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Professional Education of Physicians and Nurses

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  • 1. Professional EducationProfessional Education of Physicians andof Physicians and Nurses:Nurses: The U.S. and MexicoThe U.S. and Mexico Policy ForumPolicy Forum Access to Health Care in theAccess to Health Care in the U.S.-Mexico Border RegionU.S.-Mexico Border Region El Paso, TXEl Paso, TX October 14, 2004October 14, 2004
  • 2. PresentersPresenters  Steven R. Shelton., M.B.A., PA-CSteven R. Shelton., M.B.A., PA-C • Executive Director, East Texas Area HealthExecutive Director, East Texas Area Health Education Center, The University of Texas MedicalEducation Center, The University of Texas Medical Branch at GalvestonBranch at Galveston  MC. Noemi Alcaraz MorenoMC. Noemi Alcaraz Moreno • Directora, Facultad de Enfermeria,Directora, Facultad de Enfermeria, Universidad de ColimaUniversidad de Colima  Lic. Patricia Salazar DiazLic. Patricia Salazar Diaz • Directora, Programa Universitario deDirectora, Programa Universitario de Ingles y Centro de Auto accesoIngles y Centro de Auto acceso • Universidad de ColimaUniversidad de Colima
  • 3. Physician Education in the U.S.Physician Education in the U.S.  125 accredited allopathic medical125 accredited allopathic medical schoolsschools  Liaison Committee on MedicalLiaison Committee on Medical Education(AAMC and AMA) accreditsEducation(AAMC and AMA) accredits US and Canadian allopathic schoolsUS and Canadian allopathic schools  20 accredited osteopathic medical20 accredited osteopathic medical schoolsschools  Commission on Osteopathic CollegeCommission on Osteopathic College Accreditation for osteopathic schoolsAccreditation for osteopathic schools
  • 4. Preparation for Medical SchoolPreparation for Medical School  Preferred academic preparation variesPreferred academic preparation varies by medical school, depending onby medical school, depending on emphasis/valuesemphasis/values • Science/technology backgroundScience/technology background • Humanities backgroundHumanities background  Work experience in health care highlyWork experience in health care highly valuedvalued  Community service of interest toCommunity service of interest to some schoolssome schools  Minimum of 90 credit hours, usuallyMinimum of 90 credit hours, usually prefer a degreeprefer a degree
  • 5. Application to Medical SchoolApplication to Medical School  Candidates consider their “fit”Candidates consider their “fit” with schools of interestwith schools of interest • Professional interestProfessional interest • Cost/financesCost/finances • Special interestsSpecial interests • LocationLocation • Student supportStudent support  Early guaranteed admissionEarly guaranteed admission
  • 6. Application…Application…  Medical College Admission Test -Medical College Admission Test - MCATMCAT  Texas Medical and DentalTexas Medical and Dental Schools Application Service –Schools Application Service – TMDSASTMDSAS  Amer. Assn. of Colleges ofAmer. Assn. of Colleges of Osteopathic Medicine ApplicationOsteopathic Medicine Application ServiceService
  • 7. Selection to Medical SchoolSelection to Medical School  Schools rank candidates based uponSchools rank candidates based upon formula scoring preferred attributesformula scoring preferred attributes • MCATMCAT • Grade point averagesGrade point averages • Service pointsService points • Recognition points, etcRecognition points, etc  Candidates interviewed and re-scoredCandidates interviewed and re-scored  Ranked and invited to attendRanked and invited to attend
  • 8. Admission to Medical SchoolAdmission to Medical School  Candidates select preferredCandidates select preferred school to enterschool to enter  Student entry planningStudent entry planning completedcompleted • Financial aidFinancial aid • Pre-matriculation programsPre-matriculation programs • OrientationOrientation • Housing ,etc.Housing ,etc.
