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An application of Stark's framework

Material Information

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

Subjects

Subjects / Keywords:
Allied health ( jstor )
College students ( jstor )
Colleges ( jstor )
Educational evaluation ( jstor )
Health professions ( jstor )
Professional certification ( jstor )
School accreditation ( jstor )
Schools ( jstor )
Science education ( jstor )
Universities ( jstor )
Paramedical education -- Curricula -- United States ( lcsh )
Science -- Study and teaching (Higher) -- Evaluation -- United States ( lcsh )
City of Gainesville ( local )

Notes

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

Record Information

Source Institution:
University of Florida
Holding Location:
University of Florida
Rights Management:
Copyright [name of dissertation author]. Permission granted to the University of Florida to digitize, archive and distribute this item for non-profit research and educational purposes. Any reuse of this item in excess of fair use or other copyright exemptions requires permission of the copyright holder.
Resource Identifier:
023350279 ( ALEPH )
AFG4288 ( NOTIS )
19087341 ( OCLC )

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I
















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


ZOLIKA


EVALUATE


HEATH


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

















COPYRIGHT


ZOLIKA


1988


HEATH


























you


can


trust


yourself


when


men


doubt


you,


make


allowance


their


doubting


too;


you

you


can

can


dream--and

think--and


not

not


make

make


dreams your m

thoughts your


aster;

aim;


Yours


the


Earth


everything


that


Rudyard


Kipling


dedicate


this


study


my parents


who


gave


life


Bell


who


helps


make


life


fun.
















ACKNOWLEDGMENTS


acknowledge


the members of the Alumnae Association


the Mount Sinai Hospital


School


of Nursing,


New York


City,


the


personnel


of the College of


Pharmacy


, University


Florida,


and the owner


and artist of


Satellite


Dance


Studio,


Jacksonville


for their


financial


assistance.


thank all


those who assisted


with


preliminary


critiques


necessary


for this


study


especially


. Gutekunst


Gudat.


Special


gratitude


is due


participants


this


professional


study.

staff c


Also


express my


)f the education,


appreciation


health


center,


and main research


libraries.


It was my privilege


to have been associated with many


outstanding people during my


studies


the University


Florida.


extend my


appreciation to


Kern Alexander


Dr. Margaret Morgan,


and Dr.


John


Wahl.


also


thank


Dr. Darrel


Mase


offering his


support and sharing


ideas.


thank my


committee members


, Dr.


Arthur Sandeen and


Albert Smith


III.


Special


thanks go to


Sandeen


open door policy


and trust shown toward me.


Lastly



















TABLE OF CONTENTS

Page


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

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

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

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

CHAPTERS


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


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


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


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

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

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

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












Page

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

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

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

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


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


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


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


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


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


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


. ... .. .206


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

APPENDICES

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

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

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

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

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

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

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









Page

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


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


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


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


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


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


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


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


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


BIBLIOGRPPHYC ..... .. . 274

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








LIST


OF TABLES


Table


Maximum


Number


of Years


of Program


Accreditation
Requirements.


and


Minimal


Program


Duration


Number


Accredited
Programs..


Percent


of Institutions


Baccalaureate


Health


with


Science


. ..63


Accreditation


Requirements


Prof


ess


ional


Credential


Accreditation
Credentials o

Accreditation


of Program


Directors.


Requirements


f Program


Academic


Directors


Requirements


erience


of Program


Director


S...


S. ... .69


Sciences


Named


Accreditation


Standards.


. ....... .92


Charact


eristics


AAHC


Memb


ers


which


sted


Allied


Health


as a Component


Identifi


cation


of Science


Relate


d Courses


SRC)


from


Catalog


Course


Desc


riptions


Percent


, and


Consensus
04A......


re:


Statements


01A,


Rank


of Importance


of Factors


in Establishing


Science


Related


Course


Faculty


Cred


ential


S .


. 160


Percent
Faculty


Consensus
Qualifica


re: Science


Relat


ed Course


tions


S. 164


Percent
Faculty
Sponsor


Consensus


and


re:


Organi
Faculty


Science
national


Relate


d Course


Structure:


. ...169


S. .. .. 65


Page


. ..66


. ....103


. .. 143


. ....157









Tabl


Round


Percent


Consensus


re:


Science


Related


Course


Faculty


Roles


Organi


national


Structure


: Sponsor


and


Faculty


(F) .


Round


Percent


Consensus


re: Science


Related


Course


Faculty


Couns


eling


.... ... 172


Percent


Consensus


re: Role


CAH


Dean


Evaluation


of non-CAH


Science


Related


Courses


.. 176


Percent


Consensus


re: CAH


Evaluation


non


-CAH


Faculty


Who


Teach


science


Related


Courses


. 178


Rank


of Locus


of Respons


ibility


Alli


Health


Curricula


. .180


Percent


Consensus


re: Curricula


Responsibility...


. ..181


Percent


Con


Science


sensus
Relat


re: CAH


ean


spons


ibility


ed Courses


. ...183


Percent


Respon
Organi


Consensus


sibility
national


for
Stru


re: CAH


Science
cture:


Faculty
Related
Sponsor


Courses


and


Faculty


(F). .


S. .185


Round


CAH


III:


Percent


Faculty


Consensus


Teaching


Science


re: Rol


Related


Courses
Sponsor


Organi


national


Faculty


Structure:


S. .186


(F) .


Votes


Round


re: Statements


01A,


and


Science


Related


Course


ulty


Qualifications


. 261


Votes


Round


Statements


14-22


Science


Related
Organiz
Faculty


Course
national
(F)...


Faculty


Structure


Roles


: Sponsor


and


.. .263


Votes
Course


in Round
Faculty


re:


Counse


Science


ling


Relat


..........265


Page


.. ........170


I











Table


Page


Votes
non-CA
Teach


Votes


Round


Science
i ....


Science


R


Round


re: CAH
Related


elated


Evaluation


Course


Faculty


Courses..


re: Curricula


Who


. .267


Responsibility


. .268


Votes


Round


re:


CAH


Dean


Responsibility


ence


Related


Courses


...... .269


Votes


Round


Science


Structure


re:


Related


: Spon


CAH


Faculty


Courses


sor


Respons
Organiz


ibility
national


Faculty


S. .270


I









LIST OF FIGURES


Ficrure


Page


A Framework


Describing


Professional


Preparation Programs...


Specific


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


Influences on Professional


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


Professional


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
















Abstract


of Dis


sertation


Pres


ented


Graduate


School


the


University


of Florida


Partial


Fulfillment


the Requirements


Degree


Doctor


AN APPLICATION


of Philos


OF STARK


;ophy


FRAMEWORK:


IDENTIFICATION


AND


VALIDATION


OF CRITERIA


TO EVALUATE


SCIENCE


COURSE


DELIVERY


SYSTEMS


Zolika


April


. Heath

1988


Chairman:


James


Wattenbarger


Major


Department


Educ


national


Leadership


The


purp


ose


this


study


was


to d


develop


criteria


which


can


used


to evaluate


the


science


course


delivery


stem


baccalaureate


allied


health


students


in academic


health


centers.


The


need


criteria


was


justifi


ed by


literature


review


content


analy


ses


of coll


catalogs


20 sets


spec


iali


zed accreditation


standards.


Stark


erdi


sciplinary


prof


ess


ional


education


framework


was


used


identify


science


courses


from


ected catalogs


structure


the


proposed


criteria


A modified


three


round


Delphi technique


was


then


used


obtain


(allied


expert


health


opinion


and


and


basic


consensus


science


from


21 partic


faculty and


adminis


ipants


itrators)







Consensus


was


defined


as 100%


or 80%


agreement


last


(third)


round.


science


delivered


courses


under


allied


a variety


health


organize


students


national


were


auspices


crit


eria


identified


validated


accommodate


these


basi


structures


are


applicable


across


sciplines,


professions,


colleges.


Parti


cipants


agreed


that


science


teachers


should


have


a university


appointment,


demonstrate


undergraduate


teaching


effectiveness


, and


have


a science


or relat


graduate


degree.


Tenure


,senior


rank,


and


a health


profe


ssions


credential


were


rejected


as needed


cred


entials


College


of alli


ed health


partic


ipants


' expectations


ence


goals


relate


, objectives


course


, and


faculty


teaching


included


methods


choosing


plus


course


research.


Academi


advi


sing


, curriculum


planning


acc


reditation


activity

college

expected


were


sponsor


expectations

d courses.


to recommend


goals


reserved


Allied


health


objectives


faculty

faculty


and


teaching

were


relay


accreditation


practice


requirements


, regard


ess


appointment


status


science


faculty


or college


sponsoring


course.


College


deans


were


expected


to attract


faculty


but


they


other


specific


faculty


courses.


were


Deans


expected


were


to identify


expected


teachers


to participate







Specific


recommendations


for a


college of


allied health


to use


were


in adapting,


provided.


adopting,


Also other organizations


implementing the criteria


for which


criteria


could be


used were


listed as


nonhealth


center


allied health


units,


other health


center


colleges,


accreditation agencies.


Suggestions


further research


were


provided.













CHAPTER I

INTRODUCTION


An academic


health center


(AHC)


is an institution


that


includes a school of

least one additional


medicine,


a teaching hospital,


health educational


program


and at


There are


approximately


AHCs


the United States,


of which


were members of


the Association of Academic Health


Centers


(AAHC)


(Association of Academic


Health


Centers


1985;


1986) .


these,


60 were


reported


as having


colleges


of allied health


(Association of Academic


Health


Centers


[AAHC],


1985,


1986).


A comprehensive


study


the organization and


governance of


87 member


institutions


(as of


1977)


was


initiated by the AAHC


1977.


The


report of this study was


published


1980


and consisted of


an extensive review


the


literature,


several


position papers,


the presentation of


descriptive


information,


priority


issues


as described by


AHC administrators.


Among the


16 major topics


addressed


were departmental


structure/administration and


interschool


relationships.


Conclusions


regarding these


issues were


part


that


"inadequate


interschool


coordination and


cooperation often result


in significant administrative







location of


the basic science departments and


the quality


the teaching program for students


in fields other than


medicine continue


several health schools"


to present problems


(AAHC


for those AHCs with


, 1980a,


Several


studies


indicate that the delivery


system


basic and


applied


science courses


health


professions


students constitutes a major challenge


(Association of


Schools of


Allied Health Professions,


1973;


Clarke,


1983;


Krieger


, 1977;


Lewis,


1981;


Sirota,


1981)


Science


core


curricula


accreditation


for allied health


students have been plagued by


impediments and criticized


insufficient


depth and


irrelevance


(Association of


Schools of


Allied


Health Professions,


without a


1973) .


pathophysiology


Some nursing


curricula have been


course because qualified


faculty


could not be


found


or other department


faculties


were


unable


or unwilling to teach


the content


(Lewis,


1981) .


A survey


regarding


biochemistry


courses


for all


dietetics


programs


the United States


revealed


courses


taught


different


departments,


little


communication between biochemistry


dietetics departments


, and marked variation


in course


duration and


content


Sirota,


1981) .


When Krieger


(1977)


collected data


from allied health


faculty


in Florida


community


colleges,


many respondents


indicated a


need


update their


knowledge of the science


topics on


the


questionnaire.


In a study


of medical


technology program


* a S


1





1*


* ( ~ J







Concerning the administrative


science departments


location of


, in the AAHC governance stu


the basic

dy (1980b)


was


found that they were


located


in colleges of medicine


(n=42),


in each


the health


centers'


schools


(n=23) ,


in a


health


center-wide arrangement


(n=13


, or


in a


university-


wide system


(n=8) .


Although


the researchers did not address


basic science


faculty


qualifications,


they


did allude


them and recognize


the organizational


variety by


recommendation


When


the basic


sciences are centralized,


the deans of


all health schools with ba
content should participate


sic science curriculum
in the development of


the budget


these departments and


in the


appointment and
faculty members.


promotion of key basic science


(AAHC,


1980a,


Superimposed


upon


this


basic


science organizational


variety


the complexity


Typically they


offer several


the colleges of


programs


allied health.


with distinct


curricula and unique accreditation standards


imposed by


different accrediting bodies.


Structurally


, the colleges


may


be autonomous entities


or subdivisions


of larger units


such as a


college of medicine.


In a survey


organizational


structure of


colleges


of allied health


respondents attributed many


course duplication,


of their problems,


conflicts with


such as


other departments,


inadequate


laboratory


facilities to organizational


structure


(Kleinfelter


, 1976).


Perhaps


in their quest


for professionalism or







allied health


professions claim that their practice


is or


should be dependent on supporting biophysical


sciences


(Covey


& Burke,


1987;


Hinkle,


1986) .


Yet,


as noted,


investigators have


found


that science courses


for health


professions students are beset by problems.

curricular needs of allied health programs


is complicated by the structural


The diverse

for the sciences


complexity and diversity


the colleges and


the basic science


departments.


The


literature has


failed


to reveal


any


common


criteria


upon which a


college of


allied health


(CAH)


faculty


could


evaluate


the delivery


system


biophysical


science curricular components


for students


in all


programs.


Yet


there


is widespread support


for meritorious criteria


be set by


experts


for the assessment of


goals


(Fincher,


1978;


Koontz,


1971;


Nevo,


1983;


Roueche


, 1976)


In a


review


of the evaluation


literature Nevo


(1983)


wrote


"to choose


the criteria


to be


used to


judge


the merit of


an evaluation


object


one of


the most difficult tasks


educational


evaluation"


theorists


121) .


ignore


He noted


the entire


that many


issue of


evaluation


the worth


criteria by


goal


concentrating


achievement or by


on data


collection


disregarding the


to demonstrate


judgmental


nature


evaluation.


Stark


, Lowther


, Hagerty


, and Orczyk


(1986)


have


proposed a


framework


for the study


of professional


degree


1 1







influenced


internal,


intraorganizational


, and


external


forces"


. 236)


These


forces,


they


claim,


interact


create


profe


ssional


preparation


environment


which


influences


educational


processes


which


result


prof


ess


ional


preparation


outcomes.


The


outcomes


consi


st of


categories


, prof


ess


ional


competencies


and


prof


ess


ional


attitudes.

conceptual


Several el

competence,


.ements


concern


the

the


former


goals


category,


namely


the biophys


ical


sciences


in allied


health


curricula


Thousands


have


partic


ipated


the


deve


lopment


this


framework.


From


through


authors


plus


contributors


have


been


identified


on publications


relative


eve


lopment


framework


(Stark


Lowther


For


simpli


city


throughout


this


research


report


the


framework


will


referred


"Stark


No discredit


intended


other


researchers


Problem


Statement


The


purpose


this


study


was


identify


and


validate


criteria


evaluate


using


the


Stark


delivery


s framework,


system


that


can


science


used


related


courses


baccalaureate


centers.


allied


Criteria


health


were


students


identified


academic


validated


health


answer


the


following


questions:


What


professional


academic


qualifications


, n.d







In what roles


should science related


course


faculty


engage?


3. What

dean and

related


control


should the college of


faculty have


course


in the evaluation


faculty who do not have


allied health

of science


primary


appointments


the college?


What control


should


the allied health


faculty


dean have


upon


the delivery


and content of


science


related


courses?


Operational


Definitions


Academic health


center


(AHC)


is defined


as an


institution


that


includes a school


of medicine,


a teaching


hospital,


least


one additional health


educational


program.


A synonymous


older term is academic medical


center.


Adaptive competence


is the ability to anticipate


adapt


to changes


(e.g.,


technological


changes)


important


the


profession


(Stark


et al.,


1986).


Allied health


an umbrella


term with many


definitions.


this


study


refers


to those


occupations


which are health related and have educational


programs


colleges of


allied health,


such as medical


technology,


physician assistant,


and respiratory therapy.


This excludes


most of


the older


, independent,


or more established


* a a &


*







auspices of


colleges


of allied health.


Examples


are


dentistry


, medicine,


nursing,


and pharmacy.


Allied health


faculty are


instructors with a health


science credential


and a primary appointment


in a


college


allied health,


who teach baccalaureate


level


allied health


students


in the classroom.


Allied health professional


is one


prepared in an allied


health occupation at


the baccalaureate or higher


level.


Basic science


faculty


are


instructors who teach


one or


more


science


related


course to


baccalaureate


level


allied


health students.


They usually


have a


graduate degree


in a


biophysical


science,


do not hold a health


professional


credential,


and may


or may not have a


college of


allied


health appointment.


Clinical


practice


refers to professional/technical


work


the service site by


faculty


or students when a


client/patient


is directly


or indirectly the


recipient


care.


College of


allied health


(CAH)


is an academic unit


university

allied heal


or academic


health


educational


center with more


program,


faculty,


than one

and


administrative


personnel.


Such units are


sometimes called


school


or division.


The


term college will


be used


to refer


to all


colleges,


schools,


or divisions of


allied health


AHCs.







Conceptual


competence


understanding


theoretical


foundations


profession


(Stark


et al


1986).


Contextual


competence


is the


understanding


societal


context


(environment)


which


the


prof


session


practiced


(Stark


et al. ,


1986)


Criteria


are


written


statements


on which


a judgment


deci


sion


may


be based.


In this


study


, criteria


are


stinguished


from


standards


guidelines


that


latter


are


specifically


purposes


of accreditation.


Delivery


svs


relative


science


related


courses


refers


those


elements


such


faculty,


nonhuman


resources


, locus


of control


organizational


structure


which


are


antecedent


the


presentation


courses


Department


chairper


son


the


academic


leader


who


represents


particular


the faculty


program


may


one


or seven


programs.


responsibility


of a department


chairperson


or a program


director.


The


older


term


chairman


, may


be retained


to report


those


studi


which


that


term


was


used.


Guidelines


are


written


narrative


which


serve


to extend


explain,


and


clarify


accreditation


standards


They


are


absolute


Health


professional


a global


term


used


to describe


profess


ional


personnel


involved


patient


care


(direct







facilities,


in public


health,


or environmental


health


activity


es.


includes


allied


health


profes


sional


Intecirative


competence


the


ability


to integrate


theory


practice


(Stark


et al


, 1986)


Interpersonal


communications


the


ability


use


written


or oral


communication


effectively


(Stark


et al


1986)


Prof


essi


onal


courses


are


ose


theoretical


and


practical


required


subjects


which


result


student


being


to demonstrate


prescribed


competencies


i.e.,


practice


the profession.


This


includes


prof


essi


onal


phase


required


courses


except


those


identified


as science


related.


Program


is a curricular


system


designed


to educate


persons


Procra


function

m director


in a particular

r is a person r


health


prof


ession.


responsible


teaching,


admini


station,


periodic


review


, continued


development,


general


effectiveness


a program.


Research


is an activity


that


treats


the


substance


one


s di


scipline/profession


in a creative


and


scholarly


manner


communicates


knowledge


gained


from


that


work


so that


available


the


scipline


or profession


whole.


Scholarly


concern


improvement


is the


degree


which


a graduate


recogni


zes


the


need


increase


knowledge







Science


related


courses


(SRC)


are basic or applied


biophysical


science subjects which health professions


students take during


enrollment


in the


professional


program.


The


published


indicate


catalog descriptions


that a major


expected outcome


for these courses


the development


conceptual


competence.


This excludes prerequisites,


clinical


practice,


social


sciences,


and professional


technical methods courses.


Service refers


to all


professional


faculty


activities


not defined


as teaching


or research.


These activities


may


include


committee work,


accreditation activities,


clinical


practice,


and service


to the


profession


or community.


Standards are written statements by which


educational


programs


are reviewed,


surveyed,


or evaluated


for purposes


of accreditation.


programs.


essentials or


They are generally


Some accrediting agencies


criteria.


binding


use


accredited


terms,


In this dissertation,


such


statements will


be called standards.


Teaching c


includes


preparation


, evaluation


, and


student


contact hours associated with a


given course,


module,


or lesson.


Technical


competence


is the ability to perform tasks


required of


profession


(Stark et al.,


1986).


Delimitations and Limitations







that were members


of the AAHC


(AAHC,


1985,


1986).


The


program population of


interest


included all


baccalaureate


programs


in AHCs


administered by the college of


allied


health


except nursing,


pharmacy,


or social


work


(Occasionally these are organized within


colleges.).


the same


Allied health programs within the university


but outside of a

hygiene programs


CAH were excluded.


in CAHs were


included,


example,


those


dental


in dental


colleges were not.


The


panelists who


participated


in the development of


the criteria


consisted


three subgroups,


CAH


deans,


basic


science


faculty,


and allied health


faculty.


Students and


individuals


who taught exclusively


the clinical


area


were


included.


The strength


of the criteria


formulated were


a reflection


the appropriateness of


framework


developed by Stark et al.,


the


literature


review,


expertise of the


panel


experts.


One


limitation results


from developing


criteria


general


enough


to apply to any


biophysical


science course


baccalaureate allied health


program.


Other studies are


usually

programs


limited

. While


to one science or a


few allied health


this might simplify the situation


it would


defeat the


purpose of


this study


It was not


the


intent


compare among


sciences or programs.


issue was the


development of


criteria


that any professional


could


use







baccalaureate allied health students


in colleges of


allied


health


in academic health


centers.


The operational


definition of


a science


related


course


is both asset and liability.


The term


is unique.


grouping

bridge,


of what may be


clinical,


labeled basic,


or professional


applied,


sciences


fundamental,


under one


category may


appear artificial


(Thier,


1987) .


This may


represent an


unfamiliar way


of viewing the allied health


curricula.


This may be


perceived as an


impingement


professional


course


"turf"


or the attenuation


science


The courses may


be difficult


to identify


in programs


that


use


an integrated


curriculum,


that


basic


science


professional


content


combined


in one course.


The validity


the aggregation of


these courses


function


the methods


used


to identify them and


the


assumptions on which


these methods


rest.


In brief


, a group


of experts determined


that


the course descriptions


met a


criterion


the Stark et al.


framework.


This assumes


that


framework and


framework will


expert


opinion have validity.


be discussed in Chapter


The


use


in the


identification of


science


related


courses will


be explained


Chapter


III.


Critics may


claim that


there were already


several


sets


of criteria


for the evaluation of


allied health programs,


i.e.,


accreditation standards.


This was correct.


The


- a -I







programs and each had


its own set of


standards


(American


Medical Association


[AMA],


1987).


In addition


this,


several


programs


found


colleges of


allied health


such


dietetics,


dental hygiene,


and physical


therapy were


accredited by


other


agencies.


Program accreditation


is most representative of


professional


practice concerns


(Hinkle,


1986)


Various sets


of standards are


intended


to address the biophysical


sciences vaguely


, narrowly,


indirectly


from


their


own


unique p

consider


perspectives.


is no wonder that deans


"accreditation standards


giant


of CAHs


stumbling


blockss"


(McTernan,


1972


168).


Furthermore,


questionable


faculty


of colleges of


allied health


in AHCs


should measure


their biophysical


science course delivery


success by


accreditation standards


(Schermerhorn,


1986).


Of 3,042


programs accredited by CAHEA only


672 were


year colleges,


universities,


or medical


schools


(AMA,


1986,


244).


Often the same standards are


used


to evaluate


programs

schools,


in hospitals,


blood banks,


community

government


colleges, proprietary

institutions, and AHCs.


Procedures


Study


Design


A review of


literature was undertaken regarding


academic health centers,


colleges of


allied health,







and goals claimed by


several AHCs and their universities


colleges


allied health were reviewed.


Using Stark's


framework as a


guide,


literature review was


focused


identify and define


further biophysical


science


curricula.


From the


upon which


literature


science


review statements were


related course delivery


formulated


systems


colleges of


allied health could be evaluated.


statements were critiqued by three experts;


These


one


allied


health dean and


courses


two


faculty who teach science


to health professions


students.


related


After all had


reviewed


the material,


each


expert was


interviewed


The


statements and supporting


information were


revised


prepared


for a


three


round modified


Delphi


study with


panel


experts.


The Delphi


technique


is recommended


for use


with


problems


that do


lend


themselves


precise


analytical


techniques.


is suggested as a method


of choice


when


communication among


diverse


peoples must be


facilitated but


time and


cost


preclude group meetings.


It was


a method


used


in the academic


health


center governance


study


cited


previously


(AAHC,


1980a,


The Delphi


will


be explained


Chapter


Selection of


III.


Colleges


The colleges


were


in centers


that were AAHC members







generic allied health programs.


Every


effort was made


include at


least


one center representative of


each of


four possible basic science department structures.


Ten


colleges,


which were


public,


private,


and geographically


dispersed around


the nation were then selected as


representative


leaders by two deans of


allied health and


investigator.


Eight deans of


10 colleges


nominated


indicated their willingness to participate.


Selection


Panel


The


purpose and method of


the study was briefly


explained by


letter to


10 deans.


They were


told the


purpose


the study,


why their college was chosen to participate,


and


their rol


A follow-up telephone call


was made


answer questions and


learn of


their willingness to


participate.


The


8 who agreed


to serve were


selected.


Program confirmation and


faculty nominees


were also


requested.


The


panel


consisted


of 21 experts;


deans


basic


science


faculty


, and


allied health


faculty


from among the colleges.


Broad disciplinary


input was encouraged by the


instructions


provided


the deans


for nominating


faculty


(see


Appendix B).


Identification of


faculty per CAH


insured


substitutes should some choose not


to participate.


It also


permitted


investigator to select


disciplinary and professional


for diverse


representation


from all







Role of the


Panel


After review by the preliminary


study


experts and after


revision of


the statements,


the statements as


well


supporting


information were distributed by mail


panel


members.


Panelists were asked to


indicate


their


agreement


or disagreement with


each statement and


contribute opinions


Inclusion,

by a prese


exclusion,


t score.


or revision of


This


procedure


any


item was determined


is discussed


in Chapter


III.


Panel members were asked


to reevaluate and


respond


same and additional


statements on a second


and


third


round.


criteria


From the


that may


literature and panel


be used


expert


opinion


to evaluate elements of


the


science related


course delivery


system were developed.


Significance of the Study


The


fact


that science related course delivery


allied health students


often a


challenge


indisputable


(Clarke,


1983;


Krieger


, 1977;


Sirota,


1981).


Furthermore


location of


an allied health program


health center--the citadel


need not ameliorate


location of


in an academic


for health sciences


the problems.


education--


"The organizational


the basic science departments and


the quality


teaching program


for students


in fields


other than


medicine continue


several health schools"


to present problems


(AAHC,


for those AHCs with


1980a,







sciences

of such


into the varied


courses.


curricula


In advocating


and


improve


laboratory


the delivery


and not


just


lecture of


the basic sciences


for medical


students,


Flexner


(1910)


stated


after a


strenuous


laboratory


discipline,


the


student will


still be


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


ignorant of many things


facts:
and wha


he will


but


have


to do with


them when he has


them.


In her treatise on nursing


education,


Goldmark


(1923)


noted:


"Common defects of


scientific


instruction


training


schools


studied are the


lack of


good


teachers,


neglect of


laboratory work,


insufficient allowance


of time"


257) .


Obviously


recent as well


as classical


studies of


the education of


students of


the health


professions


have


shown concern


for the quality


quantity


the biophysical


sciences be


they


labeled basic


science,


applied science,


or professional


courses.


Organization of the Study


Report


Chapter


justification


used


has provided background


information and


a study to develop criteria


that can be


to evaluate the science related course delivery


Chapter


a review of the related


system.


literature.


encompasses three general


areas:


Stark


s theoretical


framework upon which


this study was based,


literature


about academic health


centers,


colleges of


allied health,







analyses of


accreditation standards and college of


allied


health


catalogs.


Discussed


chapter


the methodology


employed


select


the


participants


identify the science


related


courses.


Also explained


is the


Delphi


technique


data


collection and analysis.


Chapter


an analysis of


the data


obtained while developing the criteria.


Lastly


Chapter V


is a


discussion


of the


resulting


criteria,


their


implications,


recommendations


further


research.
















CHAPTER II

REVIEW OF THE LITERATURE


The


purpose of


this chapter


is to provide an


overview


of academic

health, the


health


center


ir structure


sponsored


, faculty


colleges


curricu


of allied

la pertinent


science course delivery


systems.


is divided


into


following


sections:


an overview


of academic


health


centers;


allied health,


information and studies


faculty,


about


and administrators;


colleges


a review


Stark's


framework for professional


education;


analysis of


specialized


proposed


college-wide


accreditation standards;


a review


of college


allied


health


catalogs;


and


a review


of studies


relevant


delivery


science courses


for allied health


students.


Literature


pertinent


to the methodology


this


study will


be addressed


in Chapter


III.


Academic


Health


Centers


Academic health


centers


(AHC)


have evolved


from a


confluence of


several


entities within American society.


comprehensive review would


entail


a discussion


of higher


* S ft


I. *


n t t 4


I







health


care delivery


system.


The development


and synthesis


of these subjects was beyond


the scope of this


study.


an overview


mandatory


since


the colleges within


this


study were all AHC sponsored,


and this


has major


implications


for the science related


course delivery


system.


The genesis


of AHCs


occurred during the


latter


19th


century


(Ginzberg,


1985).


Prerequisite


this were


advances


immunology,


in the basic sciences;


and bacteriology


concomitant clinical


asepsis,


discoveries


roentgen


chemistry,


(Ludmerer,


such


(Friedson,


physiology,


1983)


as anesthesia,


1973).


physicians


of the


leading medical


schools


the day,


already university


affiliated,


began


to seek


closer


alliances with


the hospitals where


these


new technologies


could be


taught


(Ludmerer,


1983).


Medical


education


focused


the


undergraduate and


research


was


secondary


(Ginzberg


, 1985).


With


the opening


and Hospital


1893,


of Johns Hopkins


role of


University


research


1876


gained momentum


(Ludmerer,


1983).


1910,


the now


luminary


Flexner


report,


gave


impetus


for medical


school


faculties


pursue


closer


affiliations with both


universities


hospitals


(Ashley,


1976;


Ludmerer,


1983).


During the early


decades


century the


university-teaching hospital-medical


school


triad became


well


established


(Ashley


, 1976;


Ludmerer,


1







in hospitals


(Ashley,


1976;


Friedson,


1973).


Allied health


occupations which


trace


their


origins external


to hospitals


and


independent of


medicine,


such as occupational


therapy


moved


into the hospital


during this period


and became


(Savitt


Kopper


physician dominated

I, 1982).


After World War


these centers


for medical


care and


education began to undergo major changes


(Hogness


Akin,


1977) .


Factors


inducing


change were


perceived need


collegiate nursing


and allied health


educational


programs,


the medical


schools ambition


to expand


the clinical


teaching


sites


to veterans and


community hospitals,


universities


responsibility to coordinate


health related activities,


integrate


and policies


expanding


federal


government


(Ebert


Brown,


1983).


Petersdorf


Wilson


(198


identified


three


overlapping post-World War I

recognizable by governmental


I phases in

influences.


AHC development


The biomedical


research era


commenced


in the middle


1940s when government


leaders decided


to rely primarily


on academia


to conduct


biomedical


research.


Federal


financial


support began


contribute


immensely to


the expansion


of basic science


departments


(Ginzberg,


1985;


Petersdorf


Wilson,


1982).


This


facilitated specialization


provision of


in the clinical


intensive tertiary


care


departments


for referred


patients


teaching hospitals.







physicians


and medical


schools


(Petersdorf


Wilson,


1982).


These reports were catalysts


for passage of


Professions Education Assistance Act


1963


the Health

. This


legislation,


later amendments,


and manpower


acts which


followed


provided money


facilities and


training


more


health professionals.


This era


peaked


1971


(Ginzberg,


1985).


Petersdorf's


, public service era began


1960s.


By this


time AHC


faculty


had trained hundreds


of physi


clan


specialists who had


migration


or would


suburbs.


follow the middle


Given


class


their quality training,


became less


necessary


for these


physicians


to refer


clients.


For the AHCs,


this


translated


into smaller patient


pools


declining


hospital


admissions


, heretofore


sine quo


non


for the


"cash


cow,


" i.e.,


teaching


hospital


(Ginzberg


, 1985).


This manifestation


of success coupled


with more general


social


phenomena;


a decline


in city


services,


urban traffic


congestion


civil


rights


movements,


increased minority


indigent


populations;


facilitated


a demand


for more responsiveness


to the


local


community.


Now the AHC


leaders,


with


their world


view


, renowned


biomedical


research


programs,


graduate


graduate


medical


education emphases were being


forced


to compete with


community


hospitals


primary health


for paying patients


care needs of


and respond


their neighborhoods


(Rogers


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


n .. -. -.~L


I


n


__l _


-_ -


ILCI


r 1 ~n







referred


from outside the Baltimore area--indeed,


often


from


abroad"


(Rogers


& Blendon,


946).


Thirty years


later this


situation had been reversed,


"80 percent of


the patients


admitted came


from a


16-km.


radius of


Baltimore"


946)


Rather than diagnose,


treat,


and


cure


cases


typhoid


fever


, tuberculosis,


poliomyelitis,


the health


professionals and


their teaching hospitals now


care


victims of

syndrome (


trauma,


AIDS).


cirrhosis,


and acquired


The nonbiological


etiology


immunodeficiency


of many


today diseases


the domain of


lie outside of


traditional


the germ


medicine


theory


(Rogers


of disease


Blendon,


1978) .


In addition


to problems posed by present day


epidemiology,


the AHC


is also challenged by


"problems


organization and


governance"


(AAHC,


1980a,


vii)


There


is no list of


common characteristics of


AHCs


therefore no absolute agreement on how many


exist


(Ginzberg,


1985).


But experts concur on


the dominant


role of


college of


medicine


(Morris,


1980;


Petersdorf


Wilson


1982


and on the crucial


relationship of


academic medicine


with


the


teaching hospital


(Ebert


Brown,


1983).


Their


overall missions;


research,


service,


teaching are


technically


congruent with


universities of which most


are a part.

However the AHCs and in particular their medical


colleges service commitments


far surpass


intensity


1







public


school


system,


or the stock exchange.


colleges


of medicine dominate


teaching


hospitals


(Rogers


Blendon,


1978).


This


business


enterprise necessitates


considerable int

have millions of


erface with

dollars in


the community.


vested


The centers


their physical


plants


and may


employ thousands of modestly skilled


workers


(Wilson


& McLaughlin,


1984).


Health center


scientists,


physicians,

with zoning


and scholars


boards


turned administrator may


, insurance agencies,


working


union negotiators,


city planners


Internally


(Rogers


AHC governance


Blendon,


"tends


1978).


to be decentralized,


ad hoc,


and vested


in small


committees"


(Rogers


Blendon,


1978,


944) .


The decision-making process


is slow


cumbersome

to engage


(Ginzberg,

in teaching


1985). Ideally

, research, and


leaders

patient


are

care


expected

as well


administer the departments


center-wide


affairs


(Weisbord,


Lawrence,


Charns


, 1978).


To compound


the


difficulties


of governance on all


levels,


"the


autonomous


medical


science culture


tends


to value


technical


above


interpersonal


and group skill


s" (Weisbord


et al.,


1978,


303)


recent


past AHC


faculty


administrators


enjoyed


the National


Institutes


of Health grant monies.


They


still


but


these


funds are now abating


(Ebert


Brown,


1983)


diminishing


in real


dollars


(Ginzberg,







Medicaid


could


pay


medical


services


deemed


necessary


any


phys


ician.


now


been


capped


with


a prospective


payment


Renn


system


, & Bil


, whi


ch became


, 1986).


effective


intent


was


1984


in-hospital


Schramm


cos


containment.


reductions


Some

fewer


affects


diagnostic


tests


have

, and


been


staff


shorter


lengths


stay


Relatively


more


health


care


is being


delivered


side


the


traditional


voluntary


teaching


hospital


the


AHCs,


these


changes


have


increase


d competition


among


health


care


agencies


providers.


1950


American


phy


sician


professor


become


resp


ected


as hi


19th


century


German


counterpart


(Ludmerer,


1985)


The


intimate


medical


school-teaching


hospital


alliance


had


een


fought


and


won.


Medical


means


were


called


to Washington


advi


(Rogers


Blendon,


1978


changing


Phys


icians


are


now


called


Was


hington


told


they


are


unresponsive


society


meeting


Blendon


needs


, 1978)


(Evangelauf


Coordination


1986


among


, 1987;


hospital (


ers


and


the


center


coll


eges


is more


complex.


Nursing


and


alli


health


, large


subordinate


to medicine


, and


pharmacy,


denti


stry,


primarily


isolated


from


medi


cine


are


demanding


greater


part


AHC


affairs


(Henderson,


1980;


Morris


1980)


The


watchwords


now


are


improved


interpersonal







1977)


, government


(Rogers


Blendon


, 1978),


faculties


(Christensen,


1978)


The solutions demand


effective


leaders


(Petersdorf


Wilson,


1982)


who are possibly


selected by a

(Christensen,


set of


1978


criteria different


They


from the


should be capable


past


of strategic,


proactive


planning


and not


just


respond


to each


(Ebert


Brown,


1983;


Wilson


& McLaughlin,


1984)


Today's


AHC


leaders may


disagree over the


role of


specific


occupational


groups


in health


center governance but many


are advocates


sciences and humane


an improved application


arts.


social


One administrator with


responsibility


for encouraging this


vice


president


health affairs.


Today most AHCs


have such an officer


(AAHC


, 1980b)


This


style


person's presence


have a


(or absence),


direct bearing


responsibility


on colleges of


, and


allied health.


The authority


roles of the


vice


presidents


are


diverse


as the AHCs


they


orchestrate


(Pellegrino,


1975).


Petersdorf


and Wilson


(1982)


describe


three


typolog


ies.


one,


the dean


of medicine


serves


vice


president,


another,


capacity


vice


Lastly


president


, the vice


serves


president


president may


be a


a staff


line officer


with


all AHC deans


administratively reporting to


him or her.


Christensen


(1972,


1978),


a dentist,


believed


that a


line


vice president


fosters professional


interaction


and believed


1. .


+ 1 I --


1 1.


I







vice presidents who served between 1960


1976,


20 or


were not


physicians


(Wilson


& McLaughlin,


1984).


The stance of


president position

advocated a strong


academic physicians


mixed.


line vice


toward


physician,


president,


vice


Hogness


in part


improve


coordination of the curriculums of


the various health


science schools


(Hogness


& Akin,


1977)


In a


discussion of


leadership and medicine,


Wilson and McLaughlin


(1984),


described a


population


of "322


individuals who served


dean of


a medical


school


. and 98


individuals who served


only [em

school d

dean and


phasis added]


means


as vice president"


also are not enamored


the hospital


director being


42) .


"Medical


f the concept of the

directly accountable


the vice president"


And


(Petersdorf


&


"vice presidents are probably


Wilson,

here tc


1982,


stay


p. 1

but"


157).


(Petersdorf


Wilson


, 1982,


1161)


they


"must not


'run'


the medical


school"


(Pellegrino


, 1975,


227)


One area


agreement


is that


the authority


and responsibility


vice president should be consciously decided


and made known


to all


concerned


(Pellegrino,


1975).


The perceived


threat


to college of medicine autonomy


control


which


the vice presidency poses


for some


(Hogness


& Akin,


1977)


is accompanied


literature by


references


to college of medicine dominance within


the AHC


(Morris,


1980,


156;


Wilson


& McLaughlin,


1984,


63).







much


influence on the academic health


center"


(Ebert


Brown,


1984,


1201).


"Leadership positions


in academic


health centers must be defined according to


professional


dimensions


. medicine and


. management"


(Lostetter,


1981,


college of medicine,


"more


than any


other


component


influences


the character of the center because


encompasses


the maior biomedical


science base"


[emphasis


added]


(Petersdorf


Wilson,


1982


, p.


1153) .


Where does


this


situation


find


colleges of


allied health


their


science


related


course delivery


system?


Colleges of


Allied Health


Emergence of


the Allied Health


Professions


The curriculum of


colonial


Harvard was


based


classical


trivium and


quadrivium


Levine,


1978)


During


the

as a


first


field


centuries


of study


of American higher


gradually


education


gained acceptance.


science


This


occurred with


establishment


provided f

1978). Th

comparable


changes


new


in the existing


curricula


institutions and new


or modern as well


e basic


as classical


sciences did not always


to classical


considered lacking


subjects because


in academic rigor


and by


curricula

courses (R

carry cre


that


udolph,

dit


former were


Levine,


1978


secondary


status


basic sciences all


ended


late


1800s with


the


leadership of Harvard's


President Eliot







Beyond academia,


agrarian America


needed


citizens with


practical


skills and


this


intensified with


the


rise of


industrialization in


19th century.


