Activities carried out under the Veterans' Administration medical school assistance and health manpower training act of ...

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Title:
Activities carried out under the Veterans' Administration medical school assistance and health manpower training act of 1972, Public Law 92-541
Physical Description:
v. : 24 cm.
Language:
English
Creator:
United States -- Veterans Administration
United States -- Veterans Administration
United States -- Congress. -- House. -- Committee on Veterans' Affairs
United States -- Congress. -- Senate. -- Committee on Veterans' Affairs
Publisher:
U.S. Govt. Print. Off.
Place of Publication:
Washington
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Frequency:
annual

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Subjects / Keywords:
Veterans -- Medical care -- Periodicals -- United States   ( lcsh )
Federal aid to medical education -- Periodicals -- United States   ( lcsh )
Medical colleges -- Finance -- Periodicals -- United States   ( lcsh )
Genre:
federal government publication   ( marcgt )

Notes

Dates or Sequential Designation:
3rd (1979)-
Dates or Sequential Designation:
1st- 1972/77-
Numbering Peculiarities:
Reports for 197 -19 submitted to the Committee on Veterans' Affairs, United States House of Representatives, and Committee on Veterans' Affairs, United States Senate; <1981-> submitted to the Committee on Veterans' Affairs, United States Senate.
General Note:
MONTHLY CATALOG NUMBER: gp 82012290
General Note:
At head of title: 97th Congress, 1st session. Senate committee print no. 2.
General Note:
Feb. 7, 1981.
General Note:
CIS Microfiche Accession Numbers: CIS 81 S762-1, CIS 81 H762-3, CIS 80 S762-4, CIS 80 H762-8, CIS 78 S762-6
General Note:
At head of title: Senate committee.
General Note:
Reuse of record except for individual research requires license from Congressional Information Service, Inc.
General Note:
Also printed for the House Committee on Veterans' Affairs.
General Note:
Reuse of record except for individual research requires license from LexisNexis Academic & Library Solutions.
General Note:
Title from cover.
General Note:
"An annual report prepared by the Veterans' Administration (pursuant to section 5070(h) of title 38, U.S. Code) submitted to the Committee on Veterans' Affairs, United States Senate."
General Note:
At head of title: 96th Congress, 2d session. Senate committee print no. 22.

Record Information

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University of Florida
Rights Management:
All applicable rights reserved by the source institution and holding location.
Resource Identifier:
aleph - 022288622
oclc - 03955158
lccn - 81643989
Classification:
lcc - PAR
System ID:
AA00024009:00001

Related Items

Preceded by:
VA annual report on activities carried out under the Veterans' Administration Medical School Assistance and Health Manpower Training Act of 1972

Table of Contents
    Front Cover
        Page i
        Page ii
    Letter of transmittal
        Page iii
        Page iv
    Table of Contents
        Page v
        Page vi
    Preface
        Page vii
        Page viii
    Introduction
        Page 1
        Page 2
    Legislative history of 38 U.S.C. Chapter 82 (Public Law 92-541)
        Page 3
        Page 4
        Page 5
    Implementation of the legislation
        Page 6
        Page 7
    Establishment and development of administrative and operational policies
        Page 8
    Review and approval processes
        Page 9
        Page 10
        Page 11
        Page 12
    Award and report processes
        Page 13
    Current status of 38 U.S.C. Chapter 82 programs
        Page 14
        Page 15
    Subchapter I. Assistance in the establishment of new state medical schools
        Page 16
        Page 17
        Page 18
        Page 19
    Subchapter II. Grants to affiliated medical schools
        Page 20
        Page 21
        Page 22
        Page 23
        Page 24
        Page 25
    Subchapter III. Assistance to public and private nonprofit institutions of higher learning, hospitals and other health manpower institutions affiliated with the veterans' administration to increase the production of professional and other health personnel
        Page 26
        Page 27
        Page 28
        Page 29
        Page 30
        Page 31
        Page 32
        Page 33
        Page 34
        Page 35
    Subchapter IV. Expansion of veterans' administration hospital education and training capacity
        Page 36
    Approved/unfunded applications
        Page 37
    Summary
        Page 38
        Page 39
        Page 40
    Appendices
        Page 41
        Page 42
        Page 43
        Page 44
        Page 45
        Page 46
        Page 47
        Page 48
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    Back Cover
        Page 107
        Page 108
Full Text



95th Congress SENATE COMMITTEE PRINT NO. 16 2d SessionJ




ACTIVITIES CARRIED OUT UNDER THE VETERANS' ADMINISTRATION MEDICAL SCHOOL ASSISTANCE AND HEALTH MANPOWER TRAINING ACT OF 1972
(Public Law 92-541)





AN ANNUAL REPORT

PREPARED BY THE

VETERANS' ADMINI STRATION
(Pursuant to Section 5070 (h) of Title 38, U.S. Code)

STTBMITL'ED TO THE

COMMITTEE ON VETERANS' AFFAIRS
UNITED STATES SENATE



': t
~Z




FEBRUARY 13, 1978



Printed for the use of the Committee on Veterans' Affairs

U.S. GOVERNMENT PRINTING OFFICE 23-072 0 WASHINGTON :1978

























COMMITTEE ON VETERANS' AFFAIRS ALAN CRANSTON, California, Chairman HERMAN E. TALMADGE, Georgia STROM THURMOND, South Ca
JENNINGS RANDOLPH, West Virginia CLIFFORD P. HANSEN, Wyoming RICHARD (DICK) STONE, Florida ROBERT T. STAFFORD, Vermont JOHN A. DURKIN, New Hampshire SPARK M. MATSUNAGA, Hawaii



SUBCOMMITTEE ON HEALTH AND READJUSTMENT ALAN CRANSTON, California, Chairman JOHN A. DURKIN, New Hampshire, Vice Chairman
JENNINGS RANDOLPH, West Virginia STROM THURMOND, South Caroling RICHARD QK) STONE, Florida CLIFFORD P. HANSEN, Wyoming






-: II









LETTER OF TRANSMITTAL


VETERANS' ADMINISTRATION,
OFFICE OF THE ADMINISTRATOR OF VETERANS' AFFAIRS,
Hon.ALANCRANTONWashington, D.C., January 3, 1978.
Chairman, Subcommittee on Health and Hospitals, Commit tee on
Veterans' Affairs, U.S. Senate, Washington, D.C.
DEAR MR. CHAIRMAN: The first annual report of activities carried out under the Veterans' Administration Medical School Assistance and Health Manpower Training Act of 1972 (Public Law 92-541) is a record of the initiation of the grants program from 1.972, through the initial appropriation of funds in late fiscal year 1973, to the close of fiscal year 1977. Awards have been made to support the establishment of new medical schools, to assist existing medical schools affiliated with Veterans' Administration health facilities in expanding and improving their training liaison, and to aid institutions involved in the training of other prof essional, paraprofessional and technical health manpower personnel. Each component of this diversified support program shares the common objective of enlarging the pool of highly trained health personnel at professional and technical levels to provide high-quality, comprehensive health care to the Nation's veterans eligible for that care.
The number of veterans eligible for care and the number of veterans who apply for care have been increasing over the past decade; the Veterans' Administration health care system continues, therefore, to expand its array of services and recruit and maintain a staff competent to serve as faculty at clinical sites available to medical schools and other training institutions, as well as to deliver high-quality services to meet the individual needs of each veteran patient. The Veterans' Administration manpower grants program, in its initial months, has established an awards pattern designed to assist in the development of personnel skilled in the treatment techniques and specialties of primary importance in caring for the health problems of all VA patients, as well, as to develop a corps of personnel trained in specialized skills and techniques required in the sophisticated clinical procedures of modern scientific medicine.
Sincerely,
MAX CLELAND,
Administrator.
(Mf)












rP ABLE OF CONTENTS


Page
Letter of Transmittal ------------------------------------------------- M
Preface ------------------------------------------------------------- v][1
Introduction --------------------------------------------------------- 1
Legislative History of 38 U.S.C. Chapter 82 (Public Law 92-541) --------- 3
Implementation of the Legislation -------------------------------------- 6
Appropriations History ----------------------------------------------- 8
Establishment and Development of Administrative and Operational
Policies ----------------------------------------------------------- 8
Review and Approval Processes ---------------------------------------- 9
Award and Report Processes ------------------------------------------- 13
Current Status of 38 U.S.C. Chapter 82 Programs ----------------------- 14
Subehapter I-Assistance in the Establishment of New State Medical
Schools ----------------------------------------------------------- 16
Subehapter II-Grants to Affiliated Medical Schools -------------------- 20
Subehapter III-Assistance to Public and Private Nonprofit Institutions
of Higher Learning, Hospitals and Other Health Manpower Institutions Affiliated With the Veterans' Administration To Increase the Production
of Professional and Other Health Personnel --------------------------- 26
Subehapter IV-Expansion of Veterans' Administration Hospital Education and Training Capacity ------------------------------------------ 36
Approved/Unfunded Applications -------------------------------------- 37
Summary ----------------------------------------------------------- 38
Appendices ---------------------------------------------------------- 41
A. Letters From Special Medical Advisory Group and D.H.E.W ------- 41
B. Authorization and Appropriation Levels ------------------------- 45
0. Review Participants ------------------------------------------- 47
D. Grants Awarded ----------------------------------------------- 57
E. Health Professions and Occupations Categories ------------------- 87
F. Approved/Unfunded Applications ------------------------------- 89
(v)












PREFACE


The following Report to the Congress is mandated under Public, Law 94-581, VETERANS OMNIBUS HEALTH CARE ACT OF 1976:
"Sec. 116, Chapter 82 of Title 38, United States Code is amended by
it (2) inserting at the end of section 5070 the following
new subsection:

(h) Not later than ninety days after the end of each
fiscal year, the Administrator shall submit to the
Congress a report on activities carried out under this
chapter, including (1) an appraisal of the effectiveness of the programs authorized herein in carrying out their statutory purposes and the degree of cooperation
from other sources, financial and otherwise, (2) an
appraisal of the contributions of such programs in
improving the quality and quantity of physicians and other health care personnel furnishing hospital care
and medical services to veterans under this title,
(3) a list of the approved but unfunded projects under
this chapter and the funds needed for each such project,
and (4) recommendations for the improvement or more
effective administration of such programs, including
any necessary legislation;"

(VII)


















Digitized by the Internet Archive
in 2013












http://archive.org/details/actrriel977unit









INTRODUCTION

The original mission of the Veterans Administration, to provide hospital bed-care and some outpatient services to veterans with service-connected disabilities,, has been broadened and extended by a series of legislative actions. The prime beneficiaries of the VA health care program are, and will continue to be, those veterans with service-connected conditions; but as eligibility for care in VA facilities increases, the Department of Medicine and Surgery must concern itself with the further development of a system that provides comprehensive health care of high quality to an increasing quantity of-veterans eligible for that care.

To aid in achieving this objective, the Congress in
1972 adopted the Veterans' Administration Medical School Assistance and Health Manpower Training Act (P.L. 92-541) in which Part VI of Title 38, Unl"te States Code, was amended to include Chapter 82, providing for assistance in establishing new State medical schools; grants to affiliated medical schools; and assistance to health manpower training institutions.

For many years, the Veterans Administration has taken an active and fundamental part in the training of health manpower by providing clinical facilities and faculty personnel to medical schools and other training institutions throughout the United States, through a variety of contractual and consortial arrangements. For the first time, however, Chapter 82, USC 38 established a Congressional mandate to the VA through its Department of Medicine and Surgery to initiate, implement and administer a program of grants to assist in the expansion and improvement of educational programs of medical schools and other health manpower training institutions.

The responsibility to develop and administer the new grants program was assigned by the Department of Medicine and Surgery, within its Office of Academic Affairs, to the Manpower Grants Service, created for this spec-l-fic purpose.
is report will e f-oc-used on the initiation of the grants program under Chapter 82 and its development since adoption of the statute five years ago and the initial appropriation of funds late in FY 1973.

Today's VA health care system has the responsibility for providing comprehensive health care to veterans with service-connected disabilities, to all veterans who cannot otherwise defray the cost of medical care, to veterans 65 years of age and over regardless of their financial resources, and to specific categories of veterans' dependents. In order to provide the wide array of services required to meet






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the individual needs of each patient, the VA has developed
a health care system unique in government and in the American society as a whole. It can serve as a model for testing and
evaluating the impact of alternative modes of delivery of
services, and the utilization of health manpower trained in
a variety, of skills.

It is in regard to VA support of the training of
professional and technical health manpower that the following
report on the initial three years of operation under 38 USC
Chapter 82, VA Medical School Assistance and Health Manpower
Training Act of 1972 should be considered, as it relates to
expansion and improvement of the capability of the VA health
care system to provide high qual. ity care to patients, while
contributing to health care resources in the community.





































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LEGISLATIVE HISTORY OF 38 USC CHAPTER 82 (P.L. 92-541)

Within the Veterans' Administration Medical School
Assistance and Health Manpower Training Act of 1972, Chapter 82, as an amendment to the United States Code 38, is comprised of four subchapters:

Subchapter I establishes a pilot program for assistance
in t e establishment of new State medical schools.

Subchapter II provides for grant support to medical schools affiliated with the Veterans Administration
to assist them in expanding and improving their
training facilities.

Subchapter III provides for assistance to public
and private non-profit institutions of higher learning,
hospitals, and other health manpower institutions
affiliated with the Veterans Administration to
increase the production of professional and technical
health personnel and to aid in development of new
approaches to training.

Subchapter IV provides for expansion of Veterans
Adm-inistration hospital education and training
capacity through expenditures to remodel and make
special allocations to VA hospitals for health manpower
education and training.

As adopted, the statute established a four-part administrative authority to provide Federal assistance to private and public, non-profit agencies. However, the four parts share a common purpose: to improve training of medical and health manpower. Therefore, when the legislation was signed into law in 1972, it was a logical step in a long series of legislative initiatives which began in January 1946 with the adoption of Public Law 293. Five months following the end of combat in World War II, the Veterans Administration was faced with the responsibility to provide for the care and treatment of thousands of veterans wounded or otherwise disabled in that war. To enable the VA to meet that responsibility, P.L. 293 established the Department of Medicine and Surgery within the VA as the administrative entity responsible for operation and planning of what would, of necessity, become a greatly expaRded health care system. Proponents of the legislation also realized that the available staff was inadequate for the size and complexity of the task; therefore, the statute also provided for the training, with compensation, of physicians as resident staff of VA hospitals.

Within the same month, the Department of Medicine and
Surgery (DM&S) issued Policy Memorandum No. 2, which encouraged

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VA hospitals to affiliate with the nation's medical schools, as the first statement of a major policy of this department. The potential value of this opportunity for expanded medical education was so broadly recognized that by July of 1946, some 56 medical schools had entered into agreements of affiliation with VA hospitals; and 6SO resident physicians were participating in the care of VA patients. In the following year, the opportunities had been broadened to
include health professionals of other disciplines who delivered direct care to patients, principally.as clinical psychologists, rehabilitation personnel and dietitians. These programs expanded rapidly throughout the system during the immediate postwar years, and a number of today's medical schools were aided in their initial establis-hment by utilizing VA facilities as teaching centers.

In subsequent years, while the VA Department of Medicine and Surgery continued to strengthen its liaison with medical and other health professional training centers, practicing physicians and medical academicians continued to debate the role of medical schools, including the number of schools needed and the most efficient size of the schools. By June 1965, Dr. Stafford Warren, Vice-Chancellor of the University of California at Los Angeles, had been appointed Special Assistant for Mental Retardation to the President of the United States. Dr. Warren proposed the development of 11 small" medical schools in testimony before the Veterans Affairs Committee of the House of Representatives, recommending utilization of the existing resources of VA hospitals with their staffs and research programs, as well as the resources of community hospitals and local colleges.

In November 1966, with the adoption of Public Law 89785, the Congress directed the Department of Medicine and
Surgery to carry out a program of training and education of health services personnel, in schools of medicine and schools for the training of other health professionals, in order to
strengthen the Department's capability to carry out its
mission of providing high quality care to veterans eligible for that care.

Designed to enhance the professional competence of the VA staff and faculties and staffs of all participating training centers, this statute also authorized the program now known as the Exchange of Medical Information. Its purpose was to proVide close educational, scientific and professional links among all VA hospitals and major medical centers in order to create an environment of high standards of academic medicine. To stimulate action toward this end, the law provided two mechanisms for financial support: direct funding assistance to VA hospitals and grants to academic institutions, hospitals, and research centers.


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At this time, concerns over the need to improve standards of academic medicine were linked with a perceived need to increase the enrollment of the nation's medical schools. In 1968, the American Medical Association and the Association of American Medical Colleges issued a joint statement emphasizing "the urgent and critical need for more physicians if national expectations for health services are to be realized."

Two years later, in 1970, the Carnegie Commission on
Higher Education published its report: Higher Education and the Nation's Health. The Commission recommended a 50 percent increase in medical school entrance places, acceleration of ..iedical and dental education, curricular integration, and development of area health education centers affiliated with university health science centers.

As these concepts related to the VA, they were included in legislation in 1971, when House Joint Resolution 798 was introduced.

The program it proposed was generally the embodiment of Dr. Warren's plan for the establishment, with Veterans Administration support, of new State medical schools to be affiliated with and located geographically adjacent to VA hospitals. In the following year, a companion bill S. 2219, proposed an almost identical program at a co-nsiderabT-y higher.authtrization level, but also included provision for direct grant support to medical schools and other health educational institutions affiliated with VA hospitals, to allow them to expand and improve their educational programs and the extent of their VA affiliations. These two initiatives were merged into an amended H.J. Res. 785, passed by the Congress and signed-by the President on October 24, 1972 as Public Law 92-541.

