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October 21, 22, 23, 1957

ATLANTIC CITY, NEW JERSEY

Office of the Secretary2530 Ridge Ave.Evanston, Illinois

Minutes of the 68th Annual Meeting

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Sixty-Eighth Annual' Meeting

Association of American Medical Colleges

Chalfonte-Haddon Hall, Atlantic City, N. J.

October 21-22-23, 1957

MONDAY, October 21, 1957

Introduction of New Deans .. . .

Introduction of Visitors from Foreign Medical Schools

Institute Highlights............... .. . .

Open Hearings on Annual Reports of Committees

Borden Award............ .

Plaque to D~~ Abraham Flelner

TUESDAY, OCTOBER 22, 1957

Roll Call .

Approval of Minutes of 67th Annual Meeting

Institutional Membership............ .

Affiliate Institutional Membership........ .

Individual Members .

Report of Chairman of Executive Council

First Report of Executive Director. ... . ..

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Joint Report of the Committee on Educational Research and Services andthe Director of Research _.. .. _ ••._•._ _ .._ .•_ .. .._ 75

Report of the Seoretary and Editor... . .

Report of the Treasurer _............... . .

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REPORTS AND RECOMMENDATIONS 01' COMMITIEES

Audio·Visual Education and Medical Audio·Visual Institute

Report on Hungarian Refugees ".

Nominating CommiHee

Continliation Education

Report of Chairman of Editorial Board

Supplemental Report of Editorial Board

Financing Medical Education

International Relations in Medical Education

Internships, Residencies and Graduate Medical Education

Licensure Problems

Medical Care Plans ../

Medical Education for National Defense

Public Information .

Veterans Administration.Medical School Relationships

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INTRODUCTION OF NEW DEANS

The following new deans were intro­duced:

Robert J. Glaser, University of Colo­rado School of Medicine; John E. Deit­rick Cornell Medical College; John L.Parks, George Washington UniversitySchool of Medicine; Thomas J. Turner,Johns Hopkins University School ofMedicine; Robert A. Moore (also presi­dent of the Medical Center), StateUniv. of New York College of Medicine,Brooklyn; T. H. Brem (Chairman ofInterim Committee), and Clayton G.Loosli (just appointed dean), Universityof Southern California School of Medi­cine; Robert Alway (Acting Dean), Stan­ford University School of Medicine; JeanJacques Lussier, University of OttawaFaculty of Medicine; Jean Baptiste Jobin,Laval University (now an Affiliate In­stitutional Member); Lee E. Powers(representing Dr. McDonald, dean) ofthe American University of Beirut, Leb­anon.

INTRODUCTION OF VISITORS FROMFOREIGN MEDICAL SCHOOLS

The following visitors from foreigncountries were introduced: Dr. John R.Ellis, University of London; Dr. DenisO'Donovan, University College of Dub­lin, Ireland; Dr. Lee Powers, AssociateDean, Faculty of Medical Sciences,American University, Beirut, Lebanon;Dr. Rubens Maciel, Faculdade de Medi­cina de Porte Alegre, Brazil; Dr. Soe­joenoes, Medical Faculty, Surabaja, In­donesia; Dr. Ba Than, Medical Facultyof University of Rangoon, Burma; Dr.Bo Valquist, Upsala University, Sweden;Dr. Ramon Villarreal, Medical School ofSan Luis Potosi, Mexico.

INSTITUTE HIGHLIGHTS

The summary of the 1957 TeachingInstitute on the Ecology of the MedicalStudent, which was held October 15-19,was presented by: George Packer Berry,Perspective on the AAMC Teaching In­stitutes; Robert J. Glaser, Introduction tothe 1957 Institute. Reports by InstituteParticipants-To Hale Ham. Curricular

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and Noncurricular Forces Affecting theMedical Student and His Development;Charles R. Strother, Characteristics ofthe Medical Student and the Diversity ofValues and Objectives in Medical Edu­cation; and Julius B. Richmond. Socio­logical Studies in Medical Education andEducational Patterns for Medicine.

OPEN HEARINGS ON ANNUALREPORTS OF COMMITTEES

Open hearings on the Annual Reportsof all of the Association's standing com­mittees were held. The innovation thisyear was a hearing for the Administra­tive Committee of the Executive Coun­cil. The reason for this was to give theCouncil, through this committee, an op­portunity to present complicated or con­troversial matters to those with specialconcerns, ahead of the annual businessmeeting.

BORDEN AWARD

Dr. Murray L. Barr, professor andhead of the department of microscopicanatomy, Faculty of Medicine, Univer­sity of Western Ontario, was presentedwith the 1957 Borden Award in theMedical Sciences. The award, a goldmedal and $1,000, was presented byOliver H. Lowry, chairman of the Com­mittee on the Borden Award. The awardwas based on Dr. Barr's work on sexualdimorphism in the structure of the rest­ing mammalian nuclei.

PLA9UE TO DR. ABRAHAM FLEXNER

Dr. John B. Youmans announced theestablishment of the Abraham FlexnerAward for Distinguished Service to Med­ical Education. Since Dr. Flexner wasnot able to be present, Mr. John Gard­ner, president of the Carnegie Corpora­tion of New York, attended in his placeand responded for him as he accepted aplaque upon which the following reso­lution had been inscribed.

ABRAHAM FLEXNER

A.B., A.M., LLD.• Utt.D., M.D. CHon. University ofBerlin, Washington University.)

Whereas, you have played an impOT­tant Tole in improving this nation's

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educational and social institutions andpractices, and

Whereas, as the result of your surveyand report "Medical Education in theUnited States and Canada," supportedand sponsored by the Carnegie Founda­tion for the Advancement of Teachingand published in 1910, you have madea particularly significant contribution tothe progress of medical education in theUnited States and Canada,

Now be it therefore resolved, that theAssociation of American Medical Col-

ROLL CALL

All Institutional Members were rep­resented.

APPROVAL OF MINUTES OF67TH ANNUAL MEETING

The minutes of the 67th Annual Meet­ing, November 12, 13, 14, 1956, TheBroadmoor, Colorado Springs, Colo.,were approved and published.

INSTITUTIONAL MEMBERSHIP

The American University of BeirutFaculty of Medicine, and the Miami Uni­versity School of Medicine were votedinto full institutional membership.

AFFILIATE INSTITUTIONAL MEMBERSHIP

The Laval University Faculty of Med­icine was voted into affiliate institutionalmembership.

INDIVIDUAL MEMBERSA total of 73 Individual Members were

voted into the Association.

REPORT OF THE CHAIRMANOF THE EXECUTIVE COUNCIL

The Council met for its organizationmeeting on November 13, 1956, at Colo­rado Springs. Dr. John B. Youmans waselected Chairman and the members ofthe Association's standing committees for1956-1957 were named.

A statement on internships preparedby the Committee on Internships, Resi­dencies and Graduate Education was

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leges, as the representative of the medi­cal schools and medical faculties of theUnited States, the Dominion of Canadaand their possessions, in recognition ofthese facts, hereby establishes the"Annual Abraham Flexner Award forDistinguished Service to Medical Edu­cation," and

Further be it resolved, that as evi­dence of this act, you be presented withthis plaque upon which this resolutionhas been inscribed. ASSOCIATION OFAMERICAN MEDICAL COLLEGES,October 21, 1957.

approved in principle. Dr. Robert Moorewas requested to make minor revisionsin it and circulate it to the ExecutiveCouncil. In final form it is to be pub­lished in The Journal of MEDICALEDUCATION accompanied by an editor­Ial to be written by Dr. Moore.

The recommendation of the Committeeon Internships, Residencies and Gradu­ate Medical Education that a study beinitiated of the internships connectedwith medical schools was approved.

The Committee on Planning for Na­tional Emergency was requested toattempt to prepare basic plans underwhich the functions of a bombed-outmedical school would be resumed.

The following statement of the Com­mittee on Medical Care Plans was ap­proved:

"The Committee recommends ...that appropriate steps be taken atthe state and national levels toprotect medical education fromthe potentially deleterious effecton clinical teaching of the newpublic assistance medical care pro­gram."

Dr. Youmans was requested to takethe matter up with the Department ofHealth, Education and Welfare.

The Secretary was instructed to poll:(a) The four-year medical schools todetermine how many additional studentsmight be accommodated in their thirdyear class if well-qualified students wereavailable; (b) All U. S. medical schoolsto procure, in cooperation with Dr. Ed­ward Turner, the information sought bythe staff of the House Committee to com­plete his study for the H. R. Committeeon Interstate and Foreign Commerceregarding the need for Federal aid inmediCal school construction 1957-1962.

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The second meeting of the Council washeld on February 8, 1957, in Chicago andDr. Ward Darley was welcomed as thefirst incumbent of the newly created po­sition of Executive Director of the Asso­ciation.

Upon the recommendation of Dr.Stockton Kimball, and after a reviewof the history of the various committeesdealing with national defense problems,the following committee structure wasvoted:

(a) The Joint Committee on Medi­cal Education in Time of Na­tional Emergency is to beabolished (subject to similaraction by the Council on Med­ical Education and Hospitalsof the AMA).

(b) The Association's present Com­mittee on P!:mning for Na­tional Emergency is to be re­named "The Committee onMedical Education for NationalDefense."

(c) The present Subcommittee onMedical Education for Na­tional Defense (of the JointCommittee) will be made asubcommittee of the Associa­tion's new "Committee onMEND" and entitled "TheSubcommittee for the MENDProgram."

Approval of the teaching program ofthe freshman and sophomore years ofAlbert Einstein College of Medicine ofYeshiva University was voted.

The following statement submitted bythe Committee on Financing MedicalEducation was approved:

"It is the conviction of the Execu­tive Council of the AAMC:(1) That agencies, governmental

or private, making researchgrants should cover the indi­rect as well as the direct costof the research;

(2) That the current allowancesfor overhead almost univer­sally fail to cover the full in­direct costs of research;

(3) That because of the inade­quate overhead allowance onresearch grants, many criticalfinancial situations exist in ourmedical schools and univer­sities."

"The Executive Council therefore ex­presses the hope that action on thisimportant matter, which has so longbeen under discussion, will be takenpromptly."

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At the budget meeting of the Councilon May 25, 1957, in Chicago, approvalwas given to the Administrative Com­mittee's decision: (a) To.set up threecommittees-one in New York, one inChicago, and one in San Francisco toscreen displaced Hungarian medical stu­dents; (b) To give such assistance aswas possible in placing the qualifiedstudents in American schools.

Approval was given to the Adminis­trative Committee's decision that theAAMC should serve as the applicant,custodian and dispensing agent for fundsfor a new stUdy of premedical educationby Severinghaus, Carman and Cadbury.

A second, more complete, question­naire study revealed that there are 336vacant places in the third year classesof our four-year medical schools.

The Executive Council voted to recom­mend to the Association that it: (a) Voteinto Affiliate Institutional Membershipat this meeting Laval University Facultyof Medicine, visited April 15-18, 1957.The Chairman then asked for a vote ofapproval by the members which on. mo­tion was seconded and duly carried.

(b) Vote into Institutional Member­ship at this meeting the American Uni­versity of Beirut School of Medicinevisited May 6-9, 1957. At this point inthe membership meeting, Dr. GeorgeBerry requested permission to make thisrecommendation personally. Permissionwas granted and motion was duly sec­onded and carried.

(c) Confirm by voice vote the approvalgiven by mail vote for full InstitutionalMembership for Miami University Schoolof Medicine, visited February 18-21, 1957.

Council approval was voted for thebooklet "The Guiding Principles in theCare and Use of Laboratory Animals"published by the National Society forMedical Research.

During the present meeting, four meet­ings of the Executive Council were heldon Wednesday afternoon, Thursday after­noon and Friday morning and afternoonrespectively.

The minutes of the meetings of No­vember 13, 1956, February 8, 1957, andMay 25, 1957, were approved as sub­mitted.

It was agreed the procedure for theuse of data from the "Medical CollegeStaff Salaried Questionnaire" would beas follows:

When a request for these data comesfrom a dean, six somewhat comparableschools will be selected and their datasent to the requesting dean. There will

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be added such descriptive but non-iden­tifying statements as "State-owned­Large City-South," etc.

The following action was taken re­garding meeting places. As already ap­proved, the 1958 meeting will be heldat Swampscott, Massachusetts, and the1959 meeting at Chicago, Illinois. Coun­cil decided to recommend the Eden RocHotel at Miami Beach, Florida, for the1960 Annual Meeting, October 31-No­vember 2. The Teaching Institute wouldbe held October 25-0ctober 29. On mo­tion duly seconded and carried, the date1960 was approved by the membership.

A communication from the BowmanGray School of Medicine in which thecontinuing practice of pharmaceuticaloffices to employ medical students asdetail men was discussed. The Chairmanreported the sense of his discussion withcertain officers of the National Pharma­ceutical Association with regard to thediscouragement of the members of theAssociation from employing medicalstudents in this capacity. The Chairmansuggested that scholarships and fellow­ships would be a desirAble substitution.The Council then approved the follow­ing statement:

"The Council of the Association ofAmerican Medical Colleges is ofthe opinion that any activity of astudent which might be interpretedas exploitation of his or her statusas a medical student or throughhim or her, of the medical school,is undesirable and should be dis­couraged."

The Executive Director was instructedto send this statement to the deans ofall medical schools and in addition, in­dicate that the employment of medicalstudents as detail people constitutes anexample of the kind of practice respon­sible for the adoption of this statement.

On motion duly seconded and carried,the approved resolution was adopted bythe membership and the action of theCouncil in this matter approved.

A motion approving the joint AMA­AAMC statement of "Functions andStructure of the Modern Medical School"for submission to the membership forconsideration was passed. On motionduly seconded and carried, the member­ship approved the statement.

The Council received a report fromthe chairman of the Committee on Fi­nancing Medical Education and on pass­ing a motion to approve the report, aresolution was adopted recommendingthat the Association at this meeting ex-

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press its deep appreciation for the serv­ice which Dr. Hinsey had rendered overmany years as chairman of this impor­tant committee. On motion, without dis­cussion, this resolution was adoptedunanimously by the membership.

The Council received the report ofDr. George Berry, chairman of the Com­mittee on Educational Research andServices. In passing a motion to approvethis report, the Council adopted a reso­lution recommending that the member­ship at its October 22 meeting expressits deep appreciation for the importantservice which Dr. Berry has renderedover these many years for this very im­portant committee. On motion, withoutdiscussion, the resolution was adoptedunanimously by the membership.

The Council received a report fromthe Executive Director, the Chairman,Dr. Stanley Olson, Dr. Stockton Kimballand Dr. Edward Turner on a meetingheld in Washington on September 18called by the Task Force on Health Man­power of the Office of Defense Mobili­zation. Following discussion of the re­port, it was agreed that an ad hoc liaisoncommittee would be set up with theCouncil on Medical Education and Hos­pitals of the American Medical Associ­ation to continue work on this matter.

The Committee heard a report fromDr. Olson dealing with the MEND pro­gram and it was decided to· await aconference with representatives of thegovernment services to be held on Sat­urday, October 19, following which thematter would be referred to the newCouncil.

In closing this report, your Councilwishes to present the following threematters for your consideration:

(1) Whereas, Dr. Alan Gregg, formany years Director of the Division ofMedical Sciences of the RockefellerFoundation died on June 19, 1957 and

Whereas, Alan Gregg was recognizedthroughout the world as a leader inmedical education and

Whereas, Alan Gregg was instrumen­tal in the development of psychiatry andpreventive medicine as major educa­tional and research disciplines and

Whereas, Alan Gregg stimulated manymedical educators here and abroad tocreative careers and

Whereas, Alan Gregg was deeply in­terested in the development of this Asso­ciation:

Now therefore be itResolved that this Association recog-

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nizes the loss to medical education inthe death of Alan Gregg and

Resolved that this Association estab­lishes the Alan Gregg Lecture to be de­livered at the Annual Meeting of theAssociation of American Medical Col­leges and

Resolved that a copy of these resolu­tions be transmitted to his widow andchildren.

This resolution was unanimously ap­proved.

(2) The Association of AmericanMedical Colleges recognizes that it~

elected officers, its committee member..!and its full-time staff must enjoy :tneprivilege of academic freedom just as dothe individuals who are on the facultiesof its member colleges.

With this in mind as the policy of theAssociation, the elected officers, the com­mittee members and the full-time staffare urged that when they speak orwrite as the official representatives ofthe Association, this fact be stated andthat, conversely, when doing responsiblespeaking or writing as individuals re­garding matters that are not covered byAssociation policy or directives, or mayeven be contrary to same, they use thebest possible judgment in avoiding em­barrassment to the Association and tothemselves by making it clear that theyare acting as individuals and not as therepresentatives of the Association.

This statement was unanimously ap­proved.

(3) At its 1956 Annual Meeting, theAssociation of American Medical Col­leges issued a statement to the effect thatthis country should increase its output ofphysicians by increasing the number ofits medical schools.

As things stand now, after makingallowance for the four new schools indevelopment, it appears that between1957 and 1964 our annual number ofmedical graduates will increase by ap­proximately 450 to 7400. In the opinionof the Association, exploration of meansbeyond additional~4-year schools forfurther increases for the period after1964 is necessary.

A recent survey revealed that due toattrition during the freshman and sopho­more years, plus the fact that someschools can accommodate more clinicalthan preclinical students, the juniorclasses of our 4-year schools have facili­ties for between 300 and 400 additionalstudents. If this number of studentswere progressing from new 2-year medi­cal programs fully integrated on the onehand, with the undergraduate college

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program, and on the other hand, withexisting 4-year schools, our annual num­ber of medical graduates would be in­creased significantly.

If these new programs were initiatedin a sound university environment, manywould undoubtedly evolve in due timeinto first-rate 4-year schools, as eVI­denced by the events of recent years. Atthe close of World War II, there were8 schools in this country offering thefirst two years of the 4-year medicalcourse. Graduates of these schools wereeasily absorbed into the third-yearclasses of our 4-year schools. At thepresent time all but 3 of these 2-yearschools have changed or are changingto 4-year programs.

In view of these facts and in view ofthe lower capital and operating expenseof 2-year programs, the Association ofAmerican Medical Colleges encouragesuniversities with strong leadership andnecessary resources to establish new pro­grams in medical education which wouldoffer the first two years of the 4-yearmedical course.

This statement was unanimously ap­proved.

Following this reading, the Chairmanasked acceptance and approval of theentire report by the membership. Onmotion duly seconded and carried, thereport was accepted and approved.

JOHN B. YOUMANS, chairman.

THE FIRST REPORT OF THE EXECUTIVEDIRECTOR

Ward Darley, M.D.*

Ordinarily the Executive Director'sreport would review the year's accom­plishments, present problems and activ­ities and future plans. But since I havebeen on the job for only a few months, Ithought that rather than attempt to spellout such a report, I would prefer toshare with you my conception of whatthe basic goals should be, not only forthis Association but for myself as itsExecutive Director.

When the announcement of my ac­cepting this position was first made, Iwas frequently asked to explain itsnature. Since very few people haveheard of the Association of American

*In order that the membership may fully appre­ciate the goats which the Executive Director seesror the Association. these remarks. as comparedto the original verbal report. have been expandedvery considerably.

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Medical Colleges, I found the answerthat was most readily accepted was theexplanation that I was supposed to dofor the 90-plus medical colleges of theUnited States and Canada what a presi­dent does for the colleges of a univer­sity. I still find that this is the easiestanswer to this question. But when I givethis answer, I always do so with therealization that there is one very im­portant difference between this Associa­tion and a university. This differencebeing that the governing board of auniversity has complete authority overits president and its constellation ofcolleges. Any authority enjoyed by thepresident and the individual collegesis delegated by the governing board.With the Association of American Med­ICal Colleges the situation is the reverse,the Executive Council and the ExecutiveDirector have no authority except thatwhich may be delegated by the membercolleges.

This statement is not to be taken asa complaint. The complete independenceof each member is as it should be. Infact, I think that this is the source ofthe Association's collective strength. Theindependence of our medical schools plustheir multiple and diversified sponsor­ship means that, except under the mostunusual of circumstances, they are freefrom the threat of legislative action fromanyone source that can simultaneouslyforce uniformity or conformity. Con­versely, this also means that the deckscan be kept clear so that each school canindividualize its goals and programs andindulge in experimentation in whateverway it feels may be indicated. The free­dom of each medical school to resistoppression or pressure and to set its owndestiny in its own way, if intelligentlytranslated into a central organization,such as this Association which is dedi­cated to the preservation of freedom onthe one hand and to the intelligent co­ordination of this freedom toward theinterests of general progress on theother, cannot help but result in a posi­tion of strength.

