A Brief History
Edwin F. Rosinski
Professor and Director
Office of Medical Education
University of California, San Francisco
Table of contents: Preface | History | References | Appendix A | Appendix B | Appendix C
The Society of Directors of Research in Medical Education (SDRME), represents the latest development in the thirty-year history of this specialized field. A brief review of the evolution of the seven initial offices or divisions of research in medical education and the developments leading to the creation of SDRME are key to understanding the current status of this discipline.
Within a matter of several months during late 1958 and early 1959, three offices dedicated to research in medical education were established. They included an office at Case-Western Reserve University (CWRU) [then Western Reserve] under the directorship of T. Hale Ham, M.D.; another at the University of lllinois (U of I) with George E. Miller, M.D., as director; and the third at the Medical College of Virginia (MCV) with Edwin F. Rosinski, Ed.D., director. The office at CWRU was an outgrowth of the studies on the revolutionary curriculum being developed there. The offices at U of I and MCV were essentially "experiments" supported by the Commonwealth Fund of New York to determine if such offices have an impact on the educational efforts of those institutions. Prior to assuming their positions at the U of I and the MCV, Miller and Rosinski worked together for three years at the University of Buffalo (UB) School of Medicine [now the State University of New York, Buffalo] in what was called the Projject in Medical Education, an innovative and pioneering educational program designed to improve the teaching competence of a group of medical school faculty. Miller was the head of the project, and for the last two years Rosinski was its director of research. An excellent comprehensive review of how these first three offices came into being is presented by Miller (1980).
For the next three years no medical school followed the lead of CWRU, U of I, and MCV (Brown 1970). However, the directors of these programs met at the annual meeting of the Association of American Medical Colleges (AAMC). These informal meetings at times included staff members as the operations at CWRU and U of I were expanding each year. At this time, some medical school faculty, not connected with any office, also were becoming interested in research in medical education. Because of this growing constituency, Hale Ham suggested the AAMC sponsor a conference on research in medical education to be held in conjunction with its annual meetings. A committee on Research in Medical Education-including Ham, Miller and Rosinski-was appointed by the AAMC to organize and conduct the conference, and the first one was held during the AAMC meeting in Los Angeles on October 31, 1962 (AAMC 1986).
As the three original offices gained national recognition and the annual 5 research conferences drew increasing attention to the importance of research in medical education, additional deans began to commit resources to creating offices of research in medical education. In January 1962, Albany Medical College established an office with Frank Husted, Ed.D., as director. This development was followed in February 1963, by the University of Southern California (USC) with Stephen Abrahamson, Ph.D., as director, and in July 1963, by the University of Rochester (U of R) with Hilliard Jason, M.D., Ed.D., appointed director.
These three offices merit special historical note for their directors had a direct tie to the University of Buffalo. Abrahamson was one of the seminar leaders in the Project in Medical Education and as Director of the Educational Research Center of the School of Education was instrumental in developing the overall evaluation plan of the project. [Abrahamson also had been the doctoral advisor to Rosinski, who was the principal staff person evaluating the project as part of his dissertation prior to becoming its director of research.] In addition, he had spent a year as visiting professor at Stanford University's School of Medicine during 1959-60 and through that experience made a commitment to foster research in medical education. Jason, on the other hand, as a medical student at UB, extended his medical education for an additional year so that he could participate in the project, and also began work in the School of Education on his Ed.D. Husted, another doctoral candidate of Abrahamson's was encouraged to consider the position at Albany after he obtained his degree.
Still another office, this one a t the Medical College of Georgia (MCG), was established in 1964 with Loren Williams, Ph.D., director. Where Rosinski, Abrahamson, and Husted did their graduate education and had experience in educational research and evaluation, and Miller, Ham, and Jason in medicine, William's background and experience were in industrial psychology. By virtue of education, experience, and professional interest, the composition of the directors began to change with subsequent changes evolving in the objectives of each new center (Brown 1970).
