Struggling to understand the national debate over health care? You're not alone -- your future doctor may well be baffled, too.

A study published in the September issue of Academic Medicine found that nearly half of all medical students believe they have been inadequately educated about the "practice of medicine" -- especially related to medical economics.

“Our patients expect us to understand the system,” said Matthew M. Davis, one of the researchers and an associate professor of pediatrics and internal medicine in the Child Health Evaluation and Research Unit at the University of Michigan's medical school. “If we don’t, that can result in poor patient care. And if we don’t expect doctors to understand the health care system, who is going to?”

The study, by Davis and two colleagues at Michigan, examined tens of thousands of survey responses from medical students about the extent and perceived quality of their training in an array of curricular areas, including clinical care and decision making and the practice of medicine -- with the latter including health care systems, managed care, and practice management, among other areas.

The vast majority of respondents (more than 80 percent across the board during the period, which ran from 2003 to 2007) reported receiving "appropriate" levels of training in the clinical aspects of their education, including such things as diagnosis and management of disease, ethical decision making, pharmacology, and care of patients.

But fewer than 50 percent of medical students said they believed they had received appropriate training in areas related to the profession they are prepping to enter. (Because it is based on a survey, all of the data relate to future doctors' impressions of the education they received, not their actual aptitudes.)

The picture looked a little different when the researchers compared the national sample of students with responses from two individual medical schools, one of which had a "higher intensity" curriculum when it comes to the medical profession, and another that provided less instruction on that set of skills and knowledge.

Students in the former program were significantly likelier than those in the latter to report satisfaction with their level of training on the practice of medicine. And they were three times likelier to report appropriate training in medical economics and health care systems.

"The high-intensity curriculum in health care systems -- which differed from the lower-intensity curriculum both in structure and in class time devoted to the subject -- seems to have translated into a greater sense of appropriate instruction on the subject among graduating students," the authors wrote.

And it did not appear that the additional attention paid to that subject matter distracted students from the more clinical aspects of their medical training: They reported comparable levels of satisfaction with their perceived instruction in clinical areas as their peers did.

"This means that a higher intensity curriculum in health care systems could hold the potential to overcome medical students' perceptions of inadequate training in the practice of medicine and health care systems," without impairing the hugely important clinical aspects of their training, the authors say.