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TITLE * ealtE OccupatiOns EducationA NationA'InvitationalConference. Determi'ning the 'Future Directions for the.,

.Developtent of Efficient and Effective.Teacher.',Education Programs.- California Univ:, Los. Angeles. Div.:* of VocationalEducation.Office of EdUcation(DHEW), Washington, D.C.VT-102-2h

INSTITUTION

SPONS AGENCYREPORT NOPUB DATENOTE

74103p.

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EDRS PRICE -MF-$0.76 HC; $5.70 Plus PostageDESCRIPTORS *Conference Reports; Curridulum Development; %Health

Occupations Education -; Iservic Teacher Education;Instructional Program's; Preservice Education Program

r Development; Speeches; Teacher Education.IDENTIFIERS ' O- klahoma (Oklahoma City) .

ABSTRACT.

The National Conference on,Health Occupations'Educatiop was organiged in response to a nationwide demand fordissedinktion of project findings and instructional materials in the 1field'of,health educationmphasis throughout the 'research ,project

conferenceonference was on'ele total instructional process.Approiimately 100 participants contributed their knowledge andexpertise on teacher education, examined current practices;inpreservice and inseryiqe teacher training, and recommended newapproaChes for healt14 occupations education teachtr educationprograms throughout 'the country. Recommendations generafed by theconference participants provide abagis on which guidelines forcriteria xelating to kealth occupations teacher education may bedeveloped. (Author/MA),

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44**4*****************************************************************4 * . Documents acquired by ERIC include many. informal unpUhlishet lit

* Materials not available from, other sources. ERIC makes every effort * .

* to obtain the best copy available. Nevertheless, items of marginal '**irepr6ducibility are often encountered and this affects the quality *

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* of the microfiche and hardco'y reproductions ERIC Makes available *

* via the ERIC Document Reprod ction Service (EDRS). EDRS is not . 4,'

* responsible for.the quality f the original document. Reproduction *

* supplied by EDRS are the best that cal be made from the original. ************************************************#********************* .,

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SIEPATMENT OF HEALTHEDUCATION & WELFARENATIONAL INSTITUTE OF

EDUCATION

Trots DOCUMENT HAS EEE' REPRO.DVCED EXACTLY AS ,RECEIVED' FROMTHE PERSON ORORGANIZATION ORIGIN.ATING I' POINTS OF vItW OR OPINIONSSTATED,00 NOT NECESSARILY REPRE.SENT OFFICIAL NATIONAL

INSTITUTE OFEDUCATION POStNONCPR POLICY

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to2.-2009NATIONAL INVITATIONAL CONFERENCE: .

Determining the Future Directions for the Developmentof Effidientpnd Effective TeRcher Education Programs

.HOLIDAV INN WESTOKLAHOMA CITY, OKLAHOMAFEBRUARY 25 MARCH 1, 1974

, , ... .Presented tiy ,

. UNIVERSITY OF CALIFORNIA . . ,

IN1,r DIVISION OF VOCATIONAL EDUCATION

ALLIED HEALTH PROFESSIONS PROJECT

01 In Cooperation with .

en . . t U.S. OFFICE OF EDUCATION. .

CALIFORNIA STATE DEPARTMENT OF EDUCATIONOKLAHOMA STATE DEPARTMENT OFEDUCATION

, OKLAHOMA REGENTS FOR HIGHER EDUCATION

0 /,.. ,. OKL6HOMA 'STATE DEPARTMENT OF VOCATIONAL

AID TECHNICAL EDUCATION

0 AMERICAN VOCATIONAL ASSOCIATION 44 .

. . AMERICAN ASSOCIATION OF COMMUNITY &JUNIOR COLLEGESLEAGUE FOR INNOVATIOk IN COMMUNITY COLLEGES

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`The National Conference on Health Occupations' Educa-tion,.conducled by the Allied Health Professions Project,Division Of Vocational Educationi.University of California,Los,Anteles, was organized in response to a nationwidedemanagor dissemination of project findings anWinstruc-fional materials in the. field of health education. Thisworking conference was/held at Oklahoma .City duringthe week of February 25 .--- March 5, 1974. The infor-mation acquired by participantsfulfilled the demand foran assessment of teacher education in the health occupa-tions today,,and the findings of the /conference will be'

. helpful in deterFnining,.future directions for State Depart-'v ments of Education and universities in developing and im-.

plementing appropriate, effective teacher training in thisfield. ../

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Emphasis throughout the.researeh project and the.confer-eye .wa5 on the total instructional' process. Approxi-mately.100 participants contributed their knowledge andexpertise, on teacher education,. examinedicurrent .prac-tices in- preservice and inservice teacher training, andrecommended new approaches for Health/Occupations

iEducation teacher eduCation progranis throughout theIco tintry.

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,... %..---% ,, .T.hjS report, therefore,- represents the considered judg= "rent of Many people. Recommendations generated bythe conference provide a I5 its uponswhith gbidelineS forcaiteria rerating to Healtht.Occ pations EdAation teachereducation may be-devielope . Dissemination of theknowledge produced bythe Hied Health ProfessionsProject will be further expand d with the' distribution of

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this final cinfergence report. '.\ir ,

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Melvin L1 ...

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Conference flirec or e %.

Univer1 sity f Cali ornia, tos 5\ ngeles

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.CONFEIZEN.CE STAF

Ellen M. AbbottDavid Allen

?Miles H. Andergon

'Don G. BrekkeL. Barlow

Lowell A. BurkettClacerice Fielstra .

Thomas L. FreelandNancy J. Goff

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Elizabeth E. KerrMary Elizabeth MillikenCharles L. PhillipsHelen K. PowersChester S: RzoncaIRobertt(M. TornlirisbnFrancis B. 'TuttleDiane'i."Watson.Lucile A. Wood

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"Thanks and appreciation are extended to Dr. Phil Chartdler, president of klahorrid:':Technical Institute, and Bob Gilkeson., au,diCk-viOpal director, for supplying the

conference with the necessary, audio-visual, equipment.,

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PUBLISHERS' REPRESENTATIVES

ekonaldW. D ns,pinJ. B. LippincOtt Compapy

yruck A. qeInyy,Jr.;.W: B. Saunders Company

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f- Julian H. Jourard ;

Holt, Rinehart, and Winston, IriGorpoi-ated

FINAL REPORT STAFF'Editors

Nancy GoffW./ Lorraine: Phillips,Charles L. Phillips

Art Ctirect6iCarolyn Le.ekner

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Speech TranscriberConnie J. Freeman

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/FEBRUARY 25,1974MONDAY

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5:00 p.m. REGISTRATION

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CONFERENCE OPINING 14

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INTRODUCTION OF' OFFICkS AND HONORED GUESTS.. . . ..

Melvin L Barldw - ,-

9OVERNOR'S \A/TLC/MING ADDRESS .'Honorable David Hafk;.introdycectAiy Francis 8 Tlittle,t

- Stat&Direc_oir Oklahoma State Department of,Vocational,re-chnical Edutation

FEBRUARY 26, 1974TUESDAY

Adjournment,

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, 8:30 a.m, CONFERENCE SCHEDULE AND 114STRUTION9,Melvin. L Barlow

,9.30 a.m. PROBLEM AREAS IN THE ALLIED HEALTH FIELD AND

WHAT NEEDS '0 BE DONE TO, PROMOTE SUCCESSLowell A. -Bet4tt, Executive Director, American Vocational Associatio.(Keynote Speaker)'

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AkIchenteSpeaker Interaction. .

-12:00 noon lunch (no-hosty

1:30 prat. THE UCLA ALLIED HEALTH PROFESSIONS PROJECT:. PURPOSES, METHODS, RESULTS

Thomas L. Freeland

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T.HE CLINICALAISTRUCTOR.TRAININC/PROGRAM.Mules H Anderson

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FEBRUARY 77,1974,leyEbRESDAY '' ..

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. - ., ..;:., : ,,-900'41-n. CAREER, MODEL DEVELOPiv1INT11 di 4

.. ;. Lucile A. Wood , '

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; k 11.00 a.m. A'MODfl, CURRICULUM:. THE NyRSING PROGRAM, licile A. Wood :

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12:00. noon Luna-Ono-host)1 P

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130 p.m. THE COOPERATIVE RELATIONSHIP BETWEEN THE SOUTH. DAKOTA STATEWIDE CORE CURRICULUM. PROJECT AND ''' ,

_ 2 * ,THE UCLA ALLIED HEALTH PROFESSIONS PROJECT.

Donald G. ,Brekke / ,..I k . I . 4 ,

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Z:00 p.M. RESULTS AND BENEFITSOF THE TWO UCLA-- SOUTHpAKOTA CORE-CURRICULUM, WORKSHOPS

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Donald .G. Brekke' ,...

Thomas L. Fr.eeland...t.

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FEBRUARY 28, 1974,..

'THURSDAYt .'8.:30 .am. EALTH0CCUPATIONS TEAcHER'EDIJCATI,pN::,

'2=-1r\ITRODUCTIVN OF DISCUSSION TOPICS. ,Melvin L. Barlo1/41, Group Moder.ator .

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10:00 "a.m. GROUPDiscur

sic5Ns PHASE 'I., .

Group .a --1... Teacher Selection Criteria ,\Mary Elizabeth MtIliken 4 \ ' ,

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'Group. 2:-.,-- Co.nterit for the Health Occupations',Education.- '

Basic- Teaching Degree -

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FEBRUARY 28, 1974THURSDAY -

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Group 3 Preparation for Leadership Rotes)in 'Health Occupations EducationElizabeth E. Kerr

Group 4 Certification Standards for Personnel, in Health Occupations Education

ChesCer Rzonca

12:00 noon _SPECIAL LUNCHEON IN HONOR OF HELEN K. POWERSIntroduction' by Melvin L. Barlow

MY HOPES AND FEARS FOR HEALTH OCCUPATIONS EDUCATI9NHelen K. Powers,/Consultant, Health Occupations EducationU.S. Office of Edikation (Retired)

2:30 p.m. GROUP DISCUSSIONS PHASE II

Group 1 Teacher Selection CriteriaMary Elizabeth Milliken

Group 2 .Content for the Health Occupations Educat.ignBasic Teaching Degree

, Robert M. Tomlinson

group 3_ P,reparttion for Leaderqlip Roles in HealthOccupations Educatipn .EElizabeth Kerr

Group 4 Certification Standards for Per;onnel inHealth Occupations Education ,Ch,este! S. RzonCa

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4:30 p.m. 'EVALUATIVE IMPRESSIONS OF THE GROUP bISCUSSJOIISBY THE "ROVING EVALUATOR"

,. Clarence Fielstra

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. t8.30 a.m7 HOW TO GET A NEW HEALTH OCCUPATIONS EDUCATI N

. '. PROGRAM STARTED 4 1 - 1/

.: lip,Ellen M Abbott tie 4

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9:00 a.m. THE UCLA SECONDARY,SCHOOLS PILOT AND41 DEMONSYR,ATION PROJECT FbR AN INTRODUCTION

, TO ALLIED HEA14"1-1 CAREERS '.Diane F.. Watson

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10.30 a.m. EVALUATION OT THE _UCLA SECONDARY .5,CHOOUSPILOT AND pEMONSTRATION.PRDWCT-Clarence FaVtra

11:00 a.m. Audience/Speaker Interaction

11:30 a.m. SUMMARY AND CLOSING OF THE CONFERENCEMelvin L. Ballow

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INTRODUCTION ,

ACKNOWLEDGMENTS 4,

. CONFERENCE AGENbA.

CONTENTS

PRESENTATIONS

GOVF.RNOR'S WELCOMING ADDRESS 1Honorable David Hall fjPROBLEM AREAS )N THE ALLIED HEALTH FIELD ANDWHAT NEEDS TO BE DONE TO PROMOTE SUCCESS 3

. Lowell A Burkett, MS. .

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THE UCLA -ALLIED HEALTH PROFESSIONS PROJECT:PURPOSES,MEilipDS, RESULTSThomas J.. FF'eeraockl, Ph.D. .

THE CLINICAL INSTRUCTOR, TRAINING PROGRAMMiles H Anderson, Ed.D.

CAREER MODEL DEVELOPMENT AND A MODELCURRICULUM: THE "'NURSING PROGRAM 23Tucile A. Wood, MS R N

THE COISIPERATIVE FiELATIONSHIP BETWEEN THE SOUTHDAKOTA- STATEWIDE CORE CURRICULUM PROJECTAND THE -UCLA ALLIED HEALTH PROFESSION /PROJECT 35Donald G. Brekke, BS

MY HOPES AND FEARS FOR HEALTHOCCUPATIONS EDUCATION 41Helen K. Powers, M,5,,R.N:

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HOW TO GET A NEW HEALTH OCCUPATIONSEDUCATION PROGRAM STARTED 47Ellen M Abbott, M:S,

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THE UCLA SECONDARY SCHOOLS PILOT AND .

DEMONSTRATION PROJECT FOR AN INTRODUCTIONTO ALLIED HEALTH CAREERS,Diane E. Watson, M

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EVALUATION OF THE UCLA SECONDARY SCHOOLSPILOT AN DEMONSTRATIQN PROjECTClarence Ftelstra, Ph D.

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RECOMMENDATIONS V

.TEACHER SELECTION CRITERIAMary Elizai)orh Milliken, Ed D

.. '..CONTENT F91 THE HEALTH OCCUPATIONS EliUCATION iBASIC TEACHING DEbREE 71Robert M Tomlinson, Ph D

PREPARATION FOR LEADERSHIP ROLES INHEALTH OCCUPATIONS EDUCATION .

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75Elizabeth E Kerr, Ed D ',:,

CERTIFICATION STANDARDS FOR .PERSONKELN HEALTH OCCUPATIONS EDUCATION ' 79pester S Rzonca, Ph D

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-r7, ,APPENDIXES

FINAL EVALUATION OF THE HEALTHOCCUPATIONS EDUCATION CONFERENCE

CONFERENCE STAFF 87

CONFERENCE PARTICIPANTS 89

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GOVERNOR'S WELCOMING ADDRESSHonorable David Hall, Governor, State of Oklahoma

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Y.ou are all-professiOnals. You are the peoplewho are going to,. teach us how America candeliver' health care whether national healthinsurance comes or not, whether the care ispublic or private, you are ,going to haVe tolead the,,w0. The ddctors, Cawyers, Senators,Representatives, and Governors ar6 all so .busythat no one seems able to comelip with an-swers to healthcare problems, so you who aretaking the time as you are today are going tohave to provide' the-answers for 1975 and,beyond.

About two years ago I had a chance to gb;.tothe' Soviet Union with seven other Govern&q.One of the main objectives of the visit we fpview the health care delivery system 'therel:found a system that was very inadequateabove the early. level 'compared to ours! But I

also saw a system pat designed paramedialactivities which I thought were superior toours in many ways. There was not, for 'exam-ple, a village Or an apartment complex we 5Awthat did not have paramedical personnel as-signed to take care of the daily problemstheincidentalithat, doctors and more highly'trained, people object to so much in their dailycare' routine. And there was a very vverm,friendly attitude among these paramedicalpeople and those they served, which is a goodlesson for us. This is an area we need to take aharder look at because there are thousands.ofyoung men and, women who would be ex-tremely good as paramedics if. they knewabout and were inspired to search out thevocatioPi The peed today is more 'critical thanever.

In Oklahoma, our HealthiScierice Center is

now a three part activity. 1) the educationalactivity from the University of Oklahomawhich trains doctors; 2) the,University hospitalwhich' provides 'indigent care and a training,center for doctors; and 3) Children'sMemorial Hospital. That triangle is providiiig,we think) some of the best health cire facilities'in the world. Our main thitusr ham laeen aimedat educating., dottors and. thert professionalassistants in the, allied health occupations.

But I Ion'tthink we have given enough atten-tion to the paramedical personnel and I think.we are,going to have to give this area more ofour concern. I hope perhaps in this conferencest'me of the guidelines th4t yoil develop andsome of the leadership shown by brt Barlow-and others will give us a method by whichzwecan determine the proper. direction to take.

I think it is important' that Our Voca-tionalTechnical educatiOn bdexpanded.

!Vocational education is a brand newdimensibn for Oklahoma young people, manyof whom never intended to' go to collegd butthey were ill-equipped after finishing high'school to compete in a progressively indutrialized,societymore progressive today thanit has ever been. Twenty thousand riew

"vocational titles will go into the books by1980! The change that goes on every year inour system .is almbst _unbelievable.

Vo-Tech iii Oklahoma is "where it's at." You-can see thousands of satisfied young peoplebecoming economically independent and that

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is a tremendous incentiye,-(1 really envy thembecause they are going into the labor market

making twIc,e what I made a:, a beginninglawyer when I left law school and went out onmy own.) The 9,000 secondary students andthy 1,070 adults we serve in Vo-Tech are testiYtrnony to the excellent activity that can)akeplace: One of the most innovative prOgiamswe have is one where we have taken peopleof lower mentality who cannot cope with thecomplicated 'and frustrating mechahSms of'ourindustrial society and trained them in occu-pations from domestic help to janitorial help.They are professionals. They receive a cer:tificate just like .everyone else, and they takepride in Mat they do. Those people wereconsidered a loss to society' in many, cases'prior to this time.

ere w.as a news media report in Oklahomathat 'said we, have 400 surplus doctors-in this

u because I

state. Well, I want to tellAyou something. I wishall those 400 would call me.

`could sure tell them where we need them. We. are really about 600 doctors short in the 'rural

areas just as you tare in every one of yourstates.

It is amazing how the locale of a. small townOroduces.some.,af the.strongest' people in theworld. How are we. going to iriduceese peo-'plet.te,_ move baCk into. their rural areas? rnOkia.Floma, we took a;step in this direction in.1971. We decided,. that" we would urge in-dustry to go to the rural areas and not to-cometo the cities. The result-is that 83 percent of:.the new factories in the last 36 months havebekn located outside of Otdahoma City andTulsa. Thirty -seven "of our counties havegained population In the list 36 months. Thereason is that the young person of today has adifferent dream than you and I had When westarted out. I can remember my friends saying,"I want to leave't§et country. I want to go tothe cityand I wa to get the biggest house/.and the biggest' car I can and tell everybod,that I

im a success." The yo,ung person,tod ysays, "I want to move out of the city, I wanyto

,go to the country, and I want' to enjoy, my.-. family and the environment." Well, if we-are' going to provide that environment, and if we

are going to-have a meaningful, otal lifesituation, we are.going to have t proviaehealth gare closer than 50 miles (t ':t's what itaverages in man), of our rur.al,c6

, a round trip to see a doctor).unities for

We can provide that care, and am cdnvincedthat education is the golden fi obitm solver of

-the twentieth century. Now, seime, of the cor-porations and two of the 'main leadmg-dailynewspapers in Oklahoma did not believe thatbecause they never paid/state tax before I

became governor; and they have not let meforget that fact for 36 ohths. But, do youknow what that tax m ney did? It helped uslead themhation in the duction of welfare lastyear. We decreased welfare rolls 11.4 percentand led" the 50 states in 'the number ofrecipients taken off ouLyvelfare rolls in 1973.,The reason was not' because we, were .prose-'wing offenders or hiring More case workers,the reason was thal.We.edu<ated those welfarerecipients so that they could gain te digntty,'they Wanted. That is really the secret. I findthat 98 percent of the people on welfare don'twant to be there any more than we want. tosupport them. But We do!Th.pe a duty to sup-On the blind disabled, deaf, elderly, andfather,less. ;They \deserve our help .and they aregoing to &era. .

It is 4p to .us to inspire ,young people to entercareers in health o4upations by letting themknow the tremendous scope available. and thetremendous' satisfaction derived frorh pro-viding healthcare. One of the terrible thingsabOut viorking in an industrialized society dis*the iningible accomplAment factor that yOuget from doing just one motion in the makingof a'product. How' can you satisfy that urge tocreate? But, when you provide care for sickPeople so that eventually their sickness is

cured or their life is made better, you experi-ence a tangible reward. An old Chinesephilosopher said that, "If you would plan for

Fars,year, plant rice. If you would plan for tenfears, plant trees. But if.you would plan for ahundred years,_educate men." That is the an-

.swer. And that is why America will continue to .

lead the world as long as we all believe ineducation.

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PROBLEM AREAS IN THE ALLIED \ E LTHFIELD AND WHAT NEEDS TO BE `DO ETO PROMOTE SUCCESS

4 -Lowell A. Burkett, _M.S.

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Vocational education is my. life, and I'm verypt.qud of that fact. Vocational education issomething that has proven itself for many,years, and it is benefitting thbusands and thou-sands of young people in this t ountry. I

get very upset at people who try to find newterms to describe the field. The new descrip-).tions just cause confusi n; and, besides, I thinkthe idea that t tuti Vocational Education",present a. bad image is being overplayed atthis point in time. ...

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Vocational educatibq.Ls here to stay. It is ''n

something that is a passin)-vrd, it is not jus a.passing idea. It-was'starled, ol-cur.se, in re.-

historic days and has"gradually belome oreand more important to the welfare of manbecause of its function in preparing people foremployment. I recall that when I 'first came toWashington it was almost impossible to getanyone to talk about vocational education andabout the preparation of people for workthrough the educational system. We 'ocoUldhave to go out and drum up business in . termsof what We did tb promote.. vocationaleducat'i'on. But that is not true today. There

mote people interested in vocalipnal,

education than ever before, everybody-if Con-,

cerned about it.

-Vocational education is becoming more im-portant as time gOes on fdii the) simple reasonthat the labor force of this country_ is66coming much more technical. By 1980, ac-cording to the Department of-tabor, 83 per-cent of the work force of .the nation will be inoccupations that do not require a, bacca;laureate degree. That means- that we in the

1 . ..field of -vocational education are going to bepreparing_at least 83 percent of the nation'swork force! We do not erect to do it all inthe public school system, here are going to bepthe1r places where this'Pkr aration will occur..,iit,,,certainly the method% f training people

/ HI come from vocational e cation, and thatpl ces considerable respond' ilay on , oursh ulders.

Thd' leadership. in vocational education is

. emerging on practically every,front. As I travelthe coumtry and .talk with people in

ethicatton and in many other fields as, well, I

,continuously hear the names of people who.are having an impact, on manpower: needs ineducation. Dr. Barlow and other vocational

,education leaders are often mentioned. We.,can be proud of the leadership that w haveexerted.' There is a need; bf course, td con- ,

tinue in that role and we should be working atleadership training more as time goes. on,

The Ameritan Vocational Association and ttleorganizations that preeede it have been in-

, strumental in keeping the q otas of manpowertraining in the public schools. Wecontinuouslywork at this job. The Association ha4 not beeninsensitive to manpower needs. In 1936, theUSOE started programs in practical nursearain:ing, and then the AVA began ta.see the .needfor manpower tramiing in that area. The AVAalso worked very diligently and effectively intbe passage of the Health Amendments Act of1956.1n July, 1969, the AVA added a newdivision of Health Occupations for the specificpurpose of developing ., higher degree of pro-fessionalism among 'the health educators in

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vocational :education This division of theAVA, although still small,' represents almost2,000 vocational educators whoare making a.tremendous contribution to the total man-power efforts and to the American Vocational,association. .

Although our interest started with the practicalnurse field, it then expanded to the total AlliedHealth Occupations which cover a vast .num.-ber of jobs in the health fields,There is noquesliop about the extenso.:e opportunities forthe development. 4f ocationareducation inthe Allied Health field. Ideed, there are cur-

- rently programs at all levels.

We were particularly interested in a number ofspecial' projects including the Allig.d HealthProf(*sions Project at UCLA and the studytke National League for Nursing which con-tfibuted solutions to the problem oftan opencurriculum in nursing. The project underdiscussion ere (the4CHP/) has perhaps, con-tributed m re to the Health Occupations fieldof education thall anything we have observedfor some time. But there are two .majorproblems connected with any project of thistype: On' the dissemination of the findings.This confYence will be helpful in solving thatproblem, but the findings have to be carried toothers outside of this particular *group. An-other problem that We have with a project ofthis' type is getting .the ideas implemented'.Although the ideas are good and research hasbeen fruitful over the years,' many of theresults'have gone on' the shelf and have notbeen implemented. Vile have had the Educa-tional Resources Information Center (ERIC)which, for vocational education, was locatedat The Ohio State University and -which hasbeeh very` helpful to educators and research-ers, but it has not been accessible to prac-titioners.

In preparationqor this conference, I reviewedthe past activities of the Health OccupationsDivision of the .AVA in order to see, what theirconcerns were. I looked at many of the, re-ports of the policy committees and the various

seminars and activities in which,they were tcn-gaged to see if there was anthing.uniqu. e that

, you would be interested in. But, as'l examinedthese activities I found they coryespond to theconcerns of many occupational fields..I wobldlike to take a few moments to talk.about someof these concerns and to give you some of my'thoughts and interpretatiOns of them at they.relate nationally to the problems facing us in

sour. field.

One cif the problems with which we aielfaCedis the FaIt that vbtational education ogcurs atall levels of education and at practically eyerY.'age of a person's life. In contrast, ourpublicschool system has become very compartrhen-;talized. There is elementary education, secon-dary eduCition, post-seco'ndary education, andthen there is Continuing education. But people'cannot be compartmefitalized no.. can theirexperiences. The whole problem of articula-tion in vocational education has become over-whelming because pet* approach and leav'evocational. education ,at various periods intheir school experiences. They want to get intothe training program from the education pro-gram, but articulation between the two sj,s-terns sometimes doeshlot exist.

This lad( of articulation had become a seriousprOblem that is created primarily by state laws.I had a member of my staff do a study recent-ly. He looked at five selected states in theUnited States to determine if' there is anythingto t4he stale laws cit- policies that is impedingthe progress of vocational education. It is in-teresting to note what the study revealed.There is no relationship in many of these statesbetween what is occurring in the secondaryschools and in the post-seeondary schools. Inspme cases there are two different ad-ministrative bodies concerned with settingpolicy. In the Federal Vocational EducationActs, funds are allocated to the State Board ofVocatyrial Education, However, many stateshave Misstpated that concept in their inter-pretations of the Federal law. Sometimes theState Board of VOCational Education 45 the

, same. as the State Board of Education. They'will meet' for a whole day on GeneralEducation problems and spehd only .fiveniinut.es on Vocational Educitjoh. Seldomdoes the State Board df Eclueation relate to the,Bpard of Higher Education.o you can seethat the articulation between elementary,secondary,' and higher education_ is a veryserious pioblerry as it relates to vocationaleducation.

The 'Corfgress of the United States is going tostart. taking a look at the current Vocational. goal." It is almost.impos4131e for mein my roleEducation Act 'of 1968. ) have already been to relate to Congress what .the needs actuallynotified to be prepar0 because there will be are 'because you sAy.)%our, needs are, nothearings this year an& possibly the erlactment greater thz*?...the,resoarces you hive available.of new 'legislation. I-am of the opinion that This is a serious problem. We are going tohow well wei are articulating the program at have to look, gt the needs of the pepylle inf he state and local levels is going to be one of terrns.ortrwing and manpower, and this is athe major concerns. Congress is getting report)._ difficult Job. ft means that cot.) are going tofrom the post-Secondary institutions that the have to think,4hot in terms' of what staff andState Board is not giving them the right facilities you have so that your can utilize thoseamount of money or that they are not being effectively, but you are going to ha've to saytreated fairly' In other states `the opposite that, there are this many people who need ser-complaint is voiced=that the post-secondary vicing and these;are the manpower needs andprdgram, is controlling the funds a-0 the we are gaingjiS trity to 'meet them.secondary schools are not"getting enough..This'-is,a serious problem, and I think the Congress I think these is going to be monitoring of the*of the United States' is going to take a very planning,process in the new Federal legislation.close look at this area. I, do not know 'how We, talk about giving responsibility to ocal andthey are going,to resolve ii because, after all, it state people' to implement their progrAms,.butis up to the - states to deferminehosw , they are the job is not done we can expect' Federalgoing to spend the money., But I think it is. regulations and Federal Monitoring. The stateSOmething that we as'a ProfessioAat group are Rians ate,going lb have to be much moregoing to have to try to resolve. Much of this p eher*ve and monitored very carefiutly4 I

situation is to be replved at the 'state and believe Congress`is going,to take a lot of thatlocal level, it can't be done by Federial law. yob on themselves. That is.the Feason Congress

is not holding hearings on a specific vocationalAnOther of

,the prob lem areas identified and educatico 'act being introdpced this year. In-

discussed by_ Health Occupations specialists stead, they are saythg, "wv really want toover the years is the question of comprehen- miznitor. We want to see how well you havesive planning.- The.1968 Vocational Educatio,p 'done with what you already have been given."Act called for state, plans for yocationaieducation. But this Act has been interpreted to Another problem- that we are ficed with ismeet the requirements' of the laW, not to plan "Career Mobility,", or the ability of;,,,people tofor operational purposes. We need to get tlist move from one part' of the country to anotherplanning straightened out to address' tsii.olt and continue to utili e the training and educa-elem,entss. First are the needs of the people, tion they possess in a ive manner. Why

s

5 ecifical y the kind of ed.ucatton they 'need.'And sec nd, vve have to relate those needs tothe man wer,needs b.ecause you should not'train people without prOiding employment orelse the training is of little value. The task ofamending the Federal,Acts 15a job f hat-youaregoing/ to haye to accorhoIrsh,at whatever levelyou r-e functioning, either state or local.'There is a tendency in the pl ning process toplan indaccordance with 4he sources that weare going IQ receive so tha at the end of theyear we can say, "Oh, yes, e did achieve 'our

, .,

lb this becoming a serious problem? There areessentially two reasons. One is that our train-

, ing has been raaterspecific'for any given com-munity. The second reason is that state ken-sIng laws have been so out of order they havenot Peally been concerned with the training ofpeople who move from one location' to an-other. In other words, they are trying t6protect that field, that occupation, in thatgiven state. Our licensing laws' are archaic,they are going, to have to be rewritten. Thepublic needs the protecro of licensing laws,but the present Jaws need revision in order toprovide for the mobility of people from Onestate to another. ,

myst also be concerned with the wholequestion of teacher preparation: This is an-

.

other very serious problefn with which weearefaced IN. this country: The first thing we mustdo is get the right kind ofeople into theteaching; profession' in order to strengthen our.educational programs* across the board. In

addition, those who are in the field should re-,ceive continuous in-service training.. Weshould help them improve their techniquearid _encourage them to urdaie theirknowledge of -their technical fields.

All our instrualonal,materialt need up-dating.I am delighted with what 'has been crone in thisarea. Health O,Ccupations Education is aheadof many of the vocational fields and park-cularlythe siiecialized occupations in this. re7sriect. But it is not good enough ,to orintthi.s

. new material today, and_ notcome back two orthree years from nowto up-date it. The UCLA.project should undergo corkettious pertinent ,

revisions. We cannot afford to be outdatecrinour curriculum and our instructional materials.VVe,.ought to be looking down the road. to

,what kind of occupations the young peo.pleare going to be entering tomorrow. I know wehave occupational analysis that tells ul what isneeded at a given point in time, but we aughtto be' doing some researct3 and making prvec-tons for the futu'Re. I have seen in some ,Elass-rooms the teaching Of technical matters that

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have gone out of existence completely. Wecannot justify' that kind of mistake in

vocational eAI4Jcation. It is said .that there is atwenty-year lag between education and reality.Vocational education shOuld make an effort to_close that gap. 1.

