(1)::o

Association of American Medical CollegesAnnual Meeting

andAnnual Report .

1983

Table of Contents

Chairman's Address 219

Annual MeetingPlenary Session . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 222The Current Status of Academic Medical Center-HMO

Relationships . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 222Special General Session. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 222Council of Academic Societies. . . . . . . . . . . . . . . . . . . . . . . . . . .. 223Council of Deans 223Council of Teaching Hospitals 223Organization of Student Representatives 223GSA/Minority Affairs Section .... . . . . . . . . . . . . . . . . . . . . . .. 224Minority Affairs Program . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 224Women in Medicine. . . . . . . . . • . . . . . . . . . . . . . . . . . . . . . . . . .. 224Data Bases in- Academic Medicine . . . . . . . . . . . .. 225Faculty Roster System ... 1t • • • • • • • • • • • • • • • • • • • • • • • • • • • • •• 225Institutional Profile System. . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 225Group on Business Affairs. . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 225Group on Institutional Planning 225Group on Medical Education. . . . . . . . . . . . . . . . . . . . . . . . . . . .. 226Liaison Committee on Medical Education 228Group on Public Affairs. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 229Group on Student Affairs 230Research in Medical Education. . . . . . . . . . . . . . . . . . . . . . . . . .. 230

Assembly Minutes. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 233

Annual ReportExecutive Council, Administrative Boards . . . . . . . . . . . . . . . . .. 238The Councils -. . . . . . . . . . . . . . . . . . . . . . . .. 239National Policy 247Working with Other Organizations. . . . . . . . . . . . . . . . . . . . . . .. 252Education . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 255Biomedical and Behavioral Research 258Faculty . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 260Students . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 261Institutional Development . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 264Teaching Hospitals 265Communications. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 270Information Systems . . . . . . . .. 272AAMC Membership . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 274Treasurer's Report. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 274AAMC Committees. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 276AAMC Staff. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 280

218

Chairman's Address

What's Right About American Medicine

Steven c. Beering, M.D., Se.D.

university to be as open to all kinds ofstudents as it was to new ideas. He wantedhis faculty to provide not just the tradi­tional disciplines but to offer practicalsubjects-such as science and engineer­ing-in realistic settings. He wanted theuniversity to become an essential partnerwith other segments of society in plan­ning, building, and developing our newcountry.

In 1846, when Charles Eliot returnedfrom Europe to assume the presidency ofHarvard, he was troubled that Americanmedical education consisted oflittIe morethan vocational training. He insisted onbringing the medical school into the uni­versity. He called for a full-time facultyand demanded the same scientific vigorthat he expected from the other researchsciences.

In 1910, Abraham Aexner surveyedthe American medical education sceneand made five major recommendations:(a) relate the medical school to the uni­versity to improve teaching; (b) create ascientific learning environment by theprovision of laboratories; (e) appoint afull-time faculty with research interests;(d) allow students to participate in actualpatient care; and (e) emphasize the sci­entific approach to clinical problems.

It took us nearly 50 years to implementthese various recommendations, but we

This paper was delivered at the November 8,1983, plenary session of the Annual Meeting of thessociation of American Medical Colleges, Wash­

'ngton, D.C.Or. Beering. president ofPurdue University, was

e 1982-83 chairman ofthe AAMC.-!, ,

ao<.l:1

Benjamin Disraeli once said: "The healthof the people is really the foundationupon which all their happiness and alltheir powers as a state depend." Gathered

§ here today are students and teachers, pro-~] '. viders and consumers, researchers, andi radministrators. There are rep~esentatives~ t~ of government, the lay publIc, and the~ I~· media. Each ofus comes from a different~ : background but all of us share the sameu - goal-a healthy America. And the best~ . way to assure this goal is to maintain and

. improve our system of medical educa­tion, scientific research, and compassion­ate care.

We owe our success in large measureto the life and thought of three greatAmericans-Jefferson, Eliot, and Flex­ner.

In 1819, Thomas Jefferson founded theUniversity of Virginia. This was going to

a different kind of school. He wasoncerned that our early colleges were

. mall copies of their European counter­·Parts. What we needed in America was

n institution which would teach "knowl­ge useful to this day." H'e wanted his

219

VOL. 59, MARCH 1984 Ch

We discovered that we are living at least of10 years longer than the actuarial tables me'had predicted. We also learned that the (last decade of life is the most expensive. tiviIt is then that we rely on Social Security me'and consume fully one-third ofthe federal bilihealth care dollar. J

For awhile we assumed the trouble lay discin poor management, overuse of the sys- erntem, lack of advertising, absence of con- to asumer choices, not enough competition, ityor even fraud. Gradually it became evi- res}:dent that the cost of modern technology, putcoupled with increasing need, was at the enttroot of the dilemma. . tior

So it is time once again to reorder our: UP'priorities and to draw up another agenda erfor concerted action: - air

1. The individual must learn aboutt".

health risks and use common sense. ~

2. Public schools, colleges, and the meJdia must teach social awareness and pre-~ ns!·vention of life-style problems. t atlc

3. Cities and. counties must monitor~. h) tpublic health matters, and provide-atl' osr.least in part-for the poor, the elderlY,r orand individuals in institutions. ~ eah.

4. The states must provide for welfare, - W:public health, and environmental con- -ne:cerns.

5. Employers must make the workplace safe and provide reasonable insur- ­ance coverage.

6. The third-party payers should pafor ambulatory care and pool risks andprovide prospective reimbursements.

7. Physicians must act as informed fieduciaries and safeguard the quality 0

care, assess new technology, and help ed· ­ucate the public.

8. Congress must provide for indigentsand medical research. Furthermore, inorder to make good on our promises tothe young, the elderly, the minorities, theveterans, the aliens, the disabled, and theinstitutionalized, we must recognize thenecessity to spend more than 10 percent

220 Journal ofMedical Education

got the job done. Today, our open systemof universal education, our universities,and our medical centerS are matched inonly few places in the world. However,progress was not universal or continuous.And by the 1960s, we were cognizant ofmanpower shortages, uneven physiciandistribution, and problems with access,availability, and afTordability of medicalcare. In 1965, we invented Medicare; andwhen we gathered for our Association ofAmerican Medical Colleges AnnualMeeting in November 1968, we wereready to discuss changes in the medicalcurriculum to meet the "health care cri­sis."

It was an altogether remarkable meet­ing. We not only changed the structure ofour entire organization but also agreed tothe following actions: (a) to increase theenrollment of each medical school by 10percent; (b) to admit students from di­verse economic, cultural, and geographicbackgrounds; (c) to assume responsibilityfor graduate medical education; (d) toconcern ourselves with the organizationand delivery ofhealth services; (e) to helpcontrol rising health care costs by trainingparamedical personnel; (j) to encourageour graduates to work in underservedareas; (g) to experiment with shorter anddecentralized curricula; and (h) to de­velop teaching programs in new fieldssuch as family medicine, emergency med­icine, and ambulatory care.

Most of us will remember these pointsas the general marching orders for theensuing decade. We did well and com­pleted the job in record time. It is themark of the American genius that we riseto crises and usually with such enthusi­asm as to overcompensate..And so it wasnot surprising that the 1970s ended withthe recognition that our resource alloca­tions were inadequate and that we had,in fact, promised more than we coulddeliver.

'84 Chairman#s Address/Beering

:ast of the GNP on health care; we have thelIes means and the moral imperative.'.he 9. The AAMC must emphasize crea-

tivity and quality as the most effectiveveeity measure to meet our national responsi-~ral bilities.

America is the world leader in scientific,discovery, medical education, and mod­.ay

'ys- em medical care. We can point with prideIn- to a record of: (a) progress and productiv­

ity enhanced by freedom of inquiry andIn,~vi- responsible public funding; (b) a balanced

public-private partnership in our research~,

h enterprise; (c) the development ora func­. e~ tioning system of peer review; (d) the~ lur: upport of projects based on scientific~.da erit; (e) the maintenance ofa system of§ , air public and scientific accountability;~ lU( the rational application of basic.g J nowledge to practical problems; (g) the~ le-~' reation and perpetuation ofthe National~ re-~- nstitutes of Health as the wellspring ofa~ I ational biomedical research effort; andu 'ot: h) the founding of the modem teaching~ -at~~ ospital as an effective social instrument~ ~ly,f or the provision of tertiary care and~ 'ealth care education.o

] What's right about American medi-~ re,] n- ne?Just look at these achievements, and~ e could add the development of organo

~ rka§ Jr·oQ

ay.nd

ti­o

xl-

115int~

hehehe:ot

221

transplants, bypass surgery, advances ingeriatrics and immunology, the CATscanner, magnetic resonance, dialysis,chemotherapy, synthetic insulin, andhigh-technology monitoring.

There is much here to support the ar­gument that American medicine is excep­tional. We have a magnificent capacityfor imagination. We have knowledge,skills, determination, programs, prod­ucts-in short, steady and spectacularprogress.

As Americans we have special tradi­tions of shared values, hard work, anddemocratic governance-of compassionfor individuals and charity to nations­of willingness to tackle tough problems.

In Herman Melville's words, Ameri­cans are "the pioneers of the world; theadvance-guard, sent on through the wil­derness of untried things, to break a newpath.... In our youth is our strength; inour inexperience, our wisdom."

It is time we quit being skeptics, for itis only when we despair that things be­come impossible. So let us learn from ourlimits but celebrate opportunity for use­fulness and thus continue to provide be­lievable hope for mankind. Jeffersonwould have liked that.

The Ninety-Fourth Annual Meeting

Washington Hilton Hotel, Washington, D.C., November 5-10, 1983

Theme: Creativity: The Keystone of Progress in Medicine

Program Outlines

PLENARY SESSION THE CURRENT STATUS OF ACADE~ICMEDICAL CENTER-HMORELATIONSHIPS

November 6

November 8

Moderator: Morton A. Madon: M.D.J(eynote: Bernard W. Nelson, M.D.

The Extent ofUndergtaduate MedicalTraining in HMOsJoseph C. Isaacs

The Extent ofGraduate MedicalTraining in HMOsBruce J. Sams, Jr., M.D.

Affiliation with an Independent HMO I:Howard L. Kirz, M.D.

Transformation ofa Prepaid Plan from IAcademic Governance to anIndependent EntityLawrence Kahn, M.D.

A Medical Center-Sponsored HMO: IEvolution ofa Stable Relationship ,Ronald P. Kaufman, M.D. 1_'

A Newly Developing HMO with Close Tiesto an Academic Medical CenterWilliam W. Emmot, M.D. ISPECIAL GENERAL SESSION

GENERAL PROFESSIONAL EDUCATION

OF THE PHYSICIAN AND COLLEGE

PREPARATION FOR MEDICINE

Emerging Perspectives:lProblems,

Priorities, and Prospects Reported to the

222

November 7

Presiding: Steven C. Beering, M.D.

Transformation of Medicine Since 1945Julius R. Krevans, M.D.

Medical and Scientific Advances:Social Cost or Social Benefit?Uwe E. Reinhardt, Ph.D.

Nurturing the Scientific EnterpriseJames B. Wyngaarden, M.D.

Alan Gregg Memorial Lectur~:

Managing the Revolution in Medical CareRobert G. Petersdort: M.D.

November 8

Presiding: Robert M. Heyssel, M.D.

Presentation of AAMC Research andAexner Awards

Presentation ofSpecial Recognition Award toMartin M. Cummings, M.D.

Infuriating Tensions: Science andthe Medical StudentJ. Michael Bishop, M.D.

Medical Progress: How Much MoneyWill It Take?Eli Ginzberg, Ph.D.

Chairman's Address:What's Right About American MedicineSteven C. Beering, M.D.

1983 AAMCAnnualMeeting

Panel by Project ParticipantsPresiding: Steven Muller, Ph.D.

Discussants:Perspectives on LearningJohn H. Wallace, Ph.D.Pamelyn OosePerspectives on Oinical EducationDaniel D. Federman, M.D.Grady Hughes, M.D.

- Perspectives on College Preparation andAdmission to Medical SchoolMargaret Olivo, Ph.D.Martin A. Pops, M.D.

Perspectives on Faculty InvolvementI .. D. Kay Oawson, M.D.- : Ernst Knobil, Ph.D.~0..

"5o

~] OUNCILOF] CADEMIC SOCIETIESe(1)

.D

.8

~ November 6

- CAS PLENARY SESSION

Research Support: A Consensus is Needed

_Research Funding Priorities of theNational Institutes ofHealthWilliam F. Raub, Ph.D.

Statement ofBasic Principles of theNation's Medical Research ProgramJohn F. Sherman, Ph.D.

Congressional "Micromanagement" ofthe NIHJohn Walsh

The Science of Politics and thePolitics of ScienceLeonard Heller, Ph.D.

Can Biomedical Research Survive theAttacks ofConfused Lucidity?Sherman M__ MellinkofT, M.D.

November 7

Business MeetingPresiding: Frank C. Wilson, M.D.

223

COUNCIL OF DEANS

November 7

Business MeetingChairman: Richard Janeway, M.D.

COUNCIL OF TEACHING HOSPITALS

November 7

Business MeetingPresiding: Earl J. Frederick

General SessionPresiding: Haynes RiceEthical Dilemmas and Economic RealitiesLaurence B. McCullough, Ph.D.

ORGANIZAnON OFSTUDENT REPRESENTATIVES

November 4

Regional MeetingsCentralNortheastSouthernWestern

Business Meeting

Joint Program with Society for Health andHuman Values-"Ethical Dilemmas ofMedical Students: Questions No One Asks"Moderator: Carol MangioneSpeakers: Louis Borgenicht, M.D.

Kathryn Hunter, Ph.D.Joanne Lynn, M.D.Brent Williams, M.D.

NovemberS

Business Meeting

Small Group Discussions with Societyfor Health and Human Values

OSRProgram

Becoming an Effective Oinical Teacher­for Yourself: Your Patients and OthersSpeakers: Hilliard Jason, M.D., Ed.D.

Jane Westberg, Ph.D.Teaching Skills WorkshopsRegional Meetings

I

224 Journal ofMedical Education

CentralSouthernWesternNortheast

November 6

Candidate for OSR Office Session

Issues Assessment Group Discussions

Business Meeting

Regional MeetingsCentralSouthernNortheastWestern

November 7

Discussion Sessions

Computers & Medical Students:A Hands-On WorkshopLisa Leidan, Ph.D.

A Seminar for Third & Fourth Year MedicalStudents: Retaining Your Humanism in theFace ofTechnologic ExplosionRobert Lang, M.D.Alan Kliger, M.D.

GSA/MINORITY AFFAIRS SECfION

November 6

Minority Student Medical CareerAwareness Small Group Session

Minority Student Medical CareerAwareness Workshop

November 7

Regional MeetingsCentralNortheastWesternSouthern

Business Meeting

MINORITY AFFAIRS PROGRAM

November 8

PRESENTATION OF NATIONAL MEDICAL FEL­

WWSHIP AWARDS

VOL. 59, MARCH 1984

Leon Johnson, D.Ed.Franklin C. McLean Award:Angelo GaliberWilliam and Charlotte Cadbury Merit Award:Crystal Terry

PRESENTATION OF GSA-MAS SERVICE AWARDS

John A.D. Cooper, M.D.GSA-MAS Service Award:Alonzo C. Atencio, Ph.D.Maxine Bleich

MINORITIES IN MEDICINE

Keynote SpeakerU.S. Representative Charles B. Rangel---

WOMEN IN MEDICINE

November 6

Women Liaison Officers Meeting

WOMEN, MEDICINE AND THE LAW

Moderator: Jane Thomas, Ph.D.Keynote: Sylvia LawRespondents: W. Donald Weston, M.D.

Beverly B. Huckman

Reception

November 7

Regional MeetingsWesternSouthernNortheastCentral

A TALEOFO

A slide tape show based on Dr. RosabethMoss Kanter's research for her award­winning book, Men and Women o/theCorporation. The slide-tape demonstrateswhat happens to any minority individual in a ;workgroup.

WOMEN IN MEDICINE TAPES

Video tapes produced at Harvard MedicalSchool featuring women professors inmedicine and science.

November 8

Women in Medicine LuncheonGender Differences and Bioethical DilemmasChristine K. Cassel, M.D.

I

84 1983 AAMCAnnual Meeting

. November9

Joint Meeting with Association ofTeachersofPreventive Medicinerd:WOMEN, WORK AND HEALTH

225

Midwest-Great PlainsNortheastSouthernWestern

S DATA BASES INACADEMIC MEDICINE

November 7

PUTTING WNGITUDINAL RESEARCH TO

WORK IN THE ADMISSIONS PROCESS

Introduction, Problems and ProspectsCharles P. Friedman, Ph.D.

. Results ofRecent StudiesHarold G. LevineJon J. Veloski

Interaction with the Admission ProcessRoger Girard, Ph.D.

Reactions -Barry Stimmel, M.D.

. FACULTY ROSTER SYSTEM

November 6 and 7

The Faculty Roster System is a computer­based data storage and retrieval system con­taining biographical and education data on

- U.S. medical school faculty. Annual Meetingparticipants were invited to stop by and learnabout this AAMC system. Special reportsavailable to the medical schools weredescribed, and questions regarding utiliza­tion of the data were answered.

EMERGING ISSUES RELATED TO

MEDICAL SCHOOL/HOSPITAL

AFFILIATIONS

As Viewed By the Medical CenterNeal A. Vanselow, M.D.

As Viewed By the University-OwnedHospitalJeptha W. DalstoD, Ph.D.

As Viewed By the Affiliated HospitalScott R. Inldey, M.D.

As Viewed By the Veterans AdministrationPaul East, M.D.

As Viewed By the County HospitalT. Franklin Williams, M.D.

November 8

CARROLL MEMORIAL LECTURE AND

LUNCHEON

William G. Anlyan, M.D.

National Business Meeting

The Role of Investor-Owned Hospitals inMedical EducationS. Douglas Smith

Understanding and Effective ManagementofSelfA. Jack Turner, Ph.D.

INSTITUTIONAL PROFILE SYSTEM

November 6 and 7

a The AAMC Institutional Profile System is acomputer-based data storage, retrieval, andanalysis system containing many variableson each U.S. medical school. AnnualMeeting participants were invited tovisit to learn about this data service.

GROUP ON BUSINESS AFFAIRS

November 7

Regional Meetings

GROUP ON INSTITUTIONAL PLAN­NING

November 6

Open Discussion Groups

Prospective Reimbursement andInstitutional ResponseConvenor: Thomas G. Fox, Ph.D.

Strategic Planning for Medical SchoolsConvenor: Charles W. Tandy

University-Industry RelationshipConvenor: David R. Perry

ao<.l:11::(1)

a§o

Q

226 Journal ofMedical Education

THE EFFECTS ON MEDICAL

EDUCATION OF CHANGES IN THE

HEALTH DELIVERY SYSTEM

IntroductionMarie Sinioris

The Effect of the For-ProfitDelivery SystemsBradford H. Gray, Ph.D.

The Effects of the Imperativesfor Hospital SystemsJohn Danielson

The Effect of Increasing Numberof PhysiciansRobert G. Petersdorf, M.D.

How Might the Schools RespondEdward J. Stemmler, M.D.

GROUP ON MEDICAL EDUCATION

November 6

GME MINI-WORKSHOPS

USING OBJECTIVE MEASURES OF

PERSONAL QUALITIES IN ADMISSIONS

DECISIONS

Organizer: Agnes G. Rezler, Ph.D.Faculty: Barbara Sharf, Ph.D.

Joseph Flaherty, M.D.

HELPING OTHERS IMPROVE

TEACHING SKILLS

Organizer: Neal Whitman, Ed.D.Faculty: Thomas L. Schwenk, M.D.

THE IMPLEMENTATION OF LEARNING

STRATEGIES/TEACHING STRATEGIES FOR

MEDICAL STUDENTS, RESIDENTS AND

FACULTY

Organizer:Karen Collins, Ph.D.Faculty: Joni E. Spurlin, Ph.D.

MEDICAL STUDENT LEARNING

PROBLEMS: DIAGNOSIS AND

MANAGEMENT

Organizer:Judy SchwenkerFaculty: Jean Saunders, Ph.D.

Donald RoebuckFrancoise KingRobert Blanc, Ph.D.

VOL. 59, MARCH 1984

MAKING ORDER OUT OF CHAOS:

CRITERIA FOR INSTRUCTIONAL

SOFTWARE SELECTION

Organizer: Connie L. Kohler, M.A.Faculty: Madeline P. Beery, M.A.

Charles P. Friedman, Ph.D.David Swanson, Ph.D.

GME/SMCDCME JOINT SESSIONS

TELECONFERENCING AS A COST

EFFECTIVE DELIVERY MECHANISM OF

MEDICAL EDUCATION

Organizer:Clyde Tucker, M.D.Faculty: Rickiann Saylor Bronstein, Ph.D.

Elmer Koneman, M.D.Thomas C. Meyer, M.D.

SMALL GROUP DISCUSSIONS

FACILITATING LIFE-LONG LEARNING:

ROLE OF SELECTION AND EDUCATION

Moderator: William A. ClintworthPanelists: Donald V. Catton, M.D.

S. Scott Obenshain, M.D.

COMPUTER BASED INFORMATION

MANAGEMENT SYSTEMS FOR MEDICAL

PRACTICE

Moderator: David Steinman, M.D.Lawrence Lutz, M.D.

Panelists: Neal Whitman, Ed.D.Jim Cunningham, Ph.D.Donna Harris, Ph.D.Priscilla MaydenEllen Tabak, M.S.D.H.

COMPETENCE ASSESSMENT: PRACTICAL

EVALVATION OF CLINICAL SKILLS

Moderator: Paula L. Stillman, M.D.Panelists: G. James Morgan, M.D.

Lila N. Wallis, M.D.

GME/CME SPECIAL SESSION

THE GENERAL PROFESSIONAL

EDUCATION OF THE PHYSICIAN AND ITS

RELATIONSHIP TO CONTINUING

MEDICAL EDUCATION: ISSUES AND

PRIORITIES

Moderator: Gerald H. Escovitz, M.D.Presentation of the IssuesVictor R. Neufeld, M.D.Panel Discussion and IssuesChair: Oscar A. Thorup, M.D.

227

Continuing Medical Education ProgramsModerators: Lynn Curry, Ph.D.

Nancy Coldeway, Ph.D.

Faculty DevelopmentModerators: Hilliard Jason, M.D.

Jane Westberg, Ph.D.

Computer Applications in MedicalEducationModerators: Robert M. Rippey, Ph.D.

David Swanson, Ph.D.

Educational Support Systems for Students,Including Tutoring and RemediationModerators: Miriam Willey, Ph.D.

Evelyn McCarthy, Ph.D.

Innovative Approaches to Admissions andStudent Financial AidModerators: Jon Veloski

Robert Keimowitz, M.D.

