aamc annaul meeting and annual report 1985

Association ofAmerican Medical CollegesAnnual Meeting

andAnnual Report

1985

Table of Contents

Annual MeetingPlenary Sessions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 195Special General Session. . . . . . . . . . . . . . . . . . . . . . . . . .. 195Council of Academic Societies . . . . . . . . . . . . . . . . . . . . .. 195Council of Deans. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 196Council of Teaching Hospitals . . . . . . . . . . . . . . . . . . . . .. 196GSA-Minority Affairs Section . . . . . . . . . . . . . . . . . . . . .. 196Organization of Student Representatives . . . . . . . . . . . . .. 196Women in Medicine. . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 197AAMC Data Bases. . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 197Faculty, Student, and Institutional Studies Using AAMC

Data Bases 197Group on Business Affairs . . . . . . . . . . . . . . . . . . . . . . . .. 198Group on Institutional Planning. . . . . . . . . . . . . . . . . . . .. 198Group on Medical Education . . . . . . . . . . . . . . . . . . . . . .. 199Group on Public Affairs . . . . . . . . . . . . . . . . . . . . . . . . . .. 210Group on Student Affairs . . . . . . . . . . . . . . . . . . . . . . . . .. 211

Assembly Minutes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 213

Annual Report 217Executive Council, Administrative Boards. . . . . . . . . . . .. 218President's Message . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 219The Councils . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 223National Policy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 233Working with Other Organizations. . . . . . . . . . . . . . . . .. 240Education 243Biomedical and Behavioral Research. . . . . . . . . . . . . . . .. 245Faculty 248Students 249Institutional Development 251Teaching Hospitals. . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 252Communications . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 258Information Systems. . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 259AAMC Membership. . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 261Treasurer's Report . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 261AAMC Committees 263AAMC Staff . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 268

194

The Ninety-Sixth Annual Meeting

Washington Hilton Hotel and Mayflower Hotel, Washington, D.C., October 26-31, 1985

Theme: From Aexner to Cooper and Beyond: The Road to Quality in Medical Education

Program Outlines

PLENARY SESSIONS

October 28

FROM FLEXNER TO COOPER AND BEYOND: THE:::~ ROAD TO QUALITY IN MEDICAL EDUCATION

l Presiding: Richard Janeway, M.D."5o The Future of the Kaleidoscope: Medical~] Education and the University.g Harold T. Shapiro, Ph.D.~ Dr. Shapiro presented the Alan Gregg~ Memorial Lecture.8~ Health Care at a Crossroads

Honorable Bruce Babbitt

~ Coggeshall Revisited: A Reaffirmation of the~ AAMC's Purpose~ Sherman M. Mellinkoff, M.D.o

] Health Research and National Priorities"8

Q) Honorable Lowell P. Weicker, Jr.-Bj Presentation of Special Recognition Awards~ Edward N. Brandt, Jr., M.D., Ph.D.~ J. Alexander McMahonoQ James H. Sammons, M.D.

October 29

Presiding: Virginia V. Weldon, M.D.

Presentation of Abraham Aexner Award

Arthur C. Christakos, M.D.John A. D. Cooper, M.D., Ph.D.

Presentation of AAMC Research AwardRichard M. Krause, M.D.Eric R. Kandel, M.D.

Medical Education and SocietalExpectations: Conflict at the ClinicalInterfaceRichard Janeway, M.D.

Inauguration ofJohn A. D. Cooper LectureKarl D. BaysRobert M. Heyssel, M.D.

The John A. D. Cooper Lecture: What IsImmediate Past Is Prologue-UnfortunatelyJohn A. D. Cooper, M.D., Ph.D.

The Prospects for Science in MedicineLewis Thomas, M.D.

SPECIAL GENERAL SESSION

October 29

TWO PERSPECfIVES ON PHYSICIAN SUPPLY

AND MEDICAL SCHOOL CLASS SIZE

Moderator: Stuart Bondurant, M.D.

Thomas K. Oliver, Jr., M.D.Jeffrey Harris, M.D., Ph.D.

COUNCIL OF ACADEMIC SOCIETIES

October 27

CAS Plenary Session

Who Will Do Medical Research in TheFuture?Gordon N. Gill, M.D.John W. Littlefield, M.D.

Peer Review: A Crisis ofConfidenceEdward N. Brandt, Jr., M.D.Ruth L. Kirschstein, M.D.

October 28

CAS Business MeetingPresiding: Virginia V. Weldon, M.D.

195

196 Journal ofMedical Education

COUNCIL OF DEANS

October 28

Business MeetingPresiding: Arnold L. Brown, M.D.

COUNCIL OF TEACHING HOSPITAlS

October 28

Luncheon

Business MeetingPresiding: Sheldon S. King

General SessionPresiding: C. Thomas Smith

Health Policy Direction in an Era of BudgetConstraintsSheila P. Burke

Looking Ahead at the Academic MedicalCenterJames D. Bentley, Ph.D.Richard M. Knapp, Ph.D.

GSA-MINORITY AFFAIRS SECfION

October 27

Minority Student Medical Career AwarenessWorkshop

October 28

Regional Meetings

Business Meeting

GME/GSA-MAS Special SessionOngoing Studies of Factors AffectingMinorities in Medical EducationModerator: Rudolph Williams

October 29

Minority Affairs Program

Minorities in Medicine

Opening RemarksDario O. Prieto

Presentation of National Medical FellowshipAwardsLeon Johnson, D.Ed.

Franklin C. McLean Award:Michael Quinones

VOL. 61, MARCH 1986

William and Charlotte Cadbury Award:Carol Brown

Introduction of Keynote SpeakerRudolph Williams

Keynote SpeakerJohn A. D. Cooper, M.D., Ph.D.

GSA-MAS Service Award:W. Montague Cobb, M.D., Ph.D.

Oosing RemarksDario O. Prieto

ORGANIZATION OF STUDENTREPRESENTATIVES

October 2S

Regional Meetings

Business Meeting

Student Leadership Workshop:More Pearls of Change

October 26

Plenary Session

FROM APATHY TO PANIC AND BEYOND:

ACIlONS TO SHAPE A BETTER EDUCAnON

IntroductionJohn A. D. Cooper, M.D.

Lessons from HistoryKenneth Ludmerer, M.D.

Lessons from the Health Care EnvironmentArnold ReIman, M.D.

Small Group Discussions

Patient Interviewing as a Preclinical StudentAlan Kliger, M.D.Harriet Wolfe, M.D.

Computer-Based Medical EducationJack Myers, M.D.Ricardo Sanchez, M.D.

Curricular Integration of Health Care CostAwareness and EthicsPeter E. Dans, M.D.Michael J. Garland, D.Sc.Rel.Gail Geller

An Experiment in Promoting TeamworkBetween Medical Students and Hospital

1985 AAMCAnnual Meeting 197

WOMEN IN MEDICINE

Women in Medicine Luncheon

The Oassroom Oimate:A Chilly One for Women?Bernice R. Sandler

Academic Women Chairmen

October 28

Regional Breakfast Meetings

Liaison Officers' Caucus

October 27 and 28

AAMC DATA BASES

Women's Biologic AdvantageEstelle Ramey, Ph.D.

Reception

FACULTY, STUDENT ANDINSTITUTIONAL STUDIES USINGAAMC DATA BASES

October 29

AAMC maintains a number of computerbased data systems on subjects of interest toits members: The Institutional Profile Systemcontains variables describing each medicalschool, including sources of revenue, studentcharacteristics, number of faculty by rank anddepartment, and curricular features. The Faculty Roster System contains biographical andcurrent appointment data on U.S. medicalschool faculty. The Student and ApplicantInformation Management System contains information on medical school applicants andstudents since the early 19705. Annual meetingparticipants were invited to learn about thesesystems. Special reports available to medicalschools were on display.

October 27

Introduction: Purpose and Scope of AAMCData BasesJohn F. Sherman, Ph.D.

Research Activities of Internal MedicineFacultyPaul Jolly, Ph.D.

Use of Data from SAIMS to Profile the

Financing Graduate Medical EducationJames Bentley, Ph.D.Nancy Seline

Repeat of Small Group Discussions

Regional Receptions

Meet the Candidate Session

OSR/AAMC Future Challenges DiscussionSessions

OSR Organizational Issues

Issues in Admissions and College Preparation

~ Issues in Basic Science Education(1)

~ Issues in Oinical Education:g] Business Meeting

] Regional Meetings-B

October 27

General Session

Moderator: Carola B. Eisenberg, M.D.

Issues in Women's Health:

Administrative and Nursing PersonnelPatricia E. CaverJames A. Chappell, M.D.Lin C. Weeks

Preventive MedicineKimberly Dunn

Legislative Affairs WorkshopDavid BaimeJohn DeJongPaul R. Ellio~ Ph.D.JeffStoddard

j October 28"EJ

~ Workshopso

Q Aid for the Impaired Medical Student:A Program"Thafs Working at the Universityof TennesseeJames StoutHershel P. Wall, M.D.

Literature and Medicine: The Patient as ArtJohn H. Stone, M.D.

:::

~

~~ October 27o

~].g8e(1)

.D

.8oZ


Changing Applicant Pool in OhioNorma E. Wagoner, Ph.D.

The AAMC Student and ApplicantInformation Management System (SAIMS):A Resource for Longitudinal ResearchStephen EnglishJudy Teich

Research Oriented Medical Schools: HowStable is the Research Share of the TopForty?Gary Cook

GROUP ON BUSINESS AFFAIRS

October 28

REGIONAL MEFTINGS

GBA NATIONAL PROGRAM

Bernard McGintyDavid BachrachHollis Smith

Keynote Address: Moles, Colds, Sore Holes,Five Kinds of Fits and the Blind Staggers

William F. Ross, M.D.

To What Extent Can Universities BenefitFinancially from Commercialization ofTheir Research Technology?

William B. Neaves, Ph.D.

Discussion of Preliminary Report ofGBASelf Study Committee

Bernard McGinty

Reception

October 29

CARROLL MEMORIAL LECfURE AND

LUNCHEON

Biomedical Administration: Are We MovingForward or Backwards?

Robert G. Petersdorf, M.D.

GBA NATIONAL BUSINESS MEFTING

Bernard McGinty

GBA NATIONAL PROGRAM (CONTINUED)

Health Care in the 1990's: Trends andStrategies

James Wallace

The Impact of Changes in Direct and

VOL. 61, MARCH 1986

Indirect Funding of Graduate MedicalEducation on Teaching Hospitals andMedical Schools

James Bentley, Ph.D.

New Horizons in MedicineNorman Cousins, Litt.D.

GROUP ON INSTITUTIONALPLANNING

October 27

OPEN DISCUSSION GROUPS

Determining the Institution's Driving ForceConvener:M. Orry Jacobs

In Pursuit of Centers of ExcellenceConveners:Thomas G. Fox, Ph.D.Leonard Heller

Computers in PlanningConveners:David R. PerryConstantine Stefanu, Ph.D.

FORMAL PRESENTATIONS

THE FUTURE OF GRADUATE MEDICAL

EDUCATION

Welcoming RemarksVictor CrownJohn A. D. Cooper, M.D.

Program IntroductionLeonard HellerJohn W. Harbison, M.D.

Historical Background and Pending FederalLegislationJ. Robert Buchanan, M.D.

Perspective of a Teaching Hospital PresidentRobert M. Heyssel, M.D.

Perspective of a State Commissioner ofHealthDavid Axelrod, M.D.

Perspective of a Commercial InsuranceExecutiveRobert Snyder

GME in CanadaDouglas R. Wilson, M.D.

1985 AAMC Annual Meeting

PANEL DISCUSSION

Moderator:J. Robert Buchanan, M.D.Panel Members:David Axelrod, M.D.Robert M. Heyssel, M.D.Edward W. Hook, M.D.Ronald Rohrich, M.D.Robert SnyderDouglas R. Wilson, M.D.

October 28

REGIONAL BUSINESS MEETINGS

NATIONAL BUSINESS MEETING

~ October 29

~ CARROLL MEMORIAL LECTURE AND0..

"5 LUNCHEONo

~ Biomedical Administration: Are We Moving] Forward or Backwards?.g~ Robert G. Petersdorf: M.D.(1)

.D

.8

~ GROUP ON MEDICAL EDUCATION

October 27

GME Mini-Workshops

GME/Generalists Co-Sponsored Session

ELECTRONIC INFORMATION AND

COMMUNICATIONS FROM YOUR DESK

Organizer: George Nowacek, Ph.D.

Faculty: Oyde Tucker, M.D.

GMEjProblem Based Learning GroupCo-Sponsored Session

PROBLEM-BASED LEARNING IN LARGE GROUP

SEITINGS

Organizer: Howard S. Barrows, M.D.Faculty: Reed G. Williams, Ph.D.

GME/Generalists Co-Sponsored Session

ETHNOGRAPHIC, NATURALISTIC, AND

QUALITATIVE METHODS IN EVALUATING

MEDICAL EDUCATION

Organizer: Larry Laufman, Ed.D.Joni E. Spurlin, Ph.D.

199

TEACHING CLINICAL DATA INTEGRATION

Organizer: I. Jon Russell, M.D., Ph.D.

Faculty: Anthony Voytovich, M.D.William D. Hendricson

APPLYING GUIDELINES FOR THE REVIEW OF

A CURRICULUM INNOVATION IN

UNDERGRADUATE MEDICAL EDUCATION

Organizer: Victor R. Neufeld, M.D.Howard L. Stone, Ph.D.

GME/Generalists Co-Sponsored SessionOBJECTIVE STRUCTURED CLINICAL EXAMS

Organizer: Emil R. Petrosa, Ph.D.

Faculty: Abdul W. Saiid, Ed.D.Martha LevineJames C. Guckian, M.D.

HANDS ON INTRODUCTION TO

MICROCOMPUTERS

Organizer: Tracy L. Veach, Ed.D.

Faculty: Jan Carline, Ph.D.Michael HerringJoel Lanphear, Ph.D.

UTILIZING A COMPETENCY BASED SYSTEM

TO IMPROVE A SURGICAL RESIDENCY

TRAINING

Organizer: David R. Cole, Ed.D

Faculty: James Alexander, M.D.William DeLong, M.D.Richard Spence, M.D.

TEACHING RESIDENTS TO TEACH

Organizer: Franklin J. Medio, Ph.D.

Faculty: Steven Borkan, M.D.Linda Lesky, M.D.Lu Ann Wilkerson, Ed.D.

GME/Generalists Co-Sponsored SessionUSE OF SIMULATED PATIENTS IN SMALL

GROUP PROBLEM BASED TUTORIALS

Organizer: David E. Steward, M.D.

Faculty: Michelle L. MarcyM. J. Peters

INTEGRATING COMMUNICATION AND

PSYCHOSOCIAL SKILLS INTO THE MEDICAL

RESIDENCY: IMPLEMENTATION OF THE GPEP

REPORT


Organizer: Marsha Grayson

Faculty: Lee R. Barker, M.D.David E. Kern, M.D.Marsha Grayson

INCREASING ACI1VE LEARNING AND

PERSONALIZING INSTRUCTION: SOME SIMPLE

TECHNIQUES

Organizer: Henry B. Slotnick, Ph.D.

Faculty: J. Gregory Carroll, Ph.D.

DEVELOPING A PEER TUTORING PROGRAM

FOR MEDICAL STUDENTS IN THE BASIC

SCIENCES

Organizer: Leslie Walker-Bartnick

Faculty: Leslie Walker-BartnickMurray M. Kappelman, M.D.David E. CarterStudent TutorStudent TuteeBasic Science Faculty Member

OONRDENCE TESTING ON MICROCOMPUTERS

Organizer: Robert M. Rippey, Ph.D.

Faculty: Anthony E. Voytovich, M.D.

IMPLEMENTING A PRE-MATRICULATION

PREPARATORY PROGRAM FOR ACCEPTED

MEDICAL STUDENTS

Organizer: Cornelius F. Strittmatter, Ph.D.

Faculty: Gwendie Camp, Ph.D.Maura Campbell

HOW TO TEACH GERIATRICS: OVEROOMING

PROBLEMS IN MULTIDISCIPLINARY

EDUCATION

Organizer: Gerald Goodenough, M.D.Neal Whitman, Ed.D.

Faculty: Cecil Samuelson, M.D.Margaret Dimond, Ph.D.Lynn Gayton, D.S.W.

October 27

General Sessions

CURRICULUM DEANS' SESSIONS

Orientation: Paula L. Stillman, M.D.

Simultaneous Discussion Groups

VOL. 61, MARCH 1986

I. Negotiation and Politics: PersonalExperience

Group Leaders:Gerald Escovitz, M.D.Murray Kappelman, M.D.Theodore J. Phillips, M.D.

II. Gaining Acceptance of EducationalChangeGroup Leaders:Jules Cohen, M.D.Gordon T. Moore, M.D.Charles P. Gibbs, M.D.Vietor R. Neufeld, M.D.William D. Mattern, M.D.S. Scott Obenshain, M.D.

Plenary Session

III. The Management of Human ResourcesD. Kay Clawson, M.D.

RESIDENCY EDUCATION COORDINATORS

Planning Session

Follow-up Session for Residency EducationCoordinators

Joint Session with Group on InstitutionalPlanning and SMCDCME

GME/SMCOCME Co-Sponsored Session

TOWARD MORE EFFECTIVE CLINICAL

TEACHING

Moderator: Thomas C. Meyer, M.D.

Panel: Dona L. Harris, Ph.D.Howard L. Stone, Ph.D.Frank T. Stritter, Ph.D.

GME/SMCDCME Co-sponsored Session

LEARNING STYLES AND PROBLEM SOLVING

Moderator: Nancy L. Bennett, Ph.D.

Panel: Robert D. Fox, Ed.D.Donald E. Moore, Jr., Ph.D.Jackie Parochka, Ed.D.

GME/SMCDCME Co-sponsored Session

MEDICAL SCHOOLS AND OOMMUNITY

PHYSICIANS: ESTABLISHING AND

MAINTAINING GOOD RELATIONSHIPS

Moderator: Harold A. Paul, M.D.

Panel: Martin P. Kantrowitz, M.D.Peter A. J. Bouhuijs, Ph.D.


INNOVATlONS IN MEDICAL EDUCATION

EXHIBITS

DATA BASES IN ACADEMIC MEDICINE

Organizer/Discussant:Charles P. Friedman, Ph.D.

Chairman: J. Dennis Hoban, Ph.D.

Panel: Hilliard Jason, M.D.Beth JohnsonGeorge Nowacek, Ph.D.

MCAT ESSAY PIWT PROJECT: PRELIMINARY

DATA

Moderator: Robert L. Beran, Ph.D.

Speakers: Daniel J. Bean, Ph.D.Shirley Nickols Fahey, Ph.D.Robert I. Keimowitz, M.D.Karen J. Mitchell, Ph.D.John B. Molidor, Ph.D.Marliss Strange

October 28

INNOVATIONS IN MEDICAL EDUCATION

EXHIBITS

GME Regional Meetings

GME National Meeting

Innovations in Medical EducationDiscussion Groups:

INSTRUCTIONAL DESIGN OR EVALUATION OF

BASIC SCIENCE COURSES

Resource: Candice B. Rettie, Ph.D.John Markus


INTRODUCTION TO CLINICAL MEDICINE

COURSES

Resource: Jon H. Levine, M.D.


CLINICAL CLERKSHIPS


RESIDENCY PROGRAMS

Resource: James Pearsol, Ph.D.

COMPUTER APPLICATIONS IN MEDICAL

EDUCATION

Resource: Oyde Tucker, M.D.

DEVEWPMENT AND ASSESSMENT OF VALUES,

201

PERSONAL QUALITI~, AND AITITUD~

Resource: Virginia I. Nunn, Ed.D.

FACULTY DEVEWPMENT

Resource: Margaret Jenkins

EDUCATIONAL SUPPORT SYSTEMS FOR

STUDENTS

Resource: Martha G. Camp, Ph.D.

INNOVATIVE APPROACHES TO ADMISSIONS

AND STUDENT FINANCIAL AID

Resource: Gerry R. Schermerhorn

GME Special Session

THE AAMC CLINICAL EVALUATION PROGRAM

Session I-The Outcome of the AAMCOinical Evaluation Program

Chairman: Daniel D. Federman, M.D.

Speakers: Mitchell T. Rabkin, M.D.Edward J. Stemmler, M.D.Xenia Tonesk, Ph.D.

Session II-Reflections on Participating inthe Self-Study of Oinical Evaluation SystemsSpeaker: Victor R. Neufeld, M.D.

GME/GSA-MAS Special Session

ONGOING STUDI~ OF FACTORS AFFECTING

MINORITIES IN MEDICAL EDUCATION

Moderator: Rudolph Williams

GME/SMCDCME Joint Special Session

HEALTH CARE CORPORATIONS AND mE

FUTURE OF MEDICAL EDUCATION: ISSUES OF

CONTROL AND QUALITY

Moderator: Rose Yunker, Ph.D.

Panel: Marvin Dunn, M.D.Thomas D. Moore, M.D.S. Douglas Smith

Reactors: George T. Bryan, M.D.Duncan Neuhauser, Ph.D.Abdul Sajid, Ed.D.

October 29

Exhibits

GME Special Plenary Session


RESEARCH ON THE ASSESSMENT OF

CLINICAL COMPETENCE

Moderator: Daniel D. Federman, M.D.

Research Findings

Data from a Current ProjectPaula L. Stillman, M.D.David B. Swanson, Ph.D.

Highlights from the LiteratureGeoffrey R. Norman, Ph.D.

Implications of FindingsFor Medical Student EducationRichard H. Moy, M.D.

For Resident EducationJohn S. Thompson, M.D.

For Continuing Medical EducationGerald Escovitz, M.D.

RIME Third Annual Invited Review

THE TEACHING AND TRAINING OF

TEACHERS

Speaker: Lee S. Shulman, Ph.D.

Moderator: Harold G. Levine

Special Plenary Session

RIME New Investigators

Moderator: Fredric D. Burg, M.D.

Computers and Medical Decision Making: ANew Elective Course in Medical InformationScienceJ. Robert Beck, M.D., et al.

A Study of Probabilistic Technique forTeaching Diagnostic Skills to MedicalStudentsDavid H. Hickam, M.D., et al.

Oinical Competencies of GraduatingMedical StudentsYvette Martin, et al.

October 30

GME/GSA Joint Plenary Session

THE RESIDENCY CHASE AND THE

DISRUPTION OF THE CLINICAL EXPRIENCE:

THE NEED FOR COOPERATION

Moderator: Paula L. Stillman, M.D.

VOL. 61, MARCH 1986

Factors Complicating an Orderly TransitionNorma E. Wagoner, Ph.D.

Maintaining the Integrity of StudentEducation and EvaluationL. Thompson Bowles, M.D., Ph.D.

Planning and Instituting CooperativeSolutionsEdward J. Stemmler, M.D.

October 30

RIME Conference-Paper Sessions

NEW DEVELOPMENTS IN CLINICAL

TEACHING

Moderator: Donn Weinholtz, Ph.D.Discussant: W. Dale Dauphinee, Ph.D.Process and Product In Clinical Teaching:A Correlational StudyKelley M. Skeff, M.D., Ph.D., et a1.

A Prospectively Designed Assessment of theCondition Diagramming Method forTeaching Diagnostic ReasoningI. Jon Russell, M.D., Ph.D., et al.

Educational Implications of the RelationshipBetween Patient Satisfaction and MedicalMalpractice ClaimsElaine T. Adamson, et al.

CONTROVERSIES IN BASIC SCIENCE

EDUCATION

Moderator: Parker A. Small, Jr., M.D.

Discussant: Gerald J. Kelliher, Ph.D.

The Role of a Student Note TakingCooperative in a Basic Science CurriculumDorthea Juul, et a1.

Teaching Journal Reading Skills to FirstYear Medical Students: Results of anImmediate and Follow-up ExaminationRichard K. Riegelman, M.D., Ph.D.

Teaching Basic Science: Dr. Fox in thePhysiology Chicken CoopNeal Whitman, Ed.D., et al.

EVALUATION FOR CURRICULUM PLANNING

Moderator: Janine C. Edwards, Ph.D.Discussant: Gordon Page, Ed.D.Utilization of the Objective Structured


Clinical Examination (OSCE) InGynecology/ObstetricsPaul Grand'Maison, M.D., et al.

Pretest in Biochemistry, Used To EstablishConference Groups, Becomes Less SensitivePredictor of Course Grade as CurriculumDensity DecreasesJames Baggott, Ph.D., et al.

Curriculum Development Processes In TenInnovative Medical SchoolsRonald Richards, Ph.D., et ale

Emergency Medicine Skills and Topics inUndergraduate Medical EducationArthur B. Sanders, M.D., et al.

FACTORS IN MEDICAL DECISION MAKING

Moderator: Geoffrey R. Norman, Ph.D.

Discussant: Georges Bordage, M.D., Ph.D.

Knowledge Integration From Oinical Texts:Use of Factual, Inferential, and IntegrativeQuestionsVimla L. Patel, Ph.D., et a1.

Adapting a Paradigm From CognitiveScience to Medical Education: Problems andPossible SolutionsLorence Coughlin, et al.

A Longitudinal Study of Internal MedicineResident Attitudes Toward the MedicalHistoryEugene C. Rich, M.D., et a1.

SPECIALTY CHOICE & CAREER DEVELOPMENT

Moderator: George Zimny, Ph.D.

Discussant: Agnes G. Rezler, Ph.D.