With seven offices of research in medical education now actively involved in a wide range of activities, the need to share experiences and engage in collaborative research became evident. To that end, a meeting of the seven directors was held in the spring of 1965 at CWRU with Ham as host. [After the second meeting which was held at the U of I, it was agreed that staff of the host institution would participate only in that portion of the agenda which dealt with the activities of that institution. The remainder of the meeting would be restricted to directors only.] Table I shows these annual meetings continued for 22 years with a four-year hiatus during 1971, 1972, 1973, and 1974, for reasons that will be 6 described later.
These spring meetings, however, were not the only time the directors met. For several years, brief sessions were held during the annual AAMC meeting where all of the directors would be present.
During the late 1960's, still more offices of research in medical education were formed. The important contributions of existing offices to the educational activities of medical schools continued to play a role in that development, but other factors were coming into play, most notably the federal government. During those years a number of pieces of federal legislation had a marked impact on medical education, especially research in medical education.
Sites and Hosts of the Annual Meetings of the Directors of Research in Medical Education
|Year||Host||Institution and Location|
|1965||T.H. Ham||Case-Western Rescrvc University, Cleveland, Ohio|
|1966||G. Miller||University of Illinois, Chicago, Illinois|
|1967||S. Abrahamson||University of Southern California, Los Angeles, California|
|1968||H. Jason||Michigan State University, East Lansing, Michigan|
|1969||W.L. Williams||Medical College of Georgia, Augusta, Georgia|
|1970||J. Greisen||Ohio State University, Columbus, Ohio|
|1975||J. Greisen||University of Michigan, Ann Arbor, Michigan|
|1976||L. Fisher||University of Calgary, Calgary, Alberta, Canada|
|1977||C. Dohner||University of Washington, Seattle, Washington|
|1978||A. Elstein||Michigan State University, East Lansing, Michigan|
|1979||M. Flair||University of North Carolina, Chapel Hill, North Carolina|
|1980||V. Neufeld||McMaster University, Hamilton, Ontario, Canada|
|1981||T.J. Sheehan||University of Connecticut, Farmington, Connecticut|
|1982||J.J. Ferland||Laval University, Quebec, Ontario, Canada|
|1983||R. Richards||University of Illinois, Nordic Hills, Illinois|
|1984||S. Abrahamson||University of Southern California, Pasadena California|
|1985||C. Dohncr||University of Washington, Seattle Washington|
|1986||W.L. Williams||Medical College of Virginia, Richmond, Virginia|
|1987||D. Cohner||University of Washington, Orcas Island, Washington|
The first was Public Law 69-239, October 6, 1965. Although officially titled "The Heart Disease, Cancer and Stroke Amendments of 1965," it quickly became known by its popular name, Regional Medical Programs (RMP) [TO assist the national director of the RMP, a medical educator was recruited. That person was Frank Husted, Ed.D., the former director of the Office of Research in Medical Education at Albany Medical College.] This law, in addition to many other provisions, initiated a national effort in continuing medical education on heart disease, cancer and stroke. To ensure that the programs were effective and efficient, it provided funds for each region to hire educators to help develop and evaluate the educational programs.
The second piece of legislation, Public Law 89-751, November 3, 1966, Section 792(a), provided grants to develop, demonstrate, or evaluate curriculums for training health personnel. Of still greater significance was Public Law 90- 175, December 5, 1967, the act known as the "partnership for Health Amendments of 1967." Several parts of the act were of considerable importance to research in medical education. Section 304(a)(1) included the wording"...to make grants for the conduct of research, experiments, or demonstrations" related to training. Section 304(c) provided for ' ' . . .projects for research and demonstration in new careers in health manpower and new ways of educating." But perhaps the single most important portion of the act for research in medical education was Section 8(a) Paragraph (1) of Section 314(d) of the Public Health Service Act, amending it by authorizing the Secretary of Health, Education and Welfare to use up to one percent per annum of the funds appropriated for the act for evaluation directly by grant or contracts. In this amendment the desirability, indeed the necessity of, evaluating programs had been established in a federal act and continued in subsequent acts involving health manpower and medical education.
