THE ACADEMIC HEALTH CENTER:CHALLENGES AND OPPORTUNITIESFOR PROMOTION OF SOCIAL GOOD
AND SOCIETAL WELLNESS
THE ACADEMIC HEALTH CENTER:CHALLENGES AND OPPORTUNITIESFOR PROMOTION OF SOCIAL GOOD
AND SOCIETAL WELLNESS
L. Maximilian Buja, M.D.Executive Vice President for Academic Affairs
L. Maximilian Buja, M.D.Executive Vice President for Academic Affairs
TEXAS MEDICAL CENTERTEXAS 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
THE UNIVERSITY OF TEXAS HEALTH SCIENCE CENTER AT HOUSTONComponents1. Medical School 4. School of Public Health2. Dental Branch 5. School of Health Information Sciences3. School of Nursing 6. Graduate School of Biomedical Sciences
7. Brown Foundation Institute of Molecular MedicinePersonnel
1,273 Faculty 800 Medical Residents & Fellows3,651 Students 3,154 Staff
Budget$681.7 Million Operating Budget FY 2007
Major AffiliationsMemorial Hermann Healthcare System – MHH & CMH-TMC; Harris County Hospital District – LBJ HospitalHarris County Psychiatric CenterUT MD Anderson Cancer CenterTIRR (The Institute for Rehabilitation & Research) Texas Heart Institute
CHALLENGES FOR THE AMERICAN HEALTHCARE SYSTEM
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
CHALLENGES FOR THE TEXAS HEALTHCARE SYSTEM
Texas (2005)* U.S.A. (2005)
Uninsured Children >1,300,000 9,000,000
Percent of Uninsured Children 20.7% 11.2%
Total Uninsured >5,600,000 46,000,000
Total Percent Uninsured 24.2% 15.9%
* Houston 1,469,146 (28%) Brownsville 123,466 (33%)
National Health Expenditures (Current Dollars) And Percentage of GDP
National Center for Health StatisticsNational 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 Organization for Economic Co-Operation and Development (OECD) Health Data 2000(OECD) Health Data 2000
THE PARADOXES OF AMERICAN HEALTHCARE
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 EDUCATIONGOALS 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 EducationThe Continuum of Medical Education
LiberalArts
CoreSciences
Clinical Sciencesand Practice
BasicSciences Research Opportunities MD-PhD
SpecialtyTraining
Residencies
Fellowships
ResearchFellowships
PrivatePractice
Academics
Other
CME
Premed EdPremed Ed Medical SchoolMedical SchoolMedical SchoolMedical SchoolGraduateMed Ed
GraduateMed Ed
MedicalPracticeMedicalPractice
TRENDS IN MEDICAL EDUCATIONTRENDS 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 8 hours ICM and Behavioral Science Courses
Community Health 6 hours Family Practice/Pediatrics Clerkships
Epidemiology 33 hours ICM and FCM, PBL Cases
Family/Domestic Violence 6 hours Behavioral Science Course
Medical Ethics 25 hours Ethics Course
Medical Socioeconomics 6 hours FCM and PBL Case
Nutrition 12 hours In ICM lectures and web-based module
Population-based Medicine 6 hours Family Medicine
Prevent/Health Maintenance 20 hoursFamily Practice, Pediatrics, Internal Medicine, PBL Case
Substance Abuse 20 hoursBehavioral Science, Pharmacology, FCM, Psychiatry, Family Practice Clerkships
UT HOUSTON MEDICAL SCHOOL CURRICULUM Prevention and Public Health Issues
Health Determinants 6 hours ICM, FCM
Disease Screening Tests 10 hours ICM, Genetics, Pediatrics
Immunization 8 hours Pediatrics
Environmental Health 6 hours Pharmacology, Family Practice
Counseling for Health Risk Education
6 hours Genetics, Family Practice, Pediatrics
Evaluation of Health Research Literature
10 hours PBL, Pediatrics
Patient Health Education 8 hours Family Practice
Racial/Ethnic Demographics of Illness
4 hours ICM, Family Practice
PBL CasesEpidemiology, Prevention, Risk Factors, Substance Abuse, Screening Tests, Patient Education
COMPETENCIES AND OUTCOMES IN MEDICAL 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 INITIATIVESNATIONAL INITIATIVESAAMC
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)
ACGMECommittee for Innovations in the Learning Environment (CILE)
AMACouncil on Medical Education:Initiative to Transform Medical Education (ITME)
IHI100,000 Lives Campaign5 Million Lives Campaign
PROMOTION OF COMPETENCY IN MEDICAL EDUCATION AND PRACTICE
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 DIRECTIONSFUTURE 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
PERSPECTIVESPERSPECTIVES
Julius B. Richmond and Rashi Fein. Julius B. Richmond and Rashi Fein. The Health Care Mess: The Health Care Mess: How We Got Into It And What It Will Take To Get OutHow We Got Into It And What It Will Take To Get Out. . Cambridge, Harvard University Press, 2005.Cambridge, Harvard University Press, 2005.