AAMC annual meeting and annual report 1986 Meeting and Annual Report 1986. Table of Contents ......

Association of American Medical Colleges

Annual Meeting

andAnnual Report

1986

Table of Contents

Annual MeetingPlenary Sessions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 205Special General Sessions . . . . . . . . . . . . . . . . . . . . . . . . .. 205Council of Academic Societies . . . . . . . . . . . . . . . . . . . . .. 206Council of Deans. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 206Council of Teaching Hospitals . . . . . . . . . . . . . . . . . . . . .. 206Organization of Student Representatives . . . . . . . . . . . . .. 206Women in Medicine. . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 207AAMC Data Bases. . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 207Aging of Medical School Faculty: Implications for Insti-

tutional Renewal and Productivity . . . . . . . . . . . . . . . .. 207Group on Business Affairs . . . . . . . . . . . . . . . . . . . . . . . .. 208Group on Institutional Planning . . . . . . . . . . . . . . . . . . . .. 208Group on Public Affairs . . . . . . . . . . . . . . . . . . . . . . . . . .. 208Group on Student Affairs . . . . . . . . . . . . . . . . . . . . . . . . .. 210GSA-Minority Affairs Section . . . . . . . . . . . . . . . . . . . . .. 211Group on Medical Education . . . . . . . . . . . . . . . . . . . . . .. 212

Assembly Minutes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 225

AnnualReport 0 •••••• 0 •• 00000 •• 0.0 229Executive Council, Administrative Boards 0 •• 0 •• 0 • 0 • 0 0 0 230The Councils .... 0 • • • • • • • • • • • • • • • • • • • • • • • • • • • • • •• 231National Policy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 242Working with Other Organizations . . . . . . . . . . . . . . . . .. 251Education 254Biomedical and Behavioral Research. . . . . . . . . . . . . . . .. 257Faculty 261Students 262Institutional Development 265Teaching Hospitals. . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 266Communications. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 273Information Systems. . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 274AAMC Membership. . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 276Treasure~sReport 276AAMC Committees 278AAMC Staff . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 282

The Ninety-Seventh Annual Meeting

New Orleans Hilton Riverside and Towers, New Orleans, Louisiana, October 25-30, 1986

Theme: Leadership in Academic Medical Centers

Program Outlines

PLENARY SESSIONS

October 27

Presiding: Virginia V. Weldon, M.D.

Presentation Honoring Centennial of the National Institutes of HealthJames B. Wyngaarden, M.D.

In the Eye of a HurricaneHonorable Thomas F. EagletonSenator Eagleton presented the Alan GreggMemorial Lecture

Leadership in Medical Education: The Challenge of DiversityClifton R. Wharton, Jr., Ph.D.

Leadership in Meeting Ethical ChallengesAlbert Jonsen, Ph.D.

Educational Impacts of New Care SystemsJ. Robert Buchanan, M.D.

October 28

Presiding: Edward J. Stemmler, M.D.

Presentation of Abraham Aexner Award toDavid E. Rogers, M.D.

Presentation of AAMC Research Awardby Joseph E. Johnson III, M.D.,to Paul C. Lauterbur, Ph.D.

Presentation of Special Recognition Award toEdithe J. Levit, M.D., for contributions toevaluation methodologies in medical education, service to academic medicine and themedical profession, and distinguished leadership of the National Board of Medical Examiners

Why the Dinosaurs Died: Extinction or Evolution?Virginia V. Weldon, M.D.

Making Medicine a More Attractive ProfessionPaul B. Beeson, M.D.Dr. Beeson presented the John A.D. CooperLecture

A Report on the EstablishmentRobert G. Petersdorf, M.D.

SPECIAL GENERAL SESSIONS

October 26

GRADUATE MEDICAL EDUCATION AND THE

TRANSITION FROM MEDICAL SCHOOL TO RESI

DENCY

Moderator: Edward J. Stemmler, M.D.

Institutional ResponsibilityCommentator: Spencer Foreman, M.D.Reactors: C. Rollins Hanlon, M.D.

Fran~ A. Riddick, Jr., M.D.

Problems at the TransitionCommentator: Joseph S. Gonnella, M.D.Reactors: Robert B. King, M.D.

Ture W. Schoultz, Ph.D.

October 28

USING NEW TECHNOLOGIES IN MEDICAL EDU

CATION

Moderator: Ernst Knobil, Ph.D.

Keynote Speaker: Anthony G. OettingerRespondents: Richard B. Friedman, M.D.

William S. Yamamoto, M.D.

205

206 Journal ofMedical Education

COUNCIL OF ACADEMIC SOCIETIES

October 27

Business Meeting

Presiding: David H. Cohen, Ph.D.

COUNCIL OF DEANS

October 27

Business MeetingPresiding: D. Kay Clawson, M.D.

COUNCIL OF TEACHING HOSPITALS

20th ANNIVERSARY-1966-1986

October 27

Business MeetingPresiding: C. Thomas Smith

General SessionPresiding: Spencer Foreman, M.D.

The Margin of Success: New ManagementRoles in a Competitive EnvironmentJack Jackson

ORGANIZATION OF STUDENTREPRESENTATIVES

October 24

Regional Meetings

Business Meeting

New Member Orientation: Getting the MostOutofOSRJanet Bickel

GENERAL SESSION

The Light at the End of the Medical SchoolTunnel: Watch Out for Trains

Moderator: Vietta Johnson

Carola Eisenberg, M.D.Leon Eisenberg, M.D.

October 25

PLENARY SESSION

Physicians' Responsibilities for Keeping theDoors Open in Health Care

Moderator: Richard Peters, M.D.

VOL. 62, MARCH 1987

Panel: H. Jack Geiger, M.D.Robert M. Heyssel, M.D.Vivian Pinn-Wiggins, M.D.James B. Spear, Jr., Ph.D.

ALM: Learning Medicine: The New MexicoExperiment

Moderator: Arthur Kaufman, M.D.

Four "social responsibility" tracks

ETHICS IN ACTION

The Heart and Soul of Medicine: EverydayEthicsBetsy Garrett, M.D.Norma Wagoner, Ph.D.

Giving Human Values Courses a Clinical FocusJanet BickelJoy D. SkeelDavid Thomasma, Ph.D.

STAYING HEALTHY

Incorporating Preventive Medicine Into YourPracticeDaniel S. Blumenthal, M.D.Mark BlumenthalJames Carter, M.D.Kevin Patrick, M.D.

Alternatives to High Tech Health CareAndrew Weil, M.D.

PRACTICE TRENDS

Community Oriented Primary CareH. Jack Geiger, M.D.Arthur Kaufman, M.D.

Emerging Health Care Delivery SystemsRobert M. Heyssel, M.D.Nancy Seline

KEEPING THE DOORS OPEN TO MEDICAL SCHOOL

Simulated Minority Admission ExerciseDario PrietoElsie Quinones

GENERAL SESSION

REVOLUTION IN MEDICINE HEALTH AND HEAL

ING IN THE YEAR 2000Andrew Weil, M.D.

1986 AAMC Annual Meeting

October 26

Students Leading the Way in InternationalHealth and Community Service

Moderator: Joann Elmore

Panel: Judith CrowellDavid KregerPeggy SpencerCynthia CarlsonJohn Dejong, M.D.Karem Ali

Problem-Based Learning

Moderators: Vicki DarrowKim Dunn

Panel: Myra Bergman Ramos:::~ William Shragge, M.D.~ Arthur Kaufman, M.D.0..

§ Business Meeting~"8 Regional Meetings.g

~ WOMEN IN MEDICINE(1)

.D

~ October 26zu Plenary Session

~ Moderator: Joan M. Altekruse, M.D.::o Managing the Woman's Way:go Marilyn Loden]] October 27-B§ Breakfast Program

<.l:1

~ Topics for Discussion:88 Taking better care ofourselves: Issues in wom-

en's health

The fine line: When to speak out against sexualharassment and when to let it go

Black women in medicine: Double trouble?

Women's organizations: What are appropriateroles for organizations of women faculty andstudents?

What policies should academic medical centers develop concerning maternity and parenting issues?

Equity issues: Salary, rank and "good" committee assignments

Liaison Officers' Caucus

207

October 28

Women in Medicine Luncheon

Institutional Response to Sexual HarassmentLinda Weiner

Academic Women Chairmen

DEMONSTRATIONS OF AAMC DATABASES

October 26 aDd 27

STUDENT AND APPLICANT INFORMATION MAN

AGEMENT SYSTEM

The AAMC's extensive data on medical schoolapplicants and students form a comprehensivedata base called the Student and ApplicantInformation Management System (SAIMS).The purpose of the system is to facilitate studies of trends in applicant and student characteristics and to assist member institutions withtheir own institutional studies.

INSTITUTIONAL PROFILE SYSTEM

The AAMC Institutional Profile System is acomputer-based data storage, retrieval, andanalysis system containing many variables oneach U.S. medical school. It is used to provideannual ranking reports placing each school ina national context on a variety of measures ofinterest and to serve the needs of the institutions, the Liaison Committee on Medical Education, and the AAMC for comparative institutional data.

Annual Meeting participants were invited tostop by and learn about these new facilities.Services available to medical schools were described, and questions regarding utilization ofthe data were answered.

AGING OF MEDICAL SCHOOL FACULTY: IMPLICATIONS FOR INSTITUTIONAL RENEWAL AND PRODUCfIVITY

October 27

Moderator: Eleanor Shore, M.D.

Faculty Age Distributions and Research ProductivityPaul Jolly, Ph.D.


Faculty Renewal in the University of California SystemPaul Friedman, M.D.Increasing Aexibility in Academic Staffing:Lessons from Higher EducationKenneth Mortimer, Ph.D.

GROUP ON BUSINESS AFFAIRS

October 27

Regional Meetings

GOA NATIONAL PROGRAM

Physician Payment: Future Directions UnderMedicareHenry R. Desmarais, M.D.

The Future of Biomedical ResearchMary McGrane

October 28

Augustus J. Carroll Memorial Lecture andLuncheonMitchell T. Rabkin, M.D.

National Business Meeting

NATIONAL PROGRAM

Leadership in Academic Health Science CentersDonna H. Ryan, M.D.

Low Road to Morality: Notes on LeadershipValuesE. Grady Bogue, Ph.D.

GROUP ON INSTITUTIONALPLANNING

October 26

Discussion Group I-MergersConveners: Ruth A. Kalish, Ph.D.

Ellen R. Krasik

Discussion Group II-MarketingConvener: John Eudes

Discussion Group III-Information ManagementConvener: Donald Fenna, Ph.D.

GIP NATIONAL PROGRAM

Interdisciplinary Approaches: Opportunitiesfor Creative Problem Solving

VOL. 62, MARCH 1987

In Medical EducationV.R. Neufeld, M.D.

In Biomedical ResearchLouis Glaser, Ph.D.

In Clinical ServicesJoseph Kiely, M.D.

In AdministrationWilliam T. Butler, M.D.

GROUP ON PUBLIC AFFAIRS

October 27

GPA AWARDS PRESENTATION

Moderator: Carolyn Tinker

Publications-External Audiences

Single or Special IssueGregory GrazeSusan Sample

PeriodicalsJohn DeatsMichela Reichman

Publications-Internal AudiencesTom GeddieAnne Insinger

Electronics Program-AudioEldean BorgKaren Stamm

Electronics Program-VisualJanet Norton

Special Public Relations/Development/Alumni ProjectGayle McNutt

Premier Performance during 1985 by a Medical School or Teaching HospitalAlumniElizabeth P. Waters

DevelopmentBrenda Babitz

Public RelationsBarbara BarrowGayle McNutt

ALUMNI PROGRAM

Moderator: Jean D. Thompson

GPA BUSINESS MEETING

Presiding: Robert Fenley


Alumni Boards-Strengths, Weaknesses,ControlsMarcie Seligman RobertsLeslie F. Wilson

Annual Funds, Grateful Patient Programs,Specialty Conferences and Other Alumni Activities

Moderator: Jean D. ThompsonColleen MehanKellie SemlerJack SiefKas

New Alumni Programming Initiatives

Moderator: Leslie WilsonElizabeth P. Waters

~ Jerry Passer

~ DEVELOPMENT PROGRAM0..

§ Current Issues in Tax Legislation~] Moderator: Richard Griffin] David M. Donaldsone~ Changing Institutions, New ConstituenciesE Clyde P. Watkinsoz

~ October 28o

§ GPA AWARDS LUNCHEON]] Welcome: Carolyn Tinker-B§ Speaker Introduction: Robert Fenley

<.l:1

~ Awards Presented by John W. Collotona§ Speaker: Edmund J. TunstallQ

GPA GENERAL SESSION

Medicine's Future Can Be As Bright As ItsPastAugust G. Swanson, M.D.

COMBINED ALUMNI AND DEVELOPMENT PROGRAM

Alumni/Development Caucus

Discussion Leader: Arthur M. Brink, Jr.

PR PROGRAM

Marketing Strategies That Work

Moderator: John Milkereit

Patricia McCarthyRoland Wussow

209

October 29

COMBINED ALUMNI AND DEVELOPMENT PROGRAM

Alumni, Development and Public Relations:Together in Theory and Practice

Moderator: Clyde WatkinsJoe SiglerBill D. Glance

PR SESSION

Update on Animal LegislationFrankie Trull

Corporate Crisis ManagementJames L. Ewing III

GPA TABLE TOPICS

Parents GroupsDiscussion Leaders: Barbara T. Blough

Patricia E. CaverSondra M. Ives

Faculty ParticipationDiscussion Leaders: Patricia M. Ashmore

Krista Mattox

Joining a Medical CenterDiscussion Leaders: Rebecca Chapman

Leslie F. Wilson

Alumni PublicationsDiscussion Leaders: Ellen Soo Hoo

Jean D. Thompson

Involving Younger AlumniDiscussion Leaders: Patricia L. Head

Elizabeth C. Morris

Creating Major Gift OpportunitiesDiscussion Leaders: G. Robert Alsobrook

W. Charles Witzleben

Non-Traditional Academic Medical CentersDiscussion Leaders: John F. Record

Gail L. Anderson

The PR Problem of AIDS:Discussion Leaders: John Deats

Gregory Graze

Supporting the Legislative EffortDiscussion Leaders: D. Gayle McNutt

Susan Reynolds

Who's in Charge of MarketingDiscussion Leaders: Gloria Howton

J. Antony Lloyd


Marketing Clinical Services ofAcademic Medical CentersDiscussion Leaders: Anne Doll

Roland Wussow

Is Talk Cheap?: Radio-TV as a PR ToolDiscussion Leaders: Eldean Borg

Douglas Buck

Publications: Keeping Costs Down and Readership UpDiscussion Leader: Bill D. Glance

Medical Magazines: State of the Art

Discussion Leaders: Jeff MillerSusan Sample

GROUP ON STUDENT AFFAIRS

October 27

GSA Plenary Session

A Nuts and Bolts Approach to Student Affairs

Moderator: Ture W. Schoultz, Ph.D.

Financial AssistanceRuth Beer Bletzinger

Minority AffairsCarolyn M. Carter, Ph.D.

Student AffairsJack C. Gardner, M.D.

AdmissionsBilly B. Rankin

Student Affairs: Student Advocacy vs.Institutional ResponsibilityPanel: Henry M. Seidel, M.D.

Bernice Sigman, M.D.Joanna H. Spiro, Ed.D.

Admissions: Managing Multiple Acceptances-Traffic Rules RevisitedBilly B. RankinCharles E. Spooner, Jr., Ph.D.

Financial Assistance: MEDLOANS-WhatDo You Think So Far?

Moderator: Robert L. Beran, Ph.D.Panel: Robert Colonna

William F. KidwellKevin MoehnRichard Randlett

VOL. 62, MARCH 1987

Student Affairs: AIDS-and its Effect onUndergraduate Medical EducationDavid Altman, M.D.

Admissions: Premedical Requirements-Timefor Review, Time for Change?Gerald Foster, M.D.J. Donald Hare, M.D.

October 28

Student Affairs: Grading Systems and TheirEffect on Residency SelectionClyde G. Huggins, Ph.D.Morris Kerstein, M.D.Wallace Tomlinson, M.D.

Admissions: Does Quality Decrease with aDeclining Applicant Pool?John B. Molidor, Ph.D.Cynthia G. Tudor, Ph.D.

Financial Assistance: Financial PlanningProgram, Part I-Medical Student on theBlock-What is Your Bid?

Moderator: Marilyn A. ComerPanel: Joan M. May

Charles E. Spooner, Jr., Ph.D.

Admissions: Trends in the Selection ofUnderrepresented Minorities (the WheelGoes 'Round)Leonard E. Lawrence, M.D.

Financial Assistance: Financial PlanningProgram, Part II-Sign on the Dotted Line:Passivity to Bankruptcy

Moderator: Kathryn F. Fink, Ph.D.Speaker: Pearl Rosenberg, Ph.D.

Student Affairs: Trends in GraduationQuestionnaire Data, 1981-1986Cynthia G. Tudor, Ph.D.

Student Affairs: The Fourth Year Curriculum-Poor Utilization?Paul R. Mehne, Ph.D.Stephanie S. Rand

Admissions: The MCAT-Constructive Useor Abuse?Karen Mitchell, Ph.D.Nancy A. Solomon, M.D.


Student Affairs: Career Counseling in an Eraof Changing Medical PracticeLinda D. Lewis, M.D.John D. Tolmie, M.D.

October 29

Student Affairs: Dismissing the ProblemStudent

Moderator: Ronald D. Franks, M.D.Panel: Daniel Frank, M.D.

Carl J. Getto, M.D.Grant Miller, M.D.Kenneth Tardiff: M.D.

Admissions: Current Issues in Admissions: AChallenge to Develop an Information Exchange Network among Admissions OfficersA. Geno AndreattaW. Qifford Newman, Ph.D.

Financial Assistance: Status of Federal Programs

Moderator: Ruth Beer Bletzinger

Status of Health Manpower ProgramsMichael Heningburg

Status of Higher Education Act ProgramsDavid Baime

Financial Assistance: Financial PlanningProgram, Part III-Repayment to Retirement:Long-term Implications of Mortgaging YourLife

Moderator: Dorothy E. Brinsfield, M.D.

Speaker: Theresa Orr

Student Affairs: The NRMP-How It WorksPhyllis Weiland

Admissions: MCAT Essay Pilot Project-AProgress Report

Moderator: Robert I. Keimowitz, M.D.Panel: Zenaido Camacho, Ph.D.

Terry Leigh, Ed.D.Marliss Strange

October 30

GSA Business Meeting

211

GSA-MINORITY AFFAIRS SECTION

October 26

Minority Medical Career Awareness Workshop

October 27

Regional Meetings

Business Meeting

Speakers: Margaret Haynes, Ed.D.Robert L. Volle, Ph.D.

High School Health Professions ProgramsEffectiveness in Increasing the MinorityApplicant Pool

Moderators: Maxine Bleich; Maggie S.Wright, Ph.D.Panel: Manny Begay

Harry J. Knopke, Ph.D.William A. Thomson, Ph.D.E. Belvin Williams, Ph.D.

October 28

Minority Affairs Program

Speaker: Cornelius Hopper, M.D.

October 29

GSA-MAS Symposium

Increasing the Minority Applicant Pool-AComprehensive Approach

Moderator: Margaret C. Woodbury, M.D.

GSA-MAS Research Forum

Research on Minorities in Medical Education

Moderator: Stephen Keith, M.D.Panel: Evelyn W. Jackson, Ph.D.

Elena K. Lesser, Ed.D.Karen Mitchell, Ph.D.Cecilia M. Roberts, Ph.D.Vera B. Thurmond, Ed.D.

GSA-MAS Workshop on Research Principles,Practices, and Publications

Moderator: Fernando Mendoza, M.D.Panel: Henry Frierson, Ph.D.

Paul Jolly, Ph.D.Merrill McCordWilliam Sedlacek, Ph.D.


GROUP ON MEDICAL EDUCATION

October 26

GME Mini-Workshops

THE PROCESS APPROACH: AN ALTERNATIVE

TO CONTENT TUTORING

Organizer: Norma E. Wagoner, Ph.D.Faculty: Dorothy H. Air, Ph.D.

Carol Banks Setter, Ph.D.

EVALUATING AND REWARDING

EXCELLENCE IN TEACHING IN MEDICAL

EDUCATION PROGRAMS

Organizer: Howard L. Stone, Ph.D.

THE ADVANTAGE OF UTILIZING SKILLED

NURSING FACILITY AS A TEACHING

SITE FOR RESIDENTS, FELLOWS, AND

MEDICAL STUDENTS

Organizer: Elaine J. LenkeiFaculty: Roseanne Berger

David M. Holden, M.D.Daniel Morelli, M.D.

HOW COMPUTERS HELP CURRICULUM

PLANNING AND EVALUATION

Organizer: Edward M. Sellers, M.D.

Faculty: Jon VeloskiPeter WanMahmood KaraJames J. Haf, Ph.D.William Mattern, M.D.

COUNSELING MEDICAL STUDENTS AND

RESIDENTS IN SELECTING A CAREER:

TECHNIQUES FOR MEDICAL SCHOOL

FACULTY AND RESIDENCY TRAINING

PROGRAM DIRECTORS

Organizer: Leslie S. Jewett, Ed.D.

Faculty: Larrie W. Greenberg, M.D.Zandy B. Leibowitz, Ph.D.

TEACHING DURING THE PATIENT

ENCOUNTER

Organizer: Franklin J. Medio, Ph.D.

Faculty: Steven Borkan, M.D.Linda Lesky, M.D.LuAnn Wilkerson, Ed.D.

VOL. 62, MARCH 1987

DEVEWPING AND MAINTAINING A

RESIDENT RATING SYSTEM

Organizer: John H. Littlefield, Ph.D.Faculty: James J. Gaspard, M.D.

Gary D. Harris, M.D.

DEVELOPING CASES FOR PROBLEM-BASED

LEARNING

Organizer: Stewart P. Mennin, Ph.D.Faculty: Elizabeth Baca

Stewart Duban, M.D.Arthur Kaufman, M.D.Susan M. LuceroNancy Martinez-BurrolaStewart P. Mennin, Ph.D.Scott Obenshain, M.D.Bert Umland, M.D.

COMPUTER CONFERENCING FOR MEDICAL

EDUCATORS

Organizer: George Nowacek, Ph.D.Faculty: Doug Smith

Clyde Tucker, M.D.

COMMUNITY-BASED STUDENT RESEARCH

PROJECTS AS A MEANS OF INDEPENDENT

LEARNING

Organizer: David B. Reuben, M.D.Faculty: Stephen R. Smith, M.D.

HELPING STUDENTS IN ACADEMIC

DIFFICULTY

Organizer: Karen Collins-Eiland, Ph.D.Faculty: Karen Collins-Eiland, Ph.D.

Lester M. Geller, Ph.D.

GME Generalists Co-Sponsored Session

ETHNOGRAPHIC, NATURALISTIC, AND

QUALITATIVE METHODS IN EVALUATING

MEDICAL EDUCATION

Organizer: Larry Laufman, Ed.D.

TEACHING RESIDENTS HOW TO TEACH

Organizers: Janine C. Edwards, Ph.D.c. Benjamin Meleca, Ph.D.

Faculty: Janine C. Edwards, Ph.D.C. Benjamin Meleca, Ph.D.James A. PearsolWarren C. Plauche, M.D.

OBJECTIVE STRUCTURED CLINICAL EXAMS

Organizer: Emil R. Petrosa, Ph.D.


Faculty: Thomas A. Blackwell, M.D.Sharon Parcel

OOMPUTER-ASSISTED INSTRUCTION IN THE

CLINICAL CURRICULUM: WHAT IT CAN AND

CANNOT OONTRIBUTE TO THE EDUCATION

OF PHYSICIANS

Organizer: James McCorkel, Ph.D.

Faculty: John Culleton, M.D.James McCorkel, Ph.D.Yehia Mishriki, M.D.Ollie Jane Z. Sahler, M.D.

GME Problem-Based Learning Group CoSponsored Session

PERFORMANCE-BASED MULTIPLE STATIONS

EXAMINATION: A OONCEPTUAL AND

HANDS-ON APPROACH TO ITS DESIGN,

DEVELOPMENT, ADMINISTRATION, SCORE

INTERPRETATION, AND REPORTING

Organizer: Nu Viet Vu, Ph.D.

Faculty: Michelle MarcyDavid Steward, M.D.Steve J. VerhulstNu Viet Vu, Ph.D.Reed G. Williams, Ph.D.

FOSTERING EFFECTIVE SELF CRITIQUE:

FOR LEARNERS AND OURSELVES

Organizer: Hilliard Jason, M.D.Faculty: Jane Westberg, Ph.D.

THE HIDDEN CURRICULUM IN MEDICAL

EDUCATION

Organizer/Faculty: Kelly M. SkefT, M.D.

October 26

Curriculum Deans' Sessions

MANAGING THE CHANGE PROCESS

Orientation: Paula L. Stillman, M.D.

Program Options

Special General Session-Graduate MedicalEducation and Transition from MedicalSchool to Residency

Managing the Change Process: A WorkshopDavid Irby, Ph.D.

213

Maximizing Your Professional StaffsPerformance and Productivity: A SkillsWorkshopPaul TaylorGerald Escovitz, M.D.

GROUP DISCUSSIONS ON AAMC GRADUATE MED

ICAL EDUCATION REPORT AND ISSUES OF BROAD

CONCERN TO CURRICULUM DEANS

Moderators:Barry D. Lindley, Ph.D.David Altman, M.D.Fredric D. Burg, M.D.Terrence T. Kuske, M.D.Julian I. Kitay, M.D.Stephen Smith, M.D.

October 26

GME/SMCDCME Joint Sessions

ALTERNATIVES IN TEACHING AND

LEARNING

Moderator: Harold A. Paul, M.D.

Panel: John D. Chappell, M.D.Peter AJ. Bouhuijs, Ph.D.

PROGRESS IN COGNITIVE SCIENCE

PRACTICAL IMPLICATIONS FOR CURRENT

MEDICAL EDUCATORS

Moderator: W. Dale Dauphinee, M.D.Panel: Georges Bordage, M.D.

Henk Schmidt, Ph.D.Geoffrey R. Norman, Ph.D.

CME APPLICATIONS OF COMPUTERS IN

MEDICAL EDUCATION

Moderator: David S. Gullion, M.D.

Panel: Phil R. Manning, M.D.Wayne Putnam, M.D.

GME/SMCDCME Co-Sponsored PlenarySession

EDUCATING PHYSICIANS TO FUNCTION IN

THE NEW HEALTH CARE ENVIRONMENT

Moderator: Gerald H. Escovitz, M.D.

Speaker: Leonard Katz, M.D.

Panel: Saul Farber, M.D.Harold A. Paul, M.D.Theodore J. Phillips


October 27

GME REGIONAL MEETINGS

GME National Meeting

Innovations in Medical EducationDiscussion Groups

Instructional Design or Evaluation of BasicScience Courses-Traditional and ProblemBased ApproachesResource: Franklin Medio, Ph.D.

