Brit.3. m d . Educ., 1970, 4, 4-8

Medical Student Participation in Academic Affairs DONALD F. M. BUNCE' College of Osteopathic Medicine and Surgery, Des Moines, Iowa, U.S.A.

The organization and management of the medical school has traditionally been reserved to its teaching staff and administrative staff; participa- tion by students in the policy-making affairs of the institution has been minimal or non-existent.

This position seems to be changing. Students in recent years have become increasingly outspoken in their concern over the structure and direction of the educational process. They feel that they have something to contribute, and that their views should be considered, especially in the establish- ment of those academic policies which affect them directly. The schools, in turn, have recognized the potential value of student opinion, and have opened a variety of formal and informal channels to encourage communication.

There is a rapidly accumulating literature on the nature of student involvement in the academic affairs of the university, but little parallel informa- tion in schools of medicine. Since this is a topic of considerable current interest, an inquiry into the form and extent of medical student participation in institutional affairs was initiated. This report sum- marizes the results of the investigation.

Methods In November 1968, a letter was mailed to the Deans of 96 medical and four osteopathic schools in the United States asking them to supply a descrip- tive report of medical student participation in the academic affairs of their institution. Among other elements, it was the purpose of this investigation to explore the mechanisms existing among the schools which permit or encourage communication of student views to faculty and administration, and to

'Kennedy Institute of Rheumatology, Bute Gardens, Hammersmith, London W.6.

4

learn something of faculty and administrative sentiments regarding the role of the medical student in the determination of educational policies.

Quantitation of a series of narrative statements presents certain difficulties; nevertheless, where it was possible the data derived from this inquiry were translated into tabular summaries. Other information pertinent to the study which could not be treated statistically is described.

Follow-up letters were mailed to several res- pondents requesting clarification of certain points - for example, committee titles and functions where they were not implicit in the title, and methods for appointment of student members to faculty com- mittees, and their voting status.

Results Eighty-three medical Deans (83 %) replied to the IOO inquiries. Follow-up mailings to the remaining schools brought no further response.

The replies left no doubt that medical students, in parallel with their counterparts in other faculties, are evidencing mounting interest in being allowed to participate in shaping their educational future. The Deans generally were agreed that student opinion is valuable, and should be considered in the decision-making process. But on the question of whether student participation should be consulta- tive or determinative, the respondents were divided.

The polar views were expressed by about an equal number of schools. The view on one side was that students should not be involved in the deter- mination of institutional policies which are properly the responsibility of the faculty and administration. The other side heId that students should be considered as partners in the educa- tional process, and that they should participate in decision making at all academic and executive levels.

Medical Student Participation in Academic Affairs 5

The large middle ground appeared to favour active solicitation of student views in matters which affect them directly, and participation with staff in developing new approaches to improve and expand their professional education. Some Deans commented that students are often a refreshing and fruitful source of ideas, and that their contribu- tions are generally constructive and innovative, notably in such areas as curriculum rebision.

As views on the role of the student in the management of academic affairs are varied, so too are the methods by which they participate. In general they can be separated into two categories: one in which students are members of faculty committees, and thus have a direct voice in the formulation of policies; the other in which student views are heard informally through a variety of means, such as parallel student and staff commit- tees, recommendations of student organizations, group discussions in the schools or at retreats, etc.

Table I. Number of schools reporting student membership on staff committees

SchooIs (no.)

Student members 51 No student members 32

Student Participation by Membership on Faculty Committees Students serve as regular members of staff commit- tees at 51 (61%) of the 83 medical schools report- ing (Table I). Regular membership implies that students are elected or appointed to the commit- tees, and that they participate in all its delibera- tions. Casual observers or individuals invited to attend special meetings are not included.

Medical students do not serve on faculty com- mittees at 32 schools (39%).

The names of the various committees with student members are listed in Table 2. In most instances, committee titles reflect their functions, but these may vary between schools. Committees on curriculum are examples: in most schools they are identified simply as the curriculum committee; in others, they are variously termed council on medical education, educational policies committee, etc. When a Dean identified curricular study as the primary mission of a study section, it was listed as curriculum committee in Table 2.

