Because of these relative high costs, the technical programs necessarily find themselves in competition with the other programs in the college for funds. I personally feel that the product turned out by the technical program is well worth the cost and, in fact, is much more economical than any other way in which this same technician could be trained. Still there is a limited number of budget dollars and it would behoove us to get as much for our dollar in technical education as we possibly can.

The Problem of Accreditation

Technical programs very frequently run into major obstacles in the form of accreditation requirements imposed by state and national accrediting agencies. Some of these requirements are unrealistic, archaic, and in very great need of revision. In Clinical Laboratory Technology, for example, there are at least three accrediting agencies for registry each competing with the others. In Radiological Technology there are two such agencies. In Dental Hygiene the accrediting agency insists that at least twenty-five credit hours shall be of the "college transfer" level so that the student can progress with a minimum of lost credit into a baccalaureate program. In reality only a very small percentage of students move into the four year program but all students must take the proper transfer course rather than a more applicable technical course.

It is recognized that some kind of accreditation is needed but it is strongly urged that a careful study be made of accreditation requirements and that a uniform, realistic, and practical approach be made to accreditation. This accreditation should permit movement from state to sate. Many skilled technicians are prevented from practicing because they have moved into a state where they are not licensed.

Cooperation Between Educational Institutions

There is no doubt that the number and quality of para-medical professionals, as well as a greater degree of efficiency in their training, could be achieved by closer articulation between the training institutions.

In the greater St. Louis area, an Inter-Institutional Committee on Allied Health has been formed under the auspices of the Bi-State Regional Medical Association. This committee consists of representatives from Missouri University, St. Louis University, Washington University, Southern Illinois University, The Junior College District of St. Louis-St. Louis County, Belleville Junior College, East St. Louis Junior College, and the Medical Societies.

Areas that have been designated for mutual cooperation include:

1.

Maintenance of continuing survey information on health manpower
needs in the region.

2.

3.

4.

Maintenance of a current registry of allied health education programs being offered in the area.

Maintenance of a central data bank on standards and requirements for approval of allied health manpower programs.

Maintenance of a central data bank on funding mechanisms
state, and local.

federal,

3. Coordinate curricular offerings with regional allied health manpower needs.

6. Maximize vertical and horizontal mobility within and among programs.

7. Expedite faculty and/or student exchange to make maximum use of faculty manpower.

8. Coordinate use of available clinical training facilities.

9. Develop common definitions of general education requirements in "Core" Curriculum.

10. Design and coordinate student recruitment program.

11. Respond to requests for consultation.

12. React to and recommend approaches to current disparities in state regulations affecting allied health manpower in Missouri and Illinois.

Seletion of Students

Millions of dollars are lost each year in the form of "drop outs" from the various technical programs as students find out that they aren't interested in a particular program or that they aren't suited or qualified for that particular program. This kind of mismatch between student and curriculum causes student mrest and discouragement and is costly to all concerned.

A very extensive and exhaustive study needs to be made to develop methods measuring aptitude and predicting success in courses, curricula, and in later employment. The information secured from such a study, of course, would necessarily need to be accompanied by a very effective counseling program. Some say every student should have a right to enter any curricula he chooses and fail, if he is not adapted to that particular field. This certainly isn't a very efficient way to spend the limited budget in a career program, especially when there may be a waiting list of qualified students, and in an inner city situation The thing the student needs least is "another failure".

Sereneity for New Techniques

Community Colleges, having appeared relatively recently on the scene, are not bound by tradition and hence can afford to be innovative. Certainly in the training of allied health personnel, we need to explore new techniques. why shouldn't career courses be "open ended" with no particular time reference? hran't much of the instruction material be made available on video-tapes, audio-tapes, and cartridge projectors? Might it not be possible to abolish grading system and indicate just pass, fail, or withdraw and not advance a student until he masters at least 80% of the material. The student could remain in the class long enough to achieve this goal. Should we eliminate course prerequisites as "absolute"? We might be shocked to find that some absolute prerequisites are not necessary at all. In fact prerequisites in some instances have been shown to screen out the very students best suited to a particular two year career program.

Retention of Allied Health Personnel

In some ways the shortage of health personnel may not be as acute as it might seem. A greater effort needs to be made to keep health personnel in the profession. In the St. Louis area there is a shortage of about 3,000 nurses. We are graduating 750 nurses each year from our schools. This should in a few years relieve the shortage except that the average nurse stays in the profession less than three years. The radiological technologist averages less than two years. after a time to their field of training.

training and manpower.

Government Health Funds

We do not know how many return
This is an inefficient use of

With the acute shortage of operating funds, particularly for the 19701971 year, it appeared for a time that the allied health programs would have to be maintained at the same level or even cut back in the St. Louis Junior College District. However, an allied health grant through H.E.W. of $25,617 has enabled us to greatly increase the size of the health programs for which these funds are applicable. A continuation of this kind of support is necessary if our health programs are to be expanded. Again Vocational Education Funds are an absolute necessity for the continued growth of Para-Medical Programs.

