If we can shorten this time, then we can use it either for teaching other essential material or we can shorten the course by that amount of time, or we can share the space with other courses, because laboratory space is the most expensive and also largest in square footage in the medical school. We could utilize this space for teaching more students the basic sciences by teaching more than one laboratory section as we would then teach using a revised curriculum. We could, let us say, add 25 or 30 percent more students to our classes.

Whenever you consider enlarging enrollment, and this is true in our school at this moment, one runs into the problem of limited laboratory space. Clinical space is not so precious because in addition to our hospital, we have other hospitals with which we are affiliated, and there are other hospitals in the community where affiliations could be effected if it were in the best interests of medical education. Most of the students coming to us now know as much genetics or biochemistry or microbiology or physiology as the medical student of 40 years ago knew when he had completed these courses in medical school. Perhaps a modified and more applied course could be taught in medical school which would, in addition to the basic scientists, utilize clinicians who are well prepared in the basic sciences, and this would give more clinical relevance to these subjects.

It would also, as much as anything else, impress upon the student the fact that he must constantly keep abreast of the basic sciences in this particular field and not rely on the material as it was taught to him at the time he was a student.

The time that could be saved if we could recapture curricular hours. now devoted to the basic sciences could be devoted to demonstrations and actual experience in the delivery of health care by the student. We are all well aware that the great public need is for more practicing physicians, particularly physicians who can serve as a primary health resource for the entire family. Such physicians would not only be concerned with the treatment of illness, but would also, and in some ways more importantly, be concerned with the prevention of disease and disability, that is, with health maintenance. If students are to be motivated to enter this type of practice, they certainly must have an adequate exposure to it and under conditions such that they will find the work exciting, challenging, and respectable.

This they do by working under preceptors and other instructors in the actual delivery of health care. In accomplishing this purpose, the medical school really achieves its four great missions, which are: To actually deliver health care, because this is necessary for teaching; to play a leadership role in health in the community, by virtue of its storehouse of knowledge and the experts on the faculty; to engage in teaching the next generation of professionals; and to add to the total sum of knowledge through the research it carries on concerning the delivery of health care and seeking the answer to health care problems.

A small example of what I am talking about might be helpful at this point. Not long ago, our department of community medicine, and you will hear from our chairman a little later. received a grant for the purpose of studying the problem of lead poisoning among children in one of the areas of St. Louis. Students were recruited to work with the faculty on testing the children, contacting the families, and gather

ing the data. The problem as it unfolded was discussed in seminars and lectures with the students, and the clinical syndrome of pica, which is a condition which develops when children have ingested lead, was discussed and demonstrated a number of times and in a number of contexts. The Yeatman Community Health Center, where this work was carried on, took the next step by informing the public of the situation. This aroused a great deal of community interest and was the subject of news stories and comments in our very excellent press in St. Louis. I am sure you would agree with me that few cities are blessed with such an excellent press, and I include in the press here the radio and television.

The result was an aroused public opinion, which, it appears at this point in time, will result in community action to eliminate the hazards and prevent the condition occurring in the future.

Our students saw this health program in all of its stages, from the design for the collection of data to the public action and the results. I know of no teaching which can be as effective as this. This was a laboratory in the best sense of the word. We need a great deal more of this kind of teaching, but it requires personnel and personnel cost

money.

At the present time we have reached the saturation point insofar as our teacher-student ratio is concerned. We cannot improve the situation because we haven't the funds to do it. We are admitting this fall the largest class since I have been dean here. We will admit 141 new freshmen, which is 10 more than were admitted last year, and, I might add, 10 of those freshmen are black students. If these students are to receive what they are capable of absorbing

Senator EAGLETON. What percentage of last year's 130 admittees were black?

Dr. FELIX. Two, two students.

Senator EAGLETON. Last year 128 white, two black. What is it this year?

Dr. FELIX. 141 students, 131 white, 10 black, and we expect to move from that point forward as we have faculty.

Many of these students, these 10, have educational deficiencies such that they are going to require some special attention. This means more of a person-to-person kind of teaching, and will require more personnel.

Senator EAGLETON. Is it person-to-person teaching in the sciences or even beyond the sciences?

Dr. FELIX. More in the sciences, Senator. I would hope that by the time the student becomes a junior, he will have come abreast, as far as the underpinning material is concerned, with the rest of his class, so that from then on it is every man for himself. I might say that our experience here over the last few years has been essentially no failures after the second year of school.

To help us in this, I might say, I have, with the consent of the president and the vice president of the university, appointed a committee of citizens in the community, a majority of whom are black, distinguished citizens, their names are known to all of you, who will assist us and advise us on the problems that will arise as we get more and more of the minority students as the years go by. If we take 10 this year, 10 or more the next year, 10 or more the next, in 4 years or so, we will have 40 to 50 or more, and I am not limiting it to that, but at least that many minority students, black or other nonwhite. We are dedicated to this; we are committed to it. It is consistent with the credo of the university.

