aamc annual meeting and annual report 1977
TRANSCRIPT
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~ Association of American Medical Colleges0..
§ Annual Meeting..s::~ and'"d
~ Annual Report~ 1977(1)\-;
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NOTE: The minutes of the 1977 meeting of theAAMC Assembly will be published in a subsequentissue.
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Table of Contents
Annual Meeting
Plena!'Y' Sessions ................•......•...........•....•............•233CouncllofI>eans ..•.••••.....•.•.•...•••••••...••.•...•••••••..••••••233Council of Academic Societies ••••••••••••••••••••••••••••••••••••••••••233Council of Teaching Hospitals ••••••••••••••••••••••••••••••••••••••••••233COD/CAS/COTH Joint Program •••••••••••••••••••••••••••••••••••••••233COD/COTH Joint Program ••••••••••••••••••••••••••••••••••••••••••••234Organization of Student Representatives •••••••••••••••••••••••••••••••••234Minority Affairs Program 235Women in Medicine 235Group on Medical Education ••••••••••••••••••••••••••••••••••••••••••• 235Group on Business Affairs 237Group on Public Relations 237GME Continuing Medical Education Program ••••••••••••••••••••••••••••238GSA/GME Joint Program •••••••••••••••••••••••••••••••••••••••••••••238Planning Coordinators' Group ••••••••••••••••••••••••••••••••••••••••••238Research in Medical Education •••••••••••••••••••••••••••••••••••••••••238
Annual Report
Message from the President 245The Councils 248National Policy 255Working with Other Organizations •••••••••••••••••••••••••••••••••••••• 259Education 262Biomedical Research 265Health Care •••••••••••••••••••••••••••••••••••••••••••••••••••••••••• 267Faculty 269Students 271Institutional Development 274Teaching Hospitals 276Communications 278Information Systems •••••••••••••••••••••••••••••••••••••••••••••••••• 279AAMC Membership 281Treasurer's Report 281AAMC Committees, 1976-77 •••••••••••••••••••••••••••••••••••••••••• 283AAMC Staff', 1976-77 288
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The Eighty-Eighth Annual Meeting
Washington Hilton Hotel, Washington, D.C., November 5-10,1977
Theme: Graduate Medical Education: Critical Issues for the Eighties
NovemberS
COD/CAS/COTHJOINT PROGRAM
November 7
COUNCIL OF TEACHING HOSPITALS
The Food and Drug Administration and theAcademic Medical CenterDonald Kennedy, Ph.D.
Business Meeting
Presiding: David D. Thompson, M.D.
General Session
Presiding: David L. Everhart
PHYSICIAN RESPONSIBILITY AND ACCOUNTABILITY
FOR CONTROLLING THE DEMAND FOR HOSPITAL
SERVICES
As Viewed By the Department ChairmanRobert G. Petersdorf, M.D.
As Viewed By a Dean Turned ChiefExecutiveOfficerJ. Robert Buchanan, M.D.
As Viewed By the Hospital D,rectorRobert M. Heyssel, M.D .
CHALLENGES IN GRADUATE MEDICAL EDUCATION
SESSION I
TRANSITION BETWEEN UNDERGRADUATE AND
GRADUATE MEDICAL EDUCATION
Moderator: Julius R. Krevans, M.D.
The Transition to Graduate Medical Education-A Student's Point ofView
233
Program Outlines
PLENARY SESSIONS
PRESENTATION OF AWARDS
NovemberS
November 7
November 7
COUNCIL OF ACADEMIC SOCIETIES
Presiding: Ivan L. Bennett, Jr., M.D.
Chairman's AddressIvan L. Bennett, Jr., M.D.
November 7
Presiding: Robert G. Petersdorf, M.D.
Historical Development of Specialization andGraduate Medical EducationRosemary Stevens, Ph.D.
The Hospital/Medical School PartnershipRobert A. Derzon
Options for Financing Graduate Medical EducationJames Kelly, Ph.D.ALAN GREGG MEMORIAL LECTURE:
The Education ofthe PhysicianDonald W. Seldin, M.D.
Business Meeting
Chairman: Julius R. Krevans, M.D.
Business Meeting
Chairman: A. Jay Bollet, M.D.
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234 Journal of Medical Education
Thomas A. Rado, M.D., Ph.D.
The Readiness of New M.D. Graduates toEnter Their GME-I YearBarbara Korsch, M.D.
The Search for a Broad First YearWilliam Hamilton, M.D.
SESSION II
QUALIlY OF GRADUATE MEDICAL EDUCATION
Moderator: A. Jay Bollet, M.D.
The Evaluation ofResidents' PerformanceJohn A. Benson, Jr., M.D.
Supervisory RelationshIps in Graduate Medical EducationWilliam P. Homan, M.D.
The Program Director's ResponsibilityThomas K. Oliver, Jr., M.D.
November 9
SESSION III
INFLUENCING SPECIALTY DISTRIBUTION THROUGH
GRADUATE MEDICAL EDUCATION
Moderator: Richard Janeway, M.D.
The Coordinating Council on Medical Education Should Participate with the Federal Government to Regulate Opportunities for Specialty TrainingJohn C. Beck, M.D.
The Private Sector Should A void Participatmgwith the Federal GovernmentC. Rollins Hanlon, M.D.
SESSION IV
INSTITUTIONAL RESPONSIBILIlY FOR GRADUATE
MEDICAL EDUCATION-THE MCGAW MEDICAL
CENTER OF NORTHWESTERN UNIVERSIlY EXPERI
ENCE
Moderator: J. Robert Buchanan, M.D.
The Concept and its DevelopmentJames Eckenhoff, M.D.
How it OperatesJacob Suker, M.D.
How It Affects the Program DirectorLee F. Rogers, M.D.
Its Impact on the Teaching HospitalDavid L. Everhart
VOL. 53, MARCH 1978
COD/COTH JOINT PROGRAM
November 6
ANALYZING THE VETERANS ADMINISTRATION/
MEDICAL SCHOOL RELATIONSHIP
Moderator: John A. D. Cooper, M.D.
A View From the General Accounting OfficeMurray Grant, M.D.
A View From the National Academy of Sciences StudySaul J. Farber, M.D.
The Veterans Administration PerspectiveJohn D. Chase, M.D.
ORGANIZATION OF STUDENTREPRESENTATIVES
NovemberS
Regional MeetingsDiscussion Sessions:
Student Financial AidHealth LegislationCareer CounselingCurriculum and Evaluation
Business Meeting
November 6
Discussion Sessions:Health LegislationNational Intern and Resident
Matching ProgramWithholding of Physician ServicesMinority Affairs
Discussion Sessions:Student Financial AidMedical School AccreditationMinority Admissions Programs-
Legal ChallengesWomen in Medicine
Business Meeting
Regional Meetings
November 7
IS HOUSESTAFF UNIONIZATION UNDER THE RULES
OF THE NATIONAL LABOR RELATIONS ACT AN
APPROPRIATE AND DESIRABLE MEANS FOR HOUSE
STAFF TO ACHIEVE PATIENT CARE AND EDUCA
TIONAL PROGRAM IMPROVEMENTS?
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1977 AAMC Annual Meeting
Moderator: Thomas A. Rado, M.D., Ph.D.
Introduction and OverviewRichard M. Knapp, Ph.D.
The Case for UnionizationRalph M. Stanifer, M.D.
The Case Against UnionizationSandra Foote, M.D.
Panel: Cheryl GutmannWilliam H. Luginbuhl, M.D.Alvin Tarlov, M.D.
November 7
Discussion Sessions:
MEN IN MEDICINE
Robert JaffeTerry S. Stein, M.D.
ENHANCING MEDICAL STUDENTS' MENTAL HEALTH
Dale Garell, M.D.Patrick Tokarz, M.D.
Discussion Sessions:
ALTERNATIVES TO TRADITIONALLY SCHEDULED
RESIDENCIES
Moderator: Eileen Shapiro
Panel: Kenneth Rowe, M.D.Jo Bouffard, M.D.Ron Sable, M.D.Naomi Kistin, M.D.Shirley G. Driscoll, M.D.Marcia LaneStuart H. Shapiro, M.D.
THE GAY PATIENT AND PROVIDER IN A STRAIGHT
HEALTH CARE SYSTEM
Paul A. Paroski, Jr.Janet O. Yardley
MINORITY AFFAIRS PROGRAM
November 8
MINORITIES IN MEDICINE: FROM RECEPTIVE PAS
SIVITY TO POSITIVE ACTION, 1966-76
Presiding: Dario O. Prieto
IntroductionJohn A. D. Cooper, M.D.
Keynote AddressCharles E. Odegaard, Ph.D.
235
WOMEN IN MEDICINE
November 7
WOMEN IN MEDICINE: ASSESSING THEIR IMPACT
Moderator: Judith B. Braslow
Women in Medicine: An OverviewEstelle Ramey, Ph.D.
Current Status ofWomen III MedIcineMarilyn Heins, M.D.
Traditional Residency Training: The Impacton Personal and Career DecIsionsBarbara A. Korsch, M.D.
The Impact on Hospital Planning
Mitchell Rabkin, M.D.
The Impact on Academic MedicineRosalyn Yalow, Ph.D.
Discussant
Eli Ginzberg, Ph.D.
GROUP ON MEDICAL EDUCATION
November 7
Plenary Session
STUDENT PROMOTION AND DISMISSAL: JUDICIAL
INCURSION IN THE EDUCATIONAL PROCESS
IntroductionRobert A. Barbee, M.D.
Student Rights, the SOCIetal Expectations andInstitutional Responsibility: The JudiCial ViewHonorable Harold H. Greene
Student Rights, the Societal Expectations andInstitutional ResponsibIlity: The InstitutionalViewCarl F. Hinz, M.D.
Panel: Redefinition of Due Process in the EraofJudicial InvolvementMurray Kappelman, M.D.Redefinition of Competence- TheNeed for Valid Educational CriteriaChristine McGuireRedefinition of the Faculty Role in theEducational ProcessVincent A. Fulginiti, M.D.
Regional Meetings
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236 Journal of Medical Education
NovemberS
INTRODUCTION TO CLINICAL MEDICINE
General Session
PHYSICAL DIAGNOSIS: THE STATE OF THE ART
IntroductionRobert A. Barbee, M.D.
Bedside Physical DiagnosisW. Proctor Harvey, M.D.
Simulation TechniquesHoward S. Barrows, M.D.Robyn Tamblyn, R.N.
Teaching Interviewing Skills-An OverviewRay E. Helfer, M.D.
INTRODUCTION TO CLINICAL MEDICINE
Small Group Discussions
Moderator: Dennis O'Leary, M.D.Recorder: Peter Tuteur, M.D.
Moderator: Jerome Berman, M.D.Recorder: H. Verdain Barnes, M.D.
Novemher9
Business Meeting
Small Group Discussions
Primary Care Residencies: Competencies aCurriculum Should Address
Moderator: Richard Reynolds, M.D.
The House Officer as Teacher
Moderator: Russell R. Moores, M.D.
Strategies and Assessment in Medical FacultyDevelopment
Moderator: James W. Lea, Ph.D.
Evaluation and Grading ofMedical Students
Moderator: Winfield H. Scott, Ph.D.
How to Use Audit for Continuing EducationPlanning
Moderator: David Walthall, M.D.
The Current Status and Potential ofInterinstitutional Learning Resources Development
Moderator: Robert G. Crounse, M.D.
INTRODUCTION TO CLINICAL MEDICINE POSTER
SESSIONS
Kodachrome MicroficheRobert Hillman, M.D.
VOL. 53, MARCH 1978
The Use ofVideo-Tape to Teach InterpersonalSkillsGary Kahn, M.D.
Results of a Nationwide Survey of ICMCoursesPeter Tuteur, M.D.
Integration of Interviewing and Physical Examination SkillsJerry May, Ph.D., et al.
A Medical Interview GlossaryJerry May, Ph.D., et al.
Student Faculty Interpersonal RelationshipWorkshopJerry May, Ph.D., et al.
Evaluation ofStudent CompetencyLawrence Tremonti, M.D.
Program EvaluationLawrence Tremonti, M.D.
Evaluation ofPhysical Examination SkillsRobert Petzel, M.D., et al.
ICM CourseDonald MacKay, M.D.
Outline of ICM Course-Clinical SkillsA. David Ginsburg, M.D.
Medical Student Reading Ability: Assessment,Application to Course Requirements, Improving Reading EffectivenessH. Verdain Barnes, M.D., et al.
Learning to Perform the Female Pelvic ExaminationRobert A. Munsick, M.D.William Pond
Introduction to Patient EvaluationHarold Levine
The Physical ExaminationDavid M. Klachko, M.D.
A Technique for Establishing and AssuringStudent CompetencyFrederick Holmes, M.D.
ICM-A Continuity Program for Years Oneand TwoHelen Kornreich, M.D., et al.
"Harvey" -A Cardiology Patient SimulatorMichael Gordon, M.D.
Examination of the Personality-A UniqueLearning Package
Moderator: David A. Sinclair
GROUP ON BUSINESS AFFAIRS
PARTNERSHIP WITH THE GOVERNMENT
Moderator: Jerry E. Huddleston
Federal V,ew-Past, Present and FutureRobert F. Knouss, M.D.
State View - Expansion or RetrenchmentRichard D. Ruppert, M.D.
Institution View- Benefits and CommitmentsGeorge M. Norwood
GROUP ON PUBLIC RELATIONS
237
Thomas A. Rolinson
Prospects for Future Congressional Legislationand National Health InsuranceMarc Ash
AUGUSTUS J. CARROLL MEMORIAL LECTURE
Joseph A. Diana
Busmess Meeting
November 6
November 7
PresIding: J. Michael Mattsson
PUBLIC RELATIONS RESPONSE TO SPECIAL PROB
LEMS
Presiding: Barbara Austin
Senator Hubert Humphrey's OperationT. Gerald Delaney
Reactor Panel: Barbara J. CullitonVictor Cohn
George Washington University MedIcal Centerand the Hanafi MuslimsPatricia Hurley
Gary Gilmore and The Umversity of UtahMedical CenterJohn J. Keahey
November 8
Presidmg: Hugh Harelson
Awards PresentationsRobert G. Petersdorf, M.D.
Guest SpeakerMerlin K. DuVal, M.D.
LIVING WITH FEDERAL LAWS AND REGULATIONS
Presiding: Susan K. Stuart-Otto
Teaching Hospital Viewpomt
COST CONTAINMENT IN THE HEALTH CARE
INDUSTRY
1977 AAMC Annual Meeting
Nancy A. Roeske, M.D.
The Use of Practical Instructors to Teach andEvaluate Physical Diagnosis SkillsPaula L. Stillman, M.D., et al.
The Use of Practical Instructors to Teach theNeurological ExaminationJose Laguna, M.D., et al.
Teaching Strategies for Interviewing Skills inIntroduction to MedicineJerome Berman, M.D., et al.
Evaluation Techmque ofStudents' Progress inPhysical DiagnosisJerome Berman, M.D., et al.
An Experimental Physical DIagnosis in AnOut-Patient SettingThomas McGlynn, M.D., et al.
Teaching the Gynecologic ExaminationLeonard Aaro, M.D.
Teaching Physical Diagnosis SkillsBruce Bucher, M.D.
Teaching Interviewing SkillsBruce Bucher, M.D.
§ Federal Prospects for the Futurer.l:1 Various State Rate-Setting Schemes as Demon-~ stration Projects by the Department of Health,a Education, and Welfare8 Fred Hellingero
Q A State's Approach to Health Care Cost Re-ductionsBernard Forand
Effects of Containment PoliCIes on PatientCare and the Teachmg Hospital ServicesLawrence A. Hill
Effects of Cost Containment on Medical Education
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~ Faculty Development Survey<l) Hilliard Jason, M.D.
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238 Journal of Medical Education
Sidney Lewine
Medical School ViewpointArthur H. Keeney, M.D.
Reactor Panel: Judith RobinsonStephan E. Lawton
November 9
Business Meeting
Presiding: Terry R. Barton
Special Project Awards Presentation
Presiding: Harold E. Kranz, Jr.
Total Program Awards Presentation
Presiding: Harold E. Kranz, Jr.
GME CONTINUING MEDICALEDUCATION PROGRAM
November 8
PREPARATION FOR SELF-DIRECTED LEARNING AS
AN ELEMENT OF OPTIMUM PHYSICIAN PERFOR
MANCE
Moderator: David Walthall, M.D.
Intrinsic Motivation and SelfDirected LearningMerrel D. Flair, Ph.D.
Management and Evaluation as Tools ofSelfDirected LearningHarold G. Levine
Quality of Care and Patient Outcomes asMechamsms to Determine Educational NeedsJohn Williamson, M.D.
The Practicality ofApplying These Principlesto the Clmical Learning SituqtionRobert C. Davidson, M.D.
GSA/GME JOINT PROGRAM
November 10
EVALUATION FOR ADVANCED PLACEMENT
Moderator: Martin S. Begun
Federal Regulations and PerspectivesRobert Knouss, M.D.
Institutional Experience and PerspectivesJoseph P. Tassoni, Ph.D.Marvin R. Dunn, M.D.
VOL. 53, MARCH 1978
Panel Discussion
PLANNING COORDINATORS' GROUP
November 6
INTERNAL INSTITUTIONAL RELATIONSHIPS AND
THEIR EFFECT ON THE PLANNING PROCESS: A
LOOK AT THE 1980s
Moderator: Howard J. Barnhard, M.D.
