aamc annaul meeting and annual report 1984

! Association of American Medical Collegesi Annual Meeting] and8e~ Annual Reporto

z 1984

Table of Contents

Annual MeetingPlenary Sessions . . . . . . . . .'. . . . . . . . . . . . . . . . . . . . . . .. 213Special General Session . . . . . . . . . . . . . . . . . . . . . . . . . .. 213Council of Academic Societies . . . . . . . . . . . . . . . . . . . . .. 213·Council of Deans " . . .. 214Council of Teaching Hospitals . . . . . . . . . . . . . . . . . . . . .. 214Organization of Student Representatives. . . . . . . . . . . . .. 214GSA/Minority Affairs Section ;-.'. . .. 214_Minority Affairs Program 215Women in Medicine. . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 215Data Bases in Academic Medicine. . . . . . . . . . . . . . . . . .. 216

::'~:'> -'-' '~·Group.on'Btisiness·Affairs .::'~".".-'.-.- ._:~'-. :-'.:~".. !~". ~<.~. ,~.~;;: ;~. *--~16 <

Group on'Institutional Planning ....<...•.v ••• .-.- .-. <. : .. ~~. 216. Group on Medi~l_ E4ucation .-~~4 .- :.~ ~'-••0 '.~. • • • • • • • • • • •• 216

Group on Public Affairs . . . . . . . . . . . . . . . . . . . . . . . . . .. 222Group on Student Affairs '.:;-:.'~~. . . . . . . . . . . . . . . . . . .. .. 223Research in Medical EduCation : . . . . .. 223Student and Applica_~t..Iriform~ti9~ ~aJiagement System. 226

Assembly Minutes ~ : ._~.. . . . . . . . . . . . . . . . . . . . . .. 227-

Annual ReportExecutive Council, Administrative Boards. . . . . . . . . . . .. 232The Councils . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 233National Policy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 240Working with Other Organizations. . . . . . . . . . . . . . . . .. 248Education 251Biomedical and Behavioral Research . . . . . . . . . . . . . . . .. 254Faculty ".. 256Students 257Institutional Development 260Teaching Hospitals . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 261Communications . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 265Information Systems. . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 266AAMC Membership. . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 268Treasurer's Report . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 268AAMC Committees .•.... "....................... 270AAMC Staff. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 275

212

The NirietY:Pifth Annual Meeting, ~"'''. ,...-; .

Conrad Hilt~~Hot:i'i~dPalme~Hou~ Hotel, Chicago, Illinois, Oct. 27-No~: I, 1984. . rt ~ :' l ~ I l ~ _ ....~ .': • ~'

Theme: Challeriges to Medical Education

Program Outlines

PLENARY SESSIONS ~ SPECIAL GENERAL SESSION

October 30

October 29

CHALLENGES TO ~EOICAL EOUCATION

Presiding: R~bert M. Heyssel, M.D.

Medicine: A Learned'ProfeSsion?Steven Muller, Ph.D.The Teaching Hospital and Medi~"~ q ~~ '.

Education: One Room SChoolhouse,······~· "Multiversity, Dinosaur?Mitchell T. Rabkin, M.D. .": .' . '/

Reflections on Medical Education:'~ -.Concerns of the StudentBrian J. Awbrey, M.D.

Medical Education for.the 21st..Century..Lloyd H. Smith, Jr., M.D. ? ' .

Dr. Smith presented the Alan G'r~Memorial Lecture . <

INDIRECf COSTS-TOWARO'A' GREATER .'UNOERSTANDING· ~.",'.~ ..

Moderator: Virginia V~ Weldon, M.D~

U'~i~~rsity Administ~tion's -Viewpoini~ ...Donald Kennedy, Ph.D..

Faculty Member's ViewpointIra B~ Black,.M.D. ,.

Federal Government's' PositionBernadine H. Bulkley, M.D.

_, 1"" .... ~~ ~

Review of the Nature of Indirect CostsDavid A. Blake, Ph.D.

COUNCIL OF ACADEMIC SOCIETIES

October 28

CAS BUSINESS MEETING

Presiding: Robert L.·Hill, Ph.D.'- .

October30

CAS PLENARY SESSION .

Consideration of the RePort of the AAMCProject on the General Professional "Education of the Physician and College '

Presiding: Richard,Janeway, M.D. Preparation for Medicine,

Presentation ofAAMC Research and Aexner . College Preparation for Medicine'Awards - . David Alexander, D.Phil. ..

Education in Our Society Medical sChool Education~~est L Boyer, Ph.D. , August G. Swanson, M.D.

The Patienb' E~pectiti~ns of Physicians. Panel Piscussion-GPEP ConclusionsAnn Landers . .~ -

<-:(' October 29AAMC Chairman's Address:To See OurselvesRobert M. Heyssel, M.D.

213

f

1

;; .

,- :--;Regional MeetingsCentralNortheast

Naiio~a"ReSide~tMa:tching 'Pr~gram:: :' ._The Nuts and Bolis ;Martin A: PopS,' M.D~·Pamelyn Close, M.D.

Workshop: Medicine as a HumanExperienceDavid H. Rosen, M.D.David E. ~eiser, .M.P-;',. :':-""::'"

October 28 ' . ~'_f:':'~ :.~< ': j: .':'J.<'.......

Minority Student Medi~i 6r~i Aivar~hessWorkshop '. ., ~:"~ t.: '. ~'i:' . '1- S -~. ;

#~ --;:.": ~: r';,., ,~-:, -(t ..

October 29

October 29

VOL. 60, MARCH 1985

~- ~',",Baca.aureate Education/AcquiringLearning Skills ..~. .... f ~

James Erdmann, Ph.D.Richard 'Peters

Oinical EducationXenia Tonesk, Ph.D.Ed SchwagerrM.D~: . - ~ ~--' " 'y' ,

Faculty Involvemen( :'August Swanson, M.D. > •• <'.. :

Ricardo Sanchez ." _. .:It .... , ~ r· ...

Business ~~e~ing., . < .: i.:·.··· ", ' ~;:H

Regional Meetings . :'~., ,~ :Western '... <...~.

SouthernNortheastCentral

Ann Lee Zercher, R.N.Ann C. Jobe

Skills for Success 'iif Medicine. !oh~-IJ~~JY Pfifff?rling, Ph.D.~ ~ .

-. ~. • . 4 ~ 1._ ...: - .. .

October 28

Candidate for OSR Office Session

Di~~~io~ Gr~ups; ~dershipand. Change: Putting GPEP. to.:Work·at You~ .

School ~.

, ~....

Luncheon

Business Meeting .Presiding: Haynes ·Rice.

General SessionPresiding: Sheldon S. King

Strategic Planning and .the ,TeachingHospital: Lessons from Other, IndustriesThomas J. M;~nni~g '. ~

SeveritY.Measures: The Teaching HospitalDifference .Richard A. Berman

ORGANIZATION OF STUDENTREPRESENTATIVES ..

214 Journal ofMedical Education

COUNCIL OF DEANS .

... .""" ~ ..-,October 26

COUNCIL~OF TEACHING HOSPITALS4 ~ _ ....

October 29

Business MeetingChairman: Edward J. Stemmler, M~D.

Regional MeetingsWesternSouthernNortheast'~ -Central

October 29

Becoming an Effective Change Agent andOSR Member at Your.Schoor ' .Mary E. Smith;·M~D. '.. '- ..,

The Physician as'Health Advocate:Responsibilities and Barriers :Moderator: Steve.Hasley,' M.D.Speakers: Quentin Young, M.D. :.

Robert G. Pet~rsdon: ~.D.

October 27

Business Meeting_~ __ '".

Issue Ideniifi~tion ~ion - r;;

Small Group Discussions of Issues

Working with Nurses an<fOther Health'Professionals: Issues and Assumptions: "...; ~

Ruth Purtilo, P.T., Ph.D.

1984 AAMCAnnual Meeting 215

~ >Ctober 28o. .'

~ 'OMEN IN MEDICINE RESEARCH FORUMa " , ,- -. ,§ foderator: Patricia Williams, Ph.D. .. .'Q

'omen and the MCAT: An Overview of.esearch in Progress.obert Jon~> Ph.D.

"edictors of Performance ofMale and,~male MediCal StudentsVirginia Calkins

JeS Pregnancy During 'Residency Have a~gher. Incidence of Loss and)mplications?)na L. Harris; Ph.D.ey Osborn, M.D. ,

fTerences in CharacteristicS of Men and .)men in Departments of Medicine,11 Jolly, Ph.D~"'· '

Study of Womeri' Physicians in KentuckyLeah Dickstein, M.D.

Older Women Applicants and StudentsKathleen S. TurnerGENERAL SESSION

Improving Residency Performance:Overcoming Barriers to ChangeModerator: Eleanor Shore, M.D.

. Residents' Work,Schedules: Impacts onSleep and PerformanceMartin C. Moore-Ede, M.D., Ph~D.

Pregnancy and Parenting During Residency ,Maureen Sayres, M.D.

Isolation: Reality or Myth?Malkah Notman, M.D.·

ReceptionOctober 29

Regional Breakfast MeetingsWestern -SouthernCentralCASNortheast

Issues Pertaining to Academic CareerS in M~.icine

'-:r-c' CHILD CARE AS AN INSTITUTIONAL""' _

OPTION

Moderator: Beverly Huckman

The Status ofChild Care Programs atHealth Care Institutes. . :Jane C. Grady

Day Care-The New Extended FamilyMarjorie P. Whitehead

The State of the Art in Employer-Supported .Child CareSandra L. Burud

Symposium followed by an optionaltour of the Laurence Armour Day School

.. October30

Wome~ in Medicine Luncheon . :

FactorS in Academic Adv~ncement -.florence Haseltine, M.D.

Leah Lowenstein: An Appreciation '.Marilyn Heins, M.D.

WesternSouthern

Business Meeting

MINORITY' AFFAIRS 'PROGRAM

OctoberJO'

MINORITIES IN MEDICINE

Opening Remarks:Dario O. Prieto

Presentation of National MediCal'FellowshipAwards: ' . c

Leon Johnson, D.Ed. . ,

~ Franklin C. Mclean 'Award:" '.~

~ Kenneth Lucero§~ William and Charlotte Cadbury Award: J •

~ John M. Porter~ -] 3SA-MAS Se"rvice Awards: . '] Nilliam E. Benne~ Ph.D. '. ' -~ ~viAdams

.D . ,

~ 'ntroduction ofKeynote Speaker:" ,..Z obn A. D. Cooper, M.D., Ph.D. .u~ ;~~ote .Speak~r:. - , ' ,.-\~ IVlan Plnn WIggInS, M.D.o:g

] VOMEN IN. MEDICINE"8

216 Journal o/Medical Education

DATA BASES IN· ACADEMICMEDICINE

. VOL. 60, 'MARCH, 1985

GROUP ON INSTITUTIONAL ~'"

PLANNING

October 28 O~ober28

J.'t¥:.

October 29 '.

National BU,si~ess Meeting

Regional Business Meetings..Midwest-Great Plains '.' ~

NoI1heast· ., ., ~ ~

SouthernWestern

October 28

Discussion ~roups .. , >

Information' Sy~ie~s . ; ; .

Behavioral Aspects ofChange in Medical .Schools

FacHities Planning

National Program

CHANGING'MEDICAL EDUCATION TO,' ~".""

PROSPER IN A MARKET DRIVEN

ENVIRONMENT

Welcoming Remarks.· ,-', "~-. ',;John A. D. Cooper, M.D.

The Changing Environment.-.~

Howard Berman

Shifting Patient Care.to the AmbulatorySetting-StatTand Role Changes "Jerome Grossman, M.D. -

Perspective of Medical Educator j ••

Thomas F. Ferris, M.D. '.- :..

Perspective of Hospital C.E.O.H. Richard Nesson, Ph.D.

Open DiscussionVictor Crown

DATA BASES FOR MEDICALCURRICULUM MANAGEMENT

This was the- fifth in·'an annu~ ~'ri~'o'f ~"sions to explore innovative uses of data baseS·'in academic medical centers. The.session f<rcused on ways in which computerized data.bases of various types can facilitate manag~-;ment of the curriculum~ Panelists discussed'three'specific applications: keyword indexing;of curricular content, test' item banks' as amanagement tool, and use of..a computerized .version of the AAMC Curriculum Directory. ~J

Organizer: Charles P. Friedman,'Ph.D. -, ...."

Moderator: David P. Yens, Ph.D.

Panelists: K1ara K. Papp,.Ph.D.Edward J. Ronan, Ph.D. "_<. ~

Robert F. Rubeck, Ph.D. i~ •

October: 29 ..~~.. '.'

Regional MeetingsMidwest-Great PlainsNortheastSouthWest

GROUP ON BUSINESS AFFAIRS

UNIVERSITY RETIREMENT PLANS-THE -PUSH

FOR CHANGE

Roy A. Schotlaod; L.L~B... ' .,.John H. ,Biggs

October )0' . , '.

CARROLL MEMORIAL LECTURE· ANDLUNCHEON

J. Alexander McMahonNational Business Meeting ,. GME Special ~~ori .. 'Report of the President's Commission of the·· THE ROLE OF THE CURRICULUM~fo ' <:_.~~.

Year 20 lOon the Collapse ofMedical Finance' MANAGER-PROBLEMS AND 'APPROACHES~AGregory Pence~'Ph~D~~' ,. . '1 CASE STUDY METHOD .,

Do More Than Try-Triu-m~h! Organizer:,Paula L.Stillmanj M.D. · , .'

Dale O. Ferner, Ph.D. . . _ __ ,Speaker: C.R~landChiisteilsO,n,·Ph;D. .

1984 AAMC,AiinualMeeting

Session Leaders and Recorders:'Marilyn Appel, Ed.D. "G. Dean Oeghom, Ph~D.D. Daniel Hunt, M.D. ,~

Roy Jarecky, Ed.D.Murray Kappelman, M.D.Julian I. Kitay, M.D.Terrence Kuske, M.D. '. ,>.

Jon H. Levine, M.D.- S. Scott' Obenshain, M.D.

GME MINI-WORKSHOPS:' .~:

TEACHING RESIDENTS TO 'TEACH' .. r ~~

Organizer: Franklin J. Medio,~ Ph.D.~ ,

Faculty: Stev~n"BOrk2n, M.D.:Linda Lesky, M.D.' .' , ,- ,,' ,LuAnn .Wilkerson, Ed.D.

QUALITATIVE, C~RRICULUM EVALUATION IN'MEDICAL EDUCATION

Organizer: James A. Pearsol ,'. ~ ~~->.,r~.-t,:-,: ..

Faculty: Lynn Kerbeshian, Ph.D... . _. ,,-,Deborah C. Rugg

OOMPUTERIZED .INFOR~AT~ON .- MANAGEMErffIN MEDICAL EDUCATION

Organizers: Charles P. Friedman, Ph.D. .:., M~deline P•. Beery . . -

LEARNING PREFERENCES AND TEACHINGMETHODS FOR eME

Organizer: Agnes G. Rezler, Ph.D.

Faculty: Richard P. Foley, Ph.D~

FACULTY DEVELOPMENT. OF CUNICAL TEACHING

Organizer: 'Fiank'T<Stritie~, j>h.D.Faculty: Kelley,M. Ske~ M.D.' r ~',,< '

• David Irby, Ph.D.

GME/SMCDCME SMALL GROUP -DISCUSSIONS' .

Educational Applications ofOinicalDecision Making

MOderator: Ralph Bloch, M.D.Panel -.,' '" "J.~::.''''' '

Learning Styles in CME-Implications inProgramming '. - -

Moderator: Thomas C. Meyer:'"M.D.

217

Panel: Nancy Bennett, Ph.D~Robert K. Richards, Ph.D.'Lynn Curry, Ph.D.

Understanding and Using the ACCME.Essentials and Guidelines with a SpecialFocus on the Commercial Guidelines Williard M. Duff, Ph.D.Frances Maitland

Basic Mechanics of Doing SurveyResearchCharles E: Osborne, Ed.D. 'Jacqueline N. Parochka, Ed.D.

Roundtable Discussion on Using Computers, in CME Administration ,~

Alan L. Hull, Ph.D.Richard L. Moore, Ed.D.

How to Work Effectively with Nori~

accredited/Commercial Organizations to -,Develop and Conduct ConferencesJoseph A. D'Angelo, Jr•.Robert J. Schaefer

INNOVATIONS IN MEDICAL EoveATIONEXHIBITS

GSAiGME Speci~ Session' .

'THE. MCAT,.EXPERIMENTAL. BSAY.. PROJEcr: ..'STUDY ISSUES

,Moderator: Robert L. Beran, Ph.D. ,- 7- ,

Speakers: Edward White, Ph.D.Marliss Strange -Zenaido Camacho, Ph.D.,Terrence Leigh, Ed.D~ i'

GME/SMCDCME Joint Session

A LIFEWNG APPROACH TO MEDICAL,EDUCATION',

Organizer: Peter A. Bowman~,Ph.l?!Panel:'Linda K. Gunzburger, Ph.D.

Robert D. Fox, Ed.D.Barbai"a Gerbert, Ph.D.

, : Martyn o~ Hotvedt,' Ph.D.

Comine'ntaior:' George E~ Miller, M.D. '

October 29

INNOVATIONS IN MEDICAL EDUCATION

EXHIBITS

VOL. \60,. <MARCH ,1985

October 30

MINORITY"SUPPORT PROGRAMS: 'PURPOSES,

APPROACHES, AND EFFEql,yENESS

Moderator: Rudolph M. Williams ,Speakers: Henry T. Frierson, Jr.; Ph.D.

A. J. Alamia, P~.D. ~", .Susan V. Lourenco, Ph~D..

Joseph S. Gonnella, M.D~Janine Edwards, Ph.D..Victor R. Neufeld, M.D.Virginia Nunn, Ed.D. '-Fredric Burg, M.D.Jan Carline, Ph.D. -

Educational Support Systems for StudentsResource: Karen Collins-Ei~an~, .~h.D.. -

Innovative Approaches to :Admissions andStudent Financial Aid .'-Resource: Gerry R. Schermerhorn . "

Joint GSA-MASjGME Special Session.

INNOVATIONS IN MEDICAL EDUCATION

EXHIBITS

GME SPecial Plenary Session ..

PRACTICAL 'RESPONSES TO THE GPEP

RECOMMENDATIONS

Session C~air:man: Victor R. Ne~feld, M.D.

Special Perspectives:Arnold Brown, M.D.William Dignam, M.D.Richard Moy, M.D.Edward furshpan, M.D. .'JohnR. Evans, M.D.

RESEARCH IN MEDICAL EDUCATION SECOND, . .

ANNUAL INVITED REVIEW

Medical Problem So,~i~g: A Critique of-the Literature' .Christine McGuire

RIME NEW' INVESTIGATORS SPECIAL

PLENARY SESSIONS

Session I : ~~ .

Moderator: Stephen Abrahamson, Ph.D.-, :-"

, . The Selection of Priority Problems and -~ , ; .Conditions: An Innovative Approach-to.~'

Curriculum Design in Medical Education ;..'John P. Chong, M.D., et at. ",','" -0' -. '."1,

~218 Journal ojMedical Education

GME Regional Meetings,.Southern 'WesternNortheastCentral

GME NATIONAL MEETING ~

INNOVATIONS INIMEDICAL EDUCATION

DISCUSSION GROUPS

Instructional Design or Evaluation of BasicScience CoursesResourc~: Enrique ?antoja, M.D... ,: .. ' I • <

Instructional Design or Evaluation of- 'Introduction to Oinical Medicine CoursesResource: Ian R. Hart, M.D.

Instructional Design or Evaluation ofClinicalOerkships ' ,Resource: Ian R. Hart, M.D.'

Instructional Design'or Evaluation of . "Residency Programs ." . 'Resource: Neal A~ Whitnian~ Ed.~. ,

Computer Application in Medical EducationResources: Tracey L. Veach, Ed.D. .

Michael ~. Herring

Interdisciplinary Health EducationResource: Steph~~ _~: Sheldo,n, D.O.

Faculty Development .Resource: Marilyn ~.< ApPel, Ec!.D. .

GME Special Session ' .. ',", ~'

PRACTICAL IMPLICATIONS :-OF' ASSESSING

EVALUATION SY~TEMS: REPORTS, FROM EIGHT

PILOT SCHOOLS IN THE AAMC CLINICAL

EVALUATION PROGRAM

Participants:, ' "'~

Martin Pops, M.D.Robert B. Layzer, M.D.

Election of National Chairman-Elect "

National Officers' Projects Reports

Special Acti'viiies Status . ,.AAMC Curriculum Network ProjectTask Force on the'Critique.ofCurricular

Innovations .Task Force on Evaluation ReSou'rces,AAMC Clinical Evaluation ~rogam. . .~

Status of Aex I and II

'Installation of New Chairman

1984AAMC~tnnlia/Meeting ·219

PROBLEM-BASED SELF-DIRECTED LEARNING:

CASE STUDIES IN THE SEARCH FOR

SOLUTIONS 'TO GPEP . PROBLEMS

Moderator: Phyllis Blumberg, Ph.D.

Panel: S. J. Adelstein, M.D., Ph.D.Gerald S. Gotterer, M.D.,S. Scott Obenshain, M.D.Reed G; Williams, Ph.D.

COMPUTER-BASED 'TESTING OF CLINICAL

COMPETENCE

Moderator: David B~ Swanson, Ph.D.Panel: Barbara Andrew, Ph.D.

Geoffrey R. Norman, Ph.D.George D. Webster, M.D.

TEACHING INCENTIVES: PROBLEMS AND

POSSIBILITIES ..

Moderator: Marilyn H~ Appel, Ed.D.Panel: August Swanson, M.D.

Edward J. Stemmler, M.D.Leonard L Ross, Ph.D. 'John Provan, M.D.,

STUDENTS IN ACADEMIC DIFFICULTY:"

ISSUES AND EFFORTS AT RESOLUTION

Moderator: Lester M. Geller, Ph.D.Panel: Lester M. Geller,Ph.D. ~.

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

PROVIDING' OPPORTUNITIES TO DEVELOP

AND IMPROVE THE TEACHING SKILLS OF.RESIDENTS

Moderator: Howard L. Stone, Ph.D. "Panelist: Sigurd E. Si~ertson, M.D•

BROADENING THE MEASUREMENT OF

STUDENT COMPETENCE IN THE BASIC

SCIENCES

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

Panel: Thomas' H. Kent,' M.D.-~Bruce Squires,. M.D.; Ph.D. Jack L Maatseh, Ph.D...

THE OBJECTIVE STRUCTURED CLINICAL

EXAMINATION (oseE) iN THE ASSESSMENT

OF CLINICAL COMPETENCE

< Pan~l: Julian' I. Kitay~ M.D: ','Virginia I~ Nunn, Ed.D.

