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

BEEN TAUGHT IN ESSENTIALLY THE SAME MANNER WITH, OF COURSE, THE
ADDITION OF NEW MATERIAL TO THE CURRICULUM AS NEW KNOWLEDGE HAS
BEEN UNEARTHED. THE STUDENT'S INTRODUCTION TO MEDICINE HAS
TRADITIONALLY BEEN VIA THE BASIC BIOLOGICAL SCIENCES IN WHICH
HE HAS BEEN REQUIRED TO BE REASONABLY PROFICIENT BEFORE HE
MOVED ON TO THE DIAGNOSIS AND TREATMENT OF PATIENTS. ONE CAN-
NOT PROPERLY EVALUATE SUSPECTED DISORDERS OF THE BODY OR MIND NOR
INSTITUTE EFFECTIVE STEPS TO PREVENT ILLNESS UNLESS HE HAS A
GOOD KNOWLEDGE OF THOSE PHENOMENA WHICH ALLOW US TO LIVE AND
BREATHE AND THINK AND DEFEND OURSELVES AGAINST NATURE'S ON-
SLAUGHTS. THIS KNOWLEDGE WAS IMPARTED TO THE STUDENT EARLY
IN HIS CAREER. THE TROUBLE WAS THAT THESE SUBJECTS WERE OFTEN
TAUGHT AS PHENOMENA WHICH WERE IMPORTANT PRIMARILY FOR THEMSELVES
AND NOT BECAUSE THEY PROMOTED UNDERSTANDING OF PEOPLE. AS TIME
HAS GONE ON IT HAS BEEN FOUND ADVANTAGEOUS TO MOVE CLINICAL
EXPERIENCES INTO THE EARLIER YEARS IN THE MEDICAL CURRICULUM
IN ORDER TO GIVE MORE CLINICAL RELEVANCE TO SUCH SUBJECTS AS
BIOCHEMISTRY, PHYSIOLOGY, ANATOMY AND MICROBIOLOGY. THESE SCI-
ENCES HAVE ALWAYS BEEN TAUGHT BY COMBINING THE EYE, THE EAR,
AND THE HAND, THAT IS, THROUGH LECTURES AND DEMONSTRATIONS AND
LABORATORY EXERCISES, IT HAS BEEN THESE LABORATORY EXERCISES
WHICH HAVE REQUIRED LARGE AMOUNTS OF SPACE AND EXPENSIVE EQUIP-
MENT AS WELL AS A GREAT DEAL OF TIME.

WITH INCREASING PRESSURE UPON SCHOOLS TO PRODUCE

MORE PHYSICIANS IN A SHORTER PERIOD OF TIME OUR TRADITIONAL
METHODS OF TEACHING HAVE COME UNDER CRITICAL SCRUTINY BY

MEDICAL PEDAGOGUES, PRACTICING PHYSICIANS AND THE GENERAL
PUBLIC. SUCH PRESSURE HAS, OF COURSE, FORCED EXPERIMENTATION
WITH TEACHING METHODS AND CURRICULUM CONTENTS, BUT IN MY OPINION
SUCH EXPERIMENTATION HAS NOT BEEN PUSHED VIGOROUSLY ENOUGH NOR
IN MOST CASES EVALUATED SUFFICIENTLY CRITICALLY TO DRAW CONCLU-
SIONS WHICH COULD BE TRANSLATED INTO ACTION.

AT OUR SCHOOL, FOR INSTANCE, I HAVE RECENTLY APPOINTED

A COMMITTEE OF THE FACULTY TO EXAMINE CRITICALLY AND IN DEPTH,
THE ROLE OF THE BASIC SCIENCES IN MEDICINE, IF THIS COMMITTEE
IS TO FIND ANSWERS TO THE QUESTIONS I POSED IN MY LETTER OF IN-
VITATION, IT WILL BE NECESSARY TO EXAMINE BOTH THE CONTENT OF
THESE COURSES AND THEIR METHODS OF PRESENTATION. THIS EXAMINA-
TION SHOULD INCLUDE OBSERVATION AND STUDY OF TEACHING PROGRAMS OF
A NUMBER OF OTHER SCHOOLS WHICH ARE MOVING FORWARD IN THIS DI-
RECTION, AS WELL AS THE BASIC MISSION OF OUR SCHOOL AND THE
EFFECTIVENESS AND ECONOMY TIME-WISE WHICH NEW TEACHING METHODS
AND EQUIPMENT COULD ACHIEVE. WHAT WE ARE REALLY LOOKING FOR
IS SOME WAY TO SHORTEN THE LENGTH OF TIME REQUIRED TO RECEIVE
THE M.D. DEGREE WITHOUT COMPROMISING THE QUALITY OF THE EDUCA-
TION OFFERED AND AT THE SAME TIME INCREASING THE NUMBER OF
STUDENTS IN EACH CLASS. ONE WAY, OF COURSE, THAT THIS COULD BE
ACCOMPLISHED WOULD BE TO SIGNIFICANTLY SHORTEN THE PERIOD OF
TIME THE STUDENTS NEED TO SPEND IN LABORATORIES. IF THIS COULD
BE ACCOMPLISHED WITHOUT COMPROMISING THE COURSE IN ANY WAY WE
COULD THEN UTILIZE THE TIME SO SAVED EITHER FOR TEACHING OTHER
ESSENTIAL MATERIAL OR WE COULD SHORTEN THE COURSE BY THE AMOUNT

