Education in Veterinary Public Health Ani) Preventive Medicine

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EDUCATION IN VETERINARY PUBLIC HEALTH ANI) PREVENTIVE MEDICINE

PAN AMFRICAN HIIALT'H ORGANIZATIO()N Pan Amierican Sanitary Bureau, Regional Office of the \WORLD) HEALTHI ORGANIZATION

1969 SYMPOSIUM ON EDUCATION IN VETERINARY PUBLIC HEALTH AND PREVENTIVE MEDICINE

(St. Paul, Minnesota, 18-22 March 1968)

Scientific Publication No. 189

PAN AMERICAN HEALTH ORGANIZATION Pan American Sanitary Bureau, Regional Office of the WORLD HEALTH ORGANIZATION 525 Twenty-Third Street, N.W. Washington, D. C. 20037

CONTENTS

PREFACE ...... V Organization of the Symposium ...... vii Objectives of the Symposium Pedro N. Acha and Harold B. Hubbard...... ix RECOMMENDATIONS OF THE SYMPOSIUM ...... 3

PART I. THE VETERINARY PUBLIC HEALTH CURRICULUM Teaching Programs to Meet Present and Future Needs: The Public Service Veter- inarian-Ernest E. Saulmon...... 17 Teaching Programs to Meet Present and Future Needs: A Veterinary Medical Scientist Training Program-James H. Steele ...... 20 Teaching Programs to Meet Present and Future Needs: An Air Force View- Edward L. Menning ...... 23 Teaching Programs to Meet Present and Future Needs: An Epidemiological Approach-Paul R. Schnurrenberger...... 25 The Teaching of Epidemiology: Teaching the Basic Principles- Leonard M. Schuman ...... 27 The Teaching of Epidemiology: The Kentucky Program-Hugh S. Fulmer..... 33 The Teaching of Biostatistics: Objectives and Principles-Paul Leaverton..... 38 The Teaching of Biostatistics: Minimum Goals for Veterinary Students- Jacob Bearman ...... 43 The Teaching of Food Hygiene: Meat and Poultry Hygiene-James D. Lane.. 44 The Teaching of Food Hygiene: Curriculum Objectives-Morris A. Shiffman.... 50 The Teaching of Environmental Health: Over-All Objectives and Responsi- bilities-William F. McCulloch ...... 55 The Teaching of Environmental Health: Expanding the Curriculum- J. Douglas McCluskie ...... 62 The Teaching of Veterinary Community Medicine: Changes in Emphasis and Methods-Henry M. Parrish and Donald C. Blenden ...... 68 The Teaching of Veterinary Community Medicine: Are Our Veterinary Schools Equal to the Task?-Calvin W. Schwabe ...... 75 The Teaching of Veterinary Community Medicine: An Applied Program- John H. Helwig...... 82 Field Training Programs: The Ohio Preventive Medicine Program- Jack H. Russell ...... 84 Field Training Programs: Veterinary Student Orientation in the U.S. Department of Agriculture-Daniel F. Werring...... 88 Field Training Programs: The St. Paul Program-Paul J. Cox ...... 91 Field Training Programs: The U.S. Department of Agriculture Meat Inspection Program-V. L. Dahl...... 92 The Teaching of Disaster Preparedness-Donald C. Blenden...... 94

PART II. BIOMEDICAL COMMUNICATIONS Some Implications of Research for the Design of Instructional Material- William T. Stickley ...... 101 Application of Learning Resources in the Veterinary Curriculum-Robert Getty.. 110 iii iv Contents

The Computer Fact Bank: Multidisciplinary Laboratory Interrelationships- Fred W. Clayton...... 119 Audiovisual Communications: An Action Program-NormanL. Cole...... 121

PART III. EVALUATION Evaluating the Student's Learning-Edwin F. Rosinski...... 129 Appendix: List of Participants ...... 138 PREFACE

While this Symposium on Education in Veterinary Public Health and Pre- ventive Medicine was being planned, an expression on education in general was kept in mind: "If the learner hasn't learned, the teacher hasn't taught." The instructor of public health and preventive medicine is first of all a teacher. The teacher speaks, but what he does speaks as strongly as what he says. To the students of veterinary public health, the teacher of that discipline is public health. The students respect the teacher who can see beyond his own image, who creates in each of them an awareness of their responsibility for the health of the people in their community. The teacher must provide knowledge of the most acceptable and recently developed principles and procedures for resolving the health problems of man that have a veterinary medical aspect. But knowledge and experience are not enough in this discipline; it is vital that the skills learned be applicable to the mores, superstitions, and sociopoli- tical differences of any community. In today's borderless world, every person is our neighbor and every country is within our community. The health problems of the community today are poverty, disease, illiteracy, and ignorance. One of the paramount objectives of any future teaching program in veterinary public health and preventive medicine should be the development and implementation of a contemporary educational philosophy. From this first Sympo- sium on Education in Veterinary Public Health and Preventive Medicine come recommendations outlining methods for instilling in students a contemporary educational philosophy aimed at achieving the optimum health of man.

HAROLD B. HUBBARD Editor of the Proceedings

ORGANIZATION OF THE SYMPOSIUM

In October 1966 the University of Minnesota College of Veterinary Medi- cine extended an invitation to the Association of Teachers of Veterinary Public Health and Preventive Medicine to conduct a symposium on education in these subjects at the University. The Pan American Health Organization furnished financial support for the organization and conduct of the Sympo- sium. Doctors Pedro N. Acha, Robert K. Anderson, and Harold B. Hubbard were designated program co-chairmen. In January 1968 invitations were extended to the deans and professors of veterinary public health and preventive medicine of the colleges and schools of veterinary medicine in the United States of America and Canada to participate in the Symposium, and the Pan American Health Organization invited educators from medical schools, schools of public health, and schools of other health-related disciplines to prepare working documents. Registration and a social hour were held on Sunday evening, 17 March 1968. Participants included representatives of twenty-one schools of veterinary medicine (twenty in the United States and Canada, one in Latin America), six medical schools, and three schools of public health. Federal and state agencies were represented by fourteen participants, and the United States Armed Forces by four. The opening session was held in the Veterinary Science Building, at the University of Minnesota College of Veterinary Medicine in St. Paul, Minne- sota. Dr. Donald K. Smith, Associate Vice-President, Academic Administra- tion, University of Minnesota, who welcomed the participants, pointed out quite explicitly in his remarks the significance to the academic arena of a symposium on veterinary medical education, particularly in the fields of public health and preventive medicine. Short presentations (twenty to forty-five minutes in duration), followed by long discussion periods open to all participants, provided a new approach to the conduct of symposia on veterinary medical education. Participants expressed favorable comments concerning this method of presentation. It was felt that more self-evaluation of each teacher's instructional program was accomplished in this manner. The subjects for the daily sessions were selected and programmed to focus study on the constituents needed in the public health curriculum. The main topics of the public health curriculum were scheduled early in the program in order to develop discussion on what to teach before the several excellent sessions on biomedical communications, which engendered discussion on how to teach. Evaluation of the teaching-learning process was reserved until last to emphasize the fact that evaluation is equally as important as the subject matter and how it is to be presented. The recommendations on subject content and methods for their implementation were considered during the final session. Chairmen of the various com- vii viii Organization of the Symposium

mittees presented the recommendations as prepared by each committee. Sug- gestions for alterations, additions, and corrections were offered by the Sympo- sium participants, and it was voted to adopt the recommendations. A general recommendation was proposed and adopted: to develop a reference list of the recommendations formulated by the Symposium, which should be circulated to each college and school of veterinary medicine in the United States and Canada to verify implementation of the recommendations or to solicit a schedule of implementation. To provide continuity to the efforts of the Symposium, another general recommendation was proposed and approved; to establish and support an Advisory Group of members of the Association of Teachers of Veterinary Public Health and Preventive Medicine to visit each college or school of veterinary medicine in the United States and Canada for the purpose of presenting the concepts, responsibilities, and requirements of veterinary public health and preventive medicine as expressed by the Symposium. Dr. Pedro N. Acha, Chief of the Veterinary Medieal Services of the Pan American Health Organization, expressed appreciation to the University of Minnesota for its contribution to the Symposium and stated that it was a pleasure for the Pan American Health Organization to cooperate with the Association of Teachers of Veterinary Public Health and Preventive Medicine by providing financial support for the Symposium. Dr. Daniel Cohen, Chief of the Section of Epidemiology and Public Health of the University of Pennsylvania School of Veterinary Medicine, expressed on behalf of the Association gratitude to the Pan American Health Organiza- tion for their leadership and financial support, and to the University of Minnesota College of Veterinary Medicine for their hospitality in providing facilities conducive to intellectual concentration and expression of opinion. An evaluation of the Symposium by the participants revealed unanimous praise for the agenda, the speakers, the method of presentation, and the conduct of the Symposium in general. It was suggested that the next such conference be held as a cooperative effort with the teachers of veterinary public health and preventive medicine in Latin America in order to promote a unified educational philosophy in the Western Hemisphere in instruction in this discipline. In conclusion, the participants suggested that the deans, other administrative officers, and curriculum revision committees of the veterinary medical colleges and schools give serious and favorable consideration to the implementation of the recommendations of this Symposium. During the banquet held on the evening of 18 March, the Association of Teachers of Veterinary Public Health and Preventive Medicine presented an Award of Recognition to Dr. Gaylord W. Anderson for his outstanding leadership and contribution to the education of veterinarians in public health. Dr. Anderson is Mayo Professor and Director of the School of Public Health, University of Minnesota. OBJECTIVES OF THE SYMPOSIUM

PEDRO N. ACHA, D.V.M., M.P.H.,* AND HAROLD B. HUBBARD, D.V.M., M.P.H.t

In recent years, three Seminars on the Teaching of Preventive Medicine and Public Health in Schools of Veterinary Medicine in the Americas have been sponsored by the Pan American Health Organization: in August 1959 at Kansas City, Missouri; in August 1963 at Mexico City, Mexico; and in March 1967 at Lima, Peru. In a sense, the 1968 meeting in St. Paul complements the meeting held in 1967 in Lima. During that meeting, at which representation was limited to the teachers of public health in veterinary medical schools in Latin Amer- ica, a series of recommendations were adopted which should be of considerable interest to participants in the present Symposium. We shall mention a few of the most important recommendations. Before doing so, however, we should mention the fact that some essential differences exist regarding the importance of public health as a subject in the veterinary curriculum in Latin America. First and foremost, it must be borne in mind that the countries of the Americas are in a state of accelerated development. This is especially true of the livestock industry, which is an industry basic to the economic development of these countries. This fact in itself underscores the growing need for more veterinarians. From 1957 to 1967, a total of 25 new veterinary schools were opened in Latin America, and the number continues to increase. Secondly, a great deal more than simple attention to veterinary medical activities is being expected of, and demanded from, the graduating veterinarian. He is expected to suddenly be prepared to deal with a whole host of disease problems which in some instances have a specific relationship to the gravity of economic problems. Many times he is the only qualified professional in the public health field who not only understands the major zoonoses and other disease complexes but can interpret their significance and formulate, execute, and evaluate a program designed for their control. In the United States the veterinary profession has had the benefit of years of experience, advanced thinking, resources, and assistance in the development of programs of veterinary public health significance. Federal and state veterinary medical services have been developing at a high level as part of a complex watchdog structure, designed to afford a quick response to the appearance of zoonoses which threaten the safety of the public or which constitute a hazard to the economic well-being of the livestock industry. Guidance has been supplied for the enactment of Federal, state, and local legislation in such

* Chief, Veterinary Medical Services, Pan American Health Organization, Regional Office of the World Health Organization, Washington, D.C. t Associate Professor, Department of Medical Microbiology, School of Veterinary Medi- cine, University of Georgia, Athens, Georgia. At present, Deputy Chief, Veterinary Medical Services, Pan American Health Organization, Washington, D.C. ix x Objectives of the Symposium

areas as inspection of food, meat hygiene, storage, and transportation. With few exceptions (and those are in very special situations) such trusteeship over public health from the veterinary medical point of view is absent from the Latin American scene, though we must point out that this is changing. Today, as never before, the demand is for both quantity and quality, as regards the knowledge of veterinary public health expected of the veterinary medical student. The extent to which the recommendations which came from the 1967 meeting in Lima should be borne in mind by the participants of this meeting is a matter of degree. It will be found that, to a great extent, the recommendations are entirely applicable to the North American scene. Therefore, we present for consideration the following summary of viewpoints expressed by our Latin American colleagues: 1. The teaching of biostatistics, epidemiology, and administration constitutes a basic prerequisite in the preparation of a fully trained veterinarian. 92 The health departments and livestock units of departmcents of agr,1cultre at various levels of government should establish departments of epidemiology and biostatistics; furthermore, all officers of such departments who are carrying out work related to either of these fields should be adequately trained in their specialty. 3. Postgraduate courses in the subject of teaching of public health should be held from time to time. 4. Courses in public health held in schools other than veterinary medical schools should be so designed as to afford special usefulness to the participating veterinary medical graduate; and the usefulness of having a suitably qualified veterinarian in the school of public health as part of the teaching staff should be recognized. 5. The graduate veterinarian, with his adequate knowledge of public health implications of veterinary medical interest, should be utilized to the full in the team approach to solutions of problems in environmental health, zoonoses control, food hygiene, etc. For the participants in the present Symposium, perhaps, the subject is not what but how, as it is for our colleagues in Latin America. The papers presented are intended to provoke discussion as to how best we can achieve our goals. As more and more demands are made by society and by our times, it behooves us always to anticipate the needs of the future and to define the responsibilities which fall to us. We should remember, too, that our response to such provocation is necessarily a delayed reaction. Even if we begin at once to implement recommendations, it is usually not until two to three years after (or even later) that the first results can be perceived, and it is much longer before the fledgling veterinarian can contribute significantly. The Pan American Health Organization has continued to support efforts to meet this challenge. Now, as never before, we are conseious of the need to maintain close liaison with our colleagues in Latin America and with our sister profession of human medicine, if full use is to be made of resources for the attainment of the economic and health goals of the countries of the Hemisphere. If a survey were to be conducted among recent graduates of schools of veterinary medicine concerning their opinions regarding public health training, Objectives oj the 5Symposium xi there would be a considerable variation in responses. Some would suggest that more time be spent in teaching public health; others would want to eliminate the teaching of the subject altogether. We would guess that some would agree that certain teaching programs are poorly organized and lack imagination in presentation. Departmentalization of public health activities in various schools presents almost the same state of disorganization. The public health teaching program is incorporated into the teaching of microbiology, pathology, parasitology, or almost any other subject embraced by "public health." In contrast, many schools have complete departments devoted to comprehensive public health instruction. Hand in hand with diversity in instruction go differences in the quality of the student's background. Each of you knows the basic knowledge implanted into the students of your region. You alone are aware of the metal or steel with which you must work. Ofttimes, the tempering of this steel presents the greatest difficulty. The purpose of this Symposium is to help find newer and better ways to perform this tempering process. To provide a protocol of instruction for every school would be a pretentious and obviously inadequate effort. Each format of instruction must be geared to the local philosophy and facilities. However, certain fundamental concepts and commonly accepted practices can be utilized by all. We need to strive for a realistic approach to veterinary public health instruction applicable to today's needs and challenges. Concurrently, each teacher must be dedicated to a program of unified effort if we are to achieve our goals. A unified group of dedicated teachers can present programs and resolutions calling for action that will be listened to more attentively and judged far sooner than can a few teachers individually. The implication here is not necessarily securing more curriculum time but seeking support in depth for the philosophy of the public health teaching program. At the same time far-reaching instructional resources should be provided. By attaching some slight human health significance to their research programs, some schools of veterinary medicine are able to operate vast research programs with monies obtained from the Federal health agencies. But the true purpose of some of these programs is to provide the means for research in the researchers' own discipline, some of which is quite removed from public health. While soaking up the benefits of these resources, some researchers and administrators pay only lip service to their teaching programs in veterinary public health. When observant students begin to ask why this is so, the need for administrators to correct this imbalance becomes all the more necessary. The responsibility of public health instruction in schools of veterinary medicine should not be delegated to teachers whose foremost interests are in microbiology, pathology, or some other discipline. Public health is a discipline in itself like parasitology, medicine, or surgery. The true public health teacher who conducts research in microbiology, pathology, or immunology is to be admired, since the new knowledge he gains will be fed back into his teaching program in public health. It is time we subjected our public health teaching to a re-evaluation. Is it a sideline activity or our primary endeavor? If it is not just a job to be accomplished with token enthusiasm, then we should request the administration to secure the services of a full-time instructor formally trained in public health. xii Objectives oj the Symposium

This Symposium offers the opportunity not only for self-analysis by the individual but for an external analysis of the entire teachers' group by highly skilled teachers of medicine, public health, education, and other disciplines. Our present teaching programrs should' be re-evaluated in the light of the curricula and methods presented here. Some sound, realistic recommendations will be proposed by this Symposium, in line with today's needs. If we implement these recommendations when we return to our classrooms, we will have taken great strides in the direction of the optimum health of man. RECOMMENDATIONS OF THE SYMPOSIUM

RECOMMENDATIONS OF THE SYMPOSIUM

THE PROMOTION OF HEALTH

Although progress has been made since the 1963 Seminar on the Teaching of Preventive Medicine and Public Health in Schools of Veterinary Medicine, not all of the recommendations of that meeting have been implemented. The critical shortage of personnel in the health professions has increased the demands on both veterinary medicine and public health. As a member of this "health team," the veterinarian has been asked to assume an ever- increasing number of responsibilities in the field of public health at local, state, national, and international levels. These increased demands have occurred because of both existing environmental and public health problems and increased awareness on the part of the public as to the veterinarian's ability to contribute to the solving of community health problems (e.g., serving on local boards of health). Because of these trends and further improvements in the teaching of veterinary public health and preventive medicine, more graduating veterinarians are entering directly into full- or part-time positions with various health agencies. If the schools of veterinary medicine are to provide the necessary leadership in these areas, then it is imperative that basic material on veterinary public health and preventive medicine be taught by faculty trained specifically in public health. It is recognized that other areas of the curriculum incorporate public health philosophy. However, it is recommended that schools of veterinary medicine establish teaching and research departments, sections, or units for the purpose of organizing and coordinating the teaching of this subject and for developing the student's knowledge and understanding of the objectives and principles of public health. Subject matter in the veterinary medical curriculum must reflect trends in society that affect the health of man, animals, and plants. Promotion of health is as important as prevention of disease and disability. The deans of the schools and colleges of veterinary medicine must accept the responsibility for seeing that all veterinary medical students are not only trained but educated to assess the importance and consequences of future technological changes that affect the "wellness" and "illness" of the total animal kingdom of which man is a part.

EPIDEMIOLOGY

It is vital that all students of veterinary medicine be taught the principles and practices of epidemiology, since this science is basic to all problems of disease and veterinary community medicine. To begin with, there should be a separate course in the veterinary curriculum 3 4 Recommendations of the Symposium

on the principles of epidemiology, comprising a minimum of 30 contact hours. Preferably, this basic epidemiology course should be presented early in the student's experience. Opportunities for formal reinforcement of epidemiological principles should be provided late in the curriculum, perhaps in connection with the teaching of preventive medicine, infectious diseases, and/or public health. This formal epidemiological training should include problem-solving experience. Oppor- tunities for this experience should be created both in the field and in the laboratory. Experimental epidemiological models should be developed for teaching purposes. The general availability of closed laboratory animal and poultry populations on all veterinary medical campuses, and the practical importance to veterinary medicine of studies on these populations, suggest their use for this purpose. These courses require for their instruction the participation of veterinarians who have had postdoctoral-level training and experience in epidemiology. Prompt, adequate attention should be given to effective correlation of epidemiological and biostatistical instruction in the curriculum. Teachers of veterinary public health and preventive medicine should actively encourage the exchange of teaching materials, particularly those relevant to epidemiological problems. The Association of Teachers of Veterinary Public Health and Preventive Medicine should designate from its membership a teacher of epidemiology to assume the functions of collection, duplication, and distribution of these materials. Serious consideration should be given to the possible utilization of existing extramural programs, both at home and abroad, in the training of veterinary medical students in epidemiology and related fields. The Association should make an effort to expand such training opportunities for veterinary medical students and to keep its membership adequately informed.

BIOSTATISTICS

The Second Seminar on the Teaching of Preventive Medicine and Public Health in Schools of Veterinary Medicine, held in Mexico City in August 1963, expressed in general terms the need for education in statistical methods. Be- cause of the delay in implementation of the Seminar's recommendations, it is appropriate at this time to provide more specific guidelines for effecting such a program. The impact of a resident statistical unit on the progressive development of quantitative thinking makes it essential that all schools aim for the establishment of a fully trained statistical unit in residence at the veterinary medical school. Its functions should include (1) assistance to students and faculty in the design and analysis of experiments and (2) the training of students and faculty in statistical techniques. This unit should be located within the department or section of public health, epidemiology, or preventive medicine, since these areas are the prime users of biostatistical procedures. Recommendations of the Symposium 5

There are three areas in which all students should be instructed: I. Basic Biostatistics 1. Population distributions Binomial, Poisson, and normal distributions Central tendencies (means, medians, and modes) Dispersion (range, standard deviation, standard error) 2. Probability theory 3. Methods of testing hypotheses-null and alternate t tests for numbers t tests for proportions chi-square Analysis of variance 4. Experimental design Randomized individuals or blocks Greco-Latin squares Incomplete balanced blocks Principles of scientific methods 5. Regression analysis II. Vital Statistics (Population characteristics in health and disease) 1. Natality, growth, and mortality of normal and abnormal populations; age, sex, breed, etc. 2. Rates and ratios Incidence and prevalence rates Case fatality, attack rates-apparent and inapparent 3. Adjustment of rates and standardization of rates 4. Comparison of rates 5. Life tables and life table methods-life expectancy 6. Sampling and sampling surveys and bias Random sampling Systematic Stratified Clustered Two-stage sampling Sequential analysis Double blind studies 7. Validity and reliability of testing Agreement Specificity Sensitivity 8. Data processing Principles of collection of data Construction of tables and graphs Review of methods used in data processing Hand methods (tally sheets, cards, etc.) Machine methods (IBM, etc.) III. Statistical Applications in Other Disciplines (such as pharmacology, physiology, microbiology, and clinical medicine; e.g., Reed-Muench, geometric means, etc.) The first area (basic biostatistics) should have a minimum of 30 contact hours to be presented in the preveterinary medical curriculum or within the first two years of the veterinary medical curriculum. The second area (vital statistics) should have a minimum of 16 contact hours plus an appropriate amount of time for work sessions or homework. It should be given as part of the course in epidemiology. 6 Recommendations of the Symposium

The third area (statistical applications) can best be left to the individual departments concerned. These departments could utilize the basic biostatistics unit as a teaching resource. Laboratory space and equipment (caiculaLing machines and data processing equipment) should be provided for the teaching of biostatistics. Furthermore, appropriate space, faculty positions, personnel, and equipment should be allo- cated for the purpose of establishing a statistical unit as soon as possible within the veterinary medical school. It has been said that statistics is the language of modern science. Through statistics, students and graduate veterinarians alike are able to communicate with each other and with other scientists in their professional pursuits. Accordingly, statistics is an essential component of professional preparation and must receive its appropriate share of faculty positions, facilities, and curriculum time.

FOOD HYGIENE

The current era is one of great change, both in legal aspects of inspection and in food production, transportation, and processing technology. These changes are necessary to meet the demands of the consumer and to protect his health and welfare. Rapid movement of livestock, people, and goods increases hazards from exotic diseases of both man and animals. The Wholesome Meat Act of 1967, the pending Wholesome Poultry Products Act, and the act pertaining to the inspection of fish and marine products place a greatly increased demand on inspection personnel (both veterinarians and subprofessional food inspection technicians) and on the competency of the individuals involved. It has long been recognized that one of the major responsibilities of the veterinary profession is to assure the wholesomeness of human food products of animal origin. To meet the requirements of the increasingly complex situation it is essential that the veterinary profession assume leadership in establishing, expanding, and improving both the scope and the quality of general food hygiene and the hygiene of foods of animal origin in particular. To fulfill the responsibilities of the profession and achieve our objectives, the following recommendations should be implemented: that the Association of American State Boards of Examiners in Veterinary Medicine and the Na- tional Board of Veterinary Medical Examiners re-evaluate coverage of food hygiene in their examinations; and that questions related to food hygiene emphasize scientific knowledge of principles or concepts rather than the ability to perform techniques of food inspection. The Association of Teachers of Veterinary Public Health and Preventive Medicine should be requested to provide the examination questions. Currently, there is a great lack of uniformity among states in the scope of coverage of food hygiene in the examinations. Further, in examinations both by the states and the National Board emphasis is frequently placed on minutiae of techniques of inspection rather than on a knowledge of principles and concepts. The curricula of the veterinary medical colleges and schools must include fish hygiene in the food hygiene program. The role of fish as a protein source is increasing tremendously, in part because fish farming is coming more into Recommendations of the Symposium 7 use. Fish raising, fish harvesting, and diseases of fish are subjects which are receiving close scrutiny by marine biologists and wildlife scientists. The wholesomeness of fish and marine products should be the concern of the veterinary food hygienists. The veterinary medical profession has to assume its role of leadership in the proper use of chemicals and other substances which may affect the wholesomeness of foods of animal origin and also influence human and animal ecological factors. Drugs, biologics, herbicides, insecticides, rodenticides, anti- microbials, and other chemicals and biological substances are being used in ever-increasing frequency for diverse purposes, requiring a constant revision of acceptable tolerances. Many new compounds are being developed and used. The full impact on man and animals, on the ecology of both human and animal diseases, and on the environment has not been accurately and fully assessed. Residues in foods of animal origin and the solution of problems associated with them are logically veterinary medical public health responsibilities. Schools and colleges of veterinary medicine should begin to provide intensified, in-depth training in principles and practices of food hygiene at the Master's and Ph.D. degree levels for those veterinarians who will be required to assume positions of responsibility in teaching, administration, and supervision of food hygiene activities. Schools and colleges of veterinary medicine are the logical educational institutions to assume leadership in providing such graduate training for developing the necessary expertise for veterinarians engaged in this area of veterinary medicine, so vital to the health and welfare of man and to the control, prevention, and eradication of diseases of animals. Continuing education courses in food hygiene should be made available to veterinarians engaged in food hygiene. These courses are necessary to properly inform interested persons of new developments concerning diseases, toxicology, emergencies, and disasters, and other topics. This training will provide expertise to help safeguard the health of man and animals. Course offerings in all aspects of veterinary food hygiene in the colleges of veterinary medicine should be formulated with more uniformity. They should be strengthened, improved in quality, and modernized and their subject content scientifically oriented with less emphasis on mechanical techniques. Current and pending legislation demands uniformity of competence of graduates of all veterinary medicine schools and colleges throughout the United States and Canada. Since the shortage of veterinarians will require them to participate in an appropriately comprehensive professional capacity, the training must of necessity provide the veterinarian with a higher level of professional competence in the area of food hygiene. Microbiological examination should be properly applied in monitoring sanitation procedures and food processing activities in food plants. Eventually this may lead to the establishment of ranges of microbial content as one of the criteria for judging the wholesomeness of foods. Organoleptic examination is no longer sufficient owing to the complexity of food processing. Furthermore, the effectiveness of sanitizers in food processing plants can be evaluated only by microbiological examination. Techniques of inspection must be subjected to a continuing evaluation and re-evaluation to ensure the most effective utilization of personnel and the application of new techniques and concepts in control systems. Techniques of inspection as currently applied are essentially the same as when veterinary 8 Recommendations of the Symposium

medical inspection was first instituted. However, profound changes in disease patterns of man and animals and in food processing techniques have taken place. Under certain conditions, meat and poultry inspection could be based on a continuing survey of the, health conditions in the production unit as a supplemnent to ante-mortem and post-mortem inspection in the slaughtering plant. This would not only protect the consumer but would also contribute to the prevention of diseases in food animals. It should also be pointed out that principles of statistical quality control have not yet been generally applied in the inspection of foods of animal origin and should be given serious consideration. Job specifications for inspectors of red meat and poultry need to be changed in order to establish as a prerequisite certification of completion of an approved two-year course in food inspection or its equivalent. The curriculum for a two-year food hygiene course for the training of subprofessional technicians should be developed by a committee appointed by the Council on Education of the American Veterinary Medical Association. The curriculum for such a two-year course should be under the supervisior of a veterinary food hygienist, and uniformity of curriculum content for these courses should be assured. Certification of veterinary food hygienists by the American Board of Veteri- nary Public Health is essential to ensure the quality of training. The Board should study the matter of the certification of subprofessional food technologists with a view to the development of this specialty. The more sophisticated techniques of inspection require a better-trained, more capable inspector. If veterinary food hygienists are to assume a totally professional role in the food hygiene program, the inspector of meat products must have increased competence and ability.

ENVIRONMENTAL HEALTH

The initial objective in teaching veterinary medical students the practice of environmental health is to make them aware that the health of animals, plants, and man are significantly related to the quality of the environment. The ultimate objective is to improve the quality of the environment for the well-being of mankind. Environmental influences on health include physical, chemical, biological, and sociological agents. Technologists in agriculture and industry are causing shifts in host-agent relationships which in many instances are detrimental to health. The student should be trained to assess the consequences of new technologies as they affect society generally and the practice of veterinary medicine specifically. Pollutants, as related to the population explosion, are increasing in the environment at an alarming rate. Control of these agents has become a responsibility of all informed persons, particularly members of the medical professions. The understanding of the concept of environmental hazards should be established early in the veterinary curriculum, or even in the preprofessional years. Training in environmental health practices should be integrated in all of the veterinary medical curricula, but should be specifically covered in a department of veterinary public health or community medicine. Recommendations of the Symposium 9

We recommend that the teaching of environmental health practices include consideration of the following: animal and human wastes; air and water pollutants; ionizing radiation; environmental stresses from overcrowding, inadequate housing, and high noise levels; occupational and institutional hazards; accidents; food and residues in foods; drugs; recreation-created hazards; disasters (natural and man-made); and vectors. Plans for the study of these factors should encompass: research; legislation; inspection standards; enforcement; incentives; systems analysis and evaluation; demography and land usage; sociological and aesthetic considerations; and forensic medicine. Teaching methods and techniques for presenting this material should include: lectures; field and laboratory exercises; demonstrations; visual aids; externship programs; visits to environmental health agencies; performance testing, and problem-solving situations. A curriculum including the above considerations would not only make each veterinarian aware of his increased responsibility as a citizen but would help him to successfully carry out his role in society by providing him with an understanding of: The fundamentals of ecology; The fact that good and bad changes of our ecologic equilibrium are often very subtle and difficult to measure; The "natural" and "man-made" factors affecting health and disease; The effect of man's technological impact on man-animal relationships; The socioeconomic-political implications of controlling and preventing environmental hazards to optimum health; The fact that multiple causes are involved in environmental health problems; The interdisciplinary approach to problem-solving; The use of the scientific method in assessing the effect of the environment on host- agent relationships; and Iatrogenic disease conditions.

VETERINARY COMMUNITY MEDICINE

In view of the rapid changes in society in the last 50 years-including modifications in scientific knowledge, migrations of the general population from rural to urban areas, diversities in the aspirations of the people for better health care, alterations in the functions of veterinary medical practitioners, and transpositions in educational aims-it is suggested that the administrative officers and executive faculties of colleges and schools of veterinary medicine recognize these changes by giving serious consideration to the following recommendations. The role of the veterinarian in society and the health care field should receive more emphasis in the veterinary medical school curriculum. Specific departments of veterinary public health and preventive medicine should be created in colleges and schools of veterinary medicine. It is assumed that such departments will be given administrative, faculty, secretarial, and budgetary support. "Joint academic appointments" should be given to qualified and interested public health professionals in schools of medicine, schools of public health, 10 Recommendations of the Symposium

and schools of allied sciences, particularly engineering. Ordinarily, this joint appointment does not require an additional salary or partial salary commitment. Trainled and initerested pul"ic htealth professlonals M local, state, and national health agencies should be given "clinical faculty appointments" in the department of veterinary public health and preventive medicine. These clinical appointments do not ordinarily require salary funds. Such departments are to be responsible for presenting either alone or in cooperation with other departments in the veterinary medicine school or college, such course content as biostatistics, epidemiology, community and veterinary public health, food hygiene, regulatory or preventive animal medicine, and environmental health. These departments, in addition to undergraduate instruction, should sponsor a "total educational program" of graduate and resident study in veterinary public health and preventive medicine, with emphasis on continuing education for practitioners of veterinary medicine. This instructional program should contribute to the preparation for certification by the American Board of Veterinary Public Health. A large part of the teaching of veterinary public health and preventive medicine can best be done by using the community as a laboratory. There- fore, such departments should establish for undergraduate veterinary medical students practical field training in health departments and in regulatory agencies, and with the utilization of owned herds. These field training assignments may be on a local, national, or international level. The department of veterinary public health and preventive medicine should emphasize the concept of disaster preparedness to the undergraduate student. It is important that the student recognize the responsibility of the veterinary medical profession in the multidisciplinary effort of a post-disaster period.

FIELD TRAINING

The responsibility for teaching and research in the disciplines of preventive medicine and public health should be delegated to a section in the departmental or curricular structure of a college or school of veterinary medicine. In these areas, programs of field training in which the student is actively involved should be developed. Participation should be supervised and directed by a qualified instructor with faculty rank assigned to the preventive medicine curriculum. The college administration should give consideration to faculty assignments in order that an adequate faculty-student ratio will allow development of such field training. The following types of facilities are suggested as appropriate for utilization in field training: available university facilities (food, health, and animal); cooperating local, state, Federal, and international health agencies and laboratories (for example, public health and animal health diagnostic laboratories should be utilized in the teaching processes to familiarize the student with the available services, diagnostic tests, specimen processing, and data gathering; also, laboratory personnel will help promote the philosophy of value gained by cooperation between them and the private and public veterinary medical Recommendations oa the Symposium 11 practitioner in reporting both human and animal diseases); animal health agencies and laboratories; all types of food establishments and food processing plants; animal holding and handling facilities (zoos, dog pounds, laboratory animal facilities); and animal production units (farms, feedlots, etc.). An appropriate amount of time from the total college curriculum should be devoted to the increasingly important area of preventive medicine and public health. Considering the utilization and application of the professional capabilities of a graduate veterinarian, whether in private or public practice, an adequate amount of time for this specific area of teaching would be one-third of the total curriculum time available in the third and fourth years. An appropriate portion of this time should be devoted to field training.

BIOMEDICAL COMMUNICATIONS

The Symposium endorses the following report by Dr. Robert Getty, which was published in The Proceedings of the 104th Annual Meeting of the American Veterinary Medical Association, 9-13 July 1967: The 14th annual meeting of the Audiovisual Conference of Medical and Allied Sciences was held on July 18-19, 1966, at the Washington Hilton Hotel, Washington, D.C. This conference meets annually under the auspices of the National Audiovisual Association at its annual convention. The Conference membership includes the Council, made up of representatives from nonprofit medical and allied science organizations, and associate and individual organizational members. A total of 96 registrants, in addition to Council members, attended the 1966 meeting. The first day of the meeting was devoted to reviews of the audiovisual programs of the respective professional associations represented. Each attending member of the Council gave an oral report and submitted a written report to the Secretary of the Conference. The reports of the respective professions represented emphasized, as in past years, the sophisticated programming and the tremendous amount of time, energy, and money being expended in the general area of audiovisual education by the health- related professions. The remaining one and one-half days of the Conference were devoted to papers and discussions of the following topics, all presented by nationally recognized authorities in their respective fields: the multimedia approach; designing educational facilities for best use of audiovisuals; television, versatile servant of the health sciences; curriculum courses on educational television; the 8-mm cartridge film for programmed instruction; the potential for research in biomedical A/V education; mental health film forums; communicating to world's medical scientists; medical tapes; remote dial selection of video and audiotape. Recommendations for the future. In view of the information explosion and the limited time available to impart this information, the shortage of faculty and trained personnel, the increased student enrollment, and the fact that the veterinary profession is playing a more and more important role in world health and agricultural and economic welfare, a more effective means of presenting information seems imperative. The effectiveness of audiovisual methods in biomedical communication has been well documented and proved over the years by our sister health professions. Some national central agency or council of the AVMA, or both, consisting of several full-time professional personnel, should be delegated responsibility in the general area of biomedical communication. These individuals, committee, or council could ascertain 12 Recommendations of the Symposium

the status of audiovisual material, not only in the veterinary profession but in all allied health-related professions as well, and advise the AVMA and its constituent state associations and educational institutions relative to the many facets of audiovisual education. The aetivities could be coordinated with those of the Council on Education, Council of Research, and the American Association of Veterinary Medical Colleges. Their duties would encompass serving in a liaison capacity between medical communi- cators at the college and university levels in all matters pertaining to audiovisual education and research; ascertaining the ideal objectives of postgraduate veterinary medical programs at a national level, and coordinating such activities at a state and local level through audiovisual methods; indexing, summarizing, and codifying all available audiovisual material as it pertains to the veterinary profession; circulating an annual report and questionnaire to institutions throughout the United States; keeping all abreast of new films contemplated or in production, the availability of videotapes, kinescopes, 5-minute concept films, programmed material, and other audiovisual aids and tools; working at a national and local level, using audiovisual methods and media in the continuing education of our profession; coordinating the audiovisual activities of the AVMA central office at local, state, and national levels as well as with the audiovisual activities of our sister ea1..1.-rela.+ed.. sie-.. It should be noted that similar recommendations had been presented to the deans of schools and colleges of veterinary medicine as early as 1956 (Getty, this volume, Ref. 3). To help achieve these goals in biomedical communications in the schools and colleges of veterinary medicine, the following recommendations should be given serious consideration. The dean of each school or college of veterinary medicine should include, as part of the duties of an assistant or associate dean (or a director appointed for the purpose), the development of biomedical communications for the college. This person should be assisted by a committee of interested faculty members. He should be provided with a budget and empowered to seek additional funds to support this work. This committee should include as a part of its responsibility the development of competency in areas such as educational technology (including methodology and objectives), photography, the graphic arts, information retrieval (including retrieval of literature and demographic information) and medical illustration. The committee should obtain full-time personnel as soon as possible to expedite the development of these special areas. It is further recommended that this committee develop channels through which members of the faculty and the profession (via continuing education or other methods) will be informed of the newer concepts of teaching and instructed in the use and operation of equipment and procedures related to the biomedical communications field. The Symposium recommends the exchange of biomedical communications teaching materials among schools and colleges of veterinary medicine, and advocates the concepts of EDUCOM, CIC, and WICHE as examples of the spirit of exchange of information with other institutions. The Symposium recommends that each college make an immediate and serious effort to develop biomedical communications teaching materials and that any future Symposium on Education in Veterinary Public Health and Preventive Medicine devote a portion of the program to the review of recently developed materials. Recommendations of the Symposium 13

GENERAL RECOMMENDATIONS

Establishment of An Advisory Group

In consideration of the sincere efforts of the Symposium participants and the complex problems faced by the individual schools and colleges of veterinary medicine, a specific method of actively supplementing the publication and implementation of the recommendations formulated at this Symposium should be initiated. It is recommended that an Advisory Group of members of the Association of Teachers of Veterinary Public Health and Preventive Medicine be established and supported financially so that this group may schedule visits to each school and college of veterinary medicine for the purpose of presenting, by the most direct method possible, the concepts, requirements, and obligations of veterinary public health and preventive medicine as expressed during this Symposium.

Development of a Reference List of Recommendations

In order to focus emphasis on the efforts of the teachers of veterinary public health and preventive medicine in their endeavor to implement the recommendations formulated by the Symposium, a reference list shall be prepared that incorporates every recommendation. Each school and college of veterinary medicine in the United States and Canada shall receive this reference list so as to determine which of the recommendations have been adopted in the curriculum and to what degree. The replies from the various schools and colleges will be consolidated into a master reference list, which will be reproduced and made available to editors of journals in the field of veterinary medicine, to the Council on Education of the American Veterinary Medical Association, the Association of American State Boards of Examiners in Veterinary Medicine, and the American Board of Veterinary Public Health. As an additional aid to the teachers of veterinary public health and preventive medicine in implementing the recommendations and in improving their teaching programs, instructional resource material will be compiled and registered. A registration or catalog list of all this material will be printed and circulated to each school or college of veterinary medicine in the United States and Canada.

