Facilitator:
Wayne Johnson, Executive Director of the Office of University Relations

Panel:
Charles Baldwin, O.P. and Evalyn Hammons University Professor of Pre-Medical Studies
Elsie Smith, Associate Professor of Biology
Susan Jacob, Dean of the School of Nursing and Professor of Nursing
Jill Webb, Director of the Master of Science in Nursing Program and Associate Professor of Nursing
Tharon Kirk, Department Chair of Nursing, Jackson and Associate Professor of Nursing

UNIONITE: The public is constantly hearing of major advances in research on all medical fronts. Those same sources report a reduction in quality care, mistakes and patient dissatisfaction. Those of you around this table have given your careers to the preparation of students entering the medical field. What does health care look like in 2002 in this country and what does that tell us about the future?

Jacob: Health care has undergone dramatic changes in the last 20 years. We have become a more consumer-oriented society; therefore, we’re very concerned about educating the public. We have severe shortages in health care professional numbers, increasing aging populations, and 14 percent more patients in acute care situations.

Patients in the hospital today are sicker and go home sicker and quicker. Hence, we have developed numerous community-based health care delivery systems to provide for those people in their homes.

UNIONITE: Are increasing complaints that we hear about health care accurate?

Baldwin: It’s possible those grievances are telling us something about health care in this country. The issues are care without discrimination and the right of grievance being heard quickly. That indicates many people in our population have access to basic health care. But, the concern is about how well it’s delivered and issues relative to the quality care.

When our students and faculty go on global missions trips (GO TRIPS), they frequently encounter populations who have only basic health care. In our country there are two major programs: Medicaid and Medicare. This indicates we are concerned about health care access for the elderly and those who cannot provide it for themselves. These are economic issues. People in the middle usually have good, basic, health care.

UNIONITE: Does the United States still set the standard for health care in the world?

Baldwin: In many ways we do set the standard, but, I would not want us to think of ourselves as necessarily providing the best health care in the world.

Jacob: We have Medicare and Medicaid. And, we’ve developed social programs, medical health programs. Yet, we have a widening gap in the access to health care – financial, geographical, cultural, whatever.

Smith: I heard recently that even with all the coverage we provide for people in this country, one out of every six Americans is without any medical insurance.

UNIONITE: In addition to economics, what other major factors are impacting health care today?

Jacob: The increasingly diverse population in our society. Many do not speak English or are not acculturated. Less than two percent of our health care professionals are of Hispanic or Asian origin. Therefore, this diversity of our population forces us to address culture issues in health care.

Smith: I think we would agree we are in the best position of any country in the world to provide the ultimate in health care. That’s verified by the fact that you don’t hear of people in the United States going to other countries for operations.

Conversely, there is a massive influx into this country to get surgical procedures you can’t get anywhere else in the world. I don’t know of any people in other countries coming here to provide us services. We’re set up to deliver the service but we’ve yet to find an economic way to do so.

Baldwin: That’s a very good way to put it.

Webb: I can remember when I started in nursing in 1976. There was a different way of delivering care. We did everything that was needed and there was really not much attention paid to the cost of delivering that care. The notion was, we will give the best care we have available to anybody who needs it. Health care cost spiraled as a result of that mentality. We’ve had significant government intervention.

Baldwin: Another philosophical issue impacting health care delivery in our country is the question: do we believe health care or access to health care is a right or a privilege? If it’s a privilege, we move more toward the consumer model – if it’s a right, we move toward models we find in Europe and the UK.

UNIONITE: Socialized medicine?

Baldwin: I would rather talk in terms of making available health care to everyone.

UNIONITE: “Right or privilege” seems to frame the discussion. What have your departments done to accommodate these trends? What feedback do you receive from graduates who are working in health care positions?

Baldwin: Recently, I was talking with a young lady who is completing her physical therapy degree work and licensure. She commented that in her work in the last three months she had encountered a situation where an HMO was determining how many times she could have a session with the patient and what the parameters of those sessions would be and what the reimbursement would be. This was new to her.

Another change has occurred in that much of decision-making regarding medical procedures has been moved out of the doctor’s office and health care professionals’ arena into the business arena.

Webb: The most significant change the nurses face is that they are not allowed the time needed to deliver care that’s required. Hospital stays are much shorter. With procedures people might have had in the past—they might have gone in the day before for preparation, have the procedure the day after, and spend two or three days in the hospital recovering. That would be for a relatively minor procedure.

Now, that’s outpatient surgery. Preparations made at home, perhaps receiving their instructions the day before on the phone, in addition to the written instructions. Then, they just show up. They’re given the minimum of information they require before they have the procedure and give their consent. The procedure is performed and the rush is on to get them recovered and back home. That doesn’t allow much time for communication between the person receiving care and the people delivering it.

UNIONITE: What about shortages we hear of in health care professions?