The President's PerspectiveRobert Q. Marston, M.D.
The Chancellor's PerspectiveJames L. Dennis, M.D.
The Dean's Perspective.Robert L. Van Citters, M.D.
The Planning Coordinator's ResponseRuth H. HaynorMichael T. Romano, D.D.S.
RESEARCH IN MEDICAL EDUCATIONSIXTEENTH ANNUAL CONFERENCE
November 9
POSTER SESSIONS
Interpersonal Problem Solving: A TheoreticalPerspective and Methodology for the Evaluation of Residency Education and Its Relationship to Health Care Processes and OutcomesM. J. Hogan, et al.
Assessing Student Response to Participation ina Simulated Malpractice Trial in a Program ofLaw in MedicineLinda Coulter, et al.
Toward a Comprehensive Methodology forResident EvaluationR. Gallagher, Ph.D., et al.
An Assessment ofthe Effectiveness ofPLATOBasic Medical Science LessonsDiane L. Essex, Ph.D., et al.
PRESENTATION OF PAPERS
OBSERVATIONS IN CLINICAL INSTRUCTION
Moderator: A.M. Bryans, M.D.
Student/Patient Contact-Do the PatientsMind?Ralph R. Hadac, et al.
Moderator: D. Kay Clawson. M.D:
The Evaluation ofTeachl1lg Effectiveness: TheMyths About Student RatingsHoward L. Stone, et al.
Cll1lical Teacher Effectiveness in MedicineDavid M. Irby, Ph.D.
The DIffUSIOn of SelfInstructIOnal UnitsAmong MedIcal School Faculty MembersCharles P. Friedman, Ph.D.
Factors Affecting Time Allocations of TeachIng PhySIcians
and Validity of Complex Multiple Choice,Multiple Response and Multiple True-FalseItemsMark A. Albanese, et al.
An Investigation of Three Types of MultipleChoice QuestionsErnest N. Skakun, et al.
The Effect of Open versus Closed-Book Testing Conditions Upon Performance on a Multiple-Choice Examination in PediatricsCharles F. Schumacher. Ph.D., et al.
A Study ofthe Applicability ofa Truly Objective Measurement Model in Medical EducationGilles Cormier, M.D .• Ph.D.
MULTIDIMENSIONAL EVALUATION OF CLINICAL
COMPETENCE
Moderator: Sarah M. Dmham, Ph.D.
Assessment of Cognitive and InterpersonalSkills in Clinical Problem-Solving - A ComparISon Between CertificatIOn Examinationand Formative EvaluatIOnJ. G. Wakefield, M.D., et al.
Validation of a CardIOlogy SubspeCialty Examination by Faculty Ratl1lgs of Competencies: A Multivariate ApproachJohn A. Meskauskas
Use of an Oral Exam in an Internal MedIcineClerkshipJohn H. Littlefield, Ph.D .• et al.
Consistency in Ratings of Clinical Performance ofthe Same Students Throughout MedIcal School and InternshIpSandra L. Lass, et al.
ISSUES IN FACULTY DEVELOPMENT/EVALUA
TION
239
Moderator: Michael J. Gordon, Ph.D.
MULTIPLE CHOICE TESTING
Moderator: Harold G. Levine
A Comparison of the Difficulty, Reliability
1977 AAMC Annual Meeting
Death Education in Selected Medical Schoolsas Related to Physicians' Attitudes and Reactions Toward Dying PatientsGeorge E. Dickinson, Ph.D., et al.
Teaching the Psychiatric Aspects of Medicine:::: Report ofa SuccessfUl Pilot Experience:2 David H. Rosen, M.D., et al.rJ)
;!.1 Evaluation of the Community Phase of a Re-B glOnalized Medical Education Program8, Mabel L. Y. Moy, Ph.D., et al.
INNOVATIONS IN CLINICAL INSTRUCTION
~ Moderator: Richard M. Caplan, M.D.oB Perceived Abtlity Versus Actual Ability: A~ Problem for Continuing Medical Education"0 Armin D. Weinberg, Ph.D., et al.u
] The Development of a Medical Record Audit...... for Continuing Medical Education§ Vivian Erviti, Ph.D., et al.
<.l:1 Changes in Physician Referral Patterns as a1:! Result ofContinuing Education(1)a J. Maurice Mahan, Ph.D., et al.
8 The Effects ofa Geographic Continuing Edu8 cation Program on Physician Referral Behavior: An Unobtrusive StudyCharles H. Christiansen, et al.
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Senior Medical Students as Patient-PreceptorsIntroduce Basic History and Physical ExamInation Skills to Second Year Medical StudentsH. Verdain Barnes, M.D., et al.
The Nurse Practitioner as a Teacher of Physical Examination SkillsPaula L. Stillman, M.D., et al.
The Effectiveness of Pediatric Nurse Associates as Teachers of Medical Students In Ambulatory Settings
U Helen Johnson, M.D., et aI.
::§ A Modified, Personalized System ofEducation~ for Junior Internal Medicine Clerkship at a
Multi-Campused SchoolRobert Talley, M.D., et al.
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240 Journal of Medical Education
Sunny G. Yoder, et aI.
PRESENTATION OF SYMPOSIA
FACULTY DEVELOPMENT IN CLINICAL TEACHING
Organizer· JosephIne M. CassIe
Chariman: George F. N. Collins, M.B.
ParticIpants: C. Benjamin Meleca, Ph.D.Josephine M. CassieFrank T. Stntter, Ph.D.
Discussant: Hilliard Jason, M.D.
METHODS AND RESULTS IN FOUR STATISTICALLY
EVALUATED ALTERNATIVE APPROACHES TO
TEACHING OF MEDICAL GROSS ANATOMY
Organizer: Weston D. Gardner, M.D.
PartIcipants: Paul H. JonesDavid G. WhitlockShIrley A. GIlmoreJohn E. PaulyNorbert A. JonesJerome SutinWeston D. GardnerF. David Anderson
STUDIES OF THE CLINICAL REASONING PROCESS
OF MEDICAL STUDENTS AND PHYSICIANS
Organizer: Howard S. Barrows, M.D.
PartIcipants: Geoffrey Norman, Ph.D.Victor Neufeld, M.D.John Feightner, M.D.
Discussants· Arthur S. ElsteIn, Ph.D.Bert Sandok, M.D.
ALTERNATIVE MECHANISMS TO ASSESS EDUCA
TIONAL NEEDS IN CONTINUING MEDICAL EDU
CATION
Organizer: Floyd Pennington, Ph.D.
Participants: Floyd Pennington, Ph.D.Paul E. MazmanianJoseph S. Green, Ph.D.Patnck L. WalshThomas C. Meyer, M.D.
November 10
PRESENTATION OF PAPERS
ASSESSMENT OF NONCOGNITIVE CHARACTERIS
TICS
Moderator: Barbara Andrew, Ph.D.
VOL. 53, MARCH 1978
AcademIC and Personal Characteristics as Predictors of Clinical Success in Medical SchoolRobert Murden, et aI.
The Measurement ofAffective Sensitivity: TheDevelopment ofan InstrumentDonald W. Werner, et aI.
Learning Style and Instructional PreferencesofFamily PhysiciansMarcia A. Whitney, et al.
A Theoretical and Practical Approach to Evaluating Clinical SkillsEdward Schor, et aI.
CAREER CHOICE AND PRACTICE STYLES
Moderator: Jo Boufford, M.D.
Recruitment Strategies in the Health ProfessionsEleanor G. Feldbaum, Ph.D.
Medical Speczalty Choice: Replicatlons andExtensIOnsLarry A. Sachs
Factors Influencing Internship/Residency andPractice Locations: Implications for PublicPoliCYHoward L. Stone, Ph.D., et aI.
Styles of Practice ofFemale PhysiciansBetty Hosmer Mawardi, Ph.D.
CLINICAL PROGRAM EVALUATION
Moderator: James V. Griesen, Ph.D.
Problem Solvers or Medical Dictionaries:What Are We Teaching For?Richard Foley, Ph.D., et aI.
A Comparison of Primary Care EducationalExperiences In Two Urban Pediatric Settings,Robert M. Politzer, Sc.D., et aI.
An Internal Review of a Residency TrainingProgramCarole J. Bland, Ph.D., et aI.
Costs ofEducating Child Health AssociatesJohn E. Ott, M.D., et aI.
ISSUES IN SELECTION
Moderator: Howard Teitelbaum, Ph.D.
Experiment in an Early AdmiSSIOns Programat the University of Utah College of MedicineThomas W. Cockayne, Ph.D., et aI.
1977 AAMC Annual Meeting
A Statistical Procedure for Predicting MedicalSchool Graduates' Specialty ChoicesDavid R. McLean, et al.
Do Admission Decisions Predict PerformanceDuring Medical School? A Comparison ofOne Medical School's Rejected and AcceptedAppllcants Who Attended Other SchoolsRobert M. Milstein, et al.
::: The Choice ofRural Practice: A Longitudinal:2 ViewrJ)
rJ) Susan Elder, et al.§(1)
0..
"5o..s:: CURRICULUM DEVELOPMENT AND EVALUATION
~ Moderator: Gary M. Arsham, M.D., Ph.D."'d~ A Monitor for the Medical Curriculum
..§ Robert G. Bridgham, Ed.D.
e Predictors of Impact of a Minorzty Program15' Upon a Medical School\-;
(1) George M. Neely, Ph.D., et al..Do The Development and Use ofa Comprehensive~ Test for Evaluating Decentralized Medical EdZ ucation-the WAMI Experience
Thomas J. Cullen, Ph.D., et al.
u~ Educational Objectives in Rheumatology forMedical StudentsThomas W. Cockayne, Ph.D., et al.
~ PATIENT MANAGEMENT PROBLEMS......'0 Moderator: Gordon Page, Ed.D.
~ Reliability and Validity ofSimulated Problemso as Measures of Change In Problem-SolvingB Skills~ Sereta A. RobInson, et al.oU Measuring the Outcome of Cllmcal Problem-~ SolvingaG. R. Norman, Ph.D., et al.
eAn AnalysIS of the Problem-Solving Process': of Third-Year Medical Students~ Edetll E. Ekwo, M.D.
§ Clinical Problem Solving: The RelatIOnship ofg Cognitive Abilities to PMP PerformanceQ
241
Martin J. Hogan, et al.
PRESENTATION OF SYMPOSIA
MEDICAL PROBLEM SOLVING: CAN IT BE
TAUGHT?
Organizer: Eta S. Berner, Ed.D.
Chairman: Chnstine McGUIre
Participants: E. FeinsteinH. G. LevineHoward Barrows, MD.Robyn TamblynSarah Sprafka, Ph.D.Arthur Elstein, Ph.D.Eta S. Berner, Ed.D.Lawrence P. Tremonti, M.D.
SUMMER PREPARATORY PROGRAMS FOR MINORITY
STUDENTS
Organizer: Paul S. Rosenfeld, M.D.Participants: William Wallace, Ph.D .
Anthony Clemendor, M.D.A. C. AtenCIO, Ph.D.F. Marvm Hannah, Sr.
CAREER PLANNING IN MEDICAL SCHOOL. PROC
ESS AND APPROACHES
Orgamzer: George H. Zimny, Ph.D.
Chairman: Betty Hosmer Mawardl, Ph.D.
Participants: Edwin Hutchms, Ph.D .Thomas Brown, Ph.D.Bill D. Burr, M.D.George H. Zimny, Ph.DRosalia Paiva, Ph.D.Deane R. Doolen
THE WOMAN PHYSICIAN: RECENT RESEARCH PER
SPECTIVES
Orgamzer: Dorothy Rosenthal Mandelbaum,Ph.D.
Participants: Judith B. BraslowElizabeth McAnarney, M.D.Mary Walsh, Ph.D.Dorothy RosenthalMandelbaum, Ph.D.
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:Message from the President
245
:::9~ John A. D. Cooper, M.D.E(1)
0..The past year has been one of high expectations for the academic medical centers. It wasassumed by many that a new Administrationworking with a Congress dominated by members of the same party would bring normalcyback to the government and, acting together,they would undertake thoughtful and constructive initiatives to get the nation movingagain. There was hope that we would bespared the enervating battles of the past fewyears and be able to reestablish the privatesector-government relationships that strengthened medical education, biomedical researchand medical services so dramatically in the
U 1950s and early 1960s.::§ These expectations have not yet been met.~ The President and the large staff of Georgians
he brought to Washington have largely been(1)':5 occupied during the first nine months in office
....... projecting the image of Jimmy Carter as a~ leader who will bring normalcy and respect§ back to the federal government. There hasB been little follow-up of campaign promises or~ development of explicit policies and specific"0 legislation. The White House has had to~ learn, often the hard way, how to operate on
':5 the Washington scene and establish construcS tive relationships with the Congress. Theo wholesale removal of key agency heads in the
<.l:1 Department of Health, Education, and WeI~ fare before Inauguration Day and the delayS in replacing them and in appomting an Assist8 ant Secretary for Health have exacted theiro toll on programs vital to the academic medical
Q centers. It has been difficult for the bureaucracy to understand and partiCIpate in Secretary Califano's unconventional style of management. His sharp rhetonc has often createdheat rather than shed light on the subject. Asa consequence, we remain mostly m the darkon Administration policies on health matters.
At the President's request, the Congresspostponed substantive action on expiring legislation for the National Cancer Institute, theNational Heart, Lung, and Blood Instituteand the support of biomedical research training. Thus, there has been no clear enunCIatIOnof policy on biomedical research and training.The fears engendered m a group of Universitypresidents who met with President Carter bythe questions he seemed to have about thevalue of basic research have been somewhatallayed by a clarification provided by FrankPress, the PreSIdent's science advisor.
While Administration policies on manyhealth issues remain a mystery, there hasbeen no equivocatIon on controllIng healthcare costs. Viewed as a necessary precursorto national health insurance, cost control ISthe Administration's number one pnorIty andonly real initiative to date in the health fIeld.In addition to emphasizing preventive medIcine, education of the publIc, and the promotion of alternative delIvery systems, the Carterplan would impose a 9 percent cap on increases m hospItal expenditures. Agreementof the House and Senate on cost controllegislation may not be achieved before adjournment, but it is almost certain to beenacted m some form dunng the next sessIonof Congress. The teaching hospitals face adifficult challenge in maintainmg their critIcalcontributions to education, research, and service undergrowmg governmental restrictIonsand regulation.
The long-awaited health manpower law, inmany respects infinitely better than earlIerbills conSIdered by the House and Senate,was seriously flawed by the now mfamous"USFMS proVIsion." While the schools wereunanimous in their opposition to ItS infringement on the fundamental academIC declsion-
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246 Journal of Medical Education
making process, it was not clear how manyinstitutions would or could refuse to comply.Even less clear was how the program wouldoperate, if It could be administered at all.The confusion over the section was best summanzed by Federal District Court Judge Edward Becker, who, in ruling against Guadalajara students seeking enforcement of the provision this year, called the law "far from amodel of lucidity."
The officers and Executive Council of theAssociation wrestled uncomfortably with thepolitical dilemma of seeking amendment ofthe law at the risk of gaining little or nothingwhile sacrificing other provisions. Whileworking to obtain legislative relief, we alsolabored hard to get regulations which wouldmake this program manageable and maximizeits acceptability to the schools. The Congresswas finally convinced to reexamine this section of the manpower law and to initiateconstructive amending legislation. But themedical schools may yet pay a price for thisactivity. With the law now reopened for
VOL. 53, MARCH 1978
amendment, Congressional reconsideration ofother capitation conditions has been promisedfor next year. It appears that we will haverolling legislation, subject to review andchange each year, providing little of the stability for which we had hoped.
Despite these problems, there is somecause for advancing our great expectations tothe next year. Although we clearly cannotexpect a return to the climate of the Sixties,particularly where federal expenditures areconcerned, several of the Administration'sappointments in the health and science areasoffer hope for enlightened leadership in thefuture. If this leadership is assertive, perhapsthe Administration and Congress can beginto work more effectively with the privatesector in confronting the serious health problems that face the nation. Given proper roles,the academic medical centers can participatein the development of solutions. Given inappropriate roles, their ability to make uniquecontributions to society may be lost.
Administrative Boards of the Councils, 1976-77
Executive Council, 1976-77
• deceased•• Dr. Gronvall served as chairman from No
vember 1975 until April 1977 when Dr. Krevansbecame chairman. Dr. Krevans will serve untilNovember 1978.