Phyllis Blumberg, Ph.D.

Instructional Design or Evaluation orIntroduction to Clinical Medical Courses

Resource: Jon H. Levine, M.D.

Instructional Design or Evaluation ofOinicalClerkshipsResource: Louise Arnold, Ph.D.

Computer Based CommunicationResource: Clyde Tucker, M.D.

Data Base ManagementResource: Barbara J.N. Hunt

Educational SoftwareResource: Lisa Leiden, Ph.D.

Approaches to the Development andAssessment of Values, Attitudes, and PersonalQualities

Resource: Janet BickelLinda Blank

Education Support Systems for Students"Too Much Chicken Soup"

Resource: Evelyn Jackson, Ph.D.

Instructional Design or Evaluation ofResidency Programs: "What Are We Preparing Residents For?"

Lame Greenberg, M.D.

Innovative Approaches to Admissions andStudent Financial Aid

Resource: E. Virginia Calkins

Approaches to Problem Based LearningLearning Medicine: The New MexicoExperiment

Resource: Ben DiatzArthur Kaufman, M.D.Stewart Mennin, Ph.D.

VOL. 62, MARCH 1987

GME/GSA-MAS JOINT SESSION

HIGH SCHOOL HEALTH PROFESSIONS

PROGRAMS: EFFECTIVENESS IN

INCREASING THE MINORITY APPLICANT

POOL

Moderator: Maxine Bleich

Panel: Manny BegayHarry J. Knopke, Ph.D.William A. Thomson, Ph.D.E. Belvin Williams, Ph.D.

October 28

GME Plenary Session

PROMOTING AND ASSURING THE

COMPETENCE OF GRADUATES THROUGH

ASSESSMENT

Overview/Introduction/ModeratorS. Scott Obenshain, M.D.

Presentation of Institutional Experiences:

Southern Illinois UniversityReed G. Williams, Ph.D.

University of MassachusettsPaula L. Stillman, M.D.

University of AdelaideDavid B. Swanson, Ph.D.

Impact on the Continuum: Three Perspectives:Medical Student EducationRobert S. Daniels, M.D.

Resident EducationThomas K. Oliver, M.D.

LicensureBryant Galusha, M.D.

SHARING INSTITUTIONAL EXPERIENCE:

REPRESENTATIVE ASSESSMENT

APPROACHES

Southern Illinois, University ofMassachusetts,University of Adelaide, University of NewMexico, University of Texas-Galveston, University of Limburg-Maastricht-The Netherlands, University of Calgary, Alverno College,University of Ottawa

Self Directed Learning: Finding a New Balance in Medical EducationDonald H. Brundage, Ed.D.


October 29

RIME ROUND TABLE DISCUSSIONS

Clinical Decision MakingHosted by Geoffrey R. Norman, Ph.D.

The Link Between Health Services Researchand Medical EducationHosted by Rose Yunker, Ph.D.

Research Issues on Clinical TeachingHosted by Janine C. Edwards, Ph.D.

Research Priorities for CMEHosted by David S. Gullion, M.D.

Teaching Medical Ethics and MedicalHumanitiesHosted by Sandra Bertman

Research Issues in Graduate MedicalEducationHosted by Larrie Greenberg, M.D.

Evaluation of Clinical PerformanceHosted by Reed G. Williams, Ph.D.

Academic Support Systems/Minority Retention ResearchHosted by Miriam Willey, Ph.D.

Managing Medical Information/MedicalInformaticsHosted by Charles P. Friedman, Ph.D.

Deriving Health Manpower Requirementsand Curriculum Content from NationalHealth PrioritiesHosted by Tamas Fulop, M.D., and J. J. Guilbert, M.D.

October 29

RIME Conference

Silver Anniversary Plenary Session

CHALLENGES FOR MEDICAL EDUCATION

RESEARCHERS IN THE CHANGING HEALTH

CARE ENVIRONMENT

Moderator: Murray M. Kappelman, M.D.

Keynote Speaker:The Challenges and Options for Meeting theChangesCarl J. Schramm, Ph.D.

215

Reactor Panel:

A Hospital Administrator's ViewSpencer Foreman, M.D.

A Foundation President's ViewJohn G. Freymann, M.D.

An Educational Researcher's ViewWayne K. Davis, Ph.D.

RIME Paper Sessions

TEACHING CLINICAL SKILLS

Moderator: Paula L. Stillman, M.D.

Discussant: Ian R. Hart, M.D.

A Prospective Educational Trial ComparingEfficacy of Computer-Assisted Learning andWeekly Seminars in Teaching EKGInterpretationRuth-Marie E. Fincher, M.D., et ale

· Long-Term Effects of Breast Exam TeachingUnit in Physical Diagnosis on MedicalStudents' PracticeImogene Smith, Ed.D., et ale

Evaluation ofan Animal Simulation To TeachEndotracheal IntubationMahesh P. Mehta, M.D., et ale

HARVEY: The Impact ofa CardiovascularTeaching Simulator on Student Skill AcquisitionJames O. Woolliscroft, M.D., et al.

MEDICAL FTHICS AND HUMANISTIC VALUES

Moderator: T. Joseph Sheehar.; Ph.D.

Discussant: Sandra Bertman

Learning and Teaching the Process ofInformed ConsentCarolina E. Yahne, Ph.D., et al.

Medical Students' Perceptions of Pre-CIinicalMedical Ethics TeachingKenneth Howe, Ph.D.

Teaching Interviewing Skills to First YearMedical Students: Do They Learn?Joan Harvey, M.D., et al.

The Ideal Physician: An Analysis from TwoPerspectivesTheresa J. Jordan, Ph.D., et al.


EVALUATION OF CLINICAL COMPETENCE

Moderator: Frank Stritter, Ph.D.

Discussant: Richard Wakeford

Evaluating Clinical Competence in Anesthesia: Using Faculty Comments to DevelopCriteriaM. Frances Rhoton, Ph.D., et ale

Comparing Self and Supervisor Evaluations:A Different ViewPaul Kolm, Ph.D., et al.

An Evaluation of the Construct Validity ofFour Alternative Theories of Clinical CompetenceJack L. Maatsch, Ph.D., et al.

CURRICULUM CHANGE

Moderator: Robert Rippey, Ph.D.

Discussant: Charles W. Dohner, Ph.D.

New Directions for Organizing StructuralCurriculum ReformBarbara J. Hunt, et ale

Influential Literature in Medical EducationEta S. Berner, Ed.D., et ale

Factors Influencing Experiential Learning ofMedical Students on Third Year FamilyMedicine ClerkshipsDonald Witzke, Ph.D., et al.

Programmatic and Institutional QualityAnalysis: The Perspective of the AlumniRobert P. O'Reilly, Ph.D., et al.

ADMISSION AND SELECfION DECISIONS

Moderator: Robert Keimowitz, M.D.

Discussant: Thomas J. Cullen, Ph.D.

Characteristics of Students Recruited inDifferent Types of Medical SchoolsBrigitte Maheux, M.D., Ph.D., et ale

Career Choices of Men and Women inMedicine: A Study of a Cohort of RecentMedical GraduatesChristel A. Woodward, Ph.D., et al.

Exploring the Relationship of Entry andPerformance Data to NBME Part I Examination Scores for Use in Decision MakingJames J. Haf, Ph.D.

VOL. 62, MARCH 1987

CLINICAL DECISIONS MAKING, PART I

Moderator: Fredric D. Burg, M.D.

Discussant: Georges Bordage, M.D., Ph.D.

Training Resident Physicians to Use ClinicalPrediction RulesDavid A. Bergman, M.D., et al.

An Approach to Teaching and EvaluatingDiagnostic ReasoningCarlyle Chan, M.D., et al.

The Impact of Clinical Appearance on Pediatric Residents' Assessment of the Febrile InfantDavid A. Bergman, M.D., et al.

CME AND POSTDOCTORAL EDUCATION

Moderator: Dave Davis, M.D.

Discussant: W. Dale Dauphinee, M.D.

The Effects of Continuing Medical EducationUpon Family Physician Performance in theOffice Management of HypertensionPenny Jennett, Ph.D., et al.

The Role of the Consultation Process inPhysician LearningJocelyn Lockyer, et aI.

Review of Family Medicine FacultyDevelopment Fellowship Programs, TheirAlumni and Recommendations for FutureProgramsCarole J. Bland, Ph.D., et al.

IMPACf OF PRIOR EXPERIENCE

Moderator: Donn Weinholtz, Ph.D.

Discussant: Gordon Page, Ed.D.

The Relationships of Clinical Exposure toExamination Performance on a SurgicalClerkshipRobert Cohen, Ph.D., et al.

Practical Experience in the Pre-RegistrationYear in Relation to Undergraduate PreparationBrian Jolly, et al.

The Influence of Prior Experience andConfidence on Physician Preferences forInformation Sources and Continuity of CareLarry D. Gruppen, et al.


CLINICAL DECISION MAKING, PART II

Moderator: Daniel Frank, M.D.

Discussant: Arthur Elstein, Ph.D.

Some Cognitive Characteristics of MedicalStudents with and Without DiagnosticReasoning DifficultiesGeorges Bordage, M.D., Ph.D., et al.

Oinical Decision Making: A Study to DefineEducational Objectives for ResidentPhysiciansDavid Hickam, M.D., et a1.

Decision Making of Internists and FamilyPhysicians in the NetherlandsJaap G.M. Gerritsma, Ph.D.

ISSUES IN CERTIFICATION

Moderator: James B. Erdmann, Ph.D.

Discussant: John S. Lloyd, Ph.D.

Defining the Content of Board CertificationExaminationsNicholas Pisacano, M.D., et al.

Something Old, Something New: TheCertification Examination of the UnitedKingdom Royal College of GeneralPractitionersRichard Wakeford, et a1.

Utilization of In-Training Examinations forCurriculum Evaluation: A Model from theSurgical ResidencyMarcia Z. Wile, Ph.D., et a1.

COMPUTERS AND INFORMATION TRANSFER

Moderator: David B. Swanson, Ph.D.

Discussant: Richard B. Friedman, M.D.

Formative Evaluation of a Structured DataBase as an Educational Strategy in MedicalMicrobiologyCharles P. Friedman, Ph.D., et al.

Teaching Oinicans To Search MEDLINE:Description and Evaluation of a Short CourseAnn McKibbon, et al.

A Program of Microcomputer Use in a JuniorInternal Medicine OerkshipRobert C. Talley, M.D.

217

CHANGES IN MEDICAL PRACTICE

Moderator: George Zimny, Ph.D.

Discussant: John G. Freymann, M.D.

A Re-Evaluation of the Projected PhysicianSurplus in the United StatesSteven J. Jacobsen, et a1.

Perceived Influence of the MedicareProspective Payment System on Educationand Practice: Comparison of University andAffiliated HospitalsBarbara Barzansky, Ph.D., et a1.

The Organizational, Professional, and OinicalCharacteristics of General Practitioners andFamily Physicians' Medical PracticeBrigitte Maheux, M.D., Ph.D., et ale

CLINICAL TEACHING AND CLINICAL

PERFORMANCE

Moderator: S. Scott Obenshain, M.D.

Discussant: Kelly M. Skefl: M.D., Ph.D.

Effective Attending Physician Teaching: TheCorrelation of Observed Instructional Activities and Learner Ratings of Teaching EffectivenessDonn Weinholtz, Ph.D., et ale

Perceived Performance and OinicalExperiences: A Comparative EvaluationAcross Five OerkshipsJudith G. Calhoun, Ph.D., et al.

The Effect ofa Monitoring System on OinicalTrainingDebra DaRosa, Ph.D., et ale

ATTITUDES AND RELATIONSHIPS IN THE

LEARNING PROCESS

Moderator: Winfield Scott, Ph.D.

Discussant: D. Daniel Hunt, M.D.

Distress and Attitudes Toward the LearningEnvironment: Effects of a CurriculumInnovationMaggi Moore-West, Ph.D., et ale

Empirical Observations on the Stability andAttitudinal Correlates of Warmth and Caringin Medical StudentsPeter B. Zeldow, Ph.D.


Reliability and Validity of the Medical Helping Relationship InventoryFredric M. Wolf, Ph.D., et aI.

Change in Medical Student Learning Styles:A Four Year Prospective StudySusan Wentz, M.D., et aI.

October 29

RIME Symposia

MEDICAL EDUCATION AND HEALTH

SERVICES DELIVERY-FORGING

RESEARCH LINKS

Organizer/Moderator: Rose Yunker, Ph.D.

Panel: Jack L. Maatsch, Ph.D.Edwin Rosinski, Ed.D.Abdul W. Sajid, Ed.D.

SELF-DIRECfED LEARNING AND

PHYSICIANS' PRACfICE CHANGES:

CONCEPTS, RESEARCH, AND IMPLICATIONS

FOR CME

Organizer: Philip Bashook, Ed.D.

Moderator: Thomas C. Meyer, M.D.

Panel: Robert J. Long, Ph.D.John Parboosingh, M.D.Robert K. Richards, Ph.D.

DEVELOPMENT OF THE ORAL EXAMINATION

AS PART OF SPECIALIST CERTIFICATION

EXAMINATIONS: AN INTERNATIONAL

PERSPECfIVE

Organizer/Moderator: Richard Wakeford

Panel: Andrew Belton, M.D.Jack L. Maatsch, Ph.D.Geoffrey R. Norman, Ph.D.Paul Rainsberry, Ph.D.

THE USE OF HEALTH CARE DATA IN

MEDICAL EDUCATION

Organizer/Moderator: Vietor R. Neufeld,M.D.Panel: Elizabeth Alger, M.D.

John Chong, M.D.Robert Lawrence, M.D.

VOL. 62, MARCH 1987

PARALLEL INNOVATIVE TRACKS: ARE THEY

AN EFFECfIVE VEHICLE FOR CHANGING

TRADITIONAL MEDICAL EDUCATION?

Organizer: Arthur Kaufman, M.D.

Moderator: Myra Ramos

Panel: Phyllis Blumberg, Ph.D.Arthur Kaufman, M.D.Douglas B. McKeag, M.D.

THE USE OF SITE VISITS TO EVALUATE

CLINICAL CLERKSHIPS

Organizer: Karin E. WetmoreModerator: Lawrence LaPalio, M.D.

Panel: Fredric D. Burg, M.D.Gerard M. Cerchio, M.D.Myra B. Ramos

DILEMMAS IN THE EVALUATION OF

RESIDENTS

Organizer/Moderator: Agnes G. Rezler, Ph.D.Panel: Nadine C. Bruce, M.D.

John S. Lloyd, Ph.D.Brian P. Schmitt, M.D.

October 30

GME Small Group Discussion

IMPROVING EDUCATIONAL RESEARCH IN

NIH CENTERS

Moderator: Charles P. Friedman, Ph.D.

Panel: Tommy L. Broadwater, Ph.D.Sam Brown, Ed.D.Wayne K. Davis, Ph.D.

IMPLEMENTING PROBLEM-BASED

LEARNING: PROBLEMS, PITFALLS, AND

POSSIBLE SOLUTIONS

Moderator: Mimi Wetzel, Ph.D.

Panel: Elizabeth Brain, M.D.Linda DistlehorstDouglas McKeag, M.D.William Shragge, M.D.

DEFINING AND MEASURING SELF

DIRECfED LEARNING

Moderator: Terrill A. Mast, Ph.D.

Panel: Debra A. DaRosa, Ph.D.Peter Powles, M.D.

(1)::o:go


Bart E. Umland, M.D.

MEASUREMENT ISSUES IN ASSESSMENT OFCLINICAL SKILLS

Moderator: David B. Swanson, Ph.D.Panel: Victor R. Neufeld, M.D.

Mary Beth Regan, Ed.D.Reed G. Williams, Ph.D.

SELECTION AND PREPARATION OF TUTORSFOR PROBLEM-BASED LEARNING

Moderator: LuAnn Wilkerson, Ed.D.

Panel: Stewart Mennin, Ph.D.

ASSESSING THE ABILITY OF MEDICALSTUDENTS TO USE BASIC SCIENCE MATERIAL--COMPLETING THE FEEDBACK LOOP

Moderator: Clyde Tucker, M.D.

Panel: Paul Feltovich, Ph.D.Parker Small, M.D.Bryce Templeton, M.D.

THE UTILIZATION OF INSTITUTIONALEXPERTISE IN GRADUATE MEDICALEDUCATION

Moderator: Gerald H. Escovitz, M.D.

Panel: J. Roland Folse, M.D.LaTrie Greenberg, M.D.

THE PRE-RESIDENCY SYNDROME: FACTS ANDFALLACIES

Moderator: Stephen R. Smith, M.D.

Panel: Norma Wagoner, Ph.D.

PARALLEL INNOVATIVE TRACKS: APOLITICAL STRATEGY FOR INSTITUTIONALCHANGE IN TRADITIONAL MEDICAL SCHOOLS

Moderator: Arthur Kaufman, M.D.

Panel: Phyllis Blumberg, Ph.D.Stewart Duhan, M.D.Douglas McKeag, M.D.Myra B. Ramos

UNCOVERING NEW PATIENT RESOURCESFOR AMBULATORY TEACHING OR THEVANISHING PATIENT

Moderator: Nancy E. Gary, M.D.

COMPUTER ASSISTED INSTRUCTION ANDLEARNING: CURRENT STATUS ANDDEVELOPMENT

Moderator: Tracy L. Veach, Ed.D.

219

Panel: Ronald Comer, Ph.D.Martin Kamp, M.D.

IMPLEMENTATION OF PROBLEM BASEDLEARNING AS AN INTEGRATEDCURRICULUM COMPONENT

Moderator: Joel D. Feinblatt, Ph.D.

Panel: Paul R. Mehne, Ph.D.Ointon H. Toewe, II, M.D.

INVOLVING STUDENTS IN RESEARCH

Moderator: Daniel Frank, M.D.

Panel: Richard Cruess, M.D.Robert Griggs, M.D.Paul Heil

REVIEW OF CURRICULUM INNOVATION INUNDERGRADUATE MEDICAL EDUCATION

Moderator: Laurence Fisher, Ph.D.

Panel: M. Brownell AndersonDoreen Oeave-Hogg, D.Ed.Paul Grover, Ph.D.

October 30

GME Mini-Workshops

MICROCOMPUTER LITERACY AND SKILLSFOR MEDICAL EDUCATORS-Introduction tothe Macintosh and Its Features

Organizer: Tracy L. Veach, Ed.D.

Faculty: Larry DoyleLisa Leiden, Ph.D.

MICROCOMPUTER LITERACY AND SKILLSFOR MEDICAL EDUCATORS-Introduction toMS-DOS Based Machines and ProfessionalSoftware Applications

Organizer: Tracy L. Veach, Ed.D.

Faculty: Jan Carline, Ph.D.Tracy Veach, Ed.D.

Innovations in Medical Education Exhibits

October 26, 27, and 28

DESIRABLE PERSONAL QUALITIES, VALUES ANDATIITUDES

INDICATORS OF POTENTIAL ALUMNI INVOLVEMENT COLLECfED BY SURVEYBarbara L. Moser


STUDENT STRESS AND STUDENT ATTITUDES: AS

SESSING MEDICAL SCHOOL EXPERIENCE

Brett Steenbarger, Ph.D.

ASSESSING THE GLOBAL COMPETENCIES OF MED

ICAL STUDENTS

A.F. Payer, Ph.D., et al.

HONORS PROGRAM IN MEDICAL ONCOlOGY: A

PROGRAM IN CLINICAL RESEARCH

Q. Scott Ringenberg, M.D., et ale

COMMUNITY SCIENCE RURAL PRECEPTORSHIP

Richard D. Fehlenberg, M.D.

INTEGRATING HUMAN VALUES TEACHING INTO

CLINICAL EDueATION

Janet BickelL. Blank

ADMISSIONS AND STUDENT FINANCIAL AID

SURVEY OF MEDICAL SCHOOL GRADUATES'

STRATEGIES FOR MANAGING THEIR MEDICAL

EDUCATION DEBTS

David R. Perry, et al.

USE OF ALTERNATIVE STANDARDIZED TESTS IN

SELECTING MEDICAL STUDENTS: THE FIRST

YEAR'S EXPERIENCE

N.D. Anderson, M.D.

THE STRUCTURE AND FUNCTIONS OF AN ADMIS

SIONS COMMITTEE

G.R. Ragan, et al.

CORRELATION OF APPLICANT CHARACTERISTICS

WITH SELECTION INTO A SIX-YEAR COMBINED

B.A.-M.D. PROGRAM-A FIVE YEAR REVIEW

E.V. Calkins, et al.

ANALYZING THE LEARNING AND THINKING

PROBLEMS OF MEDICAL STUDENTS WHO FAIL

PART I OF NATIONAL BOARDS

R. Blanc, et al.

CLINICAL CLERKSHIPS

WHAT IS AN ADEQUATE PATIENT BASE FOR MED

ICAL EDUCATION?

C.J. Riordan, Ph.D., et al.

CONDITION DIAGRAMMING: A NEW METHOD

FOR TEACHING AND EVALUATING CLINICAL

DATA INTEGRATION

I. Jon Russell, M.D., Ph.D., et al.

VOL. 62, MARCH 1987

TEACHING JUNIOR AND SENIOR MEDICAL STU

DENTS THE SKILLS OF PATIENT EDUCATION AND

MOTIVATION

L. Farquhar, Ph.D., et al.

PREPARATION IN CLINICAL PROBLEM SOLVING

FOR CLERKSHIP

Peter Price, M.D., Ph.D., et ale

THE DOCENT TEAM CONCEPT IN MEDICAL EDU

CATION

L. Arnold, Ph.D., et al.

CONTINUOUS ASSESSMENT OF CLERKSHIPS us

ING lOGBOOK AND MICROCOMPUTER TECHNOL

OGY

Patrick Mongan, M.D.

DO CLINICAL SITE AND DURATION INFLUENCE

MEDICAL STUDENT PERFORMANCE IN SURGERY?

M.J. Jacobson, et al.

oseE DATABANK INTERNATIONAL

Ian R. Hart

TEACHING IN MEDICINE: AN ELECTIVE FOR

THIRD YEAR STUDENTS

Jennifer Craig, Ph.D., et al.

RESIDENCY PROGRAMS

SOCIETY OF TEACHERS OF EMERGENCY MEDI

CINE GOALS AND OBJECTIVES PROJECT

John L. Lyman, M.D.

TRAINING FOR COMPETENCE: A FUNCTIONAL

APPROACH TO RESIDENCY MANAGEMENT

D. Cole, Ed.D., et al.

FACULTY DEVELOPMENT AND CME

DEVELOPMENT AND UTILIZATION OF A SLIDE

TAPE ORIENTATION PROGRAM FOR AN OFFICE

BASED FAMILY MEDICINE ROTATION

Dennis Baker, Ph.D., et al.

RESIDENCY TEACHER SERIES

J.B. Battles, Ph.D., et ale

GOOD MEDICAL PRACTICE IS GOOD EDUCA

TIONAL PRACTICE: A MODEL FOR A FACULTY

DEVELOPMENT PROGRAM

Howard L. Stone, Ph.D., et al.

A CME CURRICULUM FOR GENERAL PRACTI

TIONERS

E.B.J. de Groot, et aI.


EDUCATIONAL SUPPORT SYSTEMS

THE NETWORK-A PEER COUNSELING PRO

GRAM FOR MEDICAL STUDENTS

W.O. Zerega, Ed.D., et aI.

APPLICANT POOLS: IMPLICATIONS FOR RECRUIT

MENT AND RETENTION PROORAMS

Judy Garrett, et al.

BOARDWALK: A COMPREHENSIVE PREP PRO

GRAM FOR NB PART I

Judy Schwenker, et al.

MEDPREP FOLWW-UP: IMPACT OF A PRE

PROFESSIONAL PROORAM

E.W. Jackson, et al.

STUDENT STRESS REDUCTION THROUGH INFOR

MAL SUPPORT GROUPS

S.M. Wagner, et aI.

MENTOR PROORAM FOR FIRST YEAR MEDICAL

STUDENTS

M.B. Tamburrino, et aI.

STUDENT AFFAIRS CARES: A NEW ORIENTATION

PROORAM

J .H. Spiro, et al.

INTRODUCTION TO CLINICAL MEDICINE

SIMULATED PATIENTS IN AN INTRODUCTION TO

CLINICAL MEDICINE COURSE

John H. Shatzer, et aI.

THE COMMUNITY RESOURCES PROJECT: VISITS

TO COMMUNITY SERVICES BY FIRST YEAR MEDI

CAL STUDENTS

J.P. Pennell, et aI.

AN INTRODUCTION TO HOME HEALTH CARE FOR

FIRST YEAR MEDICAL STUDENTS

Elizabeth Kachur, et aI.

STUDENT LED PROJECTS IN THE FIRST YEAR AT

TEMPLE MEDICAL SCHOOL

John E. Fryer, M.D.

FOURTH-YEAR MEDICAL STUDENTS AS CLINICAL

INSTRUCTORS IN AN INTRODUCTION TO CLINI

CAL MEDICINE COURSE

D.E. Steward, et aI.

A MODEL FOR EVALUATING THE DEVEWPING

CLINICAL COMPETENCE OF THIRD YEAR MEDI

CAL STUDENTS

Howard L. Stone, Ph.D., et al.

221

THE USE OF INTERACTIVE VIDEO TEACHING AND

EVALUATING INTERVIEWING SKILLS

D. Applelbaum, et aI.

TEACHING DIAGNOSTIC STRATEGIES TO PRE

CLINICAL STUDENTS

William C. Mootz, M.D.

LECTURES ON DENTISTRY TO SECOND YEAR

MEDICAL STUDENTS

M. Lorber, D.M.D., et aI.

CLINICAL REASONING ENCOUNTER

Reed G. Williams, Ph.D., et aI.

INTERDISCIPLINARY HEALTH EDUCATION

VISITING PROFESSORSHIP IN NUTRITION PRO

GRAM

David A. Mark, Ph.D., et aI.

THE EMORY STD TEACHING SECTION: A MULTI

DISCIPLINARY CURRICULUM IN SEXUALLY

TRANSMITTED DISEASES

M. McKay, M.D., et ale

AOOLI3CENT ALCOHOLISM

Lawrence L. Gable, Ph.D.

MEDICAL COST CONTAINMENT

M.D. Jones, et aI.

INTEGRATION OF EDUCATIONAL VIDEOS TO

TEACHING BASIC SCIENCES INTO A TRADITIONAL

MEDICAL CURRICULUM

B. Goldstein, et aI.

COMPUTERIZED TOMOORAPHY OF THE HAND

AND WRIST: A PROTOTYPE OF CROSS-SEC

TIONAL LEARNING MODULES FOR THE RADIOL

OOY, ANATOMY, AND SURGERY DEPARTMENTS

F. Chavez, et ale

RECENT DEVEWPMENTS IN PREVENTION EDU

CATION

Association of Teachers of Preventive Medicine

CURRICULUM DEVEWPMENT IN PREVENTIVE

MEDICINE

Centers for Educational Development inHealth

BASIC SCIENCE

INTEGRATING CLINICAL PROBLEM SOLVING

WORKSHOPS AND LECTURES IN A BIOCHEMISTRY

COURSE

Franklin Medio, Ph.D., et al.


