An application of Stark's framework

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Title:
An application of Stark's framework identification and validation of criteria to evaluate science course delivery systems
Added title page title:
Criteria to evaluate science course delivery systems
Physical Description:
xiv, 297 leaves : ; 28 cm.
Language:
English
Creator:
Heath, Zolika A ( Zolika Anna )
Publication Date:

Subjects

Subjects / Keywords:
Paramedical education -- Curricula -- United States   ( lcsh )
Science -- Study and teaching (Higher) -- Evaluation -- United States   ( lcsh )

Notes

Thesis:
Thesis (Ph. D.)--University of Florida, 1988.
Bibliography:
Includes bibliographical references (leaves 274-295).
General Note:
Typescript.
General Note:
Vita.
Statement of Responsibility:
by Zolika A. Heath.

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Source Institution:
University of Florida
Rights Management:
All applicable rights reserved by the source institution and holding location.
Resource Identifier:
aleph - 001079356
notis - AFG4288
oclc - 19087341
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AA00002138:00001

Full Text
I
















AN APPLICATION OF STARK'S FRAMEWORK:
IDENTIFICATION AND VALIDATION OF CRITERIA TO
SCIENCE COURSE DELIVERY SYSTEMS


ZOLIKA


EVALUATE


HEATH


A DISSERTATION PRESENTED TO THE GRADUATE SCHOOL
OF THE UNIVERSITY OF FLORIDA IN PARTIAL
FULFILLMENT OF THE REQUIREMENTS
FOR THE DEGREE OF DOCTOR OF PHILOSOPHY

















COPYRIGHT


ZOLIKA


1988


HEATH


























you


can


trust


yourself


when


men


doubt


you,


make


allowance


their


doubting


too;


you

you


can

can


dream--and

think--and


not

not


make

make


dreams your m

thoughts your


aster;

aim;


Yours


the


Earth


everything


that


Rudyard


Kipling


dedicate


this


study


my parents


who


gave


life


Bell


who


helps


make


life


fun.
















ACKNOWLEDGMENTS


acknowledge


the members of the Alumnae Association


the Mount Sinai Hospital


School


of Nursing,


New York


City,


the


personnel


of the College of


Pharmacy


, University


Florida,


and the owner


and artist of


Satellite


Dance


Studio,


Jacksonville


for their


financial


assistance.


thank all


those who assisted


with


preliminary


critiques


necessary


for this


study


especially


. Gutekunst


Gudat.


Special


gratitude


is due


participants


this


professional


study.

staff c


Also


express my


)f the education,


appreciation


health


center,


and main research


libraries.


It was my privilege


to have been associated with many


outstanding people during my


studies


the University


Florida.


extend my


appreciation to


Kern Alexander


Dr. Margaret Morgan,


and Dr.


John


Wahl.


also


thank


Dr. Darrel


Mase


offering his


support and sharing


ideas.


thank my


committee members


, Dr.


Arthur Sandeen and


Albert Smith


III.


Special


thanks go to


Sandeen


open door policy


and trust shown toward me.


Lastly



















TABLE OF CONTENTS

Page


ACKNOWLEDGMENTS...........................................iv

IIST OF TABLES................. .. ..... ......... ........ viJ)

LIST OF FIGURES............................. ..*..........xl

ABSTRACT. ....... ..... ......................... .. ... .xii

CHAPTERS


INTRODUCTION.... ...... ... .... .......... ..1


Problem Statement.......................
Operational Definitions..................
Delimitations and Limitations...........
Procedures. .................. ......
Significance of the Study.............
Organization of the Study Report.........


......... ..5
. ..........6
..........10
. .. 13
..... .. ...16
. .........17


II REVIEW OF THE LITERATURE..........................19

Academic Health Centers............................19
Colleges of Allied Health.......................... 28
Stark's Framework............................. ... .47
Accreditation Standards: Tools for
Academia. ........ .... .. .......... ...... .58
College of Allied Health Catalogs.................102
Science Related Courses..........................119
Summary. . . . . . . . . .......133

III METHOD............................. ......... ... 135

Population.......... .................. . . 135
Selection of the Colleges of Allied Health........136
Selection of the Preliminary Activity












Page

The Delphi Technique......... .. ....... .......... 146
Data Analysis and Criteria Development........... 151

RESULTS ....................................... ....155

Preliminary Statements...........................156
Science Related Course Faculty
Qualifications. ...................... ... .. .162
Expectations for Science Related
Course Faculty......... ... ... ... .. .. ... 167
Role of Dean and Faculty in Evaluation
of non-CAH Faculty. ... .... ... .. .. .. 175
CAH Control of Delivery and Content of
Science Related Courses....... ...............179
Summary.......... .............................. .189

SUMMARY AND CONCLUSIONS.......................... 191


Summary....
Criteria...
Discussion.
Weaknesses.


.. ........00 Q .. .
... .. ... .. .....
C. ..... C... .......
..... .... .. C


....... ... o
.CC...C..C.
. .. .... .


Implementation of the Criteria.........
Recommendations for a CAH to Adopt the


Criteria .. ....... ... .. .


. ..191
..... 194
. ...200
. .203
.... 205


. ... . .. .206


Suggestions for Further Research and Practice ..... 207
Conclusion.. .. ....... .. .. .. ... .. .. 211

APPENDICES

A CATALOG REQUEST LETTER.......................... 213

B CATALOG REQUEST FOLLOW-UP LETTER..................215

C COLLEGE NOMINATOR REQUEST LETTER..................217

D INSTRUMENT TO NOMINATE COLLEGES.................219

E LETTER TO PRELIMINARY EXPERTS..................222

F GUIDELINES TO IDENTIFY SCIENCE RELATED
COURSES.... ... ........................ ... .. .224

G INSTRUMENT TO IDENTIFY SCIENCE RELATED
COTJR R .. S. ..... ............................ 226









Page

LETTER OF ENDORSEMENT.............................230


FORM TO NOMINATE FACULTY..........................232


INVITATION TO ALLIED HEALTH FACULTY...............234


INVITATION TO BASIC SCIENCE FACULTY...............236


ROUND II COVER LETTER............................. 238


ROUND III COVER LETTER............................ 240


INSTRUMENT TO DEVELOP CRITERIA....................242


VOTES BY ROUND FOR STATEMENTS.....................260


COLLEGE PARTICIPANTS............................ ..272


BIBLIOGRPPHYC ..... . . .. . . . . . . 274

BI OGRAPH ICAL, SKETCH ................... ...................29 6








LIST


OF TABLES


Table


Maximum


Number


of Years


of Program


Accreditation
Requirements.


and


Minimal


Program


Duration


Number


Accredited
Programs..


Percent


of Institutions


Baccalaureate


Health


with


Science


. . . ..63


Accreditation


Requirements


Prof


ess


ional


Credential


Accreditation
Credentials o

Accreditation


of Program


Directors.


Requirements


f Program


Academic


Directors


Requirements


erience


of Program


Director


S...


S. ... .69


Sciences


Named


Accreditation


Standards.


. ....... .92


Charact


eristics


AAHC


Memb


ers


which


sted


Allied


Health


as a Component


Identifi


cation


of Science


Relate


d Courses


SRC)


from


Catalog


Course


Desc


riptions


Percent


, and


Consensus
04A......


re:


Statements


01A,


Rank


of Importance


of Factors


in Establishing


Science


Related


Course


Faculty


Cred


ential


S .


. 160


Percent
Faculty


Consensus
Qualifica


re: Science


Relat


ed Course


tions


S. 164


Percent
Faculty
Sponsor


Consensus


and


re:


Organi
Faculty


Science
national


Relate


d Course


Structure:


. ...169


S. . .. .. 65


Page


. . . ..66


. ....103


. .. 143


. ....157









Tabl


Round


Percent


Consensus


re:


Science


Related


Course


Faculty


Roles


Organi


national


Structure


: Sponsor


and


Faculty


(F) .


Round


Percent


Consensus


re: Science


Related


Course


Faculty


Couns


eling


.... ... 172


Percent


Consensus


re: Role


CAH


Dean


Evaluation


of non-CAH


Science


Related


Courses


.. 176


Percent


Consensus


re: CAH


Evaluation


non


-CAH


Faculty


Who


Teach


science


Related


Courses


. . 178


Rank


of Locus


of Respons


ibility


Alli


Health


Curricula


. . . . .180


Percent


Consensus


re: Curricula


Responsibility...


. . ..181


Percent


Con


Science


sensus
Relat


re: CAH


ean


spons


ibility


ed Courses


. ...183


Percent


Respon
Organi


Consensus


sibility
national


for
Stru


re: CAH


Science
cture:


Faculty
Related
Sponsor


Courses


and


Faculty


(F). .


S. .185


Round


CAH


III:


Percent


Faculty


Consensus


Teaching


Science


re: Rol


Related


Courses
Sponsor


Organi


national


Faculty


Structure:


S. .186


(F) .


Votes


Round


re: Statements


01A,


and


Science


Related


Course


ulty


Qualifications


. . 261


Votes


Round


Statements


14-22


Science


Related
Organiz
Faculty


Course
national
(F)...


Faculty


Structure


Roles


: Sponsor


and


.. . .263


Votes
Course


in Round
Faculty


re:


Counse


Science


ling


Relat


..........265


Page


.. ........170


I











Table


Page


Votes
non-CA
Teach


Votes


Round


Science
i ....


Science


R


Round


re: CAH
Related


elated


Evaluation


Course


Faculty


Courses..


re: Curricula


Who


. . .267


Responsibility


. . .268


Votes


Round


re:


CAH


Dean


Responsibility


ence


Related


Courses


...... .269


Votes


Round


Science


Structure


re:


Related


: Spon


CAH


Faculty


Courses


sor


Respons
Organiz


ibility
national


Faculty


S. .270


I









LIST OF FIGURES


Ficrure


Page


A Framework


Describing


Professional


Preparation Programs...


Specific


............. 50


Influences on Professional


Preparation Programs.................. .......... ...51


Professional


Preparation Outcomes...................53
















Abstract


of Dis


sertation


Pres


ented


Graduate


School


the


University


of Florida


Partial


Fulfillment


the Requirements


Degree


Doctor


AN APPLICATION


of Philos


OF STARK


;ophy


FRAMEWORK:


IDENTIFICATION


AND


VALIDATION


OF CRITERIA


TO EVALUATE


SCIENCE


COURSE


DELIVERY


SYSTEMS


Zolika


April


. Heath

1988


Chairman:


James


Wattenbarger


Major


Department


Educ


national


Leadership


The


purp


ose


this


study


was


to d


develop


criteria


which


can


used


to evaluate


the


science


course


delivery


stem


baccalaureate


allied


health


students


in academic


health


centers.


The


need


criteria


was


justifi


ed by


literature


review


content


analy


ses


of coll


catalogs


20 sets


spec


iali


zed accreditation


standards.


Stark


erdi


sciplinary


prof


ess


ional


education


framework


was


used


identify


science


courses


from


ected catalogs


structure


the


proposed


criteria


A modified


three


round


Delphi technique


was


then


used


obtain


(allied


expert


health


opinion


and


and


basic


consensus


science


from


21 partic


faculty and


adminis


ipants


itrators)







Consensus


was


defined


as 100%


or 80%


agreement


last


(third)


round.


science


delivered


courses


under


allied


a variety


health


organize


students


national


were


auspices


crit


eria


identified


validated


accommodate


these


basi


structures


are


applicable


across


sciplines,


professions,


colleges.


Parti


cipants


agreed


that


science


teachers


should


have


a university


appointment,


demonstrate


undergraduate


teaching


effectiveness


, and


have


a science


or relat


graduate


degree.


Tenure


,senior


rank,


and


a health


profe


ssions


credential


were


rejected


as needed


cred


entials


College


of alli


ed health


partic


ipants


' expectations


ence


goals


relate


, objectives


course


, and


faculty


teaching


included


methods


choosing


plus


course


research.


Academi


advi


sing


, curriculum


planning


acc


reditation


activity

college

expected


were


sponsor


expectations

d courses.


to recommend


goals


reserved


Allied


health


objectives


faculty

faculty


and


teaching

were


relay


accreditation


practice


requirements


, regard


ess


appointment


status


science


faculty


or college


sponsoring


course.


College


deans


were


expected


to attract


faculty


but


they


other


specific


faculty


courses.


were


Deans


expected


were


to identify


expected


teachers


to participate







Specific


recommendations


for a


college of


allied health


to use


were


in adapting,


provided.


adopting,


Also other organizations


implementing the criteria


for which


criteria


could be


used were


listed as


nonhealth


center


allied health


units,


other health


center


colleges,


accreditation agencies.


Suggestions


further research


were


provided.













CHAPTER I

INTRODUCTION


An academic


health center


(AHC)


is an institution


that


includes a school of

least one additional


medicine,


a teaching hospital,


health educational


program


and at


There are


approximately


AHCs


the United States,


of which


were members of


the Association of Academic Health


Centers


(AAHC)


(Association of Academic


Health


Centers


1985;


1986) .


these,


60 were


reported


as having


colleges


of allied health


(Association of Academic


Health


Centers


[AAHC],


1985,


1986).


A comprehensive


study


the organization and


governance of


87 member


institutions


(as of


1977)


was


initiated by the AAHC


1977.


The


report of this study was


published


1980


and consisted of


an extensive review


the


literature,


several


position papers,


the presentation of


descriptive


information,


priority


issues


as described by


AHC administrators.


Among the


16 major topics


addressed


were departmental


structure/administration and


interschool


relationships.


Conclusions


regarding these


issues were


part


that


"inadequate


interschool


coordination and


cooperation often result


in significant administrative







location of


the basic science departments and


the quality


the teaching program for students


in fields other than


medicine continue


several health schools"


to present problems


(AAHC


for those AHCs with


, 1980a,


Several


studies


indicate that the delivery


system


basic and


applied


science courses


health


professions


students constitutes a major challenge


(Association of


Schools of


Allied Health Professions,


1973;


Clarke,


1983;


Krieger


, 1977;


Lewis,


1981;


Sirota,


1981)


Science


core


curricula


accreditation


for allied health


students have been plagued by


impediments and criticized


insufficient


depth and


irrelevance


(Association of


Schools of


Allied


Health Professions,


without a


1973) .


pathophysiology


Some nursing


curricula have been


course because qualified


faculty


could not be


found


or other department


faculties


were


unable


or unwilling to teach


the content


(Lewis,


1981) .