Part I

THE VETERINARY PUBLIC HEALTH CURRICULUM

TEACHING PROGRAMS TO MEET PRESENT AND FUTURE NEEDS

THE PUBLIC SERVICE VETERINARIAN

ERNEST E. SAULMON, D.V.M.*

Economists stress that the heart of their the Animal Health Division of the U.S. problems lies in trying to plan for the most Department of Agriculture, an organization effective use of resources that are never ade- devoted to large-scale public programs of quate to the demand. It seems to me that animal disease prevention, control, and this is the type of situation confronting us eradication. There are at present in the in this Symposium. neighborhood of 800 veterinarians in our We all know that the explosion of knowl- organization; a comparable number com- edge in recent years has affected veterinary prise the state organizations with which we medicine as well as the other sciences. From work cooperatively. Approximately 13,000 the standpoint of teaching programs, the veterinarians in the United States are ac- problem is one of deciding which is the most credited to perform professional services in important information to present, rather connection with our activities, so this field than how to cover all that a professional of effort is one that has a direct relationship student should really have. to most members of our profession in this Given the variety of specialties that a country. veterinarian may elect, the basic profes- One important factor in basic foundation sional curriculum obviously cannot fully training for this field is presenting the con- prepare a graduate for a lifetime career in cept of disease prevention. This is impor- all of these fields. It would appear, there- tant in many fields of veterinary medicine. fore, that the preparation must lay a strong In our field it is vital. basic foundation from which to advance, To be effective, the public service veteri- with the concurrent aim of giving the stu- narian in the animal health field must dent an understanding of other fields within understand how his work relates to a total the profession so that he can relate his population. Though he may work in some chosen activity to those of the specialists programs with the individual animal, he he must work with, in our current era of must have the perspective to see beyond the interdependence. animal or the herd-or the county or even My professional life has been spent in the state. We are increasingly convinced that the real professional, in our work, must * Director, Animal Health Division, Agricultural be able to visualize how his activities fit Research Service, U.S. Department of Agriculture, Hyattsville, Maryland. into the very large and very complicated 17 18 The Veterinary Public Health Curriculum network that makes up our modern live- these cases, upon faculties from several uni- stock industry. versities; our demands upon the University The public service veterinarian needs to of Minnesota have been as great as, if not go further. He needs to recognize that he is greater than, for any other institution. in an action situation and that his technical We know that basic orientation is not ability, even in terms of this total popula- enough-which is why we have sent, and tion awareness, must be translated into a will continue to send, selected veterinarians program that produces measurable and back to the university for graduate train- beneficial results-and that he will be ing. But the stronger the emphasis placed judged on these results. on epidemiology at the undergraduate level, This is a stimulating and challenging the better the foundation for professional demand and one not easy to learn; there- life. fore, it is important that it be an early and There is another area of increasing im- significant part of professional preparation. portance, and that is an understanding of This does not mean that the basic medical disease conditions exotic to our iivestock disciplines have decreased in importance in population. In our work in the Animal our work. The need for these is even greater Health Division we are of necessity becom- than before, and this need will grow. Our ing internationally minded. It is a cliché veterinarians, as those in other fields repre- to say that the world is getting smaller, but sented in this Symposium, use more of their in relation to foreign animal diseases it is basic veterinary education than ever before. nonetheless true. We no longer have a To these we now must add as broad an lengthy built-in quarantine period aboard appreciation of epidemiology as can be ship for animals coming to this country, packed into the already crowded curricula. and we are no longer reasonably self-suffi- Given an understanding of the concept of cient in terms of animals and animal prod- preventive medicine, the tools of our trade ucts. We imported in excess of 900,000 are closely allied with what we call epide- live animals and over a billion pounds of miology-although I suppose epizootiology animal prouuts iast year. would be more precise terminology for most So these foreign animal diseases are not of our work. For this reason, we applaud something to be mentioned in passing dur- the great progress made in adding an appre- ing a pathology course-as was the case ciation of epidemiology to undergraduate when I was in school. They are knocking instruction. We hope there can be more. on our doors every day, and there is no Here again, we recognize that there are way to put a guard on every door to ensure limits to what can be covered in a four-year against their entry. While our system of period, but epidemiology is so closely related safeguards at points of entry has been to to preventive medicine, which is so much a date quite effective as a first line of defense, part of either public or private veterinary the pressure grows and will continue to practice, that it is an area of great value to grow. most graduates. Our livestock industry depends on the The importance of epidemiology to our veterinary profession as a second line of work is illustrated by the fact that in the defense to rapidly detect any exotic agent last six or seven years we have conducted that may enter. Our division maintains basic epidemiological orientation courses about 80 specially trained veterinary diag- for more than 800 state and Federal veteri- nosticians at strategic points throughout narians. We have depended heavily, in the country with a primary mission of The Public Service Veterinarian 19 immediate investigation of suspected exotic cialization in early academic training, and disease conditions. In a normal year, we properly so. In our field, as in others, we conduct several hundred such investiga- want a man with a broad basic foundation tions, but the heart of a successful effort in in veterinary medicine. We are not inter- this direction is not these few trained men ested in technicians. Recognizing the ab- but the alertness of the thousands of veteri- solute necessity of continuing education narians on farms and their awareness of throughout a working lifetime, we want every case that looks "different." men who are capable of continued growth. So it is important that veterinary stu- In recognizing the primary need for dents learn the nature of foreign animal training in the basic sciences, I have men- diseases and develop an awareness of the tioned three areas that appear worthy of danger they pose here. It is important that consideration: preventive medicine, epi- they carry such knowledge away with them demiology, and, especially, exotic diseases. upon graduation. All three are important as preparation for One of the strong unifying factors in any the public service veterinarian and also, I profession is a common basic educational believe, for the majority of graduates, no background. This rules out excessive spe- matter what field they elect to enter. TEACHING PROGRAMS TO1 MEET PRESENT AND FUTURE NEEDS

A VETERINARY MEDICAL SCIENTIST TRAINING PROGRAM *

JAMES H. STEELE, D.V.M., M.P.H.t

Veterinary medicine is capable of fulfilling has two directions: the first in the ing a more significant role in the future. basic science disciplines, and the second in In order to attain this role, a cleariy iden- the clinical specialties. Veteri.aiy. medi- tifiable program should be developed which cine, on the other hand, has a third dimen- is aimed (1) at the attraction of a few sion in the application of scientific and excellent scholars from each participating medical knowledge to a variety of animal veterinary school into the veterinary medi- species. Because of this third dimension, cal sciences, and (2) at the establishment of the veterinary curriculum is perhaps even well-demarcated but flexible pathways by more crowded than the medical curriculum which the developing young scientist can and more difficult to compress. However, obtain appropriate combinations of scien- as a result of this dimension, veterinarians tifle, medical, and veterinary training are in a position to introduce a compara- needed for a research and/or academic tive approach into medical research which career. For the first five years the program is of definite value. should be clearly experimental in nature Veterinary medical scientists can con- since, of necessity, this is an undertaking tribute to meudical research in a number of that not all veterinary schools would be in ways: a position to undertake at this stage in 1. In basic research, in which veterinary their development. medical scientists can utilize their scientific An important aspect of the proposal training for research in the area of com- would be the development of a veterinary parative medicine, utilizing a wide variety associate program through which the re- of animal species with which they are search training of the veterinary medical familiar. scientist could be continued while he is in 2. In veterinary pathology, because of the government service. their common interest with pathologists in The veterinarian, like the physician, is animal diseases as models for human subject to a rather rigid curriculum during disease. his didactic training. The physician's train- 3. In clinical investigation in many areas * Reprinted from Appendix C of "Career De- of clinical medicine, in experimental sur- velopment for Veterinarians," Career Service gery, and in other clinical subspecialties. Board for Veterinarians (James H. Steele, Chair- man), Department of Health, Education, and 4. In medical research and public health Welfare, 21 June 1968. administration, as the result of their broad t Chief, Veterinary Public Health, U.S. Public Health Service, Atlanta, Georgia. knowledge of medicine and disease and 20 Veterinary Medical Scientist Training 21

their depth of training in a given scientific trainee through his veterinary medical area. years, enabling him to initiate his scientific training and to begin to define his career In considering the development of a vet- goals within the biomedical sciences. Train- erinary medical scientist training program, ing initially should focus on the develop- one must be aware of the differing state of ment of research competence in the basic the evolution of veterinary medicine as sciences, with later training provided as compared with human medicine. Whereas needed in appropriate clinical areas. An human medicine has reached a high degree additional period of thorough and rigorous of specialization during the past half-cen- research training should be provided during tury, veterinary medical practice is still in the postdoctoral years. In any case, the a relatively unspecialized state, with far total training period greater involvement of most veterinarians should be approximately four to six years to assure adequate with general practice. Because of this dif- maturation of the trainee as a well-trained ference it may not be feasible at this time scientist. Training grants should be re- for veterinary schools to attempt the same viewed by a committee composed of veteri- types of revisions in their curricula that nary medical scientists and scientists from medical schools are undertaking today. appropriate basic science and clinical disciplines. Program Plan In-Service Training The goal of the veterinary medical scientist program would be the development of With regard to in-service training, the a flexible program which provides the following points merit particular considera- trainee access to the appropriate basic tion: scientific and clinical training that he will 1. A certain number of positions should need to develop his career along a clearly be specifically assigned to this program for defined path. The breadth of his veterinary in-service scientific and research training. training will provide considerable latitude 2. The in-service aspect of the program in this effort and will enable him to cross should be operated under the guidance of discipline lines in ways that are not readily a committee or board composed of repre- achieved by basic scientists. His veterinary sentatives from the Career Service Board experience will provide a depth and rich- for Veterinarians of the Department of ness of experience to clinical investigation Health, Education, and Welfare and an that is different from that commonly avail- equal number of carefully selected repre- able on the medical scene. sentatives from veterinary and medical Students should be able to enter the pro- schools who can assist in the definition and gram at various stages in their career: development of the program. after the first two basic science years of 3. The period of obligated service in the veterinary curriculum; immediately return for in-service training should be after D.V.M. training; after military ser- carefully considered and kept as short as vice training; or during mideareer training. reasonably possible so as to enhance the The veterinary medical seientist program attraction of outstanding veterinarians to should concentrate primarily on freeing as the program. much time as possible for the individual 4. An important in-service aspect of the 22 The Veterinary Public Health Curriculum program would be the development of a veterinarians-if its quality is kept very veterinary associate program, which would high. enable veterinary officers to continue their 5. The need for quality within the veteri- research training at the National Institutes nary medical scientist program is para- of Health, the National Communicable mount, and the primary goal of the pro- Disease Center, or at other appropriate loci gram should be to attract outstanding within the Department of Health, Educa- students into the program and to give them tion, and Welfare. The identity of a special superb training for a scientific career within program for veterinarians within the ser- government, within veterinary schools, or vice would help attract outstanding young in other biomedical research settings. TEACHING PROGRAMS TO MEET PRESENT AND FUTURE NEEDS

AN AIR FORCE VIEW

EDWARD L. MENNING, LT. COL. USAF, VC *

There are several recommendations that rectly at maintaining or promoting human I should like to make concerning teaching health. programs to meet the current and future * At any one time there are more than needs of veterinary public health. 1,000 veterinarians in military service. First, several basic tenets must be * Of the approximately 900 veterinary accepted: graduates each year the military utilizes 1. The raison d'étre of the veterinary several hundred for at least a two-year profession is the over-all well-being of man period. -not animals. What can veterinary colleges do to bet- 2. Disease is a unit. In our borderless ter prepare these individuals to meet the world, subject to foot-and-mouth disease needs of society whether in the Air Force, pollution as well as to air pollution, when private practice, or other direct health sup- one species is affected, others will be also. port endeavors? From my point of view 3. Veterinary education, by omission or (in the Air Force) a change of emphasis commission, is building "cash technicians" in various subject areas is needed. rather than professionals who are truly in- Rather than instill a philosophy in stu- terested in animal disease as it relates in dents that the animal patient is an indi- the broadest sense to public health. vidual entity, we should stress that the 4. We are members of a team of health animal is protein nourishment for man professionals. (this fits in with our civic action programs What educational programs or philoso- in the Air Force). It should also be stressed phies are required to meet the needs which that foreign animal diseases could cripple logically flow from these tenets? parts of our society (the Air Force is con- Aside from our reason for existing, let us cerned because of the many military air- look at a few figures: craft that enter the United States from other countries). Pet owners must be made * One-third of our profession in the aware of the disease potential when a United States is engaged in other than zoonosis is encountered (Air Force clinics private practice; the majority of veteri- are based solely on zoonoses). There is a narians are in health specialties aimed di- psychological need for pet owners to have *Department of Veterinary Medicine, Medical a better understanding of their pets' health Service School, US. Air Force, Sheppard Air Force Base, Texas. in general. Most laymen are aware of the 23 24 The Veterinary Public Health Curriculum

danger of rabies, but their knowledge of out repetitious facts and encourage thought animal diseases stops there. by discussing principles. Albert Schweitzer The reporting of morbidity and mortality once said, "Our age has discovered how to information should be encouraged. In- divorce knowiedge from thought." The stu- volvement in epizootiological investigations dent should be able to correlate facts so should also be encouraged, as should liaison they can effectively solve new and unfa- with other members of health service teams. miliar problems. Memorization courses- Veterinarians have been individualists and such as anatomy, embryology, learning isolationists by tradition. We have dug which lymph nodes to incise on post- our own professional rut. In the counties mortem inspection-should be re-evaluated where I and two other members of our staff as to time spent for value gained. have been stationed, the only monthly mor- * Exemplify professionalism in public bidity and mortality totals for the state health. Our students feel that public health have been our totals. (Evidently none of is beneath them, yet the "giving of shots," the onfhr Iq on19 nranftitioners in the coun- which consumes a good percentage of their ties diagnosed any reportable conditions.) time in practice, is a professional public We should be very willing to advertise and health procedure. educate by speaking to any group in our * Discourageisolationism. community and by privately discussing * Form dynamic teaching programs. The mutual areas of concern with members of typical veterinarian fights with vigor other professions. against unqualified persons diagnosing, Additional enlightenment in the areas of treating, or even "giving shots"; neverthe- environmental health principles in food less he usually considers himself qualified, hygiene and sanitation, sanitizers and dis- without any preparation, to teach and test infectants, and water and air pollution students. It should be obvious that there would be invaluable for veterinarians in is more to teaching and learning than lis- private practice, for part-time public health tening to a 50-minute lecture of facts de- veterinarians, and for members of boards of livered in a monotone. We in public health health. I am constantly amazed that new cannot change school policy but we can students know little if anything about the personally avail ourselves of all types of principles of chemical or heat disinfection, courses which could teach us to teach bet- yet this is basic to modern clinical practice, ter. We must learn to: not to mention public health sanitation. Laboratory animal medicine is vital to Motivate progress in medicine, yet what is taught Profitably use training aids today? Exude interest Better teaching methods are needed. All of which requires teaching plans that These can be effected if public health are focused more on student learning and teachers will: less on lecturing and grading. Colleges * Deemphasize the tradition of spilling should educate the student. TEACHING PROGRAMS TO MEET PRESENT AND FUTURE NEEDS

AN EPIDEMIOLOGICAL APPROACH

PAUL R. SCHNURRENBERGER, D.V.M., M.P.H.*

One method of analyzing the problem of accept, his responsibility in motivating the programs in teaching to meet present and student to learn. The teacher is the initial future needs entails the epidemiological contact which most students have with the approach-visualizing the agent as the in- field of preventive medicine and public structor, the host as the student, and the health. If this exposure leaves him with a environment as the school or curriculum. sense that the field is exciting and important, we will have progressed a great dis- tance toward changing the image of public The Agent health and preventive medicine from that of a professional area which collects only We have long been concerned with estab- the dregs of veterinary medicine to one lishing qualifications of the teacher as an which requires vision, foresight, and a de- expert in the field of preventive medicine gree of competence unsurpassed within the or public health. Unfortunately, this has profession. Then it will no longer be con- on occasion resulted in neglecting the fact sidered merely as a last resort for those that he is primarily a teacher and only who have failed at all other phases of vet- secondarily a preventive medicine expert. erinary medicine. We must recognize that in today's society Further, one of the most effective ways it is vital for each person to be truly of recruiting individuals into a specialty is competent in his specialty. Further we to provide them with an attractive image. must realize that, with the present over- The teachers must be such that they will loading of curricula, there will be less and encourage students to follow their example. less time available to present more and An interested student automatically enters more material. It then becomes obvious the high-risk group for future enlistment. that the teacher must make maximum uti- This in itself is the greatest opportunity lization of the teaching opportunities avail- for recruiting available to us. able. It is vital that the time spent with the students be a genuine learning process and not a mere exposure to facts. The Host It is further important that the agent, or teacher, realize the importance of, and Every day there are more graduate veterinarians entering the field of preventive *Bureau of Epidemiology, Division of Preven- medicine or public health as a full-time tive Medicine, Illinois Department of Public Health, Springfield, Illinois. specialty; however, it is important for us 25 26 The Veterinary Public Health Curriculum to remember that the majority of these than courses. This necessitates close coor- individuals enter and leave veterinary col- dination with other faculty members and lege with the sole intent of entering private a total awareness of the contents of courses. practice. Therefore, it is far better to instill Again, we must keep in mind that each in the student a sense of responsibility to area cannot be covered in equal detail. society and an awareness of his role in the There is little logic to teaching detailed community aspects of preventive medicine local or state regulations which will vary than to try to convert him to a public with the students' location. With the pro- health specialist. Regardless of his area of liferation of information which we are en- specialization after graduation, there will countering in this age, we must realize that be countless opportunities to practice pre- what is being taught today will be dis- ventive medicine, since it is one of the carded as obsolete or, in many instances, important foundations of the total veteri- untrue in the near future. We are farther nary education process. It is much better ahead when we teach broad principles Ulla we ihave an entire class of practutioneruI O rather than present specific detailed facts leaving the college with a full awareness which are subject to rapid obsolescence. of their responsibilities in this area and a Therefore, we must know now what these complete understanding of the principles of men will be doing in the next five years preventive medicine than it is to have one and present them with that information specialist in a class while the other mem- which will be most useful to the majority bers have only a small understanding of, of the class. This decision must be based or worse yet, an active distaste for the field. on projected roles to be filled by the profession, not the specific interests of a teacher. Further, it must not be guided by the avail- The Environment ability of teaching aids but rather should be based on the needs of the students in This approach requires that we avoid an the period immediately following gradua- environment, or curriculum, full of regulation. tory details aimed at producing a specialist in public health. Rather, we must first provide the student with broad principles of In Summary preventive medicine that he can use after graduation, regardless of whether he enters 1. We must teach efficiently to teach preventive medicine, commercial medicine, effectively. or private practice, and becomes a zoo vet- 2. In the eye of the student, the teacher erinarian, a laboratory animal specialist, of public health is "public health." or what have you. After this has been 3. Preventive medicine is a set of con- accomplished, specific, detailed information cepts, not a dated collection of details. can be filled in as time permits. 4. Regardless of his specialty, every vet- Since these principles are to apply to erinarian utilizes preventive medicine prin- every phase of veterinary practice, private ciples daily in his work. or otherwise, they should be taught It is an established fact that veterinary throughout the curriculum and not re- medicine has an important role to play in stricted to courses labeled "preventive the future of public health; how well we medicine." Preventive medicine and public fulfill that role will be determined by what health must be taught as principles rather we ourselves do. THE TEACHING OF EPIDEMIOLOGY

TEACHING THE BASIC PRINCIPLES

LEONARD M. SCHUMAN, M.D.*

For more than a decade now, I have trace of glamour, a more realistic approach maintained the conviction that the science is the control of spread or continued pro- of epidemiology may readily be taught to duction of disease in a population or herd, veterinary medical students, for much of and only the epidemiologic approach can their curriculum is dedicated to the concept provide him with the necessary expertise of the herd, which in a real sense is one for such control. Even for the practitioner of the types of population that epidemi- who insists on the individualistic approach ology is concerned with. The experience to diagnosis and treatment of a single mem- of the past 14 years in teaching both vet- ber of the species, the principles of epi- erinary and medical students has led me demiology will enrich his approach in terms to believe that the early teaching of the of the contribution which this single case basic principles of epidemiology is highly makes to the health status of the herd or desirable in order that the student quickly species population. Without a basic under- recognize that he must live and work in an standing of these principles the practitioner ecosystem in which the magnitude of occur- cannot appreciate the relative hazard which rence of a given disease is the resultant of his case represents to the rest of the popu- a multifactorial display of causes and mod- lation, the milieu in which the disease de- ifying factors-of a dynamic interaction veloped, the risk of more cases developing, of the characteristics of the agent (or and the feasibility of controlling the rele- agents), the host, and the environment. It vant factors contributing to the develop- is desirable that this be done before he falls ment of the disease. into the rut of believing that disease is It is not necessary early in the curricu- invariably the result of a single necessary lum to belabor the details of the epidemi- and sufficient agent acting on a host-an ology of blocks of representative diseases. approach which is all too often, if uncon- These could much more meaningfully be sciously, the outgrowth of our microbio- integrated later with other subject areas in logical regimen. individual disease study. What is more im- It is also important that the student portant is that the student very early in realize quite early in his career that, his career conceptualize the epidemiologic whereas the cure of disease may have a principles-learn early the grand overview, lest he become a slave to rote learning of * Professor and Head, Division of Epidemiology, a flood of details which are all too fre- School of Public Health, University of Minnesota. Minneapolis, Minnesota. quently meaningless to him and remain 27 28 The Veterinary Public Health Curriculum isolated facts rather than illustrations or is conceived of as a living organism and examples of an integrated, dynamically the manifestation of disease in the popula- interacting whole. With basic concepts tion as akin to disease in the individual. clearly understood, the facts which the stu- The students are told that the epidemiolo- dent must master become easier to handle gist approaches disease in a population in and, more important, the student has de- much the same way that a physician probes veloped the ability to understand the mech- for the meaning of a presenting symptom. anisms in epidemiologically related diseases, He is warned that the symptoms and signs through transfer and application of these of disease in a population are qualitatively concepts. With experience he can add the different from, though analogous to, symp- concentric layers of sophisticated details toms and signs in a patient. The quantity to the core. Disease occurrence then takes of cases is likened to the intensity of pain, on the characteristics of a dynamic process for example; the geographic distribution of rather than a collection of boring details the disease, its differential occurrence in and onily lopefully reialed faclus. age, sex, racial, oUecupati Ouial, Ulorbuociou- To accomplish these ends the principles economic subgroups is likened to the ana- of epidemiology must be presented for their tomical location of the pain; and the tem- own sake, as common-denominator truths poral distribution of the cases is likened to for all diseases, or at least for groups of the relationship, in time, of the symptom to epidemiologically related diseases. Empha- other events in the life of the individual. sis should be on concepts. Examples and The student thus comes to appreciate the illustrations are to be used not as facts for epidemiologic approach as a diagnostic ap- facts' sake but to communicate the essence proach to disease in the community, popu- of the concept. Analogies and models prove lation, or herd, with community control of also to be quite helpful in this regard. the disease as its objective-just as the Although many of the principles are physician seeks a diagnosis in the individ- intentionally derived from communicable ual in order that he may apply the proper disease experience (not only because we therapy. have at this stage of our development more The agent-host-environment complex or information in this area, but also because interaction is also presented as a concept their meanings are conventionally easier to of multifactorial causation of disease by grasp in the infectious disease frame, ex- generalizing with examples rather than by amples, analogies, and models in the chronic monotonous, repetitive recitals of its com- degenerative disease area are nevertheless ponents, disease by disease. It is at this interwoven-at every opportunity and point that the student begins to under- wherever applicable-in order to strengthen stand the reasons for the rise and fall of the concept and illustrafe its universality. disease incidence. It is only when he has We begin with a definition of epidemi- been shown that the magnitude of ocdur- ology based on etymologic derivation. Then rence of disease in the population is de- a sophisticated definition involving the fac- pendent not only on the presence of the tors influencing the occurrence of disease agent or agents, their quantity or dose, is presented as an elaboration on the skele- their virulence, pathogenicity or toxicity, tal definition; the concept of epidemiology and their infectivity, invasiveness, or pene- as the science of the mass phenomena of trability, but also on the presence and in- disease is also presented by analogy. The fluence of environmental factors such as community, the population, the herd itself temperature, humidity, and moisture on Epidemiology: Basic Principles 29 the agents, vehicles, vectors, and even hosts several characteristics of the agent that (as well as on variables within the host, influences the magnitude of occurrence of such as the competency of the reticulo- disease in the population are clarified. The endothelial system, its prior challenges by yields of cases with agents of high as antigens, genetic makeup, age, sex and opposed to low infectivity are demon- hormonal status and race)-it is only then strated. The relationship of virulence to that the student can fully understand their severity of disease and of levels of patho- interaction and disease production is a genicity to the yield of cases and the pro- multifactorial phenomenon. In man cul- portion of transient carriers produced is tural and behavioral patterns (and in ani- presented. The phenomenon of the transient mals, behavioral patterns) may, in turn, carrier becomes readily understandable by be determinants of disease and these are this approach via the pathogenicity of the also shown to act via environmental fac- parasite. tors such as socioeconomic status and per- The student is not left with the impres- sonal hygiene, for example. Once this sion at this point that, given an agent in concept has been grasped and its relevancy large numbers with high infectivity and to any disease demonstrated, the student high pathogenicity, the population will be can accept the fact that control need not overwhelmed by disease. Although sus- be dependent solely on our ability to manip- ceptibility will more logically be dealt with ulate the causal agent but can be accom- in detail in terms of host variables, it is plished by manipulating modifying factors at this time that the student is warned that in the environment or in the host. A linear the susceptibility of the host is a strong equation, deliberately simplified by noting determinant and that disease, in the final only a few representative variables in the analysis, is the resultant of a number of agent, the host, and the environment-and vectorial forces in both the agent and the equaling a quantity of disease-assists in host. presenting the logic of this multifactorial Although the chain of infection is the concept. It is through such an equation structural model upon which the discussion that the principle of eradication may be is based, and although I do draw upon expressed, that the meaning of a necessary microbiologic and clinical data as an aid but not sufficient cause becomes clear. It in understanding, the basic approach is via also becomes clear how control of disease the conceptualization of epidemiologic prin- can still be achieved even when the cause ciples as they derive from the links in this of the disease is unknown. Such an equa- chain. Thus, for example, the approach to tion enables the student to grasp the notion the reservoir of disease is not through an of multiple causes of the same disease as enumeration of sources or habitats of the well and the principles involved in decision- agents, but rather through the magnitude making for control, including the variations of the risk to the rest of the population as possible and the manipulability and feasi- posed by each kind of source; and this bility of approach. magnitude is considered in the frame of After a cursory sketch of the agent-host- relative risk as based upon the dose, the environment complex, utilizing familiar intensity, the number of sources, and the examples, the complex is dissected in more relative mobility of that class or source. detail, still utilizing examples for illustra- Thus the student can be taught to disabuse tive purposes. The epidemiologic-as himself of the preconceived notion that the opposed to microbiologic-meanings of the severity of a case spells greater hazard to 30 The Veterinary Public Health Curriculum the rest of the population or herd. It can and vectors are brought into the picture, be shown that the greater number of tran- and their availability and utilization by sient carriers and their normally great classes of agents are discussed. Also dis- mobility provide a proauct of risk far cussed at tlis puoin is the epiudemioloogic greater than the relatively smaller number principle of geographic limitations of disease of severe cases with relative immobility due to climatic, geologic, and physiographic and even self-induced isolation. In this restrictions and vector mobility (or lack way the reservoirs of disease, as represented of it). by the clinical types of cases of illness and In discussing portals of entry, it is empha- by the incubationary, convalescent, chronic, sized that, where more than one portal of and transient carriers, are evaluated as a entry is possible, the form of the disease spectrum of risk to the rest of the popula- may be an expression of the portal utilized. tion. The concept of the dependence of the Particularly important for epidemiologic size of the reservoir on seasonal and secular investigation is the fact that, in a given patterns of prevalence of cases and carriers disease, the involved part is not necessarily is also introduced at this point. an indicator of the portal of entry. Even in Then the efficiency of the several portals hitherto unknown diseases, making their of exit (in terms of organ systems and appearance in an area for the first time, physiologic mechanics) is discussed and the mode of transmission may be inferred evaluated. Emphasis is placed here on the from considerations of age, sex, race, occu- epidemiologic principle of the effective frac- pational attack rates, and secondary attack tion of the reservoir, i.e., that portion of the rates, as opposed to the assumption of a reservoir from which the agent can escape. portal of entry based on the clinical designa- Multiple portals of exit for the same disease tion of the involved anatomical part. and their significance as risks to the poten- Our next consideration in the agent-host- tially exposed population are discussed. It environment complex is the host. After is here that the concept of the secondary some preliminary considerations of primary attack rate as a relative measure of infec- factors of host resistance (which include tiousness or communicability is introduced. such nonspecific autarceologic factors of The student almost spontaneously recog- inherent resistance as the first and second nizes the portal of exit as the first link in lines of defense and the protective influence the chain of infection where control methods of hormonal activity-and such specific may be applied. factors as humoral and tissue immunity and The study of the several modes of trans- the antigenicity of the agents), these phe- mission yields a wealth of concepts with nomena are blended into a synthesis of the epidemiologic significance. Students are patterns of development of immunity via informed that the modes of transmission natural and artificial means. The secon- practical for a parasite are dependent on dary factors of resistance, which include the ability of the parasite to survive out- the extrinsic or environmental factors such side the body of the host-outside the reser- as diet, fatigue from overcoming gravity or voir. They are told that the danger of inertia, temperature, humidity, and ionizing spread and hence the size of the caseload radiation, and the intrinsic factors such as produced is in great part dependent upon age, sex, and race are then discussed. From the mode of transmission available for that these considerations, age selection or dis- agent in that place and at that time. It tribution of disease emerges as one of the is here that the characteristics of vehicles most dynamic of the epidemiologie princi- Epidemiology: Basic Principles 31 ples. By discussing the roles and interac- rates on an age basis is then introduced, and tions of such factors as passive transplacen- the roles of both hormonal differences and tal antibody transfer, relative resistance differences in exposure potential between the of the skin, pulmonary tree, and gastro- sexes are discussed. Disparities of attack intestinal tract, the state of the reticulo- rates by race may provide further epide- endothelial system over age, the influence of miologic clues as to the mechanisms of dis- selected pathologic states, and the concept ease production in the population; these are of increasing exposure potential with age- then discussed generally. To the veterinary as well as the imprint on the population medical student this would have more mean- or herd of previous disease or exposure ing in terms of animal breeds in a species. experience-students realize that age pat- Breed differences in resistance or suscepti- terns of disease are the resultants of system- bility to disease may readily be explained atic combinations of these factors and not on genetic grounds, but in man the overlay some mystical maturation process. of socioeconomic difference leading to quali- With this background, the age distribu- tative and quantitative differences in ex- tion patterns of disease are synthetically posure very frequently overwhelms pure evolved, utilizing various combinations of considerations of race as a genetic factor. agent and host factors. There is presented Nevertheless, such insight into racial pat- the classic situation of a childhood disease, terns becomes important in the teaching of where the agent is endemically present, its principles of epidemiology, for they are pre- infectivity, pathogenicity, and antigenicity requisites to an understanding of shifting are high, and there is maternal antibody patterns of disease in time. An illustrative transmission in utero. Variations of this experience, such as the shift from higher theme are presented where the agent char- attack rates of poliomyelitis in whites than acteristics are varied to the opposite in Negroes to the reverse (and that in even extreme but taken one at a time, with or younger age groups) following immuniza- without passive transfer of antibody. The tion programs, becomes quite helpful. role of occupation as modifying exposure These considerations then lead normally potential is also interjected at this point, as to a discussion of the influence exerted on is the effect of postponing exposure poten- patterns of disease occurrence in popula- tial, with physiologic maturity a prerequi- tions by programs of active immunization, site to sexual exposure as an example. In particularly such innovations as the replace- addition to the patterns which may be ment of a wild virus in a population with evolved utilizing agents of high or low anti- an attenuated transmissible virus through genicity, the students are asked to develop an orally administered live virus vaccine. the age distribution pattern of diseases Crowding, or aggregation of populations, reintroduced into isolated island communi- and its influence on the occurrence of dis- ties after years of disease absence, or intro- ease would certainly be easy enough to duced for the first time into any community. understand much earlier in a course on The reverse procedure is then utilized. basic principles, but the dynamics which Curves are drawn, and the students are involve the ratio of susceptibles to immunes asked to discuss the possibilities in terms of in a population, which in turn is dependent antigenicity and exposure experience. All upon the ease of spread, rate of exhaustion in all, this provides a good experience in of susceptibles, and their replacement by epidemiologic inference. new births or by immigration to urban An overlay of sex differences in attack from rural communities (or dense as 32 The Veterinary Public Health Curriculum opposed to sparse populations) must await when maternal antibody is still present in the considerations of the phenomena of im- the child and when the disease is in an munity and age distribution of disease for a extremely mild clinical form in the very more solid conceptualization. Only now, young. With improvement in the stanidard in my opinion, will the student understand of living and improvement in hygiene, why urban or dense populations develop including protection of the young against immunity earlier to an endemic disease pro- indiscriminate exposure, infection is post- duced by an agent of high antigenicity poned to a time when passive antibody is than do rural or sparse populations-and gone and the disease tends to be more why the urban community, though having a severe clinically and hence more overt. greater absolute number of cases, usually Finally, students are presented with the has lower attack rates and fewer explosions phenomena of seasonal and secular cyclic- of disease. ity as epidemiologic principles. At this time the additional overlay of To round out the students' experience socioeconomie differences in the same popu- with th nrbls inlps nf onidominlngyv an lation can be brought before the student. outbreak problem is posed for class dis- The emphasis is on the epidemiologic mean- cussion and solution. The disease is not ing of such socioeconomic differences in identified, and the clinical diagnosis and terms of earlier and greater exposure to the all clinical and laboratory features are disease agent via poorer environmental deliberately withheld until the very end of sanitation and personal hygiene. If the the discussion in order that the student may disease in question increases in severity appreciate the fact that the particular and in number of overt cases with inereas- dynamics of production of this disease and ing age, the student with this background its mode of transmission may be derived by now understands why the upper socioeco- sequential logic and inference from the nomic groups would have higher attack epidemiologic data alone, including the dis- rates. If, on the other hand, the disease tribution of cases in time, the extent of decreases in severity with age then, under minultiple cases in. househoids, arld the age identical conditions of socioeconomic dif- and sex distributions. Thus the students ferences, the attack rate will be higher and occur earlier in the lower socioeconomie are prevented from following false leads groups. Illustrations of disease examples based on a priori notions of the reason for are here supplied. the outbreak, just because they are familiar This background leads to a considera- with the disease in question. tion of changes in the age distribution In summary, it is my conviction that patterns of disease over time, particularly the basic principles of epidemiology can be in developing nations, which demonstrate taught conceptually, utilizing specific facets the emergence of man-made disease patterns of specific disease epidemiology only as in a very compressed period of time. The examples or illustrations to clarify and student is presented with the example of augment the concepts, not as an accumula- poliomyelitis, which is clinically rare in tion of facts to be memorized without any underdeveloped, poorly sanitized countries, feeling for their meaning. This conceptuali- where immunity is virtually universal and zation in the hands of reasonably intelligent is acquired very early in life. The student students should help them to elicit the understands that this is the result of a specifics in epidemiology without much fur- combination of extremely early infection ther guidance and to engage in problem because of poor personal hygiene at a time solving with confidence. THE TEACHING OF EPIDEMIOLOGY

THE KENTUCKY PROGRAM

HUGH S. FULMER, M.D. *

This paper is presented from the vantage was involved in epidemiological research point of teaching epidemiology in a medical without, however, having had any formal school. Whether the objectives and princi- training in the discipline. It became my ples are appropriate for teaching in a lot to learn the hard way-by my own school of veterinary medicine I leave for mistakes. After two years of this I obtained your judgment. didactic instruction in epidemiology during I should first present my biases, because an M.P.H. year-what might be termed a the evolution of this particular teaching "remedial" year. We thought that it was program in epidemiology has been affected the fault of medical educators for having by the guiding philosophy of our own slighlited so important a discipline and that we ought to be able to do better. Department of Community Medicine at the University of Kentucky, which repre- Formulation of our own program, therefore, capitalized on a review of my own sents a unique departure in medical educa- checkered career in painfully learning how tion. Hence, the teaching of epidemiology it could be done differently and optimally. is to be viewed in the larger context of I was not alone. The original members what we call community medicine. Our of our Department had had similar experi- teaching approach in Kentucky is, however, only one example of what can undoubtedly ences. We were sure that undergraduate medical students should have a good firm be accomplished in many different ways. base in the discipline. Our concept of My own experience had some influence medical education had evolved to the point on how we designed our program at the where we viewed it conceptually as needing new University of Kentucky Medical School to be based on three interdependent parts: in 1960. I myself had received virtually laboratory, clinical, and community medi- no training in epidemiology in medical cine. Community medicine had to have a school. Throughout my internship and resi- scientific foundation. One major aspect of dency training in internal medicine, there that scientific base could be designated was no exposure to the concepts and prin- epidemiology. ciples of epidemiology. After training, I In order to teach epidemiology success- had the opportunity of participating in a fully, we believed strongly that it had to field health research program on the Navaho have both a didactic and a Indian reservation. For the first time I1 field phliase. The formal classroom exposure would occur *Professor of Community Medicine, Depart- during the preclinical years, the application ment of Community Medicine, University of Ken- tucky Medical School, Lexington, Kentucky. in the clinical years. 33 34 The Veterinary Public Health Curriculum

Second-Year Course (Didactic Teaching) phase is (4) experimental epidemiology, which has the capacity for rigorously con- The preclinical teaching occurs in an firming or denying causal hypotheses in the extensive second-year course in epidemio- arena of the real world. logy. It consists of 72 hours of classroom Our course is divided into segments. The time, covering the second half of the second first series of three-hour sessions consists year. By this time, the students have had of "epidemiologic methods," outlining the microbiology and a good share of pathology, role of descriptive, analytic, and experi- and they are beginning to examine patients. mental epidemiology. The balance of the Once a week for three hours we teach course is divided into two parts and is epidemiology. We think that for the subject oriented to specific disease or health prob- to be most palatable it should be both lems. The first of these two parts dis- oriented toward the clinical and rich with cusses the problems of infectious diseases illustrations of local and national signifi- such as influenza, tuberculosis, hepatitis, can ce. polio, zoonoses, and venereal disease; the Our teaching is founded on MacMahon's latter part of the course covers the chronic comprehensive yet succinct definition of disease area: coronary heart disease, epidemiology as the science of "the distri- smoking and atmospheric pollution, cancer, bution and determinants of disease prev- the population problem, mental health, etc. alence in man." Whether the etymologic We have a flexible formula for this definition (the science of "upon the didactic course. Each session is initiated people") might be improved with the inser- by a lecture period one-half to one hour tion of a root meaning "disease" (so that in length. A clinical case is presented at the the word might be modified to epidemio- start of the lecture to whet the students' pathology) is an academic question. The interest through the demonstration of a live veterinarian term "epizootiology," the patient with the problem of the day. The study of epizootic disease, similarly suffers entire class of 75 attends the lecture; the from the lack of "disease" as one of its class is then divided into small groups of roots. 7-8 students each for a seminar session At any rate, our second-year teaching lasting two hours or so. Each group is led stresses the MaeMahon definition, thus by a faculty member. This allows discus- leading to the strategy implied in that sion of the topic of the day in some depth, definition. This strategy is that the epide- favors a certain degree of individual miologic approach to the study of disease instruction, and makes possible a close has, conceptually, four phases. These are faculty-student relationship. (1) descriptive epidemiology, a study of The format of the seminar period is to rates of disease in subgroupings of the some degree structured, but it may be population, leading to (2) hypothesis form- liberalized by the individual faculty semi- ulation, based on asking why rates of nar leader. Each student is assigned a disease are as they are; the testing of these specific epidemiologic article from the medi- hypotheses of causation is the task of (3) cal literature, pertinent to the subject of analytic epidemiology, which by itself, the day, and is required to report upon it either through prospective or retrospective orally during the seminar period. He is methodology, only establishes associations instructed to analyze the article critically, between proposed cause and effect vari- using his knowledge of epidemiologic ables by controlled observation; the last methods. There may be three or four such Epidemiology: The Kentucky Program3 35 readings assigned, with two students in a faculty to accept critical evaluations of group having the same reading assignment, teaching ability and of attempts at change neither knowing who will be called upon and improvement is to be favored and to report; the one not reporting acts as a nurtured. critic of the other. The article may or The development of group dynamics may not be scientifically sound. In addi- among the students and between the stu- tion, all students are assigned a general dent and his faculty leader is interesting reading for which all are responsible. This to observe and may be used to promote may be from a text, or it may be an article learning. To know who the better students from the medical literature, but in either are, who the peer leaders are, who responds case it treats of the subject in a compre- well to whom, who are the better teachers hensive fashion. Also, all students are among the students themselves, is of great assigned a homework problem on the day's advantage in improving the entire teaching topic which emphasizes epidemiologic process. We ought to make more of this; methods and principles in relation to the the behavioral scientist could help us here. categorical disease entity. Solution of the problem is discussed during the seminar. Fourth-Year Course (Field Teaching) To round out the materials, all students receive the weekly morbidity and mortality The medical students spend the third reports issued by the National Communi- year in the hospital wards and clinics learn- cable Disease Center; these are grist for the ing clinical skills. We are involved with mill of discussion. All seminar groups are them only indirectly during the third year assigned the same mix of ingredients, lend- by virtue of serving as clinical faculty. In ing uniformity to the teaching of the entire community medicine-epidemiology instruc- class. In sum, the seminar period may be tion per se we are not involved at all. used to discuss the patient of the day, the In the fourth (senior) year all students lecture, the general or specific reading, the spend a full six weeks under our aegis. It problem, or the morbidity and mortality is during this period that we believe the report, so as to re-emphasize those easily "payoff" occurs in the learning of epide- recallable principles that we hope the stu- miology. Again, this is to be viewed in the dent will carry away from the course in larger context of community medicine. lis memory. The student is assigned to study a com- The seminar leader may vary the amount munity and its health problems. He moves of time that he devotes to any of these to that community and lives in it for five teaching devices. We have found some and a half weeks. He is told to make the teachers who are problem-oriented, some analogy to the patient in the hospital bed. who regard dissection of literature as their We tell him, "You have learned the clinical particular joy, some who dwell on "the big approach to the patient by working with picture," or the patient, and some who individual patients in the ward and the favor a free-wheeling, pot-boiling discussion clinics. Now learn the approach to the 'sick around the over-all theme. To say that all community' by being at its 'bedside.' Just seminar leaders should do their teaching in as you learn diagnosis and management, the a predetermined manner is to say there is science and art of clinical medicine, at the only one road to Mecca. It prevents leaders bedside of the patient, now learn the identi- from playing to their own strengths. On fication and solution of community health the other hand, the willingness of the problems in the community." We empha- 36 The Veterinary Public Health Curriculum

