Association of American Medical Colleges Annual Meeting and Annual Report . 1983
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::o Table of Contents
Chairman's Address 219 Annual Meeting Plenary Session ...... 222 The Current Status of Academic Medical Center-HMO Relationships ...... 222 Special General Session...... 222 Council ofAcademic Societies...... 223 Council ofDeans 223 Council ofTeaching Hospitals 223 Organization ofStudent Representatives 223 GSA/Minority Affairs Section ...... 224 Minority Affairs Program ...... 224 Women in Medicine...... •...... 224 Data Bases in- Academic Medicine ...... 225
Faculty Roster System ... 1t •••••••••••••••••••••••••••• •• 225 Institutional Profile System...... 225 Group on Business Affairs...... 225 Group on Institutional Planning 225 Group on Medical Education...... 226 Liaison Committee on Medical Education 228 Group on Public Affairs...... 229 Group on Student Affairs 230 Research in Medical Education...... 230 Assembly Minutes...... 233 Annual Report Executive Council, Administrative Boards ...... 238 The Councils -...... 239 National Policy 247 Working with Other Organizations...... 252 Education ...... 255 Biomedical and Behavioral Research 258 Faculty ...... 260 Students ...... 261 Institutional Development ...... 264 Teaching Hospitals 265 Communications...... 270 Information Systems ...... 272 AAMC Membership ...... 274 Treasurer's Report...... 274 AAMC Committees...... 276 AAMC Staff...... 280 218 Chairman's Address
What's Right About American Medicine
Steven c. Beering, M.D., Se.D.
Benjamin Disraeli once said: "The health university to be as open to all kinds of of the people is really the foundation students as itwas to new ideas. He wanted upon which all their happiness and all his faculty to provide not just the tradi their powers as a state depend." Gathered tional disciplines but to offer practical § here today are students and teachers, pro- subjects-such as science and engineer ~ ] '. viders and consumers, researchers, and ing-in realistic settings. He wanted the i radministrators. There are rep~esentatives university to become an essential partner ~ t~ of government, the lay publIc, and the with other segments of society in plan ~ I~· media. Each ofus comes from a different ning, building, and developing our new ~ : background but all of us share the same country. u - goal-a healthy America. And the best In 1846, when Charles Eliot returned ~ . way to assure this goal is to maintain and from Europe to assume the presidency of . improve our system of medical educa Harvard, he was troubled that American tion, scientific research, and compassion medical education consisted oflittIe more ate care. than vocational training. He insisted on We owe our success in large measure bringing the medical school into the uni
ao to the life and thought of three great versity. He called for a full-time faculty <.l:1 Americans-Jefferson, Eliot, and Flex and demanded the same scientific vigor ner. that he expected from the other research In 1819, ThomasJefferson founded the sciences. University ofVirginia. This was going to In 1910, Abraham Aexner surveyed a different kind of school. He was the American medical education scene oncerned that our early colleges were and made five major recommendations: . mall copies of their European counter (a) relate the medical school to the uni ·Parts. What we needed in America was versity to improve teaching; (b) create a n institution which would teach "knowl scientific learning environment by the ge useful to this day." H'e wanted his provision of laboratories; (e) appoint a full-time faculty with research interests; This paper was delivered at the November 8, (d) allow students to participate in actual 1983, plenary session ofthe Annual Meeting ofthe patient care; and (e) emphasize the sci ssociation of American Medical Colleges, Wash entific approach to clinical problems. 'ngton, D.C. Or. Beering. president ofPurdue University, was It took us nearly 50 years to implement e 1982-83 chairman ofthe AAMC.-!, , these various recommendations, but we 219 220 Journal ofMedical Education VOL. 59, MARCH 1984 Ch got thejob done. Today, our open system We discovered that we are living at least of of universal education, our universities, 10 years longer than the actuarial tables me' and our medical centerS are matched in had predicted. We also learned that the ( only few places in the world. However, last decade of life is the most expensive. tivi progress was not universal or continuous. It is then that we rely on Social Security me' And by the 1960s, we were cognizant of and consume fully one-third ofthe federal bili manpower shortages, uneven physician health care dollar. J distribution, and problems with access, For awhile we assumed the trouble lay disc availability, and afTordability of medical in poor management, overuse ofthe sys- ern care. In 1965, we invented Medicare; and tem, lack of advertising, absence of con- to a when we gathered for our Association of sumer choices, not enough competition, ity American Medical Colleges Annual or even fraud. Gradually it became evi- res}: Meeting in November 1968, we were dent that the cost ofmodern technology, put ready to discuss changes in the medical coupled with increasing need, was at the entt curriculum to meet the "health care cri root ofthe dilemma. . tior sis." So it is time once again to reorder our: UP' It was an altogether remarkable meet priorities and to draw up another agenda er ing. We not only changed the structure of for concerted action: - air t our entire organization but also agreed to 1. The individual must learn about". the following actions: (a) to increase the health risks and use common sense. ~ enrollment ofeach medical school by 10 2. Public schools, colleges, andthe meJ percent; (b) to admit students from di dia must teach social awareness and pre-~ ns!· verse economic, cultural, and geographic vention oflife-style problems. t atlc backgrounds; (c) to assume responsibility 3. Cities and. counties must monitor~. h) t for graduate medical education; (d) to public health matters, and provide-atl' osr. concern ourselves with the organization least in part-for the poor, the elderlY,r or and delivery ofhealth services; (e) to help and individuals in institutions. ~ eah. control rising health care costs by training 4. The states must provide for welfare, - W: paramedical personnel; (j) to encourage public health, and environmental con- -ne: our graduates to work in underserved cerns. areas; (g) to experiment with shorter and 5. Employers must make the work decentralized curricula; and (h) to de place safe and provide reasonable insur- velop teaching programs in new fields ance coverage. such as family medicine, emergency med 6. The third-party payers should pa icine, and ambulatory care. for ambulatory care and pool risks and Most of us will remember these points provide prospective reimbursements. as the general marching orders for the 7. Physicians must act as informed fie ensuing decade. We did well and com duciaries and safeguard the quality 0 pleted the job in record time. It is the care, assess new technology, and help ed· mark ofthe American genius that we rise ucate the public. to crises and usually with such enthusi 8. Congress must provide for indigents asm as to overcompensate..And so it was and medical research. Furthermore, in not surprising that the 1970s ended with order to make good on our promises to the recognition that our resource alloca the young, the elderly, the minorities, the tions were inadequate and that we had, veterans, the aliens, the disabled, and the in fact, promised more than we could institutionalized, we must recognize the deliver. necessity to spend more than 10 percent '84 Chairman#s Address/Beering 221 :ast of the GNP on health care; we have the transplants, bypass surgery, advances in lIes means and the moral imperative. geriatrics and immunology, the CAT '.he 9. The AAMC must emphasize crea- scanner, magnetic resonance, dialysis, vee tivity and quality as the most effective chemotherapy, synthetic insulin, and ity measure to meet our national responsi- high-technology monitoring. ~ral bilities. There is much here to support the ar America is the world leader in scientific gumentthat American medicine is excep .ay ,discovery, medical education, and mod tional. We have a magnificent capacity 'ys- em medical care. We can point with pride for imagination. We have knowledge, In- to a record of: (a) progress and productiv skills, determination, programs, prod In, ity enhanced by freedom of inquiry and ucts-in short, steady and spectacular ~vi- responsible public funding; (b) a balanced progress.
~, public-private partnership in our research As Americans we have special tradi .h e enterprise; (c) the development ora func tions of shared values, hard work, and ~ tioning system of peer review; (d) the democratic governance-of compassion ~ lur: upport of projects based on scientific for individuals and charity to nations ~.da erit; (e) the maintenance ofa system of ofwillingness to tackle tough problems. § , air public and scientific accountability; In Herman Melville's words, Ameri ~ lU( the rational application of basic cans are "the pioneers of the world; the .g J nowledge to practical problems; (g) the advance-guard, sent on through the wil ~ le-~' reation and perpetuation ofthe National derness of untried things, to break a new ~ re-~- nstitutes ofHealth as the wellspring ofa path.... In our youth is our strength; in ~ I ational biomedical research effort; and our inexperience, our wisdom." u 'ot: h) the founding ofthe modem teaching It is time we quit being skeptics, for it ~ -at~~ ospital as an effective social instrument is only when we despair that things be ~ ~ly,f or the provision of tertiary care and come impossible. So let us learn from our ~ 'ealth care education. limits but celebrate opportunity for o use ]~ re, What's right about American medi- fulness and thus continue to provide be ] n- ne? Just look at these achievements, and lievable hope for mankind. Jefferson ~ e could add the development of organ would have liked that. o ~ a rk § o Jr· Q ay .nd
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115 in t~ he he he :ot The Ninety-Fourth Annual Meeting
Washington Hilton Hotel, Washington, D.C., November 5-10, 1983 Theme: Creativity: The Keystone ofProgress in Medicine Program Outlines
PLENARY SESSION THE CURRENT STATUS OF ACADE~IC MEDICAL CENTER-HMO RELATIONSHIPS November 7 November 6 Presiding: Steven C. Beering, M.D. Moderator: Morton A. Madon: M.D. Transformation ofMedicine Since 1945 J(eynote: Bernard W. Nelson, M.D. Julius R. Krevans, M.D. The Extent ofUndergtaduate Medical Medical and Scientific Advances: Training in HMOs Social Cost or Social Benefit? Joseph C. Isaacs Uwe E. Reinhardt, Ph.D. The Extent ofGraduate Medical Nurturing the Scientific Enterprise Training in HMOs James B. Wyngaarden, M.D. Bruce J. Sams, Jr., M.D. Alan Gregg Memorial Lectur~: Affiliation with an Independent HMO I: Managing the Revolution in Medical Care Howard L. Kirz, M.D. Robert G. Petersdort: M.D. Transformation ofa Prepaid Plan from I Academic Governance to an Independent Entity November 8 Lawrence Kahn, M.D. Presiding: Robert M. Heyssel, M.D. A Medical Center-Sponsored HMO: I Evolution ofa Stable Relationship , Presentation ofAAMC Research and Aexner Awards Ronald P. Kaufman, M.D. 1_' A Newly Developing HMO with Close Ties Presentation ofSpecial Recognition Award to to an Academic Medical Center Martin M. Cummings, M.D. William W. Emmot, M.D. I Infuriating Tensions: Science and the Medical Student SPECIAL GENERAL SESSION J. Michael Bishop, M.D. November 8 Medical Progress: How Much Money Will It Take? GENERAL PROFESSIONAL EDUCATION Eli Ginzberg, Ph.D. OF THE PHYSICIAN AND COLLEGE PREPARATION FOR MEDICINE Chairman's Address: l What's Right About American Medicine Emerging Perspectives: Problems, Steven C. Beering, M.D. Priorities, and Prospects Reported to the 222 1983 AAMCAnnualMeeting 223 Panel by Project Participants COUNCIL OF DEANS Presiding: Steven Muller, Ph.D. Discussants: November 7 Perspectives on Learning Business Meeting John H. Wallace, Ph.D. Chairman: Richard Janeway, M.D. Pamelyn Oose Perspectives on Oinical Education COUNCIL OF TEACHING HOSPITALS Daniel D. Federman, M.D. Grady Hughes, M.D. November 7 - Perspectives on College Preparation and Business Meeting Admission to Medical School Presiding: Earl J. Frederick Margaret Olivo, Ph.D. General Session Martin A. Pops, M.D. Presiding: Haynes Rice Perspectives on Faculty Involvement Ethical Dilemmas and Economic Realities I .. D. Kay Oawson, M.D. Laurence B. McCullough, Ph.D. - : Ernst Knobil, Ph.D. ~ 0.. ORGANIZAnON OF "5 o STUDENT REPRESENTATIVES ~ ] OUNCILOF November 4 ] CADEMIC SOCIETIES e Regional Meetings (1) .D .8 Central ~ November 6 Northeast Southern - CAS PLENARY SESSION Western Research Support: A Consensus is Needed Business Meeting _Research Funding Priorities ofthe Joint Program with Society for Health and National Institutes ofHealth Human Values-"Ethical Dilemmas of William F. Raub, Ph.D. Medical Students: Questions No One Asks" Statement ofBasic Principles ofthe Moderator: Carol Mangione Nation's Medical Research Program Speakers: Louis Borgenicht, M.D. John F. Sherman, Ph.D. Kathryn Hunter, Ph.D. Congressional "Micromanagement" of Joanne Lynn, M.D. the NIH Brent Williams, M.D. John Walsh NovemberS The Science ofPolitics and the Politics ofScience Business Meeting Leonard Heller, Ph.D. Small Group Discussions with Society Can Biomedical Research Survive the for Health and Human Values Attacks ofConfused Lucidity? OSRProgram Sherman M__ MellinkofT, M.D. Becoming an Effective Oinical Teacher for Yourself: Your Patients and Others Speakers: Hilliard Jason, M.D., Ed.D. November 7 Jane Westberg, Ph.D. Business Meeting Teaching Skills Workshops Presiding: Frank C. Wilson, M.D. Regional Meetings 224 Journal ofMedical Education VOL. 59, MARCH 1984 Central Leon Johnson, D.Ed. Southern Franklin C. McLean Award: Western Angelo Galiber Northeast William and Charlotte Cadbury Merit Award: Crystal Terry November 6 PRESENTATION OF GSA-MAS SERVICE AWARDS Candidate for OSR Office Session John A.D. Cooper, M.D. Issues Assessment Group Discussions GSA-MAS Service Award: Alonzo C. Atencio, Ph.D. Business Meeting Maxine Bleich Regional Meetings MINORITIES IN MEDICINE Central Keynote Speaker Southern U.S. Representative Charles B. Rangel--- Northeast Western WOMEN IN MEDICINE November 7 November 6 Discussion Sessions Computers & Medical Students: Women Liaison Officers Meeting A Hands-On Workshop WOMEN, MEDICINE AND THE LAW Lisa Leidan, Ph.D. Moderator: Jane Thomas, Ph.D. Keynote: Sylvia Law A Seminar for Third & Fourth Year Medical Students: Retaining Your Humanism in the Respondents: W. Donald Weston, M.D. Face ofTechnologic Explosion Beverly B. Huckman Robert Lang, M.D. Reception Alan Kliger, M.D. November 7 GSA/MINORITY AFFAIRS SECfION Regional Meetings November 6 Western Southern Minority Student Medical Career Northeast Awareness Small Group Session Central Minority Student Medical Career A TALEOFO Awareness Workshop A slide tape show based on Dr. Rosabeth Moss Kanter's research for her award November 7 winning book, Men and Women o/the Regional Meetings Corporation. The slide-tape demonstrates I Central what happens to any minority individual in a ; Northeast workgroup. Western WOMEN IN MEDICINE TAPES Southern Video tapes produced at Harvard Medical Business Meeting School featuring women professors in medicine and science. MINORITY AFFAIRS PROGRAM November 8 November 8 Women in Medicine Luncheon PRESENTATION OF NATIONAL MEDICAL FEL Gender Differences and Bioethical Dilemmas WWSHIP AWARDS Christine K. Cassel, M.D.
I 84 1983 AAMCAnnualMeeting 225 . November9 Midwest-Great Plains Joint Meeting with Association ofTeachers Northeast Southern rd: ofPreventive Medicine WOMEN, WORK AND HEALTH Western
S DATA BASES IN EMERGING ISSUES RELATED TO ACADEMIC MEDICINE MEDICAL SCHOOL/HOSPITAL AFFILIATIONS November 7 As Viewed By the Medical Center Neal A. Vanselow, M.D. PUTTING WNGITUDINAL RESEARCH TO WORK IN THE ADMISSIONS PROCESS As Viewed By the University-Owned Hospital Introduction, Problems and Prospects Jeptha W. DalstoD, Ph.D. Charles P. Friedman, Ph.D. As Viewed By the Affiliated Hospital . Results ofRecent Studies Scott R. Inldey, M.D. Harold G. Levine Jon J. Veloski As Viewed By the Veterans Administration Paul East, M.D. Interaction with the Admission Process Roger Girard, Ph.D. As Viewed By the County Hospital T. Franklin Williams, M.D. Reactions - Barry Stimmel, M.D. November 8 . FACULTY ROSTER SYSTEM CARROLL MEMORIAL LECTURE AND November 6 and 7 LUNCHEON The Faculty Roster System is a computer William G. Anlyan, M.D. based data storage and retrieval system con National Business Meeting taining biographical and education data on The Role ofInvestor-Owned Hospitals in - U.S. medical school faculty. Annual Meeting Medical Education participants were invited to stop by and learn S. Douglas Smith about this AAMC system. Special reports available to the medical schools were Understanding and Effective Management described, and questions regarding utiliza ofSelf tion ofthe data were answered. A. Jack Turner, Ph.D.
INSTITUTIONAL PROFILE SYSTEM GROUP ON INSTITUTIONAL PLAN November 6 and 7 NING a The AAMC Institutional Profile System is a computer-based data storage, retrieval, and November 6 analysis system containing many variables on each U.S. medical school. Annual Open Discussion Groups Meeting participants were invited to Prospective Reimbursement and visit to learn about this data service. Institutional Response Convenor: Thomas G. Fox, Ph.D. GROUP ON BUSINESS AFFAIRS Strategic Planning for Medical Schools Convenor: Charles W. Tandy November 7 University-Industry Relationship Regional Meetings Convenor: David R. Perry 226 Journal ofMedical Education VOL. 59, MARCH 1984
THE EFFECTS ON MEDICAL MAKING ORDER OUT OF CHAOS: EDUCATION OF CHANGES IN THE CRITERIA FOR INSTRUCTIONAL HEALTH DELIVERY SYSTEM SOFTWARE SELECTION Introduction Organizer:Connie L. Kohler, M.A. Marie Sinioris Faculty: Madeline P. Beery, M.A. Charles P. Friedman, Ph.D. The Effect ofthe For-Profit David Swanson, Ph.D. Delivery Systems Bradford H. Gray, Ph.D. GME/SMCDCME JOINT SESSIONS The Effects ofthe Imperatives TELECONFERENCING AS A COST for Hospital Systems EFFECTIVE DELIVERY MECHANISM OF John Danielson MEDICAL EDUCATION Organizer:Clyde Tucker, M.D. The Effect ofIncreasing Number Faculty: Rickiann Saylor Bronstein, Ph.D. ofPhysicians Elmer Koneman, M.D. Robert G. Petersdorf, M.D. Thomas C. Meyer, M.D.