A survey


regarding


biochemistry


courses


for all


dietetics


programs


the United States


revealed


courses


taught


different


departments,


little


communication between biochemistry


dietetics departments


, and marked variation


in course


duration and


content


Sirota,


1981) .


When Krieger


(1977)


collected data


from allied health


faculty


in Florida


community


colleges,


many respondents


indicated a


need


update their


knowledge of the science


topics on


the


questionnaire.


In a study


of medical


technology program


* a S


1





1*


* ( ~ J







Concerning the administrative


science departments


location of


, in the AAHC governance stu


the basic

dy (1980b)


was


found that they were


located


in colleges of medicine


(n=42),


in each


the health


centers'


schools


(n=23) ,


in a


health


center-wide arrangement


(n=13


, or


in a


university-


wide system


(n=8) .


Although


the researchers did not address


basic science


faculty


qualifications,


they


did allude


them and recognize


the organizational


variety by


recommendation


When


the basic


sciences are centralized,


the deans of


all health schools with ba
content should participate


sic science curriculum
in the development of


the budget


these departments and


in the


appointment and
faculty members.


promotion of key basic science


(AAHC,


1980a,


Superimposed


upon


this


basic


science organizational


variety


the complexity


Typically they


offer several


the colleges of


programs


allied health.


with distinct


curricula and unique accreditation standards


imposed by


different accrediting bodies.


Structurally


, the colleges


may


be autonomous entities


or subdivisions


of larger units


such as a


college of medicine.


In a survey


organizational


structure of


colleges


of allied health


respondents attributed many


course duplication,


of their problems,


conflicts with


such as


other departments,


inadequate


laboratory


facilities to organizational


structure


(Kleinfelter


, 1976).


Perhaps


in their quest


for professionalism or







allied health


professions claim that their practice


is or


should be dependent on supporting biophysical


sciences


(Covey


& Burke,


1987;


Hinkle,


1986) .


Yet,


as noted,


investigators have


found


that science courses


for health


professions students are beset by problems.

curricular needs of allied health programs


is complicated by the structural


The diverse

for the sciences


complexity and diversity


the colleges and


the basic science


departments.


The


literature has


failed


to reveal


any


common


criteria


upon which a


college of


allied health


(CAH)


faculty


could


evaluate


the delivery


system


biophysical


science curricular components


for students


in all


programs.


Yet


there


is widespread support


for meritorious criteria


be set by


experts


for the assessment of


goals


(Fincher,


1978;


Koontz,


1971;


Nevo,


1983;


Roueche


, 1976)


In a


review


of the evaluation


literature Nevo


(1983)


wrote


"to choose


the criteria


to be


used to


judge


the merit of


an evaluation


object


one of


the most difficult tasks


educational


evaluation"


theorists


121) .


ignore


He noted


the entire


that many


issue of


evaluation


the worth


criteria by


goal


concentrating


achievement or by


on data


collection


disregarding the


to demonstrate


judgmental


nature


evaluation.


Stark


, Lowther


, Hagerty


, and Orczyk


(1986)


have


proposed a


framework


for the study


of professional


degree


1 1







influenced


internal,


intraorganizational


, and


external


forces"


. 236)


These


forces,


they


claim,


interact


create


profe


ssional


preparation


environment


which


influences


educational


processes


which


result


prof


ess


ional


preparation


outcomes.


The


outcomes


consi


st of


categories


, prof


ess


ional


competencies


and


prof


ess


ional


attitudes.

conceptual


Several el

competence,


.ements


concern


the

the


former


goals


category,


namely


the biophys


ical


sciences


in allied


health


curricula


Thousands


have


partic


ipated


the


deve


lopment


this


framework.


From


through


authors


plus


contributors


have


been


identified


on publications


relative


eve


lopment


framework


(Stark


Lowther


For


simpli


city


throughout


this


research


report


the


framework


will


referred


"Stark


No discredit


intended


other


researchers


Problem


Statement


The


purpose


this


study


was


identify


and


validate


criteria


evaluate


using


the


Stark


delivery


s framework,


system


that


can


science


used


related


courses


baccalaureate


centers.


allied


Criteria


health


were


students


identified


academic


validated


health


answer


the


following


questions:


What


professional


academic


qualifications


, n.d







In what roles


should science related


course


faculty


engage?


3. What

dean and

related


control


should the college of


faculty have


course


in the evaluation


faculty who do not have


allied health

of science


primary


appointments


the college?


What control


should


the allied health


faculty


dean have


upon


the delivery


and content of


science


related


courses?


Operational


Definitions


Academic health


center


(AHC)


is defined


as an


institution


that


includes a school


of medicine,


a teaching


hospital,


least


one additional health


educational


program.


A synonymous


older term is academic medical


center.


Adaptive competence


is the ability to anticipate


adapt


to changes


(e.g.,


technological


changes)


important


the


profession


(Stark


et al.,


1986).


Allied health


an umbrella


term with many


definitions.


this


study


refers


to those


occupations


which are health related and have educational


programs


colleges of


allied health,


such as medical


technology,


physician assistant,


and respiratory therapy.


This excludes


most of


the older


, independent,


or more established


* a a &


*







auspices of


colleges


of allied health.


Examples


are


dentistry


, medicine,


nursing,


and pharmacy.


Allied health


faculty are


instructors with a health


science credential


and a primary appointment


in a


college


allied health,


who teach baccalaureate


level


allied health


students


in the classroom.


Allied health professional


is one


prepared in an allied


health occupation at


the baccalaureate or higher


level.


Basic science


faculty


are


instructors who teach


one or


more


science


related


course to


baccalaureate


level


allied


health students.


They usually


have a


graduate degree


in a


biophysical


science,


do not hold a health


professional


credential,


and may


or may not have a


college of


allied


health appointment.


Clinical


practice


refers to professional/technical


work


the service site by


faculty


or students when a


client/patient


is directly


or indirectly the


recipient


care.


College of


allied health


(CAH)


is an academic unit


university

allied heal


or academic


health


educational


center with more


program,


faculty,


than one

and


administrative


personnel.


Such units are


sometimes called


school


or division.


The


term college will


be used


to refer


to all


colleges,


schools,


or divisions of


allied health


AHCs.







Conceptual


competence


understanding


theoretical


foundations


profession


(Stark


et al


1986).


Contextual


competence


is the


understanding


societal


context


(environment)


which


the


prof


session


practiced


(Stark


et al. ,


1986)


Criteria


are


written


statements


on which


a judgment


deci


sion


may


be based.


In this


study


, criteria


are


stinguished


from


standards


guidelines


that


latter


are


specifically


purposes


of accreditation.


Delivery


svs


relative


science


related


courses


refers


those


elements


such


faculty,


nonhuman


resources


, locus


of control


organizational


structure


which


are


antecedent


the


presentation


courses


Department


chairper


son


the


academic


leader


who


represents


particular


the faculty


program


may


one


or seven


programs.


responsibility


of a department


chairperson


or a program


director.


The


older


term


chairman


, may


be retained


to report


those


studi


which


that


term


was


used.


Guidelines


are


written


narrative


which


serve


to extend


explain,


and


clarify


accreditation


standards


They


are


absolute


Health


professional


a global


term


used


to describe


profess


ional


personnel


involved


patient


care


(direct







facilities,


in public


health,


or environmental


health


activity


es.


includes


allied


health


profes


sional


Intecirative


competence


the


ability


to integrate


theory


practice


(Stark


et al


, 1986)


Interpersonal


communications


the


ability


use


written


or oral


communication


effectively


(Stark


et al


1986)


Prof


essi


onal


courses


are


ose


theoretical


and


practical


required


subjects


which


result


student


being


to demonstrate


prescribed


competencies


i.e.,


practice


the profession.


This


includes


prof


essi


onal


phase


required


courses


except


those


identified


as science


related.


Program


is a curricular


system


designed


to educate


persons


Procra


function

m director


in a particular

r is a person r


health


prof


ession.


responsible


teaching,


admini


station,


periodic


review


, continued


development,


general


effectiveness


a program.


Research


is an activity


that


treats


the


substance


one


s di


scipline/profession


in a creative


and


scholarly


manner


communicates


knowledge


gained


from


that


work


so that


available


the


scipline


or profession


whole.


Scholarly


concern


improvement


is the


degree


which


a graduate


recogni


zes


the


need


increase


knowledge







Science


related


courses


(SRC)


are basic or applied


biophysical


science subjects which health professions


students take during


enrollment


in the


professional


program.


The


published


indicate


catalog descriptions


that a major


expected outcome


for these courses


the development


conceptual


competence.


This excludes prerequisites,


clinical


practice,


social


sciences,


and professional


technical methods courses.


Service refers


to all


professional


faculty


activities


not defined


as teaching


or research.


These activities


may


include


committee work,


accreditation activities,


clinical


practice,


and service


to the


profession


or community.


Standards are written statements by which


educational


programs


are reviewed,


surveyed,


or evaluated


for purposes


of accreditation.


programs.


essentials or


They are generally


Some accrediting agencies


criteria.


binding


use


accredited


terms,


In this dissertation,


such


statements will


be called standards.


Teaching c


includes


preparation


, evaluation


, and


student


contact hours associated with a


given course,


module,


or lesson.


Technical


competence


is the ability to perform tasks


required of


profession


(Stark et al.,


1986).


Delimitations and Limitations







that were members


of the AAHC


(AAHC,


1985,


1986).


The


program population of


interest


included all


baccalaureate


programs


in AHCs


administered by the college of


allied


health


except nursing,


pharmacy,


or social


work


(Occasionally these are organized within


colleges.).


the same


Allied health programs within the university


but outside of a

hygiene programs


CAH were excluded.


in CAHs were


included,


example,


those


dental


in dental


colleges were not.


The


panelists who


participated


in the development of


the criteria


consisted


three subgroups,


CAH


deans,


basic


science


faculty,


and allied health


faculty.


Students and


individuals


who taught exclusively


the clinical


area


were


included.


The strength


of the criteria


formulated were


a reflection


the appropriateness of


framework


developed by Stark et al.,


the


literature


review,


expertise of the


panel


experts.


One


limitation results


from developing


criteria


general


enough


to apply to any


biophysical


science course


baccalaureate allied health


program.


Other studies are


usually

programs


limited

. While


to one science or a


few allied health


this might simplify the situation


it would


defeat the


purpose of


this study


It was not


the


intent


compare among


sciences or programs.


issue was the


development of


criteria


that any professional


could


use







baccalaureate allied health students


in colleges of


allied


health


in academic health


centers.


The operational


definition of


a science


related


course


is both asset and liability.


The term


is unique.


grouping

bridge,


of what may be


clinical,


labeled basic,


or professional


applied,


sciences


fundamental,


under one


category may


appear artificial


(Thier,


1987) .


This may


represent an


unfamiliar way


of viewing the allied health


curricula.


This may be


perceived as an


impingement


professional


course


"turf"


or the attenuation


science


The courses may


be difficult


to identify


in programs


that


use


an integrated


curriculum,


that


basic


science


professional


content


combined


in one course.


The validity


the aggregation of


these courses


function


the methods


used


to identify them and


the


assumptions on which


these methods


rest.


In brief


, a group


of experts determined


that


the course descriptions


met a


criterion


the Stark et al.


framework.


This assumes


that


framework and


framework will


expert


opinion have validity.


be discussed in Chapter


The


use


in the


identification of


science


related


courses will


be explained


Chapter


III.


Critics may


claim that


there were already


several


sets


of criteria


for the evaluation of


allied health programs,


i.e.,


accreditation standards.


This was correct.


The


- a -I







programs and each had


its own set of


standards


(American


Medical Association


[AMA],


1987).


In addition


this,


several


programs


found


colleges of


allied health


such


dietetics,


dental hygiene,


and physical


therapy were


accredited by


other


agencies.


Program accreditation


is most representative of


professional


practice concerns


(Hinkle,


1986)


Various sets


of standards are


intended


to address the biophysical


sciences vaguely


, narrowly,


indirectly


from


their


own


unique p

consider


perspectives.


is no wonder that deans


"accreditation standards


giant


of CAHs


stumbling


blockss"


(McTernan,


1972


168).


Furthermore,


questionable


faculty


of colleges of


allied health


in AHCs


should measure


their biophysical


science course delivery


success by


accreditation standards


(Schermerhorn,


1986).


Of 3,042


programs accredited by CAHEA only


672 were


year colleges,


universities,


or medical


schools


(AMA,


1986,


244).


Often the same standards are


used


to evaluate


programs

schools,


in hospitals,


blood banks,


community

government


colleges, proprietary

institutions, and AHCs.


Procedures


Study


Design


A review of


literature was undertaken regarding


academic health centers,


colleges of


allied health,







and goals claimed by


several AHCs and their universities


colleges


allied health were reviewed.


Using Stark's


framework as a


guide,


literature review was


focused


identify and define


further biophysical


science


curricula.


From the


upon which


literature


science


review statements were


related course delivery


formulated


systems


colleges of


allied health could be evaluated.


statements were critiqued by three experts;


These


one


allied


health dean and


courses


two


faculty who teach science


to health professions


students.


related


After all had


reviewed


the material,


each


expert was


interviewed


The


statements and supporting


information were


revised


prepared


for a


three


round modified


Delphi


study with


panel


experts.


The Delphi


technique


is recommended


for use


with


problems


that do


lend


themselves


precise


analytical


techniques.


is suggested as a method


of choice


when


communication among


diverse


peoples must be


facilitated but


time and


cost


preclude group meetings.


It was


a method


used


in the academic


health


center governance


study


cited


previously


(AAHC,


1980a,


The Delphi


will


be explained


Chapter


Selection of


III.


Colleges


The colleges


were


in centers


that were AAHC members







generic allied health programs.


Every


effort was made


include at


least


one center representative of


each of


four possible basic science department structures.


Ten


colleges,


which were


public,


private,


and geographically


dispersed around


the nation were then selected as


representative


leaders by two deans of


allied health and


investigator.


Eight deans of


10 colleges


nominated


indicated their willingness to participate.


Selection


Panel


The


purpose and method of


the study was briefly


explained by


letter to


10 deans.


