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NOTE: The minutes of the 1977 meeting of theAAMC Assembly will be published in a subsequentissue.

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Table of Contents

Annual Meeting

Plena!'Y' Sessions ................•......•...........•....•............•233CouncllofI>eans ..•.••••.....•.•.•...•••••••...••.•...•••••••..••••••233Council of Academic Societies ••••••••••••••••••••••••••••••••••••••••••233Council of Teaching Hospitals ••••••••••••••••••••••••••••••••••••••••••233COD/CAS/COTH Joint Program •••••••••••••••••••••••••••••••••••••••233COD/COTH Joint Program ••••••••••••••••••••••••••••••••••••••••••••234Organization of Student Representatives •••••••••••••••••••••••••••••••••234Minority Affairs Program 235Women in Medicine 235Group on Medical Education ••••••••••••••••••••••••••••••••••••••••••• 235Group on Business Affairs 237Group on Public Relations 237GME Continuing Medical Education Program ••••••••••••••••••••••••••••238GSA/GME Joint Program •••••••••••••••••••••••••••••••••••••••••••••238Planning Coordinators' Group ••••••••••••••••••••••••••••••••••••••••••238Research in Medical Education •••••••••••••••••••••••••••••••••••••••••238

Annual Report

Message from the President 245The Councils 248National Policy 255Working with Other Organizations •••••••••••••••••••••••••••••••••••••• 259Education 262Biomedical Research 265Health Care •••••••••••••••••••••••••••••••••••••••••••••••••••••••••• 267Faculty 269Students 271Institutional Development 274Teaching Hospitals 276Communications 278Information Systems •••••••••••••••••••••••••••••••••••••••••••••••••• 279AAMC Membership 281Treasurer's Report 281AAMC Committees, 1976-77 •••••••••••••••••••••••••••••••••••••••••• 283AAMC Staff', 1976-77 288

232

The Eighty-Eighth Annual Meeting

Washington Hilton Hotel, Washington, D.C., November 5-10,1977

Theme: Graduate Medical Education: Critical Issues for the Eighties

NovemberS

COD/CAS/COTHJOINT PROGRAM

November 7

COUNCIL OF TEACHING HOSPITALS

The Food and Drug Administration and theAcademic Medical CenterDonald Kennedy, Ph.D.

Business Meeting

Presiding: David D. Thompson, M.D.

General Session

Presiding: David L. Everhart

PHYSICIAN RESPONSIBILITY AND ACCOUNTABILITY

FOR CONTROLLING THE DEMAND FOR HOSPITAL

SERVICES

As Viewed By the Department ChairmanRobert G. Petersdorf, M.D.

As Viewed By a Dean Turned ChiefExecutiveOfficerJ. Robert Buchanan, M.D.

As Viewed By the Hospital D,rectorRobert M. Heyssel, M.D .

CHALLENGES IN GRADUATE MEDICAL EDUCATION

SESSION I

TRANSITION BETWEEN UNDERGRADUATE AND

GRADUATE MEDICAL EDUCATION

Moderator: Julius R. Krevans, M.D.

The Transition to Graduate Medical Educa­tion-A Student's Point ofView

233

Program Outlines

PLENARY SESSIONS

PRESENTATION OF AWARDS

NovemberS

November 7

November 7

COUNCIL OF ACADEMIC SOCIETIES

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

Chairman's AddressIvan L. Bennett, Jr., M.D.

November 7

Presiding: Robert G. Petersdorf, M.D.

Historical Development of Specialization andGraduate Medical EducationRosemary Stevens, Ph.D.

The Hospital/Medical School PartnershipRobert A. Derzon

Options for Financing Graduate Medical Ed­ucationJames Kelly, Ph.D.ALAN GREGG MEMORIAL LECTURE:

The Education ofthe PhysicianDonald W. Seldin, M.D.

Business Meeting

Chairman: Julius R. Krevans, M.D.

Business Meeting

Chairman: A. Jay Bollet, M.D.

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§ COUNCIL OF DEANS<.l:1

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234 Journal of Medical Education

Thomas A. Rado, M.D., Ph.D.

The Readiness of New M.D. Graduates toEnter Their GME-I YearBarbara Korsch, M.D.

The Search for a Broad First YearWilliam Hamilton, M.D.

SESSION II

QUALIlY OF GRADUATE MEDICAL EDUCATION

Moderator: A. Jay Bollet, M.D.

The Evaluation ofResidents' PerformanceJohn A. Benson, Jr., M.D.

Supervisory RelationshIps in Graduate Medi­cal EducationWilliam P. Homan, M.D.

The Program Director's ResponsibilityThomas K. Oliver, Jr., M.D.

November 9

SESSION III

INFLUENCING SPECIALTY DISTRIBUTION THROUGH

GRADUATE MEDICAL EDUCATION

Moderator: Richard Janeway, M.D.

The Coordinating Council on Medical Educa­tion Should Participate with the Federal Gov­ernment to Regulate Opportunities for Spe­cialty TrainingJohn C. Beck, M.D.

The Private Sector Should A void Participatmgwith the Federal GovernmentC. Rollins Hanlon, M.D.

SESSION IV

INSTITUTIONAL RESPONSIBILIlY FOR GRADUATE

MEDICAL EDUCATION-THE MCGAW MEDICAL

CENTER OF NORTHWESTERN UNIVERSIlY EXPERI­

ENCE

Moderator: J. Robert Buchanan, M.D.

The Concept and its DevelopmentJames Eckenhoff, M.D.

How it OperatesJacob Suker, M.D.

How It Affects the Program DirectorLee F. Rogers, M.D.

Its Impact on the Teaching HospitalDavid L. Everhart

VOL. 53, MARCH 1978

COD/COTH JOINT PROGRAM

November 6

ANALYZING THE VETERANS ADMINISTRATION/

MEDICAL SCHOOL RELATIONSHIP

Moderator: John A. D. Cooper, M.D.

A View From the General Accounting OfficeMurray Grant, M.D.

A View From the National Academy of Sci­ences StudySaul J. Farber, M.D.

The Veterans Administration PerspectiveJohn D. Chase, M.D.

ORGANIZATION OF STUDENTREPRESENTATIVES

NovemberS

Regional MeetingsDiscussion Sessions:

Student Financial AidHealth LegislationCareer CounselingCurriculum and Evaluation

Business Meeting

November 6

Discussion Sessions:Health LegislationNational Intern and Resident

Matching ProgramWithholding of Physician ServicesMinority Affairs

Discussion Sessions:Student Financial AidMedical School AccreditationMinority Admissions Programs-

Legal ChallengesWomen in Medicine

Business Meeting

Regional Meetings

November 7

IS HOUSESTAFF UNIONIZATION UNDER THE RULES

OF THE NATIONAL LABOR RELATIONS ACT AN

APPROPRIATE AND DESIRABLE MEANS FOR HOUSE­

STAFF TO ACHIEVE PATIENT CARE AND EDUCA­

TIONAL PROGRAM IMPROVEMENTS?

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1977 AAMC Annual Meeting

Moderator: Thomas A. Rado, M.D., Ph.D.

Introduction and OverviewRichard M. Knapp, Ph.D.

The Case for UnionizationRalph M. Stanifer, M.D.

The Case Against UnionizationSandra Foote, M.D.

Panel: Cheryl GutmannWilliam H. Luginbuhl, M.D.Alvin Tarlov, M.D.

November 7

Discussion Sessions:

MEN IN MEDICINE

Robert JaffeTerry S. Stein, M.D.

ENHANCING MEDICAL STUDENTS' MENTAL HEALTH

Dale Garell, M.D.Patrick Tokarz, M.D.

Discussion Sessions:

ALTERNATIVES TO TRADITIONALLY SCHEDULED

RESIDENCIES

Moderator: Eileen Shapiro

Panel: Kenneth Rowe, M.D.Jo Bouffard, M.D.Ron Sable, M.D.Naomi Kistin, M.D.Shirley G. Driscoll, M.D.Marcia LaneStuart H. Shapiro, M.D.

THE GAY PATIENT AND PROVIDER IN A STRAIGHT

HEALTH CARE SYSTEM

Paul A. Paroski, Jr.Janet O. Yardley

MINORITY AFFAIRS PROGRAM

November 8

MINORITIES IN MEDICINE: FROM RECEPTIVE PAS­

SIVITY TO POSITIVE ACTION, 1966-76

Presiding: Dario O. Prieto

IntroductionJohn A. D. Cooper, M.D.

Keynote AddressCharles E. Odegaard, Ph.D.

235

WOMEN IN MEDICINE

November 7

WOMEN IN MEDICINE: ASSESSING THEIR IMPACT

Moderator: Judith B. Braslow

Women in Medicine: An OverviewEstelle Ramey, Ph.D.

Current Status ofWomen III MedIcineMarilyn Heins, M.D.

Traditional Residency Training: The Impacton Personal and Career DecIsionsBarbara A. Korsch, M.D.

The Impact on Hospital Planning

Mitchell Rabkin, M.D.

The Impact on Academic MedicineRosalyn Yalow, Ph.D.

Discussant

Eli Ginzberg, Ph.D.

GROUP ON MEDICAL EDUCATION

November 7

Plenary Session

STUDENT PROMOTION AND DISMISSAL: JUDICIAL

INCURSION IN THE EDUCATIONAL PROCESS

IntroductionRobert A. Barbee, M.D.

Student Rights, the SOCIetal Expectations andInstitutional Responsibility: The JudiCial ViewHonorable Harold H. Greene

Student Rights, the Societal Expectations andInstitutional ResponsibIlity: The InstitutionalViewCarl F. Hinz, M.D.

Panel: Redefinition of Due Process in the EraofJudicial InvolvementMurray Kappelman, M.D.Redefinition of Competence- TheNeed for Valid Educational CriteriaChristine McGuireRedefinition of the Faculty Role in theEducational ProcessVincent A. Fulginiti, M.D.

Regional Meetings

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236 Journal of Medical Education

NovemberS

INTRODUCTION TO CLINICAL MEDICINE

General Session

PHYSICAL DIAGNOSIS: THE STATE OF THE ART

IntroductionRobert A. Barbee, M.D.

Bedside Physical DiagnosisW. Proctor Harvey, M.D.

Simulation TechniquesHoward S. Barrows, M.D.Robyn Tamblyn, R.N.

Teaching Interviewing Skills-An OverviewRay E. Helfer, M.D.

INTRODUCTION TO CLINICAL MEDICINE

Small Group Discussions

Moderator: Dennis O'Leary, M.D.Recorder: Peter Tuteur, M.D.

Moderator: Jerome Berman, M.D.Recorder: H. Verdain Barnes, M.D.

Novemher9

Business Meeting

Small Group Discussions

Primary Care Residencies: Competencies aCurriculum Should Address

Moderator: Richard Reynolds, M.D.

The House Officer as Teacher

Moderator: Russell R. Moores, M.D.

Strategies and Assessment in Medical FacultyDevelopment

Moderator: James W. Lea, Ph.D.

Evaluation and Grading ofMedical Students

Moderator: Winfield H. Scott, Ph.D.

How to Use Audit for Continuing EducationPlanning

Moderator: David Walthall, M.D.

The Current Status and Potential ofInterinsti­tutional Learning Resources Development

Moderator: Robert G. Crounse, M.D.

INTRODUCTION TO CLINICAL MEDICINE POSTER

SESSIONS

Kodachrome MicroficheRobert Hillman, M.D.

VOL. 53, MARCH 1978

The Use ofVideo-Tape to Teach InterpersonalSkillsGary Kahn, M.D.

Results of a Nationwide Survey of ICMCoursesPeter Tuteur, M.D.

Integration of Interviewing and Physical Ex­amination SkillsJerry May, Ph.D., et al.

A Medical Interview GlossaryJerry May, Ph.D., et al.

Student Faculty Interpersonal RelationshipWorkshopJerry May, Ph.D., et al.

Evaluation ofStudent CompetencyLawrence Tremonti, M.D.

Program EvaluationLawrence Tremonti, M.D.

Evaluation ofPhysical Examination SkillsRobert Petzel, M.D., et al.

ICM CourseDonald MacKay, M.D.

Outline of ICM Course-Clinical SkillsA. David Ginsburg, M.D.

Medical Student Reading Ability: Assessment,Application to Course Requirements, Improv­ing Reading EffectivenessH. Verdain Barnes, M.D., et al.

Learning to Perform the Female Pelvic Exam­inationRobert A. Munsick, M.D.William Pond

Introduction to Patient EvaluationHarold Levine

The Physical ExaminationDavid M. Klachko, M.D.

A Technique for Establishing and AssuringStudent CompetencyFrederick Holmes, M.D.

ICM-A Continuity Program for Years Oneand TwoHelen Kornreich, M.D., et al.

"Harvey" -A Cardiology Patient SimulatorMichael Gordon, M.D.

Examination of the Personality-A UniqueLearning Package

Moderator: David A. Sinclair

GROUP ON BUSINESS AFFAIRS

PARTNERSHIP WITH THE GOVERNMENT

Moderator: Jerry E. Huddleston

Federal V,ew-Past, Present and FutureRobert F. Knouss, M.D.

State View - Expansion or RetrenchmentRichard D. Ruppert, M.D.

Institution View- Benefits and CommitmentsGeorge M. Norwood

GROUP ON PUBLIC RELATIONS

237

Thomas A. Rolinson

Prospects for Future Congressional Legislationand National Health InsuranceMarc Ash

AUGUSTUS J. CARROLL MEMORIAL LECTURE

Joseph A. Diana

Busmess Meeting

November 6

November 7

PresIding: J. Michael Mattsson

PUBLIC RELATIONS RESPONSE TO SPECIAL PROB­

LEMS

Presiding: Barbara Austin

Senator Hubert Humphrey's OperationT. Gerald Delaney

Reactor Panel: Barbara J. CullitonVictor Cohn

George Washington University MedIcal Centerand the Hanafi MuslimsPatricia Hurley

Gary Gilmore and The Umversity of UtahMedical CenterJohn J. Keahey

November 8

Presidmg: Hugh Harelson

Awards PresentationsRobert G. Petersdorf, M.D.

Guest SpeakerMerlin K. DuVal, M.D.

LIVING WITH FEDERAL LAWS AND REGULATIONS

Presiding: Susan K. Stuart-Otto

Teaching Hospital Viewpomt

COST CONTAINMENT IN THE HEALTH CARE

INDUSTRY

1977 AAMC Annual Meeting

Nancy A. Roeske, M.D.

The Use of Practical Instructors to Teach andEvaluate Physical Diagnosis SkillsPaula L. Stillman, M.D., et al.

The Use of Practical Instructors to Teach theNeurological ExaminationJose Laguna, M.D., et al.

Teaching Strategies for Interviewing Skills inIntroduction to MedicineJerome Berman, M.D., et al.

Evaluation Techmque ofStudents' Progress inPhysical DiagnosisJerome Berman, M.D., et al.

An Experimental Physical DIagnosis in AnOut-Patient SettingThomas McGlynn, M.D., et al.

Teaching the Gynecologic ExaminationLeonard Aaro, M.D.

Teaching Physical Diagnosis SkillsBruce Bucher, M.D.

Teaching Interviewing SkillsBruce Bucher, M.D.

§ Federal Prospects for the Futurer.l:1 Various State Rate-Setting Schemes as Demon-~ stration Projects by the Department of Health,a Education, and Welfare8 Fred Hellingero

Q A State's Approach to Health Care Cost Re-ductionsBernard Forand

Effects of Containment PoliCIes on PatientCare and the Teachmg Hospital ServicesLawrence A. Hill

Effects of Cost Containment on Medical Edu­cation

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~ November 10

~ Faculty Development Survey<l) Hilliard Jason, M.D.

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238 Journal of Medical Education

Sidney Lewine

Medical School ViewpointArthur H. Keeney, M.D.

Reactor Panel: Judith RobinsonStephan E. Lawton

November 9

Business Meeting

Presiding: Terry R. Barton

Special Project Awards Presentation

Presiding: Harold E. Kranz, Jr.

Total Program Awards Presentation

Presiding: Harold E. Kranz, Jr.

GME CONTINUING MEDICALEDUCATION PROGRAM

November 8

PREPARATION FOR SELF-DIRECTED LEARNING AS

AN ELEMENT OF OPTIMUM PHYSICIAN PERFOR­

MANCE

Moderator: David Walthall, M.D.

Intrinsic Motivation and SelfDirected Learn­ingMerrel D. Flair, Ph.D.

Management and Evaluation as Tools ofSelfDirected LearningHarold G. Levine

Quality of Care and Patient Outcomes asMechamsms to Determine Educational NeedsJohn Williamson, M.D.

The Practicality ofApplying These Principlesto the Clmical Learning SituqtionRobert C. Davidson, M.D.

GSA/GME JOINT PROGRAM

November 10

EVALUATION FOR ADVANCED PLACEMENT

Moderator: Martin S. Begun

Federal Regulations and PerspectivesRobert Knouss, M.D.

Institutional Experience and PerspectivesJoseph P. Tassoni, Ph.D.Marvin R. Dunn, M.D.

VOL. 53, MARCH 1978

Panel Discussion

PLANNING COORDINATORS' GROUP

November 6

INTERNAL INSTITUTIONAL RELATIONSHIPS AND

THEIR EFFECT ON THE PLANNING PROCESS: A

LOOK AT THE 1980s

Moderator: Howard J. Barnhard, M.D.

The President's PerspectiveRobert Q. Marston, M.D.

The Chancellor's PerspectiveJames L. Dennis, M.D.

The Dean's Perspective.Robert L. Van Citters, M.D.

The Planning Coordinator's ResponseRuth H. HaynorMichael T. Romano, D.D.S.

RESEARCH IN MEDICAL EDUCATIONSIXTEENTH ANNUAL CONFERENCE

November 9

POSTER SESSIONS

Interpersonal Problem Solving: A TheoreticalPerspective and Methodology for the Evalua­tion of Residency Education and Its Relation­ship to Health Care Processes and OutcomesM. J. Hogan, et al.

