The School of Medicine is trying to keep pace with the changing face of health care with two recent curriculum changes.
Medical students will receive more thorough education in cost-effective medicine and primary care as the two new programs are integrated into the medical school's curriculum.
A clinical clerkship will be required of all second-year medical students starting this October to highlight the increasing need for cost-effective health care, said Tia Blake, coordinator of medical student programs. To fit the clerkship into students' schedules, students' rotations in specialized areas such as psychiatry will be shortened from eight to six weeks. The two-week clerkship will be taught by a group of local physicians, Blake said.
Lectures held in tandem with the clerkship will be relevant to the recent debate over health coverage in the United States, said Russell Rothman, a second-year medical student and incoming head of the student curriculum committee.
"The class will deal with such questions as `Why is cost an issue right now in medical care? How is current U.S. health care oriented right now?' It'll deal with the ins and outs of the finances of health care," Rothman said.
Students will also meet with patients at the Medical Center to try to determine the least costly way for them to receive the health services they need.
"Duke is notorious for looking for zebras. When we're looking for rare diseases, we order a gazillion tests. Now people are working to see if it's effective to order all these tests that we order all the time," said Rothman.
Many said that cost-effective health care is a necessary part of the medical school curriculum.
"The cost-effectiveness class really was a quick fix to a problem. The dean realized that students were not being taught cost-effectively," said Barbara Sheline, assistant clinical professor of community and family medicine. "Residents are not practicing cost-effective care now, so when students [work] with them they can't learn it from them yet."
Some students said that before the clerkship, cost-effectiveness was taught sporadically.
"As it is now we try to get a sense for that kind of thing. We'll kind of discuss it at the initial lecture," said third-year medical student Timothy Ballard.
The primary-care program, which is voluntary, aims to give students more exposure to primary-care role models. Students who enroll in the program will be paired with a mentor from the primary-care field. They may also elect to work in primary-care clinics or to take courses in primary care.
Some medical school students said that primary-care medicine has not been held in high regard in the past.
"It'd be nice to be encouraged instead of discouraged from primary care," said third-year medical student Lori Langdon. "When I told people that I was interested in family medicine and primary care, they told me you're too smart for that' andwhy waste your life?'"
Sheline said that the medical school has heard those comments from numerous students.
"Our idea is to combat that by increasing their exposure to primary care," Sheline said.
The students will also have discussion sections at physicians' homes periodically to discuss important issues in medicine. This will keep the students in contact with their mentors and aware of the bigger issues, Sheline said.
Students agree that such education is necessary because of President Clinton's emphasis on primary care in his health care reform package.
"There's a new emphasis on training more primary-care physicians because many people today feel that there's an imbalance. The Clinton proposal says it may be more cost-effective," said Linda Fetko, second-year medical student and co-chair of the family medicine interest group. "Everybody's pretty reluctant to go out and get a board specialty under Clinton."
The Clinton program requires that 55 percent of all medical school graduates be in primary care, said a spokesperson in senator Jesse Helms' office.
"I don't think that the president's mandates are going to work; even if you make a physician enter primary care, there's nothing that the government can do to keep the physician in that field. It's un-American," the spokesperson said. "The best thing to do is to show medical students from the beginning how rewarding and beneficial primary care it."
Some medical students said that a new emphasis on primary care is beneficial so long as it does not create a bumper crop of new primary care physicians.
"I think it's a good idea as long as you make sure that the primary-care doctors are placed where they need them," said third-year medical student Broadus Atkins.
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