A"Problem common to.all vocational fields isthe matter of teacher certification. State cer-tification boards cause trouble in practicallyevery state. There needs to be certification; weshould not ,let jut anybody teach. But thisproblem ought to be lookeicfrat realistically todetermine what kind Orteacher is desird.andwhat kind of certification he needs. This is

something that should be taken care of, withinThe states because certification a staterespons.ibitity, there i$ nothing that can bedone with Federal' regulation. But it is. aprocess that has to. be worked at const;ntly..Remember that you have to contend,with agreat= d_eal in the Allied Health field becauseyou are involved in occupations that effect thehealth and welfare of the public.

Accreditation, which c(n be defined as .theprocess 97:-',fa llofession policing itself, nowconfronts die Health Occupations. No govern-ment agency is supposed to be involved in thisProcess, it is a profession setting its own,minimum standards for a good program. Ingeneral, the accrediting agencies, particularlythe- regional accrediting asencie, have said,"We want to look at the institution to seewhether ithas the qualities needeq to-conducta good educational programhow manybooks in its library, what kind of'degreis yhasfor teachers, and what the budget is for this in-stitution."

I have I:teen on accrediting teams_school system. We never really I

what was going on inside t

the publicoked to seec lass roo ms.

Some ofus got pretty upset about this pro-"cedure and we called upon th9 National Com-mission of 4ccrediting. We wint-to the Officeof EducatiOn and said, "You've got institutionsout there condoning very poor programs of

vocational-technical education. Now what areyou going to do about that?" And the' said,"Well, we can's visit every classroom in the p-stitutions. That is just. an impossible task." I ,believe that any visiting team going to an in-stitution should take-a few moments to lookfor spme of the very essential characteristics ofa gdod program: It would not take much timeto do that..

As a result of. pressuring, them, we got a grant,from the Office of Educati6n aridrauthoriza-,non to conduct a study of what we thoughtwere'esSeniials,Nracteristics for a qualii pro-.gram The results of that study have gonethrough some held' resting and,...arezurrentlybeing utilized by a number of schools for seff-

.sludy r urpos8 (We have tome copies of thktstudy in Sour office and we can make themavailable to anyone who . is interested.) But,some of those findings still need to lie 'verified.A lot of research probably needs to go on, butat least we1are beginning to really examine theaccreditation process, the quality of programs,and other essential characteristics. And that(has to: happen', otherwise accreditation is

valueless. The public:will, get fed up with ac-creditation unless the National Commissiondoes be in to discuss quality programs oredGcatio

One.of e things for which we are con-tinuousl being called upon is evaluation.. Howwell are we doing? Once we set objectives forourselves, we must determine how well wehave met those objectives. One f tie best.evaluation techniques is merely. t follow upon our education. That is, are pe le ',gettingjobs? Are they performing on tln, job? Arethey happy with their jobs? I would be satis-fied with that form of evaluation. And W allthese fancy evaluation technigueswe can say, "Well, if we've got time. we'll ap-ply those." The public is.looking at that, too. Itis demanding some kind of an evaluationbecause they people are unhappy with theeduCation program. The kind of'evaluation thepublic is placing upon vocational educationcoricerns how well we are preparing people

fi

for the jobs they have to perform in the worldof work. Is the money the taxpayers are spend-ing getting us- return? That is the question theyare asking. The one tbing that is wing to saveus Is the fact that we can prepare' people tqget jobs, they stay on the job, and they areperforming well on ,the job.

1

Theie are other problems thal are similar forall fields, particularly this whole question o&career ladders. How clo`y15-u build acurrrculumso that.people4 can get back into the work sys-tem at various times in their lines and thenreturn late) io' the PCI uca t io na I system . for .training to take a different job? 'Vocationaleducation has been saddled with a term that is

hurtitig ithe program: In the early das we talk-ed -abOuf voCtational education as being ter-minal; that,. word cannot exist in our,vocabulary.. We havte to' think of vocationaleducation vs the development of an individualwhiCh lets him spin off whenever he so desiresOr move.to the next career ladder. And I don'tmeant move for higher krestige. This is one ofthe things that has hurt vocational edu---catioy--the fact that people have placed .avalue sister onvariousjobs in our society sothat it,is down'-grading to be a nurse's aide, for'instance, instead of being an RN. A- nurse's.aide, if she is hapPy performing-her job shouldhave just as much prestige as would an RN.We try vocational education have to be thechange agents to alter public attitudes. We area small number of people so we have to workhard at this 'task.

Identifying, research needs and their ap-plication is another area of concern. Last WeekI. spent a day and a half with the National In:

,stitute for Education on Resource Workexamining their program in Career Education.

reseechers like to choose theirown, topics for,., investigation. But I contendthat 'we practitioners in the field need to 'den-tify some really crucial issues for these re-searchers to get into because they are missinga lot, of important needs that should be re-searched. They are not even paying any atten-tion .to Them. They are snot practitioners, in

F3 # . .

_a

40

general, and they du not have the background .

.,--t,hat practitioners have. Su we should help..qetermine_ what those research needs are.

The lash of the 'areas I will speak about istheneed for collaboration--working together. Myjob is, first, ti:tfy to get all lhe4o.cationa1 peo-ple to work together so that we Have a coor-dinated, played program. Second, we have towork in education ayross the board, and thenwith all of sour professional groups. We cannotserve-Thepeople unless we all work thether.

.

0

4 wr

r

0 .

At the moment we arehaving overwhelmingproblems with Federal agencies. I know of onecity in the United States that has 28 Federal,state, and Local programs all With theame ob-jectivfes and aimed at the same clientele. OUr.professional- groups are going to find them-selves in t4e same predicament as theyrecognize.their.needs,and try to develop pro-grams'unless the' collaborate. We have a longway to go in dealing withall the issues con-fronting us.

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49'.4

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,-9 O'

THE UCLA ALLIED HEALTH PROFESSIONS: fROJECT PURPOSES, METH ODS;) RESULT'S

, .

') Thomas L Freeland, PhD .

.

,The Allied Health Professions Project, a

curriculum research and de\ielopthent projectin the allied health\oupations, began opera-

,tions in' August, 1968. it was originally fundedas a lour-year.gvant under the aegis- of theUniveFsity of California, Los Angeles Divisionof Vocational Education. The basic objectiveof the project was to create curricula and in- .

structional materials for those allied 'healthfunctions that can appropriately be taught inprograms through t j/e associate degree level.

-/The establishment of the project reflected an

. increasing awareness of 'thershortage of per-sonnel required to meet:the fast- growing de-mand for health care ,services, Regardless ofthe statistics cited, health administrators every-where can attest to the severity of the man:.

... power shortage, and to the need for largenumbers of allied health personnel to extendthe services of the highly trained profeSsionals.

The growth and expansion of allied health hasbeen precipitated by. 1) the declaration by the

, 89th Congress that lcsess to health care is abasic human right of every citizeri in theUnited States of America; 2) rapid change andnumerous technological advances which haveoccurred in the health industry; 3) increase inpopulation:along with igreater,number of theaged in the population; 4) availability of pre-paid insurance plans to a greater percentage ofthe population; and 5) an increased awarenessof' the general population about health andhealth-related activities. Other factors whichresulted in the creation of the Allied HealthProfessions Project were 4he 'rapid prolifera-tion 'of health specialties and the lack of a

functional definition and. differentiation , be-tween and among many of the allied health

'occupations.

.The Allied Health Professions Project was,theresult of a U.S. Office of Education grant. The.grantee institution was the,University of Cali-fornia; Los Angeles. At the time of thp.,-award

:J11./1-968, it was the first consolidated researcheffort, funded by the Office of Edycition, inwhich many of the. health occupations couldbe simultaneously investigated. The availabilityof the UCLA Suryey Research Center and theUCLA Training Hospital were of prime impor-tance in UCLA being awarded the grant.

. The Allied Health Professions Project defines"allied health" as encompassing all health-related occupations (professions). We are verymuch in agreement with Darrel J. Mase whenhe says, "The cope of allied health in thebroadest use oi'the term. covers all profes-sional, technical, and supportive workers inpatient care, public health, and health, researchas well as personnel engaged in environmentalhealth activities."

The basic .philosophy of the project may besummarized as follows:

- ....,.,:.

9' 4"'P

..

The aim is to develop instructionalmaterial which will enable the stu-dent, 'after a sutcessful period ofstudy, to perform a skill or a series ofskills. Correct performance of thetask (job/activity) will enable the stu-dent to have sufficient marketable

W

skills for. legitimate -remunerative ern-

. .ployTent. The basic strategy for thedev.ellypment of' appropriate 'mstruc:tidhal materials is to use the job. asabenchmark for', deciding whatskills /tasks /activities will be taught.The criterion of acceptable perform-ance is dependent upon standards ofthe local agency, however, the AlliedHealth Professions Project has andwill continue to suggest minimumperformance standards.

As indicated breviousiy, the primary goal .wad'to develop modern and effective curricula andinstructional materials appropriate for trainingpersonnel up to and including the Associate.

degree. A secondary goal was to provfor continuous, updating of these materia and.to provide a mechanism for Q. nwidedistribution. Stated more specifica , the ob-jectives of the project were.' 1) to develop'curricula in health-related fields using moderneducational methods; 2) to develop instruc-tional materials on a modular basis, 3) to in-vestigate the concept of core curricula, 4) todevelop an allied health occupations careerlattice, 5) to provide and distribute, by publicor private means, the instructional materialsdeveloped by the project.

: The basic project methodology may be .sum-marized as follows. After extensive field andlibrary research, the resultant information isreviewed by a national technical advisorycommittee in o rder to form a task list of allidentifiable activities and functions for a'givenoccupation. Data about each of the tasks areobtainid by way of a national survey of healthcare petsonnel.,

The data are analyzed and published in an oc-cupational analysis report. Using the results ofthis report, a curriculum outline is formulated,and from this outline a design of the instruc-

-tional unit is developed. This design includesthe rationale, the overall eachipg strategy,specifications of behavioral bjecfives, and di-vision of the units into m ules of instruction.

For each module in the unit, a teaching ell-aft isdeveloped and field tested. On the b2sis of thefield tests, revisions are,' made:' Inftructionalmaterials are then produced and distributed.,Material is reviewed and critiqued by membersof the natiqnal technical advisory committeeat each step in their developnient. Each curri-culum is oriented to .the concept of careereducatiQn. Each course or set of coursesprovides' the foundation- on which additional.competencies can be based. The curriculumhas been de ned An an open-entry, open-eXit plan t'hereb nabling stOclents to obtainsets of emOoyable

The purpose of sequencing the instructionalaterials into,set pf job skills is to provide the

stu nt with rketable skiE which . willenable 4Plirn to be gainfully ,employed. Each'stage of the career sequence is based on theskills and knowledge of the preceding stage.The total curriculum then consists of,a can-tinuum of skills- and knowledge.

The curriculum for any given occupation con-sists of a series of courses., Because the curri-culum is oriented to career education, thelearning experiences for all health personnelwho perform a given set of procedures are in-cluded.. By selection of appropriate courses, acustom-made curriculum can be constructed,.

The'sequence of modules, units, and courses isbased on.seis of marketable job skills. A sug-gested sequence for those health occupationsfor which curricula have been developed.ispresented in the teacher's manual of the in-structional material.

.

However, this sequence may be altered orrevised to match local job market conditionsand manpower pool requirements. The pri-,mary consideration is to provide sets of jobskills which will lead to gainful employmentand permit each individual to expand his corn-,petency to whatever stage he +-nay select,while minimizing the repetition of previouscourse content.

erg'&111 Ur

The Allied Health Professions Project'sdevelopmenYal system is made up of four"basicsteps,,ach of which has one or,Moresubstepswithin it , The first step' is to formulate a task

'inventory The second is-,to produce an oc-cupational analysis rePort based on a survey, ofjob functions The next step is to develop in-.strudional,,,,, materials on a modular' basis 'ifrerjuired..

4

Within this third step are five substeps orphases' pre-planning, planning your structuraln-iodule, producing your prototype instruc-ti3nal module, evaluating the instructionalmodule, and revising the instructional module.The fouith step is to reproduce .the productand make it'available for distribution.

, .

This is a broad overview tkelhe developmentalsystem whiCh we utilize* etleast, initheory, at

Z; Allied' Health fi.Ofe3sions Project. ThisdevelOpniental system Was a product of thecliniCal services gropp. The original flow, chartwas developed by Dr. David AinsWorth whowas our lechnical,consultant in instructionalmethodology and media preparation. I wouldlike:to

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review each of:the steps in more detail.

The compilation of the task inventory is thefirSt step in developing" instrutional materials

.at the Allied Health Profession's Project. Thetask list is in essence a laundry list of all taskswhich may be performed in a fun'ctional area.A functional area m a y comprise one or moreoccupational titles.

For ex pie, nursing is a functional area whichconsis s of several related occupational titles.Inhalation therapy or respiratory care iskA fuhc-tional area which Aomprised of at last threetitles: ,the 4i inhalation therapy ItaTde, theinhalation therapy tfthnigiar\, and theinhalation therapjst. An example of a Junc-tional area which has only ,asingle,.Occupa-tional title would be that of the gastroenter-ology assistant.

In compiling a task inventory, two substeps areperformed almost simultaneously.. First, the in-

dividual.analy,st performs the necessary field.research in order to 'catalog existing inven-tories and existing information pektaining tothe functional, area under consideration. At thesame .timea rational 'technical advisory com-mittee (NTAC) srcted to guide and assist

,

in.the deOlopme t of instructional materialand preliminary analysis.

.

The: I\TLAC is compOsed of experts in thefieldeducators and practitioners.- The pur-

, pose of the NTAC is. to define and 'qualify theneed for instrlktional research, assist inre.\,iewing that instructionalMaterial:which.is,available, recommend revisions in existingmaterials and resources, and assist in 'identify-irig critical areas of need.

Theltext step is to generate an initial task list.Incidental,ly a task ,is a piece of work whichneeds to be done. Synonyms for task includeactivity, skill, and job. In formulating an initialtask list,. the specificity of . tasks should besimilar within various subsectiOns of the tasklist. That is to say;.if the. task is stated in fairlybroad terms, such as "make a .bed,"then alltasks within that specific subsection should be

,stated with the sar.ne degree of specificity. Inothe.h, words, 'it Atuld be inappropriate tohave one task, "make a bed," in the sanlegrouping with apother task such as "make anOccupied bed contairiiirk an orthopedicpatient who is in tiaction,"At.the same time,in formulating the,initial task list, the precisionfor stating the task -should be dependent onthe criticality of correct performance. Themore critical the nature\of tbe task, the morepreCisely the task should be identified.

Again, using our example of making a bed, ifthe task is thought not to be too critical, thetask description "making a bed" may be suffi-cient.. However, if the 'task is critical,. then theprecision'of statement should be "making a

closed bed" or "making an., occupied bedwhich contains a patient who is in traction."

The initial task 115t,is generated along the linesof inclusion. The principle of inclusion assures

it 7

that all tasks, n matter .how remote in anygiven function I rea, will be included in theinitial task list. Sources for the rnijial task listinclude field research, expert opinion, site,

visits, job descript s, and existing proceduremany

The next step is for the .,,NTAC to add newtasks, cull outdated tasks, and, if necessary,segment the task list into sets or sections ofrelated skills. This procedure has been used onal national scale. kwever, it may also be used.on a local or regional basis.

The next step within the developmental system

. is to verify the task list, This verification stepmay be performed by way of a survey

questionnaire or some other, Occupationalstudy mechanism. In selecting a.method forvalidating the task list, two critical questionsmust, be answered:-1) What is the cost of such,data? and 2) What is the. usefulness' of suchdata?. .

.

In considerationf.cost and utility factors, theAllied Heafth' Professions Project elected todevelop a' self-administered survey question-naire: The primary intent 'bf pekluestionnairewas to develop a frequency, difficulty, andsupervision index for each of the listed tasks.

In conjunction with this,,numerical data, ap-propriate demographic and background-influ-enced respondent information was obtained.

Because of cost factors (approximately $15per questionnaire), a selected hospital samplewas'obtained. The hospital panel constituted ajudgmental sample. All cooperating institutionswere JCHA approved,and participated in

Medicare. In addition, they were willing toparticipate in a survey activity of the project.

The aartinistrators or directors of eachhospital were personally contacted and or-iented to the project, its purposes, and itsmethodology, A 4/system to distribute and

, return questionnaires was developed in co-operation with hospital personnel at each of

the facilities.

'Individual survey respondents were randomlyselected to 'participate in the survey 'pro-cedures. Surveys were individually returned tothe UCLA Survey Research Center, where theywere collated, coded, and assigned a securitynumber.

On the completion of the data-gathering phaseof the occupational analyis, the data were an-,alyzed electronically by way of several, pro-,grams. For the most part, the data werereduced to frequency distributions which wereused to formulate job matrices. On comple-tion of the data analysis phase, the resultswere scteened by the .NTAC to determinereasonableness of the findings, and to_ assessthe criticality and .difficulty for specific tasks.After consideration and screening by. theNTAC, an occupational analysis report wasprepared. .

The occupational analysis reports have beenused nationwide for 1) developing new instructional materials, 2) writing new jobdescriptions, 3) re-organizing working depart-ments, 4) justifying salary increases, arid5) defining work responsibilities'

The next major operation is that of developinginstruc.tio nal materials. The instructionalmaterial development subSystem is comprisedof five steps or phases. Phase" one is 'pre-planning.

In pre-planning instructional materials ormodules, the intent is to obtain definitive an-swers to two simple .questions. 1) Is there atraining 'need? and 2) Is the skill suitermediated (indirect) instruction? Informatiolipertaining to the first ,questiOn is collectedfrom several sources. the NTAC, occupationalanalysis,. literature research, field research(which incltides both interviews and obser-vations), and research of manpoWer pfojec-tions.

If it appears that a sufficient number of per-sonnel are being trained to perform a giventask or group of tasks, then and only then do

"112

9project personnel explore the feasibility ofdeveloping instructional materials.

In' answering the second question, severalkinds of information Are required such as. How

' much instructor interface is required? What isthe extent or possibility for self-evaluation per-formance.checks to be utilized? Is_the contentadaptable to mediated instruction? If thesequestiorls.are answered affirmat/ely, ve thengo-on to the next step of p12nning an instruc-tional module.. Prior to discussing this process,I would like to define a module and thendiscuss the advantages"of programmed learn-ing.

A module is, a self-containedrsegment of in-struction. It ,teaches a task which has a begin-ning and a definitive end-4 task which en-ables one to Oun useful employment. The prl--mary advantage of developing instructionalcontent in modules is the great flexibility.which this system permits. Many he'alth work-ers performih same tasks. By selecting in-structional modiffs Which are task-oriented,an individual can receive .specific and appro-priate training for hi' job function, regardlessof his functional title.

There has been much research in the area ofprogrammed (instruction and individualized-learning in the last several years. It isiot ourpurpose tulebate the pros and cons of pro-grammed instruction. However, I would like topoint out that the Allied Health ProfessionsProject prefers to use the term "programmedlearning" in Tlace of the more popular term,"programmed instruction." We believe thatthe teem 'programmed' instruction" eliminatesthe teacher -from the (teaching-learningprocess, whereas the term "programmedlearning" redefines the teacher's role. In a pro-graMmed learning system, the teacher, is nolonger a traffic cop responsible for theregulation of learning, but rather becorties a

resource, individual and a learning motivator..

In this way, each individual student, canachieve according, to his caiSabilities and his

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motiNiation. It was tIA considered opinion ofthe project's staff that individualized instruc-tion would, enable each student to progress tohis own level The ability to perform a giventask or set of tasks should be the learningcriterion, not the rime required to assimilatethe required knowledge and skills.

The next phase of developing materials plan-ning the 'module Within this phase there arethree distinct steps. Step one is setting thelimits of student performance. This requiresthe writerlautlibr to. 1) define the prerequisitebehaviors and characteristics of the student.population; 2) develop a prerequisite -test;3) check for a match or a mismatch betweenthe prerequisite behaviors and the prerequisitecriteria (performance ,objectives), 5) developperformance tests, and 6) check for a match-mismitch between performance' objectivesand performance 'tests.

The: definition of 'student characteristics andprerequisite test .items should establish thelower limits for student -acceptance in theteaching-learning, process. The definition ofbehavioral objettives (pel-formance objec-tives) and performance tests should establishthe minimal acceptable standards for perform-

,ance of any lob /task /activity.

The next: subprocess is. that of ,selecting themedia of .instwction. In determimng the mosteffeCtive. method for presenting the instruc:tional information, one should assess thecharacteristics of the student population. Inother words, one must idintify their readingability, the nature of the material which is robe taught, the kinds and types of student re-sponses desired, and determine the relativecost benefits various methods of presentingthe instructional material. This informationshould enable one to select the most appro-priate media for presentation and at the sametime prevent excessive cost expenditures.

The last step Within this phase is that ofdefining the learning environment. The learn-ing environment should be defined in terms of

the supervisory characteristics required by thenature of the tasks and instructional materialbeing utilized, the space requirements per stdent, and the equipment requirements erstudent. This information should enable o e topredict the size and type of learning f cilitiesrequired for the teaching-learning pro ess forany given module.

The next phase withirilt the s system ofdeveloping instructional materials is that ofproducing the prototype Module. Producingthe module, is subdivided into two sets s ooperations. 1) producing the instructionalcontent of the module, and 2) devising a con-trol' system for the module.

developing the instructional module the firststep is to, develop a step-by-step outline of in:structionar content. This step-by-step outline isusually developed by ,way of a job operationsbreakdown. The job operations breakdown(JOB) is a modificktion of the job instructortechnique developed by Dr. Miles Anderson.The. center of the JOB is. the task or activity tobe taught. The task was selected for analysisbased on information obtained via the oc-cupationalanalysis, i.e., frequency of pertorm-a nce.

The process went something like this. Based onthe assumption that correct task performancewas of prime concern, the task and the knowl-edge.And skills. required for acceptable per-/formance became fhe center point of atten-tion. Information directly related to task per-tormance is a key point, and is associated withan important step. Thil informatioi must beavailable and known by the practitioner and/orstudent in order-for them to perform the taskcorrectly. '

Secondar'y to key points and important steps isindirectly related knowledge -about thetaskinformation which increases an in-

, dividuals breadth of understanding but whichanot a primary requisite for correct task per:-formance. Next we have a large area ofunrelated knowledge which may be "nice to

4

kndw" but which is not essential for correcttask performance

Incidentally, the JOB also aidg in sequencingthe instr`uctional content contained within aspecific module and within a series ofmodules. A visual review of key points, impor-tant steps, and indirectic, related knowledgeassists in association of similar informationwhich at a minimum provides an opportunityto reinforce preview kerning.

The step-by-step outline is checked by a groupof outside experts for 'completeness and ac-curacy. The outline is then edited and pre-pared in the deired format. Artwork,'photo-graphy, and final typing of the drafts are com-pleted. The prototype module is then inspec-ted and reviewed by members of the NTAC.

During the same time, a control system for useof the module is developed. The control sys-tem consists of the following steps. 1) studentinstruction, 2) a motivational irltrodu'ction tothe module (why it is important to learn thisparticular task), 3) a listing of technicalvocabulary terms, 4) a bibliography of refer-ence's and resources which may be availablefor student use, 5) enrichment 'material whichmay broaden the student's knowledge aboutthis particular skill or salt of skills.

As previously indicated, modules are self-contained instructional segments. The advan,tage of the modular curriculum is flexibilityand adaptability of the teaching materials todifferent types of ,allied health workers. Oneor more modules may be combined to makeup a unit of instruction. One or more units ofinstruction may be combined to comprisecourse's, and a number of courses' constitutethe 'curriculum. Of course, thecurriculu'm isthen the sum total of the learning experiencesfor which the school is responsible.

The next phase of activity within the sub-system of developing instructional materialis titled formative evaluation. This processinvolves two distinct types of activity. The

A

first activity is called developmental evalua.Lion The prototype module has been as-sembled The. critical question that must beanswered is:+ean a student successfully learnfrom this programmed-learning, indivi-dualized-instruction Manual? .(

In order to evaluate the efficacy of themodule, several developmental evaluationsare conducted. The first path is to have a naivesubject, usually one of our secretaries, read allthrough the module and identify 'areas of in-consistency or areas which lack clarity. Thenext stop is i() find a subject representative ofthe student population, and to provide him orher with the equipment and space representa-tive of that required in the learning environ-ment. The student is then presented themodule for study. His reactions to the moduleare observed and noted. Areas of difficulty, ofimprecise language, of poor directions arenoted and corrected.

When the student completes the instructionalmodule, the performance test is administered.If the student can pass the performance test, itis assumed the module is a successful learning-teaching mechanei. This process is repeatedapproximately thee to seven times for eachmodule. During this iterative testing, themodule is continually refined and debugged.

When it"appears that the Rodu.le is an effec-tive teaching-learning device, the next step offormative evaluation takes place. That step isgroup evaluation. Project staff members iden-tify subjects representative of the studentpopulation. At the same time, they obtain the,equipment, space, and instructors presenta-tive of those required in a pal teachingsituation. The instructors are oriented onthe techniques of teaching by way of pro-grammed-lear ing, individualized-instructionmanuals. The instructors then present themodule to a group of subjects.

On completion of the le rning processeachsubject is interviewed, ach teacher is inter-viewed, test results are nalyzed, and the in-.

formation is c?rrelated aind incorporated intorerised editions of the modple. This results in a

continuous process of revision and upgrading.

I would like to relate a' summary of what hap-pened the first time we evaluated the instruc-tional materials on a group basis. Incidentally,nursing materials were the first. After obtainingpermission fro'm appropriate authorities,orienting teachers and students, we wereready to try out the instructional materials(Metropolitan Hospital 'in Santa Monica). Atthe end of the first day a very frustrated teach-er called, "Good Lord, I don't like this." Forthe next several days the instructor called veryfrequently with complaints "I don't haveanything to do." "The students are not learn-ing anything.." ,Project staff once againreviewed the proper method of use of theself-paced learning modules. We explained inmare detail the shift of the teacher's role fromthat of a traffic cop to that of a manager oflearning resources. By the time the first testproject was, completed the teacher .stated,."You know, busier now than I ever was,these students really focus, in on importantprocedures and really phrase difficultquestions."

As a result of this experiment, to this day thehospital uses the UCLA nursing materials andprogram for their in-service nurse aide train=ing. Their ,results have been extremely good.,They have better student retention during theteaching process and the quality of perform-ance (assessed via floor supervision) has im-proved. They have also demonstrated thepotential for career development. In the firstpilot class, five of the original fifteen studentswent back to school to increase their knowl-edge and skills in the nursing area. In_ addition,on completion of training, it appears that stu-dents are being retained for a longer period oftime as nurse aides.

Another example of this. process: Our dentalhygiene units were finished just before theassociate director of,that area went to Europe,we distiibuted the materials the day she left.

1s ,31

/.4

Ve distributed abouit1200 of the "Detectionand Remova) of Calculus- learning packets toseven schools. The schools used them and sentthe modules and evaluation sheets from theinstructors and from the'students back to theproject office... These were, independentlycollated by an outside consultant, then we em-ployed an independent writer to review andevaluate the comments. At that time, Annacame back from Europe and she had an op-portunity to review all of .the collected in-formation and tS revise the instructionalmaterials as required.

Finally, after all field tests were conducted, weproducted the revised module. Frequently wehad to re-do the artwork and the photb-graphy. We always had to cut and pate thenarrative. Sometimes we did not del e ourterms approptely or consistently. Based oninformation gathered from the students, theteacher, and the thorough review by the\NTAC, the final product was arlast completedand available for distribution.

We distributed the final product in, one of twoways. We attempted to interest private pub:lishers in distributinF, and marketing or in somecases we distributed and marketed the infor-mation ourselves. I believe that the interestand intent that private publishers have shownthus far is a great intlicatcii of the value of thematerials. When you have people putting theirown money into the production process, itindicates that the material is more than satis-

4*.

32L

factoryor at lest itiS more than satisfactoryaccording to the expectations of the publisher!,

We have been,quite pleased with the parti?cipation ,pf. W. B. Saunders, Charles C.

Thomas, Reinhart, :Lippincott, Resti7n andothers in publishing' and distributing thematerials. Not only will their distribution of,thematerials increase the availability, but it willalsb increase the feedback for revisions apdlater generations of instructional materials. Weare quite hopeful that we will somehow gainaglditional .support so we can complete someof the instructional materials which have no,kbeen completed to date.

In summary, the productivity of the projecthas been 25 task invehtories, 18 occupationalanalyses, and4,01;rn not mistaken, 11 books ormanuals2There was some fallout from the pro-ject. Educational .Products Inc.; at the Univer-

, sity,of Pittsburg, conducted task analyses in' sixareas using the methodology of the project,they obtained essentially, the same results.South Dakota's project has been assisted bythe UCLA Allied Health Professions Project.

Perhaps one of the most important` fallouts, atthee culmihation of any project is thedistribution of people who work on it. Wehave now spread thrOughout the United Statesand each of us is using the materials, the con-cepts, the principles in our own locale to in-crease the efficiency in teaching allied healthpractitioners in our areas.

--4

O

CLINICAL INSTRUCTORTRAINING PROGRAMMiles H Anderson, Ed D.

Clinical instructor training is .=crucial to theallied,health program. Its.main' objective is totrain hospital personnel to teach while on theirjobs.in the hospital. The reason for this is thatthe education of students who are learning tohelp sick people get well (and I always etnpha-size the idea that their function is to helppatients get well) must, ol necessity, take placeon the jOb. It cannot 'be effective if offeredpartially in a college, special school, or nursinglaboratory because sick people must be avail-able for the -students to work with: Thus,clinical instructor, training solves the probleAriby training hospital personnel how to teach onthe job in the hospital. .:

However, there are p oblems in getting clinicalpersonnel to accept t e notion of teaching onthe job Teaching is eWarding and 'fun, but'trying to convince clinical people to take timefrom their duties to learn this is_ a majorproblem. .Because they are working peoplewho' are needed on their jobs, I have found it,necessary to condense-4ny training programfrom 30 hours originally to 12 hours of con-centrated instruction in order to facilitate their

s,work schechAes.r'

A second problem I find is the psychologicalaspect invblvecl in the teaching/learningprocess. For example, the 'staff nurse doesn'tfeel that st-se is an instructor, partly because

.she has gone to school herself and thinks ofteaching in:ternis Of hr own experience,-4,sitting in a ,room filled with rows of seats andsomebody ,up at (.he front with a blackboardand a-riointer, lecturing. I have s'aid, "No, no,that's not the kind:of instruction We are talking

a.

about. The kind we are advocating is muchsimpler, easier, and a lot more fun. It is almostentirely individUal instruction. It won't takeyou any time at all to prepare for it, and therewards will be very great. Now, if you will goalong with me on this, in 12 hours you will,beable to understand it so that you can do ityourself, and then we will see what the resultsare." ,In fact, the results have been quiterewarding for those who have engaged in thisactivity as evidenced by the fact 'that mahypeople I have taught have ultimately becometrainers themselves.