COMMUNITY EPIDEMIOLOGIC PROJECTS (Categorized by main emphasis and methodology) A. Population Description: General and Specific Health Status and Health Indices Follow-Up Perinatal mortality and prenatal care School children heights and weights Vision testing of school children Current status of mentally retarded children Immunization levels in infants Domestic water supply evaluation B. PopulationDescriptions: Health Attitudes, Knowledge, and Behavior Family planning, knowledge and practices Adolescent prisoners' attitudes Alcoholics Anonymous population study Epileptics' social problems Over-65 population needs for knowledge of health services Consumers' attitudes about University of Kentucky Medical Center C. Health Servic Dsrpti, Evauatio and/or 1;tilizationReview Vacation area health services availability Cholecystectomies in a community hospital Coroner's office services Regional pediatric clinic operation Rabies vaccination clinic operation Rural doctor's office and hospital utilization Mental health service for children Post-partum complication of office deliveries Medical record data retrieval in general practice Prenatal care utilization by a minority group College health service evaluation EKG screening test evaluation Medical history questionnaire development Medical care resources for a factory population Carcinoma of cervix detection in welfare recipients D. Disease Detection, Early Diagnosis, and Control Diabetes detection in school and factory Cervical cancer detection in office practice Tuberculosis detection and follow-up Alcoholism detection in a large factory E. Infectious Disease Prevalence, Incidence, and Care Studies Group A beta streptococcus prevalence in general practice Tuberculosis and histoplasmosis skin test positivity in students Toxoplasmosis in retarded children Intestinal helminths in school children F. Noninfectious Disease Prevalence, Incidence, and Care Studies Highway accidents Accident patients at a community hospital Chronic respiratory disease and smoking Glaucoma in a nursing home population Mental illness in doctor's practice and community Glaucoma in family practice Aluminum dust and chronic lung disease Familial disease genetic work-up size that the science he is now going to was all about, and the preparation obtained have the opportunity to apply is epidemiol- in the didactic phase is now going to be ogy. This is what the second-year course applied in the field. Epidemiology: The Kentucky Program 37

Therefore, in addition to studying indi- community medicine than other medical vidual patients and families in the commu- graduates. Thus far, we have only gradu- nity setting and making a comprehensive ated four classes. descriptive study of the medical needs and We would like to see every practitioner resources of the community, the student is apply the epidemiologic approach as he required to complete an epidemiologic pro- practices medicine. If not that, we would ject. hope that practitioners would recognize its This latter task involves several ele- significance and know whom they should ments. He selects a disease or health prob- call upon when problems of epidemiologic lem in which he has a certain amount of dimensions arise in the community and they interest---one that has significance in the have need of such expertise. community. He reviews the pertinent litera- An evaluation ought to be made of our ture. He designs the study, selecting a graduates; even though we have no control proper sample and detailing the research group, we plan to do so. Evaluation for protocol. He presents the study design to the long term will have the most meaning. faculty and colleagues at the end of the first week of the clerkship. He then carries Conclusions it out; the study is modest in scope and is planned to consume no more than three We are constantly being surprised and weeks in data collection. During the fifth even amazed at how our students have week he analyzes, interprets, and writes up developed sophistication in epidemiology. the study. At the conclusion of the six- This reflects our own impoverished under- week period he presents the results to a graduate background in this discipline. faculty-student seminar group. Epidemiology, as the diagnostic arm of The particulars of such studies are item- public health-community medicine, has ized in the accompanying table. been sadly neglected in our curricula. Yet its importance cannot be overstated. If we Evaluation are to make our physicians and health professionals aware of the magnitude of the What is the over-all impact of this pro- health problems we face in the coming gram? We really do not know as yet. We years, we have to instill in them the con- do not aim to create specialists in this field cept that the scientific approach is as but rather to widen the horizons of all. We important and meaningful, if not more so, do not know whether or not our graduates to the study of population pathology as it will practice medicine with a finer sense of is to individual patients. THE TACHTING OFr rTOSATTSrTC'

OBJECTIVES AND PRINCIPLES

PAUL LEAVERTON, PH.D. *

Statistical methods and concepts are used There is some overlap between the two but today in every field of science. This this division will prove to be useful. naturally follows if we accept the fact that science is defined on the basis of whether Descriptive Methods or not relevant entities can be measured. Statistics is most often defined as the col- The idea of a relative frequency distribu- lection of methods for summarizing and tion is basic to any attempt to describe analyzing data. Those methods most appli- data or to perform a "statistical analysis." cable in the biological sciences are called The histogram, or bar graph of a frequency biostatistics, and they have long been a part distribution, is still the best way to describe of the curricula in public health and pre- a set of measurements and it deserves pri- ventive medicine. mary emphasis. Of course the familiar, Obviously, it would be presumptuous for concise, summary measures of central ten- anyone to offer a set of principles on a dency and variation are also necessary. One subject as though they were universal, and of these, the standard deviation, is very fre- these comments should not be so construed. quently misused. For some reason people What follows, therefore, represents some of tend to forget that the standard deviation my personal views on the objectives and gives you a useful description of variation principles in teaching biostatistics. I will only when the frequency distribution is briefly outline what I consider to be the approximately symmetric. As an alterna- essentials of the subject and will point out tive, more attention should be given to the a few topics, which, from my experience, use of percentiles, which do not depend on seem to need more teaching emphasis than the shape of the underlying distribution. they generally have enjoyed. Statistical methods are based on an The basic subject matter of a first course abstraction-a model-which is an approxi- in biostatistics may be divided into two mation to real-world phenomena. If the areas: approximation is a good one, we have a useful, sometimes even powerful, tool. If the 1. Descriptive methods. approximation is poor, ridiculous conclu- 2. Statistical inference (analysis). sions can easily result. This critical point * Associate Professor, Department of Preventive can be illustrated even with a simple de- Medicine and Environmental Sanitation and De- scriptive measure such as the average, or partment of Statistics, University of Iowa, Iowa City, Iowa. mean. When the number of observations is 38 Biostatistics: Objectives and Principles 39 small and includes one or two extreme conclusions. Not stating an assumption values, the mean gives a figure which simply does not affect its requirement, of course. does not describe the "center" of the fre- As Hooke (1) puts it, "We do not subscribe quency distribution very well. For example, to the common fallacy that he who does not the average of the four numbers 0, 1, 2, and mention his assumptions is not restricted 97 is 25. The descriptive usefulness of the by their limitations." mean requires that we deal with an approxi- Statistics is sometimes generally de- mately symmetric distribution. Obviously scribed as "the science and art dealing with the underlying assumptions such as this one variation in such a way as to obtain reliable must be kept in mind, even when we use results" (2). Obviously situations do exist such an elementary technique, if misleading where variation is not a problem and no conclusions are to be avoided. This decep- formal statistical analysis is needed. It tively simple axiom applies to all of statis- seems reasonable, in fact, to require the tics. presence of variation as a prerequisite for Descriptive methods involve easy con- a statistical analysis. If there is no vari- cepts, which can be covered briefly in a ability, then a sample size of one is suffi- course. However, it has become apparent cient. As Bradford Hill has pointed out: that more emphasis on the specific purpose and limitations of each method is needed. If we were to use a new drug upon one proven case of acute leukaemia and the patient made an immediate and undisputable recovery should we Statistical inference not have a result of the most profound importance. The reason underlying our acceptance of merely one patient as illustrating a remarkable The use of statistical methods for mak- event-not necessarily of cause and effect-is ing decisions on a "probability basis" has that long and wide experience has shown that in been a recent development in the history respect of acute human leukaemia human beings are not variable. They one and all fail to make of science. In fact, it was only in this cen- immediate and indisputable recovery. They one tury that the methods and concepts of and all die (3). statistical inference, principally under the influence of R. A. Fisher, became widely Of course this is an extreme example. accepted. These ideas, used to quantitate When dealing with almost any biological the decision process in estimation problems phenomenon, remarkable variability usually and in testing hypotheses, are the main exists between elements in a group or substance of statistics today. These between observers. This fact can hardly methods of statistical analysis may be be overemphasized. And there certainly is grouped under the label "statistical infer- no shortage of examples. ence" to differentiate them from purely The relative frequency (Neyman- descriptive methods. Pearson) concept of probability is the basis Even more attention must be given to for statistical inference, and its principles our assumptions in this area. This require- are a necessity in any statistics course. A ment should not be considered a disadvan- concept of probability (subjective Bayes- tage of the statistical approach, for when- ian) based on quantitating one's "degree ever inferences are drawn from observations of belief" in hypotheses has recently gained -whether a formal statistical analysis is some support among statisticians. How- used or not-some assumptions about the ever, this approach to probability has been nature of the data are necessary for valid mainly of theoretical interest and its even- 40 The Veterinary Public Health Curriculum tual usefulness in helping to solve real- straightforward, it is the proper interpreta- world biomedical problems is doubtful. tion of the resulting statements concerning Since the main objective of a statistical statistical significance (p-values) that anaiysis is to make inferences about popu- seems to elude most persons. It seems lations, it is essential that the idea of a obvious, therefore, that more time should population (in the statistical sense) be be spent on interpretation than has been grasped. Selecting random samples and the case. considering the variation among them is A related problem is the failure to dif- basic. In fact, the concept that data from ferentiate between "statistical significance" a study may be considered a sample and "practical significance." This semantic result-from among many possible such difficulty has been caused by the statisti- samples taken from a population-is the cians' unfortunate choice of the term basis of statistical inference and the induc- "significant difference." What is meant by tive reasoning process (from the particular this is that differences as large as that to the general). observed or larger, could be expected to This "population-sample" concept and have occurred by randomization alone only the rationale for random sampling are pre- a small percentage of the time. Conversely, requisites for all of the methods of statis- a difference judged to be not statistically tical analysis. There are two major reasons significant is one which might well have for selecting samples at random: occurred by chance alone. Being specific 1. Chances for bias are minimized. about the expressions "small percentage of 2. The laws of probability may be em- the time" and "might well have occurred" ployed in evaluation of results. is what the p-values are all about. But these These are strong advantages which may be expressions pertain to the reality of a dif- illustrated many ways. Perhaps the point ference, not the magnitude. It is easy to cite is made most dramatically to students by examples of real and statistically significant considering examples of inferential diffi- differences between two treatments where culties encountered when nonrandom sam- the actual magnitude is biologically un- ples are chosen. important. The use of randomization is not limited The fact that the subject of test "power" to sampling, of course. In comparative is sometimes omitted from statistics courses experiments random allocation of subjects and textbooks no doubt contributes to the to treatments has come to be regarded as a confusion about statistical significance. fundamental scientific principle for the two But an understanding of power is absolutely reasons given above. necessary for proper understanding of all Randomization allows a judgment to be statistical tests. It needs to be pointed out made about the compatibility of observed more often that mistakes in judgment about group or "treatment" differences with the hypotheses can go either way. We may hypothesis that all groups effects are alike. "reject" them when they are true or Making this judgment on a probabilistic "accept" them when they are false. A sta- basis is the essence of hypothesis testing. tistical test does not prove or disprove a This broad subject may be illustrated by hypothesis but merely establishes the prob- some of the simpler, but very useful statis- ability of a judgment error about the reality tical tests. Although their calculation is of a difference. Biostatistics: Objectives and Principles 41 -

Experiments and Nonexperimental Studies calculations for standard analyses of variance, bioassays, regression problems, and The term "experiment" has been best many others. As a result, the production of defined by Donald Mainland (4) as "an routine statistical computations is going up. investigation in which randomization is One particular area of statistics that owes performed and in which throughout the its recent rapid development to the com- experiment nothing is allowed to interfere puter is multivariate analysis, in which with the effects of randomization except methods are studied for simultaneously the treatments, if they can do so." In this handling many correlated variables. Al- case the investigator has control over the though most of the ideas are not new, their independent variables and assigns them application has been limited by the com- himself to the subjects. In nonexperimental plexity of the required calculations. The studies no such control exists over the rele- development of computers has removed this vant variables. Such investigations are constraint, and many applications are now sometimes called "observational studies" or being found for these techniques. simply "surveys." Students often fail to Multivariate statistical methods are appreciate the fundamental difference naturally of particular relevance to epi- between the two with regard to the infer- demiology, where measurements of multiple ences which may be drawn from each. dependent variables is usually the case. Part of the difficulty lies in the fact that, Many of these methods are techniques in many instances, the same computational which enable a search for "patterns" in large methods of statistical analysis are appro- quantities of data. This is sometimes called priate in each of the two types of studies. "data analysis" as opposed to testing hy- For example, differences between two potheses. There is nothing wrong with such groups may be tested for statistical signif- procedures; interesting possibilities are icance in either case, but a cause-and-effect often uncovered in this manner. (Unfor- relationship may appropriately be inferred tunately a lot of nonsense is also spawned.) only in experiments. However, it is inappropriate to formulate Nonexperimental studies of both a retro- hypotheses and "test" them on the same set spective and prospective nature are useful of data. for suggesting possible cause and effect re- Although the computer is a powerful tool lationships. Such investigations are, of for the analysis of data, it enjoys an unde- course, the heart of epidemiologic research. served reputation as a data purifier. The However, it needs to be stressed that, when easy accessibility of statistical computer the criteria for an experiment are not ful- programs allows researchers to produce filled, all we can ever "prove" are associa- myriads of impressive statistics, p-values, tions. etc., regardless of how casually a program may have been selected. Mistakes of great Computers and Biostatistics magnitude can now be calculated with greater precision. And somehow the words The increasing availability of high-speed "analyzed on a computer" seem to lend an computers enables many statistical analyses aura of dignity and authority to any result, to be easily and inexpensively calculated. no matter how fallacious it might be. Such In fact, there are numerous packaged pro- statements as "the standard deviations were grams which will perform all the necessary thus developed on the computer" or "the 42 The Veterinary Public Health Curriculum

data were analyzed by computer" are com- The basic statistical flaws in most studies mon annotations. are not complicated but have to do with some of the ideas already mentioned here, osuchas roandomi;ao, pr+ob;; , andex Teaching Biostatistics perimental inference. Proper understanding of these basic concepts would do much to This attitude toward computers is ac- alleviate the problem. tually only a step beyond that of a fairly Probably the most important single prevalent blind faith in "statistical analy- guideline for teachers of biostatistics to keep ses." If Hogben's (5) 1950 statement that in mind is that nature is under no obligation "less than one percent of research workers to provide data which fit our mathematical clearly apprehend the rationale of statistical assumptions. Therefore, we must question techniques they commonly invoke" was the suitability of these assumptions in correct almost two decades ago, then the every instance where a statistical method is computerized simplicity by which statistical contemplated. No other general principle techniques may now be used has certainly can contribute more toward giving students not made it less so. the correct perspective of statistics in One of the best ways to counteract this biology. They will see these methods and situation in biostatistics courses is to point concepts not as a panacea-not as ritualistic out and discuss examples of redundant and nonsense-but as a very reasonable ap- erroneous use of statistical methods whether proach to formulating and solving many or not the crime was aided by computers. real-world problems.

REFERENCES

(1) Hooke, R. Introduction to Scientific Infer- (4) Mainland, D. Statistical ward rounds-1. ence. San Francisco, Holden-Day, 1963. Clin Pharmacol Ther 8(1) :139,1967. (2) Mainland, D. Elementary Medical Statistics, (5) Hogben, L. Chance and Choice by Cardpack 2nd ed. Philadelphia, Saunders, 1963. and Chessboard. New York, Chanticleer (3) Hill, A. B. Statistical Methods in Clinical and Press, 1950, vol. 1, p. 5. Preventive Medicine. New York, Oxford University Press, 1962. THE TEACHING OF BIOSTATISTICS

MINIMUM GOALS FOR VETERINARY STUDENTS

JACOB BEARMAN, PH.D.*

I should like to make but a few brief of being able to make use of the help offered remarks on this subject. by statisticians. It is clear that, in the time available to In order to accomplish these objectives, teach biostatistics to veterinary students, it is intended that certain principles in- the goals must of necessity be rather mod- volved in statistical reasoning be clarified: est. That is to say, we cannot expect to a) make statisticians out of these students. Since chance and chance fluctuations are at the foundation However, we can expect to accomplish cer- of biostatistics, the tain valuable objectives: student should be presented the elements of probability calculations. a) Veterinarians should be expected to b) On such a basis, the principles of learn to read their own technical and scien- sampling and sample surveys can be devel- tific literature critically and with under- oped, and some applications in veterinary standing. public health can be used to illustrate the b) They should understand the nature of principles. biological variation and the formation of c) In this context, some basic distribu- judgments in the face of variation. tions, e.g., the binomial and normal dis- c) They should understand the uses of tributions, and their uses should be intro- rates and their importance to the interpre- duced. tation of public health problems. d) Estimation of parameters should be d) Those who will do at least some scien- emphasized; the student should distinguish tific work should do so with some confidence between precision and accuracy. of understanding the jargon of statistics and e) Methods for averting bias should also be included, and the central role of appro- * Professor, Division of Biometry, School of priate random processes should be given Public Health, University of Minnesota, Min- neapolis, Minnesota. major attention.

43 THE TEACHING OF FOOD HYGIENE

MEAT AND POULTRY HYGIENE

JAMES D. LANE, D.V.M.*

In December 1967 the U.S. Congress troduced a bill in Congress to provide for a passed-and the President of the United poultry inspection act that in substance will States signed into law-the Wholesome be equal to the Wholesome Meat Act. Meat Act. This dramatically focused atten- Should this bill pass, and there is reason to tion on the quality of meat being served in believe that it will, all poultry slaughter and the American home. processing will also have to meet or exceed The states have been given two years in Federal standards within a given period of which to bring their standards of meat time. inspection to the point where they are at I believe that the impact of these two least equal to Federal requirements. If at pieces of legislation on the veterinary pro- the end of this period the states are making fession is just beginning to be felt, and progress toward this standard, they can within the next two or three years the de- petition the Secretary of Agriculture for a mand for veterinarians in meat and poultry one-year extension so that they can meet inspection activities, both state and Fed- the requirements. At the end of this one- eral, will be almost more than the profes- year extension the state inspection programs sion can meet. The Federal meat and poul- must either meet the Federal standards or try inspection programs now utilize nearly the Federal Government will operate the 1,500 veterinarians, and the states hire inspection program within the states con- about 200-300 additional men. But the cerned. What this means is that by 1971 Wholesome Meat Act and the poultry legis- virtually 100 per cent of the meat being lation, if adopted, will, within the next two offered for sale in the United States will be to three years, require at least a 40 per cent regulated to the extent that it will meet the increase in this number. And that is a standards of the Federal Government. At healthy segment of the veterinary profes- the same time, the Federal Meat Inspection sion by anyone's standards. I want to point Program will be expanding its review of out, however, that not all of these men need foreign inspection programs to ensure that be engaged full-time in inspection work. the meat imported into the United States is There will be many positions open requiring equivalent in every respect to the product only part-time inspection duties. Presum- produced in this country. ably, these jobs could coincide with large Just recently, the Administration has in- or small animal practice or with animal health regulatory work at the state or * Chief Veterinarian, Meat Hygiene Training Federal level. And let us Center, Consumer and Marketing Service, U.S. not forget that Department of Agriculture, Chicago, Illinois. during the coming years our meat- and 44 Meat and Poultry Hygiene 45 poultry-consuming public will grow ever Marketing Service is to identify and woo larger, the demand for these commodities the brightest students of veterinary medi- will increase, and the need for veterinary cine that we can find. We need men who food inspectors will continue to inerease. not only have a well-developed knowledge The critical question, as I see it, is how of anatomy, pathology, and microbiology the profession can best meet this rapidly but who have the quality of leadership and expanding demand for veterinarians in food the brightness and alertness to come up with inspection work. It is a serious problem and creative answers to problems of control we as leaders and advisers in the field of systems and statistical analysis and the veterinary education have to provide the ability to meet and deal with all types of leadership for change in the veterinary plant management at the state, local, or curriculum. I think it is generally recog- foreign government level. We cannot find nized and agreed that many forces are at these people-and will not be able to-until work today changing the focus of veterinary the veterinary faculties as a whole bring medicine. Large animal practice is chang- food hygiene concepts into the daily lectures ing to the herd or preventive medicine con- and discussions carried on in the classrooms cept. Small animal practice is slowly but and laboratories during the four years of surely growing. More graduates each year school life. This is a large order and I fully are going into biomedical research, and the realize that years may pass before it be- number of veterinarians in one or another comes a fact, but a start must be made. aspect of public health work is steadily More specifically, I am looking for a increasing. Change seems to be the order veterinarian who can walk into a meat or of the day, and frankly I do not envy the poultry plant and know what to do without curriculum committees of the various going through a long training period by a schools in their efforts to make veterinary state or Federal agency. In the Federal education relevant to the needs of to- Government we now find it necessary to morrow. train our veterinarians a minimum of 12 weeks before they can be allowed to act on their own in making an inspection and A Program for Food Hygiene disposition of an animal. This, it seems to me, reflects the underemphasis on food To meet the problems I have outlined, I hygiene in the veterinary schools. Very would like to point out a few objectives that basic sanitation principles and practices I believe must be substantially met by the must be taught to our newly hired veteri- schools if they are to provide the manpower narians. True, they have a good back- for food hygiene programs of the future. ground in the sanitation requirements of As a broad objective I propose that it is surgery, but at the present time they all too high time to accept food hygiene as an frequently lack the ability to relate these integral part and responsibility of the pro- sanitary principles to food-handling prac- fession as a whole. For too many years food tices. In pointing to this as one example of hygiene has been the poor country cousin deficiency in the total veterinary curricu- who ends up with the neck of the chicken or lum, I do not intend to criticize the food the cheapest cuts of the cow. Food hygiene hygiene teacher. What I am saying is that is becoming a science requiring special skills food hygiene is too often taught as an iso- and talents just as any other segment of the lated segment of the curriculum, and the profession. Our job in the Consumer and segment is all too brief considering the 46 The Veterinary Public Health Curriculum

major role food hygiene will be playing in common conditions calling for rejection of the future. meat as a food. I would like to see the man who enters When the meat is rejected, he must know a meat or poultry plant for the first time what to do with it to ensure that it is not have a better understanding of how ante- and cannot find its way into food channels mortem symptoms relate to the wholesome- after he has left the plant. All else is of ness of the meat as a food, or a better little use unless the meat is effectively understanding of how and why the meat destroyed as a food and he knows that this from the animal may be objectionable from has taken place. an esthetic viewpoint. There are many These, it seems to me, are the basic ob- lesions of animals and birds, as well as jectives of any meat hygiene program, and meat-handling practices during the dressing such capability must be obtained by the or processing operation, that would make student during his undergraduate years. the meat repugnant to the consumer if the Meat and poultry inspection will be the latter knew what he was bcing asked to iiveiihood, at least partially, of a large pro- accept as food for himself and his family. portion of our graduates during the coming The veterinarian must see that such meat years. Consequently, it is the responsibility does not enter food channels. of the schools to adequately prepare their This man should also know the techniques students for this work to the same extent, of providing a full post-mortem inspection for example, as they do in the case of small of at least one species of animal and one animal medicine. It would seem to me that he can class of poultry. With this ability our national board of veterinary examiners very quickly learn the techniques of in- should examine license applicants in the specting other species of livestock or of various aspects of food hygiene. poultry. Without such a capability by each graduating veterinarian, we can expect to continue to see the only too familiar cursory Curriculum Objectives inspection of animals being dressed for food by the veterinarian who did not have an What principles to follow in order to gain opportunity for postgraduate training in these objectives is a more complex problem meat hygiene and who may be inspecting and I hesitate to suggest changes that may meat or poultry on a part-time basis. seem radical or "far out." But change is He should also know the more common long overdue so I will make some sugges- causes of condemnation and why these parts tions that, though not unique or original, or carcasses should be condemned. And he must be able to recognize this pathology will, if followed, go a long way toward meet- when he sees it. Again, I ask you to keep ing the stated objectives. in mind that meat in its various forms is a First, I suggest that the history of veteri- prime responsibility of the profession. Not nary medicine become an integral part of all state agencies, for example, can provide each curriculum. Veterinary medicine, as a an extensive training program for veteri- biological and medical science, has a rich narians starting work in meat hygiene. In and diverse history, and our students from these cases, the Federal Government will the onset of their training should be oriented assist the states whenever possible, but to their profession's over-all role in human certainly a man leaving veterinary college society and alerted to the great variety of should already know and recognize the more career opportunities open to them. As Dr. Meat and Poultry Hygiene 47

Calvin Schwabe of the University of Cali- heavily rely on sampling plans established fornia points out, later in this volume, many according to statistically sound principles. American medical schools support depart- I predict that a veterinarian lacking knowl- ments of medical history while, so far as is edge of this subject will, within a very few known, not a single chair of veterinary years, be just as handicapped as a graduate history exists on an American veterinary of my era was in entering his professional faculty. The effect of emphasizing the study life with no knowledge of the powerful of veterinary history would be to broaden effect of antibiotics on disease entities. the outlook of the student, provide him with Statistical analysis provides a means to better tools to chart his future, and tend to control large volumes of meat and poultry guide him away from the concept of veteri- production that simply cannot be ade- nary medicine as a narrow technical spe- quately controlled by a casual and random cialty. It certainly is anything but a narrow examination by a man who looks in now profession, and the student body should be and then on the manufacture of frank- able to draw its own conclusions on this if furters or hams. they are provided with a wealth of infor- Within the past few years, ever since mation on past and present achievements the publication of the book Silent Spring, and the opportunities that exist in veteri- both the public and the profession have nary medicine. become more aware of the long-range To further introduce the student to basic chronic effects of consuming foods contain- meat hygiene, I propose that each student ing potentially dangerous insecticides, spend a minimum of four weeks in a meat grubicides, herbicides, and veterinary phar- and in a poultry packing plant learning the maceuticals. Ecology is a rapidly growing techniques of inspection and the principles science today, and man, as a mammal, is of determining when and why meat is suit- not exempt from the toxicity produced by able or not for use as food for human con- consuming contaminated foods. The extent sumption. The U.S. Department of Agricul- and effects of the resultant toxicity is a ture has attained an exceptional record of serious consideration of the Consumer and protecting the public from unwholesome Marketing Service, and the Service's meat meat and poultry for many years and is and poultry inspection programs have continuing to evaluate newly recognized inaugurated broad survey programs of fresh diseases and pathology and the effect of such meat and poultry-as well as sausage and conditions on the flesh of the affected ani- other items-in order to identify and con- mals. Learning how to conduct inspection demn, if necessary, foods containing exces- and to recognize the more common lesions sive amounts of such chemicals. I believe is a time-consuming process, and actual that the veterinary profession as a whole participation by the student in a real situa- has a responsibility to ensure that such tion has proven to be the most effective chemicals are utilized only according to experience from the learning viewpoint. instructions dictated by the U.S. Depart- The subject of basic statistics is not ment of Agriculture and the Food and Drug always considered to be a vital part of a Administration. Perhaps someday these veterinarian's education. Yet research de- toxic chemicals will be even more strin- sign as well as food inspection techniques gently controlled than today. But in any depend more and more on the utilization of event the schools must strongly impress on this mathematical tool. Both the military the student body the hazards of such potent and the civilian food control programs now chemicals and the need for our meat supply 48 The Veterinary Public Health Curriculum to be as free as possible from traces of these standards. Now let me turn briefly to the dangerous, but also beneficial, drugs and art or science of turning meat and poultry chemicals. Where the public health and our into the tremendous variety of food prod- meat supply are concerned, the veterinarian ucts seen in our supermarkets today. Fresh must be concerned. meat and poultry are becoming almost old- In all honesty, food poisoning seems of fashioned compared to the exotic combina- little concern in many veterinary schools tions in plain and fancy wrappers available today. Yet the veterinarian is striving to to us. Millions of dollars are spent on food become the primary source of concern with research, testing, and marketing programs poisoning arising from the mishandling of in an attempt to grab the magic formula food of animal origin. This assumption of that will tickle the palate of the American authority, however, is based not on the title with a new meat, cereal, or other combina- of doctor or veterinarian but on the famili- tion of ingredients that is tasty, attractive, arity of the individual man with the source, and low-priced-and the merchandisers are course, andcl syndrome nf fond poisnning succeeding in a remarkably high number cases. The veterinarian can be an invalu- of cases. Meat technology or food technol- able aid in the field of public health if he is ogy graduates are swept up by large cor- knowledgeable regarding the causes and porations almost before the ink is dry on effects of consuming toxic meat or poultry their diplomas. But if we are really inter- products and knows how to avoid conditions ested in emphasizing our ability to feed the leading to such illness. We all recall the modern American, we had better wake up fatal cases of botulism poisoning of a few and start producing veterinarians with some years ago brought on by eating canned tuna knowledge of meat technology. In my own fish and smoked whitefish. Although cases organization, we finally realized that the like these are extremely rare, this is small veterinarian is quite deficient in his knowl- consolation to the families of the victims. edge of how new products are prepared, Why, we can ask, has the veterinary pro- why certain chemicals are added to these fession in America consistently ignored foods, and what, if any, effect the additives marine life as a source of rich protein for the may have on the long-term health of the public? Fish, too, suffer from pathology consumer. Also, there are many ways to and disease. In future years, fish farming degrade the quality of food, even though will become an important agricultural enter- we know the ingredients are perfectly safe prise in the United States simply because to eat. Meat technology is becoming a fish are an inexpensive source of protein highly complex field and, as it continues to and our population is growing ever larger. develop, the regulation of these foods be- In Japan this is already the case. The comes even more difficult. The veterinarian veterinarian has the responsibility from the planning to enter meat hygiene work could standpoint of both agriculture and public well use a core of basic information on the health to protect this small but growing in- principles and practices of meat technology. dustry and the people who include fish as a Unless we understand the field we cannot portion of their diet. When the profession realistically expect to evaluate and regulate recognizes this, then and then only will the the flood of new products entering the mar- veterinarian become a vital link in this seg- ket place each year. As a rule these prod- ment of the food chain. ucts are wholesome, but we in the Consumer I have been talking a good deal about and Marketing Service are concerned with food and how to see that it meets our high quality, and we must be able to assure the Meat and Poultry Hygiene 49 buyer that the product he eats is accurately two-year curriculum be designed by the described on the package so that he is not veterinary profession to properly train such deceived into paying meat prices for a people and that the implementation of these lower-grade product. recommendations in junior colleges or agri- Finally, I suggest that the veterinary cultural institutes be pushed with vigor schools and the profession are well advised before state boards of higher education. It to be concerned with the development of is conceivable that schools of this type subprofessional meat technicians. Man- might even be attached to veterinary power is critical in the veterinary profes- schools in the same way that classes for sion, and the graduate veterinarian is best medical technicians are sometimes allied utilized in work that is a challenge to him with medical schools. and draws on his reservoir of professional In summary, the needs of our profession talents. Many of the jobs in meat and are changing rapidly. What was of primary poultry inspection work, however, do not importance yesterday quite obviously is not meet these criteria. In these cases, subpro- quite so important today. Values in a professional people should obviously be used. fession are relative in many respects, se Our problem in the Federal Government long as the ethical character of our liveli- (and I am sure it is a problem in the state hood remains strong. We are first of all inspection programs as well) is to find and people, but let us remember that we are a attract competent employees who can per- people with a strong vested interest in our form the tasks of the noncritical aspects of profession. As such, each hopes to pass this inspection. By noncritical, I mean those interest on to the next generation in the jobs that are not directly related to health form that they can use best to serve the considerations, such as evaluating disease society they are entering. The importance conditions in the animals presented for of food hygiene is growing by leaps and slaughter or during slaughter. There is a bounds, and we have the responsibility to need each year for about 500 new employees so alter our profession that graduates in the of this type in the meat and poultry inspec- years to come can enter this field with the tion programs throughout the country. confidence that their role within the profes- During the next year or two the demand will sion will be played with competence and rise sharply. I would suggest that a one- to satisfaction. THE TEACHING OF FOOD HYGIENE

CURRICULUM OBJECTIVES

MORRIS A. SHIFFMAN, D.V.M., M.P.H., PH.D.*

Proposing objectives for the teaching of The predominant teaching objective is food hygiene is difficult for two reasons: the preparation of a student who is factually (1) food hygiene is not a separate diseipline and intellectually equipped to adapt to but borrows its subject matter from a num- change. Therefore, it is important to have ber of scientific disciplines and technologies, some knowledge of the history of a field of and (2) the establishment of objectives is a study. Knowledge of the past and present difficult exercise in itself. Recent develop- state of the discipline is necessary to plan- ments in systems analysis, cost-benefit ning for future teaching objectives. analysis, and program-planning-budget- ing systems point to the formidable prob- Historical Perspective lems of determining objectives that allow for the systematic assessment of accom- An account of the highlights plishment in terms of criteria for these ob- of food hygiene practice over the last 100 years jectives. It is necessary to deal with objec- could be structured around three tives in terms of: phases, beginning with the sanitary reform move- 1. Relevance: Do the objectives reflect ment of the latter part of the nineteenth the present problems, conditions, and devel- century and leading to the scientific uncer- opments, or do they relate to conditions tainty of the present day. Dubos (1) has which no longer prevail? described the sanitary reform period in 2. Realism: Are the objectives designed terms of a reaction to the destruction of to impart a warm and noble feeling or do human values that accompanied the first they express the operational realities and phase of the Industrial Revolution. The sanitarians the limitations and constraints that beset of that time observed that disease coexisted all objectives? with poverty, dirt, and pollution. They had faith that health could be 3. Focus: To what extent are the objec- restored to the people by bringing back tives an expression of disciplinary back- pure food, air, and water and more pleas- ground, experience, and individual values ant surroundings. This assumption was rather than a wider expression of societal indeed based on social reform rather than requirements? scientific findings. The era of the sanitary *Associate Professor, Department of Environ- reform movement lasted till the rise of mental Sciences and Engineering, School of Public scientific medicine and was supplanted by Hfealth, University of North Carolina, Chapel H:ill, North Carolina. advances in disinfection and vaccines and 50 `--- Food Hygiene: Curriculum Objectives 51

by the development of the environmental creased international exchange in food barriers of pasteurization and water treat- products. ment. 4. Changing consumer patterns which re- The second phase in food hygiene prac- sult in the creation of new food products, tice was the era of the microbiological new food technologies, processes, and food- causation of food-borne illness. We have handling methods. hardly passed out of this era; however, the 5. Although there is a greater need for third phase requires that microbiology share food protection programs, food hygiene the stage with physical and chemical con- must now compete with other programs of taminants. The rapid social and techno- environmental pollution control. Therefore, logical changes of the post-World War II issues arise which relate to the allocation years resulted in the introduction of new of resources among competing objectives in chemical and physical contaminants-pesti- food hygiene programs and in competition cides, additives, and radiation. The nature with other programs. The student should of the pollution problem has changed dras- be familiar with some of the methodologies tically. The philosophies and strategies for for measuring efficiency and effectiveness of the containment of pollution must also program design. change, since the control strategies of a 6. Food protection programs have been previous era may not be applicable to based on the untenable assumption that changed conditions. The point at issue is control should be complete and all-inclusive. that many programs and some teaching in The reality of the control situation is un- food hygiene are based on a past historical certainty, limitation of resources, and the and developmental phase. Students may be necessity of making choices among compet- learning (and practitioners may be doing) ing objectives. The all-inclusive food pro- things which are inappropriate to the pres- tection program is usually not feasible. ent problem. Control strategies will depend on sampling Some of the significant changes may be procedures, selective methodologies for summarized as follows: sensing the environment, and surveillance. 1. The change in epidemiological patterns The student should be familiar with these of food-borne disease from patterns in which approaches and with the need for dealing cause and effect could be readily related to with probabilities rather than certainties. more complex multifactorial etiologies, In summary, a rapidly evolving society which require prospective epidemiological and an expanding technology have dimin- investigations in addition to the retrospec- ished some of the risks that were connected tive approaches. with food adulteration and microbiological 2. The mechanisms of microbiological contamination in earlier times. However, contamination are sufficiently complex, but these same changes have added factors of the newer chemical contaminants add fur- complexity to the solving of food hygiene ther dimensions of complexity. These problems and factors of uncertainty to both mechanisms include the effects of cofactors etiology and the solution of these problems. and accelerators as well as problems of A peculiar aspect of the nature of these synergism, potentiation, and antagonism. newer risks is that they have dual, built-in 3. Changes in the patterns of food pro- values of benefit and disability. The choices duction and distribution to large-scale, cen- for control are therefore less clear-cut than tralized food production facilities and in- ever before. With pesticides, for instance, 52 The Veterinary Public Health Curriculum there is a legitimate choice as between bene- milk hygiene or meat hygiene. Or the pre- fits to society and costs in health and de- sentation may be related to the nature of the struction of natural systems. Food and contaminant, e.g., microbiological or chemi- food hygiene are so closely tied to the fabric cal. These are manageable approaches. of society that students must be introduced However, food hygiene should be considered to the study of social and technological within the framework of the food system changes that determine food production and rather than from the standpoint of an iso- utilization if they are to be at all prepared lated food commodity waiting to be con- to make decisions for society. taminated by an isolated microorganism. Ackoff (2) notes that "we must stop acting Objectives of a Food Hygiene Program as though nature was organized into disciplines in the same way that universities The defining of objectives is of little use are." The inadequacies of treating food unless these definitions express the prevail- hygiene within the conventional disciplinary ing vnalues of a snniety in a realistie manner. framework benmes anpparent in the plan- The importance of multiple and conflicting ning of a suggested curriculum for a course objectives have been ignored by public in food hygiene. health practitioners. Attempts were made We may insist that the foci of study can to compress the rationale for food protec- be limited to the food commodity and the tion programs within the rigid framework pertinent microbiological, chemical, and of a single objective called "public health physical agents. Food control officials edu- reason." In fact, there are a number of cated within these disciplinary frameworks, obj ectives that must be considered: however, would have missed a number of 1. Maintenance of a food supply. The important elements of food protection. The objective in this case is the provision of an essence of food protection is a knowledge of acceptable level of food to support a popu- the operation of the food system. In the lation at a specified nutritional level. broadest sense, a system is any set of inter- 2. Prolongation of the shelf life and keep- related components. What are some of the ing quality of food. The prevention of food components of the food system which relate deterioration and wastage is the primary to food hygiene? The primary link between objective of food protection programs in a food and contaminant is the mechanism of major part of the world. contamination. The probabilities the con- 3. The maintenance of a food supply that taminant will gain entrance to the food meets the cultural and esthetic expecta- depends on a number of interrelated factors, tions of the consumer. including: 4. The maintenance of a safe food supply. Food handling methods, and human fac- It is only at this point that the "public health reason" becomes the predominant tors of care or carelessness Consumer food habits and food cultural objective. practices Food technology Approaches to Teaching Food Hygiene Patterns of distribution and transportation There are a number of alternatives in Microbial ecology organizing a curriculum in food hygiene. The straightforward approach is to teach The immediate food-contaminant system on the basis of a food or class of food, e.g., is surrounded by a larger system for the Food Hygiene: Curriculum Objectives 53 ______ control strategy and the public response. points to the differences between science and A knowledge of the food-contaminant sys- technology by noting that the technologist tem permits the choice of the point in the must deal with problems that are invariably chain of pollution where the control strategy complex: may be optimal. There are usually a He must consider problems of materials, number of alternate approaches to control energy, information and control. He must have procedures; these include inspection, tech- some idea of the scientific and technical knowl- nological fixes, laboratory testing, and sam- edge necessary to his project. He must consider pling (as opposed to total inspection pro- matters concerned with utility such as costs, markets, state of other arts and legal restric- cedures). tions. The questions he deals with spill over into The system is extended further, since con- the social sciences, law, health and medicine and trol strategies and methods cannot be iso- even into history, literature and philosophy. lated from the agencies and organizations Scientists have a preference for small, manage- for the program. There are, able problems. René Dubos notes that the biolo- responsible gist who decides on a student to study man, soon therefore, additional subsystems that must narrows to the study of an organ, then to a be considered. The control may be through single cell, then to the cellular fragments, then to one or all of a number of Federal, state, or the molecular groupings, individual molecules local agencies. The food industry is another and atoms. Though he is losing sight of man in the process, he is looking for some fundamental organization involved in the control pro- understanding of nature's building blocks (3). gram. The mechanism of control is determined by the objectives, which in turn The School of Public Health at the Uni- depend on political and social factors. These versity of North Carolina cooperates with factors are intimately related to considera- the Department of Food Science at the tions of law, economics, and administration. North Carolina State University in prepar- Food hygiene should be taught from the ing students with backgrounds in science for careers in the public health aspects of viewpoint of human ecology rather than as food science and food product safety. The a subdiscipline under chemistry of micro- required course work in food processing, biology or a similar subject. food chemistry, and microbiology is given It would be self-deluding, however, to at the Department of Food Science, and the expect any teaching program to deal with School of Public Health provides the in- all these factors in depth. The objective of struction in food protection, environmental a teaching program may be geared to the control, epidemiology, statistics, and ad- preparation of specialists and generalists. ministration. The graduate of this program Differing programs are required for: (1) should have the basic skills for the under- research seientists, who require a rigorous standing of scientific findings and for the and specialized education within a basic translation of these facts into current food discipline; (2) technologists, who are edu- hygiene practice. In sum, he should have cated for the translation and application of the skills and attitude of the "technologist" research findings into current practice; and described by Kranzberg. (3) technologist-managers, who will follow There is a third level of preparation which career patterns in government or industry has been suggested: that for the technolo- in the operation and management of food gist-manager. This educational pattern is protection programs. intended for those who have achieved the It may be useful to differentiate the edu- skills of the technologist and are preparing cational needs of these groups. Kranzberg for managerial functions with government 54 The Veterinary Public Health Curriculum or industry. There is increasing recognition such as those for example, between the rela- that scientists and technologists do become tive content of conceptual instruction and managers and that there is a separate and practical instruction, and between coverage additional set of skills that must be learned in depth of limited subject matter as against in this progression. The School of Public a more superficial coverage of a wider con- Health at the University of North Carolina tent. I would favor conceptual instruction offers courses in environmental health ser- over practical and breadth over depth. For vices management for persons concerned instance, practical instruction in meat with the direction or supervision of profes- hygiene inspection methods could be given sional and technical programs in environ- in continued education courses to those mental protection. The curriculum includes veterinarians who will actually follow this program planning, administration and man- career. agement, systematic approaches to decision- I believe that it would be useful to intro- making, public policy development, and an duce the student to the concept of the food appreciation of the significant factors that system, its components, and their interrela- are involved in the impiementation of tech- tionships. Food hygiene has reached a stage nical solutions to environmental and food of complexity and specialization that re- protection problems. quires graduate education. Courses in the The foregoing discussion has evaded the veterinary school cannot prepare the stu- real purpose of this part of the Symposium, dent for effective comprehensive food hy- which is concerned with the teaching of food giene practice. In emphasizing the food hygiene to veterinary students. The organi- system, the few students interested may zation of a course or curriculum in food choose to pursue graduate study and then hygiene for veterinary students is more diffi- participate in the total approach to prob- cult than that for the preparation of the lems of food protection. The other students graduate student in food protection. There will have gained some appreciation of the is limited time as well as limited interest. scope and complexity of modern food There are conflicting educational objectives, hygiene practice.