The voting status of student members of staff

Table 2. Staff committees having medical students as regular members, number of schools with student members of each committee, and voting status of student members

Schools Student voting status

Committee students on With- Not com'ttee With out desig-

(no.) vote vote nated

with

Curriculum 43 1 6 12 15 Admissions I3 5 3 5 Student affairs I0 3 2 5 Library 5 2 - 3 Executive 3 - 3 - Disciplinary 3 Medical education 3 Student health 2 2 - Awards and prizes 2 1 - 1 Student housing 2 1 - 1 Internship 2 Review of admissions

Student welfare I I - - Research I I - - Student research I I - - Research in medical

education I I - - Joint Advisory

committee I I - - Faculty-trustee I I - - Faculty and alumni

relations I I - - Promotions I - I - Faculty appointments I - 1 - Educational

environment I I Basic sciences - - Second year electives I Fourth year electives I I Out-patient clinical

training I Patient care I Pre-medical student

rclat ions I Guest lectureship r Parking - - Allied health I - - I Health insurance I Honour code I - - I Evaluation I - - I Student evaluation and

examination I Undergraduate

training I - - I Clinical resources I Regional medical

programmes I - - I Educational resources I - - I International affairs I - - I Community relations I I Social medicine - - I Therap-utic abortion I Diagnostic conference I - - I Preceptorship I - - I Commencement I - - I Professional affiliations I - - I

2 - 1 - 3 - -

2

I 1 - - - -

procedures

- - I I

I - - - - I I

I I

I I

I

- - - - - - - -

- -

I - - I - -

- - I

I - -

Table 2. continued on next page

6 Donald F. M . Bunce

Table 2. continued

Minority group problems I - - I

Animal care I I Archives I Committee to

- - - I -

restructure the faculty I - - I

committees as designated by the respondents also is listed in Table 2. Policies regarding voting differ: in some schools student members vote on all committees; they are non-voting members at others where they function mainly in a consultative capacity; or they may vote on some but not on other committees in the same school.

Students sit on the curriculum committee in 43 (84%) of the 51 medical schools reporting student membership on any staff CoIflIILittee - more than half (52%) of all schools in this survey. Thirteen schools (26%) have students on admissions, and 10 (20%) on student affairs committees. The library, executive, disciplinary, medical education (not a curriculum group), student health, awards, student housing, and internship committees have student members in two to five schools. All the remaining committees listed in Table 2 have single student members.

Table 3. Number of staff committees with student members in each medical school

Committees Schools (no.) (no.)

None 1-5 6-10 11-15

32 43 4 0

16- I

i.e., several 3 Not designated,

Forty-eight schools reported the number of faculty committees with student members (Table 3). Students partiupate in one to five committees in 43 of these (go%), and in six to 10 committees in four (8%). One school appoints students to 16 committees.

As might be predicted, the number of students serving on committees varies between schools, and between committees in the same school. For simplicity, the number of students per committee for each school was averaged; the results are shown

Table 4. Average number of student members on staff commirrees

Students per committee Schools

(no.) (no.)

I 5 2 13 3 I 0 4 6

Not reported 17

in Table 4. Of the 34 schools reporting this data, 23 (68%) averaged two to three students per committee. The remainder were about evenly divided between schools averaging one and those averaging four per committee. It is important in interpreting the results to point out that the average figures reported don’t reflect the actual distribution in many instances. For example, one committee in a school might have four student members, while four other committees have one each for a reported average of two students per group.

The mechanisms by which students are chosen to serve on staff committees were reported by 28 schools; these are summarized in Table 5. Again, the methods vary between schools, and between different committees in the same school. In the latter instance, for example, the officers of the four classes may serve on one committee, an elected student representative on another, while a third committee may have two students appointed by the administration. It is interesting that students serve as members of staff committees by reason of office or by administrative appointment in only nine of the 28 schools. Students are elected or selected (the precise form for selection was not defined) by their peers in the remaining rg schools.

Table 5. Methods for selection of medical students for membership on staff committees

Metho& employed for selecting committee members

One representative from each class elected by

Members selected by student council Appointed by administration Presidents of each class President of student council Elected from third and fourth year classes Presidents of second and fourth year classes Senior student selected bv his class

student body

Schools (no.)

10 6 3 2 2 2 I I

Appointment by student-executive committee (composed of an elected member from each class) I

7 Medical Student Participation in Academic Affairs

Other Methods for Student Participation Student Committee Counterparts Eighteen (56%) of the schools reporting no student membership on any staff committee have estab- lished student committee counterparts to one or more staff committees. In general, the parallel committees study the same issues, with the student group reporting their findings or views to the staff committee. The faculty then considers these in formulating their recommendations to the adminis- tration. This was generally reported to be a useful mechanism for learning student opinion, and pro- vides increased opportunity for cross-fertilization of ideas between students and faculty. Additional benefits from this form of participation are that it introduces students to the problems and complexi- ties of committee work; students also select the most suitable hours for their deliberations, thus avoiding scholastic conflicts which could easily be possible if they attended meetings at the faculty’s convenience.