The declarations of purpose for the subchapters of
Chapter 82 were stated by the Congress in general terms, as it assigned the responsibility for implementation and organization to the Veterans Administration. As stated earlier in this report, administrative responsibility was assigned by the Department of Medicine and Surgery to the newly created Office of Academic Affairs, which in turn established the Manpower Grants Service to translate the Congressional mandate into an operating program.

Some of the grants procedures set forth in the statute were new to Veterans Administration patterns of administration. In the period in which the Manpower Grants Service was organizing its own staff of 20, it was necessary to begin to define a rationale for the specific regulations, guidelines and materials for applicants. Of major importance in this undertaking was a clause included in an omnibus bill signed into law in August 1973 as Public Law 93-82.






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short section of this statute broadened the opportunities ,ind responsibilities of DM S to participate in the education and training of health manpower "...to meet the needs of the
na t i on. "

Therefore, as the Veterans Administration set out to meet its obligations under Chapter 82, its overall purpose was the same as the purpose of Public Law 293, adopted in 1946 a quarter century earlier. That law and the succeeding legislation described here were all directed toward improvement of training for medical and health manpower to assure the quality and continuity of care available to VA patients. In some cases, the objective was specifically stated; in others, there was a wider breadth of purpose. But P.L. 93-82 directed the VA to help meet the needs of the nation by participation in the education and training of health manpower.

By statutory definition, then, the newly created Manpower Grants Service, in conjunction with the Department of Medicine and Surgery and its Office of Academic Affairs was given a clear field for decision as to what "the needs of the nation" are within the context of Chapter 82. That the field for decision was limited by the funding authorization is obvious; but within its available resources the new manpower grants program was committed to an operational experiment, in a period of controversy and some confusion over the assigned roles of professional and technical health disciplines which is now of great concern in every health training institution in the United States. How this operational experiment has progressed will be presented in this report on the current status of each of the four subchapters, of this authority.


IMPLEMENTATION OF THE LEGISLATION

During the period prior to the appropriation of funds for the new assistance program, the Veterans Administration designated the Allied Health Division of the Education Service as the focal point for early planning and implementation of projected programactivities.

The first draft of implementing regulations was forwarded through the Administrator to the Office of Management and Budget on December 1S, 1972. Following lengthy negotiation, the Regulations were published in the Federal Register, first as proposed rule-making in June 1973, and then in final form in September of that same year.

In the meantime, VA staff held its first official
meeting with the designees of the Secretary of the Department of Health, Education and Welfare and with the Administrator's


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Special Medical Advisory Group, as well as representatives of the professional groups identified with the health occupations to which the grant programs are addressed. The official approval of these groups, as prescribed in the legislation, was received late in January 1973. (See Appendix A)

Occurring simultaneously was the development of application materials, including Guidelines, which were published as further explanation and expansion of the Regulations. These were developed and submitted through VA channels for forms and printing clearances.

It is important to stress the extent of the Manpower
Grants Service's recognition of the value of both intra and inter-agency coordination in the implementation of this statute. In addition to the essential concurrences of the Offices of the General Counsel and of the Controller, their advice on details of interpretation and development of processes was frequently sought and willingly provided. Close working relationships are also required, and have been developed, between the Manpower Grants Service and nearly every organizational unit within the Office of Construction, and with the Office of the Assistant Administrator for Planning and Evaluation.

Within the Department of Medicine and Surgery every
effort was made to apprise other groups in-the VA as to the potential impact of the implementation of this program upon their areas of responsibility, and to request their guidance and advice along the way. Major among these have been the various Professional Services, the Engineeringand Supply Services, and most especially, the individual medical care facilities in the field. This was done not only by Gistribution of printed material, but by frequent appearances before staff meetings and conferences, and by many field visits.

An amount of $20 million was included in a supplemental appropriation f or the Agency, which was received during the last days of fiscal year 1973; an additional amount of $25 million was then added to the Agency's FY 1974 appropriation. Although both of these amounts were appropriated pursuant to Section 5072 (Subchapter I) of the statute, the Administration requested, and the Congress agreed, that the former amount (i.e., $20 million) be redirected for the purposes of Section 5082 (Subchapters II, III, and IV).

Based upon a request originally submitted in June,
approval was received from the Administrator on October 2, 1973, to create a Manpower Grants Service with a staff of 20, to be organized within the Department of Medicine and Surgery under the Assistant Chief Medical Director for Academic Affairs.
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Finally, beginning in October 1973, the Guidelines and
application materials were distributed to potential app-licants
on a list which had been developed from various institutional
directories, all VA medical care facilities in the field,
and all persons who had inquired directly about the program
having learned about it from our efforts as previously
described.

One hundred and ninety eligible applications were
received by the announced deadline of March 1, 1974, and the
review process, as will be described, was initiated.


APPROPRIATI-ONS HISTORY

As noted above, the initial a appropriations were allocated
$25 million for Subchapter I; and 20 million for Subchapters
II, III and IV -- in order to allow for the implementation
of the statute in its entirety.

The levels of authorization and appropriations are
summarized in Appendix B. All appropriations prior to 1976 were initiated by the Congress. 'Although the Department of
Medicine and Surgery's projections for FY 1976, the Transition
Quarter, FY 1977, and FY 1978, were based on the total
amount of the authorization, the amounts recommended by the
President have been essentially limited to the amounts
necessary to meelt future year commitments for grants initiated
prior to that ti6.

ESTABLISHMENT AND DEVELOPMENT OF ADMINISTRATIVE AND OPERATIONAL
POLICIES

The Guidelines are for the purpose of informing potential
applicants about program's objectives and provisions,
and assisting applicants in deciding on whether they are eligible, whether they wish to apply, and what they may
expect to be required to do and to receive if their application
is approved and funded. The other materials are for the guidance of active grantees, and of the staff of the VA
(that is principally the Manpower Grants Service, but also
the staffs of the Office of Construction and of the Engineering
and Supply Services, etc.) who manage the grants, assess
their progress, and maintain responsibility for the stewardship
of the Federal funds appropriated.

A document entitled Standard Grant Conditions and Procedures
is provided every grantee. While it contains a number of features that are specific to the programs of P.L. 92-541,
it also incorporates, for the convenience of grantees,


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pertinent references from other documents, principally OMB Circulars and Federal Management Circulars.


REVIEW AND APPROVAL PROCESSES

The review and approval mechanism is based essentially on the two-level peer review system which is similar to that used by the National Institutes of Health and which has become a traditional pattern employed by Federal agencies that disburse funds as grants (as contrasted to contracts). See Flow Chart page 10.

Prior to arriving in the Manpower Grants Service,
properly prepared applications have been carefully coordinated .between the applicant institution and the VA facility with which it is or plans to become affiliated, and appropriate notification of local and State planning bodies has been made in accordance with the Intergovernmental Cooperation Act as administered under OMB Circular A-95.

The application then reaches the Manpower Grants Service
and undergoes a staff assessment to assure its basic eligibility, completeness and appropriateness.

A list of all applications received at the end of each deadline is forwarded to the appropriate offices of the Bureau of Health Manpower of DHEW. (They provide the VA with similar notification.) These are checked for possible overlap of programs and duplicative funding requests.

tach application is then reviewed for its intrinsic
meri t and feasibility by a "committee of peers." All medical school applicants, i.e., Subchapters I and II, are reviewed by the Medical School Assistance Review Committee; and all applications for programs in other health professions and occupations, by the Health Manpower Training Assistance Review Committee. These committees have been established under the terms of the Federal Advisory Committee Act and are chartered as provided by the implementing OMB Circular A-63. Appendix C lists the members of the Committees and other consultant participants.

All applications are further assessed as a group by the Academic Affairs Subcommittee of the Administrator's Special Medical Advisory Group, for their statutory relevance and general relationship to other activities of the Department of Medicine and Surgery.

The overall results of this process are then summarized and presented to'and reviewed in detail by the Chief Medical Director, who, in turn, makes the final recommendation to

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FLOW CHART
REVIEW PROCESS FOR P. L. 92-541 GRNTMS


__________________________MAKNPOWER GRANTS SERVICE (WCS) STAFF ACIO


GRANT APPLICATION



Determine eligibility Check DRE1W for duplication or conflict Procedural & technical compliance (State & Local Clearinghouses)
-Summuary preparation Distribute suaries, information, appli cat ions & assignments to reviewers
______________ Conduct site visits, as necessary

REVIEW COMMITTEE MEETING DISCUSSION, RECOMMENDATIONS PR IORITY ASSIGNMENT

ISummarize Review Committee discussion

4 mConduct site visits, as necessary
SPECIAL MEDICAL ADVISORY GROUP REVIEW OF REVIEW COMMITTEE & STAFF RECOMMENDATIONS,
FURTHER RECOMMENDATIONS

Summarize Special Medical Advisory Group Conduct necessary site visits Prearereview package & brief ing for Chief

Preiare DirectorJ

CHIEF MEDICAL DIRECTOR
REVIEW
F INAL RECOMMENDATION

Final check with DREW on approvals Preparation of final recommendations pca Preparation of notification documents

ADMINISTRATOR FINAL DECISION










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the Administrator. The Administrator accepts his statutory responsibility for the final decisions by signing what is called the recommendations package.

After completion of the review process, all applications are grouped into five categories:

Approval in the time and amount requested.

Approval with conditions -- These are in effect
contingencies which the grantee may or may not wish
to accept, and generally relate to such 'details as elimination of certain budget items or alterations
of the length of the program period.

Deferral with final decision delegated to staff or
a site visit team -- In this case, approval is
recommended based on conditions which clearly can
either be met by the applicant or cannot and require
no further quality judgment and can, therefore, be
handled by staff; or which require first-hand investigation
by representatives of the peer review committee. If
the decision in either case is negative, the application
and the report are returned, and re-entered into the
next review cycle.

Return for revision -- In these cases the reviewers
find themselves in general support of the program
presented but believe that it is not adequately prepared
or thought through. After applicants are so notified,
the staff provides them with as much advice as possible
regarding the recommended revisions if the applicant
requests such help.

Disapproval without prejudice.

Each application recommended for approval, approval
with conditions, or deferral, is assigned a priority score by the review committee members. This is intended to measure in absolute terms the quality of the project and its relevance to the purposes of P.L. 92-541. No such scores are assigned to applications being recommended for return for revision or for disapproval.

A final catalogue accompanies the recommendation package and lists approved applications in descending order of priority. Grants are made as far down the list as available appropriations will allow.

Only in the initial years (FY 1974 and 1975) were
-appropriations sufficient to allow for funding of all applications which were judged worthy of support and approved by the

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Administrator. Approved applications were held under active
consideration for 12 months and if not funded within that
period were withdrawn and returned to the applicant who, if
he chose, resubmitted the application in a later competition.
(This situation is discussed more fully in a separate section
of this report -- See Page 37 et seq). When, in FY 1977 it
became apparent that appropria-ti-ons would again, as they had
been in FY 1976,, be sufficient only to support the costs of
continuation of grants initiated in earlier years, all
eligible institutions were notified of a temporary moratorium on new applications and the intent to re-open the competition at such time as funding for new activities becomes available.

A similar review and assessment procedure takes place
at the end of each annual period of the approved program
period of each grant. It is, however, handled entirely by
staff, with referrals to review groups only where necessary.

In summary, this annual review procedure provides the
process by means of which program progress and fiscal expenditures
are scrutinized to assure continued relevance of the activity
to the approved proposal, and prudent use of obligated grant
funds. As a general policy, funds that are unobligated by
the grantees remain in the grant account and are used to
offset amounts required for funding in the subsequent year.

In cases in which staff detects "slippage" in either
program or fiscal operations, a number of steps can be taken
depending on the severity of the situation. These range
from simple phone calls for additional information and/or
staff assessment visits, to early termination of grants.
If, in the judgment of staff, the progress is adequate, but unforeseen events have required a significant change in the
course of the program, the application may be referred to
the full peer review process with "tide-over" funding provided
to the grantee as required.

As provided in the statute, all grants are subject to
audit by the Administrator and by the Controller General. In
the latter case, audits are conducted by the General Accounting
Office and in the former case, the Administrator accepts his responsibility as provided by his organization for audits to
include:

Staff procedures as described, as well as spot
checks, special data collections and visits conducted by staff and/or consultants and advisors as
required.

Cooperation of the Agency's Internal Audit Service;
and

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Receipt of, and response to, institutional audits
conducted under FMC 73-6 by the assigned cognizant
agencies; in this case, principally the Department of
Health, Education and Welfare, the Department of
Defense; and the Department of the Interior.


AWARD AND REPORT PROCESSES

Each approved application which is to be the basis of
a grant is subjected to one more careful budget scrutiny and any items of questionable eligibility or conflict in policy are negotiated directly with the applicant institution. A formal Notice of Grant Award is then prepared. It includes a statement of any specific legal contingencies or temporary restrictions on the use of funds that may be required by the Law or by various Regulations and policies of the VA. ft is signed by the Director of the Manpower Grants Service. It may not involve funds in excess of the amounts for both the first award period and for the total program period which appear in the recommendation package signed by the Administrator.

The Notice of Grant Award is transmitted with a letter which covers additional special considerations, if any, and reminders of certain specially relevant policies. It also deals with the amounts "awarded" for modification of facilities at the affiliated VA hospital if such was requested and approved in connection with the approved grant; this occurs under the terms of Subchapters I and IV of P.L. 92-541.

Also prepared and appropriately distributed are Federal assistance forms, SF 424, to State clearinghouses and/or State Central Information Reception Agencies, as prescribed by OMB Circular A-95.

All these documents are processed through the Department of Medicine and Surgery Budget Service which prepares the Transfer of Disbursing Authority. Then the Office of the Controller establishes an obligation against the appropriated funds for each grantee/grant award. Grantees can then draw upon the account either by direct communication with the VA or by a Federal letter of credit. P.L. 92-541 funds to be used for VA facilities' modification are processed in exactly the same fashion as funds from any other of the Agency's appropriations, through channels appropriate to the transaction, i.e., purchases of equipment, space modification, and minor and major construction.

The legally required reporting process for both fiscal
and program progress is set forth in the Regulations; however, a slightly more detailed process has been implemented and can be outlined as follows: Fiscal reports are required

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quarterly to control the flow of Federal funds. Estimated annual fiscal reports are submitted with the request for continuation funding, which is due 60 days prior to the end of each grant award period. These accompany and also relate closely to the program progress reports which are submitted at the same time. The two together become the basis of the staff review for continuation of the grants into the subsequent grant period. The final annual fiscal report -- the traditional Report of Expenditures (ROE) -- which is not due until 90 days after the end of each grant period, differs frequently from the estimate and, therefore, further budget adjustment for the currently effective budget period is nearly always required.


CURRENT STATUS OF 38 USC CHAPTER 82 PROGRAMS

With its 172 hospitals, 219 outpatient clinics, 89
nursing homes and 16 domiciliaries, the Veterans Administration operates the largest centrally-directed national medical care program in the United States. However, the VA system is more than an aggregation of individual facilities. Through its affiliations with schools of medicine and other health professional schools and programs, and through its liaisons with and utilization of a variety of personnel and health facilities outside the VA, the VA health care system now constitutes a unique and significant portion of the national health care resources.

-Since 1946, with the establishment of the Department of Nledicine and Surgery, the VA has provided leadership in the health community in developing the concept of comprehensive care into an operational system. For example, there has been a change in the meaning of VA affiliation with medical schools since 1946, when the first such affiliations were somewhat informal and were predominantly educational. By 1976, the meaning of affiliation had expanded into a broad concern with teaching and with patient care and research in relation to teaching and therefore with the training of health manpower in a variety of skills that were either unknown or rarely practiced thirty years ago.

Under the terms of Chapter 82 of the Veterans' Administration. Medical School Assistance and Health Manpower Training Act of 1972, the VA hasaccepted the responsibility to add some new dimensions to its participation in training health manpower. Under the four-part authority mandated by the statute's four Subc.hapters, the Manpower Grants Service has accepted the challenge to experiment in unique ways by granting assistance for training in occupational skills, as well as in the traditional health professions, and for assisting individual institutions in developing interdisciplinary

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training in specialties that range alphabetically from audiology to social service and that involve personnel ranging from medical specialists to a variety of aides and therapeutic technicians.

It is impossible at this early date in the Chapter 82 programs to make a definitiveand respectable quantitative or qualitative evaluation of either the effectiveness of the assistance provided, or of its eventual contribution to the overall health manpower pool; but on balance, after three years of experience, it can be stated that the effect of the total program will be greater than the sum of its component parts. For, although the Chapter 82 programs represent a small part of the VA health care budget, their ability to initiate support for new pilot and demonstration programs has a potential significance, as yet unmeasured, in improving the quality of health care both in the facilities of the Veterans Administration and in the nation as a whole.

The unique opportunity represented by these programs
for medical and other health professions educati-on programs at all levels to obtain not only direct funding but a wealth of well-supervised clinical education settings, can perhaps best be illustrated by the response to the program. The following Table illustrates the number of separate applications for new grants and for funding supplements which were submitted in a period of two and one-half years.


No. of Eligible No. No. Funded No. Pending
Subchapter Applications Approved (Total) (As of 9/30/77)


1 16 12 11 1
51 25 20 0
111 531 218 135 6

Total 598 255 166 7*


82 applications were withdrawn

Size and Cost of Program:

The-Manpower Grants Service is charged with full responsibility to administer this four-part authority providing Federal assistance to private and public, non-profit institutions and agencies.

By FY 1977the Manpower Grants Service had managed obligations of approximately $62.7 million in 158 grants ranging from less than $2S,000 to more than $2.5 million.

