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THE LIFE SCIENCES mate centers, animal surgery facilities, and tissue-culture facilities were so heavily utilized. The data indicate that clinical research wards are not quite the unique province of clinical medical scientists, while at the same time indicating that only 59 percent of all departments of clinical medical science consider that they even have access to clinical research wards. UTILIZATION OF RESEARCH INSTRUMENTS The unity of the life sciences, the pervasiveness not only of concepts but of research tools, is again evident in the instruments available to the pur- portedly disciplinary departments (Table 331. Most particularly, as we saw earlier, the tools of biochemistry are employed in research in all areas of the life sciences. Ultracentrifuges, amino acid analyzers, gas chromato- graphs, scintillation counters, ultraviolet spectrophotometers, and electro- phoresis apparatus find intensive use across all the biological disciplines, as do electron and phase-contrast microscopes. Indeed, some of the data are particularly surprising, such as those indicating that the 38 clinical science departments utilize or have access to mass spectrometers, as do 43 departments of biology, 21 departments of botany, and 32 departments of zoology. Although intensive-care patient-monitoring systems remain in the particular purview of clinical science departments, large-scale fer- mentors are available across numerous disciplines, as are multichannel recorders, which have usually been thought of as especially associated with physiologists and pharmacologists. In short, we see once again that biolo- gists, whatever the discipline of their training, are relatively quick to seize upon any useful tools that will assist them in their continual inquiries of nature. MEDICAL SCHOOLS AS RESEARCH AND EDUCATIONAL ENTERPRISES In academic year 1968-1969, 85 four-year medical schools and six ap- proved two-year schools providing preclinical training were in operation. Eight additional schools that had not yet been certified for approval had opened their doors, and 17 four-year schools were in various stages of development, from being about to accept their first classes to advanced planning on the drawing boards. Enrolled in all four medical classes were 35,833 students, and, at the end of the year, 8,059 students were awarded medical degrees. Total enrollment had grown by 6,200 medical students in the previous decade. However, as shown in Table 34, these medical

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THE ACADEMIC ENDEAVOR IN THE LIFE SCIENCES 307 students constitute less than half of the total educational responsibilities of these institutions. The growth of graduate education in preclinical departments is shown in Table 35. Patently, an appropriate fraction of the attention of the medical faculties must be addressed to each category of student as well as to research and to the responsibility for medical care essential to operation of such institutions. The growth of the total student body has been paral- leled by growth of the faculty. From academic 1962-1963 to 1968-1969 the total full-time faculty of these institutions grew from 13,681 to 23,014, which was accomplished by increasing the basic sciences faculty from 4,716 to 7,098 while the clinical faculty grew from 8,965 to 15,916. The latter figures may be misleading in some part as they may reflect the con- version from part-time to full-time clinical faculty status as much as they do an absolute increase in the number of individual teaching faculty mem- bers. The total number of basic sciences faculty personnel bears almost a one-to-one relationship to the total number of graduate students in the system, while the ratio of arts and sciences faculty personnel to students is close to one-to-three. This should not suggest an excessive faculty-staffing pattern in the medical schools since the basic sciences faculties have pri- mary responsibility for the instruction of medical students as well as for the conduct of research and graduate education. Despite this growth rate, or perhaps because of it, throughout the decade of the 1960's, there has always been a substantial number of budgeted but unfilled faculty positions within the medical schools. For the academic year 1968-1969, 1,112 clinical and 579 preclinical positions were budgeted but vacant; these were distributed among all disciplines, and the unsatisfied demands for pathol- ogists, anatomists, and biochemists were most acute. Overall, 6.8 percent of the budgeted places on medical school faculties were unoccupied during that year; this fractional level of vacancies had persisted for a decade. In contrast to graduate students and postdoctoral fellows, virtually all of whom receive financial support from some source, by and large it is still necessary for the families of medical students to provide the funds neces- sary for their maintenance and tuition during their medical educations. Internships and residencies are increasingly better paid than they have been historically, so the sense of exploitation of this group has been mitigated in small degree. But it remains true that, with rare exceptions, only the chil- dren of the upper economic segments of American society can afford attendance at medical school. To be sure, in academic year 1968-1969, 35 percent of all students received some scholarship help, and 56 percent were the beneficiaries of loans. But the average loan was $924 and the

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310 THE LIFE SCIENCES TABLE 34 Composition of the Student Body of 85 Four-Year Medical Schools in the United States TOTAL Medical Students Interns and Residents Graduate Students Postdoctoral Fellows Other 91,046 35,833 23,462 9,743 6,166 5,842 Source: Data from "Medical Education in the United States (1968 - 1969)." J.A.M.A. 210(8) :1478, November 1969. TABLE 35 Growth of the Graduate Academic Endeavor in Preclinical Departments of 85 Four-Year Medical Schools in the United States 1962-1963 1968-1969 CLASS OF Graduate Ph.D.'s Post-Graduate Ph.D.'sPost DEPARTMENT Students Awarded doctorateStudents Awardeddoctorate TOTAL 4,105 382 1,0617,892 9341,200 Anatomy 531 49 112958 118125 Biochemistry 1?158 125 2672,029 246356 Microbiology 680 65 1621,374 143173 Pathology 473 29133 Pharmacology 499 50 135940 131140 Physiology 688 57 1521,268 171176 Other a 549 36 233850 9697 a Includes genetics, pathology (1962-1963), and other programs not listed above. Source: 1962-1963 data from *Medical Education in the United States ( 1967-1968) ." J.A.M.A. 206(9) :2012, November 1968; 1968-1969 data from "Medical Education in the United States (1968-1969)." J.A.M.A. 210(8) :1479, November 1969. average scholarship $860, while annual tuition varied from $500 to $2,600, quite apart from the cost of living. It is anticipated that, by academic year 1972-1973, medical schools will admit 11,650 students annually; unless important new initiatives are taken, the financial hardships they and their families will be asked to endure clearly will increase with the passage of time. We find little merit in this circumstance, and recommend that federal funds on a decidedly larger scale be made available for the personal assis- tance of medical students. Meanwhile, the medical schools themselves face increasingly difficult times. American society now looks to the medical schools for the man

