aamc annual meeting and annual report 1978 · recruiting practices. but there is little to laugh...

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Association of American Medical CollegesAnnual Meeting

andAnnual Report

1978

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Table of Contents

:::Chairman's Address 1359

rJ)rJ) Annual Meetinga\-; PlenarySession 143(1)

0.. Council of Academic Societies 143...... Council of Deans 143;:l0 Council of Teaching Hospitals 143..s::~ COD/CAS/COTH Joint Program 143

'"dMinority Affairs Program 143

(1) Organization of Student Representatives 144u;:l Cost Containment in Medical Education 144

'"d Annual Financial Questionnaire Workshop 1450\-;

FacuIty Roster Workshop 1450..(1)

Women in Medicine 145\-;

(1) Group on Business Affairs 145.D0 Group on Medical Education 145......

GME/GSA Joint Program 147......0 Group on Public Relations 148Z

Group on Student Affairs 148U Planning Coordinators' Group 148

~Research in Medical Education 148

Assembly Minutes 153(1)

Annual Report..s::......4-< Message from the President 1590rJ) The Councils 162:::

National Policy 1699...... Working with Other Organizations 174u2 Education 177<3 Biomedical Research 180u(1) Health Care 182..s:: FacuIty 183......a Students 1840 Institutional Development 187<.l:11:: Teaching Hospitals 189(1) Communications 193a Information Systems 194;:lu AAMC Membership 1960

Q Treasurer's Report 196AAMC Committees, 1977-78 198AAMC Professional Staff, 1977-78 203

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135

The Chairman Looks at the AAMC

I then tried to find some inspiration inthe addresses of former chairmen of theAssociation, and a distinguished groupthey are. But how could I, a little olddepartment chairman, try to equal theennobling thoughts of these gentlemen, allof whom are deans or presidents of medical centers (Figure I). Moreover, the verbal pyrotechnics ofIvan Bennett, the steelyanalysis of the issues that divide the academic world and government delivered byLeonard Cronkhite, the careful review ofhealth programs presented by CharlieSprague, the biblical sagacity of ShermanMellinkoff, and the uplifting rhetoric, liberally punctuated by quotations fromThomas Jefferson we heard from DanTosteson can have no equal. Besides, theysaid everything I wanted to say.

Rather than discourse on one or severalof the weighty issues with which we are allfamiliar-cost containment, financing ofmedical education, health manpower, orsupport of biomedical research-I want tospend a few minutes talking to you aboutour organization, the AAMC. I do this, inpart, because this organization is subjectto a lot of criticism; some perceive it asdoing too little too slowly, and others thinkof it as doing too much too fast. Somethink of it as an action-oriented politicallobby, while others see it as an academicdebating society contemplating its collective navel. Some might define it as a herdof bulls, the deans, chasing their cows, thefederal buck, in totally uncoordinatedfashion, while others conceive of it as a

Robert G. Petersdoif, M.D.

It has become customary for the chairmanof this organization to deliver himself ofan address to this semicaptive audience,semicaptive because it has usually beenleft too numb by the previous speakergenerally a government functionary-whoeither has berated it for failing to meet animportant challenge, such as admitting tomedical school any student who wishes togo, despite the fact that there is no needfor him or her, or has exhorted it to accomplish a task that is quite impossible, suchas delivering better care to more people at1975 prices. At the very least, the haplesschairman is expected to soothe the pain,usually by relying on the old standbys,quality, stability, and excellence, a form ofverbal balm which has little meaning intoday's health scene.

Indeed, I had a good deal of difficultyin finding a theme for this talk. In the past,I have used similar platforms to takesemihumorous looks at such academicphenomena as departmental chairmen orrecruiting practices. But there is little tolaugh about these days. As the patient saidwhen he was informed on awaking fromanesthesia that a sponge had been left inhis abdomen, it hurts too much to laugh.

This paper was delivered at the October 24, 1978,plenary session of the Annual Meeting of the Association of American Medical Colleges, New Orleans,Louisiana.

Dr. Petersdorf, professor and chairman, Department of Medicine, University of Washington Schoolof Medicine, was the 1977-78 chairman of theAAMC.

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VOL. 54, FEBRUARY 1979

that patience is a virtue. The wheels ofprogress-and I use the term euphemistically-in the health business grind slowlyand often imperceptibly, a point whichshould not be lost on our policymakers.Secondly, although it may not seem so tothe officers of the Association, who are alltoo often engaged in crisis-oriented conference calls, the major issues which anorganization like the AAMC must addressrequire a long-range view and transcendthe terms of the elected chairman and,indeed, in some instances the three- to sixyear terms ofthe members ofthe ExecutiveCouncil. And, thirdly, continuous attention to these long-range issues requires astaff of permanency, skill, and dedication.We are blessed by having such a staff atthe Association.

While many of the recent issues confronting the AAMC may seem like perennial bloomers, in point of fact thatAAMC is a young organization, if notchronologically at least functionally. Although the Association celebrated its lOOthbirthday in 1976, a fact which along withmy 50th birthday was lost in the nation'sbicentennial, and appropriately so, it reallycame of age only in 1965 when, as a resultof the Coggeshall report, it was decided totransform it from a comer grocery inEvanson, Illinois, that could barely meetits payroll to a modern department storein Washington, D.C. (Figure 2) which

FIGURE IThe past recent chairmen of the Association of American Medical Colleges are, from left, Dr.Ivan L. Bennett, Jr., Dr. Leonard W. Cronkhite, Jr., Dr. Sherman M. Mellinkoff, Dr. Daniel C.

Tosteson, and Dr. Charles C. Sprague.

group ofsheep led by a firm, and hopefullywise, shepherd, John Cooper. Few whotalk about the AAMC, either in laudatoryor critical terms, know much about it, andI thought that it might not be amiss toleave you with a few impressions of thisorganization-gleaned from the top, so tospeak-and to tell you what we do well,what we do poorly, and, perhaps mostimportantly, what we might do better andhow we might do it better.

The last time a chairman dealt with theproblems and progress of the AAMC wasat the 1972 meeting in Miami when RussellNelson reviewed the issues that confrontedthe Association at that time. They includedinstitutional responsibility for graduatemedical education; the staffing and modusoperandi of the LCGME and the LCCME,which had just been conceived, but bothofwhich have suffered from growth arrest;the Association's relationships with otherorganizations; and, of course, its intercourse with government. At that time, Dr.Nelson focused on HMOs and nationalhealth insurance as the issues most likelyto affect the educational establishment.These may still come to pass, but it isperhaps most noteworthy that the problems with which the Association was grappling in 1972 have not been resolved andare still in full bloom in 1978.

This recounting of history is valuable, Ithink, to make three points. The first is

136 Journal of Medical Education

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137

Dr. NelsonDr. Cooper

hospitals are university-owned, more areprivate institutions governed by boardswhich are not the regents or trustees of theuniversity. Some hospitals are governmentinstitutions, and others are church-affiliated; some are closely affiliated with theuniversity while others have relatively distant connections. Among the academic societies, some consist of basic scientists andothers of clinical specialists; and a thirdgroup comprises largely organizations ofdepartment chairmen. These three constituencies within the CAS have very different agenflas; moreover, the cause of unanimity is not helped by the fact that mostacademic societies elect a new slate ofofficers annually, making any sense ofcontinuity difficult if not impossible.

It should not be surprising that an organization as large and heterogeneous asthe AAMC would have difficulty arrivingat a common point ofview on major issues,and therein lies one of our problems. Wesometimes have had difficulty in speakingout clearly in unison on some major issues.Sometimes, these internal political conflicts can be kept "inter familias" and permit the Association to present a solid front.This was the case in the Association's unrelenting opposition to HR 2222, whichwould permit unionization of house staffunder the NLRB. In this instance, theOSR voted to support the bill but wassimply outvoted by a large majority of theother constituents on the Executive Council.

In another instance, however, that of themanpower legislation that mandated the

Chairman's Address/Petersdorf

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opened its doors for business in 1970. Moreimportantly, the AAMC changed conceptually from a "dean's club" to an organization that is representative of all of academic medicine. Lest you think that I usethe term dean's club pejoratively, the 1940

::: meeting was called exactly that.~ The spectacular progress of the Associ-rJ)

~ ation, particularly in espousing the causes;j) of the academic community in Washing0.. ton, is a matter of record; and, indeed, the§ recognition of John Cooper, our leader, as..s:: the nation's third or fourth most powerful~ individual-after Senator Kennedy, Rep1$ resentative Rogers, and perhaps SecretaryU Califano-in health matters attests to our.ao rapid growth and increasing influence. Ia need not detail the multiple services likee AMCAS, AMCAT, the faculty roster, or~ data on house staff and faculty salarieso that the Association offers.......o With its rapid growth, the AAMC hasZ become an increasingly complex organi

zation. This is largely a reflection of theconscious decision made a decade ago tohave the AAMC represent the medicalschools not only through their deans butalso through their teaching hospitals in theform of the Council ofTeaching Hospitals,their faculties through the Council of Academic Societies, and their students in theform of the Organization of Student Representatives. This has made the constituency of the AAMC extraordinarily largeand diverse and its governance unusuallycomplex. Figures 3 and 4 depict an organizational chart of the AAMC as viewedby the staffand, in more surrealistic terms,by me. Even within its quadricameralstructure, there is little homogeneity. Forexample, within the Council of Deans,there are representatives of private schoolsand state schools, and the interests ofnewly developing schools are representedalong with those of more traditional institutions. And while some of the teaching


lectively reimburse some teaching hospitals on a cost, rather than a fee-for-service,basis. In an attempt to redress a few instances of alleged fraud, the proposed lawwould punish a large number of teachinghospitals for the presumed transgressionsof a few. Moreover, the legislation wouldnot serve its professed purpose; rather, itwould impose a strict fiscal test on teachinghospitals which, in turn, would reintroduceseparate care for public and private patients, the very distinction that the Medicare law was meant to obliterate. Led bya group of southern deans, the Associationmarshaled its constituency and within afew days nearly 30 senators had been persuaded to cosponsor an amendment forrepeal. More importantly, the entire constituency got behind this effort, whether ornot a particular institution or its hospitalswould be affected adversely. Put differently, we forgot our diverse interests andworked for the common good. Althoughthe final compromise will be a delay inimplementation of Section 227, followedby appropriate revisions, this is an exampleof highly effective political action on thepart of the AAMC achieved largely, Imight say, by the extraordinary efforts ofa number of individuals who worked in acommon cause.

138 Journal ofMedical Education

transfer ofUSFMGs to American medicalschools in order for the schools to qualifyfor capitation, the AAMC's initial positionwas much more equivocating. While deepin his heart everyone felt that the law waswrong and tlt'at the government had nobusiness in the medical school admissionsprocess, the Association did not issue aclarion call of outright opposition to theimplementation of the legislation for several reasons. First, a number of schoolscould not have survived financially without capitation support; secondly, somestate schools felt that rejection of capitation would lead to retaliation by their ownlegislatures, which were under pressure topass similar laws; and, finally, there wassome hesitation on the part of some in theAAMC to offend the sponsors of the billwho had done so much for the benefit ofmedical education. The AAMC's positionwas, therefore, conceived in internal political conflict, and, as a result, was lessexplicit than it might have been.

In contrast, when the Association getsits act together and marshals its forces fora common purpose, it can achieve resultsthat are nothing short of spectacular. Arecent example was the concerted effortthat was made to repeal Section 227 of theSocial Security regulations that would se-

FIGURE 2The AAMC's former headquarters in Evanston, Illinois, is shown at left. At right is the building

in Washington, D.C., that includes the AssociatiOll's present headquarters.

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Chairman's Address/Petersdorf

FIGURE 3Staff diagram of organizational structure of the AssocIation of American

Medical Colleges.

139

professional schools; the Association forAcademic Health Centers; not to mentionorganizations, such as the AMA, that dealprimarily with medical practice as well aseducation. I do not question the prerogative of these organizations to exist on theWashington scene; nor do I question theiror their constituencies' legitimate interestin health issues. But I am concerned abouttheir occasional tendency to becloud aclear-cut issue in smoke, fog, or both. Andeven a non-Californian knows that thesmog is irritating. An example of this occurred in the recent Section 227 imbrogliowhen, irrespective of the steps that were inprogress to repeal the statute, another organization took it upon itself to proposethat the issue be negotiated without firstobtaining more information about the extensive and prolonged history behind Section 227 or the AAMC's long involvementand expertise in it and without assessingthe political consequences of its action.Although the problem was resolved, to putit in the vernacular, those folks nearly blew

ASSEMBLY

COD 124CAS 60 nCOTH 60OSR 12

EXECUTIVEhCOUNCIL

23

IEXECUTIVE ICOMMITTEE

6

I ICOUNCIL COUNCIL OF COUNCIL OF

OF ACADEMIC TEACHINGDEANS SOCIETIES HOSPITALS

124 60 400

ORGANIZATIONOF STUDENT

REPRESENTATIVES117

Because so many in Washington, including Congressional staff, members ofthe HEW bureaucracy, the NIH, and theOSTP, look to the AAMC for leadershipon issues dealing with medical education,

(1)':5 it is particularly important for the Associ-'0 ation to arrive at clear positions and torfl factor internal political considerations out:::o of the equation when formulating theseB positions. This is not always easy and, as~ long as the AAMC is as ecumenical an<3u organization as it is, will be troublesome~ from time to time.S A more difficult situation arises wheno one or another of the many organizations

r.l:1 concerned with health policy that seem to~ be springing up in Washington like weedsa on a well fertilized lawn takes a position8 which is contrary to one assumed by theoQ AAMC. Among the organizations dealing

with health policy are scientific umbrellaorganizations such as FASEB; organizations which represent university presidentssuch as AAU, ACE or NASLGUC; organizations that represent other health

FIGURE 4Author's concept of the organizational structure of the Association of

American Medical Colleges.

OthersClenMIC

organizations

Otherhealth

oroamzatlons


being on center stage when we should haveremained in the wings, we are more awarethan most of the importance of presentinga unified front to those who make healthpolicy. For example, in recent years ourrecommendations on the HEW budgethave been made a part of those of theCoalition for Health Funding, a consortium of health agencies conceived witheducation. Similarly, our position on newregulations dealing with overhead for research, circular A-21, is being communicated through those organizations thatdeal with pan-university matters. This isas it should be; reimbursement of indirectcosts is clearly a budgetary problem forthe entire university and not only its medical school.

Finally, we are sometimes perceived asa self-serving special interest organizationwhose only agenda is the benefit of itsmembers. Let me say here and now that

OtherAAMCorgamzahons

AccreditatIon

Un,verslfyorganizations

it for us. More importantly, the wholebusiness could have been avoided if thatorganization had communicated its concerns to the AAMC before striking out onits own.

This little diatribe should not be interpreted to mean that the AAMC shouldcorner the market in all issues that dealwith medical education or health care related to education. It does mean that thoseorganizations that want to play in this ballpark playas a team and not as individuals.It means that all organizations have to besensitive to each others' concerns, andmost of all it means that they have toinform one another, regularly and candidly . And it also means that from time totime, for the sake of reaching consensus,one organization must subject its intereststo that of another. This applies to theAAMC as well as other organizations. Although we have sometimes been guilty of


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Chairman's Address/Petersdoif

there is nothing inherently wrong in anorganization representing the special interests of the medical schools. If we didn't,who would? Besides, the representation ofspecial interests is very much part of ourpolitical process; in fact, the only individual in Washington who doesn't espouse aspecial interest is the ticket manager of theWashington Redskins; he doesn't need to,because he will sell out the house no matterwhat.

In the case of the AAMC, of course, ourspecial interests must be tempered with theneeds of the public, at least to the extentthat these needs are perceived by the framers of public policy. And because wehave to take the stand of acting in thepublic interest as well as our own, we aresometimes put in uncomfortable positions.I have no problem, for example, with ourposition expressing the need for federalsubsidies for medical education because Ifeel, along with many of you, that ourmedical schools represent a national resource whose products benefit the entirecountry. But I have a good deal of troublein championing capitation predicated onclass size as the instrument with which tosupport the medical schools, when there isincreasing evidence that there will be asurfeit of physicians within a decade, ifthere is not already, and that the remedyfor this surfeit might actually be a decreasein class size. And I question whether it isappropriate to take a position against payback for biomedical research trainingwhen it is far from clear that this administrative device has deterred entry into research training in the first place, orwhether it has kept the trainees in academerather than having them pursue a lucrativecareer in a clinical specialty. And I wonderwhether we can ever shed the stigma of"double dipping" as long as we insist onreimbursement of supervisory services byteaching physicians under Part A of theMedicare law while collecting fee-for-ser-

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vice under Part B. Admittedly, in manyinstances these services are clearly separable and billing for both is entirely justifiable and follows the intent of the law.But, in some instances, the boundary between professional and supervisory services is blurred, and it is in these instancesthat we must take particular care to bill forone or the other but not both.

These examples have been cited as situations in which the Association may beperceived as having placed the welfare ofone or the other of its constituencies aheadof the public interest. Clearly, such aninterpretation is subject to argument andthere are articulate champions for eachposition within the Association. My pointis that we must go to extraordinary lengthsto shed our more parochial instincts andto examine the impact of our actions onthe public welfare. Only by following sucha course can we maintain and enhance theAssociation's credibility in Washington.

Finally, effective though our Association is, how can we do better? First, byincreasing the participation of our colleagues-deans, faculties, administrators,and students-in the affairs of the Association. I never cease to be amazed at therelatively few individuals who populateour conferences, committees, and taskforces. I also never cease to be disappointed by those who refuse to serve because they are too busy or overcommitted,who resign from committees before thetask is completed, or who quit de facto, ifnot de jure, by failing to show up for themeetings. Although the AAMC has a superb, dedicated, and knowledgeable staff,it is in essence a voluntary organizationthat derives many ofits ideas and concepts,and eventually all of its policies, from itsmembership. If we care about the valuesthat attracted us to academicmedicine-the importance of excellentteaching and research, the training of

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young people, and the practice of exemplary medicine-then we must becomegood academic citizens in much the sameway that we must practice good citizenshipto preserve the values in our society. Wemust become involved.

Secondly, we need to communicate withone another about the issues that concernus as academic citizens and that, as ourcitizens' lobby, concern the Association.This implies a greater commitment thanperusing John Cooper's weekly reader,dazzling though his prose may be. It meansinformed discussion of the issues at facultymeetings, over laboratory benches, in thecorridors and lunchrooms of our schoolsand hospitals, and even on ward rounds.The days when the majority of the academic establishment can remain sequestered in its ivory tower in splendid isolation from the world about it are goneforever. Academic medicine is very muchin the public sector and demands a newand additional role of all of us-that ofthe informed, thoughtful academic citizen.


Lastly, let me come back to one point.We in academe are, whether we like it ornot, very much in the public eye. Most ofour wherewithal comes in one way or another from the taxpayer; most of our decisions affect not only our internal constituency, the faculty, and students but alsoa much larger one, our patients. And because we are in one way or another responsible for the education and training ofthose who will deliver health care in thefuture, we have been given an extraordinary public trust. An organization like theAAMC gives us, as individuals, the opportunity to serve the cause of academic medicine. We may not always agree with thepositions it takes, the causes that it champions, or the means by which it achievesits ends. But it is more often right thanwrong, more often responsible than derelict, and more often winner than loser.With its strong staff and the talent amongits membership, it is by far the best gamein town. It needs all of us-all of you-tomake it even better.

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The Eighty-Ninth Annual Meeting

Chairman: Julius R. Krevans, M.D.

October 24

Business Meeting

Presiding: David L. Everhart

General Session

Presiding: Robert M. Heyssel, M.D.

MULTIPLE HOSPITAL SYSTEMS AND THE TEACH

ING HOSPITAL

The OpportunitiesEd J. Connors

The ProblemsMark S. Levitan

COD/CAS/COTHJOINT PROGRAM

THE INTERPLAY OF GOVERNMENTAL REGULA

TION, PROFESSIONAL RESPONSIBILITY AND MAR

KET FORCES IN THE FIELD OF HEALTH

Alan K. PalmerJulius R. Krevans, M.D.

BIOMEDICAL RESEARCH AND THE PUBLIC INTER

EST: THE ROLE OF PUBLIC SECTOR REGULATION

Laura Nader, Ph.D.Ivan L. Bennett, Jr.

COUNCIL OF TEACHING HOSPITALS

MINORITY AFFAIRS PROGRAM

October 23

October 24

MINORITIES IN MEDICINE: THE NEXT DECADE

Presiding: Dario O. Prieto

PRESENTATION OF NATIONAL MEDICAL FELLOW

SHIPS AWARDS

Program Outlines

PLENARY SESSION

October 23

Presiding: John A. GronvaIl, M.D.

Medical Care and the UniversitiesJohn T. Dunlop

Public Policy and the Medical Establishment:Who's on First?Victor R. Fuchs

Regulation andAcademic Medicine: The QuebecExperienceSidney S. Lee, M.D.

ALAN GREGG MEMORIAL LECTURE:

On the Planning ofBiomedical ScienceLewis Thomas, M.D.

New Orleans Hilton Hotel, New Orleans, Louisiana, October 21-26, 1978

Theme: National Health Planning and Regulation: Implications for Medical Education

October 24

October 23

October 23

Business Meeting

COUNCIL OF ACADEMIC SOCIETIES

Presiding: Robert G. Petersdorf, M.D.

PRESENTATION OF BORDEN AND FLEXNER

AWARDS

Honorable Joseph A. Califano, Jr.

Chairman's AddressRobert G. Petersdorf, M.D.

Business Meeting

Chairman: Robert M. Berne, M.D.

The Teaching of Geriatric Medicine in U.S.Medical SchoolsPaul B. Beeson, M.D.

COUNCIL OF DEANS

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Franklin C. McLean Award

William and Charlotte Cadbury NMF Scholarship Award

NMF Scholarship Award for Scholastic Excellence

IntroductionJohn A. D. Cooper, M.D.

Keynote AddressHonorable Edward R. Roybal

ORGANIZATION OF STUDENTREPRESENTATIVES

October 21

Regional Meetings

Discussion Session:Introduction to the OSR and the AAMCPaul ScolesPeter Shields

Discussion Sessions:A Career in Academic Medicine and ClinicalResearch-Let's Look at the FactsRichard Knazek, M.D.Jay R. Shapiro, M.D.Thomas E. Morgan, M.D.

Student Financial AidRobert J. Boerner

National Resident Matching ProgramJohn S. Graettinger, M.D.

Business Meeting

October 22

Discussion Sessions:National Resident Matching ProgramJohn S. Graettinger, M.D.

Medical Students and Faculty: Research &Service TeachingJudith Swazey, Ph.D.

Women in ManagementJudith B. BraslowDoris A. Howell, M.D.Molly Osborne, Ph.D.

Candidate for OSR Office Session

Business Meeting

Regional Meetings


MOLDING OF PHYSICIANS FOR THE 1980s: SELEC

TION, SOCIALIZATION, OR LEGISLATION'!

Moderator: Eileen Shapiro

Selection ProcessDaniel H. Funkenstein, M.D.

Professional Socialization During MedicalSchoolPearl Rosenberg, Ph.D.

Impact of LegislationFitzhugh Mulllln, M.D.