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16


This represents an increase of 33 new grants and $10.1 million over FY 1976 activities.

Over this same period of time, the staff of the Manpower
Grants Service has not been increased, and although reproduction supplies and travel costs have risen, the administrative overhead for the entire grant program has dropped from 1.3 percent to 0.8 percent. Administrative overhead is funded entirely from regular Department of Medicine and Surgery operating funds.


SUBCHAPTER I ASSISTANCE IN THE ESTABLISHMENT OF NEW STATE
MEDICAL SCHOOLSDeclaration of Purpose

"The purpose of this subchapter is to authorize the
Administrator to implement a pilot program under which the Administrator may provide assistance in the establishment of new State medical schools at colleges or universities which are primarily supported by the States in which they are located if such schools are located in proximity to, and operated in conjunction with, Veterans' Administration medical facilities."


Awards Under This Authority

Under Subchapter I of P.L. 92-541, awards have been
made to the following five institutions, in affiliation with Veterans Administration medical facilities:

Wright State University, in affiliation with the
Dayton (Ohio) Veterans Administration Center.

University of South Carolina', in affiliation with the Columbia (South Carolina) Veterans Administration
Hospital.

Texas A&M University, in affiliation with the Temple
Veterans Administration Center and the Marlin and Waco
Veterans Administration Hospitals.

Marshall University, in affiliation with the Huntington
and Beckley (West Virginia) Veterans Administration
Hospitals.

East Tennessee State University, in affiliation with
the Mountain Home Veterans Administration Center.

A list of these institutions, with total amounts awarded, is in Appendix D.

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Under the regulations prescribed for grantees, these
new medical schools agreed to operate in conjunction v ith o Veterans Administration health care facility (VAHCF): and to obtain a total level of support resources sufficient to allow them to proceed to full accreditation (and to enroll students) within a reasonable length of time. Target dates for admission of classes, the size of the classes, and the nature of the curriculum, have to some extent governed the size of the grant request.

The five new medical schools are in varying stages of early development.

Each of the five new schools has admission policies that give priority admission to otherwise qualified
veterans.

Wright State University admitted its first class of
32 students in September 1976 and second class of 48
in September 1977.

The Medical School at the University of South Carolina
admitted its first class of 24 students in September
1977.

Texas A&M admitted its first student class in
September 1977. The Texas A&M curriculum is unique
in that it starts its basic science program in the
traditional junior undergraduate year of college.

Marshall University has recently received provisional
accreditation which allows it to admit a charter class
in January 1978.

East Tennessee State University has received a
Letter of Reasonable Assurance of Accreditation and
continues with the recruitment of faculty and curriculum
development.


Objectives of Applicants

In addition to the requirement that the new State medical schools affiliate with a VAH or other VA health facility, these schools must document their acceptance as "a recognized element in the State system of higher education," thereby promoting further cohesion among the VA health system and other community health care providers.

To strengthen the academic environment, the schools
will establish a close "Deans Committee affiliation" with at least one VAHCF which will become a major clinical teaching

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resource for the medical school. The schools will also aim to make maximum appropriate use of VA "land, buildings and structures" which are available for use as educational facilities. And, of courseV the administration and faculties of the schools will have as a major objective the development of a capabilitv to provide all appropriate support to the affiliated VAHCF in upgrading its service capacity and in improving not only the breadth and quality of its services, but also the pace at which these services are delivered to veteran patients.


Effectiveness in Meeting ITegislative Purposes

The actual admission of students in three of the new
schools, the receipt of a Letter of Provisional Accreditation (which paves the way for admission of a charter class) by one school, and the demonstrated progress toward receiving such accreditation by the fifth school are, to date, the most concrete indicators of success. Less tangible but equally important measures are indications of the progress of the affiliated VA facilities toward becoming partners in medical education -- the development of resources, both hardware and software, that accompanies such emerging affiliations. The following criteria have been established as those upon which the success of each new medical school, eventually will be based: establishment of a medical school within a State university with an independent Dean and authority to award the degree of Doctor of Medicine; achievement of full accreditation; the continued receipt of State appropriations and funding from other sources; approval by the Chief Medical Director and the Administrator of an affiliation agreement and a Deans Committee; approval of plans for the rotation of medical students; and demonstrated progress in lease agreements and the actual occupancy of VA buildings.

In a sequential manner, the new schools will be expected to receive full accreditation, admit students and project plans for enrollment growth. The overriding objective for all funded schools is to establish a viable base in the communities they serve. This will occur as the schools affiliate with other clinical resources -- including the design of adequately attractive faculty professional practice plans; develop other resources to provide for a comprehensive teaching program; and develop local support to aid in achieving the program objectives.

A number of highly sophisticated studies have attempted to identify the costs of establishing a medical school and still there are no definitive measures which can be used to compare one with another. One point of agreement in all studies, however, is that maintaining a viable clinical base

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(usually a hospital) is the single most costly and unpredictable component in a medical school's operating budget. In the case of these five schools, the potential availability "in perpetuity" of a fully and independently funded VA clinical facility and the immediately adjacent educational facilities obtained through these grants, represent a significant reduction in operating costs throughout the entire future of these schools, long after the seven-year period of the faculty support grant has ended.

Effectiveness in Improving Care to Veterans

Since the Department of Medicine and Surgery's primary
mission is to provide health care for veterans, effectiveness of the medical schools established under Subchapter I will be gauged in large measure in the future by the ability of the schools to include the VAHCF, for example, in graduate and continuing education programs. Effectiveness will also be judged on the ability of the schools to provide additional clinical faculty serving full or part-time in VA hospitals (currently nearly 200 physician/faculty are receiving grant support); to make available as consultants additional staffing acquired by the VA affiliate; to offer new and improved services through sharing and regionalization; to increase the ease of recruitment and retention of professional staff; and to assume leadership in providing high quality practice in the community -- including new treatment specialties -so that the VA can expand consultation for veterans' families and those.veterans who are not utilizing VA-owned facilities.

In establishing their academic programs, the schools
have had understandable difficulties in achieving provisional accreditation and assurances of State support, and in meshing their programs with the administration of the affiliated VA facilities. Therefore, the effectiveness of both the regulatory and organizational plans initiated under Subchapter I and of the operation of the schools themselves can be monitored*and assessed only in future months$ as both the short term and long term commitments develop into teaching programs of demonstrated progress.


Future of Subchapter I Grants

The rationale for provision of VA financial support in establishing new State medical schools hasbeen presented earlier in this report. The controversy over the number of medical schools needed to provide medical care for the population of the United States, and the optimal size and
-distribution of those schools continues. From a period in which a large part of the medical community favored creation

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of additional medical schools, there is at present a vocal rex-ersal of that concept.

This reversal in thought is specifically documented in two reports by the Carnegie Commission on Higher Education. The first, in 1970, (see Legislative History) recommended "a 50 percent increase in medical school entrant places."

In 1976 this same Commission published another report: "Progress and Problems in Medical and Dental Education" that includes the following warning:

"Ile are in serious danger of developing too many new medical schools, and decisive steps need to be taken
to stop this trend..."

This report and other similarly voiced concerns, will be of considerable influence in the development of manpower planning throughout the private and public sectors of the health establishment.


SUBCHAPTER II GRANTS TO AFFILIATED MEDICAL SCHOOLS

Declaration of Purpose

"The purpose of this Subchapter is to authorize the Administrator to carry out a program of grants to medical schools which have maintained affiliations with the Veterans Administration in order to assist such schools to expand and improve their training capacities and to cooperate with institutions of the types assisted under Subchapter III of Chapter 82 in carrying out the purposes of such subchapter."


Legislative Mandate

Throughout the years since 1946, the VA Department of
Medicine and Surgery has established and continued to develop day-by-day, operational, working liaisons with an increasing number of medical schools across the United States. The effectiveness of these affiliations has fluctuated from time to time and from place to place, reflecting available levels of support, changing attitudes within the VA health care system, and changes in the perceived need on the part of medical schools and other health care facilities for such liaisons. By 1972, however, there was general agreement that the idea of such affiliations was sound and that the time was propitious for provision of additional support not only in aid of the already existing cooperative programs, but in aid of expansion of these joint efforts to more medical schools and to institutions that provide training

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for health manpower in other disciplines and at a variety of professional and occupational levels.

Subchapters II and III, therefore, are complementary, since health care facilities, more than ever before, are aware of the potential benefit to patients, if teaching and treatment centers can surmount difficulties caused by their separate and disparate needs, in favor of interdisciplinary training and the effective development of shared responsibilities and techniques in providing treatment.

The basic difference between the two Subchapters lies
in the difference in function of the various types of health manpower personnel who make up what has come to be known as the health team, and the different needs of the several institutions which concentrate 'on the training of one or another segment of the health manpower pool.

Under Subchapter II, all institutions eligible for
support are medical schools which are already operating in affiliation with one or more VA health care facilities. The statute mandates grant recipients for the basic purpose of establishing more effective, closer cooperation with their present VA affiliate and/or affiliating with other VAHCFs with expansion of undergraduate enrollment without jeopardy to accreditation; and with the assurance of "supplemental" support from sources other than the VA. Applicants may propose programs designed to improve and enhance undergraduate, graduate and continuing medical education in their schools, and to demonstrate their ability to participate in cooperative activities with o ther schools and programs focused on health professions other than medicine and with programs focused on the training of support personnel.

To attract additional support, in dollar funding or inkind contributions, grantees are expected to relate their proposed activities to their own institutional programming and to other sources potentially able to supply such support (Federal, State or private community hospitals and other agencies) during the grant support period and the years following termination of the grant.


Effectiveness in Meeting Legislative Purpose

Although sufficient time has not elapsed to permit a final assessment of the program of grants authorized under Subchapter II, some of the evaluative criteria are obvious and permit a preliminary appraisal of program progress.

Some of the affiliations existing prior to the grant
award were nominal and have been revitalized through grant21.






22


supported activities, necessitating expanded Deans Committee arrangements and increased medical school recognition of the VA staff.

Undergraduate enrollment at the grantee medical schools has increased by approximately 3S percent since the academic year prior to the implementation of this program of grants.

Some indicators of improvement in educational programs are:

Recruitment and retention of medical school faculty,
those currently receiving full or partial salary support
through grant funds numbering just under 500.

The continuation of accreditation despite the substantial
enrollment increases.

New and expanded clinical rotations at the affiliated
VA hospitals.

New and enhanced curricula.

Expansion or reorientation of house staff programs.

Integration of continuing education programs with
the pre- and post-graduate medical curriculum, demonstrating
the improved quality of practice in the community and
creating a "talent bank" of readily available preceptor
faculty.

In furthering cooperative activities with other health manpower institute ions and programs, medical schools often involve other disciplines in curriculum development toward a team approach to clinical education, including the sharing of faculty and the more effective utilization of scarce clinical resources, emphasizing use of VA health care facilities.


Effectiveness in Veteran Care

From the standpoint of the Veterans Administration, the most significant gauge of effectiveness will be the extent to which these affiliations result in improved quality and quantity of care to veterans. If indeed these affiliations
become maximally operative, the results will include improved recruitment and retention of qualified full and part time VA
staff; additional clinical faculty available for part time or consulting services to the VA (more than 350 physicians
receiving full or part-time salaries paid from grant budgets
currently spend time serving patients in affiliated VA
facilities); and new and expanded services available to VA

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utients at the VAHCF or at other community facilities; more ighly qualified VA faculty-staff and House-staff attending VA patients; improved services to veterans receiving care outside the VA system; and in terms of cooperative activities with other training institutions, the end result should be the exposure of VA staffs to the team concepts of interdisciplinary patient care.


Number of Veterans as Students

As in the instance of Subchapter 1, terms of the statute relating to Subchapter II provide that special consideration be given applications providing priorities for the admission of otherwise qualified veterans to the grantee medical schools. Of the 18 affiliated medical schools receiving grant funds under Subchapter II, eight provided admissions policies giving priority/special treatment to otherwise qualified veterans.

The eight include medical schools at the University of
California at Irvine, University of California at San Francisco, University of North Dakota, Eastern Virginia Medical School, University of Health Sciences/The Chicago Medical School, Loyola University of Chicago, University of Kansas and .ouisiana State University and A&M at Baton Rouge.

The following information was gathered from documents presented by the medical schools:

No. of Veterans No. of Veterans Schools in 1976 in 1977

University of California, 30 27
Irvine

University of California, is 22
San Francisco

University of North Dakota 27 21

Eastern Virginia Medical School 18 26

University.of Health Sciences/The 11 is
Chicago Medical School

Loyola University of Chicago 4 not available

University of Kansas 31 45

Louisiana State University and A&M 17 17


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Many of the parent institutions which have not had
priority admissions policies for otherwise qualified veterans have shown increased interest as their medical schools qualified for Subchapter II grants. As a result, a number of the schools have shown increases in the number of veterans and/or significant percentages of veterans enrolled. Most notable of these are the following:

No. of Veterans No. of Veterans Schools in 1976 in 1977

University of South Dakota is 20
University of Texas, Dallas, 26 30
University of Florida 12 16
Southern Illinois University_. 17 18
University of Alabama 29 not available


GRANTS PROJECTS IN AFFILIATED MEDICAL SCHOOLS

A list of the 18 affiliated medical schools awarded
grants since FY 1974 when this program was activated is in Appendix D. Data include the time period of each grant, the amount of funding for the entire multiple-year program period, and a brief summary of the activities proposed by the grantee.

Any random sample selected from among the proposed
projects is indicative of the wide range of activities which medical school administrations and faculties perceive as necessary to enrich the effectiveness of their schools as centers of excellence in training and clinical treatment. Projects proposed by one school may differ from those proposed by another on the basis of their individual needs, but there are enough common denominators to indicate that this granting mechanism, under VA support, is relevant to the state of the art in medical teaching in the 1970's and under careful supervision can only serve to improve the "product" of the institutions receiving awards, and therefore, the end product of high quality patient care.

In addition to the mandated enrollment increases, the
grant protocols cluster in three areas: curriculum expansion and improvement, creation and expansion of two-year clinical outreach campuses, and conversion of existing two-year medical school programs to four-year degree-granting institutions.

Twelve grantees fall into the curriculum expansion and
improvement category. All modern medical schools are concerned with their teaching curricula. Therefore, without exception, the grantees' requests reflect that concern and many pf them
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specifically list curriculum improvement as a major objective. Academic medicine devotes a vast amount of time to problems within medical school curricula and there is no doubt that any support through these grants to the resolution of curriculum problems will be money well spent, since the benefit to medical students will have a ripple effect that spreads throughout the health manpower personnel in the United States. Programs at the University of Texas Southwestern Medical School, the Eastern Virginia Medical School, and the Mount Sinai School of Medicine are illustrative of grants directed toward general expansion and improvement.

Medical schools are also increasingly concerned with
their abilities to teach students the fundamentals of primary health care. This concern stems partially from a fear of over-specialization within the profession; but it appears to stem more directly from the expressed demands of the populace whose perceptions of effective medical care are changing. The reasons for that are complex, and reflect dismay over high costs of care, growing interest in preventive medicine as a means to maintain health, concerns with disease-related conditions in the environment, interest in nutrition and dietetics, and specialized interest among an increasing number of veterans, as well as in the general population, in the aging process and development of geriatric medicine ancillary care. The growing emphasis on all of these areas, which can be subsumed under the concept of primary care, is resulting in significant changes in the curricula of medical schools and the realization that only by working with other disciplines and therapists can the medical schools train today's students to meet current and future demands from their clients. As an illustration of grant activities in this area, the University of Florida, College of Medicine and the Medical College of Pennsylvania both have developed programs in primary and ambulatory care.

Medical schools are also in need of support to help
complete the education of students who transfer from foreign medical schools, whether those students are United States citizens or citizens of other nations. The California College of Medicine (U.C.) at Irvine, for example, has successfully implemented a program directed specifically toward the acceptance of third and fourth-year transfer students from foreign medical schools.

Four programs are included in the clinical outreach
category. Medical schools that traditionally were centered geographically in one building or a cluster of adjacent buildings, now-see as valuable a liaison with widely separated facilities that can become "clinical campuses" of the medical school, serving a wider constituency, and at times located

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as much as 200 miles distant from the medical school central facility. The University of Oklahoma, College of Medicine, for instance, is located in Oklahoma City. With grant support, a two-ypar campus has been created in Tulsa, affiliated with the Muskogee VA Hospital. Similarly, the University of California, San Francisco Medical Center, is in the process of establishing a Fresno/Central San Joaquin County extension campus, centered around the facilities of the Fresno VA Hospital.

The University of North Dakota and the University of South Dakota Schools of Medicine have used grant funds to aid in the conversion from two to four-year medical schools. The University of South Dakota, in fact, graduated its first class of medical students in Ma-y 1977.

Outside the three major clusters, however, there are themes that are common to many Subchapter 11 grants. Many grant recipients have documented needs to provide for continuing education of the physicians already practicing in their service community. All medical specialties agree that to maintain competence in modern scientific medicine, the physicians specializing in any branch of the profession must have facilities readily available to continue their medical education throughout their professional careers. And, throughout the applications for funding, medical school administrators indicate a realization that they can no longer wait for the population to come to them: that they must initiate and develop outreach programs that provide care to the people where the people live -- be it in a VA domiciliary facility or a mountain hamlet. Proposals for out-reach programs are characteristic of many in both Subchapters II and III.


