1. How are health maintenance organizations used in the USA?

2. Some medical schools have networks of primary care physicians serving as a referral base, have not they?

3. What purposes are managed care organizations used for during the preclinical years?

MEDICAL SCHOOLS AND MANAGED CARE

Some Medical schools are responding to the changes in the health care environment, including the growth of managed care, by forming or con­tracting with managed care organizations. In 1994-1995, 36 medical schools or their parent universities owned a health maintenance organi­zation (HMO) or other managed care organization. There were 75 medical schools that had contracts with HMOs or other types of managed care organizations for the provision of primary care services and 76 medical schools that had contracts for the provision of specialty services. In addi­tion, some medical schools are forming networks of primary care physi­cians to serve as a referral base. Within the past 5 years, 54 medical schools had acquired primary care physician practices and 65 had started primary care clinics in the community.

Managed care organizations such as HMOs are used as sites for med­ical student education in some medical schools. There were 18 medical schools where all students spent time in a managed care organization at some time during the curriculum, 60 schools where some students spent time, and 47 schools where no students spent time. During the preclini­cal years, managed care organizations were used as teaching sites for physical diagnosis and introduction to clinical medicine courses, as well as for preceptorships and other courses designed to acquaint students with medical practice in the community. In the third and fourth years, managed care organizations were used as clerkship sites, mainly in med­icine, pediatrics, and family medicine, out also for other clerkships in some schools.

VIII. The following text will give you some information about

evaluation of student performance in USA colleges and

universities. Comment on the following.

1. Step 1 examination.

2. Step 2 examination.

3. The evaluation of the clinical process.

EVALUATION OF STUDENT PERFORMANCE

In the 1994-1995 academic year, 110 schools required students to take Step 1 of the US Medical Licensing Examination (USMLE), and 87 schools required a passing grade for advancement or graduation. Ninety- seven schools required students to take Step 2 of the examination, and 53 schools required a passing grade for advancement or graduation. Of the 97 schools that required students to take both Stop 1 and Step 2, 52 re­quired a passing score on both examinations. The number of schools that required a passing grade in both Steps 1 and 2 was 51 in 1992-1993 and 52 in 1993-1994.

Subject examinations of the National Board of Medical Examiners are used in one or more disciplines in 113 schools. The individual subject tests are used as follows: anatomy (20 schools), behavioral science (12 schools), biochemistry (26 schools), microbiology (28 schools), patholo­gy (35 schools), pharmacology (23 schools), physiology (22 schools), fam­ily medicine (21 schools), medicine (94 schools), obstetrics-gynaecology (90 schools), pediatrics (78 schools), psychiatry (69 schools), and surgery (73 schools).

The use of standardized patients has been advocated to introduce con­sistency into the clinical evaluation process and to supplement evaluations performed by faculty members and house staff. In 76 schools, standard­ized patients were used in evaluation during a basic course in which inter­viewing physical examination skills were taught, and in 69 of these schools, the results from these evaluations were considered in decisions about student progress. In 53 schools, standardized patients were used in clinical clerkship examinations, and in all cases these results were used as part of progress decisions.