Jacob: Nurse-patient ratios, mandatory overtime and all the issues we’re facing in nursing are because of the acute shortages which can lead to medical errors.

We are trying to get legislation passed to deal with patient ratios to alleviate that situation. Another issue is the increase in numbers of unlicensed assistance personnel replacing professionals in providing care for the patient.

Smith: In rural areas and small towns if you go to a hospital there now, the doctor that sees you is likely to be a doctor who comes one day a week from a larger city. The doctors that come out of medical schools today…many of them prefer going to large cities. They can work in a big clinic and be in a little more in control of their time, than they can as a small town doctor. In smaller towns, doctors are likely to be called 24 hours a day.

There are some things that have been done in our medical schools in Tennessee and, perhaps other states, to encourage the practice of medicine in rural areas. If you go into family practice and agree to practice in a rural area, for every year you practice there, you diminish your medical school debt. That illustrates how much of a distribution problem we have with doctors and that medical schools feel they have to use this approach to move people to where there is need.

Baldwin: It is a distribution problem, because we also have a concentration of specialists and physicians in the urban areas.

UNIONITE: How have these issues affected your work as you prepare students to go into these fields?

Webb: I think we have to teach the students to think outside of their little circle—outside the box, so to speak. They have to learn to think in a “systems” fashion.

They can no longer think about what ‘I’m doing for this patient,’ exclusively. When you’re interacting with an individual, they think they’re the most important person in the world. That’s the way it ought to be. But, they are not the only person with whom you interact.

You interact with different patients, other health care professionals…so they have to think collaboratively, in complex fashions, systematically. It isn’t just what I’m doing. It’s about the whole group of physicians. One has to think about what is happening at their facility, particular unit and about the home and cultural environment of the patient.

When we first began our baccalaureate-only program, one of our first students in the program had grown up in India. You don’t realize benefits you get from attracting that kind of global student population.

When this student went to clinical, we discovered an Indian lady on the unit who was very, very ill. When our student walked into that room and understood the icons of the culture around the patient, the food her family had brought in and could speak to her in Hindustani, it was just phenomenal.

At a baccalaureate institution, those are the things you can go after – a kind of global understanding – that takes them beyond West Tennessee. We have to teach our students to think globally but to act locally.

Baldwin: As faculty members interact with students, we look for the “teachable moment” – times when skills and information are imparted in a more inspirational way. At Union, those moments seem to be more than just accident – partly because of the type of student that we have attending here.

There is a team approach here, with the Office of Campus Ministries and with GO Trips. Rarely do we have a pre-med student leave Union without having been on one or more GO Trips to a foreign country or to a rural area of need in this country. So our students are already keen on those needs and they come with a servant mentality that allows and prepares them to be good health care professionals.

One of our goals in pre-medical education is to see that our students leave here competent and then build on that competence in their clinical education. I hope each student that passes through and graduates from Union will be a person I would be comfortable with being my doctor. These are the characteristics our students exhibit and gifts that they develop – competence and compassion.

Jacob: Another change we’ve seen is in informatics, the integration of information technology into telemedicine or telenursing. We now use information systems to deliver health care.

UNIONITE: What feedback do you receive from our graduates after they leave Union?

Smith: We get feedback before they actually complete medical school. The feedback we’ve been getting for years is how well prepared our students feel when they get to medical school. Some of them tell us “we were afraid at first,” because we realize that sitting next to us was someone who had done undergraduate work at a Ivy League university. It turns out that—according to one story I heard – Union students were better equipped for this class than some of those students.

We hear from professors who teach the medical courses, at UT Memphis in particular. They tell us our students are in the top 20 percent of their medical class, every year.

We’ve set a tremendous record at UT Memphis. It’s amazing to me how many years we have consistently sent really good students who have done well. The school is eager to get our students.

There’s no doubt in my mind that our students have an edge in getting into medical school, because they’ve had so much positive experience with Union.

UNIONITE: Is that a product of our size as well as our philosophy?

Smith: I think so. When our committee does evaluations of students applying to health professions, we find schools to which we send these evaluations to pay more attention to what we say because they know we know our students better than professors at larger universities. They know we do a lot of one-on-one instruction.

Webb: The students tell us that it’s more rewarding than they anticipated—interactions they have with the client population. I don’t think they see, how much difference they really make in those lives. And, when they get that feedback it’s very gratifying.

UNIONITE: Do you believe those enhanced people skills are the by-product of a school setting like we enjoy at Union?

Baldwin: I think it is. There is more social interaction in our science courses. We put an emphasis on taking students to professional meetings, completing a research project here and presenting that work. So they leave with the confidence that they can communicate in field and interact with other professionals. One plus for our students who will attend the University of Tennessee for medical school next year is that the class this year will go over and discover that our first year students, already there in medical school, have adopted them.