An Analysis Of Medical Students' ResidencyAnd Specialty ChoicesSteven A. Wartman, M.D., Ph.D., et al.

A Case Study of Primary Care InternalMedicine Alumni: I. Career Paths andPractice CharacteristicsJohn M. Dirkx, et al.

TEACHING MEDICAL ETHICS

Moderator: Jo BoufTord, M.D.

Discussant: David C. Thomasma, Ph.D.

203

Patients' Responses to Involvement inMedical EducationAlfred A. Sarnowski, Jr., Ph.D., et ale

Summary of the Evaluation of the Ethics inthe Core Curriculum ProjectKenneth R. ,Howe, Ph.D., et ale

The Ethical Implications of Medical StudentInvolvement in The Care And Assessment OfPatients in Teaching Hospitals-InformedConsent From Patients for StudentInvolvement, Part I & Part IIDaniel L. Cohen, M.D., et ale

CRITICAL CONCERNS IN RESIDENT TRAINING

Moderator: Hugh M. Scott, M.D.

Discussant: Geoffrey R. Norman, Ph.D.

Morning Report: A Descriptive View FromTwo Different Academic SettingsWilliam C. McGaghie, Ph.D., et ale

Influences on Residents' Laboratory TestOrderingLewis R. Coulson, M.D., et al.

Physician's Test Ordering Behavior as aFunction of Justification of the TestGeno Merli, M.D., et ale

The Relationship of Resident Physicians'Medical Care Performance to Their MedicalRecordingJames E. Davis, M.D., et ale

PREDICfORS AND DETERMINANTS OF THE

APPLICANT POOL

Moderator: Anna Cherne Epps, Ph.D.

Discussant: Miriam S. Willey, Ph.D.

The Student Physician Inventory: Towardthe Assessment of Non-cognitiveCharacteristics of Medical School ApplicantsWoodrow W. Morris, Ph.D., et al.

Premedical Indicators of a Research CareerChristel A. Woodward, Ph.D.

Determinants of the Size and Composition ofthe Pool of Black Applicants to MedicalSchoolSandra R. Wilson-Pessano, Ph.D., et al.


CONTEMPORARY ISSUES IN CONTINUING

MEDICAL EDUCATION

Moderator: Thomas C. Meyer, M.D.

Discussant: Gerald Escovitz, M.D.

The Use of Undetected Standardized(Simulated) Patients as a Needs DeterminingTool in CMEDavid Davis, M.D.

A Practice Based CME Program inHypertension Using a Medication andBehavioral Treatment ApproachDavid S. Gullion, M.D., et al.

An Investigation of Physician Self-DirectedLearning ActivitiesLinda Joy Hummel

Physician Consultation Practices in SmallRural HospitalsI. John Parboosingh, M.D., et al.

THE LICENSING AND CERTIFICATION OF

PHYSICIANS

Moderator: Barbara J. Andrew, Ph.D.

Discussant: John S. Lloyd, Ph.D.

The Determination of Passing Scores onMedical Licensure Examinations: Should WeMonitor Students With Marginally PassingGrades?Barbara J. Turner, M.D., et a1.

A Criterion Referenced Examination in ECGInterpretationJohn J. Norcini, Ph.D., et a1.

The Relationship of Subtest andExamination Scores From the MedicalScience Knowledge Profile and Part I of theNational Board Medical ExaminationDavid Cole, Ed.D., et al.

PSYCHOSOCIAL CHARACfERIS11~ OF

FACULTY AND STUDENTS

Moderator: Stephen Smith, M.D.

Discussant: W. Loren Williams, Jr., Ph.D.

Empathy And Psychosocial Attitudes inMedical School Faculty and StudentsRhea L. Dornbush, Ph.D.

Do Medical Faculties Value ComprehensiveCare? The Students' ResponseBrigitte Maheux, M.D., Ph.D., et al.

VOL. 61, MARCH 1986

Measuring Teaching Excellence in OinicalMedicine: A Faculty PerspectiveSheila M. Fallon, M.D., et a1.

October 30

RIME Conference-Symposia

DISCREPANCIES BETWEEN PHYSICIANS'

TRAINING AND PRACTICE: NEW

CHALLENGES FOR GRADUATE MEDICAL

EDUCATION

Organizer: Barbara Gerbert, Ph.D.

Panel: Saul Farber, M.D.Jack D. McCue, M.D.David Reuben, M.D.

A TOPOLOOICAL PARADIGM OF PHYSICIAN

PERFORMANCE AND COMPETENCE

Organizer: Philip G. Bashook, Ed.D.

Moderator: John S. Lloyd, Ph.D.

Panel: Philip G. Bashook, Ed.D.Richard B. Friedman, M.D.Geoffrey R. Norman, Ph.D.

PREPARING COLLABORATIVE RESEARCH

PROPOSALS: THREE APPLICATlONS IN

MEDICAL EDUCAnON

Organizer: James A. Pearsol

Panel: Charles Dohner, Ph.D.C. Benjamin Meleca, Ph.D.W. Loren Williams, Jr., Ph.D.

PREVENTION OF STUDENT ATIRmON IN

MEDICAL SCHOOL

Organizer: Joan B. Chase, Ed.D.

Panel: Grace Bingham, Ed.D.Carol MacLaren, Ph.D.Peter Nicholas, M.D.

DEVELOPING AND NURTURING THE TALENTS

OF MINORITY HIGH SCHOOL STUDENTS FOR

CAREERS IN MEDICINE

Organizer: M. Gwendie Camp, Ph.D.Velma Gibson Watts, Ph.D.

Moderator: M. Gwendie Camp, Ph.D.

Panel: Harry J. Knopke, Ph.D.William A. Thomson, Ph.D.Velma Gibson Watts, Ph.D.


SELF DIRECfED LEARNING: WISDOM FROM

INDEPENDENT STUDY PROGRAMS

Organizer: Terrill A. Mast, Ph.D.

Panel: Howard Barrows, M.D.Robert L. Beran, Ph.D.Lewis R. Coulson, M.D.Robert D. Fox, Ph.D.Stephen C. GieserThomas C. Meyer, M.D.Richard Nuenke, Ph.D.Ralph Samlowski

PUTTING COMPUTERS TO WORK FOR

CURRICULUM PLANNERS

Organizer: E. M. Sellers, M.D., Ph.D.

Panel: William D. Mattern, M.D.Edward J. Ronan, Ph.D.E. M. Sellers, M.D., Ph.D.

MEDICAL STUDENT & RESIDENT

"IMPAIRMENTS": PREDICfION, EARLY

RECOGNITION, AND INTERVENTION. SHOULD

THEY BE REHABILITATED OR SHOULD THEY

BE REMOVED?

Organizer: Ronald D. Franks, M.D.

Panel: Carl Getto, M.D.Grant Miller, M.D.Kenneth Tardiff, M.D.

CLINICAL TEACHING: THREE PERSPECfIVES

ON FACULTY DEVELOPMENT

Organizer: Franklin J. Medio, Ph.D.

Panel: Larrie Greenberg, M.D.Kelley M. Skeff: M.D., Ph.D.LuAnn Wilkerson, Ed.D.

MEDICAL UNDERSTANDING AND ITS LIMITS

IN CLINICAL REASONING

Organizer: Paul J. Feltovich, Ph.D.

Moderator: John T. Bruer, Ph.D.

Panel: Arthur S. Elstein, Ph.D.Paul J. Feltovich, Ph.D.Vimla L. Patel, Ph.D.

CURRICULAR REFORM AT THE STRUcrURAL

LEVEL

Organizer: LuAnn Wilkerson, Ed.D.

Moderator: Vietor R. Neufeld, M.D.

Panel: Betty Mawardi, Ph.D.

205

Gordon T. Moore, M.D.Howard L. Stone, Ph.D.

October 31

Small Group Discussions

GMEjProblem Based Learning Group C0Sponsored Session

ASSESSMENT OF CLINICAL COMPETENCE

WITH THE OBJECfIVE STRUCfURED

CLINICAL EXAMINATION

Moderator: David B. Swanson, Ph.D.

Panel: Ian R. Hart, M.D.Emil Petrosa, Ph.D.Reed G. Williams, Ph.D.James Wooliscroft, M.D.

CLINICAL ETHICAL PROBLEMS ENCOUNTERED

AND PERCEIVED BY RESIDENTS

Moderator: Harold B. Haley, M.D.

Panel: Laurence McCullough, Ph.D.Two Residents

STUDENTS IN ACADEMIC DIFFICULTY: ISSUES

AND EFFORTS AT RESOLUTION

Moderator: Lester M. Geller, Ph.D.

Panel: Martha G. Regan-Smith, M.D.Stephen R. Smith, M.D.Miriam S. Willey, Ph.D.

RECOGNITION OF FACULTY TEACHING

EFFORTS

Moderator: Myra B. Ramos

Panel: Howard L. Stone, Ph.D.John S. Baumber, M.D., Ph.D.

THE PRERESIDENCY SYNDROME: AVOIDABLE

OR INESCAPABLE?

Moderator: Julian I. Kitay, M.D.

Panel: Charles A. Stuart, M.D.August G. Swanson, M.D.

THE CHALLENGES AND SURPRISES OF

IMPLEMENTING CHANGE IN THE MEDICAL

CURRICULUM

Moderator: S. Scott Obenshain, M.D.

Panel: Phyllis Blumberg, Ph.D.John MarkusStewart P. Mennin, Ph.D.


A RESPONSE TO THE AAMC CLINICAL

EVALUATION PROJECf: EVALUATION OF

CLINICAL COMPETENCY DURING MEDICAL

SCHOOL CLERKSHIPS-BRINGING ABOUT

INSTITUTIONAL CHANGE

Moderator: Fredric D. Burg, M.D.

Panel: D. Daniel Hunt, M.D.Carol Maclaren, Ph.D.M. William Schwartz, M.D.

THE MEDICAL SELF ASSESSMENT CENTER: A

NEW APPROACH TO THE ASSESSMENT OF

CLINICAL COMPETENCE

Moderator: Robert E. Anderson, M.D.

Panel: Peter A. J. Bouhuijs, Ph.D.Georgine Loacker, Ph.D.Geoffrey R. Norman, Ph.D.S. Scott Obenshain, M.D.

TEACHING RESIDENTS HOW TO TEACH

Moderator: Larrie W. Greenberg, M.D.

Panel: Martha G. Camp, Ph.D.Janine C. Edwards, Ph.D.Leslie Jewett, Ed.D.LuAnn Wilkerson, Ed.D.

REVIEW OF CURRICULUM INNOVATION IN

UNDERGRADUATE MEDICAL EDUCATION

Moderator: Arthur I. Rothman, Ed.D.

Panel: M. Brownell AndersonVictor R. Neufeld, M.D.E. M. Sellers, M.D., Ph.D.Stephen Smith, M.D.

HOW TO SELECf MEDICAL STUDENTS WITH

THE POTENTIAL FOR INDEPENDENT

LEARNING

Moderator: Luis A. Branda, D.Sc.

Panel: Gerald S. Foster, M.D.Joseph S. Gonnella, M.D.

TEACHING COST CONTAINMENT: WHEN?

WHAT? HOw? WHY?

Moderator: Terrill A. Mast, Ph.D.

Panel: James E. Davis, M.D.John G. Freymann, M.D.Christopher Lorish, Ph.D.David E. Steward, M.D.

STRATEGIES FOR MOVING TO ACfIVE

LEARNING

VOL. 61, MARCH 1986

Moderator: Harold A. Paul, M.D.

Panel: Phyllis Blumberg, Ph.D.Stewart P. Mennin, Ph.D.Parker A. Small, Jr., M.D.Roger P. Zimmerman, Ph.D.

Medical Education Exhibits

October 28, 29, and 30

INSTRUCfIONAL DESIGN OR EVALUATION OF

INTRODUCfION TO CLINICAL MEDICINE

COURSES

Learning Cardiac Anatomy Through FreshBeef Heart DissectionPhilip K. Fulkerson, M.D.

Lectures on Dentistry in "Introduction toClinical Medicine"Mortimer Lorber, M.D., et ale

Library Projects in a Behavioral ScienceCourse: Promoting Independent Learningand Communication SkillsJ. Phillip Pennell, M.D., et ale

Instructional Design for a Short Course inOinical Decision-MakingThomas A. Parrino, M.D., et al.

An Extended Patient SimulationDavid E. Steward, M.D., et al.A Surgical Training Program Utilizing CrossSectional AnatomyKenneth T. Sim, M.D., et al.

Teaching Medical Students PatientInforming and Motivating SkillsRuth B. Hoppe, M.D., et ale


BASIC SCIENCE COURSES

Peer Teaching in Gross AnatomyVernon L. Yeager, Ph.D., et al.

Cross-Sectional Anatomy: MultidisciplinaryLearning ModulesBarry Goldstein, Ph.D., et al.

"Trigger" Clinical Videotapes in BasicScience InstructionNeil Love, M.D.

Integrated Second-Year Curriculum andExaminations at New York Medical CollegeMario A. Inchiosa, Jr., Ph.D., et al.


A Health Promotion Curriculum forFreshmenR. P. O'Reilly, Ph.D., et al.


CLINICAL CLERKSHIPS

The Development and Validation ofaCompetency Based Assessment System for aPediatric Core OerkshipJanelle McDaniel, et al.

Emergency Medicine in the Medical SchoolCurriculumSociety of Teachers of Emergency MedicineImplementing a Patient Log SystemRobert F. Rubeck, Ph.D., et al.Association for Surgical EducationM. J. Peters, et ale

The Role of the Mentor in the MedicineClerkshipAnn Myers, et al.Data Base for Student HonorsTerry A. Travis, M.D.

AAMC Oinical Evaluation ProgramXenia Tonesk, Ph.D., et ale

INNOVATIVE APPROACHES TO ADMISSIONS

AND STUDENT FINANCIAL AID

Selection of Students for a CombinedBaccalaureate-M.D. Degree Program: TheInterview and Orientation for ProspectiveStudents and Their ParentsGloria Ragan, et aI.

A Critical Reappraisal and SuggestedChanges in the Use of Standardized Tests forSelecting Medical StudentsNonnal D. Anderson, M.D.

Student Views About the Honors Program inMedical Education at the University ofMiami School of MedicineJeffrey P. Jacobs, et al.

Motivating and Recruiting Students fromGroups Under-Represented in Medicine viaa Videotape About MEDPREPShirley McGlinn, et al.

The Medical College Admission TestImplications for Its Use In Student SelectionKaren Mitchell, Ph.D., et al.

EDUCATIONAL SUPPORT SYSTEMS FOR

STUDENTS

207

Exit Interviews: Why Students Leave a BAMD Degree Program PrematurelyLouise Arnold, Ph.D., et ale

Electives Options in a Combined BA/MDProgramTheresa Andrews, et ale

Personal and Professional Development: AResource Program for Medical StudentsNancy A. Stilwell, Ph.D.

Functions of a Women's Support GroupR. G. Shannon, Ph.D., et al.

MEDFILE (Medical Information FilingSystem)W. E. Golden, M.D., et ale

FACULTY DEVEUOPMENT

Teaching Improvement (TIPS) Within aMedical SchoolJennifer Craig, Ph.D., et ale

Student-Centered Learning and BasicSciences in Internal Medicine OerkshipRoundsLarry Laufman, Ed.D., et ale

"Effective Teaching: Improving Your Skills"Marilyn Appel, Ed.D., et al.

Preparation of Faculty for Educational RolesRon McAuley, M.D., et ale

A New Model for Educational LeadershipDevelopment for PhysiciansRichard Foley, Ph.D., et ale


RESIDENCY PROGRAMS

Resident Teaching SkillsNeal A. Whitman, Ed.D.

Instructional Materials for Education in CostEffective Patient CareJack L. Mulligan, M.D., et at.

SIMED-A Videotape Instructional Programto Teach Management of EmotionallyDifficult Physician-Patient Interactions inOffice PracticeCarol Herbert, M.D., et at.

Problem-Based, Self-Directed Learning forResidents in SurgeryMartin H. Max, M.D., et at.


Comprehensive Basic Science Course forOtolaryngology ResidentsMargaret H. Cooper, Ph.D., et a1.

Incorporation of Contingency Skills inGraduate Medical EducationL. C. Ellwood, et a1.

INSTRUcnONAL DESIGN OR EVALUATION OF

CONTINUING MEDICAL EDUCATION

PROGRAMS

A Nationwide Oinical Education Program inType II Diabetes: Evaluation by theAmerican Diabetes AssociationFrancis C. Wood, Jr., M.D., et al.

Hospital Satellite NetworkRon Pion, M.D., et al.

Family Practice Certification andRecertification Preparation Utilizing ActualTestingJames E. Van Arsdall, Ed.D., et al.

Exploring Linkages: Continuing MedicalEducation and the Professional ReviewOrganizationRobert E. Kristofco, et al.

COMPUTER APPLICATIONS IN MEDICAL

EDUCATION

Computer Based Oinical ReasoningEncounterReed G. Williams, Ph.D., et ale

Computer Software for Student UseWilliam R. Ayers, M.D., et aI.

Evaluation Instruments for CAl MedicalCoursewareBeverly E. Hill, Ed.D., et aI.

Information Management in an InnovativeCurriculumJan Beeland, et aI.

Interactive Videodisc Instruction in MedicalEducationKevin W. McEnery

Interactive Learning System for CPR andDysrhythmia RecognitionSandra O'Connell, et aI.

Computer Programming by MedicalStudentsL. E. Waivers, M.D.

VOL. 61, MARCH 1986

Microcomputer Support of MedicalEducationT. Lee Willoughby, et a1.

Pharmacokinetic CAl Program-TeachingKinetics and Patient CareCandice S. Rettie, Ph.D., et al.

Three-Dimensional ComputerReconstructions of NeuroanatomicalPathways in the BrainJoan C. King, et ale

"Nutri-Calc"-A Microcomputer NutritionEvaluation ProgramFredrick N. Hanson, M.D.

Medical Students' Nutrition Knowledge: ACollaborative Study in Southeastern MedicalSchoolsR. L. Weinsier, M.D., et al.

Development of a Model for a Nutrition TestItem BankJ. R. Boker, Ph.D., et al.

Computer Aided Instruction for the BasicSciencesRichardo M. Valdez, et ale

Computers in Education at JeffersonF. Scott Beadenkopf, et aI.

A Computer Assisted Tutorial on Body AuidCompartmentsJohn A. Bettice, Ph.D.

Curriculum Scheduling DatabaseJames M. DeWine, M.Ed., et al.

A Mainframe Medical Student Data BasePenny Persico, Ph.D., et al.

The Expandable Computerized Learning andInquiry in Pathology System (ECLIPS)Donald R. Thursh, M.D., et aI.

Application of Computer AssistedInstruction in a Surgical CurriculumDominic K. Cheung, M.D., et aI.

A Personal Data Base for Medical EducationCharles P. Friedman, Ph.D., et a1.

Using Computer-Based Interactive Video toTeach Dealing with DyingGeoff Weiss, M.D., et ale

Computer-Assisted Instruction in Auid,Electrolyte, and Acid-Base Balance.Morris Davidman, M.D.

1985 AAMCAnnual Meeting

C.A.S.E.S. Computer Assisted Simulationand Education SystemProf. Hugo A. Verbeek

Computerized Scheduling of MedicalStudents-Third Year OerkshipsSteve Woloshin

MEDCAPS Computer-Assisted ProblemSolvingo. J. Sahler, M.D., et aI.

INTERDISCIPLINARY HEALTH EDUCATION

National Oearinghouse for Alcohol InformationJudith McClure, et al.

Blending Medical History with the Radio~ logic Education of Medical Students~ Enrique Pantoja, M.D., et aI.0..

§ Interdisciplinary Subcommittee: A Pilot Pro-~ gram] Fred L. Ficklin, Ed.D., et al..g

~ Nutrition in Health Promotion~ Lawrence L. Gabel, Ph.D.E

~ Effecting Increased Enrollment in Electiveu Nutrition Course~ D. E. Kipp, Ph.D., R.D., et al.

(1)

~ The Medical Center Hour§ Lynne A. Tillack, et aI.]"8 A Course for Medical Students on the Princi-.s pIes of Medical Instrumentationj Vinay N. Reddy1::a A Cancer Prevention Laboratory for Second~ Year Medical Students

Gail F. Luketich et aI.

Area Health Education CenterJoel Meister, Ph.D., et aleA Ouster Course Approach to Issues inDeath and DyingLouise Arnold, Ph.D., et al.

APPROACHES TO THE DEVELOPMENT AND

ASSESSMENT OF DESIRABLE PERSONAL QUAL

ITIES, VALUES AND AITITUDES

Patients Say: "It's About Time!"Alfred Sarnowski, Ph.D.

V.C. Berkeley Health and Medical Apprenticeship ProgramAllen M. Fremont, et aI.

209

APPROACHES TO PROBLEM BASED LEARNING

An Outward Bound Preclinical Program: Alternative CurriculumPhyllis Blumberg, Ph.D., et ale

Assessing Oinical Reasoning: The IndividualProcess AssessmentDiana E. Northrup et ale

Biomedical Problem Tutorial Program: AnInterdisciplinary Approach to the Basic SciencesRichard Menninger, Ph.D., et ale

Qinical Reasoning and Content Integrationin the First Year Medical CurriculumRoger Robinson et ale

Integrating Cost Containment Strategies intothe Teaching ofOinical Problem SolvingM. Sue Wingrove et ale

OTHER

Generating and Maintaining Interest in Medicine as a CareerVelma Watts, Ph.D., et ale

Problems of Black Medical Students in SouthAfricaN. Badsha et ale

Community Medicine Health Fair: A Student Designed CurriculumDavid Resch et ale

The Aorida Keys Health Fair: A CommunityService Project Teaching Oinical SkillsJ. E. Crowell et ale

The Association of Biomedical Communications DirectorsGeorge C. Lynch et ale

Publisher of Medical VideotapesFrank Penta, Ed.D., et ale

Management Education in a Teaching HospitalCherry McPherson, Ed.D.

Evaluation of Medical School Curriculum byAssessment of Performance ofGraduatesDuring Their First Postgraduate Year Training Program.Marilyn F. M. Johnston, M.D., Ph.D., et ale

AAMC Curriculum Network Project-TheNext StepsM. Brownell Anderson, et ale


Medical Sciences Liaison EducationThe Upjohn Company

Survival Manual: The Who, What, Where,When and Why of Medical SchoolL. H. Francescutti et al.

Motivating and Recruiting Students fromGroups Under-Represented in Medicine viaa Videotape About MEDPREPShirley McGlinn et al.

GROUP ON PUBLIC AFFAIRS

30th Anniversary Program (1955-1985)

October 27

GPA AWARDS PRESENTATIONS

Moderator: Lillian Blacker

Premier Performance During 1984 by aMedical School or Teaching Hospital

Public RelationsD. Gayle McNuttJudith Rice

Publications-External Audiences

Single or Special IssueMartin S. BanderKay Rodriguez

PeriodicalSpyros AndreopoulosM. Keith Kaufher

Publications-Internal AudiencesAnne InsingerJudith Rice

Electronics Program-AudioD. Gayle McNutt

Electronics Program-VisualD. Gayle McNuttLinda Morningstar

Special Public Relations/Development/Alumni ProjectBrenda BabitzJ. Antony Lloyd

October 28

GPA AWARDS LUNCHEON

Welcome: Arthur Brink Jr.

VOL. 61, MARCH 1986

Speaker Introduction: Dean Borg

Awards Presented byEdward J. Stemmler, M.D.

Speaker: Sarah McClendon

MEET THE INVESTOR-oWNED HOSPITAL

Moderator: D. Gayle McNutt

Guests: George L. AtkinsRoland Wussow

Questioners: Ann J. DuffieldGregory GraceJoann RodgersKenneth Trester

DEVEDOPMENT PROGRAM

Moderator: Arthur Brink Jr.

Class Endowment ProgramM. C. BeckhamWilliam Stoneman III, M.D.

Building Synergism in External AffairsR. C. "Bucky" Waters

GPA BUSINESS MEETING

Presiding: Dean Borg

October 29

GPA LUNCHEON/ROUND TABLE TOPICS

Animals as Medical Research Subjects andthe Controversy Surrounding It

Discussion Leaders: D. Gayle McNuttKay Rodriguez

Advertising the Academic Medical Center

Discussion Leaders: Anne DollRobert Fenley

Is There Still Value in Producing the AnnualReport?Discussion Leaders: Bill Glance

Gloria GoldsteinHowton

How to Prepare for Awards Contests

Discussion Leaders: Elaine FreemanMichela Reichman

Competition-Living in the Same Marketwith a "For-Profit" Hospital

Discussion Leaders: David OgdenSuzan Russell


Operating a Cost-Effective PR OfficeDiscussion Leaders: Kathleen Conaboy

Helaine Patterson

MDs as a Developmental ResourceDiscussion Leaders: Robert Hart

Oyde Watkins

Alumni Special EventsDiscussion Leaders: Jeane Hundley

Jean D. Thompson

Special Ideas in Alumni ProgramsDiscussion Leaders: Nancy Groseclose

Muriel Sawyer

The Grateful Patient as Donor Prospect

Discussion Leaders: Robert AlsobrookJack Siefkas

CHALLENGES AND OPPORTUNITIES FACING

ACADEMIC MEDICAL CENTERS

Speaker: James Bentley, Ph.D.

ALUMNI PROGRAM

HOW CAN WE BElTER SERVE OUR

INSTITUTION?

