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IUB SPEA-H 124 - Exam 3 Study Guide

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SPEA H 124 1st EditionExam #3 Study Guide**Roughly 45 multiple choice and true false questions; read over lecture powerpoint and listen to lectures posted online to perform well**Chapter 6: Medical Education and the Changing Practice of Medicine Colonial America:- No medical schools existed in America; physicians trained in Europe as an apprentice to aEuropean-trained physician- There were no formal tests or licenses; mentor decided when future doctor was ready to begin practicingEarly Medical Education- Hospitals established mid 1700s; - First medical school was College of Philadelphia, next King’s College (later Columbia University) - 1800- still only four medical schools - Doctors who practiced without licenses were more common than now; now it is against the law - 1821- first state to restrict licenses to medical school graduates - 1876-American Association of Medical Colleges (AAMC) began standardization of medical educationo -no strict admission standards; rigid guidelines while in school AMA and Education Reform - 1904; AMA establishes - Council on Medical Education- JAMA: Journal of the American Medical Association o Published medical school failure statistics and group schools by fail rateso Sent out weekly The 1910 Flexner Report - “Medical Education in the U.S. and Canada”- Recommended reducing schools from 155 to 31 (did reduce to 85 by 1920)- -Outlines failings and calls for a change -John Hopkins cited as “model for medical education” - At this point, medical schools were typically separate entities from universities now they are attached to universities to benefit from the researchMedical Education Classifications- MD: “Doctor of Medicine” –allopathic medicineo 125 schools of medicine; 4 years after college - DO: “Doctor of Osteopathy” –osteopathic medicine; o 29 schools of osteopathy; 4 years after college plus 300-500 hourso Emphasize musculoskeletal manipulation - Osteopathy used to be viewed as a lesser form of medicine; now they are viewed as equalsMedical School Funding - 30% source of clinical practices of faculty; these faculty members give up having a largersalary so they can teach - 18% research and grants - 20% State and local government - 18% Tuition; this is where most students accumulate debt Residency Training - After completion of medical school - 3-7 years specialty training - Residency programs operated by hospital Graduate Medical Education (GME) “Residency” Funding - Prior to 1950: costs were negligible- NOW: residents earn wages (small) - Medicare program pays for the hospital’s residency program; pays for extra cost of residency program Growth of Medical Specialists - AMA resistance to specialization in mid 1800s o People wanted specialists with actual training, not “self-declared” - WWI: negative findings from armed forces; quality problems for those “Self-declared” - 1924-1964 explosion in growth of residency programs; poor quality hospital residency programs- STILL NO STANDARDS FOR QUALITY - Specialty ratio is 67:33 specialty to primary care; recommended 60:40 - Specialization influenced by earning potentials, better lifestyles- Medical schools encourage primary care; applicants indicate they want to practice primary care after graduation but then go into specialties o It isn’t up to med schools to determine where a person goes after graduation The John Mills Report-1996- Created standards for residency training- “Intern” typically an old phrase for first year of internship- Mills report lead to qualifying exams and specialty board certifications Who determines…- Hospital determines how many residency programs will operate, with what specialties, and what admission standards- Why so many international students in residency programs? There are extra spots that need to be filled; - Supply and demand; hard admission to keep too many people from becoming doctors; keeps salary up- Person who graduates last in their medical school class called “doctor” “Holy land of medicine is the US.” –reasons for overseas students in residency spots Physician Workforce- 1960s government predicted a shortage of physicians; medical schools increased by 50%;number of physician nearly doubled by mid 90s- Now about one physician for about 360 persons Hospitalist- Employed by one or more hospitals or contracted by companies- Sole responsibility to care for hospitalized patients; soley ICU patients Clinical Practice Guidelines- Evolved in 1980s to narrow the gap in variations in practicing medicine- Some physicians offended; offered “cookbook medicine” instead of using their brain to treat patients - Agency for Health Care Quality and Research (AHRQ)-funds outcome research and provides data promoting clinical guidelines- Narrows practice of medicine; standardized medicine Physician Report Care - 1970s AMA ethics prohibited “information that points out differences between doctors”- protected doctors- Insurance has access to physician quality - Healthgrades.com will be a site for consumers to look at by the end of 2014 with info on quality of physicians Chapter 7: The Healthcare WorkforceHealth Care Employment- 10% of US workforce in the health care industry - New vocations arise from changing system - 41% of people in health care employed by hospitals; 13% by nursing homes Credentials- Credentialing: system used for organizations and agencies to ensure that their healthcare practitioners meet all of the necessary requirements- Licensure: state issued and defines scope of practice; can change from time to time; most restrictive form of regulation- Certification: voluntary!! No legal “teeth” to prevent incompetent people from practiceIndependent vs Dependent Providers- Independent: physicians, dentists, podiatrists, psychologist, optometristso Rest of health professions are independent on another entity Dentistry- DDS or DMD; determined by dental school; means the same thing o 56 dental schools; decline in graduates each year since 1980s - 85% of dentists are general; the rest specialists Optometry- Doctor of Optometry (OD) diagnoses vision problems, eye disease, prescribe treatment, fits eyeglasses, contact lenses- Can’t do surgery; not ophthalmologist (MD) Nursing- Initially worked in private or public health settings; first professional training in 1861 at


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