the old tradition is that you have to keep them moving up. Now we give them that alternative. If they feel there is a possibility they will move up, then we counsel them in the English comp, but the great mass of them will not go on and we feel these programs are better for them.

The cooperation between the educational institutions, as Dr. Stoneman has pointed out, has been excellent, and this dental school relationship is just one of many.

Senator EAGLETON. Doctor, let me ask you this. Almost from the inception of vocational-technical education, back to the old Hughes— what was the first great Federal law, Smith-Hughes, I believe it was, passed about 1917-there has always been a stigma applied to vocational, now vocational-technical education. Its best exemplification in the St. Louis area was the stigma that attached to O'Fallon-Tech. Now you know the school board has gone back to what I think is the right system of a half day at Cleveland or Roosevelt or Southwest, and a half day at O'Fallon. How do you see this stigma business? Is it still heavily with us? Is it still a serious psychological impediment, or is it abating somewhat?

Dr. DUGGINS. I think we have gotten around it in our institution pretty well in this way. We have seven divisions in the institution. The life sciences division is an academic division, the physical science division, another. Now, these technical courses are not separated. The technical courses are assigned to an academic division. They have the same faculty, they intermix with other students. There is no stratification, or very little stratification, except in their technical courses. As far as other things, they are a part of the regular student body and have the same instructors.

Senator EAGLETON. I mean are you a bigger man on campus at Forest Park if you are in liberal arts than if you are in one of these others?

Dr. DUGGINS. You are probably the biggest if you are in nursing or dental hygiene. They have that status. The liberal arts students are working to get in there. This is kind of a reversal of the ordinary trend. I don't know whether it is just our institution, but this is a fact.

I would just like to say one thing in closing-well, two things. There is a tremendous amount of dropout. This is not just our experience, this is experienced throughout the country, a dropout because students get into programs where they are not suited, where they are not interested. Certainly a very definite study needs to be made of some method by which students can be selected and fitted to the proper technical course. This would save a great deal.

Senator EAGLETON. Isn't that what you are supposed to do in your counseling program?

Dr. DUGGINS. Well, it is, but I don't think any real big program of this type has ever been undertaken-I mean, I am thinking of a large research program to identify these people that counselors could use. Right now they have very few tools by which they can do this, other than just their own impression. A very intensive and extensive and exhaustive study needs to be made, because what a lot of these students need least is just another failure. To get in a program and then fail at it, or have to drop out of it, is very humiliating and discouraging, as well as being very inefficient.

Of course, new techniques are important. The community college, being new, can afford to be innovative. I see no reason why students couldn't go into a program at any time, move through the program and graduate at any time that they have completed the work, some students moving faster than others. Why can't we use audiovisuals and video tapes, and all this sort of thing as an adjunct to improve instruction? Why do we have to have an A and a B and a C or a D system? Why not have pass or fail/ If a student passes 80 percent of the work, which is probably what he should to qualify, why not then move him into the next area, or let him stay as long as he needs to. If it

Senator EAGLETON. You don't need Federal legislation or anything to do that. The great advantage of the junior college system is its flexibility and it has been the savior of American higher education. But for it, I don't know where in the world we would be. We would be in a heck of a fix. Its great genius is its flexibility.

Are you hamstrung by any State laws insofar as affording the kind of flexibility you mention?

Dr. DUGGINS. No; financial, primarily, because this takes more faculty time, but it's something we are working toward.

Finally, I'd just like to express my opinion, as have others here, not opinion, but thanks to all for the money that we have gotten; $25,617 doesn't sound like much

Senator EAGLETON. How much?

Dr. DUGGINS. $25,617 we got in the allied health areas.

Senator EAGLETON. We waste that much on paper clips in one Federal bureau.

Dr. DUGGINS. This helped us to increase our clinical lab program by 50 percent. Otherwise, we were frozen, we couldn't increase at all. Senator EAGLETON. That is your total Federal grant insofar as these allied health professions are concerned?

Dr. DUGGINS. We get $5,000 for each program that has more than seven students.

Now, vocational education, of course, comes in here, too. That helps us pay faculty salaries here. It is amazing what a little bit of money like this can do in order to increase. You have your faculty and all. Thank you very much.

Senator EAGLETON. Doctor, you are a great witness and you are so easily satisfied by $25,000.

Dr. DUGGINS. We are desperately trying to get two programs.
Senator EAGLETON. We are going to have you back again.

Dr. DUGGINS. We have an operating room technology program that we are desperately trying to get started with 20 students this October, and a health-aid program with 300 students from the intercity area that would come from these health areas and would come into our continued education program and be trained in five special areas. This is being held up on Federal grant money and approval, but, if this comes through by October, we'll have those two programs, too. Thank you.

Senator EAGLETON. Excellent; thank you, Doctor.

Sister, and gentlemen, thank you very, very much. You have been very patient and indulgent.

(The prepared statement of Dr. Duggins follows:)

"THE ROLE OF THE JUNIOR COLLEGE DISTRICT OF ST. LOUIS AND ST. LOUIS COUNTY IN THE PREPARATION OF ALLIED HEALTH PERSONNEL.

"1

A very

The fact that a shortage of allied health personnel exists in the St. Louis area, and in the country at large, is well documented. real attempt is now being made to relieve this shortage.

Probably no institution is in better position to contribute to this effort than the Community College. There are several reasons for this:

(1) More than 40% of the students enrolled in colleges today are in Community Colleges. This number will probably increase to 60% by 1975.

(2) Community Colleges, by definition, are "open docr" institutions attempting to provide a variety of offerings to meet the specific needs of all who apply, as well as to meet the needs of the community.

(3) Technical or career training is one of the major emphases of the Community Colleges.

(4) There are more than 200 allied health or para-medical careers. A majority of these can be completed in one or two years.

Enrollment Figures

The Junior College District of St. Louis, at the present time, has 600 students enrolled in eight allied health programs. These students are distributed as follows: Clinical Laboratory Technology, 34; Dental Hygiene, 74; Dental Assisting, 63; Inhalation Therapy, 22; Institutional Food Service, 10; Medical Office Assistant, 25; Nursing, 324; and Radiologic Technology, 59. addition, every effort is being made to inaugurate an Operating Room Technology Program (20) and a Community Health Aid Program (300) by October 1, 1970.

The Problem of Cost

In

One very real problem involves the disproportionate cost of technical education. The cost per credit hour in my institution, for example, for nursing is $51.58; for dental hygiene, $48.47; for clinical laboratory technology and radiologic technology, about $32.00; while the credit hour cost in the social sciences and humanities is less than $16.00. In addition, the original capital outlay for equipment in technical programs may be very high. Equipment for our dental hygiene clinic was in excess of $100,000. Also professional personnel, such as dentists, in these programs may be very costly.

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.

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

3.

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

4.

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

5.

6.

7.

Coordinate curricular offerings with regional allied health manpower needs.

Maximize vertical and horizontal mobility within and among programs.

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

8. Coordinate use of available clinical training facilities.

9.

10.

11.

12.

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

Design and coordinate student recruitment program.

Respond to requests for consultation.

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

Selection 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 unrest and discouragement and is costly to all concerned.

A very extensive and exhaustive study needs to be made to develop methods of 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".

Necessity 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? Why can't much of the instruction material be made available on video-tapes, audio-tapes, and cartridge projectors? Might it not be possible to abolish a 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.