This has actually, become a self-perpetuatingprogram because I always try to encourage thepromising members, of any one group whoseem capable of, teaching and who would en-joy getting up in front of a group and puttingon such a program. Invariably there will be atleast one (Cr two. ildren's Hospital in LosAngeles, I found four uch people, and nowthis procedure is an o -going part of their in-service training .pro ram with at least fourclasses a month being conducted. This beganback in 1968, so you can see that the self-perpetuating aspect is quite important.

I think one mistake made by many schools is

their failure to provide enough hospital clinicalexperience, and in addition, the hospital itself,wants a piece of the action; a little credit, inother words. A good friend of mine in.

Chicago, where I put on four classes, had avery convenient affiliation with a hospitalthere. He got out a brdchure to advertise anallied health program at the hospital. andproudly sent me a copy of it. I happen to know

17

OW*

that he is prett adept at writing nasty lett rs,

so I wrote to m and said, Now look, yougot out this brochure to invite these stbdentsto your school. Every picture in it was taken atthe hospital where they get their clinical ex-perience working with patients, yet nowhere inthis brochure do I see any mention of thathospital's name or who the cl(nical instructorkrainer is or Who the .staff-people are that trainthem. To look at this brochure you 'wouldn't

*think that the hospital even ei5isteci or that thestudents went to a hospital to get their experi-ence. If I were the administrator over there, I

would throw you out." You know, a furinything happened about a year laterfthey didthrow him out He was g tting all t t servicetor nothing, but he failed co give the, 'a littlerecognition.

1

There's another problem. It's noMair to ask,people to do something for nothing. specially

2,4/hen it is hard work as in teaching. ) thinkthat, if possible, it should be arranged so hatthe clinical instructors in the hospitals'can begiven a monetary reward for the extra workthey do in teaching.

it is my feeling that most of our problems ingetting them to work could also be solved inthis way. As it is, about the best that I can do isto give them a. certificate or an "instructor'smedal of honor" or,sornething of that, sort, butyou can't go .out And buy a loaf of bread withthat type of recognition.

In order to sell this program, I have developeda little presentation that is'on a very elemen.tart' level. Remember, most of these people

'think of leaching as standing up. befOre agroup just as I am doing now, with a black- ,

board aria a textbook. I .want to differentiateoccupational instruction from academic.teach-sing methods so that you won't gel confusedwith what we're attempting to.do here. Whatwe are talking about now is task-oriented in-struction in'faci, that's the.naMe of this littlePresentation. It doesn.t take very long to ex-Plain and well just run through it very quickly.

16

`e will be very elementary in our approach;.e-to get the idea across to the.people

ypu are wo with. Otherwise you will notget the cooperation in the hospitals that you'llneed if you want them to play ball with you

,and help you,, They have to4Understand that .this isn't nearly as complicated as it appears tobe and that actually it isnot only fairly easy tolearn to do; but it is)also a lot of fun.

,It seems to me, I usually explain to ese

,

groups4hat there are two basic purposies fostudent to pursue education bey9md highschool ,(or while still in ,higfrsehool, becausenow we have dropped down to' the tenthgrade level in our secondary school program,and th efore I mention thg fact that it reallyrequi s a secondary education-as well). Thesetwo god Sre occupational and cultural. Theoccupational goals either are or shOuld be theacqgisition of skills, knowledge, and attitudestharenable us to get a job, hold it, enjoy it(hopefully), and advance to higher levels inour"-chosen field tl)f 4Work. The cultural goalsalso encompass the acquisition of shills,knowledge, and again attitudes that are essen-tial to 'fit comfortabIS, and. pleasurably into they,desired social setting, In other words, we mustde\elop the capacity to appreciate and enjoyaesthetic valuesmusic, art, darxe, ballet, orwhatever you like, maybe just sitting, in frontof, the TV watching a football game and drink-ing a beer(I'm not condemning thatI enjoy,it myself)..

1 ,. .

In our society, both cultural and occupationalactivities are desirable fo productive and44happy life. Otherwise, we re oeit of balance.ATI occupations that are not anti-social orcriminal in nature and that provide usefulpods Sand services are respecfableevery-'thing,from the garbage man on up to the Presi-dent.However, we will confine our discussionto those...allied health occupations that requiresome form of occupational education.

. .

Education for cultur41 development should belargely a matter of personal pref6rence anyway

because our tastes in these matters wary sowidely On the other hand, vie ought to agreethat there is, little- or .no reason for what weused to call "faculty discipline." We hearabout this notion every once in a while from a

.great many people who stilt believe that thestudy of cultural subjects.is imperative (parti-.cularly if the subjects are what we-used to call"solids"), This has been disproven.convincing-ly by research done as far back as 1906, sothat by now we should know that the oldfaculty 'discipline idea 'doesn't hold. We realizenow that. the study of geometry and Calculus,etc , is not necessarily going to make a goodplumber, p r se. Contrarywise, he must havespecific training in how to be a plumber. Cer-tatnly he may enjoy calculus, but if he isn'tgoing to be an engineer Or take up some otheroccupation where he can use it, it's not reallygoing to do him much good because he willjust 'forget It./`o what is learning and what is task-oriented

Instruction? Learning is what happens when a

person changes his own behavidr (remember,this explanation is highly. sIMplified for thepeople in the class). I smash hard on "changeshis own"; )you can't make him do it. Thatwould be going back to ,the hickory rod, andyou'd get nowhere with that. He has to do ithimselfno one can do it for himand helearns either by acquiring of discarding 'skills,knowledge, and attitudes. Actually, discardingis one of the most difficult learning situations(et., trying t9 learn to stop smoking). Skills arethe ability to perform 'Occupatiapal tasks.Knowledge is the possession of and the abilityto use scientific and technical facts. Attitudes_are the sum.total of the opinions, beliefs, andfeelings we hold that influence our work, ourfellow workejs, our patients, our employees,our employers, and our environment ingeneral Let emphasize again that earningincludes 'tie discarding as well as the acquiringof these behavioral tors; discarding ob-solete skills, knowledge, anci undesirable atti-tudes is a learning process just as much asacquiring neW attributes is. In fact, most learn-,ers find it More difficult tp discard strongly en-.

19

trenched behavioral patterns or fallaciousknowledge than to acquire neov 'informationand attitudes.

..

Let's assume that a task involves the perform-ance' of a series of physical, mental, and hi-tudinal acts by means of which one achieves aspecific objective. in order' to be .teachable, ,

the taskamust be specific, precisely stated, andfree from ambiguity that would result in theomission of important details. For example, thephrase "position a, bed patient" is too vague.There are a number of tasks included in this in-

,

struction, each different. "Position a bedpatient in the SIMS position" is a more preciseand teachable concept. "Teach an amputee touse his prosthesis" is too broad ar.id imprecise;there are many kinds of amputees and manytypes of prostheses. Compare this to "teach anabove-elbow arm -amputee to operate thecontrols oh a prosthesis with a Hosmer elboWand a Dorrance hook." Now you can getdown to business, you know what the job

,ryisyou know hat the task is. The first exarrf-ple is impos le in terms of usable behavioralobjectives, you can't do it. Rut the second one-you can. The first requirement for task-oriented instruction is a precise, acewatestatement of the task to be taught.

Task performance requires the application ofskills, knowledge, and attitudes, whichrre4Dotbe accomplished without physical and mentalactivities. Indeed, there is no learning withoutphysical and mental activities. Some peopleassume that task-oriented instruction ismechanisticthat it turns" out unthinkingrobots whb are ignorant of basic science, prin-scipIK and theory. -This is not hue, although Iagree that the possession of scientific knowl-edge itself is of little value in pursuing an oc-cupationit is what you can do with it thattounts.One of the toughest problems that I

have wr4tledrwith for over 35 years is to inte-grate theaelA concepts so that one supportsthe othep, atiii then the basic science. makessense. WeZhai,e to be willing to accept thenotion that itte mere possession cif scientificknowledge in itself is of little value in pursuing

an occupation. It's what you do with theknowledge\ that counts, and when you dosomething with it, you are. performing a task.This, task-oriented instruction in the basic sci-ences does not merely each the facts, it alsoteaches how to use them.

Now let's examine the skill of teachingbecause we all know that teaching and learn-ing must'go together. Actually, people can anddo learn skills, knowledge,,and attitudes ontheir own, this goes on all the time. All:of you,everyone Sitting in this room, is learning some-thing new every day, independently, withouthelp from anybody. We can and often dochange our on behavior without help byreading, performing a task, following instruc-tion in a manual:observing an object, attempt-ing by trial and error to duplicate it, and soforth. Since we can learn on our own, thenwhy do we have schools and teachers? Whynot just let everybody do as we do so much ofthe time anyway? There are several reasons forhaving schools and teachers, but the most im-portant is lack of enough time. Time is of theessence. Organized education exists becausewe don't have enough time. Given enoughyears,in almost any health occupations depart-ment, in medical technology; say, if I walkedaround in a medical technology* department

4 for a number'of years withoy anybody payingtoo much attention to me, eventually enoughwould rub off on me so that I could become amedical technologi4. That's the old pick-upmethod. Tru,e, it would take most of my Work-i'ng life t) master it, but eventually I could doit.

Since we don't live forever, we have to makethe most of the relatively short life span that 'Isallotted, and this means that we must shortenthe learning process. Well-organized andoperated schools justify their cost (which ispretty considerable) by establishing the meansby which students can achieve in minimal, timethe necessary occupational perf.ormhnce goalsused for successful entry into and pursuirof,their chosen occupation.

I20

Teaching then, as I see it, is helping students tolearn, or as we said earlier, to change *theirown behavior. You must always rememberthat as a teacher, you cannot change the stun,dent's behayior for him, but you can help himo change it hirnself. A good teacher in a well-

,organi2ed school helps the 'student to learnmore in less time with greater retentionAhanhe could if he were just lett to his, ondevices. If the school arid its teachers dO notdo this, then they really cannot justify theirexistence because that's what they are there todo.' Perhaps this idea seems, harsh andmaterialistic, but remember, we're living.iniapretty tough world in which money spent foreducation is more criticalh scrutinized thanother expenditures. Voters' are rejecting bondissues, universities' budgets are being cut, andI've heard this word "accountability" here acouple. of times, as well as "cost 'effective-ness," etc. In the business world there is a veryCommon saying. 'time is money." Event ineducation we have to make the most of every'minute that we can.

In health occupations education, task-orientedinstrutlion is aimed at attaining more learningin less time but .with greater retention. The 4 nstructor's job `then is to help the student tochange his own behavior, i.e., to..learn.Andalthough it is hard work, it is much easier ifyou folloW a systematic plan.

The system in task-oriented instruction consistsof four steps which are basic in as much asthey can be implemented by a great variety ofkchniques, instructional materials4 audio-visual aids, and the like. They form the foun-dation of the Clinical Instructor Training Pro-gram which I have taught for a number ofyears in hospitals to help, clinicians improve`their teaching on the job. I can't take time hereto do more than quickly review the steps andtheir purposes. 1

Perhaps' you think that the first thing Co dowould be to prepare what you 'are going Aoteach. But That doesn't 'Work because .pre-paring what you are going to teach depends

on how you are going to teach it. So I 'have- folnd that you need to establish the teaching

technique, i.e., the four sets of instructions.The first of the four steps. is theyreparation.prepare the learner by getting him to relax sothat hii ability-to think.and remember will notbe impaired Then motivate him to want tolearn by getting him interested in the task wewant him to master.

' can be used on either an individual or-smallgroup basis,, and the,instructor's performance

,must be as perfect as possible.

- It is in the PresentatiOn Step that'audio/yisualaids arefhost useful to the instructor. A well-made 'filmipf the task being demonstrated canbe watched by 'one or mdre students, whichreliev°6 the instructor for other activities suchas supervising Other students who are-learning

This is a very critical aspect of all teachtng,. to put into Practice tasks, they have seenbecause it is here that we must get tile'learner demonstrated but nerd help and direction intb want to change his own behavior. To me, actually dOing them. The use of audio /visual'arousing interest in students is one of the most, materials in this way saves the instructor's timefascinating aspects of teaching because and increases his efficiency. However, to bestudents are infinitely varied, 'and what works 'effective in this way the materials have to be'wit one may not work 'with another. Explain- really well Made, anunfortunately this is noting ffie task and its purpose is, of course, a first always the case.essential. Relating it to the welfare of thepatient is the second one, and relating it to the So, the Presentation Step is summarized asstudent-IS own progress ,in mastering his oc' "tell, show, illustrate, one important step at acuOtion is the third.' This is an aspect of time; stress each key point, instruct clearly-,teaching in which the only limitation -is the completely, and, patiently, but .no more than

;teacher's imagination and ingenuity, as well as the student can master.'the study of each individual student to seewhere the ignition key is located that will turnhim on I have discovered that the ignition keyis not located in the same place for any two

* students; but I have also found that an appealto. the desire td help other people in a hospitalbecomes a very powerful motivating factor.

In the "How to Instruct" reminder card that I

use in Clinical Instructor Training, the Prepara-tion Step is stifnmarized as "put him at ease,find out what he knows about the'jd.b, get himinterested in learning the-job; and put him inthe correct position to see and hear the jobdemonstrated."

The second of, the four steps is the Presen-tation In this step the instructor presents theskill or knowledge of the task to the trainee of -.ter he has motivated him to want,to learn. Inpresenting a skill, the most widely used meth-od is for'the instructor to demonstrate' howthe task is done and to explain'the procedureone step at a-time as he does it. This.technique

Next is the most, important .step-"of .all, Ap-plication. Immedjately 'following the Presen-

-tation Step in teaching a task, the instructorhas the student do what he saw demonstratedwhile the instructor watches closely, correctserrors, and gives help as needed to try to havethe student experience success on his first tryif it is at all possible. I think this is a very im-,portant factor. The.Aptlication Step is wherethe student learns by doing. It is here that hedevelops good work habits from the very start.The instructor is needed and absolutely essen-tial in this step. He can-guide -the. learner tosuccess in performance with% the use ofssuggestiops,, questions, repeat demonstraticinsin diffictilt; steps, encouragement, and themaintenance of a calm and easy atmosphere.The Application Step is summarized as "havehim do the task, correct his errors, and havehim do the task again as he explains each keypoint to you, ask questions to make sure heunderstands, have him repeat the.task untilYo6 knoW that he knows."

21

7.

The last of the four steps is the Test Step. Thisis a check on the trainee's-ability to performthe task correctly and without help. It a

means by which the instructor can discoverany weakness in his own teaching while there.is still an opportunity to do remedial workto correct it. He rs concerned first with deter -

__mining the trainee's ability to perform byha%,ins him do the task without help and then

8 judg4g the quality of the results. In effect, thisis a performance 'test whin is vital to task-oriented instruction. He is concerned secondlywith the student's knowledge of the task's keypoints irnok mg basic science and theory. Hecan eva luate this by means of an oralexamination, observation, or clinical instruc-tion. Oral questioning is-what we encourage.Teachers simply don't have the time to write agood test, certainly they can use writtenquestions if th-e-y-Thave the time, or they canuse other methods. When you do step four,the lest, put the student on his own, with nohelp, ask ,questions about key points to findout-What -ts-tn his head. Most important, praisegood work and don't chelni him out if he

makes a.mistake. ,Finally, re-instruct to correcterrors. .*.

Now, in summary, the four-step cycle of in-struction is the most effective technique that I

have experienced to help learners lean, i.e., to-their own behavior. It not only pro-

vides the basic system for carrying on instruc-tion, it is flexible and easily adapted. to manyvariations. Teaching aids should be evaluate.dcarefully in terms of where they fit into thisfour-step pattern. When applying the foursteps, the commonest error is to emit or ne-glea step three, the Application, which is vitalto task-oriented instruction; without it, youaren't doing the jobithe way it should be done.There can be no learning without physical andmental activity. Learning by cluing is the heartof the Application Step. This is Where I pausewhen working with a group in a hospital in or-der to give them a kind of over-view of, what itcis all about, although I don't go into the matterof "How to Get Ready to Instruct." (On yourcards you'll see that one side is entitled "How

to Instruct" and the_ other side "How to GetReady to Instruct.")

When I travel to teach my clinical instructioncourses, I carry as little equipment as possible,l'have learned to use a 5 x 8 card for much ofmy work. I never use projectors, but prefer todo things as simply as I can, and I depend oneasy little teaching devices to get the jobdone.

Now we will turn the card over and discuss"How to Get Ready to Instruct.- This is wherewe teach how to analyze a task by breaking itdown into two 'columns, i.e., placing the im-portant steps in one column and the key pointOf knowledge needed .to perform that task inthe other column. I -make it clear that thisshould not become a ,long, laborious job, itcan be done on the back of artegnvelope. Theidea is really to get the students to Think

through the task. "What is the first thing to do,and what do you have to know to do it? WhaeL"will you do next? What do you have to knowto do that?" --4 tell them to use abbreviations.Don't write out big long sentences becauseyou'll never read them and you haven't gottime anyway. This is a note from yourself toyourself. You're not going to give this to thestudent. This is merely your guide to puttingj-,)n the demonstration in step two. Keep this as

-simple as you conceivably can makejt. It is ex-tremely important thuat we make these clinical.people become education-minded, which ofcourse they ark n9 when you first deal withthem. They think that teaching- is somemysterious priesthood vv- here caps and gownsare worn and everyone has a degree and along row of letters afteL his name.

Clinical instructor.,traming will go a long way,but don't go into a hospital and.try to ramgitdown their throats, or try to sell it as apanacea for all ills, or promise that it will be alot of fun. But it will save them time and theirmistakes. Less material will be ruined,. andthere will be savings in 50 different way's if agood job of instructing is done. And if doesn'ttake a lot of time. This is the most importantfactor of all.

22 ;8

on how you are going to teach it. So I havefound that you need to establish the teachingteclinique, i.e., the four sets of instructions.The first of the four steps is the Preparation.prepare, the learner by getting him to relax SQthat his ability to think and remember will notbe impaired. Then motivate him to want to

.learn by, getting him interested in the task wewant hil-n to master.

This is a very critical aspect of all teaching,because it is her% that we must get the learnerto want to change`hisown behaviOr.- To me,arousing interest in students is one of the mostfascinating aspects of, teaching becausestudents,are infinitely varied, and what workswith one may not work with another. Explain-ing the task ancLits purpose is, of course, a firs.tessential. Relating it t he welfare of thepatient is the second or and relating i to'thestudent's own progress in mastering his 'or-cupatioin is the third. This is an aspect ofteaching in which the only limitation is theteacher's pagination' and ingenuity, as well asthe study 9f each individual student to seewhere the ignition key is located that will turnhim on I have discovered that the ignition keyis not located in the same place for any twostudents; but I have also found that an appealto the desire to help other people in a hospitalbecomes a very powerful motivating factor.

In the "How to Instruct" reminder card that I

use in Clinical Instructor Training, the Prepara-tion Step is summarized as "put him at ease,find out what he knows about the job, get himinterested Inlearning the job, and put him inthe correct position to see and hear the jobdemonWated."

The second of the four steps is the Presen-tation. In this step the instructor'presents theskill or knowledge of the task to the trainee af-ter he has motivated him to want to learn. In.presenting a skill, the most widely used meth-/od is for the instructor to demonstrate how

e ask is done and to explain the procedureore step at a time as he does it. This techniquet

.N1

can be used on either an individual or smallgr.oup basis, and the instructor's performancemust be as perfect as possible.

It is in the Presentation Step Oat audio/visualaids are most useful to the instructor. A well-made film of the task being demonstrated canbe.watched by one or more students, whichrelieves the instructor Or otOei- activities suchas supervising other students who are learningto put into practice tasks they have seendemonstrated but need help and direction inactually doing them.. The use of audio/visualmaterials in this way saves the instructor's timeand increases his efficiency. However, to beeffective in this way the materials have to bereally well made, anAnfortunatel this is notalways the case..

So, the Presentation Step is summarized as"tell, show, illustrate, one important step at a

time; stress each key point, instruct etgarly,,completely, and patiently, but no more thanthe student can master.

r

Next is the most important step of all,.Ap-plication. Immediately following .the Presen-tation Step in teaching a task, the instructorhas the student do what he saw demonstratedwhile the instructor watches closely, correctserrors, arld gives help as needed to try to havethe student experience success on his first tryif it is at all possible. I think this is a very im-portant factor. The Application Step is wherethe student learns by doing. It is 'here that hedevelops ood work hallits from the very start.The instruttor is needed and absolutely essen-tial in this step. He can guide the learner tosuccess in performance with the use ofsuggestions, questions, repeat deinonstrationsin difficult steps, _encouragerhent, and themaintenance of a calm and easy atmosphere.The ,Application Step is summarized as "havehim do the task, correct his errors, and havehim do the task agtin as he explains each keypoint to you, as questions to make sure heunderstands, have him repeat the task untilyou know that he knows."

#

21

1

. 4

The last of the four steps is the Test Step. Thisis a check an the trainee's ability to performthe task correctly and without help. It is ameans by which the instructor can discoverany weakness in his own teaching while thereis still an opportunity to do remrdial workto correct it. He is concerned first with deter-mining the trainee's ability to perform byhaving him do the task without help and thenjudging the qualit.cc.of the results. In effect, thisrs a performance test which is 'vital to task-_oriented instruction. Hss.is concerned secondlywith the student's knoge of the task's keypoints involving basic science and theory. Hecan evaluate , this by means of an oralexamination, observation, or clinical insttuc-hon. Oral questioning is what" we encpurage.Teachers simply don't have the time to write agood test; Certainly they can use writtenquestions if they have the time, or they canuse other'methocis. When you do step four,the tests put the student on his own, with nohelp, ask questions abzut key points to findout ,what is in his head. Most important, praisegood work and don't cheti him out if hemakes a mistake. Finally, re-instruct,to corre terrors.

Now, in summary, the four-step cycle of in-struction is the most effective technique that -Ihave experienced to help learners learn, i.e., tochange their, own behavior. It not only pro-vides the basic system for carrying on instruc-tion, tt is flexible .and easily adapted to manyvariations. Teachinu. aids should, be evaluatedcarefully in terms of where they fit into thisfour-step pattern. When applying 'the foursteps, the commonest error is to omit or ne-glect step three, the Application, which is vitalto task-oriented instruction; without it, youaren't doing the job the way it should be done.There can be no learning witribut physical andmental activity. Le-arning by doing is the heartof the Application Step. This is where I pause

,.when working with a group in a hospital in or-der to give them a kind of over-view of what itis all about, although I don't go into the matterof "How to Get Ready to Instruct." (On yourcards you'll see that one side js entitled "How

40 ts 22

to Instruct" and the other side "How to GetReady to Instruc't4' °,Y.

When I travel to teach my clinical instructioncourses, I carry isdittle.equipment as possible,I have learnefl to, use a 5 x 8 card for much ofmy.work. I never use'ProieCtors, but prefer todo things as simply as I can, and I depend oneasy' little teaching devices ,to get the jobdone.

Now we will turn the card over and discuss"Hoye toGet.Ready to'Instruct." This is wherewe teach how to analyze a task by .breaking itdown into two columns, i.e., placing the im-portant steps in one column and the key pointof knowledge rigecied to perforni that task inthe' other column. I, make it clear that thisshould not become a long, laborious job,. itcan be done on trie back of an envelope. Theidea is really to get the students to thinkthrough the task. "What is the first thing to do,and what do you have to know to do 'it? Whatwilt -,you do next? What do ,ysru have to khowto do that?" I tell therm to. use abbreviations.Don't write out big long sentences becauseyou'll never read them and you .haven't gottime anyway. This is a note from yourself toyourself. You're not going to give this to the'student. This is merely your guide to puttingon the demonstration in-step two. Keep this assimple as you conceivably can make it. It is ex-tremely important that we make these clinicalpeople become education-Minded, whichtofcourse they are not when you first deal withthem. They think that teaching is somemysterious priesthc?od where caps and gownsare worn and everyone has a degree and along row of letters after his name.

Clinical instructor training will go a long way,but don't go into a hospital and try to ram itdown their throats, or try to sell it as apanacea for all iLs, q- promise that it will be alot of fun. Put itill save them time and theirmistakes. Less material will be ruined, and rt

there will be savings. in 50 different ways if agood job of instructing is done. And it doesn'ttake a lot of time. This is the most importantfactor 'of all.

.

CAREER MODEL DEVELOPMENT AND A MO,DELCURRICULUM: THE NURSING PROGRAM.' .

Luc de A Wood, MS, RN

During the years since the beginning of theUCLA project, great .progress has been madein developing career mobility opportunities innursing. In 1970, the National ,League forNursing made an Open Curriculurri PositionStatement suggesting that all nursing educationprograms provide for career mobility. It alsohad some general beliefs about, education pro-grams for nursing that I think are important forall of us to think about today in the alliedhealth fields, specifically that individuals .whowish to change career goals should have anopportunity sto do so. Educational opportunityshould be provided for those who 'are in-terested in upw. Igckmobility without loweringthe standards of the fietd. In any type of nurs-ing program, opportunity should be providedto validate previous education and experience.Sound educational plans must. be developed inorder to avoid unsound projects or programs.,There should be more effective guidance at allstages of student development. And, if pro-jects and endeavors in this area are to be suc-cessful, nursing must accept the open curri-culum piocess. The UCLA staff does accept,the open curriculum process. students shouldhave the opportunity to change career goalsand continue their education throughout alife-tirne.

As late as 1973, the National League or Nurs-ing published the Directory of Career MobilityOpportunities in Nursing Education.. Of the'total 2,687 nursing education programs, 5%have provisions for career mobi4ydpportuni-ties There are 1,377 programs which preparefor the RN license,.64% of the total programs

offer mobility. Of the associate' degree. pro-grams, 77%.offer some form of advance place-,ment or mobility, and 82% -of the bac-calaureate programs offer mobility. 'Of the

.1,310 Practical Nurse programs, 37% .reportsome method for career mobility.. I think thatis a pretty outstanding thing for nursing tohave, accomplished in a fairly short period oftime.

'For those of you who know very much aboutnursing, we are usually slow about changing,and we have been very traditional in our ap-proach to practically everything. For/myself,however, I ,have done pretty well in changingin most areas. I finally was able to wear pantstarts at work, and that was really very hard forme to do! I have changed quite a bit but thereare still somethings that I cannot give up; andI think that is probably true with rrrany nurses.But, I believe that the nursing influe4e andthe nursing input at the UCLA project 'reallybroadened the"re'St of/the staff.

In my travels across'.the country I haveoundmany nursing educators seeking positive meth-ods for their graduates to continue in careeropportunities. HokNever, there still seems to besome reluctance to look at the entry point of,their respective curricula. It does appear fromthe NLN directory, that most Of the RN pro-grams are rapidly, making progress to providecareer mobility opportunities. It seems to methat there is a paradox here. Faculties are ac-tively,seeking ways 'for their graduates to pro-

-teed in a career 'ladder, but some facultymembers still have blinders on when someone

23-4.1.

comes knocking,o'n their door. We really don'tseem.to be vely trusting of one 'another, dowe? Unfortunately, it is the student who iscaught in the crossfire.

.

There are a variety of career mobility patternsin nursing that are now bekg. utilized.Probably the most common one is credi byexamination, or challenge exams, The m le

exit programs with entry arid'exit, re-enti intothe field, and exit again are usually within oneinstitutictn. There are some cooperative effortsin existence, and updoubtedly more willevolve with the continuing efforts of ,all of usto economize iii the use of faculty, suppliesand equipment, eduCational .institutions, etc.

There are also the specialized programs.whichqlk admit already licensed nurses, e,g., LPN's who

can iget their RN license win aone -yearpevd or RN's whO maybe admitted to thebacTalaureate program. And .then, pf course,

, we have the eternal degree prograrivurrentlybeing offered in New York. This program em-phasizes the demonstrated skill and knowledgeot,the practitioner regardless ,of where or howit was attained. In other words, they are trust-

that you can, in fact, learn something out;of the classroom and thd educational in-

stittkon.

1n the,1960's, with our emphasis placed on.,credentials, we put unrealistic burdens on the

etlu'cational institutions to prepare practi-tioners in addition to 'pushing jobqualifications far beyond those needed to do a.job.. It is not .possible, for everyone in an-orsanizatiorrlo be prepared for the top, levellob, In actuality very few top jobs exist. In

addition, those with-credentials become disen-chanted very quickly With- the so- celled lower

.jobs and., frequently become the trouble-makers for the employer. Can weprovide self-actualization foi.the bulk of jobs in the health"field? I believe' w.e can if, we per(nit,anden-,courage life-long continuing education so that

,

the highest quality service can be given to ourPattetts while at the,same time permitting the .

learner to extend his sphere of Aderstanding.

,.1'

Before I begin d description of the function ofthe career model, I would like to briefly reviewthe UCLA Allied Health Professions Project I

know you talked about this yesterday but I

just want to recap it quickly for you. The pro-ject was funded for tour years by 'the U.S. Of-fice of Education. It began operations :inAugust, 1968. The project was administeredthrough UCLA's Division of VocationalEducation, nd the main thrust of the projectwas dIrectetl toward curriculum research anddevelopment in 18 allied health Ziccupations.

was one occupation researched andprobably the most important one.

The pi,;Oject also had a secondary schooldemonstration program which provided tenthgrat students with an introduction to thehe Ith field.. During the eleventh and twelfthgrades, these students selected the oc-cupations they were most interested .an.

Classes and laboratory practice in' a clinicalsetting were offered on a regular basis, and, atthe completion of fhe,tweiffh grade, these stu-dents-had the possibility of completing the en-try level curriculum in their chosen field. Theywere, therefore, equipped with a salable skillon the job Market. As an alternative theycou-ld continue with their ucation at thetecond step of their occup al curriculumin a posst-s,econdary progra though the re-search pant has completed its four years of ef-fort, many high schools throughout the coun-try are still utilizing some of the tools andcon-cepts developed on the project. But you willbe hearing more about that aspect of the pro-ject on Friday.

42; ;4.

Returning to the major thrust of our project,the curriculum for each of the 18 occupationswas built on national occupation survey datawith four main. objectives. 1) develOpmeakofcurricula in health related fields, 2) consideia-tion of core curricula, 3) consideration ofcareer ladders or lattice, and 4) developmentof instructional materials.