Approaches to the Development andAssessment of Desirable PersonalQualities, Values, and AttitudesModerators: Joseph Sheehan, Ph.D.

Michael Gordon, Ph.D.

GME/GSA-MAS SPECIAL SESSION

IDENTIFYING STUDENT PROBLEMS IN

LEARNING AND TAKING EXTERNAL

EXAMINATIONS

Moderator: William Wallace, Ph.D.Panelists: Robert Blanc, Ph.D.

Deanna Martin, Ph.D.Alonzo C. Atencio, Ph.D.Marcia Wile, Ph.D.

November 8

November 9

GME-Plenary Session

INNOVATIONS IN MEDICAL EDUCATION

EXHIBITS

RIME FIRST ANNUAL INVITED REVIEW

Measuring the Contribution of MedicalEducation to Patient CareSpeaker: Joseph S. Gonnella, M.D.

November 7

1983 AAMCAnnual Meeting

INNOVATIONS IN MEDICAL EDUCATION

EXHIBITS

GME/GSA-MAS SPECIAL MCAT SESSION

MINORITY PERFORMANCE ON THE MCAT

Moderator: Stanford A. Roman, Jr., M.D.Panelists: Sandra R. Wilson, Ph.D.

Robert F. Jones, Ph.D.Robert L. Beran, Ph.D.

:::~ Regional Meetings§ Southernv Central0.."5 Northeast..81 Western

~l GME NATIONAL MEETING'"d '~ I Election of New Officers

..gIRegional Reactions to GPEP Issues~ Statementv,~ I Regional Chairmen

.D.8 Phase II of the Clinical Evaluation Project:o Evaluation Along the ContinuumZ Xenia Tonesk, Ph.D.

~ Report of GME Task Force on Evaluation~ Resourcesv Parker A. Small, M.D.

..s::

.::; INNOVATIONS IN MEDICAL EDUCATIONorfl DISCUSSION GROUPS:::BIn~tructional Design and Evaluation of Basic~ Science Courses8 Moderators: Jane Middleton, Ed.D.

.B Omelan Lukasewycz, Ph.D.

§ Instructional Design and Evaluation of Intra­<.l:1 duction to Clinical Medicine Courses......~ Moderators: Reed Williams, Ph.D.§ Peter Tuteur, M.D.e:>

8 Instructional Design and Evaluation of Clini­cal OerkshipsModerators: Hugh M. Scott, M.D.

Harold Levine

Instructional Design and Evaluation ofResidency ProgramsModerator: Paula L. Stillman, M.D.

John Corley, M.D.

Instructional Design & Evaluation of

228 Journal ofMedical Education

TWENTY-FlRSf CENTURY MEDICAL

EDUCATION: ECONOMIC, SOCIAL,

POLITICAL AND TECHNOLOGICAL

IMPLICATIONS FOR CHANGE

Keynote Address:Duncan Neuhauser, Ph.D.

Special Perspectives:Impact ofTechnological AdvancesEspe~ially Information ManagementJack Myers, M.D.

Impact of Political/Governmental TrendsRobert E. Tranquada, M.D.

Implications for Educational PracticeThomas C. Meyer, M.D.

November 10

Small Group Discussions

DIAGNOSING AND MANAGING CLINICAL

PERFORMANCE PROBLEMS OF

STUDENTS IN ACADEMIC DIFFICULTY

Moderator: Howard S. Barrows, M.D.Panelist: Xenia Tonesk, Ph.D.

CLINICAL EXPOSURE FOR FIRST YEAR

MEDICAL STUDENTS

Moderator: L. Thompson Bowles, M.D.Panelist: David Cadman, M.D.

ASSISTING FACULTY IN THE EVALUATION

OF MEDICAL STUDENTS: A PROPOSAL

FOR SHARING MATERIALS AND METHODS

Moderator: Parker A. Small, Jr., M.D.Task Force: Howard S. Barrows, M.D.

Fredric Burg, M.D.James B. Erdmann, Ph.D.Kaaren Hoffman, Ph.D.Geoffrey Norman, Ph.D.Dave Smith, M.D.

Guest: D. Dax Taylor, M.D.

RESPONSIBILITIES OF FACULTY AND

ADMINISTRATION IN CURRICULUM

CHANGE

Moderator: William R. Ayers, M.D.Panelists: S. James Adelstein, M.D.

Murray M. Kappelman, M.D.S. Scott Obenshain, M.D.

COMPUTER-BASED INFORMAnON

MANAGEMENT SYSTEMS FOR MEDICAL

EDUCATION

Moderator: Robert F. Rubeck, Ph.D.

VOL. 59,. MARCH 198'

Panelists: Charles P. Friedman, Ph.D.Tracey Veach, Ph.D.A. Dwayne Anderson, Ph.D.

OUTCOMES OF EDUCATIONAL

PROORAMS IN RURAL SETTINGS

Moderator: DeWitt C. Baldwin, Jr., M.D.Panelists: Harry Knopke, Ph.D.

Beverly D. Rowley, Ph.D.H. Thomas Weigert, M.D.

AN EXAMINATION OF THE RATIONALE

AND EFFECTS OF PROBLEM-BASED AND

SUBJECf MATTER-BASED APPROACHES

FOR TEACHING THE BASIC SCIENCES

Moderator: Paul J. Feltovich, Ph.D.Panelists: Kurt E. Ebner, Ph.D.

Richard L. Coulson, Ph.D.

UTILIZING STUDENT MOTIVATION TO

SAVE FACULTY TIME: A NEW LOOK AT

LEARNING GROUPS

Moderator: S. Scott Obenshain, M.D.Panelists: Clark Bouton, Ph.D.

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

RESEARCH IN MEDICAL EDUCATION

EMERGING FROM GPEP

Moderator: Ronald W. Richards, Ph.D.Panelists: Margaret Bussigel, Dr. paed.

Victor Neufeld, M.D.T. Joseph Sheehan, Ph.D.Reed G. Williams, Ph.D.

THE ROLE OF ELECfIVES IN MEDICAL

EDUCATION

Moderator: Myra B. RamosPanelists: Stephen Smith, M.D.

Lewis R. First, M.D.

SHARING INFORMATION ON

CURRICULUM DEVELOPMENT,

IMPLEMENTATION, MANAGEMENT AND

EVALUATION

Moderator: Paula L. Stillman, M.D.Panelists: Alberto Galofre, M.D.

Gregory L. Trzebiatowski, Ph.D.

LIAISON COMMITfEE ONMEDICAL EDUCATION

November 6

Institutional Self-Study ofa College ofMedicine Preparation Workshop

J84 1983MMCAnnualMeeting

Edward S. Petersen, M.D.James R. Schofield, M.D.

Discussion

).

GROUP ON PUBLIC AFFAIRSNovember 7

AWARDS 'NOMINEE PRESENTATIONS

Moderator: Dean BorgNominee Presentations for Excellence in:

Special CitationLillian Blacker

Publications-External AudiencesElaine FreemanDavid A. Friedo

Publications-Internal AudiencesGregory GrazeMichela Reichman

.' Special Public Relations/Development/Alumni ProjectJ. Antony Lloyd

. Michela Reichman

Electronics Program-Audio. Frances Cebuhar

Sarah Stratton

Electronics Program-VisualVirginia HuntJames Schlottman

Total Public Relations/Development/AlumniProgram-COTH MemberTeaching HospitalDoug Buck and Arline Dishong

Total Public Relations/Development/AlumniProgram-Medical SchoolJohn DeatsElaine Freeman

DEVELOPMENT TRACK

TO PROVIDE PROPER FUNDING FOR

RESEARCH, EDUCATION AND

PATIENT CARE

Moderator: Everett R. Nordstrom

Major GiftsLewis W. Barron

Deferred GiftsDonald C. Mackall

Interviewers:Arthur Brink, Jr.

David W. CanfieldJames CopelandRobert HartJohn MecouchModerator: Dallas MackeySpecial EventsR.C. "Bucky" Waters

Annual GivingPatricia King

Public RelationsPatrick StoneInterviewers:James AustinSuzanne Ryan CurranBiU GlanceJ. Michael MattssonBiUMcCabe

GPA Business SessionPresiding: Vicki Saito

November 8

AWARDS LUNCHEON

Moderator: Dean Borg

Tylenol-From Crisis To ComebackLawrence G. Foster

Presentation ofAwardsRobert M. Heyssel, M.D.HIGH TECH MEDICINE:

ADVANCEMENT/ETHICS

Moderator: J. Michael Mattsson

Barney Oark's HeartChase N. Peterson, M.D.

To Walk AgainWilliam D. Sawyer, M.D.

Life At What Cost?Laurence B. McCullough, Ph.D.

ISSUES SURROUNDING THE USE OF

ANIMALS IN MEDICAL RESEARCH

Moderator: Michela ReichmanSpeakers: Frederick A. King, Ph.D.

William SamuelsSpyros Andreopoulos

November 9

ISSUES FOR TEACHING HOSPITALS­

EQUATIONS FOR SURVIVAL

Moderator: Roland D. Wussow

229

230 Journal ofMedical Education

Speakers: JeffGoldsmith, Ph.D.William B. Kerr

A DESCRIPTION OF ALUMNI ACTIVITIES

Moderator: Gail AndersonPanelists: Perry J. Culver, M.D.

Tony GoetzSharon Sweder

ROUND TABLE DISCUSSIONS

Getting on the Editorial PageDiscussion Leader: Elaine Freeman

TeleconferencingDiscussion Leader: Clyde Tucker, M.D.

DRGs and the Public Affairs ImplicationsDiscussion Leader: James Bentley, Ph.D.

Cost Conscious PublicationsDiscussion Leader: Nancy Grover

Town-Gown Relationships as HealthScience Centers Enter the Era ofCompetitionDiscussion Leader: Dean Borg

Governmental RelationsDiscussion Leader: Susan Phelps Reynolds

Labor RelationsDiscussion Leader: Shirley Bonnem

Corporate Restructuring and theFoundationDiscussion Leader: Robert Hart

Marketing through DevelopmentDiscussion Leader: John Mecouch

Are You Ready for Fund Raising?Discussion Leader: James Austin

How to Create Alumni Activities in MedicalSchoolsDiscussion Leader: Perry Culver, M.D.

The Role ofAlumni in Communicating withLegislatorsDiscussion Leader: Timothy Lemon

GROUP ON STUDENT AFFAIRS

November 7

Student Financial Assistance: Status ofFederal ProgramsModerator: Cheryl WilkesDepartment ofEducationJames W. MooreDepartment ofHealth and Human Services

VOL. 59, MARCH 1984

Thomas D. HatchMilitary and Service-Commitment ProgramsJudith Simpson, Ph.D. . .Education Can Be Affordable: Strategies forFinancial PlanningModerator: Roberta Popik, Ph.D.For the School: James F. Glenn, M.D.For the Community: Bruce E. MartinFor the Student and Family:Ernest W. Stiller, Jr., M.D.

November 9Plenary Session

Joint Session with the Group on Medicai­Education

21st Century Medical Education: Economic,Social, Political and Technical Implicatio~sfor Change

GSA Goals for the 80s:A Brainstorming SessionModerator: Pearl Rosenberg, Ph.D.

Business MeetingChairman: Robert I. Keimowitz, M.D.

RESEARCH IN MEDICAL EDUCATION

November 8

INVITED REVIEW

MEASURING THE CONTRIBUTION OF

MEDICAL EDUCATION TO PATIENT CARE

Speaker: Joseph S. Gonnella, M.D.

November 9

PRESENTATION OF SYMPOSIA

SIMULATED PATIENTS IN EVALUATION OF

MEDICAL EDUCATION AND PRACTICE

Organizer: Christel A. Woodward, Ph.D.Moderator: Victor R. Neufeld, M.D. .Panelists: Geoffrey R. Norman, Ph.D.

Christel A. Woodward, Ph.D.Paula L. Stillman, M.D.

THE DEHUMANIZATION OF MEDICINE:

IS MEDICAL EDUCATION A CAUSE

OR A CURE?

Organizer: Peter A. Bowman, Ph.D.Moderator: Ronald A. Carson, Ph.D.Panelists: Donnie J. Self, Ph.D.

Ruth Purtilo, R.P.T., Ph.D.Laurence B. McCullough, Ph.D.. -

[

~4

1S

1983 AAMCAnnualMeeting

HIGH TECHNOLOGY AT LOW <X>ST:.THREE MODELS OF TELECONFERENCING

IN CONTINUING MEDICAL EDUCATIONOrganizer: Judith,G. Ribble, Ph.D.Moderator: Richard L. Moore, Ed.D.Panelists: Ann R. Bailey

Robert J. SchaeferDavid W. Shively

THE STUDY AND IMPROVEMENT OFCLINICAL INSTRUCfIONOrganizer: Frank T. Stritter, Ph.D.Moderator: Frank T. Stritter, Ph.D.Panelists: Frank T. Stritter, Ph.D.

M~rray M. Kappelman, M.D.David M. Irby, Ph.D.Kelly M. Skefl: M.D., Ph.D.

CONTINUING MEDICAL EDUCATION:MEASUREMENT ISSUES ON TRIALOrganizer: John S. Uoyd, Ph.D..Moderator: John S. Lloyd, Ph.D.Panelists: Philip G. Bashook, Ed.D.

Stuart J.,Cohen, Ed.D.James A. Farmer, Jr., Ed.D.

THE ESSENCE OF CLINICALCOMPETENCE-PSYCHOLOGICAL

. STUDIES OF EXPERT REASONING IN

. MEDICINE

Organizer: Geoffrey R. Norman, Ph.D.Moderator: Geoffrey R. Norman, Ph.D.Panelists: Paul J. Feltovich

Georges BordageVimla PatelLinda Muzzin

APPROACHES TO RESEARCH ON

INNOVATION IN MEDICAL EDUCATIONOrganizers: Barbara Barzansky, Ph.D.

Gary G. Grenholm, Ph.D.Moderator: Gary G. Grenholm, Ph.D.Panelists: John D. Engel, Ph.D.

Charles P. Friedman, Ph.D.Margaret N. Bussigel, Ph.D.

PAPER SESSIONS

CURRICULAR CONSEQUENCES OFASSESSMENT SCHEDULING

Moderator: Ronald Richards, D.E<tLearning in Medical School Oerkships: TheEffects ofTime on ComprehensiveExamination ScoresJon Veloski, et al.

231

The Impact of Examinations on Medical: .Student Time Utilization CyclesHenry B. Slotnick, Ph.D.

Evaluation ofa Comprehensive Non­Traditional Assessment for Final YearMedical StudentsGrahame I. Feletti, Ph.D., et ale

TECHNICAL CONSIDERATIONS INWRI1TEN MEASURES OF COMPETENCE

Moderator: Wayne K. Davis, Ph.D.A Comparison ofSeveral Methods forScoring Patient Management ProblemsJohn J. Norcini, Ph.D., et aI.

Sequence-of-ordering Questions: AnObjective Question Format Designed toTest Aspects ofOinical JudgmentLynn O. Langdon, et ale

Reliability, Validity and Efficiency of VariousItem Formats in Assessment ofPhysicianCompetenceJohn J. Norcini, Ph.D., et ale

PREDICTORS OF MEDICAL STUDENTPERFORMANCE

Moderator: Richard E. Gallagher, Ph.D.Incremental Validity of the MedicalReasoning Aptitude Test (MRAT)-A NewAdmission Test ofOinica1 Problem SolvingAbilityNu V. Vu, Ph.D., et aI.Predicting Oinical Performance: The CaseofAdmissions PreferenceRichard A. DeVaul, M.D., et ale

The Relationship of NoncognitiveCharacteristics to Performance on NBMEPart IRonald J. Markert, Ph.D.

Analysis of Differences in Performance onNational Boards Between Traditional andNon-Traditional StudentsSheila Eder, M.P.H., et ale

PERSPECTIVFS ON PERFORMANCEModerator: Reed G. Williams, Ph.D.

An Investigation ofa Medicine Subtest ofthe National Board Part II ExaminationWilliam C. McGaghie, Ph.D., et ale

The Measurement ofGrowth in MedicalKnowledge in a Non-Departmental

VOL. 59, MARCH 1984

I

II.

I

The Crime and Punishment ofCheating inMedical School .Thomas W. Cockayne, Ph.D., et aI.

SelfEvaluation in Undergraduate MedicalEducation: A Longitudinal ApproachLouise Arnold, Ph.D.

CLINICAL TEACHING

Moderator: W. Dale Dauphinee, M.D.

A Study ofthe Long-Term Effectiveness ofEducation Provided to Medical Students byTeaching Associate Simulated PatientsWalter Gerber, M.D., et al~

Bedside Encounter and CliniCalPerformance ofJunior Clinical ClerksDavid J. Dawson, M.D.C.M., et al.

A Qualitative Study ofTeaching Rounds ina Department ofMedicineJoseph A. MaXwell, et ale

PERSONALITY TRAITS OF PRE-MEDS

Moderator: Linda K. Gunzburger, Ph.D.Type A Behavior in a Pre-Moo StudentPopulationRobert P. O'Reilly, Ph.D.

Assessing the Relationship BetweenMeasures of Personality and Measures ofSocial Networks in Entering MedicalStudentsJeffrey C. Salloway, Ph.D., et ale

Preliminary Evaluation ofan ExperimentalApproach to Selecting Medical Studentswith CareGrahame I. Feletti, Ph.D., et al.

EMOTIONAL DEVELOPMENT AND MEDICAL

EDUCATION

Moderator: Miriam S. Willey, Ph.D.Reactions to Human Dissection: A Report,and a Proposal for Curriculum Modification ;June C. Penney, Ph.D.

Prevalence ofPsychiatric Risk FactorsAmong First-Year Medical StudentsDavid C. Clark, Ph.D.

Depressive Symptoms in Medical HouseOfficersDavid B. Reuben, M.D.

232 Journal ojMedical Education

Organized Medical SchoolM.A.B.J. Sprooten-van Hoot: M.D., et ale

Evaluating Communication Skills ofPhysicians: Four Methods ofMeasurementLeslie S. Jewett, Ed.D., et ale

MEDICAL PROBLEM SOLVING

Moderator: Jack L. Maatseh, Ph.D.The Generalizability ofMeasures ofQinicalProblem SolvingGeoffrey R. Norman, Ph.D., et ale .

Concurrent and Criterion-ReferencedValidity of Patient Management ProblemsFredric M. Wolt: Ph.D., et ale

Expertise in Recall ofClinical Protocols inTwo Specialty AreasLinda J. Muzzin, et ale

AN EXPERIMENT IN MEASURING

PRACI1CE OUTCOMES

Moderator: Philip G. Bashook, Ed.D.Part I: Agreement Among Four PhysicianPerformance Assessment Methods: IN

SEARCH OF A "GOLD STANDARD"

Barbara Gerbert, Ph.D., et alePart II: Implications for AssessmentPanelists: Anthony Voytovich, M.D.

Jeffrey Salloway, Ph.D.Fredric D. Burg, M.D.

FACTORS IN CAREER DEVELOPMENT .

Moderator: C. Benjamin Meleca, Ph.D.Doubts Regarding the Choice ofMedicineas a Career Among First-Year ResidentsMark Vasconcelles, et aleThe Effect ofSex on Physician WorkPatternsLynn Curry, Ph.D.Enhancing Rural Health Care DeliveryThrough Physician Continuing Education:Lessons From Evaluation 'ofa Mid-CareerSabbatical ProgramIlene B. Harris, Ph.D.SELF REPORTS AS AN JNVESTIGATIVE

TOOL

Moderator: Arthur I. Rothman, Ed.D.

Critical Clinical Procedures: A Survey ofResidentsSusan M. Case, Ph.D., et al.

84

Minutes of AAMC Assembly Meeting

November 8, 1983'

Washington Hilton Hotel, Washington, D.C.

Call to OrderDr. Steven c. Beering, AAMC Chairman,called the meeting to order at 8:30 a.m.

Quorum Call

Dr. Beering recognized the presence ofa, quorum.

r Consideration of the Minutes

.: The minutes ofthe November 9, 1982, Assem­· bly meeting were approved without change.

Report of the Chairman

· Dr. Beering reported on events in Congressand at AAMC Executive Council meetings

· that led to the adoption of a statement ofprinciples relating to support for biomedicalresearch. The document, "Preserving Ameri­ca's Preeminence in Medical Research," hadbeen discussed at each ofthe Council meetingson the previous day, and Dr. Beering indicatedthat widespread distribution of the documentwas planned. Dr. Beering added that he was amember of the National Academy ofSciencesInstitute ofMedicine Committee on the Struc­ture and Function of the NIH, and in hiscapacity as a member of that committee hadbeen participating in public hearings relatingto the history of NIH, its current structure,and alternative structures.

Dr. Beering also reported that the ExecutiveCommittee of the AAMC continued to meetwith its counterpart at the Association of Ac­ademic Health Centers to discuss areas of c0­

operative effort. A 1983 AAMC-AAHC con­ference on hospital reimbursement issues re­sulted in a publication, "Medicare ProspectivePayment: Probable Effects on AcademicHealth Center Hospitals." Representatives of

the Association's Executive Committee alsomet regularly with the Joint Health PolicyCommittee of the AAU/ACE/NASULGC.

Earlier in the year a group of deans hadexpressed concern about problems associatedwith the selection of senior medical studentsinto positions at the second postgraduate year.As a result of this concern Dr. John Cooperhad been in correspondence with the chairmenof 18 member CAS societies soliciting theirviews. The Executive Council had studiedtheir replies and had scheduled a meeting onDecember 7 with program directors represent­ing specialties that do not use the NationalResident Matching Program. Also in responseto some ofthe concerns identified, the NRMPhad moved to establish a new advisory com­mittee composed of representatives of eachclinical specialty.-

Dr. Beering extended a special thanks to thefollowing individuals whose terms on the As­sociation's Executive Council or Administra­tive Boards had expired: from the ExecutiveCouncil, Thomas K.. Oliver, Jr., MansonMeads, and Edward Schwager; from the Coun­cil of Deans, William Deal and William Lu­ginbuhl; from the Council of Academic Soci­eties, David Brown, Lowell Greenbaum, andJohn Lynch; from the Council of TeachingHospitals, James Bartlett, Mitchell Rabkin,and John Sheehan; from the Organization ofStudent Representatives, John Deitz, GradyHughes, Carol Mangione, David Thorn, JesseWardlow, and Nora Zorich.

Report of the President

Dr. John A. D. Cooper summarized Congres­sional action on appropriations for the De­partments ofLabor, Health and Human Serv­ices, and Education. Under the act, the Na­tional Institutes ofHealth had received an 11.7percent increase over the previous year's allo­cation, and Dr. Cooper attributed the increase

233

234 Journal ofMedical Education

in part to an effort by more than 100 researchorganizations which worked together toachieve an increase for NIH.

