Here are some examples of the contributions to medical education and student advocacy AMSA has made during its history
In the late ’60s, there was a small interest in community health among a few well-known academic types. SAMA students, through their large, national community health programs in Appalachia, on American Indian reservations and with migrant workers, became the impetus for pushing the community health movement to new levels of interest in medical education as well as among federal and private funding sources. From these activities came numerous student-run community clinics, an elevated interest in community health among educators and students, and eventually, the idea of community-based medical education. Approximately 30,000 medical students participated in SAMA’s/AMSA’s community health programs from 1967 through 1984. These were all community service programs organized and conducted by AMSA student leadership.
JOINT COMMISSION ON MEDICAL EDUCATION
In the late ’60s, SAMA students, through funding by the Carnegie Foundation, took the initiative to evaluate the nation’s medical curricula and publish a set of recommendations for changing the nation’s medical education agenda. Called the “Handbook for Change,” this document had far-reaching effects on reforming medical education, such as students participating on curriculum and admission committees, engaging in community-based experiences and promoting the advent of a family medicine specialty, etc.
Although widely used today, the preceptorship was not always recognized or accepted as a legitimate medical educational modality. AMSA students, working through their community health programs, redefined the preceptorship as a way to expand their educational experience beyond the confines of medical school. In the 1970s, AMSA conducted research and published formal guides to using the preceptorship model as a way to influence medical schools to and expose students to health-care problems outside their tertiary care settings. Slowly, schools have adopted this model for expanding their students’ experience to a community-based setting. All schools now recognize the value of the preceptorship model.
USE OF THE MYERS-BRIGGS TYPE INDICATOR (MBTI) IN MEDICINE
AMSA has had a long-standing affiliation with the MBTI. From 1971 until her death in 1984, AMSA worked closely with Isabel Briggs Myers, who was the author and developer of the MBTI, to conduct research on various issues concerning psychological type and physician development and utilization. As part of this effort, the AMSA Foundation founded the Center of Psychological Type, which still exists in Gainesville, Florida. The MBTI has now become the most widely used and respected psychological instrument of its kind in the world.
STUDENT RIGHTS AND DUE PROCESS
Since its inception, SAMA/AMSA has looked out for student interests. In 1960, SAMA confronted its then supporter the American Medical Association (AMA) on issues of federal student loans. The AMA disagreed with SAMA’s work with the federal government to establish a federal loan program for medical students. Ignoring the AMA’s resistance, SAMA worked to establish the first federal loan program available to medical students in the early 1960s. Today it continues to provide students’ financial needs. AMSA’s student advocacy program dates back to 1971, promoting due process for rights of students. The program continues to exist. In addition, during the 1970s and 80s, the organization worked to establish programs to foster medical student well-being within their medical school learning environments. The first national conference on medical student well-being was organized and administered by AMSA in 1992. The association continues to work to secure universal standards for medical student well-being throughout medical education.
FINANCING OF MEDICAL EDUCATION
AMSA has been concerned with the increasingly high cost of medical education since 1961. SAMA students were the first to advocate and lobby successfully for federal student loans to medical students. From 1982 to 1986, AMSA worked with Knight Tuition Payment Programs, Sallie Mae and Key Bank to establish the AMSA Health Education Assistance Loan (HEAL) Deal, the first nationally discounted educational loan program available to medical students. This program had more than 20,000 participants by the time it closed in 1991 and saved its student borrowers an average of $60,000 interest if they paid their Heal loans off over the maximum term of 25 years. Equally important, the program forced many banks to discount their loan programs to stay competitive. Since the introduction of the AMSA HEAL Deal, students have had access to discounted loan programs. There is no way to calculate the amount of money medical students saved with AMSA’s initiative. In 2004, AMSA announced its in-school consolidation program that allowed students to lock in interest rates at their lowest rates in 38 years by consolidating their loans while in school. If just 30% of eligible students participate, this program can save AMSA members over $100 million in interest payments. In collaboration with the Association of American Medical Colleges-Organization of Student Representatives and the American College of Physicians, and with the assistance of the Macy Foundation, AMSA hosted its second national conference on financing medical education in 2005, and brought legislators, educators, loan servicers, and students to discuss solutions to the skyrocketing debt. AMSA has since introduced the concept of free medical schools through the United States Public Health Medical College act, and continues to explore innovative ways to reduce the burden of debt on medical students.
AMICUS BRIEF ON REVERSE DISCRIMINATION
In 1978-79, the hottest topic in medical education was the pending reverse discrimination case before the U.S. Supreme Court (University of California Regents v. Bakke). AMSA was the first medical organization to publicly support the affirmative action position of the University of California and wrote and filed an amicus brief with the Supreme Court. The court eventually ruled in favor of the University of California, and it now stands as a landmark case on discrimination.
SAMA PROTESTS THE VIETNAM WAR
AMSA was the first national medical organization to formally involve itself in the protest of the Vietnam War. In 1970, the organization organized a large demonstration in Washington of concerned health organizations in opposition to the U.S. government’s involvement in Southeast Asia. The organization also organized and supported opposition to the doctor draft and helped successfully propose alternatives for physicians, such as duty with the National Health Service Corps.