REFERENCES

(1) Dubos, R. J. Mirage of Health. New York, interdisciplinary research. General Sustems Anchor Books, 1961. 5:6, 1960. (2) Ackoff, R. L. Systems, organizations, and (8) Kranzberg, M. The disunity of science-technology. Amer Sci 56:21, 1968. THE TEACHING OF ENVIRONMENTAL HEALTH

OVER-ALL OBJECTIVES AND RESPONSIBILITIES

WILLIAM F. MCCULLOCH, D.V.M., M.P.H.*

No socially aware professional would sources in such a way as to prevent disease deny today that the environment is chang- and debility, and to assure an environment ing. What we need to understand is how it which is esthetically satisfying and devel- is changing, why it is changing, and what oped in conformity with the highest aspira- are the emerging problems. Although these tions of the human spirit." According to questions may never be completely an- Weisburd (4), environmental health is an swered, we as educators must prepare our- approach to medicine and public health selves and our students to cope with this rather than a major scientific field in itself. changing environment, both now and in the The American Public Health Association future. "The future," as Blakely states, Committee Report on the Environment (5) "belongs to prepared intelligence" (1). This states that "comprehensive health planning obviously means that we must have a plan must consider the major role that environ- (2). As teachers of preventive medicine ment plays in health." The report includes and environmental health, we must not fall the following checklist of program areas, into the rut of believing that all motion is together with plans and methods to be used necessarily progress. As one physician puts as guidelines: it, let it not be said of us that "having lost sight of our objectives, we redoubled our I. Environmental ProgramArea effort." Conferring together, pooling exper- Wastes Air tise, and sharing experiences are steps to- Sewage and liquid ward reassessing present objectives and Solid principles in teaching veterinary public Water supply health and preventive medicine. Housing and residential environment Food and drugs What, then, is the objective of environ- Radiation mental health? Logan (3) states that it Noise is "the improvement of the quality and Accidents character of the total environment for the Occupational and institutional hazairds Vectors well-being of mankind . . . and implies the Recreation conservation and utilization of natural re- II. Planning Considerations * Associate Professor of Preventive Medicine Health and Environmental Health, and Chief, Compara- Economic tive Medicine Section, Institute of Agricultural Medicine, College of Medicine, University of Iowa, Demographic and land use Iowa City, Iowa. Social 55 56 The Veterinary Public Health Curriculum

Esthetic lated, directly or indirectly, to the quality Resource conservation of the environment. Of the three terms III. Methods and Techniques "host," "parasite," "environment," the last Research is probably the least understood. In review- Demonstration ing motivation, Paul (8) states that "so- Education ciety's mandate to the individual is to Standards achieve or accomplish 'something' which Legislation Inspection implies a goal or objective .... The job Enforcement of education is to teach the individual to Planning take care of himself in society and society's Evaluation reciprocal obligation is to create an environ- Incentives ment conducive to the achievement or Systems analysis attainment of these personal goals." Cer- The Committee emphasizes the importance tainly, this is also true of the objectives and of other resources, among them, manpower, prininciples nf tho pnoahin nf envrirnnmpenfnl facilities, and services. health. Those in veterinary medicine have a role Environmental influences on health and to fill in every one of the categories listed. safety include physical, biological, chemical, The student, therefore, must be taught the and social groupings. They have been dis- fundamental concepts of integrated plan- cussed in detail by Dubos (9, 10), Top (11), ning in environmental health. To do this, and Gordon (12). The by-products of he must know who the other participants human living and advancing technology are and what they can offer. This will allow have polluted the air, water, and soil beyond him to understand how he can best serve on the saturation point, especially in and near the team in solving environmental health large cities, both by implosion and explo- problems. sion. Sooner or later, we will have to pay Health care for man is presently one of the consequences, unless we work together the largest industries in the United States to more fully understand what the environ- and Canada. Because of shortages of ment is and what our role will be, indi- "health" professionals, all members of the vidually and collectively, in solving present health team will have increasing demands and future problems. Because of expanding placed on their time. These trends will human and animal populations, we will have require more communication and coopera- to "pay" our way into a relatively healthy tion among the health professions (6, 7). environment. Berry reviews the trends and Veterinarians must do their part in revers- organization of agricultural health and ing the daily pollution and deterioration of safety programs in this regard (13, 14). the air we breathe, the food we eat, and the As educators, we must read and listen to water we drink. accounts of what society is doing around us. Educators in veterinary public health We must teach understanding. We must must share responsibility for improving our teach our students how to keep up, how to rapidly deteriorating environment. To do analyze the potential effects of changes and, this we must assess our own knowledge hopefully, to take early, preventive steps. before we can hope to educate our students Unfortunately, it is difficult to sell preven- and fellow faculty members. tion because it is difficult to measure the The student must be motivated to believe impact of what has been prevented. that the health of man and animals is re- The veterinary student must be taught Environmental Health: Curriculum Objectives 57 - - __

that to "get it done" he must often join an spirosis associated with squirrel hunting, organized structure to effect major changes reported by Diesch et al. (19). in which timing is an important factor. A man-made problem, not necessarily of Good laws do not always pass. What with man's "external" environment, but one of vested interests, economics, and politics, the medical progress, has been the use of im- role of the future veterinarian in these areas munosuppressive drugs on human patients will become more complex. The student prior to organ transplants and also in the must be made aware of these basic facts of treatment of Hodgkin's disease (20). Be- life. He must be taught that interagency cause of the reduction of host resistance, a local, state, and Federal communication is kidney transplant patient died of general- a necessity because of the complexity of ized toxoplasmosis following such treatment many of the basic environmental health (21). This is an example of an iatrogenie problems (15). He must be taught to under- effect, a result of medical progress (22). stand public health administration, methods Do this and the afore-mentioned examples of problem-solving, and the role of local have implications for veterinary-medical boards of health (at present 20 of the 99 progress? counties in Iowa have veterinarians on their A syndrome characterized by acute ab- local boards of health). dominal pain and signs of peritoneal irrita- Few environmental health problems have tion was seen with increasing frequency simple cause-and-effect relationships, and beginning in 1955 in the Netherlands. Stud- many defy description. Certainly, the con- ies of the involved segment of the small in- cept of multiple causation must be im- testine revealed penetration of the intestinal pressed upon the student. New changes in wall by a nematode. This infection was technology have and are causing shifts in contracted by eating raw or improperly host-parasite relationships, many of them cured herring containing larval stages of the being detrimental to the health of both man nematode that normally mature in the and animals. Therefore, the student must stomach of aquatic animals such as por- poises and seals. The increasing prevalence be told of some of the "knowns" that result of the disease was attributed not only to from society's changes so that he might be the increased consumption of herring as part further educated to assess the importance of the diet, but also to a change in the and consequences of future technological economics within the fishing industry that of veteri- changes as they affect the practice led to delayed processing of the fish (23). nary medicine. Heinemann has studied the effects of sonic The human leptospirosis outbreak caused booms on the hatchability of chicken eggs by swimming in an irrigation canal in the and on mink breeding and whelping (24, 25). State of Washington typifies how changing He raises the question: What will be the the environment (in this case, reclaiming long-range effects of the supersonic trans- land by irrigation) alters disease pat- port on man and animals? terns (16). Because of man's desire to use Dr. William Buck and colleagues at the his leisure time for recreational activities, Iowa State University College of Veterinary he often becomes exposed to zoonotic agents Medicine observed an unusual environ- shed via urine or feces into farm ponds and mental problem recently. Although fluorosis streams by infected animals (17, 18). Often in animals had not been a problem in Iowa, "new" host-agent relationships become changes in the industrial patterns and the apparent, as in the human cases of lepto- establishment of a chemical plant manu- 58 The Veterinary Public Health Curriculum facturing defluorinated phosphate near the dents how to critically evaluate these Mississippi River led to considerable prob- trends, how to be aware of potential new lems in the area where farmers began associations in man-made relationships, and reporting a reduction in corn and other how to keep open minds through the use of crop yields. Livestock began to show re- scientific methods of observation. duced weight gains and many animals in The veterinary student must be told of milk and calf production became emaciated the interrelationships, responsibilities, and -a good example of livestock and crop roles of other disiciplines and professions production losses associated with industrial with which he will work in solving environ- air pollution-one more case in which indus- mental health problems, both present and trial technology has changed some of the future. He must be taught the principles specific geographic patterns of certain dis- and objectives of teamwork. He must be ease syndromes (26). taught that, as a "giver" of advice and Types of farm accidents have also information, he must understand the "user." ehanne pcl ausO nf t.ehnolnogic develop- He mf.ust underst andthat the environment ment in farm-machinery design. Knapp influences the relationship between giver (27, 28) states that the power-take-off and user and that political, social, and (PTO) replaced the auxiliary engine on economic trends affect these communica- farm equipment and therefore reduced fires tions. He must be told of the importance and cranking accidents. However, the PTO of client education and motivation and have produced entangling accidents such as an understanding of issues and problems emasculations, fractures, and amputations, that affect man (the owner) and his which required the development of new animals. shielding. Further changes have developed The veterinary public health curriculum with the use of hydraulic lines to motors must reflect the trends in environmental to replace the mechanical PTO drive. health and develop in the student a desire Although this has helped to reduce acci- for contributing to the solution of local dents of the former type, they have been health problems. The cuiirriculum must do replaced by such consequences as derma- more than just impress him with the eco- titis, injections of oil into the body, and nomic value of the services he can provide burns. According to Knapp, the lesions to the community (29). There are only so are not initially visible, and the physician many hours availabie for teaching, and must eventually operate to remove "invisi- with the increasing amount of technical ble" oil droplets. information available daily, the teacher Extensive mining and farming of the must continually reassess his teaching pro- oceans will take place by the year 2000. gram. The student need not know all the It is predicted that approximately one-fifth facts, because many will change, but he of the world's food will come from the must certainly understand the concepts oceans. What, then, will be the contribu- which remain fairly constant. More impor- tion of veterinarians toward understanding tantly, the student must be taught how to potential environmental health problems keep up with the changes by taking advan- associated with farming the oceans? Again, tage of continuing education programs and a problem of advanced technology. the printed word. He must continue his We must critically observe trends in education after graduation. society and assess their impact on the health As Osler has stated: of man and animals. We must teach stu- In addition to the various senses, the student Environmental Health: Curriculum Objectives 59 needs to have a sense of "responsibility" and The student should be made to read basic more important, a sense of "proportion." . . . information in environmental health (31- Thoroughness is the most difficult habit to 41), including the basic areas (air, food, acquire, but it is the pearl of great price, worthy of all the worry and trouble of the search ... water, soil) and pollution, whether natural What we need is the man who knows the records, or man-made (ionizing radiation, chemicals, who, with a broad outlook and drilled in what agricultural waste). Such reading should may be called the embryology of history, has yet be assigned as background information, and a powerful vision for the minutiae of life.... lecture The scholar can never feel initiated into the time should be spent discussing the company of the elect until he can approach all why, where, future applicability, and impor- of life's problems from the cosmopolitan stand- tance of environmental health in its broad- point . . . and it is not only book knowledge est concept. and journal knowledge, but a knowledge of men The student, of necessity, will have to be that is needed (30). tested on subject matter and will have to We must also realize that what students "regurgitate" certain fundamental facts to are taught and what they learn may not pass exams; however, it is hoped that necessarily be the same thing. Teachers "spoon-feeding" will be kept at a minimum must understand the background and moti- and that we, as teachers, will have the vations of students if they are to be realistic courage, conviction, and ability to stimulate in their approach to educating them about the student to utilize the scientific-method the impact of environmental health prob- approach in educating himself while in lems and their importance in the practice school-so that he may continue to edu- of veterinary medicine. Both training and cate himself after graduation. education are important in veterinary medi- It is also important that we know and cine, but "educated" is the key word for consider the human factor in teaching. We the total professional life of the veteri- must understand students' motives for en- narian. tering the school of veterinary medicine. There is a need for coordination of Therefore, the challenge of teachers of pre- environmental health areas in the present ventive medicine and veterinary public veterinary curriculum. The teachers of pre- health will be to continually instill and ventive medicine and veterinary public motivate the student to believe in the value health can play an important role in the of preventive medicine. Top emphasizes over-all education of the total faculty in that "wellness" is an attribute that has to this regard, and, hopefully, will prevent be sought and preserved in addition to the duplication of teaching material in an al- after-the-fact treating of illness (42). It ready too crowded curriculum. must be realized that the environment has Teachers of veterinary public health been a great friend. Nature's air, water, might also influence information given in and soil have provided natural benefits for lectures in the preveterinary curriculum. man's survival. However, concentration of The "users" of veterinary services need animal and human populations and techno- to be educated as to the value of veterinary logical developments in industry and agri- medical professional talents. While I have culture have undermined nature's own not taught formally in a college of veteri- method of disinfection. nary medicine, I feel there is a need to Some students may wish to pursue en- pursue an expansion of the environmental vironmental health training within the health or ecology courses that are offered undergraduate curriculum, and it is possi- and/or required. ble that a part-time or summer externship Public Health Curriculum fiRO TheT VVeterinary . Pu H . uu program could be made available for them * Understand natural and man-made factors and disease. in environmental health programs in medi- affecting health * Understand the effect of man the "invader," cal centers, health departments, or veteri- his technology, and his impact upon man-animal nary colleges. In 1967 a Comparative Medi- relationships. cine Externship was initiated at the Uni- * Understand the socioeconomic-political im- versity of Iowa College of Medicine, and plications in controlling and preventing environ- two freshmen veterinary students spent the mental hazards to health. * Understand that multiple causation or a summer working in various areas of our combination of factors is involved in environ- field and laboratory studies, primarily on mental health problems. leptospirosis and toxoplasmosis. They were * Understand the team approach to problem- allowed to participate in and see the various solving. the aspects of a total environmental health * Use the scientific method in assessing effect of the environment on host-agent relation- center and to confer with the people work- ships. ing in these areas. Such an interchange of * Understand and cope with the "diseases" of ideas not only helps the students directly medical and veterinary medical progress. involved, but is of value in educating their Iinlueunce tlne teaching of the vathuu con- classmates in the veterinary school. The cepts of environmental health in the total veterinary medical curriculum, not just in the veteri- externship program was continued through nary public health area. the summer of 1968. I am sure that there * Educate our students on how to be objec- are many other potential externships tive and instill in them a heightened sense of throughout the United States and Canada awareness. current with the literature, both state, or Federal sponsor- * Keep under private, inside and outside of veterinary medicine. ship. Vacation time is limited, but the * Volunteer our talents to the solution of en- more students become involved in active vironmental health problems and encourage in- programs of environmental health, the terprofessional communication. we preach. broader will be their concepts and the more * Practice what effective will be their contribution to society Representative John C. Culver of Iowa and their future profession. best summarizes my thoughts when he I personally feel that if we are to develop states that '"more than anything else, our be the a curriculum which will enable future vet- society needs today the man who can skilled professional, yet is not imprisoned erinarians to successfully carry out their by his subject or calling" (43). role in society, then we must: The great challenge then, is to develop * Understand the fundamentals of ecology. an individual who has the confidence and that change is inevitable and * Accept the fact courage to actively and intelligently involve that these changes will have both good and bad effects on our ecologic equilibrium, effects which himself in solving the problems of tomor- are often very subtle and difficult to measure. row.

REFERENCES

(1) Blakely, R. J. The future belongs to prepared ference on Health, November 3 and 4,1965. intelligence. State University of Iowa Ex- Washington, p. 493. tension Bulletin No. 795, 1962. (4) Weisburd, M. Summary of environmental (2) Duhl, L. J. Environmental health: politics, health problems. Paper presented at planning and money. Amer J Public A.M.A. Congress on Environmental Health, Health 58:232, 1968. 1965, Chicago. (3) Logan, J. A. Environmental health (panel (5) American Public Health Association Com- 3). Proceedings of the White House Con- mittee. Report: environmental factors in Environmental Health: Curriculum Objectives 61 __

health planning (guidelines prepared by the in-and-outside human gastro-intestinal wall. Committee on Environment). Amer J Trop Geogr Med 19:56, 1967. Public Health 58:358, 1968. (24) Heinemann, J. M. Effect of sonic booms on (6) Harrell, G. T. Trends in education, practice, the hatchability of chicken eggs. Regional and organization of health services. JAMA Environmental Health Laboratory, Kelly 196:334, 1966. Air Force Base, Project No. 65-2, 1965. (7) McCulloch, W. F. Socioeconomic aspects of (25) Heinemann, J. M. Reactions of breeding and pharmacy-veterinary medical relations. J whelping mink to sonic booms. Regional Amer Vet Med Ass 149:1518, 1966. Environmental Health Laboratory, Kelly (8) Paul, E. J. Motivation: an imperative of Air Force Base, Project No. 67-5, 1967. human dynamics. Paper presented at (26) Buck, B. Personal communication, 1968. Drake University, Des Moines, Iowa, 1967. (27) Knapp, L. W., Jr. Personal communication, (9) Dubos, R. Mirage of Health, World Per- 1968. spectives, vol. 22. New York, Harper, 1959. (28) Knapp, L. W., Jr. Agricultural injury pre- (10) Dubos, R. Environmental biology. Bio-Sci vention. J Occup Med 7:545, 1965. 14:11,1964. (29) McCulloch, W. F. The role of the practicing (11) Top, F. H., Sr. Environment in relation to veterinarian in comparative medicine. Vet infectious diseases. Arch Environ Health Econ Aug. 1962, p. 52. (Chicago) 9:699, 1964. (30) Osler, W. The student life. In: A Way of (12) Gordon, J. E. Ecologic interplay of man, Life. New York, Dover, 1951. environment and health. Amer J Med Sci (31) Environmental Pollution Panel, President's 252:341, 1966. Science Advisory Committee. Restoring (13) Berry, C. M. Agricultural industry-the the quality of our environment. The White changing pattern. Amer J Public Health House, 1965. 49:616, 1959. (32) Diesch, S. L., and K. R. Long. Starlings and (14) Berry, C. M. Organized research in agricul- health. J Iowa Med Soc Jan. 1967, p. 35. tural health and safety. Amer J Public (33) Beasley, O. C., and K. R. Long. Toxic effects Health 55:424, 1965. from the use of agricultural chemicals. (15) Terry, L. T. Environment and health: 70 J Iowa Med Soc Jan. 1966, p. 45. years after. Yale J Biol Med 35:133, 1962. (34) Upholt, W. M., and P. C. Kearney. Pesti- (16) Nelson, K. E., E. A. Ager, M. M. Galton, and cides. New Eng J Med 275:1419, 1966. R. W. H. Gillespie. An outbreak of Lepto- (35) First, M. W. Environmental hazards-urban spira pomona infections in Washington solid-waste management. New Eng J Med State. Proc., 11th Pacific Science Con- 275:1478, 1966. gress (University of Tokyo) 6:16, 1966. (36) Harrington, J. J. Environmental hazards- (17) Diesch, S. L., and W. F. McCulloch. Isola- operations research-a relatively new lation of pathogenic leptospires from waters approach to managing man's environment. used for recreation. Public Health Rep New Eng J Med 275:1341, 1966. 81:299, 1966. (37) Ferris, B. G., and J. L. Whittenberger. (18) The not-so-healthy outdoors (editorial). Environmental hazards-effects of com- JAMA 196:133, 1966. munity air pollution on prevalence of (19) Diesch, S. L., R. P. Crawford, W. F. Mc- respiratory disease. New Eng J Med 275: Culloch, and F. H. Top. Human lepto- 1413, 1966. spirosis acquired from squirrels. New Eng (38) Little, J. B. Environmental hazards-ionizing J Med 276:838, 1967. radiation. New Eng J Med 275:929, 1966. (20) Cheever, A. W., M. P. Valsamis, and A. S. (39) Health is a Community Affair. Cambridge, Rabson. Necrotizing toxoplasmic encepha- Harvard University Press, 1966. litis and herpetic pneumonia complicating (40) Human Resources for Health. Milbank treated Hodgkin's disease. New Eng J Med Memorial Fund, 42nd Conference, October 272:26, 1965. 17-19,1967, New York. (21) Reynolds, E. S., K. W. Walls, and R. I. (41) Stewart, W. H. Manpower for better health Pfeiffer. Generalized toxoplasmosis follow- services. Public Health Rep 81:393, 1966. ing renal transplantation. Arch Intern Med (42) Top, F. H., Sr. The D.V.M.'s contributions 118:401, 1966. to the health of man. Vet Econ Aug. 1962, (22) Moser, R. H. Iatrogenic disorders. Med Col- p.25. lege of Virginia Quart 3(2) :91, 1967. (43) Culver, J. C. New demands on colleges in (23) Van Thiel, P. H., and H. Van Houten. Lo- the shaping of change. Speech given at calization of herringworm Anisakis marina, Loras College, Dubuque, Iowa, Oct. 1967. T T THwE T F, G 0. ENVI* RONMENTAL HEALTH

EXPANDING THE CURRICULUM

J. DOUGLAS MCCLUSKIE, D.V.M., M.P.H.*

Unfortunately, veterinary public health adequately trained and equipped to deal has been used synonymously with meat in health matters than the veterinarian, inspection over the years. It is extremely with the possible exception, of course, of difficult to correct this impression, not only the medical physician. Our basic training in the eyes of the public but, even more in microbiology, parasitology, immunology, important, in the minds of our fellow vet- chemistry, and many other sciences is un- erinarians. Such a misconception is pri- surpassed by the education of any other marily the fault of our veterinary colleges, professional entity and is particularly of our several professional organizations, and value in matters dealing with the health of veterinarians themselves. Our colleagues the public. The average veterinarian, how- have been guilty of not looking at the full ever, is not aware of this, as he has had range of health activities and determining little opportunity to compare his training where the veterinarian can fit into the pic- with that of his fellow professionals and ture. It should be one of the major goals usually does not come into close enough of veterinary public health education to contact with an organized public health correct this professionally damaging image. department to become knowledgeable in this Meat inspection services are an important respect. It is therefore the responsibility of consumer protection funetion. However, it the teacher of veterinary public health to is only one part of the over-all public make these facts known. The increased health activity involving the veterinarian. utilization of the governmentally employed Traditionally the veterinarian has been public health veterinarian in the teaching associated only with inspection of the foods program of veterinary colleges would con- of animal origin, whereas he should be tribute significantly to the improvement of concerned with the processing of all foods. this situation. His training gives him an excellent back- In certain health matters the veterinarian ground for dealing with the problems asso- is the only one that has the professional ciated with canned, frozen, cooked, dried, knowledge to answer technical health ques- and other processed foods. We should not tions and should take a definite stand in exclude ourselves from this area of food resolving such problems. He should not protection responsibility. consider himself inadequate and "pass the There is no member of a profession more buck". to a physician or other health professional. If the problem is within the * Director, Environmental Health Service, Den- scope of his health competence, he should ver Department of Health and Hospitals, Denver, Colorado. exert his influence and knowledge in a posi- 62 Environmental Health: Expanding the Curriculum 63

tive manner. I have observed many times ists, including the veterinarian, work in a the reluctance of the practicing veterinarian highly integrated and complex program with to commit himself on a technical question a common objective. of a veterinary public health nature. In planning a course in the environ- Public health departments, be they local, mental aspects of veterinary public health, state, or Federal, are beginning to realize one must first consider the administrative the multiple values of a veterinarian's train- framework of the governmental agencies ing and are more and more utilizing his with which we deal. Veterinary students skills and expertise in a variety of health should be exposed to training in basic programs. In my own case, for example, I governmental administration. Such train- was recently made chairman of the Hospital ing should include public health law, gov- Infections Committee at Denver General ernmental organization, relationship of one Hospital. Being the only veterinarian on level of government to another, and rela- the medical staff of this city hospital pleases tionship of organized health organizations me very much, not only because of the to the governmental body. Today we fre- personal recognition, but because it shows quently see local practicing veterinarians that the medical administration of the hos- appointed to boards of health and other pital recognizes the knowledge, training, and governmental bodies, both at the city and capability of the veterinarian. This assign- state level. Very often they are elected to ment has been particularly challenging and state legislatures, city councils, and boards of considerable professional interest, but the of county commissioners or become mayors assignment of a veterinarian to such a of municipalities. Too often they find responsibility should not be too surprising, themselves lost for the first few months as the microorganisms found in the hospital because of their lack of familiarity with are not unknown to the veterinarian. Fur- governmental organization and adminis- thermore, the equipment and unique en- tration. This can lead to their embar- vironment of the hospital are not totally rassment, frustration, and frequently to unfamiliar to us, particularly if we have dissatisfaction and withdrawal from govern- had any public health training and experimental participation. I realize that the ence. The hospital and institutional en- present-day veterinary curriculum limits vironment should be an area of environ- the amount of time that can be devoted to mental health interest to the veterinarian. such a subject. However, some time should When considering a topic such as en- be spent on this worthwhile topic, which vironmental health and what the veterinary is a part of the over-all program of veteri- student should be taught about such a sub- nary public health. Veterinarians should ject, we should first recognize that most know how laws are developed and enacted. public health problems require a team ap- They should know the basic responsibilities proach. Many health disciplines are a part of boards of health, state legislatures, city of the environmental health team. Health councils, and the like. Furthermore, the professionals-physician, sanitarian, engi- duties and responsibilities of the state health neer, nurse, laboratory technician, and officer and the administrative framework of others, as well as the veterinarian-make the health department should be covered up this health team. A good example of for the veterinary student. This would be environmental health and the team ap- valuable information, even if he were never proach would be our country's space pro- to become intimately involved with govern- gram, where a great many health special- ment. It appears that we have always had 64 The Veterinary Public Health Curriculum a relationship to departments of agriculture with the subj ect. Therefore, in the teaching and have been given some exposure to the of veterinary public health, considerable administrative organization of those agen- emphasis should be placed upon treatment cies. Should not organized public health of water supplies and proper waste disposal, be given equal time? as these two processes are vital to the Webster's dictionary defines environ- health and well-being of all our citizens. ment, as it pertains to biology, as "the In addition, these two environmental con- aggregate of all the external conditions and siderations are extremely important na- influences affecting the life and develop- tionally at this time. Even though veteri- ment of an organism." We can accordingly narians are usually not going to be actively define environmental health as the external involved in water treatment or in waste conditions and forces which affect man's disposal, the principles of such treatment health and well-being. These are tremen- and processing are important. The com- dous and complex factors, as you can well plex water filtration and chlorination treat- unduerstani . V¥ 1eln oriLening new personnel ment principles should be understood by at the Denver Department of Health and the veterinarian and he should be able to Hospitals to the environmental health pro- talk with some authority on this subject gram, I usually illustrate my subject by because of the relationship to disease pre- utilizing a rough sketch of a man with vention and health. For example, most arrows coming at him from all directions. health professionals are aware today that Each arrow is labeled with one type of normal water treatment does not free the environmental influence or force exerted water supply of viruses. The general public upon him: the air he breathes, the water feels, I am sure, that it does. The veteri- he drinks, the food he consumes, his animal narian should also know of the water-borne associates, his occupation, recreation, and diseases of man and animals. Veterinarians, housing or shelter. I then run several ar- particularly those engaged in public health, rows back from the figure of the man, should be able to speak indicating his contaminating influence on with detailed knowledge the environment in areas such as air, indi- on this subject. The problem cating man's pollutional influence on his of cross-connections with relationship to the air supply. The same example applies, of water supply piping system should also be course, to man's waste, both solid and stressed, as veterinarians can and do create liquid, which influences his water supply these problems in veterinary hospitals, and creates other environmental health in laboratories, and in meat processing problems. It is important to visualize man establishments. They should know how to as an organism with various influences act- prevent this dangerous back siphonage ing upon him, and with man influencing problem into potable water supplies. It is his environment in turn. surprising the lack of knowledge that vet- The principles of sewage disposal, includ- erinarians have on this subject of cross- ing the large municipal treatment plant as connections. Many of these cross-connec- well as the small private septic tank sys- tions have been noted in establishments tem and lagoons, should be covered in any inspected by the U.S. Department of Agri- course of public health. Proper and ade- culture. The principles of well construction quate treatment of human and animal waste should also be given attention in our courses is an extremely important matter and all of veterinary public health, as the veteri- veterinarians should have some familiarity narian can serve as a valuable consultant to Environmental Health: Expanding the Curriculum 65 the farmer and his community in the prob- scratch fever. He concluded, therefore, that lems of water supply. the patient's infection was from the leopard The problem of solid waste disposal has and not the gorilla, as first thought. (I become a matter of concern to the entire do not know whether this should be called country. The tons of waste that are created an exotic disease or a disease of an exotic each year is a growing problem with no pet animal.) easy solution. New and better packaging Look at the problem of pet turtles in methods are multiplying the amount and the home and the increasing problem of types of wastes requiring proper disposal. salmonellosis. What closer environmental Veterinarians must know of the health haz- health relationship could we have than this? ards created and should be able to contrib- In many cases man's relationship to his ute to the solution of the problem. When animals is occupational rather than recrea- attending veterinary school, many of us tional or for his own personal enjoyment. had no thought that we would be engaged The danger of brucellosis to the farmer, in any pursuit other than the practice of veterinarian, and packinghouse worker are veterinary medicine after receiving our de- well documented. Here again, man can con- grees. I was one of those persons and I tribute to health problems in his environ- could have used such health information, ment by not providing proper care and at- which I had to gain later through practical tention to his occupational relationship. experience. Another example might be the problems The relationship of man to his animal created by fly production on the farm from associates is a close environmental influence. poor environmental sanitation practices in I am certain that you spend considerable the handling and disposal of organic wastes. time with veterinary students on zoonotic There is a tremendous problem today in and epizootic diseases. Today, because of the disposing of cow manure, as inorganic the ease and speed of modern transporta- chemicals have many advantages as a tion, we must further consider the exotic source of fertilizer over the natural product. diseases of foreign origin, both microbio- The veterinarian should assume the respon- logical and parasitic, which affect man's sibility of advising his client as to proper health. For example, the large numbers of waste disposal methods which do not create monkeys and other animals imported into a hazard to himself and to his family. He this country have contributed to the grow- should be knowledgeable of the life cycle ing zoonotic disease lists. Two weeks ago of the fly and know the methods for con- I attended a hospital infections course at trolling this health threat. He should stress the National Communicable Disease Center the value of good environmental sanitation in Atlanta. One of the speakers, a medical and convince the farmer that fly control doctor whose practice is in Southern Cali- does not rest with the use of insecticides fornia, was called to examine a patient who alone. The veterinary student should also had been injured by a gorilla and subse- be taught mosquito control and the manage- quently developed a fever and enlarged ment of other insect vectors of disease. axillary lymph nodes. Upon further investi- The hazard to animals should not be the gation it was learned that the patient had only consideration in dealing with pesti- been scratched earlier by a leopard and cides used in vector control; information on that, through consultation with a public modern insecticides should be current and health veterinarian, had learned that leop- should include types, application, and spe- ards can carry the disease known as cat- cific uses for distinct problems. Safety 66 The Veterinary Public Health Curriculum

factors involving these agents and their use upon to perform a wide range of health should be stressed. tasks and would be consulted for answers The same consideration should be given to a multitude of environmental health to the subject of rodent control. Today questions. we often forget that rats and other rodents I fully realize that the competition for provide serious problems and are a threat the course time of veterinary students in to man's health. In addition, the rat con- educational subject matter is tremendous. sumes tons of food of both man and ani- Each department head feels his subject area mals each year. This dangerous pest, which to be the most important and in need of lives in close association with man, con- substantial time increase. In any event, taminates our food supply and destroys our additional time should be provided to cover material goods. This problem has become some of the basic principles of environ- so serious in our large urban centers that mental health. Veterinary education should Congress has shown concern and has pro- take into account that the activities of vided funds, through the U.S. Public Health veterinary medicine have an environmental Service, for grants to cities to conduct health influence and that the environment comprehensive rat control programs. Our affects the practice of veterinary medicine veterinary graduates should be knowledge- and the health of our citizens as well as able about this problem and its control- our animal associates. but are they? With the observed population shift lead- Today the veterinary student is exposed ing to greater numbers of our nation's to considerable training in the use of X-ray citizens moving into the urban areas of our and other gamma radiation sources. He country, environment plays an increased should and does, I assume, receive training role in the health of man. The veterinarian in radiation safety and radiological health. is also becoming more prominent in the In numerous states and in the U.S. Public urban scene than was the case 15 or 25 Health Service, veterinarians have been years ago. The employed as radiological health officers after practicing veterinarian will be confronted supplemental training. The effects of radia- with an increasing number tion are a very important environmental of questions pertaining to diseases of ani- health consideration, and the veterinarian mals and their relationship to the health can play an important role in this field. of their owners and the public. With this Our teachers of veterinary public health more congested living situation, the veteri- should provide some additional background narian must assume his proper place in the in this subject area. urban scene. Although the subject of civil defense is In summary, teachers of veterinary pub- commonly an unpopular one, the possible lic health must assume the important re- civil defense participation of the veteri- sponsibility of making known to their narian as it relates to environmental health students the numerous problems of the en- problems should be provided. for. This vironment as it affects the health of man. could be done in a highly palatable manner After all, man too is an animal and should by interjecting these topics while covering not be excluded from our consideration just waste disposal, water supplies, food pro- because he is of a higher order. No other tection, radiation hazards, and other health area of the veterinary curriculum can pro- problems of the environment. At a time vide this important health training. En- of disaster the veterinarian might be called vironmental health encompasses a broad Environmental Health: Expanding the Curriculum 67 range of complex problems, the list of nary public health divisions, to make these which grows longer each day. The veteri- problems known to the student and to de- narian cannot escape participation in the fine his part in the over-all picture. Let us development of solutions to these problems. make the veterinarian and the public aware It is therefore the responsibility of colleges of our professional credentials and broaden of veterinary medicine, through the veteri- our participation on the public health team. THE TEACHING OF VETERINARY COMMUNIT-Y MEDICINE

CHANGES IN EMPHASIS AND METHODS

HENRY M. PARRISH, M.D., DR.P.H.*

AND

DONALD C. BLENDEN, D.V.M., M.S.t

Change is inevitable in society. Profes- providing those students with the training sions supported by society must change to they need to funetion effectively and meet social needs. The past 50 to 100 years efficiently? have been characterized by accelerated There are innumerable similarities be- changes in scientific knowledge, in the num- tween human medicine and animal medi- ber and distribution of people and their cine. Likewise the aims and methods of aspirations for better health, in the func- teaching students in these two health pro- tions of health practitioners, and in educa- fessions are similar. During the past 10 tional aims and pedagogies. Lane (1) has years there has been tremendous improve- stated that "a profession, to remain viable, ment in and expansion of the teaching of must serve the society in which it lives and preventive medicine and public health in breathes." Anderson (2) believes that vet- American medical schools. Almost all new erinary medicine "must respond to change medical schools are planning large depart- by acquiring new knowledge and by adapt- ments of community medicine. The Shep- ing our services to the needs of the times if ard-Roney report (4) describes the status we are to be useful and productive, not only of the teaching of preventive medicine in as citizens but professionally." According schools of medicine prior to these recent to Burney (3), "the university is an instru- developments. Historically, preventive ment of society, an instrument for social medicine was characterized by few separate change." One must keep in mind that the departments, inadequate numbers of poorly students being trained today must function trained staff members, lack of budgetary in society 10 to 25 years from now. Are we support, and unimaginative teaching programs. Coker and associates (5), in a study * Professor of Community Health and Medical of medical students' attitudes, showed that Practice, School of Medicine, and Associate Pro- fessor of Veterinary Microbiology (Public Health), public health ranked low as a career choice. School of Veterinary Medicine, University of Mis- of the teaching experiences souri, Columbia, Missouri. Knowledge t Associate Professor of Veterinary Microbiology and innovations in medical schools may and Chief of the Section on Veterinary Public Health, School of Veterinary Medicine, and Asso- prove useful to those teaching communitY ciate Professor of Community Health and Medical medicine (public health) in schools of vet- Practice, School of Medicine, University of Mis- souri, Columbia, Missouri. erinary medicine. Therefore, the purposes 68 Changes in Veterinary Community Medicine 69 of this paper are: (1) to review some of the protection. This legislation includes the important changes in society, medical sci- regional medical programs (Heart, Cancer, ences, and medical education; (2) to indi- and Stroke), Medicare, Medicaid, the Com- cate why more emphasis should be placed prehensive Health Planning Act, and the on community medicine in schools of veteri- Allied Health Professions Act. Government nary medicine; and (3) to suggest some is becoming more interested in safer food methods that may prove useful in teaching and drugs, environmental health, and ani- veterinary community medicine. mal health. This trend in health legislation is likely to continue. The health industry now ranks as the third largest industry in Changes in Society the country and employs between 3 and 4 million people (7). Perhaps the most dramatic change in Increases in population and new health society in the past 100 years has been the programs have resulted in a decline in the population explosion. Steele (6) in 1963 number of veterinarians, physicians, and pointed out that the world population is dentists per 1,000 population. In addition, estimated at 3 billion people and that this there is poor distribution and inappropriate figure probably will double by the end of the use of available health personnel. How is century. Moreover, better than one-half of veterinary medicine helping to meet this the world's population subsists on a sub- problem? According to Health Resources standard diet. Add to this the aspirations Statistics (8), 22.4 per cent of all veteri- of developing nations and we face a critical narians in this country are employed in public health and socioeconomic problem, veterinary public health and regulatory to which birth control is only a partial an- animal medicine. Because of inaccuracies in swer. The veterinary profession and agri- reporting there is reason to believe that be- culture are faced with the immediate prob- tween 25 and 30 per cent of veterinarians lem of increasing livestock and food produc- are employed by agencies directly or in- tion. Widespread animal diseases limit food directly related to public health. Veteri- production in many countries. Obviously, narians are performing jobs today that were veterinary practitioners will never conquer not even envisaged 50 years ago. These these diseases by treating individual sick range from air pollution control and inter- animals. A public health approach is needed national health to medical care administra- in animal populations to prevent diseases tion and the Air Force's new civic action before they occur. In the United States the population is increasing rapidly and moving programs in various countries (9). from rural to urban areas. The number of Looking at the other side of the coin- people operating small farms is rapidly what do practicing veterinarians do? decreasing. Large farms and stock opera- Strangely enough, no one really knows. tions are the emerging pattern. These trends There have been no detailed time studies of emphasize the need for veterinarians trained veterinary practice, either small-animal or in herd medicine (public health) and inter- large-animal practice. For human medicine, national health. a recent time study of 25 rural general prac- During the past 10 years there has been titioners' office hours (10) showed that the increased social legislation in the United physician's time was apportioned as States to improve health care and health follows: 70 The Veterinary Public Health Curriculum