Christopher C. Fordham, IIINeal L. Gault, Jr.Julius R. KrevansWilliam H. LuginbuhlClayton RichChandler A. Stetson·Robert L. Van Citters
COUNCIL OF TEACHING HOSPITALS
David D. Thompson, chairmanDavid L. Everhart, chairman-electJohn W. CollotonJerome R. DolezalJames M. EnsignRobert M. HeysselBaldwin G. LamsonStuart MarylanderStanley R. NelsonMitchell T. RabkinMalcom RandaUJohn ReinertsenRobert E. ToomeyCharles B. WomerWilham T. Robinson, AHA representative
David L. EverhartRobert M. HeysselDavid D. ThompsonCharles B. Womer
COUNCIL OF TEACHING HOSPITALS
ORGANIZATION OF STUDENT
REPRESENTATTVES
Thomas A. Rado, chairpersonPaul Scoles, chairperson-electRobert BernsteinRobert H. CassellMargaret ChenJessica FewkesCheryl GutmannJames MaxwellRichard S. SeiglePeter ShieldsJon Christopher Webb
ORGANIZATION OF STUDENT
REPRESENTATIVES
Thomas A. RadoPaul Scoles
247
Ivan L. Bennett, Jr., chairmanRobert G. Petersdorf, chairman-electJohn A. D. Cooper, president
Council Representatives:
COUNCIL OF ACADEMIC SOCIETIES
DISTINGUISHED SERVICE MEMBER
Kenneth R. Crispell
COUNCIL OF ACADEMIC SOCIETIES
COUNCIL OF DEANS
Stuart BondurantJohn A. Gronvall
COUNCIL OF DEANS
John A. GronvaU"§ Julius R. Krevans··
<.l:1 Steven C. Beering1:! Stuart Bonduranta Christopher C. Fordham, III8 Neal L. Gault, Jr.o William H. Lunginbuhl
Q Clayton RichChandler A. Stetson·Robert L. Van Citters
A. Jay BoUet, chairmanU Robert M. Berne, chairman-elect
~F. Marion BishopEugene BraunwaldCarmine D. Clemente
~ G. W. N. Eggers, Jr..::: Daniel X. Freedmano Rolla B. Hill, Jr.~ Thomas K. Oliver, Jr.oB Roy C. Swan
Samuel O. Thier~"0 Leslie T. Websteru<l)
..s::......
:::9i2 Robert M. Berne§ A. Jay Bollet<l) Rolla B. Hill, Jr.0.. Thomas K. Oliver, Jr."5o..s::~'"d
<l)u.go\-;
0..<l)\-;
<l)
.Do......
......oZ
248
ao<.l:1
The Councils
Executive Council
The Executive CouncIl met four times dunngthe year, acting on a wide range of issuesaffecting the medical schools and teachinghospitals. The councIl considered a numberof policy questions referred for action bymember institutions or by one of the constituent councils. Except where immediate actionwas necessary, all policy matters were referred to the constituent councils for dIscussion and recommendation before final actionwas taken.
The retreat of the elected officers andexecutive staff was held 10 December prior tothe first meeting of the Executive Council.The retreat participants reviewed the membershIp structure of the Association, partIcularly ItS relationship to member institutionsand organizations representing universitypresidents and vice presidents for health affaIrs. The retreat focused most of its attentionon major issues eIther of Immediate concernor whIch were expected to confront the AssocIatIOn within the coming year. Specificallydiscussed were national health insurance, efforts to amend the National Labor RelationsAct to cover housestaff, strengthening theOrgaOlzation of Student Representatives, andimplementation or possible modification ofthe new health manpower law.
At Its January meetlOg the ExecutiveCouncil reVIewed and approved the detailedreport of the Officers' Retreat. ExtensivediscussIOn on the health manpower law produced agreement with the retreat recommendation that the Association not seek modification of the law. Although there was unanimous agreement on the undesirability of thecontroversial USFMS provision, councilmembers felt that there was little chance formodification and that other parts of the newlaw should not be jeopardized. It was feltthat the potentially harmful effects of this
provision could be alleviated by implementingregulatIOns which were sensitIve to the pOSItion of the schools. The council asked theAAMC staff to work closely with HEW regulation writers in order to assure the smoothope!atlOn of this program.
Another provision of the new health manpower law came under close Executive Council scrutiny. New limitations on the grantingof visas to alien physicians were stronglysupported by the Executive Council. However, council members supported a one-yearblanket waiver of the new law in order toallow the appropriate examinations to be putinto place. The Executive Council pressed forspeedy implementation of tht:se provisionsfollowing the one-year hiatus, while supporting a narrow exception to allow distinguishedphysician visitors to enter the country.
Consistent WIth these new limitations onexchange VIsitors, the Executive Councilasked the Liaison Committee on Graduate.Medical Education to withdraw recognitIOnof ECFMG certification based upon passingthe ECFMG exammation and to require instead that all physicians educated in medicalschools not accredited by the Liaison Committee on Medical Education be required tohave ECFMG certification based upon passing Parts I & II of the National Board ofMedIcal Examiners examination or an equivalent examination prepared by the NBME inorder to be eligIble to enter accredited graduate medical education programs in the UnitedStates.
The Executive Council continued its carefulperiodic review of the actions and activitiesof the Coordinating Council on Medical Education and the three accreditlOg liaison committees. Of particular concern this year wasthe staff support provided by the AmericanMedical Association to the CCME and theLiaison Committee on Graduate Medical Education. Although each of these groups has
249
Two major AAMC task forces appOintedduring the previous year presented Interimreports to the Council thiS year. The TaskForce on Student FinanCing, chaired by Dr.Bernard Nelson, analyzed the shortcomingsof current student financial aid programs andproposed a new federal Guaranteed StudentLoan Program which would have more support from the banking community. The TaskForce on Minority Student Opportumtles inMedicine, chaired by Dr. George Lythcott,presented a series of recommendations onrecruitment, retention, counselling, and assessment of minority students. Final reportsfrom each of these task forces are expectedduring the coming year.
The Executive CounCil continued to enterImportant legal disputes where It felt that th<;issues before the court were of general andmajor concern to the medical schools andteaching hospitals. The ASSOCiation filed anamicus curiae brief in the United States Supreme Court In the case of Regellls of theUniversity of Califorilla v. Bakke, asking thatthe court uphold the constitutionality of special minority admiSSIons programs In medicalschools. The ASSOCiation also filed an am/cllsbrief in the case of Koulllz v. State UllIversityof New York, asking the New York SuperiorCourt to reverse the lower court ruling thatthe school's faculty practice plan was an unlawful confiscation of personal income. Atthe request of several New York hospitals.the Association fJled several briefs in NewYork state and federal courts urging that theNational Labor Relations Board had preempted state labor boards from taking jUrisdiction over hospital/housestaff relations. Aruling by the United States Court of Appealsfor the Second Circuit agreed with the Association's position.
The Executive CouncJl thiS year respondedto a request from the liaison Committee onSpecialty Boards for an Association positionon recognitIOn of emergency medicine as anew specialty. The Executive Council at firstagreed that the AssociatIon should take nosubstantive position on thiS question, Indicatmg that these broad policy deCISions fallwithin the scope of review of the CCME. Thecouncil also asked that the petitionmg boardbe required to present a detailed statement of
AAMC Annual Report for 1977
discussed possible changes in staffing and itsImplication on the financing of the organizations, no concrete proposals have yet beenadvanced. Staffing and financing of theLCGME, which now reviews the actions of
::: Residency Review Committees and accredits:2 all programs of graduate medical educationi2 in the United States, will continue to be a§ major issue in the coming year.<l) The Executive Council continued to review0..
all policy-related actions of the LCME, thisyear approving LCME GUidelines to theFunction and Structure of a Medical School.These guideHnes elaborate on the publishedaccreditation policy contained in the document "Function and Structure of a MedicalSchool," and are designed to assist site visitteams in evaluating the programs of an institution. In response to a request from theOffice of Education and its Advisory Committee, which reviews all federally recognizedaccrediting agencies, the Executive Councilagreed to reiterate its delegation to the LCMEof final authority on all accreditation decisions. The Executive Council also authorizedthe LCME to develop its own prospectivebudget, to establish formal criteria for theappointment of members, and to adopt Its
~ own operating procedures. The Executive...... Council reserved authority to grant final ap4-<o proval to the establishment and revision of~ educational standards.o In response to a recommendation of theB retreat, the Executive Council appointed two~"0 major task forces. The first, the Task Forceu on Graduate Medical Education, was charged~ with reviewing the entire field and presenting...... recommendations to the Executive Council§ on how graduate medical education in the
<.l:1 United States should develop programmati-1:! cally, structurally, and institutionally. This<l) task force is chaired by Dr. Jack Myers of the§ University of Pittsburgh School of Medicine.Uo The second, the Task Force on the Support
Q of Medical Education chaired by Dr. StuartBondurant of Albany Medical College, hasbegun discussions with key federal policymakers in pursuit of its charge of recommendIng to the Executive Council appropriatemechanisms for federal support of medicaleducation after the expiration of the currenthealth manpower law.
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250 Journal of Medical Education
the financial impact of recognition of a newspecialty. Following LCSB approval of theformation of an American Board of Emergency Medicine, the Executive Council appointed a small working group to recommendan AAMC position when this matter camefor a final vote before the American Board ofMedical Specialties. The Executive Counciladopted the working group's recommendationthat a conjoint board in emergency medicinebe established with mandatory representationfrom family practice, internal medicine, pediatrtcs, and surgery.
Members of Congress asked the ExecutiveCouncil to take a position on the continuedfederal support of the Uniformed ServicesUniversity of the Health Sciences, which hadbeen opposed by the Carter Administration.The Council reaffirmed its position that theAssociation should only speak to the qualityof the educational program at the militarymedical school and should not take sides onthe politIcal controversy of its cost effectiveness. It was agreed that the Associationshould help place currently enrolled USUHSstudents in other U.S. medical schools andshould assist the faculty in finding new positions If the Congress decided to close theschool. Congress subsequently voted to continue funding for at least one year.
The Executive Council adopted indepthresponses to several major studies affectingacademIC medicine. An HEW proposal forcredentialling health manpower was reviewedat considerable length with council membersexpressing concern over the economic impactof increased speCialization and credentiallingof health personnel. A Government Accounting Office report, "Problems in Training anAppropriate Mix of Physician Specialists,"was generally supported by the council members. Its recommendation that the CCMEaccept the responsibility for recommendingthe appropriate distnbution of residencies wassupported, but it was agreed that the CCMEshould not be responsible for enforcing orimplementing these recommendations. A NatIOnal Academy of Sciences report on "HealthCare for American Veterans" was analyzedby the Executive Council and support expressed for expanding and strengthening affiliation agreements between medical schoolsand VA hospitals.
VOL. 53, MARCH 1978
At the request of the Council of Deans,the Executive Council appointed a smallworking group to consider the ethical issuesraised when physicians withhold patient services in order to accomplish financial or political objectives. The Executive Councilagreed that the Association, as the representative of academic medicine, should take astand on this moral dilemma. The workinggroup will prepare a recommendation for theExecutive Council, which will ultimately bepresented to the AAMC Assembly.
During the year the Executive Council continued to oversee the activities of the fiveAssociation Groups. Rules and regulationsrevisions were approved for several of thesesub-council organizations and guidelines wereapproved for the newly created Minority Affairs Section of the Group on Student Affairs.The Association receives progress reports onGroup activities twice each year.
The Council's Executive Committee metprior to each Executive Council meeting andby conference call on numerous occasionsthroughout the year. The Committee metwith HEW Secretary Joseph Califano in Juneto discuss issues of major concern to theacademic medical centers and to inform theSecretary about ways in which the Associationmight be of assistance.
The Executive Council, along with theAAMC secretary-treasurer, Executive Committee, and Audit Committee maintainedcareful surveillance over the fiscal affairs ofthe Association and approved a moderatelyexpanded general funds budget for fiscal year1978. At the recommendation of the ASSOCIation's legal counsel, the Executive Councilhas approved and recommended to the Assembly a Bylaws amendment adding a provision for the indemmfication of AAMC officers and directors.
Council of DeansThe Council of Deans sponsored three programs at the 1976 Annual Meeting in SanFrancisco. The first program was cosponsoredwith the OSR and entitled "EducationalStress: the Psychological Journey of the Medical Student." This program featured a keynote address dramatizing and describing manyof the anxieties and conflicts students experi-
251
mittees concerned with accreditation, the sta·tus of the new MCAT, and progress reportsfrom the AAMC Groups. Under new businessthe council discussed the impact of the recently enacted health manpower legislationand passed a resolution in opposition to theprovision mandating acceptance of U.S. students in foreign medical schools. Finally, thecouncil expressed its unanimous appreciationfor the service of Dr. J. Robert Buchanan,who had resigned as the council's chairmanelect.
The Administrative Board met quarterlyto carry on the business of the council. Itdeliberated on all Executive Council items ofsignificance to deans. Of particular interest tothe board was sharing with the OSR Administrative Board its understanding of the impactof placing house staff negotiations under theprovisions of the National Labor RelationsAct. This topic was a subject of discussion ata joint dinner of the two boards. The boardwas also particularly concerned about theethical issues raised by the increased tendencyof groups of physicians to withhold professional services as a means of pursuing personal or political objectives. Thus, the boardinitiated consideration of this matter by theExecutive Council and stimulated the appointment of a committee to study and recommend an Association position.
The Council of Deans held its Spring Meetmg in Scottsdale, Arizona, continuing thetradition of an annual three-day retreat devoted to an issue of current significance todeans. The theme of the program "GraduateMedical Education: Do We Have To DoBusiness in the Same Old Way?" was elaborated on by 22 speakers and panel members.Fourteen Canadian deans, four COD distinguished service members and the COTHchairman joined with 91 institutional representatives for a comprehensive look at theissues surrounding the role of the medicalschool in graduate medical education. Anhistoric retrospective traced the factors leading to the recommendation that the universitybegin to assume comprehensive responsibilityfor medical education through the graduatelevel and was followed by a status reportderived from the recent experience of theNIRMP. The underlying public concernswhich suggest the prospect of increasing con-
AAMC Annual Report for 1977
ence in medical school. This was followed byfour student presentations elaborating perceptions of the major causes of the stressesthey face: inadequate role models, inappropriate grading and evaluating systems, too
::: many demands on their time and financial:2 burdens. The program concluded with a deanrJ)
rJ) describing his perspective on the institutional§ causes of stress and how it could be managed8, or reduced in the medical school setting. The
second program was entitled "Current andChoice: Developments in Medical Education." Representatives of six schools describea wide variety of imaginative developmentsat their own institutions. Subjects coveredmcluded innovative outreach service and educational programs, the development of moreeffective medical school-hospital relationships, an interdisciplinary curriculum on socialand moral values, an institutional program oncomprehensive primary patient care education, and experience with an independentstudy program. The third program was cosponsored with the Council of Teaching Hos-pitals and focused on the activities of the
~u CClmmission on Public General Hospitals.
The two major presentations elaborated theapproach of the commission to dealing with
~ Issues for state university-owned hospitals and.::: those related to big city public teaching hoso pitals.~ The November Business Meeting included:2 a presentation of reports from the Chairman,~'--' the President, and representatives from se-~"0 lected AAMC committees. The activities ofu the Association for Academic Health Centers~ were described in detail. The council en...... dorsed the Executive Council recommenda§ tion that the AAMC Bylaws be amended to
<.l:1 authorize a second voting OSR representative1:! on the Executive Council. The Chairman ofa the Association's Data Development Liaison8 Committee reported on that committee's deo liberations regarding recommended policies
Q and procedures for handling medical schooldata maintained by the AAMC. In its discussion of the program ahead, the council reviewed the planning for its 1977 Spring Meeting and considered items to be presented tothe AAMC Officers' Retreat. The councilreceived a number of items for informationmcluding a report on the Coordinating CouncIl on Medical Education, the Liaison Com-
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252 Journal of Medical Education
trol by government and third party carnerswere sketched by several speakers. Alternatemodels for preparing the physician for practice whIch would integrate more closelypremedical, medical, and graduate medicaleducation were proposed as ways to implement the concept that the award of the M.D.degree should be based on the demonstratedcompetence to practice medicine independently. The institutional response to the concept of corporate responsibility for graduatemedical education was discussed and one particularly successful experience was described.Finally, a Canadian dean provided a lucidand comprehensive review of the Canadianexperience with substantial governmental involvement in medical care and medical education in that country. The meeting concludedwith a business session which provided forgeneral dIscussion of many matters of concern. The council endorsed the proposal thata telephone alert network be established as ameans of informing the Institutions of urgentmatters requiring theIr immediate response.The meeting closed with a comprehensivereview of the Bureau of Health Manpower'sapproach to the Implementation of some ofthe more complex and controversial provisions of the Health Manpower Act.
In June, the Administrative Board resolvedto dedicate the Proceedings of the SpringMeeting to the late Dr. Chandler A. Stetsonin recognition of his substantial contributionto the AAMC, including his service as chairman of the 1977 Spring Meeting programplanmng committee.
Council of Academic SocietiesThe Council of Academic Societies made significant progress in coordinating the activitIesof its members and improving their interactions with the AAMC, with each other, andwith the public sector.
During 1976, a number of CAS societiesevinced growing concern about the increasingfederal intrusIon into all of the activities ofacademic medical centers. The societies expressed their desire for increased participationin the legislative and executive process. Responding to these Interests, the CAS spon-
VOL. 53, MARCH 1978
sored a public affairs workshop last December. The objective of the workshop was toacquaint the public affairs representativeswith the intricacies of Congressional and Executive branch procedures. More than 30newly appointed public affairs representatives, who will assume primary responsibilityfor interfacing with their members and theAAMC in the arena of public affairs, attendedthe workshop.
The CAS Brief, first published in the fallof 1975, now appears quarterly and is circulated to the officers and official representatives of the 61 member societies. Additionally, eight societies now distribute the Briefto all their members. This brings the totalCAS Brief circulation to just under 8,000readers. In response to a recent poll, 16additional societies expressed interest in distributing the Brief to another 12,000 individuals.