Moderator: Jean D. Thompson

Fostering Alumni Relations-Bringing Them~ Back for Reunions~ Marcy Seligman Roberts

~ Helping Support Your Alumni Activities] How to Build a Dues Program"8 Milli Fox

(1)

~ Bringing in Big Dollars-How to Apply foro

<.l:1

1::a8oQ

211

Foundation GrantsKatherine Wolcott Walker

Securing "Seed" Money-Annual AlumniGivingKent G. Sumrall

GROUP ON STUDENT AFFAIRS

October 28

Student Financial Assistance: Status of Federal Programs

Moderator: Ruth Beer Bletzinger

Status of Health Manpower ProgramsMichael Heningburg

Status of Higher Education Act ProgramsRose M. DiNapoli

October 29

Business MeetingChair: Norma E. Wagoner, Ph.D.

NRMP: Update on MatchingJohn S. Graettinger, M.D.

October 30

Topic Forums: Creative Problem-Solving onCurrent IssuesAdmissionsFinancial AssistanceCareer CounselingRetention

Minutes of AAMC Assembly Meeting

October 29, 1985

Washington, D.C.

Call to Order

Dr. Richard Janeway, AAMC Chairman,called the meeting to order at 8: 15 a.m.

Quorum Call

Dr. Janeway recognized the presence ofa QUO

rum.

Consideration of the Minutes

The minutes of the October 30, 1984, Assembly meeting were approved without change.

Report of the Chairman

Dr. Janeway reported on several ExecutiveCouncil committees which had been workingthroughout the year. The Committee on Financing Graduate Medical Education was expected to submit a draft report for the JanuaryCouncil meeting. Dr. Janeway emphasizedthat the Executive Committee action with respect to Association testimony on the DoleDurenberger bill had been taken as an interimAAMC position pending action on the committee's final report by the Executive Council.

Other committees appointed during thepast year were concerned with research policy,review ofthe Medical College Admission Test,and clinical faculty practice. The ExecutiveCouncil also planned to appoint a committeeon issues relating to the transition to graduatemedical education. During the year the Executive Council had received final reports froma joint AAMC-AAU committee on institutional responsibility for the humane use ofanimals and a working group commenting onthe General Professional Education of thePhysician report.

Dr. Janeway reviewed the major policy de-

bates expected in Washington over the nextyear and predicted that the strong concernsabout the level of the federal deficit and theneed for tax reform would require the Association and its constituents to continue theirhard work to develop reasoned solutions tothe needs of medical schools and teachinghospitals.

Dr. Janeway commended the retiring members of the Executive Council: Robert Heyssel,L. Thompson Bowles, Robert Hill, JosephJohnson, Haynes Rice, and Ricardo Sanchez.

Report of the President

Dr. John Cooper reported on a number ofprogram activities at the Association, including AAMC sponsored conferences on clinicaleducation and medical informatics in medicaleducation, the proceedings of which would bepublished in early 1986. He called attentionto upcoming meetings on the implications formedical education of vertical integration inhealth care, medical malpractice insurance issues, and information management in the academic medical center.

The introduction, on a pilot basis, of anMCAT essay began with the two 1985 nationaladministrations of the MCAT. The steeringcommittee was preparing specific plans for thepilot use of the MCAT essay in the selectionof the 1987 entering class at 35-40 schoolsthat had volunteered to participate in the pilotproject.

Dr. Cooper reported on expected continueddeclines in the applicant pool. He also indicated that studies of the recent applicant poolshowed that applicants were coming fromwealthier families and that they had higherlevels ofeducational debt prior to their admission to medical schools.

Dr. Cooper reviewed AAMC activities inconnection with the FY 85 appropriations billand research grant awards for NIH and

213


ADAMHA, health manpower reauthorizationlegislation and student financial assistanceprograms, and changes in Medicare reimbursement policies.

Report of the Organizationof Student Representatives

Dr. Ricardo Sanchez reported that the priorities of the Organization of Student Representatives had been the discussion and implementation of the GPEP report, public support forstudent financial assistance programs, and thedevelopment of an OSR paper on critical issues in medical education, which provided anagenda for the future for the OSR. RichardPeters had been installed as chairperson of theOSR.

Report of the Council of Deans

Dr. Arnold Brown reported that the CODspring meeting had focused on discussions ofthe future ofthe COD and the AAMC. Duringthe annual meeting the COD had sponsored aspecial program on implications of the newcomprehensive national board examinationand transition to graduate medical education.Dr. Brown commended departing COD Boardmembers Thomas Miekle, Henry Russe, L.Thompson Bowles, and Edward Stemmler.Dr. Kay Oawson was the new COD chairman.

Report of the Council of Academic Societies

Dr. Virginia Weldon reported that the CASspring meeting had been concerned with support for M.D. and Ph.D. research training atthe predoctoral and postdoctoral levels. TheCAS had been pleased that its concerns withthe development offederal research policy hadbeen met with the appointment of a newAAMC committee in this area. Dr. Weldoncommended departing CAS Board membersPhilip Anderson, Harold Ginsberg, RobertHill, and Joseph Johnson. Dr. David Cohenwas the new CAS chairman.

Report on the Council of Teaching Hospitals

Mr. Sheldon King described three publicationsissued during the previous year by the Association, and meetings the Council had held onhospital consortia and relationships with alter-

VOL. 61, MARCH 1986

nate delivery systems. The COTH Board hadrecommended a change in the Associationbylaws to permit the membership in COTHof investor-owned hospitals, and that amendment would be acted on by the Assembly laterin the session. Mr. King commended retiringCOTH board members Thomas Stranova,Glenn Mitchell, Haynes Rice, and DavidReed. Mr. Thomas Smith was the new COTHchairman.

Report of the Secretary-Treasurer

Mr. King referred members of the Assemblyto the complete treasurer's report which appeared in the agenda and indicated that theAudit Committee had found no irregularitiesin the Association's annual audit report.

ACTION: On motion. seconded, and carried.the Assembly adopted the report of the Secretary-Treasurer.

Election of New Members

ACTION: On motion. seconded, and carried,the Assembly by unanimous ballot elected thefollowing organizations. institutions, and individuals to the indicated class ofmembership:

Institutional Member: The MorehouseSchool of Medicine.

Academic Society Members: American Geriatrics Society, Inc.; American Society for Clinical Nutrition; Surgical Infection Society.

Teaching Hospital Members: City of FaithHospital, Tulsa, Oklahoma; McLean Hospital,Belmont, Massachusetts; The Naval Hospital,Bethesda, Maryland; St. Elizabeth HospitalMedical Center, Youngstown, Ohio; St. Mary'sHospital, Waterbury, Connecticut; St. Peter'sMedical Center, New Brunswick, New Jersey;San Francisco General Hospital, San Francisco,California; Shadyside Hospital, Pittsburgh,Pennsylvania.

Corresponding Member: The Institute forRehabilitation and Research, Houston, Texas.

Distinguished Service Members: Joseph J.Ceithaml, Robert L. Hill.

Emeritus Members: Robert W. Berliner;Betty W. Mawardi.

Individual Members: List attached to archivecopy of these minutes.

Amendment of AAMC Bylaws

ACTION: On motion, seconded, and carried,the Assembly by unanimous ballot amended the

1985 Assembly Minutes

Association bylaws to permit investor-ownedhospitals to be members of the Council ofTeaching Hospitals. The text of the bylawschange follows:

A. Section I. Shall be amended to read asfollows (current language of Section I to bedeleted is indicated by strike through):

Section J. There shall be the followingclasses of membership: eaeh of whieh thathM the right ta •ate shall be (a) 8n afPftifttion deserihed in Seetion 591 (e) (3) afthe Intemal Rewentle Code of 1954 (ar theeanre9l'8nding pre •isian afan~ Stl6geEttientFederal tax la ws), and (6) an atpnimtiende3erihed in Seetian S99 (a) (I) ar (2) afthe Intemal Re.entle Code af 19S4 (ar theearresl'6nding 1'1'6' iMans af an~ stillS(Cltlent Federal tax law), and eaeh of whiehshall al96 meet (e) the Cltlalifieatiens setferth in the Artieles af Ineafl'6ratian andthese B) la ws, and (d) ather mtena eM&lished b) the Exeeuti we Cetlneil far eaehelass af membership.

A. Institutional Members-InstitutionalMembers shall be medical schools and colleges of the United States.

B. AjJiliate Institutional Members-Affiliate Institutional Members shall be medicalschools and colleges of Canada and othercountries.

C. Graduate AjJiliate Institutional Members-Graduate Affiliate InstitutionalMembers shall be those graduate schoolsin the United States and Canada closelyrelated to one or more medical schoolswhich are institutional members.

D. Provisional Institutional MembersProvisional Institutional Members shall benewly developing medical schools and colleges of the United States.

E. Provisional Affiliate Institutional Members-Provisional Affiliate InstitutionalMembers shall be newly developing medical schools and colleges in Canada andother countries.

F. Provisional Graduate Affiliate Institutional Members-Provisional GraduateAffiliate Institutional Members shall benewly developing graduate schools in theUnited States and Canada that are closelyrelated to an accredited university that hasa medical school.

G. Academic Society Members-Aca-

215

demic Society Members shall be organizations active in the United States in theprofessional field of medicine and biomedical sciences.

H. Teaching Hospital Members-Teaching Hospital Members shall be teachinghospitals in the United States.

I. Co"esponding Members-Corresponding Members shall be hospitals involved inmedical education in the United States orCanada which do not meet the criteriaestablished by the Executive Council forany other class ofmembership listed in thissection.

B. A new Section 2 shall be inserted to read asfollows (language which materially changes thetext of the previous Section I is set out in boldface):

Section 2. Members shall meet the qualifications set forth in the Articles of Incorporation, these Bylaws and other criteriaestablished by the Executive Council forthe various class of members. All membenthat have tbe rigbt to vote, except membenof class H. TellC1Ii1lg HOlpitlll Members,shall be (a) organizations described in Section 501(c)(3) of the Internal RevenueCode of 1954 (or the corresponding provision of any subsequent Federal Taxlaws), and (b) organizations described inSection 509(a)(l) or (2) of the InternalRevenue Code of 1954 (or the corresponding provisions of any subsequent FederalTax laws).

C. Existing Sections 2 through 5 shall be renumbered 3 through 6 respectively for conformity.

Report of the Resolutions Committee

There were no resolutions reported to the Resolutions Committee for timely consideration andreferral to the Assembly.

Report of the Nominating Committee

Dr. Joseph Gonnella, chairman of the Nominating Committee, presented the report ofthatcommittee. The committee is charged by thebylaws with reporting to the Assembly onenominee for each officer and member of theExecutive Council to be elected. The followingslate of nominees was presented: AAMCChairman-Elect: Edward Stemmler; ExecutiveCouncil, COD representatives: Richard Ross


and William Deal; Executive Council, CASrepresentative: William Ganong.

ACfION: On motion, seconded, and carried,the Assembly approved the report ofthe Nominating Committee and elected the individualslisted above to the offices indicated.

Resolution of Appreciation

ACfION: On motion, seconded, and carried,the Assembly adopted the following resolutionofappreciation:

WHEREAS, Dr. Richard Janeway has faith-fully and with great vigor served the AssociationofAmerican Afedical Colleges as a member andchairman ofthe Council ofDeans, the ExecutiveCouncil, and the Assembl)', and

VOL. 61, MARCH 1986

WHEREAS, his 14 years of leadership at theBowman Gray School of Medicine of WakeForest University have greatly strengthened andenhanced the achievements and reputation ofthat institution, andWHEREAS, he has been an effective advocatefor reforming and strengthening American med-ical education at the undergraduate and graduate levels, for promoting biomedical and behavioral research, andfor improving the qualityofpatient care,NOW BE IT RESOLVEO that the Associationexpress our sincere appreciation for his contributions and our hope that his future endeavorsbe rewarded with success.

Adjournment

The Assembly adjourned at 9: 15 a.m.

(1)::o

Annual Report

1984-85

217

Executive Council, 1984-85

Richard Janeway, Chairman·Virginia V. Weldon, Chairman-Elect·Robert M. Heyssel, Immediate Past ChairmanJohn A. D. Cooper, President·

COUNCIL OF ACADEMIC ~IETIES

David H. Cohen·Robert L. HillJoseph E. Johnson, IIIVirginia V. Weldon

DISTINGUISHED SERVICE MEMBER

Charles C. Sprague

COUNCIL OF DEANS

L. Thompson BowlesArnold L. Brown·William Butler• Member of Executive Committee.

D. Kay OawsonRobert DanielsLouis J. KettelRichard H. MoyJohn NaughtonEdward J. Stemmler

COUNCIL OF TEACHING HOSPITALS

J. Robert BuchananSheldon S. King·Haynes RiceC. Thomas Smith

ORGANIZATION OF STUDENT

REPRESENTATIVES

Richard PetersRicardo Sancl)ez

Administrative Boards of the Councils, 1984-85

COUNCIL OF ACADEMIC ~IETIES

Virginia V. Weldon, chairmanDavid H. Cohen, chairman-electPhilip C. AndersonWilliam F. GanongHarold S. GinsbergRobert L. HillA. Everette James, Jr.Joseph E. Johnson, IIIDouglas KellyJack L. KostyoFrank G. MoodyFrank M. Yatsu

COUNCIL OF DEANS

Arnold L. Brown, chairmanD. Kay Oawson, chairman-electL. Thompson BowlesWilliam T. ButlerRobert S. DanielsLouis J. KettelWalter F. LeavellThomas H. Meikle, Jr.Richard M. MoyJohn NaughtonHenry P. RusseEdward J. Stemmler

COUNCIL OF TEACHING HOSPITALS

Sheldon S. King, chairmanC. Thomas Smith, chairman-electRobert J. BakerJ. Robert BuchananJeptha W. DalstonGordon M. DerzonSpencer ForemanGary GambutiGlenn R. MitchellJames J. MonganEric B. MunsonDavid A. ReedHaynes RiceThomas J. Stranova

ORGANIZATION OF STUDENT

REPRESENTATIVES

Ricardo Sanchez, chairpersonRichard Peters, chairperson-electSharon AustinPamelyn OoseVicki DarrowJohn DeJongKimberley DunnRoger HardyKirk MurphyMiriam ShuchmanKent L. Wellish

218

President's Message

John A. D. Cooper, M.D., Ph.D.

For the last 16 years I have been privileged toserve the Association of American MedicalColleges as its first full-time president. WhenI assumed this responsibility, the officerscharged me to implement a number of therecommendations in the reorganization planfor the membership and governance structureproposed by the Coggeshall Committee,strengthen the Association, and move its offices to Washington. The last of these chargeswas the most readily accomplished. Since 1970the AAMC central offices have been in thenation's capital, and the voice of academicmedicine has become known and respected asan effective advocate for vigorous biomedicaland behavioral research, improved medicaleducation, and high quality patient care.

The charge to implement an approved ·reorganization of the Association provided thegreatest challenge. However, in keeping withthe recommendations in the 1965 CoggeshallCommittee report, over the last decade and ahalt: the Association has been transformedfrom a Deans' Club into an organizationbroadly representative of all those involved inthe increasingly complex structure ofthe medical school and its affiliated institutions.

Some predicted that an organization composed ofdeans, faculty members, and hospitaladministrators, whom they viewed as naturalenemies, would soon deplete its energy andinfluence in exhausting internecine struggles.Instead, these groups have found it possible towork together with little friction to achieveconsensus on ways to confront the challengesand opportunities facing our institutions andto establish priorities for Association programs. No group may have gotten everythingthat it wanted out of this collaboration. How-

ever, there has been a growing recognition byall segments of the constituency that decisionscentered on the academic medical center asan institution bring greater returns than thosederived from the narrow interests of anyoneof the groups.

The reorganization was not limited to justa restructure of the Association's governance.A conscious decision was made to emphasizethe use ofad hoc committees, advisory panels,and task forces as necessary to consider andmake recommendations on the important issues of the day rather than maintain a cumbersome and costly array ofstanding committees. This approach has made more effectiveuse of the time and efforts of the constituencyand staff in carrying out the work of the organization. The appointment of committeesby the Association's Chairman and ExecutiveCouncil and action by the Executive Councilon all committee reports assure that the workofthe committees is consonant with the priorities established by the Association.

Participation in Association activities andeducational and training programs for professional advancement has been opened to administrators and faculty members, appointedby deans and hospital administrators, throughmembership in Association sponsored groups.Since the reorganization, the membership ofgroups has been expanded. Now professionalswith interests in student and minority affairs,medical education, public affairs, alumni relations and development activities, businessaffairs, and institutional planning can shareproblems and ideas under the umbrella of anAAMC group. The total membershp of thegroups now numbers almost 4,000.

The charge to strengthen the Association

219


was a broad one and has been an ongoingprocess that will continue into the future. Itincluded the desire of the Executive Councilto improve the financial stability of the organization by the accumulation of a reserveequal to its annual operating budget, a goalthat has been approached but not yet achieved.

During my tenure the staff has grown from79 to 155 and the annual operating budgetfrom $2,035,711 to $11,358,696. These figureshave meaning not because they reflect sustained growth but because they now assurethat the Association has more adequate resources to serve its constituency more effectively. While resources grew, membership duesand service fees have fallen from 31.5 to 26percent of the annual budget; the remainderhas come from foundation grants, gifts, government contracts, and Association programsand services. More important than these statistics has been the recruitment ofa staffwhosetalents and abilities are recognized nationallyto be of the highest caliber.

The Association's response to the needs ofthe constituency has been diverse, but certainprograms stand out as important landmarksin the AAMC's development.

The American Medical College ApplicationService (AMCAS), a centralized applicationservice to help schools deal with a growingnumber of applicants, was initiated in 1969with seven schools and 7,500 applicants filing13,610 applications. In 1986 102 schools willparticipate in AMCAS, which will process303,000 applications for 33,000 students. Beyond its primary purpose, this program hasalso provided data that allow more extensivestudies of applicants and enrolled students,now being extended by a follow-up of theirresidency training. The system has also permitted the development of a program to identify the use of forged documents and otherirregularities in the admission process.

The Medical College Admission Test(MCAT) has been given under AAMC auspices since 1930. A major effort to revise theexamination culminated with the design of anew test first administered in 1977. The Association continually reviews the examinationto assure that it meets constituent needs andto evaluate the validity and reliability of thetest. As part of this process, the value of incor-

VOL. 61, MARCH 1986

porating an essay question in the examinationis being assessed in a pilot program with thecooperation of 30 medical schools.

One of the most effective of the Association's programs has been the managementeducation program designed to improve themanagement capabilities of deans and theirmanagement teams, department chairmen,and teaching hospital administrators. The program provides both an ongoing series of seminars in basic management principles and special topic sessions developed to meet evolvingneeds. The latter have included managementof human resources, academic medical centerfinances, information resources, and technological innovation. More than 60 seminarshave been offered since the program's inception in 1972.

In 1972 the Association took a leadershiprole in professional education with the appointment of a committee to develop a blueprint to assist medical schools in improvingthe representation of minority groups in medicine. The AAMC Office of Minority Affairswas established to assist the schools in implementing the recommendations and to monitorprogress in achieving the goals established.This effort for ethnic minorities has been complemented by a special emphasis on womenin medicine begun in 1976.

Recently the Association published the report of its advisory panel on the GeneralProfessional Education of the Physician andCollege Preparation for Medicine. This threeyear comprehensive review of undergraduatemedical education and its interface with baccalaureate education followed on previousAAMC reviews of graduate and continuingmedical education. The report has attractedinternational attention and has already beentranslated into Spanish, Japanese, Chinese,and Dutch. With this study, Association committees have intensively examined the continuum of medical education over the past decade.

Other studies have addressed ethics inbiomedical and behavioral research, the use ofanimals for research and education, characteristics of medical schools, affiliation agreements, primary care education, the teachingof quality assurance and cost containment,health maintenance organizations, medical

1984-85 Annual Report

school curricula, medical practice plans, careerpatterns of faculty, characteristics of medicalschool applicants and enrollees, evaluation ofclinical performance, reimbursement mechanisms, geriatrics in medical education, the roleof the library in information management,and medical informatics in education and clinical decision-making.

The Association has always viewed communication with its constituents as an important responsibility. The Journal of MedicalEducation is in its 60th volume, and over 600issues of a Weekly Activities Report have beendistributed. This report keeps members current on both Association programs and otherimportant activities on the national scene.

~ Other publications include the COTH Report,the Student Affairs Reporter, and the OSR

~0. Report. More detailed information has been§ provided by the more than 900 memoranda~ sent to members of the councils since 1969.].g Another major activity has been the collec-~ tion and analysis of information on AAMC] members and their characteristics. During this~ period the Association established its ownZ computer center with a capable professional~ staff. The Institutional Profile System, opera-

Q) tional since 1972, contains 33,000 variables~ from 132 sources. The Faculty Roster includes§ information on 112,000 individuals who have] served on medical school faculties in the last"8

Q) two decades. The new Student and Applicant-B§ Information Management System records in-~ formation on 680,000 individuals.a One of the Association's strengths has been88 its ability to work cooperatively with other

organizations. The Association has been instrumental in the development of a numberofcoalitions which have worked together overtime to achieve agreement on issues like federal funding for education, research, and reimbursement for medical care. It has expandedits joint efforts with the American MedicalAssociation to accredit medical education begun in 1942 to include participation with otherorganizations in accrediting graduate medicaleducation and continuing medical education.

Legal interventions have increasingly become a part of our armamentarium for making our views known. The Association had asignal success during the Nixon Administration when its suit resulted in the release of

221

$225 million in impounded research funds.Currently the Association is engaged in legalactions to protect the integrity of the MCAT,to challenge regulations on medical treatmentof severely handicapped infants, to protectphysician-patient privilege, and to defend theright of the faculty to make decisions aboutstudents' academic progress.

One reason for the Association's move toWashington was to add our voice to publicpolicymaking. The Association routinely testifies at Congressional hearings-45 times inthe past three years-and comments on pending legislation and regulations. Dealing withCapitol Hill has become increasingly complexbecause of the turnover of membership, theexpansion of Congressional staff, and an increased tendency of Congress to use the legislative process to effect change and to prescribedetails for administration of its views. As anadopted Virginian, I have come very much toadmire Thomas Jefferson, who in his autobiography had this comment on Congress,"That one hundred and fifty lawyers shoulddo business together ought not to be expected." Surely Mr. Jefferson would blanch atthe thought of today's 212 congressional lawyers.

There have been many changes in the Association since I first became president, andmany others will follow. To quote Mr. Jefferson again, "... laws and institutions must gohand in hand with the progress of the humanmind ... as new discoveries are made, newtruths discovered ... with the change of circumstances, institutions must advocate also tokeep pace with the times." As change is considered, it is important that we not merelyreact and accommodate passively to changesoccurring in society, for we have a responsibility to use our special resources to help defineand implement new efforts that will strengthenand improve our society. One thing I hopewill never change is the willingness of allwithin academic medicine to work together toovercome parochial interests in favor of abroad view to achieve our missions in education, research, and patient care. The friendship, support, and assistance that I haveknown from my colleagues in academic medicine are the most important legacies that Ican bequeath to my successor.

The Councils

Executive Council

The Association's Executive Council meetsfour times a year to consider policy mattersrelating to medical education, biomedical andbehavioral research, and the delivery of medical care. Issues are referred by member institutions and organizations and from the constituent councils. Policy matters considered bythe Executive Council are fIrSt reviewed bythe Administrative Boards of the constituentcouncils for discussion and recommendationbefore fmal action.

Newly elected officers and senior staff ofthe Association held a retreat in December atGraylyn Conference Center in WinstonSalem, North Carolina. Primary attention wasgiven to reviewing papers on future challenges and directions for the Association andits Council of Deans, Council of TeachingHospitals, and Council of Academic Societies.Also discussed. was an array of programmaticactivities which might be undertaken by theAssociation to follow up on its study on theGeneral Professional Education of the Physician and College Preparation for Medicine.Other agenda items included proposals foreducating foreign medical students and graduates, the use of animals in biomedical research and education, and membership ofinvestor-owned hospitals in the AAMC'sCouncil of Teaching Hospitals.

Many of the issues reviewed and debatedby the Executive Council during the past yearwere related to the nation's biomedical andbehavioral research enterprise. In particular,considerable governance council attentionwas devoted to a proposal from the Office ofManagement and Budget which would havedelayed expenditure of a substantial portionof FY85 funds appropriated for the NationalInstitutes of Health and the Alcohol, DrugAbuse, and Mental Health Administration un-

til later years by making multi-year grant commitments. This would have had the effect ofsubstantially reducing the number of competing research project grants which could havebeen funded, and the proposal was vigorouslyopposed by the Executive Council.

For the past several years the Associationhas been troubled by the efforts of animalrights activists to limit the use of animals inbiomedical and behavioral research. An Executive Council statement emphasized the importance of contributions from such researchto the nation's health. The statement alsorecognized the responsibility of the academicmedical community to assure that the use ofanimals in laboratory research is conducted ina judicious, responsible, and humane manner.The Executive Council also reviewed and approved a report of an ad hoc committee onguidelines for the use of animals in researchand education. This committee was chairedby Henry Nadler, dean of Wayne State University School of Medicine, and William H.Danforth, chancellor of Washington University.