A Theoretical FrameworkJudith Swazey, Ph.D.

A Student's PerspectivePaul Scoles

October 23

BECOMING A PHYSICIAN: INFLUENCES ON CA

REER CHOICE

Session I

Academic Physicians: An Endangered SpeciesMarianne J. Legato, M.D.

Session II

Mentors and Role Models in Medical EducationEileen ShapiroJoan G. Stelling, Ph.D.Samuel W. Bloom, M.D.

Session III

Impact o/the Federal Government on Careers inAcademic Medicine and ResearchLeah M. Lowenstein, M.D.David R. Challoner, M.D.Ruth HanftRuth L. Kirschstein, M.D.

COST CONTAINMENT INMEDICAL EDUCATION

October 24

Moderator: Stanley M. Aronson, M.D.

IntroductionStanley M. Aronson, M.D.

A REVIEW OF SELECTED COST CONTAINMENT

PROGRAMS

Indiana University School of MedicineSteven C. Beering, M.D.

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1978 AAMC Annual Meeting

Hospital of the University of PennsylvaniaSankey V. Williams, M.D.

Jackson Memorial HospitalLeon W. ZuckerWilliam I. Roth, M.D.

THE IMPLICATIONS OF COST CONTAINMENT: A

CURRENT APPRAISAL AND EVALUATION

John G. Freymann, M.D.

Questions and Discussion

ANNUAL FINANCIAL QUESTIONNAIREWORKSHOP

October 23

FACULTY ROSTER WORKSHOP

October 24

WOMEN IN MEDICINE

October 23

MANAGEMENT ROLES FOR WOMEN IN ACADEMIC

MEDICINE

Moderator: Judith B. Braslow

Classic Managerial Theory: Its Modern DayApplicationPeter B. Vaill, Ph.D.

How Women Respond in Managerial PositionsCaroline Bird

Perspectives of Managing at the National Institutes ofHealthRuth L. Kirschstein, M.D.

Managing the Academic Medical Center: TheView ofa Former Public OfficialTheodore Cooper, M.D.

Discussion

RESEARCH SYMPOSIUM

Chairperson: Nancy Roeske, M.D.

The Specialty Preferences of Recent WomenMedical School GraduatesJanet Melei Cuca

Graduate Medical Training in the School ofMedicine at Yale UniversitySherry Penney, Ph.D.

145

A Follow-up Study ofMale and Female MedicalSchool GraduatesCarol Nadelson, M.D.Malkah Notman, M.D.

Women Medical Students: A New AppraisalMarilyn Heins, M.D.Jane Thomas, Ph.D.

Discussion

GROUP ON BUSINESS AFFAIRS

October 21

Regional Meetings

October 22

Carroll Memorial Lecture"Institutional Responsibility (?) in 1978"Christopher C. Forham, III, M.D.

National MeetingFINANCING GRADUATE MEDICAL EDUCATION:

TEACHING PHYSICIAN FEES, HOUSE STAFF STI

PENDS AND THE COST OF SUPERVISION

Moderator: RIchard G. Littlejohn

Financing Graduate Medical Education: As ISee ItMitchell T. Rabkin, M.D.

House StaffStipends and the Cost ofEducation:Medical School/Teaching Hospital FinancialRelationshipsDavid D. Thompson, M.D.

Professional Fee Income as it Relates to Financing Graduate Medical EducationHiram C. Polk, Jr., M.D.

GROUP ON MEDICAL EDUCATION

October 23

Plenary Session

THE HOUSE OFFICER AS A TEACHER: PRIORITIES

FOR UNDERGRADUATE AND GRADUATE MEDICAL

EDUCATION

Moderator: George L. Baker, M.D.

FormaliZing Teaching Responsibilities for theHouse OfficerHugh M. Scott, M.D.

How Teaching Complements and EnrichesHouse Officer Education and Patient CareFred Schiffman, M.D.

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What Schools Expect and Measure: The AAMCClinical Evaluation ProjectXenia Tonesk, Ph.D.

Reactor: David H. Solomon, M.D.

Regional Meetings

October 24

Special Sessions

CAN ACCREDITATION ASSURE QUALITY IN CON

TINUING MEDICAL EDUCATION'?

Moderator: Thomas C. Meyer, M.D.

LCCME

Julius Stolfi, M.D.

StateLeonard S. Stein, Ph.D.

AAMC

William D. Mayer, M.D.

CME DirectorFrank R. Lemon, M.D.

PRA/ConsumerRoss L. Egger, M.D.

USE OF THE NATIONAL BOARDS FOR PROGRAM

EVALUATION

IntroductionFrank T. Stritter, Ph.D.

The Needfor External CriterionNeal A. Vanselow, M.D.

History and Current Policy of the NBMEEdithe J. Levit, M.D.

A Case StudyGregory L. Trzebiatowski, Ph.D.

A Case StudyFrank T. Stritter, Ph.D.

TRANSITION PROBLEMS FROM UNDERGRADUATE

TO GRADUATE MEDICAL EDUCATION: PRELIMI

NARY RECOMMENDATIONS FROM THE AAMC TASK

FORCE

Moderator: D. Kay Clawson, M.D.Chairman, Working Group on Transition

John S. Graettinger, M.D.Special Staff Consultant to AAMC Task Forceon Graduate Medical Education

Ann S. Peterson, M.D.Member, Working Group on Transition


Kenneth W. Rowe, Jr., M.D.A Program Director

October 25

Business Meeting

INTRODUCTION TO CLINICAL MEDICINE EDUCA

TIONAL EXHIBITS

A Systematic Approach to Designing an ICMCourseRobert L. Pace, M.D., et al.

Approaches to the Evaluation of ICMJerry R. May, Ph.D., et al.

Teaching Chart Review at the Preclinical LevelM. J. Peters, et al.

The Problem ListDavid M. Klachko, M.D.

Learning Resources to Teach and EvaluateProblem-SolVing SkillsHoward S. Barrows, M.D., et al.

Evaluation ofProblem-Solving SkillsJohn Corley, M.D.

Teaching Examination and Problem-SolVingSkillsJames C. Guckian, M.D., et al.

Acquisition of Examining and Problem-SolVingSkillsPaul Cutler, M.D.

Computer-Assisted Instruction-Simulation ofSeminars in Problem-SolvingPeter Tuteur, M.D.

Comparison ofInstructor, Checklist, and Videotape Feedback on Student Performance ofPhysical ExaminationWilliam E. Shreeve, Ed.D.

Teaching Clinical Methods to Sophomore StudentsKenneth Walker, M.D., et al.

Instructor-Patient Program at the University ofWisconsinKaren K. Anderson

Non-Physicians as Instructors and Evaluators ofPatient Assessment SkillsPaula L. Stillman, M.D., et al.

A Clinical Skills Instruction Program: The AcuteAbdomenRobert M. Kretzschmar, M.D., et al.

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Checklist Evaluation ofPhysical ExaminationRobert Petzel, M.D., et al.

Talking with Patients: Teaching and EvaluatingInterpersonal SkillsMarsha Grayson, et al.

The Psychiatric Patient Evaluation ProcessRobert E. Froelich, M.D., et al.

"Human Caring Skills" CurriculumLoretto Comstock

Teaching Interpersonal Skills Development in aMedical CurriculumMary Edna Helfer

A Physical Diagnosis Course Designed ThroughEvaluative ResearchThomas McGlynn, M.D., et al.

SMALL GROUP DISCUSSIONS

Interdisciplinary Topic Inclusion in the Curriculum: Geriatrics

Moderator: Peter E. Dans, M.D.

Panel: Ransom J. Arthur, M.D.L. Thompson Bowles, M.D.Carl Eisdorfer, M.D.Leonard A. Katz, M.D.Jack W. Lukemeyer, Ph.D.

Continuing Education Network in the VA System: Regional Education Center Concept

Moderator: David B. Walthall, M.D.

Panel: F. A. Zacharewicz, M.D.William F. Maloney, M.D.Mark W. Wolcott, M.D.Benjamin D. Wells, M.D.Makis J. Tsapogas, M.D.

Health Services Planning: Implications of theLawfor Medical Education Programs

Moderator: James D. Bentley, Ph.D.

Panel: S. Philip Caper, M.D.Ray CornbillColin C. Rome, Jr., Ph.D.

Alternate Healing Methods

Moderator: Russell R. Moores, M.D.

Panel: Peter O. Ways, M.D.David Hufford, Ph.D.

Curriculum Evaluation and the CurriculumChange Process

147

Moderator: Robert L. Beran, Ph.D.

Panel: Robert L. Beran, Ph.D.Robert L. Tuttle, M.D.Sarah M. Dinham, Ph.D.

Medical Ethics/Human Values

Moderator: E. A. Vastyan

Panel: E. A. VastyanWarren T. Reich, S.T.D.

Criteria ofEffective Performance by Students inClinical Clerkships

Moderator: Donald M. Hayes, M.D.

Panel: Xenia Tonesk, Ph.D.John C. Mueller, M.D.John E. Ott, M.D.Harold G. LevineGeoff Norman, Ph.D.

Student Academic Support Programs

Moderator: Miriam S. Willey, Ph.D.

Panel: Anna Epps, Ph.D.John G. Bruhn, Ph.D.

Instructional Resource and Technology Units:Care and Nurture

Moderator: Murray M. Kappelman, M.D.

Panel: Thomas Held, Ed.S.David Garloff, Ed.D.Dean Fenley, Ed.D.Carol Hampton

Evaluating Faculty Effectiveness in Teaching

Moderator: Winfield H. Scott, Ph.D.

Panel: Frank Schimptbauser, Ph.D.W. Loren Williams, Jr., Ph.D.

GME/GSA JOINT PROGRAM

October 24

PROBLEMS IN STUDENT PROFESSIONAL DEVEL

OPMENT: WHO SHALL BE GRADUATED?

Moderator: Marilyn Heins, M.D.

Keynote: Implications of the Horowitz DecisionMarvin E. Wright, L.L.D.Lee Langley, Ph.D., L.L.D.

Assessing Student Performance: Non-CognitiveCriteriaL. Thompson Bowles, M.D.

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Reconciling Evaluation and AdvisingRobert I. Keimowitz, M.D.

The Student/Consumer ViewpointMolly Osborne, Ph.D.

GROUP ON PUBLIC RELATIONS

October 23

Presiding: Kay Rodriguez

ISSUES OF THE DAY

Moderator: Vicki Saito

The Bakke DecisionDonald ReidhaarBart Waldman

The Role of Public Relations in Hospital CostContainment

Moderator: Ruth Jacobwitz

Panel and Discussion

October 24

THE PUBLIC AND HEALTH

Moderator: Frank J. Weaver

Public Attitudes Toward Health CareGeorge P. Van

Patterns of Mass Media Utilization: How thePublic Gets Health InformationGraham Ward

Moderator: Paul Van Nevel

Pretesting Messages, Media and StrategiesWilliam Novelli

Moderator: Joe Sigler

Managing the Public Relations FunctionWilliam Mindak, Ph.D.

October 25

Nominee Presentations for Excellence In:Electronic MediaPublicationsSpecial ProjectsTotal Programming

Presiding: Bill Glance

Awards Luncheon

Presiding: Frank J. Weaver

Presentation of AwardsJohn A. Gronvall, M.D.


Business MeetingPresiding: Frank J. Weaver

GROUP ON STUDENT AFFAIRS

October 23

Minority Affairs Section Regional Meetings

Minority Affairs Section Business Meeting

October 24

GSA Regional Breakfasts

GME/GSA Joint Program

PROBLEMS IN STUDENT PROFESSIONAL DEVEL

OPMENT: WHO SHALL BE GRADUATED?

October 25

GSA Regional Breakfasts

GSA Business Meeting

PLANNING COORDINATORS' GROUP

October 22

National Program

The Coordination ofPlanning Functions in Contemporary Academic Health Institutions

Speakers:

Edmund Pellegrino, M.D.Charles C. Sprague, M.D.James A. Pittman, Jr., M.D.Arthur L. GillisMichael T. Romano, Sr.George Stuehler, Ph.D.David R. PerryThomas A. RolinsonConstantine Stefanu, Ph.D.

Business Meeting

Regional Meetings

RESEARCH IN MEDICAL EDUCATIONSEVENTEENTH ANNUALCONFERENCE

October 25

POSTER SESSIONS

A Two-Phase Strategy for the Early Identification ofPotential Academic Problems in MedicalSchool

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David S. Thomson, et al.

Attitudes of Physicians in Four Different Specialty Areas Toward An Innovative Form ofContinuing Medical EducationDiane L. Essex, Ph.D., et al.

Useful Statistical Proceduresfor Identifying Academically ''At Risk" Medical StudentsDavid B. West, et al.

How Medical Students Learn: A Case StudyWilliam H. Young, Ed.D., et al.

Role of the Pathology Resource Center in Undergraduate Medical EducationJoshua A. Fierer, M.D., et al.

An Evaluation of Pediatric Clerkship Performance in a Multicomponent Evaluation SystemRobert G. Pierleoni, Ed.D., et al.

Computer-Generated Problem Simulations as anAid to the Development of Clinical ReasoningSkills-a Methodfor Training in Clinical Problem SolvingJohn L. Gedye, M.D., et al.

PRESENTATION OF PAPERS

VALIDITY OF PMP'S

Moderator: Joseph S. Gonnella, M.D.

Performance on PMP's and Performance inClinical Practice: Are They Related?Gordon G. Page, Ed.D., et al.

Computer-Based Problems as a Measure of theProblem-Solving Process-Some ConcernsAbout ValidityJ. W. Feightner, M.D., et al.

Construct Validity ofPatient Management Problems: Emergency Versus Non-Emergency ContextsMichael B. Donnelly, et al.

The Dimensionality of Linear Patient Management ProblemsErnest N. Skakun

INSTRUCTIONAL AND FACULTY DEVELOPMENT

Moderator: Jon Wergin, Ph.D.

Workshops: An Effective Format for PromotingFaculty Development in Family MedicineCarole J. Bland, Ph.D., et al.

Medical Faculty Acceptance of Peer Reviewedand Recommended Audiovisual ProgramsJudith G. Calhoun, Ph.D.

149

The Relationship Between Student and FacultyInstructional Preferences in Predicting Basic Science Course PerformanceCharles P. Friedman, Ph.D.

CONTINUING MEDICAL EDUCATION

Moderator: Phil R. Manning, M.D.

Risk Factors of Heart Disease: A Survey ofTexas Physicians and Implications for Continuing EducationLawrence Ullian, et al.

Clinical Learning in Respiratory Disease: AComparison of Computer-Assisted Instructionand Lecture MethodCharles M. Plotz, M.D., et al.

Improving Physician Performance by ContinuingMedical EducationO. E. Laxdal, M.D., et al.

A Problem-Based, Self-Directed EducationalProgram in Neonatal Respiratory Disease forCommunity Hospital Personnel. I. DevelopmentH. S. Barrows, M.D., et al.

ASSESSMENT OF STUDENT SELECTION

Moderator: Paul R. Elliott, Ph.D.

Assessment of Problem-Solving Skills as aScreen for Medical School AdmissionsJohn B. Molidor, Ph.D., et al.

Cognitive and Personality Variables in the Prediction ofPreclinical PerformanceRobert Roessler, M.D., et al.

Monitoring the Process of Selection: The Identification of Successful Applicants by an Admissions CommitteeLouise Arnold, et al.

Faculty Assessment of Medical School Admission CriteriaCarl N. Edwards, et al.

INFLUENCES ON SPECIALTY CHOICE AND

LOCATION

Moderator: Edwin B. Hutchins, Ph.D.

The Cooperative Michigan Longitudinal Studyof Medical Student Career Choice: ResearchDesign and Preliminary Results

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

A Longitudinal Evaluation of Student PhysicianExperience in Primary Care and Its Effect onResidency Choice

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Marian Osterweis, Ph.D., et al.

Factors Associated With Satisfaction in RuralPractice: The Medical School's RoleMartin P. Kantrowitz, M.D., et al.

Effects of Off-Site Experience on Medical Student Awareness and Interest in Rural HealthCare DeliveryJane Elzey, et al.

HEALTH SERVICES AND EDUCATION

Moderator: Charles W. Dohner, Ph.D.

An Ambulatory Care Information System ForEvaluating Clinical Performance of MedicineResidentsRoberta A. Monson, M.D., et al.

The Validity of the Medical Record: A Comparison of Elicited and Recorded Clinical DataJ. G. Wakefield, et al.

The Cost of Student Instruction in the PracticeSettingL. Gregory Pawlson, M.D., et al.

Medical Student Instructional Costs in a Primary Care ClerkshipL. Gregory Pawlson, M.D., et al.

PRESENTATION OF SYMPOSIA

IMPLICATIONS OF THE AAMC LONGITUDINAL

STUDY FOR MEDICAL EDUCATION AND MEDICAL

CARE DELIVERY

Chairman: James B. Erdmann, Ph.D.

Participants:

Xenia Tonesk, Ph.D.Robert F. Jones

Discussants:

Lee Sechrest, Ph.D.John S. Graettinger, M.D.

TEACHING THE INTERPERSONAL SKILLS OF MED

ICAL INTERVIEWING

Organizer: J. Gregory Carroll, Ph.D.

Chairman: Edwin B. Hutchins, Ph.D.

Participants:

J. Gregory Carroll, Ph.D.Judy MonroeJ. Dennis Hoban, Ed.D.Mary Heider, Ph.D.Joseph Stoner


John M. Schneider, Ph.D.B. Kaye Boles, Ph.D.

Discussant: Joseph W. Hess, Jr., M.D.

STUDENT RATINGS OF INSTRUCTIONAL EFFEC

TIVENESS: IMPACT ON AND IMPLICATIONS FOR

MEDICAL EDUCATION

Organizer: Marilyn A. Mendelson, Ph.D.

Chairman: Ronald Jordan, Ph.D.

Participants:

G. Robert Ross, Ph.D.Carol J. LancasterSusan B. BloodworthWayne K. Davis, Ph.D.Stephen L. ManchesterSara R. Frisch, Ph.D.Josephine M. CassieElizabeth RitchieGeorge F. CollinsJames H. Hardin, Ph.D.Stephen D. Canaday, Ph.D.Marilyn A. Mendelson, Ph.D.

ISSUES AND DIRECTIONS IN THE USE OF SMALL

LEARNING GROUPS IN MEDICAL EDUCATION

Chairman: Evelyn B. McCarthy

Participants:

Joyce M. Jaffe, Ph.D.Jay B. Forrest, Ph.D.Parker A. Small, Jr., M.D.SuiWah Chan, Ph.D.

Discussant: Dale Lefever, Ph.D.

ANALYSIS OF STRESS IN THE MEDICAL SCHOOL

ENVIRONMENT: AN ALTERNATIVE APPROACH

Chairman: Jerry A. Royer, M.D.

Participants:

Jerry A. Royer, M.D.Lois Huebner, Ph.D.Donald L. Cordes, Ph.D.James MooreLouise Arnold, Ph.D.Robert K. Marshall, Ph.D.Carl N. Zimet, Ph.D.Marc T. Edwards, M.D.

TOWARD A TESTABLE THEORY OF PHYSICIAN

COMPETENCE: AN EXPERIMENTAL ANALYSIS OF A

CRITERION-REFERENCED SPECIALTY CERTIFICA

TION TEST LIBRARY

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Chairman: Jack L. Maatsch, Ph.D.

Participants:

Steven DowningSarah Sprafka, Ph.D.Thomas Holmes, Ph.D.Jack Maatsch, Ph.D.

October 26

PRESENTATION OF PAPERS

MULTIPLE MEASURES OF STUDENT CLINICAL

PERFORMANCE

Moderator: Robert M. Rippey, Ph.D.

Relationships Between the Pre-Clinical and Clinical Years of Medical School: A Study of theInterrelatedness of Several Performance MeasuresRalph A. Sirotkin, et aI.

Prediction of Graduate Clinical PerformanceRatings From Multi-Component Medical SchoolExaminationsRene L. Nerenberg, et aI.

A Study of the Predictive Validity of PatientManagement Problems, Multiple Choice Testsand Rating ScalesMichael B. Donnelly, et aI.

Six Years Experience With a Supervised Yearof Training ("Fifth Pathway") For AmericansStudying Medicine AbroadJames E. Mulvihill, D.M.D., et aI.

CLINICAL TEACHING

Moderator: Daniel S. Fleisher, M.D.

Patient's Rights: An Approach to Informing andInstructing Teaching Patients Who Are To BeEvaluated by Sophomore Medical StudentsM. Albanese, et aI.

Pilot Experience of a Family Practice-BasedCombined ClerkshipL. Edmond Eary, M.D., et aI.

The Evaluation ofOn-Campus and Off-CampusSenior ElectivesM. A. Mendelson, Ph.D., et aI.

The Hospital Work of Family Physicians: AComparison of Teaching Settings to PracticeSettingsRonald C. Slabaugh, Ph.D.

INSTRUCTIONAL METHODS

151

Moderator: Sam Brown, Ed.D.

Towards the Experimental Validation ofClinicalTeaching StrategiesRobert A. Petzel, et aI.

A Comparison ofthe Effects of Videotape Feedback, Instructor Feedback, and Checklist Feedback on Medical Student Performance of thePhysical ExaminationWilliam E. Shreeve, Ed.D., et aI.

An Effective Model for Teaching SophomoreMedical Students to Perform the Male GenitalRectal ExaminationA. Behrens, et aI.

The Use ofPeer Group Models in Breast, Pelvicand Rectal Examination Instruction as an Integral Part ofMedical Gross AnatomyE. D. Prentice, Ph.D., et aI.

EDUCATIONAL POTPOURRI

Moderator: Donald M. Gragg, M.D.

A Method for Studying Medical Interviews: ANew Taxonomy for Coding Verbal InteractionsSamuel M. Putnam, et aI.

Identification of Physician Educational Influentials (El's) in Small Community HospitalsRoland G. Hiss, M.D., et aI.

A Comparative Analysis of Residents' Goals forTrainingEvelyn R. Dienst, Ph.D., et aI.

PATIENT VARIABLES IN QUALITY OF CARE

Moderator: John Corley, M.D.

Teaching Strategies 10 Family Practice Residentsto Improve Patient Adherence: Recent Advancesin Social-Psychological ResearchEdward E. Bartlett

Effects of Differences in Quality of Care onPatient Satisfaction and Other Variables: AnExperimental SimulationJohn E. Ware, Jr., et aI.

Modifying House StaffBehavior: Physician Versus Patient Oriented InterventionP. Rudd, M.D., et aI.

APPLICATION OF MODELS FOR CURRICULUM

DEVELOPMENT AND EVALUATION

Moderator: Craig L. Gjerde, Ph.D.

Strategy for Curriculum Planning

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Lawrence Tremonti, M.D., et al.

An Empirical Comparison of Responsive andPreordinate Approaches to Program EvaluationGerry R. Schermerhorn, et al.

Initial Evaluation of an Innovative Basic Sciences ProgramV. Patel, et al.

An Evaluation of an Undergraduate OncologyCurriculum by Time, Performance and Preference Dimensionsfrom the Point of View ofFunction, Academic Discipline and Body Organ SystemsPatricia M. Scalzi, et aI.

