AACBNC
Council of Academic Societies Spring Meeting
March 11-14, 2004
Santa Monica, California

Changing Academic Medicine’s Focus From
Growth to Quality

Meeting Summary
Meeting Objectives

For decades, the goal of many medical schools and teaching hospitals has been
to grow the clinical enterprise and improve market share, while at the same time
increasing the amount of their funded research grants and moving up in the NIH
research rankings. Given the inevitable flattening in NIH appropriation
increases, the decrease in Medicare reimbursement rates, and the increasingly
competitive clinical services environment, few institutions can realistically plan
to continue expanding (and to grow out of their problems). While always
concerned about quality, many progressive institutions are now beginning to
focus on maximizing the quality of their enterprise more broadly and are
becoming less concerned with expansion. This objective of this meeting was to
focus on the role of faculty and faculty leaders in changing academic medicine’s
focus from growth to quality.

Pre-Meeting and Other Activities

CAS Administrative Board: The CAS Administrative Board held a luncheon
meeting on March 11. The panel heard various staff reports. The Board
discussed the committee of deans draft report related to framing the mission of
the new AAMC Institute for Improvement in Medical Education. The committee,
chaired by Dr. Joe Martin of Harvard, has been charged with undertaking “a
comprehensive review of the current state of medical education in the country,
in order to set a strategic direction for reform across the medical education
process.” The CAS Administrative Board decided that the CAS would not seek to
edit the document, but rather provide substantive comments on the concepts
and issues it contains. Dr. Schuster was asked to share the draft report with the
CAS representatives and solicit their comments before composing a formal CAS
response.

CAS Program Committee: The Committee met on March 11 to begin planning for
the CAS programs at the AAMC Annual Meeting, scheduled for November 5-10,
2004 in Boston. The CAS will likely sponsor or co-sponsor one plenary session
on Saturday afternoon, November 6; two sessions Sunday morning, November 7;
hold its business meeting at lunch on Monday, November 8; and, hold a joint
plenary with the Council of Deans on Monday afternoon.

Basic Science Chairs Leadership Forum: The Forum met on March 13 to begin
planning the second National Meeting of Basic Science Chairs that is scheduled
for October 7-9, 2005 at the Marriott City Center Hotel in Salt Lake City, Utah.
Individual chair societies will be polled to see if they are interested in organizing
discipline specific sessions within the meeting.

CAS Orientation Session: Mr. Tony Mazzaschi, AAMC Director of CAS Affairs, gave
an orientation to the AAMC and the Council of Academic Societies for new CAS
representatives on March 11. The session discussed the history of the CAS, its
role in AAMC governance, recent CAS initiatives, and some of the challenges
and opportunities offered by the CAS.

Plenary I: Promoting Quality and Creativity in Faculty and
Students

David Baltimore, Ph.D., President, California Institute of Technology, discussed
the evolution of the biomedical research enterprise. The initial paradigm
featured research as a cottage industry, occurring in small laboratories. By the
mid 1980s, sophisticated instruments became associated with the labs. In the
current era, Dr. Baltimore asserted that multiple styles of biomedical academic
research exist. He drew an analogy between physics and biomedical research:
small-scale labs supported by shared facilities, experimentalists in huge groups
trained in multiple fields, and theoreticians. He suggested that in biomedical
research, theoreticians will require the widest range of skills and that these
individuals also will be the brightest and most creative. Dr. Baltimore suggested
that biomedical research trainees are kept in training too long and that the
system emphasizes dependence and not independence -- “a crisis about to
approach a disaster.” In order to break the dependency cycle, he offered a few
solutions: the recognition of a cadre of full time career laboratory research
professionals, each receiving living wages and recognition, but not independent
status; a decreased training period for researchers; and, encouraging the
independence of trainees. The issues revolving around the training process,
rewarding creativity, and evaluating the contributions of a team need to be
considered in novel and innovative ways. During the discussion period, Dr.
Baltimore said the stem cell issue is disastrous for research in the U.S. since
one of the strongest advantages of the U.S. research enterprise is being
threatened -- the freedom to pursue one’s ideas.

