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Association of American Medical CollegesAnnual Meeting

andAnnual Report

1976

NOTE: The minutes of the 1976 meeting of theAAMC Assembly will be published in a subsequentissue.

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Table of Contents

Annual Meeting

Plenary Sessions 235Council of Deans 235Council of Academic Societies 236COD/COTH Joint Program 236Council of Teaching Hospitals 236Organization of Student Representatives 236OSR/COD Joint Program 236Women in Medicine Program 236Minority Affairs Program 237Group on Business Affairs 237Group on Medical Education ~38

GME Graduate Medical Education Program 238GME Continuing Medical Education Program 239Group on Public Relations 239Group on Student Affairs 239Planning Coordinators' Group 239International Program 240Research in Medical Education 240

Annual Report

Message from the President 247The Councils 249National Policy 255Working with Other Organizations 259Education 262Biomedical Research 265Health Care 267Faculty 269Students 271Institutional Development 274Teaching Hospitals 276Communications 279Information Systems 280AAMC Membership 282Treasurer's Report 282AAMC Committees, 1975-76 284AAMC Staff, 1975-76 289

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235

The Eighty-Seventh Annual Meeting

COUNCIL OF DEANS

U.S. Health Care- The Road AheadKaren Davis, Ph.D.

Business Meeting

Presiding: John A. GronvaIl, M.D.

November 11

November 12

General Session

CURRENT AND CHOICE: DEVELOPMENTS IN

MEDICAL EDUCATION

Presiding: John A. Gronvall, M.D.

Outreach Service and Education Programs inthe Remote Parts ofHawaii and MicronesiaTerence A. Rogers, Ph.D.

The County Hospital-From Chaos to Con­tractSteven C. Beering, M.D.

North Carolina AHEC ProgramGlenn Wilson

Interdisciplinary Elective: Social and MoralValues in the Health SciencesAlvin G. Burstein, Ph.D.

The Evolution of an Institutional Program inComprehensive Primary Patient Care Educa­tionAndrew D. Hunt, M.D.

University of Washington Independent StudyProgramGary E. Striker, M.D.

Program Outlines

PLENARY SESSIONS

November 13

November 14

San Francisco Hilton Hotel, San Francisco, California, November 11-15, 1976

Theme: The Next Hundred Years

Presiding: Leonard W. Cronkhite, Jr., M.D.

Presentation of Awards

Alan Gregg Memorial Lecture: The Art andScience of Medical Practice- Past, Present,and FutureWillam B. Bean:M.D.

The Evolution of Biomedical Science-Past,Present, Future PerspectivesJulius H. Comroe, Jr., M.D.

The Association of American Medical Col­leges: Looking Ahead from the First HundredYearsJohn A. D. Cooper, M.D.

Perspectives on the Future Development ofMedical EducationEli Ginzberg, Ph.D.

Presiding: Ivan L. Bennett, Jr., M.D.

Chairman's Address:Leonard W. Cronkhite, Jr., M.D.

Is the Medical School a Proper Part of theUniversity?David S. Saxon, Ph.D.

Recent Developments Bearing Upon NationalPolicy in the Health SciencesDavid A. Hamburg, M.D.

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236 Journal ofMedical Education

COUNCIL OF ACADEMICSOCIETIES

November 12

Business Meeting

Presiding: Rolla B. Hill, Jr., M.D.

General Session

THE ROLE OF MEDICAL EDUCATION IN REDUC­

ING MEDICAL COSTS AND THE DEMAND FOR

MEDICAL SERVICES

Presiding: Rolla B. HilI, Jr., M.D.

Panel: Duncan Neuhauser, Ph.D.Sherman M. MeIlinkoff, M.D.

COUNCIL OF TEACHINGHOSPITALS

November 12

Business Meeting

Presiding: Charles B. Womer

General SessionPresiding: David D. Thompson, M.D.

CLINICAL CASE MIX DETERMINANTS OF HOS­

PITAL COSTS

Speaker: Clifton R. Gaus, Sc.D.

Panel: Baldwin G. Lamson, M.D.John D. ThompsonCharles T. Wood

COD/COTH JOINT PROGRAM

November 12

THE COMMISSION ON PUBLIC-GENERAL HOS­

PITALS

Activities of the CommissionRussell A. Nelson, M.D.

Issues for State-University Owned HospitalsJohn R. Hogness, M.D.

Issues for Big City Public Teaching HospitalsJoseph V. Terenzio

VOL. 52, MARCH 1977

ORGANIZATION OF STUDENTREPRESENTATIVES

November 10

Orientation and Business Meeting

Regional Meetings:SouthernNortheastWesternCentralDiscussion Sessions

November 12

Discussion SessionsBusiness MeetingReception

November 13

Regional Meetings:NortheastWesternSouthernCentral

Discussion Sessions

OSR/COD JOINT PROGRAM

November 11

EDUCATIONAL STRESS: THE PSYCHOLOGICAL

JOURNEY OF THE MEDICAL STUDENT

Moderator: Richard S. Seigle

Keynote AddressGordon H. Deckert, M.D.

Educational Stress: The Students' PerspectiveThomas A. Rado, Ph.D.Sheryl A. GroveMark Cannon, M.D.Robert Rosenbaum, M.D.

Educational Stress: A Dean's PerspectiveWilliam R. Drucker, M.D.

Discussion

WOMEN IN MEDICINE PROGRAM

November 12

WOMEN IN MEDICINE: JUST WHAT ARE THE

ISSUES?

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1976AAMC Annual Meeting

An open forum focusing on identification andresolution of national issues related toWomen in Medicine.

Presiding: Judith B. Braslow

MINORITY AFFAIRS PROGRAM

November 11

Symposium

THE CHALLENGE OF MEDICAL EDUCATION­

THE MINORITY MEDICAL STUDENT

Chairman: Henry C. Johnson, Ph.D.

Moderator: Vivian Pinn, Ph.D.

Correlations Between Admission Variables,Medical School Performance, and NationalBoard Part 1 Performance for Medical Stu­dentsHenry C. Johnson, Ph.D.

An Intervention to Prepare Minority Studentsfor the National BoardsHenry T. Frierson, Ph.D.

The Attitude of Medical Schools and FacultyToward Minority StudentsAlonzo C. Atencio, Ph.D.

Student Evaluation as it Relates to Admissionsand Performance in Medical SchoolAlvin F. Poussaint, M.D.

Quality and Competence in Medical Practiceas it Relates to Medical EducationArthur H. Hoyte, M.D.

Discussants: Anna C. Epps, Ph.D.Arthur Coleman, M.D.

The Need for More Minority PhysiciansTherrnan Evans, M.D.

The Location of Black Physicians in Michi­gan: A Summary ReportLawrence Lezotte

November 12WORKSHOPS ON SIMULATED MINORITY ADMIS­

SIONS EXERCISES

Moderator: Dario O. Prieto

Panel: Juel HodgeRoy K. Jarecky, Ed.D.William E. Sedlacek. Ph.D.

237

Panel: Paul R. Elliott, Ph.D.Walter F. Leavell, M.D.Dario O. Prieto

MINORITY AFFAIRS FINANCIAL AID WORK-

SHOP

Moderator: Frances D. French

Participants: Harry W. Clark, M.D.Ralph Gibson, Ph.D.Bernard W. Nelson, M.D.Vivian W. Pinn, M.D.George W. WarnerAlice SwiftRicardo Ortega

November 13

General Session

CONTRIBUTIONS AND BENEFITS OF MINORI­

TIES IN MEDICINE

Presiding: Dario O. Prieto

IntroductionJohn A. D. Cooper, M.D.

Keynote AddressYvonne B. Burke

GROUP ON BUSINESS AFFAIRS

November 11

Malpractice: Risk Management and Cost Con­tamment

Moderators: Cyril KupferbergDavid Sinclair

Panel: Daniel CreaseyTarky LombardiWilliam J. McGill, Ph.D.Mark Olsen

Management of Multi-site Medical Education

Moderator: Don B. Young

Panel: Steven C. Beering, M.D.Truman O. Anderson, M.D.M. Roy Schwartz, M.D.Elliot Wells

AUGUSTUS J. CARROLL MEMORIAL LECTURE

Richard Janeway, M.D.

Business Meeting

GROUP ON MEDICALEDUCATION

238 Journal ofMedical Education

November 12

Faculty Information Systems

Moderator: Daniel P. Benford

Panel: Ruth E. BardwellRobert I. BensonRobin GeorgePaul Jolly, Ph.D.Russell C. Mills, Ph.D.Frederick B. Putney, Ph.D.Norman E. Toy, D.B.A.

A Case Study: Grant Management at the NewYork University Medical Center

Moderator: Thomas A. Fitzgerald

Panel: Ira GoodmanJoel SteeleC. N. Stover, Jr.

State Appropriations for Medical Education:Comparisons and Contrasts

Moderator: Joseph L. Preissig

Panel: Frank BachichRobert D. DammannLarry HershmanJames C. Rich, Jr.

Critical Issues in Hospital/Medical School Affiliation

Moderator: Thomas A. Rolinson

Panel: George R. DeMuth, M.D.Ruth HaynorRex S. Levering

Medical Service Plan Update

Moderator: Clyde Hardy, Jr.

Panel: Ronald P. Kaufman, M.D.James V. Maloney, Jr., M.D.Bernard Siegel

November 14

VOL. 52, MARCH 1977

Chairman: Merrel D. Flair, Ph.D.

The Basic ScientistRonald W. Estabrook, Ph.D.

The Humanistic PractitionerCharles Lewis, M.D.

The Health Services ResearcherJohn M. Williamson, M.D.

The Consumer of Physician ServicesGlenn Wilson

Regional Meetings

LOGISTICS, ACCREDITATION, FINANCING: IS-

SUES FOR GRADUATE MEDICAL EDUCATION

LogisticsJohn Graettinger, M.D.

AccreditationJames A. Pittman, Jr., M.D.

FinancingRichard Knapp, Ph.D.

November 14

GME GRADUATE MEDICALEDUCAnON PROGRAM

Business Meeting

Small Group Discussions

Time-Flexible Clinical TrainingModerator: David Heinbach, M.D.

PSRO-Impact on Continuing Medical Edu­cationModerator: Robert K. Richards, Ph.D.

Innovations in the Teaching and Organizationof Physical DiagnosisModerator: Robert T. Manning, M.D.

Graduate Medical Education for the GeneralistModerator: John Graettinger, M.D.

Models of Human Values ProgramsModerator: Larry R. Churchill, Ph.D.

Communication Technology in Off-Site Edu­cationModerator: Clyde E. Tucker, M.D.

ON EDUCATING THE

IMPACT ON HEALTH

FOUR PERSPEcnvES

MEDICAL STUDENT:

CARE DELIVERY

November 12

Plenary Session

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1976 AAMCAnnual Meeting

GME CONTINUING MEDICALEDUCATION PROGRAM

November 14

Convenor

Robert Barbee, M.D.

TIlE GME AND CONTINUING MEDICAL EDUCA­

TION

MANDATORY CONTINUING MEDICAL EDUCA­

TION: EXPECTATIONS AND ISSUES

Moderator: Phil R. Manning, M.D.

Can Competency Be Legislated?John Milton

The Role and the Relationship ofthe Board ofRegistrationJohn Moses, M.D.

Reappraising the Federal RoleFrederick V. Featherstone, M.D.

Goals and Priorities of the LCCMESaul Farber, M.D.

Continuing Medical Education Without Fail­ure: Carrot or StickDavid Walthall, M.D.

The View ofa Medical School DeanNeal A. Vanselow, M.D.

Discussion

GROUP ON PUBLIC RELATIONS

November 11

Presiding: Susan Stuart-OttoAI Hicks

Our HeritageHelen M. Sims

The Next HundredAugust G. Swanson, M.D.

Awards LuncheonPresiding: Herbert Kadison

Presentation of AwardsIvan L. Bennett, Jr., M.D.

Grass Roots Legislative EffortsJohn F. Sherman, Ph.D.

Cast Study PresentationsModerator: J. Michael Mattsson

239

November 12

General Session

SAMPLINGS FROM THE REGIONS

Health Education Is Intrinsic to Health CareDavid Burns, M.D.

Out ofthe Ivory Tower and Into TownJane D. Schultz

Measuring Public Opinion and AttitudesDarvin Winick, Ph.D.

Medical EthicsDonald M. Hayes, M.D.

The Press and the PR OfficeCharles Petit

Business Meeting

GROUP ON STUDENT AFFAIRSNovember 14

Business Meeting

DOCTORS/PEOPLE: CONFLICTS

SIONAL AND PERSONAL ROLES

STUDENTS AND PHYSICIANS

Opening Statement and Introduction of Panel

Norma Wagoner, Ph.D.

Comparison ofWomen and Men PhysiciansMarilyn Heins, M.D.

Overview ofPresentation by Panel ModeratorDonna Rabin

Slide Tape Presentation and Panel Discussion

Panel: Donna RabinLinda FriedMartin HickeyDenise RodgersCraig Vanderwagen

The Medical Schools' ResponsibilityNorma Wagoner, Ph.D.

DiscussionDonna Rabin

PLANNING COORDINATORS'GROUPNovember 11

HEALTII PLANNING, HSAS, AND THE MEDI­

CAL SCHOOL-EXPERIENCES, IMPACT, AND

IMPLICATIONS FOR US NOW.

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240 Journal ofMedical Education

Moderator: Russell C. Mills, Ph.D.

Panel: Roger BennettFrederick J. Bonte, M.D.Thomas J. CampbellRaymond K. CombillLillian PrideSteven J. Summer

November 12

THE MEDICAL CENTER AND ITS EXTERNAL

ENVIRONMENT

Moderator: Howard J. Barnhard, M.D.

David R. Challoner, M.D.Robert U. Massey, M.D.Stanley van den Noort, M.D.Joseph A. KeyesRaymond K. Combill

Business Meeting

INTERNATIONAL PROGRAM

November 11

SHOULD MEDICAL SCHOOLS BE INVOLVED IN

INTERNATIONAL HEALTH?

Moderator: Dieter Koch-Weser, M.D.

International Health Education DevelopmentJames W. Lea, Ph.D.

Nutrition and Rural Health Clerkship in LatinAmericaM. G. Herrera, M.D.

Research in Geographic MedicineKenneth S. Warren, M.D.

The AAMC and International HealthEmanuel Suter, M.D.

Discussion

SummaryDieter Koch-Weser, M.D.

RESEARCH IN MEDICALEDUCATION: FIFTEENTHANNUAL CONFERENCE

November 13

PRESENTATION OF PAPERS

STUDENT CHARACTERISTICS

VOL. 52, MARCH 1977

Moderator: Lillian K. Cartwright, Ph.D.Development of a Medical Cognitive Prefer­ences Test-Pinchas Tamir, et al.

An Empirical Inventory Comparing Instruc­tional Preferences of Medical and OtherHealth Professional Students-Charles P.Friedman, et al.

A Typology ofMedical Students on Cognitive,Personality and Attitudinal Variables - FredDagenais, et al.

PHYSICIAN-PATIENT INTERACTION SKILLS

Moderator: Norman Kagan, Ph.D.

Use ofTrained Mothers to Teach and EvaluateInterviewing Skills-Paula L. Stillman, M.D.,et al.

Interviewing Skills: A Comprehensive Ap­proach to Teaching and Evaluation - MaureenHutter, et al.

The Effect ofPersonality Factors and Trainingon the Development of Interpersonal Skills byFreshman Medical Students-B. Kaye Boles,Ph.D.

CLINICAL EVALUATION

Moderator: Philip G. Bashook, Ed.D.

Rater-Ratee Relationships as Related to RaterConfidence for Different Domains of Compe­tence-Fred J. Dowaliby, Ph.D.

Training Medical Record Abstractors to As­sure High Inter-Rater Reliability - Bryce Tem­pleton, M.D., et al.

Resident Performance Evaluation - A Com­parison Among Members of the Health CareTeam-G. R. Norman, Ph.D., et al.

REMOTE SITE CLINICAL EVALUATION

Moderator: Elisabeth Zinser, Ph.D.

Learning Primary Care by Audit of Perform­ance-A Dynamic Experience in a Problem­Oriented System - Richard E. Bouchard,M.D., et al.

An Evaluation of Primary Care Preceptor­ships-Dona L. Harris, Ph.D., et al.

A Systematic Comparison of Teaching Hospi­tal and Remote Site Clinical Education­Charles P. Friedman, et al.

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The Patient Encounter Project: Comparisonsof Medical Student Experiences in Rural andUniversity Settings - Judith Garrard, Ph.D., etal.

MEDICAL PROBLEM SOLVING

Moderator: Harold G. Levine

Concurrent Validity of Patient ManagementProblems by Comparison with the Clinical En­counter-J. W. Feightner, M.D., et al.

Teasing Apart the Problem Solving Process­Eta S. Berner, Ed.D., et al.

Measuring Performance on Patient Manage­ment Problems - Michael B. Donnelly

The Relationship Between Computerized Pa­tient Management Problems and Other Pediat­ric Certifying Examinations - Ernest N.Skakun, et al.

CURRICULUM INNOVATIONS IN CLINICAL

AND BASIC SCIENCES

Moderator: Gary M. Arsham, M.D., Ph.D.A First Year Clinical Study ofHealth Care as aSystem - Harry Deicher, et al.

Replacement of Traditional Anatomical Dis­section by a Stereoscopic Slide-Based Auto­Instructional Program -E. D. Prentice,Ph.D., et al.

Teaching Preclinical Medical Students in aClinical Setting-Arthur Kaufman, M.D., etal.

Medical School Biochemistry via the Personal­ized System: A Three Year Perspective-FrankSchimpfhauser, Ph.D., et al.