PRESENTATION OF SYMPOSIA

LAW AND MEDICINE: APPROACHES TO UNDER

GRADUATE MEDICAL SCHOOL CURRICULUM

PROGRAMMING

Organizers:

Linda H. CoulterTheodore R. LeBlang

Chairman: Theodore R. LeBlang

Participants:

George J. AnnasBarbara R. GrumetAngela R. HolderTheodore R. LeBlang

Discussant:

Salvatore Francis Fiscina, M.D.

ALTERNATIVE PROGRAMS IN MEDICAL EDUCA

TION: HOW WELL ARE THEY WORKING, AS MEA

SURED BY STUDENT PERFORMANCE?

Organizer: Louise Arnold, Ph.D.

Chairman: Ernest H. Blaustein, Ph.D.

Participants:

Melton E. Golmon, Ph.D.Harry W. Linde, Ph.D.T. Lee WilloughbyFrederick W. Pairent, Ph.D.

Discussant: Stanley Olson, M.D.

TEACHING HEALTH CARE COST CONTAINMENT IN

THE NATION'S MEDICAL SCHOOLS

Organizer: Mohan L. Garg, Sc.D.

Chairman: Joseph G. Giacalone


Participants:

Donald R. Korst, M.D.James E. Davis, M.D.Jack L. Mulligan, M.D.Carter Zeleznik, Ph.D.Joseph S. Gonnella, M.D.Mohan Garg, Sc.D.

Discussants:

Robert Stone, Ph.D.Michael J. Goran, M.D.Jane S. Mathews

THE RELATIONSHIP BETWEEN MORAL REASON

ING, TREATMENT OF THE CRITICALLY ILL, RESI

DENT PERFORMANCE, AND ROLE CONCEPT

Chairman: T. Joseph Sheehan, Ph.D.

Participants:

Susan D. R. HustedCharles D. Cook, M.D.T. Joseph Sheehan, Ph.D.Daniel Candee, Ph.D.

Discussant: Bryce Templeton, M.D.

WHAT ARE THE NEW MEDICAL SCHOOLS DOING

ABOUT CURRICULUM EVALUATION: AN INTER

NATIONAL PERSPECTIVE

Chairman: Vic Neufeld, M.D.

Participants:

Christel Woodward, Ph.D.Cees van Boven, M.D.Rufus Clarke, M.D.Ascher Segall, M.D.

A NATIONAL STUDY OF PHYSICIAN PRACTICES IN

TWENTY-FOUR SPECIALTIES: SELECTED FINDINGS

Organizer:

Stephen Abrahamson, Ph.D.

Chairman: John S. Lloyd, Ph.D.

Participants:

Roger A. Girard, Ph.D.Robert C. MendenhallGeorge P. DeFlorioPaul A. Repicky, Ph.D.

Discussants:

William D. Holden, M.D.C. H. William Ruhe, M.D.Alvin R. Tarlov, M.D.

153

New Orleans Hilton Hotel, New Orleans, Louisiana

tion had authorized the filing of amicus curiaebriefs in two additional cases, In Cannon v. theUniversity of Chicago the issue pertained towhether Title IX of the Education Amendments of 1972 prohibiting discrimination onthe basis of sex conferred a private right ofaction or whether a disappointed applicantmust first comply with the administrative remedies in the statute. Shapp v. Sloan involvedwhether a state legislature can reappropriatefederal funds for educational institutions orwhether the Board of Regents retains autonomy for the governance of the academic institution. Dr. Petersdorfalso reported on the workof a number of task forces and committees ofthe Association, including the Task Force onStudent Financing and the Task Force on Minority Student Opportunities in Medicine, thefmal reports of which were adopted by theExecutive Council. The Executive Council alsoadopted reports from Ad Hoc Committees onBiomedical and Behavioral Research andTraining and Section 227 ofthe Medicare Law.The activities of the two ongoing Task Forceson Support of Medical Education and Graduate Medical Education were also discussed.

The Association had been involved in effortsundertaken by the Department of Health, Education and Welfare, and particularly the National Institutes of Health, to develop an HEWplan to support health research, and the Association had also begun to review medical faculty involvement in research regulated by theFood and Drug Administration.

The Association's activities with respect toSection 227 regulations were detailed and Dr.Petersdorfreported that Secretary Califano hadannounced that the implementation of the regulations would be delayed and that the Asso-

Call to Order

Dr. Robert G. Petersdorf, AAMC chairman,called the meeting to order at 11:30 a.m.

Consideration of Minutes

The minutes of the November 8, 1977, Assembly meeting were approved without change.

Quorum Call

The Chairman recognized the presence of aquorum.

October 24, 1978

Minutes of AAMC Assembly Meeting

Report of the ChairmanDr. Petersdorf reported that the Associationand its constituents had been involved in anumber of court cases during the past year,most notably the Bakke case in which theAAMC had filed an amicus curiae brief andacted as a supplier of data and coordinator ofinformation for the university, the federal government and other amici. The Association hadalso filed an amicus brief in Kountz v. the StateUniversity ofNew York, a case that challengedthe authority of an institution to regulate thepractice income of the physician members ofits full-time faculty. Although the Associationplayed no direct role in the case of Horowitz v.the Regents of the University of Missouri: information on the court's decision reaffirming theuniversity's role in regulating academic standards and promotions was distributed by theAssociation to constituents. In Chrysler v.Brown the Association acted in its amicus toalert the court to the adverse impact on therights of academic scientists that would resultfrom a decision that the government can releaseinformation exempt from the Freedom of Information Act. Recent Executive Council ac-

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clation would continue to discuss its concernswith HEW staff.

Finally, Dr. Petersdorf reported that Congress had adjourned without acting on H.R.2222, a bill to treat house staff as employeesfor the purposes of the National Labor Relations Act. He reported that this legislationwould undoubtedly be introduced in the nextCongress.

Report of the President

Dr. John Cooper reported that the Associationhad completed its activitIes funded under amajor Bureau of Health Manpower contract,and had successfully initiated a number ofnewprojects including a joint venture with the Veterans Admmistration to develop criteria andstandards for evaluating contmuing medicaleducation programs, a Health Care FinancingAdministration project to develop a primer onteaching cost containment and quality assurance to medical students, and an expansion ofthe AAMC Simulated Minority AdmissionsExercises program.

Dr. Cooper had served as chairman of theCoordinating Council on Medical Educationsince last March. The major effort of the Association had been to strengthen the LiaisonCommittee on Graduate Medical Education bysupporting the establishment ofan independentstaff and by reaffirming the LCGME's authority as the accrediting agency for graduate medical education programs.

The number of medical school applicants forfall 1978 had declined by 9.1 percent over thoseapplying in the previous year, although whenthe number of ,available freshman places wasat an all-time high. The Association planned tostudy the drop in applicants and the impact theovtrall decline had on the number of womenand minority students. Health manpower issuescontinued to playa major role at the Association during 1978, as manifested in discussionsby the Association's task forces, the adoptionof an interim position paper by the ExecutiveCouncil on specialty distribution, and in continued negotiations with Congressional andagency personnel preparing for new healthmanpower legislation in the next Congress. Dr.Cooper also discussed Congressional changesoccurring because of Congressman Rogers' retirement and the assumption of the Judiciary


Committee chairmanship by Senator EdwardKennedy. Dr. Cooper said that many healthbills would be debated in the new Congressincluding cost containment, drug regulationand reform, health planning amendments,Medicare and Medicaid fraud and abuse legislation, and the Clinical Laboratories Improvement Act. Congress had taken final actionon the appropriations bill setting a level formedical school capitation payments at about$1,325 per student, a slight decrease over thelevel of the previous year.

Also, Dr. Cooper stated that in recent conversations with Dr. James Crutcher, the newchief medical director of the Veterans Administration, he had received assurances that proposed cutbacks in the VA residency trainingprograms had been restored. Dr. Crutcher hadpromised to continue to work closely with theAAMC to maintain a good relationship between his agency and the medical schools.

Report of the Council of Deans

Dr. Julius Krevans reported that the Councilof Deans had been actively involved in reviewing Association policies during the past yearand had no new business to present to theAssembly.

Report of the Council of Academic Societies

Dr. Robert Berne reported that the Council ofAcademic Societies had elected six new members. He also reported that the Council hadspent much of its time formulating the policystatement on Biomedical Research and Behavioral Research Training that the ExecutiveCouncil had endorsed. Further efforts wereunderway to work with the Department ofHealth, Education, and Welfare to develop thatagency's research policy. During the course ofthe year the CAS had met with Dr. Carl Douglass of the NIH Division of Research grants todiscuss the peer review system and with Dr.Richard Crout of the Food and Drug Administration to discuss the effect ofFDA regulationon research conducted by medical school faculty.

The CAS would sponsor a Public AffairsWorkshop during the latter part of the annualmeeting and would hold an interim meeting inthe spring.

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1978 Assembly Minutes

Report of the Council of Teaching Hospitals

Mr. David Everhart reported that the COTHhad begun sponsorship of a spring meeting toincrease opportunities for its members to become involved in the formulation of Association positions. Two important issues consideredby COTH during the year were cost containment and the concept ofmulti-hospital systems.

Report of the Secretary-Treasurer

Mr. Everhart reviewed the published treasurer'sreport and reminded the Assembly of the Executive Council's goal of reserving the equivalent of one year's operating funds, and furtherreported that at the conclusion of the last fiscalyear the reserves were equal to 82 percent ofthat goal. Mr. Everhart also paid special tributeto J. Trevor Thomas, director of business affairs, for his oversight of the financial affairs ofthe Association.

ACTION: On motion. seconded, and carried, theAssembly accepted the report of the SecretaryTreasurer

Report of the Organization of StudentRepresentatives

Mr. Paul Scoles reported that major OSR activities involved finding ways of making moreinformation on graduate medical educationprograms available to students and reviewingoptions in fmancing medical education.

Election of New Members

ACTION: On separate motions. seconded. andcamed. the Assembly by unanimous ballot electedthe followmg-inslllutions and individuals to theindicated classes ofmembership.

Provisional Institutional: Marshall UniversitySchool of Medicme; Catholic University ofPuerto Rico School ofMedicine; School of Medicine at Morehouse College; and East TennesseeState University College of Medicine.

Academic Society: American Society of Hematology; American Society of Pharmacology andExperimental Therapeutics; Association of Academic Departments of Otolaryngology; Association for the Behavioral Sciences and MedicalEducation; Society for Neuroscience; and Thoracic Surgery Program Directors.

Teaching Hospital: Baroness-Erlanger-T.CThompson Childrens Hospitals, Chattanooga,Tennessee; Charles F. Kettering Memorial Hospital, Kettering, Ohio; Children's Hospital Medical Center. Cincinnati, Ohio; Good SamaritanHospital and Health Center, Dayton. Ohio; Jerry

155

L. Pettis Memorial Veterans Hospital, LornaLinda. Cahfornla. Smal Hospital of DetrOIt. Detroit, Michigan; and University of MassachusettsHospital, Worcester, Massachusetts

Corresponding. Mercy Hospital. Urbana, Illinois; North Chicago Veterans AdministrationHospital, North Chicago, IlhnOls, OrthopaedicHospital. Los Angeles, Cahfornla; SouthwesternMichigan Area Health Education Center, Kalamazoo, Michigan, Veterans Admmlstratlon Hospital, FayetteVille, North Carohna.

Individual: (List attached to archive mmutes.)DlS/mguished Service. Leonard W. Cronkhite,

Jr., M.D.Emeritus: Donald G. Anderson, M.D., T

Stewart Hamilton, M.D.• John S Hirschboeck,M.D.; Russell A. Nelson, M 0, and Edward CRosenow, Jr., M.D

Report of the Finance Committee

Mr. Charles Womer stated that the FinanceCommittee report had been presented to theCouncil of Deans and to the Council of Teaching Hospitals at their spring meetings and tothe Administrative Boards of all three Councilsand endorsed by each group. The FinanceCommittee had recommended that althoughthe Association was in good financtal health,an increase in the dues structure beginning to

fiscal year 1980 be made to assure that theAssociation was able to meet the challengesthat lie ahead. The recommended changes include an inflator imposed on dues and servicefees that would be subject to watver or decreaseby action of the Executive Council.

ACTION' On motion. seconded. and camed. theAssembly approved the report ofthe Fmance Commillee recommending a raise m mSIl/Ulional andorganiza/lonal dues. (Copy of report aI/ached toarchive minutes.)

Eligibility for Continuing COTH Membership

Mr. Everhart explained that there were twocategories of COTH membership: TeachingHospital membership and Correspondingmembership. Both membership categories required the applicant institution to have a documented affiliation agreement with a medicalschool accredited by the LCME, and a letterrecommending membership from the dean ofthe affiliated medical school. Teaching Hospital membership was limited to not-for-profitand publicly owned hospitals that sponsor orsignificantly participate in at least four approved active residency programs. at least two

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of which are in the areas of internal medicine,surgery, obstetrics-gynecology, family medicine, or psychiatry. A statT study of COTHmembers revealed that 24 COTH memberslacked the required signed affiliation agreement, six COTH members sponsored or participated in three or fewer residency programs,and three members had fewer than two residencies in the required specialties. The Executive Council recommended the following revisions in COTH membership requirements:

I. That hospitals belonging to COTH priorto July I, 1978, without a signed affiliationagreement be retained as members providedthey continue to maintain the required numberof residencies

2. That Teaching Hospital members thateither do not sponsor or participate in four approved residency programs or do not have twoprograms within the required basic six residencies be reclassified as Corresponding Memberseffective July I, 1979.

3. That the NIH Clinical Center be retainedas a full Teaching Hospital member recpgnizmgits specialty care nature.

ACTION: On motion. seconded. and carried. theAssembly approved the recommendations of theExecutive Council with respect to continuingCOTH membership in the AAMC

Statement on Withholding of Medical Care ByPhysicians

Dr. Clayton Rich reported that the statementon withholding of medical care by physicianshad been adopted by the Executive Council inresponse to Association concern about physicians witholding services to make social oreconomic points. He further explained that thestatement did not proscribe withholding ofservices, but emphasized the seriousness of theethical issues that must be considered in sucha decision.

ACTION: On motion. seconded. and camed. theAssembly adopted thefollowing statement on withholding ofmedical care by physicians:

Fundamental ethical tenets of the medicalprofessions mandate that physicians providecare for the sick and neither abandon or exploittheir patients. These ethical tenets apply to physicians whether they are acting individually orin concert as members ofgroups or associations.

An important ethical issue, one not ordinarilypresent in the traditional relationship betweenan individual physician and his patients, emergeswhen physicians act together to restrict or withhold medical services. An mdividual phySICian


need not accept as his patient every person whoseeks medical attention because, in most situations, alternative sources of care are available.However, the option of alternative care may beforeclosed when physicians act together to limitor withhold medical care. It is clear that physicians acting in concert have an ethical responsIbility to all of those In the general public whocould be patients of indIVIdual physicians had agroup decision denying them some form of medical care not been made. When such a deciSIOnis implemented by all available physicians, thesephysicians abandon members of the public seeking medical care. Therefore, physicians who actIn concert to restrict or Withhold medical carecontravene some of the profession's primary ethical precepts.

(Physicians are, ofcourse, justified in refusingto perform procedures or acts designed to furtherinherently corrupt or evil purposes. Indeed thereis an ethical mandate that they do so. but suchacts are not properly defined as medical care.)

In the recent past groups of physicians haveacted to restrict or withhold medical care in orderto call attention to social issues. such as the needto improve the quality of care afforded onesegment of the public. An analysis of the ethicalconsiderations raised by this practice begins withthe recognition that physicians are members ofthe public With special knowledge and experience which provide a unique perspective on theconditions of medical practice, the relations between the profession and the pubhc and themajor social issues Involving health and welfare.Physicians acting individually or together havea special SOCial responsibility to provide adViceand leadership in such matters. However, inadvancing positions about social issues, physicians act as specially informed citizens, not fromtheir unique and primary positions as healers.Any attempt to justify on ethical grounds thedeciSion to restrict medical care in order toadvance an assumed social good confounds thespecific role of phySICians in society as providersof heahng services, with a more general roleshared with all other citizens. These conSiderations make it doubtful that a justification reasonably can be advanced. To the extent that anelement of self-mterest motivates a decision tolimit or withhold profeSSIOnal services. ethicalJustification of that stance is even more suspect.

Because the ethics and pubhc duty of theprofeSSIOn restrain physicians from acting inconcert to withhold services. they should avoidthis powerful method of advancing their interests. It is a responsibility of society to foregoexploitation of this ethical standard by providinga fair process for resolving valid economic andorganizational issues which influence the welfareof the profeSSIOn and the quality of medical care.

The Association of American Medical Colleges reaffirms Its support of fair processes forresolving concerns of medical professionals and

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opposes the withholding of medical care bygroups of physicians as a means of resolvIngsuch issues.

Report of the Task ForceOn Support of Medical Education

Dr. Stuart Bondurant reported on the activitiesof the Task Force on Support of Medical Education. In its draft report the Task Forcerecommended that:

I Broadbased support. equal to one-thud ofthe average national cost of medical education(as determined by established methodologies).be an Integral part of health manpower renewallegislation.

2. Programs of federal assistance to medicalschools be Implemented primarily through incentives rather than through detailed speCifications of institutIOnal operations. have continUityof purpose. respect the health and integrity ofthe responsible institutIOn. and permit institutional diverSity withIn the frame-work of national objectives

3. Direct federal institutional support tomedical schools continue to be the primary vehicle of federal assistance.

4. Institutional support grants coupled withappropriate conditions for partiCipation be requested.

5. There be no expansion of medical schoolenrollments for three to five years while information is gathered to support a reasoned deCIsion on whether a change In physician production would serve the national interest.

6. Special projects be continued, but not asthe preferred or primary mechanism for thesupport of medical education.

7. Most current special projects such asAHEC be contInued and new programs in education In the principles of cost contaInment anda special assistance program for schools withsignificant mInority enrollments be Implemented.

8. The recommendations of the AAMC TaskForce on Student FinanCIng be supported.

9. Careful assessment ofthe status of medicaleducation facilities be undertaken and that themedical educational facihties program be revitalized.Copies of the complete draft report were

made available to Assembly members whowere invited to submit comments to the TaskForce.

Report from the Task ForceOn Graduate Medical Education

Dr. Jack Myers. chairman of the Task Forceon Graduate Medical Education, reported thatthe task force hoped to present Its final report

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to the 1979 Assembly. The task force had divided into five working groups on Transitionfrom Undergraduate to Graduate Medical Education, Quality, Accreditation, Specialty Distribution, and Financing. The task force hadworked closely with the Graduate Medical Education National Advisory Committee, andother groups that were also studying variousaspects of graduate medical education.

AAMC Working Paper on Specialty Distribution

Dr. Petersdorf reported that the ExecutiveCouncil had adopted an interim working paperon specialty distribution for use in discussionswith persons working on new health manpowerlegislation. The working paper recommendeda goal of 50 percent of U.S. medical graduatesentering careers in primary care; that the number of first year residency positions filled insurgical and other nonprimary care specialtiesremain at the 1977-78 level; that the number ofentering positions for subspecialty training ininternal medicine and pediatrics be decreasedby one-third, with half of the remaining positions in programs emphasizing careers in research and academic clinical practice; that theorganizations, institutions and program directors responsible for graduate medical educationadopt these principles in the public interest andwork for their iIhplementation; and that theLiaison Committee on Graduate Medical Education establish a registry of subspecialty programs and develop an accreditation mechanismto assure the quality of subspecialty trainingprograms. The issues addressed in the WorkingPaper would be dealt with in more detail in thefmal report of the Task Force on GraduateMedical Education.

Comments from the floor indicated the hopethat the final report would recommend continued support for family practice training programs, and that the final report of the TaskForce on Graduate Medical Education wouldbe submitted to the membership for detaileddiscussion before its adoption.

Final Report of the Task ForceOn Minority Student Opportunitiesin Medicine

Dr. Paul Elliott, chairman of the Task Forceon Minority Student Opportunities in Medi-

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cine, reported that the task force had completedits work and its final report had been adoptedat the September Executive Council meeting.The principal goals of the report were:

I. Increase the pool of quahfied racial mInority apphcants to levels equivalent to theirproportion in the U.S. population with progresstoward that goal reviewed on a biennial basis.

2. Enlarge the number of qualified racialmmonty students admtlted to medical schoolsthrough contmued Improvement of the selectionprocess

3. Emphasize the importance of financial assistance for racial minority group students pursuing careers in medicine

4. Strengthen programs which support thenormal progress and successful graduation ofracial minority students enrolled m our medicalschools.

5. Increase the representallon of racial minority persons among basic science and clinicalfaculties

6. Encourage the establishment of faculty development programs aimed at fostering an understanding of the history and culture of racialminority groups and at improving the quality ofmedical school instruction.

7. Insure that graduate medical educationneeds and opportunities for racial minority student are met.

Report of the Resolutions Committee

There were no resolutions presented to theResolutions Committee for timely consideration and referral to the Assembly.

Resolution on Research OpportunitiesFor Undergraduate Medical Students

Mr. Paul Scoles offered the following resolutionfrom the Organization of Student Representatives:

Whereas, firsthand research experience contnbutes greatly to the development of scientificthought processes which are ofvalue in all areasof medicine and continuing education;

Whereas, medical undergraduates have theopportunity to devote smaller blocks of time toresearch endeavors than is reqUired for postgraduate research commitments,


Whereas, many medical students have beenunaware of the opportunities or have been unable to fully utIlize such opportunities becauseof problems with scheduhng, funding, and soforth;

Be it therefore resolved that the COD, OSR,and CAS form a joint committee to Invesllgatepossibilities for improving and encouraging research opportunilles, basic as well as clinical, formedical students with an interest towards fundIng, scheduling, and student research presentations.

ACTION: On motion, seconded, and carriedunanimously, the Assembly approved the resolution proposed by Mr. Scoles and the OrganizationofStudent Representatives

Report of the Nominating Committee

Dr. Jack Eckstein, Chairman of the AAMCNominating Committee, presented the reportof the Nominating Committee. The Committeeis charged by the Bylaws with reporting to theAssembly one nominee for each officer andmember of the Executive Council to be elected.The following slate of nominees was presented:Chairman-Elect: Charles B. Womer; ExecutiveCouncil, COD representatives: Clayton Rich,M.D., William H. Luginb,uhl, M.D., John E.Chapman, M.D.; Executive Council, CAS representative: Carmine D. Clemente, Ph.D.; Executive Council, COTH representatives: JohnW. Colloton, Stuart J. Marylander.

ACTION: On motion, seconded, and carried, theAssembly approved the report of the NominatingCommittee and elected the individuals listed aboveto the offices indicated.

Installation of Chairman

Dr. Petersdorf presented the gavel to Dr. JohnA. Gronvall, the new AAMC chairman. Dr.Gronvall expressed the appreciation of the Association for Dr. Petersdorrs leadership.

Adjournment

The Assembly was adjourned at 1:05 p.m.

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Annual Report

of schools to use a variety of selection factorsincluding race to achieve a goal of diversity inthe student body.

Government concern about specialty andgeographic distribution of physicians has beenmanifested in efforts to hold medical schoolsaccountable for the individual career choicedecisions of their graduates. Efforts to enforcea national standard on all schools wouldthreaten the diversity of medical education andignore the advantages of a pluralistic approachto physician education.

