Relationship University and Academic Hospital in Medical Education

Transcription

1 Relationship University and Academic Hospital in Medical Education Between Charybdis and Scylla? Ben Van Camp, MD, PhD

2 The Flexner Report ( Carnegie Foundation 1910 ): Medical Education in the United States and Canada Revue of medical education offered at the beginning of 20th century in US and Canada. Taking into account the emerging scientific knowledge towards patientcare as was pioneered at Johns Hopkins Guidelines to best practice in medical education Physical link of medical school with a comprehensive hospital under university auspices Provision of specific hospital wards for teaching purposes Staffing of medical school by regular university appointement ( generally accepted in US and EU today ) No private practice but full time university salaries ( problematic fulfillment )

3 A birds view on the general structure of Medical Education in Europe Secundary school Master Bachelor Undergraduate: 2-3 year Graduate: 3-4 year Entrance prerequisites Biomedical sciences (Pre)Clinical sciences Clinical practice continuum Doctor Postgraduate: 3-6 years Specialisation Training : Clinical specialist ( n > 30 ) General practitionar Public Health Medical Research (PhD) Continuous education: life long

4 A birds view on Medical Education Scientific Environment Basic biomedical sciences Medical sciences Basic clinical skills General clinical training Medical Research Translational medicine Clinical specialist ( > 30 ) General practitionar Public health organisation Clinical Environment

5 Scientific environment in Medical education University Faculty of medicine (= medical school ) core departments with associated research facilities: - biomedical sciences (including Farmacology) - pre-clinical sciences - clinical sciences Other faculties or associated departements - basic sciences ( fac. Sciences ) - public health ( fac. Humanities ) - bio-engineering ( fac. of Engineering ) - medical biotechnology and molecular biology ( fac. of Science ) - medical ethics, law, economics, sociology ( fac. Humanities ) - medical communication and psychology ( fac. Humanities ) - medical IT, etc. ( fac. Engineering ) University Hospital Clinical and translational research linked to Academic Research Groups

6 Clinical Environment in Medical Education Skills training center (faculty medicine) Comprehensive teaching (= academic) Hospital: - specific teaching wards ( bedside teaching ) - complete spectrum of specialities (postgraduate) - academic- clinical teaching staff - evidence based medicine ( rounds ) Affiliated (non academic) hospitals: - pre-specialist practice - specialist training ( maitre de stage ) General Practice training - academic clinical teaching staff Teaching Staff under supervision of Medical School

7 Medical Education at a crossroad Medical education integrates evolving biomedical scientific knowledge and clinical handling of diseases in a public health setting. Endterms of academic medical education includes scientific thinking and aptitude to enter medical profession The quality of Medical Education is dependent on an integrated setting of academic rigour and clinical excellence. The cost for an excellent Medical Education is high

8 Medical Education thorn between Charybdis and Scylla How to integrate scientific and clinical environment? Who is paying for Medical Education: social security, ministry of health, ministry of education? How to govern an integrated UMC?

9 Case study : the medical center of the VUB Medical campus VUB Brussels airport University (VUB) main campus

10 The medical campus of the VUB Erasmus College Nursing scool Campus: 37 hectare Faculty of Medicine University Hospital

11 Medical Professional Education University Hospital - beds: 729 (occupancy 76 %) - personel: 3003 (413 MD 84% FT) hospitalisations (av. 7d) day hospitalisations ambulant patients emergency patients Faculty of Medicine m2 buildings m² lab s - 8 aula s, library - 50 teachingrooms, - restaurant - 6 master programmes - doctoral School

12 Academic tasks of UZBrussel According to Belgian law a University with a full program of Medical Education (7 B) can have a University Hospital, whether or not in a separate legal entity Legal accreditation of University hospital is linked to specific function in (para)medical education, postgraduate training, continuous ecucation, applied clinical and translational research, additional criteria: - 1MD/3 beds - > 70% fulltime MD s - > 70% MD employed by Hospital - all clinical disciplines accredited for postgraduate training A specific number of University Beds are recognised of which most are located in the University Hospital, few in associated hospitals Hospital income is regulated through ministry of Health and Social affairs ( except research, clinical studies, gifts, university input

13 Financing of academic task of UZBrussel UZBrussel global income: EUR (2007) Income for academic task: B7 parameter ( health ministry ): 5,4 % of G.I. B7 parameter: Federal budget is allocated to 7 University Hospitals weighted on the basis of - 25% for n. scientific publications - 15% for n. postgrad.stud./ maître de stage - 60% for global budget research, patents, clinical studies income: 2,5 % of G.I. sponsoring: 0,5 % of G.I. university input: 0,9 % of G.I. total Estimated real academic cost (Antares Study): 9,3 % of G.I. 25,0 % of G.I. Note: Cost of UZBrussel buildings ( taking into account the academic function ) separate budget (1970 s); 100m²/UZ bed compared to 80m²/non-U.b.

14 Governance structure of UZBrussel VUB R&D Medical school Committees: - financial - strategic - audit UZResearch Council UZBrussel Board of Governors Steering committee CEO Management committee Delegated power VUB Board governors UZB VUB: 6 delegates (rector, chairvub,dean) UZB: 6 delegates External: 4 members Clinical departments Non-medical dept Medical council

15 Faculty of Medicine ( Medical School) 5 departements: - basic clinical sciences (5 educational divisions) - pre-clinical sciences (5) - clinical sciences (7) (linked to UZdepartements) - Farmacy departement (4) - Primary Health and Social Medical Sciences (6) - ( Dentistry ) Ba-Ma-Dr structure in educational programmes (MD, Farmacy, BMS, Gerontology, Med. Social Sc., Sportsmedicine, Mr. Nursing, public health) Research groups or centers (cluster of research groups) are thematically organised stimulating interdisciplinary and translational research All MD s with PhD have academic appointment at faculty (in principle no staff appointement without PhD) All MD s are appointed by UZB but selected by joint committee (Fac/UZ)

16 Financing of faculty of Medicine VUB total income: EUR ( 2007) Centralised Academic and A/T services for education, infrastructure, building, student-facilities, research and innovation support, etc. Faculty budget (2007): - Academic (115 FTE) and A/T personnel: 12.5 milj. ( UZB based: 2.2 milj or 0,9% of G.I. UZBrussel) - Educational working credit: milj. - Research money ( competition based): > 30.0 milj Note: facilities etc. in central budget

17 Governance structure of Medical Education UZB AP-MD: 67 All MD: 413 Delegated power VUB Rector Chairman Board of governors Medical faculty departements (5) eductional divisions (30) researchgroups R&D Research Programs UZB R&D Teaching programs MD program, Postgraduate Biomedical Sciences program Farmacy program; etc.

18 Conclusion Integration between hospital and faculty is paramount for MD Education and Accreditation as University Hospital Integration is hampered by differences in: Solutions: - governance structure - income sources - mission - salaries of MD versus AP, - statutes of ATP - ownership of building and campus Integration top-down : - VUB and UZB delegation for autonomous Medical Campus Governance ( separate entity for Medical Education versus campus management?) Integration bottom up : - centers of excellence (clusters of academic research and UZ divisions) - management clusters: infrastructure, HR, Communication, research management, etc.

19 Medical Centers worldwide If you have seen one medical center... you have seen just that one medical center!!