PRESENTATION OF SYMPOSIA

mE EVALUATION OF TEACHING EFFECTIVE­

NESS IN MEDICAL EDUCATION: ISSUES AND

PROBLEMS

Organizer: Howard L. Stone, Ph.D.

Participants: Robert FishmanCharles W. Drage, M.D.David Graham, M.D.George L. Baker, M.D.

Discussant: Lawrence G. Crowley, M.D.

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GEOGRAPHIC AND SPECIALTY MALDISTRIBU­

TION AND PREDQCTORAL MEDICAL EDUCA­

TION

Organizer: Ronald W. Richards, Ph.D.

Participants: Ronald W. Richards, Ph.D.Judith Krupka, Ph.D.Peter O. Ways, M.D.P. J. Neelands, M.D.

Discussant: Harold Haley, M.D.

IMPLEMENTING CHANGE IN RESIDENCY EDU­

CATION-mE MODEL, mE OPERATIONS, AND

THE RESULTS

Organizer: Leonard Levine

Participants: Leonard LevineJohn C. Sibley, M.D.Allan H. McFarlane, M.D.Sol Levin

DESIGN, IMPLEMENTATION, AND EVALUA­

TION OF AN INNOVATIVE CLINICAL INTERDIS­

CIPLINARY TEAM COURSE IN FIVE UNIVERSI­

TIES

Organizer: Suzanne Eichorn

Participants: Suzanne EichornLeonard SaxeDale Lake

November 14

POSTER SESSIONS

Education of the Geriatric Patient-JeoffreyK. Stross, M.D., et al.

A Student Information Retrieval System: Usein Student Tracking, Performance Compari­son Data, and Financial Implications- GeraldM. Cerchio, M.D., et al.

Selected Parameters of Medical Education inthe United States-Douglas J. McRae, Ph.D.

Student Response to an Interdisciplinary TeamExperience in Developmental Disabilities - J.B. Green, et al.

Student Education: Physician-Nurse Interdis­ciplinary Health Care Team-A Family Prac­tice Model-Nellie B. Ramage, et al.

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242 Journal ofMedical Education

Highlights from a Study on the Use ofSimula­tion Technologies in Medical Education­James R. Messick

An Evaluation ofthe Quality of Medical Carein Three Comprehensive Health Centers Usingthe Staging Methodology-Craig S. Spirka, etal.

Chart Review as a Measure ofClinical Compe­tence-Axel Goetz, M.D., Ph.D., et al.

Note Taking During Interviewing: An Empiri­cal Study-Jerry R. May, Ph.D., et al.

PRESENTATION OF PAPERS

FACTORS IN MEDICAL SPECIALTY CHOICE

Moderator: George Zimny, Ph.D.

Changing Perceptions ofMedical Specialties­A Factor ofSocialization? - Susan McAllister,et al.

Ambulatory Care in the Community-Impli­cations for Medical Education - David L. Ra­bin, et al.

A Way to Distribute Physicians Into RuralMinnesota-John E. Yerby, M.D.

SOCIALIZATION OF THE MEDICAL STUDENT

Moderator: Ann G. Olmsted, Ph.D.

Clinical Teaching on the General PediatricWards of a University Teaching Hospital­Josephine M. Cassie, et al. .

The Role ofMedical Education in Dehumaniz­ing Health Care Delivery - Lawrence Hart­lage, Ph.D., et al.

Sex Differences in Specialty Attitudes and Per­sonality Among Medical Students, and TheirImplications - Ellen McGrath, Ph.D., et al.

\PATIENT SATISFACTION AND THE QUALITY OF

CARE

Moderator: Alberta Parker, M.D.

A Correlational Study of the Personality andNonverbal Sensitivity of House Officers andEvaluative Ratings by Their Patients - M. Ro­bin DiMatteo, et al.

The Importance of Consumer Attitudes To­ward Doctors and Services in Relation to Gen­eral Satisfactiqn with Health Care - Barbara J.Doyle, et al.

VOL. 52, MARCH 1977

Differences in the Outcomes ofCare Providedby Various Types of Family Practitioners-'Robert L. Kane, M.D., et al.

CASE STUDIES IN FACULTY DEVELOPMENT

Moderator: David M. Irby

A SelfInstructional Departmental Approachfor Improving Lecture Skills of Medical Fac­ulty - Richard P. Foley, et al.

A House Staff Training Program to Improvethe Clinical Instruction of Medical Students­C. Benjamin Meleca, Ph.D., et al.

Planning, Implementing, and EvaluatingShort-Term Faculty Development Programs:A Case Study-Jonathan Smilansky, et al.

An Approach to Faculty Workshops-M. Jen­kins, et al.

EVALUATION OF COMPETENCE

Moderator: Miriam S. Willey, Ph.D.

A Multivariate Analysis of National BoardScores of Three- and Four-Year MedicalSchool Graduates-Nathaniel Givner, Ph.D.,et al.

The Feasibility of Using the Simulated Patientas a Means to Evaluate Clinical Competence ofPracticing Physicians in a Community (a pilotproject) -A Burri, M.D., et al.

Concurrent Validity ofthe Canadian Certifica­tion Examination in Family Medicine - W.Pawluk, M.D., et al.

Utilization of a Video-Tape Based Test toEvaluate Competence of Psychiatric Clerksand Aspects ofa Teaching Program-A Mey­erson, M.D., et al.

FACTORS IN ADMISSIONS

Moderator: Judith Krupka, Ph.D.Undergraduate Preparation in a Basic ScienceDiscipline and Subsequent Success in that Dis­cipline in The First Year of Medical School­Diane L. Essex, Ph.D.

Interrelations Between Interviewer and Appli­cant in Medical School Admissions-RobertM. Milstein, et al.

Science Versus the Arts: The Influence ofPremedical Education on Subsequent CareerSpecialization and Attitudes - Noralou P.Roos, et al.

AREA HEALTH EDUCATION CENTERS: SOME

IMPORTANT EDUCATIONAL CONCEPTS DEVEL­

OPED DURING THE INmAL FOUR YEARS

Jack Hadley, Ph.D.Wanda W. Young, Sc.D.Hesook Suzie Kang

Discussant: Edwin B. Hutchins, Ph.D.

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INDEPENDENT STUDY PROGRAMS: ARE THEY

PRACTICAL FOR MOST MEDICAL SCHOOLS?

Organizer: Harold M. Swartz

Participants: Gregory L. TrzebiatowskiThomas C. Meyer, M.D.Harold M. SwartzD. Dax Taylor, M.D.

Organizer: F. Ross Woolley, Ph.D.

Participants: Evert Reerink, M.D.William F. Jessee, M.D.John W. Williamson, M.D.Robert L. Kane, M.D.

QUALITY ASSURANCE AND MEDICAL EDUCA­

TIONRE-OUTCOMES

PRESENTATION OF SYMPOSIA

1976 AAMCAnnual Meeting

Participants: Eugene S. Mayer, M.D.Thomas F. Zimmerman, Ph.D.Albert Aranson, M.D.Gary F. Dunn

Discussants: Daniel R. SmithDonald R. Korst, M.D.

Organizer: Dorothy M. Zorn

Participants: William A. Rushing, Ph.D.Albert F. Wessen, Ph.D.

DIMENSIONS OF PRACTICE

LATED TO POLICY ISSUES

::: Organizers: Donald R. Karst, M.D.s: Daniel R. SmithrJ)rJ)

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247

Message from the President

quality medical care is available to all citizensat a price we can afford promises that aca­demic medical centers will come under evenheavier outside pressures in the future. Un­fortunately, the centers provide a convenienttarget on which to level criticism and to directlegislation and regulation. Given this pros­pect, they will have to extend their interestsand concerns further into the community ifthey are to protect the fundamental missionsand scholarly values of the university.

To meet its new responsibilities to the aca­demic medical centers, the Association hasundergone extensive change. In 1968, thegovernance structure was broadened to en­compass the principal components of the aca­demic medical centers. Opportunities havebeen given to the growing administrative staffof the centers to participate in and contributeto Association activities. The staff has beenexpanded under a full-time president andchief executive officer and organized intofunctional departments and divisions to workmore effectively with the officers, councils,and the constituency in meeting the new chal­lenges, opportunities, and problems facing theacademic medical centers.

Powerful forces are abroad in the landwhich by advertence or by inadvertence couldseriously damage the university as a socialinstitution. These include dissatisfaction withscholarship as an end in itself, more proscrip­tive legislation, the enormous growth in bothsize and insensitivity of bureaucracy, the in­tractable problems of cost and inflation, and ahost of others. History has provided ampleevidence that the university is an enduringsocial institution. It has survived the Inquisi­tion, waves of anti-intellectualism, and des­pots who would impose their wills upon it. Butas we begin our second hundred years we arefaced by challenges as great as any in historyto protect the diversity of our institutions andtheir right to preserve essential goals and ob­jectives within reasonable societal bound­aries.

Are we up to the challenge?

John A. D. Cooper, M.D.When the Association was founded 100 yearsago, American medical education was at itsnadir. The education and training of physi­cians was still obtained largely in apprentice­ships of variable duration and questionablequality. There were few quality standards formedical schools and most of the 101 institu­tions in operation were proprietary, estab­lished more to provide the faculty with a sup­plement to their inadequate practice incomethan to advance the art and science of medi­cine.

However, there were stirrings of change inthe air to assist the Association in its goal ofraising standards of medical education andeliminating marginal and inadequate schools.Its efforts played a crucial role in setting thestage for the far-reaching reforms that fol­lowed Abraham Flexner's 1910 report.

Throughout its existence, the Associationhas reflected the interests and concerns of themedical schools. Before World War II, thefocus was on improving the intrinsic quality ofmedical education and on bringing the medi­cal schools into the mainstream of universitytradition and scholarship. After the war, themedical schools abandoned their introspectivemode in the face of pressures originating inthe world around them and developed intolarge, complex academic medical centers.They provided undergraduate, graduate, andcontinuing medical education for an expandednumber of students; trained a rapidly growingnumber of other health professionals;mounted a biomedical research effort that isone of the wonders of the 20th century; anddelivered a substantial amount of hospital andambulatory care, as well as almost all of thenation's complex tertiary care. In the process,the academic medical centers have becomeheavily dependent on federal and state funds.This dependence has brought the threat ofgovernment interference in their programsand the loss of traditional academic freedom.

Further expansion of the role of govern­ment in our national life and growingCongressional frustration in assuring that

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Executive Council, 1975-76

Administrative Boards of the Councils, 1975-76

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Leonard W. Cronkhite, Jr., chairmanIvan L. Bennett, Jr., chairman-electJohn A. D. Cooper, president

Council Representatives:

COUNCIL OF ACADEMIC SOCIETIES

Rolla B. Hill, Jr.A. J. BolletRobert G. PetersdorfJack W. Cole

DISTINGUISHED SERVICE MEMBER

Kenneth R. Crispell

COUNCIL OF DEANS

John A. GronvallJ. Robert Buchanan

COUNCIL OF ACADEMIC SOCIETIES

Rolla B. Hill, Jr., chairmanA. J. Bollet, chairman-electRobert M. BerneF. Marion BishopCarmine D. ClementeJack W. ColePhilip R. DodgeDaniel X. FreedmanDonald W. KingThomas K. Oliver, Jr.Robert G. PetersdorfLeslie T. Webster

COUNCIL OF DEANS

John A. Gronvall, chairmanJ. Robert Buchanan, chairman-electChristopher C. Fordham, IIINeal L. Gault, Jr.Andrew D. HuntJulius R. Krevans

Christopher C. Fordham, IIINeal L. Gault, Jr.Julius R. KrevansWilliam H. LuginbuhlClayton RichChandler A. StetsonRobert L. Van Citters

COUNCIL OF TEACHING HOSPITALS

Charles B. WomerDavid D. ThompsonSidney LewineJohn M. Stagl

ORGANIZATION OF STUDENT

REPRESENTATIVES

Richard S. Seigle

William H. LuginbuhlClayton RichChandler A. StetsonRobert L. Van Citters

COUNCIL OF TEACHING HOSPITALS

Charles B. Womer, chairmanDavid D. Thompson, chairman-electJohn W. CollotonDavid L. EverhartDavid A. GeeRobert M. HeysselBaldwin G. LamsonSidney LewineStanley R. NelsonS. David PomrinseMalcom RandallJohn ReinertsenJohn M. StaglRobert E. ToomeyWilliam T. Robinson, AHA representative

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The Councils

Executive Council

The Executive Council met four times duringthe year, acting on a wide range of issuesaffecting the medical schools and teachinghospitals. The Council considered a numberof policy questions referred for action bymember institutions or by one of the constitu­ent Councils. Except where immediate actionwas necessary, all policy matters were re­ferred to the constituent Councils for discus­sion and recommendation before final actionwas taken.

The Annual Retreat of the elected officersand executive staff was held in Decemberprior to the first meeting of the new ExecutiveCouncil. The Retreat participants discussedthe major issues which were expected to con­front the Association during the coming year,including health manpower, the nationalhealth planning law, and methods of financingeducation in the ambulatory care setting. TheRetreat also reviewed several proposed areasof new or expanded staff activity, and offeredrecommendations on which programs the As­sociation might support and which were wor­thy of seeking outside support. At the requestof the AAMC Assembly, the Retreat dis­cussed frankly the role of the Organization ofStudent Representatives within the Associa­tion, attempting to answer several questionsraised by the students at the annual meeting.The Executive Council, at its January meet­ing, approved the detailed report of the Re­treat on these and other major issues.

The progress of health manpower legisla­tion remained a vital interest of the ExecutiveCouncil throughout the year. After almosttwo years of operating under authority of acontinuing resolution while numerous legisla­tive proposals appeared and disappeared, theCouncil labored to keep informed of the latestdevelopments and enable the Association torespond effectively on behalf of the schools.The passage and signing of this le,gislation at

the close of the 94th Congress culminatedthese efforts.

A major policy consideration during thepast year was the Association's review andformal response to the Institute of MedicineSocial Security Studies. The 10M study, enti­tled "Medicare-Medicaid ReimbursementPolicies," was requested by Congress in re­sponse to inequities demonstrated by the As­sociation in the reimbursement of teachingphysicians under Section 227 of the 1972 So­cial Security Amendments. The Administra­tive Boards and Executive Council formulateda detailed response to the 10M recommenda­tion in this area and in the areas of specialitydistribution, financing of primary care train­ing, geographic distribution, and foreign med­ical graduates.

A ~econd major policy report was reviewedin depth and commented upon by the Execu­tive Council this year. The report of the Presi­dent's Biomedical Research Panel followed18 months of deliberations which includedmeetings with several Association groups andthe preparation under contract by the AAMCof a report on the impact of biomedical re­search funding on academic medical centers.An Association task force, the AdministrativeBoards, and ultimately the Executive Councilscrutinized the Panel's recommendations and,with high praise for the Panel's work, pre­pared a formal AAMC response. Dr. FranklinD. Murphy, Chairman of the Panel, wasasked to discuss the report with the Assemblyat the 1976 Annual Meeting.

As a result of concerns raised by severaldeans, the Executive Council appointed a spe­cial Task Force on Student Financing to ex­amine the problems faced by students in pay­ing for their medical education and to recom­mend solutions which might be effected by theschools, by federal or state agencies, or by theprivate lending community. Of particular con­cern was the possibility that highly qualifiedstudents from lower income families were by-

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250 Journal ofMedical Education

passing medicine as a career choice because offinancial inaccessibility.

A 1969 AAMC task force had made exten­sive recommendations for better minority stu­dent recruitment, admissions, and retentionwith 1976 set as the target date for achievingcertain numerical and qualitative goals. TheExecutive Council recognized that, despiteencouraging signs in previous years, the enun­ciated goals would not be met. A special TaskForce on Minority Student Opportunities inMedicine was charged by the Council withpreparing a follow-up report to the 1969study, identifying why the goals proved una­chievable and what the Association and theschools could do to increase the real oppor­tunities available to minority students.

On the recommendation of the Retreat, theCouncil established a Committee on Gover­nance and Structure to review all requests fororganizational change within the representa-.tive structure of the Association. The Com­mittee reviewed requests for the establish­ment of new groups in the areas of minorityaffairs and continuing medical education andrecommended the creation of formal sectionswithin existing groups to provide the desiredforum without destroying important interrela­tionships. Both the Council and the petition­ing groups endorsed these recommendations.

A task force charged with assessing theAAMC role in the rapidly expanding field ofcontinuing medical education presented its re­port to the Executive Council in March. Thereport defined continuing medical educationand reviewed the variety of problems andpressures affecting its application. The taskforce outlined the Association's role and limi­tations in continuing education and recom­mended the appointment of an ad hoc com­mittee to recommend national policies, partic­ularly relating to the functioning of the Liai­son Committee on Continuing Medical Edu­cation. The Executive Council endorsed thisrecommendation and a committee was ap­pointed.

As one of the parent organizations of theCoordinating Council on Medical Education,the AAMC is asked to ratify all CCME policystatements. This year three major actionswere forwarded for the Executive Council's

VOL. 52, MARCH 1977

approval. The Council approved a report on"Physician Manpower and Distribution: TheRole of the Foreign Medical Graduate," re­iterating its earlier disapproval of a sectiondealing with Fifth Pathway programs. CCMERecommendations on Financing GraduateMedical Education reflected the considerableinput of the Council of Teaching Hospitalsand were approved. The Executive Councilalso approved a CCME-recommended Proce­dure for Approval of New Specialities underwhich the Coordinating Council and its parentorganizations would have the ultimate respon­sibility for recognizing a new speciality.