How Might the Schools Respond SMALL GROUP DISCUSSIONS Edward J. Stemmler, M.D. FACILITATING LIFE-LONG LEARNING: ROLE OF SELECTION AND EDUCATION Moderator: William A. Clintworth GROUP ON MEDICAL EDUCATION Panelists: Donald V. Catton, M.D. November 6 S. Scott Obenshain, M.D. COMPUTER BASED INFORMATION GME MINI-WORKSHOPS MANAGEMENT SYSTEMS FOR MEDICAL USING OBJECTIVE MEASURES OF PRACTICE PERSONAL QUALITIES IN ADMISSIONS Moderator: David Steinman, M.D. DECISIONS Lawrence Lutz, M.D. Organizer: Agnes G. Rezler, Ph.D. Panelists: Neal Whitman, Ed.D. Faculty: Barbara Sharf, Ph.D. Jim Cunningham, Ph.D. Joseph Flaherty, M.D. Donna Harris, Ph.D. HELPING OTHERS IMPROVE Priscilla Mayden TEACHING SKILLS Ellen Tabak, M.S.D.H. Organizer:Neal Whitman, Ed.D. COMPETENCE ASSESSMENT: PRACTICAL Faculty: Thomas L. Schwenk, M.D. a EVALVATION OF CLINICAL SKILLS o THE IMPLEMENTATION OF LEARNING Moderator: Paula L. Stillman, M.D. <.l:1 1:: STRATEGIES/TEACHING STRATEGIES FOR Panelists: G. James Morgan, M.D. a(1) MEDICAL STUDENTS, RESIDENTS AND Lila N. Wallis, M.D. § FACULTY o GME/CME SPECIAL SESSION Q Organizer:Karen Collins, Ph.D. THE GENERAL PROFESSIONAL Faculty: Joni E. Spurlin, Ph.D. EDUCATION OF THE PHYSICIAN AND ITS MEDICAL STUDENT LEARNING RELATIONSHIP TO CONTINUING PROBLEMS: DIAGNOSIS AND MEDICAL EDUCATION: ISSUES AND MANAGEMENT PRIORITIES Organizer:Judy Schwenker Moderator: Gerald H. Escovitz, M.D. Faculty: Jean Saunders, Ph.D. Presentation ofthe Issues Donald Roebuck Victor R. Neufeld, M.D. Francoise King Panel Discussion and Issues Robert Blanc, Ph.D. Chair: Oscar A. Thorup, M.D. 1983 AAMCAnnual Meeting 227 GME/GSA-MAS SPECIAL MCAT SESSION Continuing Medical Education Programs MINORITY PERFORMANCE ON THE MCAT Moderators: Lynn Curry, Ph.D. Moderator: Stanford A. Roman, Jr., M.D. Nancy Coldeway, Ph.D. Panelists: Sandra R. Wilson, Ph.D. Robert F. Jones, Ph.D. Faculty Development Robert L. Beran, Ph.D. Moderators: Hilliard Jason, M.D. Jane Westberg, Ph.D. Computer Applications in Medical November 7 Education INNOVATIONS IN MEDICAL EDUCATION Moderators: Robert M. Rippey, Ph.D. EXHIBITS David Swanson, Ph.D. ::: ~ Regional Meetings Educational Support Systems for Students, § Southern Including Tutoring and Remediation v Central Moderators: Miriam Willey, Ph.D. 0.. "5 Northeast Evelyn McCarthy, Ph.D. ..81 Western Innovative Approaches to Admissions and ~l GME NATIONAL MEETING Student Financial Aid '"d ' Moderators: Jon Veloski ~ I Election ofNew Officers Robert Keimowitz, M.D. ..g IRegional Reactions to GPEP Issues ~ Approaches to the Development and v, Statement ~ I Regional Chairmen Assessment of Desirable Personal .D Qualities, Values, and Attitudes .8 Phase II ofthe Clinical Evaluation Project: Moderators: Joseph Sheehan, Ph.D. Evaluation Along the Continuum o Michael Gordon, Ph.D. Z Xenia Tonesk, Ph.D. GME/GSA-MAS SPECIAL SESSION ~ Report ofGME Task Force on Evaluation IDENTIFYING STUDENT PROBLEMS IN ~ Resources LEARNING AND TAKING EXTERNAL v Parker A. Small, M.D. ..s:: EXAMINATIONS .::; INNOVATIONS IN MEDICAL EDUCATION o Moderator: William Wallace, Ph.D. rfl DISCUSSION GROUPS ::: Panelists: Robert Blanc, Ph.D. BIn~tructional Design and Evaluation ofBasic Deanna Martin, Ph.D. ~ Science Courses Alonzo C. Atencio, Ph.D. 8 Moderators: Jane Middleton, Ed.D. Marcia Wile, Ph.D. .B Omelan Lukasewycz, Ph.D. § Instructional Design and Evaluation of Intra <.l:1...... duction to Clinical Medicine Courses November 8 ~ Moderators: Reed Williams, Ph.D. § Peter Tuteur, M.D. INNOVATIONS IN MEDICAL EDUCATION e:> 8 Instructional Design and Evaluation ofClini EXHIBITS cal Oerkships RIME FIRST ANNUAL INVITED REVIEW Moderators: Hugh M. Scott, M.D. Measuring the Contribution of Medical Harold Levine Education to Patient Care Speaker: Joseph S. Gonnella, M.D. Instructional Design and Evaluation of Residency Programs Moderator: Paula L. Stillman, M.D. John Corley, M.D. November 9 Instructional Design & Evaluation of GME-Plenary Session 228 Journal ofMedical Education VOL. 59,. MARCH 198' TWENTY-FlRSf CENTURY MEDICAL Panelists: Charles P. Friedman, Ph.D. EDUCATION: ECONOMIC, SOCIAL, Tracey Veach, Ph.D. POLITICAL AND TECHNOLOGICAL A. Dwayne Anderson, Ph.D. IMPLICATIONS FOR CHANGE OUTCOMES OF EDUCATIONAL Keynote Address: PROORAMS IN RURAL SETTINGS Duncan Neuhauser, Ph.D. Moderator: DeWitt C. Baldwin, Jr., M.D. Special Perspectives: Panelists: Harry Knopke, Ph.D. Impact ofTechnological Advances Beverly D. Rowley, Ph.D. Espe~ially Information Management H. Thomas Weigert, M.D. Jack Myers, M.D. AN EXAMINATION OF THE RATIONALE Impact ofPolitical/Governmental Trends AND EFFECTS OF PROBLEM-BASED AND Robert E. Tranquada, M.D. SUBJECf MATTER-BASED APPROACHES FOR TEACHING THE BASIC SCIENCES Implications for Educational Practice Moderator: Paul J. Feltovich, Ph.D. Thomas C. Meyer, M.D. Panelists: Kurt E. Ebner, Ph.D. November 10 Richard L. Coulson, Ph.D. UTILIZING STUDENT MOTIVATION TO Small Group Discussions SAVE FACULTY TIME: A NEW LOOK AT DIAGNOSING AND MANAGING CLINICAL LEARNING GROUPS PERFORMANCE PROBLEMS OF Moderator: S. Scott Obenshain, M.D. STUDENTS IN ACADEMIC DIFFICULTY Panelists: Clark Bouton, Ph.D. Moderator: Howard S. Barrows, M.D. Parker A. Small, Jr., M.D. Panelist: Xenia Tonesk, Ph.D. RESEARCH IN MEDICAL EDUCATION CLINICAL EXPOSURE FOR FIRST YEAR EMERGING FROM GPEP MEDICAL STUDENTS Moderator: Ronald W. Richards, Ph.D. Moderator: L. Thompson Bowles, M.D. Panelists: Margaret Bussigel, Dr. paed. Panelist: David Cadman, M.D. Victor Neufeld, M.D. ASSISTING FACULTY IN THE EVALUATION T. Joseph Sheehan, Ph.D. OF MEDICAL STUDENTS: A PROPOSAL Reed G. Williams, Ph.D. FOR SHARING MATERIALS AND METHODS THE ROLE OF ELECfIVES IN MEDICAL Moderator: Parker A. Small, Jr., M.D. EDUCATION Task Force: Howard S. Barrows, M.D. Moderator: Myra B. Ramos Fredric Burg, M.D. Panelists: Stephen Smith, M.D. James B. Erdmann, Ph.D. Lewis R. First, M.D. Kaaren Hoffman, Ph.D. SHARING INFORMATION ON Geoffrey Norman, Ph.D. CURRICULUM DEVELOPMENT, Dave Smith, M.D. IMPLEMENTATION, MANAGEMENT AND Guest: D. Dax Taylor, M.D. EVALUATION RESPONSIBILITIES OF FACULTY AND Moderator: Paula L. Stillman, M.D. ADMINISTRATION IN CURRICULUM Panelists: Alberto Galofre, M.D. CHANGE Gregory L. Trzebiatowski, Ph.D. Moderator: William R. Ayers, M.D. Panelists: S. James Adelstein, M.D. LIAISON COMMITfEE ON Murray M. Kappelman, M.D. MEDICAL EDUCATION S. Scott Obenshain, M.D. COMPUTER-BASED INFORMAnON November 6 MANAGEMENT SYSTEMS FOR MEDICAL EDUCATION Institutional Self-Study ofa College of Moderator: Robert F. Rubeck, Ph.D. Medicine Preparation Workshop J84 1983 MMCAnnual Meeting 229 Edward S. Petersen, M.D. David W. Canfield James R. Schofield, M.D. James Copeland Robert Hart Discussion John Mecouch GROUP ON PUBLIC AFFAIRS Moderator: Dallas Mackey Special Events November 7 R.C. "Bucky" Waters AWARDS 'NOMINEE PRESENTATIONS Annual Giving Moderator: Dean Borg Patricia King Nominee Presentations for Excellence in: Public Relations Special Citation Patrick Stone Lillian Blacker Interviewers: Publications-External Audiences James Austin Elaine Freeman Suzanne Ryan Curran David A. Friedo BiU Glance J. Michael Mattsson Publications-Internal Audiences BiUMcCabe Gregory Graze Michela Reichman GPA Business Session Presiding: Vicki Saito .' Special Public Relations/Development/ Alumni Project November 8 J. Antony Lloyd . Michela Reichman AWARDS LUNCHEON Electronics Program-Audio Moderator: Dean Borg . Frances Cebuhar Tylenol-From Crisis To Comeback Sarah Stratton Lawrence G. Foster Electronics Program-Visual Presentation ofAwards Virginia Hunt Robert M. Heyssel, M.D. James Schlottman HIGH TECH MEDICINE: Total Public Relations/Development/Alumni ADVANCEMENT/ETHICS Program-COTH Member Moderator: J. Michael Mattsson Teaching Hospital Barney Oark's Heart Doug Buck and Arline Dishong Chase N. Peterson, M.D. Total Public Relations/Development/Alumni To Walk Again Program-Medical School William D. Sawyer, M.D. John Deats Life At What Cost? Elaine Freeman Laurence B. McCullough, Ph.D. DEVELOPMENT TRACK TO PROVIDE PROPER FUNDING FOR ISSUES SURROUNDING THE USE OF RESEARCH, EDUCATION AND ANIMALS IN MEDICAL RESEARCH ). PATIENT CARE Moderator: Michela Reichman Speakers: Frederick A. King, Ph.D. Moderator: Everett R. Nordstrom William Samuels Major Gifts Spyros Andreopoulos Lewis W. Barron Deferred Gifts November 9 Donald C. Mackall ISSUES FOR TEACHING HOSPITALS Interviewers: EQUATIONS FOR SURVIVAL Arthur Brink, Jr. Moderator: Roland D. Wussow 230 Journal ofMedical Education VOL. 59, MARCH 1984 Speakers: JeffGoldsmith, Ph.D. Thomas D. Hatch William B. Kerr Military and Service-Commitment Programs A DESCRIPTION OF ALUMNI ACTIVITIES Judith Simpson, Ph.D. . . Moderator: Gail Anderson Education Can Be Affordable: Strategies for Panelists: Perry J. Culver, M.D. Financial Planning Tony Goetz Moderator: Roberta Popik, Ph.D. Sharon Sweder For the School: James F. Glenn, M.D. For the Community: Bruce E. Martin ROUND TABLE DISCUSSIONS For the Student and Family: Getting on the Editorial Page Ernest W. Stiller, Jr., M.D. Discussion Leader: Elaine Freeman Teleconferencing November 9 Discussion Leader: Clyde Tucker, M.D. Plenary Session DRGs and the Public Affairs Implications Joint Session with the Group on Medicai Discussion Leader: James Bentley, Ph.D. Education Cost Conscious Publications 21st Century Medical Education: Economic, Discussion Leader: Nancy Grover Social, Political and Technical Implicatio~s Town-Gown Relationships as Health for Change Science Centers Enter the Era of GSA Goals for the 80s: Competition A Brainstorming Session Discussion Leader: Dean Borg Moderator: Pearl Rosenberg, Ph.D. Governmental Relations Business Meeting Discussion Leader: Susan Phelps Reynolds Chairman: Robert I. Keimowitz, M.D. Labor Relations Discussion Leader: Shirley Bonnem RESEARCH IN MEDICAL EDUCATION Corporate Restructuring and the November 8 Foundation Discussion Leader: Robert Hart INVITED REVIEW Marketing through Development MEASURING THE CONTRIBUTION OF Discussion Leader: John Mecouch MEDICAL EDUCATION TO PATIENT CARE Speaker: Joseph S. Gonnella, M.D. Are You Ready for Fund Raising? Discussion Leader: James Austin November 9 How to Create Alumni Activities in Medical PRESENTATION OF SYMPOSIA Schools SIMULATED PATIENTS IN EVALUATION OF Discussion Leader: Perry Culver, M.D. MEDICAL EDUCATION AND PRACTICE The Role ofAlumni in Communicating with Organizer: Christel A. Woodward, Ph.D. Legislators Moderator: Victor R. Neufeld, M.D. . Discussion Leader: Timothy Lemon Panelists: Geoffrey R. Norman, Ph.D. Christel A. Woodward, Ph.D. GROUP ON STUDENT AFFAIRS Paula L. Stillman, M.D. November 7 THE DEHUMANIZATION OF MEDICINE: IS MEDICAL EDUCATION A CAUSE Student Financial Assistance: Status of OR A CURE? Federal Programs Organizer: Peter A. Bowman, Ph.D. Moderator: Cheryl Wilkes Moderator: Ronald A. Carson, Ph.D. Department ofEducation Panelists: Donnie J. Self, Ph.D. James W. Moore Ruth Purtilo, R.P.T., Ph.D. Department ofHealth and Human Services Laurence B. McCullough, Ph.D.. - [ ~4 1983 AAMCAnnualMeeting 231 HIGH TECHNOLOGY AT LOW Minutes of AAMC Assembly Meeting November 8, 1983' the Association's Executive Committee also met regularly with the Joint Health Policy Washington Hilton Hotel, Washington, D.C. Committee ofthe AAU/ACE/NASULGC. Earlier in the year a group of deans had Call to Order expressed concern about problems associated Dr. Steven c. Beering, AAMC Chairman, with the selection of senior medical students called the meeting to order at 8:30 a.m. into positions at the second postgraduate year. As a result of this concern Dr. John Cooper Quorum Call had been in correspondence with the chairmen Dr. Beering recognized the presence ofa of 18 member CAS societies soliciting their , quorum. views. The Executive Council had studied their replies and had scheduled a meeting on r Consideration ofthe Minutes December 7 with program directors represent .: The minutes ofthe November 9, 1982, Assem ing specialties that do not use the National · bly meeting were approved without change. Resident Matching Program. Also in response to some ofthe concerns identified, the NRMP Report of the Chairman had moved to establish a new advisory com mittee composed of representatives of each Beering reported on events in Congress · Dr. clinical specialty.- and at AAMC Executive Council meetings Dr. Beering extended a special thanks to the · that led to the adoption of a statement of following individuals whose terms on the As principles relating to support for biomedical sociation's Executive Council or Administra research. The document, "Preserving Ameri tive Boards had expired: from the Executive ca's Preeminence in Medical Research," had Council, Thomas K.. Oliver, Jr., Manson been discussed at each ofthe Council meetings Meads, and Edward Schwager; from the Coun on the previous day, and Dr. Beering indicated cil of Deans, William Deal and William Lu that widespread distribution ofthe document ginbuhl; from the Council ofAcademic Soci was planned. Dr. Beering added that he was a eties, David Brown, Lowell Greenbaum, and member ofthe National Academy ofSciences John Lynch; from the Council of Teaching Institute ofMedicine Committee on the Struc Hospitals, James Bartlett, Mitchell Rabkin, ture and Function of the NIH, and in his and John Sheehan; from the Organization of capacity as a member ofthat committee had Student Representatives, John Deitz, Grady been participating in public hearings relating Hughes, Carol Mangione, David Thorn, Jesse to the history of NIH, its current structure, Wardlow, and Nora Zorich. and alternative structures. Dr. Beering also reported that the Executive Committee of the AAMC continued to meet Report of the President with its counterpart at the Association ofAc Dr. John A. D. Cooper summarized Congres ademic Health Centers to discuss areas ofc0 sional action on appropriations for the De operative effort. A 1983 AAMC-AAHC con partments ofLabor, Health and Human Serv ference on hospital reimbursement issues re ices, and Education. Under the act, the Na sulted in a publication, "Medicare Prospective tional Institutes ofHealth had received an 11.7 Payment: Probable Effects on Academic percent increase over the previous year's allo Health Center Hospitals." Representatives of cation, and Dr. Cooper attributed the increase 233 234 Journal ofMedical Education VOL. 59, MARCH 1984 in part to an effort by more than 100 research ing on the previous day be distributed to all organizations which worked together to COD members. achieve an increase for NIH. Dr. Cooper also reported on the Associa Report ofthe Council ofAcademic Societies tion's suit against Multiprep, a commercial Dr. Frank Wilson indicated tharthe 76 mem review firm, to enjoin that firm from further ber societies of the CAS had held two major use ofcopyrighted materials from the MCAT meetings in 1983. At the interim meeting in exam and to recover damages suffered by the :ebruarr, impli.~tionsfor research and !=hang program. The copyright violations had forced lng medIcal polICIes at academic health centers the Association to offer a retake ofthe MCAT were considered. The previous day's business examination to approximately 250 medical meeting focused attention on the Executive school aspirants who had been exposed to Council's document on principles. for the sup material used on the MCAT exam. A prelim port ofbiomedical research. inary injunction against Multiprep had been During the quarterly 'Administrative Board granted, and a criminal investigation by the meetings, the CAS had met with Dr. George FBI and the U.S. Attorney's office was under Mandell, Dr. Len Heller, Dr. James Ebert and way. various NIH staffmembers. ' The'General Professional EduCation ofthe Physician and College Preparation for Medi Report of the Council ofTeaching Hospitals cine project was ready to consider how medi cal schools and their faculties might approach Mr. Earl Frederick related that the' COTH improving medical education and baccalau Administrative Board had discussed a wide reate preparation for the study of medicine. variety ofinterests and had reviewed two pub Although the panel's conclusions and recom lications in a series of reports on the unique mendations would be presented at the 1984" characteristics ofteaching hospitals. AAMC annual meeting, a special general ses The Administrative Board had also been sion on the project was scheduled for the engaged in a review ofthe membership criteria afternoon ofthe Assembly meeting. for the Council ofTeaching Hospitals and the Dr. Cooper indicated that considerable at future directions the Council should take. The tention by Association staffand leadership had COTH Administrative Board had reviewed been devoted to issues relating to the reim papers on these issues and had requested that bursement ofteaching hospitals, especially as they be placed on the agenda of the 1983 mandated by the new Medicare Prospective AAMC Officers Retreat. Payment System. He referred the members of Haynes Rice was elected Chairman of the . the Assembly to the Association's annual re Council, Sheldon King Chairman-Elect, and port for a complete discussion of AAMC ef Spencer Foreman Secretary. Elected to the forts in this and other programmatic areas. Administrative Board were William Kerr, Robert Bucha~an, Eric Munson, and Thomas Stranova. ' Report of the Council of Deans Report ofthe Secretary-Treasurer Dr. Richard Janeway described the Council of Deans spring meeting in Scottsdale, Arizona, Mr. Frederick referred the members of the - and some of the discussions at that meeting, Assembly to the detailed Treasurer's report in particularly those relating to the GPEP project the agenda book and indicated that the Audit and the MeAT interpretive studies. Committee Jtad found no irregularities in the During the year the COD Administrative Associ~tion's ~nnual audit report. He added Board had met with the Board ofthe OSR to that Ernst & Whinney had issued an unquali discuss the National Resident Matching Pro fied opinion, and he commended Dr. Cooper gram. The COD members had requested that on the financial position ofthe AssociatiQ~. Dr. (:ooper's, remarks to their business meet- ACfION: On motion, seconded, and carried, 84 1983 Assembly Minutes 235 all the Assembly adopted the report ofthe Secre Report ofthe Resolutions Committee tary-Treasurer. There were no resolutions reported to the Res s Report ofthe Organization olutions Committee for timely consideration and referral to the Assembly. n of Student Representatives ·or Dr. Edward Schwager reported that the OSR Report of the Nominating Committee in had been encouraging medical students to Mr. John Colloton, Chairman of the AAMC g- meet with their legislators or their staffs to Nominating Committee, presented the report express their views on important health issues, ofthat committee. The committee is charged ~ particularly student financial assistance. by the bylaws with reporting to the Assembly ve Major discussion topics for the OSR Board one nominee for each officer and member of .pe throughout the year were the GPEP project the Executive Council to be elected. The fol and the resident matching program. An issue lowing slate of nominees was presented: rd ofthe OSR Report was distributed. AAMC Chairman-Elect: Richard Janeway; e Pamelyn Oose became Chairperson and Executive Council, COD representatives: ld Ricardo Sanchez Chairperson-Elect. Richard Moy and John Naughton; Executive Election of New Members Council, Distinguished Service Member: ACTION: On motion, seconded, and carried, Charles C. Sprague. the Assembly by unanimous ballot elected the ACTION: On motion, seconded, and carried, following organizations, institutions, and indi- the Assembly approved the report ofthe Nom viduals to the indicated class ofmembership: inating Committee and elected the individuals Academic Society Members: American As listed above to the offices indicated. sociation ofDirectors ofPsychiatric Residency Training; American Psychiatric Association; Installation ofNew Officers American Society for Cell Biology. Dr. Robert M. Heyssel was installed as the Teaching Hospital Members: Baptist Medi AAMC's new Chairman. cal Centers, Birmingham, Alabama; Lubbock General Hospital, Lubbock, Texas; The Meth Resolution ofAppreciation odist Hospital, Houston, Texas; Methodist Hospitals of Memphis, Memphis, Tennessee; ACflON: On motion, seconded, and carried, Metropolitan Hospital Center, New York, New the Assembly adopted the following resolution York; Orlando Regional Medical Center, Or ofappreciation: lando, Rorida; Pitt County Memorial Hospital, WHEREAS, Steven C. Beering has served with Greenville, North Carolina; St. Joseph Medical diligence, thoughtfulness, andskillas Chairman Center, Wichita, Kansas; St. Vincent Hospital ofthe Assembly, Chairman ofthe Council of and Health Care Center, Indianapolis, Indiana. Deans, and member ofthe Executive Council Corresponding Members: Germantown since 1976, and s Hospital and Medical Center, Philadelphia, WHEREAS, his term of service has been Pennsylvania; Latrobe Area Hospital, Latrobe, markedby his qualities as a leader in academic Pennsylvania; S1. Mary9s Hospital, Milwaukee, medicine and a statesman on public policy is Wisconsin; Southern Nevada Memorial Hos sues, and pital, Las Vega$, Nevada; Tulsa Medical Edu WHEREAS, Steven Beering has now left the cation Foundation, Inc., Tulsa, Oklahoma. 1 fray of academic medicine for the relatively Distinguished Service Members: Steven C. simple perils ofBig Tenfootball, Beerin& David R. Challoner, James E. Ecken hon: Thomas K. Oliver, Jr., Daniel X. Freed BE IT RESOLVED that the Association of man. American Medical Colleges recognizes his/aith Emeritus Members: DeWitt Baldwin, John ful service with this resolution ofthanks and D. Chase, Daniel Funkenstein, William D. Hol commendation. den, Joseph F. Volker. Adjournment Individual Members: List attached to ar chive minutes. The Assembly adjourned at 9: 10 a.m. Annual Report 1982-83 Note: The President's Message appeared in , the December 1983 issue of the Journal of Medical Education as an editorial. 