Since congressional consideration of NIHreauthorization legislation was limited to repassage in an only slightly modified form oflegislation vetoed in 1984, the developmentof new legislative strategies was not a majorissue for the Council. However, the Councildid reaffmn the Association's ·Principles forthe Support of Biomedical Research,· whichprecluded Association endorsement of thepending legislation. The Council authorizedthe establishment of a new ad hoc committeeon research policy, to be chaired by EdwardN. Brandt, chancellor at the University ofMaryland School of Medicine. The committeewas charged with developing of reaffumingAssociation positions relating to researchtraining and research manpower needs, federal support for research institutions, research

223


funding mechanisms and levels of funding,and the goals of federal research and the roleof Congress in setting science policy. As anintroduction to this undertaking, the Executive Council heard a presentation from Representative Don Fuqua, chairman of theHouse Committee on Science and Technology, and chairman of a new congressionalScience Policy Task Force.

The Institute of Medicine of the NationalAcademy of Sciences had issued a report onIResponding to Health Needs and ScientificOpportunity: The Organizational Structure ofthe National Institutes of Health. I An AAMCad hoc committee under the chairmanship ofRobert Berliner of Yale University School ofMedicine prepared a critical review of the10M document, which was submitted to andapproved by the Executive Council. TheAAMC report concurred with the majorthrusts of the 10M report and in most of itsconclusions, although reservations were expressed about some of the recommendations.The Committee was disappointed that thereport did not address increasing congressional activism in reauthorizing the NIH anda stronger statement on the preeminence andgreat contributions of the NIH within thenational and international scientific community.

The Executive Council reaffirmed AAMCopposition to including the Public HealthService in any cabinet reorganization to createa Department of Science.

Much of the Executive Council's attentionin the patient services and medical care areawas focused on Medicare reimbursement policies. Strong support was given for adoptionof a DRG-specific blend of an average priceand a hospital-specific price. The Council accorded the highest priority to funding a DRGprice formula that was cognizant of hospitalspecific differences. The Council also opposedarbitrary cuts in the resident-to-bed adjustment, any change or reduction in the passthrough for direct medical education costs,and any freeze in DRG prices, especially ifunaccompanied by a freeze in the blend usedto determine payments. The Council supported the continued opportunity for states to

VOL. 61, MARCH 1986

be granted Medicare payment waivers as longas no increased funding was required.

Throughout the year the Council discussedmembers' concerns that rapid changes in thehealth care delivery system and reimbursement mechanisms would require some repositioning by the medical schools' clinical faculty. It was feared that in many cases academic medical centers were not presently organized to compete successfully in providingmedical care, and that faculty members andteaching hospitals may not have establishedworking relationships to permit them to worktogether effectively in the changing medicalservice environment. The Council defined arole for the Association in providing a betterunderstanding of this environment and identifying key issues which must be consideredas academic medical centers developed localstrategies to meet new challenges. An Association committee chaired by EdwardStemmler, dean of the University of Pennsylvania School of Medicine, was appointed toidentify important issues for AAMC constituents and to propose areas where the Association could provide either temporary or permanent services centered on these issues forits members.

The Association's position on health planning was reviewed and concern was expressedthat the usefulness of health planning legislation was limited because it was impossibleto have all providers covered by the samelegislation. The Council supported continuingthe requirement of certificate of need for expanded inpatient capacity, but not for othertypes of capital expenditures.

The Executive Council endorsed an actionplan to deal with the problems surroundingthe formation of regionalized compacts forthe disposal of low-level radioactive waste.Recommended actions at the federal and statelevels were specified in order to assure thatthe medical service and research activities ofAAMC member institutions were not hampered by congressional and state inability torespond to a legislative mandate to establishregional compacts for the disposal of lowlevel radioactive waste.

The Executive Council supported a legisla-


tive proposal for the creation of a vaccineinjury compensation program in response toconcerns about the growing inadequacy ofimmunization of children.

At the beginning of the year the ExecutiveCouncil considered a number of programmatic activities to implement some of the recommendations and findings of the GeneralProfessional Education of the Physician(GPEP) project. These discussions coincidedwith more detailed consideration of the GPEPreport by subgroups of the AdministrativeBoards of the Council of Academic Societiesand the Council of Deans.

J. Robert Buchanan, general director of theMassachusetts General Hospital, was asked tochair an Association committee on financinggraduate medical education that would makeregular reports on its deliberations to the Executive Council. The introduction of severalsignificant legislative proposals is expected tomake financing of residency training one ofthe principal Executive Council agenda itemsthis year.

The Executive Council had been concernedabout the impact on graduate medical education of specialty board decisions to lengthenperiods of training required for certification.As a result the Association sponsored anamendment to the bylaws of the AmericanBoard of Medical Specialties to require suchdecisions to be approved by ABMS and concerned specialties before implementation. Although the amendment was tabled, the ABMSheld an invitational conference on the impactof the certification process on graduate medical education which Robert M. Heyssel, president of The Johns Hopkins Hospital, attended as the AAMC representative. TheCouncil believed that the Association hadbeen instrumental in stimulating professionalconsideration of this issue, and hoped that themore extensive impact statements required ofboards considering educational changeswould be a meaningful way of monitoring theproblem.

The Medical College Admission Test, itsuse by medical schools in their selection process, and the effects of this use on undergraduates and undergraduate institutions were the

225

subject of substantial interest and attention bythe Executive Council. The consideration andenactment by several states of so-called 'truthin testing' legislation, concerns surfaced during the GPEP study, the repudiation of thetest by one medical school, and the concernof others that its importance as a source ofrevenue to the Association precluded objective oversight by the Association led the Executive Council to authorize a new committeeto review the MCAT in the context of theseconcerns. The committee is chaired by Sherman Mellinkoff, dean of the University ofCalifornia, Los Angeles, School of Medicine.

Another educational issue of concern to theExecutive Council is the transition betweenmedical school and residency training. TheCouncil had previously sponsored efforts toencourage all specialties to participate in theNational Resident Matching Program, and isnow developing other efforts to deal with the'preresidency syndrome.'

In its role as a parent organization, theExecutive Council reviews the policy actionsof a number of accrediting bodies. It gavefinal approval to revisions in Functions andStructure ofa Medical School of the LiaisonCommittee on Medical Education. The Council also reviewed several proposed changes inthe general requirements section of the essentials for accredited residencies of the Accreditation Council for Graduate Medical Education. The Executive Council approved achange relating to completion of training, butsuggested alternate language in another sectionto ensure that the balance between medicalstudents and residents was such that the education ofboth was augmented and not diluted.The Council vetoed an amendment to thegeneral requirements charging residency program directors with assessing clinical skills ofnew residents during the first year of training.Instead the Council reiterated its long-standingposition that the ACGME should develop ahands-on clinical skills examination by whichgraduates of non-LCME accredited schoolscould be evaluated for adequate clinical competence before entering residency training.

Discussions concerning the membership eligibility of investor-owned teaching hospitals


during Executive Council meetings over thepast two years culminated in a decision torecommend to the Assembly a bylaws changethat would permit membership by such institutions in the Council of Teaching Hospitalsif assurances were obtained from the InternalRevenue Service that this action would notthreaten the 50 I (c)(3) status of the Association.

The Executive Council and the ExecutiveCommittee are responsible for decisions relating to AAMC participation in court cases.Considerable attention has been given to litigation in New York concerning the application of that state~s test disclosure statute onthe MCAT. Several years ago the Associationsecured a preliminary injunction against a lawthat would have required that the MCAT notbe offered in the state. A trial on the merits ofthe Association~s complaint in the near futurewill provide a final decision in the case. TheAssociation filed an amicus brief in The Regents of the University of Michigan v. ScottEwing. The Council hoped that the SupremeCourt had accepted the case for review in orderto answer definitively and in the negative thequestion of whether there are circumstancesunder which the courts might appropriatelyengage in a review of the actual merits ofacademic decisions as opposed to the processby which they are made. The Association alsojoined with the American Medical Associationas an amicus curiae in two cases before theSupreme Court dealing with the constitutionality of state laws putting requirements onphysicians with respect to abortions; the arguments were limited to the proper role ofstates in regulating physician-patient relationships in the practice ofmedicine, and not withthe issue ofabortion. With the American Hospital Association and a number of other national professional organizations, the AAMChad fought in the courts efforts by the Department of Health and Human Services to applySection 504 of the Vocational RehabilitationAct to medical decisions about severely handicapped infants.

The Executive Council continued to oversee the activities of the Group on BusinessAffairs, the Group on Institutional Planning,

VOL. 61, MARCH 1986

the Group on Medical Education, the Groupon Public Affairs, and the Group on StudentAffairs.

The Executive Council, along with the Secretary-Treasurer, the Executive Committee,and the Audit Committee, exercised carefulscrutiny over the Association~s fiscal affairs,and approved a small expansion in the generalfunds budget for fiscal year 1986.

The Executive Committee convened priorto each Executive Council meeting and conducted business by conference call as necessary. During the year the Executive Committee met with William Roper, special counselto the president for health policy, and JohnCogan, associate director ofthe Office ofManagement and Budget, to discuss issues relatingto biomedical research and the problems facing clinical faculties and teaching hospitalsunder proposed federal legislation. They alsomet with the Executive Committee of the Association of Academic Health Centers to exchange views on issues of mutual concern.

Council of DeansTwo major meetings dominated the CouncilofDeans activities in 1984-85. A new programsession and social event expanded the eventsof particular interest to deans at the Association's annual meeting in Chicago, Illinois. TheCouncil's spring meeting was held in Scottsdale, Arizona on March 20-23. The Council'sAdministrative Board met quarterly to reviewExecutive Council agenda items of significantinterest to the deans and to carry on the business of the COD. More specific concerns werereviewed by sections of the deans broughttogether by common interests.

At the dean~s annual meeting program session, Robert L. Friedlander, dean, AlbanyMedical College, described practice plan litigation involving his institution. Henry P.Russe, dean, Rush Medical College, reviewedexperience at his institution in auditing medical education costs. An update on the impactof the implementation of the prospective payments system on teaching hospitals was presented by James Bentley, associate director ofthe AAMC's Department of Teaching Hospi-


13ls. The session concluded with an analysis ofthe cost of medical education in West Virginiapresented by James Young, vice chancellor forhealth affairs, West Virginia Board ofRegents.John E. Jones, vice president for health sciences, West Virginia University, Richard A.DeVaul, dean, West Virginia UniversitySchool of Medicine, and David K. Heydinger,associate dean of academic affairs, MarshallUniversity School of Medicine, served as apanel of commentators on the report. Discussions at the annual business meeting weredevoted to primarily three issues: the Council'sresponse to the General Professional Education of the Physician report; the Committeeon Financing Graduate Medical Education;and the new challenges facing the Council ofDeans and the Association. Charles Sprague,president of the University of Texas Southwestern Health Science Center at Dallas, anAAMC distinguished service member, led offthe "new challenges" discussion with reflections on the history and future of the AAMC.

The Council of Deans spring meeting addressed educational and scientific issues andfeatured deliberations regarding future directions for the AAMC. The spring meeting waspreceded by an orientation session for newdeans that introduced the AAMC leadershipand start: and provided an overview of theresources and programs of the AAMC.

Responding to an expressed interest inlearning about recent developments in scientific research, Hilary Koprowski, director,Wistar Institute, University of Pennsylvania,reviewed developments in the use ofmonoclonal antibodies in the treatment of cancer. Hewas followed by several presentations on medical education programs that were responsiveto the spirit of the GPEP report. Ernst Knobil,director, Laboratory for Neuroendocrinologyat Houston, addressed the difficult task ofintroducing problem-solving as a method ofinstruction in the basic sciences. He describedone program that required students to determine, through library research, whether or notone of a list of common assertions made inmedical textbooks was supported by availableevidence. Knobil suggested that a single department of basic sciences within medical

227

schools might result in better integration ofbasic science teaching and greater flexibility inresponding to the evolution of the biomedicalsciences. J. Robert Buchanan, general director,Massachusetts General Hospital, and chairman, AAMC Committee on Financing Graduate Medical Education, reported on thatcommittee's progress. He described the various issues under consideration and the strategies being discussed; he emphasized that noclear solution had emerged. By a brief questionnaire, he solicited the dean's view on keyissues before the committee. Gerald T. Perkoff, curator's professor of family medicine,University of Missouri, described the problems and prospects of teaching clinical medicine in the ambulatory setting. He stressedthat successful programs would involve facultywho shared practice and research interests inthe field as well as an enthusiasm for ambulatory care as a setting for clinical education.A discussion of the MeAT essay pilot projectpresented by four members of its advisorycommittee reviewed recent advances in theassessment of writing skills over the past decade and outlined the committee's deliberations concerning objectives for the project.The essay is intended to be a cognitive ratherthan personality assessment, one which tapsthinking and organizational skills as well aslanguage mechanics. The panel outlined afour-phase program for evaluating the pilotproject. Two hours of the meeting were setaside for small group discussions, chaired bythe members of the COD AdministrativeBoard, on the future directions for the AAMC.The groups addressed the AAMC's mission,structure and governance, program priorities,external relations, the COD, CAS, and COTHissues papers, and selection of the new AAMCpresident.

At the business meeting, discussions centered on developments in medical student education, graduate medical education, medicallicensure, and animal research issues. FrankieTrull, executive director, Foundation forBiomedical Research, described the growth ofthe animal rights movement and several legislative initiatives in this area. She describedthe resources and the developing programs of


the Foundation and the newly established National Association for Biomedical Research.Ed Wolfson, chairman, Federation of StateMedical Boards Commission on Foreign Medical Education, described the commission'sprogram to develop a data base for state licensing boards on the educational programs offoreign medical schools. Various issues arisingat the transition between medical school andresidency education were discussed. The deanssoundly rejected, as misdirected and insufficient, a proposal of the Accreditation Councilfor Graduate Medical Education to amend thegeneral requirements of the essentials of accredited residencies. It would have requiredindividual program directors to assess the adequacy of clinical skills of enrolled residentsand to remove prior to the completion of thefirst year those whose deficiencies could notbe remediated. The deans recommended thatthe Executive Council reject the proposed language in favor of an approach endorsed in1981: an independent assessment of the clinical skills of foreign medical graduates prior totheir entry into residency programs.

The southern and midwest deans and thedeans of community-based medical schoolsmet during the year, and the deans of privatefreestanding schools convened a special session at the COD spring meeting.

Council of Teaching HospitalsThe Council of Teaching Hospitals held twogeneral membership meetings in 1984-85.Thomas J. Manning, formerly a consultantwith McKinsey and Company, Inc., and Richard A. Berman, executive vice president, theNew York University Medical Center, werekeynote speakers at the COTH general sessionheld during the 1984 AAMC annual meeting.Manning spoke on "Strategic Planning andthe Teaching Hospital: Lessons from OtherIndustries." Berman described and analyzedthe effect of the imposition of a severity factoron reimbursement, and upon resource utilization for specific DRGs in his presentationentitled "Severity Measures: The TeachingHospital Difference." Berman emphasized thevalue of using severity measures, a "funda-

VOL. 61, MARCH 1986

mental tool for the effective manager," inbudgeting and forecasting, in marketing andprice strategies, and in promoting an effectiveworking relationship with physicians througha refined, more precise data base.

Over 200 hospital executives met in SanFrancisco May 8-11 for the eighth annualCOTH spring meeting. The program openedwith Victor Fuchs, professor of economics,Stanford University, taking a retrospectivelook at his 1974 book, Who Shall Live?Health, Economics and Social Choice. Fuchsobserved that the past decade has shown thateconomics can contribute substantially to anunderstanding ofhealth systems and hospitals,but he expressed concern that some policymakers fail to recognize the limits of the marketplace model for care. Views of how thechanging hospital environment affects physician education were presented by Harry Beaty,dean, Northwestern University MedicalSchool, Hiram Polk, chairman of surgery,University of Louisville, and John Gronvall,deputy chief medical director, the VeteransAdministration. Charles Buck, executive director, the Hospital of the University of Pennsylvania, and Frankie Trull, executive director, the Foundation for Biomedical Research,discussed issues raised by the growing animalrights movement.

One-half day was spent examining significant issues in the control and financing ofgraduate medical education. Steven Schroeder, chairman of the division of general internal medicine, the University ofCalifomia, SanFrancisco, reviewed the multiple organizationsand committees involved in setting the requirements for accrediting graduate medicaleducation. W. Donald Weston, dean, Michigan State University College of Human Medicine, described a voluntary, state-wide effortto reduce the number of residency trainingpositions. J. Robert Buchanan, general director, Massachusetts General Hospital, summarized the deliberations of the AAMC Committee on Financing Graduate Medical Educationwhich he chairs.

Evolving relationships with investor-ownedcorporations were considered as James Simmons, chairman ofthe not-for-profit parent of


Samaritan Health Service of Phoenix, described the process of considering a sale to afor-profit corporation and then deciding notto sell. Richard O'Brien, dean, Creighton University School of Medicine, discussed the saleof S1. Joseph's Hospital to a for-profit corporation. Arnold LaGuardia, senior vice president and director of finance, Scripps Oinicand Research Foundation, concluded the session with a review ofarrangements Scripps haswith drug and manufacturing companies anda hospital management company.

The COTH Administrative Board met fourtimes to conduct business and discuss issuesof interest and importance. A policy keenlydebated throughout the year was the extensionofCOTH membership to investor-owned, forprofit hospitals. Participation of for-profitteaching hospitals was discussed at the 1984COTH spring meeting, the 1984 annual meeting, and a variety ofother forums. In addition,the COTH Administrative Board reviewedand analyzed all aspects ofthe debate over thisissue. During the business session that concluded the 1985 sping meeting, Sheldon King,COTH chairman and director and executivevice president, Stanford University Hospital,presented the COTH Administrative Board'srecommendation that AAMC membership reQuirements be amended to permit for-profithospitals to join COTH. The discussion wasfavorable to the recommendation.

In addition to other matters ofbusiness, theAdministrative Board heard an informativepresentation by Board members on the activities of the consortia to which their hospitalsbelong. A synopsis of the activities of theUniversity Hospital Consortium, AssociatedHealthcare Systems, Consortium of JewishHospitals and Voluntary Hospitals ofAmericaproved particularly interesting since largenumbers of COTH members belong to theseorganizations.

Council of Academic SocietiesThe Council of Academic Societies is comprised of representatives from 79 academicand scientific societies in the biomedical field.The CAS provides a forum for the expression

229

of medical school faculty concerns and enhances faculty participation in the formulationof national policy related to medical education, research and patient care.

The CAS convened two meetings during1984-85. At the annual meeting in October1984, the CAS considered the recently releasedreport of the AAMC Project Panel on theGeneral Professional Education of the Physician and College Preparation for Medicine.The plenary session featured David Alexander,president of Pomona College, and a memberof the GPEP panel, and August Swanson,director of the AAMC Department of Academic Affairs. Dr. Swanson, project directorof GPEP, provided the Council with the developmental sequence of GPEP and noted itsmajor purposes of assessing present approaches to teaching, and encouraging discussion of the issues. He stressed that the reportwas not anti-science, but rather supported thedevelopment of critical analytic thinking andlifelong scientific curiosity. Dr. Alexander discussed the pervasive effects of the disjointedmedical school admission requirements onundergraduate curricula. He noted the growing trend to teach to the entrance exams andexpressed a preference for small group teaching and an increased use ofwritten papers andessays. Following these two talks the membersof the Council met in small groups corresponding to the major GPEP conclusions. Thegroups held spirited discussions about specificphrases and apparent paradoxes of the document but agreed that the report served as anagenda of issues for serious deliberation.

The annual meeting also provided an opportunity for members to discuss the issuespaper entitled "Future Challenges for theCouncil of Academic Societies" which emanated from the 1984 CAS Spring Meeting.During that meeting Council representativesidentified and defined the major challengesfacing medical school faculties in the areas ofeducation, research and clinical practice, andconsidered the particular governance issues ofthe CAS. The comprehensive issues paper wascirculated to CAS members who then identified key priorities. The respondents gave thehighest priority to strong advocacy for


biomedical research appropriations, efforts toachieve increased funding for research training, working with departmental chairmen toincrease the institutional priority for medicalstudents' education, examining policies andinitiatives for the support of junior faculty/new investigators, developing policies to balance competing interests in an atmosphere ofconstrained funding, examining how medicalstudent education programs are supported,and opposing restrictions on the use ofanimalsin research.

The basic science societies hoped that theCAS would provide a forum for the presentation and discussion of knowledge and skillsthat should be shared by all disciplines in thebiomedical sciences, and examine how facultyinvolvement in planning and implementingimprovements in medical education can beenhanced. Clinicians wanted the CAS to become involved in policy issues related to faculty practice efforts and their relation to theoverall academic missions of faculty and policies and funding for graduate medical education.

Following discussion of these priorities atthe annual meeting, the CAS AdministrativeBoard reviewed current activities and notedthat significant activities are in progress orproposed in each of the highlighted areas. TheCAS Administrative Board plans to continueand expand its involvement in these issues.

The Council's spring meeting was held inWashington, D.C., March 14-15. The plenarysession addressed the issues of support forgraduate education in the biomedical and behavioral sciences. Four speakers with extensivebackground and expertise provided the Council with a good overview and their talks weresubsequently published as an AAMC monograph entitled, Support for Graduate Education in Biomedical and Behavioral Research.

Robert M. Bock, dean of the GraduateSchool, University of Wisconsin, identifiedfive major sources of funding for predoctoralstudents in the life sciences at the top 50 Ph.D.producing schools: research assistantships,teaching assistantships, research traineeships,National Science Foundation fellowships, andloans. The use of these different mechanismsvaried significantly among schools and de-

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partments, and their relative merits were discussed. Postdoctoral Ph.D. education was addressed by Frank G. Standaert, chairman ofpharmacology, Georgetown University Schoolof Medicine and Dentistry. Noting that overhalfofall Ph.D.'s now seek postdoctoral training, he characterized the training environment, trainees, support mechanisms, employment patterns, and future trends. He emphasized the variability in training length andsupport mechanisms which include peer-reviewed research grants, federal traineeshipsand fellowships, and industry and foundations. Support for the clinical subspecialtytraining of physician investigators was discussed by Harold J. Fallon, chairman ofmedicine at the Medical College of Virginia. In astudy ofall internal medicine fellows, the mostimportant source of funds identified was patient care revenues, followed by VA and military fellowships, federal training grants, andprofessional fees. He noted that in the increasingly competitive health care marketplace, resources for support of specialty training maycontract. However, support to prepare futureacademic research physicians must be preserved. Doris H. Merritt, NIH research training and research resources officer, discussedthe NIH effort to provide research training forclinicians through the National Research Service Award program and the advanced careerdevelopment awards. She agreed on the importance of a continued federal program inproducing physician investigators who cancompete effectively for NIH independent investigator grants.

Council members met in small groups todiscuss the challenges of recruiting and training the next generation of research scientists.The program concluded with a presentationby J. Robert Buchanan, general director, Massachusetts General Hospital and chairman ofthe AAMC Committee on Financing Graduate Medical Education. He noted the impetusto the Committee's formation lay in a seriesof proposals to reduce Medicare payments forGME and discussed the issues involved. He }warned that continuing the status quo will beincreasingly difficult as academic medicine isrequired to compete in a price-conscious environment.


The spring meeting also included an exhibitroom of print and video resource materials onthe use of animals in research. Produced byscientific groups and pro-research organizations in various parts of the country, the brochures and articles gave samples of what canbe done to counter active animal rights organizations. Of particular interest was theAAMC video featuring excerpts from TV talkshows, "Animals as Medical Research Subjects: An Issue Engulfed in Controversy,"which illustrated the strengths and weaknessesofanimal spokespersons and scientist-speakersin television interviews.

The CAS Administrative Board conductsits business at quarterly meetings held prior toeach Executive Council meeting. In April theAdministrative Board ofthe CAS reviewed theGPEP report with the COD AdministrativeBoard. The Boards attempted to identify thoseareas within each conclusion where a consensus could be reached on the role ofthe AAMCin either providing additional commentary onthe GPEP report or in implementing its recommendations. The discussion was lively andillustrated the variety ofopinion on the GPEPreport, particularly among the academic societies. Subsequent meetings of the Board-appointed GPEP working groups have produceda commentary on the report's five conclusions.

The Association's CAS Legislative Services 'Program continued to assist societies desiringspecial legislative tracking and public policyguidance. Five societies participated in theprogram in 1984-85: the American Federation for Oinical Research, the AmericanAcademy of Neurology, the American Neurological Association, the Association of University Professors of Neurology and the ChildNeurology Society.

Organization of StudentRepresentativesDuring 1984-85, 122 medical schools designated a student representative to the AAMC.Approximately 130 students attended the1984 OSR annual meeting, which opened witha presentation by Mary E. Smith, former University of Miami OSR representative, on howOSR members can become effective change

231

agents at their schools. The opening plenarysession featured Quentin Young, president,Health and Medicine Policy Research Group,and Robert G. Petersdorf, dean, University ofCalifornia School of Medicine, San Diego,both ofwhom urged students to inform themselves about the many important economic,social, and political issues impacting the practice of medicine and the delivery of healthcare. After its business meeting, which included remarks from John A. D. Cooper,AAMC president, and Norma Wagoner,Group on Student Affairs chairperson, theOSR identified eight topics as foci of smallgroups discussions: methods of student evaluation, improving one's teaching abilities, career counseling, social responsibilities/patientadvocacy, curricular innovations, recognitionand support ofindividuality in medical school,student involvement in the administrativeprocess, and preparing for clinical responsibilities. Programs were offered on "Working withNurses and Other Health Professionals" withRuth Purtil0, associate professor at the University of Nebraska College of Medicine, AnnLee Zercher, director of nursing services, University of Chicago, and Ann Jobe, medicalstudent at the University of Nevada, and"Skills for Success in Medicine" with JohnHenry Pfifferling, director, Center for Professional Well-Being, and JoAnn Elmore, Stanford University medical student. Discussionsgeared to helping OSR members put GPEP towork at their schools were held, followed bythe main business meeting to elect the 198485 OSR Administrative Board. The OSR alsooffered workshops on "Medicine as a HumanExperience" by David Rosen, associate professor, University of Rochester, and "The Nutsand Bolts of the NRMP" by Martin Pops,UCLA associate dean, and Pamelyn Oose,OSR immediate past chairperson.