Reseaich~ and Teaching Elective in a <,,' i

Primary Care Oriented SchoolEnrique Pantoja, M.D., et ale . .'. ,

The Cost ofProblem-Based v's; Traditional -,~-~

Medical Education --.Stewart P."Mennin, Ph.D.,; et al. ' % ••

Session II' -,':...

Moderator: George Miller, M.D.·~·-~

Supply a'~~i Demand for Academic GeilerntIntemists:-An Exploratory Study ofa Re- .emerging Academic Discipline ; . .. ,"John Dirkx, et al.·

Stresses and Supports During ResidencyTrainingCarol Landau, Ph.D., et al~ "; ;~.~

The Case Study as Research in Medical "Education: Issues Related to the '.'.' .~~" ,Educational Quality ofa Medical Resi~ency ..~Program ' .Michael Seefeldt, ·Ph.D., et aI. ,: :.

November 1 ,,',

October 31

GME/GSA 'Joint Plenary SeSsion ,A'~. ," •

EVALUATION:' THE BRIDGE'TO GRADUATE· .

MEDICAL EDUCATION

Moderator: Norma E. Wagoner, Ph.D.Speakers: Stephen Abrahamson~ ph.D~·· ,';'J~,'

o Richard J. Reitemeier, M.D.. OJ',

, Gordon H. Deckert, M.D.,

RIME" CONFERENCE .

(See RIME section of this program)' .~

GME Small Group Discussions. ~ ... .,. ~

MICROCOMPUTER' APPLICATIONS IN MEDICALEDUCATION - .-~." ',' , ..,' ","

Moderator: Tracey Veach, Ed.D.: . -i.' r ..

Panel: Hilliard Jason, M.D. ~'. : . 'Oyde Tucker, M.D.' ": c"",' -~" -

.' James W.-Woods,'Ph.D.Abdulla Abdulla, M.D. ":-'''~'

UTILIZING THE AAMC CURRICULUM

NETWORK ,', '

Moderator: M. Brownell Anderson


Moderator: Ian R. Hart~ M.D. ~Panel: Geoffrey R. Norman,·Ph.D.

Reed G. Williams, Ph.D.Emil R. ~etruSa, Ph.D~

SELECfION OF PRIORITY, HEALTH CAREPROBLEMS IN CURRICULUM DEVELOPMENT

. . ._:.::< .'" < \,. ;~i

Moderator: John.Chong, Ph.D.Panel: Howard S. BarrowS: M.D.-·~·

Gordon Moore, ,M.D... , <

CRITIQUE OF CURRICULUM INNOVATIONS

Moderator: Arthur I. Rothman, Ed.D.

Panel: Christel A. Woodward,·Ph.D. ~

Howard Stone, Ph.D.M. Brownell Anderson

.Victor R. Neufeld, M.D.

INTRA-INSTITUTIONAL REVIEW' OFRESIDENCY TRAINING PROORAMS

Moderator: Thomas A. DuO: M.D. .

PREPARING'SELF-DIRECfED LEARNERS:THE ROLE OF INFORMATION MANAGEMENT,.

EDUCATION IN MEDICAL SCHOOLS .

Moderator: Diana' E~ Northup ."Panel: Phil R. Manning, 'M.D.

Debra DaRosa, Ph.D.Ann McKibbin·Harold M. Schoolman, M.D.

October 28, 29, and 30 .

INNOVATIONS IN MEDICAL -EDUCATION"

EXHIBITS

BASIC SCIENCE COURSES

Role' of Cadaver History and'RadiogCaphs. in ~the Gross Anatomy LaboratoryEnrique Pantoja, M.D., et al. . ,'"

Activating Teaching in Medical Chemisti-y'::::'Short and LongTerm Evaluation ofRetention and Attitudes'Dick Martenson, Ph.D., et al. .' .' }CLINICAL CLERKSHIPS ~,> ',"1,'" r, ,,..r

Area Health Education' Centers (AHEC) as'Sites for Required Clinical Oerkships ,"~L. B. Morrow, et ale ,- -< , ,<,"; , , '

A Bank of Stations for the Objective Struc··tured Clinical Examination" - ..Ian R. Hart, M.D. ' , -j

VOL. 60, ..MARCH -1985

Five Years. Experience in, Required ,Geriatric'~

Medical Education;-;., . ',' ..,~. -:,,?:: . ,-';"~-r'-

E. A. Wolfson, et al. . ".

Realistic- Video ':Instruction Techniques· ofPhysical Diagnosis: A Visual Approach '..Donald W. Novey, M.D. ~""',. "The Simulated Patient as a Learning Resource.'Roby M. Kerr, P~.D., et ~.,: . ': '. .i.Y' ;".

Experimental Evaluation o(Psychjatry< ClerksTerry A.....T~vi~? M.D.. "_~ ..' '

INTRODUCTION TO 'CLINICAL'~:MEDICINE...

COURSES . ~ .,~. <:

Teaching~aClinical Reasoning ModelL. S. Lichtenstein, et al.Lectures on Dentisti-y in '"IntroduCtiori-'~toOinical'Medicine"· .Mortimer Lorber, D.M.D., M.D;, et al. .

Work-Study Experi~~ce for 'year I -MediCal.Students "K. R. Mares, Ph.D., 'et al.

Teaching the Pelvic Examination of~he ~edi~.

atric Patient 'Gloria A. Bachmann, M.D.'

Teaching Human SexualityE. Whiting, et al.

Home Visits to People with Genetic Disorders: !

Introducing First-Year Medical, Students tothe flumanJ)imensio~s ofMedicine ThroughExperim'ental Learni,ngJudith L. Benkendort: et al.

• t ••• • -.'

Teaching the Female Genital Exam"~'Using

Non-Professionals as PatientS arid InstructorsP. G. Tutuer, M.D., et aI.

Teaching Medical Students Patient'EdiiciltionConcepts and S~ills . --,~ ,Lynda J. Fa~qu_h~r, ,Ph.D., et~.

RESIDENCY PROORAMS

Do You Want to:Encourage Residents to Im-~'

prove Their Teaching,Skills? . . . ~ ;Neal A. Whitman, Ed.D. .-,. " '_

Instructional Materi~l1s for Educatio'n in CostEffective Patient Care ,~. ' :i:':'"

J. L"·Mulligan,·M~D., eral. J -,~ ,. . •••-t: ,:

Research Training for'Family'Medicine Residents -,'~ If'" 'r: . " t •• ~.<~,~- :

1984 AAMCAnnua/.Meeting

Richard L. Holloway, Ph.D., et at" ' ... .,~~-( -","',

Family· Practice Residency' ASsistance Pr0-gram . '.' ,Daniel J. Ostergaard, M.D., et aI.

OOMPUTER APPLICATIONS, " . "t<, .~ "_'•.:.:.'

Library Information System" Dahlgren ,- Me-morial Library :'''''''f ~_,,-.~ _ •. ,

Naomi C. Broering .

Applicaiion of a Daiab3Se 'Management SyS:-tem in Curriculum Planning' ., ','D. A. Gotlib, et aI. . "/ :1". ",.-. ,;

Responding to a Medical,Emergency: A Demonstration of Computer-Based InteractiveVideodisc Instructional Materials <.,,: ..'-,

~ William D. Aggen. et at.. .c, '. , ..

~ Microcomputer Management of Curriculum0. Information, '! ~ .......-1". - • ..' ('5

~ M. E. Bell '.. . ,,"" ._._"8 Qinical Reference Systems-Healthcare Soft-.g ware ,~ Michael 'Selby, 'et ale _,'

.D

~ Use of Natural Language and Laser Video inZ "High Fidelity" ComputerBased Oinical Sim-~ ulations

Q) Abdulla M. Abdulla, M.D., et.aI.~o MED-CAPS, Medical Computef,y,Assisted:go Problem Solving ,i Chris Herndi' "',

~ Computer Based Evaluation of a Predoctoral~ Training Program in Family Practice '.~ Charles E. Driscoll, M.D., e£aI.' . ..~"

~ Standatd Faculty and Cou~.E~~tionComputerization "T. L. Veach, Ed.D., et aI.

An Automated 'System for intei-acti~e' Multimedial Independent Study' .Leo L. Leveridge, M.D., et aI. '.~~~~;," " ; " ,'.

Georgia Interactive Network (GAIN) f~r Med-ical Information ,Jane Beel~nd, et aI~,:, . ,.' :'<.<r,:_/ -' _.. "

An Analysis of Several ~ Different AuthoringSoftware Packages for_~~Medical. CoursewareDevelopment ~ " , , ',' '., "'. .B. E. Hill, Ed.D.,'et aI. '.' .

FACULTY DEVEWPMENT':"

221

STEM Educational Resources CompendiumGary R. Strange, M.D.."

Effective Teaching: Improving Your SkillsM. H. Appel, et al.

EDUCATIONAL SUPPORT SYSTEMS

Test Taking"Skills oe~e]opmentA. Duane Anderson~ Ph.D., et aI•. '

Faculty' Centered Learning in Medical Edu-'cation: Implications for Educational SupportServices for Students, Residents and FacultyKaren Collins-Eiland, Ph.D., et aI. '

MSL EducationThe Upjohn Company' ",

INTERDISCIPLINARY HEALTH EDUCATION"

Pediatric Ecology Fellowship Program:Development and DesignStephen H. Sheldon, et al.' , .

Health Sciences Consortium instructionalVideocassettesv. Pfifferling --.'

Teaching Oinical Teaching: An Interdisciplinary Workshop Can Be FunP. A. Robertson, et al. ,

,Humanities in Surgery: Ethics and Communication in the Surgeon/patient RelatiorishipS. Bertman~ et aI.Medicine and Nuclear War CurriculumM. McCally. et aI.

ADMISSIONS AND FINANCIAL ,AID

Long Range Minority Applicant RecruitmentVia Career Awareness Videotapes . , ,Gerry R. Schermerhom~<et at. '

A Training Wo~kshop for Medical'SChool Admissions Interviewers

,Gerry R. Schermerhorn, et al. .~ .".. ,-

OTHER, ' .

V.A. Health 'P;ofessio~ a;~iinuing EducationNetwork: National Programming'Robert Frymier, M.D.

"American Academy of Otolaryngology-Headand Neck Surgery Foun'dation~ontinuing

Medical Education Educational Oearinghouse Association for Surgical EducationM. J•.Peters, et aI•.


Medicine as a CareerVelma Gibson Watts, et al.

GROUP ON PUBLIC AFFAIRS

October 29

AWARDS NOMINEE PRESENTATIONS

Moderator: Robert Fenley

Nominee Presentations for Excellence in:

Total Public Relations/Development/Alumni-Medical SchoolKay Rodriguez

Total Public Relations/Development/COTH Member Teaching HospitalBrenda BabitzJudith M. Rice

Publications-External AudiencesSpyros AndreopoulosMichela Reichman

Publications-Internal AudiencesGregory GrazeRobert Schwartz

Electronics-AudioJoanne BruggerRobert Schwartz

Electronics-VisualJohns Hopkins Medical InstitutionsLyn Jones

Special ProjectsBarbara W. CahnD. Gayle McNutt

DEVEDOPMENT TRACK

Moderator: Arthur Brink

Medical Alumni and Annual GivingModerator: Dallas Mackey

Panel: Bronson C. DavisNancy Groseclose

Giving from the Corporate PerspectiveSpeaker: Robert H. Marik

Major GiftsModerator: Sheldon Garber

Panel: Anthony S. BridwellJack Siefkas

GPA Business MeetingPresiding: Dean Borg

VOL. 60, MARCH 1985

October 30

GPA AWARDS LUNCHEON

Welcome: Robert Fenley

Speaker Introduction: Hali Wickner

Presentation of AwardsRichard Janeway, M.D.

Speaker: Charles B. Kitz

THE COMMERCIALIZATION OF HEALTH CARE

Moderator: Antony Lloyd

Speaker: Mitchell T. Rabkin, M.D.

CRISIS AT TAMPA GENERAL

Moderator: Antony Lloyd

Speaker: Julian Rice

October 31

THE ETHICS OF MODERN MEDICINE

Moderator: Roland Wussow

Speaker: Baruch Brody, Ph.D.

ALUMNI TRACK

Moderator: Muriel Sawyer

ALUMNI DEVEWPMENT

Moderator: John Thomas

Alumni Development-Marketing andMotivationPerry J. Culver, M.D.

The New Medical SchoolFrederick Bennet

The Established Medical SchoolDallas Mackey

Alumni Relations-New IdeasJean D. Goral

ROUND TABLE DISCUSSIONS

Doctors Are Alumni TooDiscussion Leader: Jack Siefkas

The Doctor's Role in Gifts from PatientsDiscussion Leader: Clyde Watkins

Who Owns the Alumni?Discussion Leader: Lynn Kienzler

Market Surveys Can HelpDiscussion Leader: John Milkereit

1984 AAMCAnnual Meeting

Competing for Capital DollarsDiscussion Leader: Arthur Brink

Mini Computers: Yes or No?Discussion Leader: Brendan Cassidy

Update on Animal ResearchDiscussion Leader: Spyros Andreopoulos

Transplant IssuesDiscussion Leader: Mary Lou' Michel

In-House Video SystemsDiscussion Leader: Joe Sigler

Images of Teaching HospitalsDiscussion Leader: Shirley Bonnem

Public Relations-In House or Out of theHouse?Discussion Leader: Patrick Stone

Keeping Up Your CreativityDiscussion Leader: Elaine Freeman

Preplanning the Annual ReportDiscussion Leader: Anne Doll

Organizing Alumni Where There Aren't AnyDiscussion Leader: Margie Taylor, Ph.D.

GROUP ON STUDENT AFFAIRS

October 29 .

Student Financial Assistance:Status of Federal Programs'

Moderator: Cheryl Wilkes

Status of Health Manpower ProgramsDavid Sundwall, M.D.

Status of Higher Education Act ProgramsJohn E. Dean .

October 30

- Group on Student Affairs Business MeetingChair: Norma E. Wagoner, Ph.D.

National Resident Matching Program:. How Do You Think the Match is Working?

Moderator: John S. Graettinger, M.D.

October 31

. Joint Plenary Session with the Gro~p onMedical Education

EVALUATION: THE BRIDGE TO GRADUATE

- MEDICAL EDUCATION

~ Moderator: Norma E. Wagoner, Ph.D.

223

Medical SchoolStephen Abrahamson, Ph.D.

ResidencyRichard J. Reitemeier, M.D.

LicensureGordon H. Deckert, M.D.

GSA Special Session

ORWELL'S 1984 FOR THE GSA: RECURRING

THEMES WITH CREATIVE PROBLEM-SOLVING

Admissions

Financial Assistance

Career Counseling

Retention Issues

RESEARCH IN MEDICAL EDUCATION

October 31

PAPER SESSIONS

CERTIFICATION PROCEDURES IN THE

EVALUATION OF RESIDENT COMPETENCE

Moderator: John S. Lloyd, Ph.D.

The Reliability and Validity of In-TrainingEvaluatiQn Reports in Obstetrics andGynecologyP. A. Cranton, Ph.D., et al.

. Reliability and Validity ofObjectiveExaminationsSteve Downing, Ph.D., et aI.

Reliability and Validity of Ratings ofPhysician PerformanceRaywin Huang, Ph.D., et al.

The Predictive Validity ofTest Formats anda Psychometric Theory ofOinicalCompetenceJack Maatseh, Ph.D., et ale

NONCOGNITIVE FACTORS

Moderator: Janine C. Edwards, Ph.D.

Visual Arts Training to EnhanceObservational Skills ofMedical StudentsMarilyn H. Appel, Ed.D., et aI.

Patient Instruction and Locus ofControl:An Application of the Aptitude x TreatmentInteraction ApproachRichard L Holloway, Ph.D., et aI.

224 Journal ojMedical Education

Individual Learning Style: The Developmentofa Reliable MeasureDonald Witzke, Ph.D., et at.

PROGRAM EVALUATION

Moderator: Rose Yunker, Ph.D.

Evaluation ofan Innovative Self-InstructionalProgram in the Surgical Sub-SpecialtiesDavid P. Yens, Ph.D., et al.

Enhancing Learning ofOinical DiagnosisThrough Computer Graphics Feedback ofDiagnostic WeightingRobert S. Wigton, M.D., et al.

The Effects ofTeaching Oinical OerlesPsychotherapy Skills in the OutpatientDepartmentDaniel Frank, M.D., et aI.

ANALYSIS OF COGNITIVE LEARNING INMEDICINE

Moderator: Arthur Eistein

Role of Prior Knowledg~-in Comprehensionof Medical Information by Medical Studentsand PhysiciansVimla Patel, Ph.D., et at.

Text Comprehension Among MedicalStudents and Experienced PhysiciansHelene Leclere, M.D., et ale

Representation ofClinical Case Cues:A Multi-dimensional Scaling DemonstrationRuth de Bliek, et at.

STUDIES OF PRACTICE PATIERNS

Moderator: Thomas C. M~yer, M.D.

Analysis of Practice Patterns: Differences inPrimary Care Practice by PostgraduateTraining RouteLynn Curry, Ph.D.

Physicians' Evaluation ofTheirPostgraduate Education for Primary CareChristel A. Woodward, Ph.D., et aI.

Factors Underlying the Cognitive Difficultyof Patient CareSandra Wilson-Pessano, Ph.D.

CAREER SELECTION

Moderator: Marilyn Heins, M.D.

Women in Medicine: Factors Which

VOL. 60, MARCH 1985

Influence Career PatternsGerry R. Schermerhorn, et al.

The Relationship Between CognitiveFactors and Medical Student Specialty/Residency SelectionDiane Essex-Sorlie, Ph.D., et al.

Career Choice in Family Medicine: ALongitudinal StudyCharles Friedman, Ph.D., et ale

Models for Predicting Practice OutcomesBased on Branching and Switching ofPhysicians Among Specialties DuringGraduate Medical EducationTracy Frandsen, M.D., et al.

EVALUATING THE PERFORMANCE OFCLINICAL CLERKS

Moderator: Anthony Voytovich, M.D.

Leniency and Score DistributionDifferences Among Oinical RatersJohn Littlefield, Ph.D., et al.

Evaluating Medical Student Oinical Skill Performance: Relationships Among Self:Peer, and Expert RatingsJudith G. Calhoun, Ph.D., et at.

A Multiple Station Objective Oinica1EvaluationEmil R. Petrusa, Ph.D., et at.

Student Evaluation in Clinical Education:A Field Study at One Medical SchoolAllen C. Smith, et al.

INFORMATION TRANSFER IN PRACTICE: CME

Moderator: Phil Manning, M.D.

Phy~ician Adoption of New ClinicalInvestigations-A Study of the InformationSources Utilized During the DecisionMaking ProcessJocelyn Lockyer,-et at.

The Role ofCommunication Networks inPhysicians' Adoption of InnovationsJoseph A. Maxwell, et al.

Information-Seeking Behavior AmongPhysicians Practicing in Urban and NonUrban AreasMaggi Moore-West, Ph.D., etaI. ,-

Effects ofCPR Training: PartiCipant

1984 AAMCAnnual Meeting 225

CompetenCe and Patient OutcomesLynn Curry, Ph.D., et ale

STUDENT STRESS

Curricula in Medical SchoolsGary Grenholm, Ph.D., et al.

Promoting Medical Student Attention to" .Preventive Medicine in the Oinical SettingJames O. Woolliscroft, M.D., et aI.

The Primary Care Curriculum: Educating forChange in MedicineJohn Booker, Ph.D., et ale

Freshman and Senior Medical Students'Opinions Concerning Economic Aspects ofthe Health Care System, 1980-1983Mary W. Herman, Ph.D.

PRESENTATION OF SYMPOSIA

THE POTENTIAL EFFECTS OF CHANGIN~

FISCAL POLICIES ON MEDICAL EDUCATION

Organizer: Barbara Barzanksy, Ph.D.

Moderator: Mohan Garg, Se.D.

Panel: Harry Ackerman, Ph.D.Lewis Coulson, M.D.Earl Frederick

CONTRASTING PERSPECTIVES ON THE

CLINICAL RATINGS PROCESS

Organizer: James A. Pearsol

Moderator: Larry A. Sachs"Ph.D.

Panel: GeraldJ. ~n,.Ph.D..James A. PearsolDonn Weinholtz, Ph.D.

Reactor: Beth K. Dawson-Saunders, Ph.D.

VIDEOTAPES AS TEACHING TOOLS:

THREE APPLICATIONS IN MEDICAL

EDUCATION

Organizer1Moderator:Barbara Gerbert, Ph.q.

Panel: Mack Lipkin, Jr., M.D.Sheldon Retchin, M.D.Kelley M. Skert: M.D., Ph.D.

DEVEWPING MEDICAL CURRICULA

R~PONSIVE TO NATIONAL HEALTH NEEDS

Organizer/Moderator: Christine H. McGuire

Panel: Tamas Fulop, M.D.J. J. Guilbert, M.D.Ma'rafin Husin, M.D.Zohair Nooman, M.D.

PREDICTING PERFORMANCE ON

STANDARDIZED EXAMINATIONS

Moderator: Frank Schimpfhauser, Ph.D.

Predicting National Board PerformanceUsing MCATs and Medical ~hool CourseScoresMichael Donnelly, Ph.D., et ale

Doomed to Failure? Correlates ofSuccessAmong Students Predicted to Fail theNBME Part IJudy Schwenker, et aI.

The Effect of Item Format on TestPerformanceHans J. Woltt Ph.D., et ale

CHANGING MEDICAL SCHOOL CURRICULA

Moderator: Gordon Page, Ed.D.

Coping with "Loose Coupling":The Introduction and Maintenance of New

ao<.l:1

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

Can the Future Adjustment of MedicalStudentS Be Predicted?'A Thirty-Five YearFollow-UpC. Knight Aldrich, M.D.

Assessing Student Stress Levels andPsycho-Physiological Stress ReactionsWilliam P. Metheny, Ph.D., et ale

A Ten Year Freshman Support GroupProgram: Leader Review

~ Pearl P. Rosenberg, Ph.D.

~ EVALUATION OF CLINICAL TESTING~~ -,- Moderator: David Irby, Ph.D.o

~ Outstanding Oinical Teachers: Methods,].;, Characteristics, and Behaviors] - Edward Schor, M.D., et al.e'~ Evaluation ofAttending Physicians:~ Three PerspectivesZ Kelley M. Skeff, Ph.D., et at.

~ Improving Teaching Rounds: ActionResearch in Medical EducationFranklin J. Medio, Ph.D., et ale

(1)::o _


IDENTIFYING THE MARGINAL STUDENT

DURING CLINICAL CLERKSHIPS

Organizer/Moderator: Gordon L. Noel, M.D.

