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.

J.B. Richmond & M. Kotelchuck. Three-Factor Approach to Health PolicyJ.B. Richmond & M. Kotelchuck. Three-Factor Approach to Health Policy