In addition to considering Executive Council agenda items and nominating students toserve on committees, the 1984-85 OSR Administrative Board focused on better ways forstudents to communicate with the Congress insupport of influencing the National Board ofMedical Examiners in directions suggested bythe GPEP recommendations. In conjunctionwith similar activities on the part of the


AAMC councils to identify the issues mostimportant to their constituents, the Board developed a paper entitled "Challenges Identifiedby the Organization of Student Representatives.~ One of the salutary results of this selfexamination was a new formulation of OSRmember responsibilities; also accrued werebroadened perspectives on the deficits ofmedical education and on the high degreeof faculty/administrator/student cooperationneeded to achieve improvements.

An area of continuing OSR interest is sharing information on computer-based medicaleducation, and in March an OSR compendium of computer activity in medical education was mailed to OSR members and deans.Data for this report was obtained from a survey sent to academic deans of U.S. and Canadian medical schools requesting information about electives or required courses utilizing computers for educational purposes andabout the availability of computer-assisted in-

VOL. 61, MARCH 1986

struction. The report contains information on70 institutions; and, while recognizing that thecompendium is incomplete, the OSR Administrative Board is pleased to have made a beginning in this area.

The Spring 1985 issue of OSR Reportsought to interest all medical students in thecountry to consider the GPEP recommendations in conjunction with their faculty andoffered concrete ideas for generating interestin change. This issue also included an articleon the role of medical students in the animalresearch debate, and the Association of Professors ofMedicine provided copies ofits pamphlet "Must Animals be Used in BiomedicalResearch?~ to accompany the article. The Fall1985 issue discussed medical student/nurserelations. It offered background on the nursingprofession, nursing education, and sources ofconflicts with physicians, and included suggestions to help medical students become betterallies with nurses.

National Policy

The landslide reelection of President Ronaldw. Reagan by the largest electoral vote inhistory was labeled by many within the administration as a firm public mandate to continue policies ofdecreasing domestic spending,lowering the tax burden, and increasing thenation's defense program. However, a rapidlyemerging consensus on a new imperative-tocontrol the burgeoning federal budget deficit-has highlighted the serious incompatibilities between traditional and new goals. Howthe dilemma will be resolved is far from clear.

The 99th Congress has experienced intensepreoccupation with reducing federal spending,and no program appears to be immune fromthe budgetary ax. The Association's energiesin 1985 have been spent in efforts to protectprograms of crucial importance to its constituency, including funding for biomedical andbehavioral research, direct and indirect costsofgraduate medical education and other components of the Medicare Prospective PaymentSystem, and health professions education assistance. Until the federal budget is broughtmore nearly into balance, government programs, no matter how much in the publicinterest, are at risk of serious funding reductions, alterations, and in some cases, outrightelimination.

Despite this bleak budgetary outlook, however, the morale of the nation's biomedicaland behavioral research community was revived last October by the enactment of H.R.6028, the generous FY 1985 Labor-HHS appropriations bill. For the second consecutiveyear, Congress passed this appropriations bill,a feat not accomplished in the prior four fiscalyears. The $100 billion measure containedsubstantial increases in funding for vital healthprograms, including an impressive $5.1 billionfor the National Institutes of Health, an increase of 14 percent over FY 1984 levels andalmost 13 percent above the president's FY

1985 request. Funding for research, researchtraining, and clinical training for the threeinstitutes at the Alcohol, Drug Abuse andMental Health Administration totaled $351.8million, 10.9 percent over the 1984 level and18.3 percent above the Reagan administration's fiscal year 1985 budget request.

House and Senate conferees did not specifyin the language of the appropriations bill thenumber of competing research grants to befunded at NIH in FY 1985, but the reportlanguage of the bill explicitly envisioned anincrease in the number from the 1984 level of5,493 to approximately 6,500. The ink hadhardly dried on the appropriations law, however, when rumors circulated about an administration move to spread the funding increasesover future years, rather than to expand thelevel of current operations. The administration proposed to obligate funds for only 4,350conventional one-year awards and 650 multiyear awards. All funds appropriated by Congress for the latter would be "obligated," intechnical terms, in FY 1985 thereby complying with the Budget and Impoundment Control Act of 1914; but those committed to forward-funded multiyear awards would reducethe need for additional appropriations in FYs1986 and 1987.

The grants "rollback" plan, formally released in the president's FY 1986 budget documents, stirred up protest not only within thescientific community but also on Capitol Hill.Senator Lowell Weicker attacked it vigorouslyafter receiving a response from the GeneralAccounting Office that the proposal was indeed illegal. Representative William Natchermade it clearly known that because the moneyhad been appropriated by Congress, he expected it to be spent. In an effort to demonstrate the angry sentiment in the House andSenate, Representative Henry Waxman andSenator Edward Kennedy introduced resolu-

233


tions to restore the grant level intended byCongress. These measures, eventually subscribed to by over 200 members of Congress,were heartily endorsed in AAMC testimony.

Senator Weicker proposed to resolve thegrants rollback controversy between the executive branch and Congress by adding languagein the Senate FY 1985 supplemental appropriations bill mandating the award of approximately 6,000 NIH and 540 ADAMHA grants.By specifically authorizing the forward funding of between 150 and 200 competing NIHresearch proposals, the Senate asserted thatwithout explicit authorization, multiyearfunding of NIH grants was illegal.

The FY 1985 supplemental bill passed bythe House contained no language regardingthe funding of NIH and ADAMHA grants.Fortunately for the research community, conferees who understood the importance to thenation of biomedical research quickly reachedagreement on the grants situation, authorizingfunds to support 6,200 NIH and 550ADAMHA grants for FY 1985. Enactment ofthis bill represents a silver lining in an otherwise dark cloud hanging over the researchcommunity during efforts to reduce government spending. By the same token, sustainingthe increase in FY 1986 promises to be abattle.

The administration's budget request for FY1986 reflected extraordinary emphasis on deficit reduction. Reminiscent ofprevious budgetsubmissions, the president's FY 1986 requestwould spare defense spending from cutbackswhile making significant reductions in nondefense discretionary and entitlement programs. Of the total $51 billion in spendingcuts sought in this budget plan, over ten percent are comprised of health spending cutswhich could have substantial, adverse ramifications for the elderly, the disadvantaged, andthe physically and mentally ill.

Major reductions in health spending aretargeted to the Medicare program, combininglegislative and regulatory proposals to effect asavings of $4.2 billion in FY 1986, allowing amere two percent overall increase in the program. Despite estimates of a nine percent increase in the current services estimate for Med-

VOL. 61, MARCH 1986

icare expenditures in FY 1985, and concomitant projections of escalating growth in thenumber of Medicare beneficiaries, the president's budget emphasizes a freeze for manyitems including DRG prices, reimbursementrates for hospitals exempt from prospectivepayment, payments for direct medical education, and physician fees.

The Public Health Service, historically therecipient of most of the federal discretionaryhealth budget, also faces significant reductionsin FY 1986. The administration has proposed:cuts in, or elimination ot: most of the studentaid or health manpower programs containedin Title IV of the Higher Education Act andTitle VII of the Public Health Service Act; noadditional capitalization funds for HealthProfessions Student Loans, a continuationinto the FY 1986 budget request of a sevenyear trend; no funding for either the Exceptional Financial Need or Disadvantaged Assistance programs; lowering the guaranteelevel for the Health Education AssistanceLoan program to $100 million from last year's$250 million because a perceived physicianoversupply diminishes the need for medicalstudent financial assistance; and no funds fornew National Health Service Corps scholarships or for health planning.

The National Institutes of Health wouldsuffer its first reduction since 1970 under theFY 1986 budget request. Despite the $5.1billion FY 1985 appropriation for the NIH,the administration has requested only $4.85billion for the agency in FY 1986, a reductionofsix percent. This level of funding would alsobe sufficient to support only 5,000 competingresearch project grants, the same number theadministration proposed to fund in FY 1985.

The Alcohol, Drug Abuse and MentalHealth Administration would suffer much thesame fate as the NIH, with a request for $311.5million in FY 1986 for ADAMHA's researchprograms, a one percent reduction from FY1985. The 583 competing grants level fundedin the FY 1985 appropriations bill would bereduced to 500 in both FY 1985 and FY 1986under a grant rollback plan similar to thatproposed for NIH, resulting in an award ratefor ADAMHA of around 33 percent.


The Veterans Administration, which hasbeen spared budget cuts in prior years, nowfaces attempts to reduce its health care expenditures and to alter longstanding fundamental policies regarding eligibility. The Presidenfs FY 1986 budget request contained amere 2.6 percent increase over 1985 levels formedical care, and a two percent decrease inVA research funding, despite the fact that inconstant dollars, neither of these programshave been increased in eight years. Even moresignificant, however, are plans to slow downthe growth of the VA health care system byimplementing a means test for all veteransseeking nonservice-connected medical care,and requiring third-party reimbursement forinsured veterans. Additional savings would berealized by drastic reductions of administrative and operational funds.

In hearings before the House and SenateAppropriations Committees, the AAMC argued that proposals for a means test and thirdparty reimbursement would transform the VAinto a chronic care system of last resort, requiring substantial out-of-pocket expendituresfor many veterans before being entitled to VAmedical care. The Association expressed alarmover the proposed staffing reductions and theconsequent lowering ofstaffing ratios, alreadyfar below standards for non-federal hospitals,and the fact that neither the medical care norresearch budgets have increased in eight years.It was also argued that the long-standing andmutually-beneficial relationships betweenmedical schools and their VA affiliated hospitals could be adversely affected if VA hospitals are transformed into chronic care facilities.

After the House and Senate approved theirrespective budget resolutions, the debate between conferees on a compromise package wasprotracted and often heated. Items of conflictin the conference included Social Security,Medicare and Medicaid, defense spending,foreign aid, and a host of domestic issues.Politics fanned the controversy over an acceptable compromise, and resolution ofdifferences was difficult. The final compromise,passed by the House and the Senate just beforethe August recess, diverges dramatically from

235

the spending priorities contained in the president's fY 1986 budget request. It calls for a1988 deficit of $112 billion, allows an inflation-only increase for defense spending, andspares domestic spending from much of theproposed reductions. The compromise contains no tax increases, and no major domesticprograms were eliminated, causing many lawmakers to question whether deficits will everfall below the $100 billion mark. Althoughseven of thirteen appropriations measureswere passed by the House before the Augustrecess, many programs of interest to theAAMC may have to be funded through acontinuing resolution.

Proposals to simplify the federal tax codereceived a great deal of attention in the 99thCongress. President Reagan's tax reform proposal contains provisions that would have asubstantial and in some cases adverse impacton institutions of higher education: repeal ofthe tax-exempt status of industrial development bonds, extensively used by universitiesand teaching hospitals to generate capital forconstruction and renovation of facilities; limits on deductions for charitable contributionsto itemizers; elimination of deductions forstate and local taxes; extension of the investment tax credit for research and developmentfor only three years and a tightening of thedefinition of research expenditures that wouldqualify under the credit; and imposition oflimited taxes on employer-provided fringebenefits.

The Association and a dozen other highereducation organizations joined the AmericanCouncil on Education in supporting the concept of tax simplification, but cautioningagainst the deleterious effects on higher education of some of the president's proposals.The statement noted that institutions ofhigherlearning would suffer if deductions for charitable contributions and for state and localtaxes were repealed, and pointed out that several studies estimate that charitable giving tonon-profit institutions could be reduced by$11 billion, or 17 percent

Legislation reauthorizing several key programs of the National Institutes of Health waspassed during the last week of the 98th Con-


gress. The bill that emerged from the conference reauthorized expired NIH authorities forfiscal years 1986 and 1987 only, providedgenerous ceilings for the NCI and NHLBI, andrecodified the Public Health Service Act, amajor objective ofRepresentative Henry Waxman. It also contained numerous new statutory directives that the AAMC had criticizedas allowing an unwise degree of congressionalintrusion into the operation of the NIH andas contrary to the Association's preference forsimple renewal of existing authorities.

Some of the bill's more objectionable itemswould have: created new nursing and arthritisinstitutes; imposed new restrictions on the useof animals in research; established new statutory restrictions on fetal research and imposeda 36-month moratorium on the use ofa waiverfor this research; added requirements that institutions establish procedures for handling reports of scientific fraud; directed institute advisory councils to include non-biomedical scientists as part of the scientific representationon the council; required peer-review of intramural research; and mandated NIH supportfor specific types of research, research centers,advisory committees, interagency committeesand other commissions.

President Reagan's pocket veto of this billin early November was accompanied by amessage charging that it "would impede theprogress of this important health activity bycreating unnecessary, expensive new organizational entities" and that it mandated "overlyspecific requirements for the management ofresearch that place undue constraints on executive branch authorities and function." Thepresident's views were entirely compatiblewith those of the AAMC.

The Congress was clearly frustrated by theveto of legislation that was a product of extensive negotiation and compromise. The Housein June passed H.R. 2409, a bill virtuallyidentical to the vetoed bill except that it contains a reauthorization of only one year forNIH; the Senate followed suit with the introduction ofS. 1309. The Senate bill differs fromthe House version in that it reauthorizes expired NIH programs for three years, containsfunding ceilings sufficient to support 6,000competing project grants for FYs 1986-1988,

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and maintains current services support forother programs. Moreover, the Senate versiondoes not provide for the creation of a nursinginstitute.

The conference to iron out the differencesbetween the two measures is not likely to befree from controversy. The threat of anotherpresidential veto also remains very real, despite numerous minor changes made in thenew legislation to appease the administration.

A new twist in the NIH reauthorizationdebate arose early this spring when the administration circulated its own draft of a threeyear NIH reauthorization bill containing noadditional mandates to NIH's authorities andno recodification provisions for the PublicHealth Service Act. The bill would eliminatethe two current authorization ceilings for NCIand NHLBI and seven relatively small lineitems within NIADDK; thus these programswould use funding authority provided in Section 301. While this outcome would be thebest possible from the Association's point ofview, it would likely elicit strong oppositionfrom the constituency groups traditionallyaligned with these institutes.

Health manpower legislation, passed byCongress in October 1984 and supported bythe AAMC, was also pocket-vetoed, to thechagrin of the health professions educationcommunity. The vetoed H.R. 2574 proposeda three-year reauthorization ofthe health manpower authorities in Title VII of the PublicHealth Service Act at levels generally higherthan FY 1984 levels, made several changes tothe HEAL and HPSL programs, and providedauthorizations for nurse training and researchand the National Health Service Corps program.

The Administration, which apparently favors a single omnibus authorization of allhealth professions education authorities, opposed the compromise manpower bill primarily because of the authorization ceilings. Stating that H.R. 2574 was seriously flawed, theveto message argued that the legislation would"continue to increase obsolete federal subsidies to health professions students and wouldmaintain the static and rigid categorical framework to deliver such aid."

Despite House and Senate agreement on


the need for swift renewal ofhealth manpowerprograms, particularly in light of the proposedelimination of funding for Title VII in the FY1986 budget request, action in the 99th Congress has proceeded slowly. In late April, Rep-resentative Henry Waxman introduced H.R.2251, a bill nearly identical to the vetoedmanpower proposal ofthe last Congress. During hearings the AAMC argued that studentassistance continues to be in the public interestand would be necessary even if enrollmentswere reduced. The sharp declines in HPSLdelinquency rates at medical schools werepointed out, and suggestions made for statutory changes to further improve the management of the HEAL program. The AAMC alsoexpressed support for higher HEAL loan guarantee ceilings to meet growing borrower demand.

§ Committee amendments to H.R. 2251, re~ named H.R. 2410, reduced the interest rate] on HEAL loans to T-bills plus three percent.g8 while eliminating the provision allowing onlye~ simple interest to be charged on HEAL loansE for up to six years; allowed unused HEAL~ lending authority to be carried forward intoU succeeding years; and required HEAL loans to~ be disbursed jointly to institutions and bor~ rowers. The bill passed the House in July.~ Senators Orrin Hatch and Edward Kennedyo] introduced a companion bill S. 1283 that] would renew Title VII programs for three~ years. It contains authorization ceilings ten~ percent below the aggregate appropriations1::a levels for Title VII, and freezes each line-item§ at its FY 1986 level for the two succeedingQ

years. The bill continues the HPSL programbut without new capital. The Senate measurealso incorporates the House provisions onmaximum interest for HEAL loans and onallowing unused HEAL authority to be carriedover into succeeding years. S. 1283 was passedby the Senate with an amendment to increasethe maximum HEAL insurance premiumfrom two to six percent. This premium wouldbe charged only on the original principal of aloan, not on each year's outstanding principal,as in current law.

It remains to be seen whether the conference health manpower bill will be vetoed asecond time by President Reagan. The admin-

237

istration's opposition to the bill, which is already a matter of public record, will likely befueled by the HHS Inspector General reportreleased last March that identified "serious,interrelated deficiencies in the HEAL program." As was the case last year, the Association believes that the bill likely to emerge fromconference is as favorable as is possible underthe current political and economic conditions,and hopes that the president will approve it.

Medical students also rely on education assistance programs authorized in Title IV ofthe Higher Education Act. They expire at theend of the current fiscal year, but can beextended automatically for another year underthe General Education Procedures Act. TheAAMC has joined with other higher educationgroups in proposing recommendations for thereauthorization of this act, suggesting that annual graduate and professional student borrowing maximums be increased to $8,000,with a $40,000 cumulative limit for Guaranteed Student Loans, while eliminating the current five percent loan origination fee. Alsorecommended were: an automatic fifteen yearrepayment schedule for students with GSLdebts exceeding $25,000; reauthorization ofloan consolidation with repayment schedulesand interest rates linked to a student's indebtedness; and creation of a campus-based grantprogram, with funds earmarked to needy students in their first two years of study.

The Association has been increasingly involved in the push to enact consent languagefor regional low-level radioactive waste disposal compacts. No action was taken on thisissue during the 98th Congress, and as theJanuary I, 1986 deadline-the date by whichcurrent law allows those compact regions withoperating disposal sites to deny out-of-regiongenerators access to their sites-draws near,pressure continues to mount in Congress toapprove submitted compacts.

Representative Morris Udall, the majorcongressional leader on this issue, introducedcompact consent legislation (H.R. 1083) inJanuary, that, as marked up by subcommitteein July, requires the three compacts with operating sites to otTer access to their sites to outof-region generators through 1992 as a precondition for consent oftheir compacts. However,


those compacts without sites would have tomake specific progress toward establishingtheir own sites to gain this continued access.Nuclear-powered utilities would be requiredto reduce the volume of waste they ship tothese three sites, but health-related generators,including medical schools and hospitals,would not. H.R. 1083 must be approved bythe Interior Committee and the Energy andCommerce Committee before it can be takento the House floor.

Another phenomenon of increasing concern to the Association is the growth of theanimal rights movement in membership, resources, sophistication, and political clout.The debate over the propriety ofusing animalsas experimental subjects has escalated significantly at the national, state and local levels,posing a threat to their continued availabilityand use in research and education. The goalsof the animal rights movement range frompromoting improved care for laboratory animals to prohibition on their use in researchentirely. Some extremists are increasingly resorting to terrorist tactics-such as laboratorybreak-ins, theft and destruction of researchproperty, threats against scientists and theirfamilies, and occupation ofgovernment buildings such as the NIH-to make their viewpoints known to the public.

Constant pressure exerted by the animalrights movement to strengthen guidelines governing the use of animals in federally-fundedresearch projects prompted the National Institutes of Health to conduct an in-depth twoyear study of its animal care guidelines. Thereview resulted in a revised PHS policy onhumane care and use of laboratory animals byawardee institutions, released in May. Thenew policy adds numerous requirements foranimal welfare assurances and mandates thateach institution designate an official who isultimately responsible for the animal care program. The role, responsibilities and membership of the institutional animal care and usecommittees are more clearly defined and significantly expanded to involve them in virtually all aspects of PHS-funded animal research activities. The new policy will likelyhave a positive impact on animal care and use

VOL. 61, MARCH 1986

during the conduct of biomedical and behavioral research in research institutions.

Promulgation of this new policy has nottempered the crusade of many animal rightsactivists to eliminate any use of animals inresearch. Several testified before the Houseand Senate Appropriations Committees during consideration of the FY 1986 NIH budget,arguing specifically against continued federalfunding for particular research projects. Thefact that the viewpoints of animal rights activists are being considered in Congress duringthe development of funding decisions is illustrative of the increasing persuasiveness withwhich this group conveys its views.

The NIH reauthorization bill is the onlylegislation containing animal provisions to seeaction in the 99th Congress. This attenuatedversion of previously severely restrictive legislation is now relatively consistent with theprovisions in the new PHS animal policy, andshould not create major problems for researchinstitutions.

Representative George Brown has again ledthe effort in the 99th Congress to find a compromise bill to strengthen the Animal WelfareAct. H.R. 2653 contains new requirementsand provisions that far exceed the requirements in the new PHS policy. The AAMC hasobjected to the increased authority that wouldbe bestowed upon the Secretary ofAgricultureto promulgate new standards and prescriptions on specific research procedures, arguingthat it could promote substantial governmentinterference in the conduct of scientific research. Representative Brown and SenatorRobert Dole, who introduced an identical Senate bill, have indicated their determination toenact their animal legislation during this Congress, despite repeated assertions from the scientific community that it is unwarranted.

Another measure of great concern to theAssociation is H.R. 1145, legislation reintroduced by Representative Robert Torricelli thatwould create a National Center for ResearchAccountability to prevent unnecessary duplication of research by conducting full-textsearches of the world's literature to determinewhether the research proposed in each federalgrant application has ever been done. The


AAMC argued that the bill is based on theinaccurate assumption that duplication of research is unnecessary and wasteful, and that itundermines the peer-review process at fundingagencies where grant applications are carefullyevaluated by experts who offer added protection against unnecessary or unintentional duplicative research. Though the Torricelli billnow has over SO sponsors, it is doubtful thatit will be acted on in this Congress because ofits far-reaching implications and its expensiveprice tag of almost $S billion.

The Association was asked by the Office ofTechnology Assessment to participate in itsstudy on the use of alternatives to animals inresearch, education and testing by providingspecific data on the use ofanimals for teachingpurposes. A sample of medical schools revealed a reduction over the decade in the

§ number of animals used because of the in~ creasing costs associated with such use and the] development of valid alternatives. The study] also showed that alternative methods have not~ replaced animal use entirely, but served priE marily as adjuncts to animal models in the~ laboratories.U A new focus of interest has emerged in the~ 99th Congress with the introduction by Rep~ resentative Don Fuqua of H.R. 2823, legisla~ tion to create a set-aside from the universityo] research and development budgets of the six] largest federal research agencies in order to~ fund facilities construction and renovation~ projects. Beginning with a straight line-item~ authorization for facilities projects in FY§ 1987, the first year of the ten year program,Q

the proposal would set-aside ten percent ofuniversity research development budgets forfacilities projects. Under the proposal, fifteenpercent of the set-aside would be further earmarked for emerging universities and colleges.In years in which federal funds for universityR&D drop, the facilities program would bearthe entire brunt of the cut until it is exhausted.

239

The bill also sets broad guidelines and criteriafor funding each agency's university construction programs. The AAMC will likely be amajor player in the ensuing discussion on thislegislation. Broad Questions remain to be answered, however, regarding the facilities needsof the country, and the appropriate fundingmechanism for providing improvements forour nation's research facilities.

The General Accounting Office has undertaken a follow-up of its 1980 study of u.s.citizens studying medicine abroad. At a preliminary conference held in June, the Association pointed out that the for-profit schools inwhich 75 percent or more of U.S. citizensstudying medicine abroad are enrolled are significantly subsidized by U.S. governmentalagencies and private institutions. These subsidies include guaranteed student loans, the provision of clinical education in U.S. hospitalswithout charge or at a fraction of its true cost,and the provision ofresidency training to U.S.foreign medical graduates. It was recommended that these subsidies be terminated bynot allowing guaranteed student loan eligibility for students enrolled in foreign medicalschools where more than 25 percent of thestudents are not citizens of the country inwhich the school is located; by denying licensure to graduates of medical schools that donot provide the full program of education(including clinical education) in the countriesin which they are located, and by not supporting the graduate medical education of foreignmedical graduates through Medicare.

The Association's clear challenge for thecoming year is to continue to work to ensurethat its high priorities-a vigorous biomedicaland behavioral research program, student financial assistance, and health care programsthat are compatible with sound medical education-are maintained. In an atmospherewhere no program will be free from budgetaryscrutiny, this task will be difficult indeed.

Working with Other Organizations

The Council for Medical Affairs-composedof the top elected officials and chief executiveofficers of the American Board of MedicalSpecialties, the American Hospital Association, the American Medical Association, theCouncil of Medical Specialty Societies, andthe AAMC-continues to act as a forum forthe exchange of ideas by these important private sector health organizations. Among thetopics considered during the past year werefederal recognition of self-designated specialtyboards, financing graduate medical education,clerkships in U.S. hospitals for foreign medicalgraduates, falsification ofphysician credentialsfrom certain foreign medical schools, proposed legislation on fraudulent medical credentials, and problems of cheating on andsecurity of national medical examinations.