Dr. Cooper also reported on the Associa­tion's suit against Multiprep, a commercialreview firm, to enjoin that firm from furtheruse of copyrighted materials from the MCATexam and to recover damages suffered by theprogram. The copyright violations had forcedthe Association to offer a retake ofthe MCATexamination to approximately 250 medicalschool aspirants who had been exposed tomaterial used on the MCAT exam. A prelim­inary injunction against Multiprep had beengranted, and a criminal investigation by theFBI and the U.S. Attorney's office was under­way.

The'General Professional EduCation of thePhysician and College Preparation for Medi­cine project was ready to consider how medi­cal schools and their faculties might approachimproving medical education and baccalau­reate preparation for the study of medicine.Although the panel's conclusions and recom­mendations would be presented at the 1984"AAMC annual meeting, a special general ses­sion on the project was scheduled for theafternoon of the Assembly meeting.

Dr. Cooper indicated that considerable at­tention by Association staffand leadership hadbeen devoted to issues relating to the reim­bursement of teaching hospitals, especially asmandated by the new Medicare ProspectivePayment System. He referred the members ofthe Assembly to the Association's annual re­port for a complete discussion of AAMC ef­forts in this and other programmatic areas.

Report of the Council of Deans

Dr. Richard Janeway described the Council ofDeans spring meeting in Scottsdale, Arizona,and some of the discussions at that meeting,particularly those relating to the GPEP projectand the MeAT interpretive studies.

During the year the COD AdministrativeBoard had met with the Board of the OSR todiscuss the National Resident Matching Pro­gram. The COD members had requested thatDr. (:ooper's, remarks to their business meet-

VOL. 59, MARCH 1984

ing on the previous day be distributed to allCOD members.

Report of the Council of Academic Societies

Dr. Frank Wilson indicated tharthe 76 mem­ber societies of the CAS had held two majormeetings in 1983. At the interim meeting in:ebruarr, impli.~tionsfor research and !=hang­lng medIcal polICIes at academic health centerswere considered. The previous day's businessmeeting focused attention on the ExecutiveCouncil's document on principles. for the sup­port ofbiomedical research.

During the quarterly 'Administrative Boardmeetings, the CAS had met with Dr. GeorgeMandell, Dr. Len Heller, Dr. James Ebert andvarious NIH staff members. '

Report of the Council of Teaching Hospitals

Mr. Earl Frederick related that the' COTHAdministrative Board had discussed a widevariety ofinterests and had reviewed two pub­lications in a series of reports on the uniquecharacteristics of teaching hospitals.

The Administrative Board had also beenengaged in a review ofthe membership criteriafor the Council ofTeaching Hospitals and thefuture directions the Council should take. TheCOTH Administrative Board had reviewedpapers on these issues and had requested thatthey be placed on the agenda of the 1983AAMC Officers Retreat.

Haynes Rice was elected Chairman of the .Council, Sheldon King Chairman-Elect, andSpencer Foreman Secretary. Elected to theAdministrative Board were William Kerr,Robert Bucha~an, Eric Munson, and ThomasStranova. '

Report of the Secretary-Treasurer

Mr. Frederick referred the members of the -­Assembly to the detailed Treasurer's report inthe agenda book and indicated that the AuditCommittee Jtad found no irregularities in theAssoci~tion's ~nnual audit report. He addedthat Ernst & Whinney had issued an unquali­fied opinion, and he commended Dr. Cooperon the financial position of the AssociatiQ~.

ACfION: On motion, seconded, and carried,

84

all

s

n­·oring-

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rde

ld

s

1

1983 Assembly Minutes

the Assembly adopted the report ofthe Secre­tary-Treasurer.

Report of the Organizationof Student Representatives

Dr. Edward Schwager reported that the OSRhad been encouraging medical students tomeet with their legislators or their staffs toexpress their views on important health issues,particularly student financial assistance.

Major discussion topics for the OSR Boardthroughout the year were the GPEP projectand the resident matching program. An issueof the OSR Report was distributed.

Pamelyn Oose became Chairperson andRicardo Sanchez Chairperson-Elect.

Election of New Members

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

Academic Society Members: American As­sociation of Directors of Psychiatric ResidencyTraining; American Psychiatric Association;American Society for Cell Biology.

Teaching Hospital Members: Baptist Medi­cal Centers, Birmingham, Alabama; LubbockGeneral Hospital, Lubbock, Texas; The Meth­odist Hospital, Houston, Texas; MethodistHospitals of Memphis, Memphis, Tennessee;Metropolitan Hospital Center, New York, NewYork; Orlando Regional Medical Center, Or­lando, Rorida; Pitt County Memorial Hospital,Greenville, North Carolina; St. Joseph MedicalCenter, Wichita, Kansas; St. Vincent Hospitaland Health Care Center, Indianapolis, Indiana.

Corresponding Members: GermantownHospital and Medical Center, Philadelphia,Pennsylvania; Latrobe Area Hospital, Latrobe,Pennsylvania; S1. Mary9s Hospital, Milwaukee,Wisconsin; Southern Nevada Memorial Hos­pital, Las Vega$, Nevada; Tulsa Medical Edu­cation Foundation, Inc., Tulsa, Oklahoma.

Distinguished Service Members: Steven C.Beerin& David R. Challoner, James E. Ecken­hon: Thomas K. Oliver, Jr., Daniel X. Freed­man.

Emeritus Members: DeWitt Baldwin, JohnD. Chase, Daniel Funkenstein, William D. Hol­den, Joseph F. Volker.

Individual Members: List attached to ar­chive minutes.

235

Report of the Resolutions Committee

There were no resolutions reported to the Res­olutions Committee for timely considerationand referral to the Assembly.

Report of the Nominating Committee

Mr. John Colloton, Chairman of the AAMCNominating Committee, presented the reportof that committee. The committee is chargedby the bylaws with reporting to the Assemblyone nominee for each officer and member ofthe Executive Council to be elected. The fol­lowing slate of nominees was presented:AAMC Chairman-Elect: Richard Janeway;Executive Council, COD representatives:Richard Moy and John Naughton; ExecutiveCouncil, Distinguished Service Member:Charles C. Sprague.

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

Installation of New Officers

Dr. Robert M. Heyssel was installed as theAAMC's new Chairman.

Resolution of Appreciation

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

WHEREAS, Steven C. Beeringhas served withdiligence, thoughtfulness, andskillas Chairmanof the Assembly, Chairman of the Council ofDeans, and member ofthe Executive Councilsince 1976, andWHEREAS, his term of service has beenmarkedby his qualities as a leader in academicmedicine and a statesman on public policy is­sues, andWHEREAS, Steven Beering has now left thefray of academic medicine for the relativelysimpleperils ofBig Tenfootball,

BE IT RESOLVED that the Association ofAmericanMedicalColleges recognizes his/aith­ful service with this resolution of thanks andcommendation.

Adjournment

The Assembly adjourned at 9: 10 a.m.

Annual Report

1982-83

Note: The President's Message appeared in, the December 1983 issue of the Journal of

Medical Education as an editorial.

237

Administrative Boards of the Councils, 1982-83

Executive Council, 1982-83

Steven C. Beering, chairmanRobert M. Heyssel, chairman-electThomas K. Oliver, Jr.,

immediate past chairmanJohn A. D. Cooper, president

COUNCIL OF ACADEMIC SOCIETIES

David M. BrownRobert L. HillJoseph E. Johnson, IIIFrank C. Wilson, Jr.

DISTINGUISHED SERVICE MEMBER

Manson Meads

COUNCIL OF DEANS

John E. ChapmanEphraim Friedman

COUNCIL OF ACADEMIC SOCIETIES

Frank C. Wilson, Jr., chairmanRobert L. Hill, chairman-electDavid M. BrownBernadine H. BulkleyDavid H. CohenWilliam F. GanongLowell M. GreenbaumJoseph E. Johnson, IIIDouglas KellyJohn B. LynchFrank G. MoodyVirginia V. Weldon

COUNCIL OF DEANS

Richard Janeway, chairmanEdward J. Stemmler, chairman-electArnold L. BrownJohn E. ChapmanD. Kay ClawsonWilliam B. DealEphraim FriedmanFairfield GoodaleLouis J. KettelWilliam H. LuginbuhlRichard H. MoyM. Roy Schwarz

Fairfield GoodaleRichard JanewayLouis J. KettelWilliam H. LuginbuhlRichard H. MoyM. Roy SchwarzEdward J. Stemmler

COUNCIL OF TEACHING HOSPITALS

Robert E. FrankEarl J. FrederickMitchell T. RabkinHaynes Rice

ORGANIZATION OF STUDENT REPRESENTATIVES

Pamelyn CloseEdward Schwager

COUNCIL OF TEACHING HOSPITALS

Earl J. Frederick, chairman, Haynes Rice, chairman-electJames W. BartlettJeptha W. DalstonSpencer ForemanRobert E. FrankIrwin GoldbergSheldon S. KingGlenn R. MitchellMitchell T. RabkinDavid A. ReedJohn V. SheehanC. Thomas Smith

ORGANIZATION OF STUDENT REPRESENTATIVES

Edward Schwager, chairpersonPamelyn Close, chairperson-electJohn W. DietzGrady HughesCarol M. MangioneRicardo SanchezMark T. SchmalzMary E. SmithDavid ThomJesse WardlowNora Zorich

238

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- initioffieplan.EduaratipriOIregieeduc'tion,newin tbPolicwas,regulgiverOthe:trendtricu},socia

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!# The Councils

ao<.l:1

Executive Council

Between the annual meetings of the Associa­tion, the Executive Council meets quarterly todeliberate policy matters relating to medicaleducation. Issues are referred by member in­stitutions or organizations and from the con­stituent councils. Policy matters considered by

~ ~ the Executive Council are first reviewed by the~ Adniinistrative Boards of the constituent~ councils for discussion and recommendation~ before final action.o

~ The traditional December retreat for newly"8 ,elected officers and senior staff of the Associ­] ,ation provided an opportunity to review a~ number of the Association's major ongoingB activities and to develop priorities for the com-~ ing years. Final revisio~s were made in "Strat­

egies for the Future: An AAMC Workplan,"initially conceived and developed at the 1,981officers' retreat The current status and futureplans of the AAMC's General ProfessionalEducation of the Physician and College Prep­aration for Medicine project were reviewedprior to the- project's beginning its series ofregional hearings on u~dergraduate medicaleducation. Possible AAMC activities for a na-tional medical research awareness project, fornew constituent services, and for participationin the American Medical Association's HealthPolicy Agenda project were considered. Therewas also discusSion ofexpected legislative andregulatory actions, wit~ particular attentiongiven to Medicare reimbursement issues.Other agenda topjcs i~cluded the study oftrends in- medical, school 'applicants and ma­triculants and the appropriate role for the As­sociation in manpower 'forecasting.

Many of the issues reviewed and debatedby the Executive Council-during the past yearwere concerned with the interface between thefederal government and the educational, re­search and patient care missions of AAMCconstituents.

Particularattention was given to reimburse­ment issues since major changes in Medicarepolicies were incorporated in the Tax Equityand Fiscal Responsibility Act and in the Pro­spective Payment System for Medicare. Earlyin the year the Executive Council adopted ninecriteria °as essential in any prospective pay­ment plan. These included recognizing theimpact of the hospital's scope of services, pa­tient mix and intensity of care in operatingcosts, and recognizing the costs associated withmanpower education, clinical research, andthe use of new diagnostic and treatment tech-nmogies. •

The Executive Council also reviewed a pro­posal to establish a Physician's Advisory Com­mission on Oinical Practice to examine majordifferences in medical practice and their con­tributions to variances in length of stay. Inanother action the Council identified certainissues in calculating a hospital's resident-to­bed ratio, and requested that they be broughtto the attention of the Health Care FinancingAdministration prior to the implementationof the prospective payment system.

A number ofconcerns were expressed withDepartment of Health and Human Servicesregulation on "Nondiscrimination on the Ba­sis of Handicap," which related to the provi­sion of appropriate medical treatment toseverely handicapped infants. The Council op­posed the regulation as too broad an interpre­tation of 1973 legislation, and because it spec­ified an ill-conceived method of obtaining in­formation and inappropriately injected thegovernment in medical decision-making.

Since federal research funding had not en­joyed any real growth in the past several years,a number of proposals had surfaced to"stretch" such funds by reducing. the amountof money awarded to approved applicantswith the highest priority scores and distribut­ing the amounts thereby recovered among ap­proved applications with lower scores. The

239

240 Journal ofMedical Education

Council strongly endorsed the current systemfor research funding, believing that the slidingscale would endanger the future funding ofbiomedical and behavioral research.

The reimbursement of indirect costs forresearch supported by the National Institutesof Health continued to occupy the attentionof the Association. The NIH had drafted aproposal for controlling indirect costs underwhich each institution's level of indirect costswould be tailored to its own historical experi­ence. The Executive Council added its supportto a request by other higher education associ­ations that DHHS examine whether existingcriteria for determining allowable costs of re­search were appropriate and whether methodsof apportioning costs among university func­tions and research projects were fair.

In response to the expiration of the author­ity for the President's Commission for theStudy of Ethics ·in Medicine and Biomedicaland Behavioral Research, the Executive Coun­cil expressed support for the continued studyof ethics in medicine through an establishedbody such as the National Academy of Sci­ences. The Council also worked on a proposalunder which the educational loans of physi­cians choosing careers in academic researchwould be forgiven.

Various legislative proposals relating to theNational Institutes ofHealth were reviewed bythe members of the Executive Council whowere distressed by the level of"micromanage­ment" evidenced in these bills. The Councilelucidated a set of principles in support of astrong biomedical research effort which it en­dorsed as the basis for any legislation in thisarea.

A series ofcourt actions related to the Med-.ical College Admission Test required oversightby the Council, which also considered ways tostrengthen and improve the examination. Twoprojects were approved, one to add an essayquestion and another to establish a diagnosticservices program that would provide a detailedassessment ofstrengths and weaknesses ofstu­dents in the areas pf academic preparationtested by the exam.

Questions relating to the match for second­year postgraduate positions led the Council torequest a staff review of current policies and

lVOL. 59, MARCH 1984 1'. l~

problems with the thought that refinements ~. ofcould improve the match program in this area. -..: w,

A report from the Association of Minority co.Health Professions Schools was reviewed, and Pathe Executive Council was pleased to note that Heit had anticipated many of that body's rec- mrommendations in its own 1978 task force re- Sc'po~ ~

As a parent or founding member of other COl

organizations, the Association must occasion- imally review and approve policy decisions by ice~

these organizations. The Executive Council ~

ratified a policy statement ofthe Accredi~tion forCouncil for Graduate Medical Education re- Melating to criteria for entry into graduate med- byical education programs by graduates of III,schools not approved by the Liaison Commit- Gntee on Medical Education or the American. graeOsteopathic Association. The Council also en-I~ Imrdorsed an elaboration of transitional year spe- ~ riCl

cial requirements. . meeThe Accreditation Council for Continuing . geri:

Medical Education presented guidelines to ac- 1company toe Essentials of the ACCME; these ;. datiwere approved by the Council. The Council : Ed\\was also asked to act op the ACCME protocol : sylv·for recognizing state medical societies as ac- whiccreditors of local continuing medical educa- ASS(tion courses. The Executive Council made granseveral suggestions for revision in the protocol min·to assure that the ACCME would ,retain ac- prirrcountability in this process. Although modifi- educcations were made to allow additional input The·into the process by ACCME representatives, tion~

the Executive Council remained dissatisfied gion,rwith the degree to which the ACCME would tivemaintain oversight and provide a national ac- cal Screditation standard. . Dl

The Educational Commission for Foreign COUf

Medical' Graduates asked the Association, as visora founding member, to comment on proposed Gen~bylaw changes being considered by that orga- ciannizati«;>o. Although some of the changes pre- Tl­sented no problem, the Council was especially see tconcerned that proposals to increase the num- Affaiber ofpublic members and to alter the process the Cby which representatives were nominated: to on Ptthe Board of Trustees would further distance Affairthe ECFMG from its sponsoring organiza- Tbtions. retal)

The Executive Council's Continuing review the A'

~4 1982-83 AnnualReport

ts of important medical education policy areas3. was augmented by the work of a number of~y committees. A report from the Committee for.d Payment of Physician Services in Teachingat Hospitals, chaired by Hiram C. Polk, chair­..,- man of surgery, University of Louisville~- School of Medicine, was presented and ap-

proved for distribution so that its findings~r could be considered as HCFA developed and1- implemented special payment rules for serv-Y ices in a teaching setting..it The final report of the Steering CommitteeIn for the Regional Institutes on Geriatrics and~- Medical Education project was also approved:1- by the Executive Council. Joseph E. Johnson,

~)f III, chairman of internal medicine, Bowman~ ~- Gray School of Medicine, presented "Under­[ ,n. graduate Medical Education Preparation for§ .- f Improved Geriatric Care: A Guideline for Cur­~ ~- .~. riculum Assessment," which outlined ways for] ., medical schools to enhance their teaching of.g~ g geriatrics and gerontology.~:- The Council also approved the recommen­E ~ dations of an ad hoc committee chaired by~ ] . Edward Stemmler, dean, University of Penn-

11 sylvania School of Medicine. The committee,which had been charged with reviewing the

,- Association's management education pro­grams, recommended that the continuing ad­ministrative education of its members be a

- primary mission ofthe AAMC and that new- educational efforts be planned and initiated.,t The .implementation of these recommenda­, tions was seen in the successful series of re­i gional seminars held on "Medicare Prospec­:1 tive Payment System: Implications for Medi­• cal Schools and Faculties."

During the course of the year the ExecutiveCouncil also reviewed the activities of the ad­visory panel and working groups for theGeneral Professional Education of the Physi-

• cian project. .The Executive Council continued to over­

see the activities of the Group on Business· Affairs, the Group on Institutional Planning,~ the Group on Medical Education, the Group

on Public Affairs, and the Group on StudentAffairs.

The Executive Council, along with the Sec­retary-Treasurer, Executive Committee, and'the Audit Committee, exercised careful scm-

241

tiny over the Association's fiscal affairs andapproved a modest expansion in the generalfunds budget for fiscal year 1984.

The Executive Committee met prior to eachExecutive Council meeting and conductedbusiness by conference call as necessary. Dur­ing the year the Executive Committee metwith HUS Secretary Margaret Heckler, Con­gressman Albert Gore, Betty Pickett, director,Division of Research Resources, National In­stitutes of Health, and Senator LowellWeicker. They also met twice with the Exec­utive Committee of the Association of Aca­demic Health Centers to discuss issues of mu­tual concern.

Council of DeansThe activities of the Council of Deans in1982-83 centered on business meetings andprogram sessions conducted in conjunctionwith the Association's annual meeting inWashington, D.C., and at the Council's springmeeting in Scottsdale, Arizona. During theintervening periods the Council's Administra­tive Board met quarterly to deliberate Execu­tive Council items of significance to the As­sociation'5 institutional membership' and tocarry on the business ofthe Council ofDeans.More specific concerns were reviewed by sec­tions of deans brought together by coinmoninterest.

The annual business meeting consistedmainly of a series of discussions on recentlycompleted work products, planned activities,and current issues. The work products in­cluded a summary of issues and proposedactions ofthe AAMC relating to the evaluationof the clinical performance of clerks and thereport, "Academic Information in the Aca­demic Health Sciences Center: Roles for the'Library in Information Management." TheCOD presentation was a prelude to an annualmeeting panel discussion entitled, 66AcademicMedical Centers Confront the InformationAge." Key among the current issues portionwas a review of the new Medicare programregulations with particular attention to thethree sets of regulations of primary interest tothe members of the Council: payment of feesfor assistants at surgery, the limitation on rea-

242 Journal ofMedical Education

sonable charges for services in hospital out­patient settings, and hospital based physicianregulations. The Council unanimously sup­ported the }lrinciple that the disposition or useof a fee should not alter the amount of aMedicare fee, opposed that portion of the reg­ulatory proposal which would mandate com­pensation-based fees for physicians paid on asalary basis, and opposed the implementationuntil proposed regulations on .payment forphysicians' services in teaching hospitals werealso published with an appropriate commentperiod. Additional discussions focQsed on theproposed medical research awareness projectand the plan developed by the Group on Stu­dent Affairs to promote adherence to the Na­tional Resident Matching Program agree­ments.

Ninety~ight deans attended the annualspring meeting April 6-9th. Kenneth W.Oarkson, associate director for Human Re­sources, Veterans and Labor, Office of Man­agement and Budget, began the first programsession with an overview of President Rea­gans's FY 1984 budget and described the ad­ministration's rationale for health-related ex­penditures. Major General Garrison Rap­mund, commander, U.S. Army Medical Re­search and Development Command, andRobert Newburgh, leader of biological sci­ences, Office of Naval Research, presentedreviews of their health research programs anddiscussed areas of current priority for extra­mural funding. Donald Young, deputy direc­tor, Bureau of Program Policy, Health CareFinancing Administration, and Truman Es­mond, president, Health Charge, Inc~, dis­cussed recent changes in Medicare physicianreimbursement policies 'and the implicationsof forthcoming prospective pricing for hospi­tals. Raja Khurl, 'dean, American Universityof Beirut, provided an historical prospectiveon the role of the AUB medical center duringthe recent military crisis in Lebanon, notingits significant medical and humanitarian con­tributions. Alfred E. Gellh'orn, director emer­itus, Sophie Davis School of Biomedical Edu­cation, City College of New York, describedthe seven Interface Experiments sponsored bythe Commonwealth Foundation. Dr. Gellhornhighlighted the programs at three universities

l)VOL. 59, MARCH 1984 J,~ 1!

and their attempts to implement early admis- f' dasion options to medical school, and the pro- ~:- sorgrammatic initiatives· undertaken to integrate r; S?Cthe natural and behavioral sciences with the ~ cIa:basic sciences. Donald Drake, a ,science writer .. ancfor the The Philadelphia Inquirer, provided a ~ Te.unique perspective on medical education En:­through his personal experiences while living Meas a medical student with the class of 1978 at exrthe University of Pennsylvania. The program apt:concluded with an open forum on the ingAAMC's General Professional Education of .. rna.the Physician Project, with chairman St~ven _ "Muller, co-chairman William Gerberding, in.panel members John Gronvall, Daniel Toste- forson, David Sabiston, Victor Neufeld, and proj- theect director August Swanson. ' sior

The spring meeting was preceded with an tencorientation session for new deans introducing ~ s~a.them to the AAMC leadership and start: fol-ll tlve..lowed by a briefing on the resources and pro- : Insfgrams of the AAMC. During the spring busi- _gaarness meeting, the Council reviewed topics re- ~. direclating to the Medical College Admission Test, ~ portthe Regional Institutes on Geriatrics and Med- : trairical Education, trends in the National Resi- ~ size(dent Matching Program, applicant and ma- :denttriculant trends, and an overview of current cantlegislative activities in medicine. of t

Sections of the Council that met during the ~. emp.year were the Southern -and Midwest deans in arand the deans of New and Developing Com- andmunity-Based Medical Schools. The deans of and·private-freestanding schools convened a spe- . KreV'cial meeting session at the COD Spring Meet- fomiing. ship

emITthe 1.