Assessing Student Response to Participation ina Simulated Malpractice Trial in a Program ofLaw in MedicineLinda Coulter, et al.

Toward a Comprehensive Methodology forResident EvaluationR. Gallagher, Ph.D., et al.

An Assessment ofthe Effectiveness ofPLATOBasic Medical Science LessonsDiane L. Essex, Ph.D., et al.

PRESENTATION OF PAPERS

OBSERVATIONS IN CLINICAL INSTRUCTION

Moderator: A.M. Bryans, M.D.

Student/Patient Contact-Do the PatientsMind?Ralph R. Hadac, et al.

Moderator: D. Kay Clawson. M.D:

The Evaluation ofTeachl1lg Effectiveness: TheMyths About Student RatingsHoward L. Stone, et al.

Cll1lical Teacher Effectiveness in MedicineDavid M. Irby, Ph.D.

The DIffUSIOn of SelfInstructIOnal UnitsAmong MedIcal School Faculty MembersCharles P. Friedman, Ph.D.

Factors Affecting Time Allocations of Teach­Ing PhySIcians

and Validity of Complex Multiple Choice,Multiple Response and Multiple True-FalseItemsMark A. Albanese, et al.

An Investigation of Three Types of MultipleChoice QuestionsErnest N. Skakun, et al.

The Effect of Open versus Closed-Book Test­ing Conditions Upon Performance on a Mul­tiple-Choice Examination in PediatricsCharles F. Schumacher. Ph.D., et al.

A Study ofthe Applicability ofa Truly Objec­tive Measurement Model in Medical EducationGilles Cormier, M.D .• Ph.D.

MULTIDIMENSIONAL EVALUATION OF CLINICAL

COMPETENCE

Moderator: Sarah M. Dmham, Ph.D.

Assessment of Cognitive and InterpersonalSkills in Clinical Problem-Solving - A Com­parISon Between CertificatIOn Examinationand Formative EvaluatIOnJ. G. Wakefield, M.D., et al.

Validation of a CardIOlogy SubspeCialty Ex­amination by Faculty Ratl1lgs of Competen­cies: A Multivariate ApproachJohn A. Meskauskas

Use of an Oral Exam in an Internal MedIcineClerkshipJohn H. Littlefield, Ph.D .• et al.

Consistency in Ratings of Clinical Perfor­mance ofthe Same Students Throughout Med­Ical School and InternshIpSandra L. Lass, et al.

ISSUES IN FACULTY DEVELOPMENT/EVALUA­

TION

239

Moderator: Michael J. Gordon, Ph.D.

MULTIPLE CHOICE TESTING

Moderator: Harold G. Levine

A Comparison of the Difficulty, Reliability

1977 AAMC Annual Meeting

Death Education in Selected Medical Schoolsas Related to Physicians' Attitudes and Reac­tions Toward Dying PatientsGeorge E. Dickinson, Ph.D., et al.

Teaching the Psychiatric Aspects of Medicine:::: Report ofa SuccessfUl Pilot Experience:2 David H. Rosen, M.D., et al.rJ)

;!.1 Evaluation of the Community Phase of a Re-B glOnalized Medical Education Program8, Mabel L. Y. Moy, Ph.D., et al.

INNOVATIONS IN CLINICAL INSTRUCTION

~ Moderator: Richard M. Caplan, M.D.oB Perceived Abtlity Versus Actual Ability: A~ Problem for Continuing Medical Education"0 Armin D. Weinberg, Ph.D., et al.u

] The Development of a Medical Record Audit...... for Continuing Medical Education§ Vivian Erviti, Ph.D., et al.

<.l:1 Changes in Physician Referral Patterns as a1:! Result ofContinuing Education(1)a J. Maurice Mahan, Ph.D., et al.

8 The Effects ofa Geographic Continuing Edu­8 cation Program on Physician Referral Behav­ior: An Unobtrusive StudyCharles H. Christiansen, et al.

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..s::......<0 CONTINUING MEDICAL EDUCATION

Senior Medical Students as Patient-PreceptorsIntroduce Basic History and Physical ExamI­nation Skills to Second Year Medical StudentsH. Verdain Barnes, M.D., et al.

The Nurse Practitioner as a Teacher of Physi­cal Examination SkillsPaula L. Stillman, M.D., et al.

The Effectiveness of Pediatric Nurse Associ­ates as Teachers of Medical Students In Am­bulatory Settings

U Helen Johnson, M.D., et aI.

::§ A Modified, Personalized System ofEducation~ for Junior Internal Medicine Clerkship at a

Multi-Campused SchoolRobert Talley, M.D., et al.

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240 Journal of Medical Education

Sunny G. Yoder, et aI.

PRESENTATION OF SYMPOSIA

FACULTY DEVELOPMENT IN CLINICAL TEACHING

Organizer· JosephIne M. CassIe

Chariman: George F. N. Collins, M.B.

ParticIpants: C. Benjamin Meleca, Ph.D.Josephine M. CassieFrank T. Stntter, Ph.D.

Discussant: Hilliard Jason, M.D.

METHODS AND RESULTS IN FOUR STATISTICALLY­

EVALUATED ALTERNATIVE APPROACHES TO

TEACHING OF MEDICAL GROSS ANATOMY

Organizer: Weston D. Gardner, M.D.

PartIcipants: Paul H. JonesDavid G. WhitlockShIrley A. GIlmoreJohn E. PaulyNorbert A. JonesJerome SutinWeston D. GardnerF. David Anderson

STUDIES OF THE CLINICAL REASONING PROCESS

OF MEDICAL STUDENTS AND PHYSICIANS

Organizer: Howard S. Barrows, M.D.

PartIcipants: Geoffrey Norman, Ph.D.Victor Neufeld, M.D.John Feightner, M.D.

Discussants· Arthur S. ElsteIn, Ph.D.Bert Sandok, M.D.

ALTERNATIVE MECHANISMS TO ASSESS EDUCA­

TIONAL NEEDS IN CONTINUING MEDICAL EDU­

CATION

Organizer: Floyd Pennington, Ph.D.

Participants: Floyd Pennington, Ph.D.Paul E. MazmanianJoseph S. Green, Ph.D.Patnck L. WalshThomas C. Meyer, M.D.

November 10

PRESENTATION OF PAPERS

ASSESSMENT OF NONCOGNITIVE CHARACTERIS­

TICS

Moderator: Barbara Andrew, Ph.D.

VOL. 53, MARCH 1978

AcademIC and Personal Characteristics as Pre­dictors of Clinical Success in Medical SchoolRobert Murden, et aI.

The Measurement ofAffective Sensitivity: TheDevelopment ofan InstrumentDonald W. Werner, et aI.

Learning Style and Instructional PreferencesofFamily PhysiciansMarcia A. Whitney, et al.

A Theoretical and Practical Approach to Eval­uating Clinical SkillsEdward Schor, et aI.

CAREER CHOICE AND PRACTICE STYLES

Moderator: Jo Boufford, M.D.

Recruitment Strategies in the Health Profes­sionsEleanor G. Feldbaum, Ph.D.

Medical Speczalty Choice: Replicatlons andExtensIOnsLarry A. Sachs

Factors Influencing Internship/Residency andPractice Locations: Implications for PublicPoliCYHoward L. Stone, Ph.D., et aI.

Styles of Practice ofFemale PhysiciansBetty Hosmer Mawardi, Ph.D.

CLINICAL PROGRAM EVALUATION

Moderator: James V. Griesen, Ph.D.

Problem Solvers or Medical Dictionaries:What Are We Teaching For?Richard Foley, Ph.D., et aI.

A Comparison of Primary Care EducationalExperiences In Two Urban Pediatric Settings,Robert M. Politzer, Sc.D., et aI.

An Internal Review of a Residency TrainingProgramCarole J. Bland, Ph.D., et aI.

Costs ofEducating Child Health AssociatesJohn E. Ott, M.D., et aI.

ISSUES IN SELECTION

Moderator: Howard Teitelbaum, Ph.D.

Experiment in an Early AdmiSSIOns Programat the University of Utah College of MedicineThomas W. Cockayne, Ph.D., et aI.

1977 AAMC Annual Meeting

A Statistical Procedure for Predicting MedicalSchool Graduates' Specialty ChoicesDavid R. McLean, et al.

Do Admission Decisions Predict PerformanceDuring Medical School? A Comparison ofOne Medical School's Rejected and AcceptedAppllcants Who Attended Other SchoolsRobert M. Milstein, et al.

::: The Choice ofRural Practice: A Longitudinal:2 ViewrJ)

rJ) Susan Elder, et al.§(1)

0..

"5o..s:: CURRICULUM DEVELOPMENT AND EVALUATION

~ Moderator: Gary M. Arsham, M.D., Ph.D."'d~ A Monitor for the Medical Curriculum

..§ Robert G. Bridgham, Ed.D.

e Predictors of Impact of a Minorzty Program15' Upon a Medical School\-;

(1) George M. Neely, Ph.D., et al..Do The Development and Use ofa Comprehensive~ Test for Evaluating Decentralized Medical Ed­Z ucation-the WAMI Experience

Thomas J. Cullen, Ph.D., et al.

u~ Educational Objectives in Rheumatology forMedical StudentsThomas W. Cockayne, Ph.D., et al.

~ PATIENT MANAGEMENT PROBLEMS......'0 Moderator: Gordon Page, Ed.D.

~ Reliability and Validity ofSimulated Problemso as Measures of Change In Problem-SolvingB Skills~ Sereta A. RobInson, et al.oU Measuring the Outcome of Cllmcal Problem-~ SolvingaG. R. Norman, Ph.D., et al.

eAn AnalysIS of the Problem-Solving Process': of Third-Year Medical Students~ Edetll E. Ekwo, M.D.

§ Clinical Problem Solving: The RelatIOnship ofg Cognitive Abilities to PMP PerformanceQ

241

Martin J. Hogan, et al.

PRESENTATION OF SYMPOSIA

MEDICAL PROBLEM SOLVING: CAN IT BE

TAUGHT?

Organizer: Eta S. Berner, Ed.D.

Chairman: Chnstine McGUIre

Participants: E. FeinsteinH. G. LevineHoward Barrows, MD.Robyn TamblynSarah Sprafka, Ph.D.Arthur Elstein, Ph.D.Eta S. Berner, Ed.D.Lawrence P. Tremonti, M.D.

SUMMER PREPARATORY PROGRAMS FOR MINORITY

STUDENTS

Organizer: Paul S. Rosenfeld, M.D.Participants: William Wallace, Ph.D .

Anthony Clemendor, M.D.A. C. AtenCIO, Ph.D.F. Marvm Hannah, Sr.

CAREER PLANNING IN MEDICAL SCHOOL. PROC­

ESS AND APPROACHES

Orgamzer: George H. Zimny, Ph.D.

Chairman: Betty Hosmer Mawardl, Ph.D.

Participants: Edwin Hutchms, Ph.D .Thomas Brown, Ph.D.Bill D. Burr, M.D.George H. Zimny, Ph.DRosalia Paiva, Ph.D.Deane R. Doolen

THE WOMAN PHYSICIAN: RECENT RESEARCH PER­

SPECTIVES

Orgamzer: Dorothy Rosenthal Mandelbaum,Ph.D.

Participants: Judith B. BraslowElizabeth McAnarney, M.D.Mary Walsh, Ph.D.Dorothy RosenthalMandelbaum, Ph.D.

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:Message from the President

245

:::9~ John A. D. Cooper, M.D.E(1)

0..The past year has been one of high expecta­tions for the academic medical centers. It wasassumed by many that a new Administrationworking with a Congress dominated by mem­bers of the same party would bring normalcyback to the government and, acting together,they would undertake thoughtful and con­structive initiatives to get the nation movingagain. There was hope that we would bespared the enervating battles of the past fewyears and be able to reestablish the privatesector-government relationships that strength­ened medical education, biomedical researchand medical services so dramatically in the

U 1950s and early 1960s.::§ These expectations have not yet been met.~ The President and the large staff of Georgians

he brought to Washington have largely been(1)':5 occupied during the first nine months in office

....... projecting the image of Jimmy Carter as a~ leader who will bring normalcy and respect§ back to the federal government. There hasB been little follow-up of campaign promises or~ development of explicit policies and specific"0 legislation. The White House has had to~ learn, often the hard way, how to operate on

':5 the Washington scene and establish construc­S tive relationships with the Congress. Theo wholesale removal of key agency heads in the

<.l:1 Department of Health, Education, and WeI­~ fare before Inauguration Day and the delayS in replacing them and in appomting an Assist­8 ant Secretary for Health have exacted theiro toll on programs vital to the academic medical

Q centers. It has been difficult for the bureau­cracy to understand and partiCIpate in Secre­tary Califano's unconventional style of man­agement. His sharp rhetonc has often createdheat rather than shed light on the subject. Asa consequence, we remain mostly m the darkon Administration policies on health matters.

At the President's request, the Congresspostponed substantive action on expiring leg­islation for the National Cancer Institute, theNational Heart, Lung, and Blood Instituteand the support of biomedical research train­ing. Thus, there has been no clear enunCIatIOnof policy on biomedical research and training.The fears engendered m a group of Universitypresidents who met with President Carter bythe questions he seemed to have about thevalue of basic research have been somewhatallayed by a clarification provided by FrankPress, the PreSIdent's science advisor.

While Administration policies on manyhealth issues remain a mystery, there hasbeen no equivocatIon on controllIng healthcare costs. Viewed as a necessary precursorto national health insurance, cost control ISthe Administration's number one pnorIty andonly real initiative to date in the health fIeld.In addition to emphasizing preventive medI­cine, education of the publIc, and the promo­tion of alternative delIvery systems, the Carterplan would impose a 9 percent cap on in­creases m hospItal expenditures. Agreementof the House and Senate on cost controllegislation may not be achieved before ad­journment, but it is almost certain to beenacted m some form dunng the next sessIonof Congress. The teaching hospitals face adifficult challenge in maintainmg their critIcalcontributions to education, research, and ser­vice undergrowmg governmental restrictIonsand regulation.

The long-awaited health manpower law, inmany respects infinitely better than earlIerbills conSIdered by the House and Senate,was seriously flawed by the now mfamous"USFMS proVIsion." While the schools wereunanimous in their opposition to ItS infringe­ment on the fundamental academIC declsion-

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246 Journal of Medical Education

making process, it was not clear how manyinstitutions would or could refuse to comply.Even less clear was how the program wouldoperate, if It could be administered at all.The confusion over the section was best sum­manzed by Federal District Court Judge Ed­ward Becker, who, in ruling against Guadala­jara students seeking enforcement of the pro­vision this year, called the law "far from amodel of lucidity."

The officers and Executive Council of theAssociation wrestled uncomfortably with thepolitical dilemma of seeking amendment ofthe law at the risk of gaining little or nothingwhile sacrificing other provisions. Whileworking to obtain legislative relief, we alsolabored hard to get regulations which wouldmake this program manageable and maximizeits acceptability to the schools. The Congresswas finally convinced to reexamine this sec­tion of the manpower law and to initiateconstructive amending legislation. But themedical schools may yet pay a price for thisactivity. With the law now reopened for

VOL. 53, MARCH 1978

amendment, Congressional reconsideration ofother capitation conditions has been promisedfor next year. It appears that we will haverolling legislation, subject to review andchange each year, providing little of the sta­bility for which we had hoped.

Despite these problems, there is somecause for advancing our great expectations tothe next year. Although we clearly cannotexpect a return to the climate of the Sixties,particularly where federal expenditures areconcerned, several of the Administration'sappointments in the health and science areasoffer hope for enlightened leadership in thefuture. If this leadership is assertive, perhapsthe Administration and Congress can beginto work more effectively with the privatesector in confronting the serious health prob­lems that face the nation. Given proper roles,the academic medical centers can participatein the development of solutions. Given inap­propriate roles, their ability to make uniquecontributions to society may be lost.

Administrative Boards of the Councils, 1976-77

Executive Council, 1976-77

• deceased•• Dr. Gronvall served as chairman from No­

vember 1975 until April 1977 when Dr. Krevansbecame chairman. Dr. Krevans will serve untilNovember 1978.

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

COUNCIL OF TEACHING HOSPITALS

David D. Thompson, chairmanDavid L. Everhart, chairman-electJohn W. CollotonJerome R. DolezalJames M. EnsignRobert M. HeysselBaldwin G. LamsonStuart MarylanderStanley R. NelsonMitchell T. RabkinMalcom RandaUJohn ReinertsenRobert E. ToomeyCharles B. WomerWilham T. Robinson, AHA representative

David L. EverhartRobert M. HeysselDavid D. ThompsonCharles B. Womer

COUNCIL OF TEACHING HOSPITALS

ORGANIZATION OF STUDENT

REPRESENTATTVES

Thomas A. Rado, chairpersonPaul Scoles, chairperson-electRobert BernsteinRobert H. CassellMargaret ChenJessica FewkesCheryl GutmannJames MaxwellRichard S. SeiglePeter ShieldsJon Christopher Webb

ORGANIZATION OF STUDENT

REPRESENTATIVES

Thomas A. RadoPaul Scoles

247

Ivan L. Bennett, Jr., chairmanRobert G. Petersdorf, chairman-electJohn A. D. Cooper, president

Council Representatives:

COUNCIL OF ACADEMIC SOCIETIES

DISTINGUISHED SERVICE MEMBER

Kenneth R. Crispell

COUNCIL OF ACADEMIC SOCIETIES

COUNCIL OF DEANS

Stuart BondurantJohn A. Gronvall

COUNCIL OF DEANS

John A. GronvaU"§ Julius R. Krevans··

<.l:1 Steven C. Beering1:! Stuart Bonduranta Christopher C. Fordham, III8 Neal L. Gault, Jr.o William H. Lunginbuhl

Q Clayton RichChandler A. Stetson·Robert L. Van Citters

A. Jay BoUet, chairmanU Robert M. Berne, chairman-elect

~F. Marion BishopEugene BraunwaldCarmine D. Clemente

~ G. W. N. Eggers, Jr..::: Daniel X. Freedmano Rolla B. Hill, Jr.~ Thomas K. Oliver, Jr.oB Roy C. Swan

Samuel O. Thier~"0 Leslie T. Websteru<l)

..s::......

