economy; introduction to epidemiology) and the following seminars in small groups: social security systems; health insurance; excursion to a rehabilitation hospital; health r eporting; epidemiology. The topics are presented and taught with emphasis o n didactically useful and local examples. Methods: To ensure student participation "personal data" were introduced: S tudents give short reports on topics presented to them or they have to form ulate questions to the topic of the seminar, questions or subjects to be de alt with. The questions concerning "social security systems" and "health in surance", collected over a 6 year period, were analyzed. Results: Initially, the subject "sociomedicine" is not much appreciated by the students. The analysis shows what students think when they are challeng ed. The spectrum of questions mainly reflects the discussion in the media: Finance and benefits predominate, also budget and misuse, especially with r eference to old-age pension and health insurance. Questions related to spec ific medical functions as e.g. medical expert opinion, are less often raise d. However, topics such as "expansion of preventive measures", "chip card a nd utilisation" and "unconventional methods" are often addressed. A special demand for personal advice is seen during small talk discussions in interm issions (health insurance). Conclusion: The topics "medical expert opinion" and "comparison of public a nd private health insurance" have become positive knowledge required for th e examination and for practising the medical profession. With these subject s as a starting point it appears easier for us to describe the relevant ins titutions and structures and the general principles of solidarity.