SUBCHAPTER III ASSISTANCE TO PUBLIC AND PRIVATE NONPRUPIT INSTITUTIONS OF HIGHER LEAR-N-T-NG,
HOSPITALS AND OTHER HEALTH MANPOWER
INSTITUTIONS AFFILIATED WITH THE VETERANS ADMINISTRATION TO INCREASE THE PRODUCTION OF PROFESSIONAL AND OTHER HEALTH PERSONNEL

Declaration of Purpose

"The purpose of this subchapter is to authorize the Administrator to carry out a program of grants to provide assistance in the establishment of cooperative arrangements among universities, colleges, junior colleges, community colleges, schools of allied health professions, State and local systems of education, hospitals, and other non-profit health manpower institutions affiliated with the Veterans Administration, designed to coordinate, improve and expand the training of professional and technical allied health and

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paramedical personnel, and to assist in developing and evaluating new health careers, inter-disciplinary approaches and career advancement opportunities so as to improve and expand allied and other health manpower utilization."


Legislative Mandate

The legislative mandate for Subchapter III of 38 USC
Chapter 82 assigns responsibility to the Veterans Administration to establish, through grant support, cooperative arrangements among the broad spectrum of institutions and facilities described in the Declaration of Purpose. At least one of the cooperating agencies, institutions or facilities involved in each grant award must be a VA health care facility. Beyond that limitation, the Department of Medicine and Surgery and the Manpower Grants Service within the Office of Academic Affairs of the VA are given an unprecedented opportunity to experiment in developing clinical training methods, in establishing administrative and operational groupings among facilities, and, as the ultimate objective, improving direct health care for veteran patients and other clients of this wide variety of schools and health facilities.

When administered under this mandate, added to provisions of Public Law 93-82, these programs are unique in their potential to improve care throughout the community, since P.L. 93-82 places responsibility on DM&S for participating in the education and training of health manpower "...to meet the needs of the nation." That those needs are great and diverse cannot be argued; but it is difficult for administrators of such a broad support program to make the initial decisions on new directions for experimenting in joining the skills of the professions of medicine, nursing, dentistry, and social work (among others) and the skills of a large and growing number of allied health personnel specializing in a number of therapeutic fields, to create cohesive programs of patient care. A summary of the health professions and occupations represented in the grant-assisted programs is in Appendix E.


Effectiveness in Meeting Legislative Purposes

In the case of assistance programs now in operation under terms of Subchapter III, therefore, any overall or comprehensive appraisal of their effectiveness cannot be made in FY 1977. There can, of course, be assessments of the progress of individual grant-assisted projects; but, here again, the substantive variety of the Subchapter III grants programs is so great that some time must pass before it will be possible even to estimate whether a given pilot


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or demonstration program will produce results worthy of recommendations to continue the experiment as a routine component of health training in the specific institutions, or to extend such training programs into other institutions, colleges, schools and hospitals, as may be relevant.

Allied health professionals and technicians as a group have practiced as credentialed entities in health care for a very short time, as compared to medical, dental and nursing professionals, for example. This fact has established a positive acceptance of the opportunities afforded under Subchapter III, since there is an enthusiasm among allied health personnel for participation in demonstration programs that are formally administered as opposed to the short term ad hoc efforts which have been mounted at times without adequate funding support or administrative structure.


Grant Programs in Other Health Man]2ower Training Institutions

A total of 135 grants had been awarded under Subchapter III as of September 1977., Most of them are devoted primarily to improving the utilization or distribution of health manpower. Grantees include academic institutions with programs in nursing, dentistry, optometry, pharmacy, podiatry, social services and the traditional allied health professions, as well as consortia of academic and health care institutions in 40 States, the District of Columbia and Puerto Rico. (See Appendix D).

Each of these grant-supported activities encompasses
one or more Veterans Administration medical facilities among the clinical affiliates. Many are specifically designed to build upon the resources unique to the Veterans Administration hospitals or clinics, in order to produce manpower especially trained to meet the needs common to the VA and to the community. Among these are training for multi-disciplinary services to the chronically ill and to aging adults. The prospect of a larger, well-trained pool of health manpower in the requisite disciplines is especially attractive to the Department of Medicine and Surgery. The Veterans Administration is committed to the provision of life-long care to eligible veterans who need such care. Therefore, development of humane and personalized care of chronically ill patients increases in importance as more veterans become eligible for comprehensive care and choose to request such services. Proportionately, there is a larger group of veterans of World War II which has arrived at the age of sixty or above, now requesting treatment and care. It is imperative that the VA have available to it the personnel who can provide care that goes beyond clinical treatment for hospitalized veterans, for veterans who are ambulatory,, including thousands who, alone or with their



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families, can be helped to maintain physical and mental well-being as they grow older.

Other Subchapter III programs are designed to provide
additional training for personnel who perform highly skilled technical services to physically disabled persons. Many other projects deal with training for treatment of specific disabilities; and another group of projects is designed to upgrade and improve basic training programs to prepare personnel for underserved areas ranging from geographically isolated rural areas to socially isolated inner cities.

Grant awards under Subchapter III have also been designed to support the comprehensive development of health manpower by supporting tYaining at various career levels. In this context, as of June 1977, the distribution of grants by level of training was as follows:

Programs in support of training at technical levels
below the baccalaureate degree totalled 20 percent; baccalaureate programs, 54 percent; and post-baccalaureate programs, 26 percent.

Other indications of progress in meeting the objectives of Subchapter III are illustrative of the directions in which.various grantees are proceeding, to improve the quality and scope of their training capabilities.

Faculty support: Conservative estimates place the
number of faculty members in grantee institutions who are receiving some part of their support from grant funds in excess of 300. Of these, at least 130 individuals are clinical faculty based, full or part time, at the affiliated VA hospital. Additionally, in VA's affiliated with grant programs there are now 240 more staff members who hold faculty appointments than tFe-re were prior to implementation of the grants program.

Enrollment: Total student enrollment for institutions receiving grant support has increased from approximately 5,500 students to about 10,000 students since the year prior to initiation of the grants program.

Continuing education: Interest throughout the health
manpower training comple3E is further illustrated by the fact that at least 45 percent of the grant-supported programs report that they are conducting continuing education activities in conjunction with the grant program. More than 10,000 persons employed'in the health field at various levels have been able annually to participate in continuing education activities sponsored by the grantee institutions.

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That Subchapter III provides opportunities for program enrichment, aS well as expansion, is illustrated by the fact that at least 2S percent of the programs have established training curricula new to the individual institution: either as a new program in an established health occupation or in offering training in a "new health career." However, the largest proportion of grant support is utilized to expand and improve existing programs.

Emp~pyment: It is already evident that the VA hospital systemisibei7titting from this training program. Fifty percent of the grantees report that graduates of their training programs are employed in the VA hospital system. As of June 1977, a total of 415 such employees had been reported. This total will be more accurately estimated as grantee institutions improve their methods of reporting the employment status of their graduates.

Even in the brief period of operation for most of the
trainee programs, employment statistics indicate a desire on the part of graduates to accept employment in the VA health system and a readiness on the VA's part to employ these graduates. Southern Vocational College, for example, is receiving grant support through the Tuskegee AHEC for a Licensed Practical Nurse program. Forty-two of the graduates of this program are currently employed at the Tuskegee VA, comprising approximately one-half of the hospital's entire LPN staff.

Since Subchapter III programs span the spectrum of
disciplines, levels of training, and educational emphases, it is difficult to provide a representative sample. However, descriptions of a few grant activities follow.

Orthotics is the field of knowledge relating to the
straightening of a deformed or distorted part of the body. Prosthetics is the science of replacing body parts that may be missing or defective, These are areas of obvious critical importance for the Veterans Administration, and two grants have been made for the training of orthotics/prosthetics technicians, with two varying emphases. Shelby State Community College conducts a program in cooperation with the Memphis VA Hospital, and grant support has enabled curriculum strengthening,. increased enrollment and expansion of laboratory facilities, Four recent graduates are employed at VA hospitals - two in Memphis and two elsewhere in the VA system. In Minnesota, the 916 Vocational Technical Institute of White Bear Lake has directed its grant-supported efforts toward the development of a personalized, self-paced learning format for training orthotics/prosthetics technicians. The teaching modules have been field tested and now are being disseminated to interested VA and private facilities. Four VA hospitals,

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31



including the primary affiliate at Minneapolis, participated in the field testing and validation process. The program has elicited international attention; 916 Vo-Tech has plans to train Canadians in the use of the program, and an Australian school has expressed interest in receiving similar training.

Five social work programs and a number of related programs in the areas of patient counseling and mental health technology have received grant support from the VA manpower grants program.

The social*work programs have generally offered basic salary support for faculty preceptors, and coordinators for training episodes at rural clinical sites. For example, the program at West Virginia University has developed continuing education courses for social workers at six VA hospitals in Pennsylvania, Ohio and West Virginia. In addition, graduate students have gained field practicum experience at the six VA hospitals. In another case, the University of Utah, in conjunction with the University of Denver, developed a unique bloc plAcmement program. Essentially, the graduate curriculum was modified to allow selected students to gain practical experiences for an extensive bloc of time at rural non-affiliated Rocky Mountain VA Hospitals. Two students were placed at each VA Hospital in Wyoming, Colorado and Montana for this training. Employment figures show that upon graduation, approximately one-third of the students placed in this program have taken jobs at VA hospitals. Also in Utah, Utah State University expanded its counseling training program to include a field practicum training phase involving veterans and their families.

The College of St. Benedict in Minnesota has set up a
large clinical training program with the St. Cloud VA Hospital. A two-year mental health technician.program has developed trained auxiliary personnel for a variety of mental health and psychiatric settings. Graduates of this program have supplied the St. Cloud VA Hospital with a pool of candidates for employment. Similarly a program training mental health associates at Ohio University in Chillicothe has been able to use the nearby Chillicothe VA Hospital as both a setting for training experiences and a place for future employment. Both of these programs have proven to be of great interest to local VA hospital employees. Many employees have successfully completed the program and have used the training for job improvement skills and promotional advancement.

A number of nursing programs at all levels and with a variety of clinical thrusts, are being supported. For example:

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Georoia College in Milledgeville, Georgia, has received grant fUnds to initiate an affiliation with the Dublin Veterans Administration Center in order to provide additional clinical experience for nursing students enrolled in the College's Associate Degree Nursing program. The need for nurses in rural Georgia is great but it is predicted that with the present number of nurses graduating from this program each year, the need will be adequately met for the area surrounding Milledgeville. In addition, there was an expressed need to develop continuing education programs for nurses in the rural regions surrounding Dublin and Milledgeville and the grant-supported faculty has developed such programs for practicing area nurses. The Director of the Dublin VA Center has used the program as a recruitment resource for the VA and has pointed out that a number of nursing assistants and licensed practical nurses at the VA have taken advantage of the program to further their education in the nursing field.

California State University, Long Beach, has received a
grant to provide registered nurses with the necessary knowledge and skills to function as spinal cord injury practitioners. Nurses, qualified both by education and experience, will be selected for the program from the Long Beach Veterans Administration Hospital Nursing Service and from the community at large. This project involves faculty members from California State University and the VA Hospital. The cooperation between these two institutions is long-standing and their affiliation has been effective since 1964.

The University of Florida has established a continuing professional education program in affiliation with the Gainesville VA Hospital to prepare selected Nurse Practitioners for extended care responsibilities in VA hospitals. This program is a component of the College of Nursing's graduate program and provides the option for Nurse Practitioner students to continue their education and complete requirements for a Master's Degree. Fifty percent of the Nurse Practitioner graduates are presently employed in the Federal system, i.e., Veterans Administration hospitals and the U.S. Public Health Service.

VA manpower grants have been supportive of a number of Cooperative Health Manpower Education Programs (CHEP). Formerly known as Area Health Education Centers (AHEC), the CHEPs are located in rural areas not readily served by major medical education centers. CHEPs were initiated a number of years ago with Veterans Administration support, and since have broadened their activities as well as their base of support to include a variety of community activities as well as numerous other funding sources. Manpower grants have provided short-term support for some of these CHEP-sponsored
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activities: activities in hospital continuing education, community health education, and Licensed Practical Nurse training in Tuskegee, Alabama; community-based family practice residencies in Lincoln, Nebraska and Togus, Maine, and programs in continuing and consumers health education, as well as nursing and biomedical communications activities at Boise, Idaho.

Grants to support educational programs in gerontology
and care of the aging have been awarded to five universities throughout the country. These include: Adelphi University, School of Nursing, for assistance in preparing nurses at the Master's degree level in gerontological nursing as either clinical specialists, administrators or educators; Boston University, to conduct short-term continuing education programs designed to prepare registered nurses as gerontological/ geriatric nurse practitioners in primary care; Duke University, for assistance in implementing a graduate program with a focus on long term nursing of the aging adult; The Rocky Mountain Gerontology Center, University of Utah, to develop an education program based upon an integrated multidisciplinary, coordinated approach to gerontology; and The University of Wisconsin-Madison, for developing an interdisciplinary educational sequence in geriatrics for professional and technical health manpower. All of these programs rely on VA expertise in aging as well as the use of VA clinical facilities.

ome grants for multiple-component programs at an
individual institution include coordinating activities which ease the VA/College interface. At the Medical College of Virginia, for instance, grant funds provide support for education activities in the areas of physical therapy, occupational therapy, medical technology, patient counselling, nurse anesthesia, and medical records administration. Funds also are provided for a Project Coordinator, an Associate Professor of Allied Health Education who is physically located at the Richmond VA Hospital. Though specifically charged with coordinating the day-to-day instructional activities associated with the grant, some of the most interesting developments have occurred as "spinoffs" in the process of working toward stated objectives -- revolving primarily around continuing education for both college and VA personnel (more than 100 programs were conducted in the first two years of the grant); and increased interdisciplinary understanding and communication through the development of education committees with varied membership, and publication of an educational newsletter. ,

Two areas which in recent years have been recognized as important specialties with particular relevance to the VA's patient population, are podiatry and optometry.

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34



Among elderly veterans and especially among diabetic
Patients, foot problems are common. Podiatry is the medical specialty that treats these conditions. Grant funds have enabled the Pennsylvania College of Podiatric Medicine to establish a strong clinical teaching base at the Philadelphia VA Hospital. Current1v 12 students are rotating through seven services at the 'A hospital and recently students have begun a one-month rotation in the Orthopedic Service. The Philadelphia VA Hospital uses triage for all incoming patients and those with foot problems are referred to the Podiatric Clinic which is being established with funds for equipping two examining and treatment rooms at the VA hospital. It is interesting to note the growth in the podiatry program since the inception of the grant. In 1974-7S there were 1,703 student clinical exposures at the VA hospital. In 1975-76 this increased to 8,744 and from July 1, 1976 through February 20, 1977 there were a total of 18,707 student clinical exposures.

Southern California College of Optometry was awarded a grant to improve the education and training of optometry students and optometric technicians by expanding their clinical experiences in affiliation with the Los Angeles VA Outpatient Clinic. Throughout the program period, a total of 682 student interns and more than 175 optometric technician trainees are expected to broaden their experiences in terms of the number of patients seen, the variety of visual problems with which they must cope and the use of innovative techniques in the diagnosis and care of patients needing vision services.

Nine audiology and speech pathology programs cover a geographically dispersed area and include a variety of aspects of training in t1ke field. An interesting program at Memphis State University is concentrating on training graduate students in the treatment of adult aphasic patients (many programs emphasize childhood ;T-isorders) and a variety of clinical experiences is being provided by the Memphis VA Hospital through an innovative curriculum approach which includes training via experiences videotaped at the VA. In a companion effort, Memphis State University also has developed a pilot program for training Language Therapy Assistants, with candidates to be drawn primarily from among braininjured veterans and veterans with military medical occupation specialties. This portion of the program had a slow start, and both the usefulness and employability of this new type of health worker are yet to be demonstrated. But it certainly is one of the more exciting and innovative elements of the program.

A program with a different twist is taking place at the University of Arkansas at Little Rock where a new graduate program in communicative disorders has been established with


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35



specialty courses in aural rehabilitation. This is the only school in the State offering this program.

VA grant support to the University of Oklahoma is
helping to bring Audiology/Speech Pathology expertise to the Muskogee, Oklahoma area. Previously, veterans at Muskogee had to obtain these services from the Oklahoma City VA Hospital. Now a clinic has been established by the University at the Muskogee County Health facility, in conjunction with the Muskogee General Hospital, which offers audiology and speech pathology services to Muskogee residents, including patients of the Muskogee VA Hospital. Veterans receiving treatment at the clinic help to form an additional pool of learning experiences for the University of Oklahoma graduate students in communication disorders.

The Rehabilitation Therapies have received substantial support, with ten programs in physical therapy, nine in occupation therapy, and two in recreation therapy. Occupational Therapy is a good example of a profession that is changing its image, in its case beyond the "arts and crafts" emphasis with which many associate it. At the University of WisconsinMilwaukee, for instance, the occupational therapy program recently has received grant support to add an industrial training component to its curriculum. The program will produce occupational therapists with experience in the rehabilitation of veterans to assume responsibilities in industrial settings. The Wood VA Hospital serves as a bas'e for the clinical experiences in the program. At Towson State University in Baltimore, affiliating with the Ft. Howard VA Hospital, a grant has enabled the Department of Occupational Therapy to expand 11.aspects of clinical education. The grantee reports that because of the presence of students in community hospitals their staffs have been strengthened in order to upgrade service and to provide a better educational environment for the students. Also, the grant supported staff at Towson is involved in establishing a Regional Clinical Council made up of Towson, Virginia Commonwealth University, Community College of Baltimore and Howard University. This council will meet in the Spring of 1978 and develop plans for a coordinated clinical education program.

P.L. 92-541 funds have been provided nine institutions
from Maine to Montana, for the training of Dental Assistants, Dental Laboratory Technicians, and Dental Hygienists, in the field of dental auxiliary training that is expanding the role of the dentist's aide. A grant to Dutchess and Orange County Community Colleges in upstate New York supports educational programs in all three of these specialty areas. In addition, these Programs are notable for the attention given to recruitment, training, and job-placement of wheelchair35.






