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Chapter 2
LOOKING AHEAD: AN AGENDA GROUP ON
EDUCATION OF HEALTH PROFESSIONALS
This planning and review committee believes that the health needs
of the public should provide the context in which the systems for
education of health professionals are viewed. Both the health needs
and the health professions have changed over the years, and they are
expected to continue to evolve (Chapters 4, 6, 10, 11~. The rate of
change of national health needs and of the health-care system have
been rapid in recent years compared with change in the education
system. A new and better match needs to be made between the
educational processes for the health professions and society's needs
and expectations of those professions.
A number of institutions in the United States medical education
system have undertaken innovations with goals re sponsive to the
public's needs (Chapter 5~. These goals include practitioners who can
better meet particular national or local health care needs, more
physicians trained in a shorter period of time, more physician-
researchers, or "better" physicians. Education for other health
professions also has responded to perceived national need--as in the
creation of training programs for nurse practitioners, for example,
when a shortage of physicians was projected.
These innovations in education may derive both from internal and
external forces: the creativity, enthusiasm, and skillful leadership
of an individual; the push and pull of economic constraints and
opportunities; and changes in the social, political, cultural,
educational, and scientific climate. External forces, especially
economic ones, influence the health professional education systems,
but not necessarily in directions such that education of the
professional student better promotes the health of the public. This
is especially problematic in academic medical centers, which have a
broad range of activities encompassing research, care, and training,
and in which education does not always have highest priority.
There is a continuing need to scan the horizon f or the impact of
these forces on the education system, to inform public and private
decision-makers of opportunities and of missteps, and to formulate and
implement sound policies for health professional education.
Therefore ~ the ma jar recommendations
__ ~^ lo_
be established. The proposed Agenda Group would provide a mediating
_ .
force to motivate and support institutions involved in education o: :
health professionals to move toward constructive innovations
re sponsive to health needs .
We make the recommendation of an Agenda Group on Education of
Health Professionals in full knowledge of the difficulties previous
commissions have had, even when their charge was sharply focused and
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they had a mandate from the President or the Congress. but our
planning study has led us to the conclusion that the problem of
matching education to health needs is involved with so many constantly
shifting scientific, economic, social, and political factors that no
immediate prescription for reform can be satisfactory, and the best of
today's plans will require readjustment later. An Agenda Group on
Education of Health Professionals should serve over the next several
years to help stimulate and integrate the efforts of the many
independent educational and professional organizations that must
cooperate if their interests, and those of the public as a whole, are
to be harmonized.
The Agenda Group would provide a locus for systematic communica-
tion among colleges, universities, professional schools, professional
organizations, governments, and public interest groups. The Agenda
Group also would be a mechanism for scanning for events and trends
that might affect health professional education and its responsiveness
to national health needs. The Agenda Group als o could commission
studies on issues it judged to be of major significance and in need of
detailed analysis.
In the past two decades, much has been written about the need for
reform in medical education, and the charge to this committee was to
plan a review of medical education. However, the committee has
concluded that the total needs for health care personnel and their
education, rather than those only of physicians, must be considered in
an integrated fashion. Physicians (allopathic and osteopathic)
interact with a variety of other health professionals, and health care
is broadly construed. Nurses, midwives,- physician extenders, and
dentists, for example,* provide direct health services to patients,
and their training has many features and problems in common with that
of physicians. Thus, the Agenda Group's sphere is not limited to
medical education.
Previous studies often have recommended establishment of some sort
of national commission with a long-term monitoring function. In the
letter of transmittal for this 1965 report1 to the Association of
American Medical Colleges, Lowell Coggeshall states:
The enormous expansion of medical education, research,
and service, especially in the past two decades, has
resulted in greater changes than have occurred during any
other period in our medical history. The great and growing
national concern over the health of our people requires
that those responsible for medical education today and in
the future turn their attentions to a question of the
greatest importance and most far-reaching consequences:
Will the methods and practices currently followed in
-
*The Agenda Group should not dilute its efforts to include all health
professionals. Thi s listing provides a suggested start. Consensus on
the prof essions to be included should be an early goal of the Agenda
Group.