All of this means that if your electedofficers, your committees and your staffare to lead your Association to a posi­tion of effective national leadership, itwill have to be through the process ofeducation-education first of ourselvesand then of the many publics with whichwe must deal: our students, faculties,universities and alumni; the many pro­fessions and organizations important tomedicine as a function of society; ourcity, county, state and national govem-

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ments; and last but not least, all of thepeople of our land, partiCUlarly thoseactively concerned with our economic,social and political leadership. And so,although the source and extent of mydelegated authority may be different,I still come back to comparing my jobto that of a university president, becauseI am still engaged in helping to pro­vide continuing leadership to an educa­tional enterprise that involves bringingmany colleges together in a coordinatedeffort.

Now if education is to be the founda­tion of this enterprise, we must lookto the substance and to the means ofa program of communication. First, wemust have something to communicate,we must maintain effective lines ofcommunication and we must be certainthat we reach those with whom com­munication should take place. And sec­ond, if our efforts are to be crownedwith success, we must be certain of themoral and financial support essential toa sustained and aggressive effort.

By the term "substance of commu­nication" I mean that we must have ac­curate facts and information, translatedinto terms that can be adJusted to thecommunication media we are using andto the audience we are trying to reach.

This emphasizes the importance ofour research. For a long time researchhas been one of the Association's funda­mental activities. Currently our over­all research program falls into tworather distinct categories: (l) basic re­search, dealing largely with the medicalstudent and the measurement of his in­tellectual and nonintellectual character­istics and their significance, and (2)operational research, dealing primarilywith the day-to-day collective operationof our medical schools and With medicaleducation as a function of society.

The BasIc Research Program

Perhaps the mosllaoutstanding charac­teristics of our basic research programhas been its continuous growth-both inimportance and in volume. The futureindicates a continuation of this growth.

The perusal of the published reportsof our annual Teaching Institutes willemphasize what I mean, for each yearthe Office of the Director of Researchhas provided Institute participants withan increasing amount of data for studyand discussion. It is believed that thereport of the 1956 Teaching Institute,The Appraisal of Applicants to MedicalSchools, contains the most extensive sur-

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vey and analysis of the student selectionand admission process ever conductedby any branch of higher education.

Using the techniques of psychologicalresearch, studies are under way on thediversity of interests, personality char­acteristics, and intellectual abilities ofmedical students which are pointing theway to a longitudinal analysis of therelationship of these characteristics toscholastic achievement in medical school,to achievement in the internship andresidency, and eventually to accomplish­ment in medical practice. As this caseload increases, and as important sideleads develop and are pursued, the vol­ume of this research activity will in­evitably expand.

The present and projected outcomesof the Association's basic research ac­tivities are both theoretical and prac­tical. For one thing, our research isgrowing both in breadth and depth, be­cause it is beginning to interest researchworkers in the social as well as themedical sciences. This leads to inquiryin new fields. For another thing, as re­search results are published and thepractical application of our new knowl­edge becomes apparent, the developmentof a considerable service program isinevitable.

As an example of these services, theOffice of the Director of Research is­sues such publications as student accom­plishment reports and Medical CollegeAdmission Test performance reports tothe undergraduate colleges supplyingstudettU to meditallielto()Is.,And for themedical schools thtlJnSelVes, a vastamount of data is routinely available, ofwhich the annual AppUcant Study andthe Undergraduate Qrigim RepoTts arewell-known examples. For premedicalstudents, the annual Admbaion Require­ments of American Medical Collegeshas become an indispensable handbook.

Not so well known is our response tonumerous requests that come in fromindividual schools Qr groups of schoolsfor assistance in setting up local studiesor interpreting research findings so ,theymay proceed more intelligently with theplanning and direction of such things asadmissiOns policies or special educa­tional programs.

The application of research results­the service aspect 01 our research ac­tivities-is something that cannot beneglected. It often leads to importantnew research. It also represt!nts thepractical payback of a tremendous in­vestment of money and professionaltalent-professional talent at the Educa-

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tional Testing Service in Princeton aswell as of the Association staff-and alsoof the time and energy of our medicalschool deans and their countless unsunghelpers, without whose interest and ac­tive cooperation in data gathering thisimportant work would not be possible.

Much of what we do can be applied tothe study of other student groups; infact, much of the knowledge we aregaining about medical students is justas significant to the general field ofhigher education as it is to medical edu­cation itself. More and more frequentlythe Office of the Director of Research isreceiving requests for data to be utilizedin studies originating outside our ownprogram. Doctor's dissertations by stu­dents in psychology from several uni­versities are based on Association data.Our participation in the Carnegie-sup­ported Institute of Higher Educationstudy on the diversity ot student char­acteristics in all higher education is anexciting example of the kind of coop­erative work we can do.

I have dwelt at length upon the basicresearch part of the Association's pro­gram so that, as we take steps to in­crease its financial support and staff,there will be a sound understanding forthe reasons. Now that we are well em­barked on this all-important work, wehave no choice but to move ahead.Where we are today is a far cry fromthose heroic days when Fred Zapffe wastrying to keep records capable of re­search analysis-still a significant partof our data-in his own handwriting on3 by 5 filing cards!

Tlte Operat'ou' lIelearcll I'rogra.In an activity as complex as medical

education, the need for information im­portant to the day-to-day operation andcoordination of our member schools andto the education of the public I men­tioned in my introduction is very great.Over the past the Association has beenconducting the questionnaire and sur­vey research essential to the gatheringof this kind of information, but the efforthas usually been sporadic and limitedto the meeting of crises or needs thathave become apparent upon short no­tice. The time has come when it is essen­tial that we strengthen this aspect ofOUr program so that we can do a moreefficient job of meeting critical situa­tions, so that we can study problemswell ahead of the crisis stage and alsoso that we can be developing the kindof research that will permit regular re­ports to our member schools for pur-

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poses of more efficient fiscal, administra­tive and academic operations and thecomparisons essential thereto.

This increased effort will also be nec­essary if we are to support a sustainedprogram of public information-some­thing essential if medical education isto be properly understood.

Let me illustrate the kinds of studyI am talking about:

The most recent examples of suddenneed for information are reflected in thecommunications you have received rela­tive to the recovery of the completecosts of research and the availability ofconstruction funds. Since neither ofthese questions have been settled, youwill probably receive more calls for in­formation and help, because we willagain be taking these two problems tothe next session of Congress.

There are two very important prob­lems that I see coming over the horizonand that we must be preparing for.

One of these has to do with the chang­ing economic status of our teachingpatients. The ramifications of this- prob­lem are legion, and the quicker we canget to the business of their identificationand study the better. Here, particularly,is indicated a re-analysis of the purposeswhich our medical service plans mustserve and the principles that must un­derly their administration. Much dataand information as well as carefulthought will be essential to these con­siderations.

The second problem I refer to herehas to do with an analysis of the intern­ship as it exists in our medical school­controlled hospitals. For years we haveseen the internship gradually becomingcaught between the senior year of themedical school and the first year of theresidency. With the objectives, contentand methods of undergraduate teach109

undergoing rapid and radical change, itis essential that the impact that this ishaving upon the internship be carefullystudied. In 1958 and 1959 we are plan­ning for the first Institutes that will beconcerned with clinical teaching. Duringthese Institutes the internship and Itsplace in the education of the physicianwill frequently be referred to, so thatby 1960 the organization of an Institutearound the internship will probably re­sult. If we are to gather and collate thedata, opinions and attitudes essential toan Institute on the internship, we shouldget underway with our effort as soon aspossible. Other reasons for a prompt ap­proach to this enterprise are to be found

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in the pressures being exerted upon theinternship by the hospital, medical andlIcensing interests-many of which arenot compatible with the internship as anexperience that should be primarily edu­cational. With the number of intern slotscontinuing to exceed the number ofavailable interns, it is inevitable thatthese pressures will continue to grow,and as a consequence, if we are to pro­tect the best interests of medical educa­tion and of medical students, and if weare to base this upon sound reasoningand action, it IS essential that we developa more satisfactory body of knowledgethan is now available.

The most pressing need from thestandpoint of long range operational re­search is the job that needs to be donein the area of comparative cost and 10­

come reportmg. The fact that no definiteor reliable method of providing a com­parable cost breakdown of the manifoldeducational, research and service opera­tions of our teaching medical centers isundermining the public interest in med­Ical education and is also depriving ouradministrators of much of the informa­tion they need in order to improve theefficiency and effectiveness of their ownoperations. Along with the study of costsmust go an analysis of income, how eachsource of income is spent and the influ­ence which each is having in shaping oureducational goals and programs.

If cost and income reporting are to bedeveloped so that the schools can becompared, methods must be found forgiving adequate consideration to circum­stances that account for the differencesbetween schools. Variations in the rela­tionships between a medical school andits teaching hospital on the one handand its parent university or governingbody upon the other, variations in plansof geographic full time and variationsregarding the use of volunteer facultyare examples of what I mean here. Therecent studies conducted by the StateUniversity of New York and EmoryUniversity have demonstrated that theproblems of cost and income analysiscan be solved, and it is incumbent uponthis Association to find ways and meansof developing a program of regular re­porting so that the vacuum that is cur­rently being filled with guesses, opin­ions and inaccurate and incomplete dataceases to exist.

There are many other areas that needinvestigation-some upon a one-time,others upon a recurring basis. Obviously,limitations of funds and staff will makeit impossible to shoulder too much at any

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one time, but we must be in a positionto move effectively and quickly whenan emergency job of operational re­search is necessary and, upon a prioritybasis, to plan ahead for the longer termand often time continuing studies thatwe know will be essential if m.edicaleducation is to move ahead and keepahead academically, administratively andfinancially, and this in a manner thatwill be consistent with the potentialprogress that we see ahead.

When I speak of operational researchI am not unmindful that the demandsupon the time and energy of our deansand their staffs constitute factors thatplace additional limits upon the amountof work that can be kept going at onetime, and I assure you that as an ex­panded program may be developed, thesefactors will be kept in mind and properallowances and provisions made.

Staff and Administrative Organization

So much to illustrate what I meanwhen I talk about the substance of com­munication. We have much to do. Ourstaff must be reorganized and aug­mented. In line with this, the followingimportant appointments have beenmade: Dr. Richard Young has beenelected Secretary and in this capacitywill take over the administrative re­sponsibility for school visitations and theAnnual Meeting. Dr. John Bowers hasbeen appointed Editor of the Journal ofMedical Education. Much of the Journalwork will be done at Madison, Wiscon­sin, which will free some badly neededspace at the home office. Mr. ThomasColeman, recently with Dr. Robert Mooreat the University of Pittsburgh, has beenappointed Director of Public Informa­tion, thus satisfying a long standing rec­ommendation of our Committee on Pub­lic Information. Dr. Charles Schumacherhas been appointed Assistant Director ofResearch; Mr. Fred Meier, recently withthe National Opinion Research Council,Technical Director of our IBM Depart­ment; and Mrs. Lotus R. Barnes, As­sistant to the Executive Director. Mrs.Barnes will gradually assume the re­sponsibility for the business and person­nel operation of the office.

Only one more major position, the Di­rector of Studies (the by-laws shouldchange this title to Associate ExecutiveDirector) has yet to be filled. It will bethis individual who will largely be re­sponsible for operational research andthe administration of the Teaching In­stitutes. To make the administrative pic-

Minutes of the 68th Annual Meetinl:

ture complete, I should indicate that Dr.Helen Gee will continue as Director ofResearch and that Miss Audrey Skaifewill take over the administration of thefilm library. The positions I have out­lined, together with the necessary sup­porting technical and secretarial per­sonnel, are all provided for in the1957-58 budget as it was adopted by theExecutive Council last June.

With the staff properly organized andfunctioning, the deliberations of yourExecutive Council and standing and adhoc committees, as well as your owndeliberations in business session, shouldbe greatly enhanced. Also it should bepossible to develop a sound and broadpattern of policies so that between ses­sions of the Council and the AnnualMeeting of the Association, your staffcan provide the continuing leadershipnecessary to a growing and purposefulprogram.

A word about committee work. This isthe best way to bring fresh people, freshviewpoints and new ideas into the workof the Association. I assure you that inthe future all committee reports will bestUdied with care. I know that in thepast many of our committees have feltfrustrated because of the Association'sinability to follow through with many oftheir recommendations. Even these oldand apparently forgotten reports willserve as a gold mine for ideas as wemake a fresh start in approaching ourproblems and developing our program.

Avenues of Communication

Now given the substance of communi­cation and the staff to translate this sub­stance into meaningful terms, I mustdeal for a bit with the avenues of com­munication that are so readily availableto us. There are five of these at the pres­ent time. Others can be developed later.

(1) The Journal of Medical Education.Because of its scholarly articles, its re­ports of educational programs and ex­periments, its reports on both basic andoperational research, its editorials andits reports of committees and businessproceedings, the Journal constitutes amedium through which we can com­municate with all of our publics, bothin this country and abroad. The meetingof the Editorial Board just concludedleads me to believe that the Journal ison the threshold of another importantperiod of development.

(2) The Teaching Institute. This is amost important medium of communica­tion, particularly between our faculties

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and administrators and our colleaguesin other disciplines. The Institute re­ports, like the Journal, reach all of ourpublics. The research essential to theseInstitutes constitutes a body of informa­tion, which after being tested, discussedand integrated, becomes indispensableto the improvement of medical educa­tion. But if the Teaching Institutes, theInstitute reports and the research in­cident to the Institutes are to serve any­thing like their ultimate potential, muchmore than the attendance of the dele­gates to the Institutes as they now func­tion and the reading of the reports mustresult.

Three additional things should happen,first, each Institute delegate shouldpromptly transmit the substance and thespirit of each Institute to his faculty. Asa result each faculty should almost holdan institute of its own. Second, ourschool faculties do not come togetheroften enough for the, discussion of cur­rent and mutual problems and interests.The Annual Institute should serve asthe pattern and oftentimes the point ofreference for regional faculty meetings.The annual meeting of the SouthernAssociation of Medical Schools andTeaching Hospitals comes close to thistype of activity. Third, the Institutes andtheir reports should serve as the patternand the points of reference for nationalmeetings for those with special interestsand responsibilities. The meeting of theAdmissions Officers just concluded is anexample of what I mean here.

(3) The Annual Meeting. The extentto and the manner in which this meetinghas been growing in attendance andstature is ample evidence of its impor­tance as a medium of communication.It is not only the Annual Meeting itself,but the constellation of other meetingsthat precede and follow that are of im­portance. To illustrate, the TeachingInstitute, the day given to the govern­mental services, the meeting of the ad­missions officers, the many committeemeetings of our own and related organi­izations, and last but almost of firstimportance, the conversations and "bullsessions" that take place in the lobbies,corridors and rooms. This entire opera­tion is a very strenuous affair, and astime goes on it will become more strenu­ous. Importance justifies the effort.

While the Annual Congress of MedicalEducation conducted each February bythe American Medical Association is nota primary responsibility of this Associa­tion, it does represent another golden

71

opportunity for the communication es­sential to our effectiveness, particularlythe opportunity to meet with the gen­eral medical profession and the specialtyand licensing groups. Many of our com­mittees and committees upon which wehave representation meet at this time,and I strongly suspect that before longthe deans of our schools will find it nec­essary to take advantage of this occasionto add a business session of their own.

(4) School Visitation. Until now ourofficial school visiting has been largelylimited to the accrediting programwhich we share WIth the CounCil onMedical Education and Hospitals of theAmerican Medical Association. Whilethis type of visitation will continue tobe important, it is essential that, in ad­dition, our top staff have the time andenergy which will enable them to makefrequent, independent visits so that theycan develop an intimate knowledge ofeach member school, its faculty and Itsparticular programs and problems. Upuntil now, due to lack of time and en­ergy, I have been privileged to visit butfew institutions in this capacity, but eventhese few and all-too short visits haveconvinced me of the importance of thisparticular activity. Every school oper­ates in a milieu and must adjust toeducational and service demands thatdiffer from every other school. In short,no two schools are alike and unless thestaff leadership has both a direct knowl­edge and a "feeling" for each school andits setting, and also a personal acquaint­ance with its faculty and administrators,the Association will fall far short ofmeeting the potential of its opportuni­ties for service and leadership.

And while I mention the need for per­sonal acquaintance with our medicalschool administrators, I must make itclear that I include here, in addition tothe deans and their staffs, the presidents,chancellors and heads of governingboards, even the board members them­selves. It is essential that as the workof the Association grows in magnitudeand stature it does so with the informedsupport of these very important people.This represents an assignment thatshould receive our very early attention.After all it is the governing board andits chief administrative officer that rep­resents the source of authority of eachof our schools.

(5) Medical Education Week. MedicalEducation Week was initiated severalyears ago by the National Fund forMedical Education with the cooperation

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of the American Medical Association,the Association of American MedicalColleges, the American Medical Educa­tion Foundation, the Student AmericanMedical Association and the Woman'sAuxiliary to the American Medical As­sociation. Time and experience are be­ginning to reveal that this is proving tobe an important opportunity to acquaintthe American public with the funda­mental part which our medical schoolsare playing in this nation's system ofmedical and hospital care. Beginningwith the 1958 Medical Education Weekthe Association of American MedicalColleges will assume the major respon­sibility for the coordination of the sev­eral agencies that sponsor this program.The addition of staff in the field of pub­lic relations should enhance the effec­tiveness of our effort, particularly if by1959 we can have some reliable dataregarding the costs of operating ourteaching medical centers. I sincerelyhope that each of our schools will nowsupport Medical Education Week withrenewed interest. Each school willshortly begin to receive the communica­tions that will be essential to this effort.

Need for Adequate Support

If the Association of American Medi­cal Colleges is to assume a greater lead­ership role in the field of medical educa­tion, it must enjoy the complete supportof the faculties of its members colleges,and when I say support I mean bothmoral and financial. I submit that thisis no longer an association of medicalschool deans. Since the end of the war,while the medical school administratorshave played and should continue to playa role in Association affairs, the changeover from administration to faculty em­phasis has been rapid indeed. The Jour­nal of Medical Education has definitelybecome faCUlty centered and the vastmajority of the manuscripts that areoffered and accepted come from the rankand file of our faculties. The same canbe said for the papers that are presentedat our Annual Meeting. Our TeachingInstitutes are definitely faculty plannedand centered. Our faculties are more andmore playing a part in committee workand in representing the Association toorganizations whose purposes are relatedto ours. In short, it is my opinion thatif the Association rises to the challengesthat lie ahead, it will be because facultyparticipation has been added to the ef­fort. I suggest that the teachers of medi­cine are professional teachers in theirown right and that they be invited and

Minutes of the 68th Annual Meeting

urged to look upon the Association ofAmerican Medical Colleges as their pro­fessional association and the Journal ofMedical Education as their professionalpublication. If our faculties would ac­cept this position and as a consequencesubscribe to the work and the Journalof the Association through the mediumof the individual membership, I am cer­tain that both its financial and organ­izational security will be assured. In theyear ahead I hope that the leadership inall of our schools will work toward thISend.

Conclusion

I realize that these expanded remarkshave dealt with many different subjects.This is necessary because of the needfor adequate communication betweenmyself and my constituents. You mustbe made aware of the goals that I seeahead. If it had not been for the chal­lenges that are inherent in these goals,I would not have joined the Associationas its Executive Director. As the con­clusion of this report, I would like tooffer as the summary of these goals thestatement I made upon the occasion ofthe dedication of our new building.

"This beautiful and functional build­ing is the symbol of the unity that mustexist among this nation's schools of med­icine. It is also the symbol of the sta­bility and security of the organizationthat is essential to this unity.

It is therefore appropriate that, as weof the Association of American MedicalColleges dedicate this building, we alsorededicate ourselves to the goals setmore than three-quarters of a centuryago by this Association's founders i.e.the constant improvement of medicaleducation and the continuous increasein medical knowledge. But if the dedi­cation of this building and the rededica­tion of ourselves are to be meaningfulto our time and to time to come, wemust not only keep these goals beforeus but also the manner of their attain­ment.

To this end we must recognize thatthe most enduring influence and powercome from the exercise of intellectualleadership,-leadership that persuades,unifies and works steadily for progres­sive change through the presentation ofproperly gathered, properly organizedand properly presented information.

In subscribing to this thesis, the manyactivities of the Association-the Jour­nal; the Teaching Institutes; the schoolvisitation program, the Medical Audio­Visual Institute; the work of the Execu-

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tive Council and its many committees,and the supporting program of vigorousresearch-quickly take on a logicalmeaning because they then stand out asthe instruments of discussion, synthesisand communication essential to the lead­ership which we profess.

This occasion, therefore, must belooked upon as a very significant mile­stone in the history of the Associationof American Medical Colleges, for here,while we accept and dedicate a perma­nent home in which and from which wecan carryon our work, we also rededi­cate ourselves to the kind of work thatwe know must go forward if our medicalschools are to make their proper con­tribution to a nation that must continuehealthy and strong in a world rapidlyincreasing in complexity and competi­tive effectiveness."

REPORT OF THE SECRETARY AND EDITOR

The school visitation program of theAssociation and the Council on MedicalEducation and Hospitals included visitsand reports to 15 schools this past year.Assisting the Secretary m this programwere Dr. Robert Glaser, Dr. Arthur Eb­bert and Dr. Leonard Fenninger.