Forty-seven societies were represented atthe CAS Interim Meeting at the AAMCHeadquarters in June. Current policy issuesin biomedical research, medical education,and health care involved the participants in avigorous exchange of information. Of foremost interest was the matter of legal restraintson the freedom of inquiry as proposed inlegislation to regulate recombinant DNA andclinical laboratory research. As a result ofthis meeting, many societies individually contacted key pohcy makers. Another IntenmMeeting is planned for January 1978. Stimulated by' a request from the Association ofProfessors of Medicine, a CAS Services Program has been established on a two-yearexperimental basis. This provides an opportunity for member societies to obtain certainservices through the staff and facilities of theAssociation. These services include maintainIng membership lists, providing billing andaccounting services, making plenary and committee meeting arrangements, and preparingnewsletters and memoranda on subjects ofspecial interest to a society. It is anticipatedthat the Services Program will further solidifythe CAS and enhance its effectiveness indealing with the multiple challenges facingacademic medicine. During the two-year experimental period, the best approach to pro-
IAAMC Annual Report for 1977
I viding services on an affordable basis to allmember societies will be sought.
253
view, government health care programs-including Medicare - must eventually replacepresent payment approaches reqUIring individual pattent bills and records In order toavoid being buned in an ever increasingamount of paperwork.
At its March meeting, the board devotedthe majority of its attention to the reportfrom the Association's Ad Hoc Committee toReview the Talmadge Bill. The board recommended that the Executive Council modifythe committee's recommendations on statecost control programs and the classificationof tertiary care/teaching hospitals beforeadopting the report as Associatton policy.These changes were approved by the Executive Council and the revised report providedthe basis for the AssociatIOn's subsequenttesttmony on the Talmadge Bill.
Robert A. Derzon, the first administratorof HEW's new Health Care Financing Administration and a former COTH chairman,met with the board at its June session. HereVIewed the reorgamzation of health financing activities within HEW and descnbed someof the organizattonal problems faced byHCFA. Mr. Derzon concluded by emphasizIng Secretary Califano's commitment to theCarter Administratton's cost containmentproposal.
At its June business meeting, the boardreVIewed the Administration's proposed"Hospltal Cost Containment Act of 1977."David Everhart, COTH chairman-elect andchairman of the aSSOCiation's ad hoc committee on the Administration's hospital cost control proposal, summanzed the committee'sanalySIS of the Administration's proposal andreviewed policy positions recommended bythe committee. The board strongly supportedthe committee's analysis and recommendations.
At the September meeting Joseph Onek,associate director of the Domestic Council,reViewed the Administration's health poliCies,especially its proposal to limit hospital revenues and capital expenditures.
As a result of the Carter AdmimstratlOn'sdecision to advocate an immediate short-termprogram to modify the rate of hospital costincreases, this year's Administrative Board
Council of Teaching HospitalsBecause reimbursement limitations and legislated cost containment programs can threatenthe financial stability of teaching hospItals byfailing to adjust for cost differences resultingfrom atypical diagnostic patient mixes andmore intensive patient services, the council,at its annual business meeting, sponsored areview of current developments in quantifyingdiagnostic case mix. Clifton R. Gaus, directorof the Division of Health Insurance Studiesof the Social Security Administration, reviewed the federal concern with the costs ofdiffering case mixes using data from the MedIcare program; Professor John Thompsom ofYale University described an ongoing research program in patient classification that isproviding an essential methodological basefor several case mix studies in COTH memberhospitals; Charles Wood, director of the Massachusetts Eye and Ear Infirmary, reviewedhis hospital's practice of charging patients forroutine services based on the intensity ofservice provided; and Baldwin Lamson, director of the UCLA Hospital and Climes, demonstrated how case mix at UCLA had beenused to explain and document changes in thehospital's budget.
~ During the year, the COTH Administrative:2 Board held quarterly meetings to develop thet)~ Association's program of teaching hospital"0 actIvities and to consider and act on all matU ters brought before the Executive Council of~ the Association. Preceding three of the board~ meetings, evening sessions were held to pro-§ vide seminar discussions on specific issues of
<.l:1 concern to teaching hospitals.At the January meeting, Thomas M. Tier
ney, director of the SSA Bureau of HealthInsurance, reviewed controversial policIesand issues faced by the Medicare program.In a dialogue wIth board members, he discussed federal concerns and decisIOns on thetreatment of nursing education costs and reviewed their implications for medIcal education program expenses. Mr. Tierney concluded by suggesting that, in hIs personal
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254 Journal of Medical Education
activities were heavily focused on proposalsto change the Federal Government's hospitalpayment practices. Other major topics of attention included legislation and court suitsdesigned to define house staff as employeesfor purposes of the National Labor RelationsAct, proposed JCAH guidelines for surveyinguniversity-owned hospitals, and the Association's management advancement program forCOTH executives.
Organization of StudentRepresentativesIn its sixth year of operation, membership inthe Organization of Student Representativescontinued at a high level, with 112 of thenation's medical schools represented. At the1976 Annual Meeting, over 100 studentsrepresenting 94 schools attended businessmeetings, discussion sessions, and a jointOSR-Council of Deans program entitled,"Educational Stress: The Psychological Journey of the Medical Student."
Also at the Annual Meeting, OSR representatives approved a revision to the OSRRules and Regulations to provide for theoffice of Chairperson-Elect. As a result ofthis action and of a change in the AAMCBylaws, approved subsequently by the Assembly, the OSR now holds two voting seatson the AAMC Executive Council.
During the year, the OSR AdministrativeBoard held quarterly meetings to discuss issues of concern to medical students and toact on all matters brought before the Executive Council. In a joint meeting last January,the OSR and COD administrative boardsshared widely differing viewpoints on housestaff unionization. At this session and at othertimes during the year, the OSR urged the
VOL. 53, MARCH 1978
AAMC to seek ways of improving the educational and patient care aspects of those graduate training programs which participatinghouse officers consider marginal in quality.
The OSR, through its members on AAMCtask forces, maintained keen interest duringthe year in the problems of medical studentfinancing, in the opportunities for minoritiesin medicine, and in graduate medical education.
A continuing priority for the OSR duringthe year was the problem of stress in medicaleducation. This spring, the OSR surveyedstudents and student affairs deans of all U.S.medical schools to learn the types of psychological counseling that are offered by theschools and those counseling systems thatseem to be most effective in meeting theneeds of students.
In an effort to improve communicationsbetween the OSR and the approximately60,000 U.S. medical students, the Association began publishing, on a trial basis, anewsletter to be distributed free-of-charge toall medical students. The OSR Report is intended to inform medical students of thenature and scope of the AAMC's involvementin national policy issues affecting medicaleducation. The two editions published to datewere distributed to all medical students viathe local OSR representatives.
As in previous years, the OSR held regional spring meetings in conjunction withthe AAMC Group on Student Affairs andthe regional Associations of Advisors for theHealth Professions. These meetings traditionally provide an opportunity for OSR representatives to interact with medical school student affairs officers and to learn about activities and programs of the AAMC.
255
National Policy
During the past year the Association hasoperated within a national arena that has
::: undergone dramatic changes since the last9fa Annual Meeting. The election of 1976 pro-S duced a new President, eighteen new sena-l-; •
8, tors, and siXty-seven new members of the"5 House of Representatives. These changes.B brought a new Administration to Washington,~ including a new cast of characters in the top
"g health positions in DHEW, and caused au
..§ realignment of the leadership in both houses~ of Congress. In addition, the Senate made ane effort to bring more efficiency to its opera~ tions by reorganizing its committee system.8 for the first time since 1946.~ The new Administration got off to an un-
certain start in health when, following the~ appointment of a new Secretary, several key~ senior health officials were quickly swept from<l) office. Despite the uncertainty of who would
':5 comprise the health leadership, the Associa-4-<o tion made a vigorous effort to inform therJ)
§ Carter health leaders about the AAMC, itsB constituency, and its position on relevant is~ sues. Association staff met with members of<3u the Carter transition team prior to the inau<l)
':5 guration and with other top officials thereaf-§ ter, culminating in a meeting between the
<.l:1 Association's Executive Committee and~ HEW Secretary Joseph A. Califano, Jr., inS June. Association staff also conveyed similar8o information to new members of the staffs of
Q the Congressional health committees.Even though President Carter had an
nounced that it would take over a year toprepare his promi~ed national health insurance proposal, in April he submitted a majorlegislative proposal designed to reduce therapid rate of increase in health care costs. Asthis year's only major initiative in the healtharea, the Congress immediately seized uponcost containment as one of the major itemsfor consideration during the 95th Congress.A series of hearings was quickly held by the
four House and Senate subcommittees withjurisdiction over the legislation, and four alternative pieces of legislation were developed.Senator Herman Talmadge CD-Ga.), chairman of the Subcommittee on Health of theSenate Committee on Finance, reintroduceda revised version of the Medicare and Medicaid Administrative and Reimbursement Reform Act which he had originally sponsoredduring the last Congress as still another viablealternative to the President's proposal. Intestimony presented to both House and Senate subcommittees, the Association stronglyopposed the Administration's proposal, contending that it was unreasonable in the shortrun to place arbitrary controls on a singlesector of the economy and in the long runwould have adverse effects upon our nation'sability to rationally limit hospital expenditures. The Association was generally supportive of the Talmadge bill and recommendedseveral modifications to provide more flexibleprovisions. In developing a position on behalfof the medical schools and teaching hospitals,the Association relied on two ad hoc committees, one which reviewed the Talmadge biIIand one which reviewed President Carter'shospital containment proposal.
The Association's officers and staff devotedconsiderable time and attention this year tothe implementation and reconsideration ofthe Health Professions Educational Assistance Act of 1976, which became law in October of 1976. As the Bureau of HealthManpower, DHEW, began the formidabletask of developing regulations to implementthis act, it became apparent that major technical problems existed and that the development of regulations would be a nearly impossible task. Most controversial among the provisions of the new law was Title V, whichmakes the receipt of capitation awards contingent upon the medical school reserving spacesfor the transfer of United States citizens en-
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rolled in foreign medical schools. This sectionprecluded schools from refusing to admitthese students on academic grounds if theyhad passed Part I of the National Boardexamination. Although the insertion of thetransfer provision during the House-Senateconference on the manpower bill came as acomplete surprise to the AAMC, the Association, after a survey of the deans, urged thatPresident Ford sign the bill while indicatingthe desirability of amending it at a later date.The opposition of the medical schools to thisprovision was underscored at the 1976 Annual Meeting when the Council of Deansadopted a resolution condemning this provision for intruding into the academic prerogatives of the institutIOns. Since that time, theAssociation has actively participated in thewriting and reviewing of regulations to mmimize the intrusiveness of the provision andhas constantly explored the possibility ofmodifying or deleting the provision. Largelydue to the efforts of the Association membership and the university community, Congresshas begun to move toward modification ofthe onerous part of this provision.
Another provision of the new health manpower law, designed to curtail the immigration of foreign trained physicians, requiredsubstantIal AAMC mvolvement to implement. The AssocIation participated in discussions leading to the establishment of a VisaQualifying Examination for foreign physicians, and supported the one-year generalwaiver of this requirement until the VQEcould be offered. The Association has opposed a further extension of this waiver, feeling that the objectives of the law are laudableand that it should be enforced. Only to theextent that foreign physicians are unable topass the VQE or the English language requirement of the law and thus be deemedunqualified would this law be exclusionary.The Association supported a carefully limitedexemption from these requirements for distinguished Visitors.
In addition to involving itself with the implementation of the 1976 health manpowerlaw, the Association has begun to prepare forthe renewal of this legislation in 1980. ATask Force on the Support of Medical Edu-
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cation was appointed and charged with recommending an AAMC position and strategyin anticipation of Congressional reconsideration.
The federal appropriation process wascomplicated this year by the passage of severalpieces of authorizing legislation after enactment of the 1977 appropriation and by themid-year change of Administration. Fundingof the new health manpower law required asupplemental to the 1977 appropriation,which the Congress passed in May. Enactment of the 1978 Labor-HEW bill has beenconsiderably more difficult. President Carter'sbudget request for 1978 acknowledged thathis Administration had not had time to revisesubstantially the budget submitted by PresIdent Ford. The Congress realized this andsignificantly increased funding levels in several key areas, negotiating a compromise withthe Administration at one point to avoid thethreat of a veto. The Association workedwith the Congress to overcome efforts toreduce capitation support by those disenchanted with institutional funding. TheAAMC's activities were closely coordinatedwith the Coalition for Health Funding. Although prospects seemed bright for enactmentof the 1978 appropriation prior to the October 1 start of the fiscal year, House andSenate conferees reached an impasse in tryingto resolve the language of their two verydifferent antiabortion amendments and a continuing resolution once again became necessary.
A set of administrative decisions by thefederal government prompted additional activity for the Association. During 1976,through enactment of the CongressionalBudget and Impoundment Control Act, thefederal government transferred the startingdate of its fiscal year from July 1 to October1. This was accomplished by providing for atransition quarter in 1976 and by appropriating 25 percent in additional funds to coverthis period. Unfortunately, no additionalfunds were provided for capitation grants. Asa reSUlt, capitation funds from the 1976 appropriation represented a fifteen rather than atwelve month award. Although the Association made a vigorous attempt to secure a
LCME statement presented to the Committeedemonstrated that the LCME had met thepublished criteria of the Office of EducatIonand had operated effectively in the interestsof quality without any hint of political mterference for thirty-five years. The Associationhas also opposed any extension into the nonprofit field of the FTC's statutory authorityto regulate trade, arguing that the historicmission and economic orientation of thatagency are unsuited to a field in which interInstitutional planning and coordInation arevital.
A major development during 1977 was theintroduction in Congress of two bills whichwould, for the fIrSt time, limit research activities either directly or indirectly. One, theRecombinant DNA Research Act, wouldplace serious restraints on SCientifIc Inquiry Inthis very Important research area. The second, the ClInical Laboratory ImprovementAct, as origInally introduced, would haveadded unnecessary barriers to the transfer ofresearch-proven ideas to the care of patients.The Association took leadership to bringthese potential research restramts to the attentIOn of legislators and the scientifIc commumty and to work for theIr modification.
The AssocIation has actively opposed legislation introduced in both the House andSenate to reverse a National Labor RelationsBoard deCIsion that housestaff should not berecognized as employees covered by federallabor law. AAMC testimony emphaSIzed thatresidency traimng is an integral part of themedical education process and that the resident's relationshIp with a hospital should bebased on an educational, rather than an industrial, model. The testimony also discussed thedevelopment of contemporary graduate medical education and the effect that the legislatIOn could have on the form and structure ofgraduate medical education.
The AAMC played a major role last yearas the U.S. Supreme Court prepared to hearthe case of Regents of the University of Califorma v. Bakke. Called the most importantcivil rights case since the 1954 desegregationdecision, Bakke challenges the constitutionality of special mInority admissions programs
257AAMC Annual Report for 1977
supplemental appropriation to fund the hiatusperiod, these efforts proved to be unsuccessful.
Initiatives by both the Congress and theExecutive branch to regulate the activities ofthe private sector were of significant concern
::: to the Association during the past year. Most9rfl notable among the regulations issued by therfl~ Executive branch to implement federal laws~ were the final DHEW regulations to promote(1)0.. non-discrimination on the basis of handicap
in programs and activities receiving or benefiting from federal financial assistance. Theseregulations, which implement Section 504 ofthe Rehabilitation Act of 1973, took effect inJune and have far-reaching implications forall schools of medicine and teaching hospitals.Although the Association had responded tothe proposed regulations both independentlyand jointly with the American Council onEducation, many comments went unheeded.Preadmission inquiry into physical, mental,or emotional disabilities is now effectivelyprohibited and extensive and costly facilityrenovations may become necessary.
U The Federal Trade Commission made two::§ attempts to secure authority under which it~ would have been able to insert itself into the(1) affairs of the medical schools and teaching
-S hospitals. The Association, in concert with'0 other organizations, has resisted both of theserfl challenges. The first potential encroachment§ was averted when the DHEW Office of EduB cation's Advisory Committee on Accredita~ tion and Institutional Eligibility, charged by"0 law with advising the Commissioner of Eduu
(1) cation on recognition of accrediting agencies,-S recommended that the Liaison Committee ona Medical Education continue to be recognized
..g as the official accrediting body for medicaleducation. The LCME's status had been chal-
"EJ(1) lenged before this Advisory Committee bya the FTC, on the grounds that the involvement8 of the American Medical Association consti8 tuted a conflict of interest and compromised
the autonomy of the Liaison Committee. TheFTC argued that the AMA, as a trade association, represented the economic interests ofphysicians and therefore had a vested interestIn restricting the development and growth ofnew and existing schools of medicine. The
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through which schools of higher educationhave admitted increased numbers of qualifiedminority students. The Association filed anamicus curiae brief in the Supreme Court, asit had previously done in the California Supreme Court, arguing that fair evaluation ofapplicants required schools to take race intoaccount when evaluating other admissions cnteria; that class diversity was an essentialeducational objective; and that integration ofthe profession and increased service to medically underserved minority communities werecompelling state interests which could not beachieved by alternative means. The association served as a national resource for theUniversity attorneys and others filing briefs
VOL. 53, MARCH 1978
on studies concerning medical education andminorities in medicine. In addition, anAAMC study conducted last year was citedto the court as authoritative proof that specialadmissions programs for the economically disadvantaged were not a rational alternative tospecial programs for minority applicants.
The Association welcomed efforts this yearby the Carter Administration to reorganizeand streamline federal government. The Association commented upon and participatedin the Administration's comprehensive reviewof the federal government's system of advisory committees, undertaken early in 1977,and in the reorganization project establishedby the President in June.
