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DOCUMENT RESUME

VT 011 515

Frederick, Molly, Ed.Readings in Health and Medical Technology EducationPrograms. Vision 1.American Association of Junior Colleges, Washington,D.C. Occupational Education Project.Kellog (W.F.) Foundation, Battle Creek, Mich.7052p.

EDRS Price MF-$0.25 HC-$2.70Associate Degrees, *Curriculum Development, *HealthOccupations, *Health Occupations Education, JuniorColleges, Manpower Needs, *Program Planning,*Resource Materials

This foundation-supported publication will be ofspecial interest to those planning associate degree programs inhealth education. The articles represent published and unpublishedpapers and are divided according to general orientation to ailedmedical and health technologies, avid information on specific careersopen to students. Topics covered in the 12 articles include: (1)Building a New Allied Health Curriculum, (2) Master Plan for fleetingCommunity Allied Health Needs, (3) The Pole of Junior Colleges inEducational Programs in Radiologic Technology, and (4) A Profile ofAccredited Associate Degree Nursing Programs. Another document inthis series is available as VT 011 516. (JS)

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VISION: Readings in Health and Medical TechnologyEducation Programs

Edited by Molly Frederick

A W.K. Kellogg Foundation-Supported Publication

U.S DEPARTMENT OF HEALTH. EDUCATIONA WELFARE

OFFICE OF EDUCATIONTHIS DOCUMENT HAS BEEN REPRODUCEDEXACTLY AS RECEIVED FROM THE PERSON ORORGANIZATION ORIGINATING IT POINTS OFVIEW OR OPINIONS STATED DO NOT NECESSARILY REPRESENT OFFICIAL OFFICE OF EDUCATION POSITION OR POLICY

AMERICAN ASSOCIATION OF JUNIOR COLLEGESOccupational Education ProjectKenneth G. Skaggs, Coordinator

i

"PERMISSION TO REPRODUCE THIS

COPYMG, D MATERIAL HAS BEEN GRANTED

BY 40.:.,A _. . //2f _mow:_TO4 MC ,(1 ORGANIZATIONS OPERATING "U ER A REEMENTS WITH THE U.S. OFFICE OF

EDUCATION. FURTHER REPRODUCTION OUTSIDE

THE ERIC SYSTEM REOUIRES PERMISSION Of

THE COPYRIGHT OWNER."

Copyright 1970

American Association of Junior CollegesOne Dupont Circle, N.W.Washington, D.C. 20036

Printed in U.S.A.

CONTENTS

I. READINGS FOR BACKGROUND

Education for Health Technicians: An Overview 1

Building A New Allied Health Curriculum 5

Core Curriculum in Allied Health Education 8

Master Plan for Meeting Community Allied Health Needs 11

Career Mobility in Allied Health Education 13

II. READINGS ABOUT SPECIFIC PROGRAMS

Guidelines for Developing Medical Record Technician Programs in Junior Colleges 17

The Role of Junior Colleges in Educational Programs in Radio logic Technology 24

A Proposed Interrelated Dental Auxiliary Personnel Curriculum 28

III. READINGS WITH TWO VIEWS

Questions and Answers About Associate Degree Nursing Progiams 32

A Profile of Accredited Associate Degree Nursing Programs 35

Mental Health Technology Programs: Present and Future 40

Community College Programs in Mental Health Technology 43

Editor's Note:

The articles collected in this booklet represent published and unpublished papers. They

are presented together for the first time, divided into (1) general orientation to allied

medical and health technologies, and (2) articles about several specific careers open to the

student. This publication begins a series of six or eight publications.

The articles are timely although some were written a year or two ago. The reader

should use the readings for background and stimulation of ideas. Some technologies maychange radically in coming years, but one thing is certain: Health problems will always be

with us. The human animal is subject to disease, malnutrition, and physical neglect. There

have never been and probably never will be enough doctors and dentists to go around. The

technician, then, has an invaluable contribution to make. The educator of the technician

must make just as great a contribution by preparing appropriate and adequate training, by

knowing the limit and reach of two-year college training, and by being comfortably

informed in the allied medical technology field. This publication, and the series to come, are

dedicated to the last of these goals. Molly M. Frederick

READINGS FOR BACKGROUND

Education for Health Technicians: An Overview*

The following report is intended to provide an initial,brief introduction to an emerging and significant educationalproblem. To help the reader relate the technical level ofpreparation of health service personnel (professionals, tech-nicians, and practical aides), the following chart has been pre-pared. Health service technicians, indicated by underlined ex-amples, are normally prepared for entry into their occupationsby pursuing a post-secondary educational program that doesnot demand the completion of requirements for a four-yearbaccalaureate degree but usually includes a combination oftheory, practical knowledge, manual skill, and, when appropri-ate, actual clinical practice.

Many educational leaders throughout the country seemto be aware of the critical shortages of adequately preparedtechnical personnel in the health field. In response to thisawareness, there are surprisingly widespread but often unco-ordinated efforts to develop education to alleviate these short-ages. The plans and the programs range from poorly advised,to moderately helpful, to inspired. Junior-community colleges,technical institutes, hospitals, professional schools, vocationalcenters, proprietary schools, federal, state, and local govern-ment agencies, and professional organizations are all involved.New federal legislation will have great influence on future de-velopments in this field.

Voluntary accrediting bodies and registries, often work-

ing through professional societies, have provided leadership in

many instances. However, in other cases, their assistance hasnot been solicited, their guidelines have been ignored, andtheir conditions for approval have been judged unrealistic andinappropriate. The degree to which the professional associa-tions have been able to appropriately modify their require-ments as a number of educational programs for technicians

*Selection from the booklet by the same title by Robert E.Kinsinger, Program Director, W.K. Kellogg Foundation, Bat-tle Creek, Michigan. Published in 1965 by AAJC

have moved from hospital control to college control has fre-quently determined how great an influence they have beenable to maintain.

There are numerous regulatory bodies, both official andvoluntary, that are struggling to assure orderly development ofeducation programs. However, in the face of acute shortagesand pressures for crash programs, their efforts are sometimesless than successful. By virtue of their legal powers, statelicensing bodies are the most influential, but licensing require-ments vary greatly from state to state, and many fields are notcovered by licensure.

It is not within the scope of this report to judge thevalue of leadership or lack of it being provided by each of thesocieties and agencies that have set up standards for the healthtechnologies. However, educational institutions should beaware that standards have been formulated for many educa-tional programs for medical and dental auxiliary personnel.There is no single group that can hope to coordinate thegrowth of educational programs for health technicians. How-

ever, many associations could help to provide some degree ofuniformity and quality for programs developed in two-yearcolleges. For example, these associations could publish periodi-cally a roster of representative health career programs thatmight serve as models. A clearinghouse for information and, ifpossible, for consultation also would do much to assure crea-tion of sound programs. If such a service were available, col-leges planning to establish new programs would at least be

spared the necessity of rediscovering in each instance whatstandards and regulations have already been developed; whathas been tried and what has failed; and what has proven suc-cessful. It would not relieve the colleges of the task of develop-ing their own programs to fit their unique situations, but itwould help avoid costly mistakes and unnecessary frictionwith approving agencies.

The great bulk of workers are needed in our hospitalsand nursing homes, but, to the dismay of hospitals competing

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for their services, the same skills are needed in public healthdepartments, social welfare agencies, private medical and den-tal offices, and even in industry. The need in terms of numbersis disconcerting, but complicating the matter further are ela-sive facts in relation to the kinds of service these technicianswill be called upon to perform and the educational back-ground they will require. In 1960, a committee of the Ameri-can Medical Association identified over fifty allied medicaloccupations. At that time the committee estimated that therewore already some eight individuals in allied health activitiesfor each physician engaged in patient care. An even greaternumber and more diverse groupings were predicted for thefuture.

A vast number of technical workers are currently neededto provide new health services which are a direct outgrowth ofrecent scientific advances. For example, radioisotope techni-cians and biomedical electronics technicians are needed to serv-ice, maintain, and operate the growing list of machines used inconjunction with medical care and for scientific research. Inother cases, shifting medical service and social patterns havecreated new demands for trained technical personnel. A dra-matic example of such a shift is the "ambulance problem." Itis true that not all of the difficulty is due to the lack ofprepared personnel. Poorly equipped ambulances, inadequaterules governing their operations, as well as inadequatelytrained or nonexistent attendants are to blame. Only a fractionof a nationwide sample of cities and towns require attendantsto accompany ambulance drivers.

Dr. Oscar P. Hampton, speaking before the AmericanCollege of Surgeons, suggested that, "casualties on the streetsshould get as good treatment as those on the battlefield." Thefact is that thousands of victims do not get this care.

is not the increasing demand for more and differenttypes of health workers the direct responsibility of healthagencies?

Hospitals have assumed a traditional three-part servicefunction: patient care, research, and education. However, therising costs of the educational function have recently becomeof increasing concern to hospitals. The rising costs of nursingand other allied medical education to the hospital, and thus tothe patient, is only one complication of hospital-sponsoredprograms. The hospital, primarily a service institution, almostinevitably faces a conflict between service and education. Evengraduate medical education, which depends on hospitals forfurther educating those holding internships and residencies,faces problems of differentiating clearly between service andeducation.

This same dilemma and a reluctance to forego service inthe interest of education often impedes educational progress inrelation to nursing, medical record technology, x-ray technol-ogy, and other fields traditionally offered by hospital schools.The procurement of instructors has also become a problem forthe hospital. The clear-cut emphasis of the college on educa-tional objectives to the exclusion of conflicting needs forpatient service, the academic ethos of the college, and theprestige of faculty appointment have tended to draw more andmore of the scarce number of instructors from the hospitals to

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the college campuses. There has been, in addition, a preferencefor working closely with faculty members in other disciplinesand with resources more readily available in a multipurposecollege than in a single-purpose school. The growing number ofhigh school graduates who are going to college has also tendedto shift students from hospital-centered to college-centeredprograms.

If the number and size of hospital schools for healthtechnologies is static or in some cases declining and the needfor more and different types of graduates continues to increasedrastically, there should be supplemental programs. There are,or, more exactly, there can be. The junior-community collegesand technical institutes are currently preparing for this chal-lenge. The evidence can be seen all across the land.

Out of a pioneer national research project, using thetwo-year college as a base and nearby hospitals and otherhealth agencies as practice laboratories, grew the rapidly devel-oping associate degree nursing program.

These programs, in general, adhere to the followingguidelines: (a) students are treated as regular collegestudentswith a major in nursing; (b) nursing students take allbut nursing classes with other college students (applications ofprinciples taught in regular biological and physical science andhumanities courses are taught by the college nursing instruc-tors in the classroom and at the patient's bedside); (c) collegenursing instructors select appropriate clinical practice for stu-dents at nearby hospitals and other clinical facilities that haveagreed to permit college nursing instructors and students touse the patient service areas as part of the college's extendedcampus; and (d) the program prepares the student at the timeof graduation to take the state licensing examination for regis-tered nurse (RN) and for a beginning position as a staff nursegiving direct care to patients.

There are pressures throughout the United States work-ing at cross purposes to a program for the sound developmentof education for the health technologies. Rapidly expandinghealth facilities and increasing demands for health serviceshave placed a strain on hospitals and other health agencies.Institutions, physicians, and dentists must find assistancequickly to meet the mounting needs of the public. Hastilyconceived on-the-job training programs are often the result.Sometimes based oa the assumption that anyone on the job isbetter than no help at all, short-term training programs areinstigated for unskilled and therefore unemployed individualswho frequently have low scholastic aptitude. Graduates ofsuch training programs, admittedly stimulated by praiseworthymotives, often offer their services to health agencies after ac-quiring only limited skills and knowledge. Under the pres-sures of personnel shortages, these individuals are sometimesrequired to provide services to patients far beyond their abil-ity. Such an approach is perhaps more defensii,le in trade andindustry where the principle of caveat emptor is operative.However, the ill and otherwise handicapped are least able todefend themselves from inept service.

Short-term, quickly developed training programs are byno means the only threat to safe patient services. The same

pressure for technical health personnel are at work on two-year colleges. Crash programs undertaken to alleviate criticalshortages suffer to varying degrees from a series of planningerrors or omissions. Once an inadequately planned educationalprogram has been inaugurated prematurely, it is much moredifficult to modify than it would have been in the planningstages. Health technology programs developed under forceddraft usually suffer from some or all of the following planningdefects:

1. There has been an inadequate discussion with poten-tial employers, institutional managers, and professional practi-tioners regarding the nature of employment that will be avail-able to graduates, and the kind of skill and knowledge theyshould bring to a beginning position.

2. Plans for use of clinical facilities and other learningfacilities outside the jurisdiction of the college are looselyformulated, not based on written contrvAs, and subject tofrequent breakdowns because of lack of clear-cut plans, orpersonnel changes at the hospital or college.

3. The curriculum has not been built on adequate studyof already existing programs, expert consultation, considera-tion of available criteria formulated by professional societies,boards of registry and licensing bodies, but, rather, depends on

untried hypotheses and trial-and-error adjustments.

4. There is no sharp distinction regarding educationalresponsibility for the entire curriculum making it jossible forthe quality of the educational program to fall in a gray zone ofshared responsibility between the college faculty and the staffof the clinical facility.

5. The "internship" concept is misused as a postgrad-uate work experience to fill gaps in the basic program or toprovide indentured and inexpensive labor for a service facility.

6. Educational blocks of theory and of practice arecompletely separated due to lack of time to plan.

7. Faculty without adequate background in the subjectto be taught, or familiarity with the organization and conductof collegiate education are employed on the assumption thatthey can learn on the job.

8. Library resources, college laboratory facilities, audio-visual materials, reading lists, syllabi, and other tools of educa-tion are inadequately provided.

9. Hastily recruited students are afforded little counsel-ing regarding the nature of the field they hope to enter or theattitudes or academic rigor that will be required of them.

To alleviate public pressure for educational programs inthe health fields, colleges may sometimes establish programs in

name only. A series of courses in the sciences and humanitiesfundamental to the health field are offered together with oneor two introductory survey courses relative to the technology.The program is then mislabeled a curriculum for technicians.Actual instruction in the skills and knowledge of the technol-ogy is provided following tht completion of college classes

(during what is sometimes euphemistically termed a prac-ticum) under the jurisdiction of a hospital or other clinicalfacility.

Another expedient, often the product of pressuresbrought about by manpower shortages, is the narrowly con-ceived collegiate program which trains only for a limited range

of skills. The curriculum provides no theoretical base, little ofthe "why" of the technician's job, no general education tohelp the graduate adapt to his changing role in a particularlyfluid vocational setting. The need for skills training programsin contrast to broader educational programs may be justifiedin isolated instances by severe time restrictions, but it penal-

izes and sharply limits the continuing usefulness of the gradu-ate. It is a less than satisfactory approach to providing long-term solutions to personnel shortages in the health fields. For-tunately, however, foundations, professional associations, andfederal agencies have taken some encouraging initial steps tocounteract these problems.

A limited number of foundation. grants have beenoffered to community colleges to enable them to employfaculty six months to a year before students are admitted to anew program, thus assuring adequate planning. A few teacher-training programs for instructors of health technologies havebeen partially underwritten. Some workshops and short-termtraining grants, both pre-service and in-service, for potential oractual college teachers of health technologies, have beensupported by foundation grants and governmental subven-

tions ," long-term study and action program for communitycollege health careers is being supported in one state. Abeginning has been made toward organized assistance forcolleges. However, mounting demands for crash programs willcontinue to challenge educators to resist expediency in favorof quality.

The planning and operation of college-based technicalprograms in the health fields pose unique problems. In mostcases the laboratory, so essential to the educational process, isnot under the control of the college. Clinical practice for stu-dents is subject to the approval of a separate institution or aprofessional practitioner primarily concerned with patientservice rather than education. The pitfalls and nuances of thisnecessary relationship are many and worthy of an entiretreatise. However, the mutual interest of all parties in securinglarge numbers of quality graduates has usually overcome theconflicts that may occur. The hospital or medical practitionercannot permit the presence of students to upset the serviceroutine too severely or to have the quality of service impaired.The college, on the other hand, cannot have its curriculum sobadly distorted by service needs that essential learning exper-iences are not available or are available at the wrong time. Theproblem is difficult but it has been overcome again and again.If there is one key to the resolution of this problem it is awritten contract and a code of relationships, procedures, andresponsibilities of the two parties to the contract.

The problem of faculty procurement, an old story in allfields of education, has a few additional facets in the field ofauxiliary dental and allied medical education.

There is a much larger proportion of women engaged inthe health technologies than men. It is from this pool of

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womanpower that most recruits must be drawn and preparedas instructors. The Bureau of the Census tells us that mostadult women are wives, and that most wives are mothers and/or homemakers. This sometimes adds to a teacher shortage.Also, the technician's knowledge of what and how to teachmay be limited because she may have learned her skills byapprenticeship. Programs for identifying outstanding techni-cians and preparing them as instructors must have high priorityin any plan for meeting the challenge for technicians in thehealth field.

Much has been written about the potential for betterteaching and utilization of instructional talent through televi-sion, and education in the health field is uniquely suited toapplications of instructional television's six functional cate-gories. Sometimes educators have insisted that the intenselypersonal task of education cannot be mixed with the coldscientific approach of technology. The literary tradition ofeducation sits uneasily with the scientific tradition of the tech-nologies, but television already has been used imaginativelyand effectively for education in many health fields. Medical,dental, and health technology educators have used televisionfor:

1. Transportation: of students to surgery, psychiatricinterviews, clinical demonstrations, etc., of instructors to thestudent at the bedside.

2. Magnification: to see what is really happening in thetest tube, the mouth, or on a gauge during a detaileddemonstration.

3. Memory: to record for later analysis at a post-clinicalconference or to transfer to film as part of a permanent clini-cal library.

4. Transformation: to see through body tissues withx-ray image intensifiers, in the dark with infrared sensitivetubes, and within body cavities with fiber bundles.

5. Associations: making simultaneous comparisons byusing actual pictures in conjunction with diagrammatic draw-ings and by alternate use of live film and videotape presenta-tions.

6. Multiplication: by showing the same image at closerange to any number of students in large auditoriums, sepa-rated rooms, or even separated buildings.

A substantial portion of the educational process hasalways involved awkward and imperfect translations. Theteacher must translate previous visual experiences into worddescriptions. The student, hopeftilly, reconverts these descrip-tions into something approximating the teacher's originalmental image. The potential for circumventing these awkwardtranslations is one of the great hopes of those working withtelevision in the clinical setting. The television camera comescloser to becoming the "fly on the wall" than was ever pos-sible with the bulky motion picture camera. Perhaps thegreatest benefit to clinical education will be TV's contributionto what Dr. David Ruhe calls sensiture, as a counterpart toliterature, our great store of written knowledge. The preciseillustration, the elusive example, the classic case can be identi-

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fied and transferred to film as a permanent contribution to theteaching process. Skillful editing can gradually bring into beinga vast storehouse of material that will enable the student andinstructor to figuratively move to the bedside of appropriatepatients in the educational process. At last community collegesare beginning to use television to great advantage for teachingthe health technologies.