Plenary II: Promoting Quality in Clinical Service

Thomas L. Garthwaite, M.D., Director and Chief Medical Officer, Los Angeles
Department of Health Services, discussed Promoting Quality at the System Level.
Dr. Garthwaite discussed the many challenges facing the health care enterprise,
which provides care that is too often inaccessible, expensive or inconsistent.
He discussed various incentives inherent in the health care “non-system” which
often underlie the undesirable outcomes. He emphasized that too often health
care reform is synonymous with fixing the financing of healthcare, ignoring the
importance in reforming how we deliver it. Dr. Garthwaite believes that other
futures are possible. Dr. Garthwaite discussed his efforts to change the
incentives and therefore the quality and quantity of care of the Veterans Health
Administration when he was undersecretary for health at the Department of
Veterans Affairs. He then discussed similar changes he is attempting to instill in
the health care system funded by the county of Los Angeles. These changes
include: clinical consolidation, implementing care and case management
systems, extensive use of information technology, implementing a performance
management system, creating a culture of safety, and managing and improving
affiliations.

Carolyn M. Clancy, M.D., Director, Agency for Healthcare Research and Quality,
discussed The Role of the Federal Government and Health Services Research in
Promoting Health Care Quality. Dr. Clancy discussed efforts to improve
healthcare quality. Most success has focused on the under use of effective
treatments. There has been less focus on the misuse and overuse of treatments.
The federal government plays various roles in the healthcare system, including
being a major purchaser and provider of healthcare, a monitor of healthcare
quality and a regulator of healthcare systems. Dr. Clancy outlined various
essential elements of quality: 1) structure -- are the optimal structural elements
in place; 2) process -- are the right things done to the right people at the right
time; and, 3) outcomes -- are the results as good as they should have been given
the technical knowledge. Dr. Clancy discussed various issues facing those
concerned with healthcare quality:

-Will public reporting lead to quality improvements?
- Payers appear to be willing to pay for quality, but how?
- If quality improvement is local, what is the federal role?
- By what process can quality standards gain legitimacy?

Dr. Clancy concluded by discussing various new reports published by AHRQ on
quality and health disparities. She also urged attendees to review the resources
now available on the AHRQ quality web site < http://www.qualitytools.ahrq.gov/>,
a clearinghouse for practical, ready-to-use tools for measuring and improving
the quality of health care.

Mark Chassin, M.D., M.P.P., M.P.H., Edmond A. Guggenheim Professor of Health
Policy and Chairman of the Department of Health Policy, Mount Sinai School of
Medicine, and Executive Vice President for Excellence in Patient Care, Mount
Sinai Medical Center, discussed Fantasies, Myths, and Wishful Thinking: Painful
Truths About Quality Improvement. Dr. Chassin discussed what is currently
known about the state of quality in U.S. healthcare. As technology improves, the
burden of harm is increasing and the need for major improvements is growing.
The goals of such improvements are clear: to always deliver effective care, to
avoid providing ineffective care and to eliminate preventable complications. Dr.
Chassin discussed various obstacles to quality improvement, including on-going
debates as to who will lead and fund quality improvement efforts.

Dr. Chassin discussed various types of errors and how they need to be treated.
He believes that egregious errors that do harm should lead to retraining and/or
discipline. However, a cascade of small errors precedes most adverse events,
and blame and punishment are counterproductive. In those cases, system
participants must be open to discuss and diagnose errors in order to change the
behaviors and systems that led to them. Dr. Chassin concluded by stating that
achieving and sustaining improvements in healthcare quality is the foremost
challenge facing the healthcare enterprise in the 21st century. He asked, “Will
academic medicine lead the way?”

Plenary II Breakout Sessions:

Three breakout sessions were held following the Promoting Quality in Clinical
Service plenary session, two of which focused on extending topics raised in the
session. The third session was targeted to basic scientists attending the
meeting. The breakouts were:

- J. Thomas Rosenthal, M.D., Associate Vice Chancellor, David Geffen School of
Medicine at UCLA, and Chief Medical Officer, UCLA Healthcare, led a breakout
session on The Challenge of Creating a Culture of Quality.
- Edgar Pierluissi, M.D., Medical Director for Performance Improvement, San
Mateo Medical Center, led a breakout session on the use of Morbidity and
Mortality Conferences in Residency.
- William T. Mallon, Ed.D., Director of Organization and Management Studies,
AAMC, led a breakout session on The Future of Compensation for Basic Science
Faculty.