Working with Other Organizations
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assistance to their own efforts in maintainingthe quality of their education programs. Survey teams are able to identify areas requiringincreased attention and indicate areas ofstrength as well as weakness. In the recentperiod of major enrollment expansion, theLCME has pointed out to certain schools thatthe limitations of their resources precludeexpanding the enrollment without endangering the quality of the educational program. Inyet other cases it has encouraged schools tomake more extensive use of their resourcesto expand their enrollments. During the decade of the sixties, particularly, the LCMEencouraged and assisted in the developmentof new medical schools; on the other hand, ithas cautioned against the admission of students before an adequate and competent faculty is recruited, or before the curriculum issufficiently planned and developed and resources gathered for its implementation.
Continued recognition of the LCME bythe commissioner of education was challengedthis year by a staff arm of the Federal TradeCommission on the grounds that designationof committee members by the AMA createdan inherent conflict of interest, compromisedits autonomy, and made suspect its ability toconform to the requirements of due process.The LCME vigorously defended its structureand procedures and was awarded continuedrecognition for two years on the recommendation of the Commissioner's Advisory Committee. This action, however, carried with ita requirement for an interim report on LCMEactions to alleviate identified concerns relatedprimarily to the committee's relationship tothe AMA and the AAMC. This matter willrequire the continuing attention of the Association over the next year.
The private sector recognizing authority,the Council on Postsecondary Accreditation,also evaluated the LCME and continued itsrecognition for a full term of four years.
:::9i2 Since 1972, the AAMC has worked closely§ with the American Medical Association,<l) American Hospital Association, American0.. Board of Medical Specialties, and the Council"5o on Medical Specialty Societies through partic-..s:: ipation in the Coordinating Council on Medi~ cal Education. In the CCME, representatives'"d of the five parent organizations, the federal~ government, and the public have a forum to
..§ discuss issues confronting medical education8 and to recommend policy statements to the15' parent organizations for approval.\-;<l) During the past year, the Association ac-
.D tively participated in a number of ongoing.8 and new committees of the CCME. Majoro actions by the CCME included the final apZ proval of a report of a joint CCME-LCGME
Committee on the Financing of GraduateMedical Education and a tentatively positiveresponse to a recommendation in a draftGovernment Accounting Office Report that
~ the CCME assume responsibility for monitor.::: ing the specialty and geographic distributiono of physicians and making recommendations~ to the HEW Secretary on actions which theo government should take to influence theseB distributions. In the latter action, the CCME~<3 did not respond positively to the further GAOu recommendation that it assume regulatory~ responsibilities in this area. A number of new...... CCME committees were formed, including§ committees on future staffing of the CCME,
<.l:1 on coordination of data on physicians, on1:: finance, on the distribution of residencies by<l) specialty, and on the creation of new and the§ expansion of existing schools of medicine.o The Liaison Committee on Medical Edu
Q cation continues to serve as the nationallyrecognized accrediting agency for programsof undergraduate medical education in theUnited States and for the medical schools inCanada.
The accreditation process provides for themedical schools a periodic, external review of
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During the 1976-77 academic year, theLCME conducted 46 accreditation surveys inaddition to a number of consultation visits touniversities contemplating the developmentof a medical school. The list of accreditedschools is found in the AAMC Directory ofAmerican Medical Education. During the pastyear, the LCME issued Letters of ReasonableAssurance for future accreditation for fournew programs in medical education andgranted provisional accreditation to two newmedical schools. 1)te LCME completed development of guidelines for the policy statement, "Functions and Structure of a MedicalSchool," and supplemental guidelines formedical schools with branch campuses.
The Liaison Committee on Graduate Medical Education placed a special emphasis during the past year on improving communications with the twenty-three Residency ReviewCommittees whose activities it now oversees.Significant misunderstandings had developedregarding the complementary role theLCGME and the RRCs play in the accreditation of programs in graduate medical education. Paramount among these was an apprehension by the RRCs that the LCGME wasusurping their prerogative to evaluate theeducational and scientific merits of the programs which they review. Through directmeetings with RRC chairmen, the role of theLCGME was clarified and the RRCs nowapprecIate that the LCGME review of theiractions is carried out to ensure that there issufficient documentation to sustain the RRCrecommendations as to the accreditation status that is recommended following RRC review. Through meetings with the RRC chairmen, several areas of mutual concern regarding the accreditation process have been identified and efforts to improve accreditationthrough more effective staff support andcloser interaction between RRCs and theLCGME are moving forward.
In July the LCGME received a draft revision of the General Requirements sections ofthe Essentials of Graduate Medical Educationfrom its Subcommittee on Essentials. Thedraft is being widely circulated for commentprior to being approved by the LCGME andforwarded to the Coordinating Council onMedical Education for approval and transmit-
VOL. 53, MARCH 1978
tal to its five sponsoring organizations. Approval by the sponsors is required before therevised General Requirements are effective.The draft revision emphasizes the responsibilities of institutions which sponsor programsin graduate medical education, implementinga CCME Statement on Institutional Responsibility for Graduate Medical Education whichwas approved in 1974. It is anticipated thatfinal approval of the General Requirementswill occur in 1978.
The Liaison Committee on ContinuingMedical Education decided to assume its official accrediting function in July 1977. At thattime the LCCME will accredit organizationsand institutions offering continuing medicaleducation to practicing physicians on a national and regional basis. For national accreditation the LCCME will carry out both thesurveys and the accreditation, while for theregional and local institutions the LCCMEwill receive for ratification recommendationsfrom state committees and councils as a resultof their local review process. For the immediate future, the LCCME has the tasks ofestablishing new criteria for accreditation, designing an accounting system for monitoringperformance at the regional and local levels,and resolving financing and staffing.
The Coalition for Health Funding, whichthe Association helped form seven years ago,now has over 60 nonprofit health relatedassociations in its membership. A coalitiondocument analyzing the Administration's proposed health budget for fiscal year 1978 andmaking recommendations for increased funding is widely used by Congress and the press.
As a member of the Federation of ASSOCIations of Schools of the Health Professions,the AAMC meets regularly with membersrepresenting both the educational and professional associations of eleven different healthprofessions. The Association staff has alsoworked closely with the staff of the AmericanAssociation of Dental Schools on matters ofmutual concern.
The AAMC continues to work with theAssociation for Academic Health Centers onissues of concern to the vice presidents forhealth affairs. Representatives of each organization are invited to the Executive Counciland Board meetings of the other.
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AAMC Annual Report for 1977
As a member of the board of trustees, theAssociation maintains an active interest inthe program of the Educational Commissionfor Foreign Medical Graduates and especiallyin its involvement in the implementation ofprovisions affecting foreign medical graduatescontained in the Health Professions Education Assistance Act of 1976. The AAMC isadvocating prompt implementation of theseprovisions through various channels includingECFMG.
The staff of the Association has maintainedclose working relationships with other organizations representing higher education at the
261
university level, including the AmericanCouncil on Education, the Association ofAmerican Universities, and the National Association of State Universities and LandGrant Colleges. This year the AAMC workedcooperatively with these organizations as wellas others to respond to the academIc Intrusions of the health manpower law and onfederal regulations broadly affecting highereducation, such as those pertaining to affirmative action and the handicapped. TheAAMC participates on an InterassociationTask Force on Equal Employment Opportunity staffed by the ACE.
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Education
A vanety of pressures, both internal andexternal, have brought about a clear emphasison evaluation at national as well as locallevels. Internal pressures have derived fromthe faculty's increasing concern about theeffectiveness of their educational programsand of their roles in the educational process.Since many faculty have made more explicittheir instructional objectives, they have foundthis accomplishment an important facilitatingfactor in more refined student and programevaluation. The time has also seemed appropriate for the review of educational innovations in curriculum structure and materialsand in methods of assessing student performance. These interests have received reinforcement from society's demand for moreexplicit accountability both in terms of assuring that those who are certified by the educational community to deliver health care arethe best available and in terms of assuring thestudents that their individual rights have notbeen compromised in the process.
Evidence of these thrusts has been manifested in the programs of the Association andits member organizations. Especially noteworthy have been the activities of the Groupon Medical Education. A GME TechnicalResource Panel submitted its final report ona "Protocol for the Follow-up of Graduates,"offering suggestions to individual schools forsystematically studying the relationship between educational and institutional variablesand practice outcomes. The GME spring regional meetings devoted significant attentionto evaluation. The Southern GME held aworkshop on the need for monitoring theeffort of the educationally disadvantaged together with mechanisms designed to enhancetheir progress. A plenary session in the Northeast Region focused on considerations forestablishing a formal medical school unit toprovide a wide variety of evaluation supportto the educational process. The Western Re-
gion coordinated its meetings with those ofthe directors of such units and programmatically looked at ways to make continuing medical education efforts more effective. TheCentral Region dealt with the evaluation ofinstructor effectiveness, the assessment of student performance, and program review basedon stated objectives. All of these themes arescheduled for renewed attention at theAAMC Annual Meeting.
The AAMC Ad Hoc Committee on Continuing Medical Education has worked closelywith the GME at regional and national meetings in highlighting issues in continuing education that are of particular concern to medical schools and their faculties. As a result,the AAMC is now planning a research anddevelopment effort to explore means by whichstudents in the continuum of medical education can learn to appreciate the importanceof self-assessment and self-directed learningin maintaining and enhancing professionalcompetence. The Ad Hoc Committee continues to engage AAMC constituents and otherorganizations in an effort to link more closelycontinuing education of physicians with theirprofessional competence and performance.
A significant segment of the membershiphas contributed heavily to a Study of ThreeYear Curricula in U.S. Medical Schools. Theproject staff is analyzing questionnaire responses from: (a) administrators, faculty, andstudents of medical schools that conductedthree-year programs between 1970 and 1976;(b) deans offour-year schools; and (c) clinicalprogram directors who evaluate graduatesfrom three-year programs. Site visits at eachof the schools participating in the study willcomplete the data collection phase of theproject. A final report on the study is scheduled for completion in early 1978.
Heavy membership involvement in allphases of development and implementationhas characterized the preparation of the New
to identify areas of weakness; (c) on anindividual basis to test progress of self-pacedstudents; and (d) as a final examination. It isrevised and updated annually and is now inits eIghth edition. Previous forms of the testare also available.
The AAMC EducatIOnal Matenals Projectcontinued collaboration with the National Library of Medicine in the development ofquality control and information systems aimedat aiding the improvement of health professions education through educational methodology. One project relates to AVLINE, acomputerized data base on nationally available multimedia educational matenals in thehealth sciences. By means of a review systemengaging over 1,000 health sciences experts,the AAMC assesses the majority of educational materials in the AVLINE data baseand produces critical abstracts, which are accessible to the user as part of the AVLINEsearch. AVLINE now contains over 3,000cItations covering medicine, dentistry, andnursing - almost double the number reporteda year ago. This audiovisual data base at theNational Library of Medicine is expanding atthe rate of approximately 100 items permonth.
A related project is concerned with theneed for extended sharing of computer-basededucational materials. As a first step, thefeasibility of appraising computer-based edI!cational materials has been explored. In collaboration with some of the major programdevelopers and users and in association withthe Lister Hill National Center for BiomedicalCommunications, the AAMC conducted apilot appraisal program. The possIbility ofestablishing some quality standards of computer-based educational materials has nowbeen ascertained, and the next step is toassess the interest among the producers andconsumers in the development of such anappraisal system.
A 75 percent response rate was achievedin the 1976 follow-up of physicians who participated in the AAMC Longitudinal Study ofMedical Students of the Class of 1960. Thestudy, supported by a grant from the NationalCenter for Health Services Research, is inthe final stages of data analysis. A final reportrelating practice outcomes discovered in the
263AAMC Annual Report for 1977
Medical College Admission Test. First administered in April 1977, the New MCAT provides six scores to students and to designatedmedical schools. Science knowledge andproblems questions are combined and reported for each disciplinary area, giving scores
§ in biology, chemistry, and physics. Problemsi2 are combined to yield one science problems§ score. Skills analysis tests yield one score<l) each in reading and quantitative concepts.0.. Sessions explaining the new program have"5 been held at the 1976 regional meetings ofo..s:: the Group on Student Affairs and the Na-~ tional Association of Advisors for the Health'"d Professions. Two publications have been pre~ pared to provide extensive background infor-
..§ mation. One, for the prospective examinee,8 The New MCAT Student Manual, was first15' published in 1976. The second edition ap\-; peared this fall. It was expanded tp include a<l)
.D four-hour illustrative test. The other publica-E tion, the New Medical College Admission Testo Interpretive Manual, has been prepared to asZ sist admissions committees and premedical
advisors. It provides technical informationrelative to the use of test scores. The Interpretive Manual was distributed this summer. It isdesigned as a dynamic compendium to beupdated at regular intervals. In this way, themost current information on the various applications of test data will be made available.
~ Working closely with the Committee ono Admissions Assessment, staff have continuedB to pursue various strategies for the evaluation~ of personal characteristics. These noncogni-<3u tive measurements are seen as necessary to
<l) broaden the basis for medical student selec..s::...... tion and to document promotions decisions.a Specific efforts have led to a project which
..g involves explicating in observable terms rele-1:: vant personal characteristics as they manifest<l) themselves during the medical educationa process. Consensus on the precision and useg fulness of such criteria will enhance perform-
Q ance evaluations and, as a result, will providefoci toward which predictive admissions instruments can be developed and tested.
The Biochemistry Special AchievementTest continues to be used for a variety ofpurposes by participating schools. These purposes include administering the test: (a) foradvanced placement; (b) as a diagnostic tool
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recent follow-up to early personal, educational, and institutional variables is scheduledto be available at the end of this calendaryear.
The AAMC responded to considerable interest among medical students and faculty indeveloping, over the past two years, an introductory course to international health in a
VOL. 53, MARCH 1978
self-instructional mode. Aided by a contractfrom the John E. Fogarty International Center of the National Institutes of Health, thisinternational health course offers the studenta cross-cultural and comparative approach tohealth problems. The course was tested lastwinter by approximately 200 medical studentsin 15 medical schools and is now availablefrom the Springer Publishing Company.
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Biomedical Research
The Association's major concern in the areaof biomedical research during the past yearhas been in promoting means by which thefunding of research and research trainingmight be made more stable. The 1976 reportof the President's Biomedical Research Panel,to which the AAMC contributed, was presented and discussed at the November meeting of the AAMC Assembly by Panel Chairman Franklin Murphy. A series of Congressional hearings on biomedical and behavioralresearch followed this report.
The Association actively supported a oneyear extension of the legislative authoritiesfor cancer research; for heart, lung, and bloodresearch; for environmental research; and forresearch training in order to permit a morethorough review of the nation's effort. Thisextension was enacted and, during the respitethus afforded, the Association continuedstudies examining the status of the researchendeavor in academic medical centers. Theresults indicated that, although the totalamount of federal funds for research andresearch training in academic medical centerswas maintained or increased slightly over thepast decade, the proportion of the totalbudget of academic medical centers allocatedfor research declined sharply. This occurredbecause academic medical centers in recentyears have engaged more heavily in educationand patient care activities. The AAMC carried these findings to its constituents, to theCongress, and to the Executive branch duringthe past year.
For several years, the funding of biomedIcal research training has suffered from continuing pressure by the Office of Managementand Budget to eliminate federal support. Erosion of Congressional support for traininggrants led to a decrease in the level of fundsto a point below that needed to meet therecommendations of the National Academyof Sciences Human Resources Commission.
To counter this trend, the Association collected information demonstrating the effectsof cutbacks in research training funds andmobilized the mterest of several organizationsin seeking adequate funding levels. Becausethe perennial questIoning of research trainingbecame increasingly severe, the AAMC hastaken the leadership in coordinating a numberof studies of research manpower. The AAMChas brought together various groups, including the Institute of Medicine and the NationalInstitutes of Health, to define the data neededand to see that they are gathered and analyzed. Reports of problems in research trainmg, especially in the clinical disciplines, ledthe AAMC to undertake a study of the statusof such training at the request of the NationalAcademy of Sciences Committee on Personnel Needs for Biomedical and BehavioralResearch. The results of these studies provided data and recommendations for theCommittee's 1977 recommendations to Congress and DHEW on the numbers and kindsof research personnel that need to be tramed.
A study of the factors associated with thechoice of careers in biomedical research wascontinued in 1977 with support from theNational Institutes of Health. The careerchoices of the class of 1960 were examined todetermine how the 500 members of this classwho joined medical school faculties differedfrom theIr classmates who chose other careers. Patterns of research and graduate traming of 15,000 basic science and clinical facultywere also explored in this study. In a relatedeffort, a study was conducted on the impactof changes in federal programs on biomedIcaland behavioral research training in clinicaldisciplines. At the request of the clinical sciences panel of the Commission on HumanResources, National Academy of Sciences,the period 1972-1976 was studied.
The results of AAMC studies of biomedicalresearch were also discussed by an AAMC
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study group appointed in September 1977 toassess the overall status of the biomedicalresearch effort in academic medical centers,to review present Association policy, and torecommend any necessary policy changes. Itis expected that the ultimate recommendations of this committee after review by theExecutive Council will form the basis ofAAMC efforts to secure more rational andstable federal support of the vital researchfunction.
The AAMC has continued to be active indiscussions of the ethics of biomedical research and the protection of human subjects.As a result of these activities, the public hasbecome more aware of the negative effectson biomedical research of the Freedom ofInformation Act and the Federal AdvisoryCommittee Act. Both the President's Biomedical Research Panel and the Commission forthe Protection of Human Subjects reviewedthis problem and indicated that revisions ofthese "sunshine laws" are necessary to protectmore adequately human subjects of research,the conduct of clinical research, and the intellectual property rights of individual researchers.