Federal support for research in medical education probably reached its apex with the "Health Manpower Act of 1968," Public Law 90-490, August 16, 1968. In this law an entire section (772) described a wide variety of medical education research activities which were authorized and encouraged. The precedent for federal support of research in medical education had been established by that law and continued for some time into the future. As indicated by Grupenhoff (1971), the Health Manpower Act of 1968 saw the most important additions ever made to federal programs supporting medical education.
Another factor of historical note to the Society and the development of research in medical education is that the Deputy Assistant Secretary for Health Manpower of the Department of Health, Education and Welfare, who during 1966-68 was responsible for developing and helping to enact all the federal legislation and policies relating to medical education, was this author, who was a director of research of medical education on leave from his medical school. [It was also during that time that President Lyndon B. Johnson, in his 1967 State of the Union message on health (February 28, 1967), announced the establishment of the National Center for Health Services Research and Development.].
So, by 1970, the growth of research in medical education had accelerated considerably. Some medical schools capitalized on the federal funds to develop offices of research; unfortunately some later were abandoned as the availability of federal funds decreased. Many medical school administrators also encouraged their clinical departments to apply for these federal grants and contracts without committing themselves to the creation of an office. The ranks of researchers in medical education began to escalate dramatically.
Also, in 1970, a development occurred that had considerable importance to the directors of research in medical education. During the 1960's, the AAMC began expanding the means through which medical school interest groups could have a greater voice at the annual meetings. These "groups," as they were called, were part of the formal organizational structure of the AAMC. The earliest was the Group on Student Affairs. Its membership consisted of medical school admissions officers and it served as the model for the creation of subsequent groups (JME 1988). With the growing number of individuals in medical education engaged in such activities as curricular modifications, resident education, research in medical education and the like, the AAMC began to explore the possibility of forming a group to encompass this divergent constituency.
The directors of research in medical education were aware of this development, and initially were less than enthusiastic toward such an organization to the point of referring to themselves as the "Nongroup." However, the issue came to ahead at the 1970 spring meeting at Ohio State University. To that meeting, schools without offices of research also were invited to send representatives and the directors were asked to bring key staff members. A full-scale discussion of the need for a new AAMC group and its composition took place. Opposition to its creation was based on several arguments. One concern was who would be appointed by the dean of each school to represent research in medical education? Fear existed that not always the most qualified or knowledgeable individual would be selected. Whereas in each medical school an admissions officer represented student affairs, research in medical education did not have such advocates. Furthermore, it was argued that the coherence of the directors would diminish without annual spring meetings. All of these issues were discussed in the presence of James Erdmann, Ph.D., of the AAMC's Division of Research and Measurement. After considerable discussion- some of it emotional-it was the 9 consensus of the meeting to recommend that a broad reference group be established. This new Group on Medical Education (GME) would represent three constituencies: educational research, instructional media, and curriculum. It was agreed to endorse this proposal, although by some with reservations and trepidation.
In recommending the establishment of the Group on Medical Education, the directors assumed that the meetings of the new GME, as part of the annual AAMC meetings, would satisfy their needs as did their previous annual spring get-togethers. For the next four years the directors met during the AAMC meeting.
Over time, however, a number of things became obvious. First, the group meetings were attended by a diffuse representation of medical school faculty...the directors of research were in the minority. The agenda of the group was likewise diffuse. The meetings tended to focus on courses of study, experimental courses, and the like. The concerns expressed by the directors at the 1970 meeting also became a reality-at times the credentials of an individual appointed to the group were suspect. Furthermore, some deans appointed only one person to represent two or three constituencies, and there were those who even appointed themselves to represent the school's constituencies. Most of all, what clearly emerged after just three years was that the directors did lose the collegiality generated through their spring meetings.