These students are to receive what they are capable of absorbing. That which they should receive to practice medicine in the last quarter of the 20th century, to say nothing of the early years of the 21st century, must be imparted by what I call the medium of the epistle and the apostle. They must learn from textbooks and current literature and from lectures, but they must also learn by seeing the procedures done by highly qualified people and then repeating them themselves under supervision. This would be the act of the apostle. This means relatively small groups of students working with an instructor. If we can accomplish this objective, we would be in an excellent position to prepare students whose interest was in the area of family practice and community medicine.

By the same token, we could have the opportunity to experiment with our curriculum and to evaluate the changes as they were made. We would certainly be able to find more definitive answers to questions that are being asked now in so many quarters concerning increased production of physicians and shortened curriculum.

We would do all of these things, Mr. Chairman. We have the motivation, we have the know-how. Thanks to the Congress and the Department of Health, Education, and Welfare, we will have more and better facilities.

As I say, we could do those things if we had the funds to carry them out. We have made no secret of our critical financial situation. If we can hold the line and continue what we are now doing, we will thank kind providence, but oh, how we would like to utilize our potential and move forward to meet the needs of tomorrow.

I hope, Mr. Chairman, that what I have said here in the few minutes allotted to me has given you some view of our problems, our hopes, our dreams here at St. Louis University. I think they are typical of other schools in this country. I hope I have also been able to communicate to you my firm conviction that these dreams can be realities if we are given the opportunity to put them into action.

Like my colleagues, I will be happy to attempt to answer any questions you wish to put to me.

Thank you very much.

Senator EAGLETON. Thank you, Doctor, and thanks to the four gentlemen from St. Louis University.

(The prepared statement of Dr. Felix follows:)

TESTIMONY OF

ROBERT II. FELIX, M.D., M.P.H., DEAN

SAINT LOUIS UNIVERSITY

SCHOOL OF MEDICINE

PRESENTED BEFORE

THE HEALTH SUBCOMMITTEE

OF

THE COMMITTEE ON LABOR AND PUBLIC WELFARE

OF THE

UNITED STATES SENATE

MEETING IN ST. LOUIS, MISSOURI

SEPTEMBER 2, 1970

MR. CHAIRMAN AND MEMBERS OF THE COMMITTEE:

I AM DELIGHTED TO HAVE THE OPPORTUNITY OF APPEARING

BEFORE YOUR COMMITTEE TO DISCUSS SOME OF THE PROBLEMS WHICH ARE FACING MEDICAL SCHOOL ADMINISTRATORS NOT ONLY AT SAINT LOUIS UNIVERSITY BUT AT MANY OTHER MEDICAL SCHOOLS THROUGHOUT THE UNITED STATES.

THE FACT THAT YOU ARE TAKING TESTIMONY TODAY ON THE SUBJECT OF EDUCATION FOR THE HEALTH PROFESSIONS IS IN ITSELF VERY SIGNIFICANT. I AM SURE THAT YOU WOULD AGREE WITH ME THAT THE QUESTION IS NOT SO MUCH WHETHER THE QUALITY OF MEDICAL EDUCATION IS OF A HIGH ORDER IN THIS COUNTRY, BUT, RATHER, WHETHER THE QUANTITY OF PHYSICIANS REQUIRED TO MEET OUR HEALTH CARE NEEDS CAN BE PRODUCED WITHOUT COMPROMISING THE QUALITY OF THE PRODUCT. BUT EVEN THIS IS NOT THE WHOLE QUESTION, FOR WE ARE EQUALLY CONCERNED WITH AN ADEQUATE DISTRIBUTION OF PHYSICIANS SO THAT ALL SEGMENTS OF THE POPULATION, RURAL AND URBAN, POOR OR AFFLUENT HAS AN EQUAL OPPORTUNITY FOR HIGH QUALITY MEDICAL CARE.

WHEN ONE BEGINS TO DISCUSS MODIFICATIONS OF THE CURRICULUM OF A SCHOOL OF MEDICINE ONE ENCOUNTERS A VARIETY OF OPINIONS. THERE IS LITTLE OR NO DISAGREEMENT REGARDING THE SHORTAGE OF PHYSICIANS. MOST AUTHORITIES CONCUR THAT THERE IS A SERIOUS PROBLEM OF MANPOWER DISTRIBUTION. DISCUSSIONS OF HOW TO ATTACK AND OVERCOME THOSE PROBLEMS, HOWEVER, BRING FORTH DIFFERING POINTS OF VIEW. FOR OVER HALF A CENTURY STUDENTS HAVE