Per cent drugs used to fill prescriptions today had not Personal activities 8.6 been discovered 100 years ago. Superficial Preventive medicine 10.9 diagnoses and symptomatic treatment of Administration 16.3 Health information and counseling 17.2 animrnals and tender loving care to clients Treatment 20 are no longer acceptable in modern practice. Diagnosis 27 Today many diseases can be prevented or A surprising finding was that less than 50 controlled. Where these measures fail, po- per cent of the physician's time was spent tent methods of cure are available through on diagnosis and treatment. Most likely the use of drugs and surgery. Professional similar findings apply to the everyday prac- school is but a brief interlude in the con- tice of veterinary medicine. There may be tinuing education of a veterinarian. Are a great disparity between what veterinary we motivating and preparing our students medical educators and students think vet- for a lifetime of learning? erinarians do and what they actually do! The United States citizens have indicated through their Congressmen that they are willing to support health-related research Changes in Science on a large scale. This is reflected by the proliferation and growth of the National What are some of the changes in scientific Institutes of Health. Universities have knowledge and technology that should be entered into partnership with government taken into account when planning the train- to produce this research. This has affected ing of future veterinarians? There has been schools of veterinary medicine in several an explosion of scientific information since ways: (1) a sizable number of faculty mem- 1900. The number of outstanding scientists bers are being supported by grant funds; currently living exceeds the total number (2) more emphasis is being given to research of such individuals throughout history up by the faculty and administration; and (3) to the present time. The number of scien- more students are becoming interested in tific papers published has increased in a research careers. Laboratory animal medi- geometric fashion. Yet reviews of these cine has evolved as a specialty, owing in publications in human medicine journals part to increased demands for animals for indicate that many of them are not based medical research. Veterinary public health on sound experimental and statistical meth- is firmly established as a specialty. Com- ods (11, 12). Similar findings probably are parative medicine has finally come of age. true for veterinary medicine journals. Stu- Multidisciplinary research is past the talk- dents must have enough knowledge of bio- ing stage. statistics to be able to evaluate the articles appearing in their professional journals. Otherwise, true scientific discoveries may Changes in Medical Education never be translated into effective veterinary medical practice in local communities. Com- A university and its professional schools puters have opened new vistas for research, must meet the needs of society. They can- medical diagnosis, and the handling of not operate effectively in an academic masses of scientific data. Pharmacology vacuum. They must extend their influence and therapeutics have emerged from the beyond their granite walls into the com- realm of empiricism to rather exact bio- munity. They must anticipate the needs of logical sciences. Over 75 per cent of the society and prepare their students to meet Changes in Veterinary Community Medicine 71 these needs. Curricula and courses should members, a secretary, and a laboratory be reviewed and revised periodically if they technician. are to stay in the mainstream of social and What categories of professionals might be scientific progress. found in a department of veterinary com- Some recent changes in the organization munity medicine? A veterinary epidemiolo- and educational aims of schools of medicine gist, a veterinarian specializing in regula- are pertinent to improving the teaching of tory animal medicine, a veterinarian with community medicine (public health) in experience in veterinary public health prac- schools of veterinary medicine. These are: tice, a biostatistician, an environmental Creating separate departments of community health specialist, and a comparative medi- medicine. cine specialist-all might prove useful, de- Financing departments of community medi- pending on the teaching objectives of a cine on the same basis as other preclinical de- particular department. Most members of a partments. department of veterinary community medi- Providing adequate time in the curriculum for teaching community medicine. cine should have graduate training in public Introducing subjects such as behavioral scien- health leading to an M.P.H. or M.S.P.H. de- ces, biostatistics, epidemiology, medical care gree in addition to their basic professional organization, and clinical preventive medicine training. It is highly desirable that the into the curriculum. veterinarians on the staff be certified by the Establishing preceptorships with medical practitioners and/or preceptorships in com- American Board of Veterinary Public munity medicine which all students are required Health or be working toward this goal. to take. Adequate office and laboratory space should Providing more free time in the curriculum be provided for the professional and non- for electives of the student's choice. professional staffs and for resident physi- Moreover, schools of medicine have be- cians and/or graduate students. come more and more active in the health Schools of veterinary medicine have not affairs of the communities which surround used the "clinical faculty appointment" as them. Examples of this are the Regional extensively as schools of medicine. For Medical Programs (Heart, Cancer, and example, public health veterinarians in local Stroke), Operation Headstart, and the com- or state health departments might be given munity health centers financed by the clinical appointments in the department of Poverty Program. veterinary community medicine. This academic appointment usually carries no salary Departmental Status commitment from the school. Another useful administrative procedure that we have Schools of medicine have recognized for used at the University of Missouri is the some time that community medicine cannot "joint faculty appointment." Selected mem- function successfully as the poor stepchild bers of the Department of Community of a department of microbiology or a de- Medicine in the School of Medicine are partment of medicine. Thus, separate de- given joint appointments in the section on partments of community medicine were veterinary public health in the School of established. Owing to the broad, multidis- Veterinary Medicine. The reverse is also ciplinary nature of community medicine, true. In most instances the school of the one-man departments are grossly inade- primary appointment pays the faculty quate. A school should provide basic member's total salary. In other cases the support for at least three full-time staff faculty member's salary is shared by both 72 The Veterinary Public Health Curriculum schools. The joint appointment might be riculum. At least 20 contact hours are used even if both professional schools of a needed to introduce basic statistical con- university are not located on the same cepts. The object of the course is not to campus. Similar joint appointments could make a statistician out of the student but be used with schools of public health and to impress on him that measurement is schools of engineering. In our experience essential in basic and clinical veterinary doctors of medicine are very willing to teach sciences. in schools of veterinary medicine. 2. Epidemiology. This course should occur during the second year of the curriculum. It is a basic science of community Teaching Program medicine and should be taught at the same time other basic sciences are taught. Thirty What subjects should be taught by a de- contact hours are needed for adequate cov- partment of veterinary community medi- erage of this subject. cine, either within the department or in 3. Meat and food hygiene. This course cooperation with other departments? There may be taught during the third year of the are certain subjects that are basic to com- curriculum. At this time the student has munity medicine and that would be appli- completed his basic microbiology and path- cable to both schools of veterinary medicine ology courses. Some environmental sanita- and schools of human medicine. Several tion can be taught in this course which authorities (13-17) agree that the following should consist of both lectures, practical subjects are appropriate: biostatistics, epi- demonstrations, and field trips. This sub- demiology, medical (veterinary) care or- ject might be taught jointly by the depart- ganization and administration, and clinical ment of veterinary community medicine preventive medicine or clinical public and pathology. About 40 to 50 hours are health. Meat and food hygiene and certain needed to present this material. aspects of environmental sanitation should 4. Regulatory animal medicine. This sub- be added to this list for veterinary schools. ject would be taught during the third or Zoonoses and comparative medicine could fourth year of the curriculum in a clinical be taught within the framework of epide- setting. The department of veterinary com- miology. We believe that some aspect of munity medicine could cooperate with the veterinary community medicine should be department of large animal medicine in offered during all four years of the curricu- teaching this subject. lum. It is unrealistic to believe that a 5. Veterinary community medicine. This single lecture series presented to fourth-year course is taught during the third year of veterinary students will ever meet their the curriculum and emphasizes the role of needs in community medicine. In our ex- the veterinarian in the community and the perience the sooner community medicine organization of community health services. can be introduced to a student the more Thirty hours are required for this course. likely he is to become interested in this 6. Electives and free time. These assign- subj ect. ments are for students especially interested A suggestion of courses to be taught and in veterinary community medicine. They the time they might be presented in the are designed to get the student outside the curriculum follows: four walls of the veterinary school and into 1. Biostatistics. This course should be the community. The elective should be at introduced during the first year of the cur- least four weeks in duration. It may be Changes in Veterinary Community Medicine 73 - taken during the summer months or during Health Service Act and what they could free-time or elective blocks in the curricu- provide schools of veterinary medicine were lum. Helwig (18) has pioneered in train- recently reviewed by Parrish and asso- ing veterinary students in health depart- ciates (20). ments, in abattoirs, in regulatory agencies, Departments of veterinary community and with state-institution-owned herds and medicine should organize residency training flocks. Other types of electives include programs which would qualify graduate community health surveys, epidemiological veterinarians for certification by the Ameri- research, and preceptorships with practi- can Board of Veterinary Public Health. An tioners. Elective assignments in developing experimental two-year residency program in nations is a very effective way to teach the veterinary public health recently was international aspects of community medi- started at the University of Missouri (21). cine. Community medicine should be taught One year is for formal training leading to a in the community as well as in the class- Master of Science in Public Health degree. room (16,17). This training may be taken at a school of public health or another institution providing comparable training. One year of addi- Other Activities tional training is taken in a department of veterinary community medicine in a school The Third National Conference on Public of veterinary medicine. This training in- Health Training (19) recommended to the cludes research, teaching, and field experi- Surgeon General that training grant funds ence in an agency which practices some provided by Sections 306 and 309 of the aspect of veterinary public health. The Public Health Service Act be extended to physical presence of residents and graduate schools other than schools of medicine, students in veterinary community medicine osteopathy, engineering, and public health. is a powerful stimulus to interest under- If this recommendation is approved by Con- graduate veterinary students in this spe- gress, schools of veterinary medicine will ciality. become eligible for training grants to Research and participation in continuing strengthen the teaching of public health. education are two other functions of a The project, apprenticeship, and residency department of veterinary community medi- training grants covered by the Public cine.

REFERENCES

(1) Lane, J. D. Meat hygiene in the veterinary (3) Burney, L. E. The university and community curriculum. Seminar on the Teaching of health services. Amer J Public Health 56: Preventive Medicine and Public Health in 394, 1966. Schools of Veterinary Medicine. Scientific (4) Shepard, W. P., and J. G. Roney, Jr. The Publication No. 96. Washington, Pan teaching of preventive medicine in the American Health Organization, 1964, p. 50. United States. Milbank Mem Fund Quart (2) Anderson, R. K. Public health teaching as 42(2) :1, 1964. related to needs of government agencies. (5) Coker, R. E., K. W. Black, T. G. Donnelly, First Seminar on the Teaching of Public N. Miller, and B. S. Phillips. Public health Health and Preventive Medicine in Schools as viewed by the medical student. Amer J of Veterinary Medicine in the Americas, Public Health 49:601,1959. sponsored by the Pan American Health (6) Steele, J. H. Role of the veterinarian in the Organization, Kansas City, Mo., 1959. socioeconomic nutritional welfare of the 74 The Veterinary Public Health Curriculum ______

community. Seminar on the Teaching of (15) Acheson, R. M. The role of the department Preventive Medicine and Public Health in of social medicine in undergraduate medi- Schools of Veterinary Medicine. Scientific cal education. J Med Educ 38:676, 1963. Publication No. 96. Washington, Pan (16) Deuschle, K., and H. Fulmer. Community American Health Organization, 1964, p. 20. medicine-A "new" department at the Uni- (7) Darley, W., and A. R. Somers. Medicine, versity of Kentucky College of Medicine. money and manpower-The challenge to J Med Educ 37:434,1962. professional education. III. Increasing per- (17) Parrish, IH. M. Teaching medical students sonnel New Eng J Med 276:1414, 1967. their responsibility to society. World Med (8) Health Resources Statistics: Health Man- J 14:25, 1967. power, 1965. Public Health Service Publi- (18) Helwig, J. HI. The teaching of public health cation No. 1509. Washington, Government in our schools of veterinary medicine. Semi- Printing Office, 1965, p. 157. nar on the Teaching of Preventive Medi- (9) Williams, J. T., and T. P. Griffin. Military cine and Public Health in Schools of Vet- veterinarians in civic action programs. J erinary Medicine. Scientific Publication Amer Vet Med Ass 151:1751, 1967. No. 96. Washington, Pan American Health (10) Parrish, H. M., F. M. Bishop, and A. S. Baker, Organization, 1964, p. 79. Time study of general practitioners' office (19) Third National Conference on Public Health hours. Arch Environ Health (Chicago) 14: Training: Report to the Surgeon General. 892, 1967. Publid calth Sc'v-ice Publication NTo 1728. Washington, Government (11) Ross, O. B., Jr. Printing Use of controls in medical Office, 1967. research. JAMA 145:72, 1951. (20) Parrish, 1H. M., D. C. Blenden, and F. Szata- (12) Schor, S., and I. Karten. Statistical evalua- lowicz. Need to strengthen public health tion of medical journal manuscripts. JAMA training in schools of veterinary medicine. 195:1123, 1966. J Amer Vet Ass 151:1757, 1967. (13) Terris, M. Social medicine as an academic (21) Blenden, D. C., E. R. Price, and IH. M. discipline. J Med Educ 33:565, 1958. Parrish. Experimental residency program (14) Morris, J. N. Social medicine. J Med Educ in veterinary public health. Public Health 34:1159, 1959. Rep 82:545, 1967. THE TEACHING OF VETERINARY COMMUNITY MEDICINE

ARE OUR VETERINARY SCHOOLS EQUAL TO THE TASK? *

CALVIN W. SCHWABE, D.V.M.t

In a penetrating little book entitled Sci- of our professional education, which shapes ence and Human Values, Jacob Bronow- our future outlook and either restricts or ski (1) espoused the view that a real under- enhances our vision as veterinarians. I am standing of any science "disputes the petty convinced personally that our schools of view which many scientists take of their veterinary medicine do not today assume own work." As a veterinarian, I have the leadership role in this regard which thought a great deal about this statement. society has every right to expect of them. For a long time I have wondered whether This is the utmost importance to us all. we veterinarians fully understand our work. For example, are our schools truly serv- Do we as a group clearly see our profes- ing our profession as its germinal center? sion's role in society at this critical juncture Are they opening up new horizons and new in man's history? Or do many of us- vistas of service for each new class of perhaps even most of us-tend to take the graduates? At the same time are they "petty view" of our responsibilities and constantly re-examining, redefining, and re- our obligations as a profession? vitalizing our old and established relation- If, as I believe, we are not completely ships? Are our schools truly innovative and certain of our role, then should we not visionary in their approach, or are our begin to engage in somrne frank introspection? faculties content more often than not to Should we not begin to query ourselves bask in the deceptively secure warmth of about those influences which determine our an unbecoming professional smugness and horizons-the limits of our outlook-and uneritical self-conceit? our purposefulness as members of a learned To be sure, we do ocecasionally ask our- profession? It seems clear that the problem selves whether our veterinary schools are of horizons in veterinary medicine lies fulfilling well the more traditional of their chiefly in our schools. More than any other responsibilities to private practice? But how factor, I believe that it is the influence of frequently do we inquire beyond this as to our schools upon each of us, i.e., the impact their alertness in identifying and respond- ing to new and potentially exciting pro- * Originally presented as the Annual Phi Zeta Lecture at Michigan State University, 19 July fessional responsibilities? We might ask 1967; adapted from the Michigan State University ourselves, do our veterinary schools often Veterinarian, Fall 1968, pp. 9-15. t Professor and Head of Department of Epi- reflect a conservatism in this respect and an demiology and Preventive Medicine, School of introversion which is uninspiring at best Veterinary Medicine, University of California Davis, California. and certainly unbecoming to a learned and 75 76 The Veterinary Public Health Curriculum

dynamic profession? In short, the question search uses of new species, breeds, or strains is simply this: Are our veterinary schools of laboratory animals? We did none of really equal to their task? Are they provid- these things! Where, for example, were our ing us with the leadership which we must veterinary schooi centers for germ-free and have if we as a profession are to render our specific pathogen-free animal research at full measure of service to society? the time when veterinarians in other insti- In all honesty I do not personally believe tutions were pioneering in this field? that they are. I say this as no prognostica- Is the record of our schools really any tor of doom (far from it) but as one who is better in public health, in wildlife diseases, convinced that our schools can and must in primate biology and medicine, in experi- become what society and enlightened vet- mental surgery, in food science, in animal erinarians everywhere have the right to reproduction, in nutrition, in fish diseases, expect them to be-and they must become in diseases of invertebrates, or in experi- this soon. But to bring this about will re- mental aspects of the behavioral sciences? quire nothing short of a revolution in vet- These are just a few important facets of the erinary education, a revolution certainly no field in which veterinarians are working less dramatic than that earlier one which today and in which they individually or forced the closing of the veterinary diploma collectively have made their mark. Why is mills and private profit schools in this coun- it that leadership in each of these new direc- try. tions in veterinary service has come not We in veterinary education are guilty- from our veterinary schools but from veteri- guilty not only of failing to lead our pro- narians and others situated in other types of fession today but, in many respects, of institutions? Have we in the schools even failing even to keep pace with our profes- attempted to solve the acute yet long-stand- sion. At times we do little better than ing problems associated with the perform- "follow the crowd" and even then we some- ance of such routine veterinary tasks as times do that ever so reluctantly. meat inspection, artificial insemination, and As an example, let us consider just for a mass testing, perhaps by setting up courses moment our uninspiring record with respect or qualifying standards for veterinary tech- to laboratory animal medicine. Did the nicians on our own campuses? veterinary schools take the lead in identify- If our schools are failing us professionally ing laboratory animal medicine as a vet- in providing leadership in these and many erinary specialty, or, once this need was other areas, are we not forced to ask the demonstrated to us by others, did we pio- question as to what role our schools do neer in establishing programs of graduate envision for themselves? I believe that the study which would enable veterinarians to role which they recognize is very much more effectively assume positions of respon- a role which conceives of veterinary medi- sibility in this area? Did we even take the cine almost exclusively in terms of its pri- lead in developing this increasingly im- vate practice and increasingly, I am afraid, portant sphere of veterinary service by of its more lucrative luxury practice. But creating within our own schools model is the private practice of veterinary medi- physical facilities or standards of care for cine really the sum total of veterinary laboratory animals? Did we develop re- medicine? Is this the only, or even the most search programs or research institutes whose important, outlet for veterinary service? Of aim was to identify, breed, domesticate, and course not. Then why do our schools give define the characteristics and particular re- every indication that they assume that it is? Are Our Schools Equal to the Task? 77

It is certainly self-evident to many of us physician and the veterinarian, respec- in and out of the profession that veterinary tively, who bear the major obligation in medicine represents, and historically has these areas. Are we assuming our broad always represented, three overlapping responsibilities as biological scientists? spheres of activity and service-agricul- The tasks and the opportunities in vet- ture, public health, and the general bio- erinary medicine are, in fact, crystal clear. logical sciences. This is our real source of Why then are not the obligations and the professional strength and of our utility to responsibilities of our schools equally clear? society. I do not for a moment believe that there is Our profession, unlike most others, de- a simple panacea to this dilemma which our rives its sustenance not from a single root veterinary schools now face, nor do I be- but from deep roots in each of these three lieve that there is any single solution. We equally important areas. Herein lies our can, however, begin here to consider some unique usefulness as a profession. It strikes of the things which we can do about our me as absolute folly therefore to think, situation. as some of us do, that we must deny one or What I believe is needed above all is for another of these parental roots in order to us to open up more effective channels of personally identify with or to strengthen communication within our profession so our ties to the second or the third. It ill that we as veterinarians may begin to share becomes us and demeans us to do this. It more effectively with each other our shows that we do not really understand our thoughts with respect to veterinary educa- own work. tion and types of veterinary service. Some All the administrative maneuvering and of our sister professions are doing this far petty rationalization in the world cannot better than we are. For instance, the World alter our profession's overriding responsi- Health Organization has published a 391- bility to agriculture-for helping in a very page annotated bibliography of the litera- significant way to ensure that mankind has ture on medical education (2). Its 2,600 an adequate supply of food. Verbal skull- entries represent the literature on medical duggery will not alter by one iota our role as education for only one 10-year period! a health profession, the character of our Each year the Association of American bonds to our sister health professions, our Medical Colleges through its Journal of direct responsibilities to public health, or our Medical Education and through the pro- even more important role in basic biomedi- ceedings of countless conferences and semi- cal research. An individual obsession with nars adds impressively to this literature. any of these admittedly important aspects As a result of these attempts to communi- of veterinary service, agriculture, or public cate, many medical school faculties today health, should never obscure for a moment are in the throes of self-criticism, experi- the fact that veterinary medicine is synony- ment, and drastic reorientation. Are we? mous with pathological zoology. Veterinary Why is there so little literature on vet- medicine is the field of study specifically erinary education? Our profession certainly concerned with problems of disease in all does not lack ideas, nor do we lack potential lower animals. While representatives of sponsors for conferences or seminars on many different disciplines and professions veterinary education. It seems that we contribute directly or indirectly to the solu- members of veterinary faculties communi- tion of the disease problems of man and the cate our original thoughts far more effec- disease problems of lower animals, it is the tively to our students than we do to each 78 The Veterinary Public Health Curriculum other. It is ironic, but I am sure at the years is a virtually unheard-of-commodity. same time most fortunate, that each new Do we intend that the pet hospital is to crop of veterinary graduates finds itself be the ultimate product of our professional very much in the vanguard of ,suchnew life in America--and that it is to be the ideas as we individually generate. In our principal reason our schools exist? If so, contacts with them they receive and accept then we are certainly shortchanging the from us individually our own half-formed public as well as ourselves. hopes and aspirations for the profession and Let us examine a few of our profession's our most "far-out" thoughts. To the new needs, such as the need, for example, to graduate who hears them and accepts them, provide governmental services. The fact is as our colleagues seldom have the oppor- that 25 years ago the U.S. Public Health tunity to do, these points on the veterinary Service was as unattractive to young phy- horizon at which we teachers have so labori- sicians and as uncompetitive for their ca- ously arrived serve our students as their reers as the U.S. Department of Agricul- immediate points of departure. In truth ture's veterinary divisions are to most they collectively begin at a point at which young veterinary graduates today. Yet to- we collectively have yet to arrive. day the Public Health Service offers a In a recent graduating class at the Uni- great variety of attractive and exciting versity of California, for instance, there career opportunities not only to physicians were at least 15 students who were deeply but to veterinarians and others-in the Na- concerned about (and, from a career stand- tional Institutes of Health, the National point, seriously interested in) working Communicable Disease Center, and many abroad in an underdeveloped country in other branches of the agency. order to help face the critical problems of Topnotch scientists are found in these food production and livestock disease con- organizations today. Their work is interest- trol. Four or five of them were as keenly ing and the positions they occupy are at- interested in veterinary aspects of marine tractively competitive. Bright young stu- biology; several others were interested in dents and graduates are being exposed to disease of terrestrial wildlife. Having in- opportunities in the Public Health Service dividually aroused their interests and con- through two-year appointments in the vinced some of them of the needs and the NCDC's Epidemic Intelligence Service or opportunities, have we collectively provided through such imaginative devices as new graduate programs and the like which COSTEP-the Public Health Service's are required to channel students along the career development summer training pro- road to these careers of service? gram for professional students. It has not As we carry out our existing programs of always been that way. We in veterinary education, I wonder whether we who run medicine should not forget for one moment the schools understand at all that the pri- that outstanding veterinary scientists in the vate practice of veterinary medicine is a early decades of the U.S. Bureau of Animal luxury most countries have never experi- Industry were making medical history in enced-that almost the entire veterinary the United States at a time when the NIH complement elsewhere in the world is en- and the NCDC were not even dreamed of! gaged either in research, in governmental The accomplishments in fundamental re- service, or in academic life. Even in Western search of the young Bureau of Animal In- Europe the pet hospital as we have come dustry, more than those of any other U.S. to experience it in this country in recent institution, first attracted world attention to Are Our Schools Equal to the Task? 79

American medicine. The pioneering efforts ernmental research and disease control ca- of Daniel Elmer Salmon and his colleagues reers constitute an extremely important in microbiology, immunology, parasitology, avenue of veterinary service and one for food hygiene, and disease control and era- which we must prepare our students. dication constitute one of the brightest What can we do? First of all I believe chapters of our profession's history. that our students must, from the very onset The greatest share of the blame for the of their training, be better oriented to fact that the governmental veterinary ser- veterinary medicine's over-all role in hu- vices today do not compete, as they once man society and properly alerted to the did, for the careers of our brightest gradu- great variety of career opportunities open ates lies with our schools. If these govern- to them. They must be exposed much more mental organizations have tended to become to the history of veterinary medicine than dull or unexciting it is because we in the they are now so that they will have the veterinary schools have failed in our re- cultural background upon which to truly sponsibilities to society. Today's generation become not only "citizens in their profes- of veterinary students, like all university sion" but citizens in the world. This is not students in America, is up to its ears in a frill; it is absolutely basic. deeply felt concerns for society and for our To me it is utterly fantastic that in a day fellowmen. Is it necessary that they shame when many American medical schools sup- us into action? port departments of medical history there They come into my office-and I am is not, to my knowledge, a single chair in sure into your office-every day asking us veterinary history on an American veteri- how they are going to bring their veterinary nary faculty. Is this not a disgrace? Is not training to bear upon human needs, how such an appointment really more important, they are going to really do something for example than an eighth or ninth mem- worthwhile. They do not necessarily have ber of an already quite adequate physiology to go to Africa or Asia to do these things department? Are we proud of the fact that as so many of them believe. They can do we veterinarians probably know less of the them right here in the United States, and accomplishments of our profession-of its perhaps more effectively, by helping to very sizable accomplishments-than the revitalize the governmental veterinary ser- members of any other professional group vices. of which I am aware? The problems and the challenges are at We must completely overturn the falla- our very doorstep. What activities are in- cious and almost uniquely American notion herently more exciting or more worthwhile that the teaching of clinical veterinary than efforts to combat and eradicate dis- skills should be directed solely to the de- eases, to lift these tremendous burdens from mands of private veterinary practice and society, and, in a concrete way, to contrib- increasingly, I am afraid, to the limited ute to a solution of the overwhelming food demands of a luxury type of pet practice. shortage and disease problems which face To do this the schools must in every way the people of the world today? In other possible strengthen the natural herd basis words, the U.S. governmental veterinary of clinical veterinary medicine by engaging services in agriculture must become again more actively in such things as feedlot prac- the pioneering organizations they once were, tice, contractual herd health plans, and and for this to come about we in the veteri- poultry practice, rather than in concentrat- nary schools must accept the fact that gov- ing more and more-and to the exclusion so The Veterinary Public Health Curriculum of all else-upon the intensive treatment been concerned about diseases of fish at of the valuable individual sick animal least from the time of the compilation of within the unnatural confines of a veteri- the Egyptian veterinary papyrus of Kahun nary hospital. some 4,000 years ago! Ours is herd medicine. Our goals as a Many veterinary schools in Europe, in profession are not a carbon copy of those Japan, and elsewhere have had departments of human medicine and they never will be. or organized research units concerned with We should completely integrate a portion the diseases and pathology of fish and other of each of our school's clinical staff into the marine forms practically from the begin- cooperative Federal-state livestock disease ning, and they have had the same for dis- control activities of our area. We should eases of economically important insects. Is work with the U.S. Department of Agricul- this not precedent enough? Yet is there a ture and our state veterinary authorities to single elective course in either of these im- set up model disease control districts in portant fields in an American veterinary which basic and operational research can school? If so, I am not aware of it. Does be carried out as part of these activities, any American veterinary schooi other than where new disease reporting and epidemio- that at Guelph, Ontario, in Canada even logical surveillance techniques can be tried support a regular staff position in either of out, where the requisites for exciting and these fields? We know that there are sev- attractive careers can be established, and eral academic departments of invertebrate where our students can be exposed to a pathology already in existence in the United type of veterinary practice which has a States-but not in veterinary schools-and more lasting and meaningful impact upon we know that practically every marine bio- pressing problems of our society. logical or fisheries research institute in this We can speed up the process of upgrad- country is engaged in disease-related studies ing the governmental veterinary services by of one kind or another. setting up imaginative graduate programs Why are we not doing something to de- in preventive veterinary medicine for those sign graduate programs for veterinarians promising yuung veterinarians who are al- who wish to enter veterinary specialties ready serving in these agencies, as well as such as these? Why are we not working out for those whom we will help attract to these cooperative research and teaching arrange- positions in the future. It is not that re- ments with the departments of marine biol- sponsible veterinarians in government have ogy, entomology, and zoology in our univer- not been asking for our interest and our sities and creating positions on our faculties assistance for many years, for they have. for veterinarians who become trained in It is rather a question of when are we these fields? Who else should more logically going to begin to respond? do research or offer courses on diseases of Turning to another, and perhaps equally wild vertebrate and invertebrate animals or important, problem area, that of the veteri- on their important roles in the epidemiology nary role in the general biological sciences, of diseases of man and domestic animals? provides us an opportunity to consider for Such courses would not only serve as elec- a moment the rigidity of most of our ex- tives for our own students but could also isting academic programs and some of the meet the special needs of graduate students ways in which we might begin perhaps to in the other branches of zoology. We say make them more flexible. Most of us are that veterinary medicine is comparative aware, for example, that veterinarians have medicine. We say it often, and there is Are Our Schools Equal to the Task? 81 good historical evidence for our claim, but These then are a few of the serious questions so long as the veterinary schools in this with which we in academic veterinary medi- country fail to see their real responsibilities cine must, in all urgency, begin to more as extending beyond concern for a few actively concern ourselves. important domestic animal species, how true In concluding I would say that it has really can our claim be? Until at least some certainly not been my intent to detract in attention to disease and disease-related the slightest from private veterinary prac- problems in the whole spectrum of the ani- tice as an established and valuable type mal kingdom is evident on our veterinary of veterinary service nor to imply that our campuses, the full benefits of our profes- schools are not now meeting the require- sion's traditionally comparative approach to ments of our future private practitioners of disease will not be realized. veterinary medicine quite effectively, for We must not let the limited demands of they are. What I would leave you with, its private practice obscure the fact that however, is the thought that, if the veteri- veterinary medicine is a broad academic is to serve mankind as it discipline in its own right and that our nary profession schools, at least through a wide variety of can and as I think it must, then we in the elective professional courses, specialized schools of veterinary medicine must grasp graduate training programs, and research the reins of leadership and begin to guide activities, have the responsibility to de- our unique veterinary team not only down velop and communicate the knowledge and this well-trod pathway of private practice skills which are required if veterinarians but simultaneously down the three principal and others are really to raise the veil of avenues of veterinary service to mankind- ignorance in these areas and to help com- agriculture, public health, and general biol- parative medicine become something other ogy. To do anything less than this, I be- than the undifferentiated monster it now is. lieve, is to fail in our task.

REFERENCES

(1) Bronowski, J. Science and Human Values, rev. (2) World Health Organization. Medical Educa- ed. New York, Harper & Row, 1965. tion: Annotated Bibliography, 1946-1955. Geneva, 1958. ' THE TlnAHITTNTLA ,O,I' . TTT"!T Or^I'r '~T1rl?)TTVETETRNARY A COXMU.CTMMTu f'fiJ.'JTT'L.TY'r,17'J lTTYi MEDlCITNE

AN APPLIED PROGRAM

JOHN H. HELWIG, D.V.M.*

The teaching of community medicine of the municipality. This latter point is should be incorporated in the over-all public important and should not be overlooked. health training of veterinary students. An If we exercise care in selecting problems early understanding and introduction of when cooperating with local communities in students to community health problems a teaching program, there is much to be will better orient and prepare them to ap- gained by both students and the commun- preciate the team effort in applied preven- ity. Restricting the problems also ensures tive medicine. The teaching result is more continued cooperation and confidence on the effective when the student is provided an part of officials. Selected community prob- opportunity to participate in solving actual lems can be effectively supplemented in a community problems. Perhaps it would be teaching program by using data that per- an ideal situation to use a neighboring tain to hypothetical communities. An ex- community for studying all aspects of ap- cellent example is the Dixon-Tiller County plied community medicine. This approach material that is available through the Com- would be effective in acquainting students munity Service Training Section of the with the good as well as the bad conditions National Communicable Disease Center. and practices that prevail. The learning ex- The only request made by the Center is for perience would very likely be an interesting information as to the application of the one since a first-hand evaluation of the material. application of principles and objectives of The hypothetical community acts as a community medicine could be made. teaching reference for a population of about The applied preventive medicine training 170,000. The material incorporates all the program of the College of Veterinary Medi- necessary statistics, maps, slides, and data cine at the Ohio State University utilizes that are relative to an average community. an adjoining community with a population The data are flexible and lend themselves of approximately 39,000. This community to uni- or multidiscipline training in veteri- provides the laboratory for applying the nary preventive medicine. Contents are principles and objectives of food hygiene. We have limited the student assignments readily adaptable to many problems and to those areas that would be least likely to with minor modifications and supplements cause concern and resentment by officials allow for data relative to the distribution of domestic animal populations, wildlife * Professor and Chairman, Department of Pre- conservation practices and populations, the ventive Medicine, College of Veterinary Medicine, Ohio State University, Columbus, Ohio. status of animal disease eradication pro- 82 An Applied Veterinary Community Medicine Program 83 grams, and the like. The use of a hypo- Early diagnosis and treatment thetical community as a substitute for the Disability limitations actual community is not ideal but is about Rehabilitation and program appraisals as close to ideal as one might hope for. These represent the core of the course and The teacher will find that through dele- are just as applicable today as they ever tion or rearrangement of data, he can con- were. Objectives and principles have not vey a real community working feeling to changed but communities have. There is the student. The course content should be not a great need to influence adults to con- specific and definite when possible and tinue their education. We must exercise designed for flexible application to environ- leadership and communicate to these per- ment and circumstances that will differ sons our objectives and principles so that from community to community. This learn- they will be incorporated into a philosophy ing experience should help the student to that will become a part of the everyday acquire an applied understanding of the fol- life of the community. lowing five levels of prevention: "Continuing education" for adults of all Health promotion ages is the present-day keynote to the Specific prevention successful teaching of community health. FIELD TRAINING PROGRAMS

THE OHIO PREVENTIVE MEDICINE PROGRAM

JACK H. RUSSELL, D.V.M.*

At the Ohio State University College of to students during their senior year at the Veterinary Medicine, inqtruction in pre- Ohio State College of Veterinary Medicine. ventive medicine is culminated by a full quarter (10 weeks) of study during each undergraduate student's senior year. The Preventive Medicine Program senior class is divided into three groups and one group each quarter rotates into this Animal health and disease control-The program from the autumn through the entire group of approximately 24 students spring quarter. The remainder of the class is given four days of instruction in state is assigned to the veterinary clinics during and Federal quarantine regulations by any given quarter. members of the Animal Health Division of Prior to their senior year all students the U.S. Department of Agriculture and the have already been exposed to the basic Bureau of Animal Industry of the Ohio academic aspects of preventive medicine, Department of Agriculture. Lectures in the including meat hygiene, epidemiology, bio- control of specific animal diseases and epi- statistics, and the control of specific infec- demiological techniques used in the tracing tious diseases, including the zoonoses. of animal disease sources are also given. The objective of this quarter of preven- Clinical demonstrations of testing and diag- tive medicine during the student's senior nostic procedures are included. year is to apply the basic principles he has Meat hygiene-Four days of "in-plant" learned to real-life situations. Thus in a instruction in meat and poultry inspection very real sense the world outside the con- procedures are given by Meat Inspection fines of the university can be considered Division personnel of the Federal Depart- to be a laboratory to these students, whether ment of Agriculture. At this time the in- they are being exposed to a public agency, structional groups are broken down into a meat or food processing plant, or a state- units of five or six students. owned dairy herd. To give an idea of the Milk hygiene-One day is devoted to learning experience each group is exposed dairy farm inspection with regular sanita- to each quarter, I have listed below the wide tion workers who perform this duty for the variety of field assignments that are given Columbus, Ohio, Health Department. Another day of instruction is given by the * Chief Public Health Veterinarian, Division of Department of Dairy Technology at Ohio Communicable Diseases, Ohio Department of Health, Columbus, Ohio. State University with respect to milk proc- 84 The Ohio Field Training Program 85 essing and pasteurization. Factors affecting standard housing and its effects on public milk quality are discussed. Equipment used health. The veterinarian's role in general in milk processing is broken down, and the sanitation is discussed from the standpoint operational aspects are explained. of veterinarians in both private and public Organization and responsibilities of the practice. local health department-A one-day visit to Humane society animal shelter-The the Health Department of the city of Franklin County Humane Society by con- Columbus (about 500,000 population) ex- tract serves as the official agency for the poses the students to the organization, func- city of Columbus and Franklin County in tion, and philosophy of local health depart- enforcing stray dog control, licensing, and ment structure in Ohio. This Department the confinement of biting animals. The has well-organized programs utilizing vet- shelter's operation is explained by the Hu- erinarians in many ways. The Deputy mane Society staff and the students have Health Commissioner and Chief of the an opportunity to see how a modern, we ll- Environmental Health Section is a veteri- equipped animal shelter operates. narian. Aerospace research-The entire group of Military preventive medicine-A one-day 24 students tours the aerospace research visit to the nearby Lockbourne Air Force facilities of the Wright-Patterson Air Force Base gives the student a chance to see mili- Base at Dayton, Ohio, about 50 miles from tary preventive medicine in action. The Columbus. In addition to the base veteri- base veterinarian lectures on this subject at nary staff, several veterinarians are engaged the University during the quarter. in research on aerospace travel studies. Vector and rodent control-Pest control, The Air Base has the ultimate in laboratory its industrial and agricultural applications, animal medicine facilities. and its economic importance are presented Laboratory animal medicine-One day is by the district agent representing the Preda- spent on Ohio State University campus at tor and Rodent Control Branch of the U.S. the College of Medicine. General principles Department of the Interior. Control meth- and the scope of activities are covered. ods and the use of poisons are covered, as Animal foods inspection-A modern plant well as the importance of rodents and preda- that manufactures a variety of pet foods tors as disease vectors. and slaughters horses under U.S. Depart- Food hygiene-The basic principles of ment of Agriculture inspection is visited food hygiene are covered in two days. This for one day. includes food-borne disease, Ohio laws and Pilot Dogs, Inc.-A training facility for regulations on food service, and inspection Seeing Eye dogs enables the student to visits to restaurants, food stores, and baker- better understand special problems asso- ies in a nearby suburb of Upper Arlington. ciated with the care and treatment of ani- The students fill out inspection forms to- mals used for this purpose. gether with the instructor, who is Deputy Columbus Zoo-Special problems asso- Health Commissioner of the local health ciated with zoo management are discussed department. They are expected to explain during a tour of facilities with the Zoo Di- and justify their inspection reports. rector, who is a veterinarian. General sanitation-Students travel with Equine health problems-Preventive Columbus Health Department sanitarians medicine problems associated with equine to see public water supply treatment, sew- practice are discussed with staff clinicians age disposal, landfill operations, and sub- and private practitioners. 86 The Veterinary Public Health Curriculum