Government regulation of biomedical research was of particular interest to the Association as the Congress consIdered two billsthat would place major restraints upon thescientific research community. Concern overthe potential dangers to public health and theenvironment of recombinant DNA researchproduced a flurry of proposals which would
VOL. 53, MARCH 1978
have severely restricted the ability of scientiststo conduct such research. The Association,along with other scientific organizations, wasgreatly distressed by the content of these billsand the haste with which the Congress actedupon them. The Association communicatedto the Congress its conviction that it wasinappropriate for the Congress to attempt toregulate research by statute except in the faceof the clearest potential for danger, and attempted to demonstrate that the potentialbenefits of recombinant DNA research hadbeen understated while the potential hazardshad been overemphasized. The Associationasked that the NIH guidelines on recombinantDNA research, which previously applied onlyto federally financed research, be adopted asthe formal regulations for all research in thisarea. The Association strongly opposed theestablishment of a freestanding national commission charged with regulating this research.
The second potential restraint on researchcame in the form of legislation establishingdetailed standards for clinical laboratories.While the AAMC recognized the legitimateconcern over the quality and management ofroutine testing laboratories, the Associationopposed the extension of this regulation toresearch laboratories. It was recommendedthat the HEW Secretary be authorized todevelop more appropriate standards for laboratories combimng both clinical and researchfunctions In order to avoid inhibiting thetransfer of research technology to patientcare.
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Health Care
New initiatives in primary care education havebeen taken by virtually all the nation's medical schools and teaching hospitals during thepast decade. Almost universally, these initiatives have involved broader utilization of ambulatory care facilities for teaching, and inmany instances they have resulted in majorchanges in affiliated residency programs. Asurvey conducted by the AAMC in 1973demonstrated the nature of change which hadoccurred by that date. The data from thatsurvey, published in the September 197 4 issueof the Journal ofMedical Education, indicatedthat one half of the institutions had mademajor changes in primary care education during the preceding three years, that one-halfof the institutions had programs for graduatelevel training in family medicine. Whatemerged from this analysis was a picture ofprimary care education in transition with asyet no clear pattern of optimum programdevelopment. In 1976, this survey was repeated using a modification of the originalsurvey instrument in order to ascertain themagnitude of change which had occurred during the three year interval. The results will bepublished in the December 1977 issue of theJournal ofMedical Education. By 1976, moreschools were making an ambulatory experience a required part of the curriculum, 80percent of the institutions had affiliated programs for graduate training in family medicine, and there had been a marked increasein the number of schools with affiliated graduate programs for the training of generalistsin internal medicine and in pediatrics.
These changes have increased the demandsfor high quality ambulatory care training sites,particularly in university or affiliated teachinghospital out-patient clinics. For the past twoyears, the AAMC, supported by the HealthResources Administration, DHEW, has conducted a program consisting of workshopsand on-site consultations to improve ambulatory services.
Institutional groups representing 27 of thenation's medical schools participated m thisproject over a 2-year period. The workshopportion of the project consisted of an mtenseplanning, problem solving, and team buildingexperience deSIgned for top management ofuniversity affiliated teaching hospitals whosestaff are interested in developing innovativeambulatory care delivery models, providingmore efficient and accessible "one class" care,and improving educational experiences formedical students and house staff. During thiSprocess each institutional group workedclosely with an inter-disciplinary faculty teamexperienced in ambulatory care operations,organizational development and group process, and developed a time-specific action planfor initiating a change at its institution following the workshop program. A final programreport is due early in 1978 and will summarizethe collective expenences of the 27 partiCipating institutions.
There is a natIOnal concern WIth developingeffective measures to insure quality of carewhile at the same time containing the rapidlysoaring overall costs of health care services.Physician self-evaluation and assessment ofperformance by peers is now generaIly accepted as an integral part of the health careprocess. It is postulated however, that thedegree of physician compliance with, and theenthusiasm for, quality assurance programsmay be directly related to the extent of appropriate experience with this subject receivedduring the formatIve training years. Introducing these concepts into the curriculum is acomplex matter involving many academic departments. While several academic medicalcenters are now interested in this concept,few have been successful in initiating largescale programs. The AAMC has encouragedprograms operated by students, under facultysupervision, to assist the quality of the patientcare in which they are involved. In this way,students can gain a better appreciation and
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understandmg of the need to develop a formalmethod of self appraisal. The AAMC hasreceived support from the National Fund forMedical Education to conduct workshops onthe subject in 1977-78. The initial workshop
VOL. 53, MARCH 1978
presented several models of inter-departmental curriculum design, a clarification of institutional prerequisites for successful programdevelopment, a strategy for curriculum phasing, and necessary resource allocations.
Faculty
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155 faculty members from 82 different medical schools participated in these workshops.
Support for the national survey, self-assessment program, and workshops has come fromthe Kellogg Foundation, the CommonwealthFund, and the Bureau of Health Manpower.
The Faculty Roster System, initiated in1965, continues to provide valuable information on the intellectual capital of medicaleducation. This data-base maintains demographic, current appointment, employmenthistory, and training/credentials informationfor all salaried faculty at U.S. medical schools.The data collection procedures include feedback to the schools providing the data in anorganized and systematic manner that assistsschools in activities that require faculty information, such as the completion of questionnaires for other organizations and the identification of alumni now servIng on faculty atother schools.
This database has also been used for avariety of manpower studies, including a report released this year entitled DescriptiveStudy of Salaried Medical School Faculty:1969-70 and 1974-75. This study was performed under contract WIth the Bureau ofHealth Manpower and contains summary information on faculty appointment characteristics, educational characteristics, employment history, and various breakdowns by sex,by race/ethnic group, for foreign medicalgraduates, and for newly-hired faculty. Acompanion study is underway contaIning1976-77 data on salaried medical school faculty.
As of June 1977, the faculty roster contained information for 47,567 faculty, an increase of 6.4 percent over June 1976. Anadditional 25,788 records are maintained for"inactive" faculty, individuals who have helda faculty appointment during the past 12years but do not currently hold one.
The 1976-77 Report on Medical School
:::9i2 During the year, the Association has con§ ducted several programs aimed at assisting8, faculty development and promoting under
standing of the ways in which decisions arereached for careers in biomedical research. Aproject in faculty development, with particular reference to teaching skills, was continued.In 1977, the data collection and analysis forthe National Survey of Faculty were receivedfrom 1,910 medical school faculty members,out of a stratified random sample of 2,700,for a very satisfactory response rate of 71percent. The basic findings from this surveyhave been presented in three preliminary reports which have been distributed to eachmedical school. The final report of this project, summarizing its highlights and major implications, will be distributed in December1977.
The written simulations that were a majorsource of data for the national survey willnow be used as part of a voluntary, confidential, self-assessment program for faculty. DurIng the past year, a pair of documents was
~ developed to accompany each simulation.9 One provides a discussion of the rationale fort) the recommended routes through the simula-~"0 tions and an explanation of the basis for theu other routes not being recommended. The~ other provides a general discussion of the~ topic area of the simulation, such as test§ construction, small group discussion, clinical
<.l:1 supervision, and a list of suggested readings.These materials have been field-tested amongfaculty members at seven medical schools.The self-assessment packages will be readyfor distribution in early 1978.
Beginning at the 1976 AAMC AnnualMeeting, a series of four workshops on facultydevelopment was offered to medical schoolfaculty members who have been identified bythCJir deans as having responsibilities for contributing to the improvement of the instructional program at their institutions. A total of
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Faculty Salaries was released in December bythe Association. Data on salaries by degreetype were collected and reported for the firsttime since the beginning of the Survey. Toinsure comparability with prior years, datafor faculty with all degrees combined are also
VOL. 53, MARCH 1978
included. This year's report presents data on30,677 individuals, as compared to 30,487 inthe 1975-76 report. The modest increase canbe attributed to the elimination of affiliatedfaculty, house staff, and fellows from thisyear's reporting format.
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Students
In the competItIOn for 1977-78 first-yearplaces in U.S. medical schools, more than41,000 applicants submitted over 350,000applications. This reflected, for the secondconsecutive year, a slight decline in the number of individuals seeking admission. Medicalstudent enrollments, however, continue torise, and the 15,613 freshmen and 57,765total students reported by the nation's medicalschools for 1976-77 represent an all-timehigh.
The application process was assisted againthis year by the Early Decision Program aswell as by the American Medical CollegeApplication Service (AMCAS). For the1977-78 first-year class, 58 medical schoolsparticipated in the Early Decision Program,and 892 students were accepted. Since eachof the 892 students filed only one applicationas opposed to the average of 8.9, the processing of about 7,047 applications was eliminated.
AMCAS was utilized by 86 medical schoolsfor the processing of first-year applicationmaterials. Besides collecting and coordinatingadmissions data in a uniform format, AMCASprovides useful rosters and statistical reportsto participating schools. At the same time,AMCAS maintains a national data bank forresearch projects associated with admissions,matriculation, and enrollment. The AMCASprogram continues to be guided in the development of its procedures and policies by theGroup on Student Affairs Medical StudentInformation System Committee.
At the direction of the AAMC, the American College Testing Program continued responsibility for operations related to the registration, test administration, test scoring,and score reporting procedures for the Medical College Admission Test. Approximately53,600 examinations were given in the springand fall of 1976, down from 57,500 in 1975,and 58,200 in 1974.
April 30, 1977 marked the first use of theNew Medical College Admission Test, whenthe test was administered to 30,648 individuals.The New MCAT represents an attemptto improve the assessment procedures foradmissions and provides a more differentiatedway for candidates to present evidence oftheir preparation for entering medical school.Beginning with the 1978-79 entering class,medical school admissions officers will requireNew MCAT scores as part of the applicationprocess.
Commissioned in 1976 to examine existingand potential mechanisms for providing financial assistance to medical students, the TaskForce on Student Financing made an interimreport to the Executive Council in June. Inits report, the task force outlined long- andshort-term recommendations and a proposalfor a new guaranteed student loan program.The final report is expected in June 1978.
Also in the area of student financial assistance, the chairman of the Group on StudentAffairs, members of the Task Force on Student Financing, and the GSA Committee onFinancial Problems of Medical Students metwith representatives of the White House Domestic Council to discuss the problems offinancing medical students. The major concern stated was that rising costs and decreasesin need-based financial assistance programswere combining to cause an upward trend Inthe income levels of enrolled medical students. Such a trend could seriously limIt theopportunities for a medical education of thefinancially disadvantaged.
Several AAMC activities and publication,have been aimed at increasing opportunitie,for minority students in medicine. Foremostamong these has been the Simulated MInorityAdmissions Exercise (SMAE), first developed in 1974. The purpose of the SMAE isto train admissions committee members toassess the potential for medicine of minority
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272 Journal of Medical Education
applicants. To do this, the trainees reviewsimulated applicant data which includegrades, test scores, and noncognitive information. The SMAE has been offered to regional groups of admissions officers, advisers,and medical school admissions committees.Admission workshops have been conductedfor over 20 schools.
Minority Student Opportunities in UnitedStates Medical Schools, published in 1975,was updated in July and distributed to admissions officers and advisors. This publicationprovides detailed information about medicalschool programs of recruitment, admissions,academic reinforcement, and financial aidavailable to disadvantaged students. TheMedical Minority Applicant Registry has beencompiled and circulated to all U.S. medicalschools. This registry is designed to assist theschools in identifying minority and financiallydisadvantaged candidates who are seekingadmission to medical school.
Because of the increasing concern over thenumber of lawsuits being filed against schoolscharging that special minority admissions programs discriminate unlawfully against whites,the AAMC conducted a survey to determinethe characteristics and outcomes of such suits.In the case of Bakke v. Regents of the University of California, the Association filed anamicus curiae brief before the California Supreme Court. The AAMC's position was thatspecial admIssion programs for minority students do not violate constitutional equal protection safeguards. Continuing its support inthe same case, the Association filed an amicuscuriae brief before the U.S. Supreme Courtaskmg for reversal of the California decision.
The AAMC Task Force on Minority Student Opportunities in Medicine was established to make recommendations to improveopportunities for minorities seeking careersin medIcine. The 14-member task force presented an interim report to the ExecutiveCouncil in September and should completeits final report in the coming year.
A major national program focusing on minorities in medical education is sponsoredannually during the AAMC Annual Meeting.The program in San Francisco in 1976 featured U.S. Representative Yvonne Brathwaite Burke (D-CaIiL) who spoke on the contribution of minorities in medicine.
VOL. 53, MARCH 1978
An action of the AAMC Executive Council, adopted last fall by the Group on StudentAffairs, provides for a section within the GSAto include minority affairs representativesfrom every medical school in the country.The section will hold its first meeting this fallto discuss programs affecting admissions, financial aid, and the graduate education ofminority medical students.
During the year, 11 major student studieswere completed under contract with the Bureau of Health Manpower (BHM). Particularly notable was The Medical School Admissions Process: A Review of the Literature,1955-1976, a comprehensive bibliography ofalmost 500 items.
Five of these reports dealt with medicalstudent financing. Medical Student Indebtedness and Career Plans, 1974-75 concludedthat career choice was probably more closelyrelated to student background than to indebtedness. Student Finances and Personal Characteristics, 1974-75 revealed that nine in 10of those who applied for aid received someassistance. Medical Student Finances and Institutional Characteristics, 1974-75 confirmedthat students in private schools were moredependent on parental and outside aid thanthose in public schools. A Study of PublicHealth Service (PHS) Scholarship Recipientsand National Health Service Corps (NHSC)Participants showed that the scholarship holders were somewhat more apt than medicalstudents in general to be minority group members and to come from relatively lower socioeconomic backgrounds. A special report addressed itself to the topic, Additional SelectionFactors Suggested for the Public Health ServiceScholarship Program.
The other five projects dealt with the characteristics and career choices of recent applicants and students. The Descriptive Study ofMedical School Applicants, 1975-76 includedan analysis of the 42 percent of applicantswho were college seniors applying for thefirst time and showed their acceptance rate tobe substantially higher than that for candidates in general. An analysis of Economicand Racial Disadvantage as Reflected in Traditional Medical School Selection Factorsdemonstrated the grade-point averages andMCAT scores of applicants varied onlyslightly by level of parental income within a
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mission Test to the time they applied to theNational Intern and Resident Matching Program. At graduation, almost two-thirds preferred a primary care residency when definedto include internal medicine and pediatrics aswell as family practice. Finally, a pilot studyto ascertain the career aspirations and practiceplans of graduates and the influence of theirmedical education was carried out at ninemedical schools. This survey will be conducted nationally in 1977-78.
Other research initiated during 1976-77included studies on 1976-77 applicants andenrolled students, a COTRANS trend studyfor 1970 through 1976, several additionalstudies of medical student financing, and atargeted study comparing the admissionsprocess for 1976-77 and 1973-74.
AAMC Annual Report for 1977
given racial grouping, but varied far moresubstantially by race within a given incomeclass. A study of Characteristics of u.s. Citizens Seeking Transfer from Foreign to U.S.Medical Schools in 1975 via the CoordinatedTransfer Application System (CO TRANS)
::: confirmed that the majority had previously9 applied unsuccessfully to a U.S. school andi2 that two-thirds were from New York, New§ Jersey, and California. The Descriptive Study<l) of Enrolled Medical Students, 1975-76 in0.. cluded the finding that more first-year stu-
dents than final-year students had preadmission career choices of general/primary care.A study of Career Choices of the 1976 Graduates ofu.s. Medical Schools found that overhalf changed their specialty preferences fromthe time they took the Medical College Ad-
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Institutional Development
administrators work with a limited number ofmedical school decision-makers who requestthe kind of assistance offered. Documentationof observations is an important part of thework.
Since its inception, the MAP has been bothan educational effort and an opportunity forsenior administrators from academic medicalcenters to develop institutional plans. Allmedical school deans are invited to attend.Since 1972, 102 deans, 41 hospital administrators and 27 department chairmen have participated in Executive Development sessions.Institutional Development Seminars have included 64 institutions of which 20 have attended more than one such follow-up se~sion.
Over 652 individual participants have attended; in addition to deans, departmentchairmen and hospital administrators, vicepresidents, chancellors, program directors,business officers, planning coordinators, andstate legislators have been included.
The Management Advancement Programwas planned by an AAMC Steering Committee chaired by Dr. Ivan L. Bennett, Jr. Thesteering committee has sought the advice of anumber of individual consultants and expertson design of the overall effort, and togetherthey have continued to monitor program content and structure carefully. Support for earlyprogram planning was provided by the Carnegie Corporation of New York and by theGrant Foundation. Three grants from theRobert Wood Johnson Foundation have permitted full implementation of the program.
During the past five years, ManagementAdvancement Program participants have expressed a growing and continuing interest inmanagement issues facing their institutions.In addition, requests for seminars from awide range of groups in the academic medicalcenter environment have indicated the needto reach a broader audience. In order todevelop a critical mass of individuals informed
This past year represented the fifth year ofthe AAMC Management Advancement Program, which now includes three separate butrelated components: Executive DevelopmentSeminars (Phase 1), Institutional Development Seminars (Phase II) and a TechnicalAssistance Program.
Phase I is an intensive six day workshop inmanagement technique and theory. Lecturesand discussion sessions provide an opportunity for medical school deans to share common problems while acquiring theoreticalbackground knowledge in the general management area. Whenever possible, departmental chairmen and teaching hospital administrators are included as participants. Topicsare drawn from a wide range of planning andcontrol and behavioral science concepts.