The visitation program for 1957-58got under way WIth a visit to the Uni­versity of Kentucky, September 11, 12.It will include visits to 15 schools, fourof which are in development. Assistingthe Secretary in the program WIll be Dr.Robert Glaser, Dr. Arthur Ebbert, andDr. John Cooper.

With the voting into Affiliate Institu­tional Membership of Laval UniversityFaculty of Medicine, another milestoneis passed in that all the existing medicalschools in Canada are now for the firsttime members of our Association. Thoughwe have an Institutional Member inPuerto Rico and have had for manyyears an Affiliate Institutional Memberin the Philippines, the voting of theAmerican University's School of Medi­cine in Beirut into Institutional Mem­bership establishes a new policy of con­sidering for membership medical schoolswith American charters, AmericanBoards of Trustees, American financialsupport and sponsorship, Americanteaching program, and American staffmembers.

Our membership list stands as fol­lows:

Institutional Members 83Affiliate Institutional Members 13

73

Sustainmg Members 8Individual Members 1,401

The need for a vigorous promotion ofIndividual MembershIps is apparent.

During the past year 10 questionnaireswere submitted to the Secretary's officefor recommendation. The recommenda­tion was for cooperation in 5, againstcooperation in 5.

The demand of foreign trained physi­cians for help in obtaining opportumtiesfor advanced training in this countrywas considerably less thIS year thanlast year. While 103 such students maderequests for help last year, only 50 madesuch requests this year. In addition tothe 50 requesting aSSIstance, 371 regis­tered m the National Intern MatchingProgram and 160 of these were matchedand received appointments in UnitedStates hospitals. The estabhshment ofthe Jointly sponsored Educational Coun­cil for Foreign MedICal Graduates onOctober 1, 1957 should contribute con­:>iderably to solving some of the knottyproblems associated WIth placmg foreIgnmedical graduates in United States hos­pItals.

The Journal of MEDICAL EDUCA­TION has had a very successful year.The quality of the articles submittedhas been steadily improving and thanksto our active Editorial Board the pro­portion of solicited articles increased.Twenty-one manuscripts were rejectedthis last year. A backlog of approxi­mately 60 articles makes a 6 months lagbetween receipt of the article and itspubhcation almost routine but thanksto a Macy Foundation grant a rush ar­ticle can simply be added to a previouslyplanned issue and the added cost of theoversize issue absorbed. In the courseof the year five supplements were pub­lished, each one subsidized by an outsideagency and each one serving as an extrabonus to our readers. For the first timein the history of the Journal the saleof advertismg has exceeded $35,000.Throughout the year each article hasbeen summarized in Spanish and thissummary pubhshed. Through the effortof Dr. Bowers, Chairman of the EditorialBoard, the number of foreign corre­spondents has been increased and thenumber of reports on progress in medi­cal education m other countries hasmultiplied. The Journal is definitely be­ginning to take its place as an importantmedium for the international exchangeof Ideas m medical education.

As I close this 9th and last report tothe AssociatIOn, may I thank you all tor

REPORT OF THE TREASURER

Mmutes ot the 6llth Annual Meetmg

$271,804.47

$ 71,305.84

. $343,110.31

$108,910.0082,973.48

2,973.287,304.394,296.55

21,137.1235,227.95

8,494.86486.84

$137.629.312,373.97

20,402.4225,454.2616.024.6/19,479.0827.286.02

2,720.20382.32

52.646.042,248.12

., $ 10,000.0050,000.0010,000.00

1,305.84

$85,000.0013,910.0010,000.00

Dr. Stockton Kimball presented aseries .of slides which summarized thefinancial operations of the Associationover the past year as follows:

transfer to its new offices in Evanston,and

Whereas, during this same time, asEditor, he has played a prominent partin raising the stature of the Journal OfMedical Education in the fields of medi­cal journalism and higher education, and

Whereas, he is now leaving the Asso­ciation to assume the Directorship of theEducational Council for Foreign Medi­cal Graduates, 11n. activity that may wellprove to be of the first importance inmaintaining the standards Of medicaland hospital service in this country,

Now be it therefore resolved that theAssociation of American Medical Col­leges, at this 68th Annual Meeting, Oc­tober 22, 1957, express deep apprecia­tion for the good works of Dr. Smileyand wish him every success with hisnew and important assignment.

YEAR 1956-1957EARNED INCOME

Dues-lnstitutioMIDues-lndividu~1 .Dues-Sust~ining .

M. C. A. T.-Revenue. . .Bldg. Fund-Interest IncomeInterest on InvestmentsSubscriptionsPublic~tions. .Advertising .., .Film S~les & Rent~ls .Miscell~neous . ., . .

TOTAL INCOME.

DISBURSEMENTS FOR REGULAR SERVICESS~I~ries & AnnuitiesP~yroll T~xes .....Contr~eted Services & EquipmentOffice Supplies, Telephone, Post~ge .Rent & House Expenses ..Furniture & Equipment.. . . '"Tr~veling '. . " .Annu~1 Meeting .. . .Insur~nce ... . .Public~tions & Printing ..... , . . ..M~iling ~nd Engr~ving (Journ~l) ..

GRANT INCOME FOR SPECIAL PROJECTSAbbott L~bor~tories .N~tion~1 He~rt Institute ..Josi~h M~cy, Jr. Found~tion..Overhe~d on Proiects ...

74

the fine cooperation and support youhave given me throughout my term ofservice and congratulate you on the wayin which you have implemented the As­sociation to carry on its increasingly im­portant work in the years ahead.

As Director of the newly establishedEducational Council for Foreign Medi­cal Graduates I will have many occa­sions to call upon you for assistance andI hope you will continue to be as co­operative in the future as you have beenin the past. DEAN F. SMILEY, secretary.

After the report of the Secretary andEditor, the following resolution wasunanimously passed.

Whereas, Dr. Dean Smiley has servedthe Association of American Medical

. Colleges faithfully and effectively asExecutive Secretary and Editor since1948, and

Whereas, during this time as Secre­tary he has assisted the Association withthe expansion of its program and re­sponSibilities, with the enlargement ofits staff and with the construction of and

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TOTAL DISBURSEMENTS

Net Income (working c~pit~l) ... $154,191.74(restricted funds) . .. 162,030.05

BUILDING FUND

75

$265,331.71229,697.47

$ 35,63424

$343.110.31

$307.476.07

$237,896.1070.00

6.908.5814,290.35

$316,221 79

762.2767.45

. $ 20.488.642,840.003,221.55

.... .... 5,683.89. $162,930.34

8.986.91 171,917.25

bl,180.38

Building:Contr~ct

Testing Ch~rge ..Additions .Architect's Fee .

Tot~1 reserves 6/30/57 .

DISBURSEMENTS FOR SPECIAL PROJECTSFilm Purchases & Expenses.. . .Foreign Subscriptions ..... " .Moving ......•....M~intenance ..Building , ..l~nd , .

Advertising & Circul~tion PromotionMiscell~neous '" .... .. , . . ..

Te~ching Institute ~nd Speci~1 Studies

Deducted from Reserves ..

Minutes of the 68th Annual Meeting

Medical Colleges. Inasmuch as thcrehave been no changes in the Committee'sleadership nor in the organization of itsactivities during the past year, it is notnecessary to review these activities indetail again this year. Dr. Berry con-

$259,165.03

B,8 18.251.068.66

.. $295,970.77

25,882.00'1,03683"

26,918.83

..... $286,083.86

.$ 5,974.75148.50

2.695.00

258.82

I. Minules 01 Ihe Proceedings, 66th Annual Meeling:Report 01 the Committee on reaching Instilulos andSpecial Siudies, Journol of Mo<ficol felucotion. Vol.30. No. 12, December I95S, pp. 727.ns.

2. M,nul.. of Ihe 671h Annual Meeling: Reporl of IheOlreetor of Research and Reporl of Ihe Commllleeon Educalional Research and ServIces, Journol ofMo<flcol fducolion, Vol. 32, No. J, pp. 61·63 and71·78.

. " .GRAND TOTAL

........... $10,200.0015,682.00

$ 178.D1

Building Tot~1

Air ConditioningArchitect's Fee ..

• 1st p~yment-p~id 9/25/572nd p~yment-due ..

•• Due on fees-~rchitects' .... .,.Due (.possibly) architect's fee on

~ir-conditioning .. ., . '"

Ground Tot~1

B~ck T~xes ......

Ground:Landsc~ping ., ...Tree Remov~l " ..Sprinkler System ..

JOINT REPORT OFCOMMITTEE ONEDUCATIONAL RESEARCHAND SERVICES AND THEOFFICE OF THE DIRECTOROF RESEARCH

The developmental history of theCommittee on Educational Research andServices (CERS) and summaries of itsmanifold research and service activitieswere detailed in the Committee's reportsmade at the 66tht and 67th:! AnnualMeetings of the Association of American

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tinues to serve as Chairman of the Com­mittee, Dr. Hunter as Chairman of theSubcommittee on Evaluation and Meas­urement, and Dr. Gee as Director ofResearch. Dr. Darley, who joined theAssociation as Executive Director inFebruary of 1957, has contributed gen­erously of his time and effort to variousproblems with which the Committee hasdealt.

Growth in the Committee's programsduring the past year has been manifestedchiefly in emerging research and test­development activities and in prepara­tion for the next series of Teaching In­stitutes. Beginning in 1958, these Insti­tutes will delve into the problems ofteaching and learning during the futurephysician's clinical and postgraduateyears. The many meetings that havebeen held during the past year in carry­ing out the work of the Committee, andto which various subgroups of the Com­mittee's membership have contributed agreat deal of time and effort, are speci­fied in the sections of the present reportdevoted to an account of these delibera­tions.

The change in location of the Asso­ciation's central office from downtownChicago to Evanston resulted in a com­plete turnover in the clerical staff of theresearch organization and approximatelya 50 per cent turnover in the technicalInternational Business Machines staff.Obviously, such a revolution has had itseffect on the smooth operation of theCommittee's activities. In addition, thenormal course of events has' resulted inthe loss of key supervisory and staff­level personnel. It is expected that re­staffing operations will be completed onNovember I, 1957. It is anticipated alsothat many improvements will by thenbe effected in the promptness and effi­ciency with which the Committee's ac­tivities can be carried on. Notable amongnew appointments to the research staffare: Mr. Charles Schumacher as As­sistant Director of Research to replaceMr. Clifton Gray; Mr. Fred Meier, whoreplaces Miss Joan McJoynt in supervis­ing technical and IBM operations; andMiss Lorraine Camper, who will suc­ceed Mrs. Lotus Barnes as Administra­tive Assistant when the latter assumesa staff-level position in the Association'scentral office. Mrs. Barnes earlier in theyear replaced Mrs. Frances Halsey. Mr.Schumacher previously worked with theresearch staff during the summer of 1956when he conducted the analysis of thequestionnaire materials for that fall'sInstitute. His doctoral dissertation, which

Minutes of the 68th Annual Meeting

will presently be submitted to the De­partment of Psychology at the Uni­versity of Minnesota, is concerned withmethods of identifying the characteristicsof medical students who plan to engagein various types of careers in medicineand in specialty practice. Research forhis dissertation was carried out underthe auspices of the Committee, and anaccount of this research will be pub­lished in the Journal of Medical Educa­tion. Mr. Meier joins the research stafffollowing ten years of technical super­vision of data-processing activities atthe National Opinion Research Centerat the University of Chicago.

Finances. Expenditures for the Com­mittee's operations totaled nearly $104,­000 for the 1956-57 fiscal year, exclusiveof restricted research project and Teach­ing Institute activities. Expenditures forthe latter totaled approximately $11,500and $50,000, respectively. The Com­mittee's expenditures were within theamounts budgeted for each area of ac­tivity. Because income from publicationsexceeded expectations, a balance of ap­proximately $6,000 was returned to theAssociation's general funds.

During the past year, the Common­wealth Fund and the National Institutesof Health have reaffirmed their confi­dence in the Committee's programs. A$100,000 grant from the CommonwealthFund contributes $50,000 for the supportof research and service activities and$50,000 for the partial support of the1958 and 1959 Teaching Institutes. Par­tial support, in the amount of $25,000per year, has been granted by the Na­tional Institutes of Health for the fourTeaching Institutes that are scheduledfor 1958 to 1961. The National Institutefor Neurological Diseases and Blindnesswill sponsor the 1958 Teaching Institute,the National Institute of Mental Healthwill sponsor the 1959 program, and theNational Heart Institute the 1960 and1961 programs.

The Committee wishes to take thepresent opportunity to express sincerethanks to the Commonwealth Fund andthe National Institutes of Health of thePublic Health Service for thus continu­ing to recognize and encourage the mem­bers of the Committee in their efforts toserve society through the developmentand improvement of medicql education.

Teaching Institutes. The 1957 Instituteon "The Ecology of the Medical Stu­dent" will be held from October 15 to19 at Atlantic City, New Jersey, underthe dynamic leadership of Dr. Robert J.Glaser, Chairman. This Institute con-

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eludes the pair devoted particularly tothe problems of the medical student. Thebackground of the development of thispair of Institutes was discussed in detailin the Committee's 1956 Annual Report,which was published in the January1957 issue of the Journal of Medical Ed­ucation. The chronology of the TeachingInstitute program as a whole, and of the1953-55 series of Institutes that dealtwith the problems of teaching the basicmedical sciences, was presented in theCommittee's 1955 Annual Report, pub­lished in the December 1955 issue of theJournal.

The Report of the 1956 Institute, TheAppraisal of Applicants to MedicalSchools, was published in the fall of1957 in two simultaneous editions, aclothbound volume and Part 2 of theOctober 1957 issue of the Journal. Whenthis book is joined by the Report of the1957 Institute on "The Ecology of theMedical Student," the two volumes willmake available to medicine and to highereducation at large a unique compendiumof information on, and interpretation of,the interrelationships among psycho­logical, sociological and administrativefactors associated with education for aprofession. Other professions, lacking asthey do a similar forum for the free ex­change of ideas and information, standto benefit significantly from the Associa­tion's efforts.

At the meeting of the Committee onEducational Research and Services thatwas held on November 11, 1956, it wasagreed that the 1958 Institute on theproblems of teaching clinical medicinewould require an extended period oftime for adequate preparation. The As­sociation's Executive Director, Dr. Dar­ley, with the assistance of the Chairmanand the members of the Committee onEducational Research and Services, or­ganized two ad hoc planning sessions.Through the generosity of the Common­wealth Fund, these ad hoc meetings wereheld on May 18 and June 29 at Hark­ness House in New York City. Distin­guished representatives of clinical de­partments chosen from medical schoolsthroughout the nation were invited tojoin in planning for the series of com­plex Institutes that lies ahead. Repre­senting the Committee and the Asso­ciation's staff at both meetings wereDoctors Berry, Darley, Gee, Hunter andJacobsen. Present at the May 26 meetingwere: Doctors Lester Evans, KnightAldrich; Dana Atchley, Charles Jane­way, Richard Magraw, Carl Moyer,George Reader and Julius Richmond.

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Present at the June 26 meeting were:Doctors Evans, Reader and Richmond,who helped to provide continuity for thediscussions, and Doctors Thomas Brooks,Thomas Holmes III, .Ian Stevenson,George Jackson, Ben Wilson and Stew­art Wolf Jr. Stenotyped records of thediscussions held at these ad hoc meetingsare available in the Committee's files.

Following the second ad hoc session,the appointment of Dr. Julius Richmondof Syracuse University as Chairman ofthe 1958 Institute was recommended tothe Executive Council.

Tentative selection of a PlanningCommittee for the 1958 Institute wasmade at another ad hoc meeting that washeld on July 14 in Estes Park, Colorado.In attendance, in addition to the Com­mittee's and Association's staff repre­sentatives who had been present at theprevious mcctmgs, were the new Chair­man, Dr. Richmond, and Dr. Glaser,Chairman of the 1957 Institute. Objec­tives toward which the 1958 Instituteshould aim were extensively explored,an agreement being reached that thecontent should center around the learn­ing process of the student. Such tenta­tive subtopics for the Institute weresuggested as: the setting for learning,faculty development, student evaluation,and curricular development.

The need for a nationwide study onperception by the public, the medicalfaculty, and the medical student of so­ciety's medical requirements and de­mands was discussed. Such a study,designed to prOVIde background for theseries of "clinical" Institutes, wouldnecessarily require the help of a pro­fessional survey research center. OnJUly 26, Doctors Richmond, Jacobsenand Gee viSited the Michigan SurveyResearch Center to explore the feasi­bility of securing the services of theMichigan group for undertaking a na­tionwide study under the auspices of theAssociation. Further explorations arecontingent upon the availability of newfinancial support.

Meetings of the Planning Committeefor the 1958 Institute will be resumed inNovember, after the complete member­ship of the Planning Committee has beenapproved by the Executive Council.The Continuing Group' on Student Evaluation.An immediate result of the l!J56 Insti­tute on "The Appraisal of Applicantsto Medical Schools" was the earnestexpression of need by admission offi­cers for a new mechanism to make pos­sible the implementation of programsto which the Institute had opened the

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doors. The Committee on EducationalResearch and Services was requested tosponsor an arrangement through whichadmission officers could continue to meetregularly to learn about selection tech­niques, to hear current reports of re­search on selection methods, and to de­velop projects aimed broadly at im­proving recruitment, appraisal and ap­plicant selection.

The Committee agreed to sponsor anew organization, asking Dr. John L.Caughey Jr., to act as Chairman. Anad hoc committee, consisting of membersof the 1956 Institute Planning Commit­tee, met on February 10, 1957, to ar­range for the first meeting of the neworganization, which will be held betweenthe conclusion of the 1957 Institute andthe start of the 68th Annual Meeting ofthe Association. This meeting will followthe techniques developed for the Teach­ing Institutes-brief general meetings be­ing followed by round-table discussions.Material to be presented at the meetingon October 19-20 includes discussions ofthe role of the Association's researchoffice in the admission procedure, plansfor MCAT development, the use of testsin applicant appraisal, and a report onthe research concerning personality andinterest measurement that is being car­ried on under CERS auspices.

At the conclusion of the first meetingof Dr. Caughey's group, considerationwill be given to the desirability of es­tablishing a continuing and more formalorganization.

Medical College Admission Test. In its1956 report to the 67th Annual Meet­ing of the Association, the Committeedescribed a study made during 1955-56of the status of the MCAT. It was thenreported that the test has well served itspurpose since 1948, when it was estab­lished in its present format, but thatprogress in the field of test methodologyand construction now indicates the de­sirability of the establishment by CERSof a program of test development.

Plans for a test-development program,to be carried on under the guidance ofof CERS by the Educational TestingService (ETS) of Princeton, New Jersey,were approved at the Committee's meet­ing held on November 11, 1956, at Colo­rado Springs. The Subcommittee onEvaluation and Measurement was au­thorized to work with representatives ofthe ETS staff toward the preparation ofa specific proposal, both for the develop­ment of new forms of the test and forappropriate research projects to investi­gate their utility.

Minutes of the 68th Annual Meeting

As a result of the 1955-56 study, it hadbeen agreed that (a) new forms of thetest would be needed by 1960; (b) itwould be desirable to consider some re­vision of content for the new forms; (c)a panel of teachers drawn from variousmedical schools should be selected tomeet with representatives of the Com­mittee and ETS for the purpose of de­fining the intellectual qualities believednecessary for optimal success in medicalschool; (d) on the basis of (c), ETSshould prepare a proposal for test devel­opment and research to be submitted tothe Subcommittee on Evaluation andMeasurement.

Doctors W. P. Anslow, John L.Caughey Jr., George A. Perrera andGordon H. Scott constituted the panelreferred to above. This group met withrepresentatives of the Committee (Doc­tors Berry, Hunter and Gee) and of theETS staff on January 4 and 5, 1957. Fromthe discussion of intellectual qualitiesbelieved to be important in the success­ful development of a future physician,the following emerged:

(1) Flexibility in thinking - theability to change or to re­evaluate an accepted hypothe­sis in the light of new evi­dence;

(2) Balanced judgment-the abil­ity to evaluate and to weighthe importance of quantitativeand semi-quantitative factorsin a complex in which the ab­solute or "true" value ofthese factors is unknown, andto arrive at a reasonable hy­pothesis among the many pos­sible hypotheses provided bythe complex and factors;

(3) Critical perception-the abil­ity to evaluate the printedpage or the spoken word in animpartial, nongullible manner;

(4) Educability-the capacity forcontinuous intellectual growth;

(5) Selectivity-the ability to se­lect from a mass of learnedmaterial those elements rele­vant to the problem at hand;

(6) Synthesizing ability-the abil­ity to perceive unity and re­latedness among apparentlydiscrete areas of knowledge;

(7) Cultural awareness-a broadinterest in, and sensitivity to,the world of which the indi­vidual is a part.