Special student-staff committees have been formed at 14 schools (4%). These committees meet at regular intervals, in the schools reporting, to provide students with a forum to discuss their problems and express their views on any issues. Any recommendations arising from such a commit- tee are reported to the proper faculty or adminis- trative group.

Although most schools have some form of student government, only eight schools (25%) report their student council representatives meet on a regular basis with the dean or other administra- tive officer, and/or the faculty. The meetings may be formal or informal, but the objective is to provide students an opportunity to express their views. Two schools - one northern, one southern - arrange these meetings on a scheduled monthly basis in the evening for cocktails and dinner.

Retreats and Conferences Another organized method for encouraging student-staff-administration communication is the retreat. Eight schools (25%) utilize this approach, although the organization of the conference, its length, main objectives, and designation of those invited to attend vary somewhat. One school recently initiated a confrontation day to which all faculty and students were invited for general dis- cussions. Other retreats are held over a weekend, and one school holds a week-long conference in June of each year. The objectives of the meetings

vary, some ranging the gamut of medical school experience and allowing free expression of ideas between the entire faculty and student body, others are more parochial. The latter restrict their agenda to consider only special problems, such as curricu- lar revision, admissions procedures, methods for evaluation of students in clinical years, etc. One school holds a two-day retreat each June attended by all departmental chairmen, 111 professors, the curriculum committee, and 10 students. Their major purpose is to study curricular changes for the coming year.

Most retreats include large percentages of a school’s staff; students who attend participate enthusiastically and constructively for the most part, according to Deans’ descriptions, but in some schools student turnout is less than expected. One school has established a two-day retreat which provides an opportunity for students to meet officials from outside the school on an informal basis. These include the president of the state medical society, state health and social welfare commissioners. A number of practising physicians also are invited to attend. In this connection, several respondents noted a trend toward involving students as junior members of their state societies. This is not restricted to, but attracts the greatest interest from, students in the upper years. Another school has developed still another novel approach : a freshman curriculum retreat is held to which is invited the first year teachers and class and the faculty curriculum committee. Before the retreat, students prepare a critique of each course which is duplicated and distributed to the faculty. The Dean commented that these meetings have led to signifi- cant changes in curriculum, and, as in any other similar seqing, to increased respect and under- standing in both directions between students and faculty.

Discussion It appeared from this study that there is a growing recognition among medical teachers and adminis- trative officers of the desirability -if not the need - of hearing the student voice in the planning and establishment of academic policy. The means by which this is accomplished is termed student participation, and its expression has been shown to vary between schools.

The form of participation appears to be linked largely to interpretation of the word. To some, student participation connotes consideration of student views in structuring those areas in which

8 Donald F. M. Bunce

they are immediately concerned; to others, it means active student-faculty partnership in the determination of academic policies; and to still others it implies direct student involvement in the decision-making process at all levels. And there are shades of each of these.

There is some suggestion from a number of schools that perhaps they compose a progression, one form of participation leading to another, and then to a third. There would seem to be some substance to this in view of the historical develop- ment of participation related by respondents from several schools. In these, students were first given opportunities for free expression of their views. Their contribution apparently was constructive enough to warrant their being named members, often with full voting privileges, of staff committees dealing with curricular and other scholastic affairs. The scope of their administrative involvement finally broadened by faculty recommendation to include many additional aspects of academic and executive responsibility.

A number of Deans commented on the unques- tioned value of hearing student views, but expres- sed some concern over their membership on staff committees. One respondent stated that student participation on such committees would occupy their time with efforts quite outside their main purpose in being in medical school so that they could suffer academically. Another wondered how extensive student involvement in administration could remain economic. The Dean of one school said that students are members of some staff com- mittees, but without vote. He felt some concern

with their reaction if they were permitted to vote, but were consistently outvoted by the larger number of faculty. A problem which exists in another school, according to the respondent, is apparent lack of feedback between student mem- bers of faculty committees and the student body they represent.

Student views on their participation in academic affairs have been actively solicited by many Deans. The concensus of their findings, as reported in the survey, seemed to indicate generally that students are interested in having some voice in those areas which affect them directly, but have little real concern for involvement in the long-range affairs facing the institution. Many students apparently shared the opinion that the mechanism for partici- pation was not the real issue; they felt it most important to know that the faculty and administra- tion were concerned with their vicws, and that these could indeed have some influence i l the determination of policy decisions.

It would appear from this survey that the traditional separation between the student and the faculty and administration is fast disappearing. The trend seems to be establishment and encourage- ment of greater communication between the groups, with the student treated more as an individual whose ideas should be heard and respected than as merely a name on the class roll. If the students in turn accept their new responsi- bilities with mnturity and understanding, then medicine itself' may indeed be on the threshold of its brightest future.