Phase II, the Institutional DevelopmentSeminar, is a four and a half day session forwhich medical school deans who have participated in a Phase I session are invited toidentify an institutional opportunity or problem requiring careful study. Each dean isasked to select a group of individuals fromthe medical school who would need to beinvolved in the implementation of any decision reached on the issue he has chosen toaddress. Five or six such institutional teamsmeet at an off-site location for lectures andteam discussion sessions. Each team is assigned an expert management consultant whois responsible for facilitating group discussionduring team sessions, and where appropriate,for suggesting alternative means of dealingwith the self-identified management issue.
The Technical Assistance Program is designed to provide on-site management consultation to interested academic medical centeradministrators. The purpose of the programis to encourage improved organizational diagnosis, problem solving and/or planning. Sitevisit teams comprised of management consultants and experienced academic medical center
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AAMC Annual Report/or 1977
of current management theory and practices,the AAMC negotiated a contract with theNational Library of Medicine, which began inthe spring of 1976 and was renewed for asecond year in January 1977. The Management Education Network Project is aimed atproviding academic medical center administrators with regular access to managementinformation. The project also includes documentation of the results of studies of institutional management problems and issues forwider dissemination. The contract encompasses the following specific tasks: (a) designof management literature retrieval system,which includes the publication of "MAPNotes," a summary of current managementinformation; (b) development of audiovisualinstructional materials which will be availablefrom the National Medical Audiovisual Center; (c) documentation of selected academicmedical center managerial processes; and (d)exploration of the desirability and feasiblityof simulation modeling as a management toolfor medical school decision-makers. Dr. J.Robert Buchanan has served as chairman ofthe Advisory Committee, which has helpeddesign and monitor program activities.
During the past year a detailed examinationof the affiliation arrangements between asample of six selected medical schools andtheir networks of affiliated teaching hospitalswas completed. The Medical School-Clinical
275
Affiliations Study, supported under contractwith the Bureau of Health Manpower, follows!i management perspective to examine thestructure and process of decision-making inaffiliation relationships. The project was completed under the guidance of a project reviewcommittee chaired by Dr. Robert Massey andwith the assistance of a liaison representativefrom each medical school in the sample. Substantial quantitative data and the reports ofsite visits were analyzed to develop descriptions of the affiliation networks and to providesome assessment of what factors contributeto an effective relationship. Copies of thereport were distributed to each member ofthe Council of Deans and the Council ofTeaching Hospitals.
The Visiting Professor Emeritus Program,established in 1976, completed its first fullyear of operation during the past year. Withsupport from the National Fund for MedicalEducation, this program serves as a link between emeritus faculty interested in continuing their careers on a limited basis and medical schools desiring to utilize the availabletalents of senior physicians and scientists. Theresponse to the program has been most encouraging and greater utilization of this valuable reservoir of experienced medical educators promises to make a significant contribution to medical education.
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Teaching Hospitals
Three major issues have dominated the Association's teaching hospital activities duringthe past year: Senator Talmadge's proposalto establish a prospective ceiling on paymentsfor routine operating costs under the Medicare and Medicaid programs, the Carter Administration's proposal to place a ceiling onhospital revenue increases and to reduce hospital capital expenditures, and Congressionaland legal challenges arising from the NationalLabor Relations Board's finding that housestaff are students for purposes of the NationalLabor Relations Act. Other issues receivingsignificant attention included the impact onmajor medical centers of the National HealthPlanning and Resources Development Act,the Association's court challenge of regulations implementing the routine service costlimitations of the Medicare program, and theanticipated implementation of legislation establishing fee-for-service payment requirements for physicians in teaching hospitals.
In early May Senator Herman Talmadge,chairman of the Subcommittee on Health ofthe Senate Finance Committee, and 20 cosponsors introduced a revised version of theMedicare and Medicaid Administrative andReimbursement Reform Act. The biII wasvery similar to one introduced last year, including provisions to establish a payment limitation procedure for routine operating costs,to establish a special payment limitation category for the "primary affiliates of accreditedmedical schools," and to eliminate MedicarelMedicaid recognition of percentage contractsfor certain physician services often performedin hospitals.
Association positions on the provisions ofthe Talmadge biII were initially reevaluatedby an ad hoc committee and subsequentlyadopted by the Association's Executive Council. In testifying on the biII before the Subcommittee on Health of the Senate FinanceCommittee, the Association acknowledged
that hospital payment limitations derivedfrom cross-classification schemes are one legitimate approach to containing expendituresfor hospital services and recommended addingflexibility to the biII so that learning acquiredthrough experience would not require newlegislation. The AAMC recommended thatthe HEW Secretary initiate studies to definetertiary carelteaching hospitals and to examine the impact of establishing a-special payment category for them. The Associationstrongly supported amending the bill to ensure that faculty physicians could be paid foreither professional or educational serviceswhen providing care in the presence of students and opposed physician payment mechanisms which would inhibit the developmentof any discipline. Staff members of the Association have worked with subcommittee staffto refine these proposed modifications.
In April President Carter introduced hisHospital Cost Containment Act of 1977, stating that "the cost of care is rising so rapidly itjeopardizes our health goals and our otherimportant social objectives." The Associationevaluated the Administration's proposal withthe assistance of an ad hoc committee thatincluded representatives from all constituentCouncils. In House and Senate testimony onthe cost containment proposal, the Association stated its strong opposition to both theimposition of a cap on hospital revenues whenno other segment of the economy is similarlycontrolled and to a capital expenditure ceilingthat fails to provide adequate funds for government-mandated facility improvements andfor the replacement of obsolete facilities essential to patient care. In lieu of the President's proposal, the Association advocated asix-point cost containment program based onimplementing a system of uniform hospitalcost reporting, publishing hospital cost data,establishing a cost impact statement for hospital-related legislation and regulation, ex-
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AAMC Annual Report for 1977
panding and fully implementing utilizationand health planning controls, enacting prospective payment limitations derived fromcross-classification schemes, and permittingMedicare to pay state-determmed hospitalrates where the programs comply with necessary Federal standards.
In March of 1976, the NatIOnal LaborRelations Board (NLRB) ruled in its CedarsSinai decision that "interns, residents, andclinical fellows are primarily engaged in graduate training and are students rather thanemployees within the meaning of the NationalLabor Relations Act." In spite of this decision, some house staff associations have pursued legal and legislative actions to havehouse staff redefined as employees. In bothstate and federal court actions, the Association has filed amicus curiae briefs supportingthe NLRB decision and arguing that itpreempts contradictory state labor board action. The U.S. Court of Appeals for theSecond Circuit agreed with this position, preventing the New York State Labor Boardfrom exercising jurisdiction over house staffin hospitals subject to the federal labor law.
Bills specifically defining house staff asemployees under the National Labor Relations Act have been introduced in both theHouse of Representatives and Senate. TheAssociation has reiterated in testimony itsposition that residency programs are an integral part of the medical education program,that residents' primary relationship with thehospital should be based on an educationalrather than an industrial model, and that theimposition of a labor-management relationship would seriously reduce the effectivenessof these programs.
The National Health Planning ResourcesDevelopment Act originally due to expire in1977 was extended by Congress until 1978.Because the administration of the Act is principally based on local health planning agencieswhich may give inadequate consideration tothe regional and national missions of medicalschools and teaching hospitals, the Association contracted with Eugene Rubel, formerdirector of HEW's Bureau of Health Planningand Resources Development, to study theimplementation of the Act. Based on recentlycompleted site visits to several medical centers
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and health planning agencies, the study willprovide the informatIOn necessary to evaluatehow the Act is affecting the academic medicalcenter.
The Association's appeal of its suit overDHEW's implementation of Medicare routineservice cost limitations is still pending beforethe U.S. Court of Appeals for the District ofColumbia Circuit. While oral arguments onthe appeal were presented in September1976, the court this past spring requestedsupplemental briefs on the jurisdictional authority of the courts in this matter. The Association filled the requested brief arguing that,while individual claimants seeking judicial review of specific benefit determmations mustfollow prescribed administrative proceduresbefore turning to the courts, the court hasdirect and immediate jurisdiction to reviewagency regulations implementing legislation.
During the year, the Association workedclosely with Executive agencies and COTHmembers in several areas where policies werebeing established or reviewed. These includeuniform hospital accounting and reportingsystems, Medicare offset requirements forfamily practice grants, Medicare's treatmentof interest provisions of Section 227 of the1972 Medicare amendments, and Medicare'srecently enacted policy of recognizmg selfinsurance contributions as reimbursable malpractice costs.
The Associations' program of teaching hospital surveys combines four regular and recurring surveys with a limited number of special,issue-oriented surveys. The regular surveysare the Educational Programs and ServicesSurvey, the House Staff Policy Survey, theIncome and Expense Survey for UniversityOwned Hospitals, and the Executive SalarySurvey. During the year, each of these surveyshad an excellent response rate from memberhospitals. The findings of each of these surveys have been furnished to participating hospitals and, when appropriate, results havebeen publicly distributed. Three special surveys were conducted this year: the Survey ofthe Impact of Section 223, the Survey ofProfessional Liability Insurance in UniversityOwned Hospitals; and the Survey of Construction Funding for Non-Federal COTHHospitals.
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Communications
A variety of publications, news releases, newsconferences and personal interviews with representatives of the news media are used bythe Association to communicate its views,studies, and reports to its constituents, interested federal representatives, and the generalpublic. The major vehicle used by the Association to inform its constituents is the President's Weekly Activities Report. This publication, which is issued 43 times a year andreaches about 9,000 readers, reports onAAMC activities and federal activities thathave a direct effect on medical education,biomedical research, and health care.
In addition to the Weekly Activities Report, other newsletters of a more specializednature are: The Advisor, CAS Brief, COTHReport, DEMR Report and Student AffairsReporter. Numerous other publications suchas directories, reports, papers, studies, proceedings, and archival listings are also produced and distributed by the Association.
In an effort to keep U.S. medical studentsabreast of national medical education issues,the Association has undertaken on a trialbasis the publication of a newsletter distributed free-of-charge to the approximately60,000 students. The two editions of OSRReport published to date have dealt withlegislation, activities of the AAMC Organization of Student Representatives (OSR), andAAMC programs of special interest to medical students. The Report is mailed in bulk toeach school's OSR representative in sufficientquantity for distribution to all medical students. Publication of the OSR Bulletin Board,which has been the AAMC newsletter formedical students for the past two years, hasbeen temporarily suspended until after theExecutive Council evaluates the effectivenessof OSR Report.
The Journal of Medical Education in fiscal
1977 published 1,166 pages of editorial material in the regular monthly issues, comparedwith 1,042 pages the previous year. Onesupplement was published during the year:"Analysis and Comment on the Report ofthe President's Biomedical Research Panel."In addition to the regular issues, a 104-pagepublication, Federal Support of BiomedicalSciences: Development and Academic Impact, by James A. Shannon, M.D., was carried as Part 2 of the July 1976 issue. Theplenary addresses from the 1975 AAMC Annual Meeting and the 1976 AAMC Proceedings and Annual Report also were publishedin the Journal.
Excluding the supplement and the Part 2publication, a total of 174 papers (82 regulararticles, 81 Communications, and 11 Briefs)were published, compared with 152 papers infiscal 1976. The Journal also continued topublish editorials, Datagrams, book reviews,letters to the editor, and bibliographies provided by the National Library of Medicine.
The volume of manuscripts submitted tothe Journal for consideration continued torun high. Papers received in 1976-77 totaled411, compared with 404 and 422 the previoustwo years. Of the 411 articles received in1976-77, 141 were accepted for publication,179 were rejected, 15 were withdrawn, and76 were pending as the year ended.
Pages of paid advertisements totaled 81during the fiscal year, compared with 92 pagesthe previous year. As the year ended, theJournal's monthly circulation was almost6,800, an increase of 100 over a year ago.
About 30,000 copies of the annual MedicalSchool Admission Requirements, 3,500 copies of the AAMC Directory of AmericanMedical Education, and 6,000 copies of theAAMC Curriculum Directory were sold ordistributed.
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Information Systems
The Association has acquired a general purpose computer system to support its information requirements. Most information systemshave become operational on the computersystem since its instalIation in September1976. This in-house system will alIow theAssociation to optimize the use of its information resources in the programs of the Association.
The information system was utilized togenerate several exploratory studies of medical schools in general, including: Study ofMedical Education: Interrelationships Between Component Variables; An EmpiricalClassification ofu.s. Medical School by Institutional Dimensions; and A MultidimensionalModel of Medical School Similarities.
In addition to the annual "Study of V.S.Medical School Applicants" published in theJournal of Medical Education, the data basesupports research and special reports on topical subjects. During the past year these specialreports included: Descriptive Study of Medical School Applicants, 1975-76, DescriptiveStudy of Enrolled Medical Students, 197576, and a series of studies concerning themanner in which medical students financetheir education, based on a previous AAMCsurvey of 1974-75 students. The series included Medical Student Finances and Personal Characteristics, 1974-75, and MedicalStudent Finances and Institutional Characteristics, 1974-75.
The Institutional Profile System containsover 12,000 data elements from more than70 sources describing V.S. medical schools asinstitutions of higher education. The primarysource~ of data for the Institutional ProfileSystem have been ad hoc and recurrent questionnaires administered by the AAMC andothers, such as the Liaison Committee onMedical Education Annual QuestionnaireParts I and II. Data from other AAMC information systems, such as the Medical Student
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Information System and the Faculty RosterSystem, are also aggregated by institution andentered into the Institutional Profile Systemdatabase.
The primary objective of the InstitutionalProfile System IS the provision of a readilyaccessible repository of valid data that describe medical education institutions. This isaccomplished through an on-line integrateddatabase and supporting computer softwarepackage that allows immediate user retrievalof data via remote terminals. The system isused to respond to requests for data frommedical schools (especially for comparativeinformation) and other interested parties.Such requests numbered approximately 225during the 12 months ending June 1977 andover 550 for the three years that IPS hasbeen operational.
The Institutional ProfIle System has al~o
been used exten~ively to support a variety ofstudies or projects that require institutionalinformation. During the last year, severalreports describing medical education institutions using multivariate statistical procedure~
were prepared under contract with the Bureauof Health Manpower, DHEW. The Institutional Profile System was also used to proVIdedata to relate institutional characteristics tostudent finances and career choices.
The Association serves as the primarysource of information on teaching hospitals.Annual surveys are conducted to obtain national information on housestaff stipends,benefits, and training agreements; income,expense and general operating data for university-owned hospitals; hospital and departmental executive compensation; and generaloperating, educational program, and servicecharacteristics of teaching hospitals. SpecIalstudies conducted during the past year collected information on the impact on teachinghospitals of the routine service cost limitationsimposed under the Medicare program and on
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280 Journal of Medkal Education
the professional liability insurance coverageof and premiums paid by university-ownedteaching hospitals. These surveys providedthe necessary data for five general publications during the year: 1977 COTH Directoryof Educatlonal Programs and Services, 1976COTH Survey of House Staff Policy and
VOL. 53, MARCH 1978
Related Issues, COTH Survey of UniversityOwned Teaching Hospitals' Financial and General Operating Data, 1976 Council of Teaching Hospitals Executive Salary Survey, andCOTH Survey of Professional Liability Insurance in University-Owned Hospitals.
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1976-77115
317o1
60400
1,9444371
612
1975-76III
617o1
59396
2,0264270
717
reserve equal to 65.17% of the expendituresduring the year.
By action of the Executive Council theOfficers of the Association have been directedto maintain unrestricted reserves of not lessthan 50% and, as a goal, 100% of the AssocIation's annual operating budget. It is ofincreasing importance that this policy of reserve accumulation be continued. Approximately 30% of the Association's revenuesare derived from sources outside of the Association. Because of the uncertainties associated with such funding, the existence of adequate reserves is needed to assure the continuation of essential services through transitional periods should there be substantial reductions in funding from outside sources. AFinance Committee appointed by the Executive Council is currently studying the financIalstructure of the Association with particularemphasis on future sources of funding.
AAMC Membershjp
Treasurer's Report
TYPEInstitUlJonalProvisional InstitUlJonalAffiliateProvisional AffiliateGraduate AffiliateAcademic SocietiesTeaching HospitalsIndivIdualDistinguished ServiceEmeritusContributingSustainmg
On August 31,1977, the AssocIation's AuditCommittee met and reviewed in detail theaudited statements and the audit report forthe fiscal year ended June 30, 1977. Meetingwith the Audit Committee were representatives of Ernst & Ernst, the Association'sauditors; the Association's legal counsel; andAssociation staff. On September 16, 1977the Executive Council reviewed and acceptedthe final unqualified audit report.
Income for the year totaled $8,786,232an increase of 1.37% from the previous fiscalyear. Operating expenses increased 4.59% to$8,231,313.