Panel: Winfield Scott. Ph.DXenia Tonesk, Ph.D.

DUAL CAREERS IN MEDICINE

Organizer/Moderator:Betty Hosmer-Mawardi, Ph.D.

Panel: Robert C. Griggs, M.D.Carol C. Nadelson, M.D.David B. Nash, M.D.Esther J. Nash, M.D.

TECHNICAL CONSIDERATIONS AND

ESTABLISHING STANDARDS FOR SCORING

CLINICAL PERFORMANCE IN SIMULATED

CLINICAL ENCOUNTERS

Organizer: Nu Viet Vu, Ph.D.

Moderator: Victor R. Neufeld, M.D.

Panel: Barbara J. Andrew, Ph.D.John Norcini, Ph.D.Paula L. Stillman, M.D.

IMPLICATIONS OF PROSPECTIVE CURRICULUM

PLANNING

Organizer: Abdul W. Sajid, Ed.D.

Moderator: Julian Kitay, M.D.

Panel: Steven Jonas, M.D.Arthur Rothman; Ed.D~Abdul Sajid, Ed.D.

STRESS IN CLINICAL TRAINING:

CAUSES, RECOGNITION AND INTERVENTION

Organizer/Moderator: Gordon L. Noel, M.D.

Panel: Dennis Cope, M.D.Carol Nadelson, M.D.David Reuben, M.D.

VOL. 60, -MARCH 1985

USE OF THE oseE (OBJECTIVE STRUCTURED

CLINICAL EXAMINATION) TO ASSESS

CLINICAL COMPETENCE

Organizer: Christel A. Woodward. Ph.D.

Moderator: Peter Powles, M.D.

Panel: David Cadman, M.D.Lynn Curry, Ph.D.Ian R. Hart, M.D.

STRATEGIES FOR INTEGRATING THE BASIC

AND CLINICAL SCIENCES

Organizer/Moderator: Madelin~ Beery

Panel: Nancy Allen, Ph.D.Howard S. Barrows, M.D.Arthur Christakos, M.D.William Mattern, M.D.

STUDENT AND APPLICANTINFORMATION MANAGEMENTSYSTEM

October 29 and 30

The AAMC's extensive data on medical schoolapplicants and students are being assembledto form a comprehensive data base called theStudent and Applicant Information Management System (SAIMS). The purpo~ of thesystem is to facilitate studies of trends in applicant and student characteristics and to assistmember institutions with their own- institutional studies.

Annual Meeting participants were invitedto visit and learn about this new facility. Services available to medical schools were described, and questions regarding utilization ofthe data were answered. Materials on otherAAMC data bases, including the InstitutionalProfile System and Faculty Roster System,were also available.

Minutes of AAMC Assembly Meeting

October 30, 1984

Chicago, Illinois

Call to Order

- Dr. Robert M. Heyssel, AAMC Chairman,called the meeting to order at 8:15 a.m.

~ Quorum Call'

a Dr. Heyssel recognized the presence ofai,. quorum.

~~] _ Consideration of the Minutes~ 38- The minutes of the November 8, 198 ,~- Assembly meeting were approved withoutB change.oz~ _ Report of the Chairman

~ Dr. Heyssel began by commending members~ of the Executive Council and Administrative§ I Boards whose terms were expiring:] · From the Executive Council: Steven Beer] ing, John Chapman, Pamelyn Oose, Robert~ Frank, Earl Frederick, Fairfield Goodale,~ Frank Wilson1:Ja Council ofDeans: John Chapman, FairfieldB8 Goodale

Council ofAcademic Societies: BernadineBulkley, Frank Wilson

Council of Teaching Hospitals: RobertFrank, Earl Frederick, Irwin Goldberg

Organization of Student Representatives:Tim Brewer, Daniel Cooper, Steve Hasley,Patrick Hennessey, Mark Schmalz, EdSchwager, Mary Smith

Dr. Heyssel discussed a number of developments relating to current financing arrangements for graduate medical education. He hadappointed an AAMC committee on financinggraduate medical education, under the chairmanship of J. Robert Buchanan. The committee is charged with developing an AAMCposition on how residency training programsshould be supported.

The final report of the Association's General Professional Education of the Physicianand College Preparation for Medicine studyhad been released the previous month, andmore than 37,000 copies had been distributed.The Executive Committee would be considering mechanisms for formal Association response to the report's recommendations at theofficers' retreat in December.

Dr. Heyssel announced that the AmericanHospital Supply Corporation h~d given theAssociation a gift to fund a John A. D. CooperLecture as part of the annual meeting plenarysessions. The lecture would be inaugurated atthe 1985 meeting.

Report of tbe President

Dr. John A. D. Cooper reported that the Association was predictinga decline in applicantsfor the 1985 medical school entering class.The decline was estimated to be 7.8 percent,with fewer women and minorities applying.

A number of legislative items adopted inthe final days of the 98th Congress were ofconcern to academic medical centers. Awaiting presidential signature or veto were theLabor, HHS appropriations bill, the NIH renewal bill, renewed authorizations for thehealth manpower $tatutes, and legislation relating to organ transplantation, to patents, andto employee educational assistance.

The AAMC, the American Medical Association, and the American Physiological Society had been working together to develop acoordinated response from the scientific community to growing threats from organizationsdedicated to the elimination of animals assubjects for biomedical and behavioral research. It was expected that around the first ofthe year a document outlining an overall strategy would be distributed to organizationswhich might wish to join such a cooperativeeffort.

Dr. Cooper reported on several joint activ-

227


ities of the AAMC and the Association ofAcademic Health Centers, including cosponsorship of a study on university ownership ofteaching hospitals and the development ofpo- ~

sition papers for the Joint Health Policy Committee of the Association of American Universities, American Council on Education,and the National Association ofState Universities and Land-Grant Colleges.

Report or the Council or Deans

Dr. Edward Stemmler reported that the CODhad reviewed and discussed an issues paperdeveloped by the Administrative Board tomake the Council more effective as it lookedat the future ofthe organization.

The new COD Chairman would be ArnoldBroWIi. D. Kay Oawson would be ChairmanElect, and new board members were WalterLeavell; Thomas Meikle, and Henry Russe.

Report or the Council of Academic Societies

Dr. Virginia Weldon stated that the CAS hadconsidered a white paper describing issues andchallenges for faculty. The CAS had assignedpriority in· the areas of appropriations forbiomedical research, research training, educational priorities, fesearch faculty development,financial aid, and the use of animals in research.

The CAS had received information on ongoing studies on research facilities and hadreviewed appropriate actions with respect tothe use of animals in research. The Councilhad also discussed the autonomy of specialtyboards, particularly relating to the plans ofsome boards to increase the period ofgraduatemedical education required for board certification.

Report of the Council o~Teaching ~ospitals

Mr. Haynes Rice reported that the COTHprogram had been concerned with how to dealwith uncompensated care in a research envi-.ronment.

During the y~ the. COTH Board had revieWed.several issues relating to Medicare, including the. progress of the Prospective Pay-

VOL. 60, MARCH 1985

ment System Assessment Committee, the report from the AAMC's Committee on capitalcosts in teaching hospitals, and 18 studies thatHCFA would be conducting or supervisingrelating to reimbursement issues.

The COTH Spring Meeting had included adiscussion ofthat Council's issues paper, "NewChallenges for the Council of Teaching Hospitals and the Department of Teaching Hospitals."

Mr. Rice reported that Earl Frederick, former chairman of the Council of TeachingHospitals, had been elected to the Board -ofTrustees of the American Hospital Association. Sheldon King would be the new cornChairman and C. Thomas Smith the Chairman-Elect, and n~w Board members wereRobert Baker, Gary Gambuti, and JamesMongan.

Report of.the Secretary-Tr~urer

Mr. Rice referred the members of the Assembly to the detailed Treasurer's report in theagenda book and indicated that the AuditCommittee had found no irregularities in theAssociation's annual audit report.

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

Report or the OrganizationofStudent Representatives

Dr. Pamelyn Oose reported that the OSR haddeveloped ethical guidelines for medical students and had published an edition ofthe OSRReport on ethical issues. The OSR programon October 26 had featured Quentin Youngand Robert Petersdorfin a discussion of"ThePhysician as Health Advocate: Responsibilities and Barriers."

Discussion sessions on the GPEP report hadresulted in a number of directives to the Administrative Board.

Ricardo Sanchez had become Chairpersonand Richard Peters. Chairperson-Elect. NewBoard membeJ.:S. were Sharon Austin, ,VlckiDarrow, John DeJong, Kimberly Dunn,:K.irkMurphy, Miriam Shuchman, and Kent Wellish..

1984AssemblyMinutes

Election of New Members

ACTION: On motion, seconded, and eamed,the Assembly by unanimous ballot elected thefollowing organizations, institutions, and individuals to the indicatedclass ofmembership:

Institutional Member: Universidad Centraldel Caribe Escuela de Medicina de Cayey

Academic Society Members: American College ofPsychiatrists; American OrthopaedicAssociation; University Association for Emergency Medicine

Teaching Hospital Members: Arkansas Children's Hospital, Little Rock, Arkansas; Carraway Methodist Medical Center, Birmingham,Alabama; Children's Hospital, New Orleans,Louisiana; Germantown Hospital and MedicalCenter, Philadelphia, Pennsylvania; MemorialMedical Center, Savannah, Georgia; St. Elizabeth's Medical Center, Dayton, Ohio; St.Mary's Hospital, San Francisco, California;TheToledo Hospital, Toledo, Ohio; VA MedicalCenter, Mountain Home, Tennessee

Corresponding Members: Bayfront MedicalCenter, St. Petersburg, Florida; John PeterSmith Hospital, Ft. Worth, Texas; The MedicalCenter, Columbus, Georgia

Distinguished Service Members: Ivan LBennett, Jr., Robert L Tuttle, Frank C. Wl1son,Jr.

Emeritus Members: Woodward D.Beacham, William P. Longmire, Woodrow W.Morris, C. H. William Rube

Individual Members: List attached to archive copy ofthese minutes.

Report of the Resolutions Committee

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

Report of the Nominating Committee

Dr. Richard Reynolds, a member of theAAMC Nominating Committee, presentedthe report of that committee. The committeeis charged by the bylaws with reporting to theAssembly one nominee for each officer andmember of the Executive Council to beelected. The following slate of nominees waspresented: Chairman-Elect: Virginia V. Weldon; Executive Council, COD representatives:William Butler and Robert Daniels for three-

229

year terms, L. Thompson Bowles for a oneyear term; Executive Council, COTH representative: William Kerr.

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

Installation of New Officers

Dr. Richard Janeway was installed as theAAMC's new Chairman. Dr. Janeway announced the appointment of the followingindividuals to the AAMC Presidential SearchCommittee: Richard Janeway, chairman protempore, William Anlyan, Steven Beering, Arnold Brown, J. Robert Buchanan, PamelynOose, John Colloton, Ronald Estabrook,Robert Petersdol"f: and Virginia Weldon. Hefurther announced that the search committeewould meet for the first time during the December AAMC officers' retreat and that thecommittee would consult widely both withinthe constituency and with other organizationswith which the Association interacts.

Resolution of Appreciation

ACTION: On motion, seconded, and ctm'ied,the Assembly adopted the following resolutionofappreciation:

WHEREAS, Dr. Robert M. Heyssel has diligently served the cause ofacademic medicinethrough his exemplary leadership as presidentofthe Johns Hopkins Hospital, andWHEREAS, he has distinguished himself byhis contributions to theAssociation ofAmericanMedical Colleges as a member and chairmanofthe Council of Teaching Hospitals, the Executive Council, and the Assembly, andWHEREAS, he has been much admiredjOr hisimaginative approaches to the thorny issue ofcost control in teaching hospitals, demonstrating the advantages of plastic cutlery and thesavings to be made by eliminating the wastefulpickle chip,NOWBE IT RESOLVED that the Associationexpress our sincere appreciation for his serviceand ourhope that the Association maycontinueto profit from his involvement in our activities.

Adjournment

The Assembly adjourned at 9:05 a.m.

Annual Report

1983-84

Note: The President's Message appeared in theFebruary 1985 issue of the Journal ofMedical

Education as an editorial.

Executive Council, 1983-84

Robert M. Heyssel, chairmanRichard Janeway, chairman-electSteven C. Beering, immediate past chairmanJohn A. D. Cooper, president


Robert L. HillJoseph E. Johnson, IIIVirginia V. WeldonFrank C. Wilson, Jr.

DISTINGUISHED SERVICE MEMBER

Charles C. Sprague

COUNCIL OF DEANS

Arnold L. BrownJohn E. Chapman

D. Kay OawsonFairfield Goodale·Louis J. KettelRichard H. MoyJohn NaughtonM. Roy Schwarz·Edward J. Stemmler

COUNCIL OF TEACHING HOSPITALS

Robert E. FrankEarl J. FrederickSheldon S. KingHaynes Rice

ORGANIZATION OF STUDENT REPRESENTATIVES

Pamelyn CloseRicardo Sanchez

I- I

f(

es'-sItAcc

-Ix

Administrative Boards of the .Councils, 1983-84.: ell_at.

': nt

. ac, Inerprmlofwe:A~

COUNCIL OF TEACHING HOSPITALS

Haynes Rice, chairmanSheldon S. King, chairman-electJ. Robert BuchananJeptha W. DalstonSpencer ForemanRobert E. FrankEarl J. FrederickIrwin GoldbergWilliam B. KerrGlenn R. MitchellEric B. MunsonDavid A. ReedC. Thomas SmithThomas J. Stranova

-mr_-an-ide'edt~poi:

uatuat

ORGANIZATION OF STUDENT REPRESENTATIVES rbiPamelyn Close, chairperson ~ ngRicardo Sanchez, chairperson-elect ng,Tim Brewer ncDaniel Cooper . heRoger Hardy :nclSteve Hasley trPatrick T. HennesseyRichard PetersMark SchmalzEd SchwagerMary Elizabeth Smith


Robert L. Hill, chairmanVirginia V. Weldon, chairman-electPhilip C. AndersonBernadine H. BulkleyDavid H. CohenWilliam F. GanongHarold S. GinsbergJoseph E. Johnson, IIIDouglas KellyJack L. KostyoFrank G. MoodyFrank C. Wilson~ Jr.

COUNCIL OF DEANS

Edward J. Stemmler, chairmanArnold L. Brown, chairman-electL. Thompson BowlesWilliam T. ButlerJohn E. ChapmanD. Kay ClawsonRobert S. DanielsFairfield Goodale·Richard JanewayLouis J. KettelRichard H. MoyJohn NaughtonM. Roy Schwarz·

• Resigned

232

IThe Councils

Executive Council

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

:s stituent councils. Policy matters considered by:::~ the Executive Council are first reviewed by the~ Administrative Boards of the constituent~ councils for discussion and recommendationo~ before final action.] The traditional December retreat for newly] : elected officers and senior staff of the Associ-~ ation provided an opportunity ·to review aE . number of the AssOciation's major ongoing~ activities and to develop priorities for the com

ing year. Constituent participation in the General Professional Education of the Physicianproject was discussed, and the 1984 annualmeeting program was planned to explore someof the challenges to medical education whichwere considered during the GPEP project. TheAssociation's new student and applicant infor-

,mation management system was describedland areas for potential research and studyidentified. Several aspects ofgraduate medical!education were discussed including the ape~'POintment ofresidents in the second postgrad,uate year, institutional responsibility for graduate medical education, the national account-

~ : bility ofcertifying boards in decisions affect-,ng the resources required for graduate trainng, and relationships between medical schoolsnd Veterans Administration hospitals. Sinceecongressional calendar for the coming year

Deluded NIH authorization legislation, thetreat participants considered appropriate As- .iation legislative strategy. Another concern

elated to the desirability ofinvolving medicalhool practice plans in the Association and

n the academic mission of medical schools.e COTH Board had developed an issuesper for that Council and a draft version was

presented for retreat consideration. Participants felt that similar papers should be developed by the other Councils so that all aspectsof the Association's programs could be reviewed by the governance structure. Otherissues discussed included the Association's relations with other organizations, corn membership criteria, and Medicare reimbursement.

Many of the issues reviewed and debatedby the Executive Council during the past yearwere concerned with graduate medical education. The Council had discussed problems associated with the appointment ofmedical students and graduates into specialty programsin the second postgraduate year. The currentsystem places an undue burden on students tomake early career decisions, requires dean'sletters to be written before critical evaluationsare available, and does not provide the mostlogical educational sequence for students. TheExecutive Committee met with representatives of those specialties to discuss their concerns and to understand better the needs ofthe specialties. Participants at that meetingendorsed a proposal that the National Resident Matching Program establish an advisorypanel of program directors from each of thespecialties. There was also agreement that aproductive dialogue had been initiated andshould be continued.

Of particular concern to the ExecutiveCouncil was action by the American Board ofPathology to lengthen training requirementsfor certification in that specialty. The Executive Council opposed this action since it wasfelt that the Board had acted without considering the opinions of the educational institutions and other programs which must providethe resources for the additional year of training. That other certifying boards were alsoconsideringsuch decisions without widespreaddiscussions within the academic communityheightened the Council's concern and led toits statement of formal opposition to the ac-

233


tion by the pathology board. As a member ofthe American Board of Medical Specialties,the AAMC introduced an amendment to theABMS bylaws to require such decisions to bediscussed by ABMS and concerned specialtiesbefore implementation.

TEFRA and the Medicare prospective payment system have revised reimbursement policies significantly. With these changes hascome renewed discussion of the appropriatepayment mechanism for graduate medical education. To assure that the views of the Association's constituents are considered in suchdiscussions, the Executive· Council has established a new AAMC committee on financinggraduate medical education. To begin thecommittee's deliberations, a special joint session of the administrative boards was held inSeptember 1984 to review ongoing studies, todiscuss alternative financing mechanisms, andto engage the governance structure and thecommittee in a review of these issues. TheAssociation also commissioned a paper byJudith Lave on the historical development andfuture prospect of the indirect medical education adjustment under the Medicare prospective payment system.

The Association approved the Special Requirements for the Transitional Year of theAccreditation Council for Graduate MedicalEducation.

Research and research training continue tobe important priorities ofthe Association, andmuch Executive Council attention has beendevoted to such issues. The Council's "Principles for the Support ofBiomedical Research"has been the cornerstone ofAssociation policyin this area and has been widely distributed toother organizations and policymakers.

The Council reviewed a number of studieson the status of research facilities and instrumentation and endorsed such efforts to document the research needs of universities andmedical schools.. The Council supported theobjectives ofthe University Research CapacityRestoration Act of 1984 and discussed changesto the legislation that would alleviate Councilconcerns with the treatment of NIH.

Methods of financing the construction ofresearch facilities were discussed and supportwas given for a new matching grant programfor this purpose. The Council also discussed

VOL. 60, MARCH 1985

how faculty salaries are charged to grants andcontracts; it was agreed that the Associationwould continue to provide information to itsconstituents in this area.

A major research issue that continuedthroughout the year concerned the use of animals in biomedical research. The proposedrevisions to the Public Health Service animalwelfare policy were reviewed and several problems with the revisions identified. The Councilstrongly recommended that Association constituents be urged to participate in educationefforts on the use of animals in research_andthat such educational efforts be conducted onthe local as well as national level. .

The Institute of Medicine of the NationalAcademy of Sciences was studying the organizational structure of the National Institutesof Health. The Council endorsed an Association submission to that study's steering com- 'mittee. The AAMC statement recommendedprogram selection and project funding basedon scientific promise and quality, congressional reliance on general authorities ratherthan detailed statutory prescriptions for NIH,ten-year reviews of the organizational structure of NIH for reaffirmation or revision,strengthening of the office of the NIH Director, and establishment of a forum at NIH inwhich advocates of programs could presenttheir views and learn of NIH efforts in theirareas of interest.

Discussions at the COD and COTH springmeetings on relationships between some oftheAssociation's constituents and investor-ownedorganizations had resulted in a survey on medical school contacts with for-profit organiza- ~,

tions. It was agreed that the Association wouldcontinue to monitor such activity, but that fbecause of the diverse and strongly held opinions of its constituents, no action to changemembership policies would be taken at pres- .ent.

A new program offaculty development willbe sponsored by the Association. With the cosponsorship of the American Council on Education, a National Identification ProjectForum for Women will be held in February1985 to foster professional advancement forwomen into senior positions in medical centeradministration.

The Executive Council's continuing review

1983-84 Annual Report

of important medical education policy areaswas augmented by the work of a number ofcommittees. The final report of the GeneralProfessional Education of the Physician andCollege Preparation for Medicine study wasreceived by the Executive Council and willserve as the basis for new Association policiesand programs in the years ahead.

The final report of the ad hoc Committeeon Capital Payments for Hospitals was alsopresented. The Council endorsed a policy thatwould allow institutions to choose either costreimbursement for depreciation and interestor a prospective capital add-on. This committee was chaired by Robert Frank, president ofBarnes Hospital.

The Executive Council continued to over-:=:

~ see the activities of the Group on Business~ Affairs, the Group on Institutional Planning,i the Group on Student Affairs, the Group on~ Public Affairs, and the Group on Medical] Education.] The Executive Council, along with the Sec-~ retary-Treasurer, Executive Committee, andB_the Audit Committee, exercised careful scru~ tiny over the Association's fiscal affairs and~ approved a modest expansion in the general~ funds budget for fiscal year 1985.~ The Executive Committee met prior to each~ Executive Council meeting and conducted] business by conference call as necessary. Dur] ing the year the Executive Committee met~ with Assistant· Secretary for Health Edward~ Brandt. They also met with the Executive~ Com~ittee of the Association of Acad.emic§ . Health Centers to discuss issues of mutualQ ,t

concern.

.Council of DeansJt The Council of Deans activities in 1983-84were dominated by its two major ~eetingsthe business meeting at the Association's annual meeting in Washington, D.C., and thespring meeting in Pine Mountain, Georgia.During the interim the Council's Administrative Board met quarterly to review ExecutiveCouncil agenda items ofsignificant interest tothe deans and to carry on the business of theCOD. More specific concerns were reviewedby sections ofdeans brought together ~y common interests.

235

At the program session of the annual business meeting, William H. Luginbuhl, dean,University of Vermont College of Medicine,gave the feature presentation on health carecost containment. Discussions at the businessmeeting centered on commercial sponsorshipof medical education programs, problems associated with federal intervention in decisionson the medical treatment of severely handicapped infants, and the management andreimbursement of the indirect costs of research. Two resolutions were adopted by theCouncil. The first expressed concern that thepoll conducted in conjunction with the projectexamining undergraduate medical education(GPEP) prevented the expression ofimportantviews by the deans; the second was a resolutionexpressing appreciation to the AAMC president for his inspirational address opening themeeting.