The patient care activities of academic medical centers and their teaching hospitals aremore thoroughly regulated than ever before,and it frequently seems that the complexitiesinherent in a patient care setting with corollarymissions of research and teaching are inadequately considered in the promulgation of regulations. Concern about nsing health care costshas made cost containment a national priority,but the regulatory approach to teach109 institutions/tertiary care centers has been inconsistent and paradoxical. In some instances teachinghospitals have been singled out for special restrictions; in others, there has been a failure toacknowledge the special role of the teach109institution. Similarly, local and state healthservices planning efforts frequently ignore theunique position and contributions of teachinginstitutions.

Biomedical research in this country has longbeen a model of productive participation bythe private academic and scientific commuOityin meeting goals articulated by the public sector. The peer review system at the NationalInstitutes of Health has particularly succeededin coupling input from the pnvate sector withthe allocation of federal funds. The keystone inthis arrangement has been the implicit ac-

Message from the President

John A. D. Cooper, M.D.

Each year the activities of the Association andIts constituents become more inextricably related to federal and state governments. In thepast this cooperative relationship has benefitedboth parties; for example in the creative partnership forged to advance biomedical researchor in the responsiveness of medical schools topast federal concerns about the adequacy ofphysician manpower production. Recently,however, the delicate balance necessary tomaintain a productive relationship has begunto fail. The threat to our institutions of medicaleducation-and to society-should this balance be destroyed has led to extensive reviewwithin the Association as to how such a partnership can be continued with mutual benefit.It is critically important that the diversity andindependence of the academic medical centersbe preserved even as we recognize the expectation of society that these institutions will provide needed services to the nation. The educational mission of medical schools has beenassailed by federal efforts to direct the admissions process. Although the most notorious occasion was ~he "USFMS provision" of recentmanpower legislation, federal regulations Qnnondiscrimination against the handicapped offer the threat of further governmental interference in an area long held to be within theinstitutional autonomy of a university. Despitethe spectre of increasing government involvement in academic decisions, the Associationwas heartened this year by two Supreme Courtdecisions affirming the independence ofschoolsin traditionally academic areas. In Board ofCurators ofthe University ofMissouri v. Horowitz the Court reiterated its faith in the ability ofacademic institutions to evaluate the performance of their students fairly and impartially.The celebrated case of Regents ofthe UniversityofCalifornia v. Allan Bakke reaffirmed the right

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knowledgment that the impartial assessment ofresearch proposals by prominent scientists results in funding those research efforts mostlikely to contribute to improving healththrough increasing biomedical knowledge. Several trends in recent years now jeopardize thisvery effective system. There has been an increasing tendency on the part of the government to favor centralized direction of biomedical research at the expense of traditional investigator-inItiated research. Further, despitethe growth in the country's research enterpriseand a substantial increase in research applications to NIH, support and staff for the peerreview system have remaIned virtually unchanged. The net result has been a severe erosion of the capability for effective and timelyscientific review. A final threat to the biomedical research effort has been the periodic attempt by the government to inject public participation into the decision-making processesfor research. While the Association stronglysupports public accountability in all aspects ofthe activities of its constituents, too often theincrease in public participation is at the expenseof the scientists most knowledgeable about thepolicy In question.

Inevitably it is a perceived lack of concernby the private sector that Invites regulation by


the government. The responsibility ofour medical schools when accepting public funds cannot be limited to an audit statement that fundswere properly expended; responsibility also encompasses the need to work with the government to identify ways to achieve public goals.Failure to respond in a cooperative manner willresult in increased government impositions andregulation, making it more difficult for medicalschools to make their unique contributions tothe improvement of the quality of life. TheAssociation believes that progress in seekingsolutions to our health problems can best beachieved when schools retain the flexibility tobe innovative; a pluralistic approach to problem-solving offers better opportunity for success. We are strongly committed to a policyusing incentives rather than regulation to implement public goals, to maintaining creativediversity among medical schools, and to increasing medical school sensitivity and responsiveness to public needs. Anne Somers hasstated, "Of all the communications gaps in ourcomplex pluralistic society, none is greater thanthat between academic medicine and the general public." The Association rededicates itselfto improving communications between ourconstituents and the public and its representatives.

Administrative Boards of the Councils, 1977-78

AAMC Annual Reportfor 1978

Executive Council, 1977-78

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ORGANIZATION OF STUDENT REPRESENTATIVES

Paul ScolesPeter Shields

Christopher C. Fordham, IIINeal L. Gault, Jr.Richard JanewayJulius R. Krt'vansWilliam H. LugmbuhlClayton RichRobert L. Van Citters


John W. CollotonDavid L. EverhartRobert M. HeysselDavid D. Thompson

David L. Everhart, chairmanRobert M. Heyssel, chairman-electJohn W. CollotonJerome R. DolezalJames M. EnsignLawrence A. HillStuart MarylanderStanley R. NelsonMitchell T. RabkinMalcom RandallJohn ReinertsenElliott C. RobertsDavid D. ThompsonRobert E. Toomey

ORGANIZATION OF STUDENT REPRESENTATIVES

Paul Scoles, chairpersonPeter Shields, chairperson-electFred EmmelClayton GriffinCheryl GutmannMichael MahlJames MaxwellDan MillerMolly OsborneThomas RadoDennis Schultz

Robert J. Glaser

Robert G. Petersdorf, chairmanJohn A. Gronvall, chairman-electJohn A. D. Cooper, president

Council Representatives:

DISTINGUISHED SERVICE MEMBER


Robert M. BerneA. Jay BolletDaniel X. FreedmanThomas K. Oliver, Jr.

COUNCIL OF DEANS

Steven C. BeeringStuart Bondurant

COUNCIL OF DEANS

Julius R. Krevans, chairmanChristopher C. Fordham, III, chaIrman-electSteven C. BeeringStuart BondurantJohn E. ChapmanNeal L. Gault, Jr.Richard JanewayWilliam H. LuginbuhlClayton RichRobert L. Van Citters


Robert M. Berne, chairmanThomas K. Oliver, Jr., chairman-electF. Marian BishopA. Jay BolletDavid M. BrownCarmine D. ClementeG.W.N. Eggers, Jr.Daniel X. FreedmanJames B. PrestonSamuel O. ThierFrank C. Wilson, Jr.Frank E. Young


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The Councils

Executive Council

At its four meetings the Executive Councildiscussed and acted on many issues affectingmedical schools and teaching hospitals andtheir faculty and students. Policy questionscame to the attention of the Executive Councilfrom member institutions or through one of theconstituent Councils. Policy matters consideredby the Executive Council were first referred tothe constituent Councils for discussion and recommendation before final action.

The December retreat for the Association'selected officers and executive staff allowed participants to review the Association's relationship with other organizations concerned withmedical education, particularly the Coordinating Council on Medical Education, the LiaisonCommittee on Medical Education, the LiaisonCommittee on Graduate Medical Education,and the Liaison Committee on ContinuingMedical Education. Participants also focusedattention on areas in which new federal legislation was expected, such as biomedical research policy and the national health planningprogram. The role of the Association in developing statements on ethical issues of concern toits constituency received considerable discussion, and recognition of the Association's responSIbilities in this area led during the year toExecutive Council consideration of a statementon financial considerations for admission tomedical school, involvement of medical schoolfaculty with foreign medical schools, privatelysponsored research in academic settings, andwithholding of services by physicians. As aresult of Retreat discussions, the AAMC staffexplored activities to assist medical schools andteaching hospitals to increase their role in educating the public about awareness of healthrisks and the practice ofbetter health standards.Another Retreat discussion item receiving further attention at Executive Council meetingsconcerned ways of improving communicationsamong the Association's officers, staff, and constituents.

The Association's participation in the Coordinating Council on Medical Education was

actively reviewed throughout the year. Particular attention was paid to CCME reports onthe future staffing of CCME, policy planningfor physician distribution, women in medicine,and residency positions for foreign medicalgraduates. The Executive Council strongly supported the establishment of an independentstaff for the Liaison Committee on GraduateMedical Education, and reaffirmed theLCGME's authority as the accrediting agencyfor graduate medical education programs. TheExecutive Committee also urged the CCME todevelop a long-range financing plan for theLiaison Committee on Continuing Medical Education.

The Executive Council's continuing reviewof important medical education policy areaswas augmented by the work of a number ofspecially constituted committees and taskforces. Two major AAMC task forces completed their work and presented final reports tothe Council. The Task Force on Minority Student Opportunities in Medicine, chaired by Dr.Paul Elliott, finished a comprehensive reviewof the problems faced by medical schools inseeking to increase the enrollment of minoritystudents and the problems encountered by minority applicants seeking medical education.The Executive Council endorsed recommendations to increase the pool of qualified racialminority applicants to a level equivalent totheir population proportion, to emphasize theimportance of financial assistance for minoritystudents, to improve the selection process, tostrengthen programs to retain minority studentsin medical schools, to increase minority representation on medical school faculty, to fosterfaculty understanding ofminority students, andto ensure that the graduate medical educationneeds of minorities are met.

Dr. Bernard Nelson, Chairman of the TaskForce on Student Financing, presented a finalreport which analyzed the shortcomings of existing student financial aid programs and offered recommendations for improving suchprograms.

The Executive Council also adopted a position paper on Biomedical and Behavioral Re-

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AAMC Annual Report/or 1978

search Policy prepared by a committee underthe leadership of Dr. Robert Berne.

The work of two other major AAMC taskforces continued.

The Task Force on the Support of MedicalEducation, under Dr. Stuart Bondurant's chairmanship, held three meetings during the pastyear and conducted a large portIOn of its business through working groups on the relationship of the university to the federal governmentand the rationale for continuing federal support, the character and need for financial support of medical education institutions, numberand distribution of physicians, the role of medical schools in cost containment, and specialinitiatives.

The Task Force converged on a series ofpreliminary recommendations for submissionto the Executive Council. However, in view ofthe unstable and unpredictable political situation facing the health industry in the wake ofCongressman Paul Rogers' announced retirement from the House of Representatives, theTask Force decided that its first set of recommendations should be of a general and not aspecific nature, and included the following:

I. Institutional support on the part of theFederal Government should be continued andshould approximate one-third of the nationalaggregate medical education bill.

2. In recognition of the fact that a basicentitlement grant, though justified, was unrealistic, the Association should set forth standardsfor appropriate qUid pro quos which wouldreflect both propriety in academic/governmentrelationships as well as sound public policyobjectives.

3. Enrollment increases over the next threeto five years would be unwise.

4. The acceptance of the report of AAMCTask Force on Student Financing on incomecontingent loan programs.

Dr. Jack D. Myers, chairman of the TaskForce on Graduate Medical Education, designated five working groups to focus on concernsof major import to this study. A WorkingGroup on the Transition Between Undergraduate and Graduate Medical Education, chairedby Dr. Kay Clawson, studied the problems atthe interface between these phases in the education and training of physicians. The grouprecommended that steps be taken to improve

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the amount and quality of information available about graduate programs; that the application cycle be modified to increase the timeavailable for decision-making; that letters ofevaluation and transcripts not be supplied bydeans and faculty until the fall of a student'sfinal year; that interview schedules by graduateprograms be sufficiently flexible to accommodate students' needs at the least expense; andthat only two types of first graduate year programs be offered-categorical and mixed. TheWorking Group on Quality led by Dr. SamuelB. Guze considered institutional responsibilityto assure the quality of their graduate programs. The group is also studying how programdirectors and faculty can improve the qualityof their educational programs and their evaluation of residents' performance. A WorkingGroup on Accreditation under the chairmanship of Dr. Gordon W. Douglas began deliberations in the fall. Other working groups onspecialty distribution and financing graduatemedical education will report to the TaskForce. The W. K. Kellogg Foundation, theEducation Foundation of America, and theHenry J. Kaiser Family Foundation have supported the work of the Task Force.

In response to Department of Health, Education and Welfare regulations on the admission of handicapped persons to education programs, the Executive Council established a Special Advisory Panel on Technical Standards forMedical School Admission. The Panel met witha representative of HEW's Office of CivilRights to discuss the impact of the regulationson medical schools. Primary concerns of thePanel are maintenance of the M.D. degree asa broad, undifferentiated degree, and protection of the integrity of the admissions process.

A key Supreme Court decision in the case ofRegents of the University of California v. AllanBakke approved the use of race as one factorin the selection of students. Although the useof specific quotas based on race is not permissible, the Court's decision does support affirmative action programs. In an amicus curiae briefthe Association had urged that the constitutionality of special minority admissions programsin medical schools be upheld. Chrysler v. Brownprovided an opportunity for the Association tofile an amicus brief supporting the use of Exemption 4 of the Freedom of Information Act

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to maintain the confidentiality of the NIH peerreview process and protect the proprietaryrights of NIH applicant scientists.

The Executive Council this year respondedto a series of questions posed by Rep. PaulRogers, chairman of the Subcommittee onHealth and Environment of the House Committee on Interstate and Foreign Commerce,concerning the conduct in public or publiclyfunded schools or research centers, of directedresearch funded by profit-making enterpriseswith economic interests in the research outcome. A position paper on the responsibilitiesof institutions and individuals engaged in industry-sponsored research and consultationwas prepared as a discussion document for useby constituent medical schools. The workingpaper was also used to initiate a dialogue onthis subject with university presidents since theproblems transcended the medical school andaffected other departments within the university as well.

Periodic allegations of improprieties in theadmission process of some medical schoolsprompted the Executive Council to reaffirm itslong-standing policy that admission of studentsto medical schools should be based on theirindividual merits and the probability that theywill fulfill goals established by the institution;no actual or perceived relationship betweenadmission and financial contributions shouldexist.

A number of students who aspired to bephysicians but who were not admitted to a U.S.medical school entered medical training innewly developing off-shore medical schools.Information received by the Association indicated that many of these schools were of substandard quality, and some were soliciting U.S.faculty members to serve as visiting professors.U.S. teaching hospitals were also asked to provide clinical clerkships for students. The Executive Council urged faculty and hospitals considering such arrangements to exercise due caution and to become familiar with the quality ofthe educational experience offered at the foreign institution before lending their names,services, or facilities.

Information provided to the Council ofDeans and the Council of Academic Societieson the peer review system at the NationalInstitutes of Health caused grave concern


within the Executive Council. A significantincrease in capacity of the nation's biomedicalresearch enterprise and an enormous increasein NIH research grant applications, when coupled with decreases in study section staff andadministrative rulings increasing access to application review files, have jeopardized the integrity of the peer review process. At the direction of the Executive Council, staff developeda working paper that was distributed to allmembers of the Assembly.

After considering the desirability of actingon new health manpower legislation, Congressdecided not to amend existing statutes. However, intensive activity in both the public andprivate sector on issues relating to physicianmanpower continued. The Executive Councilreviewed major reports issued by the CCME,the General Accounting Office, and the Institute of Medicine, and the Executive Committeehas been designated as a special subcommitteeto review manpower issues.

Cost containment initiatives were also thesubject of considerable discussion at ExecutiveCouncil meetings. Although the Council supported the recommendations of the NationalSteering Committee on Voluntary Cost Containment, it made four recommendations to theCommittee: that allowances be made for changmg hospital expenditures resulting from increasing ambulatory care services; that guidelines and procedures not discriminate againsthospital-based physicians and capital expenditures; that allowances be made for increasedcosts resulting from new accredited manpowertraining programs; and that scope of servicesand patient mix be considered in cost containment programs.

During the year the Executive Council continued to oversee the activities of the Group onStudent Affairs, the Group on Medical Education, the Group on Business Affairs, theGroup on Public Relations, and the PlanningCoordinators' Group. Groups submit progressreports twice a year.

Prior to each Executive Council meeting theExecutive Committee met and business wasconducted by conference calls as necessary.

The Executive Council, along with theAAMC secretary-treasurer, Executive Committee, and Audit Committee, exercised carefulscrutiny over the Association's fIScal affairs,

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and approved an expanded general fundsbudget for fiscal year 1979. The revision of thedues structure and provisions for inflation-related increases, as recommended by the Finance Committee, were approved.

Council of DeansThe Council of Deans sponsored two programsat the 1977 annual meeting in 'Washington,D.C. The first, Analyzing the Veterans Administration/Medical School Relationship, held inconjunction with the Council of Teaching Hospitals and the Veterans Administration, featured representatives from the General Accounting Office, the VA, and medical schools.The second program was jointly sponsored withthe Council of Academic Societies and theCouncil of Teaching Hospitals. "Challenges inGraduate Medical Education" devoted sessionsto the transition between undergraduate andgraduate medical education, the quality ofgraduate medical education, influencing specialty distribution through graduate medicaleducation, and institutional responsibility forgraduate medical education. Twelve speakersincluding house officers, program directors,hospital directors, and representatives of several boards and colleges addressed various aspects of these four major topics.

The November business meeting includedinterim reports of the Task Force on StudentFinancing and the Task Force on MinorityStudent Opportunities in Medicine as well asreports from the Chairman and President. Thework of the Task Force on Graduate MedicalEducation and the Task Force on the Supportof Medical Education was also described. In itsdiscussion of the program ahead, the Councilreviewed the planning for its 1978 spring meeting and considered items to be presented to theAAMC Officers' Retreat.

The Administrative Board met quarterly tocarry on the business of the Council, and todeliberate on all Executive Council items ofsignificance to the deans. Much of its energywas devoted to providing guidance to and reviewing drafts of Association reports and position papers. Of particular interest was a staffpaper on individual and institutIonal responsibilities in the conduct of industries-sponsoredresearch and consultation. The Administrative

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Board recommended that the Association's initial positions be discussed with and reviewedby organizations representing university presidents prior to the paper's release as an officialAssociation statement. The Board also devotedspecial attention to the workload problems ofthe NIH Division of Research Grants and suggested the development of a comprehensivepaper to notify the Association's constituentsand governmental policy makers of the graveproblems bemg faced by that agency.

The Council chairman initiated a new approach to assuring adequate communicationbetween the members of the Council and itsleadership. A series of small group meetingswere held with deans around the country tofacilitate an informal exchange of Ideas andconcerns. These meetings disclosed the desireon the part of many deans to be more intimately involved in the development of theAssociation's policies and positions. A recurring theme was the need for the Association todevelop closer working relationships with university presidents and their organizations.

The Council ofDeans held its spring meetingin Snowbird, Utah, continuing the tradition ofan annual three-day retreat devoted to an issueof current significance. The theme of the program, "The Interface Between Governmentand Academic MedIcine," was elaborated onby 10 speakers representing a variety of perspectives. Among the topics covered at the firstsession were environmental trends and economic forces affecting medical schools, effortsby the Carter Admmistratlon to revise the federal regulation writing process, the implementation of the National Health Planning Act,and local response to state and national policyinitiatives.

The second day of the program was devotedto an examination of how institutIons mightimprove their interaction with state legIslatorsand governmental officials. The program concluded with a detailed description of the Voluntary Cost Containment Program sponsoredby the American Hospital AssocIation, theAmerican MedIcal Association, and the Federation of American Hospitals.

At the closing business session, the Councilendorsed the Executive Council proposal torevise the dues structure and adopted a resolution reaffirming the deans' commitment to

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affirmative action programs for recruitmentand retention of qualified disadvantaged students, including minonty students. Confirmingthe results of a recent survey, meeting participants indicated that with very few exceptionsdeans believed that the provision of some formof undifferentiated institutional support by thefederal government should be the cornerstoneof the AAMC's legislative efforts. A number ofAssociation activities were reviewed, includingthe Task Force on the Support of MedicalEducation, a draft report on AAMC Biomedical and Behavioral Research Policy, a draftreport of the Task Force on Student Financing,a draft position paper on industry-sponsoredresearch and consultation, an AAMC responseto the workload problems being encounteredby the NIH Division of Research Grants, andthe appointment of a new committee on technical standards for medical school admission.Other agenda items included the NBME policyof refusing to permit students from nonaccredited schools to sit for the examination unless sponsored by an accredited school,LCME's request that schools review proceduresfor acceptmg students in advanced standing,the planned meeting of the AMA Section onMedical Schools, and issues related to medicalcenter involvement in continuing medical education.

Attendance at the meeting included 98 institutional representatives, three DistinguishedService Members, and one Canadian dean, inaddition to Association staff and speakers.

Council of Academic SocietiesThe Council of Academic Societies continuesto grow and now numbers 60 member societies.Involvement of the member societies in theoverall activities of the Association was advanced by having 18 societies designate representatives to the Group on Medical Educationand by the designation of Public Affairs Representatives by additional societies. Societieswere also requested to name a woman liaisonofficer to work with the Association's Womenin Medicine program.

The CAS Services Program began its twoyear experimental phase in JUly 1977. TheAssociation of Professors of Medicine was thefirst CAS member to participate in the program. Staff to the program manage the APM's


business affairs, track issues and legislation ofparticular interest to departments of medicine,and prepare weekly memoranda for the APMCouncil and a monthly newsletter for the entiremembership. The Association of UniversityProfessors of Neurology, the American Academy of Neurology, and the American Neurological Association joined to use the CAS Services Program for tracking issues and legislation and to improve the amount and currencyof information provided to their membersabout neurological research, education and service issues.

Expanded communication with CAS societies and their members was an important activity of the Association. A twice-monthly memorandum on issues of interest to CAS PublicAffairs Representatives was initiated. Thequarterly CAS Brief increased circulation tomore than 14,000 members.

At the 1977 annual meeting in Washington,D.C., Donald Kennedy, Ph.D., commissionerof the Food and Drug Administration, spokeon "The Food and Drug Administration andthe Academic Medical Center." CommissionerKennedy, after nearly a year in office, expressed his belief that the FDA and academicmedical centers needed to work together toimprove physician knowledge about the importance of FDA's role in drug and medical deviceregulation and how the FDA fulfills its responsibilities.

An interim meeting of the CAS was held inJanuary to discuss the Biomedical ResearchPolicy Committee's recommendations on revisions to the Association's research policy. Thismeeting provided for broad input into thisimportant paper which eventually was adoptedby the Executive Council.

At its meetings the CAS AdministrativeBoard reviewed items from the ExecutiveCouncil agenda and forwarded recommendations on issues of concern to faculty. Thesequarterly meetings also provided an opportunity for Board members to meet with representatives of the Executive and LegislativeBranches for informal discussions.

Council of Teaching HospitalsDuring the past year, the Council of TeachingHospitals held two general membership meetings. At the November 1977 AAMC annual

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meeting, the Council sponsored a program onphysician responsibility and accountability forcontrolling the demand for hospital services,with presentations reflecting three varyingpoints of view. Robert G. Petersdorf, M.D.,chairman of the University of Washington'sDepartment of Medicine, considered the department chairman's influence in controllingthe demand for hospital services, suggestingthat a clinically active department chairmanmay be able to affect hospital costs by controlling the use of the laboratory, limiting thedeployment of new medical technology, reducing the length of hospital stay, and achievingan appropriate balance between inpatient medicine and ambulatory medicine. J. Robert Buchanan, M.D., president of the Michael ReeseMedical Center in Chicago and a former medical school dean, argued that unless the professional hospital staffs voluntarily lead in controlling health service costs, hospitals will facea series of progressively more damaging andrestrictive regulations. Robert M. Heyssel,M.D., executive vice-president and director ofthe Johns Hopkins Hospital, described the decentralized program of hospital management atJohns Hopkins which brought the physiciansand hospital staff into more responsible management roles and enabled the hospital to contain or reduce costs in a number of areas.

