The CHAIRMAN. You brought us some fine testimony. We deeply appreciate it and certainly want to thank you both. Thank you. Now, Dr. William A. Sodeman, dean of the Jefferson Medical College and member of the American Medical Association Council on Medical Education.

STATEMENT OF DR. WILLIAM A. SODEMAN, DEAN OF THE JEFFERSON MEDICAL COLLEGE, AND MEMBER OF THE AMERICAN MEDICAL ASSOCIATION COUNCIL ON MEDICAL EDUCATION, ACCOMPANIED BY DR. C. H. WILLIAM RUHE, ASSOCIATE SECRETARY OF THE AMA COUNCIL ON MEDICAL EDUCATION; AND PAUL R. M. DONELAN, ATTORNEY ON STAFF OF THE AMA LEGISLATIVE DEPARTMENT

Dr. SODEMAN. Thank you, Mr. Chairman.

As you have mentioned, I am Dr. William A. Sodeman, a physician residing in Philadelphia, Pa. I am dean of the Jefferson Medical College of Philadelphia and serve as a member of the American Medical Association Council on Medical Education. With me today are Dr. C. H. William Ruhe, associate secretary of the AMA Council on Medical Education, and Mr. Paul R. M. Donelan, an attorney on the staff of the AMA legislative department.

The CHAIRMAN. May I say we are happy to have Dr. Ruhe and Mr. Donelan with us, too?

Dr. SODEMAN. Thank you very much.

The American Medical Association has always recognized the importance of medical libraries at all levels of education for health personnel. Evidence of this is contained in statements of the "essentials" of various educational programs accredited by the AMA Council on Medical Education. For example, the following paragraph is contained in "Functions and Structure of a Modern Medical School," a statement developed by the American Medical Association and the Association of American Medical Colleges as a general guide in the medical school accreditation program:

A well-maintained and cataloged medical library that can be used conveniently and effectively by both students and faculty is essential to a modern medical school. A trained librarian with experience in medical library work should be employed to supervise the development and operation of the library with the advice and assistance of an active representative committee of the faculty. The library should receive regularly the leading medical periodicals, the current numbers of which should be readily accessible. Adequate arrangements should be made by the librarian and the faculty to instruct all students in the use of the library at the beginning of their medical studies.

Similar statements may be found in the "Essentials of Approved Internships." "Essentials of Approved Residencies," "Essentials of an Acceptable School of Medical Technology," "Essentials of an Accredited School of X-Ray Technology," "Essentials of an Acceptable School of Occupational Therapy," "Essentials of an Acceptable School of Cytotechnology," "Essentials of an Acceptable School of Physical Therapy," "Essentials of an Acceptable School for Medical Record Librarians," and "Essentials of an Acceptable School for Inhalation Therapy Technicians."

The medical library is likewise recognized as playing an important role in the continuing education of the practicing physician. An area, parenthetically, which you, Senator, have just discussed. The AMA's "Guide Regarding Objectives and Basic Principles of Continuing Medical Education Programs" cites the medical library as one of the important facilities which should be available to the physician-student.

The current bill, S. 597, is based on the premises that the massive growth of knowledge in the health sciences in the past 20 years has not been matched by a growth of library facilities and techniques, and that much of the value of the knowledge and information may be lost unless proper measures are taken to develop the appropriate facilities and techniques. The American Medical Association is in agreement with these premises and believes that action should be taken to provide assistance in the construction of new facilities, the expansion and rehabilitation of existing facilities, the training of professional personnel and the development of new tools and methods for dissemination of medical knowledge and information.

Evidence of the need for assistance is available from information gathered through the annual report of the AMA Council on Medical Education, published in the November 16, 1964, issue of JAMA and from a series of studies on the subject published in recent issues of the Journal of Medical Education.

A comparision of the 87 existing medical school libraries with minimum standards recommended by a joint USPHS-AMA-AAMC committee (table I) showed that the average existing library was well below recommendations in space, volumes, and serial titles during the 1963-64 academic year.

(Tables I and II follow :)

TABLE I.-Comparison of existing libraries with recommended standards

1 From Medical Education Facilities, U.S. Department of Health, Education, and Welfare, Public Health Service, Publication 1180-A-1b, 1964.

Review of the information provided by the 87 medical schools in existence during 1963-64 revealed startling variations in size and holdings among the various school libraries. The number of volumes held ranged from 2,000 to 359,000; the number of serial titles from 275 to 5,057. The range in annual budgets was from $13,000 to $382,101, and the number of full-time staff varied from a low of 1 to a high of 55. Details are given in table II.

The CHAIRMAN. Quite a variation, Doctor.

Dr. SODEMAN. Yes, it is quite a variation.

It is clear from these figures that one should not make general statements about the condition of all medical school libraries. A few appear to be relatively very well off, while many others fall below the minimum standards recommended by the joint committee.

Recent articles in the Journal of Medical Education have shown that expenditures for medical school libraries have not kept pace with the growth in their research expenditures, even though the marked increase in research activity has brought about greatly increased demands upon the library facilities. Similarly, the growth in complexity of activities in medical schools and hospitals has resulted in unusual demand upon the holdings and services of the medical library. Hosts of new professional, scientific, and technical personnel are seeking access to new kinds of scientific and medical information which many medical school libraries are simply not prepared to provide. As a result, there has been some impediment to the flow of productive research and to the availability of research information to professional practitioners.