Ohio Department of Agriculture Animal a veterinarian from the State Health De- Diagnostic Laboratory-Diagnostic ser- partment staff. The programs and responsi- vices offered to veterinarians, toxicology, bilities of the Veterinary Medical Section feed additives, and chemical residues are of the Ohio Department of Health are covered. described, and students are encouraged to State herds and flocks-Visits are made ask questions and discuss any particular to herds and flocks at state prison and interests they may have regarding public mental institution farms for the purpose of health. This often involves topics such as applying the principles of preventive medi- their legal responsibility after graduation cine to herd health problems, especially in regard to health agencies and disease mastitis control. reporting, personal protection (including Ohio Department of Health Laboratory pre-exposure rabies vaccination), employ- -One-half day is devoted to the adminis- ment opportunities in veterinary preventive tration and operation of a state public medicine and public health, rabies control, hcalth laboraatory. Tests and servces--1 use- xrUbi vy aIi.IO, a unla raUUly sbU V iuC ful to veterinarians for diagnostic purposes available at the state health laboratory. (A are covered, and literature categorizing visit to the Ohio Department of Health these services and containing the interpre- Laboratory is always scheduled the morn- tation of test results is given to each stu- ing of this seminar.) Printed health educa- dent. tion and public health materials issued by Ohio Department of Health Veterinary the State Health and Agriculture Depart- Medical Unit-Two days are spent present- ments are discussed, and students are urged ing and discussing various aspects of prob- to contribute, after graduation, to the news- lem assignments relating to veterinary pre- letter Animal Disease Trends and also to ventive medicine. make good use of the State Health Labora- I think it is obvious that the students in tory and the Ohio Department of Agricul- this program have an opportunity to apply ture Animal Diagnostic Laboratory. The basic concepts and principles regarding pre- importance of the reporting of zoonotic ventive medicine to an infinite variety of diseases to the detection of human zoonotic environmental and community health prob- infections is stressed. This two-hour semi- lems. The most important aspect in the stu- nar is presented to each of the four groups dent's favorable response to this type of of students each quarter. teaching is student participation. Every Near the end of the quarter all four attempt is made to involve the student groups (24 students) are given public health rather than to let him merely tour these problem assignments. Each of the groups agencies and facilities. is given a problem and assigned a three- hour period for its presentation and discus- OfJficial Health Agencies sion. While a given group is presenting its The part played by the Ohio Department problem, the other three groups listen and, of Health in this program will be discussed after the presentation, are encouraged to in more detail, since this is the portion of join in the discussion, with the leader of the the program that I personally am involved presenting group acting as discussion chair- in. man. The students participating in the program Some of the problem assignments are as are divided into four groups of six students follows: each. Each of these small groups has a two- * As members of a county veterinary medical hour informal, discussion-type seminar with association, prepare a workable rabies control The Ohio Field Training Program 87 program and present it as you would to a local ease incidence data for Ohio, etc.), this is board of health that had requested you to do so. furnished to the group at the time they are (Specific situations are set up involving different assigned the problem. Otherwise, students types of rabies problems. Complete data-such as incidence of rabies over recent years and type are expected to find their own resource of species involved-are included.) material. * Make recommendations for a complete and A group is allowed to make its entire workable meat or poultry hygiene program for presentation before being challenged or a local health department. questioned. After correction of any glaring * Prepare a plan for setting up better inter- professional relations and liaison in relation to mistakes and discussion by everyone con- disease reporting and sharing of knowledge be- cerned, the public health veterinarian sum- tween a local veterinary medical society, a medi- marizes the discussion, presents alternative cal society, and the local health department. solutions, if any, and relates the problem * Prepare a plan for the ideal reorganization of all veterinarians working at the state level, by assigned to the situation actually existing departments, programs, and responsibilities. in Ohio at that time. * Discuss the veterinarian's role in disaster While this is by no means a perfect solu- medicine programs. tion to the problems of teaching public * Recommend solutions to a number of prob- health, it does accomplish the following: lems based on situations involving specific zoonotic diseases, either single cases or epidemics, 1. It motivates the student to listen and and state your reactions to them as private prac- learn to a much greater extent than he ticing veterinarians. (Occasionally one of these would if he were merely to listen to a lec- problems involving an epidemic is to be considered from the official health agency's point of ture on the same topic. view rather than from the standpoint of the pri- 2. It involves the student and encourages vate practicing veterinarian.) him to participate more than he usually * Prepare guidelines for state legislation con- would. Each student must participate to cerning some problem involving veterinary pre- some degree, at least in the problem ventive medicine (e.g., rabies control, compul- sory immunization, or psittacosis regulations). assigned to his group. 3. It acquaints the student with the Always the students are asked to be pre- standpoint of a private practicing veteri- pared to defend their recommendations and narian and his responsibility as such, and to give reasons for any decisions. They are at the same time gives him an understand- asked to make their proposals practical and ing of the health official's responsibility in workable and to conform to Ohio Law and the same situation. to the restrictions or data presented with 4. It requires the student veterinarian to the problem. consider client relationships, responsibilities The problems are always based on actual, to public agencies, personal protection confirmed disease outbreaks ocourring in against infection, and other points he might Ohio or on actual health needs existing in not think of if he merely writes a paper on Ohio, with the obvious exception of the disaster medicine and veterinary services in a chosen topic. state government problems. It is realized 5. Actual participation in a disease in- that it is perfectly possible to prepare prob- vestigation is rarely possible for a number lems based on purely hypothetical situa- of reasons, but this method permits the use tions. However, it is felt that by utilizing of epidemiological data and confirmed out- actual situations the student will be more breaks for teaching purposes and provides interested and motivated. a substitute for participation in epidemio- If any special reference material is needed logical activities involving veterinarians for solving a problem (state dog laws, dis- working in official health agencies. FIELD TRAINING PROGRAMS

VETERINARY STUDENT ORIENTATION IN THE U.S. DEPARTMENT OF AGRICULTURE

DANIEL F. WERRING, D.V.M.*

In the veterinary student orientation biologics production and the testing of su'! programs of the U.S. Department of Agri- products for safety, purity, and potency. culture, remarks center on activities of the The recognized association of immunizing Federal veterinarian attached to the Agri- agents with a relatively large percentage cultural Research Service, the parent or- of hog cholera outbreaks makes biologics a ganization of the Animal Health Division. prime topic of concern today. The removal We also refer to the Animal Disease and of a number of the products as unsafe has Parasite Research Division, which provides spurred interest in the field. Discussions on many of the tools and much of the know- the use of various approved products under how applied in the control and eradication varying situations will assist the student programs. We identify the following facili- when in practice to select the one most ties of the latter Division and their areas of indicated. These decisions will be impor- research: (1) Plum Island (foreign animal tant to the industry as well as to the hog diseases); (2) National Animal Disease cholera eradication effort. Laboratory (native diseases); (3) South- The Animal Health Division's activities east Poultry Research Laboratory (poultry are naturally covered somewhat more in diseases); and (4) Beltsville Parasitology detail since many of them, particularly the Laboratory. These facilities also maintain state-Federal programs, directly involve a diagnostic capability that is of impor- the general veterinarian practitioner and, tance to the field programs. The student of to some extent, the small animal practi- veterinary medicine today, we have ob- tioner. The Division, however, has uni- served, is increasingly research conscious, lateral programs that elicit student interest as indicated by the questions posed and and are therefore given attention. One of the interest voiced in possible employment these involves the precautions taken to in the Animal Disease and Parasite Re- prevent the introduction of foreign diseases search Division. by controlling the imports of animals, Another agency of importance is the animal products, and certain other related Veterinary Biologics Division, which is material. This is accomplished by the responsible for the regulation of veterinary enforcement of health requirements at point of origin, veterinary inspection at *Veterinarian in Charge, Animal ltenlth Divi- ports of entry, or in some instances, total sion, Agricultural Research Service, U.S. Depart- ment of Agriculture, St. Paul, Minnesota. exclusion of imports from countries where 88 Department of Agriculture Student Orientation 89

certain diseases exist. For example, no Health Division. The organizational struc- domestic cloven-hoofed animals are per- ture, background, authority, responsibili- mitted entry into the United States from ties, and operative policies of each agency areas where foot-and-mouth disease or is described and current field programs rinderpest is present. Similar restrictions (there are 10 major programs and a number are imposed with respect to African horse- of lesser scope) are presented. sickness and contagious bovine pleuro- The State Veterinarian's Office discusses pneumonia. As a result there are very activities at the state level, while we from limited movements of many animal species the Federal Animal Health Division pre- into this country other than from countries sent the national situation. Emphasis is on the North American continent. placed on practitioner involvement and Public stockyard inspection is another actual participation in many of the pro- unilateral program of the Animal Health grams. The practitioner's knowledge and Division that is stressed with the student. support of all programs is in the interest of One half-day is devoted to a tour of the industry and public acceptance. stockyards at South St. Paul. Explanations Students are alerted to the need for sur- and discussions supplement observations. veillance against the introduction of foreign Here the student is introduced to the mar- diseases and the urgency of prompt report- keting procedure-receipt, sorting, yard- ing of suspicion of such diseases. The ing, weighing, and disposition by slaughter practicing veterinarian would normally be or reshipment of aimals-and the part that the first to encounter these conditions and veterinary and lay inspection play in the his immediate action could be the key to orderly flow of healthy livestock in com- preventing extension. Attached to the force merce. The special handling of reactor is a foreign animal disease diagnostician animals is observed, with emphasis on who recently returned from England, where precautions to avoid exposure to susceptible he assisted in the foot-and-mouth eradica- nonslaughter animals. The practitioner's tion operation. He is available to assist in responsibility in this area is pointed out, as diagnosis or to collect material for labora- is the danger of recommending that owners tory examination. In case of confirmation, use public facilities to dispose of non- there is within the state an Emergency reactor diseased animals with possible Disease Organization, composed of joint contagious diseases. Additional student agency professional and subprofessional observations are made of Market Cattle personnel, which could institute eradication Testing tag application, vehicle cleaning measures on short notice. This group and disinfecting, testing activity in the periodically takes part in hypothetical yards, tissue specimen collections, patrol exercises and would suffice to handle small- inspections, and other aspects of the opera- scale outbreaks or at least to contain tion. Yard orientation is concluded with a things until additional help arrived in case summarization and discussion of observa- of larger outbreaks. We are prepared to tions and the distribution of printed employ all the eradication measures of materials. inspection, quarantine, appraisal, depopula- The rest of the training is concerned with tion, cleaning, disinfecting, and whatever cooperative state-Federal programs and is else might be necessary. presented separately at two half-day ses- Training at the Animal Health Division sions by veterinarians of the Minnesota office is concluded with a discussion of the Livestock Sanitary Board and the Animal export-international shipment of livestock 90 The Veterinary Public Health Curriculum and the involvement of the practitioner in cooperating agencies are in fact service groups certifying to the health of the animals to whose funetion is to assist the professional and the industry in maintaining a healthy livestock be exported. Minimum requirements, by population. species, are explained, including test inter- 6. The Minnesota Livestock Sanitary Board pretations and other details. A health uses the occasion to advise on the necessity of certificate exercise is then presented in obtaining permits for administration of certain which each student prepares a "John Doe" biologics and to explain other Board controls. mock certificate from a list of animals of The methods or principles employed in varying status, of which some are qualified the training have been incorporated in part for export and others are not. The exercise in a discussion of objectives. Presentations ends with a review of entries made and a are very informal and questions are invited critique of the exercise. at all times. Discussions are initiated at Many areas have been identified in the frequent intervals to stimulate interest. foregoing where the practicing veterinarian Visual aids, including slides and charts, are is directly involved in conoperative pro- used in Uorler to avoid dry narralion. Exer- grams. There are a number of other ob- cises involving student participation are jectives we in the joint agencies strive for used whenever possible and appear to be in student training: well received. Published materials outlin- 1. Our foremost objective is to instill in the ing agency organization and functions are student the philosophy of prevention, control, distributed. and eradication of animal diseases. A preventive In addition to the type of training dis- disease attitude is being developed in preference cussed above, members of the joint agen- to individual treatment as a total answer to problems. cies participate periodically in seminars 2. A personal relationship is being established which deal with certain programs in greater that will lend itself to mutual benefit in disease depth than is possible at the briefing ses- control. sions. Two such seminars have recently 3. A briefing on the significance and responsibility of veterinary acereditation is made. Mate- been held for senior students on tuberculosis rial is generally covered that should assist in and brucellosis. Epidemniologists periodi- writing the acereditation examination. cally make presentations. 4. Various documents, such as test charts, Working with the students has been a vaccination records, quarantines, and shipping pleasant and rewarding experience. If permits, are discussed and their proper execution and use is stressed. they have profited to the extent we have, 5. We impress on the student that we in the the training can be considered a success. FIELD TRAINING PROGRAMS

THE ST. PAUL PROGRAM

PAUL J. COX, D.V.M., M.P.H.*

In St. Paul, senior veterinary students function effectively in an organized environ- who are to take field training are scheduled mental hygiene program. to appear in the office of Environmental The general objectives of this field train- Hygiene at the Bureau of Health, in groups ing can be summarized as follows: of four to five students, one day a week during the fall quarter. The period of indoc- 1. Create an awareness of the functions trination is approximately two hours. The of a veterinarian in a health department. sessions are informal and the students are 2. Discuss additional educational require- encouraged to participate in the discussions, ments for a veterinarian in public health which are based on the following points. which may be required. 3. Cite public health problems which 1. Discuss with the students the function stimulate feedback from the students. of a veterinarian in a local health depart- 4. Allow each student to give his per- ment charged with the directorship of ception of a veterinarian's function in environmental hygiene. environmental hygiene. 2. Identify the public health significance 5. Contrast the ability of other disci- of disease processes in animals and man. plines to funetion as effectively as a vet- 3. Indicate that experience and knowl- erinarian in environmental hygiene. edge gained in practice and formal educa- 6. Illustrate how the basic veterinary tion are adaptable to the field of public educational requirements equip a veterinar- health. ian to be actively engaged in public health 4. Compare the application of a vet- matters while in private practice. erinary education in private practice to 7. Discuss the fact that veterinarians in public health. public health are using their education to as 5. Construct the administrative organi- great a degree as a practitioner. zational chart and the plan of activities of a 8. Contrast working conditions between typical health department. a public health official and a practitioner. 6. Identify the student's formal vet- 9. Allow free discussion among students erinary education with the field of public on points of difference. health and state why he is qualified to 10. Truthfully and freely answer personal questions relating to the position of a * Director, Environmental Hygiene, Bureau of Health, St. Paul, Minnesota. veterinarian in public health.

91 FIELD TRAINING PROGRAMS

THE U.S. DEPARTMENT OF AGRICULTURE MEAT INSPECTION PROGRAM

V. L. DAHL, D.V.M.*

The Meat Inspection Program of the tal in the training of the new employee, U.S. Department of Agriculture has since it is most important that the new experienced greater advancement in the inspector is introduced to the what, why, basic and continued training of its in- when, and how-to of correct procedure. spectional personnel in the last decade Program policy, however, always gave first than during the first 50 years of its exist- priority to having an employee fill an in- ence. This is not to imply that all early spectional assignment at the earliest possi- training practices were unacceptable. Most ble moment. His first job was usually a supervisors have always recognized the simple one, and from that time on his importance of training and have had a career consisted of a series of delays in deep interest in seeing that personnel were training for new tasks. Manpower short- properly trained. Some enjoyed the ages caused by vacations, sickness, retire- advantage of having personnel on their ments, resignations, and economic austerity rosters with exceptional training talents, directives were some of the factors which and others had geographic concentrations blocked orderly and progressive employee of personnel providing the advantage of development. assignment flexibility during the periods of The second significant problem was the training need. lack of training aids and quality trainer Deficiencies of early training practices personnel. On-the-job training was con- were generally recognized to be lack of ducted in most instances by whichever more program uniformity, delayed employee experienced inspector happened to be development and self-fulfillment, and assigned to the inspectional station at the reduced manpower flexibility because of time the trainee was to be qualified. There incomplete work qualifications of the in- existed in these temporary trainers great spectional force. Three problem elements variation in technical competence, teaching appeared to be most significant. capability, and interest. Even when these First, no time was specifically allotted to qualities were present in the trainer, train- training. This problem was most detrimen- ing was just another responsibility added to * Assistant to the Director, North Central Meat his already demanding job. Inspection District, Consumer and Marketing Ser- The third and probably major underlying vice, U.S. Department of Agriculture, Chicago, Illinois. cause for the lack of uniform training 92 USDA Meat Inspection Training Program 93 practices in those years was the absence of sota; Omaha, Nebraska; Fort Worth, central program direction. The good train- Texas; and Los Angeles, California. Vet- ing programs that did exist at some loca- erinarians currently receive 12 weeks of tions were the result of local initiative basic training and nonprofessional in- and ingenuity. Training information was spectors, four weeks. These centers have a not disseminated broadly so it could be projected capability of training 300 vet- utilized where creativity and talent were erinarians and 800 nonprofessional in- not strong. Most of the effective training spectors annually. (it was carried out by design rather than Another type of training which has by accident) was accomplished through recently received considerable attention is unauthorized use of personnel. Training continuing education of field inspectors. was always recommended and encouraged, The goal here is to broaden the capabilities but there were no directions for carrying it of inspectors already on the job. The pur- out, and there was no provision for time, pose is to increase proficiency in current personnel, and training aids. assignment responsibilities and to prepare Early in 1964 the first nationwide pro- employees for advanced grade positions. gram of in-plant slaughter inspection The "package concept" has been devel- training was adopted by the Federal Meat oped in order to provide training aids and Inspection Program. This training was ini- guidance to field supervisors in conducting tially applied to veterinarians just entering their local, continuing education programs. the inspection service. Recently it has been The scope of each package is a limited area extended to nonprofessional personnel as of inspectional responsibility, such as plant wcll. Basic characteristics of this plan sanitation, sanitary carcass dressing proce- include providing adequate and exclusive dures, or trades labels. A package essen- is time for training, during which training tially consists of a prepared instruction responsibility of the trainee. the sole duty booklet for the trainee's prestudy use, a Qualified trainers are selected on the basis discussion guide, and visual aids for the of tecIhnical competence and teaching talent, trainer's use in classroom presentation. and training is their only duty assignment. Field supervisors have a great need for Teaching is accomplished by a combination aids for scheduled training, of classroom lectures, laboratory work, and these training in-plant instruction and practice. The goal as well as for use during unexpected op- is to prepare the employee to be basically portunities arising from nonoperational functional before reporting to his first duty plant stand-bys. The package concept is assignment. considered to have great potential value This basic training is now carried out for orderly and uniform employee develop- under the direction of the U.S. Department ment in the field. Singularity of subject of Agriculture Livestock Slaughter Inspec- matter, authenticity of content, and ready tion Division at four strategically located availability are basic qualities of this training centers: South St. Paul, Minne- concept. THE TEACHING OF DISASTER PREPAREDNESS

DONALD C. BLENDEN, D.V.M., M.S.*

The ever-present threat of disaster has bilities of a particular population, or the haunted mankind all through history. disaster may overwhelm available capa- Under this threat, man has learned to bilities for providing medical care. predict certain events of nature so that the The purpose of this paper is to describe effects are minimized. Other natural events the reasons for presenting disaster pre- cannot be predicted, as evidenced by the paredness to undergraduate students in fact that citizens of our country are being veterinary medicine and to relay some of continually exposed to disasters of different the principles of disasters and post-disaster types with little or no warning. Man-made behavior which are used in this teaching. disasters also seem to be an ever-present It would seem necessary first of all, potential, especially those that might result before discussing the implications of dis- in widespread trauma, death, or exposure aster and disaster preparedness, to define to radiation. Accidental explosions and these terms as they are discussed with fires oocur from time to time because of students. There are two legitimate schools human error or neglect. The remote but of thought concerning the definition of ever-present threat of enemy attack with disaster. These are represented (1) by nuclear weapons cannot be ignored by those most affected and closest to the dis- responsible professional persons, even aster, and (2) by those who must record, though most people prefer to ignore, rather classify, and analyze disasters in order to than to nourish, the health concepts of predict future events or to render the prevention and preparedness. It is this medical care necessitated by the event. We potential of disaster that stimulates multi- must assume at this point that the defini- disciplinary thought in the teaching of dis- tion of disaster is variable and relative for aster preparedness. The involvement of the individuals involved and that for different professional groups, specifically present purposes a disaster consists of an the veterinary medical profession, seems unforeseen happening resulting in the death very important, as the disaster itself may or serious injury of 25 or more persons. By eliminate some of the medical care capa- this administrative definition, few people realize that about 1,300 deaths have *Associate Professor of Veterinary Microbiology occurred in disasters every year of this and Chief of the Section on Veterinary Public Health, School of Veterinary Medicine, and Asso- century, with an additional 13,000 to ciate Professor of Community Health and Medical 15,000 persons injured annually. This in Practice, School of Medicine, University of Mis- souri, Columbia, Missouri. itself is a staggering figure, but if one were 94 Disaster Preparedness 95 to include all "minor disasters" such as preparedness, as they are the ones who will automobile accidents, fires, and drownings, be called on for leadership and for the the figure might well be unbelievable. various ramifications of management and Disasters, then, present a serious problem medical care. For example, what com- in terms of individual and public health. munity is prepared to accommodate 50,100, Even more unfortunate than the losses or even 1,000 persons injured at the same incurred is the fact revealed by retrospec- time, with all the attendant problems in tive studies that many or most disaster food and water handling, sanitation, losses and deaths are preventable. The animals, utility breakdowns, and the many United States has a rather modest incidence other problems that few persons think of of disaster injury; some countries have had until they do occur? These, of course, are single events killing more persons than all not unreasonable figures to contemplate of those killed in one-half century of our with natural disasters and would be mag- own disaster history. nified manyfold in the more unlikely event Review of disaster situations where loss of a nuclear disaster. of life has been extensive reveals that the use of any one of the several preventive measures available at each incident would Importance of the Concept of DisasterPre- have greatly reduced the loss of life. paredness in the Veterinary Medical Cur- Experience proves that once the chain of riculum events leading to disaster has been initiated, it is too late to institute effective casualty- Disaster preparedness programs have reducing measures. For this reason ade- been in effect for several years in medical quate preventive measures must be built schools under the Medical Education for into community, professional, and individ- National Defense (MEND) Program. Since ual thinking so that they are more or less disaster preparedness is being recognized as a part of everyday life. Then, when an a multidisciplinary endeavor, the other event begins that can potentially become health professions are now becoming in- a disaster, the preventive program auto- volved. Programs are under way in schools matically takes up where preparedness of nursing, dentistry, and pharmacy. The programs leave off. To accomplish this purpose of the program in schools of veter- objective, the philosophy of preparedness inary medicine is to acquaint the potential must be instilled during the educational veterinarian with the fact that he does have years when persons are receptive to ideas a role and a community responsibility in a and are actively engaged in the learning post-disaster situation. It is obvious that process and then maintained on a continu- the veterinarian has a great background of ing basis. training and experience in the concepts of This, then, is the concept of disaster health care and will be looked to as a com- preparedness, or adequate preparation for munity leader in a situation of this sort. disaster. Veterinarians, by and large, have A secondary but equally important facet taken a head-in-the-sand approach until of the teaching of disaster preparedness lately. It appears quite obvious that this exists. Disaster preparedness is used as a concept will be properly accepted only dramatic tool to illustrate to students that during the learning years of an individual. public health embraces more than the tra- Members of the health professions must be ditional areas of meat and milk hygiene or well acquainted with the concept of disaster even infectious disease epidemiology. The 96 The Veterinary Public Health Curriculum student is quite interested in the fact that Phase 1. This is a stage of apathy and disbe- public health encompasses a variety of lief, in which persons are dazed and stunned and have little to do with the tra- undertake purposeless activity. fields which Phase HI. This is a stage of gratitude for any ditional infectious disease control approach. help that can be given. The individual yields to any suggestions but is highly inefficient. Phase III. This phase is distinguished by Principles of Disasters euphoria, feelings of brotherhood, and pleas to "take care of everyone else first as they need It is interesting that the epidemiologic help worse than I." Phase IV. This phase develops after several method can be applied in describing disaster weeks, when disaster victims are recovering from occurrences and in selecting the bases for the effects of the disaster and are beginning to control programs of future disasters. It is come back to the realism of life. During this true that there is a basic host-agent en- phase people become annoyed and criticize the vironment relationship. Also, the incident way officials handled the disaster. may be related to the basic epidemiologic In the post-disaster period the so-called parameters of time, place, and person. For "phenomenon of convergence" is of special example, tornadoes and hurricanes have importance. This is a rather formidable both a seasonal and a geographic distribu- term applied to the simple principle that tion. Earthquakes have a geographic dis- all things seem to flow into a disaster area tribution. Municipal riots seem to have and very few things seem to flow out. This seasonal and social relationships. In many can cause tremendous problems in restoring instances, disasters can be characterized services with emergency personnel and in according to the persons that are affected; the management of casualties and deaths. indeed, it seems that there would actually For example, immediately after a disaster, be risk groups to certain types of disaster. people descend upon the area to see what The epidemiologic principles involved in has happened. Some rush home to see what disaster can be used to minimize casualties has happened to relatives or friends. Others, and deaths by the prediction of so-called perhaps a majority, are simply curiosity warning times of the events. In the teach- hunters and thrill-seekers. In any event, ing of epidemiology to veterinary medical the disaster scene becomes choked with students, disasters can be used as examples people, automobiles, airplanes, motorcycles, just as realistically as cardiovascular dis- and many other basically nonessential per- ease or an outbreak of food poisoning. sonnel and vehicles. Convergence has be- The principles of disaster and disaster come so extreme in some disasters that behavior should be presented to students. officials have seen fit to organize conducted They should be oriented to the fact that tours through certain parts of the area to post-disaster behavior can be divided into control traffic rather than let it roam in a four distinct phases. The first two phases haphazard fashion. are undergone by all persons, including responsible health and disaster-oriented The Veterinarian's Role individuals. The prime purpose of disaster planning is to minimize the length of time A fact easily overlooked by relief officials involved in adjusting to these two phases is that the veterinary hospital and clinic so that the disaster is not entirely a new has a large stock of dressing, drugs, anti- experience to all people. The four phases biotics, sedatives, sutures, instruments, and are: plaster bandages, as well as facilities for Disaster Preparedness 97

sterilization, radiography, administration of assure that foods provided the surviving oxygen, first aid, and minor surgery, not to population are safe for consumption. This mention intravenous setups, clinical labora- type of work should be closely coordinated tories, and so on. Consider, too, the large with sanitarians of the local health units. animal practitioner who possesses portable 4. Veterinarians should participate in refrigeration units, mobile clinics complete surveillance for communicable diseases in with sinks and hot running water, steriliz- the surviving population by the application ers, refrigerators, and two-way radios, and of epidemiologic methods. They should help who has an intimate knowledge of roads, define and eliminate or control sources of bridges, and terrain. Equipment and facili- infection for human populations. ties are tangible things, easily evaluated as 5. Able and highly trained veterinarians' to whether or not they are adequate. More assistants could be invaluable aid in disaster difficult to evaluate are the professional situations. judgment and skills of veterinarians. It It must be remembered that physicians, would appear that the most obvious func- only some of whom may be able to funetion, tion of the veterinarian during and after will be overwhelmed with direct medical disaster would consist primarily of expan- care services and must be relieved of all sions of his routine functions modified to services which the paramedical professions the new and stressful situation. can adequately handle. Should it happen The activities of a veterinarian following that the veterinarian is called upon to give a disaster might be expected to follow this direct medical care to injured individuals, it pattern: would seem that in most, if not all, cases 1. Like everyone else, the veterinarian this care would be first aid, which most will take action to safeguard his own life persons are qualified to give, or that such and that of his family. Certainly, aside care would be under the direct supervision from any aspects of basic self-preservation, of a physician, who would therefore be persons who are incapacitated will be of no responsible. While many veterinarians ex- service in a post-disaster period. Also, it press great fear of this type of endeavor, it has been demonstrated, even in persons seems doubtful that many would relinquish experienced in disaster management, that these responsibilities when confronted with their first impulse is to make sure their own an actual emergency situation. families are secure. 2. Following the immediate post-disaster Applications of Principles in Specific period, the veterinarian should determine Disasters how he can be of greatest service, preferably by acting according to a prearranged disas- Many types of disasters that occur regu- ter plan or else by checking with the health larly throughout the United States provide officer or other responsible officials. Imme- realistic examples of what might be ex- diate needs will depend on the nature of the pected of the veterinary student. For ex- disaster, the available medical care, pre- ample, the severe floods of northern Cali- vious disaster plans, transportation, com- fornia and the Northwestern coast illustrate munication facilities, and so forth. some primary and secondary effects that 3. Perhaps the most obvious and impor- might be anticipated. This particular type tant contribution that the veterinary pro- of disaster illustrates that large numbers of fessional can and should make is to super- dead and injured animals, as well as vise sources of food of animal origin and frightened but otherwise normal animals, 98 The Veterinary Public Health Curriculum must be dealt with. The veterinarian is, of responsibility of all of the health-related course, in one of the best positions to assist professions. The benefit of advanced train- and supervise operations of this nature. ing and disaster preparedness becomes clear Sometimes assistance will take the form of when we consider that most disaster injuries helping to establish a portable water supply and deaths are preventable. to be used by surviving populations. Occa- Disaster preparedness should be taught sionally large numbers of deaths of domestic in the undergraduate curriculum of veteri- animals occur, so that the disposal of car- nary medicine for two reasons: (1) The casses presents a tremendous problem. disaster-oriented veterinarian merely modi- Chaos resulted from an unusual situation in fies his normal routine enough to provide which a recent tornado swept through To- expanded service in the new situation; and peka, Kansas, and destroyed the physical (2) disaster preparedness can be used as a facilities of the health department itself. model to illustrate the noninfectious aspects In such an instance, of course, a disaster plan will fall apart if the health department of disease, with which veterinary public is the main focal point of supervised re- health has professional concern. sponsibility. Disasters can be studied by the epide- It is also of great importance that disaster miologic method. They have predictable plans be given a test of their effectiveness at phases of human behavior. The phenome- regular intervals through the performance non of convergence occurs at all disaster of disaster exercises. It is only through this sites. Disaster plans and regular disaster type of exercise that the effectiveness of a exercises help minimize the effects and in- disaster plan can be evaluated. crease speed of rehabilitation. The veterinarian should be oriented toward disaster Summary preparedness and, should the occasion arise, Disasters are thrust upon us at frequent find his role as a respected community intervals, and disaster preparedness is the health leader. Part II BIOMEDICAL COMMUNICATIONS

SOME IMPLICATIONS OF RESEARCH FOR THE DESIGN OF INSTRUCTIONAL MATERIAL*

WILLIAM T. STICKLEY, PH.D.t

Research and development in the prep- emerged from the introduction of instruc- aration and employment of instructional tional television into higher education. materials are essential if the design of in- Yet the proper approaches to change may structional systems is to pass through increase the likelihood of its occurrence. In progressive stages of refinement. Change in a discussion of the Case Western Reserve any social system is notably difficult to program, Ham (10) described one way to achieve. Those who are concerned with the provide an environment receptive to preparation of instructional materials and change: "Change is built into this organi- with innovation in education, especially in zational structure so that the curriculum higher education, must accept as fact this has never been fixed or static. Change is reluctance to change. In The Prince, considered inevitable, essential, predictable, Machiavelli described the danger of initi- and to be a steady state itself." ating a new order of things: It is impossible in a paper of this size to It must be considered that there is nothing summarize experimental findings for the more difficult to carry out, nor more doubt- multifarious variables that concern the pro- ful of success, nor more dangerous to handle, ducer and user of instructional materials. A than to initiate a new order of things. For the mere outline of these variables would prove reformer has enemies in all those who profit by extremely long (7). Several reviews of the the old order, and only lukewarm defenders in all those who would profit by the new order, literature are available, however, that fur- this lukewarmness arising partly from fear of nish the producer with listings of the chief their adversaries, who have the laws in their experimental studies (8, 12, 15, 22, 25). favour; and partly from the incredulity of This paper will focus on a few principles mankind, who do not truly believe in anything of programmed instruction that apply to new until they have had actual experience of it. Thus it arises that on every opportunity for the preparation of many types of instruc- attacking the reformer, his opponents do so with tional materials. The delineation of prin- the zeal of partisans, the others only defend him ciples and guidelines should assist the sub- half-heartedly, so that between them he runs ject-matter expert when he considers the great danger (19). transformation from traditional instruc- In a theoretical and research-based tional methods to newer methods of in- study, Evans (5) documented the reluc- struction. tance to change in higher education by re- The works of Fry, Lysaught, Taber, and cording many of the difficulties which Lange, as well as other writings, set down the principles of programmed instruction * Supported in part by a grant from the Carnegie Corporation of America. (7, 14, 17, 18, 30). I myself am not a strong t Assistant Professor, Division of Research in advocate of the kind of programmed in- Medical Education, School of Medicine, Case Western Reserve University, Cleveland, Ohio. struction that is exemplified by many of 101 102 Biomedical Communications the commercial programs now available be- Despite the recognized importance of in- cause of their low degree of sophistication, structional objectives, they are not in wide with regard to the quality both of the in- use in higher education. The number of formation they attempt to impart and of experimental studies that attempt to assess the techniques they employ. However, the the value of objectives is indeed small. In principles which underlie programmed in- part, this paucity results from the difficulty struction offer basic approaches to the of defining objectives and the time required preparation and use of instructional mate- to do so. In summarizing research on learn- rials of many types and to the relation of ing from television, Schramm (24) com- research to practice. Although programmed pared learning from television with learning instruction principles are an outgrowth of from ordinary classroom instruction. The operant conditioning (despite Skinner's findings from 393 reported experiments disclaimer), they are similar to the learning showed that 83 favored television instruc- principles generally accepted by most learn- tion, 255 revealed no significant difference, ing theorists (11, 28, 31). and 55 favored the traditional classroom This paper will emphasize four principles instruction. While many of these studies for the design of programmed instruction: can be criticized from the standpoint of (1) preparation and use of instructional ob- their experimental design, it is possible that jectives, (2) active student participation, these equivocal results occur because ex- (3) logical sequencing of material, and (4) plicit objectives for both the television in- feedback of information. struction and conventional instruction were absent.

Preparationand Use of Instructional Objectives Active Student Participation

Ralph Tyler, as early as the 1930's, Student involvement is a long-term goal stressed the importance of defining educa- of producers of instructional materials tional objectives in behavioral terms. Not (23). Lumsdaine (15) and Allen (1) re- until the 1950's, however, was formulation port that high student involvement is one of of objectives accepted as an essential and the most fruitful areas of advance in educa- regular principle by a significant number of tional research in recent years. In the early producers of instructional materials. Em- stages of the programmed instruction move- phasis on explicitly stated objectives has ment, an active student response was con- been supported by Bloom's Taxonomy of sidered identical to high student involve- Educational Objectives (3) and by Robert ment and was thus thought to assure Mager's engaging book entitled Preparing learning. Most programmed instruction Instructional Objectives (21). The stress on material commercially available was there- task specification and task analysis in mili- fore of the linear type, providing space for tary and industrial training programs has the student to write a short answer for each also had an important effect. Some pro- frame. It was surprising when some studies ducers of programmed materials have even reported that those students instructed to taken the position that it is impossible to only "think" the response often performed prepare programmed instruction without as well on post-test evaluations as did those the statement of objectives in behavioral students instructed to write in the response. terms. And the covert (thinking the answer) Some Implications of Research 103 group frequently completed the program in many of the existing textbooks on the sub- less time than the overt (writing the an- ject were reported to be difficult to under- swer) group. stand. After examining alternate methods, The results, however, are not surprising a workbook was devised that was similar, when the programs are examined upon in some respects, to the programs developed which these studies are based. Instructional by Wilds and Zachert (32, 33). The first programs that call for one-word responses part of the Stenchever-Kitay workbook is are boring and usually will not spark the devoted to a written description or syllabus imagination of the bright graduate student. of basic information about labor and in- He is accustomed to attacking difficult, pro- cludes many matching, multiple-choice, vocative questions and to focusing attention and constructed-response questions. The for long periods of time before resolving answers and a short explanation of the problems. When preparing materials for questions are included in this part. The medical students and other adult learners, second part consists of six case problems, the aim is to seek how best to structure the each containing a series of questions that instructional environment to assure in- attempt to place the student in the role of volvement and participation to a degree the physician as he goes through the deci- that fits the learner. Student participation sion-making process. Some of the questions that "builds in" little challenge will not re- contained in the first case are presented in sult in high involvement but will lead to Figure 1. rejection of the material. Conversely, ma- Each case is graded in difficulty so that terial that is too difficult and too challeng- the student encounters a simple first case ing leads to frustration. and challenging last case. Students on the Glaser (9) has pointed out that the full clerkship have delivery floor duty every spectrum of response variables has not yet third night, and that setting was judged ap- been touched, despite the numerous re- propriate for the use of the workbook. After search reports on student participation. the student reads the first part of Labor and Continued research in exploring new ways works through the cases in the second part, of providing heightened interaction be- he is requested to arrange a conference with tween the student and the environment fur- his resident preceptor to discuss the cases. nished by the instructional material is The student's environment has been ar- clearly needed. ranged so that he has little alternative but The Division of Research in Medical to become highly involved with the mate- Education of the School of Medicine, Case rial. The material is available to each stu- Western Reserve University, is currently dent to keep and use in a manner to fit his engaged in a study that demonstrates high needs. Our initial studies with this work- student involvement in a structured en- book indicate that students are enthusi- vironment. This study uses a programmed astic about this approach. Resident pre- unit titled Labor (29) for fourth-year ceptors also respond well, because their medical students in their clerkship on ob- conferences with students can be conducted stetrics-gynecology. Subject-matter spe- at high levels of sophistication. cialists determined that a certain amount of core information should be learned by stu- Logical Sequencing of Material dents during the clerkship. The traditional lecture was considered an inappropriate Early investigators who prepared pro- means of imparting that information, and grammed materials pointed out the im- 104 Biomedical Communications

CASE PROBLEM 1 22-year-old gravida 1 para 0 white female at term. Past history: uneventful. Antepartum course: uneventful. Pelvis: adequate gynecoid clinically. Contractions began, six hours prior to admission but were somewhat irregular and between 7 and 20 minutes apart. During the hour lower case p.t.a. contractions are every 5 minutes, lasting 30-35 seconds. On admission the EFW is 7#, cervix 100% effaced, 4 cm. dilated and the vertex is at station 0 with membranes intact and bulging slightly. Fetal heart is heard at 144 in RLQ. 1. What is your impression of this patient?

