Policy Forum
Access to Health Care in the
U.S.-Mexico Border Region
El Paso, TX
October 14, 2004

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

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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

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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

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Candidates consider their “fit” with schools of interest
• Professional interest
• Cost/finances
• Special interests
• Location
• Student support
Early guaranteed admission

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

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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

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

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

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Year one
• Basic sciences
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Anatomy and physiology
Neuroscience
Behavioral science
Biochemistry
• Introduction to patient
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Hx and PE
• Genetics, nutrition, human sexuality, etc
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Year Two
• Basic-to-Clinical
Sciences
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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

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

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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

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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

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Practical nursing - certificate
• LPN/LVN - training usually at community college or vocational/ technical training center
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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

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

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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

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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

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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

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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

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Candidates consider their “fit” with schools of interest
• Professional interest
• Cost/finances
• Special interests
• Location
• Student support

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Schools rank candidates based upon formula scoring preferred attributes
• Grade point averages
• Service points
• Recognition points, etc
Candidates interviewed and rescored
Ranked and invited to attend

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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

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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
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Involve patients and families in decisionmaking
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

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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