Council of Academic' Societies feder

The Council of Academic Societies is com- ~ f retprised of 73 academic societies representing re.U.S. medical school faculty members and oth- t theers from the basic and clinical science disci- secplines. Two major meetings of the CAS were Ie o.convened in 1982-83. ffeet

The 1982 CAS annual meeting in Novem- Anber focused on the AAMC's General Profes- erial'sional Education of the Physician project. In resiCa joint program with the Organization ofStu- ergndent Representatives, students and faculty dis- or Incussed the GPEP working group topics: fun- ume

tt"t:

4 ~ 1982-83 AnnualReport

,So- damental skills, essential knowledge, and per­l- - sonal qualities, values and attitudes thatte should comprise the education of the physi­le .- cian. Stanley J. Reiser, professor ofhumanities~r ~ and technology in medicine, University ofa . Texas Health Sciences Center, spoke on "TheIn Enigmatic Future and Tumultuous Past ofg Medical Education." He emphasized the rapidt expansion of biomedical· knowledge and the

n application of technological advances, point-,e ' ing out the complex ethical dilemmas they)f may place on today's physicians.'n "The Effects of Changing Federal Policies- t in Academic Medical Centers: Implications; for Biomedical Research," was the theme of

. the 1983 CAS Interim Meeting. Key congres­sional staff and executive branch officials at­tended a plenary session and participated insmall group discussions with CAS representa­tives. The plenary session began with National

_Institutes of Health Director James B. Wyn­.g;t- ~. gaarden who discussed program and policy~:._ '1 directions ofthe NIH. The importance ofsup­]~ - porting investigator-initiated research and the~ ,. training of future investigators was empha­z •_ ~ sized. Theodore Cooper, executive -vice presi-~_ dent of Upjohn Company, spoke on political

Q) _t - control and its effects on federal sponsorship~ of biomedical and behavioral research. He§ ~ emphasized that decisions to support research~; in any area should be based on scientific merit~ _ and the opportunities available for discovery

..s::if and ,advancement of knowledge. Julius R.~~_ Krevans, chancellor at the University ofCaIi-~-._ fornia, San Francisco, discussed the partner­8 ship which evolved between the federal gov­

ernment and academic medical centers sincethe 1950s and the destabilizing effect ofrecentfederal policy changes regarding the supportf research, medical education and patient

e. Gerald S. Levey, chairman of medicine_ t the University of Pittsburgh, discussed pro­

sed animal research legislation, one exam­Ie of how changing -policy could adverselyfTect medical schools.

Another session of the meeting considered• eriatrics and medical education. AAMC Vice

resident John F. Sherman reported on "Un-• ergraduate Medical Education Preparation• or Improved Geriatric Care: A Guideline for

urriculum AssessmenL" The document, pre-

243

pared by an AAMC steering committee, re­flected discussions held at four regional insti­tutes in 1982. Dr. John Rowe, director of thedivision on aging at Harvard Medical School,discussed future directions for academic ger­iatrics.

The CAS Administrative Board conductedbusiness at quarterly meetings held prior toeach Executive Council meeting. At its Janu­ary meeting, the CAS and Council of DeansAdministrative Boards met with H. GeorgeMandel, chairman ofpharmacology at GeorgeWashington University, and William F. Raub,associate director for extramural research andtraining at NIH, to discuss the implications ofa number of proposals to stretch researchfunding. Leonard Heller, Robert Wood John­son Health Policy Fellow working with Rep­resentative Edward Madigan, joined the Aprilmeeting for an informal discussion of the roleof the academic community in federal policymaking. In June special attention was given tothe NIH peer review system and the work ofstudy sections. William F. Raub, Thomas E.Malone, NIH deputy director, and StephenSchiafino, deputy director ofthe NIH Divisionof Research Grants, were present to answerquestions and discuss the Board's concerns.

The changing pace and complexity of leg­islative activity stimulated concern aboutwhether the quarterly CAS Briefcould provideadequate information to member societies ina timely manner. The Administrative Boarddecided to discontinue publication ofthe Briefand, instead, encourage member societies tosubscribe to the AAMC Weekly Activities Re­port. The Association's CAS Services Programcontinued to 'assist societies desiring speciallegislative tracking and office managementservices. Six societies participated in the pro­gram in 1982-83: American Federation forOinical Research, Association ofProfessors ofMedicine, American Academy of Neurology,American Neurological Association, Associa­tion ofUniversity Professors ofNeurology andChild Neurology Society.

Council of Teaching HospitalsTwo general membership meetings high­lighted the activities of the Council of Teach-

COrr

at~

thefordem'

244 Journal ofMedical Education

ing Hospitals during ,1982-83. "Health CareCoalitions: Trustees in a New Role or BusinessAs Usual?" was the theme of the COTH gen­eral session at the AAMC annual meeting.The featured speakers were Irving W. Rabb,vice chairman ofthe board and director oftheStop & Shop Companies, Inc., and WillisGoldbeck, director of the Washington Busi­ness Group on Health.

Mr. Goldbeck, whose organization repre­sents approximately 200 ofthe nation's majorbusiness corporations, has assisted corpora­tions in responding to rapidly rising healthcosts. He asserted that business leaders areincreasingly concerned about the cost andmanner in which health care is delivered andaware of the need to exert their influence inthis arena. Goldbeck cited examples in whichbusiness coalitions are monitoring hospitalutilization and introducing increased compe­tition into the health care market. He inviteda coalition from the academic medical com­munity to meet with business representativesto address the future financing of medicaleducation.

Following Mr. Goldbeck, Mr. Rabb ex­plained the problems he faced as both a hos­pital trustee and a major employer. He advisedhospital executives to educate policy-makersand businessmen on the nature of teachinghospitals and the reasons for the differencesbetween teaching hospitals 'and communityhospitals. He said, "Only if business is con­vinced that you are running an efficient oper­ation, engendering prudent utilization, andworking for prudent cost behavior in bothscholarship and service, will we be recruitedto work with you to preserve this extraordinarycapacity which you have developed in Amer­ican academic medicine."

The sixth annual spring meeting of theCouncil of Teaching Hospitals was held inNew Orleans, Louisiana, May 12 and 13. Themain topic of discussion for the more than200 teaching hospital executives in attendancewas state and local initiatives in hospital costcontainment. William Guy, Medi-Cal negoti­ator for California, described the Californiaone-year experiment in which hospitals bid oncontracts to treat Medicaid patients. Underthis highly controversial program some hos­pitals traditionally providing service to a large

VOL. 59, MARCH 1984 {!'

proportion of Medi-Cal patients failed to re- ! cceive contracts. Guy found the real issue of s~

concern to be ihe financial accountability of c'hospitals and suggested the hospitals' ability Cto unilaterally determine the cost and charges;" (for inpatient care would soon disappear. Guy t e:was followed by Paul Ward, president of the f dCalifornia Hospital Association, and William:f crGurtner, executive vice president of Mount ii c(Zion Hospital and Medical Center in San i; trFrancisco. In responding to Guy's remarks, ,- JeWard indicated that he felt the contracting t1-process was a temporary approach and.Jlre- sicdicted that attention would be diverted from itthe issue ofcost to denial ofcare. Gurtner told frehis colleagues of the reaction when his hospi-: th'tal, a substantial provider ofMedi-Cal services ( ofprior to the contracting, was denied a contract. I wtGurtner specified the three areas of concern l~:-'~- IAin implementing such a negotiation process: ;~---

the skimming ofthe healthier patients by some '; fTChospitals; teaching costs, which payers and ~, Hegovernment bodies ~rceived to be someone 'at:else's responsibility; and a simplistic approach socto competition and contracting that failed to therecognize appropriate differences among hos- mepitals and the type of services provided. I tic

Other state and local plans discussed during !

the spring meeting included a description of I istrthe "managed care" approach taken by the· ItsCommonwealth Health Care Corporation in; serBoston, Massachusetts, described by Rena K. I~ bot.Spence, its executive director; the Rochester,;~ fe~

New York, area cost containment approach ' Th{of developing caps on hospital revenues, ex- ~ rna'plained by Gennaro Vasile, executive director t ofof Strong Memorial Hospital; North Caroli- thena's recent limitations on the days of care pitrallowed Medicaid patients receiving certain reirtypes of care, described by Eric Munson, ex- proecutive director of North Carolina Memorial hos'Hospital; the Arizona Health Care Cost Con- soci:tainment System, that state's first Medicaid Hurprogram, outlined by David A. Reed, presi- rete:dent of Samaritan Health Services; ·and a to rteaching hospital experience in establishing a thepreferred-provider organization in response to It alcompetitive pressures, discussed by Gary Bro­kardt, vice president of affiliated corporationsof Presbyterian-St. Luke's Health Care Cor­poration.

John M. Eisenberg, chief of general medi-

t4 r 1982-83 AnnualReport

\

-e: ~ cine at the Hospital ofthe University ofPenn­)1 i sylvania, Richard Gaintner, president and)f L chief executive officer of the Albany Medical~y!~ Center, and Warren Nestler, vice president of~ 'i: Overlook Hospital in Summit, New Jersey,Y \ explained various approaches to managing the

Ie delivery of care. Eisenberg discussed modifi-n cation ofphysicians' behavior to promote costIt I containment. Gaintner described the decen­,n!; tralized approach to management used at The.s, :~ Johns Hopkins Hospital, and Nestler told ofg ~~ the use of DRG information to compare phy­~- r sician performance in delivering care to var­n ( ious types ofpatients. The audience also heard: r' from Richard Thompkins, a manager at Ar-

thur Young and Company, on his firm's studyof the cost of graduate medical education,which is currently being conducted for theDepartment ofHealth and Human Services.

The spring meeting attendees also heardfrom Carl Eisdorfer, president of MontefioreHospital and Medical Centers in New Yorkand John Sherman, vice president of the As­sociation of American Medical Colleges, onthe need for increased attention to geriatricmedicine and the education of future practi­tione~ to meet the needs ofgeriatric patients.

The Council ofTeaching Hospitals Admin­istrative Board met five times during the year.Its discussions dwelt on payment for hospitalservices and payment for physician services,both of which were changed dramatically by

a~ '( federal Jaw and regulation during 1982-83.~ ,I ,: The Board considered how to make policy­§ '. makers more aware ofthe functions and needsQ ~r of the teaching hospital and how to protect

the physician practice plans in teaching hos­-e pitals. As part of its overall attention to1 reimbursement issues, the Board reviewed

proposals for prospective payment systems for1 - hospitals made by the American Hospital As­,- sociation a.nd the Department of Health andi Human Services, and reviewed and advocated,- retention ofa modified Medicare Cost Reporta to provide accurate data with which to assessa the effects of the system on various hospitals.) It also considered the report from an AAMC

committee on paying for physician services inS a teaching setting. Other topics highlighted at".. the COTH Board meetings were preparation

for leadership in the teaching hospital/aca­.. demic medical center and the role of the

245

AAMC in assuring that such leadership train­ing existed; the regulation on "Nondiscrimi­nation on the Basis ofHandicap," which dealtwith instances in which severely handicappedinfants were not treated; and the role of theAAMC in providing services to its memberinstitutions. The COTH Board also reviewedand considered items on the Executive Coun­cil agenda which were of interest to the mem­bership of the AAMC as a whole.

Organization of StudentRepresentativesDuring this year 123 medical schools desig­nated a student representative to the Associa­tion of American Medical Colleges, an in­crease of five from the previous year and thehighest number in the Organization's history.Students from 106 schools attended the 1982Organization of Student Representatives an­nual meeting. The first evening's program on"Nuclear Weapons, Denial Psychology, andPhysicians' Responsibilities" drew a diverseaudience and was offered by H. Jack Geiger,professor of community medicine, City Col­lege ofNew York; Tony Robbins, professionalstaff member, Committee on Energy andCommerce ofthe United States House ofRep­resentatives; and Bruce Dan, formerly withthe Centers for Disease Control. On the nextday, attendees heard presentations by Law­rence Weed, professor ofmedicine at the Uni­versity of Vermont College of Medicine, on"New Premises and New Tools in MedicalEducation" and by John-Henry Pfifferling, di­rector, Center for the Well-Being of HealthProfessionals on "Recreating the Joy of Med­icine." Discussions stimulated by these ses­sions resulted in the formulation and approvalofaction plans on medical use of informationsystems, social responsibilities of physicians,housestaff concerns, financing medical edu­cation, programs for fostering personal growthand development, and improvement of teach­ingand evaluation techniques. Additional pro­grams were given by Robert Lang and AlanKliger, both associate professors of medicinefrom Yale University School of Medicine, on"Retaining Your Humanism in the Face ofTechnologic Explosion," and by Leah Dick-

246 Journal oJMedical Education

stein, associate dean fOf student affairs, andJoel Elkes, professor of psychiatry and behav­ioral sciences, both from the University ofLouisville School of Medicine, on "CreatingSelf-Help Programs."