Ninety-two deans attended the annualspring meeting April 1-4. Richard Schmidt,president, SUNY-Upstate Medical Center, began the first session with a discussion of theneed for adequate house officer supervision.Ronald P. Kaufman, vice president for medical affairs and executive dean, George Washington School of Medicine and Health Sciences, explored medical school relations witha for-profit hospital. Jerome H. Grossman,president, New England Medical Center, reviewed challenges to medical school/teachinghospital relationships brought about by changing demographics and new methods of reimbursement for medical services. An industrialist's perspective on medical care cost containment was provided by J. Paul Stiehl, chairman, R. J. Reynolds Industries, Inc. BaruchA. Brody, director, Center for Ethics, Medicine, and Public Issues, Baylor ~ollege ofMedicine, and H. Tristram Engelhardt, professor,department ofmedicine and community medicine, Baylor College of Medicine, presentedethical issues in a medical system designed tobe price sensitive. The second day was devotedto undergraduate medical education. ShermanMellinkoff; dean, University ofCalifornia, LosAngeles, UCLA School ofMedicine, discussededucating students in the clinical disciplines.He was followed by Robert L. Hill, chairman,department of biochemistry, Duke UniversitySchool of Medicine, on educating students in


the basic science disciplines. The presentationsstimulated discussion among the deans on issues bearing directly on their responsibilitiesas educators.

The spring meeting was preceded by anorientation session for new deans that introduced the AAMC leadership and staff andprovided an overview of the resources andprograms ofthe AAMC. At the spring businessmeeting, the Council discussed methods bywhich its membership could develop a greatersense of access to and influence on AAMCdecision-making. Board members and committee chairmen commented on their ownperceptions of effective channels of communication. The Council recommended revisionsin the Council ofDeans' roster to enhance itsutility. Also considered were the draft "LCMEStandards for Accreditation of Medical Education Programs Leading to the M.D. Degree,"medical education and international relations,the national earthquake conference, theAAMC clinical evaluation program, and aCOD issues identification paper which outlined the issues facing medical school deansand their implications for the COD as a con-

. stituent part of the Association and for theAAMC itself:

Sections of the Council that met during theyear were the southern and midwest deans andthe deans of new and developing communitybased medical schools. The deans of privatefreestanding schools convened a special meeting session at the COD spring meeting.

The Council endorsed its chairman's proposal that the annual meeting include additional events and meetings targeted to theneeds and interests of the deans. This newformat will provide more participation fordeans in discussions on issues and will alleviatethe concerns expressed at the spring meeting.

Council of Academic SocietiesThe Council of Academic Societies is comprised of 76 academic societies representingu.S. medical school faculty members and others from the basic and clinical science disciplines. The Council convened two meetingsduring 1983-84.

The CAS meeting at the 1983 AAMC an-

VOL. 60, MARCH 1985

nual meeting addressed "Research Support: AConsensus Is Needed." A series of speakers caddressed concerns that in an era ofdiminish- ~

ing resources, advocacy for disease and pro- (gram-specific interests within the overall pro- fgram for biomedical and behavioral research rresulted in fragmentation of research effort fland funding rather than an increase in resources. Speakers included William F. Raub, lassociate director for extramural research, d:NIH, who spoke on "Research Funding Prior- tities ofthe National Institutes ofHealth," John 14

F. Sherman, vice president, AAMC, who Ieenunciated the AAMC's position on "Piinci- cl:pIes for the Support of Biomedical Research," W'

John Walsh, reporter for Science, who dis- pcussed "Congressional 'Micromanagement' of itthe NIH," Leonard Heller, vice chancellor for IXacademic affairs, University of Kentucky . ttMedical Center, who reviewed "The Science m'of Politics and the Politics of Science," and . ~Sherman M. MellinkoO: dean of the Univer- '- tbsity ofCalifornia, Los Angeles, UCLA School .of Medicine, addressing the question "Can ch;Biomedical Research Survive Attacks ofCon- thlfused Lucidity?" JeT

The Council's annual spring meeting was wiheld in Washington, D.C., April 10-11, 1984. theRepresentatives ofthe societies participated in wh,a plenary session and workshops to identify meand explore the "Issues and Challenges FacingMedical Faculty in the Next Five Years." In . itshis keynote address, Kern Wildenthal, dean of .eac'the University ofTexas Southwestern Medical AdSchool, addressed the challenges raised by exa:the multiple roles and duties confronting an deteindividual faculty member including compete searing disciplinary and institutional demands. spe:Council members then were addressed by proLspeakers who articulated the issues and chaI- direlenges facing faculty in each of their three of fetraditional roles in education, research and Amfpatient care.

Victor Neufeld, chairman of the M.D. program at McMaster University and a memberof the Panel on the General Professional Ed·ucation of the Physician, addressed the explosive growth of knowledge, the increase in institutional complexity and changing patternsof health care delivery. Ronald Estabrook,professor of biochemistry at the University of

985 1983-84 AnnualReport

1: A Texas Southwestern Medical School, con,kers eluded there was concern for continued appro-ish- priation of research funds and their effectivepro- distribution, for appropriate training programslro- for future research faculty, and for the need to

arch modernize university research equipment andTort facilities.

re· Kenneth Shine, chairman of medicine ataub, UCLA, noted that an era characterized by a,reb, dramatic increase in access to health care hasior- been followed by an era emphasizing cost conobo tainment in care delivery. Faculties are chalwbo lenged to provide high quality health care andnei- clinical education within such a setting. Ed~h," ward Stemmler, dean at the University ofdis- Pennsylvania School of Medicine, stressed

~ ~' of that this was· a critical time for faculty to~ · for participate in governance and to concern~ ,cky themselves with clarifying and affirming theiro~ ~nce missions so that they would be prepared to] and, assist in the formulation of major policies at] ver-' their institutions.~ 1001' After workshops further discussed theseE :an challenges, the CAS concluded by considering~ :on- the role it might play in meeting these chal-

lenges. The deliberations at the spring meetingwas will form the basis ofan issues paper reviewing'84. the challenges and strategies for meeting themj in which will be considered at the next annualtify meeting.~ng The CAS, Administrative Board conductsIt In its business at quarterly meetings held prior tolof each Executive Council meeting. In April theical Administrative Board undertook a thoroughby examination ofthe growing concern about thean deteriorating condition of institutional re

let· search facilities and instrumentation. Guestuk speakers included Helen H. Gee, chief of the

by program evaluation branch ofthe office ofthe,w- director, NIH, John C. Crowley, the directorree of federal relations for science, Association oflnd American Universities, and Carol R. Sche

man, director of federal relations for healthlro- and biomedical research, AAU. The Board',bet reviewed a series ofstudiescurrently undelWay:.d. to document and quantify the need for major,10- new investment in the physical plant at re-in- h institutions. Discussion centered both

;rns n the perceived deterioration in the research)k, nfrastructure and on proposed and contem."of fated policies to remedy such deterioration.

237

At its June meeting, the CAS and CODAdministrative Boards met jointly to discussattempts to restrict the use of animals in research. A briefresume was provided ofcurrentbills before Congress and there was discussionof the recent attack on the laboratory of aresearch scientist at the University ofPennsylvania School of Medicine and theft ofrecordsof long term research projects. A successfuleffort to educate the public and state legislature in California concerning the threat toresearch implicit in a bill to restrict the use ofpound animals was analyzed. Members weremade aware of a national effort by societiesmost concerned with the use of animals inresearch to form a working group which couldundertake a more concerned effort to deal withlegislative, regulatory or public pressurethreats to limit the use ofanimals in research.

The Association's CAS Services Programcontinued to assist societies desiring speciallegislative tracking services. Six societies participated in the program in 1983-84: theAmerican Federation for Oinical Research,the Association of Professors of Medicine, theAmerican Academy of Neurology, the American Neurological Association, the AssociationofUniversity Professors of Neurology and theChild Neurology Society.

Council of Teaching HospitalsTwo general membership meetings highlighted the activities of the Council of Teaching Hospitals in 1983-84. On November 7ththe COTH General Session, held annually aspart of the AAMC annual meeting, addressed"Moral Dilemmas and Economic Realities."Laurence B. McCullough, associate professorofcommunity and family medicine and seniorresearch scholar at the Kennedy Institute ofEthics of Georgetown University, discussedthe role of hospital administrators in ethicalproblems facing the medical community. Hestressed the need for clarity ofreasoning, rigorand consistency in reaching the resolution ofa problem, and developing the appreciation ofand tolerance for the ongoing challenge tobalance the demands of conflicting moralprinciples and the obligations they generate•James Bartlett of Strong Memorial Hospital

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238 Journal oJMedical Education

and Charles O'Brien of Georgetown University Hospital responded to Dr. McCullough'sremarks, raising questions regarding ethicalbehavior and moral dilemmas facing teachinghospital chiefexecutive officers.

Senator David Durenberger was the keynote speaker for the 7th COTH spring meetingheld May 16-18 in Baltimore. The Senatorreiterated his position favoring competitionand consumer choice in the health care marketplace, although he recognized that suchcompetition could place teaching hospitals ina difficult position. To provide a more equitable, competitive environment for teachinghospitals, Durenberger indicated his interestin developing a state block grant program tofinance graduate medical education.

Two main themes carried the meeting:changes to the teaching hospital organizationand environment and the relationship ofinvestor.owned corporations to the teachinghospital. Robert W. Crandall, senior fellow,the Brookings Institution, described the restructuring of a variety of marketplaces toemphasize competition in other industries.Observing that entrepreneurial activity was thekey to development of competition in otherindustries, Crandall believes hospitals mustdevelop more entrepreneurial activities intheir new marketplace. Karl D. Bays, chairman ofthe board, the American Hospital Supply Corporation, described the conflicting signals being received in the re-regulated marketplace, including competition, use of waivers,rate setting, access to care, business coalitionsand the attitude of the general public. Theneed for a more efficient system was repeatedly emphasized. The alternative to efficiency,Bays said, is more federal control and perhapssecond rate medical care.

Addressing the problem of paying for charity care, Lawrence Lewin, president of Lewinand Associates, demonstrated that appropriatepolicy responses require identifying characteristics both of individuals unable to pay forservices and of hospitals providing the care.He noted that the problem is most acute inpublic teaching hospitals located in large cities.James Isbister, senior vice president, federalprograms, Blue Cross and Blue Shield, described changes in consumer choice of insur-

I"

VOL. 60, MARCH 1985 I

ance coverage based primarily on level ofpremium. Gordon Derzon, superintendent, theUniversity of Wisconsin Hospital and Clinics,and Robert Zelten, associate professor, theWharton School, each discussed operatingchanges necessary to compete in the new environment. Derzon emphasized that restructuring for pre-paid health care with its assumption ofprovider risk should be an objective of the teaching hospital. Zelten describedthe options available for hospitals rangingfrom simply supplying services to organizingand underwriting health programs.

Judith R. Lave, professor ofhealth economics, the University of Pittsburgh, reviewed thehistorical development and future prospects ofthe indirect medical education adjustment under the Medicare prospective payment system.James Bentley of the AAMC made observations about the impact of the prospective payment system on COTH members from thepreliminary results of an AAMC survey.

Three speakers presented case studies exploring the relationship ofinvestor-owned corporations to the teaching hospital. They wereRonald P. Kaufman, vice president far medical affairs and executive dean, George Washington University Medical Center, Donald R.Kmetz, vice president for hospital affairs anddean, University ofLouisvill~ School ofMedicine, and J. Robert Buchanan, general director of the Massachusetts General Hospital.

AAMC staff member Richard Knapp presented the discussion paper "New Challengesfor the Council ofTeaching Hospitals and theAAMC Department of Teaching Hospitals."The meeting concluded with a spirited discussion of the possible inclusion of investorowned hospitals in COTH.

The Administrative Board of the Councilof Teaching Hospitals met four times to 'conduct business and discuss issues ofinterest andimportance. Substantial attentionwas devotedto the Medicare prospective payment systemand its effects on teaching hospitals. A surveyinstrument to determine the impact ofthe new'payment system was reviewed and approved.Other topics at the COTH Board meetingsincluded new JCAH requirements, residentsupervision in teaching hospitals, and participation of investor-owned hospitals iIi COTH.

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85 1983-84 AnnualReport 239

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Medical Students: A Hands-On Workshop"by Lisa Leidan, research assistant, UniversityofArizona College of Medicine, and "Retaining Your Humanism in the Face of Technologic Explosion" by Robert Lang and AlanKliger, both associate professors of medicineat Yale University School of Medicine. Inaddition to attending regional and business.meetings, which included a presentation fromWesley Oark, a member of the professionalstaffofSenator Edward Kennedy, OSR members identified'a series of issues important tostudents. Plans were formulated by smallgroups for addressing the following issues during the year: ethical responsibilities ofmedicalstudents, student financial aid, housestaffconcerns, developing teaching skills, career decision issues, highlighting the social responsibilities ofphysicians, and curricular innovations.

At its four meetings during the year, theBoard considered many of the ExecutiveCouncil's agenda items, shared informationon regional OSR projects including the springmeetings, and discussed updates provided bystaffon the addition ofan'experimental essayto the MeAT, the need to educate medicalstudents about the role ofanimals in research,renewal of health manpower legislation, andfinancial aid program updates. Two Administrative Board projects underway are a compendium of residency interview travel tips toassist fourth-year students to economize andplan efficiently and ethical guidelines for medical students during the clinical years.

Two issues of OSR Report were distributedto medical students. The Spring 1984 issue,"Ethical Responsibility and the Medical Student: Setting Personal and ProfessionalGoals," included guidelines for traversing thepath from perceiving a moral dilemma to acting on it and probed dilemmas physicians face.The Fall 1984 issue, "Economic Changes Affecting Medical Practice: What Do MedicalStudents Need to Know?" described the ongoing revolution in health care financing. Italso offered students advice on coming toterms with new limitations on the use of medical resources and on physicians' autonomy.

Organization ofStudent RepresentativesAgain this year 123 medical schools designateda student representative to the AAMC. Approximately 1SS students from 98 schools attended the 1983 Organization ofStudent Representatives annual meeting. The first programwas sponsored jointly with the Society forHealth and Human Values on "Ethical Dilemmas of Medical Students: Questions No OneAsks." Observations on ethical conflicts confronting third and fourth year students wereoffered by Joanne Lynn, a practicing physician; Kathryn Hunter, assistant professor ofhumanities in medicine, University of Rochester Medical Center; Brent Williams, residentin internal medicine, University of Virginia;

. and Louis Borgenicht, assistant professor ofus- family and community medicine, University.or- ofUtah School ofMedicine. Then Society and

OSR members held small group discussionslcil on ethical cases prepared by the OSR Admin

istrative Board. On Saturday afternoon, Hilliard Jason and Jane Westberg ofthe NationalCenter for Faculty Development in Miamipresented a session on "Becoming an EffectiveQinical Teacher-For Yourself, Your Patients and Others," followed by teaching skillsdiscussion groups. Two programs offered onMonday afternoon were "Computers and

lre- The Board asked that the COTH membershipthe express its views on the latter issue at the next

Council business meeting.Under the guidance of the COTH Admin

istrative Board, AAMC staff prepared "NewChallenges for the Council of Teaching Hospitals and the Department of Teaching Hos.

, pitals." Outlined in the paper are major trends. facing teaching hospitals and managerial needs

receiving increased attention. The paper describes the environment for the Council ofTeaching Hospitals, the growth in hospitalorganizations competing for national attention, and the members of the Council. Thediscussion paper was sent to all AAMC constituents for review'and comment.

·cl·otH.

National Policy

Events during the twelve months since the lastnational policy review have increasingly comeunder the influence of presidential electionyear politics. Of those legislative and regulatory issues in which the academic medicalcommunity has an interest, many that theAssociation perceives as of the highest publicbenefit have languished, while other legislationhas acquired unexpected momentum. Whatever the merit of much of the activity on the

- national scene over the past year, there isgeneral agreement that the impending presidential election has made it an extremely busyone.

This was the year to ensure recommitmentto a major national policy decision taken in1963 when the Congress initiated direct support to medical education. Authorities in TitleVII ofthe Public Health Service Act for healthprofessions educational assistance were expiring, and the AAMC testified for their renewalbefore the Senate Labor and Human Resources Committee. Since no bill had beenintroduced, the Association generally advocated simple extension of current law withgenerous authorization ceilings, stressing theneed for federal support of student financialassistance and targeted educational initiatives.

Senate health manpower legislation (S.2559) was eventually introduced in April bySenator Orrin Hatch, while Senator EdwardKennedy circulated an alternative bill. Theeventual compromise proposed a four-yearreauthorization of all programs of interest tothe AAMC. Unfortunately, except for theHealth Professions Student Loan and the Disadvantaged Assistance programs, the authorization ceilings only slightly exceeded FY 1984appropriations. Authority for equipment andinstrumentation grants was added. Modifications of the HPSL program would: allow theIRS to release to institutions the present addresses of borrowers whose loans are in default; give HHS the authority to collect on

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'atdefaulted loans; allow insurance premiums to grbe charged to cover losses for borrower death fu,and disability; and direct all new capital con- tis:tributions to schools that entered the program fOl

after July 1, 1912. Apparently persuaded by viepredictions of a high default rate for HEAL ph'loans, the Senate empowered HHS to raise theinsurance premiums from 2 to 6 percent. In wa,addition, HHS would be required to study Ntfinancial disincentives in certain physicianspecialty and practice location choices and torecommend legislative solutions. This pro.posal cleared the full Senate in late June.

A companion bill, S. 2281, to continue theNational Health Service Corps and to autho~

ize 150 new NHSC scholarships annually hereported in late March. The bill requires ' elong-term staffing plan for the Corps and com rcbines two private practice loan option author· n,ities. The AAMC has long felt that as the ng,national supply of physicians increases, the °ocneed for a NHSC diminishes. The NHSC °sescholarship program, with its high unit costs, ehas been traditionally justified on the basis of n"the field program needs. To the extent that the on~

need for the Corps is fading, so too is that for °erethe scholarship program. The amount of termoney now expended on NHSC scholarships he:could be used more effectively in other student infinancial assistance programs. Nevertheless, UIT

the Senate subsequently passed the NHSC and ethe NHSC scholarship programs without neeamendment. xter

The AAMC also testified at a House Sub- uarcommittee on Health and the Environment Prhearing in late April on the renewal of Title is tVII authorities, although no bill had been ere'introduced. The Association's position was es- lit:sentially the same as in the Senate, but call eterparticular attention to the deleterious effi Yenofunderfunding ofthe Health Professions Stu ident Loan and Exceptional Financial N oreScholarship programs and the urgency of at udgeleviating the burden ofthe debts accumulat

240

1983-84 Annual Report

- by medical graduates. Other items on the Association's priority list were geriatric education, computer applications to medical information management, and the growing problems of deterioration of the capital plant formedical education. A House bill, H.R. 5602,was reported by the Energy and Commerce.Committee in early May. It provided generous:authorization ceilings for almost all the pro

lS to grams endorsed by the AAMC. However, a-eath full Committee amendment to ensure biparcon- tisan support reduced the authorization from,-am ',four to two years. Some members felt that in.d by view of the predictions of an oversupply of,EAL physicians, a more frequent reexamination ofraise the continuing need for these programs wast. In warranted. H.R. 5602 also reauthorized the

~1udy NHSC programs, maintaining the field pro~ ician m at higher levels than allowed for in the~ld to nate bill and providing SSO new scholarships~ pro- ch year.] Medical students also use assistance pro-1~ the ms authorized in Title IV of the Higher~hor ucation Act. A bill (H.R. 4350) to reau-E horize that student loan consolidation au-~ -es . ority passed the House in November. The~ =om roposal granted consolidation authority to~ hor- nks as well as to the Student Loan Market~. the ng Association, shortened the repayment pe-~ the "ad of consolidated loans to 1S years, and~HS( "sed the loan interest rate to nine percent.S~osts, eSenate bill introduced in April contained~ ;is of n "ability to pay" provision requiring loan~ .t the onsolidation recipients to undergo a two~ t for "ered "needs" test and included a nine percent~ ,t of terest rate on the consolidated loans, except

;hip here a PLUS!AlAS loan superseded. The:lent ill was reported from the Senate Labor andJess, uman Resources Committee in early May.,and eprincipal matters at issue in any confer-lout nee are the "needs" tests and the propriety of

xtending consolidation authority to state loanSub- uarantee agencies.

ent President Reagan's release on February 1ofTitle is budget request for FY 1985 initiated thexen creasingly complex and progressively mores es- Iitical annual cycle of events leading to the1 ennination ofthe level ofexpenditures and

~ venues for the next fiscal year. In each sue-Stu ing year the process seems to become~ ore divergent from that prescribed in the~ a1 udget and Impoundment Act. This year, the.at

241

budget resolutions and reconciliation instructions to set ceilings on appropriations levelsand to suggest legislative approaches toachieve required compliance with the expenditure ceilings were embodied in unusual vehicles: the Tax Reform Act of 1984 and separate, differing and unconferenced Senate andHouse budget resolutions.

As a result of explicit expenditure reductions and the net increase in taxes, the TaxReform Act of1984 provides that a $63 billion"down payment" on the deficit be made overthe period FY 1985-FY 1987. Among theprovisions to accomplish this are: Medicareexpenditure reductions totaling nearly $8 billion, Medicaid expenditure increases ofabout$400 million, removal of tax exemption ontuition assistance to employees, except whenthe courses are related to the employee's job,limitation on the use oftax exempt state bondsand possibly on the availability of capital forthe Guaranteed Student Loan program, exemption from taxation oftuition remission forcollege employees only if the benefit is offeredon a non-discriminatory basis, and tax exclusion for the loans forgiven or cancelled bygovernment entities when the borrower provides professional services required by thelender.

Not included in the compromise tax billwas a Senate proposal to renew and expandthe scope of the 2S percent investment taxcredit provided to corporations for researchinvestments. Authorization for the tax creditdoes not expire until the end of 1985, but theSenate version of the tax bill made it permanent. AAMC had supported the tax credit inthe general belief that it would stimulate industrial support of research, including that inacademic settings, and because pressure toreduce the federal budget deficit by restricting"tax expenditures" is likely to make enactmentin 1985 even more difficult.

Further contributions to deficit reductionwere included in the budget resolutions passedby the House and Senate. The House versioninstructed its committees to achieve a total 3year savings of $182 billion by reducing discretionary expenditures. On the Senate side,the budget resolution called for 3-year savingsof$140 billion.