OF TIME. THE ECONOMY, WHERE SPACE IS CONCERNED, WOULD ALSO BE SIGNIFICANT AND WOULD PERMIT THE UTILIZATION OF THAT SPACE FOR ADDITIONAL STUDENTS BY RUNNING THE LABORATORY COURSE IN MORE THAN ONE SECTION.

ALL THIS SOUNDS VERY FINE, OF COURSE, BUT WE DO NOT KNOW AT THIS TIME IF THE ADOPTION OF SUCH A POLICY WOULD RESULT IN INADEQUATELY PREPARED MEDICAL STUDENTS. WE DO KNOW THAT WE CAN ACCOMMODATE MORE STUDENTS IN THE CLINICAL YEARS BECAUSE OF THE NUMBER OF CLINICAL FACILITIES IN THE COMMUNITY WHICH COULD BE UTILIZED FOR TEACHING PURPOSES. THIS WOULD SIGNIFICANTLY AUGMENT OUR POTENTIAL FOR CLINICAL TEACHING. ONE PROPOSAL HAS BEEN THAT AT LEAST A PART OF THE BASIC SCIENCE MATERIAL NOW TAUGHT IN MEDICAL SCHOOL COULD BE MOVED INTO THE PRE-MEDICAL YEARS. WE ARE ALL AWARE THAT THE COLLEGES AND UNIVERSITIES TODAY WHO ARE PREPARING STUDENTS FOR ENTRANCE TO MEDICAL SCHOOL DO A MUCH MORE SOPHISTICATED JOB OF TEACHING THAN WAS TRUE EVEN A DECADE OR TWO AGO. IN ADDITION, MANY SUBJECTS ARE NOW TAUGHT IN THE PRE-MEDICAL YEARS WHICH IN MY DAY, FOR INSTANCE, WERE PART OF THE MEDICAL SCHOOL CURRICULUM. MOST OF THE STUDENTS COMING TO US NOW KNOW AS MUCH GENETICS, BIOCHEMISTRY, MICROBIOLOGY AND PHYSIOLOGY AS THE MEDICAL STUDENT OF FORTY 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 IN ORDER NOT ONLY TO GIVE MORE CLINICAL RELEVANCE TO THE SUBJECTS BUT ALSO TO COMBINE THEM WITH

CLINICAL TEACHING IN SUCH A WAY THAT THE STUDENT COULD MAKE PRAC-
TICAL USE OF THE INFORMATION, BOTH SCIENTIFICALLY AND CLINICALLY
IN THE PRACTICE OF MEDICINE, AND ALSO BE CONSTANTLY AWARE OF THE
NEED TO UPDATE HIS SCIENTIFIC KNOWLEDGE IF HE IS PROPERLY TO SERVE
HIS PATIENTS.

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 AWARE THAT THE GREAT PUBLIC NEED IS FOR MORE PRACTICING PHYSICIANS AND 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 AND CHALLENGING. 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: IT IS ENGAGED IN THE ACTUAL DELIVERY OF HEALTH CARE BECAUSE THIS IS NECESSARY FOR TEACHING; IT OCCUPIES A LEADERSHIP ROLE IN HEALTH IN THE COMMUNITY IN WHICH IT IS LOCATED; IT IS ENGAGED IN THE TEACHING OF THE NEXT GENERATION OF PROFESSIONALS; AND IT IS ADDING TO THE TOTAL SUM OF KNOWLEDGE THROUGH THE RESEARCH IT CARRIES ON TO IMPROVE THE QUALITY OF HEALTH CARE.