The Board met prior to each ExecutiveCouncil meeting to coordinate OSR activities,to consider Executive Council agenda items,and to share information on regional projects,including the OSR spring meetings. Adminis­trative Board members prepared stimulus ma­terials to encourage student participation ininstitutional activities related to the AAMC'sGeneral Professional Education of the Physi­cian project. At its April meeting, the Boardapproved a proposal recommending that theAssociation explore mechanisms to achieveadditional 4input from residents. The OSRchairperson presented this proposal to theCouncil of Deans Administrative Board at itsJune meeting. A new area discussed by theBoard was the use of animals in biomedical

~~~

VOL. 59, MARCH 1984 t:!.~

research; it agreed that many medical students r;.

could benefit from reading a pamphlet on thissubject produced by the-Association ofProfes-lsors of Medicine and copies were sent to OSR !~members. As in previous years, the Board ~.~ ~nominated medical students for the position f~of. student part~cipant on ~he Liaison Com- r:mlttee on MedIcal EducatIon and made ape ..:propriate information available to OSR mem- n

ga'bers at schools with upcoming LCME site - at:visits. t

One issue of OSR Report was prepared by t eliindividual members of the Board and distrib-'- Be.

t m,uted to all ~edical students. It included essays f thron the NatIonal Boards, the need to develop' miteaching skills, loan repayment, career deci- f carsions, and creativity. Another publication prOof Revided to OSR membe~ and to student affairs i-. up.deans was a compendIum of programs cur- ¥._~ M'rentIy being offered at medical schools de+ Pr~s~gned to assist students in choosing a spe.~, su:clalty. ,~~:- bot

enciog

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t..-~••,,-t resei clu(~FY

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.pe. -~ The Congressional override of President Rea­~;, gan's veto of its 1982 supplemental appropri.

~: ations bill was a harbinger of change in theclimate for development of national policy.

:~. Besides representing the first Reagan loss on at major economic issue, the override displayed

ys" that Congress was capable ofexacting compre­)P mise from the executive branch. This override

~ ~- ~ carried by the slimmest possible margin in the~ .> I Republican Senate, with 30 Senators voting to~ rs ,-_uphold the veto and 60 voting for the bill.~ r-C, Many of the Republicans who objected to the] e-l-- President's veto did so on the grounds that the] e- supplemental bill stayed within the spending~ ~1 boundaries of the FY 1982 budget resolutionE ~',- endorsed by the President, and that in oppos-~ ) ing the bill he was flouting the spirit of exec-

,~~ utive-Iegislative compromise.~; The AAMC was encouraged by the NIH

,- research funding level of $4.004 billion in­cluded in the final continuing resolution for

~ FY 1983, a welcome, if slight, increase above, the amount requested by AAMC in testimonyr earlier in the 97th Congress. The funding levelf; was insufficient to reverse the trend of a de­: clining percentage of approved research proj-. ects receiving awards. The continuing resolu­

tion did not bring NIH funding, measured inconstant dollars, up to its high-level mark in

; 1979.: Despite signs of an economic recovery, fis­

cal issues retained a paramount position in thepolitical debate; legislators struggled to find apolicy mix that would both boost the economyand remain politically palatable. President

- Reagan's FY 1984 budget reaffirmed his com­mitment to defense increases, cuts in social

: programs (characterized as a "freeze~), andonly limited measures to raise revenues toreduce the deficit. These policies have partic­

-uIar implications for the Medicare program,which was a major target in the FY 1984budget resolution reconciliation instructions.

The crunch on resources fragmented andparalyzed both the 97th and the 98th Con­gresses. For example, the Departments of La­bor, Health and Human Services, and Educa­tion were funded by a continuing resolutionrather than a normal appropriation act for thefourth consecutive year. In March, when theDemocratic House passed its FY 1984 budgetresolution, the bill was immediately brandedas too costly, given the prevailing politicalenvironment of retrenchment. Then the Sen­ate took three months to produce its FY 1984budget resolution. The Senate Budget Com­mittee's original bill and two alternatives wererejected on the Senate floor, and the Commit­tee was instructed to redraft its resolution withno clear indication of what changes wouldmuster a majority. The resolution that finallypassed anticipated a $200 million increase inbiomedical research, while calling for muchlarger tax increases and only half the increasein defense spending that President Reaganrequested. The non-defense portion of thebudget generally received small increases.

The House-Senate budget conferencereached agreement after prolonged negotia­tions. That measure provided room for NIHfunding to increase in FY 1984 by a substan­tial extent. This year9s budget cycle was note­worthy for the marginal role that the WhiteHouse played in forging a compromise andfor Congress9s two-month postponement of itsJuly 22 reconciliation deadline. The Congressweathered an internal tempest in passing itsbudget resolution, which sets broad spendingguidelines, but must exact a further set. ofcompromises, this time for President Reagan,as it works on individual appropriations billsforFY 1984.

On the bright side, congressional supportfor research has been reinvigorated by a re­newed belief that research expenditures havestimulating effects on the economy as a whole

247

1.VOL. 59, MARCH 1984

picked up a large number of additional and! pcor unnecessary provisions. AAMC presented vctestimony on this proposal, stressing that sci- 1.3

entific opportunity is inherently unpredictable ttand requires organizational, operational and infunding flexibility so that the most promising ccresearch leads can be pursued. AAMC reiter- ICated its concern over the additional adminis- tbtrative structures that the bill would impose co~

upon the already adequate mechanisms within ticthe NIH. Waxman's bill is opposed by the grDHHS; there also is a group ofRepresentatives recwho, impressed by the progress NIH has made i~ atein its current configuration and management f A(structure, are determined to forestall further Wf

congressional encroachment. Highly charged ~: liafloor debate has be~un on H.R. 2350, with its f coropponents set to offer an AAMC-supported f: Las~bsti~~te reauthorizat~on that is striking i~ its /. fe\\SImplICIty. The Senate IS also about to conSIder ~~~' curits NIH reauthorization bill. The latter has -'fewer new provisions than the House compan- \ He­ion, particularly in regard to NIH reorganiza- ~ - arytion, but it is still too prescriptive in its con- ~ ridetents to elicit AAMC endorsement. tior

The newly created Public Health Emer- Secgency Fund underscores the susceptibility of ,- itylegislators to well-organized publicity cam- :: gr~

paigns. Once the Secretary certifies that a pub- I funlie health emergency exists, this $30 million 1fund authorizes expedited peer and advisory takecouncil review of relevant research grant ap- pro~

plications. This legislation grew directly out of tiarthe concern engendered by the AIDS epidemic rese'and the Tylenol package tampering tragedy. izafThe bill's proponents have erroneously as- initisumed that since the public perceives an emer- - atesgency, unlimited research opportunities must _ estaalso exist. The bill does not recognize that ~ andexisting NIH procedures already permit a revierapid commitment of research funds to meet ~

unusual opportunities. loorrThe funding picture for NIH remains pre- func

carious although there is some ground for year..optimism. The Administration's FY 1984 f. to bbudget request for NIH of $4.077 billion, an ~ 199':increase over FY 1983 funding of 1.8 percent, percewas repudiated in the congressional budget Moo:'process. The AAMC, through the Coalition jeetefor Health Funding, is working vigorously in carethe 98th Congress to increase government sup- ~ utab

248 Journal ofMedical Education

and that the government's commitment toresearch must be maintained, especially in thedomain of sophisticated technology.

The Association was heartened by the re­newed political popularity of research. How­ever, it remains opposed to the ubiquitous callsfor targeted research with related reorganiza­tional and funding demands. These forceshave left graphic imprints on NIH reauthori­zation bills in the House. In the 97th Congress,the Health Research Extension Act of 1982would have mandated research centers, dem­onstration projects and other statutorily un­necessary activities that would bind the handsofthe Appropriations Committees; limited theNIH Director's latitude to provide funding forresearch proposals showing the greatest scien­tific promise; and mandated numerous ad­ministrative changes in the NIH.

Conceivably even more disturbing than therecodification of administrative provisionsand the statutorily imposed structural uni­formity within NIH was language in the reportaccompanying H.R. 6457 that asserted that allnecessary NIH authority was included in TitleIV of the PHS Act; this came dangerouslyclose to eliminating access to the open-endedstatutory authority ofSection 301 ofthe PublicHealth Service Act. This authority is the bed­rock upon which NIH has grown, and thesevere limitation ofthis authority would marka truly dramatic change in the operationalframework of NIH. H.R. 6457 passed theHouse by a large margin, following heateddebate about the most propitious relationshipbetween the NIH and the Congress, but wasnever enacted, as the Senate version of theNIH reauthorization bill never came to a vote.An emergency, bare-bones compromise toreauthorize the NIH was unsuccessful, hencethe National Cancer Institute and the NationalHeart, Lung and Blood Institute currently op­erate only because of the existence of the Sec­tion 301 authority and the fact that NIH isoperating under a continuing appropriationsresolution. This situation is a telling exampleof the utility ofSection (301 authority.

The NIH authorization bill which Rep.Waxman introduced in the House early in the98th Congress was almost identical to the onefrom the previous session, but it subsequently

249

other increases are due to general inflation inthe cost of capital and labor, as well as to theuse ofnew and costlier technology.

The Medicare reimbursement system hasonly begun to implement drastic statutorychanges enacted during the past year­TEFRA limits on hospital reimbursement andprospective reimbursement rates based on di­agnostic related groups. However, there arealready proposa1s circulating to respond toMedicare's financial difficulties. Many oftheseare primarily concerned with cost reduction,with assurance of adequate health care a dis­tinctly secondary issue.

The growing constituency advocating moresevere restrictions on the use of animals inresearch has monopolized a good deal of theAAMC's legislative energies. Animal welfaregroups are gaining steadily in political sophis­tication, solvency, and emotional clout. In the97th Congress Doug Walgren introduced H.R.6928, "Humane Care of Animals Used inScientific Research, Experimentation andTesting,99 which would have created a numberof onerous and costly provisions for thoseusing animals to further their research. Thebill would have required all laboratories usinganimals to receive AAALAC accreditationwithin ten years, at an estimated cost of$SOOmillion. Further, the bill would have requiredinstitutional animal care committees respon­sible for determining if an acceptable substi­tute for research designs employing animalscould be developed. The fact that NIH grantand contract approval procedures require ex­plicit justification for the use of animals wasapparently disregarded. H.R. 6928 also wouldhave created an HHS grant program to de­velop alternatives to the use of animals inresearch. The AAMCs initial response to Wal­gren's proposal asserted that research on meth­odological issues alone placed a poor secondto experimental design advances made in thecourse ofdirected research; there are powerfuleconomic and experimental incentives builtinto animal research which encourage scien­tists to use animals sparingly and to keep themas healthy as possible; AAALACs require­ments exceed what is necessary to ensure thehumane care and treatment of laboratory an­imals; and that the peer review system, not

1982-83 Annual Report

port for health research. The Association ad­vocates a position taken by 133 other organi­zations to add a minimum of $487 million tothe 1983 appropriations level for NIH fund­ing. This figure would permit 35 percent ofallcompeting projects to be funded; provide for10,000 research trainees, about the average of

... the past 5 years; restore direct and indirectcost reductions proposed by the Administra­tion; and support modest growth in all pro­grams. The AAMC testified on behalf of thisrecommendation in late April before the Sen­ate Subcommittee on Labor/HHS/Education

.t Appropriations, chaired by Senator Lowell'r Weicker, as well as before Congressman WiI-:l ~ liam Natcher's House Appropriations Sub-

§.s :- committee. Another continuing resolution for!i r; Labor/HHS/Ed is highly probable, as only a~.s few working days remain before the end oftheo~;r current fiscal year.] s: The Alcohol, Drug Abuse and Mental~. \ Health Administration was a major benefici-~ ,. - ary of the FY 1983 supplemental veto over­s,. -ride. That appropriation provided an addi-~ tional $10 million for research funding. Theu·· Secretary was also given discretionary author-~ f ~ - ity to allot the research funds to areas of] • greatest need; most went to approved but un­~. I. funded investigator-initiated research grants.B1 The 98th Congress, extending the approach]y taken by 97th, swiftly authorized ADAMHA.s • programs with especially generous authoriza­j ~ tion ceilings for the alcoholism and drug abuse~ = research programs. The ADAMHA reauthor­g'. ization bill mirrors trends in congressionalQ - initiatives concerning NIH. Thus the bill cre-

ates an associate administrator for prevention,establishes procedures for responding to fraudand abuse, and places new provisions on peer

a review ofcontracts and intramural research.t Medicare's projected trust fund insolvency

looms ominously on the horizon. The trustfund had a balance of $18.7 billion just two

.. years ago, but under current law it is expected. to be in arrears by at least $200 billion by. 1995. That figure represents approximately 23

~ percent of the entire federal budget for 1984.Medicare's fiscal problems stem from a pro­

1 jected 1~.2 percent annual increase in Medi­1 care costs, of which only 2.2 percent is attrib­- utable to demographic changes. Most of the

250 Journal ofMedical Education

animals committees, can make the best deter­mination of the appropriate use ofanimals inresearch. Walgren's bill passed through theScience and Technology Committee, but diedin the Energy and Commerce Committee.Walgren continued his efforts in the 98th Con­gress and some animal care provisions wereincluded in H.R. 2350, the NIH reauthoriza­tion bill. Through the efforts of the AAMCand other groups, these provisions are lessburdensome than the ones originally pro­posed. They include the requirement to estab­lish institutional animal care committees withresponsibilities to visit laboratories using ani­mals twice yearly and report to NIH; statuto­rily imposed guidelines for NIH funded re­search using animals; alternative methods re­search; and a study by the National AcademyofSciences on the use ofanimals in research.

In the 97th Congress Senator Robert Dolealso entered the animals in research fray. Hisbill would have made standards in the AnimalWelfare Act similar to those in the "NIHGuide for Care and Use of Laboratory Ani­mals," on which AAALAC accreditation isbased. Dole's bill would also have requiredresearch facilities to establish animal studiescommittees, which would meet regularly andmake semi-annual inspections of research fa­cilities. Senator Dole's bill did· not emerge onthe floor of the 97th Congress, but was rein­troduced in 1983 and hearings were held inlate July. The AAMC testimony objected toits particularly intrusive provisions, includingthe requirement that the Secretary ofAgricul­ture promulgate standards for methodologicalprocedures in research using animals. AAMCalso expressed serious doubt about the capac­ity ofthe Animal and Plant Health InspectionService to verify compliance with those stan­dards and the wisdom of authoriZing the ani­mal studies committees to make judgmentson the appropriate care, treatment and meth­odology of animals used in research, judg­ments properly within the province ofnationalpeer review committees. AAMC did endorsea NAS study on the issue of animals in re­search. This study is now included in both theHouse and Senate versions ofthe NIH renewalauthority.

A potentially dangerous crosscurrent was

VOL. 59, MARCH 1984 if

added to the animal welfare debate when the AsAdministration's FY 1984 budget request ~~again proposed elimination of APHIS fund- .ing, eliminating support for federal oversight c setof the treatment of animals. The Administra- - bution proposed in its budget statement that the toAPHIS activity be turned over to "states, in-' ste,dustry, humane societies, and individuals." . ye'AAMC testified on behalf of seven other so- 10\\

cieties and professional organizations for the - graretention of APHIS funding. Concerns ex- mipressed included the handling of violations FYwhile the new oversight system was being im- ~ Ad­plemented, the imposition of different state ~ pr~

regulations on institutions operating in several .states, and regulation ofinterstate carriers. The t ~enAdministration's proposal was rejected in an r tuappropriations bill awaiting the President's sig- r FYnature. . (:.' ~ee

This year, the Reagan Administration con-::' IDcetinued t~ reduce ~ederal ~nancial assi~nceLIhO ffor medltal educatIon. ThIS occurs at a tIme ..~_ t eofgrowing anxiety in the medical community .• ;;oaabout its ability to draw from the widest pos- loasible array ofqualified students, given spiraling : Adrtuition charges and reports ofdiminishing op- wasportunities for newly trained physicians. Fur- ~~~ther concern stems from the continued inabil- r: CU~

ity of medical schools to increase enrollment . ~elof underrepresented minority students. The aarrfederal government remains the primary pa- .~tron of medical educational opportunity, sup- ~nplyingover 80 percent ofall studentassistance. ~J~The Association has assigned a high priority : 10 P I

to -obtaining an adequate level of financial R TIsupport to meet medical students' needs. ~g

Of all the aid programs, the Health Profes- ce~v~sions Student Loan program endured the most m!:::uncertainty and controversy, beginning with mIllmuch-publicized hearings chaired by Senator eSOJ

Charles Percy about the default rates for the tudeprogram. In late August 1982 HHS issued o~~proposed loan collection regulations so de- ISmanding that at least two-thirds ofthe schools 0 thein the program would have been rendered Dcre'ineligible for further participation. AAMC ex- 175pressed its objections to HHS, met with Sen- _ro~ator Percy's staff in an attempt to soften the utIttregulations, and, along with other health ea tl~professions groups, retained counsel to work onbfor modification of. the regulations. The

l;.41 1982-83 Annual Report

1e~' AAMC effort was modestly successful in help­st ing to persuade HHS to adopt HPSL regula-

tions that will tightly constrain medicalj- ~

Jt . schools in their administration ofthe programbut will not, as feared, foreclose their abilityto utilize it. Many schools have alreadystepped up their loan collection efforts, and byyear's end Senator Percy was lauding them forlowered HPSL default rates. The HPSL pro­gram was further endangered by the low $1.0million capital contribution included in theIT 1983 Continuing Resolution, and by anAdministration FY 1984 budget request thatprovided no further capital contribution.

This year, the president once again at-e tempted to restrict access to the Guaranteed

~.~ t Student Loan program. If adopted, .Reagan'sa'I~ FY 1984 budget proposal would Impose a!.,- -. needs test on all students, regardless of their~ 1- ::: income, and raise the loan origination fee to~:el'- 10 percent of the amount being loaned, twice~ e .~ the current charge. The Guaranteed Student~-' ~. Loan program provides almost one-halfofthe~? ' financial aid utilized by medical students. The~g dministration's FY 1984 proposal for GSL~)- .~_ was only slightly less odious than the one~". .- advanced the previous year, which would have~ I. ;. eliminated graduate medical student involve­~ 1t <- ment in the program altogether. That proposalg' e alarmed the higher education community and~ , _was the target of an energetic, successful lob­] ~ bying effort. This year's proposal was alsoi s rejected in all quarters. The program remains~;; -_ in place but needs to be reauthorized by 1985.§11 The HEAL Program was also the target of8 Reagan retrenchment but it ultimately' re-

j- ceived an FY 1983 credit allocation of $225million, a more adequate level than the $80

illion limit recommended in the first budgetIr esolution. The AAMC successfully mobilizede tudent support for this program when the, nrealistically low credit ceiling was imposed.

·s limitation would have restrained accesss 0 the program at a point when its usage has

ncreased substantially. The Administration's175 million FY 1984 budget request for this

• rogram recognizes its current importance,ut that credit ceiling is too low to give all

1 ealth students the loan funds they need. The. onbinding credit accounts in the FY 1984

251

congressional budget resolution will permitstudents to borrow to meet their full educa­tional cost.

The programs administered by the VeteransAdministration stood immune to the fiscaluncertainty which plagued the funding processin so many areas ofAAMC interest. For bothFY 1983 and FY 1984, HUD/IndependentAgencies appropriation bills, under which theVA is funded, were passed by Congress andsigned by President Reagan. The FY 1984 billprovided a welcome $12 million increase inmedical and prosthetic research, activities thatwere increased in the 1984 bill by another $6million. In its testimony before the relevantHouse and Senate Appropriations Subcom­mittees the AAMC stressed the need for re­search opportunities in veterans' hospitals sothat able staff physicians and residents can berecruited and retained. Emphasis was also.placed upon the need for higher operatingbudgets within VA hospitals to ameliorate theunsuitably low staffing ratios. The Associationcontinued to oppose VA reimbursement forchiropractic service to veterans. In testimonybefore the House Veterans' Affairs Subcom­mittee on Hospitals and Health Care, theAAMC claimed that services of unprovedmedical value do not merit funding in a timeof budgetary stress. A letter of similar thrustwas delivered to the Senate Veterans' AffairsCommittee; however, the Senate approved ameasure which would authorize VA paymentsto chiropractors.

The National Research Service Award taxissue was finally resolved when the IRS re­versed itself and ruled that the awards are tobe treated as scholarships under the tax code.The newly declared tax-exempt status of theawards means that the entire amount of theawards for pre-doctorals is excludable fromincome tax, and that $300 a month is exclud­able in the case of post-doctorals. Legislationtemporarily making the awards tax-exempthad passed the Congress a number of timesand a bill to permanently define the tax statusofthe awards was pending as the IRS, respond­ing to the urgings of the NIH as well as tocongressional pressure, rendered the legisla­tion superfluous.

1.

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Working with Other Organizations

The Council for Medical Affairs-composedof the top elected officials and chief executiveofficers of the American Board of MedicalSpecialties, the American Hospital Associa­tion, the American Medical Association, theCouncil of Medical Specialty Societies, andthe AAMC-continues to act as a forum forthe exchange of ideas among these similar butdiverse organizations. Among the topics con­sidered during the past year were the transi­tional year in graduate medical education,hospital staff organization, prospective pay­ment, and concerns about the selection pro­cess for the second year post-graduate training.

Since 1942 the Liaison Committee on Med­ical Education has served as the national ac­crediting agency for all programs leading tothe M.D. degree in the United States andCanada. The LCME is jointly sponsored bythe Council on Medical Education of theAmerican Medical Association and the Asso­ciation of American Medical Colleges. Priorto 1942, and beginning in the late nineteenthcentury, medical schools were reviewed andapproved separately by the AAMC and theAMA. The LCME is recognized by the physi­cian licensure boards of the 50 states and U.S.territories, the Canadian provinces, the Coun­cil on Postsecondary Accreditation and theU.S. Department of Education.

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

MacllC'

qlbegun the process of revising its accreditation Restandards for the evaluation of M.D. degree reeprograms with the objective of providing an theupdated policy statement for subsequent con- ansideration by the academic and practicing Se'communities. ree

Through the efforts of its professional staff, tiomembers, the LCME provides factual infor- t memation, advice, and both formal and informal r tol,consultation visits to newly developing schools It na'at all stages from initial planning to actual: accoperation. Since 1960 forty-one new medical ;,. speschools in the United States and four in Can-l'~:

ada have been accredited by the LCME. .:' sel-In 1983 there are 127 accredited medical~~- am.

schools in the United States, ofwhich one has ~ Naa two-year program in the basic medical sci- '-. natences. Two have not yet graduated their first '.: ucrclasses and consequently are provisionally ac- ~, gralcredited; the 125 schools that have graduated' clerstudents are fully accredited. Additional merl- ~ schical schools are in various stages of planning - patand organization. The list of accredited ~ eigrschools is found in the AAMC Directory of wasAmerican Medical Education. eva

A number of new medical schools have :' sehcbeen established, or proposed for develop- obstment, in Mexico and various countries in the . con..Caribbean area. These entrepreneurial schools yearseem to share a common purpose, namely to T'recruit U.S. citizens. There is grave concern havlthat these schools offer educational programs '. accrof questionable quality based on quite sparse- ACeresources. The ability ofthese foreign medical riod:'students to return to the United States for the teepractice of medicine will depend on their per- , ACesonal qualifications and backgrounds. How- : com.ever, it is anticipated that within the next five .. accr(years the number of residency appointments in faavailable in the United States will closely' T'match the number ofstudentsgraduating from . Med.U.S. medical schools. Thus, M.D. degree grad- . newuates from foreign schools ofunknown quality ~ This

252

~~

f 1982-83 AnnualReporti:

will have increasing difficulty in securing theresidency training required by many states formedical licensure.

The Accreditation Council for GraduateMedical Education continued to improve theaccreditation system for graduate medical ed­ucation programs under the new General Re­quirements that became effective in July 1982.

In Residency Review Committees, whose special.e requirements no longer are subject to veto by,n their sponsors, were active in strengthening

and clarifying their criteria for accreditation.,g Seven RRCs submitted changes in their special

requirements for ACGME approval. In addi-1 tion, the ACGME approved special require-

ments for four pediatric subspecialties (hema­gal ~ tology/oncology, nephrology, neonatal/peri-

..s::~......~~al-.sl /;.:. natal medicine, and endocrinology). Plans for~:u accrediting these and internal medicine sub-