To summarize, we find our society faced with a growingand shifting need for technicians and assistants in the healthfield. Hospitals are turning over some of their educationalactivities to two and four-year colleges. Community collegeshave already demonstrated their ability to successfully preparehealth technicians in selected fields. Some well-conceived pilotprograms give promise of a willingness on the part of the col-leges to expand their activities. New educational programs tomeet the needs must be regionally developed by study groupsof health professionals, technicians, and educators. The col-leges must establish relationships with health agencies for useof clinical facilities. Most important of all, a corps of out-standing technicians must be *dentified, recruited, and pre-pared as teachers before there is much hope of meeting thischallenge for better health care. The problem is urgent but canbe resolved by imaginative planning and bold leadership on thepart of junior and community colleges.

THEORY -SKILL SPECTRUM IN THE HEALTH FIELDS

RESEARCH SCIENTIST

PHYSICIAN AND DENTISTPRACTITIONERS

PARAMEDICAL - PARADENTAL:

R.N. (B.S.)DieticianPharmacistMedical Record LibrarianOccupational TherapistPhysiotherapist

TECHNICAL ASSISTANT:

X-Ray TechnicianR.N. (A.D.N.)Medical Record TechnicianDispensing OpticianOccupational Therapy

AssistantInhalation Therapy Technician

PRACTICAL ASSISTANT:

Licensed Practical NursePsychiatric Aide

AIDE:

Orderly - Nurse AideDietary AideHousekeeping Aide

Building A New Allied Health Curriculum*

Since new health technology programs are occurring withincreasing frequency throughout the country, junior collegesare confronted daily with the enormous responsibility ofassisting the community in meeting some of their healthmanpower needs. With a new junior college scheduled to openalmost weekly in the next year, the problem is compounded bythe lack of qualified paramedical supervisory or administrativestaff which can be responsible for the entire mission. Openinga new college is a complex, many-faceted job involvingfinancing, recruitment, curriculum development, communityrelationships, and dealing with the serious shortage of experi-enced personnel to actually assume responsibility for develop-ment. Getting off to a good start depends upon several keyfactors and it is to this end that this paper is written.

Experience gained at Dallas County Junior College inDallas, Texas, and the State Di Sion of Vocational Educationin Olympia, Washington, may be helpful to new colleges intheir primary efforts and possibly even to established schoolstrying to expand allied health programs. Certainly some of thesituations, problems, and solutions that we experienced couldprovide some red flags and green lights to ambitious but-not-too-experienced program developers.

More than two years ago El Centro College (the first ofseven in a planned junior college complex) was in early forma-tion. Carpenters, plumbers, electricians, architects, and paint-ers were rushing about to bring the college to an actualityafeat accomplished in eight months. During that time a masteradvisory committee for health education was appointed by thepresident of the junior college district. The committee's pur-pose was to advise the college administration about commun-ity n..els for health occupations education, to set priorities,

*Ruth A. Jacobson, program specialist, Health OccupationsEducation, State Division of Vocational Education, Olympia,Washington.

and to identify resources. Upon the advice of this committee,two occupations were selected for development the firstyear-dental assisting and practical nursing, with dental assistingto be developed first and practical nursing to follow as soon asfeasible. Subsequently, special "skill" or technical groups wereappointed as actual working committees to assist the collegerepresentatives. In the case of dental assisting, the group wasmade up of equal numbers of dental assistants and dentistswith the current president of the local dental society automati-cally a member, as well as a representative from the localdental school.

It is important to plan a broad enough representation onthe working committee to insure the kinds of data and know-how that are essential to thorough program planning andfollow-through. With the help of such a group, a course pro-posal or prospectus can be developed. This was our next movein Dallas. We presented explicit details of the project to collegeadministration and the District Board of Trustees as well as theTexas Education Agency. Data described program title, antici-pated length, credentials and credits to be earned, courseobjectives, a job description, anticipated enrollment, employ-ment potential, wage scale, members of the committee, sug-gested curriculum, course descriptions, supplies and equipmentneeded, and student and instructor qualifications. In addition,the method of financing and numbers of instructors neededwere included.

In general, the cooperation on the part of hospital repre-sentatives was a major factor in any success we achieved. Infact their enthusiasm was the primary impetus in getting ourprogram going. Open lines of communication and continuousfeedback kept us infornrd of current happenings and enabledus to get support data at any stage of the game.

Needless to say, more than one meeting of the "skill"committee wils necessary to develop the course prospectus.With the data supplied by these specializts the prospectus can

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be written. Either an industry representative, knowledgeable inthe specific field, or a college paramedic, or vocational staffmember can be assigned the actual writing. The mechanics oftyping, editing, and duplicating are part of this assignment andconstitute no problem other than manpower but need to beconsidered.

As soon as the proposed program was approved (thisinvolved college administration as well as state educationagency representatives), a time sequence estimate w.., made inwinch major events were scheduled. With a junior college themare built-in deadlines around which plans must be structured.This in itself is its own safeguard, but is frustrating none the

:. For instance, schedule printing, textbook requests, regis-s'o and actual starting dates are on a fixed schedule which

usually must be met. With more schools relying heavily oncomputers, these dates are milestones around which one mustwork.

In the case of El Centro College, classes were to begin onSeptember 10, allowing a maximum of five months develop-ment time. Since the campus building was at that time only anine-story downtown department store, program developmentoccurred concurrently with building remodeling and opera-tional systems development.

Equipment specifications were written and bids sent outwith the help of the purchasing department. The laboratoriesand classrooms were planned in detail with architects. Meet-ings with the director of vocational education and academicchairmen produced a curriculum. At this time an instructorwas selected and began to function as an advisor. Textbookswere reviewed and ordered; counselors' information produced;curriculums completed; publicity brochures designed and or-dered; newspaper and other recruitment publicity planned. Us-ing a format selected by the dean of instruction, work beganon the course syllabi.

As soon as bids were accepted, orders were immediatelyplaced for equipment since delays in delivery were anticipated.Through continued contact with the advisory committee, facil-ities for clinical experience were explored. Teaching materials,lesson plans, films and other media were at least all in theplanning and evaluation stage. Periodically as these eventsweremoving along, the "skill" committee met for progress reviewand additional technical support.

With the first program moving satisfactorily, the stim-ulus was given to begin work on the second paramedic pro-gram, practical nursing, with a target date of November 1.Along with this development, other program requests began toarrive, resulting in the appointment of ad hoc committees tolook into radiologic technology, medical office occupations,and the field of inhalation therapy. With these groups, longerrange planning was desirable since considerable study and datacollection was needed.

As the time grew near for classes to begin in September,more deadlines were met. Even though laboratories were farfrom complete, things were falling into place. It looked as ifwe would be meeting our first class. Students were enrolled,and dental assisting and practical nursing got underway. Thisprocess of development continued with added momentum,

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with two new one-semester classes, one for nursing aides andone for central service technicians opening in the spring of1967. In the fall of 1967, with a great deal of dedicatedassistance from all "skill" groups, two-year associate degreeprograms began in radiologic technology, medical officeoccupations, and inhalation therapy. One year later, anoperating room technician program began, and a medicalrecord option was added to the medical office clusterbringing the total number of division programs to eight.

All of this involvement led to some conclusions worthsharing. First, more time initially would have been nice, butoften the pressures of new college deadlines were an advantagemore than a handicap. The esprit de corps fostered by buildingsomething new ,ind exciting proved a marvelous incentive.Second, the use of an organized systems approach to the un-dertaking was effective. Positive end results were possible sincemany difficulties arising after the project is underway are dueto inadequate or incomplete planning during the initial stages.

The system selected for use will depend somewhat onthe philosophy of the administration, or what naturallyappears to be useful and comfortable to work with. It may bea fairly simple tine sequence chart or a more detailed networkflow chart. In any event, begin with one and modify it to yourown individual needs. You might begin with an identificationof the mission objectives, scope of the mission, and the majorcomponents. For instance, the objective may be the implemen-tation of a single health occupation program, or it may be afeasibility study and development of a series of programs overa longer period of time.

While our experiences in Dallas definitely illustrate thevalue of team planning, with hospital, health, and school spe-cialists working together, even better utilization of manpower,and more specific spelling out of responsibilities and needs canbe achieved by taking advantage of systems engineering con-cepts.

Such an approach is total in that it integrates all factorsthat have to do with the objective. With this method, one canlay out or structure the total project so that both the begin-ning and the end of all the events are seen in proper focus andrehitonship. So often q project such as the development ofparamedic programs is vaguely visualized, planned, and begun,with a very unclear goal somewhere out in the distance. With asystems approach, the total process of getting a new programunderway can be broken up into a series of small manageablesteps.

In this way realistic goals can be set for both interim andlong-term needs; responsibilities can be assigned with moreassurance that important details will not be overlooked untiltoo late or even forgotten. Alternatives can be built in andallowance made for time variables. With a time sequenceschedule laid out in advance there can be prior understandingsby all involved as to individual or agency responsibility for theaccomplishment of specific events.

The final conclusion is that the "skill" committees needto be truly working committees, providing technical know-how which the instructor would normally provide. With the

prohibitive cost of program development most schools cannotafford to bring an instructor on board too many months inadvance, so the expert advice of committee members is ofien anecessity. It is vital, however, that a college staff person suchas the vocational education director or paramedic divisionchairman direct and coordinate the activities.

With the multiplicity of health care programs coming onthe scent., and the mushrooming of junior colleges, it is unreal-istic to expect that many schools will be able to find a healthoccupations supervisor with broad occupational experienceand at the same time some concept of junior college programsand development. But such leadership is worth working for.

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ti

Core Curriculum in Allied Health Education*

In recent months the allied health professions have beenenjoying a great deal of attention from educators interested inthe development of a core curriculum. Although at one timeor another almost every academic area has been a focus forsimilar interest, none can claim to be a more likely orpersistent cynosure. What is there about these health-relatedspecialties which have made them so attractive a target for thisactivity? First, the very name allied health professions suggeststhat there exists among this diverse group a commonality ofobjectives as well as a sense of teamwork, and implicit in this isthe likelihood that there is or should be a sharing of learningexperiences. More important, however, is their sheer weight ofnumbers.

No other group of health professionals augurs togrow as rapidly as this burgeoning collection of disciplines.Many of us concerned with the delivery of health c;ze see inthe evalutionary expansion of this group and their organiza-tion into effective teams, a possible solution for the healthcare problems of tomorrow.

The consequent demands that the preparation of such avariety of personnel will make on our already overburdenedcolleges and universities beggars the imagination. It is a smallwonder then that academicians are attracted to the concept ofa core curriculum for the allied health professions, like somany moths to a liame. And each envisions in its glow his ownspecial alchemy.

The faculties in the basic sciences, who are already beingasked to develop still another variation of their subject for yetanother new type of allied health professional, find any prom-ise of simplifying the curriculum most attractive.

*Reprinted from the Journal of the American MedicalAssociation, October 6, 1969. Written by Joseph Hamburgh.

8

The educator aware or his students becoming more andmore submerged in a melange of apparently irrelevant andsometimes repetitive data recognizes in the core curriculum anopportunity to blend present information in a more compre-hensible fashion.

In addition, the development of such a common educa-tional base for the allied health professions would seem topermit greater career mobility vertically and laterally than hasheretofore existed. The possibility of having a pool of healthprofessionals whose disciplines are more responsive to both achanging science and a shifting societal need is an appealingone.

Finally, if the health care teams of the future are to beeffective, the members of these teams will have to be trainedtogether sometime in the course of their educational experi-ence. The core curriculum could be an ideal place to begin.Early enough perhaps in the careers of each to stifle prejudiceand foster an appreciation of and respect for each others'roles

With such promise, one wonders why there has not beenmore evidence of progress being made in the development andimplementation of these core curriculums. Only those of youwho have had the humbling experience of attempting to de-velop such a model will appreciate the moth-flame analogy.

Some of the delay and the resultant frustrationencountered by those intrepid few who have tried, is em-bodied in the struggle to change the traditional methods ofcourse presentation. Some of it is related to a lack of precisedata on just what a particular allied health profession requiresin the way of preparatory coursework. Some is due un-doubtedly to the restrictive and archaic accreditation andlicensure requirements which still fetter certain of our pro-grams, and some may be the result of setting for ourselveswhat are unrealistic goals. We may be asking of this principle

of core curriculum some things which it cannot do. Perhapseven the multiplicity of expectations themselves produceenough ambiguity to interfere with understanding. We are allaware of the resistance which can result from a mere lack ofcommunication.

Our School of Allied Health Professions at the Univer-sity of Kentucky has encountered many of these same ob-stacles in varying degree over the several years of our exist-ence, and we have found no simple solution for their removal.However, some good has come of their intimidating presence,for they have forced us to retreat from the naive position ofexpecting the core curriculum to be the panacea for all of oureducational ills and forced us to assume a more realistic atti-tude toward this concept. What I would like to present to youare some of the very limited exploratory thrusts we havemade. Please, recognize them for what they are; not the boldstickes of a Bellerophon, but the tentative probes of a slightlysinged moth.

The development of a core curriculum for the alliedhealth professions finds historic precedence in the evolution ofthe liberal arts programs of the last century.

In general, the first two years of the typical bacca-laureate program of today are devoted to basic studies and thelast two are directed at a major or specialty preparation. I usethe word preparation to avoid the conflict of the terms "u:du-cation" and "training." Some of my more Tradition-minnedcolleagues have tended to refer to these specialty efforts as"training programs." I personally find this sophistry unimpres-sive. To paraphrase Whitehead's statement in his book TheAims of Education, there can be no education without trainingand no training without education. Be that as it may, the firsttwo years of this type of general studies program can be seento represent in reality a core curriculum of a type.

I have arbitrarily clustered the general subjects into threemain categories: environmental, communicative and inter-pretive (Table 1). I recognize this grouping is open to challengeand that some of the subjects conceivably might be placedunder another or several of the three main headings. I believe,however, the three categories accurately present the purposesof a general education: first, to describe our environment;second, to interpret our relationship to this environment; andfinally, to provide the means by which we communicate thisinformation. I will come back to this later. Let me move onnow to some of our definitions and assumptions.

TABLE 1.GENERAL STUDIES ENVIRONMENTAL

EnvironmentalBiological sciencesPhysical sciences

Social sciences

CommunicativeHumanitiesLanguages

Mathematics

InterpretiveBehavioral scienceHistoryPhilosophy

Our definition of a core curriculum presumes that withinthis collection of health-related professions there is a common-ality of information and skills which is relevant to all students.Further, that these can be presented to them jointly orcoordinated in some meaningful amalgam.

We also assume for each course three basic purposes orlevels: (1) survey; (2) service; and (3) specialization (sequen-tial). The first level is informational. In this case the studentreceives a general survey of the discipline, not as a superficialdusting, but as a succinct presentation of the important courseelements. The second or service type provides the student witha tool to facilitate his capacity for handling another specialty,for example, the need of calculus for the student interested inphysical chemistry. Finally, the specialty track is designed tolead a student through a sequence of courses within aparticular discipline toward professional competence in thatarea.

If we return to the general studies grouping (Table 1)and look at it now in light of our definitions, we candemonstrate two basic weaknesses. First, this is purely acollection of topics and represents no "meaningful amalgam,"and second, there is no defined course level, that is, informa-tion, service, or specialty. The mere assemblage of coursesoffered cafeteria-style does not automatically make a corecurriculum.

These courses must be available not only each at itsproper level, but also articulated so their material is presentedwith the minimum of repetition in a "syncytium" of perti-nence. This latter requirement is the one which taxes theingenuity and talents of our best educators.

TABLE 2.SPECIAL STUDIES CORE

Environmental Communicative Interpretive Directive

1. Man and his 1. Health termi- 1. Health 1. Emir-environment nology ethics gencya. Natural 2. Technique of 2. Behavioral can

scion= interview and science 2. Proven-b. Social

sciencescommunica-tion

3. Statistics fiveMedi-

c. Communityhealth

3. Computerscience

cine

The grouping shown in Table 2 represents what some ofus have conceptualized as a core curriculum for the allied

ealhth professions within our school.

You will note that we followed the same basic arrange-ment of the previous general studies grouping and have addeda fourth which is labeled directive or technical if you wish.This latter group supplies the pragmatic dimension to thepurposes of an education: the preparation of a student for aspecific task or role. It is this category which expands into thespecialty preparation during the final years of the curriculum.

I would like to consider the last three groups first. Undercommunicative are listed now the specific courses which wefeel are basic to the needs of all of our students. Healthterminology and interviewing and communication would betaught at the level of a service course, with computer scienceprobably requiring all three levels depending on the previouspreparation of the student and his specific professionalpathway.

9

Under interpretive are the courses which we considerspecific to this category. Both health ethics and behavioralscience will probably be offered at the survey level, withstatistics, like computer science, requiring all three levels.

Under directive we have emergency care or first aid andpreventive medicine. Both of these would be presented at theservice level. My faculty abound with heretics who believetheir students, at whatever level of function on a health careteam, should have at least as much skill at providingemergency care as do our boy scouts.

Incidentally, since most medical faculty would probablyfind teaching so prosaic a subject quite tedious, we have beenconsidering the use of discharged Naval Hospital Corpsinstructors for this task.

The course in preventive medicine would undertake notonly to present the traditional subject matter, but to do so in afashion which would make all of our students health educatorsof a sort. In my mind, there is no conflict of interests in havinga physical therapist discuss knowledgeably with a stroke victimthe hazards of smoking while attempting to effect hisrehabilitation.

So far what I have presented of this core curriculum hasbeen rather straightforward, a listing of courses which could betaught individually with minimal articulation. The last group-ing, environmental, is the one which we consider of primaryimportance and which will probably be the most difficult topackage.

We would like to present "man and his environment" asa single course and most probably at the informational level.

10

Without going into too much detail about the separateelements of this, because in fact they are still quite nebulous,we hope that at the completion of such a course the studentwill be aware not only of the component parts of the humanorganism but also comprehend the mechanisms by which heattempts to maintain homeostasis in an apparently unfriendlyenvironment. This presentation will include under the naturalsciences the necessary elements of anatomy, physiology,chemistry, and microbiology. Further, the environment to beconsidered will not be limited purely to the physical butwould include the socioeconomic, geographic, and cultural aswellthe social sciences.

Finally, community health would describe the availableorganizational structures of our health care systems and howthey function to provide for the health professional and thepatient the avenues as well as the facilities for care. We hopethis material can be presented in a meaningful amalgam. It wasKarl Popper who noted that we are students of problems notstudents of subjects. Disciplines such as anatomy and chem-istry do not exist outside the classroom. We are painfullyaware of the difficulty of preparing such a course and of theusual fate of conjoint courses to get "out of Joint," but wefeel that the potential reward which could be realized fromsuch an arrangement is worthy of the effort. We assume alsothat in those cases where a particular career choice wouldrequire a student to pursue one or more of these subjects ingreater depth, a presentation such as this would provide himwith a firm base of understanding.

In our estimate the presentation of "man and hisenvironment" would occupy and be equivalent to twolaboratory courses of two years' duration or a total of 20credit hours. If we present each of the remaining eight subjectsas a regular three-semester-hour course, we have consumed atotal of only 44 hours. This will still permit the student thefreedom to take other electives from the general studiescurriculum during the first two years of a baccalaureateprogram.

