sociology of health/illness EXAM 4

chapter 8 and 9

medical ed for women

women had large obstacles in medical school in 1800s, but created their own medical schools and an eventual decline of women pursuing med degree happened in 1920s

medical ed for blacks

medical ed was denied prior to emancipation, but black physicians made med schools before the founding of Howard med school and Meharry med school in 1860s and 1870s

the flexner report

muckraking journalism done by Abraham Flexner, was a replica of AMA’s study and pointed our medical school inferiority in practices

results of the flexner report?

5/7 black med schools and all but 1 women’s college had to close, declining # of women and black medical graduates

homogenous standardized, education based reform in med school

basic principles of John Hopkins model (revised med school curriculum)

1. clear separation between basic sciences and clinical science

2. reliance on large class lectures and expert instructor

3. independent courses from other departments (electives)

4. clerkship years in hospitals as part of curriculum (resident years)

each med school is part of a large configuration of programs and services called an blank blank blank.

academic health center

three pronged mission of academic health center?

provide cutting edge care, conduct clinical research, and to play key role in med education

does the US offer sufficient number of spaces in medical schools to train new doctors to meet the population’s health care needs?

no, we have a shortage and is expected to get worse

MCAT revision (2015)

adding of psychological, social, and biological foundation of behavior to MCAT (how behavioral and social factors that influence health/illness)

test that med students have to take at the end of 2nd year of med school?

US medical licensing examination (USMLLE) on basic science knowledge, pass/fail test

med school years 3 and 4 are called?

clinical years

what happens during clinical years?

apply medical science to clinical problems while working with patients in hospitals, complete 10 rotations to learn specialized knowledge for 6-12 weeks each

medical residency

match iwth a teaching hospital and work under physician supervision

key criticisms of US med school curriculum

1. faculty don’t care about teaching/ working with med students

2. curriculum not properly coordinated and integrated as departments compete for funding

3. overemphasize memorization and not problem solving skills and ethical conscience

4. curricula out of date

changes in medical school reform

smaller classes with experimental learning, development of problem-based learning and flipped classroom

practice based learning

based on active learning and team based activities that occur outside the classroom

flipped classroom

watching videos on their own lectures and then coming to class prepared to discuss issues with students, emphasis on case studies

changes in curriculum content

emphasis on social determinants of health (emphasis on screening based on how basic social needs are met)

teaching professional skills/perspectives (classes like physician-patient communication and medical sociology to understand patients and the healthcare system)

working with diverse populations

further revision of the medical school curriculum

important curricular innovations including developing programs or courses on cultural competency, medical ethics, end-of-life care, health care leadership, health care delivery systems, global health, and public health

accelerating change in medical education

AMA program to promote meaningful change, gave 11 medical schools one million dollars to pursue 5 year plan to support transformative medical education projects

medical education profession socialization themes

professional identity formation (what does it mean to be a medical professional?),

learning to do clinical work (managing uncertainty, learning how to handle complex moral questions)

learning to act in professional ways (how to engage empathetically with patients and how to make medical decision-making)

tolerance for uncertainty

medical school socialized students to have tolerance for uncertainty

three kinds of uncertainty

can’t master all the concepts and facts covered in classes and textbooks

medicine knowledge base is incomplete

when students attempt to distinguish between first two (are they lacking knowledge or is it unknown in medicine?)

detached concern

concern about patients without emotional involvements, balance of objectivity and empathy

critics of detached concern say..?

med school devote to teaching students how to cure patients instead of how to care for patients

reasons for specialty choice

content of specialty, having role model in specialty, prestige, money

controllable lifestyle (CL)

the extent to which one’s specialty allows for greater control over hours worked

What motivates a medical student to select a career in primary care rather than a high-tech specialty?

strong dedication to providing patient care, desire for long term patient relationships, opportunity to be involved in the social-psychological aspects of medical care

what impacts the choice of choosing primary care?

med school applicants with high service index, interest in humanities/social science, coming from lower to middle class families