Each of them has an upperclassman who adopts them. In many instances, books can be shared. That’s cutting a major cost. But, more than that, these upper-class mentors help our student make the transition into medical school. That is invaluable. So I think our students have an easier time moving or making the transition from undergraduate to professional.

UNIONITE: What would you tell parents whose student is considering entering Union with a career goal in medicine – pre-med studies or in nursing?

Baldwin: Pre-med is a euphemism for a lot of things. We listen carefully to determine if this person is interested in medical school or other health science professions. Within the purview of the Health Profession Advisory Committee we prepare students for medical school, of course. But, we also have tracks for pharmacy, optometry, and dentistry, some of the allied health areas, cytotechnology, medical technology, dental hygiene, physical therapy, occupational therapy, medical records administration and physician’s assistant. We’ve begun an emphasis in Sports Medicine; just in the embryonic stages. This will probably be very interesting to a lot of people.

UNIONITE: What are the areas available in our nursing curriculum?

Jacob: Nursing prepares students with a baccalaureate degree in nursing. It also provides the registered nurse, who may have a diploma or an associate degree, with a route to achieve the baccalaureate degree. Our master’s program prepares educators and nurse administrators. The nursing education track has met a real need statewide and nationally, because of the severe crisis with a national shortage of nursing faculty.

Across the country many people serving as nursing faculty members are reaching retirement. Those salaries are not commensurate with what they would get in clinical practice, thus, we’re reaching another shortage. There are very few programs that prepare nurse educators. And, of course, our courses of study are accredited.

Baldwin: I don’t think we should forget those who are extremely important to health care – researchers. We prepare students for that field. I received an email from one of our 1979 graduates, Randy Johnson. Randy received his bachelor’s degree in chemistry from Union and went to Memphis, completing a Ph.D. in medicinal chemistry.

He has spent most of his time on the west coast at the University of California, San Francisco and then with a leading company in pharmaceutical research. Most of his work has been in developing diagnostic assays for hepatitis A, hepatitis C. Presently, he is working on a molecular based diagnostic and blood-screening assay for hepatitis, HIV, Chlamydia, gonorrhea, and TB.

One of our recent graduates, Jeff Jones, in his first year of medical school, discovered one of the professors working on developing an implantable sensor that measures glucose concentrations in the blood, using infrared spectroscopy. While he was at Union, he had worked on a research project dealing with IR work. He wrote that “I thought that you might like to know that all the time I spent processing and analyzing infrared spectra is helping me understand that new and very exciting development in diabetes care.”

Jacob: I recently received a note from one of our graduates. She said “Four more abstracts accepted. I owe it all to the foundation I received at Union University.”

We also have a master’s student, Zoila Sanchez, who did her practicum as a master’s administration student with the director of the Tennessee Health Care Consortium. She was researching nursing work force issues in the state and was invited to do an executive summary for that organization and now has been selected for a health policy fellowship in Washington, D.C., to pursue a Ph.D. program.

UNIONITE: What’s next for the health care professional?

Smith: We’re going to see some significant changes in health care brought about by our response to bio-terrorism. We’re going to see reorganization of local, state, and national health agencies with emphasis on things we haven’t had to consider in the past.

I think we’ll see improved health care in this nation as we prepare to respond to terrorist attacks. Our preparation for that will bring better health care to all of us.

Kirk: We’re going to see an increasing aging population, emphasis on end of life care. It’s already in our literature. We will be seeking to improve the quality of end of life care.

We’re being told that this must be part of our curriculum. They will be testing on end of life care in terms of licensure.

Another emphasis will be genetics. We have the human genome project and all sorts of ethical issues we haven’t even dreamed of.

Baldwin: We have to get the theologians in on that one! Bio-ethics has not kept up with technical development. Our students should be in a better position to face these issues because of the extra-curricular activities in terms of symposia sponsored by the Center for Christian Studies and Christian Leadership, the lecture series’ that are available at Union in addition to other opportunities we have mentioned.

Smith: This may sound like advertising, but, I run into people every day who don’t know that Union has a strong pre-med program. We have some of the best-kept secrets in the world at Union, in terms of preparing for other health professions. People don’t know the background they can get by coming to Union.

Baldwin: In the area of feedback…there is a local family that we see quite often at the symphony. Rarely do we meet without the father and mother telling how well their son was educated for medical school while at Union. Their son, Steven Hammond, played varsity golf here and majored in chemistry and minored in biology. He was a candidate to serve as the student representative on a major university medical school committee…a leadership position. Both parents are graduates of a prestigious school and wanted their children to go there – but, now, Union has supplanted that reputation.

In fact, Dr. Hammond (Steve) says, “Union gives the high quality technical education but they do it the right way.” When he talks about the right way he’s talking about the Christian foundation.

UNIONITE: Union University…it’s all about the people, excellence and doing it the right way.