Pressure from HMOs to See More Patients Decreases Time Devoted to Teaching of Third-Year Medical School Students

Study of junior medical students' educational activities in non-university teaching hospitals

Investigators at the University of Arkansas for Medical Sciences, Little Rock, conducted a 2000 study of junior medical students' (those in their third year) educational activities — instructional time and types of teachers — in non-university teaching hospitals.

In 1992, the Robert Wood Johnson Foundation (RWJF) funded a similar study (ID# 018562). Since that time there has been a large increase in managed care.

Project investigators designed this second study to measure what changes, if any, have occurred during this period of increased managed care in the amount and type of instructional time and the type of teachers who are involved in the education of junior medical students.

Key Findings

  • Students spent about 30 minutes less per day (a 5 percent decline) devoted to clinical education than they did in 1992.
  • Teaching time — defined as formal (e.g., grand rounds, structured group conferences, lectures), informal (e.g., impromptu discussions, conversations with consultants) and supervised teaching — declined 20 percent from 1992 to 2000.
  • The proportion of teaching performed by full-time faculty increased 58.2 percent, from 31.6 percent of total hours in 1992 to over 50 percent of total hours in 2000.
  • Total resident teaching time declined from 42.5 hours in 1992 to 24.4 hours in 2000 (a 42.3 percent decline). Volunteer faculty teaching remained constant, comprising 25 percent of all teaching.
  • Students' total personal time increased from 12.5 hours in 1992 to 13.1 hours in 2000.
  • In summary, the principal investigators surmise that the effects of managed care — as well as increased acuity of hospitalized patients — have increased pressures on faculty and residents to see more patients. Though the formal teaching program remains intact, the decrease in overall teaching and the marked decrease in involvement of residents may be indicators of a worrisome trend.

Funding

A $49,997 grant between February 2000 and November 2001 from RWJF funded this study.