Weill Cornell Medical College offers innovative program to teach medical students about health care system

While medical students are required to know the names of every body part and disease, most graduate with only a cursory understanding of how the health care system actually works, and some of the ways it doesn't.

Helping to redress this deficiency, Weill Cornell Medical College offers an innovative program to teach medical students and residents about the variety of ways that patient care is managed and paid for, both in this country and abroad.

"With the current debate among policymakers and others about how our health care system should be reformed, it is ever more important to give our students the skills necessary to navigate our increasingly complex health care system," says Dr. Madelon Finkel, professor of clinical public health and director of the Office of Global Health Education at Weill Cornell Medical College, and author of an article on the topic in the current issue of the journal Clinical Teacher. "As the public face of health care delivery, it is incumbent on doctors to be fully conversant with the workings of the health care system. In fact, this knowledge is a prerequisite for quality patient care."

Fourth-year students at Weill Cornell Medical College are required to take a two-week health policy clerkship -- taught by Dr. Finkel for more than 10 years -- that offers an overview of the non-clinical side of practicing medicine and aims to open their eyes to some of the issues that may confront them as they treat patients. This includes what she calls the confusing, and at times conflicting, restrictions placed on physicians and patients alike.

Students are introduced to the complexities of the U.S. health care system, including the organization, financing, administration, and delivery of care, as well as health insurance options. According to Dr. Finkel, physicians and medical students need to understand the constraints and restrictions of different insurance plans, especially prescription drug coverage. To this point, she emphasizes the importance of communicating with patients about their insurance coverage, so as to make sure they won't be exposed to unexpected charges.

The courses also take a comparative look at health care systems around the world. "The U.S. health care system is a costly hodgepodge of public and private insurance entities, and is by far the most expensive in the world," Dr. Finkel says. "Yet, when compared with other health care systems, the U.S. does not rank highest on important outcomes like infant mortality and life expectancy."

"But while there is lively debate about how the health care systems should be restructured, the issue does not receive much attention in a typical U.S.United States and abroad." medical school curriculum," she continues. "Unfortunately, health policy has been practically ignored by most medical schools and residency programs. It's our hope that the courses at Weill Cornell will serve as a model for other curricula, both in the

Student response has been enthusiastic. "The health policy course forced us to step back from our basic science and clinical courses and put our training into a real-world context," says Anthony Rosen, a fourth-year student at Weill Cornell Medical College. "We met industry experts who shared their often dramatically differing viewpoints on health care. Dr. Finkel encouraged us to discuss and grapple with the challenges of health care delivery and insurance and to think about potential solutions. The timing for the course was perfect, as we were discussing these issues as the health care reform debate unfolded. I think that understanding health policy will be invaluable for me as a practicing physician."

Third-year medical residents at NewYork-Presbyterian Hospital/Weill Cornell Medical Center are also required to take a one-week block rotation in health policy. The course is directed by Dr. Oliver Fein, associate dean of affiliations and professor of clinical medicine and clinical public health at Weill Cornell Medical College. The course gives participants an overview of the health care delivery system, including financing, organization of physician practices, comparative health systems, legal issues in health care and quality improvement. "It is especially important for our residents who are on the verge of beginning their medical careers to have this 'real-world' knowledge," says Dr. Fein. "The rotation covers issues they cannot ignore as practicing physicians."

"Given that some type of health care reform will probably be a reality in 2010, one could ask whether medical schools and residency programs can afford not to provide instruction on this important topic," Dr. Finkel says.