Plenary III: Promoting Quality in Research and Graduate
Education

Edward W. Holmes, M.D., Vice Chancellor for Health Sciences and Dean,
University of California, San Diego, School of Medicine, discussed Promoting
Quality in Cutting Edge Research. Dr. Holmes said that external forces are
transforming biomedical research in academia, including the demands of funding
sources. As evidence, he noted the NIH Roadmap, which is promoting
interdisciplinary research teams and creating incentives for more effective
translational research. Dr. Holmes believes that the maintenance of quality will
require a new research and training paradigm. Central to this new paradigm is
the training of a new type of physician-scientists researcher, one who is
comfortable working with both animals and patients; as well as a new type of Ph.
D. scientist who is comfortable working in a translational research environment.
Both types of researchers must be skilled in bioinformatics.

To accommodate this new research paradigm, Dr. Holmes contends that out
institutions must change. Policies must accommodate cross-department and
cross-school recruitments and appointments and to develop researchers and
research systems that support multidisciplinary approaches to essential
research questions. More flexible promotion and tenure processes must also be
implemented. Institutions will face difficulties measuring the productivity of
these new researchers. Traditional quantitative report cards will be insufficient
and new, more qualitative evaluations will be necessary. These methods must try
to assess creativity, research that advances the discipline and research
accomplishments that have an impact on human health. Dr. Holmes cautioned
that metrics are only an aid to judgment and not a substitute for judgment and
common sense.

John Brauman, Ph.D., J.G. Jackson-C.J. Wood Professor of Chemistry, Stanford
University, and Member, Committee to Examine the Methodology for the
Assessment of Research-Doctorate Programs, National Research Council
discussed Defining Quality in Graduate Education. Dr. Brauman discussed the
recent NRC report on how research doctorate programs should be assessed.
The panel proposed an improved approach to doctoral program assessment that
will be useful to administrators, faculty, and others with an interest in improving
the education of Ph.D.s in the United States. Dr. Brauman reviewed the
methodology of the 1995 NRC rankings and the changes recommended by the
NAS panel, including the collection of new data about Ph.D. students, additional
data about faculty, and new techniques to present data on the qualitative
assessment of doctoral program reputation. Dr. Brauman also discussed the
proposed revisions to the taxonomy of fields from that used in the 1995 rankings.

Keith Yamamoto, Ph.D., Executive Vice Dean, University of California, San
Francisco School of Medicine, and Editor, Molecular Biology of the Cell made a
presentation entitled Promoting Quality in Medicine and Science in Emerging
Systems of Scholarly Publishing. Dr. Yamamoto began by discussing needed
changes in postdoctoral training. He said the definition and scope of the
postdoctoral training experience has changed dramatically since his training
experience. Dr. Yamamoto said that the career trajectory of academic
researchers used to be linear with a clear path from undergraduate science
major to professor. Currently, however, alternative careers offer additional
opportunities for young scientists. However, for many of these alternative
career paths, the postdoctoral experience is not necessary. He believes that the
Ph.D. should become the terminal qualification for anyone interested in pursuing
a career outside research.

Dr. Yamamoto said that publication is a critical part of the scientific process – an
obligate endpoint of scientific investigation. Since the early 1970s, the scientific
community progressively has ceded publishing to commercial non-scientific
editors and publishers. As a result, many believe that scientific publication
standards have suffered. Dr. Yamamoto discussed several of the current
publishing models in use and under development. He said that there were
several tension points:

- Scientists must manage the evaluation and publication of scientists;
- Publication costs should be considered part of the cost of research;
- Publicly funded scientific information should be freely available;
- Promotion and tenure committees must consider quality and not the quantity of
research -publications; and
- Institutions need to find new ways to allocate credit for collaborative research.

Breakfast Discussion Session

Three concurrent breakfast discussion sessions were held.

- Maurice Hitchcock, Ed.D., Director & Professor, Division of Medical Education,
Keck School of Medicine, University of Southern California, led a session on
Current Issues in Faculty Development.
- Michael Whitcomb, M.D., Senior Vice President for Medical Education, AAMC,
and Jane Broecker, M.D., Chair, Organization of Resident Representatives, led a
session on Defining the Future Scope Physician Practice.
- Marcelle Willock, M.D., Dean, Chares R. Drew University of College of Medicine,
led a session on How to Attain and Maintain Diversity in Institutional Leadership.