The project methodology followed -ten basksteps which' were. 1) identification, of all tasks,

skills, or' activities in a functional area,2) verification of these tasks through a

national field survey, 3) determination of theproe4s used in performing these tasks' as wellas he knowledge and skills needed for satis-tactory performance, 4) development ofbehavioral objectives or performance goals,5) development of curricula which will in-clude career ladder concepts, continuingeducation capability, onainment of degreeobjectives, and transferability ?f credit,6) development of innovative instructionalmaterials based on a modular concept leadingto a core curriculum; 7) testing the instruc-tional 1-iaterials in the field, 8) evaluation ofthe instructional materials and revisions asneeded based on the feedback' from the stu-dents and the faculty (on the entry level nurs-ing instructional units, we had 23 testing sitesusing our material' and we were able to doseveral revisions befdre they were sent to thepublisher), 9) production'of the materials, and10) the distribution of materials.

4The- entry Itel nursing curriculum which wasdeveloped on the project is being distributedby W B SaUnders in volumes one and ,two,Nursing /Skills: for Allied Health Services.Volume-three of the text should be distributedby them in the late summer.

Our national ritzsing surrey resealed that 60%..of all the functions designated in our surveyinstrument were performed ipy 'everyone .innursingthat is, the nurse aide, the LPN, andthe RN These skillS are readily recognizable asessentially the fundamentals of nursing.',The

.structional materials that were develoPed fromthe occupational analysis include, not only im-portant ste is in the perforinarite of each skill,but eac see. is 'amplified by key points thatclarif e important steps. In addition, relatedan omical and biological principles andmi logical concepts, communicationss ills, leg I, ethical and safety guidelines, as

ell elementary problem solving ap-yr.e4ches are incorporated.

1 he 36 instructional uaits which eventuallywere published as Nursing Skills for AlliedHealth Services have been adopted by alltypes of schools of nursing, e.g., LPN, asso-ciate, diploma and baccalaureate programs. Inaddition, extended care facilities and acutecare facilities are using these text, booksprocedure books. From these statements, youcan see that it is possible to develop somestandardization in .the performance of thebasic nursing skills as well as a core curriculumconcept which could then serve as a base fdrmobility.

You, may be interested to know why the titleof the book .was selected. We actually had alittle office contest. This was the first book wehad to name and we had all kinds ofsuggestions including The Sensuous Nurse (be-cause at that time The Sensuous .Man or TheSensuous- Woman had just come out), Any-way, we had very snazzy titles, and, being thesedate people we-were, we thought that wehad better be a little careful about our finalchoice. Since our project was called the AlliedHealth

beProject, it seemed that it

would be fitting Co have that in the title of thebook. But also, as We worked on the projectwe found that many of. the skills and the in-structional units ,that were incorporated intothe nursing curriculum were, in fact,,skills thatshould be incorporated iitolother allied healthcurricula, e.g., hand washing for mediCal'asep-sis, ethics; legal guidelines, body movement,baldrfce andoalignment; isolation techniques,vital signs, etc. And as we discussed the pro -ject, we found that practitioners in the labora-tory, respiratory therapy, radiology; or medi-cine..4imply did not have these kinds of topicscovered in their curricula. And, of course, theyare ,vitally important in terms of paneint careand also for one's own personathealth care.So-quite a number of the units i,n the first two'volumes are, in fact, incorporated in some ofthe other educational curriculain laboratory,respiratory therapy, the. health careers pro-grams in the high schools, etc.

I.

The close working relationship among theAHPP staff demonstrated clearly that each ofus benefitted by the input from the otherallied health. professionals. We found that byworking together weextended the knowledgeand skills each of us brought to t p ect inmany diverse ways which were ne ed,challenging, and 'motivating. In fact, manus who have left the project are impleme ing

these same concepts in our present s ttings.We had a unique staff 11.1a1-,g tremen-dously well together.

found that the LPN is using almost all of theskills which were origin.41Iy identified as,strictrywithin the RN purview. Yet we continue toprepare these nurses in various pro-grams LPN, associate, diploma, and bacca-laureate programs. This is a paradox to me andto many others.

To return to the nursing survey, we found thatthe next 28% of the skills beyond the initial60% were more complex skills such as steriletechniques, giving of medications, assistingwith somatic therapy, assisting with varioustreatments and examrhations, the identificationof patient needs, the interpretations of sightsand symptoms, teaching of simple healthmeasures and procedures, and selecting thebest approaches to' patient care. These 28%were done by the RN/LPNIkombination. Theremaining 12% of the activities identified inour national survey that were described asstrictly within the purview of the RN were. theadministrative techniques of planning patientcare, assigning personnel, evaluating thequality of patient care and employee perfor-mance and making appropriate adjustmentlinboth of those areas, teaching programs forpatients and employees, and com-plex nursing skills. There were only sixskills which the LPN's were not able to do andthose *ills remained exclusively within the RNrealm._ They included the following: theadminisiration of vital medications andblood transfusions, reading,'of fetal .monitor-ing devicsreacling cardiac monitoring.devices, reading of Skin tes , trachealsuctipning, and the insertion' of asal gastrictubes. ,

At recent workshops in which I have, par-

. ticipated, nurses from the various states con-tinue tO validate the results of out 1969 sur-vey. However, in the last twii years, have

'1972,' the Educational Projects Incor-porate , Hied Health Professions Project inPittsburgh validated the UCLA AHPP nursingoccupational analysis with only minor varia-tions. The report stated that in 19,2 nursingwas in a period or transition. For thOse or usinvolved directly in nursing 'education andnursing service, this seems to be the under-statement of the decade! However, progress is I),

being made as outlined in the National Com-mission for Nursing and Nursing Education'sImplementatii --n Report " "From Abstract into

1

Action," and in the recent NLN publicationDirectory o4areer Mobility Opportunities inNursing Education. The latter report demon-strates that More than one-half of the schoolsof nursing in ithe country already are providingcareer mobility opportunity, and much of thiscan be attributed to legislation within thestates which has. been the .direct result ofsocietal unrest generated toward the educa-tional institutions during the 1960's. I knowthat in California we had extreme problemswith the legislature telling us what we weregoing to be doing in nursing education longbefore the educators were ready to work onthe problems, which then created its own setof problems for us.

'During the 1960's there developed an over-reliance on credentials which ultimately push-ed job qualifications comd<tely out of linewith actual knowledge and skills required forthe job to be done. This not only burdenedthe educational institutions but gave studentsan -irealistic view of what the piece of paperof, n card" could do fo; themthrO ghout life. The belief vAias that _when wegot tt t piece of paper, we were set. Well, un-fortunately, that doesn't happen to be the

case In the late 1960's, Mployers began tohave second thoughts abo t the credentialledemployee That is, the cred ntialled individualhad lots of knowledge but not necessarily theskills required for the job. This was costly forthe 'employer in providing extended training toprepare the workers for their jobs. In adtion,the over-educated employee often giame_bored with his 'job which resulted in lowmorale, poor work performance, and highlabo4 turnoverall costly for the employedthe employee, and ultimately you and me, theconsumers. That is why the focus that theUCLA staff put on ability to perform seems tobe a' great merit in curriculum constructions.That is, we did the occupational survey todetermine exactly what it was that peoplewere expected to do on the job, and then wedeveloped the building blacks of the curri-culum thereby teaching the students how toperform the essential skills until the statedcriterion was achieved. In addition, we incor-porated not only knowledge that was criticalfor correct job performance but general and"nice to know" information within the timeparameters established by the faculty. In otherwords, your time frame is the only limit tohow much you can put int&The curriculum;you can put in as much as you have timeto do. In this way we involve the learnervery early in, t(e educational &irriculum byhaving him put to use his newly" learnedknowledge and skills, in the field of Ns choice.We also provide a sound .scientific basis forcontinuation in the career plan of his choice.

Perhaps if I discuss here the curriculum planfor nursing, the. previous statements .willbecome a little clearer. Although I'm talkingprimarily about nursing, I will endeavor todemonstrate the Applicability of the model toother health disciplines. Since t?iis` is a "func-tional model," 1 have defined function as theentire range of nursing activities and their con-sequences which relate to helping an indi-vidual patient, student, or practitionerestablish an optimal relationship with the stir-

a

rounding environment. The' Model includesnot only theAindamental nursing skills that arereflected in our national survey, but also a

moderate amount of related technical in-formation in the physical and biological scien-/ces along with a minimal amount of generalknowledge.

In the beginning stage of the curriculum, mostof the. material is skills-based; there is very littletechnical or theoretical knowledge. As we pro-ceed through the nursing curriculum, how-ever, you will find that there are fewer newskills to be learned but much more knowledgeto be retained'. During stage.one, the begin-ning practitioner has the !opportunity to learnand practice the nursing kills until a moderate,competence .is achieved. In our initial testingprogram, the time required to complete thispart of the program varied from six to twelveweeks, forty hours a week. This time includedclass instruction, practice, and clinical assign-ments. Most of our test faculties and students.agreed that an eight-week program, or roughly320 hours, was minimal to accomplish all ofthese activities.

This first stage of the model was built on theAHPP's informattion which indicated that 60%of all the activities are common to all nursingpractitioners, i.e., the nurse aide, the LPN, andthe RN. In the registered nursing programs(associate, diplo'rna, and baccalaureate-pro-grams) there is quite a variation in,the amountof clinical time that studeris receive in thefield. If they have twelve hours of clinical timeper week in the field for 50 weeks a year, youare talking about a total of 600 hours in theclinical area or 15 weeks in the year!

Now let me due you in to what happened'when I was a student in a diploma program inthe 1940's. At that time it was a 50-week prO-gram, we had two weeks vacation a year. Weworked eight hours A day, six days a week, andwe had-classes in addition to the work. Now,in terms of the amount of information we had

Z7527 *:

1116

ft<

to learn, you know it realty wasnikery much.What we have done over the years is to de-crease the time needed in the curriculum andyet ye live at least fifty times more infor-ma!tion to get into that shortened time spari.One of the major things that has been cut outof all the nursing programs is the clinical prac-tice, and I know of no exceptions. It is fine tohave the information, but you must pelt it touse! I switch between education and serviceperiodically 'so I can see What service or edu-cation is doing. When I think education is notdoing what I think it. should, I go Over andstraighten it out, and then I come back and seewhat the service end is doing. I try to utilizethe best of both worlds.

.I'm really very dis-turbed with the kind of prat:tice ihat nurses are giving throughout thecountry and the kind of care the patients arereceiving. I do think that it can be improved. Ithink we can, in fact, give nursing care like wedid in the old days but really give a betterquality care because we have a lot of theoriesbehind us now which enable us to know whatwe are doing and why,end we can adapt alter-natives to meet each 'patient's needs. So I'mback in nursing service to prove that we cando just that.

One of the major problems employers are,having now with new"nursing personnel is theirlack of ability to perform basic nursing skills.Stage one, as described earlier, would permitthe learners sufficient time to ,becomemodrately competent in these skills. In prac-tice, ve have found that the more time stu-dents spend with patients, the more they seetheir own lack of knowledge and skills, theythen become motivated to learn more so thatbetter patient care can be. given.

.It was really sort of interesting to view theresults of our initial testing procedures withthe nurse aide program at St. John's Hospital inSanta Monica, California. They had always hadan eight-week training program for their nurseaides, but they agreed to take out instructional

materials and use them one time to see if thematerials would work. We did not tell any ofthe staff of the nursing units that we weremaking changes, we simply made the changesin the classroom. And, of course, the studentsdid not know there were cianges. What hap-pened was very interesting. The students veryquickly were.involved' in nursing care..)were asking all kinds of questions about w ythey couldn't do certain things for theirpatients (they were very limited in the bening in the kinds of care they could give andwhat patients they could have assigned totherm). The students did a tremendous amountof utside reading. Before long the nurse aidesthe were working with on the floor who hadcome ..ough. previous programs asked the in-structors-vhat they were doing differentlybecause these students had so much more in-formation. The supervisors were extremelypleased because the students were looking fojadditional work to do, and they were not satis-fied with just telling one of the RN's thatsomebody's temperature was high, they waiteduntil the RN actually took some action aboutit, which was quite a differebt kind of thingfrom what most aides generAlly were doingtAnd so they found that the students were very,eager to learn more.

We found this to be true in our secondaryschool project, too, where the students gainedmore knowledge and began providing directcare to patients. They soon found that theyreally did not know very much and that theyhad an awfully long way to go, and thislpusheclthe students to tlo Octra reading. I think we

probably do not give, individuals enough creditfor self-motivation. We jost have to give theman opportunity to see what they need to learnand then, of course, put them into a struc-tured program with.' a good faculty that canlead the student along.

11,

Research studies with new graduates fromvarious schools of nursing programs repeated-ly describe their dissatisfaction with the lowlevel of performance in nursing skills. The

C16*28

educators know this, the students know this,certainly nursing service employers know this.Nursing service employers have been upset formany 'years abkut the lack of ability of newgraduates to give care. With the approach wehave developed at UCLA, we feel we can dosomething constructive about improving thequality of cafe given patients. ,

Stage two of the functiOnal model would pre-pare what I choose to call the basic nursepractitioner Included in this block of. thecurriculum is the remaining 40% of the acti-vities identified in the projectthat is, the 28%that were the RN'LPN combination and thel2"o that were, in fact, identified for the RNonly I combined thew activities because itseemed like the logical thing to do at the time(early 1971). Also, I have had an opportunityto do conferences around the country and Iam finding that the LPN is, in fact, doing.every-ihing the RN is doing. ObViously, they don'thave the theoretical background, but a lot ofthese people have done a considerableamount of self-learning. They are really moti-vated and some of them are very. fine prac-titioners as well.

Stage two encompasses some pretty complexnursing skills and beginning theoreticaldevelopment in relation to humap function,combining the theory of practice and problemsolving, decision making, and communicationskills as well as administrative and teachingskills, From the proposed model, for stage twoI see the possibility of blending the strengths ofthe present LPN., associate degree, diploma,and, in some instances, baccalauieate curriculato develop a competent basic nurse practi-tioner ,who can function efficiently.

Now let me explain this further. The LPN is a

licensed nurse who has generally completedtwelve months of expel'ince in giving bedsidecare in addition, their courses give a reason-able introduction to the various scientific sub-jects The As4aciate Degree Nurse (ADN) hastwo years ex0erience in the academic setting.This program provides moderate opportunities

to.give bedside'care, usually no more that-120hours a week during the semester. In addition,these .students become oriented to theacademic setting by obtaining the scientificknowledge required for their nursing subjectsplus their general education courses which arerequired to get the associate of arts degree. Itgives students an opportunity to see howother students function within the educationalinstitution. This program also gives itsgraduates a bigboost if they elect to continuein the academic field and obtain additional de-grees. On the other hand, the diploma nurseusually evolves a close identity with her train-ing setting which is shared with the staff work-ing in the service setting, their pride in theirservice really develops close working coopera-tion. Often; many of these graduates remainwith their own home school.

In the early days of the diploma program thepriority for giving nursing care was favored insome instances in place of the education ofthe nurse. And I can certainly say that was truewhen I was a student. We knewii this as ex-ploitation of the student for the benefit of thehospital. There were some bad things about.that practice, but there were also some advan-tage.S: Today most diploma programs havecome close"to holding the same tenets as,theirpeer programs housed in academic institutionswhich provide students with an educationalopportunity. Thus, it seems to me that thebedside competence of the LPN, rhe oppor-tunity to identify with an educational in-stitution as seen in the ADN _program, and theshared identity of the hospital/school diplomapr6gram should be valued components of anynursing program.

If the basic nurse practitioner, and you wiltnotice that I have stayed away from all of thefamiliar job titles, should become stage two ofthe nursing career sequence, then it would benecessary to require only one nurse prac-titioner license. This would help eliminate thedisagreements within nursing over the "tech-nical" and "professional" as well as the otherlicensing titles in nursing. In any of the jobs

_7

that we do, there--are some elements of tech-nical work and there are some elements ofprofessional- work. Those words really havecreated many barriers in nursing, and I wouldlike to see th dropped from the vocabulary.It the nurse ractitioner elects to move in acareer sequence, it should be because he or

t. she wants to change functions.

Stage three of the model would provide thebegmn g skills and knowledge needed toteach, dminister, practice, or consult in a

special area. In addition to increased theoryin, the specialty, the students would acquireknowledge of basic administrative and educa-tional methodology which would preparethese graduates to be employed as ileginning.faculty .,for the entry levet and nurse practi-tioner prolramthat is, stages one and two ofthe car%er4rnodel or the beginning administra-tive positions in health agenties.

in the time taken to attain .it,. the presentbaccalaureate degree may be comparable tothe proposed stage three. Howeve,r, it is not atall certain that two years will be needed tocomplete this phase.. If our aim is to prepare anurset, t6 function at a certain level, a degreemay or may not be necessary. This matter con-tinues to be questionable. As a case in point,at the completion of stage two, the graduatemay desire to take one of several courses toin( rease knowledge and skills in a specificarea, for example, critical care nursing,respiratory therapy, family health practice,gel latric nurse practice, pediatric nurseassistant or ,associate, etc. These courses, asyou know, vary in length from four weeks to.two years and thus could result in certifitaitionor recognition apart from the academic de-gree. This recognition could be given,throdghan Academy of Nursing as proposed in theCommission Report and which has now beenestablished. if the academic degree is desiredin addition, then the practitioner would haveto meet the institution's academic require-ments, tad:*

In a current nursing journal, I noted that over

1,000 nurse practitiOners have now'be,en pre-pared anckdie organizing in special interestgfoups for recognition and continuededucation. So the practitioner programs havereally sprung up all over the country and lotsof nurses are involved in them. In fact, currentresearch does not jeem to demonstrate a great

,difference in the varying basic preparations ofthe experienced 'nurse the, associate,dibloma, or baccalaureate in their ability to,becone competent nurse practitioners fromany one of the current pi=bgranis, e.g.,

pediatric, geriatric, or family health..In otherwords, I'm saying that it really does not seemto make any difference whether you have anassociate, a diploma, or a baccalaureate de-gree when you continue in the practitionerprograms, all three of these are seeminglyequally successful. The research finds that theRN's with experience and personal motivationcan successfully complete the practitioner pro-grams of their choice regardless of their basicpreparation.

In the past we have been trying to upgradenursing,'and I believe we need to do this asmuch as anybody. I thirlk the complete em-phasis on the piece" of paper is the wrong ap-proach. It is very important for some peOpleto have an academic degree in their own right,but it is not important for other people. I,thinkwe need to recognize that fact.

On the employer's side of the fence, with th'e

state and federal governments and third partytaxpayers looking very critically at cost effec-tiveness programs within health agencies, it is

going to becOnle much more expedient to hirethose practitioners who have ,the knowledgeand skills needed to c16 the job rather than hirethe expensive academically oriented staff todo the routine work. In the future, employerswill be hiring the highly skilled and educatedpractitioners for certain positions, but thesepositions will entail functions which cannot bedone by the lesser prepared. In other words,there-is going to have to be a definite changein the function of people who acquire aca-demic degrees.

Quality assurance programs based on statedperformance criteria and utilization toolswhich are being re imthmended by licensingand accrediting agencies will mandate a Closerworking relationship between the employersand edkators and future allied health practi-tioners. Workers will have to perform thestated functions to criterion levels establishedin the agency, and, therefore, the educator'sare going to have to prepare workers that canbe functional in the health field. I think there isgreat evidence in the country that service andeducation are in fact beginning to talk to-gether. In' some places this is better than inothers If we don't do it ourselves, then it willbe done for us *from the outside. It seems tome that weshould be the ones to take the bitin our mouth and 'run with it.

Stage four of the model would 'prepare theteaching faculties for the stage two, three, andfour programs as well as preparing ad-ministrative personnel for large medical cen-ters and health `agencies. Beginning researchmethodology would be offered at this point inthe curriculum. I believe this is necessary' toenable stage tour graduates to be stiong sup-porters of research in nursing, and tffey wouldalso assist in identifying clinical 'nursingproblems for research. The curriculum at thisstage would be of an advanced, academicnature covering teaching and administrativetechniques that could' be applied specificallyto the areas of nursing education and ad-ministratiati. In other words, stage four of thecurriculum would not, at this time, includehigh level nursing theory. However, there cer-'tainly would be a strong possibility of that inthe near future when the fifth stage of themodel could be fully implethented.

Stage five of the model should prepare theenurse researchers and would be on the level.

'with the present doctoral degrees. The func-tions of these graduates would be to expendtheir efforts on research in order to assist.inthe development of a scientific bOdy of nurs-ing knowledge, Although nursing research and

the development of nursing's, own body of.knowledge is the major limitation to our "pro-fessional stature," many changes are, in fact,occurring in nursing research. We now haveover 1,000 nurses who have'doctorates andmany more are enrolled' in doctoral studies.Nursing research is now dealing with the ef-fects rA specificnurs.ing care on the recoveryof the patient.

We are t eginning to document with nursingresearch some of the beliefs about nursingcare that many experienced nurS's have hadover the decades because they found thattheir techniques were successful after usingthem on their patients., Until they. were docu-mented. by research study, certain practiceshad been guided simply by feelings or hunchesof the nurse. These successful treatment pro-grams were rarely passed al9ng; they weregained with experience in nursing, if they weregained at all. So the basic research in terms' ofclinical nursing really will help us improve thequality of care. . . r

0The clinical nursing knowledge that we can',obtain from nursing research rill not only pro-vide a higher and more consistent quality ofnursing care; but it will assist is in establishingstandard care plans-by which practitioners canbe evaluated. And that is what the whole .gameis about. On the nursing service side of thegame is the Joint Commission for the Ac-creditatibn. of Hospitals ()CAN) which is nowsetting up standards of rierformance..Nwsingpersonnel must be .able to demonstrate a'change in patient care 'in order to become ac-credited. Thigrotides a tremendous chal-lenge 'for nurse g Service people to get with itin terms of performance objectives and be-havioral goals and so on.

I see this model as being a sound method fordeveloping nurse 'practitioners who Would/assure competent nursing care in any healthsetting. .More_ importantly, each successivestagewould include increasing and cumulativecompetencies in nursing practice, decision

#

making, and problem solving, as well as ad-ministration, communications, and teachingskills. In every position that a nurse holds, shereally has to be an administrator of some sortand she does have to have some teachingskills/And; in general, these kinds of skills arenot taught to nurses to the degree that theyneed to be taught.

Let me briefly revithe stages of the modelbased on func n that I have outlined for youand give you estimation of percentages ofrepresentation in the nurse population. When Ioriginally prepared, the model we had about200,000 people working in the field of nursing.My predictiOns are based on that figure., Askou recall, stage one would prepare theCOtrylevel nursing practitioner in the fundamdntalskills, so this group would comprise about 25%of the total population. Stage two would pre-pare the basic nurse practitioner who wouldcarry the bulk of /The direct nursing service tothe patient. Stage two .would prepare about50% of the work orce, so these two stages to-gether would be t ing care of about 75% ofthe nursing force. T e size of this group mightbe increased in the years, to come as ourdelivery of health Services changes, which I

believe is a real possibility with such a flexible,open-enled model as I presented here.

It would be difficult to alter my.views on thecompo ition of the first two stages. However; Icould' e persuaded to change any or all of myviews on stages three, four, and five uPon thepresentation of comparable data. We have notdone any research yet at the three, four, andfive levels, and thus my ideas for the modelare as good as anybody else's.

,

Stage three, of the model would prepare thebeginning nurse educator, administrator,practitioner; or consultant in the specialtearea. This group would comprise 15% of thework force.. Stage four would prepare theteaching faculties . for the mid-level andgraduate eacational programs as .well as pre-

paring nurse administrators for large medicalcenters and health agencies. Nine percent ofthe nurse population would be needed to fillthese key, positions. Stage4ive would preparethe nurse researcher. If 1% of the total nursingpopulation could be involved in nursing re-search, we could expect to see a vast improve-ment ip clinical practices in the next twodecadet.

I believe that this model provides for creativityand flexibility based upo,n lOcal, state, regional,or national needs. It provides the mechanismto easily drop activities and content that Areobsolete as well as providing an easy metjiodfor adding new content when appropriate. As Ihave worked with nurses around the country, I

'have become convinced that there is muchmore commOnalaty among us than there aredifferences. As a member of the UCLA AlliedHealth Professions Project, I had a unique op-portunity to see an overview of nursing thatfeyv in the field ever have. I urge all nursingecucators, and all, health educators for that.matter, to guard against tunoelIvision froyour own little perch. Do noota laugh at cifdiscard unusual approaches to developing-alternative learning opportunities. Keep anopen mind. Take on all comers, `tally the re-sults, and obtain the' best solutions for yourpurpose's.

In the model presented, no reference has beenmade to the -educational settings. Diversity isthe concept to be developed. The final reportof the Commission on Non-Traditional Study,Diversity by Design, makes man 'recommen-dations for action for the educational settingsuch as pro.viding life-long learning opportuni-ties, not only basic but con'inuing andrecurrent programs, and a shift in emphasis.fora,pdemic settings from degree granting togiving service to the learner. The reportrecommends greeter utilization of existing andnewly developed non-traditional forms ofeducation and materials, and the developmentof agencies to keep and disseminate student

credits and to provide creditable counselingwhen needed by the learner. The various non-traditional and traditional education programsshould not be seen as entirely separate eriti-ties, efforts should be made to make them In-tercha geable. This could be done and stand-ards acouldhis fie

d objectives could be developed whichbe utilized to prepare the practitioner inId bf endeavor regardless of the setting.

Broad support and encouragement have beengiven to non-traditional study efforts,.so much iso that they have been incorporated into thelaw as the Educational Amendments of 1972to the Higher Education Acts Of 1965. Theseamendments propose improving. seconds.ediJcation by providing - assistance toeducational institutions and agencies for thefollowing purposes. 1) encouraging thereform; .innovation, and improvement of post-secondary education, and providing equal

-,educational opportunity for all, 2) thecreation of institutions and program's involvingnew paths to career and professional trainingand new combinations of experiential learning,

)t3) the establishment of ins ',utions and. pro*-graKs based 0,n the tec nology of cOtn'munications; 4).the carrying out in pdst-econdary educational institutions of changesin internal structure and operations designedto clarify institutional priorities and. purpose,%) the design and introduction of cost effec-tive methods of instruction and operations,6) the introduction of institutional reforms de-signed to expand individual opportunitie's forentering and re-entering institutions and pur-suing programs of study tailored to individualneeds; 7) the introduction of reforms ingraduate' education, in tz structure ofacademic professions, and iti_Ahe recruitmentand retention of faculty, 8) the creation ofgood institutions and programs for examiningand awarding credentials to individuals and theintroduction of reforms in current educationalprictices related thereto. So there is a lot ofemphasis. on non-traditional approaches.

Another and considerably more complex

problem that must be worked out is the trans-ferability of credit from one setting to another,.A workable solution to this one problem alonewould serve to speed up the preparation ofnursing practitionerneeded to meet our in- "creasing health requirements. Nurses repre-senting all types of nursing programs in Ne) .Mexico have been sitting down togetherestablishing entrance requirements' for ealevel program so that their gradates will beaccepted in the next stgp of the career ladder.In additiont together they have wo d outstatementsvdescribing the graduates each,program. In this way they are attempting todelitleate the differences among the prac-titioners so that all types of nursing programsare not in fact producing identical nurses. As Iworked with the nurses in New Mexico,xvefound that the LPN's .were doing much thesame thing as RN's were doing. And di, LPNfaculties were so pushed trying to get all therequired information into a one-year programeNat they really didn't know how they weregoing to do more. So vve'gave all the nurs-ing eclucatqs an opportunity to look at andlisten toe,thevarious nursing programs and the'Content's-and problems, of each. They haveselected the cont4hts td,be given at each levelof the nur.s.in curfriCulum, and they have alsodecidecr'whowillteacl-rvvhat content so thattheir,oUld begin 4o develop the content itself. .

Completion of one level in the nursing 'careersequence will permit total acceptance at thenext level as the- student wants to progress.

It is possible for nurses to get together to workout some of their differences as youprovide the career Mobility. These have beenagonizingly difficult tasks, but the nurses' inNew Mexico have become mole knowledge-,able about each other's programs and they arenowhore willing to compromise some of theircherished precepts for the greater good. Everyone of us here today will haye to compromisesome of our cherished precepts. Similar active-

., ties are underway in other states and most.ofthe efforts are being documented in variousreports .and papers.

1

There is a natural evolution in most of the pro----"gramr-btrtnot in all of them. This certainly

makes it necessary for each of the health oc-cupations to look at what it i\doing and toprov ide.upportunities for career mobility. Fbrexample, in medical laboratories, stage one isthe lab.assistant, stage-two is the medical

jnician, stage three 1s the medical technologist,la stage "four is tile medical technologist ad-

ministrator, consultgnt, or teachero, and instage five we would ha thj researchers inMedical technology. I know that some of theseareas do not exist, but why don't they? Thisseems like anapp4opriate approach.

The model can also be applied to respiratorytherapy. have -1.3c1 a terribly difficult timeyvith that field because on the project it washailed Inhalation Therapy and the nationalOrganization has, changed the name to Respira-tory Therapy. So, anyway, Aie are talking.about respiratory therapy aides for stage one,respiratory therapy _technicians for stage two,the respiratory theram, techrtologist for stagethree, the.administratc4, consultant, or teacherfor stage fours and stage five again would bethe researcher. And there certainly needs tobe a .lot of research done in the field ofrespiratorl, therapy.)

52

Then I took, it upon myself to apply this modelto ihe, physicians. At this point we wouldprobably eliminate stage one for the physi-cians, but tage two would be the spsysicianassistant that we are hearing so, much aboutn'ow. Stage ttfree would be the MD in thespecialty, arq,a! Stage four would be the MDwith advanced information in a specialty andhe would be ,an instructor in a medical schoolor an administrator in a health agency. Now,why in the iworld physicians beirve they canteach and administer when they have not hadany of this training in their background is

beyond me! And then MD's for stage fivewould be in 'research. This seems to/ be alogical secfuence for MD's as well as for every-one else.

I even applied this model to dentistr,y. Stageone would be the. dental' rchnicia0 or thedental assistant, stage two, the dental hygienist,stage three, the dentist, stage four, the ad-ministrator, consultant, or instructor, and stagefive, the dental researcher. It really falls rightinto line fore every one of the health occupa-tions, and it gives you some direCtibn fo(moving in,a career ladder.

ti

4

4...

THE COOPERATIVE RELATIQNSHIP BETWEENTHE SOUTH DAKOTA STATEWIDE CORE '`CURRICULUM PROJECT AND. THE 'UCLA. /ALLIED HEALTH PROFESSIONS PROJECTDonald G. 8rekke, 8 ..

\..

N.

1

S.,

For quite a number of years now there hasbeen a lot of talk about the need to develop a

'core curriculum in the health occupations, butvery little has been \done about thisi need. InSouth Dakota, we decided that rather than tryto develop a core in one selected area wewould go into all the health occupations train-ing programs that we had in our state.

I think that I should give you a brief back-ground into how the project came into beingand tell you about some of the people whoreally had foresight to try to de4lop some-thing like this. pur state, as you know, is veryrural with the exce(itibn of about four 'com-munities, and even they are still quite rural; sowe do have a rural problem. We have onephysician for every 1,262 people as comparedto the national average which is one physician,for every 608 people. We have 17 counties iciour state that do not have a physician. We alsohave 21 'counties that do not even have a

hospital, 'and our counties 'are quite large.