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providing health personnel of all categories, together with
the programs and facilities in being or planned, be
adequate to meet our national needs?
During the study, surprising unanimity of concern was
found among medical educators, university officials, public
officials and others about problems in the field of medical
education. Few persons interviewed believe improvements
needed are matters of minor adjustment. Most point to the
need to take major steps to improve medical education to
enable the nation to produce more and better prepared
physicians and other health personnel. There is a rather
consistent pattern of thought that the quality of education
is good, but not fully geared to future needs. Most
impressive is the repeated assertion that there is need for
some organization (preferably the Association of American
Medical Colleges) to assume a more aggressive and
correlative role if future needs in the f ield of education
f or all health personnel are to be me t . 1
More recently, Carleton Chapman2 concluded that the premedical
and preclinical phases of our present scheme of education for medicine
are intellectually deficient, wasteful of money and time, and in
urgent need of overhaul. Chapman defines conditions under which a
national commission might possibly set the educational process on the
road to reform, and states that the commission should not be based in
government or in a university setting because it should be insulated
from partisan and political pressures exerted by government and
academe.
A 1965 summer workshop noted the startling increases in the
number and proportion of children and the elderly, combined with
rapidly expanding biomedical knowledge, [which] create wholly new
conditions for the practice of medicine. The study reports also
stated that It is difficult, moreover, to find a locus within the
present organization of medicine and medical education for the many
cross-disciplinary activities called for. It is not easy, on the one
hand, for any institution to organize for its own alteration; it is
even less easy for it to accomplish an alteration in fellow
institutions. The solution recommended is that a steering committee
for medical education be formed and that it seek to find funds from
public or private agencies to assure it a lifetime of a year or more
and the services of a small staff. The committee might identify
areas where curriculum reform in medical education is essential, and
those persons who would be willing to engage in such reform and to
solicit funds for the prosecution of the work.
In his recent book, 4 Lewis Thomas discusses the governance of
universities, and medical schools and teaching hospitals as elements
of the university. Who are the decision makers and how does one
implement changes that are viewed to be desirable? He identified as
factors in medical education the place of most medical schools in the
university, the relationships between medical schools and other parts
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of the university, such as schools of public health; the role of
research in the schools and teaching hospitals; the relative power of
the dean and of the heads of departments that bring in large amounts
of money compared with those that do not; the relationship of the
teaching hospitals to the medical school, to the populations they
serve, and to the reimbursers of care. These factors that shape the
medical education system, however, do not have the quality of
education as a primary concern. Some other force is needed which
would have education as its primary concern.
Thus we return to the recommendation, made by a variety of groups
over a period of time, for a continuing source of independent
counsel. The Agenda Group could be an instrument for thinking in
detail about the major forces that influence health professional
education, ways to preserve valuable parts of current health
professional education, and changes in the education systems that
would help move the health care system closer to meeting the needs of
the public.
There have been many recommendations from many sources on how to
improve medical education, but very few of the recommendations have
been implemented, perhaps because change usually occurs by social
consensus. Traditional ways of reaching consensus are being strained
and may be breaking down; therefore, it behooves us not to be limited
by individual policy outlooks. The Agenda Group might-provide a
matrix around which social consensus on education of health
professionals could develop.
Other issues besides education of health professionals currently
share a degree of complexity and national importance which
necessitates innovative, interdisciplinary mechanisms for thoughtful
review. The Ad Hoc Committee on Government-University Relationships
in Support of Science, of the National Academy of Sciences, for
example, recently recommended the creation of a Forum on
Government-University Relationships.5
The Forum was recommended in an effort to channel tensions among
the federal government, the university research community, and
university administrators in constructive directions; the goal is to
develop a lasting, constructive approach, rather than to redocument
the increasing strain in government-university relations.