VIDEO DEMONSTRATIONS FOR SOPHOMORE MED

ICAL STUDENTS

Neil Love, M.D., et al.

BASIC SCIENCE SELF-TESTING SYSTEM

J.R. Thornborough, Ph.D., et al.

INTERACfIVE CURRICULUM REVIEW: PROCESS

FOR CHANGE

B.H. Bienia, et al.

GENFfICS LEARNING SYSTEM

Thomas I. Baker, Ph.D.

DEVELOPMENT AND EVALUATION OF PROBLEMS

IN A PRECLINICAL PROBLEM BASED CURRICU

LUM

P. Blumberg, et al.

EDUCATION OF PRIMARY CARE PHYSICIANS FOR

THE 21ST CENTURY

R. Menninger, et al.

COMPUTER APPLICATIONS IN MEDICAL EDUCA

TION

SOFTWARE TOOLS IN MEDICAL EDUCATION

L.1. Leiden, Ph.D., et aI.

USE OF A COMPREHENSIVE CURRICULUM RE

VIEW FOR CONSTRUCfION OF A MEDICAL CUR

RICULUM DATA BASE

Barbara J.N. Hunt, et aI.

MICROCOMPUTER IN MEDICAL EDUCATION: AN

EXPERIMENT IN ITS POPULARIZATION

Dominic Cheung, et al.

A FLEXIBLE SYSTEM FOR PROCESSING CLINICAL

PERFORMANCE RATINGS: ILLUSTRATIVE APPLI

CATIONS IN A RESIDENCY AND FOUR CLERK

SHIPS

Gerald J. Cason, Ph.D., et aI.

CREATING REAL-TIME 3-D ANIMATION WITH

COMPUTERS

Doug Mann, et al.

COMPUTERIZED CLINICAL DOCUMENTATION

M. Schaar, et al.

HEALTH SCIENCES CONSORTIUM COMPUTER-AS

SISTED INSTRUCfIONAL MATERIALS

Vera Pfifferling, et aI.

COMPUTER-BASED INTERACfIVE ANATOMICAL

EDUCATION USING A VIDEODISC AND AUTHOR

ING SYSTEM

J. Nolte, Ph.D., et al.

VOL. 62, MARCH 1987

ON THE DEVELOPMENT OF COMPUTER SOFT

WARE FOR ASSISTING IN MEDICAL SCHOOL ED

UCATION

Louis Cornacchia, et aI.

BEYOND THE LIBRARY: INTEGRATED ACADEMIC

INFORMATION MANAGEMENT SYSTEMS AT

GEORGFfOWN UNIVERSITY

Naomi C. Broering

COMPUTER-ASSISTED EVALUATION OF CLINICAL

SKILLS

J.D. Engel, Ph.D., et aI.

A COMPUTERIZED SYSTEM FOR EVALUATION OF

STUDENT PERFORMANCE

William Schwartz, M.D.

THE COMPUTER AS AN AID TO PROBLEM SOLV

ING LEARNING BY SURGICAL CLERKS

I.H. Koven, M.D., et aI.

ARTIFICIAL INTELLIGENCE AND MEDICAL EDU

CATION: USE OF LOGIC ANALYSIS AS A PART OF

CLINICAL MANAGEMENT SIMULATIONS

Max D. Miller, Ed.D.

OBSERVATIONAL STUDIES USING HAND HELD

MICROCOMPUTERS

K.J. Ferguson, Ph.D., et aI.

PathMAC: AN INTERACfIVE MICROCOMPUTER/

VIDEO DISK SYSTEM FOR TEACHING PATHOLOGY

Daniel Alonso, M.D., et al.

A RESIDENCY-BASED, COMPUTERIZED AMBULA

TORY CARE CENTER

Bruce Block, M.D., et aI.

COURSE SCHEDULING AND CURRICULUM PLAN

NING

Mike DeWine, et aI.

OTHER

MINORITY HIGH SCHOOL RESEARCH APPRENTICE

PROGRAM

Nancy A. Solomon, M.D., et aI.

ASSOCIATION FOR SURGICAL EDUCATION

M.J. Peters, et aI.

PATIENT MANAGEMENT SIMULATIONS: A RE

SOURCE CATALOG

S.J. Love, et ale

THE AAMC FACULTY ROSTER SYSTEM

T. Dial, Ph.D., et aI.


PLASTINATION: AN INNOVATIVE METHOD OF

SPECIMEN PRESERVATION FOR PATHOLOGY ED

UCATION

Robert S. Donner, M.D., et al.

USE OF A SURVEY OF GRADUATES AND PRO

GRAM DIRECTORS AS AN ASSESSMENT OF QUAL

ITY IN A OS/MD PROGRAM

Brenda Beebe Duncan

ASSESSMENT OF PERFORMANCE OF GRADUATES

DURING THEIR FIRST POSTGRADUATE YEAR AS

223

A CURRICULUM EVALUATION MECHANISM FOR

MEDICAL SCHOOLS: EVALUATION OF AN ASSESS

MENT INSTRUMENT DEVELOPED FOR THIS PRO

GRAM

Marilyn F.M. Johnston, M.D., Ph.D.

NATIONAL INSTITUTE OF DENTAL RESEARCH

National Institute of Dental Research

CURRICULUM CHANGE IN A WELL ESTABLISHED

MEDICAL SCHOOL

Jan Ekholm, M.D., Ph.D., et al.

Minutes of AAMC Assembly Meeting

October 28, 1986

New Orleans, Louisiana

Call to Order

Dr. Virginia Weldon, AAMC Chairman,called the meeting to order at 8: 15 a.m.

Quorum Call

Dr. Weldon recognized the presence ofa quorum

Consideration of the Minutes

The minutes of the October 29, 1985, Assembly meeting were approved without change.

Report of the Chairman

Dr. Weldon began her report by welcomingDr. Robert Petersdorf as the new president ofthe Association ofAmerican Medical Colleges.She also reported on a number of ExecutiveCouncil committees which had met during thepast year, including the MCAT Review Committee, the Research Policy Committee, andthe Financing Graduate Medical EducationCommittee. Committees whose work was stillin progress included a joint AAMC-AAHCCommittee on Strategies to Promote Academic Medical Centers, the Faculty PracticeCommittee, and the Committee on GraduateMedical Education and the Transition fromMedical School to Residency.

Dr. Weldon expressed her thanks to the staffof the Association and to the following members of the administrative boards and Executive Council whose terms were expiring: Arnold Brown, Richard Moy, and Jack Ecksteinfrom the Council of Deans; Gordon Kaye andJack Kostyo from the Council of AcademicSocieties; Robert Baker, Sheldon King, andEric Munson from the Council of TeachingHospitals; Richard Peters, Joann Elmore,

John DeJong, Ricardo Sanchez, Joanne Fruth,Vietta Johnson, Dan Schlager, James Stout,and Robert Welch from the Organization ofStudent Representatives; and Richard Janeway and Charles Sprague from the ExecutiveCouncil.

Report of the President

Dr. Petersdorfbegan by referring the Assemblymembers to the Association's annual report,which included a complete description of theAAMC's programmatic activities. He indicated that the Association would devote considerable attention to the issue of providingtraining in ambulatory care settings and financing such training. This would be donethrough a new project to study the transitionof medical education programs from the hospital inpatient services to the ambulatory caresetting and through invitational symposia onadapting clinical education to new forms andsites of health care delivery.

Dr. Petersdorf reported that the 1986 entering class had a decline in medical school applicants of 4.8 percent from 1985 and that thedrop-off in the applicant pool was more precipitous than the decrease in class size.

Pressure continued to mount from the animals rights movement to curtail or eliminatethe use of animals in research, education, andtesting and to strengthen existing animal careand use standards. The Association wouldcontinue to devote attention to this issue.

Dr. Petersdorfhad been undertaking a seriesof visits to become acquainted with key legislators, and he indicated that the Associationwould continue its policy of asking that itsinterests be represented to members of Congress by the Association's constituency.

Report of the Council of Deans

Dr. Kay Oawson described the issues papersthat had been presented at the Council of

225


Deans spring meeting. Discussions at thatmeeting had focused on the attractiveness ofmedicine as a profession, the reaffirmation ofinstitutional responsibility for medical education, the role of the dean in the educationalcontent of graduate medical education programs, and problems around the transitionfrom medical school to residency. The Councilof Deans had considered th,' issue of NationalBoard of Medical Examiners score reportingand found that opinion was divided onwhether or not numerical scores should bereported or a pass/fail system used. The Council had endorsed increased educational effortsto improve the use of the examination as atool for educational evaluation.

Report of the Council of Academic Societies

Dr. David Cohen reported that the Council'sspring meeting had been devoted to discussions related to the reports of the AAMCCommittee on Federal Research Policy andCommittee on Faculty Practice. The numberof CAS societies had increased to 85, and theCouncil had affirmed that the only restrictionthat should apply to membership was that thesociety should have a substantial representation of the academic faculty. The Council hadchanged the criteria for Board membership toprovide greater flexibility. The CAS had aconsensus against pass/fail reporting of scoreson the National Board of Medical Examinersexaminations.

Report of the Council of Teaching Hospitals

Mr. Thomas Smith referred the Assembly toa publication on COTH activities which hadbeen prepared for the Annual Meeting. Theassociation staff would be working on a newproject to study the effect of policy changeson different groups of hospitals. The AAMCand other data sources would be used to develop a data base to examine policies' differential impact on differing types of hospitals.

Report of the Secretary-Treasurer

Mr. Smith referred the Assembly members tothe published agenda, which included the report of the treasurer and the balance sheet and

VOL. 62, MARCH 1987

operating statement for the Association's 1986fiscal year. The report from the outside auditors was unqualified.

ACIlON: On motion, seconded, and carried,the Assembly approved the report ofthe Secretary- Treasurer.

Report of the Organizationof Student Representatives

Ms. Vicki Darrow reported that a recent issueof the OSR Report had been published onmedical liability. The OSR had conducted ajoint survey with the Association of TeachersofPreventive Medicine to discuss and describepreventive medicine parts of the curriculum.A consortium of student organizations, including the OSR, had taken collaborative action to support student financial aid and toexpress their opinion that all residency programs should be in the National ResidentMatching Program. The OSR believes that theNational Board of Medical Examiners testshould be used for licensure and not for curricular evaluation and thus supports a pass/fail reporting for this examination. The OSRNetwork had been developed to provide anopportunity for students to exchange ideas andinformation on innovative programs at theirmedical schools. There is a particular interestin the OSR in looking for innovative curriculum ideas to implement the GPEP report. TheOSR favors incorporating house staff into theAAMC.

Election of New Members

ACTION: On motion, seconded, and carried,the Assembly by unanimous ballot elected thefollowing organizations, institutions, and indi-viduals to the indicated class ofmembership:

Institutional Member: Mercer UniversitySchool of Medicine.

Academic Society Members: AmbulatoryPediatric Association; American Association ofPathologists; Association for Surgical Education.

Teaching Hospital Members: Greater Baltimore Medical Center, Baltimore, Maryland;Holy Cross Hospital, Silver Spring, Maryland;Humana Hospital-University, Louisville, Kentucky; The Queen's Medical Center, Honolulu,

1986 Assembly Minutes

Hawaii; Toronto General Hospital, Toronto,Ontario, Canada; UCLA NeuropsychiatricHospital, Los Angeles, California; VA MedicalCenter, Salem, Virginia.

Corresponding Members: California Medical Center, Los Angeles, California; NewtonWellesley Hospital, Newton, Massachusetts; St.Vincent's Health Center, Erie, Pennsylvania.

Distinguished Service Member: Sherman M.MellinkotT.

Emeritus Members: Richard J. Cross,Thomas D. Dublin, James R. Gay.

Indivdiual Members: List attached to archive minutes.

Report of the Resolutions Committee

There were no resolutions reported to the R~olutions Committee for timely considerationand referral to the Assembly.

Report of the Nominating Committee

Dr. John Chapman, chairman of the Nominating Committee, presented the report ofthatcommittee. The committee is charged by thebylaws with reporting to the Assembly onenominee for each officer and member of theExecutive Council to be elected. The followingslate of nominees was presented: AAMCChairman-Elect: John Colloton; ExecutiveCouncil, COD representatives: Walter Leavell,John Naughton, and Hibbard Williams; Executive Council, COTH representative: GaryGambuti; Executive Council, DistinguishedService Member: Edward Brandt, Jr.

ACTION: On motion, seconded, and ca"ied,the Assembly approved the report ofthe Nomi-

227

nating Committee and elected the individualslisted above to the offices indicated.

Resolution of Appreciation

ACTION: On motion, seconded, and ca"ied,the Assembly adopted the following resolutionofappreciation:WHEREAS, Dr. Virginia Weldon has served aschairman ofthe Association ofAmerican Medical Colleges for the last }'ear, providing the fullmeasure of the considerable talent and abilityfor which she is so well known, andWHEREAS, Dr. Weldon has led the Association at a critical point in its transition to newleadership and evaluation of its structure andprograms, andWHEREAS, Dr. Weldon has brought to theAssociation the same commitment to excellencein medical education, support for our researchenterprise, and concernfor the quality ofpatientcare that has characterized her career at Washington University, andWHEREAS, Dr. Weldon's thoughtful leadership and insightful contributions to the Association's deliberations have led to new understanding ofthe Association within the universitycommunity,BE IT RESOLVED, thai this Assembly extendits warm appreciation and deep gratitude andaffection to Dr. Weldon for the excellent leadership and special grace which she brought tothe Association during her tenure as our Chairman.

Adjournment

The Assembly adjourned at 8:56 a.m.

Annual Report

1985-86

NOTE: The President's Message appeared in the January 1987 issue of theJournal ofMedical Education as an editorial.

229

Executive Council, 1985-86

Virginia V. Weldon, Chairman·Edward J. Stemmler, Chairman-Elect·Richard Janeway, Immediate Past Chairman·John A. D. Cooper, President·tRobert G. Petersdorf, President·


David H. Cohen·William F. GanongFrank G. MoodyVirginia V. Weldon

DISTINGUISHED SERVICE MEMBER

Charles C. Sprague

COUNCIL OF DEANS

Arnold L. BrownWilliam Butler

• Member of Executive Committee.

D. Kay Oawson·Robert DanielsWilliam B. DealLouis J. KettelRichard H. MoyJohn NaughtonRichard S. Ross


J. Robert BuchananSpencerForemanSheldon S. KingC. Thomas Smith·

ORGANIZATION OF STUDENT

REPRESENTATIVES

Vicki DarrowRichard Peters

t Retired September 2, 1986.

Administrative Boards of the Councils, 1985-86


David H. Cohen, ChairmanFrank G. Moody, Chairman-ElectJoe D. CoulterWilliam F. GanongGary W. HunninghakeErnst R. JaffeA. Everette James, Jr.Gordon I. KayeDouglas E. KellyJack L. KostyoVirginia V. WeldonFrank M. Yatsu

COUNCIL OF DEANS

D. Kay Clawson, ChairmanLouis J. Kettel, Chairman-ElectArnold L. BrownWilliam ButlerRobert S. DanielsWilliam B. DealJack W. EcksteinFairfield Goodale·Walter F. LeavellRichard H. MoyJohn NaughtonRichard S. Ross

• Retired June 1986.

230


C. Thomas Smith, ChairmanSpencer Foreman, Chairman-ElectRobert J. BakerJ. Robert BuchananGordon M. DerzonGary GambutiJohn E. IvesSheldon S. KingLarry L. MathisJames J. MonganEric B. MunsonCharles M. O'Brien, Jr.Raymond G. SchultzeBarbara A. Small

ORGANIZATION OF STUDENT

REPRESENTATIVES

Richard Peters, ChairpersonVicki Darrow, Chairperson-ElectJohn DeJongKimberly DunnJoann ElmoreJoanne FruthVietta JohnsonKirk MurphyRicardo SanchezDan SchlagerJames StoutRobert Welch

The Councils

Executive Council

The Association's Executive Council meetsquarterly to consider policy matters relatingto medical education, biomedical and behavioral research, and the delivery of medicalcare. Issues are referred by member institutions and organizations and from the constituent councils. Policy matters considered bythe Executive Council are first reviewed by theAdministrative Boards of the Council ofDeans, Council of Academic Societies, Council of Teaching Hospitals, and the Organization of Student Representatives, the constituent components of the AAMC's governancestructure.

Newly elected officers and the senior staffof the Association attended the traditional December retreat to consider policy issues andset priorities for the Association in the comingyear. Discussion at the retreat focused on anumber of issues related to undergraduatemedical education including changes in thesize and composition of the applicant pool,clinical education, and appropriate AAMCfollow-up activities to its report on the GeneralProfessional Education of the Physician. Inthe area of graduate medical education, theretreat participants discussed financing, quality of the educational program, the transitionfrom medical school to residency, and institutional responsibility for graduate medicaleducation. Among the other topics consideredwere institutional policies on dealing with students with acquired immune deficiency syndrome, the practice of medicine by medicalschool faculty, the payment of indirect costsof research, pending legislation to authorize anew construction program for research facilities, and the appropriate role of the LiaisonCommittee on Medical Education in the review of the educational programs of foreignmedical schools.

Many of the issues reviewed and debatedby the Executive Council during the past yearreflected the Association's traditional priorities in support of research and research training, student financial assistance, and adequatereimbursement for medical care in teachinghospitals.

A research issue in which Association members have an important interest concerns thepayment of the indirect costs of conductingresearch. A number of congressional and administration proposals have been brought forward which would limit the reimbursement ofsuch costs. The Association has sought to reconcile the differences among other organizations in this area, and the Executive Councilendorsed the Associations's role as a mediator,expressing its belief that any change in themethod ofindirect cost reimbursement shouldbe made gradually and in consultation withuniversities and their faculties.

Federally-supported student financial assistance continued to suffer from budgetary constraints, and the Executive Council has beenconcerned about the availability of funds forfinancing students' medical education. In response to these concerns, the Executive Council approved the establishment of MEDLOANS, a new Association program to offerfinancial aid to medical students. In additionto providing access to federal programs suchas Guaranteed Student Loans, Health Education Assistance Loans, and Auxiliary Loans toAssist Students, MEDLOANS offers a newprivate Alternative Loan Program at marketrates, tailored to the particular needs of medical students.

Much of the Executive Council's attentionin the patient services and medical care areawas focused on Medicare reimbursement policies. The Executive Council strenuously opposed any freeze in Medicare payments tohospitals and also opposed any extension in

231


the Medicare freeze on payments to physiciansfor professional services. The Council recommended that the prospective payment systembe amended so that payments are based on aDRG-specific, blended rate ofhospital-specificand federal component prices. The Association also supported establishing an adjustmentto recognize the generally higher costs incurredby hospitals serving a disproportionate number of indigent Medicare patients.

The support of residency training under theMedicare program was an especially important issue in the past year. The Associationrecommended retaining explicit Medicarefunding of graduate medical education for atleast the number of years required to attaininitial board eligibility in various specialties(to a maximum of five years) plus one additional clinical year for advanced specialty andsubspecialty positions in hospitals in whichthe positions were supported by Medicare in1984-85. The Association also endorsed elim-inating Medicare funding for residents whoare not graduates of accredited medical orosteopathic schools located in the UnitedStates or Canada. The Association proposed aperiod ofphase-in for implementing these recommended changes.

The Association also supported a recomputation in the resident-to-bed adjustmentand a requirement that the Health Care Financing Administration update each hospital's published case mix index using data fromthe first year of prospective payment.

The Executive Council discussed a possiblelegislative move to incorporate the paymentsfor hospital-based physicians such as radiologists, anesthesiologists, and pathologists, intothe DRG hospital reimbursement program. Itwas concluded that the proposal was generallyundesirable and that the AAMC should oppose it because of its potential harmful impacton teaching hospitals and clinical faculty relationships.

Strong efforts were underway in a numberofjurisdictions to enact new legislation dealingwith professional liability insurance. The Executive Council endorsed the concept of tortreform, citing the special needs of academicmedical centers which use part-time faculty

VOL. 62, MARCH 1987

and the mobility offaculty members. The needfor better discipline within the profession wasalso recognized.

There was a discussion of a report from thecongressionally-mandated Task Force on Organ Transplantation which recommended thatthe diffusion of transplantation technology beregulated. Although the Executive Councilsupported the development ofcriteria to delineate quality standards for the provision oftransplant services, it was believed that suchcriteria should be developed by professionalsocieties and not by the federal government.The only limitations that should be placed onthe performance of transplants should be related to the institution's ability to providequality service and not to arbitrary political orgeographic factors.

Tax reform legislation was reviewed by theExecutive Council at several meetings. TheAAMC supported the continued access of universities and hospitals to tax-exempt bond financing; although the Association was willingto accept some new restrictions on such financing, it opposed a proposed state-by-statecap on the annual volume of issuances and acap on the total amount of outstanding taxexempt bonds available to each university.The Executive Council also opposed provisions that would eliminate scholarships andfellowships from taxable income and wouldimpose taxes on prizes and awards. The Association also communicated with its members on the impact of proposed changes relating to pensions, lRAs and the tax-exemptstatus of TlAA-CREF.

The Executive Council was asked to consider whether irregularities in the admissionsprocess identified by AAMC staff should bereported to non-member institutions in otherhealth disciplines and to licensing boards. TheCouncil concluded that the AAMC would provide copies of completed irregularities reportsto non-member health professions schoolswhen there was reason to believe the subjectwas applying to the school and that reportswould be provided to licensure bodies in response to requests regarding particular individuals.

At the request of the Organization of Stu-

1985-86 Annual Report

dent Representatives the Executive Councilconsidered issues relating to the reporting ofscores from the National Board of MedicalExaminers. The Executive Council believesthat the NBME should report scores to students and medical schools on a pass/fail basisonly. Implementation ofthis recommendationwill be discussed at the 1986 Annual Meeting.

The Executive Council makes extensive useofcommittees ofAAMC constituents to guideits deliberations on key policy matters. Duringthe past year the Council acted on reports froma number of such committees.

A steering committee on a project to evaluate medical information science in medicaleducation was chaired by Jack Myers, university professor at the University of Pittsburgh.The committee report, which was approved inJanuary, concluded that medical informaticsis basic to the understanding and practice ofmodem medicine and that the field should beintegrated throughout the medical educationprogram. The report, which included a stateof-the-art review, was recommended for widedistribution.

J. Robert Buchanan, general director of theMassachusetts General Hospital, chaired anAssociation Committee on Financing Graduate Medical Education. The Executive Councilendorsed the committee's recommendationthat patient care revenues continue to be theprincipal source of support for graduate medical education, but that some limitations beestablished on training support. It was recognized that payment for residents in ambulatory teaching settings continued to be a problem needing attention by the AAMC.

The AAMC's Committee on Federal Research Policy has been charged with conducting a broad overview of policy issues relatedto the federal role in the conduct and supportof biomedical research. The committee examined Association policy relating to the goalsof the federal research effort, research manpower and training, research infrastructure,research awards system, federal funding forresearch, and formulation of federal researchpolicy. The committee was chaired by EdwardN. Brandt, chancellor of the University ofMaryland.

233

Sherman Mellinkoff, dean of the UCLASchool of Medicine, chaired a committee toreview the Medical College Admission Test,its use by medical schools in their selectionprocess, the effects of this use on undergraduates and undergraduate institutions, and theAssociation's stewardship of the examination.The committee concluded that the MCAT isuseful in helping establish minimum academicqualifications, and that the AAMC shouldcontinue its efforts to improve the understanding by undergraduate advisors and medicalschool faculties and admissions committees ofthe development of specifications and thepreparation of test questions. The Committeealso concluded that the Association had beenreasonable in its stewardship of the programand not overly dependent on its income.

The Executive Council approved the establishment ofa new ad hoc Committee on Strategies for Promoting Academic Medical Centers, which will be a joint activity with theAssociation ofAcademic Health Centers. Thisnew committee is chaired by D. Gayle McNutt, director of communications at the Baylor College of Medicine.

Responding to concern from several quarters, including the Council of Deans and theGroup on Student Affairs, the ExecutiveCouncil has appointed a Committee on Graduate Medical Education and the Transitionfrom Medical School to Residency, chaired bySpencer Foreman, president, MontefioreMedical Center. A preliminary report recommended that each institution develop common policies and procedures for all its graduate medical education programs, that institutional compliance with the ACGME's generalrequirements be enforced, that limitations beplaced on electives students can take at othermedical schools, that the evaluations presented in the dean's letter be improved, thatthe NRMP be used for selection of all residency positions, and that a new timetable beestablished for the NRMP and the release ofschool evaluations. This discussion draft willbe the subject of a special general session atthe 1986 AAMC Annual Meeting.

The Association's Finance Committee,chaired by Mitchell Rabkin, president of Beth


Israel Hospital, began a long-term review ofthe Association's financial situation, includingprojections for income and expenditures infuture years, and the Association's policies formanagement of its reserves.

In its role as a parent organization, theExecutive Council has a responsibility foroverseeing the activities and policy actions ofa number of other organizations. A particularly critical issue was raised this year withrespect to the participation of the LiaisonCommittee on Medical Education in the Accreditation of foreign medical schools_ TheExecutive Council believed that medicalschool accreditation as developed by theLCME was a uniquely American system forevaluating the quality of a medical educationprogram in which peers voluntarily submit toa critical review by their colleagues_ Even ifthe LCME had the resources to accredit themore than 750 foreign medical schools withgraduates sitting for the ECFMG exam, theCouncil felt that the LCME's system of accreditation would not be transferable to otherlocalities with different traditions and patternsfor education, research, and the delivery ofcare_ The Council also noted that the LCMEhad no particular expertise to develop standards which might be appropriately used toevaluate foreign schools_ A second concernrelated to the enormous liability involved inthe accreditation of hundreds of foreign medical schools and the inability for adequate legalprotection to be assured, even through government indemnification. Instead of supportingan LCME role in the accreditation of foreignmedical schools the Executive Council committed the Association to working with otherconcerned organizations to establish criteriafor the evaluation ofgraduates of foreign medical schools and reaffirmed AAMC support forthe development ofa satisfactory examinationof clinical competence for such graduates as acondition ofeligibility for entry into accreditedresidency programs.

The Executive Council was asked to consider whether the Accreditation Council forContinuing Medical Education should be separately incorporated as a means of protectingparent organizations for legal liability. TheCouncil felt that the guiding principle should

VOL_ 62, MARCH 1987

be that if the activity was germane to theAssociation's mission, the AAMC should assume the attendant risks. It was suggested thatthe Association review its involvement in continuing medical education accreditation andother activities in relation to the Association'soverall goals.

