Health progress in the United States. Results of the 1990 objectives for the nation.
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Biomedical subjects
Publications and source records attributed to E N Brandt.
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Publicly funded institutions, such as NIH, NLM, and state-supported universities, have explicit public service missions that extend beyond the walls of a single institution. During the past few years, national organizations, such as NLM and AAMC, have funded studies and projects to measure how well universities are adapting to technological change and educational reform. The IAIMS models are evidence of universities fostering cooperative rather than duplicative effort. Opportunities and problems facing universities extending systems and services to the private practice setting, to community-based health care HMO's, and to state and local health care agencies are discussed in terms of political, economic, and geographic realities. Instilling lifelong learning concepts begins before the health professional enters practice and is dependent on the emphasis universities place on "excellence in teaching." Without cooperation among core facilities, such as libraries, computer centers, and excellent instructors, continuing education will remain a parochial issue instead of a national thrust toward the continuum of the learning process. If continuing education is to become a high priority for universities and take its place on the education spectrum, flexible policies must be established to accommodate individual practitioners' expectations and interests.
Health policy issues associated with AIDS are complex and controversial, including health care, research priorities, education, testing and confidentiality. Modelling may provide information relevant to their solution. Estimates of the future numbers of symptomatic persons and of the mix of severity are necessary for developing the capability to provide and fund health care services. Models may suggest other data needs and research directions. An important policy role of models is to permit evaluation of potential intervention steps and especially to project negative consequences. The critical contribution of models will be improved understanding of the dynamics of the AIDS epidemic.
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Medical educators are an interesting group of people. They thrive on new knowledge. They get excited and enthusiastic, and readily adopt new ways when the evidence is sufficient. Yet, at the same time, they resist with great vehemence change in the way they do their business. Ask how often the curriculum structure is examined. Indeed, the function of most curriculum committees is to ensure that that does not happen. Ask how often the criteria for medical school admission are examined, especially with respect to the knowledge requirements. Ask how often the faculty discusses, or even examines, the expectations of society as they are expressed by alumni, legislators, or members of the public. Ask how often faculties try to determine strategies for dealing with all of these external forces. Are those strategies approached with the same degree of objectivity and data-gathering skills that would be used in examining new therapeutic regimens? Medical educators are talented, creative people. They have a very large appetite for information and great ambition to be as fine academicians as possible. It is those characteristics that have served them well, as students and as responsible academicians. Indeed, the great strength of medical education, in my view, is that medical schools take some very bright people called faculty and some very bright people called students, mix them together for four years, and graduate a group of very smart people who will then spend three years or more mixed up with some very bright and creative people. That is a strength that can-not lost. Will the future allow us to continue that in an equally effective manner?
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The acquired immunodeficiency syndrome (AIDS) has spread rapidly through the high-risk population and has created fear and anxiety. The health policy implications of such a disorder are difficult to assess because the disease was totally unknown until a few years ago and because it occurs primarily in homosexual men and intravenous drug users. The latter factor has raised sociopolitical issues not present in other epidemics. Detection and surveillance systems, capabilities for prompt and effective scientific response, central coordination of scientific efforts, public information mechanisms, role definitions, and guidelines for funding are needed. The scientific community must study this epidemic and the total societal response to it with a view towards being better prepared in the future.
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