:::9i2 Robert M. Berne§ A. Jay Bollet<l) Rolla B. Hill, Jr.0.. Thomas K. Oliver, Jr."5o..s::~'"d

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248

ao<.l:1

The Councils

Executive Council

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

The retreat of the elected officers andexecutive staff was held 10 December prior tothe first meeting of the Executive Council.The retreat participants reviewed the mem­bershIp structure of the Association, partIcu­larly ItS relationship to member institutionsand organizations representing universitypresidents and vice presidents for health af­faIrs. The retreat focused most of its attentionon major issues eIther of Immediate concernor whIch were expected to confront the Asso­cIatIOn within the coming year. Specificallydiscussed were national health insurance, ef­forts to amend the National Labor RelationsAct to cover housestaff, strengthening theOrgaOlzation of Student Representatives, andimplementation or possible modification ofthe new health manpower law.

At Its January meetlOg the ExecutiveCouncil reVIewed and approved the detailedreport of the Officers' Retreat. ExtensivediscussIOn on the health manpower law pro­duced agreement with the retreat recommen­dation that the Association not seek modifi­cation of the law. Although there was unani­mous agreement on the undesirability of thecontroversial USFMS provision, councilmembers felt that there was little chance formodification and that other parts of the newlaw should not be jeopardized. It was feltthat the potentially harmful effects of this

provision could be alleviated by implementingregulatIOns which were sensitIve to the pOSI­tion of the schools. The council asked theAAMC staff to work closely with HEW regu­lation writers in order to assure the smoothope!atlOn of this program.

Another provision of the new health man­power law came under close Executive Coun­cil scrutiny. New limitations on the grantingof visas to alien physicians were stronglysupported by the Executive Council. How­ever, council members supported a one-yearblanket waiver of the new law in order toallow the appropriate examinations to be putinto place. The Executive Council pressed forspeedy implementation of tht:se provisionsfollowing the one-year hiatus, while support­ing a narrow exception to allow distinguishedphysician visitors to enter the country.

Consistent WIth these new limitations onexchange VIsitors, the Executive Councilasked the Liaison Committee on Graduate.Medical Education to withdraw recognitIOnof ECFMG certification based upon passingthe ECFMG exammation and to require in­stead that all physicians educated in medicalschools not accredited by the Liaison Com­mittee on Medical Education be required tohave ECFMG certification based upon pass­ing Parts I & II of the National Board ofMedIcal Examiners examination or an equiv­alent examination prepared by the NBME inorder to be eligIble to enter accredited gradu­ate medical education programs in the UnitedStates.

The Executive Council continued its carefulperiodic review of the actions and activitiesof the Coordinating Council on Medical Edu­cation and the three accreditlOg liaison com­mittees. Of particular concern this year wasthe staff support provided by the AmericanMedical Association to the CCME and theLiaison Committee on Graduate Medical Ed­ucation. Although each of these groups has

249

Two major AAMC task forces appOintedduring the previous year presented Interimreports to the Council thiS year. The TaskForce on Student FinanCing, chaired by Dr.Bernard Nelson, analyzed the shortcomingsof current student financial aid programs andproposed a new federal Guaranteed StudentLoan Program which would have more sup­port from the banking community. The TaskForce on Minority Student Opportumtles inMedicine, chaired by Dr. George Lythcott,presented a series of recommendations onrecruitment, retention, counselling, and as­sessment of minority students. Final reportsfrom each of these task forces are expectedduring the coming year.

The Executive CounCil continued to enterImportant legal disputes where It felt that th<;issues before the court were of general andmajor concern to the medical schools andteaching hospitals. The ASSOCiation filed anamicus curiae brief in the United States Su­preme Court In the case of Regellls of theUniversity of Califorilla v. Bakke, asking thatthe court uphold the constitutionality of spe­cial minority admiSSIons programs In medicalschools. The ASSOCiation also filed an am/cllsbrief in the case of Koulllz v. State UllIversityof New York, asking the New York SuperiorCourt to reverse the lower court ruling thatthe school's faculty practice plan was an un­lawful confiscation of personal income. Atthe request of several New York hospitals.the Association fJled several briefs in NewYork state and federal courts urging that theNational Labor Relations Board had pre­empted state labor boards from taking jUris­diction over hospital/housestaff relations. Aruling by the United States Court of Appealsfor the Second Circuit agreed with the Asso­ciation's position.

The Executive CouncJl thiS year respondedto a request from the liaison Committee onSpecialty Boards for an Association positionon recognitIOn of emergency medicine as anew specialty. The Executive Council at firstagreed that the AssociatIon should take nosubstantive position on thiS question, Indicat­mg that these broad policy deCISions fallwithin the scope of review of the CCME. Thecouncil also asked that the petitionmg boardbe required to present a detailed statement of

AAMC Annual Report for 1977

discussed possible changes in staffing and itsImplication on the financing of the organiza­tions, no concrete proposals have yet beenadvanced. Staffing and financing of theLCGME, which now reviews the actions of

::: Residency Review Committees and accredits:2 all programs of graduate medical educationi2 in the United States, will continue to be a§ major issue in the coming year.<l) The Executive Council continued to review0..

all policy-related actions of the LCME, thisyear approving LCME GUidelines to theFunction and Structure of a Medical School.These guideHnes elaborate on the publishedaccreditation policy contained in the docu­ment "Function and Structure of a MedicalSchool," and are designed to assist site visitteams in evaluating the programs of an insti­tution. In response to a request from theOffice of Education and its Advisory Commit­tee, which reviews all federally recognizedaccrediting agencies, the Executive Councilagreed to reiterate its delegation to the LCMEof final authority on all accreditation deci­sions. The Executive Council also authorizedthe LCME to develop its own prospectivebudget, to establish formal criteria for theappointment of members, and to adopt Its

~ own operating procedures. The Executive...... Council reserved authority to grant final ap­4-<o proval to the establishment and revision of~ educational standards.o In response to a recommendation of theB retreat, the Executive Council appointed two~"0 major task forces. The first, the Task Forceu on Graduate Medical Education, was charged~ with reviewing the entire field and presenting...... recommendations to the Executive Council§ on how graduate medical education in the

<.l:1 United States should develop programmati-1:! cally, structurally, and institutionally. This<l) task force is chaired by Dr. Jack Myers of the§ University of Pittsburgh School of Medicine.Uo The second, the Task Force on the Support

Q of Medical Education chaired by Dr. StuartBondurant of Albany Medical College, hasbegun discussions with key federal policymakers in pursuit of its charge of recommend­Ing to the Executive Council appropriatemechanisms for federal support of medicaleducation after the expiration of the currenthealth manpower law.

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250 Journal of Medical Education

the financial impact of recognition of a newspecialty. Following LCSB approval of theformation of an American Board of Emer­gency Medicine, the Executive Council ap­pointed a small working group to recommendan AAMC position when this matter camefor a final vote before the American Board ofMedical Specialties. The Executive Counciladopted the working group's recommendationthat a conjoint board in emergency medicinebe established with mandatory representationfrom family practice, internal medicine, pedi­atrtcs, and surgery.

Members of Congress asked the ExecutiveCouncil to take a position on the continuedfederal support of the Uniformed ServicesUniversity of the Health Sciences, which hadbeen opposed by the Carter Administration.The Council reaffirmed its position that theAssociation should only speak to the qualityof the educational program at the militarymedical school and should not take sides onthe politIcal controversy of its cost effective­ness. It was agreed that the Associationshould help place currently enrolled USUHSstudents in other U.S. medical schools andshould assist the faculty in finding new posi­tions If the Congress decided to close theschool. Congress subsequently voted to con­tinue funding for at least one year.

The Executive Council adopted indepthresponses to several major studies affectingacademIC medicine. An HEW proposal forcredentialling health manpower was reviewedat considerable length with council membersexpressing concern over the economic impactof increased speCialization and credentiallingof health personnel. A Government Account­ing Office report, "Problems in Training anAppropriate Mix of Physician Specialists,"was generally supported by the council mem­bers. Its recommendation that the CCMEaccept the responsibility for recommendingthe appropriate distnbution of residencies wassupported, but it was agreed that the CCMEshould not be responsible for enforcing orimplementing these recommendations. A Na­tIOnal Academy of Sciences report on "HealthCare for American Veterans" was analyzedby the Executive Council and support ex­pressed for expanding and strengthening affil­iation agreements between medical schoolsand VA hospitals.

VOL. 53, MARCH 1978

At the request of the Council of Deans,the Executive Council appointed a smallworking group to consider the ethical issuesraised when physicians withhold patient ser­vices in order to accomplish financial or pol­itical objectives. The Executive Councilagreed that the Association, as the represent­ative of academic medicine, should take astand on this moral dilemma. The workinggroup will prepare a recommendation for theExecutive Council, which will ultimately bepresented to the AAMC Assembly.

During the year the Executive Council con­tinued to oversee the activities of the fiveAssociation Groups. Rules and regulationsrevisions were approved for several of thesesub-council organizations and guidelines wereapproved for the newly created Minority Af­fairs Section of the Group on Student Affairs.The Association receives progress reports onGroup activities twice each year.

The Council's Executive Committee metprior to each Executive Council meeting andby conference call on numerous occasionsthroughout the year. The Committee metwith HEW Secretary Joseph Califano in Juneto discuss issues of major concern to theacademic medical centers and to inform theSecretary about ways in which the Associationmight be of assistance.

The Executive Council, along with theAAMC secretary-treasurer, Executive Com­mittee, and Audit Committee maintainedcareful surveillance over the fiscal affairs ofthe Association and approved a moderatelyexpanded general funds budget for fiscal year1978. At the recommendation of the ASSOCI­ation's legal counsel, the Executive Councilhas approved and recommended to the As­sembly a Bylaws amendment adding a provi­sion for the indemmfication of AAMC offi­cers and directors.

Council of DeansThe Council of Deans sponsored three pro­grams at the 1976 Annual Meeting in SanFrancisco. The first program was cosponsoredwith the OSR and entitled "EducationalStress: the Psychological Journey of the Med­ical Student." This program featured a key­note address dramatizing and describing manyof the anxieties and conflicts students experi-

251

mittees concerned with accreditation, the sta·tus of the new MCAT, and progress reportsfrom the AAMC Groups. Under new businessthe council discussed the impact of the re­cently enacted health manpower legislationand passed a resolution in opposition to theprovision mandating acceptance of U.S. stu­dents in foreign medical schools. Finally, thecouncil expressed its unanimous appreciationfor the service of Dr. J. Robert Buchanan,who had resigned as the council's chairman­elect.

The Administrative Board met quarterlyto carry on the business of the council. Itdeliberated on all Executive Council items ofsignificance to deans. Of particular interest tothe board was sharing with the OSR Admin­istrative Board its understanding of the impactof placing house staff negotiations under theprovisions of the National Labor RelationsAct. This topic was a subject of discussion ata joint dinner of the two boards. The boardwas also particularly concerned about theethical issues raised by the increased tendencyof groups of physicians to withhold profes­sional services as a means of pursuing per­sonal or political objectives. Thus, the boardinitiated consideration of this matter by theExecutive Council and stimulated the ap­pointment of a committee to study and rec­ommend an Association position.

The Council of Deans held its Spring Meet­mg in Scottsdale, Arizona, continuing thetradition of an annual three-day retreat de­voted to an issue of current significance todeans. The theme of the program "GraduateMedical Education: Do We Have To DoBusiness in the Same Old Way?" was elabo­rated on by 22 speakers and panel members.Fourteen Canadian deans, four COD distin­guished service members and the COTHchairman joined with 91 institutional repre­sentatives for a comprehensive look at theissues surrounding the role of the medicalschool in graduate medical education. Anhistoric retrospective traced the factors lead­ing to the recommendation that the universitybegin to assume comprehensive responsibilityfor medical education through the graduatelevel and was followed by a status reportderived from the recent experience of theNIRMP. The underlying public concernswhich suggest the prospect of increasing con-

AAMC Annual Report for 1977

ence in medical school. This was followed byfour student presentations elaborating per­ceptions of the major causes of the stressesthey face: inadequate role models, inappro­priate grading and evaluating systems, too

::: many demands on their time and financial:2 burdens. The program concluded with a deanrJ)

rJ) describing his perspective on the institutional§ causes of stress and how it could be managed8, or reduced in the medical school setting. The

second program was entitled "Current andChoice: Developments in Medical Educa­tion." Representatives of six schools describea wide variety of imaginative developmentsat their own institutions. Subjects coveredmcluded innovative outreach service and ed­ucational programs, the development of moreeffective medical school-hospital relation­ships, an interdisciplinary curriculum on socialand moral values, an institutional program oncomprehensive primary patient care educa­tion, and experience with an independentstudy program. The third program was co­sponsored with the Council of Teaching Hos-pitals and focused on the activities of the

~u CClmmission on Public General Hospitals.

The two major presentations elaborated theapproach of the commission to dealing with

~ Issues for state university-owned hospitals and.::: those related to big city public teaching hos­o pitals.~ The November Business Meeting included:2 a presentation of reports from the Chairman,~'--' the President, and representatives from se-~"0 lected AAMC committees. The activities ofu the Association for Academic Health Centers~ were described in detail. The council en­...... dorsed the Executive Council recommenda­§ tion that the AAMC Bylaws be amended to

<.l:1 authorize a second voting OSR representative1:! on the Executive Council. The Chairman ofa the Association's Data Development Liaison8 Committee reported on that committee's de­o liberations regarding recommended policies

Q and procedures for handling medical schooldata maintained by the AAMC. In its discus­sion of the program ahead, the council re­viewed the planning for its 1977 Spring Meet­ing and considered items to be presented tothe AAMC Officers' Retreat. The councilreceived a number of items for informationmcluding a report on the Coordinating Coun­cIl on Medical Education, the Liaison Com-

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252 Journal of Medical Education

trol by government and third party carnerswere sketched by several speakers. Alternatemodels for preparing the physician for prac­tice whIch would integrate more closelypremedical, medical, and graduate medicaleducation were proposed as ways to imple­ment the concept that the award of the M.D.degree should be based on the demonstratedcompetence to practice medicine indepen­dently. The institutional response to the con­cept of corporate responsibility for graduatemedical education was discussed and one par­ticularly successful experience was described.Finally, a Canadian dean provided a lucidand comprehensive review of the Canadianexperience with substantial governmental in­volvement in medical care and medical edu­cation in that country. The meeting concludedwith a business session which provided forgeneral dIscussion of many matters of con­cern. The council endorsed the proposal thata telephone alert network be established as ameans of informing the Institutions of urgentmatters requiring theIr immediate response.The meeting closed with a comprehensivereview of the Bureau of Health Manpower'sapproach to the Implementation of some ofthe more complex and controversial provi­sions of the Health Manpower Act.

In June, the Administrative Board resolvedto dedicate the Proceedings of the SpringMeeting to the late Dr. Chandler A. Stetsonin recognition of his substantial contributionto the AAMC, including his service as chair­man of the 1977 Spring Meeting programplanmng committee.

Council of Academic SocietiesThe Council of Academic Societies made sig­nificant progress in coordinating the activitIesof its members and improving their interac­tions with the AAMC, with each other, andwith the public sector.

During 1976, a number of CAS societiesevinced growing concern about the increasingfederal intrusIon into all of the activities ofacademic medical centers. The societies ex­pressed their desire for increased participationin the legislative and executive process. Re­sponding to these Interests, the CAS spon-

VOL. 53, MARCH 1978

sored a public affairs workshop last Decem­ber. The objective of the workshop was toacquaint the public affairs representativeswith the intricacies of Congressional and Ex­ecutive branch procedures. More than 30newly appointed public affairs representa­tives, who will assume primary responsibilityfor interfacing with their members and theAAMC in the arena of public affairs, attendedthe workshop.

The CAS Brief, first published in the fallof 1975, now appears quarterly and is circu­lated to the officers and official representa­tives of the 61 member societies. Addition­ally, eight societies now distribute the Briefto all their members. This brings the totalCAS Brief circulation to just under 8,000readers. In response to a recent poll, 16additional societies expressed interest in dis­tributing the Brief to another 12,000 individ­uals.

Forty-seven societies were represented atthe CAS Interim Meeting at the AAMCHeadquarters in June. Current policy issuesin biomedical research, medical education,and health care involved the participants in avigorous exchange of information. Of fore­most interest was the matter of legal restraintson the freedom of inquiry as proposed inlegislation to regulate recombinant DNA andclinical laboratory research. As a result ofthis meeting, many societies individually con­tacted key pohcy makers. Another IntenmMeeting is planned for January 1978. Stimu­lated by' a request from the Association ofProfessors of Medicine, a CAS Services Pro­gram has been established on a two-yearexperimental basis. This provides an oppor­tunity for member societies to obtain certainservices through the staff and facilities of theAssociation. These services include maintain­Ing membership lists, providing billing andaccounting services, making plenary and com­mittee meeting arrangements, and preparingnewsletters and memoranda on subjects ofspecial interest to a society. It is anticipatedthat the Services Program will further solidifythe CAS and enhance its effectiveness indealing with the multiple challenges facingacademic medicine. During the two-year ex­perimental period, the best approach to pro-

IAAMC Annual Report for 1977

I viding services on an affordable basis to allmember societies will be sought.