They were


told the


purpose


the study,


why their college was chosen to participate,


and


their rol


A follow-up telephone call


was made


answer questions and


learn of


their willingness to


participate.


The


8 who agreed


to serve were


selected.


Program confirmation and


faculty nominees


were also


requested.


The


panel


consisted


of 21 experts;


deans


basic


science


faculty


, and


allied health


faculty


from among the colleges.


Broad disciplinary


input was encouraged by the


instructions


provided


the deans


for nominating


faculty


(see


Appendix B).


Identification of


faculty per CAH


insured


substitutes should some choose not


to participate.


It also


permitted


investigator to select


disciplinary and professional


for diverse


representation


from all







Role of the


Panel


After review by the preliminary


study


experts and after


revision of


the statements,


the statements as


well


supporting


information were distributed by mail


panel


members.


Panelists were asked to


indicate


their


agreement


or disagreement with


each statement and


contribute opinions


Inclusion,

by a prese


exclusion,


t score.


or revision of


This


procedure


any


item was determined


is discussed


in Chapter


III.


Panel members were asked


to reevaluate and


respond


same and additional


statements on a second


and


third


round.


criteria


From the


that may


literature and panel


be used


expert


opinion


to evaluate elements of


the


science related


course delivery


system were developed.


Significance of the Study


The


fact


that science related course delivery


allied health students


often a


challenge


indisputable


(Clarke,


1983;


Krieger


, 1977;


Sirota,


1981).


Furthermore


location of


an allied health program


health center--the citadel


need not ameliorate


location of


in an academic


for health sciences


the problems.


education--


"The organizational


the basic science departments and


the quality


teaching program


for students


in fields


other than


medicine continue


several health schools"


to present problems


(AAHC,


for those AHCs with


1980a,







sciences

of such


into the varied


courses.


curricula


In advocating


and


improve


laboratory


the delivery


and not


just


lecture of


the basic sciences


for medical


students,


Flexner


(1910)


stated


after a


strenuous


laboratory


discipline,


the


student will


still be


at any rate he will respect
learned how to obtain them,


ignorant of many things


facts:
and wha


he will


but


have


to do with


them when he has


them.


In her treatise on nursing


education,


Goldmark


(1923)


noted:


"Common defects of


scientific


instruction


training


schools


studied are the


lack of


good


teachers,


neglect of


laboratory work,


insufficient allowance


of time"


257) .


Obviously


recent as well


as classical


studies of


the education of


students of


the health


professions


have


shown concern


for the quality


quantity


the biophysical


sciences be


they


labeled basic


science,


applied science,


or professional


courses.


Organization of the Study


Report


Chapter


justification


used


has provided background


information and


a study to develop criteria


that can be


to evaluate the science related course delivery


Chapter


a review of the related


system.


literature.


encompasses three general


areas:


Stark


s theoretical


framework upon which


this study was based,


literature


about academic health


centers,


colleges of


allied health,







analyses of


accreditation standards and college of


allied


health


catalogs.


Discussed


chapter


the methodology


employed


select


the


participants


identify the science


related


courses.


Also explained


is the


Delphi


technique


data


collection and analysis.


Chapter


an analysis of


the data


obtained while developing the criteria.


Lastly


Chapter V


is a


discussion


of the


resulting


criteria,


their


implications,


recommendations


further


research.
















CHAPTER II

REVIEW OF THE LITERATURE


The


purpose of


this chapter


is to provide an


overview


of academic

health, the


health


center


ir structure


sponsored


, faculty


colleges


curricu


of allied

la pertinent


science course delivery


systems.


is divided


into


following


sections:


an overview


of academic


health


centers;


allied health,


information and studies


faculty,


about


and administrators;


colleges


a review


Stark's


framework for professional


education;


analysis of


specialized


proposed


college-wide


accreditation standards;


a review


of college


allied


health


catalogs;


and


a review


of studies


relevant


delivery


science courses


for allied health


students.


Literature


pertinent


to the methodology


this


study will


be addressed


in Chapter


III.


Academic


Health


Centers


Academic health


centers


(AHC)


have evolved


from a


confluence of


several


entities within American society.


comprehensive review would


entail


a discussion


of higher


* S ft


I. *


n t t 4


I







health


care delivery


system.


The development


and synthesis


of these subjects was beyond


the scope of this


study.


an overview


mandatory


since


the colleges within


this


study were all AHC sponsored,


and this


has major


implications


for the science related


course delivery


system.


The genesis


of AHCs


occurred during the


latter


19th


century


(Ginzberg,


1985).


Prerequisite


this were


advances


immunology,


in the basic sciences;


and bacteriology


concomitant clinical


asepsis,


discoveries


roentgen


chemistry,


(Ludmerer,


such


(Friedson,


physiology,


1983)


as anesthesia,


1973).


physicians


of the


leading medical


schools


the day,


already university


affiliated,


began


to seek


closer


alliances with


the hospitals where


these


new technologies


could be


taught


(Ludmerer,


1983).


Medical


education


focused


the


undergraduate and


research


was


secondary


(Ginzberg


, 1985).


With


the opening


and Hospital


1893,


of Johns Hopkins


role of


University


research


1876


gained momentum


(Ludmerer,


1983).


1910,


the now


luminary


Flexner


report,


gave


impetus


for medical


school


faculties


pursue


closer


affiliations with both


universities


hospitals


(Ashley,


1976;


Ludmerer,


1983).


During the early


decades


century the


university-teaching hospital-medical


school


triad became


well


established


(Ashley


, 1976;


Ludmerer,


1







in hospitals


(Ashley,


1976;


Friedson,


1973).


Allied health


occupations which


trace


their


origins external


to hospitals


and


independent of


medicine,


such as occupational


therapy


moved


into the hospital


during this period


and became


(Savitt


Kopper


physician dominated

I, 1982).


After World War


these centers


for medical


care and


education began to undergo major changes


(Hogness


Akin,


1977) .


Factors


inducing


change were


perceived need


collegiate nursing


and allied health


educational


programs,


the medical


schools ambition


to expand


the clinical


teaching


sites


to veterans and


community hospitals,


universities


responsibility to coordinate


health related activities,


integrate


and policies


expanding


federal


government


(Ebert


Brown,


1983).


Petersdorf


Wilson


(198


identified


three


overlapping post-World War I

recognizable by governmental


I phases in

influences.


AHC development


The biomedical


research era


commenced


in the middle


1940s when government


leaders decided


to rely primarily


on academia


to conduct


biomedical


research.


Federal


financial


support began


contribute


immensely to


the expansion


of basic science


departments


(Ginzberg,


1985;


Petersdorf


Wilson,


1982).


This


facilitated specialization


provision of


in the clinical


intensive tertiary


care


departments


for referred


patients


teaching hospitals.







physicians


and medical


schools


(Petersdorf


Wilson,


1982).


These reports were catalysts


for passage of


Professions Education Assistance Act


1963


the Health

. This


legislation,


later amendments,


and manpower


acts which


followed


provided money


facilities and


training


more


health professionals.


This era


peaked


1971


(Ginzberg,


1985).


Petersdorf's


, public service era began


1960s.


By this


time AHC


faculty


had trained hundreds


of physi


clan


specialists who had


migration


or would


suburbs.


follow the middle


Given


class


their quality training,


became less


necessary


for these


physicians


to refer


clients.


For the AHCs,


this


translated


into smaller patient


pools


declining


hospital


admissions


, heretofore


sine quo


non


for the


"cash


cow,


" i.e.,


teaching


hospital


(Ginzberg


, 1985).


This manifestation


of success coupled


with more general


social


phenomena;


a decline


in city


services,


urban traffic


congestion


civil


rights


movements,


increased minority


indigent


populations;


facilitated


a demand


for more responsiveness


to the


local


community.


Now the AHC


leaders,


with


their world


view


, renowned


biomedical


research


programs,


graduate


graduate


medical


education emphases were being


forced


to compete with


community


hospitals


primary health


for paying patients


care needs of


and respond


their neighborhoods


(Rogers


-~~~~~~~~~~~~~r -I- -I -l -a 4f Ya------------


n .. -. -.~L


I


n


__l _


-_ -


ILCI


r 1 ~n







referred


from outside the Baltimore area--indeed,


often


from


abroad"


(Rogers


& Blendon,


946).


Thirty years


later this


situation had been reversed,


"80 percent of


the patients


admitted came


from a


16-km.


radius of


Baltimore"


946)


Rather than diagnose,


treat,


and


cure


cases


typhoid


fever


, tuberculosis,


poliomyelitis,


the health


professionals and


their teaching hospitals now


care


victims of

syndrome (


trauma,


AIDS).


cirrhosis,


and acquired


The nonbiological


etiology


immunodeficiency


of many


today diseases


the domain of


lie outside of


traditional


the germ


medicine


theory


(Rogers


of disease


Blendon,


1978) .


In addition


to problems posed by present day


epidemiology,


the AHC


is also challenged by


"problems


organization and


governance"


(AAHC,


1980a,


vii)


There


is no list of


common characteristics of


AHCs


therefore no absolute agreement on how many


exist


(Ginzberg,


1985).


But experts concur on


the dominant


role of


college of


medicine


(Morris,


1980;


Petersdorf


Wilson


1982


and on the crucial


relationship of


academic medicine


with


the


teaching hospital


(Ebert


Brown,


1983).


Their


overall missions;


research,


service,


teaching are


technically


congruent with


universities of which most


are a part.

However the AHCs and in particular their medical


colleges service commitments


far surpass


intensity


1







public


school


system,


or the stock exchange.


colleges


of medicine dominate


teaching


hospitals


(Rogers


Blendon,


1978).


This


business


enterprise necessitates


considerable int

have millions of


erface with

dollars in


the community.


vested


The centers


their physical


plants


and may


employ thousands of modestly skilled


workers


(Wilson


& McLaughlin,


1984).


Health center


scientists,


physicians,

with zoning


and scholars


boards


turned administrator may


, insurance agencies,


working


union negotiators,


city planners


Internally


(Rogers


AHC governance


Blendon,


"tends


1978).


to be decentralized,


ad hoc,


and vested


in small


committees"


(Rogers


Blendon,


1978,


944) .


The decision-making process


is slow


cumbersome

to engage


(Ginzberg,

in teaching


1985). Ideally

, research, and


leaders

patient


are

care


expected

as well


administer the departments


center-wide


affairs


(Weisbord,


Lawrence,


Charns


, 1978).


To compound


the


difficulties


of governance on all


levels,


"the


autonomous


medical


science culture


tends


to value


technical


above


interpersonal


and group skill


s" (Weisbord


et al.,


1978,


303)


recent


past AHC


faculty


administrators


enjoyed


the National


Institutes


of Health grant monies.


They


still


but


these


funds are now abating


(Ebert


Brown,


1983)


diminishing


in real


dollars


(Ginzberg,







Medicaid


could


pay


medical


services


deemed


necessary


any


phys


ician.


now


been


capped


with


a prospective


payment


Renn


system


, & Bil


, whi


ch became


, 1986).


effective


intent


was


1984


in-hospital


Schramm


cos


containment.


reductions


Some

fewer


affects


diagnostic


tests


have

, and


been


staff


shorter


lengths


stay


Relatively


more


health


care


is being


delivered


side


the


traditional


voluntary


teaching


hospital


the


AHCs,


these


changes


have


increase


d competition


among


health


care


agencies


providers.


1950


American


phy


sician


professor


become


resp


ected


as hi


19th


century


German


counterpart


(Ludmerer,


1985)


The


intimate


medical


school-teaching


hospital


alliance


had


een


fought


and


won.


Medical


means


were


called


to Washington


advi


(Rogers


Blendon,


1978


changing


Phys


icians


are


now


called


Was


hington


told


they


are


unresponsive


society


meeting


Blendon


needs


, 1978)


(Evangelauf


Coordination


1986


among


, 1987;


hospital (


ers


and


the


center


coll


eges


is more


complex.


Nursing


and


alli


health


, large


subordinate


to medicine


, and


pharmacy,


denti


stry,


primarily


isolated


from


medi


cine


are


demanding


greater


part


AHC


affairs


(Henderson,


1980;


Morris


1980)


The


watchwords


now


are


improved


interpersonal







1977)


, government


(Rogers


Blendon


, 1978),


faculties


(Christensen,


1978)


The solutions demand


effective


leaders


(Petersdorf


Wilson,


1982)


who are possibly


selected by a

(Christensen,


set of


1978


criteria different


They


from the


should be capable


past


of strategic,


proactive


planning


and not


just


respond


to each


(Ebert


Brown,


1983;


Wilson


& McLaughlin,


1984)


Today's


AHC


leaders may


disagree over the


role of


specific


occupational


groups


in health


center governance but many


are advocates


sciences and humane


an improved application


arts.


social


One administrator with


responsibility


for encouraging this


vice


president


health affairs.


Today most AHCs


have such an officer


(AAHC


, 1980b)


This


style


person's presence


have a


(or absence),


direct bearing


responsibility


on colleges of


, and


allied health.


The authority


roles of the


vice


presidents


are


diverse


as the AHCs


they


orchestrate


(Pellegrino,


1975).


Petersdorf


and Wilson


(1982)


describe


three


typolog


ies.


one,


the dean


of medicine


serves


vice


president,


another,


capacity


vice


Lastly


president


, the vice


serves


president


president may


be a


a staff


line officer


with


all AHC deans


administratively reporting to


him or her.


Christensen


(1972,


1978),


a dentist,


believed


that a


line


vice president


fosters professional


interaction


and believed


1. .


+ 1 I --


1 1.


I







vice presidents who served between 1960


1976,


20 or


were not


physicians


(Wilson


& McLaughlin,


1984).


The stance of


president position

advocated a strong


academic physicians


mixed.


line vice


toward


physician,


president,


vice


Hogness


in part


improve


coordination of the curriculums of


the various health


science schools


(Hogness


& Akin,


1977)


In a


discussion of


leadership and medicine,


Wilson and McLaughlin


(1984),


described a


population


of "322


individuals who served


dean of


a medical


school


. and 98


individuals who served


only [em

school d

dean and


phasis added]


means


as vice president"


also are not enamored


the hospital


director being


42) .