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a8 Balances in funds restricted by the grantoro decreased $135,348 to $153,498. After mak
Q ing provision for Board appropriations forspecial purposes in the amount of $299,000,unrestricted funds available for general purposes increased $463,419 to $5,364,571-a
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Association of American Medical CoUeges
Balance Sheet
June 30, 1977ASSETS
CashInvestments
U.S. Treasury BillsCertificates of DepositManagement Account
Accounts ReceivableDeposits & Prepaid ItemsEquipment (Net of Depreciation)Total Assets
LIABILITIES AND FUND BALANCES
LiabilitiesAccounts Payable
Deferred IncomeFund Balances
Funds Restricted by Grantor for Special PurposesGeneral Funds
Funds restricted for Plant InvestmentFunds restricted by Board for Special PurposesInvestment in Fixed AssetsAvailable for General Purposes
Total Liabilities & Fund Balances
Operating Statement
Fiscal Year Ended June 30, 1976
SOURCE OF FUNDS
IncomeDues and Service Fees from MembersGrants Restricted by GrantorCost Reimbursement ContractsSpecial ServicesJournal of Medical EducationOther PublicationsSundry
Total IncomeReserve for MCAT DevelopmentReserve for Special Minority ProgramsReserve for Special Legal ContingenciesReserve for Education NewsReserve for Data Processing ConversionReserve for Special Task ForcesDecrease in Restricted Fund BalancesTotal Source of Funds
USE OF FUNDS
Operating ExpensesSalaries and WagesStaff BenefitsSupplies & ServicesProvision for DepreciationTravel
Total ExpensesInvested in Fixed AssetsTransfer to Restricted Funds for Special PurposesIncrease in Funds Available for General PurposesTotal Usc of Funds
282
$5,283,907750,000938,992
$ 296,856613,808435,803
5,364,571
$ 185,958
6,972,899819,158
20,582435,803
$8,434,400
$ 555,4101,014,453
153,499
6,711,038$8,434,400
$1,591,725267,911
2,353,3523,557,202
69,658367,377579,007
$8,786,232167,36450,84828,33841,000
181,73838,668
135,347$9,429,535
$3,841,127502,855
3,260,89337,970
588,468$8,231,313
435,803299,000463,419
$9,429,535
AAMC Committees, 1976-77
Audit
Coordinating Council onMedical Education
AAMC Members:
John A. D. CooperJames E. EckenhoffRonald W. Estabrook
Continuing Medical Education
William D. Mayer, chairmanRichard M. BerglandClement R. BrownRichard M. CaplanCarmine D. ClementeJohn E. JonesCharles A. LewisThomas C. MeyerMitchell T. RabkinJacob R. SukerStephen TarnoffDavid Walthall
COT" Nominating .
Charles B. Womer, chairmanJ. W. Pinkston, Jr.David D. Thompson
COD Nominating
John M. Dennis, chairmanThomas A. BruceD. Kay ClawsonLawrence G. CrowleyAllen W. Mathies, Jr.
LIAISON COMMITIEE ON GRADUATE
MEDICAL EDUCATION
LIAISON COMMITIEE ON CONTINUING
MEDICAL EDUCATION
AAMC Members:
Richard M. BerglandWilliam D. MayerJacob R. Suker
283
Admissions Assessment
David D. Thompson, chairmanJohn M. DennisThomas R. Johns
CAS Nominating
A. Jay Bollet, chairmanCarmine D. ClementeRonald W. EstabrookNicholas GreeneWarren StampAllan B. WeingoldFrank E. Young
u Biomedical Research and Training
::§ Robert M. Berne, chairman~ Theodore Cooper<l)
-B Philip R. Dodge'0 Harlyn Halvorson~ Charles SandersoB David B. Skinner~ Samuel O. Thier<3u Peter C. Whybrow<l)
..s::......a Borden Awardo
<.l:1Robert S. Stone, chairman1::
<l) Cedric I. Davern§ Newton B. Everett8 Bodil Schmidt-Nielsen
David B. Skinner
Cheves McC. Smythe, chairman::: Jack Colwill~ Joseph S. GonnellarJ)§ David Jeppson<l) Walter F. Leavell0.."5 John McAnally..8 Christine McGuire~ Frederick Waldman'"d Leslie T. Webster
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AAMC Members:
Robert M. HeysselThomas K. Oliver, Jr.James A. PittmanAugust G. Swanson
LIAISON COMMmEE ON
MEDICAL EDUCATION·
AAMC Members:
Edward C. Andrews, Jr.Steven C. BeeringRonald W. EstabrookChristopher C. Fordham, IIIJohn P. KemphRichard S. Ross
Data Development Liaison
Richard Janeway, chairmanStanley M. AronsonMarion BallHoward J. BarnhardDavid DiamondJames GriesenMiles E. HenchSamuel HowardKenneth L. KutinaJames C. LemingC. Bruce McFaddenRaymond H. MurrayBernard NelsonCheves McC. Smythe
Finance
Charles B. Womer, chairmanIvan L. Bennett, Jr.Leonard W. Cronkhite, Jr.John A. GronvallRolla B. Hill, Jr.Robert G. Petersdorf
F1exner Award
Frederick C. Robbins, chairmanRobert A. BarbeeErnst KnobilMatthew F. McNulty, Jr.Manson MeadsDonald Widder
Governance and Structure
Daniel C. Tosteson, chairmanWilliam G. Anlyan
• For non-AAMC members, see page 287.
284
Sherman M. MellinkoffRussell A. NelsonCharles C. Sprague
Graduate Medical Education
Jack D. Myers, chairmanSteven C. BeeringD. Kay ClawsonGordon W. DouglasHarriet P. DustanSandra FooteCheryl M. GutmannSamuel B. GuzeRobert M. HeysselWilliam P. HomanWolfgang K. JoklikDonald N. Medearis, Jr.Stanley R. NelsonDuncan NeuhauserRichard C. ReynoldsMitchell W. Spellman
Group on Business Affairs
STEERING
C. N. Stover, Jr., chairmanWilliam Hilles, executive secretaryDaniel P. BenfordRobert D. DammannThomas A. FitzgeraldC. Duane GaitherPhilip GilletteRobert C. GravesDavid C. HouseJerry HuddlestonWarren KennedyV. Wayne KennedyErvin C. ProschekDavid A. SinclairDon B. Young
Group on Medical Education
STEERING
Robert A. Barbee, chairmanJames B. Erdmann, executive secretaryGeorge L. BakerMerrel D. FlairGunter GruppRussell R. MooresRobert F. SchuckHarold J. SimonGregory L. Trzebiatowski
285
Management Advancement ProgramSteering
Ivan L. Bennett, Jr., chairmanJ. Robert BuchananDavid L. EverhartJohn A. GronvallIrving LondonRobert G. PetersdorfClayton RichCheves McC. Smythe
Minority Student Opportunities in Medicine
George Lythcott, chairmanAlonzo C. AtencioRaymond J. BarrerasHerman R. BransonLinwood CustalowFrank DouglasPaul R. ElliottDoris A. EvansChristopher C. Fordham, IIIWalter F. LeavellCarter L. MarshallLouis W. SullivanDerrick TaylorNeal A. Vanselow
Journal of Medical Education Editorial Board
Richard P. Schmidt, chairmanStephen AbrahamsonJohn W. CorcoranHenry W. Foster, Jr.Richard J. HarperRalph W. IngersollEdgar Lee, Jr.J. Michael McGinnisChristme McGuireIvan N. MenshJacqueline NoonanEvan G. Pattishall, Jr.Osler L. PetersonGeorge G. ReaderRichard C. ReynoldsRobert RosenbaumC. Thomas SmithJames C. StricklerLouis W. SullivanJohn H. Westerman
National Citizens Adivsory Committee forthe Support of Medical Education
Mortimer M. Caplin, chairman
Group on Public Relations
STEERING
AAMC Annual Report for 1977
Group on Student Affairs
STEERING
Hospital Cost Control
Martin S. Begun, chairmanRobert J. Boerner, executive secretaryA. Geno AndreattaWillard DalrymplePaul R. ElliottMarilyn HeinsHenry H. HoffmanMartin A. Pops
U Thomas A. Rado~ W. Albert Sullivan
ao<.l:1 Implementation of Health Planning1:! Legislation(1)a Charles A. Sanders, chairman8 Walter F. Ballingero A. Jay Bollet
Q Raymond CornbillKenneth R. CrispellJohn M. DennisHenry B. DunlapWilliam H. LuginbuhlJohn M. StaglPhilip Zakowski
Terry R. Barton, chairmanCharles Fentress, executive secretaryDonald GillerCharles Gudaitis
§ Hugh Harelsoni2 Margaret Marshall~ Michael Mattsson;j) Helen M. Sims0.. Susan K. Stuart-Otto
Frank J. Weaver
(1)
...s::~ David L. Everhart, chairman~ Robert M. Heyssel::: Lawrence HilloB David H. Hitt~ Robert K. Rhamy"0 Elliott C. RobertsU Edward J. Stemmler(1)
-:5 Charles B. Womer
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286 Journal of Medical Education
George Stinson, vice chairmanJack R. AronG. Duncan BaumanKarl D. BaysAtherton BeanWilliam R. BowdoinFrancis H. BurrRetcher ByromMaurice R. ChambersAlbert G. ClayWilliam K. CoblentzAllison DavisLeslie DavisWillie DavisDonald C. DaytonBenson FordDorothy Kirsten FrenchCarl J. GilbertRobert H. GoddardEmmett H. HeitlerKatharine HepburnCharlton HestonWalter J. HickelHarold H. Hines, Jr.Jerome H. HollandMrs. GIlbert W. HumphreyErik Jons~on
Geraldine JosephJack JoseyRobert H. LeviFlorence MahoneyAudrey MarsArchie R. McCardellEinar MohnE. Howard MolisaniC. A. MundtArturo OrtegaThomas F. PattonGregory PeckAbraham PritzkerWilliam Matson RothBeurt SerVaasLeRoy B. StaverRichard B. StonerHarold E. ThayerStanton L. YoungW. Clarke WescoeCharles C. Wise, Jr.William WolbachT. Evans Wychoff
VOL. 53, MARCH 197f
Nominating
James E. Eckenhoff, chairmanA. Jay BolletJohn M. DennisHerluf V. Olsen, Jr.Charles B. Womer
Planning Coordinators' Group
STEERING
Russell C. Mills, chairmanGerlandino Agro, executive secretaryHoward J. BarnhardJohn C. BartlettMichael T. RomanoConstantine Stefanu
Resolutions
Robert L. Van Citters, chairmanCarmine D. ClementeJohn W. CollotonRichard Seigle
Student Financing
Bernard W. Nelson, chairmanJames W. BartlettJ. Robert BuchananAnna C. EppsWilliam I. IhlandfeldtThomas A. RadoJohn P. StewardRobert L. TuttleGlenn Walker
Support of Medical Education
Stuart Bondurant, chairmanStanley M. AronsonThomas BartlettSteven C. BeeringIvan L. Bennett, Jr.Frederick J. BonteDavid R. ChallonerJohn E. ChapmanRonald W. EstabrookChristopher C. Fordham, IIIJohn A. GronvallWilliam K. HamiltonMarilyn HeinsDonald G. HerzbergRobert L. Hill
AAMC Professional Staff
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Office of the PresidentPresident
John A. D. Cooper, M.D.Vice President
John F. Sherman, Ph.D.Special Assistant to the President
Bart WaldmanSpecial Assistant to the President for Womenin Medicine
Judith Braslow
Division of Business Affairs
Director and Assistant Secretary-TreasurerJ. Trevor Thomas
Business ManagerSamuel Morey
ControllerWilliam Martin
Staff AssistantDiane JohnCarolyn Ulf
SupervisorAlthea Adkins
Director, Computer ServicesJesse Darnell
Associate Director, Computer ServicesMichael McShane, Ph.D.
Manager, Computer OperationsAldrich Callins
Programmer!AnalystMehdi BalighianJennye ChungSuzanne GoodwinJay StarryJean SteeleJohn WelcherRobert YearwoodSara Zoller
Systems ProgrammerJames Studley
Division of Public Relations
DirectorCharles Fentress
288
Division of Publications
DirectorMerrill T. McCord
Assistant EditorJames Ingram
Manuscript EditorRosemarie D. Hensel
Staff EditorVerna Groo
Department of Academic Affairs
DirectorAugust G. Swanson, M.D.
Deputy DirectorThomas E. Morgan, M.D.
Senior Staff AssociateMary H. Littlemeyer
Staff ASSIStantAlan Mauney
Division of Biomedical Research
DirectorThomas E. Morgan, M.D.
Staff AssociateKathleen Dolan
Division of Educational Measurement andResearchDirector
James B. Erdmann, Ph.D.AssocIate Director
Robert L. Beran, Ph.D.Assistant to the Director
J. Michael McGrawResearch AssocIate
Robert JonesRichard E. Kriner, Ph.D.Marcia LaneAnne ShaferXenia Tonesk, Ph.D.
Research AssistantMillicent Dudley
AAMC Annual Report for 1977 287
James Kelly Ellis BensonSherman M. Mellinkoff Stuart BondurantJohn Milton John W. CollotonRichard H. Moy Marvin CornblathMitchell T. Rabkin John M. DennisPaul Scoles Jerome H. ModellPeter ShieldsEugene L. Staples
VA LiaisonEdward J. StemmlerGeorge Stinson Saul J. Farber, chairman
::: Louis W. Sullivan John R. Beljan9rJ) Virginia Weldon Lawrence G. CrowleyrJ)a George D. Zuidema D. Kay Clawson\-;(1)
Joe S. Greathouse, Jr.0........ Talmadge Bill Review Sherman M. Mellinkoff;:l0..s:: Irvin G. Wilmot, chairman James A. Pittman, Jr.~ Daniel W. Barker Robert L. Van Citters'"d
(1)u;:l
'"d0\-;
0..(1)\-;
(1)
.D0......
......0Zu
~ Liaison Committee Patrick J. V. Corcoran(1) on Medical Education Perry J. Culver..s::......
William F. Kellow4-<0
Non-AAMC Members*rJ) Robert S. Stone:::9
AMERICAN MEDICAL ASSOCIATION......u PUBLIC~<3 Warren L. Bostick Harriet S. Inskeepu
(1) Louis W. Burgher..s:: Arturo G. Ortega......a0 FEDERAL GOVERNMENT<.l:11:: • For AAMC members, see page 284. John H. Mather(1)
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Department of InstitutionalDevelopment
DirectorMarjorie P. Wilson, M.D.
Project Director, ManagementEducation Network
Cheves McC. Smythe, M.D.Assistant Director, Management Programs
Amber JonesStaff Associate
Peter ButlerStaff Assistant
Marcie Foster
289
Research AssistantMary AckermanTravis Gordon
Department of Health Services
DirectorJames I. Hudson, M.D.
Staff AssociateJoseph GiacaloneMarcel Infeld
Division of Accreditation
DirectorJames R. Schofield, M.D.
Staff AssistantJoan Johnson
Division of Institutional Studies
DirectorJoseph A. Keyes
Department of Teaching Hospitals
DirectorRichard M. Knapp, Ph.D.
Assistant DirectorJames D. Bentley, Ph.D.
Staff AssociateArmand CheckerJoseph Isaacs
Department of Planningand Policy Development
DirectorThomas J. Kennedy, Jr., M.D.
Deputy DirectorH. Paul Jolly, Jr., Ph.D.
Division of Faculty Development
AAMC Annual Report for 1977
DirectorHilliard Jason, M.D.
Associate DirectorDale R. Lefever, Ph.D.
Evaluation CoordinatorHenry B. Slotnick, Ph.D.
Workshop CoordinatorLuis L. Patino
DirectorRobert J. Boerner
Assistant Director, Special ProgramsSuzanne P. Dulcan
Director, Minority AffairsDario O. Prieto
Research AssociateJuel Hodge
Staff AssociateDiane Newman
Division of Student Studies
DirectorDavis G. Johnson, Ph.D.
Associate DirectorW. F. Dube
Research AssociateJanet CucaRichard Mantovani
Division of Student ServicesDirector
Richard R. RandlettAssociate Director
Sandra K. LehmanStaff Assistant
Carla WinstonManager
Alice CherianEdward B. GrossSharon L. Smith
SupervisorLinda W. CarterJosephine GrahamVirginia JohnsonPhilip LynchGail ShermanKathryn Waldman
1:: Data Entry Specialist(1) Janet Collinsa8o
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§(1)
0.. Division of Student Programs"5o..s::~"'d
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290 Journal of Medical Education
Legislative AnalystJudith BrasJowSteven GrossmanScott Swirling
Division of Operational Studies
DirectorH. Paul Jolly, Jr., Ph.D.
Associate DirectorWilliam HillesDouglas McRae, Ph.D.
Operations Manager, Faculty ProfileAarolyn Galbraith
Senior Staff AssociateGerlandino AgroCoralie Farlee, Ph.D.Joseph Rosenthal
Staff AssociateBetty Higgins
VOL. 53, MARCH 1978
Robert SavoyCharles Sherman, Ph.D.
Research AssistantJanet Bickel
Staff AssistantLoretta LaskowskiCynthia ScottKathryn SzawlewiczSusan Tillotson
Division of Educational Resources andPrograms
DirectorEmanuel Suter, M.D.
Research AssociateWendy Waddell
Staff AssociateBetty McIlvane
.\Iarch 19iH
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1977-78AAMC Curriculum Directory
The annually revised AAMC Curriculum Directory provides basic objective dataon the curriculum of every U.S. and Canadian medical school (including theUniversity of Puerto .Rico) matriculating students during the current academicyear. Each medical school has a two-page description which outlines theschool's instructional program. including required and elective course titles.duration and types of instruction. and specific conditions for learning. In addition. schools are grouped in terms of certain commonalities. Descriptivestatistics with frequency tables and categorical listings are drawn from theinformation provided by the individual schools which identify patterns ofchange and development in the medical curriculum.
Remittance (no cash) or institutional purchase order must accompany order.
Association of American Medical CollegesAttn: Membership and SubscriptionsOne Dupont Circle, N.W.Washington, D.C. 20036
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$5.00 (Book Rate)
300 pages
$6.50 (First Class)