237 Executive Council, 1982-83 Steven C. Beering, chairman Fairfield Goodale Robert M. Heyssel, chairman-elect Richard Janeway I: Thomas K. Oliver, Jr., Louis J. Kettel immediate past chairman William H. Luginbuhl John A. D. Cooper, president Richard H. Moy ~ r: M. Roy Schwarz COUNCIL OF ACADEMIC SOCIETIES Edward J. Stemmler David M. Brown Ex Robert L. Hill COUNCIL OF TEACHING HOSPITALS Joseph E. Johnson, III Bet Frank C. Wilson, Jr. Robert E. Frank tio. Earl J. Frederick der DISTINGUISHED SERVICE MEMBER Mitchell T. Rabkin edt Haynes Rice Manson Meads stit stit COUNCIL OF DEANS ORGANIZATION OF STUDENT REPRESENTATIVES the Adr John E. Chapman Pamelyn Close cou. Ephraim Friedman Edward Schwager here 1 elec Administrative Boards of the Councils, 1982-83 , atio: nUII COUNCIL OF ACADEMIC SOCIETIES COUNCIL OF TEACHING HOSPITALS acti Frank C. Wilson, Jr., chairman Earl J. Frederick, chairman iog. Robert L. Hill, chairman-elect , Haynes Rice, chairman-elect egie.. David M. Brown James W. Bartlett - initi Bernadine H. Bulkley Jeptha W. Dalston offie David H. Cohen Spencer Foreman plan. William F. Ganong Robert E. Frank Edu Lowell M. Greenbaum Irwin Goldberg arati Joseph E. Johnson, III Sheldon S. King priOI Douglas Kelly Glenn R. Mitchell regie John B. Lynch Mitchell T. Rabkin educ' Frank G. Moody David A. Reed tion, Virginia V. Weldon John V. Sheehan new C. Thomas Smith in tb COUNCIL OF DEANS Polic was, Richard Janeway, chairman ORGANIZATION OF STUDENT REPRESENTATIVES Edward J. Stemmler, chairman-elect Edward Schwager, chairperson regul Arnold L. Brown Pamelyn Close, chairperson-elect giver John E. Chapman John W. Dietz Othe: D. Kay Clawson Grady Hughes trend tricu}, William B. Deal Carol M. Mangione Ephraim Friedman Ricardo Sanchez socia Fairfield Goodale Mark T. Schmalz Me: Louis J. Kettel Mary E. Smith bytb William H. Luginbuhl David Thom were Richard H. Moy Jesse Wardlow feden M. Roy Schwarz Nora Zorich scarcl consf 238 ! # The Councils Executive Council Particularattention was given to reimburse ment issues since major changes in Medicare Between the annual meetings ofthe Associa policies were incorporated in the Tax Equity tion, the Executive Council meets quarterly to and Fiscal Responsibility Act and in the Pro deliberate policy matters relating to medical spective Payment System for Medicare. Early education. Issues are referred by member in in the year the Executive Council adopted nine stitutions or organizations and from the con criteria °as essential in any prospective pay stituent councils. Policy matters considered by ment plan. These included recognizing the ~ ~ the Executive Council are first reviewed by the impact ofthe hospital's scope ofservices, pa ~ Adniinistrative Boards of the constituent tient mix and intensity of care in operating ~ councils for discussion and recommendation costs, and recognizing the costs associated with ~ o before final action. manpower education, clinical research, and ~ The traditional December retreat for newly the use ofnew diagnostic and treatment tech- "8 ,elected officers and senior staff ofthe Associ nmogies. • ] ,ation provided an opportunity to review a The Executive Council also reviewed a pro ~ number of the Association's major ongoing posal to establish a Physician's Advisory Com B activities and to develop priorities for the com- mission on Oinical Practice to examine major ~ ing years. Final revisio~s were made in "Strat differences in medical practice and their con egies for the Future: An AAMC Workplan," tributions to variances in length of stay. In initially conceived and developed at the 1,981 another action the Council identified certain officers' retreat The current status and future issues in calculating a hospital's resident-to plans of the AAMC's General Professional bed ratio, and requested that they be brought Education ofthe Physician and College Prep to the attention ofthe Health Care Financing aration for Medicine project were reviewed Administration prior to the implementation prior to the- project's beginning its series of ofthe prospective payment system. a o u~dergraduate <.l:1 regional hearings on medical A number ofconcerns were expressed with education. Possible AAMC activities for a na- Department of Health and Human Services tional medical research awareness project, for regulation on "Nondiscrimination on the Ba new constituent services, and for participation sis of Handicap," which related to the provi in the American Medical Association's Health sion of appropriate medical treatment to Policy Agenda project were considered. There severely handicapped infants. The Council op was also discusSion ofexpected legislative and posed the regulation as too broad an interpre regulatory actions, wit~ particular attention tation of 1973 legislation, and because it spec given to Medicare reimbursement issues. ified an ill-conceived method ofobtaining in Other agenda topjcs i~cluded the study of formation and inappropriately injected the trends in- medical, school 'applicants and ma government in medical decision-making. triculants and the appropriate role for the As Since federal research funding had not en sociation in manpower 'forecasting. joyed any real growth in the past several years, Many of the issues reviewed and debated a number of proposals had surfaced to by the Executive Council-during the past year "stretch" such funds by reducing. the amount were concerned with the interface between the of money awarded to approved applicants federal government and the educational, re with the highest priority scores and distribut search and patient care missions of AAMC ing the amounts thereby recovered among ap constituents. proved applications with lower scores. The 239 l 240 Journal ofMedical Education VOL. 59, MARCH 1984 1'. l~ Council strongly endorsed the current system problems with the thought that refinements ~. of for research funding, believing that the sliding could improve the match program in this area. -..: w, scale would endanger the future funding of A report from the Association of Minority co. biomedical and behavioral research. Health Professions Schools was reviewed, and Pa The reimbursement of indirect costs for the Executive Council was pleased to note that He research supported by the National Institutes it had anticipated many of that body's rec- mr of Health continued to occupy the attention ommendations in its own 1978 task force re- Sc' of the Association. The NIH had drafted a po~ ~ proposal for controlling indirect costs under As a parent or founding member of other COl which each institution's level ofindirect costs organizations, the Association must occasion- im would be tailored to its own historical experi ally review and approve policy decisions by ice~ ence. The Executive Council added its support these organizations. The Executive Council ~ to a request by other higher education associ ratified a policy statement ofthe Accredi~tion for ations that DHHS examine whether existing Council for Graduate Medical Education re- Me criteria for determining allowable costs of re lating to criteria for entry into graduate med- by search were appropriate and whether methods ical education programs by graduates of III, ofapportioning costs among university func schools not approved by the Liaison Commit- Gn tions and research projects were fair. tee on Medical Education or the American. grae In response to the expiration ofthe author Osteopathic Association. The Council also en-I~ Imr ity for the President's Commission for the dorsed an elaboration oftransitional year spe- ~ riCl Study of Ethics ·in Medicine and Biomedical cial requirements. . mee and Behavioral Research, the Executive Coun The Accreditation Council for Continuing . geri: cil expressed support for the continued study Medical Education presented guidelines to ac- 1 of ethics in medicine through an established company toe Essentials ofthe ACCME; these ;. dati body such as the National Academy of Sci were approved by the Council. The Council : Ed\\ ences. The Council also worked on a proposal was also asked to act op the ACCME protocol : sylv· under which the educational loans of physi for recognizing state medical societies as ac- whic cians choosing careers in academic research creditors of local continuing medical educa- ASS( would be forgiven. tion courses. The Executive Council made gran Various legislative proposals relating to the several suggestions for revision in the protocol min· National Institutes ofHealth were reviewed by to assure that the ACCME would ,retain ac- prirr the members of the Executive Council who countability in this process. Although modifi- educ were distressed by the level of"micromanage cations were made to allow additional input The· ment" evidenced in these bills. The Council into the process by ACCME representatives, tion~ elucidated a set of principles in support of a the Executive Council remained dissatisfied gion,r strong biomedical research effort which it en with the degree to which the ACCME would tive dorsed as the basis for any legislation in this maintain oversight and provide a national ac- cal S area. creditation standard. . Dl A series ofcourt actions related to the Med-. The Educational Commission for Foreign COUf ical College Admission Test required oversight Medical' Graduates asked the Association, as visor by the Council, which also considered ways to a founding member, to comment on proposed Gen~ strengthen and improve the examination. Two bylaw changes being considered by that orga- cian projects were approved, one to add an essay nizati«;>o. Although some of the changes pre- Tl question and another to establish a diagnostic sented no problem, the Council was especially see t services program that would provide a detailed concerned that proposals to increase the num- Affai assessment ofstrengths and weaknesses ofstu ber ofpublic members and to alterthe process the C dents in the areas pf academic preparation by which representatives were nominated: to on Pt tested by the exam. the Board ofTrustees would further distance Affair Questions relating to the match for second the ECFMG from its sponsoring organiza- Tb year postgraduate positions led the Council to tions. retal) request a staff review of current policies and The Executive Council's Continuing review the A' ~4 1982-83 AnnualReport 241 ts of important medical education policy areas tiny over the Association's fiscal affairs and 3. was augmented by the work of a number of approved a modest expansion in the general ~y committees. A report from the Committee for funds budget for fiscal year 1984. .d Payment of Physician Services in Teaching The Executive Committee met priortoeach at Hospitals, chaired by Hiram C. Polk, chair Executive Council meeting and conducted ..,- man of surgery, University of Louisville business by conference call as necessary. Dur ~- School of Medicine, was presented and ap- ing the year the Executive Committee met proved for distribution so that its findings with HUS Secretary Margaret Heckler, Con ~r could be considered as HCFA developed and gressman Albert Gore, Betty Pickett, director, 1- implemented special payment rules for serv- Division ofResearch Resources, National In Y ices in a teaching setting. stitutes of Health, and Senator Lowell .it The final report ofthe Steering Committee Weicker. They also met twice with the Exec In for the Regional Institutes on Geriatrics and utive Committee of the Association of Aca ~- Medical Education project was also approved demic Health Centers to discuss issues ofmu :1- by the Executive Council. Joseph E. Johnson, tual concern. ~)f III, chairman of internal medicine, Bowman ~ ~- Gray School of Medicine, presented "Under [ ,n. graduate Medical Education Preparation for Council of Deans § .- f Improved Geriatric Care: A Guideline for Cur The activities of the Council of Deans in ~ ~- .~. riculum Assessment," which outlined ways for 1982-83 centered on business meetings and ] ., medical schools to enhance their teaching of .g program sessions conducted in conjunction ~ g geriatrics and gerontology. with the Association's annual meeting in ~:- The Council also approved the recommen Washington, D.C., and at the Council's spring E ~ dations of an ad hoc committee chaired by meeting in Scottsdale, Arizona. During the ~ ] . Edward Stemmler, dean, University ofPenn- intervening periods the Council's Administra 11 sylvania School ofMedicine. The committee, tive Board met quarterly to deliberate Execu which had been charged with reviewing the tive Council items of significance to the As ,- Association's management education pro sociation'5 institutional membership' and to grams, recommended that the continuing ad carry on the business ofthe Council ofDeans. ministrative education of its members be a More specific concerns were reviewed by sec - primary mission ofthe AAMC and that new tions of deans brought together by coinmon - educational efforts be planned and initiated. interest. ,t The .implementation of these recommenda The annual business meeting consisted , tions was seen in the successful series of re mainly of a series of discussions on recently i gional seminars held on "Medicare Prospec completed work products, planned activities, :1 tive Payment System: Implications for Medi and current issues. The work products in • cal Schools and Faculties." cluded a summary of issues and proposed During the course ofthe year the Executive actions ofthe AAMC relatingto the evaluation Council also reviewed the activities ofthe ad of the clinical performance ofclerks and the visory panel and working groups for the report, "Academic Information in the Aca General Professional Education ofthe Physi- demic Health Sciences Center: Roles for the' • cian project. . Library in Information Management." The The Executive Council continued to over COD presentation was a prelude to an annual see the activities of the Group on Business meeting panel discussion entitled, 66Academic · Affairs, the Group on Institutional Planning, Medical Centers Confront the Information ~ the Group on Medical Education, the Group Age." Key among the current issues portion on Public Affairs, and the Group on Student was a review of the new Medicare program Affairs. regulations with particular attention to the The Executive Council, along with the Sec three sets ofregulations ofprimary interest to retary-Treasurer, Executive Committee, and' the members ofthe Council: payment offees the Audit Committee, exercised careful scm- for assistants at surgery, the limitation on rea- l) 242 Journal ofMedical Education VOL. 59, MARCH 1984 J,~ 1! sonable charges for services in hospital out and their attempts to implement early admis- f' da patient settings, and hospital based physician sion options to medical school, and the pro- ~:- sor regulations. The Council unanimously sup grammatic initiatives· undertaken to integrate r; S?C ported the }lrinciple that the disposition or use the natural and behavioral sciences with the ~ cIa: of a fee should not alter the amount of a basic sciences. Donald Drake, a ,science writer .. anc Medicare fee, opposed that portion ofthe reg for the The Philadelphia Inquirer, provided a ~ Te. ulatory proposal which would mandate com unique perspective on medical education En: pensation-based fees for physicians paid on a through his personal experiences while living Me salary basis, and opposed the implementation as a medical student with the class of 1978 at exr until proposed regulations on .payment for the University ofPennsylvania. The program apt: physicians' services in teaching hospitals were concluded with an open forum on the ing also published with an appropriate comment AAMC's General Professional Education of .. rna. period. Additional discussions focQsed on the the Physician Project, with chairman St~ven _ " proposed medical research awareness project Muller, co-chairman William Gerberding, in. and the plan developed by the Group on Stu panel members John Gronvall, Daniel Toste- for dent Affairs to promote adherence to the Na son, David Sabiston, Victor Neufeld, and proj- the tional Resident Matching Program agree ect director August Swanson. ' sior ments. The spring meeting was preceded with an tenc Ninety~ight deans attended the annual orientation session for new deans introducing ~ s~a. spring meeting April 6-9th. Kenneth W. them to the AAMC leadership and start: fol-ll tlve.. Oarkson, associate director for Human Re lowed by a briefing on the resources and pro- : Insf sources, Veterans and Labor, Office of Man grams ofthe AAMC. During the spring busi- _gaar agement and Budget, began the first program ness meeting, the Council reviewed topics re- ~. direc session with an overview of President Rea lating to the Medical College Admission Test, ~ port gans's FY 1984 budget and described the ad the Regional Institutes on Geriatrics and Med- : trair ministration's rationale for health-related ex ical Education, trends in the National Resi- ~ size( penditures. Major General Garrison Rap dent Matching Program, applicant and ma- :dent mund, commander, U.S. Army Medical Re triculant trends, and an overview of current cant search and Development Command, and legislative activities in medicine. of t Robert Newburgh, leader of biological sci Sections ofthe Council that met during the ~. emp. ences, Office of Naval Research, presented year were the Southern -and Midwest deans in ar reviews oftheir health research programs and and the deans of New and Developing Com- and discussed areas of current priority for extra munity-Based Medical Schools. The deans of and· mural funding. Donald Young, deputy direc private-freestanding schools convened a spe- . KreV' tor, Bureau of Program Policy, Health Care cial meeting session at the COD Spring Meet- fomi Financing Administration, and Truman Es ing. ship mond, president, Health Charge, Inc~, dis emIT cussed recent changes in Medicare physician the 1. reimbursement policies 'and the implications Council of Academic'Societies feder offorthcoming prospective pricing for hospi The Council of Academic Societies is com- ~ f ret tals. Raja Khurl, 'dean, American University prised of 73 academic societies representing re. of Beirut, provided an historical prospective U.S. medical school faculty members and oth- t the on the role ofthe AUB medical center during ers from the basic and clinical science disci- sec the recent military crisis in Lebanon, noting plines. Two major meetings ofthe CAS were Ie o. its significant medical and humanitarian con convened in 1982-83. ffeet tributions. Alfred E. Gellh'orn, director emer The 1982 CAS annual meeting in Novem- An itus, Sophie Davis School ofBiomedical Edu ber focused on the AAMC's General Profes- erial' cation, City College of New York, described sional Education of the Physician project. In resiC the seven Interface Experiments sponsored by a joint program with the Organization ofStu- ergn the Commonwealth Foundation. Dr. Gellhorn dent Representatives, students and faculty dis- or In highlighted the programs at three universities cussed the GPEP working group topics: fun- ume tt" t: 4 ~ 1982-83 AnnualReport 243 ,So- damental skills, essential knowledge, and per pared by an AAMC steering committee, re l- - sonal qualities, values and attitudes that flected discussions held at four regional insti te should comprise the education of the physi tutes in 1982. Dr. John Rowe, director ofthe le .- cian. StanleyJ. Reiser, professor ofhumanities division on aging at Harvard Medical School, ~r ~ and technology in medicine, University of discussed future directions for academic ger a . Texas Health Sciences Center, spoke on "The iatrics. In Enigmatic Future and Tumultuous Past of The CAS Administrative Board conducted g Medical Education." He emphasized the rapid business at quarterly meetings held prior to t expansion of biomedical·knowledge and the each Executive Council meeting. At its Janu n application of technological advances, point- ary meeting, the CAS and Council of Deans ,e ' ing out the complex ethical dilemmas they Administrative Boards met with H. George )f may place on today's physicians. Mandel, chairman ofpharmacology at George 'n "The Effects of Changing Federal Policies Washington University, and William F. Raub, - t in Academic Medical Centers: Implications associate director for extramural research and ; for Biomedical Research," was the theme of training at NIH, to discuss the implications of . the 1983 CAS Interim Meeting. Key congres a number of proposals to stretch research sional staff and executive branch officials at funding. Leonard Heller, Robert Wood John tended a plenary session and participated in son Health Policy Fellow working with Rep small group discussions with CAS representa resentative Edward Madigan, joined the April tives. The plenary session began with National meeting for an informal discussion ofthe role _Institutes of Health Director James B. Wyn ofthe academic community in federal policy .g;t- ~. gaarden who discussed program and policy making. In June special attention was given to ~:._ '1 directions ofthe NIH. The importance ofsup the NIH peer review system and the work of ]~ - porting investigator-initiated research and the study sections. William F. Raub, Thomas E. ~ ,. training of future investigators was empha Malone, NIH deputy director, and Stephen z •_ ~ sized. Theodore Cooper, executive -vice presi- Schiafino, deputy directorofthe NIH Division ~_ dent of Upjohn Company, spoke on political of Research Grants, were present to answer Q) _ t - control and its effects on federal sponsorship questions and discuss the Board's concerns. ~ of biomedical and behavioral research. He The changing pace and complexity of leg § ~ emphasized that decisions to support research islative activity stimulated concern about ~; in any area should be based on scientific merit whether the quarterly CAS Briefcould provide ~ _ and the opportunities available for discovery adequate information to member societies in ..s:: if and ,advancement of knowledge. Julius R. a timely manner. The Administrative Board ~~_ Krevans, chancellor at the University ofCaIi- decided to discontinue publication ofthe Brief ~-._ fornia, San Francisco, discussed the partner and, instead, encourage member societies to 8 ship which evolved between the federal gov subscribe to the AAMC Weekly Activities Re ernment and academic medical centers since port. The Association's CAS Services Program the 1950s and the destabilizing effect ofrecent continued to 'assist societies desiring special federal policy changes regarding the support legislative tracking and office management f research, medical education and patient services. Six societies participated in the pro e. Gerald S. Levey, chairman of medicine gram in 1982-83: American Federation for _ t the University ofPittsburgh, discussed pro Oinical Research, Association ofProfessors of sed animal research legislation, one exam Medicine, American Academy of Neurology, Ie of how changing -policy could adversely American Neurological Association, Associa fTect medical schools. tion ofUniversity Professors ofNeurology and Another session of the meeting considered Child Neurology Society. • eriatrics and medical education. AAMC Vice resident John F. Sherman reported on "Un- • ergraduate Medical Education Preparation Council of Teaching Hospitals • or Improved Geriatric Care: A Guideline for Two general membership meetings high urriculum AssessmenL" The document, pre- lighted the activities ofthe Council ofTeach- 244 Journal ofMedical Education VOL. 59, MARCH 1984 { !' ing Hospitals during ,1982-83. "Health Care proportion of Medi-Cal patients failed to re- ! c Coalitions: Trustees in a New Role orBusiness ceive contracts. Guy found the real issue of s~ As Usual?" was the theme ofthe COTH gen concern to be ihe financial accountability of c' eral session at the AAMC annual meeting. hospitals and suggested the hospitals' ability C The featured speakers were Irving W. Rabb, to unilaterally determine the cost and charges;" ( vice chairman ofthe board and director ofthe for inpatient care would soon disappear. Guy t e: Stop & Shop Companies, Inc., and Willis was followed by Paul Ward, president of the f d Goldbeck, director of the Washington Busi California Hospital Association, and William:f cr ness Group on Health. Gurtner, executive vice president of Mount ii c( Mr. Goldbeck, whose organization repre Zion Hospital and Medical Center in San i; tr sents approximately 200 ofthe nation's major Francisco. In responding to Guy's remarks, ,- Je business corporations, has assisted corpora Ward indicated that he felt the contracting t1- tions in responding to rapidly rising health process was a temporary approach and.Jlre- sic costs. He asserted that business leaders are dicted that attention would be diverted from it increasingly concerned about the cost and the issue ofcost to denial ofcare. Gurtnertold fre manner in which health care is delivered and his colleagues ofthe reaction when his hospi-: th' aware of the need to exert their influence in tal, a substantial provider ofMedi-Cal services ( of this arena. Goldbeck cited examples in which priorto the contracting, was denied a contract. I wt business coalitions are monitoring hospital Gurtner specified the three areas of concern l~:-'~- IA utilization and introducing increased compe in implementing such a negotiation process: ;~--- tition into the health care market. He invited theskimmingofthe healthierpatients bysome '; fTC a coalition from the academic medical com hospitals; teaching costs, which payers and ~, He munity to meet with business representatives government bodies ~rceived to be someone 'at: to address the future financing of medical else's responsibility; and a simplistic approach soc education. to competition and contracting that failed to the Following Mr. Goldbeck, Mr. Rabb ex recognize appropriate differences among hos- me plained the problems he faced as both a hos pitals and the type ofservices provided. I tic pital trustee and a majoremployer. Headvised Otherstate and local plans discussed during ! hospital executives to educate policy-makers the spring meeting included a description of I istr and businessmen on the nature of teaching the "managed care" approach taken by the· Its hospitals and the reasons for the differences Commonwealth Health Care Corporation in; ser between teaching hospitals 'and community Boston, Massachusetts, described by Rena K. I~ bot. hospitals. He said, "Only if business is con Spence, its executive director; the Rochester,;~ fe~ vinced that you are running an efficient oper New York, area cost containment approach ' Th{ ation, engendering prudent utilization, and of developing caps on hospital revenues, ex- ~ rna' working for prudent cost behavior in both plained by Gennaro Vasile, executive director t of scholarship and service, will we be recruited of Strong Memorial Hospital; North Caroli- the to work with you to preserve thisextraordinary na's recent limitations on the days of care pitr capacity which you have developed in Amer allowed Medicaid patients receiving certain reir ican academic medicine." types of care, described by Eric Munson, ex- pro The sixth annual spring meeting of the ecutive director of North Carolina Memorial hos' Council of Teaching Hospitals was held in Hospital; the Arizona Health Care Cost Con- soci: New Orleans, Louisiana, May 12 and 13. The tainment System, that state's first Medicaid Hur main topic of discussion for the more than program, outlined by David A. Reed, presi- rete: 200 teaching hospital executives in attendance dent of Samaritan Health Services; ·and a to r was state and local initiatives in hospital cost teaching hospital experience in establishing a the containment. William Guy, Medi-Cal negoti preferred-provider organization in response to It al ator for California, described the California competitive pressures, discussed by Gary Bro COrr one-year experiment in which hospitals bid on kardt, vice president ofaffiliated corporations at~ contracts to treat Medicaid patients. Under of Presbyterian-St. Luke's Health Care Cor the this highly controversial program some hos poration. for pitals traditionally providing service to a large John M. Eisenberg, chief of general medi- dem' t 4 r 1982-83 AnnualReport 245 \ -e: ~ cine at the Hospital ofthe University ofPenn AAMC in assuring that such leadership train )1 i sylvania, Richard Gaintner, president and ing existed; the regulation on "Nondiscrimi )f L chief executive officer of the Albany Medical nation on the Basis ofHandicap," which dealt ~y!