We would recommend that a student enter the corecurriculum as early as possible in his college .xperience, sincespecialty preparation in the allied health profession usuallyconsumes most of the remaining two years. The probleminvolving student transfers from other junior or senior collegesnot having such core curriculums are real but not insurmount-able. Similar core curriculums could be adapted as well to theassociate degree level. As a matter of fact, just such anexperiment is already in its second year at one of ourcommunity colleges. At Somerset Community College we areattempting to use a core curriculum in the first year of trainingfor five different allied health careers.

In this discussion I have limited the consideration of acore curriculum to the allied health professions. It should beapparent that other of our health professionals might wellprofit from their participation in the same program. At least, itseems worthy of a trial.

In conc!-sion, I realize also that what I have presented isindeed only the bare bones of a core curriculum and that agreat deal of effort and planning still lie ahead before thisskeleton is properly draped with the musculature of action.

Master Plan for Meeting CommunityAllied Health Needs*

When the author took his present position as chairmanof the newly organized Health Sciences Division at SanJoaquin Delta College in Stockton, California, last fall, herecommended use of the master plan approach to meet theallied health training needs of this community.

This idea which had previously resulted in the firstcounty school health advisory board and the first coordinatedelementary-secondary health instruction program was ap-proved by the San Joaquin Medical Society Committee onTraining Programs for Health Professions. The purpose of themaster plan was: (1) to prepare a cooperative long-range planfor meeting the community allied health services personneltraining needs in the Delta College District; (2) to avoidduplication and overlapping of allied health training programs;and (3) to improve communication and cooperation betweencommunity health agencies.

* * *

Operational phases of this master plan included:

1. Preparation of a directory of twenty-four representa-tive community health agencies. Among these were the CancerSociety, Health Planning Association, Hospitals, Heart Associa-tion, Medical Assistants Association, Medical Society, Psychi-atric Technicians Association, Public Assistance Department,

Registered Nurses Association, State Board of MedicalF:z.ininers, Tuberculosis and Health Association, VisitingNurses Association and Vocational Nurses Association.

2. Identification of community allied health personneltraining needs. These were determined by personal conferenceswith leaders of the twenty-four health agencies and the staff ofthe college Health Services Division during a two-month

*Burt M Kebric.

period. Training needs identified are listed below in descending

order.

Nurses aides, home health aides, homemakers

Medical assistants, medical records technicians

Registered and vocational nurses

Registered and vocational nurses (post-graduate intensive

care course)

Mental health tecluticians

X-ray technicians

Core program for all students in the allied health services

Dental assistants

Medical electronic equipment technicians

Medical records librarians

Physical therapy assistants

Registered and vocational nurse; readiness programs

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3. Preparation began on a tentative master plan whichlooks like the five-year plan below:

FIVE-YEAR MASTER PLAN FORHEALTH SCIENCES DIVISION

1968 -1969

DENTAL ASSISTANTS (specifications for Pacific Ave-nue Campus)MEDICAL ASSISTANTS, MEDICAL RECORDS TECH-NICIANS (fall semester)NURSES AIDES, HOME HEALTH AIDES, HOME-MAKERS (spring semester)REGISTERED NURSES READINESS COURSE (springsemester)VOCATIONAL NURSES, MANPOWER DEVELOP-MENT AND TRAINING ACT (spring semester)

1969 -1970

MEDICAL ASSISTANTS, MEDICAL RECORDS TECH-NICIANS (spring semester)MENTAL HEALTH TECHNICIANSR.N. V.N. INTENSIVE CARE (postgraduatecourse)VOCATIONAL NURSES M.D.T A. (second classbegins)VOCATIONAL NURSES READINESS COURSE

1970 - 1971

CORE PROGRAM FOR ALLIED HEALTH SERVICESDENTAL ASSISTANTSX-RAY TECHNICIANS

1971 - 1972

DENTAL ASSISTANTS (second class begins)

1972 - 1973

NEW CAMPUS

INHALATION TECHNICIANSPHYSICAL THERAPY ASSISTANTS

4. A conference was called with the college presidentand administrative staff to review and approve the tentativemaster plan.

5. Community-Delta College Allied Health Conferencewas held November 6, 196$. Invitations from the collegepresident with the needs summary and master plan were sentto each of the twenty-four health leaders. The tentative masterplan was presented, discussed, and unanimously approved aspresented at a one-hour afternoon meeting at Delta Collegewith Julio L. Bortolazzo, college president, presiding. Everyhealth leader invited was present except for one who was ill.

6. The last step, of course, was implementation of themaster plan.

12

Accomplishments in less than a month following ap-proval of the master plan include:

A nurses aides, home health aides, homemakerscourse for January 1969

Preparation for rlistered nursing course (forstudents lacking basic skills)which begins January1969

Expansion of the RN, LVN, and medical assistantsprograms in 1969

College approval of the first accreditation of RNand LVN programs by the National League forNursing, Spring 1969

CORE course for allied health students was beingdiscussed.

Allied health training specifications for a newcollege campus have been prepared.

1969 course for upgrading psychiatric technicianswas planned.

Effective cooperation and communication wasestablished with community health agencies.

An annual evaluation will be scheduled to determinenecessary modifications in the master plan.

Career Mobility in Allied Health Education*

So much has been said about the concept of careermobility and so little has been done to implement this conceptthat we are immediately faced with the simple questions: Isthe idea of "career mobility" fiction or fact? Is it aphilosophical fable or can it be translated into reality?

In the brief time that I have, I would like to examinesome of the needs for career mobility; some of the factorswhich might make it work: a few of the attempts already inoperation; and finally, where do we go from here? This maysound more like the outline for a book than for a 20-minutespeech, but it gives you an idea of the breadth of thismuch-discussed subject.

The idea of "career ladder" has come into prominence ata time when health education and health professionals areattempting to answer the dilemma of the century: by whatmeans can we increase health manpower at a rate which willprovide qualified personnel for health care systems capable ofdelivering in quality and quantity what has been promised asan inalienable right of society today?

The visual concept of "ladder" is quite explicit: withineach health profession there should be the potential foreducational and occupational movement in a vertical, upwardthrust that might make it possible, based upon completion ofeducational requirements and measured capabilities, for anindividual to move with comparative ease from the level of theaide, to the assistant, to the full-fledged professional practi-tioner. There are those individuals who have proposed that thisshould first of all be possible within a specific allied healthprofession and others who contend that there is a core ofhealth content that might make this movement possible for aprofessional nurse or physical therapist, to name only two

*Reprinted from the Journal of the American MedicalAssociation, October 6, 1969. Written by J. Warren Perry.

examples, to move into medicine, or a dental hygienist intodentistry, without necessarily tripping down a rung or two onthe ladder before the ascent to the top of the educational orprofessional field.

In addition to the ladder concept, recently the "lattice"concept in health careers has been described. This purportsthat in addition to the vertical-movement theory in a healthfield, there should be provided a possibility for the horizontalor lateral transfer between health professions, and, specifically,allied health professions. Entry would not be at the lower levelof the ladder or lattice, but with recognition of educationaland occupational experience common to several health fields,entry to a new health career would be relatively easy toachieve by such lateral movement.

Do not think that I am being facetious when I tell youthat during the past month this vertical-horizontal movementin health careers was visually conceived as the "jungle gym"approach, with various modes of entry, transfer, and ascend-ance.

With this brief introduction as background, I trust thatyou can appreciate why I have chosen the term "careermobility" today in this presentation, for the "ladder,""lattice," and "jungle gym" are all means of conceptualizingthe intense need in the health occupations to examinecritically the educational and vocational components whichwill provide the best trained and greatest number of healthpersonnel for the future.

Need for Career Mobility

Why has there been so much discussion in the past fewyears about the concept of career mobility? Educators, as wellas enlightened professional workers, recognize that closeddoors and dead ends are ever present in many if not all of theallied health occupations.

13

Serious, constructive steps have been taken in some ofthese fields to spll out the specific roles and job functions ofthe aide and the assistant categories of workers. Educationalcriteria or essentials have been developed in some cases for thecommunity junior colleges charged with setting up trainingprograms for allied health.

But the dead ends of occupational movement at espe-cially the lower levels spell problems in job satisfaction; acurtailment of material rewards, and, more importantly, adwindling of motivation and initiative to perform the highestlevel of individual service function on the job.

We must not accept that the high percentage ofwomenwith marriage and the family on their minds is always themotivating factor for increasing incidence of occupational"drop-outs" from health occupations, transfer from job to jobin clinical facilities, and considerable dissatisfaction withdelegated responsibilities. When a gate is slammed shut in yourface, you either have to attempt to open it, climb over orunder, find another means of entry, or just withdraw from thesituation. In far too many instances, a closed door in a healthjob has meant a permanent loss to the health manpower pool.

Loss of mobility in some health occupations can betraced to the factors of too much or too little formaleducation. Professional groups themselves and the educationalstandards each promulgates are sometimes a major force in thecreation of job or professional role dissatisfaction. I am incomplete sympathy with the right of organizations andassociations to set high educational standards, and I have beenin positions to defend these standards. But let me give you anexample of the problem of lack of utilization of profi.-,sionalskills. A student who has achieved well in all of his generaleducation, professional-skills courses, and in his clinical train-ing arrives on the scene for service. What happens? He has beentaught how to accept responsibility, how to plan his labora-tory or treatment programand what does he find? Too oftenhe is in a position where his job seems related only to how wellhe takes orders and performs mechanical technical skills. Hiseducational experience has prepared him for assuming a roleon a health care team he does not get to assume; whatdisenchants him even more is that not only do other membersof the team appear unwilling to accept his potential for ahigher level of performance, but to his dismay he finds thatmembers of his own profession have learned to accept such asubordinate role.

On the other hand, nothing can be more detrimental tovocational morale than for the individual to be given a task orresponsibility for which he has received too little formalpreparation.

It is the achieving of a balance between the educationalpreparation and job responsibilities that makes the profes-sional person and his job performance more effective. Anyimbalance in over-education or under-education can inevitablylead to dissatisfaction and frustration.

Factors Involved in Career Mobility

What are some of the factors that need to be givencareful consideration if any measure of career mobility will

14

become a reality in educational programs and in vertical andhorizontal vocational movement?

1. A job description and a thorough job analysis mustbe done for the specific job level in each allied health program.Each must be analyzed in relation to specific tasks and tech-niques and its relationship to the patient and to other mem-bers of the health care team. This sounds so simple, yet thereis little that has been done to spell out such task analyses.

2. Educational programs must be designed with state-ments of objectives and evaluation of role, functions, andduties to match the prepared job descriptions and analyses.Without this kind of orderly analysis, we will never be able todifferentiate the various levels of proficiency, levels ofperformance and responsibility on which to base the educationprograms already in existence and those planned for thefuture.

3. One key will be the core-curriculum, a developmentalprocess of educational programs at all levels. The idea of"core" must become the basis upon which educationalpathways to upward and lateral mobility can be made to be areasonable possibility.

4. We are all familiar with the kinds of equivalencytesting programs established by state and local authorities forhigh school equivalency diplomas. There must be developed,and there has been created in some states, a means by whichcollege credit for independent study, television courses, adulteducation courses, and other forms of instructional pursuitsoutside the concept of regular college curriculums can beevaluated and offered credit toward college and universitywork. There has been a major increase in such programs thathave attracted students, and such educational work needs whichmust have recognition for transfer of credit potential.

In my own state of New York, the College ProficiencyExamination Program has mounted a major project, under thesupervision of the State Education Department, in an effort toopen up the educational opportunities of the state toindividuals who have acquired college-level knowledge in waysother than through regular classroom attendance. The aca-demic standards reflected in the examinations are determinedby outstanding faculty members from campuses across thestate. More than 200 college faculty members serve asconsultants for this program, in which one of the major tasksis to determine levels of performance on the examinations.Course credit is not granted by the College ProficiencyExamination program; rather, this is left to the individualhigher institution to do, or not to do, in a manner consistentwith its particular standards.

Why have I emphasized this approach? A logical exten-sion of the credit-by-examination concept must be conceived,developed, and fostered for the allied health professions. Thisis already being interpreted as one of the major needs if themobility concept is to be achieved. The relationship ofproficiency or equivalency testing procedure as might beapplied to the allied health professions is self-evident, thoughputting it into practice will not be a simple task. If tests can bedeveloped that will establish the common, core elements

involved in various health fields, measurement of the level ofperformance on a test might substitute for the actual taking ofsome of the now required courses in many fields. Based uponeffective measurement devices of such proficiency or equiva-lency levels, it would not be necessary for an individual tobegin at the very lowest level or rung of a ladder in an alliedhealth field, but rather one cou'd be admitted into aneducational program or level of clinical functioning basedupon his measured capabilities.

5. Barriers between and among associations and agenciesmust be broker, down if career mobility is to become a reality.This has been uaid so many times in so many ways that thishardly needs discussion here. The individual allied healthprofessions would not be where they are today without thepaternalistic, or in most cases maternalistic, surveillance andattention to vested interests that has characterized the slowbut orderly progress of each profession. Accepting theimportance of this independence of movement, is it not nowabout time to consider the relationship of the professionsbut rather upon the relationship of each of the systems ofhealth care and the function of each in relationship to thepatient? As we break down the boundaries of indifferenceand suspicion of intent and concentrate on the similaritieswhich exist in educational programs and in patient carefunction, we will discover ways in which core courses,perhaps core curricula, will become a standard of perfor-mance. And hopefully, our students, and ultimately thepatient, will come to that happy state of mutual respectthrough shared yet individual responsibilities that are under-stood and apprec!:,ted by all.

6. The relationship between community junior collegeprograms at the associate degree and certificate level with thebaccalaureate and graduate programs for the allied healthprofessions is one of the most crucial factors involved in theestablishment of career mobility concepts. The time has comewhen those of us in university work must admit in open forumthat the solution to some of the manpower problems facingthe health community today will, indeed, be met only by theemerging associate degree and certificate programs in thecommunity junior colleges in this nation. I have a deeprespect for the objectives and goals of the community juniorcollege programs, and the efforts being expended today inthe furtheionce of these goals. There is no greater force ineducation today than the vital movement to establish thiskind of institution in every sizable community throughoutthe country. Today, more than 1,000 such programs are inoperation, and these numbers are increasing weekly. It waspopular until quite recently to look down upon theseprograms. But I charge each one of you who has not alreadydone so to visit some of these institutions and examine thenewer teaching techniques utilized in many the studentcounseling programs, the emerging new programs whichrespond to needs of students and communities rather thanthe more usual time-honored curricula of the past; then youwill come to appreciate the force for health manpower thatis being engendered in these new educational settings, forassociate degree health programs are receiving priority devel-opment. It behooves each allied health profession and eachuniversity program to assist in all ways possible in thisdevelopment. The role of consultation and assistance is the

one which I strongly support, not the role of attempteddomination.

Together we can come up with the means by whichtransferability of credit from program to program can berationally made through careful consideration of job needs atthe various levels. This educational movement will not bedenied a most significant role in the society of the future. Themedical and health community must be prepared to assist it,offer consultation to it, and move in harmony and collabora-tion with it. Anything less will be detrimental to the veryfabric of health education in the United States today.

Evidence of Career Mobility in Action

Is there evidence that the career mobility concept willcome into bloom? Well, I must admit that it is basically in the"talk" stage today. But there are examples of ways in whichcareer ladders are being conceived which need to be carefullyexamined. There is, indeed, certain evidence that if theprofessional groups do not get involved and take action on thissubject others are going to charge ahead.

In my own state, the Departments of Mental Hygieneand Labor are conducting major studies of the utilization ofallied health personnel at all levels. The Department of MentalHygiene has already developed a "social work career ladder foroccupational therapy." For example, on the "occupationaltherapy ladder," among the three categories of (1) supervisory-administrative, (2) professional, and (3) supportive, nine stepsor levels have been determined, each defined with require-ments for entry and performance, educational requirements,and suggested salaries spelled out.

In each of the geographical areas in which you live, I amcertain you know of some examples of this kind of movementin progress, and I shall not list other examples other than tosay that certain medical specialties are also busy at definingthe role of the professional and supportive personnel in eachspecialty. Psychiatry, pediatrics, and orthopedic surgery areexamples of this movement.

Where Do We Go From Here?

One avenue is certain: action is required. The unique-ness of professional practice as contrasted with technicalpractice must be defined in each allied health field. Thesedistinctions must be clearly stated and interpreted in theeducational programs developed for the new levels of training,as well as personified in the work that each individualperforms. If we can spell out the knowledge and skills neededby practitioners in each of the health occupations, we shouldarrive at the uniqueness in each field as well as identify thosefunctions that may be shared by practitioners in all fields.

Curriculum revision is much in evidence today in theallied health professions. This, then, is the time for the sharingof new curricula between and among the allied health areas.We must break down the reluctance to communicate and beinnovative. As new subject matter is added, we should bewilling to make judicious cuts in what has gone before.Research on patient care for the allied health professions must

15

become a paramount task, as well as continuing education forall involved in these fields. New methods of educating healthpersonnel must be attempted, with more efficient methods ofeducating students at all levels.

The concept of career mobility will become a realityonly when sufficient time and priority is given to decidingwhat the problems are in each field in attempting to prove ordisprove the concept of vertical and horizontalmobility. Whoshould get involved in this act? It is quite certain that noformula derived by any resources other than the leadershipgroup in the allied health professions themselves, working in

A.

collaboration with medicine, dentistry, nursing, and healtheducators, can bring this about.

1 have great faith that the haders in allied health canmake progress in this area. But tht parochial approach to justone profession must be replaced by a staunch resolve that jointaction will benefit all the health professions and the individualhealth fields as well. Finally, the end result will be acomprehensive allied health educational and professionalprogram which will provide for maximum student mobilityand choice, with the patient we serve as the ultimatebenefactor of our efforts of being allied.

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READINGS ABOUT SPECIFIC PROGRAMS

Guidelines for Developing Medical RecordTechnician Programs in Junior Colleges*

The rapidly increasing scope and variety of vocationalprograms offered by junior colleges throughout the country,together with the expressed interest of many of theseinstitutions in developing additional kinds of vocationaleducational programs, have resulted in requests for guidelinesfor organizing medical record technicians training programs.This interest on the part of accredited junior colleges shouldbe encouraged as it expresses a need felt in the comniuritieswhich they serve. So that the medical record profession _slaybenefit by the interest junior colleges have in vocationaltraining for hospital careers, these guidelines have beendeveloped by the Education and Registration Committee, toencourage effective use of these facilities for training medicalrecord technicians. It is particularly important to the profes-sion at a time when many hospitals are fmding it necessary todiscontinue conducting schools for medical record personnel,because of difficulty in fmancing them.

The Medical Record Technician Program requirementswould seem to be very well suited to inclusion in a juniorcollege curriculum. The formal courses in Anatomy andPhysiology ,Medical Terminology and Medical Record Sciencecould be taught in accredited junior colleges with requiredperiods of directed practice experience obtained in affiliatedaccredited hospitals. Junior collt3es already engaged in hos-pital-college cooperative training programs for other categoriesof hospital personnel, both technical and professional, wouldhave little difficulty in establishiag an additional program formedical record technicians if medical record librarianfaculty members were appointed to teach the professionalcourses and to coordinate directed practice assignments in thehospitals.