253

view, government health care programs-in­cluding Medicare - must eventually replacepresent payment approaches reqUIring indi­vidual pattent bills and records In order toavoid being buned in an ever increasingamount of paperwork.

At its March meeting, the board devotedthe majority of its attention to the reportfrom the Association's Ad Hoc Committee toReview the Talmadge Bill. The board recom­mended that the Executive Council modifythe committee's recommendations on statecost control programs and the classificationof tertiary care/teaching hospitals beforeadopting the report as Associatton policy.These changes were approved by the Execu­tive Council and the revised report providedthe basis for the AssociatIOn's subsequenttesttmony on the Talmadge Bill.

Robert A. Derzon, the first administratorof HEW's new Health Care Financing Ad­ministration and a former COTH chairman,met with the board at its June session. HereVIewed the reorgamzation of health financ­ing activities within HEW and descnbed someof the organizattonal problems faced byHCFA. Mr. Derzon concluded by emphasiz­Ing Secretary Califano's commitment to theCarter Administratton's cost containmentproposal.

At its June business meeting, the boardreVIewed the Administration's proposed"Hospltal Cost Containment Act of 1977."David Everhart, COTH chairman-elect andchairman of the aSSOCiation's ad hoc commit­tee on the Administration's hospital cost con­trol proposal, summanzed the committee'sanalySIS of the Administration's proposal andreviewed policy positions recommended bythe committee. The board strongly supportedthe committee's analysis and recommenda­tions.

At the September meeting Joseph Onek,associate director of the Domestic Council,reViewed the Administration's health poliCies,especially its proposal to limit hospital reve­nues and capital expenditures.

As a result of the Carter AdmimstratlOn'sdecision to advocate an immediate short-termprogram to modify the rate of hospital costincreases, this year's Administrative Board

Council of Teaching HospitalsBecause reimbursement limitations and legis­lated cost containment programs can threatenthe financial stability of teaching hospItals byfailing to adjust for cost differences resultingfrom atypical diagnostic patient mixes andmore intensive patient services, the council,at its annual business meeting, sponsored areview of current developments in quantifyingdiagnostic case mix. Clifton R. Gaus, directorof the Division of Health Insurance Studiesof the Social Security Administration, re­viewed the federal concern with the costs ofdiffering case mixes using data from the Med­Icare program; Professor John Thompsom ofYale University described an ongoing re­search program in patient classification that isproviding an essential methodological basefor several case mix studies in COTH memberhospitals; Charles Wood, director of the Mas­sachusetts Eye and Ear Infirmary, reviewedhis hospital's practice of charging patients forroutine services based on the intensity ofservice provided; and Baldwin Lamson, direc­tor of the UCLA Hospital and Climes, dem­onstrated how case mix at UCLA had beenused to explain and document changes in thehospital's budget.

~ During the year, the COTH Administrative:2 Board held quarterly meetings to develop thet)~ Association's program of teaching hospital"0 actIvities and to consider and act on all mat­U ters brought before the Executive Council of~ the Association. Preceding three of the board~ meetings, evening sessions were held to pro-­§ vide seminar discussions on specific issues of

<.l:1 concern to teaching hospitals.At the January meeting, Thomas M. Tier­

ney, director of the SSA Bureau of HealthInsurance, reviewed controversial policIesand issues faced by the Medicare program.In a dialogue wIth board members, he dis­cussed federal concerns and decisIOns on thetreatment of nursing education costs and re­viewed their implications for medIcal edu­cation program expenses. Mr. Tierney con­cluded by suggesting that, in hIs personal

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254 Journal of Medical Education

activities were heavily focused on proposalsto change the Federal Government's hospitalpayment practices. Other major topics of at­tention included legislation and court suitsdesigned to define house staff as employeesfor purposes of the National Labor RelationsAct, proposed JCAH guidelines for surveyinguniversity-owned hospitals, and the Associa­tion's management advancement program forCOTH executives.

Organization of StudentRepresentativesIn its sixth year of operation, membership inthe Organization of Student Representativescontinued at a high level, with 112 of thenation's medical schools represented. At the1976 Annual Meeting, over 100 studentsrepresenting 94 schools attended businessmeetings, discussion sessions, and a jointOSR-Council of Deans program entitled,"Educational Stress: The Psychological Jour­ney of the Medical Student."

Also at the Annual Meeting, OSR repre­sentatives approved a revision to the OSRRules and Regulations to provide for theoffice of Chairperson-Elect. As a result ofthis action and of a change in the AAMCBylaws, approved subsequently by the As­sembly, the OSR now holds two voting seatson the AAMC Executive Council.

During the year, the OSR AdministrativeBoard held quarterly meetings to discuss is­sues of concern to medical students and toact on all matters brought before the Execu­tive Council. In a joint meeting last January,the OSR and COD administrative boardsshared widely differing viewpoints on house­staff unionization. At this session and at othertimes during the year, the OSR urged the

VOL. 53, MARCH 1978

AAMC to seek ways of improving the educa­tional and patient care aspects of those grad­uate training programs which participatinghouse officers consider marginal in quality.

The OSR, through its members on AAMCtask forces, maintained keen interest duringthe year in the problems of medical studentfinancing, in the opportunities for minoritiesin medicine, and in graduate medical educa­tion.

A continuing priority for the OSR duringthe year was the problem of stress in medicaleducation. This spring, the OSR surveyedstudents and student affairs deans of all U.S.medical schools to learn the types of psycho­logical counseling that are offered by theschools and those counseling systems thatseem to be most effective in meeting theneeds of students.

In an effort to improve communicationsbetween the OSR and the approximately60,000 U.S. medical students, the Associa­tion began publishing, on a trial basis, anewsletter to be distributed free-of-charge toall medical students. The OSR Report is in­tended to inform medical students of thenature and scope of the AAMC's involvementin national policy issues affecting medicaleducation. The two editions published to datewere distributed to all medical students viathe local OSR representatives.

As in previous years, the OSR held re­gional spring meetings in conjunction withthe AAMC Group on Student Affairs andthe regional Associations of Advisors for theHealth Professions. These meetings tradition­ally provide an opportunity for OSR repre­sentatives to interact with medical school stu­dent affairs officers and to learn about activi­ties and programs of the AAMC.

255

National Policy

During the past year the Association hasoperated within a national arena that has

::: undergone dramatic changes since the last9fa Annual Meeting. The election of 1976 pro-S duced a new President, eighteen new sena-l-; •

8, tors, and siXty-seven new members of the"5 House of Representatives. These changes.B brought a new Administration to Washington,~ including a new cast of characters in the top

"g health positions in DHEW, and caused au

..§ realignment of the leadership in both houses~ of Congress. In addition, the Senate made ane effort to bring more efficiency to its opera­~ tions by reorganizing its committee system.8 for the first time since 1946.~ The new Administration got off to an un-

certain start in health when, following the~ appointment of a new Secretary, several key~ senior health officials were quickly swept from<l) office. Despite the uncertainty of who would

':5 comprise the health leadership, the Associa-4-<o tion made a vigorous effort to inform therJ)

§ Carter health leaders about the AAMC, itsB constituency, and its position on relevant is­~ sues. Association staff met with members of<3u the Carter transition team prior to the inau­<l)

':5 guration and with other top officials thereaf-§ ter, culminating in a meeting between the

<.l:1 Association's Executive Committee and~ HEW Secretary Joseph A. Califano, Jr., inS June. Association staff also conveyed similar8o information to new members of the staffs of

Q the Congressional health committees.Even though President Carter had an­

nounced that it would take over a year toprepare his promi~ed national health insur­ance proposal, in April he submitted a majorlegislative proposal designed to reduce therapid rate of increase in health care costs. Asthis year's only major initiative in the healtharea, the Congress immediately seized uponcost containment as one of the major itemsfor consideration during the 95th Congress.A series of hearings was quickly held by the

four House and Senate subcommittees withjurisdiction over the legislation, and four al­ternative pieces of legislation were developed.Senator Herman Talmadge CD-Ga.), chair­man of the Subcommittee on Health of theSenate Committee on Finance, reintroduceda revised version of the Medicare and Medi­caid Administrative and Reimbursement Re­form Act which he had originally sponsoredduring the last Congress as still another viablealternative to the President's proposal. Intestimony presented to both House and Sen­ate subcommittees, the Association stronglyopposed the Administration's proposal, con­tending that it was unreasonable in the short­run to place arbitrary controls on a singlesector of the economy and in the long runwould have adverse effects upon our nation'sability to rationally limit hospital expendi­tures. The Association was generally suppor­tive of the Talmadge bill and recommendedseveral modifications to provide more flexibleprovisions. In developing a position on behalfof the medical schools and teaching hospitals,the Association relied on two ad hoc commit­tees, one which reviewed the Talmadge biIIand one which reviewed President Carter'shospital containment proposal.

The Association's officers and staff devotedconsiderable time and attention this year tothe implementation and reconsideration ofthe Health Professions Educational Assist­ance Act of 1976, which became law in Oc­tober of 1976. As the Bureau of HealthManpower, DHEW, began the formidabletask of developing regulations to implementthis act, it became apparent that major tech­nical problems existed and that the develop­ment of regulations would be a nearly impos­sible task. Most controversial among the pro­visions of the new law was Title V, whichmakes the receipt of capitation awards contin­gent upon the medical school reserving spacesfor the transfer of United States citizens en-

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256 Journal of Medical Education

rolled in foreign medical schools. This sectionprecluded schools from refusing to admitthese students on academic grounds if theyhad passed Part I of the National Boardexamination. Although the insertion of thetransfer provision during the House-Senateconference on the manpower bill came as acomplete surprise to the AAMC, the Associ­ation, after a survey of the deans, urged thatPresident Ford sign the bill while indicatingthe desirability of amending it at a later date.The opposition of the medical schools to thisprovision was underscored at the 1976 An­nual Meeting when the Council of Deansadopted a resolution condemning this provi­sion for intruding into the academic preroga­tives of the institutIOns. Since that time, theAssociation has actively participated in thewriting and reviewing of regulations to mmi­mize the intrusiveness of the provision andhas constantly explored the possibility ofmodifying or deleting the provision. Largelydue to the efforts of the Association member­ship and the university community, Congresshas begun to move toward modification ofthe onerous part of this provision.

Another provision of the new health man­power law, designed to curtail the immigra­tion of foreign trained physicians, requiredsubstantIal AAMC mvolvement to imple­ment. The AssocIation participated in discus­sions leading to the establishment of a VisaQualifying Examination for foreign physi­cians, and supported the one-year generalwaiver of this requirement until the VQEcould be offered. The Association has op­posed a further extension of this waiver, feel­ing that the objectives of the law are laudableand that it should be enforced. Only to theextent that foreign physicians are unable topass the VQE or the English language re­quirement of the law and thus be deemedunqualified would this law be exclusionary.The Association supported a carefully limitedexemption from these requirements for distin­guished Visitors.

In addition to involving itself with the im­plementation of the 1976 health manpowerlaw, the Association has begun to prepare forthe renewal of this legislation in 1980. ATask Force on the Support of Medical Edu-

VOL. 53, MARCH 1978

cation was appointed and charged with rec­ommending an AAMC position and strategyin anticipation of Congressional reconsidera­tion.

The federal appropriation process wascomplicated this year by the passage of severalpieces of authorizing legislation after enact­ment of the 1977 appropriation and by themid-year change of Administration. Fundingof the new health manpower law required asupplemental to the 1977 appropriation,which the Congress passed in May. Enact­ment of the 1978 Labor-HEW bill has beenconsiderably more difficult. President Carter'sbudget request for 1978 acknowledged thathis Administration had not had time to revisesubstantially the budget submitted by PresI­dent Ford. The Congress realized this andsignificantly increased funding levels in sev­eral key areas, negotiating a compromise withthe Administration at one point to avoid thethreat of a veto. The Association workedwith the Congress to overcome efforts toreduce capitation support by those disen­chanted with institutional funding. TheAAMC's activities were closely coordinatedwith the Coalition for Health Funding. Al­though prospects seemed bright for enactmentof the 1978 appropriation prior to the Octo­ber 1 start of the fiscal year, House andSenate conferees reached an impasse in tryingto resolve the language of their two verydifferent antiabortion amendments and a con­tinuing resolution once again became neces­sary.

A set of administrative decisions by thefederal government prompted additional ac­tivity for the Association. During 1976,through enactment of the CongressionalBudget and Impoundment Control Act, thefederal government transferred the startingdate of its fiscal year from July 1 to October1. This was accomplished by providing for atransition quarter in 1976 and by appropriat­ing 25 percent in additional funds to coverthis period. Unfortunately, no additionalfunds were provided for capitation grants. Asa reSUlt, capitation funds from the 1976 ap­propriation represented a fifteen rather than atwelve month award. Although the Associa­tion made a vigorous attempt to secure a

LCME statement presented to the Committeedemonstrated that the LCME had met thepublished criteria of the Office of EducatIonand had operated effectively in the interestsof quality without any hint of political mter­ference for thirty-five years. The Associationhas also opposed any extension into the non­profit field of the FTC's statutory authorityto regulate trade, arguing that the historicmission and economic orientation of thatagency are unsuited to a field in which inter­Institutional planning and coordInation arevital.

A major development during 1977 was theintroduction in Congress of two bills whichwould, for the fIrSt time, limit research activi­ties either directly or indirectly. One, theRecombinant DNA Research Act, wouldplace serious restraints on SCientifIc Inquiry Inthis very Important research area. The sec­ond, the ClInical Laboratory ImprovementAct, as origInally introduced, would haveadded unnecessary barriers to the transfer ofresearch-proven ideas to the care of patients.The Association took leadership to bringthese potential research restramts to the at­tentIOn of legislators and the scientifIc com­mumty and to work for theIr modification.

The AssocIation has actively opposed leg­islation introduced in both the House andSenate to reverse a National Labor RelationsBoard deCIsion that housestaff should not berecognized as employees covered by federallabor law. AAMC testimony emphaSIzed thatresidency traimng is an integral part of themedical education process and that the resi­dent's relationshIp with a hospital should bebased on an educational, rather than an indus­trial, model. The testimony also discussed thedevelopment of contemporary graduate med­ical education and the effect that the legisla­tIOn could have on the form and structure ofgraduate medical education.

The AAMC played a major role last yearas the U.S. Supreme Court prepared to hearthe case of Regents of the University of Cali­forma v. Bakke. Called the most importantcivil rights case since the 1954 desegregationdecision, Bakke challenges the constitution­ality of special mInority admissions programs

257AAMC Annual Report for 1977

supplemental appropriation to fund the hiatusperiod, these efforts proved to be unsuccess­ful.

Initiatives by both the Congress and theExecutive branch to regulate the activities ofthe private sector were of significant concern

::: to the Association during the past year. Most9rfl notable among the regulations issued by therfl~ Executive branch to implement federal laws~ were the final DHEW regulations to promote(1)0.. non-discrimination on the basis of handicap

in programs and activities receiving or bene­fiting from federal financial assistance. Theseregulations, which implement Section 504 ofthe Rehabilitation Act of 1973, took effect inJune and have far-reaching implications forall schools of medicine and teaching hospitals.Although the Association had responded tothe proposed regulations both independentlyand jointly with the American Council onEducation, many comments went unheeded.Preadmission inquiry into physical, mental,or emotional disabilities is now effectivelyprohibited and extensive and costly facilityrenovations may become necessary.

U The Federal Trade Commission made two::§ attempts to secure authority under which it~ would have been able to insert itself into the(1) affairs of the medical schools and teaching

-S hospitals. The Association, in concert with'0 other organizations, has resisted both of theserfl challenges. The first potential encroachment§ was averted when the DHEW Office of Edu­B cation's Advisory Committee on Accredita­~ tion and Institutional Eligibility, charged by"0 law with advising the Commissioner of Edu­u

(1) cation on recognition of accrediting agencies,-S recommended that the Liaison Committee ona Medical Education continue to be recognized

..g as the official accrediting body for medicaleducation. The LCME's status had been chal-

"EJ(1) lenged before this Advisory Committee bya the FTC, on the grounds that the involvement8 of the American Medical Association consti­8 tuted a conflict of interest and compromised

the autonomy of the Liaison Committee. TheFTC argued that the AMA, as a trade associ­ation, represented the economic interests ofphysicians and therefore had a vested interestIn restricting the development and growth ofnew and existing schools of medicine. The

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258 Journal of Medical Education

through which schools of higher educationhave admitted increased numbers of qualifiedminority students. The Association filed anamicus curiae brief in the Supreme Court, asit had previously done in the California Su­preme Court, arguing that fair evaluation ofapplicants required schools to take race intoaccount when evaluating other admissions cn­teria; that class diversity was an essentialeducational objective; and that integration ofthe profession and increased service to medi­cally underserved minority communities werecompelling state interests which could not beachieved by alternative means. The associa­tion served as a national resource for theUniversity attorneys and others filing briefs

VOL. 53, MARCH 1978

on studies concerning medical education andminorities in medicine. In addition, anAAMC study conducted last year was citedto the court as authoritative proof that specialadmissions programs for the economically dis­advantaged were not a rational alternative tospecial programs for minority applicants.

The Association welcomed efforts this yearby the Carter Administration to reorganizeand streamline federal government. The As­sociation commented upon and participatedin the Administration's comprehensive reviewof the federal government's system of advi­sory committees, undertaken early in 1977,and in the reorganization project establishedby the President in June.

Working with Other Organizations

259

assistance to their own efforts in maintainingthe quality of their education programs. Sur­vey teams are able to identify areas requiringincreased attention and indicate areas ofstrength as well as weakness. In the recentperiod of major enrollment expansion, theLCME has pointed out to certain schools thatthe limitations of their resources precludeexpanding the enrollment without endanger­ing the quality of the educational program. Inyet other cases it has encouraged schools tomake more extensive use of their resourcesto expand their enrollments. During the dec­ade of the sixties, particularly, the LCMEencouraged and assisted in the developmentof new medical schools; on the other hand, ithas cautioned against the admission of stu­dents before an adequate and competent fac­ulty is recruited, or before the curriculum issufficiently planned and developed and re­sources gathered for its implementation.