At the request of staff of the Senate Fi­nance Committee and the COTH Administra­tive Board, the Executive Council commentedon draft legislation replacing the current rou­tine hospital service cost limitations with anew cross-classification system for "primaryaffiliates of accredited medical schools." TheCouncil also authorized the Association's le­gal counsel to appeal aU. S. District Courtdecision upholding the classification systemcurrently being applied under Department ofHealth, Education, and Welfare regulations.

The Executive Council authorized the As­sociation's participation in other legal actionswhere Counsel felt that involvement would beadvantageous. The AAMC filed an amicuscuriae brief in the California Supreme Courtdefending a school's special admission pro­gram for disadvantaged students as consistentwith the safeguards of the Equal ProtectionClause. The Council also authorized the filingof an amicus curiae brief, if appropriate, toargue that the National Labor Relations Actpre-empts state labor laws where the NLRBhas assumed jurisdiction over the concernedemployer. Final determination on filing abrief awaits further development of the case.

The Council continued to review carefullythe work of the Liaison Committee on Medi­cal Education and the Liaison Committee onGraduate Medical Education, the accreditingagencies for undergraduate and graduatemedical education programs. Although theCouncil has delegated full authority for ac­creditation decisions to t~e LCME, the deci­sions are formally ratified by the ExecutiveCouncil to assure consistency with all state

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AAMCAnnual Report for 1976

licensing laws. This year, the Council com­mented on LCME Guidelines to the Func­tions and Structure of a Medical School andapproved Supplemental Guidelines for Medi­cal Schools with Branch or Multiple Cam­puses.

Since the establishment of the Organizationof Student Representatives in 1971, one OSRrepresentative has sat with vote on the Execu­tive Council. At the recommendation of theCouncil of Deans, the Executive Council ap­proved and recommended to the Assembly aBylaws change which would provide two OSRvotes. This amendment was based on changesin the OSR rules and regulations ensuringbetter continuity of representation.

The Council's Executive Committee metprior to each Executive Council meeting andby conference call on numerous occasionsthroughout the year. The Committee met withHEW Under Secretary Marjorie Lynch inJanuary to discuss the process of Departmen­tal regulation-writing. The full Council andfour Administrative Boards met with HEWAssistant Secretary for Health TheodoreCooper in June to discuss the rising cost ofhealth care and its impact on other federalhealth programs.

At the recommendation of the ExecutiveCommittee, the Council appointed a FinanceCommittee charged with recommending howthe Association might finance the programsand activities deemed appropriate by theCouncil while operating within the establishedreserve policy. The Committee was asked toreview all sources of Association income.

The Executive Council, along with theAAMC Secretary-Treasurer, Executive Com­mittee, and Audit Committee maintainedcareful surveillance over the fiscal affairs ofthe Association and approved a moderatelyexpanded general funds budget for fiscal year1977.

Council of Deans

In addition to its annual business meeting, theCouncil of Deans sponsored three programsat the Association's 1975 Annual Meeting inWashington, D. C. The first program, jointly

251

sponsored with the Council of Teaching Hos­pitals, considered recent experiences ofschools and hospitals with various organiza­tional arrangements designed to enhance co­ordination of their teaching and patient careresponsibilities. The focus of the featuredpresentation and panel discussion was re­flected in the program title, "Consortia: NewPatterns for Inter-Institutional Coordina­tion." The second program featured a discus­sion with the Veterans Administration ChiefMedical Director on recent developments af­fecting the relationships of VA hospitals tomedical schools. Accompanied by his chiefstaff officers, the medical director addressedsuch topics as the recently-enacted physicians'pay bill, regionalization of the VA system,VA appropriations, and the VA's participa­tion in the establishment of new state medicalschools. Finally, the COD joined with theCouncil of Academic Societies and the Coun­cil of Teaching Hospitals in sponsoring a pro­gram entitled "Maximum Disclosure: Individ­ual Rights and Institutional Needs." Twospeakers addressed different aspects of theissues involved, one emphasizing the societalinterest in submitting information and issuesto open review and critique, one emphasizingthe personal and institutional costs of disclos­ing matters where privacy. candor, or proprie­tary interests were at stake.

The November business meeting was de­voted to passing on a series of matters forAssembly action, consideration of the selec­tion procedures for student representatives tothe AAMC, election of officers, and discus­sion of both the Council and Association pro­gram for the coming year. In its discussions ofthe program ahead, the Council reviewed thestatus of a survey on governance issues andthe planning for its Spring 1976 Retreat. Ten­tative decisions of the program committeesuggested that this meeting would be relatedto governance issues at the medical school/university and medical school/teaching hospi­tal interfaces.

The Administrative Board met quarterly tocarry on the business of the Council. It delib­erated on all Executive Council agenda itemsof significance to the deans and devoted sub­stantial attention to the accrediting responsi-

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252 Journal ofMedical Education

bilities of the AAMC. Two interpretive docu­ments of the Liaison Committee on MedicalEducation, "Guidelines to the Functions andStructure of a Medical School" and "Supple­mental Guidelines for Schools with Branch orMultiple Campuses," were critically examinedby the Board in joint session with the CASAdministrative Board and with representa­tives of the Liaison Committee and staff. TheBoard approved a pamphlet prepared by theOrganization of Student Representatives toassist students in institutions being surveyedfor accreditation to participate effectively inthat process.

At the suggestion of a Council member, theBoard devoted particular attention to the una­vailability of student financial assistance. Theserious shortfall in available funds as com­pared to demonstrated need and its possibleeffect on the socioeconomic mix of applicantsstimulated the Board to suggest the appoint­ment of an Executive Council Task Force torecommend some specific solutions.

The Council's spring meeting, held thisyear in Clearwater, Florida, continued thetradition of an annual three-day retreat de­voted to a series of issues of significance todeans. A substantial portion of the program,"The Academic Medical Center: Present andProspective Challenges," was devoted to ma­jor governance issues surrounding medicalschool!teaching hospital relationships. TheCouncil received a sociologist's conception ofimages of leadership, and a composite view ofthe relative influence of participants in theresolution of issues at the medical school!teaching hospital interface, as perceived bydeans, department chairmen, and hospital di­rectors. Small groups of the Council ad­dressed themselves to a series of discussionquestions, sharing prior institutional and per­sonal experiences. Two morning sessions weredevoted to a discussion of five important is­sues facing academic medicine: problems instudent financial assistance; review and re­sponse to the 10M Social Secruity Studies;effect of federal research programs on aca­demic medical centers; availability of ade­quate numbers of high quality residency pro­grams; and the role of accreditation in medicaleducation.

VOL. 52, MARCH 1977

Council of Academic Societies

The Council of Academic Societies held onenational meeting during the year. In additionto the annual business meeting, the CASjoined the COD and COTH in sponsoring ahalf-day program on the impact of provisionsof the Freedom of Information Act, the Pri­vacy Act, and other "sunshine laws" on aca­demic institutions. The Administrative Boardof the Council met quarterly and acted onbehalf of the Council on all issues presentedfor the consideration of the Executive Coun­cil. New programs were initiated by the CASto improve communications between its mem­ber societies, AAMC staff, other AAMCcouncils, and the federal government.

A major focus of the CAS this year wasimproving communications with its 59 mem­bers societies, which represent over 100,000individuals. Establishing an effective commu­nications network has been difficult, primarilybecause of the diversity of the societies' inter­ests, the annual rotation of society officers,and the infeasibility of sending all newslettersand memoranda to all of the individual societymembers.

The Association continued to publish aCAS Annual Directory, which first appearedin 1973. This Directory contains a capsulesummary of AAMC programs, a brief ori­entation to the AAMC governance and orga­nizational structure, and a listing of the offi­cers and official representatives of each mem­ber society.

To strengthen the communications effort,the Association has begun publishing a quart­erly newsletter entitled CAS Brief. This news­letter is designed to permit easy reproductionand insertion by member societies into theirown journals or newsletters. Items in the Briefare written to inform the membership of ma­jor public policy issues which face the biomed­ical research and education community. Eightmember societies now recirculate the CASBrief to almost 7,000 individuals.

In another move to improve communica­tions, the president of each CAS society wasinvited to meet with AAMC staff and theCAS chair.man to discuss how more effectiveand continuous relationships could be estab-

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AAMC Annual Report for 1976

lished between the member societies and thecentral office. A significant number of socie­ties have now designated one of their repre­sentatives to be particularly responsible forcommunicating with the AAMC staff and withthe officers and members of their society.

Also during the year, the CAS participatedin an AAMC-sponsored workshop on improv­ing scientific input to the Food and Drug Ad­ministration's decision-making. The objec­tives of the workshop were to consider thepossible effects of several proposals on theacademic community ahd to discuss withmembers of the Council of Academic Socie­ties possible Association actions. Ramifica­tions of the changes proposed and the func­tion of the FDA were discussed with repre­sentatives of the agency.

The CAS Administrative Board carefullyscrutinized the activities of the Liaison Com­mittee on Medical Education, paying particu­lar attention to the drafting of "Guidelines tothe Functions and Structure of a MedicalSchool." These Guidelines, which elaborateon the basic accreditation policy of theLCME, will be redrafted to accommodateAdministrative Board comments. In addition,members of the CAS Administrative Boardplayed a leading role in the preparation of anAssociation response to the report of thePresident's Biomedical Research Panel.

Council of Teaching HospitalsDuring the year, the COTH AdministrativeBoard held quarterly meetings to d.evelop theprograms, interests, and policies of teachinghospitals and to consider and act on all mat­ters brought before the Association's Execu­tive Council. Preceding each Board meeting,evening sessions were held to provide seminardiscussions on specific issues.

At the January meeting, Mr. Jay Constan­tine and two other members of the SenateFinance Committee staff outlined the devel­opment of the Medicare-Medicaid Adminis­trative and Reimbursement Reform Act. TheBoard evaluated suggested concepts and pro­posed provisions of the bill. Among Boardconcerns were the removal of house staff andother types of expenditures from routine op-

253

erating costs, recognition of the impact of casemix on hospital costs, the classification systemto be used for hospitals, and the identificationand composition of a specific teaching hospitalgroup for reimbursement limitations. Theseconcerns were communicated to the staff ofthe Senate Finance Committee through corre­spondence and additional informal meetings.Following introduction of the bill, the Boardre-evaluated its content, expressing concernover a provision to establish a separate costcontrol category for "the primary affiliate ofaccredited medical schools." The Board de­veloped this and other concerns with the billinto the Association's testimony, which waspresented before the Subcommittee on Healthof the Senate Finance Committee in July.

At the March meeting of the Board, threefaculty members from the Management Ad­vancement Program presented plans for apilot program to be held for approximatelytwenty-five teaching hospital executives. Thisprogram was conducted in late June in WestPalm Beach, Florida. The future of this par­ticular phase of the management program isunder review by the MAP Steering Commit­tee and the COTH Administrative Board.

In June, a joint session of the CAS, COD,and COTH Boards was held to discuss costcontainment and other major health issueswith Dr. Theodore Cooper, Assistant Secre­tary for Health, Department of Health, Edu­cation, and Welfare. The September meetingprovided an opportunity to explore potentialresearch and experimentation in outpatientreimbursement and cost determination withDr. Clifton Gaus, director, DiviSIOn of HealthInsurance Studies, Social Secunty Adminis­tration.

The COTH Board was particularly activethis year in working with the Executive Coun­cil in reviewing the Institute of Medicine So­CIal Security Studies Final Report entitled,"Medicare-Medicaid Reimbursement Poli­cies." These efforts resulted in an AAMCposition statement on the report which waspresented before the Health Subcommittee ofthe House Ways and Means Committee In

August. The Board also reviewed and maderecommendations on a wide variety of otherissues including outpatient department defi-

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254 Journal ofMedical Education

cits, financing education in the ambulatorysetting, malpractice insurance in university­owned hospitals, Medicare routine servicecosts, and the President's Biomedical Re­search Panel Report.

Organization of StudentRepresentatives

Membership in the Organization of StudentRepresentatives continued at a high level dur­ing the 1975-76 academic year with 113 ofthe nation's medical schools represented. Atits fifth annual meeting in November, 86schools sent over 100 students. The openingsession of the OSR Annual Meeting identifiedtopics for later discussion through the tech­nique of group dynamics, which afforded eachOSR member the opportunity to raise individ­ual interests and concerns. The major issueswhich surfaced through this process werehealth manpower legislation, the status ofhouse staff, curriculum and evaluation, andthe structure and function of the OSR. TheOSR Jointly sponsored a program with theGroup on Student Affairs entitled, "MedicalStudent Stress: What Have We Wrought?"Various presentors discussed stress factors forstudents from the admission process throughresidency training, concluding with an assess­ment of the impact the OSR and GSA mighthave in alleviating some of the problems. Ahighlight of the program was a film from theUniversity of Southern California in whichtwo medical students discussed the stressfulaspects of their educational experiences.

The OSR Administrative Board met four

VOL. 52, MARCH 1977

times during the year to conduct business andto act on behalf of the Organization on allmatters 'being considered by the Council ofDeans and Executive Council. In addition tobeing represented at the COD and ExecutiveCouncil meetings, OSR Administrative Boardmembers participated in the joint meetings ofall the administrative boards. This format pro­vides the OSR a means to interact with mem­bers of the Administrative Boards of theCouncil of Academic Societies and the Coun­cil of Teaching Hospitals as well.

The OSR has continued to pursue issuesrelated to housestaff education, asking theAssociation to take positive steps to enhancethe educational aspects of graduate medicaleducation. An OSR task force has been askedby the Council of Deans to explore ways inwhich the AAMC might make graduate train­ing more meaningful.

The long-anticipated accreditation pam­phlet has been disseminated to all OSR mem­bers and will be made available to students ateach medical school prior to each accredita­tion visit. The pamphlet was designed to en­hance student input to the process of accredit­ing medical schools.

The OSR has continued to press for actionon factors affecting student stress in medicaleducation, and has been involved in AAMCactivities related to the particular concerns ofwomen in medicine. OSR carried on discus­sion of these and other issues at its four re­gional meetings held in conjunction with theGSA and reported its activities to all medicalstudents via the OSR-AAMC BulletinBoard - a quarterly publication in poster for­mat inserted in the Student Affairs Reporter.

National Policy

255

:::9i2 After a full year as President, Gerald Ford's§ imprint upon the presidency became more ap­<l) parent. Though initially there were indica­0.. tions that the new Administration would be

more responsive to the nation's health needs,government-by-veto continued into 1976 andthe Association found itself better able towork toward its goals with the Congress thanwith the Administration. That situation pro­vided several major successes, among themthe overrides of Presidential vetoes of theHealth Services and Nurses Training Act, the1976 Labor-HEW Appropriation, and the1977 Labor-HEW Appropriation.

Two of the major issues confronting theAssociation during the past year were healthmanpower and health appropriations. Afterseveral years of consideration, both Houses of

U Congress passed health manpower bills. The::§ Association worked closely with congressional~ staff members, testified before committees,<l) and at the request of Senator Kennedy drafted

':5 its own bill for consideration. Of particular<0 concern to the Association were provisions on~ capitation support; the distribution of resi­o dency positions among primary and nonpri­B mary care specialties; student assistance; Na­~ tional Health Service Corps Scholarships; and<3u the status of graduates of foreign medical

<l) schools. The Association, through question­..s::...... naires and other contacts, sought to reflecta accurately the consensus of its membership ono<.l:1 the major issues. Prior to the conference that1:! was called to resolve the differences between<l) the House and Senate versions of the bill, thea Association sent a detailed position paper toRo the conferees outlining the recommendations

Q of the Association and addressing in depthboth the conditions for capitation and the stu­dent assistance provisions. During the confer­ence the AAMC provided additional input tothe conferees and the Committee staffs. Inlate September the conference report was ap­proved by both Houses and sent to the Presi-

dent. While the Association was not totallysatisfied with the final legislation, the confer­ence has eliminated most of the objectionableprovisions of the bill. After polling the reac­tion of the deans to the final bill, the Associa­tion urged the President to sign it. PresidentFord signed the bill, expressing some of thereservations which the Association had ex­pressed to him, thus concluding the tediousrenewal of the legislation which had expiredover two years earlier.

Another manpower Issue of particular con­cern to the Association centered on financialsupport for the private medical schools of theDistrict of Columbia-Georgetown andGeorge Washington. Placing Congress andparticularly its Committees on the District ofColumbia in loco parelltis to these schools, theAAMC strongly supported the extension ofthe District of Columbia Medical and DentalManpower Act of 1970. A one-year extensionwas approved by Congress and signed byPresident Ford in June.

As in past years, much of the Association'sattention focused on health appropriations.The Administration's budget request for fiscalyear 1976 proposed no new health programsand cut back funding in several areas in thehealth field. Congress substantially increasedappropriations but the President vetoed thebill in January on the grounds that it wasinflationary. The Association worked with theCoalition for Health Funding, which success­fully urged Congress to override the Presi­dent's veto.

For the first time in recent memory, Con­gress passed an appropriation bill prior to thestart of the fiscal year for which it was in­tended. The timeliness of the fiscal year 1977bill was aided by the three-month shift in thestart of the federal fiscal year-from July 1 toOctober 1. The President's budget once againhad proposed substantial decreases in healthfunding from the 1976 appropriated level.

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256 Journal ofMedical Education

Again, the Association joined with the Coali­tion for Health Funding to urge Congress toincrease support for health programs, particu­larly in the vital area of research training.Congress ultimately agreed to an increase of$260 million over the previous appropriation,exceeding the President's budget by over abillion dollars in the health area. Although acontroversial anti-abortion amendmentthreatened to tie up the bill in conference, itwas reported in time to avoid the possibility ofa pocket veto. Despite the President's vetowithin days of the Congressional adjourn­ment, both the House and the Senate easilyoverrode the veto.