The sons of


traders,


farmers,


and


craftsmen needed to


know more


to perform more


complex tasks.


Gradually some of the colleges and


universities


began


to apply


knowledge


from the basic


sciences


to practical


problems.


Thus,


in a


delayed but


parallel


trend with


the basic sciences,


the applied sciences


slowly


became


part


of American higher


education


Levine,


1978).


The


19th


century


saw the development


"middling"


classes


(Bledstein,


1976).


Aspirations of


the common


citizens were


gain,


for an


social


improved


prestige


station


Levine,


life


1986) .


material


The


application of


science by the


universities coupled with


this


quest


for upward mobility permitted


the vocational-


technical-practical


occupations


to gain


access


into


higher


education.


Schools,


colleges,


and programs of


engineering,


agriculture,


business,


education were


instituted


flourished.


Their graduates


then


as now,


learned a


trade,


received professional


status,


and


entered


the middle class


Levine,


1986;


Friedrich,


1982)


Medicine,

participated i


dentistry


, pharmacy,


.n this movement


and nursing have


from apprenticeship


into


higher


education


(Brown,


1983;


Grace,


1983;


Mrtek,


1976)







essentially a


20th century


often post-World War


phenomenon


(Ford,


1983).


Several


situations and


events


have


influenced


the development of the specific allied health


occupations and


arose


each has


its own history.


to satisfy a need created by the


they


larger society


, or


some combination


thereof.


McTernan


(1972)


summarized a


typical


cycle


formation of


an allied health


profession.


First


there


need at


the work


site,


so an available and


intelligent


person


on-the-job


informally trained.


in several


Next,


institutions.


individuals are


These


trained


people develop


common interests


form an


organization.


Later they


seek


occupational


identity


finally professional


status.


acquire


Slowly the


this they


advocate higher


training programs


shift


educational


from the


standards.


job sites


educational


institutions.


Common


to most allied health


occupations was


the early


participation of


members of more established professions,


namely medicine


for medical


radiologic technology


(Soule


technology

, 1974), a


(French,


1974)


nd physician


assistant


(Howard


Lewis,


1974)


nursing


occupational


therapy


(Johnson,


1974)


, respiratory therapy


(Collier


Youtsey,


1979),


and


physical


therapy


(Scully,


1977);


dentistry


for dental hygiene


(Hein,


1974).


the allied health


occupations were also


fostered by


librarians


[medical


record


S S U 4 I S S





* 1


I*


*


'I I


-I


1 L ~ n







workers

Kopperl,


[occupational


1982),


therapy]


and physical


(Johnson,


education


1974;


teachers


Savitt


[physical


therapy]


(Scully,


1977)


Today


students of


allied health


occupations are


trained


in a


variety


of settings


(AMA,


1986)


In 1986


the Committee


on Allied Health Education and Accreditation


(CAHEA)


American Medical Association accredited


3,042


programs


fields


(AMA,


1986).


CAHEA


classified sponsors


in five


typologies:


hospitals,


clinics,


and blood banks;


community


colleges and vocational


schools;


senior


colleges,

schools,


university

consortia,


and medical


and secondary


schools;


schools;


proprietary


and


government


institutions.


Between


1981


and


1985


CAHEA


accredited


programs


increased by 37.


Two hundred and


forty-


four


hospital


programs closed


or discontinued accreditation


additional


programs


were accredited among


community


colleges


(AMA,


1986b) .


Thus


recent


shift has


been


from


hospitals


to community


colleges and not


senior


institutions,


including AHCs.


The


largest segment of


allied health


students


are trained


in community


colleges


(Ford,


1983).


Only


graduate


from programs


in AHCs


(Ebert


Brown,


1983).


Descriptive Studies of the Colleges


Descriptive


information about health professions


faculty


their colleges have been available


for years







allied health many


Commission


have deplored


on Allied Health Education


lack of


[NCAHE],


data


(National


1980;


Year-


end Highlight


, 1986-1987).


Given


the confusion


over the


definition of


allied health


(AMA,


1985a;


Anderson,


1981;


Foegelle,


1984;


Ford


, 1983;


Jacobsen,


1977;


NCAHE


, 1980)


this


is perhaps


unavoidable.


To correct


this void


a major


objective of


the American Society


of Allied Health


Professions


strategic plan


an allied health


data base


for the


1990s


("Deans'


the development


winter


conference,


1987


-1988).


Relative


to educational


institutions


, this


investigator


found


two major sources of


descriptive data,


allied health demographic and


dissertations and


professional/


accreditation association documents.


Because of


subtle


salient differences


in the data


collection and analyses


among the associations


, data


comparisons


are


often


inappropriate.


Furthermore,


the associations


vary


in their


willingness


to share data


with nonmembers.


Rosenfeld


(1972)


was among the


first


to describe


educational


settings of


allied health programs.


Regardless


sponsor


, he described three organizational


on administrative and budgetary


control.


patterns


Kleinfelter


based


(1976


named


these structures,


coordinated.


The


independent,


dependent,


independent structure has


"all


and

the


prerogatives afforded the other schools and


faculties"







of medicine


(Rosenfeld


or biology


, 1972


. 19)


department


The


the


coordinated


university"


structure


amalgam


staff]


several


. admini


Kleinfelter


other


strative


(1976)


schools


officer"


queried


or departments


(Rosenfeld,


chief


admini


under


1972


strators


118


American


Society


of Allied


Health


Professions


member


institutions


to determine


characteristics


the


allied


health


units


and


compare


findings


based


upon


organizational


structure.


stitutions


Ninety


and


-two


from


.9%)


2-year


participated,


institutions


from


The


-year


names


titi


the


allied


health


units


and


chief


admini


strative


officers


varied.


The


number


programs


each


unit


ranged


from


less


than


more


than


, with


a plurality


of 6


through


Seventy


(76.1%


the


respondents


listed


problems


which


they


attributed


in part


organize


national


structure.


These


included


lack


of autonomy


, inadequate


budget


insufficient


space,


sence


of a distinct


faculty,


course


duplication,


conflicts


with


other


departments


Kleinfelder


summarized


characteristics


units


based


upon


their


structure


recommended


formal


administrative


structure


, an adequate


financial


base


, and


coordination


to prevent


duplication


conflicts.


conclusion


was


that


more


control


the


allied


health


unit







as much


as possible


for didactic


instruction"


116) .


This


seems contradictory with his other recommendation


allied health schools


"should strive


that


for as much autonomy


possible


in all


administrative and academic areas"


. 116).


Wise


(1979)


studied


the organizational


structure,


conceptualized by


Hage,


of schools of


allied health located


in AHCs.


She developed


three sets of


questions,


which


were


sent


to 83


vice


presidents,


CAH deans,


and 200 department


chairs.


departments


, 37%


awarded more


than


one


degree,


awarded


a baccalaureate,


and none


reported


doctoral


programs.


Several


(20.3%)


offered more


than


one


level


of a particular major.


Dual


enrollment


of students


from other


institutions occurred


17.9%


of the


departments.


Some


programs were offered


the AHCs


but


external


university but


e CAHs and oth

were external


ers were sponsored by the


the AHC.


"The deans


reported


of the


faculty


. possess


bachelor's


degree as


the highest degree"


85) .


This did


include clinical


faculty.


Faculty with academic or


professional


doctoral


degrees constituted a mean


of 32.4%


Among the department heads


held master's degrees


held doctorates,


nearly


were


licensed/certified


in a


health profession.


Eighty-two percent of the deans held


doctorates,


typically


outside of


the allied health


fields


they were administering.


Most


(71.4%)


did not have a health


.a -







Appraisal


of the decision-making responsibilities of


the department heads was assessed primarily


student and


clinical


issues.


Over half


(51.9


reported


they


did not


make decisions concerning student clinical


progress


more


than one-fourth


.9%)


the departments


students


were


responsible


locating


clinical


facilities


for the


required practicums.


About one-fourth of


the chairpersons


reported


that


clinical


faculty participated


in some


[college]


departmental


affairs.


Reasons


purported


for these


findings were


facilities,


relative autonomy


the clinical


program accreditation held by the


clinical


facilities,


clinical


of programs


no reimbursement


facilities,


into


from the


universities


relatively rapid and recent


the university setting,


shift


and abdication


student clinical

Nearly 20%


education by the


the allied heal


universities.

th department heads did


not report administratively to the dean,


but


reported


other department heads,


medical


directors,


or vice


presidents.


Some


(17.8


did not


represent


their


own allied


health


field


in administrative affairs.


A medical


director


or other appointee may assume this


role.


Reasons


posited by


Wise were the current


or recent hospital


identification


the programs and


fact


that hospital


employees are


typically not


participants


in administrative matters.


Fourteen percent of


the deans


reported no


tenure







acquisition of


an advanced degree,


continued


education


of self.


Least


important were


research,


publication,


professional


consultation.


Sixty-two percent


department heads


university


"reported that more


[college]


than


the


faculty are engaged in research"


(Wise,


1979,


Wise


concluded


that


the education and


decis


ion-making


roles of the department heads varied widely,


as did


their


titles


(curriculum director,


program director


administrator,


chairman)


and department names


(division,


program,


name


of occupation).


Her


findings confirmed


dual


lines of


authority,


administrative complexity


, and


diversity


the departments.


Wise concluded


that


CAHs


are


"decentralized,


very


complex,


. stratified,


and may


formal


informal"


V.).


Kelley


(1975)


studied professional


identity


among


occupational


therapy


, physical


therapy,


and medical


technology


baccalaureate


program


faculty


and


deans


from


American Society


of Allied Health Profes


sons


member


colleges.


The colleges were geographically


representative of


three organizational


dispersed and


structures.


interviewed all


the deans


and surveyed


faculty


mailed


questionnaire.


Returns


were


received


from


176


(71%


faculty.


Issues


the deans believed most


important


concerned







interdisciplinary


activities.


Some


felt


it difficult


faculty to work in


interdisciplinary


endeavors


because


different


professional


emphases or faculty


disinterest.


They


favored greater


faculty


identification with


the concept


of allied health.


Efforts


to promote


this


included,


"interdisciplinary


committees


. and school


separately


from their medical


schools"


There was


no agreement on


purposes of


the core curriculum


should be


used,


or the courses


to be


included.


One dean


believed differences


in student


perspectives


and abilities


among the


programs


precluded


usefulness


core


curricula.


No research


was being


conducted


in three colleges and


no faculty members


were conducting


interdisciplinary


research.


The deans


concurred


that allied health


faculty


were not research oriented.


They agreed that research


interests and patterns differed among the three


professions


and


that


physical


therapy tended


to be most active.


Three


expressed


the need to develop a


research


focus


their


college and many believed their college mission statements


needed revision.

sophistication;


they wanted to


One dean mentioned the


faculty were


lack of


academic


"basically practitioners


told their objectives"


59).


The


faculty


this


study were


full-time


, female


(67%),


under


40 years of


(52%)


, and prepared


, if






appointment


in the college of medicine and/or


a basic


science department.


The


faculty


occupied


junior


faculty


ranks


(70%


assistant


professor or below),


(41%


a plurality


had taught


less than


years,


had


practiced


more


years.


Faculty


attitudes


concerning


interdisciplinary


endeavors differed significantly


health


<.05)


fields and among the colleges.


among the allied


Attitude differences


were


not significant


when


faculty were grouped by


organizational


structure,


highest degree


level,


discipline


of highest degree,


full


or part-time


status,


academic


rank


or title,


years of


clinical


experience,


or years of


teaching


experience.


Actual


participation


interdisciplinary


endeavors differed with academic rank and age.


higher


rank and


the older the


faculty member the more


interdisciplinary


activity.


Professional


reading habits among the


faculty


differed


markedly


discipline.


Medical


technologists


read more


the basic sciences,


diagnostic and


read more


in mental


physical


therapists


treatment areas,


read more


occupational


health and rehabilitation.


therapists


Consistent


with reading habits were


faculty publication histories.


They


published


in the


journals


they


read,


which


were


rarely


interdisciplinary


Nine percent had produced more


than


publications,


had not published.


When a .ked


-tn i dentifv nronbl es.


ei3ans mentioned







political


issues


Other


challenges


concerned


pressure


upgrade


the


faculty


or the


development


core


curricula


No dean


mentioned


internal


administrative


difficult


es.


Faculty


identified


more


problems


in scope


quantity


These


included


curricular


issues


, administrative


difficult


with


clinical


site


staff


facilities


personnel


management


within


colleges.


Kelley


(1975)


wrote


that


faculty


did


share


their


deans


concerns


, for


their


development.


development,


, workload,


research


were


time


listed


self-


as problems


approximately


the


faculty.


faculty,


Kelley


concluded,


may


lack


academic


sophistication


research


skill


but


they


exhibit


generous


concern


teaching


clinical


affairs--activities


which


a research


"university


environment


de-emphasi


zes


154)


Although


distinct


differences


among


three


faculties


were


found,


they


shared


limited


interest


in interdi


sciplinary


activities


and


they


had


"enlarged


their


identity


include


other


allied


health


professional


s" (p.


158)


deans


, 80%


of whom


did


hold


an allied


health


credential


favored


a broad


allied


health


identification.


Frank


(1984)


identified


personal


professional


characteristics


of allied


health


administrators


institutions


Association


accredited


of Colleges


CAHEA


the


School


Southern


Participants


included


" (p





I







colleges


held


title


dean,


were


male


, white,


mean


years,


held


a doctoral


degree


Their


undergraduate


degree


was


commonly


in a phys


ical


science,


mas


ters


in a health


field


or bu


siness


admini


claimed


station,


licensure


doctorate


in a health


in education.


field,


Twenty


medicine


nursing

a vice


president


in an allied

of health a


health


affairs


area


, supervi


They re

sed 8.2


ported


programs


had


years


prior


teaching


experience


had


public


shed


papers


during


prior


years.


Anderson


(1981)


surveyed


department


chairp


ersons


baccalaureate


medical


record


administration,


medical


technology,


physical


therapy


, and


radiologic


technology


programs


purpose


was


to determine


how


the chairp


ersons


used


their


time


, how


they


evaluated


teaching,


their


beliefs


about


teaching


The


population


contact


was


or 80%


responded.


Most


admini


chairpersons


strative


had


appointment;


acquired


their


seven


position


been


elected


faculty.


Eighty


-one


percent


departments


had


or fewer


full-time


didactic


faculty


including


chairpersons.


Three


departments


full


-time


faculty;


over


half


(55.3


use


one


or more


part


-time


didacti


teachers.


The


typical


annual


student


enrollment


was


through







most


of their


time.


Administration


was


ranked


first


68.9%

third


Teaching


73.4%


was


, and


given s

research


second


place


occupied


east


service


amount


time


82.0%


the chairpersons


The


relatively


eral


amount

devoted


time


occupied


to research


is cons


admini

istent


station


with


minimal


other


studi


time

about


allied


health


faculty


activity


(Foegelle,


1984)


Chairpersons


were


asked


to indicate,


which


among


ten


methods


teacher


evaluation


they


used


with


their


faculty


Student


opinion


.9%)


, review


course


material


.5%)


and


measures


of student


achievement


were


reported


most


frequently


Those


east


used


were


team


teaching


assroom


review


vis


of audio-video


itation


colleagues


tapes


Qualities


, and


considered


most


important


teaching


were


the


ability


encourage


thought


and


ability


to explain


clearly


.9%)


a chi


-square


analy


S1iS


<.05),


major


diff


erences


across


programs


were


entified


on several


dimensions


such


as program


chairperson


reading


habits


and


degree


, and


grading


teaching


policies


effectiveness


clinical


also


courses


varied


Methods


significantly


to evaluate


across


programs


Most


frequently


used


were


classroom


visitation


colleagues


phys


ical


therapy


, measures


of student


achievement


medical


technology


, and


review


course


materials


examinations


medical


record


administration.







professions.


Physical


therapists are accustomed


to direct


patient care;


medical


technologists are associated with


diagnostic testing,


1.e.,


outcome measures;


and medical


record administrators deal


with


the written record.


Foegelle


(1984)


identified personal


, occupational


career patterning


characteristics of


full-time,


college


of allied health


faculty


from 16


academic health


centers


Fifty-nine percent had had


6 or more


years of


prior


clinical


experience;


about half


had


taught


in a


university


less


than 5


years.


Over


had a


secondary


appointment


in another college,


which


for six


individuals was


in a


science unit.


Administrative appointments were


reported by


most


of which


were at


program level.


primary


assignment


for most


faculty was with baccalaureate


programs


and with


entry


level


occupational


preparation


.5%)


Faculty


from


clinical


laboratory


, physical


therapy,


and


occupational


therapy programs accounted


43.5%


respondents.


Foegelle


tabulated


faculty


activity


categories.


He concluded


that


faculty members were


primarily


involved


teaching,


in student


clinical


centered activities,


teaching,


namely


student advising.


classroom


Service


their respective


occupied more


programs and


time than clinical


professional

service. Sc


associations


holarship and


research


typically


consisted of


"analyzing


existing







second


most


frequently


reported


activity


was


"personal


professional


development"


. 75)


Two-thirds


were


pursuing


additional


formal


education.


Faculty


reported


preferring


to spend


more


time


on publishing


.4%)


research


.9%)


, pers


onal


development


.9%)


and


paid


service


.4%)


Their


"inservice


development


eres


were


strong


in the


area


of research"


. 187


moderate


higher


education


and


health


care


topics


, and


"not


at all


teaching


advis


topics


" (p.


100).


Over


one


-half


.0%)


reported


original


career


goals


different


from


their


pre


sent


occupation.


Over


one


-third


had


been


their


present


institution


ess


than


years


The


reasons


faculty


gave


selecting


their


universe


were


duti


and


response


ibilities


(80.0%


, geographic


location


.2%)


ready


a change


(35.


Thirty


percent


"were


serious


considering


actively


reasons


pursuing


were


a change


salary


in employment"


, potential


Major


advancement


.5%)


, ready


a change


duties


responsibilities


.7%)


, and


poli


cies


and


practi


ces


of administration


summary,


Foegell


(1984)


ed that


alli


ed health


faculty


"are


typically


underprepared


higher


education


faculty


roles


. and


they


have


administrators


who


are


often


not


able


to be first


among


equals


their


own


a


aI S % F- -


-- J L- -


II .. _- 1 .. *1


*


t-_ -_ JA- J_.


*_


f -







was


incongruent with


the relatively


"formal


[extra-


program]


administrative appointments"


maj or


plea


was


faculty


development,


which would have


involve


improving research and service


skills


and


inculcation
stewardship,


of values


for scholarship,


collegiality.


This


focus


will


require a special


interpersonal
different fro


in allied health


emphasis on conceptual


skills,


and


of which are quite


m technical--clinical


occupations,


skills


and all


inherent


of which are


learned i

Current Status


n quite different ways.


of Colleges


191


Allied Health


The allied health


professions developed


for practical


needs,


not abstractions


(Hinkle,


1986) .


The knowledge base


the different


occupations


is diverse


often


undefined,


immature,


lacking


theory,


or dependent


upon a


paradigm


claimed by


another profession


(National


Commission


on Allied


Health Education


[NCAHE],


1980)


Until


practitioners


acquire a


theoretical


base,


the hospital


tends


serve


training


site


(Rosenfeld,


1972) .


The


professional


soc


ieties serve


as vehicles


occupational


identity


one salient manifestation of


this


is specialized


accreditation


(Friedson,


1986).


College-wide missions


have


been reported


as nonexistent,


both


formal


informal


, and


in need


of alteration


(Miller,


Beckham,


Pathak,


1983)


College administrators


have generally


supported


greater


autonomy


for allied health


education


(Florida


Board


Regents,


1983;


Pyne


, 1975)


But advocacy


independence







dependence on other units


colleges of


for facilities


allied health within academic health


course work


centers may


be among the most vulnerable


(Barritt,


1980;


Ford,


1983;


Morris,


1980).


Cooperation,


communication,


and


collaboration;


successful


been confronted with


themes of


financial


earlier decades


exigency


(Ford,


have


1983).


now reads:


"Deans'


Winter Conference


to Focus on Survival


Allied Health


Units


in Higher


Education"


(Deans'


1987-1988).


Program interrelationships


Titles may not be reliable


are complex


indicators of


1979) .


function,


profession,


or role.


Studies


of department


chairs


result


reports about


program directors


(Anderson,


1981)


Many


departments have


four or


fewer members and would be


considered programs


by most higher education administrators


(Tucker,


1981) .


Goals of


individual


programs may


unrelated


to or


in conflict with


each


other or with


college-


wide goals.

professional


Examples

practice


include educational


turfs,


entry


and accreditation


level,

(Hinkle,


1986) .


continue


professions


Many members of


to view members of


as subservient


the older health


younger


(NCAHE,


professions


allied health


1980).


Unlike most professional


school


deans,


allied health


administrators


often do not share education


, experience


, or


occupation


in common with


their faculty


(Foegelle,


1984 ;


Frank,


1984)


This may partially


explain


the greater value


. I I -r .


I







McTernan,


may


1972).


be organization


The motivators

nal, financial


to espouse

, or faculty


these objectives

developmental


less concerned with a


common body


of knowledge needed


for professional


Financial


practice.


authoritative relationships between


colleges and


other units are equally


complex


(Wise,


1979).


Faculty practice


toward


plans or hospital budgets may


faculty salaries or student stipends.


the colleges may reimburse clinical


agencies o


contribute

Conversely,

r other


colleges


services


facilities.


The


influence


college of medicine


is reflected administratively


as well


professionally


faculty


responsibilities


(Kelley,


1975;


Wise,


1979)


The allied health


educational


programs


"have


relatively


institutions


(for


status


example research


very types


universities,


academic


health


science centers)


that


could play the greatest


developing


future


leaders and


contributing to


their


knowledge base


for education and


practice"


(NCAHE,


1980


34).


The


prime variable which


distinguishes among


faculty


attitudes and behaviors


is the allied health


discipline


(Anderson


1981;


Kelley


, 1975).


This


is consistent


with


other


higher


education


faculty


studies


(Clarke,


1983;


Stark


& Morstain,


1978) .


Whatever the


particular profession,


faculty tend


to be practitioners and


teachers,


theorists


- S_ 9 I S *


r


1







invested


in program/professional


administration.


Women


predominate


most


allied


health


occupations


(Foegelle


1984)


The


deans


have


been


advocates


more


formal


and


continuing


education


their


faculty


es.


Faculty


developmental


interests


have


been


reported to


research,


practice


where


most


have


had


ample


experience


teaching


where


most


faculty


development


activity


have


been


directed


(Foeg


elle,


1984)


there


evidence


that


may


be changing:


Our


faculty


must


meet


the


same


standard


expect


of faculty
Whether it


scientific


in the


biological


discipline.


or soc


sciences


, we must


find


a scientific


base of


eration


our


from


individual


which
profe


to launch


ssions


rese


. (Covey


& Burk


arch
e, 1


987


Stark


s Framework


Stark


, Lowther


, Hagerty


Orczyk


(1986)


have


developed


a conceptual


framework


the study


of degree


programs


conducted


four


-year


colleges


university


that


provide


initial


Soc


iali


zation


entry


to broadly


defined


profe


recency


thi


summarized.


ssional


elds"


framework,


will


Because


development


followed


will


a description


the


framework


how


some


components


can


serve


identify


science


related


courses


and


provide


a focus


development


of delivery


system


criteria.







liberal


arts majors.


Because


professional


curricula


vary


markedly


is difficult


for administrators


to understand


each program.


is essential


that administrators


develop a

lead. Ed


working


ucators


knowledge of the


, researchers,


programs they purport


and administrators are


commonly unaware of the similarities and differences among


professional


lend


programs;


themselves to


therefore cross-program comparisons


investigator bias and use of


noncomparable data.


Stark


et al.


(1986)


claimed


that


standard

would en


framework


for cross-professional


hance objectivity,


accommodate change


program study


over time


reduce or


eliminate specialized


language and


the


resulting


confusion,

education.


distinguish between preservice and


continuing


clarify the often ambiguous meaning


"professional


competence"


(pp.


232-3).


In developing the


framework,


investigators


used


grounded


theory


approach.


They reviewed professional


education studies


and program descriptions


held


seminars


with


different


professional


faculties,


and reviewed


literature


on professionalism.


Elements of


their


emerging


framework were


then


compared with


themes


found


"professional


education


journals of


eleven


fields"


Stark


al.,


1986


235)


including dentistry


, medicine,


nursing,


pharmacy,


and nonhealth


professions


for the


year


1979.


revised


framework was


then used


as a guide


a content







medicine.

exhaustive,


To determine

distinct, a


further


nd appropria


the elements were

te, a pilot questionnaire


was designed


perceptions of


assess


each


University

the element


of Michigan

s in the fr


"faculty


amework"


235)


The Stark


et al.


(1986)


framework asserts that professional


preparation


programs are


influenced by


internal


intraorganizational,


Figure 1].
professional


turn,


These


forces


preparation


influences


processes


intended


external
interact


forces


[see


to create


'environment'


the design o
d to achieve


which,


f educational
professional


preparation outcomes.


. Finally the extent


which


the outcomes are achieved and,


orientation of


internal,


the new professionals,
intraorganizational, ar


thus, the
influences


external


forces.


236)


The external


influences consist of


two major


categories,


societal


influences and


characteristics,


each


professional


community


of which have several


more specific


elements


(see


Figure


Elements


internal


influences are grouped


program structure,


under four


curricula


categories;


tensions


mission,


continuing


professional


involvement,


also shown


in Figure


. Stark


(1986)


believed


that


elements of the


intraorganizational


influences


(mission,


program centrality,


program


interrelationships,


financial,


technological


support,


governance)


will


"become


increasingly potent


forces


affecting professional


curricula"


238) .


Selected


elements


from amonq these


influence qroupinqs served












Professional Preparation Outcomes


External
Influences


Internal


Influences


Figure


A Framework


Desc


ribing


Professional


Preparation


Programs.


Note.
study


From,
of pi


colleges
Lowther,
Journal
Copyrigh
Press.


and


conc


servicee


eptual f
profess


universities


Hag


of Higher


1986


Reprinted


erty


ramework for t
ional programs


" by J
. & C.


Education,


the Ohio


permit


State
ssion.


. s.


Stark


Orczyk,
p. 237.
Univers


Intraorganizational


Influences


1986





























External Influences


Societal


Influences


Reward System
Marketplace for
graduates
Media
Government policies
Funding
ULcensing

Professional Community
Characteristics
Knowledge base
Client orientation


Practice


settings


Professional autonomy
Accreditation and
standards
Market control
Ethics
Publications
Alumni involvement


Intraorganizational


Influences


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


Internal

Mission.
Program


Influences


Staffing and
Organization


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

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


Curricular


Tensions


Instructional
methodology


Balance


of theory


and practice


Core


courses


Contextual study


Course
Course


sequencing
and program


evaluation

Continuing Professional
Involvement


Figure


Spec
Prog


Influences


on Profes


sional


Prepara


tion


rams.


Note.


From


, "A


conceptual


framework


study of
colleges
Lowther,


preserve ice


unive


rsit


ressiona
es" by J


programs
S. Stark


Orc


zyk,


.A.


1986


- --


_ _


_ I


_ ~ *


, *







focus


science course delivery


system for this


study.


The environment


that


these


influences collate


create


results


educational


processes which


in turn


result


professional


preparation outcomes.


There


are


major


categories of


outcomes,


professional


competencies


professional


attitudes


(see Figure


Since


the


initial


publication


of the


framework,


three other outcomes have


been


specified;


leadership capacity,


aesthetic sensibility


critical


Stark,


thinking,


personal


communication,


February


1987).


The competencies were defined


Chapter


an illustration of these


nurse anesthetist as a


competencies


representative health


consider


professional.


The


nurse


anesthetist


understands


the


uptake


distribution


of anesthetic agents


(conceptual


competence)


knows how to operate


the anesthesia machine and monitoring


equipment


(technical


competence),


and can develop a


safe and


effective anesthesia management


plan


(integrative


competence).


She recognizes


that


the same


client


undergoing


the same


unit


procedure


or hospitalized


in a


different milieu


inpatient)


may


(same day


benefit by


surgery


different


anesthesia management


(contextual


competence)


Also as


new


agents and monitoring techniques


become available she


incorporates


them


into


her practice


(adaptive


competence).


In any program


required


courses


in the curriculum


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


_ __ -L JL.. L _- _










Professional Competences

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


Professional Attitudes

Professional identity
Professional ethics
Career marketability
Scholarly concern for


Motivation for continued


External


Influences


improvement


learning


Internal


Influences


Figure


Professional


Preparation


Outcomes.


Note.
prese


From,
rvice


universe


"A concept


prof


ities"


essio


framework


programs


Stark,


in coll


the
eges


study
and


Lowther


TPrfliirn i n


Professional Preparation Environment


I


i


C


^ .. _







professional


competencies


and attitudes.


It can be


posited


that any required


course


in a


professional


program will


contribute


to each


professional


preparation


outcomes.


However


a particular


course may make a major contribution


the development


of some outcomes and a negligible


one


toward


others.


Science related courses can be perceived as


fostering the acquisition


of conceptual


competencies


biophysical


sciences


allied health students.


They


may have a


limited


role


in the development of


professional


identity.


This


is most apparent


in the case


of prerequi


site


basic sciences,


core courses,


and sciences designed


other


health


professions students


but open


to allied health


students.


The contributions of


a science course


toward


competence


and attitude acquisition may vary with


the science and/or


profession.


example,


the skills developed


the gross


anatomy laboratory may

technical competencies


contribute

that an oc


little


toward


cupational


therapist


will


use


in professional


practice.


the skills acquired


the microbiology


future medical


boratory may be germane

technologist. However


the activities


in both


situations


biophysical

remains a p


the development


science,


primaryy


of conceptual


competence


supportive of professional


goal.


in a


practice


The other outcomes described by


Stark et al.


(1986)


for which


the science


related


courses


a -


1 _


I 1 I


I







integrative


adaptive


competencies


and


a scholarly


concern


improvement.


illustrate


a representative


consider


health


nurse


professions


anesthesia


student.


A ph


student

ysiology


course


may


include


objectives


regarding


cardiova


scular


dynamics.


The


teaching


strategies


may


incorporate


laboratory


to demonstrate


some


concepts


or a


historical


discussion


methodology


used


some


early


inves


tigator


who


formulated


concepts


Thus


, the student


derives


an understanding


some


"knowl


edge


upon


which


professional


practice


based"


Stark


et al. 1986


. 244)


(conceptual


competence)


recognizes


that


this


knowl


edge


was


acquire


through


rese


arch


(scholarly


concern


improvement)


This


knowledge


of cardiovascular


dynamics


may


provide


the


S1lS


perform


some


technical


skill


pharmacologic


intervention


to maintain


blood


pressure


during


the


course


of anesthesia


(integrative


competence


Likewi


because


of a knowledge


of cardiovascular


dynamics


, the


future


nurse


anes


thetist


will


incorporate


new


technologies


when


developed


to better


monitor


cardiovascular


phys


biology


(adaptive


competence).


Stark


identification


framework


of sci


was


ence


used


related


to assist


the


courses


study


Recall


that


science


relat


courses


are


required


profess


ional


phase


biophysical


sciences


, the


primary







competencies and


the development of


a concern


for scholarly


improvement.


Thus,


it was outcome as


reflected by the


course description


course name,


faculty


background,


college sponsor that served


to identify these courses.


This


will


be discussed


Chapter


III.


After the


literature


review the


framework also served


to structure


science


related


course delivery


system


issues and


proposed


criteria.


This will


also be


explained


in Chapter


III.


Hundreds


of professional


liberal


arts and


science


faculty


have


participated


the development


this


framework.


comprehensiveness and multiprofessional


applicability have been established.


Findings of


others


using this


framework


are


underway


(Stark,


personal


communication,


February


1987)


are not


available.


However the designers


of this


framework have conducted


one


study to test


this model.


To determine


"the ability


of the


framework to assist


mapping


differences among programs"


Stark,


Lowther


, and


Hagerty


(1987,


533)


obtained and analyzed a


national


sample of professional


faculty


opinion.


specific


purpose was


to identify


discriminators


among


entry


level


professional


programs and


to determine


"each


professional


field had


a unique


preparation environment"


533).


Faculty


(n=2


11 professions


programs


among


346


universities and


colleges


participated.


- &


__


1 -







factor analyses of the data resulted


four groups


factors


representative of


named Factor


program influences.


curriculum debate,


Factor


They were


education


mission,


Factor


societal


influence/university


prestige/gender,


and Factor


professional


community


influence/university


confirm that


support.


Analysis of variance did


faculty perceptions of professional


preparation environments differed


significantly


education

on some of


factors.


Three


strong discriminants among programs


were


faculty perception of


societal


influences


(external),


social


prestige


ratings of


occupations


(external)


, and gender


ratios of


program graduates


(internal)


Strong


society


support

faculty


is perceive

(business,


for programs with


engineering,


predominately male


and pharmacy).


The professional


community


influences


(external)


were


less


powerful


program discriminants


than


societal.


However some


items did serve


as discriminants.


Some


program


faculties who


perceive weak societal


support


"perceive


strong


influence


from accreditors"


556)


(nursing


social


work).


"Faculty perceptions of having


achieved


consensus on a


professional


knowledge base"


was


discriminant.


Several


potential


influences did not serve


discriminants among professions.


These


included


"faculty


age,


possession of


a doctorate,


. .[and]


time


spent







institutional


size


type


(degree of


research


orientation),


but not professional


field.


Clearly this


framework


is developing


into a model


that


can serve to


identify


discriminators among professional


programs.


The


finding that profession and not


institutional


size or type served as a


discriminator of


faculty


perceptions of


professional


preparation environment


was


cited as having both research and practical


applications.


Accreditation Standards:


Tools


Academia


Introduction


Twenty


sets


of health


science


professions'


accreditation standards


guidelines were


perused


determine


requirements


for program officials qualifications,


faculty responsibilities


for service and research,


evidence of


sciences


in curricula.


Each set of


standards


was


applicable


which all


to a single health science occupation,


or some of


programs awarded a baccalaureate


degree.


Thus a


of standards may


apply to certificate or


graduate as well


as baccalaureate


programs.


Each responsible


the Council


accrediting


on Postsecondary


agency


Accreditation.


is recognized by


1988,


accrediting


agencies


and health


science


professions


concerned were


the American Council


on Pharmaceutical


Education


(ACPE),


pharmacy;


the American Dental


Association







Dietetic


Association


(ADA)


dietetics


; the


American


Physical


Therapy


Association


(APTA)


, phy


sical


erapy;


American


Ass


ociation


of Nurse


Anesthetists


Council


on Accreditation


of Nurse


Anesthesia


Educational


Programs/


School


(AANA


nurse


anesthesia;


the National


League


Nurs


Council


Baccalaureate


Higher


Degree


Programs


(NLN),


nursing.


In addition


to these


49 other


organize


nations


collaborated


with


Ameri


can


Medical


Assoc


nation


Committee

(CAHEA) t


on Allied


o accredit


Health

26 alli


Education

ed health


Accreditation


occupations,


14 of


which


1986)


apply


These


programs


programs


with


were


baccalaureate


cytotechnology


curric


, cardiova


(AMA,


scular


technology


histotechnology,


medi


record


admini


station,


medical


technology


nuclear


medi


cine,


oCC


upational


therapy


perfusion


technology


, radiography,


radiation


therapy


physician


ass


istant


, respiratory


therapy,


sonography


, and


surgeon


s assistant.


Although


various


sets


of accreditation


requirements


address


similar


issues


they


frequently


use


diff


erent


terms


mean


same


thing


(AMA


, 1985a;


American


sic


Therapy


Association


[APTA]


1978;


National


League


Nursing


[NLN],


1980)


there


are


nuances


among


terms


such


, internship,


externship


, clerkship,


eldwork,


practicum


both


within


among


profes


sons.


Throughout







different

verbs such


terms.

as shal


Several


accreditation documents defined


and should


(American Dental Association


[Amer


. Dent.


Assoc.]


AMA,


1981a).


A generalization


is that shall,


will


and must are mandates;


whereas


should,


could,


can,


and may


are


less


forceful


suggest


ethical


obligations,


alternatives,


or liberty to do something


(AMA,


1981a).


Accreditation standards


for the occupations


under


discussion were adopted


as early


1935


(AMA,


1983b)


recently


1985


(AMA,


1985b).


Of the


standards


effect


during


1986


sets


had been adopted


late


1970s and


remaining


were


products


of the


1980s.


The maximal


duration


of program accreditation varied


from


through


years,


the mode being


years


see


Table


illustrated


in Table


,six sets


of standards


limited


program sponsorship


to 4-year colleges


or universities.


accrediting


agency


surgeon's


assistant


programs


suggested sponsorship


in schools


of medicine


in conjunction


with


the department of


surgery


(AMA,


1982).


The


physician


assistant agency


recommended academic health


centers


educational


sponsors


(AMA,


1985c).


Sponsorship of


dental


hygiene programs


had


to be in nonprofit postsecondary


institutions


(Amer.


Dent.


Assoc.


, n.d.) .


hospital


other


health


care


facility


alone can be


accredited


as a


sponsor of


[respiratory therapy]


training program"


(AMA,


, n.d.;


... _





_







Tabl


Maximum


Number


of Years


of Program


Accreditation


Minimal


Program Duration Requirements



Duration Duration of Professional
Program Accred. Program in Months


Cardiovasc


. Tech.


Cytotechnology


Dental

Dieteti

Histote


Hygiene

cs


chnology


Medical


Record


Adm.


specified


Medical


Technology


Nuclear


Medi


cine


Nurse


Anesthesia


Nursing


specified


Occupational


Therapy


ecifiedb


Perfusion


Technology


Pharmacy


Phys


Phys


ical


cian


Therapy


Assis


specific


tant


Radiation


Therapy


Radiography


Respiratory


Therapy


Sonography


-12


Surgeon


Assi


stant







educational i

allied health

laboratories,


institution.

professional

the military


vocational-technical


colleges of medicine,


Sponsorship of t

programs might

* cancer treatme


schools,


community


proprietary


colleges,


he


remaining


include hospitals,

nt centers,

organizations,


4-year


colleges


and universities.


Some standards were specific regarding the minimal


duration of the

flexibility bas


programs


(see Table


ed upon student


prior


Others


experience


permitted

, ability,


science background


(AMA,


1980a,


1980b,


1982).


Several


just


implied


the duration by


stipulating that most


courses would


be upper division


(NLN,


1980,


or that


credential


awarded would be


a baccalaureate degree


(American Dietetic


Association


[ADA],


1976,


The number


institutions


with accredited programs


well


as the


number


and percent


which


offered


baccalaureate degree


in each health profession


shown


Table 2.


The standards examined


for dietetics,


nursing,


pharmacy were applicable solely to baccalaureate


programs.


These professions had


different or


additional


standards


other


educational


levels,


e.g.


, dietetic postbaccalaureate


certificate,


associate degree nursing,


or doctorate


pharmacy.


The


preponderance of nonbaccalaureate


programs


medical


records administration


, medical


technology


nurse


anesthesia,


occupational


therapy


, and physical


therapy were


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


-- ,_







Table


Number


Percent


of Institutions


with


Accredited


Baccalaureate


Health


Science


FBS1


Programs


Institutions


Program


Total


N BS


Cardiovasc.


Tech.


Cytotechnology


Dental


Hygiene


Dieteti


ab 65


100


Histotechnology


Medical


Record


Adm.


96.3


Medical


Nuclear


Technology


Medicine


Nurse


Anesth


esia


11.3


Nursing


b 453


100


Occupational


Therapy


Perfu


sion


Technology


Pharmacy


Physical


b 65


Therapy


Phys


ician


Assistant


Radiation


Therapy


Radiography


Respiratory


Therapy


Sonography


20.8


a .


453a


108a







nonbaccalaureate


programs


other


occupations were


associate degree,


certificate,


or diploma.


Program Directors


As shown in


Table


seven professions'


standards


required


the program director to be credentialed


occupation and


required either the program director


education


coordinator to be a member


the occupation.


