The joys of teaching health economics to medical students

1. The joys of teaching health economics to medical students the MB/BS at UEA

3. The MB/BS at UEA • Based on the PBL system of learning • Natural and social sciences integrated throughout • Students ‘set loose’ on patients from week one • Much emphasis on communication skills and ‘holistic’ approach to patient care

4. Example PBL scenario (unit 1) Jim was delighted to get his bowel screening pack through the post and thought it was a great idea. When he rang his identical twin brother , who lived in Cornwall, he was surprised to hear that he hadn't got one. Jim suggested that John write a letter of complaint to his MP. Jim's wife Doreen, aged 51, got a letter through telling her that her next cervical smear was due. Soon after she got a letter asking her to go for a mammogram. She didn't like going, but having read all the stories in Women's Own she knew it was a good idea.

5. Example learning objectives • Explain the justification for the screening programmes currently offered in the NHS. • What role does the state play in protecting and promoting health and preventing disease? • Outline how health needs are assessed and decisions about resource allocation are made in the NHS. • Discuss the role of the media in disseminating information about health and how this alters peoples perception about their health.

6. Weekly teaching slots • ‘Core’ lectures attended by all students • ‘Seminars’ attended by at least 2 members of each PBL who feedback to others • Clinical & communication skills training sessions • Primary care day

7. Health economic input • Lectures/seminars • SSS presentations & posters • Fourth year projects • PBL tutoring

8. Health economic assessment • Short answer questions (PBL-based) • Extended matching questions (EMQs) - e.g. which of these terms means maximising output for a given input? • SSS assessments - need to pass on presentation & content

9. First year SSS questions • Escalating health care costs are largely due to the aging population. Discuss. • The fundamental principle of the NHS is equality of access (for equal need): How far have we achieved this objective? • Quality Adjusted Life Years (QALYs) are used by health economists (and NICE) to measure outcome. What are QALYs and why do we use them? • Should we ration healthcare? If so, how, and to whom? • Different countries across the world adopt different health care systems. Which health care system is ‘best’- give your justifications. • Solving the funding crisis: why don't we just refuse treatment to smokers, drinkers and drug-users?

10. Strengths? • Good to have the importance of health economics recognised • UEA medical students cover more health economics than most (we guess!) • When focused adequately (as in SSS), most students do engage with HE methods and principles

11. Weaknesses? • The PBL system makes it difficult for students to follow methodological threads • HE suffers from being lumped together with ‘psychosocial sciences’ and ‘wishy washy’ stuff • The degree of integration makes ‘ownership’ of the HE curriculum difficult • Not all assessment methods are ideally suited to examine HE knowledge

12. Ongoing challenges Breaking out of the ‘social science stigma’ Overcoming prior beliefs about what HE is all about (e.g. fixation on cost cutting) Balancing what medical students ‘need to’ know with what they engage with Being more imaginative/flexible about learning processes in this situation