Professional Education of Physicians and Nurses: The U.S. and Mexico

1. Professional Education of Physicians and Nurses: The U.S. and Mexico Policy Forum Access to Health Care in the U.S.-Mexico Border Region El Paso, TX October 14, 2004

2. Presenters • Steven R. Shelton., M.B.A., PA-C • Executive Director, East Texas Area Health Education Center, The University of Texas Medical Branch at Galveston • MC. Noemi Alcaraz Moreno • Directora, Facultad de Enfermeria, Universidad de Colima • Lic. Patricia Salazar Diaz • Directora, Programa Universitario de Ingles y Centro de Auto acceso • Universidad de Colima

3. Physician Education in the U.S. • 125 accredited allopathic medical schools • Liaison Committee on Medical Education(AAMC and AMA) accredits US and Canadian allopathic schools • 20 accredited osteopathic medical schools • Commission on Osteopathic College Accreditation for osteopathic schools

4. Preparation for Medical School • Preferred academic preparation varies by medical school, depending on emphasis/values • Science/technology background • Humanities background • Work experience in health care highly valued • Community service of interest to some schools • Minimum of 90 credit hours, usually prefer a degree

5. Application to Medical School • Candidates consider their “fit” with schools of interest • Professional interest • Cost/finances • Special interests • Location • Student support • Early guaranteed admission

6. Application… • Medical College Admission Test - MCAT • Texas Medical and Dental Schools Application Service – TMDSAS • Amer. Assn. of Colleges of Osteopathic Medicine Application Service

7. Selection to Medical School • Schools rank candidates based upon formula scoring preferred attributes • MCAT • Grade point averages • Service points • Recognition points, etc • Candidates interviewed and re-scored • Ranked and invited to attend

8. Admission to Medical School • Candidates select preferred school to enter • Student entry planning completed • Financial aid • Pre-matriculation programs • Orientation • Housing ,etc.

9. Medical School Curriculum • School by school variations • Traditional curriculum - lecture • Innovative curriculum • Problem-based curriculum, case studies • Independent study curriculum

10. Year one Basic sciences Anatomy and physiology Neuroscience Behavioral science Biochemistry Introduction to patient Hx and PE Genetics, nutrition, human sexuality, etc Year Two Basic-to-Clinical Sciences Pharmacology Microbiology Pathology and disease states Immunology Integrated clinical medicine Clinical Introduction Community med, public health, ethics, etc Sit for national board exams, part 1 Standard Elements of Curriculum

11. Year Three Clinical Clerkships Four week blocks of required rotations Medicine Pediatrics Surgery Obstetrics-gynecology Psychiatry Sit for national board exams, part 2 Year Four Clerkships and electives Four week blocks Neurology Dermatology Family medicine Radiology Otolaryngology Specialties Apply, interview and match to residency training

12. Post-graduate Medical Education • Internship – first year in specialty or rotating among specialties • Residency – up to five years of specialty training, followed by state board certification for practice entry • Fellowship – additional years of training/teaching within specialty

13. Nursing Education in the U.S. • About 1700 accredited nursing schools • Voluntary accreditation of US schools by National League for Nursing Accrediting Commission • Interpretive Guidelines for Standards and Criteria for all levels of nursing education

14. Levels of Nursing Education • Practical nursing - certificate • LPN/LVN - training usually at community college or vocational/ technical training center • 56 in Texas, 3 accredited • ~12 months of study • Sit for licensing examination by National Council of State Boards of Nursing (NCSBN) • Licensed as LVN in Texas

15. Levels of nursing education… • Diploma nursing • RN – training conducted by a sponsoring organization, usually a hospital • Two accredited in Texas • Graduates often work for sponsor • Sit for NCSBN-administered NCLEX-RN exam • Licensed as registered nurse

16. Levels of nursing… • Associate degree programs - ADN, at a community college, or rarely at an upper division school • 24 – 36 months in duration • Licensed as RN through NCLEX-RN examination • RNs may be certified by American Nurses Assn in area of specialty • 49 programs in Texas, 39 accredited

17. Levels… • Baccalaureate - BSN, usually at a general higher education or health science campus • Two years of general studies • two years of nursing studies • Licensed as RN through NCLEX-RN • BSN usually required for advanced education • 27 programs in Texas, 14 accredited

18. Levels… • Masters – MSN • Is now recommended job standard for advanced practice, supervising nurses and usually preferred minimum for faculty • Clinical nurse specialists – CNM, NP, CNS • 14 programs in Texas, seven accredited • Doctoral – PhD, DScN • Preferred among faculty, and top executive positions • 7 programs in Texas, none currently listed as accredited by NLNAC

19. Preparation for Nursing School • High school preparation should be in recommended or distinguished graduation plan • Work experience in health care highly valued • Community service of interest to some schools

20. Application to Nursing School • Candidates consider their “fit” with schools of interest • Professional interest • Cost/finances • Special interests • Location • Student support

21. Selection to Nursing School • Schools rank candidates based upon formula scoring preferred attributes • Grade point averages • Service points • Recognition points, etc • Candidates interviewed and re-scored • Ranked and invited to attend

22. Nursing School Curriculum • Strong attention to detail in standards for curriculum at all levels helps uniformity • Curriculum has broad scope and depth, relevant to each level • Range includes community, workplace, and individual patient care elements • Illness care is balanced by wellness and prevention • Research essential in BSN and up

23. Population-based health care skills Means to assure access to care Evidence-based clinically competent care Understanding role of primary care Use outcome measures Use balanced approach to care Practice prevention and wellness care Involve patients and families in decision-making Promote healthy lifestyles Adopt communications and technology in practice Improve system operations and accountability Understand role of physical environment in health Exhibit ethical behaviors in practice Core Competencies of Curriculum

24. Resources • Association of American Medical Colleges, www.aamc.org • American Medical Association, www.ama.org • Liaison Committee on Medical Education, www.lcme.org • American Association of Colleges of Osteopathic Medicine, www.aacom.org • National League for Nursing, www.nln.org • NLN Accrediting Commission, www.nlnac.org • American Nurses Association, www.ana.org • American Association of Colleges of Nursing, www.aacn.org • Texas Nurses Association, www.texasnurses.org • National Federation of Licensed Vocational Nurses, www.nflpn.org • Texas State Board of Medical Examiners, www.tsbme.state.tx.us • Texas State Board of Nurse Examiners, www.bne.state.tx.us • www.texashotjobs.org • Federation of State Medical Boards, www.fsmb.org • Educational Commission for Foreign Medical Graduates, www.ecfmg.org