Four


required a member of


profession or a


physician/dentist


of a relevant


specialty.


Three


permitted


program


director to


have


same,


relevant,


or equivalent


occupational


credentials.


Pharmacy


standards did not mandate


a pharmacist

demonstrate


for dean but did require


S. professional


the dean


leadership


" (American


Council


on Pharmaceutical


Education


[ACPE],


1984,


The remaining


standards did not mention requisite


professional


credential


for the


program directors.


amount and/or


level


formal


education


required


program directors was diverse


(see Table


Nursing


standards


require


the chief program administrator to


hold a


doctoral


degree,


only the baccalaureate of


this


person


needed


to be in nursing


(NLN,


1980) .


four mandating


a master's or ongoing work toward


one


, dietetics


standards


permitted


the degree


to be


"in dietetics


or a closely


related


field"


(ADA,


1976


, p.


and nurse


anesthesia


guidelines


indicated


that an appropriate master


s degree


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


*
- n -. -w a


- -. S, -


I


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







Table 3


Accreditation Requirements


Professional


Credentials


of Program Directors


Program


Acceptable Credential


Cardiovasc.


Tech.


not specified


Cytotechnology

Dental Hygiene

Dietetics

Histotechnology


cytotechnologista

dental hygienist or dentist

registered dietitian

histotechnologista


Medical Record Adm.


med.


rec.


adm.


or equivalent


Medical


Technology


medical


technologist


Nuclear Medicine


nuclear med.


or equivalent


Nurse Anesthesia


nurse anesthetist or MD


Nursing


professional


nurse


Occupational


Therapy


occupational


therapist


Perfusion Technology


perfusion


tech.


or equivalent


Pharmacy


specified


Physical


Therapy


physical


therapist


Physician Assistant

Radiation Therapy

Radiography

Respiratory Therapy

Sonography


not specified

radiation therapist

radiographer

respiratory therapist or MD

sonographer or MD


Surgeon


s Assistant


not specified


___







Table 4


Accreditation Requirements


Academic Credentials of


ProQram Directors


Program


Acceptable Credential


Cardiovasc.


Tech.


Cytotechnology


Dental


Hygiene


higher than students


BS or


equivalent


not specified


Dietetics


masters


Histotechnology


two


years of


college


Medical


Record Adm.


masters


Medical


Technology


varies with


experience


Nuclear Medicine

Nurse Anesthesia

Nursing


BS or equivalent

masters

doctorate


Occupational


Therapy


masters


Perfusion Technology


Pharmacy


not specified


not specified


Physical


Therapy


not specified


Physician Assistant


not specified


Radiation Therapy


vari


with experience


Radiography


varies with


experience


Respirator Therapy


varies with


experience


Sonography


not specified


Surgeon


s Assistant


not specified







Council

[AANA],


on Accreditation of Educational


1980) .


Programs/Schools


Some guidelines contained discussions of


program director and/or


faculty academic qualifications


relative


to students


(ADA,


1976;


AMA,


1977b


, 1985c)


"Key


faculty


in any type of professional


program should


possess


the same or higher


level


of education and/or professional


credentials as


that


for which students


in the


[respiratory


therapy]


program are being prepared"


(AMA


, 1977b,


The


four


sets of


accreditation standards which


provided


for the substitution


experience


lieu


of degrees


tended


contain detailed discussions of


issue


(AMA,


1977a,


1977b,


1981b,


1983c)


As an example,


qualifications


radiography program director are


that he or


Shall be a radiographer qualified
methodologies.


educational


Shall be credentialed
American Registry


in radiography


by the


of Radiologic Technologists


or possess suitable equivalent qualifications.


Shall


be qualified through education and


experience.
proficiency


These qualifications shall


but shall


not be


assure


limited


the


following


areas:


curriculum design
instructional methodology


testing and
educational


evaluation
psychology


Shall


document


to the sponsor satisfactory


completion


of one of


following:


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


experience as
of two years


a radiographer


as an


instructor


and a minimum
in an


accredited


radiography program;


an associate degree with a minimum of


two


years of oostcertification experience as a








a minimum of


five


years


of postcertification


experience
of four yea


as a radiographer and a minimum


rs


as an instructor


in an


accredited radiography program
pp. 3-4)


. (AMA,


1983c,


Directives that


faculty


serve as


role models


(ACPE


1984),


have clinical


privileges


(AMA,


1977b),


be actively


practicing


(AMA,


1983a),


or periodically return


to practice


(AMA,


1981a)


indicated


importance of


clinical


experience.


The expectation that program directors


other


faculty


have


prior and/or current


work experience


was


apparent by professional


credential


requirements


see


Tables


and 5).


The


standards of


8 occupations


enumerated


years and types of


prior


experience


that


appointed


program director must have


(see Table 5).


that


explicitly mentioned


prior work


experience


for the


program


officer


had


to have


defined


it broadly.


"experience


The nursing


in baccalaureate and/or


administrator


higher


degree


programs


in nursing"


(NLN,


1980,


14) .


"Relevant


occupational


therapy


experience


in administration,


teaching,


and direct


service"


(AMA,


1983b,


was


stipulated


that profession.


The detail


to which many


the others


described


their requirements was expressed by medical


record


administration standards.


The


program director,


"must


have


a minimum of


three


years


professional


experience


at an


administrative


level


in medical


record administration


either a health


care


facility


or industry/agency


serving







Table


Accreditation Requirements


Experience of


Program


Directors


Program


Experience Specified


Cardiovasc.


Tech.


experience


recommended


Cytotechnology


Dental


Hygiene


Dietetics


5 years


teaching)


not specified


year


years preferred


Histotechnology

Medical Record Adm.


years

years


Medical


Technology


Nuclear Medicine


varies with academic degree


years


recommended


Nurse Anesthesia


not specified


Nursing


relevant experience


required


Occupational


Therapy


relevant experience


required


Perfusion Technology


Pharmacy


not specified


not specified


Physical


Therapy


specified


Physician Assistant


Radiation Therapy


Radiography


specified


varies with academic degree


varies with academic degree


Respiratory Therapy


Sonography


Surgeon's Assistant


varies with academic degree


not specified


not specified







that


this


experience


must


have


been


one


in which


erson


was


"primarily


involved


planning,


organize


ing,


directing


controlling,


and/or


evaluating


health


record


functions"


(AMA


, 1981a


, p.


After


prof


ess


ional,


academic


, and


clinical


experience


requirements


, one


other


often


mentioned


requirement


concerned


evidence


instructional


competence


(AMA


, 1980b,


1984).


Again


these


stipulations


ranged


from


general


detailed.


"The


director


has


competence


in teaching,


educational


admini


station,


curriculum


development"


(APTA,


1978


. B-3


Or the


cytotechnology


program


director


"has


completed


courses


or seminars


principles


of education


management;


has documented


continuing


education


in educational


methodologies


" (AMA


1983a,


. 4).


Medical


Direc


tors


SIX


prof


ess


ions


accredited


non


-CAHEA


agencies


none

nurse


were

anes


required

thesia s


to have


standards


a medical

permitted


director.

either a


Although


nurse


anesthetist


or an anesthes


biologist


serve


as program


director


long


as a nurse


anes


thetist


actively


involved


organization


and


administration


total


program"


(AANA,


1980,


Dental


hygiene


standards


required


program


administrative


structure


clude


dental


hygieni


or a dentist


with


current


expe


rience







require

medical


a medical

records a


director


dmini


were


station.


occupational


Standards


therapy


radiation


therapy


indicated


that


a medical


director


advi


sor


may


required


(AMA,


1981)


remaining


11 sets of CAHEA


standards


required


a medical


director;


of which,


medi


technology


radiography,


permitted


the


phys


cian


leader


to hold


a different


title


(AMA,


1977a


, unpaged;


1983c


Qualifications


medical


director


commonly


include


ed li


censure


as a physi


cian


know


edge


, expe


ence


or credentials


the relevant


specialty


Seve


standards


also


referred


to active


intere


in and


involvement


teaching.


experiencec


example


ed and


medical


proficient


director


use


was


to be


of ultrasound"


(AMA


1980a,


or "knowledgeable


about


delivery


primary


care"


(AMA


, 1985c


or "knowledgeable


effe


active


in teaching


the subjects


ass


signed"


(AMA,


1985b


more


spec


cally,


"qualifi


in the


use


radionuclides


a diplomat


of either


American


Board(


of Nuclear


Medi


cine,


Pathology,


or Radiology


possess


The


suitable


equivalent


gene


the


qualifications"


medical


(AMA


director


, 1984


insure


medical


pertinence


curriculum


often


to facilitate


public


relations


among


physi


cans.


"The


medical


director







didactic and supervised practice,


meets current acceptable


standards"


(AMA,


1985b,


Or "the medical/surgical


director


the clinical


should provide continuous,


competent direction


relationships with other educational


The medical/surgical


understanding


director should actively


programs.


elicit


and support of practicing physicians"


(AMA,


1982,


Program Faculty


Several


sets of


accreditation standards


such as


dietetics,


nursing


, pharmacy,


and physical


therapy


limited


interpretation and


discussion


of faculty to appointees


the educational


sponsor,


who


had teaching


responsibilities.


"Full-time equivalent


faculty


include


only those persons

are employed on a


who hold

partial o


at least a masters degree


r full


appointment by the college


or university"


"there must be a


(ADA,


1976,


core of


For dental


qualified


full-time


hygiene,


faculty


the majority


faculty must have


full-time


appointments"


(Amer.


Dent.


Assoc.,


When


standards and guidelines


of dietetics,


nursing,


pharmacy,


and physical


therapy referred


to memb


ers


respective


student clinical


professions who


instruction,


participate


it was apparent


primarily


that


clinicians had a more

students who are reai


circumscribed role.


stered dietitians with


"Graduate

practitioner


*


- 1-_. -*1 2 1


n.d.,


_.'IL


1 ^ _


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







be counted


calculation


full


-time


equivalent


faculty


(ADA,


1976


. 6)


"Volunteer


clinical


faculty


preceptors


should


be exemplary


mod


practitioners


, and


should


reflect


a broad


spectrum


of pharmacy


settings"


ACPE,


1984,


. 7).


Of CAHEA


accredited


programs,


sonography


, radiography


radiation


therapy


technology


, and


occupational


therapy


standards


stated


or the


guidelines


implied


that


faculty


shall


or should


have


faculty


appointment


, if


program


was


college


or university


sponso


(AMA,


1980a,


1981b,


1983b


, 1983c)


"Instructors


. must


meet


standards


required


sponsoring


institution"


(AMA


, 1983c


Cardiovascular


technology,


cytotechnology


, histotechnology


nuclear


mention


medicine


university


nurse


anesthesia


appointments


standards


program


did


faculty.


The


latter


seemed


to equate


faculty


with


anyone


partic


ipating


student


instruction.


"Faculty


should


include


"behavioral


scie


ntis


educators,


other


nurses


, hospital


administrators,


and


egal


expert


s" (AANA,


1980


Standards


remaining


seven


occupations


spec


or implied


faculty


appointment


the


program


dir


ector


official


respiratory


therapy


"program


director


shall


a member


sponsoring


educational


institution


faculty


with


rights


privileges


" (AMA,


1977b


, p.


Perfusion


technology


"program


officials


should


have


. 31)


_






program official


"faculty


appointment may be a


regular


one,


a non-salaried


clinical,


or courtesy appointment or


adjunct"


(AMA,


1977a,


unpaged).


How


eve r


faculty


are defined,


sets


of standards


contain discussions


roles and responsibilities of


program officers,


sponsor employed


faculty,


clinical


faculty.


Typical


of content,


typical because


it was


directed


to program officers


rather than all


program


faculty,


were


"examples


of responsibilities of


program


officials"


(AMA,


1977a,


unpaged)


for medical


technology:


Development of,


validation of,


revision


of program objectives when appropriate.


Implementation


of admission


policies.


Curriculum development.


Implementation
procedures.

Recruitment.


of student


evaluation


Public
catalog


relations,
s, brochure


including preparation
s, or other materials


of
relating


the


program.


Planning
ongoing


implementation


instruction


a program


in curriculum design,


to ensure
teaching


techniques, a
all personnel


d current
involved


laboratory techniques
n instruction.


Maintaining

Student cou


student records.


nseling.


Input


into the


preparation of


program


budget.


Providing


program and


liaison between


the


institution


the educational
nal administration.







. Ensuring
student'


medical


s educational


accomplished


relevance


experience.


in a variety


in the


This


including


ways


lectures


, seminars


, clini


conferences


. (AMA,


1977a,


unpage


Thus


teaching


and


related


activity


form


the bulk


faculty/program


offi


cer


as exp


resse


d in


these


most


other


sets


of accreditation


standards.


The


extent


to which


the


curriculum


was


expected


to be


controlled


sponsor


employed


faculty


varied.


A few


sets


of standards


made


perfectly


clear


"The


phys


therapy


faculty


is responsible


instruction


curriculum


development"


(APTA,


1978


. B-4


"Primary


response


ibility


development


and


conduct


academic


programs(


res


ts with


the


nurs


faculty"


(NLN


1980


. 26)


Other


sets


of standards


ves


this


responsibility


program


offi


cial


Medical


technology


"program


offi


cials


shall


ensure


appropriate


instruction


areas


the education


program"


(AMA,


1977a,


unpaged)


The cardiovascular


responsible


technology


maintaining


program


quality


director


program"


(AMA


1985b


, pp.


"The


medical


director


is expect


play


a pivotal


role


the


design,


development


and


implementation


of all


courses


relating


respiratory


phy


siology


and


respiratory


seases


. as well


evaluating


. non-clinical


courses


" (AMA,


1977b,


dental


hygiene,


"the


program


admini


strator


must


- I I a


I I


_ q -


* -(


-1


r j


*






decisions on academic and


other policies affecting the


program that


they will


have


to implement"


(Amer


. Dent.


Assoc.,


Eleven


sets of


standards


required or recommended


advisory


committee or


community


liaison mechanism.


Some


these


vested major


curricular responsibilities


these


committees


(AMA,


1977b,


1980a


1981b


, 1983c).


"The


function


the committee should be


to advise the


program


curriculum"


(AMA,


1980b


. 3).


"The advisory


committee


should


play


a key role


in developing the curriculum


[and]


periodically review the


curriculum"


(AMA,


1981b


Evidence


of a broad scope and potentially political


nature of


a required advisory


committee


was


found


respiratory therapy


guidelines.


A well organized,
important force i


active advisory


-n evaluating,


reconciling the diverse


board


of the educational


institutional


therapy


faculty


interests


institution,


administrations,
y, the hospitals,


the
the


committee


balancing,


the governing
the


respiratory
students,


the community.


should be attended by a


. The meetings of


senior executive


committee
officer.


(AMA,


1977b,


7-8)


As mentioned,


teaching and


related activities


formed


the bulk


of faculty/program officer roles as expressed


most


sets


of accreditation standards.


Before discussing the


sciences


that


faculty were expected


teach,


standards


in relation


faculty


service and


research are discussed.


Faculty Service


Co roreiy1i r1 44-4l oc f hol1 nrnocc


. on


n.d.,


nrn faec! c T 1


~fr health







prof


session


institutional/community


service


or service


the


scipline/prof


ess


ion.


In addition


service


implications


evidenced


profess


ional


cre


dential


experience


requirements


, all


sets


of standard


contained


statements


about


clini


service.


In order


director


and


"have


of clinical


evaluative


education


functions


a respiratory


therapy


staff


reform


sition,


instructional


or she


appointment


clinical


affiliates


" (AMA,


1977b


. 5)


Phys


cian


surgeon


s assis


tant


standards


mentioned


practice


physicians


as primary


teachers


and


model


(AMA


, 1982


1985c


Dieteti


standards


required


faculty


to "show


evidence


of prof


essi


onal


growth


through


continuing


education


, experience


as practitioners,


or by


other


means"


(ADA,


1976


, p.


Dental


hygiene


guid


lines


stat


that


"faculty


who


provide


preclinical


technique


clini


instruction


must


have


. profic


iency


clinical


dental


hygiene"


(Amer


. Dent.


Assoc


. 24)


And


"a periodic


return


to medical


Thus


record


faculty


practice


clinical


is desirable"


service


was


AMA,


addressed


1981a


in terms


of faculty


skill


development,


maintenance


that


relation


, continuing


to students,


education


such


modeling


or supervision.


More


prevalent


than


above


examples


which


support


faculty


service


were


standards


guidelines


which


S S S -


_ r0


-1 -


1







[histotechnology]


program director should be expected


carry


a full-time technical


service load"


(AMA,


1978,


"The


radiographicc]


program director's responsibility


shall


not be adversely


affected by


educationally unrelated


functions"


(AMA,


1983c,


For nurse anesthesia


"provisions will


be made


to allow an equitable amount


time


class


. preparation"


(AANA,


1980,


accreditation requirements except occupational


therapy


, physical


therapy,


nursing,


and pharmacy warned


against student


exploitation


in the clinical


setting.


"Students must not be responsible


in any


significant


way


the service


function of


the clinical


laboratory"


(AMA,


1977a,


unpaged).


Radiography


students


"shall


take


responsibility


or the


place of


staff.


. Shifts with


limited


or repetitious experience may


be viewed


exploitation"


(AMA,


1983c,


"The


[respiratory therapy]


program shall


substitute or permit


to be substituted


students


for paid


personnel


to conduct


the work


clinical


affiliates"


(AMA,


1977b,


Accreditation


institutional


In fact,


requirements


or community


some standards could be


extraprogram or


extrainstitutiona


for or direct


evidence


service were generally


interpreted

1 endeavors.


lacking.


to preclude

"The


[radiological


technology]


program director must be exempt


from all


clinical


or departmental


duties


not directly


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


45)


nrh~r ~m((


I ---h


1 00 1I


-- ^ ^^.^ t


CI







reference


program,


institution


or community


(ADA,


1976)


Medical


record


administration


guide


lines


limited


the


program


director


teaching


load


to one-half


two-thirds


time


so "administrative


duti


within


institution"


(AMA,


1981a,


can


be undertaken.


Dental


hygiene,


occupational


therapy,


phys


ical


erapy


nursing


, and


pharmacy


standards


stipulated


service


institution


and/


prof


session


(ACPE,


1984;


Amer


. Dent


Assoc


n.d


; AMA,


1983b


APTA


, 1978;


NLN


, 1980)


"The


institution


provides


[phys


ical


therapy]


program


faculty


participation


in the


governance


program


institution


as well


as short


-term


long-term


planning"


(APTA,


1978


. B-2


"Release


time


must


prov


ided


[dental


hygiene]


prof


ess


ional


assoc


nation


activity


(Amer


. Dent


. Assoc.


n.d.


, p.


Nursing,


"faculty


endeavors


include


participation


. professional


activities


and


community


service


" (NLN


, 1980


. 36)


And


"participation


university, as evid

of committees, and


life


enced


involvement


the college


mmittee s

in campus


. .


service


. and the

, chairmanship


governing


bodi


(ACPE


, 1984


. 7)


is expected


of pharmacy


faculty


summary


restrict

clinical


most


or equated


practice


sets


with


requirements


of standards


clinical

were di


, service


practice


scussed


was


Faculty


as supportive


or necessary


the


teaching


mission


were


- S -


I -


* _


t 1 r


II







frequently and


extensively than


faculty


responsibility


service.


six sets of


standards which required


institutional


and/or community


service all


except


dental


hygiene


limited sponsorship to 4-year


colleges


universities and all but occupational


therapy were


non-CAHEA


accredited.


Faculty


Research


Accreditation requirements


faculty


scholarship and


research are salient due to their relative


absence.


Excluding nursing


and pharmacy guidelines,


which mentioned


such


expectations


in several


contexts,


only physical


therapy,


occupational


therapy


, and


dental


hygiene guidelines


discussed


faculty


scholarship


Physical


therapy


faculty


"competence will


be evaluated


through


review


scholarly productivity"


responsibilities


(APTA


, 1978,


[for occupational


B-3)


therapy]


"Faculty


may


include.


research"


faculty


(AMA,


salaries,


1983,


dental


Regarding


hygiene standards


allocation


listed several


factors to consider


"research


competencies"


(Amer.


Dent.


Assoc.,


, p.


were among them.


Occupational


therapy


and dental


hygiene standards mentioned research


an area


for faculty


development


(Amer.


Dent.


Assoc.,


n.d.


AMA,


1983b).


Seven


sets of


allied health


standards


guidelines mentioned


research activities


in terms


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


TT^ l"-


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


n".^l ." 1


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


Ill~h


1







method,


to read


and


interpret


professional


literature,


partic


ipate


clinical


research


activity


, and


critically


analyze


new


concepts


findings


provided


ers


(APTA,


1978,


. B-8)


"The


cytot


echnologist


will


demonstrate


ability


to read


and


evaluate


published


profes


sional


literature


. [and


understand]


princ


iples


scie


ntifi


research"


(AMA,


1984,


Major


curriculum


divi


sions


were


label


res


earch


methods


stati


stics


rese


arch


occupational


therapy


medical


record


administration


, respe


active


(AMA,


1981a,


1983b)


Cardiovascular


technology


nurse


anesthesia


standards


mentioned


rese


arch


as a curricular


elective


The


word


rese


arch


was


not


found


in any


context


in the


accreditation


requirements


dieteti


, hi


stotechnology


medical

assistant


technology, pe

t, respiratory


rfusion

therapy


technology,


phy


surgeon


sician


s assistant.


Radiation

holdings


therapy


should


radiography


suffi


cient


mentioned


to promote


once:


"independent


Library


stud


and


research"


(AMA,


1981b,


1983c


Cardiova


scular


technology


, nucl


ear


medicine


, nurse


anesthesia,


and


sonography


standards


mentioned


research


library


context


(AANA


1980;


AMA,


1980a,


1984


1985b)


Phys


ical


therapy


sonography


guide


lines


mentioned


resea


paragraphs


concerning


ace


needs


(AMA,


1980a;


APTA,


1978)


Nursing


pharmacy


standards


-a a -


, p.


1 ..


h m_







creative


endeavors,


S. research


, and


scholarly


activity


es" (NLN


, 1980,


. 29)


And


pharmacy


faculty


members


were


to be evaluated


"scholarship


demonstrated


productive


research


securing


extramural


funding


in support


of research"


(ACPE


1984


, p.


summary


, five


sets


of standards


(cytotechnology


medical


records


admini


station,


nuclear


medi


cine,


occupational


program


with


therapy,


graduates


appropriate


physical


to under


res


tand


search.


therapy)


, interpret,


cardiovascular


required the

and/or assis


technology


nurse


anesthesia


suggested


this


as an


innovative


idea


Seven


did


mention


research


or scholarship.


Three


used


words


res


search


or scholarship


when


esc


ribing


space


library


holdings


, or student


loans


(radiography,


radiation


therapy


, and


sonography)


Among


alli


ed health


standards


dental


hygiene,


occupational


therapy,


and


phys


ical


therapy


standards


stated


that


scholarship


research


constitute


bona


fide


faculty


activity


es.


Excluding


these


three


, thi


marked


contras


nursing


pharmacy


The


Bionhv


sic


Sciences


The


curricular


divis


ions


in the


various


standards


were


itemi


scussed


seven


ways


This


influences


how


the


science


requirements


were


discus


since


they

the


constitute


manner


ed only


in which


a part


of each


curriculum


curriculum.


requirements


Therefore

were








discussion


cross


-professional


concerns.


first,


what


evidence


is there


that


conceptual


integrative


competence


regarding


biophysical


sciences


were


concern


those


who


wrote


the


accreditation


standard


Concern


conceptual


competence,


as defined


Stark


et al. (1986)


sciences


was


apparent


in the


accreditation

biophysical s


standards


science


because


requirements


all

and


sets


of standards


several


explained


had

why.


For


physician


assis


tants


sic


medical
bsequent


sciences
clinical


are


needed


studi


as a


foundation


[and


desirable
concepts
pathophy


. that
in anatomy,


siology,


phys


pharma


background
biology,


cology,


include


basi


clini


laboratory


medi


cine


in as much


the sub


seque


under


standing


of clinical


medi


cine


depends


upon


knowledge
p. 4)


these


content


areas


"The


structure


professional


curriculum


diagnostic


sonography


based


upon


a prerequis


foundation


postsecondary


study


biological


sciences


, introductory


phy


sics


, and


mathemati


must


include


didactic


content


appropriate


scope


depth"


(AMA


, 1980a,


. 100).


Other


statements


infered


a concern


egrative


compete


ce.


Respiratory


therapy


students


had


"under


stand


the


basi


sciences


how


basic


principles


relate


clinical


application


the


specialty"


(AMA,


1977b,


"Students


should


acquire


a cl


ear


understanding


basic


sciences


how


basi


scientific


prince


iples


relate


. (AMA,







curriculum must reflect


the relationship


between


the content


of the course of


study and histotechnology


including principles and practice,


functions,


application


of basic


sciences,


.. review


of chemistry;


laboratory mathematics;


anatomy


tissue


identification"


(AMA,


1978,


unpaged).


Biophysical


Sciences


in Each


Curriculum


Cardiovascular technology


standards divided


curriculum


into


basic,


cardiovascular,


clinical


units.


Five components


suggested


for the basic unit were


introduction,


anatomy


anatomy,


basic medical


physiology,


and physiology were


electronics,


sciences.


pharmacology,


Pharmacology,


to be concentrated


on the


cardiovascular system.


The sciences were


include


"biology,


basi


chemistry,


physical


principles


of medicine,


basic statisti


Curricular


found


and general

evidence f


the course examples


mathematics"


or biophysical


listed


(AMA,


1985b,


sciences


under the


was


clinical


unit,


1.e.,


cardiac and vascular pathology


and physics.


Cytotechnology guidelines


recommended


semester


hours


of chemistry


prerequisite


20 semester


to professional


hours


of biological


subjects.


The biology


sciences


courses


could


include


"general


biology


, bacteriology,


parasitology,


cell biology,

embryology, a


physiology,


ind genetics"


anatomy,


(AMA,


zoology


1983a,


, histology,


Professional


course


titles


or subjects were not


listed


but


the standards


'U~ aI U 0I 0


- I


I


*







disease,


the


cytotechnologist


will


be able


to develop


differential


diagnosis


based


on the


cellular


evidence


conjunction


with


pertinent


cognitive


know


edge


and


clinical


data"


(AMA,


1983a,


. 2).


Dental


general

hygiene


hygiene


education,

sciences,


standards


basi


divided


sciences,


clinical


curriculum


dental


practice.


sciences

Several


into

dental


topics


which


did


not


need


to be


equivalent


individual


courses


which


had


to be presented


are


sted


under


each


divi


sion.


Among


ese


were


general


chemi


stry,


anatomy


physiology


, biochemistry


, mi


crobiology,


pathology,


nutrition,


pharmacology,


tooth


morphology


, head


-neck-and-


oral


anatomy,


oral


embryology


stology,


oral


pathology,


radiography


, and


periodontology


dental


material


(Amer


Dent


SAssoc.


, n.d.).


Required


dieteti


prerequis


ites


were


inorganic


organic


chemi


stry,


microbiology


human


phys


biology


, and


introductory


nutrition


course.


Depending


upon


the specialty


tract


elected


biochemi


story,


biochemistry


analysis


anatomy


advanced


phys


biology,


or genetics


was


required


or recomme


nded


(ADA,


1976).


Profess


ional


courses,


topi


or competencies


were


itemized.


Histotechnology


standards


listed


topics


which


curriculum


must


include.


These


include


the


"application


basic


sciences,


. review


of chemistry


, laboratory




Full Text

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AN APPLICATION OF STARK'S FRAMEWORK:
IDENTIFICATION AND VALIDATION OF CRITERIA TO EVALUATE
SCIENCE COURSE DELIVERY SYSTEMS
By
ZOLIKA A. HEATH
A DISSERTATION PRESENTED TO THE GRADUATE SCHOOL
OF THE UNIVERSITY OF FLORIDA IN PARTIAL
FULFILLMENT OF THE REQUIREMENTS
FOR THE DEGREE OF DOCTOR OF PHILOSOPHY
UNIVERSITY OF FLORIDA
1988

COPYRIGHT 1988
by
ZOLIKA A.
HEATH

If you can trust yourself when all men doubt you,
But make allowance for their doubting too;
If you can dream—and not make dreams your master;
If you can think--and not make thoughts your aim;
Yours is the Earth and everything that's in it.
Rudyard Kipling
I dedicate this study to my parents who gave me life and to
Bell who helps make life fun.

ACKNOWLEDGMENTS
I acknowledge the members of the Alumnae Association of
the Mount Sinai Hospital School of Nursing, New York City,
the personnel of the College of Pharmacy, University of
Florida, and the owner and artist of Satellite Dance Studio,
Jacksonville for their financial assistance.
I thank all of those who assisted with the preliminary
critigues necessary for this study especially Dr. Gutekunst
and Dr. Gudat. Special gratitude is due to the 21
participants of this study. Also I express my appreciation
to the professional staff of the education, health center,
and main research libraries.
It was my privilege to have been associated with many
outstanding people during my studies at the University of
Florida. I extend my appreciation to Dr. Kern Alexander,
Dr. Margaret Morgan, and Dr. John Wahl. I also thank
Dr. Darrel Mase for offering his support and sharing his
ideas.
I thank my committee members, Dr. Arthur Sandeen and
Dr. Albert Smith III. Special thanks go to Dr. Sandeen for
his open door policy and trust shown toward me. Lastly I
extend my thanks, appreciation, and respect to my chairman,
Dr. James L. Wattenbarger.
IV

TABLE OF CONTENTS
Page
ACKNOWLEDGMENTS iv
LIST OF TABLES viii
LIST OF FIGURES xi
ABSTRACT xii
CHAPTERS
I INTRODUCTION 1
Problem Statement 5
Operational Definitions 6
Delimitations and Limitations 10
Procedures 13
Significance of the Study 16
Organization of the Study Report 17
II REVIEW OF THE LITERATURE 19
Academic Health Centers 19
Colleges of Allied Health 28
Stark's Framework 47
Accreditation Standards: Tools for
Academia 58
College of Allied Health Catalogs 102
Science Related Courses 119
Summary 133
III METHOD 135
Population 135
Selection of the Colleges of Allied Health 136
Selection of the Preliminary Activity
Participants 137
Identification of the Sciences 139
Selection and Role of the Panel Experts 144
v

The Delphi Technique
Data Analysis and Criteria Development
RESULTS
Paqe
146
151
IV
155
Preliminary Statements 156
Science Related Course Faculty
Qualifications 162
Expectations for Science Related
Course Faculty 167
Role of Dean and Faculty in Evaluation
of non-CAH Faculty 17 5
CAH Control of Delivery and Content of
Science Related Courses 179
Summary 189
V SUMMARY AND CONCLUSIONS 191
Summary 191
Criteria 194
Discussion 200
Weaknesses 203
Implementation of the Criteria 205
Recommendations for a CAH to Adopt the
Criteria 206
Suggestions for Further Research and Practice 207
Conclusion 211
APPENDICES
A CATALOG REQUEST LETTER 213
B CATALOG REQUEST FOLLOW-UP LETTER 215
C COLLEGE NOMINATOR REQUEST LETTER 217
D INSTRUMENT TO NOMINATE COLLEGES 219
E LETTER TO PRELIMINARY EXPERTS 222
F GUIDELINES TO IDENTIFY SCIENCE RELATED
COURSES 224
G INSTRUMENT TO IDENTIFY SCIENCE RELATED
COURSES 226
H INVITATION TO DEANS 2 28
vi

Page
I LETTER OF ENDORSEMENT 2 30
J FORM TO NOMINATE FACULTY 2 32
K INVITATION TO ALLIED HEALTH FACULTY 234
L INVITATION TO BASIC SCIENCE FACULTY 2 36
M ROUND II COVER LETTER 2 38
N ROUND III COVER LETTER 24 0
O INSTRUMENT TO DEVELOP CRITERIA 242
P VOTES BY ROUND FOR STATEMENTS 2 60
Q COLLEGE PARTICIPANTS 27 2
BIBLIOGRPPHY 274
BIOGRAPHICAL SKETCH 296
vii

LIST OF TABLES
Table Page
1. Maximum Number of Years of Program
Accreditation and Minimal Program Duration
Requirements 61
2. Number and Percent of Institutions with
Accredited Baccalaureate Health Science [BS]
Programs 6 3
3. Accreditation Requirements for Professional
Credentials of Program Directors 65
4. Accreditation Requirements for Academic
Credentials of Program Directors 66
5. Accreditation Requirements for Experience
of Program Directors 69
6. Sciences Named in Accreditation Standards 92
7. Characteristics of AAHC Members which Listed
Allied Health as a Component 103
8. Identification of Science Related Courses
(SRC) from Catalog Course Descriptions 143
9. Percent Consensus re: Statements 01, 01A,
04, and 04A 157
10. Rank of Importance of Factors in Establishing
Science Related Course Faculty Credentials 160
11. Percent Consensus re: Science Related Course
Faculty Qualifications 164
12. Percent Consensus re: Science Related Course
Faculty Roles by Organizational Structure:
Sponsor (S) and Faculty (F) 169
viii

Table Page
13. Round III Percent Consensus re: Science
Related Course Faculty Roles by Organizational
Structure: Sponsor (S) and Faculty (F) 170
14. Round III Percent Consensus re: Science
Related Course Faculty Counseling Roles 172
15. Percent Consensus re: Role of the CAH Dean
in Evaluation of non-CAH Science Related
Courses 176
16. Percent Consensus re: CAH Evaluation of
non-CAH Faculty Who Teach Science Related
Courses 178
17. Rank of Locus of Responsibility for Allied
Health Curricula 180
18. Percent Consensus re: Curricula
Responsibility 181
19. Percent Consensus re: CAH Dean Responsibility
for Science Related Courses 183
20. Percent Consensus re: CAH Faculty
Responsibility for Science Related Courses by
Organizational Structure: Sponsor (S) and
Faculty (F) 185
21. Round III: Percent Consensus re: Role of
CAH Faculty not Teaching Science Related
Courses by Organizational Structure:
Sponsor (S) and Faculty (F) 186
22. Votes by Round re: Statements 01, 01A, 04,
04A and for Science Related Course Faculty
Qualifications 261
23. Votes by Round for Statements 14-22: Science
Related Course Faculty Roles by
Organizational Structure: Sponsor (S) and
Faculty (F) 263
24. Votes in Round III re: Science Related
Course Faculty Counseling Roles 265
25. Votes by Round re: Role of CAH Dean in
Evaluation of non-CAH Science Related
Courses 266
IX

Table Page
26. Votes by Round re: CAH Evaluation of
non-CAH Science Related Course Faculty Who
Teach Science Related Courses 2 67
27. Votes by Round re: Curricula Responsibility 268
28. Votes by Round re: CAH Dean Responsibility
for Science Related Courses 269
29. Votes by Round re: CAH Faculty Responsibility
for Science Related Courses by Organizational
Structure: Sponsor (S) and Faculty (F) 270
x

LIST OF FIGURES
Figure Page
1 . A Framework for Describing Professional
Preparation Programs 50
2. Specific Influences on Professional
Preparation Programs 51
3. Professional Preparation Outcomes 53
xi

Abstract of Dissertation Presented to the Graduate School
of the University of Florida in Partial Fulfillment
of the Requirements for the Degree of
Doctor of Philosophy
AN APPLICATION OF STARK'S FRAMEWORK:
IDENTIFICATION AND VALIDATION OF CRITERIA TO EVALUATE
SCIENCE COURSE DELIVERY SYSTEMS
By
Zolika A. Heath
April 1988
Chairman: James L. Wattenbarger
Major Department: Educational Leadership
The purpose of this study was to develop criteria which
can be used to evaluate the science course delivery system
for baccalaureate allied health students in academic health
centers. The need for criteria was justified by a
literature review and content analyses of college catalogs
and 20 sets of specialized accreditation standards.
Stark's interdisciplinary professional education
framework was used to identify the science courses from
selected catalogs and structure the proposed criteria.
A modified three round Delphi technique was then used to
obtain expert opinion and consensus from 21 participants
(allied health and basic science faculty and administrators)
among seven health center colleges of allied health.
Xll

Consensus was defined as 100% or 80% agreement by the last
(third) round.
Science courses for allied health students were
delivered under a variety of organizational auspices. The
criteria identified and validated accomodate these basic
structures and are applicable across disciplines,
professions, and colleges.
Participants agreed that all science teachers should
have a university appointment, demonstrate undergraduate
teaching effectiveness, and have a science or related
graduate degree. Tenure, senior rank, and a health
professions credential were rejected as needed credentials.
College of allied health participants' expectations for
science related course faculty included choosing course
goals, objectives, and teaching methods plus research.
Academic advising, curriculum planning, and accreditation
activities were expectations reserved for faculty teaching
college sponsored courses. Allied health faculty were
expected to recommend goals and objectives and relay
accreditation and practice requirements, regardless of
appointment status of the science faculty or college
sponsoring the course.
College deans were expected to attract faculty but they
and other faculty were not expected to identify teachers for
specific courses. Deans were not expected to participate in
course development.
xm

Specific recommendations for a college of allied health
to use in adapting, adopting, and implementing the criteria
were provided. Also other organizations for which the
criteria could be used were listed as nonhealth center
allied health units, other health center colleges, and
accreditation agencies. Suggestions for further research
were provided.
xiv

CHAPTER I
INTRODUCTION
An academic health center (AHC) is an institution that
includes a school of medicine, a teaching hospital, and at
least one additional health educational program. There are
approximately 125 AHCs in the United States, of which 88 and
93 were members of the Association of Academic Health
Centers (AAHC) (Association of Academic Health Centers,
1985; 1986). Of these, 60 were reported as having colleges
of allied health (Association of Academic Health Centers
[AAHC], 1985, 1986).
A comprehensive study of the organization and
governance of the 87 member institutions (as of 1977) was
initiated by the AAHC in 1977. The report of this study was
published in 1980 and consisted of an extensive review of
the literature, several position papers, the presentation of
descriptive information, and priority issues as described by
AHC administrators. Among the 16 major topics addressed
were departmental structure/administration and interschool
relationships. Conclusions regarding these issues were in
part that "inadequate interschool coordination and
cooperation often result in significant administrative
problems concerning the provision of interdisciplinary
education" (AAHC, 1980a, p. 10) and "the organizational
1

2
location of the basic science departments and the quality of
the teaching program for students in fields other than
medicine continue to present problems for those AHCs with
several health schools" (AAHC, 1980a, p. 9).
Several studies indicate that the delivery system for
basic and applied science courses for health professions
students constitutes a major challenge (Association of
Schools of Allied Health Professions, 1973; Clarke, 1983;
Krieger, 1977; Lewis, 1981; Sirota, 1981). Science core
curricula for allied health students have been plagued by
accreditation impediments and criticized for insufficient
depth and irrelevance (Association of Schools of Allied
Health Professions, 1973). Some nursing curricula have been
without a pathophysiology course because qualified faculty
could not be found or other department faculties were unable
or unwilling to teach the content (Lewis, 1981). A survey
regarding biochemistry courses for all dietetics programs in
the United States revealed courses taught in 17 different
departments, little communication between biochemistry and
dietetics departments, and marked variation in course
duration and content (Sirota, 1981). When Krieger (1977)
collected data from allied health faculty in Florida
community colleges, many respondents indicated a need to
update their knowledge of the science topics on the
questionnaire. In a study of medical technology program
curricula, deficiencies were noted in pathogenic
microbiology, biochemistry, and immunology (Clarke, 1983).

