A SPECIAL REPORT TO THE NATIONAL ADVISORY COUNCIL REGIONAL MEDICAL PROGRAMS SERVICE May 11-12, 1971 to improve health manpower effectiveness For further inquiries and assistance contact: Continuing Education and Training Branch Regional Medical Programs Service Health Services and Mental Health Administration Department of Health, Educatibn and Welfare Rockville, Maryland 20852 INTRODUCTION This report to the National Advisory Coun i s intended to highlight areas of special interest and concern in the field of health manpower. It illustrates the interrelationship of issues af- fecting manpower effectiveness and summarizes Regional Medical Program activities and sources of federal and non-federal support. As an agency within the Heaith Services and Mental Health Administration, the principle objective of Regional Medical Programs Service is the improve- ment in the delivery of health services. The major thrust of the health manpoFer efforts of Regional Medical Programs relates to more effective utiliza- ti6n of existing health personnel at the profes- sional, technical, and supportive levels. Regional Medical Programs Service interests apply to every aspect of the health delivery system--patient care environments, research gr oups, public health activities, state and federal programs, education and training in institutions in the cities and rural areas alike. TABLE OF CONTENTS HEALTH MANPOWER - A DEFINITION. 1 NATIONAL ISSUES REIATING TO HEALTH MANPOWER EFFECTIVENESS 2 * WHAT ARE THE COMPONENTS OF THESE ISSUES REIATING TO HEALTH MANPOWER EFFECTIVENESS 3 * FEDERAL AND NON-FFDERAL SUPPORT FOR HEALTH MANPOWER TRAINING AND EDUCATION 19 * REGIONAL MEDICAL PROGRAMS IMPACT ON HEALTH MANPOWER TRAINING AND EDUCATION 25 RMPS POLICY STATEMENTS 37 HEALTH MANPOWER A DEFINITION All professional technical and supportive (including administrative) personnel in'the fields of patient care, public health, health education, and research. NATIONAL ISSUES REIATING TO HEALTH MANPOWER EFFECTIVENESS ESSIONAL ERATION SE SYST IZATION TERNS DISTRIBUT@ These issues are dependent upon each other, and it is their interrelationship which complicates the solution of manpower problems. 2 WHAT ARE THE COMPONENTS OF THESE ISSUES REIATING TO HEALTH MANPOWER EFFECTIVENESS? Most of..the Regional Medical Programs are directly involved in activities relating to one or more of these issues. Illustrations have been selected to indicate the scope and nature of what is going on at the present time in a n@er of Regional. Medical Programs ....... S SYSTEM NATIONAL ISSUE... THE HEALTH- SERVICE ..Equal access to health care can become a reality as the organization of the system responds to the rapidly changing needs of society. Consensus among providers on the definition and description,of quality of care will make evaluation procedures meaningful and productive for future improvements in the system. Continuity of care as well as comprehensiveness requires increasing emphasis by providers to meet growing consumer needs. AN EXAMPIE OF RMP ACTIVITY A new health maintenance system is being developed by the Georgia Regional Medical Program with a group of physicians in a rural Georgia county. Using allied health personnel time rather than physician time w@.erever possible, a program of regul ar health maintenance examinations for all members of the community will be established. Where health problems are detected, local phy- sicians have agr6e-d to provide necessary follow-up care. The objectives of this program would en- courage the maintenance of good health through. early detection of disease and to provide care for those who have not previously had easy access to medical care ... Georgia Regional Medica Program. .5 NATIONAL ISSUE... BASIC EDUCATION Curricula change within the educational system can reduce the time lag between knowledge and its application in the delivery system. Greater emphasis on the interprofessional approach to planning and implementing the basic curriculum will facilitate improvement within the delivery system. Solutions are needed for the dilemma of dealing with the uneven geographical distribution of educational resources. Many community@hospitals and service institutions do not have the capacity to develop resources to organize, administer and carry out education- ally sound training 6 AN EXAMPIE OF RMP ACTIVITY A new medical education plan will enable first year medical students enrolled at the University of Washington to take certain basic science courses in selected colleges and universities throughout the region and to take part of their clinical experience in local physicians' offices and community hospitals. Alaska was chosen to accept the first students in the plan because of their acute medical manpower shortage. This plan to decentralize medical education was facilitated by the close ties that evolved between the School of Medicine and the practitioners in remote areas through the Regional Medical Program supported Guest Residency project ... Washington/Alaska Regional Medical Program. 