Preparing physicians for practice in managed care environments.

The author first describes the evolution and characteristics of managed care and its emphasis on the care of populations as well as individuals. She then reviews managed care's implications for medical education; for example, managed care physicians must know non-office-based approaches to keeping their patients healthy. She identifies and defines eight domains of knowledge in which physicians must be competent for practice in environments dominated by managed care. These are epidemiologic thinking, human behavior, organizational behavior, information systems, quality measurement and improvement, health system financing and delivery, ethics, and systems based care. Teaching students to practice in managed care environments is a challenge partly because there are few role models of the new breed of physician among medical school faculties. The author suggests strategies and attitudes to remedy this situation (for example, faculty must understand that managed care is not homogeneous and that it is not all bad; medical schools should develop "master teachers" for the rest of the faculty; and interactive CD-ROM-driven problem-based learning sets could be used). Focusing on training faculty for the new era and on emphasizing the eight knowledge better physicians, whether they practice inside or outside managed care.