Two amendments to the general requirements section of the Essentials ofAccreditedResidencies of the Accreditation Council forGraduate Medical Education were brought tothe Executive Council for action. The Councilapproved an amendment that would call forresidency programs to foster understanding ofmedical ethics and provide instruction in thesocioeconomics of health care and the importance of cost-effective medical practice. Therewas spirited debate about a proposed amendment that would add to the accreditationstandards a stipulation that adequate financialsupport for residents' stipends is an essentialcomponent of residency programs. Consideration of this issue included discussion ofwhether stipend support was essential for aprogram to be educationally sound or whetherit was more related to issues of fairness andequity, and whether such a standard was appropriate for an accreditation document ofthis nature. The Executive Council supporteda new amendment that states that "financialsupport of residents is necessary to assure thatresidents are able to fulfill the responsibilitiesof their educational programs."

The Executive Council and the ExecutiveCommittee are responsible for decisions relating to AAMC participation in court cases. TheAssociation appears with a number of otherscientific and educational organizations andscores of Nobel laureates on an amicus briefin Edwards v. Aguillard, a case related to aLouisiana statute on the teaching ofevolutionand creation-science. The briefargues that thescience education of our school childrenshould accurately portray the current state ofsubstantive scientific knowledge and the premises and processes of science_

The AAMC had joined the American Hospital Association, the American Medical Association, and a number of other medical organizations challenging the government's"Baby Doe" regulations relating to the treat-


ment of profoundly handicapped infants. InJune the Supreme Court affirmed an AppealsCourt decision invalidating the regulationswhich had required that the federal government be granted access to the medical recordsof infants for whom the parents had chosennot to seek treatment.

The Association and other related organizations had also filed an amicus brief with theSupreme Court on the constitutionality ofstate laws putting requirements on physicianswith respect to abortions. The arguments infavor of the traditional physician-patient relationship prevailed.

The Association had also been an amicusin the University of Michigan's successful petitioning that there were not instances in whichthe courts might appropriately engage in a

§ review of the actual merits of academic deci~ sions as opposed to the process by which they] are made. The AAMC had also joined other.g~ educational associations in Connolly v. Burt,~ which involved an attempt by one physicianE to sue in the state to which a letter of evalua~ tion was sent rather than in the state where

the evaluating physician resided.In April the Association united with 67

other scientific and academic organizations infiling an amicus brief in a case before the U.S.Court of Appeals to decide whether legalstanding should be granted to animal rightsadvocates, allowing them to sue for custody oflaboratory animals under state anti-crueltystatutes. The brief pointed out the benefits ofanimal research, argued that animal rights advocates or other private parties have no standing under either federal or state law to bringsuit on behalf of laboratory animals, and emphasized the serious adverse consequences forboth science and the judicial system thatwould result from a decision supporting theanimal rights groups. The appellate court ruledagainst granting legal standing to these groups.

The United States District Court had foundViken Mikaelian and Multiprep in civil contempt of the court's injunctive order with respect to the AAMC's suit on copyright infringement on the MCAT. The AAMC wasawarded $200,000 plus attorney's fees.

During the past year the Executive Councilvoted special recognition awards to Carolyne

235

Davis, former administrator of the HealthCare Financing Administration, Edward N.Brandt, former Assistant Secretary for Health,J. Alexander McMahon, retiring president ofthe American Hospital Association, andJames H. Sammons, executive vice presidentof the American Medical Association.

The Executive Council continued to oversee the activities of the Group on BusinessAffairs, the Group on Institutional Planning,the Group on Medical Education, the Groupon Public Affairs, and the Group on StudentAffairs.

The Executive Council, along with the Secretary-Treasurer, the Executive Committee,the Finance Committee, and the Audit Committee exercised careful scrutiny over the Association's fiscal affairs, and approved a smallexpansion in the general funds budget for fiscalyear 1987.

The Executive Committee convened priorto each Executive Council meeting and conducted business by conference call as necessary. During the year the Executive Committee met with Health and Human Services Secretary Otis Bowen.

Council of DeansTwo major meetings dominated the Councilof Deans' activities in 1985-1986. The Association's annual meeting in Washington, D.C.featured a program session for deans and asocial event. The Council's spring meeting washeld in Key Largo, Rorida on April 2-5, 1986.The COD Administrative Board meets quarterly to review Executive Council agenda itemsofsignificant interest to the deans and to carryon the business of the COD. More specificconcerns are reviewed by sections ofthe deansbrought together by common interest.

The Council's annual meeting program session discussed the proposed comprehensiveexamination ofthe National Board ofMedicalExaminers and problems in the transition between medical school and residency education. A panel moderated by L. ThompsonBowles, dean for academic affairs, GeorgeWashington University Medical Center, discussed the first topic. The panel featured Robert Volle, associate dean for basic sciences and


research, University of Kentucky College ofMedicine and chairman of the NBME committee developing the new examination;David Citron, president of the Federation ofState Medical Boards; Richard Peters, chairman-elect ofthe Organization ofStudent Representatives; and Richard H. Moy, dean,Southern Illinois University School of Medicine. Arnold L. Brown, dean, University ofWisconsin Medical School, moderated a panelon transition problems. It featured a presentation by Norma E. Wagoner, chairperson ofthe Group on Student Affairs and associatedean for student affairs and educational resources at the University ofCincinnati Collegeof Medicine. Co-authors of Dr. Wagoner'spaper who provided commentary were JackC. Gardner, associate dean for student affairs,UMDNJ-Rutgers Medical School; John H.Levine, assistant dean for curriculum, MedicalUniversity of South Carolina; and Paula L.Stillman, associate dean for curriculum at theUniversity of Massachusetts Medical School.The annual business meeting featured an inspiring presentation by John A.D. Cooper,AAMC president, on the need to avoid divisions among Association members. The deansalso heard updates on institutional policies onAIDS, the AAMC's medical student alternative loan program, the MCAT pilot project,investigations of the VA inspector general regarding conflict of interest, and reports fromAssociation committees.

A new format at the Council of Deansspring meeting facilitated maximum interaction and participation of the deans on issuesof importance. Discussion groups consideredfour topics: the attractiveness of medicine as aprofession, institutional responsibility formedical student education, institutional responsibility for graduate medical education,and problems in the transition between medical school and residency. The meeting culminated with the approval of various recommendations emerging from the discussion sessions.

On the first topic, the deans recommendedthat the introductory marks of Spencer Foreman, president, Montefiore Medical Center,be used as a preamble to a strategy paper and

VOL. 62, MARCH 1987

action plan which place emphasis on pride inthe profession and restraint from an attitudeof panic. They also recommended the analysisofapplicant pool data to seek trends within oramong categories ofschools. Individual schoolapplicant pool data analysis and trends shouldbe made available on a confidential basis, withspecial analyses of underrepresented groups.The Council affirmed that a strategy shouldbe developed which assures that pre-medicaladvice through the official advisor system isaccurate and based on current informationand that demographically stratified opinionsurveys should be conducted to characterizethe present attitudes ofhigh school and collegestudents towards medicine. The deans furtherrecommended the revision of the medicalschool admissions requirement handbook toemphasize opportunities in medicine. Thedeans encouraged all medical schools to analyze individual applicant pool data for negative factors to be corrected and positive factorsto be emphasized. Finally, they stated that theAAMC and its members should emphasize thehistoric role of medicine as a socially responsible profession.

The deans reaffirmed their position as keyto the implementation of institutional responsibility for medical student education. Theyviewed the call for more self-directed problembased learning in the medical curriculum asappropriate and most productive in interdisciplinary courses. They called for a rotation ofthe primary responsibility for teaching so thatin any year fewer faculty were involved withstudents to promote closer student-faculty interactions. Also, acknowledging that the examination drives the system, the deans calledfor more faculty examinations as opposed todiscipline examinations, and ones that wouldinvolve problem-solving skills, technical skillsrelating to patients and other professionals,and the ability to handle stress. The deanssuggested more shared accountability acrossdepartmental lines, especially clinical andbasic sciences. Finally, they requested that theAAMC staff undertake an effort to identifyvalid criteria for measuring excellence inteaching.

The deans called for medical schools which


had not already done so to assume a largershare of the responsibility for the governanceofgraduate medical education programs, and,as a corollary, that the AAMC role in graduatemedical education be expanded. Medicalschools and their teaching hospitals shouldform a common organization to govern eachschool's graduate medical education programsand deans and hospital directors should bedirectly involved in every residency programreview. The deans made a number of recommendations addressed to the problems in thetransition between medical school and residency education. To ensure the continuity andquality of medical education in the third andfourth years, they resolved that dean's lettersand transcripts should not be sent before October 1, that core clerkships should occur onlyin the student's own institution, that fourthyear experiences should be carefully evaluated,and that every effort should be made to giveup independent match systems and informalactions about residency selections. The deansfurther resolved that the AAMC advocate tothe Liaison Committee on Medical Educationthe evaluation of these policies and practicesas part of the accreditation process for allmedical colleges, that the AAMC take theinitiative in establishing an AMCAS-Iike system for residency application and selection,and that the NRMP manage the match for allapplicants.

The Southern and Midwest deans, deans ofcommunity-based medical schools, and deansof private freestanding schools held variousmeetings throughout the year to discuss issuesof specific interest to their members. •

Council of Academic SocietiesThe Council of Academic Societies representsacademic and scientific societies from all basicand clinical disciplines. In 1985 three societiesjoined the Council, bringing the total membership to 82. The CAS convened two majormeetings during 1985-86.

The annual meeting in October 1985 featured presentations on two issues of interestfor medical faculty. The first was the futurerole of physician scientists in medical research.Gordon N. Gill, professor of medicine at the

237

University of California, San Diego, stressedthe importance of medical schools providingthe research centers and communication pathways within which scientific discovery willflourish. He emphasized the need for an environment that allows physician scientists topursue research opportunities freely, andwarned that bureaucratizing research will discourage "the serendipity of science."

John W. Littlefield, professor and chairmanof physiology at Johns Hopkins University,analyzed the changing role of the M.D. inscientific research. He described the importance of giving students a realistic view ofmedical research careers and ways to prepareearly for such careers. He expressed concernthat the growing number of M.D./Ph.D.s inresearch sends a message to medical studentsthat a Ph.D. is necessary to do biomedical andbehavioral investigation. Noting the increasingdifficulty in conducting medical research on apart-time basis, Dr. Littlefield stressed thatphysician scientists can make important contributions in areas tailored to their strengthsor as part of a team effort.

The second issue discussed by the Councilwas the recent challenges to and pressures onthe peer review system. Ruth Kirschstein, director of the National Institute of GeneralMedical Sciences, described the current grantaward process and characterized some of thepressures on the peer review system. She saidthat the most significant problem is the lackof adequate funds, particularly in view of theincreasing number of high quality researchproposals submitted. She suggested that thedramatically lowered award rates have contributed to a loss of confidence in peer reviewon the part of the scientists. In addition, academic institutions that obtain funding for"big-ticket" buildings directly from Congress,thereby circumventing the peer review process, weaken the system. She urged scientists tojoin in reaffirming the importance of peerreview as the foundation of biomedical research because it "provides the best adviceabout the scientific merit of competinggrants."

Edward N. Brandt, chancellor of the University of Maryland at Baltimore, described


the current congressional and public concernsrelated to peer review and the ways in whichscientific decisions are restricted by legislativeor administrative actions. He reviewed somealternatives to the present dual-review systemfor grant awards, and concluded that peerreview is "the best mechanism for the determination of scientific quality.~

An extensive debate centered on the use ofhospital patient care funds to support graduatemedical education highlighted the businessportion of the meeting. The Council reviewedthe ongoing deliberations of the AAMC adhoc Committee on Financing Graduate Medical Education. Concern focused on the possibility that pending Medicare legislationwould severely limit or eliminate support forresidents. The Council strongly urged theCommittee to advocate the use ofpatient carerevenues to support residency training of sufficient length to ensure that specialists in various disciplines are fully trained and to resistefforts to control the number of specialiststrained through reductions in the federal funding for graduate medical education.

The CAS also heard a report on the investigation by the Inspector General of the Veterans Administration into possible conflict ofinterest for VA employees who accept anyfunds from pharmaceutical companies. TheCouncil expressed concern over the confusions inherent in dual professional standardswhere some forms of consulting are encouraged in university academic roles and discouraged under a much more stringent conflict ofinterest interpretation for those with any VAaffiliation.

The Council considered the AAMC commentary on the GPEP report. This commentary, which was developed by a joint CASCOD working group, addresses the major concerns and criticisms that have been raised withregard to the GPEP report and provides specific guidance on the implementation of therecommendations of the GPEP panel in selected areas. The CAS also reviewed some ofthe recent trends in medical school applications and endorsed the report of the AAMCAAU Committee of the Management andGovernance of Institutional Animal Resources.

VOL. 62, MARCH 1987

The CAS spring meeting, which was held inWashington, D.C. March 26-27, included twopanel discussions. The first panel, which wasmoderated by Edward J. Stemmler, dean ofthe University ofPennsylvania School ofMedicine, addressed the future of faculty practicefrom the perspectives of medical school dean,hospital administrator, and faculty. This discussion focused on the effects of the changingpractice environment in academic medicalcenters on the traditional education, research,and patient care missions. Among the issuesraised were the increasing dependence of institutions upon practice income, concern overfaculty appointments and tenure decisions,access of voluntary faculty to referral patternsand diagnostic specialty units, and the impactof cost-containment efforts on the care of themedically underserved.

The second panel, which was moderated byCAS Chairman David Cohen, SlJNY-StonyBrook, reviewed the draft report ofthe AAMCad hoc Committee on Federal Research Policy. Various CAS members of the committeereviewed the report's recommendations regarding the scale and scope of the federalinvestment in biomedical and behavioral research, the priorities of the federal biomedicalresearch effort, the scientific review ofresearchproposals, renovation or replacement of research facilities, and federal biomedical research training programs. The panel also discussed the committee suggestions to enhancethe input from the scientific community intothe formulation of biomedical research policyby the executive and legislative branches ofthe federal government.

Other items on the spring meeting agendaincluded the final draft of the AAMC Committee on Financing Graduate Medical Education, the alternate fiscal 1987 budget forNIH and ADAMHA developed by the Ad HocGroup on Medical Research Funding, facultyconcerns related to the effect of the currenttax reform legislation on retirement annuityplans, and an update on the administrationproposals related to the reimbursement of indirect costs for federally sponsored biomedicalresearch.

The CAS Administrative Board conductsits business at quarterly meetings held prior to


Executive Council sessions. In January, theBoard discussed various issues related to therepresentation of individual academic societies within the Council and on the Administrative Board.

The Association's CAS Legislative ServicesProgram continued to assist societies desiringspecial legislative tracking and public policyguidance. Five societies participated in theprogram in 1985-86: the American Academyof Neurology, the American Neurological Association, the Association of University Professors of Neurology, the Child Neurology S0ciety, and the American Federation for Oinical Research.

Council of Teaching HospitalsThe Council of Teaching Hospitals held twogeneral membership meetings in 1985-86. Atthe COTH general session held during the1985 AAMC Annual Meeting, Richard M.Knapp and James D. Bentley, director andassociate director ofthe Department ofTeaching Hospitals, shared the platform with SheilaP. Burke, deputy chief of stan: Office of theSenate Majority Leader. Drs. Knapp andBentley focused on the future in "LookingAhead at Academic Medical Centers," whileMs. Burke dealt with the present dilemmas of"Health Policy Directions in an Era of BudgetConstraints." Dr. Bentley postulated that theacademic medical center, when viewed as asocial system faced with excess physician supply and hospital bed capacity, can managechange by emphasizing business practice andinsurance functions, or by establishing disciplined and functionally interrelated clinicalpractices. In considering the historical development of the hospital and its relationship tophysicians and insurers, present-day changesin hospital relationships, and implications forteaching hospitals in the years ahead, Dr. Bentley called for careful assessment of thestrengths of the teaching hospital as the underpinning for successful adaptation.

Dr. Knapp considered the pace of changeand the resulting escalation of events in thehealth care environment, calling on hospitalCEOs to take time for reflection. Remarkingon the past use of cross-subsidization to sup-

239

port the teaching hospital's multiple missions,he observed that the current climate appearsto call for an impossible alliance between c0

operation and competition, especially in graduate medical education. While allowing forflexibility and changes in the field of healthcare delivery, Dr. Knapp cautioned that members not lose respect for the roots of the teaching hospital-a triumvirate of education, research, and patient care.

Ms. Burke provided a retrospective view ofhealth policy decisions, presenting the deliberations of Congress and the administrationby focusing on institutional providers of care,patients, and cost-sharing, and the individualphysician. She warned that the overriding impetus for future federal decisions in the healthcare arena will continue to be the control ofthe deficit. Since the budget process lacks specificity, authorization committees must providesubstantive amendments to budget-related legislation to allow practical and equitable implementation. She encouraged AAMC membersto help Congress understand the complexityof the health care delivery system for knowledgeable decision-making.

The ninth annual spring meeting of theCouncil of Teaching Hospitals was held inPhiladelphia, May 7-9, 1986, with over twohundred hospital executives attending. Themeeting began with an evening in honor ofJohn A.D. Cooper, including the noted political humorist Mark Russell. Presentations atthe meeting focused on the impact of recentchanges in health care reimbursement and ondevelopments in medical technology, andtheir implications for the future. Stuart Altman, dean and professor of national healthpolicy at the Heller Graduate School of Brandeis University and Chairman of the Prospective Payment Assessment Commission,opened the first session with an overview ofthe Commission's recent activities and recommendations. Emphasizing that ProPAC'stwo major responsibilities are to advise theexecutive branch and Congress on the updatefactor, and to help them to take advantage ofnew technologies, Altman stated thatProPAC's likely impact is on structuralchanges within the DRG system. Paul Gertman, vice chairman of CAREMARK, Inc.,


discussed developments in health care research, problems with DRG assignment, andadjustment for differences in severity ofillness.Myles Lash, director of health care for ArthurYoung and Co., discussed predicted trends inteaching hospitals and new issues and challenges. Al Zamberlan, director of the GreatLakes Region of the Veterans Administration,discussed the VA's experiences in resourceallocation using DRGs. The session endedwith a discussion by Richard Berman, formerexecutive vice president of New York University Medical Center, of an approach to identifying the effects of key policy changes ondifferent groups of teaching hospitals.

John S. Najarian, regents' professor andchairman of surgery, University of MinnesotaMedical School, opened the second sessionwith a description of recent advances in transplantation technology and related the ethicaland economic issues. William Nolen, chairman of the department of surgery, LitchfieldOinic, also discussed the impact of new technology and changes in the health care deliverysystem on the practice of "small-town" medicine. R. Jack Powell, executive director of theParalyzed Veterans of America, raised ethicalissues about access for seriously disabled patients to advanced technology and medicalcare in an era of limited health resources.

The concluding session began as RobertBlendon, senior vice president of the RobertWood Johnson Foundation, reviewed the implications of recent changes in the health caremarketplace, and the need for increasedawareness of the political climate in relationto health care legislation. The meeting endedwith a panel chaired by Jack Shelton, managerof the employee insurance department, FordMotor Company, who discussed the role ofindustry in managing health care for employees. David Chinsky, senior health economistfor Ford, described the process by which thecompany identified abnormal medical carecosts and initiated discussions with participating hospitals. Dennis Becker, vice presidentfor planning and development at MEDSTATSystems, Inc., concluded by speculating onfuture actions in the area of health care costcontainment by employers.

VOL. 62, MARCH 1987

During 1985-1986, the COTH Administrative Board met four times to conduct businessand to discuss issues of importance and interest to COTl-I member institutions. Among theissues addressed by the Board were: Medicarepayment of capital costs; Medicare paymentfor services provided to patients by radiologists, anesthesiologists, pathologists, and emergency room physicians; professional liabilityinsurance legislation; tax reform; changes ingraduate medical education training requirements; the recommendations of the NationalTask Force on Organ Transplantation; theAAMC role in the promotion of academicmedical centers to the public; trends in medical school applicants; and the accreditation offoreign medical schools by the LCME.

The COTH Board joined the other AAMCCouncils in a dinner in January honoring former HCFA Administrator Carolyne Davis.The Board held an evening session in April toexchange views with Ed Mihalski, DeputyChief of Staff for Health Policy of the SenateFinance Committee, and in September tomeet with William Roper, Administrator,Health Care Financing Administration.

Organization of StudentRepresentativesAs during the previous year, 122 medicalschools designated a student representative tothe AAMC. Approximately 165 students, representing 96 of these schools, attended the1985 annual meeting. The first day includedregional and business meetings and a studentleadership workshop. The plenary program,"From Apathy to Panic and Beyond: Actionsto Shape a Better Medical Education," featured Kenneth Ludmerer, assistant professorofmedicine, Washington University School ofMedicine; Arnold ReIman, editor of The NewEngland Journal of Medicine; and RichardMoy, dean, Southern Illinois UniversitySchool of Medicine. Dr. Ludmerer offeredhistorical insights on the difficulties ofaccomplishing educational reform and urged students to pursue their ideals rather than becoming "rule of thumb" practitioners. Dr. Reimanaddressed the ethical contract that physicians


have with society and argued that medicaleducators must better address changes in thepractice environment so that students acquirethe skills necessary to fulfill this contract. Dr.Moy concluded the program with suggestionsto students about goals that they can influence.Examples were substitution of computer-storage for memory-storage and use ofeducationalobjectives and evaluation methods which aremore comprehensive than those provided bythe National Board of Medical Examiners. OnSaturday afternoon there were workshops onpatient interviewing as a preclinical student,computer-based medical education, curricularintegration of health care cost awareness andethics, promoting teamwork between medicalstudents and nurses, preventive medicine, legislative affairs, and financing graduate medicaleducation. Students also heard and questionedPatch Adams, founder of the Gesundheit Institute, on retaining humanistic ideals in medicine and building joyful relationships withpatients. The students met in small groups todiscuss "Critical Issues in Medical Education,"a paper prepared by the OSR AdministrativeBoard.

OSR offered two programs on Monday."Aid for the Impaired Medical Student: AProgram That's Working at the University ofTennessee" featured Hershel P. Wall, associatedean for admissions and students, Universityof Tennessee College of Medicine, and JamesStout, medical student at Bowman GraySchool of Medicine. John Stone, poet anddirector of admissions, Emory UniversitySchool of Medicine, spoke on "Literature andMedicine: the Patient as Art."

A new feature of the OSR annual meeting,responding to the AAMC's report on the General Professional Education of the Physician,was the OSR Network. Since programs inplace at one school interest students at otherschools, OSR members completed a page ask-

241

ing for "Information Wanted" and "Information to Share." Following the meeting, a collated summary was distributed, with entrieson curriculum, student activities, studenthealth, public health, financial, and evaluation.

In addition to considering Executive Council agenda items of direct concern to studentsand residents and nominating students andresidents to serve on committees, the 1985-86Administrative Board completed and approved its "Critical Issues in Medical Education" paper. Two other projects on which theBoard worked were a proposal to convene asymposium on problem-based learning and asurvey of OSR members in conjunction withthe Association of Teachers of PreventiveMedicine to identify innovative teaching activities in health promotion and disease prevention. Two OSR Board members developedpapers for publication in the fall issue of OSRReport: "The Medical Liability Problem" and"Keeping the Doors Open to Medical Education." The first summarized the contributionsofthe medical and legal professions, the insurance industry, and the health care consumerto the malpractice coverage problem. The second focused on disturbing trends in the accessof minority and low income students to themedical profession.

During the spring, OSR met regionally withthe Group on Student Affairs. While eachregion offered unique programs, three featuredPatch Adams' "Elixirs of Life" program. TheCentral and Southern regions continued toproduce regional newsletters containing progress reports of student-initiated projects andGPEP-related news. To cut travel costs, thesouthern and northeast regions produced student housing directories; students at 12 and14 schools, respectively, volunteered theirapartments for visiting students interviewingfor residencies or taking off-campus electives.

National Policy

The national policy issues with the greatestpotential impact on academic medical centersseem recently to have changed in character.In the past, the AAMC's major focus of concern was on legislation and regulation of relatively narrow and sharply defined scope, related to the programs of federal agencies inwhich our institutions have traditionally participated. Quite suddenly, more general issues,such as deficit reduction and tax reform thataffect AAMC interests along with those ofmany others, have begun to dominate thefederal agenda. For such problems, there are ahost of contending interests. Global decisions,purportedly for the common good, are reachedthrough bargaining among legislators advocating particular interests and special needs. Moreand more frequently, candid congressionalstaff tell their AAMC counterparts that a legislative provision ofconcern to academic medicine is marginal to the central thrust of a billand therefore will be accepted or rejected, noton its intrinsic merits, but on its value as abargaining chip. Not uncommonly these days,legislative proposals that significantly affectAAMC institutions surface unexpectedly inthe form of language insinuated anonymouslyand without prior announcement or publicconsideration into lengthy bills. The latterhave been crafted mostly behind closed committee doors and consummated rapidly, afterbrief floor consideration, often in the latehours of the waning days of a legislative period.

The enactment in December 1985 of theBalanced Budget and Emergency Deficit Control Act, familiarly known as Gramm-Rudman-Hollings (GRH), has overshadowed allnational policy issues since. With it, the prominence of deficit reduction has taken a quantum leap in the legislative arena. Members ofCongress, threatened by the huge and growingannual budget deficits of the last 4-5 years

and frustrated by the stalemating of everyreasoned and reasonable effort to modulatethe phenomenon, suddenly and out of an apparent sense of exasperation adopted this radical proposal as a way to confront the problem.

GRH imposes target limits on the annualdeficit, requiring that it be reduced in decrements of $36 billion per year, beginning withthe FY 1986 budget and continuing until thedeficit is erased in FY 1991. Each year, theCongress must enact whatever spending andrevenue-raising measures are necessary toreach the prescribed deficit level. Should theCongress fail-a determination arrived at bystatutorily defined processes carried out by theCongressional Budget Office (CBO) and theOffice ofManagement and Budget (OMB) andverified by the General Accounting Office(GAO)-a completely automatic sequestration process goes into effect and culminates ina presidential order to require expenditures toachieve the target deficit level. The requiredexpenditure reduction must be levied againsta relatively small fraction of the federal outlays, since many high cost entitlement programs, e.g. social security benefits and Medicare, are either totally or partially exempt; halfof the reduction must be borne by nationaldefense accounts, half by nondefense programs. The uniform, non-discriminating, automatic and across-the-board sanction ofGRH is widely seen as a judgment by theCongress that political considerations made itimpossible to enact conventional budgetarylegislation to reduce the deficit directly.

On January 15, 1986, scarcely one monthafter GRH's enactment, the OMB and CBOissued their expenditure and revenue projections for FY 1986 to the Comptroller General,estimating a deficit of $220.5 billion, $48.6billion over the legal maximum. However, aspecific provision of the act limited sequestration for FY 1986 to $11.7 billion. Accordingly,

242


the OMB-CBO report called for a uniformsequestration of 4.9 percent and 4.3 percent,respectively, from eligible defense and nondefense programs. The report was duly verifiedby the GAO and the president's sequestrationorder was published on March 1, effective onApril 1. The brunt of the non-defense cuts fellon discretionary spending, including manyprograms and activities vital to Associationmembers. Funding for the National Institutesof Health (NIH) and the Alcohol, Drug Abuseand Mental Health Administration(ADAMHA) was reduced by $236 million and$15.7 million, respectively, and Veterans Administration (VA) medical care lowered byover $117 million from the pre-sequestrationFY 1986 appropriations.