3
Concerning the administrative location of the basic
science departments, in the AAHC governance study (1980b) it
was found that they were located in colleges of medicine
(n=42), in each of the health centers' schools (n=23), in a
health center-wide arrangement (n=13 ), or in a university¬
wide system (n=8). Although the researchers did not address
basic science faculty qualifications, they did allude to
them and recognize the organizational variety by
recommendation 25.
When the basic sciences are centralized, the deans of
all health schools with basic science curriculum
content should participate in the development of
the budget of these departments and in the
appointment and promotion of key basic science
faculty members. (AAHC, 1980a, p. 10)
Superimposed upon this basic science organizational
variety is the complexity of the colleges of allied health.
Typically they offer several programs with distinct
curricula and unique accreditation standards imposed by
different accrediting bodies. Structurally, the colleges
may be autonomous entities or subdivisions of larger units
such as a college of medicine. In a survey of
organizational structure of colleges of allied health,
respondents attributed many of their problems, such as
course duplication, conflicts with other departments, and
inadequate laboratory facilities to organizational structure
(Kleinfelter, 1976).
Perhaps in their quest for professionalism or for a
theoretical base it is important to note that many of the

4
allied health professions claim that their practice is or
should be dependent on supporting biophysical sciences
(Covey & Burke, 1987; Hinkle, 1986). Yet, as noted,
investigators have found that science courses for health
professions students are beset by problems. The diverse
curricular needs of allied health programs for the sciences
is complicated by the structural complexity and diversity of
the colleges and the basic science departments.
The literature has failed to reveal any common set of
criteria upon which a college of allied health (CAH) faculty
could evaluate the delivery system for its biophysical
science curricular components for students in all programs.
Yet there is widespread support for meritorious criteria to
be set by experts for the assessment of goals (Fincher,
1978; Koontz, 1971; Nevo, 1983; Roueche, 1976). In a review
of the evaluation literature Nevo (1983) wrote "to choose
the criteria to be used to judge the merit of an evaluation
object is one of the most difficult tasks in educational
evaluation" (p. 121). He noted that many evaluation
theorists ignore the entire issue of the worth of the
criteria by concentrating on data collection to demonstrate
goal achievement or by disregarding the judgmental nature of
evaluation.
Stark, Lowther, Hagerty, and Orczyk (1986) have
proposed a framework for the study of professional degree
programs in 4-year colleges and universities. "Briefly, it
asserts that professional preparation programs are

5
influenced by internal, intraorganizational, and external
forces" (p. 236). These forces, they claim, interact to
create the professional preparation environment which
influences educational processes which result in
professional preparation outcomes. The outcomes consist of
two categories, professional competencies and professional
attitudes. Several elements of the former category, namely
conceptual competence, concern the goals of the biophysical
sciences in allied health curricula.
Thousands have participated in the development of this
framework. From 1 through 4 authors plus contributors have
been identified on publications relative to the development
of this framework (Stark & Lowther, n.d.). For simplicity
throughout this research report the framework will be
referred to as "Stark's." No discredit is intended to the
other researchers.
Problem Statement
The purpose of this study was to identify and validate
criteria using Stark's framework, that can be used to
evaluate the delivery system for science related courses for
baccalaureate allied health students in academic health
centers. Criteria were identified and validated to answer
the following questions:
1. What professional and academic qualifications
should science related course faculty have?

6
2. In what roles should science related course faculty
engage?
3. What control should the college of allied health
dean and faculty have in the evaluation of science
related course faculty who do not have primary
appointments in the college?
4. What control should the allied health faculty and
dean have upon the delivery and content of science
related courses?
Operational Definitions
Academic health center (AHC) is defined as an
institution that includes a school of medicine, a teaching
hospital, and at least one additional health educational
program. A synonymous but older term is academic medical
center.
Adaptive competence is the ability to anticipate and
adapt to changes (e.g., technological changes) important to
the profession (Stark et al., 1986).
Allied health is an umbrella term with many
definitions. In this study it refers to those occupations
which are health related and have educational programs in
colleges of allied health, such as medical technology,
physician assistant, and respiratory therapy. This excludes
most of the older, independent, or more established
occupations whose practitioners prefer not to be so
considered and whose programs are usually not under the

7
auspices of colleges of allied health. Examples are
dentistry, medicine, nursing, and pharmacy.
Allied health faculty are instructors with a health
science credential and a primary appointment in a college of
allied health, who teach baccalaureate level allied health
students in the classroom.
Allied health professional is one prepared in an allied
health occupation at the baccalaureate or higher level.
Basic science faculty are instructors who teach one or
more science related course to baccalaureate level allied
health students. They usually have a graduate degree in a
biophysical science, do not hold a health professional
credential, and may or may not have a college of allied
health appointment.
Clinical practice refers to professional/technical work
at the service site by faculty or students when a
client/patient is directly or indirectly the recipient of
care.
College of allied health (CAH) is an academic unit of a
university or academic health center with more than one
allied health educational program, a faculty, and
administrative personnel. Such units are sometimes called
school or division. The term college will be used to refer
to all colleges, schools, or divisions of allied health in
AHCs.

8
Conceptual competence is the understanding of the
theoretical foundations of the profession (Stark et al.,
1986) .
Contextual competence is the understanding of the
societal context (environment) in which the profession is
practiced (Stark et al., 1986).
Criteria are written statements on which a judgment or
decision may be based. In this study, criteria are
distinguished from standards and guidelines in that the
latter are specifically for the purposes of accreditation.
Delivery system relative to the science related courses
refers to those elements such as faculty, nonhuman
resources, locus of control, and organizational structure
which are antecedent to the presentation of the courses.
Department chairperson is the academic leader who
represents the faculty of one or several programs. A
particular program may be the responsibility of a department
chairperson or a program director. The older term,
chairman, may be retained to report those studies in which
that term was used.
Guidelines are written narrative which serve to extend,
explain, and clarify accreditation standards. They are not
absolute.
Health professional is a global term used to describe
all professional personnel involved in patient care (direct,
administrative, educational, or research) in patient care

9
facilities, or in public health, or environmental health
activities. This includes allied health professionals.
Integrative competence is the ability to integrate
theory and practice (Stark et al., 1986).
Interpersonal communications is the ability to use
written or oral communication effectively (Stark et al.,
1986).
Professional courses are those theoretical and
practical required subjects which result in the student
being able to demonstrate prescribed competencies i.e., to
practice the profession. This includes all professional
phase required courses except those identified as science
related.
Program is a curricular system designed to educate
persons to function in a particular health profession.
Program director is a person responsible for the
teaching, administration, periodic review, continued
development, and general effectiveness of a program.
Research is an activity that treats the substance of
one's discipline/profession in a creative and scholarly
manner and communicates the knowledge gained from that work
so that it is available to the discipline or profession as a
whole.
Scholarly concern for improvement is the degree to
which a graduate recognizes the need to increase knowledge
through research (Stark et al., 1986).

10
Science related courses (SRC) are basic or applied
biophysical science subjects which health professions
students take during enrollment in the professional program.
The published catalog descriptions for these courses
indicate that a major expected outcome is the development of
conceptual competence. This excludes prerequisites,
clinical practice, social sciences, and professional or
technical methods courses.
Service refers to all professional faculty activities
not defined as teaching or research. These activities may
include committee work, accreditation activities, clinical
practice, and service to the profession or community.
Standards are written statements by which educational
programs are reviewed, surveyed, or evaluated for purposes
of accreditation. They are generally binding for accredited
programs. Some accrediting agencies use the terms,
essentials or criteria. In this dissertation, all such
statements will be called standards.
Teaching includes preparation for, evaluation of, and
all student contact hours associated with a given course,
module, or lesson.
Technical competence is the ability to perform tasks
required of the profession (Stark et al., 1986).
Delimitations and Limitations
The college population of interest consisted of 60
colleges of allied health, within academic health centers

11
that were members of the AAHC (AAHC, 1985, 1986). The
program population of interest included all baccalaureate
programs in AHCs administered by the college of allied
health except nursing, pharmacy, or social work
(Occasionally these are organized within the same
colleges.). Allied health programs within the university
but outside of a CAH were excluded. For example, dental
hygiene programs in CAHs were included, those in dental
colleges were not.
The panelists who participated in the development of
the criteria consisted of three subgroups, CAH deans, basic
science faculty, and allied health faculty. Students and
individuals who taught exclusively in the clinical area were
not included. The strength of the criteria formulated were
a reflection of the appropriateness of the framework
developed by Stark et al., the literature review, and the
expertise of the panel experts.
One limitation results from developing criteria general
enough to apply to any biophysical science course for any
baccalaureate allied health program. Other studies are
usually limited to one science or a few allied health
programs. While this might simplify the situation it would
defeat the purpose of this study. It was not the intent to
compare among sciences or programs. At issue was the
development of criteria that any professional could use to
evaluate the science course delivery system for

12
baccalaureate allied health students in colleges of allied
health in academic health centers.
The operational definition of a science related course
is both asset and liability. The term is unique. The
grouping of what may be labeled basic, applied, fundamental,
bridge, clinical, or professional sciences under one
category may appear artificial (Thier, 1987). This may
represent an unfamiliar way of viewing the allied health
curricula. This may be perceived as an impingement on
professional course "turf" or the attenuation of science.
The courses may be difficult to identify in programs that
use an integrated curriculum, that is, basic science and
professional content combined in one course.
The validity of the aggregation of these courses is a
function of the methods used to identify them and the
assumptions on which these methods rest. In brief, a group
of experts determined that the course descriptions met a
criterion of the Stark et al. framework. This assumes that
the framework and expert opinion have validity. The
framework will be discussed in Chapter II. Its use in the
identification of science related courses will be explained
in Chapter III.
Critics may claim that there were already several sets
of criteria for the evaluation of allied health programs,
i.e., accreditation standards. This was correct. The
Committee on Allied Health Education and Accreditation
(CAHEA) accredited via its constituents 26 allied health

13
programs and each had its own set of standards (American
Medical Association [AMA], 1987). In addition to this,
several programs found in colleges of allied health such as
dietetics, dental hygiene, and physical therapy were
accredited by other agencies.
Program accreditation is most representative of
professional practice concerns (Hinkle, 1986). Various sets
of standards are intended to address the biophysical
sciences vaguely, narrowly, or indirectly and from their own
unique perspectives. It is no wonder that deans of CAHs
consider "accreditation standards . . . giant stumbling
block[s]" (McTernan, 1972 p. 168). Furthermore, it is
questionable if faculty of colleges of allied health in AHCs
should measure their biophysical science course delivery
success by accreditation standards (Schermerhorn, 1986).
Of 3,042 programs accredited by CAHEA only 672 were in 4-
year colleges, universities, or medical schools (AMA, 1986,
p. 244). Often the same standards are used to evaluate
programs in hospitals, community colleges, proprietary
schools, blood banks, government institutions, and AHCs.
Procedures
Study Design
A review of the literature was undertaken regarding
academic health centers, colleges of allied health, and
their faculty and administrators. Accreditation standards
for 20 health professions were examined. Mission statements

14
and goals claimed by several AHCs and their universities and
colleges of allied health were reviewed. Using Stark's
framework as a guide, the literature review was focused to
identify and define further biophysical science in the
curricula.
From the literature review statements were formulated
upon which the science related course delivery systems in
colleges of allied health could be evaluated. These
statements were critiqued by three experts; one allied
health dean and two faculty who teach science related
courses to health professions students. After all had
reviewed the material, each expert was interviewed. The
statements and supporting information were revised and
prepared for a three round modified Delphi study with the
panel experts.
The Delphi technique is recommended for use with
problems that do not lend themselves to precise analytical
techniques. It is suggested as a method of choice when
communication among diverse peoples must be facilitated but
time and cost preclude group meetings. It was a method used
in the academic health center governance study cited
previously (AAHC, 1980a, b). The Delphi will be explained
in Chapter III.
Selection of the Colleges
The colleges were in centers that were AAHC members
during 1985 or 1986. They were autonomous or distinct
divisions of other colleges and offered three or more

15
generic allied health programs. Every effort was made to
include at least one center representative of each of the
four possible basic science department structures. Ten
colleges, which were public, private, and geographically
dispersed around the nation were then selected as
representative leaders by two deans of allied health and the
investigator. Eight deans of the 10 colleges nominated
indicated their willingness to participate.
Selection of the Panel
The purpose and method of the study was briefly
explained by letter to 10 deans. They were told the purpose
of the study, why their college was chosen to participate,
and their role. A follow-up telephone call was made to
answer questions and learn of their willingness to
participate. The 8 who agreed to serve were selected.
Program confirmation and faculty nominees were also
requested.
The panel consisted of 21 experts; deans, basic science
faculty, and allied health faculty from among the colleges.
Broad disciplinary input was encouraged by the instructions
provided to the deans for nominating faculty (see
Appendix B). Identification of 4 faculty per CAH insured
substitutes should some choose not to participate. It also
permitted the investigator to select for diverse
disciplinary and professional representation from all of the
colleges. For this reason, 1 through 5 persons per
institution were invited by letter to participate.

16
Role of the Panel
After review by the preliminary study experts and after
revision of the statements, the statements as well as
supporting information were distributed by mail to the panel
members. Panelists were asked to indicate their agreement
or disagreement with each statement and contribute opinions.
Inclusion, exclusion, or revision of any item was determined
by a preset score. This procedure is discussed in Chapter
III. Panel members were asked to reevaluate and respond to
the same and additional statements on a second and third
round. From the literature and panel expert opinion the
criteria that may be used to evaluate elements of the
science related course delivery system were developed.
Significance of the Study
The fact that science related course delivery for
allied health students is often a challenge is indisputable
(Clarke, 1983; Krieger, 1977; Sirota, 1981). Furthermore
the location of an allied health program in an academic
health center--the citadel for health sciences education—
need not ameliorate the problems. "The organizational
location of the basic science departments and the quality of
the teaching program for students in fields other than
medicine continue to present problems for those AHCs with
several health schools" (AAHC, 1980a, p. 9).
Literature of the older health professions shows a
consistent pattern of efforts to incorporate the basic

17
sciences into the varied curricula and improve the delivery
of such courses. In advocating laboratory and not just
lecture of the basic sciences for medical students, Flexner
(1910) stated
after a strenuous laboratory discipline, the
student will still be ignorant of many things, but
at any rate he will respect facts: he will have
learned how to obtain them, and what to do with
them when he has them. (p. 68)
In her treatise on nursing education, Goldmark (1923)
noted: "Common defects of scientific instruction in the
training schools studied are the lack of good teachers, the
neglect of laboratory work, and the insufficient allowance
of time" (p. 257). Obviously recent as well as classical
studies of the education of students of the health
professions have shown concern for the guality and quantity
of the biophysical sciences be they labeled basic science,
applied science, or professional courses.
Organization of the Study Report
Chapter I has provided background information and
justification for a study to develop criteria that can be
used to evaluate the science related course delivery system.
Chapter II is a review of the related literature. It
encompasses three general areas: (a) Stark's theoretical
framework upon which this study was based, (b) literature
about academic health centers, colleges of allied health,
and science course delivery systems, and (c) content

18
analyses of accreditation standards and college of allied
health catalogs.
Discussed in chapter III is the methodology employed to
select the participants and identify the science related
courses. Also explained is the Delphi technique and the
data collection and analysis. Chapter IV is an analysis of
the data obtained while developing the criteria. Lastly,
Chapter V is a discussion of the resulting criteria, their
implications, and recommendations for further research.

CHAPTER II
REVIEW OF THE LITERATURE
The purpose of this chapter is to provide an overview
of academic health center sponsored colleges of allied
health, their structure, faculty, and curricula pertinent to
science course delivery systems. It is divided into the
following sections: (a) an overview of academic health
centers; (b) information and studies about colleges of
allied health, faculty, and administrators; (c) a review of
Stark's framework for professional education; (d) an
analysis of specialized and proposed college-wide
accreditation standards; (e) a review of college of allied
health catalogs; and (f) a review of studies relevant to the
delivery of science courses for allied health students.
Literature pertinent to the methodology of this study will
be addressed in Chapter III.
Academic Health Centers
Academic health centers (AHC) have evolved from a
confluence of several entities within American society. A
comprehensive review would entail a discussion of higher
education, the education and training of physicians and
other health professions, the teaching hospital, and the
19

20
health care delivery system. The development and synthesis
of these subjects was beyond the scope of this study. But
an overview is mandatory since the colleges within this
study were all AHC sponsored, and this has major
implications for the science related course delivery system.
The genesis of AHCs occurred during the latter 19^
century (Ginzberg, 1985). Prereguisite to this were
advances in the basic sciences; chemistry, physiology,
immunology, and bacteriology (Ludmerer, 1983) and the
concomitant clinical discoveries such as anesthesia,
asepsis, and the roentgen ray (Friedson, 1973). The
physicians of the leading medical schools of the day,
already university affiliated, began to seek closer
alliances with the hospitals where these new technologies
could be taught (Ludmerer, 1983). Medical education focused
on the undergraduate and research was secondary
(Ginzberg, 1985).
With the opening of Johns Hopkins University in 1876
and Hospital in 1893, the role of research gained momentum
(Ludmerer, 1983). In 1910, the now luminary Flexner report,
gave impetus for medical school faculties to pursue closer
affiliations with both universities and hospitals (Ashley,
1976; Ludmerer, 1983). During the early decades of the 20^
century the university-teaching hospital-medical school
triad became well established (Ashley, 1976; Ludmerer,
1985). Nurses and other workers who might later be known as
dietitians or medical technologists were trained on the job,

21
in hospitals (Ashley, 1976; Friedson, 1973). Allied health
occupations which trace their origins external to hospitals
and independent of medicine, such as occupational therapy,
moved into the hospital and became physician dominated
during this period (Savitt & Kopperl, 1982).
After World War II these centers for medical care and
education began to undergo major changes (Hogness & Akin,
1977). Factors inducing change were the perceived need for
collegiate nursing and allied health educational programs,
the medical schools ambition to expand the clinical teaching
sites to veterans and community hospitals, the universities
responsibility to coordinate and integrate the expanding
health related activities, and policies of the federal
government (Ebert & Brown, 1983).
Petersdorf and Wilson (1982) identified three
overlapping post-World War II phases in AHC development,
recognizable by governmental influences. The biomedical
research era commenced in the middle 1940s when government
leaders decided to rely primarily on academia to conduct
biomedical research. Federal financial support began to
contribute immensely to the expansion of basic science
departments (Ginzberg, 1985; Petersdorf & Wilson, 1982).
This facilitated specialization in the clinical departments
and the provision of intensive tertiary care for referred
patients in the teaching hospitals.
The health manpower era began in the late 1950s with
reports and studies in which the authors called for more

22
physicians and medical schools (Petersdorf & Wilson, 1982).
These reports were catalysts for passage of the Health
Professions Education Assistance Act in 1963. This
legislation, later amendments, and manpower acts which
followed provided money for facilities and training of more
health professionals. This era peaked in 1971
(Ginzberg, 1985).
Petersdorf's, public service era began in the 1960s.
By this time AHC faculty had trained hundreds of physician
specialists who had or would follow the middle class
migration to the suburbs. Given their guality training, it
became less necessary for these physicians to refer clients.
For the AHCs, this translated into smaller patient pools and
declining hospital admissions, heretofore the sine guo non
for the "cash cow," i.e., the teaching hospital
(Ginzberg, 1985). This manifestation of success coupled
with more general social phenomena; a decline in city
services, urban traffic congestion, civil rights movements,
and increased minority and indigent populations; facilitated
a demand for more responsiveness to the local community.
Now the AHC leaders, with their world view, renowned
biomedical research programs, and graduate and graduate
medical education emphases were being forced to compete with
community hospitals for paying patients and respond to the
primary health care needs of their neighborhoods (Rogers &
Blendon, 1978; Sloan & Valvona, 1986). "In 1948, 70 percent
of the patients cared for at Johns Hopkins Hospital were

23
referred from outside the Baltimore area—indeed, often from
abroad" (Rogers & Blendon, p. 946). Thirty years later this
situation had been reversed, "80 percent of the patients
admitted came from a 16-km. radius of Baltimore" (p. 946).
Rather than diagnose, treat, and cure cases of typhoid
fever, tuberculosis, and poliomyelitis, the health
professionals and their teaching hospitals now care for
victims of trauma, cirrhosis, and acquired immunodeficiency
syndrome (AIDS). The nonbiological etiology of many of
todays diseases lie outside of the germ theory of disease
and the domain of traditional medicine (Rogers & Blendon,
1978). In addition to problems posed by present day
epidemiology, the AHC is also challenged by "problems in
organization and governance" (AAHC, 1980a, vii).
There is no list of common characteristics of AHCs and
therefore no absolute agreement on how many exist (Ginzberg,
1985). But experts concur on the dominant role of the
college of medicine (Morris, 1980; Petersdorf & Wilson,
1982) and on the crucial relationship of academic medicine
with the teaching hospital (Ebert & Brown, 1983). Their
overall missions; research, service, and teaching are
technically congruent with the universities of which most
are a part.
However the AHCs and in particular their medical
colleges service commitments far surpass in intensity or
scope that of other professional schools. Colleges of law,
education, and business do not conduct the courts, the

24
public school system, or the stock exchange. But colleges
of medicine dominate the teaching hospitals (Rogers &
Blendon, 1978). This business enterprise necessitates
considerable interface with the community. The centers may
have millions of dollars invested in their physical plants
and may employ thousands of modestly skilled workers
(Wilson & McLaughlin, 1984). Health center scientists,
physicians, and scholars turned administrator may be working
with zoning boards, insurance agencies, union negotiators,
and city planners (Rogers & Blendon, 1978).
Internally AHC governance "tends to be decentralized,
ad hoc, and vested in small committees" (Rogers & Blendon,
1978, p. 944). The decision-making process is slow and
cumbersome (Ginzberg, 1985). Ideally leaders are expected
to engage in teaching, research, and patient care as well as
administer the departments and center-wide affairs
(Weisbord, Lawrence, & Charns, 1978). To compound the
difficulties of governance on all levels, "the autonomous
medical science culture tends to value technical far above
interpersonal and group skills" (Weisbord et al., 1978,
p. 303).
In the recent past AHC faculty and administrators
enjoyed the National Institutes of Health grant monies.
They still do, but these funds are now abating (Ebert &
Brown, 1983) and diminishing in real dollars (Ginzberg,
1985). Social legislation of the 1960s converted many
indigents into insured citizens who with Medicare or

25
Medicaid could pay for medical services deemed necessary by
any physician. This has now been capped with a prospective
payment system, which became effective in 1984 (Schramm,
Renn, & Biles, 1986). The intent was in-hospital cost
containment. Some of the affects have been staff
reductions, fewer diagnostic tests, and shorter lengths of
stay. Relatively more health care is being delivered
outside of the traditional voluntary teaching hospital. For
the AHCs, these changes have increased competition among
health care agencies and providers.
By 1950 the American physician professor had become as
respected as his 19^^ century German counterpart (Ludmerer,
1985). The intimate medical school-teaching hospital
alliance had been fought for and won. Medical deans were
called to Washington for advice (Rogers & Blendon, 1978).
But all of this is changing. Physicians are now called to
Washington and told they are unresponsive to society and
not meeting its needs (Evangelauf, 1986, 1987; Rogers &
Blendon, 1978). Coordination among the hospital(s) and all
of the center colleges is more complex. Nursing and allied
health, largely subordinate to medicine, and pharmacy, and
dentistry, primarily isolated from medicine are demanding a
greater part in AHC affairs (Henderson, 1980; Morris,
1980).
The watchwords now are for improved interpersonal,
professional, and public relations. The call is for better
rapport between the AHC and its university (Hogness & Akin,

26
1977), government (Rogers & Blendon, 1978), and faculties
(Christensen, 1978). The solutions demand effective
leaders (Petersdorf & Wilson, 1982) who are possibly
selected by a set of criteria different from the past
(Christensen, 1978). They should be capable of strategic,
proactive planning and not just respond to each crisis
(Ebert & Brown, 1983; Wilson & McLaughlin, 1984). Today's
AHC leaders may disagree over the role of specific
occupational groups in health center governance but many
are advocates of an improved application of the social
sciences and humane arts. One administrator with
responsibility for encouraging this is the vice president
for health affairs.
Today most AHCs have such an officer (AAHC, 1980b).
This person's presence (or absence), responsibilities, and
style have a direct bearing on colleges of allied health.
The authority and roles of the vice presidents are as
diverse as the AHCs they orchestrate (Pellegrino, 1975).
Petersdorf and Wilson (1982) describe three typologies. In
one, the dean of medicine serves as vice president, and in
another, the vice president serves the president in a staff
capacity. Lastly, the vice president may be a line officer
with all AHC deans administratively reporting to him or her.
Christensen (1972, 1978), a dentist, believed that a line
vice president fosters professional interaction and believed
nonphysicians should be considered for the post. Of 182

27
vice presidents who served between 1960 and 1976, 20 or 16%
were not physicians (Wilson & McLaughlin, 1984).
The stance of academic physicians toward the vice
president position is mixed. The physician, Hogness
advocated a strong line vice president, in part to improve
coordination of the curriculums of the various health
science schools (Hogness & Akin, 1977). In a discussion of
leadership and medicine, Wilson and McLaughlin (1984),
described a population of "322 individuals who served as
dean of a medical school . . . and 98 individuals who served
only [emphasis added] as vice president" (p. 42). "Medical
school deans also are not enamored of the concept of the
dean and the hospital director being directly accountable to
the vice president" (Petersdorf & Wilson, 1982, p. 1157).
And "vice presidents are probably here to stay, but"
(Petersdorf & Wilson, 1982, p. 1161) they "must not 'run'
the medical school" (Pellegrino, 1975, p. 227). One area of
agreement is that the authority and responsibility of the
vice president should be consciously decided and made known
to all concerned (Pellegrino, 1975).
The perceived threat to college of medicine autonomy
and control which the vice presidency poses for some
(Hogness & Akin, 1977) is accompanied in the literature by
references to college of medicine dominance within the AHC
(Morris, 1980, p. 156; Wilson & McLaughlin, 1984, p. 63).
"Academic health centers are dominated by their medical
schools ... no other health-professional school has very

28
much influence on the academic health center" (Ebert &
Brown, 1984, p. 1201). "Leadership positions in academic
health centers must be defined according to two professional
dimensions . . . medicine and . . . management" (Lostetter,
1981, p. 10). The college of medicine, "more than any other
component influences the character of the center because it
encompasses the major biomedical science base" [emphasis
added] (Petersdorf & Wilson, 1982, p. 1153). Where does
this situation find colleges of allied health and their
science related course delivery system?
Colleges of Allied Health
Emergence of the Allied Health Professions
The curriculum of colonial day Harvard was based on the
classical trivium and quadrivium (A. Levine, 1978). During
the first 2 centuries of American higher education, science
as a field of study gradually gained acceptance. This
occurred with changes in the existing curricula and by the
establishment of new institutions and new curricula that
provided for modern as well as classical courses (Rudolph,
1978). The basic sciences did not always carry credit
comparable to classical subjects because the former were
considered lacking in academic rigor (A. Levine, 1978). The
secondary status of the basic sciences all but ended in the
late 1800s with the leadership of Harvard's President Eliot,
who demanded equity for science with his elective system and
got it (Warfield, 1901/1971).

29
Beyond academia, agrarian America needed citizens with
practical skills and this intensified with the rise of
industrialization in the 19^ century. The sons of traders,
farmers, and craftsmen needed to know more to perform more
complex tasks. Gradually some of the colleges and
universities began to apply knowledge from the basic
sciences to practical problems. Thus, in a delayed but
parallel trend with the basic sciences, the applied sciences
slowly became part of American higher education (A. Levine,
1978) .
The 19^^ century saw the development of the "middling"
classes (Bledstein, 1976) . Aspirations of the common
citizens were for an improved station in life, material
gain, and social prestige (D. Levine, 1986). The
application of science by the universities coupled with this
quest for upward mobility permitted the vocational-
technical-practical occupations to gain access into higher
education. Schools, colleges, and programs of engineering,
agriculture, business, and education were instituted and
flourished. Their graduates then as now, learned a trade,
received professional status, and entered the middle class
(D. Levine, 1986; Friedrich, 1982).
Medicine, dentistry, pharmacy, and nursing have
participated in this movement from apprenticeship into
higher education (Brown, 1983; Grace, 1983; Mrtek, 1976).
The emergence of most of the allied health professions and
their subsequent migration into higher education is

30
essentially a 20^ century and often post-World War II
phenomenon (Ford, 1983). Several situations and events have
influenced the development of the specific allied health
occupations and each has its own history. But they all
arose to satisfy a need created by the larger society, or
some combination thereof.
McTernan (1972) summarized a typical cycle in the
formation of an allied health profession. First there is a
need at the work site, so an available and intelligent
person is informally trained. Next, individuals are trained
on-the-job in several institutions. These people develop
common interests and form an organization. Later they seek
occupational identity and finally professional status. To
acquire this they advocate higher educational standards.
Slowly the training programs shift from the job sites to the
educational institutions.
Common to most allied health occupations was the early
participation of members of more established professions,
namely medicine for medical technology (French, 1974),
radiologic technology (Soule, 1974), and physician assistant
(Howard & Lewis, 1974); nursing for occupational therapy
(Johnson, 1974), respiratory therapy (Collier & Youtsey,
1979), and physical therapy (Scully, 1977); and dentistry
for dental hygiene (Hein, 1974). But the allied health
occupations were also fostered by librarians [medical record
administration] (Pandolfo, 1977), pharmacists and engineers
[radiologic technology] (Soule, 1974), artists and social

31
workers [occupational therapy] (Johnson, 1974; Savitt &
Kopperl, 1982), and physical education teachers [physical
therapy] (Scully, 1977).
Today students of allied health occupations are trained
in a variety of settings (AMA, 1986). In 1986 the Committee
on Allied Health Education and Accreditation (CAHEA) of the
American Medical Association accredited 3,042 programs in 25
fields (AMA, 1986)• CAHEA classified sponsors in five
typologies: (a) hospitals, clinics, and blood banks;
(b) community colleges and vocational schools; (c) senior
colleges, universities, and medical schools; (d) proprietary
schools, consortia, and secondary schools; and
(e) government institutions. Between 1981 and 1985 CAHEA
accredited programs increased by 37. Two hundred and forty-
four hospital programs closed or discontinued accreditation
and 202 additional programs were accredited among community
colleges (AMA, 1986b). Thus the recent shift has been from
hospitals to community colleges and not senior institutions,
including AHCs. The largest segment of allied health
students are trained in community colleges (Ford, 1983).
Only 10% graduate from programs in AHCs (Ebert &
Brown, 1983).
Descriptive Studies of the Colleges
Descriptive information about health professions
faculty and their colleges have been available for years for
nursing and pharmacy (American Association of Colleges of
Pharmacy, 1986; National League for Nursing, 1986). But for

32
allied health many have deplored the lack of data (National
Commission on Allied Health Education [NCAHE], 1980; Year-
end Highlight, 1986-1987). Given the confusion over the
definition of allied health (AMA, 1985a; Anderson, 1981;
Foegelle, 1984; Ford, 1983; Jacobsen, 1977; NCAHE, 1980)
this is perhaps unavoidable. To correct this void a major
objective of the American Society of Allied Health
Professions strategic plan for the 1990s is the development
of an allied health data base ("Deans' winter conference,"
1987-1988).
Relative to educational institutions, this investigator
found two major sources of allied health demographic and
descriptive data, dissertations and professional/
accreditation association documents. Because of subtle and
salient differences in the data collection and analyses
among the associations, data comparisons are often
inappropriate. Furthermore, the associations vary in their
willingness to share data with nonmembers.
Rosenfeld (1972) was among the first to describe the
educational settings of allied health programs. Regardless
of sponsor, he described three organizational patterns based
on administrative and budgetary control. Kleinfelter (1976)
named these structures, independent, dependent, and
coordinated. The independent structure has "all the
prerogatives afforded the other schools and faculties"
(Rosenfeld, 1972, p. 19). The dependent structure "is part
and parcel of another school or department, such as a school

33
of medicine or biology department in the university"
(Rosenfeld, 1972, p. 19). The coordinated structure is an
amalgam "of several other schools or departments under [a
staff] . . . administrative officer" (Rosenfeld, 1972,
p. 19).
Kleinfelter (1976) queried the chief administrators of
118 American Society of Allied Health Professions member
institutions to determine characteristics of the allied
health units and compare findings based upon organizational
structure. Ninety-two (77.9%) participated, 70 from 4-year
institutions and 22 from 2-year institutions. The names and
titles of the allied health units and chief administrative
officers varied. The number of programs in each unit ranged
from less than 3 to more than 15, with a plurality of 6
through 9.
Seventy (76.1%) of the respondents listed problems
which they attributed in part to organizational structure.
These included lack of autonomy, inadequate budget,
insufficient space, absence of a distinct faculty, course
duplication, and conflicts with other departments.
Kleinfelder summarized the characteristics of the units
based upon their structure and recommended a formal
administrative structure, an adequate financial base, and
coordination to prevent duplication and conflicts. A
conclusion was that the more control the allied health unit
had, the fewer the problems. He recommended that "courses
taught in other colleges or departments should be utilized

34
as much as possible for didactic instruction" (p. 116).
This seems contradictory with his other recommendation that
allied health schools "should strive for as much autonomy as
possible in all administrative and academic areas" (p. 116).
Wise (1979) studied the organizational structure, as
conceptualized by Hage, of schools of allied health located
in AHCs. She developed three sets of questions, which were
sent to 83 vice presidents, 54 CAH deans, and 200 department
chairs. Of 129 departments, 37% awarded more than one
degree, 70% awarded a baccalaureate, and none reported
doctoral programs. Several (20.3%) offered more than one
level of a particular major. Dual enrollment of students
from other institutions occurred in 17.9% of the
departments. Some programs were offered in the AHCs but
external to the CAHs and others were sponsored by the
university but were external to the AHC.
"The deans reported 41% of the faculty . . . possess a
bachelor's degree as the highest degree" (p. 85). This did
not include clinical faculty. Faculty with academic or
professional doctoral degrees constituted a mean of 32.4%.
Among the department heads 45% held master's degrees and 40%
held doctorates, nearly 75% were licensed/certified in a
health profession. Eighty-two percent of the deans held
doctorates, typically outside of the allied health fields
they were administering. Most (71.4%) did not have a health
professions credential.

35
Appraisal of the decision-making responsibilities of
the department heads was assessed primarily by student and
clinical issues. Over half (51.9%) reported they did not
make decisions concerning student clinical progress and in
more than one-fourth (28.9%) of the departments students
were responsible for locating clinical facilities for the
required practicums. About one-fourth of the chairpersons
reported that clinical faculty participated in some
[college] departmental affairs. Reasons purported for these
findings were the relative autonomy of the clinical
facilities, program accreditation held by the clinical
facilities, no reimbursement from the universities to the
clinical facilities, the relatively rapid and recent shift
of programs into the university setting, and abdication of
student clinical education by the universities.
Nearly 20% of the allied health department heads did
not report administratively to the dean, but reported to
other department heads, medical directors, or vice
presidents. Some (17.8%) did not represent their own allied
health field in administrative affairs. A medical director
or other appointee may assume this role. Reasons posited by
Wise were the current or recent hospital identification of
the programs and the fact that hospital employees are
typically not participants in administrative matters.
Fourteen percent of the deans reported no tenure and
promotion policy for faculty. Those who did, ranked the
criteria considered most important; teaching ability,

36
acquisition of an advanced degree, and continued education
of self. Least important were research, publication, and
professional consultation. Sixty-two percent of the
department heads "reported that more than 10% of the
university [college] faculty are engaged in research" (Wise,
1979, p. 88).
Wise concluded that the education and decision-making
roles of the department heads varied widely, as did their
titles (curriculum director, program director,
administrator, chairman) and department names (division,
program, name of occupation). Her findings confirmed dual
lines of authority, administrative complexity, and diversity
of the departments. Wise concluded that CAHs are
"decentralized, very complex, . . . stratified, and may be
formal or informal" (p. v.).
Kelley (1975) studied professional identity among
occupational therapy, physical therapy, and medical
technology baccalaureate program faculty and deans from 10
American Society of Allied Health Professions member
colleges. The colleges were geographically dispersed and
representative of all three organizational structures. She
interviewed all of the deans and surveyed the faculty by
mailed questionnaire. Returns were received from 176 (71%)
faculty.
Issues the deans believed most important concerned
course and faculty development and resource acquisition.
They expressed mixed but moderate support for

37
interdisciplinary activities. Some felt it difficult for
faculty to work in interdisciplinary endeavors because of
different professional emphases or faculty disinterest.
They favored greater faculty identification with the concept
of allied health. Efforts to promote this included,
"interdisciplinary committees . . . and schools set up
separately from their medical schools" (p. 52). There was
no agreement on the purposes of the core curriculum, if it
should be used, or the courses to be included. One dean
believed differences in student perspectives and abilities
among the programs precluded the usefulness of core
curricula.
No research was being conducted in three colleges and
no faculty members were conducting interdisciplinary
research. The deans concurred that allied health faculty
were not research oriented. They agreed that research
interests and patterns differed among the three professions
and that physical therapy tended to be most active. Three
expressed the need to develop a research focus in their
college and many believed their college mission statements
needed revision. One dean mentioned the lack of academic
sophistication; faculty were "basically practitioners . . .
they wanted to be told their objectives" (p. 59).
The faculty in this study were full-time (79%), female
(67%), under 40 years of age (52%), and prepared at the
master's (68%) level. Eighteen percent had a doctoral
degree. Most of the part-time faculty also had an

38
appointment in the college of medicine and/or a basic
science department. The faculty occupied the junior faculty
ranks (70% assistant professor or below), a plurality (41%)
had taught less than 5 years, and 57% had practiced 10 or
more years.
Faculty attitudes concerning interdisciplinary
endeavors differed significantly (p. <.05) among the allied
health fields and among the colleges. Attitude differences
were not significant when faculty were grouped by CAH
organizational structure, highest degree level, discipline
of highest degree, full or part-time status, academic rank
or title, years of clinical experience, or years of teaching
experience. Actual participation in interdisciplinary
endeavors differed with academic rank and age. The higher
the rank and the older the faculty member the more
interdisciplinary activity.
Professional reading habits among the faculty differed
markedly by discipline. Medical technologists read more in
the basic sciences, physical therapists read more in
diagnostic and treatment areas, and occupational therapists
read more in mental health and rehabilitation. Consistent
with reading habits were faculty publication histories. They
published in the journals they read, which were rarely
interdisciplinary. Nine percent had produced more than 10
publications, 46% had not published.
When asked to identify problems, deans mentioned
external, resource (space, funding, and faculty), or

39
political issues. Other challenges concerned pressure to
upgrade the faculty or the development of core curricula.
No dean mentioned internal administrative difficulties.
Faculty identified far more problems in scope and
quantity. These included curricular issues, administrative
difficulties with clinical site staff and facilities, and
personnel management within the colleges. Kelley (1975)
wrote that faculty did not share their deans concerns, for
their development. But, workload, time for self¬
development, and research were listed as problems by
approximately 20% of the faculty.
The faculty, Kelley concluded, may lack academic
sophistication and research skills but they exhibit generous
concern for teaching and clinical affairs--activities which
a research "university environment de-emphasizes" (p. 154).
Although distinct differences among the three faculties were
found, they shared a limited interest in interdisciplinary
activities and they had not "enlarged their identities to
include other allied health professionals" (p. 158). The
deans, 80% of whom did not hold an allied health credential,
favored a broad allied health identification.
Frank (1984) identified personal and professional
characteristics of allied health administrators of
institutions accredited by CAHEA and the Southern
Association of Colleges and Schools. Participants included
61 administrators of 2-year and 38 administrators of 4-year
institutions. Typically the administrators of the 4-year

40
colleges held the title dean, were male (65%), white, had a
mean age of 47 years, and held a doctoral (76%) degree.
Their undergraduate degree was commonly in a physical
science, masters in a health field or business
administration, and doctorate in education. Twenty-six
claimed licensure in a health field, 11 in medicine or
nursing, and 15 in an allied health area. They reported to
a vice president of health affairs, supervised 8.2 programs,
had 9 years of prior teaching experience, and had published
2.6 papers during the prior 2 years.
Anderson (1981) surveyed department chairpersons of
baccalaureate medical record administration, medical
technology, physical therapy, and radiologic technology
programs. The purpose was to determine how the chairpersons
used their time, how they evaluated teaching, and their
beliefs about teaching. The population contacted was 213;
162 or 80% responded.
Most chairpersons (85.7%) had acquired their position
by administrative appointment; seven (4.3%) had been elected
by the faculty. Eighty-one percent of the departments had
six or fewer full-time didactic faculty including the
chairpersons. Three departments had no full-time faculty;
over half (55.3%) used one or more part-time didactic
teachers. The typical annual student enrollment was 11
through 40.
All but three department chairpersons ranked
administration or teaching as the activity that occupied

41
most of their time. Administration was ranked first by
68.9%. Teaching was given second place by 60.2%, service
third by 73.4%, and research occupied the least amount of
time for 82.0% of the chairpersons. The relatively liberal
amount of time occupied by administration and minimal time
devoted to research is consistent with other studies about
allied health faculty activity (Foegelle, 1984).
Chairpersons were asked to indicate, which among ten
methods of teacher evaluation they used with their faculty.
Student opinion (94.9%), review of course materials (85.5%),
and measures of student achievement (81.1%) were reported
most frequently. Those least used were team teaching
(46.8%), classroom visitation by colleagues (32.1%), and
review of audio-video tapes (12.1%). Qualities considered
most important in teaching were the ability to encourage
thought (54.6%) and the ability to explain clearly (15.9%).
By a chi-square analysis (p.<.05), major differences
across programs were identified on several dimensions such
as program size, chairperson reading habits and degree, and
grading policies for clinical courses. Methods to evaluate
teaching effectiveness also varied significantly across
programs. Most frequently used were classroom visitation of
colleagues by physical therapy, measures of student
achievement by medical technology, and review of course
materials and examinations by medical record administration.
Reasons for these differences were not studied but they
appeared congruent with clinical practice among these

42
professions. Physical therapists are accustomed to direct
patient care; medical technologists are associated with
diagnostic testing, i.e., outcome measures; and medical
record administrators deal with the written record.
Foegelle (1984) identified personal, occupational, and
career patterning characteristics of 435 full-time, college
of allied health faculty from 16 academic health centers.
Fifty-nine percent had had 6 or more years of prior clinical
experience; about half (51.5%) had taught in a university
for less than 5 years. Over 13% had a secondary appointment
in another college, which for six individuals was in a
science unit. Administrative appointments were reported by
37.2%, most of which were at the program level. The primary
assignment for most faculty was with baccalaureate programs
(62.1%) and with entry level occupational preparation
(77.5%). Faculty from clinical laboratory, physical
therapy, and occupational therapy programs accounted for
43.5% of the respondents.
Foegelle tabulated faculty activity by 24 categories.
He concluded that the faculty members were primarily
involved in student centered activities, namely classroom
teaching, clinical teaching, and student advising. Service
to their respective programs and professional associations
occupied more time than clinical service. Scholarship and
research typically consisted of "analyzing existing
knowledge and applying it to their own unique or special
situations or circumstances" (p. 78).