specialties are being implemented.]l-l: The requirement that graduates of medical.g - schools not accredited by LCME pass an ex-~ .:-, amination equivalent to Parts I and II of the~s . National Board of Medical Examiners exami­i,i- ~. nation before entry into graduate medical ed­u st .' ucation programs was extended to include~:- <: graduates who have taken a year of clinical.s:d <' clerkships sponsored by an accredited medical~ j- school. This brings the requirements for "fifth~,g - pathway" candidates into line with other for­;§"d eign medical graduates. An ad hoc committee~ J.! was established to explore the feasibility of~ evaluating the clinical skills of graduates ofi re :' schools not accredited by the LCME by direct§)- observation. The committee report will be8 ,e considered by the ACGME during the next

,s year.o Thirteen of24 residency review committees

have been granted independent authority to,s accredit programs without prior review by the;e ACGME. The actions of these RRCs are pe­l riodically surveyed by a monitoring commit­,e tee to ensure that the RRCs comply with• ACGME procedures and policies. An ad hoc-•. committee to appraise the effectiveness of there . accrediting process will report to the ACGME5 in fall 1983.Y The Accreditation Council for Continuing1 Medical Education has gained approval of its,. new Essentials by all member organizations.y -This permits the Council to apply the princi-

253

pIes and standards of the Essentials to thenational accreditation ofsponsors ofcontinu­ing medical education including medicalschools, national professional and specialtyorganizations, and other institutions.

The ACCME still must complete the devel­opment ofits relationship to the state medicalsocieties as accreditors ofintrastate continuingmedical education. The Council is seekingnational recognition of such organizationsthrough approval of procedures which assureadherence to national standards of accredita­tion while acknowledging the privilege ofstatesocieties to accredit local sponsors of contin­uing medical education. The acceptance andapplication of national standards for the ac­creditation ofcontinuing medical education isconsidered an important step towards assuringthe public and the profession of quality con­tinuing education for physicians.

In response to widespread demands, theEducational Commission for Foreign MedicalGraduates, in collaboration with the NationalBoard ofMedical Examiners, began to developan extended certification examination equiv­alent to Parts I and II of the examinationoffered by the NBME. This new examination,the Foreign Medical Graduate Examinationin the Medical Sciences, will replace both theoriginal ECFMG examination and the VisaQualifying Examination. The Secretary ofHealth and Human Services has declared thisnew examination equivalent to Parts I and IIofthe NBME examination for physicians seek­ing visas. The ACGME has given it provisionalapproval as the test required for graduates ofnon-LCME accredited medical schools to en­ter approved residency programs. FMGEMSwill be offered for the first time in July 1984and biennially thereafter. The ECFMG BoardofTrustees also approved recognition ofpass­ing scores on all three parts of the FLEXexamination for partial fulfillment of the re­quirements for obtaining the ECFMG certifi­cate. Under this new policy, the requirementsfor entry into U.S. graduate medical educationprograms will be the same for all graduates offoreign medical schools. This accomplishes along-standing goal of the Association.

The Coalition for Health Funding, whichthe Association joined with others in establish-

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VOL. 59, MARCH 1984

search. The Association is regularly repre­sented in the deliberations of the Joint HealthPolicy Committee ofthe Association ofAmer- r_

ican Universities/American Council on Edu­cation/National Association of State Univer­sities and Land-Grant Colleges, the Washing­ton Higher Education Secretariat, and in theIntersociety Council for Biology and Medi­cine. These liaison activities provide forumsin which information on matters of nationalinterest can be shared, varying points of viewreconciled, and collective actions undertakenin the area offederal legislation and regulation.

The Association's Executive Committeemeets periodically with its counterpart in theAssociation ofAcademic Health Centers. Thispast year the organizations co-sponsored aconference on the implementation ofthe Med­icare prospective payment system for aca­demic medical centers.

254 Journal ofMedical Education

ing 13 years ago, has expand~d its activitiesand influence by monitoring and commentingon the development of the congressionalbudget resolutions in addition to its ongoingefforts on the appropriations process. The un­predictabilities in the evolution ofthe congres­sional reconciliation process presented newchallenges to the Coalition and emphasizedthe importance of cooperation among orga­nizations with similar interests. Widespreadacknowledgement of the usefulness of the Co­alition's annual position on appropriations forthe discretionary health programs offers sig­nificant evidence of the respect with which itis held.

The diversity of the Association's interestsand the nature of its constituency offers anunusual opportunity for liaison with numer­ous other organizations representing healthcare providers, higher education, and thoseinterested in biomedical and behavioral re-

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1 During the past year, the membership of theAAMC has expanded and extended its effortsto improve the education of the physician,particularly during the period preceding theM.D. degree. These activities have sought toidentify problems in the existing system, to

5 anticipate changes required to meet the future~a demands of the profession, and to study the~, ~. options suggested by most recent advances int , educational theory and practice. Such criticalg f,:=- retrospection and self-evaluation involves~ It '-.' risks, not the least of which is the acknowl-] edgement that the current system contains~ deficiencies and can be improved. Despite an~ opportunity to adopt a defensive attitude, theB medical schools have engaged in these pro-oZ - grams enthusiastically and energetically.

The most conspicuous of these activities is-, the General Professional Education of the

Physician and College Preparation for Medi­cine project. The GPEP project achieved con­siderable momentum during the year with

~ active involvement ofover 95 AAMC medical- schools, four-year colleges from which medical

students are drawn, and organizations and. individuals engaged in medical education. The

project is in the second year of a three-yeareffort supported by the Henry J. Kaiser FamilyFoundation.

The GPEP project has been successful instimulating broad discussions among the med­ical school and college faculties about theirphilosophies and approaches to medical edu­cation and college preparation for medicine.The widespread interest in this project wasevident when 98 different faculty and studentgroups appeared before the panel at regionalhearings hosted by the University of Califor­nia, San Francisco, School of Medicine, theUniversity of Texas Medical School, North­western University Medical School, and theNew York Academy of Medicine. Many oth-

. ers submitted written statements and reports.

To gain the particular perspective ofcollegeand medical school students, two special sur­veys were commissioned by the AAMC. LouisHarris and Associates, Inc., interviewedpremedical students to obtain their percep­tions of how the medical school admissionsprocess had shaped their college education.The Center for Educational Developmentsampled second and third year medical stu­dents on their views on a variety of topicsranging from the efficacy of their scientificeducation to their personal relationships.

In July the panel under the chairmanshipofSteven Muller, president orThe Johns Hop­kins University, met to review the workinggroup reports, the testimony presented at re­gional hearings, the two special surveys, andthe institutional and organizational reports.The major issues that have emerged in thecourse of the project will be debated at aspecial general session at the 1983 annualmeeting. The final report will be presented tothe Executive Council and published as a sup­plement to the Journal ofMedical Educationin late 1984.

The AAMC Group on Medical Educationhas been enthusiastic about the increased in­terest in medical education provided by theGPEP program. The project became an im­portant focus for the GME and served as abasis for organizing discussions at regional andnational levels. The GME is currently identi­fying research and development activitiesemerging from the GPEP-related discussions.

Ajoint 1983 plenary session with the Groupon Student Affairs considered educational re­form in the context of future societal change.In that session the impact ofsocial, economic,political, and technological change on theprofession and health care system was assessedand the implications for changes in educa­tional practice weighed. The small group dis­cussion sessions, educational exhibits, work-

255

256 Journal ofMedical Education

shops, and special panels on continuing andminority education were also strongly influ­enced by the spirit of self-appraisal that hasbeen increasingly evident with the advent ofGPEP.

The Research in Medical Education Con­ference has also shown gro\\jng concern forbroad educational issues. The RIME Commit­tee established an Annual Invited Review ofMedical Education Research for publicationin the conference Proceedings and for presen­tation at the annual meeting. The first review,entitled "Measuring the Contribution ofMed­ical Education to Patient Care," was preparedby Joseph S. GonneIla of Jefferson MedicalCollege.

The RIME planning committee also recog­nized that better information about researchand evaluation projects would encouragemore attention to trends and general policy,so the Proceedings have been expanded toinclude the precis of all conference submis­sions.

The AAMC Clinical Evaluation Project hasapproached the improvement of the educa­tional process by concentrating on evaluationduring the clinical experience. The completionofthe data-gathering phase was marked by thedissemination of 7,000 copies of The Evalu­ation ofClerks: Perceptions o/ClinicalFacultyand an accompanying editorial "Oinical Judg­ment ofFaculties in the Evaluation ofOerks"from the March 1983 Journal ofMedical Ed­ucation.

The goals of the implementation phase areto develop self-assessment materials applicableat the institutional, departmental, and trainingsite levels for identifying strengths and weak­nesses of existing evaluation systems, and tooffer specially selected evaluation options foraddressing problems emerging from the. self­assessment exercise. Activities include deter­mining the ways in which medical schools willparticipate in the second phase, developingand testing of self-assessment materials, anddefining and selecting the evaluation options.

The Oinical Evaluation Project encompas­ses the clinical continuum from the introduc­tion of clinical medicine components in thepre-clinical years through the third year ofgraduate medical education. Although the

~--

VOL. 59, MARCH 1984 t 1

main focus has been on the evaluation of I- ti:medical students, activities covering all clini-! tecal education are planned. A consultant group '. d,·will assist in addressing- this challenge. . lie

The need for more systematic information teabout experiments in curriculum and evalu-

Slation has prompted plans for a network for tothe exchange ofsuch information.

In a more specific but highly critical area of ~.the future education of the physician, the f ofAAMC concluded its Regional Institutes onGeriatrics and Medical Education project. The ticAssociation published and distributed more ofthan 4,000 copies of the proceedings from the J istfour regional conferences and the SteeringCommittee's final report on "Undergraduate acenMedical Education Preparation for Improved,. be'·Geriatric Care." During 1983, the Association, r m,through the support of th~ Pew Memorial r­Trust, sponsored 50 visiting lectureships in l-. assgeriatrics and gerontology for medical schools, r ~teaIchindgd~?spitalS, a?d ~~d_e~ic socffiieti~s. r-~ TI:

n a Itlon to maIntainIng Its e orts In the : onU.S. District Court in New York to protect ,-..-the Medical College Admission Test in the : :~face of that ~te's test disclosure law, the lAAMC foun~ It n~cessary !o enter the federal t-: tiorcourt system In PhIladelphIa because ofcopy- 1: invright violations involving MCAT test mate- : ingrials. Routine activities monitoring the secu- MCrity of MCAT test materials uncovered thatthe commercial test preparation operation, .Multiprep, Inc., was in violation of AAMCcopyright, for reproducing actual MCAT ques- .tions illegally removed from an MCAT testcenter. The AAMC immediately filed suitseeking to enjoin Multiprep, Inc., from furtheruse of the test materials and to recover dam-ages. The AAMC also quickly identified andcommunicated with the examinees who had "had access to the exposed materials and ar­ranged to substitute valid scores for those thathad been compromised by the practices of :Multiprep. Approximately 250 examinees~­

were given three separate opportunitieS to re- ~take the MCAT at AAMC expense so. theirapplications to medical school would not be ~

delayed. .U.S. District Court Judge Raymond J.

Broderick granted the AAMC's request for a .preliminary injunction which prohibited Mul-

pi-

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,4 t1982-83 Annual ReportJf j. tiprep from using a number ofspecific practice

test booklets, from advertising that Multiprepdistributes and displays as "facsimile" or "rep­lica" MCAT tests, or from infringing MCAT

,n test forms and test questions. All informationJ- surrounding these events has been turned over)r to the Federal Bureau ofInvestigation and the

U.S. Attorney's office in Philadelphia which)f are actively pursuing a criminal investigation1e : ofthe individuals involved.

Work continued in the Continuing Educa-,e tion System Project conducted with the Office,~e of Academic Affairs of the Veterans Admin-,e istration, with the pilot testing of the conceptsg and products of the project. Within the Vet-.e erans Administration, the quality elements are

~ d f being used for developing a self-assessment§ 1, f manual as a part ofthe quality assessment and8. al (' assurance program for the Regional Medicalgn r:

..t:: ' t Education Center. The manual provides a 00-~s,rsis for organizational self-study and site visits.] [~The manuscripts for a comprehensive bookI ,e,. on continuing education and for learning~ :1: packages on selected aspects of continuing~ ~e : education have also been completed.~ ~L All of these efforts did not preclude atten­~ '. 1: tiOD to the admissions procCss. Staff began~ investigating the feasibility ofcollecting a writ­o~· ing sample from all examinees during each§ J. MeAT administration. An experiment was] 1t] 1, .-:5 ....a .J

0<.l:1 ;-1::a ;t8 ·,t0Q

~r

jj...tIf~'S

~. ~

~r

a,.

257

approved that would provide time on the testday for examinees to prepare an essay onassigned topics. The writing sample is viewedas an opportunity to provide admission com­mittees with a written composition, preparedby the candidate under conditions similar forall applicants. Copies of the essay would ac­company each reported MCAT score.

Meanwhile, the AAMC continued to workwith thirty medical schools participating in theMeAT Interpretive Studies Program. A pre­liminary summary ofthe relationship betweenMeAT scores and performance in the firSt twoyears of medical school is in press. The reportdocuments the predictive and incremental va­lidity of MCAT scores. During the past year,the program entered its second phase, an ex­amination ofclinical science performance andits relationship to MCAT scores. Some studiessuggesting significant correlations with fund ofknowledge measures have appeared and staffhas begun working with several schools toidentify reliable and valid measures of per­fo~ance in the clerkships as other criteria toexplore.

Otherstudies were undertaken to determinehow MCAT scores relate to categorical meas­ures denoting academic problems such aswithdrawals/dismissals for academic reasonsand program deceleration.

Iti-

Biomedical and Behavioral Research

Persisting concerns about the inadequacies ofresearch funding for both the National Insti­tutes of Health and the Alcohol, Drug Abuse,and Mental Health Administration prompteda small number of organizations, includingthe Association, to develop a new strategy forapproaching Congress about research appro­priations. It was agreed that an effort shouldbe made to secure agreement among a sizablenumber of organizations interested in thoseagencies on a single total figure for each. Thefunds would be allocated within those sumsfor individual institutes or activities in thesubsequent appropriations process. The con­gressional response was highly favorable andplayed a role in obtaining substantial increasesover the president's budget.

For the fourth consecutive year, the Con­gress did not pass a formal appropriations lawfor the Department of Health and HumanServices. However, a final continuing resolu­tion for FY 1983 provided a budget for theNIH of slightly more than $4 billion, com­pared to $3.6 billion in FY 1982. Althoughfunding for clinical training was substantiallyreduced, the overall budget forADAMHA wasincreased by $4 million to $272 million. Stim­ulated by that outcome, the Association andits initiating colleagues persuaded more than130 organizations to join a similar effort onbehalf of NIH for FY 1984. This was doublethe number of groups which had previouslyparticipated. Initial reactions from CapitolHill have been most encouraging, despite thegeneralized concerns about mounting federalbudget deficits.

It should be emphasized that this new ap­proach embodies a strong commitment to allthe programs of the NIH as well as the agencyas a whole. In the past, the research commu­nity has strongly advocated sufficient fundingto support a minimum of 5,000 new and

[chom~ting. rene~al. ~ednts (R~ Is) tbo stabilize I,t e InvestIgator-lnItlat project ase. The '.highest priority continues to be placed on these ~

awards, which hold the greatest promise for 11

important discoveries. However, it has be­come appa'rent that in recent years, within the .limits of a constrained NIH bug,get, the sup- ;port of 5,000 ROls has been ~ccomplished t

only by partial funding and ~! the expense of rother NIH programs. By way 9f illustration, l~

the percentage of the NIH e~!ramuralbudget t~­devoted to RO1s grew from 44 percent in 1972 I~'~_to 63 percent in 1982. Conversely, between ;!1972 and 1982, the percentage devoted to r:~..other research grants fell from 22 percent to'-19 percent; for R&D contracts, from 18 per- :1­cent to 12 percent; and for research training, t:'from 12 percent to 5 percent. Despite the t:~

importance of assuring adequate support for Fthese &!"nts, this diversion ~~~unds away from tother Important NIH actiVItIes greatly con- [cerns the research community._ A related concern regarding the precise al­

location of NIH funds has been the develop­ment of proposals designed to stretch federalresearch dollars. Proposed modifications in- ­elude an arbitrary reduction of indirect coststo institutions, dollar limits on support to in­dividual laboratories, an increase in the exist­ing emphasis on ROls as opposed to researchcenters and other grants, and the institution ":ofa sliding scale for research grants to reducethe amounts of money awarded to applicantswith higher priority scores and distribute therecovered funds to applicants with lowerscores. The latter proposal has received con­siderable attention and is ofparticular concerngiven the fact that fiscal constraints have al­ready prompted the NIH to fund new andcompeting grants an average 7 percent belowstudy-section-recommended budgets. In addi­tion, across-the-board reductions in non-com-

258

1982-83 Annual Report

peting renewal grants have been implementedin recent years. Following a thorough discus­sion ofthese issues at its January meeting, theAAMC Executive Council concluded thatNIH-sponsored research would be poorlyserved by the implementation ofany or all ofthe proposals to stretch research funds. Sub­sequently, the Association distributed a state­ment defending the present NIH grant systemand actively endorsing the existing peer reviewprocess.

259

With regard to research sponsored by theVeterans Administration, the Congress passeda FY 1983 appropriations bill which increasedfunding for VA research programs to $154.8million from $140.8 million the previous year.In mid-July, President Reagan signed a VAappropriations bill for FY 1984 which willprovide $162.3 million for medical and pros­thetic research, $6 million over the originalbudget request.

Faculty

The leadership of the Association has had along interest in concerns ofthe faculties aboutscholarship, research, and research training.Research training for physician faculty, theapparent decline in the number of physiciansentering research careers, and the difficulty ofPh.D. biomedical scientists in securing appro­priate academic appointments are some ofthese concerns. To illuminate these concerns,the Association performs analyses and studiesfrom time to time, based on ad hoc or regularsurveys.

The Faculty Roster System, initiated in1966, continues to be a valuable data base,containing information on current appoint­ment, employment history, credentials andtraining, and demographic data for full-timesalaried faculty at U.S. medical schools. Inaddition to supporting AAMC studies of fac­ulty manpower, the system provides medicalschools with faculty information for complet­ing questionnaires for other organizations, foridentifying alumni serving on faculties at otherschools, and for producing special reports.

In spring 1983, the Association conducteda pilot study of research activity of faculty indepartments of medicine, in cooperation withthe Task Force on Manpower Needs of theAssociation of Professors of Medicine. TheFaculty Roster provided basic demographicand appointment data for the medicine fac­ulty, and, as a byproduct, the Faculty Rosteritselfwas corrected and brought up-to-date forthe schools participating in the pilot project.The results of the pilot study were encourag­ing, and the Association agreed to support afull survey of all faculty in departments ofmedicine, again in cooperation with APM.The study will determine the extent of facultyresearch activities, sources of funding for re­search, publication activity, and amount ofassigned research space.

During 1984 the Faculty Roster data basewill be matched to NIH records on research

training and on research grant applications ':­and awards, to analyze the relationship be­tween training and academic careers, and thefaculty~s role in the conduct of biomedicalresearch. These activities, as well as the main­tenance of the Faculty Roster data base, re­ceive support from the National Institutes of .Health.

Based on the Faculty Roster, the Associa­tion maintains an index of women and mi- fnority faculty to assist medical schools and ifederal agencies in affirmative action recruit- ring efforts. Since 1980 approximately 700 re- (~cruitment requests from medical schools were ifanswered by providing records of faculty rmembers meeting the requirements set by (search committees. Faculty records utilized in Lthis service are those for individuals consent- Fing to the release of information for this pur- r~~ .

To apprise medical school affirmative ac- rtion offices of the existence of the index, de- "-,'scriptions of the index, as well as statistics ,.developed from the roster to assist in affirma- .tive action planning, have been forwarded tostaff members at medical schools.

As of July 1983 the Faculty Roster con- ~

tained information on 49,646 full-time sala­ried faculty and 2,562 part-time faculty. Thesystem also contains 51,172 records for per­sons who previously held a faculty appoint­ment.

The Association~s1982-83 Report on Med­ical School Faculty Salaries was released in .January 1983, providing compensation datafor 124 U.S. medical schools and 33,701 filled r

full-time faculty positions. The tables present >,

compensation averages and percentile statis- , r

tics by rank and by department for basic and ~~ (clinical science departments. Many of the ta· '"bles allow comparisons according to school . C

ownership, degree held, and geographic re- ; f~on. s

260

15 . As of September 2, 1983, 35,120 applicants~_ had filed 317,833 applications for the enteringle : class of 1983 in the 127 U.S. medical schools.at . These totals, although not final, represent a1- one percent decrease in the national applicant~_ pool for the 1983 entering class over the pre-)f vious year. '

The total number of new entrants to the~ 1- first year medical school class decreased from~ i- 16,644 in 1981-82 to 16,567 in 1982-83,~ d l while total medical school enrollment rosef -- '- from 66,298 to 66,748. Although the actual"8 ~- ~ number enrolled is the largest ever, the in­] -e,~ crease in total enrollment represents the small­e y r est growth in the past ten years.~ y t The number of women new entrants~ 1 t: reached 5,210, a two percent increase sincez ~-u _ [ 1981; the total number ofwomen enrolled was~ "_~. 19,597, a 5.6 percent increase. Women held~ I 29.4 percent ofthe places in the nation's med­~ ~., ica1 schools in 1982-83 compared to 24.3o ~_.. percent five years earlier.]

"8 :s _ The number of underrepresented minority.s · - new entrants equaled 1,387 or 8.4 percent of§ ) the 1982-83 first-year new entrants, compared

r.P~ to 1,422 or 8.6 percent in 1981-82. The total~ _ number of underrepresented minorities en-o rolled was 5,544 or 8.3 percent ofall medical

students enrolled in 1982-83, compared to_ 5,503 (8.3 percent) in 1981-82.

The application process was facilitated bythe Early Decision Program. For the 1983-84

_ first-year class, 883 applicants were acceptedby 65 medical schools offering such an option.Since each of these applicants filed only oneapplication rather than the average 9.1 appli­cations, the processing of more than 7,000

. additional-applications and scores ofjoint ac-: ceptances was avoided. In addition, the pro­

gram allowed successful early decision appli­cants to finish their baccalaureate programsfree from concern about admission to medicalschool.

Ninety-eight medical schools participated in

the American Medical College ApplicationService (AMCAS) to process first-year appli­cation materials for their 1983-84 enteringclasses. In addition to collecting and coordi­nating admission data in a uniform format,AMCAS provides rosters and statistical reportsand maintains a national data bank for re­search projects on admission, matriculation,and enrollment.

The Advisor Information Service circulatesrosters and summaries of applicant and ac­ceptance data to subscribing health professionsadvisors at undergraduate colleges and uni­versities. In 1982-83, 302 advisors subscribedto this program.

During each application cycle, the AAMCinvestigates the application materials of asmall percentage of prospective medical stu­dents with suspected irregularities in the ad­mission process. These investigations, directedby the AAMC "Policies and Procedures forthe Treatment of Irregularities in the Admis­sion Process," help to maintain high ethicalstandards in the medical school admissionprocess.

The total number of MCAT examineestested for each of the past several years hasremained relatively stable. With the exceptionof a seven percent decrease in examinationsadministered between 1978 and 1979, thechange for anyone year period has not ex­ceeded three percent. The reduction of onepercent in total examinee volume from 1981to 1982 is attributable primarily to a decreasein repeating examinees, who accounted for32.4 percent ofall tests administered in 1982.

The Medical Sciences Knowledge Profileexamination was administered for the fourthtime in June 1983 to 2,080 citizens or per­manent resident aliens of the United Statesand Canada. The examination assists constit­uent schools ofthe AAMC to evaltiate individ­uals seeking advanced placement. While 6.1percent of those registering for the test had

261

262 Journal ofMedical Education

degrees in other health professions, 87.5 per­cent of all registrants were currently enrolledin a foreign medical school.