*Written and approved by the Education and RegistrationCommittee of the American Association of Medical RecordLibrarians.

Although a one-year program in medical record tech-nology could be developed for a junior college, we find thatthese institutions are interested in developing programs thatcould lead to the two-year associate in arts or associate inapplied science degree. Therefore, guidelines are developedfor two types of programs for medical record techniciansone- year and one summer session, and two-year programs.

FACULTY

Director of the program should be a registered medicalrecord librarian regularly appointed to the faculty of thejunior college, in accordance with usual procedures for facultyappointment. Additional instructors in Medical RecordScience, who meet the requirements of the college, may beappointed also, full time or part time. Minimum educationaland experience requirements for MRT program director are abaccalaureate degree, registration by the AAMRL, and threeyears experience in Medical Record Science.

College faculty should be sufficient in number to give afaculty-student ratio that is comparable to other on-goingprograms in the institution. One professional faculty memberto ten or twelve students would seem to be a reasonable basison which to plan. A part-time program director for the collegewould be acceptable unt:1 such time as the student facultyratio required the full-time attention of one person.

AFFILIATED ACCREDITED HOSPITALS

Hospitals selected to participate in the medical recordteshnology programs should be good-sized, general hospitalsaccredited by the Joint Commission on Hospital Accredita-tion. The medical record departments should be well organ-ized, under the direction of a Registered Medical RecordLibrarian, with sufficient staff to permit adequate supervisionof students.

17

TECHNICAL COURSE CONTENT

(Determined by the requirements of the "Essentials for Medical Record Technician Schools" AMA-AAMRL)

Technical Course Content

Medical terminologyAnatomy & physiologyMedical record science

lecturelaboratory

Medical record science(directed practice)

Clock Hours in"The Essentials"

45 hours60 hours

90 hours90 hours.

540 hours

Approximate Credit Equivalent

3 semester or4 semester or

5 quarter credits6 quarter credits

6 semester or 9 quarter credits3 semester or 5 quarter credits

9 semester or 12 quarter credits

TOTAL: 25 semester or 37 quarter credits

The hospital chosen for the primary affiliation siteshould be large enough to provide a variety of medical careservices, and to provide the various kinds of medical recordtechnician practical experience required for students. Thiswould usually be a hospital with a minimum of 4,000 patientdischarges per year. Medical record departments chosen shouldprovide an opportunity for student practice in all phases ofmedical record technician work: i.e., stenographic pool; quan-titative analysis of medical records; hospital statistics andreports; the coding and indexing of disease and operation;preparation of medical correspondence and medical abstracts;filing of medical records and reports; experience in theadmitting office; and preparation of medical records andreports for adjunct departments, such as x-ray, laboratory, andclinical and surgical pathology reports.

ORGANIZATION OF PROGRAM

Either a one-year program of 10 to 11 months duration,or a two-year program leading to an associate degree in artsor applied science, could be developed if the requiredtechnical courses and practical experience were provided. Thebasic medical record technician program could be completedin 10 to 11 months, but as many junior colleges prefer todevelop technical vocational programs leading to an associatedegree, a two-year program is also suggested.

One-year Program: 10 to 11 months 2 semesters (or 3

quarters) and one summer session. Approximately 32 semestercredits and 8 credits for summer session total 40 credits.Required courses in medical record technology would total 25semester credits, allowing approximately 15 credits for generaleducation subjects, liberal arts and sciences.

Two-year Program: (leading to an Associate in Arts orAssociate in Applied Science Degree in Medical RecordTechnology). The required Medical Record Technologycourses would be taken, plus additional general educationcourses in line with school requirements or student preference.The summer session between the first and second years could

be used for supervised practical work, and practice in affiliatedhospitals during the school year could be integrated carefullywith the Medical Record Science lecture courses.

18

CURRICULUM

Planning for one and two-year programs is based on 15

week semesters.

Laboratory Practice: Should be closely coordinatedwith medical record science lecture, particularly during thefirst semester medical record science is taught. Introduction tomedical record procedures should be carried out throughplanned laboratory experiences, prior to hospital assignmentfor directed practice.

Credit assignment for laboratory practice is suggested ona 2 to 1 basis (2 clock hours per week equals 1 semestercredit).

Directed Practice: Practice in a hospital medical recorddepartment should be planned for the second, third and fourthsemesters in which medical record science is taught afteradequate introduction to policies and methods has beenaccomplished through lecture and laboratory practice. Blockassignments of 4 to 6 hours at a time are recommended. Atleast 6 to 12 clock hours each week should be planned duringthe last three semesters of a four-semester program.

Credit assignment for directed practice is suggested on a

4 to 1 basis (4 clock hours per week equals 1 semester credit).

Summer Session: If school requirements preclude thesuggested amount of directed practice during the regularschool year, a summer session may be planned between thefreshman and sophomore years, in which one or two academiccourses could be taken as well as directed practice experiencein affiliated hospitals.

RECOMMENDATIONS FOR NON-TECHNICAL COURSES

In a one-year program (10 to 11 months) 2 semestersand one summer session, with a minimum of 25 semesterhours of credit required for the technical courses, a studentcould still earn 15 semester hours of academic credit in generaleducation subjects. This would be the equivalent of approxi-mately one semester of college work.

The associate in arts or applied science program wouldpermit wider choice of general education courses.Recommended elective courses would include Englishcomposition and speech, secretarial practice, mathematics,ethics, psychology, literature. Other courses as required by theinstitution, should provide a broad general educationAmerican history, physical education, sociology, philosophy,religion.

The division of general education and technical coursesmight be on the basis of: 40 per cent - 45 per cent generaleducation subjects; 60 per cent - 55 per cent specializedmedical record science subjects.

Degree: None for a one-year program; Associate of Arts orAssociate in Applied Science, depending upon thejunior college requirements for the two-year program.

MEDICAL RECORD TECHNICIAN PROGRAM HOURSFOR SUPERVISED LEARNING EXPERIENCE

Incorporated in the program for the preparation of med-ical record technicians should be planned field and laboratorypractice and on-the-job project assignments, case studies, andsimilar educational designs which allow for the application ofprevious and on-going professional learning under the direc-tion of competent instructors and practitioners.

In general, it is recommended that this supervisedlearning experience be arranged for at least 1 day (6 hours) perweek, during the semesters in which medical record science istaught, either in the one-year or two-year programs; and thatduring the last one or two semesters, this time be increased, asnecessary to make a total provision for 500 to 600 hours oflaboratory and directed practice experience in all during theone-year program or the two-year AA or AAS program.

Planning could be on the basis of credit assignment asfollows: Laboratory work 30 clock hours (2 clock hoursper week) for one semester credit; and Directed Practice 60clock hours for one semester credit.

MAJOR CONSIDERATIONS

1. Courses in medical record science should be taughtby registered medical record librarians.

2. Planning and coordination of an effective program ofdirected practice experience with directors of affiliated hos-pital medical record departments should be the responsibilityof the medical record librarian program director.

3. Continuous evaluation of the effectiveness of di-rected practice experience as well as the acceptability of thesites should be carried out by the program director.

4. Continuous evaluation of the technical and nontech-nical curriculums should be carried out by the director of theprogram and the responsible college curriculum committees.

5. A joint program advisory committee composed ofrepresentatives of the college and affiliated hospitals isrecommended.

SUGGESTIONS FOR PLANNING

1. The entire MRT program, lecture, laboratory anddirected practice experience should be planned to fall withinregular school sessions, semesters, quarters, or summer ses-sions.

2. Academic credit should be arranged for laboratoryand directed practice experience.

3. Summer sessions may be utilized for directed practiceexperience when necessary. However, if the AA Program iscarefully planned, there should be no need to use two summersessions for directed practice.

4. The curriculum should be planned to include thoseliberal arts and science credits which would transfer tofour-year medical record science programs, if students wishedto continue study toward a baccalaureate degree.

5. Some of the clock hours allocated for activities in theinstructional program listed for directed practice experiencemay be carried out in a college classroom or laboratorysituation, when appropriate (medical transcription practice,discharge procedures, coding and indexing, etc.)

Theoretically, the junior college program should providea terminal course in medical record technology for one whowishes immediate employment in a medical record departmentof a hospital or clinic (under the supervision of a medicalrecord librarian) and who does not wish to go on for abaccalaureate degree. However, in planning the program, theGeneral Education courses should be those that would transferto an institution offering a four-year program in medicalrecord science, in the event the student wished later on tocontinue studies leading to a degree in medical record science.Transferability and acceptability of a part of the technicalcourse content depend upon the regulations and policies of theinstitutions involved.

Four sample curriculums follow:

19

FIGURE ONE

First SemesterONE-YEAR PROGRAM

Second Semester

English 3 cr. English 3 cr.Anatomy & physiology 4 cr. Mathematics 2 cr.Medical terminology 3 cr. Medical record scienceMedi-el record science lecture 3 cr.

'ecture 3 cr. laboratory 2 cr.laboratory 1 cr. (60 hrs.)

(30 hrs.) directed practice 3 cr.Physical education 1 cr. (180 hrs.)Typing, secretarial prac- Machine transcription 3 cr.

tice or electives 2 Cr. Physical education 1 cr.

17 cr. 17 cr.

Summer Session:

Students could take one 3-credit course in general education during summer session; 10 to 12 weeks of supervisedpractice (6 hours per day for 30 hours per week); 60 hours of directed practice equals I semester credit.

(10 weeks = 30 hours per week = 300 hours = 5 semester credits)(12 weeks = 30 hours per week = 360 hours = 6 semester credits)

It is recommended that at least one hour a week during the Summer Session be devoted to a seminar with the MRTprogram coordinator.

TWO-YEAR PROGRAM

First Semester Second Semester

English 3 cr. English 3 cr.Anatomy and physiology 4 cr. Anatomy and physiology 4 cr.Medical terminology 3 cr. Machine transcription 3 cr.Introduction to M.R. science Medical record science

lecture 2 cr. lecture 2 cr.laboratory 1 Cr. laboratory 1 cr.

(30 hrs.) (30 hrs.)Typing, secretarial prac- directed practice 2 cr.

tice or electives 3 cr. (120 hrs.)Physical education 1 cr.

17 cr.

Physical education 1 cr.

lb cr.

Medical record science

Third Semester Fourth Semester

Medical record sciencelecture 2 cr. seminar 1 cr.laboratory 1 cr. directed practice 4 cr.

(30 hrs.) (240 hrs.)directed practice 3 cr. Sociology 3 cr.

(180 hrs.) History 3 cr.Psychology 3 cr. Speech 2 cr.Mathematics 2 cr. Physical education 1 cr.Electives 4 cr. Electives 2 cr.Physical education 1 cr.

16 cr. 16 cr.

20

FIGURE TWO

FULLERTON JUNIOR COLLEGEFULLERTON, CALIFORNIA

MEDICAT., RECORD TECHNOLOGY PROGRAM

PREREQUISITES: Graduation from high school; biology and general mathematics background.

Prepares for employment as a medical record technician in medical record departments of public and private hospitals, clinics,public health departments. Open to men and women. A two-year program leading to the A.A. Degree. Graduates are eligible to takethe National Accreditation Examination given by the American Association of Medical Record Librarians, for designation ART(accredited record technician).

FRESHMAN YEAR

First Semester Second Semester

Physical education % cr. Physical education % cr.

Medical record science 75A 3 a. Medical record science 75B 3 a.

Typing 3A 3 a. Typing 3B 3 a.

Medical terminology 65A 3 a. Anatomy and physiology 16 5 a.

English 1A 3 a. History 27 3 a.

Personal health 2 cr. Elective* 3 a.

Careers in life science % cr.American government survey 5 2 cr.

17 Cr. *English encouraged. 17% cr.

SOPHOMORE YEAR

Third Semester Fourth Semester

Physical education %cr. Physical education % cr.

Machine transcription (Medical) 65 2 cr. Psychology 3 3 a.

Elective 3 cr. Elective 3 cr.

Cooperative medical record Cooperative medical recordTraining 78A. 10 cr. Training 78B. 10 cr.

15% cr. 16% cr.

*19 hours per week, one campus session once a month.Recommended electives: Medical terminology 658

Introduction to data processing 2

21

FIGURE THREE

Alpha Semester

Anatomy IEnglish I or 28Health IIMedical record science IMedical record science 2Medical record science 6Secretarial science I or 2Physical education

SUMMER SESSION

Medical Record Science 20

Gamma Semester

Medical record science 20Political science IPsychology I or 6Secretarial science 32*ElectivePhysical education

EAST LOS ANGELES COLLEGELOS ANGLES, CALIFORNIA

MEDICAL RECORD TECHNICIANOccupational Curriculum

FIRST YEAR

Units Beta Semester

3 Biology 333 Medical record science 33 Medical record science 42 Microbiology 61 Physiology I1 Physical education2 Eiective

15%

5

SECOND YEAR

Units

53332'A

16%

*Recommended electives include Psychology 3 and management 31

Delta Semester

History 14Medical record science 20Speech I*ElectivesPhysical education

22

FIGURE FOUR

ST. MARY'S JUNIOR COLLEGEMINNEAPOLIS, MINNESOTA

MEDICAL RECORD TECHNICIAN PROGRAM

FRESHMAN YEAR

Fall Winter SpringAnatomy and physiology 3 Anatomy and physiology 3 Medical legalHealth concepts 3 Medical record science 6 relationships 3English 3 Medical machine Man in society 3Medical terminology 3 Transcription 3 Religion 3Medical record science

(includes 1 credittypewriting)

4 Medical record science 6

SOPHOMORE YEAR

Fall Winter Spring

Humanities 3 Humanities 3 Humanities 3Moral theology 3 Religion 3 Elective 3General psychology 3 Elective 3 Elective 3Medical record science 6 Medical record science 6 Medical record science 6

NOTE: General education core curriculum:Program required courses:

Electives:

Graduation requirement:

39 credits43 credits

8 credits

90 quarter credits

Laboratory hours 2 clock hours = 1 quarter creditDirected practice 4 clock hours = 1 quarter credit

Hospital affiliation with accredited hospitals, where students may obtain practice on the job, under the competent supervision ofregistered medical record librarians, is essential to the medical record technician program.

23

The Role of Junior Colleges in EducationalPrograms in Radio logic Technology*

During the past decade there has been an unprecedentedincrease in the number of junior college programs in thecountry; these having tripled since 1957. Soon there will beover 1,100 junior colleges. Many of these are also increasing insize of student enrollment, especially in certain areas of thecountry in which the population is expanding rapidly. Oneexample is Dade County Junior College in Miami, Florida,which in 1967 had nearly 14,000 students, but whichanticipates quadrupling its enrollment within the next tenyears.

Understandably, many of these schools are becomingheavily involved with career or occupational programs in theallied health fields such as nursing, physical therapy andrehabilitation, medical and radiologic technology, as well asother paramedical fields. At the same time, hospiftis, whichhistorically have produced, largely at their own expense, mostof the workers in these fields have been faced with escalatingcosts of rendering patient care. Persuasive evidence is beingpresented that educational programs, especially in nursing andto a lesser extent in the technological fields allied to medicine,should be the responsibility of colleges and universities, andshould be supported by public and private fonds not by thepatient's dollar.

Hospitalization insurance agencies are taking a similarstand and at least one legal action is pending in which ahospital is suing Blue Cross for payments withheld because theinsurance carrier claimed that part of the payment requestedby the hospital was used to support educational programs, notdirectly related to patient care.

In the field of radiologic technology, the problem hasbeen compounded by the increasing demand for radiologicservices and by the complexity and amount of time consumed

*A. Bradley Soule, chairman of the Department of Radi-ology, College of Medicine, University of Vermont, Burling-ton, Vermont.

24

by many of the examinations. These factors, together with therealization by radiologists, radiation physicists, radiobiol -ogists, and public health officials that protection of patientsand their progeny from possible hazards of unnecessaryradiation emphasize the need for providing adequate educa-tional programs for workers who are administering radiation topatients. Radiologic technologists administer most of theradiation used in hospital and medical practice today with theexception of fluoroscopy, ra('Ation therapy, and certainnuclear medical procedures.

Almost all of the formally trained technologists areproduced by the 1,200 hospital based schools accredited bythe Council on Medical Education of the American MedicalAssociation. These schools provide courses 24 or more monthsin length, more than 90 per cent of which are terminal,without college affiliation, and with no college credit given forcourses offered. In 1967, the AMA approved schools turnedout 5,400 graduates. At the same time there were less than onehundred technologists who received associate degrees, andabout a dozer who received bachelor's degrees.

According to the best information now available, thereare approximately sixty colleges and universities (mostlycommunity or junior colleges) offering associate degree pro-grams, and a dozen or less which have developed or aredeveloping baccalaureate degree programs in radiologic tech-nology. The hospital-based programs have been especiallyappealing to young people from low income families thatcannot afford to send their children to college. In order not tolose this pool of promising workers, it is imperative that asmore junior college programs in radiologic technology aredeveloped, ways and means be found of keeping tuitioncharges to a minimum and providing scholarships and loanfunds for needy students.

In a few states the junior colleges are sufficientlysubsidized so that students may go from high school intocollege with minimal financial commitment. Many, however,

require an investment of several thousand dollars or more for atwo-year program. The professionals in the field of radiologyand radiologic technology believe that the most promisingsources of staff technologists in the foreseeable future are thehospital-based schools, since they are now providing 98 percent of current graduates.

It is hoped, however, that the college-affiliated programswill produce more and more of the radiologic technologists ofthe future, especially if hospitals tend to drop out of theeducational field. This is still an unproven hypothesis, andthere is a calculated risk that increased costs to prospectivestudents and drop-outs while in training may offer a real threatto the success of this venture.

The Department of Labor and the Bureau of HealthManpower of the Public Health Service have recently issuedreports in which they note that there are approximately72,000 people operating x-ray equipment in this country, ofwhich 33,000 are qualified registered technologists. TheDepartment estimated that by 1975 there will be a need for100,000 technologists, of whom at least 52,000 will or shouldbe fully trained. The number of AMA-approved schoolsincreased from 456 to 1,200 in the last decade, with acorresponding increase in training capacity from 3,600 to14,000, and increase in number of graduates from 1,800 to5,400.

Unfortunately there is a high attrition rate, primarilydue to marriage of female technologists who spend an averageof 31/2 years in the field, this including their training period.The relatively low salary scale and the paucity of opportunitiesfor advancement have tended to attract relatively few men,and a number of male technologists have left for moreremunerative positions in commerce and industry. Since mostmales entering the field do so with the expectation of makinga lifetime career of radiologic technology, the majority remain.It has been estimated that well over half of the administrativeand chief technologist positions in the country are filled bymen.

Certainly one of the real needs is for development ofmiddle management positions and for teachers who are also inexceedingly short supply. General duty technologists receivesalaries which are usually equated to other comparable staffworkers in hospitals, but there seem to be increasing oppor-tunities for advancement in rank and responsibilities withcorresponding increases in salaries and prerequisites. Thejunior colleges should play a significant role in the develop-ment of the higher echelon types of technologists in providingthem with a general basic education one that will permittalented young people to move on up the educational ladder.