~ Center, and Warren Nestler, vice president of with instances in which severely handicapped ~ 'i: Overlook Hospital in Summit, New Jersey, infants were not treated; and the role of the Y \ explained various approaches to managing the AAMC in providing services to its member Ie delivery of care. Eisenberg discussed modifi- institutions. The COTH Board also reviewed n cation ofphysicians' behavior to promote cost and considered items on the Executive Coun It I containment. Gaintner described the decen cil agenda which were ofinterest to the mem ,n!; tralized approach to management used at The bership ofthe AAMC as a whole. .s, :~ Johns Hopkins Hospital, and Nestler told of g ~~ the use ofDRG information to compare phy ~- r sician performance in delivering care to var Organization of Student n ( ious types ofpatients. The audience also heard Representatives : r' from Richard Thompkins, a manager at Ar- thur Young and Company, on his firm's study During this year 123 medical schools desig of the cost of graduate medical education, nated a student representative to the Associa which is currently being conducted for the tion of American Medical Colleges, an in Department ofHealth and Human Services. crease offive from the previous year and the The spring meeting attendees also heard highest number in the Organization's history. from Carl Eisdorfer, president of Montefiore Students from 106 schools attended the 1982 Hospital and Medical Centers in New York Organization of Student Representatives an and John Sherman, vice president of the As nual meeting. The first evening's program on sociation of American Medical Colleges, on "Nuclear Weapons, Denial Psychology, and the need for increased attention to geriatric Physicians' Responsibilities" drew a diverse medicine and the education of future practi audience and was offered by H. Jack Geiger, tione~ to meet the needs ofgeriatric patients. professor of community medicine, City Col The Council ofTeaching Hospitals Admin lege ofNew York; Tony Robbins, professional istrative Board met five times during the year. staff member, Committee on Energy and Its discussions dwelt on payment for hospital Commerce ofthe United States House ofRep services and payment for physician services, resentatives; and Bruce Dan, formerly with both of which were changed dramatically by the Centers for Disease Control. On the next a ~ '( federal Jaw and regulation during 1982-83. day, attendees heard presentations by Law ~ ,I ,: The Board considered how to make policy rence Weed, professor ofmedicine at the Uni § '. makers more aware ofthe functions and needs versity of Vermont College of Medicine, on Q ~r of the teaching hospital and how to protect "New Premises and New Tools in Medical the physician practice plans in teaching hos Education" and by John-Henry Pfifferling, di -e pitals. As part of its overall attention to rector, Center for the Well-Being of Health 1 reimbursement issues, the Board reviewed Professionals on "Recreating the Joy ofMed proposals for prospective payment systems for icine." Discussions stimulated by these ses 1 - hospitals made by the American Hospital As sions resulted in the formulation and approval ,- sociation a.nd the Department of Health and ofaction plans on medical use ofinformation i Human Services, and reviewed and advocated systems, social responsibilities of physicians, ,- retention ofa modified Medicare Cost Report housestaff concerns, financing medical edu a to provide accurate data with which to assess cation, programs for fostering personal growth a the effects ofthe system on various hospitals. and development, and improvement ofteach ) It also considered the report from an AAMC ingand evaluation techniques. Additional pro committee on paying for physician services in grams were given by Robert Lang and Alan S a teaching setting. Other topics highlighted at Kliger, both associate professors of medicine ".. the COTH Board meetings were preparation from Yale University School ofMedicine, on for leadership in the teaching hospital/aca "Retaining Your Humanism in the Face of .. demic medical center and the role of the Technologic Explosion," and by Leah Dick- ~~~ 246 Journal oJMedical Education VOL. 59, MARCH 1984 t: !.~ stein, associate dean fOf student affairs, and research; it agreed that many medical students r;. Joel Elkes, professor ofpsychiatry and behav could benefit from reading a pamphlet on this ioral sciences, both from the University of subject produced by the-Association ofProfes-l Louisville School of Medicine, on "Creating sors ofMedicine and copies were sent to OSR !~ Self-Help Programs." members. As in previous years, the Board ~.~ ~ The Board met prior to each Executive nominated medical students for the position f~ Council meeting to coordinate OSR activities, of. student part~cipant on ~he Liaison Com- r: to consider Executive Council agenda items, mlttee on MedIcal EducatIon and made ape ..: and to share information on regional projects, propriate information available to OSR mem- n ga' including the OSR spring meetings. Adminis bers at schools with upcoming LCME site - at: trative Board members prepared stimulus ma visits. t terials to encourage student participation in One issue of OSR Report was prepared by t eli institutional activities related to the AAMC's individual members ofthe Board and distrib-'- Be. t m, General Professional Education ofthe Physi uted to all ~edical students. It included essays f thr cian project. At its April meeting, the Board on the NatIonal Boards, the need to develop' mi approved a proposal recommending that the teaching skills, loan repayment, career deci- f car Association explore mechanisms to achieve sions, and creativity. Another publication prOof Re additional 4input from residents. The OSR vided to OSR membe~ and to student affairs i-. up. chairperson presented this proposal to the deans was a compendIum of programs cur- ¥._~ M' Council ofDeans Administrative Board at its rentIy being offered at medical schools de+ Pr~ June meeting. A new area discussed by the s~gned to assist students in choosing a spe.~, su: Board was the use of animals in biomedical clalty. ,~~:- bot enc iog ", uti ~- t..-~,,-•• t rese i clu( ~FY t the ~ earl ~~ was (0 e1in eets tior con. ~ 197~ : [ ~ cal i ~. poli poH 'if. and " Real mitl prog _only redu -ular whic, :~ bud~ .pe. -~ The Congressional override ofPresident Rea The crunch on resources fragmented and ~;, gan's veto ofits 1982 supplemental appropri. paralyzed both the 97th and the 98th Con ~: ations bill was a harbinger of change in the gresses. For example, the Departments ofLa climate for development of national policy. bor, Health and Human Services, and Educa :~. Besides representing the first Reagan loss on a tion were funded by a continuing resolution t major economic issue, the override displayed rather than a normal appropriation act for the ys" that Congress was capable ofexacting compre fourth consecutive year. In March, when the )P mise from the executive branch. This override Democratic House passed its FY 1984 budget ~ ~- ~ carried by the slimmest possible margin in the resolution, the bill was immediately branded ~ .> I Republican Senate, with 30 Senators voting to as too costly, given the prevailing political ~ rs ,- _uphold the veto and 60 voting for the bill. environment of retrenchment. Then the Sen ~ r-C, Many ofthe Republicans who objected to the ate took three months to produce its FY 1984 ] e-l-- President's veto did so on the grounds that the budget resolution. The Senate Budget Com ] e- supplemental bill stayed within the spending mittee's original bill and two alternatives were ~ ~1 boundaries ofthe FY 1982 budget resolution rejected on the Senate floor, and the Commit E ~',- endorsed by the President, and that in oppos- tee was instructed to redraft its resolution with ~ ) ing the bill he was flouting the spirit of exec- no clear indication of what changes would ,~~ utive-Iegislative compromise. muster a majority. The resolution that finally ~; The AAMC was encouraged by the NIH passed anticipated a $200 million increase in ~ ,- research funding level of $4.004 billion in biomedical research, while calling for much o cluded in the final continuing resolution for larger tax increases and only halfthe increase ~ FY 1983, a welcome, ifslight, increase above in defense spending that President Reagan , the amount requested by AAMC in testimony requested. The non-defense portion of the r earlier in the 97th Congress. The funding level budget generally received small increases. ao <.l:1 f; was insufficient to reverse the trend of a de The House-Senate budget conference : clining percentage ofapproved research proj- reached agreement after prolonged negotia . ects receiving awards. The continuing resolu tions. That measure provided room for NIH tion did not bring NIH funding, measured in funding to increase in FY 1984 by a substan constant dollars, up to its high-level mark in tial extent. This year9s budget cycle was note ; 1979. worthy for the marginal role that the White : Despite signs ofan economic recovery, fis House played in forging a compromise and cal issues retained a paramountposition in the for Congress9s two-month postponement ofits political debate; legislators struggled to find a July 22 reconciliation deadline. The Congress policy mix thatwould both boost the economy weathered an internal tempest in passing its and remain politically palatable. President budget resolution, which sets broad spending - Reagan's FY 1984 budget reaffirmed his com guidelines, but must exact a further set. of mitment to defense increases, cuts in social compromises, this time for President Reagan, : programs (characterized as a "freeze~), and as it works on individual appropriations bills only limited measures to raise revenues to forFY 1984. reduce the deficit. These policies have partic On the bright side, congressional support -uIar implications for the Medicare program, for research has been reinvigorated by a re which was a major target in the FY 1984 newed belief that research expenditures have budget resolution reconciliation instructions. stimulating effects on the economy as a whole 247 248 Journal ofMedical Education VOL. 59, MARCH 1984 1. and that the government's commitment to picked up a large number ofadditional and! pc research must be maintained, especially in the or unnecessary provisions. AAMC presented vc domain ofsophisticated technology. testimony on this proposal, stressing that sci- 1.3 The Association was heartened by the re entific opportunity is inherently unpredictable tt newed political popularity of research. How and requires organizational, operational and in ever, it remains opposed tothe ubiquitous calls funding flexibility so that the most promising cc for targeted research with related reorganiza research leads can be pursued. AAMC reiter- IC tional and funding demands. These forces ated its concern over the additional adminis- tb have left graphic imprints on NIH reauthori trative structures that the bill would impose co~ zation bills in the House. In the 97th Congress, upon the already adequate mechanisms within tic the Health Research Extension Act of 1982 the NIH. Waxman's bill is opposed by the gr would have mandated research centers, dem DHHS; there also is a group ofRepresentatives rec onstration projects and other statutorily un who, impressed by the progress NIH has made i~ ate necessary activities that would bind the hands in its current configuration and management f A( ofthe Appropriations Committees; limited the structure, are determined to forestall further Wf NIH Director's latitude to provide funding for congressional encroachment. Highly charged ~: lia research proposals showing the greatest scien floor debate has be~un on H.R. 2350, with its f cor tific promise; and mandated numerous ad opponents set to offer an AAMC-supported f: La ministrative changes in the NIH. s~bsti~~te reauthorizat~on thatis striking i~ its /. fe\\ Conceivably even more disturbing than the SImplICIty. TheSenate IS also about toconSIder ~~~' cur recodification of administrative provisions its NIH reauthorization bill. The latter has -' and the statutorily imposed structural uni fewer new provisions than the House compan- \ He formity within NIH was language in the report ion, particularly in regard to NIH reorganiza- ~ - ary accompanying H.R. 6457 that asserted that all tion, but it is still too prescriptive in its con- ~ ride necessary NIH authority was included in Title tents to elicit AAMC endorsement. tior IV of the PHS Act; this came dangerously The newly created Public Health Emer- Sec close to eliminating access to the open-ended gency Fund underscores the susceptibility of ,- ity statutoryauthorityofSection 301 ofthe Public legislators to well-organized publicity cam- :: gr~ Health Service Act. This authority is the bed paigns. Once the Secretary certifies that a pub- I fun rock upon which NIH has grown, and the lie health emergency exists, this $30 million 1 severe limitation ofthis authority would mark fund authorizes expedited peer and advisory take a truly dramatic change in the operational council review of relevant research grant ap- pro~ framework of NIH. H.R. 6457 passed the plications. This legislation grew directly out of tiar House by a large margin, following heated the concern engendered by the AIDS epidemic rese' debate about the most propitious relationship and the Tylenol package tampering tragedy. izaf between the NIH and the Congress, but was The bill's proponents have erroneously as- initi never enacted, as the Senate version of the sumed that since the public perceives an emer- - ates NIH reauthorization bill never came to a vote. gency, unlimited research opportunities must _ esta An emergency, bare-bones compromise to also exist. The bill does not recognize that ~ and reauthorize the NIH was unsuccessful, hence existing NIH procedures already permit a revie the National CancerInstitute and the National rapid commitment of research funds to meet ~ Heart, Lung and Blood Institute currently op unusual opportunities. loorr erate only because ofthe existence ofthe Sec The funding picture for NIH remains pre- func tion 301 authority and the fact that NIH is carious although there is some ground for year.. operating under a continuing appropriations optimism. The Administration's FY 1984 f. to b resolution. This situation is a telling example budget request for NIH of$4.077 billion, an ~ 199': ofthe utility ofSection(30 1 authority. increase over FY 1983 funding of 1.8 percent, perce The NIH authorization bill which Rep. was repudiated in the congressional budget Moo:' Waxman introduced in the House early in the process. The AAMC, through the Coalition jeete 98th Congress was almost identical to the one for Health Funding, is working vigorously in care from the previous session, but it subsequently the 98th Congress to increase government sup- ~ utab 1982-83 AnnualReport 249 port for health research. The Association ad other increases are due to general inflation in vocates a position taken by 133 other organi the cost ofcapital and labor, as well as to the zations to add a minimum of$487 million to use ofnew and costlier technology. the 1983 appropriations level for NIH fund The Medicare reimbursement system has ing. This figure would permit 35 percent ofall only begun to implement drastic statutory competing projects to be funded; provide for changes enacted during the past year 10,000 research trainees, about the average of TEFRA limits on hospital reimbursement and ... the past 5 years; restore direct and indirect prospective reimbursement rates based on di cost reductions proposed by the Administra agnostic related groups. However, there are tion; and support modest growth in all pro already proposa1s circulating to respond to grams. The AAMC testified on behalfofthis Medicare's financial difficulties. Manyofthese recommendation in late April before the Sen are primarily concerned with cost reduction, ate Subcommittee on Labor/HHS/Education with assurance ofadequate health care a dis .t Appropriations, chaired by Senator Lowell tinctly secondary issue. 'r Weicker, as well as before Congressman WiI- The growing constituency advocating more :l ~ liam Natcher's House Appropriations Sub- severe restrictions on the use of animals in §.s :- committee. Another continuing resolution for research has monopolized a good deal of the !i r; Labor/HHS/Ed is highly probable, as only a AAMC's legislative energies. Animal welfare ~.s few working days remain before the end ofthe groups are gaining steadily in political sophis o ~;r current fiscal year. tication, solvency, and emotional clout. In the ] s: The Alcohol, Drug Abuse and Mental 97th Congress Doug Walgren introduced H.R. ~. \ Health Administration was a major benefici- 6928, "Humane Care of Animals Used in ~ ,. - ary of the FY 1983 supplemental veto over Scientific Research, Experimentation and s,. -ride. That appropriation provided an addi- Testing,99 which would have created a number ~ tional $10 million for research funding. The of onerous and costly provisions for those u·· Secretary was also given discretionary author- using animals to further their research. The ~ f ~ - ity to allot the research funds to areas of bill would have required all laboratories using ] • greatest need; most went to approved but un animals to receive AAALAC accreditation ~. I. funded investigator-initiated research grants. within ten years, at an estimated cost of$SOO B1 The 98th Congress, extending the approach million. Further, the bill would have required ]y taken by 97th, swiftly authorized ADAMHA institutional animal care committees respon .s • programs with especially generous authoriza sible for determining if an acceptable substi j ~ tion ceilings for the alcoholism and drugabuse tute for research designs employing animals ~ = research programs. The ADAMHA reauthor could be developed. The fact that NIH grant g'. ization bill mirrors trends in congressional and contract approval procedures require ex Q - initiatives concerning NIH. Thus the bill cre- plicit justification for the use of animals was ates an associate administrator for prevention, apparently disregarded. H.R. 6928 also would establishes procedures for responding to fraud have created an HHS grant program to de and abuse, and places new provisions on peer velop alternatives to the use of animals in a review ofcontracts and intramural research. research. TheAAMCsinitial response to Wal t Medicare's projected trust fund insolvency gren's proposal asserted that research on meth looms ominously on the horizon. The trust odological issues alone placed a poor second fund had a balance of $18.7 billion just two to experimental design advances made in the .. years ago, but under current law it is expected course ofdirected research; there are powerful . to be in arrears by at least $200 billion by economic and experimental incentives built . 1995. That figure represents approximately 23 into animal research which encourage scien ~ percent of the entire federal budget for 1984. tists to use animals sparingly and to keep them Medicare's fiscal problems stem from a pro as healthy as possible; AAALACs require 1 jected 1~.2 percent annual increase in Medi ments exceed what is necessary to ensure the 1 care costs, ofwhich only 2.2 percent is attrib humane care and treatment oflaboratory an - utable to demographic changes. Most of the imals; and that the peer review system, not 250 Journal ofMedical Education VOL. 59, MARCH 1984 if animals committees, can make the best deter added to the animal welfare debate when the As mination ofthe appropriate use ofanimals in Administration's FY 1984 budget request ~~ research. Walgren's bill passed through the again proposed elimination of APHIS fund- . Science and Technology Committee, but died ing, eliminating support for federal oversight c set in the Energy and Commerce Committee. ofthe treatment ofanimals. The Administra- - bu Walgren continued his efforts in the 98th Con tion proposed in its budget statement that the to gress and some animal care provisions were APHIS activity be turned over to "states, in-' ste, included in H.R. 2350, the NIH reauthoriza dustry, humane societies, and individuals." . ye' tion bill. Through the efforts of the AAMC AAMC testified on behalf of seven other so- 10\\ and other groups, these provisions are less cieties and professional organizations for the - gra burdensome than the ones originally pro retention of APHIS funding. Concerns ex- mi posed. They include the requirement to estab pressed included the handling of violations FY lish institutional animal care committees with while the new oversight system was being im- ~ Ad responsibilities to visit laboratories using ani plemented, the imposition of different state ~ pr~ mals twice yearly and report to NIH; statuto regulations on institutions operating in several . rily imposed guidelines for NIH funded re states, and regulation ofinterstate carriers. The t ~en search using animals; alternative methods re Administration's proposal was rejected in an r tu search; and a study by the National Academy appropriations bill awaiting the President's sig- r FY ofSciences on the use ofanimals in research. nature. . (:.' ~ee In the 97th Congress Senator Robert Dole This year, the Reagan Administration con-::' IDce also entered the animals in research fray. His tinued t~ reduce ~ederal ~nancial assi~nce L IhO f bill would have made standards in the Animal for medltal educatIon. ThIS occurs at a tIme ..~_ t e Welfare Act similar to those in the "NIH ofgrowing anxiety in the medical community .• ;;oa Guide for Care and Use of Laboratory Ani about its ability to draw from the widest pos- loa mals," on which AAALAC accreditation is sible array ofqualified students, given spiraling : Adr based. Dole's bill would also have required tuition charges and reports ofdiminishing op- was research facilities to establish animal studies portunities for newly trained physicians. Fur- ~~~ committees, which would meet regularly and ther concern stems from the continued inabil- r: CU~ make semi-annual inspections of research fa ity of medical schools to increase enrollment . ~el cilities. Senator Dole's bill did· not emerge on of underrepresented minority students. The aarr the floor of the 97th Congress, but was rein federal government remains the primary pa- .