One of the truly bright spots this year has

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VOL. 60, MARCH 1985

tivities of ADAMHA requested $373 million,an increase of$17 million or five percent overthe FY 1984 level. Virtually all of the gainswere in the relatively small programs in drugabuse, alcoholism, and alcohol abuse. By contrast the Ad Hoc Group advocated an increaseof$47 million. The final recommendation bythe Senate Committee was for a $58 millionincrease and that of the House for one of$49million.

The full House ratified its AppropriationCommittee's recommendation for Labor/HHS/Education on August 1. The co!!~ter

part bill in the Senate has not yet passed. -The critically important partnership be

tween the Veterans Administration and academic medical centers is the basis for theAAMCs keen interest in the medical compo- ~nents of that agency's budget. In his FY 1985budget request, President Reagan proposed ur

veonly modest increases for medical care in theVA, but the increased amounts proposed for n:tbresearch were encouraging. The Association tourged the Appropriations Committees to in- ne'crease the medical" care budget by at least the wiprojected rate of increase in Medicare costs, : theadvocated parity between the staffing ratios inVA and private sector hospitals, and argued refor additional funding for medical research. TiHowever, the final appropriation bill added tio'less than one percent to the president's original resrequests for programs of concern to academic memedical centers.

More than a year ago, the House openeddebate on H.R. 2350, a lineal descendent ofthe series of House attempts initiated in early1980 to radicaIly restructure the statutory basefor NIH programs. Among other provisions,this bill renewed the expiring authorities oftheNCI, the NHLBI, the National Research Service Awards program, and the Medical LibraryAssistance program. It also proposed the elimination from Title IV ofany basis for relianceon broad general research authority (Section301), further extensive and far reaching revisions of that title, and detailed prescriptionsfor the management of NIH, including itsadvisory apparatus.

After securing an assurance- of AAMC support, Representatives James BroyhiIl and Ed·ward Madigan announced that they would


been the outcome of the work of the Appropriations Committees. The AAMC was encouraged by the determination ofthe Congressto pass a fiscal year 1985 appropriations measure for Labor/HHS/Education, coming, as itdid, on the heels of the substantial increasesfor the NIH in the FY1984 appropriations act.It should also be noted that the enactment ofappropriations legislation in FY 1984 had broken the four-year trend of funding throughcontinuing resolutions.

President Reagan sought only an $89 million (two percent) increase in the NIH budgetover expected FY 1984 expenditures. TheHouse and Senate Appropriations Committees, in accord with an historical trend towardapproving medical research appropriationssubstantially above the president's budget request, recommended levels for the NIH of$4,834.3 million and $4,932.6 million respectively, as opposed to the President's request of$4,567 million. These congressional figuresare all the more impressive because, unlike thelevel proposed by the president, they do notinclude unauthorized programs (researchtraining, medical library assistance, etc.; cancer control is also excluded from the Housefigure).

The congressional increases in the NIHbudget responded in large part to the importunings of the Ad Hoc Group for MedicalResearch Funding. This broad coalition ofmore than 150 health and medical organizations has attempted to persuade the Congressthat the level of appropriations for the NIHshould be in keeping with the extraordinaryscientific opportunities that have been uncovered through research. The Ad Hoc Group'srecommendation for the NIH budget for fiscalyear 1985 was $5.214 billion, a 16 percentincrease over FY 1984. AAMC testimony before both House and Senate appropriationssubcommittees supported the Ad Hoc Group'srecommendations for the NIH andADAMHA budgets, stressed the fundamentalrole ofbasic scientific research in the conquestofdisease, and called attention to the disturbing impact on the research community of thedownward trend in NIH's ability to fund approved research proposals.

The president's budget for the research ac-

985 1983-84 Annual Report 243

offered by Representative William Dannemeyer and another by Representative RodneyChandler, dealt with fetal research. The basisfor the AAMC's objections to the nursing institute centered on the belief that research innursing was predominantly related to health~rvices and not biomedical in character, andthe proposal brought nursing education underthe umbrella of the NIH. The AAMC is persuaded that a recently introduced Senate bill,S. 2574, which would elevate the current Division ofNursing within the Health Resourcesand Services Administration to "Bureau" status and create a National Center for NursingResearch, is a more reasonable means ofproviding needed impetus.to research in nursingand providing greater visibility to the profession of nursing at the national level.

The Dannemeyer amendment bans allforms of research on fetuses scheduled forabortion, except in cases where the research isto increase the chances of survival for thatfetus; it unnecessarily restricts fetal researchactivities already sensibly circumscribed byNIH regulations. It also eliminates the "waiverof minimal risk" provision whose retention ishighly desirable to permit policymakers to accommodate unexpected research opportunities. The Chandler amendment, intended tonullify the Dannemeyer language, essentiallytransfers current HHS fetal research regulations, including the waiver provision, into statute. While the NIH regulations are acceptable,the wisdom of codifying them in statute isquestionable, particularly in a rapidly changing area of research for which easier adjustment of regulations is more appropriate. TheAAMC opposed both the Dannemeyer andChandler amendments.

The NIH renewal Jegislation designed bythe Senate, S. 773, was reported in May 1983.This proposal made no attempt to recodifyTitle IV ofthe PHS Act, postponed legislationon the use of animals until its recommendedstudy of the need for thi$ could be completedby the National Academy of Sciences, andcontained a relatively small number of newauthorities, directives, administrative reorganizations, and report requirements. It did establish a new arthritis institute and imposed arequirement on the NIH in the prevention of

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offer a floor amendment in the form of asubstitute for H.R. 2350 that would simplyrenew expiring authorities. Since its authorization ceilings were identical to those in H.R.2350, the amendments neutralized funding asan issue of disagreement and thereby focusedthe debate clearly on the propriety ofstatutory"micromanagement" ofthe research programs

I of the NIH. The apparent partisan polarization on this question disappeared when Representative Richard Shelby joined as a cosponsor of the substitute, on the conditionthat it be expanded to include authorization

be- ofa new program ofresearch ~nters for healthpromotion and disease prevention.-

aca- Hoordebate was interrupted when the Con-~ the~, gress adjourned for its summer recess. Imme-l ~ diately thereafter, intense negotiations were,.., undertaken and in November a compromise~ lsed version of H.R. 2350 emerged. The minority] the members made clear to the Association that.g for8 the new proposal represented their best effortse ion to achieve a simple renewal, and that several~ in-E - new proposals had been kept out of the bill~ the with difficulty and these would be offered by

ls15, their proponents as floor amendments.s in The most significant gain achieved by thisued revision of H.R. 2350 was a reinstatement in"ch.1ed Title IV of the statutory recognition that Sec-inal tion 301 was the primary authority for the:mic research programs of the NIH. In addition,

many of the objectionable features th~t, in theaggregate, constitute micromanagement weredeleted. The proponents of simple renewalwere unsuccessful in eliminating provisionsthat order NIH to develop alternatives to theuse of animals in biomedical research and toestablish guidelines related to animals in research, create a National Institute ofArthritisand Musculoskeletal Diseases and mandatehe Director's Advisory Board, with the coin

sition of it as well as of the institutes' adviry councils prescribed to include an exnded number of members selected from

lelds such as law, public policy, health policy,onomies and management, thereby diluting

he scientific expertise available.When floor debate was resumed on the

evised bill, three amendments, all opposed byhe Association, were adopted. One created. aational Institute of Nursing. The others, one

VOL. 60, MARCH 1985

but goes far beyond this aim in mandating"institutional animal committees" in all re·: (search facilities, costly and unnecessary re- 'porting requirements for research personnel,and establishment of an information serviceon improved methods of animal experimentation. Representative George Brown has introduced H.R. 5725, a slightly modified vera iss'sion of the Dole bill. .

Another legislative response to the animal -n~

rights movement is embodied in H.R. 5098, u:introduced by Representative Robert Torri- atcelli. If enacted, it would affect all 'federal iragencies conducting research involving live DC

animals by requiring that all research propos- "gtals, after approval by a federal agency forfunding, be reviewed by a National Center forResearch Accountability to ensure that the ncproposal does not duplicate other research egi~

completed or in progress. Decisions would be e,made only after comprehensive literaturesearches. This bill is seriously at variance witthe philosophy and needs ofthe academic anscientific communities and wouid be costly.

The reach of animal welfare/animal righaction to influence the Congress has recentlexpanded to include appropriations legislationa Both House and Senate subcommittversions of the Department of Defense apprpriations bill for FY 1984 originally contain ndlanguage that would have prohibited the usof the appropriated funds for the purchaselive animals of any type for training studenor other personnel in the treatment ofwounproduced by any weapon. The Senate Apppriations Committee, largely through the ef.forts of Senator Daniel Inouye, modified tlanguage in its bill by limiting the prohibitioto cats and dogs; the AAMC had urged deltion of the restrictive language entirely. Iconference, the Senate provision prevailed anthe bill was subsequently signed into law. ·year the Humane Society ofthe United Statmobilized its membership to write the Cogress to urge that the NIH appropriations b"be amended to prohibit expenditure of thfunds for the purchase ofanimals from pouor shelters.

On the regulatory front, the NIH inApril published a draft proposal to amend ianimal care guidelines- and scheduled th


scientific fraud. Action on S. 773 was stalledin controversy over fetal research provisions.

Political pressures to create a separate National Institute for Arthritis and Musculoskeletal Diseases became very heavy in the latespring. Senator Orrin Hatch responded by arranging to bring S. 540, Senator Barry Goldwater's arthritis institute proposal, to the floorunder an understanding that only two amendments would be permitted. One would substitute the arthritis institute provisions of S. 773

. for those of S. 540; the other would establishin the congressional Office ofTechnology Assessment a function similar to that assignedthe now defunct National and President'sCommissions on Ethics in Medicine andBiomedical and Behavioral Research. Themodified bill cleared the Senate and was sentto the House in late May.

Almost immediately, the House acted on S.540 by striking all but the enabling clause andsubstituting H.R. 2350 for the provisions inthe Senate bill. It then unanimously approvedits version of S. 540 and appointed confereesto resolve the differences ,in the two versions.To date, Senate conferees have not been appointed. A delay in appointing conferees resulted from negotiations on representation ofthe whole range of Senate interests, includingthe remaining content of S. 773, on the conference table and by the Senate's heavy workload.

Legislation reauthorizing two of the majorresearch programs of ADAMHA was ratherroutinely passed in June by both the Houseand Senate. The low outyear authorizationceilings, particularly in the Senate ~ill, for theNational Institute of Drug Abuse and the National Institute on Alcohol Abuse and Alcoholism will severely constrain program growthin those areas.

Provisions in both House and Senate versions of NIH renewal legislation reflect growingcongressional responsiveness to the continuing importunings ofanimal welfare and animal rights groups. In addition to these legislative proposals, Senator Robert J. Dole has heldhearings on and revised S. 657, his proposalto amend the Animal Welfare Act. His bill isdesigned to strengthen and improve the' current· standards for the treatment of animals,

983-84 AnnualReport 245

District Court, largely on procedural grounds.However, the regulations were republished inessentially identical form in July after compliance with formal procedural requirements.The draft "Baby Doe" regulations requiredposting throughout hospitals of notices explaining the prohibition against failing to feedor care for handicapped infants, offered a tollfree number for reporting suspicious cases,involved state child protection agencies as wellas federal civil rights agencies in the investigation of cases, required those agencies toestablish written procedures for responding toalleged instances ofmedical negreet, and mandated that agencies provide protective servicesfor those infants, even if this necessitated obtaining court orders.

The proposed rule was opposed by theAAMC and, among others, the AmericanAcademy ofPediatrics, the American HospitalAssociation, and the American Medical Association. The AAMC expressed dissatisfaction with the regulations on the grounds thatthey were essentially identical to the invalidated March rule, insinuated that health careproviders callously allow children to die fromlack of treatment or malnutrition, and provided no guarantees against false accusationsand disruption of hospital activities duringinvestigations, or even that HHS would benotified in the event ofa decision to withholdtreatment or nutrition from a child. TheAAMC urged HHS to adopt an alternativeapproach, under which voluntary institutionalInfant Bioethical Review Committees wouldprovide advice and make recommendations indifficult cases.

The final "Baby Doe" regulation, effectivein January 1984 and called a compromise byHHSt took account ofobjections raised by theAssociation and others to only a minor extent.In the meantime, the-parents of another infant, "Baby Jane Doe," who was born withspina bifida, hydrocephaly and microcephaly,had decided against surgery, after carefullyconsidering the pros and cons of repair of thecongenital lesions. Almost as soon as the factsbecame public, HHS instituted suit to obtainthe infant's medical records, on the groundsthat only through a review of-these could itdetermine whether discrimination on the basis

ublic hearings. The Association reasserted itsndamental conviction that since there waso evidence of substantial abuse in animal

and use many aspects of the proposedliey were unwarranted. In addition to theodification of its animal care and use guide

·nes, the NIH also sponsored an open nationals in- posium on scientific and public policyvert issues related to animals in research.

It is hard to escape the conclusion that thelimaJ ntensity ofconcern about animals in research,5098, rrently manifest by both the national legis"orri· ature and the NIH, is for the most part aderal ·rect response to an extremely well-organized,live nd well-financed animal welfare/animal)p05- 'ghts movement. In addition to exerting influ-

~ y for nee on the national scene, this group has~r for ught to make its viewpoints prevail at SJate

~0. ,t the nd local levels. Its tactics include: lobbying§ ~b 'statures, public demonstrations, break-ins,~ Id be efts of experimental animals, vandalism of.g -ature xperimental data, and destruction of labora-~ ,wi ry equipment and instruments. The tempo~ rantivivisection protest is steadily mounting.~ oreover, with increasing frequency, clarity,Z nd openness, the movement is articulating

e total elimination of animal experimentaon as its principal objective.The Association has been increasingly in

olved as an active participant in the ethicalnd policy debate generally referred to as the

by Doe" problem. In. 1982, its parents'ded that their infant with Down's Syn-

orne and esophageal atresia should not berated upon or parenterally nourished but

allowed to die. A subsequent court decisionId that the parents had chosen a reasonableedical option and there was no basis forvemment intervention to overrule that paotal decision. The ensuing public controrsy has stimulated action in the executive,'slative and judicial branches of governentThe initial federal intervention was prem

on the prohibition in Section S04 of thehabilitation Act of 1973 of discrimination·nst the handicapped. Based on this as-

mption, the president in 1982 sent out aing against discrimination, and in March

83 HHS proposed regulations on the subThe latter were struck down by a Federal


of handicap had occurred. A lower court denial of government access to the records wasaffirmed by the U.S. Circuit Court; the latterconcluded that the Rehabilitation Act was notintended to apply to medical treatment decisions and was, therefore, not a legal basis onwhich to obtain access to the medical recordsof "Baby Jane Doe." While the court did notexplicitly strike down the regulations, it seriously undermined the basis on which theywere issued. Thereupon, the AAMC joinedfive other medical associations in a federal suitthat asked for an injunction against these regulations, arguing that, ifthe Rehabilitation Actwas not intended to apply to medical treatment decisions, it did not constitute a basisfor the HHS regulations. In May, the FederalDistrict Court ruled the final HHS regulationsinvalid.

While executive branch regulatory intervention was in progress, the Congress pursued adifferent approach. Both House and Senatebills were introduced that would require hospitals, physicians, and state child protection.agencies to ensure that medically indicatedtreatment was administered to all severely illinfants. In essence, the bills would, by ame~d

ment, codify the HHS regulations in TheChild Abuse Treatment and Prevention Act.The House bill passed in February. Efforts to .incorporate into the Senate version languagethat would be acceptable to the very broadspectrum of organizations deeply concernedwith this issue resulted in an agreement underwhich instances of withholding of medicallyindicated treatment would be reported to statechild protection agencies which are empowered to take any necessary legal steps to ensurethat such medically indicated treatment wasadministered.

Most medical organizations reluctantlyagreed to this language. The AAMC and theAMA refused because it still carried an implicit presumption that physicians did not actin the best interest ofsuch babies and becauseit would force physicians to embark on inhumane and unconscionable management regimes or face the sanctions of this law. Theagreement was formally introduced as a bipartisan compromise and passed the Senate unan-

VOL. 60, MARCH 1985

imously in late July; acceptance by the Houseis expected.

For the last several years, the efforts of thepharmaceutical industry and others to extendthe term of patents by the duration of thedelay in marketing due to FDA approval re- iquirements has been stalemated. Major ope rposition to patent term extension was based ~

on the conviction that less expensive generic (drugs should be made available sooner. A a,protracted negotiation finally led to the intra- Tduction of compromise legislation. The bills cproposed to shorten the FDA review process rby extending the procedure now used ~to ape itprove generic copies ofpre-1962 drugs to post- JX1962 drugs. They also extended the patent acterm for certain entities subject to FDA ape deprovaI. In instances ofextendable patents, theterm could be increased by a period of timeequal to half of that required for safety andeffectiveness testing and for FDA marketingapproval; in no case, however, could the extension exceed five years or the effective patentlife, fourteen years. The AAMC is interestedin providing adequate patent protection forthe discoveries made by medical school faculties and the need for incentives to continue toinvest in innovative pharmaceutical research.

Another issue that has emerged on the national agenda is organ transplantation policy.As survival of transplanted organs and the lifeexpectancy of transplant patients has improved, a drastic imbalance has developed be·tween the demand for and the availability ofpotential donor organs as well as resources tofund the costly medical and surgical procedures involved in-organ transplantation. Bothhouses have passed legislation to improve anational information system on organ transplantation. A conference on the differences inthe two bills is expected.

The Association continued its involvementwith problems about disposal of nuclear andhazardous waste materials. Under proposalspending before legislative committees in bothchambers, four separate groups of states thathave ratified compacts would be authorized tomanage their own low-level radioactive wastedisposal sites and to exclude other states fromaccess to these sites. Since only three shallowland burial sites, but at least seven "compact

.985 1983-84 AnnualReport

~use groups" currently exist, vital biomedical re-search and health care activities could be in

.. the terrupted if the current January 1, 1986, deadtend line is not extended. The logjam on the state• the . level accounts for the unwillingness or inabil1 re- ity of the compact authorizing committees toop- report out the four compacts submitted. But

ased pressure to act is being brought to bear on theleric Congress by the three states now saddled with". A I all ofthe·nation·s low-level radioactive waste.1tro- The AAMC has urged its·constituency to en·bills courage action in those states which have not

:>CeSS ratified compact' agreements and to promoteap- interregional agreements that would give com

lOst· pact groups lacking a ·licensed site continuedtent access to existing ones until their own are

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On the hazardous waste front, both theHouse and Senate passed major reauthorizations of the Solid Waste Disposal Act. Both S.757 and fI.R. 2867 require the Environmental

. Protection Agency to regulate generators ofmore than 100 kilograms a month of hazardous waste, a stipulation that would bring aUacademic health centers under EPA9s regulatory purview. Regulation of the storage, treatment and disposal of waste' would also besignificantly tightened. An important issue tobe resolved in conference is the threatenedprohibition on use of labpacks for the disposalof hazardous waste produced by biomedicalresearch; the placing ofliquid hazardous waste .in landfills has drawn increasing congressionalconcern.

Working with Other Organizations

The Council for Medical Affairs~omposedof the top elected officials and chief executiveofficers of the American Board of MedicalSpecialties, the American Hospital Association, the American Medical Association, theCouncil of Medical Specialty Societies, andthe AAMC-continues to act as a forum forthe exchange of ideas among these importanthealth organizations. Among the topics considered during the past year were the need fortransitional year residency programs, the relationship of the autonomy of specialty certifying boards to resources for graduate medicaleducation, licensure by endorsement of thecertificate of the National Board of MedicalExaminers, various aspects of the Medicareprospective payment system, falsification ofmedical credentials, and the "Baby Doe" regulations of the Department of Health andHuman Services.

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

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

identifyingareas requiring increased attention,and indicate areas ofstrength as well as weakness. During the past year, the LCME has beenengaged in the preparation of revised accredi~

tation standards for the evaluation of M.D.programs. The draft of revised standards wasreviewed by the medical school deans:- The trevised document is now being reviewed by 'i:the academic and practicing communities . Fprior to its final adoption. ~

Through the efforts of its professional staff emembers, the LCME provides factual infor~ [mation, advice, and both formal and informal Sconsultation visits to newly developing schools Ul

at all stages from initial planning to actual f(,operation. Since 1960 forty-one new medical fschools in the United States and four in Can- c:ada have been accredited by the LCME. This 0

consultation service is also made available to stfully developed medical schools desiring as- aesistance in the evaluation of their academic glprograms.

In 1984 there are 127 accredited medical MIschools in the United States, ofwhich one has ata two-year program in the basic medical sci- sitences. Two have not yet graduated their first thrclasses and consequently are provisionally ac- siccredited; the 125 schools that have graduated inLstudents 'are fully accredited. Additional mOO- theical schools are in various stages of planning res,and organization. The list of accredited ACschools is found in the AAMC Directory of ticAmerican Medical Education.. eat

A number of new proprietary medical COr

schools have been established or proposed for ree'development in Mexico and various countriesin the Caribbean area. These entrepreneurial Qischools seem to share a common purpose, gJ"a1

namely to recruit U.S. citizens. The exposure Lirofa scheme to provide for a price false diplo- om'mas and credentials from two schools in the by cDominican Republic has brought increased certreview by licensure bodies of all foreign med- Corical graduates and brought the indictment and The

toce248

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,ties

1983-84 AnnualReport

conviction of one individual and increasingsuspicion of proprietary schools. It is anticipated that within the next several -years thenumber of residency appointments availablein the United States will closely match thenumber of students graduating from u.s.medical schools. Thus, M.D. degree graduatesfrom foreign medical schools of unknownquality will have increasing difficulty in securing the residency training required by manystates for medical licensure.

In 1984 the Accreditation Council for Continuing Medical Education began implement

I ing the new standards set forth by its revised. Essentials" The Council also approved reci

procity between the ACCME and the Canadian medical schools accredited by the Committee on Accreditation ofCanadian MedicalSchools as sponsors ofcontinuing medical education. The ACCME adopted "Guidelinesfor Support of Continuing Medical Education." With the increasing co-sponsorship ofCME activities by private industry and schoolsof medicine, the maintenance of appropriatestandards for these activities is facilitated byadherence to the principles expressed in theguidelines.

The Accreditation Council for Graduate,cal _Medical Education, after a review of its operlas ating procedures, determined that its respon-sci- sibilities can be accomplished with three ratherirst than four yearly meetings. This reflects a conac.. siderable change; only five years ago six meet,ted ings were needed. To a degree, this is due to.00- the delegation of accreditation authority tolng ,residency review committees so that theted :ACGME no longer reviews each of their ac-of tions. Periodically the operational record of

each RRC is scrutinized by an ACGME sub-·~ committee and deficiencies identified are corfor rected.ies A Task Force on the Evaluation of theial Oinical Skills ofresidency candidates who are

graduates of schools not accredited by theLiaison Committee on Medical Education recommended that an assessment ofclinical skillsby direct observation be incorporated into thecertification examinations of the EducationalCommission for Foreign Medical Graduates.The ECFMG is developing an assessment proocol for this purpose.