43
The second most frequently reported activity was
"personal professional development" (p. 75). Two-thirds
were pursuing additional formal education. Faculty reported
preferring to spend more time on publishing (77.4%),
research (69.9%), personal development (64.9%), and paid
service (52.4%). Their "inservice development interests
were strong in the area of research" (p. 187), moderate in
higher education and health care topics, and "not at all in
teaching and advising topics" (p. 100).
Over one-half (51.0%) reported original career goals
different from their present occupation. Over one-third
(35.4%) had been at their present institution less than 5
years. The reasons faculty gave for selecting their
universities were duties and responsibilities of the job
(80.0%), geographic location (57.2%), and ready for a change
(35.2%). Thirty percent "were seriously considering or
actively pursuing a change in employment" (p. 92). Major
reasons were salary (61.3%), potential for advancement
(45.5%), ready for a change (45.5%), duties and
responsibilities of the job (44.7%), and policies and
practices of administration (37.9%).
In summary, Foegelle (1984) noted that allied health
faculty "are typically underprepared for higher education
faculty roles . . . and they have administrators who are
often not able to be first among equals in their own
academic units" (p. 180). He stated that the "considerable
. . . time invested in administrative activities" (p. 189)

44
was incongruent with the relatively few "formal [extra¬
program] administrative appointments" (p. 67). His major
plea was for faculty development, which would have to
involve
improving research and service skills, and the
inculcation of values for scholarship,
stewardship, and collegiality. This focus will
require a special emphasis on conceptual and
interpersonal skills, all of which are quite
different from technical—clinical skills inherent
in allied health occupations, and all of which are
learned in quite different ways. (p. 191)
Current Status of Colleges of Allied Health
The allied health professions developed for practical
needs, not abstractions (Hinkle, 1986). The knowledge base
of the different occupations is diverse, often undefined,
immature, lacking in theory, or dependent upon a paradigm
claimed by another profession (National Commission on Allied
Health Education [NCAHE], 1980). Until the practitioners
acquire a theoretical base, the hospital tends to serve as
the training site (Rosenfeld, 1972). The professional
societies serve as vehicles for occupational identity, and
one salient manifestation of this is specialized
accreditation (Friedson, 1986). College-wide missions have
been reported as nonexistent, both formal and informal, and
in need of alteration (Miller, Beckham, & Pathak, 1983).
College administrators have generally supported greater
autonomy for allied health education (Florida Board of
Regents, 1983; Pyne, 1975). But advocacy for independence
seems to have abated during the 1980s. Given their

45
dependence on other units for facilities and course work,
colleges of allied health within academic health centers may
be among the most vulnerable (Barritt, 1980; Ford, 1983;
Morris, 1980). Cooperation, communication, and
collaboration; successful themes of earlier decades have
been confronted with financial exigency (Ford, 1983). One
now reads: "Deans' Winter Conference to Focus on Survival of
Allied Health Units in Higher Education" (Deans' 1987-1988).
Program interrelationships are complex (Wise, 1979).
Titles may not be reliable indicators of function,
profession, or role. Studies of department chairs result in
reports about program directors (Anderson, 1981). Many
departments have four or fewer members and would be
considered programs by most higher education administrators
(Tucker, 1981) . Goals of individual programs may be
unrelated to or in conflict with each other or with college¬
wide goals. Examples include educational entry level,
professional practice turfs, and accreditation (Hinkle,
1986). Many members of the older health professions
continue to view members of the younger allied health
professions as subservient (NCAHE, 1980) .
Unlike most professional school deans, allied health
administrators often do not share education, experience, or
occupation in common with their faculty (Foegelle, 1984;
Frank, 1984). This may partially explain the greater value
the deans attribute to the generic allied health concept,
interdisciplinary activity, and core courses (Kelley, 1975

46
McTernan, 1972). The motivators to espouse these objectives
may be organizational, financial, or faculty developmental
and less concerned with a common body of knowledge needed
for professional practice.
Financial and authoritative relationships between the
colleges and other units are egually complex (Wise, 1979).
Faculty practice plans or hospital budgets may contribute
toward faculty salaries or student stipends. Conversely,
the colleges may reimburse clinical agencies or other
colleges for services and facilities. The influence of the
college of medicine is reflected administratively as well as
professionally in CAH faculty responsibilities (Kelley,
1975; Wise, 1979). The allied health educational programs
"have relatively low status in the very types of academic
institutions (for example research universities, health
science centers) that could play the greatest role in
developing future leaders and contributing to their
knowledge base for education and practice" (NCAHE, 1980,
p. 34).
The prime variable which distinguishes among faculty
attitudes and behaviors is the allied health discipline
(Anderson, 1981; Kelley, 1975). This is consistent with
other higher education faculty studies (Clarke, 1983; Stark
& Morstain, 1978). Whatever the particular profession, the
faculty tend to be practitioners and teachers, not theorists
or researchers. The ideological emphasis of CAH faculty has
concerned undergraduates and teaching with considerable time

47
invested in program/professional administration. Women
predominate in most allied health occupations (Foegelle,
1984) .
The deans have been advocates of more formal and
continuing education for their faculties. Faculty
developmental interests have been reported to be in
research, not practice where most have had ample experience
and not teaching where most faculty development activities
have been directed (Foegelle, 1984). But there is evidence
that this may be changing:
Our faculty must meet the same standards expected
of faculty in any scientific discipline. . . .
Whether it is in the biological or social
sciences, we must find a scientific base of
operation from which to launch basic research in
our individual professions. (Covey & Burke, 1987,
pp. 3-5)
Stark1 s Framework
Stark, Lowther, Hagerty, and Orczyk (1986) have
developed a conceptual framework for the study of degree
programs conducted "in four-year colleges and universities
that provide initial socialization and entry to broadly
defined professional fields" (p. 232). Because of the
recency of this framework, its development will be
summarized. This will be followed by a description of the
framework and how some of its components can serve to
identify science related courses and provide a focus for the
development of delivery system criteria.
Stark et al. (1986), as have others, noted that
students are increasingly choosing professional rather than

48
liberal arts majors. Because professional curricula vary
markedly it is difficult for administrators to understand
each program. But it is essential that administrators
develop a working knowledge of the programs they purport to
lead. Educators, researchers, and administrators are
commonly unaware of the similarities and differences among
professional programs; therefore cross-program comparisons
lend themselves to investigator bias and use of
noncomparable data. Stark et al. (1986) claimed that a
standard framework for cross-professional program study
would enhance objectivity, accommodate change over time,
reduce or eliminate specialized language and the resulting
confusion, distinguish between preservice and continuing
education, and clarify the often ambiguous meaning of
"professional competence" (pp. 232-3).
In developing the framework, the investigators used a
grounded theory approach. They reviewed professional
education studies and program descriptions, held seminars
with different professional faculties, and reviewed the
literature on professionalism. Elements of their emerging
framework were then compared with themes found in
"professional education journals of eleven fields" (Stark et
al., 1986 p. 235) including dentistry, medicine, nursing,
pharmacy, and nonhealth professions for the year 1979. The
revised framework was then used as a guide for a content
analysis of 13 specialized accreditation standards including
dentistry, nursing, pharmacy, public health, and veterinary

49
medicine. To determine further if the elements were
exhaustive, distinct, and appropriate, a pilot questionnaire
was designed to assess University of Michigan "faculty
perceptions of each of the elements in the framework"
(p. 235).
The Stark et al. (1986)
framework asserts that professional preparation
programs are influenced by internal,
intraorganizational, and external forces [see
Figure 1]. These forces interact to create a
professional preparation 'environment' which, in
turn, influences the design of educational
processes intended to achieve professional
preparation outcomes. . . . Finally the extent to
which the outcomes are achieved and, thus, the
orientation of the new professionals, influences
the internal, intraorganizational, and external
forces, (p. 236)
The external influences consist of two major categories,
societal influences and professional community
characteristics, each of which have several more specific
elements (see Figure 2). Elements of the internal
influences are grouped under four categories; mission,
program structure, curricula tensions, and continuing
professional involvement, also shown in Figure 2. Stark et
al. (1986) believed that elements of the intraorganizational
influences (mission, program centrality, program
interrelationships, financial, technological support, and
governance) will "become increasingly potent forces
affecting professional curricula" (p. 238). Selected
elements from among these influence groupings served to

Professional Preparation Outcomes
4
r^ducaUoñaMProc^sseT
' f
4
1
Professional Preparation Environment
| 1
'
/
4
\
External
Intraorgamzational
Internal
Influences
Influences
Influences
Figure 1. A Framework for Describing Professional
Preparation Programs.
Note. From, "A conceptual framework for the
study of preservice professional programs in
colleges and universities" by J. S. Stark, M
Lowther, B. M. K. Hagerty, & C. Orczyk, 1986
Journal of Higher Education. 57, p. 237.
Copyright 1986 by the Ohio State University
Press. Reprinted by permission.

51
Professional Preparation Outcomes
4
Educational Processes
4
Professional Preparation Environment
r * l\
Esternal Influences
Societal Influences
Reward System
Marketplace for
graduates
Media
Government policies
Funding
Licensing
Professional Community
Characteristics
Knowledge base
Client orientation
Practice settings
Professional autonomy
Accreditation and
standards
Market control
Ethics
Publications
Alumni involvement
Internal Influences
Mission. Staffing and
Program Organization
Faculty background
Faculty mix
Ideology and
program missions
Evaluation of faculty
Professional Program
Structure
Specialization
Time Requirements
Student evaluation
Student mix
Entrance requirements
Student/faculty ratio
Curricular Tensions
Instructional
methodology
Balance of theory
and practice
Core courses
Contextual study
Course sequencing
Course and program
evaluation
Continuing Professional
Involvement
Intraor^anizationallnfluences
Mission, history, traditions
Program centrality
Program interrelationships
Financial/technological
support
Governance patterns
Figure 2.
Specific Influences on Professional Preparation
Programs.
Note. From, "A conceptual framework for the
study of preservice professional programs in
colleges and universities" by J. S. Stark, M. A.
Lowther, B. M. K. Hagerty, & C. Orczyk, 1986,
p.239. Copyright 1986 by the Ohio State
University Press. Reprinted by permission.

52
focus the science course delivery system for this study.
The environment that these influences collate to
create, results in educational processes which in turn
result in professional preparation outcomes. There are two
major categories of outcomes, professional competencies and
professional attitudes (see Figure 3). Since the initial
publication of the framework, three other outcomes have been
specified; leadership capacity, critical thinking, and
aesthetic sensibility (J. S. Stark, personal communication,
February 10, 1987). The competencies were defined in
Chapter I.
As an illustration of these competencies consider a
nurse anesthetist as a representative health professional.
The nurse anesthetist understands the uptake and
distribution of anesthetic agents (conceptual competence),
knows how to operate the anesthesia machine and monitoring
equipment (technical competence), and can develop a safe and
effective anesthesia management plan (integrative
competence). She recognizes that the same client undergoing
the same procedure in a different milieu (same day surgery
unit or hospitalized inpatient) may benefit by different
anesthesia management (contextual competence). Also as new
agents and monitoring techniques become available she
incorporates them into her practice (adaptive competence).
In any program the required courses in the curriculum
constitute the primary formal mechanism to develop

53
Professional Competences
Conceptual competence
Technical competence
Integrative competence
Contextual competence
Adaptive competence
Interpersonal communication
Professional Attitudes
Professional identity
Professional ethics
Career marketability
Scholarly concern for improvement
Motivation for continued learning
4
Educational Processes
"
'â– 1 " â–  â– â– â– 
4
I Professional Preparation Environment
/ 4 \
External
Influences
44
Intraorganizational
Influences
44
Internal
Influences
Figure 3. Professional Preparation Outcomes.
Note. From, "A conceptual framework for the study of
preservice professional programs in colleges and
universities" by J. S. Stark, M. A. Lowther, B. M. K.
Hagerty, & C. Orczyk, 1986, Journal of Higher Education, 57,
p. 244. Copyright 1986 by the Ohio State University

54
professional competencies and attitudes. It can be posited
that any required course in a professional program will
contribute to each of the professional preparation outcomes.
However a particular course may make a major contribution to
the development of some outcomes and a negligible one toward
others. Science related courses can be perceived as
fostering the acquisition of conceptual competencies in the
biophysical sciences for all allied health students. They
may have a limited role in the development of professional
identity. This is most apparent in the case of prerequisite
basic sciences, core courses, and sciences designed for
other health professions students but open to allied health
students.
The contributions of a science course toward competence
and attitude acquisition may vary with the science and/or
profession. For example, the skills developed in the gross
anatomy laboratory may contribute little toward the
technical competencies that an occupational therapist will
use in professional practice. But the skills acquired in
the microbiology laboratory may be germane to the activities
of a future medical technologist. However in both
situations the development of conceptual competence in a
biophysical science, supportive of professional practice,
remains a primary goal. The other outcomes described by
Stark et al. (1986) for which the science related courses
may play a pivotal role are in the development of

55
integrative and adaptive competencies and a scholarly
concern for improvement.
To illustrate, consider the nurse anesthesia student as
a representative health professions student. A physiology
course may include objectives regarding cardiovascular
dynamics. The teaching strategies may incorporate a
laboratory to demonstrate some of the concepts or a
historical discussion of the methodology used by some early
investigator who formulated the concepts. Thus, the student
derives an understanding of some "knowledge upon which
professional practice is based" (Stark et al. 1986, p. 244)
(conceptual competence) and recognizes that this knowledge
was acguired through research (scholarly concern for
improvement). This knowledge of cardiovascular dynamics may
provide the basis to perform some technical skill or
pharmacologic intervention to maintain blood pressure during
the course of anesthesia (integrative competence). Likewise
because of a knowledge of cardiovascular dynamics, the
future nurse anesthetist will incorporate new technologies
when developed to better monitor cardiovascular physiology
(adaptive competence).
Stark's framework was used to assist in the
identification of science related courses for this study.
Recall that science related courses are required
professional phase biophysical sciences, the primary
objectives of which are to develop conceptual competencies.
Secondary objectives may concern integrative and adaptive

56
competencies and the development of a concern for scholarly
improvement. Thus, it was outcome as reflected by the
course description, not course name, faculty background, or
college sponsor that served to identify these courses. This
will be discussed in Chapter III. After the literature
review the framework also served to structure the science
related course delivery system issues and proposed criteria.
This will also be explained in Chapter III.
Hundreds of professional and liberal arts and science
faculty have participated in the development of this
framework. Its comprehensiveness and multiprofessional
applicability have been established. Findings of others
using this framework are underway (Stark, personal
communication, February 10, 1987) but are not yet available.
However the designers of this framework have conducted one
study to test this model.
To determine "the ability of the framework to assist in
mapping differences among programs" Stark, Lowther, and
Hagerty (1987, p. 533) obtained and analyzed a national
sample of professional faculty opinion. The specific
purpose was to identify discriminators among entry level
professional programs and to determine if "each professional
field had a unigue preparation environment" (p. 533).
Faculty (n=2217) of 11 professions in 732 programs among 346
universities and colleges participated.
The variables selected were indicative of internal,
external, and intraorganizational influences. Multiple

57
factor analyses of the data resulted in four groups of
factors representative of program influences. They were
named Factor 1 curriculum debate, Factor 2 education
mission, Factor 3 societal influence/university
prestige/gender, and Factor 4 professional community
influence/university support. Analysis of variance did
confirm that faculty perceptions of professional education
preparation environments differed significantly on some of
the factors. Three strong discriminants among programs were
faculty perception of societal influences (external), social
prestige ratings of occupations (external), and gender
ratios of program graduates (internal). Strong society
support is perceived for programs with predominately male
faculty (business, engineering, and pharmacy).
The professional community influences (external) were
less powerful program discriminants than the societal.
However some items did serve as discriminants. Some program
faculties who perceive weak societal support "perceive
strong influence from accreditors" (p. 556) (nursing and
social work). "Faculty perceptions of having achieved
consensus on a professional knowledge base" (p. 557) was a
discriminant.
Several potential influences did not serve as
discriminants among professions. These included "faculty
age, possession of a doctorate, . . .[and] time spent in
teaching" (p. 557). Faculty perceptions of the professional
preparation environment were found to be independent of

58
institutional size and type (degree of research
orientation), but not professional field.
Clearly this framework is developing into a model that
can serve to identify discriminators among professional
programs. The finding that profession and not institutional
size or type served as a discriminator of faculty
perceptions of professional preparation environment was
cited as having both research and practical applications.
Accreditation Standards; Tools for Academia
Introduction
Twenty sets of health science professions'
accreditation standards and guidelines were perused to
determine requirements for program officials qualifications,
faculty responsibilities for service and research, and
evidence of sciences in curricula. Each set of standards
was applicable to a single health science occupation, for
which all or some of the programs awarded a baccalaureate
degree. Thus a set of standards may apply to certificate or
graduate as well as baccaulaureate programs.
Each responsible accrediting agency is recognized by
the Council on Postsecondary Accreditation. In 1988, the
accrediting agencies and health science professions
concerned were the American Council on Pharmaceutical
Education (ACPE), pharmacy; the American Dental Association
Commission on Accreditation of Dental and Dental Auxiliary
Programs (Amer. Dent. Assoc.), dental hygiene; the American

59
Dietetic Association (ADA), dietetics; the American Physical
Therapy Association (APTA), physical therapy; the American
Association of Nurse Anesthetists Council on Accreditation
of Nurse Anesthesia Educational Programs/Schools (AANA),
nurse anesthesia; and the National League for Nursing
Council of Baccalaureate and Higher Degree Programs (NLN),
nursing.
In addition to these 6, 49 other organizations
collaborated with the American Medical Association's
Committee on Allied Health Education and Accreditation
(CAHEA) to accredit 26 allied health occupations, 14 of
which apply to programs with baccalaureate curricula (AMA,
1986). These programs were cytotechnology, cardiovascular
technology, histotechnology, medical records administration,
medical technology, nuclear medicine, occupational therapy,
perfusion technology, radiography, radiation therapy,
physician assistant, respiratory therapy, sonography, and
surgeon's assistant.
Although the various sets of accreditation requirements
address similar issues they frequently use different terms
to mean the same thing (AMA, 1985a; American Physical
Therapy Association [APTA], 1978; National League for
Nursing [NLN], 1980). Also there are nuances among terms,
such as, internship, externship, clerkship, fieldwork, and
practicum both within and among the professions. Throughout
this discourse, the words standards and guidelines will be
used consistently, even though a particular agency may use

60
different terms. Several accreditation documents defined
verbs such as shall and should (American Dental Association
[Amer. Dent. Assoc.], n.d.; AMA, 1981a). A generalization
is that shall, will, and must are mandates; whereas should,
could, can, and may are less forceful and suggest ethical
obligations, alternatives, or liberty to do something (AMA,
1981a).
Accreditation standards for the occupations under
discussion were adopted as early as 1935 (AMA, 1983b) and as
recently as 1985 (AMA, 1985b). Of the standards in effect
during 1986, 5 sets had been adopted in the late 1970s and
the remaining 15 were products of the 1980s. The maximal
duration of program accreditation varied from 3 through 10
years, the mode being 5 years (see Table 1).
As illustrated in Table 1, six sets of standards limited
program sponsorship to 4-year colleges or universities. The
accrediting agency for surgeon's assistant programs
suggested sponsorship in schools of medicine in conjunction
with the department of surgery (AMA, 1982). The physician
assistant agency recommended academic health centers as
educational sponsors (AMA, 1985c). Sponsorship of dental
hygiene programs had to be in nonprofit postsecondary
institutions (Amer. Dent. Assoc., n.d.). "No hospital or
other health care facility alone can be accredited as a
sponsor of a [respiratory therapy] training program" (AMA,
1977b, p. 2). They had to be part of a postsecondary

61
Table 1
Maximum Number of Years of Program Accreditation and Minimal
Program Duration Requirements
Program
Duration
Accred.
Duration of Professional
Program in Months
Cardiovasc. Tech.
5
24-12a
Cytotechnology
5
12
Dental Hygiene
10
24
Dietetics
5
24b
Histotechnology
7
12
Medical Record Adm.
8
not specified13
Medical Technology
7
12
Nuclear Medicine
5
12
Nurse Anesthesia
4
24
Nursing
8
not specified13
Occupational Therapy
5
not specified13
Perfusion Technology
5
24-12b
Pharmacy
6
3 6b c
Physical Therapy
5
not specified13
Physician Assistant
3
24°
Radiation Therapy
5
24-12a
Radiography
5
24
Respiratory Therapy
5
20
Sonography
5
24-12a
Surgeon's Assistant
3
24c
a Lesser duration for those with prior education/experience.
b Sponsorship limited to 4-year colleges or universities.
c Duration of program may vary.

62
educational institution. Sponsorship of the remaining 10
allied health professional programs might include hospitals,
laboratories, the military, cancer treatment centers,
vocational-technical schools, proprietary organizations,
colleges of medicine, community colleges, and 4-year
colleges and universities.
Some standards were specific regarding the minimal
duration of the programs (see Table 1). Others permitted
flexibility based upon student prior experience, ability, or
science background (AMA, 1980a, 1980b, 1982). Several just
implied the duration by stipulating that most courses would
be upper division (NLN, 1980, p. 41) or that the credential
awarded would be a baccalaureate degree (American Dietetic
Association [ADA], 1976, p. 8).
The number of institutions with accredited programs as
well as the number and percent which offered the
baccalaureate degree in each health profession is shown in
Table 2. The standards examined for dietetics, nursing, and
pharmacy were applicable solely to baccalaureate programs.
These professions had different or additional standards for
other educational levels, e.g., dietetic postbaccalaureate
certificate, associate degree nursing, or doctorate in
pharmacy. The preponderance of nonbaccalaureate programs in
medical records administration, medical technology, nurse
anesthesia, occupational therapy, and physical therapy were
postbaccalaureate certificate or masters. The majority of

63
Table 2
Number and Percent of Institutions with Accredited
Baccalaureate Health Science TBS1 Programs
Program
Institutions
Total
N BS
% BS
Cardiovasc. Tech.
0
0
0
Cytotechnology
58
22
37.9
Dental Hygiene
198
27
13.6
Dietetics
65a b
65
100.0
Histotechnology
43
2
4.6
Medical Record Adm.
54a
52
96.3
Medical Technology
584
187
32.0
Nuclear Medicine
141
32
22.7
Nurse Anesthesia
106
12
11.3
Nursing
453a b
453
100.0
Occupational Therapy
61a
52
93.4
Perfusion Technology
19
7
36.8
Pharmacy
73a b
65
89.0
Physical Therapy
108a
96
88.8
Physician Assistant
52
36
69.6
Radiation Therapy
101
7
6.9
Radiography
744
28
3.8
Respiratory Therapy
232
30
12.9
Sonography
24
4
20.8
Surgeon's Assistant
3
1
33.3
a Limited to 4-year colleges or universities.
b Standards examined apply only to baccalaureate programs.

64
nonbaccalaureate programs for all other occupations were
associate degree, certificate, or diploma.
Program Directors
As shown in Table 3, seven professions' standards
required the program director to be credentialed in the
occupation and two required either the program director or
education coordinator to be a member of the occupation. Four
required a member of the profession or a physician/dentist
of a relevant specialty. Three permitted the program
director to have the same, relevant, or equivalent
occupational credentials. Pharmacy standards did not mandate
a pharmacist for dean but did require the dean "to
demonstrate . . . professional leadership." (American
Council on Pharmaceutical Education [ACPE], 1984, p. 4).
The remaining standards did not mention requisite
professional credentials for the program directors.
The amount and/or level of formal education required of
the program directors was diverse (see Table 4). Nursing
standards require the chief program administrator to hold a
doctoral degree, but only the baccalaureate of this person
needed to be in nursing (NLN, 1980). Of the four mandating
a master's or ongoing work toward one, dietetics standards
permitted the degree to be "in dietetics or a closely
related field" (ADA, 1976, p. 3) and nurse anesthesia
guidelines indicated that an appropriate master's degree
could be in nursing, basic sciences, education, or
administration (American Association of Nurse Anesthetists

65
Table 3
Accreditation Requirements for Professional Credentials
of Program Directors
Program
Acceptable Credential
Cardiovasc. Tech.
not specified
Cytotechnology
cytotechnologista
Dental Hygiene
dental hygienist or dentist
Dietetics
registered dietitian
Histotechnology
histotechnologista
Medical Record Adm.
med. rec. adm. or equivalent
Medical Technology
medical technologist
Nuclear Medicine
nuclear med. or equivalent
Nurse Anesthesia
nurse anesthetist or MD
Nursing
professional nurse
Occupational Therapy
occupational therapist
Perfusion Technology
perfusion tech, or equivalent
Pharmacy
not specified
Physical Therapy
physical therapist
Physician Assistant
not specified
Radiation Therapy
radiation therapist
Radiography
radiographer
Respiratory Therapy
respiratory therapist or MD
Sonography
sonographer or MD
Surgeon's Assistant
not specified
a
Education coordinator or medical director may hold
position.

66
Table 4
Accreditation Requirements for Academic Credentials of
Program Directors
Program
Acceptable Credential
Cardiovasc. Tech.
higher than students
Cytotechnology
BS or equivalent
Dental Hygiene
not specified
Dietetics
masters
Histotechnology
two years of college
Medical Record Adm.
masters3
Medical Technology
varies with experience
Nuclear Medicine
BS or equivalent
Nurse Anesthesia
masters3
Nursing
doctorate
Occupational Therapy
masters
Perfusion Technology
not specified
Pharmacy
not specified
Physical Therapy
not specified
Physician Assistant
not specified
Radiation Therapy
varies with experience
Radiography
varies with experience
Respirator Therapy
varies with experience
Sonography
not specified
Surgeon's Assistant
not specified
a Or working on a masters
degree.

67
Council on Accreditation of Educational Programs/Schools
[AANA], 1980). Some guidelines contained discussions of
program director and/or faculty academic qualifications
relative to students (ADA, 1976; AMA, 1977b, 1985c). "Key
faculty in any type of professional program should possess
the same or higher level of education and/or professional
credentials as that for which students in the [respiratory
therapy] program are being prepared" (AMA, 1977b, p. 4).
The four sets of accreditation standards which provided
for the substitution of experience in lieu of degrees tended
to contain detailed discussions of the issue (AMA, 1977a,
1977b, 1981b, 1983c). As an example, qualifications for a
radiography program director are that he or she
Shall be a radiographer qualified in educational
methodologies.
Shall be credentialed in radiography by the
American Registry of Radiologic Technologists
or possess suitable equivalent qualifications.
Shall be qualified through education and
experience. These qualifications shall assure
proficiency in, but shall not be limited to,
the following areas:
curriculum design
instructional methodology
testing and evaluation
educational psychology
Shall document to the sponsor satisfactory
completion of one of the following:
a baccalaureate or advanced degree with a
minimum of two years of postcertification
experience as a radiographer and a minimum
of two years as an instructor in an
accredited radiography program;
or
an associate degree with a minimum of two
years of postcertification experience as a
radiographer and a minimum of three years as
an instructor in an accredited radiography
program;

68
or
a minimum of five years of postcertification
experience as a radiographer and a minimum
of four years as an instructor in an
accredited radiography program. (AMA, 1983c,
pp. 3-4)
Directives that faculty serve as role models (ACPE,
1984), have clinical privileges (AMA, 1977b), be actively
practicing (AMA, 1983a), or periodically return to practice
(AMA, 1981a) indicated the importance of clinical
experience. The expectation that program directors and
other faculty have prior and/or current work experience was
apparent by professional credential reguirements (see Tables
3 and 5). The standards of 8 occupations enumerated the
years and types of prior experience that the appointed
program director must have (see Table 5). Of the 12 that
explicitly mentioned prior work experience for the program
officer, 2 defined it broadly. The nursing administrator
had to have "experience in baccalaureate and/or higher
degree programs in nursing" (NLN, 1980, p. 14). "Relevant
occupational therapy experience in administration, teaching,
and direct service" (AMA, 1983b, p. 3) was stipulated for
that profession. The detail to which many of the others
described their requirements was expressed by medical record
administration standards. The program director, "must have
a minimum of three years professional experience at an
administrative level in medical record administration in
either a health care facility or industry/agency serving
health care" (AMA, 1981a, p. 5). The guidelines continued

69
Table 5
Accreditation Requirements for Experience of Program
Directors
Program
Experience Specified
Cardiovasc. Tech.
experience recommended
Cytotechnology
5 years (2 in teaching)
Dental Hygiene
not specified
Dietetics
1 year, 3 years preferred
Histotechnology
3 years
Medical Record Adm.
3 years
Medical Technology
varies with academic degree
Nuclear Medicine
2 years recommended
Nurse Anesthesia
not specified
Nursing
relevant experience required
Occupational Therapy
relevant experience required
Perfusion Technology
not specified
Pharmacy
not specified
Physical Therapy
not specified
Physician Assistant
not specified
Radiation Therapy
varies with academic degree
Radiography
varies with academic degree
Respiratory Therapy
varies with academic degree
Sonography
not specified
Surgeon's Assistant
not specified

70
that this experience must have been one in which the person
was "primarily involved in planning, organizing, directing,
controlling, and/or evaluating health record functions"
(AMA, 1981a, p. 5).
After professional, academic, and clinical experience
requirements, one other often mentioned requirement
concerned evidence for instructional competence (AMA, 1980b,
1984). Again these stipulations ranged from general to
detailed. "The director has competence in teaching,
educational administration, and curriculum development"
(APTA, 1978, p. B-3). Or the cytotechnology program
director "has completed courses or seminars in the
principles of education and management; and has documented
continuing education in educational methodologies" (AMA,
1983a, p. 4).
Medical Directors
Of the six professions accredited by non-CAHEA agencies
none were required to have a medical director. Although
nurse anesthesia standards permitted either a nurse
anesthetist or an anesthesiologist to serve as program
director as long as a nurse anesthetist "is actively
involved in the organization and administration of the total
program" (AANA, 1980, p. 31). Dental hygiene standards
required program administrative structure to "include a
dental hygienist or a dentist with current experience in
working with a dental hygienist" (Amer. Dent. Assoc., n.d.,
p. 4). The CAHEA accredited professions which did not

71
require a medical director were occupational therapy and
medical records administration. Standards for radiation
therapy indicated that a medical director/advisor may be
required (AMA, 1981). The remaining 11 sets of CAHEA
standards required a medical director; 2 of which, medical
technology and radiography, permitted the physician leader
to hold a different title (AMA, 1977a, unpaged; 1983c,
p. 4) .
Qualifications of the medical director commonly
included licensure as a physician and knowledge, experience,
or credentials in the relevant specialty. Several standards
also referred to active interest in and involvement in
teaching. For example the medical director was to be
"experienced and proficient in the use of ultrasound" (AMA,
1980a, p. 102), or "knowledgeable about the delivery of
primary care" (AMA, 1985c, p. 3) , or "knowledgeable and
effective in teaching the subjects assigned" (AMA, 1985b,
p. 3). Or more specifically, "qualified in the use of
radionuclides and a diplómate of either the American
Board(s) of Nuclear Medicine, Pathology, or Radiology, or
possess suitable equivalent qualifications" (AMA, 1984,
p. 4) .
The general role of the medical director is to insure
medical pertinence of the curriculum and often to facilitate
public relations among physicians. "The medical director of
the program shall provide competent medical guidance to
insure that the medical component of the curriculum both

72
didactic and supervised practice, meets current acceptable
standards" (AMA, 1985b, p. 3). Or "the medical/surgical
director should provide continuous, competent direction for
the clinical relationships with other educational programs.
The medical/surgical director should actively elicit the
understanding and support of practicing physicians" (AMA,
1982, p. 2).
Program Faculty
Several sets of accreditation standards, such as
dietetics, nursing, pharmacy, and physical therapy limited
the interpretation and discussion of faculty to appointees
of the educational sponsor, who had teaching
responsibilities. "Full-time equivalent faculty include
only those persons who hold at least a masters degree and
are employed on a partial or full appointment by the college
or university" (ADA, 1976, p. 6). For dental hygiene,
"there must be a core of qualified full-time faculty . . .
the majority of the faculty must have full-time
appointments" (Amer. Dent. Assoc., n.d., p. 26).
When the standards and guidelines of dietetics,
nursing, pharmacy, and physical therapy referred to members
of the respective professions who participate primarily in
student clinical instruction, it was apparent that the
clinicians had a more circumscribed role. "Graduate
students who are registered dietitians with practitioner
competence may be employed for clinical supervision with
guidance from senior faculty; however these students may not

73
be counted in calculation of full-time equivalent faculty"
(ADA, 1976, p. 6). "Volunteer clinical faculty and
preceptors should be exemplary role model practitioners, and
should reflect a broad spectrum of pharmacy settings" (ACPE,
1984, p. 7) .
Of CAHEA accredited programs, sonography, radiography,
radiation therapy technology, and occupational therapy
standards stated or the guidelines implied that faculty
shall or should have a faculty appointment, if the program
was college or university sponsored (AMA, 1980a, 1981b,
1983b, 1983c). "Instructors . . . must meet the standards
required by the sponsoring institution" (AMA, 1983c, p. 4).
Cardiovascular technology, cytotechnology, histotechnology,
nuclear medicine, and nurse anesthesia standards did not
mention university appointments for program faculty. The
latter seemed to equate faculty with anyone participating in
student instruction. "Faculty should include "behavioral
scientists, educators, other nurses, hospital
administrators, and legal experts" (AANA, 1980, p. 31).
Standards for the remaining seven occupations specified
or implied a faculty appointment for the program director or
officials. The respiratory therapy "program director shall
be a member of the sponsoring educational institution's
faculty with all rights and privileges" (AMA, 1977b, p. 4).
Perfusion technology "program officials should have
credentials which allow for faculty appointments"
(AMA, 1980b, p. 2). For medical technology the required

program official "faculty appointment may be a regular one,
a non-salaried clinical, or courtesy appointment or adjunct
(AMA, 1977a, unpaged).
How ever faculty are defined, all sets of standards
contain discussions of the roles and responsibilities of
program officers, sponsor employed faculty, and clinical
faculty. Typical of content, and typical because it was
directed to program officers rather than all program
faculty, were "examples of responsibilities of program
officials" (AMA, 1977a, unpaged) for medical technology:
1. Development of, validation of, and revision
of program objectives when appropriate.
2. Implementation of admission policies.
3. Curriculum development.
4. Implementation of student evaluation
procedures.
5. Recruitment.
6. Public relations, including preparation of
catalogs, brochures, or other materials relating to
the program.
7. Planning and implementation of a program to ensure
ongoing instruction in curriculum design, teaching
techniques, and current laboratory techniques for
all personnel involved in instruction.
8. Maintaining student records.
9. Student counseling.
10. Input into the preparation of the program
budget.
11. Providing liaison between the educational
program and the institutional administration.