The President's Commission for the Study of Ethical Problems in
Medicine and Biomedical and Behavioral Research provides an example of
success in interdisciplinary handling of complex problems. Its
reports6 provided guidelines that already have gained wide
acceptance on such thorny issues as informed consent and ethical
problems inherent in decisions to forgo life-sustaining treatment.
The commissionts impact was such that, since its recent scheduled
termination, legislation has been introduced to recreate it.
We believe that such groups should have a mandated termination.
At the close of the designated period, an active determination of
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continuing need and usefulness should be made . Accordingly, we
recommend that the Agenda Group should be constituted for no more than
five years, and at the outset there should be no commitment by the
fenders beyond that period. A preliminary assessment of the Agenda
Group ' s ef fectiveness should be made af ter two or three years, and
improvements made as needed . At the end of f ive years, af ter critical
review of usefulness by, among others, health professionals and their
institutions, the group could continue if the sponsors and the members
agree that it should.
Composition and Qualities of the Agenda Group
The Agenda Group should function in the modes of study and
inter-institutional cooperation, providing a mechanism for needed
perspective and new directions. It could provide an appropriate
institutional arrangement for dealing with the social ecology of the
health care system, a large industry of which medical education is
only a small part. The Agenda Group should be capable both of
reflective consideration of issues over time and short-term
responses. It should monitor relevant trends and events, suggest new
directions, make recommendations for action, and generally be
representative of the public's health.
The Agenda Group should not be an advocacy group for any of the
actors in the health professional education stage, nor for special
pleading. It should be as much as possible free from the pressures of
representing any particular interest group, and, therefore, should be
able to converse with any sector of society in the spirit of free
co nmunicat ion and trus t .
It i s recommended that appointees to the Agenda Group be a small
number of knowledgeable persons of excellent judgment whose goals are
to optimize the education of health professionals for meeting the
heal th needs of the public . The group would be composed of perhaps
six to twelve persons selected on the basis of their personal
experience, expertise, broad interest in public affairs, and wisdom,
rather than professional or ins titutional af f iliation. In aggregate,
the group should be composed of persons who have demonstrated wisdom
in matters relevant to higher education in general and health
professional education in particular, as well as in matters of public
policy and institutional change, and in various social, behavioral,
population, and biomedical sciences.
The group must be composed of persons with national stature and
credibility. Credibility with the profession, the health care system,
and the universities is important, but the group' s impact will depend
in large measure on the members' credibility with the public, and in
their representations to the Congress and the state legislatures. The
group's distinction must enable it to mobilize panels of experts to
conduct specific studies and to convene workshops or forums. Above
all, it is essential that the group be, and be perceived to be,
representative of the interests of the American people, not the
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interests of the profession of medicine or any other health profession
or the institutions of medical or other health professional education.
Because the Agenda Group should be a neutral body, it is
recommended that nominations to it be made through the Institute of
Medicine, whether or not the Institute is involved in its functions
and operation. The members should be appointed by the president of
the Institute of Medicine from a slate of nominees contributed by
health professional groups, education groups, boards of contributing
foundations, third-party payers, and representatives of the public
interest, among others.
The members of the Agenda Group should commit a substantial
portion of their time to it and the chairperson should be full time
for the first year and at least half time thereafter. Appropriate
compensation should be provided. Staggered rotation of group
membership is desirable, especially in light of the effort required of
each member. A small staff of perhaps two or three professionals
would be required, in addition to an executive director, to prepare
background materials and reports and to arrange the meetings and other
activities of the group.
Activities of the Agenda Group
The Agenda Group would examine broad issues of population and
social changes relating to health and ways in which health professions
education could contribute to their accommodation. The group would be
a continuing monitor of events, trends, quality, critical thinking,
and conceptualization about health professional education both at the
national level and the state level. Priority tasks of the Agenda
Group would be to def ine appropriate roles in health and health care
of physicians, nurses, midwives, physician extenders, and dentists,*
as well as tasks and goals of schools to prepare health professionals
for these roles. The Agenda Group would have as a major goal the
identification of needed changes in health professional education and
provision of help in bringing about these changes so as to maximize
the possibility of training the wide variety of workers in the health
care system to work well together for more effective health care.