On the basis of these criteria, ETS de­veloped a proposal for the developmentof new and revised forms of the test by

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1960 and for a program of continuingresearch aimed at further improvementof subsequent forms. The Subcommitteeon Evaluation and Measurement metwith ETS on April 13, 1957, for the pur­pose of reviewing, amplifying and clari­fying the proposal. The results of thisdiscussion were presented by Dr. Geeand Dr. Hunter to the Association'sExecutive Council on May 24, 1957. Fol­lowing the Executive Council's review ofthe envisioned program and approval ofthe expenditure of funds from incomederived from the administration of thetest, requested additional revisions weremade in the proposal by ETS. Thisproposal, in its final form, will be re­viewed by the Committee on Educa­tional Research and Services at itsmeeting on October 20, 1957.

Although the technical nature of theproposal does not warrant its repro­duction in this report, copies may be ob­tained from Dr. Gee by those who areinterested. At the spring and fall admin­istration of the MCAT in 1957, norma­tive data have been obtained concerningthe applicant's state of residence, amountof undergraduate education, and majorfield of study. From these data, distribu­tions of scores will be published thatwill enable admission committees tomake more definitive comparisons ofstudents' test performances. It will bepossible to determine, for example, howeach applicant compares with other ap­plicants from the same geographicalregion, how he compares with otherstudents who have had a similar amountof undergraduate education, and how hecompares with students whose under­graduate major field of study is similarto his own.

It was reported a year ago that ahandbook to assist admission commit­tees in making maximal use of the in­formation available from the MCATwas being planned. The need for inten­sive work on test development tookprecedence over the handbook, largelybecause information deemed essentialfor this manual was not available. Thenormative data prescribed above areneeded, as well as a substantial body ofvalidity data. The latter are currentlybeing obtained through a joint studywith the National Board of Medical Ex­aminers of interrelationships amongMCAT scores, achievement as meas­ured by the National Board tests, andachievement as reflected in grades ob­tained in medical school. Representativeexamples of the use and interpretation

i9

of MCAT data, in conjunction with theother information that is usually avail­able on applicants to medical schools,are also being gathered. In preliminaryform, the handbook should be availableby the spring of 1958.

The annual and alternate-year reportsinvolving the MCAT that are routinelymade to medical schools and undergrad­uate colleges were described in detail inthe 1956 report of the Committee. Theproduction of these MCAT reports con­tinues unchanged. The trend reported ayear ago toward lower scores in thecategories of quantitative ability andscience achievement, has continued. Onepossible explanation of this trend is thatlarger numbers of students whose talentsare strongest in the verbal-linguisticareas are applying for entrance to medi­cal schools. Another possibility is thatfewer students of outstanding abibtiesand interests in quantitative and sciencefields are making application.

Reports to medical schools. The Com­mittee's plans to establish routine re­ports to the medical schools on variousaspects of the application, admission andprogress of medical students have beendelayed as a result of the Association'smove to new quarters and the accom­panying turnover in staff. It has beenplanned also to prepare a handbook formedical schools, describing in detail theinformation exchange through whichperiodic reports are made possible, andproviding a calendar of target dates formedical schools to follow in submittingthe essential data on which the reportsare based. Preparation of this handbookhas been delayed until procedural detailis finalized.

The rapid development of the Com­mittee's research programs has revealedinadequacies in the existing record­keeping system, which has grown byaccretion since its inception in 1949. Ed­ucational Testing Service, too, has re­ported difficulties arising from the factthat records and reporting procedureshave outgrown the IBM c1jrd layouts. Thesystem has therefore been revised thisyear and brought up to date; the transi­tion is nearly complete. Decision by theCommittee is required on one remainingproblem concerning reporting procedureson student accomplishment. Once actionhas been taken by the Committee, rou­tine procedures can be established andthe handbook can be prepared.

Two reports, known as the Under­graduate Origins Reports, which describethe progress of students through medical

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schools in terms of undergraduate col­leges of origin, were changed at the June1956 meeting of the Committee from an­nual to alternate-year reports. Thesereports are scheduled for issuance inodd-numbered years; this year, one wasissued in August-the second is cur­rently in press.

The twa annual reports that keepmedical schools informed of their com­petitive status in respect to other medi­cal schools were last issued in June andAugust of 1956. The Committee will con­sider at its October 1957 meeting thepossibility that the breadth of the Com­mittee's services might be increasedif the latter reports, like the Undergrad­uate Origins Reports, were scheduled foralternate years.

The following studies for use by medi­cal schools and the public are beingmaintained: (a) bibliography of studieson medical student selection and evalu­ation, (b) vocational guidance readinglist on careers in medicine and otherhealth professions, and (c) annual cata­logues of opportunities for summer study

·in all the medical schools of the UnitedStates.

One aspect of preparation for the 1956Institute on "The Appraisal of Appli­cants to Medical Schools" involved a sur­vey of 1956 freshman medical studentopinion of the admissions process. A re­port on the over-all freshman consensusis included in the Report of the Institute,to which reference has been made pre­viously. After this analysis, which wasbased on a 10 per cent random sampleof student responses, the data wereprocessed in their entirety and a con­fidential report was prepared for eacliindividual medical school. These reportshave enabled each school to study thereactions to their admission proceduresboth of students who enrolled in theirschools and of students who applied butenrolled elsewhere. A variety of infor­mation about the distribution of socio­economic and educational backgroundsof the student body was also provided.

In December 1956, at the requestof many medical schools that are inter­ested in, or actually engaged in, per­sonality and interest measurement re­search on medical students, a reportsummarizing all reported ongoing andrecently completed research projects inthese areas was distributed to all medi­cal schools in the United States. Thissummary has also been published in theappendix of The Appraisal of Applicantsto Medical Schools: Report of the Fourth

Minutes of the 68th Annual Meeting

Teaching Institute. Exchanges of infor­mation of this kind would be helpful toall who are involved in, or who contem­plate, research studies of student charac­teristics. Unnecessary duplication ofeffort can be avoided, and those engagedin projects with similar aims gain theopportunity to exchange information onmethods, procedures and results. Whetherthe information contained in the sum­mary is of sufficient value to warrantperiodic re-issuance, will be investigatedduring the coming year.

Admission Requirements Book. The 1957­58 Admission ReqUirements of Amer­ican Medical Colleges was publishedon August I, more than a month ear­lier than in previous years. The re­sults of last year's Institute question­naire analysis made clear the fact thatthe admission book is needed by appli­cants to medical schools long before thestart of the school year-nearly half ofthe medical schools in the United Statesbegin to receive applications before Jul;r1 of the year preceding the entrance of anew class. If it is possible for medicalschools to cooperate by submittingpromptly the information needed to pro­duce the admission book, earlier publi­cation next year will be attempted. Thecurrent edition includes for the firsf.time detailed information on each of theCanadian medical schools. Thus, stu­dents interested in studying medicinenow have available in one volume accu­rate information about every medicalschool in the United States and Canada.

Agreement on admission procedures

For many years, the Association hasstriven to make easier for the studenthis transition from college to medical~chool. These efforts culminated at thebusiness session of the 65th AnnualMeeting of the Association at FrenchLick, Indiana, on October 20, 1954. Atthat time, the provisions now commonlyreferred to as the "traffic rules" wereadopted by the Association with a dis­senting vote of one. In recent months,there has been some local confusionconcerning the traffic rules, apparentlyowing to misunderstanding at a fewmedical schools of the agreement on ad­mission procedures adopted by the Asso­ciation. The Executive Council, there­fore, at the 68th Annual Meeting of theAssociation at Atlantic City instructedthe Committee on Educational Researchand Services to republish these trafficrules. The Committee was requested,alro, to review the steps that led to the

medical schools to make sure that he ismaking the best choice of schools avail­able to him.

"Whereas, this matter has been care­fully studied by the Committee onTeaching Institutes and Special Studiesand its recommendations have had fur­ther study by the Executive Council, beit therefore,

"Resolved that the membership of theAssociation of American Medical Col­leges approves the following admissionprocedures:

"1 No place in the freshman classshall be offered to an applicant morethan one year before the actual startof instruction for that class.

"2 Following the receipt of an offerof a place in the freshman class, a stu­dent shall be allowed at least two weeksin which to make a written reply to themedical school.

"3 Prior to January 15, this written!eply may be either a declaration ofintent or a formal acceptance of theplace offered. When the applicant hasdeclared his continued interest withinthe two-week period, the medical schoolagrees to hold a place for him untilJanuary 15, unless he indicates that hehas been accepted elsewhere and with­draws his application. He may, of course,and often will enter into formal ar­rangements with the one medical schoolof his choice before January IS. Becauseof the wide variation in the acceptancedates of different medical schools, somestudents will wish to change their mindsafter filing a declaration of intent, andit is understood that nothiTtg unethicalis implied when a student does sochange his mind. In such an event, thestudent is obligated to send promptwritten notification to every school hold­ing a place for him.

"4 The payment of a nonrefundabledeposit shall not be required of anyapplication prior to January 15.

"5 When a student files a declarationof intent, a refundable deposit-not toexceed $100-may be required at thediscretion of the school granting theacceptance. Such deposits will be re­funded without question upon requestmade prior to January 15.

"6 The deposit, when required to holda place in the freshman class after Janu­ary 15, shall not exceed $100.

"7 By January 15 each applicant forwhom a place in the entering class isbeing held must either accept the offerformally and pay any required nonre-

81Minutes of the 68th Annual Meeting

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present agreement.In order to protect the best interests

of both the applicants and the medicalschools without unnecessarily restrictingthe freedom of either, the ExecutiveCouncil instructed the former Commit­tee on Student Personnel Practices andits successor, the Committee on Teach­ing Institutes and Special Studies, tostudy the complicated matter of admis­sion procedures and to devise appropri­ate provisions.

The Executive Council, reflecting thewidely held views of the member col­leges, had been concerned for many yearsabout the undesirable pressures exertedby a few medical schools upon theirapplicants. Thus, at the meeting of theCouncil in November of 1949, it was theconsensus that medical colleges shouldnot select students more than one yearin advance of their actual matriculation,i.e., more than one year before the startOf professional study. Simila~y, in Chi­cago two years later, the Council wenton record as recommending stronglyagainst issuing acceptances, even provi­sional acceptances, more than one yearprior to actual matriculation. In 1952,the Council again recorded its disap­proval of the practice of offering defi­nite acceptances and requiring substan­tial reservation fees prior to the January1 preceding entrance to medical school.In October 1953 at Atlantic City, themembership of the Association sup­ported without dissent the ExecutiveCouncil's recommendation that no ac­ceptances be offered more than one yearin advance of actual matriculation.Finally, to give substance to these re­peated recommendations, the presentprocedures were adopted almost unani­mously at French Lick. They operatefairly only when applicants as well asschools adhere strictly to their spirit.This point was emphasized at ColoradoSprings at the 67th Annual Meeting ofthe Association, and again at AtlanticCity at the 68th Annual. Meeting. The

1:! so-called traffic rules are reproduceda below as printed in the proceedings of;:l the 65th Annual Meeting (Journal ofU Medical Education for December 1954,8 Vol. 29, No. 12, pp 73-74).

"Whereas, date of final acceptance ofthe applications of new students withthe filing of a nonrefundable depositvaries widely among member institu­tions of the Association.

"Whereas, variation in acceptance datemakes it very difficult for the aver­age student applying to four or more

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fundable deposit or withdraw his ap­plication.

"8 Following January 15, an appli­cant offered a place in a freshman classmust either formally accept or refusethe place, but he shall have at least twoweeks in which to decide. Deposits madeafter January 15 shall be nonrefundable.

"9 To assist the medical schools, theAAMC office will compile a list of thestudents who have formally accepted aplace in the freshman class. This list willbe distributed about February 1 andwill be kept current by frequent revi­sions."

Reports to Undergraduate Colleges. Therehas been no change in this programduring the past year. Reports are is­sued to undergraduate colleges con­cerning the distribution of ability asmeasured by the MCAT performance oftheir students who apply for entranceto medical schools, the success of theirformer students in gaining admission tomedical schools, and the success in medi­cal school of those who enter as meas­ured by regularity of progress andgrades. Each year, as these reports areissued, the volume of acknowledgmentsexpressing interest and gratitude to the'Committee for issuing them reaffirms thedesirability of continuing this service.

Applicant Information. The 1956-57 ap­plicant study is scheduled for publica­tion in the January 1957 issue of theJournal of Medical Education. No un­predicted changes of significance in thenumber of applicants has occurred, andthe evidence. indicates that the increasewill be rapid in the years ahead. The1955 increase of 400 became in 1956,1,000. It is expected that the 1957 appli­cant population will show an equallygreat proportionate increase. There islittle question that the need to stream­line application procedures to permithandling larger numbers of applicants isupon us.

Research Services. Requests for data toaid in undergraduate college, medicalschool, national agency, and statewideresearch projects continue to be receivedby Dr. Gee. An increasing number of un­dergraduate colleges and state and na­tional agencies appear to be launchinginvestigations in which the informationin AAMC records would be useful. Re­quests involving negligible expendituresof staff and/or mM time are met by Dr.Gee routinely; major projects are re­ferred to the Committee for approval.Agencies other than medical schools are

Minutes of the 68th Annual Meeting

asked to bear the cost of producing re­ports that involve substantial use of stafftime and facilities.

Currently, major projects under wayare being sponsored by the Cancer Re­search Institute and Harvard College. Itis the policy of the Committee to assistapproved research projects whenever itis possible to do so without interferingwith regular work. The current backlogof requests is such that it is not possibleto meet new requests for several months.

Research Development. The Committee'sprogram of research on the character­istics of medical students, establishedin 1956 and outlined in detail in the 1956report, is making rapid progress.

A study of the relationship betweenperformance in medical school andamount of undergraduate education priorto entrance to medical school, has beencompleted and is being prepared forpublication. In brief, the results ofthis study~ndicate that nearly all thevariation in grades that appears to beassociated with amount of undergrad­uate education can, in fact, be attributedto variations in ability as measured bythe Medical College Admission Test.

A second study nearing completion in­volves an analysis of the complete his­tory of the 1952 freshman class. A widevariety of breakdowns have been em­ployed to study relationships betweenvarious progress classifications, failuresand drop-outs, on the one hand, andcharacteristics of schools, age, sex andability, on the other. Both of these stud­ies will be submitted for publication tothe Journal of Medical Education.

During the past year, a large propor­tion of time allotted to research on per­sonality and interest measurement hasnecessarily been spent in initial data­processing activity such as test scoring,collating information on individual stu­dents from a variety of sources, trans­forming data from one form to anotherthat is better suited for statistical analy­sis, and even in extending published sta­tistical tables for use with odd samplesizes. Additional test data were collectedat 12 schools to augment the size of sam­ples of students who anticipate enteringvarious specialties and to provide infor­mation concerning the degree to whichsuccessive classes of students in a singleschool resemble one another.

Students tested as seniors in the springof 1956 were followed up in the springof 1957. Ninety-seven per cent of theseyoung physicians replied to our inquiryrequesting information about their plans

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for additional study and practice. Sucha high rate of return-rare in the case ofan inquiry made by mail-is gratifyingmdeed.

The complexity and the technical na-.ture of this research preclude the pres­entation of results in the present report.One may, however, sketch the generaloutline of the studies that are planned orare already in progress, adding notes onthe potential utility of the results ofthese kinds of investigations.

J. Wor~ in progress. Studies are beingmade of the nature and extent of varia­tion of measurable personal character­istics of men now entering the medicalprofession. Interest, ability and person­ality test data are being studied in threecontexts:

(A) Comparison with other groups:How do the characteristics of freshmanand senior medical students, as groups,compare with those of other college stu­dents, and with those of men in otherprofessions and occupations? What char­acteristics do they share in common andhow do they differ? The kinds of com­parisons that can be made are, of course,limited by the availability of informa­tion on whi~h to base comparisons. Pub­lished normative data on the Edwardsand Allport-Vernon-Lindzey tests per­mit immediate comparisons of medicalstudent characteristics measured bythese tests with those of college studentgroups. The scores on the Strong inven­tory provide direct comparisons of thedegree to which the interests of ourmedical student groups resemble the in­terests of men who are considered "suc­cessful" in 45 professions and occupa­tions, including the medical profession.Studies in progress at the Institute ofHigher Education at the University ofCalifornia wIll make available furthercomparative data.

The ultimate implications of thesecomparisons will of necessity be specu­lative until such time as we are ablesatisfactorily to identify the "good" vs."poor" representative of the medicalprofession. Nevertheless, it is possible onthe basis of data such as these to deter­mine whether present-day education isproducing men representative of a broador narrow range of personal character­istics and whether these people arestrongly representative of particularsegments of our national culture. Thedistribution of socio-economic status andeducational level of parents of medicalstudents differ considerably from thosefound in the general population - or

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even in the college population at large.The question is whether distributions ofpersonal characteristics differ also. Itwill be possible to examine, on logicalgrounds at least, the relationships be­tween trends in demands for types ofmedical service and the potential sup­ply of physicians who, as indicated bytheir interest and personality character­IStiCS, are likely to provide such services.

(8) Comparisons between schools: Itis known that average ability levels asmeasured by the MCAT vary consider­ably from school to school. Do patternsof interest and personality characteris­tics vary similarly? We wish to deter­mine whether schools can be groupedin terms of student characteristics. Thequestion is complex-it involves studyof the effects of the specific environ­ment of a school on student character­istics and of the relationship betweenpatterns of characteristics and environ­mental factors as these are in turn re­lated to performance. It IS believed thata sound contribution toward under­standing of the complexity of these re­lationships can be made by studyingsimultaneously the within- and between­school relationships of student charac­terIstics to student performance. If it isfound that schools do form stable, distinc­tive clusters, It will be possible to inves­tigate the relative success in medicalschool of students who fit and of thosewho deviate from the established <¥usternorms.

(C) Comparisons among groups of stu­dents planning to enter various types ofmedical practice: Studies of these rela­tionships are of potential value for theselection of students in that, armed withfactual information about the patterns ofcharacteristics of students who are likelyto choose various types of careers withinthe profession, admIssion committeescan more or less deliberately diversifyor unify their student groups in termsof the kinds of education they are bestequipped to provide. UltImately, itshould be possible at a national level toprovide information that will help tomaintain a favorable balance betweensociety's demands for types of servIceand the supply of physicians who will bemotivated toward providing the kinds ofservices demanded. In the interest of themedical student himself, these kinds ofdata can be of real value for In-schoolvocational counseling. Should student Xplan for a career in general practice,teaching and research, or specialty prac­tice-and, if a specialty, which one? Test

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data are potentially valuable tools forassisting students toward making suchdecisions, but only if. the tools are them­selves sound and enough is known aboutthem to use them effectively. The Asso­ciation is in a strong position to studythe tools and to guide individual medicalschools in their use.

lDJ A study of the interrelationshipsof test scores to select from among thema much smaller number of measures thatcan be used in later follow-up studies isin progress. Seventy-nine test scores areavailable for tested 1956 freshmen. Theactual number of variables needed todiscriminate effectively among variousgroups of students (e.g., high vs. lowachievement in school, the potentialteacher-researcher vs. the general prac­titioner vs. the practicing specialist ineach of a variety of fields, etc.) is notknown, but it can be determined by sta­tistical analysis. Furthermore, study ofthe interrelationships of these measuresof interest, personality and intellectualcharacteristics will in itself constitutea potentially significant contribution tothe science of measurement of humanbehavior, quite independent of its prac­tical importance to problems of selectionand guidance of medical students.

lEJ The Edwards Personal PreferenceSchedule was administered to studentstaking the MCAT in 1957. These datawill contribute to the study of currents~lect!on processes and their implica­bons for the future of medicine as it isaffected by the characteristics of thosewho.enter the profession. In addition, byspecIal handling of test administrationsany effects on scores on these tests oc~casioned by pressure to appear in a fa­vorable light for selection for admissioncan be determined. These data, like the1956 freshman data, can be used inanalYsis through extended follow-upstudies of progress through selectiontraining and professional practice. '

2. Planned and proposed studies. (a) Astudy of the use of various methods of~coring personality tests. This study isImportant for developing techniques ofusing test data in counseling medicalstudents and also for the investigationof methods of predicting achievementboth in school and in various types ofcareers within the profession of medi­cine.

(b) In the spring of 1958, the fresh­men tested in the fall of 1956 will com­plete their second year in medical schoolAn intensive investigation of interme~diate criteria of student performance

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should be made at that time. It would bedesirable, for example, if all freshmenin the test sample were to take the Na­tional Board Examinations in 1958 sothat the same objective data on achieve­ment for all students could be analyzed.Other kinds of information,.such as stu­dent ratings of fellow students and fac­ulty ratings of students, as well asgrades, would also be desirable. If thestudies that have been launched are tohave real value, careful follow-up ob­servations of student performance bothin school and beyond are essential.