36



bound students, including veterans. Special laboratorN acllitics have been designed for the Dental Clinic at the Castle Point VA Hospital where the students receive their training, and a cooperative work program has been designed to enable students to get "real world" work experience while attending school. In another interesting variation, dental hygiene programs at the University of Tennessee and the Medical College of Georgia emphasize preventive dental care programs in which students conduct plaque control activities with various patient groups of the affiliated VA hospitals -including spinal cord injury patients.


SUBCHAPTER IV EXPANSION OF VETERANS ADMINISTRATION HOSPITAL EDUCATION AND-TRATNING CAPACITY

Declaration of Purpose

"To remodel and make special allocations to Veterans Administration hospitals for health manpower education and training."


Awards under Subchapter IV

Part one of this subchapter provides for the use of funds from this appropriation to be allocated, through regular VA'channels, for modification and equipping of space in VA health care facilities, which is specially designed to help them accommodate the educational programs with which they are affiliated.

Because of the placement of this authority in 38 USC
Chapter 82, it has been utilized solely for projects related specifically to funded Subchapters Il and Ill grants.

Funds have been committed for 12 projects at 9 VA
hospitals affiliated with medical schools which are receiving Subchapter Il grants. These projects range in scope from major building additions to minor alterations and equipment. Facilities provided include classrooms, teaching laboratories, clinical training facilities, and offices.

In addition, funds have been committed for 30 projects under Subchapter III with a Subchapter IV component. These projects are generally smaller in scope, frequently involving minor renovations and equipment for training in the allied health professions, nursing and related fields.




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Effectiveness in Meeting the Legislative Mandate

In all cases, the remodelled facilities and equipment are in VA-owned facilities and are shared for use by the facilities' own education and training purposes, and/or made available"temporarily to the affiliated academic institutions under the VA revocable licensing procedures, o.r more permanently under a negotiated lease.

Since only the very newest of VA hospitals, and none of its other health care facilities, were planned to provide educational space, even for their-own staff needs, these modified facilities and equipment are a very valuable addition -both to be shared with their affiliates and, if eventually no longer needed for the original purpose, as a permanent resource for the facility.

Part (2) of Subchapter IV provides for special allocations for the development or initiation of plans which would reduce the length of educational programs required for academic degrees, and/or credentials in the health professions and occupations. Current uncertainties, and indeed controversies, both within and among the various health fields, have made it unwise, if not impossible, for the VA to experiment in this very sensitive area at this time.


APPROVED/UNFUNDED APPLICATIONS

As described earlier in this report, beginning in FY
1976, appropri tions were not sufficient to fund all of the applications flom established medical schools and other health manpower training institutions (Subchapters II, III and IV) that were recommended to, and approved by, the Administrator as proposing activities of merit and relevance to the purposes of these grant programs.

In each such case, the institution was notified that the application would, unless withdrawn by them, remain under active considerate ion for one year for any funding that might become available; and if still unfunded in a year would be administratively withdrawn and returned. This procedure was, and continues to be, carefully followed, although new applications are not being accepted.

Late in FY 1977 there was added to a supplemental
appropriation an amount of $10.045 million for the purpose of funding applications being held in this category at that time. By allocating these funds to these applications in order of the priority scores assigned to them by the Review Committees Cas described on Page 12 of this report), it was possible to fund all but seven.. It must be noted, however,

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23-072 0 78 3






38


that at the time these funds became available, 82 others had been withdrawn, either by the applicant or administratively at the end of the 12-month holding period. A complete listing of these applications is in Appendix F and the following table summarizes the situation:


APPROVED/
SUBCHAPTER UNFUNDED FUNDED WITHDRAWN PENDING

6 S
111 120 37 77 6

TOTAL 127 38 82 7

NOTE: These include applications for new grants
and for supplementation or expansion of
active grants.


SUMMARY

Public Law 92-S41, in adding Chapter 82 to*Title 38 of the U.S. Code, authorized annual appropriations through Fiscal Year 1979 and provided that each appropriation remain available through the six years following the year in which it was appropTiated.

The funding of all of the grants made to assist new
State medical schools, to assist established medical schools, to aid other health manpower training institutions, as well as all allocations of funds to the affiliated VA facilities, can be completed under this authority.

As emphasized throughout this report, assessment of the full impact of these grant programs on both the numbers and the quality of health manpower available to the Veterans Administration and to the nation -- and, more indirectly their effect on the services being delivered to veteran patients -- is only now beginning to be possible.

Although the authority for annual appropriations expires at the end of Fiscal Year 1979, the fact that each annual appropriation remains available for six additional years makes it possible for each ofAhe grantees to complete the program activities, as proposed and as approved by the Veterans Administration. Further, because grant proposals include plans for'continued support from other sources and for continued participation of theaffiliated VA facilities as sites of clinical training -- beyond the period of VA

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39


funding support -- it will be possible for the Manpower Grants Service to continue to monitor and to accumulate data on the programs beyond the grant award periods.

Additionally, the continued participation of the facilities as sites for clinical training will provide a base for longitudinal studies of both the process and the effects of such participation on each of the academic programs and on each of the VA health care facilities.

To this end, and for purposes of making the annual
report to the Congress increasingly definitive, the Service has recently initiated a more sophisticated and responsive information retrieval system. Such a system will also serve to assist the Manpower Grants Service in the maintenance of a sound basis for management of this independent appropriation.

The Department of Medicine and Surgery is acutely aware of the necessity to establish a system for assessing the impact of its affiliations with medical schools and with health manpower training programs in all of the health professions and occupations -- both from the standpoint of their costs to the Department of Medicine and Surgery and their contributions to the Department's capacity to provide quality services to eligible veteran patients.

For all of these reasons, the Manpower Grants Service
is particularly concerned with the development of its responsibility to maintain the records and evaluate the measurable outcomes of the funded programs; and, to the extent of its responsibilities in this regard, to make those records and evaluations available for broader use within the Office of Academic Affairs and the Department of Medicine and Surgery.



















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SAINT ]LOUIS UNIVERSITY

SCHOOL OF MEDICINE 1402 SOUTH GRAND SOUJLE vAROFFICE OF THE DEAN SAINT LOUIS, MISSOURI 63104
TOWNSEND 5-2288 STA, 436


January 24, 1973 M. A
I~~~ ~ FO'-1O I NAU

60' MfY S2 FOR UiTO6
The Honorable Donald E. Johnson 1f.O;O-L?
Administrator of Veterans' Affairsml 6yarnc t
Washington, D.C. 20420___Dear Mr. Johnson:


This is to advise you that I have participated, as Chairman of the Special Medical Advisory Group, in
the development of VA regulations to implement Public
Law 92-541, the Veterans' Administration Medical
School Assistance 'and Health Manpower Training Act
of 1972. As you are undoubtedly aware, two meetings
were held in Central Office for this purpose and included representatives of the Bureau of Health
Manpower Education, and Health Services Mental Health
Administration assigned by the Secretary of Health,
Education, and Welfare. In addition, your Department of Medicine and Surgery wisely coordinated the development with the Association of American Medical Colleges American Medical Association Liaison Committee for Medical Education, the Association of
Academic Health Centers, and both the Department of
Undergraduate Medical Education and the Department
of Allied Health Professions and Services of the
Division of Medical Education of the American Medical
Association.

The document as presently developed meets with my
approval as Chairman of the Special Medical Advisory
Group. I am pleased that we have had this opportunity
to participate in the coordination of this phase of
the program as provided by the statute under paragraph
5070c.



41.
APPENDIX A





42


The Hon. Donald E. Johnson January 24, 1973
Page two



Speaking for the Special Medical Advisory Group I
would say that this is a landmark piece of legislation,
demonstrating the Veterans Administration's ability
to provide direct assistance to the development of
additional health manpower, as well as signalling to
the medical community the highly beneficial assistance the VA can provide to insure-quality health and medical
care of veterans and all other citizens.

Respectfully yours,


Robert H. Felix, M.D. Dean, School of Medicine
Saint Louis University Chairman, SMAG























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4M b THE SECRETARY OF HEALTH. EDUCATION, AND WELFARE

WASHINGTON. D.C. 20201



honorable Donald It. Johason DEC 817
AodmnItrator of Veterans Affairs Veteran Adainis trat ion
Waeh~tom D. C. 20420

Dear Don

Thank you icr your letter of Iliveriber 6 requestiug that the Department designate~ si appropriate office or staff reprEeentative to assure effective coordination of program of mutual interest as you isoplmrent H. J. It"e. 746.

Dr. f,'arry iiruce, Director, Division of Physician ariti Letiltl% ?Ki'oo-Sions Education (telephone 496-6728), and Dr. Ajeniei 1. .iti--1 ccat
Director. ireau of Iealtli iLapowr EIucation. ,L~Loaali :nat! txxte- of Health telephonee 496-1071), are designated as contacts for prograia carried out under Section 309, ed Title* V11 &no' V111 of the Iuli Health Service (MK) Act. 1.wr. Jac~k ii. ;u. ;rowrA, AA6ciatc 41..eputy A.~ne traer. for Develapuesut itealtim Serviae and .sntal i.-alth ,Ln~istration (telephone 443-3173) is tho person to provide liaison concerning Title IX of the FIKS Act:.

We vish you every sue*** in yewr sew endeavor and appreciate this opportunity to d cstrate tea ability of two agencies to work tojsther to achieve a ces goal.

With best regards,

Sincerely,


// 11.10oi

Secretary















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Authorization and Appropriation Levels SUBCHAPTER I

Assistance in the Establishment of New State Medical Schools
(Dollars in Thousands)



AUTHORIZED APPROPRIATED

FY 1973 $25,000 -0FY 1974 25,000 $25,000

FY 1975 25,000 -0FY 1976 25,000 12,881

FY 1977 25,000 9,200

FY 1978 25,000 16,377

FY 1979 25,000




SUBCHAPTERS II, III, & IV Grants to Established Medical Schools and Other Health Manpower Training Institutions
(Dollars in Thousands)



AUTHORIZED APPROPRIATED

FY 1973 $50,000 $20,000

FY 1974 50,000 -0FY 1975 50,000 10,000

FY 1976 50,000 25,451

FY 1977 50,000 35,845

FY 1978 50,000 29,234

FY 1979 50,000




45.
APPENDIX B








23-072 0 78 4











47



REVIEW PARTICIPANTS

A. Membership of Medical School Assistance Review Committee


BELL, C. Cooper, Jr., M.D. (1975-77) MOY, Richard H., M.D. (1974-77)
Chief of Staff Dean, School of Medicine
Later position: Southern Illinois University
Associate Chief of Staff P. 0. Box 3926
for Research & Development 801 North Rutledge
VA Center Springfield, Illinois 62708
Hampton, Virginia 23667
SAUNDERS, Donald E., M.D. (1976-79) BLAYNEY, Keith D., Ph.D. (1976-79) (Private Practice)
Dean, School of Public and Cardiology and Internal Medicine
Allied Health 2739 Laurel Street
University of Alabama Columbia, South Carolina 29204
Birmingham,.Alabama 35294
SLATER, Robert J., M.D. (1974-76) CARLIN, Jean E., M.D., Ph.D. (1975-78) President, Medical College
Associate Dean, California College of Pennsylvania
of Medicine 3300 Henry Avenue
University of California Philadelphia, Pennsylvania 19129
Irvine, California 92664
THURMAN, William G., M.D. (1974-76) CHALMERS, Thomas C., M.D. (1974-75) Dean, School of Medicine
President & Dean, Mt. Sinai Tulane University
School of Medicine New Orleans, Louisiana 70112
City University of New York Later position:
5th Avenue & 100th Street Provost, Health Sciences Center
New York, New York 10029 University of Oklahoma Health
Sciences Center
HOLDER, Lee, Ph.D. (1974-76) 633 N.E. 14th Street
Dean, College of Community and Oklahoma City, Oklahoma 73190
Allied Health Professions
University of Tennessee VALLBONA, Carlos, M.D. (1975-78)
College of Medicine Chairman, Community Medicine Department
62 S. Dunlap Street Baylor College of Medicine
Memphis, Tennessee 38163 Texas Medical Center
1200 Moursund Avenue
HOPPER, Cornelius L., M.D. (1975-76) Houston, Texas 77025
Vice President for Health Affairs Tuskegee Institute VICKERSTAFF, Hugh R. (1974-78)
Tuskegee, Alabama 36088 Director, VA Hospital
Nashville, Tennessee 37203
McCALL, Charles B., M.D. (1976) Later position:
Dean, College of Medicine Director, VA Hospital
University of Tennessee Center San Francisco, California 94121
for the Health Sciences
800 Madison Avenue
Memphis, Tennessee 38163


Addresses given are those during the time of participation. 4 7.

APPENDIX C








48



REVIEW PARTICIPANTS

B. Membership of Health Manpower Training Assistance Review Committee


ADAMS, Frederick G., D.D.S.(1974-77) HOLCOMB, J. David, Ed.D. (1974-78)
Vice President for Student Coordinator of Allied
Affairs and Services Health Training
University of Connecticut VA Hospital
Gulley Hall, #U-122 Houston, Texas 77031
Storrs, Connecticut 06268
HOPPING, Richard L. O.D.(1975-78) BARKER, Thomas C., Ph.D.(1974-77) President, Southern California
Dean, School of Allied Health College of optometry
Professions 2001 Associated Road
Health Sciences Division Fullerton, California 92631
Virginia Commonwealth University
MCV Station Box 233 JAFFREY, Harold (1975-77)
Richmond, Virginia 23298 Director, VA Hospital
Lyons, New Jersey 07939
CHESTER, Robert (1976-79) Later position:
Department of Social Work Director, VA Hospital
University of Missouri Cleveland, Ohio 44106
Medical Center
Columbia, Missouri 65201 JOHNSON, Mae M. (1974-77)
Later address: Chairman, Department of Nursing
P. 0. Box 4415 Los Angeles Valley College
Santa Fe, New Mexico 87501 5800 Fulton Avenue
Van Nuys, California 91401
DRENNAN, Phyllis, Ph.D. (1976-79) Director of Nursing Education KENNEDY, Paul K. (1975-78)
University of Northern Colorado Director, VA Hospital
Greeley, Colorado 80639 North Chicago, Illinois 60064
Later position:
EMERSON, Ann P. (1974-76) Director, VA Center
Program Director for Clinical and Boise, Idaho 83702
Community Dietetics
College of Health Related Professions KLOOSTER, Judson, D.D.S. (1975-76)
J. Hillis Miller Health Center Dean, Dental School
University of Florida Loma Linda University
Gainesville, Florida 32610 Loma Linda, California 92354

FAHY, Ellen, R.N. Ed.D. (1974-78) LAWRENCE, David (1976-79)
Dean, School of Nursing Program Director, MEDEX Northwest
Health Sciences Center 304 "U" District Building
State University of New York 1107 Northeast 45th
at Stony Brook Seattle, Washington 98105
Stony Brook, New York 11740


48.








49



LOHR, Mary M.,Ed.D. (1974-76) SUZUKI, Howard K., Ph.D. (1974-78)
Dean, College of Nursing Dean, College of Health Related
Univer4-ity of Illinois Professions
Chicago, Illinois 60680 J. Hillis Miller Health Center
Later position: University of Florida
Dean, School of Nursing Gainesville, Florida 32610
University of Michigan
1335 Catherine Street SWINTOSKY, Joseph V., Ph.D. (1976-79)
East Lansing, Michigan 48823 Dean, College of Pharmacy
University of Kentucky
McNAMARA, Evelyn, ACSW (1974-76) Washington and Gladstone Streets
Exec. Secretary, Society for Hospital Lexington, Kentucky 40506
Social Work Directors
American Hospital Association THORESEN, Marilyn P. (1974-77)
840 Lake Shore Drive Dental Hygiene Instructor
Chicago, Illinois 60611 VA Outpatient Clinic
Boston, Massachusetts 02108
MULHERN, Frank (1974-77)
Director, Health Occupations Program UPRIGHT, John W., Ph.D. (1976-79)
Kirkwood Community College Executive Director
6301 Boiling Street, N.W. Lincoln Medical Education Foundation
Cedar Rapids, Iowa 52406 7710 Myrtle
Later position: Lincoln, Nebraska 68520
Coordinator, Rehabilitation
Placement Specialist Program WAGNER, David (1975-76)
209 Memorial Hall Associate Director
Drake University Physician's Assistant Program
Des Moines, Iowa 50311 St. Louis University
1504 S. Grand Avenue
PERRY, Catherine (1974-78) St. Louis, Missouri 63103
Chairman, Department of
Physical Therapy WATSON, Donna (1976-79)
Sargent College of Allied Health Head, Clinical Dietetics
Professions Division of Allied Health
Boston University Emory University
Boston, Massachusetts 02215 School of Medicine
Atlanta, Georgia 30322
RANDALL, Malcom (1974-77)
Director, VA Hospital WHITE, Raymond, D.D.S. (1976-79)
Gainesville, Florida 32602 Dean, School of Dentistry
University of North Carolina
SAUNDERS, Marie, Ph.D. (1974-78) Chapel Hill, North Carolina 27514
Coordinator, Allied Health Training VA Center
Temple, Texas 76501






49.