Continued recognition of the LCME bythe commissioner of education was challengedthis year by a staff arm of the Federal TradeCommission on the grounds that designationof committee members by the AMA createdan inherent conflict of interest, compromisedits autonomy, and made suspect its ability toconform to the requirements of due process.The LCME vigorously defended its structureand procedures and was awarded continuedrecognition for two years on the recommen­dation of the Commissioner's Advisory Com­mittee. This action, however, carried with ita requirement for an interim report on LCMEactions to alleviate identified concerns relatedprimarily to the committee's relationship tothe AMA and the AAMC. This matter willrequire the continuing attention of the Asso­ciation over the next year.

The private sector recognizing authority,the Council on Postsecondary Accreditation,also evaluated the LCME and continued itsrecognition for a full term of four years.

:::9i2 Since 1972, the AAMC has worked closely§ with the American Medical Association,<l) American Hospital Association, American0.. Board of Medical Specialties, and the Council"5o on Medical Specialty Societies through partic-..s:: ipation in the Coordinating Council on Medi­~ cal Education. In the CCME, representatives'"d of the five parent organizations, the federal~ government, and the public have a forum to

..§ discuss issues confronting medical education8 and to recommend policy statements to the15' parent organizations for approval.\-;<l) During the past year, the Association ac-

.D tively participated in a number of ongoing.8 and new committees of the CCME. Majoro actions by the CCME included the final ap­Z proval of a report of a joint CCME-LCGME

Committee on the Financing of GraduateMedical Education and a tentatively positiveresponse to a recommendation in a draftGovernment Accounting Office Report that

~ the CCME assume responsibility for monitor­.::: ing the specialty and geographic distributiono of physicians and making recommendations~ to the HEW Secretary on actions which theo government should take to influence theseB distributions. In the latter action, the CCME~<3 did not respond positively to the further GAOu recommendation that it assume regulatory~ responsibilities in this area. A number of new...... CCME committees were formed, including§ committees on future staffing of the CCME,

<.l:1 on coordination of data on physicians, on1:: finance, on the distribution of residencies by<l) specialty, and on the creation of new and the§ expansion of existing schools of medicine.o The Liaison Committee on Medical Edu­

Q cation continues to serve as the nationallyrecognized accrediting agency for programsof undergraduate medical education in theUnited States and for the medical schools inCanada.

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

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260 Journal of Medical Education

During the 1976-77 academic year, theLCME conducted 46 accreditation surveys inaddition to a number of consultation visits touniversities contemplating the developmentof a medical school. The list of accreditedschools is found in the AAMC Directory ofAmerican Medical Education. During the pastyear, the LCME issued Letters of ReasonableAssurance for future accreditation for fournew programs in medical education andgranted provisional accreditation to two newmedical schools. 1)te LCME completed de­velopment of guidelines for the policy state­ment, "Functions and Structure of a MedicalSchool," and supplemental guidelines formedical schools with branch campuses.

The Liaison Committee on Graduate Med­ical Education placed a special emphasis dur­ing the past year on improving communica­tions with the twenty-three Residency ReviewCommittees whose activities it now oversees.Significant misunderstandings had developedregarding the complementary role theLCGME and the RRCs play in the accredita­tion of programs in graduate medical educa­tion. Paramount among these was an appre­hension by the RRCs that the LCGME wasusurping their prerogative to evaluate theeducational and scientific merits of the pro­grams which they review. Through directmeetings with RRC chairmen, the role of theLCGME was clarified and the RRCs nowapprecIate that the LCGME review of theiractions is carried out to ensure that there issufficient documentation to sustain the RRCrecommendations as to the accreditation sta­tus that is recommended following RRC re­view. Through meetings with the RRC chair­men, several areas of mutual concern regard­ing the accreditation process have been iden­tified and efforts to improve accreditationthrough more effective staff support andcloser interaction between RRCs and theLCGME are moving forward.

In July the LCGME received a draft revi­sion of the General Requirements sections ofthe Essentials of Graduate Medical Educationfrom its Subcommittee on Essentials. Thedraft is being widely circulated for commentprior to being approved by the LCGME andforwarded to the Coordinating Council onMedical Education for approval and transmit-

VOL. 53, MARCH 1978

tal to its five sponsoring organizations. Ap­proval by the sponsors is required before therevised General Requirements are effective.The draft revision emphasizes the responsibil­ities of institutions which sponsor programsin graduate medical education, implementinga CCME Statement on Institutional Respon­sibility for Graduate Medical Education whichwas approved in 1974. It is anticipated thatfinal approval of the General Requirementswill occur in 1978.

The Liaison Committee on ContinuingMedical Education decided to assume its offi­cial accrediting function in July 1977. At thattime the LCCME will accredit organizationsand institutions offering continuing medicaleducation to practicing physicians on a na­tional and regional basis. For national accred­itation the LCCME will carry out both thesurveys and the accreditation, while for theregional and local institutions the LCCMEwill receive for ratification recommendationsfrom state committees and councils as a resultof their local review process. For the immedi­ate future, the LCCME has the tasks ofestablishing new criteria for accreditation, de­signing an accounting system for monitoringperformance at the regional and local levels,and resolving financing and staffing.

The Coalition for Health Funding, whichthe Association helped form seven years ago,now has over 60 nonprofit health relatedassociations in its membership. A coalitiondocument analyzing the Administration's pro­posed health budget for fiscal year 1978 andmaking recommendations for increased fund­ing is widely used by Congress and the press.

As a member of the Federation of ASSOCI­ations of Schools of the Health Professions,the AAMC meets regularly with membersrepresenting both the educational and profes­sional associations of eleven different healthprofessions. The Association staff has alsoworked closely with the staff of the AmericanAssociation of Dental Schools on matters ofmutual concern.

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

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AAMC Annual Report for 1977

As a member of the board of trustees, theAssociation maintains an active interest inthe program of the Educational Commissionfor Foreign Medical Graduates and especiallyin its involvement in the implementation ofprovisions affecting foreign medical graduatescontained in the Health Professions Educa­tion Assistance Act of 1976. The AAMC isadvocating prompt implementation of theseprovisions through various channels includingECFMG.

The staff of the Association has maintainedclose working relationships with other orga­nizations representing higher education at the

261

university level, including the AmericanCouncil on Education, the Association ofAmerican Universities, and the National As­sociation of State Universities and Land­Grant Colleges. This year the AAMC workedcooperatively with these organizations as wellas others to respond to the academIc Intru­sions of the health manpower law and onfederal regulations broadly affecting highereducation, such as those pertaining to affirm­ative action and the handicapped. TheAAMC participates on an InterassociationTask Force on Equal Employment Opportu­nity staffed by the ACE.

262

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Education

A vanety of pressures, both internal andexternal, have brought about a clear emphasison evaluation at national as well as locallevels. Internal pressures have derived fromthe faculty's increasing concern about theeffectiveness of their educational programsand of their roles in the educational process.Since many faculty have made more explicittheir instructional objectives, they have foundthis accomplishment an important facilitatingfactor in more refined student and programevaluation. The time has also seemed appro­priate for the review of educational innova­tions in curriculum structure and materialsand in methods of assessing student perfor­mance. These interests have received rein­forcement from society's demand for moreexplicit accountability both in terms of assur­ing that those who are certified by the educa­tional community to deliver health care arethe best available and in terms of assuring thestudents that their individual rights have notbeen compromised in the process.

Evidence of these thrusts has been mani­fested in the programs of the Association andits member organizations. Especially note­worthy have been the activities of the Groupon Medical Education. A GME TechnicalResource Panel submitted its final report ona "Protocol for the Follow-up of Graduates,"offering suggestions to individual schools forsystematically studying the relationship be­tween educational and institutional variablesand practice outcomes. The GME spring re­gional meetings devoted significant attentionto evaluation. The Southern GME held aworkshop on the need for monitoring theeffort of the educationally disadvantaged to­gether with mechanisms designed to enhancetheir progress. A plenary session in the North­east Region focused on considerations forestablishing a formal medical school unit toprovide a wide variety of evaluation supportto the educational process. The Western Re-

gion coordinated its meetings with those ofthe directors of such units and programmati­cally looked at ways to make continuing med­ical education efforts more effective. TheCentral Region dealt with the evaluation ofinstructor effectiveness, the assessment of stu­dent performance, and program review basedon stated objectives. All of these themes arescheduled for renewed attention at theAAMC Annual Meeting.

The AAMC Ad Hoc Committee on Con­tinuing Medical Education has worked closelywith the GME at regional and national meet­ings in highlighting issues in continuing edu­cation that are of particular concern to medi­cal schools and their faculties. As a result,the AAMC is now planning a research anddevelopment effort to explore means by whichstudents in the continuum of medical educa­tion can learn to appreciate the importanceof self-assessment and self-directed learningin maintaining and enhancing professionalcompetence. The Ad Hoc Committee contin­ues to engage AAMC constituents and otherorganizations in an effort to link more closelycontinuing education of physicians with theirprofessional competence and performance.

A significant segment of the membershiphas contributed heavily to a Study of Three­Year Curricula in U.S. Medical Schools. Theproject staff is analyzing questionnaire re­sponses from: (a) administrators, faculty, andstudents of medical schools that conductedthree-year programs between 1970 and 1976;(b) deans offour-year schools; and (c) clinicalprogram directors who evaluate graduatesfrom three-year programs. Site visits at eachof the schools participating in the study willcomplete the data collection phase of theproject. A final report on the study is sched­uled for completion in early 1978.

Heavy membership involvement in allphases of development and implementationhas characterized the preparation of the New

to identify areas of weakness; (c) on anindividual basis to test progress of self-pacedstudents; and (d) as a final examination. It isrevised and updated annually and is now inits eIghth edition. Previous forms of the testare also available.

The AAMC EducatIOnal Matenals Projectcontinued collaboration with the National Li­brary of Medicine in the development ofquality control and information systems aimedat aiding the improvement of health profes­sions education through educational method­ology. One project relates to AVLINE, acomputerized data base on nationally avail­able multimedia educational matenals in thehealth sciences. By means of a review systemengaging over 1,000 health sciences experts,the AAMC assesses the majority of educa­tional materials in the AVLINE data baseand produces critical abstracts, which are ac­cessible to the user as part of the AVLINEsearch. AVLINE now contains over 3,000cItations covering medicine, dentistry, andnursing - almost double the number reporteda year ago. This audiovisual data base at theNational Library of Medicine is expanding atthe rate of approximately 100 items permonth.

A related project is concerned with theneed for extended sharing of computer-basededucational materials. As a first step, thefeasibility of appraising computer-based edI!­cational materials has been explored. In col­laboration with some of the major programdevelopers and users and in association withthe Lister Hill National Center for BiomedicalCommunications, the AAMC conducted apilot appraisal program. The possIbility ofestablishing some quality standards of com­puter-based educational materials has nowbeen ascertained, and the next step is toassess the interest among the producers andconsumers in the development of such anappraisal system.

A 75 percent response rate was achievedin the 1976 follow-up of physicians who par­ticipated in the AAMC Longitudinal Study ofMedical Students of the Class of 1960. Thestudy, supported by a grant from the NationalCenter for Health Services Research, is inthe final stages of data analysis. A final reportrelating practice outcomes discovered in the

263AAMC Annual Report for 1977

Medical College Admission Test. First admin­istered in April 1977, the New MCAT pro­vides six scores to students and to designatedmedical schools. Science knowledge andproblems questions are combined and re­ported for each disciplinary area, giving scores

§ in biology, chemistry, and physics. Problemsi2 are combined to yield one science problems§ score. Skills analysis tests yield one score<l) each in reading and quantitative concepts.0.. Sessions explaining the new program have"5 been held at the 1976 regional meetings ofo..s:: the Group on Student Affairs and the Na-~ tional Association of Advisors for the Health'"d Professions. Two publications have been pre­~ pared to provide extensive background infor-

..§ mation. One, for the prospective examinee,8 The New MCAT Student Manual, was first15' published in 1976. The second edition ap­\-; peared this fall. It was expanded tp include a<l)

.D four-hour illustrative test. The other publica-E tion, the New Medical College Admission Testo Interpretive Manual, has been prepared to as­Z sist admissions committees and premedical

advisors. It provides technical informationrelative to the use of test scores. The Interpre­tive Manual was distributed this summer. It isdesigned as a dynamic compendium to beupdated at regular intervals. In this way, themost current information on the various ap­plications of test data will be made available.

~ Working closely with the Committee ono Admissions Assessment, staff have continuedB to pursue various strategies for the evaluation~ of personal characteristics. These noncogni-<3u tive measurements are seen as necessary to

<l) broaden the basis for medical student selec­..s::...... tion and to document promotions decisions.a Specific efforts have led to a project which

..g involves explicating in observable terms rele-1:: vant personal characteristics as they manifest<l) themselves during the medical educationa process. Consensus on the precision and use­g fulness of such criteria will enhance perform-

Q ance evaluations and, as a result, will providefoci toward which predictive admissions in­struments can be developed and tested.

The Biochemistry Special AchievementTest continues to be used for a variety ofpurposes by participating schools. These pur­poses include administering the test: (a) foradvanced placement; (b) as a diagnostic tool

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264 Journal of Medical Education

recent follow-up to early personal, educa­tional, and institutional variables is scheduledto be available at the end of this calendaryear.

The AAMC responded to considerable in­terest among medical students and faculty indeveloping, over the past two years, an intro­ductory course to international health in a

VOL. 53, MARCH 1978

self-instructional mode. Aided by a contractfrom the John E. Fogarty International Cen­ter of the National Institutes of Health, thisinternational health course offers the studenta cross-cultural and comparative approach tohealth problems. The course was tested lastwinter by approximately 200 medical studentsin 15 medical schools and is now availablefrom the Springer Publishing Company.

265

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Biomedical Research

The Association's major concern in the areaof biomedical research during the past yearhas been in promoting means by which thefunding of research and research trainingmight be made more stable. The 1976 reportof the President's Biomedical Research Panel,to which the AAMC contributed, was pre­sented and discussed at the November meet­ing of the AAMC Assembly by Panel Chair­man Franklin Murphy. A series of Congres­sional hearings on biomedical and behavioralresearch followed this report.

The Association actively supported a one­year extension of the legislative authoritiesfor cancer research; for heart, lung, and bloodresearch; for environmental research; and forresearch training in order to permit a morethorough review of the nation's effort. Thisextension was enacted and, during the respitethus afforded, the Association continuedstudies examining the status of the researchendeavor in academic medical centers. Theresults indicated that, although the totalamount of federal funds for research andresearch training in academic medical centerswas maintained or increased slightly over thepast decade, the proportion of the totalbudget of academic medical centers allocatedfor research declined sharply. This occurredbecause academic medical centers in recentyears have engaged more heavily in educationand patient care activities. The AAMC car­ried these findings to its constituents, to theCongress, and to the Executive branch duringthe past year.

For several years, the funding of biomedI­cal research training has suffered from contin­uing pressure by the Office of Managementand Budget to eliminate federal support. Ero­sion of Congressional support for traininggrants led to a decrease in the level of fundsto a point below that needed to meet therecommendations of the National Academyof Sciences Human Resources Commission.

To counter this trend, the Association col­lected information demonstrating the effectsof cutbacks in research training funds andmobilized the mterest of several organizationsin seeking adequate funding levels. Becausethe perennial questIoning of research trainingbecame increasingly severe, the AAMC hastaken the leadership in coordinating a numberof studies of research manpower. The AAMChas brought together various groups, includ­ing the Institute of Medicine and the NationalInstitutes of Health, to define the data neededand to see that they are gathered and ana­lyzed. Reports of problems in research train­mg, especially in the clinical disciplines, ledthe AAMC to undertake a study of the statusof such training at the request of the NationalAcademy of Sciences Committee on Person­nel Needs for Biomedical and BehavioralResearch. The results of these studies pro­vided data and recommendations for theCommittee's 1977 recommendations to Con­gress and DHEW on the numbers and kindsof research personnel that need to be tramed.

A study of the factors associated with thechoice of careers in biomedical research wascontinued in 1977 with support from theNational Institutes of Health. The careerchoices of the class of 1960 were examined todetermine how the 500 members of this classwho joined medical school faculties differedfrom theIr classmates who chose other ca­reers. Patterns of research and graduate tram­ing of 15,000 basic science and clinical facultywere also explored in this study. In a relatedeffort, a study was conducted on the impactof changes in federal programs on biomedIcaland behavioral research training in clinicaldisciplines. At the request of the clinical sci­ences panel of the Commission on HumanResources, National Academy of Sciences,the period 1972-1976 was studied.

The results of AAMC studies of biomedicalresearch were also discussed by an AAMC

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study group appointed in September 1977 toassess the overall status of the biomedicalresearch effort in academic medical centers,to review present Association policy, and torecommend any necessary policy changes. Itis expected that the ultimate recommenda­tions of this committee after review by theExecutive Council will form the basis ofAAMC efforts to secure more rational andstable federal support of the vital researchfunction.

The AAMC has continued to be active indiscussions of the ethics of biomedical re­search and the protection of human subjects.As a result of these activities, the public hasbecome more aware of the negative effectson biomedical research of the Freedom ofInformation Act and the Federal AdvisoryCommittee Act. Both the President's Biomed­ical Research Panel and the Commission forthe Protection of Human Subjects reviewedthis problem and indicated that revisions ofthese "sunshine laws" are necessary to protectmore adequately human subjects of research,the conduct of clinical research, and the intel­lectual property rights of individual research­ers.