In 1967,, Dr. Robert Hayes, Secretary of theState Department of Health (at that time Dr.Hayes was the director of the South DakotaRegional Medical,Program) decided that some-thing had to be done in the area of healthmanpoWer to try to meet future demands toprovide more trained personnel and alleviatethose problems caused by maldistributio'n of.personnel. Dr. Hayes worked out an agree-ment with the State Department of Health andComprehensive Health Planning (CHP) to pooltheir efforts and somer-of their resources tobring on board someone to work in the area as

a CoOrdi.nator of Health Manpower Develop-ment Programs. The title was very long and thejob description was about five pages. Thehopi was that work,could begin on a corecurriculum in health occupations.

In 1970, they actually created the Coordinatorposition, but they needed money for ir so theyobtained the funds half from CHP, half fromRMP. At that time there was still not a carecurriculum p-roject so they came to me andasked if I Would be the Coordinator of HealthManpower Development Programs and Pro-ject Director for the core curriculum program.Our funds for the main parts of this particularproject come from the old Bureau of HealthManpower Education now called the B reauof Health Resources Development (BH D) atNIH. We have always worked, directly wit Dr.Gunnar SydOw, Directo6, Division of HealthResources Development, DHEW, Denver. TheState Department of Health of South Dakotaputs money into the project as . do Com-prehensive Health' Planning and the RegionalMedical Program, but the two' major sourcesof funding are the Bureau of Health Resourcesand the Regional Medical Program.

Another.thing that we are doing at this time is

conducting a study on health manpower in thestate and .assessing,the needs, the resources,and the services. No one has really ascertainedwhere the needs are, yet we are all trainingnew people and starting new programs.

In the fall of 19724,we went to the Governor'soffice to talk to him and ask if we could have

-.35

-,ta-,

L'ali individual from his office who had been in-volvd

,i with us in core curriculum projects.

The Governor's office agreed that he couldwork .with us on the project as long as hewould be available to do certain things withinhis other duties, Thus, Dr. Wayne GlIdl)ethcame on board with us-and last summer wemade him the Associate Director of theproject. Oe is responsible for the major por-tion of the progress that has been made today.

At this time in South Dakota we have approxi-mately 87 h &lth manpower training/educationprograms. The 87 programs that I mentionedhere do not include the college preparatoryprograms for` medical education in pre-mOicine, pre-ddntistry, pre-optometry, pre-veterinary medicine, etc., or the four-year,school of medicine that wehave now. How-ever, the medical school is represented in ourproject. Each and every one of the 81 healthmanpower Orograrns is involved in the corecurriculum project. These programs exist in 31institutions in the state that prepare healthmanpower personnel. We say that an in-stitution is any facility offering an accredited,health manpower training education program.They are located in vocational/technicalschools, hospital-based programs, two- andfour-year colleges and universities, and pro-prietary schools. We have 14 colleges in ourstate and for some reason two of them don'thave aily health programs, but next week theyprobably will atk for one! 4

t

lust two 'weeks ago the state legislature passedlegislation which approved and funded a four-year degree-granting medical school. Many

J of us felt that this was long overdue and wefeel how that the medicaligchool could serveas the major resource for continuing healtheducation across the state.

We feel that a is unnecessary to have theduplication Lhat is offered in many pro-gramsthat, wherever possible, the com-munity educational and health resourcesshould be shared and state-wide planning byhealth education leaders should by en-.

.couraged. I think what needs)o be done is foreach of you to gpt together with the people inyour state who make the decisions in

healthnot just in health education but in

bea.lth services, health planning, and in imple-mentation of programs. In most places theseindividuals are the state health officer (theSecretary of Health, Commissioner, or what-ever you call him), the Comprehensive Health'Planning Agency, and the Regional MediclPrograms which could be a great resource forall health education Across the country.

Another thing that we found early in the pro-ject was that you have to get involved with theleaders in educationIn addition to each of thehealth manpower training and education pro-gran's in the state, we brought in people fromall of the health professional organizations andgot them involved in the project. If is easier to

ve them involved and working with youth n to, try to present it to them later. We also

imade sure that we had representation from"the4 State Board of Regents, the statelegislature, the Governor's office, the univer-sity; systems, and the people who make thedeZ,sions in vocational education.

. .

NAv to the purpose of the project itself. Themajor goal or objective of the core curriculumproject is to design a single or mutti-fattedcore of educational material which will serve

,as many of the health educational programs inSouth Dakota as possible. Based upoi thiscore, it is further desired to provide Oppor-tunities for lateral and vertical mobility for thestudents. Side issues that are involved in the.project include the transfer of credits and/orexperience, challenge examination possibilities,standardized performance examinations, thedeVelopment of educational materials, andcontinuing education possibilities. In general,the core project is concerned with health man-power training, recruitment, and distribution.However, the developMent of the core andrelated activities has been done in fullcooperation with the health manpower train-ing/education progr(ms in the state and withthe health manpower task force compospd of

" 36

the people that I mentioned earlier who arerepresentative of all the health manpowertraining/education programs as )"well asorganizations, agencies, professional and stu-dent Associations also involved with' health. Infact, we're so liberal, if someone Sthinks theyought to be involved we say, "Fine, come and,join us."

The rationale behind initiating the cooperativerelationship between the UCLA and the SouthDakota core projects was that, aftera reviewof the literature and especially after visiting theUCLA people, it became apparent the UCLAAllied .Health Professions Project was actuallydoing more than anyone else we knew abOutin developing task inventories of what eachhealth worker would be expected to do on thelob, We alsO agreed that before ,we woulddevelop the core curriculum, it must be deaarto the instructors involved what the individualwould be 'expected to do once he was on theMD We thought the curriculum could be de-signed to teach the knowledge and Skillsrequired to perform the tasks on that job. Sb Iguess it was rather a natural thing that the twoprojects would get together.

In South -..Dakota, we'hadta major 3-day workshop back in September, 1972. We' had over100 people in attendance, most of whom werehealth educators. We limited attendance toone representative for each of the health manspower training programs because we justcouldn't ItAlle anything larger. We also hadrepresentatives from all the agencies that had

,anything to do with health in the state 'plus,people from some of the federal offices. MilesAnderson, Tom' Freeland, Lucy Wood, .andHoward Taub, of the UCLA Allied Health Pro-fessions Project, came out and conducted a

very successful workshop entitled "The Prin-ciples of the Task Oriented Approach toHealth Occupation Curriculum construction."This' workshop was actually devoted to thepreparation of task analysts, *performance ob-jectives, andlask Oriented instruction. The taskanalyses of medical laboratory and nursing

'9-37

pLictice for South Dakota were completed atthat workshop.

I feel that the most important thing to comeout of the workshop was the opportunity forall these people to come together, to meet, toget to know one another, and to really find..out that we were sincere in saying that wewere going to develop something like the corecurriculum.

In May, 1973, we he)d another three-dayworkshop, againi in the Black Hills in SSouthDakota (We purposely take people to an iso-lated area). Again, we had Lucy, Tom, andFil1ward as well as Jerry Epstein who conduct-,ed a second very successful workshop on thedevelopment of the potential entry level state-wide core content for the health related oc-cupations. The potential entry level, or as wecall it now, the primary core content, wasdeveloped, tasks, skills, concepts, and otherrelated knowledge which are of potential im-portance for a health score curriculum wereisolated and identified by the participants inthe -Workshop. Generalized topical outlines for22 separate traditional academic course areashad been prepared, and they have been andare being used in deVelopttig the completehealth core curriculum'at this time. From thesetwo major workshops and other interactionswith UCLA Allied Health Professions Project, itis evident that they have played a significantrole in assisting South Dakota in developingthe core curriculum project..Dr. Miles Ander-son has been an advisor to us, as well as afriend. Lucy's textbooks are used in all of thenursing schools in the state.

The progress of the project, the actualdevelopment of the core' curricula for thehealth manpower training/education programsin South Dakota, began with the earlier work-,shops that I mentioned, especially with theone this past May during which the potential,core content items ,and the tasks, skills, con-cepts, and attitudes were identified. The re-sults of this workshop were then reviewed and

modified during a series of five sub-committeeworkshops which we have held. These work-shops were composed of people who repre:

t sent the various health manpower tram-ing,educafion programs (the 87) that are mem:bers ,of the state-wide Health ManpoWer TaskForce. In adefition, if need be, we brought inoutside resource people, e.g., chernisr&Jhecore development is done by the people %.--T,HO.

- are currently teaching chemistry to the healthrelated occupations on one of the campusesas well as health occupations educators. Wedon't bring them all irifrozoantr-carrfipus, wemix the people up from various place.

4)At sub-committee workshop no. 114vhich weheld in August, 1973, the priniary.'core wasdefined and topical outline*econtaining- tasks,skills, knowledge,; 'and 'Ittltud'es werere'

developed as the prima

In phase two, two and

y core.-

,.sub-committee work-

sh,tips were held inOctobe'r acid Deceri;ther of

cor, as defined. Topical outlines rerir sent-1973. During these workshops, the, seclida,ty

,sent

in he Casks, blk,ills, knowle4e,, and 44t1tudesririv

"deired in each ;or the six academic 'areascalled the secondary. core -were' developed.The major' areas iclentiid were anat6n-0 and-physiology, chemistry inte'ipersona relation-ships (for which it was. found. to rliq.e4retnelydifficult to jeY,belvvioral'objekilites,), 'micro-biology, nutrition, and _Rt4139c, health and neal hcafe delivery.,1-'' ,

Phase three t4):o.k 'longer to complete; In

November, 1973, we,feltbthat we needed a lit,'tle more, help so we 'worked with ,HoyvardTaub and JetrY, Epstein at Los Angeles and-hi-red thernto -translate, the, topical outlinesrepresent:1N tAe.pritnary core into measurableobjectives.,, lo rinuaiy-; 1974, we, again went

,out to Lo,s,Arageles to meet--with Jerry and.1.-Joward, and thiS tinn we discussed 'with thema,\process or,transjating the secondary core,,,

,top)cai o.utlines-into ,measurable objectives viathe t,sub-carnmit:tee workshops beCause this is

. t'. ,. .

what Wayne and I thought We wantea to do,

.

but we wanted to test our idea on someoneelse. We have been very pleased with what hasdeveloped since then. Sub-Committee work,-shops were held the last week of January, andag-attit-kus past weekend we had a three-dayworkshop at which time the primary core mea-surable otActives constructed by Jerry' and-Howard were evaluated and ,revised as

necessary. AlSo, the'secondary topical outlineswere translated into measurable objectives.We are not finished with these tasks yet, butwe will be sometime this summer.

In phase four, we plan to have all the healthmanpower training/education programs andtheir parent institutions review and commentupon the measitrable objectives and the corecurriculum, concepts thus far developed.During this review process, which willprobably take place in March and April (1974),we will be asking each program to evaluate,each measurable objective with respect. to itsdegree, of importance to that partitUlar pro-gram of to any programs within their in-stitution. Then, if necessary, we plan to hold aone-day meermg,with the institutional contactpersons to insure that the review process,Willbe essentially the same for all programs and all

ins*titutiorts in the state..

In phase five, after the review prOcess is com-.pieted ad 'any necessary modifications havebeen made, each pro,grarn't.41 be asked whe-ther the-will -adopt or reject the primary corer

,..measurable objectives as rnmithal objectives,.and whrchof the secondary core measurableobjectives they will accept as minimaltives.

Beyond the 'cleveloprrient of the core 'cure-culum itself we know it is going to benecessary to consider the professional co. ors4career ladder alternatives,. and the acquisitionand development, of instructional materialsand standardized challenge examinvOions.Already, this year we have hal: "Work'clonednthe professional courses and the career modelalternatives in the .linicaHaboritory program

1.

areas. Then, starting on June ls't, we are goingto do the same thing with nursing. The futureemphasis of the Core Curriculum Project staffwill be on the acquisition and development ofinstructional materials and standardizedexaminations as well as the development ofprofessionarrcoUrses. We will also considercareer alternatives, for health programs, andcareer ladder development will be consideredby all health occupations where the ladder is

applicable

An South Dakota, work will continua onstrengthening the role of the Health Man-power Task Force to include the assessment ofhealthpanpower needs and resources and theresultant advisory role that it plays in 'SouthDakota on matters involving health mariporertrainiiig, distribution, and recruitment We Alsohave some rather unique things in our statesuch as the fact that the Regional Medical Pro-gram has been involved in this program sinceits inception and is developing a state-widecontinuing and special health education net-work Eventually we hope to have onerepresentative from each of. the healthprofessions on a large committee to plan to-gether what is needed. If they will work to-gether, then the Regional Medical Program will.continue to fund the committee.

. 1

h ve\pOblished some of the findings of theprof ct already, but we have not put them outfor general distribution. The proceedings ofthe last two sub- committee workshops will notbe published until they have gone to the indi-vidual programs, and institutions for theirrevision. When this report comes ollt, it willcontain 'the behavioral objectives for eachtopic that is to be covered' in that particularcourse. That 'Is going to take a. while, but I'mconfident that we will do it. .

The streamlining of the educational curriculumeliminates repetitious training, time consuming

,,courses which are unnecessary, and the frus-tration of the student who is ultimately faced

. .with these problems.

It shouldmphasized that the intent of theCore Pr6ject is not to make all training in-stitutions and faculty teach identical content.Granted, similar programs will have similarcurricula, but it is believed that the Core Curri-culumculum and Career Ladder concept can beim-ylemented with adequate program flexibilityand room for creative innovationS to enabledifferent educational philosophies`to coexist.Also, no training program is obligatecl,to ac-cept all or any part of the Core Project results.Instead; the premise is that if the results arojustifiable, the programs will wish to adoptthem, and so far this has proven true.,

Throughout the, duration of the project, con-siderable emphasis has been placed on com-munication and cooperation with programsand groups of overlapping.interes , but afterdiverse viewpoints, it is believe that this op-portunity for iarge-scale involvement of indi-viduals and groups has resulted in greatervisibility of and support for the Core Projectand its approach.,,,

The support of South Dakota's Department ofHealth, comprehensive Health Planning,Regional Medical Program and the Division,ofAllied Health Manpower of the Bureau ofHealth Reources DeVelopment has been ex-tremely critical and ncessary to the success of ,

the Core Project.A" V

f=inally, the Core Project staff' is optimistic,regarding the' future. Lines of communicationhave been established, cooperation with agen-cies, organizations, association and trainingprograms. has been excellent, core curriculumdevelopment' will soon, be completed, imple-mpntation of the core will take place this fall,and excitement is in the air!

111

MY HOPES AND FEARS FOR r

HEALTH OCCUPATIONS EDUCATIONHelen l< Powers, M S

I. am most grateful to my good friends fromthe University of California, especially Dr.Barlow and his project staff members, for in-viting me to participate in this national invita-tional conference on Health OccupationsEducation. When Mel Barlow told me that I

was to address this group at the luncheonmeeting today, I wasn't quite sure what hewanted. But he did say in his letter, "Helen, IWant you to tell us what your hopes and fearsare." And I thought, "Well, my gracious. ,Acompletely subjective presentation on whatmy hopes and fears are for h alth occupationseducation! Does he really me n that?" But, heevidently did So today you are going to hearwhat my hopes and fears are from my personalpoint of yew rather than the objective pointof view from which I have addressed the sub-ject in the paste

I think my hopes outweigh My fears. I think theevidence given to us here by the UCLA project

' and the .many ,other activities that were dis-t' cussed by each distinguished member of this

conference indicates that' my hopes are well -

rounded. Commendation is well merited byth`e UCLA project staff for undertaking .thecolossal job of analyzing some 31 occupationsand preparing instructional materials for 18 ofthese. Until one has read the voluminous re-Ports, records of committee arid staff: meet-ings, survey findings, evaluation and validationreports, instruction books, and a vast amount'

,of descriptive and analytical material producedkinkhe project, one has only a limited notion oftbe total work that went -into the project.

I Couldn't believe it really would be attemptedby someonewhen we reviewed the project in

,

the beginning. Prior to that project our studieswere not of either one curriculum tor of oneoccupational area, but usually of one tinysegment of that curriculum_ or that occupa-tional area. Nobody really had ever attemptedto take a laundry list of 31 occupations andlook at them simultapeously in a.critical, an-alytical way to come pp with some answers toproblems we had been coping with fordecades in the health field. This extensivestudy has 'given us this kind of education forthe first time. It is not, I hope, the end of thestudy on the occupations as a group. Thereare other gccupations.to_ be included, otherproblems to be dissolved, and validation andrepetition of some of the work in this projectthat needs to be done. And I hope that there,will be time, money, and interest on the partof not only UCLA but other universities andgroups to continue this work.

Perhaps it is fan understatement to say that theproject has effected significant changes inhealth manpoAer training and utilization, but Ibelieve that a great deal of what has happenedin,the health field today can be traced to manydifferent projects and especially to this par-ticular project. Several speakers have empha-sized some project results that shed new lighton abuses in worker utilization and jobrequirements in the health field today. Amongthese findings are. 1) the comprehensive an-alyses of selected health occupations, 2) theidentification of skills common to several dif-ferent occupations, and 3) the differentiationof roles where several levels of workers per-form in one occupation0 area, e.g., nurseaide, RN, AND LRN.

4 -E8

My has. is off to Lucile Wood for taking a new ,look at the nursing cluster and finding somelogical reason for dividing the groups as theywere divided.But,,more importantly, what shedid was to show that these are similar in more

as than they are dissimilar, that levelsperhaps are not as readily achieved as wethought they were going to be in the nursingfield, and that another approach will have tobe used sometimes.

While you have not yet discussed the secon-dary schools phase of the project, it is a

pioneer research effort in motivating studentsthrough health occupations programs to ex-plore multiple career choices and to acquiresalable skills.,At theame time, they are im-proving their aclievement levels in schoolsand experiencing that individual personaldevelopment that we are always talking aboutin education. The addition of the secondaryschool project resulted in research and experi-mentation in an entirely new secondary healthoccupations curriculum, suited to the needs ofdisadvantaged youth in grades 10 through 12.These students are strongly motivated towardvocational preparation. To quote from theevaluation of this phase of the study (Dr.Fielstra's 1973 evaluation report), The evi-dence seems unquestionably to indicate thatan allied health curriculum in the secondaryschools can produce commendable edUca-tional results."

My hopes for the total success of the alliedhealth project, beginning in 1968, were wellfounded and have been more than generouslyfulfilled. I have some fears about the project,too! One time those fears concerned themagnitude of the undertaking. Usually, in thehealth field 'we studied one small part of acurriculum, rarely the whole program. In orderto effect any major change, it seemed essential

A that the whole broad spectrum of health oc-.cupalions should be. brought into focus at thesame time and scrutinized critically by thesame researchers working in one project. Thisis what the team at UCLA undertook to do.

91

42

Then there were some problems about fund-ing, and there were concerns that, like somuch other good research, the project wouldbe completed and filed on the shelf to remainthere gathering dust that might be disturbedoccasiony by other researchers or a studentseeking extra credits for outside reading! There,was concern also that some parts of the pro-ject would not succeed.,

But none of my fears survived. Instead, I havetremendous satisfation in what was accompifished, and that satisfaction is shared by elmof other people. One can only be pleased thatmaterials prepared in the project have hadsuch wide, dissemination and utilization. Theresponse of publishers and their interest in theproject is most gratifying. Each of you presentat this conference represents additional re-sources for spreading the word, experimentingfurther with some parts of the project, andeven taking some of the next steps in areassuch as core curriculum, career ladders,multiple.career preparation, and the like.

After several days Of being exposed to thesophisticated discussions of health oc-cupations, research in healtroc'cupations andnew career models, role differentiation, andtask analysis that has takenplace here, a

newcomer to health occupations educationmay conclude that this field is far advanced inevery'aspect of the program. In fact ,.....i. beganto glean that from some of the discussions andfeatures here. I thought perhaps it was myduty to hasten to remind you that this is farfrOm the truth. In fact, the state of the art, soto speak, is practically in its infancy. Let mereview briefly some of the history in HOEdevelopment in order.to set some of the parti-cipants on the right track with regard to somebasic fundamentals of the program.

The 1956 Public Health amendments, for'thefirst time, authorized federal funds to support"health occupations" education and officiallydelegated thi; responsibility to the Division ofVocational Education, U.S. Office of

Education, Thus, public education became in-volved in this area, and the term "health oc-cupations" education was defined under thelaw to mean those, occupations in the healthfielt requiring preparation below the bac-calaureate level Health leaders were quitewilling to allow the educatio?al systems totrain practical nurses and nurses' aides, butpresented a nearly solid front in oppositiOn toexpansion of public education's efforts intoother health occupations' Considerableresistance was exerted also against public

'education's involvement in post-secondaryassoc sate degree programs, in spite Of the factthat precedent had been established in theearly 1950's when federal state vocationalmonies were used to support some of the firstexperimental two -year nursing programs

,.

After several years of persistent effort withUSOt's National Advisory ..Committee on

--t-tErSIth Occupations Education and withnational organizations, regulatory bodies, andkey leaders in health and education, road-blocks in these areas were removed. By 1961,little orno opposition to the deyelopment`ofshort term and one-year programs was,evi-dent However, it was not until 1967 that theU S Commissioner of Eduaon invoked hisauthority under the Vocational EducationAmendmerts of 1963 and /made an ad:ministrative decision that the associate degreeprogram in nursing could be supported withfederal vocational education funds. Even aslate as 1973, some groups are still challengingthe legality of ukirig public education funds inan associate degree program preparing healthworkers. Believe me it is quite legal'met

I he 19.60's saw .r"apicl growth or school-basedhealth' occupations programs financed withpublic education funds From a nationalsenroll-ment figure of some 10,000 HOE students in':iie'early°1950's, this figure increased to nearly2,70,000 in 1971 with ex-rienclitures oftederallstateilocal funds for HOE exceeding.

.120 million dollars annually.

60.

Some of the other changes that to me highlightthe 1960's-include the tremendous push to getgood facilities for occupational training, i.e.,vocational and technical schools. We startedthe expeiimentaticiiii of secondary HOE pro-grams during the 1.960's but they didn't makemuch progress in terms of the quality of theprograms that we are talking about here thisweek. Perhaps the most important develop-ment in the 1960's was the centralizing or

,departmentalizing of the health occupationseducation programs within a school. Some ofyou do not realfze that prior to 1961 there wasnot one single school in this country wheretwo health occupations were housed togetherand operated as a unit ,Every single trainingprogram was a separate entity that operatedunder its own rules and its own faCulty. Inother words, we used to hold workshops onself-contained curricula.. . ,.

.

In 1961, we discovered a school in Massa-chusetts ttaat had decided it would centralize.

'The advantages of such departmentalizationswere quite evident so we funded a workshopto get a lot of people to Boston and we invitednot only vocational educators but health fieldleaders. We were all very. excited because wewere learning a tremendous number of thingsabout how to operate that occupatiOnseducation program, about its management,about commonality in curricula, about the in-terrelationships of teachers and the inter-change of coursesand teachers in the. schools.

Someone expressed surprise that registerednursing programs have not Joined the alliedhealth schools or departments but, remain asindependent schools or departments -in

schools. Prior to-1962, all health occupationscurricula were conducted independently` ofeach other. There was practically no, coor-dination between these programs even itlocated in the same school. In fact, for aperiod of time in the 1960's, state and nationalaccrediting bodies forbade the operation of anRN school and an LPN school in the same

4 3 ..-

tacilrties unless they were completely separateentities. In light of this experience just adecade agq, one does not expect to find thetrend toward total departmentalizing of HOEprograms tully implemented. I ,think for theIcing run and in the interest of producing thenumbers and quality ot, people that, we need,mi., programs should departmentaliz,e. I thinkit is in the best interest of .the stu'dent.

I, .

I he 19,70 s so tar nave given us quite a fewlandmitk achievements. We have had greatlyincreased collaboration between educationand the health held. (I can only measure thisby the increasing incidence of conferences atwhich one finds in attendance a broad repre-sentation from both fields. E4lucators are nolonger talking rust with each other!) The UCLAAllied Health Protessions Project 'completed itsmajor objectives and has provided health oc-cupations educators with 'much needed in-structional materials, and guides. Studentorganizations at the State level primarilyserving HOE. students have begun to emergewith tour States 'reporting active organiza-tionsTexas, Alabama, New Jersey, and In-diana. A climate for change is making possiblethe revision of outmoded processes in theeducation and credentialling of health oc-cupations student-54.

'We've looked at a quarter of a century ofhealth occupations education, and we haveseen how it moved from its rather lowly placein the educational structure to the verge ofbecoming a viable system for the 21st century_Not quite, but almost! There is not much timelett to develop that system to fit into the needsof the next century, in my opinion. We mustget on with the job quickly.

Galsworthy said that, "If you do not thinkabout the futurN you cannot have one."Believe me, I have been thinking about mytuture. What about you? How do you seeyourself in the year 2000?

The future of HOE is certainly assured, I

believe, because there is.always a need for

health services wherever there are people.Production industries, on the other hand,-mayclose the plant, move to another state. or tem-porarily suspend, operations, thus eliminatiogmany jobs by one single decision. But thereare a4ways going to be sick 'people, and thehealth needs of the peOple and the jobs thatare dependent upon those needs are alwaysthere. Another factor, absent from the healthmanpower field since the early 1940's, is thatof open market competition. Unless sufficientnumbers of workers are prepared to effectsuch competition for jobs, the employer haslittle choicqt but to retain those workers whoconsistently turn in poor job performancesand who are a threat to patient welfare and totheir co-workers' job satisfaction.

Recently there has been very little evidence ofnew jobs being created in the health field. Bycontrast, the 1960's btlught, many new typesof health technicians Ind fragmentation ofpreviOus jobs to establish several levels ofworkers within one occupation. A few yearsago, there was grave concern over the rapidproliferation of new job titles with the resultthat health leaderScalled for a temporary halt.I readily agreed with this position provided ajob analysis was done to establish the exactnature of the'44w functions to be performedand to determinewhich category of workerwould be taught to assume these new tasks.

In View of changes already occurring in thehealth delivery system, with great emphasisbeing placed on health maintenance andprotection, I have some "concern about thereversal of the trend toward the developmentof new jobs and ne., job titles. Some of usmay recall our nursing history and the earlybeginning of the practical nurse who 'was con-siiilered to be a household worker, not a healthworker. Other disciplines took responsibilityfor this person's training, if any. Another casein point is the child 'care assistant of today;Some states hold,that this 15 a health occupa-tion, others that it is just 'another houieholdworker: However, these individuals are work-ing in hospitals, child care institutions, and

4410e

,with groups of sick and handicapped childrenin many settings Is this another example of theresistance to new health worker title :and anoversight by health occupations educators?Perhaps South Dakota's approach to corecugriculum can help -us more quickly resolve

Ouch questions in the future and meet thechallenge of new and emerging occupationsrelating to the family care concept, to new.types of independent health practitioners, andto health maintenance complexes.

The gr.eatest expansion of health industryworkers in the next twenty -five years will notbe the simple, multiplication of numbers in theensting 150 or so health occupations. As theemphasis shifts from Crisis medicine to healthmaintenance, as it surely will within the nextdecade, growing numbers of technicians willbe needed whose jobs involve repetitioustasks in the screening of well persons makingregular visits to their Health Clink, 1Notice Isaid, well persons, not patients!) These work-ers will face many of the same problems ofboredoni and fatigue that factory workerstoday 'face Their education and the job theyperform must be made meaningfUl, and thetrainee rust develop an understanding of theimportance. of .his work if he or she is to beable to provide high quality services as neededand function at an optirgum level of corn-

.petency

I:ve talked.about a lot of fears and' said verylittle about my hope except to generalize. But.my hopes are very great. Essentially I hope thatyou and I and our peers in HOE continue tbplace the student and kis needs in a focalposition in our educational programs. Thehealth delivery system must be resNnsible forplacing and keeping the consumer of healthservices in the center of its operation, makingsure that education and schools exist for thelearner.

I hope that we, as part of the educational andscientific estate, will devel3p ever greaterawareness of the power we poiltsess to influ-ence the public, employers, and our fellow

members of that estate, for the good ofstudents and of Health Occupations Educa-lion. Although we do not control the supply oftalent that isrequired by the health industry,'nevertheless, vast numbers of that supply passthrough the programs over which we do havesome influence. We can and do indoctrinatethese students, for better or worse, and the in-dustry depends on us for this supply of talent.Through the product of the program, you canbe. and are being heard.

I hope that'HOE teachers will continue to takean active role in standard-setting at all levelsfor all personnel serving the health field. Noone is better qualified to participate indeveloping new methods of credentialling andverifying competencies for various health oc-cupations. We cannot leave this to the em-ployer, or to the, rOfessions, or to the univer-.sales aloRe. All levels of education, the public,and all health disciplines need.to be involvedtogether for tie best interests of the consumeran.cl of the worker. I've gone through theperiod of time when I've been told at meetingsthat vocational- education did not need tocome. to this meeting because "policydecisions will be here. When we get throughwith the decisions we will let loCu know whatthey are." I don't intend to stand still for thisand I hope you don't either. keep on playingthat very active role in standard setting; con-tinue your strong and dedicated leadership.

Also, I fifisi'thAt the federal agency, the CS.Office of Education, will continue to placehigh priority on this field by providingadequate full-time staff and funds to carry oOtits management functions as defined underfederal regulations. Without such designatedofficials in USOE, coordination 'betweenfederal education agencies, federal health andhealth manpower agencies, and others con-cerned in health manpower development willdiminish or cease entirely.

I would ho'pe that centers conducting researchand develpment activities, similar to thosedescribTI iJy the UCLA team, would become a

45f

. .

1.

permanent part of HOE for the purposqk ofconducting research in this area, where experi-mentation, demonstrations, and disseminationactivities woul oncentrate on the problemin HOE. \Nhile it s true that we already have anetwork for curriculum coordination inVocational Technical Education now operatingin seven states (Oklahoma, New Jersey., Wash-ington, California, Mississippi, Kentucky, andIllinois) which serve the essential functionswith regard to curriculum developmentdissemination, utilization, and evaluationthere is a critical need now for basic and prac-tical research in almost all aspects of HOE. I donot see the curriculum centers fulfilling thaineed, but they can extend the work of HOEResearch and Development Centers.

My last and most 'burning hope is that ourdilen3ma in leacher education will be resolved.We have a number of teacher educators hereand I commend you for the progress that youhave' made in getting on top of theseproblems. I have strong feelings yet about theselection of teachers who are competent toteach their subject matter, and who can be ef-fective with their students. Teacher educationfor health occupations teachers has been toolong neglected in most states. In reviewingsome 1974 State Plans recently, I was againshocked at the limited accomplishments inestablishing identifiable 'MOE teachereducation within the university system and atthe limited dollars assigned to it. One wouldassume that HOE teachers need little or nopreparation for the job and that t,hey are notinterested in .pursuing further preparation. I

believe the ipposite is t,ue. I hope to see the

46

splendid efforts of several universities repre-sented here continue and expand, anti I hopeother states will recognize t oversight andcorrect it. With the secondary school pro'tgrams expanding rapidly, and the role of post-secondary teachers expanding to Meet thechallenge of new curricula and neweducaticrnal approaches, this situation must becorrected or. the programs wilt encounter in=surmountable problems.

t3ut we also must haye leaders_de%,eloped whocan communicate the concerns of this field ofeducation. It is not enough just to be a goodteacher and to produce good teachers. Teach-ers must go on to,,become good leaders whocan represent us in all levels of discussions inthe education field, in the health field, in

goverhrbent, and wherever else they may beneeded.

