What Med Schools Aren't Teaching

Med students are taught about everything from pathology to microbiology, but are they asked to learn enough about public health policy?

Maybe not, two new New England Journal of Medicine articles report.

One, written by four Harvard University med students (and the brains behind Improvehealthcare.org), cites a recent survey of medical school deans in the U.S. Of the 93 respondees, 94 percent indicated that their schools had some form of policy education -- on average, about 14 hours over four years. But almost 60 percent of the deans indicated that their school had "too little" health policy education, citing barriers like a lack of "curricular flexibility" and "faculty interest."

The second New England Journal of Medicine article on the topic also called for an up-tick in the amount of public policy education med students and residents receive. The authors recommend a focus on several broad areas, including (but not limited to) health care principles, safety, politics and law. The authors wrote that if med schools don't improve their policy curriculums, there may be "unfortunate consequences" for patients and physicians.

And yet not everyone's convinced the problem is as serious as these new studies suggest. According to Medscape Medical News, at least one senior official in the Association of American Medical College thinks they overstate the problem.

"I think there is more of this [health policy] education than the articles suggest," said M. Brownell Anderson, senior director of educational affairs.

Maybe, but the latest reports aren't the only time experts have pushed for more public health education in med schools.

Science reports that last year, the Carnegie Foundation for the Advancement of Teaching co-funded research for a book outlining plans to overhaul med school education in the U.S. Colloquially known as the "Flexner II report" (referring to the original, 1910 Flexner report that, Science reports, resulted in sweeping changes to medical education, like more rigorous admissions standards and clinical rounds), the new book calls for emphasizing physicians's role in public health at large.

The book's authors wrote:

"In the course of our fieldwork, we saw ... missed opportunities for allowing learners to participate in the important nonclinical roles physicians play within health care and more broadly in society."

Comments

[Conk]

09:38 AM on 03/10/2011

Er, ah, the truth?

[Erasmus Funderburke]

02:05 AM on 03/10/2011

Congrats, Harvard, for interjecting the concept of "policy" into yet another field.

Besides all the technical stuff med school students have to learn, HHMI says they need to understand scientific inquiry better (to be better consumers of research - med literature is repleat with junk science), statistics, and communication skills.

So let's put this "policy" garbage about fifth on the wish list.

[DrKatSexChat]

12:48 PM on 03/09/2011

In addition to a lack of public health policy, there's very little human sexuality training happening either. Usually less than 3 credit hours.

[Overshadow]

02:46 PM on 03/08/2011

I don't support mandated CME or curriculum on anything other than patient care. However, I do think it is a very good idea to understand the various aspects that affect that care such as policy and the law.

Hospital-based docs don't get all of the legal stuff especially, as the Hospital has an administration to coordinate on those issues. Solo and small practice docs bear the brunt of the harsh regulations and insurance premiums.

[ricchh]

05:32 PM on 03/07/2011

It's medical school, not policy school. If you want policy, you get a different degree in public health or healthcare policy. There is only so much you can cover in four straight years with no sleep especially with the daily advances in medicine, drugs, and technology.

[RVU]

09:57 PM on 03/07/2011

You're absolutely correct. Medical school is learning about the human body, it's physiology, it's pathophysiology/illnesses, and the therapies that have been verified and reproduced using the scientific method. Its an enormous amount of information that doubles every decade or so.

However against this reality of how much a medical student must internalize, besides evolving the highest sense of professionalism, is are new and troubling ethos which politicians-outside advocacy groups seek to redefine who a medical doctor is. The two biggest and unwarranted such incursions are those who seek to force hollistic medicine on skilled traditionally trained physicians and others who want doctors to become an more public health conscience, or in other words, advocate for increasing statist control of the medical-industrial complex.

To learn Hollistic medicine, a doctor, the ultimately of medical scientistics, has to suspend belief and accept different concepts of healing that have not be proven scientifically or been shown to be safe, pure and efficacious like every cure in traditional medicine must abide by. Similarly the want to 'teach' students about public health is a deep-seated desire to turn them into an extension of the states/local governmints.