7 NATIONAL ISSUE... CONTINUING EDUCATION Learning experiences need to become more relevant to current patient care and health service delivery system problems. More adequate methods of identifying educa- tional needs of health professionals as well as determination of standards of performance in continuing education are essential to improve the quality of program. A greater number of long-range personalized continuing education programs.are needed to accommodate individual learning differences. As continuing education becomes an established part of the health care system, financial sup- port, faculty benefits, and practitioner accep- tance can be secured. AN EXAMPLE OF RMP ACTIVITY A model of.continuing.education is being developed through the voluntary involvement of practicing physicians in a self-study audit of their patient care. The medical self-audit identifies the areas of need around which the community hospitals in the .region can design continuing education programs for the medical staff ... West Virginia Regional Medical Program. NATIONAL ISSUE... AVAIIABILI Ty Student counseling, recruitment and selection should be related to the needs of the current health care system. Increased consumer demands and the impact of technology in creating new or changing health occupations result in more employment oppor- tunities being made available. In order to compete more effectively with other kinds of employment, the health industry needs ,to deal with the unattractive characteristics, of the system such as low morale and wages, lack of independent responsibility, extended training with few entry points, and with little opportunity for transfer into other careers. 10 AN EXAMPIE OF RMP ACTIVITY Through the leadership of the Core staff, the health manpower and education interests of all concerned private and public agencies have been brought together in the form of a single Inter- agency Task Force to work out solutions to identified health manpower problems. Results now anticipated through this collaboration is agreement on the approach to the most efficient and effective education, deployment, and utiliza- tion of health care personnel at every-level and within each profession ... Illinois Regional Medical Program. NATIONAL ISSUE... DISTRIBUTIO" Factors such as gaining community acceptance, finding sociocultural and professional stimu- lation in rural and ghetto areasil availability of facilities and resources for practice, ribute together with long hours and low pay cont to the maldistribution of health manpower. Adaptation of personnel policies and modifica- tion of the working environment to become more responsive to individual practitioner nee will improve the distribution of manpower. 12 AN E@IE OF RNP ACTIVITY physicians have instant access to special- ists at the University of Alabama in Birminghams through the Medical Info tion Service via Telephone (MIST). The service permits the physician wherever in practice in the -State, place a telephone call at any hour to the MST circuit where switchboard operators are trained to respond by locating the needed specialist on split-second notice. The program has evolved as a cooperative effort in- cludi-ng the Alabama ]regional Medical Program, the University of Alabama and the American Medical Association Education and-Research Fund. This service program has served as a model for similar programs being developed in other parts of the country...Alabama Regional Medical Programs. -13 NATIOgAt ig@tE... UTILIZATION PATTERNS .-,,.,Increased.-c!onsumer expectations:.result in demands f or, more and - improved,,Icomprehensive health services. Licensi4re, liability and certification are. @h-ree,,pf,@tbg,:@factors@,affecting@.@changing respon- @of health manpower and,.need to be sibilittips em in an addressed byl.-;:he.@syst T4e,im gy increasing pact,-pf-@Ichanging technolo emplpyment,-@oppprtunit,iiis for@@@traditional@.h6alth workers,,.and,@thei:emergence of new- .,health occupa- tions, .,i.e.,@@therapists and-,technicians-require innovative,,:and@imagin.ative administrative@.1 methods. Changing patterns in the financingisof health care is a major factor affecting employment practices and utilization of manpower. 14 ... AN EXAMPLE OF RMP ACTIVITY In Wisconsin, a patient care systems project was developed at St. Mary's Hospital, Milwaukee, with the cooperation of the University Schools of Nursing.- A thirty-nine bed conventional patient care unit has been converted into a demon- stration unit for optimal care of patients. The goal is to use patient care requirements as, the major focus for change. In recognition of the com- plex interrelationships of personnel and resources in the delivery of patient care,,a systems approach is used which will change personnel utilization en- vironmental factors, communication methods, equip- ment and resources. The project staff consisting of a team of two nurses, a systems engineer, a sociologist and a hospital administrator work closely with all relevant hos-.