[The social security system as a topic in medical education. Own experiences and description of student's...

The special subject "sociomedicine", as defined for medical students in "items to which the written examination in the second part of the medical examination can relate" has been taught by this department for 25 years as part of the course on medical ecology. There are 4 lectures (structure of the health care system; preventive care by doctors in the community and at the place of work; introduction to health economy; introduction to epidemiology) and the following seminars in small groups: social security systems; health insurance; excursion to a rehabilitation hospital; health reporting; epidemiology. The topics are presented and taught with emphasis on didactically useful and local examples.

To ensure student participation "personal data" were introduced: Students give short reports on topics presented to them or they have to formulate questions to the topic of the seminar, questions or subjects to be dealt with. The questions concerning "social security systems" and "health insurance", collected over a 6 year period, were analyzed.

Initially, the subject "sociomedicine" is not much appreciated by the students. The analysis shows what students think when they are challenged. The spectrum of questions mainly reflects the discussion in the media: Finance and benefits predominate, also budget and misuse, especially with reference to old-age pension and health insurance. Questions related to specific medical functions as e. g. medical expert opinion, are less often raised. However, topics such as "expansion of preventive measures", "chip card and utilisation" and "unconventional methods" are often addressed. A special demand for personal advice is seen during small talk discussions in intermissions (health insurance).

The topics "medical expert opinion" and "comparison of public and private health insurance" have become positive knowledge required for the examination and for practising the medical profession. With these subjects as a starting point it appears easier for us to describe the relevant institutions and structures and the general principles of solidarity.