  • 9. Medical School CurriculumMedical School Curriculum  School by school variationsSchool by school variations • Traditional curriculum - lectureTraditional curriculum - lecture • Innovative curriculumInnovative curriculum  Problem-based curriculum, case studiesProblem-based curriculum, case studies  Independent study curriculumIndependent study curriculum
  • 10. Standard Elements ofStandard Elements of CurriculumCurriculum  Year oneYear one • Basic sciencesBasic sciences  Anatomy andAnatomy and physiologyphysiology  NeuroscienceNeuroscience  Behavioral scienceBehavioral science  BiochemistryBiochemistry • Introduction toIntroduction to patientpatient  Hx and PEHx and PE • Genetics, nutrition,Genetics, nutrition, human sexuality, etchuman sexuality, etc  Year TwoYear Two • Basic-to-ClinicalBasic-to-Clinical SciencesSciences  PharmacologyPharmacology  MicrobiologyMicrobiology  Pathology andPathology and disease statesdisease states  ImmunologyImmunology  Integrated clinicalIntegrated clinical medicinemedicine • Clinical IntroductionClinical Introduction • Community med,Community med, public health, ethics,public health, ethics, etcetc • Sit for national boardSit for national board exams, part 1exams, part 1
  • 11.  Year ThreeYear Three • Clinical ClerkshipsClinical Clerkships  Four week blocks ofFour week blocks of required rotationsrequired rotations  MedicineMedicine  PediatricsPediatrics  SurgerySurgery  Obstetrics-Obstetrics- gynecologygynecology  PsychiatryPsychiatry • Sit for national boardSit for national board exams, part 2exams, part 2  Year FourYear Four • Clerkships andClerkships and electiveselectives  Four week blocksFour week blocks  NeurologyNeurology  DermatologyDermatology  Family medicineFamily medicine  RadiologyRadiology  OtolaryngologyOtolaryngology  SpecialtiesSpecialties • Apply, interview andApply, interview and match to residencymatch to residency trainingtraining
  • 12. Post-graduate Medical EducationPost-graduate Medical Education  Internship – first year in specialty orInternship – first year in specialty or rotating among specialtiesrotating among specialties  Residency – up to five years ofResidency – up to five years of specialty training, followed by statespecialty training, followed by state board certification for practice entryboard certification for practice entry  Fellowship – additional years ofFellowship – additional years of training/teaching within specialtytraining/teaching within specialty
  • 13. Nursing Education in the U.S.Nursing Education in the U.S.  About 1700 accredited nursingAbout 1700 accredited nursing schoolsschools  Voluntary accreditation of USVoluntary accreditation of US schools by National League forschools by National League for Nursing Accrediting CommissionNursing Accrediting Commission • Interpretive Guidelines forInterpretive Guidelines for Standards and Criteria for all levelsStandards and Criteria for all levels of nursing educationof nursing education
  • 14. Levels of Nursing EducationLevels of Nursing Education  Practical nursing - certificatePractical nursing - certificate • LPN/LVN - training usually atLPN/LVN - training usually at community college or vocational/community college or vocational/ technical training centertechnical training center  56 in Texas, 3 accredited56 in Texas, 3 accredited  ~12 months of study~12 months of study  Sit for licensing examination bySit for licensing examination by National Council of State Boards ofNational Council of State Boards of Nursing (NCSBN)Nursing (NCSBN)  Licensed as LVN in TexasLicensed as LVN in Texas
  • 15. Levels of nursing education…Levels of nursing education…  Diploma nursingDiploma nursing • RN – training conducted by aRN – training conducted by a sponsoring organization, usually asponsoring organization, usually a hospitalhospital  Two accredited in TexasTwo accredited in Texas  Graduates often work for sponsorGraduates often work for sponsor  Sit for NCSBN-administered NCLEX-RNSit for NCSBN-administered NCLEX-RN examexam  Licensed as registered nurseLicensed as registered nurse
  • 16. Levels of nursing…Levels of nursing…  Associate degree programs -Associate degree programs - ADN, at a community college, orADN, at a community college, or rarely at an upper division schoolrarely at an upper division school • 24 – 36 months in duration24 – 36 months in duration • Licensed as RN through NCLEX-RNLicensed as RN through NCLEX-RN examinationexamination • RNs may be certified by AmericanRNs may be certified by American Nurses Assn in area of specialtyNurses Assn in area of specialty • 49 programs in Texas, 39 accredited49 programs in Texas, 39 accredited
  • 17. Levels…Levels…  Baccalaureate - BSN, usually atBaccalaureate - BSN, usually at a general higher education ora general higher education or health science campushealth science campus • Two years of general studiesTwo years of general studies • two years of nursing studiestwo years of nursing studies • Licensed as RN through NCLEX-RNLicensed as RN through NCLEX-RN • BSN usually required for advancedBSN usually required for advanced educationeducation • 27 programs in Texas, 14 accredited27 programs in Texas, 14 accredited