75
12. Ensuring the medical relevance in the
student's educational experience. This may be
accomplished in a variety of ways including
lectures, seminars, clinical conferences. (AMA,
1977a, unpaged)
Thus teaching and related activities form the bulk of
faculty/program officer roles as expressed in these and most
other sets of accreditation standards.
The extent to which the curriculum was expected to be
controlled by the sponsor employed faculty varied. A few
sets of standards made it perfectly clear. "The physical
therapy faculty is responsible for instruction and
curriculum development" (APTA, 1978, p. B-4). "Primary
responsibility for the development and conduct of the
academic programs(s) rests with the nursing faculty" (NLN,
1980, p. 26). Other sets of standards vested this
responsibility in the program officials. Medical technology
"program officials shall ensure appropriate instruction in
all areas of the education program" (AMA, 1977a, unpaged).
The cardiovascular technology program director "is
responsible for maintaining the guality of the program"
(AMA, 1985b, pp. 2-3). "The medical director is expected to
play a pivotal role in the design, development and
implementation of all courses relating to the respiratory
physiology and respiratory diseases ... as well as . . .
evaluating . . . non-clinical courses" (AMA, 1977b, p. 6).
For dental hygiene, "the program administrator must
[emphasis added] participate in . . . curriculum development
. . . but the faculty should [emphasis added] participate in

decisions on academic and other policies affecting the
program that they will have to implement" (Amer. Dent.
Assoc., n.d., p. 5).
76
Eleven sets of standards required or recommended an
advisory committee or community liaison mechanism. Some of
these vested major curricular responsibilities in these
committees (AMA, 1977b, 1980a, 1981b, 1983c). "The function
of the committee should be to advise the program ... on
curriculum" (AMA, 1980b, p. 3). "The advisory committee
should play a key role in developing the curriculum . . .
[and] periodically review the curriculum" (AMA, 1981b,
p. 6). Evidence of a broad scope and potentially political
nature of a required advisory committee was found in the
respiratory therapy guidelines.
A well organized, active advisory committee is an
important force in evaluating, balancing, and
reconciling the diverse interests of the governing
board of the educational institution, the
institutional administrations, the respiratory
therapy faculty, the hospitals, the students, and
the community. . . . The meetings of the committee
should be attended by a senior executive officer.
(AMA, 1977b, pp. 7-8)
As mentioned, teaching and related activities formed
the bulk of faculty/program officer roles as expressed in
most sets of accreditation standards. Before discussing the
sciences that faculty were expected to teach, the standards
in relation to faculty service and research are discussed.
Faculty Service
Service responsibilities for health professional
faculty encompass two major areas; clinical practice of the

77
profession and institutional/community service or service to
the discipline/profession. In addition to the service
implications evidenced by professional credential and
experience requirements, all sets of standard contained
statements about clinical service. In order for the
director of clinical education to perform the instructional
and evaluative functions of this position, he or she had to
"have a respiratory therapy staff appointment in all
clinical affiliates" (AMA, 1977b, p. 5). Physician and
surgeon's assistant standards mentioned practicing
physicians as primary teachers and role models (AMA, 1982,
1985c). Dietetics standards required faculty to "show
evidence of professional growth through continuing
education, experience as practitioners, or by other means"
(ADA, 1976, p. 5). Dental hygiene guidelines stated that
"faculty who provide preclinical technique and clinical
instruction must have . . . proficiency in clinical dental
hygiene" (Amer. Dent. Assoc., n.d., p. 24). And "a periodic
return to medical record practice is desirable" (AMA, 1981a,
p. 5). Thus faculty clinical service was addressed in terms
of faculty development, that is, continuing education or
skill maintenance and in relation to students, such as, role
modeling or supervision.
More prevalent than the above examples which support a
faculty service role were standards and guidelines which
explicitly discussed not responsibility for, but freedom
from, service for both faculty and students. "No

78
[histotechnology] program director should be expected to
carry a full-time technical service load" (AMA, 1978, p. 1).
"The [radiographic] program director's responsibility shall
not be adversely affected by educationally unrelated
functions" (AMA, 1983c, p. 3). For nurse anesthesia
"provisions will be made to allow an equitable amount of
time for class . . . preparation" (AANA, 1980, p. 45).
All accreditation requirements except occupational
therapy, physical therapy, nursing, and pharmacy warned
against student exploitation in the clinical setting.
"Students must not be responsible in any significant way for
the service function of the clinical laboratory" (AMA,
1977a, unpaged). Radiography students "shall not take the
responsibility or the place of staff. . . . Shifts with
limited or repetitious experience may be viewed as
exploitation" (AMA, 1983c, p. 6). "The [respiratory therapy]
program shall not substitute or permit to be substituted
students for paid personnel to conduct the work of the
clinical affiliates" (AMA, 1977b, p. 4).
Accreditation requirements for or direct evidence of
institutional or community service were generally lacking.
In fact, some standards could be interpreted to preclude
extraprogram or extrainstitutional endeavors. "The
[radiological technology] program director must be exempt
from all clinical or departmental duties not directly
relevant to the educational program" (AMA, 1981b, p. 4).
Dietetics standards addressed faculty service, but in

79
reference to the program, not the institution or community
(ADA, 1976). Medical record administration guidelines
limited the program director teaching load to one-half to
two-thirds time so "administrative duties within the
institution" (AMA, 1981a, p. 4) can be undertaken.
Dental hygiene, occupational therapy, physical therapy,
nursing, and pharmacy standards stipulated service to the
institution and/or profession (ACPE, 1984; Amer. Dent.
Assoc., n.d.; AMA, 1983b, APTA, 1978; NLN, 1980). "The
institution provides for [physical therapy] program faculty
participation in the governance of the program and
institution as well as short-term and long-term planning"
(APTA, 1978, p. B-2). "Release [sic] time must be provided
for [dental hygiene] professional association activities"
(Amer. Dent. Assoc., n.d., p. 27). Nursing, "faculty
endeavors include participation in . . . professional
activities and community service" (NLN, 1980, p. 36). And
"participation in the life of the college . . . and the
university, as evidenced by committee service, chairmanship
of committees, and involvement in campus governing bodies"
(ACPE, 1984, p. 7) is expected of pharmacy faculty.
In summary for most sets of standards, service was
restricted to or equated with clinical practice. Faculty
clinical practice requirements were discussed as supportive
to or necessary for the teaching mission and were not
necessarily viewed as worthy ends in themselves. Faculty
and student freedom from service was addressed more

80
frequently and extensively than faculty responsibility for
service. Of the six sets of standards which required
institutional and/or community service all except dental
hygiene limited sponsorship to 4-year colleges or
universities and all but occupational therapy were non-CAHEA
accredited.
Faculty Research
Accreditation requirements for faculty scholarship and
research are salient due to their relative absence.
Excluding nursing and pharmacy guidelines, which mentioned
such expectations in several contexts, only physical
therapy, occupational therapy, and dental hygiene guidelines
discussed faculty scholarship. Physical therapy faculty
"competence will be evaluated through review of . . .
scholarly productivity" (APTA, 1978, p. B-3). "Faculty
responsibilities [for occupational therapy] may include. . .
research" (AMA, 1983, p. 4). Regarding allocation of
faculty salaries, dental hygiene standards listed several
factors to consider and "research competencies" (Amer.
Dent. Assoc., n.d., p. 27) were among them. Occupational
therapy and dental hygiene standards mentioned research as
an area for faculty development (Amer. Dent. Assoc., n.d.;
AMA, 1983b).
Seven of the 18 sets of allied health standards or
guidelines mentioned research activities in terms of
developing student competencies. The physical therapist was
to be able to "apply basic principles of the scientific

81
method, to read and interpret professional literature,
participate in clinical research activities, and critically
analyze new concepts and findings provided by others"
(APTA, 1978, p. B-8). "The cytotechnologist will
demonstrate ability to read and evaluate published
professional literature . . . [and understand] principles of
scientific research" (AMA, 1984, p. 2). Major curriculum
divisions were labeled research methods and statistics and
research for occupational therapy and medical record
administration, respectively (AMA, 1981a, 1983b).
Cardiovascular technology and nurse anesthesia standards
mentioned research as a curricular elective.
The word research was not found in any context in the
accreditation requirements for dietetics, histotechnology,
medical technology, perfusion technology, physician
assistant, respiratory therapy, and surgeon's assistant.
Radiation therapy and radiography mentioned it once: Library
holdings should be sufficient to promote "independent study
and research" (AMA, 1981b, p. 6; 1983c, p. 5).
Cardiovascular technology, nuclear medicine, nurse
anesthesia, and sonography standards also mentioned research
in the library context (AANA, 1980; AMA, 1980a, 1984,
1985b). Physical therapy and sonography guidelines
mentioned research in the paragraphs concerning space needs
(AMA, 1980a; APTA, 1978). Nursing and pharmacy standards
frequently mentioned research. Nursing faculty members were
to "pursue educational development, intellectual and

82
creative endeavors, . . . research, and scholarly
activities" (NLN, 1980, p. 29). And pharmacy faculty
members were to be evaluated for "scholarship demonstrated
by productive research . . . and securing extramural
funding in support of research" (ACPE, 1984, p. 7).
In summary, five sets of standards (cytotechnology,
medical records administration, nuclear medicine,
occupational therapy, and physical therapy) required the
program graduates to understand, interpret, and/or assist
with appropriate research. Two (cardiovascular technology
and nurse anesthesia) suggested this as an innovative idea.
Seven did not mention research or scholarship. Three used
the words research or scholarship when describing space,
library holdings, or student loans (radiography, radiation
therapy, and sonography). Among the allied health standards
dental hygiene, occupational therapy, and physical therapy
standards stated that scholarship and research constituted
bona fide faculty activities. Excluding these three, this
is in marked contrast to nursing and pharmacy.
The Biophysical Sciences
The curricular divisions in the various sets of
standards were itemized and discussed in several ways. This
influences how the science requirements were discussed since
they constituted only a part of each curriculum. Therefore
the manner in which the curriculum requirements were
explained will be described for each profession with
emphasis on the sciences. This will be followed by a

83
discussion of cross-professional concerns. But first, what
evidence is there that conceptual and integrative
competence regarding the biophysical sciences were of
concern to those who wrote the accreditation standards?
Concern for conceptual competence, as defined by Stark
et al. (1986) in the sciences was apparent in the
accreditation standards because all sets of standards had
biophysical science requirements and several explained why.
For physician assistants
basic medical sciences are needed as a foundation
for subsequent clinical studies [and it is]
desirable . . . that this background include basic
concepts in anatomy, physiology,
pathophysiology, pharmacology, and clinical
laboratory medicine in as much as the subsequent
understanding of clinical medicine depends upon a
knowledge of these content areas. (AMA, 1985c,
p. 4)
"The structure of the professional curriculum in diagnostic
sonography based upon a prerequisite foundation of
postsecondary study in the biological sciences, introductory
physics, and mathematics must include didactic content of
appropriate scope and depth" (AMA, 1980a, p. 100).
Other statements infered a concern for integrative
competence. Respiratory therapy students had to "understand
the basic sciences and how basic principles relate to the
clinical application of the specialty" (AMA, 1977b, pp. 9-
10). "Students should acquire a clear understanding of the
basic sciences and how basic scientific principles relate to
clinical applications in the cardiovascular technology
field" (AMA, 1985b, p. 4). "The [histotechnology]

84
curriculum must reflect the relationship between the content
of the course of study and histotechnology functions,
including principles and practice, application of basic
sciences, . . . review of chemistry; laboratory mathematics;
anatomy and tissue identification" (AMA, 1978, unpaged).
Biophysical Sciences in Each Curriculum
Cardiovascular technology standards divided the
curriculum into basic, cardiovascular, and clinical units.
Five components suggested for the basic unit were
introduction, basic medical electronics, pharmacology,
anatomy and physiology, and sciences. Pharmacology,
anatomy, and physiology were to be concentrated on the
cardiovascular system. The sciences were to include
"biology, basic chemistry, physical principles of medicine,
basic statistics, and general mathematics" (AMA, 1985b,
p. 4). Curricular evidence for biophysical sciences was
also found in the course examples listed under the clinical
unit, i.e., cardiac and vascular pathology and physics.
Cytotechnology guidelines recommended 8 semester hours
of chemistry and 20 semester hours of biological sciences as
prerequisite to professional subjects. The biology courses
could include "general biology, bacteriology, parasitology,
cell biology, physiology, anatomy, zoology, histology,
embryology, and genetics" (AMA, 1983a, p. 6). Professional
course titles or subjects were not listed, but the standards
described 18 competencies several of which implied a science
background. "On detection of cellular manifestations of

85
disease, the cytotechnologist will be able to develop a
differential diagnosis based on the cellular evidence in
conjunction with pertinent cognitive knowledge and clinical
data" (AMA, 1983a, p. 2).
Dental hygiene standards divided the curriculum into
general education, basic sciences, dental sciences, dental
hygiene sciences, and clinical practice. Several topics
which did not need to be eguivalent to individual courses
but which had to be presented are listed under each
division. Among these were general chemistry, anatomy,
physiology, biochemistry, microbiology, pathology,
nutrition, pharmacology, tooth morphology, head-neck-and-
oral anatomy, oral embryology and histology, oral pathology,
radiography, and periodontology and dental materials (Amer.
Dent. Assoc., n.d.).
Required dietetics prerequisites were inorganic and
organic chemistry, microbiology, human physiology, and an
introductory nutrition course. Depending upon the specialty
tract elected, biochemistry, biochemistry analysis, anatomy,
advanced physiology, or genetics was required or recommended
(ADA, 1976). Professional courses, topics, or competencies
were not itemized.
Histotechnology standards listed topics which the
curriculum must include. These included the "application of
basic sciences, . . . review of chemistry, laboratory
mathematics, anatomy and tissue identification" (AMA, 1978,
unpaged).

86
Medical record administration guidelines divided the
entire curriculum into general education, basic sciences,
professional courses, and electives. A range of credit
hours was suggested for each division; these were 16-24
semester hours for the basic sciences and 36-50 semester
hours for the professional courses (AMA, 1981a). Fourteen
content areas were specified for the professional courses,
one of which was labeled sciences. Sciences were described
as "anatomy and physiology (including a laboratory) ; the
nature, cause, treatment, and management of pathologic,
microbiologic, and clinical disease processes" (AMA, 1981a,
p. 4) .
Medical technology standards required 16 semester hours
of chemistry and 16 semester hours of biological science
plus one college level mathematics course. The
professional curriculum has five divisions; principles of
procedures and instruments, laboratory procedures in
diagnosis and treatment, quality control, laboratory
management and supervision, and methods of instruction (AMA,
1977a). Course titles and academic disciplines were not
specified.
Nuclear medicine standards itemized required
prerequisites which included postsecondary courses in "human
anatomy and physiology, physics, mathematics, . . . and
general chemistry" (AMA, 1984, p. 7). The professional
curriculum was divided into seven areas: physical science;
radiation biology, safety, and protection;

87
radiopharmaceuticals; in-vivo procedures; in-vitro
procedures; administrative procedures; and therapeutic uses
of radionuclides. Discussion of these competencies
indicated a heavy emphasis on applied science and
technology.
Nurse anesthesia standards required five college level
biophysical science course prerequisites. Eighteen terminal
competencies were listed and the curriculum was divided into
academic and clinical parts. The academic component was
subdivided into professional aspects; principles of
practice; seminar; anatomy, physiology, and pathophysiology;
chemistry and physics; and pharmacology. All of the
sciences were specified to be "in relation to anesthesia"
(AANA, 1980, p. 16) and a minimum number of clock hours was
required for each academic component.
Nursing standards did not itemize courses, content, or
subjects. However, several standards addressed the
curriculum and many guidelines imply the importance of
science. The curriculum was "supported by other sciences
or the content reflects the interactive nature of nursing
science with medical sciences, behavioral, physical, and
natural sciences" (NLN, 1980, p. 41).
Occupational therapy standards divided the curriculum
into liberal arts, sciences, and humanities; biological,
behavioral, and health sciences; occupational therapy theory
and practice; research; values and attitudes; and fieldwork.
A health science guideline was that "content should include

88
anatomy, kinesiology, physiology, neuroanatomy, and
neurophysiology" (AMA, 1983b, p. 2).
For the perfusionist "the curriculum must include or
have as prerequisites appropriate background courses
including anatomy and pathology, physiology, chemistry, and
pharmacology" (AMA, 1980b, p. 2). Several physiological
concepts and technical procedures such as hypothermia, heart
lung bypass, and blood gas analysis were listed. And "the
curriculum must include course work covering the major
clinical applications of" (AMA, 1980b, p. 2) these
technologies.
Pharmacy standards divided the curriculum into general
education, basic sciences, professional sciences, and
practical experiences. Essentially the basic sciences were
prerequisites. The professional sciences were subdivided
into three areas: "biomedical sciences; . . . [which]
include anatomy, physiology, microbiology/immunology,
biochemistry, pathology . . . [and] pharmaceutical sciences;
. . . [which] include medicinal chemistry . . . basic
pharmaceutics, biopharmaceutics, pharmacokinetics,
pharmacognosy . . . ; and pharmacology" (ACPE, 1984, p. 17).
The clinical sciences "include clinical applications based
on the biomedical and pharmaceutical sciences such as . . .
disease processes, clinical pharmacology, and therapeutics"
(p. 17).
Physical therapy standards did not specify prerequisite
or professional courses. They did require a curriculum plan

89
and listed several competencies that the entry level
clinician would have. Several of these competencies implied
a background in the sciences. A practitioner had to be able
to perform "definitive physical therapy testing of the
following systems: neurological, muscular, skeletal,
cardiovascular, pulmonary, integumentary, [and] metabolic"
(APTA, 1978, p. B-5).
Physician assistant curricular requirements had four
content areas; basic medical sciences, patient assessment,
instruction and clinical practice in relevant clinical
disciplines, and professional role. The guidelines stated
the importance of the sciences and suggested anatomy,
physiology, pathophysiology, pharmacology, and clinical
laboratory medicine (AMA, 1985c).
Radiation therapy technology standards required
students to have a background in high school science and
mathematics (AMA, 1981b). Fourteen topics which had to be
in the curriculum were listed and among them were "human
structure and function; oncologic pathology; radiation
pathology; radiobiology; mathematics and radiation physics"
(p. 2 ) .
Radiographer standards listed 17 content areas. Some
of these were introduction to radiography, human structure
and function, radiation physics, principles of radiation
protection, principles of radiation biology, and
radiographic pathology (AMA, 1983c).

90
Sixty-two semester hours in the professional program
were required by respiratory therapy standards. Required
topics were listed under basic or respiratory therapy units
of instruction. Examples of the former were "general
science to include biology, chemistry, physics, and
mathematics; general anatomy and physiology; cardio¬
pulmonary-renal anatomy and physiology; microbiology,
pharmacology [and] clinical topics" (AMA, 1977b, p. 9).
Sonography guidelines recommended "human anatomy and
physiology, mathematics, and physics" (AMA, 1980a, p.101),
as prerequisites. The professional curriculum was divided
into seven units some of which were physics, biological
effects of ultrasound, applied biological sciences, and
clinical medicine. Additional units were enumerated for the
echocardiography subspeciality. The applied science and
technical nature of the curriculum was apparent from the
unit subheadings. For example, physics was to include
"fundamental physics and mathematics, acoustical physics,
[and] physical principles of ultrasound" (p. 102).
Surgeon's assistant standards recommended two years of
college prior to admission, but course work was not
specified. The professional curriculum was divided into 13
areas, some of which were human anatomy, including
neuroanatomy; medical physiology; fundamentals of clinical
medicine, including pathophysiology; and pharmacokinetics
and pharmacodynamics (AMA, 1982).

91
Similarities Among Biophysical Science Standards
From this review of accreditation curriculum
requirements it was obvious that a variety of biophysical
sciences constitute required course content for the 20
health professions programs. Summarized in Table 6 is the
scope and diversity of these sciences. Under each primary
science discipline the adjectives or subdisciplines used by
one or several sets of standards is listed. However neither
this table nor the review necessarily indicate depth or
duration of the science course requirements. But the
guidelines give several clues.
Standards which applied only to the baccalaureate
programs in nursing, dietetics, and pharmacy (see Table 1)
can be assumed to refer to undergraduate college level
science courses. A comparable or more advanced level of
course work can probably be assumed for standards which
restrict the credential to be awarded to baccalaureate, post
baccalaureate certificate, or masters degrees, as with
medical record administration, occupational therapy,
physical therapy, and medical technology. Of these, all but
the latter limited sponsorship to 4-year colleges or
universities.
Cytotechnology, nurse anesthesia, physician assistant,
and surgeon's assistant standards all appeared to

92
Table 6
Sciences Named in Accreditation Standards
Anatomy
cross sectional
embryology
general
human
neuro
oral embryology
Anatomy & Physiology
human structure & function
cardio-pulmonary-renal
circulatory
general
human
Nutrition
advanced
human
Pathology
anatomical
clinical disease/disease
histopathology
oncological
oral
pathophysiology
radiation
Basic Sciences
academic
general
natural
physical
Pharmacology
pharmaceutics
pharmacodynamics
pharmacokinetics
radio
Biology
radiation
zoology
Physics
nuclear medicine
radiation
Chemistry
basic
biochemistry
biochemistry analysis
general
inorganic
medicinal
organic
radiation
Microbiology Molecular Sc.
bacteriology
parasitology
Physiology
advanced
human
medical
neuro
Subcellular/cellular
cell biology
genetics
histology
immunology
oral histology
Other
kinesiology
periodontology

93
build their professional curricula on at least a
prerequisite of 2 years of college. Surgeon's assistant
"candidates for admission should have completed two years of
college" (AMA, 1982, p. 3). On admission, cytotechnology
students "shall have acquired an academic background at the
college level including basic chemistry and biology courses
beyond the introductory level" (AMA, 1983, p. 6). For
physician assistant "the manner in which programs ensure
that students have sufficient background in the basic
medical sciences may vary" (AMA, 1985, p. 4), but it must be
accomplished before or during the professional curriculum.
Nurse anesthesia standards required candidates for admission
to be registered nurses and to have had "a minimum of 30
semester hours" (AANA, 1980, p. 8) including five
biophysical science courses.
Accredited programs among this group offered
certificates through masters degrees. Evidence for
considerable depth in some of the sciences was apparent.
For surgeon's assistant "neuroanatomy at an advanced level
with lectures, dissections, demonstrations, and prosections"
(AMA, 1982, p. 2) was stipulated. After having taken 32
semester hours of biological sciences and chemistry the
cytotechnology student should study pathology and
cytopathologic diagnosis (AMA, 1983a). "Advanced" (AANA,
1980, p. 36) textbooks were specified for physiology,
pathology, and pharmacology for nurse anesthesia students.

94
Nuclear medicine and sonography required candidates for
admission to have completed high school level physics,
biology, algebra, and geometry (AMA, 1980a, 1984). These
and the perfusionist standards appeared to build the
curricula on a strong high school science base. However,
all three required additional postsecondary work in the
biophysical sciences. The guidelines implied detail if not
depth in areas germane to the occupations. Nuclear medicine
students should study "biochemical and physiological
properties of radiopharmaceuticals" (AMA, 1984, p. 6). For
sonography students, pathophysiology should include
"congenital and acquired cardiac diseases [and] alterations
in hemodynamics" (AMA, 1980a, p. 102).
Although accredited baccalaureate programs existed in
all of the remaining fields, the majority of
histotechnology, radiation therapy technology, and
radiography were certificate programs and most dental
hygiene and respiratory therapy programs were associate
degree programs (AMA, 1985a). Cardiovascular technology was
a new field and no programs had completed the accreditation
process to date at the time of the review.
The use of the academic credential to be awarded as an
index of the depth of biophysical science course content can
be misleading. An example of an apparent dichotomy between
accreditation requirements or expectations and the academic
credential is illustrated by respiratory therapy
guidelines.

95
The base of all courses must be broad and the
content must review the respective areas in their
entirety well beyond the specific and particular
requirements of clinical respiratory therapy. The
students must understand the basic sciences and
how basic principles relate to the clinical
applications of the specialty. A general overview
of mathematical principles, biological sciences,
pathology, microbiology, clinical medicine, and
therapeutics must be accompanied by special, in
depth study of cardiopulmonary and renal anatomy,
pathology, clinical management and therapeutics.
In these areas the level of instruction must be
similar to those ordinarily provided to medical
students. (AMA, 1977b, pp. 9-10)
Concerning respiratory therapy faculty, "requirements
of a health related program frequently can not be met by
faculty of the average educational institution. Properly
qualified instructors in such fields as pharmacology and
microbiology are rarely found on the faculty of two-year
institutions" (AMA, 1977b, p. 6). With this, the guidelines
suggested the utilization of hospital personnel as teachers.
Recall that the standards for this occupation required
educational institution sponsorship and most programs were
in community colleges and an associate degree was awarded
(AMA, 1985a).
College-wide Accreditation
"Accreditation is a system for recognizing educational
institutions and professional programs affiliated with those
institutions for a level of performance, integrity, and
quality which entitles them to the confidence of the
educational community and the public they serve" (Harris,
1987, p. 444). Both professional and academic leaders are
nearly unanimous in their support of the concept of

96
accreditation (Amer. Dent. Assoc., n.d.; Council on
Postsecondary Accreditation, 1986; Ford & Cicarelli, 1982;
NLN, 1979; Southern Association of Allied Health Deans in
Academic Health Centers, 1985). Aside from this support in
principle, major concerns have been voiced regarding the
relationship of accreditation to federal and state
government (Dickey & Miller, 1972; Nyquist, 1980; Orlans,
1980; Tucker & Mautz, 1978), expense, proliferation of
agencies, duplication of processes, and parochial
requirements (Doerr, 1983; Elsass & Pigge, 1980).
Improvement was being urged by many (Clemow, 1985-1986;
Council on Postsecondary Accreditation, 1986; Semrow, 1982).
Criticism concerning expense, duplication,
inflexibility, and professional control associated with
specialized accreditation abounded among administrators
concerned with allied health (Ford, 1983; Freeland, 1986;
R. B. Mautz, 1987, personal communication). This was even
evident in some college catalogs. "Accreditation
requirements for the individual programs preclude the
establishment of general school admission prerequisites,
registration dates, and course and degree requirements"
(Virginia Commonwealth University, 1984, p. 104). The call
for alternatives and experimentation was acute (Florida
Postsecondary Planning Commission, 1985; NCAHE, 1980).
One response to this dissatisfaction has been the
development of school-wide "Standards for the Accreditation
of Academic Units (Colleges, Schools, Divisions) of Allied

97
Health Professions" by the Southern Association of Allied
Health Deans at Academic Health Centers (1985). While this
alternative was still in the developmental phase at the time
of the study, the standards had been written and mock self-
studies and site visits have been conducted in conjunction
with actual CAHEA visits. A primary objective of this
accreditation project was to present a valid alternative to
"the present process of programatic accreditation as a means
of quality assurance in allied health education" (Vaught,
1986, p. 38-39). How do these standards compare with the 20
specialized sets just reviewed?
Autonomy of the college was a major issue, as was
evident under many sections. "The administrative structure
of the unit . . . shall be consistent with the structure for
other units . . . [and] programs within the unit and their
directors should report administratively to the chief
administrative officer of the unit" (Southern Association of
Allied Health Deans at Academic Health Centers, 1985, pp. 7
and 6). The authority to initiate or eliminate "programs
shall rest with the governing structure of the institution,
but the specific authority for conducting programs shall be
the responsibility of the administration and the faculty"
(p. 7). "The institution and the unit must maintain control
of its policies relative to research and instruction"
(p. 16). Also, "for programs that receive a substantial
portion of their funding from sources external to the unit,
the stability of this income must be evidenced" (p. 10).

98
In contrast to the other sets of standards including
those for pharmacy and nursing, which in AHCs were usually
applied college-wide, the standards relating to
administrator qualifications, competencies, and evaluation
were absent. But qualifications, expectations, and
evaluation of teaching faculty were specified. They "must
have demonstrated competence in the fields in which they
teach. [And] . . . there must be evidence that this
competence is maintained" (p. 11). The college "should have
established criteria against which performance of individual
faculty are evaluated. These criteria should be known by
all concerned" (p. 11). There was no itemization of
requisite academic or professional credentials.
Two faculty roles were emphasized, undergraduate
teaching and professional service. College-wide commitment
to undergraduate education was evident because "graduate
work should not be undertaken unless the academic integrity
of the undergraduate program can be maintained" (pp. 14-15).
An obligation to the local and professional communities was
suggested by encouragement to "conduct many different forms
of special activities . . . off campus classes, independent
study programs, conferences, and workshops" (p. 14).
Faculty service to the university or AHC was not mentioned.
Professional practice was implied by the requirement for
faculty to remain skilled for teaching purposes and a
request that any faculty clinical practice plan be included
as an appendix.

99
Regarding faculty administrative activities, it was
stipulated that faculty should participate "in the
development of academic policies . . . [and] appropriate
members of the faculty" (p. 10) could participate in budget
preparation. Likewise there was no mandate for research,
but "the role of faculty scholarly activity and research
within the unit and the role of faculty in conducting such
activity should be addressed" (p. 15).
Professional practice in service of the teaching
mission was stressed. Service to the local professional
communities was emphasized but not to the AHC or university.
Decision-making about academic policy and research, if
espoused by the college, was mentioned. Lastly, the
standard concerning educational programs stated that
"programs must demonstrate that an effective relationship
exists between the program content and the current standard
of practice in each field where a program exists" (p. 9).
As explicit as this and other standards were, they were
still open to different interpretations. The above mandate
could imply the values which the authors placed on current
practice, that is, not lagging behind. It could also be
interpreted to retard innovation, prevent expansion of scope
of practice, or obstruct the need or wish to raise
professional entry levels. In other words, if clinicians
are not presently engaging in a given role, the course
content prerequisite to a new or expanded role can not be
justified. The recommendation that there be a "balance in

100
the overall educational offerings with determined
limitations on the number of hours allowed in specialized
areas" (p. 8) "begged" explanation. Was the underlying
premise concern for general education, a belief that
specialization is not feasible at the undergraduate level, a
method to facilitate interdisciplinary and core courses, or
something else?
In one standard there was a requirement for program
specific evidence for the teaching learning process.
Courses should have been evaluated, objectives should have
been written, the curriculum should have been under
continuous study at the program, unit, institutional, and
state levels. In marked contrast with all other sets of
standards examined, curriculum content was not addressed.
"The major responsibility for the curriculum and related
learning experiences" (p. 9) should have been vested in the
"unit administration and faculty" (p. 9). There was no
mention of medical directors or advisory committees.
Physician role, if any, in the curricula was not mentioned.
But a request for center-wide data to be included as an
appendix did imply physician participation. The request was
for medical school faculty role, strengths, weakness, and
budgetary support to be explained. Thus, according to this
standard, curricular content responsibility appeared
delegated to the college.
In summary the proposed standards were developed in
response to CAH administrator dissatisfaction with program

101
specific accreditation. The standards addressed 11 major
areas, which had the same topic headings as the Southern
Association of Colleges and School's (1975) accreditation
standards. Documentation of curriculum processes and
outcomes was required but there were no specifications and
only a few generalities regarding content. Sciences, like
other course topics were not mentioned. University/AHC
concerns were addressed and this was especially evident by
requests for information to be included in appendices rather
than by required standards. The salient theme of the entire
document was administrative, not curricular or professional.
This concludes the review of 21 sets of accreditation
standards. Detail and diversity characterized the
stipulations of the standards. Faculty were expected to
teach, but curricula development and responsibility were
sometimes vested in program administrators, advisory
committees, or physicians. Among the 20, science topics
were always mentioned, frequently in precise but
nonacademic language. Excluding clinical practice, faculty
service and research responsibilities were infrequently
mentioned. Clearly, the accreditation standards examined
did not provide a basis upon which leaders of AHC based CHAs
could evaluate the delivery system for the biophysical
science curricular components for all programs.

102
College of Allied Health Catalogs
Introduction
Letters requesting a catalog describing undergraduate
allied health programs were mailed to the office of the
registrar of 60 institutions. All institutions were listed
in the 1985 or 1986 directories of the Association of
Academic Health Centers and allied health was indicated as
one of the institutional components. Eight weeks later,
after a 63% return, one follow-up request was mailed to the
respective deans (see Appendix B). All correspondence
received (catalogs, pamphlets, and letters) was reviewed for
the purpose of identifying mission statements and goals,
faculty role regarding service and research, evidence of
science course delivery systems, and selected items
mentioned in specialized accreditation standards.
Responses were received from 51 (85%) institutions.
Some characteristics of all of the colleges are summarized
in Table 7. Most were public and part of a major university
or university system but some were private, church
affiliated, or free standing academic health centers. The
allied health units represented independent, dependent, and
coordinated structures. A few had no generic baccalaureate
programs, or their institutions just served as a clinical
practice affiliate for other institutions; but most had
several baccalaureate programs.
While it was not the intent to compare catalogs with
accreditation documents, both were reviewed for some of the

103
Table 7
Characteristics of AAHC Members which Listed Allied
Health as a Component
Population 60
Member of American Society of
Allied Health Professions 40
Institutions which Responded 51
Allied Health Unit Sponsors
Baccalaureate Programs3 44
Allied Health Organization Structure
Independent 33
Dependent 8
Co-ordinated 5
Unable to Determine 14
Carnegie Classification of University'3
Research I 17
Research II 5
Doctoral I 2
Doctoral II 3
Health Center 29
Comprehensive I 4
Note. Includes all institutions listed in 1985 and 1986
AAHC directories.
a Includes only the institutions that responded to a
catalog request.
k From "Carnegie Foundation's Classification
of More than 3,300 Institutions of Higher Education"
(1987) The Chronicle of Higher Education July 8,
pp. 22-26, 28-30.

104
same information; therefore, some comparisons of content
were made. The purposes of the two types of documents are
different. Catalogs serve to describe the institution and
its programs to the public, especially potential and
enrolled students. The content often conveys a positive
image of the institution as well as facts. Accreditation
documents, while available to the public, are generally read
by those faculty and administrators whose programs are to be
evaluated. The information is presented in a more direct
and proscriptive manner. But items of content were either
present or not in both sets of copy.
Mission Goals and Purposes
Of the brochures and catalogs received, all except one
directly or indirectly stated the institution/college
mission or general purposes. "The University of Texas
Health Science Center at San Antonio is . . . dedicated to
research, patient care, and education" (1986, p. 2). "The
State University [of New York] motto is 'To Learn--To
Search—To Serve'" (SUNY Health Science Center at Brooklyn,
n.d., p. 48). The purpose of the University of Wisconsin-
Madison (1985), "is to provide an environment in which
faculty and students can discover, examine critically,
preserve, and transmit the knowledge, wisdom, and values
that will help ensure the survival of the present and future
generations" (p. 2). The Louisiana State University (1986)
"mission involves development of the highest levels of
intellectual and professional endeavor in programs of

105
instruction, research, and service . . . [it] serves the
people as an instrument for discovery as well as
transmission of knowledge" (pp. 6-7). Clearly the
traditional teaching, research, and service triad is
evident in the mission statements.
Statements of purpose and goals of the colleges were
more specific. Objectives of the Louisiana State University
School of Allied Health Professions were "to increase the
supply ... of patient oriented health professionals . . .
to meet the need for health services and future teachers in
health educational programs ... to develop and maintain
programs of investigative studies and research" (Louisiana
State University, 1986, pp. 65-66). In some brochures the
goals were not clearly stated but the essence of the
colleges' philosophies could be inferred. Through a series
of photographs and multiple sizes and forms of print the
prospective student of the College of Health Related
Professions of the State University of New York Health
Science Center at Syracuse [SUNY-Syracuse] was told that "we
prepare you for a career . . . place you at the cutting edge
. . . let you practice what you learn ... we care, we
share . . .we teach by example . . . and when you leave
we're still just a telephone call away" (State University of
New York Health Science Center at Syracuse, n.d., pp. 3-9).
In some catalogs the purposes of each department were
further elaborated. Faculty of one department at the
Virginia Commonwealth University (1984) was "concerned with

106
improving the quality of occupational therapy. . . .
Research, community service, and continuing education are
viewed as ways to improve professional services" (p. 116).
A sense of pride and commitment associated with an
institution's history, mission, or service to a particular
locale or population was apparent in numerous bulletins.
One institution exemplifying this was Howard University. It
was established "to help uplift the nations newly
emancipated slaves ... [a founder] fervently believed that
former slaves could be educated" (Howard University, n.d.,
p. 9). "Howard is located on a hilltop overlooking the
nations capitol . . . [but it] sees itself not at the center
of a nation, but at the center of a world" (n.d., p. 5).
The State University of New York Health Science Center at
Brooklyn (n.d.) had "programs for the educationally and
economically disadvantaged [which] have become models"
(p. 48). George Washington University (n.d.) offered highly
specialized programs for military personnel such as nuclear
undersea medical technology (p. 78). The catalog authors
boasted that through its affiliates, Louisiana State
University (1986) provided health care for 75% of the states
indigents.
The complexity attributed to CAHs (Wise, 1979) was
evident in some publications. Most programs offered by the
School of Health Related Professions of the University of
Medicine and Dentistry of New Jersey (n.d.) were cosponsored
with other institutions. The Texas Tech School of Allied

107
Health Bulletin (Texas Tech University Health Sciences
Center, 1984) displayed not only the university calendar but
a calendar for each allied health program. The
Undergraduate Health Sciences Bulletin of the University of
Minnesota (University of Minnesota, 1985) described allied
health programs offered by its schools/colleges of
agriculture, home economics, liberal arts, medicine, and
others. Among the catalogs reviewed, the baccalaureate
programs offered included occupational safety and health
(Arizona), speech language and auditory pathology (East
Carolina), toxicology (Medicine and Dentistry of New
Jersey), mortuary science (Minnesota), medical illustration
(Ohio State), in addition to the 18 professions described in
the accreditation overview. Also, among the colleges the
whole range in academic level, certificate through
doctorate, was represented.
Pride in participation with the allied health movement
and its antecedents was apparent. The origin of Boston
University Sargent College of Allied Health Professions was
traced to the inception of the Sargent Normal School of
Physical Training in 1881, a predecessor for "modern
rehabilitation and preventive health care" (Boston
University, 1986, p. 1) education. The Division of Allied
Health Sciences of Indiana University "was one of 13 allied
health units from across the country to participate in
planning and formation of the . . . American Society of
Allied Health Professions" (Indiana University, 1985, p. 5).

