While medical students are required to know the names of every body part and disease, most graduate with only a cursory understanding of how the health care system actually works, and some of the ways it doesn't. To redress this deficiency, Weill Cornell Medical College (WCMC) offers an innovative program to teach medical students and residents about the ways patient care is managed and paid for in the U.S. and abroad.

"With the current debate among policymakers and others about how our health care system should be reformed, it is ever more important to give our students the skills necessary to navigate our increasingly complex health care system," said Dr. Madelon Finkel, professor of clinical public health and director of the Office of Global Health Education at WCMC. "As the public face of health care delivery, it is incumbent on doctors to be fully conversant with the workings of the health care system. In fact, this knowledge is a prerequisite for quality patient care."

Fourth-year students at WCMC are required to take a two-week health-policy clerkship that offers an overview of the nonclinical side of practicing medicine and aims to open their eyes to some of the issues that may confront them as they treat patients. Students are introduced to the complexities of the U.S. health care system, including the organization, financing, administration and delivery of care, as well as health insurance options.

The course also takes a comparative look at health care systems around the world. "The U.S. health care system is a costly hodgepodge of public and private insurance entities, and is by far the most expensive in the world," Finkel said. "Yet, when compared with other health care systems, the U.S. does not rank highest on important outcomes like infant mortality and life expectancy."

Student response has been enthusiastic. "The health policy course forced us to step back from our basic science and clinical courses and put our training into a real-world context," said Anthony Rosen, a fourth-year student. "We met industry experts who shared their often dramatically differing viewpoints on health care. Dr. Finkel encouraged us to discuss and grapple with the challenges of health care delivery and insurance and to think about potential solutions."

Third-year medical residents at NewYork-Presbyterian Hospital/WCMC are also required to take a one-week block rotation in health policy. The course gives participants an overview of the health care delivery system, including financing, organization of physician practices, comparative health systems, legal issues in health care and quality improvement. "It is especially important for our residents who are on the verge of beginning their medical careers to have this 'real-world' knowledge," said Dr. Oliver Fein, who teaches the course.

"Given that some type of health care reform will probably be a reality in 2010, one could ask whether medical schools and residency programs can afford not to provide instruction on this important topic," Finkel said.