1~Tr1-tUL~ ~.t Page 58 2. uh:!h ol the following besb describes this patient? A primigravida with uterine dysfunction go on to page 59 A primigravida in the late latent stage go on to page 60 A primigravida in false labor go on to page 61 A primigravida with cephalo-pelvic dispropor- tion and dystocia go on to page 62

Page 59 A PRIMIGRAVIDA WTIH TUTERINE DYSFUNCTION Uterine dysfunction may be of the hypertonic or hypotonic variety. In the former, contractions are strong and frequent and may be accompanied by evidence of fetal distress. In the latter case, contractions are usually poor and irregular and are associated with failure of progress in dilatation. This patient has not been observed long enough for such a diagnosis, but on the basis of facts given, she is probably not a problem of uterine dysfunction to this point. Ref. Williams' Obstetrics, p. 823-837, then go back to page 58 and select another possibility

Page 60 A PRIMIGRAVIDA IN THE LATE LATENT STAGE The best bet on the basis of the data given. The head is engaged, all anatomical relationships are probably normal, and the labor seems to be progressing as one would predict. go on to page 63

Figure 1. Sample questions and pages from the Stenchever-Kitay workbook (29). Some Implications oJ Research 105

portance of logical sequencing in arrange- method after the conclusion of his formal ment of information. Difficulties arose, education. however, when it was realized that the se- The use of the computer to prescribe sequence considered logical by the subject- quences of instruction is now under inves- matter specialist was not always the same tigation. Using the computer to prescribe as that regarded as logical by the student. instruction to fit individual needs is some- Branching programs of the multiple-choice what different from the concept of com- type were included in early attempts at puter-assisted instruction. In contrast to flexibility in the sequence of presentation. computer-assisted instruction, in which the Students who readily grasped the material student may spend long periods of time at could proceed directly through the program a computer terminal at an almost prohibi- with little or no remedial help. The student tive cost, computer-prescribed instruction who made an incorrect response was re- requires minimal computer time per stu- ferred to a frame that "told" him he was dent. The computer can administer diag- incorrect. An explanation was provided; nostic tests, keep a running record of a stu- then he was sent back to the original frame dent's progress, and prescribe sequences of to select another response, hopefully the self-instruction on an individual basis. In- correct one. When branching programs are dividual prescription of instruction has compared with linear programs, results been described by Glaser (9), Flanagan have shown no large differences in student (6), Kooi (13), Silberman (26), and others. learning (15, 25). Although material can be sequenced ac- Feedback of Information cording to several different schemes, it is the sequence viewed as logical by the learner that probably has the greatest Many writers, in discussions of the feedback of information validity. A necessary corollary is the value to students, try to equate feedback, or knowledge of results, of testing instructional materials before with reinforcement. If reinforcement is de- publication. Lumsdaine proposes such an fined as making the occurrence of a given approach, which he calls product-testing response more probable, then under some (16), sometimes referred to as formative conditions when a student responds cor- evaluation by other writers. He cites, how- rectly to a question and receives immediate ever, the scarcity of studies that report confirmation, reinforcement may be said to student learning improvement from one have occurred. Annet (2) and others, on version of the program to the next. One ob- the other hand, have raised questions about stacle to prepublication product-testing is equating knowledge of results with rein- that it significantly increases the total pub- forcement. The positive effects of feedback lication cost. on performance and learning are probably Mager reported (20) an approach that dependent upon the type of task required placed the learner in the position of gener- and the level of the learner. If involve- ating his own sequence. If the student ment of the learner with a problem is held knows what is expected of him and where at a high level, it may be necessary to with- he is, he is perhaps the person best able to hold knowledge of results for a finite period. determine the sequence of instruction. This In a recent study, Daniel (4) compared two approach has a certain appeal, in that the groups of students who took an achiev.. learner will need to apply precisely this ment test after instruction in experimental 106 Biomedical Communications psychology. One group was immediately relate the principles of instruction described given the correct responses on the test; the above to the design and preparation of a other group did not receive the proper re- complete teaching unit. The subject is con- sponses until 24 hours later. Both grouips genital heart disease as taught to second- were tested again one week later. Although year medical students during a period of it might have been predicted that the approximately nine hours. The program of group that received immediate feedback instruction was prepared in conjunetion would show the greatest gain on the post- with Dr. Jerome Liebman, a pediatric car- test, this was not the case. The students diologist. Congenital heart disease had tra- who received the delayed feedback scored ditionally been taught by lecture and labo- significantly higher. When one observes ratory demonstration. A brief description the amount of student interaction in the of the material prepared for the new pro- hall outside the classroom after a "good" gram is included, to show how certain prin- examination, this result is not surprising. ciples were applied to transform the in- Sustained involvement appears to increase structional system in order to incorporate the retention of information. intensified student participation and to en- When one extrapolates the research on courage in the student the responsibility to participation and feedback to the develop- learn on his own. ment of instructional materials, it becomes 1. Objectives. Each student received a evident that these are vital factors to con- five-page outline of objectives that included sider in the technology of displays of mo- a clear-cut description of what the student tion picture and television. If these media should be able to do upon completion of the are treated as just another means of "spray- unit. At least one example of test questions painting" the student with information, was included for each objective. Answers then we are guilty of limiting the use of to these questions were not made available this technology to didactic methods. Films to the student. He had to seek the answer that show phenomena without an interpre- on his own. The rationale was that if a tive sound track can be used effectively to student could answer these questions he increase participation between students and would know that he had attained a satis- teachers and to provide feedback on ques- factory level of competency. A sampling tions that concern the student. Examples of the objectives and questions follows: are some recent films produced by the Edu- cation Development Center in Boston. Re- Example of Congenital Heart Disease Objectives search indicates that television and motion pictures can be used appropriately to re- Given data on the catheter position, blood quire student participation through discus- oxygen saturation, and the pressures, the stu- sion or programmed instruction, accom- dent should be able to: panied by adjudication of responses. Smith A. State the anatomic diagnosis. discusses, in great detail, the value of feed- B. Describe the degree and direction of any back in instructional systems (27). existing shunt. C. Predict other pressures and oxygen satu- rations not given. A Sample Program Example of Congenital Heart Disease Test A study under investigation at the School Question of Medicine of Case Western Reserve Uni- A 25-year-old male had cardiac catheteriza- versity will be described in some detail to tion. The catheter was passed through the right Some Implications of Research 107 brachial vein into the superior vena cava, right writing and distributed to students as un- atrium, right ventricle, and pulmonary artery. knowns. Each case problem included 10 to Data were: 20 questions for students to answer. The Oxygen Catheter correct responses to these problems were saturation tip mm Hg (per cent) position pressure available at the end of each case. The stu- 70 Superior vena cava m=3 dent was encouraged not to "peek" at the 70 Right atrium m=3 answers until he had worked through the 80 Right ventricle 100/3 80 Pulmonary artery 20/3 case. At the end of each case, the student 98 Brachial artery 120/80 was instructed to view a cineangiogram to The diagnosis is: confirm his diagnosis. The cineangiogram 1. Anatomie diagnosis was a short (10 to 20 second) motion pic- 2. Physiology, including direction of shunt_ ture which showed the injection of radio opaque dye into various chambers of the 3. Characterize the probable pulmonary vas- heart. The motion picture was prepared as cular bed an 8-mm continuous-loop film in a cart- 2. Lecture material. Information tradi- ridge for use on a technicolor projector tionally given in four one-hour lectures was without sound. Students were able to stop distributed in syllabus form to the students the film or advance it one frame at a time. two weeks prior to class instruction. These Since the film was an endless loop, it could printed lectures gave details of the basic be viewed any number of times with mini- pathology and physiology of congenital mum inconvenience. The vigorous nature heart disease. Professors were thus no of the students' discussion as they at- longer committed to dispensing a stream of tempted to solve the case problems with the information during the scheduled lecture cineangiograms was evidence of their ex- periods and could devote time to answering tremely high involvement with this mate- questions and discussing unknown case rial. It was apparent that students partici- problems that are described below. In an- pated actively in the process of solving ticipation of possible student queries, basic clinical cases. diagrams on heart physiology were pre- 5. Slides with script. Slides (35 mm), pared on overhead-projection transparen- with descriptive material, were supplied on cies. Many students did not attend the two topics, Cardiac Catheterization and scheduled question-and-discussion periods Pathology of Congenital Heart Disease. since they were satisfied with their compre- The slides were encased in a Carousel pro- hension of the material and preferred to use jector and made available to students in the the time in other ways. laboratory in a rear-screen projection sys- 3. Motion picture film. "Roentgen Anat- tem. Although this projection system could omy of the Normal Heart," prepared by have been controlled by an audio tape that Dr. Mason Sones, Jr., was an 8-mm con- advanced the slides automatically, this tinuous-loop film, with sound, for use in a method was not used because it might have cartridge in the Fairchild Mark IV projec- inhibited discussion by the students. It had tor. Two copies of this film were placed in been observed in preliminary trials that, the laboratory for students to view at their while students read the script and looked convenience as reference materials. at the slides, they discussed the material 4. Case problems. Six case problems on and occasionally drew on the chalk board. congenital heart disease were prepared in An audio presentation with the slides, it 108 Biomedical Communications was felt, would discourage this type of In summary, there was a conscious, con- response. sistent effort throughout the planning for 6. Laboratory. The pathology laboratory this unit to relate programmed instruction period was structured around a television principles to the production of instructional demonstration of common congenital heart materials and the arrangement of learning defects, allowing close-up magnification of experiences. The student was told the ter- the method of examining the heart. After minal behavior expected of him; active par- the demonstration, small groups of students ticipation was included; the student de- examined gross specimens themselves. This cided the sequence for use of the material was a "view it, then do it" type of exercise. and set his own pace; and the student him- Clear presentation, followed by individual self could know where he was and how he participation, appeared desirable. was doing.

REFERENCES

(1) Allen, W. H. Research on film use: student (12) Jaspen, N. Effects on Training of Experi- participation. Audio Visual Communica- mental Film Variables Study II: Verbali- tion Rev 5:423, 1957. zation, "How it Works," Nomenclature, (2) Annet, J. The role of knowledge of results Audience Participation, and Succinct in learning: a survey. In Educational Treatment. SDC Technical Report 269-7- Technology. New York: Holt, Rinehart 11. Port Washington, N. Y.: Special De- and Winston, 1964, p. 279. vices Center, 1959. (3) Bloom, B. S. (ed). Taxonomy of Educational (13) Kooi, B. Y. Definition of course objectives Objectives, Handbook 1: Cognitive Do- and preparation of diagnostic tests for main. New York: McKay, 1956. IMS. Paper presented at the American (4) Daniel, K. B. The effects of immediate and Educational Research Association Con- delayed reinforcement treatments with reference, Chicago, 8 Feb. 1968. spect to knowledge of test results. In H. (14) Lange, P. C. (ed.). Programmed Instruc- Hausdorff (ed.), A.E.R.A. Paper Abstracts. tion, The Sixty-sixth Yearbook of the Washington: American Educational Re- National Society for the Study of Edu- search Association, p. 158. cation. Chicago: University of Chicago (5) Evans, R. I. Resistance to Innovation in Press, 1967. Higher Education. San Francisco: Jossey- (15) Lumsdaine, A. A. Instruments and media of Bass, 1968. instruction. In N. L. Gage (ed.), Hand- (6) Flanagan, J. C. Program for learning in book of Research on Teaching. Chicago: accordance with needs. Paper presented Rand McNally, 1963, p. 583. at the American Educational Research (16) Lumsdaine, A. A. Mass Communication and Association Conference, Chicago, Feb. 1968. educational media. Ann Rev Psychol (7) Fry, E. Teaching Machines and Programmed 16:475, 1965. Instruction. New York: McGraw-Hill, (17) Lysaught, J. P., and C. M. Williams. A 1963. Guide to Programmed Instruction. New (8) Glaser, R. (ed.). Teaching Machines and York: Wiley, 1963. Programmed Learning, II. Washington: (18) Lysaught, J. P. (ed.). Programmed In- National Education Association, 1956. struction in Medical Education. Rochoster, (9) Glaser, R. Adapting the elementary school N. Y.: Rochester Clearinghouse, 1963. curriculum to individual performance. (19) Machiavelli, N. The Prince. New York: Proceedings of the 1967 Invitational Con- New American Library, 1962, p. 49-50. ference on Testing Problems. Educational (20) Mager, R. F. On the sequencing of instruc- Testing Service, 1968, p. 3. tional content. Psychol Rep 9:405, 1961. (10) Ham, T. H. Research in medical education (21) Mager, R. F. Preparing Instructional Objec- participation of faculty and students. Ann tives. Palo Alto, Calif.: F. P. Pearon, NY Acad Sci 128(Art. 2):501, 1966. 1962. (11) Hilgard, E. R. Theories of Learning. New (22) Reid, J. C. and D. W. MacLennan. Research York: Appleton-Century-Crofts, 1956. in Instructional Television and Film. Some Implications of Research 109

Washington: Government Printing Office, Design. New York: Holt, Rinehart and 1967. Winston, 1966. (23) Saettler, P. A History of Instructional Tech- (28) Staats, A. W. Human Learning. New York: nology. New York: McGraw-Hill, 1968. Hiolt, Rinehart and Winston, 1964. (24) Schramm, W. Learning from instructional (29) Stenchever, M. A., and D. Z. Kitay. Work- television. Rev Edue Res 32(2):156, 1962. book in Obstetrics and Gynecology: La- (25) Schramm, W. The Research on Programed bor. Unpublished manuscript, 1967. Instruction: An Annotated Bibliography. (30) Taber, J. I., R. Glaser, and H. IHI.Schaefer. Washington: U.S. Office of Education, Learning and Programmed Instruction. 1964. Reading, Mass.: Addison-Wesley, 1965. (31) Tyler, R. W. New dimensions in curriculum (26) Silberman, H. F. Design objectives of the development. Phi Delta Kappa, Sept. 1966. instructional management system. Paper (32) Wilds, P., and V. Zachert. Applications of presented at the American Educational Gynecologic Oncology. Springfield, Ill.: Research Association Conference, Chicago, Charles C. Thomas, 1967. 8 Feb. 1968. (33) Wilds, P., and V. Zachert. Essentials of (27) Smith, K. U., and M. F. Smith. Cybernetic Gynecologic Oncology, 2nd ed. Springfield, Principles of Learning and Educational Ill.: Charles C. Thomas, 1967. APPLICATION OF LEARNING RESOURCES IN THE VETERINARY CURRICULUM

ROBERT GETTY, D.V.M., M.S., PH.D.*

Within the past two decades the scope of six years. The majority of students spend veterinary medicine has been broadened more time in the academic environment, to include many new courses in the curric- and a lifetime of learning is universally en- ulum in addition to the time-honored study dorsed in principle, if not in fact. Every of such basic courses as anatormy and phys- fleld neeus more trained bteaeiiers ald per- iology. New courses are continually being sonnel, and certainly medicine and public added to the curriculum and existing health are not exceptions. Continuing edu- courses are being expanded. More and more cation is equally vital. students must be taught with little increase In recent years there has been an in- in available manpower. In addition, we creased demand for veterinarians trained in must fit into the same time allocation vast public health and preventive medicine. amounts of new material. Faced with simi- Human health and welfare are dependent lar educational problems, the armed forces, upon an adequate food supply. Thus, the industry, and educators in other fields have veterinarian has a dual responsibility, both met this challenge by instigating various economically and toward his fellowman, for visual and audiovisual methods of presen- his efforts are also concerned directly with tation (1, 2). Computers and other elec- human health problems. Consequently, tronic systems for retrieval and correlation there will continue to be a great demand of stored information are now occupying a and a need for more individuals trained not dominant position in the broad concept of only in veterinary medicine in general but, automation. Their application in medicine more specifically, in veterinary public is increasing. However, in this paper I shall health and preventive medicine. confine my remarks to the various audio- Two questions can logically be raised: visual methods of presentation available, How can we meet this challenge? And how rather than discuss data retrieval systems we go about finding the means, the money, in general. the men, material, and motivation to ac- For the past 50 years medical education complish our goals and objectives? and veterinary medical education have pro- gressively raised their standards. Formal Audiovisual Aids medical education and training now requires a minimum of seven years and vet- To remain within the confines of my erinary medical education a minimum of topic, I shall first list the audiovisual aids that we have at our disposal and mention *President, Audiovisual Conference of Medical and Allied Sciences, Chairman, Audiovisual Com- certain advantages of a few: mittee, College of Veterinary Medicine, and Pro- fessor and Head, Department of Veterinary Anat- 1. Old-fashioned blackboard and chalk omy, Iowa State University, Ames, Iowa. 2. Overhead projection 110 Application of Learning Resources 111

3. Color pictures the newer concepts that utilize audiovisual 4. Three-dimensional camera and slides devices for individual 5. Plastic-mounted specimens self-instruction. The 6. Corrosion specimens student can set his own pace if physical 7. Dry specimens plant facilities, such as carrels equipped 8. Moist specimens with modern audiovisual self-instructional 9. Sound films hardware and software, are available (6). 10. Polaroid transparency systems 11. Microprojection Before discussing the newer audiovisual 12. Television media in detail, it would be remiss not to emphasize again the fact that many of the It is interesting to note that I listed these visual aids that are now at our disposal same audiovisual aids in 1956 in a paper have been readily available for many years, entitled "Teaching Aids in Veterinary but unfortunately their true potential has Medicine" (3). I also discussed some of not been fully exploited (7). the advantages of these visual aids in 1954 The infrequent use of the overhead pro- in a paper entitled "Visual Aids and Their jector is a good example. In spite of the Application to the Teaching of Veterinary many advantages of these projectors, there Medicine" (4). I mention these previous are those who shy away from them simply presentations to emphasize the fact that because they do not know all that can be many of the visual aids that are being done with them. Others who do use them discussed today in educational cireles were fail to recognize the full extent of their available 15 and even 20 years ago. Rela- versatility. With the use of an overhead tively few new teaching devices have be- projector, for example, radiographs may come available in recent years, namely, be projected. Overlays may be made in videotapes, cartridge film, and the cartridge different colors, thus building up a detailed projector, which can be synchronized with concept such as the ascending and descend- a standard tape recorder. ing tracts of the spinal cord. The overhead Before discussing the merits of the older projector enables the speaker, while he so-called multimedia approaches to audio- talks, to create visuals that are immedi- visual education and the advantages of the ately enlarged and projected on a viewing newer hardware, we should ask ourselves screen. The illuminating system is such why we continue to suffer from the century- that one can leave the lights on in the room old predominance of the spoken word in the and still obtain satisfactory projection. usual teacher-student classroom lecture The operator can face the audience while procedure. presenting his material. The instructor can One educator has indicated that there draw or write on a cellophane roll and have is a strong alliance by the students as the image of what he is writing or drawing well as the staff and the administration to projected on the screen. The projected adhere to the old. This may have been drawings can be used as negatives for the true in the past, but the present generation printing of pictures and graphs, which can of students-even medical students-now be passed out to the student during the reject this passive role. They demand the lecture or used in continuing education. right to participate in educational decisions Thus, the student or practitioner has a and policy-making (5). The students of permanent, accurate record of the drawing. today want to take an active part in their This saves the student the time that would own education. This changing attitude is, otherwise be spent in copying the drawing in itself, a compelling reason for the use of from the blackboard. There are many other 112 Biomedical Communications relatively inexpensive visual aids whose of existing facilities and in the use of multi- true potential has not been completely ex- media devices for large and small groups ploited. and individual learning situations. These Even colored movies and three-dimen- workshops could discuss photography, sional pictures are not beyond the realm closed circuit television, programmed learn- of the average departmental budget. We ing material, videotapes, and the proper have been producing our own movies for and effective use of the time-honored 2 x 2" years in the Department of Veterinary lantern-slide projectors and movie projec- Anatomy at Iowa State University on what tors. The net result, I believe, would be a we consider to be a shoestring budget, and better appreciation of biomedical communi- yet the movies have not only been well cations in general and an upgrading of received in our own University but have education at all levels. The multimedia been purchased by fellow institutions, approach to education, while not a substi- translated into several languages, and tute for the good teacher, should and can shipped abroad, which certainly indicates be used to improve the level of teaching the need for material of this type. One does by reaching larger audiences miore effec- not have to have a budget of $30,000 or tively and efficiently. We have the hard- $40,000 to make a single movie or an audio- ware; it is only a matter of knowing how visual aid. Our films were made at a cost to put it to good use. of approximately $300 each (4, 8, 9, 10). A second factor to consider is the lack It is quite evident that we have had at of software. This situation could be im- our disposal for many years ample visual proved if workshops were conducted in this aids and the hardware that would lend itself and other countries. With an increased to alleviating some of the problems that realization of the many values and poten- have been raised in recent years because tials of the hardware in existence, more of the information explosion and the mas- and more time could be spent in the pro- sive amount of material that must be as- duction of software. similated in formal education in shorter periods of time. Until our faculties and Core Material and Integration administrators fully appreciate and recognize the value of modern biomedical com- The basic concept of modern teaching munications technologies, we will continue emphasizes the need for conceptual meth- to suffer from not employing to the fullest ods of teaching broad principles-or core extent the technology that is at our dis- material. Gaps must be filled in by newer posal. I feel that the inertia in this area and different teaching methods. The in- is due to a lack of knowledge. tegration of subject matter can, in many instances, be accomplished with programmed material as well as with concept Workshops films and videotapes. The need for additional staff and larger budgets to prepare In order to remedy this situation in part, and obtain this material is evident. I propose that workshops be set up at individual professional schools about the coun- SeparateDepartment of Biomedical try and, hopefully, within each veterinary Communications school-during which the staff, students, and administrators (and practitioners as It is hoped that all U.S. colleges of vet- well) would become educated in the use erinary medicine will soon have a depart- Application of Learning Resources 113 _ _~~~~~~~~~~~~~~_~ ~ ~~ ment of biomedical communications. Many review material, to correct errors in his of our health-related professions have for thinking which might be revealed by ex- a long time recognized the need for such aminations, and actually to assume re- departments. Dr. Ian C. Bennett, speaking sponsibility for his own education. The at the Ninth Annual Meeting of the Council student's dependence on repetition in for- on Medical Television in New York City mal lectures would be nullified in time by in May 1967-on "Why a Division of the realization that his progress is largely Communication in a Medical Center?"- his own responsibility and by putting at stated that 25 out of the existing 88 medical his disposal at all times of the day this schools then had a medical communications Learning Resource Center, which would expert and a division of medical communi- permit him literally to dial information cations. from a retrieval center encompassing visual In our opinion (6, 7, 9), this department aids of all types. should be charged with the responsibility of developing audiovisual material and Anatomy Teaching Modules stimulating the use of audiovisual equipment as well as aiding in the technical and professional aspects of visual aids in gen- I would like to discuss briefly my concept eral and television in particular. The of an anatomy teaching module and its establishment of such a department would integration into the over-all biomedical facilitate undergraduate, graduate, and communications approach to veterinary continuing education in our veterinary education. This particular module (Figure schools. In many medical schools, the di- 1) is for 20 students and one instructor and rector of such a program is listed as the could be used for many disciplines in both Dean of Medical Communications. His undergraduate and graduate teaching. The staff should include a full-time artist, a room is designed to accommodate students professional photographer, computer and studying both macroscopic and microscopic data retrieval experts, and assistants with anatomy. The installation of TV monitors Ph.D. degrees in education. and a two-way audio system would enable the instructors in the module to communicate with the professor who presents the Learning Resource Center demonstration from another portion of the medical complex. The student can direct With the possible advent of new physical questions either to the instructor in his plant facilities at Iowa State University, module or, by way of the audio system, to it is hoped that a Learning Resource Center the demonstrator himself. Combining the will be built which will utilize and capi- teaching of both macroscopic and micro- talize on the many available and newer scopic anatomy in one module will save not facets of audiovisual education. This only space but also money and, in addition, Learning Resource Center should be com- will provide a more effective and efficient posed of rooms in which the student can, means of presenting the material. on his own time, use any and all available visual and audiovisual aids such as concept films, videotapes, and programmed mate- Closed Circuit Television and Videotapes rial. It would be a library of visual and audiovisual aids instead of textbooks. This The closed circuit TV arrangement would would allow the student to preview and include the use and preparation of video- 114 Biomedical Communications

Figure 1. Proposed teaching module for a department of veterinary anatomy (gross and microscopic).

tapes for the teaching of both macroscopic and apply that knowledge. This is not and microscopic anatomy. We already are because of a lack of technology with which utilizing this method at Iowa State Uni- to move information but rather because the versity in the Department of Veterinary new tools are not being employed. I would Anatomy (6). The videotapes for the les- concur with this statement completely and sons (or at least the core material) of each add that veterinary medicine, in my opin- subject would be shown during classroom- ion, should lead in the use of audiovisuals, teaching time and would also be available since it is concerned with more than half a for student use in the carrels that are to be dozen species, whereas the other health- built in our audiovisual research center. related sciences are concerned primarily The role of television in medical educa- with only one species-man. Thus, in one tion has been clearly outlined and de- respect, time is a greater factor in the fined (11, 12, 13), and the general field of teaching of veterinary medicine. It is im- biomedical communications, its problems perative that our veterinary colleges and and its resources have been summarized in our state and national organizations catch excellent fashion by Lieberman (14). In up with the other health-related sciences in his introductory remarks, made at a con- educational methodology (15). I have preference on this subject, Dr. Lieberman sented possible solutions to some of these stated: "In the field of medicine, man's educational problems in several publica- discovery of knowledge threatens to bog tions (7, 9). The use of television in teach- down because of unequal efforts to assess ing large university classes has been well Application of Learning Resources 115 -

described by Drs. Roberston and Pyke (16). cerned about the possibility of destruction Winifred Hector (17) discussed the theory of expensive equipment or film, since car- of programmed learning, emphasizing that tridge film is almost foolproof. There is no the student should progress at his own speed film threading or rewinding, and one can and respond actively at every stage in order change the film in a matter of seconds. The to demonstrate his understanding of each small Technicolor Super 8 Instant Movie step in the logical sequence of the lesson; Projector also lends itself to self-instruc- Hector concludes that learning must take tional procedures. place at the student's own pace and out- As the cost of videotape recorders con- lines the steps necessary to present a lesson tinues to decline, the simple storage of un- in programmed learning. usual or complicated demonstrations (sea- Dr. Novak, in the opening speech to the sonal syndromes, rare clinical cases, animals Audiovisual Conference of Medical and showing toxicity symptoms, etc.) may be Allied Sciences held in Washington, D.C., captured on film and placed on tape or on in 1966, pointed out that individualized cartridge films, to be rerun at a later time study units with integrated multimedia by the staff or the student, or shipped to presentations produced a higher achieve- other areas of the world. Dangerous, com- ment level than did conventional labora- plicated, or time-consuming demonstrations tory presentations. This was attributed to need only be performed once if they are the fact that students were able to control captured on videotape. In a matter of their own rate of learning through the com- minutes material can be demonstrated that bined facilities of closed circuit TV, indi- would ordinarily take hours of preparation vidual audiotaped lessons, 8-mm loop films, and many hours to demonstrate to small printed study guides, and small-group semi- groups of students. The integration of pre- nars. The integrated approach to learning clinical and clinical subject matter can in with emphasis on independent study has many instances be brought about by pro- also been evaluated by Drs. Postlethwait, grammed material, concept films, and Novak, and Murray (18). videotapes.

Cartridge Film Projectors and Audiovisual Classroom without Walls Tapes There is a saying that we now have class- In my opinion, two of the most significant rooms without walls. This is a reference audiovisual innovations since the 1950's not only to open and closed circuit TV but have been the development of the cartridge also to the fact that videotapes can now be film projector and the development of sent by mail to various parts of the state, audiovisual tapes. Movable audiovisual the country, and the world. In March 1968 tape recorders are now available at prices videotape classroom lectures were initiated within the reach of many university depart- at industrial sites in many cities of Iowa ments. where engineers and industrial managers The advantages of cartridge projectors were attending the lectures as graduate and films lie in the fact that the student students of the Iowa State University Col- both in the classroom and in the field can lege of Engineering. The courses were given project short concept films at a time and through videotape instructional television in place of his own choosing. The staff and combination with direct telephone hookup administration does not have to be con- with the instructor on the Iowa State Uni- 116 Biomedical Communications versity campus. Closed circuit television questions can be asked. Another method and videotapes had been utilized for partial would be to ship the tapes out on a weekly presentation of many courses at Iowa State basis, followed by a visit of the extension University for some time, but this was the veterinarian (or the instructor or professor first time that a complete off-campus course in charge of the course), thus updating vet- had been offered in this way (19). Another erinarians throughout the state on newer course (Nutrition during Human Growth methods of treatment, diagnoses, surgical and Development) was offered by the Home procedures, and public health problems. Economics Department, using a similar The time may not be too distant when combination of videotape and telephone, the practicing veterinarians in the field, as well instructor visiting the off-campus site at as those in governmental and other institu- least once a week. The fact that the small tional positions, can take many courses for Ampex 1-inch tape recorder, which is com- credit which must now be obtained by per- patible with all Ampex tapes and which sonal attendance and on-campus residence. sold (in 1968) for $995, weighs only about The fact that Colorado has now declareud 60 pounds make this type of extension the entire state a residence campus for teaching possible. The advantages of such videotaped courses indicates a trend which a system are as follows: will probably be accepted state by state 1. The tapes can be made on the campus throughout the country. in black and white or in color (if the more Audiovisual education has grown beyond expensive Ampex tape recorder is avail- the classroom stage. It has spread from able). university campuses to the countryside and 2. The viewing audience is not required to communities throughout the nation. With to listen to a certain closed circuit TV the growing availability of audiovideotape hookup at a specific time (or at a particular recorders and the production of more audio- place); videotapes can be sent anywhere for visual educational material by properly use by any audience. trained and audiovisual-oriented college with the blessings of college ad- 3. The material can be repeated several personnel, times in one day or several times during the ministrations and (hopefully) the financial week for those who may have missed one assistance of both state and Federal govern- or more lessons. ment, all the health-related professions will be able to remain abreast of the constantly It is my understanding that the entire changing modern health sciences. State of Colorado has now been classified as a residence campus for the use of videotapes and that credit is now being given in Distribution of Audiovisuals on a World- many courses at the Master's level for this Wide Basis type of teaching (19). In our own profession of veterinary medi- It seems reasonable to hope that, within cine it requires but little imagination to the near future, television monitors, video- foresee the time when much short-course tapes, and cartridge films will be as common material, including courses for credit, will to the teaching process as the blackboard be placed on tape and mailed to area exten- or the textbook. The following four-part sion offices or hand-carried by extension proposal, which I made at a meeting of the veterinarians to regional veterinary associa- Association of Land Grant Colleges in Den- tion facilities, where they can be shown and ver in 1956 and subsequently published in Application of Learning Resources 117 the Association's Proceedings (3), is as tive medicine can be distributed to those applicable today as it was in 1956. countries and areas that the World Health 1. Perhaps it would be wise if all colleges and Organization deems most appropriate. The universities would have a committee or depart- old saying that "the sky is the limit" may ment of medical communications charged with be literally true, for the time is near when the responsibility of developing and stimulating commercial and noncommercial educational the use of audiovisual equipment, films, etc., at programs will be transmitted across the their disposal in their respective institutions. 2. Perhaps a quarterly or biannual newsletter, country and around the world by means of circulated to various institutions throughout the satellite television systems. In many in- country by a central agency such as the Ameri- stances, this would eliminate the necessity can Veterinary Medical Association, could keep of personnel spending many months or us abreast of new films, contemplated and in years as technical advisers in other parts of production, and the availability of 2 x 2" lantern slides, kinescopes, and other audiovisual aids and the world. tools. Audiovisual material produced for the use 3. Perhaps the publication and circulation of of one college could be translated into any an audiovisual handbook enumerating the audio- language and sent to any country which available in the field of veteri- visual materials its nary medicine would prove useful. The selec- does not have the hardware to produce tion, evaluation, and proper utilization of the own audiovisual materials. The already numerous multisensory materials available could existing system of international cooperation be outlined and emphasized. It is hoped that between colleges could be extended, or even prove helpful to both this information would so that, instead of sending administrators and teachers. slightly revised 4. It seems imperative that we evaluate the technical advisers out of the country at present audiovisual methods now at our com- considerable cost, audiovisual materials mand and appraise their strength and their made for the use of a university in this as they contribute to our own uni- weaknesses could be converted and translated versity educational program. country by that university (or the World Health I believe that the above recommenda- Organization) and sent to a sister university tions, which I made over 12 years ago, are in another country. By using tapes easily still worthy of consideration. In fact, we made on inexpensive portable tape re- need only add that today the above sug- corders, specific questions and on-the-spot gestions are applicable not only on the state forth and national levels but on a world-wide advice could be conveyed back and basis. via the mail. With the advent of the cartridge film and Unquestionably, the need and the chal- cartridge film proj ectors and with the avail- lenge are here, and our only deterrents are ability of videotapes and lightweight, mov- our lack of vision and the lack of funds at able videotape recorders, the most recent our disposal to explore these challenges and developments in public health and preven- their many far-reaching ramifications.

REFERENCES

(1) Bildersee, M. U. Closed-circuit TV in Dar- (3) Getty, R. Teaching aids in veterinary medi- ien. Educational Screen and Audiovisual cine. Proc Ass Land Grant Colleges 70-71: Guide 43:644, 1964. 383, 1956-57. (2) Borza, J. Locally produced films do double (4) Getty, R. Visual aids and their application duty in Cleveland. Educational Screen and to the teaching of veterinary medicine. Audiovisual Guide 43:646,1964. Iowa State Univ Vet 17:33, 1954-55. 118 Biomedical Communications

(5) Sanazaro, P. J. Emerging patterns in medical with CCTV. Visual Sonic Med 2(5):16, education. Mayo Clin Proc 42:777, 1967. 1967. (6) Getty, R. The multi-media approach to (14) Lieberman, J. (ed.). Biomedical communi- veterinary education. J Amer Vet Med cations: problems and resources. Ann NY Ass.q150:74, 1967. Acad Sci 142(Art. 2) :335, 1967. (7) Getty, R. New audiovisual methods in vet- (15) Getty, R. Report to the A.V.M.A. of the erinary medical education. Iowa State 14th annual meeting of the Audiovisual Univ Vet28:113, 1966. Conference of Medical and Allied Sciences. (8) Getty, R. Recent developments in veteri- Proc Business Sessions, A.V.M.A. Annual nary anatomy at Iowa State University. Meeting, Dallas, 9-13 July 1967, p. 65. Iowa State College Vet 16:145, 1954. (16) Robertson, G. J., and H. F. Pyke, Jr. Tele- (9) Getty, R. Possible solutions to some educa- vision in continuing medical education. tional problems in veterinary medicine. Med Biol Illus 18:4, 1968. Vet Med 61:1033, 1966. (17) Hector, W. Programmed learning and the (10) lHassen, A. New developments in anatomy at education of nurses. Med Biol Illus 18:33, Iowa State University. Iowa State College 1968. Vet 29:35, 1961-62. (18) Postlethwait, S. N., J. Novak, and IH. Mur- (11) Judge, R. D. Television: its role in medical ray. An Integrated Experience Approach education. Visual Med 1:28, 1966. to Learning-with Emphasis on Indepen- (12) Judge, R. D., and M. T. Romano. Health dent Study. Minneapolis: Burgess, 1964. Science T'elevision: A Review. Ann Ar- (19) Personal communication, J. Davis, Associate bor: Edwards, 1966. General Manager, WOI Radio-Television, (13) Audette, L. G. The teaching of anatomy Iowa State University, Ames, Iowa. THE COMPUTER FACT BANK

MULTIDISCIPLINARY LABORATORY INTERRELATIONSHIPS

FRED W. CLAYTON, D.V.M.*

The Fact Bank Project at the University permits multiple low-cost transformations of Missouri is designed to locate, mobilize, of input data. and display for members of the health team The key that unlocks the wealth of detail appropriate selections of the latest biomedi- in the Fact Bank is the unique Depth Index, cal information available. Practicing phy- or thesaurus, now under construction. The sicians and paramedical personnel alike will Depth Index will be entirely in machine- find the Fact Bank helpful (1) in improving readable form on magnetic tape and will their understanding of mechanisms and pat- display important relationships between key terns of health and disease; (2) in con- words and concepts with the aid of tributing to and stimulating their interest carefully framed definitions and word asso- in lifelong learning; and above all, (3) in ciation maps. Emphasis will be on inter- contributing to quality patient care. disciplinary usage and quantitative rela- The Fact Bank itself is an open-ended tionships. collection of several hundred thousand Several rich sources of condensed medical pages of selected current facts, definitions, information are now available and will be and basic science, clinical and research in- used in constructing the Depth Index. formation. A small but exceedingly im- These include the American Medical Asso- portant portion of the Fact Bank will be in ciation's Current Medical Terminology, the machine-readable form (i.e., on magnetic National Library of Medicine's MED- tape). The major portion of the collection LARS-MESH System, and the American will at first be on 16-mm microfilm in car- College of Physician's Systematized No- tridges, or on microfiche. Any one of these menclature of Pathology, all available in pages, or any item in the machine-readable machine-interpretable form. Combined they portion of the file may be displayed auto- will furnish (1) thousands of key words and matically within a few seconds, by means of concepts; (2) important synonyms, near- existing programs with existing equipment. synonyms, and related words; and (3) When increased volumes of machine- cross-references, nomenclature code num- readable textual information become avail- bers, and hierarchical relationships. able, almost as by-products of the printing The Depth Index industry, more and more of the Fact Bank will be far more than a conventional thesaurus. It will be used as will be on magnetic tape, because this form an authorized list for indexers in indexing, * Deputy Director, Computer Fact Bank, Mis- for searchers in locating answers to specific souri Regional Medical Program, University of Missouri, Columbia, Missouri. questions, and for users generally, who. 119 120 Biomedical Communications through its use, will become aware of im- challenge him and to promote habits of life- portant new knowledge and hitherto un- long learning in his chosen profession. suspected relationships. In accordance with important require- The user will (1) enter the Fact Bank ments of the Kansas-Missouri Regional via the Depth Index, using the key word Medical Program, the Fact Bank Project or concept of his own choice; (2) be led will concentrate on information about heart rapidly to the preferred terms in the sys- disease, cancer, and (especially) stroke, tem; and (3) be shown the present word emphasizing basic medical science and clini- association map, or universe of discourse, cal and research information. It will also centering around these terms. In effect, he include representative collections on con- will be negotiating the question himself and genital, neonatal, renal, and infectious dis- will secure direct machine output when it eases, emphasizing pathophysiology and is available from machine-readable stores. causal mechanisms of disease. The indexes will be keypunched to selected A specialized collection of some 100,000 relevant literature in the microfilm collec- pages of carefuilly selected bas scierice and tion (with page numbers), which will pro- clinical information is needed to work vide additional important keywords for effectively in any major discipline, such as consideration. These keywords can be ma- pathology, or in any categorical research nipulated with the aid of such computer area, such as stroke, cancer, or heart dis- programs as B. G. Lamson's "English In, ease. The American Medical Association's English Out" system for surgical pathology. Current Medical Terminology contains Dr. Lamson's system can display hier- much machine-readable information related archical relationships, to seven levels in all, to all of these areas. We have contacted the and will accept new terms, if desired, and editors of major medical journals who seem establish links with other terms as appro- receptive to the idea of making machine- priate. readable text available for experimental In summary, the Fact Bank and its asso- uses (almost as a by-product of their pub- ciated Depth Index will enable the user: lishing processes). Our policy will be to use such sources of authentic and up-to- 1. To choose material containing answers date information on tapes to the maximum to his specific questions at the time of his extent possible, in order to permit the mul- greatest interest and clinical need. tiple low-cost transformations of input data 2. To become aware at the same time of required to assemble, condense, and inte- the availability of additional new informa- grate information from many disciplines. tion, somrne of which, perhaps, he was not For many years to come, microfilm collec- consciously seeking. tions will be needed to supplement ma- 3. To re-establish active contact with an chine-readable information, especially in ongoing information system designed to covering the older literature. AUDIOVISUAL COMMUNICATIONS

