THE ACADEMIC HEALTH CENTER: CHALLENGES AND OPPORTUNITIES FOR PROMOTION OF SOCIAL GOOD AND SOCIETAL W

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THE ACADEMIC HEALTH CENTERCHALLENGES AND
OPPORTUNITIESFOR PROMOTION OF SOCIAL GOODAND
SOCIETAL WELLNESS

• L. Maximilian Buja, M.D.Executive Vice President
  for Academic Affairs

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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

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THE UNIVERSITY OF TEXAS HEALTH SCIENCE CENTER AT
HOUSTON

• Components
• 1. Medical School 4. School of Public Health
• 2. Dental Branch 5. School of Health Information
  Sciences
• 3. School of Nursing 6. Graduate School of
  Biomedical Sciences 7. Brown
  Foundation Institute of Molecular Medicine
• Personnel1,273 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 Hospital
• Harris County Psychiatric Center
• UT MD Anderson Cancer CenterTIRR (The Institute
  for Rehabilitation Research) Texas Heart
  Institute

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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

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CHALLENGES FOR THE TEXAS HEALTHCARE SYSTEM
Houston 1,469,146 (28) Brownsville 123,466
(33)
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National Health Expenditures (Current Dollars)
And Percentage of GDP
National Center for Health Statistics
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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
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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.

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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.

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The Continuum of Medical Education
Graduate Med Ed
Medical Practice
Premed Ed
Medical School
Specialty Training
Private Practice
Clinical Sciences and Practice
Liberal Arts
Academics
Residencies
Basic Sciences Research Opportunities
MD-PhD
Fellowships
Other
Core Sciences
Research Fellowships
CME
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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)

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UT HOUSTON MEDICAL SCHOOL CURRICULUM Prevention
and Public Health Issues
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UT HOUSTON MEDICAL SCHOOL CURRICULUM Prevention
and Public Health Issues
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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

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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

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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

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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

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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.

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