U.S. MILITARY AGAINST GAYS
In 1989, AMSA’s House of Delegates adopted the policy position of not accepting advertising from the U.S. Military Services because of its known discrimination policies against gay people. Under this policy, the military cannot advertise in AMSA publications or exhibit at AMSA’s annual meetings until such time that it reverses its discriminatory practices. This was not an easy decision in that it cost the organization at least $80,000 in badly needed advertising revenues, but as usual, the organization decided it was morally right.
INTERDISCIPLINARY TRAINING FOR MEDICAL STUDENTS
During the 1970s, AMSA received several grants from the federal government and the Robert Wood Johnson (RWJ) Foundation to develop and demonstrate viable interdisciplinary training models for health professional students. The Health Team Training Program trained and placed teams of health science students into rural public health systems to work on community health service issues. The Health Team Curriculum Program piloted an interdisciplinary training model for health science students at five selected university health science centers around the country. These programs, along with one funded by RWJ at Montiefeore Hospital, were the first interdisciplinary (health team) training efforts in the country. Those groups pursuing similar interest in medical education today still often reference them.
INTERNATIONAL PARTNERSHIP IN MEDICAL EDUCATION
By tradition, AMSA has had strong international health interests and ties. In 1986, with the help of the Pew Memorial Trust and the “We Are the World” Save Africa Rock Group effort, AMSA developed the first international consortium of medical schools for exchanging and training physicians. This program ended in 1993 and exchanged/placed students in Nigeria, Ghana, Colombia and Mexico. Many of the past participants have gone on to careers in international health. AMSA has since sponsored language training institutes, another groundbreaking experience in medical education. AMSA is continuing our international partnerships, including, in 2005, with the European Medical Students’ Association.
NRMP ALGORITHM CHANGE
In 1995, with the help and encouragement of Public Citizen and other interested parties, AMSA confronted the National Resident Matching Program (NRMP) with questions concerning the fairness of the hospital-biased algorithm being used by the Match. During the course of that year, AMSA, working with professionals familiar with the research on the issue, surveyed the schools and students to obtain their opinions on the controversy. The results of this work were then presented to the NRMP with a request to formally investigate the fairness of the current Match and to change it to a student-biased algorithm. From the beginning, AMSA requested the support and participation from other medical student organizations. Groups such as the American Medical Association-Medical Student Section declined. The NRMP eventually agreed to investigate the issue. The following year, AMSA conducted its own survey research on the results of the 1996 Match and presented those findings to the NRMP. In part, taking into account the results of its own investigation and the results of the AMSA survey, the NRMP made the decision to change the Match algorithm in favor of students. In addition, AMSA made the recommendation to the NRMP to have a second Match for those graduates who did not Match in the first round to avoid the chaos and high-pressure atmosphere of the scramble. AMSA also succeeded in calling for full contract disclosures from residency programs before signing on to the Match, and the NRMP now has more student and resident representation on its Board than ever before.
HEALTH CARE AS A BASIC RIGHT
AMSA was the first mainstream national medical organization to adopt a policy supporting health care as a basic right for all Americans. Adopted by AMSA’s House of Delegates, this policy has always distinguished the organization from the AMA and the other component organizations of organized medicine. As a basic premise of its organizational philosophy, the association pursues this policy in its activities and testimony before Congress. In 1991, the organization, through the office of its legislative affairs director, conducted a set of national debate conferences on health care as a basic right. In opposition to the AMA in the late ’60s, SAMA was one of the first medical organizations to support and work for the new Medicare and Medicaid legislation. AMSA has worked politically work to get “health care as a basic right” proposed as a constitutional amendment, and local chapters all over the country continue to work towards achieving universal access to healthcare through grassroots education and activism efforts
CHALLENGE TO THE PHARMACEUTICAL INDUSTRY
Since the 1960s, SAMA/AMSA has taken exception to some of the marketing practices of the pharmaceutical industry. Early on, SAMA established a working dialogue/relationship with the industry to work through some of the differences and negative perceptions of students about the industry. At one time, the industry employed several questionable marketing practices to influence students about their companies and products. In 1979, AMSA adopted a formal policy on its conduct with the industry. In the 2000s, AMSA became the only major medical organization to ban pharmaceutical advertising from all of its publications, and now stands alone in eschewing funds from any pharmaceutical company for our publications or other revenue streams. Policies have also been adopted by AMSA’s House of Delegates to limit pharmaceutical interactions with medical students and physicians. In 2002, AMSA’s PharmFree initiative was started to encourage students to use unbiased sources of information on pharmaceuticals and to think critically about the drug industry’s marketing practices to physicians. This initiative has since been quoted by dozens of lay and medical newsources. The success of the PharmFree initiative has led to the next action step in the form of the Counterdetailing Campaign, which involves students going to local doctors’ offices to teach physicians about finding evidence-based information. Thousands of students have participated in Counterdetailing, as well as national PharmFree Day, and PharmFree continues to encourage the new generation of physicians-in-training to use integrity and professionalism throughout their education and careers.