Monitoring the availability of financial as­sistance and working to insure adequate fund­ing of the federal financial aid programs usedby medical students are major activities oftheAAMC. As indebtedness levels and medicalschool costs rise, concerns about both ade­quacy and availability of financial aid andincreasing levels of student indebtedness con­tinue to grow. These concerns motivated de­velopment of a plan for a study of medicalstudent financing to be carried out in 1983­84 with the support of the Department ofHealth and Human Services. The Associationalso worked closely with the schools and HHSto monitor delinquency rates in the HealthProfessions Student Loan program, and toreduce those rates. Current authorization forall federal programs of student assistance inthe Higher Education Act of 1965 and theHealth Professions Education Assistance Actof 1976 and subsequent amendments will berenewed in 1985. Because the aid programsare vital to medical students, the AAMC hasmade a great effort to obtain the necessaryreauthorizations. The AAMC has also beeninvolved in the development of a financialplanning and management manual for medi­cal and pre-medical students and their fami­lies.

The Association concluded a series of 17student financial management strategy semi­nars funded by the Robert Wood JohnsonFoundation. These programs spanned fiveyears and reached over 2,000 financial aidofficers, deans, student affairs deans, minorityaffairs officers, health professions advisors andstudents from schools ofmedicine, osteopathicmedicine and dentistry.

The AAMC, through its Office of MinorityAffairs, is administering several projectsfunded by the Division of Disadvantaged As­sistance (formerly the Health Careers Oppor­tunity Program) of the Department of Healthand Human Services to enhance opportunitiesfor minorities in medical education. One grantprovides three types ofworkshops to reinforceand develop effective programs for the recruit­ment and retention of students underrepre-

t

sented in medicine.V;~ ~:u:;:n~:~: tAdmissions Exercise Workshop provides op-

tiportunities for medical school personnel toimprove their programs related to the admis­sion and retention of minority students; theRetention and Learning Skills Workshop as­sists medical school personnel concerned withacademic performance and retention of mi- rnority students; and the Minority Student Fi- 1nancial Assistance Workshop assists student ::;financial aid program administrators and _premedical advisors to develop efficient andeffective administration of financial aid pro­grams for financially disadvantaged students.

A second grant, an evaluation of retentionactivities in medical schools, supplements ex- ~

isting efforts of retention programs by meas-

uring the effect of these programs on attrition 1---':~­of minority medical students. In addition, the _Robert Wood Johnson Foundation is sup­porting the development and distribution ofan annual report on the status ofminorities inmedical education. Other work is also beingcarried out in conjunction with the MacyFoundation to determine the extent of minor- 0

ity medical student participation in specialenrichment or preparatory programs. "

Ajoint project involvingAAMC, the UCLA l'f

Clinical Scholars Program, and the Rand Cor- ~

poration to analyze the specialty choices and ]practice locations ofminority and non-minor­ity graduates of the medical school class of1975 is nearing completion. Preliminary re­sults indicate that the minority graduates aremore involved in primary care and serve ahigher proportion of minority and Medicaidpatients than their non-minority peers. Theproject is supported by the CommonwealthFund.

The Group on Student Affairs-Minority Af­fairs Section (GSA-MAS) held a Medical Ca­reer Awareness Workshop for minority stu­dents at the 1982 AAMC Annual Meeting.Two hundred high school and college studentsattendeQ and fifty-four medical schools wererepresented. A similar workshop will takeplace at the 1983 Annual Meeting.

The annual medical student graduationquestionnaire was administered to the class of1983 in 123 of the 124 medical schools withseniors. A total of 10,481 students participated

1982-83 Annual Report

in the survey, a response rate of almost 66percent. The majority ofthe 1983 respondentsplanned residency training after graduation.The most frequently selected areas of special­ization were internal medicine and familypractice. Twenty-five percent of 1983 gradu­ates were considering a research-related careeras compared to 22 percent in 1982. The av­erage medical school debt of indebted re­spondents increased 12 percent to $22,694.Almost one quarter of the respondents had atotal educational debt of $30,000 or more,compared to 18.4 percent in 1982. A summaryreport comparing national responses with in­dividual institutional data was mailed to eachschool in September. Selected results appear

~ in the 1983 directory ofthe National Resident- Matching Program.~0. The Graduate Medical Education Applica-§ tlon for Residency, developed by the AAMC~ at the recommendation of its Task Force on].g Graduate Medical Education and distributed~ by the National Resident Matching Program,~ was utilized for the third consecutive year.soz

263

Medical school student affairs offices distrib­uted applications with the NRMP materials tostudents wishing to enter residency programs.The universal application form facilitates theprocess ofapplying for a residency position byproviding a standard form for communicationofbasic information.

Work was completed on Physicians in theMaking: Personal, Academic, and Socioeco­nomic Characteristics of Medical StudentsFrom 1950 to 2000 as a part of the AAMCSeries in Academic Medicine published byJossey-Bass. The book contains information,predictions, and recommendations about as­piring applicants, enrolled students, and grad­uating seniors during the latter half of thecentury. A second related volume to be pub­lished by the Association, U.S. Medical Stu­dents, 1950-2000: A Companion FactbookJorPhysicians in the Making, provides more de­tailed statistical and bibliographic informa­tion. The Commonwealth Fund helped fi­nance this project.

Institutional Development

After ten years of operation, the Association'sprogram to strengthen the management capa­bilities of medical schools and academic med­ical centers received a comprehensive reviewby an ad hoc committee convened for thatpurpose. In recent years the program had em­phasized its Executive Development Semi­nars, intensive week-long courses on manage­ment theory and technique for senior aca­demic mediCal center officials. The reviewcommittee recommended that these seminarsbe continued but modified, and urged that theAAMC define a new mission of continuingmanagement education for its members. TheExecutive Development Seminars would beprovided biennially for new deans and period­ically for department heads and hospital direc­tors on a tuition-supported basis.

The committee's recommendations wereadopted by the Executive Council in January.The first initiative under the new continuingmanagement education mandate was the pres­entation of four seminars on "Medicare Pro­spective Payment System: Implications forMedical Schools and Faculties." Similar pro­grams were conducted in Houston, Oakland,Chicago, and Philadelphia. These describedthe major features ofthe new prospective pric­ing system to be used to determine the Medi­care payment for hospital care, identified thechanged incentives and constraints facingteaching hospitals and their implications formedical schools and their faculties, and de­scribed internal management strategies neededto adapt to the new system. More than fourhundred deans, hospital directors, departmentchairmen and other medical center officialsattended the sessions and rated them veryhighly in terms of their interest and utility.Videotapes ofsome of the sessions were made

available to member institutions for a nominalfee.

Planning was also undertaken to design I:

short intensive workshops on financial man- ­agement, information management, human .,resources management, and marketing. Theseworkshops, scheduled to begin in spring 1984,will combine an emphasis on fundamental ~concepts with illustrations and exercises high­lighting their applicability to current medical f,

1-center issues and problems. I:'

The Executive Development Seminar for ~_

new deans was conducted in August at Ded-:ham, Massachusetts, with 23 participating .;deans. Twenty hospital executives and 17 de- t-~partment chairmen participated in a Septem- f.ber seminar in Florida. A similar but more (_~

compressed program was offered for Women r­in Academic Medicine during the summer. r:Forty-four women in key managerial positions tbrought the total number of Executive Devel- i;opment Seminar participants to 2,084 over t3the life of the program.

New projects under way include a moresystematic effort to collect and make availableinformation about members' use of consult­ants in dealing with management issues arising _at academic medical centers. Also in processis a survey offaculty employment policies andprocedures undertaken at the initiative of theGroup on Business Affairs with the endorse­ment of the Council of Deans AdministrativeBoard. Current plans are to develop a set ofpublications' which will -identify respondentsto specific questions so that members can con­tact others with similar or contrasting ap­proaches to particular issues and which willalso analyze selected trends in tenure relatedpolicies and practices.

264

rTeaching Hospitals

I The Association has focused attention on the

I Medicare Prospective Payment System, adopted as part of the Social Security Reform~ Act .of 1983 and on the regulations imple­'~ menting the requirements of the 1982 Tax- Equity and Fiscal Responsibility Act

(TEFRA). Additionally, the Association con-\) tinued its major role in advancing support for

~ health planning on both a state and localleveI.~ The Association opposed the modifications in~~, the standards of the Joint Commission on~ : Accreditation of Hospitals which would haveo

~, opened the hospital medical stafforganization-g, to nonphysician practitioners; sought to tem­g.."8 per the Department of Health and Human~ Services regulations on "NondiscriminationB on the Basis ofHandicap," which would inter­~ ject HHS into decisions on provision of careu for severely handicapped infants; fought leg­~ islation that would have precluded hospitals~, and other not-for-profit organizations from~, obtaining tax-free bond financing for majorj' capital projects; and drafted a report on "Pay­s ment for Physician Services in a Teaching.s Setting."j' The regulations implementing the Tax Eq­~ uity and Fiscal Responsibility Act set forth§- how physicians practicing in an institutionQ would be paid for services, when assistants at

- surgery would be paid, and redesigned theMedicare limits on hospital payments. Theregulation establishing the limits on paymentsfor hospital-based physicians sought to distin­guish clearly between services provided to theinstitution or to the patient population as awhole (Part A services) and services renderedto an individual patient (Part B services). Onceseparated, it was intended that Medicarewould pay on a reasonable cost basis for serv­ices provided to the institution and on a rea­sonable charge basis for services provided toindividual patients. Confusion over the origi­nal wording of this regulation led the Associ-

ation to conclude that if a physician assignedfees to a medical School or practice plan andaccepted a salary from that equity, then Med­icare would restrict his fees to the amount ofhis salary. Through efforts of the Association,a memorandum from a high ranking HCFAofficial clarified that the rule was not intendedto jeopardize faculty practice plans. TheTEFRA regulation also specified changes inthe 'way in which Medicare would pay forservices of radiologists, anesthesiologists, andpathologists. In changing the radiologists' pay­ments, HCFA sought to distinguish betweenphysicians who must pay their own overheadand operating costs out of the fee charged andthose for whom the hospital pays the overheadand staff salaries. Those services generallyavailable in a physician's office will be subjectto a limit of 40 percent of the prevailing feefor office-based services when provided by ahospital-based radiologist. For anesthesiolo­gists, full payment of fees was limited to serv­ices during which they conducted no morethan four concurrent procedures. Otherwise,anesthesiologists were considered to be actingas supervisors and subject to payment on areasonable cost basis only. Lastly, the majorityofclinical laboratory tests were defined as PartA services payable on a reasonable cost basisrather than on a charge basis.

In an attempt to distinguish between phy­sicians practicing in a hospital clinic where thehospital was paid on a cost basis for the over­head expenses and those running their ownoffice-based practice, HHS published a regu­lation Iimiti"ng' physician charges for servicesfurnished in hospital outpatient departments.Where a particular service is commonly pro­vided by a physician in a private office setting,the fee of a physician performing that sameservice in a hospital-based clinic would bereduced to 60 percent of the Medicare pre­vailing fee for non-specialist physicians. eer-

265

266 Journal ofMedical Education

tain services were excluded from this reduc­tion, including emergency, ambulatory sur­gery, and radiology services. The AAMC hasstrenuously objected to two aspects ofthis rule.First, it objected to the absolute nature of theregulation which disallowed fees ifthe hospitalclaimed reimbursement for any clinic over­head expenses. Since both the overhead aHo­cation required on the Medicare cost form forhospital expenses and the additional functionsofa teaching hospital such as the education ofresidents require more costs to be allocated tothe clinic service than a physician practicingin a private office setting would incur, theAssociation argued the regulation was not eq­uitable, and suggested that a more reasonableapproach would be to allow physicians to col­lect a full fee if the carrier concluded theoverhead costs paid to the hospital by thephysician were equivalent to those in a privateoffice setting. Secondly, the Association ob­jected to the use of non-specialist fees as thebase from which the determination would bemade, since many ofthe physicians providingservices in hospital clinics are specialists caringfor patients referred to them by physicians inprivate office settings. As yet, no changes havebeen made to accommodate the Association'sobjections to this rule.

HCFA's new rules implementing TEFRAalso preclude payment for an assistant at sur­gery when the hospital has residency programsin the specialty and residents were available toassist during the surgery. Through the effortsof the Association, this rule was clarified toallow a Physician not participating in the ed­ucational program to have an assistant at sur­gery paid by Medicare. Also, the Association'sefforts led to HCFA's acknowledging that res­idents have other duties besides performingdirect patient care, and may be unavailablebecause of educational or research activities.In such circumstances, Medicare will pay feesfor an assistant at surgery. Hospitals that par­ticipate in the approved programs of otherhospitals are not affected by this policy.

In addition to the rules on physician pay­ment, TEFRA and its implementing regula­tions established two limits on hospital pay­ment. The first, called the target rate, used thehospital's own base year cost adjusted for in-

VOL. 59, MARCH 1984

flation to constrain the increase in Medicarepayments. The second limit was an expansion l

of the existing routine operating cost limit toinclude special care unit and ancillary servicecosts. The revision sets cei.lings on hospitalexpenditures based on average costs per ad­mission adjusted for case mix using the diag­nosis related groups (DRGs). In this limit,HCFA compared costs across hospitals after ~

adjusting for their case mix variation and dir- I_ferences as a result of the labor market area inwhich the hospital is located. Significantly,capital and direct medical education costs are •excluded from the limit and a special adjust­ment, based on a hospital's resident-ta-bed ~

ratio, is provided for the so-called indirect _medical education costs.

As mandated by TEFRA, HHS sent a Pro­spective System for Medicare to Congress. Theproposal suggested establishing rates for eachDRG. These same rates would have been paidto every hospital except children's and psychi- fatric hospitals; the only adjustment to the rates i';_would have been to reflect the price of labor f,

t,in the hospital's community. h

The Association expressed five broad policy rconcerns with this proposal while testifying [­before the Senate Finance Committee's Sub- tcommittee on Health and the House Ways ~and Means Subcommittee on Health. The p.

AAMC noted that crucial details of the pay- :ment scheme were missing from the proposal, ~

including the computation of the "passthrough" ofdirect medical education and cap­ital costs, the treatment of costs of atypical 'cases, and the procedure for determining in­direct medical education costs. Additionally,the AAMC asserted that methodological re­finements could not compensate for inade­quate payment under the Medicare programand reminded Congress that the Medicare pay­ment system is a normative statement of thegovernment's values, not just a technical issue.The AAMC predicted that the burden of re­duction in Medicare expenditures would beunevenly distributed among types ofhospitals,disproportionately harming teaching institu­tions because allowances were not made fordifferences in hospital size and scope of serv­ice, disparities in severity of illness of patientswithin diagnostic groupings~ inadequate infor-

267

over the continuation of the health planningprogram resurfaced. The AAMC had endorseda compromise health planning bill introducedin the fall of 1982 by Representatives HenryWaxman, Edward Madigan, Richard Shelby,John Dingell, and James Broyhill. This meas­ure, adopted by the House of Representativeson September 24, made funds available forstate and local planning activities.

The Senate had also proposed to continueplanning in a bill sponsored by Senators Dan­iel Quayle, Orrin Hatch, Paula Hawkins,David Durenberger, and Daniel Inouye. TheSenate bill was more restrictive ofits allocationof funds and precluded states from regulatingthe planning, allocation, financing, or deliveryof health care resources and services. A com­promise resolution failed to come to a vote inthe Senate before the end of the Congress andhealth planning survived only by a continuingresolution.

Health planning advocates in Congress re­sumed their efforts to obtain an authorizationfor a new health planning program in spring1983. Representative Waxman's "HealthPlanning Amendments of 1983" emphasizedthe need for such legislation until capital costsare included in the DRG-based prospectivepayment system. A counter-proposal by Rep­resentatives Madigan and Shelby was defeatedin committee, but the staff of the Associationand several other health organizations helpeddevelop a health planning compromise pro­posal. It is felt that this bipartisan approachwould have a greater chance of enactment inthe Senate.

Of concern to the teaching hospitals, espe­cially those caring for a substantial number ofcritically ill infants, were attempts to regulatethe treatment decisions for handicapped in­fants. The first attempt, a regulation entitled"Nondiscrimination on the BaSis of Handi­cap" was published March 7 and became ef­fective March 22. It required hospitals to postnotices stating the government's prohibitionon withholding customary medical care ornutrition from an infant solely on the basis ofits handicap, and it offered a toll free numberfor the anonymous reporting of suspected vi­olations of this law to the office ofcivil rights.

The Association and other organizations,

1982-83 AnnualReport

mation in the HHS data base with which toproperly classify patients into DROs, andmethodological problems that overestimatethe cost of routine care while underestimatingthe cost of tertiary care. A more evolutionarychange in the payment mechanism was advo­cated so that the higher cost in teaching insti­tutions could be properly evaluated and notassumed to represent inefficiency, waste, orpoor management. Finally, the threat to hos-

'! pital-physician relationships engendered bythis proposal was raised.

The AAMC assertion that the administra­tion's proposal would disproportionately harm

4 some groups of hospitals was borne out inestimates from the Congressional Budget Of­fice, presented at the Ways and Means Sub­committee hearing, showing that teaching hos­pitals and other large hospitals would suffersubstantial losses under the proposed schemewhile small and rural hospitals would gainsizable windfalls.

Congressional amendments to the admin­istration's proposal resulted in the adoption ofa prospective payment scheme that includeda four-year phase-in of the DRG payments,

~ the use of regional and national rates to ease~. the transition, an adjustment for teaching hos­~ pitals based on their resident-to-bed ratios, ag' requirement that unusual cases ("outliers")] constitute between 5 and 6 percent oftotal per] - case payments, and a provision for special~ adjustments for national and regional referralo·~ centers. These amendments tempered CBO's~~ estimates of the adverse effects of the new8· payment system for teaching hospitals, aI-

I though the effect on individual hospitals isunclear. This was passed by Congress in lateMarch and signed into law on April 3, 1983.Staffofthe Association continue to work withthe HHS as it develops regulations to imple­ment this law. The staff has provided com­ments to HCFA on the method ofcalculatingthe base period cost, the appropriate mecha­nism for assigning patients to DRGs, methodsfor calculating the adjustments for outliers andother patients requiring special care, and theappropriate method for computing the resi­dent-ta-bed ratio.

While Congress was considering the newpayment system for hospital services, debate

268 Journal ofMedical Education

including the American Academy ofPediatricsand the National Association of Children'sHospitals and Related Institutions, protestedthat this rule interjected the HHS into thesensitive and highly emotional atmosphere inwhich parents, physicians, and other healthcare personnel make very difficult decisionsabout the care of an infant. On March 21 theAAMC wrote to Secretary Heckler urging adelay in the implementation of this rule toaddress the concerns of health care providers.The Association expressed concerns that theposted notices and the toll-free number wouldneedlessly add to the stress of the parents andhealth care personnel.

The Association's request for delay andthose of the other associations and organiza­tions involved went unheeded; however, AAP,NACHRI, and Children's Hospital NationalMedical Center in Washington, D.C., weresuccessful in a suit filed in the Federal DistrictCourt of the District of Columbia. The favor­able ruling was based largely on proceduralissues.

After deciding not to appeal to a highercourt, HHS published revised regulations onJuly 6. While the substance of the Depart­ment's regulations had not changed signifi­cantly, the Department is taking all properprocedural steps in issuing this regulation andhas attempted to address several ofthe judge'sconcerns in the preamble. The Departmenthas also included state child protection agen­cies in the enforcement of this regulation.

This inclusion of the child protection agen­cies parallels a measure introduced by Repre­sentative John Erlenborn and Senator Jere­miah Denton. They proposed revising theChild Abuse Prevention and Treatment Actto require the posted notices and "hot line"approach. While expressing a continuing com­mitment to provide medically indicated treat­ment and nutrition to infants with life-threat­ening conditions, the AAMC wrote urging thatthis legislation be rejected. In particular, theAAMC objected to the coupling ofthe medicaltreatment decisions with child abuse legisla­tion and the use of "hot lines" to monitorconformance. The Association expressed dis­satisfaction with the assumption that childabuse protection agencies had the necessary

VOL. 59, MARCH 1984 .

training or staff to assess these cases and to ~supply technical assistance on the question of J

denial ofappropriate care to severely impaired .infants. Further, the AAMC criticized the di- Iversion ofscarce resources from the important Itask of investigating child abuse to the exam­ination of complex and very difficult treat­ment decisions for impaired infants. TheAAMC again objected to the unjustifiable in- ;crease in anxiety levels of families of criticallyill infants. A more appropriate solution wouldbe the one advocated by the President's Com­mission for the Study of Ethical Problems inMedicine and Biomedical and Behavioral Re­search in its report "Deciding to Forego Life "Sustaining Treatment," which advocated thatlocal review bodies establish policies and ­maintain standards for the care given in these "-cases. This piece of legislation has been SUb-I­stantially modified to address some of the -concerns about its provisions and is still pend-:ing before the House and Senate. ~

Again this year, the issue of tax-exempt I~bonds to finance major capital projects in -.hospital and educational institutions came toIthe forefront ofthe Association's agenda when •some members of Congress sought to severely .restrict the use of tax-exempt bonds by non­profit organizations. The Association wrote to fmembers of the Senate Finance and House ;I.

Ways and Means Committees urging them tostand by the determinations made last year.The AAMC reminded them of the rationalefor supporting this decision which included:tax-exempt revenue bonds support activities Ito provide a healthier and better educated :public; the federal tax revenue lost as a result .of the issuance of these bonds is minusculeand there is no evidence that nonprofit hos­pitals and educational institutions use tax­exempt financing inappropriately.

In another arena, the Joint Commission onAccreditation of Hospitals had proposed anamendment to its accreditation manual thatwould have changed "medical staff" to "orga­nized statT" in defining the authority to admit <

and provide medical care to patients. Orga­nized staff included licensed physicians andother individuals who qualify for clinical priv­ileges and are licensed for independent provi­sion of patient care services. At the January

1982-83 Annual Report

Administrative Board meeting of the Councilof Teaching Hospitals, Dr. John Affeldt,JeAH president, told the board of JCAH's

- decision to make this change after having beenadvised by its attorneys that it was riskingcharges of restraint of trade. The AAMC crit­icized this change, stating it would alter the"long held concept that physicians have legit­imate responsibility for ensuring that highquality medical care is provided in our na­tion's hospitals." The AAMC noted the diffi­culties in defining uniform eligibility criteriawhen professionals with a variety of licensesand degrees are allowed on the stafl: The resultwould be a diminished ability to provide qual-ity assurance for the care provided. The JCAHwould simply be shifting the locus of the legalactions from itself to the hospitals.

The Association start: under the guidanceofa Committee on the Distinctive Character­istics and Related Costs ofTeaching Hospitals,

~ published two technical reports early in 1983:

269

A Description o/Teaching Hospitals· Charac­teristics and Selected Data on a Small Sampleof Teaching Hospitals.. These books provideinformation on the services rendered inCOTH member institutions as well as some ofthe characteristics of the patients admitted tothese hospitals. Also published were annualsurveys on housestafT stipends, funding, andbenefits, chief executive officers' salaries, anduniversity-owned teaching hospitals· financialand general operating data.

In conjunction with the Association of Ac­ademic Health Centers, the AAMC publisheda staff report which was the result ofa confer­ence on the implementation of the Medicareprospective payment system for academicmedical centers. The Association also devel­oped a report entitled, "Medicare Payment forPhysician Professional Services in a TeachingSetting" under the guidance of the Committeefor Payment for Physician Services in Teach­ing Hospitals.