- pital departments -in the design and in the imple- mentation of the changes within the demonstration unit. The project is now in the implementation and testing phase which will be followed by a program of instruction for health teams from other hospitals to .help them develop'more effective patient care system.. Wisconsin Regional Medical Program. 15 NATIONAL ISSUF,... -INTERPROFESSIONAL COOPERATION The "guild like"-pr-actices of health profes- sionals have impeded the development of interprofessional cooperation and continue to result in organizational control over mobility, transfer of functions and role expansion. Strategies to improve communications among the health professions are essential in order to facilitate delegation of functions, assump- tions of new roles and the development of new kinds of auxiliar' personnel. y Attitudinal changes toward the delegation of authority and respIonsibility and toward the assumption of new responsibilities are critical in planning ways of improving man- power effectiveness. 16 ACTIVITY ... AN EX Leadership is being provided to six community hospitals in a multi-disciplinary program in stroke care for nurses, physicians, therapists, nutritionists and others. All those under- . going the training share in the clinical portion of the program and case presentations are given in such a way that provides the opportunity or the various professionals to learn from one another-about each aspect of total patient care ... Oregon Regional Medical Program. 17 FEDERAL AND NON-FEDERAL SUPPORT FOR HEALTH MANPOWER TRAINING AND EDUCATION FEDERAL SUPPORT The Federal Government has assumed an increased responsibility for the training of health man- power. Actual expenditures for health manpower training for Fiscal Year (FY) 1970 were $969 million., with estimates of $1,049 million for FY 1971 and $1,128 million for FY 1972. Federal agencies supporting health training include the Department of Health, Education and Welfare, Veterans Administration, Department of Labor, Department of Defense, Agency for Inter- national Development, Environmental Protection Agency and other agencies. of the Federal agencies, the National Institutes of Health will continue to be the largest supporter of health manpower training. The Veterans Administration through its 169 hospitals, also trains large numbers of professional health students, interns and residents. The Department of Labor, under the Manpower Develop- ment Training.Act, supports the greatest number of allied health personnel of any Federal agency. Approximately 2.7 million students and trainees will be aided in support by the foregoing Federal agencies for FY 1972. Training is specified in the fields of medicine, dentistry, pharmacy, optometry, podiatry, nursing, paramedical pro- fessions, research anid "other health training" which includes short-term training. 19 The following descriptions of major Federal program illustrate their relationship to RMPS manpower goals: I. DEPARTMENT OF HEALT AND WELFARE NTAL HEALTH ADMINISTRATION A. HEALTH SERVICES AND ME comprehensive Health Planning Under Section 314c, the primary emphasis is entraining people in health planning skills. Grants may support continuing education, graduate education, and training of consumers for participation in comprehensive health planning. Under Section 314e, training is supported only when it is necessary to enable a health services development project to be staffed adequately and when it is an integral part of a health services development project to meet needs of limited geographic scope or of special- ized regional or national significance. National Center for Health Services Res Training activities focus on the develop- ment and assessment of new ways of utilizing health manpower. This in- cludes design and experimentation with models of new types of health manpower; such as NEDEX, Pediatric Nurse Associate, Family Nurse Practitioner, etc. The National Center is now.in the process of developing a uniform national pro- tocol for evaluating the NEDEX effort and other mid-level.manpower programs. National Institute of Mental Health Support is available for continuing education of personnel in the mental 2.0 health field as well as for devel- opment of training programs for new types of mental health personnel. B. NATIONAL INSTITUTES F HEALTH Bureau of Health Manpower Education The basic mission of the Bureau is to increase the health manpower supply of physicians, dentists, optometrists, podiatrists, osteopaths, pharmacists, veterinarians, nurses and the twenty allied health professions listed by the Secretary. The Health Manpower Act of 1968 and the new Allied Health Training Improvement Act of 1970 provide the authority to increase enrollment; to improve quality of training; to provide advanced traineeships, scholarships and student aid. In addition, the new Allied Health Training Act makes special provisions for returning veterans; for the development of programs for new types of health manpower and for the demons- tration and evaluation of new and im- proved means of recruitment, retraining or retention of allied health manpower. National Library of Medicine The Medical Librar Assistance Act .y includes support for expansion and improvement of a medical library's basic resources; development of regional medical library services through support of major existing health libraries; training grants for health communications service and research; grants for research and development in communications related to health and grants for biomedical communications pub- lications projects. 