By 1974, with considerable persuasiveness on the part of Loren Williams, who by then was at the Medical Collcgc of Virginia, a large faction of the directors were agitating to reinstitute their spring meeting. There was some resistance to this by the GME, nevertheless, in 1975, 25 of 37 invited directors attended a meeting at the University of Michigan. Loren Williams incisively and succinctly described that meeting as the "Party of Hopeful Optimistic Enthusiastics Negating Interruptive Experience;" PHOENIX, indeed, had risen from its own ashes! [A review of Appendices A and B reveals how the membership of the directors group changed. As can be seen, a number of medical schools discontinued their offices while others established new ones.] It should be noted that after the 1975 meeting, Jim Erdmann provided the directors with a sponsored breakfast meeting at the annual AAMC meeting, a practice that continued through 1987. By the late 1970's, the directors discarded their identity as the "Nongroup" and became known as the Directors of Research in Medical Education.
Because the directors originally did not see themselves as a formally organized group, no minutes or records were kept of what transpired during their early meetings. If an item required a follow-up or specific action, a member of the group volunteered to be responsible. It was a very loose, informal organization in those early years.
The topics the directors discussed through the year varied considerably, and included such items as staff career development, international issues and research in medical education, relationship between research and continuing medical education, funding of offices, intra- and interinstitutional collaborative research, relationship with federal agencies, relationship with the GME, the structure of offices, role of directors as agents of change in their institutions, and credibility of directors in their institutions, to mention just a few. After several years of the earlier meetings some directors began to lose interest because of what they perceived to bc the lack of "substance" on the agenda. They felt that too much time was spent discussing administrative and fiscal problems.
There was, however, a benefit from those early meetings that is difficult to assess, which is that the directors were able to come in direct contact with innovative medical education developments taking place at the institution where they were meeting. Of special note was the 1967 meeting at the University of Southern California. The host, Steve Abrahamson, provided the directors with their first opportunity to see, and to participate in, the use of a simulated patient for teaching and evaluation. That remarkable demonstration was conducted by Howard Barrows, M.D., who had conceived the notion of using actors and actresses to simulate patients with neurological disorders. Little did the directors appreciate what a dramatic impact the approach ultimately would have on medical education.
At one early--probably 1968--meeting held in conjunction with the AAMC, the directors addressed an issue that would continue to surface periodically for the next twenty years: Who was eligible to be a member of the group? Or, put another way: What was the accepted definition of a director of research in medical education? [George Miller, in his book Educating Medical Teachers, on page 176, lists 41 different designations used by medical education units.] This issue first arose because a director of a medical school biomedical communications center was to become a member. Because this center did engage in some research, although peripheral to what most directors considered basic educational research, permission to join the group was allowed. After that concession, the directors defined some unwritten membership criteria to which they by-and-large adhered. At times, requests were made for exceptions, which provoked renewed discussion on the importance of restricting memberships to directors of bona fide research centers.
Membership was not a critical issue again until the group began to reconvene on an annual basis after the 1971-74 hiatus. While it was relatively easy to restrict attendance at the spring meetings because the host institutions sent out the invitations, this was not the case with the breakfast sessions hosted by the AAMC. Some individuals who saw themselves as involved in research in medical education at times took the liberty to attend the directors' session when they knew where it was to take place.
The problem continued to grow and by the 1980 Abrahamson probably expressed the concern of a majority of the directors when, after that years meeting, held in conjunction with the AAMC, he wrote to Joseph Sheehan, host for the 1981 University of Connecticut meeting:
- It has to do with "membership" or just plain attendance at our sessions just this past month and at the meeting scheduled for the spring.
- There were in attendance at our breakfast meeting some people who were not "directors" of medical education research "units."
- These included at least one who is a director of an office of research in dental education.
- There were also two people from the same institution-and that institution is not even a medical school...