Plenary III: Promoting and Assessing Quality in Medical
Education

Jerry A. Colliver, Ph.D., Professor and Director, Statistics and Research
Consulting, Southern Illinois University School of Medicine, discussed What
Have We Learned from Research on Problem-Based Learning? A Good Question!
Dr. Colliver noted that this is "a critical question for medical education, because
the research results have been so unexpected and because their implications
are so far reaching - going well beyond just PBL." Problem-based learning has
had a major impact on thinking and practice in medical education for the last 30
to 40 years, and an extensive body of research has been conducted to assess
the educational effectiveness of PBL. Dr. Colliver presented an overview of the
research to give a general sense of the research and concluded that at best the
"results show a weak effect of PBL at best and even the weak effects can be
accounted for by pre-existing differences between groups."

The results are surprising, because PBL is said to be based on powerful
educational principles, derived from educational theory, which is often cited in
support of various practice decisions in education and medical education. Thus,
the PBL research provides a strong test of educational theory, possibly the
single strongest test to date. Dr. Colliver contended that medical schools,
unwittingly, have become a multi-site laboratory for testing educational theory,
and the results do not support the theory. Dr. Colliver briefly discussed three
main sources of educational theory - Adult Learning Theory, Constructivism, and
Cognitive Theory - and noted the major concerns that have raised about the
theory. For the most part, Dr. Colliver said, the theory is untested and untestable
metaphor, and yet it is routinely cited to justify educational practice. The
evidence from PBL research further undermines the theory. Dr. Colliver
recommended that we "should reconsider the value of thinking in terms of this
imprecise, unproven theory, and we should rethink the promise of PBL,
especially PBL curricula, for medical education practice."

Stephen R. Smith, M.D., M.P.H., Associate Dean for Medical Education and
Professor of Family Medicine, Brown Medical School discussed Does
Competency-Based Education and Evaluation Enhance Quality in Life-Long
Learners? Dr. Smith discussed how the many calls over the past few decades for
major reform in medical education usually failed to achieve any lasting change.
In contrast to these earlier efforts at reform, a competency-based model for
medical education fundamentally alters the processes of teaching, learning, and
assessment. The model detailed by Dr. Smith calls for an effort to define a
successful medical school graduate, then designing measures and standards of
performance, and only then developing and designing the learning experience.

Dr. Smith discussed efforts at Brown Medical School to advance a competency-
based curriculum. To graduate, a student must (1) demonstrate mastery of the
medical knowledge base, (2) achieve beginning and intermediate levels of
proficiency in nine key abilities, and (3) attain an advanced level in the ability
called "problem solving" and three other abilities that the student chooses
based on his or her interests. The nine abilities are effective communication;
basic clinical skills; using basic science in the practice of medicine; diagnosis,
management, and prevention; lifelong learning; self-awareness, self-care, and
personal growth; the social and community contexts of health care; moral
reasoning and clinical ethics; and problem solving. Dr. Smith said that as a major
education innovation, the new competency-based curriculum has been
successfully woven into the fabric of the medical school environment.

Linda A. Headrick, M.D., Senior Associate Dean for Medical Education and Faculty
Development University of Missouri-Columbia, School of Medicine, discussed
Teaching Quality Improvement. Dr. Headrick said that recent successes in
clinical improvement highlight the importance of teaching medical students and
residents about the improvement of health care. The ACGME includes "practice-
based learning and improvement" and "systems-based practice" as two of six
core competencies that all residents must achieve. Dr. Headrick said the
questions that need to be addressed are:

- What should we teach?
- How should we teach the improvement of health care?
- How will we measure success?

Dr. Headrick said that various studies show that medical students and residents
can develop skills to improve care through a combination of didactic and
experiential learning, while also contributing to the improvement of patient care.
For learners to achieve competence in practice-based learning and
improvement by the completion of residency, the foundation must be laid during
medical school. The framework she advanced attempts to identify concrete
learning objectives with real-life examples for each stage of training. This
requires developing competence in practice-based learning and improvement
as a skill-based activity with important theoretical and methodologic foundations.

Special Luncheon Session: Defining Issues of Concern to
Faculty

This session allowed CAS Society Representatives and Officers to share with
their CAS colleagues and the AAMC leadership their thoughts on what our
institutions, departments and faculties are doing well, doing poorly, need to
change, and/or need to re-evaluate. Four discipline leaders started the
discussion. Short presentations were made by:

- Erica Friedman, M.D., Director of Medical Clerkships, Mount Sinai School of
Medicine;
- Michael Friedlander, Ph.D., Professor and Chair, Department of Neurobiology,
University of Alabama, Birmingham, School of Medicine;
- Barry Hong, Ph.D., Associate Professor of Psychiatry and Medicine, Washington
University in St. Louis, School of Medicine; and
- Thomas C. Westfall, Ph.D., Professor and Chair, Department of Pharmacological
and Physiological Sciences, St. Louis University School of Medicine.