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THE ACADEMIC ENDEAVOR IN THE LIFE SCIENCES agement of undergraduate medical education, advanced clinical training, graduate education, and the provision of acute medical care for a large fraction of the American citizenry, while also educating large numbers of paramedical personnel-nurses, technicians, physical therapists, dieticians, medical librarians, x-ray technicians, and others. Public funding of these institutions has not kept pace with the increased expectations of either the public or those responsible for management of the medical schools and the universities of which they constitute a part. We recommend that, at an early date, block funding in support of medi- cal schools be provided from an appropriate federal program. The general approach suggested by the Carnegie Report or1 Higher Education,* in which it is proposed that such funding be based on a capitation formula, seems entirely appropriate, and we recommend it earnestly. At the same time, the medical schools, collectively, have become a major component of the national research endeavor in the life sciences. In 1967-1968, the aggregate expenditure within the medical schools for direct costs of research was $473 million, of which $389 million came from federal sources, very largely the National Institutes of Health, and $83.6 million from all other sources (state and local appropriations, endowed income, foundations, societies to combat dread diseases, and others). It is note- worthy that the total expenditure of federal research funds by medical school departments revealed by our questionnaire to department chairmen was about one half of that reported by medical school deans for their aggregate totals. In addition, a substantial fraction of all clinical research is conducted in hospitals not under the management of medical schools, as well as in federal and other nonprofit laboratories. Nevertheless, it is clear that the overwhelming bulk of all patient-oriented clinical research does occur under the auspices of the medical schools. At the same time, research in the preclinical departments of medical schools is at the leading edge of many scientific frontiers. Indeed, a medical school, in its entirety, constitutes a rather unique system in which scientists in the preclinical departments can remain au courant with the advancing edges of the biological, physical, and social sciences, translate these for their clinical colleagues, and collaborate with the latter in both clinical research and relevant fundamental research that are also part of the educa- tion of graduate, medical, and postdoctoral students. When the process is successful, the findings can be both tested and then immediately put to : Q~c'/its arid Equality: Nell Levels of Federal Responsibility for Higher Education, A Special Report and Recommendations by the Carnegie Commission on Higher Education, McGraw-Hill Book Company, Hightstown, New Jersey, p. 33-36. (Copy- right (if) 1968 by Carnegie Foundation for the Advancement of Teaching.) 311

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THE ACADEMIC ENDEAVOR IN THE LIFE SCIENCES work for the benefit of patients in the same institution. The closest analogy in the academic world is the college of agriculture, in which there are basic scientists, applied scientists, students, and postdoctoral fellows, as well as experimental fields and herds, and direct contact with the network of county farm agents who translate recent applicable research findings into agricul- tural practice in the surrounding area. The engineering school cannot behave quite analogously except by virtue of the consulting activities of the engineering faculty, which provide contacts with industrial organizations in Position to utilize and exploit recent research findings. It is, perhaps, unfortunate that there are few equivalent built-in mechanisms within the university for assuring that the research endeavors of academic physicists, chemists, sociologists, econo- mists, or attorneys can equally rapidly be tested and put into practice for the benefit of society. Medical Students in Research Increasingly, medical students are caught up in the research enterprise. Some desire careers as academic clinicians, a smaller group seeks careers on the faculties of preclinical departments, and some simply taste research and go on to careers in private practice. For all, experience in research will enhance their capabilities as physicians. Research is an exercise in biological problem solving; so too is clinical diagnosis. And the physician will be more proficient at his art if he fully appreciates the caveats to be associated with claims made in the medical literature, which he must con- tinue to study throughout his professional career. There can be no better means for learning how extraordinarily difficult it is to "prove" something in the laboratory or clinic than trying one's own hand at it. Some medical students work at research only during the summers, some work at odd hours throughout the academic year, and others drop out of regular medical school curricula for a year, most frequently between the second and third year of the curriculum, to engage in research full time. The smallest group undertakes to complete all the requirements for both a Ph.D. and an M.D., usually in one of the preclinical scientific disciplines. The magnitude of this endeavor, as reported by department chairmen, is shown in Table 36. The 2,154 medical students in the sample were work- ing in 413 individual departments, and it may be assumed that both num- hers represent about half the actual totals. v_- _~ Almost half the students undertake their research experience in clinical departments. The others are distributed over the preclinical science departments, with a scattering else- where on the university campus. Physiology departments attract a larger 313