~ troduced in 1983 and hearings were held in tron ofmedical educational opportunity, sup- ~n late July. The AAMC testimony objected to plying over 80 percent ofall studentassistance. ~J~ its particularly intrusive provisions, including The Association has assigned a high priority : 10 P I the requirement that the Secretary ofAgricul to -obtaining an adequate level of financial R TI ture promulgate standards for methodological support to meet medical students' needs. ~g procedures in research using animals. AAMC Ofall the aid programs, the Health Profes- ce~v~ also expressed serious doubt about the capac sions Student Loan program endured the most m!::: ity ofthe Animal and Plant Health Inspection uncertainty and controversy, beginning with mIll Service to verify compliance with those stan much-publicized hearings chaired by Senator eSOJ dards and the wisdom ofauthoriZing the ani Charles Percy about the default rates for the tude mal studies committees to make judgments program. In late August 1982 HHS issued o~~ on the appropriate care, treatment and meth proposed loan collection regulations so de- IS odology of animals used in research, judg manding that at least two-thirds ofthe schools 0 the ments properly within the province ofnational in the program would have been rendered Dcre' peer review committees. AAMC did endorse ineligible for further participation. AAMC ex- 175 a NAS study on the issue of animals in re pressed its objections to HHS, met with Sen- _ro~ search. This study is now included in both the ator Percy's staff in an attempt to soften the utItt House and Senate versions ofthe NIH renewal regulations, and, along with other health ea tl~ authority. professions groups, retained counsel to work onb A potentially dangerous crosscurrent was for modification of.the regulations. The l;. 41 1982-83 AnnualReport 251 1e~' AAMC effort was modestly successful in help congressional budget resolution will permit st ing to persuade HHS to adopt HPSL regula- students to borrow to meet their full educa j- ~ tions that will tightly constrain medical tional cost. Jt . schools in their administration ofthe program The programs administered by the Veterans but will not, as feared, foreclose their ability Administration stood immune to the fiscal to utilize it. Many schools have already uncertainty which plagued the funding process stepped up their loan collection efforts, and by in so many areas ofAAMC interest. For both year's end Senator Percy was lauding them for FY 1983 and FY 1984, HUD/Independent lowered HPSL default rates. The HPSL pro Agencies appropriation bills, under which the gram was further endangered by the low $1.0 VA is funded, were passed by Congress and million capital contribution included in the signed by President Reagan. The FY 1984 bill IT 1983 Continuing Resolution, and by an provided a welcome $12 million increase in Administration FY 1984 budget request that medical and prosthetic research, activities that provided no further capital contribution. were increased in the 1984 bill by another $6 This year, the president once again at- million. In its testimony before the relevant e tempted to restrict access to the Guaranteed House and Senate Appropriations Subcom ~.~ t Student Loan program. If adopted,.Reagan's mittees the AAMC stressed the need for re a'I~ FY 1984 budget proposal would Impose a search opportunities in veterans' hospitals so !.,- -. needs test on all students, regardless of their that able staffphysicians and residents can be ~ 1- ::: income, and raise the loan origination fee to recruited and retained. Emphasis was also ~:el'- 10 percent ofthe amount being loaned, twice .placed upon the need for higher operating ~ e .~ the current charge. The Guaranteed Student budgets within VA hospitals to ameliorate the ~-' ~. Loan program provides almost one-halfofthe unsuitably low staffing ratios. The Association ~? ' financial aid utilized by medical students. The continued to oppose VA reimbursement for ~g dministration's FY 1984 proposal for GSL chiropractic service to veterans. In testimony ~)- .~_ was only slightly less odious than the one before the House Veterans' Affairs Subcom ~". .- advanced the previous year, which would have mittee on Hospitals and Health Care, the ~ I. ;. eliminated graduate medical student involve AAMC claimed that services of unproved ~ 1t <- ment in the program altogether. That proposal medical value do not merit funding in a time g' e alarmed the higher education community and of budgetary stress. A letter of similar thrust ~ ,_was the target ofan energetic, successful lob was delivered to the Senate Veterans' Affairs ] ~ bying effort. This year's proposal was also Committee; however, the Senate approved a i s rejected in all quarters. The program remains measure which would authorize VA payments ~;; -_ in place but needs to be reauthorized by 1985. to chiropractors. §11 The HEAL Program was also the target of The National Research Service Award tax 8 Reagan retrenchment but it ultimately' re- issue was finally resolved when the IRS re j- ceived an FY 1983 credit allocation of $225 versed itself and ruled that the awards are to million, a more adequate level than the $80 be treated as scholarships under the tax code. illion limit recommended in the first budget The newly declared tax-exempt status of the Ir esolution. The AAMC successfully mobilized awards means that the entire amount of the e tudent support for this program when the awards for pre-doctorals is excludable from , nrealistically low credit ceiling was imposed. income tax, and that $300 a month is exclud ·s limitation would have restrained access able in the case ofpost-doctorals. Legislation s 0 the program at a point when its usage has temporarily making the awards tax-exempt ncreased substantially. The Administration's had passed the Congress a number of times 175 million FY 1984 budget request for this and a bill to permanently define the tax status • rogram recognizes its current importance, ofthe awards was pending as the IRS, respond ut that credit ceiling is too low to give all ing to the urgings of the NIH as well as to 1 ealth students the loan funds they need. The congressional pressure, rendered the legisla . onbinding credit accounts in the FY 1984 tion superfluous. 1. w re~ It: Working with Other Organizations M ac llC' ql The Council for Medical Affairs-composed begun the process of revising its accreditation Re ofthe top elected officials and chiefexecutive standards for the evaluation of M.D. degree ree officers of the American Board of Medical programs with the objective of providing an the Specialties, the American Hospital Associa updated policy statement for subsequent con- an tion, the American Medical Association, the sideration by the academic and practicing Se' Council of Medical Specialty Societies, and communities. ree the AAMC-continues to act as a forum for Through the efforts ofits professional staff, tio the exchange ofideas among these similar but members, the LCME provides factual infor- t me diverse organizations. Among the topics con mation, advice, and both formal and informal r tol, sidered during the past year were the transi consultation visits to newly developing schools It na' tional year in graduate medical education, at all stages from initial planning to actual: acc hospital staff organization, prospective pay operation. Since 1960 forty-one new medical ;,. spe ment, and concerns about the selection pro schools in the United States and four in Can-l'~: cess for the second year post-graduate training. ada have been accredited by the LCME. .:' sel- Since 1942 the Liaison Committee on Med In 1983 there are 127 accredited medical~~- am. ical Education has served as the national ac schools in the United States, ofwhich one has ~ Na crediting agency for all programs leading to a two-year program in the basic medical sci- '-. nat the M.D. degree in the United States and ences. Two have not yet graduated their first '.: ucr Canada. The LCME is jointly sponsored by classes and consequently are provisionally ac- ~, gral the Council on Medical Education of the credited; the 125 schools that have graduated' cler American Medical Association and the Asso students are fully accredited. Additional merl- ~ sch ciation of American Medical Colleges. Prior ical schools are in various stages of planning - pat to 1942, and beginning in the late nineteenth and organization. The list of accredited ~ eigr century, medical schools were reviewed and schools is found in the AAMC Directory of was approved separately by the AAMC and the American Medical Education. eva AMA. The LCME is recognized by the physi A number of new medical schools have :' sehc cian licensure boards ofthe 50 states and U.S. been established, or proposed for develop- obst territories, the Canadian provinces, the Coun ment, in Mexico and various countries in the . con.. cil on Postsecondary Accreditation and the Caribbean area. These entrepreneurial schools year U.S. Department ofEducation. seem to share a common purpose, namely to T' The accrediting process assists schools of recruit U.S. citizens. There is grave concern havl medicine to attain prevailing standards ofed that these schools offer educational programs '. accr ucation and provides assurance to society and ofquestionable quality based on quite sparse- ACe the medical profession that graduates of ac resources. The ability ofthese foreign medical riod:' credited schools meet reasonable and appro students to return to the United States for the tee priate national standards; to students that they practice ofmedicine will depend on their per- , ACe will receive a useful and valid educational sonal qualifications and backgrounds. How- : com. experience; and toinstitutionsthattheirefforts ever, it is anticipated that within the next five .. accr( and expenditures are suitably allocated. Sur years the number of residency appointments in fa vey teams provide a periodic external review, available in the United States will closely' T' identifyingareas requiring increased attention, match the numberofstudentsgraduatingfrom . Med. and indicate areas ofstrength as well as weak U.S. medical schools. Thus, M.D. degree grad- . new ness. During the past year, the LCME has uates from foreign schools ofunknown quality ~ This 252 ~~ f 1982-83 AnnualReport 253 i: will have increasing difficulty in securing the pIes and standards of the Essentials to the residency training required by many states for national accreditation ofsponsors ofcontinu medical licensure. ing medical education including medical The Accreditation Council for Graduate schools, national professional and specialty Medical Education continued to improve the organizations, and other institutions. accreditation system for graduate medical ed The ACCME still must complete the devel ucation programs under the new General Re opment ofits relationship to the state medical quirements that became effective inJuly 1982. societies as accreditors ofintrastate continuing In Residency Review Committees, whose special medical education. The Council is seeking .e requirements no longer are subject to veto by national recognition of such organizations ,n their sponsors, were active in strengthening through approval ofprocedures which assure and clarifying their criteria for accreditation. adherence to national standards ofaccredita ,g Seven RRCs submittedchanges intheirspecial tion while acknowledging the privilege ofstate requirements for ACGME approval. In addi- societies to accredit local sponsors of contin 1 tion, the ACGME approved special require- uing medical education. The acceptance and ments for four pediatric subspecialties (hema application of national standards for the ac gal ~ tology/oncology, nephrology, neonatal/peri- creditation ofcontinuing medical education is ~...... ~~al-.sl /;.:. natal medicine, and endocrinology). Plans for considered an important step towards assuring ..s::~:u accrediting these and internal medicine sub- the public and the profession of quality con specialties are being implemented. tinuing education for physicians. ]l-l: The requirement that graduates ofmedical In response to widespread demands, the .g - schools not accredited by LCME pass an ex- Educational Commission for Foreign Medical ~ .:-, amination equivalent to Parts I and II ofthe Graduates, in collaboration with the National ~s . National Board ofMedical Examiners exami Board ofMedical Examiners, began todevelop i,i- ~. nation before entry into graduate medical ed an extended certification examination equiv u st .' ucation programs was extended to include alent to Parts I and II of the examination ~:- <: graduates who have taken a year of clinical offered by the NBME. This new examination, .s:d <' clerkships sponsored by an accredited medical the Foreign Medical Graduate Examination ~ j- school. This brings the requirements for "fifth in the Medical Sciences, will replace both the ~,g - pathway" candidates into line with other for original ECFMG examination and the Visa ;§"d eign medical graduates. An ad hoc committee Qualifying Examination. The Secretary of ~ J.! was established to explore the feasibility of Health and Human Services has declared this ~ evaluating the clinical skills of graduates of new examination equivalent to Parts I and II i re :' schools not accredited by the LCME by direct ofthe NBME examination for physiciansseek §)- observation. The committee report will be ingvisas. TheACGME has given it provisional 8 ,e considered by the ACGME during the next approval as the test required for graduates of ,s year. non-LCME accredited medical schools to en o Thirteen of24 residency review committees ter approved residency programs. FMGEMS have been granted independent authority to will be offered for the first time in July 1984 ,s accredit programs without prior review by the and biennially thereafter. The ECFMG Board ;e ACGME. The actions of these RRCs are pe ofTrustees also approved recognition ofpass l riodically surveyed by a monitoring commit ing scores on all three parts of the FLEX ,e tee to ensure that the RRCs comply with examination for partial fulfillment of the re • ACGME procedures and policies. An ad hoc quirements for obtaining the ECFMG certifi -•. committee to appraise the effectiveness ofthe cate. Under this new policy, the requirements re . accrediting process will report to the ACGME for entry into U.S. graduate medical education 5 in fall 1983. programs will be the same for all graduates of Y The Accreditation Council for Continuing foreign medical schools. This accomplishes a 1 Medical Education has gained approval ofits long-standing goal ofthe Association. ,. new Essentials by all member organizations. The Coalition for Health Funding, which y -This permits the Council to apply the princi- theAssociationjoinedwith othersin establish- 254 Journal ofMedical Education VOL. 59, MARCH 1984 ing 13 years ago, has expand~d its activities search. The Association is regularly repre and influence by monitoring and commenting sented in the deliberations ofthe Joint Health on the development of the congressional Policy Committee ofthe Association ofAmer- r_ budget resolutions in addition to its ongoing ican Universities/American Council on Edu efforts on the appropriations process. The un cation/National Association of State Univer predictabilities in the evolution ofthe congres sities and Land-Grant Colleges, the Washing E sional reconciliation process presented new ton Higher Education Secretariat, and in the challenges to the Coalition and emphasized Intersociety Council for Biology and Medi the importance of cooperation among orga cine. These liaison activities provide forums nizations with similar interests. Widespread in which information on matters of national D acknowledgement ofthe usefulness ofthe Co interest can be shared, varying points ofview A. alition's annual position on appropriations for reconciled, and collective actions undertaken to the discretionary health programs offers sig in the area offederal legislation and regulation. pa nificant evidence of the respect with which it The Association's Executive Committee M is held. meets periodically with its counterpart in the ide The diversity of the Association's interests Association ofAcademic Health Centers. This an de, and the nature of its constituency offers an past year the organizations co-sponsored a l: unusual opportunity for liaison with numer conference on the implementation ofthe Med 1". OJ: ous other organizations representing health icare prospective payment system for aca fed care providers, higher education, and those demic medical centers. ~; interested in biomedical and behavioral re- k I.e ed~ .~: de OJ: me gra f: the r Ph~ V ~;~ - act· scb stue indO prc~ effc FOl 1 stirr ical phi~ catic The . evi~ : grOl hear nia, · Uni- · west · New · ers s -- Education .5 During the past year, the membership of the To gain the particular perspective ofcollege 1 AAMC has expanded and extended its efforts and medical school students, two special sur to improve the education of the physician, veys were commissioned by the AAMC. Louis particularly during the period preceding the Harris and Associates, Inc., interviewed M.D. degree. These activities have sought to premedical students to obtain their percep identify problems in the existing system, to tions of how the medical school admissions 5 anticipate changes required to meet the future process had shaped their college education. ~a demands of the profession, and to study the The Center for Educational Development ~, ~. options suggested by most recent advances in sampled second and third year medical stu t , educational theory and practice. Such critical dents on their views on a variety of topics g f,:=- retrospection and self-evaluation involves ranging from the efficacy of their scientific ~ It '-.' risks, not the least of which is the acknowl- education to their personal relationships. ] edgement that the current system contains In July the panel under the chairmanship ~ deficiencies and can be improved. Despite an ofSteven Muller, president orTheJohns Hop ~ opportunity to adopt a defensive attitude, the kins University, met to review the working Bo medical schools have engaged in these pro- group reports, the testimony presented at re Z - grams enthusiastically and energetically. gional hearings, the two special surveys, and The most conspicuous ofthese activities is the institutional and organizational reports. -, the General Professional Education of the The major issues that have emerged in the Physician and College Preparation for Medi course of the project will be debated at a cine project. The GPEP project achieved con special general session at the 1983 annual siderable momentum during the year with meeting. The final report will be presented to ~ active involvement ofover 95 AAMC medical the Executive Council and published as a sup - schools, four-year colleges from which medical plement to the Journal ofMedical Education ao <.l:1 students are drawn, and organizations and in late 1984. . individuals engaged in medical education. The The AAMC Group on Medical Education project is in the second year of a three-year has been enthusiastic about the increased in effort supported by the HenryJ. Kaiser Family terest in medical education provided by the Foundation. GPEP program. The project became an im The GPEP project has been successful in portant focus for the GME and served as a stimulating broad discussions among the med basis for organizing discussions at regional and ical school and college faculties about their national levels. The GME is currently identi philosophies and approaches to medical edu fying research and development activities cation and college preparation for medicine. emerging from the GPEP-related discussions. The widespread interest in this project was Ajoint 1983 plenary session with the Group evident when 98 different faculty and student on Student Affairs considered educational re groups appeared before the panel at regional form in the context of future societal change. hearings hosted by the University of Califor In that session the impact ofsocial, economic, nia, San Francisco, School of Medicine, the political, and technological change on the University of Texas Medical School, North profession and health care system was assessed western University Medical School, and the and the implications for changes in educa New York Academy ofMedicine. Many oth- tional practice weighed. The small group dis . ers submitted written statements and reports. cussion sessions, educational exhibits, work- 255 ~-- 256 Journal ofMedical Education VOL. 59, MARCH 1984 t 1 shops, and special panels on continuing and main focus has been on the evaluation of I- ti: minority education were also strongly influ medical students, activities covering all clini-! te enced by the spirit of self-appraisal that has cal education are planned. A consultant group '. d,· been increasingly evident with the advent of will assist in addressing-this challenge. . lie GPEP. The need for more systematic information te The Research in Medical Education Con about experiments in curriculum and evalu- Sl ference has also shown gro\\jng concern for ation has prompted plans for a network for to broad educational issues. The RIME Commit the exchange ofsuch information. tee established an Annual Invited Review of In a more specific but highly critical area of ~. Medical Education Research for publication the future education of the physician, the f of in the conference Proceedings and for presen AAMC concluded its Regional Institutes on tation at the annual meeting. The first review, Geriatrics and Medical Education project. The tic entitled "Measuring the Contribution ofMed Association published and distributed more of ical Education to Patient Care," was prepared than 4,000 copies ofthe proceedings from the J ist by Joseph S. GonneIla of Jefferson Medical four regional conferences and the Steering College. Committee's final report on "Undergraduate ac en The RIME planning committee also recog Medical Education Preparation for Improved,. be'· nized that better information about research Geriatric Care." During 1983, the Association, r m, and evaluation projects would encourage through the support of th~ Pew Memorial r more attention to trends and general policy, Trust, sponsored 50 visiting lectureships in l-. ass so the Proceedings have been expanded to geriatrics and gerontology for medical schools, r ~ include the precis of all conference submis teaIchindgd~?spitalS, a?d ~~d_e~icsocffiieti~s. r-~ TI: sions. n a Itlon to maIntainIng Its e orts In the : on The AAMC Clinical Evaluation Project has U.S. District Court in New York to protect ,-..