Optional Professional Development Session: Engaging
Faculty in Addressing the Core Competencies

Linda C. Perkowski, PhD., Director, Education Programs, University of Texas,
Medical School Houston, led an optional workshop session on Engaging Faculty
in Addressing the Core Competencies.

CAS Banquet: The Complexity of Performance Change

Jeremy Grimshaw, M.B.Ch.B., Ph.D., F.R.C.G.P., Director of the Centre for Best
Practices, Institute of Population Health, University of Ottawa, and Director,
Clinical Epidemiology Unit, Ottawa Health Research Institute, discussed the
complexity of performance change. Major difficulties arise when introducing
evidence and clinical guidelines into routine daily practice. Data show many
patients do not receive appropriate care, or receive unnecessary or harmful
care. Many approaches claim to offer solutions to this problem; which ones are
as yet the most effective and efficient is unclear. Dr. Grimshaw provided an
overview of present knowledge about initiatives to changing medical practice.

Special Session: Hot Topics

The final session of the meeting was reserved for presentations on topical
issues and recent research findings of interest to CAS representatives. The
following topics and presenter were featured during this session:

- Funding Update on Health Professions Programs: Erica Froyd, Legislative
Analyst, Office of Governmental Relations, Association of American Medical
Colleges;
- The Responsible Conduct of Research Program for Academic Societies: Carolyn
R. Fassi, M.P.H., D.P.A., Director, RCR Program for Academic Societies, Division of
Education and Integrity, Office of Research Integrity;
- Attitudes on the Usage of Institutional Review Boards: Evangeline D. Loh, Ph.D.,
GREAT Group Executive Secretary, Association of American Medical Colleges;
- Faculty Effort and Compensation Reporting: Susan Ehringhaus, J.D., Associate
General Counsel for Regulatory Affairs, Association of American Medical
Colleges; and
- Institutional Conflict of Interest Policies: Susan Ehringhaus, J.D., Associate
General Counsel for Regulatory Affairs, Association of American Medical
Colleges.
Council of Academic Societies
Draft Business Meeting Minutes

March 12, 2004
Santa Monica, California
I. Call to Order
Barbara Schuster, M.D., called the CAS Business Meeting to order at 12:30 p.m.
on Friday, March 12, 2004, in Santa Monica, California. The minutes of the
November 10, 2003 meeting were approved.

II. CAS Chair’s Report
Dr. Schuster briefly summarized the recent activities of various CAS Task Forces
and Committees:
-     Membership Committee: Currently 94 academic and scientific societies are
members of the CAS. New members in the past two years are: American Academy
of Dermatology; American Headache Society; Association of Directors of Medical
Student Education in Psychiatry;
International Association of Medical Science Educators; and The Society of
Neurological Surgeons.
Recent recruitment efforts have focused on the few program director societies
who remain outside the CAS. Their absence from the CAS relates to tax status
issues.
-     Program Committee: The Program Committee was congratulated for
organizing a very strong program for the current CAS Spring Meeting. The
Committee met on March 11th to begin planning for the CAS programs at the
AAMC Annual Meeting, scheduled for November 7-12, 2004 in Boston. The CAS
will likely sponsor or co-sponsor one plenary session on Saturday afternoon,
November 8; two sessions Sunday morning, November 9; hold its business
meeting at lunch on Monday, November 10; and, hold a joint plenary with the
Council of Deans on Monday afternoon.
-      Basic Science Chairs Leadership Forum: The Forum has begun planning the
second National Meeting of Basic Science Chairs that is scheduled for October 7-
9, 2005 at the Marriott City Center Hotel in Salt Lake City, Utah.
-     Faculty Leadership Task Force: Last year the Task Force completed the
Chairs Objectives Project that has been published as part of the AAMC
monograph, The Successful Medical School Department Chair: Characteristics,
Responsibilities, Expectations, Skill Sets. The Task Force will be working closely
in the next year with Diane Magrane, M.D., director of the new AAMC Office of
Faculty Development.
-    Task Force on Dual Degree Students, Faculty and Programs: The Task Force
has gathered extensive data from various existing AAMC databases. The Task
Force will meet again in April in an effort to finalize its research objectives and
determine any additional data needs.
-    Scholarship Dissemination Project: A report on this initiative appears below.