"Medical


f the concept of the

directly accountable


the vice president"


And


(Petersdorf


&


"vice presidents are probably


Wilson,

here tc


1982,


stay


p. 1

but"


157).


(Petersdorf


Wilson


, 1982,


1161)


they


"must not


'run'


the medical


school"


(Pellegrino


, 1975,


227)


One area


agreement


is that


the authority


and responsibility


vice president should be consciously decided


and made known


to all


concerned


(Pellegrino,


1975).


The perceived


threat


to college of medicine autonomy


control


which


the vice presidency poses


for some


(Hogness


& Akin,


1977)


is accompanied


literature by


references


to college of medicine dominance within


the AHC


(Morris,


1980,


156;


Wilson


& McLaughlin,


1984,


63).







much


influence on the academic health


center"


(Ebert


Brown,


1984,


1201).


"Leadership positions


in academic


health centers must be defined according to


professional


dimensions


. medicine and


. management"


(Lostetter,


1981,


college of medicine,


"more


than any


other


component


influences


the character of the center because


encompasses


the maior biomedical


science base"


[emphasis


added]


(Petersdorf


Wilson,


1982


, p.


1153) .


Where does


this


situation


find


colleges of


allied health


their


science


related


course delivery


system?


Colleges of


Allied Health


Emergence of


the Allied Health


Professions


The curriculum of


colonial


Harvard was


based


classical


trivium and


quadrivium


Levine,


1978)


During


the

as a


first


field


centuries


of study


of American higher


gradually


education


gained acceptance.


science


This


occurred with


establishment


provided f

1978). Th

comparable


changes


new


in the existing


curricula


institutions and new


or modern as well


e basic


as classical


sciences did not always


to classical


considered lacking


subjects because


in academic rigor


and by


curricula

courses (R

carry cre


that


udolph,

dit


former were


Levine,


1978


secondary


status


basic sciences all


ended


late


1800s with


the


leadership of Harvard's


President Eliot







Beyond academia,


agrarian America


needed


citizens with


practical


skills and


this


intensified with


the


rise of


industrialization in


19th century.


The sons of


traders,


farmers,


and


craftsmen needed to


know more


to perform more


complex tasks.


Gradually some of the colleges and


universities


began


to apply


knowledge


from the basic


sciences


to practical


problems.


Thus,


in a


delayed but


parallel


trend with


the basic sciences,


the applied sciences


slowly


became


part


of American higher


education


Levine,


1978).


The


19th


century


saw the development


"middling"


classes


(Bledstein,


1976).


Aspirations of


the common


citizens were


gain,


for an


social


improved


prestige


station


Levine,


life


1986) .


material


The


application of


science by the


universities coupled with


this


quest


for upward mobility permitted


the vocational-


technical-practical


occupations


to gain


access


into


higher


education.


Schools,


colleges,


and programs of


engineering,


agriculture,


business,


education were


instituted


flourished.


Their graduates


then


as now,


learned a


trade,


received professional


status,


and


entered


the middle class


Levine,


1986;


Friedrich,


1982)


Medicine,

participated i


dentistry


, pharmacy,


.n this movement


and nursing have


from apprenticeship


into


higher


education


(Brown,


1983;


Grace,


1983;


Mrtek,


1976)







essentially a


20th century


often post-World War


phenomenon


(Ford,


1983).


Several


situations and


events


have


influenced


the development of the specific allied health


occupations and


arose


each has


its own history.


to satisfy a need created by the


they


larger society


, or


some combination


thereof.


McTernan


(1972)


summarized a


typical


cycle


formation of


an allied health


profession.


First


there


need at


the work


site,


so an available and


intelligent


person


on-the-job


informally trained.


in several


Next,


institutions.


individuals are


These


trained


people develop


common interests


form an


organization.


Later they


seek


occupational


identity


finally professional


status.


acquire


Slowly the


this they


advocate higher


training programs


shift


educational


from the


standards.


job sites


educational


institutions.


Common


to most allied health


occupations was


the early


participation of


members of more established professions,


namely medicine


for medical


radiologic technology


(Soule


technology

, 1974), a


(French,


1974)


nd physician


assistant


(Howard


Lewis,


1974)


nursing


occupational


therapy


(Johnson,


1974)


, respiratory therapy


(Collier


Youtsey,


1979),


and


physical


therapy


(Scully,


1977);


dentistry


for dental hygiene


(Hein,


1974).


the allied health


occupations were also


fostered by


librarians


[medical


record


S S U 4 I S S





* 1


I*


*


'I I


-I


1 L ~ n







workers

Kopperl,


[occupational


1982),


therapy]


and physical


(Johnson,


education


1974;


teachers


Savitt


[physical


therapy]


(Scully,


1977)


Today


students of


allied health


occupations are


trained


in a


variety


of settings


(AMA,


1986)


In 1986


the Committee


on Allied Health Education and Accreditation


(CAHEA)


American Medical Association accredited


3,042


programs


fields


(AMA,


1986).


CAHEA


classified sponsors


in five


typologies:


hospitals,


clinics,


and blood banks;


community


colleges and vocational


schools;


senior


colleges,

schools,


university

consortia,


and medical


and secondary


schools;


schools;


proprietary


and


government


institutions.


Between


1981


and


1985


CAHEA


accredited


programs


increased by 37.


Two hundred and


forty-


four


hospital


programs closed


or discontinued accreditation


additional


programs


were accredited among


community


colleges


(AMA,


1986b) .


Thus


recent


shift has


been


from


hospitals


to community


colleges and not


senior


institutions,


including AHCs.


The


largest segment of


allied health


students


are trained


in community


colleges


(Ford,


1983).


Only


graduate


from programs


in AHCs


(Ebert


Brown,


1983).


Descriptive Studies of the Colleges


Descriptive


information about health professions


faculty


their colleges have been available


for years







allied health many


Commission


have deplored


on Allied Health Education


lack of


[NCAHE],


data


(National


1980;


Year-


end Highlight


, 1986-1987).


Given


the confusion


over the


definition of


allied health


(AMA,


1985a;


Anderson,


1981;


Foegelle,


1984;


Ford


, 1983;


Jacobsen,


1977;


NCAHE


, 1980)


this


is perhaps


unavoidable.


To correct


this void


a major


objective of


the American Society


of Allied Health


Professions


strategic plan


an allied health


data base


for the


1990s


("Deans'


the development


winter


conference,


1987


-1988).


Relative


to educational


institutions


, this


investigator


found


two major sources of


descriptive data,


allied health demographic and


dissertations and


professional/


accreditation association documents.


Because of


subtle


salient differences


in the data


collection and analyses


among the associations


, data


comparisons


are


often


inappropriate.


Furthermore,


the associations


vary


in their


willingness


to share data


with nonmembers.


Rosenfeld


(1972)


was among the


first


to describe


educational


settings of


allied health programs.


Regardless


sponsor


, he described three organizational


on administrative and budgetary


control.


patterns


Kleinfelter


based


(1976


named


these structures,


coordinated.


The


independent,


dependent,


independent structure has


"all


and

the


prerogatives afforded the other schools and


faculties"







of medicine


(Rosenfeld


or biology


, 1972


. 19)


department


The


the


coordinated


university"


structure


amalgam


staff]


several


. admini


Kleinfelter


other


strative


(1976)


schools


officer"


queried


or departments


(Rosenfeld,


chief


admini


under


1972


strators


118


American


Society


of Allied


Health


Professions


member


institutions


to determine


characteristics


the


allied


health


units


and


compare


findings


based


upon


organizational


structure.


stitutions


Ninety


and


-two


from


.9%)


2-year


participated,


institutions


from


The


-year


names


titi


the


allied


health


units


and


chief


admini


strative


officers


varied.


The


number


programs


each


unit


ranged


from


less


than


more


than


, with


a plurality


of 6


through


Seventy


(76.1%


the


respondents


listed


problems


which


they


attributed


in part


organize


national


structure.


These


included


lack


of autonomy


, inadequate


budget


insufficient


space,


sence


of a distinct


faculty,


course


duplication,


conflicts


with


other


departments


Kleinfelder


summarized


characteristics


units


based


upon


their


structure


recommended


formal


administrative


structure


, an adequate


financial


base


, and


coordination


to prevent


duplication


conflicts.


conclusion


was


that


more


control


the


allied


health


unit







as much


as possible


for didactic


instruction"


116) .


This


seems contradictory with his other recommendation


allied health schools


"should strive


that


for as much autonomy


possible


in all


administrative and academic areas"


. 116).


Wise


(1979)


studied


the organizational


structure,


conceptualized by


Hage,


of schools of


allied health located


in AHCs.


She developed


three sets of


questions,


which


were


sent


to 83


vice


presidents,


CAH deans,


and 200 department


chairs.


departments


, 37%


awarded more


than


one


degree,


awarded


a baccalaureate,


and none


reported


doctoral


programs.


Several


(20.3%)


offered more


than


one


level


of a particular major.


Dual


enrollment


of students


from other


institutions occurred


17.9%


of the


departments.


Some


programs were offered


the AHCs


but


external


university but


e CAHs and oth

were external


ers were sponsored by the


the AHC.


"The deans


reported


of the


faculty


. possess


bachelor's


degree as


the highest degree"


85) .


This did


include clinical


faculty.


Faculty with academic or


professional


doctoral


degrees constituted a mean


of 32.4%


Among the department heads


held master's degrees


held doctorates,


nearly


were


licensed/certified


in a


health profession.


Eighty-two percent of the deans held


doctorates,


typically


outside of


the allied health


fields


they were administering.


Most


(71.4%)


did not have a health


.a -







Appraisal


of the decision-making responsibilities of


the department heads was assessed primarily


student and


clinical


issues.


Over half


(51.9


reported


they


did not


make decisions concerning student clinical


progress


more


than one-fourth


.9%)


the departments


students


were


responsible


locating


clinical


facilities


for the


required practicums.


About one-fourth of


the chairpersons


reported


that


clinical


faculty participated


in some


[college]


departmental


affairs.


Reasons


purported


for these


findings were


facilities,


relative autonomy


the clinical


program accreditation held by the


clinical


facilities,


clinical


of programs


no reimbursement


facilities,


into


from the


universities


relatively rapid and recent


the university setting,


shift


and abdication


student clinical

Nearly 20%


education by the


the allied heal


universities.

th department heads did


not report administratively to the dean,


but


reported


other department heads,


medical


directors,


or vice


presidents.


Some


(17.8


did not


represent


their


own allied


health


field


in administrative affairs.


A medical


director


or other appointee may assume this


role.


Reasons


posited by


Wise were the current


or recent hospital


identification


the programs and


fact


that hospital


employees are


typically not


participants


in administrative matters.


Fourteen percent of


the deans


reported no


tenure







acquisition of


an advanced degree,


continued


education


of self.


Least


important were


research,


publication,


professional


consultation.


Sixty-two percent


department heads


university


"reported that more


[college]


than


the


faculty are engaged in research"


(Wise,


1979,


Wise


concluded


that


the education and


decis


ion-making


roles of the department heads varied widely,


as did


their


titles


(curriculum director,


program director


administrator,


chairman)


and department names


(division,


program,


name


of occupation).


Her


findings confirmed


dual


lines of


authority,


administrative complexity


, and


diversity


the departments.


Wise concluded


that


CAHs


are


"decentralized,


very


complex,


. stratified,


and may


formal


informal"


V.).


Kelley


(1975)


studied professional


identity


among


occupational


therapy


, physical


therapy,


and medical


technology


baccalaureate


program


faculty


and


deans


from


American Society


of Allied Health Profes


sons


member


colleges.


The colleges were geographically


representative of


three organizational


dispersed and


structures.


interviewed all


the deans


and surveyed


faculty


mailed


questionnaire.


Returns


were


received


from


176


(71%


faculty.


Issues


the deans believed most


important


concerned







interdisciplinary


activities.


Some


felt


it difficult


faculty to work in


interdisciplinary


endeavors


because


different


professional


emphases or faculty


disinterest.


They


favored greater


faculty


identification with


the concept


of allied health.


Efforts


to promote


this


included,


"interdisciplinary


committees


. and school


separately


from their medical


schools"


There was


no agreement on


purposes of


the core curriculum


should be


used,


or the courses


to be


included.


One dean


believed differences


in student


perspectives


and abilities


among the


programs


precluded


usefulness


core


curricula.


No research


was being


conducted


in three colleges and


no faculty members


were conducting


interdisciplinary


research.


The deans


concurred


that allied health


faculty


were not research oriented.


They agreed that research


interests and patterns differed among the three


professions


and


that


physical


therapy tended


to be most active.


Three


expressed


the need to develop a


research


focus


their


college and many believed their college mission statements


needed revision.

sophistication;


they wanted to


One dean mentioned the


faculty were


lack of


academic


"basically practitioners


told their objectives"


59).


The


faculty


this


study were


full-time


, female


(67%),


under


40 years of


(52%)


, and prepared


, if






appointment


in the college of medicine and/or


a basic


science department.


The


faculty


occupied


junior


faculty


ranks


(70%


assistant


professor or below),


(41%


a plurality


had taught


less than


years,


had


practiced


more


years.


Faculty


attitudes


concerning


interdisciplinary


endeavors differed significantly


health


<.05)


fields and among the colleges.


among the allied


Attitude differences


were


not significant


when


faculty were grouped by


organizational


structure,


highest degree


level,


discipline


of highest degree,


full


or part-time


status,


academic


rank


or title,


years of


clinical


experience,


or years of


teaching


experience.


Actual


participation


interdisciplinary


endeavors differed with academic rank and age.


higher


rank and


the older the


faculty member the more


interdisciplinary


activity.


Professional


reading habits among the


faculty


differed


markedly


discipline.


Medical


technologists


read more


the basic sciences,


diagnostic and


read more


in mental


physical


therapists


treatment areas,


read more


occupational


health and rehabilitation.


therapists


Consistent


with reading habits were


faculty publication histories.


They


published


in the


journals


they


read,


which


were


rarely


interdisciplinary


Nine percent had produced more


than


publications,


had not published.


When a .ked


-tn i dentifv nronbl es.


ei3ans mentioned







political


issues


Other


challenges


concerned


pressure


upgrade


the


faculty


or the


development


core


curricula


No dean


mentioned


internal


administrative


difficult


es.