The current program of research onstudent characteristics is being financedprimarily by a grant from the Common­wealth Fund. A grant from the MarkleFoundation, made to the Association in1953, is also contributing to the supportof the research program during the pres­ent year. To carry the program forward,however, will require new and long­term financing. GEORGE PACKER BERRY,M.D., chairman, Committee on Educa­tional Research and Services; HELENHOFER GEE, Ph.D., Director of Research.

REPORT OF THE COMMITTEE ONAUDIO·VISUAL EDUCATION ANDMEDICAL AUDIO·VISUAL INSTITUTE

The Committee held its regUlar annualmeeting at the time of the Annual Meet­ing of the Association of AmericanMedical Colleges. The Committee con­cerns itself with the provision of audio­visual services and professional assist­ance as executed by the Medical Audio­Visual Institute. During 1956-57 the ac­tivities of the Institute were as follows:

Film Library Activities. In keepingwith policy only those films were ac­quired which are suitable for under­graduate medical education and whichare difficult or impossible for the medicalschools to procure elsewhere. Twenty­nine new titles and 365 new prints wereadded to the library, making a total of97 titles now in the library. These titlesare all available for rental and some areavailable for purchase.

During the year 307 prints were sold.These are films that are available onlyfrom MAVI.

Total film purchases cost $7,457 andtotal income from sales and rentalsamounted to $8,128. By and large the fin­ished films that were purchased only forrental purposes were provided by thePfizer Laboratories grant. Films whichMAVI has helped to produce, finish orfinance were paid for from the FilmPublications Revolving Fund.

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The Pfizer Laboratories grant balanceat the end of the fiscal year was $4,776.The balance in the revolving fund was$2,77.6. The total film assets at the endof the fiscal year were $7,552 plus 269prints of films in inventory worth aboutan equal amount.

Film Production. The Institute is com­pleting the production of the teachingfilms on Living Human Cells in Culturemade possible by the three-year totalgrant of $30,000 from Abbott Labora­tories, and the assistance of Dr. C. M.Pomerat of the Tissue Culture Labora­tory at the University of Texas-MedicalBranch and Dr. I. Costero of Mexico City.Five films have been completed bearingthe following titles:

THE HELA CELL STRAINMICROGLIAOLIGODENDROGLIANORMAL ASTROCYTESABNORMAL ASTROCYTES'

By the end of the last fiscal year 200prints of the first three titles had beensold.

Prototype Teaching Area. Progress hasbeen made on the Prototype TeachingSuite intended for installation at theUniversity of Kansas Medical Center.Details of the Suite have been drawnand an architectural model completedthrough the courtesy of Darell Boyd Har­mon and Associates, architectural con­sultants of Austin, Texas.

Dr. Harmon has committed materialson behalf of his clients for the construc­tion of the suite. Illness has forced Dr.Harmon to withdraw from his businesswith a resultant loss of his clients. Whilesome manufacturers still stand ready tosupply materials some are justifiably un­willing to subsidize the cost of meetingspecifications. Between $30,000 to $50,000would be required to realize actual con­struction. This estimated figure excludesthe cost of deconstruction of presentinterior and the value of the space aswould be borne by the University ofKansas School of Medicine.

As a research study into the prob­lems of medical education this projectis a worthy one. Some foundation or or­ganization interested in medical educa­tion should be given the opportunity tosupport it.

Audiovisual News. Journal of MEDICALEDUCATION. The AV news section inthe Journal has been maintained. Itcontains news items, film reviews, andarticles selected to stimulate better andwider use of audio-visual materials.

Cooperative Audio-Visual Activities. The

85

director of MAVI has represented theAssociation of American Medical Col­leges in the following national activi­ties:

Chairman: Audio-Visual Confer­ence of Medical and AlliedSciences

Judge: Motion Picture Program ofthe Clinical Congress, AmericanCollege of Surgeons

Instructor: First Medical MotionPicture Workshop, Veterans Ad­ministration and the Calvin Com­pany

Pane! Member: Special Section onCommunications, Annual Meet­ing, American Medical Associa­tion

Chairman, Medical Category:American Film Assembly andGolden Reel Film Festival

Member: Committee on Physicaland Mental Health Film

Speaker: In terna tional Photo­graphic Exposition

Chairman: Cooperative MedicalFilm Agencies (Supplying datato Library of Congress on medi­cal films)

The Future of MAV!. The Medical Audio­Visual Institute has played a unique andpositive role, both within the Associationand as an influence on related organiza­tions. It has been a stimulant to medicalschools and medical teachers and hasprovided ideological security to otherassociations concerned with the specialproblems surrounding the use of audio­visual materials and equipment.

The Medical Audio-Visual Institute isa national voice representing the pro­duction and utilization of medical under­graduate AV teaching materials. Medicalschools are developing techniques andadministrative units for better and moreeconomical use of these materials. Someschools have made spectacular progress-a development which has been stimu­lated not only by a general increase inconcern with the problems of teachingand learning, but also by specific en­couragement and aid from the MedicalAudio-Visual Institute.

If the Institute is to show continuedprogress, it is our opinion that additionalsupport, preferably on a long-term basis,is essential. As an alternative, seriousconsideration must be given to a pro­gram leading to drastic reorganization ofthe Institute and the services which it isto render. WALTER A. BLOEDORN, chair­man of committee; J. EDWIN FOSTER, Di­rector of MAVI.

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Following the report of the Directorof the Audio-Visual Institute, Dr. You­mans announced that Dr. Foster was leav­ing the Association to join the staff ofthe American Heart Association. A mo­tion was unanimously passed, express­ing deep appreciation to Dr. Foster forhis many years of effective service andwishing him well in his new position.

REPORT ON HUNGARIAN REFUGEES

(Report of the Emergency Progr~m

for the Placement of Escapee HungananMedical Students in American MedicalSchools by the Association of AmericanMedical Colleges, Institute for Inter­national Education, World UniversityService, National Committee for Re­settlement of Foreign Physicians, Inc.)

Hungarian college students enteredthis country in large numbers duringand after the Revolution in October 1956.To enable those who were qualified tocontinue their education in this country,the World University Service and theInstitute of International Education es­tablished a placement program. Throughtheir efforts most of the undergraduatestudents have been placed in Americanuniversities. The graduate students, andmost particularly th'e medical students,posed a much greater problem. In or~er

to aid the medical students, the ASSOCIa­tion of American Medical Colleges andthe National Committee for the Resettle­ment of Foreign Physicians, Inc., joinedwith the World University Service andthe Institute of International Educationin starting an emergency placement pro­gram.

With very little available informationon the academic background of the stu­dents it was decided that it would benecessary to give screening examinationsbefore any placement program could beeffective. Screening Boards were estab­lished at Cornell Medical College,Northwestern University Medical School,and the University of California Schoolof Medicine in San Francisco. Each stu­dent was assigned, on a geographicalbasis, to one of the Screening Boards.The examinations were held in June1957, and were conducted by expe­rienced examiners in the basic sciencesand clinical fields. Dossiers, includingtranscripts in most cases, were madeavailable to the -examiners.

Thirty-seven students took the exami­nations. Twenty-six passed with bothacademic achievement and English pro­ficiency, and were considered suitable foracceptance in one of the first three years

Minutes of the 68th Annual Meeting

in an American medical school. Many ofthe failures, which numbered eleven,were not passed because of poor English.

Thirty-six member schools of theAssociation of American Medical Col­leges had indicated that they wouldconsider one or more students for ad­mission. The students were then assignedby lot on a geographical basis, to one ofthese 'schools. The student's dossier andtranscripts were forwarded to theschools, along with a report of theScreening Board. In each case a tenta­tive class assignment was suggested.However, neither the reports of theScreening Board nor the class assign­ments were considered as any commit­ment on the part of the schools, becauseit was felt that these were more prop­erly the prerogatives of the schoolsthemselves.

At the date of this report, 19 of thestudents who passed the screening ex­aminations have been admitted to medi­cal school; 10 of these were accepted inthe first year class, six in the secondyear class, and three in the third yearclass. One student who passed the ex­aminations was accepted as an audit stu­dent. One student who failed the screen­ing examinations because of lack offacility in English was finally admittedto second year standing; another whofailed for the same reason was admittedas an audit student in the first year. Inboth these cases, if the student's recordis satisfactory they will be accepted in1958 as regular students.

Of the six students who passed thescreening examinations, but failed to beadmitted, one possibly may be admittedin February 1958. Two are employed inmedical laboratories and are being con­sidered for admission in 1958. One is un­dergoing extensive plastic surgery forwounds received during the Revolution,and he expects to enter premedical studiesin February 1958, and probably will beadmitted to medical school in the fall of1958. The two remaining students wererefused admission and we have been un­able to communicate with them since.One additional student was admitted tomedical school without reference to thescreening examination. There might pos­sibly be others in this category, (SeeTables I and II for details.)

Each of the students, except one, hasreceived an allotment of funds varyingin amounts from $200 to $2,000 for main­tenance and/or tuition. The funds willbe disbursed by the school authorities,

Each student has been judged on his

SUMMARY

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19

37

Moses FoundationAlfred P. Sloan FoundationMiscellaneous

Funds for the language training pro­gram have been provided by the follow­Ing:

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Ford FoundationRockefeller Brothers FundRockefeller Foundation

Special mention should be made of thecontributions made by the following in­dividuals:

Association of American MedicalColleges

Dr. Dean F. Smiley

Institute of International Educa­tion

Mr. Richard RaymondMIss Ann Bollman

World UniverSity ServiceMr. Wilmer J. KitchenDr. Richard Carlton

The National Committee for Re­settlement of Foreign Physicians

Mrs. Laura Rubin

Chairmen or Screening BoardsUniversity of California School

of MedicineDr. Malcolm Watts

Cornell University Medical Col­lege

Dr. Dayton EdwardsNorthwestern University Medi­

cal SchoolDr. John Cooper

ROBERT BOGGs, chairman

TABLE 1

10

6

3

26

II

Possed

Failed

Passed-Accepted

First Yeor

Second Yeor .

Third Yeor ..

Students exomined by Screening Boords

Passed-Accepted (First yeor AudIt)

Possed-Not occepted 1957

Foiled-Accepted (Second yeor)

Foiled-Accepted (First yeor Audit)

merits and although there are humani­tarian and political overtones in theprogram, in the final analysis it is theprofessional community of this countrythat will stand to gain by its implemen­tation.

Many problems still remain to besolved. One, how to finance the students,who were admitted this year, during therest of their years in school. Also, a num­ber of those who failed to be admittedwill probably be accepted in 1958, andwill need support. Another 400 Hun­garian students in Yugoslavia still awaitadmission to the United States. Possibly15 to 20 medical students will enter withthis group. What we will be faced withif other Middle European countries de­fect from Communism cannot be deter­mined. All of these problems will haveto be met by the independent agencies,or possibly by the government itself. Ina great measure the possibility of any fU­ture projects for refugee medical stu­dents will depend on the record of thestudents admitted this year.

Funds for scholarships, hospitalityand administration have been providedby the following:

Commonwealth FundFirst Aid for HungaryFree Europe CommitteeInland SteelInternational Rescue CommitteeInternational Telephone &

TelegraphKellogg FoundationMilbank Foundation

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TABLE II

ACCEPTANCES BY SCHOOL AND YEAR

2

2

2

2

2

22

Total

3

Third Year

7

Second Year

REPORT OF THE COMMITTEE ONCONTINUATION EDUCATION

During the past year the Council onMedical Education and Hospitals of theAmerican Medical Association publishedwith the approval of the House of Dele­gates a "Guide Regarding Objectives andBasic Principles of Postgraduate MedicalEducation Programs." The guide is animportant beginning in bringing orderto a most complex area.

The Committee is impressed with themassiveness of the problems in continua­tion education. Although the need forincreasing activity of this field is unani­mously agreed upon, the direction ofactivity is uncertain, the desire of thephysician is only imperfectly appraised,the responsibility of schools of medicineis not universally admitted and the ef­fectiveness of any particular educationalmechanism is totally unknown.

The Committee continues to expectthat the factor of major significance isthe establishment of that environment inthe daily activity of the physician which

2 (Audit)

12

2

. 2

First Year

Vermont

Virginia, Univ. of

Medical School

Albany ..

California

Cornell ..

Creighton

George Washington

Maryland ..

Michigan ..

New York State-Syracuse

New York University

Northwestern .

Pennsylvania

Pittsburgh

Rochester

Stanford

St. Louis

The report of the Committee was ac­cepted and the nominees elected byunanimous' ballot.

REPORT OF NOMINATING COMMITTEE

The Committee placed in nominationthe fol1owing individuals for the officescorresponding:

President-elect: Dr. John McK. Mit­chell, Pennsylvania;

Vice President: Dr. Joseph Wearn,Western Reserve;

Treasurer: Dr. Stockton Kimbal1, BUf­falo;

Secretary: Dr. Richard Young, North­western

Executive Council:Term expiring in 1960: Dr. StanleyOlson, Baylor; Dr. Thomas Hunter,U. of VirginiaTerm expiring in 1959: Dr. MarkEverett, Oklahoma; Dr. GordonScott, Wayne State

J. MURRAY KINSMAN, chairman

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will support the physician's freedom inthe increasing development of his in­tellectual self-discipline. The role of full­time clinicians as a nucleus for educa­tional leadership within the hospitals isstill considered as a critical contributionto this support.

The present environment of the prac­titioner is so imperfectly known that theCommittee urges the Executive Councilof the Association to consider an inten­sive and extended study of the ecologyof American medical practice. JAMESW. COLBERT, JR., chairman.

REPORT OF THE CHAIRMAN OFTHE EDITORIAL BOARD

The resignation of Dean Smiley, M.D.recalls the valuable contribution that hemade as Editor of this Journal. He wasdevoted to all aspects of the programand the growing importance of the Jour­nal is a tribute to his work.

On October 20, the Editorial Boardwill convene to review past achievementsand chart a course for future accom­plishments. The Chairman of the Edi­torial Board will also serve as Editor ofthe Journal until decisions are made re­garding the most desirable organizationof the program.

Under this new arrangement the Edi­torial Offices will be located at "Journalof Medical Education," University Hos­pitals, Madison, Wisconsin. All commu­nications regarding manuscripts andmedical school news should be trans­mitted to this address. The PublicationsOffice will continue to operate at theheadquarters of the Association.

Manuscripts. The manuscripts have con­tinued to be the main point of focus forthe Editorial Board. Many of the manu­scripts have been solicited from medicaleducators in the United States and othercountries. There is a continuing need formanuscripts describing developments inmedical education in the United States.Articles describing educational experi­ments in progress would be valuable inkeeping the readers of the Journal in­formed on current developments.

The first series of papers on the His­tory of Medical Education has been pub­lished. Professor Frederick Norwood hasagreed to supervise the development ofa second series of profiles of distin­guished individuals in the growth ofmedical education in the United States.

The special numbers of the Journalduring the past year have included the

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study by Osler Peterson on medical prac­tice in North Carolina, the ApplicantStudy for 1955-56, and the Report of theTeaching Institute on The Appraisal ofApplicants to Medical Schools. A specialsupplement in Spanish for medical edu­cators in Latin America is in press.

The financial support of the ChinaMedical Board has made possible the dis­tribution of the Journal t6 medicalschools in other countries.

A generous grant from the JosiahMacy Foundation has supported the pUb­lication of a number of significant ar­ticles on medical education in othercountries. This grant has also financedthe preparation of the special numberfor Latin American medical educatorsand Spanish abstracts of all articles inthe Journal.

News and Announcements.The desirability of communicating

news of developments in our memberinstitutions is recognized by all readersof the Journal. Deans, their public rela­tions officers and faculty members areurged to transmit more information ofthis nature. An effort will be made tokeep our readers more fully informed onprograms of Federal agencies and phil­anthropic foundations as they are of in­terest to medical educators.

A full report of the meeting of theEditorial Board wlll be published in anearly number of the Journal.

Finally, the Chairman would like toexpress his deep gratitude to the mem­bers of the Editorial Board for theirwork with the Journal. A number ofother medical educators have been help­ful in reviewing manuscripts submittedfor publication. JOHN Z. BOWERS, chair­man.

SUPPLEMENTAL REPORT OF THEEDITORIAL BOARD

The Editorial Board of the Journal ofMedical Education met at the HotelChalfonte in Atlantic City on Sunday,October 20, 1957. All members of theBoard except Dr. Julius Comroe werepresent. Dr. Ward Darley, Executive Di­rector of the A.A.M.C. and Dr. FrederickNorwood, Consultant on the History ofMedical Education, attended the meeting.

Book Reviews. Dr. Kenneth Penrodagreed to serve as Book Review Editor.The Board adopted a program in whichonly books dealing directly with prob­lems of medical education will be criti­cally reviewed. Publications which would

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be useful as teaching instruments willbe commented upon. Other books will belisted.

Membership of the Board. A system ofrotation whereby members of the Boardwould serve for designated periods wasrecommended.

Format. The front cover will list titles,authors and pages of papers. Other sec­tions-News from the Medical Schools,Items of Current Interest, Book Reviews,Personnel Exchange and Editorials wouldbe listed on the front cover with pagereferences. Other indexing will be dis­continued.

The section entitled "With our Au­thors" will be discontinued. The facultyaffiliation of the author will be carriedas a footnote with the article.

Information on the organization of theAssociation, the organization of the Jour­nal and instructions for authors will becarried on a single page in a standardlocation in the Journal.

Bibliography will be standardized inline with the Quarterly Cumulative In­dex.

Manuscripts, editorials and book re­views will be paginated with Arabicnumbers. All other material will be des­ignated by Roman numerals. Supple­ments will be paginated consecutivelywith the related numbers of the Journal.

A section will be established as "Newsfrom the Medical Schools." Another sec­tion will be established as "Items of Cur­rent Interest."

"Audio-visual News" will be discon­tinued as a separate section and carriedunder one of the above sections. Dr.Penrod proposed ;lD annual number em­phasizing developments in audio-visualeducation.

Abstracts of Papers for Annual Meeting. Dr.Hale Ham proposed that a call for ab­stracts of experiments in medical educa­tion should be issued at the time of theAnnual Meeting. The abstracts wouldbe published and indexed in the Journal.The Board was enthusiastic about thisproposal. Dr. Ham will discuss it's de­velopment with Dr. Lowell Coggeshall,President of the A.A.M.C.

Supplements. Dr. Vernon Lippard agrE'edto assume the responsibility for thisaspect of the program. Topics suggestedincluded Medical Care, Architecture ofMedical Buildings, Development andOperation of an Animal Colony, Ad-

Minutes of the 68th Annual Meeting

ministration of Teaching Hospitals, Pa­tient Contacts by Freshmen Students,Research by Medical Students, FreeTime, Examination Systems and Chang­ing Patterns of Premedical Education.

History of Medical Education. Dr. Nor­wood reported on progress in this de­partment. The first series is nearly com­plete and the second series will documentthe lives of individuals who are out­standing in the development of U. Smedical education. Dr. Norwood pro­posed an anthology of the history ofmedical education and this was promptlyadopted by the Board.

Subscriptions. The Board suggested thatmedical faculty members should be can­vassed regarding subscriptions to theJournal. It was felt that a subscriptionto the Journal with membership in theA.A.M.C. might be more attractive thanto emphasize membership in the A.A.M.C.

The Board will meet in Chicago at thetime of the Annual Congress on MedicalEducation and Licensure. JOHN Z. Bow­ERS, Editor-in-Chief.

REPORT OF THE COMMITTEE ONFINANCING MEDICAL EDUCATION

August 20, 1957

The Committee is composed of DoctorsDonald G. Anderson, Walter A. Bloe­dorn, L. T. Coggeshall, Harold S. Diehl,Stanley E. Dorst, Vernon W. Lippard,Robert A. Moore, Norman Topping, JohnB. Youmans and Joseph C. Hinsey,Chairman. Dr. Ward Darley and Dr.Dean F. Smiley have been consideredex-officio members of this committee.

The Committee met on February 9,1957 in Chicago and the chairman hasbeen in touch with the members of theCommittee regarding problems that havearisen during the year. Because of thefact that it is necessary for this reportto be prepared so far in advance of themeetings, it will not be possible for it tobe up to date. The Committee will meetjust before the meetings in Atlantic Cityand will be prepared to submit any addi­tional information developed at that timeto the open hearings in Atlantic City.

The work with the National Fund hasprogressed satisfactorily and the Na­tional Medical Education Week has beenthought to be quite successful this pastyear. Each school has been kept informedregarding the activities of the NationalFund for Medical Education and for thatreason we shall not incorporate any of

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the details in this report. Needless to say,the chairman of this Committee has beencalled on many times during the year towork with the staff of the National Fund.

During the year, discussions have beenheld with the officers and administrationof the National Foundation for InfantileParalysis, the American Heart Associa­tion, and the American Cancer Societyregarding the possibility of the voluntaryfoundations contributing to the basicsupport of the work of the medicalschools. These discussions have beencarried on in a satisfactory manner. Al­though no definite decision has been ar­rived at, a real understanding of ourproblem has been brought to the atten­tion of these organizations.