249

Special requirements for accreditation oftransitional year programs were approved bythe ACGME and ratified by its five sponsoringorganizations. These requirements will be usedas the standard for evaluating these one yearprograms which provide a broad clinical experience in several disciplines.

An announcement by the American Boardof Pathology that future candidates for certification must have an additional year ofbroadclinical training precipitated an intense debateon the prerogatives ofcertifying boards to altertheir certification requirements without consultation with or approval by either the institutions that provide the resources for trainingor by other specialties whose programs maybe affected. The Association, a founding member of the American Board of Medical Specialties, has proposed that the ABMS bylawsbe amended to require member boards tosubmit for ABMS approval any changes incertification requirements that lengthen orotherwise affect graduate medical educationresource allocations. The ACGME, at the Association's request, has promulgated a policythat changes in training requirements for anyspecialty must be widely discussed beforeadoption by an RRC or approval by theACGME may not be forthcoming.

The Educational Commission for ForeignMedical Graduates has now instituted the Foreign Medical Graduate Examination in theMedical Sciences, which replaces both theorigi_nal ECFMG examination and the VISAQualifying Examination. In response to recentexposures of fraudulent degrees from someforeign medical schools and because ofa widespread breach ofsecurity in an administrationofthe ECFMG exam, more emphasis is beingplaced on improving the certification process.ECFMG plans to work with original sourcedocuments and develop better communications with foreign medical schools to increaseits ability to identify forged documents. Acommittee is developing a method to assessthe medical skills offoreign medical graduates.However, the proposed assessment would notevaluate the ability ofthe graduate to performa complete historyand physical exam and thusdoes not entirely meet the Association's con-

st


cerns that the clinical skills of foreign trainedphysicians be assessed before·they enter training positions in the United States.

As in the two previous years, the Association has played a prominent role in workingwith other organizations to fashion recommendations for increased appropriations formedical research. ~ore than ISO professionalsocieties and voluntary health organizationscomprised the Ad Hoc Group fOf MedicalResearch Funding and made a single recommendation to Congress for ADAMHA andNIH. Although the appropriation process isnot completed, it appears that Congress willapprove an amount for NIH reasonably closeto the Ad Hoc Group's recommendation.

Because of the increasing threat at all levelsofgovernment to the continued availability oflaboratory animals for research, education andtesting, the Association, with the American

VOL. 60, MARCH 1985

Medical Association and the American Physiological Society, is sponsoring an explorationwithin the scientific community of means tostrengthen significantly efforts .to oppose restrictive legislation and other measures.

The Association is regularly represented inthe deliberations of the Joint Health PolicyCommittee of the Association of American IUniversities/American Council on Educa- s:tion/National Association of State Universi- f

itties and Land-Grant Colleges, the WashingtonHigher Education Secretariat, and the Inter- Ksociety Council for Biology and·Medicine. t

The Association's Executive Committee -Cmeets periodically with its counterpart in the bAssociation ofAcademic Health Centers. The p,staffs ofthe two. organizations exchange information and collaborate on programs and have ptagreed to cosponsor a study ofuniversity own. IT"

ership of hospitals.

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sional education, accreditation of medicalschools, licensure ofphysicians, graduate medical education, new topics and disciplines,long-term research and educational programevaluation, and continuing medical education.

The Panel's expanded report will appear asa supplement to the Journal ofMedical Education in November 1984. The Journal supplement will contain reports of the Panel'sworking groups on essential knowledge, fundamental skills, and personal qualities, values,and attitudes. Also included will be reports ofthe Working Group on Fundamental Skills'six subgroups. These deal with clinical skills,learning skills, medical information scienceskills, critical appraisal skills-the applicationof the scientific method, teamwork skills, andpersonal management skills. Acomprehensivestatus report on medical education in theUnited States and Canada and a summaryreport of the Louis Harris and Associates survey on the status ofmedical education are alsoincluded.

Over 20,000 copies ofthe"Charges to Working Groups booklet, used nationally by theworking groups who examined issues identified by the Panel and intrainstitutionally bythe 83 medical schools, 24 colleges and universities, 21 professorial societies, and othersparticipating in the project activities, were distributed.

Some efforts already underway might beconsidered responses to the recommendationsimplicit in the project. The AAMC curriculumnetwork project was partly the outgrowth ofan ad hoc meeting ofcurriculum managementpersonnel at the 1983 AAMC annual meeting.Responses to a mailing of curriculum-relatedtopics were received from over four hundredmembers of the Group on Medical Educationwho identified their areas ofinterest and chosesix topics for the first set of networks. Shouldthe curriculum network prove effective andfeasible, the number of networks will be ex-

:xl in)licyican During 1984 the Panel on the General Profes-,uca. sional Education of the Physician and College.eiSi. Preparation for Medicine (GPEP) concluded

its three.year effort funded by The Henry, J..gtOD ' I ·,nter. Kaiser Family Foundation. The Pane ISSUed

two reports. Physicians for the Twenty-FirstCentury, widely disseminated in mid-September, contained five conclusions made by thePanel:

"The general professional education' of thephysician begins in college, continues throughmedical school, and extends into the earlyperiod of residency. Its purposes are to enable

. students to acquire the knowledge, skills, values, and attitudes that all physicians shouldhave; and to develop the abilities all physiciansneed to· undertake limited responsibility forpatient care under supervision during the earlyperiod of their residency ... "

"A broad and thorough baccalaureate education is an essential component ofthe generalprofessional education of physicians •.. "

"To keep abreast of new scientific information and new technology, physicians continually need to acquire new knowledge andlearn new skills. Therefore, a general professional education should prepare medical students to learn throughout their professionallives rather than simply to master current information and techniques ... "

"Emerging physicians will best be served byclinical education designed as an integral partofgeneral professional education.... Oinicallerkships require careful structuring ... "The last conclusion surrounds enhancing

acuIty involvement noting, "Despite frequentrtions that the general professional educa

ion of medical students is the basic missionf medical schools, it often occupies last placenthe competition for faculty time and atten-'on .•• " .Other important issues discussed in the rert include equity of access to a medicalreer, resources need~ for general profes-

ittee1 the

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251

r·-·VOL. 60, MARCH 1985

Emphasis continues to be given to generating and disseminating more informationabout the MCAT and its appropriate use. This .has taken the form of intramural researchefforts. An annotated bibliography of MCATresearch documents 43 studies in print sincethe new test was introduced. Local validitystudies predictipg performance in the first twoyears ofmedical school have been summarizedin ~ recent report, along with a national st~4y Fdocumenting the relationship between MCATscores and retention. and rate of progress ofmedical students. Staffhave turned their attention to studies of special issues in vaIidity,namely, the MCAT's predictive value forwomen, minorities, and students who takecommercial coaching courses. In addition, theAAMC continues to work with schools participating in the MCAT interpretive studiesprogram to identify reliable a~d valid measures of performance in the clinical years thatmight serve as further criteria f9r predictivevalidity studies.

Continuing and expanding its service tostudents preparing to take the MCAT and to rtheir college advisors, in 1984 the AAMC pub- _Iished the third edition of the MeAT StudentManual. Foreach ofthe 108 sample questions,an explanation that describes the content area .from which the question was drawn, the reason for the correct answer, and the level ofdifficulty is included. For the first time, apractice Medical College Admission: Test isprovided with the Manual. This is a completetest identical to the test materials used in anactual test administration. Instructions for taking the test, answer keys, and a method tocalculate scores are included.

The development of the Medical CollegeAdmission Test experimental essay project hascontinued under the guidance of an ad -hoc Icommittee with rep.cesentation from admissions, minority affairs and undergraduatehealth professions advisors, rhe project is ~being conducted to study the feasi.bilityanddesirability of including an essay as a regularcomponent of the MCAT. Data and information gathered over the next two years willserve as a basis fOf this decision. The .first andsecond roundS of fi~ld tryoutS' of essay topics I .


panded. The objective of the program is toprovide sufficient information about projectsat schools to facilitate further contact amongcurriculum manag~rs.

During the hearing phase ofthe GPEP project, it became clear that many curriculumchanges were not widely known at other institutions. Some systematic approach to identifying, reviewing, and di~minating informationabout such innovations seemed useful andimportant. Accordingly, the GME has instituted a Task Force on the Critique of Curricular Innovations as a first step for evaluatingsuch efforts.

The Conference on Research in MedicalEducation has introduced an annual meetingsession exclusively for new investigato~. Thiseffort signals the intention of the RIME organizers that the conference should be a forumfor the widest possible audience in the medicaleducation research and evaluation community. Christine McGuire of the University ofIllinois Center for Educational Developmentwill critique medical problem solving literature and related topics as the Second AnnualRIME Invited Review.

The AAMC Oinical Evaluation Program isincreasing the level offaculty communicationsboth about the process of assessing studentclinical performance and the system withinwhich those assessments occur and are transmitted. During the past year, self-assess~ent

instruments have been developed to aid medical schools and clinical departments in identifying problems at each step ofthe evaluationprocess. The materials were reviewed in Julyby the Oinica1 Evaluation Program AdvisoryGroup, chaired by Daniel Federman of Harvard Medical School. Eight medical schoolsare currently pilot-testing the materials. Thisstrategy reflects a major conclusion of thestudy that obstacles to improving the evaluation system have been misdiagnoses of theproblems. A final version of the self-assessment instruments will be available in 1985,with follow-up workshops.

Staffis also planninga related effort to assistbasic science faculty in their evaluations ofstudent performance. The value and feasibilityofsuch an undertaking as well as strategies forapproaching the project are being studied. .

~rat- 'Jon~is

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were conducted in August and September. Thecommittee and stafThope that essay questionscan be included in the 1985 MCAT administration.

In another MCAT matter. the AAMC hascooperated with the Federal Bureau of Investigation and the U.S. Attorney's Office in Philadelphia in a criminal investigation of activities of the Multiprep review course and itsowner. Viken Mikaelian. This investigationculminated in May with indictments issued bythe federal grand jury charging Mikaelian withsev~ral counts of interstate transportation ofstolen property and criminal copyright violation. As a result of negotiations with the U.S.Attorney's Office. Mikaelian pleaded guilty totwo counts ofcriminal copyright violation andagreed to terminate his MCAT preparation

253

business. In the related civil suit broughtagainst Multiprep. the AAMC filed a motionfor contempt of the court's preliminary injunction order, charging Mikaelian with continuing to use copyrighted materials in hiscourse during the summer of 1983.

The Association has been concerned thatalthough many medical schools are using computers and related new technologies for moreefficient management and administrative systems. they have yet to realize the potentialapplications of these tools in other importantareas. particularly in the educational processand in clinical decision-making. With the support of the National Library of Medicine. inspring J985 the Association will sponsor asymposium on medical informatics and medical education.

;;.-=.,

;

Biomedical and Behavioral Research

Despite economic constraints, a growing federal budget deficit, and strenuous attempts tolimit health care costs, the Congress providedfor real growth in the budget of NIH in FY1984 and will do the same for FY 1985. ForFY 1984 NIH appropriations totaled $4.477billion, an increase of II' percent over FY1983. For 1985 the House and Senate apprOpriations bills provide for at least a 14 percentincrease in the NIH budget for authorizedprograms.

These modest increases since FY 1983 reversed a steady downward trend in the NIHbudget in recent years, when appropriationsdid not keep pace with inflation. Congress hasacted to halt this erosion in the nation'sbiomedical science research capacity in theface of presidential budget proposals to increase the NIH budget by only three percentin FY 1983, one percent in FY 1984 and twopercent in FY 1985.

ADAMHA has also been recovering fromthe blow dealt it in FY 1982 when the president's budget requested a 46 percent decreaseand the final appropriation resulted in a 30percent decrease in the agency's budget forthat year. ADAMHA appropriations of $356million for FY 1984 were still.below those ofFY 1981, but it appears that the budget forthe coming fiscal year will exceed last year'sby at least 14 percent.

Beginning with the 1983 budget process, theAssociation has spearheaded an effort to unitethe research community in advocacy for anappropriate yearly increase in the overallbudgets for NIH and ADAMHA. The strategyhas involved agreement by the research community on a single overall budget request forNIH and ADAMHA research. Each year thenumber of organizations participating in thiseffort has grown and in 1984 over 150 scientific and health-related associations approached Congress with a request for a 14percent increase in the NIH budget and an 11

percent increase in the research and researchtraining components of ADAMHA. Withinthis bottom line budget request, the Ad Hoc .Group for Medical Research Funding proposed a distribution of the added funds acrossdifferent types of programs such as individualinvestigator research awards, clinical trials, research training awards,.research career awards,facilities construction, and 'Biomedical Research Grants to indicate their' intention tostrengthen the entire biomedical research effort. Advocacy for disease or institute specificprograms has been avoided, although eachsegment of the community may discuss specific initiatives it supports within the overallappropriations request. The response of the tAppropriations Committees to this unified ape ~proach has been very favorable and has con- 1

tributed to their willingness to increase 7

biomedical research appropriations in a time !~of fiscal austerity. -

The Ad Hoc Group members argued spe- ~'

cifically for full funding of the direct costs of 'research grants at study-section recommended I

levels and an increase in the number of ape cproved grants which could be funded to a ~ iminimum priority score of 185 or at least 37 cpercent of approved applications. They alsorequested that funds be provided to meet the S'

National Academy of Sciences recommended ~ rnumber of research trainees and to expand the - (research career/scientist award programs. t

Authorization for key NIH programs hasbeen lacking during FY 1984 because the reauthorization bill was not passed last year and _:has not yet been passed this year, due in large'part to serious objections by various con·stituencies to a number of provisions in both ,the House and Senate bills. There is no op- ~

position to the central authorizations for :~,

which a renewal bill was necessary; other pr~ .;visions added to this bill form the basis for thedebate it has engendered. These range from

254

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;~, 1983-84 Annual Report~i- provisions to codify the present structure oft NIH in statute to mandates for new institutes,

provisions for numerous disease specific programs, provisions to restrict fetal research, andlanguage to restrict the use of animals in research.

The successful response to the communitywide effort to secure more research fundingcoupled with the present research authorization problems led the Association to formulatea position on "Preserving America's Preeminence in Medical Research:- Principles for theSupport ofBiomedical Research." This policystatement articulates the strategy of a unitedscientific and health research communityseeking appropriate overall research fundingand broad-based authority for federal researchefforts rather than sharply focused but fragmented efforts to authorize or fund specificprojects.-Such a strategy would seek to assuremaximum flexibility in authorization andmaximum flexibility in appropriation requeststo permit scientific judgment- to be exercisedin directing the national research effort. In thelast year this policy document has been endorsed by numerous societies, advisory bodiesand interested members ofthe biomedical andbehavioral research community.

A number of bills have been introduced inCongress to restrict and!or require greater ac

::7,r countability for the use ofanimals in research.A powerful and growing public lobby is op

lded ' posed to research involving animals, and artiap- des, pamphlets and media presentations a1leg

to a . iog abuse are becoming more common. Re;t 37 cently, a medical school research laboratoryalso . was raided by animal rights activists who de

~ the .stroyed research equipment and stole records,

lded , representing their actions as justifiable civili the disobedience.

The response of the scientific communityto these growing threats to research activity

255

has been varied and uncoordinated. The Association is exploring forming an alliance ofgroups concerned to preserve the portion ofthe biomedical research effort which must relyon experimentation to advance knowledge.Coordination of resources and efforts mightenhance the effectiveness ofthe scientific community in convincing the public of the important role ofanimal research in advancing medical science.

Concern has been mounting about the impact of the restriction of research funds inrecent years on the physical condition ofagingbuilding and equipment in the research universities. ,Several studies are underway to ex- 'amine the present age and condition of research equipment and buildings. An equipment study by the National Science Foundation will survey 34 major research universitiesand, through the efforts of the AAMC, a partially linked sample of24 medical schools. Aninteragency study ofall research facilities andconstruction at a selected group of researchuniversities is planned for the coming year.Efforts are underway to examine the feasibilityof reinstating the extramural construction authority of NIH which permitted competitivematching grants to fund research fa~lity con-

. struction prior to 1968. The flexibil~ty affordedby recent changes in OMB A-21 accountingregulations to permit including depreciationor user charges for space and interest chargeson money borrowed for major capital improvements in the indirect cost pool is alsobeing analyzed as a vehicle for funding capitalimprovements. There is general agreementthat whatever the vehicles made· available, asignificant federal investment in capital costsfor research will be necessary to refurbish theinfrastructure and that these funds should be .incremental to those now expended on research projects.

Faculty

The Association has <a long-standing concernfor medical school faculty issues relating to·scholarship, research, and research training.These issues include" the apparent decline inphysicians entering research careers, the difficulty ofPh.D. biomedical scientists in securingappropriate academic appointments, and limitation on research training. Data are collectedand analyzed to illuminate these areas, andthe results are'used to inform discussions bythe Administrative Boards and committees.The study results' are also used in discussions .with staffof the National Institutes of Healthand other federal agencies, as well as in preparation of Association testimony for congressional committees.

The Faculty Roster System, initiated in1966, continues to be a valuable data basewith information on current appointmerit,employment history, credentials and train,ing,and demographic data for full-time salariedfaculty at U.S. medical schools. In addition tosupporting AAMC studies of faculty man- <

power, the system provides medical schoolswith faculty information for completing questionnaires for other organizations, for identifying alumni serving on faculties at otherschools, and for producing special reports.

Following a pilot study in early 1983, a fullsurvey of all full-time faculty in departmentsof medicine was conducted in cooperationwith the Association ofProfessors ofMedicine.Preliminary results of this study were presented to the membership of the APM and tothe Manpower Evaluation Advisory Committee of the National Institutes of Health, and afull report is being prepared for publication.The combined data from this survey and theFaculty Roster are a rich source ofinformationon the extent ofresearch activity for over7,000faculty members.

During 1984 the Faculty Roster data basewas matched to NIH records on research train-

ing and grant applications and awards to analyze the relationship between training andacademic careers and the faculty's role in theconduct of biomedical research. These activities, as well as the maintenance of the FacultyRoster data base, receive support from theNational Institutes of Health. -

Based on the Faculty Roster, the Association maintains an index of women and minority faculty which assists medical schoolsand federal agencies in affirmative action re~ruitment efforts. Since 1980 approximately915 recruitment requests from' medicalschools were answered by providing records offaculty members meeting the requirements setby search committees. Faculty records utilizedin this service are those for individuals whohave consented to the release 'of information .for this purpose.

As of June 1984, the Faculty Roster con- I.

tained information on 54,020 full-time sala- ~.

ried faculty and 2,574 part-time faculty. Thesystem also contains 54,496 records for persons who previously held a faculty appoint-ment. 1

The Association's 1983-84 Report on Med· ij.~icalSchool FacultySalaries provided compensation data for 122 U.S. medical schools and34,187 filled full-time faculty positions. Thetables present compensation averages and percentile statistics by department and rank forbasic and clinical science faculty. Salary dataare also displayed according to school ownership, degree held, and geographic region.

An analysis ofeleven years offaculty salarydata showed that faculty salaries have failed tokeep pace with inflation. Real purchasingpower declined over the ten-year period byfourteen percent for faculty members in basicscience departments and by three percent for 'faculty members in clinical departments. Theresults of the study will be published in theJournal ofMedical Education.

256

an-ndthe.ivilltythe

lrytongbyicbre

.he

Students

As of August 30, 1984, 35,922 applicants hadfiled approximately 330,249 applications forthe entering class of 1984 in the 127 U.S.medical schools. These totals, although notfinal, represent an increase in the nationalapplicant pool compared to the final figures

;ia- for the 1983 entering class. The 1984 applicantni- pool is estimated to be approximately 36,300

~ Is applicants which would represent a three per-~ recent increase over 1983-84.~·ely The total number of new entrants to the§ ~ca1 first year medical school class decreased from~s of 16,567 in 1982 to 16,480 in 1983. Total med-] set i ical school enrollment rose from 66,748 to~zed * 67,327, the highest total enrollment ever.~ "ho t The number of women new entrantsB·,on " reached 5,370, 3.1 percent higher than 1982;~ the total number of women enrolled was~ )n- IV~ 20,635, a 5.3 percent increase. 'Women held~ la- ~, 31 percent ofthe places in the nation's medical~ lle schools in 1983 compared to 25 percent five~ er- years earlier.] nt- There were 1,399 underrepresented minor-] ity new entrants, 8.5 percent of the 1983 first~ ~d- year new entrants. The total number of un-~ :Iln- derrepresented minorities was 5,600 or 8.31::"a,nd percent of all medical students enrolled in;:l80e 1983.er- The application process was facilitated by~or the Early Decision Program. For the 1984-8513 first-year class, 1,017 applicants were accepted

er- f by 67 medical schools offering such an option.Since each of these applicants filed only oneapplication rather than the average 9.1 applications, the processing ofapproximately 8,238additional applications and scores ofjoint acceptances were avoided. In addition, the program allowed successful early decision applicants to finish their baccalaureate programsfree from concern about admission to medicalschool.

One hundred medical schools participatedin the American Medical College Application

Service (AMCAS) to process first-year application materials for their 1984 entering classes.In addition to colJecting and coordinating admission data in a uniform format, AMCASprovides rosters and statistical reports andmaintains a national data bank for researchprojects on admission, matriculation and en-,Tollment. The AMCAS program is guided inthe development ofits procedures and policiesby the Group on Student Affairs SteeringCommittee.

The AAMC Advisor Information Servicecirculates rosters and summaries of applicantand acceptance data to subscribing healthprofessions advisors at undergraduate collegesand universities. In 1983, 291 advisors subscribed to this service.

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

The characteristics ofthe groups ofindividuals sitting for the Medical College AdmissionTest remained relatively consistent with thetrends observed in previous years. Since 1979,women have increased their representation inthe examinee group so that presently 38 percent ofall examinees are women, a six percentincrease over the past five years. Similarly, theproportion of examinees from groups underrepresented in medicine has enlarged from 19percent to 23 percent during the same time.The preferred. undergraduate major area ofstudy for examinees continues to be in thebiological and physical sciences.