Since 1942 the Liaison Committee on Medical Education has been the national accrediting agency for all programs leading to theM.D. degree in the United States and Canada.The LCME isjointly sponsored by the Councilon Medical Education of the American Medical Association and the Association of American Medical Colleges. Prior to 1942, and beginning in the late nineteenth century, medicalschools were reviewed and approved separately by boards of the states and territories,the Canadian provinces, the Council of Postsecondary Accreditation, and the U.S. Officeof Education.

The accrediting process assists schools ofmedicine to attain prevailing standards of education and provides assurance to society andthe medical profession that graduates of accredited schools meet reasonable and appropriate national standards, to students that theywill receive a useful and valid educationalexperience, and to institutions that their effortsand expenditures are suitably allocated. Survey teams provide a periodic external review,identifying areas requiring increased attention,

and identify areas of strength as well as weakness. In 1985 new standards for accreditationof M.D. degree programs were adopted by theLCME and approved by its sponsors. Thesenew standards defined in Functions and Structure oja Medical School will allow the LCMEto continue its role in maintaining high standards in medical education.

Through the efforts of its professional staffmembers the LCME provides factual information, advice, and formal and informal consultation visits to developing schools. Since1960 forty-one new medical schools in theUnited States and four in Canada have beenaccredited by the LCME. This consultationservice is also available to fully developedmedical schools desiring assistance in the evaluation of their academic program.

In 1985 there are 127 accredited medicalschools in the United States, ofwhich one hasa two-year program in the basic medical sciences. One has not graduated its first class andconsequently is provisionally accredited. Additional medical schools are in various stagesof planning and organization. The list of accredited schools is published in the AAMCDirectory ojAmerican Medical Education.

A number of proprietary medical schoolshave been established or proposed for development in Mexico and various countries inthe Caribbean area. These entrepreneurialschools seem to share the common purpose ofrecruiting U.S. citizens. The exposure of ascheme to sell false diplomas and credentialsfor two schools in the Dominican Republichas brought increased review by licensure bodies of all foreign medical graduates andbrought the indictment and conviction of theindividuals and increasing suspicion of proprietary schools. Moreover, the percentage offoreign medical graduates receiving residencyappointments is decreasing, due in part to thefact that the number of students graduating

240


from U.S. medical schools more closelymatches the number of residency positionsavailable. Thus, M.D. degree graduates fromforeign medical schools of unknown Qualitymay have increased difficulty in securing theresidency training required by most states formedical licensure.

The Accreditation Council for GraduateMedical Education continued to refine its policies and procedures for the accreditation ofgraduate medical education programs. A review of the procedures for programs to appealadverse decisions by residency review committees is undelWay. A chief concern is theprotracted time the present appeals procedurespermit a program to remain in accreditedstatus after an RRC has decided accreditation

:::~ should be withdrawn.~ The ACGME, in order to increase the op~ portunity for broad discussion and comment,o~ will, in the future, fOlWard all proposed] changes in special requirements to its sponsor] ing organizations at the same time that they~ are fOlWarded to residency review committeeE sponsors. Changes in educational require~ ments that impinge on institutional resourcesu are of great concern to program directors and~ teaching hospital administrators. This new~ procedure will allow more time for input to~ the RRCs before the ACGME grants finalj approval to changes in special requirements."8 The Association ratified a change in the.B general requirements of the essentials of ac-E~ credited residencies that cautions program di-"E! rectors to limit the number ofmedical studentsa§ for whom residents are responsible to thatQ which will augment both the students' and

residents' education. The AAMC did not ratifya change that would have substituted an assessment of residents' clinical skills by program directors during the first graduate yearfor a hands-on examination offoreign medicalgraduates prior to entry.

The Accreditation Council for ContinuingMedical Education, through its AccreditationReview committee, continued its vigorous review of CME programs. During the past yearthe Committee for Review and Recognitioninitiated the review process for the recognitionof state medical societies and anticipates that

241

the first review cycle of all states will be completed in 1987. The ACCME continues itsefforts to develop guidelines for judging theQuality of enduring CME materials such ascomputer-assisted and videotape programs.

At its 1985 meeting the National Board ofMedical Examiners adopted a plan to modifyParts I and II of the Board's certification ex- .amination sequence. The change is directedtoward making these examinations comprehensive assessments of students' readiness toproceed in their medical education and tocontinue their learning after graduation. Thedisciplinary composition of the examinationswill be more flexible, and rather than providing students a score for each subtest, a singleoverall score will be reported. Medical schoolswill receive reports on the aggregate scores oftheir students in each discipline. Some haveexpressed concern that this development willcause the National Board examinations tohave an even greater effect on the content ofmedical education programs than they do atpresent. The Council ofDeans will explore theproposed changes during a program at theannual meeting.

In 1984, three years after the Associationpublished a critical study ofmedical educationin certain foreign-chartered schools, the Educational Commission for Foreign MedicalGraduates instituted a more rigorous examination of foreign medical graduates seeking itscertification. The new Foreign Medical Graduate Examination in the Medical Sciences isequivalent to Parts I and II of the NationalBoard certification sequence. In its first twoadministrations, only four percent of U.S. citizen candidates passed the examination; alienFMGs passed at a twenty percent rate.

The revelation that medical schools in theDominican Republic were the source of fraudulent medical degrees caused many state licensing boards to scrutinize the credentials ofgraduates of foreign medical schools morecarefully. Some states have also imposed specific educational requirements on applicantsfor a medical license. Although directed toward denying inadequately educated graduates of foreign medical schools a license topractice, these requirements also apply to


graduates of LCME-accredited schools andimpose highly undesirable restrictions on thefaculties of accredited institutions to determine educational policies and curricula. TheAssociation expressed its concern about thistrend to the officers of the Federation of StateMedical Boards. At its 1985 annual meeting,the Federation adopted a resolution urgingthat legislative bodies not attempt to mandatespecific details of the curricula of accreditedmedical schools in the United States and Canada. Instead these were viewed as the responsibility of the faculties and the accreditingbody, to permit adaptation of medical studenteducation to the rapidly changing practice ofmedicine. This action is consistent with anaccord reached sixty years ago when the Federation and its members agreed to accept amedical school's membership in the Association as sufficient to ensure the quality of itseducational program for medical students.

Building on the successes of the past threeyears, the Association has again helped tofoster the Ad Hoc Group for Medical ResearchFunding, the coalition of more than 150professional societies and voluntary health organizations that advocates enhanced appropriations for the NIH and ADAMHA. Thisarrangement has proved remarkably successful in convincing the Congress that the communities interested in biomedical and behavioral research can work together to assure continuation of the research productivity of thesetwo agencies.

The Association was an active promoter forthe recent consolidation of the Association forBiomedical Research and the National Societyfor Medical Research in the formation of anew organization, the National Association forBiomedical Research, to undertake more vigorous efforts in the cause of continued availability of animal models for research, educa-

VOL. 61, MARCH 1986

tion, and testing. The AAMC's collaborativeefforts with the American Medical Associationand the American Physiological Society resulted recently in the establishment of an advisory council to NABR to greatly enlarge thenumber of professional societies, voluntaryhealth organizations, and- commercial companies now active in this cause.

This year the AAMC and the AmericanCouncil on Education co-sponsored a forumwithin the ACE's National Identification Project for the advancement of women in highereducation administration. The one and a halfday program for twenty-five senior womenfaculty and ten male deans and presidentsmarked the first program of this nature in theAssociation's continuing efforts to advance thestatus of women in academic medicine.

The Association is regularly represented inthe deliberations of the Joint Health PolicyCommittee of the Association of AmericanUniversities/American Council on Education/National Association of State Universities and Land-Grant Colleges, the WashingtonHigher Education Secretariat, and the Intersociety Council for Biology and Medicine.

The Association was one offive co-sponsorsof an invitational conference on financinggraduate medical education in an era of costcontainment. The Council of Medical Specialty Societies was principal sponsor and organizer of the two-day meeting which broughttogether 200 participants to explore the effectof myriad changes in health care financingand delivery on graduate medical education.

The Association's Executive Committeemeets periodically with its counterpart in theAssociation of Academic Health Centers. Thestaffs of the two organizations exchange information and collaborate on programs such asan ongoing study of university ownership ofteaching hospitals.

Education

Whether or not the AAMCs General Professional Education of the Physician project canbe considered the cause, the occasion, or thefacilitator, it is clear that the AAMC membership both collectively and individually is giving a considerable degree of attention to theeducational process.

Within the Association's governance struc-ture, a joint working group of COD and CAS

I:: members prepared a commentary on the~ GPEP report to assist faculty and administral tors using the document as an agenda ofissues§ for the local review of educational policy and~ practice, and the OSR sponsored a series of] discussions at national and regional meetings.g8 to identify the student's role and responsibilitye~ in improving the educational process.E The Group on Medical Education instituted~ a task force on the review of curricular inno-

vations, and inaugurated a series ofworkshopsfor curriculum deans to assist in the introduction ofeducational change and in the management of the educational program. This groupprovides an ongoing forum for sharing information about curricular innovations, especially in the Innovations in Medical Educationexhibits presented at each annual meeting.

The RIME Conference focuses the attentionofresearchers and evaluators on a single themein its annual invited reviews. In the past twoyears these topics have related to the importantrecommendations in the GPEP report. The1984 theme was medical problem-solving andthe 1985 topic was teacher training.

The Group on Student Affairs has beenconcerned about the residency selection process as it affects the orderly transition of themedical graduate to a residency program. TheAAMC is concerned about the implicationsfor the educational experience of medical students, and will be considering appropriatestrategies for addressing this throughout nextyear.

The AAMC and the Department of Healthand Human Services sponsored a Conferenceon the Oinical Education of Medical Studentsthat was directly related to GPEP's focus onspecific problems in clinical education. Thisconference and one for residents on the preceding day had as their goals reaching consensus on the most important problems and identifying ways that schools might resolve thesethreats to a Quality clinical education. Theconference combined commissioned paperspublished in advance and plenary presentations by acknowledged experts with extensivesmall group interactions. Conference proceedings will be published in 1986.

The GME plenary session organized for the1985 meeting concentrated on evaluation inclinical education-specifically, the level ofclinical competence possessed by graduates ofM.D. programs, how those levels are currentlymonitored, and the lessons to be learned aboutclinical education and evaluation at each stageof the continuum.

The AAMC Oinical Evaluation Programcontinues to provide support to faculty responsible for clinical education and the 1985annual meeting was the occasion for presentation of a series of materials for evaluationsystems review and modification. Includedamong these are self-study instruments for useby institutions, departments, and training sitesto review the system ofevaluation and identifyareas of specific strengths and weaknesses; aformat for workshops designed to assist dean'soffice personnel and clerkship coordinators inthe review of their evaluation policies andprocedures; a manual providing the rationalefor the assessments suggested and a brief description of the experience of schools used inthe pilot study for the instruments; summarydata from the pilot schools presenting a national perspective on systems problems, problem students, and evaluation content; and a

243


critical analysis of the literature on the assessment of clinical competence.

Interest in methods to evaluate the skillsinvolved in clinical competence and concernsexpressed in the GPEP report about the emphasis in the Medical College Admission Teston the natural sciences, have led to the introduction of the MCAT essay pilot project. The1985 spring and fall administrations includeda forty-five minute essay question to developthe data necessary to reach a decision aboutmaking the essay a regular component of theMCAT. The project evaluation plan calls fora two year trial to determine whether an essayprovides unique and useful information fordecisions on selecting students. The project isanalyzing data from the essays written during1985 to determine the performance character-istics of various examinee sub-groups and alsothe correlation of essay performance withother pre-admission variables. The projectstaff is also developing a study plan with anumber of medical schools which will useessays in the selection of 1986 entering classes.Institutional case studies involving the use ofthe essay both with and without a centrallydeveloped score are a part of the evaluationprocess. The results of the analyses conductedduring the pilot project will be disseminatedfor review during the course of the project.

Other MCAT activities are underway aswell. Staff is working with the schools participating in the MCAT interpretive studies program to identify valid measures of performance in the clinical years to serve as criteriafor MCAT validity studies. Recent publications from the interpretative studies effort in-

VOL. 61, MARCH 1986

clude a summary ofthe predictive validity datausing performance in the first two years as acriterion, and the relationship between theMCAT science scores and undergraduate science GPA. A revised MCAT technical manualand an MCAT user's manual will be publishedin 1986. An ad hoc AAMC committee willexamine a number of issues related to theMCAT program for a report to the ExecutiveCouncil during the coming year.

The preliminary injunction obtained inJanuary 1980 that protects the MCAT fromthe provisions of New York's test disclosurelaw remains in effect. A status call by the courtscheduled for this past summer prompted areview of the entire matter by the ExecutiveCouncil with the result that the Associationwill continue to pursue actively its legal actionagainst the application of the law to theMCAT.

In March 1985 the Association sponsored aSymposium on Medical Informatics: MedicalEducation in the Information Age. Teams ofacademic leaders from fifty U.S and Canadianmedical schools met to consider the impact ofadvances in information science and computer and communications technologies onthe clinical practice of medicine and educational activities of the academic medical center. This winter the conference proceedingswill be published with the project steeringcommittee's report on the state-of-the-art formedical informatics and its recommendationsfor medical center activities in this area. Thisproject has been supported by the NationalLibrary of Medicine.

Biomedical and Behavioral Research

The Association continues its efforts to obtainadequate support for basic biomedical andclinical research and the training of investigators for academic posts. The areas of involvement are described in the section on NationalPolicy in this report.

The Association has continued to spearheadefforts to enhance the scientific community~s

response to the increasingly vocal and effectiveanimal rights organizations. The Associationassisted in the formation of the National Association for Biomedical Research, which willmonitor state and federal legislation, disseminate information about legislative/regulatorydevelopments and develop positions and action strategies. Working in close cooperationwith NABR is the Foundation for BiomedicalResearch, a non-profit organization designedto inform the American public about theproper and necessary role of animal modelsthrough films, print and television media, andan information clearinghouse.

A second Association initiative was the formation, in cooperation with the Associationof American Universities, of an ad hoc committee to develop guidelines for institutionalmanagement of animal resources. The committee developed guidelines to assist universities and medical schools in a systematic reviewof policies and procedures related to the useofanimals and suggested ways to improve theorganization, management, and coordinationof animal resources.

This spring, the Public Health Service issued its revised Policy on Humane Care andUse of Laboratory Animals, a revised Guidefor the Care and Use ofLaboratory Animals,and the U.S. Government Principles for theUtilization and Care of Vertebrate Animals.Despite these activities, several bills were introduced which would restrict access to and/or require greater accountability for the use ofanimals in research. The Association contin-

ues to support the position that full implementation of the PHS Policy and Guide are sufficient to insure a high standard of care yetfacilitate scientific advancement.

Both the NIH and the Congress have conducted extensive policy discussions over thelast 18 months on a variety of issues related tobiomedical research. In response to the increasing pressures of grant competition, theNIH Director's Advisory Committee reviewedthe extramural awards system. Discussion focused on two central issues. Does the currenttwo-tiered system of review by scientific peergroups and institute advisory councils function effectively and efficiently? And are thegrants themselves structured to produce themaximum benefit, both for the individual investigators and their research careers and forthe biomedical research enterprise as a whole?Possible changes discussed included simplification of grant applications to decrease theworkload for both applicants and reviewgroups, and the use of longer award cycles forestablished investigators. The Committee alsodiscussed longer periods of support for firsttime applicants, weighing the benefits oflonger grants against the danger of increasesin the commitment base for the NIH budget.

NIH undertook further initiatives in 1985to increase the number of physicians enteringresearch careers. NRSA institutional traininggrant program guidelines for M.D.s were reissued. They recommended a minimum of twoyears of intensely supervised research trainingfor the development ofa competitive researchcareer, with a breadth and depth of basic science knowledge as a foundation for futureinvestigative work and no more than 20 percent of training time devoted to clinical activities. Finally, in order to qualify for renewal ofresearch training grants, clinical departmentsshould show that they have appointed at leastas many M.D. postdoctorals as Ph.D.s, and

245


follow the careers of former trainees for reasonable periods of time to document theircontinued research activity.

In 1985, the House of RepresentativesCommittee on Science and Technology appointed a bipartisan Task Force on SciencePolicy. This task force, chaired by Representative Don Fuqua, is in the midst ofa two-yearin-depth review of the role of the federal government in the conduct and support of basicand applied research and manpower and training. The task force has conducted hearings ona number of topics, including the goals ofnational science policy, the federal government's responsibility for the research infrastructure at universities, the role ofscientists inthe political process, and manpower and education. David R. Challoner, vice-president forhealth affairs at the University of Horida, represented the AAMC at the manpower hearings, stressing the importance of continuedsupport for biomedical research training programs, especially for physician investigators.

As a result of the deliberations and initiatives by the NIH and the Congress, the AAMCappointed an ad hoc Committee on ResearchPolicy in June 1985. The committee is chairedby Dr. Edward N. Brandt, former AssistantSecretary of Health and chancellor of the University of Maryland at Baltimore, and willreview and formulate Association policy withregard to biomedical/biobehavioral research.

During this year, concern continued for thedeteriorating state of research equipment andfacilities in the nation's universities. Efforts todocument and quantify these deficiencies wereassisted by the Association. NIH has recentlycompleted a study entitled "Academic Research Equipment Needs in the Biological andMedical Sciences," in which the medical andgraduate school departments sampled indicated that their major needs were for instruments with costs of about $60,000 and forequipment maintenance. NIH is currently reviewing how the extramural grant review process currently handles equipment purchase andmaintenance requests costing less than the$100,000 limit of the Shared InstrumentGrant program of the Division of ResearchResources. The major university associations

VOL. 61, MARCH 1986

recently completed an 18-month study of 23facilities, "Financing and Managing University Research Equipment." This study makesrecommendations to federal and state grantingagencies and universities to streamline the acquisition, financing, use, and maintenance ofuniversity research equipment.

Modernization or new construction for research facilities also continues to be a pressingneed. Much Association effort was devoted tothe work of a federal Interagency SteeringCommittee on Academic Research Facilities,which devised a survey of Academic R&DFacilities in Science, Engineering, and Medicine. Unfortunately, OMB refused to allowthis comprehensive study to proceed. The Association urged NIH to proceed with a piloteffort, and a thorough analysis of the existingphysical plant and projected needs of nineuniversities, seven with medical schools, aswell as nine independent hospitals and research institutes is underway. The pressure toobtain federal funds for research constructionhas built to the point where some universitieshave sought line item appropriations directlyfrom Congress. This trend has been deploredby the AAMC and other higher educationassociations on the grounds that such facilitiesfunding should be merit and need based. TheAssociation continues to seek congressionalsupport to reestablish the NIH competitivelyawarded facilities grants program, whose authority lapsed in 1968, and to this end theAAMC will closely examine a pending bill ofthe House Science and Technology Committee that would provide authority for a competitive matching grant program for sciencefacilities through five federal agencies.

The questions of who should regulate biotechnology and to what extent continued tobe a major concern. In an effort to delineatethe federal role with respect to both researchon and commercial application ofbiotechnology, the Cabinet Council Working Group onBiotechnology, through the White House Office of Science and Technology Policy, issueda "Proposal for a Coordinated Framework forthe Regulation of Biotechnology" in December 1984. In addition to providing a conciseindex of U.S. laws related to biotechnology,


the proposal attempted to clarify the policiesof the major regulatory agencies involved inthe review ofresearch and products ofbiotechnology. The proposal recommended the establishment ofa review mechanism, which wouldinvolve a two-tiered structure composed offive agency-based (NIH, FDA, EPA, USDA,and NSF) advisory committees, presumablymodeled after the NIH Recombinant DNAAdvisory Committee (RAC), under a coordinating parent board. Questions about the interactions of these committees with the parentboard and the vagaries of the review processoutlined by the EPA led the AAMC to joinother members ofthe academic research community, including the NIH RAC, in commenting on this plan's potential to furtherconfuse rather than clarify the review processfor research proposals involving geneticallyengineered organisms.

247

The White House Office of Science andTechnology Policy undertook a study of themajor research universities under a panel ofthe White House Science Council. The reportmay contain policy proposals or other recommendations to strengthen the partnershipof the research universities, industry, and thefederal government and to address issues ofsupport for research infrastructure and academic facilities. OSTP itself has been analyzing issues surrounding the indirect cost component of research funding. Motivated by therising share of the total research budget whichis committed to indirect costs, it is anticipatedthat they will seek a means of capping orcontrolling this portion of research costs. TheAAMC has urged support for the principle offull federal payment of the legitimate costs ofresearch conducted in universities.

Faculty

The Association has a longstanding concernfor medical school faculty issues relating toscholarship, research, and research training.These issues include the lack of sufficientfunds for investigator-initiated research grants,the apparent decline in the number of physicians entering research careers, the difficultyof Ph.D. biomedical scientists in securing appropriate academic appointments, and limitations on research training. Data are collectedand analyzed to illuminate these areas, andthe results are used to inform discussions bythe Administrative Boards of the Associationand by its committees. The study results arealso used in discussions with staff of the National Institutes of Health and other federalagencies, as well as in preparation of Association testimony for congressional committees.

The Faculty Roster System, initiated in1966, continues to be a valuable data basewith information on current appointment,employment history, credentials and training,and demographic data for full-time salariedfaculty at u.S. medical schools. In addition tosupporting AAMC studies of faculty and research manpower, the system provides medical schools with faculty information for completing questionnaires for other organizations,for identifying alumni serving on faculties atother schools, and for producing special reports.

A survey of all full-time faculty in departments of medicine was conducted in cooperation with the Association of Professors ofMedicine. Results of this study are being published in the Annals ofInternal Medicine, anda comprehensive report is being prepared forthe APM and the National Institutes ofHealth. A second survey of internal medicinefaculty on research training is in progress. Thecombined data from these surveys and theFaculty Roster are a rich source ofinformationon the extent ofresearch activity for over 7,000faculty members.

During 1985 the Faculty Roster data baseis being matched to NIH records on researchtraining and grant applications and awards toanalyze the relationship between training andacademic careers and the faculty's role in theconduct of biomedical research. These activities, as well as the maintenance of the FacultyRoster data base, receive support from theNational Institutes of Health.

Work is in progress for the report producedperiodically on the Participation of Womenand Minorities on U.S. Medical School Faculties. The publication will report, for the firsttime, faculty rank and tenure status by department.

Based on the Faculty Roster, the Association maintains an index of women and minority faculty to assist medical schools andfederal agencies in affirmative action recruitment efforts. Since 1980 more than 1100 recruitment requests from medical schools havebeen answered by providing records of facultymembers meeting the requirements set bysearch committees. Faculty records utilized inthis service are those for individuals who haveconsented to the release ofinformation for thispurpose.

As of June 1985, the Faculty Roster contained information on 52,438 full-time salaried faculty and 2,515 part-time faculty. Thesystem also contains 58,405 records for persons who previously held a faculty appointment.

The Association's 1984-85 Report on Medical School Faculty Salaries summarizes compensation data provided by 122 U.S. medicalschools. The tables present compensation averages and percentile statistics by departmentand rank for basic and clinical science faculty.Salary data are also displayed according toschool ownership, degree held, and geographicregion for the 35,307 full-time faculty reportedto the survey.

248

Students

As of September 9, 1985, 32,728 applicantshad filed 306,221 applications for the enteringclass of 1985 in the 127 U.S. medical schools.These totals, although not final, represent adecrease in the national applicant pool compared to the final figures for the 1984 enteringclass. The 1985 applicant pool is estimated tobe 32,800 applicants, which would representan 8.7 percent decrease from 1984-85.

The total number of new entrants to thefirst year medical school class decreased from16,480 in 1983 to 16,395 in 1984. Total med

g ical school enrollment also decreased from~ 67,327 to 67,016.] The number of women new entrants.g~ reached 5,469, 1.8 percent higher than 1983;(1) the total number of women enrolled was

.D

E 21,316, a 3.2 percent increase. Women heldoz 31 percent ofthe places in the nation's medical

schools in 1984 compared to 25 percent forthe 1979-80 entering class.

There were 1,440 underrepresented minor§ ity new entrants, 8.8 percent of the 1984 first] year new entrants. The total number of un] derrepresented minorities was 5,707 or 8.5~ percent of all medical students enrolled in~ 1984."EJa For the 1985-86 first-year class, 927 appli-~ cants were accepted under the Early Decision

Program by the 75 medical schools offeringsuch an option. Since each of these applicantsfiled only one application rather than the average 9.4 applications, the processing of approximately 7,800 additional applications andscores of joint acceptances was avoided. Inaddition, the program allowed successful earlydecision applicants to finish their baccalaureate programs free from concern about admission to medical school.

One hundred and one medical schools participated in the American Medical CollegeApplication Service to process first-year application materials for their 1985 entering classes.

In addition to collecting and coordinating admission data in a uniform format, AMCASprovides rosters and statistical reports andmaintains a national data bank for researchprojects on admission, matriculation and enrollment. The AMCAS program is guided inthe development of its procedures and policiesby the Steering Committee of the Group onStudent Affairs.

The AAMC Advisor Information Servicecirculates rosters and summaries of applicantand acceptance data to subscribing healthprofessions advisors at undergraduate collegesand universities. In 1984, 333 advisers subscribed to this service.