In addition to the issues of health man­power and appropriations, the Associationwas concerned with many other activities ofthe federal government. One of the firstevents of significance last year was the issu­ance of final administrative regulations forsections of the Public Health Service Act bar­ring discrimination on account of sex. TheNIH implemented new regulations for theprotection of human subjects in July and theAAMC continued throughout the year to as­sist the Commission for the Protection of Hu­man Subjects in its studies and hearings. InJune, HEW issued final regulations on privacyrights and educational records, implementingthe Buckley Amendment. Regulations issuedfor the Privacy Act had considerable potentialimpact on the continuation of importantbiomedical research supported by NIH con­tracts at member schools and hospitals. TheAssociation carefully monitored these andother regulations and proposed rule-makingshaving possible implications for the schoolsand teaching hospitals.

In April the final report of the President'sBiomedical Research Panel was released, fol­lowing fifteen months of Congressionally­mandated deliberations. The Panel had ad­dressed itself particularly to the organizationand management of NIH/ADAMHA, andalso made extensive inquiries into the effect ofbiomedical research funding on the academicinstitutions which perform most of the na­tion's biomedical research. The Associationparticipated in studies commissioned by thePresident's Panel, and, after publication of

•

VOL. 52, MARCH 1977

the Report, constituted a special Task Forceto develop a critical evaluation of that docu­ment. The Task Force concluded that the Re­port and its appendices were a remarkablythorough and a persuasive exposition of thestrengths and weaknesses of the nation'sbiomedical research enterprise. The AAMCendorsed the general conclusions of the Re­port which emphasized the necessity for con­tinued support of a sizeable, high quality, andbroad biomedical and behavioral research ef­fort. However, the Association proposed al­ternate recommendations to several of thePanel's specific proposals.

With the expiration of a previous exemp­tion, students receiving Armed Forces HealthProfessions Scholarships and Public HealthService Scholarships became subject to in­come taxation on their tuition stipend andtheir stipend for books and educational ex­penses. The AAMC urged members of boththe Senate Finance Committee and HouseWays and Means Committee to provide quickrelief for students being supported underthese programs. A provision to extend theexemption from taxation for 1976 and, forthose students receiving scholarships in 1976a further exemption until 1979, was includedin the Tax Reform Act, which passed this fall.

Authority also expired in June for the Na­tional Heart and Lung Institute. A continuingresolution maintained funding, but at a re­duced rate. In April, authority was extendedthrough fiscal years 1976 and 1977, and theInstitute's name was changed to the NationalHeart, Lung and Blood Institute. Throughoutthe hearings on these programs, as well as onthe Labor-HEW appropnations bills, the As­sociation consistently and strongly advocatedgenerous support for research training pro­grams, particularly in the area of institutionalawards.

The Association has long been concernedwith the Freedom of Information Act and therelated Federal Advisory Committee Act asthey affect NIH/NIMH peer review of re­search grant applications. As early as 1973when the Children's Defense Fund of theWashington Research Project, Inc., broughtsuit to compel DHEW to release researchgrant proposals, the AAMC has attempted to

257

The Association continues to be deeply in­terested in the quality of health programs inthe Veterans Administration. In this regardthe Association worked for an increase in thepay of Veterans Administration physiciansand dentists to equal the pay of their col­leagues in the armed services and PublicHealth Service. In October 1975, such anincrease was approved. The Association alsotestified in favor of slightly increased appro­priations for the health programs of the VA.

The Association has also noted the diffi­culty of recruiting individuals to positions ofleadership in the National Institutes ofHealth. This crisis has been caused by theerosion of staff salaries at NIH in relation tosalaries in the private sector. The Associationurged a restoration of salary comparability ornear comparability with the private sector forthe directors and senior staff of the severalinstitutes of NIH. The House Subcommitteereported a bill which was expected to passeasily, but in the midst of the usual election­year denials of salary increases the bill died inthe full Committee.

Throughout the past year the AAMC hasbeen an active participant in events of na­tional importance outside the legislativearena. In March the National Labor RelationsBoard refused to extend the jurisdiction of theNational Labor Relations Act to unions rep­resenting interns, residents, and clinical fel­lows. By a four-ta-one ruling, the Board heldthat house staff are primarily engaged in grad­uate education programs and are not employ­ees within the meaning of the National LaborRelations Act. The AAMC had filed an ami­cus curiae brief with the Board in April 1975,asking that they decline jurisdiction becauseof the involvement of house staff in graduatemedical education and the potential conse­quences of collective bargaining on the educa­tion process. The Association had joined withseveral involved members of the Council ofTeaching Hospitals in presenting oral argu­ments on these points before the NLRB.

In May of 1975, the Association filed suitin U.S. District Court to enjoin the imple­mentation of regulations setting ceilings onMedicare reimbursement of routine hospitalservice costs. Following the denial of AAMC

AAMC Annual Report for 1976

protect the confidentiality of the grant awardprocess. In the past year the President'sBiomedical Research Panel, NIH DirectorDonald Fredrickson, HEW UndersecretaryMarjorie Lynch, and others have brought sim­ilar concerns to the attention of the Congress.

:=: After several months of hearings and debates,9 Congress passed the Government in the Sun­rJ)

rJ) shine Act. Under the new law all agency§ meetings must be open to the public unless8, one of the ten exemptions applies. As a conse-

quence of efforts by the AAMC and others,the House-Senate conferees noted the specialproblem of NIH and stated that the peer re­view system must be protected. The confer­ence report stated that the exemptions thatallow a meeting to be closed because, ifopened, it would be an invasion of privacy orwould significantly frustrate the implementa­tion of a proposed agency action, should pro­vide such protection.

At the request of the staff of the HealthSubcommittee of the Senate Finance Commit­tee, the Association has assisted in the draft­ing of the Medicare-Medicaid Administrative

U and Reimbursement Reform legislation. This

~bill substantially modified Medicare and Med­icaid in the areas of administration, providerreimbursement, practitioner reimbursement,and long-term care. Without endorsing or op­posing this bill, the AAMC has offered sev­eral constructive recommendations designedto assure that the bill accurately reflects thecomplexity of contemporary medical educa­tion and the provision of services by the teach­ing hospitals. Further Congressional action onMedicare and Medicaid reform is expectedearly in the next Congress.

In hearings held in March on the ClinicalLaboratory Improvement Act of 1976, theAAMC advised Congress of the possible un­intended harm to biomedical research whichcould result by including clinical research lab­oratories in the coverage of the bill. As aresult of Association efforts, specific exemp­tions were provided in the House bill for phy­sicians performing their own laboratory workand for research laboratories. However, theCongress failed to complete action on the clin­ical laboratory bills before adjourning, andthis issue is expected to resurface next year.

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motions for an injunction and for reconsidera­tion, the Association appealed the case to theU.S. Court of Appeals for the District of Co­lumbia Circuit. A hearing on the appeal washeld in September and a decision is pending.

The As~ociation also filed an amicus curiaebrief last March in the California SupremeCourt in the case of Bakke v. Regents of theUniversity ofCalifornia. In this action, a whitemale applicant to the University of CaliforniaDavis School of MedIcine claimed that thespecial admissions program for disadvantagedapplicants violated his constitutional rights bydiscriminating against him on the basis ofrace. The Association's brief cautioned theCourt about the undesirability of having thejudiciary make individual determinations ofadmission to educational programs. Althoughthe Association recognized the legitimate in­terest of the Court in guaranteeing rightsgranted by the Constitution, the brief arguedthat schools should be permitted to tailor theirpolicies to meet perceived educational and

VOL. 52, MARCH 1977

societal needs. In September, the CaliforniaSupreme Court ruled that the medical school'spractice of setting aside first-year places forminorities is unconstitutional. The Universityof California has announced its intention ofpetitioning for United States Supreme Courtreview.

Pervading every debate and every issuewith which the AAMC has been involved thispast year is the steadily rising cost of healthcare. The price paid for health care in theUnited States has become a national problemof serious proportions. While aware that themajor responsibility to control costs lies withthe practicing medical profession and the pub­lic, the Association acknowledges that the ac­ademic medical sector must also help containcosts. In meetings of groups within the Asso­ciation, with third-party payers, and with As­sistant Secretary for Health TheodoreCooper, the Association has participated inthe search for solutions to this problem.

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Working with Other Organizations

Since 1972, the AAMC has worked closelywith the American Medical Association,American Hospital Association, AmericanBoard of Medical Specialties, and the Councilon Medical Specialty Societies through partic­ipation in the Coordinating Council on Medi­cal Education. In the CCME, representativesof the five parent organizations, the federalgovernment, and the public have a forum todiscuss issues confronting medical educationand to recommend policy statements to theparent organizations for approval.

During the past year the CCME completedthe revisions of its report, "Physician Man­power and Distribution: The Role of the For­eign Medical Graduate," and actively workedon a policy statement on the speciality andgeographic distribution of physicians. TheCCME appointed a joint committee with theLiaison Committee on Graduate Medical Ed­ucation to advise on the opportunities ofwomen in medicine. It was felt that the sub­stantial increase in the enrollment of womenin medicine will increasingly affect the resi­dency programs and that there is a need toconsider better accommodations to part-timeresidencies. The report of the joint CCME/LCGME Committee on the financing of grad­uate medical education was completed andrevised by the CCME. Other areas receivingattention are the role of telecommunicationsand satellite communications in health serv­ices and health professions education and thedevelopment of a standard order of procedurefor the approval of new specialties in medi­cine.

The Liaison Committee on Medical Educa­tion continues to serve as the nationally recog­nized accrediting agency for 117 programs ofundergraduate medical education in theUnited States and for the medical schools inCanada.

The accreditation process provides for themedical schools a periodic, external review of

assistance to their own efforts in maintainingthe quality of their education programs. Out­side survey teams are able to focus on theareas of concern which are apparent, recom­mend other areas requiring increased atten­tion, and indicate areas of strength as well asweakness. In the recent period of major en­rollment expansion, the LCME has pointedout to certain schools that the limitations oftheir resources preclude expanding the enroll­ment without endangering the quality of theeducational program. In yet other cases it hasencouraged schools to make more extensiveuse of their resources to expand their enroll­ments. During the decade of the sixties partic­ularly, the LCME encouraged and assisted inthe development of new medical schools; onthe other hand, it has cautioned against theadmission of students before an adequate andcompetent faculty is recruited, or before thecurriculum is sufficiently planned and devel­oped and resources gathered for its imple­mentation.

The LCME is recognized officially in thefederal sector by the Office of Education asthe organization responsible for accreditationof undergraduate medical education pro­grams. In the private sector, the LCME wasrecognized first by the National Commissionfor Accreditation and now by the Council onPostsecondary Accreditation, a successoragency resulting from a merger with the Fed­eration of Regional Accrediting Commissionsof Higher Education.

During the 1975-76 academic year, theLCME conducted 37 accreditation surveys inaddition to a number of consultation visits touniversities contemplating the development ofa medical school. The list of accreditedschools is now found also in the AAMC Di­rectory ofAmerican Medical Education, whichfirst appeared in 1952 and is published an­nually.

During the past year, the LCME issued

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Letters of Reasonable Assurance for futureaccreditation for two new programs in medicaleducation, and granted provisional accredita­tion to three new medical schools. The atten­tion of the LCME focused on developingguidelines for the policy statement, "Func­tions and Structure of a Medical SchooL"Also, a task force of the Committee composedsupplemental guidelines for medical schoolswith branch campuses. Both of these docu­ments are in their final stages of revision andwill be released shortly.

The Liaison Committee on Graduate Medi­cal Education assumed its official functions inthe spring of 1975. The LCGME is now re­viewing and ratifying the actions of each of thetwenty-three Residency Review Committees.The Committee has the final authority to ac­credit, disaccredit, or place on probation resi­dency programs in all recognized disciplines.Training program directors and hospital ad­ministrators now receive their formal notice ofthe status of their residency programs fromthe LCGME. As the Liaison Committee hasevolved its procedures, there have been pro­gressive modifications of the policies underwhich the Residency Review Committees op­erate. These modifications include standardiz­ing of procedures for placing programs onprobation or withdrawing approval and, mostimportantly, the development of an appealsmechanism so that adverse decisions may beappealed to a review panel mutually agreedupon by both the appellant and the LCGME.The LCGME is now in the process of rewrit­ing the general essentials for graduate medicaleducation.

A manual has been prepared by theLCGME to provide common policies for thestructure and function of residency reviewcommittees. The manual, which became ef­fective as of July 1, is a first step towardimproving review and approval procedures.Previously, the residency review committeesfor the 23 specialties for which programs areaccredited by the LCGME carried out theirfunctions under individually developed proce­dures. The new manual, which will be modi­fied as experience demonstrates the need, setsforth standardized policies relating to the re­view process. The manual does not invade theresponsibilties of the residency review com-

VOL. 52, MARCH 1977

mittees in the area of setting standards anddeveloping criteria for judging whether pro­grams have met these standards.

In November of the past year the LiaisonCommittee on Continuing Medical Educationbegan organizational meetings. The major ac­complishments were the writing and adoptionof the LCCME bylaws, the development ofpriorities for establishing an accreditation sys­tem for continuing medical education, and theadoption of principles of financing the accred­itation mechanism. The exact timing for as­suming accrediting functions by the LCCMEhas not yet been set.

The AAMC has continued to collaboratewith the American Medical Association andthe American Hospital Association on issuesof common interest. Joint discussions wereheld concerning the AAMC's leadership rolein asserting the educational purposes of in­ternships and residencies, litigation over theimposition of hospital routine service costceilings, and the activities of the other Associ­ations in the malpractice area.

The Coalition for Health Funding, whichthe Association helped form seven years ago,now has 43 non-profit health related associa­tions in its membership. A Coalition docu­ment analyzing the Administration's proposedhealth budget for fiscal year 1977 and makingrecommendations for increased funding iswidely used by Congress and the press.

As a member of the Federation of Associa­tions of Schools of the Health Professions, theAAMC meets regularly with members repre­senting both the educational and professionalassociations of eleven different health profes­sions. The Federation's activities during thepast year were mainly concerned with the re­newal of health manpower legislation. TheAssociation staff has also worked closely withthe staff of the American Association of Den­tal Schools on matters of mutual concern.

The AAMC continues to work with theAssociation for Academic Health Centers onissues of concern to the vice presidents forhealth affairs. Representatives of each organi­zation are invited to the Executive Counciland Board meetings of the other.

The Association as a member of the Boardof Trustees continues its active interest in theprograms of the Educational Commission for

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AAMCAnnual Report for 1976

Foreign Medical Graduates. Of the two majorprograms of the Commission, the sponsorshipof the Exchange Visitor Program is of particu­lar importance to the member institutions ofthe AAMC. Close collaboration between theAssociation and the ECFMG will becomenecessary to assure smooth functioning of thisprogram and to provide foreign trainees whoare admitted to the United States an appropri­ate educational experience of high quality.

The staff of the Association has maintainedclose working relationships with other organi­zations representing higher education at theuniversity level, including the AmericanCouncil on Education, the Association of

261

American Universities, and the Natlonal As­sociation of State Universities, and Land­Grant Colleges. This year the AAMC workedcooperatively with these three organizationsas well as others in the higher education areato respond to Uniform Guidelines on Em­ployee Selection Procedures issued by theEqual Employment Opportunity Coordinat­ing Council. Other federal regulations broadlyaffecting higher education, such as those per­taining to affirmative action and the handi­capped, were also the subject of cooperativeefforts. The AAMC participates on an Inter­association Task Force on Equal EmploymentOpportunity staffed by the ACE.

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Education

The uncertainty of federal support and otherfinancial constraints during the recent pasthave placed increased importance on achiev­ing economies in many aspects of the medicaleducation process. The Association has un­dertaken through its staff and member organi­zations a wide variety of activities to enhancethe efficiency as well as the effectiveness ofthe educational programs. In general, theseefforts have been attempts at greater coordi­nation of information and resource sharing.

The Group on Medical Education contin­ues to be an increasingly valuable focus forefforts to enhance information and resourcesharing. At the national level, a TechnicalResource Panel has made suggestions for apilot study on information exchange to beinitiated by the AAMC. Most of the regionalgroups have also begun specific projects inresource and information sharing, e.g., mate­rials sharing in the West, techniques for off­campus clinical evaluation in the South, cur­ricular innovations in the Central, and meth­ods for instructional evaluation by students inthe Northeast. The GME has also been ex­panding its program offerings at both regionaland national meetings to accommodate its ex­panded responsibilities to representativesfrom the areas of graduate and continuingeducation. The GME-sponsored Research inMedical Education Conference has expandedits format to respond to more varied demandsfor research information exchange throughthe introduction of a poster session formatand the enlargement of its symposium format.

A task force of the Executive Council reaf­firmed the importance of continuing medicaleducation and the necessary leadership of themedical schools in this area. To assist themedical schools in this task, the AAMC hasappointed an Ad Hoc Committee on Continu­ing Medical Education. The committee hasidentified the need to initiate research anddevelopment programs in order to establish a

firmer scholastic foundation for this importantand costly academic function.

The AAMC Collaborative Program for de­veloping a National Resource for EducatingHealth Professionals, funded by a contractwith the National Library of Medicine, con­tains three programs, two of which relate toAVLINE and Computer-Based EducationalMaterials. AVLINE is a computerized infor­mation storage and retrieval system for educa­tional materials in the health sciences. Allsubscribers to the National Library of Medi­cine's bibliographic retrieval system, MED­LINE, may access AVLINE, which now con­tains some 1,600 abstracts chiefly in the areasof neuroscience, cardiovascular, musculoskel­etal and reproductive systems. The materialscited in AVLINE are selected by means of asystematic appraisal process involving contentexperts and educational technologists. A widerange of subject areas and levels of learningexperiences in the health sciences will even­tually be included. A study is being made ofthe usefulness of the information system andthe responsiveness of the various materialsdistribution services. A research study hasbeen done on the reliability of the instrumentsused to appraise materials. Based on thesedata the appraisal instruments have been re­vised. Further research is intended to identifythose qualities of a material most likely topredict learner success.