III. AAMC Chair’s Report:
Donald Wilson, M.D., Chair of the AAMC (2003-2004), and dean of the University of
Maryland School of Medicine, discussed recent changes made by the AAMC
Executive Council in an effort to increase oversight by the Association’s elected
leadership:
-      The Executive Committee now meets twice monthly by conference call,
increasing the Committee’s knowledge and input on operational and financial
matters, as well as policy development.
At the Assembly meeting last November, changes made in the AAMC bylaws
expanded the Executive Committee from seven to ten individuals, increasing the
term of service of its members from one year to at least two years.
A separate Audit Committee has been established; in the past the Executive
Committee performed this role. The AAMC’s Audit Committee has two members
from the Executive Council and two individuals who have financial expertise
from outside the Council.
A new Compensation Committee has been established to review all
compensation policies and procedures, as well as the salaries of senior AAMC
staff.
The Council now reviews the minutes of all Executive Committee meetings and
ratifies the actions taken at those meetings.
The Executive Council agenda now has explicit time for detailed reports from the
audit, investment, and compensation committees, with the minutes of these
committee meetings also available to the Council.
The length of the Executive Council meetings and the time available to consider
and debate issues has been expanded.
Dr. Wilson also congratulated Dr. Jordan Cohen on the tenth anniversary of his
Presidency of AAMC. Dr. Wilson detailed the extraordinary progress the
Association has made in meeting its core objectives during Dr. Cohen’s tenure.

IV. President’s Report
Dr. Cohen updated CAS representatives on the Jung v. AAMC et al litigation. On
February 11th, the judge hearing the case ruled on various motions to dismiss
defendants from the suit. AMA, AHA, ABMS, CMSS were dismissed, as was
Yeshiva University and Washington University Medical Center. Motions to
dismiss AAMC, ACGME, NRMP and 27 institutions were denied. The NRMP has
filed an appeal. The AAMC and AHA are seeking the enactment of legislation that
would affirm the lawfulness of the Match. [N.B. President Bush signed into law
legislation to that affect on April 10, 2004.]

A group contends that the Graduation Questionnaire should be subject to IRB
review. The Association recently submitted the GQ to review by an outside IRB
where it was approved under the expedited review process. The AAMC is
undertaking a survey of medical school applicants and non-applicants in order to
assess attitudes about medicine as a career and about the medical school
application process.

Dr. Cohen commended the CAS representatives’ attention to a new study, The
Economic Impact of Medical College and Teaching Hospital Members of the
AAMC. The firm of Tripp Umbach Healthcare Consulting, Inc authored the report.
The application deadline for the new Fogarty International Center/Ellison
Foundation Overseas Fellowships in Global Health and Clinical Research passed
earlier this winter. Eighty applications were received, with 75 of the applicants
from medical schools. A review committee, chaired by Dr. Lynn Eckhert, selected
29 finalists who will be interviewed by the directors of the foreign research sites.
A total of 14 fellowships are expected to be awarded. [N.B. A total of 20
fellowships were awarded.] The program is likely to be continued and expanded
next year.

Dr. Cohen also discussed the Association’s actions on the faculty effort and
compensation reporting issue, noting that it has the potential to be this decade’s
PATH audits. Dr. Cohen restated the Association’s strong support for the
Association for the Accreditation of Human Research Protection Programs. He
also discussed the creation of the new AAMC Center for Clinical Care
Improvement, which is intended to stimulate the academic medicine community
to initiate large-scale innovations to improve the way health care is delivered in
settings where students and residents learn.

Dr. Cohen concluded by mentioning several new senior staff appointments. Dr.
Carol Aschenbrenner has been appointed vice president for the Division of
Medical School Standards and Assessment. She will also serve as the AAMC
secretary to the Liaison Committee on Medical Education (LCME). Edward
Salsberg has been named director of the new AAMC Center for Physician
Workforce Studies. The Center will assess the supply, demand, use, and
distribution of physicians in this country, increase the collection of relevant data
on their numbers, and help determine the AAMC's future agenda regarding this
issue. Dr. Diane Magrane has been appointed associate vice president and will
lead the Association’s faculty development and leadership programs.

