PURPOSE: Undergraduate medical education has been criticized for not keeping pace with the increasing complexity of the U.S. health care system. The authors assessed medical students' perceptions of training in clinical decision making, clinical care, and the practice of medicine, and the degree to which the intensity of education in health care systems can affect perceptions. METHOD: The authors studied data from 58,294 U.S. medical graduates who completed the Association of American Medical Colleges annual Medical School Graduation Questionnaire (2003-2007). In a second analysis, they compared responses of 1,045 medical school graduates (2003-2007) from two similar medical schools with curricula of different intensity in health care systems. RESULTS: The percentage of students reporting "appropriate" training was 90% to 92% for clinical decision making, 80% to 82% for clinical care, and 40% to 50% for the practice of medicine. Students from the school with a higher-intensity curriculum in health care systems reported higher satisfaction than students from the school with a lower-intensity curriculum for training in four of five practice of medicine components: medical economics, health care systems, managed care, and practice management. Importantly, the high commitment to education in health care systems in the higher-intensity curriculum did not lead to lower perceived levels of adequate training in other domains of instruction. CONCLUSIONS: Nationally, students consistently reported that inadequate instructional time was devoted to the practice of medicine, specifically medical economics. A higher-intensity curriculum in health care systems may hold substantial potential to overcome these perceptions of training inadequacy.
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