Brodkey Amy C, Sierles Frederick S, Spertus Ilyse L, Weiner Cindy L, McCurdy Fredrick A
Department of Psychiatry, at the University of Pennsylvania, Philadelphia, USA.
Acad Med. 2002 Nov;77(11):1112-20. doi: 10.1097/00001888-200211000-00013.
Little is known about the effect of managed care on medical students' education. Because clerkship directors (CDs) are especially well positioned to observe any changes, this study surveyed CDs from six medical specialties about their perceptions of the effects of managed care on medical students' education.
Anonymous questionnaires were mailed to 808 CDs from departments of six medical specialties at 125 U.S. allopathic medical schools between October 1997 and March 1998. Among other questions, respondents were asked whether they had observed changes in 19 different aspects of medical students' education, whether these changes were beneficial or detrimental, and whether they believed the changes were due to managed care and/or to other factors. Results were analyzed to determine perceptions of the overall magnitude and source(s) of changes, the perceived positive versus negative effect of managed care, and whether these outcomes were statistically associated with the perceived degree of managed care's market penetration.
Five hundred questionnaires (61.9%) were returned. For full-time and voluntary faculty teaching, faculty availability for educational administration, directors' clinical responsibilities, and quality of professional life, the most common response was that managed care had an adverse effect. For faculty's enthusiasm for teaching, directors' administrative and educational duties, and clerkship training sites, the second most common response after "not changed" was that managed care had a negative effect. The majority of respondents held negative opinions of managed care and thought that medical students did not understand it.
CDs in six medical specialties perceived that managed care has negatively affected medical students' education. These perceptions may influence medical students' education. Measures must be taken to ensure excellent education through adequate resources and training in the context of high-quality medical care.
关于管理式医疗对医学生教育的影响，目前所知甚少。由于临床实习主任（CDs）处于特别有利的位置来观察任何变化，本研究对六个医学专业的临床实习主任进行了调查，了解他们对管理式医疗对医学生教育影响的看法。
1997年10月至1998年3月期间，向美国125所全科医学医学院六个医学专业系的808名临床实习主任邮寄了匿名问卷。除其他问题外，还询问受访者是否观察到医学生教育19个不同方面的变化、这些变化是有益还是有害，以及他们是否认为这些变化是由于管理式医疗和/或其他因素。对结果进行分析，以确定对变化的总体程度和来源的看法、管理式医疗的感知积极与消极影响，以及这些结果是否与管理式医疗的市场渗透感知程度存在统计学关联。
共收回五百份问卷（61.9%）。对于全职和志愿教师教学、教师参与教育管理的可及性、主任的临床职责以及职业生活质量，最常见的回答是管理式医疗有不利影响。对于教师的教学热情、主任的行政和教育职责以及临床实习培训地点，在“未改变”之后第二常见的回答是管理式医疗有负面影响。大多数受访者对管理式医疗持负面看法，并认为医学生不理解它。
六个医学专业的临床实习主任认为管理式医疗对医学生教育产生了负面影响。这些看法可能会影响医学生的教育。必须采取措施，在高质量医疗的背景下，通过充足的资源和培训确保优质教育。
