Medical schools are making headway in meeting the demands of students who want a greater understanding of how health-care policy will affect their patients and practices.
Medical students are preparing to enter an industry where they need to understand the complexities of health policy to provide better care. They are encountering an ever-evolving industry where the Affordable Care Act added 20 million people to the rolls of the insured, efforts to expand state Medicaid programs continue apace, and “Medicare for All” is a line in the sand for Democratic presidential candidates.
The goal of educating medical students in health policy isn’t to make them social science researchers, but to “give students tools that can help move the everyday decisions in their practice and at their institutions,” said Christopher Scott, the associate director of health policy at the Baylor College of Medicine’s Center for Medical Ethics and Health Policy.
Medical schools are increasingly including health policy in students’ education, especially during residency, said Lisa Howley, senior director of strategic initiatives and partnerships in medical education at the Association of American Medical Colleges.
Universities are trying a wide variety of approaches to educate their students, from lecture classes to clubs where they discuss policy journal articles to mock congressional hearings.
Push From Students
The pressure on schools to increase their health policy offerings comes from the students themselves.
“The students that we get today at medical school are much more engaged, much more curious” about health policy than students a decade ago, said Jonathan Oberlander, chair of the Department of Social Medicine at the University of North Carolina, Chapel Hill. “They know that the world is changing around them, but they don’t always know what those changes are.”
Kyle Fischer, a professor at the University of Maryland School of Medicine and director of the health policy and leadership fellowship, said he has noticed an increased interest from medical students when health policy is part of the public dialogue.
For example, the Trump administration’s family separation policy and other immigration stances have caused Fischer’s students to ask about the health effects of being an undocumented immigrant.
The “zero tolerance” family policy, now defunct, led to separation of undocumented migrant children from their parents. The Department of Health and Human Services was responsible for care of the migrant children and is still working to reunite some of them with their parents.
The “public charge” proposed rule would allow federal authorities to take into account how likely immigrants are to be reliant on the government for public benefits, including health benefits, when adjudicating their visa requests.
Mock Senate Hearings
Medical schools are addressing how to educate their students on health policy in a wide variety of ways.
At North Carolina, all first-year medical students take a year-long course that in the spring semester includes staging a mock hearing of the Senate Finance Committee.
Students are split into different stakeholder roles. They take on their group’s position on health-care reform and then testify, answer questions, and debate. They end with trying to find a consensus, and they learn “just how difficult the politics are” of health-care reform, Oberlander said.
Schools also take the traditional approach of having lecture courses on the subject. Students can learn about controversies in health policy, such as birth control coverage, in a social justice elective course at the University of Maryland. Students also create their own groups to train in civic engagement.
George Washington University also offers a three-week immersion course in health policy for residents, both from GWU and outside institutions. The course includes lectures from economists and consultants at think tanks and meetings with policy professionals in Congress and federal agencies.
Baylor College of Medicine is in the middle of a new four-year program in which students learn about health-care policy, the methods for translating research questions to policy outcomes. They then run research and publish a paper on their findings.
Not all medical schools have the ability to offer courses on health policy, or they can’t do it on a larger scale.
“If the students want to learn anything beyond basic medicine, where to fit that in is difficult,” Heidi Russell, a professor at Baylor College of Medicine and a doctor at Texas Children’s Hospital, said.
Health policy isn’t on the licensing exams medical students need to pass, and “that’s what ends up mattering at the end of the day,” said Seth Trueger, a professor at Northwestern University School of Medicine.
There also has been a hesitance from university administrations to include health policy in medical school curriculum because they don’t have faculty, or the time, to teach it well, said Cedric Dark, a professor at the Baylor College of Medicine.
There are a lot of people with a background in health-care policy, but fewer have an understanding of how doctors fit into that world, Russell said.
Medical schools need the right conditions to invest in health-care policy education—a faculty, administration, and students who want it, Scott said.
The demand for greater health policy education isn’t going away.
Medical students consistently rate their health policy education lower than other subjects in a survey the Association of American Medical Colleges sends to graduating students each year, said Dark. Dark is also executive editor of Policy Prescriptions, an advocacy organization that works to promote evidence-based health policy.
Meanwhile, the accrediting body for medical programs, the Accreditation Council for Graduate Medical Education, is putting into effect a requirement in July that schools need to make sure residents incorporate consideration of value, delivery, and payment into their care. That requirement will likely push even more universities into including health-care policy in their curriculum, the AAMC’s Howley said.
Medical school professors can “train physicians to be good stewards and to interact in the world they have to work in,” Russell said.