The ORH law also contained a clause pro§ viding for expedited judicial review of its con~ stitutionality. In December, 12 members of] the House of Representatives filed suit to have~ the law declared unconstitutional. In Febru-~ ary, a special three-judge panel upheld the~ plaintiffs' claim that the role of ComptrollerZ General in determining budget cuts was an

unconstitutional infringement of the separation of powers doctrine. In June, the SupremeCourt upheld the lower court decision, rulingit unconstitutional to grant "executive"branch budget control functions to the Comptroller General, an employee under the controlofthe legislature. This decision invalidated thespending redu~ions that took place under theMarch 1986 sequestration order. But the Congress voted by a wide margin in late July toreaffirm those spending reductions.

The Supreme Court ruling struck downonly the provision of GRH that delegated tothe Comptroller General the role of makingthe final specifications of the sequestrationorder to be issued by the president. However,anticipating the possibility of a successfulcourt challenge of this aspect of the proposal,the drafters of GRH had inserted a fall-backalternative. Under it, a congressional JointCommittee on Deficit Reduction would reporta Joint Resolution embodying the OMB/CBOsequestration recommendations; the spendingreductions would only become law if passedby the Congress and signed by the president.

243

This procedure would force each senator andrepresentative to take a public stand on reductions, an action that heretofore has been assiduously avoided and is clearly not congenial.Not surprisingly, therefore, a number of constitutionally permissible proposals to restorethe act's automatic nature have been floated:one would designate the Comptroller Generalan offical of the executive branch; another,passed by the Senate in late July, would giveOMB the power to implement the cuts, butreserve for the Congress the right to challengethe executive decisions. The issue has yet ·tobe resolved.

The most desirable and rational way toachieve the target levels of deficit reduction isthrough the regular budget process. But as thedeadline approaches for completing this process, the specter of the GRH sanction of sequestration has added enormous uncertaintyabout the future funding of federal programsof critical importance to AAMC members:those of NIH, ADAMHA, the Health Resources and Services Administration (HRSA),the Health Care Financing Administration(HCFA), and the VA.

President Reagan's FY 1987 budget requestcontinued past efforts of the administration toreduce funding for domestic programs. Whileit met the GRH target of a deficit of $144billion, the proposal requested spending levelsfor NIH and ADAMHA that were $424 million and $7.7 million, respectively, below theFY 1986 pre-sequestration levels, to providefunding for 5104 new and competing grantsat NIH and 448 at ADAMHA, down from6100 and 505 in FY 1986. The request alsocalled for a reduction in Medicare paymentsof $3~94 billion under the current serviceslevel, the cost projection of FY 1986 programspecifications into FY 1987. A large portionof the savings were to come from modifications in the reimbursement system for directand indirect medical education costs, andfrom freezing physician fees. In addition, thereduction of $422 million below FY 1986appropriation levels proposed for HRSA eliminated the health professions education programs.

The president's budget request for the Vet-


erans Administration: reduced VA medicalcare funding by $172 million from FY 1986pre-sequestration levels, with the bulk of thesavings accruing from the imposition of ameans-test for certain veterans with non-service connected disabilities and from a new reQuirement that private insurers reimburse theVA for the cost of care to insured veterans;slightly reduced the VA research budget; andslashed by 40 percent over current serviceslevels its major construction program. Therequest for the Department of Educationbrought interest rates on loan programs morein line with market levels; the substantial savings to the government were offset by highercosts to students.

The president also asked that a total of$9.9billion of FY 1986 spending authority be rescinded, including $77 million from NIH, $40million from ADAMHA, $269 million fromHRSA, $22 million from the Centers for Disease Control, and $7 million from Medicaidprogram management. Congress, however,failed to approve these proposals within therequired 45 day time limit and they died.

After the Senate Budget Committee and thefull House of Representatives formally rejected the president's budget, work on a FY1987 Congressional Budget Resolution beganin March. The Senate completed action first,passing its version on May 2. The DemocraticHouse, reluctant without Republican commitment to initiate the revenue increases manyclaimed were necessary to meet the GRH deficit targets, waited for Senate action prior topassing its Budget Resolution on May 17. Thefinal compromise budget package, passed onJune 26, sets aggregate expenditures at a historic peak of almost $1.1 trillion in FY 1987,with an estimated deficit of $142.6 billion,ostensibly $1.4 billion below the GRH limit.The resolution limits defense expenditures tojust over $292 billion, but creates a separate"reserven fund of $7 billion which the president may tap, as long as both he and theCongress are willing to offset the increase bynew revenues or reductions in nondefense expenditures. Revenues are raised only by $6billion over the baseline for FY 1987, a substantial decrease from original House and Sen-

VOL. 62, MARCH 1987

ate plans. For health programs, the resolution:adds $600 million jn budget authority overpost-sequestration levels to discretionaryhealth programs in FY 1987; boosts Medicaidfunding for infant mortality programs, for coverage of the elderly poor and to help statesadversely affected by delays in the updates offederal matching rates; assumes certain savingsin federal employee health benefits; calls forsavings of $550 million during the comingfiscal year through Medicare provider payment reforms; and adds $250 million for future increases in the hospital deductible. Foreducation programs the conference agreementrestores most programs to the FY 1986 appropriated level.

Although extreme pressure to hold downexpenditures was placed upon the Appropriations Committees, support for biomedical andbehavioral research remained high. At hearings before both House and Senate LaborHealth and Human Services-Education appropriations subcommittees, AAMC witnessesurged that "the federal government must follow the policy that continuous steady investment in research and education is an investment in our country's future. This policyshould remain invariant whatever the vagariesin the economy." They endorsed the recommendations of the Ad Hoc Group for MedicalResearch Funding that the appropriations forthe research and research training programs ofNIH and ADAMHA should be no less than$6.079 billion and $465 million. They alsourged that health manpower programs be financed at least at current services levels. It wasnoted that in the research arena, the AAMCsupported levels of funding would provideonly very modest program growth over currentservices levels and would be only minimallyresponsive to scientific opportunities. Studentassistance was justified as necessary to guarantee socio-economically disadvantaged applicants access to medical education in the faceof rapidly rising tuitions and other educationalcosts.

The House passed its FY 1987 appropriations bill for the Departments ofLabor, Healthand Human Services, Education and relatedagencies on July 31. NIH fared extremely well,


receiving a proposed funding level of over$6.153 billion, an increase of $893 millionover the post-sequestration FY 1986 level and$1.2 billion over the president's request. TheADAMHA research appropriation cannot beestimated because the House deferred appropriations for certain research programs whoseexpired authorizations await renewal. However, National Institute of Mental Health(NIMH) research was increased to $229 million, $28.6 million over the FY 1986 postsequestration level, while NIMH research andclinical training each got small additions.

In early August, the Senate Labor, Healthand Human Services, Education and Related

:::~ Agencies Appropriations Subcommittee ap-~ proved a bill detailing NIH and ADAMHA~ funding for FY 1987. Funding for NIH waso~ pegged to $6.080 billion, an increase ofalmost] $811 million over last year's post-sequestra] tion level. ADAMHA research and research~ training were proposed to be funded at a com-B bined level of $462.7 million. Shortly there~ after, the full Appropriations Committee ap-

proved this markup without change.Continued strong support of medical pro

grams under the Veterans Administration wasalso advocated by AAMC witnesses testifyingbefore the House and Senate AppropriationsSubcommittees on HUD-Independent Agencies. The Association articulated its concernabout the Reagan Administration's calls forsubstantial funding and personnel reductionsin these programs for FY 1987 which, coupledwith a newly enacted means-test and GRHreductions, raised the possibilities ofa substantial shrinkage of the VA medical care systemand a reduction in the quality of care at justthe time when the VA's medical missionshould be increased to meet the growing demands. To ensure the continued vitality oftheVA medical care enterprise, the Associationrecommended the FY 1987 appropriation beat least at the current services level of $9.7billion for medical care and $193.5 million forresearch programs.

In late July the House Appropriations Committee adopted an FY 1987 funding measurefor the VA that would boost its medical careaccount by 4 percent from last year's level to

245

$9.5 billion, and increase its research budgetsubstantially to $193.9 million. The researchincrease was welcomed by many investigatorswho had feared that the VA research budgetwould be slashed to the $181.8 million levelthat the FY 1987 Budget Resolution assumed.

In what had to be one of the longest struggles in recent memory between House andSenate negotiators, Congress finally approvedthe Consolidated Omnibus Budget Reconciliation Act (COBRA). The measure, originallyintroduced to make statutory changes necessary to effect compliance with the FY 1986Congressional Budget Resolution passed inAugust 1985, bounced back and forth betweenthe two bodies until a Senate-backed versionwas finally adopted on March 20,1986.COBRA contained a number of provisions ofgreat concern to AAMC members that: increased DRG prices by 0.5 percent; added athird phase-in year for the prospective payment system, delaying the transition to a national standard; reduced the basic level for theindirect medical education adjustment to 8.1percent and moderated the influence of therising resident-to-bed ratios; increased by onepercent the direct medical education passthrough payments, with future changes tied tovariation in the CPI; limited full Medicaresupport for residents to the number of yearsnecessary to qualify for initial board eligibilityplus one, but not to exceed five, with 50percent support thereafter; and continued thefreeze on payments to physicians, except tothose who are currently "participating."

A Council on Graduate Medical Educationto make recommendations on physician specialty distribution was also established byCOBRA. This proposal had been stronglyopposed by AAMC when it was originally introduced on the grounds that it would establisha mechanism that might encourage government intrusion, by legislation or regulation,into highly complex areas more appropriatelyleft to market forces. The Association expressed doubt that such a Council could predict with accuracy future health care needs, orthe optimal distribution of physicians amongmedical specialties; however, in attempting tocarry out such a task, the Council's actions


could wreak havoc with teaching hospitalswhich vary greatly in patient mix and, thus,in the types of residencies they can offer.

The traditional process for the review andaward of federaHy-funded research grants wasdealt another blow with the passage on June24 of the Urgent Supplemental Appropriations for FY 1986. Contained in the finalconference agreement was language mandating the Department of Defense to award approximately $55.6 million in research andconstruction funds to nine specified universities for projects that had never undergone peerreview for scientific and technical merit or forrelevance to federal program goals. Earlier,during Senate floor debate on the issue, anamendment, strongly supported by theAAMC, to delete the "pork barrel" languagewas approved; but almost identical languagewas reinserted by the House conferees, and asecond attempt in the Senate to strike theobjectionable provision failed.

Almost as dominant as budgetary matterson the legislative agenda of the 99th Congresswere actions to overhaul the federal incometax laws. Identified by President Reagan as thehighest legislative goal of his second term, taxreform legislation has run a turbulent courseduring the past year.

As prescribed by the constitution, the Housebegan the tax reform process. The Ways andMeans Committee held hearings on tax reformlegislation during the spring and summer of1985, marked up the bill in closed session inOctober 1985, and then sent it to the Housefloor in December. A dramatic last-minuteappeal from President Reagan, asking HouseRepublicans to support the bill-not becauseof its merits but to keep the process alive for"perfection" in the Senate-saved it from almost certain defeat. A number of provisionsin the House legislation turned out to be highlyinimical to the best interests of the medicaleducation and research community.

On the Senate side, action on tax reformlegislation came in two distinct phases. Thefirst was the markup of a measure formulatedby the staff of Senate Finance CommitteeChairman Robert Packwood. As markup advanced, the Committee soon discovered itself

VOL. 62, MARCH 1987

adding numerous tax preferences to the bill,generating $29 billion less in revenue over fiveyears than in current law, and seriously violating President Reagan's dictum that any billmust be "revenue neutral" to gamer his support. Senator Packwood abruptly cancelledfurther markup on the bill. By the time theCommittee reconvened, he had embraced aradically different tax plan that embodiedwhat most consider to be the principles oftruetax reform. The plan retained many preferences in the current tax code relevant to theacademic health community. The Senatepassed the bill in late June with only threedissenting votes.

Starting from very divergent positions ontax reform, House and Senate conferencecommittee members began meeting in earlyJune to develop a compromise revenue bill.After long and acrimonious debates, oftenbogged down by efforts to protect tax advantages for home-state industries and concerns,a final agreement emerged on August 18ththat embodied the most sweeping changes intax structure in over 40 years. The conferenceproposal dramatically altered current tax rates,deductions, and exemptions. But it also profoundly reformed the assumptions underlyingthe use of the tax code as an instrument toeffect changes in social policy.

Included in the far-ranging reform packagewere substantial modifications in many taxprovisions of vital concern to AAMC members. On the issuance of tax-exempt bonds,non-profit, Le., 501(c)(3), organizations wouldnot be subject to any state volume cap, butnon-health care institutions would be limitedto an individual cap of $150 million in outstanding bonded indebtedness. The amount ofuntaxed appreciation on property given as agift and claimed as a deduction would besubject to an alternative minimum tax. Scholarship or fellowship awards for degree candidates in excess of the amount paid for tuitionand required equipment would be consideredtaxable income. For pension plans, the billwould: allow a distinction to be made betweenfaculty and nonfaculty employees in the offering of retirement options by academic institutions; limit annual individual contributions


to so-called 403 (b) tax-sheltered annuity plansto $9,500 with an overall contribution ceilingof $30,()()(); restrict annual contributions byemployees of non-profit firms to Sec. 457 (unfunded deferred compensation) plans to thelesser of $7,500 or one-third of total compensation; constrain contributions to so-called401(k) plans to $7,000 per year; permit fulldeductions for IRAs only for those not coveredunder an employer-sponsored retirement planand earning less than a certain amount; andallow only the pension (and not the insurance)business of TIAA/CREF to remain tax-exempt. The value of faculty housing would beexcluded from income, if rent paid to theinstitution exceeds five percent of the appraised value fo the dwelling. The tax creditfor research and development activities wouldbe extended through the end of 1988 at 20percent; and a 20 percent tax credit would beapplied to corporate cash expenditures for university basic research, above a specifIed floor.Consumer interest, including interest on student loans, would no longer be deductibleunder the plan.

Many members of the House and Senatewho must approve the final plan before itbecomes law-were quick to laud the conference agreement, as was President Reagan.

Legislation reauthorizing and setting spending limits on many programs important to theAAMC's constituency was enacted during the99th Congress. One ofthe most important andcontroversial was the measure reauthorizingprograms and activities at the National Institutes of Health. Included in the compromiseHouse-Senate legislation were provisions that:created a new National Institute for Arthritisand Musculoskeletal and Skin Diseases and aNational Center for Nursing Research; recodified Title IV of the Public Health ServiceAct to include delineation of specific authorities of the NIH Director, the establishment ofthe position of an NIH associate director forprevention, and the stipulation of the composition of national advisory councils; cappedNIH administrative expenses; and imposed along list of other mandates on NIH.

President Reagan vetoed the legislation onthe grounds that it would adversely affect the

247

pursuit of research excellence at NIH by adding numerous unnecessary administrative andprogram burdens, establishing unneeded neworganizations, and imposing a uniform set ofauthorities on all research institutes. TheAAMC supported the veto not only for thereasons cited in the veto message but becausethe cumulative impact of the bill constituteda major intrusion by government into theconduct of scientific research, a position reflecting the Association's consistent advocacyof maximum managerial and administrativeflexibility at NIH. The veto was overridden inNovember 1985.

Agreeing last October to compromise legislation, the House and Senate renewed currently-funded health manpower programs intitle VII for three years. Although he hadpocket vetoed almost identical legislation afterthe 98th Congress had adjourned, the president presumably felt that, in the face of theoverwhelming support for the measure shownin both the House and Senate, another vetowould be futile, and so signed the measureinto law. For FY 1986, overall spending ceilings were set at FY 1985 appropriations levels;over the subsequent two years, program levelsincreased by an amount approximately onehalf of the projected inflation level. No authorization was included for new federal capital contributions to the HPSL program; therefore, institutions will have to rely on theircurrent revolving funds, at least for the nextthree years.

A number of major programmatic changeswere also enacted in the reauthorization measure, especially for the Health Education Assistance Loan (HEAL) and Health ProfessionsStudent Loan (HPSL) programs. Males of relevant age will have to certify registration withthe Selective Service System in order to beeligible for these loans. In addition, HPSL ismodified to apply the National Direct StudentLoan (NDSL) program delinquency formulato the program, allow larger penalties for latepayments, and permit HHS to attempt collection on defaulted loans. HEAL programchanges include a reduction of maximum interest rates on loans to 91-day T-bill rate plusthree percent, a limitation of front-loaded in-


surance premiums to a maximum of eightpercent if there is need for an increase, and arequirement that HEAL checks be issuedjointly to the student and the academic institution. The new law also mandated an annualset-aside of 20 percent of the Health CareersOpportunity Program (HCOP) appropriationin order to provide stipends of not more than$10,000 to students of exceptional financialneed at schools of medicine, osteopathy, ordentistry.

For the last half decade, the role of animalsin research has been a source of continuingcontroversy and ongoing debate, pitting thebiomedical and behavioral research community against a small but vocal band of animalwelfare/animal rights activists. After nearlyfour years of often acrimonious hearings, debates, discussions and negotiations amongmany parties holding various positions on therelevant issues, animal welfare legislationemerged in the 1985 farm bill and the NIHreauthorization. Neither is expected to seriously impede the progress of research, exceptto the extent that implementation may increase the cost of conducting it. The farm billamended the Animal Welfare Act to require:new and stricter standards for animal care anduse; more comprehensive reporting on compliance; training for all personnel involved inresearch with animals; establishment ofat leastone institutional animal committee at everyinstitution, with membership and responsibilities clearly prescribed; exercise of dogs; anenvironment to promote the psychologicalwell-being of primates; and consultation between Department of Health and HumanServices and Department of Agriculture Secretaries to avoid conflicting regulations. TheNIH renewal legislation contained less comprehensive requirements than did the farmbill; it essentially codified Public Health Service animal care policy. Among the importantprovisions in the law are a mandate that HHSissue guidelines for the care and treatment ofanimals in research, a requirement to establishanimal care committees at all institutions receiving NIH funding whose research involvesanimals, stricter assurance requirements fromresearch applicants that animal care guidelines

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are being met and an authorization to the NIHto suspend or revoke awards for failure tocomply with guidelines. Identical provisionsare also included in the 1986 ADAMHA renewal bill.

No fewer than six pieces of legislation dealing with animals in research have emerged inthe 99th Congress including one measure toprohibit the use of NIH funds for the purchaseof pound animals for use in research andanother to grant legal standing to animal rightsgroups to sue for Animal and Plant HealthInspection Service for failing to enforce theAnimal Welfare Act.

The past year has witnessed extensive workon a five-year reauthorization of the HigherEducation Act, which includes programs indispensable to medical students. Title IV programs-the Guaranteed Student Loan (GSL),the National Direct Student Loan (NDSL),and ALAS/PLUS Loan-provide almost 50percent ofall aid received by medical students.The House version ofthe legislation embodiedsubstantial modifications to current law asadvocated by AAMC and other organizationsrepresenting graduate and professional education, including a needs analysis test for allGSL applicants and increases in the annualgraduate and professional GSL and studentALAS/pLUS loan limits to $8,000 and$4,000, respectively. It also renewed authorityfor loan consolidation, and created a graduatefellowship program in areas of national need.During the floor debate, the House approvedamendments restoring the five percent origination fee that had been eliminated under theversion reported by the Education and LaborCommittee and imposing a performancestandard on foreign medical schools as a condition for participation in the GSL program.

The Senate Labor and Human ResourcesCommittee in April approved HEA legislationraising the funding ceiling in FY 1987 to $9.7billion, almost 13 percent over the previousyear's appropriations, but almost $930 millionbelow House-passed legislation. The bill alsoembodied a provision lowering the yield tolenders on GSLs to the 91-day T-bill rate plus3 percent, strieter criteria for establishing theindependence of students applying for assist-


ance, an increase in the annual GSL limit to$7,500 for graduate and professional schoolstudents, an increase in the yearly ALAS/PLUS maximum to $4,000, and a loan consolidation provision under which HPSLs wereincluded and HEALs were authorized to berepaid simultaneously with consolidatedloans.

During Ooor debate on the Senate measure,an AAMC-backed committee amendment wasadopted, requiring that for any foreign medicalschool to participate in the GSL program atleast 75 percent of its students must be citizensof the country in which it is located. Thisdiffered from the cognate provision in the

~ House bill: for a foreign medical school to be~ eligible to participate in the GSL program, at~ least 90 percent of the U.S. nationals ma~ triculated therein must have scored in the top] quartile of an approved medical college ad.g missions test; and 50 percent of those who8e graduated must have passed an examination~ administered by the Educational Commission.8o for Foreign Medical Graduates (ECFMG).z

By the time Congress adjourned for theLabor Day recess, House/Senate conferees onthe HEA bill had reached tentative agreementon a number of issues including: a compromise provision lowering the yield to lenderson GSLs to 91-day T-bill rate plus 3.25 percent; increases in the GSL and ALAS/PLUSto $7,500 and $4,000 annually; setting GSLinterest rates at eight percent in the first fouryears of repayment, 10 percent thereafter;adopting the Senate's provision of a continuance of five percent GSL loan origination fee;loan consolidation for repayment of HPSLsalong with administrative consolidation forHEALs; adoption in principle of a needsanalysis test for all GSL applicants; and liberalization of the criteria for independency applied to graduate and professional students.Agreement was also reached on the participation of foreign medical schools in the GSLprogram; regrettably, the conferees elected toadopt both a modification of the AAMCbacked position in the Senate legislation anda modified version of its House counterpart.To be eligible to apply for GSL participation,a foreign institution must meet one of two

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requirements: either 60 percent of the school'sstudents must be nationals of the countrywhere the school is located, or the U.S. students (presumably graduates) ofthe institutionmust have achieved at least a 45 percent passrate-increasing to 50 percent after twoyears-on the ECFMG examination. Whiledisappointing that the original Senate provision was not adopted, it is encouraging thatCongress has taken action to establish morereasonable policies on the issue. Conferees,however, were still bogged down on the bill'stotal price tag, and a number of other issueshad yet to be resolved. Convergence and agreement are imperative; unless the HEA is renewed before the end of the 99th Congress,the implementation of improvements in current law could be delayed for as long as a year,causing severe hardship for medical students.

Legislation reauthorizing the Orphan DrugAct to promote the development of therapeutic agents for rare diseases was signed into lawby President Reagan in August 1985. The lawauthorizes $4 million in grants in FY 1986 forthe development of orphan drugs, and provides a seven-year market exclusivity periodin order to create incentives within the pharmaceutical industry to develop and marketthese drugs. Also created is a 2o-member National Commission on Orphan Diseases tomonitor the progress toward goals of the legislation. In 1986 a provision granting orphanstatus to all human vaccines in order to createincentives for their continued developmentand availability was added to House legislationdesigned to create an out-of-court, no-faultcompensation system for nearly two dozencommon vaccine related injuries. This system,to be funded through an excise tax on vaccines, would cap pain and suffering awards at$250,000, eliminate punitive damages, andlimit amount of lost earnings claimed as aresult of an injured child; if the plaintiffs arenot satisfied with the out-of-court award, theywould have 90 days to file a civil suit, with nolimit on pain and suffering or damage awards.

Of continuing interest to the academichealth community is the problem of an aginginfrastructure at our nation's research facilities. During the first session of the 99th Con-


gress, legislation was introduced in the Houseto create a 10 percent set-aside from the university research and development budgets ofthe six largest research funding agencies tofund facilities construction and rehabilitationprojects. The program would be authorizedfor 10 years, with the set-aside provision tobegin in FY 1988 after a single year 10 percentincrease in each agency's authorization level,earmarked for facilities construction, in FY1987. Out of the total set-aside at each agency,15 percent is to be further earmarked forawards to "emerging" universities. Concernsthat the bill's 10 percent set-aside would notconsist of new funds but instead would betaken from current research funds were magnified with the passage of the GRH Act late in1985. The possibility that there would be noreal growth in federal research spending in thenear future substantially dampened enthusiasm for this proposal.

The need to modernize research facilitieswas also the subject of a conference jointlyhosted by the National Science Board, theWhite House Office of Science and Technology Policy, and the Government-UniversityIndustry Roundtable at the National Academyof Sciences. As its report stated, "The conference was not designed to adopt consensusbased recommendations. The participantswere searching for a comprehensive set ofapproaches that would meet facilities needs ona continuing long-term basis, recognize thediversity among research institutions and disciplines, and allow for the establishment ofnew research capabilities as well as the maintenance of existing strengths." Among theidentified potential action items for the federalgovernment were acceleration of indirect costrecovery, provision of credit support throughloans, and direct federal funding ofa construction program. Also identified were actionitems for state governments and for researchinstitutions.

In early June, the Office of Science andTechnology Policy (OSTP) published in the

VOL. 62, MARCH 1987

Federal Register a proposed "Model Policy forthe Protection of Human Subjects in Research" to be adopted by the 20-plus federalagencies involved in the support, conduct orregulation of research involving human subjects. The proposed model policy is theOSTP's response to the First Biennial Reportof the President's Commission on Ethics inMedicine and Biomedical and Behavioral Research, and is based heavily on the existingDHHS regulations on human subjects promulgated in 1981. In its comments, AAMCpraised the objectives of the proposed modelpolicy to promote uniformity across all federalagencies, to recognize the differences amongresearch institutions across the nation, and toallow institutional discretion in formulatinglocal solutions to individual problems. AAMCtook serious exception, however, to the proposed deletion of the current 60-day graceperiod between the time an institution submitsa grant application to an agency and the institutional review board (IRB) certifies its approval ofthe project. The deletion ofthe graceperiod would create extreme hardship forgrant applicants, research administrators andthe IRBs, delay potentially promising research,and create unseemly pressure for IRB approval. AAMC also expressed concern that theFood and Drug Administration would not berequired to adhere to the self-assurance system, and therefore will be able to continue itsinspections to assure compliance.

Although the Association succeeded in anumber ofits efforts during the past year, thereare many problems yet to be resolved. Effective advocacy for the highest priorities of theAAMC constituency on the national policyagenda-generous support for biomedical andbehavorial research programs, adequate student financial assistance programs, and equitable reimbursement policies in academicmedical centers for health care-must continue to be pressed, despite federal financialretrenchment.

Working with Other Organizations

The two highest elected officials and the chiefexecutive officers of the American MedicalAssociation, the American Hospital Association, the Council for Medical Specialty Societies, the American Board of Medical Specialties, and the AAMC serve on the Council forMedical Affairs. During the past year, theCFMA served as a forum for these importantprivate sector health organizations to exchangeviews on such topics as assessment of clinicalskills of foreign medical graduates, tax reformlegislation, tort reform, integration of hospitaland physician payments, use of animals inlaboratory research, and international graduate medical education.