Government regulation of biomedical re­search was of particular interest to the Asso­ciation as the Congress consIdered two billsthat would place major restraints upon thescientific research community. Concern overthe potential dangers to public health and theenvironment of recombinant DNA researchproduced a flurry of proposals which would

VOL. 53, MARCH 1978

have severely restricted the ability of scientiststo conduct such research. The Association,along with other scientific organizations, wasgreatly distressed by the content of these billsand the haste with which the Congress actedupon them. The Association communicatedto the Congress its conviction that it wasinappropriate for the Congress to attempt toregulate research by statute except in the faceof the clearest potential for danger, and at­tempted to demonstrate that the potentialbenefits of recombinant DNA research hadbeen understated while the potential hazardshad been overemphasized. The Associationasked that the NIH guidelines on recombinantDNA research, which previously applied onlyto federally financed research, be adopted asthe formal regulations for all research in thisarea. The Association strongly opposed theestablishment of a freestanding national com­mission charged with regulating this research.

The second potential restraint on researchcame in the form of legislation establishingdetailed standards for clinical laboratories.While the AAMC recognized the legitimateconcern over the quality and management ofroutine testing laboratories, the Associationopposed the extension of this regulation toresearch laboratories. It was recommendedthat the HEW Secretary be authorized todevelop more appropriate standards for labo­ratories combimng both clinical and researchfunctions In order to avoid inhibiting thetransfer of research technology to patientcare.

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New initiatives in primary care education havebeen taken by virtually all the nation's medi­cal schools and teaching hospitals during thepast decade. Almost universally, these initia­tives have involved broader utilization of am­bulatory care facilities for teaching, and inmany instances they have resulted in majorchanges in affiliated residency programs. Asurvey conducted by the AAMC in 1973demonstrated the nature of change which hadoccurred by that date. The data from thatsurvey, published in the September 197 4 issueof the Journal ofMedical Education, indicatedthat one half of the institutions had mademajor changes in primary care education dur­ing the preceding three years, that one-halfof the institutions had programs for graduatelevel training in family medicine. Whatemerged from this analysis was a picture ofprimary care education in transition with asyet no clear pattern of optimum programdevelopment. In 1976, this survey was re­peated using a modification of the originalsurvey instrument in order to ascertain themagnitude of change which had occurred dur­ing the three year interval. The results will bepublished in the December 1977 issue of theJournal ofMedical Education. By 1976, moreschools were making an ambulatory experi­ence a required part of the curriculum, 80percent of the institutions had affiliated pro­grams for graduate training in family medi­cine, and there had been a marked increasein the number of schools with affiliated grad­uate programs for the training of generalistsin internal medicine and in pediatrics.

These changes have increased the demandsfor high quality ambulatory care training sites,particularly in university or affiliated teachinghospital out-patient clinics. For the past twoyears, the AAMC, supported by the HealthResources Administration, DHEW, has con­ducted a program consisting of workshopsand on-site consultations to improve ambula­tory services.

Institutional groups representing 27 of thenation's medical schools participated m thisproject over a 2-year period. The workshopportion of the project consisted of an mtenseplanning, problem solving, and team buildingexperience deSIgned for top management ofuniversity affiliated teaching hospitals whosestaff are interested in developing innovativeambulatory care delivery models, providingmore efficient and accessible "one class" care,and improving educational experiences formedical students and house staff. During thiSprocess each institutional group workedclosely with an inter-disciplinary faculty teamexperienced in ambulatory care operations,organizational development and group proc­ess, and developed a time-specific action planfor initiating a change at its institution follow­ing the workshop program. A final programreport is due early in 1978 and will summarizethe collective expenences of the 27 partiCipat­ing institutions.

There is a natIOnal concern WIth developingeffective measures to insure quality of carewhile at the same time containing the rapidlysoaring overall costs of health care services.Physician self-evaluation and assessment ofperformance by peers is now generaIly ac­cepted as an integral part of the health careprocess. It is postulated however, that thedegree of physician compliance with, and theenthusiasm for, quality assurance programsmay be directly related to the extent of appro­priate experience with this subject receivedduring the formatIve training years. Introduc­ing these concepts into the curriculum is acomplex matter involving many academic de­partments. While several academic medicalcenters are now interested in this concept,few have been successful in initiating large­scale programs. The AAMC has encouragedprograms operated by students, under facultysupervision, to assist the quality of the patientcare in which they are involved. In this way,students can gain a better appreciation and

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understandmg of the need to develop a formalmethod of self appraisal. The AAMC hasreceived support from the National Fund forMedical Education to conduct workshops onthe subject in 1977-78. The initial workshop

VOL. 53, MARCH 1978

presented several models of inter-departmen­tal curriculum design, a clarification of insti­tutional prerequisites for successful programdevelopment, a strategy for curriculum phas­ing, and necessary resource allocations.

Faculty

269

155 faculty members from 82 different medi­cal schools participated in these workshops.

Support for the national survey, self-assess­ment program, and workshops has come fromthe Kellogg Foundation, the CommonwealthFund, and the Bureau of Health Manpower.

The Faculty Roster System, initiated in1965, continues to provide valuable informa­tion on the intellectual capital of medicaleducation. This data-base maintains demo­graphic, current appointment, employmenthistory, and training/credentials informationfor all salaried faculty at U.S. medical schools.The data collection procedures include feed­back to the schools providing the data in anorganized and systematic manner that assistsschools in activities that require faculty infor­mation, such as the completion of question­naires for other organizations and the identi­fication of alumni now servIng on faculty atother schools.

This database has also been used for avariety of manpower studies, including a re­port released this year entitled DescriptiveStudy of Salaried Medical School Faculty:1969-70 and 1974-75. This study was per­formed under contract WIth the Bureau ofHealth Manpower and contains summary in­formation on faculty appointment character­istics, educational characteristics, employ­ment history, and various breakdowns by sex,by race/ethnic group, for foreign medicalgraduates, and for newly-hired faculty. Acompanion study is underway contaIning1976-77 data on salaried medical school fac­ulty.

As of June 1977, the faculty roster con­tained information for 47,567 faculty, an in­crease of 6.4 percent over June 1976. Anadditional 25,788 records are maintained for"inactive" faculty, individuals who have helda faculty appointment during the past 12years but do not currently hold one.

The 1976-77 Report on Medical School

:::9i2 During the year, the Association has con­§ ducted several programs aimed at assisting8, faculty development and promoting under­

standing of the ways in which decisions arereached for careers in biomedical research. Aproject in faculty development, with particu­lar reference to teaching skills, was continued.In 1977, the data collection and analysis forthe National Survey of Faculty were receivedfrom 1,910 medical school faculty members,out of a stratified random sample of 2,700,for a very satisfactory response rate of 71percent. The basic findings from this surveyhave been presented in three preliminary re­ports which have been distributed to eachmedical school. The final report of this proj­ect, summarizing its highlights and major im­plications, will be distributed in December1977.

The written simulations that were a majorsource of data for the national survey willnow be used as part of a voluntary, confiden­tial, self-assessment program for faculty. Dur­Ing the past year, a pair of documents was

~ developed to accompany each simulation.9 One provides a discussion of the rationale fort) the recommended routes through the simula-~"0 tions and an explanation of the basis for theu other routes not being recommended. The~ other provides a general discussion of the~ topic area of the simulation, such as test§ construction, small group discussion, clinical

<.l:1 supervision, and a list of suggested readings.These materials have been field-tested amongfaculty members at seven medical schools.The self-assessment packages will be readyfor distribution in early 1978.

Beginning at the 1976 AAMC AnnualMeeting, a series of four workshops on facultydevelopment was offered to medical schoolfaculty members who have been identified bythCJir deans as having responsibilities for con­tributing to the improvement of the instruc­tional program at their institutions. A total of

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Faculty Salaries was released in December bythe Association. Data on salaries by degreetype were collected and reported for the firsttime since the beginning of the Survey. Toinsure comparability with prior years, datafor faculty with all degrees combined are also

VOL. 53, MARCH 1978

included. This year's report presents data on30,677 individuals, as compared to 30,487 inthe 1975-76 report. The modest increase canbe attributed to the elimination of affiliatedfaculty, house staff, and fellows from thisyear's reporting format.

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Students

In the competItIOn for 1977-78 first-yearplaces in U.S. medical schools, more than41,000 applicants submitted over 350,000applications. This reflected, for the secondconsecutive year, a slight decline in the num­ber of individuals seeking admission. Medicalstudent enrollments, however, continue torise, and the 15,613 freshmen and 57,765total students reported by the nation's medicalschools for 1976-77 represent an all-timehigh.

The application process was assisted againthis year by the Early Decision Program aswell as by the American Medical CollegeApplication Service (AMCAS). For the1977-78 first-year class, 58 medical schoolsparticipated in the Early Decision Program,and 892 students were accepted. Since eachof the 892 students filed only one applicationas opposed to the average of 8.9, the process­ing of about 7,047 applications was elimi­nated.

AMCAS was utilized by 86 medical schoolsfor the processing of first-year applicationmaterials. Besides collecting and coordinatingadmissions data in a uniform format, AMCASprovides useful rosters and statistical reportsto participating schools. At the same time,AMCAS maintains a national data bank forresearch projects associated with admissions,matriculation, and enrollment. The AMCASprogram continues to be guided in the devel­opment of its procedures and policies by theGroup on Student Affairs Medical StudentInformation System Committee.

At the direction of the AAMC, the Amer­ican College Testing Program continued re­sponsibility for operations related to the reg­istration, test administration, test scoring,and score reporting procedures for the Medi­cal College Admission Test. Approximately53,600 examinations were given in the springand fall of 1976, down from 57,500 in 1975,and 58,200 in 1974.

April 30, 1977 marked the first use of theNew Medical College Admission Test, whenthe test was administered to 30,648 individ­uals.The New MCAT represents an attemptto improve the assessment procedures foradmissions and provides a more differentiatedway for candidates to present evidence oftheir preparation for entering medical school.Beginning with the 1978-79 entering class,medical school admissions officers will requireNew MCAT scores as part of the applicationprocess.

Commissioned in 1976 to examine existingand potential mechanisms for providing finan­cial assistance to medical students, the TaskForce on Student Financing made an interimreport to the Executive Council in June. Inits report, the task force outlined long- andshort-term recommendations and a proposalfor a new guaranteed student loan program.The final report is expected in June 1978.

Also in the area of student financial assist­ance, the chairman of the Group on StudentAffairs, members of the Task Force on Stu­dent Financing, and the GSA Committee onFinancial Problems of Medical Students metwith representatives of the White House Do­mestic Council to discuss the problems offinancing medical students. The major con­cern stated was that rising costs and decreasesin need-based financial assistance programswere combining to cause an upward trend Inthe income levels of enrolled medical stu­dents. Such a trend could seriously limIt theopportunities for a medical education of thefinancially disadvantaged.

Several AAMC activities and publication,have been aimed at increasing opportunitie,for minority students in medicine. Foremostamong these has been the Simulated MInorityAdmissions Exercise (SMAE), first devel­oped in 1974. The purpose of the SMAE isto train admissions committee members toassess the potential for medicine of minority

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272 Journal of Medical Education

applicants. To do this, the trainees reviewsimulated applicant data which includegrades, test scores, and noncognitive infor­mation. The SMAE has been offered to re­gional groups of admissions officers, advisers,and medical school admissions committees.Admission workshops have been conductedfor over 20 schools.

Minority Student Opportunities in UnitedStates Medical Schools, published in 1975,was updated in July and distributed to admis­sions officers and advisors. This publicationprovides detailed information about medicalschool programs of recruitment, admissions,academic reinforcement, and financial aidavailable to disadvantaged students. TheMedical Minority Applicant Registry has beencompiled and circulated to all U.S. medicalschools. This registry is designed to assist theschools in identifying minority and financiallydisadvantaged candidates who are seekingadmission to medical school.

Because of the increasing concern over thenumber of lawsuits being filed against schoolscharging that special minority admissions pro­grams discriminate unlawfully against whites,the AAMC conducted a survey to determinethe characteristics and outcomes of such suits.In the case of Bakke v. Regents of the Uni­versity of California, the Association filed anamicus curiae brief before the California Su­preme Court. The AAMC's position was thatspecial admIssion programs for minority stu­dents do not violate constitutional equal pro­tection safeguards. Continuing its support inthe same case, the Association filed an amicuscuriae brief before the U.S. Supreme Courtaskmg for reversal of the California decision.

The AAMC Task Force on Minority Stu­dent Opportunities in Medicine was estab­lished to make recommendations to improveopportunities for minorities seeking careersin medIcine. The 14-member task force pre­sented an interim report to the ExecutiveCouncil in September and should completeits final report in the coming year.

A major national program focusing on mi­norities in medical education is sponsoredannually during the AAMC Annual Meeting.The program in San Francisco in 1976 fea­tured U.S. Representative Yvonne Brath­waite Burke (D-CaIiL) who spoke on the con­tribution of minorities in medicine.

VOL. 53, MARCH 1978

An action of the AAMC Executive Coun­cil, adopted last fall by the Group on StudentAffairs, provides for a section within the GSAto include minority affairs representativesfrom every medical school in the country.The section will hold its first meeting this fallto discuss programs affecting admissions, fi­nancial aid, and the graduate education ofminority medical students.

During the year, 11 major student studieswere completed under contract with the Bu­reau of Health Manpower (BHM). Particu­larly notable was The Medical School Admis­sions Process: A Review of the Literature,1955-1976, a comprehensive bibliography ofalmost 500 items.

Five of these reports dealt with medicalstudent financing. Medical Student Indebted­ness and Career Plans, 1974-75 concludedthat career choice was probably more closelyrelated to student background than to indebt­edness. Student Finances and Personal Char­acteristics, 1974-75 revealed that nine in 10of those who applied for aid received someassistance. Medical Student Finances and In­stitutional Characteristics, 1974-75 confirmedthat students in private schools were moredependent on parental and outside aid thanthose in public schools. A Study of PublicHealth Service (PHS) Scholarship Recipientsand National Health Service Corps (NHSC)Participants showed that the scholarship hold­ers were somewhat more apt than medicalstudents in general to be minority group mem­bers and to come from relatively lower socio­economic backgrounds. A special report ad­dressed itself to the topic, Additional SelectionFactors Suggested for the Public Health ServiceScholarship Program.

The other five projects dealt with the char­acteristics and career choices of recent appli­cants and students. The Descriptive Study ofMedical School Applicants, 1975-76 includedan analysis of the 42 percent of applicantswho were college seniors applying for thefirst time and showed their acceptance rate tobe substantially higher than that for candi­dates in general. An analysis of Economicand Racial Disadvantage as Reflected in Tra­ditional Medical School Selection Factorsdemonstrated the grade-point averages andMCAT scores of applicants varied onlyslightly by level of parental income within a

273

mission Test to the time they applied to theNational Intern and Resident Matching Pro­gram. At graduation, almost two-thirds pre­ferred a primary care residency when definedto include internal medicine and pediatrics aswell as family practice. Finally, a pilot studyto ascertain the career aspirations and practiceplans of graduates and the influence of theirmedical education was carried out at ninemedical schools. This survey will be con­ducted nationally in 1977-78.

Other research initiated during 1976-77included studies on 1976-77 applicants andenrolled students, a COTRANS trend studyfor 1970 through 1976, several additionalstudies of medical student financing, and atargeted study comparing the admissionsprocess for 1976-77 and 1973-74.

AAMC Annual Report for 1977

given racial grouping, but varied far moresubstantially by race within a given incomeclass. A study of Characteristics of u.s. Citi­zens Seeking Transfer from Foreign to U.S.Medical Schools in 1975 via the CoordinatedTransfer Application System (CO TRANS)

::: confirmed that the majority had previously9 applied unsuccessfully to a U.S. school andi2 that two-thirds were from New York, New§ Jersey, and California. The Descriptive Study<l) of Enrolled Medical Students, 1975-76 in­0.. cluded the finding that more first-year stu-

dents than final-year students had preadmis­sion career choices of general/primary care.A study of Career Choices of the 1976 Grad­uates ofu.s. Medical Schools found that overhalf changed their specialty preferences fromthe time they took the Medical College Ad-

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Institutional Development

administrators work with a limited number ofmedical school decision-makers who requestthe kind of assistance offered. Documentationof observations is an important part of thework.

Since its inception, the MAP has been bothan educational effort and an opportunity forsenior administrators from academic medicalcenters to develop institutional plans. Allmedical school deans are invited to attend.Since 1972, 102 deans, 41 hospital adminis­trators and 27 department chairmen have par­ticipated in Executive Development sessions.Institutional Development Seminars have in­cluded 64 institutions of which 20 have at­tended more than one such follow-up se~sion.

Over 652 individual participants have at­tended; in addition to deans, departmentchairmen and hospital administrators, vicepresidents, chancellors, program directors,business officers, planning coordinators, andstate legislators have been included.

The Management Advancement Programwas planned by an AAMC Steering Commit­tee chaired by Dr. Ivan L. Bennett, Jr. Thesteering committee has sought the advice of anumber of individual consultants and expertson design of the overall effort, and togetherthey have continued to monitor program con­tent and structure carefully. Support for earlyprogram planning was provided by the Car­negie Corporation of New York and by theGrant Foundation. Three grants from theRobert Wood Johnson Foundation have per­mitted full implementation of the program.

During the past five years, ManagementAdvancement Program participants have ex­pressed a growing and continuing interest inmanagement issues facing their institutions.In addition, requests for seminars from awide range of groups in the academic medicalcenter environment have indicated the needto reach a broader audience. In order todevelop a critical mass of individuals informed

This past year represented the fifth year ofthe AAMC Management Advancement Pro­gram, which now includes three separate butrelated components: Executive DevelopmentSeminars (Phase 1), Institutional Develop­ment Seminars (Phase II) and a TechnicalAssistance Program.