The task in the area of computer-basededucational materials in the health sciences isthe facilitation of the sharing of these pro­grams. The major developers of such materi­als are participating with AAMC in the devel­opment of criteria for the appraisal of com­puter-based educational programs and in con­ducting pilot appraisal runs applying these cri­teria to selected programs. These appraisalsare expected to yield critical abstracts of re­viewed programs to be made available to po­tential users and to be incorporated in a com-

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AAMC Annual Report for 1976

prehensive information system. In addition,the Association is collaborating with theLister Hill National Center for BiomedicalCommunications in the design of research anddevelopment programs for the Learning Re­source Center.

Although international clerkships are pro­viding a valuable type of community healthoffering, the Association has recognized thatbudgetary constraints are forcing a curtail­ment of many international activities. It hassought to combine available expertise in inter­national health with advances in educationalmethodologies by developing self-instruc­tional education materials which can be usedby medical students who have an interest inthe international perspectives of health andhealth care. The production of internationalhealth materials is a two-year undertaking ex­pected to result in approximately 35 courseunits. Each unit will require 60-90 minutes ofstudy time for the average student. The courseshould be ready for pilot testing in the fall of1976. Following the needed program revi­sions, the material will be submitted for qual­ity review and released in early 1977 for useeither as an individual student elective or as asource of supplementary material to be usedby faculty in conjunction with communityhealth offerings. It is anticipated that thesematerials can be made available at a nominalcharge to cover only the cost of printing anddistribution. A contract from the John E. Fo­garty International Center, National Institutesof Health, provides the necessary funding forthe development of the course.

The final report of the Study of Three-yearCurricula in U.S. Medical Schools will beavailable by the summer of 1977. Over 5,000individuals representing faculty, students, ad­ministration, and clinical program directorsresponded to a questionnaire regarding theimpact of the three-year curriculum on institu­tional operation. The results of curriculumanalysis, student progress data, student careerchoice patterns, and program conversion in­formation will be analyzed with the question­naire data. The description of the process ofreconversion to the four-year program by asubstantial number of institutions that con­ducted three-year programs will be includedin the study.

263

The Biochemistry SpecIal AchievementTest has increasingly become a tool for pro­gram evaluation. Originally the test was usedfor purposes of advanced placement. butschools have begun using the test for a WIden­ing variety of purposes in the recent past. It isnow also administered as a diagnostic tool toidentify areas of student weakness, to test self­paced students on an individual basis, and as afinal examination.

The New Medical College Admission Testwill be first administered to students in spring1977. The examinatIOn is presented in foursections: Science Knowledge, Science Prob­lems, Skills Analysis: Reading, and SkillsAnalysis: Quantitative. The science testscover biology, chemistry, and physics. andreflect common entry requirements for medI­cal school. They will measure understandingof important concepts and principles and theirapplication. The skills test in reading mcludescontent generally familiar to applicants, andassesses those reading and intellectual skillsneeded in medical school. It may also serve toidentify students for whom further diagnosisof reading difficulty might be needed. Thequantitative test requires solution of quantita­tive problems in the sciences and mathemat­ics, especially involving logical reasoning anddata interpretation and utilization. The skillsexaminations are designed to assess cogmtiveskills, rather than mastery of any particularbody of knowledge. A new test manual hasbeen prepared to provide detailed informa­tion about test content. It was designed as acomprehensive guide to assist students as theyprepare to take the New MCAT.

The New MCAT will provide six scores tobe reported to students and designated medi­cal schools. Science Knowledge and Problemsquestions will be combined and reported foreach disciplinary area, giving scores in biol­ogy, chemistry, and physics. Problems will becombined to yield one Science Problemsscore. Skills analysis tests will yield one scoreeach for Reading and Quantitative. Work­shops explaining the new program have beenheld at the 1976 regional meetmgs of theGroup on Student Affairs and the NationalAssociation of Advisors for the HealthProfessions.

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264 Journal ofMedical Education

Following the recommendations of theCommittee on Admissions Assessment, a pro­posal was prepared for the development oftechniques for more formal assessment of thenon-cognitive qualities of medical school ap­plicants. Seven personal qualities were identi­fied on which more extensive and reliableinformation is sought by admissions officers.Two research companies and two university­based research groups were identified as po­tential collaborators for providing instrumentsaimed at measuring these qualities: compas­sion, coping capabilities, decision-making, in­terprofessional relations, realistic self-ap­praisal, sensitivity in interpersonal relations,and staying power. The proposal was submit­ted to a number of funding agencies.

VOL. 52, MARCH 1977

The 1976 follow-up of physicians who par­ticipated in the Longitudinal Study of MedicalStudents of the Class of 1960 is continuingunder a two-year grant awarded to the AAMCby the National Center for Health ServicesResearch (NCHSR). Approximately 2,500"study physicians," graduates of the 28 medi­cal schools in the longitudinal study, were sentquestionnaires in mid-May. The questions ad­dress both the physicians' career developmentand their current professional activities. Infor­mation from this current up-date will be cor­related with information obtained from thesame persons when they were medical stu­dents. Thus, the relationships among educa­tion, training, and medical practice may beexamined.

265

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Biomedical Research

The focus of much AAMC activity during thepast year was the President's Biomedical Re­search Panel, which was charged by Congressin 1974 with assessing the status of the na­tion's biomedical research effort. In 1975 theCouncil of Deans and the Council of Aca­demic Societies brought to the attention of thePresident's Biomedical Research Panel theneed for a study of the impact of biomedicalresearch funding on academic institutions.The Panel, in response, contracted with a con­sortium led by the~American Council on Edu­cation and including the Rand Corporationand the AAMC to study the effect of Federalprograms and policies on institutions of highereducation in general and academic medicalcenters in particular. Members of the Execu­tive Council and Administrative Boards ad­vised AAMC staff throughout the course ofthis study. Results of the study were presentedto the Panel in February of 1976 and wereincorporated into the final Report of thePanel. The Panel emphasized that Federalsupport for research has strengthened the re­search capabilities of universities and aca­demic medical centers, but pointed out thatchanging Federal policies and practices havebegun to impose difficulties which could provedetrimental to the research capabilities ofthese institutions. The AAMC study and thePanel Report showed that research activitieshave continued to receive emphasis in aca­demic medical centers, but that these researchactivities have not prevented academic medi­cal centers from responding to societal de­mands for medical services and for increasingthe supply of health manpower. The need forcontinued support of research training and forstability of research funding was emphasizedstrongly by both the ACE-AAMC-Randstudy group and the Panel. The final Reportof the Panel was submitted to the Congressand the President on April 30.

The President's Panels found that the NIH/ADAMHA was generally performing its ma­jor mission - biomedical research - very effi­ciently, and that the national research enter­prise is addressing important problems. It rec­ommended continued and strengthened re­search programs in the institutes and particu­larly called for an increase in the budgets forresearch at the National Institutes of MentalHealth, Drug Abuse, and Alcohol Abuse andAlcoholism. The AAMC supported thePanel's recommendations for a continuationof a vigorous biomedical research programand for increasing the research budget in men­tal diseases, alcoholism, and drug abuse; how­ever, the AAMC also recommended that theintramural research programs now located inADAMHA be transferred to the NIH.

The Panel made several recommendationsdesigned to improve the quality of scientificadvice to the federal government. These rec­ommendations would create an interlockingsystem of panels, councils, and advisors whichthe AAMC's Task Force felt would produceconflicting advice, overlappmg responsibili­ties, and further weakening of the authoritiesof program managers. The Task Force be­lIeved that the Office of Science and Technol­ogy Policy would, with some modification,serve the same purpose better than would therecommendations of the President's Panel.Utilizing the OSTP as the body for the fur­nishing of biomedical and behavioral scienceadvice to the President and the Office ofTechnology Assessment to serve an identicalfunction for the Congress would producemore consistent advice than the recommenda­tions of the President's Panel. The Task Forcealso recommended that science advice to theDirector of NIH and Administrator ofADAMHA should be provided through acontinuation of the present system.

The President's Panel did not recommend

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266 Journal ofMedical Education

any significant changes in the organization ofNIH/ADAMHA. The AAMC, however, be­lieved that the national cancer effort was nowwelI established and that there was no furtherneed for a President's Cancer Panel or for theseparation of the National Cancer Institutefrom the remainder of NIH.

The Task Force fully supported the Panel'srecommendations that the investigator-initi­ated grant serve as the principal instrumentfor the support of research and that the NIHpeer review process remain intact. Though theAssociation is concerned about the confiden­tiality of peer evaluation and review, the TaskForce felt that it would not be wise to seekstatutory exemption through modification ofthe Public Health Service Act, but ratherthrough modification of the Federal AdvisoryCommittee Act to permit confidential, c1osed­panel review of grant and contract applica­tions.

The Panel's recommendations addressedproblems of instability of funding, budget for­mulation, and intramural and extramural pro­gram management which urgently need solu­tion if the health of the academic institutionsand the health of the biomedical research en­terprise is to be assured; the AAMC TaskForce agreed with and strongly supportedtheir recommendations in these areas. TheAssociation also specifically targeted for com­ment the Panel's recommendations on tech­nology transfer, feeling that the limits of theNIH role should be more restrictively defined.

The AAMC has continued to be active indiscussions of the ethics of biomedical re­search and the protection of human subjects.As a result of the activities of the AAMC, thepublic has become aware of the effects onbiomedical research of the Freedom of Infor­mation Act and the Federal Advisory Com­mittee Act.

A decision in 1974 by the U.S. Court ofAppeals for the District of Columbia Circuit

VOL. 52, MARCH 1977

had the effect of requiring the release of re­search grant protocols under the Freedom ofInform'ation Act. FolIowing this decision theAssociation began efforts to bring the unin­tentional effects of these laws on biomedicalresearch to the attention of Congress. As aresult, Congress asked the President'sBiomedical Research Panel and the Commis­sion for the Protection of Human Subjects tostudy the problem. Data gathered by NIH forthese commissions indicate that revisions ofthe laws are indeed necessary. AAMC is con­tinuing to work with public groups for clarifi­cation of these "sunshine laws," particularlyas they affect the intellectual property rightsof individual researchers, the protection ofresearch subjects, the conduct of clinicaltrials, and other areas of biomedical research.

Throughout the year the funding of re­search training grants has suffered from con­tinuing pressure by the Office of Managementand Budget to eliminate Federal support forbiomedical research training. Erosion ofcongressional support for training grants ledto a decrease in the level of funds to a pointbelow that needed to meet the recommenda­tions of the National Academy of SciencesHuman Resources Commission. To counterthis erosion of support, the Association gath­ered information about the effects of cutbacksin research training funds and mobilized sup­port to seek adequate funding levels. Becausethe perennial questioning of research trainingseems to be increasingly severe, AAMC hastaken the leadership in coordinating a numberof studies of research manpower. Acting onthe recommendations of the Council of Aca­demic Societies Conference on BiomedicalResearch Manpower, AAMC has brought to­gether various groups including the Instituteof Medicine, the National Academy of Sci­ences, and the National Institutes of Health todefine the data needed and to see that it isgathered and analyzed.

267

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Health Care

In recent years interest among academic med­ical centers in both the study of and the devel­opment of model health care systems has ac­celerated. This interest has become manifestin numerous activities such as the restructureof ambulatory care services, increased affilia­tion with community-oriented health pro­grams, and development of individual orgroup practice preceptorships. Elements con­tributing to this interest include institutionalneeds for additional sites offering high qualityexperience to increasing numbers of under­graduate students, institutional responses tosocietal pressures for increased health servicesto underserved communities, and the desira­bility of providing medical students at all lev­els with experiences in a variety of health caresettings.

The Association has initiated several pro­grams aimed at facilitating these activities.Following an initial project designed to docu­ment several prototypes of academic medicalcenter/health maintenance organization affili­ations, the Association has recently com­pleted the development of optimum curricu­lum for undergraduate and graduate physiciantraining in the health maintenance organiza­tion (HMO) model. The program, supportedby the Bureau of Health Manpower, providedthe support for such curriculum developmentin six affiliated HMO programs. Among theproducts of the programs have been descrip­tive model curricula for undergraduate andgraduate medical student involvement, a ge­neric set of evaluation instruments reflectingcommon educational objectives, a methodol­ogy for estimating the educational costs forboth undergraduate and graduate studentsbased on principles of cost-benefit analysis,and a role guide and resource book for clinicalpreceptors.

Consistent with the continued emphasis onprimary education within the academic medi­cal centers, the Association has this year re-

surveyed the nation's medical schools in aneffort to identify the extent of institutionalefforts in the educatIOn and training of physI­cians and nonphysicians as primary care prov­iders. The results of an initial survey com­pleted in 1973 were published in the Septem­ber 1974 issue of the Journal ofMedical Edu­cation. It is expected that the current 1976survey will provide data to document changeswhich have occurred during the three yearinterim. Of particular interest to the Associa­tion will be an assessment of the degree towhich these changes may have resulted fromthe impact of the 1974 AAMC-sponsored In­stitute on Primary Care and the subsequentregional primary care workshops conductedduring the spring of 1975.

As a direct and mcidental follow-up tothese workshops, the Association last yeardeveloped a series of national workshops spe­cifically designed for the purpose of assistingacademic medical centers and their affiliatedteaching hospitals in the improvement of am­bulatory care services and related educationalprograms. That particular program, sup­ported by the Office of Planning, Evaluationand Legislation of the Health Resources Ad­ministration, will continue this year and willprovide an additional workshop plus on-siteconsultative services to participating institu­tIOns. It is anticipated that a guide to ambula­tory care restructuring for the purposes ofimproving education and encouraging opti­mum one-class services will be developed.

Coincidental to the study and developmentof model health care programs for use as edu­cational models, the appropriate implementa­tion of quality assurance methodologies intothe medical curriculum has been a subject oflong interest to the Association. Several medi­cal educators, noting that medical studentsreceive relatively little instruction in evaluat­ing the outcome of medical intervention on ascientific basis, have indicated interest in inte-

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grating the concepts and requisite skills neces­sary to perform quality assurance activities.The Association has sought to enhance thismovement through sponsorship of several re­gional meetings relating to the subject of qual­ity assurance methodologies and peer review

VOL. 52, MARCH 1977

procedures at the undergraduate level. De­scriptions of several new concepts related tothis curriculum development were featured ina symposium on quality assurance educationcontained in the May 1976 issue of the Jour­nal of Medical Education.

269

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Faculty

During the past year the Association's facultydevelopment program reached full implemen­tation. Begun less than a year earlier, thiseffort is designed to raise the quality and effi­ciency of medical educational programs pri­marily by helping facuIty members enhancetheir effectiveness as teachers.

Toward this end, plans were completed andpilot testing done in preparation for a nationalsurvey of a stratified, random sample ofnearly 2,700 full-time medical school facultymembers. This study will provide the firstavailable overview of how medical teaching isconducted, what faculty members perceive asinstructional problems, and whether there areareas in which they would like assistance toimprove their instructional effectiveness. Thefindings will guide the Association in the de­velopment of services that will be offered tomedical school faculty. In addition, the writ­ten simulations and questionnaires used in thesurvey will be refined to serve as the basis forthe voluntary, confidential self-assessmentprogram that will be offered to all facultymembers during 1977. This project is sup­ported by a contract with the Bureau ofHealth Manpower and by grants from theKellogg Foundation and CommonwealthFund.

A study of the factors associated with thechoice of careers in biomedical research wasbegun in 1976, supported in part by a contractwith the National Institutes of Health. Thisstudy will examine the more than 500 mem­bers of the medical school class of 1960 whohave chosen a career on the facuIty of U.S.medical schools, comparing them to theirclassmates who did not choose careers in aca­demic medicine. As a related part of thestudy, AAMC is working to identify possiblemeans by which the quality of research andteaching may be measured. This exploratorystudy will attempt to relate peer judgment ofindividual abilities in research and teaching to

other measures of the quality of a facultymember's efforts, such as publication in topjournals and service on advisory committees.

The Faculty Roster Project, initiated in1965, continues to provide valuable informa­tion on the intellectual capital of medical edu­cation. The biographical information on fac­ulty supplied to the Association by the medi­cal schools serves as a mechanism to providefeedback in an organized and systematic man­ner to the institutions. For example, mforma­tion on individual faculty by department wasmailed to each medical school in June. Theinformation was presented in a format de­signed to permit easy reporting by the schoolson the Liaison Committee on Medical Educa­tion Questionnaire-Part II. The data con­tained in th.e faculty roster are also utilized bythe Association for studies on such topics asfaculty mobility, faculty attrition, participa­tion of faculty in Federal programs, and ca­reer performance within academic medicine.

Several reports were generated this yearusing the Faculty Roster data base. Undercontract with the Bureau of Health Man­power, work on a report entitled DescriptiveStudy of Salaried Medical School Faculty wascompleted. ThIS report contains informationon faculty appointment characteristics, educa­tional characteristics, and employment historywith various breakdowns by sex, mmont}'group, and country of medical trainmg. Inrecent years, the Association has received nu­merous requests for information regarding thecurrent distribution of medical school facultyby sex and ethnic group. The publication Par­ticipation of Women and Minorities 011 U.S.Medical Faculties, released in March, is in­tended to serve these needs.

As of June, the Faculty Roster containedinformation on 44,724 individuals, an in­crease of 13 percent since June 1975. Includ­ing the addition of 5,051 new faculty mem­bers, 50 percent of the records contained in

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270 Journal ofMedical Education

the data base have been updated in somemanner.