Communications

Two studies and a round of legal actions gen­erated much news media attention on theAAMC during the past year. News conferencesin Washington, D.C., and New York City inOctober announced that the Association'sGeneral Professional Education of the Physi­cian project was about to enter the second yearof a three year effort supported by the HenryJ. Kaiser Family Foundation. Additional newsconferences were held in San Francisco andHouston as the panel began a series of fourregional hearings where college faculty, medi­cal school faculty, administrators and studentswere invited to discuss their views on medicaleducation. These news briefings focused muchnational attention on the project. A final re­port will be issued in fall 1984.

A February news conference in Washing­ton, D.C., reported the five recommendationsofan AAMC study on improving the teachingofgeriatrics to medical students. Joseph John­son, chairman, Department of .Medicine,Bowman Gray School ofMedicine and chair­man ofan II-memberAAMC committee, andAAMC President John A. D. Cooper met thepress. This news conference was the culmina­tion ofa year-long effort supported by the PewMemorial Trust and the National Institute onAging. The report received extensive nation­wide coverage by newspapers, television andradio.

The third major event involving mass me­dia coverage occurred in June when the As­sociation discovered that Multiprep, Inc., anArdmore, Pennsylvania, testing preparationcompany, had secured copies of MCAT testforms and test questions and was illegally us­ing them in its coaching courses. The AAMC's$1.5 million damage suit against Multiprep,Inc., and its owner and related legal actionshave been actively followed by the news me­dia.

In addition, the Association continues to

interact with the national news media andresponds to more than 25 media requests forinterviews, information and policy positionseach week.

The chiefpublication ofthe AAMC contin­ues to be theAAMC President's WeeklyA~tiv­

ities Report, published 43 times a year andcirculated to more than 7,200 individuals. ~

Each publication reports on AAMC activitiesand federal actions having a direct effect on ','medical education, biOmed_ica) research and fhealth care. .- f

The Journal of Medical Education pub-Ilished 999 pages of editorial material in the ,~:

regular monthly issues, compared with 1,018 rpages the previous year. The published mate- t­rial included 83 regular articles, 66 commu- rnications, and 11 briefs. The Journal also con- ttinued to publish editorials, datagrams, book t':-:

reviews, letters to the editor, and bibliogra­phies provided by the National Library of :Medicine. The Journal's monthly circulation laveraged 6,350. ·

The volume of manuscripts submitted tothe Journal for consideration continued to runhigh. Papers received in 1982-83 totaled 393,of which 137 were accepted for publication, .198 were rejected, 10 were withdrawn, and 48 _were pending as the year ended. Two supple- .-ments carried as part ofthe regular issues wereproduced: "Preparation in UndergraduateMedical Education for Improved GeriatricCare," and "AAMC Annual Meeting and An­nual Report, 1982."

About 24,000 copies of the annual MedicalSchool Admission Requirements, 4,000 copiesof the AAMC Directory ojAmerican MedicalEducation, and 7,000 copies of the AAMC :Curriculum Directory were sold or distributed.Other publications, including directories, re- .ports, papers, studies, and proceedings were ,-'also produced and distributed by the AAMC. _Newsletters include the COTH Report, which

270

1982-83 Annual Report

t, has a monthly circulation of 2,650; the OSR, Report, which is circulated twice a year to

medical students; and STAR (Student AffairsReporter), which is printed twice a year andhas a circulation of 1,000.

The AAMC Series in Academic Medicine,

271

published by Jossey-Bass, Inc., issued itsthird volume, Physicians in the Making:Personal, Academic and Socioeconomic Char­acteristics of Medical Students from 1950to 2000. Three other manuscripts are in prep­aration.

Information Systems

The Association continues to upgrade its gen­eral purpose computer system to ensure thatthe information systems support will meet theever-increasing needs ofthe Association mem­bership and the staft: A Hewlett Packard 3000,Series 64, has replaced an aging Hewlett Pack­ard 3000, Series III, and high density diskstorage has been increased. Many of the highvolume printing requirements are producedon a high speed laser printer, which currentlyproduces an average of 2.7 million pages permonth, largely related to the AMCAS pro­gram. With over 100 terminals accessing theAssociation files, there is a constant demandfor more detailed information. Data bases con­tinue to be developed to minimize data redun­dancyand to provide responsive, on-line re­trieval of reliable information. By using ex­panded computer generated graphic art, it isnow possible to provide illustrations in finalpublication form, thereby reducing camera artpreparation and outside printing expenses.

While the cyclic processing ofthe individualstudent's applications to medical schools con­tinues to be a major information systems fo­cus, the overall efficient data entry, verifica­tion and file building process remains the keyto providing constituents with reliable infor­mation on students, faculty and institutions.

The American Medical College ApplicationService system is the core of the informationon medical students. This centralized appli­cation service collects and processes bio­graphicand academic data and links these datato MCAT scores for report generation anddistribution to participatingschools. This serv­ice also enables the individual schools to re­ceive the most current update of a particularapplicant's file. Roster, daily status reports,and summary statistics prepared on a nationalcomparison basis are supported by an exten­sive and sophisticated software system andprovide medical schools with timely and reIi-

able information. Rapid on-line retrieval en­ables the Association to advise applicants ofthe daily status of their individual informa­tion. After data collection is complete, thesystem generates data files for schools andapplicant pool analyses and provides the basisfor entering matriculants in the student rec- ,ords system. -

AMCAS is supplemented by other systems,including the Medical College Admission Testreference system ofMCAT score information,a college information system on U.S. and Ca· ' ..nadian schools, and the Medical Science fKnowledge Profile system on individuals tak- r­ing the MSKP exam for advanced standing ."admission to U.S. medical schools. r

A student record system maintained in co- roperation with the medical schools containsenrollment information on individual stu­dents, and traces their progress from matricu­lation through graduation. Supplemental sur­veys such as the graduation questionnaire and '~

the financial aid survey augment the studentrecord system.

After the residency match in March ofeachyear, the National Resident Matching Pro­gram conducts a follow-up study to obtain 'information on unmatched participants andeligible students who did not enroll. Beginningwith the 1983 match, the Association, usingan initial data file supplied by NRMP, pro­duced match results listings for each medicalschool, updated the NRMP information usingcurrent student records system data and list­ings returned from the medical schools, pre­pared hospital assignment lists for each medi­cal school, and generated a final data file foruse in NRMP's tracking study.

The diverse information systems of the As­sociation each serve a unique purpose. As ":"special requests for information continue to .increase, it has become necessary to consoli- ­date these multiple systems into one Student

272

1982-83 Annual Report 273

four survey years and is used to produce thereport ofmedical school finances published inthe annual education issue of the Journal ofthe American Medical Association.

The housestaff policy survey, the incomeand expense survey for university-owned hos­pitals, and the executive salary survey are therecurring surveys that provide information onteaching hospitals.

In addition to the major information sys­tems of the Association a number of special­ized systems continue to be developed andimproved. These specialized systems supportthe activities of the Council ofTeaching Hos­pitals, the Group on Business Affairs, theGroup on Institutional Planning, the Groupon Medical Ed~cation, the Council of Aca­demic Societies, the chief undergraduatehealth profession advisors, the women in med­icine program, and legislative affairs activities.Mailing labels, individualized correspondence,and laser-produced photocomposed directo­ries are examples of the services provided.Expansion and extensive revision of the As­sociation's membership system continues as amajor project. When completed, this systemwill integrate the services provided in many ofthe specialized systems and will continue toproduce labels for the WeeklyActivitiesReportand for the Journal ofMedical Education.

Data collection, rapid processing, andtimely dissemination of information gatheredfrom its members and independent constitu­ents continue to be major objectives of theAssociation. The focus on information impor­tant to medical education that assists themembers in the decision-making process is theprime thrust of the Association's informationsystems.

of which the Institutional ProfIle System is a~ major contributor since it contains data con­~ ceming medical schools from the 19605 to the~ present. It is constructed both from survey~, results sent.directly from the medical schoolsj I· and from other information systems. This sys­~ tern, containing over 20,000 items, is used for~ on-line retrievals and supports research proj-o

~ ects.a: The information reported on Part I of the~ Liaison Committee on Medical Education an­

nual questionnaire complements the Institu­tional Profile System. Current year informa­tion is compared with data from the preceding

- and Applicant Information..Management Sys-tem. This new system, presently in the designstage, will produce a wide variety of reportsdescribing students, applicants and graduates,answer special data requests for informationfrom constituents, and provide data study filesfor additional statistical analysis.

Through the cooperation of the medicalschool staffs, Association personnel update theFaculty Roster System's information on th~

background, current academic appointment,employment history, education and trainingof salaried faculty at U.S. medical schools.These data are periodically reported to themembership in summary format, enabling theschools to 'have an organized, systematic pro-

~ file of their faculty. The Association conductsan annual survey of medical school faculty

~0. . salaries. This Faculty Salary Survey Systemg :. provides the annual report on medical school1~ faculty salaries and is available on a confiden­.g r tial, .aggregated basis in response to specialal quenes.] f The Association continues to maintain a~ t- repository of information on medical schoolsoz.

AAMC Membership

TypeInstitutionalProvisional InstitutionalAffiliateGraduate AffiliateSubscriberAcademic SocietiesTeaching HospitalsCorrespondingIndividualDistinguished ServiceEmeritusContributingSustaining

1981-82 1982-83123 125

4 216 161 I

16 1873 73

416 432331 87

1300 117451 6247 684 5

12 10

Treasurer's Report

The Association's Audit Committee met onSeptember 7, 1983, and reviewed in detail theaudited statements and the audit report forthe fiscal year ended June 30, 1983. Meetingwith the Committee were representatives ofErnst & Whinney, the Association's auditors,and Association stan: On September 22, theExecutive Council reviewed and accepted-thefinal unqualified audit report.

Income for the year totaled $11,627,154.Ofthat amount $10,696,362 (92%) originatedfrom general fund sources; $376,004 (3%)from foundation grants; $554,788 (5%) fromfederal government reimbursement contracts.

Expenses for the year totaled $10,125,955of which $9,076,543 (90%) was chargeable tothe continuing activities of the Association;$494,624 (5%) to foundation grants; $554,788(5%) to federal cost reimbursement contracts.Investment in fixed assets (net ofdepreciation)decreased $241,028 as a result ofa decision bythe Executive Council to raise the ceiling forcapitalization of fixed assets from $500 to$2,000.

Balances in funds restricted by the grantor ~

decreased $62,963 to $499,661. After making Iprovisions for reserves in _the amount of ~

$875,000 principally for student data baseconversion, the clinical evaluation project,MCAT and AMCAS development, purchaseof computer equipment and the MCAT essayand diagnostic services program, unrestricted Ifunds available for general purposes increased$706,534 to $8,239,850, an amount equal to81 % of the expense recorded for the year.This reserve accumulation is within thedirective of the Executive Council that theAssociation maintain as a goal an unre- >

stricted reserve of 100% of the Association'stotal annual budget. It is of continuing im­portance that an adequate reserve be main­tained.

The Association's financial position isstrong. As we look to the future, however, and :recognize the multitude ofcomplex issues fae- ring medical education, it is apparent that the 'demands on the Association's resources will ,continue unabated.

274

Association of American Medical CollegesBalance Sheet

. June 30, 1983

ASSETSCashInvestments

l- Certificates of DepositAccounts ReceivableDeposits and Prepaid ItemsEquipment (Net of Depreciation)Total Assets

LIABILITIES AND FUND BALANCESLiabilities

Accounts PayableDeferred IncomeFund Balances

Funds Restricted by Grantor for Special Purposes~ General Funds§ Funds Restricted for Plant Investment8. .- Funds Restricted by Executive Council for§ . Special Purposes~ i Investment in rIXed Assets-g t. General Purposes Fund~ l Total Liabilities and Fund Balances!, Association ofAmerican Medical CollegesE f Operating Statement~I':: Fiscal Year EndedJune 30. 1983

~ < SOURCE OF FUNDS~ Income§ Dues and Service Fees from Members] Grants Restricted by Grantor"8. Cost Reimbursement Contracts.s Special Servicesa Journal of Medical Education~ Other Publications~. Sundry (Interest $1,644,586)§ otal Source of FundsQ

SEOF FUNDSrating Expenses

Salaries and Wages -StaffBenefitsSupplies and ServicesProvision for Depreciation

I Travel and MeetingsLoss on Disposal of Fixed AssetsInterest Expense

otal Expensesncrease in Investment in rIXed Assets (Net ofDepreciation)

. (Decrease) .

ransfer to Executive Council Reserved Funds for SpecialProgramseserve for Replacement ofEquipment

ncrease in Restricted Fund Balances (Decrease)ncrease in General Purposes Fundsotal Use of Funds

275

$ 13,437

14,381,8961,004,923

128,666913,973

16,442,895

$ 1,330,4661,456,800

499,661

$ 496,856

3,505,289913,973

8,239,850 13,155,968$16,442,895

$ 3,008,015376,004554,788

5,007,514100,489351,735

2,228,609$11,627,154

$4,410,248718,259

3,815,386290,555883,615

7,469.423

$10,125,955

$ (241,028)

875,000223,656(62,963)706,534

$11,627,154

AAMC Committees

Accreditation Council for Continuing MedicalEducation

AAMCMEMBERS:

Richard M. CaplanJohn N. LeinHenry P. Russe

Accreditation Council for Graduate MedicalEducation

AAMC MEMBERS:

D. Kay ClawsonSpencer ForemanRichard JanewayDavid C. Sabiston, Jr.

Audit

Earl Frederick, ChairmanFrancis J. HaddyRussell Miller

CAS Nominating

Frank C. Wilson, ChairmanRobert M. BlizzardArthur DonovanRobert L. HillLeonard JarrettThomas LangfittHoward Morgan

COD Nominating

Henry P. Russe, ChairmanMarvin R. DunnJames F. GlennG. Richard LeeLeah Lowenstein

COD Spring Meeting Planning

Richard Janeway, ChairmanFairfield GoodaleLouis J. KettelWilliam H. LuginbuhlEdward J. Stemmler

COTH Nominating

Mitchell T. Rabkin, ChairmanFred J. CowellEarl J. Frederick

COTH Spring Meeting Planning

Glenn R. Mitchell, ChairmanRon J. AndersonJames W. Holsinger, Jr.Robert H. MuilenburgCharles M. O'BrienDaniel L. Stickler

Council for Medical Affairs

AAMCMEMBERS:

Steven C. BeeringJohn A. D. CooperRobert M. Heyssel

Finance

William H. Luginbuhl, ChairmanRobert FrankRobert HillRichard JanewayMitchell RabkinVirginia Weldon

Flexner Award Selection

L. Thompson Bowles, ChairmanArnold BrownSamuel DavisMary Beth GrahamHarold SoxGeorge Zuidema

General Professional Education of thePhysician and College Preparation forMedicine

Steven Muller, ChairmanWilliam P. Gerberding, Vice ChairmanDavid Alexander

. John S. Avery

I.

II

It

276

1982-83 Annual Report

~ Jo Ivey BouffordJohn W; CollotonJames A. DeyrupStephen H. FriendJohn A. GronvallRobert L. KelloggVietor R. NeufeldDavid C. Sabiston, Jr.Karl A. SchellenbergRobert T. SchimkeLloyd H. Smith, Jr.Stuart R. TaylorDaniel C. TostesonBurton M. Wheeler

Governance and Structure:::

~ Daniel C. Tosteson, Chairman~ John W. Colloton0..

§ John W. Eckstein~ I Manson Meads] ~ Sherman M. Mellinkoff'"d

8e~ Group on Business Affairs.8o : STEERINGz

. Mario Pasquale, ChairmanJohn H. Deufel, Executive SecretaryMichael B. ArneyStephen ChapnickC. Duane GaitherJerold GlickJerry HuddlestonBernard McGintyRobert B. PriceRobert Rose

. Michael A. ScullardRobert Winslow

Group on Institutional Planning

STEERING

Thomas G. Fox, Chairman, John H. Deufe), Executive SecretaryRussell E. Armistead

~ Barry H. Gagett

JVietor CrownJames N. GlasgowDavid R. PerryMarie Sinioris· Stephen Smitheorge Stuehler, Jr.Ian B. William

Group on Medical Education

STEERING

Alan Goldfein, ChairmanJames B. Erdmann, Executive SecretaryJames G. BoulgerGerald EscovitzLeonard E. HellerVietor R. NeufeldOydeTucker

Group on Public Affairs

STEERING

Vicki Saito, ChairmanCharles Fentress, Executive Secretary-

TreasurerDean BorgRobert FenleyNancy GroverAl HicksDallas MackeyB. J. NorrisGlenda RosenthalRoland Wussow

Group on Student Affairs

Robert I. Keimowitz, ChairmanRobert J. Boerner, Executive SecretaryTerrence M. LeighJohn M. MayHorace MitchellEdward SchwagerJane ThomasNorma E. WagonerWilliam WallaceJenette WheelerCheryl Wilkes

MINORITYAFFAIRSSECTION

William Wallace, ChairmanRudolph Williams, Vice ChairmanAlthea AlexanderElson CraigThomas JohnsonZubie MetcalfStanford RomanJames A. ThompsonJose TorresBenjamin B. C. Young

277

VOL. 59, MARCH 1984278 Journal ofMedical Education

Journal of Medical EducationEditorial Board

Richard C. Reynolds, ChairmanJo BouffordL. Thompson BowlesBernadine H. BulkleyLauro F. CavazosMary Stuart DavidA. Cherrie EppsJoseph S. GonnellaJames T. Hamlin, IIISheldon S. KingKenneth KutinaWalter F._LeavellRobert K. MatchEmily MumfordWarren H. PearseLois PoundsStuart K. ShapiraT. Joseph SheehanLoren Williams

Liaison Committee on Medical Education

AAMCMEMBERS:

J. Robert BuchananCarmine D. ClementeWilliam B. DealRichard C. ReynoldsM. Roy SchwarzRobert L. Van Citters

AAMCSTUDENTPARTICIPANT:

Warren Newton

Management Education Programs

Edward J. Stemmler, ChairmanD. Kay ClawsonDavid L. EverhartFairfield GoodaleWilliam H. LuginbuhlRobert G. PetersdorfHiram C. Polk

National Citizens Advisory Committee forthe Support of Medical Education

Harold H. Hines, Jr., ChairmanGeorge Stinson, Vice ChairmanJack R. AronG. Duncan Bauman

Karl D. BaysWilliam R. BowdoinFrancis H. BurrAetcher ByromAlbert G. ClayWilliam K. CoblentzAllison DavisLeslie DavisWillie DavisCharles H. P. DuellDorothy Kirsten FrenchCarl J. GilbertStanford GoldblattMelvin GreenbergMartha W. GriffithsEmmett H. HeitlerKatharine HepburnCharlton HestonWalter J. HickelJohn R. Hill, Jr.Jerome H. HollandMrs. Gilbert W. HumphreyJack JoseyRobert H. LeviAorence MahoneyAudrey MarsHerbert H. McAdams, 11Woods McCahillArchie R. McCardellEinerMohnE. Howard MolisaniC. A. MundtArturo OrtegaGregory PeckAbraham PritzkerWilliam Matson RothBeurt SerVaasLeRoy B. StaverRichard B. StoneHarold E. ThayerW. Clarke WescoeWilliam WolbachT. Evans WychofTStanton L. Young

Nominating

John W. Colloton, ChairmanJohn NaughtonMitchell T. RabkinHenry P. RusseFrank C. Wilson

I1

I

-- 1982-83 AnnualReport

~ Payment for Physician Services in Teaching, Hospitals

Hiram C. Polk, Jr., ChairmanIrwin BirnbaumDavid M. BrownThomas A. Bruce

. Jack M. ColwillMartin G. DillardFairfield GoodaleRobert W. HeinsSheldon S. KingJerome H. ModellMarvin H. SiegelAlton I. SutnickSheldon M. Wolff

:::

~ Prospective Payment for Hospitals~= C. Thomas Smith, Chairman .~ . David Bachrach-§ l R~~rt J. Baker.g ilham B. Deal~ obert J. Erra~ arold J. Fallon~~. onald P. Kaufmanz .,

~. rank G. MoodyyG. Newmanuglas Petershur Piper

l egional Institutes on Geriatrics and Medicaluation

oseph E. Johnson, 111,-Chairmanuth Bennettwald W. Bussevan Calkinsack M. Colwill

, ohn D. Loeserorence Mahoney

Ruth M. RothsteinFrederick E. ShidemanJudy A. SpitzerKnight SteelEugene Stead, ConsultantHarland Wood, Consultant

Research Award Selection

Dominick P. Purpura, ChairmanWolfgang JoklikMaria I. NewJerrold M. OlefskyDaniel SteinbergDaniel C. Tosteson

Resolutions

William B. Deal, ChairmanPamelyn OoseDavid EverhartDouglas Kelly

RIME Program Planning

Hugh M. Scott, ChairmanJames B. Erdmann, Executive SecretaryPhilip G. BashookJohn B. CorleyHarold G. LevinRobert M. RippeyPaula L. Stillman

Women in Medicine

Dorothy BrinsfieldCarol MangioneMarion NestleJacqueline NoonanEleanor ShoreJane Thomas

279

AAMC Staff

Office of the President

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

Vice PresidentJohn F. Sherman, Ph.D.

Special Assistant to the PresidentKathleen S. Turner

StaffCounselJoseph A. Keyes, J.D.

Executive SecretaryNorma NicholsRose Napper

Administrative SecretaryRosemary Choate

Division of Business Affairs

Director and Assistant Secretary-TreasurerJohn H. Deufel

Business ManagerSamuel Morey

ControllerJeanne Newman

Personnel ManagerCarolyn Curcio

Membership and Subscriptions SupervisorLossie Carpenter

Accounts Payable/Purchasing AssistantLoretta Cahill

Administrative SecretaryKaren McCabe

Accounting AssistantCathy Dandridge

Personnel AssistantDonna Adie

SecretaryCynthia Withers

Accounts Receivable ClerkRick Helmer

Accounting OerkLaVerne Tibbs

ReceptionistRosalie Viscomi

Membership ClerkIda GaskinsCecilia KellerAnna Thomas

Senior Mail Room ClerkMichael George

Mail Room ClerkJohn Blount

Director, Computer ServicesBrendan Cassidy

Associate DirectorSandra Lehman

Manager of DevelopmentKathryn Petersen

Systems ManagerRobert Yearwood

Systems AnalystPamela EastmanDonald Hollander

Programmer AnalystLori AdamsJack Chesley

Operations SupervisorBetty L. Gelwicks

Administrative SecretaryCynthia K.. Woodard

Secretary/Word Processing SpecialistLaVerne Waters

Data Control ManagerRenate Coffin

Computer OperatorPauline DimminsJackie HumphriesBasil PegusWilliam Porter

Data Preparation OperatorJessie Walker

Division of Public Relations

DirectorCharles Fentress

Administrative SecretaryJanet Macik

280

r

1982-83 AnnualReport

Division of Publications '

DirectorMerrill T. McCord

Associate EditorJames R. Ingram

StaffEditorVickie Wilson

Assistant EditorGretchen Chumley

Administrative SecretaryAnne Spencer

Department of Academic AffairsDirector

August G. Swanson, M.D.~ Deputy Director~ Elizabeth M. Short, M.D.= Senior StaffAssociate~.~ Mary H. Littlemeyer~ J Assistant Project Coordinator..g Barbara Roos~ : Editorial Assistant~ - F. Daniel Davis~: dministrative Secretary~ __ Rebecca Lindsay~ -- Assistant Project Director, GPEP~: Emanuel Suter, M.D.o:g

] Division of Biomedical Research and Faculty] -Development

~ Director~ Elizabeth M. Short, M.D.~a StaffAssociate~ I Lynn Morrison

Lucy TheilheimerSecretary

Brenda George

ivision of Educational Measurement andesearch-rectorJames B. Erdmann, Ph.D.

. ssociate DirectorRobert L. Beran, Ph.D.ogram DirectorXenia Tonesk, Ph.D.esearch AssociateRobert F. Jones, Ph.D.

Research AssistantMitchell Sommers

Administrative SecretaryStephanie Kerby

SecretaryAnnetteGomPatricia L. Young

Division of Student Programs

DirectorRobert J. Boerner

Director, Minority AffairsDario O. Prieto

Research AssociateMary CuretonThomas H. DialSock-Foon MacDougall, Ph.D.

StaffAssociateJanet Bickel

StaffAssistantElsie QuinonesJulie Reilly

Administrative SecretaryPatricia Lynn

SecretaryLily May Johnson

Division of Student Services

DirectorRichard R. Randlett

Associate DirectorRobert Colonna

ManagerLinda W. CarterAlice CherianEdward GrossMarkWood

SupervisorRichard BassLillian CallinsVirginia JohnsonCatherine KennedyDennis RennerTrudy SuitsWalter Wentz

Senior AssistantWayne CorleyKeiko DoramGwendolyn HancockEnrique Martinez-Vidal

281

VOL. 59, MARCH 1984_~;.

282 Journal ofMedical Education

Lillian McRaeAnne OveringtonEdith Young

Administrative SecretaryCynthia Lewis

SecretaryDenise Howard

AssistantTheresa BellClaudette BookerWanda BradleyRay BryantCarl ButcherKaren ChristensenJames CobbCarol EasleyHugh GoodmanPatricia JonesYvonne LewisAlbert SalasChristina SearcyHelen ThurstonGail WatsonPamela WatsonYvette WhiteJohn Woods

Typist/ReceptionistEdna Wise

Press OperatorWarren Lewis

Division of Student Studies

DirectorDavis G. Johnson, Ph.D.

Department of InstitutionalDevelopment

DirectorJoseph A. Keyes, J.D.

Senior StaffAssociateSandra Garrett, Ed.D.

Staff Assistant, Management ProgramsMarcie F. Mirsky

Administrative SecretaryDebra Day

SecretaryChristine O"Brien

Division of Accreditation

DirectorJames R. Schofield, M.D.

StafTAssistantRobert Van Dyke

Administrative SecretaryJune Peterson

Department of Teaching Hospitals

DirectorRichard M. Knapp, Ph.D.

Associate DirectorJames D. Bentley, Ph.D.

Senior StafTAssociateJoseph C. Isaacs

StafTAssociateNancy Seline

Administrative SecretaryMelissa Wubbold

SecretaryJanie BigelowAndrea McCusker

Department of Planning and PolicyDevelopment

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

Deputy DirectorPaul Jolly, Ph.D.

Legislative AnalystDavid BaimeCarolyn HenrichAnne Scanley

SecretaryAlice BarthanyDonna Greenleaf

Division of Operational Studies

DirectorPaul Jolly, Ph.D.

StaffAssociate, Faculty RosterElizabeth Higgins

StafT AssociateLeon Taksel

Operations Manager, Faculty RosterAarolyn Galbraith

StaffAssistantWilliam Smith

r.J.

982-83 AnnualReport

esearch Assistant-- Deborah Ganey

Gary Cook. Exequiel Sevilla

Donna Williamsdministrative Secretary

Mara CherkaskySecretary

Joyce BeamanData Coder

Margaret MumfordElizabeth Sherman

283

UNIVERSITY OF UTAHHANDBOOKS FOR MEDICAL TEACHERS

1. There Is No Gene for Good Teaching:A Handbook on Lecturing for Medical Teachersby Neal Whitman, Ed.D. $5.00

2. A Handbook for Group Discussion Leaders:Alternatives to Lecturing Medical Students to Deathby Neal Whitman, Ed.D and Thomas L. Schwenk, M.D. $5.00

3. Evaluating Medical School Courses:A User-Centered HandbookBy Neal Whitman, Ed.D. and Thomas Cockayne, Ph.D. $10.00

Please send orders or inquiries to:

Dr. Neal WhitmanDepartment of Family and Community MedicineUniversity of Utah School of MedicineSalt Lake City, Utah 84132Telephone: (801) 581-3614

Please make checks to University of Utah.Discounts are available for orders over 20 copies of a single handbook.

Faculty of Medicine rOffice of Medical Education--Assistant Professor r

Applications are invited for the position of Assistant Professor on a limited term appoiment with the possibility of tenure track in the future.

The University of Calgary Medical School has a unique three-year curriculum wh­stresses small-group problem-solving, independent learning, and multidisciplinary systelbased teaching.

Requirements include the M.D. and/or Ph.D. degree in Educational Psychology orlated field, with demonstrated research experience in evaluation, learning, and/or teach_skills.

The opportunity exists to develop projects in the use of microcomputers and simulapatients in student instruction and evaluation, in addition to participation in ongoing ­search projects in admissions, curriculum design, and student evaluation.

Responsibilities include acting as an Education Consultant to faculty with regardteaching skills, student evaluation and learning skills, and assessment and improvemen ­the learning environment. .

Experience in working with physicians is highly desirable.Salary competitive depending on qualifications and experience. In accordance'

Canadian immigration requirements, this advertisement is directed to Canadian citizens ,permanent residents.

Applicants should send curriculum vitae and the names of three references before ~

I, 1984 to:

Dr. John S. BaumberAssociate Dean (Undergraduate Medical Education)The Uni"ersity of CalgaryFaculty of Medicine3330 Hospital Drive N.W.Calgary, Alberta T2N 4N I