The Medical Sciences Knowledge Profileexamination was administered for the fifth

257


time in June 1984 to 2,068 citizens or permanent resident aliens of the United Statesand Canada. The examination assists constituent schools of the AAMC in evaluatingindividuals for advanced placement. While sixpercent of those registering for the test haddegrees in other health professions, 88 percentof all registrants were enrolled in a foreignmedical school.. Beginning in 1983 a joint effort was initiated to link data from the National ResidentMatching Program to the enrolled student fileof the AAMC. Listings were then forwardedto the medical schools for corrections andupdates on all seniors and their residency assignments. This effort represents another stepin the development of a research resource forlongitudinal studies in medical education andmedical manpower.

Monitoring the availability of financial assistance and working to ensure adequate funding of the federal financial aid programs usedby medical 'students were major activities ofthe AAMC during the past twelve months. Asfederal financial aid programs shrink and medical school costs rise, concern about the availability and adequacy of financial aid and increasing levels of student indebtedness grows.This concern prompted a study of medicalstudent financing carried out with the supportofthe Department ofHealth and' Human Services. The Association also worked. closelywith the schools and DHHS to monitor andreduce delinquency rates in the Health Professions Student Loan program. Comments havebeen offered to the Department about proposed modification to the Health EducationASSistance Loan program stimulated by concern about Potential default rates in that program. The Association joined other professional associations to request that the Secretary ofEducation exercise his authority to raisethe annual and aggregate 'borrowing limits forGuaranteed Student Loans. Current authorization for all federal programs of student assistance contained in the Higher EducationAct and the Health Professions Education Assistance Act expires in FY 1985. Because theaid programs are vital to medical students, theAAMC has put a great deal of effort intoactivities directed to reauthorization of these

~ ,

VOL. 60, MARCH 1985

programs. In addition, the issues of loan con- ;:solidation for student borrowers and issuance t-'of tax exempt bonds to fund student aid programs have been addressed. The AAMC alsoproduced a financial planning and, manage- ~

ment manual for medical students, residents,pre-medical students and their families.

Through its Office of Minority Affairs, theAAMC is administering several projects toenhance opportunities for minorities in medical education. Several Health Career Opportunity Program grants were received. The firstgrant provided three types of workshops toreinforce and develop effective programs forthe recruitment and retention ofstudents underrepresented in medicine. Ofthese, the Simulated Minority Admissions Exercise Workshop is for medical school personnel concerned with the admission and retention ofminority students. The Student FinancingWorkshop teaches expertise in financial counseling and administering aid to minority stu-jdents. The Training and Development Work- ;shops for Counselors and Advisors ofMinority rStudents provide information about 'ethnic ;and racial minority students and train coun- t.selors and advisors to work with the latest rtechniques appropriate for underrepresentedminority students. An important objective isto have participants gain information aboutthe differences among minority groups and tohelp participants develop alternative techniques for each group.

A second grant to evaluate retention activities in medical schools measured the effect ofHealth Career Opportunity Program-fundedretention programs on attrition of minoritymedical students. With Robert Wood JohnsonFoundation support the Office of MinorityAffairs developed Minority Students in Medical Education: Facts and Figures. Other workhas been carried out with the Macy Founda-·tion to determine the extent of minority medical student participation in 'special enrichment or preparatory programs.

The 1984-85 Minority Student Opportunities in U.S. Medical Schools was distributedto U.S. medical schools, health professionsadvisors, and libraries. This biennial publication describes minority student programs and ;recruitment activities of each medical school.

~ .! -

1985 1983-84AnnualReport~

259

con- t:.,ance ~

,pro;a1solage,ents,

;, the15 toned,)por-: first)s to,s forsun-Sim

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The Group on Student Affairs-MinorityAffairs Section held a Medical Career Awareness Workshop for minority students whichwas attended by 250 high school and collegestudents. Fifty-seven medical schools were represented.

The 1984 medical student graduation questionnaire was administered in all U.S. medicalschools with seniors, with 10,547 students participating in the survey. This represents a 64percent response rate. The majority of the1984 respondents planned to be in a residencytheir first year after graduation, with the mostfrequently selected specialties being family

practice and internal medicine. Of 1984 graduates, 24 percent designated a research-relatedcareer as their first choice, compared to 25percent in 1983 and 22 percent in J982. Theaverage medical school debt of indebted respondents was $24,328, representing a 12 percent increase from last year. Almost 32 percentof the respondents reported total educationaldebts of$30,000 or more, compared to under25 percent in 1983. A summary report comparing each schoors response to national datawas provided to each school in September.Selected results appear in the 1984 directoryof the National Resident Matching Program.

Institutional Development

The Association enhances the leadership andmanagement capabilities of its member institutions by sponsoring management educationprograms. Now in its thirteenth year, this se- .ries of programs has traditionally emphasizedexecutive development seminars for senior academic medical center officials-intensive,week-long seminars on management theoryand techniques. During the last year, two suchseminars were offered to medical school department chairmen, assistant and associatedeans, and hospital executives. Seventy-eightindividuals from 59 institutions participated.The seminars assist institutions in integratingorganizational and individual objectives,strengthening the decision-making and problem-solving capabilities of academic medicalcenteradministrators, developing strategies formore flexible adaptation to changing environments, and developing a better understandingof the function and structure of the academicmedical center.

Executive' Council guidance that new emphasis be placed on continuing managementeducation needs of AAMC members resultedin several short, intensive workshops focusingon human resources management, financialmanagement, marketing, and information resources management. These workshops combine an emphasis on fundamental conceptswith illustrations and exercises to highlighttheir applicability to current medical centerissues and problems. Three ofthese workshopswere offered in 1984. The first, "Managing theProfessional: Challenges for the AcademicMedical Center," addressed the need for creative, effective strategies for managing the institution's human resources more effectively.

The second in the series, "Financial Management," was designed for those with financial management responsibilities and exploredenvironmental changes affecting the missions

of the academic medical center and their financia}.ramifications. It provided an intensiveintroduction to basic financial managementconcepts and approaches fundamental to an",analysis of the challenge presented.

The third seminar, "Strategic Marketing:Managing in a Competitive Environment,"developed an approach to marketing as botha philosophy and a management tool. As aphilosophy, marketing energizes an institutionto formulate its programs so that they meetneeds in an effective and attractive manner.As a management tool, marketing provides anapproach to the analysis of institutional performance that complements other, more traditional approaches.

The final seminar in the new series, "Information Management in the Academic Medical Center," scheduled for January 1985, willexplore the problems and opportunities created by the revolutionary changes in the technology of information management.

For the fourth year a seminar focusing onthe academic medical center/VA medical center affiliation relationship was conducted forVA medical center executives as part of theirprofessional development program. This program was sponsored with the Veterans Administration Central Office.

An advanced executive development seminar for deans who have participated in thebasic program is now being planned. Thisprogram capitalizes on more recent work ofthe program faculty and will address the process of technological innovation, planning forthe acquisition and management ofhigh technology resources for research and patient care,changes in demographics and economics inclinical practice and their implications formedical center patient care enterprises, andmanaging interdisciplinary efforts.

260

Teaching Hospitals

Amendments to the Social Security Act signedinto law in March 1983 prescribed a newMedicare prospective payment system basedon Diagnosis Related Groups (DRGs). Whileawaiting publication of the regulations implementing the system, the AAMC learned ofaneffort by the Office of Management andBudget to have the Health Care FinancingAdministration reduce the DRG prices to offset what OMB feared would be a markedincrease in Medicare admissions in responseto the new incentives. AAMC and AHA wroteOMB Director David Stockman protestingthis proposed reduction. The letter pointed outthat the Social Security Act did not providefor such a reduction but did authorize PeerReview Organizations to monitor admissionsand disallow inappropriate utilization. Thepeer review program would assure that anyincrease in admissions reflected an increasedincidence of illness and the growing numberofelderly. .

Interim final regulations implementing theMedicare prospective payment system werepublished on September 1, 1983, and outlinedthe methodology by which payments are madeto hospitals for Medicare patients. Weightshave been established for each DRG based onacomputed average cost per admission. Theseweights are then applied against a blend ofregional, national, and hospital-specific average costs per case. At the end of three years,this blend·disappears and the payments winbe based on national averages. Currently capital and direct medical education costs areexcluded from prospective payment and arepaid on a cost basis. The AAMC consideredthe implications ofthe regulations for teachinghospitals and supported per diem payments tohospitals transferring patients, coverage of thecosts of kidney acquisition, elimination of restricted funds offset -against an institution·sallowable costs, and the modification of theapplication of reasonable compensation

equivalents to apply to physician compensation for service paid on a retrospective basis.

The Association also objected to severalprovisions in the regulations. Of particularconcern was the method for computing thenumber of residents in each hospitars resident-to-bed ratio. The method used the sumof interns and residents employed by the hospital 35 hours or more per week plus half thenumber of interns and residents working lessthan 3S hours per week. The AAMC objectedbecause of the requirement that the hospitalhave an employment relationship with theresident and the presumption ofa full-time 3Shour work week, which is substantially shorterthan the number of hours most residentsspend in the hospital. Also criticized were theabsence ofadjustments for referral centers andhospitals with a disproportionate number oflow income and Medicare patients, the insuf-

. ficiency ofoutlier payments, calculation ofthe~ wage indices for urban and rural payment

levels, the treatment of payment to hospitalsduring the transition period from cost to prospective payments, and the exclusion of themedical library as an educatio·nal cost Theletter concluded by emphasizing the need forthe Department of Health and Human Services to address the provision of care to indigent and underfinanced patients.

A consistent problem for AAMC constituents has been a misunderstanding of the indirect medical education adjustment as a meansof representing some of the factors that legitimately increase costs in teaching hospitals.The Association has commissioned, a paperfrom Judith R. Lave, professor of health economics at the University ofPittsburgh, on thedescription of the history, development andfuture prospects for this Mindirect medical education99 payment. This paper will be availablein fall 1984.

Final prospective payment regulations published in January 1984 included several sig-

261


nificant changes in response to comments received from the hospitals. AAMC concernswere met, in part, by a moderate change permitting hospitals to count residents and interns employed by other organizations withwhich they have a "longstanding historicalrelationship." In the preamble to the final rule,HCFA acknowledged that there were waysother than employed time which would accurately count residents, but felt the need toreview the data to select the best option. According to HCFA's interpretation of this language, a hospital can count both its own "employed" residents and residents trained in thehospital but paid by another organization aslong as no resident is counted more than once.

In clarifying allowable costs under the prospective payment system, HCFA explicitlyexcluded three items' of particular interest toAAMC members: the medical-education expenses for the clinical training of"students notenrolled in an approved education programoperated by the provider," the cost of care forpatients admitted solely or primarily for noncO,vered services, and payments under the costoutlier provision for patients who are alsooutliers for length of stay.

A Prospective Payment Assessment Commission was established under the Office ofTechnology Assessment to advise Congressand HHS regarding this payment system. TheCommission was charged with determininghow to incorporate new technology and newtreatment modalities into the pricing system,helping to determine the annual increase factor, and defining appropriate medical practicepatterns for specific diagnoses. To assure appropriate funding for this Commission, theAAMC supported its budget request andpointed out that it is imperative that a bodysuch as the Commission monitor changes inthe health delivery system brought about bythe switch to prospective payments to ensurethat the quality of care for Medicare beneficiaries is not adversely affected or the fiscalstability of hospitals unintentionally jeopardized. The subcommittee members were reminded lhat "absent this Commission, theDepartment of Health and Human Serviceswould be payor, regulator and evaluator" simultaneously. The AAMC supported the ob-

VOL. 60, MARCH 1985

jective viewpoint this Commission would provide.

In keeping with AAMC concerns aboutreimbursement issues and future mechanismsfor incorporating capital costs into the payment scheme, an ad hoc Committee on Capital Payments for Hospitals Under Medicarewas appointed in early 1984. The committeemet twice and reviewed a paper entitled "Toward an Understanding of Capital 'Costs inCOTH Hospitals." This paPer described capital costs and operating expenses in COTH andnon-COTH hospitals. The Committee reviewed options and possible methodologies forincorporating capital costs into the DRG system and recommended a prospectively determined and specified capital payment. Thecommittee suggested separating major movable equipment from fixed equipment andplant. The costs of the major movable equipment ought to be incorporated in the DRGpayments immediately, the Committee believed, but the fixed equipment and plant costsought to be incorporated over the course of aseveral year transition period. However, because it was unable to reach a conclusionconcerning an appropriate transition mechanism to move from cost-based to prospectivepayments for capital costs, the Committee requested guidance from the AAMC ExecutiveCouncil.

The AAMC wrote the Ways and MeansCommittee supporting a proposal that wouldslow the transition to national DRG rates byretaining for an additional year the currentformula in which 75 percent of the paymenteach hospital receives is based on its own costsand 25 percent is based on the regional DRGrates. Otherwise, Medicare payments to hospitals for the fiscal year beginning on or afterOctober 1, 1984, would be based half on thehospital's own costs, 37.5 percent on the regional DRG rates and 12.5 percent on thenational DRG rates as in the legislation thatestablished the system. The bill was not passed.

In the spring and summer of 1984, theAAMC was increasingly concerned about additional substantial cuts in Medicare/Medicaid in fiscal year 1985. 'The Tax Reform Actof 1984 mandated many changes that directlyaffect physicians and hospitals, including a


freeze on Medicare fees for physician services,the establishment of new floors for Medicarefees in a teaching setting, limitations on payment for laboratory services provided to outpatients, increases in price per case limited tomarket basket plus one-quarter ofone percent,a study of area wage indices, clarification inthe method ofcounting residents in trainingwithin the institution, payment for nurse anesthetist services on a cost-based pass through,an expanded definition of referral centers,change in the classification criteria for urbanhospitals, and an exemption for some hospitalsfrom the cost-to-charge test for outpatient services.

No hearings were held on any of these mat~ terse The AAMC objected particularly to the~ elimination ofthe one percent new technology0. factor from the Medicare prospective payment"5~ system, replacing the required market-basket] adjustment for hospital payments with a fixed.g and arbitrary inflation percentage, and arbi~ tracy cuts in the federal matching share for~ Medicaid programs. The Association noted~ that, the recent changes in hospital paymentsZ under the ,Medicare and Medicaid programs

required substantial operational changes inhospitals.

In 1983 the presidentially appointed Advisory Council on Social Security began to consider Medicare payments for the costs ofmedical and other health professional education.Declaring that it was inappropriate for Medicare to pay for anything except patient care,the Council called for a study on restructuringmedical education financing to provide for anorderly withdrawal of Medicare funds fromtraining support. AAMC testified against thisresolution, cautioning that even an "orderlywithdrawal" would be premature until theCouncil determined what Medicare pays forunder the label for direct medical education.A clearly described, administratively feasible,and politically acceptable funding alternativemust be found to support the joint productsof educational experience and clinical careservices.

The Advisory Council on Social Securityaltered its original recommendation to statethat the costs of training medical personnelshould be provided by a variety of sources,rather than by the Medicare program, and that

263

HHS should "identify and develop other federal, state, and local funding sources.~ Therecommendation also stated, "The Councilthinks that the involvement of the Medicareprogram in underwritiog these costs is inappropriate since the program is designed to payfor medical services for the elderly, rather thanto underwrite the costs oftraining and medicaleducation."

In a similar vein, a report drafted by theHHS Office of the Inspector General recommended changes in Medicare's payments tohospitals for residents' services. The AAMCvoiced serious concerns about this report andmet with. HHS officials and Secretary Margaret Heckler to discuss it. Based on an assumption that the amount Medicare pays forthese services is too high, the. report proposestwo changes. Teaching hospitals could claimthe cost of residents' patient care services foronly the first year of residency. Further, reimbursement on a reasonable charge basis forphysician services would be permitted whether

.provided by a teaching physician or a residentwho has completed the first postgraduate yearoftraining and met the state licensure requirements. The total charge for the combinedservices ofthe resident and teaching physicianshould not exceed the reasonable charge allowable for the same service in a non-teachingsituation.

On August IS the Federal Register contained proposed regulations governing utilization and quality control criteria for PeerReview Organizations, PRO area designations,and definitions of eligible organizations. Theregulations stated that HCFA will determinethat an organization is capable of conductingutilization and quality review if "the organization's proposed review system is adequate"and its "quantifiable objectives are acceptable." It is not clear from the proposed regulations what criteria will be used. The AAMCstated that such criteria must include explicitconsideration of the views of the affected parties and, therefore, an "adequate" review system must contain provision for an appeal andreconsideration mechanism that could accommodate the due process rights of affected parties. Moreover, where an adverse decision isto be made by a PRO on a review matter, thepreliminary findings should be reported to the


institution in question to provide an opportunity to submit additional clarifying information prior to the PRO's "final" decision.

The implications of the conditions of eligibility that would determine the Performanceeffectiveness of the PRO on its ability to meet"acceptable quantifiable" objectives also concerned the AAMC. There is no language inthe proposed regulations that explains whatHCFA desires the PRO to quantify. TheAAMC has expressed its objections to requiring that PROs establish'a target rate for achieving Medicare program savings above and beyond PRO contracted costs. Efficiency shouldbe encouraged, but suggesting reimbursementcost-cutting as the primary PRO goal beliesthe intent of the program-monitoring thequality of Medicare care.

Further implementing regulations were proposed by HCFA on "Acquisition, Protection,and Disclosure of Utilization and QualityControl Peer Review Organization (PRO) Information" and "Sanctions on Health CareProviders and Practitioners." Problems existedwith both regulations because they lackedqualifying descriptions of terms and becauseofthe absence ofany reassurance that hospitalconfidentiality is considered a right to be protected.

VOL. 60, MARCH 1985

A .discussion of the "ImplicationS of ForProfit Enterprise in Health Care" was' held bythe Institute of Medicine. Robert M. Heysselrepresented the AAMC. He stated,that theinvestor-owned corporations have a legal obligation to their shareholders and that eachdecision a corporation makes with regard toservice mix, program selection, and population served will have an impact on earningsper share. The issue, he said, is whether certainvery necessary societal functions can be continued, because patient service revenues in theteaching hospital are the dollar stream thatsupports societal contributions such as theprovision of tertiary care services, educationalendeavors, research initiatives, and care ofindigent patients.

A revised publication entitled "Medica] Education Costs in Teaching Hospitals: An Annotated Bibliography" was published iIi April1984 and includes a compendium ofabstractson research on the costs of medical educationin teaching hospitals and abstracts of papersaddressing the issue of modifying practices toreduce costs. Also published were annual surveys on houseStaffstipends, funding and benefits, chief executive officers' salaries, and university-owned teaching hospitals' financialand general operating data.

Communications

Media attention on the Association·s GeneralProfessional Education of the Physician project remained high during the year ~nd cameto a focus iO September when the, AAMCreleased the study at two news conferencesand a European teleconference. Members ofthe panel that conducted the study discussedtheir findings via an Oslo and Soria Moria,Norway, teleconference during a meeting of

~ the Association of Medical Education in Eu~ rope. Following the teleconference, news conl ferences were held in Washington and New§ York.~ The Association works with the national] media and responds weekly to a large variety1 of media queries for interviews, information] and Association policy positions. A major~ topic of media inquiry concerned the AssociZ ation·s legal action against the test preparation~ company Multiprep and the guilty plea of its~ founder Viken Mikaelian to two counts of~ criminal copyright infringement.§ The chief publication of the Association is~ the AAMC President's Weekly Activities Re~ port. This report, which is published 43 times~ a year, circulates to more than 7,000 and~ covers AAMC activities.and federal actions~ that directly affect the AAMC constituency.~ The Journal of Medical Education pub-

lished 1,015 pages of editorial material in .the .regular monthly issues, compared with 999pages the previous year. The published material included 89 regular articles, 59 commu-

nications, and J7 briefs. The Journal also continued to publish editorials, datagrams, bookreviews, letters to the editor, and bibliographies provided by the National Library ofMedicine. The Journal's monthly circulationaveraged 6,150. The volume of manuscriptssubmitted to the Journal for considerationcontinued to run high. Papers received in1983-84 totaled a near record of434, ofwhich149 were accepted for publication, 207 wererejected, 16 were withdrawn, and 62 werepending as the year ended.

About 24,000 copies of the annual MedicalSchool Admission Requirements, 4,000 copiesof the AAMC Directory ofAmerican MedicalEducation, and 4,000 copies of the AAMCCurriculum Directorywere published. Numerous other publications, such as directories,reports, papers, studies, and proceedings werealso distributed by the AAMC. Newslettersinclude the COTH Report, which has amonthly circulation of2,250; the OSR Report,which is circulated twice a year to medicalstudents; and STAR (Student Affairs Reporter), which is printed twice a year and hasa circulation of 1,000.

The AAMC Series in Academic Medicine,published by Jossey-Bass, issued three newbooks in 1984: Continuing Education/or theHealth Professions, New and Expanded Medical Schools, Mid-Century to the 1980s, andLeadership and Management in AcademicMedicine.

265

Information Systems

The Association continues to upgrade its general purpose computer system to ensure thatit will meet the ever-increasing needs of theAssociation membership and stall: A HewlettPackard 3000, Series 68 has replaced the Series64 and a Hewlett-Packard 3000, Series 48 hasreplaced the Series 44. These changes enabledthe Association to improve response time andprovide enhanced data communications. During the past year, high volume printing requirements increased and a second high speedlaser printer was added to the computer system. The constant demand for detailed information necessitates the use of over 100 terminals to access the Association files. To ensure the reliable retrieval of historical datafrom ofT-line storage media, the Associationadded two high density tape drives and madesubstantial improvements to the tape storagefacility. Data bases are developed to minimizedata redundancy and to provide responsive,on-line retrieval of information. Computergenerated graphic art now provides illustrations in final publication form thereby reducing camera art preparation and outside printing costs.

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

The American Medical College ApplicationService system is the core of the informationon medical students. This centralized application service collects and processes biegraphic and academic data and links thesedata to MCAT scores for report generationand distribution to participating schools. Thisservice also enables schools to receive the mostcurrent update of a particular applicant's file.Rosters, daily status reports, and summarystatistics prepared on a national comparison

basis are supported by an extensive and s0

phisticated software system and provide medical schools with timely and reliable information. Rapid on-line retrieval permits the Association to advise applicants of the daily status of their individual information. After datacollection is co'mplete, the system generatesdata files for schools and applicant pool_.analyses and provides the basis for entering-matriculants in the student records system.

AMCAS is supplemented by other systems,including the Medical College Admission Testreference system of score information, a college information system on U.S. and Canadianschools, and the Medical Science KnowledgeProfile system on individuals taking theMSKP exam fOf advanced standing admissionto U.S. medical schools.

A student record system, maintained in cooperation with the medical schools, containsenrollment information on individual students and traces their progress from matriculation through graduation. Supplemental surveys such as the graduation questionnaire andthe financial aid survey augment the studentrecord system.