50



WILCOX, Howard G., M.D. (1974-77) Associate Chief of Staff for Education VA Hospital
Salt Lake City, Utah 84113

WISEMAN, Ralph, Jr. (1974-76) VA Hospital
Memphis, Tennessee 38104
Later position:
Assistant Director Trainee
VA Hospital
Oklahoma City, Oklahoma 73104
Later position:
Assistant Director
VA Hospital
Nashville, Tennessee 37203

WOOD, Courtney B., M.D. (1974-77) Associate Chief of Staff for
Allied Health Education VA Hospital
Bronx, New York 10468

WURSTER, Dale E., Ph.D. (1974-77) Dean, College of Pharmacy University of Iowa Iowa City, Iowa 52242

ZIMMERMAN, Thomas F., Ph.D. (1975-76) Dean, School of Associated
Medical Sciences
University of Illinois College
of Medicine
808 South Wood Street Chicago, Illinois 60612




















50.








51



REVIEW PARTICIPANTS

C. All Other Review Participants


BALDWIN, William R., O.D., Ph.D. BOYER, Harold E., D.D.S.
President, Massachusetts College Vice President for Health Affairs
of Optometry Health Sciences Center
424 Beacon Street University of Louisville
Boston, Massachusetts 02115 Louisville, Kentucky 40201

BARD, Raymond C., Ph.D. BROGDON, Byron G., M.D.
Dean of Allied Health Chairman, Department of Radiology
Medical College of Georgia University of New Mexico
Augusta, Georgia 30902 School of Medicine
Albuquerque, New Mexico 87131 BELJAN, John R., M.D.
Dean, School of Medicine BURNSIDE, Helen R., Ed.D.
Wright State University Associate Provost for Health Sciences
Dayton, Ohio 45431 SUNY Central Administration
Room 1227 Twin Towers
BERSON, Robert C., M.D. 99 Washington Avenue
Chief of Staff Albany, New York 12210
VA Hospital
,Baltimore, Maryland 21218 CHRISTMAN, Luther P., R.N., Ph.D.
Vice President for Nursing Affairs BIDDY, Ralph L., M.D. Rush-Presbyterian St. Luke's
Assistant Dean, School of Medicine Medical Center
St. Louis University and:
1402 South Grand Boulevard Dean, Rush College of Nursing
St. Louis, Missouri 63104 Rush University
1725 W. Harrison
BIRD, Robert M., M.D. (Deceased) Chicago, Illinois 60612
Dean, College of Medicine
University of Oklahoma CONANT, Lucy H., Ph.D.
Oklahoma City, Oklahoma 73190 Dean, School of Nursing
University of North Carolina
BLACK, Agnes L. Chapel Hill, North Carolina 37514
Chief, Nursing Service
VA Hospital COOKE, Robert E., M.D.
Lexington, Kentucky 40507 Vice Chancellor for Health Sciences
University of Wisconsin
BLASCH, Donald Madison, Wisdonsin 53705
Director, Blind Rehabilitation
Institute COON, Robert, M.D.
Western Michigan University Assistant Chancellor, Health
Kalamazoo, Michigan 49001 Sciences Education
University of Maine
BONTE, Frederick J., M.D. Bangor, Maine 04401
Dean, Southwestern Medical School University of Texas Health
Sciences Center
5323 Harry Hines Boulevard
Dallas, Texas 75235 S1.








52



COX, Clyde G. FELIX, Robert H., M.D.
Director, VA Hospital Dean, School of Medicine
Birmingham, Alabama 35'233 St. Louis University
Later position: St. Louis, Missouri 63104
Assistant Dean for Community Later position:
Affairs Director, Bi-State Regional
University of Alabama Medical Program
School of Medicine 607 N. Grand
University Station St. Louis, Missouri 63103
Birmingham, Alabama 35294 FRAZIER, Louis M., Jr.

CULLEY, Thomas S., M.D. Director, VA Hospital
Chief of Staff Shreveport, Louisiana 71101
VA Hospital GODDARD, Beverly
Columbia, Missouri 65201 Allied Health Training Coordinator

CURRERI, A.R., M.D. VA Hospital
President, Uniformed Services Seattle, Washington 98108
University of Health Sciences GOLDBERG, Herbert S., Ph.D.
6917 Arlington Boulevard Associate Dean
Bethesda, Maryland 20014 School of Medicine

DOLEZAL, Jerome R. University of Missouri
Director, VA Hospital Columbia, Missouri 65201
Seattle, Washington 98108 GREEN, Robert L., Jr., M.D.

EGELSTON, E. Martin, Ph.D. Chief of Staff
Assistant Director VA Hospital.
Bureau of Manpower Education Durham, North Carolina 27705
American Hospital Association GRISMER, Jerome, M.D.
Chicago, Illinois 60611 Associate Chief of Staff

FARMER, T. Albert, Jr., M.D. for Education
Dean, College of Medicine VA Hospital
University of Tennessee Minneapolis, Minnesota 55417
800 Madison Avenue
Memphis, Tennessee 38163 HAGER, George, Ph.D.
Dean, School of Pharmacy
FARRISEY, Ruth, R.N., M.S. University of North Carolina
Associate Director, Ambulatory Chapel Hill, North Carolina 27514
Care Division
Department of Nursing HIGHTOWER, Ann B.
Massachusetts General Hospital Director, Dept. of Physical Therapy
Boston, Massachusetts 02114 College of Community and
Allied Health Professions
University of Tennessee
1025 E. H. Crump Boulevard
Memphis, Tennessee 38104




52.







53



HILL, S. Richardson, Jr., M.D. LONGFIELD, Aaron N., M.D.
Vice President for Health Affairs Chief of Staff University of Alabama VA Hospital
Birmingham, Alabama 35294 Houston, Texas 77211

HOLMAN, Gerald, M.D. LUNDGREN, Elizabeth J. Ph.D.
Dean and Vice President Director, Division of Allied
Eastern Virginia Medicat Authority Health Studies
358 Mowbray Arch Miami-Dade Junior College
Norfolk, Virginia 23501 Miami, Florida 33167
Later position:
KADROVACH, Dan G. Vice President, Medical Center
Director, Hermann Hospital Campus
1203 Rose Sterling Avenue Miami-Dade Junior College
Houston, Texas 77025 Miami, Florida 33167
Later position::
Director, VA Hospital
New Orleans, Louisiana 70146 LYONS, Charles
Director, VA Hospital
KNISELY, William H., Ph.D. Newington, Connecticut 06111
Vice Chancellor for Health Affairs University of Texas MAGEN, Myron S., D.O.
601 Colorado Street Dean, College of Osteopathic Medicine
Austin, Texas 78701 Michigan State University
Later position: East Lansing, Michigan 48823
Vice President for Academic
Affairs McNULTY, Matthew F., M.D.
Medical University of Executive Vice President for
South Carolina Medical Center Affairs
College of Medicine Georgetown University
80 Barre Street Washington, D.C. 20007
Charleston, South Carolina 29401 MERCHANT, William, R., M.D.

KUTNER, Bernard J., Ph.D. (Deceased) Director, VA Hospital Dean, Sargent Coliege-of Allied Madison, Wisconsin 53705
Health Professions
Boston University MITCHELL, Merlin, Ed.D.
University Road Director, Instructional
Development Unit
Boston, Massachusetts 02215 Mayo Clinic

LANKFORD, Paulette, Ph.D. Room 212, Student Center
Assistant Dean, Allied Health Rochester, Minnesota 55901
Professions
Vanderbilt University MORELAND, Ernest F., Ed.D.
School of Medicine School of Dentistry
Nashville, Tennessee 37232 University of Maryland
522 West Lombard Street
LAWRENCE, Ann M., M.D., Ph.D. Baltimore, Maryland 21201
Associate Chief of Staff
for Education MORSE, Stanley B.
VA Hospital Director, VA Hospital
Hines, Illinois 60141 Durham, North Carolina 27705

53.







54



NESS, Carmen 0., H.S.D. ROBERTSON, Roland R., Jr., M.D.
Dean, College of Health Associate Chief of Staff
Related Professions for Education
Wichita State University VA Center
1.845 Fairmount Jackson, Mississippi 39216
Wichita, Kansas 67208
SABIN, Robert N.
O'HALE, Mercedes Program Management Officer
Director, Nursing Program VA Hospital
Fayetteville Technical Institute Boise, Idaho 83702
Fayetteville, North Carolina 28303 SCHERMERHORN, John W., Ph.D.
OLDHAM, Walter J. Dean, School of Allied Health
Executive Director, Tuskegee AHEC Sciences
VA Hospital University of Texas, Dallas
Tuskegee, Alabama 36083 5323 Harry Hines Boulevard
Dallas, Texas 75235
OLSON, Stanley W.$ M.D.
Provost, College of Medicine SCHLOSSBERG, Barry J., M.D.
Northeastern Ohio Universities Associate Chief of Staff
Kent, Ohio 44240 for Education
VA Hospital
ORR, Darrell W. Baltimore, Maryland 21218
Director, VA Outpatient Clinic El Paso, Texas 79905 SCHIDT, Richard P., M.D.
President and Dean~
PARRISH, Vincent .J. College of Medicine
Director, VA Hospital State University of New York
Saginaw, Michigan 48602 Syracuse, New York 13210

POHL, Arnold W., M.D. SCHWARZ, M. Roy, M.D.
Associate Chief of Staff Associate Dean of Academic Affairs
for Education Director of WAMI Program
VA Hospital School of Medicine
Albany, New York 12208 University of Washington
Seattle, Washington 98195
PELLEGRINO, Edmund D., M.D.
Chancellor, University of Tennessee SEEBOHM, Paul M., M.D.
Medical Units Associate Dean, Collegeof Medicine
Memphis, Tennessee 38103 University of Iowa
Iowa City, Iowa 52240
PERRY, J. Warren, Ph.D.
Dean, School of Health SHERMAN, Jacques L., Jr., M.D.
Related Professions Associate Chief of Staff
SUNY Buffalo for Education
19 Diefendorf Annex VA Hospital
Buffalo, New York 14214 Northport, New York 11768

PUCEL, John C., Ph.D.
Coordinator, Mental Health Associate VA Hospital
St. Cloud, Minnesota 56301

54.








55



SINEX, F. Marott, Ph.D. TOWBIN, Eugene J., M.D.
Chairman, Department of Biochemistry Chief of Staff Boston University VA Hospital
School of Medicine Little Rock, Arkansas 72206
80 East Concord
Boston, Massachusettes 02118 UNDERWOOD, Willis
Director
SMITH, Carliton VA Hospital
Director, VA Hospital West Haven, Connecticut 06516
Boston, Massachusetts 02130 VALANCE, John
SMITH, Elizabeth R., R.N., Ph.D. Director
Acting Chief, Psychiatric Nursing VA Hospital (Brentwood)
Education Branch Los Angeles, California 90073
Division of Manpower and Training NIMH, Room 0C09 Parkiawn Building WEGNER, Karl H., M.D.
5600 Fishers Lane Vice President for Health Affairs
Rockville, Maryland 20852 and Dean, School of Medicine
University of South Dakota
SMITH, George, M.D. Vermilion, South Dakota 57069
Dean, School of Medical Sciences University of Nevada WHITE, Barbara
Reno, Nevada 89507 Assistant Editor
Journal of the APTA
SPELLMAN, Mitchell W., M.D., Ph.D. American Physical Therapy
Dean, Charles R. Drew Postgraduate Association
Medical School Washington, D.C. 20005
1620 E. 119th Street
Los Angeles, California 90059 WILLARD, William R., M.D.
Dean, College of Community
SORENSON, Gladys E., Ph.D. Health Sciences
Dean, College of Nursing University of Alabama
University of Arizona P.O. Box 6291
Tucson, Arizona 85721 University, Alabama 35426

SOVIE, Margaret, Ph.D., R.N. WITTSON, Cecil L., M.D.
Assistant Dean & Associate Chancellor Emeritus
Professor of Nursing University of Nebraska
College of Health Related Medical Center
Professions Omaha, Nebraska 68114
SlIMY Upstate Medical Center 750 E. Adams Street WOLF, Julius, M.D.
Syracuse, New York 13210 Chief of Staff
VA Hospital
STANIDISH, Miles L., Ph.D. Bronx, New York 10468
Director of Education and Training VA Hospital ZACHAREWICZ, Francis A., M.D.
Reno, Nevada 89502 Associate Chief of Staff for
Education
THOMPSON, Thomas T., M.D. VA Hospital
Chief, Radiology Service St. Louis, Missouri 63125
VA Hospital
Durham, North Carolina 27705

55.









57




VETERANS
ADMINISTRATION

DEPARTMENT OF MEDICINE AND SURGERY MANPOWER GRANTS SERVICE










GRANTS AWARDED FOR.' ASSISTANCE IN THE ESTABLISHMENT OF NEW STATE MEDICAL SCHOOLS GRANTS TO AFFILIATED MEDICAL SCHOOLS

GRANTS TO ASSIST IN THE EDUCATION AND TRAINING OF PROFESSIONAL AND TECHNICAL ALLIED HEALTH MANPOWER






VETERANs ADMINISTRATION MEDICAL SCHOOL ASSISTANCE
AND HEALTH MANPOWER TRAINING ACT

38 USC CHAPTER 82









57.
APPENDIX D










59



October 15, 1977







ASSISTANCE IN THE ESTABLISHMENT

OF NEW STATE MEDICAL SCHOOLS




Under Subchapter I of P.L. 92-541, grants have been made to the following five institutions to assist in the establishment of new State medical schools, in affiliation with VA medical facilities. In each case, the approved period of grant support is seven years.


FACULTY SEVEN-YEAR EFFECTIVE
SCHOOL ASSISTANCE FACILITIES TOTAL DATE


Wright State Univ. $20,338,055 $ 8,235,914 $28,573,969 7/74
in affiliation with the Dayton, Ohio VAC

Univ. of So. Carolina $10,412,212 $14,646,629 $25,058,841 11/74
in affiliation with
the Columbia VAH

Texas A&M Univ. in $12,903,943 $ 4,167,666 $17,071,609 3/76
affiliation with the
Temple VAC and Marlin
& Waco VAHs

Marshall Univ. in $11,075,310 $ 5,063,842 $16,139,152 7/76
affiliation with VARs
Huntington and Beckley, W.Va.

East Tennessee State $19,265,224 $15,111,168 $34,376,392 8/ /7
Univ. in affiliation
with the Mountain Home
VAC










59.










61



GRANTS TO AFFILIATED MEDICAL SCHOOLS*



Eighteen medical schools have received assistance, under Subchapter 11 of P.L. 92-541, to expand and enhance their undergraduate medical education programs through broadened involvement of Veterans Administration medical facilities with which they are affiliated. In addition to developing and strengthening individual clinical departments, the grant support is directed to such activities as establishment of "clinical campuses" distant from parent medical centers, and conversion from two to four-year programs.



ALABAMA


U. of Alabama, School of Medicine, Birmingham 7 years beginning April
1975 $6,445,172 to assist in the expansion of a primary care outreach campus at Tuscaloosa, allowing for increased enrollment,
additional faculty and staff, and continuing education for physicians
and other health care personnel, in affiliation with the Tuscaloosa
VA Hospital.


CALIFORNIA


U. of California, California College of Medicine, Irvine 7 years
beginning July 1974 $6,615,116 to improve the scope and quality
of the school's educational efforts, with major emphasis on continuing education, an outreach program in the community, and
increased enrollment, including transfer students from foreign medical
schools. VA Hospital Long Beach is integrated into the School's education system as a major affiliate. In connection with this
award, funds provided the Long Beach VA Hospital will permit alteration
and renovation of space for use in the expanded medical program.

U. of California, School of Medicine, San Diego 7 years beginning
July 1974 $3,524,725 to assist in the development and expansion
of the school to substantially increase class enrollment, in
affiliation with San Diego VA Hospital.

U. of California, San Francisco Medical Center 7 years beginning
July 1975 $8,005,000 to expand education programs at an
extension campus in Fresno/Central San Joaquin Valley, increasing


All dollar figures are for the entire multiple-year period of grant
support.
61.




















23-072 0 78 5






62



both undergraduate enrollment and clinical education sites, in
affiliation with Fresno VA Hospital. Associated with this award
are funds for construction of an education wing at the Fresno
VA Hospital.


FLORIDA


U. of Florida, College of Medicine 7 years beginning July 1974
$1,810,033 to develop the resources of a four-county rural
health care and education program, and to expand the VA ambulatory care clinics in Gainesville and Jacksonville by providing increased
educational opportunities in primary care for medical students,
house staff, and physician's assistants. An educational facility
will be built at the Gainesville VA Hospital and student enrollment will be increased as a result of VA support. The primary affiliate
is Gainesville VA Hospital.


ILLINOIS


Loyola University, Stritch School of Medicine 7 years beginning May
1975 $1,855,182 to assist with the development and initiation
of an experimental medical education program and the creation of
a Division of Continuing Medical Education. Grant support of this
program, which is conducted in affiliation with the Hines VA Hospital,
will permit significant enrollment increases.

Southern Illinois University, School of Medicine 7 years beginning
April 1975 $1,075,728 to improve the undergraduate curriculum,
increase enrollment, and support a regional continuing education
program, in affiliation with Marion, Illinois VA Hospital. Additional
funds are reserved for modification of space at the Marion VA
Hospital for the conduct of educational programs.

U. of Health Sciences/The Chicago Medical School 7 years beginning
July 1975 $9,159,267 to assist in the expansion of the medical school enrollment and to improve the overall quality of education, including graduate medical education. Facilities renovation will
take place at the affiliated VA Hospital in North Chicago with
additional funds provided in connection with this award.





62.







63



KANSAS


U. of Kansas Medical Center 7 years beginning July 1974 $3,493,800
to expand enrollment and improve the quality of clinical education at Kansas University Medical Center's two branches, in affiliation
with VA Hospitals in Kansas City and Wichita.