21 C. OFFICE OF EDUCATION Monies are made available to State Depart- merits of Education to maintain, extend, improve or develop new programs in voca- tional and technical education at less than the baccalaureate level in high schools, post secondary schools, voca- tional-technical schools, junior and community colleges and four-year col- leges and universities under an approved state plan. Special services may include special demonstration and experimental programs, teacher training and develop- ment of instructional materials including those for use in programs of continuing education. Support is also available for research, demonstration, pilot and experimental programs in new careers. D. SOCIAL AND REHABILITATION SERVICE Provides grants for rehabilitation research and demonstration; training grants to increase the supply of per- sonnel involved in rehabilitation of disabled persons; long term and short term traineeships to educational insti- tutions to support graduate students and continuing education. II. DEPARTMENT OF IABOR Occupational training programs under the Manpower Development and Training Act pro- vides grants to train the unemployed and underemployed. it can also provide re- fresher courses for workers who would be unemployable unless their skills were changed or brought up to date. Duration of training is usually less than 2 years. 22 III.VETERANS ADN[INISTRATION Veterans Administration education programs include continuing education; expanding and improving existing training categories; undertaking new ones; providing educational leave to professional staff; creating space for necessary education and-training activities; and establishing selected VA hospitals as train- ing centers-in special care programs. It also includes grants to medical schools, hospitals and research centers for the exchange of medical information and techniques and medical information services, including the use of electronic links between Veterans Administration hospitals and major medical centers. NON-FEDERAL SUPPORT Contributions of the private sector to health manpower education and training are substantial. During the year 1966, among the nationally known funds and foundations which awarded grants of $10 thousand 'or more, 153 foundations awarded over $21 million for health manpower training. Recently, for example, the awards of several large grants were announced by the W. K. Kellogg Foundation. The grants provide $.5 million per institution-for the training of allied health practitioners and educators as teachers and $1.5 million for accelerating and strengthening manpower education programs and for the continuing education of the area's health practitioners. As well as the foregoing financial resources, voluntary agencies, special - interest corpora- tions and professional associations provide fellowships and scholarships for the training of the wide range of health professionals. @23 State and local health agencies also provide the financial resources for staff advanced training. In addition, there are many hospitals that offer training free of charge and some pay trainees a modest sum. Finally, there is the whole segment within the health manpower pool which represents individuals who have undertaken some part of the financial burden of their own training. 24 REGIONAL MDICAL PROGRAMS I'MPACT ON HEALTH MANPOWER TRAINING AND EDUCATION 25 imEW REGIOil I I I Region with declared priority in health manpower health manpower committee 1Region with a .ng health 2Regions with core staff represeati manpower $2.577.300 Total @ dollars @urrently in manpower activities- * in continuing education, 31% of total * in training existing manpower, 19% of total* * in training new manpower, 0 States in D e ion Reg al Programs Maine Tonnecticut New Hampshire Maine Vermont Northern' New England Massachusetts Tri-State Connecticut Rhode island Data as of 12/31/70; excludes core staff activities. 26, DHEVI REGION II I Region with declared priority in health manpower 2 Regions with health manpower committees 1 Region with core staff representing health manpower @4,932,600 Total RMP dollars currently in manpower activities .in continuing education, 30% of total* .in trfining existing manpower 25% of total in training new manpower, 15% of total* States in DHEW Re@on Regional Medical New Jersey Albana New York Central New York Nassau Suffolk (planning) Puerto Rico New Jersey Virgin Islands New York Metropolitan Rochester Western New York Puerto Rico Data as of 12/31/70; excludes core staff activities. 