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