- approached the improvement of the educa the Medical College Admission Test in the : :~ tional process by concentrating on evaluation face of that ~te's test disclosure law, the l during the clinical experience. Thecompletion AAMC foun~ It n~cessary !o enter the federal t-: tior ofthe data-gathering phase was marked by the court system In PhIladelphIa because ofcopy- 1: inv dissemination of 7,000 copies of The Evalu right violations involving MCAT test mate- : ing ation ofClerks: Perceptions o/ClinicalFaculty rials. Routine activities monitoring the secu- MC and an accompanyingeditorial "OinicalJudg rity of MCAT test materials uncovered that ment ofFaculties in the Evaluation ofOerks" the commercial test preparation operation, . from the March 1983 Journal ofMedical Ed Multiprep, Inc., was in violation of AAMC ucation. copyright, for reproducingactual MCAT ques- . The goals ofthe implementation phase are tions illegally removed from an MCAT test to develop self-assessment materials applicable center. The AAMC immediately filed suit atthe institutional, departmental, and training seeking to enjoin Multiprep, Inc., from further site levels for identifying strengths and weak use of the test materials and to recover dam- nesses of existing evaluation systems, and to ages. The AAMC also quickly identified and offer specially selected evaluation options for communicated with the examinees who had " addressing problems emerging from the. self had access to the exposed materials and ar assessment exercise. Activities include deter ranged to substitute valid scores for those that mining the ways in which medical schools will had been compromised by the practices of : participate in the second phase, developing Multiprep. Approximately 250 examinees~ and testing of self-assessment materials, and were given three separate opportunitieS to re- ~ defining and selecting the evaluation options. take the MCAT at AAMC expense so. their The Oinical Evaluation Project encompas applications to medical school would not be ~ ses the clinical continuum from the introduc delayed. . tion of clinical medicine components in the U.S. District Court Judge Raymond J. pre-clinical years through the third year of Broderick granted the AAMC's request for a . graduate medical education. Although the preliminary injunction which prohibited Mul- (\ : ,4 t 1982-83 Annual Report 257 Jf j. tiprep from using a number ofspecific practice approved that would provide time on the test i- test booklets, from advertising that Multiprep day for examinees to prepare an essay on p distributes and displays as "facsimile" or"rep assigned topics. The writing sample is viewed lica" MCAT tests, or from infringing MCAT as an opportunity to provide admission com ,n test forms and test questions. All information mittees with a written composition, prepared J- surrounding these events has been turned over by the candidate under conditions similar for )r to the Federal Bureau ofInvestigation and the all applicants. Copies of the essay would ac U.S. Attorney's office in Philadelphia which company each reported MCAT score. )f are actively pursuing a criminal investigation Meanwhile, the AAMC continued to work 1e : ofthe individuals involved. with thirty medical schools participating in the Work continued in the Continuing Educa- MeAT Interpretive Studies Program. A pre ,e tion System Project conducted with the Office, liminary summary ofthe relationship between ~e of Academic Affairs of the Veterans Admin- MeAT scores and performance in the firSt two ,e istration, with the pilot testing ofthe concepts years ofmedical school is in press. The report g and products of the project. Within the Vet- documents the predictive and incremental va .e erans Administration, the quality elements are lidity ofMCAT scores. During the past year, ~ d f being used for developing a self-assessment the program entered its second phase, an ex § 1, f manual as a part ofthe quality assessment and amination ofclinical science performance and 8. al (' assurance program for the Regional Medical gn r: its relationship to MCAT scores. Some studies ..t:: ' t Education Center. The manual provides a 00- suggesting significant correlations with fund of ~s, r sis for organizational self-study and site visits. knowledge measures have appeared and staff ] [~The manuscripts for a comprehensive book has begun working with several schools to I ,e,. on continuing education and for learning identify reliable and valid measures of per ~ :1: packages on selected aspects of continuing fo~ance in the clerkships as other criteria to ~ ~e : education have also been completed. explore. ~ ~ L All ofthese efforts did not preclude atten Otherstudies were undertaken to determine ~ '. 1: tiOD to the admissions procCss. Staff began how MCAT scores relate to categorical meas ~ investigating the feasibility ofcollecting a writ ures denoting academic problems such as o~· ing sample from all examinees during each withdrawals/dismissals for academic reasons § J. MeAT administration. An experiment was and program deceleration. ] 1t ] 1, . -:5 .... a .J 0 <.l:1 ;- 1:: a ;t 8 0 ·,t Q ~r j j .. .t If ~'S ~. ~ ~r a ,. I t i- Biomedical and Behavioral Research [ Persisting concerns about the inadequacies of chom~ting. rene~al. ~ednts (R~ Is) tbo stabilize I, research funding for both the National Insti t e InvestIgator-lnItlat project ase. The '. tutes ofHealth and the Alcohol, Drug Abuse, highest prioritycontinues to be placed onthese ~ and Mental Health Administration prompted awards, which hold the greatest promise for 11 a small number of organizations, including important discoveries. However, it has be the Association, to develop a new strategy for come appa'rent that in recent years, within the . approaching Congress about research appro limits of a constrained NIH bug,get, the sup- ; priations. It was agreed that an effort should port of 5,000 ROls has been ~ccomplished t be made to secure agreement among a sizable only by partial funding and ~! the expense of r number of organizations interested in those other NIH programs. By way 9f illustration, l~ agencies on a single total figure for each. The the percentage ofthe NIH e~!ramural budget t~ funds would be allocated within those sums devoted to RO1s grew from 44 percent in 1972 I~'~_ for individual institutes or activities in the to 63 percent in 1982. Conversely, between ;! subsequent appropriations process. The con 1972 and 1982, the percentage devoted to r:~.. gressional response was highly favorable and other research grants fell from 22 percent to'- played a role in obtaining substantial increases 19 percent; for R&D contracts, from 18 per- :1 over the president's budget. cent to 12 percent; and for research training, t:' For the fourth consecutive year, the Con from 12 percent to 5 percent. Despite the t:~ gress did not pass a formal appropriations law importance of assuring adequate support for F for the Department of Health and Human these &!"nts, this diversion ~~ ~unds away from t Services. However, a final continuing resolu other Important NIH actiVItIes greatly con- [ tion for FY 1983 provided a budget for the cerns the research community. NIH of slightly more than $4 billion, com _ A related concern regarding the precise al pared to $3.6 billion in FY 1982. Although location of NIH funds has been the develop funding for clinical training was substantially ment of proposals designed to stretch federal reduced, the overall budget forADAMHA was research dollars. Proposed modifications in- increased by $4 million to $272 million. Stim elude an arbitrary reduction of indirect costs ulated by that outcome, the Association and to institutions, dollar limits on support to in its initiating colleagues persuaded more than dividual laboratories, an increase in the exist 130 organizations to join a similar effort on ing emphasis on ROls as opposed to research behalf of NIH for FY 1984. This was double centers and other grants, and the institution ": the number of groups which had previously ofa sliding scale for research grants to reduce participated. Initial reactions from Capitol the amounts of money awarded to applicants Hill have been most encouraging, despite the with higher priority scores and distribute the generalized concerns about mounting federal recovered funds to applicants with lower budget deficits. scores. The latter proposal has received con It should be emphasized that this new ap siderable attention and is ofparticularconcern proach embodies a strong commitment to all given the fact that fiscal constraints have al the programs ofthe NIH as well as the agency ready prompted the NIH to fund new and as a whole. In the past, the research commu competing grants an average 7 percent below nity has strongly advocated sufficient funding study-section-recommended budgets. In addi to support a minimum of 5,000 new and tion, across-the-board reductions in non-com- 258 1982-83 AnnualReport 259 peting renewal grants have been implemented With regard to research sponsored by the in recent years. Following a thorough discus Veterans Administration, the Congress passed sion ofthese issues at its January meeting, the a FY 1983 appropriations bill which increased AAMC Executive Council concluded that funding for VA research programs to $154.8 NIH-sponsored research would be poorly million from $140.8 million the previous year. served by the implementation ofany or all of In mid-July, President Reagan signed a VA the proposals to stretch research funds. Sub appropriations bill for FY 1984 which will sequently, the Association distributed a state provide $162.3 million for medical and pros ment defending the present NIH grant system thetic research, $6 million over the original and actively endorsing the existing peer review budget request. process. Faculty The leadership of the Association has had a training and on research grant applications ': long interest in concerns ofthe faculties about and awards, to analyze the relationship be scholarship, research, and research training. tween training and academic careers, and the Research training for physician faculty, the faculty~s role in the conduct of biomedical apparent decline in the number ofphysicians research. These activities, as well as the main entering research careers, and the difficulty of tenance of the Faculty Roster data base, re Ph.D. biomedical scientists in securing appro ceive support from the National Institutes of . priate academic appointments are some of Health. these concerns. To illuminate these concerns, Based on the Faculty Roster, the Associa the Association performs analyses and studies tion maintains an index of women and mi- f from time to time, based on ad hoc or regular nority faculty to assist medical schools and i surveys. federal agencies in affirmative action recruit- r The Faculty Roster System, initiated in ing efforts. Since 1980 approximately 700 re- (~ 1966, continues to be a valuable data base, cruitment requests from medical schools were if containing information on current appoint answered by providing records of faculty r ment, employment history, credentials and members meeting the requirements set by ( training, and demographic data for full-time search committees. Faculty records utilized in L salaried faculty at U.S. medical schools. In this service are those for individuals consent- F addition to supporting AAMC studies of fac ing to the release ofinformation for this pur- r ulty manpower, the system provides medical ~~ . schools with faculty information for complet To apprise medical school affirmative ac- r ing questionnaires for other organizations, for tion offices of the existence of the index, de- "-,' identifyingalumni serving on faculties at other scriptions of the index, as well as statistics ,. schools, and for producing special reports. developed from the roster to assist in affirma- . In spring 1983, the Association conducted tive action planning, have been forwarded to a pilot study of research activity offaculty in staffmembers at medical schools. departments ofmedicine, in cooperation with As of July 1983 the Faculty Roster con- ~ the Task Force on Manpower Needs of the tained information on 49,646 full-time sala Association of Professors of Medicine. The ried faculty and 2,562 part-time faculty. The Faculty Roster provided basic demographic system also contains 51,172 records for per and appointment data for the medicine fac sons who previously held a faculty appoint ulty, and, as a byproduct, the Faculty Roster ment. itselfwas corrected and brought up-to-date for The Association~s 1982-83 Report on Med the schools participating in the pilot project. ical School Faculty Salaries was released in . The results of the pilot study were encourag January 1983, providing compensation data ing, and the Association agreed to support a for 124 U.S. medical schools and 33,701 filled r full survey of all faculty in departments of full-time faculty positions. The tables present >, medicine, again in cooperation with APM. compensation averages and percentile statis- , r The study will determine the extent offaculty tics by rank and by department for basic and ~~ ( research activities, sources of funding for re clinical science departments. Many ofthe ta· '" search, publication activity, and amount of bles allow comparisons according to school . C assigned research space. ownership, degree held, and geographic re- ; f During 1984 the Faculty Roster data base ~on. s will be matched to NIH records on research 260 15 . As of September 2, 1983, 35,120 applicants the American Medical College Application ~_ had filed 317,833 applications for the entering Service (AMCAS) to process first-year appli le : class of 1983 in the 127 U.S. medical schools. cation materials for their 1983-84 entering at . These totals, although not final, represent a classes. In addition to collecting and coordi 1- one percent decrease in the national applicant nating admission data in a uniform format, ~_ pool for the 1983 entering class over the pre- AMCAS provides rosters and statistical reports )f vious year. ' and maintains a national data bank for re The total number of new entrants to the search projects on admission, matriculation, ~ 1- first year medical school class decreased from and enrollment. ~ i- 16,644 in 1981-82 to 16,567 in 1982-83, The Advisor Information Service circulates ~ d l while total medical school enrollment rose rosters and summaries of applicant and ac f -- '- from 66,298 to 66,748. Although the actual ceptance data to subscribing health professions "8 ~- ~ number enrolled is the largest ever, the in advisors at undergraduate colleges and uni ] -e, ~ crease in total enrollment represents the small versities. In 1982-83, 302 advisors subscribed e y r est growth in the past ten years. to this program. ~ y t The number of women new entrants During each application cycle, the AAMC ~ 1 reached 5,210, a two percent increase since investigates the application materials of a z t:~- u _ [ 1981; the total numberofwomen enrolled was small percentage of prospective medical stu ~ "_~. 19,597, a 5.6 percent increase. Women held dents with suspected irregularities in the ad ~ I 29.4 percent ofthe places in the nation's med mission process. These investigations, directed ~ ~., ica1 schools in 1982-83 compared to 24.3 by the AAMC "Policies and Procedures for o ~_.. percent five years earlier. ] the Treatment ofIrregularities in the Admis "8 :s _ The number of underrepresented minority sion Process," help to maintain high ethical .s · - new entrants equaled 1,387 or 8.4 percent of standards in the medical school admission § ) the 1982-83 first-year new entrants, compared process. r.P ~ to 1,422 or 8.6 percent in 1981-82. The total The total number of MCAT examinees ~ _ number of underrepresented minorities en- tested for each of the past several years has o rolled was 5,544 or 8.3 percent ofall medical remained relatively stable. With the exception students enrolled in 1982-83, compared to of a seven percent decrease in examinations _ 5,503 (8.3 percent) in 1981-82. administered between 1978 and 1979, the The application process was facilitated by change for anyone year period has not ex the Early Decision Program. For the 1983-84 ceeded three percent. The reduction of one _ first-year class, 883 applicants were accepted percent in total examinee volume from 1981 by 65 medical schools offering such an option. to 1982 is attributable primarily to a decrease Since each of these applicants filed only one in repeating examinees, who accounted for application rather than the average 9.1 appli 32.4 percent ofall tests administered in 1982. cations, the processing of more than 7,000 The Medical Sciences Knowledge Profile . additional-applications and scores ofjoint ac- examination was administered for the fourth : ceptances was avoided. In addition, the pro time in June 1983 to 2,080 citizens or per gram allowed successful early decision appli manent resident aliens of the United States cants to finish their baccalaureate programs and Canada. The examination assists constit free from concern about admission to medical uent schools ofthe AAMC to evaltiate individ school. uals seeking advanced placement. While 6.1 Ninety-eight medical schools participated in percent of those registering for the test had 261 t 262 Journal ofMedical Education degrees in other health professions, 87.5 per sented in medicine.V;~ ~:u:;:n~:~: t cent of all registrants were currently enrolled Admissions Exercise Workshop provides op- ti in a foreign medical school. portunities for medical school personnel to Monitoring the availability of financial as improve their programs related to the admis sistance and working to insure adequate fund sion and retention of minority students; the ing ofthe federal financial aid programs used Retention and Learning Skills Workshop as by medical students are major activities ofthe sists medical school personnel concerned with AAMC. As indebtedness levels and medical academic performance and retention of mi- r school costs rise, concerns about both ade nority students; and the Minority Student Fi- 1 quacy and availability of financial aid and nancial Assistance Workshop assists student ::; increasing levels ofstudent indebtedness con financial aid program administrators and _ tinue to grow. These concerns motivated de premedical advisors to develop efficient and velopment of a plan for a study of medical effective administration of financial aid pro student financing to be carried out in 1983 grams for financially disadvantaged students. 84 with the support of the Department of A second grant, an evaluation of retention Health and Human Services. The Association activities in medical schools, supplements ex- ~ also worked closely with the schools and HHS isting efforts of retention programs by meas- to monitor delinquency rates in the Health uring the effect ofthese programs on attrition 1---':~ Professions Student Loan program, and to ofminority medical students. In addition, the _ reduce those rates. Current authorization for Robert Wood Johnson Foundation is sup all federal programs of student assistance in porting the development and distribution of the Higher Education Act of 1965 and the an annual report on the status ofminorities in Health Professions Education Assistance Act medical education. Other work is also being of 1976 and subsequent amendments will be carried out in conjunction with the Macy renewed in 1985. Because the aid programs Foundation to determine the extent ofminor- 0 are vital to medical students, the AAMC has ity medical student participation in special made a great effort to obtain the necessary enrichment or preparatory programs. " reauthorizations. The AAMC has also been Ajoint project involvingAAMC, the UCLA l' f involved in the development of a financial Clinical Scholars Program, and the Rand Cor- ~ planning and management manual for medi poration to analyze the specialty choices and ] cal and pre-medical students and their fami practice locations ofminority and non-minor lies. ity graduates of the medical school class of The Association concluded a series of 17 1975 is nearing completion. Preliminary re student financial management strategy semi sults indicate that the minority graduates are nars funded by the Robert Wood Johnson more involved in primary care and serve a Foundation. These programs spanned five higher proportion of minority and Medicaid years and reached over 2,000 financial aid patients than their non-minority peers. The officers, deans, student affairs deans, minority project is supported by the Commonwealth affairs officers, health professions advisors and Fund. studentsfrom schools ofmedicine, osteopathic The Group on Student Affairs-Minority Af medicine and dentistry. fairs Section (GSA-MAS) held a Medical Ca The AAMC, through its Office ofMinority reer Awareness Workshop for minority stu Affairs, is administering several projects dents at the 1982 AAMC Annual Meeting. funded by the Division of Disadvantaged As Two hundred high school and college students sistance (formerly the Health Careers Oppor attendeQ and fifty-four medical schools were tunity Program) ofthe Department ofHealth represented. A similar workshop will take and Human Services to enhance opportunities place at the 1983 Annual Meeting. for minorities in medical education. Onegrant The annual medical student graduation provides three types ofworkshops to reinforce questionnaire was administered to the class of and develop effective programs for the recruit 1983 in 123 of the 124 medical schools with ment and retention of students underrepre- seniors. A total of10,481 students participated 1982-83 AnnualReport 263 in the survey, a response rate of almost 66 Medical school student affairs offices distrib percent. The majority ofthe 1983 respondents uted applications with the NRMP materials to planned residency training after graduation. students wishing to enter residency programs. The most frequently selected areas ofspecial The universal application form facilitates the ization were internal medicine and family process ofapplying for a residency position by practice. Twenty-five percent of 1983 gradu providing a standard form for communication ates were considering a research-related career ofbasic information. as compared to 22 percent in 1982. The av Work was completed on Physicians in the erage medical school debt of indebted re Making: Personal, Academic, and Socioeco spondents increased 12 percent to $22,694. nomic Characteristics of Medical Students Almost one quarter of the respondents had a From 1950 to 2000 as a part of the AAMC total educational debt of $30,000 or more, Series in Academic Medicine published by compared to 18.4 percent in 1982. A summary Jossey-Bass. The book contains information, report comparing national responses with in predictions, and recommendations about as dividual institutional data was mailed to each piring applicants, enrolled students, and grad school in September. Selected results appear uating seniors during the latter half of the ~ in the 1983 directory ofthe National Resident century. A second related volume to be pub - Matching Program. lished by the Association, U.S. Medical Stu ~ 0. The Graduate Medical Education Applica- dents, 1950-2000: A Companion FactbookJor § tlon for Residency, developed by the AAMC Physicians in the Making, provides more de ~ at the recommendation of its Task Force on tailed statistical and bibliographic informa ] .g Graduate Medical Education and distributed tion. The Commonwealth Fund helped fi ~ by the National Resident Matching Program, nance this project. ~ was utilized for the third consecutive year. s o z Institutional Development After ten years ofoperation, the Association's available to memberinstitutions for a nominal program to strengthen the management capa fee. bilities ofmedical schools and academic med Planning was also undertaken to design I: ical centers received a comprehensive review short intensive workshops on financial man- by an ad hoc committee convened for that agement, information management, human ., purpose. In recent years the program had em resources management, and marketing. These phasized its Executive Development Semi workshops, scheduled to begin in spring 1984, nars, intensive week-long courses on manage will combine an emphasis on fundamental ~ ment theory and technique for senior aca concepts with illustrations and exercises high demic mediCal center officials. The review lighting their applicability to current medical f, 1- committee recommended that these seminars center issues and problems. I:' be continued but modified, and urged that the The Executive Development Seminar for ~_ AAMC define a new mission of continuing new deans was conducted in August at Ded-: management education for its members. The ham, Massachusetts, with 23 participating .; Executive Development Seminars would be deans. Twenty hospital executives and 17 de- t-~ provided biennially for new deans and period partment chairmen participated in a Septem- f. ically for department heads and hospital direc ber seminar in Florida. A similar but more (_~ tors on a tuition-supported basis. compressed program was offered for Women r The committee's recommendations were in Academic Medicine during the summer. r: adopted by the Executive Council in January. Forty-fourwomen in key managerial positions t The first initiative under the new continuing brought the total number ofExecutive Devel- i; management education mandate was the pres opment Seminar participants to 2,084 over t3 entation of four seminars on "Medicare Pro the life ofthe program. spective Payment System: Implications for New projects under way include a more Medical Schools and Faculties." Similar pro systematic effort to collect and make available grams were conducted in Houston, Oakland, information about members' use of consult Chicago, and Philadelphia. These described ants in dealing with management issues arising _ the majorfeatures ofthe new prospective pric at academic medical centers. Also in process ing system to be used to determine the Medi is a survey offaculty employment policies and care payment for hospital care, identified the procedures undertaken at the initiative ofthe changed incentives and constraints facing Group on Business Affairs with the endorse teaching hospitals and their implications for ment ofthe Council ofDeans