108
The stance of a professional school was apparent in the
many references to service and continuing education. "The
professional service mission of the College includes the
offering of continuing education courses to practitioners to
enhance teaching, administration, and professional skills"
(University of Arkansas for Medical Sciences, n.d., p.l).
And a purpose of the University of Nebraska was "to provide
selected continuing education programs for practicing allied
health professionals" (University of Nebraska Medical
Center, 1985, p. 8).
A commitment to professional service by the faculty was
suggested for the Mayo School of Health-Related Sciences
where the "emphasis [is] on what is best for the patient"
(Mayo Foundation, n.d., p. 8). But faculty service
responsibility was not limited to professional practice.
Another catalog stated that the School of Community and
Allied Health of the University of Alabama at Birmingham
encourages consultation and promotes "faculty participation
in organizations and committees of the School and
University" (University of Alabama at Birmingham, 1985,
p. 4). The allied health faculty at the University of
Nebraska "provide consultant services and leadership [for]
groups and organizations . . . [and] provide services as
appropriate to patients and to the public" (1985, p. 8).
Integrating clinical service and research was Sargent
College of Boston University. "It is the first and only
school of allied health to offer bachelor's, master's, and

109
doctoral degrees in all of its departments" (Boston
University, 1986, p. 1). The college faculty conducts four
health care clinics which serve clients, students, and
faculty for service, teaching, and research purposes. The
faculty members of the College of Allied Health Professions
at the University of Kentucky were "committed to the ideals
of excellence in scholarship in both classroom and clinical
settings" (University of Kentucky, 1985, p. 3). Ample
evidence that faculty aspire to excel rather than simply
maintain technical skills or communicate facts was found in
the Medical University of South Carolina (n.d.) catalog.
"Investigative research in the health related professions
including the areas of new clinical skills, educational
methodology, and health care delivery" (p. 98) were among
college goals. Also, "the faculty and (to whatever extent
possible) students should contribute to the discovery,
dissemination, and utilization of knowledge through research
and publication, and in exemplary practice" (University of
Illinois at Chicago, n.d., p. 9).
All catalogs and brochures described the programs and
often respective courses. The colleges' of allied health
educational missions as fulfilled by teaching can be
summarized as "recruiting and retaining highly qualified
faculty" (University of Alabama at Birmingham, 1985, p. 3)
all of whom become "actively engaged in teaching with
opportunities in research and clinical practice" (Medical
College of Ohio, n.d., p. 5), and several of whom are "at

110
the forefront of their disciplines in instruction and
research" (University of Kentucky, 1985, p. 3). Clearly the
catalogs indicated that the goals of the CAHs were congruent
with and reinforced the teaching, research, and service
missions of their universities.
The Sciences
Several baccalaureate allied health curricula described
in the catalogs consisted of 2 years of preprofessional
course work followed by 2 years of professional phase
courses, the 2-plus-2 design. Other patterns, such as 3
years of prerequisite course work followed by a 1 year
professional phase, the 3-plus-l design, were also
encountered. The latter was common with the clinical
laboratory science programs. For some curricula, the
catalogs described general education, supporting sciences,
and professional courses sequenced over the entire 4-year
period, the integrated curriculum. Whatever the design, the
traditional 4-year academic calendar can not be assumed.
Countless programs included summer terms, and/or exceeded
4 years, and/or terminated after an extended period of
intensive clinical experience.
Whatever the allied health program, curricular design,
or university, all catalogs specified prerequisite
biophysical sciences. Evidence that allied health faculties
expected the biophysical sciences to serve as a foundation
for further study and not merely general education was
apparent. In reference to high school preparation, the

Ill
University of Connecticut School of Allied Health faculty
recommended that students wishing freshman admission to any
of the five baccalaureate allied health programs "have
physics, chemistry, biology, and four years of math"
(University of Connecticut, 1986, p. 7). The catalog for
the School of Allied Health Professions at the University of
Wisconsin-Madison stated that the faculty provided
"professional education in health professions based upon a
broad and firm foundation in the liberal arts and sciences .
. . [and instill] attitudes of scientific inquiry and
critical thought" (University of Wisconsin-Madison, 1985,
p. 3). In enumerating lower division sciences many catalogs
mentioned laboratory requirements for chemistry, physics,
microbiology, and physiology.
For specific programs, the importance of the
biophysical sciences was commonly rephrased. "Knowledge and
skills of a dental hygienist are indepth and highly
scientific and include such areas as anatomy and physiology,
histology, pharmacology, microbiology, pathology, nutrition,
and radiology" (Medical University of South Carolina, n.d.,
p. 121). Cardiopulmonary science majors graduate "with a
firm background in anatomy and physiology, biochemistry,
pharmacology, and clinical medicine" (Louisiana State
University, 1986, p. 73). Nuclear medicine technologists
need a "thorough knowledge . . . regarding radiation and its
physical as well as biological effects" (University of
Arkansas for Medical Sciences, n.d., p. 56). "The strengths

112
of the [occupational therapy] program lie in a strong
background of the basic human sciences. . . . During the
junior year students study basic sciences (anatomy,
neuroanatomy, physiology, kinesiology)" (SUNY Health
Sciences Center at Brooklyn, n.d., p. 23). And for physical
therapy "the basic science courses, fundamental to
understanding the theory of the clinical sciences, are
offered early in the program and include graduate courses of
the college of medicine curriculum" (University of Nebraska
Medical Center, 1985, p. 46).
Science Course Delivery System
The description of a university organizational
structure is a tangent function of a catalog. Thus they can
not be relied upon to identify basic science department
structure or the system in place for course delivery.
However by scrutinizing the narratives, course prefixes, and
accompanying explanations (when provided) it is possible to
discern patterns which may indicate where some of the
teaching and/or administrative responsibilities for science
course delivery rest.
The delivery system for the professional phase science
courses as reflected by the catalogs included at lease six
structures: (a) departments in the colleges of medicine
(Emory); (b) departments within the colleges of allied
health (Boston University); (c) departments that serve all
health center schools but are not administered by any one of
them (Virginia Commonwealth University); (d) liberal arts

113
and science departments of the university (University of
Arizona); (e) departments in other colleges of the health
center, namely dentistry (Medical College of Georgia) or
pharmacy (Wayne State University); (f) interdisciplinary
units of the colleges of allied health (University of Texas-
Galveston); and possibly, (g) program specific faculty for
all basic, applied, and clinical sciences in a given
curriculum.
The first four delivery systems are consistent with the
basic science organizational structures reported by the vice
presidents in the AHC governance study (AAHC, 1980b). When
asked, "How is basic science education organized [in your
AHC]?" (p. 330), all 86 respondents identified one of the
four preselected choices, i.e., "within each school, medical
school departments teach students from other schools, health
center-wide, [or] university-wide" (p. 330). Some of these
and other patterns reflected by the catalogs warrant
discussion.
In many programs all or almost all professional phase
courses carried the same letter prefix. This was found for
programs at the Universities of Alabama, Arkansas, and Texas
Tech. At the Universities of Connecticut and Louisville all
professional phase nonscience courses carried
program/department specific or CAH prefixes. Most of the
science courses had CAH-wide letters in the prefixes. These
courses were referred to as Allied Health: Health Sciences
(University of Connecticut) or Basic Science Core

114
(University of Louisville). But it can not be assumed that
the allied health departments or colleges actually provided
the space, laboratories, or faculty.
A direct statement that a college does assume
responsibility for a portion of the science course delivery
was in the college catalog for Boston University (1986). A
department in that college "offers intermediate and advanced
courses in human anatomy, neuroanatomy, human physiology,
and nutrition for the various health programs" (p. 15).
However not all program reguired biophysical sciences were
offered by this department. "The following courses
administered by other Boston University schools and colleges
are an integral part of degree programs at Sargent College"
(p. 70). The courses listed included upper and lower
division sciences delivered by the colleges of liberal arts,
dentistry, and medicine. This catalog left no question
about which college or department faculty was responsible
for any course.
In some catalogs, participation by the faculty of the
colleges of medicine was stated. At Emory some basic
science "courses are taught for the Allied Health programs
by the Basic Science Departments of the Medical School"
(Emory, 1986, p. 31). At George Washington University "the
School of Medicine and Health Sciences serves other
divisions of the University by making available to
nonmedical students certain undergraduate and graduate
courses in the following departments; anatomy, biochemistry,

115
microbiology, pathology, pharmacology, and physiology"
(George Washington University, 1986, p. 83). At the
University of Nebraska, course prefixes implied that some
sciences may be taught by college of medicine faculty for
four programs. But this was only verifiable for the
physical therapy curriculum where "the basic science courses
include graduate courses of the College of Medicine
curriculum" (University of Nebraska Medical Center, 1985,
p. 46).
At the Health Science Center at Brooklyn, many science
courses "designed specifically for undergraduate students
are presented by the faculty of various basic science
departments of the Medical Center" (State University of New
York Health Science Center at Brooklyn, p. 46). It was
unclear if these departments were administered center-wide
or by the medical school. The center-wide system was
described in one catalog, for Virginia Commonwealth
University. A synopsis and some assumptions about this
delivery system are pertinent.
Basic sciences historically have been an
integral part of the curriculum of medicine,
dentistry, pharmacy, nursing, and allied health
fields. In the earlier years of this university,
the basic science departments were administered by
the School of Medicine. ... In 1966, by action
of the Board of Visitors, a separate School of
Basic Sciences and Graduate Studies was
established. In 1974 ... it became the School
of Basic Sciences.
All departments in the School of Basic
Sciences provide instruction in their disciplines
for students in the other schools. By developing
large, strong departments with a good balance of
faculty, postdoctoral fellows, and graduate

116
assistants, it is possible to provide quality
instruction for all the health professions
schools, and to maintain strong research . . .
programs. (Virginia Commonwealth University, 1984,
p. 85)
Another scheme evident and sometimes explained was the
use of an interdisciplinary approach to deliver some of the
program required sciences. The University of Mississippi
School of Health Related Professions had a unit called
Interdisciplinary and Cooperative Education (University of
Mississippi at the Medical Center, n.d.). Under this
catalog heading nine faculty were listed and eight courses
were described. All courses carried an "ID" prefix, unique
to this unit. Because of the pattern followed in describing
the professional departments and curricula, the implication
was that the faculty listed for this unit taught the eight
"ID" courses, three of which were biophysical sciences.
Some of these faculty and all of those which appeared to
have graduate degrees in a biophysical science held primary
appointments in the College of Medicine.
Another interdisciplinary mode was described for the
University of Texas School of Allied Health Sciences at
Galveston. The catalog supplement and enclosed form letter
described the core curriculum, "the implementation of
[which] embraces the philosophy that there are generic
competencies, (knowledge, attitudes, and skills) that are
considered essential to the preparation of all allied health
practitioners" (University of Texas Medical Branch at
Galveston, 1985 Catalog Supplement, form letter, n.d.). Six

117
courses constitute the core, two of were in biophysical
sciences, anatomy and physiology, and pathology. All 6 of
these courses were part of four of the seven baccalaureate
curricula offered. The anatomy and physiology core course
was not a component of occupational therapy, physical
therapy, or physician assistant curricula.
Perusal of several catalogs indicated that the science
courses for any one program may have been provided with a
combination of administrative arrangements. For example,
the cytotechnology curriculum of the Medical University of
South Carolina included human anatomy, histology, and basic
sciences for cytotechnology. The former course was
described under the Department of Anatomy and Cell Biology,
and the latter under the cytotechnology/histotechnology
program courses which were part of the School of Applied
Laboratory Sciences in the College of Health Related
Professions. The histology course was not described and
carried an atypical prefix so it may have been offered by a
third unit (Medical University of South Carolina, n.d.).
The dental hygiene curriculum of the University of
Mississippi included dental anatomy described with other
program courses, biochemistry listed with college of
medicine biochemistry courses, and pathology listed under
the interdisciplinary unit for the college (University of
Mississippi at the Medical Center, n.d.).
When the catalog information concerning the biophysical
sciences was appraised collectively, countless seemingly

118
trivial statements or omissions could be interpreted as
important nuances. Seldom were the basic, applied, or
professional science course structural arrangements
elucidated; with Boston and Virginia Commonwealth
universities as notable exceptions. The presence of
interdisciplinary units and core courses were often
explained with pride. But in several instances the
profession, discipline, and university status of the
responsible faculty for the science courses was confusing or
not discernable. Lastly, if and when the medical schools'
faculties provided biophysical science courses for
undergraduate allied health students or permitted them to
enroll in medical curriculum courses it was not a presumed
right. As the writers of one catalog explained, an
advantage of enrolling in the Health Science Center at
Buffalo "is the privilege of taking basic science courses
from faculty of the medical school who have national
reputations" (State University of New York at Buffalo, n.d.,
p. 18) .
In summary, the catalog review revealed that the
biophysical sciences were perceived as important and were a
component of the heterogeneous allied health curricula. The
delivery of these courses was accomplished through colleges
and departments for which allied health faculty and
administration may or may not have had responsibility or
authority. The apparent disparity between the neat
categorization of the basic science organizational structure

119
by the vice presidents (AAHC, 1980b) and the assortment
reflected by the catalogs may not be contradictory. The
vice presidents responded to a question about department
structure. "How is basic science education organized?"
(AAHC, 1980b, p. 330). They were not asked which
departments provided biophysical science instruction for
baccalaureate level allied health students. Perhaps the
vice presidents, like the authors of the documents reviewed
for the governance study "tended to view the academic health
center in terms of its medical school" (AAHC, 1980d, p. 4).
Science Related Courses
The operational definition of a science related
course consists of three components. First, a science
related course is one required during the professional phase
of an allied health baccalaureate program. This excludes
prerequisite and elective courses. The level of the courses
may be lower division, upper division, or graduate.
Second, the course content must concern the biological
or physical sciences. Separate courses in mathematics,
statistics, and medical terminology, are excluded as are
social sciences, clinical practicum, and courses concerned
with the theory or applications unique to the various
professions. Both general introductory and advanced or
specialized biophysical sciences are included. Typically
for health professions students these courses were
chemistry, physics, anatomy, physiology, microbiology,

120
pharmacology, pathology, and nutrition, plus the divisions
among these disciplines (see Table 6)
Lastly, the science courses for this study were
identified by the use of Stark's framework (Stark et al.,
1986). The published course description had as a primary
purpose the promotion of conceptual competence, in the
opinion of experts.
Although allied health occupations "differ with respect
to the scientific foundations of their knowledge base"
(NCAHE, 1980, p. 66), science courses constituted an
important curricular segment for most. The accreditation
and catalog reviews established this fact. Concern for a
theoretical mastery (conceptual competence) of
professionally relevant science was evident in a broad array
of literature. Medical technology "faculty feel that a
major strength of the program is the basic science
preparation provided its students" (Florida Board of
Regents, 1983, p. 52). Dietitians are committed to
"advancing the science of nutrition" (Hart, 1979, p. 127),
they contribute "special knowledge of biochemistry,
physiology, nutrition, and drug interaction with nutrients"
(p. 127). "Occupational therapy student[s] need [to] study
pathology . . . as a means to understanding occupational
dysfunction" (Johnson, 1974, p. 212). "To understand and
use the apparatus and techniques of anaesthesia,
anaesthetists require a knowledge of basic physics" (Duffin,
1976, p. vii).

121
"How much [science background] to acquire and to what
depth are as yet unanswered questions" (Duffin, 1976,
p. vii). As health professions have developed and matured a
common theme has been the advocacy of formal education and
more science prerequisite to and during the curricula. This
has occurred in medicine, dentistry, nursing, and pharmacy
(Flexner, 1910; Gies, 1926; Goldmark, 1923; Mrtek, 1976).
These same trends were apparent within the allied health
professions.
Hart (1979) quoted from the 1972 Millis commission on
dietetics "the amount and quality of nutrition science
learning seem inadequate to form a firm base for the
practice of a health service which needs to be clearly
professional in it's competence" (p. 118). Collier and
Youtsey (1979) wrote that respiratory therapy professional
content is "based on a core knowledge in . . . chemistry,
physics, basic anatomy, and physiology" (p. 110). In a
historical review of radiological technologies curricula,
Soule (1974) traced the education from on-the-job training
to "three years (90 semester hours) of acceptable college
credit and [a] major in the biological or physical sciences"
(p. 155). Rhoton and Gravenstein (1977) justified the
implementation of an undergraduate anesthesia program in a
university setting, "because of the need for students to
understand and manipulate concepts rather than simply to
perform technical tasks in routine settings" (p. 10). Some
contend that "people who act as leaders in health must have

122
a strong background in basic science" (NCAHE, 1980, p 7).
The authors cited above all directed their remarks to
specific health professions. For the allied health
professions collectively, the literature on biophysical
sciences was sparse. When the sciences were addressed it
usually concerned the delivery or advocacy of core courses
(Bassoff, 1983; Connelly, 1978; Wutka & Baxter, 1981). The
National Commission on Allied Health Education (1980)
claimed program faculty "may be unaware that some of their
own courses, particularly in basic sciences, essentially
duplicate those of other programs" (p. 144). Of the
commission's 70 plus recommendations and subrecommendations
one mentioned the sciences.
Arrangements should be made for maximum use of
existing institutional resources, including shared
courses. In particular, whenever possible, allied
health students should receive instruction in the
basic sciences and humanities through
participation in general university courses
offered by faculty of the department in those
disciplines rather than in special courses offered
exclusively for allied health majors. (NCAHE,
1980, p. 204)
One explanation of this recommendation may have been
the commission's awareness of the difficulty health
professions students have reported in transferring credits
(Brooks, 1985). This phenomenon was summarized by Rhoton
and Gravenstein (1977).
The typical nursing curriculum prescribed
specialty credits in the basic sciences rather
than requiring or allowing students to register
for comparable courses offered by basic science
departments. The level of the nurse's academic
preparation in the sciences was therefore not

123
comparable to that of other science majors.
Nursing students found themselves generally unable
to apply their specialty credits toward graduate
study in areas outside nursing, (p. 3)
Challenges to the credibility of "prescribed specialty
credits in the basic sciences" (Rhoton & Gravenstein, p. 3)
for medical or graduate students were not found. Some
studies of science course content or the associated delivery
system have indicated that there is indeed a basis to
question the credibility of these courses for undergraduate
health science students (Clarke, 1983; Sirota, 1981) .
Clarke (1983) examined the views of 286 medical
technology faculty, students, administrators, and advisors
about their curricula. "Differences were found in the
academic preparation with deficiencies noted in pathogenic
microbiology, immunology, biochemistry, and instrumentation"
(p. 2372-A). From a content analysis of mathematics and
selected science catalog descriptions and information,
Buescher (1984) developed content items which he posited
were needed by medical technologists. The opinions of 618
clinical and educational medical technologist directors
confirmed many items. In content areas selected there was
concurrence on requisite knowledge for a medical
technologist.
Sirota (1981) studied the teaching of biochemistry for
dietetics students in all programs in the United States by a
survey of dietetics directors and biochemistry instructors.
One finding was that total class and laboratory contact

124
hours ranged from 39 to 280.5. Differences in course
content and textbook choices depended upon the type of
majors in the class. There was more emphasis on qualitative
than theoretical or conceptual material. She concluded
there was little communication between biochemistry
instructors and dietetic departments, minimal input from
nutritionists about course content, and "great variability
in the biochemistry education of future dietitians" (p.
4467-B).
Krieger (1977) queried 152 allied health and science
support faculty in selected Florida community colleges for
opinions about needed bio-organic course content. Faculty
indicated (a) a preference for minimal laboratory
experience, but when appropriate believed it should occur
during clinical practice rather than during the chemistry
course laboratory; (b) courses should carry general
education not specialty credit; and (c) a need to update
their own knowledge of the items on the questionnaire.
From a literature review, Perkin and Crandell (1985)
established that physician assistants performed "diet
therapy and nutrition counseling and/or prescribing"
(p. 185) usually without a physician present. They reviewed
the curricula of 91% of all U.S. physician assistant
programs for nutrition content. Nutrition classes averaged
13.3 clock hours. Content was presented as separate
courses, parts of other courses, or during clinical
rotations. The authors concluded, that "nutrition content

125
is rather limited . . . [with] a great deal of variation
. . . independent of the type of degree . . . [and] related
more to faculty interests and institutional resources than
to length of the curriculum" (p. 187).
Gerald (1976) reviewed pharmacology courses taught by
college of pharmacy faculty to nonpharmacy majors. He noted
the enrollment of many allied health students who did not
have a pharmacology course in their curricula. Riley (1978)
advocated a "more scientific orientation" (p. 6) and
scholarly approach for teaching pharmacology to nursing
students. Robinson (1987) reported results of a
pharmacology examination given to recently graduated nurses
upon initial employment. Nurses who had completed a
separate pharmacology course scored significantly better
than those who had received pharmacology by an integrated
curriculum. In the interest of guality, Freston (1976)
proposed that pharmacology departments be responsible for
all pharmacology education in any AHC program.
Faculty interest in content and method has stimulated
the development of new courses. Wutka and Baxter (1981)
described the planning of an "interdisciplinary course in
growth and development for allied health students" (p. 248).
When education or psychology department faculty presented
these courses, they stressed psychosocial development and
de-emphasized physical aspects, nutrition, and nonschool age
population needs. The courses implemented by the authors
corrected these perceived deficiencies.

126
Giese and Lawler (1978) developed a human physiology
course which used a personalized system of instruction.
They concluded this approach required more preparation time
of students and faculty than traditional approaches,
provided more instructor—student interaction, and more
flexibility depending on student preexisting knowledge and
ability. They advocated this method especially for "schools
of allied health which frequently offer courses
(particularly basic science courses) which are shared by
students from different departments or programs" (p. 273).
Lewis, (1981) described a team taught pathophysiology
course for baccalaureate medical technology, nursing, and
pharmacy students. Design of this course was preceded by a
survey of nursing program pathophysiology courses. Two-
thirds of the baccalaureate nursing programs had such a
course and there were reported variations in level
(sophomore through graduate), credit hours (2 quarter hours
through 6 semester hours), and teacher credentials. Reasons
the remaining one-third did not have a pathophysiology
course were, use of an integrated curriculum, insufficient
time, no one qualified on the faculty, or other departments
would not teach it.
Another topic in the literature was a concern for the
relevance of science content to clinical practice, that is,
the development of integrative competence (see p. 9).
Boren, Dixon, and Harden (1982) cited and agreed with
earlier authors that there is a weakness "between scientific

127
knowledge and its application . . . nutrition education can
not be effective unless it corresponds to real world
situations" (p. 148). Barr (1979) designed microbiology
courses for associate and baccalaureate medical technology
students which she claimed improved the integration between
theory and practice. This interest in integrative
competence may explain the inconsistency of faculty opinion
in Krieger's (1977) study. Faculty wanted the chemistry
courses to carry general education credit but when
laboratories were indicated they wanted the sessions to
occur during clinical rotations.
Vittetoe (1983) reviewed instruments designed and used
by others to measure learning styles of health professions
students. She generalized that the overwhelming evidence of
several studies using different instruments indicate a
student preference for concrete and teacher-structured
experiences. In her study, she compared the learning styles
of physical therapy and medical technology students with
each other and over time. From the literature, the study
reported, and her 30 years of teaching experience, she "has
found that most [allied health] students want factual
material presented or directed by the teacher. They want to
learn only that which is practical and has direct
application to their future roles" (p. 664).
In a study, "Dental Students' and Graduates Perceptions
on the Relevance of Selected Basic Science Topics to
Clinical Dentistry," Feiker (1976) found agreement between

128
both groups on what was and was not pertinent. He concluded
student perception of topic importance to practice develops
early and this "implies that placing some basic science
courses later in the curriculum may not effectively resolve
the problem of correlation of the basic science with dental
practice" (p. 6290-A).
Mentioned in Chapter I was the magnitude of the
academic health center governance study (AAHC, 1980a,b,c,d).
A decade before a group of faculty and administrators
convened to identify "core components of an integrated
science course for community college allied health
professionals" (Meek, 1970, p. 2). Meek (1970) and her
colleagues deplored the detailed demands of accreditation
agencies. Over three-fourths of the AAHC governance study
respondents hoped for a unified accreditation process, but
were less optimistic that it would occur (AAHC, 1980b). The
vice presidents reported strong opposition to impingement of
accreditation policies on hospital resources (p. 77).
Neidle (1985) asked why national licensure procedures
excessively should influence dental curricula (p. 16).
Neidle (1985) challenged dentistry to identify the science
topics without which it is impossible for a dentist to
function. "What is the justification . . . for hours of
instruction on the pathology of the female reproductive
tract" (p. 16) in a dental curriculum?
Consensus on the biophysical science knowledge base for
students was implied in some college catalogs (Indiana

129
University, 1985; University of Texas Medical Branch at
Galveston, 1985) . It appeared to be an accomplished fact
from some accreditation standards (Amer. Dent. Assoc., n.d.;
AMA, 1977b). The research evidence was inconclusive
(Buescher, 1984; Clarke, 1983; Perkin & Crandall, 1985;
Sirota, 1981). King and Breegle (1983) proposed an "urgent
need to identify the common components of the categories of
allied health professions, provide a common education for
them in the basic and social sciences, and then add
discipline specific education to this general base"
(pp. 103-116).
Students of allied health professions often share
courses with others (Barritt, 1980; Giese & Lawler, 1978).
Advantages and disadvantages claimed are increased
efficiency, facilitation of career mobility, fostering the
health care team approach, insufficient depth, irrelevance,
and accreditation impediments (Burnett, 1973; Connelly,
1978; "Core Concept in Allied Health, 1973; Meek, 1970;
Neidle, 1985). Some have advocated team teaching by
scientists and practitioners. The intent is to reduce
students' perception of irrelevance and stimulate
practitioners to apply scientific principles
("Interdisciplinary Panel Discussion", 1975; Talbert &
Walton, 1976). Others have opposed dilution or reduction of
science content and expressed the belief that science
courses need to be taught by scientists (Freston, 1976;
Pitkow & Davis, 1975) . Authors of an 1984 American

130
Association of Medical Colleges study questioned if
physician faculty members were capable of biomedical science
instruction without help from the scientists (Neidle, 1985).
Many have suggested better communication between
practitioners and scientists (Christensen, 1972; "Core
Concept in Allied Health", 1973; "Interdisciplinary Panel
Discussion", 1975; Meek, 1970; Sachs & Reynolds, 1983).
"The science faculty need not only speak in tongues
(symbols) and the allied health faculty [need] not only
speak in tasks (jobs) if the two groups are to communicate
with each other" (Meek, 1970, p. 7). Both medical and
science literature document the differences between
practitioner and science faculty (Jason & Westberg, 1982).
"An advantage to working in many private medical schools is
the absence of a large number of allied health programs that
require an extensive teaching load. . . . You will be better
able to concentrate on developing your research program"
(Bell, 1983). Granger (1983) listed six priorities for a
successful science career. He apologized for omitting
teaching.
Conversely heavy demands from the health professional
schools on a pharmacology department encouraged the science
faculty to develop a computer assisted teaching system
(Pazdernik & Walaszek, 1983). They reported a broader user
group than anticipated. Pharmacology standardized test
scores improved. A goal of the American Chemical Society
Task Force on Chemical Education for Health Professions was

131
"to open communication ... to form affiliations with . . .
organizations of the health professions" (Treblow, Daly, &
Sarquis, 1984, p. 629). The chemists developed a course
syllabus but were disappointed because the "professional
organizations . . . are caught up in their own problems and
agendas . . . [a] two semester course in chemistry is,
unfortunately, of minor concern to some health professions"
(p. 269).
Science faculties and allied health educators in the
community college workshop (Meek, 1970) received praise for
their collaboration. But "it is unfortunate a greater
dialogue is not always occurring at the administrative
levels" (p. 5). Meek (1970) summed up part of the situation
when she noted that
programs in the allied health field are assigned
to one pattern of organization and yet a
considerable portion of their curriculum is the
assigned responsibility of another pattern of
organization--with those at the top working under
different sets of priorities, how can the faculty
upon whom the ultimate work load rests be less
than enthused, (p. 5)
Often AHC students outside of medicine "insist they get
second class instruction, frequently from junior or less
experienced and less qualified faculty" (AAHC, 1980b, p. 2).
Many have reported the loyalty of the basic scientists is to
the medical students (AAHC, 1980b; Hogness & Akin, 1977).
Sachs and Reynolds (1983) disagree and quote Saxon.
My salary may be paid by the College of Medicine,
but my soul belongs to the Graduate College. . . .
The arrogance of medical faculties is a bar to
genuine interdisciplinary activities and so is the

132
arrogance of some in the academic world who view
their fields as the only truly academic ones and
view medical and other professional schools as
trade schools. (Sacks & Reynolds, 1983, p. 146)
Some have expressed the belief that science course
delivery system dilemmas would be improved if the
departments were removed from college of medicine control
(Hogness & Akin, 1977; Needham, 1969). Others have stated
that the political power of medicine in the AHC is in part
due to its science departments and that medicine would lose
prestige by this separation (Ebert & Brown, 1983; Petersdorf
& Wilson, 1982; Weil, 1970). It has been noted that it is
the science faculty and not the clinical physician faculty
that usually have graduate faculty appointments, tenure, and
higher ranks (Jason & Westberg, 1982; Sachs & Reynolds,
1983) .
In the governance study the vice presidents viewed
health center decision making "as a relatively well-
controlled system" (AAHC, 1980b, p. 58) with themselves as
leaders. They reported seriously considering the deans'
recommendations. The allied health deans did not share this
perspective. They were dissatisfied with their influence on
AHC decision making. College-wide, Wilson (1977) found that
allied health faculty believed their deans had little
influence as educational leaders. The deans wanted a
greater role in college academic affairs.
Miller, Beckham, and Pathak (1983) studied formal and
informal missions and goals of 41 colleges of allied health.

133
A goal, to "conduct comprehensive program[s] of health
sciences curricula" was considered formally operant by 65.7%
of faculty and 46.7% of the administrators. This finding
surprised the investigators. Miller et al. thought the
administrators would be more likely to support and formalize
comprehensive program development. This "raises questions
as to the administrators perceptions" (p. 18). The
explanation was that administrators were more concerned with
comprehensive allied health curricula. Faculty were more
interested in the health--biophysical--sciences.
This part of the literature review has documented the
importance which the health professionals ascribe to the
biophysical sciences. Course content and delivery system
challenges have been identified. The interface between
the curricula and the course delivery system has been
established. Consensus about biophysical science courses,
their content, and their delivery, has apparently not been
achieved among the allied health professions.
Summary
This entire literature review has presented an overview
of the academic health center and the colleges of allied
health. Stark's framework (Stark et al., 1986) and the
dependence of the study herein on it to develop the criteria
was explained. A content analysis of 21 sets of
accreditation standards was presented. Published
information from 51 colleges of allied health was reviewed.

134
Prior studies indicate that the science course delivery
system presented problems across programs and science
disciplines. Although there were multiple accreditation
standards there were no known criteria upon which AHC allied
health faculty and administrators could rely as a guide for
their science course delivery system.

CHAPTER III
METHOD
Explained in this chapter is the study population,
selection of the colleges, selection of the preliminary
activity participants and panel experts, and how the science
related courses were identified. The modified Delphi method
used is reviewed. The chapter is concluded with a
discussion of the methods used to analyze the data from the
Delphi study and develop the criteria.
Population
Colleges of allied health in academic health centers
that are members of the Association of Academic Health
Centers (n=60) constituted the college population for this
study (see Table 7). The chief administrative officers
(deans) of the colleges, their immediate associates, and
assistants constituted the administrator population. The
faculty consisted of two groups, basic scientists and allied
health professionals. The basic scientists were those with
or without a CAH faculty appointment, who did not hold a
health professional credential, but who taught any of the
identified science related courses. The allied health
professionals were those who possessed a health professional
135

136
credential, held a full-time CAH faculty appointment, and
taught or arranged for science related courses for
baccalaureate allied health students.
Selection of the Colleges of Allied Health
In 1987 about 75% of all AHCs belonged to the
Association of Academic Health Centers (AAHC) (AAHC, 1987;
Association of American Medical Colleges, 1987). A goal of
the AAHC, "to be the national resource for higher education
concerned primarily with issues—of a multi-professional and
interdisciplinary nature—involving health manpower
education ..." (AAHC, 1986, p. ii) was congruent with this
study. The AAHC directory listed the major academic and
health care units for each member institution. Perusal of
this directory showed the membership to be among the North
American leaders in both higher education and health care
(Carnegie Foundation's Classification, 1987; Kruzas, 1980).
A catalog that described baccalaureate allied health
programs was reguested from the 60 member institutions which
listed units of allied health (see Appendix A). After one
follow-up letter, 51 (85%) had responded (see Appendix B).
Nineteen colleges, those without a definitive administrative
structure (the coordinated structure) and those with fewer
than three generic baccalaureate programs were eliminated.
The purpose was to reduce the logistical problems of
communicating with several program directors. Also, it was
assumed that colleges with more programs would offer more

137
science related courses and probably encounter more
challenges with the associated delivery system. The
Universities of Florida and Alabama at Birmingham were
eliminated because some of their personnel participated in
activities preliminary to this study. This left 30 CAHs.
Two deans of allied health were asked to identify 15
leading colleges among this group of 30. The deans were
provided with a list of the 30 colleges and asked to select
the most representative mix (control, structure, program
diversity, and geographic location) of outstanding colleges
(see Appendices C and D). The investigator also made an
independent assessment based upon statements gleaned from
all catalogs and correspondence. Information considered was
(a) whether or not course descriptions were received,
(b) number and names of baccalaureate programs, (c) college
structure and control, and (d) whether or not the science
related course delivery structure was discernable. An
effort was made to include colleges with programs less
frequently encountered or new to higher education. The 15
that received the most votes from the deans and investigator
were selected as the 10 leading colleges and 5 alternates in
priority order of total votes.
Selection of Preliminary Activity Participants
As discussed, two academic health center deans of
allied health served to nominate the colleges. The deans

. 138
were selected because their colleges met all criteria for
inclusion in this study and the investigator knew both.
Three persons assisted the investigator with the
initial activities for the identification of science related
courses. Two were graduate students with an undergraduate
science degree and one was an allied health professional.
Three other individuals actually served to identify the
science related courses offered by the colleges nominated to
participate in this study. These three persons had health
center faculty appointments at the University of Florida.
Also, they were involved during the academic year in the
teaching of, or administrative activities for, science
related courses. These persons plus the investigator
constituted two basic scientists and two health
professionals outside of allied health (nursing and
pharmacy).
Three persons critiqued the instrument which listed the
proposed criteria as well as reviewed each criterion. These
persons were the dean and two faculty, a basic scientist and
an allied health professional, all of the College of Health
Related professions of the University of Florida. They were
representative of the panel experts who were later asked to
participate in this study.
Some persons participated in more than one of the
activities just mentioned. Altogether eight individuals
from four colleges (two allied health, education, and
pharmacy) at two universities contributed to nominate,

139
identify, validate, or critique the colleges, courses, and
proposed criteria. All had been requested to assist the
investigator in person or by telephone.
Identification of the Sciences
Because of the ambiguous and changing distinctions
among the modifiers used to describe science courses in
health professions curricula (applied, basic, bridge,
clinical, fundamental, professional) (Thier, 1987) the term
science related course (SRC) was used in discussion and
correspondence with all preliminary participants and panel
experts. Panel experts did not determine science related
courses for their own institutions. They were supplied with
a list of preselected science related courses specific to
their respective colleges' curricula. These courses were
the ones that panel experts were asked to consider in
determining criteria for evaluation of the delivery system.
The procedure employed to identify the science related
courses is summarized as follows.
1. Reviewed course descriptions from all CAHs from
which catalog descriptions were received.
2. Identified tentative science related courses from
among these descriptions.
3. Validated this opinion by the judgments of two
others.
4. Extracted course descriptions from the catalogs of
the CAHs nominated to participate in this study.

140
Deleted course titles and inserted a substitute
numbering system.
5. Wrote instructions and constructed packet for the
University of Florida faculty to use in identifying the
science related courses among these course
descriptions.
6. Tabulated votes and prepared a list of science
related courses specific to each of the 10 colleges
nominated to participate.
To qualify tentatively as science related, a course had
to be required for students of one or more baccalaureate
allied health program(s) during the professional phase of
their programs. With few exceptions, each course title
included the name of a biophysical science, for example,
nutrition or radiation physics, not dietetics or clinical
radiology. Descriptions of clinical practice courses,
whether or not the title included a science, were excluded.
Stark's framework (Stark et al., 1986) was then used to
identify further which of these course descriptions were
science related. It was selected because it was cross¬
professional and both inputs (the delivery system) and
outputs (professional competencies) were addressed. In the
judgments of all evaluators registering an opinion, the
course description must have (a) concerned the biophysical
sciences and (b) encompassed the development of conceptual
competence as a major purpose of the course. The
development of integrative competence may or may not have

141
been an apparent secondary purpose, as reflected by the
description. Also the course description may or may not
have implied that the course instructor(s) was a health
professional or basic scientist.
The purpose of the initial identification of science
related courses from all catalogs was to determine if it was
feasible to use Stark's framework to identify and validate
the courses. Over 400 course descriptions were reviewed.
Although not guantified, congruent judgments among the
investigator and two others were noted for about 75% of the
course descriptions. This was considered sufficient to
proceed with the use of Stark's framework. It was then used
to identify science related courses in the allied health
curricula at the University of Florida. This list was
prepared for use by the participants who would critique the
proposed criteria.
Several factors were not to influence the decision to
identify a course as science related. Among these were
course level; college, department, or faculty conducting the
courses; scope; type of allied health student(s); and
science discipline. This was facilitated by substitution of
an investigator developed numbering system, by not including
the course title, and by not identifying the colleges
participating. Evaluators received verbal and written
guidelines to assist in avoiding these influences. (See
Appendices E and F).

142
The catalog review indicated that some science related
courses would be graduate level. Also for the colleges
where students were admitted into the professional programs
as freshmen, some science related courses would be broad
based or lower division. The substitute numbering system
was intended to obscure course level and discipline or
allied health identity, that is, factors not to be
considered.
Evidence that a course might encompass more or less
rigor based upon college or department sponsor has been
presented in Chapter II (Brooks, 1985; Rhoton & Gravenstein,
1977). To guard against this possible bias among
evaluators, course titles were not included and the colleges
were not identified. A course titled biochemistry for
dental hygienists, was to be considered no more or no less
science related than biochemistry for medical technologists
or biochemistry for undergraduate chemistry majors. College
or department sponsor was irrelevant. The evaluators were
to base their judgments on the course descriptions apparent
content and fulfillment of the conceptual competence outcome
identified by Stark.
Evidence of professional "turf guarding" of curricula
was also presented in Chapter II (Meek, 1970; NCAHE, 1980;
Sachs & Reynolds, 1983). This may have occurred during the
activities associated with the identification of these
courses. After the procedure to identify the science
related courses was deemed feasible, it was decided to use

143
one basic science and one allied health faculty member to
validate the science related courses from the curricula of
the nominated colleges. Both basic science and allied
health faculty received the same packet and instructions
(see Appendices E and F).
Table 8 shows the markedly different opinion of the
allied health faculty evaluator. Adjacent to some
descriptions this evaluator wrote in comments such as "we do
not consider these courses as having much scientific depth"
or "sounds superficial." Recall that level and scope were
not to have influenced the decision. Review of
Table 8
Identification of Science Related Courses (SRC) from
Catalog Course Descriptions
Number
Identified
as
SRCa
Evaluator
yes
no
not
sure
Allied Health Faculty
84
116
3 +
llb
Pharmacy Faculty
156
7
51
Basic Science Faculty
204
10
0
Basic Science Faculty
192
17
5
Investigator (Nursing)
183
16
15
a Total course descriptions (n=214).
b Evaluator skipped one page.
this evaluator's selections indicated that he/she eliminated
course descriptions that implied a broad scope, an
introductory level, or for which a particular allied health
profession was named or implied in the description.

144
It was decided to add another basic scientist and
substitute a health professional faculty member from a
nonallied health field to identify the courses. Since the
investigator could be perceived as representing nursing, a
pharmacist was chosen. Thus the investigator and three
health center faculty served to identify and validate the
course descriptions which met the stated criteria. All
evaluators had taught in baccalaureate health professional
programs. The three received written and verbal
instructions from the investigator and all provided
independent appraisals (see Appendices E and F).
There was complete agreement that 138 descriptions of
214 met the criteria. For 38 additional descriptions, one
of the four evaluators was unsure, but the others agreed
that they met the criteria. Thus 176 course descriptions
with a reliability coefficient of .94 were identified as
science related among the 10 colleges. A sample of the
course descriptions is in Appendix G.
Selection and Role of the Panel Experts
Choice of administrator panel experts was a function of
their positions in one of the selected colleges. The deans
were mailed a letter stating the purpose of this study, its
significance, why they were selected, and their role (see
Appendix H). A letter of support from a dean emeritus, Dr.
Darrel Mase who had been very active in the allied health
field, was included (see Appendix I). The deans were then

145
telephoned and asked to help develop college-wide criteria
for the science related course delivery system. Eight
agreed, one of whom later had to withdraw.
Each dean who agreed to participate was asked to
confirm a list of generic baccalaureate degree programs for
their college (see Appendix J). Each was asked to nominate
two allied health faculty members who (a) had a full-time
CAH appointment, (b) had a health professional credential
and, (c) were involved in the teaching or delivery of any of
the science related courses identified for the curricula of
their college. Each was asked to nominate two basic science
faculty who (a) had primary appointments in any unit of the
university, (b) had graduate, preferably doctoral degrees in
any of the biophysical science disciplines, and (c) who
taught any of the science related courses identified for the
college's curricula (see Appendix J).
In order to obtain broad program representation, at
least one faculty member from the allied health group was
required to be associated with any program except medical
technology, occupational therapy, or physical therapy. This
was because relative to these programs, the others are
underrepresented. Four faculty nominees were requested in
order to provide for those not wanting to participate and to
insure broad allied health profession and basic science
representation.
The use of administrators to identify faculty
participants for research studies is acceptable practice in

146
higher education (Stark, Lowther, & Hagerty, 1987). Seven
deans nominated 23 faculty, 17 of whom were invited to
participate and 14 did. Thus the panel consisted of 21
experts with allied health, basic science, and administrator
representation. The professions and disciplines known to
have been represented by the participants included anatomy,
anesthesiology, biomedical engineering, cardiopulmonary
science, chemistry, dietetics, extracorporeal circulation
technology, medical records administration, medical
technology, occupational therapy, pathology, pharmacology,
physical therapy, and physiology.
Upon receipt of program confirmation and faculty
nominees from the deans, each of the 17 faculty members was
mailed a letter of introduction (see Appendices K and L).
This explained the purpose and significance of the study and
the reasons they were chosen to participate. Their role and
approximate time commitment was mentioned. The role of all
experts was to participate in a group communication process,
known as the Delphi technique, by responding to statements
concerning science related course delivery systems.
The Delphi Technique
Delphi is "characterized as a method for structuring a
group communication process so that the process is effective
in allowing a group of individuals, as a whole, to deal with
a complex problem" (Linstone & Turoff, 1975, p. 3). It is
circumstance and not the inherent nature of a problem that

147
determines the feasibility of Delphi. Among these
circumstances are (a) the problem does not lend itself to
precise analytical techniques, (b) the individuals needed to
participate have no history of adequate communication and
may represent diverse backgrounds, (c) time and cost make
group meetings infeasible, and (d) heterogeneity must be
preserved to assure validity or to avoid domination by a
particular group or person (Linstone & Turoff, 1975).
Lewis, (1984), cited Helmer and Weaver in her definition of
the Delphi technique. It
involves the opinions and predictions of carefully
chosen experts who react . . . to 'a carefully
designed program of sequential individual
interrogations . . . and opinion feedback.' The
technique has three features (Weaver, 1971):
anonymous response, iteration and controlled
feedback, and statistical group response. (Lewis,
1984, p. 5)
Linderman (1981) cited Quade as having described the
first known utilization of the Delphi process. This
occurred around 1948 and was used to predict horse race
outcomes. Olaf Helmer, a mathematician-philosopher is
credited with the development and use of the first true
Delphi technique. His 1953 study was sponsored by the
United States Air Force under the auspices of the Rand
Corporation and concerned strategic defense forecasting. It
was classified as secret and was not published until 1962
(Linderman, 1981).
During the past 25 years the uses of Delphi have
expanded from forecasting to decision-making, risk analysis,

148
and goal setting (Lewis, 1984). It has been used in diverse
fields such as government, industry, business, science, and
the professions (Linderman, 1981 ; Linstone & Turoff, 1975).
Since the 1970s it has been used extensively in health care
research and later education (Lewis, 1984; Linstone &
Turoff, 1975). Higher education lends itself to the use of
Delphi because of the extensive use of participative
planning, disdain for authoritarianism, and an established
bureaucracy which encourages procedure and tolerates
guestionnaires (Linstone & Turoff, 1975).
Lewis (1984) examined Delphi studies conducted in
higher education from 1967 through 1981. Among the studies
cited and analyzed, the number of panelists ranged from six
to several hundred. Panelists had been selected for
political expediency as well as or in lieu of expertise. Of
the 26 studies analyzed consensus was sought in 24 but not
measured in 18 of these. Fifteen of the 26 studies
consisted of three rounds. Most administrator participants
in these studies had not had prior experience with the
technigue. When examined, faculty and administrator
differences were insignificant.
There have also been several Delphi studies specific to
health professions education. Lewis (1984) reviewed one
concerning a pediatric medical department and another
regarding pathology department chairpersons goals for the
specialty. Fazio (1985) reported use of the Delphi
procedure to assess a medical school's needs and goals.