Role of the Medical Center in Delivering Health Care

The concept of Health Service Centers to supervise and take the responsibility for providing and delivering health care is an excellent one. Since the large medical schools are largely research oriented, I am not sure that they would make the delivery of health care their number one priority. Might not the Regional Medical Programs provide the kind of leadership needed in this area?

It has been a distinct privilege to report to this Committee. Be assured that the providing of health personnel is one of the major aims of the Community Colleges. With your assistance they will continue to do so.

Serator EAGLETON. We have one more witness, Dr. Max Pepper, Iartment of Community Medicine, St. Louis University.

STATEMENT OF MAX PEPPER, M.D., DEPARTMENT OF COMMUNITY MEDICINE, ST. LOUIS UNIVERSITY

Dr. PEPPER. Thank you for allowing me to testify, Senator. Senator EAGLETON. I understand you have been here all day, so you an a remarkable man, too. Go ahead.

Dr. PEPPER. So are you.

Senator EAGLETON. I asked for it.

Dr. PEPPER. Senator, I did submit a brief statement (appended) and I don't want to take your time to read that now, but I do want to rase a few comments on what I have heard today and coming out of our own experience in the new department of community medicine. In the statement we highlighted one of the things that we have already begun to learn, and some of the people mentioned today. I real Dean Felix and Mr. Henley both talked about the efforts of some of our students in the community with the lead project. One of the tags that we have learned is that there can be an integrating force in medical education, quite aside from all the sciences the students leart, the biomedical and-what we feel is equally important-the *.al and behavioral sciences. What we have begun to do in our teachg program is to try to link up our medical students with groups. in the community. We are experimenting with having paid consumers who both come in to lecture didactically in the classrooms of our næsical school and also work with the students in field experiences in the ommunity.

None of the kinds of projects that we have been beginning, as for example the case finding in lead poisoning, could have been possible, ether in their design or implementation, without the active collabora t.on of community residents.

Senator EAGLETON. Is this the lead and paint in old buildings, is that what you meanby the lead poisoning?

Dr. PEPPER. That's correct. I would comment further on the lead I porsoning, Senator.

This is a really great problem that has been overlooked for a long time. The current president of the American Public Health Associat on conservatively estimates that there are some 225,000 children in the country suffering with one form or another of this affliction.

Senator EAGLETON. It is somewhat analogous, isn't it, in its effect to mer ury poisoning? Doesn't it affect the brain?

Dr. PEPPER. Yes, the central system, and it can lead to irreversible damage, mental retardation, and other central nervous system -3m.ptoms.

Father Drummond earlier in the day talked about attitudes, and then Dr. Whittico and the black students talked further about some of the racist attitudes in our society. I would like to make a few comments about white racism.

In testimony before Congressman Symington's hearings here a few tiago-the House Subcommittee on Science and Technology-I tried to develop the following point in greater length: namely, in my opinion, white racism is a very central health problem in and of itself A our society.

This is not to minimize the effects of racism in jobs, in housing, and in educational and other efforts throughout our society. However, I do feel that very central and special attention must be given to the effects of racism in the health field-not only in terms of what you have been. focusing on a good bit here today vis-a-vis black admissions to medical schools, but also in terms of many other institutional and personal forms of white racism in the health field.

I think that there is too often the tendency to blame the victim here rather than to label the perpetrator. I truly believe that we can and must first of all identify and diagnose the condition which is fundamental to develop some kind of prescription and cure, and that this must be done not only morally-the preachments we know over the years have not led to much change-but that in and of itself white racism as a health problem deserves scientific attention. It deserves the careful scrutiny of legislators and physicians and other professionals. I truly believe that the problem must be made explicit, labeled and recognized, and its implications and outcomes made clear to the white community-that is, that the white community is also suffering from this condition, and that it is not only the black population who are the victims. Like any other malignant process or condition, it is just not going to go away through "benign neglect," as one of the administration officials has suggested, and some very active mechanisms for cure are needed.

One of the things that we are learning in our work in community medicine is that the prescription is going to have to come not only from professionals, but from a partnership with nonprofessionals and consumers in the community.

Senator EAGLETON. Do you feel that your experiences in this community health field where medical students, white physicians have, many for the first time in their lives, had their first exposure to the black community other than just driving through it or around it, have you seen any breakthrough in terms of such racial prejudice or racial distrust as we all know exists?

Dr. PEPPER. Yes, I think so, Senator. You heard one graduate of the school talk about some of his feelings. But there are other students like those that the black students talked about, who have been involved in these programs and who haven't had the same kinds of experiences and the same kinds of feelings of distrust. I am talking now about our white students who have worked with black people in the community. I think that this is a real ray of hope.

I don't, by the way, mean to suggest that community medicine is concerned only with poor people or black people or urban people. Our charge and mission goes beyond that. We are truly concerned with communities of people, but we certainly put very high priority on what we feel is-whether we call it a disease or condition or malignant social process-white racism as deserving our continuing attention. Senator EAGLETON. Well, I think what you are saying, Doctor, perhaps we all don't use the same semantics, but you have said it, that these racial barriers that have been with us two centuries, at least, in this country, pervade the totality of our lives, whether it be in medicine, housing, other forms of education, employment, a simple