2.7 rg I iinDl REGION III 1 Region with declared priority in health manpower 2 Regions with health-manpowcr comittees Region with core staff representing health manpower $4,7 5,000 Total RMP dollars @urrently in manpower activities in continuing education, 9%-of total* in training existing manpower, 32% of total* in training new manpower, 17% of'total* eional Med Delaware Marylana Maryland Metropoli.tan.Washington, D.C. Pennsylvania Susquehanna Valley Virginia Virginia West Virginia West Virginia Western Pennsylvania Data as of 12/31/70; excludes core staff activities. 28 DHbi REGION- IV JO Pool IV 2 Regions with declared priorities in health manpower ittees 3 Regions with health manpower comm 3 Regions with core staff,representing health manpower $9,170,000 Total RW 'dollars currently in manpower activities . in continuing education, 18% of total . in training existing manpower,, 21% of total* . in training new manpower, 5% of total* States in DHEW Region Regional Medical rams Alabama N. Carolina Alabama N. Carolina Florida S. Carolina Florida Ohio Valley Georgia Tennessee Georgia S. Carolina Kentucky ;. Memphis Tenn/Mid-South Mississippi Data as of 12/31/70; excludes core staff activities. 29 DHEW REGION V 1 Region with declared priority in health manpower 0 Regions with health manpower comi.ttee 3 Regions with core staff representing health manpower $6,471,400 Total RMP dollars,currently in manpower activitiesw . in continuing education, 21% of total . in training existing manpower 15% of total* in training new manpower,, 0.4% of total States in DHEW Region Regional Medical Programs Illinois Indiana Indiana Michigan Michigan Minnesota Northeastern Ohio Ohio Northlands Wisconsin Northwestern Ohio Ohio State Wisconsin Data as of 12/31/70; excludes core@staff activities. 30 DHB.L REGION VI 2 Regiorlp with declared priorities in health manpower 3 Regions with health manpower comittees 2 Regions with core staff representing health manpower $3.,767,500 Total RMP dollars currently in manpower activities* * i ducation, 19% of total n continuing e * in tr@ining existing manpower, 17% of total'x *in training new manpower, 5% of total States in DHEW Region Regional MedicA rams Arkansas Arkansas Louisiana Louisiana New Mexico New Mexico Oklahoma Oklahoma Texas Texas Data as of 12/31/70; excludes core staff activities. 31 DHEW REGION VI I 1 Region with declared priority in health manpower 2 Regions with health manpower committees 2 Regions with core staff-representing health manpower $5.146,500 Total RMP dollars urrently in manpower activities@ in '@'ucation 17% . continuing e of total . in training existing manpower, 21% of total* in training new manpower, 23% of total states in DHEW Region Regional Medical Programs Iowa Bi-State Kansas Iowa Missouri Kansas Nebraska Missouri Nebraska Data as of 12/31/70; excludes core staff activities,, data for Nebraska/South Dakota as one region. 32 DHDI RE61UN VIII Vill 0 Regions with declared priorities in health manpower 1 Region with health manpower committee 1 Region with core staff representing health manpower $3,796,900 Total RMP dollars currently in manpower activities in continuing education, 27% of total in training existing manpower 28% of total*, in training new manpower, 2% of total States in DHEW Region- Regi onal Medical Programs Colorado Colorado/Wyoming Montana Intermountain North Dakota Mountain States South Dakota North Dakota Utah South Dakota(planning)* Wyoming Data as of 12/31/70; excludes core staff activiti,6s; see Region VII for Nebraska/Sbuth Dakota RMP 33 DFBAI RE61ON IX I ix 0 Regions with declared priorities in health manpower 0 Regions with health manpower comittee 1 itegion with core staff representing health manpower ,503,400 Total RMP dollars currently in, manpower activities* *in continuing education 15% of total* * in training existing manpower, 26% of total* * in training new manpower., 2% of total States in D@EW Region Regional Medical Programs Arizona Arizona California California Hawaii Hawaii Nevada -American Samoa Guam Trust Territories of Pacific Islands Wake island Data as of 12/31/70; excludes core staff activities. 34 I)MLII rEUIUll A x 2 Regions with declared priorities in healtl manpower 0 Regions with health manpower committee 1 Region with core staff representing healtl manpower $1,725,700 Total RNP dollars currently in manpower activities in continuing education 46% of total in training existing manpower, 17% of total* in training,new manpower, 0 States in D e ion Regional Medical Programs Alaska tfashington/Alaska Idaho Oregon Oregon Washington Data as of 12/31/70; excludes core staff activitir. 35 RMPS MANPOWER CONTRACTS Through the mechanism of contracts the Branch is able to draw upon, as well as create, national resources for development of selected types of health manpower. As an illustration of the use of contracts in this context, evaluation special- ists in continuing education have been trained to assume such responsibilities. The University of Illinois and University of Washington-have long and short term training pro- grams underway; the Universities of Southern California, Ohio State and Michigan State have also had contracts to support long term training at the pre and/or post doctoral level. 