My hopes and fears are in the best hands inthe worldyours, representatives from theleadership in the field of health occupations/education and in the health field! I have great'confidence in what you will Otlo about ,theseand about other.probleMs as they come downthe road. You have already demonstrated yourconcern and I hope that you aren't going to letsomeone else shoulder the responsibility foryou. Your involvement, in solving problemsthat you and others have identified is quiteevident and I think we are close to the solu-tion of many of the problems that have facedus over the years. After attending this meetingand participating with many of you, I think I

can leave my.fears behind and I,v ill depart thisconference with great hopes for a. betterfuture in health and in health education.

_ s.

6

HOW TO GET i NEW HEALTH OCCUPATIONSEDUCATION PROGRAM ,STARTED '

Ellen Al Abbott, M 5 R N

It seems that most of you are interested instarting'a program at a high school or pre -Highschool level rather than at a post-ssecondary,level irerhaps it would be best if I were to listsome of the programs we Offer, specificallythose some of you have asked about at thisconference. And I think, too, it might be best ifI explain a little about the district in which 1work. 1

In 1956, I started the firs(nurse aid programin the district because I discovered there wereno nurse aide' programs in the entire San DiegoCounty. So I asked if I, as a volunteer, couldconduct a nurse aide program. We started outwith twenty-seven people and devised a 50-hour, on- the -fob program. From th!t we wrat.ethe first course outline to be introduced inCalifornia. In 1957, we started a_ vocationalnursrogram, and in 1960, I became directorof that program. Then, in 1961, a communitycollege came into the district. It was thedecision of the college that only two-year pro-grams would be offered there, and the otherprograms (the vocational programs) wouldbe in an adult high school erhironroent. In theGrossmont area there is an adult and post-secondary program All vocational educationprograms in this district are under this set-up,with the technical 'Programs, including thttwo-year programs, at the college.

We started by adding one new program a year.The first one was an RN refresher course, thenwe added OR technique, then OB technique.As a consequence, we now have 15 full-timeprograms in health - occupations and quite afew extension program-s. Some of them are of

47

short duration and some are on a continuingbasis.

Then we began to have difficulty with the ar-ticulation of students into the two-year RN,prbgram. We met with the nursing board andstarted a one-year RN program for LVN's.Those who wish to continue in nursingeducation articulate into the baccalaureateprogram at California State University, San,Diego, as space permits.

In starting a new program, you have to knowyour community nd you must have a con-cept, i.e., what ou think you would like tohave in your .pr gram. My concern for the tenhigh schools.in the Grossmont district was thatthere were no occupational programs for girls.TheThem was carpentry, auto mechanics, etc., forthe boys, but the girls were usually excludedfrom every one of these areas. Each highschool had typing classes and a business pro-gram, but each was fairly small at that time andrestricted to 50 percent girls. There was no-thing exclusively for them. Seven months ofmeeting with counselors finally paid off, but

maven then, of the ten high schools, only twoprincipals would enddlelhe program allowingtheir S'tudentslOgo into a nurse aide program.Now it is such a large programWe have ap-proximately 170 students involved in it an-nually.

In developing program content, you may haveto innovate to accommodate changing coursecontents based on hospital or -health com-munity facilities as well as keeping in mind in-dividual learning rates, styles, and motivations.

In other words, to shift the responsibility oflearning from the teacher to the student, theremust be a student - oriented curriculum regard-less of the programs you are going to start. Butmore than providing a direction, health oc-cupations education offer4s a systematic ap-

, proach to learning. And this is part of yourselling job wherever you are going to initiatehigh school health occupations programs. (Ifanyone is interested in starting a WI schoolprogram, please contact me and I will sendyou data we have prepared.)

Abe utter one program in paramedics open toreturning servicemen who have been in theMedical Corps for twelve months or more andquality ro apply for vocational nurse licensure.It they had twelve months in a nursing relatedassignment or twenty-three months in a healthoccupations area, they are eligible for this pro-gram.'Most of the applicants are male. Whenthe young men started coming to us for sup-portive edutatior) or guidance to successfullytake the LVN exam:we discovered that themilitary was not informing them of their op-portunity to take the State Board for Voca-tkal Nursing or the Registered Nutse exam.In Cal4ornia,dany person who has had .twelvemonths of-nursing .or twenty-three months ex-perience in a medical corps may take the LVNlicensing exam, or, if he has had forty-eightmonths experience, he may take the RN licen$sing exam. When they applied to one of ourprograms, I found they were not aware of thisintormatii. So I ,went to the Board to askabout the successes of the yfoung men and dis-covered that only twenty percent who didtake the test failed.

We wrote to the military services and askedfor their basic course outline. They sent all theeducational material for tItliir basic school. Weevaluated that material and ran a couplq ofstories in the paper. When the young mencame in, we discussed their education, gavethem a tew comprehensive tests, and tried todetermine what type of background they. had..We decided that most of the people who

failed the exams did so because they did not`have the theoretical background nor thetransitional experience from military to civilianhospital. Additionally, some young men haddifficulty adjusting to working in a woman-oriented situation.

We have tried to present a Curriculum to meettheir individual needs ,F..deficiencies for suc-cessful job placement; We wrote our entirecourse outline on this tylpe of approach. 1) tomeet their educational needs so that they cansuccessfully pass their Boards; 2) to preparethem forthe licensed level of nursing at whichthey can function, and 3) to give them theknOwledge base they need to continue teducation. We designed the course curriculumbased on the tasks and knowledge they wouldneed on the job. Next we talked to the youngmen asking them in what hospital areas theythought they would like to work. I then did atask analysis of RN's/INN's on the job to deter-mine what they would be doing. We includedrelated theory because we felt that, first of all,they had to pass the Board exams, and,second, they had to continually grow in their'jobs. There have not been any failures on theState Boards among the program gradates.

The program is feclqralfY; funded, and theyoung men and women receive a $59 weeklystipend as part of the project. They also usethe GI bill if they wish and receive $2.50 perweek for transportation plus all books andtheir, uniforms. If they leave before we thinkthey arb ready to gofrwe take the uniforms andbooks back. But if they stay as long as it is

determined a need dxists, they On take thoseitems with them.

Another program we started recently is

Medical Transcription Specialist based on thesamq format of our Medical Office Assistingprogham. In a neighbo.ring school district therehas been a medical assistant program for years.A few years ago I Spent some time analyzingthe program trying to decide 'whpiti took twoyears to train someone in medical assisting. In

48 F5

looking at their progr.im, I felt' it did not haveto take that long. Thus, in our medic& assistingprogram, the students attend one semester forcourse content and then attend skills lab on acontractual basis while they work,five days a

week, They can attend our labs as long as theyfeel they need it. When they are ready for cer-tain areas, they chvk out cassettes or meetwith the instructor for assistance.

Our Medical Transcriptionist program is of-ferecrin the same format. To get the progra'mstarted, we hired the best medical transcrip-tionist in the city, right out of the hospital set-ting, and paid her to write the course. (I didnot know that Miles Anderson and his groupwere doing the same thing just one-hundredand twenty miles away!) She has written thecurriculum as she has performed on-the-job,with all dictation for student' practice dictatedspecially from medical charts or taken from ac-tual dictation -hospitals send us. Occasionallywe choose doctors who mumble end grumblea lot and that is the kind of dictation practicethe students heed.

We also started 'a program for Medical Clerks.The course for high school medical clerks infact encompasses all hospital clerical jobs. Thestudents rotate to very department of thehospital, but it is a low paying job. We wrote.the course curriculum by studying thi clericaltasks nurses were performing that we feltclerks could do and incorporated these tasksin curriculum. Then we gained per-mission for our- students to be assigned thetasks at ward stations (for expertnce, please).At first the staff offered a great deal ofresistance, but now ward clerks are cceptedthroughout the hospital. Nurses are o longerrecording and doing the clerical chores theywe're formerly performing.

So how do you get a progratn started? How doyou get the money? I think California is uniquein that we Piave fugds (ADAaverage daily at-tendance) based on students' daily attendancewith monies paid propor,tionately to the

49

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school district from state funds to meet basicprogram cost. What it really takes is someonetorget out and look.at the possibilities fof pro-grams and see the need. Then meet with thepersonnel in the hospital or facility in whichyou feel you can place the program. If youneed equipment, look at the facility where thestudents will affiliate and usually your stu-dents' use of the equipment available willmeet curriculum needs.

It is also good to have an advisory committeeas an initial activity when considering new pro-grams. I have found that the "retired" healthcommunity, such as doctors and dentists, havemore Znowledge of what is going on becausethey have a different perspective now. Andalso they have time to devote to programplanning and assisting with raising monies forcapital outlay, equipment, etc. I have a rulethat no advisory board be larger than six mem-bers because that way they know you better,you kinow thein better, and they are willing tocome in and meet with you a little more often.

I have one more statement to make and that isabout attitudes. We are interested in the atti-tudes of students and in the attitudes of theteacher. This, more than anything else, is thebasis of the success of a program. I assumethat any person who comes to me for a teach-.ing job has all the tools he 'needs to do thejob. I ask him to give me the names of twopeople with whom he has worked. I don'twant to know the supervisor; I want tq knowthe people who work with him side,by side. I

do)'t ask about .past experience or how long, It' do 't' think that one year, three years, ortwelve years is that important. Before I talkto,these/two co-workers, I study the applicant's'resume. If it meets the requirements, we set up .

an interview appointment. In the meantime, Italk to the two references (usually I call themon the phone). I ask,,pem four or, fivequestions that are routintiof listen to the voice,°and,you can tell when siiineone is giving you agood recommendation and whether theygenuinely believe it. If they are enthusiastic, I

off

4

invite the applicant in for a two-hour inter-view. We talk about anything, horses, flying,hobbies I like, or hobbies he tikes (he talksabout mine as much as his). If, at the end oftwo hours I like him and I think tha e likesme, he is hired. That's my techniq for hiring,teachers. And I think that it has b en success-ful. People think I'm crazy, but it really works.Attitude is important in determining the qualityof work you do.

When you start a program you have to analyzethe health manpower needs data that is avail-able. Sometimes this means meeting with thepeople in the institution or agency, sometimesit means lookingsat printed data, sometimes itis looking at UCLA and what they have done.Seek whatever is available.

Occasionally we have to convince a hospitalthat they need a new progra,m. Sometimes wehave to convince the advisory committee thata need exists. When we first started the highschool Orderly program in the evenings, thepresident of my advisory committee was the

mit

41.

50

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administr4or of the only licensed accreditedgehatric hospital in California at the time. Oh,how he 'opposed that Grogram. He did notwant it because he had no budget to hire per-sonnel. So we finally got approvalit passedone day when he did not come to a meeting.You have to go around in your community tomeet people, to talk to them, Oecatase youhavq to get into the institutions. Your advisorycommittee members are the people who helpthe most here. The one rule is never to havemore than one person from one institutionbecause you need cross-fire.

Adjoining our school district is Mountain Em-pire School District. It has no docfors, nohospitals, no public health nurse, and yet wehave four programs in the district. We rented abig trailer to use there. We pull the trailer intothe townships for the educational phase of theprogram, the students get their training in

hospitals on Saturday, and we sake the trailerback on Monday. It is an old ring that barelyworks and we have a volunteer who tows it.So you can do it!

tTHE UCLA ..SECONDARY SCHOOLS PILOT ANDDEMONSTRATION PROJECT FOR ANINTRODUCTION TO ALLIED HEALTH CAREERSDiane Watson, M S

UCLA's Allied Health Professions Project wascharged with adding another component towhat they were already doing, and that wAs todevelop a secondary school program thatwould introduce high school students to alliedhealth occupations and also to develop acurriculum that would accomplish that goalWe began by researching the literature. Wesearched school libraries, hospital libraries,etc and found nothing that 'we thought wouldserve the purpose. So before Dr. Barlow, theprincipal investigator, would accept the moneyfor the project he asked for a year to do plan-ning. "We need to think this thing through, totalk to people, and we need to find out wht itis all about," he said. Many interesting andstimulating things occurred Mi that year alongwith some very serious problems. As a resultof that year's experience, we can't tell youmuch about what to do, but we can tell youplenty about what not to do! .

....

We came up with program that we titled"Careers in Health Services" because of theemphasis at that time on career education. Thesecondary school allied health program was athree phase program. The first phase cor-responded to grade ten with fifteen year aidstudents In this phase, they were given an in-troduction to the field of health, i.e., what it isail about, curriculum, and field experiences.The second phase, or grade eleven, was WorkExperience, and the third year was a

cooperative education program.

.The year prior to implementing the11

programwas spent planning. We had to select staff.What kind of people should be, involved in

4

developing and implementing the ,program?Certainly we needed teachers and someone tocoordinate activities with the community. Wefelt that if this was going to be a successfulprogram, we needed to have someone whowas free from the structure of the school set-ting, who could work with hospitals and otherhealth facilities at any time during the day. Sowe added a field coordinator who was part ofthe team working closely with a Classroomteacher. Of course, there were clerical person-nel and administrators.

Then began the search for a complex which in-cluded a high school, a neighboring com-munity college, and a hospital in close proxi-mity to the high school. Each facility was con-tacted, procured, and oriented to our project.

Now, this was not an easy task; we had to sellthis program to the schools. They thought,"Why should we confuse the issue by bringingin another health program? We have alwayshad health occupations in the schools/ Afterall, we have nurse's tra,ining." We tried to con-vince them that we were not training onlynurses; we wanted to train youngsters in a

generalized orientation to health care so thateventually they could select an occupation oftheir choice. It , was hoped. they wouldrecognize the fact that there were other oc-cuations composing the health care systembesides nursing. Finally the program was ac-cepted because we were going to provide100% of the financing.

The next big move was to convince hospitalsthat a fifteen year old student did have a place

r851

there. They. questioned 'what a fifteen yearolder really could do, "besides running allar).und here getting in our way." We reasoned'with them ,by pdinting Out nurse aide taskssuch as answering the ,telephone and readingto a patient that could be efficiently per-formed by students.

Getting facility approval was. the first step.

- Once we secured the hospitals,,they wantedto know who was going to bp responsible forthese young people. It was explained that thehospital, medical facility, or wherever the std-,dents were working, vvils an extension of theclassroom and whatever insurar/ coveredthe student in the classroom would _Clover

them in the hospital. We alsii set up a -wper-visory system so that any time a student wason -the premises there would b a supervisorthere also.

The second step was to contact supervisorsand sell them oil the fact that they would hayemore people in their department to supervise.The third step was to ask the-actual workers ifthey would like to have a student workingwith them. The typical responses were "Myday is already too full." "There are too manydemands." ''How in the world can I take timeout to teach a student?" And we said, "Don'tworry about' teaching the student. Go aboutyour tasks the best you can and have the stu-dent observe you. After observing a few times,explain to him what you are doing. After hehas heard the explanation a `few times, let himwork with you. If he does a good,enough jOb,let him do that particular task." In this way,they wereThf-tenteLl to how they could workwith students.

Then we realized we needed to have a sum-mer hospital internship, for teachers, and stu-dents. Four students were selected that we feltcould help us develop curriculum. We didn't4cnow how to select teachers but we thoughtwe might need someone with a nursing back-ground. you were in the workshop that I

was in esteilday, you know that I am not

52

against nurses, but we found that,the nurse as'a classrdorfn instructor in,allied health occupa-tions tended to want to teach only nursingtasks and, to go into mare depth,in that areathan was 'needed in an exPeriential, explora-tory program.) We:tried to overcome thisproblem but had difficulty all the way becausewe found that nurses are so well trained theyseem t4; want to duplicate their training in the'classroom. We did find some nurses wethought could be more flexible. You have tohave a special kind of nurse who can trans-cend her training and be the kind of instructorwho can relate to the youngsters who want togo into pharmacy, the mediCal laboratory, orsome field other than nursing.

Our idea was to have our teachers come inciiiring the summer for a ten-week internshipwhere they would rotate throtigh the vtipusdepartments in the hospital and actually d) thetasks that are done in each department. Wethought that if they were outside the field ofhealth, they certainly 'needed to kriow what ahospital was all about, who the people' werethat worked there, .and what they did. Well,that internship failed miserably. We paidteachers. their i'egular salary for the ten weeks.We thought we could bring them into the pro-ject office in the morning and have them in thehospitals in the afternoon. It was a failurebecause we found that you cannot workteachers during the summer at the same rateand pace you worked them during the schoolyear .and expect them to produce becausethey are tired. Secondly, many of. our teachersfelt that the tasks4they were asked to performwere below their professional status, and theyrebelled against the department. We also triedto give them segments of curriculum todevelop and that was no good-either; theywould rather see the .wholet,thing than justpieces. We did not have a concept that wascomprehensive enough. So we learnedthroug,higial and error and it was a very costlykind of thlrig, as Miles Anderson will tell you.But we had to go through this procedure' tofind out what to do.

*7-2'Two weelcA-7before starting the program wefound that we were losing three ofibpU,r fourteuhers. So, ther we wet .with only oneteacher' and .;our 'progr;i'm starting in two

;.yveeks.VVe hadp go out and beat the bushes.--We hired a young lady right out of college'who, had .a health science background. We,were'able to hold onto a science teacher. Wehired a Rersonwho was director of nursesfrom.job orps and a science teacher who hadtaught one Week in a .high school. We had to.put our faith in these people because we had._no other choice But you know, it worked outalright because -these people had no precon-

'ceived ideas. They had not -been molded into a

structure that would restrict th.en'they wereflexible because they had little experience.

They came to. the project office in the morn-.

ing,,,we gave them the lesson plan-for that day,demonstrated its use, and thenItheV'Would im-plement the lesson ,that afternoon. This .waStremendous fore curriculum de/elopmentbecause if we, 'from our ivory towers,developed something' that we thought wasgreat and it,nrit.go over in the classro'Om,the teacher would tell us the next morning andit went immediately .into the trash can. Butwhat we did come up with,was a product thatwas very relevant, effectiVe, and it worked.We trained teachers ,right do the spot, and,believe me, it-was difficult because we had tostart from the beginning.

We tried to get input from the students oncurriculum but found it was too difficult a taskfor them. We learned that the best way to usethe students at that ,particular level was to letthem .observe and give their input if they

;,chose. But we' cot* not expect them to getactively 'involved because they did ,i`iot feelco`frifortable around instructional staff. Whenwe were in a big circle, looking eye t eye,They Would..Nnot say a word. Howey theywould talk to the individuakoteachers in theirschools'and they built up a very close relation-ship wish them, but they would nat relate tothem in a group. They were never critical

1111,

4)

because as instructors' we akvays -have a Wayof getting back at student don't we? We can'gra& them from A to F, wf-nc.hthey know, so

athey don't go too far out on limb. We reallyWanted them to be operi and honest, but theycouldn't f5e. So 't'hey acted as observers with.___the knowledge that they could give inpiit atany time.

The next process was recruiting students. 11/61,wanted 1.00 ,students and_ we wanted to keepour classes small so we decided on. 25 perclass. We also wanted to include as many baysas girls because health Occupation,s have.beena man's .world. Most doctors are male; mostengineerMg, people are men,. moss mainten-

,$nce people are men. So we wanted theyoungsters to know that males'Were just asmuch a part of health occupations as females.What kind of student did we want?,We did notwant to close the door on any student .wlaoneeded the. program so we discarded all kindsof testing. We said, "Let's open the door to allstudents but let's place the responsibility onthe,m.",

450 we held a general assembly and invited allthe students in tale ninth grade at the juniorhigh schools which fed into our four experi-mental high .schools. We announced that .anexciting program awaited them at the highschool level. There was a catchy little film andpop music to turn them on: Arid then one ofour field coordinators who reflected themajority of the student population at thatschool would speak.. If .it was an all blackschool, we would send a black mile there sothat the boys wotend be able to identify with a

successful male figure. ff it wa's a Mexican-American school, we would send a Mexicah-American fem. so that, we could attractfemales into health occupations. These werereally sharp people who did a tremendous job.

\We gave the students an application form andlooked to see if they wrote anything on theline that said, "Why do you want to becomepart of this allied health PrAgram?" If-ihey did

7053

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not- write.on that line, we did not consider- facility, and, of course, the community. Thetheir application because it was felt that, if parents of our program studdnts also played athttK-ere truly interested, they could at least" large part.write, "because I like people," or "because Iwant to-help." That, was agod enough for us. 41 In the schools, we. worked with principals,

vice-pnrCipals, counselors, teachers, students,We had only 100 slots and we received over and, naturally, the Board of Education, In the900 applications from our four feeder Junior hospitals we wdrked with the counterparts ofhigh schools. The 9400 applicants e divided those listed'above. We had difficulties in bothinto small groups. of six to eight. We dis- camps.eln.the hospitals it was the nurses, and'covered that at the nirith grade level jt was their counterparts were _the counselors in

very difficult to find out about an individual schools. Why was there difficulty with the,student on a one-to-one basis. These kids do counselors? Number one, a high school coun-

,

not relate that well to adults. We threw out a selor oftentimes functions as an advisor and'question to find out about Jimmy, and Johnny doesn:t yto indepth counseling and guidancewould answer. They wo.uld talk among them- due to lack of time. And you are saying toselves while we Watched the interaction to them, "Wt. want a program that, will give adecide which kids we wanted to interview fur- sti'dent options in case he chooses not to gother. From the group interview, we wenLto a to college." The Counselors would say, "Oh.one-to-one ihterview. Each interviewer Rad a my gosh, no. Everyone here is going to Stand-check,sheet on which to identify the enthu- ford, UCLA, or USC."-And we said, "Well, thesiastic students. They rapped with the students records show that 58% of your students dropasking them questions about schopl. The stu- tut, at the 11th rade." The statistics meantdents were rated along a contiptum, those noting to them because they had their owncorning closest to the side marked "Potential" goals set for the students even though ,we

, were considered for the program. would say7 Here is a program that can pick up. . these kids who feel they must drop out of

Vie also looked at tl-)e different levels of class- schoolthat can train them and give themroom Makeup. We wanted 15-25% to be some direction in their lives." And you know,college bound and 60`1/4 average students, but we foughtolthat battle for three' yeais -anc11our.rearlocal group wa\the 15% of those stu- reallodon't think ve err won it because alldents who were non-motivated; who had no they saw in this rogram was that 'we wereplans for themselveS, and who were potential going to block thes,e youngsters from going to

,dropouts. We felt that,if we could develop a college. They were told that these studentsprogram that would keep this group in school, could eventually move up to a professionalthen we would have a program that would level, but it was hatiLiowconvin,ce them. Theykeep all our students *interested. did not see how 'the students ,vy,ould have time

to take all the academic. courses that wouldWe( used an dvisory committee that

could give us real clout, and there were veryfew educators /Ittn it. We-rteeded people from.outside education, from hospitals, professionalorganizations/ and industry, that "Lould makean adrriinj,,q.r6tive decision. We needed, to usetheir names to make things happen for us inthe community. Then we had to solicit thecooperation of the school district, the health'

prepare them for college and be in the alliedhealth program, too.

In the hospitals, the nursing departments saidto us, ','Well, you know our.first responsibilityis to the patient." But the youngsters them-selves won these people over. They sold theprogram by asking questions and offering todo tasks. That started opening doors for them.

The tenth year students began with an intro-ductory course We wanted these young peo-ple to have a different experience than theyhad ever' had as a student before. We wantedyoungSters, especially in the ghetto area, whowere really turned on and motivated to attendschool. So we said to the schools, "On dayone, we're going to take the students out towhere the action is The administrators almostcollapsed They said, "You can't do it, firstly,because you can't get yoUr hands on the warmbodies, and, secondly, we cannot provide youtransportation because our buses have to takekids to and from school We finally wonwhen_we told them we would pay for thebuses and extra drivers.

The teachers were the ones who gave us themost opposition on this point. They did notwant to work that hard- the first 'Iwo weeks.The'V won when the youngsters came they'weren't taken out that first week. Instead, wehad a slide tape presentation accompanied bypop music' The kids kept time with the musicwhile slides were flashed on the screen. Theslides covere both modern and historicalhealth cone pts They were flashed on quicklybecause w wanted subliminal kind of con-ditiohing; then they were presented again a lit-

tle slower and then the third tihie.they wereused as discussion tOpics."It was really a

fascinating experience because all their senses'were involved, and it was their first time forthis kind of curriculum.

No pencils, and paper _were used ttie first twoweeks. We talked a little the first day aboutvisiting a medical facility the next week. Theywere asked, "What do' you. think you shoulddo?" "How' do you. think you should act ?""How should you dress?" We got ,all the itildtfrom tiltrp. The teacher would say; "how, beat the bus on time," and "Maybe you shouldkeep roeft voice down in the hospital. Why doyou think you should keep it down?" "Whyshould you walk and not run?" These kinds ofthings were treated very superficially in thebeginning because we did not want to havestructure 'coming out of the kids' ears.

There was 160% attendance the second day, ofschool. This was unbelievable! The schoolnever had this happen before. Why did wehave 100% attendance one day after summervacation? Because our coordinators who' hadselected these kids had continued contact withthem over the summer. They went to theirhomes, sent three different letters addressed intheir names, wrote letters to the parents in-forming them that their child would be in theprogram, and we went out and talked to theparents to solicit their support and reinforce-ment of the program. So we literally pulled thestudents in, and when they came, they stayed.

In the tenth year, students were in class twohours per day plus an additional two hours a

clay for one month of.work experience.- Theyreceived ten units of credit for being in theallied health program. Counseling was done onan individual basis by teachers, coordinators,school counselors, and hospital supervisors.Students stayed in the program because theyfelt that adults were interested in them. It wasa program that gave them a four-to-one con-tact ratio with adults. Also, parental confer-ences were maintained all the way through; wenever neglected our parents.

The curriculum was divided into three units.The fiist was an orientation to the health caresystem, the second, and the real meat of thecurriculum, took a case study apprisach; andthe third unit was the health care co.ffiplex, theactual on- the -lob experience. At the end therewas a culmination program put on by the stu-dents.

In the first unit, we swoht six weeks takrngyoungsters to every kind of health care facilitywe could get into, including_ dental offices,mental health facilities, youth clinics, hospitals,and so on. They got a pretty good picture Ofwhat health care facilities are like. However, itwasn't Just a pleasure cruise, they went withcertain goals in mirid. They were given a checksheet on which to record information. Theyhad to talk to several people at the facility,find out their titles, identify uniforms, identify

)

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terminology, observe functions and tasks, askabout training, salaries, personality, and atti-tudes. Before going on a trip they Were given acheck sheet and something specific to look foron their visit to the facility, and the infor-mation they brought back became the core ofthe next day's class activity.

After six or eight weeks the students pro-gressed to unit two which took up abouttwenty weeks of the school semester. This unitwas divided into eight sections. Since this wasan exploratory program, we wanted the youngpeople it, get a feel for health care. We want-

, ed them to have the essential knowledge andsome related knowledge o0he field Of healthcare in order to be able to do simple entrylevel tasks. The essential information theyshould have was listed: the sciences, the ter-minology, the tasks, etc. Then we had to find avehicle for *teaching this information. Wedecided to use actual case studies, 'so we con-sulted hospital4 to see if they had cases aboutyoung people with the specifics we were look-ing, for.

'Using these ,real case studies, we began with aPhysical Examination. Every student was.

4amiliar with the physical exammatiorfprocess.However, we took all the stulents to thehealth office and they observe the\ schooldoctor and nurse perform a physicalexamination of a youngster. They were taughthow to read the Snellen charts, how to taketemperatures, etc. Then the nurse would teachone student, through demonstration, to do atask. That student would select another,student and teach him how to do the task un-der' the supervision of the nurse or the doctgr.Next they-paired off so that every youngsterhad the opportunity, to perform the task. Inthis ch\se study, the cardio-vascular sySlem wasthe focus. In the classroom the students wouldstudy the functions of this system and how ithad meaning. for .t hem.

Our next case was one of a broken leg. It wasintroduced as 'A Case of a Broken Leg," but.

the students never ustd _those terms again. In-steadthey learned to refer to it as "a fractureof a tibia,",and, boy, they loved learnmg thejargon! This is the way to present the termin-ology. The students not only hear the termsbut learn to comprehend their meanings andthey learn to use them. This case provided anopportunity to learn the muscular-skeletal sys-tem of the body. The teacher did not say tothem, "Now you're going to learn all of -thebones of 4,he body." Instead, they le4rnedabout the case of a kid who, while runningacross the schoQI grounds,. fell and broke 'hisleg. First aid Zs given (this is where webrought in first aid). There was a temporarysplint applied. By this time the ambulance wason hand and the attendants took over fromthere. The kids got a chance to ride with .the

'patient in the -ambulance to the hospital, andthis was great stuff! The ambulance came Onthe school grounds with sirens going andloaded a few st4lentc at a time. They rode inthe ambulance to Emergency. There thestudents observed the nurse doing her duties,then they we t with the patient to X-ray wherethey saw the ople in radiology going abouttheir work, the hey went to the cast room,etc.

Our next case was that of an Appendectomy.'This began as a young lady was going to theprom and fainted., Her boyfriend called forhelp and she was taken to the hospital wherethey found she had to have an appendectomy.This was whet we got into the gastrointestinalsystem and saw the lab work being done andthe people in the laborhtory who do it.

Following that was 'a case of Food Poisoningand this was where we did a really interestinginvestigation of' environmental health throughthe Public Health Department. We used astory from "Eleven Blue Men" that many ofyou are familiar with. It is about some Polishpeople who Are having a picnic. They makesausage -and because it smells so good, theyeat sotne of the patties before they arecooked. Of course, you know what happened

after that. The students visited theHealth Department and went on calls with thePublic.Health Investigators The mechanics hadall been worked out befdrehand. We didn'tcall up on an emergency basis and ask, "Canwe bring 25 kids over?" We worked this dirtprior to the beginning of the semester. Wewere then informed that, "On this particularday, this investigator will be doing this kind ofinvestigation and if you want to bring the stu-dents 'over we will be happy to take themalong."

We then got into Ecology and the RespiratorySystem. The students wiote a play, and it wasthis play that was used as motivation. They gotall involved in playing the parts, and they start-ed researching smog and other environmentalproblems. And then we got in a Tuberculosiscase where sex education was presented. Sexeducation appeared throughout the curd-culurr?, but it was emphasized here. Our philo-sophy was, if. the need arises, deal with it atthat time We tried to train our teachers to beopen and free with the youngsters,-discussingwhatever topics came forth in an intelligentmanner. Discussions of all kinds were heldwith the students.