[Red45]

12:24 PM on 03/07/2011

Seems to me that public health policies should be part of their regular regimen and courses in nutrition would help tremendously. I just got out of a short hospital stay and was appalled at the "food". Soup was a cfc (foam) container with hot water and a little packet of what looked like diarrhea. It didn't taste that bad, thank God, but it had no nutrition in it whatsoever.

I'm a vegetarian so they sent me lots of jello---which comes from cow bone marrow--not something an informed vegetarian would ever eat. This lack of basic understanding of the importance of food in our bodies---especially when we're healing from something major in the hospital--is one of the biggest voids in the medical profession today. They really need to know more about nutrition so they can use it to help us heal and to prevent sickness in the first place.

[Fred Butters]

12:52 PM on 03/07/2011

"They really need to know more about nutrition so they can use it to help us heal and to prevent sickness in the first place."

My father was diagnosed with type 2 diabetes, and the doctor never once asked what he eats - he just wrote him a prescription.

I think the show "The Biggest Loser" is highly flawed in it's methods, but almost all of the contestants talk about getting off all their prescription medicine after they lose weight and start eating healthier food, yet almost all doctors will prescribe a pill before they even ask about diet.

[MBin]

11:39 PM on 03/08/2011

Well, if you want to get well, you don't go to an M.D.---that stands for "medical" doctor, and that is what you'll get...drugs. If you want to get well you need to go to a naturopath who is a doctor with all the standard M.D. training AND also understands the biochemical makeup of the body and understands nutrition.

My husband was diagnosed with diabetes and I took him to a naturopath who put him on a low glycemic diet and various cleansers (liver, pancreas, intestinal) AND an exercise regimen. He lost 40 pounds, and after getting into shape, bought a bike and has become a fervent bike-rider. By the way, his diabetes is entirely reversed, he NEVER took, or needed to take, any drugs, and he only needs his blood levels checked each six months. Two years have passed and he's never been healthier! Medical doctors are not taught any of this in medical school, and the drug salesmen provide their medical information after they leave college. So...what you get from a medical doctor is drugs and surgery.

[taylor5]

09:42 AM on 03/07/2011

Teaching public health policy to medical students would be a complete waste of time. The students are trying to take in massive amounts of information so that when they see the multitude of SICK patients on the wards they have a way to process this information. Patients admitted to teaching hospitals typically have a multitude of disorders that have to be carefully teased apart. Dumping this course of med students is unhelpful and unfair. Introduction during the residency years would be muck more efficacious.

[ElizaDarcy]

09:06 PM on 03/06/2011

I'm a Canadian med student, and I'm getting 3 hours per week of public health education. I feel it's sufficient. It's interesting to see the interaction of medicine with community, and some of the discussions this brings out are fascinating. The reality is you need to understand the community and culture a patient comes from in order to treat them effectively (eg. you perscribe a drug, but they can't afford it, you suggest a lifestyle change, but there are no venues for exercise in their community, you ask them to consider quitting smoking, but everyone in their workplace smokes....)

I agree that a more solid basis in nutrition would be great BUT, there's a whole degree program (BSC nutrition) and professional designation (registered dietician) that deals with food and health. Yes, I realize in Canada that a dietician's services aren't free, and a physician's are, but that doesn't mean that every physician should have to be a dietician as well.

[Sharon Hanson]

08:47 AM on 03/07/2011

I would be happy if they would stop poisoning us with their toxic treatments including gadolinium based contrasting agents (GBCAs that causes new man-made disease called gadolinium associated systemic fibrosis (GASF), MDL 1909 lawsuit now before the courts) and all the fluoroquinolone antibiodics (MDL lawsuit currently before the courts). It would also be nice if our government would work to close the lethal loophole that allows voluntary reporting of adverse events and make it mandatory to report adverse events.

[WhatchaTalkinBoutWillis]

06:58 PM on 03/07/2011

So I guess the Adverse Event Reporting System (AERS) is just a figment of my imagination?