Your Committee has made every effortto get the percentage available for in­direct costs from Federal grants raisedfrom 15 per cent to 25 per cent. DoctorsCoggeshall and Hinsey appeared beforeSenator Hill's committee on May 6,1957. Dr. Coggeshall presented a pre­pared statement before the Senate Ap­propriations Committee, copies of whichhave been made available to the deans.I quote from the report I made to theCOMMITTEE ON FINANCING MEDI­CAL EDUCATION on July 1, 1957, re­garding the action taken and what thepresent status of this report is:

(The following quotation is fromGross's Washington Report on the Med­ical Sciences of July I, 1957)

"Senate conferees, headed by Ala­bama's Lister Hill, were unable totalk House conferees into droppinga clause which forbids NIH fromallowing grantees more than 15 percent toward helping defray over­head expenses. In the short run,this may be rather a serious blowto institutions which go deeperinto the red with every researchproject they undertake; but theCongressional and General Ac­counting Office inquiries into re­search costs soon to be launchedcould easily lead to more substan­tial financial assistance to trainingand research institutions."The House conferees, whose leaderand spokesman is Rep. John E.Fogarty (D., RI), are not so muchopposed to increasing the 15 percent allowance as they are deter­mined to turn a strong light on theexpense items that go into thatoverhead. They don't want indirectcosts, such as sidewalk repairs,charged against research.

91

"The Senate conferees, in contrast,are more tolcrant to inclusion ofindirect costs. The study whichthey have requested General Ac­counting Office to perform is to becompleted by end of this year.House is planning to conduct itsown separate mvestigation."

Every dean should have a copy of theNATIONAL SCIENCE FOUNDATIONBULLETIN, entitled: "Reviews of Dataon Research and Development, No.2,March, 1957." This presents the findingsunder a title "Funds for Research andDevelopment in Colleges and UniverSI­ties, 1953-54." This should be read byevery dean of a medical school and stu­died very thoroughly because it showswhat the research we do costs us for theindirect expenses.

The legislation which has been intro­duced at this session may be summarizedbriefly as follOWS:

(1) H.R. 6602, which IS a bill in­troduced on April 3, 1957, byMr. Dorn, of New York, toprovide for the establishmentof a commission to study theshortage of doctors of medi­cine in the United States.

(2) Bill S. 1922, introduced bySenator Hill, and SenatorsKennedy, Neely, Humphrey,and Smathers, on April 18,1957, to authOrize a five yearprogram of grants for con­struction of medical and dentaleducational and research fa­cilities and for other purposcs.The companion bill in theHouse of Representatives isnumber H.R. 7841 and it wasintroduced by Mr. Fogarty onMay 29, 1957. This is the billwhich Scnator Hill introduccdin the previous session of Con­gress.

(3) Bill S. 1917, introduced onApril 17, 1957 by ScnatorSmith of New Jersey for him­self and for Senator Purtell ofConnecticut.

The bill is the administration bill toamend the provisions of the PublicHealth Service Act relatmg to grants forconstruction of research facilities so asto increase their duration from three tofive years and to authorize grants formedical and dental teaching facilities.

There is no question but what thespirit of economy has dominated a greatdeal of the thinking in our present Con­gress. It seems to me that our position

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should be not to take sides on any of thepresent legislation but to continue topresent our great needs. We are mostfortunate that the Committee on Inter­state and Foreign Commerce releasedthe staff report on March 14, 1957, whichcontains the background informationrelating to schools of medicine, dentistry,osteopathy, and public health. We aredeeply indebted to Mr. Kurt Borchardtwho is the legal counsel for this com­mittee for the tremendous amount ofmost careful work and thought that hegave to this whole problem. This reportis a veritable storehouse of importantinformation and should be in the handsof every dean and his staff.

We are grateful for the work that hasbeen done by the members of the staffof our medical schools in response to theletter of April 15, 1957, addressed tothe deans of the medical schools over thesignature of Dr. Ward Darley. In this hehas pled for contacting the members ofCongress from the areas where our med­ical schools are located and to informthem of the needs and to elicit their sup­port for legislation for medical schoolconstruction. The members of the staff ofthe Association, as well as the membersof our Committee have done a great dealof work in establishing contacts andpresenting the needs to the members ofCongress. This should be continued dur­ing the coming year. In presenting theneeds, it seems important to make a pleafor multiple support of Our medicalschools. If the corporations of this coun­try would up the amount they contrIbuteto the National Fund, a great good couldcome. If the states that now do not sup­port medical education would start toprovide funds, as well as if greater sup­port could come from a number of ourstates, OUr medical schools would begreatly benefited. We need to accelerateand intensify the presentation of ourproblems to the various foundations overthe country. Certainly, the members ofthe state legislatures must realize theimportance of health education and itscosts and, of course, many private indi­viduals of means could do a great dealof good by contributing to various medi­cal schools. All of us should strive toemphasize a continued need today andour future needs, and that we hope tokeep the support of medical educationon as broad a base from as many sourcesas it is possible to do. The Federal gov­ernment is not the only source of thissupport and we should not lose sight ofour other benefactors. Certainly during

Minutes of the 6~th Annual Meeting

this past year a great deal has come tothe medical schools of this countrythrough grants like those to the privatemedical schools from the Ford Founda­tion, the ones made by the Common­wealth Fund to certain of our schoolsand, of course, various states haveupped the support that they have givento medical schools.

Your chairman has just returned fromWashington where he discussed the pres­ent status of legislation with Mr. JohnR. McKenzie of the staff of SecretaryFolsom, with Senator Hill and to a briefextent with Senators Ives, Purtell, Thur­mond and Murray, and with Mr. KurtBorchardt, who is the legal counsel forthe staff of the Committee on Interstateand Foreign Commerce of the House ofRepresentatives. We are most fortunateto have the support of all of these friendsin government to whom we go for helpand guidance. Special tribute should bepaid to Secretary Marion Folsom and Dr.Aims McGuinness and their staff in theDepartment of Health, Education andWelfare. Mr. Oren Harris, Mr. John BellWilliams and the others in their Com­mittee on Interstate and Foreign Com­merce and their legal counsel, Mr. KurtBorchardt, have shown great interest inunderstanding our problems. Over theyears, Senator Lister Hill and the sen­ators from both parties on his Committeeon Labor and Public Welfare have helpedus immeasurably and have had real in­sight into our problems. Our support hasbeen bi-partisan. In the next session ofCongress, if the House of Representativeswill take the initiative in developinglegislation for the support of the needsof medical education, for rehabilitationand new teaching facilities, we shouldmeet with success. In all of our work onthis legislation, it has been particularlygratifying to have the support of theAmerican Medical Association, and themembers of their staff have been helpfUlto us.

I want to strongly recommend to thecommittee for its consideration at itsmeeting in Atlantic City that we sendletters of invitation to both ChairmanOren Harris, of the full Committee onInterstate and Foreign Commeree and toRepresentative John Bell Williams whois chairman of the Health Sub-Com­mittee of this committee, to have themembers of the committee make visits toa number of our institutions so that theycan see first hand the needs for newfacilities. I think it would be desirableto have this committee visit some of the

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new institutions to see what modem fa­cilities are like and then go to some ofthe institutions to see where the facili­ties are inadequate and out-dated inorder that comparisons can be made. Ibelieve that these visits should be ar­ranged for some time during the fall andearly winter and that every effort shouldbe exerted to see that they are made.Certainly, if we invite the members ofthe committee we will have taken the10itiative in this matter. The other mem­bers in addition to Representative Wil­liams on the Health Sub-committee ofthe House Interstate and Foreign Com­merce Committee are Democrats-Diesof Texas; Rhodes, of Pennsylvania;O'Brien of New York; Dingell, of Michi­gan; Loser, of Tennessee; and Repub­licans Heselton, of Massachusetts; Bushof Pennsylvania; Schenck, of Ohio; Car­rigg, of Pennsylvania; and Neal of WestVirginia. Representative Neal is a physi­cian who was elected last fall after serv­ing one previous term.

It will be important for some members10 the respective states to contact Rep­resentatives John Tabor, of New York,and Clarence Cannon, of Missouri. The1Oformation which I received leads meto believe that it is very essential thatthese two men be talked to and con­vinced 01 the importance of our needs.Without their understanding, we willhave great difficulty getting appropria­tions that we would like to see madethrough the House.

The senators that are largely con­cerned with legislation for health in theCommittee on Labor and Public Welfare,are Senators Hill, of Alabama, Mc­Namara, of Michigan; Murray of Mon­tana; Purtell, of Connecticut and Cooper,of Kentucky.

We have been laboring under difficul­ties that have been brought forth by theeconomy wave in Congress, the concernof Federal aid to education and its impactupon our problems, and by the wholeCivil Rights discussion. It is to be hopedthat in the next session of Congress thatit will be possible for us to gain con­sideration of our medical school con­struction legislation. We should hammeraway at our needs and what the futurewill bring to the health of the nation ifthese needs are not met. At present, itdoesn't seem advisable to get involvedin anyone of specific legislative pro­posals which have been made.

I want to express to the members of theCommittee and to the members of theAssociation, as well as to the staff of the

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Central Headquarters, my sincere ap­preciation for the help which I have re­ceived in the work on Financing MedicalEducation during this past year. JOSEPHC. HINSEY, chairman.

P.S.-August 20, 1957

Yesterday, Secretary Marion B. Fol­som, of Health, Education and Welfareannounced the appointment of a groupof consultants to make a study of medi­cal research and education and theirneeds. They are being asked to investi­gate the relationship between govern­mental and private research, influence ofincreased research upon medical educa­tion, supply of teaching personnel, andother matters (Washington Report onthe Medical Sciences, No. 531, August19, 1957). Secretary Folsom has sug­gested that an intenm report be pre­sented within a year and a final reportsome six months later. The members ofthe group are as follows:

Chairman, Stanhope Bayne-Jones,who at the time of his retire­ment in 1953, was President ofthe Joint Administrative Boardof The New York Hospital-Cor­nell Medical Center.

George P. Berry, Dean, HarvardMedical School.

Lowell T. Coggeshall, Dean, Uni­versity of Chicago School ofMedicine.

Stafford L. Warren, Dean, Univer­sity of California at Los AngelesMedical School.

Fred C. Cole, Vice-President, Tu­lane University.

Irvine H. Page, Director, ResearchDivision, Cleveland Clinic Foun­dation.

Thomas P. Carney, Vice President,Eli Lilly Company.

Samuel Lenher, Vice President, E.I. du Pont de Nemours & Co.

Robert C. Swain, Chief of Researchand Development, AmericanCyanamid Co.

James E. Webb, President, Repub­lic Supply Co.

lt is to be hoped that medical edu­cators will cooperate fully in the furnish­ing of information needed by this groupof consultants. Certainly, it will not bea new experience in the light of the vari­ous surveys and studies that have beenconducted in the past few years such asthe Deitrick-Berson study, (1953), thereport of the Magnuson Commission(1952), and the material assembled bythe Ford Foundation about private med-

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ical schools in 1956-57. I enclose a copyof a statement prepared for SecretaryFolsom in 1955. There is a basic philoso­phy expressed here that is vital to thefuture of the nation's medical schools.Statement prepared by Dr. Joseph C.Hinsey at the request of Dr. PalmerDearing. This is an elaboration of cer­tain points of view expressed at a con­ference held by Secretary Marion B.Folsom, of Health, Education and Wel­fare, with the Committee on FinancingMedical Education of the Association ofAmerican Medical Colleges on Friday,November 18, 1955, in the Secretary'sOffice in Washington, D.C.

Each of the nation's 85 medical schools hasresponsibilities in three areas: medical (might bemore appropriately called health) I) education,2) research and 3) service. In the majority ofinstances, it is extremely difficult to delineateabsolutely these three activities. Many times, aclinical teacher carries an educational and reosearch functions at the same time he renderspatient care, i.e., to a patient with hypertensionor with tuberculosis. It is fair to say that thequality of patient care is better because it isdone in the presence of teaching and research.In a like manner the teaching under these cir­cumstances is much more stimulating and the reosearch profits much in such an environment.While generalizations should be made with care,many believe ihat ieaching environments suchas are present in our medical schools providethe most effective milieu for scientific advance­ment. Nobel prize winners such as Dr. Endersand his co-workers and Dr. du Vigneaud and hisstaff, work and teach in medical schools. Dr.Jonas Salk likewise is a member of a medicalschool faculty. A pathologist teaches studentsat the same time he does an autopsy. A teacherof anatomy who is interested in variations andanomalies, which are so important to the sur­geon. may do research at the same time hesupervises a student's dissection of a cadaver.These examples, which could be enlarged manyfold, will illustrate how arbitrary one must be toseparate one individual staff member's time inorder to allocate it accurately to teaching, re­search and to patient care or medical service.

Just as such a separation is quite complicatedon the functional side, so is it as far as thedesignation of the physical facilities. In most ofour medical schools, the student laboratoriesare used for medical and other health sciencecourses for several months of the year and. inthe remaining months. they are used for researchprojects of the staff. Sometimes, these two ac­tivities are carried on simultaneously in the samequarters. Dr. Stanley Dorst, Dean of Medicineat ihe University of Cincinnati, described justthis sort of utilization of their space in iheirdepartment of pharmacology, and the same istrue for the facilities in pharmacology at Cor­nell. Modern medical schools are so arrangedthat research laboratories and student labora­tories occupy adjacent positions in the de­partments. Such is the caSe in the Physiology

Minutes of the 68th Annual Meeting

Building at Cornell where research facilities de.veloped for special problems in fluid balance,neurophysiology and metabolism are used forstudent group teaching when the course is goingfull force and for graduate student teachingat other times in the year. Students becomefamiliar and work with special apparatus thaiwould be most difficult to provide out of medi·cal school budgets, they are stimulated in themost modern methodology, and in some in·stances use these facilities for research of theirown.

Most medical school staff members are reosearchers as well as teachers and demand properresearch laboratories and facilities right in themedical schools. Dr. lowell Coggeshall, Dean ofMedicine at the University of Chicago. relatedthe problems in his institution where a surveyhad shown the difficulties encountered in hold·ing and attracting able young medical men intoacademic careers. These difficulties were not somuch involved with salaries, which had been in­creased to better levels, but with the lad ofadequate facilities io properly provide for theirresearch needs.

It can be said unequivocally that a large vol·ume of the medical research conducted in thiscountry is being done in medical schools by staffmembers who teach and take care of patientsas well. The rehabilitation of present plant andthe enlargement thereto in the nation's medicalschools constitutes the primary need that mustbe met before more physicians can be gradu.ated and the nation's research can be upgradedand amplified. Such improvement would alsocontribute to an increase in the preparation ofallied para·medical personnel and in graduatetraining for the-basic medical sciences so essen·tial to the teaching of our schools and to theadvancement of research in medicine.

The medical schools are the "factories" thatprepare all of our physicians and most of ourgraduate students in the basic medical sciences;they contribute to the education of dentists,nurses, and many allied medical personnel; theyconduct ihe largest portion of the medical reosearch; and they are responsible for a largevolume of medical care and the maintenance ofthe quality thereof. Any program for the better·ment of the nation's health must make provisionfor adequate plant and facilities to our 85 medi·caI schools.

Joseph C. Hinsey, DirectorThe New York Hospital.Cornell Medical Center

Chairman. Committee on Financing MedicalEducation, Association of American MedicalColleges

Following the report of the Committee,Dr. Youmans presented the followingreSOlution, which was adopted unani­mously.

Whereas, it is generally recognized thatthe physical facilities for hOUsing theeducational programs of many of ourmedical schools are in great need of ex­pansion and modernization beyond thepresent economic resources of theseschools themselves and

Whereas, several members of the pres-

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ent Congress are sponsoring legislationdesigned to aid these medical schools intheir needs and

Whereas, we have been led to believethat some members of the Congress arenot convinced that the proposed legisla­tion has the interest of the entire mem­bership of the Association of AmericanMedical Colleges in spite of the diligentefforts of the officers of this Associationand its Committee on Financing MedicalEducation in surveying the needs of theindividual member schools and in trans­mitting information regarding theseneeds to congressional committees there­fore

Be it resolved that the membership ofThe Association of American MedicalColleges in its 68th Annual Meeting goon official record as being in completeaccord with the principle of Federal fi­nancial assistance in the construction ofnew, and the expansion and moderniza­tion of existing, facilities for medicaleducation in our medical schools.

Be it further resolved that a report ofthis action be transmitted to each mem­ber of the Congress.

REPORT OFCOMMITTEE ONINTERNATIONAL RELATIONSIN MEDICAL EDUCATION

The Committee exists to orient mem­bers of the Association to the responsi­bilities and opportunities involved ininternational relations in the field ofmedical education and to bring aboutunderstanding and exchange of ideasacross national boundaries. The Com­mittee, also, functions in an advisorycapacity to the Executive Committee andthe Executive Secretary of the Associa­tion. The Committee is concerned with(1) keeping under continuous scrutinythe problems involved in the exchangeof students and faculty between theUnit:d States and other countries, (2)keepmg in close touch with and to en­courage exchange relationships betweenselected foreign medical schools and sis­ter institutions of the United States and(3) giving special assistance to foreign~tudents or teachers who are studyingm the United States in preparation forr~turning to teaching at home. The prin­CIple concern, however, has been limitedlargely to the exchange of medical per­sonnel at the advanced scholar level(research scholars, medical faculty mem­bers and lecturers) and to contractualprograms between American and foreignmedical schools.

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I quote from the CommIttee report m1956:

"There are three principle govern­ment-sponsored exchanges, the Inter­national Cooperation Administration ofState Department, administered by theDivision of International Health of Pub­lic Health Service, the Fulbright Programof 1946 and the Smith-Mundt Program,which in 1948 broadened exchange ac­tivities to include other kinds of grantsand non-Fulbright countries. Two non­governmental agencies through contrac­tual agreements with the Department ofState assist in the selecting and placmgof the Fulbnght and Smith-Mundt gran­tees, namely, the Committee on Inter­national Exchange of Persons of theConference Board of Associated Re­search Councils (CIEP) and the Insti­tute of International Education (lIE).The former orgamzation deals only withsenior scholars.

"In addItion to the government ex­change programs innumerable institu­tions and agencies have sponsored ex­change programs of their own. Amongthese programs are the Rockefeller Foun­dahon, the Kellogg Foundation, the PanAmerican Samtary Bureau (PASB),Regional Office of the World Health Or­ganization (WHO), CommonwealthFoundation, John Jay Whitney Founda­tion, CarnegIe Foundation, GuggenheimFoundation, the Chma MedIcal Boardand the Unitanan Service Committee.The picture is complex, and overlapping,eligibility, screening processes, selectionmethods, assignments, stipends, travelfunds for local or internatIOnal use, bookallowances, medical expenses, etc. varyconSIderably. It has been said that for­eign scholars now 'look for the agencygiving the highest stIpends and the great­est fringe benefits'."

For medical educators interested inthe problem of exchange of medicalschools and/or contractual agreementsthe following publications are easily ob­tainable:

"I.C.A Fact Sheet" (InternationalCooperation Administration)

Office of Public Reports, I.C.A.Washington 25, D.C.

Information concerning the new sys­tem of I.C.A. contract procedures, whichallows for "responsible stewardship ofpublic funds in the achievement of apublic purpose" and "permits sufficientdelegation of authority to contractors toassure achievement of the educational

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vbjectives of the program," can be ob­tained through:

Office on Institutional ProjectsAmerican Council on Education1785 Massachusetts Avenue, N.W.Washington 6, .D.C.

Other aspects of contract relations be­tween American medical schools andforeign medical schools are covered in:University of California Medical Science

Teaching in Indonesia, J. Med. Educ.,32:344-349, May 1957.A new contract program initiated since

last year has been made between theUniversity of Indiana School of Medicineand Pakistan to establish a basic scienceinstitute at Karachi (Dean John D. VanNuys, General Program Director).

The University of Iowa has, also, madea contract with I.C.A. to work with theUniversity of Quito, Ecuador in making asurvey of the teaching of basic sciences.

Publications concerning programs forforeign students at both the undergrad­uate and graduate levels have beenmailed to alI medical schools and canbe had on request from the variousagencies:

(1) "United States Medical Trainingfor Foreign Students and Physicians"

Committee on Educational Inter-change Policy

Institute of International EducationOne East 67th StreetNew York 21, New York

(2) "Open Doors 1957-A Report 011

International Exchange"Institute of International EducationOne East 67th StreetNew York 21, New York

(3) Committee on International Ex­change of Persons

Conference Board of AssociatedResearch Councils

2101 Constitution Avenue, N.W.Washington 25, D.C.

Mailed under date of December 31,1956:(a) Information for American univer­

sities wishing to invite a foreignscholar through the United Statesgovernment's Educational ExchangeProgram.

(b) "Annual List of Visiting Scholars"­providing information regarding thenationality, field of study and loca­tion in the United States of scholarsreceiving United States governmentgrants (1956-57 over 600).