LOUISIANA


Louisiana State U., School of Medicine, at Shreveport 5 years beginning
July 1975 $2,772,000 to assist in the development of the school to substantially increase entering class enrollment. Affiliation is
with Shreveport VA Hospital.


NEW YORK


Mt. Sinai School of Medicine of the City University of New York
7 years beginning July 1974 $2,885,150 to assist in the expansion
of undergraduate enrollment and to support additional refinement for
continuing education of physicians, in affiliation with Bronx VA
Hospital.


NORTH DAKOTA


U. of North Dakota, School of Medicine 7 years beginning July 1975
$12,240,000 to convert to a four-year school through use of North Dakota clinical agencies for educational experiences, including the Fargo VA Center, where additional funding will permit the conversion
of certain space for educational use.


OKLAHOMA


U. of Oklahoma Health Sciences Center, College of Medicine 7 years
beginning July 1974 $1,458,910 to establish the Tulsa College
of Medicine as a two-year campus (3rd and 4th years), in association
with the existing College of Medicine in Oklahoma City, affiliating
with VA Hospital, Muskogee. Substantial increases in enrollment




63.






64



will occur. Associated with this award are funds for renovation
of space at the Muskogee VA Hospital to provide educational
facilities for the expanded medical program.


PENNSYLVANIA


Medical College of Pennsylvania 7 years beginning May 1975 $6,017,781
to provide assistance for initiation of a primary care education
program, an increase in medical student enrollment, and strengthening of
the medical school's ongoing continuation education program.
Through additional resources made available to the VA Hospital,
educational space at the Philadelphia VA Hospital will be expanded.


PUERTO RICO


U. of Puerto Rico, School of Medicine 7 years beginning July 1975
$1,941,285 to strengthen the educational program and expand the
entering class enrollment, in affiliation with the San Juan VA Center.


SOUTH DAKOTA


U. of South Dakota, School of Medicine 7 years beginning July 1974
$9,128,547 to convert the two-year medical school to a fouryear degree-granting medical education program, in affiliation with Sioux Falls VA Center. Funds also are being provided for upgrading
of facilities at Sioux Falls VA Center for the new four-year
program.


TEXAS


U. of Texas, Southwestern Medical School at Dallas 7 years beginning
July 1974 $7,567,950 to increase enrollment, incorporating
recent changes in medical curriculum, with the VA Hospital at
Dallas accommodating a large portion of the expanded classes during
clinical instruction. In addition, funds are being provided the Dallas VA Hospital for renovation of space to provide classrooms
and conference rooms.




64.







65



VIRGINIA


Eastern Virginia Medical School 7 years beginning January 1975
$5,206,673 to assist in the development of a community-based
medical school by improving and expanding health education
capabilities, to increase the number of undergraduate medical
students, and to better the quality of undergraduate medical
education, in affiliation with Hampton VA Center.

411 years beginning July 1977 $637,925 to provide supplemental
support to expand faculty and provide additional facilities renovation
and equipment, in affiliation with the Hampton VA Hospital.







































65.










67



GRANTS TO OTHER HEALTH MANPOWER TRAINING

INSTITUTIONS AND PROGRAMS*



Subchapter III of P.L. 92-541 has permitted the awarding of grants to schools of other health professions and occupations for health manpower training and education programs to be conducted in affiliation with Veterans Administration Hospitals and other health care facilities. These programs are directed toward improving the utilization or distribution of health manpower and the availability of health personnel needed to provide special services in VA hospitals and in hospitals and health care facilities throughout the nation.



ALABAMA


Tuskegee Area Health Education Center, Inc. 7 years beginning
September 1974 $1,378,187 to provide support for a multifaceted project which consists of (1) a coordinating component for the AHEC; (2) a licensed practical nurse education program
at Southern Vocational College; (3) a hospital continuing education program at Lee County Hospital; and (4) a health
education learning program at Auburn University. The
affiliating hospital is Tuskegee VA Hospital.

3 years beginning July 1977 $212,608 to provide supplemental support to expand the present Lee County regional program which provides continuing education opportunities for area health
workers, in affiliation with the Tuskegee VA Hospital.

U. of Alabama at Birmingham 7 years beginning July 1975 $154,779
to strengthen and expand the administrative residency portion of the
graduate program in hospital and health administration, in affiliation
with the Birmingham VA Hospital and VA Medical District #11.

U. of Alabama at Birmingham 3 years beginning January 1975 $78,855
to assist in the development of a simulated laboratory to improve
clinical instruction in the medical technology program, in affiliation
with the Birmingham VA Hospital.

U. of Alabama at Birmingham 4 years beginning July 1977 $103,210
to expand and improve a dietetics internship and dietetics
technician training program, in affiliation with Birmingham VA
Hospital.


All dollar figures are for the entire multiple-year period of grant
support. 67.






68



U, of Alabama at Birmingham 3 years beginning July 1977
$103,217 to upgrade the present non-credit certificate
program in nuclear medicine technology to a four-year B.S. program and also to provide continuing education
opportunities. The affiliating hospital is the Birmingham
VA Hospital.

U. of Alabama at Birmingham 3 years beginning July 1974
$159,955 to assist in the establishment of a new program
for training certified dental assistants, in affiliation
with Birmingham VA Hospital.

U. of Alabama at University 7 years beginning July 1975
$254,154 to expand the coordinated undergraduate dietetics
program, in affiliation with Tuscaloosa VA Hospital.


ARIZONA


U. of Arizona 5 years beginning January 1975 $332,409 to
expand the baccalaureate nursing program by integrating
hospital nursing service with nursing education at Tucson
VA Hospital. Funds also have been allocated for renovation of a nursing unit at the Tucson VA Hospital for use in the
education program.

U. of Arizona 3 years beginning October 1977 $155,400 to
assist in th initiation of a senior-year internship in a medical
technology education program and to establish a continuing education program for laboratory personnel, in affiliation
with Tucson, Phoenix and Prescott VA Hospitals.


ARKANSAS


U. of Arkansas, Little Rock 7 years beginning July 1974
$451,651 to provide assistance for a new program leading to a Master of Science in Communication Disorders. The program combines the resources of the University of Arkansas Medical
Center, local VA hospitals, and the University of Arkansas
at Little Rock. The major affiliating VA Hospital is
Little Rock.

4 years beginning July 1977 $119,644 to provide supplemental
support to permit the expansion of the present curriculum of the


68.






10
69



University of Arkansas Graduate Program in communicative
disorders to include a maior emphasis of study in the area of
aural rehabilitation. The affiliating hospital is the Little Rock
VA Hospital.


CALIFORNIA


California State U., Long Beach 2 years beginning October 1977
$92,701 to initiate a spinal cord injury nurse practitioner education program, in affiliation with Long Beach VA Hospital.

California State U., Los Angeles 7 years beginning January 1975
$119,132 to strengthen and expand the ongoing coordinated
undergraduate dietetic program. Students rotate through
Long Beach VA Hospital in their senior year.

Center for Training in Community Psychiatry/Southern California
Consortium for Continuing Education in Mental Health 1 year
beginning July 1974 $12,875 to coordinate mental health
continuing education efforts among several institutions, including
VA Hospital Brentwood.

Health Services Education Council of San Jose 1 year beginning
July 1974 $28,000 to assist the clinical placement project
in nursing which serves a number of community institutions,
including VA Hospitals Palo Alto and Menlo Park.

Los Angeles Valley College 7 years beginning July 1974 $342,570
to enable qualified vocational nurses, employed at VA Wadsworth
Hospital Center, as well as VA Hospitals at Brentwood and Sepulveda,
to complete educational requirements for an Associate Arts Degree
in nursing. In connection with this award, funds have been
reserved for the development of nursing classrooms and office space
at the VA Hospital.

Southern California College of Optometry 7 years beginning July 1977
$808,339 to improve the education and training of optometry
students and optometric technicians by expanding their clinical
experiences, in affiliation with the Los Angeles VA Outpatient
Clinic.

U. of California, Los Angeles 4 years beginning July 1974 $444,914
to expand and improve medical technology, radiologic technology
and dietetics training programs. Wadsworth VA Hospital Center
is the primary VA affiliate.


69.







70



U. of California, San Francisco 3 years beginning July 1975
$141,782 to integrate academic theory with nursing practice
in six-month internships for recent graduates, in medical center
hospitals including San Francisco VA.


COLORA.DO


Otero Junior College 7 years beginning July 1977 $557,303 to
initiate an Associate Degree nurse program at Otero and Trinidad
State Junior Colleges, in affiliation with the Fort Lyon VA
Hospital.


CONNECTICUT


Quinnipiac College 5 years beginning July 1974 $337,500 to expand
and improve the clinical phases of the occupational and physical
therapy programs, in affiliation with West Haven VA Hospital, where
additional funds are available for equipment and space modifications.

U. of Connecticut 5 years beginning July 1975 $157,711 to expand
and improve clinical dietetics program, in affiliation with the
Newington VA Hospital.

Yale U. 5 years beginning July 1974 $200,000 to assist in the
expansion of the physician's associate program, providing training
in emergency treatment, primary care and management of chronic
problems, in affiliation with the West Haven VA Hospital.


DISTRICT OF COLUMBIA


Georgetown U. 7 years beginning July 1974 $105,000 to assist
in the expansion of the ophthalmic technician program with
clinical training to occur at the Washington VA Hospital.


FLORIDA


U. of Florida 7 years beginning July 1974 $427,459 to implement
a program in clinical and community dietetics; affiliated with
Gainesville VA Hospital.



70.








71



U. of Florida 7 years beginning July 1975 $585,527 to initiate
a program in administration and education, leading to a Bachelor
of Health Science Degree, for Associate Degree graduates in the
health fields, in affiliation with Gainesville VA Hospital.

U. of Florida 4 years beginning January 1975 $304,205 to provide
support for competency-based curriculum improvements in medical
technology; affiliated with Gainesville VA Hospital.

U. of Florida 5 years beginning July 1974 $119,181 to enlarge
the existing intern-residency program to prepare nurse practitioners
for extended care responsibilities in VA hospitals, in affiliation
with Gainesville VA Hospital.


GEORGIA


Emory U. 7 years beginning January 1975 $313,915 to provide funds
in the area of basic physiology and monitoring instrumentation for
the anesthesiology-allied health basic science curriculum, which is common to the (1) Master of Medical Science in Anesthesia and
Life Support Systems; and (2) Master of Medical Science in Intensive
Respiratory Care. This program is affiliated with Decatur VA
Hospital where additional laboratory equipment has been procured.

Emory U. 7 years beginning July 1974 $1,190,000 to expand and
improve the graduate program in physical therapy and the dietetic
internship program, in affiliation with Decatur VA Hospital.

Medical College of Georgia 7 years beginning July 1974 $1,671,586
to expand and improve the training programs in occupational therapy,
physical therapy, medical record administration, dental hygiene and nuclear medicine technology, in affiliation with Augusta VA Hospital. Additional funds are directed toward the expansion of
clinical facilities at the VA Hospital.

Medical College of Georgia 7 years beginning July 1977 $330,610
to expand a four year baccalaureate program in respiratory therapy,
in affiliation with the Augusta VA Hospital, where funds are available
for renovation of the respiratory therapy treatment room.

Georgia College 7 years beginning July 1975 $464,973 to expand
the number and variety of clinical experiences for Associate
Degree nursing students in rural Georgia hospitals, including Dublin VA Center, to which funds are allocated for additional
equipment.







72



1 DA110


Area Health Education Consortium of Treasure Valley 8 months beginning
November 1974 $75,523 to renovate a health education building
for community use. VA Hospital Boise is a consortium member.

Area Health Education Consortium of Treasure Valley 2 years beginning
July 1974 $79,400 to establish a health information retrieval center beneficial to institutions throughout the state, including
VA Hospital Boise, Idaho.

Area Health Education Consortium of Treasure Valley 3 years beginning
July 1975 $220,885 to develop a unified approach to nursing education in Idaho, for improvement in educational programs and
health services throughout the state, including the Boise VA Hospital.

Area Health Education Consortium of Treasure Valley 3 years beginning
July 1974 $24,000 to coordinate a series of six-week courses
to train nurses for expanded roles in intensive and coronary care.
VA Hospital Boise is a consortium member.


ILLINOIS


College of St. Francis 3 years beginning July 1974 $43,830 to
expand and improve the therapeutic recreation program with curriculum
revamping and clinical upgrading, in affiliation with Hines VA
Hospital.

Rend Lake College in consortium with Southern Illinois Collegiate
Common Market 7 years beginning July 1974 $854,000 to
develop and implement an interdisciplinary approach to Associate Degree nurse training and provide a base for program development
in other allied health areas, in affiliation with Marion, Illinois
VA Hospital.


IOWA


U. of Iowa 3 years beginning July 1975 $114,418 to establish
a psychopharmacotherapy teaching center, for undergraduate and
graduate pharmacy students at Iowa City VA Hospital.




72.









73



KANSAS


Wichita State U. 7 years beginning January 1975 $1,593,615
to provide support for four interrelated components: an equivalency and competency oriented learning resource center which lends support
to all the programs in the College of Health Related Professions;
a graduate level program in nursing; a medical technologist expansion project; and a respiratory therapy cardio-pulmonary
technologies enhancement project, in affiliation with the Wichita VA Center. Additional expenditures are approved for the purchase of equipment and provision of student laboratory space at the VA
Hospital.


KENTUCKY


U. of Kentucky 3 years beginning July 1974 $50,616 to expand the
enrollment and improve the quality of education in the clinical
nutrition department, in affiliation with the Lexington VA Hospital.

U. of Kentucky 3 years beginning July 1974 $60,000 to expand the
physical therapy program and improve the clinical training phase,
in affiliation with Lexington VA Hospital.

U. of Kentucky 5 years beginning July 1974 $165,900 to assist in
the establishment of a clinical training program in pharmaceutical
technology, in affiliation with the Lexington VA Hospital.


LOUISIANA


Louisiana State U. and A&M College at Baton Rouge 4 years beginning
July 1974 $160,000 to increase coordination between LSUMC in
New Orleans and the VA Hospital, New Orleans, with improvement
and expansion of a graduate program in clinical chemistry.

Louisiana State U. and A&M College at Baton Rouge 7 years beginning
July 1974 $261,440 to increase the number of social workers
in the health field especially in rural Louisiana areas, in
affiliation with Alexandria VA Hospital where funds are allocated
for space modifications.




73.








74



M-A I N E


Bangor Community College of the U. of Maine 5 years beginning
July 1975 $218,291 to expand a program for training of
dental hygienists and to initiate a dental assisting program,
in affiliation with Togus VA Center.

Medical Care Development, Inc. 2 years beginning October 1977
$298,805 to continue VAts participation in the operation of
the community-based Maine Family Practice Residency program, in
affiliation with the Togus VA Center.

U. of Maine at Augusta 4 years beginning January 1975 $198,578
to expand an existing Associate Degree nursing program and establish
a medical laboratory technician program in affiliation with Togus
VA Center.


MARYLAND


Towson State College 5 years beginning July 1974 $98,435 to assist
in the establishment of a four-year undergraduate program in
occupational therapy, in affiliation with Fort Howard VA Hospital.


MAS SACHUSETTS


Boston U. 3 years beginning July 1975 $341,781 to establish a
short-term continuing education program for nurse practitioners
in geriatric nursing, in affiliation with Bedford VA Hospital
where funds have been reserved for the purchase of video equipment.

Boston U. 3 years beginning July 1977 $156,260 to initiate a
three-year, three-component program in electrophysiological
technology, based largely on training in the electroencephalographic field, to be conducted in cooperation with Labour6
Junior College. The Boston VA is the affiliating hospital.

Bunker Hill Community College 7 years beginning July 1975 $572,232to develop and conduct a new Associate Degree program in radiologic
technology, in affiliation with Boston and other VA hospitals in
Medical District #1. Associated with this award are additional
funds for space modification and equipment at the Boston VA
Hospital.




74.








75



Labour6 Junior College 5 years beginning July 1977 $217,491
to improve and expand an Associate Scienct Degree program for
dietetic technicians, in affiliation with the Brockton and
Boston VA Hospitals.

Middlesex Community College 3 years beginning January 1975 $89,606
to assist in the development of an Associate Degree program in
dental laboratory technology, in affiliation with the Bedford VA Hospital, where additional funds are available to upgrade
the dental clinic.

Middlesex Community College 7 years beginning July 1977 $277,084
to expand a fully-accredited two year Associate Degree dental hygiene
program, in affiliation with the Bedford VA Hospital.


MICHIGAN


Mercy Collegeof Detroit 3 years beginning July 1974 $60,000
to support three one-year traineeship phases of the clinical
dietetics program, in affiliation with Allen Park VA Hospital.

Mercy College of Detroit 3 years beginning January 1975 $60,326
to assist in the support of selected clinical rotations for
the training of primary care physician's assistants, in affiliation
with Ann Arbor VA Hospital.


MINNESOTA


College of St. Benedict 2 years beginning July 1974 $23,090
to expand a mental health associate training program with principal
clinical experiences provided by St. Cloud VA Hospital.

2 years beginning July 1977 $60,633 to provide additional
support for the mental health associate training program in
affiliation with the St. Cloud VA Hospital.

U. of Minnesota 5 years beginning October 1977 $200,133 to establish
a program to train pharmacy students to provide patient education
in the use of therapeutic compounds, in affiliation with the
Minneapolis VA Hospital.

916 Area Vocational Technical Institute 2 years beginning July 1975
$145,858 to support a two-year training program for orthotic and


75.







76



prosthetic technicians, in affiliation with Minneapolis VA
Hospital. In connection with this award, funds are reserved,
for remodeling an orthotics/prosthetics workshop at the VA
Hospital.


