Since 1971, the University of Washington School of Medicine, Seattle, has operated a four-state, medical education program covering Washington, Alaska, Montana, and Idaho. This WAMI Program involves four universities without medical schools and 15 communities. To maintain this program, communication between the sites is imperative and mandates travel. The experiments described in this article were undertaken to determine whether full-duplex audio and color-video interactions via communications satellites could replace the travel requirements of the WAMI Program. Experiments involving the administration of the program, the presentation of the undergraduate medical education curriculum, the provision of health services, and the formation of public policies were conducted. The results suggest that satellite communication has broad applicability in medical education and health care provision.
In this report are examined the patterns of control of diabetes mellitus achieved by practicing family physicians in small communities in the Pacific Northwest and Alaska. The diabetic patients under study appear to be broadly similar to patients in tertiary care settings, where most studies of diabetes care have been carried out. Motivated, competent family physicians, knowledgeable about tight control of diabetes, appear to have considerable difficulty in maintaining even modest levels of biochemical control. Goals in this study for fasting plasma glucose levels for patients with insulin-dependent diabetes mellitus (IDDM) averaged between 120 and 160 mg/100 ml. Glucose levels actually achieved ranged up to 360 mg/100 ml. A similar though lesser discrepancy was noted for patients with non-insulin-dependent diabetes mellitus (NIDDM), with achieved levels ranging up to 270 mg/100 ml fasting plasma glucose. There were wide individual differences among physicians in management styles and treatment policy, including wide discrepancies in emphasis on diet, use of oral hypoglycemic agents, and insulin use. This diversity is felt to merit further investigation. Collaborative studies of this type with community based physicians are feasible and academically rewarding. Significant research questions can be addressed and answered.U
In an effort to make the geographic distribution of physicians closer to the distribution of the population as a whole, in 1971 the states of Washington, Alaska, Montana, and Idaho established the WAMI Program. In a departure from the Flexnerian model of medical education, the WAMI Program was organized to distribute the components of medical education throughout the region, both at the medical center at the University of Washington School of Medicine and at remote sites. In the present article, the authors describe the results of the first seven years of the program (1975-1981) in terms of the geographic and specialty distribution of the school's graduates before and after the establishment of the program. At the time of the study, 23 percent of the graduates with WAMI Program experience practiced in nonmetropolitan areas as defined by the U.S. Bureau of the Census. Only 13 percent of all U.S. physicians practiced in such areas in 1981, while 24 percent of the U.S. population lived there. In addition, 61 percent of the graduates with program experience were in primary care practice in contrast to 35 percent of all U.S. physicians. If all U.S. physicians behaved as these graduates do, the distribution of U.S. physicians would be reversed, with the proportion of physicians practicing primary care in nonmetropolitan areas being larger than the proportion of the population living in those areas.
The predictive validity of the new Medical College Admission Test as it relates to end-of-quarter examinations in anatomy, histology, physiology, biochemistry, and "ages of man" is presented. It is recognized that the maximum predictive power is attenuated by the reliability of the criterion variables. To determine the value of attempting to increase the reliability in the criteria, the authors corrected the validity coefficients for attenutation. Regression analyses were also undertaken to examine the extent to which the new MCAT subtests can predict scores on end-of-quarter examinations. Results indicate that the Science Knowledge assessment areas of chemistry and physics and the Science Problems subtest were the most useful in predicting student performance, followed by the Skills Analysis: Quantitative and Skills Analysis: Reading subtests and the biology area of the Science Knowledge subtest.