The last case was about Drug Abuse. This waswhere. we presented the nervous system. I

failed to mention, though, that before we-started the case studies, we presented one ofthe most interesting sections "of the curriculumwhich really held the kidsa .unit onQuackery In order for them to be knowtdge-able consumers of the health care system, theyshould kn what state health care is in. WeiQtroduced his by using .a film from the"Hawaii Five-0" series. It told the story of adoctor who had invented a machine thatwould diagnose cancer from a drop of. bloodand provide the ,treatment. A couple ofpatients died, and the families brought a lawsuit against the doctor. We used this as a basepoint for quackery and, boy, did it take hold.The kids were bringing in all,- sorts of news-paper clippings and magazine articles. Theyreally had their eyes and ears alert.

The first year curriculum included classroomtime and field experience. The students spent a

dakin class and a day out. As the semesterprogressed, the curriculum became more diffi-cult and more cormirehensive but they wereready to accept it. Ech student was evaluatedindividually _againstihis own rate of learning tomake sure no one was left behind.

In. their 11th )/ear, the students went into aWork Experience Program. The first year pre-pared them to locus on an area that theymight want to get into. Program people talked,with them all the time to help them makedecisions In the second year, rather thancome to class, they spent their two hours inthe hospital where they were assigned tovarious departments. The second year curri-culum consisted of a series of booklets con-taining tasks for a specific area. The clinical in-structors _taught these tasks, and as the studentlearned to perform them, they were checkedoff in these. booklets and dated. Frequencywas indicated so that one could check to see ifa student was doing- the same thing. over andover. The coqrdinata'r was constantly workingwith the supervisors do see that there was avariety of tasks provided and that they werebeing marked off in the bboklets.

During their 11th year, the students had ten totwenty hours a week in the hospital and weregiven ten units of school credit. In their 12thyear, the students were in a CooperativeEducation Plan. This could mean manythingsthey Could continue on with What theywere doing in grade 11 or they could go into,an articulation program at the communitycollege. If one wanted to become a pharmacistlater on, he might take some of the basic sci-ence courses that he needed at the communitycollege while he was a 12th grader and receive_high 9chool4credit as well as college credit atthe same time. Some might want to work part-or full-time and get high school credit, orothers might want to go into the nursing pro-gram that was already established at theirschool. There were many different possibili-ties. The program became more individualized

at the 12th grade level. This was where theteachers and coordinators sat down with eachindividual student and asked him what hewanted to do. The program was revised at thattime to accommodate whatever direction thestudent wanted to take.

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Teaching in the prograni started with the entireclass, then small groups, then individual in-struction. A topic would be presented to thewhole class, then they would divide up intosmaller groups for project work, and fromthere they would go into individualized .in-struction with the teacher working with each

student. q

We wondered how we were going to sell thi'S

program outside Los Angeles. We ,loved it rand

i we thought it was the greatest thing in theworld, but who else cared? We approachedanother school district that was similar (Santa

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Monica), and they turned us down cold. Butthe Beverly Hills School, District decided thatthey needed a program of this kind. Why?Because the kids were asking for it There is anew trend in that affluent community.Students from broken homes are not stayingwith mother in the mansion but are going outand renting their own apartments. They are ontheir own and need money to put gas in thecar and eat. So the 'District thought there wasno more likely an area to train in than healthoccupations. They wrote a beautiful proposaland found that they had several thousanddollars of entitlement funds they had- nevertapped. They were able to geethat money thisyear. We made a presentatiOn to the schoolboard which gave its approval, and theyopened their program. It was not, as simple as Imade it sound. It really takes a lot of work, butit can be dyne!

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EVALUATION OF THE UCLASECONDARY SCHOOLS PILOT ANDDEMONSTRATION PROJECTClarence helstra, Ph D

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'A very important part of a pilot programsurely. is that of documenting it, and the UCLAprogram as you have heard and observed ,isvery well documented. We thoroughly recom-mend that you do the same with yours if youare getting one under way, document it as yougo along.

Another very important part of a pilot pro-gram is the planning for evaluating it. That is,determining from the beginning how you aregoi to judge it and in terms of wham criteria.This was the job tkat I was privileged to be in-volved in at UCLA. I think there were two orthree\ reasons I was chosen. First, I was not ahealth educator, and second, I was not a voca-tional educator; so I way almost totally un-related to the job at hand. And I suppose an-other reason might be that I spent a very en-joyable year in 1960 on leave from UCLA fortwelve months td 'study the vlprk experienceeducation program in Santa Barbara City andCounty It was undoubtedly the most highlydeveloped *work experience education pro-gram in California at that time, and the Rosen-berg foundation was willing to pay for anevaluation of it. So we studied not only theon-going programs, but we also followed upon all of the students who had gone through itwhom we co.uld 'find.

We were very mush impressed with the resultsof that study. Quite clearly, youngsters whohad gone through the work experienceeducation program had advantages all the waythrough They actually completed more unitsof work while in high school. They were morelikely to go on to tollege, believe it or not,They had a higher grade point average in bothhigh school and college. When they got a job,

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the jobs were more closely related to theirvocational aptitudes and interests, and their in-comes were higher. To me this was veryrevealing and very impressive, and I'm morethan ever convinced that the close relatioRshipof education in school and the world of workmakes great sense. I guess it has from thebeginning of time, but we haven't been willingto concede it fully enough. Maybe now wecan.

For the evaluation of the UCLA secondaryschools program I,was assisted nobly and fully'by a young lady whose name is Barbara Rosen-quist, now Barbara Rosenquist Chrispin. Bar-bara collected much of the data and togetherwe did much of the thinking regarding whatdata we should collect.

First of all, we tried to state as clearly as wecould to ourselves for the purpose .of ourstudy what our objectives were ior the pro-gram. Among the objectives we outlined wasto have a program that increased interest onthe part of youngsters in their curriculum. Wasthere greater relevance in the curriculum whenthis component was a part of their experience?Did involvement in this program decrease thedropouts? Did it increase the grade point aver-age of these youngsters? Did it help them pro-gress in some pretty specific ways as*faf as theallied health occupations are concerned? Onthat score, the nine behavioral or performanceobjectives that we identified. were. 1) The in-ductees will tell what the workers do in severalof th allied health occupations, becomeacqu inted with the occupations, and be ableto laescri_be them, 2) they will make a wiservocational choice than they might have with-out being in the prc(gram, 3) they will develop

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each of the steps necessary to get into anallied health job (How do you get into it?

What is the .ladder and how do you climb it?),' 4) they will emonstrate knowledge of howthe health care facilities operate, 5) they willmaintain their own health through the help ofappropriate health care (and it pas quitedramatic to see how much better the young-sters took care of themselves as well as takingcare of their families), 6) they will be able toreter tamily and friends to appropriate healthcare tacilities; 7) they will,be able to performbasic skills In the selected I1'ealth occupa-tionsat least one, possibly two, maybe eventhree, 8) they will be able to identify and de-scribe the fiturtions of specific equipmentused in a health care system (it was fun for theyoungsters to use the equipritnt and to learnhow to do it. well), and, finally, 9) they willdemonstrate behavior appropriate in theworld of work, e.g., dependability, good at-tendance, good persoiial appear44-1ce, and allthose behaviors and ;characteristics that areessential to tfie world of work. Those were theobjectives, and then we had to discover waysor invent ways of collecting data regardingthem. We relied on every source we couldidentify.

4 .We relied very heavily on reactions fromyoungsters t einselves, their opinions, theirreactions, the own evaluations, and also onthe opinion's and reactions of Nrents. I shouldsay immediately that although the youngsters

to were enthusiastic'as has, been specified, espe-cially by Diane Watson, the parents wereslightly more so. In the evaluation instrumentswe gave to both, we found the grading slightlyhigher by parents than by youngsters, which isvery reassuring. Also we relied on evaluationsby supervisors with whom the youngstersworked as hospital personnel. So opinion wascollected oh structured forms of one kind oranother which we developed for the purpose.In addition, we used the free respOnses of the-youngsters involved, letting thetn say whatthey had to say outside Of any structured kindcat form.

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Whenever we could, we also used tests thathad been previously developed, such as, astandardized objective test of vocationalmaturity or health information, and wedeveloped some tests ourselves to get infor-mation which was not collected through theuse of standardized tests. And then we wouldhave to use the cumulative files, the academicrecords of the youngsters_ in the sevetarschools, to find out what their grade pointaverages wire at the beginning and at the end,to find out who dropped out, who transferred,what the attendance was, etc.

from several sources we attempted to collectdata that would be related to the objectives ofthd program so we would be able to see if theoutput was related to whrat we had expectedwhen we detelmined the objectives. I can't

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possibly go into alt'of the findings, biit you cansee them in a volume called The UCLA's*ondary Schools.Pilot and Demonstration

,Praject fol. an Introduction to Allied Health'Careers, which is a summary evaluative reportfor 1972-73.

In the evaluation orthe-nine performance ob-fectives thathat I enumerated,'we found that on ascale o "none," "little," "quite a bit,". and"much" all of the objectives were rated byparents, youngsters, and supervisors as havingbeen achieved at a level of "quite a bit" whichis the next to the highest rating possible. Theone pefformance in which they made thegreatest growth in the course of their being inthe project was in the ability to explain step.necessary to enter an allied- hdtilth job, sand, foranother, in the ability to make ,a wise voca-tional choice. By the'end af the first. year, ofthe project, we found th-at.almost 80 percentof the youngsters could match occupationaltitles with descriptiOrA of jobfinctions, whichis something, of course, they could not dobb ore they started. Sixty-f6ur" percnt couldd monstrate an understanding of the career.ladder, 46 percent could identify occupationalclusters. We found that in the haying or gain-ing of health information, these youngsters

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Wmpared very favbrably, with other young-qers who, had taken the*regitlar health sciencecourse in theme various schools. In fact, on thehealth behave inventor , the project young-sters score 16 points her.' In this practicalapproach to real Problems of health,. they ac-ttlally learned more health knowledge and gotmore health information as measured on",astandardized: test We used as our controjgroup 100 youpgsteri.who weire_nz)t admittedto the piogram.merely because there were notenough openings but who had othei charat-teristics that makhed (hose whO were chosen.So we watched both. groups 'of 100t4h 100who were a,dmitted and the 100 who were likethem bucnoindmittedand then comparedthein in rious ways:, We also found that onthe,,vocaTpnal maturity test (the lohn Critesvocational inventory, a standardized test), theyoungsters in*the program grew significantlyMore, statistically, than did those who were intie control group So vocational maturity isone of the goals' that is achievedthe in-

-creasing of vocatinal maturity as a result ofthis program.

Hospital supervisors' ratings of sevenbehavioral characteristics of students during

--phase twothe second year of the pro-gramindicated that betWeen "the 'end Of the.first,semester and the end of that' year, stu-dents had improved in each one of the ch%rac-

, teristics The behavioral characteristics of stu-dents which- were'rated lowest by the hospitalsupervisors duripg phase two were.attendanceand dependability. I think the nature of thegroup would tend to account for this

1 Behavioral characteristics for -the studentswhich rated highest; i.e., above average, orhigh average, by hospital supervisors duringthat ;second year were these: 'relations with,others, appearance, and job competence:These c-taracteristics improved so much thatthese youngsters were employable, by the timethey had completed even their second year ofth prograrh and stirelj, by the time they hadco leted the ,third...

As thgrade point averages of the students

whp participated in the program as compared .

with the 1019 who did not participate but whowere just like 'them in as Many ways as wecould determine, the grade point averageswere not very different. But over the two-yearperiod, this is what happened. The youngStersin' the prograr9 during the two years had theirgrade point average increase from 2.4 to 2.5.-Now when you can go from grade nine tograde 11 and increase your grade pointaverage even by a tenth of a grade point,

'mthat'snot bad, becatise the tendency on. thelaaft of the particular group we were servingWas to drop out or to drop off or to coastittn-til they did drop out. But there was actually anincrease. So I think the increase is more signifi-..cant than one tenth of a grade point would'indicate. r+te youngsters who were not'.in thee`program, the control group, had a slight dropfrom 2.5 in 1970 to 2.3 in 1972. They droppedtwo tenths of a grade point. So the one tendedto increase and the other tended to decreaseover that two-year period.

`A little more dramatic is this next finding.Thepercentage of students in the program whodropped out of school during the first twoyears of the p.roject was only 2.6 percent andthe percentage of the control group who

,-dropped was 8.9 percent. However, we raninto a problem when we tried to determinethe percentage of students in the program whotransferred, to -another school district duringthe first two years. When, a youngster leftschool, there was a hesitancy to say--he drop-ped out; there was a preference to say hemoved elsewhere, i.e., he transferred. And of-ten it was difficult to know what had hap-pened to him, but he wasn't there. St), we were

. strongly suspicious that many of the trans-ferred were-i in reality, d s. Anyway, wefound that the youngsters in t e'program who"transferred" to another school during the firsttwo years was' 16 percent and the percentageof students in ,the control group who trans-ferred to another school during the sameperiod was 34 percent. So if you add thesefigures to the dropout figures, you find that 19.percent of the students in the project either,

dropped out or transferred and 44 percent ofthe youngsters who were not in the programeither transferred or dropped out.

I would like to conclude with some quotationsby the youngsters themselves who wentthrough the pr6gram. This first one is from a

--youngster who really was affected by her ex-perience. She said, "I'm working in the Irter-community Education Children's HomelandI've found it to be very rewarding and a beau-tiful experience. Probably I am learning just asmuch a4, the children. I have learned to loveother people who are like me and havebecorie mere responsible for myself andothers arourad,me. I have learned understand-ing and compassion for retarded children.Many limes I reach cwt to them as much asthey do to mo. No words can explain the.ful-fillment and joy that comes from seeing these.children learn: to watch the children get off.the bus and run.,to you and hug you and kiss

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you is pyre love For a child to trust you andto believe in you and to return your love isfantastic. To be apart of this and to learn howto cope with and handle these childre'P is anunbelievable experience for me." This is a

youngster in high school speaking. Isn't it

great?

Many parents that their childrenblossomed 0th as.a result of being.in this pro-gram, a-nd that, fo; the first time, they talked'about school', they talked about life, and theyeven began to respect their parents Attie bitas people:who might be interesting, worthknowing, and with whom they might have acomradeship and an affeclionate relationship.

Here .is what another youngster said. "My ex-perience in the hospital is helping me to havemore confidence in myself. M fir as my goalsare concerned, it has helped me a greatdealespecially with _my personality, groom,ing, working with others and learning to keepsome things fo myself."

Another student said, "I have a clearer pictureof. what it is like in the vocational field-1 have

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chosen. My job now has helped me to makeup my mind as to whether oi'not I really wantto pursue this field. It has also given me anidea as to what other jobs. similar to the one l_chose would be like."

ItAt the end of the whole three-year experience,we had a collective confeyence. Some of thequotations that came -from the conferencefollow. One person said, "The program hasmeant a great deal to me. It has provided sum-mer employmeht so I wouldn't have to run thestreets .during the summer. But rvos.t of all ithas opened up what working in a hospital is allabout. It has helped me a lot. I now have a jobat a hospital during the week, and Saturdaydeveloping X-rays, and somedy I hope tobecome an X-ray technician. I hope that theprogram continues so that it can help others,too."

And another one said, "The allied health pro-gram has been a big help to me. I have gainedthe necessary experience I will need to enterthe profession I. have chosen. It has exposedme to the different vocations available in themedical field an1 in hospitals in general whichenaCled me todecide on my occupational ob-jectives Allied health has also helped me in myhome. I learned a>44at about symptoms for dif-ferent illnesses which enabled me to take careof myself and family."

One last quotation. "While working in thisproject, I discovered the importance of .having,a good job. I also found that having my ownmoney to spend helped me a great deal. %lhope this program will continue, and I feel thatstudents that' go into it should go into it withtheir minds set on succeeding, not jiving."

These` are just 4 few of the highlights of theevaluation. I hiipe that-y-o-u might be inspiredto look at the rest of it properly but part.k.cularly to look at the ppgram guide, theteacher's manuals, and the other volumes towhich I have referred. I think those manualsand probably among the most important,developments of the entire program.

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. TEACH ER SELECTION CRITERIA

Recommendations

1 Teacher's should be selected on the basis of some predictor ofsuccess as a teacher: how well do the students or. gradtfatesperform in the role for which the teacheri_s pieparing them?

2 Be aware of results of research on teacher effectiveness. Is theperson open minded? Does he seek new challenges? Is heaware of current trends? Does he have in-depth knowledge ofhis own 'field? Is he.able to utilize evaluation techniques effec-tively?

3 Identify the local. constraints and policies effecting teacherselection.

4 Develop and make explicit the assumptions which underliethe opeiations of a specified health occupations program. Forexample, work experience as a deliverer of health care com-bined with educafional preparation constitutes sufficient back-ground'for teaching, is an assumption which will influence theselection of teachers.

5 Consider attributes desired which are. not necessarily learnedin a formal program, i.e., attributes which are 'earned througha lifetime of living. What must the person bring with him tothe teaching position?

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GROUP DISCUSSION LEADER: Mary Elizabeth Milliken, Ed.D.

We might start by admitting that' in manysituations whefe a teacher is being sought for a

position, selection really does not take place atall. The individual is employed on the basis ofavailabilitythat is pretty much the onlycriterion And yet we would all recognize thatthis is not the way it hould be; teachersshould be selected on the basis of some pre-dictor of success as a teacher.

Let us deal with the ultimate criterion of effec-tive teaching: how a teacher's students orgraduates perform at some future date in therole for which that teacher presumably waspreparing them. No 4w, you may sa,y` that is a'whole lot different from selecting the teacherand we should proceed on some other basis.But 1 would like to suggest that the criteria re-lated to teacher selection can be found byexamining the performances of graduates ofprograms which manifested differing charac:teristics; or that, even if we cannot derivespecific criteria, we at least should keep inmind that what we are really concerned with ishow well the graduates of this teacher's pro-gram will function according to the purpose ofthe program.

I frequently see manifestations of indifferenceor lack of awareness of this ultimate criterion.`For example, a teacher in the practical nursingprogram recently said to me, "I want you toknow that over 50 percent of our graduateshave gone on to professional nursing schools."And she stood there waiting for me to praisethis accomplishment. It shook her up a bitwhen I said, "Is the mission of your practicalnursing program to recrvit students for profes-sional nursing programs? Did they spend a yearin your program to get ready to go on to pro-fessional nursing programs?" She sputtered fora few minutes and I continued, "You know, Iwould rather hear you talk about hov.7 many of

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your graduates have accepted positions. aspractical nurses, have participated in con-tinuing education programs to extend theircompetencies as practical nurses, and are ac-tually delivering those health services whichwe classify as functions of practical nurses. Ifthis is not the way your gaduates are perform-ing, something is wrong with your program. Ormaybe it isn't your OiDgram that is out ofkilter; perhaps it is your selection procedures."

As we explorecrtheir selection procedures, itturned out that they did give a pre-selectiontest which yielded an IQ score, and they wereaccepting no one with an IQ of less than 110. Iwould say this person is not functioning effec-tively as a teacher of practical nurses. Shereally ought to be on the faculty of a profes-sional nursing program because of her ownvalues.

There are many articles being published abouteffective Caching and much of what is beingprinted is based on sound research. We arefinally beginning to come to griOs with...whatdifferentiates effective teaching from ineffec-tive teaching. As you examine the results ofsuch research, you will again identify samecriteria thdt can be used to select a teacher.

About eighteen months ,ago 1 heard a state-mentkconcerning a person who is very wellknown in allied health and also in teachereducation, who said that a particular telt,could absolutely select those who could teach.Now, this worries me because this was a per-son tin a leadership position, but her statement,tells me that she does not understand the stan;darized test or how to use it. It also tells methat she does not understand the importanceof professional ludgments which take intocount many variables rather than a single vari-able. Please, whatever criteria you establish,

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do not select a standardized test and say, This

will make my decision for me." That is a totalcop-out on this matter of selecting teachersaccording to some explicit criteria.

When selecting teachers for health oc-cupations, we are asking someone to give uppracticing as a health practitioner and assumethe functions of a teacher. This person is aptto relate to what has previously been his areaof practice as a teaching field in which to pre-pare others to function as practitioners. Andwhen you ask a health professional to makethis career changea major change in his orher own career developm,ent pathyou arereally asking him to do something that is goingto be a traumatic experience for the first yearwith many of them not even surviving that firstyear and going back to health practice afterdeciding that they cannot adapt to the con-straints of the educational system.

To help, prevent such disenchantment withteaching, selection criteria should be em-ployed,. Identify the local constraints and poli-cies effecting teacher selection. Determine thelevel of the program in which the, teacher willfunction. Will he be teaching in a middleschool career-oriented program, a high schoolprogram combining career components no'job skills, or a post secondary program? Arethe learners disadvantaged, middle class, orminorities? Is the program self-paced or is arigid curriculum to be followed? Is teacher,creativity encouraged or discouraged? The an-,swers to these questions will aid in selectingteachers who have greater potential for suc-cess.

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I would like to suggest one approach which isa ,skull-cracking kind of experience, it is slowand developmental, but it does lead to theability to make explicit some criteria you coulduse in your situation to select teachers. Ofcourse, when we talk about te4c-low of healthoccupations education, we are talking about

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people who must conform to societal institu-tions, for the health field is a major societal institution.

The approach that will p2,1,mit deriving somespecific criteria appropriate to your localsituation is to develop and make explicit theassumptions which underlie the operakns ofyour health occupations program. I havepulled a number of assumptions from a pub-lication' which is now in press in which an' en-tire chaptei- is devoted to assumptions. Anassumption, as I am using it here, can be eithera statement of fact, ,an hypotheSis, or anystatement of a belief or. commitment. If it is a:

statement of fact, it can be documented withevidence to support it. If it is an hypothesis, itis thb-ught to be true and is something that canbe tested to determine itsvalidity. If it is astatement of belief, it is recognized as a per-sonal thing and ,there would be those whowould adept it and those whfk would not.

Many school people assume that any creden1111tialled health practitioner has an adequategrasp of his particuFar field and thus can teachit. If you accept this assumption, then creden-tialling as a health person is one,of the criteriayou would use in selecting a teacher. IfrejeCt this assumption, then, of course, ',afarwould mean a different criterion should beselected. Those of you who are vocationaleducators will immediately 4'recognize thisassumption as' a basic tenet of vocationaleducationthat both educational preparationa 464r,k/Ork experience shoUld enter into thepreparation of an individual for teaching in ana,OCCOatiPlial program.

This particular assurription, whether it is ex-plicit or not, is used for selection of, teachers invocational education. I would suggest that atthe professional leyel, this criterion is violatedfrequently. ,Often, a brand new graduate ofprogram is put on the faculty as a new teacher.without ever testing and validating the content

tof that preparatory program in the-real worldof work. I .feel that work exptrience as 'adeliverer of health services, combined withpreparation as,,a health educ4tor, constitutessufficient background for7--\,teaching.

`Thiere(are, numerous other assumptions whichcan be experPCI ,811you pet down on *pa{Dersome thoughts you 'have. about health oc-cupations edqation, examine them andasay,"Well, do we or do we not believe this ?" Fromthis basic assumption underlying the program,you Can derive those criteria. which will help'you..select a teacher.

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Ultimately, the cgestions must be.a

,Whatshould the ,person bring to the teachingpositiosi sally? hat should the personpossess as13ersorial and as results ofpast experienEes? What should we considerthat the teacher education program will helpthis person develop? I# you are going to pro-vide pre-service gducatine 'in your criteria, yowmust considerat mig e gained by the in-dividual through the pre-service ,progfam. Ifthere is no pre-service program, then you aregoing 'to look for these capabilitiespresent already in the person applying for thepositibn. ;

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CONTENT FORP.THHEALTH OCCUPATIONS EDUCATIONBASIC TEACHING DEGREE

Recommendations

1 Determine the competencies and abilities needed to teach suc-. /I AS . A . II e

these competencies and abilities to a level of mastery.

Determine the selectidn criteria for people wtio will be admit-ted

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to the teaching degree process:

a. What is their potential?b. What are your constraints, i.e., time, resources, and audio-

visUal aids available; how motivated people are; etc.?c. What characteristics%are desirable in teachers?

'3 " The content of a teacher educaQoin program 'should foCus onprocess, i.e., Methods as oppoled fo subject matter.

-a. Provide basic courses in methods of writing and ,utilizing-meaningful, measurable -Objectives. .

b. `.Provide training in evaluatignctechniques and proceduresto include the proper uses of evaluation.

c. Provide leadership and problem-solviQg training:`"d. Provide training in irktih-onal relationships.

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et. ::4 Upgrade.the'status and recoghition of persons in Health bc-cupattoni 'Education. ' .

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.--. ., . . ,. '.0.' -.a. Allow individualS to do self-evaluatibris of their own

, trengil-ts and weaknesses. .'.

.. tit Assist in,,f4luating the situations in which they may pre-'

,vide leadership in their particular, roles..

,c.' Allow theo,freedo. m to develop a style of operations that,.. . is casisterit-wititheir own chatacteristits and with -refer-.

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5 Persons who complete the required training should be given adegree title consistent with their actual job, e.g., Allied Health

'Education Administration or Allied Health Teacher Preparation.

6 Maintain continuing education to_keep teachers informed ofcurrent trends and new developments. r;

a. Provide mini:course, in-service °grams for 'specificolo problem areas in lieu of some univ sity-based education

courses.b. Allow credit for Fecent documented emplo ymEnt experi-.

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GROUP DISCUSSION LEADER: Robert M Tomlinson, Ph D

When, discussing the health occupationseducation teaching degree, it is necessary todefine the role of health care personnel basedon developed task analyses in order to moreclearly define the role of the teacher of thesehealth care personnel. We must also determinewhether we want an adrpinistrator, a teachereducttor, or a teacher .preparing practitionersin a specialty field Each of these roles requiresa different set of competenciesoand a differentset of activities, so it is important to determinethe competencies and performances expectedof the individual receiving the training.

There is also seleCtion criteria to be dealt with..Selection criteria focuses on who% is going to.enter the process, what you are going 'to beable to do with them, and what your conestraints are, e.g., how much time you Will haVe,how many resources, what type Of people,what kind of motivation and .what audio -

visual aids are available. It helps td..define whothe individual is and what characteristics heshould possess. Certainly, the best you candois such that in some future 'fimeof decision,the person who completes the process willMake a better quality decision' ander a certainset of circumstances than they would havemade had you not had contact with them int,this prOcess.

You cannot give a lot of,q.e's for makingdecisions because these is no Way anyone canremember all those rules. Situations come uptoo fast and the person has to be able to selectthe solution that best suits each situation. alt

`haS t be something that is a part of the in-divi ual. Essentially that means they are goingto ake decisions on the basis of .prin4lesand genei=alizations, which takes you rightba to the basic, philosophies that mustbecome a part of each person.

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Within the overall structure, too often wethink of content as an .organized body of.knowledge. The most important content in ahealth practitioner preparation program or in ateacher education program, whether it be forhealth or another area, is process as content.That really means that you teach more of howto do things. We can teach all the rules andcontent of psychology for example, but thatdoes not mean the student can actually helpsomeone solve his problems.

We recently had a workshop on the problem-solvii approach, i.e., how.you get people tohave that approach as a part of their way of

,dbing things and how this could be integratedand titilized throughout a curriculum. At theend of two dal, one person sitting in the brow. said', "OK, you have finally convince *lethat problem solving is a"competency; 'it is achit we should have in our curriculum. Now,should that course in problem solving comebefore or after?" Obviously, he had not hlardwhat we really said.,

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People in the he5Ith field have to think of theirfellow workers as people. Do you choose theword,"we" or "they" when you refer to somegroup? So many times health practitionerscome. to me with all the principles of the in-tegrity of the individual, their rights to privacy;.`rights,to respect, and rights to be treated as anindividual. They" apply that more or less totheir own role 'arid totally 'iolate it, in the waythey choose .their words in referring to "thatstupid aide," monkey could do that job,"and they take away all the dignity and respectby .the way they speak.

The role of sociological structuring is impor-tant in asking a 'practitioner to become a

teacher and give up all the status and security

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he has gained from being a recognized prac-titioner. He steps into the educational area atthe bottom of the ladder in status and com-petence because he is now competing in

somebody else's field. Many people cannotever really overcome the trauma, it is a toughlob stepover to make.

Along this line there is the distinction betweenleadership capabilities and someone, in a

leclership position in an organizational struc-ture. They 'are totalry independent ,concepts.Hopefully, the person you have as supervisoror administrator alsd has lead'ershiplability. Butthey don't necessarily, becaus an ad-ministrati\,e role takes Its power and authorityfrom the. orgalization. Leadership is the -influ-ence a person an exert on a group in helpingthat group meet some need that it "has. An in-dR, dual teacher can do this, and heooften hasto in this field where we deal with small groupsand inter-personal relationships.

We can give some of the st.aVIS, recognition,.and 'relationships to individuals by gettingthese kinds of concepts across and lettingthem do some self-evaluations of their own

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strengths and weaknesses. We should also pro-vide some assistance in evaluating thesituations in which they may provide leader-ship in their particular role so that they canhave a style of operations that is consistentwith their own characteristics.and with refer-ence to their work. In addition, they should begiven a degree title which states clearly the ac-tueOlob they will be doing. Rather thaji simplyreceiving a teaching credential, they tan gainstatus in knowirl that their degree title:ac-curately reflects he function they perform,e.g., 'Allied Health Teacher Preparation.

After initial certification requirements havebeen met, there should be provisions for con-tinuing ekucation for health occupationseducation teachers. This education could con-sist of in-service workshops, university cours-

, or mini- courses offered on specific topicsu of some university courses.

These al'e all consideralions with which wemust be concerned in determining the contentfor the Health Occupations Education basicteaching degree.

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PREPARATION FOR LEADERSHIP ROLESIN HEALTH OCCUPATIONS EDUCATIONRecommendations

1 Leaders in health occupations education should, pdssessspecific skills, knowledge, and abilities directly related tohealth care and the principles of vocational-technicaleducation.

2 y Leaders{, training and teacher education personnel shouldwork together in identifying and develop* potential leadersin health' occupations education.

3 People who possess some of the basic leadership charac-teristics should be encouraged to develop all of the 'skills and

to,competencies needed to be effective leaders..

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4' The experiences offered potential leaders should be purposelyplanned, meaningful, and challenging. ..

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5 Accept and utilize all. the competencies of potential leadersthat have been gained from all sources, e.g., occupationalperience, alliance with professional organizations, ,parti-cipation in workshops, etc., ,

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GROUP DISCUSSION LEADE Elizabeth E Kerr, Ed D

I would like to share with you those charac-teristics that I believe to be basic to effectiveleadership in general. These characteritics in-clude fairness, objectivity, honesty, sincerity,forthrightness, the ability to effect positive in-ter-personal relationships and attempt to bringout the best in people, the,ability to work withgroups of people having either common ordiverse interests or goals, strength of convic-tions and preparedness to justify One'sposition yet have the ability to compromise:oreven yield- if-necessary and appropriate, theability to recognize and learn from misyakes,the ability and readiness to speak beforegroups, the ability to .be creative and innova-tive,to develop a climate conducive toenabling people ro further develop and usetheir expertise, and the willingness and ability-to delegate responsibility and accept and fulfill-,the.rale,as a change agent. And I have addedone more=effective leaders must possess, self -

confidence. There are others, I am sure, thatyou could thinIaltf, but those,are the basicthings I wanted to,share with you for leader-ship in any field.