V. Government Affairs Report
At the last minute, David Moore was unable to attend the meeting. In his place,
Mr. Tony Mazzaschi gave an abbreviated legislative and regulatory affairs report.
Mr. Mazzaschi noted that there were 235 days until the presidential election, with
all seats in the House of Representatives and one-third of the Senate seats also
in play. The political environment in 2004 is being shaped by the presidential
election, the war In Iraq, homeland security issues, jobs and the economy, issues
related to tax cuts, and efforts to control the Federal deficit.

The President’s FY 2005 budget proposes to limit overall discretionary spending
to a 3.9 percent increase, with defense receiving a 7.1 percent increase,
homeland security receiving a 9.7 percent increase and all other discretionary
spending held to a 0.5 percent increase. The President has proposed that the
overall discretionary budget authority for DHHS in FY 2005 be held to $676 billion,
a one percent cut. The President is proposing a small increase (+2.6 percent) for
the National Institutes of Health and to all but eliminate finding for the Title VII
health professions programs.

Congressional oversight of NIH has grown intense. The latest area of concern
was raised in an investigative series in the L.A. Times that showed that some of
the National Institutes of Health's top scientists are also collecting paychecks
and stock options from biomedical firms. The NIH Director has appointed a
committee to review the existing laws, regulations, policies, and procedures
under which NIH currently operates regarding real and apparent financial conflict
of interest of NIH staff where compensation or financial benefit from outside
sources is received, including consulting arrangements and outside awards.

VI. Staff Report
Mr. Mazzaschi reported that the revisions to the CAS private web site are
complete. The web site is now divided into four sections: a general CAS page,
and special pages for chairs, program directors and clerkship directors. There
are additional resources for CAS members on all of the new pages. There are
also new benchmarking tools located on the site. Each CAS representative and
society officer will have access to individual passwords allowing access to
additional web resources. The site will allow CAS members to have access to
almost all of AAMC’s data resources. Mr. Mazzaschi also noted that the new CAS
Directory is in the mail. The directory will be updated on-line.

Mr. Mazzaschi announced that the Office of Research Integrity (ORI) has
extended the AAMC-ORI Cooperative Agreement for four additional years with
$250,000 in awards to be available each year. The goal of this program is to fund
activities promoting the responsible conduct of research. Mr. Mazzaschi
explained that a new component of future rounds of awards is the inclusion of a
$50,000 award. He asked that all members encourage their own societies to
submit applications. A brochure promoting the program has been created and
was distributed.

VII. CAS Scholarship Dissemination Project
Dr. Gary Byrd, co-chair of the project, reported that a number of data elements
have been gathering on CAS society-sponsored and -published journals. The
information gathered from publicly available sources is being sent to the
societies for verification. An advisory committee has been formed composed of
faculty members, society publishers, library directors, an economist, and journal
editors. It met in late February and recommended additional survey questions to
help develop a more informed database of society publication trends.

VIII. Committee of Deans Draft Report on Framing the Mission of
the AAMC Institute for Improvement in Medical Education
Dr. Barbara Schuster discussed the committee of deans draft report related to
framing the mission of the new AAMC Institute for Improvement in Medical
Education. The committee, chaired by Dr. Joe Martin of Harvard, has been
charged with undertaking “a comprehensive review of the current state of
medical education in the country, in order to set a strategic direction for reform
across the medical education process.” It is hoped that their findings will serve
as a blueprint for the Institute's future projects and activities. Upon its creation,
the CAS Administrative Board voiced concern that the panel was formed without
faculty representation.

The committee has shared its draft report with the CAS in an effort to receive
input on the final product. The CAS Administrative Board considered the report
at length. The CAS
Administrative Board decided that the CAS would not seek to edit the document,
but rather provide substantive comments on the concepts and issues it
contains. Dr. Schuster shared the draft report with the CAS representatives and
asked them for their comments. She requested all all comments by April 6th in
order to complete the CAS response.

XIV. Recognition of the CAS Past Chair
Dr. Schuster presented a plaque in grateful recognition of the efforts of William
Dantzler, MD, Ph.D., 2002-2003 chair of the Council of Academic Societies. Dr.
Dantzler is chair, Dept. of Physiology, University of Arizona School of Medicine
and is a CAS representation from the American Physiological Society.

XV. Adjournment
With no further new business, the CAS Business Meeting was adjourned.