Transcript HOUSTON HOSPITAL SUPPORT OF ACADEMIC INSTITUTIONS’ …
THE ACADEMIC HEALTH CENTER: CHALLENGES AND OPPORTUNITIES FOR PROMOTION OF SOCIAL GOOD AND SOCIETAL WELLNESS
L. Maximilian Buja, M.D.
Executive Vice President for Academic Affairs
TEXAS MEDICAL CENTER
45 Member Institutions, 13 hospitals, and 2 specialized patient facilities 100+ Permanent Buildings with 44,188+ Parking Spaces 5.2 Million Patient Visits in 2004, including 10,456 International Patients 4,000+ Physicians, 11,000+ Nurses, & 12,000+ Volunteers 73,600 Employees 11 Educational Institutions with 22,000+ Students $3.5 Billion committed to research 6 Million Projected gross square feet of space through 2008
THE UNIVERSITY OF TEXAS HEALTH SCIENCE CENTER AT HOUSTON
Components
1. Medical School 2. Dental Branch 3. School of Nursing 4. School of Public Health 5. School of Health Information Sciences 6. Graduate School of Biomedical Sciences 7. Brown Foundation Institute of Molecular Medicine
Personnel
1,273 Faculty 3,651 Students 800 Medical Residents & Fellows 3,154 Staff
Budget
$681.7 Million Operating Budget FY 2007
Major Affiliations
Memorial Hermann Healthcare System – MHH & CMH-TMC; Harris County Hospital District – LBJ Hospital Harris County Psychiatric Center UT MD Anderson Cancer Center TIRR (The Institute for Rehabilitation & Research) Texas Heart Institute
CHALLENGES FOR THE AMERICAN HEALTHCARE SYSTEM
Healthcare Disparities Discrepancies in Access to Healthcare Increasing numbers of non-elderly uninsured 45.3 million in 2004 46.6 million in 2005 Aging Population Medicare Beneficiaries: 19 million (1966), 40 million (current), 77 million (2030) Low Income Americans 40 million on Medicaid Misaligned Incentives for Healthcare Providers and Consumers of Healthcare
CHALLENGES FOR THE TEXAS HEALTHCARE SYSTEM
Uninsured Children Percent of Uninsured Children Total Uninsured Total Percent Uninsured Texas (2005)* >1,300,000 20.7% >5,600,000 24.2% U.S.A. (2005) 9,000,000 11.2% 46,000,000 15.9% * Houston 1,469,146 (28%) Brownsville 123,466 (33%)
National Health Expenditures (Current Dollars) And Percentage of GDP
National Center for Health Statistics
International Comparison of Health Care As a Percentage of GDP and Infant Mortality Rates, 1996
Organization for Economic Co-Operation and Development (OECD) Health Data 2000
THE PARADOXES OF AMERICAN HEALTHCARE
While the future of biomedical research has never been brighter based on the advances to date and the promise of molecular and genomic medicine, national priorities and economic realities are constraining ongoing funding of research. While the pace of biomedical discovery and new knowledge quickens, the pace of application of the knowledge to effectively prevent disease and improve the health of the population lags behind.
The effectiveness of the healthcare delivery system is constrained because of increasing dysfunction of its socioeconomical foundation.
GOALS OF MEDICAL EDUCATION
The goals of medical education are to develop physicians with scientific knowledge and understanding of health and disease; proficiency in basic clinical skills; and attitudes that foster patient-centered care, disease prevention and wellness; and support the highest standards of medical professionalism.
The Continuum of Medical Education
Premed Ed
Liberal Arts Core Sciences
Medical School
Clinical Sciences and Practice Basic Sciences MD-PhD
Graduate Med Ed
Specialty Training Residencies Fellowships Research Fellowships
Medical Practice
Private Practice Academics Other CME
TRENDS IN MEDICAL EDUCATION
Evidence-Based Medicine Problem-Based Learning Team-Based Learning Simulation Interactive learning modules (computer-based) Simulated patients (computer-based) Standardized patients Mannequins Interdisciplinary Education Competency- and Outcomes-Based Learning and Evaluation Testing of Competencies Objective Structured Clinical Examination (OSCE) Clinical Performance Examination (CPX)
UT HOUSTON MEDICAL SCHOOL CURRICULUM Prevention and Public Health Issues
Biostatistics Community Health Epidemiology Family/Domestic Violence Medical Ethics Medical Socioeconomics Nutrition Population-based Medicine Prevent/Health Maintenance Substance Abuse 8 hours 6 hours 33 hours 6 hours 25 hours 6 hours 12 hours 6 hours 20 hours 20 hours ICM and Behavioral Science Courses Family Practice/Pediatrics Clerkships ICM and FCM, PBL Cases Behavioral Science Course Ethics Course FCM and PBL Case In ICM lectures and web-based module Family Medicine Family Practice, Pediatrics, Internal Medicine, PBL Case Behavioral Science, Pharmacology, FCM, Psychiatry, Family Practice Clerkships
UT HOUSTON MEDICAL SCHOOL CURRICULUM Prevention and Public Health Issues
Health Determinants Disease Screening Tests Immunization Environmental Health Counseling for Health Risk Education Evaluation of Health Research Literature Patient Health Education Racial/Ethnic Demographics of Illness PBL Cases 6 hours 10 hours 8 hours 6 hours 6 hours 10 hours 8 hours 4 hours ICM, FCM ICM, Genetics, Pediatrics Pediatrics Pharmacology, Family Practice Genetics, Family Practice, Pediatrics PBL, Pediatrics Family Practice ICM, Family Practice Epidemiology, Prevention, Risk Factors, Substance Abuse, Screening Tests, Patient Education
COMPETENCIES AND OUTCOMES IN MEDICAL EDUCATION
ACGME/ABMS Competencies
Patient care Medical knowledge Practice-based learning/improvement Interpersonal and communication skills Professionalism Systems-based practice
NATIONAL INITIATIVES
AAMC Institute for Improving Medical Education (IIME) Institute for Improving Clinical Care (IICC) Academic Chronic Care Collaborative (in partnership with the McColl Institute for Healthcare Innovation) ACGME Committee for Innovations in the Learning Environment (CILE) AMA Council on Medical Education: Initiative to Transform Medical Education (ITME) IHI 100,000 Lives Campaign 5 Million Lives Campaign
PROMOTION OF COMPETENCY IN MEDICAL EDUCATION AND PRACTICE
LCME Medical School Accreditation USMLE Licensing Exam – Steps 1, 2CK, 2CS, and 3 ACGME GME Program Accreditation ABMS Specialty and Subspecialty Certification State Medical Board Licensure Continuing Medical Education (CME) Maintenance of Certification by ABMS Maintenance of Licensure by State Medical Board
FUTURE DIRECTIONS
Education of medical and other healthcare professionals Continuity over the entire professional career Competency-based Interdisciplinary professional teams organized around themes and disease processes Clinical practice Biomedical research Focus on balancing care for patients with disease prevention and promotion of health and wellness
PERSPECTIVES
Julius B. Richmond and Rashi Fein.
The Health Care Mess: How We Got Into It And What It Will Take To Get Out
. Cambridge, Harvard University Press, 2005.
J.B. Richmond & M. Kotelchuck. Three-Factor Approach to Health Policy