Extensive consultation and collaboration with leaders of national,
regional, and state professional organizations and educational
institutions, and with policymakers, will be essential. Periodically,
but no less often than after three and five years, the group would
report on its findings regarding significant trends having inpact on
health professions education, anticipated problems, and approaches to
their resolution.
While the Agenda Group is developing its long-term work plan, a
series of shorter studies could be implemented. This planning
committee has identified four targeted studies on medical education
. .
*See footnote on page 16 e
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(Chapter 3) which would address specific problems in improving the
education and training of physicians. These studies--on modulating
the impacts of financial pressures on education, on the changing role
of the physician, on the cultures of the medical education system, and
on the science base of medicine, would provide data and analyses for
the Agenda Group. The studies could contribute substantially to the
eventual solution of problems that already can be identified or
anticipated . It is our expectation that other studies will be
recommended as the Agenda Group deliberates, especially in view of its
expanded scope to include non-physician health professionals.
The charge to the Agenda Group is a broad conceptual one, so
specif ic committees should be constituted to conduct these shorter
targeted studies. The Agenda Group should be instrumental in
designating needed expertise and resources for each study committee.
Direct participation by one or more Agenda Group members would be
valuable but not essential. As appropriate, the special resources of
professional organizations* should be called upon. The parallel study
of the AAMC, "General Professional Education of the Physician and
College Preparation for Medicine, " to be completed in 1984, should
prove especially valuable to the suggested studies on the cultures of
the medical education system and the science base of medicine. The
recent Institute of Medicine study on nursing educations also is
highly relevant, especially to the theme "the changing role of the
physician."
Sponsorship of the Agenda Group
The organizational locus of the Agenda Group requires careful
consideration, because the group risks being viewed as a competitor by
existing entities that have an obvious stake in the issues. The
climate of the times and complexity of the issues require unfailing
objectivity of assessment, but the group also must be able to involve
leaders in medical and health professional schools, in professional
organizations and other influential bodies that have particular
interest in the issues. Several possibilities come to mind.
One place for the Agenda Group would be as a more or less
independent body housed in a sponsoring foundation. The amount of
responsibility and control of the foundation staff would be a matter
for prior agreement.
*For example, the American Academy of Nursing, American Academy of
Physician Assistants, American Association of Colleges of Nursing,
American Association of Colleges of Osteopathic Medicine, American
Association of Colleges of Pharmacy, American Association of Dental
Schools, American Dental Association, American Medical Association,
American Medical Student Association, American Nurses Association,
American Public Health Association, American Society of Allied Health
Professionals, Association of Academic Health Centers, Association of
American Medical Colleges, Association of Schools and Colleges of
Optometry, Association of Schools of Public Health, Association of
University Programs in Health Administration, Committee on Allied
Health Education and Accreditation (AMA), National Governors
Association, and National League for Nursing.
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A second possibility would be a freestanding operation, such as
that of the Carnegie Commission on Higher Education, chaired
successfully by Clark Kerr for some years. That commission had
credibility, and was not viewed as serving particular interest
groups. According to Clark Kerr,8 the committed people who served
on the commission learned from each other and produced work of much
more weight than if the studies had been done by any single
individual, no matter how wise. Although the foundation provided a
name and funds, it allowed the group complete freedom in its work.
Unlike the Carnegie Commission, the Agenda Group for the Education of
Health Professionals might be incorporated so that it could establish
its own program of issues to study and have both control of and public
accountability for its work. In this case, the sponsors of the Agenda
Group would be involved initially in delineating the group's mission,
but then would sever the formal tie.