36 RMPS PO] NTS The major thrusts of the health manpower efforts of RNPS are related to more effective utilization of existing manpower. Some of the ways of accomp- lishment are through linkages of educational and health care resources to make optimum use of limited resources and manpower; regionalization of resources and services; updating of knowledge and skills of health workers at all levels; redefinition of roles; expansion of functions of existing health manpower; development of inter- disciplinary programs; attitudinal learning to overcome obstacles to changes in health care practices. In short, the manpower emphasis of RMPS is primarily on continuing education as a /V@ procdss-i ower problem rathe'r than on basic education to increase the manpower,pupply. DEFINITION OF CONTINUING EDUCATION AND TRAINING As an operational definition of continuing educa- tion, the following has been acdepted: "Those educational endeavors which are above and beyond those normally considered appropriate for qua.li- fication or entrance into a health profession or an occupation in a health related field." Continu- ing education activities must not be designed principally to quality one for a degree, diploma or certification; therefore, internship and residency programs have been excluded from primary consideration. Continuing education and training activities should lead to the assumption of new responsibility in the already chosen career field, upda-te knowledge and skills in the chosen career or add knowledge and skill in a different but basically related health field but not provide for career change. 37 POSITION ON BASIC EDUCATION AND TMINI_NG Generally speaking, other agencies exist whose primary efforts are aimed at supporting supply and training of health manpower at the basic and post-graduate levels. However, because of the critical need in regions for basic training sup- port not usually available from other Federal and non-Federal sources, Regional Medical Programs Service has developed policy in three.areas,affect- ing support of basic training: (1) health careers recruitment; (2) basic training in established allied health professions; and (3) basic training for the development of new types of health per- sonnel. (1) Health careers recruitment grant funds are not to be used for ct operational grant support of lth careers recruitment projects. ions are encouraged however, to use ff assistance to stimulate cooperative efforts between professional associations, clinical resources, educational institu- tions and other appropriate agencies to provide new opportunities for recruitment into health careers. RNP funds may also e used in planning health careers recruit- ment activities as a part of and coordinated with the overall manpower strategy'for the region. (2) Basic trainina in establis hed allied health professions A health profession will be considered estab- lished if a Board of Schools of the AMA Council in Medical Education, or some similarly recognized mechanism, has been set up to approve schools, outline standards for admission, curriculum requirements and certification procedures, and/or if defini- tive formal educational programs in the 38- particular health occupation have already been instituted in the educational and training systems of hospitals, technical schools, junior and senior colleges. No RMP grant funds may be used for the cost of providing basic education and training in established allied health professions as defined above. The use of professional staff assistance is encouraged as well as direct support of special planning studies to simulate educational institutions in conjunction with clinical resources to provide new educational and training opportunities in established allied health disciplines and to add new disciplines. (3) Basic training for the development of new types of health personnel Grant funds may be used for innovative training approaches and the development of new types of health personnel or new arrange- ments of health personnel to meet the Region's goal of improved patient care for those suffering from-heart disease, cancer, stroke or related diseases. Some of these activities may fall into the category of basic education. Training of new types of health personnel I.s defined as that training which relates to newly developing technologies of new modalities of diagnosis and treatment for which no standard curriculum is yet recognized, no minimum national standards for certifica- tibn or licensuke are yet established and. which is not generally part of the regular offerings of the health-related educational and training system of hospitals and/or technical schools, junior and senior colleges. .39 DEF SHORT RM TRAINING (1) Training conferences and seminars Presentations which are planned full- time participation for periods from one full day to five consecutive days, or intermittently on a regular basis. (2) Short-term traininF. @Activities which are planned for full- time participation for more