To the extent which is possible, therefore, I think we ought to try to insist on the kinds of criteria which we looked at rather cursorily last spring in Hamilton. In that way, I think we can maintain an identity which is unique and avoid the kind of diffusion and dilution which will lead to just one more gathering of people interested in education in health professional settings. (Abrahamson 1980)
Three areas of concern surfaced for me:
Abrahamson's argument, supported by almost all of the directors, was that for those interested in education in health professions, there already existed more appropriate organizations including the AAMC Group on Medical Education, the AAMC Research in Medical Education Conference, Division I of the American Education Research Association, and the newly organized Generalists in Medical Education. Nevertheless, even though criteria were developed at the 1981 Connecticut meeting, until the Society was founded the issue of membership in the group continued to arise periodically.
As noted earlier, the meetings of the directors concerned a variety of issues. Occasionally the matter of formalizing the organization was brought up, but never pursued with any real enthusiasm. That is, until 1987.
The June 10-12, 1987, meeting at Orcas Island, Washington, was unquestionably the most significant to date for the directors (Appendix C). Most came to the meeting for the usual camaraderie, which through the years became more casual and more relaxed as an increasing number of spouses attended and more social activities were provided. The agenda included a discussion on the reorganization of the AAMC, issues relating to the 1988 RIME Conference, the director's relationship with federal funding agencies, and a discussion to consider a formal organizational structure for the directors. With foresight, Wayne Davis came to the meeting with a draft of a set of bylaws, and what evolved from that discussion perhaps no one anticipated. Part of the minutes of that meeting graphically described the turn of events: (Minutes 1987)
This portion was intended as a forum to discuss the potential advantages and disadvantages of a formal organization for the DRIME. We first considered the advantages which would accrue from a more formal organization. These were:
- To promote and support research in medical education
- lmprove visibility
- Being better able to respond to initiatives and requests from others
- Establishing relationships with other organizations having common interests
- Development and support of new offices of research in medical education
- Provide leadership in research in medical education, and
- Establish and maintain communication between offices of research in medicaIeducation.
As for the disadvantages, one were registered. At the conclusion of discussion a motion was made to consider a formal organization structure. This motion was seconded, and the directors in attendance voted 17 to 0 to suspend the program and continue work on producing a set of bylaws which could be submittcd to the entire membership for consideration. This work continued for the rest of the day and into Friday. On Friday morning the group approved an action plan consisting of the following steps:
- Attendees would approve in principle the establishment of a formal organization (passed 17-O)
- Attendees would discuss and modify the proposed set of bylaws (passed 17-O)
- All current DRIME members would vote on the proposed bylaws (passed 15-l-1 abstention)
- Nominations for officers would be completed by September 1, with an election being held prior to the AAMC meeting in the fall (passed 17-O).
Proposed bylaws were discussed and several changes were made. Following some discussion it was recommended that the name of the new organization should be the Society of Directors of Research in Medical Education (SDRME), and that copies of these revised bylaws would be submitted to the larger membership for a vote after updating the membership list.
Thus, the Society of Directors of Research in Medical Education was conceived at Orcas Island. In a memorandum dated August 26, 1987, Wayne Davis announced that the vote was 37 acceptance, 1 rejection, and 2 nonresponders to the ballot on the bylaws. The Society was born!
The first official meeting of the Society was held on November 11, 1987, in Washington, D.C., in conjunction with the annual AAMC meeting. Elected to the executive committee were: Stephen Abrahamson, Wayne Davis, Charles Dohncr, Jack Maatsch, T. Joseph Sheehan, and Loren Williams. On December 1 8 , 1987, at an executive committee meeting held at the University of Michigan, the following slate of officers were elected: chairman, Charles Dohner; chairman-elect, Stephen Abrahamson; secretary, Loren Williams; and treasurer, Wayne Davis. Later, at the first formal meeting of the Executive Committee, titles were changed from chairman to president and from chairman-elect to vice president.