Medical Student Education in Managed Care Settings

Veloski, J. Jon; Barzansky, Barbara; Nash, David B.; Bastacky, Stanford; Stevens, David P.

doi:10.1001/jama.1996.03540090013004

Cited by 25 publications

(3 citation statements)

References 43 publications

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“…22 We report on what clinicians say they do to assess behaviors, such as treatment choice; actual behavior may differ from reported behavior. 28,33 Organization differences we observed may reflect differences in clinical goals providers brought with them when they were hired, 14,34 but the similarity between staff/groupmodel and network-model MCO providers' knowledge of depression treatment suggests that selection bias is not a major confound.…”

Section: Discussionmentioning

confidence: 87%

Treating depression in staff-model versus network-model managed care organizations

et al. 1999

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Section: Discussionmentioning

confidence: 87%

Treating depression in staff-model versus network-model managed care organizations

et al. 1999

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“…At Sharp, medical residents and family therapy interns see a model of collaboration in action, and modeling by faculty highlights the importance of diverse skills and strong relationships to effective treatment. In a study of medical student education in managedcare settings, the experiential aspect of education is stressed—students come to understand the unique characteristics of these sites—through observing the prac tice of physicians and other healthcare providers, and not through formal lectures or other didactic sessions (Veloski, Barzansky, Nash, et al, 1996, p. 669).…”

Section: Training In Collaborative Modelsmentioning

confidence: 99%

Training for collaboration: Suggestions for the joint training of mental health clinicians and family practice residents.

Patterson¹,

Scherger²,

Bischoff³

et al. 1998

Families, Systems, & Health

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“…As noted, our residents’ ambulatory training is currently entirely within the staff model of HPHC's health centers. Just as Veloski and colleagues describe the experiences of medical students’ training in staff model HMOs, 14 we know that the residents’ learning in our staff model health centers is not only a function of the explicit objectives of the program, but also the result of their immersion in the culture of the health centers. As staff model practice represents only about 10% of what is considered managed care practice, we anticipate the need to explore how to provide optimal training to ensure that program graduates will master the knowledge and practice skills required for work in the more prevalent models of practice.…”

Section: Challengesmentioning

confidence: 99%

The clinician-teacher in managed care settings

1997

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anaged care has grown tremendously over the last decade. 1 In 1985, there were fewer than 8 million members; in 1995, there were more than 53 million members. Increasing numbers of doctors are now working in managed care, and most new graduates of residency programs will spend their careers in capitated managed care practices. Ten years ago, we wrote about the benefits of affiliations between academic health centers and health maintenance organizations (HMOs). 2 What was then an interesting idea now has become a necessity.Curricula in medical schools and residency training programs have begun to address the changes in medical practice, but they have not kept pace with managed care practice development. In fact, in many parts of the country academic institutions have been insulated from the changes in practice. The well-described gap between skills emphasized in residency training and those necessary for practice continues to widen. 3-5 As a result, HMO medical directors consider the majority of primary care physicians to be "poorly qualified" for managed care practice. 6 There is an alarming growth of physician dissatisfaction in practice. A recent study by the California Medical Association revealed the dimensions of the problem. On the basis of their current work experiences, nearly 40% of California primary care physicians under the age of 40 would not again choose careers in medicine. Physician claims for disability, another symptom of physician distress, are at an all time high. The majority of these discontented physicians attributed career dissatisfaction to negative experiences with managed care practice. 7 Residency training program directors must ensure that their graduates do not suffer from these negative attitudes.Patients also express dissatisfaction that can be attributed to deficient training. When patients say that their doctors don't listen, are rushed, devalue their opinions, and treat them like objects, they are indirectly criticizing the programs that have trained the doctors.These concerns reflect the current problems of primary care practice and medical education. Building excellent managed care practices that incorporate the training of future physicians can serve to correct these deficiencies. Learning to practice in real managed care siteswhere residents and medical students interact with role models and participate in authentic clinical work-may be the best way to prepare doctors to provide high-quality care in a cost-effective manner and to take pride and pleasure in their work. 8,9 In this article we will present the results of nearly 25 years of experience in the graduate medical education of primary care internists in one managed care organization, Harvard Pilgrim Health Care (HPHC, formerly Harvard Community Health Plan). We have chosen to describe our experience in depth rather than to survey the small number of programs that have addressed the challenge of teaching in managed care settings. We will present our view of the elements of clinical competence that excellent managed ca...

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Medical Student Education in Managed Care Settings

Cited by 25 publications

References 43 publications

Treating depression in staff-model versus network-model managed care organizations

Treating depression in staff-model versus network-model managed care organizations

Training for collaboration: Suggestions for the joint training of mental health clinicians and family practice residents.

The clinician-teacher in managed care settings

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