Let us look for a moment at additional charac-teristics that are needed for effectiv5 _leader-ship in health occupations education. A leaderin this ;field must be familiar with the totaleducational system and the role of vocationaleducation 'wjthin it; have a commitment to thephilosophy and goals of vocaknal and tech-6nical education; where required' or appro-priate, have acizieved competence in a healthprofession and all the necessary credentials as-required by that profession or group; be some-what familiar with variotA "health professions;possess skills in .curriculiiin development, in-'Strtictional processes, and counselling; icrentifyand work wits health 'professional associationsand agencies which set standards for educa-.tiOnal'proftssionalism; be alert to community

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health care needs, and ritclentify. and use com-munity resources to help meet these needs; befamiliar with the needs of and the current andnew developments in the health-care oetiverysystem, be familiar with existing and potentialstate and national legislation that effects.or hasimplications for /the field of education ingeneral, vocational eduction, and govern-ment. And I would add another characteris=ticthe ability to prepare and administerbudgets.

As We look at these basic chOratteristics ofleadership that are needed, we find ourselvesasking, "How are they gained?" I think too of-ten we assume that the development of thesetaasic personal, liaracte-ristics or the attainment

these Competencies can be gained only at,,t4griduate level of eduCation. If we loo'f atr -the experiences that contribute to our whole'self as ,a person, I think we would have,,toVecqgnize them as having.an inpwt, too. We.would gave to look at our commoneducational experiences, our church activities,our 'Oda! experiences, employment situations,community activities, professio.nal asso-ciations, continuing education, and (mili-tary service...There are many, many seqingsin which you can gain these characteristics andcompetencies, Therefore, I believe it is im-perative to recognize that these kinds hf at-tribules can be gined in a variety of settingsand ttiat.,.we do not tequire ie-learning orgoing through hoops a second time merely tomeet requirements of a specific curriculum.Hopefully, we are gaining in this area, but I

think we still have a long way to go in accept-ing those competencies achieved in settingsother than educational institutions:

If wellook for the sources of leadership com-3.petencies, then we must also look at the rolesdifferent people or groups play. First, we

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should look at the role of the learner. It is im-portant that the learner be interested, mote-vated,..and challenged. I/ is our role, as I see it,to help this individual become motivated andchallenged in the right dir'ections. Then there isthe role of the eduational institution whichplays an informal Art ,through workshops,seminars, and conferences made available topeople seeking these kinds of competencies.

The .experiences olfered, whether they beby an educational institution, a' health .pro-tessional, an employmenp. agency, or what-ever, need to be purposely planned, meaning-ful, and th-allenging so that the diseasesthreatening. the vitality of leadership can beprevented.

Let me tell you what some of these diseasesare. There is feverish nearsightedness, nova- 'phobia (the illogical fearrof the new), antiqua:phobia (the illogical fear of the old), cerebral-attacknia (the inability to get the wheelsgoing), marrowmalasia (tile softening of nervesor lack of backbone), "hydroaesthesia (de-creased sensibility), and hyperaesthesia. (ex,cessive sensibility). These are the kinds ofthings we.have to prevent if we are to havestrong leadership inle field..

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I want to give you an example of what) amtalking about. Ida Kent came to us in our areawith our first program in dental assisting. Shehad no education beyond high school,, but shehad had experience working'in a dental officeShe came to us with many ,of the attributes. Ihave been talking about which had beengained outside of formal education. She set upour first dental ass5istiQg program in the stateand she also helped others get started. Wenow have seven such programs. Ms. Kent is

very active nationally and holds a national of-fice in sexvice and consulting. She will soon .befinishing her baccalaureate degree, but with-out her help we would not have. gotten our-program going as effectively as we did. By thesame token, we have a person on campus whohas a P.I.D. in higher education and if we lethim lie will bean obstruction to what we wantto do.

,-What I am saying that leadership ability isnot all gaii4d from higher education. It is

derived from our daily experiences throughoutour lives, and we should be willing to overldokthe lack of 'formal education in persons whohave attained the basic leadership chabc-teristics And competencies through personalexperiences.

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CERTIFICATION STANDARDSFOR PERSONNEL IN HEALTHOCCUPATIONS EDUCATION

Recorrimendations

1. Consideration should be gixen to an-applicanl's work experi-ence when determining hig. qualifications.

Certificatioh standards should ,include a professional educationcomponent which consists ,of a ,general 'education or 'liberalarts component when certification-is :obtained in conjunction ,

with a university degree, i.e.clegree ,requirements.

3 Crtification standards should include a minimum of :prepara-tiowlin a health specialty to assure in- depth' knowledge of thehealth care delivery system.

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4 Certification requirements should be made flexible to accom-modate individual differences in background, preparation, andcreeds. -

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Certificat,ionl3rograrns should .be qffered at a varOty of in-stitutions to include community colleges, intermediate andunified schyol district education prograrivs, and the Depart-rhent of Public Instriktion.

06; Provisiqns should be made for continuing certification to in-

. clude further, Course work beyond the initial certification; at-tendance at professional riketings, workshops, and in-serviceseminars; 'and work exper-ience.-

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Teachers ihd future teachers should be surveyed to maintain acertificationcurrent assessment of their needs in relation to c, .req ,uirements. ,

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GROUP DISCUSSION LEADER: Chester 5 Rzonca, Ph D

What should the certifiCation program for per-sonnel in heat occupations education con-tain? There shbruld be a work experience com-ponent, a*prQfessional education component,and, in terms of relating this to a university de-gree (if That is desired, though it is not essen-tial), you need a general education or liberalarts component. It has also been-found helpfulfor the allied health teacher to have a healthspecialty preparation. Lastly, perhaps one ofthe conditions ought to be that people are notexcluded because of certification requirements'without looking at some of the experiencesthey have had in the past.

A fact6r that needs to be cohsidered whenlooking at certification for health occupationseducation is the inflexibility of current cer-tification requirements. 'Typically, require-ments are spelled out as a certain 'number ofcourses that all people have to take. They are,the same for everyone regardless of previousbackground eve9 if the person has taught forseveral years or has experience as an in-servicedirector in a hospital In our quest to provide auniform standard, we try to enforce a specifictype of levy whether it be degree related ornot Certification requirements for health oc-cupations education should be more flexible..

We tend to make slime assumptions based oncurrent certification programs. One assump-tion is that the -universities are primarily re-sponsible for providing the educational cer-tification component. 11,9wever, intermediateschool-districts, comMtnity colleges, and theDepartment of Public Instruction provide themeans for limiting the role of the universitylerais of being the save-all for certificationrec wrements. Trk role, is.bn important one in

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terms of the amount of people that need basiccertification services, but we need to look toother levels of education to provide these ser-vices.

One of the things that we fail to consider incertification is the difference between'initialcertification and continuing certificatiqn. Cer-tification brings people up to. a certai level.After that, there ought to._ be some way forpeople to maintain that certificate, Ourcurrent procedure is to bring them up to aspecified level throuh education courses andthen maintain that eertificate through addi-tional education courses. Actually, coursework is only one of the ways to maintain aneducation certificate. Professional meetingsconducted by professional associations alsoshould help people maintain their certificate.While work experieke is important.'for an en-try level credential, it is also im'portant in main-taining a credential over 'e,period of ysars.Additionally4 in terms of continuing cer-tificitign,V4fia,?enegrected the role of pe9.rsand administrators in deterinining how good ajob the people do.

Another factor .that is neglected is the role ofthe teacher in terms of how certification6requirements are established. Have you evertalked to people when they got through with a

university program? They are not concernedwith how the certifidation programs wereestablished, their first question concerns howthey' are going to meet the renuireinents forthe credential' We should talk to these peopleto determine what their needs are and whatkinds of things (hey feel they should have inorder to function in the classropm.

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FINAL EVALUATION OF THEHEALTH OCCUPATIONS EDUCATION

CONFERENCE

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The main objectives of the Health Occupations EduCation(HOE) conference were twofold: (1) Toiamiliarize HOE per-sonnel tfie materials produced by the Allied Health Proles-sions Project (AHPP) -at the University of California,LosAngeles, and to assist personnel in ashieving a level of masteryin their use; (2) To disseminate natio6wide the AHPP materialsthrough Conference,sparticipants. These E11:4 conference goalswere achieved s described in the following paragraphs.

in.order to ascertainkthe effectiveness of- the HOE conference, anevaluation was conducted six rhonths\later by means of a' surveyquestionnaire sent to all participants; 65 percent of the confereesresponded. ©f these respondents, 71 percent felt that the objet-tives were adequately met.There was sufficient time allowed to ,"familiarize everyone with the AHPP materials and, in turn, eachparticipant could 'subsequently instruct others.

AH ma t vials were disseminated by all participants responding tothe survey: A.tonference was the most popular method, usell by43 percent of the i-ksEondents. Twenty-five percent used work-shops to disseminate the materials, and nine percent conductedserilinv. individuals also utilized faculty meetivgs, super-visory andconsultant,visits, perso'hal cortversationsand discuOions, And inser-vice training. In addition, the materials have benefitted respon-dents by serving as a.' resource' for curriculum derlaprrient,revision of occupatioilal task requirements, and.writing objectives.SeVerai participants have displayed them at conferences. Othersare using thee inaterials,to initiate changes, as a, guic0;for deter-mining levels orcomp,etency, as ? counseling kool, and as back-ground for .research. The materials have been modified wherenecessary to 'Meet the needs of the specific programs.

For many participants the most useful aspect of the conferencewas the interaction with other professionals in HOE and the oppor,

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Itmities provided to exchange ideas, information, and perspectives.The second most useful aspect concerned the UCLA AHPP and thematerials produced by the project. Participants approved of theMme allowed to study the displays and were particularly grateful__for the descriptidns of their use. Specific comments focused on the

ffecondary' Schbols Program and on the concepts of corecurriculum and career mobility. Also ranking high in usefulness,were the group discussion's and the fact that a good exchange:ofideas was possible..

S5me of thelaxiditional remarks made by conference pahiciparlisare stated below..

"The concept involved is not difficult but the implementationis. How about some follow -up conferences and Materials?" ,

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"The information generated from one of the group sessionshas facilitated the approval of the position of State SUpervisorin HOE in South Dakota. This one outcome made the entireconference worthwhile:

"Our teachers" are happy tO.see materials of such quality atpYices'they can afford."

"The outcome, I feel, was that the government wants leader-yak,ship in health decisions. It itiip to us to provide that leader-ship." .° .

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Based on 'the survey questionnaire, the HOE contirenceachieved its objectives. Nearly three-quarters of the responrdents indicated adequate familiarization. with the AHPPmaterials and sufficient mastery of their content to enable in-str'uction.of others. Dissemination.of the materials by confereeshas ,been widespread and varied/ indicating a national impactof tremendous scope.

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CONFERENCE STAFF

ABBO11, Ellen MDirector, Health Occupations EducationGrossmont School DistrictVocational Nursing School

25345 Timken StreetLa Me,ya, California 92041

(7c ALLEN, DavidAssociate DirectorDivision -of Vocational EducationUniversity of California,

Los Angeles100 3 Wihire BoUlevardSanta Monica, 'California 9040121 3/825-7909

'ANDERSON, Miles HDiyeztor

Fie4Ith Professions Research' and Instructional ProjectsDivision of Vocation,al Education1003 Wilshire BoulevardSanta Monica, California 90401213/82512608'

BRiovy, Melvin L.DirectorDivision of VocatiOnal EducationUniversity .Of California,

Los. Angeles12 3iMoore Hall .

Los Ahgeles, California 90024.2131825-1838

BREKKE, Donald G.Director, South Dakota Regional

Medical ProgramState Department of Health416 East ClaryVermillion, South Dakota 57069-605/624-4446

BURKETT, Low I A.

Executive Director, Am scanVocational Association

1510 H Street, NWWashington, District of iol'urtibia 29065

'202/737-3722

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FIELSTRA, ClarenceProfessor of EducationGraduate School of EducationUniversity of California,

. 4` Los Angeles347 Moore HallLos Angeles, California 90024.213/825-8360

FREELAND, Thomas LDcan, 'School of Health Related ProfessionsUniversity of Mississippi Medical Center2590 North Side streetlacksoskAississippi 39216601/362-4411

87

GOFF, Nancy I.Administrative= AssistantDivision of Vocational EducatiOnUniversity of California,

Los Angeles123 Moore, HallLos Angeles, California 90024213/.825-18 38

KERR,'Elizabeth E.Director, Program in Health

Occupations educationThe University of Iowa135 Melrose AvenueIowa City, Iowa 5212319/353-3536

MILLIKEN, Mary ElizabethCoordinator, Health Occupations

. ,.Teacher Education ProgramUniversity o1 GeorgiaCollege of EducationDivision of Vocational Education603 Atherhold Hall'Athens, Georgi'a 30601404/542-3891

PHILLIPS, CHARLES LConference Assistant:Division of Vocational Education

` University of *California,Los Angeles 4

12'3 Moore HallLos Angeles, California 90024213/825-1.732

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. .POWERS, Helen K.Consultant,.HeSfth Occupations

EducationU.S :- Office of %location Retired)1989 Tahoe Dr e,,'Xenia, Ohio 453

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RZONCA, Chester. S.Assistant Professor

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. 'Health Occupations EducationMARA Building135 Melrose AvenueIowa City, Iowa 5224031'9/353-3536 '

TOMLINSON,' ,Robert M.Professor of Vodational ,Educiition

. )University of lifinois at Urbana. Champaign

(College. of EducationDepartment cif Vocatron alaand

'Technical Education° 61801

2177'333-0807

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PUBLISHERS

TUTTLE, Francis B.Stale Director :'Oklahotrra SiateDepattment of Voca:-

tional and Technical.EducatiOn151'5 West ,6th. AVenucStillwater, Oklahoma 74074405/37,2000 .

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WATSON, Diarie E.COnstiltantLos Angeles City Schools5331 Harcourt Avenue ,Los Angeles, California' 90043213/291-1250

WOOD, Lucile .A. rDirector of Nursing ServicesBay Afea Hospital .

1775 Thomp§ca RoadCoos Bay, Oregon 98420

. 503/269-5951

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BENSON, Ronald). B. Lippincott Company '-

,3762 Arbolada RoadLos. Arigeles, California 90027

.213/6.66-7482

DEWEY, Buck A!, Ir.. W. B. Sunder Company Publishers

West Washington Square'Philadelphia, Pennplvania 19105

*2151574-4902 -

.

JOURAR9, luliap H. .-4Holt, Rinehart, and Winston, .

Incorporated5643 Peadise,DFiveCorte Madera,'Califoinia 949251415192419(40

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CONFERENCE ii3ARTICIPANTS:

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3: e

ANTRIM, BobbieInstructor' in Medic;1 Office..

. Administrative Procedures2044 NW A6th,Street ,

Oklahoma City, Oklahoma 73112* .4051271-6422

BARNES, Dorothy G.Trade & Industriil Instructor1530 South Grand BoilevardSt. Louis; Missouri, 63104314/664411'1 J

BARTHOLOMEW, JarnesE: 1 .

State Supervisor of Health''Ocoilpations

65 SOuth ErOntStreet, Room. 61pColumbus,' Ohio 321.5

'6610466;2901 ./. , .

.

130TON, Sharon 1.Director, Department of Dehtal.

Hygiene.College of Dentistry; ,

the University of Oklahoma- , f)44 NE 14t1i.

'Oklahoma City, Oklahoma 73190271-4435

trBELK, Lyle V.

. Health Services .Coordinator.

North Dakota State University'Department .of HealthFargo, North Dakota '58102'701/237-8981;

IfENDER, YvOnne.As,sista'nt 'Slate Supervisor,. Health Octupatirs,EduvationState DepartrinenVbf Vbcation.11-

Technical Educatiorl .4100 Li;coln Boulevard

.Oklahoma City, 0,1dalioma 7.3105.405/521-3309

I

,BERG, Sohn C.Assistant PrOfesok, St: Louis; . Junior College District .

' ; 954 FAIray Drive `

Norman, Okjahofna Z3069

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BERGPIA,N,William H.Associate Director, Busintss,

Researeq Bureau '209 N. YaleSteeetVermillion, South Dakota 57069:

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411FtCHENALL; Joan M.DWector, Health Occupations Edu'cationDepartment of Education

-Division of Vocational Education225 West State StreetTrenton, Nev Jersey 08625(269/292-6592

-BLOUNT,'Al C.Chief Consultant, Heiltil Occupations

Education17 Yucca DriveAustin., Texis78744

130ETTNER, MarianneSuperviset of Health Occupations

EducatioinColorado State Board for ComnhunifY

College andccupStional Education,20.7 State Services BuildingDenver, Colorado 80203303/8132-3162

$

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BORTZ, Richard F:Occupiohal Curriculum DesignerSouthetn Illinois Uriiversity.School of Engineering '

Carbondale, Illinois 62901?6181534-381-, 'BRADLEY,'John L.Research AisistantSouthern Illinois University327 -1 Southern HillsCarbondale; Illinois 6290146141536-23)31

BRADSHAW, FlorencePractical:Nure Instructor522- 18th Street WestBillings, Montana 59102

. 406/25.2-8449

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' BRENTLIOQER, Clara' E...Assistant Professor, Health

Sciences,drid NursingEastCentral Stafe.College'11'06 East .18th, No. 213Ada; Oklahor9.74820.4051332:8000, X-3116/

CLE ENGER; Mardriet ,R.e. Supervisor, Health

c-upations,- Neva tate Department of

5 4'Educate

'Carson Ci Nevada '89701,7021882 -73.1

41

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.CRE.130, Barbara B'.Supervisor, He,aLth'Occupations.Educdtion

Office .of the. Superintendent ofPublic In,structionm

State CapitolHelena, Montana 59601

.40p/449-2087

.CRICK, Pauline S.Regional. Supervisor, Health*Occupations Education-

. 207\East.Main StreetMurfreesboro, Tennessee 37130615'ik396-1853

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IDEAMICIS, Anna C... State Supervisor, I4ealth

:Occupations Education.6.t12 chesworth Roadtatonville, Maryland 21228301/796-8306,X-.408 .

DENHAM, 'Harriet` R.Supervisor, Prat.ticalArts

Unit, Health and PersOnhel ,`Service Occupations.

2,109.Capital Plaza TowerFrankfort, Kentucky 40601'5021564-.3775

'.

DE STEFANO,'Peter,laructor, Health Education Lab7331 Ticonderqa PlaceAnchorage, Alaska. 99502

PILTS, 'Ruth. J.

'Director`. :..v:il

I. New Mexico Board of Nursingl:,s505 Marquette NW. .."AlbUquerque,:NeW Mexic9 87102 ,

505842-1026 ' ,

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DONNELLY, leAh W.Insttuctar,.Health OccupationsHoward Vocational-Technical CenterEllicott City,

'Howard County, Maryland 21043%

ER501SA,.aigi L.'Instructor-Coordinator, Health

Occupations Education1300 Kimberly RoadTwin Falls, Idaho 83301208/733-9554 X-294 ,

GILDSETH, Wayne M:Associate DirectorSouth Dakota Core Curriculum Project216 East Clark.Vermiltion, South Dakota 57065605/624-4446 . '.GILLEVIE, Wilma B.Professor of N'ursing/ViceiPresident

Health 0&upatioQ.Uducation,American Vocationall, sociation

Breyard Community Coll e

Cocoa, Florida 3294 .30%9411.11

, \/GLOVER, abhita M.Instructor, Nedical Office Assistant.3420 South MemoialTulsa, Oklahoma 741459181627-4955

GRIFFITH, Jaenesfi.t Health Occupations:Instructor'z

.e. San Die o City' Schools - .

Health cups..x4100 Nor I. Street, Room 2 09'

tiqn Program

San Diego;.'Califorpia 92103 i.7141298-A681, X-443' '

. ;

HALti.ue D. ,.

epatlinent Chairman, Al20, Dawn Allan Drive..rants Pass, Oregon 975 6

, 3/479-'022

,HAMER, Clyde C.

/ Assistant State Supeivi r,

' . Health: dccup-ations Education'State 'Department of Oational- 0

Technical Edilcatio It4100 Lincoln Boule aid:Oklahoma City, Pk ahoma 7.3105 e t.4051521-3305 / ,

. .'

d Health1,N

90 a'

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Nancy, D.Coordinator, School of

_Pracitical Nursing ,

Box HWayne, O1 oma 73095 \405/44,94391-

,,+11FIELD, Gladys E..Health OcCupations Department

. Chairman4389 Satter Drive NESalem,"Oregon 9730350315A5-7900

H14, loY' Associate Curnculan Specialist,

He,ilth OccupationsRoom 151, Taylor Education

BuildingUniversity of Kentu cky-Lexington, Kentucky 405026061258428,5.0

;,HOEKSEMA, riut-D.Coordinator, Allied Health

Teacher -EducationScIV)ol oi.,Education

.Fil- is State College . ,

.. Big RaPit,Isistichigan 493076161796- 997"1,' X-558

HARRISON,

1

HU 1E, Mary. ,

P1-og am Content Analysis, Healthupatio6s

;Indiana ,Vogational Technical." College: .

P.D. Box 1763Indianapolis, Indiana 46206,,317/297-3210

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.AMISON, Patricia. State Sppenlisor, Health

Occupations EducationState Department Vocational-" -.Technical Education-4100 Liocoln.BoulevardOklah-cinta City, Oklahoma 73165405/5.2,t-3 305

1OHNISON,Illbora A._Program Specialist, Health

Occupations -EducationUniversity -NOrthern ColoradoMcKee '318Greeley, 'Colorado $0639351-2.072 ..

4r s

LUNGE, CatherineConsultant, Health Occupations.

Eclikation. TexasrEducatiOn Agency

Box 758Denton, Texas 76201

, .

KEELING, LindaAstiStant ProfessorHealth Science InstituteCollege of EducationTexas Wonrian's University,601ton, Texas 76201',81711312-4913

KRYGER, Lois K.4" Dental Training Advisor I

Division of Dentistry, BHRD9000 RoOvilsle Pike .

Belhesd",,Maryland 200143 1/49 3136

LAN.T2,/ Patricia LDirector, Health, Home Economics

and Human ServicesCla,ckamas Community Colleg19600 South Molalla Avenue .

Or'egori City, Oregon 970455031656-2631, X-264.LARSON, Julie C.Consultant, Health OccupationsDivision of Vocational and Technical

Education .1035 Outer Par, DriveSpringfield, Minors' 62:706217/525-4877

LOVE, David C.Direcfbr adioldgical Sciences

,Eroard of Direttoo, ChairmanNew Jersef 'Council of Radiologit

Technology,tducators, .

Directorof Radiological SciencesPaSsaic County Community Cone*

,A1JiedHealth Ceh\ter,170 Paterson, Sir*Patgrsoni,New ierey 075052011279-5000; X-3 '

, 4._4

ersing.InstrOctorMAC-QONALD, Ma I,il1600 SW Wright \Betieiton,,Ciregoii 97095

r.

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M

MACK, Fred b.Assistant ProfessorSouthern Illinois UniversityEducation (Office DPT,Stop 129

e Scott Air Force Base,Illingii .62225 .

618/256i-3327.

.MACULIEWICZ, JudithHealth Occupations Education

I tructorStevens High SchoolClaremont, New Hampshire.03743542-9562'

MARCO /A Elbert M.Director, Healthy Occupations,.

EducationTexas Education Agency101 East Eleventh StreetAustin, Texas 78701512/475-4796 or 475-2294

MASSEY, Eileen C.: .

CobidinatorMedical Office.Assistant Program

Lane Community College389 Brookside DriveEugene., Oregon 97405503/747-4501, X-266 .

it 'MATTHEWS, Eloise .,. Supervisor, 411ealth Occupalions

Education207 Cordell Hull BuildingDivision of Vocational-ti4chnical

EducationProgram' Planning and EvaluationNashville, Tennessee, 37219615/741-1931

\ 11' .1-arc:AD, rarritos* 4 .

DIFector, Governor's Commission toStudy Nursing in lowa

Oakdale CarrippsThe University of Iowalova City, Iowa 5319/353.696'7

MILLER; Ethel G.Curriculum* Specialis Health '

OccupationsBroWard County, Schools-§27 SW -10th AyenueFort Lauderdale, Florida 33312305/521-6387 .

A

,

MUCCIARONi, Joari M.Instructor, Health OccupatiOnsAtlantic Co: Niocational--WhnicalSurrogate BuildingMays Landing, New Jersey 083306091345-043.8

4

°ANO, Keijo G.Director, Health Occupations,

Education . .

Departmentof EducationCapitol Building,

Cheyenne, Wyoming 82002..307/777-7411 .

, .

OVESTREET, LeroyDirector, Allied Health Education100 North University DriveCentral State' University

'Edmond,: Oklahoma 78034405/341-980 ''

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1

PATT1SON,' JoyceEducation Coordinator CLA SchoOlSt. Vincent Infirmary,Markham andiUniversityLittle Rock, Arkansas 722055011661-3774 r

. .

PETERS,H. IreneConsultant,,Health,:pccupations

Education :

Division of Vocational-TechnicalEducation

1105- LoUdon RoaditConcord, New Hambsitire 03301603/271 -2662 . .PIERCE, William M.PresidevOwner

. 7201. CiAnalfhe venue-Okla1 ma.City,..0kJahoma .70132.

P ITTMAN, Mildred/M.,Education Professions Development

Act Awardee; student at .

Oklahoma Stare Oniversit .

Route 4, Box 32Choctaw, Oklahoma 730,20405/763-2736

PRANGE, MaryAsiociate Coordinator of Health

OccupationsNortheast Wisconsin Technical

Institiite2740 Wk Masontreen Bay, Wisainsin 54302

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, RAYNOR, Nancy L.Chielcori'sultant of Health

Ociupations Education5S4 Education BuildingRaleigh, North Carolina 276 141v9191829..7970

-,

REDFOIW, 'leaflet ieAssoc is Pi 9.1,,css, n Walt

Ockupaiions Education--I eac her Education.

School of EducationUnix ersity or Alabama,Birmingham, Alabama 3S486

RODRIGUEZ, Inga R.Director, Health OccupationsDepaiiment,ot EducatiohP 0 Box 759Hato, Rey, Ifverto Rico 60914765-9505

ROGERS, Helen-V.Cum( ulum SpeCialistState Department of Vocational

le.chnical EducationCurriculum and Instructimpl

Materials Center1515 West 6Stillwater,. Oklahoma .74074

ROSENBARGER, MaxineAssociate Professor,

Occupational EducationTechnology BuildingSouthern 11ligois University

ar#10ondale, Illinois 62901618,536-2381 .'RUFF, Rita M.Coordinator, Regional OperationsKansas 1,4rgional M,eqical Progiam

. 4125 Rainbow , y I bkKan,as;Qty, Kansas 66103

SANcis, William F.Program Officer, United States Office s'

of Ed"ucatiiiry Department of Health,Education and Welfire,'Regiori VI

* I t14 Commerce StreetDallas, Texas 752022141749-2341 pr 749-2405'

rSAUNDERS, F. GleeProgram SpecialistU U

,nited States Office of Education,. .Bureau 'of Adult Education ,"'

01

Room 5122 Regional Operations Bureau 30

_Washington, District of Columbia *20202

202/245-9814

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SCHLOMER, Camilla R.Consultant, Health Occupations

EducationWisconsin Board bf Vocational,

Techniedl and Adult EducAon4802Sheboygan Avenue'HFSOB Seventh Floor'Madison,. Wisconsin '53702

SEIBERT, Mary Lee -

Director, Bachelor of Science PrsogAmin Health Occupations Education

Indian' University Medical CenterAllied Y,lealth Building, Room N228.1100 West Mrchigah StreetIndiarwolic, Indiana 46202317/264-8602

SHE ERD, Norma A.' ,

Health Occupations InstructOr4525 S ,165Beaverto , Oregon 97005

tty leanHealth Occupations

'SMITH, BSupervisor,

EducationDepartment t Education B-237

'1900 Washing on Street, EastCharleston, W st Virginia 2531 1304/348-2389.

SMITH, Viviar7 rAdjunet4ssoci te Iltottes6or,,

Allied HattilducationUniversity_ of Oklahoma

'College of Health and AlliedHealth

Oklahoma City, Oklahoma 73190*STARRETT, Marcia R.

- Director of Nurses'Western Nevada Community College14815 Echo Avenue ".Reno, Nevada 89506702i97207`01 .

*-1".

1.

44:444")- es24- 11

C

_.-"l .5

1.11-113 93 ,

.

TALKINGTON, Donna' R.Research AssistantSocithern 'Illinois University,

School of MedicineRoute .1, Box 161Carbondale; Illinois ,629016181457-488.2

THOMAS, MarianState;' Supervisor, Health

Occupations EducationDivision 01 Vocational Technical' ,

EducationState Department of Education

me Fe, New Mexico 87501.

THOMA5, Marilyn M.Director of Nursing EducationFort Scott- Community Junior

.Cpllege2108 South HoltonFort Scott; Kansas 66701316'22 3-2700

THQMPK1NS, Patricia A., .

Supervising Director, HealthOccupations Education .

'Division of Career Development'Programs

District of Columbia PublitSchools

77(r Kenyon) St reet NWWashington, District of Ccilumbra*.20010402491-3709

TRACY;iKeithSupervisor anti Specialist; Health

Occupations Education1400 Univeisity.Club Building

' 1 3h East Sbuth TAnpleSalt Lake City, Utah 84111801'328-8 371 .

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WALKER, Sacidri'lkHealth Occupations DirectorGrants Pass High School522 North East OliveGiants Pass, Oregpn 97526503121799382 .

WEISS, ScisanDirector of InformationAssociation j)f Schools of Allied -

Health ProfessionsOne DCipont Circle, NW, uife 30Q-Washingtonyistrict of Col nibia -

'20036202124W-4422

'WILLIAMS, Romona P.Health Career CoordinatorJefferson high School `s\2906 Spring RoadRoanoke, Virginia 24015703(.774-6568

WITMAN, Karl .Associate SupervisorBureau of Health Occupations4thicationNew York State Department of education99 Washington Avenue .

Albany, New York 122105181474-1711

WRIGHT, .Robert E.Nursing .Editor

- --W: B. Saunders CompanyWest Washington Square.Philadelphia, Tennsylvania 19106

'YOUNG, La VeFne.-M. N.

.Cocirdinalr, Allied Health OccupationsLararpie County Community. College1400 - East College DriveCheyenne, Wyoming 82001 .

307/634-5813 "

I.