(c) "Information for Visiting Scholars"-awarded grants under the Ful­bright and Smith-Mundt Acts.

(4) "Quarterly Reports of Medical

Minutes of the 68th Annual Meeting

Education Information Center" (MEIC)Pan American Sanitary Bureau1501 New Hampshire Avenue, N.W.Washington, D.C.

These reports cover activities of agenciesin the field of medical education in thePan American countries and list fellow­ship awards giving names, nationality,professional positions held, country ofstudy, purpose and sponsoring agency(P.A.S.B., W.H.O., K e 11 0 g g, I.C.A.,U.S.P.H.S., etc.).

(5) The new revised second edition of"Handbook on International Study" pre­pared by

The Institute of International Edu­cation

One East 67th StreetNew York 21, New York

is to be released October 3, 1957 (price$3.00). This handbook will contain com­prehensive information of interest toAmericans going abroad to study and tonationals of other countries coming tothe United States.

Progress of the joint efforts of theFederation of State Medical Boards ofthe United States, the American HospitalAssociation, the American Medical Asso­ciation and the Association of AmericanMedical Colleges to evolve a plan toevaluate individual foreign graduatescan be folIowed in:

(1) Foreign Medical Schools and Stu­dents, J.A.M.A., 161: 1661-1664,August 25, 1957.

(2) Kinsman, J. Murray: EducationalCouncil for Foreign Medical Grad­uates, Fed. Bull., 44: 217-220, Au­gust 1957.The group was incorporated underthe laws of the State of Illinois onMay 14, 1956. Dr. Dean F. Smileywill become full-time Director onor about October I, 1957. Theheadquarters are to be establishedin Evanston, Illinois. The Educa­tional Council function "is toevaluate individual foreign gradu­ates and to supply informationconcerning this evaluation to stateboards, hospitals or other agenciesupon legitimate request."

The Association cooperated with theNational Committee for Resettlement ofForeign Physicians, Inc. in screening ofHungarian medical student refugees. InNew York Dayton Edwards, Secretary ofthe Faculty of Cornell Medical School,in Chicago John A. D. Cooper, Assist­ant Dean of Northwestern MedicalSchool, and in San Francisco Malcolm

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Watts, Assistant Dean of the Universityof California Medical School, did the ac­tual evaluation of individual candidates.

The new series of articles in MEDI­CAL EDUCATION on medical educationin foreign countries is very informative.(1) Bargmann, W.: Medical Education

in Germany, J. Med. Educ., 32:422­426, June 1957.

(2) Smyth, Francis Scott: University ofCalifornia Medical Science Teachingin Indonesia, J. Med. Educ., 32: 344­349, May 1957.

(3) Bonetti, Eugenio: Medical Teachingin Italian Universities, J. Med. Educ.,32:547-551, August 1957.

(4) Sinclair, David C.: Medical Educa­tion at Oxford, J. Med. Educ., 32:467-475, July 1957.

(5) Leake, Chauncey: Medical Educa­tion in the U.S.S.R., J. Med. Educ.,32: 269-277, April 1957.

(6) Wahi, P. N.: Medical Education inIndia, J. Med. Educ., 31: 249-254,April 1956.

(7) Kusama, Yoshio: Medical Educationin Japan, J. Med. Educ., 31:393-398,June 1956.

The Association was a participatingorganization in the Second NationalConference on Exchange of Persons,Education for International Responsibili­ties, December 5-7,1956 in Chicago. Yourchairman attended, and Dr. Howard M.Kline, a consultant to this committee,was a panel discussant.

The Association co-sponsored with TheChina Medical Board of New York, Inc.and the Conference Board of AssociatedResearch Councils, a Conference onMedical Education for Foreign Scholarsin the Medical Sciences, held at the Uni­versity of Wisconsin, June 24-26, 1957.This is reported in J. Med Educ., 32: 590­591, August 1957, by John Z. Bowers,Dean, University of Wisconsin, whoacted as moderator and host. The meet­ing was eminently successful, wellplanned and beautifully conducted. Sev­eral members of this committee parti­cipated.

A survey team, consisting of John Z.Bowers, Dean of the University of Wis­consin Medical School, Dean F. Smiley,Secretary of the Association of AmericanMedical Colleges, and Richard H. Young,Dean of Northwestern Medical School,visited the American University of BeirutFaculty of Medicine, Beirut, Lebanon,May 6-9, 1957. The American Universityof Beirut was chartered on April 24, 1860by the State of New York; the medicalschool opened in 1867. There is an Amer-

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ican Board of Trustees and Americanplan of instruction, with key personnelbeing American, and American financialsupport. The proclaimed objectives of themedical school are: "To offer medicaleducation of the American type andquality to the people of the Near Eastwhere many countries as yet have nofacilities of their own; to set a highstandard for existing state schools toemUlate; and to turn out medical educa­tors who may assist other schools in theirdevelopment." A report and recommen­dations were submitted to the ExecutiveCouncil of the Association.

Dean Bowers and your chairman hadthe pleasure of individually contactingDr. E. Grzeoorzewski, Director of Medi­cal Education, World Health Organiza­bon, Geneva, Switzerland. RICHARD H.YOUNG, chairman.

Following this report Dr. Young pre­sented the following resolutions, whichwere referred to the Executive Councilfor study and recommendation.

(l)lt is the opinion of the Committeeon International Relations in MedicalEducation that the faculties of medicineand their respective universities shouldrecognize that programs of education inthe foreign field, whether by private orFederal subsidy, need the consultationand cooperation of our educational insti­tutions, that such partiClpation is botha university responsibility and an op­portunity and that such service enrichesthe experience of both the individualparticipant and his institution and henceshould be encouraged by proper recogni­tion and appreciation in terms of univer­sity service and academic status.

Be it resolved that copies of the fore­going statement be sent the respectiveconstituent institutions of the'Associa­tion of American Medical Colleges.

(2) Because of the almost insurmount­able difficulties and frustrations con­fronting foreign students who seek pre­medical or undergraduate medical edu­cation in this country, and

Because of the usual inappropriatenessof undergraduate education in thiscountry for foreign students who intendto return to medical practice in their owncountry,

Be it resolved that, the Association ofAmerican Medical Colleges recommendsto the State Department and other gov­ernment and non-government agenciesthat they do not encourage foreign stu­dents to seek premedical and under­graduate medical education in this coun­try, and that their recommendations be

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limited to those graduates of foreignmedical schools who are seeking post­graduate or graduate experience.

REPORT OF THE COMMITTEE ONINTERNSHIPS, RESIDENCIES ANDGRADUATE MEDICAL EDUCATION

During the year 1957 this Committeeaas been concerned largely with twomatters:

(1) activities to remove the restric­tions on types of internships whichmay be approved by the Council onMedical Education and Hospitals ofthe American Medical Association, and(2) A study of the internship in ouruniversity teaching hospitals.

(A) It will be recalled that in 1955the Council on Medical Educationani Hospitals was instructed bythe House of Delegates of the Amer­ican Medical Association to approvefor internship training only thoseprograms in which the service wasof the rotating type. Further instruc­tions were given urging that actionbe taken to encourage the elimina­tion of the straight internship inservices then offering such programs.This action to restrict form and typeof the internship was protested bymany different groups and organiza­tions, including our Association. Onthe recommendation of this Com­mittee the Association Counciladopted a forceful position on thismatter at the last Colorado meeting.It is gratifying to report that at theJune 1957 meeting, the House ofDelegates of the American MedicalAssociation, on the recommendationof the Council on Medical Educationand hospitals and with the approvalof the Reference Committee, re­scinded its action prohibiting ap­proval by the Council of straight in­ternships. The House again ex­pressed their preference for the ro­tating internship experience but au­thorized the Council to consider forapproval straight internship of su­perior educational content in medi­cine, surgery, pediatrics and, in spe­cial instances, in obstetrics.(B) At the meeting of the ExecutiveCouncil of the Association of Ameri­can Medical Colleges during the lastAnnual Meeting action was takenapproving the recommendation ofthis Committee that a study of theinternship be initiated by the Asso­ciation. Two meetings of the Com­mittee were held in Chicago on Feb­ruary 9 and II, 1957, at which

Minutes of the 68th Annual Meeting

tentative plans were submitted tothe Executive Council and approvedon May 25, 1957. The Committee isnow working on final plans for thestudy which should be submitted tothe Executive Council at the Atlan­tic City meeting for final approval.E. HUGH LUCKEY, chairman.

Following this report, a proposal for"A Survey of the Internship in Univer­sity Teaching Hospitals" was referred tothe Executive Council for study andaction.Annual Meeting:

A meeting of the Committee was heldin Atlantic City on Sunday, October 20

·from 10 a.m. to 12: 30 p.m. Present were:Doctors Deitrick, Lawrason, Luckey,Manlove, Stowe, Wolf, and by invitationDr. Charles Kiely (representing Dr.Vilter) and Dr. Edward Turner. DoctorsAagaard, Armstrong and Pruitt were notable to be present.

1. The activities of the Committee dur­ing the past year were reviewed. Atten­tion was called to the gratifying action ofthe House of Delegates in June 1957 re­moving restrictions on the approval ofstraight internships by the Council onMedical Education and Hospitals.

2. The current status of the Berry Planand influence of military medical per­sonnel requirements on the residencyprograms in our university hospitals wasdiscussed. All information now availableindicates that in the academic year 1958­59 the needs for physicians in militaryservice will be exceeded by volunteers.This introduces problems of a new sortin our university hospitals: the provisionof an adequate number of high qualityresidency experiences for those menwho in recent years would have beencalled to military service at the end oftheir internships. Although this is not anunwelcome prospect, considerable re­organization of our internship and resi­dency programs is necessary to accom­modate this sudden change in militaryrequirements. Further, it seems to ourCommittee that this current period pro­vides our governmental agencies the op­portunity to plan for future medical per­sonnel requirements in a more satisfac­tory manner. The following recommen­dations are made:

A. That physicians be called toactive military service only aftercompletion of their period of resi­dency training.

B. That consideration be givento a reduction in the amount of

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time an individual physician is re­quired to spend in military service.

C. Not least important, thatproper recognition be given to theimportance of research and thelarger contributions to the overalldefense efforts afforded by reten­tion on medical school staffs of se­lected individuals with unusual re­search and teaching responsibilitiesand potentialities. Some provisionshould be made for the exemptionof these individuals from militaryservice in order to prevent the in­terruption of their scientific andeducational productivity.

D. The chairman referred to aletter to the Association from DeanMarsh of the University of Miamirequesting approval of a survey inmedical schools and selected hospi­tals concerning their policies re­garding the compensation and per­quisites to resident physiCIansfrom extramural sources. TheCommittee recognized the import­ance and extent of this problembut considered that the survey re­quested would produce no gener­ally useful information and sug­gested that this was a matter forlocal policy determination. How­ever, -the Committee was in agree­ment that the compensation for in­ternships, fellowships and trainee­ships should be approximately thesame at any given period aftergraduation from medical school.

E. Finally, the Committee dis­cussed at length the plans for astudy of the internship in our uni­versity hospitals. The proposal forthis study is attached as an adden­dum to this report for the consid­eration of the Executive Council.

REPORT OF THE COMMITTEEON LICENSURE PROBLEMS

Your Committee has held no formalmeeting within the past year, althoughits chairman and other members at­tended the Annual Session of the Fed­eration as a part of the Congress onMedical Education in Chicago in Feb-ruary 1957. .

At that meeting the general theme was"A Reevaluation of Examination Tech­niques," and the first of a proposed seriesof Institutes was held, this one coveringObstetrics and Gynecology. This interestof the Federation in experimenting withmethods of examination represents ahealthy forward step.

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At its meeting in February 1956, theFederation had approved a model Medi­cal Practice Act which had been pro­posed by a special committee, and itrecommended that the various statesadopt legislation in line with the prin­ciples laid down in this model Act.

In creating the Committee on Licen­sure Problems, the Association was mo­tivated by its concern over the great dif­ference in licensing practices between thevarious State Boards, and it is hopedthat it might be possible to developgreater uniformity in this respect,throughout the country. The two devel­opments referred to above constituteheartening evidence that progress is be­ing made in this direction. Much still re­mains to. be accomplished; e.g., it is stillhoped that some way can be foundwhereby a senior student will not haveto take his medical school final examina­tions and then, immediately followinghis graduation, take another set of ex­aminations for licensure. Acceptance byall of the State Boards, of the NationalBoard certification would solve this prob­lem to a large extent, and therefore yourCommittee repeats the statements whichit has made in previous reports, to theeffect that every effort should be madeto encourage the widespread acceptanceof the National Board.

In the earlier years of its existence,your Committee was greatly concernedover the problem of the foreign medicalgraduate. With the organization and ac­tivities of the Educational Council forForeign Medical Graduates, one phaseof this problem no longer remained amajor responsibility of your Committee.However, the Educational Council is notdirectly concerned with licensure of theseforeign graduates; this will continue tobe a major problem for some time yet,and hence it is likely to remain a matterof pertinent concern to the Associationand therefore to your Committee. J. MUR­RAY KINSMAN, chairman.

REPORT OF THE COMMITTEEON MEDICAL CARE PLANS

In its report at the Annual Meeting in1956, the Committee on Medical CarePlans made note of the fact that the rapidexpansion of medical care plans had ledto increasing use of private patients inteaching at both the undergraduate andgraduate levels. Major difficulties hadarisen, partiCUlarly in the later stagesof residency training in surgery whenfull responsibility for the definitive careof patients is necessary. Several possible

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solutions were presented to the member­ship, but no recommendation was made.

Two developments since the report of1956 indicate the need for further con­sideration of the use of private patientsin residency programs: In a recent issueof the Journat of Medicat Education, theSociety of University Surgeons is quotedas stating that "a properly trained andlicensed surgical resident is fully capableof performing surgery, with consent ofthe patient, and that charges for thisservice should be recognized by insur­ance, governmental and other agencies."On the other hand, at the June 1957 An­nual Meeting of the American MedicalAssociation, the House of Delegates con­demned Medicare payments by the Gov­ernment to residents.

The Committee on Medical Care Planshas formulated a tentative plan to bediscussed at the meetings of the CommIt­tee at the time of the Annual Meetingnext October. Two propositions are in­cluded in the plan:

1. That the geographical full-timephysicians in university and otherhospitals integrated with medicalschools be so organized that pri­vate practice by them in these hos­pitals would constitute group prac­tice of a type already approved byorganized medicine.

2. That properly trained and li­censed residents in these hospitalsbe incorporated as bona fide mem­bers in the groups designatedabove, with the right to fees forlimited private practice from thepatients served or from third par­ties responsible for the fees.

It is obvious that many objections maybe raised. The Committee hopes to beable to meet these objections and to drawup a final plan acceptable to the Associa­tion of American Medical Colleges, theAmerican Medical Association, hospitals,and specialty boards. JOHN F. SHEEHAN,chairman.

Prior to the 1957 Annual Meeting theCommittee formulated a tentative planfor the use in teaching and research ofprivate patients by full-time membersof clinical facilities. The basic provi­sions of the plan were outlined in a pre­liminary annual report which has beendistributed to the membership. At aclosed meeting of the Committee on Oc­tober 20, 1957 modifications and additionswere made. The revised plan was pre­sented at an open hearing on October 21,1957. As a result of the discussions at

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this session additional changes have beenmade. The final draft follows:

Institutional Group Practice by ClinicatFaculties of Medical Schools-A State­ment of Principtes.1. The rendering of medical service by

full-time members of clinical facultiesof medical schools is necessary for thefulfillment of the teaching and researchobligations of the clinical departments.The amount of medical serVIce and thenumber of physicians providing suchservice should be proportionate to theteaching load and volume of research.

2. The association of some or all of thefull-time members of a clinical facultyin groups designed for collaborative pri­vate medical practice is ethical provided.

a. That fees are set by the par­ticipating physicians.

b. That the income from fees isdeposited in a separate fund orfunds in the business office of theuniversity or medical school and

c. That disbursements are madein accordance with a plan pre­arranged by the university ormedical school, and acceptable tothe physicians involved. Control ofdisbursements may be delegated toa committee or other agency ap­proved by the participating phy­sicians.

A single fund for all of the clin­ical departments is recommendedsince controlled expenditures froma common fund can nest insure thebalanced development of the teach­ing and research programs of theindividual clinical departments.

3. The economic and sociological prob­lems resulting from the long period ofeducation and training necessary for thepractice of medicine have impeded therecruitment of qualified candidates formedicine and fostered the abandonmentof many graduates of medical schools ofplans for continued education in institu­tions best adapted to provide such oppor­tunities. To offset, at least in part, theseunfavorable trends, expedients may haveto be adopted to insure some degree ofeconomic security, particularly in thelater stages of preparation for practice.Hence, despite apparent violation of thetraditional concept of resident-training,residents may have to be permitted toengage in limited medical service forfees. Those permitted this privilegeshould be members of a group of full­time members of a clinical faculty, or­ganized for collaborative private medi-

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cal practice. Such participation by resi­dents is not unethical provided:

a. That, in the judgment of thephysicians directing their educa­tion and training, they havereached a stage of competency ade­quate for the assumption of appro­priate responsibility.

b. That they have secured a li­cense to practice medicine in thestate or states in which are locatedthe institutions in which they serveas residents.

c. That they have obtained theconsent of the patients for whosecare they assume responsibility.

All fees received by these resi­dents should be deposited in thefund or funds designated by theplan which governs the terms ofmedical service by the group ofwhich the residents are members.

The Committee on Medical Care Plansis well aware that the adoption of theseproposals may tend to weaken the bondbetween a university or medical schooland its faculty and may portend retro­gression toward a proprietary type ofschool. Nevertheless, the financial plightof many of our medical schools is seriousenough to warrant the risk. JOHN F.SHEEHAN, chairman.

The recommendations regarding insti­tutional group practices by clinical fac­ulties of medical schools-a statement ofprinciples-was referred to the Execu­tive Council for study and action.

RlPORT O' THI COMMlnEEON MIDICAL EDUCATIONFOR NATIONAL DEFENSE

At its October meeting, the Execu­tive Council of the Association of Ameri­can Medical Colleges indicated its wishthat the Committee on Planning for Na­tional Emergency expand its activitieson behalf of the Association. It added thefollowing members to the Committee:

Melvin A. Casberg, M.D., Vice Presi­dent, UniveTsity of Texas

George Armstrong, M.D.,Vice Chancel­lor for Medical Affairs, New York Uni­versity

Daniel T. Rolfe, M.D., Dean, MeharryMedical College

William S. Stone, M.D., Dean, Univer­sity of Maryland School of Medicine

At its meeting in February, it voted torename and redefine the Committee asfollows:

a) "The Joint Committee on Medi­cal Education in Time of Na­tional Emergency is to be abol-

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ished (subject to similar actionby the Council on Medical Edu­cation and Hospitals).

b) The Association's present Com­mittee on Planning for NationalEmergency is to be renamed'The Committee on MedicalEducation for National Defense.'

c) The present Subcommittee onMedical Education for NationalDefense of the Joint Committeewill be made a subcommittee ofthe new Association's 'Commit­tee on MEND' and entitled 'TheSubcommittee for the MENDProgram.'

d) If joint action of the AAMCand the Council on MedicalEducation and Hospitals is re­quired, the Liaison Committeeon Medical Education will ap­point a subcommittee for thepurpose."

The newly re-organized Committee onMedical Education for National Defenseprepared the following statement of ob­jectives which was approved by theExecutive Council by mail vote.

In spite of the widely held view that awar involving nuclear weapons would bea short war, it appears safer and morerealistic to assume that such a conflictwould last, as have other major wars, forat least four years before a decision orstalemate is reached. The need for healthservices will increase progressivelythroughout the combat period. Consider­ing the devastation that weapons of massdestruction now available can create,adequate support by a superior healthservice with sufficient professional per­sonnel may well be a major factor invictory or its lack a critical factor indefeat.

Medical education and medical re­search are essential resources of our na­tion which should be protected in timeof national emergency because even tem­porary interruption has immediate andlasting effects which we can ill afford.Orderly procedures to preserve the qual­ity of professional education and the con­duct of important research should be de­veloped in advance of such emergency bydefining for the several degrees of mili­tary commitment the extent to whicheducational and research personnel andstudents shall be assigned to this vitaltask.

Colleges of medicine and teaching hos­pitals should develop proposals for al­ternate sites of operation and for mutualcooperative assistance in the event attack

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occurs or appears imminent. Colleges ofmedicine should insure that their stu­dents and graduates are fully prepared tomeet their unusual responsibilities asphysicians in time of national emer­gency.