After the residency match in March ofeachyear, the National Resident Matching Program conducts a follow-up study to obtaininformation on unmatched participants andeligible students who did not enroll. The Association, using an initial data file supplied byNRMP, produces match results listings foreach medical school, updates the NRMP information using current student records systems data and listings returned from the medical schools, prepares hospital assignment listsfor each medical school, and generates a finaldata file for use in NRMP's tracking study.

The diverse information systems of the Association each serve a unique purpose. Asspecial requests for information continue toincrease, multiple systems have been consolidated into one Student and Applicant Infor-

266


mation Management System. The system currently produces a wide variety of reports describing students, applicants and graduates,answers special data requests for informationfrom constituents, and. provides data studyfiles for additional statistical analysis.

Through the cooperation of the medicalschool staffs, the Association updates the Faculty Roster system's information on salariedfaculty at U.S. medical schools and periodically provides schools with an organized, systematic profile of their faculty. The Association's survey ofmedical school faculty salariesis published annually and is available on aconfidential, aggregated basis in response tospecial queries.

~ The Association maintains a repository of~, information on medical schools of which the~0. Institutional Profile System is a major contrib-§ utor since it contains data concerning medical~ schools from the 19605 to the present. It is.g constructed both from survey results sent di~ reetly from the medical schools and from other~ information systems. This system contains~ items used for on-line retrieval and supportsZ research projects.

The information reported on Part I of theLiaison Committee on Medical Education annual questionnaire complements the .Institu-

267

tional Profile System. Current year information is compared with data from the precedingfour survey years and is used to produce thereport of medical school finances published inthe annual education issue of the Journal ofthe American Medical Association.

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

In addition to the major information systems of the Association a number of specialized systems support the activities ofthe Councils and Groups of the Association. Mailinglabels, individualized correspondence, andlaser-produced photocomposed directories areexamples of the services provided.

Anew membership system is being initiatedto integrate the services provided by many ofthe specialized systems now in use. It willcontinue to produce labels for the WeeklyActivities Report and the Journal ofMedicalEducation.

Th~:'rapid assimilation of data into usefulinformation coupled with timely distributionto the Association membership to allow informed .decision-making continues to be ourgoal.

AAMC Membership

Treasurer's Report

an upgrade in computer equipment.Balances in funds restricted by the grantor

decreased $20,450 to $479,211. After makingprovisions for reserves in the amount of$200,000 for MCAT and AMCAS development, unrestricted funds available for generalpurposes increased $1,466,791 to $9,706,641,an amount equal to 95% of the expense recorded for the year. This reserve accumulationis within th~ directive ofthe Executive Councilthat the Association maintain as a goal anunrestricted reserve of 100% of the Association's total annual budget. It is of continuingimportance that an adequate reserve be maintained.

The Association's financial position isstrong. As we look to the future, however, andrecognize the multitude ofcomplex issues facing medical education, it is apparent that thedemands on the Association's resources willcontinue unabated.

InstitutionalProvisional InstitutionalAffiliateGraduate AffiliateSubscriberAcademic SocieiiesTeaching HospitalsCorrespondingIndividualDistinguished ServiceEmeritusContributingSustaining

The Association's Audit Committee met onSeptember 4,1984, and reviewed in detail theaudited statements and the audit report forthe fiscal year ended June 30, 1984. Meetingwith the Committee were representatives ofErnst & Whinney, the Association's auditors,and Association staft On September 13, theExecutive Council reviewed and accepted thefinal unqualified audit report.

Income for the year totaled $12,328,998.Ofthat amount, $11,486,753 (93%) originatedfrom general fund sources; $229,351 (2%)from foundation grants; $612,894 (5%) fromfederal government grants and contracts.

Expenses for the year totaled $10,226,320of which $9,316,938 (91%) was chargeable tothe continuing activities of the Association;$296,488 (3%) to foundation grants; $612,894(6%) to federal government grants and contracts. Investment in fixed assets (net ofdepreciation) increased by $420,293 as a result of

1982-83125

2161

1873

43287

117462685

10

1983-84125

2161

1676

43447

109965605

10

268

Association or American Medical CollegesBalance Sheet

, June JO, 1984

, ASSETS~ Cash

InvestmentsCertificates of Deposit

Accounts ReceivableDeposits and Prepaid ItemsEquipment (Net of Depreciation)Total Assets

LlABILmES AND FUND BALANCESLiabilities

Accounts Payable,Deferred Income

:::~ Fund Balances~' Funds Restricted by Grantor for speclal Purposes0. General Funds§ Funds Restricted for Plant Investment~ Funds Restricted by Executive Council for Special Purposes] Investment in Fixed Assets] General Purposes Funde Total Liabilities and Fund Balances

~ Association or American Medical Collegeso Operating StatementZ Fiscal Year Ended June 30, 1984

SOURCE OF FUNDSIncome

Dues and Service Fees from MembersPrivate GrantsCost Reimbursement ContractsSpecial ServicesJournal of Medical EducationOther PublicationsSundry (Interest $1,594,493)

Total Source of Funds

USE OF FUNDSOperating Expenses

Salaries and WagesStaff BenefitsSupplies and ServicesProvision for DepreciationTravel and MeetingsSubcontractsInterest Expense

Total ExpensesIncrease in Investment in Fixed Assets (Net of Depreciation)Transfer to Executive Council Reserved Funds for Special ProgramsReserve for Replacement of EquipmentIncrease in Restricted Fund Balances (Decrease)Increase in General Purposes FundsTotal Use of Funds

269

$ 496,8563,741,3331,334,2669,706,641

S 181,654

15,701,035901,329169,421

1,334,26618,287,705 '

1,080,8181,448,580

479,211

15,279,096S18,287,705

S 3,120,430229,351612,894

5,531,35597,965

340,7082,396,295

$12,328,998

$ 4,670,282822,328

3,063,656313,644948,668,406,685

1,057S10,226,320$. 420,293

200,00036,044

(20,450)1,466,791

$12,328,998

AAMC Committees

Accreditation Council forContinuing Medical Education

AAMC MEMBERS

John N. LeinHenry P. RussePatrick B. Storey

Accreditation Council forGraduate Medical Education

AAMC MEMBERS

D. Kay ClawsonSpencer ForemanHaynes RiceDavid C. Sabiston, Jr.

Audit

Haynes Rice, ChairmanL. Thompson BowlesLeo HenikoffJohn RoseFrank Standaert

Capital Payments for Hospitals

Robert C. Frank, Chairman. William G. Anlyan

Bruce C. CampbellDavid GiilzbergLeo M. HenikoffLarry L. MathisRichard MeisterWilliam RyanC. Edward SchwartzClyde M. WilliamsLeon Zucker

CAS Nominating

Robert L. Hill, ChairmanS. Craighead AlexanderLewis ArnowJoe Dan CoulterGordon KayeVirginia V. WeldonBenson R. Wilcox

COD Nominating

Richard C. Reynolds, ChairmanArthur C. ChristakosDavid C. DaleJohn M. DennisJohn W. Eckstein

COD Spring Meeting Planning

Edward J. Stemmler, ChairmanArnold L. BrownWilliam T. ButlerDavid C. DaleFairfield GoodaleLeo M. HenikofTRichard Janeway

COTH Nominating

Earl J. Frederick, ChairmanJohn A. ReinertsenHaynes Rice

COTH Spring Meeting Planning

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

Council for Medical Affairs

AAMC MEMBERS

John A. D. CooperRobert M. HeysselRichard Janeway

Evaluation of Medical InformationScience in Medical Education

STEERING

Jack D. Myers, Chairman'G. Octo BarnettHarry N. BeatyDon E. DetmerErnst Knobil

270


Charles E. MolnarStephen G. PaukerEdward H. ShortliffeEdward J. Stemmler

FINANCE

Mitchell T. Rabkin, ChairmanWilliam DealRobert C. FrankRobert L. HillRichard JanewayFrank C. Wilson, Jr.

Financing Graduate MedicalEducation

~ J. Robert Buchanan, ChairmanRichard A. Berman

~0. David W. Gitch§ Louis J. Kettel~] Frank G. Moody.g Gerald T. Perkoff~ Robert G. Petersdorf~ Louis Sherwood~ Charles C. SpragueZ William Stoneman, III~ Richard Vance

Q) W. Donald Weston~ Frank C. Wilson, Jr.:go

]] F1exner Award-B§ Sherman M. Mellinkoff, Chairman~ John W. Eckstein .~ Joann G. Elmore8 Daniel D. Federman

Scott R. InkleyGordon Meiklejohn

General Professional Education of thePhysician and College Preparation forMedicine

Steven Muller, ChairmanWilliam P. Gerberding, Vic'e ChairmanDavid AlexanderJohn S. AveryJo Ivey BouffordJohn W. CollotonJames A. DeyrupStephen H. FriendJohn A. Gronvall

Robert L. KelloggVictor R. NeufeldDavid C. Sabiston, Jr.Karl A. SchellenbergRobert T. SchimkeLloyd H. Smith, Jr.Stuart R. TaylorDaniel C. TostesonBurton M. Wheeler

Governance and Structure'

Sherman MellinkoO: ChairmanJohn W. CollotonWilliam DealJoseph E. Johnson.Frank C. Wilson, Jr.

Group on Business Affairs

STEERING

Michael A. Scullard, ChairmanJohn H. Deufel, Executive SecretaryStephen ChapnickJohn DeeleyThomas A. FitzgeraldJerold GlickJames HackettBernard McGintyMario PasqualeSally RyceGeorge W. SeilsLester G. Wilterdink

Group on Institutional Planning

STEERING

Marie Sinioris, ChairmanJohn H. Deufel, Executive SecretaryPeter J. BentleyGerard J. CelitansRuth M. CovellVictor CrownThomas G. FoxAmber JonesDavid R. PerryG. Michael Timpe

271


Group on Medical Education

STEERING

Vietor P. Neufeld, ChairmanJames B. Erdmann, Executive SecretaryGerald EscovitzAlan L. GoldfienHarold B. HaleyPaula L. StillmanHoward StoneClyde Tucker

Group on Public Affairs

STEERING

Dean Borg, ChairmanRoland Wussow, Chairman (11/83-4/84)Charles Fentress, Executive SecretaryArthur Brink, Jr.Robert FenleyGloria GoldsteinJames KingHal MarshallVicki SaitoJohn TurckAnn Williams

Group on Student Affairs

STEERING

Norma E. W~goner, ChairmanRobert J. Boerner, Executive SeCretaryRuth Beer BletzingerJohn C. GardnerWilliam M. HooperRicardo SanchezAnthony P. SmuldersJane R. ThomasJohn D. TolmieRudolph WilliamsBenjamin B. C. Young

MINORITY AFFAIRS SECTION

Rudolph Williams, ChairmanCarolyn Carter, Vice ChairmanSharon AustinBilly BallardBruce BallardCarrie JacksonScharron LaisureZubie Metcalf

VOL. 60, MARCH 198:

Percy RussellMaggie WrightJohn Yergan

Journal of Medical EducationEditorial'Board

Richard C. Reynolds, ChairmanJo BouffordL. Thompson BowlesBernadine H. BulkleyLauro F. CavazosA. Cherrie EppsJoseph S. GonnellaJames T. Hamlin, IIILeonard HellerSheldon S. KingKenneth KutinaRobert K. MatchEmily MumfordWarren H. PearseLois PoundsStuart K. ShapiraT. Joseph SheehanJ. H. WallaceKern Wildenthal

Liaison Committee on Medical Education

AAMC MEMBERS

J. Robert BuchananCarmine D. ClementeWilliam B. DealMarvin R. DunnMarion MannRichard C. Reynolds

AAMC STUDENT PARTICIPANT

Peggy B. Hasley

Management Education Programs

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

. 1983-84AnnualReport

. National athens Advisory Committeefor tbe Support of Medical Education

George Stinson, Vice ChairmanJack R. AronKarl D. Bays

, William R. Bowdoin! Francis H. Burr, Aetcher ByromAlbert G. CayWilliam K. CoblentzLeslie DavisWillie DavisCharles H. P. DuellDorothy Kirsten FrenchStanford GoldblattMelvin Greenberg

§ Martha W. Griffiths~ Emmett H. Heitler8. Katharine Hepburn] Charlton Heston! Walter J. Hickel'~ John R. Hill, Jr.~ Jerome H. Holland~ Mrs. Gilbert W. Humphrey~ Jack JoseyZ Robert H. Levi

Aorence MahoneyAudrey MarsHerbert H. McAdams, IIWoods McCahillArchie R. McCardellEinerMohnE. Howard MolisaniC.A. MundtArturo OrtegaGregory PeckAbraham PritzkerWilliam Matson RothBeurt SerVaasleRoy B. StaverRichard B. StoneHarold E. ThayerW. Oarke WescoeWilliam WolbachT. Evans WychotTStanton L. Young

Nominating

Joseph E. Johnson, III, ChairmanEarl J. Frederick

Robert L. HillWilliam H. LuginbuhlRichard C!. Reynolds

Payment for Physician Servicesin Teaching Hospitals

Hiram C. Polk, Jr., ChairmanIrwin BirnbaumDavid M. BrownThomas A. BruceJack M. ColwillMartin O. DillardFairfield GoodaleRobert W. HeinsSheldon S. KingJerome H. ModellMarvin H. SiegelAlton I. SutnickSheldon M. WoltT

Prospective Payment for Hospitals

C. Thomas Smith, ChairmanDavid BachrachRobert J. BakerWilliam B. DealRobert J. ErraHarold J. FallonRonald P. KaufmanFrank G. MoodyRay G. NewmanDouglas S. PetersArthur H. Pipe~, Jr.

Research Award Selection

Kern Wildenthal, ChairmanRobert J. LefkowitzJohn T. Potts, Jr.Leon E. RosenbergJay P. SanfordDiane W. Wara

Resolutions

William B. Deal, ChairmanPamelyn OoseDavid L. EverhartDouglas Kelly

273

274 Journal o/Medical Education

RIME Program Planning

Robert M. Rippey, ChairmanJames B. Erdmann, Executive SecretaryFredric D. BurgJohn B. Corley .,David S. GullionHarold G. LevineArthur I. Rothman

VOL. 60, MARCH 1985

Women in Medicine

Joan M. AltekruseShirley Nichols FaheyEleanor G. ShoreKaren SmithJane ThomasPatricia Williams

I'

AAMC Staff

Office of the President

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

Vice PresidentJohn F: Sherman, Ph.D.

Special Assistant to the' PresidentKathleen S. Turner

StaffCounselJoseph A. Keyes, J.D.

Executive SecretaryNorma NicholsRose Napper

Administrative Secre~ry

Rosemary Choate

Division of Business Affairs

Director and Assistant secretary-TreasurerJohn H. Deufel

Associate DirectorJeanne Newman

Business ManagerSamuel Morey

Personnel ManagerCarolyn Curcio

Membership and Subscriptions SupervisorMadelyn Roche

Accounts Payabletpurchasing AssistantlaVerne Tibbs '

Administrative SecretaryPatricia Young

Accounting AssistantCathy Brooks

Personnel AssistantDonna AdieTracey Nagle

SecretaryCynthia Withers

Accounts Receivable Oerk .Rick Helmer

Accounting OerkDavina Waller

ReceptionistRosalie Viscomi

Senior Order OerkLossie Carpenter

Membership OerkIda Gaskins .Anna Thomas

Senior Mail Room OerkMichael George

Mail Room OerkJohn Blount

Director, Computer'ServicesBrendan Cassidy

Associate Directo1rSandra Lehman

Manager of DevelopmentKathryn Petersen

Systems Manager -Robert YearwOod

Systems A~alyst

Pamela EastmanMaryn Goodson

Programmer/AnalystJack Chesley'Exequiel SevillaJames Shively

Operations SupervisorWilliam Rose

Administrative SecretaryCynthia K. Woodard

Secretary/Word Processing SpecialistJoyce Beaman .

Data Control ManagerRenate Coffin

Computer OperatorStacey BurnsPauline DimminsJackie HumphriesBasil PegusWilliam Porter

Division of Public Relations

DirectorCharles Fentress

Administrative SecretaryJanet Macik

275

276 Journal ofMedical Education VOL. 60, MARCH l~,

Division of Publications

DirectorMerrill T. McCord

Associate EditorJames R. Ingram

Staff EditorVickie Wilson

Assistant EditorGretchen Chumley

Administrative SecretaryAnne Spencer

Department of Academic Affairs

DirectorAugust G. Swanson, M.D.

Deputy DirectorElizabeth M. Short, M.D.

Senior Staff AssociateMary H. Littlemeyer

Assistant Project CoordinatorBarbara Roos

Administrative SecretaryRebecca Lindsay

Division of Biomedical Researchand Faculty Development

DirectorElizabeth M. Short, M.D.

StaffAssociateChristine BurrisDavid Moore

Administrative SecretaryCarolyn Demorest

Division of EducationalMeasurement and Research

DirectorJames B. Erdmann, Ph.D.

Associate DirectorRobert L. Beran, Ph.D.

Program DirectorXenia Tonesk, Ph.D.

Research AssociateRobert F. Jones, Ph.D.

Staff AssociateM. Brownell Anderson

Research AssistantJudith AndersonRobin Buchanan

Administrative SecretaryStephanie Kerby

SecretaryMary Salemme

Division of Student Services

DirectorRichard R. Randlett

Associate DirectorRobert Colonna

ManagerLinda W. CarterAlice CherianEdward GrossMarkWood

SupervisorRichard BassLillian CallinsVirginia JohnsonDennis RennerTrudy SuitsWalter WentzJohn Woods

Senior AssistantC. Sharon BookerKeiko DoramHugh GoodmanGwendolyn HancockEnrique Martinez-VidalLillian McRaeEdith Young

Administrative SecretaryCynthia Lewis

SecretaryDenise Howard

AssistantTheresa BellWanda BradleyCarl ButcherKaren ChristensenJames CobbWayne CorleyMichelle DavisCarol EasleyCarl GilbertPatricia JonesYvonne LewisCarrie MurrayMary MolyneauxAlbert SalasChristina SearcyHelen ThurstonGail WatsonPamela Watson

r

rl

1'983-84 Annual Report

Yvette White

JTYPist/ReceptionistEdna Wise

Press OperatorWarren Lewis

Division of Student Programs

DirectorRobert J. Boerner

Director, Minority AffairsDario O. Prieto

Staff AssociateJanet Bickel

Research AssociateMary CuretonThomas H. Dial

§ Staff Assistant~ Elsie Quinones8. Sharon Taylor] Research Assistant! Nadine Jalandoni~ \dministrative Secretary~ Vivian Morant~ jecretary~ Brenda GeorgeZ Lily May Johnsonu

~ )eparfment of~ :nstitutional Development:gB)irector] Joseph A. Keyes, J.D..s ;tafTAssociatej Marcie F. Mirsky~"dministrative Secretarya§ Debra DayQJecretary

Farisse MooreChristine O'Brien

livision of Accreditation)irector

James R. Schofield, M.D.;tafTAssistant

Robert Van Dyke,dministrative SecretaryJoan Baquis

)epartment of Teaching Hospitals)irector

Richard M. Knapp, Ph.D.

Associate DirectorJames D. Bentley, Ph.D.

Staff AssociateKaren PfordresherNancy Seline

Administrative SecretaryMelissa Wubbold

SecretaryJanie BigelowMarjorie LongCassandra Veney

Department of Planningand Policy Development

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

Deputy DirectorPaul Jolly, Ph.D.

Legislative AnalystDavid BaimeMelissa BrownLeonard Koch

Administrative SecretaryLaura Beatty

SecretaryAlicia BarthanySandra Taylor

Division of Operational Studies

DirectorPaul Jolly, Ph.D.

Staff Associate, Faculty RosterElizabeth Higgins

Staff AssociateWilliam SmithLeon Taksel

Research AssociateDona Boyce-ManoukianGary CookStephen EnglishJudith Teich

Operations Manager, Faculty RosterAarolyn Galbraith

Research AssistantPaul HalvorsonDonna Williams

Administrative SecretaryMara Cherkasky

SecretarySusan Shively

Data AssistantElizabeth Sherman

277

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A MACNEAL." Hospital

AdimIrJ ucrlllJlc,iIIH,.'tJectm

SENIORINTERNAL MEDICINEFACULTY POSITIONSTwo Senior Level Internal Medicine FacultyPositions are available at MacNeal Hospital,a 427-bed university-affiliated communityhospital, for candidates with teaching andadministrative experience who are certifiedor board-eligible in Internal Medicine. SubspEtCialists will be considered. Responsibilitieswill include clinical, teaching and researchactivities. In'addition, one of these positionswill have major resPQnsibilities for coordinating the Transitional Residency Program andthe other position for development of anAmbulatory Care Program. Opportunities forprivate practice are available. Address inquiries and curriculum vitae to:

LAWRENCE R. La PALlO, M.D.Medical Education

CHANCELLORHEALTH SCIENCES CENTERUNIVERSITY OF COLORADO

The University of Colorado Health Sciences Centerin Denver, which includes the Schools of Dentistry,Medicine and Nursing as well as the UniversityHospitals, is seeking a O1ancellor. That individual willbe the chief academic and administrative officer of thecampus, and will report directly to the President of theUniversity and the Board of Regents.

An earned doctorate or equivalent degree isdesirable, as well as experience in scientific and/orhealth related activities. Candidates. must possessoutstanding leadership qualities in the area of educatioo, research and delivery of health care. Anunderstanding of the environment of a public educational institution is essential. Applications should be accompanied by a complete curriculum vita as well as alist of references with addresses.

Nominati<m and applications must be received byApril 30, 1985 and should be sent to:

Stuart A. Schneck, M.D., ChairmanChancel1or's Search Committee

University of Colorado Health Sciences Center4200 East 9th Avenue, Box C269

Deo~,Colorado80262

The University of Colorado isan Equal OPPOrtunity/Affirmative Action Employer

RESEARCU ASSISTANT/PROGRAM MANAGER

Evolving Geriatric program has aneed for a Research Assistant towork with staff in developing clinical research protocols, data analysis, and grants. Experience inhealth service research preferred.

Apply to: William s. Vaun, MD, DirectorAnna Alexander Greenwall

Geriatric Center

MONMOUTUMEDICAL CENTER

300 Second AvenueLong Branch, New Jersey 07740

f.qua' Opportunity ~pIoyaPIlI'

The Department of Pathology,University of KentucQY College of Medicine, is seekinq aCo-Director for a cell surfaceantigen laboratory. Ph.D. inimmunology or related fieldand minimum three years experience in clinical immunology required. Position also involves developing graduateprogram in School of MedicalTechnology. Send curriculumvitae and references to: AbnerGolden, M.D., University ofKentucky Medical Center, 800Rose Street, Room MS-305,Lexington, Kentucky 405360084.

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aamc annaul meeting and annual report 1984

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