Detailed information on the current status of private, independent medical libraries, of those in community hospitals, and of those in State and county medical societies and other professional medical socieries is not available to us at this time. The AMA is undertaking a study of the status and needs of medical libraries of state and county medical societies; but the results will not be available until later this THE

The American Medical Association strongly supports the intent and purposes of S. 397. We will comment, however, separately on each of the substantive sections of the bill.

383—18SISTANCE FOR THE CONSTRUCTION OF FACILITIES

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SECTION 395-ASSISTANCE TO SPECIAL SCIENTIFIC PROJECTS, AND SECTION 396-RESEARCH AND DEVELOPMENT IN MEDICAL LIBRARY SCIENCE AND RELATED FIELDS

Section 396 provides for grants for projects of research and investigation in the field of medical library science and for "the development of new techniques, systems, and equipment, for processing, storing, and retrieving and distributing information pertaining to sciences related to health."

We believe this section to be of particular importance.

Since emphasis is usually placed on space, budget, and library holdings, the important aspect of utilization is often overlooked. The critical factor in the value of a medical library is, after all, the question of how effectively its stored information is made available to the learner in response to his need. The largest and most magnificent library is of little value until its storehouse of information is actually in use. New methods of meeting the requirements of the learner more quickly and efficiently are badly needed, and we strongly support this section which is intended to develop such new methods.

SECTION 397-GRANTS FOR IMPROVING AND EXPANDING BASIC RESOURCES OF LIBRARIES

This section would provide the means for libraries to improve their holdings of books, journals, et cetera, and thus strengthen their basic resources and facilities. The provisions permitting acquisition of films, projectors, duplicating devices, and new technologic equipment are particularly valuable since most medical libraries are deficient in these areas. The AMA supports this section of the bill.

SECTION 398-GRANTS FOR ESTABLISHMENT OF REGIONAL MEDICAL

LIBRARIES

The concept of having a strong medical library in each region of the country to serve as a source of support for other libraries in the area appears to be a very reasonable one under present conditions.

The purpose of this section would seem to be best fulfilled by strengthening existing medical libraries in strategic locations to serve as regional libraries. Except in the unusual circumstances where a geographic area is completely lacking in library resources, new and separate regional libraries need not be established.

SECTION 399-FINANCIAL SUPPORT OF BIOMEDICAL PUBLICATIONS

We make no specific comment as to sections 395 and 399. However, the need for these provisions is less apparent to us.

Mr. Chairman and members of the subcommittee, the American Medical Association appreciates this opportunity of presenting its views on this important legislation. We will be pleased to attempt to answer any questions the committee may have.

The CHAIRMAN. Doctor, we very much appreciate your presence and very much appreciate these views from the American Medical Association. I was naturally very much impressed with your statement

showing the great variation in medical schools with respect to the adequacy of their libraries. Does this same variation exist with respect to other aspects of their operations, their budgets for the training and education of physicians?

Dr. SODEMAN. It does exist generally, Senator, in other areas as well. I think it is more striking, perhaps, in the library area, but we have important deficits in many areas aside from the library itself.

The CHAIRMAN. Aside from the libraries.

Doctor Ruhe, anything you would like to add, sir?

Dr. RUHE. Mr. Chairman, you asked one of the previous testimonies, about the expenditures of libraries, and how they might have grown in recent years. I happen to have with me some figures on this which are not our figures alone. Some of these are from an article by Scott Adams of the National Library of Medicine published in the Journal of Medical Education. Some are based on a report by Dr. Deitrick and Dr. Berson in their study of medical schools back in 1950.

In 1951, for 59 schools, a total of $1,377,000 was spent on medical libraries and school libraries

The CHAIRMAN. Excuse me 1 minute, Doctor. You speak about spent. Does that mean physical construction, or just operation, or both?

Dr. RUHE. These are total expenditures. I believe that includes— this is not construction.

The CHAIRMAN. It would not be construction. That is what I thought.

Dr. RUHE. No, this is for acquisitions of volumes and serial titles, for salaries of personnel, this kind of thing-the operating expenses. This figure of $1,377,000 had grown to $5,030,000 in 1961 for 87 schools. In the academic year 1963-64, the figure for 87 schools was $8,519,000. So there has been a growth in the expenditures of the libraries, but we believe not nearly enough to meet the needs.

The CHAIRMAN. There has been a definite growth, but you started pretty small, did you not?

Dr. RUHE. That is right.

The CHAIRMAN. Anything else you would like to add?

Dr. RUHE. No, sir, thank you.

The CHAIRMAN. Mr. Donelan?

Mr. DONELAN. No, sir, thank you.

The CHAIRMAN. Senator Yarborough?

Senator YARBOROUGH. I want to commend the distinguished chairman of this Health Subcommittee for this bill, another of the many measures for the improvement of the health of the American people and their care and medical treatment over the years. I want to say I fully support it.

I have not had an opportunity to hear all of these statements. I have just heard Dr. Sodeman's statement for the American Medical Association, glanced through the statement of Dr. Chapman, who is president of the American Heart Association, a constituent of mine from Dallas, Tex. I regret that another committee held me and I have another one I must go to, so I have to leave you now. But this faithful chairman is always here, even when the other members are out.

You gentlemen know what he has done in so many fields-the HillBurton Act, Medical Education Act of 1963, all of these many acts.