MISS 1 SS I PP I


U. of Mississippi 5 years beginning July 1974 $125,000 to provide
assistance in the establishment of a new physical therapy program
in affiliation with Jackson VA Center.

U. of Mississippi 5 years beginning July 1974 $112,100 to assist
in the establishment of a medical records transcription program,
in affiliation with Jackson VA Center.

U. of Mississippi 7 years beginning July 1975 $749,477 to
develop and implement a respiratory therapy program in affiliation
with Jackson VA Center. Additional funds are available for programrelated equipment at the VA Center.

U. of Mississippi 7 years beginning July 1974 $155,681 to assist
in the expansion and improvement of the medical records administration
program, with coordinated learning experiences taking place at the
Jackson VA Center.

U. of Mississippi 7 years beginning July 1974 $1,133,179 to support
a Statewide Network of Allied Health Programs (SNAP) in developing
and coordinating a cooperative system for the education and training of allied health personnel in Mississippi. Members include colleges, secondary schools, health care facilities and the Jackson VA Center.


MISSOURI


The Junior College District of Metropolitan Kansas City 7 years beginning
July 1977 $255,994 to support a medical laboratory technician
education program, in affiliation with the Kansas City VA Hospital.

St. Louis University 5 years beginning January 1975 $151,747 to
modify the ongoing bachelor's program in nursing to emphasize
patient assessment, in affiliation with St. Louis and Jefferson
Barracks VA Hospitals.





76.








77



MONTANA


Carroll College 7 years beginning July 1974 $575,562 to assist
in the establishment of the state's first training center for dental hygienists, in affiliation with Ft. Harrison VA Center.


NEBRASKA


Area Health Education Consortium for Southeast Nebraska 7 years
beginning July 1975 $206,050 to assist in the continuing
education of health professionals and health care workers in a seventeen county, predominantly rural area, in affiliation with
the Lincoln VA Hospital.

2 years beginning October 1977 $75,000 to provide supplemental
funds to continue the VA's participation in the expansion of a
developing family medicine residency program, in affiliation
with the Lincoln VA Hospital.

Kearney State College 7 years beginning July 1974 $495,528 to
expand, strengthen and modify an existing program in dietetics
into a coordinated undergraduate program, and to plan and implement
a graduate program in speech pathology-audiology, in affiliation
with Grand Island VA Hospital.

St. Francis Hospital, School of Nursing 7 years beginning January 1975
$236,940 to strengthen and expand the basic nursing education program in affiliation with Grand Island, Nebraska, VA Hospital,
where additional equipment is being made available for faculty
offices.

U. of Nebraska Medical Center 3 years beginning July 1977
$51,409 to assist in the initiation of a Baccalaureate Program
in nursing in Lincoln, in affiliation with the Lincoln VA Hospital.


NEVADA


U. of Nevada 5 years beginning July 1975 $357,927 to-expand and
strengthen the clinical portion of the medical technology program
at the Reno VA Hospital.





77.




















23-072 0 78 6






78



NEW HAMPSHIRE


New England Hospital and Health Foundation 3 years beginning
July 1975 $181,959 to assist this consortium in meeting the
continuing education and career development needs of health
services personnel in upper New England, in affiliation with
Manchester and other Medical District #1 VA Hospitals.


NEW YORK


Adelphi U. 5 years beginning July 1975 $304,852 to establish
and conduct a Masters Degree program in gerontological nursing,
in affiliation with Northport VA Hospital.

Bronx Community College 4 years beginning July 1975 $333,489
to develop and conduct a satellite center offering degree programs
in nursing and medical laboratory technology at the Bronx VA
Hospital.

Bronx Health Manpower Consortium 2 years beginning July 1974
$230,750 to provide support for an urban consortium designed
to better meet the health manpower needs of the metropolitan
New York area, affiliated with Bronx VA Hospital.

Duchess Community College in Consortium with Orange County Community
College 7 years beginning July 1974 $580,175 to assist in the development and expansion of three dental auxiliary program
including a dental laboratory technology program with special
emphasis on recruiting handicapped veterans, in affiliation with
Castle Point VA Hospital. Additional funds are available to
establish and equip a dental clinic for use by trainees at the
VA Hospital.

Erie Community College 7 years beginning July 1977 $670,699
to support a dental laboratory technician training program through
a consortium composed of Erie Community College, the School of
Dentistry at the State University of New York at Buffalo, Roswell
Park Memorial Institute, and the hospitals in VA Medical District II.
(Medical District 11 includes the VA Hospitals in Buffalo, Albany,
Batavia, Bath, Canandaigua, and Syracuse.) Additional funds are
available for VA laboratory equipment.

Genesee Community College 3 years beginning July 1974 $167,229
to strengthen a consortium of hospitals in western New York in





78.







79



which the members share health educational resources, including library, media and educational facilities, in affiliation with
the Batavia VA Hospital.

La Guardia Community College 5 years beginning October 1977
$361,202 to initiate a dietetic technician (food service management) Associate Degree program, in affiliation with
the Brooklyn VA Hospital.

State U. of New York, Upstate Medical Center 5 years beginning
January 1975 $197,640 to establish a four-year baccalaureate
-program in respiratory therapy, in affiliation with Syracuse
VA Hospital.

Syracuse U. 7 years beginning July 1974 $197,190
to expand the existing coordinated undergraduate program in
dietetic training, affiliating with Syracuse VA Hospital.

Westchester lCommunity College 5 years beginning July 1974 $162,353
to support a program to train dietetic technicians in two fields
nutrition care and food service systems management -- in affiliation
with Montrose VA Hospital.


NORTH CAROLINA


Duke U. 5 yearsIbeginning January 1975 $267,376 to provide
assistance for implementing a graduate program in long-term nursing
of the aging adult. The major affiliating VA Hospital is at
Durham, with another affiliation at the Asheville VA Hospital.

Duke U. Medical Center 7 years beginning July 1977 $383,959
to implement a continuing education residency training program in speech pathology and audiology, in affiliation with the Durham VA
Hospital. Additional funds are available for equipment at the
VA Hospital.


NORTH DAKOTA


U. of North Dakota 7 years beginning July 1977 $271,730 to assist
in the initiation of an affiliation with VA Center Fargo for the
development of clinical education objectives and the expansion and
improvement of the quality of education offered to physical therapy
students at University of North Dakota. In addition, funds are available for the purchase of equipment to be used in the educational
program at the VA Hospital.


79.






80



OHIO


Ohio U., Chillicothe 7 years beginning July 1974 $373,161 to assist
in the establishment of a two-year program in human services
technology, in affiliation with Chillicothe VA Hospital.


OKLAHOMA


U. of Oklahoma Health Sciences Center 7 years beginning September 1974
$1,008,501 to provide support for a multi-faceted program for
the expansion, development, and improvement of existing activities in five allied health disciplines (occupational therapy, physical
therapy, radiologic technology, dietetics, and communication disorders) in affiliation with the Oklahoma City and Muskogee
VA Hospitals. Additional funds are provided for equipment at the
two cooperating VA medical care facilities.


PEN14SYLVANIA


Community College of Beaver County 7 years beginning July 1974
$280,000 to assist in the establishment of a two-year medical
laboratory technician program. Major clinical training experiences
will occur at Butler VA Hospital.

Edinboro State College 4 years beginning July 1975 $308,530 to
strengthen an undergraduate program and add a masters program in audiology and speech pathology, in affiliation with the Erie VA
Hospital. In addition, funds are reserved for renovating and
equipping a VA audiology clinic.

Elizabethtown College 7 years beginning July 1974 $563,609 to
expand and improve the occupational therapy program by integrating
clinical training with two affiliated VA Hospitals -- Lebanon and Coatesville. In connection with this award, additional funds are
available to establish an Activities of Daily Living Clinic at the
Coatesville VA Hospital.

Hahnemann Medical College Hospital of Philadelphia 7 years beginning
July 1977 $368,400 to implement a two-year course of study
leading to an MA in speech pathology and audiology, in affiliation
with the Philadelphia VA Hospital.



8U.







81



Pennsylvania College of Podiatric Medicine 7 years beginning July
1975 $679,226 to establish and conduct a clinical training
program in pediatric medicine at Philadelphis VA Hospital.
Additional funds provide program-related equipment at the VA
Hospital.


PUERTO RICO


U. of Puerto Rico, Medical Sciences Campus 5 years beginning
July 1977 $200,942 to develop a B.S. program for training technologists in nuclear medicine, in affiliation with the San Juan VA
Center.


RHODE ISLAND


U. of Rhode Island College of Nursing 2 years beginning July 1975
$138,679 to establish an adult medical nurse practitioner program in affiliation with the Providence VA Hospital, Additional funding
provides for equipment to be used by students at the VA Hospital.


SOUTH CAROLINA


U. of South Carolina 4 years beginning July 1977 $244,680 to
establish an educational model for pharmaceutical service programs in the areas of inpatient care and ambulatory care, in affiliation
with the Columbia VA Hospital. In connection with this award,
additional funds are available for space modifications at the VA
Hospital.


TENNESSEE


Memphis State U. 7 years beginning July 1975 $439,333 to expand
the graduate program in audiology and speech pathology to emphasize
the management of brain damaged veterans and aphasic adults, in
affiliation with Memphis VA Hospital.

Shelby State Community College 7 years beginning July 1975 $227,600
to expand a training program for orthotics and prosthetics
technicians, in affiliation with Memphis VA Hospital.







82



U. of Tennessee 4 years beginning July 1974 $504,925 to establish
contemporary and advanced teaching models in pharmacy education
at VA hospitals in Tennessee. Major emphasis includes the upgrading
of graduate, undergraduate, and continuing education programs.
Memphis VA Hospital is the major affiliate.

U. of Tennessee 7 years beginning July 1974 $733,250 to support a
program establishing, expanding, and improving disciplines in the allied health professions. Major program areas include physical
therapy, radiologic technology, dental hygiene, medical record
administration, and human values and ethics, in affiliation with
Memphis VA Hospital.

Vanderbilt U. 3 years beginning July 1974 $53,345 to strengthen
the Vanderbilt-Nashville VA Hospital Cytotechnology program.

Vanderbilt U. 3 years beginning July 1974 7 $45,000 to strengthen
and expand the present curriculum for the medical technologist
program, in affiliation with the Nashville VA Hospital.

Vanderbilt U. 3 years beginning July 1974 $74,853 to strengthen
and expand the present curriculum for the respiratory therapy
program in cooperation with the Nashville VA Hospital.

'Vanderbilt U. 3 years beginning July 1974 $118,571 to expand the
dietetic internship program to improve the learning experiences
and to make more experiences available to interns, in coordination
with the Nashville VA Hospital.


TEXAS


El Paso Community College 3 years beginning July 1974 $393,094
to assist the College in renovating a building to house the allied health programs as well as provide funding for equipment and staff.
VA outpatient Clinic at El Paso is the affiliate.

Southwest Texas State U. 4 years beginning July 1975 $370,000
to support a comprehensive program of basic and continuing education
and career development for health care personnel, in affiliation
with Temple, Waco, and Marlin VA Hospitals.

Texas Woman's U. 5 years beginning July 1974 $210.026 to
develop and improve the clinical occupational therapy education
program at Dallas VA Hospital, with new programs established
in the Hemodialysis and Cardiac Care Units and t1he Day Treatment
Center.


82.







83



Texas Woman's U., Denton 5 years beginning July 1977 $314,991
to initiate a continuing education program In specific areas of
clinical nursing, In affiliation with the Houston VA Hospital.

Texas Woman's U., Denton 3 years beginning July 1977 $116,882
to improve dietetic training at the graduate level and to support continuing education, in affiliation with the Houston VA Hospital.

U. of Houston 5 years beginning July 1977 $221,776 to expand an
existing clinical pharmacy program through which undergraduate
pharmacy students receive significant portions of their professional
education at the Houston VA Hospital.

U. of Texas Health Sciences Center at Dallas 7 years beginning
July 1974 $979,729 to expand educational capabilities in four
allied health components (physical therapy, nutrition and dietetics,
physician's assistant and allied health education). Affiliation
ties are strengthened with VA Hospital in Dallas. Associated with
this award is an additional sum to provide classroom space at the
VA Hospital.


UTAH


Rocky Mountain*Gerontology Center (U. of Utah) 2 years beginning
July 1975 $79,021 to assist a consortium of five institutions
of higher education, offering an interdisciplinary, healthoriented training program in providing services to the elderly,
in affiliation with Salt Lake City VA Hospital.

U. of Utah 3 years beginning July 1974 $95,683 to expand an
existing program to include rural aspects of social work, in
affiliation with Salt Lake City VA Hospital. Students are assigned to VA facilities at Cheyenne, Fort Lyon, Miles City, Grand Junction,
'Fort Harrison, Sheridan, and Denver.

U. of Utah 4 years beginning July 1974 $189,550 to expand student
enrollment and improve an existing medical technology program in
affiliation with Salt Lake City VA Hospital. Additional monies
are directed toward expansion of laboratory facilities at the VA
Hospital.

Utah State U. 4 years beginning July 1974 $100,800 to strengthen
and improve the training of B.A. and B.S. students in social work,
and to work closely with the VA Hospital in Salt Lake City to
provide social services for veterans and their families in rural
areas of the western Mountain States.


33.






84



Utah State U. 5 years beginning July 1974 $98,892 to establish a coordinated undergraduate degree program in dietetics, in
affiliation with the Salt Lake City VA Hospital. Additional funds
permit the remodeling of VA facilities for use as classroom
and office space.

Weber State College 4 years beginning January 1975 $485,435 to develop and implement a new four-year dental hygiene program, in
close association with Salt Lake City VA Hospital.

Weber State College 7 years beginning July 1977 $203,636 to expand and refine the current education and training opportunities
in social work through expansion of the operations of the VA Hospital Field Services Center in Ogden, in affiliation with
the Salt Lake City VA Hospital-.


VIRGINTA


Hampton Institute 7 years beginning July 1974 $1,612,568 to support a multi-faceted program involving the Departments of
Nursing and Communicative Disorders to improve and expand
educational opportunities for graduate and undergraduate students,
with clinical experience at the Hampton VA Center.

Medical College of Virginia, Virginia Commonwealth U. 5 years beginning
July 1974 $687,300 to assist in the coordination, expansion,
and improvement of five allied health projects (physical therapy, occupational therapy, patient counseling, medical technology, and
nurse anesthesia) and an allied health coordinating component.
Affiliation is with the Richmond VA Hospital. In connection with
this award, resources are available for renovation of space at
the Richmond VA Hospital.

Medical College of Virginia, Virginia Commonwealth TJ. 7 years beginning
July 1977 $248,818 to implement a four-year course of study
in medical records administration, in affiliation with the Richmond
VA Hospital. Additional funds are reserved for space renovation
and equipment at the VA Hospital.

Virginia Polytechnic Institute and State U. 7 years beginning July 1977
$123,692 to develop a coordinated undergraduate educational
program in dietetics, in affiliation with the Salem VA Hospital.
Associated with this grant are funds for remodeling of space at
the Salem VA Hospital.


84.











WASHINGTON 85


Bellevue Community College 7 years beginning July 1974 $140,000
to improve the biomedical photography program with laboratory
learning situations provided by the college, a community hospital, and
the Seattle VA Hospital affiliate.

Seattle U. 2 years beginning July 1974 $73,453 to redirect the
health information services program curriculum to include data
processing, with Seattle VA Hospital providing hospital-based
experience.

U. of Washington 7 years beginning July 1974 $181,250 to develop
a regionally-coordinated undergraduate program in clinical dietetics,
with students in training at Seattle VA Hospital.

U. of Washington 7 years beginning January 1975 $165,946 to
strengthen and expand a program leading to a Master of Science in
occupational therapy, in affiliation with Seattle VA Hospital.


WEST VIRGINIA


West Virginia U. 7 years beginning July 1974 $333,316 to assist
the School of'Social Work in the establishment of new on-campus
courses in health care, and off-campus continuing education courses
at VA hospitals in Medical Districts 6, 8, and 14. The major VA
Hospital affiliation is Clarksburg.


WISCONSIN


U. of Wisconsin Medical Center 7 years beginning July 1975 $1,133,733
to develop an interdisciplinary education sequence in geriatrics for professional and technical health manpower. The Madison VA
Hospital is the major clinical affiliating institution.

U. of Wisconsin, Milwaukee 5 years beginning October 1977 $125,000
to initiate an industrial training component in an established occupational.therapy education program, in affiliation with the
Wood VA Center.








8S.










87



November, 1977




VETERANS ADMINISTRATION MEDICAL SCHOOL
ASSISTANCE AND HEALTH MANPOWER TRAINING ACT OF 1972 (P.L. 92-541)


SUBCHAPTER III
HEALTH PROFESSIONS AND OCCUPATIONS CATEGORIES

(135 Grants with 196 Components)




Administrative Training 2
Anesthesiology/Life Support Systems 3
Audiology & Speech Pathology 9
Biomedical Communication & Learning Resources 4
Clinical Laboratory Sciences 17
Community Health Manpower Coordination 18
Continuing Education 7
Dental Assisting 5
Dental Hygiene 9
Dental Technology 3
Dietetics 21
E lectroencephalography 1
Medical Illustration 1
Medical Records 6
Mental Health Education 4
Nuclear Medicine 3
Nursing, Professional 25
Nursing, Technical 1
Occupational Therapy 9
Ophthalmic Technology 1
Optometry 1
Pharmacy 6
Physical Therapy 10
Physician Assisting 5
Podiatry I
Prosthetics 2
Radio logy 6
Rehabilitation Counseling 1
Rehabilitation Therapy 2
Respiratory Therapy 8
Social Work 5

Total Components 196





APPENDIX E

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