Administrative medical schools and their faculties, and de Board. Current plans are to develop a set of scribed internal management strategies needed publications' which will -identify respondents to adapt to the new system. More than four to specific questions so that members can con hundred deans, hospital directors, department tact others with similar or contrasting ap chairmen and other medical center officials proaches to particular issues and which will attended the sessions and rated them very also analyze selected trends in tenure related highly in terms of their interest and utility. policies and practices. Videotapes ofsome ofthe sessions were made 264 rTeaching Hospitals I The Association has focused attention on the ation to conclude that ifa physician assigned Medicare Prospective Payment System fees to a medical School or practice plan and , adopted as part ofthe Social Security Reform accepted a salary from that equity, then Med I~ Act .of 1983 and on the regulations imple icare would restrict his fees to the amount of '~ menting the requirements of the 1982 Tax his salary. Through efforts ofthe Association, - Equity and Fiscal Responsibility Act a memorandum from a high ranking HCFA (TEFRA). Additionally, the Association con- official clarified that the rule was not intended \) tinued its major role in advancing support for to jeopardize faculty practice plans. The ~ health planning on both a state and localleveI. TEFRA regulation also specified changes in ~ The Association opposed the modifications in the 'way in which Medicare would pay for ~~, the standards of the Joint Commission on services of radiologists, anesthesiologists, and ~ o : Accreditation of Hospitals which would have pathologists. In changing the radiologists' pay ~, opened the hospital medical stafforganization ments, HCFA sought to distinguish between -g,g.. to nonphysician practitioners; sought to tem physicians who must pay their own overhead "8 per the Department of Health and Human and operating costs out ofthe fee charged and ~ Services regulations on "Nondiscrimination those for whom the hospital pays the overhead B on the Basis ofHandicap," which would inter and staff salaries. Those services generally ~ ject HHS into decisions on provision of care available in a physician's office will be subject u for severely handicapped infants; fought leg to a limit of 40 percent ofthe prevailing fee ~ islation that would have precluded hospitals for office-based services when provided by a ~, and other not-for-profit organizations from hospital-based radiologist. For anesthesiolo ~, obtaining tax-free bond financing for major gists, full payment offees was limited to serv j' capital projects; and drafted a report on "Pay ices during which they conducted no more s ment for Physician Services in a Teaching than four concurrent procedures. Otherwise, .s Setting." anesthesiologists were considered to be acting j' The regulations implementing the Tax Eq as supervisors and subject to payment on a ~ uity and Fiscal Responsibility Act set forth reasonable cost basis only. Lastly, the majority §- how physicians practicing in an institution ofclinical laboratory tests were defined as Part Q would be paid for services, when assistants at A services payable on a reasonable cost basis - surgery would be paid, and redesigned the rather than on a charge basis. Medicare limits on hospital payments. The In an attempt to distinguish between phy regulation establishing the limits on payments sicians practicing in a hospital clinic where the for hospital-based physicians sought to distin hospital was paid on a cost basis for the over guish clearly between services provided to the head expenses and those running their own institution or to the patient population as a office-based practice, HHS published a regu whole (Part A services) and services rendered lation Iimiti"ng' physician charges for services to an individual patient (Part B services). Once furnished in hospital outpatient departments. separated, it was intended that Medicare Where a particular service is commonly pro would pay on a reasonable cost basis for serv vided by a physician in a private office setting, ices provided to the institution and on a rea the fee of a physician performing that same sonable charge basis for services provided to service in a hospital-based clinic would be individual patients. Confusion over the origi reduced to 60 percent of the Medicare pre nal wording ofthis regulation led the Associ- vailing fee for non-specialist physicians. eer- 265 266 Journal ofMedical Education VOL. 59, MARCH 1984 tain services were excluded from this reduc flation to constrain the increase in Medicare tion, including emergency, ambulatory sur payments. The second limit was an expansion l gery, and radiology services. The AAMC has ofthe existing routine operating cost limit to strenuouslyobjected to two aspects ofthis rule. include special care unit and ancillary service First, it objected to the absolute nature ofthe costs. The revision sets cei.lings on hospital regulation which disallowed fees ifthe hospital expenditures based on average costs per ad claimed reimbursement for any clinic over mission adjusted for case mix using the diag head expenses. Since both the overhead aHo nosis related groups (DRGs). In this limit, cation required on the Medicare cost form for HCFA compared costs across hospitals after ~ hospital expenses and the additional functions adjusting for their case mix variation and dir- I_ ofa teaching hospital such as the education of ferences as a result ofthe labor market area in residents require more costs to be allocated to which the hospital is located. Significantly, the clinic service than a physician practicing capital and direct medical education costs are • in a private office setting would incur, the excluded from the limit and a special adjust Association argued the regulation was not eq ment, based on a hospital's resident-ta-bed ~ uitable, and suggested that a more reasonable ratio, is provided for the so-called indirect _ approach would be to allow physicians to col medical education costs. lect a full fee if the carrier concluded the As mandated by TEFRA, HHS sent a Pro overhead costs paid to the hospital by the spective System for Medicare to Congress. The physician were equivalent to those in a private proposal suggested establishing rates for each office setting. Secondly, the Association ob DRG. These same rates would have been paid jected to the use of non-specialist fees as the to every hospital except children's and psychi- f base from which the determination would be atric hospitals; the only adjustment to the rates i';_ made, since many ofthe physicians providing would have been to reflect the price of labor f, t, services in hospital clinics are specialists caring in the hospital's community. h for patients referred to them by physicians in The Association expressed five broad policy r private office settings. As yet, no changes have concerns with this proposal while testifying [ been made to accommodate the Association's before the Senate Finance Committee's Sub- t objections to this rule. committee on Health and the House Ways ~ HCFA's new rules implementing TEFRA and Means Subcommittee on Health. The p. also preclude payment for an assistant at sur AAMC noted that crucial details of the pay- : gery when the hospital has residency programs ment scheme were missing from the proposal, ~ in the specialty and residents were available to including the computation of the "pass assist during the surgery. Through the efforts through" ofdirect medical education and cap of the Association, this rule was clarified to ital costs, the treatment of costs of atypical ' allow a Physician not participating in the ed cases, and the procedure for determining in ucational program to have an assistant at sur direct medical education costs. Additionally, gery paid by Medicare. Also, the Association's the AAMC asserted that methodological re efforts led to HCFA's acknowledging that res finements could not compensate for inade idents have other duties besides performing quate payment under the Medicare program direct patient care, and may be unavailable and reminded Congress that the Medicare pay because of educational or research activities. ment system is a normative statement of the In such circumstances, Medicare will pay fees government's values, notjusta technical issue. for an assistant at surgery. Hospitals that par The AAMC predicted that the burden of re ticipate in the approved programs of other duction in Medicare expenditures would be hospitals are not affected by this policy. unevenly distributed among types ofhospitals, In addition to the rules on physician pay disproportionately harming teaching institu ment, TEFRA and its implementing regula tions because allowances were not made for tions established two limits on hospital pay differences in hospital size and scope ofserv ment. The first, called the target rate, used the ice, disparities in severity ofillness ofpatients hospital's own base year cost adjusted for in- within diagnostic groupings~ inadequate infor- 1982-83 AnnualReport 267 mation in the HHS data base with which to over the continuation of the health planning properly classify patients into DROs, and program resurfaced. The AAMC had endorsed methodological problems that overestimate a compromise health planning bill introduced the cost ofroutine care while underestimating in the fall of 1982 by Representatives Henry the cost oftertiary care. A more evolutionary Waxman, Edward Madigan, Richard Shelby, change in the payment mechanism was advo John Dingell, and James Broyhill. This meas cated so that the higher cost in teaching insti ure, adopted by the House ofRepresentatives tutions could be properly evaluated and not on September 24, made funds available for assumed to represent inefficiency, waste, or state and local planning activities. poor management. Finally, the threat to hos- The Senate had also proposed to continue '! pital-physician relationships engendered by planning in a bill sponsored by Senators Dan this proposal was raised. iel Quayle, Orrin Hatch, Paula Hawkins, The AAMC assertion that the administra David Durenberger, and Daniel Inouye. The tion's proposal would disproportionatelyharm Senate bill was more restrictive ofits allocation 4 some groups of hospitals was borne out in offunds and precluded states from regulating estimates from the Congressional Budget Of the planning, allocation, financing, ordelivery fice, presented at the Ways and Means Sub ofhealth care resources and services. A com committee hearing, showing thatteaching hos promise resolution failed to come to a vote in pitals and other large hospitals would suffer the Senate before the end ofthe Congress and substantial losses under the proposed scheme health planning survived only by a continuing while small and rural hospitals would gain resolution. sizable windfalls. Health planning advocates in Congress re Congressional amendments to the admin sumed their efforts to obtain an authorization istration's proposal resulted in the adoption of for a new health planning program in spring a prospective payment scheme that included 1983. Representative Waxman's "Health a four-year phase-in of the DRG payments, Planning Amendments of 1983" emphasized ~ the use of regional and national rates to ease the need for such legislation until capital costs ~. the transition, an adjustment for teaching hos are included in the DRG-based prospective ~ pitals based on their resident-to-bed ratios, a payment system. A counter-proposal by Rep g' requirement that unusual cases ("outliers") resentatives Madigan and Shelby was defeated ] constitute between 5 and 6 percent oftotal per in committee, but the staffofthe Association ] - case payments, and a provision for special and several other health organizations helped ~ adjustments for national and regional referral develop a health planning compromise pro o· ~ centers. These amendments tempered CBO's posal. It is felt that this bipartisan approach ~~ estimates of the adverse effects of the new would have a greater chance ofenactment in 8· payment system for teaching hospitals, aI- the Senate. I though the effect on individual hospitals is Ofconcern to the teaching hospitals, espe unclear. This was passed by Congress in late cially those caring for a substantial number of March and signed into law on April 3, 1983. critically ill infants, were attempts to regulate Staffofthe Association continue to work with the treatment decisions for handicapped in the HHS as it develops regulations to imple fants. The first attempt, a regulation entitled ment this law. The staff has provided com "Nondiscrimination on the BaSis of Handi ments to HCFA on the method ofcalculating cap" was published March 7 and became ef the base period cost, the appropriate mecha fective March 22. It required hospitals to post nism for assigning patients to DRGs, methods notices stating the government's prohibition for calculating the adjustments for outliersand on withholding customary medical care or other patients requiring special care, and the nutrition from an infant solely on the basis of appropriate method for computing the resi its handicap, and it offered a toll free number dent-ta-bed ratio. for the anonymous reporting ofsuspected vi While Congress was considering the new olations ofthis law to the office ofcivil rights. payment system for hospital services, debate The Association and other organizations, 268 Journal ofMedical Education VOL. 59, MARCH 1984 . includingthe American Academy ofPediatrics training or staff to assess these cases and to ~ and the National Association of Children's supply technical assistance on the question of J Hospitals and Related Institutions, protested denial ofappropriate care to severely impaired . that this rule interjected the HHS into the infants. Further, the AAMC criticized the di- I sensitive and highly emotional atmosphere in version ofscarce resources from the important I which parents, physicians, and other health task ofinvestigating child abuse to the exam care personnel make very difficult decisions ination of complex and very difficult treat about the care ofan infant. On March 21 the ment decisions for impaired infants. The AAMC wrote to Secretary Heckler urging a AAMC again objected to the unjustifiable in- ; delay in the implementation of this rule to crease in anxiety levels offamilies ofcritically address the concerns ofhealth care providers. ill infants. A more appropriate solution would The Association expressed concerns that the be the one advocated by the President's Com posted notices and the toll-free number would mission for the Study of Ethical Problems in needlessly add to the stress ofthe parents and Medicine and Biomedical and Behavioral Re health care personnel. search in its report "Deciding to Forego Life " The Association's request for delay and Sustaining Treatment," which advocated that those of the other associations and organiza local review bodies establish policies and tions involved went unheeded; however, AAP, maintain standards for the care given in these "- NACHRI, and Children's Hospital National cases. This piece of legislation has been SUb-I Medical Center in Washington, D.C., were stantially modified to address some of the - successful in a suit filed in the Federal District concerns about its provisions and is still pend-: Court ofthe District ofColumbia. The favor ing before the House and Senate. ~ able ruling was based largely on procedural Again this year, the issue of tax-exempt I~ issues. bonds to finance major capital projects in -. After deciding not to appeal to a higher hospital and educational institutions came to I court, HHS published revised regulations on the forefront ofthe Association's agenda when • July 6. While the substance of the Depart some members ofCongress sought to severely . ment's regulations had not changed signifi restrict the use of tax-exempt bonds by non cantly, the Department is taking all proper profit organizations. The Association wrote to f procedural steps in issuing this regulation and members of the Senate Finance and House ;I. has attempted to address several ofthe judge's Ways and Means Committees urging them to concerns in the preamble. The Department stand by the determinations made last year. has also included state child protection agen The AAMC reminded them of the rationale cies in the enforcement ofthis regulation. for supporting this decision which included: This inclusion ofthe child protection agen tax-exempt revenue bonds support activities I cies parallels a measure introduced by Repre to provide a healthier and better educated : sentative John Erlenborn and Senator Jere public; the federal tax revenue lost as a result . miah Denton. They proposed revising the of the issuance of these bonds is minuscule Child Abuse Prevention and Treatment Act and there is no evidence that nonprofit hos to require the posted notices and "hot line" pitals and educational institutions use tax approach. While expressing a continuingcom exempt financing inappropriately. mitment to provide medically indicated treat In another arena, the Joint Commission on ment and nutrition to infants with life-threat Accreditation of Hospitals had proposed an eningconditions, theAAMC wrote urging that amendment to its accreditation manual that this legislation be rejected. In particular, the would have changed "medical staff" to "orga AAMC objected to the couplingofthe medical nized statT" in defining the authority to admit < treatment decisions with child abuse legisla and provide medical care to patients. Orga tion and the use of "hot lines" to monitor nized staff included licensed physicians and conformance. The Association expressed dis other individuals who qualify for clinical priv satisfaction with the assumption that child ileges and are licensed for independent provi abuse protection agencies had the necessary sion of patient care services. At the January 1982-83 AnnualReport 269 Administrative Board meeting ofthe Council A Description o/Teaching Hospitals· Charac of Teaching Hospitals, Dr. John Affeldt, teristics and Selected Data on a Small Sample JeAH president, told the board of JCAH's of Teaching Hospitals .. These books provide - decision to make this change after having been information on the services rendered in advised by its attorneys that it was risking COTH member institutions as well as some of charges ofrestraint oftrade. The AAMC crit the characteristics ofthe patients admitted to icized this change, stating it would alter the these hospitals. Also published were annual "long held concept that physicians have legit surveys on housestafT stipends, funding, and imate responsibility for ensuring that high benefits, chief executive officers' salaries, and quality medical care is provided in our na university-owned teaching hospitals· financial tion's hospitals." The AAMC noted the diffi and general operating data. culties in defining uniform eligibility criteria In conjunction with the Association ofAc when professionals with a variety of licenses ademic Health Centers, the AAMC published and degrees are allowed on the stafl: The result a staff report which was the result ofa confer would be a diminished ability to provide qual- ence on the implementation of the Medicare ity assurance for the care provided. The JCAH prospective payment system for academic would simply be shifting the locus ofthe legal medical centers. The Association also devel actions from itselfto the hospitals. oped a report entitled, "Medicare Payment for The Association start: under the guidance Physician Professional Services in a Teaching of a Committee on the Distinctive Character Setting" under the guidance ofthe Committee istics and Related Costs ofTeaching Hospitals, for Payment for Physician Services in Teach ~ published two technical reports early in 1983: ing Hospitals. Communications Two studies and a round oflegal actions gen interact with the national news media and erated much news media attention on the responds to more than 25 media requests for AAMC during the past year. News conferences interviews, information and policy positions in Washington, D.C., and New York City in each week. October announced that the Association's The chiefpublication ofthe AAMC contin General Professional Education ofthe Physi ues to be theAAMC President's WeeklyA~tiv cian project was about to enterthe second year ities Report, published 43 times a year and ofa three year effort supported by the Henry circulated to more than 7,200 individuals. ~ J. Kaiser Family Foundation. Additional news Each publication reports on AAMC activities conferences were held in San Francisco and and federal actions having a direct effect on ',' Houston as the panel began a series of four medical education, biOmed_ica) research and f regional hearings where college faculty, medi health care. .- f cal school faculty, administrators and students The Journal of Medical Education pub-I were invited to discuss their views on medical lished 999 pages of editorial material in the ,~: education. These news briefings focused much regular monthly issues, compared with 1,018 r national attention on the project. A final re pages the previous year. The published mate- t port will be issued in fall 1984. rial included 83 regular articles, 66 commu- r A February news conference in Washing nications, and 11 briefs. The Journal also con- t ton, D.C., reported the five recommendations tinued to publish editorials, datagrams, book t':-: ofan AAMC study on improving the teaching reviews, letters to the editor, and bibliogra ofgeriatrics to medical students. Joseph John phies provided by the National Library of : son, chairman, Department of .Medicine, Medicine. The Journal's monthly circulation l Bowman Gray School ofMedicine and chair averaged 6,350. · man ofan II-memberAAMC committee, and The volume of manuscripts submitted to AAMC President John A. D. Cooper met the the Journal for consideration continued to run press. This news conference was the culmina high. Papers received in 1982-83 totaled 393, tion ofa year-long effort supported by the Pew of which 137 were accepted for publication, . Memorial Trust and the National Institute on 198 were rejected, 10 were withdrawn, and 48 _ Aging. The report received extensive nation were pending as the year ended. Two supple- .