Since 1942, the Liaison Committee on Medical Education has been the national accrediting agency for all programs leading to theM.D. degree in the United States and Canada.The LCME, jointly sponsored by the Councilon Medical Education of the American Medical Association and the Association of American Medical Colleges, has documented substantial change in U.S. and Canadian medicalschools since its formation in 1942. The primary responsibility of the LCME is to attestto the educational quality of accredited programs, directly serving the interests of the general public and of the students enrolled. Thus,the process of accreditation is designed to determine the achievement and to certify themaintenance of minimum standards of education.

Historically, licensing bodies in the UnitedStates and Canada accept the M.D. degreefrom a program accredited by the LCME as aprerequisite for licensure. The process of evaluation and accreditation by the LCME assistsinstitutions in determining effective allocationof their efforts and resources. Survey teamsprovide periodic external review, identifyingareas requiring increased attention, as well asareas of strength and weakness. The LCME

serves the public interest by encouraging institutions with accredited programs leading tothe M.D. degree to support, to the extent oftheir available resources, other educationalprograms, including graduate and continuingphysician education, allied health education,graduate education in the biomedical sciences,public health, and research. In 1985, newstandards for accreditation of M.D. degreeprograms were adopted by the LCME andapproved by its sponsors. The ongoing implementation of these standards, defined in Functions and Strncture ofa Medical School, allowsthe LCME to continue its role in maintainingand enhancing high standards in medical education.

Through the efforts of its professional staffmembers of LCME provides factual information, advice, and formal and informal consultation visits to developing schools. Since 196041 new medical schools in the United Statesand four in Canada have been accredited bythe LCME. This consultation service is alsoavailable to fully developed medical schoolsdesiring assistance in the evaluation of theiracademic programs.

In 1985 there were 127 accredited medicalschools in the United States, ofwhich one hasa two-year program in basic medical sciences.Additional medical schools are in variousstages of planning and organization. The listof accredited schools is published in theAAMC Directory ofAmerican Medical Education.

A number of proprietary medical schoolshave been established or proposed for development in Mexico and various countries inthe Caribbean area. These entrepreneurialschools seem to share the common purpose ofrecruiting U.S. citizens. The exposure of ascheme to sell false diplomas and credentialsfor two schools in the Dominican Republichas brought increased review by licensure bod-

251


ies of all foreign medical graduates, the indictment and conviction of the individuals involved, and greater suspicion of proprietaryschools. Moreover, the percentage of foreignmedical graduates receiving residency appointment is decreasing, due in part to the factthat the number of students graduating fromU.S. medical schools closely matches the number of residency positions available. Thus,M.D. degree graduates from foreign medicalschools of unknown quality may have increased difficulty in securing the residencytraining required by most states for medicallicensure.

The Accreditation Council for GraduateMedical Education increased the scope of itsresponsibilities by initiating the accreditationof subspecialty programs in internal medicineand pediatrics. Accreditation is only accordedto subspecialty programs conducted in conjunction with a program in the primary specialty. Nevertheless, this brings over 2,000programs under the ACGME's accreditationauthority. The appeals process for programssustaining adverse accreditation decisions wasstreamlined and a training program was established for members of appeal panels. A revision of the general requirements section of theEssentials oj Accredited Residencies statingthat all programs should provide instructionin ethical issues, in the socioeconomics ofhealth care and in the importance of costeffective medical practice was approved by theACGME and ratified by its sponsoring organizations.

During this past year one of the major challenges for the Accreditation Council for Continuing Medical Education was clarifying theprocedures for treating "enduring materials,"such as "printed, recorded, or computer-assisted instructional materials which ... constitute a planned activity of continuing medicaleducation." Guidelines were prepared to assistsponsors to comply with the ACCME Essentials Jor Accreditation oj Sponsors oj CME.The first formal appeal ofan ACCME decisionled to some revisions in the procedure forreconsideration and appeal of adverse accreditation decisions.

The American Board ofMedical Specialties,

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in response to the Association's concern aboutautonomous decisions by specialty boards tolengthen training requirements or otherwiseimpose additional resource demands on teaching hospitals, established a process to facilitatebroad input by the medical education community before certification changes areadopted. An open forum will be convened bythe ABMS within 180 days before the adoption ofchanges by a member certifying board.

Stimulated by the Association's 1981 recommendation that graduates of medicalschools not accredited by the LCME be required to pass an examination of their clinicalskills through direct observation, the Educational Commission for Foreign Medical Graduates began pilot testing an examination progra.}ll for this purpose in 1985. The ECFMGplans to continue development of this "handson" clinical examination in 1987 but has notyet decided whether the examination will become a part of its certification process.

For the fourth consecutive year, the Association provided the primary staff support andplayed a substantial role in the promotion ofthe Ad Hoc Committee on Medical ResearchFunding that seeks optimal appropriations forthe National Institutes of Health and the Alcohol, Drug Abuse and Mental Health Administration. As in the earlier years, the coalitionof approximately 150 organizations has recommended funding levels for the two agenciesthat the Congress has received as well justifiedand highly appropriate, thus displaying to thelegislators a broadly-based dedication to acommon goal.

In another research-related area, the Association has worked closely with other scientificand educational organizations in continuingto strengthen the capabilities of the NationalAssociation for Biomedical Research for theprimary effort to maintain the availability oflaboratory animals for research, education andtesting. The increased aggressiveness, sophistication and financial strength of the animalrights movement have required a series ofcollective activities, ranging from participationin legislative battles to opposing litigation thatwould grant legal standing to organizations tosue for custody of laboratory animals under


state anti-cruelty statutes. The Association wasinvolved in most of them.

The Association participates in the deliberations of the Joint Health Policy Committeeof the Association of American Universities/American Council on Education/National Association ofState Universities and Land GrantColleges, the Washington Higher EducationSecretariat, and the Intersociety Council forBiology and Medicine.

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The Association's Executive Committeemeets periodically with its counterpart in theAssociation of Academic Health Centers. Theorganizations regularly exchange informationand collaborate on programs such as an ongoing study of university ownership of teaching hospitals and a committee to develop strategies for the promotion of academic medicalcenters.

Education

Improving medical education is a high priorityfor the Association and its constituents. Thisis evidenced by the focus of the Council ofDeans 1986 spring meeting on the attractiveness of medicine as a profession, institutionalresponsibility for medical student and graduate medical education, and transition frommedical school to residency education. Thereis a growing consensus that medical studenteducation is too fragmented and in manyschools lacks a unifying authority. Greaterinterdisciplinary cooperation in program development and student evaluation is necessarywith deans assuming primary academic responsibility and authority. One outcome ofthe deans' discussions has been the development of a project to identify and reward excellence in teaching.

The Executive Council appointed an ad hocCommittee on Graduate Medical Educationand the Transition from Medical School toResidency in response to concerns about problems in moving between medical student andresident education. The committee, recognizing the need for encouraging discussion of keyissues among all who are responsible for medical student and resident education, developeda working document that has been widelydistributed for discussion and comment. Thecommittee's key recommendations are that:the ACGME establish an institutional reviewcommittee to determine whether institutionssponsoring graduate medical education programs are in compliance with the general requirements section of the Essentials of Accredited Residencies, students take clinicalelectives at other institutions only after completing their required clerkships at their ownschools; written evaluations of students' performances be more candid and describe weaknesses as well as strengths; residency programsnot encourage students to take electives intheir programs for making selection decisions;

the National Residency Matching Programchange its timetable to announce matchingresults on April 1; student evaluations not beprovided to program directors before November 1 of the senior year; and negotiations beundertaken with specialties currently holdingearly matches to have these specialties use t4eNRMP. These recommendations are the topicofa special general session at the 1986 annualmeeting.

The 1985 Conference on the Oinical Education of Medical Students cast a strong lighton the need for moving clinical educationfrom the current heavy dependence on hospitalized patients to more diverse clinical settings. The increasing complexity ofthe clinicalproblems of hospitalized patients and policiesto shorten hospital stays make it difficult forstudents to acquire basic clinical skills in hospital clerkships. Greater use of ambulatorycare settings for education must be developed.The Association is planning a symposium onthe problems that occur when basic clinicaleducation is given in ambulatory clinics andhow they can be resolved.

The Association's Clinical Evaluation Program is entering a new period emphasizing thedissemination of the self-assessment materialsand literature evaluations developed in theproject's earlier phases. The pilot schools willcontinue to be a resource as insights gainedfrom the project become available to the entiremembership. The Association also plans toincorporate the project's findings into otherongoing AAMC projects.

Oinical evaluation continues to be an important topic for the Group on Medical Education. One of the 1986 annual meeting sessions will focus on experimental efforts toassess student performance against the clinicalcompetencies identified by faculty as implicitin the awarding of the M.D. degree. The session will review the experience of three insti-

254


tutions in depth and explore the practice atnine other schools.

In its continuing efforts to reinforce therecommendations from the General Professional Education of the Physician Project Report, the GME has undertaken several projectsto facilitate educational progress review andthe development ofa program of change. Oneinstance involves the development of guidelines for instituting change and the preparationof scenarios for developing skills in dealingwith change. The GME Task Force on theReview of Curricular Innovations is developing a compendium ofeducational innovationsthat will include/descriptions and reviews ofeach according/to guidelines developed andtested previousl'y by the Task Force.

The deans for curriculum or academic affairs meet r,gularly to improve their expertiseand skills if1 the performance of their roles. Aproposal to develop a formal workshop program on facilitating educational change on aninstitutional basis builds on the key role of thecurriculum dean in managing such change.

The essence of almost all GME activities isproviding forums for the exchange of information and material to improve medical education. One ofthe most efficient mechanismsfor doing this has turned out to be the AAMCEducation Networks, which make it possiblefor the membership to identify colleagues interested and expert in six high-priority problem areas. New networks may be developed inclinical evaluation and among those responsible for "Introduction to Clinical Medicine"courses.

One of the most enduring forums for discussing medical education has been the Conference on Research in Medical Education.This year RIME celebrates its 25th Anniversary. A brochure recounting the history ofRIME and its contributions to medical education has been prepared. The Silver Anniversary Invited Review emphasizes the importance ofdrawing from adult education in confronting the challenges of medical education.

The Executive Council appointed an ad hoccommittee to review the Association's MedicalCollege Admission Test program. The committee found that the MCAT is useful in help-

255

ing to establish minimum academic Qualifications ofapplicants. It recommended that theessay pilot project continue to assess the inclusion of an essay as one subtest of the MCAT.The Committee recommended an evaluationof the content of the science subtests and theconsideration of alternative methods of scorereporting. The Committee also endorsed aprogram to improve the ways that admissionscommittees use the MCAT in selection decisions.

The MCAT Essay Pilot Project has yieldedsome very encouraging results. The project hasbeen successful in developing essay topics thatelicit a sufficiently wide range of responses.Correlations between the essay and otherMCAT tests indicate that the essay assesses askill or skills unexamined by the other tests.Data from three administrations verify thatessays can be scored wtih a high degree ofreliability. Research on the development ofessay topics that are equivalent in differentadministrations continues.

Validity data on enrolled medical studentsand the essay's impact on the selection processare being investigated by schools participatingin the pilot project. Research on the essay'simpact on the attitudes, course selection, curriculum, and application patterns of undergraduate students has been designed. Cost dataon the development, administration, and distribution of the essay will become available asthe project progresses. The essay will continueto be administered on a pilot basis in 1987.Many schools expect to use essays in their1988 admissions decisions.

Results from an Association survey of admissions officers will be used to evaluate thepresent system of disseminating MCAT dataand interpretive information and to documentmethods of using scores in the admissionsprocess. A nontechnical guide to the use oftheMCAT will be available November 1986.

Clinical data are being collected from several schools in the MCAT interpretive studiesprogram. These data will be used to examinethe relationship between pre-admission dataand performance in the clinical setting. Research is underway on the appropriateness ofthe current format and content coverage of


the MCAT. Two studies on the effects ofcommercial review courses on MeAT scoresrecently appeared in the Journal of MedicalEducation.

The MCAT Score Release System now allows examinees to have personal data circulated to U.S. and Canadian schools of medicine, osteopathy, podiatry, and veterinarymedicine for recruitment purposes. For thespring 1986 administration, 87 percent of theexaminees signed the release.

The MCAT continues to be offered in NewYork State under the protection of the preliminary injunction issued by the Federal Courtin 1980 after the Association challenged thatstate's law on disclosure of standardized tests.Discovery has been under way during this pastyear and a trial date seems likely in the comingyear. Meanwhile, new legislation further reg-

VOL. 62, MARCH 1987

ulating standardized testing failed to be enacted but is expected to be reintroduced.

The Association completed work on itsproject on the evaluation of medical information science in medical education, andmore than 5,500 copies of the project's finalreport have been distributed. The report concluded that medical informatics is basic to theunderstanding and practice of modern medicine and recommended that it become anintegral part of the medical education program. Academic medical centers were urgedto develop an identifiable locus of activity inmedical informatics to foster research, integrate instruction, and encourage appropriateuses for patient care. The National Library ofMedicine was recognized as the major federalagency to support the development of thisfield.

Biomedical and Behavioral Research

The support and conduct of research in thebiomedical and behavioral sciences continueto receive challenges from many quarters.

The scale of the federal investment inbiomedical and behavioral research persists asa major concern for the academic medicalcommunity. The number of high quality research proposals continues to increase fasterthan the growth of funding to support suchresearch. This growing disparity between existing scientific opportunities and the resources available to realize this potential generates tremendous pressures and conflictswithin the system. These pressures were amplified by the enactment of the Gramm-Rudman-Hollings deficit reduction amendment,which resulted in a 4.3 percent across theboard reduction of the funding for biomedicaland behavioral research in fiscal 1986.

The Gramm-Rudman-Hollings cuts infunding, coupled with the failure of the Congress to appropriate sufficient funds to pay thefull costs for the 6,100 new and competingresearch project grants that it mandated theNational Institutes of Health to support infiscal year 1986, necessitated an average"downward negotiation" of more than 9 percent from study section recommended levelsfor competing grants and 6.5 percent for noncompeting grants at the NIH.

The specter ofadditional Gramm-RudmanHollings budget slashing in fiscal year 1987,combined with administration efforts to "zeroout" programs such as the Biomedical Research Support Grants, augur further fiscalstringencies that can only aggravate the already intense competition for research funding.

The difficulties in reconciling limited federalresources and the cost~ of research surfaced inthe debate surrounding the administration'sattempt to reduce payments for the "indirect"costs associated with federally sponsored re-

search projects. In February, the Office ofManagement and Budget (OMB) published aproposal to limit the administrative costs portion of the indirect costs to 26 percent of themean total direct costs (MTDC) as of April I,1986, and to 20 percent of MTDC as of AprilI, 1987. The 20 percent ceiling is below current cost recovery for all but 10-15 percent ofthe nation's top 150 research universities.

The Association urged OMB to negotiatewith research faculty, university administrators, and other interested parties to reorganizethe accounting of indirect costs. AAMC urgedthat instead oflumping all administrative coststogether, OMB provide a fair and reliablemethod for determining departmental administrative costs that also permits relief from theneed for faculty effort reporting and a separatecost pool for those administrative expensesmandated by federal regulation (such as animal care and human subjects committees).

At the same time, the Association advocatedimposition of an immediate freeze in place ofeach university's present administrative ratethrough fiscal year 1987 and permanent elimination of the DHHS system of retroactivereimbursement of indirect cost adjustmentsduring the grant year. The Association notedthat these two actions would distribute budgetary savings more equitably and prevent further growth in administrative indirect costrates while negotiations took place.

The Government-University-Industry Research Roundtable of the National Academyof Sciences assembled a negotiating team representing the major constituencies to meetwith OMB. As a result of pressure from theacademic community, the OMB modified itsproposal in early June. The revised policylimits the salaries and benefits for administrative work by department heads, directors ofdivisions and research units, faculty, andprofessional staff at three percent of MTDC.

257


Expenses for deans' offices, academic departments, organized research units, and othersimilar units will no longer be included underthe general administration cost pool. The departmental administration rate will be basedon an accounting of actual departmental administrative indirect costs, with the exceptionof those now included in the fixed three percent category. No effort reporting documentation will be required to support the threepercent allowance. This new proposal will beimplemented on all grants awarded after July1, 1987.

The competition for research support alsohas resulted in efforts to persuade the Congressto earmark increasingly larger portions of thefederal research budget for particular programs. The wisdom of such earmarks wasagain debated during reauthorization hearingsfor the Small Business Innovation Research(SBIR) program. This set-aside program wasenacted in 1982, and currently requires theDepartment of Health and Human Servicesand other federal agencies with annual extramural research and development budgets inexcess of $100 million to reserve 1.25 percentof those budgets for awards to small businesses.

At hearings in July on H.R. 4620, whichproposed permanent authority for the SBIRprogram, the Association opposed the use ofset-asides as not compatible with sound publicpolicy. Such mechanisms reduce programmatic flexibility and force federal agencies tosupport grant applications on a basis otherthan scientific and technical merit. TheAAMC also cautioned against establishingpermanent authority for a program that hasnot undergone any formal evaluation of theeffectiveness of its expenditures.

The Association completed a major reviewof its policies on biomedical and behavioralresearch with the publication, in April, of thefinal report of the ad hoc Committee on Federal Research Policy. This committee conducted a year-long overview of the broad policy issues related to the federal role in biomedical and behavioral sciences research. Thisoverview was stimulated, in part, by the activities of the House Task Force on Science Pol-

VOL. 62, MARCH 1987

icy, which moved into its second year of astudy of all aspects of national science policy.

The committee made recommendations insix key areas related to biomedical and behavioral sciences research: the goals of the federalresearch effort; research manpower and training; research infrastructure; research awardssystem; federal funding for research; and formulation of federal science policy.

The committee reaffirmed that the goal offederally supported biomedical and behavioralsciences research should be to acquire an expanded base of scientific knowledge to improve the health of the American people. Itwas noted that NIH and ADAMHA have theacquisition of basic biological and clinicalknowledge as their primary mission, and thatthis mission must be protected and enhanced.The limited resources available for researchmust not be deployed to achieve non-scientificobjectives. The committee concluded that thebenefit to all aspects of the economy derivedfrom research should be a consequence, not agoal of the research effort.

The federal contribution to biomedical andbehavioral research through NIH andADAMHA is unique because it emphasizesbasic biological and clinical investigations,many of which would go unfunded withoutfederal support. The committee emphasizedthe long-term nature of biomedical research;the nation's medical schools and academicmedical centers took years to acquire and develop the talent and resources necessary toachieve current levels of contributions toknowledge. Reductions in federal support forbiomedical research have a far greater impactthan merely the immediate cuts suffered byindividual programs; such cuts have a lastingeffect on the nation's biomedical research effort that may take years to reverse.

The committee recommended an increaseof 10 percent per year in annual appropriations for NIH and ADAMHA to maintain thepresent scale of research effort. An additionalfive to 10 percent yearly increase in NIH andADAMHA appropriations for the next fiveyears was recommended to allow the systemto take full advantage of currently availablebut unmet scientific opportunities.


The committee urged that the federal government continue to maintain diverse programs of research support that emphasize thevital role of investigator-initiated research.The committee also reaffirmed the value andnecessity of basing funding selections on arigorous technical review for scientific merit.They advocated continuation of the predominantly extramural and academically basedsystem of research to take advantage of theenormous national pool of creative scientifictalent and resources, and to maintain theunique bond that exists between educationand research. In addition, a diversity of institutions provides greater flexibility to respondto scientific opportunities of varying degreesof scale and complexity.

The basic components of a sound federalprogram for the support of research trainingare in place. The committee recommendedmaintaining the current heterogeneity oftraining programs, with continued emphasis onsupport for postdoctoral programs. Two problem areas with regard to research training werehighlighted. The committee recommended efforts to identify and address the causes for thedeclining interest of young people in careersin biomedical research. The committee alsoexpressed concern over the lack of well-qualified physician investigators and praised programs such as the NIH Medical ScientistTraining Program and the Physician ScientistAwards as models for the design of M.D.research training.

Often overlooked in the debate surroundingthe scale of the federal investment in biomedical research are the research resources beyondthe direct cost portion of the grant that areneeded to sustain the fragile research environment. The committee made several sugges-tions to enhance federal support for equipment, facilities, and shared resources. Thecommittee also urged all segments of the research community to work toward ensuringthat indirect costs are true and necessary costsof research. At the same time, the governmentmust make efforts to streamline and reducethe bureaucratic requirements that add unnecessary institutional and administrative burdens and indirect costs.

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Finally, the committee urged greater involvement of the scientific community in theformulation of national research policy by theexecutive and legislative branches. Effortsmust be made to ensure that the Congress andthe president receive impartial, realistic, andtimely advice from scientists related to thegoals of the biomedical and behavioral research and the means to achieve these goals.Research agency advisory councils and theNational Academy of Sciences were seen asappropriate sources of such advice.

Attention remains focused on the issues surrounding the care and use of animals in laboratory research. In October 1985, a combinedad hoc committee representing the AAMCand the Association of American Universitiesissued its final report on the "Governance andManagement of Institutional Animal Resources." This report identifies the responsibilities of institutional personnel in assuringthat all animal facilities and research andtraining procedures are beyond reproach andare in compliance with all applicable laws,regulations, and guidelines. The report alsoaddresses the need to educate the non-scientific public about the importance of animalsin research and education. The report's recommendations are intended as guidelines forinstitutional administrators, animal resourcemanagers, researchers, faculty and public affairs personnel.

In December the president signed legislationamending the Animal Welfare Act governingthe use of animals in research, education, andtesting. In a coordinated effort, the Associationjoined forces with other members of thebiomedical research community to assure thatthe needs of researchers were considered during the lengthy negotiations involved in thefinal passage of this bill. As a result, theamendments to the Animal Welfare Act arefar less burdensome and restrictive than earlylegislative proposals, and should ensure continued access to animal models for both research and education in the biomedical andbehavioral sciences. The Association was alsoactive in providing information to the Department of Agriculture's Animal and PlantHealth Inspection Service (APHIS), which was


responsible for promulgating regulations toimplement the Animal Welfare Act amendments. The Association was concerned thatAPHIS recognize the need for broad, genericregulations that will allow for institutionalflexibility and individual professional judgment.

The Association also joined nearly 100other organizations representing both scientific and animal protection interests in urgingincreased funding for APHIS. The administration had proposed that APHIS be terminated,in spite of the new responsibilities mandatedby the Animal Welfare Act amendments. TheAssociation urged the Congress to provide$6.6 million for APHIS in fiscal year 1987.

Activities on behalf of animal rights continue. Beginning in April, animal rightsgroups, led by the People for the Ethical Treatment of Animals, staged a vigil at the NIHcampus, demanding the release of 15 primatesbeing held at the NIH animal facility. Theanimal activists wanted the animals, which

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were owned by the Institute for BehavioralResearch, to be transferred to a privatelyowned primate facility in Texas. The vigilattracted the attention of more than 200 congressmen and 50 senators who signed lettersto the Director of NIH requesting the releaseof the animals to the Texas facility. The Association and 27 other organizations sent aletter to Congress in support of the NIH position that the monkeys were the subject ofpending litigation and that the animals shouldbe available for an appropriate institution tocomplete the research for which they wereacquired. Resolutions were introduced in boththe House and Senate requiring that NIHtransfer the animals to the private facility, butthese measures did not receive sufficient support. The Department of Health and HumanServices and NIH attempted to reach a compromise late in July by sending the primatesto the Delta Primate Center in Louisiana,where the animals would not be subjects ofinvasive research procedures and every reasonable effort would be made to resocialize them.

Faculty

The Association has a long-standing concernfor medical school faculty issues relating toscholarship, research, and research training.These issues include the lack of sufficientfunds for investigator-initiated research grants,the apparent decline in the number of physicians entering research careers, the difficultyof Ph.D. biomedical scientists in securing appropriate academic appointments, and limitations on research training. Data are collectedand analyzed to illuminate these areas, andthe results are used to inform discussions bythe Administrative Boards of the Associationand by its committees. The study results arealso used in discussions with staff of the National Institutes of Health and other federalagencies, as well as in preparation of Association testimony for congressional committees.

The Faculty Roster System, initiated in1966, collects and maintains information oncurrent appointment, employment history,credentials and training, and demographicdata for full-time salaried faculty at U.S. medical schools. In addition to supporting AAMCstudies of faculty and research manpower, thesystem provides medical schools with facultyinformation to be used in completing questionnaires for other organizations, identifyingalumni serving on faculties at other schools,and producing special reports. As of June1986, the Faculty Roster data base containedrecords for 58,277 active and 60,924 formermembers of medical school faculties.

A survey of all full-time faculty in departments of medicine was recently conducted incooperation with the Association of Professorsof Medicine. Results of this study were published in the Annals ofInternal Medicine, anda comprehensive report is being prepared for

the APM and the National Institutes ofHealth. A second survey of internal medicinefaculty on research training is in progess. Thecombined data from these surveys and theFaculty Roster are a rich source ofinformationon the research activities of more than 7,000faculty members.

Faculty Roster data are periodicallymatched to NIH records on research trainingand grant applications and awards to analyzethe relationships among training, academiccareers, and the faculty's role in the conductof biomedical research. These research activities, as well as the maintenance of the FacultyRoster data base, receive support from theNational Institutes of Health.

A new edition of Women and Minorities onU.S. Medical School Faculties was publishedin early 1986. This is an updated and expanded version of reports that have been published periodically since 1976. The Associationassists its members in their affirmative actionrecruitment efforts by providing, on request,lists of women and minority faculty memberswho are qualified for specified faculty openings and who have consented to the release oftheir names. Since 1980 more than 1,200 recruitment requests from medical schools havebeen answered.

The Association's 1985-86 Report on Medical School Faculty Salaries summarizes compensation data provided by 122 U.S. medicalschools. The tables present mean compensation data and percentile statistics by department and rank for basic and clinical sciencefaculty. Salary data are also displayed according to school ownership, degree held, and geographic region for the 36, 150 full-time facultyreported to the survey.

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Students

As of September 5, 1986, 31,267 applicantshad filed 293,206 applications for the enteringclass of 1986 in the 127 U.S. medical schools.These totals, although not final, represent acontinuing decrease in the national applicantpool. The 1986 applicant pool is estimated tobe approximately 31,300 applicants, a 4.8 percent decrease from 1985.

The total number of new entrants to thefirst year medical school class decreased from16,395 in 1984 to 16,268 in 1985. Total medical school enrollment also declined from67,016 to 66,585.

The number of women new entrantsreached 5,520; the total number of womenenrolled was 21,650, a 1.6 percent increase.Women held 32.5 percent of the places in thenation's medical schools in 1985 compared to26.5 percent in 1980.

There were 1,388 underrepresented minority new entrants, 8.5 percent of the 1985 firstyear new entrants. The total number of underrepresented minorities was 5,655 or 8.5percent of all medical students enrolled in1985.

For the 1986-87 first-year class, 836 applicants were accepted under the Early DecisionProgram by the 75 medical schools offeringthis option. Since each ofthese applicants filedonly one application rather than the average9.3 applications, the processing of approximately 6,900 additional applications andscores of joint acceptances was avoided. Inaddition, the program allowed successful earlydecision applicants to finish their baccalaureate programs free from concern about admission to medical school.