  • 18. Levels…Levels…  Masters – MSNMasters – MSN • Is now recommended job standard forIs now recommended job standard for advanced practice, supervising nurses andadvanced practice, supervising nurses and usually preferred minimum for facultyusually preferred minimum for faculty • Clinical nurse specialists – CNM, NP, CNSClinical nurse specialists – CNM, NP, CNS • 14 programs in Texas, seven accredited14 programs in Texas, seven accredited  Doctoral – PhD, DScNDoctoral – PhD, DScN • Preferred among faculty, and topPreferred among faculty, and top executive positionsexecutive positions • 7 programs in Texas, none currently listed7 programs in Texas, none currently listed as accredited by NLNACas accredited by NLNAC
  • 19. Preparation for Nursing SchoolPreparation for Nursing School  High school preparation shouldHigh school preparation should be in recommended orbe in recommended or distinguished graduation plandistinguished graduation plan  Work experience in health careWork experience in health care highly valuedhighly valued  Community service of interest toCommunity service of interest to some schoolssome schools
  • 20. Application to Nursing SchoolApplication to Nursing School  Candidates consider their “fit”Candidates consider their “fit” with schools of interestwith schools of interest • Professional interestProfessional interest • Cost/financesCost/finances • Special interestsSpecial interests • LocationLocation • Student supportStudent support
  • 21. Selection to Nursing SchoolSelection to Nursing School  Schools rank candidates basedSchools rank candidates based upon formula scoring preferredupon formula scoring preferred attributesattributes • Grade point averagesGrade point averages • Service pointsService points • Recognition points, etcRecognition points, etc  Candidates interviewed and re-Candidates interviewed and re- scoredscored  Ranked and invited to attendRanked and invited to attend
  • 22. Nursing School CurriculumNursing School Curriculum  Strong attention to detail in standardsStrong attention to detail in standards for curriculum at all levels helpsfor curriculum at all levels helps uniformityuniformity  Curriculum has broad scope andCurriculum has broad scope and depth, relevant to each leveldepth, relevant to each level  Range includes community,Range includes community, workplace, and individual patient careworkplace, and individual patient care elementselements  Illness care is balanced by wellnessIllness care is balanced by wellness and preventionand prevention  Research essential in BSN and upResearch essential in BSN and up
  • 23. Core Competencies ofCore Competencies of CurriculumCurriculum  Population-based healthPopulation-based health care skillscare skills  Means to assure accessMeans to assure access to careto care  Evidence-basedEvidence-based clinically competentclinically competent carecare  Understanding role ofUnderstanding role of primary careprimary care  Use outcome measuresUse outcome measures  Use balanced approachUse balanced approach to careto care  Practice prevention andPractice prevention and wellness carewellness care  Involve patients andInvolve patients and families in decision-families in decision- makingmaking  Promote healthyPromote healthy lifestyleslifestyles  Adopt communicationsAdopt communications and technology inand technology in practicepractice  Improve systemImprove system operations andoperations and accountabilityaccountability  Understand role ofUnderstand role of physical environment inphysical environment in healthhealth  Exhibit ethicalExhibit ethical behaviors in practicebehaviors in practice
  • 24. ResourcesResources  Association of American Medical Colleges,Association of American Medical Colleges, www.www.aamcaamc.org.org  American Medical Association, www.ama.orgAmerican Medical Association, www.ama.org  Liaison Committee on Medical Education,Liaison Committee on Medical Education, www.www.lcmelcme.org.org  American Association of Colleges of Osteopathic Medicine,American Association of Colleges of Osteopathic Medicine, www.www.aacomaacom .org.org  National League for Nursing,National League for Nursing, www.www.nlnnln.org.org  NLN Accrediting Commission,NLN Accrediting Commission, www.www.nlnacnlnac.org.org  American Nurses Association, www.ana.orgAmerican Nurses Association, www.ana.org  American Association of Colleges of Nursing, www.aacn.orgAmerican Association of Colleges of Nursing, www.aacn.org  Texas Nurses Association, www.texasnurses.orgTexas Nurses Association, www.texasnurses.org  National Federation of Licensed Vocational Nurses, www.nflpn.orgNational Federation of Licensed Vocational Nurses, www.nflpn.org  Texas State Board of Medical Examiners, www.tsbme.state.tx.usTexas State Board of Medical Examiners, www.tsbme.state.tx.us  Texas State Board of Nurse Examiners, www.bne.state.tx.usTexas State Board of Nurse Examiners, www.bne.state.tx.us  www.texashotjobs.orgwww.texashotjobs.org  Federation of State Medical Boards, www.fsmb.orgFederation of State Medical Boards, www.fsmb.org  Educational Commission for Foreign Medical Graduates,Educational Commission for Foreign Medical Graduates, www.ecfmg.orgwww.ecfmg.org