In May the Council of Teaching Hospitalsinitiated a two-and-a-half day spring meetingto provide COTH representatives with an opportunity to personally meet and discuss problems faced by tertiary care/teaching hospitals.The meeting in St. Louis opened with a dinneraddress by David Kinzer, president of the Massachusetts Hospital Association, speaking onthe new myths of health planning. During thegeneral meeting session, members heard anddiscussed papers on the institutional responsibility for graduate medical education, hospitallabor relations, and health maintenance organization/teaching hospital relationships. Following a presentation by John Affeldt, M.D.,President of the Joint Commission on the Accreditation of Hospitals, members examinedthe particular problems faced by teaching hospitals seeking JCAH accreditation. The concluding address at the meeting was presentedby Robert Derzon, administrator of the HealthCare Financing Administration, who reviewed

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his agency's legislatIve agenda and summarizedhis impressions and observatIons about the federal government and HCFA. Copies of theformally prepared papers presented at thespring meetIng were distributed to all COTHmembers. The spring meeting was well receivedby the membership and plans are l1nderway tocontinue this functIOn.

The COTH Administrative Board met quarterly to develop the Association's program ofteaching hospItal activities. Preceding three ofthe Board meetings, evening sessions were heldto provide seminar discussions on specific issues of concern to teaching hospitals. At theJanuary meeting, Stewart Shapiro, M.D., andDavid Winston, professional staff membersfrom the Subcommittee on Health and Scientific Research of the Senate Human ResourcesCommittee, met with the Board to considerupcoming proposals to review and extend theNational Health Planning and Resource Development Act. Describing the collaborativeprocess by which majority and mmority staffshad met to formulate general positions for renewal legislation, Shapiro and Winston reported that Committee members favored athree year extt;nsion of the bill building uponthe present planning structure. Following thepresentation, COTH Board members and representatives from other AAMC Councils discussed the Association's interest and concernsabout the planning legislation.

At its March meeting, the AdministratIveBoard met with Paul Rettig, professional staffmember of the Subcommittee on Health of theHouse Committee on Ways and Means. Mr.Rettig, whose career includes several years withthe Social Security Administration and its Bureau of Health Insurance, discussed the statusand evolution of cost containment legislationin the House of Representatives. He describedRepresentative Rostenkowski's interest in stimulating voluntary cost containment and his interest in proposing "compromise" legislationwhich would reqUIre mandatory cost containment programs by the federal government ifthe voluntary cost containment program wasunsuccessful. Lastly, Mr. Rettig reviewed thefunding status of the Social Security Admmistration programs and recent legislation increasing Social Security taxes.

Dr. Petersdorf met with the Admmistrative

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Board in June to discuss recent graduate medical education trends in internal medicine programs. Reviewing findings from the NationalStudy of Internal Medicine Manpower, Dr.Petersdorf drew the Board's attention to therapid increase in the percentage of internalmedicine residents who follow their initial residency training with a fellowship in a medicalsubspecialty. Dr. Petersdorf then led a discussion of the implications of this trend for thecosts of graduate medical education, the availability of general Internal medicine services,and the demand for subspecialty services.

In addition to discussing and acting on allmatters brought before the Executive Councilof the AAMC, the COTH AdministrativeBoard directed special attention to topics ofspecial interest to COTH members. As requiredby a 1972 action of the AAMC Assembly whichestablished the category of CorrespondingMembership in COTH, the Board reviewed themembership eligibility of all present COTHhospitals and recommended that general hospitals belonging to COTH which do not havethe required number or types of residency programs be reclassified as Corresponding Members. The Council also reviewed plans for andagreed to cosponsor, with the American Hospital Association and Rush-Presbyterian-St.Luke's Medical Center, an invitational conference on multi-institutional systems. After giving serious consideration to the voluntary costcontainment program sponsored by the American Hospital Association, the American Medical Association and the Federation of American Hospitals, the Administrative Board supported the objectives of the voluntary cost containment program and recommended that special consideration be given to teaching hospitalrequirements for revenues necessary to supportmedical education, medical research, and tertiary care services.

Organization of StudentRepresentativesIn its seventh year the Organization of StudentRepresentatives continued to serve as an effective vehicle for incorporating medical studentcontributions into the Association's programsand policies and for disseminating informationfrom the Association to medical students.Membership remained at a high level, with 109


of the nation's medical schools represented. Atthe 1977 annual meeting students representing85 schools attended business and regional meetings, the OSR Program entitled "A Debate onHouse Staff Unionization," and discussion sessions on reduced-schedule residencies andwithholding of physician services. As in previous years, the OSR held regional spring meetings in conjunction with the AAMC Group onStudent Affairs and the regional associations ofAdvisors for the Health Professions.

The OSR Administrative Board met beforeeach Executive Council meeting to coordinateOSR proposals and activities and to formulaterecommendations on matters under consideration by the Executive Council. Through itsmembers on AAMC task forces, the OSR contributed to and learned from Association activities on graduate medical education, studentfinancing, opportunities for minorities in mediCine, and support of medical education.

An important goal of the OSR was realizedthis year when the Liaison Committee on Medical Education requested that the AMA Council on Medical Education and the AAMC Executive Council provide student representationto the LCME. The Executive Council approvedthis request, and acting on OSR recommendations, appointed a medical student to serve asa nonvoting member of the LCME for a oneyear term.

During 1977-78, three issues of the OSRReport were published and distributed withoutcharge to all U.S. medical students. This newsletter was initiated to improve communicationsbetween the OSR and its constituency and toapprise students of the nature and scope of theAAMC's involvement in events and issues related to medical education. The first three issues were so well received that continuation ofthe newsletter has been approved for an additional year.

A continuing priority for the OSR was theeffort to increase the availability of informationon graduate training programs. A threepronged effort is underway: 1) coordinationwith the National Resident Matching Programto expand information published in the NRMPDirectory, 2) development of a survey instrument for graduates to evaluate residencies; and3) publication of an issue of the OSR Reporton the residency selection process.

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National Policy

Formulating national policies for the contamment of rising health care costs was a principalconcern of the Carter Administration and theCongress during the past year. The Associationplayed a significant role in the development ofnational cost containment policies. The Association's officers and staff also devoted considerable time and attention to amending andimplementing the Health Professions Educational Assistance Act of 1976, to certain issuesaffecting medical school admissions, to the appropriations process and to legislative and regulatory proposals affecting biomedical research. Both the Administration and the Congress have shown a willingness to considercarefully the views of the Association in theirdeliberations. However, final decisions onmany important issues are still pending andmany may be deferred for consideration whenthe 96th Congress convenes.

During the past year the White House andthe Department of Health, Education and Welfare (HEW) continued to press for mandatoryhospital cost containment legislation as the centerpiece of efforts to control all health carecosts. In April Rep. Daniel Rostenkowski,chairman of the Health Subcommittee of theHouse Ways and Means Committee, stronglysupported primary reliance on a voluntary costcontainment program for hospitals and helpedmobilize Congressional support for this approach. Although a great deal of time andenergy have been spent by the Congress andthe Administration on cost containment legislation, final Congressional action on currentlegislation, which places the emphasis on voluntary measures, is anything but certain beforethe 95th Congress adjourns in the late fall. Theassociation expressed its concerns to the National Steering Committee, Congressional committee staffand to the Congress that allowancesshould be made for increased hospital expenditures which may result from increased emphasis on hospital based ambulatory care services,costs of accrediting and operating health manpower training programs, and increases in capital and service costs related to the scope of

services provided and the patient populationserved by teachmg hospitals.

In related action, the Department of Health.Education, and Welfare published NationalHealth Planning GUidelines for occupancyrates in obstetrical units. minimum activitylevels for open heart surgery services, serviceareas for megavoltage radiation therapy unitsand work loads for each computed tomographic (CT) scanner. The AssocIation, whilerecognizing that these guidelines are intendedto limit unwarranted proliferation of expensivetechnology. cautIOned that planmng guidelinesand planning agencies should recognize thespecial needs of academic medical centers. Inits testimony before the Subcommittee onHealth and the Environment of the HouseCommittee on Interstate and Foreign Commerce, which was considering revision and renewal of the National Health Planmng andResources Development Act, the Associationsuggested the development of guidelines, asopposed to standards, and improvements andrefinements in the law which would encouragea greater involvement on the part of medicaleducators in the planning process and preventunwarranted intrusIOns into educational matters and biomedical research by Health SystemsAgencies. Health care planning and the containment of health care costs will likely remamimportant national policy concerns for the foreseeable future.

The Association continued its efforts toamend the United States foreign medical student (USFMS) proVision of the Health Professions Educational Assistance Act of 1976 (P.L.94-484). With the appointment of the TaskForce on the Support of Medical Education,the Association began to prepare for revisionand renewal of this legislation during the 96thCongress. Implementing the provisions of thecurrent law dealing with capitation, specialprojects, student loans and foreign medicalgraduates (FMGs) were other major healthmanpower concerns of the Association duringthe past year.

The Association viewed the terms of the

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USFMS capitatIOn provisIOn that mandatedadmissIOn into U.S. medical schools of U.S.citizens studying medicine abroad as an unprecedented and unjustified intrusion of thefederal government into the process of medicaleducation and a violation of the academic freedom of the institution. Such action was alsodeemed unnecessary because medical schools,using their own admissions criteria, have formany years voluntarily admitted into advancedstanding substantial numbers of American students who had matriculated in foreign medicalschools. The Association, working with theCongress and with tremendous help from theconstituency. succeeded during the latter halfof 1977 In persuading the Congress to modifythe most objectionable features of the USFMSprovision. President Carter signed the amendment into law on December 19. 1977 (P.L. 95215.) The modified USFMS provision requiresa five percent increase in third year class size(drawing primarily from the pool of U.S. foreign medical students) as a condition for receiptof capitation funds; but schools are allowed touse their normal academic criteria in selectingstudents to fill these positions and to place theUSFMS into either the second or third yearclass. As originally structured in P.L. 94-484,the USFMS was the only example of a totallyunacceptable qUid pro quo in the history of thecapitation program and one with which manyinstitutions stated they would not comply. Although Initially incensed with the provision,the Association expressed its gratitude to theleadership of both Houses of Congress for theirwiIlingness to recognize inappropriate legislation and subsequently amend the law.

Problems were also encountered in implementing the provisions of P.L. 94-484 that applied to alien foreign medical graduates. Theseprovisions were intended to reinforce U.S. selfsufficiency in the supply of physicians and toset higher standards for patient care, whileallowing to a limited extent the training offoreign physicians in this country and the immigration of outstanding foreign physicians.During the spring of 1978 the U.S. State Department amended its exchange visitor (J-visa)regulations for alien physicians to clarify thestatus of such physicians already in training inthe U.S. and to set forth regulations permittingwaivers to be granted on a limited basis to

VOL. 54. FEBRUARY 1979

certain residency programs to avoid substantialdisruption in the delivery of health servicesprovided by the hospital.

The last area ofP.L. 94-484 which proved tobe bothersome was in the implementation ofthe Health Education Assistance Loan (HEAL)Program. designed to provide loans of up to$10,000 per year to health professions students.As originally conceived by the legislation. thisprogram has had little appeal to the lenders,the schools, or the students. The Associationhas been working, however. with the Bureau ofHealth Manpower to find ways to implementthis loan program.

Planning for renewal and perhaps majorrevisions in health manpower legislation was amajor concern of the Association during thelast year. The Congress initially expressed itsintent to reconsider health manpower legislation as a whole during the current session but.after much urging by the Association. demurred. Under the terms of the CongressionalBudget Act. the Administration should submitits proposals for the renewal of health manpower legislation by May IS, 1979. In parallelwith this process the Association established aTask Force on the Support of Medical Education. chaired by Dr. Stuart Bondurant. to develop recommendations and legislative specifications for the Executive Council of the Association to submit to the Congress when itformally begins to consider health manpowerlegislation in 1979. Considerable attention wasfocused on the projected physician/populationratios projected for the next 30 years and onthe extent to which these forecasts should modulate medical school enrollments. The prospectwas raised that in a few years the current rateof physician production would create an oversupply of physicians in this country. even without taking into account new medical schools,U.S. citizens studying medicine abroad, andforeign medical graduates.

Leaders of the Task Force and the seniorstaff of the Association met with key HEWpersonnel to discuss the Departmental initiatives related to health manpower, the mostconcrete of which was the Health ResourcesAdministration (HRA) preliminary proposal.The key features of the HRA proposal focusedon repealing capitation for medical schools,discouraging further enrollment increases, con-

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tmuing programs to correct geographic andspecialty maldistribution, strengthening curriculum in priority areas, increasing minority enrollment and enhancing the productivity andcompetence of health personnel. In reacting tothe HRA proposal AAMC representativesidentified a number of concerns including thefollowing:

1. In the opinion of the AAMC, the nation'sacademic medical centers have a superb recordof working for the public good and are eager tocontinue as a partner with the federal government in the solution of the nation's healthproblems.

2. The complexity and the multiplicity ofthe interdependent functions of academic medical centers should be recognized; while undergraduate medical education per se is just onecomponent of the costs of a center, suddenchanges in the fmancing of the educationalactivity could have unexpected deleterious effects on the centers as a whole.

3. The diversity that currently characterizesthe academic medical centers should be preserved because of the great value that accruesto the nation as a result; and

4. A very important mechanism to achievethis end-as well as a great many otherswould be for the government to relate to theacademic medical centers by offering economicincentives rather than by imposing restrictiveand inflexible regulations.

HEW officials seemed genuinely grateful tohave had the opportunity for discussion withthe AAMC group and extremely interested infurther interaction, particularly after preliminary proposals have been formulated by theHEW and the AAMC.

Throughout the year the Association alongwith the education community in general, anxIOusly awaited the Supreme Court decision inRegents of the University of California v. AllanBakke. That long awaited decision came onJune 28, when a sharply divided SupremeCourt ordered the admission of Allan Bakke tothe University of California at Davis MedicalSchool, while simultaneously approving the useofrace as one factor in the selection of medicalstudents and thus giving its imprimatur to affirmative action programs. However, the Courtclearly stated that any factors used in the selection process must be applied to all applicants

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and that all applicants must be considered forall places in a class. In commenting on thedecision, the Association stated that the principal problem for medical schools will be tofind an appropriate weight for race among themany factors used in evaluating applicants.Since most medical schools are using admissions procedures consistent with the decision ofthe Court, there should be little effect on current affirmative action programs, other thanthe positive impact of removing past uncertainties. Both the AAMC and the medical schoolswill continue their vigorous efforts to encouragemmority students to aspire to medicine as acareer.

In a separate but related issue, on January10, 1978, the U.S. Commission on Civil Rightsreleased its Age Discrimination Study. In testimony before the Commission, the AAMCasserted and provided data showing that lesserqualifications and other non-discriminatoryfactors accounted for proportionally lower percentage of medical school acceptances amongolder applicants. The Commission's reportnonetheless singled out medical schools by recommending that age should not be a criterionto determine eligibility for admission to medical and other professional schools that receivefederal support. Among other things. the studyalso concluded that all present age discriminatory policies uncovered by the Commission areunreasonable. This conclusion constitutes animplicit rejection of the traditional "limitedresources/best return on investment" argumentoften advanced in defense of a perceived policyof age discrimination by medical schools. TheAAMC statement to the Commission mentioned this argument but did not rely upon it.

As in past years, the Association contmuedto monitor the federal appropriatIOns process,particularly for its impact upon medical schoolsand teaching hospitals. The fiscal year 1978appropriations process was unique because ofthe major controversy that developed over theuse of federal funds to pay for an abortion.Because the Congress never fully resolved theissue, all Labor and HEW programs werefunded under a continuing resolution for FY78, rather than by a complete AppropriationsAct. In order to pass the Continuing Resolution, the Congress was forced to reach a compromise after five months of debate. Although

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not really satisfactory to either side, the abortion provision allowed the federal governmentto pay for the abortion of pregnancies in whichthe life of the mother was endangered, longlasting damage to the health of the motherwould ensue or the pregnancy was the result ofrape or incest promptly reported to a publichealth or law enforcement agency. Because thedisagreement on federal funding of abortionswas not resolved to the mutual satisfaction ofthe House and the Senate, it is likely that theFY 79 Labor-HEW Appropnations bill andperhaps other appropriations bills may be similarly delayed this year.

The first health budgets wholly developedby the Carter Administration were for FY 79.They proved austere, disappointing supportersof health professions education and biomedicalresearch. Under the proposals of the Administration, funding for health professions education was drastically reduced, and funding forthe National Institutes of Health was limited toa one percent increase. The Association workedwith the Congress to increase the allocationsfor education, biomedical research and community health programs. As in previous years,the Association's efforts were closely coordinated with the Coalition for Health Funding.The First Concurrent Budget Resolution reflected these efforts by providing for a six percent increase for health programs other thanMedicare and Medicaid. The AppropriationsCommittees of both the Senate and the House,staying within the limits set by the BudgetCommittee, substantially increased funding forbiomedical research and for health manpower.Subsequently the Congress reduced funding forseveral HEW programs plagued by revelationsof fraud or mismanagement. The Associationwas particularly concerned by an HEW proposal to terminate capitation funding but, withstrong support from the medical schools, wasable to convince the Congress not to adopt thisproposal. The Association also fought for substantial increases over the Carter proposals formedical prosthetics, health services research,and general operating expenses for the Veterans Administration.

One of the principal issues of concern to thescientific community over the past year waslegislation designed to regulate recombinantDNA research. Similar bills introduced into


the House and Senate provided for extensionof NIH Guidelines for Recombinant DNA Research for two years, establishment of a compliance system administered by HEW, and formation of a Commission for the Study of Research and Technology Involving Genetic Manipulation. Although committee action wascompleted in the House, it is unlikely thatlegislation will be enacted in the 95th Congressbecause of a growing belief that the risks ofrecombinant DNA may have been overstatedand that regulation may not be necessary at all.It would not be surprising however, if the issuereemerged in the 96th Congress because of afear on the part of the scientific communitythat federal pre-emption of state and local lawsmight be necessary to counter the efforts ofthose at the state and local level that favorextremely stringent regulation. Thus, the Association has worked closely with other segments of the biomedical research communityand with the Congress to develop legislationthat would adequately protect public healthand other life systems without unduly constraining laboratory research. The Associationlikewise advocated changes in the pending revisions to the Clinical Laboratory Improvement Act to exempt clinical laboratories involved solely in research and those portions ofclinical laboratories that conduct routine testssolely for research purposes. That legislationhas not yet become law, although enactment isanticipated.

Through an amicus curiae brief the Association acted to bring to the attention of theSupreme Court the possible harm to the interests of research investigators, academic institutions and the public should the Court ruleadversely in Chrysler Corporation v. Brown, acase involving interpretation ofthe Freedom ofInformation Act (FOIA) "trade secrets" exemption. Citing the conclusions and recommendations of both the National Commissionfor the Protection of Human Subjects ofBiomedical and Behavioral Research and thePresident's Biomedical Research Panel, theAAMC argued that untimely disclosure of andunrestricted access to materials contained inresearch grant applications through the operation ofthe FOIA would result in the destructionof valuable property rights, undermine the effectiveness of the system for awarding grants

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on the basis of scientific merit, and inhibitand in some cases preclude-the transfer oftechnology from the "laboratory to the patientbedside." Consequently, the Association urgedthe Court to hold that Exemption 4 of theFOIA must be interpreted as a mandatory prohibition of agency action to disclose information described therein.

The Association was also involved in a number of other important legislative and regulatory issues affecting biomedical research. Representing both the AAMC and the AmericanFederation for Clinical Research, the Association supported Congressional action to renewthe National Research Service Awards. TheAssociation also engaged in efforts to restorethe tax exempt status of research trainingawards; to protect and strengthen the peer review process for research grants; to reduce unnecessary federal paperwork; to adopt realisticmeasures for the protection of human subjectsInvolved in research; and to establish adminis-

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trative principles for health and safety researchsponsored by industry and conducted in medical schools. AAMC also focused increasingattention on the activities of the Food and DrugAdministration and on the Administration'sproposals to reform the drug regulation process.

The decision of Rep. Paul G. Rogers not toseek reelection and the probable assumption bySen. Edward M. Kennedy of additional senatorial responsibilities outside the health fieldare certain to result in many changes for theCongressional committees dealing with healthissues. The support of Rep. Rogers for medicaleducation and biomedical research will bemissed. During the coming year the 96th Congress and the Administration will be dealingwith many issues of vital importance to thehealth of the nation. The Association will beworking with them to protect and strengthenthe medical education, health services, andbiomedical research programs of this country.

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Working with Other Organizations

LCME has pointed out to certain schools thatthe limitations of their resources preclude expanding the enrollment without endangeringthe quality of the educational program. In yetother cases it has encouraged schools to makemore extensive use of their resources to expandtheir enrollments. During the decade of thesixties, particularly, the LCME encouraged andassisted in the development of new medicalschools; on the other hand, it has cautionedagainst the admission of students before anadequate and competent faculty is recruited, orbefore the curriculum is sufficiently plannedand developed and resources gathered for itsimplementation.

During the 1977-78 academic year, theLCME conducted 42 accreditation surveys inaddition to a number of consultation visits touniversities contemplating the development orexpansion of medical schools. The list of accredited schools is found in the AAMC Directory of American Medical Education. Duringthe past year, the LCME awarded the status of"provisional accreditation" to four new medicalschools and issued a "letter of reasonable assurance" to one two-year school to convert toa four-year M.D. degree granting program.

Two student participants, one from theAMA, and one from the AAMC, were authorized to become non-voting members of theLCME.

A number of new medical schools have beenestablished, or proposed for development, invarious developing island countries in the Caribbean area. These schools seem to share acommon purpose, namely to recruit U.S. citizens. There is grave concern that these areeducational programs of questionable qualitybased on quite sparse resources. While theLCME has no jurisdiction outside the UnitedStates and its territories, the staff has attemptedto collect information about these new schoolsand to make such data available, upon request.to premedical students and their collegiate advisors.

The Liaison Committee on Graduate Medical Education continues to evolve its role in the

Since 1972 the AAMC has been, along with theAmerican Medical Association, the AmericanHospital Association, the American Board ofMedical Specialties, and the Council on Medical Specialty Societies, a member of the Coordinating Council on Medical Education. Inthe CCME representatives of the five parentorganizations, the federal government, and thepublic have a forum to discuss issues confronting all aspects of medical education and torecommend policy statements to the parentorganizations for approval.

During the past year the Association participated in a number of new and ongoing CCMEcommittees addressing the continuing competence of physicians, the coordination of physician data, the future staffing of the CCME andits liaison committees, opportunities for womenin medicine, the regulation of numbers andtypes of residency positions for foreign medicalgraduates, and the impact of new medicalschools and issues of increasing enrollment, sizeand establishment of new medical schools. ACCME report submitted to the parent bodiesaffirmed CCME's responsibility to relate theeducation and training of physicians in theUnited States to the requirements for medicalcare, and CCME as well as the individualparent organizations has been working with theDepartment of Health, Education, and Welfare's Graduate Medical Education NationalAdvisory Committee on issues relating to graduate medical education and specialty distribution.