AN ACTION PROGRAM

NORMAN L. COLE, PH.D.*

Almost daily, communications problems sional persons related to the use of such are brought to representatives of the Na- materials. Instructors welcome the possi- tional Medical Audiovisual Center of the bility of using audiovisual materials to National Library of Medicine for solution. communicate routine information. They The problems are posed by professional complain that they spend so much time persons from leading schools throughout the answering such questions as "What's a United States, from schools abroad, from tibia?" that they are unable to serve the regional medical programs, or from national purpose for which the school hired them. health and medical organizations. In many Their attitudes toward communication instances, a person with great expertise in problems vary from placing the burden of his own medical specialty finds himself in a learning entirely on the student to assum- full- or part-time situation requiring coming that the student must be "spoon-fed." munications knowledge that he does not Their attitudes toward the purchase of new possess but which is necessary to solve an audiovisual equipment vary from a desire otherwise seemingly insoluble problem. Or to purchase the latest equipment without the problem may have originated with a consideration as to whether it is really national organization which, realizing the needed to a hesitancy to make any pur- magnitude of a problem in continuing edu- chases because, next year, better equipment cation, desires to reappraise its position and will undoubtedly be available. In addition, develop a plan for action. some instructors express a dislike for the The time for such action plans is now, idea of putting their presentations into and some organizations are moving rapidly audiovisual form. They do not have time in this direction. Viewing the situation for the advance planning required and occa- in toto, however, we find that there have sionally express fear of criticism that may been many plans, much talk, and surpris- result when colleagues view their presenta- ingly little action, except on an individual tions. I am not surprised at their resistance, basis. for in attempting to use audiovisuals as we The various reactions to our discussions know them today, many instructors have of audiovisuals at the National Medical met with justifiable frustration. Audiovisual Center give insight into some The instructor cannot be expected of the problems and concerns of profes- to use audiovisual material in conjunetion with * Chief, Educational Studies and Development classroom presentations unless its use is Section, National Medical Audiovisual Center, National Library of Medicine, Atlanta, Georgia. easy. He does not want the embarrassment 121 122 Biomedical Communications of mechanical failures. And, last but cer- instructor, low-level illumination for stu- tainly not least, he does not want to use dent note-taking, and access to audiovisual material that is not specifically fitted to his pnuinment when and where it ;is neededare needs. "musts." A school that wants its instructors to use On many occasions, we at the National audiovisuals should plan to provide a per- Medical Audiovisual Center have been son-other than the instructor-to be re- asked to visit schools which want an evalua- sponsible for the acquisition, maintenance, tion either of their existing facilities or of and distribution of audiovisual equipment, plans for new or modified facilities. Gen- if not also for its operation, and for the erally, when construction is contemplated, location and procurement of software such we discuss ideas and review blueprints with as films and videotapes. the architects. It would be conservative to In addition, each classroom should be so say that such a review is well worth while. designed and equipped as to provide both We find that, from an architectural and an ideal learning environment for the stu- engineering standpoint, the drawings are dent and an ideal teaching environment for well done. But the architect produces his the instructor. To some degree, most drawings from the requirements given him, schools, even the most modern, have fea- and he cannot be expected to produce an tures which we consider to result from poor adequate plan unless he is told in detail classroom design. We see these problems how each room will be used-each labora- even in the blueprint stage when plans are tory as well as each classroom-both today brought to us for review. Effective audio- and 10 years from now. Only then can he visual communication demands adequate consider the feasibility of various plans, facilities. Therefore, any plan for action such as vertical and horizontal access for at the local level should include a careful television cable. Without information as to study of learning spaces and of the require- specific needs, he can design little more than ments of those who will use them and a boxes. review of all architectural plans in progress. The question of whether it is practical to Faculty and students should not have to adapt themselves to adverse environmental produce audiovisual materials locally to and structural conditions. Rather, the meet one's own needs is not an easy one to building and environment should be adapted answer. However, it is both possible and to meet human needs and, parenthetically, practical to produce audiovisual material at there should be a functional relationship the local level with a minimum of means. among the various buildings and their parts. A plan for action at the local level should, You may be able to perform this survey therefore, include a study of the feasibility yourself, or you may wish to secure the of producing materials for use with any one assistance of an architect specially trained of the more common delivery systems. (In in classroom design. Unfortunately, there its simplest form such a plan would be are few specialists so trained. Students' concerned perhaps with slides, then with viewing angles should be checked. Both slides plus audiotapes, and so on.) acoustics and physical comfort are of major In addition to documentation of visual importance. Consideration should be given material on slides, film, or videotape, one to the way in which each room is to be might consider the possible advantage of used. Such features as console control of preparing more sophisticated productions. projection equipment and room lights by the Such productions are time-consuming, how- Audiovisual Communications 123

ever, and may require skills which the aver- faculty members. Regrettably, much of this age instructor may not have. material is not accessible to others who The instructor cannot be expected to pro- could use it. duce audiovisual material unless its pro- Its inaccessibility may be due to an duction is easy. To assist in this-and for internal communications problem-one in- other reasons stated earlier-we therefore structor does not know what another has recommend, as Dr. Getty did as far back as stored in his desk, and the students, unless 1956, that each school of veterinary medi- they happened to see the material used in cine seriously consider the feasibility of class, are also unaware of its existence. establishing a department of biomedical Therefore, in every school, we recommend communication. The staff of such a depart- expansion of the library to provide a com- ment would be competent in those skills and prehensive service for the storage and re- talents required to work with faculty mem- trieval, by both faculty and students, of bers, to analyze curriculum content and information in as wide a variety of forms as specific communications problems, and to possible. Ideally, this learning resource come up with means or products for their center should not only be staffed by at least solution. Such a department would also one full-time librarian but should be pro- serve as the focal point for ordering and vided with a mechanism for duplicating the maintaining audiovisual equipment, so as still photographs, slides, motion picture to ensure ease of operation and compati- footage, audiotapes, and videotapes of the bility throughout the school. faculty. These duplicate materials would be We envision the administrator of such an available for use on demand, with the origi- activity as having either department chair- nals protectively stored. Moreover, a cen- man status or operating out of the dean's tral card catalog would list all available office. Ideally he should have in-depth materials on a specific subject, regardless familiarity with the fields of veterinary of the medium. It would thus refer the user medicine, education, and audiovisual com- to texts, other publications, films, video- munications. Such persons are now being tapes, still photographs, etc., in a single trained in at least one graduate program. search operation. Under this administrator's supervision, as Learning resource material produced at budget allowed, would be project directors the local level might also be of use nation- and technicians with specific communica- ally. Much of it, unfortunately, is not tions skills-artists, photographers, and an available for national use. It is conceivable electronics specialist, to mention but a few. that, in individual schools of veterinary The administrator's first task might well medicine, money and time are expended be the analysis of school needs and the documenting or producing instructional exploration of ways in which the school materials of essentially the same type as might work cooperatively with other com- those produced in other schools. This dupli- munications resource persons and organiza- cation is, of course, wasteful wherever it tions within the university and community. occurs. A community medical television system To avoid duplication and provide assist- such as that in Atlanta, which utilizes the ance at the local level, any plan for action, 2,500-megahertz bandwidth, is an example therefore, should take into account the of one such cooperative relationship. problem of locating what has already been Often, excellent motion picture footage done and is being done, both locally and or slides are photographed by individual nationally, in the area of audiovisual pro- 124 Biomedical Communications

duction. I do not have even the remotest that the amount of available material which idea of the number of separate items in any would be of use to veterinarians is limited. single medium that might potentially be If such should prove to be the case, a ser- useful to veterinarians, but I assume the vice will still have been performed. Even number would be considerable. In our own a negative report regarding resource ma- experience, an intensive search for films in terial in specific subject matter areas is the area of cancer turned up approximately valuable. Until such a survey has been 1,300 titles, of which 1,200 were found to be made, we will not know what is available still available. A comparable number of and what is not and cannot be sure that films were located in the area of neurologi- time and money spent on new productions cal and sensory diseases. Whether they are will not be wasted through duplication. useful and current, one can only surmise, Perhaps a search of the type outlined for no attempt was made to review and above has already been made. To my evaluate them. knowledge, however, not even the scope of Catalogs at various levels of sophistica- such a search has been defined, or a sum- tion, and consequent usefulness, will requirc mary of subject categories outlined. evaluations of several types, varying with 2. At the next level, there is need for a the information sought: catalog of audiovisual productions being 1. At the first level, there is an urgent used in the profession and recommended as need for a comprehensive catalog of all helpful. Such a catalog could be prepared available materials in a particular subject as a result of a survey in which reporting area. Learning of such materials is not an forms might be sent to every school of vet- easy task. It requires surveying schools and erinary medicine and publie health in the producers, searching the literature, and United States and Canada. In addition to getting one's name on distributors' mailing title and description, the form could include lists. These steps only begin to solve the the information required to key the use problem. The information obtained will of the material to a specific point in the vary in format and completeness. Some- curriculum. times the information will be inaccurate; A second method of compiling a catalog sometimes the items listed will be out of of the above type would be to establish a date or no longer available. committee of subject-matter specialists to I would estimate that there are several evaluate those slides, films, and other audio- thousand audiovisual productions that, visual materials which have promising according to the standard information descriptions. Logistically, however, this is given, would appear to be of use to instruc- a time-consuming task, since someone needs tors of veterinary medicine and public to borrow the items, arrange for their re- health. The available listings of this type view, and return them to their sources. need to be assembled and put into some Evaluations of this type would be sub- sort of order. Duplicate listings, which occur jective. While subjective evaluations can when the same item is distributed and pub- be helpful, they should not be accepted licized by several sources, must be eliminated. Since many present listings describe without reservations, for they do not mea- films of peripheral interest, titles and de- sure whether the material will or will not scriptions must be culled and items of little actually be effective when used by the stu- apparent value eliminated. dents for whom it was designed. An investigation of this type might reveal 3. At the highest level, there is an urgent Audiovisual Communicattons 125 need for a comprehensive catalog in which for new production by the profession. Re- all audiovisual materials useful in veteri- view of a well-prepared catalog, in con- nary medicine and public health are ade- junetion with analysis of the total need for quately described. The instructor planning learning resource materials, would result in a series of presentations (perhaps a series a clear picture of gaps which might be filled of videotapes), the researcher wanting to through audiovisual means. Priorities could know what has already been done in a then be set and a broad coordinated produc- particular area, the practitioner with a par- tion program started. ticular problem, the student seeking infor- It will not be easy to determine those mation-all could use such a catalog. A parts of the curriculum where audiovisual catalog adequately describing educational support might be useful. I suggest, how- material should provide information that ever, that there might be merit in establish- will assist the user in judging the instruc- ing an ongoing program to identify such tional potential of available materials with areas and to produce, periodically review, his particular group. and update learning resources. This does not necessarily mean the establishment of a Who should undertake the task of locat- core curriculum, because I realize that needs ing and evaluating useful audiovisual learn- vary, but it does mean that I recommend ing resource material? It is my opinion consideration of the production, on a prior- that the individual instructor should do ity basis, of a wide variety of materials that what he can to help improve his own com- can be put into learning resource centers- munications at the local level. It is also my so that faculty and students can draw, cafe- opinion that the job of satisfying total cata- teria-style, as with texts on shelves, those loging and evaluation needs, especially as items which best suit their immediate they relate to continuing education, is too purposes. big a job for any one instructor to handle, an individual instructor will not with the limited resources of a single school. Just as to produce every text If a school cannot do the job, who can? personally attempt be useful to him, neither will he The instructor is in a better position to that will every videotape or motion analyze the curriculum, the audience, and try to produce deem useful. And the possible uses of audiovisual materials picture that he might specialists write texts in specific by his students than is a committee repre- just as they might produce other senting a group of schools or a national subject areas, specialties. The learning organization. On the other hand, a national media in their center, then, would house a com- group is in a better position to provide per- resource of productions, represen- sonnel, equipment, and time-resources prehensive series of existing opinions and methodolo- critical to the development of effective tative Thus the instructor, in planning his communication materials. A broadly based, gies. own presentation, would not be limited by well-organized, coordinated effort is the of supportive material and would have only solution to the problem. Whether such lack of material from which to draw, a time-consuming and costly effort would a wealth of any item of which might be worthwhile, only you can decide. Who the production individual resources. should take the leadership and assume the be beyond his it to responsibility? Again, only you can decide. A new day will come if we want One advantage of documenting the avail- come. There are many things possible with ability and usefulness of audiovisual ma- the technology we now have. Whether we terials is that it uncovers the possible need really want to do something about it is 126 Biomedical Communications another question. The old shoe is comfort- The plan I have suggested involves both able and can be worn as long as it holds local and national participation. Questions together. As to the age-old problem of of leadership need to be decided and courses learning, there are undoubtedly other solu- of action apped out. I hopo cducators in tions which I have not touched upon and veterinary public health and preventive of which I have not dreamed-but I do medicine will give this matter careful con- hope I have directed attention to the possible advantages of working toward the de- sideration and that, individually or as a velopment of a plan of action for the im- group, they will explore further the oppor- proved production, storage, retrieval, and tunities that will result from more intensive use of audiovisual resource material. activity in this area. Part III EVALUATION 1 EVALUATING THE STUDENT'S LEARNING

EDWIN F. ROSINSKI, ED.D.*

HOW WE DECIDE WHAT TO TEACH your attention, but these three seem to be the most significant. Before the question of objectives, or 1. Curriculum design depends on objec- deciding what to teach, is considered, a par- tives. In all the literature dealing with cur- ticular educational term must be defined. riculum development, a sina qua non of That term is evaluation. To the educator sound curriculum planning is the develop- this term has a specific meaning and con- ment of objectives. A curriculum cannot be tains certain ingredients. These ingredients designed until it is firmly decided what the are (1) objectives, (2) criteria, and (3) curriculum should achieve. Thus, an objec- measurement. Therefore, in the process of tive in veterinary medicine might be for a evaluation the first step is to decide what student to be able to integrate and corre- to teach (objectives); the second step is to late all his knowledge in physiology and spell out the standards by which these anatomy so that he can effectively utilize objectives should be achieved (criteria); it in a clinical setting. A curriculum (with and the final step is to develop the tools all its ramifications and complications) will for appraising whether the objectives are a have to be designed so as to provide this fact (measurement). kind of experience. Or, if another objective This is quite different from the normal states that a student should develop skill or lay use of the term. In its common usage in the practical application of his knowl- the concern is usually with the measure- edge in veterinary medicine, then the cur- ment or appraisal part of the term. In this riculum will have to be so designed as to paper, evaluation as defined above will serve provide opportunity for him to put into as the frame of reference. practice the knowledge he has gained in Now to consider the first part of evalua- veterinary medicine. tion-objectives-or, to state it another Obviously this point could be discussed way, how to determine what it is that our in considerable detail, but the discussion students are to achieve. To this end, several above should suffice. questions will be posed and answered. 2. Teaching methodology depends on objectives. The particular teaching materials Why Do We Need Objectives? and methods to use cannot be decided until objectives have been stated! As an ex- There are three paramount reasons why ample, if an objective veterinary medicine we need objectives. Others may come to calls for a student to develop proficiency4n *Deputy Assistant Secretary for Health Man- performing skills, obviously he will not power, Office of Assistant Secretary for Health achieve this proficiency by merely listening and Scientific Affairs, Department of Health, Edu- cation, and Welfare, Washington, D.C. to a teacher lecturing about them. True, 129 130 Evaluation some proficiency can be imparted in a lec- of veterinary medicine. Such objectives as ture, but the student will also have to see providing a lecture, a laboratory, a demon- demonstrations of these skills and have the stration, or a clinical setting, can be classi- opportunity to actually perform them with fied as objectives dealing with process. patient care. Three different kinds of teach- Process objectives are satisfied when the ing methods have been considered here be- particular teaching exercise takes place. cause of the way the objective was stated: These objectives are not concerned with lecture, demonstration, and clinical per- whether a student has actually achieved. formance. The same kind of thinking will 3. Objectives dealing with product. These have to take place when making plans on are the objectives with which all (or most) how to achieve any particular objective. teachers are concerned. They deal with 3. Appraising student progress depends behavioral changes in the student. It is on objectives. It should be obvious that universally agreed that the primary purpose what a student has achieved cannot be mea- in teaching veterinary medicine is to bring sured unless lt, is first elearly undersLood about changes in the student so that he what he was to achieve. For example, if a acquires certain kinds of knowledge, skills, student is to acquire certain knowledge, understanding, and attitudes. In short, devices to measure this knowledge will have certain changes are to occur in the indi- to be developed. If he is to develop a certain vidual by virtue of teaching-learning. skill, then ways by which the skills can be What follows deals with such product observed will have to be formulated. In objectives, i.e., the changes that occur in this case the kind of measuring device to be students. developed depends entirely on the objective. Are There Different Levels of Objectives Is There a Difference between the Kinds Dealing with Product? of Objectives We Have? To answer this question it is necessary There appear to be three major kinds of to classify objectives into specific cate- obj ectives. gories. Here, again, three classifications 1. Objectives dealing with structure. seem appropriate. These would be objectives that provide the 1. Over-all objectives. These might legiti- broad physical setting for a particular edu- mately be called institutional objectives, cational program. These types of objec- such as the objectives of a school of veteri- tives are few and encompass an entire nary medicine. Specifically, these deal with educational program. Under this heading the kind of end product a school of veteri- might be listed such objectives as: "To nary medicine wishes to produce. Usually develop an operational school of veterinary this product is a student so educated that medicine." This objective deals with merely he or she can be certified as a veterinarian providing a school of veterinary medicine. upon completion of the educational pro- This classification may seem elementary; gram. To achieve this objective, the kinds nevertheless, objectives can be classified in of knowledge, skills, attitudes, and under- this category. standing a student is to possess will have 2. Objectives dealing with process. These to be stated in general terms. While these objectives provide the particular setting in are classified as over-all objectives, they are which something will take place in a school still the concern of every teacher, for unit Evaluating the Student's Learning 131

and teaching objectives as described below for veterinary medicine, the needs of society must be in harmony with the objectives of will have to be considered. the institution. 2. The needs of the profession. Is, or will, 2. Unit objectives. These are the objec- veterinary medicine be content with merely tives of a particular department, such as producing practicing veterinarians? Will physiology or anatomy. In unit objectives there be a greater need for practitioners in a particular department refines the insti- hospitals, for practitioners in private offices, tutional objectives to an operational level. for practitioners in federally supported in- Unit objectives are an attempt to particu- stitutions, or for teachers in schools of larize the objectives stated by an institu- veterinary medicine? Is there going to be tion. A department of physiology (or an increased need for veterinarians inter- anatomy) will clearly have to spell out what ested in research, and is there going to be a it is that a student should acquire during place for technical assistants for veteri- his tenure in the department. narians? All of these questions will have 3. Teaching objectives. As teachers, these to be considered in terms of how they will are the objectives with which each of us is affect the future program in veterinary concerned. The daily lesson plan is for all medicine. The significant and crucial prob- intents and purposes an attempt to satisfy lems of the profession will have to be con- teaching objectives. Every time a teacher sidered when objectives are being devel- lectures, runs a laboratory, gives a demon- oped. stration, or teaches in the clinic, he is 3. Scientific developments. As discover- attempting to satisfy certain teaching ob- ies in medicine and medical care develop, jectives. these will have a role to play in the development of veterinary medicine programs. With the development of new drugs and How Do We Decide What Our Objectives techniques, the content of a veterinary Should Be? medicine program will depend a great deal on scientific discoveries. The contributions Again, it seems that three major factors of science must always be considered when determine objectives. Stated another way, developing objectives. there are three major sources which must be considered when developing objectives. How Can We Decide Whether Objectives 1. The health needs of society. If we con- Are "Good"? sider society in general, we can readily see that our population is growing; that it will This question can be answered only by a have a larger proportion of younger and faculty that is charged with the responsi- older citizens; that it will be highly mobile; bility of developing objectives. However, that a larger portion of our population will there are criteria that can be applied to carry hospitalization (ergo, larger numbers objectives to determine if they qualify as will be hospitalized); and that greater "good." The following questions represent emphasis on ambulatory patient care will these criteria and can be applied to any set be stressed. If it is agreed that all of these of objectives, whether they be over-all are factors of our society, then they will objectives, unit objectives, or teaching undoubtedly affect the kind of medical obj ectives. service veterinary medicine will have to 1. Are the objectives understandable?Or, provide. Therefore, in developing objectives asked in another way, does everyone know 132 Evaluation the meaning of the stated objectives? To difference in the time span. However, both types satisfy this criterion, objectives should be of objectives apply to the formal educational program. stated in such a manner that there is no Ultimately measurable. This is the most diffi- difference of opinion as to the meaning of cult type of measurability to achieve since, once the words used. This calls for the best use a student has left the confines of an educational of language so that misunderstanding does setting, it is difficult to attest whether he is not occur. The importance of this criterion actually achieving and performing that which should be obvious; if objectives are not the educational program had hoped to instill or develop in him. understood by all the faculty, then it is likely that, in teaching, members of the There is a strong relationship between faculty will be working at cross-purposes. this and the preceding criterion (are objec- What this criterion implies is that objectives realistic?). If objectives are unreal- tives should be stated in terms that mean istic, it is impossible to tell in an immediate, the same to all readers. intermediate, or ultimate setting if they are 2. Are the objectives real? Objectives actually being achieved. While ultimate should be practical. They should not deal rieasu-rei7en'i, is di"'cult to accomplish, it in sweeping generalities or in such futuristic should not be discounted. There are plenty concepts or in such altruistic ideals that it of ways in which follow-up studies can be would be impossible for any educational constructed to determine whether, in a program to achieve them. Ideals are laud- setting outside the educational institution, able and have a place in the educational a student is actually performing as he program but being too idealistic borders on should perform. As previously stated, this the unrealistic. Objectives should deal with is an extremely difficult means of measure- specifics and should, if possible, be attainment. able within the educational program. 3. Are the objectives measurable? An educational program, in order to prove its MEASURING WHAT WE HAVE TAUGHT effectiveness, should be able to produce AND WHAT THE STUDENT HAS LEARNED some data that will prove that what it set out to do has been accomplished. To achieve Before considering the measurement this, objectives should be stated in terms phase in the process of evaluation, it would that can be measured. Measurability can be appropriate to discuss the interval be- be classified into three additional categories. tween the time that objectives are stated Imnmediately measurable. At the completion and the time they are measured. of a particular teaching session, various mea- During that interval the whole teaching- surement devices can be used to see whether a learning process takes place. It is at this student has actually achieved the desired out- time that the individual teacher must decide comes. Immediately measurable objectives are on the teaching methodology he will use those that are part of the teaching objectives. Intermediately measurable. These are the to achieve the objectives, and it is then that unit objectives that can be measured at the end he must select the appropriate teaching of a particular course of study. In addition, materials to supplement the teaching meth- the outcomes of an entire educational program, odology and decide on the learning theories such as certification examinations, can be classi- most suitable for his students. In addition, fied as devices for measuring the intermediate processes of an educational program. Perhaps the teacher will have to display a sensitiv- the sole difference between immediately and ity to individual student differences and an intermediately measurable objectives is the awareness of individual student problems Evaluating the Student's Learning 133 and of all the other factors that comprise number of judges looking at the student's the educational environment. Between the response, all would have to agree as to the time that the objectives are stated and the rightness or wrongness of the answer. If time that they are actually measured, a the judges disagree, this particular test whole galaxy of teaching-learning activities item would not satisfy the criterion of takes place. objectivity. What objectivity means, then, This brief summary is not intended to is that there can be no difference of opinion minimize the effects of the teaching-learn- as to what constitutes an interpretation of ing process but merely to bring into per- an answer. spective all the other material covered at Often references are made to the terms this Symposium and how it ultimately objective and subjective. In examinations, affects the process of evaluation. No single test items also fall into these categories. entity-teaching-learning, teaching method, The usual paper-and-pencil test, consisting evaluation-is of itself the most single im- of such items as multiple-choice questions, portant factor but, woven together, these can be classified as an objective examina- entities create the pattern for an education. Essay-type or discussion examinations tional program. fall into the category of subjective because At the beginning, measurement was men- more often than not there is a difference of tioned as a part of evaluation. Another way opinion as to what should be the correct that this might be stated is that, in this response to a posed question. phase of evaluation, the concern is with Even when dealing with essay questions, appraising the extent to which students there are specific techniques that can be actually achieve the formulated objectives, used to make essay-type examinations whether they be over-all, unit, or teaching much more objective than they are at pres- obj ectives. ent. In developing test items, examina- Before deciding on a particular measur- tions, or any kind of a measurement device, ing device, it is important to consider the objectivity should always be a goal. essentials that comprise a good measuring device. These criteria, or essentials, are Practicability applicable to either a classroom or a laboratory situation. They are concerned with A synonym for practicability might be measurement per se and, as such, have economy. What this criterion means is applicability to any kind of measurement that measurement devices should not technique or device. become so elaborate, complicated, or ex- There are several criteria for a "good" pensive that the actual process of produc- measurement device: ing, administering, or scoring the examination is so time-consuming that it would be Objectivity impossible to accomplish in a reasonable time. Undoubtedly it is possible to create In interpreting the results of a test-if measurement devices that could actually the test is to be perfectly objective-there achieve all that they were designed to do, can be one and only one answer. This is but these devices would be so involved and what is meant by objectivity. If a student's complicated that their use would be quite response to a test item was made available unrealistic. to a group of judges in order to meet the Therefore, in developing a measuring criterion of objectivity, regardless of the device certain sacrifices will have to be 134 Evaluation made. Perhaps the examination cannot be device actually does measure what it is quite as objective as it might be if it were suppose to measure is a form of validity. longer and more detailed. Individual judg- If an examination in physiology is supposed ment will have to play an important role to measure understanding of physiology, in deciding what measurement devices are obviously merely looking at the examina- practicable for classroom use. tion and seeing if physiology questions are included satisfies a superficial type of validity. If the examination contains ques- Reliability tions on microbiology, it would obviously not be a valid examination because it is By reliability is meant that a measure- not measuring what it is supposed to mea- ment device must have consistency. For sure. This is a very elementary form of example, if a student took an examination validity, but it is an accepted form. on Tuesday and then took the very same There are other ways of obtaining examination on Thursday-all things being validiy, buu these are statisticai. The equal-he should obtain the same score on means of obtaining statistical validity are Thursday that he obtained on Tuesday. more complicated than those for obtaining This is what is meant by reliability. Now, reliability. But, again, they are worth because certain things do happen between investigating. the time the student takes the examinations, Once the essentials of a "good" measuring perfect reliability in educational measure- device are clearly established and accepted, ment is never obtained. All things are it is possible to consider what to measure. never equal! The goal, then, is a measure- A close scrutiny of any set of over-all, ment device that is as reliable as possible. unit, or teaching objectives reveals that To make sure that an examination device normally they deal with such areas as does approximate perfect reliability, am- knowledge, skills, and attitudes. Each of biguous statements, double-barreled state- these will be considered in turn and illus- ments, leading statements, and the like trations of the various ways in which they should be avoided. By avoiding these pit- can be measured will be cited. falls in constructing measurement devices, the reliability of the instrument is improved. Knowledge Validity The usual procedure for measuring Validity can best be defined by a ques- knowledge is through paper-and-pencil tion: Does the measuring device measure tests. These take various forms. They may what it is suppose to measure? Or, to put be essay-type or the more common "objec- it another way: What is the relation be- tive" (or multiple-choice) type of examina- tween the measurement device and its crite- tions. Essay examinations have fallen from rion? Validity, while one of the most favor in the past few years. This is an un- important criteria, is in its purest sense the fortunate development, since this type of most difficult to obtain. The more elaborate examination has a definite place in a means of obtaining validity will not be con- testing program, especially in measuring a sidered here. student's understanding. The reason they Generally speaking, making an empirical have fallen into disfavor is the poor way decision as to whether a measurement in which the essay questions were posed. Evaluating the Student's Learning 135

Often such words as "discuss," "describe," itself is not enough, since a clear delineation and "outline," are used as introductory of what is to be observed has to be formu- statements in essay examinations. The lated. Observation as a measuring tech- failure of teachers to state essay questions nique will also be discussed in greater in clear, concise terms so that a student detail in the section on skills. clearly knows what he is supposed to do These are the three major ways to mea- has also caused problems in scoring. What sure knowledge. The paper-and-pencil test one individual instructor may consider is perhaps the most practical since it pro- an appropriate discussion of a question, vides specific data about those objectives another may not. What has happened is dealing with knowledge. These testing that essay examinations have failed to be techniques have their place but should be objective. studied more carefully. To correct this situation there has been a trend in the use of objective, multiple- Skills choice questions. Multiple-choice questions In the field of physical therapy the fall into several categories: true-or-false, acquisition of certain skills is of the utmost completion, matching, or actual multiple- importance. Yet little formal effort is made choice questions, where several options or to discover whether skill objectives have choices are provided for each question. actually been achieved. These types of questions have gained in The first way to measure skills involves prominence in the past few years because, the process of observation. Normally while they are not necessarily easier to con- students are observed performing in a struct, they are considerably easier to score. laboratory or in a clinical setting, and some If well constructed, they are highly objec- generalizations as to student proficiency are tive, but even in the construction of these made, but when the teachers are asked to objective-type questions there are numerous define proficiency in finite terms, many are pitfalls which a test constructor must at a loss. It is not enough to say that an avoid. individual is proficient in, say, doing a Another way to measure knowledge is physical examination. The observer must through interview or a form of oral exami- determine what it is in a physical that the nation. The laboratory is a good example student does or does not do. of a place where interviews or questions In the final analysis, observation, in can be asked students to determine their gross terms, is not enough. The specifics level of comprehension of a particular to be observed must be listed so that a subject. Well-worded questions can divulge student's strengths and weaknesses can be more than basic knowledge. They can also pointed out to him. This may involve the give some indication of a student's level of development of some sort of rating scale comprehension and his ability to synthesize by which a student's proficiency in each of and correlate the basic information that he the skills can be checked. The more refined has gathered. the instrument, the more information it The formal interview, as a technique for provides. The use of rating scales has a measuring knowledge, will be discussed in beneficial effect on the learning process of greater detail in the section on measuring the student, since he actually comes to skills, below. know his own weaknesses and strengths and Another good way to measure knowledge can take steps to correct deficiencies and is through observation, but observation of further improve his ability. 136 Evaluation

Another way to measure the student's ventories and scales, are rather complicated skill is through the development of per- and detailed as described in the literature. formance tests. These are not too dis- Understandably, the faculty avoids the similar from the tests in which a student development of such devices. There are places blocks in assigned spaces or strings certain other steps, however, that can be various sizes of beads. I do not know taken to measure-although not quite so whether this approach is practical for perfectly-whether attitudes are being veterinary medicine. I would, however, developed. pose the question of whether this approach One of the best and most simple ways has ever been fully investigated by veteri- this kind of information on attitudes can be narians in their educational programs. It obtained is through anecdotal data. This might be possible to develop a test in which involves maintaining a file on each student. a student actually has to perform a par- Whenever a member of the faculty observes ticular activity while being checked to see or hears some negative or positive state- whether he has achieved the required level ment about a student's behavior-whether of proficiency. it concerns a fellow student, a patient, or For all intents and purposes it is safe to the faculty-this bit of evidence is entered assume that the best single way to measure in the student's folder. After several years skills is through the process of observation. a number of these anecdotes become avail- The observation itself can be refined able, and a pattern regarding the student's through use of an observation form or behavior can be detected. The use of through some sort of performance test. anecdotal records is perhaps the most practical approach for classroom teachers, since it does not involve the amount of Attitudes time that would be required in the creation of more refined instruments. While Every professional school seems to agree anecdotal records are not perfect, they at that one of its primary objectives is the least provide soine information about the development of "sound, wholesome, ethical, student's attitudes. attitudes." Whether these attitudes con- These, then, constitute some of the major cern fellow human beings or ethical be- ways in which knowledge, skill, and atti- havior in the profession is irrelevant; the tudes can be measured. The measurement fact that such attitudes should be developed of understanding has been deliberately is important. Yet, when a member of the omitted, since there are differences of faculty is asked how he measures whether opinion as to what constitutes understand- students have actually acquired these ing. The kinds of devices usually used to attitudes the answer is usually a blank measure understanding are classified under stare or an indefinite response such as "I paper-and-pencil tests and have been dis- know what they have (or have not) cussed above, under the heading of Knowl- acquired." When faculty members are edge. asked to provide objective evidence as to Recent years have seen the creation of whether these attitudes have actually been various hybrid forms of examinations. achieved, nine times out of ten there is no These are now being investigated. The use evidence. of a test for diagnostic skills developed by One of the reasons for this is that the Dr. IH. J. Rimoldi of Stritch Medical School devices to measure attitudes, such as in- at Loyola University in Chicago may be Evaluating the Student's Learning 137 adaptable for use in veterinary medicine It would seen expedient for every school education. The University of Colorado of veterinary medicine to actively consider School of Medicine has developed a series the development of new measurement tech- of films that measure a student's ability to niques. There is enough evidence in the observe patient behavior and to correlate literature to indicate that the measurement this measurement with other data. The devices developed for public education and work of other schools actively engaged in for medical and dental education can be preliminary work in the field of measure- applied to problems in veterinary medicine. ment shows tremendous promise. They deserve your attention. Appendix

PARTICIPANTS

Pedro N. Acha Medicine, University of Pennsylvania, Phila- Chief, Veterinary Medical Services, Pan delphia, Pennsylvania American Health Organization, Regional Office Norman L. Cole of the World Health Organization, Washing- Chief, Educational Studies and Development ton, D.C. Section, National Medical Audiovisual Center, Gaylord W. Anderson National Library of Medicine, Atlanta, Geor- Mayo Professor and Director, School of Public gia Health, University of Minnesota, Minneapolis, Paul J. Cox Minnesota Director of Environmental Hygiene, St. Paul Robert K. Anderson Bureau of Health, St. Paul, Minnesota Associate Dean, College of Veterinary Medi- R. P. Crawford cine, and Professor, School of Public Health, Assistant Professor, Institute of Agricultural IJniversity of Minnesota, St. Paul, Minnesota Medicine, College of Medicine, University of Jacob Bearman Iowa, Iowa City, Iowa Professor, Division of Biometry, School of V. L. Dahl Public Health, University of Minnesota, Min- Assistant to the Director, North Central Meat neapolis, Minnesota Inspection District, Consumer and Marketing Everett D. Besch Service, U.S. Department of Agriculture, Chi- Professor and Head, Department of Veterinary cago, Illinois Parasitology and Public Health, College of Veterinary Medicine, Oklahoma State Univer- Stanley L. Diesch sity, Stillwater, Oklahoma Assistant Professor, Department of Veterinary C. H. Bigland Microbiology and Public Health, College of Western College of Veterinary Medicine, Uni- Veterinary Medicine, and Assistant Professor, versity of Saskatchewan, Saskatoon, Saskat- School of Public Health, University of Min- chewan, Canada nesota, St. Paul, Minnesota Donald C. Blenden Norman A. Fish Associate Professor of Veterinary Microbio- Associate Professor, Department of Veterinary logy and Chief, Section on Veterinary Public Bacteriology, School of Veterinary Medicine, Health, School of Veterinary Medicine, and Guelph, Ontario, Canada Associate Professor of Community Health and A. I. Flowers Medical Practice, School of Medicine, Univer- Professor and Head, Department of Veteri- sity of Missouri, Columbia, Missouri nary Public Health, College of Veterinary A. B. Childers Medicine, Texas A. & M. University, College Department of Veterinary Public Health, Station, Texas College of Veterinary Medicine, Texas A. & M. Dean M. Fluharty University, College Station, Texas Associate Professor, Department of Veterinary Gus Cholas Pathology, College of Veterinary Medicine, Associate Professor, Department of Microbiol- Washington State University, Pullman, Wash- ogy, College of Veterinary Medicine and Bio- ington medical Sciences, Colorado State University, Hugh S. Fulmer Fort Collins, Colorado Professor of Community Medicine, Depart- Fred W. Clayton ment of Community Medicine, University of Deputy Director, Computer Fact Bank, Mis- Kentucky Medical School, Lexington, Ken- souri Regional Medical Program, University tucky of Missouri, Columbia, Missouri Robert Getty Daniel Cohen Professor and Head, Department of Veterinary Professor and Chief, Section of Epidemiology Anatomy, College of Veterinary Medicine, and Public Health, College of Veterinary Iowa State University, Ames, Iowa 138 Appendix 139

Joyce Goggin J. Douglas McCluskie Assistant Professor, Department of Epidemiol- Director, Environmental Health Service, Den- ogy and Preventive Medicine, School of Vet- ver Department of Health and Hospitals, erinary Medicine, University of California, Denver, Colorado Davis, California William F. McCulloch John H. Helwig Associate Professor of Preventive Medicine Professor and Chairman, Department of Pre- and Environmental Health and Chief, Com- ventive Medicine, College of Veterinary Medi- parative Medicine Section, Institute of Agri- cine, Ohio State University, Columbus, Ohio cultural Medicine, College of Medicine, Uni- Harold B. Hubbard versity of Iowa, Iowa City, Iowa Associate Professor, Department of Medical W. J. Mackey Microbiology, School of Veterinary Medicine, Veterinary Director of Research Animal Hos- University of Georgia, Athens, Georgia pital, College of Medical Science, University Ephren M. Jacques of Minnesota, Minneapolis, Minnesota Director, Ecole de Médecine Vétérinaire de la Angel Marquez Province de Québec, Saint-Hyacinthe, Quebec, Professor, School of Veterinary Medicine, Uni- Canada versidad Central de Venezuela, Maracay, William E. Jennings Venezuela Professor, Department of Microbiology, Col- Edward L. Menning, Lt. Col. USAF lege of Veterinary Medicine, Auburn Univer- Instructor, Department of Veterinary Medi- sity, Auburn, Alabama cine, Medical Service School, U.S. Air Force, David O. Jones Sheppard Air Force Base, Texas Professor, Department of Preventive Medi- Victor cine, College of Veterinary Medicine, Ohio S. Meyers Assistant Professor, State University, Columbus, Ohio Department of Veterinary Russell K. Jones Surgery and Radiology, College of Veterinary Medicine, Professor, Department of Microbiology, University of Minnesota, St. Paul, Minnesota Pathology, and Public Health, School of Vet- erinary Science and Medicine, Purdue Uni- Ralph W. Mohri versity, Lafayette, Indiana Associate Professor, Department of Veterinary R. F. Kahrs Microbiology and Preventive Medicine, Col- New York State Veterinary College, Cornell lege of Veterinary Medicine, Iowa State Uni- University, Ithaca, New York versity, Ames, Iowa Donald C. Kelley Bennard L. Moseley Associate Professor, Department of Infectious School of Veterinary Medicine, University of Diseases. College of Veterinary Medicine, Missouri, Columbia, Missouri Kansas State University, Manhattan, Kansas John P. Newman Ronald J. Kolar Professor, Department of Microbiology and Director, Department of Education and Licen- Public Health, and Assistant Dean, College of sure, American Veterinary Medical Associa- Veterinary Medicine, Michigan State Univer- tion, Chicago, Illinois sity, East Lansing, Michigan James D. Lane Joseph E. Orthoefer Chief Veterinarian, Meat Hygiene Training Instructor, Department of Veterinary Micro- Center, Consumer and Marketing Service, biology and Public Health, College of Veteri- U.S. Department of Agriculture, Chicago, nary Medicine, University of Minnesota, St. Illinois Paul, Minnesota Paul Leaverton W. M. Osteen, Col. U.S. Army Associate Professor, Department of Preven- Office of Assistant for Veterinary Services, tive Medicine and Environmental Sanitation OTSF, DH, Washington, D.C. and Department of Statistics, University of Henry M. Parrish Iowa, Iowa City, Iowa Professor of Community Health and Medical James Lieberman Practice, School of Medicine, and Associate Director, National Medical Audiovisual Professor of Veterinary Microbiology (Public Center, National Library of Medicine, Atlanta, Health), School of Veterinary Medicine, Uni- Georgia versity of Missouri, Columbia, Missouri 140 Appendix

John R. Riddel, Major U.S. Army Donald K. Smith 5th A Student, 2277 Carter Ave., St. Paul, Associate Vice-President, Academic Adminis- Minnesota tration, University of Minnesota, Minneapolis, Hians P. -iem.a.n. Minnesota Associate Professor, Microbiology, Depart- James H. Steele ment of Epidemiology and Preventive Medi- Chief, Veterinary Public Health, U.S. Public cine, School of Veterinary Medicine, Univer- Health Service, National Communicable Dis- sity of California, Davis, California ease Center, Atlanta, Georgia Edwin F. Rosinski H. J. Steinmetz Associate Deputy Administrator, Consumer Deputy Assistant Secretary for Health Man- and Marketing Service, U.S. Department of power, Office of Assistant Seeretary for Health Agriculture, Washington, D.C. and Scientific Affairs, Department of Health, William T. Stickley Education, and Welfare, Washington, D.C. Assistant Professor, Division of Research in Jack H. Russell Medical Education, School of Medicine, Case Chief Public Health Veterinarian, Division of Western Reserve University, Cleveland, Ohio Communicable Diseases, Ohio Department of H. L. Stoddard Health, Columrnbus, Ohio Professor, International Veterinary IvMedicine, Walter W. Sadler College of Veterinary Medicine, University of Professor, Department of Epidemiology and Minnesota, St. Paul, Minnesota Preventive Medicine, School of Veterinary W. Ri. Strieber Medicine, University of California, Davis, Chief Staff Veterinarian, Technical and Pro- California fessional Development, Animal Health Divi- Ernest E. Saulmon sion, Agricultural Research Service, U.S. De- Director, Animal Health Division, Agricul- partment of Agriculture, Hyattsville, Mary- tural Research Service, U.S. Department of land F. T. Szatalowicz, Capt. U.S. Air Force Agriculture, Hyattsville, Maryland Chief~ Geographic Zoonoses Branch, A.F.I.P., Jay H. Sautter Washington, D.C. Professor of Veterinary Pathology, College of W. T. S. Thorp Veterinary Medicine, University of Minne- Dean, College of Veterinary Medicine, Uni- sota, St. Paul, Minnesota versity of Minnesota, St. Paul, Minnesota Paul R. Slchnurrenberger Sebastián Viale-Rigo Bureau of Epidemiology, Division of Preven- Professor, School of Veterinary Medicine, Uni- tive Medicine, Department of Public Health, versidad Central de Venezuela, Maracay, Springfield, Illinois Venezuela Leonard M. Schuman E. E. Wedman Professor and Head, Division of Epidemiology, Associate Director, Veterinary Medical Re- School of Public Health, University of Min- search Institute, College of Veterinary Medi- nesota, Minneapolis, Minnesota cine, Iowa State University, Ames, Iowa Daniel F. Werring Calvin W. Schwabe Veterinarian in Charge, Animal Hlealth Divi- Professor and Head, Department of Epide- sion, Agricultural Research Service, U.S. De- miology and Preventive Medicine, School of partment of Agriculture, St. Paul, Minnesota Veterinary Medicine, University of California, L. P. Williams, Jr. Davis, California Assistant Professor, School of Public Health, Morris A. Shiffman Tulane University, New Orleans, Louisiana Associate Professor, Department of Environ- George T. Woods mental Sciences and Engineering, School of Associate Professor, Department of Pathology Public Health, University of North Carolina, and Hygiene, College of Veterinary Medicine, Chapel Hill, North Carolina University of Illinois, Urbana, Illinois