The 1975-76 Medical School Faculty Sal­ary Survey was released in February by theAssociation. This year, for the first time, fac­ulty positions were reported separately butwithin the same survey for the 16 Canadianmedical schools. The inclusion of the Cana-

VOL. 52, MARCH 1977

dian schools accounts for 3,361 additionalfilled full-time faculty positions. In the 1975­76 surVey, 30,487 full-time positions were re­ported. The survey, begun in the early 1960sand updated annually, continues to providemedical school administrators, departmentchairmen, and others with a valuable tool forreviewing faculty salary trends.

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Students

In the competition for 1976-77 first-yearplaces, 42,000 applicants submitted 370,000applications, reflecting for the first time inmany years a slight decline in the number ofindividuals seeking admission. Yearly growthrates in enrollments have shown moderate ad­vances in the last two years and the totals for1976-77 are expected to be larger than the15,295 freshmen and 55,818 overall enroll­ment reported by the nation's medical schoolsfor 1975-76.

The application process was assisted by theEarly Decision Program and by the AmericanMedical College Application Service. For the1976-77 first-year class, 58 medical schoolsparticipated in the Early Decision Program,and 1,046 students were accepted. Since eachof the 1,046 filed only one application, theprocessing of about 8,000 multiple applica­tions was eliminated.

AMCAS was utilized by 86 medical schoolsfor the processing of first-year application ma­terials. Besides collecting and coordinatingadmissions data in a uniform format, AMCASprovides useful rosters and statistical reportsto participating schools. At the same time,AMCAS maintains a national data bank forresearch projects associated with admissions.The AMCAS program continues to be guidedin the development of its procedures and poli­cies by the Medical Student Information Sys­tem Committee.

The AAMC, in cooperation with the Na­tional Board of Medical Examiners and theBureau of Health Manpower, offered a spe­cial opportunity for Vietnamese refugee med­ical students to receive AAMC sponsorship totake NBME Part I in June. Vietnamese refu­gees who were students in good standing atone of the three medical schools in Vietnamimmediately prior to their arrival in NorthAmerica were eligible for this special sponsor­ship. Since in most cases such individuals didnot have transcripts or other credentials avail-

able to them, their eligibility was confirmed toAAMC by former faculty of the three Viet­namese medical schools who had personalknowledge of each sponsored student. Thesestudents may use the scores as evidence oftheir competence when applying to U.S. med­ical schools.

The American College Testing Programcontinued responsibility at the direction of theAAMC for operations related to the registra­tion, test administration, test scoring, andscore reporting procedures for the MedicalCollege Admission Test. The number ofMCAT examinees continued to decrease, as ithas during the last two years. The estimate for1976 is 55,000 examinations, down from57,500 in 1975 and 58,200 in 1974. Thesignificantly greater decrease for 1976 seemsmostly accounted for by the GSA-sponsoredrequirement that all examinees applying toclasses beyond 1977 must supply data fromthe New MCAT. Ordinarily, a certain per­centage of the examinees take the exam inadvance of the usual cycle for counseling pur­poses. These students apparently deferredtaking the exam. This interpretation is sup­ported by the significant increases in MCATmean scores for the spring 1976 administra­tion. These mean values were observed to bemore typical of an applicant group than theusual examinee population.

In response to concerns expressed by a va­riety of the members of the medical educationcommunity over the increasing financial prob­lems of medical students, a Task Force onStudent Financing has been created with atwo-year charge to examine existing and po­tential mechanisms for providing financial as­sistance to medical students. The task forcewill make interim reports to the ExecutiveCouncil and may in its final report also makerecommendations to the medical schools, fed­eral and state governments, and private fund­ing agencies. Also in the area of student aid,

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272 Journal ofMedical Education

the Association supported an extension of thelegislation which provided an income tax ex­emption to those students who were recipientsof the Public Health Service/National HealthService Corps and Armed Forces HealthProfessions Scholarships.

In order to continue the effort to increaseopportunities for careers in medicine for mi­nority students, the Simulated Minority Ad­missions Exercise, first developed in 1974,was offered to regional groups of admissionsofficers, advisors, and medical school admis­sions committees. Admissions workshopswere conducted for eleven schools. The publi­cation Minority Opportunities in U.S. MedicalSchools was updated in 1975 and distributedto admissions officers and advisors. Thisbooklet provided detailed information aboutmedical schools' programs which offer oppor­tunities for minorities. The Medical MinorityApplicant Registry was prepared and circu­lated to all U.S. medical schools to assist theschools in identifying minority candidatesseeking admission to medical school. Becauseof the increasing concern over the number oflawsuits being filed against schools chargingreverse discrimination in the selection of mi­nority students, the survey conducted last yearto determine the characteristics of suits andtheir outcome has been updated. The Associ­ation filed an amicus curiae brief in the case ofBakke v. Regents of the University of Califor­nia which supported the position that specialadmission programs for minority students donot violate constitutional equal protectionsafeguards. The AAMC Task Force on Mi­nority Student Opportunities in Medicine wasestablished to make recommendations to im­prove opportunities for minorities seeking acareer in medicine. An increasing number ofminority students are now proceeding into thegraduate phase of their medical education. Astudy published in the Journal ofMedical Ed­ucation in June 1975 indicates that a highproportion .:If minority students are success­fully achieving the graduate programs of theirchoice.

The Association has taken the position thatthe United States should make available in itsmedical schools the number of places neces­sary to meet the need for physicians in future

VOL. 52, MARCH 1977

years so that undergraduate medical educa­tion abroad does not become a regular alter­native' to the study of medicine at home. Thequalified U.S. citizen studying medicineabroad should, if resources can be made avail­able, be admitted to advanced standing by thefaculties of U.S. schools. The Association hasadvocated that policies and programs forthese transfer students should be subjected tothe scrutiny of the accreditation process andshould supersede existing "Fifth Pathway"programs.

In 1975, the Coordinated Transfer Appli­cation System sponsored 769 U.S. citizensstudying in foreign medical schools for Part Iof the National Board of Medical Examiners.Of the 664 who were examined, 377 passedand 243 were accepted with advanced stand­ing by U.S. medical schools. An additional 2,9transfer students were admitted who had beensponsored directly by medical schools. The 18percent decrease over the previous year inCOTRANS-sponsored examinees was par­tially offset by an increase in the test pass rate.

In December 1975, three major studentstudies were completed under contract withthe Bureau of Health Manpower. The Studyof 1974-75 Applicants focused on changesfrom 1970-71 and showed substantial in­creases in women and under-represented mi­norities. The Study of 1974-75 Enrolleescompared the characteristics of these studentsby type of medical school (public and private)and by class level. The "Survey of How Medi­cal Students Finance Their Education, 1974­75," updated similar surveys for 1963-64,1967-68 and 1970-71 and revealed that sevenout of ten medical school seniors were in debtby an average of $9,000 during 1974-75. Un­der an expanded BHM contract, the applicantand enrollee studies are being replicated for1975-76 and the analysis of the data from thesurvey of student financing is being extended.This analysis shows that a gratifyingly highproportion of 1974-75 medical students re­ported an interest in primary care specialties(61 percent) and in practicing in underservedareas (47 percent).

The transition from undergraduate to grad­uate medical education has been receiving in­creasing attention from both inside and out-

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AAMCAnnual Report for 1976

side academic medicine. Pressure to place ex­ternal regulations upon the number and typeof residency positions available to graduatesof U.S. medical schools may be in part ame­liorated by the natural phenomena which havelocated nearly 50 percent of first year resi­dents in the generally recognized primary carespecialties. The total number of first yeargraduate positions available is now only 19percent greater than the number ofU.S. grad­uates applying for these positions. Currentstatistics suggest that virtually all primary careresidency positions are being filled. The over­all perspective on the trends in graduate medi-

273

cal education is becoming clearer due to theincreasing availability of data from the Na­tional Intern and Resident Matching Pro­gram. The Executive Director of NIRMP at­tended all four regional meetings of theGroup on Student Affairs and the springmeeting of the Council of Deans to presentthese data.

The Group on Student Affairs continued toplay an active role in helping to guide theAssociation's student programs. Representa­tives of the GSA have played key roles in theAAMC consideration of student financingand minority student opportunities.

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Institutional Development

This past year represented the fourth year ofthe Management Advancement Program.Since its inception, the program has been bothan educational effort and an opportunity forsenior administrators from academic medicalcenters to develop institutional plans. The for­mer objective, education, has been ap­proached through the presentation of didacticlectures and through an open exchange be­tween program participants and lecturersthroughout the course of the various semi­nars. The latter objective, planned institu­tional change, is a longer term goal, which hasbeen approached by induding institutionalrepresentatives, aided by expert managementconsultants, in problem-identification and in­stitutional planning sessions.

The Management Advancement Programwas planned by an AAMC Steering Commit­tee chaired by Dr. Ivan L. Bennett, Jr. TheSteering Committee has sought the advice of anumber of individual consultants and expertson design of the overall effort, and togetherthey have continued to monitor program con­tent and structure carefully.

Phase I, The Executive Development Sem­inar, is an intensive workshop in managementtechnique and theory. Phases II and III, Insti­tutional Development Seminars, permit amanagement team from each participatingschool to work on a real issue identified fromwithin their own setting.

With the sixth Phase I, August 1976, over100 deans have participated in the ExecutiveDevelopment Seminars. The follow-up semi­nars have involved 54 institutions in Phase IIand 17 in Phase III. Over 500 individual par­ticipants have attended; in addition to thedeans, 99 department chairmen, 55 hospitaladministrators, 19 vice presidents, 4 chancel­lors, as well as program directors, businessofficers, and planning coordinators have at­tended. Support for early program planningwas provided by the Carnegie Corporation of

New York and by the Grant Foundation. Twogrants from the Robert Wood Johnson Foun­dation, the first a two-year award and thesecond a three-year award, have permittedfull implementation of the program.

Requests for seminars from groups otherthan the target population have initiated con­sideration of alternatives for broadening theprogram audience. As academic medical cen­ters have grown in size and complexity, theneed to develop a larger critical mass of indi­viduals informed of management conceptsand techniques has become increasingly ap­parent. In an attempt to accommodate thegrowing demand for management informa­tion, the AAMC has negotiated an importantnew contract with the National Library ofMedicine. The Management Education Net­work Project, initiated in the Spring of 1976,will expand the target audience of the Man­agement Advancement Program. In addition,documentation of academic medical center in­stitutional problem-solving will now be possi­ble. Specific tasks identified indude:(a) de­sign of a management literature retrieval sys­tem; (b) development of audio-visual instruc­tional packages around the subject matterpresented in the MAP; (c) documentation ofselected academic medical center managerialprocesses; and (d) exploration of the desira­bility and feasibility of simulation modellingas a management tool of medical school deci­sion-makers. This project is monitored by anAdvisory Committee chaired by Dr. J. RobertBuchanan.

Two projects were undertaken during theyear with the objective of enhancing the un­derstanding of medical school-teaching hospi­tal relationships, particularly the complex ofgovernance and management issues whichthese relations entail. The first project fo­cused on the relations between the medicalschool and a principal teaching hospital. Apanel of deans, hospital directors, and faculty

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members were queried as to their perceptionsof the relative influence of eleven possibleagents on each of the twenty-six decision areasinvolving both medical school and hospital.The panel was also asked to provide judg­ments as to the level of formal responsibilityeach agent bore for the resolution of issues ineach area. Preliminary results of this surveywere presented at the Council of Deans meet­ing and a final report will be contained in theproceedings of that meeting.

A second project is designed to investigatein detail the affiliation arrangements betweena sample of six selected medical schools andthe network of teaching hospitals with whomthey are affiliated. This study, supported un­der contract with the Bureau of Health Man­power, follows a management perspective toexamine the structure and process of decision­making on specific areas of concern to bothparties: assignment of students to clerkships,assignment of residents by specialty, initiationof new patient care programs, selection ofeducation officers in the affiliate, allocation ofresearch by sponsored programs, and the par­ticipation of volunteer faculty in the medicalschool decision-making process. The projectis proceeding under the guidance of a projectreview committee chaired by Dr. Robert Mas­sey and with the assistance of a liaison repre­sentative from each medical school in thesample. Substantial quantitative data and thereports of site visits will be analyzed to de­velop descriptions of the affiliation networksand to provide some assessment of what fac­tors contribute to an effective leadership.

A Visiting Professor Emeritus Program hasbeen established at the AAMC with supportfrom the National Fund for Medical Educa­tion. The program was developed to fill tem­porary faculty positions in the medical schoolswith available emeriti professors. The sub­stantial response to the announcement of the

275

program early in July reflects the need for thisservice to the medical schools.

The Association maintains its interest ininstitutional development in Latin Americancountries in close collaboration with the Pana­merican Federation of Associations of Medi­cal Schools. Major efforts were devoted to theprogram, which assists the establishment ofclose relationships between social security in­stitutions in Latin Amencan countries andtheir medical schools. For this purpose, addi­tional regional workshops were held, includ­ing preliminary and follow-up meetings withparticipating agencies and institutions. Repre­sentatives from Bolivia, Brazil. Paraguay, andPeru attended these workshops. Based on thefavorable outcome of all five workshops heldduring the past two years, preparations havenow been made for workshops to deal withspecific issues relating to the development ofcollaborative programs between social secu­rity institutions and medical schools in threecountries.

The AAMC also participated in a confer­ence to formulate mmimal standards for thedevelopment of new medIcal schools in LatinAmerican countries. The sponsorship for thisprogram stemmed from an agreement be­tween PAFAMS and the Pan AmericanHealth Organization that the adoption of suchminimal standards would have beneficial andlong-range effects on medical education inLatin America.

During the past year the executive officesof PAFAMS moved from Bogota, Colombia,to Caracas, Venezuela, and a new ExecutiveDirector, Dr. Francisco Kerdel-Vegas, wasdesignated. The AAMC assisted the new Ex­ecutive Director in the development of back­ground materials for several projects, includ­ing a proposal for the initiation of a Panameri­can Institute for the Training of Teachers ofHealth Associated Professions in Caracas,Venezuela.

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Teaching Hospitals

The Association's teaching hospital activitiesfor 1975-1976 focused on the continuing gov­ernmental efforts at regulating the health careindustry. Considerable Association activitywas directed toward analyzing and respondingto legislation, regulations, and special studiesdealing with health care industry controls hav­ing a special impact on teaching hospitals.

The Institute of Medicine conducted an in­depth study of Medicare and Medicaid reim­bursement practices pursuant to the directionof Congress in the 1973 Social SecurityAmendments. The charge to the Institute ofMedicine was to study five major areas: (1)appropriate and equitable methods of reim­bursement of physician services in hospitalshaving teaching programs; (2) the extent towhich Federal funds were supporting thetraining of medical specialties which were inshort supply; (3) how such funds could beexpended in ways which support more ra­tional distribution of physician manpowerboth geographically and by specialty; (4) theextent to which such funds support or encour­age teaching programs which disproportion­ately attract foreign medical graduates; and(5) the existing and appropriate role of theFederal health care funds in meeting the costof stipends of interns and residents.

The 10M study staff used teaching hospitalsite visits, survey questionnaires, and advisorypanels to explore and evaluate present reim­bursement practices. The Institute's final re­port, published in March, proposed significantchanges in present reimbursement practicesfor some teaching hospitals. In responding tothese recommendations, the Association hasdescribed three distinct physician services inteaching hospitals: direct and personal medi­cal services; administration and supervision ofthe hospital and its organizational compo­nents; and teaching and instruction in medicaleducation programs. While there are alterna­tive procedures for reimbursing practitioners

and providers of services, failure to reimburselegitimate costs of any of these three hospitalservices threatens the ability of teaching hos­pitals and physicians to fulfill patient care andmedical education responsibilities. The Asso­ciation has presented its views on this portionof the study as well as on those recommenda­tions in the study directed at the issues ofspecialty and geographic distribution of physi­cians and foreign medical graduates to the10M and the Congress.

The Medicare-Medicaid Administrativeand Reimbursement Reform Act, introducedby Senator Talmadge, contains provisions af­fecting program administration, providerreimbursement, and practitioner reimburse­ment. During the development of the legisla­tion, the Association actively discussed gen­eral concepts and tentative provisions of thebill with staff of the Health Subcommittee ofthe Senate Finance Committee. These meet­ings were informative and mutually beneficial.While the Association endorses many provi­sions of the Talmadge bill, several recommen­dations for revisions were presented in testi­mony before the appropriate subcommitteesin both Houses. The Association's testimonyconcentrated on the proposal to replace theroutine service cost limitations of Section 223with a new cross-classification and cost limita­tion system. The Association was pleased tonote that the proposed legislation excludesfrom the routine operating cost calculationsand limitations: capital costs; direct educationand training costs; costs of interns, residents,and medical personnel; and energy costs.However, the highly restrictive language ofthe bill resulted in the Association recommen­dations for a more flexible cross-classificationsystem, for elimination of the category "pri­mary affiliates of accredited medical schools,"and for an examination of the implications ofalternative definitions of "teaching/tertiarycare hospitals." The Association is continuing

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AAMC Annual Report for 1976

to follow the development of this legislationand has been asked to assist the Subcommit­tee with constructive proposals and sugges­tions.