The Liaison Committee on Medical Education serves as the nationally recognized accrediting agency for programs of undergraduate medical education in the United States andfor the medical schools in Canada.

The accreditation process provides for themedical schools a periodic, external review ofassistance to their own efforts in maintaimngthe quality of their education programs. Surveyteams are able to identify areas requiring anyincreased attention and indicate areas ofstrength as well as weakness. In the recentperiod of major enrollment expansion, the

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accreditation of graduate medical education.The relationship between the LCGME and theResidency Review Committees is becomingclarified, and steps have been taken to improvethe information provided to both the RRC'sand the LCGME about programs under review.However, significant modifications in the review and accreditation process may be required, and a subcommittee of the LCGMEhas been appointed to study the process andrecommend changes.

Contemplating alternatives to the presentpolicy of having the American Medical Association provide staff services, the LCGME requested that the five sponsoring organizationsre-examine the original articles of agreementand negotiate the necessary changes.

A draft revision of the General Requirements for Graduate Medical Education waswidely circulated during the year. Based uponcomments and criticisms of that draft, a fmaldraft will be presented to the LCGME.

The Liaison Committee on Continuing Medical Education assumed from the AMA in July1977 the function of accrediting institutionsand organizations offering programs in continuing medical education. Many of the deficiencies of the present system have been identifiedand corrective measures will be considered.The LCCME has begun by addressing a newdefmition and description of the scope and theprinciples of continuing medical education.AAMC members of the LCCME are activelycontributing to this process and as members ofthe AAMC Ad Hoc Committee on ContinuingMedical Education are able to apply directlythe Ad Hoc Committee's fmdings to the deliberations of the LCCME.

The Coalition for Health Funding, whichthe Association helped form eight years ago,now has over 50 non-profit health related associations in its membership. A Coalition document analyzing the Administration's proposed health budget for fIScal year 1979 andmaking recommendations for increased funding is widely used by Congress and the press.

As a member of the Federation of Associations of Schools of the Health Professions, theAAMC meets regularly with members representing both the educational and professionalassociations of eleven different health professions. The Association staff has also worked

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closely with the staff of the American Association of Dental Schools on matters of mutualconcern.

The AAMC continues to work with the Association for Academic Health Centers on issues of COl)cern to the vice presidents for healthaffairs. Representatives of each organizationare invited to the Executive Council and Boardmeetings of the other.

As a member of the Board of Trustees forthe Educational Commission for Foreign Medical Graduates, the AAMC expresses its interestin continuing implementation of provisionscontained in PL 94-484, the Health ProfessionsEducational Assistance Act of 1976. Undercontract with the NBME the ECFMG administers the Visa Qualifying Examination developed by the NBME as the mandated eqUivalentto Parts I and II of the NBME examinationrequired for foreign trained physicians by federal statute. In spite of a decline in the numbersof FMG's seeking admission to this country,the ECFMG continues to play an importantrole as a certifying agency, as the sponsor ofthe exchange visitor program, as the administrator of the VQE examination, and as a repository of valuable records.

The staff of the Association has maintainedclose working relationships with other organizations representing higher education at theuniversity level, including the American Council on Education, the Association of AmericanUniversities, and the National Association ofState Universities and Land-Grant Colleges.This year the AAMC worked cooperativelywith these organizations as well as others in anumber of areas where federal law and regulation affect higher education.

Continuous efforts have been made with theNational Resident Matching Program to improve the transition from undergraduate tograduate medical education. The Associationhas worked closely with that organization toexpand the NRMP Directory to provide additional information to students selecting residency training positions. Representatives ofNRMP and the AAMC Task Force on Graduate Medical Education and the Organizationof Student Representatives have been in frequent communication on matters of mutualinterest.

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The Panamerican Federation of Associations of Medical Schools is composed of organizations similar to the AAMC throughout theWestern Hemisphere. In 1978 the Associationhosts the Seventh Panamerican Conference onMedical Education; the theme of the Conference is "General Physicians to Meet PrimaryCare Needs in the Westen! Hemisphere."

Efforts have been made to articulate theconcerns of women and document the current


status of women in medicine to concerned individuals and groups. Towards this end, theAssociation staff and the Women Liaison Officers have interacted with the National Coalition for Women and Girls in Education, theWomen and Health Roundtable, the AmericanPersonnel and Guidance Association, theAmerican Medical Women's Association, andHealth on Wednesday, a women's governmental relations group.

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Education

During this year the medical education community has found it important on several occasions to refine its understanding and application of the concept of "educational accountability." This Issue was at the basis of the 1977Group on Medical Education (GME) PlenarySession explaining judicial reviews of facultyjudgments regarding student promotion anddismissal. Two recent U.S. Supreme Court decisions involving medical schools will have significant impact on schools' decisions on academic dismissal and admissIOns.

Two regional meetings of the Group onMedical Education fostered expanded discussion ofthis concept ofaccountability. The Central Region reviewed performance on the National Boards as an external critenon for program evaluation. The Western GME discussedlegislative incursions into medical educationand their implications for legislature and faculty interactions.

Another aspect of accountability was seen inefforts of two state legislatures to place expliCitrestrictions on the conduct ofstandardized testing. As a result of these forces, the medicaleducation community has found it essential toclarify the nature of its accountability to society, to students, and to the professIOn, and nowperceives an obligation to participate more actively in the development of public policies.

The Group on Medical Education is continuing its discussions on this subject at natIOnaland regional levels. In addition to a furtherconsideration of the appropriateness of National Boards for internal program evaluation,the GME is sponsoring discussions of the effectiveness of the accreditation ofcontinumg medIcal education programs, the management ofstudents with deficiencies in their professionaldevelopment, and the incorporation of topicalareas like nutrition and human sexuality in themedical cUrrIculum. The membership and staffhave dedicated significant effort to meetingwith legislative and regulatory groups to explain the impact of their policies on educationalprograms.

A specific project to improve documentation

of student performance is the AAMC ClinicalEvaluation Project, representing continuingAssociation interest in the area of personal(noncognitlVe) characteristics assessment. Theproject, which has received the support ofchaIrmen's groups in several specialties, IS anational study of the process used by faculty toevaluate the performance of students m theirclerkships.

In the first phase of the project, mstrumentsused in assessing the performance of clerks andcomments regarding the evaluation processwere gathered from each of the partlcipatmgspecialty groups. This will result in a summarystatement of current evaluation practices witha special emphasis on personal qualities assessment. In the second phase of the proJect, smallgroups of clinical faculty will meet to addressspecific problems. In the third phase the Association will develop and distribute a handbookof suggestions for evaluation.

The New Medical College Admission TestProgram is continumg interpretive studies ofthe new test which began its second year Withthe April 1978 administration. To assist admissions committees With the interpretation anduse of the New MCAT, the AAMC arrangedcollaborative efforts for schools of medicineand undergraduate colleges. Longitudinal studies for the 1978-79 entering class are underwayto address the relatiOnship between medicalschool performance and New MCAT results,and descriptive studies also are being conducted on various examinee subgroups. Theresults of these studies will be distributed toadmissions committees to augment the information in the New MCAT Interpretive Manual.

The AAMC Ad Hoc Committee on Continuing Medical Education was appointed by theExecutive Council to review and make recommendations regarding the role of the AAMC inContinuing Medical Educauon (CME). Togain a better insight into the relatIOnships ofcontinuing education, physician competenceand performance, and quality of patient care,the Committee participated in an AAMC re-

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search project supported by the Veterans Administration. The project employed a Delphiprobe of medical school faculty and practicingphySIcians to obtain perceptions and experiences about CME objectives and program implementation. In addition, two regional groupsof the Council of Deans and a group of medicalschool directors of continumg medical education engaged in nominal group technique discussions about the CME role of medicalschools. The Committee is using this study toprepare a final report.

The Committee also helped to plan a newproject to be carried out with the VeteransAdministration. This project will develop criteria and procedures for planning, implementing, and evaluating continuing education programs for health professIOnals involved in theVeterans Administration health care system.

The AAMC Longitudinal Study of the Medical School Graduates of 1960 focused on various medical care outcomes to better understand the dynamics of the career developmentprocess. A final report of the Study was submitted to the National Center for Health Services Research this year. The study examinedthe relevance of information collected earlieron members of the physician cohort and theschools they attended to eventual practice outcomes as surveyed in 1976. Findings underscored the relative importance ofpersonal qualities of the physicians, their attitudes, interests,and preferences expressed early in medicalschool on career outcomes. Interest in the report has spurred the preparation of a monograph as a vehicle for dissemination of thefindings.

Three-year medical programs received federal support in anticipation of a positive effecton medical manpower. An AAMC Study ofThree-year Curricula in U.S. Medical Schoolswas completed for HEW's Bureau of HealthManpower. Eighteen schools of medicine participated in the study, representing two-thirdsof all institutions conducting three-year programs in 1970-1976. As of July 1978 requiredthree-year programs are conducted in onlyseven institutions, four of which propose conversion to a four-year program within the1978-79 academic year. The study examinedthe process of education program change innew and old schools and the characteristics of


the resultant curriculum and educational program.

The results of the study indicate that theconsideration, initiation, and presence of threeyear programs during the early and middle1970s were directly related to the financialincentives provided by the federal government.The decrease in the number of programs fromthe peak year of 1973 resulted, in large part,because of the diminution and eventual absence of these incentives. Although no objectivedifferences in undergraduate academic performance were found between the students ofthree- and four-year programs, factors such ascurriculum compression, perceived stress offaculty and students, and perceived problemswith the timing of student career choices contributed to the decline of interest in the threeyear programs. Furthermore, the opinion ofgraduate medical education program directorsregarding the lesser quality of three-year program graduates had considerable effect on therelatively short tenure of three-year programs.

The nation realized 2,438 additional physicians because of the "extra" graduating classesin institutions converting from four to threeyear programs. However, the return to fouryear programs has lessened the impact of thebonus graduates. It is evident from the resultsof the study that unless enrollments are enlarged, the one-time increase in the nationalmanpower pool will be eroded by schools returning to four-year programs.

Resource and information exchange effortscan be of significant assistance to medical faculty in the discharge of their responsibilities.The Association supports a variety of theseactivities as a continuing commitment to improving faculty effectiveness.

The Educational Materials Project, a continuing collaborative program with the NationalLibrary of Medicine, has continued the development of a review system for multi-mediaeducational materials entered into theAVLINE data base. This review system engages approximately 1,400 academic expertsrepresenting the various health professions andtheir specialties and subspecialties. For six specialty areas collaborative arrangements havebeen made with specialty societies to assumesome or all of the tasks involved in the reviewof appropriate educational materials. The re-

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suIts of this review are entered into the AVLINE record and include a content descriptionof the material, a recommendation regardingits usefulness, educational format, and the mostlikely audience, and a critique of its contentsand presentation. The AVLINE data base nowcontains over 6,000 entries covering the healthprofessions disciplines, with new records beingentered at the rate ofabout 100 per month. TheAVLINE information system on multi-mediaeducational materials has become a regularcomponent of NLM's MEDLARS and can beaccessed for searches from MEDLINE remoteterminals and on-line searches from NLM. TheAVLINE catalog is published on a quarterlyand annual basis. Now that operational problems of AVLINE have been resolved, evaluation efforts are underway.

The Western Group on Medical Educationwill test the value of a Clearinghouse of Innovative Educational Projects. This idea emergedfrom a GME Technical Resource Panel onMedical Education Resources as a method toexchange information on interesting activitiesand personnel with special expertise. Utilization data will be collected to determine thevalue of the project as a national resource.

The GME Technical Resource Panel on the

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Introduction to Clinical Medicine (ICM) submitted its final report in the form of a resourcemanual/compendium of ICM course descriptions, focusing on innovative and successfulmethods for teaching physical diagnosis. TheTechnical Resource Panel supplemented thisreport with educational exhibits and programactivities at the 1977 and 1978 Annual Meetings.

Following a pilot testmg of 144 students in15 medical and public health schools in early1977, the self-instructional InternationalHealth Course was revised and published as:International Health Perspectives: An Introduction in Five Volumes. Volume I concerns Worldwide Overview of Health and Diseases; VolumeII, Assessment of Health Status and Needs;Volume III, Ecologic Determinants of HealthProblems; Volume IV, Sociocultural Influenceson Health Care, and Volume V, Systems ofHealth Care.

The Annual Conference on Research inMedical Education (RIME) has achieved enhanced status as a medmm for informationexchange during this past year, and the National Library of Medicine will begin listingpapers accepted for the Conference in IndexMedicus.

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Biomedical Research

A major undertaking of the Association duringthe past year was the complete re-examinationof its policies in the area of biomedical andbehavioral research. For several years theAAMC Executive Council has appreciated thesignificant changes occurring in the goals, environment, and mechamsms of support ofbiomedical and behavioral research. In June1977 the Executive Council appointed an adhoc committee to review AAMC's existing policy and recommend needed revisions. The committee's draft policy statement was extensivelydiscussed at a special meeting of the Council ofAcademic Societies, and during the 1978 springmeetings of the AAMC Administrative Boards,Council of Deans, and Executive Council.

Following these discussions, the AAMC Executive Council approved the following goalsas well as additional specific recommendationsrequired to meet them as the AAMC policy forbiomedical and behavioral research: (a) to emphasize that all levels of biomedical and behavioral research-basic, applied, and targetedare necessary; (b) to train a sufficient numberand diversity of skilled investigators to conductbiomedical and behavioral research; (c) to develop effective public involvement in the formulation of research policy; (d) to strengthenthe mechanisms of reviewmg and coordinatingresearch; (e) to improve the structure and function of the institutions that perform researchand those that support research so as to promote the orderly transfer of research findingsto patient care; and (f) to assure adequatesupport for all aspects of the research process.

This document will guide AAMC representatives who present the Association's views onbiomedIcal and behavioral research to Congress or to federal agencies.

The discussions of the ad hoc committee andthe Boards, Societies and Councils were especially helpful because they provided a timelyconsensus which increased the effectiveness ofAAMC comments on legislation affectingbiomedical and behavioral research beforeCongress. Extensions of the authorities for theCancer and Heart, Lung and Blood Institutes

were considered by Congress. AAMC supported changes which would strengthen theoperation of these two Institutes and of theNIH overall while providing increased levels offunding for the Institutes.

The AssocIation worked with other societiesto support the amendment and extension forthree years of the authority for the NationalResearch Service Awards Act (NRSA), theonly authority under which research trainingmay now be conducted by NIH andADAMHA. The Office of Management andBudget (OMB) continued to oppose federalsupport of research training, and proposed tophase out the institutional research traininggrant programs beginning in fiscal year 1979.However, both the House and the Senate havebeen persuaded to accept the principle that atleast 50 percent of training awards made byNIH and ADAMHA must be made as institutional training grants. Such a requirement hasnow been written into the law, thus assuringsuch grants for at least three years.

In the area of federal funding of research theyear began on an encouraging note with boththe President and the Congress calling for increased funding ofbasic research. However, thefederal biomedical research budget proposedfor fiscal year 1979 was less than needed tokeep pace with inflation. When these inconsistencies of purpose and reality were explained tothe Congress, the Congress added sufficientfunds to make an increase in basic researchfunding possIble, only to remove the fundssubsequently in response to the California "taxpayer revolt."

For many years the first $3,600 to $3,900 offederal research training awards has been excludable as income for tax purposes. In September 1977 the Internal Revenue Service ruledinformally that research training stipends madeunder the 1974 National Research ServiceAward Act were taxable. The Association,through its legal counsel, protested this rulingto no avail. When the situation was explainedto key Congressmen, legislative provisions wereintroduced to restore the tax exclusion.

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Government regulation of biomedical research was of particular interest to the Association as the Congress considered bills thatwould place major restraints upon the scientificresearch community. Concern over the potential dangers to public health and the environment of recombinant DNA research produceda flurry ofproposals which would have severelyrestricted the ability of scientists to conductsuch research. The Association, along withother scientific organizations, was greatly distressed by the content of these bills, and communicated its conviction that It was inappropriate for the Congress to attempt to regulateresearch by statute except in the face of theclearest potential for danger, and further attempted to demonstrate that the potential benefits of recombinant DNA research had beenunderstated while the potential hazards hadbeen overemphasized. The Association askedthat the NIH guidelines on recombinant DNA

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research, previously applied only to federallyfinanced research, be adopted as the natIOnalstandard for all research in this area, and alsostrongly opposed the establishment of a freestanding national commission charged Withregulating this research.

Through a combination of factors, the Association became aware that the NIH peerreview system had come under severe stress. Inless than 10 years the number of applicationsbeing processed had doubled while the scientists and administrators charged with review ofapplications had remained constant or evendeclined. The causes of this situation and somepossible remedies were studied by the Association and brought to the attention of membersof the Executive and Legislative Branches. TheAssociation continues its efforts to support thepeer review system which has served thebiomedical research community so well.

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Health Care

The organization of ambulatory services remamed an issue of primary concern to teachinghospitals, many of which are planning or haverecently completed facility construction and/orprogrammatic restructunng. In early 1978 theAAMC completed a workshop program, supported by the Health Resources Administrationof the Department of Health, Education andWelfare, to develop improved ambulatory careprograms in teaching hospitals. The final reportof that program provides a descriptive analysisof the various organizational models used byparticipatmg institutions and suggests methodsby which certain institutional characteristicsmay be modified to achieve more efficient,financially independent ambulatory care programs. Those programs organized around astrong, well integrated faculty practice planappear to be making the greatest progress toward a goal of selfsustaining one-class systemswith diversity in undergraduate and graduateeducation.

Education of future health practitioners inthe complexities of quality assurance and costcontainment has become a goal of increasingimportance for the Association and its constituents. Support from the National Fund forMedical Education has allowed the AAMC tosponsor a series of workshops on this issue forteams from twenty-two institutions. The finalproduct of this effort included an outline of a"primer" for faculty and students on the essential elements of a comprehensive program ofquality measurement, quality assurance, andrelated cost containment strategies. The complete text will include chapters on basic elements of quality assurance and cost containment programs adaptable to institutional or

individual practice situations, the present stateof the art in the undergraduate and graduatemedical education efforts, strategies for developing programs within academic institutions,and methods for evaluating the impact of suchprograms.

As a further step in the development ofcomprehensive programs to introduce medicalstudents and residents to the principles andstrategies of health care cost containment, theAAMC plans to use results from its survey ofcost containment programs in medical schoolsto provide the basis for a clearinghouse ofinformation for interested constituents, and abaseline from which to plan strategies for thenational development of such programs.

A major element of any quahty assuranceprogram must be continuing education relatedto the performance and quality of the carerendered by health professionals. Thus, theprofession and the public need to be confidentof the quality of learning opportunities designed to improve the performance of physicians and other health professionals. Duringthe coming year the AAMC will work with theVeterans Administration to develop a systemto evaluate continuing education programs, including the development of standards and cnteria based on adult-directed learning concepts.Detailed guidelines suitable for applying theseprinciples to continuing education systems andthe development of a management informationsystem necessary for ongoing evaluation WIll

be parts of the collaborative work programeffort. It is expected that these various elementsdeveloped withm the VA system will be applicable to any continuing education program.

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Faculty

During the past year the Association completeda series of national workshops in facultydevelopment, tested a clearinghouse on innovative educational projects, and developed aseries ofvideotapes on the teaching ofinterpersonal skills. In addition, the Final Report ofthe Faculty Development Survey was completed and distributed to each medical school.

In mid-1978 the activities of the Association's faculty development program were transferred to the new National Center for FacultyDevelopment at the University of MiamiSchool of Medicine. The Association and theprogram's sponsors, the Kellogg Foundationand the Commonwealth Fund, agreed that theUniversity's ability to serve as a "living laboratory" for faculty development activitieswould provide an appropriate base for continuing the educational programs established during the past four years at the Association.

The Faculty Roster System, initiated in 1965,continues to provide valuable information onthe key resource for medical education-thefaculty. This data base maintains demographic,current appointment, employment history, credentials and training data for all salaried faculty at U.S. medical schools. This system includes providing medical schools with facultydata in an organized and systematic manner toassist the schools in their activities requiringfaculty information. These activities includecompletion of questionnaires for other organizations, the identification of alumni now serving on faculty at other schools, and specialreports which display faculty data by differingsets of variables.

This data base has also been used for avariety of manpower studies, including an annual report, third in a series, entitled Description ofSalaried Medical School Faculty 1971-72and 1976-77. These studies were supported bya contract with the Bureau of Health Manpower, and contain summary information onfaculty appointment characteristics, educational characteristics, employment history, andvarious breakdowns by sex, by race and ethnicgroup, for foreign medical graduates, and for

newly hired faculty. A companion report isunderway this year, supported by a contractwith the National Institutes of Health, whichwill contain 1977-78 data on salaried medicalschool faculty.

As of June 1978, the Faculty Roster contained information for 48,586 faculty. An additional 24,002 records are maintained for "inactive" faculty, individuals who have held afaculty appointment during the past twelveyears but do not currently hold one.

Six workshops were held during the pastyear to inform school personnel of revised reporting forms and procedures and to increaseparticipation in the system. There is a continualeffort to improve services to the schools and,through their active participation in the FacultyRoster, to maintain complete and current information on their faculty.

The Association's 1977-78 Report on Medical School Faculty Salaries was released inMarch 1978. As a result of several pilot studies,the treatment of nature of employment waschanged. It had been evident for some timethat the conventional definitions of strict andgeographic full-time infrequently conformedexactly to institutional practice. This year theschools were asked to report the designationsused by the schools themselves and a portionof the Report reflects this request. An analysiswas also included, however, of salary data conforming to the definitions from earlier studies.The data collectiOn instrument focuses on theindividual salary components as they combineto reflect total compensation.

Compensation data were presented for 108U.S. medical schools and covered 23,530 filledfull-time faculty positions. The decrease fromlast year's level of participation is attributableto the more rigorous elimination of incompletely reported salanes. The tables presentcompensation averages, number reporting andpercentile statistics by rank and by departmentfor basic and clinical science departments.Many of the tables provide comparison datilaccording to type of school ownership, degreeheld, and geographic region as well.

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Students

Approximately 36,000 applicants filed morethan 300,000 applications for first year placesin the 1978-79 entering classes of U.S. medicalschools, a 10 percent decline in applicants fromthe previous year. The quality of the applicantsremains high, and there are still more than twocandidates for each available place. Medicalschool enrollments continue to rise, and the16,136 freshmen and 60,039 total students reported by the nation's medical schools for1977-78 constitute an all-time high.

The application process was assisted by theEarly Decision Program and by the AmericanMedical College Application Service (AMCAS). For the 1978-79 first year class 816students were accepted at 61 medical schoolsparticipating in the Early Decision Program.Since each of the 816 students filed only oneapplication compared to the average of 9 applications, the processing of about 6,500 multiple applications was eliminated.

Eighty-nine medical schools use AMCAS toprocess first-year application materials. Besidescollecting and coordinating admissions data ina uniform format, AMCAS provides rostersand statistical reports to participating schools,and maintains a national data bank for researchprojects on admissions, matriculation, and enrollment. The AMCAS program is guided inthe development of its procedures and policiesby the Group on Student Affairs Steering Committee.