In furtherance of these objectives, theCommittee on Medical Education for Na­tional Defense recommends to the Execu­tive Council of the Association of Ameri­can Medical Colleges:

1. That strong efforts be made by theAssociation of American Medical Col­leges in cooperation with such organiza­tions, persons, and governmental agen­cies as it deems appropriate, to define assoon as possible mechanisms wherebystudents salaried and voluntary faculty,interns ~nd residents may be permittedto carryon essential medical educationand research activities in the event ofnational emergency. There may be manyways to define the essentiality of. thegroups mentioned above, but we believeit could be effectively accomplished bythe following:

a. Continue the function of the Na­tional Advisory Committee to SelectiveService as a permanent activity.b. Divide the registrants for which thiscommittee is now responsible into twomain categories:

(l) Professional persons in practice(2) Those engaged in teaching and

researchc. Continue to delegate to the state andlocal advisory groups, as now consti­tuted responsibility for advising withrespe~t to professional persons in prac­tice.d. Develop new regional advisory com­mittees, composed of representativesfrom medical education and research,to advise with respect to medical stu­dents teachers and investigators, in­terns' and residents. These regionalcommittees would function under theNational Advisory Committee as dothe state and local advisory commit­tees.2. That the MEND Program be con­

tinued and expanded to include as manyschools as wish to participate. Seriousinquiry should be made into the possi­bility of further expanding this activityin time of emergency to include, underdirection of the faculty, those additionalresponsibilities of medical students thatare essential during national emergency.This might include military orientationand training and such other courses andactivities as would best fit them to servetheir country. It is believed that this

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mechanism would be superior to thoseused in other emergencies.

3. That medical schools be requestedand encouraged (perhaps required) todevelop an "emergency plan" with localand national support. This would re­quire that each school survey the sur­rounding area to locate possible alternatesites of operation if enemy attack shouldoccur or appear imminent and have aplan for evacuation of this location. Re­gional plans should be developed for thecontinued education of students and theutilization of faculty displaced by de­struction of medical schools. Considera­tion should be given to the possibility offorming "affiliated medical care units"composed of faculty and students to goto the aid of devastated areas for aperiod limited to the acute emergency.All schools should be familiar with thesetting up and operation of emergencyhospital equipment in public buildingssuch as schools and churches.

4. That continuing study and revisionbe made of these plans to keep them cur­rent with changing concepts of war anddefense. There should be continuing ef­forts to maintain close liaison with re­sponsible officers and officials of the mili­tary services and other Federal agenciesconcerned with medical aspects of de­fense. The program of the conventionof the Association of American MedicalColleges should be planned with this asone of its objectives.

If the Executive Council approves ofthis approach to planning for nationalemergency, the Committee will proceedin cooperation with the Executive Direc­tor of the Association of American Medi­cal Colleges to implement the plan as 'ex­peditiously as possible and will keep theCouncil informed of its activities.

On May 4 the Committee met in spe­cial session in Washington to considerthe following matters:

1. It reviewed in detail the proposedamendment to selective service authoriz­ing physicians, dentists, and allied spe­cialists to be selectively called up to age35, irrespective of the age grouping em­ployed by selective service for other reg­istrants. Recommendation was made withreference to a prepared statement to bepresented to the House Armed ServicesCommittee at its hearings on the bill(Subsequently the' Chairman presentedthe attached statement when the HouseCommittee met on May 8.)

2. Information was obtained regardingthe appointment of a special stUdy com­mittee under the chairmanship of Dr.Harvey Stone to report to the Director

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of the Office of Defense Mobilization re­garding plans for the continuation ofmedical education during time of emer­gency. It seemed advisable that ourgroup should work as closely as possiblewith this newly formed committee.

3. Considerable discussion took placeabout how to proceed in the matter ofpersuading the schools to develop an"emergency plan" for evacuation or forthe reception of "bombed out" studentsand faculties.

The Committee approved two steps atthis time:

(l) To contact Dr. Middleton to see ifa national policy can be formulated au­thorizing managers of V.A. hospitals lo­cated in smaller communities to co­operate with officials of medical schoolsin their area who consider their hospitala suitable potential alternate site for thecontinuance of medical education in theevent an alternate site is required. Thismight not be feasible for all schoolsbut might be for a large percentage. Ithas the further merit that these hospitalsmight become extremely important re­sources for civilian medical care underemergency circumstances and in thatcase would have excellent clinical ma­terial.

(2) It was further suggested that theOffice of the AAMC send a copy of theCommittee's objectives (as approved bythe Executive Council) to each -schoolwith a request for copies of such plansas have already been formulated. Weexpect few schools have such plans, buteven those few should be studied beforesuggestions are made to the schools asto how to proceed in the developmentof a plan. If the Veterans' Hospital ap­proach has been cleared, they could begiven this information and requested toexplore the merits of the plan for theirarea.

4. There was inquiry into the prob­lem of the Armed Forces granting grad­uate degrees. The Committee requestedthat Dr. Colin MacLeod, Chairman of theResearch Advisory Board of the WalterReed Army Institute of Medical Re­search be contacted for information asto how academic work at the Institutewas organized and the relationship of hiscommittee to educational activities.

5. Colonel Fitts, who was in charge ofthe ASTP program in the office of theSurgeon General of the Army duringWorld War II met with us for an hourand provided information about the his­tory of the ASTP. Apparently the think­ing of the Army was influenced greatly

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by the experience of World War I whenit was found that large numbers of medi­cal students volunteered for active dutyeven though they were deferred by thedraft boards. As a result, the graduatingclass in 1922 was only 2,250 as com­pared with 4,500 in 1917.

The subcommittee on the MEND pro­gram has met on three occasions-inOctober at Colorado Springs, in Febru­ary at Chicago, and in June at New YorkCity. It has reviewed the operation ofthe programs at the 35 schools. It hasplanned symposia and orientation toursand has tentatively selected additionalschools for inclUSIOn in the program asfunds become available. Dr. Schofieldand Mr. Don Smith have done outstand­ing work in implementing the MENDprogram and findmg new ways to tie themedical schools and the Armed Forcestogether more closely. STANLEY W. OL­SON, chairman.

Following this report, Dr. Olson pre­sented the followmg additional reportwhich was referred to the ExecutiveCOl-ncil for stUdy and action.

REPORT OF MEND COMMITTEE

1. This group notes with satisfactionthe steps taken by our government tostrengthen the Health Section of 1heOffice of Defense Mobilization as evi­denced by the following appointments:

a. That of Dr. Palmer Dearing to theposition of Assistant Director forHealth.b. That of the Task Force For HcalthManpower under the chairmanship ofDr. Harvey Stone and the staff direc­tiOll of Dr. Leslie Knott.The report presented by Dr. Knott

at the conference on Saturday, October19 gives good evidence that this taskforce is approaching the problems ofMedical Education in Time of NationalEmergency with sound objectives inmind. Further, this governmental inter­agency committee apparently is willingto seek consultation from responsibleeducational groups and to be guided bytheir suggestions.

In view of the great significance thatthis Task Force's recommendations canhave for the entire field of medical edu­cation, we urge in the strongest termspossible that the AAMC continue itsefforts to guide their decisions to the endthat they may be supportive of ratherthan destructive of sound educationalprograms in medicine.

Further, it is quite clear that the prob­lems of medical manpower in time of na-

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tional emergency impinge almost imme­diately upon educational policies andprograms. Every effort should be made(probably in cooperation with the Coun­cil on Medical Education and Hospitalsof the AMA) to insure that policies re­garding educational manpower require­ments not be formulated solely by groupsand individuals primarily concernedwith the allocation of medical manpowerbetween the military and the generalpopulation.

2. We request that the President ofthe AAMC write to Dr. William Mid­dleton, Chief Medical Director of theVeteran's Administration, stating thatthe AAMC officially endorses the pro­posal that medical schools individuallyconsider the use of Veteran's Adminis­tration Hospitals in other than their otherimmediate areas as potential sites forclinical teaching in the event of destruc­tion of normal clinical facilities by en­emy action. Dr. Middleton has indicatedhis desire to receive such an official re­quest before entering into further dis­cussions of the possibilities of such a plan.

3. The Committee believes the timehas come for the AAMC to put itselfon record as having officially requestedeach school to proceed with the develop­ment of emergency plans for the con­tinuation of education in the event itsphysical plant is destroyed or severelydamaged by enemy action. We believe itmay be<1Ppropriate to direct such a let­ter to the president of the university(when feasible) with a CODY to the dean.

It appears important to study man­power requirements as an integral partof such an emergency plan, and the Com­mittee requests that the deans be ad­vised with respect to whatever plans theAAMC may have in this regard sothey not begin a study which would besuperseded by a later request for dif­ferent information.

When emergency plans have been de­veloped by the schools some mechanismwould be devised for informing theAAMC or its appropriate committee of

. their nature. Information regarding par­ticularly appropriate plans should be cir­culated to the other schools for theirconsideration.

REPORT OF THE COMMITTEEON PUBLIC INFORMATION

The Committee met in Cleveland onMarch 20-21, 1957, with Dr. Ward Dar­ley, to discuss long range plans for anAAMC public relations program. Repre­senting the Committee: Doctors Caughey

Minutes of the 68th Annual Meeting

(Western Reserve) and Van Nuys (In­diana), Milton Murray (College of Medi­cal Evangelists) and Ray Torr (NationalFund for Medical Education). Absentwere Doctors Cameron (Hahnemann)and Forster (Georgetown) and RalphRohweder (National Society for MedicalResearch). This report summarized thediscussion at that meeting.

Opening the first session, Dr. Darleystated that public relations has top prior­ity among AAMC organization problems.He expressed the hope that the Commit­tee would provide guidance to him inworking toward an effective solution.

Considerable question was raisedabout the importance to medical educa­tion of newspaper publicity. It was em­phasized that good PR begin at home,in dealings with students, staff, employ­ees, relatives, volunteer workers andothers participating in medical center ac­tivities. Each of these groups must feelthey are a part of a high quality opera­tion if they are to make their best pos­sible contribution to medical school PRin the community.

Dr. Caughey expressed the feeling thatone AAMC PR objective should be tohave every informed citizen know thatmedical schools locally and the AAMCnationally are sources of medical leader­ship, just as are county medical societiesthe AMA. Dr. Van Nuys emphasizedthat these two sources of medical lead­ership are not necessarily in conflict,since all practitioners are former stu­dents and could be helped to developthorough understanding of medicalschools' objectives and problems.

Dr. Darley stressed the need of AAMCfor competent PR staff if it is to planahead to meet recognized problems. Hepointed out that the AAMC is frequentlyput in a defensive position because issuesarise in areas where AAMC has noclearly defined policy. He cited privatepractice by geographical full time teach­ers, internships in teaching hospitals,residency programs, and postgraduateeducation as examples of problems need­ing effective long-range planning byAAMC. Dr. Darley also spoke of the needof AAMC for "operational research" toprovide data on which to base its over­all policy-making. Under this heading hediscussed:

(1) cost accounting in medical edu­cation,

(2) university - medical school rela­tionships,

(3) the proper scope of private prac­tice by medical school teachers,

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(4) the reasons for, and effects of,geographical limitations on medi­cal school admissions,

(5) the predictable need for newmedical schools, including possible2-year schools,

(6) the means for decreasing thedrop-out rate among medical stu­dents,

(7) the potential "pool" from whichadditional faculty personnel canbe drawn, and

(8) the most effective way of prepar­ing and using an "Annual Report"of AAMC activities.

Dr. Darley pointed out that the addi­tion to AAMC of divisions concernedwith PR and with Operational Researchheaded by persons capable of working atthe policy and planning levels wouldmake it possible to have very effectivestaff conferences in the central office.

There was considerable discussion ofthe relations of medical schools with theuniversities. It was emphasized thatmany presidents are ill-informed aboutmedical education, and that faculties inliberal arts and other divisions are oftenantagonistic because of the medicalschools' higher salary scales, and greaterability to attract research funds. It wasstressed that effective PR are needed todeal successfully with these and othergroups, including students and alumni.

The Committee discussed in detail theorganization of a PR program for AAMC.It was agreed that PR should be a recog­nized department of AAMC, and shouldbe headed by a Director capable of par­ticipating with the Executive Directorand other department heads in the de­velopment of Association policies andlong-range plans. From an organizationalpoint of view, the PR department wouldcorrespond to other units of the Associa­tion such as the Journal of Medical Edu­cation, Educational Research and Serv­Ices, and the projected OperationalResearch.

There was extensive consideration ofthe qualifications an AAMC PR directorshould have. It was agreed that abilityto understand the broad significance ofmedical education and the problems ofthe Association and member schools, andto give professional level assistance tothe Executive Director would be moreimportant than any specialized trainingor experience in techniques of commu­nication. The concensus was that knowl­edge and experience in the field ofeducation should be considered essential,while previous direct contacts with

lOS

health and with public relations shouldbe classed as desirable.

The following suggestions were madeabout functions of an AAMC PR director:

(A) Professional level assistance tothe Executive Director in plan­ning and policy functions.

(B) Development of personal rela­tions with individual medicalschools to understand their prob­lems and assist them in local PRprograms.

(C) Formulation of a national PRprogram to serve and support theobjectives of the AAMC.

(D) Cooperation with the Committeeon Public Information, for whichhe would serve as secretary, exofficio.

The CommIttee discussed the staffneeded for an AAMC PR program. It wasagreed that the addItional personnelshould include at least one person withspecific communication skills and ex­perience who would be capable of pre­senting effectively the information thevarious "publics" should have about theAAMC and its functions. It was recog­nized that such a person should be se­lected to complement the abilities andexperience of the PR Director, and thatthis second person might also have func­tions in connection with the Journal ofMedical Education.

The Committee recommended to Dr.Darley a detailed budget of $23,000,$33,700, and $35,000 for the three yearsm which the build-up of a PR programwould be made.

The Committee discussed its own roleafter the AAMC establishes a PR de­partment. It was agreed that m accord­ance with usual AAMC procedure, theCommittee should have an advisoryfunction only, with normal channels ofcommunication to the Association at theAnnual Meeting, and to the Central Of­fice and member schools through theDirector of the PR Department. It wasfelt that the Committee could providehim with valuable suggestions, espe­cially in regard to the reactions of medi­cal schools to PR problems and plans. Itwas agreed that the Committee mightwell be enlarged by the addition of threeor four more deans to assure adequaterepresentation of medical adminbtrativeopinion.

Mr. Murray reviewed the presentstatus of his proposals for a traineeshipprogram in medical public relations. Hesuggested that the scope of National In­stitute of Health trameeship programs

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is so wide that medical PR persons mightbe included even under present regula­tion. It was agreed that more needs to bedone to define the qualifications suchtrainees should have, to determine whatdemand there may be for this training,and also to be sure that there are ade­quate places where they can be trainedand appropriate jobs for them to fillwhen their training is completed. It wassuggested that the AAMC PR Depart­ment might be an excellent training re­source at some later date.

In addition, the Committee discusseda number of public relations problemswith which medical education is faced­that is, questions on which there is ad­mitted to be considerable misunder­standing, both within the medical pro­fession and among the general public:medical school admissions policies, theso-called "doctor shortage;" geographicfull time arrangements; the reasons forand extent of financial needs; geographicrestrictions on enrollments; the widerange of medical school activities andresponsibilities (that is, what the schoolsdo besides turn out new doctors): therole of medical education in the promo­tion of national health, productivity andsecurity, and others.

Any long range program to clarifythese issues, it was agreed, can best beforwarded through the cooperation andjoint efforts of

(1) the individual schools,(2) the Association of American Med­

ical Colleges and(3) the Association's natural allies.

such as the American HospitalAssociation, the AMA, the Na­tional Fund for Medical Education,the U.S. Department of Health,Education and Welfare, the volun­teer health agencies and othergroups that disseminate informa­tion in the health field.

The primary impetus and leadershipfor such a program, the Committeeagreed, should come from the AAMCExecutive Council, through a public l-e­lations department which, it was hoped,may be set up in the near future.

It was agreed, however, that the in­dividual medical schools can do a greatdeal in the way of public relations with­out waiting for impetus and guidancefrom the national office. The Committeeemphasized that medical schools-likeall institutions, like all people, in fact­have public relations all the time,whether they are aware of it or not. Thequestion is: Are these public relationsgood or bad? How do the various publics

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look upon us? It was pointed out, duringthe Committee's discussion, that thepracticing physicians who make up thecounty medical societies were once ourstudents. Do the schools do all theyshould to help students understand thegeographic full time problem? Good pub­lic relations with this important "public"might help us in establishing under­standing and close working relationshipsin the future with county medical so­cieties.

It is clear from the above summarythat, as it has each year for the past ten,the Committee on Public Informationadvocates a vigorous Public RelationsProgram in the central office of the As­sociation. We believe this is absolutelynecessary if the Association is to meetfully its obligations for national leader­ship in all matters affeeting medical edu­caticn, JOHN L. CAUGHEY, chairman.

REPORT OF THE COMMITTEE ONVETERANS ADMINISTRATION­MEDICAL SCHOOL RELATIONSHIPS

No specific problems relating to therelations of Deans' Committees, or Medi­cal Schools, to the Veterans Adminis­tration requiring a meeting of your Com­mittee has been brought to our attentionduring the past year.

It seems proper however to reportbriefly on the problems which confrontthe Veterans Administration and manyaffiliated medical schools in both theeducational and research programs.

There are 90 VA hospitals affiliatedthrough Dean's Committees with 72 med­ical schools. In 81 of these hospitalsthere are approved resident trainingprograms.

The VA Hospitals, like many others.are not filling the number of residenciesoffered. This is in part due to the factthat there are many more residenciesoffered throughout the country thanthere are applicants. Another factor insome programs has been the difficulty ofthe VA in meeting the requirements ofthe specialty boards because of the lackof female and pediatric patients. This hasbeen met in some places by integrationof the resident program at the VA hos­pital with that at the university hospital,and in others by various forms of affili­ated services.

It seems to this Committee that ifDeans' Committees are to assume re­sponsibility for residency training pro­grams in VA hospitals they should makeevery effort to see that these programsare of high standards and meet all re-

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quirements of the boards, or else rec­ommend that they be discontinued. Ifresident programs are discontinued,there would be less need for Consultantsand Attendings, and the suitability ofVA facilities for undergraduate teachingwould vanish. Aside from any patrIOticmotives, it would seem that it is proper,after some ten years of Deans' Com­mittees-VA relationships, for the medi­cal schools to decide whether the asso­ciation has been worth the cost to theschool, and whether it is sufficiently de­sirable to actively support the VA resi­dency programs.

For the year 1956-1957, 61 medicalschools assigned students to 60 VA Hos­pitals. Thirty-one schools sent all ofeither third or fourth year classes to VAHospitals for clerkships. About one-thirdof all third and fourth year students hadclerkships in VA hospitals.

One of the most interesting and im­portant developments has been the es­tablishment of the Clinical InvestigatorProgram. This IS designed to prOVIde oneto three years training for men who de­sire training in clinical investigativetechniques, with a view of either a careerin the VA or university setting. At pres­cnt 23 have been selected by a specialcommittee from among some 50 appli­cants. This program does not competewith existing USPHH or Markle awards.It is designed to provide training forinvestigators who have completed theirformal years of residency trammg, butwho are not yet capable of fully inde­pendent research. It is a distinct con­tribution to increasing the pool of trainedmedical investigators.

The research programs in VA hospitalshave shown commendable growth. Re­search in the VA is essentially for im­provement in care of VA patients, and isunder the aegis of VA physicians. Thereare now some 170 laboratories in VAhospitals. The larger ones naturally, arein hospitals closely associated with med­ical schools. The unique position of theVA hospital system in conducting coop-

10;

erative studies is being more fully ex­ploited. In addition to the original co­operative studIes on the chemotherapyof tuberculosis, cooperative studiesamong a group of hospitals are now inprogress on a number of problems, in­cluding coccidIOmycosis, histoplasmOSIs,sarcoidosis, tranquilizers, antihyperten­sive agents, pulmonary function testing,multiple sclerosis, esophageal varIces,staphylococcal reSistance, and chemo­therapy of cancer. All of these are co­ordinated by the Hospital Education andResearch Committee which includesrepresentatives of the medical schools aswell as VA physiCians.

The most serIOus threat to the VAmedical program IS the fallure of Con­gress to prOVIde any increase 10 salaryfor VA phYSicians. This Will make re­crUitment more difficult, and poses a realthreat to the contmued scrvlce of manyof the best men now 10 the VA roles.

As Dr. Berry has pointed out, whilethe affiliatIOn between the medicalschools and the VA was not establishedfor the primary purpose of aiding themedical schools per se, the objectIVes arebest attained when the relationship ismutually benefiCIal to both the VA andthe medical schools. It would thereforeseem incumbent on the schools to makeevery effort to preserve the high qualityof patient care and personnel whiCh ex­IStS in VA hospitals JOSEPH M. HAYMAN,chairman

ThiS Committee recommends to theAssociation that the CounCil be requestedto consider the desirability of a studyto determine whether the Veterans Ad­ministration-Medical School relatIOn­ships have been mutually beneficial andshould be contmued, and If to be con­tinued how the mutual advantages of therelationships might be enhanced.

The question of the study of VeteransA.dmmistratlOn-Medlcal School Relation­~hips was referred to the ExecutiveCounCil for study and appropnate action.