The Institute of Medicine of the National Academy of Sciences
offers other possibilities. The Agenda Group could operate either as
a committee of the Institute or as an independent unit housed in the
Institute. The Institute charter directs it to examine "policy
matters pertaining to the health of the public;" its membership is
diverse and expert in the many health-related professions, as well as
other relevant disciplines such as economics, law, and ethics. The
Institute members could be drawn on for expertise, not only in the
Agenda Group, but also on its panels. Review procedures like those in
force in the Institute of Medicine and the National Academy of
Sciences complex would help assure critical assessments of the reports
of ad hoc groups convened by the Agenda Group to deal with specific
questions. The way in which the reports of the Agenda Group will be
peer reviewed needs to be worked out.
On balance, our committee favors the option of an independent body
housed in the Institute of Medicine. The potential sponsors providing
financial support will undoubtedly want to make their views known
regarding the organizational basis of the Agenda Group.
Financial Support
Regardless of the option selected for the organizational base of
the Agenda Group (a foundation, freestanding, or the Institute of
Medicine), it is our recommendation that the financial sponsorship
come mainly from foundations, with a lesser but meaningful
contribution from the federal government.* A single foundation or a
consortium of foundations should provide leadership and initial
commitment of funds. As discussed earlier, the planning committee
believes that the initial commitment should be for five years, a
*Whatever role federal and state government play in the future in
relation to health care and health professions education, government
and the Agenda Group will need each other as informed and critical
interlocutors.
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period of time that would provide a good test of the usefulness of the
enterprise.
Because technological, scientific, social, and economic change s
are more rapid now than ever before, the need to look ahead in
education of health professionals is more critical than in the past.
Private foundations traditionally have played a pivotal role in
providing financial support for medical education and research and in
sponsoring studies in medical education. Our proposed venture
provides further opportunity for foundation involvement in educational
innovation.
Foundation support is particularly important at this time, when
substantial support from government agencies appears unlikely. An
additional advantage of foundation sponsorship would be its great
potential for accelerating implementation of the Agenda Group's
recommendations. The offering of grants for model programs could be
more persuasive than the logic and rhetoric of the report itself.
Flexner, in preparing his 1910 report, visited each medical school in
the U.S. at that time.9 Coming from the Carnegie Foundation, he
found doors opened to him that might otherwise have been closed,
because the foundation name must have evoked "dancing visions of
endowment plums."10 .
It is estimated that the Agenda Group would cost about $500,000
the first year. Specific targeted studies would require additional
funding. If the concept of the Agenda Group is accepted, a workshop
should be held with leaders of interested foundations to discuss the
project and plan a strategy for its financial support.
Implementation of the Agenda Group Recommendations
If the Agenda Group is sponsored by several foundations, each
should assist in the wide dissemination of reports and implementation
of recommendations. Informed leadership opinions should be developed
within the affected professions. In addition, the leadership of those
segments of society that the medical, nursing, and other health
professional schools depend on, such as state governments and
components of the federal Department of Health and Human Services,
should be involved in both the planning and the follow-up to the work
of the Agenda Group.
The group's recommendations will stand primarily on their merit,
but their implementation can be facilitated beyond the persuasiveness
of wise, credible, well-intentioned people. Some of the leaders in
medical schools, schools of public health, nursing schools, teaching
hospitals, and other relevant institutions might wish to implement
needed improvements, but need assistance or support in doing so. The
sponsoring foundations, if they find the ideas put forth by the Agenda
Group worthwhile, could provide support to follow through on the
recommendations. Foundations could ask that their concerned grantees
make a major effort to follow the general thrust of the recommendations
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of the Agenda Group in order to remain eligible for funding by the
foundation in educational and in other areas.
There should be special attempts to reach users, the Congress, and
others, even before the studies are completed; their comment on the
draf t reports could be solicited. This would provide valuable
feedback to the study committees and the Agenda Group, and enhance
prospects for subsequent implementation.