Faculty


identified


more


problems


in scope


quantity


These


included


curricular


issues


, administrative


difficult


with


clinical


site


staff


facilities


personnel


management


within


colleges.


Kelley


(1975)


wrote


that


faculty


did


share


their


deans


concerns


, for


their


development.


development,


, workload,


research


were


time


listed


self-


as problems


approximately


the


faculty.


faculty,


Kelley


concluded,


may


lack


academic


sophistication


research


skill


but


they


exhibit


generous


concern


teaching


clinical


affairs--activities


which


a research


"university


environment


de-emphasi


zes


154)


Although


distinct


differences


among


three


faculties


were


found,


they


shared


limited


interest


in interdi


sciplinary


activities


and


they


had


"enlarged


their


identity


include


other


allied


health


professional


s" (p.


158)


deans


, 80%


of whom


did


hold


an allied


health


credential


favored


a broad


allied


health


identification.


Frank


(1984)


identified


personal


professional


characteristics


of allied


health


administrators


institutions


Association


accredited


of Colleges


CAHEA


the


School


Southern


Participants


included


" (p





I







colleges


held


title


dean,


were


male


, white,


mean


years,


held


a doctoral


degree


Their


undergraduate


degree


was


commonly


in a phys


ical


science,


mas


ters


in a health


field


or bu


siness


admini


claimed


station,


licensure


doctorate


in a health


in education.


field,


Twenty


medicine


nursing

a vice


president


in an allied

of health a


health


affairs


area


, supervi


They re

sed 8.2


ported


programs


had


years


prior


teaching


experience


had


public


shed


papers


during


prior


years.


Anderson


(1981)


surveyed


department


chairp


ersons


baccalaureate


medical


record


administration,


medical


technology,


physical


therapy


, and


radiologic


technology


programs


purpose


was


to determine


how


the chairp


ersons


used


their


time


, how


they


evaluated


teaching,


their


beliefs


about


teaching


The


population


contact


was


or 80%


responded.


Most


admini


chairpersons


strative


had


appointment;


acquired


their


seven


position


been


elected


faculty.


Eighty


-one


percent


departments


had


or fewer


full-time


didactic


faculty


including


chairpersons.


Three


departments


full


-time


faculty;


over


half


(55.3


use


one


or more


part


-time


didacti


teachers.


The


typical


annual


student


enrollment


was


through







most


of their


time.


Administration


was


ranked


first


68.9%

third


Teaching


73.4%


was


, and


given s

research


second


place


occupied


east


service


amount


time


82.0%


the chairpersons


The


relatively


eral


amount

devoted


time


occupied


to research


is cons


admini

istent


station


with


minimal


other


studi


time

about


allied


health


faculty


activity


(Foegelle,


1984)


Chairpersons


were


asked


to indicate,


which


among


ten


methods


teacher


evaluation


they


used


with


their


faculty


Student


opinion


.9%)


, review


course


material


.5%)


and


measures


of student


achievement


were


reported


most


frequently


Those


east


used


were


team


teaching


assroom


review


vis


of audio-video


itation


colleagues


tapes


Qualities


, and


considered


most


important


teaching


were


the


ability


encourage


thought


and


ability


to explain


clearly


.9%)


a chi


-square


analy


S1iS


<.05),


major


diff


erences


across


programs


were


entified


on several


dimensions


such


as program


chairperson


reading


habits


and


degree


, and


grading


teaching


policies


effectiveness


clinical


also


courses


varied


Methods


significantly


to evaluate


across


programs


Most


frequently


used


were


classroom


visitation


colleagues


phys


ical


therapy


, measures


of student


achievement


medical


technology


, and


review


course


materials


examinations


medical


record


administration.







professions.


Physical


therapists are accustomed


to direct


patient care;


medical


technologists are associated with


diagnostic testing,


1.e.,


outcome measures;


and medical


record administrators deal


with


the written record.


Foegelle


(1984)


identified personal


, occupational


career patterning


characteristics of


full-time,


college


of allied health


faculty


from 16


academic health


centers


Fifty-nine percent had had


6 or more


years of


prior


clinical


experience;


about half


had


taught


in a


university


less


than 5


years.


Over


had a


secondary


appointment


in another college,


which


for six


individuals was


in a


science unit.


Administrative appointments were


reported by


most


of which


were at


program level.


primary


assignment


for most


faculty was with baccalaureate


programs


and with


entry


level


occupational


preparation


.5%)


Faculty


from


clinical


laboratory


, physical


therapy,


and


occupational


therapy programs accounted


43.5%


respondents.


Foegelle


tabulated


faculty


activity


categories.


He concluded


that


faculty members were


primarily


involved


teaching,


in student


clinical


centered activities,


teaching,


namely


student advising.


classroom


Service


their respective


occupied more


programs and


time than clinical


professional

service. Sc


associations


holarship and


research


typically


consisted of


"analyzing


existing







second


most


frequently


reported


activity


was


"personal


professional


development"


. 75)


Two-thirds


were


pursuing


additional


formal


education.


Faculty


reported


preferring


to spend


more


time


on publishing


.4%)


research


.9%)


, pers


onal


development


.9%)


and


paid


service


.4%)


Their


"inservice


development


eres


were


strong


in the


area


of research"


. 187


moderate


higher


education


and


health


care


topics


, and


"not


at all


teaching


advis


topics


" (p.


100).


Over


one


-half


.0%)


reported


original


career


goals


different


from


their


pre


sent


occupation.


Over


one


-third


had


been


their


present


institution


ess


than


years


The


reasons


faculty


gave


selecting


their


universe


were


duti


and


response


ibilities


(80.0%


, geographic


location


.2%)


ready


a change


(35.


Thirty


percent


"were


serious


considering


actively


reasons


pursuing


were


a change


salary


in employment"


, potential


Major


advancement


.5%)


, ready


a change


duties


responsibilities


.7%)


, and


poli


cies


and


practi


ces


of administration


summary,


Foegell


(1984)


ed that


alli


ed health


faculty


"are


typically


underprepared


higher


education


faculty


roles


. and


they


have


administrators


who


are


often


not


able


to be first


among


equals


their


own


a


aI S % F- -


-- J L- -


II .. _- 1 .. *1


*


t-_ -_ JA- J_.


*_


f -







was


incongruent with


the relatively


"formal


[extra-


program]


administrative appointments"


maj or


plea


was


faculty


development,


which would have


involve


improving research and service


skills


and


inculcation
stewardship,


of values


for scholarship,


collegiality.


This


focus


will


require a special


interpersonal
different fro


in allied health


emphasis on conceptual


skills,


and


of which are quite


m technical--clinical


occupations,


skills


and all


inherent


of which are


learned i

Current Status


n quite different ways.


of Colleges


191


Allied Health


The allied health


professions developed


for practical


needs,


not abstractions


(Hinkle,


1986) .


The knowledge base


the different


occupations


is diverse


often


undefined,


immature,


lacking


theory,


or dependent


upon a


paradigm


claimed by


another profession


(National


Commission


on Allied


Health Education


[NCAHE],


1980)


Until


practitioners


acquire a


theoretical


base,


the hospital


tends


serve


training


site


(Rosenfeld,


1972) .


The


professional


soc


ieties serve


as vehicles


occupational


identity


one salient manifestation of


this


is specialized


accreditation


(Friedson,


1986).


College-wide missions


have


been reported


as nonexistent,


both


formal


informal


, and


in need


of alteration


(Miller,


Beckham,


Pathak,


1983)


College administrators


have generally


supported


greater


autonomy


for allied health


education


(Florida


Board


Regents,


1983;


Pyne


, 1975)


But advocacy


independence







dependence on other units


colleges of


for facilities


allied health within academic health


course work


centers may


be among the most vulnerable


(Barritt,


1980;


Ford,


1983;


Morris,


1980).


Cooperation,


communication,


and


collaboration;


successful


been confronted with


themes of


financial


earlier decades


exigency


(Ford,


have


1983).


now reads:


"Deans'


Winter Conference


to Focus on Survival


Allied Health


Units


in Higher


Education"


(Deans'


1987-1988).


Program interrelationships


Titles may not be reliable


are complex


indicators of


1979) .


function,


profession,


or role.


Studies


of department


chairs


result


reports about


program directors


(Anderson,


1981)


Many


departments have


four or


fewer members and would be


considered programs


by most higher education administrators


(Tucker,


1981) .


Goals of


individual


programs may


unrelated


to or


in conflict with


each


other or with


college-


wide goals.

professional


Examples

practice


include educational


turfs,


entry


and accreditation


level,

(Hinkle,


1986) .


continue


professions


Many members of


to view members of


as subservient


the older health


younger


(NCAHE,


professions


allied health


1980).


Unlike most professional


school


deans,


allied health


administrators


often do not share education


, experience


, or


occupation


in common with


their faculty


(Foegelle,


1984 ;


Frank,


1984)


This may partially


explain


the greater value


. I I -r .


I







McTernan,


may


1972).


be organization


The motivators

nal, financial


to espouse

, or faculty


these objectives

developmental


less concerned with a


common body


of knowledge needed


for professional


Financial


practice.


authoritative relationships between


colleges and


other units are equally


complex


(Wise,


1979).


Faculty practice


toward


plans or hospital budgets may


faculty salaries or student stipends.


the colleges may reimburse clinical


agencies o


contribute

Conversely,

r other


colleges


services


facilities.


The


influence


college of medicine


is reflected administratively


as well


professionally


faculty


responsibilities


(Kelley,


1975;


Wise,


1979)


The allied health


educational


programs


"have


relatively


institutions


(for


status


example research


very types


universities,


academic


health


science centers)


that


could play the greatest


developing


future


leaders and


contributing to


their


knowledge base


for education and


practice"


(NCAHE,


1980


34).


The


prime variable which


distinguishes among


faculty


attitudes and behaviors


is the allied health


discipline


(Anderson


1981;


Kelley


, 1975).


This


is consistent


with


other


higher


education


faculty


studies


(Clarke,


1983;


Stark


& Morstain,


1978) .


Whatever the


particular profession,


faculty tend


to be practitioners and


teachers,


theorists


- S_ 9 I S *


r


1







invested


in program/professional


administration.


Women


predominate


most


allied


health


occupations


(Foegelle


1984)


The


deans


have


been


advocates


more


formal


and


continuing


education


their


faculty


es.


Faculty


developmental


interests


have


been


reported to


research,


practice


where


most


have


had


ample


experience


teaching


where


most


faculty


development


activity


have


been


directed


(Foeg


elle,


1984)


there


evidence


that


may


be changing:


Our


faculty


must


meet


the


same


standard


expect


of faculty
Whether it


scientific


in the


biological


discipline.


or soc


sciences


, we must


find


a scientific


base of


eration


our


from


individual


which
profe


to launch


ssions


rese


. (Covey


& Burk


arch
e, 1


987


Stark


s Framework


Stark


, Lowther


, Hagerty


Orczyk


(1986)


have


developed


a conceptual


framework


the study


of degree


programs


conducted


four


-year


colleges


university


that


provide


initial


Soc


iali


zation


entry


to broadly


defined


profe


recency


thi


summarized.


ssional


elds"


framework,


will


Because


development


followed


will


a description


the


framework


how


some


components


can


serve


identify


science


related


courses


and


provide


a focus


development


of delivery


system


criteria.







liberal


arts majors.


Because


professional


curricula


vary


markedly


is difficult


for administrators


to understand


each program.


is essential


that administrators


develop a

lead. Ed


working


ucators


knowledge of the


, researchers,


programs they purport


and administrators are


commonly unaware of the similarities and differences among


professional


lend


programs;


themselves to


therefore cross-program comparisons


investigator bias and use of


noncomparable data.


Stark


et al.


(1986)


claimed


that


standard

would en


framework


for cross-professional


hance objectivity,


accommodate change


program study


over time


reduce or


eliminate specialized


language and


the


resulting


confusion,

education.


distinguish between preservice and


continuing


clarify the often ambiguous meaning


"professional


competence"


(pp.


232-3).


In developing the


framework,


investigators


used


grounded


theory


approach.


They reviewed professional


education studies


and program descriptions


held


seminars


with


different


professional


faculties,


and reviewed


literature


on professionalism.


Elements of


their


emerging


framework were


then


compared with


themes


found


"professional


education


journals of


eleven


fields"


Stark


al.,


1986


235)


including dentistry


, medicine,


nursing,


pharmacy,


and nonhealth


professions


for the


year


1979.


revised


framework was


then used


as a guide


a content







medicine.

exhaustive,


To determine

distinct, a


further


nd appropria


the elements were

te, a pilot questionnaire


was designed


perceptions of


assess


each


University

the element


of Michigan

s in the fr


"faculty


amework"


235)


The Stark


et al.


(1986)


framework asserts that professional


preparation


programs are


influenced by


internal


intraorganizational,


Figure 1].
professional


turn,


These


forces


preparation


influences


processes


intended


external
interact


forces


[see


to create


'environment'


the design o
d to achieve


which,


f educational
professional


preparation outcomes.


. Finally the extent


which


the outcomes are achieved and,


orientation of


internal,


the new professionals,
intraorganizational, ar


thus, the
influences


external


forces.


236)


The external


influences consist of


two major


categories,


societal


influences and


characteristics,


each


professional


community


of which have several


more specific


elements


(see


Figure


Elements


internal


influences are grouped


program structure,


under four


curricula


categories;


tensions


mission,


continuing


professional


involvement,


also shown


in Figure


. Stark


(1986)


believed


that


elements of the


intraorganizational


influences


(mission,


program centrality,


program


interrelationships,


financial,


technological


support,


governance)


will


"become


increasingly potent


forces


affecting professional


curricula"


238) .


Selected


elements


from amonq these


influence qroupinqs served












Professional Preparation Outcomes


External
Influences


Internal


Influences


Figure


A Framework


Desc


ribing


Professional


Preparation


Programs.


Note.
study


From,
of pi


colleges
Lowther,
Journal
Copyrigh
Press.


and


conc


servicee


eptual f
profess


universities


Hag


of Higher


1986


Reprinted


erty


ramework for t
ional programs


" by J
. & C.


Education,


the Ohio


permit


State
ssion.


. s.