Equivalency tests are being developed which shouldenable qualified technologists already in the field to obtaincollege credits for knowledge acquired in their schooling andemployment. Northeastern University has developed an inter-esting plan, whereby technologists employed in the Bostonarea may take evening courses which will lead over a period ofseveral years to the granting of an associate degree.

While the need is greatest for technologists in the field ofdiagnostic x-ray, there is also an increasing demand for

technologists in radiation therapy and nuclear medicine; andfor such specialized workers as radiologists' assistants, specialprocedures technologists, administrative assistants, electronicsand engineering technologists. Colleges and universities willundoubtedly play a leading role in development of many ofthese specialists, but of necessity with the collaboration of thestaffs of clinical radiology departments.

The Council on Medical Education of the AmericanMedical Association is charged with the responsibility forgranting approval of programs of instruction in radiologictechnology. They establish standards of training which areexpressed in the Essentials of an Approved School of Radio-logic Technology, copies of which may be obtained from theCouncil's office. The Essentials outline the Council's require-ments for administration, organization, faculty, admissionrequirements, curriculum, ethics, etc., for qualification as anapproved school. Recently, the American Medical Associationhas created a Department of Allied Medical Professions andServices within the Division of Medical Education. This newdepartment will supervise the broad field of educationalprograms in the paramedical areas.

The American College of Radiology, through its Com-mission on Technologist Affairs, assists the AMA Council bykeeping under constant study the changing needs in the fieldof radiologic technology, and by conducting survey inspec-tions of schools of radiologic technology to evaluate suchschools and make recommendations regarding approval oftheir programs. The Commission has developed a Committeeon Technologist Training, a Committee on College AffiliatedTraining. a Committee on Training in Nuclear MedicineTechnology, and a Committee on Training in RadiationTherapy Technology, all of which act as study committees intheir fields. The Committee on Technologist Training, whichincludes both radiologists and technologists, handles thedetails of the survey inspections.

The American Society of Radiologic Technologists,acting largely through its Education Committee, also keepsunder surveillance educational needs and advises the Collegeand AMA Council regarding desired goals, standards, details ofcurriculum, etc.

The American Registry of Radiologic Technologists, anindependent agency which derives its membership fromradiologists appointed by the American College of Radiologyand from technologists named by the American Society,conducts a program of examination and certification ofqualified graduates of approved schools. Since its organization,the Registry has certified qualified candidates in generalradiologic technology; in 1962 they added certification inradiation therapy technology and in nuclear medicine tech-nology. Since July 1, 1966, the Registry has allowed onlythose candidates who have successfully completed 24 or moremonths in an AMA spproved training program to take theexaminations in radiologic technology.

Recently developed are the Essentials for An ApprovedSchool of Technologists in Radiation Therapy, which provideguidelines and requirements for training of technologists inthis area.

25

The field of nuclear medicine technology engages theinterest of not only the radiologic groups but also crossesspeciality lines so that in the planning of educational programsfor technologists in this relatively new field, the AmericanSociety of Clinical Pathologists, the Society of NuclearMedicine, the American Society of Medical Technologists, theAmerican College of Radiology, and the American Society ofRadio logic Technologists are equally concerned. It is antici-pated that there will soon be an Essentials of an AcceptableSchool for Nuclear Medical Technicians and Technologistsdeveloped by the AMA Council which will utilize a Board ofSchools made up of representatives of all of the abovelisted organizations to assist the Council in survey inspectionsand evaluation of schools of nuclear medicine technology.Under consideration are two general types of programs onewhich may or may not lead to an associate degree for"technicians" and one which leads to a baccalaureate degreefor "technologists." Currently, registered radiologic or medicaltechnologists may enroll in a course in nuclear medicaltechnology of twelve or more months in length, and may, iftheir qualifications are acceptable to the Registry Boards,receive additional certification in nuclear medical technology.Certification may be granted by either the American Registryof Radiologic Technologists or the American Society ofClinical Pathologists through its Commission on MedicalTechnology. Under study is an additional type of trainingunder which nuclear medical technologists may be developeddirectly without prior training in radiologic or medicaltechnology. Minimal standards have not as yet been formalizedfor this new program, but it is anticipated that criteria quitesimilar to those for radiologic technology will be developed.

The AMA Council will only approve schools which areorganized in colleges of medicine or in radiology departmentsaffiliated with accredited general hospitals. Under considera-tion is a revision which, if adopted, will provide for thedevelopment of schools in specialty hospitals or in educationalfacilities other than those named above which have demon-strated capabilities of providing suitable training in radiologictechnology.

Thus, it is essential that, in the development of a collegeaffiliated program, the hospital school or schools must applyto the AMA Council on Medical Education for approval,naming the college as the affiliate. Both the hospital school orschools and the college shall be held to the required standards.Provisional approval may be granted to the combined schoolprogram without an on-site survey if the program appears tomeet all of the requirements of the AMA Council. Surveyinspections of the college and hospital programs will beconducted by a team representing the ACR Committee onTechnologist Training in not less than one year nor more thantwo years after provisional approval has been granted.

The organization and operation of the school of radiol-ogic technology shall be the joint responsibility of the collegeand of the radiology department or departments of thecooperating hospital or hospitals. The school may carry thenames of all affiliated organizations if desired.

Each hospital shall be fully accredited by the JointCommission on Accreditation and the radiology departmentmust provide a wide variety and a reasonable volume of

26

radiologic procedures. If the department is unable to offeracceptable experience in specialized procedures and/or inradiation therapy, affiliation shall be established with aninstitution providing such experience. At least 2,400 hours ofhospital-based practicum shall be provided. Time used in workon phantoms and other inanimate objects shall not be grantedcredit toward the 2,400 hours of the practicum.

A qualified radiologist shall be responsible for theorganization and conduct of the School of Radiologic Tech-nology. This will require staff appointment at the college andfull time or nearly full time appointment at the hospital.Should n'ure than one hospital be affiliated in the program, itmay be necessary or advisable for a radiologist to be appointedfor each hospital. In such a case, the radiologists shouldcomprise a committee which oversees the entire program.

A full-time qualified radiologic technologist shall be onthe staff of the College, who will work in cooperation with theaffiliated hospital or hospitals to coordinate the entireprogram in all institutions involved.

It is the responsibility of the colleges and universities todevelop and teach some of the courses in the technical fieldand all of the additional courses required for the granting ofdegrees. Teaching of the so-called radiologic technologycourses will depend on the availability and competency ofcollege faculty to develop and present them so that they willbe most meaningful to the student. In some cases this can bedone entirely within the college, but usually courses willrequire supplementation by individual and small group instruc-tion in the hospital radiology department schools. The latterwill, of course, function as the clinical laboratories for thepracitum where students have an opportunity of working withpatients. Since students must develop skills in handlingseriously ill and injured patients and in performing all types ofradiologic examinations, including a number which are quitecomplex, the hospital experience must extend over a periodlong enough for such skills to be acquired.

It is currently required that training in both thehospital-based and the college-affiliated schools extend over atotal period of not less than 24 months. In the collegeaffiliated programs granting associate degrees, it is rarelypossible to develop a well-rounded experience in less than 27to 36 months. It has long been the impression of theprofessional study groups (radiologists and technologists) thatat least 2,400 hours should be devoted to the practicum in ahospital environment and that this is a minimum requirementfor college affiliated schools. In the hospital-based terminalprograms, it actually approaches 3,600 hours.

In developing a program with a junior college, a widerange of operating details is possible. A common pattern is onein which a student attends the college for 4 semesters, thisbeing followed by 15 or more months in the hospital radiologydepartment school. In such a case the hr. pital school mustassume responsibility for the practical training and workexperience, including not over two months in the darkroom.The hospital school must also provide at least two hours aweek of didactic instruction. Near the close of training, reviewsessions should be provided either by the hospital school or

the college. Film critiques should be conducted at least once aweek during the hospital experience.

In another pattern, which is only possible if the collegeand the hospital are in close proximity, the student spendspart of his time in the college and part in the hospitalthroughout the training period. There are variants of both ofthese basic plans. Certain guidelines have been established toassist in the development of an integrated plan for conduct ofthe school. Because of the many individual variations inprogram operation, it is necessary that each be evaluated on itsown merits. The committee on Technologist Training recog-nizes that, while there must be room for individual differencesin the method of operation, all programs must function at orin excess of certain minimum standards. These standards orguidelines have been imposed after careful thought to fulfill atwofold purpose: first, to provide a channel for schools tofollow in completing objectives favorable to the profession;and, second, to provide a means for responsible control of thequality of technologists produced and their performance in theprofession.

The objective in all programs must be to provide aneducational experience of sound academic v.tlue balancedbetween theory and practice. The combined affiliated programmust be so organized and integrated as to accomplish thisobjective.

Directors of schools are therefore urged to offer coursesthat will meet all requirements for an associate degree, and willalso provide on a college level the technical courses outlined inthe AMA Basic Minimum Curriculum. Time should be allowedfor study, recreation, holidays, and vacations. The programmust include didactic and applied training in radiologictechnology adequate in course content and in length, breadth,and depth of clinical experience sufficient to fully prepare thestudent for a professional career in this field. Not over 40hours per week should be devoted to the practicum.

The course material and practicum must be designed toinsure that graduates are qualified for registration by theAmerican Registry of Radio logic Technologists. Selection ofstudents for the school shall be the joint responsibility of thecollege and hospital or hospitals. Efforts should be made torecruit students who show an aptitude for radiologic tech-nology, and who have desirable traits of character, personality,and intelligence. Unpromising applicants should be discour-aged. Aptitude tests, relative class standing in secondaryschools, references, and personal interviews should be used inevaluation of candidates.

All didactic courses, whether provided by the college orhospital, should be of college credit quality. These shallinclude courses required in the AMA Basic Minimum Curric-ulum or those of equivalent content. The college is encouragedto offer background courses in subjects designed to preparegraduates for teaching and supervisory positions in radiologictechnology. If all of the required courses are not taught in thecollege, the remainder must be given in the hospital school.

The subject material of courses to be taught shouldi follow the outline in the Teacher's Syllabus, published by the

American Society of Radio logic Technologists, except thatthis may be varied by instructors to provide each student witha well rounded background in the science and art of radiologictechnology.

Careful attention shall be paid to the organization of thepracticum which will be provided in the hospital radiologydepartment. This should provide a meaningful educationalexperience. Students must be given thorough instruction in theoperation of equipment and in the handling of all patients,especially the seriously sick and injured, before being per-mitted to perform such examinations. They shall practice firstunder close supervision, then under general supervision, andfilially unaided. Each student must be taught the principlesand application of radiation safety and of general safety. Thestudent shall not be permitted to perform an x-ray examina-tion until this can be done with safety to the patient and tothe personnel in the department. Practical experience shouldnot include excessive time in duties which involve a minimumof learning, such as darkroom work, filing, typing, transpor-tation of patients, etc.

Each student shall be provided with a workbook whereinare recorded procedures which the student performs. Beforegraduation, each student shall be required to perform asuitable number of examinations in multiple categories, atleast one third of which shall have been made unaided.

The school shall not permit those students to graduateor to be certified as eligible for registration by the AmericanRegistry of Radio logic Technology who have failed to com-plete satisfactorily courses listed in the "Basic MinimumCurriculum." The radiologist directing the program shallcertify each student candidate for graduation as being techni-cally competent in order for the student to be graduated.Records of students' activities and accomplishments must becomple to and readily available for inspection teams when theycome to appraise the educational program.

The Committee on Technologist Training and theCommittee on College Affiliated Programs welcome inquiriesfrom radiologists directing hospital departments of radiologyand from administrative officers of colleges and universitiesregarding projected programs in radiologic technology; andwill gladly furnish advice and help in organizing affiliatedschools. Inquiries should be directed to the American Collegeof Radiology, 20 North Wacker Drive, Chicago, Illi-nois 60606, or to the Council on Medical Education, Ameri-can Medical Association, 535 North Dearborn Street, Chicago,Illinois 60610.

Information regarding registration of radiologic technol-ogists may be obtained from the American Registry ofRadiologic Technologists, 2600 Wayzata Boulevard, Minne-apolis, Minnesota 55455.

Copies of the Teacher's Syllabus and Basic MinimumCurriculum may be obtained for $3.50 postpaid from theExecutive Secretary, American Society of Radiologic Technol-ogists, 537 South Main Street, Fond du Lac, Wis-consin 54935.

27

A Proposed Interrelated DentalAuxiliary Personnel Curriculum*

The report of the National Advisory Commission onHealth Manpower calculates that demand for dental serviceswill increase 100 to 125 per cent in the period of 1965-1975.The trend of a substantial increasing ratio of auxiliary dentalpersonnel to active practicing dentiits is noteworthy. Thereport also states "The development of health personnel at theintermediate professional level has been repeatedly explored,and a few pilot programs are now underway. Because weregard the use of such personnel as a major factor in improvingthe utilization of health professionals, we recommend that theFederal Government give high priority to the support underuniversity direction of experimental programs which train andutilize new categories of health professionals." Anotherrecommendation that might provide guidance is "Professionalsocieties, universities, and state governments should undertake,with Federal support, studies on the development of guidelinesfor state licensure codes for health personnel. Licensurethroughout the nation should be based on minimum require-ments which would assure to citizens a basic standard ofquality . . . ."

The American College of Dentists dental manpowerconference sponsored by U.S.P.H.S. was held in St. Louis onDecember 13-18, 1967. Study group II whose topic was"Increasing Productivity" recommended specific measuresseveral of these were:

1. To provide legal opportunity for expansion of dutiesand functions of auxiliaries

2. To extend duties without undue harm to the pa-tient's health

3. To provide a responsible body of the dentalprofession such as the State Board of Dental Examiners to

regulate considering regional needs and attitudes. This groupshould be strongly encouraged to implement experimentationand change in the areas of broadened duties.

4. To expand functions and programs under supervisionof responsible dentists, perhaps in the setting of an educationalinstitition.

5. To convince the profession that auxiliary personnelcan assume effectively additional responsibilities. Apathy, fearof change as a threat to established "successful" patterns, andlack of awareness of the need are factors related to theprofessional's resistance. One recommended proposal was thateditorials supporting expanded functions be directed to theprofession through journals.

Junior and community colleges can be employed inexpanding present program and developing new programs toeducate auxiliaries. They can serve as models for developmentof optimal auxiliary utilization. Cooperative action withadjacent university dental schools is to the advantage of allparties involved. The Forest Park Community College DentalClinic has been designed to provide opportunity for thestudents to have experiences in delivery of services in a mannerwhich has been shown to increase both quantity and quality.The emphasis in the teaching program will be directed towardprevention of dental disease rather than correction of symp-toms.

Experimental programs indicate that another ancillarycareer will become part of the dental health team. Some of theimportant considerations in the establishment of this newcareer follows:

1. The acceptance of the dental profession of his newauxiliary in the dental health team

*Frederic Custer, director, Dental Programs, Forest Park 2. The acceptance of the new auxiliary by the presentCommunity College, St. Louis, Missouri dental auxiliary group

28

3. The control of new auxiliary by the dental professionto assure high quality service

4. The designation and limitation 4 the duties of thenew auxiliary

5. Establishment of educational r.ograms related to thedesignated responsibilities.

6. The provision of direction and teaching manpowerfor new programs through establishment of a group repre-senting the dental profession, dental examiners and educators,both general and dental.

7. The need to provide a continuing increase of dentalauxiliaries with a flexible interrelated curriculum resulting in amore effective and economical use of present facilities andmanpower.

The thoughts contained in the following recommenda-tions are presented for your evaluation and have beenencouraged by the dental profession, examiners and educatorshave demonstrated. The new auxiliary may be designated as(1) dental hygienist (2) clinical dental technologist (3) clinicaltechnician or (4) dental therapist. The terminology is impor-tant here, only in that it provides a common means ofcommunication. (See flow graph adjoining)

All individuals pursuing any of the dental auxiliaryprograms will be exposed to the same educational experiencesduring the first semester. Both those continuing their specifk,interest, or those that might !lave a change in directionthrough different motivatirmal factors (qualification, econom-ics or varied other reasons), can all have a more satisfactoryapproach in the second semester. For example, a girl con s tothe program for dental hygiene, but for some personal reasoncannot continue a future threee semesters plus one summersession schedule. She now has another acceptable choicecontinuing in the dental assisting program for just one moresemester and then e--tering into active dental employmentwhere she can function to the advantage of herself and todental health manpower. If her situation changes, she couleethen re-enter at the advanced dental technology level toprogress to her original objective. Those indwistuals entering inthe dental assisting program need rot repeat the completeyear, as is now required, but could change their objectivewithout loss of the individual's first year, duplication of theteacher's time, and the doubled use of fae!t'es.

Presently, five of nineteen dental hygiene students atForest Park have completed the junior college district dentalassistant program. The 1968-69 entering class of hygienists willhave even a higher percentage of assistants since it might bepossible to implement a testing instrument to give qualified,experienced dental assistants credit for the basic dentaltechnology stage. Other statewide junior college dentalassisting programs that meet the curriculum requirements ofbasic dental technology, would have the opportunity to placetheir motivated students :n the auvanced program. Thismatriculation offers braider horizons for recruitment at thehigh school level, while local identification in the initial phaseof their training encourages the trained individuals to return totheir original locale.

The propt,zed curriculum could also provide basicallytrained students fcr a dental laboratory technician program.The summer session would be basic clinical experience, clinicorientation, radiography, and other preliminary activities suchas preparation of study models, charting, preventive ineatbaresand health education. Limited experiences should be offeredin dental hygiene prophylactic practice.

In the second-year first-semester program, there wouldbe an emphasis placed on either (1) the dental hygiene areas aspresently known (with minor additional curriculum changes,or (2) the clinical dental technologist (the name here is onlygiven to differentiate duties or emphasis.) The overlap betweenthe two areas is apparent and would be advantageous to theprofession in acceptance, flexibility, control through licensure,and opportunity for development of the new auxiliary withoutduplicating an established curriculum. The cufficuluff of theclinical dental technologist could be guided by the results ofprojects related to expansion of duties from other institutions,i.e., tir:versity of Alabama, School of Dentistry; U.S. NavyAuxiliary Dental Personal Program; University of Louisville,School of Dentistry. Limiting responsibilities would be afunction of organized dentistry through a combined com-mittee of individuals from the profession, examiners andeducators,

The second semester has less overlap since greateremphasis is in the direction of interest. The student, aftersatisfactorily completin , the curriculum of didactic andclinical experiences, would then be eligible to apply forlicensuie examination.

The related responsibilities of the present dental hygien-ist and the future clinical dental technologist is notable.Concern is voiced over the loss of now-practicing dentalhygienists wanting to become clinical dental technologists.This program would give flexibility in the development ofshort postgraduate programs to solve this problem. Initiatingnew and separated pr it vm would be expensive in facilitiesand manpower. There world be the two-year-course-timedelay from initiation through development until this man-power source became productive.