The AAMC continues to investigate theapplication materials of prospective medicalstudents that contain suspected admission irregularities. These investigations, directed bythe 64AAMC Policies and Procedures for theTreatment of Irregularities in the AdmissionProcess," help to ensure the provision ofcomplete, accurate information to medical schooladmissions officers and the maintenance ofhigh ethical standards in the medical schooladmission process.

Although the number of Medical CollegeAdmission Test examinees has not alwaysbeen a good indicator of the size of the applicant pool, several recent changes in the MCATpopulation are of interest. In 1984, the number of examinees decreased eight percent andrepresented the largest single year decrease inthe past seven years. This appears to correspond with the projected nine percent drop inthe number ofapplicants for the 1985 enteringclass. The decrease in the number of individuals sitting for the MCAT continued into thespring 1985 administration. Compared to thespring 1984 examinee group, seven percentfewer individuals sat for the spring 1985MCAT administration.

The Medical Sciences Knowledge Profile

249


examination was administered for the sixthtime in June 1985 to 1,823 citizens or permanent resident aliens of the United Statesand Canada. The examination assists constituent schools of the AAMC in evaluating individuals seeking placement with advancedstanding. While 3.8 percent of those takingthe test had degrees in other health professions,91 percent of all registrants were enrolled inforeign medical schools.

Beginning in 1983, a joint effort was initiated to link data from the National ResidentMatching Program to the enrolled student fileof the AAMC. Listings were then fOlWardedto the medical schools for corrections andupdates to residency assignments for all seniors, prior year graduates, and Fifth Pathwaystudents registering for the 1983 match. Thiseffort continued in 1984 and 1985. By reporting the results of this data collection effort tohospitals, and by incorporating deletions andadditions provided by the hospitals, theAAMC is now able to track the progress ofmedical school graduates, (beginning with1983) through their graduate medical education. This effort represents another step in thedevelopment of a resource for longitudinalstudies in medical education and medicalmanpower.

The Association is actively involved inmonitoring the availability of financial assistance and working to insure adequate fundingof the federal financial aid programs used bymedical students. As federal financial aid programs shrink and medical school costs rise,concern about the availability and adequacyoffinancial aid and increasing levels ofstudentindebtedness grows. This concern resulted ina recently completed study of medical studentfinancing carried out with the support of theDepartment of Health and Human Services.The Association also worked closely this yearwith the schools and the DHHS to monitorand reduce delinquency rates in the HealthProfessions Student Loan program. TheAAMC is represented on a recently appointedtask force which will work with DHHS staffin review of the regulations covering the writeoff of delinquent and defaulted loans.

The AAMC also produced a guide for medical schools designed to assist them in reaching

VOL. 61, MARCH 1986

compliance with federal regulations on satisfactory academic progress and receipt of thetitle IV student aid.

Through its Office of Minority Affairs, theAAMC is administering several projects toenhance opportunities for minorities in medical education. Several Health Career Opportunity Program grants were received. The firstgrant provided two types ofworkshops to reinforce and develop effective programs for therecruitment and retention of students underrepresented in medicine. Of these, the Simulated Minority Admissions Exercise Workshop is for medical school personnel concerned with the admission and retention ofminority students. The Training and Development Workshops for Counselors and Advisors ofMinority Students provide informationabout ethnic and racial minority students andtrain counselors and advisors to work with thelatest techniques appropriate for underrepresented minority students. An important objective is to have participants gain informationabout the differences among minority groupsand to help participants develop alternativetechniques for each group.

Phase one has been completed in a secondgrant to develop a tracking mechanism forstudents participating in Health Career Opportunity retention programs.

With Robert Wood Johnson Foundationsupport the Office of Minority Affairs developed Minority Students in Medical Education:Facts and Figures II. Other work has beencarried out with the Macy Foundation to determine the extent ofminority medical studentparticipation in special enrichment of preparatory programs.

The 1986-87 Minority Student Opportunities in U.S. Medical Schools questionnaire wasdistributed to U.S. medical schools. The biennial publication describes minority studentprograms and recruitment activities of eachmedical school.

The Group on Student Affairs-Minority Affairs Section held its Medical Career Awareness Workshop for minority students, attended by 250 high school and college students. Fifty-eight medical schools were represented.

Institutional Development

The AAMC Management Education Programs, now in their fourteenth year, offer seminars to enhance the leadership and management capabilities of AAMC member institutions. These programs for senior academicmedical center officials emphasize management theory and techniques. The ExecutiveDevelopment Seminar, an intensive weeklong session, was offered twice during the last

~ year. Fifty-one medical school department~ chairmen and assistant and associate deans~ from thirty-eight institutions participated in0..

§ the first program; the second was offered for~ new deans. These seminars assist institutions] in integrating organizational and individual.g8 objectives, strengthening the decision-makingeQ) and problem-solving capabilities of academicE medical center administrators, developing~ strategies for more flexible adaptation to~ changing environments, and developing a bet~ ter understanding of the function and struc~ ture of the academic medical center. Due to~ the high demand for this seminar, it will beo] offered twice during the 1985-1986 year.s In addition to the Executive Development~ Seminars, special topic workshops are offered.~ A seminar on Information Management in~ the Academic Medical Center was attended by§ sixty-one individuals from twenty-eight instiQ

tutions, and will be presented again in the1985-1986 year. The seminar acquaints administrators with the problems and opportunities arising from the rapid development ofadvanced information technologies and assiststhem in meeting the challenges of informationmanagement in the complex environment ofthe academic medical center. For the fifthyear, a seminar focusing on the academic medical centerIVA medical center affiliation rela-

tionship was conducted for VA medical centerassociate directors as part of their professionaldevelopment program. This program was c0

sponsored by the Veterans Administration.A series ofeducational seminars devoted to

the challenges posed to academic medical centers by alternative medical care delivery systems is under development. The seminars willbe held regionally during the fall and winterof 1985 and will include an analysis of thecurrent environment, a conceptual frameworkfor analyzing the academic medical centers'position and role in this environment, and anexploration of the experience of several institutions in coping with alternative delivery systems such as brokered care or capitated systems. In addition, plans are underway for aprogram to address the process and technological innovation and planning for the acquisition and management of high technology resources for research and patient care.

A survey to identify the most salient problems and issues facing medical school facultyclinical practice was sent to vice presidents,deans, hospital directors, department chairmen and faculty representatives. The resultshighlighted the need for greater coordinationof practice activity in the academic medicalcenter in order to practice high quality, costeffective medicine in the changing environment while preserving academic values.

An outcome of this survey project was theappointment ofan ad hoc committee chargedwith discussing the issues raised and suggestingAAMC projects or programs that would be ofservice to member institutions in dealing withthe changes in the practice environment. Thecommittee's initial meeting was held in September 1985; a report is due in spring 1986.

251

Teaching Hospitals

The future financing of graduate medical education and prospective payment for hospitalshave been overriding concerns of the AAMCthroughout the year. The Association reviewedseveral legislative proposals to change currentfinancing policy for residency training. TheAssociation commented on several significantproposals in the FY 1986 budget to amendMedicare's Prospective Payment System forinpatient hospital care and also addressed published regulations for the third year of PPS.The proposals to amend the payment systemfall inequitably upon the nation's teachinghospitals.

The AAMC Committee on FinancingGraduate Medical Education first met in September 1984 to consider methods of financingresidency training in the future. The committee and the AAMC Administrative Boards andExecutive Council held a special session forreports on GME financing studies being conducted by the federal government and theCommonwealth Fund Task Force on Academic Medical Centers. An intentionally provocative financing proposal was presented byRobert Petersdorf, dean, University ofCalifornia, San Diego, School of Medicine, to stimulate discussion. After wide-ranging discussionon options to modify current GME fundingpractices, the committee reassessed theAAMC's traditional position supporting financing for all approved residency positionsthrough hospital patient care revenue and concluded this approach was at risk as third-partypayers changed their hospital payment policies. In its exploration of alternative approaches to financing GME, the committeeconcentrated its efforts on a series of majorquestions relating to whether payments shouldcontinue to come through patient care revenues or be separately indentified, the numberof years of training to be financed, whetherthe financing method should be used to influence the mix of specialists being trained, the

appropriate roles for the federal and the stategovernments and voluntary organizations indecisions regarding the numbers and types ofphysicians to be trained, supporting trainingin non-hospital sites, and funding for foreignmedical graduates. Because of the wide rangeof views held by members, the committee'schairman discussed the deliberations withAAMC Administrative Boards to elicit furtherdirection and comments. The debate resultedin publication of a "Statement of Issues," describing the competing views on policy optionsunder consideration by the Committee. Thiswas sent to all AAMC constituents for discussion at each council's spring meeting. Constituents were surveyed about the GME financingproblems facing teaching hospitals in a pricecompetitive market, whether training for foreign medical graduates should be supported,and the length of training which should besupported. Results showed a consensus thatthird party payers should continue to supportgraduate medical education through firstboard certification. It is expected that the committee's final report will be issued in the coming year.

The Subcommittee on Health of the SenateFinance Committee initiated congressionaldebate with a hearing on current and futurefinancing for residency training. The AAMCtestimony described Medicare's historical support through payment of the direct medicaleducation passthrough and the resident-to-bedadjustment to prospective payments. The Association emphasized the need to maintainand strengthen the medical education systemincluding residency training in the face ofdramatic changes in the environment forteaching hospitals. These institutions are finding it increasingly difficult to accommodatetheir multiple services of education, researchand patient care, and their financial stabilityis at immediate risk. The Association fearsthat in a price competitive market, tertiary

252


care teaching hospitals will suffer financiallybecause paying an average price per case isinsufficient for teaching hospitals. Even a subsidy for graduate medical education is insufficient if it does not include additional expenses for tertiary care services, stand-by, newtechnology, and charity care.

Senator David Durenberger, chairman ofthe Senate Finance Health Subcommittee, andSenators Robert Dole and Lloyd Bentsen introduced S. 1158 which would freeze Medicarepayments for GME in FY 1986. Subsequently,the proposal would change the conditions forMedicare support for graduate medical education, financing only the training of LCMEapproved medical school graduates and foreign medical graduates who are U.S. or Canadian citizens. Financial support would belimited to the lesser of five years of residencyor initial board eligibility. These economicdisincentives are intended to reduce the number ofsubspecialty and lengthy specialty training positions available. The Association's testimony emphasized the real costs of graduatemedical education and the interwoven relationship of residency training and patient services in teaching hospitals. The Association suggested that the bill be amended to increase thedirect education passthrough by the same rateused to increase the federal component ofDRG prices, that residency training be supported at least through initial board eligibility,that the proposal allow billing for professionalservices for residents beyond initial board eligibility, and that Medicare support be eliminated for all foreign medical graduates over athree-year period.

An amended S. 1158 would appear to meetmany AAMC concerns and recommendations. However, several other legislative proposals are currently on the table. Senator DanQuayle has proposed establishing a registry ofteaching hospitals as part ofa system to ensurea prescribed number of residency positions inprimary care specialties. Although a residencywould be available for every graduate of anLCME-approved medical school, there wouldbe no guarantee that it be in the specialty ofthe graduate's choice. The proposal would require that an affiliation agreement between ateaching hospital and medical school be in

253

place to allocate primary care training positions. Finally, at least 75 percent of the residents in a program would have to be graduatesof an LCME or AOA approved school. ANational Council on GME would determinethe appropriate number of primary care residency positions.

The AAMC testified on this proposal beforethe Senate Committee on Labor and HumanResources' Subcommittee on Employmentand Productivity. In regard to the requirements of an affiliation agreement, the Association testified that such agreements are established primarily for securing clinical resourcesfor the education and training of medical students, and are highly varied. The Quayle billwould require regulations to define the natureand content of acceptable affiliation agreements, and the Association opposes federalintrusion into this area. Secondly, the AAMCstated that the graduate medical educationsystem needs flexibility to permit graduates toprepare themselves for careers in those specialties for which they are best suited by theirtemperament, skills, and interests. Finally theU.S. must consider the desirability of trainingindividuals from other countries to improvethe quality of their nation's health care, regardless of how such training is funded.

A compromise proposal forged in the Committee on Labor and Human Resources eliminated a clause that would have prohibitedfederal GME financial assistance for hospitalsnot complying with the primary care percentage or the FMG limit. The medical schoolaffiliation requirement was removed and itwas agreed that residents in obstetrics-gynecology would not be counted as primary careresidents. The National Advisory Councilcould recommend different minimum percentages for classes for hospitals rather than asingle national percentage target. The committee unanimously reported the revised billfor Senate consideration, and agreed to allowSenator Kennedy to otTer a committee amendment when the bill comes up for debate. Thatamendment would add financial incentives forhospitals meeting the nationally-set primarycare targets. Payments to other hospitalswould be reduced to assure budget neutrality.

The AAMC testified before the Subcom-


mittee on Health and the Environment of theHouse Energy and Commerce Committee inan educational briefing on the federal government's role in funding graduate medical education. The AAMC's testimony pointed outthat while the majority of residents are concentrated in a small number of hospitals, specialities, and states, the remaining residentsare widely distributed, and public policymakers must carefully consider the varying impactof proposed policies. The AAMC stated thatsince its inception Medicare had paid its shareofthe added expenses hospitals incurred whenproviding clinical training for residents,nurses, and allied health personnel. The Association cautioned that the current emphasison reviewing national policies in light of morelimited public resources places teaching hospitals and their vital activites at significant riskif their special nature and role are not appreciated.

Congressman Henry Waxman, chairman ofthe Subcommittee on Health and the Environment, has introduced a bill to alter the methodby which Medicare and Medicaid pay for graduate medical education by limiting theamount paid per resident. It would influencephysician specialty mix by weighting the countof residents to favor primary care positions.Also the "indirect medical education adjustment" would drop to nine percent in FY 1986,with further decreases in subsequent years ifregulations are developed for hospitals with adisproportionate share of low income andMedicare patients. The HHS Secretary is permitted to develop a sliding scale for residentto-bed ratios in excess of .1.

A fourth legislative proposal to limit Medicare's funding of graduate medical educationwas introduced by Congressmen Ralph Regulaand Thomas Tauke. It would establish a separate formula-driven grant mechanism forMedicare's share of GME expenses. The allocation formula compares the ratio of Medicare's portion of full-time equivalent (FfE)residents in each hospital to Medicare's portion of total FfE residents nationally. Theallocation can be adjusted for area differencesin stipends, specialty mix, and service area.New entrants into the medical education fieldwould be allowed to claim their actual number

VOL. 61, MARCH 1986

of residents in the initial year, but hospitalscould not increase their number of residentsby more than ten percent in anyone yearwithout penalty.

The financing of graduate medical education was also addressed outside the legislativearena, in proposed regulations published bythe Health Care Financing Administration tofreeze permanently payments to hospitals fordirect medical education. The proposed freeze,effective July I, 1985, would be based on acost reporting year beginning on or after October I, 1983, but before October I, 1984. TheAAMC vigorously opposed these regulationsin comment letters to HCFA, HHS, and WhiteHouse officials and to members of Congress.The Association believes a policy change ofthis magnitude is highly inappropriate prior toresolution of the on-going· congressional debate on the proper role for Medicare. Moreover, the AAMC believes Medicare has a responsibility to help train professionals whoserve its present and future beneficiaries. TheAssociation asked HCFA to suspend furtheraction on a regulatory freeze in the directmedical education passthrough until Congresshas considered fully and acted upon a Medicare policy for supporting hospital costs formedical education activities; the AAMC wasjoined in its effort by twenty-nine other healthorganizations. The AAMC also asked Congress to stop this regulation until appropriatecongressional review had occurred. Finally, toevaluate the legality of HHS' implementation

. of these proposed regulations, the AAMC requested counsel to investigate the avenuesavailable for challenging implementation ofthese proposed regulations. Legal action maynot be necessary if Congress endorses a recommendation from the Subcommittee onHealth of the House Ways and Means Committee to prohibit HHS from imposing a freezeon direct medical education payments. Nevertheless, final rules to implement this freezewere published by HCFA on July 5, 1985.

The administration's proposed FY 1986budget included reductions in health care expenditures beyond the freeze in the directmedical education payments to hospitals. Thebudget proposed reductions of $4.2 billion in1986, with seventy-nine percent of the Medi-


care savings coming from changes affectingproviders of health care. Individually, eachproposal would result in a substantial reduction in Medicare revenues for teaching hospitals; collectively, the proposals would result inan unparalleled reduction in Medicare revenues, seriously weakening the financial stability of many of the nation's teaching hospitals.In particular, the budget called for a fifty percent reduction in the indirect medical education adjustment, a freeze in the diagnosisrelated group (ORO) per case payment tohospitals for Medicare inpatients, and a freezein Medicare payments to physicians as well asthe freeze in the direct medical education payment.

The Medicare Adjustment for the IndirectCost ofMedical Education: Historical Development and Current Status, a paper by JudithR. Lave commissioned by the AAMC, wasinvaluable as the Association confronted thesesevere budgetary measures. The publicationdescribes this adjustment's original purpose torecognize the additional costs incurred by providing tertiary care and other unique servicesin the teaching hospital setting. The paperpoints out that the adjustment is necessarydue to the limitations of the ORO as a unit'ofpayment and recommends modifying the statistical methodology used to calculate the percentage increase.

The Association addressed specific budgetproposals in a February 1985 policy positionpaper. The AAMC vigorously opposed anyfreeze in diagnosis-related group prices;strongly recommended that Congress eitheramend the prospective payment system so thatpayments would be based on a ORO-specific,blended rate of hospital-specific and federalcomponent prices, or amend the ORO priceformula so it is based on a blend of fiftypercent hospital-specific and fifty percent regional average costs; supported recomputingthe resident-to-bed adjustment using currentand corrected data; strongly opposed anychange or reduction in the passthrough fordirect medical education costs at present; supported correcting the wage index numbersused in prospective payments but recommended amending the law to eliminate thecurrent requirement that the new index num-

255

bers be applied retroactively to October I,1984; and recommended Congress requireHCFA to update each hospital's publishedcase mix index using data from the hospital'sfirst year under prospective payment. The p0

sition paper concluded that for the Medicareprospective payment system to provide hospitals with an appropriate incentive for efficiency, methodological weakness must beeliminated, inaccurate data corrected, and realdifferences in the costs of various types ofhospitals recognized.

The Association's testimony before the Subcommittee on Health ofthe House Committeeon Ways and Means reiterated that the FY1986 budget proposals would require majorchanges in the Medicare system for inpatientcare, and focused specifically on the DROprice freeze, the fifty percent reduction in theindirect medical education adjustment, andthe freeze in direct medical education costs.

The Association also testified before thatsubcommittee regarding the technical issuesunderlying the current policy debate on Medicare's prospective payment system. Six concerns were highlighted in the testimony: thelimited number of factors used to account fordifferences in hospital costs; the relationshipbetween prospective payment prices and thephase-in schedule; the computation and roleof the resident-to-bed adjustment in a systemwhich uses hospital-weighted prices but lacksa measure on patient severity; the method ofdetermining Medicare's share of direct medical education expenses; a suggestion for assisting disproportional share providers; and thelegislated retroactivity of the wage index adjustment. In particular, the Association reiterated its opposition to the proposed budgetarycuts and called for the HHS to recompute theresident-to-bed adjustment.

The subcommittee reported recommendations regarding changes in the Medicare program in July. The Association supported itsrecommended one percent increase in DROpayments rather than a freeze, the development of a disproportional share adjustment, arecalculated indirect education adjustment of8.1 percent (8.7 percent without a disproportional share adjustment), no freeze on directmedical education costs, and a one year pause


in the transition towards a national paymentrate by DRGs for hospitals. The Associationopposed the one year extension of the physician fee freeze.

While Congress was considering the budgetproposals, HCFA published regulations on thethird year of prospective payment, requiringnumerous and extensive changes. In brief, theproposed rules would freeze DRG prices andrevise their weights, recalculate the thresholdsfor length of stay outliers, modify the wageindex adjustment, and change the methodology used to count residents. The proposedchange in resident counting would have allhospitals count residents on September I, excluding those assigned to outpatient settings.

In comments to HCFA on the proposedregulations, the Association opposed the proposed DRG price freeze; supported the use ofthe "gross" index of hospital wages to determine hospital payments, but opposed its retroactive implementation; requested thatHCFA alternate the use of charge and costbased reweighting of the DRO weights; supported the specific reclassification of DRGs ascontained in the proposal, but opposed reclassification without following normal rulemaking procedures; and supported the eliminationof mandatory medical review of outliers andpayment for such case when the bill is presented. In addition, the AAMC strongly opposed the removal of residents assigned to thehospital outpatient department from the resident count. The House Ways and MeansCommittee added clear language to prohibitHCFA from excluding residents assigned tooutpatient units, and the AAMC hopes toobtain similar language from the Senate Finance Committee. Since the issue may remainunclear for some time, the AAMC has urgedall members to maintain their resident countdata in order to recreate an accurate report ofresidents assigned to outpatient units uponresolution of this issue.

When Medicare enacted its prospective payment system for inpatient hospital costs, Congress directed HHS to develop a recommendedpolicy on Medicare's payment of capital costsby October 1986. An Association policy position was developed under the guidance of anad hoc Committee on Capital Payments for

VOL. 61, MARCH 1986

Hospitals. It supports a percentage add-on tothe prospective payment for capital paymentsfor movable equipment, to include plant andfixed equipment only after an acceptable transition period.

The AAMC wrote to HHS to express graveconcerns with the proposed regulations implementing the "Baby Doe" amendment to theChild Abuse Prevention and Treatment Act,which identified the withholding of medicallyindicated treatment as a form of child abusethat must be reported to state child protectionservices. It defined withholding of medicallyindicated treatment as the failure to respondto life threatening conditions except when theinfant is irreversibly comatose, treatmentwould merely prolong dying, or the treatmentwould be virtually futile and, therefore, inhumane. The AAMC had objected to the legislation because it inadequately addressed thecomplexities of the issues and decisions involved, and the proposed regulations gaveeven less recognition to these complexities.Through a series of "clarifying definitions"the proposed regulations sought to force aggressive treatment for each infant. This approach failed to recognize that truly difficultdecisions must be made when medical carecan reverse only certain aspects of the infant'scondition, but cannot correct or reverse theunderlying disease or permanent brain damage.

The AAMC objected to the implication inthe regulations that such children must beaggressively treated when standard medicalpractice would be "a limitation of all medicalmeans for prolongation of life." The Association reminded HHS that aggressive treatmentof all severely ill infants would tax availableneonatal care resources, perhaps precludingother infants, who would clearly benefit, fromreceiving intensive neonatal care. Finally, theAAMC recommended that the "clarifying definitions" developed by HHS be removed fromthe proposed regulations and that the law'sdefinition of"withholding medically indicatedtreatment" not be changed.

In related developments, the Civil RightsCommission held a hearing to examine theneed to apply Section 504 of the Rehabilitation Act to this type of case. Notwithstanding


the recent passage of the amendments to theChild Abuse Act, the Civil Rights Commissionintends to recommend that Congress amendthe legislation that prohibits discriminationagainst the handicapped to specifically addresscongenitally impaired infants. Secondly, theSupreme Court heard the case ofthe AmericanHospital Association v. Heckler, in which theSecond Circuit Court of Appeals questionedthe applicability of Section 504, and whichformed the basis for striking down the originalBahy Doe regulations.

The AAMC testified on uncompensatedcare and the teaching hospital before the Subcommittee on Health of the Senate FinanceCommittee and the National Council onHealth Planning and Development late in1984. The Association described the increasingly competitive marketplace for hospitalservices as forcing hospitals to balance thecosts of uncompensated care for current patients with the hospital's fiduciary responsibility to remain viable to serve future patients.The AAMC noted that teaching hospitals havehistorically fulfilled special missions as a consequence of their location in metropolitanareas, frequently in inner city neighborhoods.In response to the hospital's location and thearea's shortage of health personnel, teachinghospitals have often established large clinicsand primary care services to meet neighborhood needs, even at a financial loss. The teaching hospital's area-wide programs for bum,trauma, high risk maternity, alcohol and drugabuse, and intensive psychiatric care may alsoattract patients unable to pay for their care.As a result, many public and private teachinghospitals are major providers of uncompen-

257

sated care. The Association emphasized thatuncompensated care is a problem in a competitive environment because such care is unevenly distributed across hospitals, handicapping those serving the indigent and medicallyindigent.

Final rules on disclosure responsibilities andsanction criteria to be used by Peer ReviewOrganizations were issued by HHS. These regulations allow PROs to disclose hospital-specific information on quality and appropriateness of health care services subject to certainnew requirements. PROs must notify hospitalsif they intend to release information, providehospitals with a copy of the information, andallow the hospital to comment, with thosecomments forwarded to the requestor. Aggregate data that does not identify institutions,individual patients, or practitioners can bedisclosed without comment, but release of patient-specific information requires the consentof the patient. This emphasis on PRO disclosure responsibilities reiterates HHS's intentionto allow public access to data that the AAMCbelieves could be misused or misinterpreted,such as hospital death rates and prevalence ofhospital-acquired infections. The language allowing hospitals' comments to become part ofthe requested information will be especiallyimportant as these data are released and interpreted in the public arena. Because of thepublic interest in this information and thesophistication needed to properly understandit, analyses may oversimplify findings. TheAAMC urged its members to establish a carefully defined internal process that providestimely responses during the comment periodprovided.

Communications

News media, both regional and national, viewthe AAMC as a major source ofnews concerning medical education, medical research policyand funding, and patient care issues. Eachweek more than 25 news reporters who aredeveloping stories contact the Association forits expertise and opinions. In addition theAssociation generates stories through news releases, news conferences, and personal interviews.