Positive incentives for implementation need to be studied
carefully so that the recommendations would appear attractive both
from a fiscal point of view and from a desire to shape new consensus
among colleagues. Some thought would also have to be given to the
factors that are likely to affect the acceptability of innovations in
particular settings. What would innovations mean to the prestige and
authority of those who must adopt them? What is the intrinsic value
to the user of curricular or teaching programs or arrangements that
are going to be replaced? How can people who are going to experience
a change be involved in the planning and implementation of the
innovations? And how can individuals and institutions be motivated to
take a leadership role?
The sustained dissemination of the reports of the program would be
important. Perhaps an advance arrangement for publication of the
Agenda Group's reports and other products, as a recognizable series,
would be feasible. The Agenda Group should assume responsibility for
distribution of its publications to a selected group of people, and
the publications should be available to the general public, on
request. Forums and press conferences also could provide mechanisms
for dissemination. .
No matter how good the recommendations of the Agenda Group, their
implementation could bring some unintended and undesirable ef feet s .
The Flexner report 's consequences provide some examples. To the good,
the foundation-sponsored* victory of adoption of a four-year medical
school curriculum, the introduction of laboratory teaching exercises,
the improvement of the quality of instruction by means of a full-time
faculty, the expansion of clinical teaching through the introduction
of the clinical clerkship, the incorporation of medical schools into
the framework of the universities, and the establishment of research
in the teaching program.12 However, unintended effects of the
Flexner renc~rt included development of uniformity and rigidity in
*The universities responded with alacrity deco the challenge posed by
the foundations and the dollars they provided--$78 million from the
Rockef eller Foundation alone by 1928 , roughly equivalent to 445
million 1983 dollars; and $154 million by 1936, roughly equivalent to
1.1 billion 1983 dollars. (Dollar figures from Starr, Note 102,
p.462; Calculations based on Consumer price indices (CPI) for 1928,
1936, and February, 1983. CPI's were provided by the Bureau of Labor
Statistics. ~ Most of this money went to seven schools, a distribution
that de termined which schools and which ideals of education would
dominate .11
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medical school curricula, which lasted for the next 60 years, and a
major emphasis on diagnostics and therapeutics and little attention to
health maintenance, despite Flexner's warnings that uniformity and
rigidity stifled creative work, and that preventive and social
medicine were of central importance.
Also, after 1910, the number of women entering medicine declined
markedly. According to Starr,13 as schools closed and places in
medical school diminished, schools started to exclude women; the
justification was that they would not continue to practice after
marriage. For blacks, the situation was similar--outright
discrimination in predominantly white schools accompanied the closing
of five of the seven medical schools for blacks that existed in 1910.
Casting medical schools on the Johns Hopkins model also removed
some of the practical orientation from American medicine and reduced
the health manpower available to meet needs, particularly of the rural
poor. By 1919, there were about half the number of graduates as in
1900 and it was not until after World War II that their number
returned to the level of 1900. While more rigorously educated
physicians seems a desirable goal, we can ask retrospectively if the
decreased number of doctors was, on balance, beneficial in an era of
limited therapeutic possibilities in which physicians' major role was
to comfort.
Thus, it is important that the Agenda Group monitor the impacts of
implementation of its recommendations, to allow for timely
corrections. This is particularly important in view of the diversity
of U.S. medical schools; a given program or recommendation may not be
suitable to all schools. The ability to resist conservative pressure,
the wisdom to foresee the consequences of its actions, and the
resiliency to meet new problems generated by the ramified effects of
its actions, 14 will be invaluable to the Agenda Group.
The endorsement of the Agenda Group from the beginning by such
groups as the American Medical Association, the American Nurses
Association, the American Osteopathic Association, the American Public
Health Association, the Association of Academic Health Centers, the
Association of American Medical Colleges, the Association of
University Programs in Health Administration, the U.S. Department of
Health and Human Services, and others who would be at fected by its
recommendations would be invaluable to the Agenda Group's aims. Such
endorsement would demonstrate what Henry Pritchett called professional
patriotism.l5 "By professional patriotism amongst medical men I
mean that sort of regard for the honor of the profession and that
sense of responsibility for its efficiency which will enable a member
of that profession to rise above the consideration of personal or of
professional gain."
