Professional Education of Physicians and Nurses: The U.S. and Mexico Policy Forum Access to Health Care in the U.S.-Mexico Border Region U.S.-Mexico Border.

Professional Education Professional Education of Physicians and of Physicians and

Nurses:Nurses: The U.S. and Mexico The U.S. and Mexico

Policy ForumPolicy ForumAccess to Health Care in theAccess to Health Care in the U.S.-Mexico Border RegionU.S.-Mexico Border Region

El Paso, TXEl Paso, TXOctober 14, 2004October 14, 2004

PresentersPresenters Steven R. Shelton., M.B.A., PA-CSteven R. Shelton., M.B.A., PA-C

• Executive Director, East Texas Area Health Executive Director, East Texas Area Health Education Center, The University of Texas Medical Education 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 de Directora, Programa Universitario de

Ingles y Centro de Auto accesoIngles y Centro de Auto acceso• Universidad de ColimaUniversidad de Colima

Physician Education in the U.S.Physician Education in the U.S.

125 accredited allopathic medical 125 accredited allopathic medical schoolsschools

Liaison Committee on Medical Liaison Committee on Medical Education(AAMC and AMA) accredits Education(AAMC and AMA) accredits US and Canadian allopathic schoolsUS and Canadian allopathic schools

20 accredited osteopathic medical 20 accredited osteopathic medical schoolsschools

Commission on Osteopathic College Commission on Osteopathic College Accreditation for osteopathic schoolsAccreditation for osteopathic schools

Preparation for Medical SchoolPreparation for Medical School

Preferred academic preparation Preferred academic preparation varies by medical school, depending varies by medical school, depending on emphasis/valueson emphasis/values• Science/technology backgroundScience/technology background• Humanities backgroundHumanities background

Work experience in health care highly Work experience in health care highly valued valued

Community service of interest to Community service of interest to some schoolssome schools

Minimum of 90 credit hours, usually Minimum of 90 credit hours, usually prefer a degreeprefer a degree

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

Application…Application…

Medical College Admission Test - Medical College Admission Test - MCATMCAT

Texas Medical and Dental Texas Medical and Dental Schools Application Service – Schools Application Service – TMDSASTMDSAS

Amer. Assn. of Colleges of Amer. Assn. of Colleges of Osteopathic Medicine Osteopathic Medicine Application ServiceApplication Service

Selection to Medical SchoolSelection to Medical School

Schools rank candidates based upon Schools 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

Admission to Medical SchoolAdmission to Medical School

Candidates select preferred Candidates select preferred school to enterschool to enter

Student entry planning Student entry planning completedcompleted• Financial aidFinancial aid• Pre-matriculation programsPre-matriculation programs• OrientationOrientation• Housing ,etc.Housing ,etc.

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

Standard Elements of Standard Elements of CurriculumCurriculum

Year one Year one • Basic sciencesBasic sciences

Anatomy and Anatomy and physiologyphysiology

NeuroscienceNeuroscience Behavioral scienceBehavioral science BiochemistryBiochemistry

• Introduction to Introduction to patientpatient

Hx and PEHx and PE• Genetics, nutrition, Genetics, nutrition,

human sexuality, etchuman sexuality, etc

Year TwoYear Two• Basic-to-Clinical Basic-to-Clinical

SciencesSciences PharmacologyPharmacology MicrobiologyMicrobiology Pathology and Pathology and

disease statesdisease states ImmunologyImmunology Integrated clinical Integrated clinical

medicinemedicine• Clinical IntroductionClinical Introduction• Community med, Community med,

public health, ethics, public health, ethics, etcetc

• Sit for national board Sit for national board exams, part 1exams, part 1

Year ThreeYear Three• Clinical ClerkshipsClinical Clerkships

Four week blocks of Four week blocks of required rotationsrequired rotations

MedicineMedicine PediatricsPediatrics SurgerySurgery Obstetrics-Obstetrics-

gynecologygynecology PsychiatryPsychiatry

• Sit for national board Sit for national board exams, part 2exams, part 2

Year FourYear Four• Clerkships and Clerkships and

electiveselectives Four week blocksFour week blocks NeurologyNeurology DermatologyDermatology Family medicineFamily medicine RadiologyRadiology OtolaryngologyOtolaryngology SpecialtiesSpecialties

• Apply, interview and Apply, interview and match to residency match to residency trainingtraining

Post-graduate Medical EducationPost-graduate Medical Education

Internship – first year in specialty or Internship – first year in specialty or rotating among specialtiesrotating among specialties

Residency – up to five years of Residency – up to five years of specialty training, followed by state specialty training, followed by state board certification for practice entryboard certification for practice entry

Fellowship – additional years of Fellowship – additional years of training/teaching within specialtytraining/teaching within specialty

Nursing Education in the U.S.Nursing Education in the U.S.