American Medical College ApplicationService in processing first-year application materials for the 1986 entering classes had 102medical schools participate, as well as theDrew/UCLA and Berkeley/San FranciscoJoint Medical Programs. In 1987, 105 medical

schools will participate in AMCAS. In addition to collecting and coordinating admissiondata in a uniform format, AMCAS providesrosters and statistical reports and maintains anational data bank for research projects onadmission, matriculation, and enrollment.The AMCAS program is guided in the development of its procedures and policies by theGroup on Student Affairs Steering Committee.

The AAMC Advisor Information Servicecirculates rosters and summaries ofapplicantsand acceptance data to 340 subscribing healthprofessions advisers at undergraduate collegesand universities.

The Medical Sciences Knowledge Profileexamination was administered for the seventhtime in June 1986 to 1,659 citizens or permanent resident aliens of the United Statesand Canada. The examination assists constituent schools of the AAMC in evaluating individuals for advanced placement. While 3.9percent of those registering for the test haddegrees in other health professions, 91 percentwere enrolled in a foreign medical school.

Beginning in 1983, the AAMC and the National Resident Matching Program cooperatedto establish the AAMC/NRMP Follow-upSystem for medical school graduates. This system combined the results of the matchingprogram with the AAMC Student RecordsSystem and provided listings to individualmedical schools of their current graduates aswell as prior year graduates and Fifth Pathwaystudents registering for the current match.These listings provide information on programs and hospitals where these individualsmatched through NRMP and solicit information on those who did not register for thematch, withdrew from the match, or registeredbut did not receive a residency assignmentthrough NRMP. This exchange ofinformationby U.S. medical schools has continued for

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three years. Commencing with the 1985 graduating class, actual LCME medical schoolgraduate reports were generated from the follow-up system for the schools to report graduation information to the AMA and theAAMC.

In the fall of 1984, hospitals identified inthe 1983 follow-up system as having individuals enrolled in their graduate medical education programs received computer-generatedlistings to confirm the previous year's appointment and to report individual plans for thecurrent academic year. They were also askedto provide similar information for individualswho did not appear on the computer-generated listings. Responses were received from all825 hospitals surveyed. This was repeated infall 1985 with the addition of 1984 medicalschool graduates and associated match results,and will be continued for 1986.

During the past year, the Association hasworked with student affairs offices in the development of guidelines for the managementofstudents with Acquired Immune DeficiencySyndrome. A document containing examplesof institutional policies has been distributedand an updated version will be disseminatedin early 1987.

The Association has conducted several studies to examine the characteristics of the applicant pool particularly during the period beginning in 1981. Although the number of applicants has decreased to a national applicant-toposition ratio of 1.9 to I, the qualifications ofthe group as assessed by MCAT scores andGPAs have not been affected. While the national group of 1985 applicants is comparableto the 1981 group, there exists considerablevariation in the qualifications of the applicantgroup categorized by age, sex, and self-description. These differences are the subject of current study by the Association.

The increasing cost of medical educationand the rise in the debt of medical schoolgraduates are of great concern to the Association. The percentage ofgraduates with debt inexcess of $30,000 has increased from 14.5percent in 1981 to 38.6 percent in 1985. In1985, the mean debt for graduates with debtwas $30,256.

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In response to the substantial changes instudent financial assistance, the Associationhas initiated MEDLOANS, a new consolidated medical student loan program, in whichstudents can apply for three federal loan programs (GSL, ALAS, HEAL) and a new Alternative Loan Program (ALP) through a consolidated application procedure. ALP is anassured access program that does not requirethe medical student to have a cosigner, nordoes it require the borrower to make interestpayments while in school or during the first 3years of residency training. Since it is not afederal loan, the terms and conditions are notsubject to the unpredictable changes made byCongress. The Association is also planning acomprehensive program in counseling anddebt management for medical students thatwill begin in spring 1987.

The Association continues to administerseveral projects to enhance opportunities forminorities in medical education. The activitiesunder two Health Career Opportunity Program grants include workshops to reinforceand develop effective programs for the recruitment and retention of students underrepresented in medicine. Of these, the SimulatedMinority Admissions Exercise Workshop isfor medical school personnel concerned withthe admission and retention of minority students. The Training and Development Workshops for Counselors and Advisors ofMinorityStudents provide information about ethnicand racial minority students and train counselors and advisers to work with the latesttechniques appropriate for underrepresentedminority students. An important objective isto have participants gain information aboutthe differences among minority groups and tohelp participants develop alternative techniques for each group.

The Association, through the continuingsupport of the Robert Wood Johnson Foundation, is developing the third edition of Minority Students in Medical Education: Factsand Figures.

Recently, the AAMC was awarded a contract from the Department of Health and Human Services, Health Resources and ServicesAdministration to provide an analysis of med-


ical schools with high and low minority graduation rates. The study will examine the factors associated with the retention and graduation of underrepresented minorities. The out-

VOL. 62, MARCH 1987

come of this project should be of considerablevalue to understanding the factors that influence minority student enrollment in and graduation from non-minority institutions.

Institutional Development

The AAMC Management Education Programs, now in their 15th year, offer seminarsto enhance the leadership and managementcapabilities of AAMC member institutions.These programs for senior academic medicalcenter officials emphasize management theoryand techniques. The Executive DevelopmentSeminar, an intensive week-long session, waspresented to 105 medical school departmentchairmen and assistant and associate deansfrom 72 institutions. These seminars assistinstitutions in integrating organizational andindividual objectives, strengthening the decision-making and problem-solving capabilitiesof academic medical center administrators,developing strategies for more flexible adaptation to changing environments, and developing a better understanding of the functionand structure of the academic medical center.

In addition to the Executive DevelopmentSeminars, special topic workshops are offered.A seminar on "Information Management inthe Academic Medical Center" was attendedby 51 individuals from 29 institutions. Theseminar acquaints administrators with therapid development of advanced informationtechnologies and assists them in meeting thechallenges of information management in thecomplex environment of the academic medical center.

A series of four educational seminars devoted to the challenges posed to academicmedical centers by alternative medical caredelivery systems was held regionally duringthe spring of 1986. Each included an analysisof the current environment, a conceptualframework for analyzing the academic medical center's position and role in this environment, and an exploration of the experience ofseveral institutions in coping with alternative

delivery systems such as brokered care or capitated systems.

Six new workshops based on AAMC dataand conclusions from its clinical evaluationproject are designed to assist schools in thedevelopment and implementation of more responsive evaluation systems.

A key strategic issue for AAMC memberinstitutions is the preservation of their patientbases for teaching and research in a morecompetitive medical practice environment.The AAMC Committee on Faculty Practice atits first meeting discussed the growth ofserviceorganizations associated with the medical education institutions and increasing institutional dependence on medical practice income, academic medical center sponsorshipof and/or affiliation with health maintenanceorganizations, the governance of faculty practice activities, trends toward ambulatory caredelivery and role of the academic medicalcenter in providing primary care, and clinicalfaculty appointment systems and personnelpolicies. In addition to the regional seminarson alternative delivery systems, several initiatives have resulted from the committee's activities. A survey identifying medical schools withspecial non-tenure clinician-educator facultytracks for full-time faculty members engagedin patient care and teaching was reported. TheAssociation is seeking funding for a more comprehensive study of the appointment systemsand personnel policies that govern the activities ofclinical faculty members, physician employees of the medical center, and medicalstaff That study includes a national conference on faculty practice in 1987. In November1986, the AAMC will sponsor a small groupinvitational symposium on adapting clinicaleducation to the ambulatory care setting.

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Teaching Hospitals

The refinement of the Prospective PaymentSystem (PPS) for Medicare reimbursement tohospitals and the options for future financingof graduate medical education continue to beimportant concerns for the AAMC. The Association is also concerned with the effect ofthe prospective payment system on quality ofcare, how capital will be handled under PPS,continued access of non-profit hospitals anduniversities to tax-exempt financing, and proposed changes to Medicare reimbursement forfinancing graduate medical education.

AAMC actions were taken within theframework of two policy documents acceptedby the Executive Council on Medicare reimbursement and on financing graduate medicaleducation.

As a result of activities in the last Congress,the Association reviewed and revised its positions on Medicare hospital payment policies.The AAMC vigorously opposes any freeze inMedicare payments to hospitals and stronglyrecommends that Congress amend the prospective payment system so that payments aremade on a DRG-specific blended rate of hospital-specific and federal component prices. IfCongress does not enact DRG-specific priceblending, then the Association recommendsamending the DRG price formula to a blendof 50 percent hospital-specific costs and 50percent regional average costs.

The AAMC supports recomputing the resident-to-bed adjustment using current hospitalresident and bed data, up-to-date correctedhospital case mix indices, corrected wage indices, and a regression equation which incorporates only variables used in determiningDRG payments. The most recent analyses bythe Congressional Budget Office support a curvilinear adjustment of 8.7 percent per 0.1 resident per bed. The AAMC strongly supportsincluding the same types of residents in thepayout of the indirect medical education ad-

justment as are included in the statistical formulation of the adjustment. The AAMC supports eliminating Medicare funding for residents who are not graduates of accreditedmedical or osteopathic schools in the UnitedStates or Canada. Explicit Medicare fundingshould be retained for graduate medical education for the period required to attain boardeligibility (to a maximum of five years) plusone additional clinical year for advanced specialty and subspecialty positions in hospitalsin which the positions were supported by Medicare in FY 1984-85. For any resident presently in training who would not be includedin the passthrough, there should be a phase-inof Medicare payment changes.

The Association endorses an adjustment inprospective payments to recognize the generally higher costs incurred by hospitals servinga disproportionate number of indigent Medicare patients, even if implementation of suchan adjustment leads to a recalculation of theindirect medical education adjustment. TheAAMC supports correcting the wage indexnumbers used in prospective payments butrecommends amending the law to eliminatethe current requirement that the new indexnumbers be applied retroactively to October1, 1983. Congress should require HCFA toupdate each hospital's published case mix index using data from the hospital's first yearunder prospective payment. The Associationalso advocates removing the Medicar~ Part ATrust Fund from the automatic reduction provisions of the Emergency Deficit Control Actof 1985.

The AAMC Committee on FinancingGraduate Medical Education was charged withassessing the current methods for financinggraduate medical education and determiningwhether those sources could continue to provide adequate support in the near future. Sincegraduate medical education takes place pri-

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marily in teaching hospitals and adds to thecost of operating the hospital, changes in payment methods have raised the concern thatteaching hospitals may no longer be able tosustain their current support ofgraduate medical education. Further, more care is deliveredin ambulatory settings which have no clearsources of funding for education activities.

The first major issue discussed by the Committee was the creation of a separate fund forfinancing graduate medical education to eliminate the current reliance on teaching hospitalpayments from insurers and governmentalprograms. However, it would mean total dependence on the funding policies establishedby this single source. The committee concluded that changes in hospital payments arelikely to reduce the support teaching hospitalscan provide for graduate medical education.Although the full effects of the current environment on teaching hospitals' ability to support graduate medical education are unknown, the committee believed that they donot warrant acceptance of the disadvantagesof a single national fund. The committee recommended that teaching hospital revenuesfrom patient care payers continue to be theprincipal means of supporting graduate medical education with all payers providing theirappropriate share. Sources such as state andlocal governments, special purpose federalprograms, and private organizations may alsoneed to provide greater support in the future.Other recommendations of the committeeconcerned the obligation of the medical education community to monitor the quality ofresidency training programs, to train the typesofphysicians needed by society, and to operatein a cost-effective manner. The committeefurther recommended that limits be placed onthe length of training for which teaching hospitals are expected to provide a major sourceof support. Residents should be supported intheir training at least until they are capable ofthe independent practice of medicine. A coordinated, nationwide private sector effortshould be made to collect and disseminateinformation on the supply of physicians byspecialty, and residents and programs in theambulatory care settings must be supported.

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In February 1986, the AAMC testified before the Subcommittee on Health ofthe HouseCommittee on Ways and Means on Medicarepayments for hospital capital. The AAMC testimony pointed out that historical data comparing capital to total expenses have beenmisinterpreted by some to imply that majorteaching hospitals have lower absolute capitalcosts than other hospitals. In fact, capital costsper unit of workload performed are higher inmajor teaching hospitals than in other hospitals. Further, major teaching hospitals haveolder plants than other hospitals, and recentlyincreased capital spending by major teachinghospitals may alter statistical relationshipsfrom the 1970s and early 1980s. The AAMCsupports replacing institutionally specific,cost-based retrospective payments for capitalwith prospectively specified capital payments,and supports separating capital costs intomovable equipment and fixed equipment andplant. The Association's testimony indicatedsupport for incorporating capital payments formovable equipment into prospective paymentusing a percentage "add-on" to per case payments. The AAMC supports a percentage addon to per case prices for capital costs of fixedequipment and plant that is no less than Medicare's current percentage of hospital payments for facilities and fixed equipment, provided it appropriately compensates teachinghospitals for their distinctive costs. TheAAMC further supports a long-term, hospitalspecific transition from the capital passthrough to prospective payments for plant andfixed equipment. The transition period shouldallow each hospital its choice of cost reimbursement for depreciation and interest onadjusted base period capital or a prospectivepercentage add-on that is no less than Medicare's current percentage ofhospital paymentsfor facilities and equipment.

The Association testified before the HouseWays and Means Committee's Subcommitteeon Health outlining the AAMC's positions onthe Administration's FYI986 Medicarebudget proposals. Ofspecific concern to teaching hospitals and physicians were proposals to:reduce payments in direct medical education;reduce to 5.79 percent the indirect medical


education adjustment in spite of an extensiveCBO analysis supporting a reduction to only8.7 percent; implement DRG payments at 100percent national rates effective October I,1987; increase DRG prices by two percent,essentially a freeze at 1985 payment levels ifGramm-Rudman-Hollings reductions go intoeffect; implement a restrictive capital paymentpolicy; and retroactively recalculate the Medicare economic index to reduce fee paymentsfor physicians.

The AAMC made a number of specificrecommendations in its testimony. First, theAssociation supported retaining explicit Medicare funding of graduate medical educationfor at least the number of years required toattain board eligibility in various specialties(to a maximum of five years) plus one additional clinical year where hospitals had supported the position in FY84-85. Other AAMCrecommended changes in training supportwere congruent with positions taken by theExecutive Council. The testimony also recommended that Congress amend the prospective payment system so that payments arebased on a DRG-specific, blended rate ofhospital-specific and federal component prices,that the current pause in the phase-in of national prices be continued throughout 1986,and that the FY 1987 price be based on ahospital-specific component of at least 25 percent. The AAMC further supported increasingDRG prices for 1987 by the market basketplus 0.25 percent, and establishing an adjustment in prospective payments to recognize thegenerally higher costs incurred by hospitalsserving a disproportionate number of indigentpatients. The AAMC opposed any extensionof the Medicare freeze on payments to physicians for professional medical services, andurged Congress to mandate retaining the present methodology for calculating the medicaleconomic index.

In March 1986 the AAMC testified beforethe Subcommittee on Health of the SenateFinance Committee on Medicare paymentsfor hospital capital. The administration's proposed budget for FY 1987 advocated implementing a new policy for Medicare capitalpayments by regulation. The AAMC strongly

VOL. 62, MARCH 1987

opposed changing Medicare capital paymentsby regulation, preferring the legislative processbecause it is more open and public. To ensurethat the legislative process has an opportunityto consider a new capital payment policy, theAAMC recommended that the Health Subcommittee adopt legislation prohibiting HHSfrom making changes in the capital passthrough until Congress enacts legislation witha specific capital payment methodology. TheAssociation further recommended that thefederal component for computing capital payments for a phase-in be based on actual 1986Medicare capital payments updated annuallyfor increased construction and borrowingcosts, and that the hospital-specific component for computing capital for a phase-in transition be based on each hospital's actual capitalcosts for that current year. With regard to thecapital proposal made by Senators Durenberger and Quayle, the AAMC recommendedconsideration of a hospital-specific transitionapproach which varies the transition periodwith either the percentage of a hospital's fixedassets which are debt financed or the percentage of fixed assets presently depreciated. TheAssociation recommended specifying the baseyear and the specific update factors in thelegislation, recommended that any offset ofinterest earned be limited to interest earnedon funded depreciation, and that any effectivedate for a new capital policy be based onindividual hospital fiscal years.

The AAMC joined 29 other organizationsrepresenting nonprofit health care and highereducation institutions in opposing HouseWays and Means Committee action to restricttax-exempt financing for 501(c) (3) organizations. The committee placed section 501(c) (3)bonds under a state volume cap and protectedonly about one-halfoftheir 1984 volume witha $25 per capita set-aside. This set-aside wouldinevitably become a "ceiling" rather than a"floor" because the demand for other types ofbonds far exceeds the amount which could beissued under the remainder ofthe volume cap.The AAMC and other organizations opposedthe committee's position because it did notrecognize that private nonprofit health careand higher education institutions serve public


purposes which the government would otherwise have to provide. It would treat privatenonprofit institutions differently from publicinstitutions performing the same functions.The committee's position would arbitrarilyallocate capital for nonprofit hospitals anduniversities according only to state population,despite these institutions' characteristics as national resources.

The committee bill also denied advancerefunding authority to section 501(c) (3) organizations, which is used to reduce debt service. The committee also proposed a limit onthe amount of outstanding bonds of institutions other than hospitals, eliminated the useofarbitrage, and placed numerous restrictionson bond issuance for section 501 (c) (3) organizations. The AAMC emphasized that it isessential that they not be subject to any volume restrictions, and that such organizationshave the same limited advance refunding authority that the bill provides for governmentalbonds.

Another issue of concern to the AAMC inthe past year has been Medicare payment forphysician services. The AAMC recognizes thepresent dissatisfaction and unrest with Medicare's usual, customary and prevailing systemfor determining payments for physician services, but stresses that the form and content ofany revised payment system for professionalservices will provide economic incentives thatinfluence the attractiveness of the various specialties and subspecialties. Therefore, changein the payment system must be approachedcarefully and with demonstration projects sothat intended benefits and unintended conseQuences are understood. At the same time, theAAMC believes that Congress should not extend the physician fee freeze. Currently, feesfor physician services are based on information submitted in 1982 with no adjustmentprovided for increasing practice costs such asthe rapid rise in malpractice premiums. TheAAMC strongly recommends halting the feefreeze on physician services.

As new approaches to physician paymentare considered, the AAMC urges careful attention to the application of the approach inteaching settings. The revised payment system

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should incorporate several principles for theequitable application of payments in teachingsettings. If the level of professional medicalservices provided is equivalent to the level ofservices furnished a patient in a non-teachingsetting, payment should be made on the samebasis. Payments should be determined in thesame manner regardless of setting. The determination of the level of payments for professional services should not be influenced by theextent to which physicians provide services tonon-paying or Medicaid patients. Paymentsfor physicians in teaching settings should notimpose requirements which result in artificialor atypical relationships on the provider organization and its medical staff. The AAMCfurther believes that any revised payment system does not preclude or discourage residenttraining in the full spectrum of long-term careand ambulatory care settings.

The Association expressed its views on theproposed regulation to augment the procedures for establishing reasonable charge limitsfor Part 8 of Medicare in a letter to the HealthCare Financing Administration. The proposedregulation sought to establish a mechanism bywhich the usual method ofestablishing a "reasonable charge" for a service can be abridgedwhen it will result in an unreasonably highcharge. The AAMC expressed its understanding that there m&y be instances in whichHCFA's formula for determining charges mayresult in inappropriate levels of payment; e.g.,new medical technologies and techniques candramatically affect the time and effort involved in providing services to patients. However, the Association opposed the method suggested in the proposed regulation, in whichHCFA would identify areas in which it suspects that Part 8 compensation is excessive,would calculate new payment amounts forthese services, and would publish proposedregulations to establish those paymentamounts. After eliciting comments from thepublic, HCFA would then publish the finalregulation, which may contain changes fromthe proposed rule. As the agency responsiblefor Medicare outlays, HCFA is not an objective independent party able to determine whatconstitutes a "reasonable" outlay for a partic-


ular service. Under this regulation, HCFAwould act as both the unilateral determiner ofthe rules for "reasonable paymentn under PartB and as the payer. The interests of the government, patients, and providers would be bestserved if proposed changes from the currentaccepted method of fee determination werediscussed publicly, and enacted only on adviceand consent of a knowledgeable, independentadvisory body established to look at such payment issues. The Physician Payment ReviewCommission (PhysPRC) or a similar bodywould be an appropriate adviser for these payment changes. The Association proposed analternative process in which HCFA publishesinstances which it believes warrants deviationfrom the normal methodology for calculatingpayments. That publication is followed by ahearing before an independent body whichreviews HCFA's rationale and which advisesHCFA on whether to proceed with regulations.

In March 1986 concern about health budgetcuts prompted the AAMC to join with over100 health-related organizations in writing toSenator Pete V. Domenici, chairman of theSenate Budget Committee. The letter statedthat despite concerns about budget deficits, abalanced solution is needed. The organizationswere deeply disturbed by continued efforts tocut public health programs, including healthresearch and education, in a disproportionatemanner. The letter pointed out that during thepast five years, Medicare had been cut bynearly $40 billion. This constituted 12 percentof total budget cuts, even though Medicarerepresented only 7 percent of federal outlays.An additional $55 billion in cuts over the nextfive years were proposed along with cuts of$1.3 billion from Medicaid in 1987, althoughthat program is already unable to protect millions of indigent patients due to inadequatefunding. These proposals would adversely impact the quality of services and access toneeded health care by elderly and poor patients. The AAMC urged Congress to adopt abudget resolution which rejected such arbitrary and unfair cuts and established reasonable targets for health programs in the FY 1987budget resolution.

VOL. 62, MARCH 1987

In June 1986 the Association wrote allmembers of Congress opposing the tax billamendment being offered by Senator GordonJ. Humphrey. Senator Humphrey wished toamend the tax reform bill by denying taxexempt status and tax deductibility to anyorganization that "directly or indirectly performs, finances, or provides facilities for anyabortionn except when required to save thelife of the mother. This amendment wouldjeopardize the tax-exempt status and charitable contributions for most of this nation'smajor teaching hospitals and for several majorprivate universities which own a teaching hospital. It is inappropriate to deny tax-exemptstatus to these multi-function, public purposeorganizations simply because they offer a medical service that is legal and desired by theirpatients. Although this amendment was subsequently removed from the tax reform measure, its supporters plan to introduce it as anamendment to another important piece oflegislation.

The AAMC has submitted written comments to the Health Care Financing Administration regarding the proposed rule for thefourth year of the Medicare prospective payment system. The Association is especiallyinterested in the proposed rules because itsteaching hospital members provide approximately 20 percent of Medicare inpatient days.The Association's comments focused on theincrease in DRG prices, payment for capitalcosts, market basket recalculation, restandardization of prices, classification of bum patients, and periodic interim payments. In theproposed rule, HCFA argued that an appropriate price increase for FYI986 DRG pricesis a 0.9 percent decrease, but recommended a0.5 percent increase in DRG prices. TheAAMC is concerned with the inadequate justification HCFA offers for both the increaseand the decrease. Given HCFA's apparent unwillingness to develop an adequate, politicallyindependent estimate for DRG prices, theAAMC recommends using the price increaseof 2.2 percent developed by the ProspectivePayment Assessment Commission (ProPAC).

The proposed regulation also recommendedincluding capital payments in DRG prices by


regulation, and the AAMC reiterated its support for House and Senate efforts to precludea regulatory change in capital. The AAMCstrongly recommends that HCFA continue topay capital costs using the current cost reimbursement methods until Congress providesan alternative capital methodology.

The AAMC opposes five major elements ofHCFA's capital proposal. First, the capital costdata from 1983 substantially understate current capital costs. HCFA's efforts to update1983 data are inadequate because the HCFAadjustment is based primarily on interest ratechanges and ignores the increase in capitalspending since 1983. Second, the AAMC opposes using a four-year transition to nationalrates as too short to allow hospitals with majormodernization or replacement projects to adjust their capital costs to an average nationalrate. A lo-year transition is more appropriate.Third, the AAMC opposes limiting the hospital-specific payment during the transition to1986 allowable costs. During each year of thetransition, hospitals should be allowed to useactual allowable costs. Fourth, the AAMC opposes offsetting interest received on fundeddepreciation against interest paid on capitalcosts. For 20 years, allowable capital costs havenot included the offset, and debt instrumentscurrently in force often require segregatingboth depreciation and interest earned onfunded depreciation. Thus, interest earned onfunded depreciation is often not legally available for capital payments. Fifth, the AAMCopposes a capital exceptions policy that requires hospitals to approach insolvency beforequalifying for more individualized capital payments. In good faith, communities and hospitals have sought to maintain technically upto-date facilities and equipment. Requiringthese hospitals to substantially weaken theirfinancial position in order to have atypicalcosts recognized is an inappropriate publicpolicy which threatens hospital viability andbeneficiary access. Each of these five elementsof the capital proposal is a major short-coming; together they constitute an unacceptableproposal.

In developing a capital payment policy, theAAMC does not recommend using a separate

271

component after the transition period. To accomplish this objective, it is important to adjust all payments by the case mix index, theindirect medical education adjustment, andthe disproportionate share adjustment. Tohelp ensure equity across hospitals, it is necessary to standardize any capital componentby each of these payment variables.

The AAMC supports the regular revisionsin the market basket to estimate price increases in the goods and services purchased byhospitals. The AAMC is disappointed, however, that HCFA, in proposing a new wageindex, has not conducted a retrospective impact analysis using data from 1982-1984. TheAAMC believes that in proposing a new market basket, HCFA should demonstrate the redistributional impact of using the new approach. Until such an analysis is conductedand published, the AAMC is unable to evaluate the market basket weights and proxies ofthe HCFA proposal.

COBRA made significant changes in areawage indices, the indirect medical educationadjustment and the disproportionate share adjustment. As a result, the law required HCFAto restandardize regional and national prices.The AAMC believes these adjustments havebeen proper.

The AAMC is pleased that HCFA is usingits discretionary authority to categorize andweight tertiary care services. While HCFA hasnot released the data necessary to evaluate thechange in DRGs relating to burn patients, theAssociation believes this is an appropriate stepand recommends that HCFA continue to develop additional diagnosis-related groups forpatients requiring substantially different hospital resources.

The AAMC opposes HCFA's proposal simply to eliminate the periodic interim paymentsuntil detailed specifications for intermediaryperformance are in place and enforceable.Rather than abandoning PIP in a blanketmanner, HCFA should initially establish intermediary standards for paying providerclaims. Only when a provider demonstrates asustained ability to meet the performancestandard should HCFA consider eliminatingPIP for that intermediary. If an intermediary


is allowed to discontinue PIP, HCFA shouldpublish semiannual data on intermediary payment performance. If an intermediary fails tomeet the performance criteria, HCFA shouldimmediately reinstate PIP until the performance standard can be met.

The AAMC believes that the proposed regulation for the fourth year of prospective payment demonstrates HCFA's continued emphasis on limiting program expenditures andits unwillingness to provide adequate publicstatistical information on the impacts of itsproposals.

