The national survey of more than 58,000 medical students from 2003-2007 showed an overwhelming majority were confident about their clinical training. But when it came to understanding health economics, the health care system, managed care, managing a practice or medical record-keeping, 40 percent to 50 percent of students reported feeling inadequately prepared.

The findings were published this month in Academic Medicine.

“Our patients expect us to understand the system,” says Matthew M. Davis, M.D., associate professor of pediatrics and internal medicine in the Child Health Evaluation and Research (CHEAR) Unit at the University of Michigan Medical School. “If we don’t, that can result in poor patient care.

“And if we don’t expect doctors to understand the health care system, who is going to?” asks Davis, who co-authored the research with Monica L. Lypson, M.D., assistant dean of graduate medical education at the U-M Medical School and Mitesh S. Patel, M.D., M.B.A., a U-M medical school graduate now at the University of Pennsylvania.

Davis explains researchers wanted to assess what medical students are learning about health care systems, especially as the nation struggles with health care reform. It’s important, Davis says, that physicians can contribute to the national dialogue.

The study looked at graduates nationwide from 2003 to 2007, and also compared two top-ranked medical schools in more detail. One of those schools had a higher intensity curriculum in health care systems.

Students who had the higher intensity curriculum were three times more likely to report that they had appropriate training in health care systems. The time devoted to health care systems training, however, did not lead to lower perceptions about their clinical or other training.

“So, a higher intensity curriculum in health care systems could hold the potential to overcome medical students’ perceptions of inadequate training in the practice of medicine,” Davis says.

“Those students in the higher-intensity curriculum were not less confident about other things … in other words, instead of a tradeoff, there is a payoff,” he says.

Davis says he hopes the survey will prompt medical schools to stress the importance not only of physicians’ ability to heal, but also to help guide their patients through a complex health care system. A higher-intensity curriculum in medical economics appears to work, he says.