The 1978 entering class of students was thefirst admitted using performance on the NewMedical College Admission Test (New MCAT)as part of the evaluation process. Examinees in1977 numbered 56,658. In the spring of 1978,a total of 27,331 examinations was administered, a 10 percent decrease from the spring of1977. The AAMC, in cooperation with selectedundergraduate colleges and schools of medicine, is studying the new test to facilitate theuse and interpretation of score performance bystudents, advisors, and admissions committees.Under AAMC direction, the American CollegeTesting Program continued responsibility for

operations related to the registration, test administration, test scoring and score reportingfor the New MCAT.

In response to concerns on the part of avariety of members of the medical educationcommunity over the increasing financial problems of medical students, a Task Force onStudent Financing was created in 1976 to examine existing and potential mechanisms forproviding financial assistance to medical students. The Task Force report addressed theneed to eliminate financial barriers for studentsseeking a medical education, to keep studentborrowing at reasonable levels, to continue anadequate federal loan program and necessaryfmancial aid counseling, and to assure thateach medical school uses a variety of strategiessuited to that institution to provide studentfinancing.

There have been several AAMC activitiesand publications to increase opportunities forminority students in medicine. Foremostamong these has been the Simulated MinorityAdmissions Exercise (SMAE), first developedin 1974 and recently broadened to include newtypes ofsimulated cases. The purpose ofSMAEis to train admissions committee members toassess the potential for medicine of minorityapplicants. Trainees review simulated applicantdata including grades, test scores, and noncognitive information. SMAE workshops havebeen presented at 25 medical schools and topreprofessional advisors. By request, presentations have also been made to representativesfrom schools of pharmacy, optometry and osteopathic medicine.

Minority Student Opportunities in UnitedStates Medical Schools, updated in 1977, isavailable for prospective medical school applicants, admissions officers, and premedical advisors. This publication provides detailed information about medical school programs of recruitment, admissions, academic reinforcement, and financial aid available to disadvantaged students. It also includes data on minoritygroup graduates. The Medical Minority Appli-

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cant Registry, circulated to all U.S. medicalschools, assists schools in identifying minorityand fmancially disadvantaged candidates seeking admission to medical school.

The AAMC Task Force on Minority StudentOpportunities in Medicine submitted its fmalreport to the Executive Council. The reportpresented recommendations to increase theparticipation of underrepresented minoritygroups in medicine. During its deliberations,the Task Force solicited input from premedicaladvisors, medical school faculty, administratorsand students, and other individuals and researchers who have studied the issues and problems affecting the participation of underrepresented minority group members in medicine.

A major program focusing on minorities inmedical education is sponsored annually durmg the AAMC annual meeting. The 1977 program featured Dr. Charles E. Odegaard, President Emeritus of the University of Washington, who discussed the efforts of the medicalschools over the past decade to increase opportunities for members of minority groups.

The Group on Student Affairs-Minority Affairs Section (GSA-MAS) held its first formalmeeting at the 1977 AAMC annual meeting.The GSA-MAS will serve in an advisory andresource capacity to the Association on issuesrelated to minority students. The section hasrepresentation from all U.S. medical schools.

During the year, eight major student studieswere completed under contract with the Bureauof Health Manpower (BHM). Three dealt withthe admissions process, one with enrolled students, one with graduating seniors and threewith medical school fmancing.

The Descriptive Study ofMedical School Applicants, 1976-77 included new data on size ofhometown which showed that 41 percent ofapplicants were from localities with populations under 50,000 and 52 percent anticipatedestablishing practices in areas of this population size. An A nalysis ofthe A dmissions Processto U.S. Medical Schools, 1973 and 1976 confirmed that recent efforts to increase the acceptance of women and minority group applicants were successful but revealed that mostadmissions committees do not emphasize thefuture career plans of applicants. The TrendStudy of Coordinated Transfer Application Sys-

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tem (CO TRANS) Participants, 1970 Through1976 revealed that the overall trend in advanced standing admissions and performanceon Part I of the NatIOnal Board Examinationswas up from 1970 through 1975 but plateauedin 1976. Half of COTRANS participants arefrom families with annual incomes over$20,000 and over a fifth have "physician" fathers compared with about 12 percent for regular applicants.

The DeScriptive Study of Enrolled MedicalStudents, 1976-77 provides a detailed pictureof the characteristics of the 58,000 enrollees,and shows a contInued trend toward interest ingeneral/primary care. Forty percent of the firstyear students had preadmiSSion career choicesin this area compared with 31 percent of finalyear students.

The study of Feasibility of IncorporatingGraduation Data Into AAMC's Medical StudentInformation System led to the initiatIOn of thefirst national survey of graduating seniors. Annual administration of this seven-page questIOnnaire will permit trend analyses of studentexperiences in medical school, plans for graduate medical education, and ultimate plans forcareer specialty and geographic location.

Reports on medical student financing included Comparisons of1974-75 Survey Findingswith Data from Other Sources showing that thenational surveys of Individual students areneeded to supplement aggregate data providedby medical school fInancial aid officers. Proposed Plans (and Questionnaire) for identifyingFactors Inhibiting Medical Studentsfrom Applying to the NHSC Scholarship Program outlineda plan aimed at making NHSC scholarshipprograms more appealing to future medicalstudents. The methodology used in nationalAAMC surveys of medical education financingis included in Proposed Methodologyfor FutureSurveys of Medical Student Financing.

Three efforts concerned with Women InMediCIne are underway. The first concerns ananalysis of the diffenng acceptance rates ofwomen at medical schools to determIne thecharacteristics of institutions with high percentages of women medical students. The second study is an effort to determine if womenmedical students obtain their choice of specialty and residency program with the same

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degree of success as male medical students. ItIS anticIpated that an analysIs of the AAMCGraduatIOn Questionnaire and the NRMP datawill be conducted for that purpose. TheAAMC. in cooperation with Wellesley College.presented a day long Women in Medicine


Workshop for Wellesley College Pre-medicalstudents and advisors. Because of the successof the workshop. funding is being sought toreplicate the workshop to develop educationalmatenals for all female college students interested in a career in medicine.

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Institutional Development

Now in its sixth year, the AAMC ManagementAdvancement Program offers a variety ofmanagement development opportunities formedical school administrators. Originally designed as an educational program for medicalschool deans, the program audience has expanded to include department chairmen andhospital directors.

The MAP encompasses several kinds of activities, all designed to facilitate effective decision-making in the academic medical centercomplex. In the Executive Development Seminar or Phase I, medical school deans, department chairmen or hospital directors discusscommon administrative problems while acquiring a basic working knowledge in planning andcontrol and behavioral science concepts. Lectures and discussion sessions provide an opportunity for consideration of management technique and theory.

Institutional Development Seminars orPhase II encourage the generation of problemsolving plans by small teams of institutionalrepresentatives. Medical school deans whohave participated in a Phase I session are invited to identify an institutional issue requiringcareful study. Each dean then selects a groupof individuals from the medical center involvedin the implementation of actions taken on theIssues being addressed. Each school team isassigned a management consultant responsiblefor facilitating the work of the group and forsuggesting alternative approaches to the particular issues being considered.

The third part of the Management Advancement Program is the Technical Assistance Program (TAP). TAP provides follow-up assistance to Phase I and Phase II participants, including administration of seminars designedaround specific management topics, identification of individuals or teams of individuals whocan provide management consultation on siteat medical center locations, and design andimplementation of studies to document management issues and/or techniques of particularrelevance to academic medical center decisionmakers. For example, as a part of the TAP, a

seminar on financial management will be offered to medical school deans in the fall of1978.

The MAP has been both an educationaleffort and an opportunity for semor administrators from academic medical centers to develop institutIOnal plans. All medical schooldeans are invited to attend, and since 1972, 112deans, 69 hospital directors and 48 departmentchairmen have participated in Executive Development Seminar sessions. Institutional Development Seminars have included 70 institutions, 25 of which have attended Phase II morethan once. More than 727 individual partIcipants have attended MAP seminars, includingdeans, department chairmen, hospital directors,vice presidents, chancellors, program directors,business officers, planning coordinators,trustees, and state legislators.

The Management Advancement Programwas planned by an AAMC Steenng Committeechaired by Dr. Ivan L. Bennett, Jr. This SteerIng Committee continues to participate in program design and monitoring. Faculty from theSloan School of Management, the Massachusetts Institute of Technology, have played animportant role in the selection and presentationof seminar content. Consulting expertise hasbeen supplied by many individuals, includingfaculty from the Harvard University GraduateSchool of Business Administration, the University of Oklahoma College of Business AdminIstration, the Brigham Young University, theUniversity of North Carolina School of Business Administration, and the George Washington University School of Government andBusiness Administration. Initial financial support for the program came from the CarnegieCorporation of New York and from the GrantFoundation. Funds for MAP implementatIonand continuation have come primarily from theRobert Wood Johnson Foundation; in addItion, conference fees help to meet expenses.

The Management Advancement Programhas stimulated requests from academic medicalcenter administrators for access to managementinformation on a regular basis. In addition,

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requests for program participation have beengreater than can be accommodated in a limitednumber of Phase I and Phase II sessions. Inresponse to these demands, the ManagementEducation Network Project was designed toidentify, document and disseminate to a broadaudience management theory and techniquesspecifically applicable to the academic medicalcenter setting. Supported by the National Library of Medicine, this project focuses on fourtasks: (0) regular review of the managementliterature for books and articles of relevancefor the MAP audience. Quarterly publicationof an annotated bibliography, "MAP Notes,"keeps those on the mailing list abreast of newinformation about management practices andprocedures; (b) development and review of audiovisual instructional materials based on selected aspects of Phase I contents; (c) documentation of medical center experiences with specific reference to management issues or practices. In this area, an extensive case study onthe use of Departmental Review in MedicalSchools has been completed and distributed;


(d) design and implementation of a simulationmodel to be used for projecting implications ofacademic tenure policies under each of severalcircumstances. The emphasis in this area is todevelop a viable model and to demonstrate thecapabilities of simulation modelling as a management tool.

In the past year the Visiting Professor Emeritus Program with support from the NationalFund for Medical Education has established aroster of active senior physicians and scientistsin diverse specialty areas, and has encouragedmedical schools to participate in the programwhenever temporary faculty assistance isneeded. These goals are being realized andvisits to medical schools by emeritus professorsfrequently occur. As a result, the Association isnow considering additional ways to utilize thetalents of experienced medical educators. It ishoped that the program can continue to be aworthwhile service to the medical schools aswell as providing new opportunities for seniorprofessors to contribute in areas where theirskills are greatly needed.

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Teaching Hospitals

The Association's teaching hospital activitiesfor 1977-1978 focused heavily on six topics:proposed federal actions to restrict hospital revenues for patient services; Medicare regulationsgoverning payments for teaching physicians;proposals to extend, amend, and implement theNational Health Planning and Resource Development Act; legislative and legal challengesarising from the National Labor RelationBoard's fmding that house staffare students forpurposes of the National Labor Relations Act;major revisions in the governance and management sections of the accreditation manual ofthe Joint Commission on the Accreditation ofHospitals; and proposed changes in hospitalaccounting for related organizations and fundsheld in trust by others.

In the spring of 1977 the Carter Administration proposed legislation to limit hospital revenues and capital expenditures. The Administration's proposal and several competing proposals were widely debated and consideredduring the past year. In addition to testifyingbefore four Congressional subcommittees oncost containment last year, the As!iOciationworked with congressional staff on issues ofparticular concern to tertiary care and teachinghospitals.

In response to charges that his MedicareMedicaid reform bill did not address all payorsand hospital charges, Sen. Talmadge announced an expanded version of the bill whichwould limit routine service revenues on a perdiem basis and ancillary service revenues on aper admission basis. At hearings held to obtaininitial reaction to the Talmadge proposal, theAssociation-while supporting several principles in the proposed bill such as the effort torecognize differences among institutions andgeographic regions and the effort to excludeuncomparable or uncontrollable costs whencomparing institutions-expressed concernabout: the classification system for groupinghospitals, the price indexes for calculating ancillary service limits, the lack of a defmition for"revenue," the absence of a method for incorporating excluded routine service costs into the

revenue limit, and the question of whetherspecial care units would be treated as ancillaryor routine services. Lastly, the AAMC cautioned against establishing a long-run approachto hospital payment which would fragmenthospital management and operations by calculating separate revenue centers for individualroutine and ancillary service costs.

Later in the year Chairman Dan Rostenkowski of the Subcommittee on Health of theHouse Ways and Means Committee challengedthe American Hospital Association, the American Medical Association, and the Federationof American Hospitals to initiate and organizea program to restrain cost increases in hospitals.As a result of the Rostenkowski challenge, thethree organizations organized a voluntary costcontainment program under the direction of aNational Steering Committee for VoluntaryCost Containment which adopted a fifteenpoint program for voluntary hospital cost containment. The Association's Executive Councilsupported the overall objective of voluntarycost containment but expressed concern thatthe fifteen-point program ofthe National Steering Committee failed to make allowances forincreased hospital expenditures resulting fromincreases in the number and availability ofambulatory care services, large number of hospital-based physicians, costs for accreditedma~power training programs, and the impactof a hospital's scope of services and patientmix.

In 1975 the Association filed suit in the U.S.District Court for the District of Columbiaseeking relief from the regulations implementing Medicare routine service payment limitations imposed by Section 223 of Public Law92-603. Following a District Court decisionupholding the regulations, the Association appealed the case, but the Court of Appeals forthe District of Columbia dismissed the Association's Section 223 challenge for lack of jurisdiction. The Court held that the AAMC hadfailed to exhaust its administrative remediesbecause the Association, through its teachinghospitals, had not presented a claim to the

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Provider Reimbursement Review Board forwhat it believed to be appropriate reimbursement for teaching hospitals. While the Court ofAppeals' opinion did dismiss the Association'schallenge, it had the potential beneficial effectof vacating the District Court decision upholding the regulations implementing Section 223.In addition to the legal challenge of Section223 regulation, the Association has objectedannually to the proposed Section 223 limitations because they fail to adequately recognizethe increased costs of teaching/tertiary carehospitals and fail to establish explicit exceptioncriteria for hospitals with atypical costs.

Section 227 of the 1972 Social Security ActAmendments included Medicare modificationsfor "payments for the professional medicalservices of physicians rendered at teaching hospitals." Implementation regulations originallyproposed in 1973 were withdrawn by the government. HEW then recommended to Congressthat the implementation of Section 227 be delayed, and Congress responded by delayingimplementation until October I, 1978.

Throughout the past year staff of the HealthCare Financing Administration have workedto develop proposed regulations implementingSection 227. The Association has monitoredthese activities and assisted in developing andevaluating potential regulatory language. Inaddition, the Association obtained a commitment from Health Care Financing Administrator Robert Derzon to have at least one comment session on the proposed regulations priorto their publication in the Federal Register. Thecomments session, involving faculty, deans, andteaching hospital representatives from the Association, was held in early April using an earlyand preliminary draft of the 227 regulations.At this writing, the Association remains prepared to review, distribute, and organize comments on the 227 regulations when they areofficially published in the Federal Register.

During the past year proposed legislation torenew the National Health Planning and Resource Development Act and regulations implementing the original act have received substantial attention from the Association. Lastyear, the Association asked Eugene J. Rubel,former Acting Director of Bureau of HealthPlanning and Resource Development, to studythe participation of medical schools and teach-


ing hospitals in the national health planningprogram. Mr. Rubel's report, based on sitevisits in seven cities summarizing the involvement of AAMC constituents in the planningprocess, was widely distributed within the Association for comments and evaluation.

The Association testified before the HouseSubcommittee on Health and the Environmenton proposed legislation to review and renewthe national health planning act. The Association's testimony favored provisions of the proposed bill to extend certificate of need to noninstitutional providers, to increase federal funding for health planning, to permit planning inagencies to carry over funds from one year tothe next, and to prevent individuals serving onHealth Systems Agencies (HSAs) in both theirplace of residence and employment. AAMCrecommended that institutional health serviceproposals be encouraged to address their impact on the clinical needs of medical educationand biomedical research programs; that HSAreview and approval for federal funds be eliminated for manpower and research grants; thatHSAs be permitted to approve the limited introduction of new technologies prior to thedevelopment ofplanning guidelines; that HSAsbe prohibited from conditioning approval ofone health service on an institution's agreementto develop a second health service; thatCongressional intent on health planning guidelines be clarified to indicate that guidelines areadvisory not mandatory; and that HSAs andState Health Coordinating Councils be required to include a medical school dean, inareas with a medical school, and the chiefexecutive officer of a tertiary care/referral hospital. Similar health planning recommendations were advocated in a statement submittedto the Senate's Subcommittee on Health andScientific Research.

HEW published three proposed planning actregulations of interest to Association membersthis year. Draft regulations proposing nationalguidelines for health planning were criticizedby the Association for failing to accommodatethe unique role of academic medical centersand teaching hospitals, for inadequate exception procedures, for rigidity and arbitrariness,for the questionable way in which numericalstandards were derived, and for failing to specify that the guidelines are advisory, not man-

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datory. The Association's response also contained detailed comments and suggestions foreach of the eleven guidelines proposed.

HEW also published draft regulations concerning Health System Agencies' review ofproposed uses of federal funds. In commenting onthese draft regulations, the Association encouraged HEW to recognize the confidentiality ofresearch grants and contract proposals, requested clarification ofHSA responsibilities forfederally-funded projects impacting on morethan one health service area, requested additional clarification on provider responsibilityfor periodic reports to health service agencies,urged HEW to establish dollar thresholds below which HSA review would not be required,and requested clarification of the special consideration for projects meeting the needs ofminorities, women and the handicapped.

HEW also published proposed regulationsfor Health System Agency and state agencyreview of existing and new institutional healthservices. In comments on the proposed regulations the Association cited a study by the Orkand Corporation to suggest that HSAs wouldbe over-taxed by the imposition ofthe proposedprogram review activities. The Association alsocited the failure of the proposed regulations toconsider the special needs and circumstances ofmedical education in the development of appropriateness review criteria, requested additional provisions for provider participation andappeal mechanisms as a part of the reviewprocess, urged that the appropriateness reviewbe treated as a planning rather than a regulatory function, and urged adding provisions toencourage state agencies to utilize existing information sources rather than to create additional sources of information.

A 1976 decision by the National Labor Relations Board (NLRB) declaring that housestaffare primarily students rather than employeesfor purposes of the National Labor RelationsAct continues to involve the Association inboth legislative and judicial actions. Early in1977 Representative Frank Thompson, Jr., introduced legislation overturning the NLRB decision by defming housestaff as employees forpurposes of the National Labor Relations Act.During the past year the Thompson bill hasbeen approved by the full House Committeeon Education and Labor and cleared for floor

191

action by the House Rules Committee. TheAssociation continues to work with Congressmen who are opposed to legislation whichwould mandatorily defme housestaff as employees and impose an industrial labor relations model on graduate medical educationprograms.

In related court actions, the Association submitted amicus curiae briefs in two cases inwhich the Physicians National Housestaff Association (PNHA) sued the National LaborRelations Board. In the first case, the Court ofAppeals for the Second Circuit ruled that thejurisdiction of the NLRB preempted state laborboards from asserting jurisdiction over housestaff. In a separate case PNHA alleged that theNational Labor Relations Board had exceededits authority in the Cedars-Sinai decision; however, the suit was dismissed for lack ofjurisdiction by the U.S. District Court for the Districtof Columbia. PNHA is attempting to appealthe dismissal and the Association continues tomonitor court activities of this suit.

The Joint Commission on the Accreditationof Hospitals circulated proposed revisions forthe governing bqdy and management sectionsof a revised Accreditation Manualfor Hospitals.To prepare the Association's comments on therevision, copies of the proposed section weresent to a sample of COTH Chief ExecutiveOfficers selected to represent different types ofteaching hospital ownership, affiliation, andspecialty. On the basis of membership comments, the Association submitted an extensivereview of the proposed manual to the JointCommission. In addition to particular concernswith specific JCAH recommended standardsand interpretations, the Association expressedconcern that the draft standards were an overlyspecific, cookbook approach to governance andmanagement and that they failed to address theparticular governance structures of universityowned and public hospitals. The Associationcontinues to review revised drafts for the manual.

In February the Subcommittee on HealthCare Matters of the American Institute of Certified Public Accountants (AICPA) proposednew hospital reporting practices for related organizations and for funds held in trust by others. Abandoning the existing principle that

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combined financial statements should be prepared for related organizations controlled bythe hospital, the AICPA's proposal advocatedcombined fmancial statements for the hospitaland for "resources handled by an organizationseparate from the hospital ... if, in substance,(resources) use for eventual distribution werelimited to support activities managed by, orotherwise closely related to, the hospital." TheAssociation testified before the AICPA Subcommittee, objecting to the proposed reportingpolicy. The Association strongly recommendedretaining control as the primary determinant ofreporting requirements and suggested eight criteria for developing reporting guidelines andfour types of control relationships. The Association continues to follow the activities of theAICPA and has asked to testify on any reviseddraft recommending reporting procedures for


related organization funds and for funds heldin trust by others.

The Association's program of teaching hospitals surveys combines four recurring surveyswith special issue-oriented surveys. The regularsurveys are the Educational Programs andServices Survey, the House Staff Policy Survey,the Income and Expense Survey for UniversityOwned Hospitals, and the Executive SalarySurvey. The fmdings of these surveys are furnished to participating hospitals and, when appropriate, results have been publicly distributed. One special survey, the COTH Survey ofPhysical Plant and Capital Equipment Expenditures Required to Meet lCAH Standards, wasconducted during the past year. Informationfrom the 1977 survey will accompany a newsurvey to be submitted to the COTH membership in the upcoming year.

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Communications

The Association employed a variety of pUblications. news releases, news conferences andpersonal interviews with representatives of thenews media to communicate its views, studiesand reports to its constituents, interested federalrepresentatives. and the general public.

Perhaps the largest news story to occur thisyear affecting the Association and its membermedical schools was the U.S. Supreme Courtdecision in The Regents of the University ofCalifornia v. Allan Bakke. The AAMC responded to news media inquiries shortly afterthe Court handed down the decision with ashort statement and then after the decision hadbeen analyzed. held a news conference whichreceived extensive media coverage.

The major means by which the Associationinforms its constituents of federal and AAMChappenings is the President's Weekly ActivitiesReport, which reaches more than 9,000 individuals 43 times a year. This Report covers eventsthat have a direct effect on medical education.biomedical research, and health care.

In addition to the Weekly Activities Report,other newsletters of a more specialized natureare: The COTH Report, which has a monthlycirculation of2,400; the OSR Report, circulatedthree times a year to all medical students; andSTAR (Student Affairs Reporter), which isprinted four times a year with a circulation of900. The CAS Brief, a quarterly newsletterbegun in 1975, is prepared by the staff of theAAMC Council of Academic Societies and isdistributed to individual CAS members

through the auspices of the indiVidual societies.Reporting on major public policy issues ofparticular interest to medical school faculty, theCAS Briefnow reaches 14,000 readers.

The Association's Journal of Medical Education received a Distinguished AchievementAward from the Educational Press Associationof America for "excellence in educational journalism."