The initial need and acceptance of the clinical dentaltechnologist might be faster or slower than anticipated. Thecombining and overlapping of the second year curriculumwould allow the program to emphasize the need for eachgroup as it develops. Licensure would offer the control overquality of service and direct the educational experiences. Thecombined program might reduce the difficulty of modifyingexisting dental laws, and would offer a more versatileemployee to the practicing dentist who needs such versatility.The dentist retains the responsibility of dental health service inthe office, while organized dentistry directs the future ofdentistry to provide the b'st health care for everyone involved.

The program I have proposed a solution to the urgentproblem of estimated manpower shortage and the futureincreased demand of dental health services. Finally, the pro-posed program would provide:

1. Quality in dental services

29

2. Control through the profession

3. Economizing a educational resources

4. Versatility in meeting future practice needs

5. Greater acceptance of the new auxiliary by the dentalprofession and other related auxiliary groups

6. Flexibility of existing programs.

FLOW GRAPH FOR A PROPOSED INTERRELATED DENTAL CURRICULUM FOR DENTAL AUXILIARIES

First Semester--..1. High school ----0.1 Basic Dental2. College Technology3. Noncertified dental asst. --a- Curriculum

1. Certifieddental asst. whopass qualifyingexam

2. Students who havesuccessfully com-pleted B.O.T.course at other Jr.college Program

30

iSummer Session

Basic dental technology clinic(charting, models, radiographs,prevention, oral hygiene).

Third Semester

Dental hygiene

/10%Eic-7/.1-119)/z . .r v

Dental technology

iFourth Semester

Dental hygiene

I

3Licensure by state dental board

IManpower

Certification

Manptower

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READING WITH TWO VIEWS

Questions and Answers AboutAssociated Degree Nursing Programs*

1. What is the administrator's role in starting an associatedegree nursing (ADN) program?

The decision for inaugurating an associate degree nursingprogram in a junior college must be made by the adminis-trator. In making his decision to proceed with programdevelopment, the administrator must examine carefully thesurvey of need; be certain that appropriate and satisfactoryclinical experiences are available, and be sure that affiliationagreement with hospitals are fully in order; draw up theorganizational pattern for planning and for supervision of theprogram; and determine conclusively sources of financialsupport and instructional personnel. During the period ofdevelopment and after the program is underway, the adminis-trator should be closely related to all activities.

2. How do you go about getting qualified personnel? What arethe sources available?

Obtaining qualified personnel for all paramedical pro-grams is a major problem at this time. There probably areinstances of programs needed but not implemented in juniorcolleges because adequate instructional personnel could not befound. Start searching for personnel early the director ordean should be employed early enough to participate in allplanning and development. Sources ofpersonnel are hospitals,universities and four-year colleges, and from other institutions.A good source of help may be current directors of programsthese people may know of competent staff people who would

*These questions and answers came out of the AlabamaState Conference on Paramedical Education held at Mobileon May 10-11, 1966. The conference was sponsored by theCommittee on Paramedical Education of the Health CareersCouncil of Alabama with cooperation of AAJC. A publica-tion, titled Paramedical and Health-Related Programs in theJunior College, was later printed through AAJC

32

make good directors the NLN, the ANA, or the State Boardsof Nursing.

2. What kind of accrediting is necessary, and what standardsare set up?

Accreditation by the regional accrediting association andapproval of your State Board of Nursing so that yourgraduates may take the Board licensure examination arenecessary. For federal funding, NLN accreditation or approvalis necessary at this time.

4. Please discuss fully the financing of an ADN program. Howmuch does it cost?

The main cost of an ADN program is salary forcompetent and able people, and for enough of them to dothe job of instruction, guidance, and clinical supervisionproperly. While a good ADN program requires more financialsupport than some other programs in the junior colleges,equipment and space need not be a major factor. Instruc-tional media library books and periodicals, classroommaterials, charts, graphs, illustrative, material, slides, films,filmstrips, and recordings must be used for up-to-date andsuperior instruction. It would be difficult to put a dollar andcents figure to cost be assured that such a program mayrequire at least twice the amount per student cost as generaleducation programs.

5. Who is responsible for the curriculum? How do youorganize curriculum development?

Curriculum responsibility lies with total staff andfaculty. Howe.:er, there must be a coordinator. In most juniorcollege:, a dean of instruction or a dean of academic affairs is:esponsible for overall curriculum development, and thenursing education director or dean and her staff is responsiblespecifically for developing the curriculum and presenting it tothe administration. Several factors may influence curriculum

development: (1) state board of nursing requirements; (2)state department of education requirements; (3) the profes-sion's requirements for adequate and satisfactory reachingorogratns; (4) the college-philosophy requirements of objec-tives and goals; (5) proven programs of other institutions; (6)local planning factors.

6. Who does the college administration appoint to organizerecruitment of students for these programs the ADN pro-gram especially? What are the sources of students?

There are several sources of students for paramedicalprograms but all require various degrees of active recruit-ment. The college that develops a program and then sits backwith doors open waiting for students to come in is doomed todisappointment and frustration. Our largest source of studentsis the high school graduate but again, the junior college thatdepends wholly upon high school graduates for its students inhealth-related programs will experience enrollment disappoint-ment. All sources should be explored and, yes, exploited.Current college students who have been misdirected into otherprograms, or who have entered programs through false ormisunderstood objectives, or who, for many reasons, may befrustrated in their college work, may be recounseled into theparamedical programs. Adults who now wish to or find theneed to engage in a career may be motivated into programs.Adults who practiced a health profession years ago, and whonow wish to re-enter the profession, may need much refresherwork. Adults currently in a health-related career who wish tomove into another field or upgrade themselves in their presentemployment may be interested. However, we emphasize thatin order to attract students from any of these categories intothe paramedical programs, a dynamic, aggressive, well-plannedprogram of information, encouragement, and counseling mustbe undertaken.

7. How do you determine the need for the ADN program inthe first place?

Need for paramedical programs should be determined bywell-planned surveys in the areas to be served. The surveyshould concentrate on the users of the product of theproposed program. A survey, based upon a printed question-naire distributed through the mail with requests for writtenreplies is not effective and frequently may also be inaccurate.The basic westion really is not how many people are needed,but how many people will be employed a different approachaltogether. A hospital may need fifty more nurses a year, butits budget may permit it to employ only ten. The written-answer survey as a part of a survey may be useful. The proce-dures may be suggested as follows:

Personal conferences with selected key people in theprofession in th! community. An informational campaign bynewspaper, speeches to clubs and other organizations, TVstations and radio, to acquaint people of the community withwhat the junior college can do in organizing programs andoffering them. A broadened personal interview list to see whatthe reaction of the professional "rank and file" might be tosuch program development. Conferences with officials of otherlevels of the local school system to enlist their support. Areview of similar surveys or reports based upon state, region11,or national surveys.

8. Should administrators of small junior colleges less than athousand students plan to develop an ADN program, or anyother paramedical program? What should guide them in theirdecisions?

Generally, they stould consider thoroughly and wiselyall the problems attendant upon paramedical programs beforeproceeding with development. A small junior college usuallyindicates a small or scattered population area, and this in itselfmay be deterrent to a successful program. Administrators ofsmall junior colleges should examine carefully cost, studentresource, and placement opportunities for graduates beforestarting such programs.

9. What facility arrangements must be made for ADN pro-grams on the campus? At what hospital? What do you thinkabout the "extended campus" plan where much of theteaching is done off campus?

Visits to many junior college campuses have shown avariety of physical facilities for ADN programs, and for otherparamedical offerings. Some colleges have accomplished minorremodeling of current spaces to provide very functional andsatisfactory facilities for the health programs. Other collegeshave constructed well-planned new facilities in new buildingsor wings of present buildings.

Whatever is done, facilities should not be crampedplan adequately for the program or not at all. Also, it shouldbe remembered that the educational programs in the healthareas represent an occupation that must emphasize environ-ment, and students should be aware of this from thebeginning. Thus facilities should be ample for the job to bedone, pleasant, cheerful, light, and well-ventilated. Anotherconsideration is a careful study of the possible use of facilitiesalso being used by other programs of the college labora-tories, classrooms, audiovisual auditoriums and the like. Somespecial facilities will be needed, and these should be planned asan outcome of the curriculum being developed and theobjectives of the course.

Facilities for use at the hospital are usually defined inthe agreement mutually prepared by the college and thehospital. It has been recommended that facilities at thehospital be used as such are available, and if they providebetter teaching media than can be found at the college.Experience has indicated, however, that college controlledfacilities should be used as much as is possible.

This, of course, brings us to the matter of the "ext-ended" campus. It is not at all the characteristic of the"extended" campus for the college to give up its control andsupervision of facilities used away from the maincampus . . . rather it is implied by the "extended" campusthat there is nothing magic in having all instruction on onephysical location or "campus". A good community juniorcollege may very well regard the community or the area as itscampus, and facilities may be used wherever they provide thekind of teaching environment and climate conducive to bestinstructional practices.

10. In beginning ADN programs, what is the very first "move"of the administrator?

33

First, to determine real need; second, to determinesupport from the professions, the community, and fromfacilities.

11. How do you satisfactorily establish clinical and bedsideexperience opportunities for ADN students with the hospitals?What are tke problems? How are schedules made up? Will youplease tell as what you believe a good contact with thehospital would be? What are special things to which we shouldbe alerted?

Yes, of course there are problems . . . there always arewhen several institutions of varying characteristics, policies,and procedures get togther. However, the problems thus raisedcan be solved through mutual and open communication and areal effort to understand each other's characteristics andqualities. The college must understand that the first job of ahospital is to provide services, either normally or underemergency conditions. The hospital schedule and policies mustbe accepted and understood. The hospital in turn must acceptthat it is providing services to a collegiate institution, and thecontrol, supervision, and policies of the college must beobserved. The people using the clinical facilities are collegestudents, and they are responsible only to college officials andstaff. The supervisor is a member of the college faculty, and isresponsible to the college administration, and not to thehospital. With these understandings and acceptance, mostother problems are easy to solve.

12. What qualifications should a good director of ADNprograms have? Where do we find these people? Could you saysomething about salaries?

A good director of ADN programs hopefully should havehad a successful background of "practice" experience, if

34

possible in several kinds of environments; should be wellfounded in the knowledge areas of the field, a proven recordof competency and skill; some knowledge of the educationalworld, its procedures, activities, and developments, a knowl-edge of the most current devices of instruction, a forwardlooking philosophy, a tendency to develop innovative practicesand procedures, but a maturity that will allow their soundevaluation, a "practical" approach to the profession and to itseducation and training, skill to work with people as a goodadministrator, and a sense of public relations. A person with amaster's degree as a minimum is usually required.

Where would we find such a paragon? Universities andfour-year colleges with programs for preparing such people,hospitals, clinics, laboratories, private practice, and in otherinstitutions. After all, we cannot ignore that junior collegesand other educational institutions are competitive amongthemselves.

No, a general statement concerning salaries could not bemade in fairness. Salary levels differ widely from one part ofthe country to another, depending somewhat upon cost ofliving, size of city or area, and local factors. It can safely besaid that such people as described above are usually in thehigher brackets of the college salary scale.

13. What are major problems to be overcome in securing goodinstructors in paramedical programs? Specifically in the ADNprogram?

The major problems facing the junior colleges in securinggood instructional personnel for the paramedical programs,and this includes the ADN program, is finding competent,experienced people with teaching abilities and an orientationto education, and second, the salaries offered.

A Profile of Accredited Associate DegreeNursing Programs*

In recent years, the entire health field has been involvedin tremendous ferment. The forces initiating these changeshave come from many segments of our society. Recentsocioeconomic developments which have direct implicationsfor nursing include the population increase, increased longev-ity, scientific discoveries, and changes in the public's expecta-tions of the health professions; at the same time, the field isexperiencing a severe shortage of nurses.

As a result of the Cadet Nurse Corps Training Programof the 1940's, many advocated a shortened and revised basicnursing education program. In 1952 the first program leadingto an associate degree in nursing was started in Michigan underthe direction of Mildred Montag. By December 1967 therewere 286 such nursing programs in the United States andterritories. They are found in all geographical areas, withespecially large concentrations in New York, California, andFlorida.

The associate degree is the most rapidly developingprogram in nursing education. The movement is stimulated bythe recommendation of the the American Nurses Associationthat the preparation of both the professional nurse and thetechnical nurse take place in institutions of higher learning; theincreasing interest in technical education in colleges anduniversities; and the tremendous growth of the junior collegemovement.

NEED FOR STUDY

In 1962 the Department of Diploma and AssociateDegree Programs in Nursing of the National League forNursing approved criteria to be used in evaluating suchprograms for national accreditation. As of October 1, 1964,

Reprinted from the Junior College Journal, March 1969.Written by Virginia Barker, dean, School of Nursing, AlfredUniversity, Alfred, New York.

only thirty-two of the 260 known associate degree programs innursing had received national accreditation from the N.L.N.One hundred and twenty-two had received "reasonable assur-ance of accreditation," a preliminary step toward full nationalaccreditation, but 106 of the programs had not had any kir('of national evaluation. This is in spite of the fact that many %them had been in operation a sufficient length of time toqualify for evaluation.

There has been, and still is, the feeling in certain areas ofthe country that specialized accreditation of one segment of ajunior college's curriculum is not needed as long as theinstitution is accredited by its regional accrediting association;thus, nursing programs in institutions with this philosophy donot apply for national accreditation by the N.L.N. The leaguehas also had a shortage of qualified people for accreditationvisits. As a result there is no overall picture available giving thecharacteristics of these programs in general systematicallygathered data are missing.

The purpose of this article is to give a profile of associatedegree programs in nursing which are accredited by theNational League for Nursing, the recognized accrediting body.

A letter was sent to thirty-two programs, requestinginformation concerning such areas as control and type ofinstitution, institutional accreditation, length of programs,degree awarded, tuition charges, entrance requirements, aca-demic areas included in the programs, and the specific numberof hours required in each academic area. Out of the thirty-twoprograms polled, thirty-one answered a response of 96.8 percent.

All data in this paper are based on the response ofthirty-one of the thirty-two programs, unless otherwise stated.

Of the thirty-two programs, sixteen are located in fourstates: seven in New York, four in California, three in Indiana,and two in Colorado. Fifteen states each have one program, as

35

does the Territory of Puerto Rico. Thirty-one states do nothave programs accredited by the N.L.N. as of October 1, 1967.

All of the schools were accredited by their regionalaccrediting associations. Table I shows the number of schoolsaccredited by the various agencies. All six of the regionalaccrediting bodies are represented.

TABLE IREGIONAL ACCREDITATION OF INSTITU-

TIONS WITH PROGRAMS IN NURSINGLEADING TO AN ASSOCIATE DEGREE

Regional bodyNumber ofinstitutions

Middle States Association of SecondarySchools and Colleges 10

New England Association of Colleges andSecondary Schools 1

North Central Association of Colleges andSecondary Schools 1

Northwestern Association of Secondary andHigher Schools

Southern Regional Association of Collegesand Secondary Schools 3

Western Association of Schools mnd Colleges 5

1

Total 31

Table II shows that the majority of the nursing programsare located in two-year public institutions. All but two of theprograms are coeducational. It is interesting to note that 35.4per cent of the programs are found in four-year institutions.

TABLE IICONTROL AND TYPE OF INSTITUTIONSWITH PROGRAMS IN NURSING LEADING

TO AN ASSOCIATE DEGREE

Cor.:.ol Two-year Four-year Total

Public 16 7 23Private 4 4 8

Total 20 11 31

The length of the programs varies from eighteen totwenty-two months. Twenty-three of the programs are eithereighteen or twenty months in length as is shown in Table III.This is considerably less time than the diploma programs(thirty-three months) or the baccalaureate programs (thirty-sixmonths). Even the 25.8 per cent which are twenty-two monthsin length are still eleven months shorter than the diplomaprograms.

36

TABLE IIILENGTH OF PROGRAMS IN NURSINGLEADING TO AN ASSOCIATE DEGREE

IN INSTITUTIONS OF HIGHER EDUCATION

Number ofLength of program institutionsTwo academic years (18 months) 11

Two academic years and one summer(20 months) 12

Two academic years and two summersin months) 8

lotal 31

:able IV indicates the wide variety of associate degreesawarded by the institutions.

TABLE IVKINDS OF ASSOCIATE DEGREES AWARDED

IN NURSING PROGRAMS OFFERED BYINSTITUTIONS OF HIGHER EDUCATION

Number ofDegree institutions

Associate in science 11Associate in applied science 9Associate in arts 6Associate in arts in nursing 2Associate in arts in general nursing 1

Associate in nursing 1

Associate in arts or associate in science 1

Total 31

The cost of tuition for the entire nursing program variestremendously from one institution to another. Table V givesthe 'range of cost of tuition for the total program within eachcategory according to the type and control.

One two-year public community college reports thatstudents matriculating in nursing do not have to pay tuition.The bulletin specifies that this applies to residents andnonresidents of the state alike. Under the private schoolcategory, two schools one two-year institution and onefour-year institution have higher rates for out-of-stateresidents.

The bulletin of one four-year public college states thatthose students registering with honors pay no tuition. It doesnot say whether this applies to residents only or if it is limitedto any one area of the curriculum. If it also applies toout-of-state residents, the range in the category of four-yearpublic institutions would be from no cost to $1,548.

Other costs which are listed by some institutions, butnot by all, include: extra general fees which range from $12to $30 per academic year; health fees, which are sometimeslisted separately, run as high as $44 for two years; uniforms,$43 to $150, and books, $50 to $260.

TABLE VNURSING PROGRAM CHARGES FOR TUITION AND REQUIRED FEES ACCORDING TO INSTITUTIONAL

TYPE AND CONTROL FOR THE ACADEMIC YEAR 1967-1968

Control Two-year Four-year

Private

State resident

Median

In four schools, the range is $700 to$2,400

$1,288Out-of-state resident In four schools, the range is $700 to

$2,400Median $1,628

Public

State resident In fifteen schools, the range is no costto $875 with fourteen of the fif-teen under $650 (six have no tui-tion and one did .not list tuition)

Median $355 $630Out-of-state Resident In fifteen schools, the range is no cost In seven schools, the range is $478 to

to $2,130 with ten of the fifteen $1,548under $1,250 (one did not listtuition)

Median $940 $1,410

In four schools, the range is $1,500 to$2,680

$2,050in four schools, the range is $1,700 to

$2,680$2,450

In seven schools, the range is: no costto $856

Nineteen of the thirty-one institutions have dormitories.The twelve which do not are all two-year public colleges.However, various restrictions are placed on the use ofdormitories. One unique institution has dormitory roomsavailable at no charge to nursing students, both state andout-of-state residents alike. The range for room and board persemester or quarter is from no cost to $748. The highest rate isin a four-year public institution. Two institutions indicate thatthey have dormitories but do not give the rates in theirbulletins.

In one school the students enrolled in the nursingprogram are given a monthly scholarship grant from the city tohelp defray the cost of transportation to and from thehospitals, books, and miscellaneous expenses. The amount ofthe grant is not listed. This is the same school which has freetuition for all nursing students as well as free room and board.