The Association's appeal of its suit on theimplementation of routine service cost limita­tions under Section 223 is pending before theU.S. Court of Appeals for the District of Co­lumbia Circuit. In the absence of court-or­dered relief or legislation replacing the costlimitations of Section 223, the Association isactively monitoring the impact of this sectionon teaching hospitals. Throughout the year,the Association has encouraged the Bureau ofHealth Insurance to adopt an exception pro­cedure for routine service costs limitationswhich provides: (a) that information describ­ing the specific methodology and data utilizedto derive exceptions be made available to allinstitutions; (b) that the identity of compara­ble hospitals located in each group be madeavailable; (c) that the basis on which excep­tions are granted be publicly disclosed andeasily accessible to all interested parties; and(d) that the exceptions process permit the useof "per-admission cost" determinations rec­ognizing that compressing the length of stayoften results in an increase m the hospitals'routine per diem operating costs withoutchanging the per-admission costs. Apart fromIntermediary Letters establishing proceduresfor adjustments for house staff and nursingeducation costs, these efforts have had mini­mal success. Therefore, COTH members havebeen requested to provide the Associationwith a copy of all exceptions requests andcorrespondence so that member experiencesmay be shared. The Association also surveyednon-federal COTH members to assess the fi­nancial impact of these cost limitations. Sur­vey findings indicate that at least 20 percent ofall COTH member hospitals have exceededthe ceiling during the past two years; thatCOTH members most likely. to exceed theceiling are state or county owned, under 410beds, and university-owned; and that the limi­tations are working to the disadvantage of themembers with higher house staff expendi­tures. The Association will continue to workwith teaching hospitals and Bureau of HealthInsurance representatives in hopes of improv-

277

ing the exception process and reducing thedisproportionate impact of these limItationson COTH members.

During the year, the Association filed nu­merous comments with Executive Branchagencies on proposed regulations and activi­ties including limitations on inpatient costsunder Medicare and Medicaid, standards forpersonnel in clinical laboratories, require­ments for State Health Coordinating Coun­cils, procedures for Certificate of Need re­view, Medicare's draft proposal on recogniz­ing self-insurance contributIOns as reimbursa­ble costs, and the draft uniform accountingsystem being prepared by the Bureau ofHealth Insurance.

In March, the NatIOnal Labor RelationsBoard announced Its initial deciSIOn .. . ..that interns, residents, and c1imcal fellows areprimarily engaged in graduate training and arestudents rather than employees within themeaning of the NatIOnal Labor RelationsAct." Thus, the Board ruled that house stafforganizations at the involved hospitals couldnot invoke the protections of the NationalLabor RelatIOns Act. The Board's decisionwas based on the factual eVIdence presented,and was not a policy decision. Thus, in anyteaching hospital having house staff but littleinstruction and training, such house staffmight be declared employees rather than stu­dents. Last year, in an amicus cUriae briefsubmitted to the Board, the Association ar­gued that interns and residents were primarilystudents and that designation of house staff asemployees would have a significant detrimen­tal impact upon the structure, function, andcontent of graduate medical education.

Following Assembly approval, the Associa­tIOn mitiated a Corresponding Membershipcategory for teaching hospitals not eligible forCOTH membership. Corresponding Mem­bers must have a documented affiliationagreement with a school of medIcine and ob­tain a letter of support from the dean of theaffiliated medical school This type of mem­bership IS available to nonprofIt and/or gov­ernmental hospitals. Benefits of such mem­bership include notification of and ehgibilityto attend all open AAMC meetings and to

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278 Journal ofMedical Education

receive all general AAMC publications andcommunications.

The Association's program of teaching hos­pital surveys combines four regular and recur­ring surveys with a limited number of special,issue-oriented surveys. The regular surveysare the Educational Programs and ServicesSurvey, the House Staff Policy Survey, theIncome and Expense Survey for University­Owned Hospitals, and the Executive Salary

VOL. 52, MARCH 1977

Survey. During the past year, each of thesesurveys had an excellent response rate frommember hospitals. The findings of each ofthese surveys have been furnished to partici­pating hospitals and, when appropriate, re­sults have been publicly distributed. Two spe­cial surveys were conducted this year: the Sur­vey of the Impact of Section 223 and theSurvey of Professional Liability Insurance inUniversity-Owned Hospitals.

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Communications

The Association communicates its views,studies, and reports to its constituents, inter­ested Federal representatives, and the generalpublic through a variety of publications, newsreleases, news conferences, personal newsmedia interviews, and memoranda. The ma­jor communications vehicle for keeping theconstituents of the AAMC informed is thePresident's Weekly ActivitIes Report. Thispublication, which is issued 43 tImes a year,reaches more than 9,000 readers. It reportson AAMC activities and Federal actions thathave a direct effect on medical education,biomedical research and health care.

In addition to the President's Weekly Actlv­ities Report, other newsletters of a more spe­cialized nature are: AAMC Education News,which is published five times each year and IScirculated free-of-charge to all medical schoolfull-time faculty members whose names areregistered with the AAMC Faculty Ro~ter;

The Advisor; COTH Report; CAS Briet Stu­dent Affairs Reporter; and the OSR BulletinBoard. Numerous other publications such asdirectories, reports, papers, studIes, proceed­ings, and archival listings also were producedand distributed by the Association.

The Journal of MedIcal Education in fiscal1976 published 1,042 pages of editorial mate­rial, compared with 1,242 pages the previousyear. One supplement was published duringthe year: "Recruitment and Progress of Mi­nority Medical School Entrants, 1970-1972."Special issues were devoted to teaching qual­ity assurance and to the six-year curriculum.A 265-page book, Perspectives in PrimaryCare Education, was published as Part 2 of theregular December issue of the Journal. The

plenary addresses from the 1975 AAMC An­nual Meeting and the 1975 AAMC Proceed­ings and Annual Report also were publishedin the Joumal.

Excluding the supplement and the Part 2publication, a total of 152 papers (80 regulararticles and 72 communications) were pub­lished, compared with 167 papers in fiscal1975. The Joumal also continued to publisheditorials, datagrams, book reviews, letters tothe editor, and bibliographies provided by theNational Library of Medicine and initiated anew section for abstracts.

The volume of manuscripts submitted tothe Joumal for consideration continued to runhigh. Papers received in 1975-76 totaled 404,compared with 422 and 397 the previous twoyears. Of the 404 articles received in 1975-76,145 were accepted for publication, 177 wererejected, 24 were withdrawn, and 58 werepending as the year ended.

Pages of paid advertisements totaled 92durlllg the fiscal year, compared with 91 theprevious year. As the year ended, the Jour­nal's monthly circulation was about 6,600.

In order to hold down production costs, thenumber of pages was limited to 96 in .mostissues, the composition-printing process usedfor the Joumal was changed from "hot type"to "cold type," and a different grade of paperwas used for the pnntmg of the pubhcation.

About 35,000 copies of the annual MedicalSchool Admission Requiremeflts, 4,000 copiesof the AAMC DIrectory ofAmeTlcan MedicalEducation, and, 3,000 copies of the AAMCCUrriculum Directory were sold or distrib­uted.

279

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Information Systems

The Association is continuing the develop­ment of a comprehensive and integrated in­formation system including data on students,faculty, and institutions. The junction of thesecomponents permits summary informationfrom the person-oriented data bases to beincluded as institutional data and permitsstudies of faculty or students to take into ac­count the characteristics of the institutionswith which they are associated.

In addition to the annual "Study of U.S.Medical School Applicants," published in theJournal of Medical Education, the data basesupports research and special reports on topi­cal subjects. During the past year, these spe­cial reports included the Descriptive Study ofMedical School Applicants, 1974-75, Descrip­tive Study ofEnrolled Medical Students, 1974­75, and Survey of How Medical Students Fi­nance Their Education, 1974-75.

Data on medical school faculty includesbasic biographic information as well as pres­ent appointment, employment, and educa­tional history, and information on past orpresent participation in federal programs. Thedata provide a roster and descriptive statisticsto each medical school, and support researchon faculty development, mobility, and attri­tion.

Data descriptive of medical schools as insti­tutions are managed by the Institutional Pro­file System, a computer-based informationsource containing approximately 10,000 dataelements for each U.S. medical school. Theprimary sources of data for the InstitutionalProfile System have been recurrent and adhoc data collection instruments administeredby the AAMC, and other information systemsmaintained by the Association such as theStudent and Faculty Profile Systems.

The primary objective of the InstitutionalProfile System is to provide a readily accessi­ble repository of valid, reliable data that de­scribes and differentiates the medical educa-

tional environment. This objective is accom­plishedthrough use of an integrated data baseand supporting computer software packagethat together allow immediate user retrievalof data via computer terminals. The Institu­tional Profile System is used to respond to adhoc requests from medical schools and otherinterested parties, particularly requests forcomparing one school's data to that of otherschools. The system is also the source of datafor regular descriptive reports as well as fornumerous targeted research efforts on medi­cal schools as institutions of higher education.In two years of operation, the IPS has grownfrom 1,500 variables for each medical schoolderived from three sources of data to approxi­mately 10,000 variables for each medicalschool derived from more than 60 sources ofdata.

Use of the Institutional Profile System hasincreased significantly during the 1975-76 fis­cal year. Over 350 specific requests for datahave been filled directly by the IPS in less thantwo years of operation. The system is usedheavily within the AAMC to support datarequirements for targeted research and otheractivities.

The Association continues to serve as aprimary source of teaching hospital informa­tion. Annual surveys are conducted to obtainhouse staff stipend information; income, ex­pense, and general operating data for univer­sity-owned hospitals; data on executive salaryremuneration; and general operating informa­tion for the COTH Directory of EducationalPrograms and Services. Special surveys con­ducted during the year collected informationon medical school affiliation agreements,house staff manual provisions, and teachinghospital status under Section 223 of the 1972Social Security Amendments.

Two major studies were published duringthe year. For the eighth consecutive year theCOTH Survey of Housestaff Policy was pub-

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AAMC Annual Report for 1976

Iished. The survey describes the relationshipbetween teaching hospitals and house officersand serves as a comprehensive source of dataon housestaff stipends and fringe benefits. InFebruary the Association published its sixthannual "Analysis of University-Owned

281

Teaching Hospital Income, Expenses andGeneral Operating Data." It provided an ov­erview of income and expense trends for thefiscal year 1974 as well as statistical tablescomparing the hospitals along selected in­come, expense, and operational dimensions.

Balances in funds restricted by the grantordecreased $139,568 to $288,846, while unre­stricted funds available for general purposesincreased $871,034 to $4,901,152 - a reserveequal to 62 percent of expenditures during theyear. By action of the Executive Council theofficers of the Association have been directedto maintain unrestricted reserves of not lessthan 50 percent and, as a goal, 100 percent ofthe annual operating budget. Such a goal is areasonable one and its achievement should bea continuing mandate on the officers of theAssociation. To assist in the achievement ofthis goal, a finance committee has been ap­pointed by the Executive Council.

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AAMe Membership

TYPEInstitutionalProvisional InstitutionalAffiliateProvisional AffiliateGraduate AffiliateAcademic SocietiesTeaching HospitalsIndividualDistingUished ServiceEmeritusContributingSustaining

Treasurer's Report

The audited statements and the audit reportfor the fiscal year ending June 30, 1976 werecarefully examined by representatives of theAssociation's auditors, Ernst and Ernst; bymembers of the Association Audit Commit­tee; and by Association staff on September I,1976. At its meeting in Washington on Sep­tember 17, 1976 the Executive Council re­viewed and accepted the final unqualified au­dit report and the management letter contain­ing the auditors' recommendations.

Total income for the year increased 8.73percent to $8,667,131. Operating expendi­tures totaled $7,869,791.

1974-75109

717o1

56396

2,1493565

917

1975-76111

617o1

59396

2,02642707

17

282

AAMCAnnual Report for 1976 283

Association of American Medical CoUeges

Balance Sheet

June 30,1976

ASSETS

Cash $467,663::: U.S. Treasury Bills 5,462,5669rJ) Accounts Receivable 904,889rJ)a Deposits and Prepaid Items 29,372\-; Investments in Management Account 863,789(1) Total Assets $7,728,2790........;:l Liabilities and Fund Balances0..s::

Liabilities~ Accounts Payable $661,691"'d Deferred Income 756,970

(1)u Fund Balances;:l

Funds Restricted for Special Purposes 1,111,610"'d0 Funds Restricted for Investment in Plant 296,856\-;

0.. General Funds 4,901,152(1)\-; Total Liabilities & Fund Balances $7,728,279(1)

.D0 Operating Statement............ Fiscal Year Ended June 30, 19760Z

SOURCE OF FUNDS

U Income

~Dues and Service Fees from Members $1,535,516Grants Restricted by Grantor 303,174Cost Reimbursement Contracts 2,570,682

(1)Special Services 3,433,833..s::......Journal of Medical Education 64,3154-<

0 Other Publications 198,337rJ) Sundry 561,274:::9 Total Income $8,667,131......

Reserve for MCAT Development 234,926u~ Reserve for Special Minority Programs 23,913<3 Reserve for Special Legal Contingencies 27,787u

(1) Decrease in Restricted Fund Balances 139,568..s:: Total Source of Funds $9,093,325......a0 USE OF FUNDS

r.l:1"EJ Operating Expenses(1) Salaries & Wages $3,348,201a Staff Benefits 500,932;:l Supplies and Services 3,456,620u0 Equipment 53,344Q Travel 510,694

Total Expenses $7,869,791Transfer to Restricted Funds for Special Purposes 352,500Increase in Unrestricted Fund Balances 871,034Total Use of Funds $9,093,325

AAMC Committees, 1975-76

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Admission Assessment

Cheves McC. Smythe, ChairmanJack ColwillJoseph S. GonnellaDavid JeppsonWalter F. LeavellJohn McAnallyChristine McGuireFrederick WaldmanLeslie T. Webster

Audit

Charles B. Womer, ChairmanHarry PrystowskyRoy C. Swan

Borden Award

Daniel X. Freedman, ChairmanEugene BraunwaldJack W. ColeJames J. FergusonRobert S. Stone

CAS Nominating

Rolla B. Hill, Jr., ChairmanFloyd W. DennyRonald W. EstabrookWilliam L. ParryJames B. PrestonJohn E. SteinhausFrank E. Young

COD Nominating

Leonard M. Napolitano, ChairmanJohn E. ChapmanJohn M. DennisJoseph M. HolthausRobert S. Stone

COTH Nominating

Sidney Lewine, ChairmanRoy S. Rambeck

Charles B. Womer

Centennial

Robert J. Glaser, ChairmanWilliam G. AnlyanRobert B. HowardRussell A. NelsonCharles C. SpragueDaniel C. Tosteson

Continuing Medical EducationTask Force

William H. Luginbuhl, ChairmanClement R. BrownMichael CarusoCarmine D. ClementePhil R. ManningWilliam D. MayerMitchell T. RabkinEdward C. Rosenow, Jr.Neal A. VanselowJohn Williamson

Continuing Medical Education

William D. Mayer, ChairmanRichard M. BerglandClement R. BrownRichard CaplanCarmine D. ClementeJohn E. JonesCharles A. LewisThomas C. MeyerMitchell T. RabkinJacob R. SukerStephen TamoffDavid Walthall

Coordinating Council onMedical Education

AAMC Members:

William G. AnlyanJohn A. D. Cooper

284

AAMCAnnual Report/or 1976 285

Ronald W. Estabrook John A. Gronvall

LWSON COMMITI'EE ON CONTINUINGRolla B. Hill, Jr.

MEDICAL EDUCATIONRobert G. Petersdorf

AAMC Members: Flexner Award

::: Richard M. Bergland Thomas H. Hunter, Chairman9 William D. Mayer Harry EaglerJ) Jacob R. SukerrJ) John W. Ecksteina\-; LIAISON COMMITIEE ON GRADUATE

Merrel D. Flair(1) T. Stewart Hamilton0.. MEDICAL EDUCATION...... Charles Ludmer;:l0 AAMC Members:

.s:::~

Jack W. Cole Governance and Structure

"'dRobert M. Heyssel Daniel C. Tosteson, Chairman

(1) James A. Pittmanu August G. Swanson

William G. Anlyan;:l

"'d Sherman M. Mellinkoff0\-; LIAISON COMMITIEE ON

Russell A. Nelson0..(1) MEDICAL EDUCATION-

Charles C. Sprague\-;

(1)AAMC Members:.D Group on Business Affairs

0 Steven C. Beering............ STEERING0 Ralph J. CazortZ Ronald W. Estabrook V. Wayne Kennedy, Chairman

U John D. Kemph William Hilles, Executive Secretary

~Thomas D. Kinney Daniel P. Benford

C. John Tupper Warren KennedyDonald H. Lentz

(1) Data Development Liaison Richard G. Littlejohn.s:::...... Richard Janeway, Chairman M. James Peters4-<0 Marion Ball Joseph L. PreissigrJ)

John C. Bartlett Ralph M. Rogers:::9 David Diamond Marvin H. Siegel

......u Paul Gazzerro, Jr. David A. Sinclair~"0 James Griesen C. N. Stoveru Mary Ellen Hartman Robert Walker(1)

Miles Hench Sid R. Wallace.s:::......Kenneth Kutina Marion E. Woodbury

a0 James Leming~ Marion Mann Group on Medical Education1:: Raymond H. Murray(1)

Marvin F. Neely, Jr.STEERING

a;:l Bernard Nelson Merrel D. Flair, Chairmanu0 John E. Pauly James B. Erdmann, Executive Secretary

Q Robert A. BarbeeFinance Gunter Grupp

Charles B. Womer, Chairman Christine McGuire

Ivan L. Bennett, Jr. James R. Scholten

Leonard W. Cronkhite, Jr. Robert F. SchuckGary E. Striker

- For non-AAMC members, see page 288. Clyde E. Tucker

286 Journal ofMedical Education VOL. 52, MARCH 1977

Group on Public Relations Journal of Medical Education

STEERINGEditorial Board

Helen M. Sims, Chairman Edmund D. Pellegrino, Chairman

Charles Fentress, Executive Secretary Stephen Abrahemson

Terry R. Barton Carlton P. AlexisJohn W. Corcoran

::: Bill D. GlanceHenry W. Foster, Jr.9 Hugh Harrelson

rJ)

Herbert Kadison Ralph W. IngersollrJ)a Milton B. Lederman L. Edgar Lee, Jr.\-; Richard M. Magraw(1) Mary Ann Lockwood0..