Stark


Orczyk,
p. 237.
Univers


Intraorganizational


Influences


1986





























External Influences


Societal


Influences


Reward System
Marketplace for
graduates
Media
Government policies
Funding
ULcensing

Professional Community
Characteristics
Knowledge base
Client orientation


Practice


settings


Professional autonomy
Accreditation and
standards
Market control
Ethics
Publications
Alumni involvement


Intraorganizational


Influences


Mission, history, traditions
Program centrality
Program interrelationships
Financial/technological
support
Governance patterns


Internal

Mission.
Program


Influences


Staffing and
Organization


Faculty background
Faculty mix
Ideology and
program missions
Evaluation of faculty
Professional Program
Structure

Specialization
Time Requirements
Student evaluation
Student mix
Entrance requirements
Student/faculty ratio


Curricular


Tensions


Instructional
methodology


Balance


of theory


and practice


Core


courses


Contextual study


Course
Course


sequencing
and program


evaluation

Continuing Professional
Involvement


Figure


Spec
Prog


Influences


on Profes


sional


Prepara


tion


rams.


Note.


From


, "A


conceptual


framework


study of
colleges
Lowther,


preserve ice


unive


rsit


ressiona
es" by J


programs
S. Stark


Orc


zyk,


.A.


1986


- --


_ _


_ I


_ ~ *


, *







focus


science course delivery


system for this


study.


The environment


that


these


influences collate


create


results


educational


processes which


in turn


result


professional


preparation outcomes.


There


are


major


categories of


outcomes,


professional


competencies


professional


attitudes


(see Figure


Since


the


initial


publication


of the


framework,


three other outcomes have


been


specified;


leadership capacity,


aesthetic sensibility


critical


Stark,


thinking,


personal


communication,


February


1987).


The competencies were defined


Chapter


an illustration of these


nurse anesthetist as a


competencies


representative health


consider


professional.


The


nurse


anesthetist


understands


the


uptake


distribution


of anesthetic agents


(conceptual


competence)


knows how to operate


the anesthesia machine and monitoring


equipment


(technical


competence),


and can develop a


safe and


effective anesthesia management


plan


(integrative


competence).


She recognizes


that


the same


client


undergoing


the same


unit


procedure


or hospitalized


in a


different milieu


inpatient)


may


(same day


benefit by


surgery


different


anesthesia management


(contextual


competence)


Also as


new


agents and monitoring techniques


become available she


incorporates


them


into


her practice


(adaptive


competence).


In any program


required


courses


in the curriculum


r_ --- 1 - _. J^. 13 -- 1 -


_ __ -L JL.. L _- _










Professional Competences

Conceptual competence
Technical competence
Integrative competence
Contextual competence
Adaptive competence
Interpersonal communication


Professional Attitudes

Professional identity
Professional ethics
Career marketability
Scholarly concern for


Motivation for continued


External


Influences


improvement


learning


Internal


Influences


Figure


Professional


Preparation


Outcomes.


Note.
prese


From,
rvice


universe


"A concept


prof


ities"


essio


framework


programs


Stark,


in coll


the
eges


study
and


Lowther


TPrfliirn i n


Professional Preparation Environment


I


i


C


^ .. _







professional


competencies


and attitudes.


It can be


posited


that any required


course


in a


professional


program will


contribute


to each


professional


preparation


outcomes.


However


a particular


course may make a major contribution


the development


of some outcomes and a negligible


one


toward


others.


Science related courses can be perceived as


fostering the acquisition


of conceptual


competencies


biophysical


sciences


allied health students.


They


may have a


limited


role


in the development of


professional


identity.


This


is most apparent


in the case


of prerequi


site


basic sciences,


core courses,


and sciences designed


other


health


professions students


but open


to allied health


students.


The contributions of


a science course


toward


competence


and attitude acquisition may vary with


the science and/or


profession.


example,


the skills developed


the gross


anatomy laboratory may

technical competencies


contribute

that an oc


little


toward


cupational


therapist


will


use


in professional


practice.


the skills acquired


the microbiology


future medical


boratory may be germane

technologist. However


the activities


in both


situations


biophysical

remains a p


the development


science,


primaryy


of conceptual


competence


supportive of professional


goal.


in a


practice


The other outcomes described by


Stark et al.


(1986)


for which


the science


related


courses


a -


1 _


I 1 I


I







integrative


adaptive


competencies


and


a scholarly


concern


improvement.


illustrate


a representative


consider


health


nurse


professions


anesthesia


student.


A ph


student

ysiology


course


may


include


objectives


regarding


cardiova


scular


dynamics.


The


teaching


strategies


may


incorporate


laboratory


to demonstrate


some


concepts


or a


historical


discussion


methodology


used


some


early


inves


tigator


who


formulated


concepts


Thus


, the student


derives


an understanding


some


"knowl


edge


upon


which


professional


practice


based"


Stark


et al. 1986


. 244)


(conceptual


competence)


recognizes


that


this


knowl


edge


was


acquire


through


rese


arch


(scholarly


concern


improvement)


This


knowledge


of cardiovascular


dynamics


may


provide


the


S1lS


perform


some


technical


skill


pharmacologic


intervention


to maintain


blood


pressure


during


the


course


of anesthesia


(integrative


competence


Likewi


because


of a knowledge


of cardiovascular


dynamics


, the


future


nurse


anes


thetist


will


incorporate


new


technologies


when


developed


to better


monitor


cardiovascular


phys


biology


(adaptive


competence).


Stark


identification


framework


of sci


was


ence


used


related


to assist


the


courses


study


Recall


that


science


relat


courses


are


required


profess


ional


phase


biophysical


sciences


, the


primary







competencies and


the development of


a concern


for scholarly


improvement.


Thus,


it was outcome as


reflected by the


course description


course name,


faculty


background,


college sponsor that served


to identify these courses.


This


will


be discussed


Chapter


III.


After the


literature


review the


framework also served


to structure


science


related


course delivery


system


issues and


proposed


criteria.


This will


also be


explained


in Chapter


III.


Hundreds


of professional


liberal


arts and


science


faculty


have


participated


the development


this


framework.


comprehensiveness and multiprofessional


applicability have been established.


Findings of


others


using this


framework


are


underway


(Stark,


personal


communication,


February


1987)


are not


available.


However the designers


of this


framework have conducted


one


study to test


this model.


To determine


"the ability


of the


framework to assist


mapping


differences among programs"


Stark,


Lowther


, and


Hagerty


(1987,


533)


obtained and analyzed a


national


sample of professional


faculty


opinion.


specific


purpose was


to identify


discriminators


among


entry


level


professional


programs and


to determine


"each


professional


field had


a unique


preparation environment"


533).


Faculty


(n=2


11 professions


programs


among


346


universities and


colleges


participated.


- &


__


1 -







factor analyses of the data resulted


four groups


factors


representative of


named Factor


program influences.


curriculum debate,


Factor


They were


education


mission,


Factor


societal


influence/university


prestige/gender,


and Factor


professional


community


influence/university


confirm that


support.


Analysis of variance did


faculty perceptions of professional


preparation environments differed


significantly


education

on some of


factors.


Three


strong discriminants among programs


were


faculty perception of


societal


influences


(external),


social


prestige


ratings of


occupations


(external)


, and gender


ratios of


program graduates


(internal)


Strong


society


support

faculty


is perceive

(business,


for programs with


engineering,


predominately male


and pharmacy).


The professional


community


influences


(external)


were


less


powerful


program discriminants


than


societal.


However some


items did serve


as discriminants.


Some


program


faculties who


perceive weak societal


support


"perceive


strong


influence


from accreditors"


556)


(nursing


social


work).


"Faculty perceptions of having


achieved


consensus on a


professional


knowledge base"


was


discriminant.


Several


potential


influences did not serve


discriminants among professions.


These


included


"faculty


age,


possession of


a doctorate,


. .[and]


time


spent







institutional


size


type


(degree of


research


orientation),


but not professional


field.


Clearly this


framework


is developing


into a model


that


can serve to


identify


discriminators among professional


programs.


The


finding that profession and not


institutional


size or type served as a


discriminator of


faculty


perceptions of


professional


preparation environment


was


cited as having both research and practical


applications.


Accreditation Standards:


Tools


Academia


Introduction


Twenty


sets


of health


science


professions'


accreditation standards


guidelines were


perused


determine


requirements


for program officials qualifications,


faculty responsibilities


for service and research,


evidence of


sciences


in curricula.


Each set of


standards


was


applicable


which all


to a single health science occupation,


or some of


programs awarded a baccalaureate


degree.


Thus a


of standards may


apply to certificate or


graduate as well


as baccalaureate


programs.


Each responsible


the Council


accrediting


on Postsecondary


agency


Accreditation.


is recognized by


1988,


accrediting


agencies


and health


science


professions


concerned were


the American Council


on Pharmaceutical


Education


(ACPE),


pharmacy;


the American Dental


Association







Dietetic


Association


(ADA)


dietetics


; the


American


Physical


Therapy


Association


(APTA)


, phy


sical


erapy;


American


Ass


ociation


of Nurse


Anesthetists


Council


on Accreditation


of Nurse


Anesthesia


Educational


Programs/


School


(AANA


nurse


anesthesia;


the National


League


Nurs


Council


Baccalaureate


Higher


Degree


Programs


(NLN),


nursing.


In addition


to these


49 other


organize


nations


collaborated


with


Ameri


can


Medical


Assoc


nation


Committee

(CAHEA) t


on Allied


o accredit


Health

26 alli


Education

ed health


Accreditation


occupations,


14 of


which


1986)


apply


These


programs


programs


with


were


baccalaureate


cytotechnology


curric


, cardiova


(AMA,


scular


technology


histotechnology,


medi


record


admini


station,


medical


technology


nuclear


medi


cine,


oCC


upational


therapy


perfusion


technology


, radiography,


radiation


therapy


physician


ass


istant


, respiratory


therapy,


sonography


, and


surgeon


s assistant.


Although


various


sets


of accreditation


requirements


address


similar


issues


they


frequently


use


diff


erent


terms


mean


same


thing


(AMA


, 1985a;


American


sic


Therapy


Association


[APTA]


1978;


National


League


Nursing


[NLN],


1980)


there


are


nuances


among


terms


such


, internship,


externship


, clerkship,


eldwork,


practicum


both


within


among


profes


sons.


Throughout







different

verbs such


terms.

as shal


Several


accreditation documents defined


and should


(American Dental Association


[Amer


. Dent.


Assoc.]


AMA,


1981a).


A generalization


is that shall,


will


and must are mandates;


whereas


should,


could,


can,


and may


are


less


forceful


suggest


ethical


obligations,


alternatives,


or liberty to do something


(AMA,


1981a).


Accreditation standards


for the occupations


under


discussion were adopted


as early


1935


(AMA,


1983b)


recently


1985


(AMA,


1985b).


Of the


standards


effect


during


1986


sets


had been adopted


late


1970s and


remaining


were


products


of the


1980s.


The maximal


duration


of program accreditation varied


from


through


years,


the mode being


years


see


Table


illustrated


in Table


,six sets


of standards


limited


program sponsorship


to 4-year colleges


or universities.


accrediting


agency


surgeon's


assistant


programs


suggested sponsorship


in schools


of medicine


in conjunction


with


the department of


surgery


(AMA,


1982).


The


physician


assistant agency


recommended academic health


centers


educational


sponsors


(AMA,


1985c).


Sponsorship of


dental


hygiene programs


had


to be in nonprofit postsecondary


institutions


(Amer.


Dent.


Assoc.


, n.d.) .


hospital


other


health


care


facility


alone can be


accredited


as a


sponsor of


[respiratory therapy]


training program"


(AMA,


, n.d.;


... _





_







Tabl


Maximum


Number


of Years


of Program


Accreditation


Minimal


Program Duration Requirements



Duration Duration of Professional
Program Accred. Program in Months


Cardiovasc


. Tech.


Cytotechnology


Dental

Dieteti

Histote


Hygiene

cs


chnology


Medical


Record


Adm.


specified


Medical


Technology


Nuclear


Medi


cine


Nurse


Anesthesia


Nursing


specified


Occupational


Therapy


ecifiedb


Perfusion


Technology


Pharmacy


Phys


Phys


ical


cian


Therapy


Assis


specific


tant


Radiation


Therapy


Radiography


Respiratory


Therapy


Sonography


-12


Surgeon


Assi


stant







educational i

allied health

laboratories,


institution.

professional

the military


vocational-technical


colleges of medicine,


Sponsorship of t

programs might

* cancer treatme


schools,


community


proprietary


colleges,


he


remaining


include hospitals,

nt centers,

organizations,


4-year


colleges


and universities.


Some standards were specific regarding the minimal


duration of the

flexibility bas


programs


(see Table


ed upon student


prior


Others


experience


permitted

, ability,


science background


(AMA,


1980a,


1980b,


1982).


Several


just


implied


the duration by


stipulating that most


courses would


be upper division


(NLN,


1980,


or that


credential


awarded would be


a baccalaureate degree


(American Dietetic


Association


[ADA],


1976,


The number


institutions


with accredited programs


well


as the


number


and percent


which


offered


baccalaureate degree


in each health profession


shown


Table 2.


The standards examined


for dietetics,


nursing,


pharmacy were applicable solely to baccalaureate


programs.


These professions had


different or


additional


standards


other


educational


levels,


e.g.


, dietetic postbaccalaureate


certificate,


associate degree nursing,


or doctorate


pharmacy.


The


preponderance of nonbaccalaureate


programs


medical


records administration


, medical


technology


nurse


anesthesia,


occupational


therapy


, and physical


therapy were


-Y a n 4. in a* a -* ., a) A. a4 C 4 a .IW 4. a a w nL .4. a* '. iA in a .


-- ,_







Table


Number


Percent


of Institutions


with


Accredited


Baccalaureate


Health


Science


FBS1


Programs


Institutions


Program


Total


N BS


Cardiovasc.


Tech.


Cytotechnology


Dental


Hygiene


Dieteti


ab 65


100


Histotechnology


Medical


Record


Adm.


96.3


Medical


Nuclear


Technology


Medicine


Nurse


Anesth


esia


11.3


Nursing


b 453


100


Occupational


Therapy


Perfu


sion


Technology


Pharmacy


Physical


b 65


Therapy


Phys


ician


Assistant


Radiation


Therapy


Radiography


Respiratory


Therapy


Sonography


20.8


a .