- wide coverage by newspapers, television and ments carried as part ofthe regular issues were radio. produced: "Preparation in Undergraduate The third major event involving mass me Medical Education for Improved Geriatric dia coverage occurred in June when the As Care," and "AAMC Annual Meeting and An sociation discovered that Multiprep, Inc., an nual Report, 1982." Ardmore, Pennsylvania, testing preparation About 24,000 copies ofthe annual Medical company, had secured copies of MCAT test School Admission Requirements, 4,000 copies forms and test questions and was illegally us ofthe AAMC Directory ojAmerican Medical ing them in its coaching courses. The AAMC's Education, and 7,000 copies of the AAMC : $1.5 million damage suit against Multiprep, Curriculum Directory were sold ordistributed. Inc., and its owner and related legal actions Other publications, including directories, re- . have been actively followed by the news me ports, papers, studies, and proceedings were ,-' dia. also produced and distributed by the AAMC. _ In addition, the Association continues to Newsletters include the COTH Report, which 270 1982-83 AnnualReport 271 t, has a monthly circulation of2,650; the OSR published by Jossey-Bass, Inc., issued its , Report, which is circulated twice a year to third volume, Physicians in the Making: medical students; and STAR (Student Affairs Personal, Academic andSocioeconomic Char Reporter), which is printed twice a year and acteristics of Medical Students from 1950 has a circulation of 1,000. to 2000. Three other manuscripts are in prep The AAMC Series in Academic Medicine, aration. Information Systems The Association continues to upgrade its gen able information. Rapid on-line retrieval en eral purpose computer system to ensure that ables the Association to advise applicants of the information systems support will meet the the daily status of their individual informa ever-increasing needs ofthe Association mem tion. After data collection is complete, the bership and the staft: A Hewlett Packard 3000, system generates data files for schools and Series 64, has replaced an aging Hewlett Pack applicant pool analyses and provides the basis ard 3000, Series III, and high density disk for entering matriculants in the student rec- , storage has been increased. Many ofthe high ords system. - volume printing requirements are produced AMCAS is supplemented by other systems, on a high speed laser printer, which currently including the Medical College Admission Test produces an average of 2.7 million pages per reference system ofMCAT score information, month, largely related to the AMCAS pro a college information system on U.S. and Ca· ' .. gram. With over 100 terminals accessing the nadian schools, and the Medical Science f Association files, there is a constant demand Knowledge Profile system on individuals tak- r for more detailed information. Data bases con ing the MSKP exam for advanced standing ." tinue to be developed to minimize data redun admission to U.S. medical schools. r dancyand to provide responsive, on-line re A student record system maintained in co- r trieval of reliable information. By using ex operation with the medical schools contains panded computer generated graphic art, it is enrollment information on individual stu now possible to provide illustrations in final dents, and traces their progress from matricu publication form, thereby reducing camera art lation through graduation. Supplemental sur preparation and outside printing expenses. veys such as the graduation questionnaire and '~ While the cyclic processing ofthe individual the financial aid survey augment the student student's applications to medical schools con record system. tinues to be a major information systems fo After the residency match in March ofeach cus, the overall efficient data entry, verifica year, the National Resident Matching Pro tion and file building process remains the key gram conducts a follow-up study to obtain ' to providing constituents with reliable infor information on unmatched participants and mation on students, faculty and institutions. eligible students who did not enroll. Beginning The American Medical College Application with the 1983 match, the Association, using Service system is the core ofthe information an initial data file supplied by NRMP, pro on medical students. This centralized appli duced match results listings for each medical cation service collects and processes bio school, updated the NRMP information using graphic and academic data and links these data current student records system data and list to MCAT scores for report generation and ings returned from the medical schools, pre distribution to participating schools. This serv pared hospital assignment lists for each medi ice also enables the individual schools to re cal school, and generated a final data file for ceive the most current update ofa particular use in NRMP's tracking study. applicant's file. Roster, daily status reports, The diverse information systems ofthe As and summary statistics prepared on a national sociation each serve a unique purpose. As ":" comparison basis are supported by an exten special requests for information continue to . sive and sophisticated software system and increase, it has become necessary to consoli- provide medical schools with timely and reIi- date these multiple systems into one Student 272 1982-83 AnnualReport 273 - and Applicant Information..Management Sys- four survey years and is used to produce the tem. This new system, presently in the design report ofmedical school finances published in stage, will produce a wide variety of reports the annual education issue of the Journal of describing students, applicants and graduates, the American Medical Association. answer special data requests for information The housestaff policy survey, the income from constituents, and provide data study files and expense survey for university-owned hos for additional statistical analysis. pitals, and the executive salary survey are the Through the cooperation of the medical recurring surveys that provide information on school staffs, Association personnel update the teaching hospitals. Faculty Roster System's information on th~ In addition to the major information sys background, current academic appointment, tems ofthe Association a number of special employment history, education and training ized systems continue to be developed and of salaried faculty at U.S. medical schools. improved. These specialized systems support These data are periodically reported to the the activities ofthe Council ofTeaching Hos membership in summary format, enabling the pitals, the Group on Business Affairs, the schools to 'have an organized, systematic pro- Group on Institutional Planning, the Group ~ file oftheir faculty. The Association conducts on Medical Ed~cation, the Council of Aca an annual survey of medical school faculty demic Societies, the chief undergraduate ~ 0. . salaries. This Faculty Salary Survey System health profession advisors, the women in med g :. provides the annual report on medical school icine program, and legislative affairs activities. 1~ faculty salaries and is available on a confiden Mailing labels, individualized correspondence, .g r tial, .aggregated basis in response to special and laser-produced photocomposed directo al quenes. ries are examples of the services provided. ] f The Association continues to maintain a Expansion and extensive revision of the As ~ o t- repository ofinformation on medical schools sociation's membership system continues as a z. of which the Institutional ProfIle System is a major project. When completed, this system ~ major contributor since it contains data con will integrate the services provided in many of ~ ceming medical schools from the 19605 to the the specialized systems and will continue to ~ present. It is constructed both from survey produce labels for the Weekly Activities Report ~, results sent.directly from the medical schools and for the Journal ofMedical Education. j I· and from other information systems. This sys Data collection, rapid processing, and ~ tern, containing over 20,000 items, is used for timely dissemination ofinformation gathered ~ on-line retrievals and supports research proj- from its members and independent constitu o ~ ects. ents continue to be major objectives of the a: The information reported on Part I of the Association. The focus on information impor ~ Liaison Committee on Medical Education an tant to medical education that assists the nual questionnaire complements the Institu members in the decision-making process is the tional Profile System. Current year informa prime thrust ofthe Association's information tion is compared with data from the preceding systems. AAMC Membership Type 1981-82 1982-83 Institutional 123 125 Provisional Institutional 4 2 Affiliate 16 16 Graduate Affiliate 1 I Subscriber 16 18 Academic Societies 73 73 Teaching Hospitals 416 432 Corresponding 331 87 Individual 1300 1174 Distinguished Service 51 62 Emeritus 47 68 Contributing 4 5 Sustaining 12 10 Treasurer's Report The Association's Audit Committee met on Balances in funds restricted by the grantor ~ September 7, 1983, and reviewed in detail the decreased $62,963 to $499,661. After making I audited statements and the audit report for provisions for reserves in _the amount of ~ the fiscal year ended June 30, 1983. Meeting $875,000 principally for student data base with the Committee were representatives of conversion, the clinical evaluation project, Ernst & Whinney, the Association's auditors, MCAT and AMCAS development, purchase and Association stan: On September 22, the ofcomputer equipment and the MCAT essay Executive Council reviewed and accepted-the and diagnostic services program, unrestricted I final unqualified audit report. funds available for general purposes increased Income for the year totaled $11,627,154. $706,534 to $8,239,850, an amount equal to Ofthat amount $10,696,362 (92%) originated 81 % of the expense recorded for the year. from general fund sources; $376,004 (3%) This reserve accumulation is within the from foundation grants; $554,788 (5%) from directive of the Executive Council that the federal government reimbursement contracts. Association maintain as a goal an unre- > Expenses for the year totaled $10,125,955 stricted reserve of 100% of the Association's ofwhich $9,076,543 (90%) was chargeable to total annual budget. It is of continuing im the continuing activities of the Association; portance that an adequate reserve be main $494,624 (5%) to foundation grants; $554,788 tained. (5%) to federal cost reimbursement contracts. The Association's financial position is Investment in fixed assets (net ofdepreciation) strong. As we look to the future, however, and : decreased $241,028 as a result ofa decision by recognize the multitude ofcomplex issues fae- r the Executive Council to raise the ceiling for ing medical education, it is apparent that the ' capitalization of fixed assets from $500 to demands on the Association's resources will , $2,000. continue unabated. 274 Association ofAmerican Medical Colleges Balance Sheet . June 30, 1983 ASSETS Cash Investments $ 13,437 - Certificates ofDeposit l Accounts Receivable 14,381,896 Deposits and Prepaid Items 1,004,923 Equipment (Net ofDepreciation) 128,666 Total Assets 913,973 16,442,895 LIABILITIES AND FUND BALANCES Liabilities Accounts Payable Deferred Income $ 1,330,466 Fund Balances 1,456,800 Funds Restricted by Grantor for Special Purposes ~ General Funds 499,661 § Funds Restricted for Plant Investment $ 496,856 8. .- Funds Restricted by Executive Council for § . Special Purposes ~ 3,505,289 i Investment in rIXed Assets 913,973 -g t. General Purposes Fund ~ 8,239,850 13,155,968 l Total Liabilities and Fund Balances $16,442,895 Association ofAmerican Medical Colleges !,E f Operating Statement ~I':: Fiscal Year EndedJune 30. 1983 ~ < SOURCE OF FUNDS ~ Income § Dues and Service Fees from Members ] Grants Restricted by Grantor $ 3,008,015 "8. Cost Reimbursement Contracts 376,004 .s Special Services 554,788 a Journal ofMedical Education 5,007,514 ~ Other Publications 100,489 ~. Sundry (Interest $1,644,586) 351,735 § otal Source ofFunds 2,228,609 Q $11,627,154 SEOF FUNDS rating Expenses Salaries and Wages - Staff Benefits $4,410,248 Supplies and Services 718,259 Provision for Depreciation 3,815,386 290,555 I Travel and Meetings Loss on Disposal ofFixed Assets 883,615 Interest Expense 7,469 otal Expenses .423 $10,125,955 ncrease in Investment in rIXed Assets (Net ofDepreciation) . (Decrease) . $ (241,028) ransfer to Executive Council Reserved Funds for Special Programs 875,000 eserve for Replacement ofEquipment 223,656 ncrease in Restricted Fund Balances (Decrease) (62,963) ncrease in General Purposes Funds otal Use ofFunds 706,534 $11,627,154 275 AAMC Committees Accreditation Council for Continuing Medical COTH Nominating Education Mitchell T. Rabkin, Chairman AAMCMEMBERS: Fred J. Cowell Richard M. Caplan Earl J. Frederick John N. Lein Henry P. Russe COTH Spring Meeting Planning Glenn R. Mitchell, Chairman Accreditation Council for Graduate Medical Ron J. Anderson Education James W. Holsinger, Jr. AAMC MEMBERS: Robert H. Muilenburg Charles M. O'Brien D. Kay Clawson Daniel L. Stickler Spencer Foreman Richard Janeway Council for Medical Affairs David C. Sabiston, Jr. AAMCMEMBERS: Audit Steven C. Beering Earl Frederick, Chairman John A. D. Cooper Francis J. Haddy Robert M. Heyssel Russell Miller Finance CAS Nominating William H. Luginbuhl, Chairman Frank C. Wilson, Chairman Robert Frank Robert M. Blizzard Robert Hill Arthur Donovan Richard Janeway Robert L. Hill Mitchell Rabkin Leonard Jarrett Virginia Weldon Thomas Langfitt Howard Morgan Flexner Award Selection L. Thompson Bowles, Chairman COD Nominating Arnold Brown Samuel Davis Henry P. Russe, Chairman I. Marvin R. Dunn Mary Beth Graham James F. Glenn Harold Sox I G. Richard Lee George Zuidema Leah Lowenstein I General Professional Education of the COD Spring Meeting Planning Physician and College Preparation for Richard Janeway, Chairman Medicine I Fairfield Goodale Steven Muller, Chairman t Louis J. Kettel William P. Gerberding, Vice Chairman William H. Luginbuhl David Alexander Edward J. Stemmler . John S. Avery 276 1982-83 AnnualReport 277 ~ Jo Ivey Boufford Group on Medical Education John W; Colloton James A. Deyrup STEERING Stephen H. Friend Alan Goldfein, Chairman John A. Gronvall James B. Erdmann, Executive Secretary Robert L. Kellogg James G. Boulger Vietor R. Neufeld Gerald Escovitz David C. Sabiston, Jr. Leonard E. Heller Karl A. Schellenberg Vietor R. Neufeld Robert T. Schimke OydeTucker Lloyd H. Smith, Jr. Stuart R. Taylor Daniel C. Tosteson Group on Public Affairs Burton M. Wheeler STEERING Governance and Structure Vicki Saito, Chairman ::: Charles Fentress, Executive Secretary- ~ Daniel C. Tosteson, Chairman Treasurer ~ John W. Colloton 0.. Dean Borg § John W. Eckstein Robert Fenley ~ I Manson Meads Nancy Grover ] ~ Sherman M. Mellinkoff '"d Al Hicks e8 Dallas Mackey ~ Group on Business Affairs B. J. Norris .8 o : STEERING Glenda Rosenthal z Roland Wussow . Mario Pasquale, Chairman John H. Deufel, Executive Secretary Michael B. Arney Stephen Chapnick Group on Student Affairs C. Duane Gaither Robert I. Keimowitz, Chairman Jerold Glick Robert J. Boerner, Executive Secretary Jerry Huddleston Terrence M. Leigh Bernard McGinty John M. May Robert B. Price Horace Mitchell Robert Rose Edward Schwager . Michael A. Scullard Jane Thomas Robert Winslow Norma E. Wagoner William Wallace Group on Institutional Planning Jenette Wheeler Cheryl Wilkes STEERING Thomas G. Fox, Chairman MINORITYAFFAIRSSECTION ,John H. Deufe), Executive Secretary William Wallace, Chairman Russell E. Armistead Rudolph Williams, Vice Chairman ~ Barry H. Gagett Althea Alexander Vietor Crown Elson Craig JJames N. Glasgow Thomas Johnson David R. Perry Zubie Metcalf Marie Sinioris Stanford Roman · Stephen Smith James A. Thompson eorge Stuehler, Jr. Jose Torres Ian B. William Benjamin B. C. Young 278 Journal ofMedical Education VOL. 59, MARCH 1984 Journal of Medical Education Karl D. Bays Editorial Board William R. Bowdoin Richard C. Reynolds, Chairman Francis H. Burr Jo Boufford Aetcher Byrom L. Thompson Bowles Albert G. Clay Bernadine H. Bulkley William K. Coblentz Lauro F. Cavazos Allison Davis Mary Stuart David Leslie Davis A. Cherrie Epps Willie Davis Joseph S. Gonnella Charles H. P. Duell James T. Hamlin, III Dorothy Kirsten French Sheldon S. King Carl J. Gilbert Kenneth Kutina Stanford Goldblatt Walter F._Leavell Melvin Greenberg Robert K. Match Martha W. Griffiths Emily Mumford Emmett H. Heitler Warren H. Pearse Katharine Hepburn Lois Pounds Charlton Heston Stuart K. Shapira Walter J. Hickel T. Joseph Sheehan John R. Hill, Jr. I Loren Williams Jerome H. Holland Mrs. Gilbert W. Humphrey 1 Jack Josey Liaison Committee on Medical Education Robert H. Levi AAMCMEMBERS: Aorence Mahoney I J. Robert Buchanan Audrey Mars Carmine D. Clemente Herbert H. McAdams, 11 William B. Deal Woods McCahill Richard C. Reynolds Archie R. McCardell M. Roy Schwarz EinerMohn Robert L. Van Citters E. Howard Molisani C. A. Mundt AAMCSTUDENTPARTICIPANT: Arturo Ortega Warren Newton Gregory Peck Abraham Pritzker Management Education Programs William Matson Roth Beurt SerVaas Edward J. Stemmler, Chairman LeRoy B. Staver D. Kay Clawson Richard B. Stone David L. Everhart Harold E. Thayer Fairfield Goodale W. Clarke Wescoe William H. Luginbuhl William Wolbach Robert G. Petersdorf T. Evans WychofT Hiram C. Polk Stanton L. Young National Citizens Advisory Committee for Nominating the Support ofMedical Education John W. Colloton, Chairman Harold H. Hines, Jr., Chairman John Naughton George Stinson, Vice Chairman Mitchell T. Rabkin Jack R. Aron Henry P. Russe G. Duncan Bauman Frank C. Wilson -- 1982-83 AnnualReport 279 ~ Payment for Physician Services in Teaching Ruth M. Rothstein , Hospitals Frederick E. Shideman Hiram C. Polk, Jr., Chairman Judy A. Spitzer Irwin Birnbaum Knight Steel David M. Brown Eugene Stead, Consultant Thomas A. Bruce Harland Wood, Consultant . Jack M. Colwill Martin G. Dillard Research Award Selection Fairfield Goodale Dominick P. Purpura, Chairman Robert W. Heins Wolfgang Joklik Sheldon S. King Maria I. New Jerome H. Modell Jerrold M. Olefsky Marvin H. Siegel Daniel Steinberg Alton I. Sutnick Daniel C. Tosteson Sheldon M. Wolff ::: Resolutions ~ Prospective Payment for Hospitals ~ William B. Deal, Chairman C. Thomas Smith, Chairman . = Pamelyn Oose ~ . David Bachrach R~~rt David Everhart -§ l J. Baker Douglas Kelly .g ilham B. Deal ~ obert J. Erra ~ arold J. Fallon RIME Program Planning ~~. z ., onald P. Kaufman Hugh M. Scott, Chairman ~. rank G. Moody James B. Erdmann, Executive Secretary yG. Newman Philip G. Bashook uglas Peters John B. Corley hur Piper Harold G. Levin Robert M. Rippey l egional Institutes on Geriatrics and Medical Paula L. Stillman uation oseph E. Johnson, 111,- Chairman Women in Medicine uth Bennett Dorothy Brinsfield wald W. Busse Carol Mangione van Calkins Marion Nestle ack M. Colwill Jacqueline Noonan , ohn D. Loeser Eleanor Shore orence Mahoney Jane Thomas AAMC Staff Office of the President Membership Clerk President Ida Gaskins John A. D. Cooper, M.D., Ph.D. Cecilia Keller Vice President Anna Thomas John F. Sherman, Ph.D. Senior Mail Room Clerk Special Assistant to the President Michael George Kathleen S. Turner Mail Room Clerk StaffCounsel John Blount Joseph A. Keyes, J.D. Director, Computer Services Executive Secretary Brendan Cassidy Norma Nichols Associate Director Rose Napper Sandra Lehman Administrative Secretary Manager ofDevelopment Rosemary Choate Kathryn Petersen Systems Manager Robert Yearwood Division of Business Affairs Systems Analyst Director and Assistant Secretary-Treasurer Pamela Eastman John H. Deufel Donald Hollander Business Manager Programmer Analyst Samuel Morey Lori Adams Controller Jack Chesley Jeanne Newman Operations Supervisor Personnel Manager Betty L. Gelwicks Carolyn Curcio Administrative Secretary Membership and Subscriptions Supervisor Cynthia K.. Woodard Lossie Carpenter Secretary/Word Processing Specialist Accounts Payable/Purchasing Assistant LaVerne Waters Loretta Cahill Data Control Manager Administrative Secretary Renate Coffin Karen McCabe Computer Operator Accounting Assistant Pauline Dimmins Cathy Dandridge Jackie Humphries Personnel Assistant Basil Pegus Donna Adie William Porter r Secretary Data Preparation Operator Cynthia Withers Jessie Walker Accounts Receivable Clerk Division of Public Relations Rick Helmer Accounting Oerk Director LaVerne Tibbs Charles Fentress Receptionist Administrative Secretary Rosalie Viscomi Janet Macik 280 1982-83 AnnualReport 281 Division of Publications ' Research Assistant Director Mitchell Sommers Merrill T. McCord Administrative Secretary Associate Editor Stephanie Kerby James R. Ingram Secretary Staff Editor AnnetteGom Vickie Wilson Patricia L. Young Assistant Editor Gretchen Chumley Division of Student Programs Administrative Secretary Director Anne Spencer Robert J. Boerner Director, Minority Affairs Department ofAcademic Affairs Dario O. Prieto Research Associate Director Mary Cureton August G. Swanson, M.D. Thomas H. Dial ~ Deputy Director Sock-Foon MacDougall, Ph.D. ~ Elizabeth M. Short, M.D. StaffAssociate = Senior StaffAssociate Janet Bickel ~.~ Mary H. Littlemeyer ~ StaffAssistant J Assistant Project Coordinator. Elsie Quinones Barbara Roos .g Julie Reilly ~ : Editorial Assistant Administrative Secretary ~ - F. Daniel Davis Patricia Lynn ~: dministrative Secretary Secretary ~ __ Rebecca Lindsay Lily May Johnson ~ -- Assistant Project Director, GPEP ~: Emanuel Suter, M.D. Division ofStudent Services o :g Director ] Division of Biomedical Research and Faculty Richard R. Randlett ] -Development Associate Director ~ Director Robert Colonna ~ ~ Elizabeth M. Short, M.D. Manager a StaffAssociate Linda W. Carter ~ I Lynn Morrison Alice Cherian Lucy Theilheimer Edward Gross Secretary MarkWood Brenda George Supervisor Richard Bass ivision of Educational Measurement and Lillian Callins esearch Virginia Johnson Catherine Kennedy -rector Dennis Renner James B. Erdmann, Ph.D. Trudy Suits . ssociate Director Walter Wentz Robert L. Beran, Ph.D. Senior Assistant ogram Director Wayne Corley Xenia Tonesk, Ph.D. Keiko Doram esearch Associate Gwendolyn Hancock Robert F. Jones, Ph.D. Enrique Martinez-Vidal 282 Journal ofMedical Education VOL. 59, MARCH 1984_~ ;. Lillian McRae Division of Accreditation Anne Overington Director Edith Young James R. Schofield, M.D. Administrative Secretary StafT Assistant Cynthia Lewis Robert Van Dyke Secretary Administrative Secretary Denise Howard June Peterson Assistant Theresa Bell Department ofTeaching Hospitals Claudette Booker Wanda Bradley Director Ray Bryant Richard M. Knapp, Ph.D. Carl Butcher Associate Director Karen Christensen James D. Bentley, Ph.D. James Cobb Senior StafT Associate r Carol Easley Joseph C. Isaacs .J. Hugh Goodman StafT Associate Patricia Jones Nancy Seline Yvonne Lewis Administrative Secretary Albert Salas Melissa Wubbold Christina Searcy Secretary Helen Thurston Janie Bigelow Gail Watson Andrea McCusker Pamela Watson Yvette White Department of Planning and Policy John Woods Development Typist/Receptionist Director Edna Wise Thomas J. Kennedy, Jr., M.D. Press Operator Deputy Director Warren Lewis Paul Jolly, Ph.D. Legislative Analyst David Baime Division of Student Studies Carolyn Henrich Director Anne Scanley Davis G. Johnson, Ph.D. Secretary Alice Barthany Donna Greenleaf Department of Institutional Development Division of Operational Studies Director Director Joseph A. Keyes, J.D. Paul Jolly, Ph.D. Senior StaffAssociate StaffAssociate, Faculty Roster Sandra Garrett, Ed.D. Elizabeth Higgins StaffAssistant, Management Programs StafT Associate Marcie F. Mirsky Leon Taksel Administrative Secretary Operations Manager, Faculty Roster Debra Day Aarolyn Galbraith Secretary StaffAssistant Christine O"Brien William Smith 982-83 AnnualReport 283 esearch Assistant Mara Cherkasky -- Deborah Ganey Secretary Gary Cook Joyce Beaman . Exequiel Sevilla Data Coder Donna Williams Margaret Mumford dministrative Secretary Elizabeth Sherman UNIVERSITY OF UTAH HANDBOOKS FOR MEDICAL TEACHERS 1. There Is No Gene for Good Teaching: A Handbook on Lecturing for Medical Teachers by Neal Whitman, Ed.D. $5.00 2. A Handbook for Group Discussion Leaders: Alternatives to Lecturing Medical Students to Death by Neal Whitman, Ed.D and Thomas L. Schwenk, M.D. $5.00 3. Evaluating Medical School Courses: A User-Centered Handbook By Neal Whitman, Ed.D. and Thomas Cockayne, Ph.D. $10.00 Please send orders or inquiries to: Dr. Neal Whitman Department of Family and Community Medicine University of Utah School of Medicine Salt Lake City, Utah 84132 Telephone: (801) 581-3614 Please make checks to University of Utah. Discounts are available for orders over 20 copies of a single handbook. Faculty of Medicine r Office of Medical Education--Assistant Professor r Applications are invited for the position of Assistant Professor on a limited term appoi ment with the possibility of tenure track in the future. The University of Calgary Medical School has a unique three-year curriculum wh stresses small-group problem-solving, independent learning, and multidisciplinary systel based teaching. Requirements include the M.D. and/or Ph.D. degree in Educational Psychology or lated field, with demonstrated research experience in evaluation, learning, and/or teach_ skills. The opportunity exists to develop projects in the use of microcomputers and simula patients in student instruction and evaluation, in addition to participation in ongoing search projects in admissions, curriculum design, and student evaluation. Responsibilities include acting as an Education Consultant to faculty with regard teaching skills, student evaluation and learning skills, and assessment and improvemen the learning environment. . Experience in working with physicians is highly desirable. Salary competitive depending on qualifications and experience. In accordance' Canadian immigration requirements, this advertisement is directed to Canadian citizens , permanent residents. Applicants should send curriculum vitae and the names of three references before ~ I, 1984 to: Dr. John S. Baumber Associate Dean (Undergraduate Medical Education) The Uni"ersity of Calgary Faculty of Medicine 3330 Hospital Drive N.W. Calgary, Alberta T2N 4N I