Phase I is an intensive six day workshop inmanagement technique and theory. Lecturesand discussion sessions provide an opportu­nity for medical school deans to share com­mon problems while acquiring theoreticalbackground knowledge in the general man­agement area. Whenever possible, depart­mental chairmen and teaching hospital admin­istrators are included as participants. Topicsare drawn from a wide range of planning andcontrol and behavioral science concepts.

Phase II, the Institutional DevelopmentSeminar, is a four and a half day session forwhich medical school deans who have partici­pated in a Phase I session are invited toidentify an institutional opportunity or prob­lem requiring careful study. Each dean isasked to select a group of individuals fromthe medical school who would need to beinvolved in the implementation of any deci­sion reached on the issue he has chosen toaddress. Five or six such institutional teamsmeet at an off-site location for lectures andteam discussion sessions. Each team is as­signed an expert management consultant whois responsible for facilitating group discussionduring team sessions, and where appropriate,for suggesting alternative means of dealingwith the self-identified management issue.

The Technical Assistance Program is de­signed to provide on-site management consul­tation to interested academic medical centeradministrators. The purpose of the programis to encourage improved organizational di­agnosis, problem solving and/or planning. Sitevisit teams comprised of management consult­ants and experienced academic medical center

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AAMC Annual Report/or 1977

of current management theory and practices,the AAMC negotiated a contract with theNational Library of Medicine, which began inthe spring of 1976 and was renewed for asecond year in January 1977. The Manage­ment Education Network Project is aimed atproviding academic medical center adminis­trators with regular access to managementinformation. The project also includes docu­mentation of the results of studies of institu­tional management problems and issues forwider dissemination. The contract encom­passes the following specific tasks: (a) designof management literature retrieval system,which includes the publication of "MAPNotes," a summary of current managementinformation; (b) development of audiovisualinstructional materials which will be availablefrom the National Medical Audiovisual Cen­ter; (c) documentation of selected academicmedical center managerial processes; and (d)exploration of the desirability and feasiblityof simulation modeling as a management toolfor medical school decision-makers. Dr. J.Robert Buchanan has served as chairman ofthe Advisory Committee, which has helpeddesign and monitor program activities.

During the past year a detailed examinationof the affiliation arrangements between asample of six selected medical schools andtheir networks of affiliated teaching hospitalswas completed. The Medical School-Clinical

275

Affiliations Study, supported under contractwith the Bureau of Health Manpower, follows!i management perspective to examine thestructure and process of decision-making inaffiliation relationships. The project was com­pleted under the guidance of a project reviewcommittee chaired by Dr. Robert Massey andwith the assistance of a liaison representativefrom each medical school in the sample. Sub­stantial quantitative data and the reports ofsite visits were analyzed to develop descrip­tions of the affiliation networks and to providesome assessment of what factors contributeto an effective relationship. Copies of thereport were distributed to each member ofthe Council of Deans and the Council ofTeaching Hospitals.

The Visiting Professor Emeritus Program,established in 1976, completed its first fullyear of operation during the past year. Withsupport from the National Fund for MedicalEducation, this program serves as a link be­tween emeritus faculty interested in continu­ing their careers on a limited basis and medi­cal schools desiring to utilize the availabletalents of senior physicians and scientists. Theresponse to the program has been most en­couraging and greater utilization of this valu­able reservoir of experienced medical educa­tors promises to make a significant contribu­tion to medical education.

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Teaching Hospitals

Three major issues have dominated the As­sociation's teaching hospital activities duringthe past year: Senator Talmadge's proposalto establish a prospective ceiling on paymentsfor routine operating costs under the Medi­care and Medicaid programs, the Carter Ad­ministration's proposal to place a ceiling onhospital revenue increases and to reduce hos­pital capital expenditures, and Congressionaland legal challenges arising from the NationalLabor Relations Board's finding that housestaff are students for purposes of the NationalLabor Relations Act. Other issues receivingsignificant attention included the impact onmajor medical centers of the National HealthPlanning and Resources Development Act,the Association's court challenge of regula­tions implementing the routine service costlimitations of the Medicare program, and theanticipated implementation of legislation es­tablishing fee-for-service payment require­ments for physicians in teaching hospitals.

In early May Senator Herman Talmadge,chairman of the Subcommittee on Health ofthe Senate Finance Committee, and 20 co­sponsors introduced a revised version of theMedicare and Medicaid Administrative andReimbursement Reform Act. The biII wasvery similar to one introduced last year, in­cluding provisions to establish a payment lim­itation procedure for routine operating costs,to establish a special payment limitation cate­gory for the "primary affiliates of accreditedmedical schools," and to eliminate MedicarelMedicaid recognition of percentage contractsfor certain physician services often performedin hospitals.

Association positions on the provisions ofthe Talmadge biII were initially reevaluatedby an ad hoc committee and subsequentlyadopted by the Association's Executive Coun­cil. In testifying on the biII before the Sub­committee on Health of the Senate FinanceCommittee, the Association acknowledged

that hospital payment limitations derivedfrom cross-classification schemes are one le­gitimate approach to containing expendituresfor hospital services and recommended addingflexibility to the biII so that learning acquiredthrough experience would not require newlegislation. The AAMC recommended thatthe HEW Secretary initiate studies to definetertiary carelteaching hospitals and to exam­ine the impact of establishing a-special pay­ment category for them. The Associationstrongly supported amending the bill to en­sure that faculty physicians could be paid foreither professional or educational serviceswhen providing care in the presence of stu­dents and opposed physician payment mech­anisms which would inhibit the developmentof any discipline. Staff members of the Asso­ciation have worked with subcommittee staffto refine these proposed modifications.

In April President Carter introduced hisHospital Cost Containment Act of 1977, stat­ing that "the cost of care is rising so rapidly itjeopardizes our health goals and our otherimportant social objectives." The Associationevaluated the Administration's proposal withthe assistance of an ad hoc committee thatincluded representatives from all constituentCouncils. In House and Senate testimony onthe cost containment proposal, the Associa­tion stated its strong opposition to both theimposition of a cap on hospital revenues whenno other segment of the economy is similarlycontrolled and to a capital expenditure ceilingthat fails to provide adequate funds for gov­ernment-mandated facility improvements andfor the replacement of obsolete facilities es­sential to patient care. In lieu of the Presi­dent's proposal, the Association advocated asix-point cost containment program based onimplementing a system of uniform hospitalcost reporting, publishing hospital cost data,establishing a cost impact statement for hos­pital-related legislation and regulation, ex-

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AAMC Annual Report for 1977

panding and fully implementing utilizationand health planning controls, enacting pro­spective payment limitations derived fromcross-classification schemes, and permittingMedicare to pay state-determmed hospitalrates where the programs comply with neces­sary Federal standards.

In March of 1976, the NatIOnal LaborRelations Board (NLRB) ruled in its Cedars­Sinai decision that "interns, residents, andclinical fellows are primarily engaged in grad­uate training and are students rather thanemployees within the meaning of the NationalLabor Relations Act." In spite of this deci­sion, some house staff associations have pur­sued legal and legislative actions to havehouse staff redefined as employees. In bothstate and federal court actions, the Associa­tion has filed amicus curiae briefs supportingthe NLRB decision and arguing that itpreempts contradictory state labor board ac­tion. The U.S. Court of Appeals for theSecond Circuit agreed with this position, pre­venting the New York State Labor Boardfrom exercising jurisdiction over house staffin hospitals subject to the federal labor law.

Bills specifically defining house staff asemployees under the National Labor Rela­tions Act have been introduced in both theHouse of Representatives and Senate. TheAssociation has reiterated in testimony itsposition that residency programs are an inte­gral part of the medical education program,that residents' primary relationship with thehospital should be based on an educationalrather than an industrial model, and that theimposition of a labor-management relation­ship would seriously reduce the effectivenessof these programs.

The National Health Planning ResourcesDevelopment Act originally due to expire in1977 was extended by Congress until 1978.Because the administration of the Act is prin­cipally based on local health planning agencieswhich may give inadequate consideration tothe regional and national missions of medicalschools and teaching hospitals, the Associa­tion contracted with Eugene Rubel, formerdirector of HEW's Bureau of Health Planningand Resources Development, to study theimplementation of the Act. Based on recentlycompleted site visits to several medical centers

277

and health planning agencies, the study willprovide the informatIOn necessary to evaluatehow the Act is affecting the academic medicalcenter.

The Association's appeal of its suit overDHEW's implementation of Medicare routineservice cost limitations is still pending beforethe U.S. Court of Appeals for the District ofColumbia Circuit. While oral arguments onthe appeal were presented in September1976, the court this past spring requestedsupplemental briefs on the jurisdictional au­thority of the courts in this matter. The Asso­ciation filled the requested brief arguing that,while individual claimants seeking judicial re­view of specific benefit determmations mustfollow prescribed administrative proceduresbefore turning to the courts, the court hasdirect and immediate jurisdiction to reviewagency regulations implementing legislation.

During the year, the Association workedclosely with Executive agencies and COTHmembers in several areas where policies werebeing established or reviewed. These includeuniform hospital accounting and reportingsystems, Medicare offset requirements forfamily practice grants, Medicare's treatmentof interest provisions of Section 227 of the1972 Medicare amendments, and Medicare'srecently enacted policy of recognizmg self­insurance contributions as reimbursable mal­practice costs.

The Associations' program of teaching hos­pital surveys combines four regular and recur­ring surveys with a limited number of special,issue-oriented surveys. The regular surveysare the Educational Programs and ServicesSurvey, the House Staff Policy Survey, theIncome and Expense Survey for University­Owned Hospitals, and the Executive SalarySurvey. During the year, each of these surveyshad an excellent response rate from memberhospitals. The findings of each of these sur­veys have been furnished to participating hos­pitals and, when appropriate, results havebeen publicly distributed. Three special sur­veys were conducted this year: the Survey ofthe Impact of Section 223, the Survey ofProfessional Liability Insurance in University­Owned Hospitals; and the Survey of Con­struction Funding for Non-Federal COTHHospitals.

278

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Communications

A variety of publications, news releases, newsconferences and personal interviews with rep­resentatives of the news media are used bythe Association to communicate its views,studies, and reports to its constituents, inter­ested federal representatives, and the generalpublic. The major vehicle used by the Asso­ciation to inform its constituents is the Presi­dent's Weekly Activities Report. This publi­cation, which is issued 43 times a year andreaches about 9,000 readers, reports onAAMC activities and federal activities thathave a direct effect on medical education,biomedical research, and health care.

In addition to the Weekly Activities Re­port, other newsletters of a more specializednature are: The Advisor, CAS Brief, COTHReport, DEMR Report and Student AffairsReporter. Numerous other publications suchas directories, reports, papers, studies, pro­ceedings, and archival listings are also pro­duced and distributed by the Association.

In an effort to keep U.S. medical studentsabreast of national medical education issues,the Association has undertaken on a trialbasis the publication of a newsletter distrib­uted free-of-charge to the approximately60,000 students. The two editions of OSRReport published to date have dealt withlegislation, activities of the AAMC Organiza­tion of Student Representatives (OSR), andAAMC programs of special interest to medi­cal students. The Report is mailed in bulk toeach school's OSR representative in sufficientquantity for distribution to all medical stu­dents. Publication of the OSR Bulletin Board,which has been the AAMC newsletter formedical students for the past two years, hasbeen temporarily suspended until after theExecutive Council evaluates the effectivenessof OSR Report.

The Journal of Medical Education in fiscal

1977 published 1,166 pages of editorial ma­terial in the regular monthly issues, comparedwith 1,042 pages the previous year. Onesupplement was published during the year:"Analysis and Comment on the Report ofthe President's Biomedical Research Panel."In addition to the regular issues, a 104-pagepublication, Federal Support of BiomedicalSciences: Development and Academic Im­pact, by James A. Shannon, M.D., was car­ried as Part 2 of the July 1976 issue. Theplenary addresses from the 1975 AAMC An­nual Meeting and the 1976 AAMC Proceed­ings and Annual Report also were publishedin the Journal.

Excluding the supplement and the Part 2publication, a total of 174 papers (82 regulararticles, 81 Communications, and 11 Briefs)were published, compared with 152 papers infiscal 1976. The Journal also continued topublish editorials, Datagrams, book reviews,letters to the editor, and bibliographies pro­vided by the National Library of Medicine.

The volume of manuscripts submitted tothe Journal for consideration continued torun high. Papers received in 1976-77 totaled411, compared with 404 and 422 the previoustwo years. Of the 411 articles received in1976-77, 141 were accepted for publication,179 were rejected, 15 were withdrawn, and76 were pending as the year ended.

Pages of paid advertisements totaled 81during the fiscal year, compared with 92 pagesthe previous year. As the year ended, theJournal's monthly circulation was almost6,800, an increase of 100 over a year ago.

About 30,000 copies of the annual MedicalSchool Admission Requirements, 3,500 cop­ies of the AAMC Directory of AmericanMedical Education, and 6,000 copies of theAAMC Curriculum Directory were sold ordistributed.

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Information Systems

The Association has acquired a general pur­pose computer system to support its informa­tion requirements. Most information systemshave become operational on the computersystem since its instalIation in September1976. This in-house system will alIow theAssociation to optimize the use of its infor­mation resources in the programs of the As­sociation.

The information system was utilized togenerate several exploratory studies of medi­cal schools in general, including: Study ofMedical Education: Interrelationships Be­tween Component Variables; An EmpiricalClassification ofu.s. Medical School by Insti­tutional Dimensions; and A MultidimensionalModel of Medical School Similarities.

In addition to the annual "Study of V.S.Medical School Applicants" published in theJournal of Medical Education, the data basesupports research and special reports on topi­cal subjects. During the past year these specialreports included: Descriptive Study of Medi­cal School Applicants, 1975-76, DescriptiveStudy of Enrolled Medical Students, 1975­76, and a series of studies concerning themanner in which medical students financetheir education, based on a previous AAMCsurvey of 1974-75 students. The series in­cluded Medical Student Finances and Per­sonal Characteristics, 1974-75, and MedicalStudent Finances and Institutional Character­istics, 1974-75.

The Institutional Profile System containsover 12,000 data elements from more than70 sources describing V.S. medical schools asinstitutions of higher education. The primarysource~ of data for the Institutional ProfileSystem have been ad hoc and recurrent ques­tionnaires administered by the AAMC andothers, such as the Liaison Committee onMedical Education Annual QuestionnaireParts I and II. Data from other AAMC infor­mation systems, such as the Medical Student

279

Information System and the Faculty RosterSystem, are also aggregated by institution andentered into the Institutional Profile Systemdatabase.

The primary objective of the InstitutionalProfile System IS the provision of a readilyaccessible repository of valid data that de­scribe medical education institutions. This isaccomplished through an on-line integrateddatabase and supporting computer softwarepackage that allows immediate user retrievalof data via remote terminals. The system isused to respond to requests for data frommedical schools (especially for comparativeinformation) and other interested parties.Such requests numbered approximately 225during the 12 months ending June 1977 andover 550 for the three years that IPS hasbeen operational.

The Institutional ProfIle System has al~o

been used exten~ively to support a variety ofstudies or projects that require institutionalinformation. During the last year, severalreports describing medical education institu­tions using multivariate statistical procedure~

were prepared under contract with the Bureauof Health Manpower, DHEW. The Institu­tional Profile System was also used to proVIdedata to relate institutional characteristics tostudent finances and career choices.

The Association serves as the primarysource of information on teaching hospitals.Annual surveys are conducted to obtain na­tional information on housestaff stipends,benefits, and training agreements; income,expense and general operating data for uni­versity-owned hospitals; hospital and depart­mental executive compensation; and generaloperating, educational program, and servicecharacteristics of teaching hospitals. SpecIalstudies conducted during the past year col­lected information on the impact on teachinghospitals of the routine service cost limitationsimposed under the Medicare program and on

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280 Journal of Medkal Education

the professional liability insurance coverageof and premiums paid by university-ownedteaching hospitals. These surveys providedthe necessary data for five general publica­tions during the year: 1977 COTH Directoryof Educatlonal Programs and Services, 1976COTH Survey of House Staff Policy and

VOL. 53, MARCH 1978

Related Issues, COTH Survey of University­Owned Teaching Hospitals' Financial and Gen­eral Operating Data, 1976 Council of Teach­ing Hospitals Executive Salary Survey, andCOTH Survey of Professional Liability Insur­ance in University-Owned Hospitals.

281

1976-77115

317o1

60400

1,9444371

612

1975-76III

617o1

59396

2,0264270

717

reserve equal to 65.17% of the expendituresduring the year.

By action of the Executive Council theOfficers of the Association have been directedto maintain unrestricted reserves of not lessthan 50% and, as a goal, 100% of the Asso­cIation's annual operating budget. It is ofincreasing importance that this policy of re­serve accumulation be continued. Approxi­mately 30% of the Association's revenuesare derived from sources outside of the Asso­ciation. Because of the uncertainties associ­ated with such funding, the existence of ade­quate reserves is needed to assure the contin­uation of essential services through transi­tional periods should there be substantial re­ductions in funding from outside sources. AFinance Committee appointed by the Execu­tive Council is currently studying the financIalstructure of the Association with particularemphasis on future sources of funding.

AAMC Membershjp

Treasurer's Report

TYPEInstitUlJonalProvisional InstitUlJonalAffiliateProvisional AffiliateGraduate AffiliateAcademic SocietiesTeaching HospitalsIndivIdualDistinguished ServiceEmeritusContributingSustainmg

On August 31,1977, the AssocIation's AuditCommittee met and reviewed in detail theaudited statements and the audit report forthe fiscal year ended June 30, 1977. Meetingwith the Audit Committee were representa­tives of Ernst & Ernst, the Association'sauditors; the Association's legal counsel; andAssociation staff. On September 16, 1977the Executive Council reviewed and acceptedthe final unqualified audit report.

Income for the year totaled $8,786,232­an increase of 1.37% from the previous fiscalyear. Operating expenses increased 4.59% to$8,231,313.