453a


108a







nonbaccalaureate


programs


other


occupations were


associate degree,


certificate,


or diploma.


Program Directors


As shown in


Table


seven professions'


standards


required


the program director to be credentialed


occupation and


required either the program director


education


coordinator to be a member


the occupation.


Four


required a member of


profession or a


physician/dentist


of a relevant


specialty.


Three


permitted


program


director to


have


same,


relevant,


or equivalent


occupational


credentials.


Pharmacy


standards did not mandate


a pharmacist

demonstrate


for dean but did require


S. professional


the dean


leadership


" (American


Council


on Pharmaceutical


Education


[ACPE],


1984,


The remaining


standards did not mention requisite


professional


credential


for the


program directors.


amount and/or


level


formal


education


required


program directors was diverse


(see Table


Nursing


standards


require


the chief program administrator to


hold a


doctoral


degree,


only the baccalaureate of


this


person


needed


to be in nursing


(NLN,


1980) .


four mandating


a master's or ongoing work toward


one


, dietetics


standards


permitted


the degree


to be


"in dietetics


or a closely


related


field"


(ADA,


1976


, p.


and nurse


anesthesia


guidelines


indicated


that an appropriate master


s degree


a^ 1 A L aA. -.. 4*. 4 a ^ a /-i-


*
- n -. -w a


- -. S, -


I


,1-. t. **-I^ kk







Table 3


Accreditation Requirements


Professional


Credentials


of Program Directors


Program


Acceptable Credential


Cardiovasc.


Tech.


not specified


Cytotechnology

Dental Hygiene

Dietetics

Histotechnology


cytotechnologista

dental hygienist or dentist

registered dietitian

histotechnologista


Medical Record Adm.


med.


rec.


adm.


or equivalent


Medical


Technology


medical


technologist


Nuclear Medicine


nuclear med.


or equivalent


Nurse Anesthesia


nurse anesthetist or MD


Nursing


professional


nurse


Occupational


Therapy


occupational


therapist


Perfusion Technology


perfusion


tech.


or equivalent


Pharmacy


specified


Physical


Therapy


physical


therapist


Physician Assistant

Radiation Therapy

Radiography

Respiratory Therapy

Sonography


not specified

radiation therapist

radiographer

respiratory therapist or MD

sonographer or MD


Surgeon


s Assistant


not specified


___







Table 4


Accreditation Requirements


Academic Credentials of


ProQram Directors


Program


Acceptable Credential


Cardiovasc.


Tech.


Cytotechnology


Dental


Hygiene


higher than students


BS or


equivalent


not specified


Dietetics


masters


Histotechnology


two


years of


college


Medical


Record Adm.


masters


Medical


Technology


varies with


experience


Nuclear Medicine

Nurse Anesthesia

Nursing


BS or equivalent

masters

doctorate


Occupational


Therapy


masters


Perfusion Technology


Pharmacy


not specified


not specified


Physical


Therapy


not specified


Physician Assistant


not specified


Radiation Therapy


vari


with experience


Radiography


varies with


experience


Respirator Therapy


varies with


experience


Sonography


not specified


Surgeon


s Assistant


not specified







Council

[AANA],


on Accreditation of Educational


1980) .


Programs/Schools


Some guidelines contained discussions of


program director and/or


faculty academic qualifications


relative


to students


(ADA,


1976;


AMA,


1977b


, 1985c)


"Key


faculty


in any type of professional


program should


possess


the same or higher


level


of education and/or professional


credentials as


that


for which students


in the


[respiratory


therapy]


program are being prepared"


(AMA


, 1977b,


The


four


sets of


accreditation standards which


provided


for the substitution


experience


lieu


of degrees


tended


contain detailed discussions of


issue


(AMA,


1977a,


1977b,


1981b,


1983c)


As an example,


qualifications


radiography program director are


that he or


Shall be a radiographer qualified
methodologies.


educational


Shall be credentialed
American Registry


in radiography


by the


of Radiologic Technologists


or possess suitable equivalent qualifications.


Shall


be qualified through education and


experience.
proficiency


These qualifications shall


but shall


not be


assure


limited


the


following


areas:


curriculum design
instructional methodology


testing and
educational


evaluation
psychology


Shall


document


to the sponsor satisfactory


completion


of one of


following:


a baccalaureate or advanced degree with a
minimum of two years of postcertification


experience as
of two years


a radiographer


as an


instructor


and a minimum
in an


accredited


radiography program;


an associate degree with a minimum of


two


years of oostcertification experience as a








a minimum of


five


years


of postcertification


experience
of four yea


as a radiographer and a minimum


rs


as an instructor


in an


accredited radiography program
pp. 3-4)


. (AMA,


1983c,


Directives that


faculty


serve as


role models


(ACPE


1984),


have clinical


privileges


(AMA,


1977b),


be actively


practicing


(AMA,


1983a),


or periodically return


to practice


(AMA,


1981a)


indicated


importance of


clinical


experience.


The expectation that program directors


other


faculty


have


prior and/or current


work experience


was


apparent by professional


credential


requirements


see


Tables


and 5).


The


standards of


8 occupations


enumerated


years and types of


prior


experience


that


appointed


program director must have


(see Table 5).


that


explicitly mentioned


prior work


experience


for the


program


officer


had


to have


defined


it broadly.


"experience


The nursing


in baccalaureate and/or


administrator


higher


degree


programs


in nursing"


(NLN,


1980,


14) .


"Relevant


occupational


therapy


experience


in administration,


teaching,


and direct


service"


(AMA,


1983b,


was


stipulated


that profession.


The detail


to which many


the others


described


their requirements was expressed by medical


record


administration standards.


The


program director,


"must


have


a minimum of


three


years


professional


experience


at an


administrative


level


in medical


record administration


either a health


care


facility


or industry/agency


serving







Table


Accreditation Requirements


Experience of


Program


Directors


Program


Experience Specified


Cardiovasc.


Tech.


experience


recommended


Cytotechnology


Dental


Hygiene


Dietetics


5 years


teaching)


not specified


year


years preferred


Histotechnology

Medical Record Adm.


years

years


Medical


Technology


Nuclear Medicine


varies with academic degree


years


recommended


Nurse Anesthesia


not specified


Nursing


relevant experience


required


Occupational


Therapy


relevant experience


required


Perfusion Technology


Pharmacy


not specified


not specified


Physical


Therapy


specified


Physician Assistant


Radiation Therapy


Radiography


specified


varies with academic degree


varies with academic degree


Respiratory Therapy


Sonography


Surgeon's Assistant


varies with academic degree


not specified


not specified







that


this


experience


must


have


been


one


in which


erson


was


"primarily


involved


planning,


organize


ing,


directing


controlling,


and/or


evaluating


health


record


functions"


(AMA


, 1981a


, p.


After


prof


ess


ional,


academic


, and


clinical


experience


requirements


, one


other


often


mentioned


requirement


concerned


evidence


instructional


competence


(AMA


, 1980b,


1984).


Again


these


stipulations


ranged


from


general


detailed.


"The


director


has


competence


in teaching,


educational


admini


station,


curriculum


development"


(APTA,


1978


. B-3


Or the


cytotechnology


program


director


"has


completed


courses


or seminars


principles


of education


management;


has documented


continuing


education


in educational


methodologies


" (AMA


1983a,


. 4).


Medical


Direc


tors


SIX


prof


ess


ions


accredited


non


-CAHEA


agencies


none

nurse


were

anes


required

thesia s


to have


standards


a medical

permitted


director.

either a


Although


nurse


anesthetist


or an anesthes


biologist


serve


as program


director


long


as a nurse


anes


thetist


actively


involved


organization


and


administration


total


program"


(AANA,


1980,


Dental


hygiene


standards


required


program


administrative


structure


clude


dental


hygieni


or a dentist


with


current


expe


rience







require

medical


a medical

records a


director


dmini


were


station.


occupational


Standards


therapy


radiation


therapy


indicated


that


a medical


director


advi


sor


may


required


(AMA,


1981)


remaining


11 sets of CAHEA


standards


required


a medical


director;


of which,


medi


technology


radiography,


permitted


the


phys


cian


leader


to hold


a different


title


(AMA,


1977a


, unpaged;


1983c


Qualifications


medical


director


commonly


include


ed li


censure


as a physi


cian


know


edge


, expe


ence


or credentials


the relevant


specialty


Seve


standards


also


referred


to active


intere


in and


involvement


teaching.


experiencec


example


ed and


medical


proficient


director


use


was


to be


of ultrasound"


(AMA


1980a,


or "knowledgeable


about


delivery


primary


care"


(AMA


, 1985c


or "knowledgeable


effe


active


in teaching


the subjects


ass


signed"


(AMA,


1985b


more


spec


cally,


"qualifi


in the


use


radionuclides


a diplomat


of either


American


Board(


of Nuclear


Medi


cine,


Pathology,


or Radiology


possess


The


suitable


equivalent


gene


the


qualifications"


medical


(AMA


director


, 1984


insure


medical


pertinence


curriculum


often


to facilitate


public


relations


among


physi


cans.


"The


medical


director







didactic and supervised practice,


meets current acceptable


standards"


(AMA,


1985b,


Or "the medical/surgical


director


the clinical


should provide continuous,


competent direction


relationships with other educational


The medical/surgical


understanding


director should actively


programs.


elicit


and support of practicing physicians"


(AMA,


1982,


Program Faculty


Several


sets of


accreditation standards


such as


dietetics,


nursing


, pharmacy,


and physical


therapy


limited


interpretation and


discussion


of faculty to appointees


the educational


sponsor,


who


had teaching


responsibilities.


"Full-time equivalent


faculty


include


only those persons

are employed on a


who hold

partial o


at least a masters degree


r full


appointment by the college


or university"


"there must be a


(ADA,


1976,


core of


For dental


qualified


full-time


hygiene,


faculty


the majority


faculty must have


full-time


appointments"


(Amer.


Dent.


Assoc.,


When


standards and guidelines


of dietetics,


nursing,


pharmacy,


and physical


therapy referred


to memb


ers


respective


student clinical


professions who


instruction,


participate


it was apparent


primarily


that


clinicians had a more

students who are reai


circumscribed role.


stered dietitians with


"Graduate

practitioner


*


- 1-_. -*1 2 1


n.d.,


_.'IL


1 ^ _


...... -L I. ~ ... -~~







be counted


calculation


full


-time


equivalent


faculty


(ADA,


1976


. 6)


"Volunteer


clinical


faculty


preceptors


should


be exemplary


mod


practitioners


, and


should


reflect


a broad


spectrum


of pharmacy


settings"


ACPE,


1984,


. 7).


Of CAHEA


accredited


programs,


sonography


, radiography


radiation


therapy


technology


, and


occupational


therapy


standards


stated


or the


guidelines


implied


that


faculty


shall


or should


have


faculty


appointment


, if


program


was


college


or university


sponso


(AMA,


1980a,


1981b,


1983b


, 1983c)


"Instructors


. must


meet


standards


required


sponsoring


institution"


(AMA


, 1983c


Cardiovascular


technology,


cytotechnology


, histotechnology


nuclear


mention


medicine


university


nurse


anesthesia


appointments


standards


program


did


faculty.


The


latter


seemed


to equate


faculty


with


anyone


partic


ipating


student


instruction.


"Faculty


should


include


"behavioral


scie


ntis


educators,


other


nurses


, hospital


administrators,


and


egal


expert


s" (AANA,


1980


Standards


remaining


seven


occupations


spec


or implied


faculty


appointment


the


program


dir


ector


official


respiratory


therapy


"program


director


shall


a member


sponsoring


educational


institution


faculty


with


rights


privileges


" (AMA,


1977b


, p.


Perfusion


technology


"program


officials


should


have


. 31)


_






program official


"faculty


appointment may be a


regular


one,


a non-salaried


clinical,


or courtesy appointment or


adjunct"


(AMA,


1977a,


unpaged).


How


eve r


faculty


are defined,


sets


of standards


contain discussions


roles and responsibilities of


program officers,


sponsor employed


faculty,


clinical


faculty.


Typical


of content,


typical because


it was


directed


to program officers


rather than all


program


faculty,


were


"examples


of responsibilities of


program


officials"


(AMA,


1977a,


unpaged)


for medical


technology:


Development of,


validation of,


revision


of program objectives when appropriate.


Implementation


of admission


policies.


Curriculum development.


Implementation
procedures.

Recruitment.


of student


evaluation


Public
catalog


relations,
s, brochure


including preparation
s, or other materials


of
relating


the


program.


Planning
ongoing


implementation


instruction


a program


in curriculum design,


to ensure
teaching


techniques, a
all personnel


d current
involved


laboratory techniques
n instruction.


Maintaining

Student cou


student records.


nseling.


Input


into the


preparation of


program


budget.


Providing


program and


liaison between


the


institution


the educational
nal administration.







. Ensuring
student'


medical


s educational


accomplished


relevance


experience.


in a variety


in the


This


including


ways


lectures


, seminars


, clini


conferences


. (AMA,


1977a,


unpage


Thus


teaching


and


related


activity


form


the bulk


faculty/program


offi


cer


as exp


resse


d in


these


most


other


sets


of accreditation


standards.


The


extent


to which


the


curriculum


was


expected


to be


controlled


sponsor


employed


faculty


varied.


A few


sets


of standards


made


perfectly


clear


"The


phys


therapy


faculty


is responsible


instruction


curriculum


development"


(APTA,


1978


. B-4


"Primary


response


ibility


development


and


conduct


academic


programs(


res


ts with


the


nurs


faculty"


(NLN


1980


. 26)


Other


sets


of standards


ves


this


responsibility


program


offi


cial


Medical


technology


"program


offi


cials


shall


ensure


appropriate


instruction


areas


the education


program"


(AMA,


1977a,


unpaged)


The cardiovascular


responsible


technology


maintaining


program


quality


director


program"


(AMA


1985b


, pp.


"The


medical


director


is expect


play


a pivotal


role


the


design,


development


and


implementation


of all


courses


relating


respiratory


phy


siology


and


respiratory


seases


. as well


evaluating


. non-clinical


courses


" (AMA,


1977b,


dental


hygiene,


"the


program


admini


strator


must


- I I a


I I


_ q -


* -(


-1


r j


*






decisions on academic and


other policies affecting the


program that


they will


have


to implement"


(Amer


. Dent.