Another area of concern to the AAMC inrecent months has been that developing stateand national policies on health care deliveryand payments usually assume that teachinghospitals are relatively homogeneous. A number of pilot studies conducted by the TaskForce on Academic Medical Centers of theCommonwealth Fund clearly indicated thatthis simplifying assumption is incorrect. In aneffort to replace the assumption of homogeneity with clear analytical information on thediffering characteristics of subgroups of teaching hospitals, the AAMC has received fundingfrom the Commonwealth Fund for a threeyear effort to establish a coordinated data baseon teaching hospitals. Data will be developedat the individual hospital level so that theimpacts of a particular policy can be assessedon different types of teaching hospitals. To the

VOL. 62, MARCH 1987

degree that it is possible, the data base will beassembled using existing data currently collected by the American Hospital Association,the Health Care Financing Administration,the National Institutes of Health, the Accreditation Council for Graduate Medical Education, and the Social Security Administration.For COTH hospitals, the general data will besupplemented by both existing annual surveyson resident stipends and funding sources forgraduate medical education and by specialpurpose surveys developed to collect information on issues such as hospital debt structure and payment requirements.

Three types of project reports will be prepared. The first set will develop alternativetypologies of teaching hospitals based on theirorganizational, patient service, educational,research, and financial characteristics. Thenext reports will use the developed typologiesto assess the comparative impacts of existingpolicies/developments on subgroups of teaching hospitals. For example, changes in thenumber ofadmissions can be compared acrosshospital subgroups to identify relationshipsbetween hospital characteristics and operational experience. The third set of reports willuse the alternative typologies and the assessments of present policies to model the impactof proposed policies. Advising the AAMC onthe project will be a committee comprised ofindividuals knowledgeable about teaching hospitals and policy analysis.

Communications

The Association continues to wage an aggressive public relations program by encouragingnational and regional news media representatives to view the AAMC as a major source ofinformation on medical education, biomedical research and patient care policy and funding issues. More than 25 reporters contact theAssociation each week to seek interviews anddata as they develop their reports for radio,television, newspapers and magazines. TheAAMC also generates stories by issuing newsreleases and conducting news conferences ontimely subjects.

The Association's flagship publication is thePresident's Weekly Activities Report. Thispublication, now in its 16th year, circulates tomore than 6,000 individuals 43 times a year.It reports on AAMC activities and federalactions having a direct affect on medical education, biomedical research and patient care.

The Journal of Medical Education published 75 regular articles, 59 communications,and 7 briefs, as well as editorials, datagrams,book reviews, letters to the editor, and bibliographies provided by the National Library ofMedicine.

Supplements were published on the 1985AAMC Annual Meeting and Annual Report,commentary on the GPEP report, and theevaluation of medical information science inmedical education.

Manuscripts submitted to the Journal in1985-86 totaled 425, compared with 403 theprevious year. Of these 425 articles, 136 wereaccepted for publication, 238 were rejected,15 were withdrawn and 36 were pending asthe year ended. The Journal's monthly circulation continued to average about 6,100.

About 20,000 copies of the annual MedicalSchool Admission Requirements, 5,000 copiesof the AAMC Directory ofAmerican MedicalEducation, and 5,000 copies of the AAMCCurriculum Directory were published. Numerous other publications, such as directories,reports, papers, studies and proceedings, wereproduced by the AAMC. Newsletters includethe COrH Report, which has a monthly circulation of about 2,600; the OSR Report,which is circulated twice a year to medicalstudents and deans, and STAR (Student Affairs Reporter), which is printed four times ayear and has a circulation of 1,100.

273

Information Systems

The Association's computer system consists ofa Hewlett-Packard 3000, Series 68 and a Hewlett-Packard 3000, Series 48, each with a highspeed laser printer. The Association meets theneeds of its membership and stafTthrough theuse of over 100 terminals and enhanced datacommunication technology. Data base development continues as a top priority to minimize data redundacy and to provide responsive on-line information retrieval. More s0

phisticated computer-generated graphic artnow permits the creation of 35 mm slides andthe preparation of other camera art.

The American Medical College ApplicationService system provides the core of the information on medical students by collecting biographic and academic data, and linking thesedata to MCAT scores. A sophisticated softwaresystem provides participating medical schoolswith timely and reliable data to support theadmissions process and statistics describingtheir own and the nation's applicant pool.

AMCAS is supplemented by the MedicalCollege Admission Test reference system ofscore information, a college information system on U.S. and Canadian schools, and theMedical Science Knowledge Profile system onindividuals taking the MSKP examination foradvanced standing admission to U.S. medicalschools.

A student record system, maintained in cooperation with the medical schools, traces theprogress of individual students from matriculation through graduation. Supplemental surveys such as the graduation questionnaire andthe financial aid survey augment the studentrecord system.

After each residency match carried out bythe National Resident Matching Program(NRMP), the AAMC and the NRMP receiveinformation on unmatched participants andeligible students who did not enroll. Using this

information and the match results, the Association produces lists of graduates with residency choices for each school and for theLiaison Committee on Medical Education. Ina continuation of the tracking studies initiatedby NRMP, AAMC and NRMP collect datafrom hospitals and training programs eachyear, providing data for longitudinal studiesextending through residency.

The Student and Applicant InformationManagement System (SAIMS) consolidatesinto one comprehensive data base more thana decade's information on applicants, medicalstudents, and residents. This is the Association's largest data base, containing information on more than 500,000 individuals.SAIMS provides data for a wide variety ofreports, including cross-sectional and longitudinal studies performed by Association stafffor researchers at member institutions.

Through a cooperative network at eachmedical school, the Association updates theFaculty Roster System's information on fulltime faculty and periodically provides schoolswith an organized, systematic profile of theirfaculty. A survey of medical school facultysalaries is published annually, and the datacan be used on a confidential, aggregated basisfor special studies requested by member institutions.

The Association maintains an on-line repository of information on medical schools,ofwhich the Institutional Profile System is themajor component. IPS contains over 30,000data items describing medical schools fromthe 1960s to the present. It is constructed bothfrom survey results sent directly from the medical schools and from other AAMC information systems. The information reported onPart I of the Liaison Committee on MedicalEducation annual questionnaire is used withthe Institutional Profile System to produce the

274


report of medical school finances publishedannually in the Journal ofthe American Medical Association.

The Association also collects and maintainsinformation on teaching hospitals. The comprehensive Directory ofEducational Programsand Services and surveys on executive salaries,house staff stipends and benefits, and aca-

275

demic medical center financing are publishedannually.

The rapid assimilation of data into usefulinfonnation coupled with its timely distribution to its membership to allow infonned decision-making continues to be the Association's goal.

AAMC Membership

InstitutionalProvisional InstitutionalAffiliateGraduate AffiliateSubscriberAcademic SocietiesTeaching HospitalsCorrespondingIndividualDistinguished ServiceEmeritusContributingSustaining

1984-85127

1161

1379

43535

1,07468605

10

1985-86128

°161

1382

43630

1,005685359

Treasurer's Report

The Association's Audit Committee met onSeptember 3, 1986, and reviewed in detail theaudited statements and the audit report forthe fiscal year ending June 30, 1986. Meetingwith the committee were representatives ofErnst & Whinney, the Association's auditors,and Association staff. On September 11, theExecutive Council reviewed and accepted thefinal unqualified audit report.

Income for the year totaled $13,068,967. Ofthat amount, $12,407,342 (94.9%) originatedfrom general fund sources, $159,032 (1.2%)from foundation grants, and $502,593 (3.9%)from federal government grants and contracts.

Expenses for the year totaled $11,891,798of which $11,226,119 (94.4%) was chargeableto the continuing activities of the Association,$163,086 (1.4%) to foundation grants, and$502,593 (4.2%) to federal government grants

and contracts. Balances in funds restricted bygrantors increased $45,133 to $383,319. Aftermaking provisions for Executive Council designated reserves for special programs in theamount of $223,834, unrestricted funds available for general purposes increased $506,725to $11,488,124, an amount equal to 96% ofthe expense recorded for the year. This reserveaccumulation is within the directive of theExecutive Council that the Association maintain as a goal an unrestricted reserve of 100%of the Association's total annual budget. It isof continuing importance that an adequatereserve be maintained.

The Association's financial position isstrong, but with the multitude of complexissues facing medical education, it is apparentthat the demands on the Association's resources will continue.

276

Association of American Medical CollegesBalance SheetJune 30, 1986

CashInvestmentsAccounts ReceivableDeposits and Prepaid ItemsEquipment (Net of Depreciation)Land and Building (Net of Depreciation)TOTAL ASSETS

ASSETS$ 68,206

19,289,247535,39494,348

935,472814,405

$21,737,072

LIABILmES AND FUND BALANCES

LiabilitiesAccounts Payable

Deferred IncomeFund Balances

Funds Restricted by Grantor for Special PurposesGeneral Funds

Funds Restricted for Plant InvestmentFunds Restricted by Executive Council for Special PurposesInvestment in Property and EquipmentGeneral Purposes Fund

TOTAL LIABILITIES AND FUND BALANCES

Association of American Medical CollegesOperating StatementFiscal Year Ended June 30, 1986

SOURCE OF FUNDS

IncomeDues and Service Fees from MembersPrivate GrantsCost Reimbursement ContractsSpecial ServicesJournal of Medical EducationOther PublicationsSundry (Interest $1,873,349)

TOTAL SOURCE OF FUNDS

USE OF FUNDS

Operating ExpensesSalaries and WagesStatT BenefitsSupplies and ServicesProvisions for DepreciationTravel and MeetingsContracted ServicesNet Loss on Disposal of Fixed Assets

TOTAL EXPENSESIncrease in Investment in Property and Equipment

(Net of Depreciation)Transfer to Executive Council Reserved Funds for Special Programs

(Decrease)Reserve for Replacement of EquipmentIncrease in Restricted Fund BalancesIncrease in General Purposes FundsTOTAL USE OF FUNDS

277

$ 496,8564,005,6931,749,877

11,488,124

S 1,572,7892,040,414

383,319

17,740,550$21,737,072

$ 3,428,920159,032502,593

5,508,61590,105

382,8712,996,831

S13,068,967

$ 5,228,205972,501

3,556,501351,401

1,203,911578,194

1,085$11,891,798

551,236

(206,688)

280,76345,133

506,725$13,068,967

AAMC Committees

Accreditation Council forContinuing Medical Education

AAMC MEMBERS

Thomas MeyerHenry P. RussePatrick B. Storey

Accreditation Council forGraduate Medical Education

AAMC MEMBERS

D. Kay GawsonSpencer ForemanHaynes RiceDavid Sabiston, Jr.

Audit

C. Thomas Smith, ChairmanMilton ComDouglas R. Knab

CAS Nominating

Frank G. Moody, ChairmanJo Anne BraselDavid H. CohenRolla B. HillMary Lou PardueJerry Wiener •Nicholas Zervas

COD Nominating

George T. Bryan, ChairmanHenry H. BanksRobert L. FriedlanderTom M. JohnsonJoseph W. St. Geme

COD Spring Meeting Planning

D. Kay Gawson, ChairmanBernard J. FogelLouis J. KettelWalter F. Leavell

Leon E. RosenbergCecil O. SamuelsonWilliam D. Sawyer

COTH Nominating

Sheldon King, ChairmanDavid ReedC. Thomas Smith

COTH Spring Meeting Planning

James Morgan, ChairmanPaul GrinerDavid HittDelanson HopkinsBarbara SmallMichael Stringer

Council for Medical Affairs

AAMC MEMBERS

Robert G. PetersdorfEdward J. StemmlerVirginia V. Weldon

Evaluation of Medical InformationScience in Medical Education

STEERING

Jack D. Myers, ChairmanG. Octo BarnettHarry N. BeatyDon E. DetmerErnst KnobilCharles E. MolnarStephen G. PaukerEdward H. ShortliffeEdward J. Stemmler

Faculty Practice

Edward J. Stemmler, ChairmanArnold L. BrownWilton BunchSaul J. Farber

278

1985-86 Annual Report 279

Robert M. Heyssel Joseph E. Johnson, IIIJohn E. Ives Frank C. Wilson, Jr.Ernst KnobilRichard G. Lester Group on Business AffairsCharles A. McCallum

STEERINGDavid R. Perry

Lester C. Wilterdink, ChairmanAlan K. PierceJohn H. Deufel, Executive SecretaryCharles Putman

Raymond G. Schultze Stephen M. CohenJohn DeeleyDonald TowerJames Hackett

Finance Bernard McGintyDavid Mendelow

Mitchell Rabkin, Chairman Roger D. MeyerWilliam Deal Edward K. ParkerRobert M. Heyssel Lauren Pike

::: Robert L. Hill Robert B. Price~ Richard Janeway Kathleen M. Sheehan~0.. Edward J. Stemmler"5 Virginia V. Weldon Group on Institutional Planning0

~ Frank C. Wilson, Jr.] STEERING;:l

'"d

Amber B. Jones, Chairman8 Financing Graduate MedicaleJohn H. Deufel, Executive Secretary(1) Education.D

.8 J. Peter Bentley0 J. Robert Buchanan, ChairmanVictor Crownz

u Richard BermanDonald Fenna

~ David GitchDavid R. Perry(1) Louis Kettel:: James F. Pfister0 Frank MoodyCharles W. Tandy:g

0 Gerald PerkofT]Robert Petersdorf Susan Vogt

"8(1) Louis Sherwood

Group on Medical Education-B

Charles SpragueWilliam Stoneman, III STEERING

Richard Vance S. Scott Obenshain, ChairmanW. Donald Weston James B. Erdmann, Executive SecretaryFrank Wilson, Jr. Gerald Escovitz

Lawrence FisherFlexner Award Selection Charles FriedmanStuart Bondurant, Chairman Myra RamosHarry N. Beaty Paula StillmanPaul F. Griner Howard StoneKent Wellish

Group on Public AffairsKern WildenthalFrank C. Wilson, Jr. STEERING

Governance and Structure Robert Fenley, ChairmanCharles B. Fentress, Jr., Executive Secretary

Sherman M. MellinkofT, Chairman Eldean BorgJohn W. Colloton Arthur Brink, Jr.William Deal John Deats


Anne DollD. Gayle McNuttJohn MilkereitCarolyn TinkerOyde WatkinsNancy Severa Zimmers

Group on Student Affairs

STEERING

Ture W. Schoultz, ChairmanRobert L. Beran, Executive SecretaryRuth Beer BletzingerCarolyn M. CarterJack C. GardnerRobert I. KeimowitzRoy MamyJohn B. MolidorRichard M. PetersBilly B. RankinAnthony P. SmuldersEthel WeinbergCheryl Wilkes

MINORITY AFFAIRS SECfION

Carolyn M. Carter, ChairmanStephen N. Keith, Vice ChairmanMargie BeltranMargaret HaynesCarrie B. JacksonVietta L. JohnsonScharron A. LaisureLeonard E. LawrenceFernando MendozaVelma G. WattsRudolph WilliamsMaggie S. Wright

Graduate Medical Education and theTransition from Medical School toResidency

Spencer Foreman, ChairmanArnold L. BrownD. Kay OawsonRobert DicklerMark L. DykenGerald H. EscovitzJ. Roland FolseJoseph S. GonnellaJames J. LeonardCarol M. Mangione

VOL. 62, MARCH 1987

Thomas K. Oliver, Jr.Vivian W. PinnBernice SigmanMorton E. Smith

Guidelines for Management ofAnimal Resources

William H. Danforth, Co-ChairmanHenry L. Nadler, Co-ChairmanAlbert A. BarberThomas B. Clarkson, Jr.D. Kay ClawsonJoe D. CoulterFranklyn G. KnoxD. Gayle McNutt

Journal of Medical Education

EDITORIAL BOARD

Joseph S. Gonnella, ChairmanPhilip C. AndersonL. Thompson BowlesPamelyn ClosePreston V. Dilts, Jr.Charles W. DohnerNancy E. GaryDavid S. GreerPaul F. GrinerJohn E. IvesDonald G. KassebaumFernando S. MendozaEmily MumfordGordon PageLois A. PoundsHugh M. ScottManuel TzagournisJ. H. WallaceJesse G. WardlowKern Wildenthal

Liaison Committee onMedical Education

AAMC MEMBERS

Carol AschenbrenerJ. Robert BuchananCarmine D. ClementeWilliam B. DealWilliam H. LuginbuhlRichard C. Reynolds


AAMC Student Participant

Ian Cook

Management Education Programs

William H. Luginbuhl, ChairmanWilliam T. ButlerD. Kay OawsonRobert L. FriedlanderJerome GrossmanWilliam B. KerrHiram C. Polk, Jr.

MeAT Essay Pilot Project

ADVISORY COMMIITEE

Daniel J. BeanZenaido CamachoShirley Nickols FaheyRobert I. KeimowitzScharron A. LaisureTerrence M. LeighJohn B. MolidorMarliss Strange

MCATReview

Sherman M. Mellinkoff, ChairmanFredric D. BurgJohn DejongDaniel D. FedermanNathan KaseDouglas E. KellyWalter F. LeavellWilliam LuginbuhlBilly B. RankinRichard S. RossAndrew G. Wallace

Nominating

John E. Chapman, ChairmanGeorge T. BryanSheldon S. KingFrank G. MoodyFrank M. Yatsu

Research Award Selection

Rudi Schmid, ChairmanMichael S. BrownJoseph E. Johnson IIIDavid M. KipnisEdwin G. KrebsPhilip Leder

Research Policy

Edward N. Brandt, Jr., ChairmanStuart BondurantDavid H. CohenRobert E. FellowsThomas W. MorrisJohn T. Pot~ Jr.Leon E. RosenbergBenjamin D. SchwartzDavid B. SkinnerEdward J. StemmlerVirginia V. WeldonPeter C. Whybrow

Resolutions

Harry S. Jonas, ChairmanVicki DarrowEarl FrederickA. Everette James, Jr.

RIME Program Planning

Arthur Rothman, ChairmanJames B. Erdmann, Executive SecretaryDavid S. GullionDavid IrbyMurray M. KappelmanWilliam D. MatternChristine McGuire

Strategies for Promoting AcademicMedical Centers

D. Gayle McNutt, ChairmanRoger J. BulgerJames ChristensenMilton ComJ. Roland FolseJames C. HuntJohn E. IvesJ. Antony LloydGary A. MecklenburgRobert H. Waldman

Women in Medicine

Joan AltekruseBetsy BennettJoanna FruthDona HarrisMargaret HinesBernice Sigman

281

AAMC Staff

Office of the President

PresidentRobert G. Petersdorf, M.D.

Vice PresidentJohn E. Sherman, Ph.D.

Special Assistant to the PresidentKathleen S. Turner

StaffCounselJoseph A. Keyes, J.D.

ArchivistMary H. Littlemeyer

Executive SecretaryNorma NicholsRose Napper

Administrative SecretaryRosemary Choate

President EmeritusJohn A. D. Cooper, M.D., Ph.D.

Division of Business Affairs

Director and Assistant Secretary-TreasurerJohn H. Deufel

Associate DirectorJeanne Newman

Business ManagerSamuel Morey

P~nnelManager

Carolyn CurcioSupervisor, Membership and PublicationOrders

Madelyn RocheAdministrative Secretary

Carolyn DemorestPersonnel Assistant

Donna AdamsAccounts Payabletpurchasing Assistant

Farisse MooreAccounting Assistant

Cathy BrooksAccounts Payable Assistant

Anna Thomas

Accounts Receivable aerkRick Helmer

Annual Meeting RegistrarRosalie Viscomi

Membership OerkIda Gaskins

Book Order aerieDiann Pender

Senior Mail Room OerkMichael George

Mail Room OerkJohn Blount

Director, Computer ServicesBrendan J. Cassidy

Associate DirectorSandra K. Lehman

Manager of DevelopmentMaryn Goodson

Systems ManagerRobert Yearwood

Systems AnalystDavid BurhopSteve HammondPenny RifePeggy Yacovone

Programmer/AnalystJohn Chesley, III

Operations SupervisorJackie Humphries

Administrative SecretaryCynthia K. Woodard

Secretary/Word Processing SpecialistMary Ellen Jones

Data Control and Graphics SpecialistRenate Coffin

Senior Computer OperatorWilliam Porter

OperatorjData Communications SpecialistBasil Pegus

Computer OperatorHaywood MarshallGary Thomas

282


Division of Public Relations

DirectorCharles Fentress

Division of Publications

DirectorMerrill T. McCord

Associate EditorJames R. Ingram

Staff EditorVickie Wilson Ahari

Assistant EditorAddeane Caelleigh

Administrative SecretaryAnne Mattheisen

Department of AcademicAffairs

DirectorAugust G. Swanson, M.D.

Deputy DirectorElizabeth M. Short, M.D.

Senior Staff AssociateMary H. Littlemeyer

Administrative SecretaryAmy Eldridge

SecretaryBrenda George

Division of Biomedical Researchand Faculty Development

DirectorElizabeth M. Short, M.D.

Staff AssociateChristine BurrisDavid Moore

Division of EducationalMeasurement and Research

DirectorJames B. Erdmann, Ph.D.

Project DirectorKaren Mitchell, Ph.D.

Staff AssociateM. Brownell Anderson

Manager, MCAT OperationsGretchen Chumley

Research AssistantJudith AndersonPamela Brown

Administrative SecretaryStephanie Kerby

SecretaryPat Cooleen

Division of Student Services

DirectorRichard R. Randlett

Associate DirectorRobert Colonna

ManagerLinda CarterAlice CherianEdward GrossMark Wood

SupervisorHugh GoodmanEnrique Martinez-VidalLillian McRaeDennis RennerWalter WentzJohn Woods

Senior AssistantC. Sharon BookerKeiko DoramWarren LewisHelen ThurstonEdith Young

Administrative SecretaryMary Reed

SecretaryDenise Howard

Typist/ReceptionistSandra Smalls

AssistantWanda BradleyMarvin BrimageJames CobbWayne CorleyKathryn CreightonMichelle DavisCarol EasleyCarl GilbertGwendolyn HancockBettie Ann JonesPatricia Jones

283


Shelia JonesLetitia LeeYvonne LewisMary MolyneauxBeverly RuffinAlbert SalasChristina SearcyTamara WallaceGail WatsonPamela WatsonOscar WellsYvette White

Division of Student Programs

DirectorRobert L. Beran, Ph.D.

Director, Minority AffairsDario O. Prieto

Staff AssociateJanet Bickel

Research AssociateMary CuretonCynthia Tudor

Staff AssistantElsie QuinonesSharon Taylor

Research AssistantWendy Luke

Administrative SecretaryMary Salemme

SecretaryDebra DabneyLily May Johnson

Department ofInstitutional Development

DirectorJoseph A. Keyes, J.D.

Director, Institutional StudiesRobert Jones, Ph.D.

Staff AssociateMarcie F. Mirsky

Administrative SecretaryDebra Day

SecretaryLinda ButlerDorothy Mallorey

Division of Accreditation

DirectorJames R. Schofield, M.D.

VOL. 62, MARCH 1987

Staff AssistantRobert Van Dyke

Administrative SecretaryLinda Aack

Department of Teaching Hospitals

DirectorRichard M. Knapp, Ph.D.

Associate DirectorJames D. Bentley, Ph.D.

Staff AssociateNancy SelineJudith Teich

Administrative FellowSonia Kohan

Administrative SecretaryMelissa Wubbold

SecretaryJanie BigelowMarjorie LawaiCassandra Veney

Department of Planningand Policy Development

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

Deputy DirectorPaul Jolly, Ph.D.

Legislative AnalystDavid BaimeMelissa BrownJames Tetwilliger

Administrative SecretaryCynthia Withers

SecretaryTonya BorgesSandra Taylor

Division of Operational Studies

DirectorPaul Jolly, Ph.D.

Staff AssociateThomas DialAarolyn GalbraithWilliam Smith

Research AssociateJudith FrostNancy Gentile


Charles KillianLeon TakselStephen ToyDonna Williams

Research AssistantGail AhluwaliaDiane LindleyElizabeth Sherman

Byron WelchAdministrative Secretary

Dorothea HudleySurvey/Editorial Assistant

Sandra GarbrechtSecretary

Dawn Walley

285

286

JOURNAL OF Medical Education

Editorial Board

L. Thompson Bowles, M.D., Ph.D. (Chairman)Dean for Academic AffairsGeorge Washington UniversitySchool of Medicine and Health SciencesWashington, D.C.

Philip C. Anderson, M.D.ChairmanDepartment of DermatologyUniversity of Missouri, ColumbiaSchool of MedicineColumbia. Missouri

G. William Bates, M.D.DeanCollege of MedicineMedical University of South CarolinaCharleston. South Carolina

Pamelyn Close. M.D.Pediatrics ResidentHarbor-UCLA Medical CenterTorrance. California

Preston V. Dilts, Jr., M.D.ChairmanDepartment of Obstetrics and GynecologyUniversity of Michigan Medical SchoolAnn Arbor, Michigan

Nancy E. Gary, M.D.Associate Dean for Educational AffairsUniversity of Medicine and Dentistry

of New JerseyRobert Wood Johnson Medical SchoolPiscataway. New Jersey

David S. Greer, M.D.Dean of MedicineBrown University Program in MedicineProvidence, Rhode Island

Paul F. Griner, M.D.General DirectorStrong Memorial HospitalRochester, New York

Kaaren I. Hoffman, Ph.D.Associate ProfessorDepartment of Medical EducationUniversity of Southern CaliforniaSchool of MedicineLos Angeles, California

John E. IvesExecutive Vice PresidentShands HospitalUniversity of AoridaGainesville, Aorida

Donald G. Kassebaum, M.D.Executive DeanUniversity of Oklahoma College of MedicineOklahoma City, Oklahoma

Fernando S. Mendoza, M.D.Assistant Dean of Student AffairsStanford University School of MedicineStanford. California

Emily Mumford, Ph.D.Professor of Clinical Social ScienceColumbia UniversityChiefDivision of Health Services and Policy ResearchNew York State Psychiatric InstituteNew York City, New York

Gordon Page, Ed.D.DirectorDivision of Educational Support and

DevelopmentUniversity of British Columbia Faculty

of MedicineVancouver, British Columbia, Canada

Lois A. Pounds, M.D.Associate Dean for StudentsUniversity of Pittsburgh School of MedicinePittsburgh. Pennsylvania

Hugh M. Scott, M.D.PrincipalBishop's UniversityLennoxville. Quebec. Canada

Charles E. Spooner. Ph.D.Associate Dean for AdmissionsUniversity of Californi~

San DiegoSchool of MedicineLa Jolla, California

Manuel Tzagournis. M.D.Vice President for Health Services and DeanOhio State University College of MedicineColumbus. Ohio

Jesse G. WardlowStudentYale University School of MedicineNew Haven. Connecticut

AAMC annual meeting and annual report 1986 Meeting and Annual Report 1986. Table of Contents ......

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Transcript of AAMC annual meeting and annual report 1986 Meeting and Annual Report 1986. Table of Contents ......