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a8 Balances in funds restricted by the grantoro decreased $135,348 to $153,498. After mak­

Q ing provision for Board appropriations forspecial purposes in the amount of $299,000,unrestricted funds available for general pur­poses increased $463,419 to $5,364,571-a

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Association of American Medical CoUeges

Balance Sheet

June 30, 1977ASSETS

CashInvestments

U.S. Treasury BillsCertificates of DepositManagement Account

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

LIABILITIES AND FUND BALANCES

LiabilitiesAccounts Payable

Deferred IncomeFund Balances

Funds Restricted by Grantor for Special PurposesGeneral Funds

Funds restricted for Plant InvestmentFunds restricted by Board for Special PurposesInvestment in Fixed AssetsAvailable for General Purposes

Total Liabilities & Fund Balances

Operating Statement

Fiscal Year Ended June 30, 1976

SOURCE OF FUNDS

IncomeDues and Service Fees from MembersGrants Restricted by GrantorCost Reimbursement ContractsSpecial ServicesJournal of Medical EducationOther PublicationsSundry

Total IncomeReserve for MCAT DevelopmentReserve for Special Minority ProgramsReserve for Special Legal ContingenciesReserve for Education NewsReserve for Data Processing ConversionReserve for Special Task ForcesDecrease in Restricted Fund BalancesTotal Source of Funds

USE OF FUNDS

Operating ExpensesSalaries and WagesStaff BenefitsSupplies & ServicesProvision for DepreciationTravel

Total ExpensesInvested in Fixed AssetsTransfer to Restricted Funds for Special PurposesIncrease in Funds Available for General PurposesTotal Usc of Funds

282

$5,283,907750,000938,992

$ 296,856613,808435,803

5,364,571

$ 185,958

6,972,899819,158

20,582435,803

$8,434,400

$ 555,4101,014,453

153,499

6,711,038$8,434,400

$1,591,725267,911

2,353,3523,557,202

69,658367,377579,007

$8,786,232167,36450,84828,33841,000

181,73838,668

135,347$9,429,535

$3,841,127502,855

3,260,89337,970

588,468$8,231,313

435,803299,000463,419

$9,429,535

AAMC Committees, 1976-77

Audit

Coordinating Council onMedical Education

AAMC Members:

John A. D. CooperJames E. EckenhoffRonald W. Estabrook

Continuing Medical Education

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

COT" Nominating .

Charles B. Womer, chairmanJ. W. Pinkston, Jr.David D. Thompson

COD Nominating

John M. Dennis, chairmanThomas A. BruceD. Kay ClawsonLawrence G. CrowleyAllen W. Mathies, Jr.

LIAISON COMMITIEE ON GRADUATE

MEDICAL EDUCATION

LIAISON COMMITIEE ON CONTINUING

MEDICAL EDUCATION

AAMC Members:

Richard M. BerglandWilliam D. MayerJacob R. Suker

283

Admissions Assessment

David D. Thompson, chairmanJohn M. DennisThomas R. Johns

CAS Nominating

A. Jay Bollet, chairmanCarmine D. ClementeRonald W. EstabrookNicholas GreeneWarren StampAllan B. WeingoldFrank E. Young

u Biomedical Research and Training

::§ Robert M. Berne, chairman~ Theodore Cooper<l)

-B Philip R. Dodge'0 Harlyn Halvorson~ Charles SandersoB David B. Skinner~ Samuel O. Thier<3u Peter C. Whybrow<l)

..s::......a Borden Awardo

<.l:1Robert S. Stone, chairman1::

<l) Cedric I. Davern§ Newton B. Everett8 Bodil Schmidt-Nielsen

David B. Skinner

Cheves McC. Smythe, chairman::: Jack Colwill~ Joseph S. GonnellarJ)§ David Jeppson<l) Walter F. Leavell0.."5 John McAnally..8 Christine McGuire~ Frederick Waldman'"d Leslie T. Webster

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AAMC Members:

Robert M. HeysselThomas K. Oliver, Jr.James A. PittmanAugust G. Swanson

LIAISON COMMmEE ON

MEDICAL EDUCATION·

AAMC Members:

Edward C. Andrews, Jr.Steven C. BeeringRonald W. EstabrookChristopher C. Fordham, IIIJohn P. KemphRichard S. Ross

Data Development Liaison

Richard Janeway, chairmanStanley M. AronsonMarion BallHoward J. BarnhardDavid DiamondJames GriesenMiles E. HenchSamuel HowardKenneth L. KutinaJames C. LemingC. Bruce McFaddenRaymond H. MurrayBernard NelsonCheves McC. Smythe

Finance

Charles B. Womer, chairmanIvan L. Bennett, Jr.Leonard W. Cronkhite, Jr.John A. GronvallRolla B. Hill, Jr.Robert G. Petersdorf

F1exner Award

Frederick C. Robbins, chairmanRobert A. BarbeeErnst KnobilMatthew F. McNulty, Jr.Manson MeadsDonald Widder

Governance and Structure

Daniel C. Tosteson, chairmanWilliam G. Anlyan

• For non-AAMC members, see page 287.

284

Sherman M. MellinkoffRussell A. NelsonCharles C. Sprague

Graduate Medical Education

Jack D. Myers, chairmanSteven C. BeeringD. Kay ClawsonGordon W. DouglasHarriet P. DustanSandra FooteCheryl M. GutmannSamuel B. GuzeRobert M. HeysselWilliam P. HomanWolfgang K. JoklikDonald N. Medearis, Jr.Stanley R. NelsonDuncan NeuhauserRichard C. ReynoldsMitchell W. Spellman

Group on Business Affairs

STEERING

C. N. Stover, Jr., chairmanWilliam Hilles, executive secretaryDaniel P. BenfordRobert D. DammannThomas A. FitzgeraldC. Duane GaitherPhilip GilletteRobert C. GravesDavid C. HouseJerry HuddlestonWarren KennedyV. Wayne KennedyErvin C. ProschekDavid A. SinclairDon B. Young

Group on Medical Education

STEERING

Robert A. Barbee, chairmanJames B. Erdmann, executive secretaryGeorge L. BakerMerrel D. FlairGunter GruppRussell R. MooresRobert F. SchuckHarold J. SimonGregory L. Trzebiatowski

285

Management Advancement ProgramSteering

Ivan L. Bennett, Jr., chairmanJ. Robert BuchananDavid L. EverhartJohn A. GronvallIrving LondonRobert G. PetersdorfClayton RichCheves McC. Smythe

Minority Student Opportunities in Medicine

George Lythcott, chairmanAlonzo C. AtencioRaymond J. BarrerasHerman R. BransonLinwood CustalowFrank DouglasPaul R. ElliottDoris A. EvansChristopher C. Fordham, IIIWalter F. LeavellCarter L. MarshallLouis W. SullivanDerrick TaylorNeal A. Vanselow

Journal of Medical Education Editorial Board

Richard P. Schmidt, chairmanStephen AbrahamsonJohn W. CorcoranHenry W. Foster, Jr.Richard J. HarperRalph W. IngersollEdgar Lee, Jr.J. Michael McGinnisChristme McGuireIvan N. MenshJacqueline NoonanEvan G. Pattishall, Jr.Osler L. PetersonGeorge G. ReaderRichard C. ReynoldsRobert RosenbaumC. Thomas SmithJames C. StricklerLouis W. SullivanJohn H. Westerman

National Citizens Adivsory Committee forthe Support of Medical Education

Mortimer M. Caplin, chairman

Group on Public Relations

STEERING

AAMC Annual Report for 1977

Group on Student Affairs

STEERING

Hospital Cost Control

Martin S. Begun, chairmanRobert J. Boerner, executive secretaryA. Geno AndreattaWillard DalrymplePaul R. ElliottMarilyn HeinsHenry H. HoffmanMartin A. Pops

U Thomas A. Rado~ W. Albert Sullivan

ao<.l:1 Implementation of Health Planning1:! Legislation(1)a Charles A. Sanders, chairman8 Walter F. Ballingero A. Jay Bollet

Q Raymond CornbillKenneth R. CrispellJohn M. DennisHenry B. DunlapWilliam H. LuginbuhlJohn M. StaglPhilip Zakowski

Terry R. Barton, chairmanCharles Fentress, executive secretaryDonald GillerCharles Gudaitis

§ Hugh Harelsoni2 Margaret Marshall~ Michael Mattsson;j) Helen M. Sims0.. Susan K. Stuart-Otto

Frank J. Weaver

(1)

...s::~ David L. Everhart, chairman~ Robert M. Heyssel::: Lawrence HilloB David H. Hitt~ Robert K. Rhamy"0 Elliott C. RobertsU Edward J. Stemmler(1)

-:5 Charles B. Womer

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286 Journal of Medical Education

George Stinson, vice chairmanJack R. AronG. Duncan BaumanKarl D. BaysAtherton BeanWilliam R. BowdoinFrancis H. BurrRetcher ByromMaurice R. ChambersAlbert G. ClayWilliam K. CoblentzAllison DavisLeslie DavisWillie DavisDonald C. DaytonBenson FordDorothy Kirsten FrenchCarl J. GilbertRobert H. GoddardEmmett H. HeitlerKatharine HepburnCharlton HestonWalter J. HickelHarold H. Hines, Jr.Jerome H. HollandMrs. GIlbert W. HumphreyErik Jons~on

Geraldine JosephJack JoseyRobert H. LeviFlorence MahoneyAudrey MarsArchie R. McCardellEinar MohnE. Howard MolisaniC. A. MundtArturo OrtegaThomas F. PattonGregory PeckAbraham PritzkerWilliam Matson RothBeurt SerVaasLeRoy B. StaverRichard B. StonerHarold E. ThayerStanton L. YoungW. Clarke WescoeCharles C. Wise, Jr.William WolbachT. Evans Wychoff

VOL. 53, MARCH 197f

Nominating

James E. Eckenhoff, chairmanA. Jay BolletJohn M. DennisHerluf V. Olsen, Jr.Charles B. Womer

Planning Coordinators' Group

STEERING

Russell C. Mills, chairmanGerlandino Agro, executive secretaryHoward J. BarnhardJohn C. BartlettMichael T. RomanoConstantine Stefanu

Resolutions

Robert L. Van Citters, chairmanCarmine D. ClementeJohn W. CollotonRichard Seigle

Student Financing

Bernard W. Nelson, chairmanJames W. BartlettJ. Robert BuchananAnna C. EppsWilliam I. IhlandfeldtThomas A. RadoJohn P. StewardRobert L. TuttleGlenn Walker

Support of Medical Education

Stuart Bondurant, chairmanStanley M. AronsonThomas BartlettSteven C. BeeringIvan L. Bennett, Jr.Frederick J. BonteDavid R. ChallonerJohn E. ChapmanRonald W. EstabrookChristopher C. Fordham, IIIJohn A. GronvallWilliam K. HamiltonMarilyn HeinsDonald G. HerzbergRobert L. Hill

AAMC Professional Staff

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Office of the PresidentPresident

John A. D. Cooper, M.D.Vice President

John F. Sherman, Ph.D.Special Assistant to the President

Bart WaldmanSpecial Assistant to the President for Womenin Medicine

Judith Braslow

Division of Business Affairs

Director and Assistant Secretary-TreasurerJ. Trevor Thomas

Business ManagerSamuel Morey

ControllerWilliam Martin

Staff AssistantDiane JohnCarolyn Ulf

SupervisorAlthea Adkins

Director, Computer ServicesJesse Darnell

Associate Director, Computer ServicesMichael McShane, Ph.D.

Manager, Computer OperationsAldrich Callins

Programmer!AnalystMehdi BalighianJennye ChungSuzanne GoodwinJay StarryJean SteeleJohn WelcherRobert YearwoodSara Zoller

Systems ProgrammerJames Studley

Division of Public Relations

DirectorCharles Fentress

288

Division of Publications

DirectorMerrill T. McCord

Assistant EditorJames Ingram

Manuscript EditorRosemarie D. Hensel

Staff EditorVerna Groo

Department of Academic Affairs

DirectorAugust G. Swanson, M.D.

Deputy DirectorThomas E. Morgan, M.D.

Senior Staff AssociateMary H. Littlemeyer

Staff ASSIStantAlan Mauney

Division of Biomedical Research

DirectorThomas E. Morgan, M.D.

Staff AssociateKathleen Dolan

Division of Educational Measurement andResearchDirector

James B. Erdmann, Ph.D.AssocIate Director

Robert L. Beran, Ph.D.Assistant to the Director

J. Michael McGrawResearch AssocIate

Robert JonesRichard E. Kriner, Ph.D.Marcia LaneAnne ShaferXenia Tonesk, Ph.D.

Research AssistantMillicent Dudley

AAMC Annual Report for 1977 287

James Kelly Ellis BensonSherman M. Mellinkoff Stuart BondurantJohn Milton John W. CollotonRichard H. Moy Marvin CornblathMitchell T. Rabkin John M. DennisPaul Scoles Jerome H. ModellPeter ShieldsEugene L. Staples

VA LiaisonEdward J. StemmlerGeorge Stinson Saul J. Farber, chairman

::: Louis W. Sullivan John R. Beljan9rJ) Virginia Weldon Lawrence G. CrowleyrJ)a George D. Zuidema D. Kay Clawson\-;(1)

Joe S. Greathouse, Jr.0........ Talmadge Bill Review Sherman M. Mellinkoff;:l0..s:: Irvin G. Wilmot, chairman James A. Pittman, Jr.~ Daniel W. Barker Robert L. Van Citters'"d

(1)u;:l

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.D0......

......0Zu

~ Liaison Committee Patrick J. V. Corcoran(1) on Medical Education Perry J. Culver..s::......

William F. Kellow4-<0

Non-AAMC Members*rJ) Robert S. Stone:::9

AMERICAN MEDICAL ASSOCIATION......u PUBLIC~<3 Warren L. Bostick Harriet S. Inskeepu

(1) Louis W. Burgher..s:: Arturo G. Ortega......a0 FEDERAL GOVERNMENT<.l:11:: • For AAMC members, see page 284. John H. Mather(1)

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Department of InstitutionalDevelopment

DirectorMarjorie P. Wilson, M.D.

Project Director, ManagementEducation Network

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

Amber JonesStaff Associate

Peter ButlerStaff Assistant

Marcie Foster

289

Research AssistantMary AckermanTravis Gordon

Department of Health Services

DirectorJames I. Hudson, M.D.

Staff AssociateJoseph GiacaloneMarcel Infeld

Division of Accreditation

DirectorJames R. Schofield, M.D.

Staff AssistantJoan Johnson

Division of Institutional Studies

DirectorJoseph A. Keyes

Department of Teaching Hospitals

DirectorRichard M. Knapp, Ph.D.

Assistant DirectorJames D. Bentley, Ph.D.

Staff AssociateArmand CheckerJoseph Isaacs

Department of Planningand Policy Development

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

Deputy DirectorH. Paul Jolly, Jr., Ph.D.

Division of Faculty Development

AAMC Annual Report for 1977

DirectorHilliard Jason, M.D.

Associate DirectorDale R. Lefever, Ph.D.

Evaluation CoordinatorHenry B. Slotnick, Ph.D.

Workshop CoordinatorLuis L. Patino

DirectorRobert J. Boerner

Assistant Director, Special ProgramsSuzanne P. Dulcan

Director, Minority AffairsDario O. Prieto

Research AssociateJuel Hodge

Staff AssociateDiane Newman

Division of Student Studies

DirectorDavis G. Johnson, Ph.D.

Associate DirectorW. F. Dube

Research AssociateJanet CucaRichard Mantovani

Division of Student ServicesDirector

Richard R. RandlettAssociate Director

Sandra K. LehmanStaff Assistant

Carla WinstonManager

Alice CherianEdward B. GrossSharon L. Smith

SupervisorLinda W. CarterJosephine GrahamVirginia JohnsonPhilip LynchGail ShermanKathryn Waldman

1:: Data Entry Specialist(1) Janet Collinsa8o

Q

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§(1)

0.. Division of Student Programs"5o..s::~"'d

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290 Journal of Medical Education

Legislative AnalystJudith BrasJowSteven GrossmanScott Swirling

Division of Operational Studies

DirectorH. Paul Jolly, Jr., Ph.D.

Associate DirectorWilliam HillesDouglas McRae, Ph.D.

Operations Manager, Faculty ProfileAarolyn Galbraith

Senior Staff AssociateGerlandino AgroCoralie Farlee, Ph.D.Joseph Rosenthal

Staff AssociateBetty Higgins

VOL. 53, MARCH 1978

Robert SavoyCharles Sherman, Ph.D.

Research AssistantJanet Bickel

Staff AssistantLoretta LaskowskiCynthia ScottKathryn SzawlewiczSusan Tillotson

Division of Educational Resources andPrograms

DirectorEmanuel Suter, M.D.

Research AssociateWendy Waddell

Staff AssociateBetty McIlvane

.\Iarch 19iH

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DIRECTOR ofPRIMARY CARESERVICES_,~,r rO('ld'" e:..pond'ng -100 bPd un ~ers'lv Teo h ng ... sp fOI .,so"'ek ng a P~""Sl:'an 0 re f"r ,~ Pr'T'or'r Lor.... sPr •• 5 ,. thl

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Unhrersltg ofMa~"C1chusetts

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1977-78AAMC Curriculum Directory

The annually revised AAMC Curriculum Directory provides basic objective dataon the curriculum of every U.S. and Canadian medical school (including theUniversity of Puerto .Rico) matriculating students during the current academicyear. Each medical school has a two-page description which outlines theschool's instructional program. including required and elective course titles.duration and types of instruction. and specific conditions for learning. In addi­tion. schools are grouped in terms of certain commonalities. Descriptivestatistics with frequency tables and categorical listings are drawn from theinformation provided by the individual schools which identify patterns ofchange and development in the medical curriculum.

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

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

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$5.00 (Book Rate)

300 pages

$6.50 (First Class)