Assoc.,


Eleven


sets of


standards


required or recommended


advisory


committee or


community


liaison mechanism.


Some


these


vested major


curricular responsibilities


these


committees


(AMA,


1977b,


1980a


1981b


, 1983c).


"The


function


the committee should be


to advise the


program


curriculum"


(AMA,


1980b


. 3).


"The advisory


committee


should


play


a key role


in developing the curriculum


[and]


periodically review the


curriculum"


(AMA,


1981b


Evidence


of a broad scope and potentially political


nature of


a required advisory


committee


was


found


respiratory therapy


guidelines.


A well organized,
important force i


active advisory


-n evaluating,


reconciling the diverse


board


of the educational


institutional


therapy


faculty


interests


institution,


administrations,
y, the hospitals,


the
the


committee


balancing,


the governing
the


respiratory
students,


the community.


should be attended by a


. The meetings of


senior executive


committee
officer.


(AMA,


1977b,


7-8)


As mentioned,


teaching and


related activities


formed


the bulk


of faculty/program officer roles as expressed


most


sets


of accreditation standards.


Before discussing the


sciences


that


faculty were expected


teach,


standards


in relation


faculty


service and


research are discussed.


Faculty Service


Co roreiy1i r1 44-4l oc f hol1 nrnocc


. on


n.d.,


nrn faec! c T 1


~fr health







prof


session


institutional/community


service


or service


the


scipline/prof


ess


ion.


In addition


service


implications


evidenced


profess


ional


cre


dential


experience


requirements


, all


sets


of standard


contained


statements


about


clini


service.


In order


director


and


"have


of clinical


evaluative


education


functions


a respiratory


therapy


staff


reform


sition,


instructional


or she


appointment


clinical


affiliates


" (AMA,


1977b


. 5)


Phys


cian


surgeon


s assis


tant


standards


mentioned


practice


physicians


as primary


teachers


and


model


(AMA


, 1982


1985c


Dieteti


standards


required


faculty


to "show


evidence


of prof


essi


onal


growth


through


continuing


education


, experience


as practitioners,


or by


other


means"


(ADA,


1976


, p.


Dental


hygiene


guid


lines


stat


that


"faculty


who


provide


preclinical


technique


clini


instruction


must


have


. profic


iency


clinical


dental


hygiene"


(Amer


. Dent.


Assoc


. 24)


And


"a periodic


return


to medical


Thus


record


faculty


practice


clinical


is desirable"


service


was


AMA,


addressed


1981a


in terms


of faculty


skill


development,


maintenance


that


relation


, continuing


to students,


education


such


modeling


or supervision.


More


prevalent


than


above


examples


which


support


faculty


service


were


standards


guidelines


which


S S S -


_ r0


-1 -


1







[histotechnology]


program director should be expected


carry


a full-time technical


service load"


(AMA,


1978,


"The


radiographicc]


program director's responsibility


shall


not be adversely


affected by


educationally unrelated


functions"


(AMA,


1983c,


For nurse anesthesia


"provisions will


be made


to allow an equitable amount


time


class


. preparation"


(AANA,


1980,


accreditation requirements except occupational


therapy


, physical


therapy,


nursing,


and pharmacy warned


against student


exploitation


in the clinical


setting.


"Students must not be responsible


in any


significant


way


the service


function of


the clinical


laboratory"


(AMA,


1977a,


unpaged).


Radiography


students


"shall


take


responsibility


or the


place of


staff.


. Shifts with


limited


or repetitious experience may


be viewed


exploitation"


(AMA,


1983c,


"The


[respiratory therapy]


program shall


substitute or permit


to be substituted


students


for paid


personnel


to conduct


the work


clinical


affiliates"


(AMA,


1977b,


Accreditation


institutional


In fact,


requirements


or community


some standards could be


extraprogram or


extrainstitutiona


for or direct


evidence


service were generally


interpreted

1 endeavors.


lacking.


to preclude

"The


[radiological


technology]


program director must be exempt


from all


clinical


or departmental


duties


not directly


't- A**l a. -i t- 4a a ,n^ 4r n n a i t *% II I


45)


nrh~r ~m((


I ---h


1 00 1I


-- ^ ^^.^ t


CI







reference


program,


institution


or community


(ADA,


1976)


Medical


record


administration


guide


lines


limited


the


program


director


teaching


load


to one-half


two-thirds


time


so "administrative


duti


within


institution"


(AMA,


1981a,


can


be undertaken.


Dental


hygiene,


occupational


therapy,


phys


ical


erapy


nursing


, and


pharmacy


standards


stipulated


service


institution


and/


prof


session


(ACPE,


1984;


Amer


. Dent


Assoc


n.d


; AMA,


1983b


APTA


, 1978;


NLN


, 1980)


"The


institution


provides


[phys


ical


therapy]


program


faculty


participation


in the


governance


program


institution


as well


as short


-term


long-term


planning"


(APTA,


1978


. B-2


"Release


time


must


prov


ided


[dental


hygiene]


prof


ess


ional


assoc


nation


activity


(Amer


. Dent


. Assoc.


n.d.


, p.


Nursing,


"faculty


endeavors


include


participation


. professional


activities


and


community


service


" (NLN


, 1980


. 36)


And


"participation


university, as evid

of committees, and


life


enced


involvement


the college


mmittee s

in campus


. .


service


. and the

, chairmanship


governing


bodi


(ACPE


, 1984


. 7)


is expected


of pharmacy


faculty


summary


restrict

clinical


most


or equated


practice


sets


with


requirements


of standards


clinical

were di


, service


practice


scussed


was


Faculty


as supportive


or necessary


the


teaching


mission


were


- S -


I -


* _


t 1 r


II







frequently and


extensively than


faculty


responsibility


service.


six sets of


standards which required


institutional


and/or community


service all


except


dental


hygiene


limited sponsorship to 4-year


colleges


universities and all but occupational


therapy were


non-CAHEA


accredited.


Faculty


Research


Accreditation requirements


faculty


scholarship and


research are salient due to their relative


absence.


Excluding nursing


and pharmacy guidelines,


which mentioned


such


expectations


in several


contexts,


only physical


therapy,


occupational


therapy


, and


dental


hygiene guidelines


discussed


faculty


scholarship


Physical


therapy


faculty


"competence will


be evaluated


through


review


scholarly productivity"


responsibilities


(APTA


, 1978,


[for occupational


B-3)


therapy]


"Faculty


may


include.


research"


faculty


(AMA,


salaries,


1983,


dental


Regarding


hygiene standards


allocation


listed several


factors to consider


"research


competencies"


(Amer.


Dent.


Assoc.,


, p.


were among them.


Occupational


therapy


and dental


hygiene standards mentioned research


an area


for faculty


development


(Amer.


Dent.


Assoc.,


n.d.


AMA,


1983b).


Seven


sets of


allied health


standards


guidelines mentioned


research activities


in terms


Al 4t n A- n a t n a a... 3.-b *3 flN '4- In a t


TT^ l"-


/*3 n"^i ^-^~ I wn ^*h- %/


n".^l ." 1


4- I^ f\ Tb^^ vr *r r^ +


Ill~h


1







method,


to read


and


interpret


professional


literature,


partic


ipate


clinical


research


activity


, and


critically


analyze


new


concepts


findings


provided


ers


(APTA,


1978,


. B-8)


"The


cytot


echnologist


will


demonstrate


ability


to read


and


evaluate


published


profes


sional


literature


. [and


understand]


princ


iples


scie


ntifi


research"


(AMA,


1984,


Major


curriculum


divi


sions


were


label


res


earch


methods


stati


stics


rese


arch


occupational


therapy


medical


record


administration


, respe


active


(AMA,


1981a,


1983b)


Cardiovascular


technology


nurse


anesthesia


standards


mentioned


rese


arch


as a curricular


elective


The


word


rese


arch


was


not


found


in any


context


in the


accreditation


requirements


dieteti


, hi


stotechnology


medical

assistant


technology, pe

t, respiratory


rfusion

therapy


technology,


phy


surgeon


sician


s assistant.


Radiation

holdings


therapy


should


radiography


suffi


cient


mentioned


to promote


once:


"independent


Library


stud


and


research"


(AMA,


1981b,


1983c


Cardiova


scular


technology


, nucl


ear


medicine


, nurse


anesthesia,


and


sonography


standards


mentioned


research


library


context


(AANA


1980;


AMA,


1980a,


1984


1985b)


Phys


ical


therapy


sonography


guide


lines


mentioned


resea


paragraphs


concerning


ace


needs


(AMA,


1980a;


APTA,


1978)


Nursing


pharmacy


standards


-a a -


, p.


1 ..


h m_







creative


endeavors,


S. research


, and


scholarly


activity


es" (NLN


, 1980,


. 29)


And


pharmacy


faculty


members


were


to be evaluated


"scholarship


demonstrated


productive


research


securing


extramural


funding


in support


of research"


(ACPE


1984


, p.


summary


, five


sets


of standards


(cytotechnology


medical


records


admini


station,


nuclear


medi


cine,


occupational


program


with


therapy,


graduates


appropriate


physical


to under


res


tand


search.


therapy)


, interpret,


cardiovascular


required the

and/or assis


technology


nurse


anesthesia


suggested


this


as an


innovative


idea


Seven


did


mention


research


or scholarship.


Three


used


words


res


search


or scholarship


when


esc


ribing


space


library


holdings


, or student


loans


(radiography,


radiation


therapy


, and


sonography)


Among


alli


ed health


standards


dental


hygiene,


occupational


therapy,


and


phys


ical


therapy


standards


stated


that


scholarship


research


constitute


bona


fide


faculty


activity


es.


Excluding


these


three


, thi


marked


contras


nursing


pharmacy


The


Bionhv


sic


Sciences


The


curricular


divis


ions


in the


various


standards


were


itemi


scussed


seven


ways


This


influences


how


the


science


requirements


were


discus


since


they

the


constitute


manner


ed only


in which


a part


of each


curriculum


curriculum.


requirements


Therefore

were








discussion


cross


-professional


concerns.


first,


what


evidence


is there


that


conceptual


integrative


competence


regarding


biophysical


sciences


were


concern


those


who


wrote


the


accreditation


standard


Concern


conceptual


competence,


as defined


Stark


et al. (1986)


sciences


was


apparent


in the


accreditation

biophysical s


standards


science


because


requirements


all

and


sets


of standards


several


explained


had

why.


For


physician


assis


tants


sic


medical
bsequent


sciences
clinical


are


needed


studi


as a


foundation


[and


desirable
concepts
pathophy


. that
in anatomy,


siology,


phys


pharma


background
biology,


cology,


include


basi


clini


laboratory


medi


cine


in as much


the sub


seque


under


standing


of clinical


medi


cine


depends


upon


knowledge
p. 4)


these


content


areas


"The


structure


professional


curriculum


diagnostic


sonography


based


upon


a prerequis


foundation


postsecondary


study


biological


sciences


, introductory


phy


sics


, and


mathemati


must


include


didactic


content


appropriate


scope


depth"


(AMA


, 1980a,


. 100).


Other


statements


infered


a concern


egrative


compete


ce.


Respiratory


therapy


students


had


"under


stand


the


basi


sciences


how


basic


principles


relate


clinical


application


the


specialty"


(AMA,


1977b,


"Students


should


acquire


a cl


ear


understanding


basic


sciences


how


basi


scientific


prince


iples


relate


. (AMA,







curriculum must reflect


the relationship


between


the content


of the course of


study and histotechnology


including principles and practice,


functions,


application


of basic


sciences,


.. review


of chemistry;


laboratory mathematics;


anatomy


tissue


identification"


(AMA,


1978,


unpaged).


Biophysical


Sciences


in Each


Curriculum


Cardiovascular technology


standards divided


curriculum


into


basic,


cardiovascular,


clinical


units.


Five components


suggested


for the basic unit were


introduction,


anatomy


anatomy,


basic medical


physiology,


and physiology were


electronics,


sciences.


pharmacology,


Pharmacology,


to be concentrated


on the


cardiovascular system.


The sciences were


include


"biology,


basi


chemistry,


physical


principles


of medicine,


basic statisti


Curricular


found


and general

evidence f


the course examples


mathematics"


or biophysical


listed


(AMA,


1985b,


sciences


under the


was


clinical


unit,


1.e.,


cardiac and vascular pathology


and physics.


Cytotechnology guidelines


recommended


semester


hours


of chemistry


prerequisite


20 semester


to professional


hours


of biological


subjects.


The biology


sciences


courses


could


include


"general


biology


, bacteriology,


parasitology,


cell biology,

embryology, a


physiology,


ind genetics"


anatomy,


(AMA,


zoology


1983a,


, histology,


Professional


course


titles


or subjects were not


listed


but


the standards


'U~ aI U 0I 0


- I


I


*







disease,


the


cytotechnologist


will


be able


to develop


differential


diagnosis


based


on the


cellular


evidence


conjunction


with


pertinent


cognitive


know


edge


and


clinical


data"


(AMA,


1983a,


. 2).


Dental


general

hygiene


hygiene


education,

sciences,


standards


basi


divided


sciences,


clinical


curriculum


dental


practice.


sciences

Several


into

dental


topics


which


did


not


need


to be


equivalent


individual


courses


which


had


to be presented


are


sted


under


each


divi


sion.


Among


ese


were


general


chemi


stry,


anatomy


physiology


, biochemistry


, mi


crobiology,


pathology,


nutrition,


pharmacology,


tooth


morphology


, head


-neck-and-


oral


anatomy,


oral


embryology


stology,


oral


pathology,


radiography


, and


periodontology


dental


material


(Amer


Dent


SAssoc.


, n.d.).


Required


dieteti


prerequis


ites


were


inorganic


organic


chemi


stry,


microbiology


human


phys


biology


, and


introductory


nutrition


course.


Depending


upon


the specialty


tract


elected


biochemi


story,


biochemistry


analysis


anatomy


advanced


phys


biology,


or genetics


was


required


or recomme


nded


(ADA,


1976).


Profess


ional


courses,


topi


or competencies


were


itemized.


Histotechnology


standards


listed


topics


which


curriculum


must


include.


These


include


the


"application


basic


sciences,


. review


of chemistry


, laboratory