About 1700 accredited nursing About 1700 accredited nursing schoolsschools

Voluntary accreditation of US Voluntary accreditation of US schools by National League for schools by National League for Nursing Accrediting CommissionNursing Accrediting Commission• Interpretive Guidelines for Interpretive Guidelines for

Standards and Criteria for all levels Standards and Criteria for all levels of nursing educationof nursing education

Levels of Nursing EducationLevels of Nursing Education

Practical nursing - certificatePractical nursing - certificate• LPN/LVN - training usually at LPN/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 by Sit for licensing examination by

National Council of State Boards of National Council of State Boards of Nursing (NCSBN)Nursing (NCSBN)

Licensed as LVN in TexasLicensed as LVN in Texas

Levels of nursing education…Levels of nursing education…

Diploma nursingDiploma nursing• RN – training conducted by a RN – training conducted by a

sponsoring organization, usually a sponsoring organization, usually a hospital hospital

Two accredited in TexasTwo accredited in Texas Graduates often work for sponsorGraduates often work for sponsor Sit for NCSBN-administered NCLEX-RN Sit for NCSBN-administered NCLEX-RN

examexam Licensed as registered nurseLicensed as registered nurse

Levels of nursing…Levels of nursing…

Associate degree programs - Associate degree programs - ADN, at a community college, or ADN, 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-RN Licensed as RN through NCLEX-RN

examinationexamination• RNs may be certified by American RNs 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

Levels…Levels…

Baccalaureate - BSN, usually at Baccalaureate - BSN, usually at a general higher education or a 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 advanced BSN usually required for advanced

educationeducation• 27 programs in Texas, 14 27 programs in Texas, 14

accreditedaccredited

Levels…Levels…

Masters – MSNMasters – MSN• Is now recommended job standard for Is now recommended job standard for

advanced practice, supervising nurses advanced practice, supervising nurses and usually preferred minimum for and usually preferred minimum for facultyfaculty

• 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 top Preferred among faculty, and top

executive positionsexecutive positions• 7 programs in Texas, none currently 7 programs in Texas, none currently

listed as accredited by NLNAClisted as accredited by NLNAC

Preparation for Nursing SchoolPreparation for Nursing School

High school preparation should High school preparation should be in recommended or be in recommended or distinguished graduation plandistinguished graduation plan

Work experience in health care Work experience in health care highly valued highly valued

Community service of interest to Community service of interest to some schoolssome schools

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

Selection to Nursing SchoolSelection to Nursing School

Schools rank candidates based Schools rank candidates based upon formula scoring preferred upon 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

Nursing School CurriculumNursing School Curriculum Strong attention to detail in Strong attention to detail in

standards for curriculum at all levels standards for curriculum at all levels helps uniformityhelps uniformity

Curriculum has broad scope and Curriculum has broad scope and depth, relevant to each leveldepth, relevant to each level

Range includes community, Range includes community, workplace, and individual patient workplace, and individual patient care elementscare elements

Illness care is balanced by wellness Illness care is balanced by wellness and preventionand prevention

Research essential in BSN and upResearch essential in BSN and up

Core Competencies of Core Competencies of CurriculumCurriculum

Population-based Population-based health care skillshealth care skills

Means to assure access Means to assure access to careto care

Evidence-based Evidence-based clinically competent clinically competent carecare

Understanding role of Understanding role of primary careprimary care

Use outcome measuresUse outcome measures Use balanced approach Use balanced approach

to careto care Practice prevention and Practice prevention and

wellness carewellness care

Involve patients and Involve patients and families in decision-families in decision-makingmaking

Promote healthy Promote healthy lifestyleslifestyles

Adopt communications Adopt communications and technology in and technology in practicepractice

Improve system Improve system operations and operations and accountabilityaccountability

Understand role of Understand role of physical environment in physical environment in healthhealth

Exhibit ethical Exhibit ethical behaviors in practicebehaviors in practice

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