149
Jacobsen (1977) used it to gain consensus on
interdisciplinary health professions education. Blayney and
Rogers (1980-81) developed characteristics for leading
colleges of allied health with a modified Delphi technique.
Elder (1985) employed the Delphi to develop future
objectives for colleges of allied health. He cited The
Organization and Governance Study of Academic Health Centers
as "one of the most effective" (p. 26) uses of the Delphi to
forecast and gain consensus.
As a research technique the Delphi seems incompatible
with controlled experimentation (Linstone S Turoff, 1975).
Nash (1978) discussed a report by Sackman in which the
latter claimed the Delphi is lacking in validity,
reliability, and sampling methodology. Nash (1978)
summarized eight Delphi studies conducted in education. He
generalized that the investigators of these studies did not
use experts, did not generate items consistently, and were
subject to bias. Other weaknesses cited were that the
researchers did "not explore characteristics of
nonrespondents . . . [or] examine participant commitment or
fatigue" (p. 46). However several of his criticisms may be
applicable to other methods. And certainly the Delphi does
not have a monopoly on researcher bias (Bogdan & Biklen,
1982; Borg & Gall, 1983).
Weaver faulted the Delphi reliance on experts (Nash,
1978). Delphi experts are typically people of position or
power and are unlikely to include radical thinkers or the

150
disenfranchised. It is probable that the experts in control
will be more successful in implementing their own Delphi
generated forecasts. Thus, position and power may account
for the accuracy of pooled expert opinion. The inaccuracy
of Delphi forecasting may also be attributed to position and
power. If the forecast is perceived as undesirable it may
promote change. The forecasters, unhappy with their
forecast, implement change to avoid perceived impending
disaster. The Delphi expert forecast then proves inaccurate
(Linstone & Turoff, 1975).
As a communication mechanism, the Delphi is not
faultless. For example, with the paper and pencil Delphi
there is a built in time lag and nonverbal clues are lost.
Differences in language and logic of the participants may
occur. Other possible communication weaknesses noted,
germane to this study, and over which the investigator has
some control include overspecification, inaccurate reporting
of literal data, investigator influence on the responses,
and the use of Delphi to substitute for all needed
communication (Linstone & Turoff, 1975). Approaches to
insure the validity and communicative integrity of this
study have been described and will be further discussed in
the context of the remainder of this chapter.
In defense of the Delphi, it provides the individual
with great freedom of expression, assures anonymity, and
prevents dominance by any one individual (Linstone & Turoff,
1975). Since its initial use, the volume of Delphi studies

151
has expanded in number, across disciplines, and types of
applications. Often its critics still advocate its use
(Nash, 1978). When the circumstances are right, Delphi may
indeed be the research method of choice (Linstone & Turoff,
1975).
Data Analysis and Criteria Development
Once the research questions were posed, the literature
review, including the content analyses of the accreditation
standards and catalogs, provided the initial guide for
criterion development. Stark's framework provided further
structure. Each proposed statement represented an element
of the external, intraorganizational, or internal influences
as defined by Stark et al. (1986) (see Figure 2). Recurrent
themes in the literature in conjunction with a conceptual
framework have been used to develop criteria by other
investigators (Hekimian, 1984).
The initial set of proposed criteria consisted of 48
statements and 4 open-ended questions. The preliminary
packet included these items, definitions, a list of science
related courses for the University of Florida, background
information, and directions. It provided space for
revisions and suggestions and asked the three reviewers of
the instrument to agree or disagree with each statement.
After their perusal of the instrument each reviewer was
interviewed.

152
The statements and supporting information were revised
and prepared for the panel experts. The first round
instrument contained 50 statements of which 3 were rank
order. Among the statements there was a total of 94 items
that required a response. Additionally, there were 4 open-
ended statements or questions. Participants from the
colleges were asked to agree or disagree with the statements
and encouraged to write in brief comments or opinions. The
latter was facilitated by the instructions and ample white
space.
The second round instrument included 9 additional,
revised, or new statements plus all of the original
statements. Panel experts were provided with the group
response from round one for each item. If 100% consensus
had been reached on an item the statement was retained but
the brackets above the number of votes were deleted.
Written contributions from all participants were printed
verbatim on the page facing the statement(s) to which they
referred. Panel experts were again asked to agree or to
disagree with each item for which consensus had not been
achieved.
The final instrument (see Appendix 0) included all
items from the first two rounds, except the open-ended
statements. These were deleted. Panel experts were
provided with all unedited narrative data from both rounds,
the group vote from round two, and their individual round
two vote for each item. Each expert was asked if he or she

153
would like a copy of the resulting criteria and a summary.
The deans were asked for consent to name their respective
colleges as having provided the participants for this study.
The time frame for the entire study was the fall
academic term. The first contact with the deans was made
just after Labor Day, and the due date for all experts to
return the round three instrument was December 11. This was
a compact but workable schedule. Twenty-one, 19, and 18
participants met the deadlines for the respective rounds.
The data to be analyzed consisted of dichotomous
responses to the statements and literal feedback. Responses
from each panelist about each item for each round was
recorded as received. All literal feedback was recorded
adjacent to each statement and identified by round when it
was contributed. Individual authors were not identified,
but status (dean, allied health, or basic scientist), was
indicated. Results from the three statements asking for a
rank order were recorded for relative frequency. The raw
numerical data were recorded and provided to the panel
experts.
The interpretation of literal data from a Delphi study
is often accompanied by inductive reasoning. When this
approach is used, as in this study, it is imperative to
incorporate measures to reduce investigator bias. To
analyze the data but avoid these weaknesses certain
procedures were followed. Each original statement, even if
consensus had been reached, was retained for panel expert

154
reference in the subsequent instruments. Narrative input
from the panel experts was reported in total and not edited
or summarized. All proposed item additions were verified or
reinterpreted by a knowledgeable expert, who was not
conducting this study. As recommended by Linstone and
Turoff (1975) the investigator served as the person
knowledgeable in the problem and the expert served as editor
and monitor to insure accurate reporting and eliminate bias.
In cases of ambiguity the pilot experts could have been
called upon for an interpretation.
The percent of agreement needed to define consensus was
100% of those reporting an opinion for the first or second
round and 80% of those reporting an opinion for the final
round. To identify an item as a criterion, 100% consensus
was needed. Items which received 80% consensus may have
been recommended as a criterion depending upon the
literature review and narrative contributions of the panel
experts.
Described in this chapter were the preliminary
activities necessary before this study could be undertaken.
The methodology of the study was explained as were the
procedures to reduce investigator bias. The data analysis
and definition for consensus were discussed. It has
explained that the investigator employed 21 experts from 7
institutions, relied upon a framework to generate items
consistently, and endeavored to avoid bias by the active
participation of eight others prior to and during the course
of this study.

CHAPTER IV
RESULTS
The purpose of this chapter is to present and discuss
the results obtained in this three round Delphi study. The
Chapter is divided into six sections. In the first section
the responses to the preliminary statements (01 through 04A)
will be discussed. In the next four the results for each of
the four research questions will be presented. This will be
followed by a summary. For the readers perusal, the
instrument and vote for each statement on each round are in
Appendices O and P respectively.
Selected responses from the panelists, whether in
support or dissent of an outcome for a given statement will
be incorporated as the results for the individual statements
or sets of statements are discussed. Comments regarding the
four open-ended questions/statements will be presented in
context with the sets of statements which relate to each
research question.
Statements which were added to the instrument for
subsequent rounds are indicated by a letter in the statement
prefix e.g., 01A. The percent of consensus (100% or 80%),
if any, and the round in which it was achieved is
illustrated in the tables accompanying this chapter. If the
155

156
consensus was in disagreement with the statement this is
indicated by a "D" following the percent of consensus
indicated. If by round three consensus was less than 80% on
an item this is indicated by a zero in the last column.
Preliminary Statements
Although the preliminary statements (01 through 04A)
did not directly answer any of the research questions, they
were included to determine if participants believed that the
biophysical science knowledge bases antecedent to
professional practice have been agreed upon (statements 01
and OlA) (see Table 9). They were also included to
ascertain if allied health faculty members should be
qualified to teach all of a programs science related
courses, that is, the courses identified as containing the
conceptual biophysical science knowledge base (statements
04, and 04A) (see Table 9). Third, they were included to
determine if among the participants there was a basis for
them to identify and validate these criteria (statements 02
through 03) (see Table 10). Statements 32 through 34 also
related to this point but will be discussed later.
On round one, 16 of 21 participants agreed that the
biophysical science knowledge bases which individual allied
health professions deem necessary for practice have been
agreed upon (statement 01). One participant wrote, "In
general I agree, yet I am also of the opinion that for a
number (more than 2) of the allied health professions there

157
Table 9
Percent Consensus re: Statements 01. 01A,
04, and 04A
Round
Statement
I II III
01 The biophysical science knowledge
bases which individual allied health
professions deem necessary for practice
have been agreed upon by members of
the respective professions.
80
01A REVISED STATEMENT: The
biophysical science knowledge bases
which individual allied health
professions deem necessary for
practice have been agreed upon by
members of most of the respective
professions.
80
04 Allied health credentialed faculty
should be able to teach any science
related course required of
baccalaureate students in their
respective professional phase
curricula.
80D
04A REVISED STATEMENT; Allied
health credentialed faculty should
be qualified to teach any science
related course required of
baccalaureate students in their
respective professional phase
curricula.
8 0D
Note. D = Disagree.

158
is little if any agreement." Another stated, "In many cases
the individuals within the CAH have little or no
appreciation of the basic science itself and teach it as a
cookbook exercise." Recall that the literature support for
statement 01 is inconclusive. Because of this and the
written input, an additional statement, 01A which modified
the statement to read 'most of' the allied health
professions had agreed upon a knowledge base, was added to
the round two instrument. For both statements 80% consensus
was reached on round three (see Table 9).
The statements (04 and 04A) that allied health
credentialed faculty should be able (qualified) to teach any
science related course required of baccalaureate students in
their respective curricula prompted input reflecting the
specialized nature of many of the allied health professions.
"Oftentimes the allied health professions are so specialized
basic science instruction would distract teaching faculty."
"The statement is preposterous. No one is qualified to
teach everything." "A single faculty member should teach in
her area of expertise." "You wouldn't want a psychiatrist
to remove your appendix!" "Why be part of a university if
each school/college is going to duplicate the effort?" For
both statements there was one participant who agreed but did
not provide a rationale for the opinion.
In statements 02 and 03 panelists were asked to rank
the importance of university mission, college mission, and
accreditation for establishing science related course

159
faculty academic and professional credential requirements
(see Table 10). The rank of importance of the three
factors, for establishing faculty academic credentials
remained the same between the first two rounds (university,
college, accreditation). This statement was eliminated from
further consideration. Movement of opinion concerning the
importance in establishing faculty professional credentials
was more pronounced, with college mission occupying a
different rank on each round. But the significance of the
entire statement may be moot, because a majority disagreed
that science related course faculty should have a health
professional credential (see Table 11, statement 06). "I
don't care if basic science faculty have any [emphasis
original] professional credentials".
Twenty narrative responses were contributed. "I believe
that professional accreditation standards should be more
important. However there still exists mail order diploma
mills that allow individuals to participate in some allied
health professions." "Academic faculty must [emphasis
original] respond to college/university missions to obtain
tenure." "The academic credential of the science related
faculty is the institutions responsibility (and prerogative)
more than the accreditation standard; although it is an
appropirate concern as expressed in the standard." "In an
academic institution the mission of the college has priority
if that college is to remain part of the institution.

160
Table 10
Rank of Importance of Factors in Establishing Science
Related Course Faculty Credentials
02 Which of the following should be most important in
establishing preferred science related course faculty
academic credentials?
Votes
in
Rank
in
Round
Round
I
II
I
II
Univ. Mission
most important
12
9
intermediate
3
2
1
1
least important
6
5
CAH Mission
most important
10
5
intermediate
7
10
2
2
least important
2
2
Accreditation
most important
4
2
intermediate
9
2
3
3
least important
6
10

161
Table 10--continued
03 Which of the following should be most important in
establishing preferred science related course faculty
professional credentials?
Votes
Round
in
a
Rank
Round
in
I
II
III
I
II
III
Univ. Mission
most important
8
8
10
intermediate
5
3
2
2
1
1
least important
6
6
4
CAH Mission
most important
11
3
3
intermediate
8
12
13
1
3
2
least important
2
0
0
Accreditation
most important
6
5
3
intermediate
6
2
2
3
2
3
least important
7
9
11
a Some did not rank all three.

162
Accreditation standards cannot control a college mission but
should be compatible with that mission." "I don't see how
the professional credentials necessarily relate to basic
science instruction." "I consider the university mission as
a broad base statement, thus believe the CAH and accrediting
bodies are and should be most important in defining the
professional [emphasis original] credentials."
Another theme among the narrative responses suggested
that the university and college missions "should be unified"
and that it was inappropriate to rank these. "[I] cannot
imagine these being incongruent," or "I can understand why
some did not rank all three."
The responses to the preliminary statements by the
panel experts established 80% consensus that the biophysical
science knowledge bases for the allied health professions
have been agreed upon, and that individual faculty should
not be expected to be qualified to teach all required
science related courses in a baccalaureate curriculum.
Among important factors to consider in establishing science
related course faculty credential requirements was first the
university mission, followed by the college mission and
accreditation standards.
Science Related Course Faculty Qualifications
Research question number one was as follows. What
professional and academic qualifications should science
related course faculty have?

163
By round three, 11 statements were posed to identify
science related course faculty qualifications (see
Table 11). Two of these were additions based upon panel
expert input. All agreed that science related course
faculty should have a primary appointment in the university
(statement 09) and demonstrate effectiveness teaching
undergraduate allied health students (statement 13A). No
one agreed that tenure or senior faculty rank were necessary
(statements 10 and 11). Concerning tenure, "they come with
and without." Concerning rank, "some instructors and
assistant professors are the best teachers." "A blend of
all levels would make for stronger departments." All
reported graduate students as acceptable science related
course faculty assistants (statement 12), "providing they
have content, capacity, and interest."
Most indicated that graduate students were not
acceptable (80% consensus) as science related course faculty
(statement 13). "[I] do not believe they have adequate time
while students to give the necessary commitment required.
. . . Undergraduates may get shortchanged." Representative
minority opinions were "it depends where the graduate
student is in his preparation, like ABD." "I have a few
faculty members who are pursuing advanced degrees somewhere
else. In effect they are 'graduate students'."
Agreement and 80% consensus was recorded for science
related course faculty to show evidence of research

164
Table 11
Percent Consensus re; Science Related Course Faculty
Qualifications
Round
Statement
I
II
Ill
Science related course faculty should:
05 Have a doctoral degree.
—
—
0
06 Have a health professional
credential.
—
—
80D
07 Show evidence of recent/current
research or scholarship.
--
—
80
08 Excluding research and
scholarship, show evidence of own
continuing education.
80
09 Have a primary faculty appointment
in some unit of the university.
--
—
100
10 Hold tenure.
—
--
100D
11 Hold a senior faculty rank
(associate or full professor).
—
—
100D
12 Graduate students are acceptable
as science related course faculty
assistants for college of allied
health undergraduates.
100
13 Graduate students are acceptable
as science related course faculty
for college of allied health
undergraduates.
80
13A ADDITIONAL STATEMENT:
Demonstrate effectiveness teaching
undergraduate allied health students.
—
100
—
13B ADDITIONAL STATEMENT: Hold a
graduate degree in the same or
closely related science of the
science to be taught.
—
—
80
Note.
D = Disagreement.

165
(statement 07) and continuing education (statement 08).
"Should never stop—why else are universities 'halls of
knowledge'." Because continuing education was not defined
for statement 08, agreement and 80% consensus for this
statement may be deceptive. One expert wrote, "[it] would
depend on [the] meaning of continuing education. In
broadest sense of reading [I] agree." Another commented, "I
don't understand this question, they should do research, it
can't be excluded." And another, "this [continuing
education] is not enough to credential one to teach the
sciences."
A majority agreed that science related course faculty
should have a doctoral degree (statement 05) but disagreed
that they needed a health professional credential (statement
06). However consensus was not reached for the degree
requirement but was 80% against the need for a health
professional credential. "A PhD and interest in the field
is enough" but the degree should be "in sciences not
administration or education." Another "would rather have a
nondoctoral who knows/understands the medical field than a
doctoral in an inappropriate area." Congruent with this was
agreement and 80% consensus for the faculty member to hold a
graduate degree in the same or closely related discipline of
the science to be taught (statement 13B).
Twenty-one contributions were received in response to
the first open-ended statement: Please describe any other
qualifications science related course faculty should have.

166
The suggestions concerned three domains, communication
skills, enthusiasm for students and teaching, and formal
credentials. Sample contents were the ability to "speak
good English," demonstrate "reasonable instructional
technigues and skills," and "a desire to improve . . . their
instructional capability." Statements supporting enthusiasm
for students and teaching were to be a "dedicated teacher,"
"they should love to teach and be around the students in
their charge," or have an "appreciation for the diversity of
student interests and needs."
Representative opinions about credentials were more
specific. "Ideally those individuals teaching basic science
courses should have an advanced degree in a basic science.
Those courses which are applied science courses should be
taught by individuals with advance degrees and with
professional credentials." "Any graduate student teaching
in science related courses should be working on a PhD in
that science area and be under direct supervision of the
allied health person." "Most of the subjects in pathology
should be taught by faculty or residents in pathology i.e.,
they should be MD1s [emphasis original] plus have training
and experience in pathology." In response to this
statement, "this university offers a PhD degree in clinical
pathology. Johns Hopkins offers the ScD in the same. I
don't understand the MD [emphasis original] restriction."
In summary, 100% of the panel experts agreed that
science related course faculty should have a primary

167
appointment in some unit of the university and demonstrate
effectiveness teaching undergraduate students. They agreed
graduate students are acceptable as assistants (100%
consensus) but not as faculty (80% consensus). All
concurred that tenure and a senior faculty rank were not
necessary. Most concurred that research (80%) and
continuing education (80%) were to be be expected, although
the latter was not defined and therefore confusing to some.
No consensus was reached on the doctoral degree requirement
but 80% consensus was achieved for a science related
graduate degree requirement and the absence of a need for a
professional credential.
Expectations for Science Related Course Faculty
Research question number two was as follows. In what
roles should science related course faculty engage?"
Statements 14 through 22C (see Table 12) served to
identify CAH expectations of science related course faculty.
Each of these statements was posed thrice, to apply to each
of the major organizational science related course delivery
structures: (a) college faculty teaching college sponsored
courses (CAH F and CAH S), (b) noncollege faculty teaching
college sponsored courses (non-CAH F and CAH S), and
(c) noncollege faculty teaching required professional phase
courses sponsored by other colleges (non-CAH F and non-
CAH S) .

168
For faculty with primary appointments in the CAH
teaching college sponsored courses there was 100% consensus
for seven of the nine statements (see Table 12) and few
narrative remarks. All participants expected CAH science
related course faculty to participate in curriculum planning
(statement 14) and accreditation activities (statement 15),
to engage in dialogue with others concerning science related
courses (statement 16), to select their teaching methods
(statement 20), and to conduct research (statement 21).
There was agreement and 100% consensus that these faculty
should counsel CAH students (statement 17) and have students
evaluate their courses (statement 22). One person who did
not agree that faculty should set course goals or develop
objectives (statements 18 and 19), wrote that these
activities should be a "shared process."
As faculty appointment and course sponsorship were
removed from the CAH there was less consensus of faculty
role and fewer expectations (see Tables 12 and 13).
Regardless of science related course delivery structure, all
agreed that faculty should choose their own teaching methods
and that students should evaluate the courses (statement 20
and 22).
All concurred that college faculty should conduct
research (statement 21), but 80% consensus was reached for
this item for noncollege faculty. One expert wrote that the
research expectation "would depend, if visiting contract no;
[emphasis original] if part of another department in

Table 12
pprcent Consensus re: Science Related Course Faculty Roles by
Organizational Structure: Sponsor (S) and Faculty ÍF}
Statement
CAH S CAH S non-CAH S
CAH F non-CAH F non-CAH F
Round Round Round
I II III I II III I II III
Relative to the science related courses taught, the college
of allied health faculty and administration should expect these
science related course faculty to:
14 Participate in allied health curriculum planning.
100 — — — — 80 — — 0
15 Participate in program accreditation activities.
100 — — — 100 — — — 0
16 Participate in collegial dialogue with other
college/program faculty about proposed or revised course
goals, objectives, and methods.
100 — — — 100 — — -- 80
17 Provide academic counseling to CAH students.
100 — — — — 0 — — 0
18 Set course goals.
80 — — 80 — — 80
19 Develop course objectives, syllabi; select textbooks.
80 — — 80 — — 80
20 Choose teaching methods.
100 — — 100 — — — 100
21 Conduct basic or applied research.
100 — — — 80 — — 80
22 Student evaluation of the science related course(s)
should be expected.
100 — — — 100 — — — 100

170
Table 13
Round III Percent Consensus re:
Science Related Course
Faculty
Roles
bv Orqanizational
Structure:
Sponsor (S) and
Faculty
—UL)-
CAH S
CAH S
non-CAH S
S
CAH F
non-CAH F
non-CAH F
14
100
80
0
15
100
100
0
16
100
100
80
17
100
0
0
18
80
80
80
19
80
80
80
20
100
100
100
21
100
80
80
22
100
100
100
Note.
Number
in the left column refers to
the statement (S)
number

171
university yes [emphasis original]." One panelist did not
believe that non-CAH faculty who taught externally sponsored
courses should engage in dialogue with CAH faculty
(statement 16). No reason was provided.
Opinion was divided regarding participation in
curriculum planning and accreditation (statements 14 and 15)
by non-CAH faculty teaching externally sponsored courses.
This is "actually required by some accreditation bodies," or
"faculty need to know how their courses complement
curriculum/program" and "these are idealistic statements in
a research university."
Responses to the counseling statements (17, 22A, 22B,
and 22C) were diverse (see Tables, 12, 13, and 14). Even
though the stem for statement 17 and all others in this set
(statements 14 through 22) stated, "relative to the science
related courses taught," some participants questioned or
further specified this. "Unclear as to intent of statement"
or I agree "if this pertains to the course being taught."
Such clarifications or additional qualifiers were not made
for any of the other statements in this set, to which the
same stem applied.
In response to the remarks elicited by the counseling
statement, three additional statements (22A, 22B, and 22C)
were added (see Table 14). Each asked if counseling was
appropriate relative to the course and relative to the
curriculum. Although 80% consensus was reached for four

172
Table 14
Round III Percent Consensus re: Science Related Course
Faculty Counseling Roles
Statement
Counsel
Course
relative to
Curriculum
22A ADDITIONAL STATEMENT:
Science related course faculty
who are members of the profession
to which the students aspire and
teaching required courses should
provide academic counseling to
CAH students.
80
0
22B ADDITIONAL STATEMENT:
Science related course faculty
(allied health or basic scientist)
with CAH primary appointments and
teaching required courses should
provide academic counseling to
CAH students.
80
80
22C ADDITIONAL STATEMENT:
Science related course faculty
outside of the CAH and teaching
required but non-CAH sponsored
courses should provide academic
counseling to CAH students.
0
80D
Note. D = Disagree.

173
items in this set, the prominent finding was diversity of
opinion. Also about one-fourth did not respond or indicated
no opinion. For all rounds some registered their opinion
and then added modifications. "If it is related to the
course [I agree] otherwise they should refer students to
appropriate CAH faculty." One wrote that "only allied
health faculty, not [emphasis original] basic scientists"
should provide counseling. And another stressed that "all
[emphasis original] teachers should provide academic
counseling."
Among the four counseling statements there were nine
items, none of which asked exactly the same thing. One
hundred percent consensus was not attained for any of these
items except that college faculty teaching college sponsored
courses should provide academic counseling. Most concurred
(80% consensus) that professional faculty should provide
course counseling (statement 22A) but no consensus was
reached for professional faculty to provide curriculum
counseling. One wrote that "some faculty may be a member of
the profession but removed from current up-to-date clinical
practice." A majority disagreed that non-CAH faculty
teaching required non-CAH sponsored science related courses
should provide academic counseling to CAH students relative
to the course (statement 22C). There was 80% consensus that
these faculty not provide curricular counseling.
In response to the open-ended question (What other
expectations should the CAH have of science related course

174
faculty?), contributions concerned three areas, service,
teaching, and knowledge about allied health. The faculty
should "serve on academic committees like admissions" or
"participate in . . . university service." They should have
"some knowledge of the mission of the college of allied
health" or awareness of "the professional goals of the
various allied health disciplines." Opinions about teaching
ability were similar to those submitted in response to the
faculty qualification statement. "They should love their
work" or "provide practical examples for the students
field."
In summary, 100% consensus was reached for all faculty
to select their teaching methods and to have students
evaluate the courses. Except for one dissenting vote
regarding course goals and objectives there was 100%
consensus that all other expectations listed were CAH
faculty responsibilities. Although there was a
preponderance of nonconsensus and much diversity on the
counseling issue the emergent theme is that this is a CAH
faculty responsibility.
Faculty teaching non-CAH sponsored courses were
generally accorded the same expectations as CAH faculty
regarding specific course activities. The major exception
was academic counseling. For broad based activities such as
curriculum planning and accreditation activities there were
fewer expectations for noncollege faculty. Some panel
experts had identical expectations for most faculty

175
regardless of science related course organizational
structure. "Irrespective of the location of the faculty,
. . . instructors need to be sensitive to the needs of their
students."
Role of Dean and Faculty in Evaluation of Non-CAH Faculty
Research question number three was as follows. What
role should the college of allied health dean and faculty
have in the evaluation of science related course faculty who
do not have primary appointments in the college?
Asked in the initial statements about CAH dean
responsibility for science related courses and faculty (see
Table 15) was if the dean should have responsibility for all
CAH sponsored courses regardless of faculty status
(statement 23) and for all required courses regardless of
college sponsor (statement 24). Statement 25 asked if the
dean was responsible for a course should the dean also have
responsibility to evaluate the faculty. Most agreed with
these statements, resulting in 80% consensus. One panel
expert who disagreed asked, "how can one dean be directly
academically responsible for a science course that is under
the administration of another dean? . . . The fiscal
[emphasis original] decision rests with the dean of the unit
presenting the course." Also "the responsibility may be
shared" or the CAH dean may "be asked for evaluation input."
Agreement and 100% consensus was obtained for statement
25A (Deans of the respective colleges should have

176
Table 15
Percent Consensus re; Role of the CAH Dean in Evaluation
of non-CAH Science Related Courses
Statement
Round
I
II
III
23 The college of allied health
dean should have administrative
and academic responsibility for
all college sponsored science
related courses (no matter where
the teaching faculty hold their
primary appointment).
80
24 The college of allied health
dean should have responsibility
for the academic integrity of all
required professional phase
science related courses (no
matter what college or department
sponsors them).
80
24A ADDITIONAL STATEMENT: The
college of allied health should
have responsibility for the
academic integrity of all required
professional phase science related
courses sponsored by the CAH.
80
25 In situations where the
college of allied health dean should
have academic or administrative
course responsibility he should
also have responsibility to
evaluate the science related course
faculty.
80
25A ADDITIONAL STATEMENT: Deans
of the respective colleges should
have responsibility for the
academic integrity of all courses
sponsored by their colleges.
100

177
responsibility for the academic integrity of all courses
sponsored by their colleges.) Statement 24A was about the
same thing (see Table 15) but in reference to the CAH. This
received 80% consensus. Among the deans, both statements
25A and 24A received 100% consensus.
Statements 26 through 31 were about the college of
allied health faculty role in the evaluation of non-CAH
faculty who teach science related courses sponsored by the
CAH and sponsored externally (see Table 16). All agreed
that these faculty should be evaluated (statement 29), that
the evaluation should address all CAH expectations
(statement 28), and be communicated to the faculty member
and his or her dean or department chairperson (statement
30). "Evaluations should be communicated to the faculty
member teaching the course and if necessary to the head of
the faculty members primary department and that is all
unless the faculty member is in the CAH." "The mission for
which the faculty member was asked to join the faculty
should be clearly defined as well as a clear definition of
the guidelines for promotion, raises, services, etc."
Most panel experts did not agree (80% consensus) that
the CAH evaluation should be confined to a decision to
retain or displace the faculty member (statement 26) or
course (statement 27). Most agreed (80% consensus) that the
evaluation should affect tenure and promotion for the
faculty member in his or her respective department
(statement 31).

178
Table 16
Percent Consensus re: CAH Evaluation of non-CAH Faculty
Who Teach Science Related Courses
Courses sponsored by
CAH non-CAH
Round Round
Statement
I II III I II III
Formal college of allied
health evaluation of
science related faculty
who teach required
professional phase
course should:
26 Be confined to the
decision to retain or
dismiss the faculty
member.
8 0D
NA
27 Be confined to the
decision to retain the
course as required
or not.
80D
0
28 Address all
expectations the college
of allied health has of
the faculty member.
100
100 —
29 Not occur.
100
—
--
100 —
30 Be communicated to
the science related
course faculty and his/
her chair or dean.
100
100 —
31 Affect merit raise,
tenure, and promotion
decisions made by the
science related course
faculty members primary
department. — — 80 — — 8 0
Note
D = Disagree

179
In summary, participants believed that non-CAH science
related course faculty should be evaluated by CAH faculty
and administration and that the evaluation be communicated
to the faculty member and his or her primary department.
The deans were to be responsible ultimately for the courses
sponsored by their respective colleges. If problems occur
with externally based faculty or courses, communication was
identified as a method of choice for resolving differences.
"If I'm unhappy with an anatomy course sponsored by the
college of medicine I'd sit down with the dean of medicine
and work it out cooperatively."
CAH Control of Delivery and Content of Science
Related Courses
Research question number four was as follows. "What
control should the college of allied health faculty and dean
have upon the delivery and content of science related
courses?"
The purpose of statements 32 through 34 was to
determine if the participants perceived themselves as
responsible for the curricula. In effect they were
preliminary statements for this section. The panel experts
indicated that curricula responsibility (statement 32)
belonged first to the faculty, followed by accreditation,
and dean (see Table 17). The relative rank among these
choices remained constant in the first two rounds so the
statement was not ranked in round three. Statement 33 (see
Table 18), which stated that curricula responsibility be

180
Table 17
Rank of Locus of Responsibility for Allied Health Curricula
32 Please rank order where
the allied health curricula
the primary
should rest.
responsibility
for
Votes
Round9
in
Rank
Round
in
I
II
I
II
Dean
most responsibility
2
0
intermediate
6
5
3
3
least responsibility
11
13
Faculty
most responsibility
14
17
intermediate
5
2
1
1
least responsibility
1
0
Accreditation
most responsibility
4
2
intermediate
8
12
2
2
least responsibility
7
5
a Some did not rank all three.

181
Table 18
Percent Consensus re; Curricula Responsibility
Round
Statement
I
II
Ill
33 Responsibility for the
allied health curricula
should be shared by the
faculty and administration.
100
34 Responsibility for the
allied health curricula
should be shared by all
instructional personnel
(class, laboratory, and
clinical) regardless of
appointment.
—
—
80

182
shared by faculty and administration, received agreement and
100% consensus. Most also agreed (80% consensus) that all
instructional personnel should share curricular
responsibility (statement 34).
Narrative data for these statements indicated that "all
should have input" but "not necessarily equally." The
"final responsibility should rest with department faculty"
or "program chairperson." "Primary responsibility rests
with dean but primary work on curricula rests with the
faculty." "If the dean is the chief academic officer he has
to be involved." How can the dean "capitulate decisions to
[an] external party re: course quality?"
Total consensus on dean responsibility for the science
related courses was obtained for one of the six statements
in the set concerning dean activity (statements 35 through
40), (see Table 19). All agreed that the dean has an
administrative role if there is a transfer of funds among
colleges or departments (statement 40). Most agreed (80%
consensus) on a dean role if the course was limited to
allied health students (statement 39). A majority disagreed
with a CAH dean role for courses sponsored outside of the
college (statements 35 through 38). Eighty percent
consensus was reached that the dean not identify faculty
(statement 36) or participate in course development
(statement 37) for externally sponsored courses.
Most participants disapproved (80% consensus) of a dean
role in course development where ever the course was

183
Table 19
Percent Consensus re: CAH Dean Responsibility for Science
Related Courses
Statement
Courses sponsored bv
CAH non-CAH
Round Round
I II III I II III
The dean should:
35 Attract and retain
qualified faculty to
teach these courses.
80 — — 0
36 Identify qualified
faculty to teach these
courses.
0 — — 8 0D
37 Participate in
course development or
revisions.
8 0D — — 8 0D
38 Have an adminis¬
trative role in the
course delivery under
all circumstances.
0 — — 0
39 Have an adminis¬
trative role in the
course delivery if
the course is limited
to allied health
students.
NA — — 8 0
40 Have an adminis¬
trative role in the
course delivery if
there is a transfer
of funds to the
other college/
department for the
course.
100 — — 100
Note. D = Disagree.

184
sponsored (statement 37). The dean "lacks power but can
make suggestions." "In reality deans have little to do with
the specifics of the curricula so their responsibility is to
obtain a faculty that is competent at developing and
maintaining a curriculum." One who advocated a dean role
stated, "a dean should be in a position to integrate all
information all the time."
Within the CAH, most concurred (80% consensus) that the
dean has a role in attracting and retaining qualified
faculty (statement 35). But when it came to specifically
identifying faculty to teach the courses (statement 36) "one
should trust their colleagues." "Allied health programs
[are] too varied for one person to have enough expertise to
identify qualified faculty in all areas."
Other narrative data for statements 32 through 40
indicated that many of the roles are "usually delegated to
the chair" or should be. The "dean is ultimately
responsible but actual management is delegated to department
heads." "We assign to departments the responsibility to
administer all interdisciplinary courses." Or "all
[emphasis original] should have input but first
responsibility should rest with the department faculty."
The "chairperson should have final responsibility." Or "the
curriculum is the responsibility of the faculty 1" [emphasis
original].
The specific roles of CAH faculty not teaching science
related courses generated considerable agreement (statements
41 through 50). These statements (see Table 20 and 21) were

185
Table 20
Consensus re:
CAH Faculty Responsibility for Science Related Courses by Organizational Structure: Sponsor fS) and Faculty (F)
Statement
CAH S
CAH S
non-CAH S
CAH F
non-CAH F
non-CAH F
Round
Round
Round
I II
III
I II III
I II
III
College of allied health faculty who are not teaching science related
courses should:
41 Identify faculty to teach these courses.
42 Have input into the science related course(s)
goals - objectives under all circumstances.
43 Have input into the science related course(s)
goals - objectives if/when the course is limited
to allied health students.
44 Have input into the science related course(s)
goals - objectives if/when there is a transfer of
funds from the college of allied health to the other
college/department.
If and when college of allied health faculty input
is warranted the faculty should:
45 Relay accreditation requirements to the
science related course faculty.
46 Relay practice situations which the students
are likely to encounter to the science related course
faculty.
47 Recommend course goals.
48 Recommend specific course content.
49 Recommend teaching methods.
50 Recommend course textbooks.
0 — — 0 — — 100D
80 — — 8 0 — — 0
100 — — — 100 — — 100
NA — — 100 — — 80
100 — — 100 — — — 100
100 — — 100 — — — 100
100 — — 100 — — — 80
100 — — 100 — — — 80
0 — — 80 — — 100D
00 0 — — 0 — — 0
Note.
D = Disagree.

186
Table 21
Round III: Percent Consensus re: Role of CAH Faculty not
Teaching Science Related Courses by Organizational
Structure: Sponsor (S) and Faculty (F)
s
CAH S
CAH F
CAH S
non-CAH F
non-CAH
non-CAH
41
0
0
100D
42
80
80
0
43
100
100
100
44
NA
100
80
45
100
100
100
46
100
100
100
47
100
100
80
48
100
100
80
49
0
80D
100D
50
0
0
0
Note. Note
statement
number in
(S) number.
left column refers
D = Disagree.
to the

187
posed for each of the science related course organizational
structures. For courses sponsored outside of the college
most agreed (80 or 100% consensus) that faculty have input
if the course is limited to allied health students
(statement 43) and if there is a transfer of funds
(statement 44). When course input is warranted, 80 or 100%
consensus indicated that faculty should relay accreditation
requirements (statement 45), relay practice situation
requirements (statement 46), recommend course goals
(statement 47), and recommended specific course content
(statement 48). For CAH sponsored courses 100% consensus
was achieved for these statements.
For externally sponsored courses there was 100%
consensus that CAH faculty not identify science related
course teachers (statement 41). For college sponsored
courses, opinions about this statement were mixed. The
collective responses to the statements which addressed dean
(statements 35 and 36) or faculty (statement 41)
responsibility for identification of science related course
faculty indicated that participants considered the
recruitment of college faculty a dean role. The narrative
data indicated that they viewed the identification of
faculty to teach specific courses as a department head
responsibility. "Faculty may have input, but the .
decision is up to the department head or dean." Or, "Where
is the department head in all of this?"

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Most agreed that CAH faculty not teaching science
related courses should have input into course goals for CAH
sponsored courses (statement 42). Also most agreed that
they should recommend goals (statement 44) and specific
course content (statement 48) for externally sponsored
courses. But a minority disagreed. Allied health faculty
may "designate and area e.g., lung pathology but detailed
content should be left to the basic science departments."
"A basic course . . . should be just that and cover all
areas. . . and not [be] directed toward any specific
program or student." Among the minority who advocated that
CAH faculty recommend teaching methods (statement 49) one
wrote that this was pertinent to explain "the way their own
students seem to learn best."
Summarized in Table 21 is the role across
organizational structures of the CAH faculty who do not
teach science related courses. It is evident that their
role is expected to be greatest when courses are sponsored
by the CAH and taught by CAH faculty. Regardless of
organizational structure participants expect these faculty
to have input if the course is limited to allied health
students (statement 43) and to communicate accreditation
requirements (statement 45) and practice situations
(statement 46). They are nearly unanimous in agreement that
CAH faculty recommend course goals (statement 47) and
specific course content (statement 48). But participants

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tend to delegate choice of teaching methodology (statement
49) to the individual faculty.
In response to the terminal open-ended question (What
other activities should the faculty or dean perform to
enhance the delivery of science related courses taught by
faculty without a CAH primary appointment?), the theme was
communication. Basic science faculty participants asked
that they be provided with feedback "from student
evaluations," "on how well students do in subsequent
classes," or their "performance on state board exams." One
participant suggested forums for CAH and non-CAH faculty as
"they share a similar purpose and so should communicate
regularly". Participants advocated "continuous . . .
efforts to keep communication open" and provide
"recognition."
In summary, the panel experts believed that the CAH
dean had a major role in attracting college faculty but
neither dean nor faculty had responsibility to identify
faculty for specific courses. The dean was not expected to
have a role in course development. CAH faculty were
expected to have major input in course content and
development regardless of course sponsorship. The exception
was that they should not recommend teaching methods.
Summary
Presented in this chapter are the results from the
conduct of this study. According to the study design, items

representing external, internal, and intraorganizational
elements of Stark's framework have been identified and
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validated if 100% consensus was reached. Other items have
been identified and may be valid if 80% consensus was
achieved. In the next chapter these items are synthesized
into criteria that can be used to evaluate the delivery
system for science related courses for baccalaureate allied
health students in academic health centers.

CHAPTER V
SUMMARY AND CONCLUSIONS
Summary
This study was undertaken to identify and validate
criteria that can be used to evaluate the delivery system
for selected science related courses. The need for a s