Summary of the Strategic Approach of the Agenda Group
If the Agenda Group is to be effective, its members will have to
avoid the temptation of thinking that their tactical problem is as
straightforward as that of the professional and philanthropic leaders
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who pushed for the adoption of the Flexner report recommendations.
The situation was fundamentally different at that time: the
government was only minimally involved, the professional leadership in
the AMA was eager to support the tightening of educational standards,
and the small number of major f oundations were in control of the only
outside funds that could influence the aspirations of medical schools.
Today, by contrast, the foundations are numerous and committed to
varying philosophies and approaches. The big money comes from the
federal government, whose programs are not always coordinated. Each
foundation can supply money only in comparatively small amounts, but
their funds can be of great influence as seed money to develop ideas
and stimulate discussion.
On the encouraging side, there is more general recognition of the
importance of the problem, and great pressure to find some solution.
There is widespread belief that health programs are a public
responsibility, but one which should permit as much local and
professional freedom as possible.
Education of health professionals is an area in which political
and philanthropic leadership is likely to acknowledge the need for
some independent review from professional sources--provided that those
sources can be made truly independent. An approach toward developing
such review is suggested here in the Agenda Group. It involves the
following:
1) The selection of an institution with a reputation for
independence to take responsibility for organizing the group
and providing it with logistical support, but without
attempting to control the substance of its deliberations.
2) The selection by that institution of the members of the group.
The members should include respected leaders of the academic
and professional interests involved, and also experienced
leaders in various aspects of public affairs outside the health
professions. The members should understand and represent, but
still freely criticize, the points of view of the competing
interests in the health professions. The professional
interests should not be requested to choose representatives as
instructed delegates, but should be asked to suggest possible
nominees for membership.
3) The Agenda Group members should expect to make its work a major
part-time commitment, with meetings several times a year to
review the current situation and make projections about future
trends and impacts, to reevaluate the various reports on health
profession education of earlier years and their practical
consequences, to identify topics in need of further data
gathering and/or analysis, and to commission appropriate
studies. It should have an adequate staff to help it gather
data and formulate issues for discussion and proposed
resolution.
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4) Funds for operation should come from individual donors or
foundations which preferably are not committed to particular
formulas for health or educational policy, whose support would
not give grounds for any suspicion that the group 's conclusions
or the selection of its membership from time to time were
predetermined by f inancial or political influence. Government
support also should be sought, especially at the federal level,
and at the state level as well, as appropriate.
5) The group will obviously need to maintain continuous and close
liaison with several parts of the federal government and
various professional and academic interests--the support of
which may be required to carry into effect its recommendations.
6) The four targeted medical education studies (Chapter 3) given
high priority by this planning committee, and other targeted
studies identified by the Agenda Group, will require
combinations of review of available data, data collection,
discussion, critical analysis, and recommendations for action.
The studies could be conducted under the aegis of the Agenda
Group or independently. A decision should be made for each
study as to whether it would best be housed in the Institute of
Medicine, which would establish a study committee, or set up as
an ef fort of a professional organization, a single scholar, a
research institute, or some other entity. The planning
committee makes the preliminary recommendation that the
Institute of Medicine conduct the targeted studies, but
suggests that the Agenda Group, once appointed, consider
further whether a particular group or individual is better
suited to carry out one of The full studies or a component
part. Liaison wi th other groups should be established as
appropriate, and full participation of the health professions
augmented by social scientists, public policy experts,
economists, and others, sought as needed.
Our hopes for the Agenda Group thus include that it will provide a
continuing mechanism for examining change, that it will contribute to
a climate leading to improvements in the education of health
professionals, and that it will facilitate communication and the more
rational resolution of shared problems among the partnership of health
professionals.
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28
Representative terms from entire chapter:
health professionals