Thus, according to the information listed in the catalogs,it is possible to complete an associate degree nursing programfor as little as $200 to $300 or for as much as $5,600. Bothprograms are two academic years in length, and both areaccredited by the N.L.N. It must be said that these twoprograms represent the extremes on a continuum with themajority of programs falling closer to the midpoint. Theprograms in public colleges usually cost less than those inprivate institutions.

All but three of the institutions indicate that there arescholarships and loans available. Nineteen schools offer part-time work assistance. Five list part-time work as beingavailable but discourage the nursing students from attemptingit because of the demands of their academic schedules.

The entrance requirements of the programs vary aswidely as do the other characteristics, as shown in Table VI.

All schools require entrance examinations for everystudent with one exception: One requires these tests offoreign students only. Five schools use two tests. Table VIIlists the various entrance examinations used and the number ofschools using each one.

Four of the schools are on the quarter system; the restare on a semester basis. The total number of hours in thenursing programs averaged 74.26 credit hours with a range of58 to 109 credit hours. Since one of the characteristics of theassociate degree nursing programs is the emphasis given generaleducation, the programs were examined to see what per-centage of the total credit hours the nursing credits repre-sented.

Table VIII shows that there is a wide variation in theamount of professional education in the thirty institutionsreporting this information. On the average, the four-yearinstitutions have more general education, while the two-yearinstitutions have more professional education.

In order to evaluate in any degree the general educationoffered in a program, it is necessary to see in what areas thehours of general education fall. Table IX distributes the credithours of the programs according to the categories found in anN.L.N. publication representing information from thirty insti-tutions. The greatest difference is found in the range of thenumber of credit hours given for nursing subjects.

37

TABLE VIENTRANCE REQUIREMENTS OF NURSINGPROGRAMS LEADING TO AN ASSOCIATEDEGREE, IN INSTITUTIONS OF HIGHER

EDUCATION, ACCORDING TO TYPEAND CONTROL FOR THE

ACADEMIC YEAR 1967-1968

Requirement

Public Private

TotalTwo- Four- Two- Four-year year year year

Age:Restricted 3 1 2 1 7Not restricted 13 6 2 3 24

High school preparation:Graduate 4 1 3 3 11Graduate or general

equivalencydiploma 11 6 1 1 19

Not specified 1 1

High school coursesrequired orrecommended:

College prepara-tory 8 6 3 4 21

Laboratory scienceand mathematics 3 1 4

Laboratory scienceonly 3 1 4

Not specified 2 2

The second greatest difference is found in the last class.All electives which were not designated as being from aparticular area were placed in this section. This helped tospread the range in that not all institutions have electives intheir nursing programsonly seventeen of the thirty programshave elective credits, and it varies from program to program asto whether the elective credits are to be taken in any particulararea. The greatest number of elective hours given is twenty-five. This is in a private, four-year institution which also re-quires thi largest number of total credit hours of any of thenursing programs. The program is two academic years plus twosummer sessions in length.

Although time is limited in two-year programs, it issignificant that thirteen programs have no elective hours.

The number of science hours runs rather high.Considering the usual time spent in lecture and laboratory, aswell as the preparation and study needed in the science areas,it is possible to understand why such programs are not for theless-academically prepared individual.

Courses in social studies frequently include psychology,sociology, and growth and development; courses in thehumanities encompass ethics, philosophy, literature, foreignlanguages, and the fine arts appreciation courses of music,andart.

38

TABLE VIIPRE-ENTRANCE TESTS REQUIRED FOR

ADMISSION TO NURSING PROGRAMS LEADINGTO AN ASSOCIATE DEGREE, IN INSTI-

TUTIONS OF HIGHER EDUCATION,ACCORDING TO CONTROL ANDTYPE FOR THE ACADEMIC YEAR

1967-1968

Test

Public Private

Two- Four- Two- Four- Totalyear year year year

American CollegeTest Battery 6 3 1 10

College EntranceExaminationBoards 1 2 3 6

Junior CollegeDistrict PlacementTest 1 1

National League ForNursing Pre-Nursing andGuidance Test 1 1

Nursing AptitudeTest of Psycho-logical Corpora-tion 2 2

(Own) School Test 1 1

Regents ScholarshipExamination 1 1

Scholastic AptitudeTest 6 2 2 4 14

State UniversityAdmission Ex-amination 1 1

Total 18 7 5 7 37*

*Six institutions use more than one test.

TABLE VIIIPERCENTAGE OF NURSING CREDITS REPRE-

SENTATIVE OF TOTAL CREDITS IN PROGRAMSLEADING TO AN ASSOCIATE DEGREE, OFFERED

BY INSTITUTIONS OF HIGHER EDUCATION,ACCORDING TO CONTROL AND TYPE FOR

THE ACADEMIC YEAR 1967-1968

InstitutionRange

(per cent)Mean

(per cent)

Public:Two-year 41.09 to 67.58 52.12Four-year 41.02 to 53.00 48.27

Private:Two-year 40.62 to 50.66 46.53Four-year 35.89 to 54.54 43.58

All Programs 35.89 to 67.58 49.37

There is a great deal of variety in tuition costs, entrancerequirements, facilities offered, and courses required in nursingprograms leading to an associate degree.

Although variety in educational offerings is desirable inorder to meet the different needs of students, there must besome consistency which identifies the discipline in general.Criteria which permit wide variations do not give sufficientguidance, especially during this period of tremendous growthin numbers of programs when many qualified and experiencedleaders in associate degree nursing programs are so few. If theassociate degree programs are to provide large numbers ofqualified individuals prepared to give bedside nursing care, theprograms must be planned on sound educational principles;they must meet the needs of the nurse both professionally andgenerally, insofar as it is practicable to do so.

There are limits, of course, in a two-year program. Thechallenge is to provide, within those limits, a program neithertoo pretentious and thus unreasonable nor too narrow andthus unduly confining. The associate degree programs have theadvantage of being able to select from a wide range of generaleducation offerings, but selections should be made wisely.There should be some room for individual preferences; educa-tional programs must not dictate every course hour.

Those individuals in the associate degree programs innursing must assume the responsibility for carrying on research

projects in their area. If they wish their area to be accepted byothers in general, and, if they want this area to make thetremendous contribution to the nation's health of which it iscapable, then they must secure the answers to manyproblems: What should the entrance requirements be? Dorestrictive requirements such as high school graduation, certainage limits, and college preparatory courses upgrade the kind ofstudent enrolled at the expense of losing many others withgood potential for nursing? If this does occur can we justifythis practice in light of the nation's health needs? What doesthe associate degree program intend for its graduate to developas a result of the educational program in the way of specificskills, knowledge, and attitudes? What are the expectations ofnursing service employers? Are there any differences?

Other questions need investigation: Do the present stateboard examinations adequately evaluate the graduate of anassociate degree program in nursing? If they do not, howshould they be changed? How does the performance of thegraduate of the non-N.L.N.-accredited school compare withthe graduate of the N.L.N.-accredited school, and what are theimplications for both schools?

It is time to substitute careful study and analysis forpersonal beliefs and blind obedience to tradition. The associatedegree program represents an important step toward meetingthe critical need for nursing care. But we must take care tobuild a solid foundation for this enterprise or a valuableeducational venture will be lost for lack of critical evaluation.

TABLE IXDISTRIBUTION OF CREDIT HOURS IN NURSING PROGRAMS LEADING TO AN ASSOCIATE

DEGREE, OFFERED IN INSTITUTIONS OF HIGHER EDUCATION, ACCORDING TO CONTROLAND TYPE FOR THE ACADEMIC YEAR 1967-1968

Category

Range of credit hours Average credit hours

Public Private Public Private

Two-year Four-year Two-year Four-year Two-year Four-year Two-year Four-year

Nursing 30-50 30-52 26-38 25-36 38.53 37.71 32.50 31.00

Social studies . . 6-15 8-15 9-17 6-18 10.86 11.43 12.75 10.75

Humanities . . 0-9 0-9 0-3 0-9 3.06 4.14 .75* 4.25

Natural sciences 3-16 7-16 9-15 9-17 11.20 11.57 13.25 13.00

Communications 3-12 3-11 6-12 3-10 7.00 6.71 6.75 6.25

Others (includeselectives) 1-12 0-22 0-8 0.6 4.20 7.57 4.50 3.50

*Of the four private two-year institutions, only one program has a three-hour course in the humanities. Thus, the average for thefour institutions is .75 credit hours for the category "Humanities."

39

Mental Health Technology Program:Present and Future*

The rapid expansion in mental health services in recentyears has magnified the already acute shortage of professionalpersonnel. There is now increasing awareness that many time-consuming tasks being performed by professional workerscould be delegated to qualified persons who have beeneducationally prepared for an assisting role.

In response to this demand for the training of thesubprofessional worker from the mental health institutions thecommunity colleges of the nation became interested in theestablishment of such training programs. Historically thecommunity college has been very sensitive to the needs of thecommunity and the area of mental health proved to be noexception.

The first two year program in community colleges beganon the Fort Wayne Campus of Purdue University. This twoyear curriculum was launched in 1966 to meet the specificmental health needs as viewed by the staff at PurdueUniversity.' Since that time a number of community collegeshave initiated programs in the area of mental health tech-nology training.

The response to this demand occurred as a direct resultof the need to provide semiprofessional personnel to meetpatient demands and needs. These needs were unmet andlargely ignored, not deliberately, but due specifically to thelack of service personnel to carry out functions and tasks atthe local institutions. It was realized at an early date that theincreased output of Ph.D. psychologists, M.D. psychiatrists,master's degree psychiatric social workers, and R.N.'s couldnot fill the crisis demand for mental health workers at a pacerapidly enough to keep up with the current demand much less

*James L. Moncrief, director, Career Programs, Departmentof Mental Health, State of North Carolina, Raleigh, NorthCarolina.

40

meet the expanded needs of the institutions nationwide. Theresponse to this demand came from a number of institutions.

Those institutions that responded by establishing pro-grams are: Amarillo College, Amarillo, Texas; Black HawkCollege, Moline, Illinois; Catonsville Community College,Catonsville, Maryland; Central YMCA Community College,Chicago, Illinois; The City Colleges of Chicago (specializedcurriculum on specific campuses); Community College ofBaltimore, Baltimore, Maryland; Community Collge of Phila-delphia, Philadelphia, Pennsylvania; Daytona Beach JuniorCollege, Daytona Beach, Florida; Essex Community College,Baltimore, Maryland; Jefferson State Junior College, Birming-ham, Alabama; Kingsborough Community College, Brooklyn,New York; Metropolitan State College, Denver, Colorado;Miami-Dade Junior College, Miami, Florida; Sandhills Com-munity College, Southern Pines, North Carolina; SinclairCommunity College, Dayton, Ohio; Somerset CommunityCollege, Somerset, Kentucky; Sullivan Community College,South Fallsburg, New York; Thornton Junior College, Harvey,Illinois.

Institutions scheduled to begin programs in the summeror fall quarter are: Western Piedmont Community College,Morganton, North Carolina; Montgomery College, TakomaPark, Maryland; Greenville Technical Educational Institute,Greenville, South Carolina; Borough of Manhattan CommunityCollege, New York, New York.

The need for this type of training program is exemplifiedby comments made by those individuals on the firing line. Dr.Frank James, superintendent of Cherry Hospitql, Goldsboro,North Carolina, has stated in writing and at conferences thatthe only answer to the current manpower shortage is the train-ing of the subprofessional or middle-level mental health workerto meet the acute needs of the state mental health system, notonly the psychiatric hospital but comprehensive mental healthcenters. "There can be no hope for meeting manpower needs,"

James continues, "if v... rely solely on master's degree levelworkers. Concurrently we would develop a career ladderbaccalaureate program to provide upward mobility for theseindividuals that we have trained as a two-year technician."

Dr. Robert M. Vidiver, director of education for theDeparture; of Mental Hygiene, State of Maryland, has writtennumerms articles on the specialized needs and nature of theassociate professional worker and has stated that the approachto major problems in the medical-paramedical field is thegreater utilization of the middle-level or the associateprofessional types in the health fields.

However, to effect this we must design appropriateundergraduate curricula and field instruction to prepare suchbeginning personnel for entry-level positions of higher respon-sibility. Students enrolled in the mental health programs atSandhi!Is Community College expressed the concept which isgenerally found throughout the mental health technologytraining programs. They were exceptionally pleased with therelatedness of the classroom instruction to the actual clinicalrequirements. They were being told "like it is" in theclassroom phase of their mental health program. There was nohesitation on their part to implement the classroom instruc-tion for it is meaningful and directly related to the activitiesencounte..vd in the clinical setting.

Students involved in the clinical phase of the JeffersonState Junior College program in Birmingham were quiteimpressed, however, initially shocked with the problemsconfrontin; the mental health worker in the psychiatricsetting. They felt that the clinical experience would enablethem to cope with problems of similar nature in the future andprovide for a more meaningful work role as a result of thedetailed and well-programmed clinical supervision and experi-ence. These students were much impressed with the comple-mentary aspects of the academic and clinical practicum. Theydove-tailed very nicely, for each complemented the other andprovided a more meaningful job experience for them.

Dr. Ralph Simon of the National Institute of MentalHealth has expressed his interest through NIMH support ofcommunity college training programs. Recently he stated thatthe future of the associate worker in the field of mental healthis very bright for the training programs are quite meaningful,but the individual must realize that he is being trained forskills that a baccalaureate worker or a master's degreeworker may not possess. Thus, the associate-level worker is ahighly trained individual and can fill many of the roles inour mental health institutions that are yet unforeseen. Thisis an answer to the current crisis of supplying manpower forthe mental health field.

Mr. Ingram Pannley, the dirt.;tor of the SandhillsCommunity College mental health technology program re-ported that the students enrolled in this curriculum areabove average and the training program thus structured bythe institution must provide for high competency skills forthese students. The student tends to mature very rapidly andperform services unanticipated at the of .,et of the program.The clinical portion of the program assisted in this matura-tion process and the use of "the group" has caused many ofthe students to become more useful members of the commu-

nity in addition to a more competent member of the mentalhealth team.

The curriculum for training the mental health technicianis not standardized in the sense that there are specificsestablished for all curriculum; however, many of them sharesome commonalty in a concentration in the field of socialsciences as a basic point of departure. However, the curriculaoffered varies so that in some cases there may be found onlythree hours of clinical or field experience, with heavyconcentration in general education courses and three or fourmental health technology courses. Other programs have asmany as twelve mental health technology training courses,with 48 credit hours of clinic or field experience. Someprograms carry heavy concentration in courses such asEnglish and the biological sciences, while others carry nosuch courses as part of the required curriculum. In manycases this is taken with the elective credit and incorporatedas part of the elective sequence of courses.

The clinical schedules of students enrolled in such aprogram are many and varied. Basically, one can take themedical and nursing model in which the students are assignedto a specific type of case, as an introductory aspect, and thenfollowed by assignment to individual patients and follow thesepatients through the entire resocialization and/or treatmentactivities that he receives in the hospital. On the newgeographical unit-type organization of state hospitals thisinvolves all aspects of the mental health treatment teamactivities. In the unit organization the patient is assigned to ageographic unit with specific services being performed byconsultants coming to the unit, thereby altering the system ofpsychiatric care from the old illness orientation to thetreatment of the individual in a geographic unit setting. Theoccupational therapist is brought in with the nurse, thepsychiatric social worker, the psychologist, the psychiatrist.Thus, the patient is no longer assigned to a ward for acuteillness, schizophrenia, paranoia, etc.; he is assigned to aspecific geographic area unit and then treated with otherpatients who may have completely unrelated illnesses, andwith completely dissimilar problems. Thus, a student assi-gned to a patient in this setting will receive a broader scopeof clinical experience. There are two methods of patientassignments. One is the full-time assignment for a completequarter of twelve weeks, during which time the studentactually works almost an eight-hour day with the patient.This is not comparable to the apprenticeship or guild-typeorganization. But the student is actually working with thepant nt. In a sense he becomes a member of the treatmentteam and follows that patient daily over an extended periodof time.

A second method of work assignment is the fragmenteddaily assignment during which time the student may spendthree days a week on the unit with patients, two days in anacademic classroom setting or in some other assignment. Thestudent normally is assigned a three -or four-hour block oftime during those days of clinical assignment. Or he may begiven a full day on the two or three days which he is assignedto the unit and the patient. This would permit the student towork in a multiple assignment situation of which three hourscould bt assigned to patient A, three hours to patient B, orTuesday-Thursday assigned to A, and Monday, Wednesday andFriday assigned to B. The advantages of these assignments are

41

debated, and no attempt will be made here to identify themore preferable type of assignment.

These assignments and work schedules are designed forthose students working in the psychiatric hospital setting. Thestudent receiving clinical experience in the comprthensivecommunity mental health center will have a different type ofassignment. Here the student will work with families on amore prolonged basis than the psychiatric hospital setting, andhave more direct contact with the community, and will dealwith more varied problems in the setting of the mental healthcenter. Also the student is involved with assignments which ofnecessity will take more time during the day and the weekbecause of the different types of patients seen and thedifferent services offered such as aftercare and the problems ofresocialization while the patient is living in his community.The student is assigned to the role of an observer and then as aparticipant in the therapeutic team relationship.

Another assignment for the student in this curriculummay be in the areas of social welfare, travelers aid, assistant toschool guidance counselors (to serve as a crisis-type counselorwhen the professional counselor is not available),involvementin mental retardation centers vital children's educationalprograms, and in the area of alcoholic rehabilitation. Studentscan provide invaluable service in assignments to such rehabili-tation centers and can receive excellent experience for this in acombination of the hospital and comprehensive mental healthcenter assignments.

The future of mental health technology training pro-grams is extemely bright, and a few trends have beenidentified. First, the rapid development of technician trainingprograms is a commonly recognized phenomenon, for thebeginning of September 1%9, will see the number of collegesoffering such training programs more than double. This hasbeen brought about by two factors the communitydemanding better mental health treatment and by the mentalhealth professionals who have recognized that the need forassistance is quite critical, and this is a means whereby thisneed can be met. Thus, with pressure coming from theprofessionals and the community, the community collegeresponded to these sensitive needs and proceeded to launchnew training programs for the associate professional.

A basic trend which is not as widely recognized has beenthe movement from the extremely, highly specialized mentalhealth technology programs to a more generalized, or general-ist, approach. This has been evident in individual discussionsand conferences, and is documented by a curriculum surveycompleted in January 1%9. Programs which started withhighly specialized curricula are now in the process of curric-ulum revision and are developing new curricula with moreconcentration in the area of generalized studies in the mentalhealth field.

42

The obvious reason for this change in training activitiesstems from the need to fit this person into a broader field thanwas originally defined for the mental health worker. Aspointed out in this article,the trend in mental health treatmenthas progressed from the illness classification and grouping ofpatients on wards or units by this method to the geographicalunit classification with those workers assigned to a variety oftasks from recreational therapist assistants to a member of thegroup therapy treatment team. Thus, a person trained innarrow skills, so highly specialized, would not feel comfortablein such a broad role as the new treatment team approachdictates in our current systems. Additionally, the communitycollege can train this mental health worker to serve not only inpsychiatric hospitals, which is one phase of employment need,but to function in the comprehensive community healthcenter which is a most valuable addition to the national mentalhealth system.

