Clerkship Directors ’ Perceptions of the Effects of Managed Care on Medical Students ’ Education

Purpose. 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 man-aged care on medical students ’ education. Method. 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 dif-ferent 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 statis-tically associated with the perceived degree of managed care’s market penetration. Results. Five hundred questionnaires (61.9%) were re-turned. For full-time and voluntary faculty teaching, fac-ulty 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 re-sponse after ‘‘not changed’ ’ was that managed care had a negative effect. The majority of respondents held nega-tive opinions of managed care and thought that medical students did not understand it. Conclusions. CDs in six medical specialties perceived that managed care has negatively affected medical stu-dents ’ education. These perceptions may influence med-ical students ’ education. Measures must be taken to en-sure excellent education through adequate resources and training in the context of high-quality medical care