The Association's major publication continues to be the AAMC President's WeeklyActivities Report, which is circulated to morethan 6,000 individuals 43 times a year. Eachpublication reports on AAMC activities andfederal actions having a direct effect on medical education, biomedical research, and patient care.

The Journal of Medical Education published 977 pages of editorial material in theregular monthly issues, compared with 1,015pages the previous year. The published material included a total of 78 regular articles, 72communications, and 14 briefs. The Journalalso continued to publish editorials, datagrams, book reviews, letters to the editor, andbibliographies provided by the National Library of Medicine. The monthly circulation

averaged 6,100.The volume of manuscripts submitted to

the Journal for consideration continued to runhigh. Papers received in 1984-85 totaled 403,of which 137 were accepted for publication,205 were rejected, 24 were withdrawn, and 37were pending as the year ended.

In addition to the regular monthly issues, a216-page Part 2 to the Journal was publishedon the report of the Project Panel on theGeneral Professional Education of the Physician and College Preparation for Medicine.The publication was titled Physicians for theTwenty-First Century.

About 24,000 copies of the annual MedicalSchool Admission Requirements, 5,000 copiesof the AAMC Directory ofAmerican MedicalEducation, and 4,000 copies of the AAMCCurriculum Directory were sold or distributed.The AAMC also produced and distributednumerous other publications, such as directories, reports, papers, studies, and proceedings.Newsletters include the COTH Report, whichhas a monthly circulation of about 2,800; theOSR Report, which is circulated twice a yearto medical students; and STAR, which isprinted four times a year and has a circulationof 1,000 student affairs personnel.

258

Information Systems

The Association~s computer system consists ofa Hewlett-Packard 3000, Series 68 and a Hewlett-Packard 3000, Series 48, each with a highspeed laser printer. The use of over onehundred terminals and enhanced data communications technology has provided improved response time and permits the Association to meet the needs of its membership andstaff Database development continues as atop priority to minimize data redundancy andto provide responsive on-line information retrieval. More sophisticated computer-generated graphic art now permits the creation of35mm slides and the preparation of othercamera art, reducing outside graphic art costs.

The American Medical College ApplicationService System provides the core of the information on medical students by collecting biographic and academic data, and linking thesedata to MCAT scores. A sophisticated softwaresystem provides participating medical schoolswith timely and reliable statistics with nationalcomparisons. The system generates data filesfor schools and applicant pool analyses andprovides the basis for entering matriculants inthe student record system.

AMCAS is supplemented by the MedicalCollege Admission Test reference system ofscore information, a college information sys-tem on U.S. and Canadian schools, and theMedical Science Knowledge Profile system onindividuals taking the MSKP exam for advanced standing admission to U.S medicalschools.

A student record system, maintained in c0

operation with the medical schools, traces theprogress of individual students from matriculation through graduation. Supplemental surveys such as the graduation questionnaire andthe financial aid survey augment the studentrecord system.

After each match, the National ResidentMatching Program obtains information on

unmatched participants and eligible studentswho did not enroll. The Association, using aninitial data file supplied by NRMP, producesmatch results listings for each medical school,updates the NRMP information using currentstudent records system data and listings returned from the medical schools, prepares hos-pital assignment lists for each medical school,and generates a final data file for use inNRMP~s tracking study.

The Student and Applicant InformationManagement System consolidates into onecomprehensive database more than a decade~s

information on applicants, medical students,and residents. SAIMS provides data for a widevariety ofreports including cross-sectional andlongitudinal studies performed by Associationstafffor reseachers at member institutions andfor others.

Through the cooperation of U.S. medicalschool staffs, the Association updates the Faculty Roster System~s information on salariedfaculty and periodically provides schools withan organized, systematic profile of their faculty. A survey of medical school faculty salaries is published annually and is available ona confidential, aggregated basis in response tospecial queries.

The Association maintains an on-line repository of information on medical schools ofwhich the Institutional Profile System is amajor component since it contains data concerning medical schools from the 19605 to thepresent. It is constructed both from surveyresults sent directly from the medical schoolsand from other information systems. The information reported on Part I of the LiaisonCommittee on Medical Education annualquestionnaire complements the InstitutionalProfile System and is used to produce thereport of medical school finances publishedannually in of the Journal of the AmericanMedical Association.

259


The Association also collects and maintainsinformation on teaching hospitals. The comprehensive Directory of Education Programsand Services and surveys on executive salaries,housestafTstipends and benefits, and academicmedical center financing are published annually.

VOL. 61, March 1986

The rapid assimilation of data into usefulinformation coupled with its timely distribution to its membership to allow informed decision-making continues to be the Association's goal.

AAMC Membership

InstitutionalProvisional InstitutionalAffiliateGraduate AffiliateSubscriberAcademic SocietiesTeaching HospitalsCorrespondingIndividualDistinguished ServiceEmeritusContributingSustaining

1983-84

1262

16I

1676

43447

10996560

510

1984-85127

I161

1379

43535

107468605

10

Treasurer's Report

The Association's Audit Committee met onSeptember 3, 1985, and reviewed in detail theaudited statements and the audit report forthe flSca1 year ended June 30, 1985. Meetingwith the committee were representatives ofErnst & Whinney, the Association's auditors,and Association staft: On September 12, theExecutive Council reviewed and accepted thefinal unqualified audit report.

Income for the year totaled $12,547,089.Of that amount, $11,962,157 (95.3%) originated from general fund sources; $36,031(0.3%) from foundation grants; $548,901(4.4%) from federal government grants andcontracts.

Expenses for the year totaled $11,358,696of which $10,627,762 (93.6%) was chargeableto the continuing activities of the Association;$182,033 (1.6%) to foundation grants;$548,901 (4.8%) to federal government grantsand contracts. Investment in fixed assets (net

of depreciation) decreased by $135,625 as aresult of the sale of outdated computer equipment. Balances in funds restricted by grantorsdecreased $141,025 to $338,186. After makingprovisions for Executive Council designatedreserves for special programs in the amount of$430,000, unrestricted funds available for general purposes increased $1,274,758 to$10,981,399, an amount equal to 96% of theexpense recorded for the year. This reserveaccumulation is within the directive of theExecutive Council that the Association maintain as a goal an unrestricted reserve of 100%of the Association's total annual budget. It isof continuing importance that an adequatereserve be maintained.

The Association's financial position isstrong, but with the multitude of complexissues facing medical education, it is apparentthat the demands on the Association's resources will continue.

261

Association of American Medical CollegesBalance SheetJune 30. 1985ASSETS

CashInvestmentsAccounts ReceivableDeposits and Prepaid ItemsEquipment (Net of Depreciation)TOTAL ASSETS

LIABILmES AND FUND BALANCES

LiabilitiesAccounts Payable

Deferred IncomeFund Balances

Funds Restricted by Grantor for Special PurposesGeneral Funds

Funds Restricted for Plant InvestmentFunds Restricted by Executive Council for

Special PurposesInvestment in Fixed AssestsGeneral Purposes Fund

TOTAL LIABILmES AND FUND BALANCES

Association of American Medical CollegesOperating StatementFiscal Year Ended June 30. 1985

SOURCE OF FUNDS

IncomeDues and Service Fees from MembersPrivate GrantsCost Reimbursement ContractsSpecial ServicesJournal of Medical EducationOther PublicationsSundry (Interest $1,892,803)

TOTAL SOURCE OF FUNDSUSE OF FUNDS

Operating ExpensesSalaries and WagesStaff BenefitsSupplies and ServicesProvision for DepreciationTravel and MeetingsSubcontractsNet Loss on Disposal of Fixed Assets

TOTAL EXPENSESDecrease in Investment in Fixed Assets(~et of Depreciation)

Transfer to Executive Council Reserved Fundsfor Special Programs

Reserve for Replacement of EquipmentIncrease in Restricted Fund Balances (Decrease)Increase in General Purposes FundsTOTAL USE OF FUNDS

262

$ 496,8563,931,618

1,198,64110,981,399

332,19717,566,132

609,55052,633

1,198,64119,759,153

1,187,2811,625,172

338,186

16,608,514$19,759,153

3,259,88136,031

548,9015,399,867

103,113477,953

2,721,343$12,547,089

4,629,553871,312

3,790,135348,513

1,119,566544,248

55,36911,358,696

(135,625)

210,994

( 20,709)(141,025)1,274,758

$12,547,089

AAMC COMMITTEES

Accreditation Council forContinuing Medical Education

AAMC MEMBERS

Thomas MeyerHenry P. RussePatrick B. Storey

Accreditation Council forGraduate Medical Education

AAMC Members

D. Kay OawsonSpencer ForemanHaynes RiceDavid Sabiston, Jr.

Audit

C. Thomas Smith, ChairmanMilton ComVivian PinnRichard Ross

Capital Payments for Hospitals

Robert C. Frank, ChairmanWilliam G. AnlyanBruce C. CampbellDavid GinzbergLeo M. HenikofTLarry L. MathisRichard MeisterWilliam RyanC. Edward SchwartzQyde M. WilliamsLeon Zucker

CAS Nominating

David H. Cohen, ChairmanJohn M. BissonnetteWilliam R. DruckerGeorge A. HedgeWilliam P. JollieLouisM.ShenNoodVirginia V. Weldon

COD Nominating

Stuart Bondurant, ChairmanHarry S. JonasLeonard M. NapolitanoJames A. PittmanRobert E. Tranquada

COD Spring Meeting PlaDning

Arnold L. Brown, ChairmanRichard E. BehrmanGeorge T. BryanD. Kay OawsonDonald W. KingRichard S. RossEdward J. Stemmler

COTH Nominatiog

Haynes Rice, ChairmanRobert E. FrankSheldon S. King

COTH Spring Meeting Pbuming

Gary Gambuti, ChairmanCharles R. BuckJames C. DeNimRobert B. JohnsonGerald W. MungersonC. Edward Schwartz

Council for Medical Affain

AAMC MEMBERS

John A. D. CooperRichard JanewayVirginia V. Weldon

Evaluation of Medical InformationScience in Medical Education

STEERING

Jack D. Myers, ChairmanG. Octo BarnettHarry N. BeatyDon E. Detmer

263


Ernst KnobilCharles E. MolnarStephen G. PaukerEdward H. ShortlifTeEdward J. Stemmler

Faculty Practice

Edward J. Stemmler, ChairmanArnold L. BrownWilton BunchSaul J. FarberRobert M. HeysselJohn E. IvesRichard G. LesterCharles A. McCallumDavid R. PerryAlan K. PierceCharles PutmanRaymond G. SchultzeDonald Tower

Finance

Mitchell T. Rabkin, ChairmanWilliam DealRobert M. HeysselRobert L. HillRichard JanewayEdward J. StemmlerFrank C. Wilson, Jr.

Financing Graduate MedicalEducation

J. Robert Buchanan, ChairmanRichard A. BermanDavid W. GitchLouis J. KettelFrank G. MoodyGerald T. PerkofTRobert G. PetersdorfLouis SherwoodCharles C. SpragueWilliam Stoneman, IIIRichard VanceW. Donald WestonFrank C. Wilson, Jr.

F1exner Award Selection

Arthur C. Christakos, ChairmanErnst KnobilMitchell T. Rabkin

VOL. 61, MARCH 1986

Lloyd H. Smith, Jr.Daniel C. TostesonCharles Weaver

Governance and Structure

Sherman M. MellinkofT, ChairmanJohn W. CollotonWilliam DealJoseph E. Johnson, IIIFrank C. Wilson, Jr.

Group on Business Affairs

STEERING

Bernard McGinty, ChairmanJohn H. Deufel, Executive SecretaryDavid J. BachrachJason BarrJohn DeeleyThomas A. FitzgeraldJerold A. GlickJohn C. MelendiRoger D. MeyerMichael A. ScullardGeorge W. SeilsLester G. Wilterdink

Group on Institutional Planning

STEERING

Victor Crown, ChairmanJohn H. Deufel, Executive SecretaryDonald FennaLeonard HellerAmber B. JonesDavid R. PerryDavid D. PinterThomas RosePhilip SharkeyMarie Sinioris

Group on Medical Education

STEERING

Paula L. Stillman, ChairmanJames B. Erdmann, Executive SecretaryLawrence A. FisherHarold B. HaleyVictor R. NeufeldS. Scott ObenshainMyra Bergman RamosHoward L. Stone


Group on Public Affairs

STEERING

Eldean Borg, ChairmanCharles Fentress, Executive SecretaryShirley BonnemArthur M. Brink, Jr.Robert G. FenleyNancy GroverEllen Soo HooPatrick StoneCarolyn TinkerHali WicknerRoland D. Wussow

Group on Student Affairs

STEERING

Norma Wagoner, ChairmanPaul R. Elliott, Executive SecretaryJohn C. GardnerBilly B. RankinRicardo SanchezAnthony P. SmuldersJohn F. SnarrRudolph WilliamsBenjamin B. C. Young

MINORITY AFFAIRS SECI10N

Rudolph M. Williams, ChairmanCarolyn M. Carter, Vice ChairmanBilly R. BallardBruce L. BallardCarrie B. JacksonVietta L. JohnsonScharron A. LaisureFernando S. MendozaZubie MetcalfWilliam WallaceMaggie S. WrightJohn Yergan

Guidelines for Managementof Animal Resources

William H. Danforth, Co-ChairmanHenry L. Nadler, Co-ChairmanAlbert A. BarberThomas B. Oarkson, Jr.D. Kay OawsonJoe CoulterFranklyn G. KnoxGayle McNutt

10M Report Review

Robert W. Berliner, ChairmanRobert M. BerneStuart BondurantDavid H. CohenRichard JanewayMitchell T. RabkinDavid B. SkinnerVirginia V. WeldonSheldon M. Wolff

Journal of Medical Education

Editorial Board

Joseph S. Gonnella, ChairmanPhilip C. AndersonJo BouffordL. Thompson BowlesLauro F. CavazosPamelyn OoseCharles W. DohnerA. Cherrie EppsNancy E. GaryDavid S. GreerJohn E. IvesDonald G. KassebaumEmily MumfordWarren H. PearseLois A. PoundsT. Joseph SheehanManuel TzagournisJ. H. WallaceJesse G. WardlowKern Wildenthal

Liaison Committee onMedical Education

AAMC MEMBERS

J. Robert BuchananCarmine D. OementeWilliam B. DealWilliam H. LuginbuhlMarion MannRichard C. Reynolds

AAMC STUDENT PARTICIPANT

John F. McCarthy

Management Education Programs

Edward J. Stemmler, ChairmanD. Kay Oawson -

265


David L. EverhartFairfield GoodaleWilliam H. LuginbuhlRobert G. PetersdorfHiram C. Polk, Jr.

MCAT Essay Pilot Project

ADVISORY COMMIlTEE

Daniel J. BeanZenaido CamackoShirley Nickols FaheyRobert I. KeimowitzScharron A. LaisureTerrence M. LeighJohn MolidorMarliss Strange

MCATReview

Sherman M. Mellinkoff, ChairmanFredric D. BurgJohn DeJongDaniel D. FedermanNathan KaseDouglas E. KellyWalter F. LeavellWilliam LuginbuhlBilly B. RankinRichard S. RossAndrew G. Wallace

Nominating

Joseph Gonnella, ChairmanStuart BondurantDavid CohenStuart MarylanderHaynes Rice

Payment for Physician Servicesin Teaching Hospitals

Hiram C. Polk, Jr., ChairmanIrwin BirnbaumDavid M. BrownThomas A. BruceJack M. ColwillMartin G. DillardFairfield GoodaleRobert W. HeinsSheldon S. KingJerome H. Mod~llMarvin H. Siegel

VOL. 61, MARCH 1986

Alton I. SutnickSheldon M. Wolff

Presidential Search

Richard Janeway, ChairmanWilliam G. AnlyanSteven C. BeeringArnold L. BrownJ. Robert BuchananPamelyn OoseJohn W. CollotonRonald EstabrookRobert G. PetersdorfVirginia V. Weldon

Research Award Selection

Richard M. Krause, ChairmanAnthony FauciJohn W. KendallFranklyn G. KnoxBernard L. MirkinOscar D. Ratnoff

Research Policy

Edward N. Brandt, Jr., ChairmanStuart BondurantDavid H. CohenRobert E. FellowsRichard JanewayThomas W. MorrisJohn T. Potts, Jr.Leon E. RosenbergBenjamin D. SchwartzDavid B. SkinnerVirginia V. WeldonPeter C. Whybrow

Resolutions

Thomas Bruce, ChairmanEarl FrederickWilliam GanongRicardo Sanchez

RIME Program Planning

Harold G. Levine, ChairmanJames B. Erdmann, Executive SecretaryFredric D. BurgDavid S. GullionMurray M. Kappelman


Christine McGuireArthur I. Rothman

Women in Medicine

Joan Altekruse

Shirley Nickols FaheyMargaret HinesSharon HullBernice SigmanPatricia Williams

267

AAMC STAFF

Office of the President

PresidentJohn A. D. Cooper, M.D., Ph.D.

Vice PresidentJohn F. Sherman, Ph.D.

Special Assistant to the PresidentKathleen S. Turner

Staff CounselJoseph A. Keyes, J.D.

Executive SecretaryNorma NicholsRose Napper

Administrative SecretaryRosemary Choate

Division of Business Affairs

Director and Assistant Secretary-TreasurerJohn H. Deufel

Associate DirectorJeanne Newman

Business ManagerSamuel Morey

Personnel ManagerCarolyn Curcio

Supervisor, Membership and PublicationOrders

Madelyn RocheAccounts Payabletpurchasing Assistant

LaVerne TibbsAdministrative Secretary

Patricia YoungAccounting Assistant

Cathy BrooksPersonnel Assistant

Tracey NagleCheryl Naimark

Accounts Receivable ClerkRick Helmer

Accounts Payable AssistantFarisse Moore

Annual Meeting RegistrarRosalie Viscomi

ReceptionistKathryn Mannix

Senior Order OerkAnna Thomas

Membership ClerkIda Gaskins

Senior Mail Room OerkMichael George

Mail Room ClerkJohn Blount

Director, Computer ServicesBrendan Cassidy

Associate DirectorSandra Lehman

Manager of DevelopmentMaryn Goodson

Systems ManagerRobert Yearwood

Systems AnalystDavid BurhopPamela Eastman

Programmer/AnalystJack ChesleyHelen IllyJames Shivley

Operations SupervisorJackie Humphries

Administrative SecretaryCynthia K. Woodard

Secretary/Word Processing SpecialistMary Ellen Jones

Data Control and Graphics SpecialistRenate Coffin

Computer OperatorEarl BestKaren DimminsHaywood MarshallBasil PegusWilliam Porter

Division of Public Relations

DirectorCharles Fentress

Administrative SecretaryJanet Macik

268


Division of Publications

DirectorMerrill T. McCord

Associate EditorJames R. Ingram

StatT EditorVickie Wilson

Assistant EditorAddeane Caelleigh

Administrative SecretaryRosemary Boyd

Department of AcademicAffairs

DirectorAugust G. Swanson, M.D.

Deputy DirectorElizabeth M. Short, M.D.

Senior StatT AssociateMary H. Littlemeyer

Project CoordinatorBarbara Roos

Administrative SecretaryRebecca Erdmann

Division of Biomedical Researchand Faculty Development

DirectorElizabeth M. Short, M.D.

StatT AssociateChristine BurrisDavid Moore

Administrative SecretaryCarolyn Demorest

SecretaryAmelia Green

Division of EducationalMeasurement and Research

DirectorJames B. Erdmann, Ph.D.

Associate DirectorRobert L. Beran, Ph.D.

Program DirectorXenia Tonesk, Ph.D.

Project DirectorKaren Mitchell, Ph.D.

Staff AssociateM. Brownell Anderson

Research AssistantJudith AndersonRobin Buchanan

Administrative SecretaryStephanie Kerby

SecretaryLeigh Ann Kemp

Division of Student Services

DirectorRichard R. Randlett

Associate DirectorRobert Colonna

ManagerLinda W. CarterAlice CherianEdward GrossMarkWood

SupervisorLillian CallinsHugh GoodmanLillian McRaeDennis RennerOaudette SimpsonWalter WentzJohn Woods

Senior AssistantC. Sharon BookerKeiko DoramWarren LewisEnrique Martinez-VidalHelen ThurstonEdith Young

Administrative SecretaryMary Reed

SecretaryDenise Howard

AssistantTheresa BellWanda BradleyDonald BrownJames CobbWayne CorleyMichelle DavisCarol EasleyCarl GilbertGwendolyn HancockPatricia JonesSheila JonesLetitia LeeYvonne Lewis

269


Mary MolyneauxBeverly RuffinAlbert SalasChristina SearcyTamara WallaceGail WatsonPamela WatsonOscar WellsYvette White

Typist/ReceptionistSandra Smalls

Division of Student Programs

DirectorPaul Elliott, Ph.D.

Director, Minority AffairsDario O. Prieto

Staff AssociateJanet Bickel

Research AssociateMary Cureton

Staff AssistantElsie QuinonesSharon Taylor

Administrative SecretaryMary Salemme

SecretaryBrenda GeorgeLily May Johnson

Department ofInstitutional Development

DirectorJoseph A. Keyes, J.D.

Director, Institutional StudiesRobert Jones, Ph.D.

Staff AssociateMarcie F. Mirsky

Administrative SecretaryDebra Day

SecretaryLinda ButlerIrene Stapler

Division of Accreditation

DirectorJames R. Schofield, M.D.

Staff AssistantRobert Van Dyke

VOL. 61, MARCH 1986

Administrative SecretaryLisa Hofmann

Department ofTeaching Hospitals

DirectorRichard M. Knapp, Ph.D.

Associate DirectorJames D. Bentley, Ph.D.

Staff AssociateKaren PfordresherNancy Seline

Administrative SecretaryMelissa Wubbold

SecretaryJanie BigelowMarjorie LongCassandra Veney

Department ofPlanning and PolicyDevelopment

DirectorThomas J. Kennedy, Jr., M.D.

Deputy DirectorPaul Jolly, Ph.D.

Legislative AnalystDavid BaimeMelissa BrownLeonard Koch

Administrative SecretaryCynthia Withers

SecretarySusan ShivelySandra Taylor

Division of Operational Studies

DirectorPaul Jolly, Ph.D.

Staff AssociateThomas DialWilliam Smith

Research AssociateGary CookStephen EnglishNancy GentileLeon TakselJudith Teich


Operations Manager, Faculty RosterAarolyn Galbraith

Research AssistantDonna WilliamsPeggy Yacavone

Administrative SecretaryKaren Scullen

Data AssistantElizabeth Sherman

271

272

JOURNAL OF Medical Education

Editorial Board

Joseph S. Gonnella., M.D. (Chainnan)Dean and Vice PresidentDirector, Center for Research in Medical

Education and Health CareJefferson Medical College

of Thomas Jefferson UniversityPhiladelphia., Pennsylvania

Donald G. Kassebaum, M.D.DirectorHealth Policy StudyOregon Health Sciences UniversitySchool of MedicinePortland, Oregon

Fernando S. Mendoza, M.D.Assistant Dean of Student AffairsStanford University School of MedicineStanford., California

Emily Mumford, Ph.D.Professor of Clinical Social ScienceColumbia UniversityChiefDivision of Health Services and Policy ResearchNew York State Psychiatric InstituteNew York City, New York

Gordon Page, Ed.D.DirectorDivision of Educational Support and

DevelopmentUniversity of British Columbia Faculty

of MedicineVancouver., British Columbia, Canada

Lois A. Pounds, M.D.Associate Dean for StudentsUniversity of Pittsburgh School of MedicinePittsburgh, Pennsylvania

Hugh M. Scott, M.D.Associate DeanPostgraduate Medical EducationMcGill University Faculty of MedicineMontreal, Quebec, Canada

Manuel Tzagournis, M.D.Vice President for Health Services and DeanOhio State University College of MedicineColumbus, Ohio

J. H. Wallace, Ph.D.Professor and ChainnanDepartment of Microbiology and ImmunologyUniversity of Louisville School of MedicineLouisville, Kentucky

Jesse G. WardlowStudentYale University School of MedicineNew Haven, Connecticut

Kern Wildenthal, M.D., Ph.D.DeanUniversity of TexasSouthwestern Medical School at DallasDallas., Texas

John E. IvesExecutive Vice PresidentShands HospitalUniversity of RoridaGainesville, Rorida

Paul F. Griner, M.D.General DirectorStrong Memorial HospitalRochester, New York

David S. Greer, M.D.Dean of MedicineBrown University Program in MedicineProvidence, Rhode Island

Nancy E. Gary, M.D.Associate Dean for Educational AffairsUniversity of Medicine and Dentistry

of New JerseyRutgers Medical SchoolPiscataway, New Jersey

Charles W. Dohner, Ph.D.Professor and DirectorDivision of Research in Medical EducationUniversity of Washington School of MedicineSeattle, Washington

Preston V. Dilts., Jr., M.D.ChainnanDepartment of Obstetrics and GynecologyUniversity of Michigan Medical SchoolAnn Arbor, Michigan

Pamelyn Oose, M.D.Pediatrics ResidentHarbor-UCLA Medical CenterTorrance, California

L. Thompson Bowles, M.D.., Ph.D.Dean for Academic AffairsGeorge Washington UniversitySchool of Medicine and Health SciencesWashington, D.C.

Philip C. Anderson, M.D.ChainnanDepartment of DennatologyUniversity of Missouri, ColumbiaSchool of MedicineColumbia, Missouri

aamc annaul meeting and annual report 1985

Documents