Indicators of Stress in Medical School and During the Residency

high lebels of stress lead to high levels of mental health issues, high levels of burnout, depression, fatigue, suicide ideation, and substnace abuse

three primary types of stressors during four med school years

academic stress (exams, studying hours)

anticipated medical career stressors (passing national exams, selecting specialty field, securing residency, making errors in patient care)

social stressors (limited amount of time with family and friends)

stressors during medical residency

med school stressors become more significant, as well as other life stressors (marriage, kids, parent relationships, financial stuff, emotional let down)

BIGGEST stressors of residency

evil schedules (extended work, no sleep)

worries about med school debts (typically in the 100,000s)

feelings of mistreatment (feel abused in med school by faculty, sexual harassment)

early America nurse duties

(formally untrained) focused on childcare, surrogate breastfeeding, birthing, care of the ill

early midwifery

sent from england (church of england granted licenses to practice), held in high esteem, no formal training in US but there were manuals that women could use to prepare themselves

early nursing

increased dominance of men in birthing process lead women to nursing, importance and visibility of nursing increased during civil war

advent of nursing education

programs developed around philosophy of florence nightingale (founder of modern nursing, made caring center of nursing work)

maternity care

the American Journal of Obstetrics became the first specialized medical journal published in the United States

allied health workers

(health care workers such as physical therapists and medical technologists whose work supports that of the physician), developed bc of encouragement by the complexity of new methods and not enough physicians

three main types of nurses

licensed practical or licensed vocational nurses (LPN/LVN)- only tx and ca license vocational nurses but everything else is practical, high school graduate+ 12-18 months vocational nursing program+ exam pass

registered nurses (RNs)- diploma/degree in nursing and are distinguished based on level of nursing (diploma, associate, and baccalaureate nurses)

advanced practice RNs- rns who have master’s or post master’s degree and additional certification as NP, CNS, CRNA, CNM

key roles of nurses

caregiver (meet hygiene, nutrition, safety) and integrator (coordinate separate medical units in hospital or clinic to provide effective patient treatment)

responses to nursing shortage

increase nurse salaries to atract nurses from other countries, employing recruting companies to recruit nurses

internationally educated nurses (IENs)

nurses from other countries, US made mandatory licensing exam to take to make it easier for them to practice in the US

consequences of recruiting internationally educated nurses

taking nurses from low-income countries leaves them vulnerable to health issues, negative impact on quality of care in the US

demographics in nursing: gender

men used as nurses in monasteries and military orders, but stigma of being gay decreased numbers, 90.5% of nurses are women

demographics in nursing: race and ethnicity

81% white, 6.7% black (RNS), higher proportion of POC LPN/LVNs, white men being racial and gender minorities in nursing elevates them and

socialization of nurses

students enter nursing school as initial innocence but teachers fail to endorse this and this creates anxiety, entered labeled recognition of incongruity (statements of despair between fantasy and reality)

diffrentiated practice model

which bases the roles and functions of RNs on education, experience, and competence

downsizing nursing staffs

in mid 90s, hospitals cut back nurses and reassigned job responsibilities to be cost effective

nurse practitioners

RN + grad degree in advanced practiced nursing, must pass national certification exam

certified nurse midwives

RN + training + national certification ecam

certified register nurse-anesthetists

RNs with a master’s degree from an accredited nurse anesthesiology program who have passed a national certification exam, highest paid nurse specialty

Physician Assistants/Associates

can offer most of the basic care provided by physicians, including performing physical examinations, monitoring and treating minor ailments, counseling, and prescribing some medications

a majority of health care workforce are

allied health personnel

health care teams

less hierarchical and more egalitarian mode of health care organization and decision making amongst all working members of hospital

team based care

provision of health services to individuals, families, and/or their communities by at least two health providers who work collaboratively with patients and their caregivers to achieve coordinated, high-quality care

triple aim of health care systems

improved population health, improved patient experience, and lower health care costs