In fIScal 1978 the Journal published 1,034pages of editorial material in the regularmonthly issues. including 173 papers (83 regular articles, 75 Communications, and 15 Briefs).The Journal also continued to publish editorials, datagrams, book reviews, letters to theeditor, and bibliographies provided by the National Library of Medicine. Monthly circulation averaged about 6,700.

The volume of manuscripts submitted to theJournal for consideration continued to runhigh. Papers received in 1977-78 totaled a record 429; 139 were accepted for publication, 201were rejected, 11 were withdrawn, and 78 werepending as the year ended.

About 32,000 copies of the annual MedicalSchool Admission Requirements. 3,500 copies ofthe AAMC Directory ofAmerican Medical Education, and 6,000 copies of the AAMC Curriculum Directory were sold or distributed. Numerous other publications, such as directories,reports, papers, studies, and proceedings alsowere produced and distributed by the Association.

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194

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Information Systems

The Association has continued to expand thescope and increase the content and utility ofthe information systems which support its activities. These systems are now almost entirelyon an inhouse computer system and the AAMCstaff has available major data systems for students, faculty, and institutions.

Primary among the student information systems is the American Medical College Application System. This system supports the Association's centralized admission system by maintaining data on applicants to medical school.Products from this system are sent to medicalschools and applicants on a daily basis, androsters of applicants and summary statistics aresent to the schools periodically. In addition, theapplicant information is available to Association personnel on an immediate basis for responding to telephone inquiries from bothmedical schools and applicants. The AMCASsystem also generates a number of special reports throughout the year, and the data areused to answer specific questions which arisefrom schools or the Association staff. The information maintained in the AMCAS systemis used as the basis for the Association's annualdescriptive study of medical school applicants.

There are a number of other data systemsthat support the AMCAS system and provideinformation for the admissions process. Amongthese systems are the New MCAT ReferenceSystem, providing information on the NewMCAT scores and questionnaire responses ofapplicants; the College System of informationon all colleges in the United States; and theCoordinated Transfer Application System(COTRANS) of records of U.S. foreign medical students applying to U.S. medical schools.

Other data systems have been created tosupport the Association's research on students.These include systems to process informationobtained from the Graduation and FinancialAid Questionnaires, both of which were in thefield in early 1978.

Work is currently in process on the conversion of the remaining student information systems to in-house operation. The major devel-

oping system is the enrolled medical studentinformation system, which will become the central repository of information on medical students and will establish a career developmentdatabase to follow medical school graduatesinto practices. In concert with the creation ofthe enrolled medical student information system, work is underway to facilitate historicaland comparative studies of medical school applicants, medical students, and medical schoolgraduates.

The Association maintains two major information systems on medical school faculty: TheFaculty Roster System and the Faculty SalarySurvey Information System. The Faculty Roster System has undergone a major conversionin the past year and currently exists on an online system for research focused on medicalschool faculty. The Faculty Roster System includes information on the background, currentacademic appointment, employment history,education and training of all salaried faculty atU.S. medical schools. Medical schools benefitfrom the reports from the system presentingdata on faculty in an organized and systematicmanner. Data from the Faculty Roster alsohave formed the basis for an annual descriptivestudy of salaried medical school faculty for thepast three years.

The Faculty Salary Survey System is used togenerate annual reports on medical school faculty salaries. The information is also availableon a confidential, aggregated basis in responseto special inquiries from schools.

The Association supports a number of information systems on institutions, the predominant being the Institutional Profile System, arepository for information on all medicalschools. The data base is supported by a computer software package that allows immediateuser retrieval of data from remote terminals torespond to requests for data from medicalschools and other interested parties, as well asto support a variety of in-house research projects. In the past year, IPS has responded to 200requests for information and has supplied datafor a number of studies including Institutional

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Characteristics of u.s. Medical Schools:1975-76, and a series ofstudies describing medical education institutions prepared for the Bureau of Health Manpower, Department ofHealth, Education, and Welfare.

The Association has developed an ancillarysystem to the Institutional Profile System toprocess Part I of the Liaison Committee onMedical Education Annual Questionnaire.This system generates reports which comparethe data for the current year with those reported

195

in previous years.Institutional data on teaching hospitals are

also maintained. Annual surveys are conductedto obtain national information on housestaffstipends, benefits and training agreements, income, expenses, and general operating data foruniversity-owned hospitals; hospital and departmental executive compensation; and general operating, educational program, and service characteristics of teaching hospitals. Thismass of information serves as the basis for anumber of Association publications.

196

AAMC Membership

1977-78115

6161

60399

81,824

4470

6II

1976-77115

3171

60400

41,944

4371

612

general purposes increased $813,021 to$6,177,643-an amount equal to 82.11 percentof the expense recorded for the year. Thisreserve accumulation is within the directive ofthe Executive Council that the Associationmaintain as a goal an unrestricted reserve of100 percent of the Association's annual operating budget. It is of continuing importancethat an adequate reserve be maintained.

The level of Association income realizedfrom general fund sources has stabilized. General fund income during fiscal year 1977 increased 1.06 percent above fiscal year 1976.The increase during fiscal year 1978 just endedwas also 1.06 percent.

The Association's fmancial position is strong.As we look to the future, however, and recognize the multitude of complex issues facingmedical education, it is apparent that the demands on the Association's resources will continue unabated. General fund income over thelast two years has been maintained at a constantlevel primarily by an increased return on invested funds. The budget for the current yearis balanced with projected expenditures equalto anticipated income. Since a six percent inflation factor produces a requirement for an additional $380,000 in general funds at currentbudget levels, it is evident that the Associationmust in the near future seek increased generalfund revenue sources to support even the present level of program.

TYPE

InstitutionalProvisional InstitutionalAffihateGraduate AffiliateAcademic SocietiesTeaching HospitalsCorrespondingIndividualDistinguished ServiceEmentusContributingSustaining

Treasurer's ReportThe Association's Audit Committee met onSeptember 13, 1978, and reviewed in detail theaudited statements and the audit report for thefiscal year ended June 30, 1978. Meeting withthe audit committee were representatives ofErnst & Ernst, the Association's auditors; theAssociation's legal counsel; and Associationstaff. On September 14, the Executive Councilreviewed and accepted the fmal unqualifiedaudit report.

Income for the year totaled $8,909,319. Ofthat amount $6,473,624 (72.66 percent) originated from general fund sources; $648,528 (7.28percent) from foundation grants; $1,736,663(19.49 percent) from federal government reimbursement contracts; and $50,504 (.57 percent)from revolving funds.

Expense for the year totaled $7,523,883, ofwhich $5,583,274 (74.21 percent) was chargeable to the continuing activities of the Association; $405,512 (5.39 percent) to foundationgrants; $1,328,606 (17.66 percent) to federalcost reimbursement contracts; $175,351 (2.33percent) to council designated reserves; and$31,140 (.41 percent) to revolving funds. Investment in fixed assets (net of depreciation)increased $7,617 to $435,803.

Balances in funds restricted by the grantorincreased $71,823 to $368,856. After makingprovision for reserves in the amount of$525,020, principally for equipment acquisitionand replacement and MCAT and AMCAS development, unrestricted funds available for

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Association of American Medical CollegesBalance SheetJune 30, 1978ASSETS

CashInvestments

U.S. Treasury BillsCertificate of Deposit

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

Liabilities and Fund BalancesLiabilities

Accounts PayableDeferred IncomeFund Balances

Fund Restricted by Grantor for Special PurposesGeneral Funds

Funds Restricted for Plant InvestmentFunds Restricted by Board for Special Purposes

.Investment in Fixed AssetsAvailable for General Purposes

Total Liabilities & Fund Balances

Operating Statement

Fiscal Year Ended June 30, 1978

SOURCE OF FUNDS

IncomeDues and Service Fees from MembersGrants Restricted by GrantorCost Reimbursement ContractsSpecial ServicesJournal of Medical EducationOther PublicationsSundry (lnterest-$531,719)

Total IncomeReserve for Special Legal ContingenciesReserve for CAS Service ProgramReserve for Special StudiesReserve for Data Processing ConversionReserve for Minority ProgramsReserve for Special Task ForcesTotal Source of Funds

USE OF FUNDS

Operating ExpensesSalaries and WagesStaff BenefitsSupplies and ServicesProvision for DepreciationTravel

Total ExpensesIncrease in Investment in Fixed Assets

(Net of Depreciation)Transfer to Itoard Reserved Funds for Special ProgramsReserve for R~placement of EquipmentIncrease in Restricted Fund BalancesIncrease in Funds Available for General PurposesTotal Use of Funds

197

$4,490,9674,050,000

$ 296,856963,425443,420

6,177,643

$ 71,805

8,540,967

805,40226,041

443,420$9,887,635

$ 495,5071,142,105

368,679

7,881,344$9,887,635

$1,624,052645,283

1,736,6633,754,008

80,998349,889718,426

$8,909,31929,5474,053

31,9569,762

54,79645,237

$9,084,670

$3,722,430518,912

2,638,91482,049

561,578$7,523,883

7,618405,000120,020215,128813,021

$9,084,670

AAMC Committees

Admissions Assessment James T. Hamlin, III

::: Cheves McC. Smythe, chairman Charles C. Lobeck9 Jack M. Colwill Harry P. WardrJ)rJ)

Joseph S. Gonnellaa COTH Nominating\-; David Jeppson(1)

Walter F. Leavell David D. Thompson, chairman0........ John McAnally Daniel W. Capps;:l0 Christine McGuire David L. Everhart..s::~

Frederick WaldmanLeslie T. Webster COTH Spring Meeting Planning

'"d(1)

Stuart Marylander, chairmanu Audit;:lDennis R. Barry'"d

0 David L. Everhart, chairman Robert E. Frank\-;

0.. Jo Anne Brasel A.A. Gavazzi(1)\-; Jesse L. Steinfeld Bruce M. Perry(1)

.D David S. Weiner0 Biomedical Research and Training......

...... Robert M. Berne, chairman Continuing Medical Education0Z Theodore Cooper William D. Mayer, ChairmanU Philip R Dodge Richard M. Bergland

~Harlyn Halvorson Clement R. BrownCharles Sanders

Richard M. CaplanDavid B. Skinner(1) Samuel O. Thier Carmine D. Clemente

..s:: John E. Jones...... Peter C. Whybrow4-< Charles A. Lewis0Thomas C. MeyerrJ) Borden Award::: Mitchell T. Rabkin9...... David B. Skinner, chairman Jacob R. Sukeru

Francois M. Abboud~ Stephen Tarnoff<3 William F. Ganong David Walthallu Louis J. Kettel(1)

..s:: Gerhard Werner Coordinating Council on......a Medical Education0 CAS Nominating

<.l:1 AAMC Members:1:: Robert M. Berne, chairman(1) Thomas M. Devlin John A. D. Coopera G.W.M. Eggers, Jr. James E. Eckenhoff;:lu Rolla B. Hill, Jr. Ronald W. Estabrook0

Q Mary Ellen JonesLIAISON COMMIlTEE ON CONTINUINGSamuel O. ThierMEDICAL EDUCATIONClarence S. WeldonAAMC Members:

COD Nominating John N. LeinStanley M. Aronson, chairman William D. MayerEphraim Friedman Jacob R. Suker

198

AAMC Annual Reportfor 1978 199

LIAISON COMMITTEE ON GRADUATE Gordon W. DouglasMEDICAL EDUCATION Harriet P. Dustan

AAMC Members: Sandra Foote

Robert M. HeysselSpencer ForemanCharles Goulet

Richard JanewayCheryl M. Gutmann

Thomas K. Oliver, Jr.:=: August G. Swanson

Samuel B. Guze

9 William P. HomanrJ) Wolfgang K. JoklikrJ) LIAISON COMMITTEE ONa MEDICAL EDUCATION Donald N. Medearis. Jr.\-;

Dan Miller(1)AAMC Members:0.. Stanley R. Nelson......Edward C. Andrews, Jr.;:l Duncan Neuhauser0..s:: Steven C. Beering Ann S. Peterson

~ Ronald W. Estabrook Richard C. Reynolds"d Christopher C. Fordham, III Mitchell W. Spellman

(1) John D. Kemphu;:l Richard S. Ross Group on Business Affairs"d0\-; AAMC Student Participant: STEERING0..(1)\-; Lee Michael Kaplan Warren H. Kennedy. chairman(1)

.D H. Paul Jolly. Jr., executive secretary0 Finance Harry W. Bernhardt......

...... Charles B. Womer, chairman Lester H. Buryn0Z Ivan L. Bennett, Jr. Michael Coleman

ULeonard W. Cronkhite, Jr. Reggie Graves

~John A. Gronvall Jack M. Groves

Rolla B. Hill, Jr. William D. Howe

Robert G. Petersdorf Jerry Huddleston(1) R. R. Neale

..s::Flexner Award Mario Pasquale......

4-< Richard C. Spry0 Daniel C. Tosteson, chairmanrJ) C. N. Stover, Jr.:=: Truman O. Anderson9 George L. Baker

George W. Warner......u

Gary Dubois~ Group on Medical Education<3 James V. Warrenu Ivan G. Wilmot STEERING(1)

..s:: George L. Baker, chairman......Governance and Structurea James B. Erdmann, executive secretary

0 Daniel C. Tosteson, chairman Robert A. Barbeer.l:11:: William G. Anlyan Murray M. Kappelman(1) Sherman M. Mellinkoff Thomas C. Meyera Russell A. Nelson Russell R. Moores;:l

Charles C. Sprague David L. Silberu0

Q Harold J. Simon

Graduate Medical EducationTask Force Group on Public Relations

Jack D. Myers. chairman STEERING

Steven C. Beering Frank J. Weaver, chairmanD. Kay Clawson Charles Fentress, executive secretary

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Terry R. BartonWinifred A. CoxHugh HarelsonRonald A. KeyMary Ann LockwoodJ. Michael MattssonRuth N. OliverJack W. Righeimer

Group on Student Affairs

STEERING

Marilyn Heins, chairmanRobert J. Boerner, executive secretaryMartin S. BegunRobert T. BinhammerFrances D. FrenchPatricia GeislerAndrew M. GoldnerM. Roberts GroverRobert I. KeimowitzWalter F. LeavellW. Clifford NewmanAnn S. PetersonMitchell J. RosenholtzPaul ScolesW. Albert Sullivan, Jr.

MINORITY AFFAIRS SECTION

Walter F. Leavell, chairmanAlthea AlexanderAnna C. EppsRobert LeeMarion PhillipsVivian W. Pinn

Journal of Medical EducationEditorial Board

Richard P. Schmidt, chairmanStephen AbrahamsonJohn W. CorcoranMerrel D. FlairHenry W. Foster, Jr.Walter F. LeavellEdgar Lee, Jr.Ronald LouieJ. Michael McGinnisChristine McGuireIvan N. MenshJacqueline A. NoonanGeorge G. ReaderRichard C. ReynoldsMona M. Shangold


C. Thomas SmithJames C. StricklerJohn H. WestermanMiriam Willey

Management Advancement Program

STEERING

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

Medicare Section 227

Charles B. Womer, chairmanFrederick J. BonteRobert W. HeinsLawrence A. HillWilliam H. LuginbuhlJerome H. ModellHiram C. Polk:Jr.

Minority Student Opportunitiesin Medicine Task Force

Paul R. Elliott, chairmanAlonzo C. AtencioRaymond J. BarrerasHerman R. BransonLinwood CustalowDoris A. EvansChristopher C. Fordham, IIIWalter F., LeavellGeorge LythcottCarter L. MarshallLouis W. SullivanDerrick TaylorNeal A. Vanselow

National Citizens Advisory Committeefor the Support of Medical Education

Mortimer M. Caplin, chairmanGeorge Stinson, vice chairmanJack R. AronG. Duncan BaumanKarl D. BaysAtherton BeanWilliam R. BowdoinFrancis H. Burr

AAMC Annual Reportfor 1978 201

Fletcher Byrom Planning Coordinators' Group

Maurice R. Chambers Howard Barnhard, chairmanAlbert G. Clay H. Paul Jolly, Jr., executive secretaryWilliam K. Coblentz Ruth HaynorAllison Davis David I. HoppLeslie Davis James NelsonWillie Davis Carole StapletonDonald C. Dayton George StuehlerDorothy Kirsten FrenchCarl J. Gilbert ResolutionsRobert H. Goddard

Robert L. Van Citters, chairman::: Stanford GoldblattCarmine D. Clemente9

rJ) Melvin GreenbergJohn W. CollotonrJ)a Emmett H. HeitlerPeter Shields\-;

(1) Katharine Hepburn0........

Charlton Heston;:lRIME Program Planning0

Walter J. Hickel..s::~ John R. Hill, Jr. Thomas C. Meyer, chairman'"d

Harold H. Hines, Jr. Gary M. Arsham(1)u

Arthur S. Elstein;:l Jerome H. Holland'"d0

Mrs. Gilbert W. Humphrey Victor R. Neufeld\-;

0..(1)

Geraldine Joseph T. Joseph Sheehan\-;

(1)

Jack Josey Frank T. Stritter.D0

Robert H. Levi...... .......Student Financing Task Force0 Florence MahoneyZ

UAudrey Mars Bernard W. Nelson, chairman

~Woods McCahill James W. BartlettArchie R. McCardell J. Robert Buchanan

(1) Einar Mohn Anna C. Epps..s::E. Howard Molisani......

William I. Ihlandfeldt4-<0 C. A. Mundt Thomas A. RadorJ)

::: Arturo Ortega John P. Steward9......Thomas F. Patton Robert L. Tuttleu

~Gregory Peck Glenn Walker<3

uAbraham Pritzker(1)

..s::William Matson Roth Support of Medical Education......

a Beurt SerVaas Task Force0<.l:1 LeRoy B. Staver Stuart Bondurant, chairman

Richard B. Stoner Stanley M. AronsonHarold E. Thayer Thomas BartlettW. Clarke Wescoe Steven C. BeeringCharles C. Wise, Jr. Ivan L. Bennett, Jr.William Wolbach Frederick J. BonteT. Evans Wychoff David R. ChallonerStanton L. Young John E. Chapman

Ronald W. EstabrookNominating Christopher C. Fordham, III

John W. Eckstein, chairman John A. GronvallWilliam K. HamiltonStanley M. AronsonMarilyn HeinsRobert M. Berne

David D. Thompson Donald G. Herzberg

Leslie T. Webster Robert L. Hill

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James KellySherman M. MellinkofTJohn MiltonRichard H. MoyMitchell T. RabkinPaul ScolesPeter ShieldsEugene L. StaplesEdward J. StemmlerGeorge StinsonLouis W. SullivanVirginia WeldonGeorge D. Zuidema

Technical Standards for MedicalSchool Admission

M. Roy Schwarz, chairmanJ. Robert BuchananGerald H. Holman

LIAISON COMMITIEE ON MEDICAL EDUCATION

Non-AAMC Members·

American Medical Association

Warren L. BostickLouis W. BurgherPatrick J. V. CorcoranPerry J. CulverWilliam F. KellowRobert S. Stone

• For AAMC members, see page 199.


John H. MortonMolly OsborneMalcolm PerryJerome B. PosnerAnn S. PetersonAlain B. RossierHarold M. Visotsky

Women in Medicine Planning Group

Lynn EckhertLynne EddyShirley FaheyJudith FrankMildred GordonJudith KrupkaNancy RoeskeMiriam RosenthalPearl RosenbergElizabeth Tidball

Public

Harriet S. InskeepArturo G. Ortega

Federal Participant

Robert F. Knouss

Student Participants

Timothy Michael HoseaPeter Shields

ao<.l:1

AAMC Professional Staff

Office of the President

PresidentJohn A. D. Cooper, M.D.

Vice PresidentJohn F. Sherman, Ph.D.

Special Assistant to the PresidentKat Dolan

Special Assistant to the Presidentfor Women in Medicine

Judity BraslowStaff Counsel

Joseph A. Keyes

Division of Business Affairs

Director and Assistant Secretary-TreasurerJ. Trevor Thomas

Business ManagerSamuel Morey

ControllerWilliam Martin

Staff AssistantDiane JohnCarolyn VIf

Director, Computer ServicesJesse Darnell

Associate Director, Computer ServicesMichael McShane, Ph.D.

Systems AnalystJean Steele

Systems ManagerJames Studley

Programmer/AnalystMargaret PalmieriJay StarryAustin Yingst

Division of Public Relations

DirectorCharles Fentress

Division of Publications

DirectorMerrill T. McCord

Assistant EditorJames Ingram

Manuscript Editor

Rosemarie D. HenselStaff Editor

Vema Groo

Department of Academic Affairs

DirectorAugust G. Swanson, M.D.

Deputy DirectorThomas E. Morgan, M.D.

Senior Staff AssociateMary H. Littlemeyer

Staff AssociateMartha Anderson, Ph.D.

Division of Biomedical Research

DirectorThomas E. Morgan, M.D.

Project Director, Study of Biomedical Researchers

Charles Sherman, Ph.D.Staff Associate

Diane Newman

Division of Educational Measurementand Research

DirectorJames B. Erdmann, Ph.D.

Associate DirectorRobert L. Beran, Ph.D.

Program Director, Personal CharacteristicsAssessment

Xenia Tonsek, Ph.D.Research Associate

Robert JonesResearch Assistant

Donna Potemken

Division of Student Programs

DirectorRobert J. Boerner

Assistant Director, Special ProgramsSuzanne P. Dulcan

Director, Minority AffairsDario O. Prieto

Research AssociateJuel Hodge

203

ao<.l:1


Staff AssistantJanet Bickel

Division of Student Services

DirectorRichard R. Randlett

Associate DirectorSandra K. Lehman

Staff AssistantCarla Winston

ManagerAlice CherianEdward B. GrossKathryn Waldman

SupervisorLinda W. CarterJosephine GrahamVirginia JohnsonMansfield RussellGail ShermanTerry White

Division of Student Studies

DirectorDavis G. Johnson, Ph.D.

Research AssociateJanet Cuca

Research AssistantTravis Gordon

Department of Health Services

DirectorJames I. Hudson, M.D.

Department ofInstitutional Development

DirectorMarjorie P. Wilson, M.D.

Assistant Director, Management ProgramsAmber Jones

Staff AssociatePeter Butler

Staff AssistantMarcie FosterLynn Sukalo

Division of Accreditation

DirectorJames R. Schofield, M.D.

Staff Assistant


Joan Johnson

Division of Institutional Studies

DirectorJoseph A. Keyes

Department ofTeaching HospitalsDirector

Richard M. Knapp, Ph.D.Assistant Director

James D. Bentley, Ph.D.Senior Staff Associate

Armand CheckerJoseph Isaacs

Department of Planningand Policy Development

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

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

Legislative AnalystJudith BraslowSteven Grossman

Division of Operational Studies

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

Senior Staff AssociateJoseph Rosenthal

Staff AssociateBetty Higgins

Operations Manager, Faculty RosterAarolyn Galbraith

Research AssistantFrances Gragg

Staff AssistantCynthia Scott

Division of EducationalResources and Programs

DirectorEmanuel Suter, M.D.

Staff AssociateWendy Waddell

Project CoordinatorAlison Connell

Staff AssistantVickilyn Gigante

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Association of American Medical Colleges

Annual Meeting

and

Annual Report

1979

aamc annual meeting and annual report 1978 · recruiting practices. but there is little to laugh...

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