AMSA AND FAMILY MEDICINE/PRIMARY CARE
Starting with its community health projects in the 1960s, AMSA has always been a strong supporter of primary care and equal distribution of primary care physicians. SAMA, working with the American Academy of General Practice (predecessor to the American Academy of Family Physicians), vigorously supported the establishment of family practice as a medical specialty. Early on, the organization did extensive survey work to prove and support the position that medical students were interested in such a specialty as a career choice. On Capitol Hill, SAMA, now AMSA, has continued to work to support the funding of family medicine and primary care training programs for physicians. AMSA has since had numerous training programs to develop leaders in primary care, is an active member of the Primary Care Organizations Consortium, and is currently producing a new career development program for its members to help them make more informed career decisions.
AMSA ON HOUSE STAFF
AMSA has always been a strong supporter of the physician house staff movement. The organization has worked on issues to improve house staff working conditions and the quality of their graduate medical training. In the late 1960s, SAMA helped organize the first national house staff conference and the first national house staff organization, Physicians for National Health Program. Two other national house staff conferences followed. The latest, held approximately seven ago, gave birth to the Consortium of House Staff Organizations AMSA also works closely with the Committee on Interns and Residents (CIR/SEIU), the largest housestaff union in the country, on many vital legislative issues.
REFORMING RESIDENCY WORK HOURS AND IMPROVING PATIENT SAFETY
Following the 2000 Institute of Medicine report, “To Err Is Human,” that showed 98,000 deaths occurred as a result of medical error per year, AMSA has fought for reductions in resident physician work hours to improve resident and patient safety. AMSA’s petitioned the Occupational and Safety Health Administration in 2001 and introduced federal legislation in 2002, 2003, and now 2005 to improve resident physician working conditions and reduce medical errors. As a result of AMSA’s work, the Accreditation Council on Graduate Medical Education (ACGME), changed their accreditation requirements to include tougher standards on resident work hours (“the 80-hour work week”). Though AMSA’s work has unquestionably improved the lives of resident physicians, AMSA continues to fight for stricter standards and better oversight through federal legislation.
ADVOCATING FOR DIVERSITY AND REDUCING HEALTHCARE DISPARITES
AMSA strives to improve the recruitment and retention of under-represented minorities into medicine while increasing the diversity of our own leadership, in order to create a tolerant, accepting and culturally diverse physician workforce. AMSA has worked with the Sullivan Commission and our partner organizations to increase diversity in medicine, and continues to increase our widen the pipeline and mentor programs. On the disparities front, AMSA works to empower students with knowledge about domestic and global health disparities and provide opportunities for students to take action to eliminate health disparities on the local, state, national, and international levels. Our Jack Rutledge Fellow recently developed the first nationwide, randomized study of medical students’ knowledge and attitudes about health policy, health care delivery, and racial/ethnic disparities in health care access; this study has been published in several peer-reviewed journals.
AMSA AND INNOVATIVE CURRICULA
AMSA has made tremendous strides in becoming the leading voice of health professionals in calling for medical education reform. Following on our “Handbook for Change” in the 1970s, AMSA has pioneered numerous innovative programs. The AMSA Foundation currently has a 5-year grant funded by the NIH to develop, promote, and disseminate Complementary and Alternative Medicine education curricula and programs at medical institutions. It also has numerous other programs to teach cultural competency, geriatrics, primary care, health policy, and other subjects not addressed in most medical schools to students around the country.
AMSA AND LEGISLATION
Since AMSA’s move from Chicago to the Washington, DC area in 1978 and the creation of the full-time Legislative Affairs Director position in 1984, AMSA has been very active in the legislative arena. AMSA was instrumental in the support for the establishment of the National Health Service Corps. It subsequently introduced legislation on resident-physician work hours that led to the 80-hour guidelines. In 2006, AMSA introduced to Congress the concept of the United States Public Health Medical College. The U.S. is facing a severe physician shortage, rampant health disparities, and problems with accessibility to medical education due to rising student debt. AMSA proposed a new model of education based on combining public health and medicine where medical school education in 10 new medical schools would be free, in exchange for service in an underserved community. This legislation will be introduced in the 109th Congress. Also in 2006, AMSA proposed to Congress the concept of restricting pharmaceutical representatives’ access to resident physicians; this has also been written into legislation, and will also be introduced. AMSA continues to lobby on hundreds of pieces of legislation affecting medical education and healthcare, and members have the opportunity to develop further lobbying and leadership skills through the Paul Ambrose Political Leadership Institutes (named after past LAD Dr. Paul Ambrose who passed away tragically on Sept. 11, 2001).
For 60 years, AMSA has provided the world with responsible, humanistic and ethical physician-leaders of the future who serve as a united force for change and advocate for our patients and communities. As an entirely student-run organization, AMSA provides leadership opportunities on every level, including over 105+ national positions with now five full-time student office staff officers. Currently there are 18 leadership institutes during the year, including several at the AMSA office in Sterling, VA. AMSA members develop into physician-leaders who are now shaping the world of healthcare as clinicians, educators, researchers, administrators, public health officials, FDA Commissioners, and Surgeon Generals.