Ruth N. Oliver J. Michael McGinnis......Christine McGuire;:l Susan K. Stuart-Otto0 Jacqueline Noonan..s:: Frank J. Weaver

~ Evan G. Pattishall, Jr.

"d Osler L. Peterson(1) Group on Student Affairs George G. Readeru;:l Richard C. Reynolds

"d STEERING0 Robert Rosenbaum\-; Martin Begun, Chairman Richard P. Schmidt0..(1)

Robert Boerner, Executive Secretary Mona M. Shangold\-;

(1) Willard Dalrymple C. Thomas Smith.D0 Paul R. Elliott John H. Westerman......

John Herweg......0 George Lowrey Management Advancement ProgramZ

Suydam Osterhout Steering

U Richard Seigle Ivan L. Bennett, Jr., Chairman

~W. Albert Sullivan J. Robert Buchanan

David L. Everhart

(1) Health Services AdvisoryJohn A. Gronvall

..s:: Irving London......4-< Christopher C. Fordham, III, Chairman Robert G. Petersdorf0 Clement R. Brown Clayton RichrJ)

::: David R. Challoner Cheves McC. Smythe9...... Luther P. ChristmanManagement Systems Developmentu

James M. Ensign~ Liaison<3 M. Alfred Haynesu Standiford Helm, II Cheves McC. Smythe, Chairman(1)

..s:: Robert M. Heyssel Howard J. Barnhard......a Richard L. Meiling Daniel P. Benford0 Tomas E. Piemme Ben R. Forsyth

r.l:1 Anne R. Somers Patrick Hardwick1:: Robert J. Weiss Samuel Howard(1)

a John H. Westerman Richard Janeway;:l L. Edgar Lee, Jr.u0 Russell Mills

Q 10M Social Security Studies John RockartReview Constantine StefanuJohn A. Gronvall, Chairman

Minority Student OpportunitiesRobert BernsteinJack W. Cole in Medicine

John W. Colloton George Lythcott, Chairman

AAMCAnnual Report for 1976 287

Alonzo C. Atencio E. Howard MolisaniHerman R. Branson C. A. MundtRobert A. Derzon Arturo OrtegaFrank Douglas Gregory PeckPaul R. Elliott Abraham PritzkerDoris A. Evans Beurt SerVaas

::: Christopher C. Fordham, III LeRoy B. Staver9 Herbert Fowler George StinsonrJ)rJ) Walter F. Leavell Richard B. Stonera Carter L. Marshall Harold E. Thayer\-;(1) Louis W. Sullivan Stanton L. Young0..

...... Derek Taylor W. Clarke Wescoe;:l

Neal A. Vanselow Charles C. Wise, Jr.0..s:: William Wolbach~ National Citizens Advisory Committee T. Evans Wyckoff

'"d for the Support of Medical Education(1)u Gustave L. Levy, Chairman Nominating;:l

'"d William Matson Roth, Co-Chairman James V. Warren, Chairman0\-; Jack R. Aron Robert W. Berliner0..(1) G. Duncan Bauman Rolla B. Hill, Jr.\-;

(1) Karl D. Bays SIdney Lewine.D0 Atherton Bean Leonard M. Napolitano

...... William R. Bowdoin......0 Francis H. Burr Planning Coordinators' GroupZ Fletcher Byrom STEERING

U Mortimer M. Caplin John C. Bartlett, Chairman

~Maurice R. Chambers Gerlandino Agro, Executive SecretaryWarren M. Christopher Roger L. Bennett

(1)Albert G. Clay Raymond Cornbill

..s:: William K. Coblentz Russell C. Mills......4-< Allison Davis Michael T. Romano0

rJ) Leslie Davis::: Willie Davis President's Biomedical Research9...... Max M. Fisher Panel Report Reviewu~ Benson Ford Robert W. Berliner, Chairman<3 Dorothy Kirsten French Daniel X. Freedmanu Carl J. Gilbert(1) Thomas J. Kennedy, Jr...s:: Robert H. Goddard...... Chandler A. Stetsona Emmett H. Heitler Leslie T. Webster0 Katharine Hepburn

<.l:11::

Charlton Heston Rime Program PlanningWalter J. Hickel(1) Jo Boufford, Chairmana Jerome H. Holland

;:l Mrs. Gibert W. Humphrey Robert G. Crounseu

Charles W. Dohner0 Erik JonssonQJack Josey Arthur S. Elstein

Robert H. Levi Thomas C. Meyer

Audrey Mars T. Joseph Sheehan

Archie R. McCardellResolutionsHoward W. McCall, Jr.

Einar Mohn Robert L. Van Citters, Chairman

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288 Journal ofMedical Education

Carmine D. ClementeJohn W. CollotonStephen F. Scholle

Student Financing

Bernard W. Nelson, ChairmanJames W. Bartlett

Liaison Committee onMedical Education

Non-AAMC Members·

AMERICAN MEDICAL ASSOCIATION

Louis W. BurgherWarren L. BostickPatrick J. V. Corcoran

• For AAMC members, see page 285.

VOL. 52, MARCH 1977

J. Robert BuchananAnna C. EppsWilliam I. IhlandfeJdtThomas A. RadoJohn P. StewardRobert L. TuttleGlenn Walker

William F. KellowJoseph M. WhiteChris J. D. Zarafonetis

PUBLIC

Harriet S. InskeepArturo G. Ortega

FEDERAL GOVERNMENT

John H. Mather

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AAMC Staff, 1975-76

Office of the President

PresidentJohn A. D. Cooper, M.D.

Vice PresidentJohn F. Sherman, Ph.D.

Special Assistant to the PresidentBart Waldman

Special Assistant to the Presidentfor Women in Medicine

Judith B. Braslow

Division of Business Affairs

Director and Assistant Secretary-TreasurerJ. Trevor Thomas

Business ManagerSamuel Morey

ControllerWilliam Martin

Staff AssistantLinda AdamsonNancy MurphyCarolyn VIf

Division of Program Liaison and Evaluation

DirectorGeorge DeMuth, M.D.

Division of Public Relations

DirectorCharles Fentress

Division of Publications

DirectorMerrill T. McCord

Assistant EditorJames Ingram

Manuscript EditorRosemarie D. Hensel

Staff EditorVickie Wilson

Department of Academic Affairs

DirectorAugust G. Swanson, M.D.

Deputy DirectorThomas E. Morgan, M.D.

Senior Staff AssociateMary H. Littlemeyer

Division of Biomedical Research

DirectorThomas E. Morgan, M.D.

Staff AssociateDaniel D. Jones, Ph.D.·

Division of Educational Measurementand Research

DirectorJames B. Erdmann, Ph.D.

Associate Director.Ayres D'Costa, Ph.D.·

Assistant to the DirectorJ. Michael McGraw

Project Director, MCAAPJames Angel

Associate Project Director, MCAAPMary A. Fmen, Ph.D.

Project Director, Longitudinal StudyRosemary Yancik, Ph.D.

Project Coordinator, Three YearsCurriculum

Robert L. Beran, Ph.D.Research Associate

Susan BartholomewRobert FeitzRichard E. Kriner, Ph.D.Marcia LaneRosalind O'Conner·Anne SchaferXenia ToneskDorothy Zorn·

• Resigned

289

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290 Journal ofMedical Education

Research AssistantKaren House

Analyst/ProgrammerJay Starry

Division of Faculty Development

DirectorHilliard Jason, M.D.

Associate DirectorDale R. Lefever, Ph.D.

Evaluation CoordinatorHenry B. Slotnick, Ph.D.

Workshop CoordinatorLuis L. Patino

Editor, AAMC Education NewsLeonard Baker

Research AssistantHelen Eden

Division of Student Programs

DirectorRobert J. Boerner

Assistant Director, SpecIal ProgramsSuzanne P. Dulcan

Director, Minority AffairsDario o. Prieto

Research AssociateJuel Hodge

Staff AssistantDiane Newman

Division of Student Services

DirectorRichard R. Randlett

Consultant to the DirectorGerald Kurtz

Associate Director for ServicesMary Gainer·

Manager, Applicant and School RelationsMelissa Ashabranner

Manager, ProductionJean Steele

Staff AssistantCarla Winston

Division of Student Studies

DirectorDavis G. Johnson, Ph.D.

• ResIgned

VOL. 52, MARCH 1977

Associate DirectorW. F. Dub6

Research AssociateJanet CucaJulie Lambdin·Richard Montovani

Research AssistantMary AckermanTravis GordonLinda SakakeenyAlicia Terry·

Departmel.1t of Health ServicesDirector

James I. Hudson, M.D.Deputy Director

Joseph Shipp, M.D.·Staff Associate

Joseph GiacaloneMarcel Infeld

Department ofInstitutional Development

DirectorMarjorie P. Wilson, M.D.

Deputy DirectorGeorge Demuth, M.D.

Project Director, ManagementEducation Network

Cheves McC. Smythe, M.D.Assistant Director, Management Programs

Amber JonesStaff Associate

Peter ButlerStaff Assistant

Connie Choate·Marcie Foster

Division of Accreditation

DirectorJames R. Schofield, M.D.

Staff AssistantKaren Entwistle·Joan Johnson

Division of Institutional Studies

DirectorJoseph A. Keyes

Research AssociatePerry Cohen

AAMC Annual Report for 1976 291

Staff Assistant Robert YearwoodSusan Langran Staff Assistant

Suzanne GoodwinDepartment of Robert C. Meadows

Teaching Hospitals

Director Division of Operational Studies::: Richard M. Knapp, Ph.D. Director9 Assistant Director H. Paul Jolly, Jr., Ph.D.rJ)rJ) James D. Bentley, Ph.D.E Associate Director\-; Steven Summer· William Hilles(1)

Staff Associate0.. Douglas McRae, Ph.D....... Robert Carow· Senior Staff Associate;:l0 Armand Checker Gerlandino Agro..s::~

Joseph Issacs Joseph RosenthalStaff Associate

"d Department of Planning and Philip Anderson, Ph.D.·(1)u;:l Policy Development Sharon Fagan

"d0 Director CoralIe Farlee, Ph.D.\-;

0.. Thomas J. Kennedy, Jr., M.D. Betty Higgins(1)

Thomas Larson·\-;Deputy Director(1) Michael McShane, Ph.D..D H. Paul Jolly, Ph.D .

0 Legislative Analyst Richard Nunn·......Robert Savoy...... Judith B. Braslow0 Charles Sherman, Ph.D.Z Steven Grossman

Scott Swirling Research AssociateU Pamela Griffith

~Division of Information Systems Research Assistant

Lindy LainDirector Staff Assistant

(1) Jesse Darnell..s:: Richard Kaye...... Associate Director4-< Loretta Laskoski0 Ellis R. Lamb Susan TillotsonrJ)

::: Manager, Systems and Programming Sara Zoller9 Dennis Lavery......u Manager, Computer Operations~<3 Aldrich Callins Division of Educationalu Operations Manager, Faculty Profile

(1) Resources and Programs..s:: Aarolyn Galbraith......

Analyst/Programmer DirectorE0 Edwin Bain Emanuel Suter, M.D

<.l:1 Mehdi Balighian Staff Associate

1:: Jennye Chung Oscar Gomez-Povina, M.D.(1)

Daniel Church Jenny Johnson, Ph.D.E;:l Gwendolyn Malone Research Associateu

Stephan Roberts Wendy Waddell0Q Steven Tai AV Project Coordinator for Medicine"

John Welcher Norbert A. Jones, Ph.D.

• Resigned •• Atlanta Staff

Copies of earlier studies also available.

Remittance (no cash) or institutional purchase order must accompany order.

Association of American Medical CollegesAttn: Membership and Subscriptions

One Dupont Circle, N.W.Washington, D.C. 20036

$5.0060 pages1976

Report on Medical School

Faculty Salaries 1976-1977

H. P. Jolly, Ph.D., and Thomas A. Larson

Participation of Women and Minoritieson U.S. Medical School Faculties

1976 48 pages $5.00

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Remittance (no cash) or institutional purchase order must accompany order.

Association of American Medical CollegesAttn: Membership and SubscriptionsOne Dupont Circle, N.W., Suite 200Washington, D.C. 20036

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STAFF POSITIONS

SUNY-Binghamton/Upstate Medical Center Clinical CampusBinghamton, N. Y.

The SUNY Upstate Medical Center and the SUNY University Center at Binghamton are estab­lishing an innovatIve, commumty-based program In medical education. The program WIll Includetwo years of basic science education at Upstate Medical Center, followed by clinical traimng forthird and fourth year medical students In Binghamton and the surrounding area. Programs in gradu­ate medical education and In continuing medical education will also be Integral parts of the ClImcalCampus. SUNY IS seeking staff for the Clinical Campus to assume responsibility for the developmentand administratIon of this new Umversity program. These posItIons report to the Dean of ClImcalMedicine based at the University Center In Blnghamtom.

COORDINATOR OF CLINICAL CURRICULUM

ResponsibilitIes. Work with medical school and umversity faculty to prepare a curriculum which en­ables the student to synthesize an approch to chmcal medicine based on the phYSical, bIOlOgical,behaVioral, and clinical sciences; work with local hospital staff to develop residency programs andother consortial programs; plan continuing eductIon programs.Background. M D degree, significant academic (teaching) and admimstrative experience, familiar­Ity With the clmical campus concept.Salary commensurate with experience and quahficatlOns.

EDUCATIONAL SPECIALIST

ResponslblhtIes: AsSiSt the dean and faculty m the deSign, ImplementatIon and evaluatll7n of theclinical campus currIculum Plan and manage media resources needed for mnovative pedagogy Inchmcal medicine. Assist the faculty m use of educational tools such as computer-aided mstructlOn,Videotape, simulation, etcBackground. Advanced degree In appropnate dIScipline, expenence In development and evaluationofmedical school curnculum Famiharity WIth new educational technology and instructional deSignSalary commensurate With expenence and qualifications

ADMINISTRATIVE ASSOCIATE

Responslblhtles. Coordmate all busmess and managenal actiVities for the Chnlcal Campus Includmgthe budget, the faculty practice plan, and affiliatIon agreements, supervise the admmlstratIve opera­tIons of the Clmical Campus and serve as administratIve mterface bet"een the University and themedical programs, the medical programs and the affihated hospitals, and the medical programs andthe community.Background Administrative experIence m health care field, demonstrated skill In management andfinanCial plannmg, famlharity With contracts and reimbursement procedures in health care fieldLegal background deslrble, but not reqUIredSalary commensurate With experience and quahficatlOns.

These poSitions are available ImmedIately Persons Interested In bemg corilndered for any of themshould submit a current resume as soon as poSSible to:

Ms Barbara CarterOffice of the Dean of Clmlcal MedicmeState Umversity of New York at BinghamtonBmghamton, New York 13901

State University of New York IS an equal opportumty, affirmative action employer

Binghamton

XI

Xll

Position Description

University of Rochester, Assistant ProfessorPrimary appointment In Medical Education(School of Medicine and Dentistry) andpart-time jOint appointment in Center forDevelopment, Learning. and Instruction(College of Education) Prerequisites (1)Ph.D. or Ed.D. in educational psychology orrelated field; (2) strong research and evalu­ation skills; (3) Interests In pursuing re­search on instructional problems. (4) one ormore years' expenence in a medical settingand either participation In a health profes­sions education project or faculty develop­ment. Duties Include teaching graduate levelcourses In instructional design and instruc­tional psychology; prOViding consultant helpon Instructional matters anc~ matenals, pur­sUing own research and collaborating on re­search/evaluation projects Three-year Initialappointment, 12-month salary, negotiable.Equal opportunity/affirmative action em­ployer.

Send vita, reprints, and other matenals to.

Irene AtheyProfessor of EducationUniverSity of RochesterCollege of EducationCenter for Development, Learning,

and InstructionRochester, New York 14627

PATHOLOGY CHAIRMAN:

The University of MississippiMedical Center invitesapplicationsfor the position of chairmanof the Department of Pathology.Candidates should send currentcurriculum vitae and threereferences toDr. James D. Hardy, Chairman,Department of Surgeryand Chairman, Pathology SearchCommittee,University of MississippiMedical Center,2500 North State,Jackson, MS 39216.

Equal Opportunity Employer,Male/Female.

The Unwerslly IS an Equal OpportUnity Employer

Applications Being Accepted for President of Health University

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,--------~ --------~--- ----~-~-------------- -

I

A senior individual, recognized nationally as a proven leader in thefield of health sciences, with experience in health education, manage­ment and long range planmng IS being sought for the position ofthe President of the Uniformed Services University of the HealthSciences, an agency of the Department of Defense. The University, es­tablished in 1972, has already developed an outstanding School of Medi­cine. A new President is being sought to provide continuing strongleadership to enable the UniversIty to become a school of great dis­tinction in both teaching and research, with the goal of providing thehighest quality of professional leadership for the total health care deliv­ery system of the Uniformed Services of the country. The candidates'qualifications should include the following:• Ability to work with federal agencies involved in providing health

support, particularly Congressional and Executive bodIes;• An understanding of and an appreciation for health problems relat­

mg to the mIhtary services;• The ability to maintain strong and effective relationships with other

federal as well as civilian health agencies; and• Good management ability in deahng with the faculty, staff and

student body of the University.

Interested individuals should forward curriculum vitae to the Board ofRegents, Uniformed Service University of the Health Sciences, 6917 Ar­lington Road, Bethesda, Maryland 20014