Btw, your remarks only resonate with those unfamiliar with medicine. Next time, try speaking on that of which YOU do know?

Enjoy your evening.

http://www.fda.gov/Drugs/GuidanceComplianceRegulatoryInformation/Surveillance/AdverseDrugEffects/default.htm

[RVU]

10:07 PM on 03/07/2011

You're are perpetuating lie and are a useless foo/

FACTS:

Unless you have severe kidney disease, which is now screened universall­y before every contrast enhanced MRI injection, there is NO danger or risk posed by Gadolinium contrast.

http://www­.ajronline­.org/cgi/c­ontent/ful­l/196/2/W1­38

http://www­.cardiovas­cularbusin­ess.com/in­dex.php?op­tion=com_a­rticles&vi­ew=article­&id=26396&­division=c­vb

An enormous population set, 159,000 patients, were examined in the American Journal of Radiology study. Gadolinium contrast was concluded by this study and the FDA to be 'very safe', being that there was an adverse reaction rate of less than one per million of contrast dose administra­tion.

You are promoting non-factua­l fear and bizarrе personal bias in this post. And, unlike the irrational fear mongеring about immunizati­ons, this slandеr against Gadolinium contrast has and will continued to be nipped in the bud.

[Fred Butters]

06:15 PM on 03/06/2011

Something else they're not being taught:

As of 2006, 70% of med schools in the U.S. had no requirement for a separate nutrition course. The other 30% only required one.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2430660/?tool=pubmed

[akrau82]

08:49 PM on 03/06/2011

yup. my school had one and it was a total JOKE

[Fred Butters]

12:43 PM on 03/07/2011

"The doctor of the future will give no medicine, but will interest his patients in the care of the human frame, in diet, and in the cause and prevention of disease."
- Sir Isaac Newton

[Gildersleeve]

03:59 PM on 03/06/2011

nutrition

[froidytoidy]

03:52 PM on 03/06/2011

When doctors are taught that their role is to keep America healthy rather than making several hundred thousand a year - medicine and the health of Americans might reverse from the downward spiral it is now on. World view is not in the picture. Bank accounts are!

[Spartacle12]

04:45 PM on 03/06/2011

Amen!

[hagagaga]

06:41 PM on 03/06/2011

But they don't make that much. Those are the hospital directors with MBA's as well as MD's.

[alongst]

02:47 PM on 03/06/2011

Amazing how much is crammed into 4 years, after 4 years of heavy sciences in college and yet everyone wants to add more and more courses to med school.
It's called Life , people.

[Sharon Hanson]

09:00 AM on 03/07/2011

I don't want to add more alongst just a different curriculum that replaces the influence of the pharmaceutical companies and the medical manufacturers.

[taylor5]

09:45 AM on 03/07/2011

Lipitor will kick diets butt everytime.

[lookingforintegrity]

02:46 PM on 03/06/2011

I don't know about medical school, but I can say that to see docs making rounds in a hospital, is to see a group of folks in scrubs studying charts and speaking in terse med-speak, with nary a glance at the person in the bed.

[NotEve]

02:22 PM on 03/06/2011

I'm in med sch, and while my school is actually one of the better ones in terms of incorporating public health & policy curriculum, it is still inadequate.

These are important topics for Drs to have a basic foundation in in order to be informed advocates and participants in the social dialogue. Also, while public health and medicine are not the same, they are closely intertwined. I'm fortunate to have earned my MPH before entering med school and it has provided me with an additional perspective that I think is invaluable to any physician, and sorely lacking in most.

[taylor5]

09:51 AM on 03/07/2011

Get that MPH and dedicate your life to teaching!

[littlebrowngirl]

01:38 PM on 03/06/2011

Cleaniness and hand washing is a big thing that is not practiced enough in hospitals. Improvement in this area alone will save many lives and not complicate the health of people who need to get well. The things I have seen nurses and doctors do in hospitals would make your skin crawl.