Outside the mental health system there is an oppor-tunity for this generalist to work as an assistant to the schoolguidance counselor to provide first-line consultation andreferral to the master's degree-level counselor. Under thelimited budgets the system is not able to provide a "mastercounselor" for all of these positions. This would enable theschool systems to employ a larger number of associatecounselors to guarantee the students and their parents accessto d guidance counselor when the need arises.

With the generalist background the student can performin various Red Feather or United Fund agencies, which inmany cases are dependent upon individuals with limitedtraining or who cannot devote a great deal of time to suchactivities.

With the current manpower shortage in the field ofmental health, the need for this type of worker is extremelygreat. There is, at this point, no danger of flooding the laborforce with this graduate,for we envision the retraining of ourcurrently employed aides and technicians through theseprograms. Hence, they will become a part of the pool ofassociate degree trained workers.

A statement on the shortage of health manpower doesnot need repeating and this type of training program for theassociate worker offers the most sensible and coherent answerto a complex, chaotic and confusing system of education andtraining (education composed of in-service programs, limitedon-the-job training, and the employment of some individualswith records which at best are questionable). This type ofeducation/training program will at least assure the patient thathe is receiving competent care and from an individual who itbasically trained as a "people worker," and not a stop-tapemployee thrown into the system to fill aitical personnelneeds on an ad hoc basis.

Community College Programs inMental Health Technology*

People working in the mental health professions are wellaware of the manpower shortage which has existed for manyyears. In mental hospitals, facilities for the mentally retarded,psychiatric clinics, day care centers, halfway houses in fact,in every type of mental health service, there is a critical lack ofmental health personnel at all levels. With the development ofcommunity mental health centers and demands for mentalhealth services from such establishments as welfare agencies,correctional institutions, courts, and public schools, theshortage becomes even more acute.

The supply of personnel already falls far short of thedemand. As more and more agencies and facilities areestablished to meet the needs of the mentally ill, the mentallyretarded, and others in need of services, new and effectiveways must be found to identify, recruit, train and placepersonnel to do this work.

In his book, Mental Health Manpower Trends, writtenfor the Joint Commission on Mental Health and Illness (1960),Dr. George Albee made a strong plea for the development ofworkers who could be trained in shorter periods of time thanthe traditional training periods of the existing professions suchas psychiatry, clinical psychology, psychiatric social work, andpsychiatric nursing, and yet be prepared tv do many of thetasks common to a.L of them.

The objective of this new kind of training is not toprepare a person for independent practice psychiatry,medicine, psvchoiogy, nursing, etc., but rather to develop a"middle 41),--el" mental healih worker capable of performing

*Harold L Mcriteeters, associate director for mental healthtraining and research, Southern Regional Education Board(SREB), .4tlania, Georgia, and E. .Io Baker, consdtantRED Commorety Mental Health Worker Project, GeorgiaInstimie of Technology, Atlanta. Georgia.

many of the tasks now verformed by ine professional and inmany cases of extending the impact of the professional. Thistechnologist would be a mental health generalist trained towork in a wide variety of mental health seivic:s. He would becapable of exercising considerable independence of judgementand action, but would always work under the general directionof an established mental health program.

This new class of mental health worker, then, woulddevelop skill necessary to render services which do not requirethe individual attention of the highly skilled professional, butwhich require more skill and knowledge than that of thetraditional aide.

Although the need for this mental health technologisthas long been recognized, it was not until recently thatcommunity junior colleges were given serious consideration asresources for training such workers. In 1965 the NationalInstitute of Mental Health funded an experimental program atthe Fort Wayne campus of Purdue Uni-..ersity,and a conferencefor the Southern Regional Education Board in April 1966, toexplore further the possibilities for training between commun-ity college authorities and menial health professionals. Sincethat conference, NIMH has funded a small ntmtber of otherexperimental programs, namely at Daytona Beach JuniorCollege in Florida; Metropolitan State College in Denver,Colorado; Sinclair College in Dayton, Ohio; and JeffersonState Junior College in Bic:1140am, Alabama.

Interest in developing various mental health workerprograma is spreading rapidly across the nation, and programsare being inaugurated without waiting for evaluation of theexperimental pogrom For example, in September 1968,there were nine colleges with mental healli technoiogprograms in operation. By September 196(:, there will betwenty-seven such programs, and according to estimates, byJanuary 1970, as many as fifty-wen programs will beunderway.

43

With this kind of booming interest, it is time to take acareful look at some of the existing community collegeprograms, clPtermine trends, and point out some of thecautions that should be kept in mind by persons interested indeveloping programs in mental health technology.

Most colleges offering programs in mental health tech-nology established a planning committee of educators andlocal mental health professionals to help them develop acurriculum. In some cases where the members of the planningcommittee all came from a single agency (i.e., state hospital,community health center, etc.), or a single profession (i.e.,nursing or psychology), the curriculum was naturally biased inthe pattern of these agencies or specialties. This may be well ifit is anticipated that nearly all of the graduates of the programwill work in a single agency or with a single discipline.Generally, however, the colleges want to prepare a mentalhealth generalist who can work in a wide variety of mentalhealth settings and with several different disciplines. Sincegraduates of these programs are expected to possess suchversatility, the planning committee should be representative ofthe various agencies and generally knowledgeable aboutprogram activities in mental health and mental retardation.

While most colleges have set out to prepare a mentalhealth generalist, a few have focused on training of specialistsin such areas as mental retardation, alcoholism, psychiatrichospital care, or community mental health. Most of thegeneralist programs have put a heavy emphasis on communitywork. As such their graduates may resemble the graduatesother programs variously describcd as social service assistant,community service technician, child care worker, and voca-tional counseling assistant. While mental health technologyprograms are generally classed as "health-related," they areequally related to both the health field and the field of socialwelfare. In a few cases programs in mental health technologyare included in the social sciences area of the college.

Examples of the kinds of work settings graduates mightbe expected to enter are state mental hospitals, psychiatricunits of general hospitals , psychiatric clinics, programs foremotionally disturbed children, institutions for the mentallyretarded, day care programs, community mental health cen-ters, mental health associations, halfway houses, shelteredworkshops, and consultation and education programs. Ob-viously such a generalist will require a period of in servicetraining in the specific agency and role in which he is to beemployed. He will not be an expert in any single area after histwo years of college training.

The mental health field poses a nevi problem in.siciploying community college-trained workers because mostagencies have never used such people and therefcn-e have, nobudgeted positions or job descriptions for them. Up to nowthe mental health field has been dominated on the one handby highly sophisticated professionals and or. the other hasbeen heavily weighted with aides who receive only a fewmonths of on-the-job training.

Since the agencies and services wail be the inarketplacefor future graduates, it is especially important that juniorcolleges considering programs in mental health technologyestablish good working reiat;onshtps with state and local

44

mental health agencies and Flan with them the kinds of tasksand activities that will be expected cf the graduate. Carefulforesight and planning will help to assure that jobs atsatisfactory salaries will be available to the graduates. Thisplanning cannot be postponed until a few months ahead of thestudent's graduation day since many public agencies, in orderto obtain legislative budget approval, process personnel paperwork, etc., must know as much as two years in advanceprecisely how many positions must be established anc vhatpoints in time. A superficial one-time inquiry or questionnaireis far from adequate to determine these needs. A few collegeshave neglected this part of the program planning and now findthat their graduates are unable to find suitable employment.

Only after there is assurance that budgeted positions atadequate salaries and with adequate career developmentopportunities and supervision are available for graduates, andafter the mental health agencies have clearly specified thekinds of skills they expect the graduates to possess, can therebe planning for a specific curriculum. In most of the existingprograms the curriculum contains a balance among the fourtypes of offerings:

1. Basic liberal arts courses (English, history, etc.)

2. Basic behavioral science courses (psychology, sociol-ogy)

3. Courses in mental health technology

4. Field experience.

Community junior colleges would seen' to offer asplendid opportunity for total curriculum development with-out being hamstrung with traditional departmental autonomy.If the faculties representing these four offerings could plantogether toward the objectives of the program, small butsignificant changes could be made in some of the moretraditional courses to make them relate better to each otherfor the ultimate advantage of the student. For example, ageneral psychology course might be modified to place lessemphasis on physiological and animal behavior and more onclinical and human behavior.

Programs may vary widely in the structure of thecurriculum, especially in the fourth category, field experience.In general, program planners have offered students fieldexperience beginning early in the program, feeling that this isextremely in.portant to enable the student to gain experiencein working with people throughout the training program. Fieldexperiences provide opportunities for the student to developsome basic skill in interviewing people, to listen and accuratelyperceive what others are saying, and to understand familyrelationships. It also enables the student to communicateface-to-face with the client, to be natural and at ease withtroubled pewle, and to establish accurate empathy with theclient. Some academicians may consider these objectives toosimple for the junior college student; nevertheless, they arebasic skills for the human services. just as reading and writingare basic skills for the learned professions, and they are nottaught elsewhere in academic programs.

The objectives of the field experience should be welldefined. Is the purpose to provide the student with a briefacquaintance with several different settings? Is it to give thestudent an opportunity to see mental health professionals atwork? Is it to provide experience in working with disturbedpersons? Or is it to give the student a challenge andopportunity to solve real-life mental health problems underteaching supervision? Will there be a seminar in whith severalstudents discuss and share their field experiences' Who willsupervise the student in his field work classroom teachers oragency staff workers? Programs vary greatly depending uponthe answers to these questions.

The rationale for including any basic course in theprogram should be carefully developed. For example, onecourse that is sometimes (but not always) included is biology.The rationale for including biology often is not firmlyestablished in relation to the goals of the mental healthtechnology program. It is not sufficient to include biology in amental health program simply because mental health is ahealth-related field.

The contents of the courses in mental health technologyalso depend to a considerable extent on the goals of theparticular program. Some programs include courses in psycho-pathology, theories of personality development, treatment andrehabilitative approaches, group process, and behavior modifi-cation techniques. Other courses relate to the mental healthprofessions and the institutions concerned with mental disor-ders and to special problem areas (i.e., children, alcholics, theaged, the mentally retarded). Some courses emphasize devel-oping the student's skill in functioning as a therapeutic agenteither individually or in a group situations. Sensitivity trainingis sometimes a part of the program.

Faculty for the mental health programs generally includefrom one to three full-time classroom teachers drawn from thedifferent mental health professions. One of these usually servesas the program director. As the programs enroll more students,they require larger faculties, of course. Persons who supervisethe field experience may be paid by the college or by theagency. Most programs favor a close relationship between thefield work and the college, and joint appointments for agencypersons on the faculty of the college are not uncommon.There should be a written agreement between the faculty ofthe school and the staff of the supervising agency to assurethat there is mutual understanding regarding what is expectedof the student and what are the responsibilities of thesupervisor.

An important part of the program director's responsi-bility is to assure that provision is made for evaluation of theprogram, especially since these programs are still in theexperimental and developmental stages. Much data is neededabout the students who enroll in the programs, information asto age, sex, educational level, and prior experience in mentalhealth is needed, as well as assessments of maturity level,personality traits, etc. Consideration should be given todeveloping ways to measure progress in knowledge, skill, andmaturity of the students.

When students graduate, other questions need to beanswered: Where do they go to work? What and how well do

they do? What is their salary level? What problems do theyencounter? What changes might be made in the program tomake training more effective? How do employing agencies rateathe nit.: of the graduate's work? What is the overall cost ofthe program? What is the cost per student?

Meaningful evaluation requires that complete and de-tailed records be maintained on each stuent. (The SouthernRegional Education Board is developing some guidelines onevaluation.)

Thus far in existing programs, women students faroutnumber men. Two populations of women appear to beequally represented those just graduating from high school,and those in middle life. Ways should be found to recruit moremen into the programs.

The number of students in any program is usually small,ranging from ten to thirty. At this time only two programshave graduates. Most of these have been employed in vuiouscommunity agencies rather than in the regular mental healthinstitutions and agencies. With so few graduates in the field, itis much too early to make predictions on where most of themwill ultimately find employment. A few programs haveattempted to recruit disadvantaged students without muchsuccess. It would be helpful to include remediation programsalong with, or prior to, the metital health technology coursework if disadvantaged students are recruited.

The cost of these programs is not as high as for someother health-related programs, primarily because there is noneed for expensive laboratories and equipment. On the otherhand, the cost increases if the college pays for the fieldsupervision where the teacher-student ratio is high. The costalso varies with the number of part-time, special facultyemployed, such as psychiatrists, clinical psychologists, and thelike.

No data are available on student costs, but manystudents are on stipends or are working part time at nearbymental health institutions or agencies. Many of the studentsare psychiatric aides who enrolled in the program to improvetheir performance and upgrade their salaries, especially in thestates where career ladders have been developed for personswho want to move up. Some persons have suggested thatrecruiting psychiatric aides is a good way to begin a newmental health technology program since it provides a group ofwell-motivated students who already know something aboutthe field and are able to articulate more precisely what theyperceive to be their educational needs.

Several of the programs have made special provisions foradvanced students to participate in planning the program.These students we encouraged to speak up for what they feelshould be in the program, either in course content or in fieldexperience, that might not have been considered in the initialplanning.

Based upon reported experiences of existing mentalhealth technology programs, the following guidelines areoffered to community colleges interested in developing similarprograms. Although adaptations and modifications of thefollowing statements may be recessary to meet unique

45

situations, it is recommended that they be considered. Thevarious steps are numbered for clarity and to indicate thegeneral direction that planning should take. It is understoodthat several phases of the planning must be carried onsimultaneously.

GUIDES FOR PROGRAM PLANNERS

PRELIMINARY STEPS

1. Appoint a director of the program whose primaryresponsibility is to articulate and coordinate the contributionsof the community college faculty, the students, variousagencies, and other interested parties. To a great extent, thedirector's skill in interacting with these various individuals inorganizing and coordinating their efforts, and in followingthrough on the multiple aspects of implementation willdetermine the success of the program.

The program director should work closely and continu-ously with agency supervisors to assure that the work thesemental health technicians do is more than just routine aidework, and to assure that opportunities are provided for thesepersons to move up to positions of greater responsibility andpay. Otherwise, these workers may become locked intodead-end jobs with the inevitable consequences of poormorale and high turnover.

The program director should keep in touch with localfour-year colleges to assure that at least a reasonable core ofthe community college credits is acceptable for transfer tofour-year colleges for graduate who aspire to higher levels ofacademic training.

2. Appoint an evaluator. To avoid a possible conflict ofinterest or contamination of the data, the evaluator, ideally,should not be directly involved in the teaching phases of theprogram.

The appointment of these two individuals is crucial tothe success of the program.

3. Establish a planning committee. The composition ofthis committee may vary depending upon the needs of theparticular community in which the graduates are expected tofind jobs. As mentioned earlier, it should be representative ofall institutions and disciplines involved in the program.(Interested and knowledgeable persons in the general com-muPiry should not be overlooked. Their enthusiasm andinfluence can be valuable assets to the program.)

4. Make a thorough analysis of the surrounding geo-graphical area to determine the number and types of agenciesthat might employ mental health workers trained by commun-ity colleges. Be liberal in the survey and include all possibleagencies, such as hospitals, schools for the retarded, correc-tional agencies, juvenile courts, children's agencies, varioustypes of clinics, etc.

5. Contact the key people within each agency. Includethe superintendent or director of each facility, the chief ofeach discipline, and the administrator of each clinic or servicewithin the agency. Explain to them the general goals of the

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program and try to involve as many of them as possible in theprogram. If possible, include them on the planning committee.The probability of developing a successful program is directlyrelated to the degree of commitment and support of theagencies. A strong effort should be made at this time to assurethe representatives of each discipline that the program is notbeing designed to train "junior professionals" but rather todevelop a different kind of worker whose skills will supple-ment those of the professionals.

6. From these agency representatives, obtain as muchinformation as possible about their needs and willingness tocooperate in developing the program to train this new type ofmental health worker. The following kinds of information willbe needed:

a. Their ideas about the tasks and activities thatcommunity college-trained mental health workers might carryout

b. The basic knowledge and skills that would berequired to fulfill these functions

c. The best methods for obtaining the above

d. Attitudes expected of such workers

e. Personality traits desired in such workers

f. The salary such workers might expect to receive

g. Problems anticipated relative to the introductionof such new workers into their agency and su:,:estions foravoiding or overcoming conflicts or problems

h. Degree of commitment to such a training pro-gram, specifically: supervision of students, teaching specialtycourses at the community college, hiring graduates, assistancein evaluation of the results of the program. It is necessary thatboth the community college and the agency clearly understandthe role the agency is expected to play in the program. Writtenagreements are desirable. Where agencies have had experiencewith nursing contracts, the situation is simplified. Otherwise,progress toward written agreements may have to develop in aseries of tentative steps.

Some existing programs devoted the first year to layingthe groundwork as outlined above. Once this was done theyfound that other steps of program development followedsmoothly, including the final and crucial stage successfulplacement of graduates in the field.

DEVELOPMENT OF TRAINING PROGRAM

1. Goals: Generalist versus specialist: The mental healthhealth worker will be a specialist in one sense of the word; thatis, he will receive a particular type of training that will enablehim to work effectively with people who have problems. Thedegree of specificity is another question. The needs of theparticular community should be carefully considered indetermining how specialized a program will be. As a generalguideline, broad training in concepts relating to mental healthis desirable. Then the needs of the region as well as the unique

strengths of the individual student should determine thedegree and type of specialized training to be undertaken.

2. Courses: What is the course designed to do? Specificobjectives should be established and documented for eachcourse. Involvement of the total faculty is obviously needed.Efforts should be made to insure that each instructorunderstands the relevance and the relationship of his particularcourse to the overall goals of the program. In the basic collegecourses such as English, biology, etc., which the students takefrom the general faculty, the problem of relevance becomesmore complex. Some program directors have found, however,that members of the general college faculty are eager tocooperate if they understand the objectives of the program.

Consideration should be given to transfer ability ofcourse credits acquired in the mental health program to otherprograms in the community college or to progranas at afour-year college.

3. Field experience: Ideally the student should beexposed to a variety of work situations which provideopportunities for the identification and development of thestudent's individual strengths and interests. If active communi-cation is maintained between the field supervisors and thecommunity college throughout the training, problems oftencan be identified early and handled with a minimum of effort.Overall supervision of the student and the integration of his

field experience with the academic situation help to providefor his maximum personal growth.

At all times during the training program, thestudents should be encouraged to ferret out work arrange-ments that might have been overlooked at the inception of theprogram. In some instances, novel arrangements discovered bythe students have developed into permanent employment.

4. Faculty: Experience has shown that clinicallyoriented rather than academically oriented instructors aremore effective in teaching the mental health courses. Where-ever feasible, experts from the field should be used. At thepresent time there are no preferences for any particulardiscipline of faculty.

The possibility of using graduates of the mental healthprograms as part of the faculty should not be overlooked.Their training and experience can be valuable.

5. Students:a. Recruitment: Use all possible sources to let

potential students know about the program. Radio andtelevision programs, newspaper articles, personal appearancesat high schools and civic organizations, and descriptivepamphlets circulated among the college and high schoolpopulation have been used advantageously. Ways should besought to reach the disadvantaged.

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