than five consecu- tive days, but not more than a single academic session (quarter or semester). (3) Long-term Activities requiring full-time partici- pation for more than a single academic session (quarter or semester). SP CIES (1) Training for coronarv care unit Coronary care unit training projects are to disengage Regional Medical Program funding at the end of their current project periods or within a reasonable time thereafter (no more than 18-24 months.is considered as a reasonable period of time"). (2) Cardiopulmonary resuscitation trai@@ Regional Medical Program grant funding for projects in cardiovascular resuscitation training must be limited to activities which are directed principally to medical and allied health personnel. Such personnel must be employed in hospitals and other in-patient facilities, or in but-patient or emergency facilities operated by or directly related to institutions which can provide immediate follow-up care. 40 STIPENDS PER DIEM AND TRAVEL (1) Training conferences and seminars Stipends are not authorized for training conferences and seminars. (2) Short-term training Grant funds mav not be used for the payment It of stipends, either directly or on the "maintenance of income principle", to participants in s ort-term continuing educa- tion and training projects. Grant funds may be requested and awarded for 50 percent of the total amount budgeted for per them and travel for the trainees. The awarded funds may then be paid to the enrolled trainees as considered appropriate by the project personnel, depending on the partici- p,ants' ability to provide these costs for themselves, and/or the willingness of their employers to provide them. No single indi- vidual may receive per them or travel al.- lowance at a rate higher than that prescribed by the present Addendum'-Guidelineso Grant funds may not be rebudgeted, from within or without the project budget, to increase the total amount awarded for per them and travel above the 50 percent level. (3) Long-term training <_ Payment of stipends and cipant costs for long-tem post-doctoral support at the senior resident and post-resident levels, particularly in the clinical sub- specialties of importance in patient EXCEPTION: Stipends for training for new types of health personnel is an exception and may be supported with RMP,funds. 41 management in the diseases targeted by Regional Medical Programs Service, may not be made from operational grant funds awarded under Section 904 of Title IX of the Public Health Service Act. EDUCATIONAL TECHNOLOGY An advice letter to the Regions covering:ebe planning, equipment requirements, costs, utiliza- tion and evaluation of technblogy---for-'6ducational purposes was sent to the Coordinators in January, 1971. The theme of the letter is guidance for effective use of technology within the context of Regional Medical Program operation. 42 SELECTED REFERENCES REGIONAL MEDICAL PROGRAMS SERVICE PUBLICATIONS 1. Continuing Education Activities in Selected Allied Health and Health Related Practitioner Organizations. Allied Health Section, Continuing Education and Training Branch, Division of Regional Medical Programs, HSMHA, Bethesda, Maryland, March 1969. .2. National Conference for Allied Health Profes;-ions. Regional Medical Programs, Asilomar, California, Proceedings, April 21-24, 1969. 3. Regional Medical Programs Core Staff Activities in Health Manpower, Office of Program Planning and Evaluation, RNPS, March 5, 1971. 4,i Regional Medical Programs National Allied Health Conference. Airlie House, Warrenton, Virginia, April 26-29, 1970. 5. Selected Data, Regional Medical Programs, office of Program Planning and Evaluation, RMPS, February 15, 1971. 6. Selected Listing of Federal and Non-Federal Programs Relating to Allied Health. Continuing Education and Training Branch, Division of Regional Medical Programs, H§MHA, Bethesda, Maryland, April 1, 1969. GENERAL SOURCES 1. Allied Health Manpower: Trends and Prospects. .Harry I. Greenfield with the assistance of Carol A. Brown, Columbia University Press, New York and London, 1969. 43- 2. Health Man ower Source Book, Section 21, Alliei npowel, 0. U.S. Department of Health, Education and Welfare, PHS, NIH. 3. HSMHA Activities Related to Health M wer. Speech presented by Vernon E. Wilson, M.D., Administrator, Health Services and Mental Health Administration, at Conference on Physician Manpower, Bethesda, Maryland, January 13, 1971. 4. Manpower Report of the President. A Report on Manpower Requirements, Resources, Utiliza- tion, and Training, Department of Labor, 1970. on 6. Special Analysis, Bu United States Government, Fiscal Y cu- ments, U.S. Government Printing Office, Washington, D.C., 1971. 44 Compiled by the Continuing Education and Training Branch, Division of Professional and Technical Development, Regional Medical Programs Service,, Health Services and Mental Health Administration. Illustrations by Miss Judith Fleisher, Office of Communications and Public Information, Regional Medical Programs Service, Health Services and Mental Health Administration. 45