The authority for this program is contained in section 301 of the Public Health Service Act with an indefinite authorization for 1971.

Research to improve nursing practice is an integral part of the total field of health sciences research. Research in methods of improving nursing services is concerned with all aspects of health services including direct care of patients, with the settings in which services are given, with the education and the characteristics of the nurse herself. The results of such research influence the education of nurses through improvement of curricula and the initiation of improved and new training methods. For example, more information is needed on the effects of the nurse and of the nursing procedures as she provides care and health services to people, and on the effects with different patterns of nurse staffing and services particularly the expanding role of the nurse. One nursing research grant has demonstrated that the professional nurse can serve as the primary source of care for large numbers of adult chronically ill ambulatory patients, heretofore exclusively a function of physicians.

Another project has shown that professional nurses, given additional experience and training in pediatrics, can relieve the pediatrician of up to 60 percent of his present activities thus allowing better utilization of his diagnostic-therapeutic and preventive expertise. Several research grants are providing for investigation into a variety of hospital settings which impede or facilitate the professional nurse in the use of her professional skills and knowledge. (These studies are of particular importance in the modification and development of nurse educational and training programs.)

Practicing nurses and nursing students must learn and know how to apply the results of research in all health service settings. Developments in physiology and pharmacology and other scientific medical disciplines can affect nursing care substantially and must be incorporated into nursing practice and nursing education. Research projects underway are studying the potential of biological research in nursing and more specifically, studies of peripheral circulation as it relates to nursing care. Many of these projects are interdisciplinary with the nurse, the physician and the technologist working together to develop better methods of education, training and prevention and cure of illness.

The Statutory Program Review Committee emphasized the need for more research into all aspects of nursing practice and education, and the communication of research findings. If research is to be translated into improved services in a minimum amount of time, projects must be designed to carry the research to a point where results can be communicated effectively for incorporation into practice.

The $2,455,000 for 1971, the same level of funding as in 1970, will support approximately 46 projects.

The authority for this program is contained in section 301 of the Public Health Service Act with an indefinite authorization for 1971.

More nurses must be prepared in depth in the biological, physical and behavioral sciences and in research methods to design and carry out projects to improve nursing care and practice and collaborate in the increasing amount of multidisciplinary research.

Colleges and universities need increased financial support in order to strengthen and expand their doctoral programs in the basic sciences and to make training opportunities available to nurses in these highly competitive fields. Research training grants provide this institutional support as well as stipends for nurses admitted to these programs.

Nurse scientist training grants are assisting eight universities in providing nurses with graduate education in 34 departments of the universities. These grants make it possible for more nurses to be prepared in such fields as anthropology, microbiology, and sociology; thereby, bringing this knowledge to studies for improving nursing services.

Funds requested in the amount of $700,000 in 1971 are required for the continued support of the eight grants begun in prior years.

These funds are available for initial committee review of research construction grant applications including those submitted under the multipurpose provision of the Health Manpower Act and for post review evaluation of projects previously awarded.

The mission of the Division of Physician Manpower is to encourage national programs that increase the quantity and quality of physician manpower in the United States. To implement this mission, the Division has formulated realistic objectives for their program of direct operations as follows.

Program Plans for 1970 and 1971

Physician Education

This program is designed to encourage and develop new materials and methods to increase the number of physicians graduating from medical and osteopathic schools without decreasing the quality of physician education. The problems of medical education are complex and require planned progressive study.

Some projects being developed in 1970 include: (1) A study to develop criteria for the use of community hospitals as teaching centers for medical and osteopathic students; (2) the use of self-instructional techniques, i.e., computer assisted instruction; and (3) the feasibility of developing two-year schools of basic science to serve as a source of students to fill spaces available from attrition in the last two years of four-year schools.

Other on-going programs will study how more and better trained faculty for medical and osteopathic schools may be developed, how existing and future teaching facilities may be more efficiently utilized and stimulating general utilization of modern management techniques in the administration of medical and osteopathic schools.

Approximately 150 special project grants applications were reviewed and processed in 1970. Thus far, 29 of these applications were for the new initiated Physician Augmentation Program. In 1971 an estimated 250 special project grant applications, including the Physician Augmentation Program, will be reviewed and processed.

A program increase of $50,000 for contracts is included for the studies mentioned above. An increase of one position, a deputy branch chief (physician), is requested to carry out the essential staff work in this program area. Physician Resources

In order to utilize available physician manpower in the United States more effectively, it is essential to develop and maintain a continuing record of the supply and distribution of physicians by geographic area and specialty. This information will serve as a base for studying the effectiveness of the physician in providing health services.

National needs for physician manpower must be continuously projected by assessing supply and requirement trends. In addition, the impact of socio-economic, environmental, technological, and medical research and practice factors on requirements and supply potential must also be studied and evaluated.

In 1970 and 1971 we will continue to participate in the collection of resource requirements data on schools, students, graduates and physicians for the Bureau, NIH, and the Department integrated manpower reporting systems.

Through the dissemination of the information collected, we are serving as a clearinghouse for information concerned with the supply, distribution, and availability of the Nation's medical and osteopathic schools, students, graduates, and physicians.

Statistical studies are being conducted to evaluate distribution, capacity, and resources of schools; the number and distribution is evaluated by age, race, sex, and other characteristics of students and graduates. A survey of all medical and osteopathic students has been designed to gather a broad spectrum of socioeconomic data and to evaluate how these students finance their education, including an evaluation of what effects Federal programs have provided in recent years. That study, "How Medical and Osteopathic Students Finance Their Education," will be published during fiscal year 1970.

Further plans include the development of techniques to make opportunities to enter the medical profession more available to students from the disadvantaged groups and recommendations to increase the output of medical and osteopathic school graduates.

In 1971, with the increase requested, the program can pursue various highpriority projects including the development of an analytical model for the evaluation and projection of physician manpower needs, demands, and resources. A study concerning the migration of physicians is urgently needed since little definitive information exists on that subject.

A program increase of $100,000 in contracts is for studies outlined above. 1970 one additional position, a statistician, is requested to carry forward and expand this essential element of the total physician manpower effort.

Continuing Education

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The practice of medicine, more than any other profession, is complicated by the rapid advances in medical knowledge and the resultant continuum of modifications to medical theories, practice, and health care systems.

The practicing physician finds it difficult to fit into his crisis-oriented schedule the continuing education demands of his profession. Urgently needed are new ways to assist the physician in keeping abreast of new medical information while providing medical services to his patients.

Continuing medical education takes many forms from journal reading to audiovisual educational devices. Regardless of the medium selected, there is a growing necessity to establish and support the environment and system that will stimulate and assist the physician in his efforts to fulfill his educational needs.

Specifically, it is our intent to study the dynamics of the problems of continuing education, to analyze factors in physician participation; to evaluate new and modified methods and techniques in continuing education; and to explore other relevant variables that affect continuing medical education in various settings.

Significant achievements in 1970 include the development of a model program of continuing education for non-hospital-affiliated urban physicians, which has already sustained considerable popularity in New York City; completion of initial investigations into the effectiveness of several new approaches toward meeting the educational needs of practicing physicians including development of a program for

physicians in an urban black community; and development of a preliminary model of preceptorship-home study courses for rural practitioners in the techniques of anesthesiology.

Professional Activities Branch

In order to arrive at more reliable manpower projections, and in order to encourage the development of education and training programs which are geared to the service functions health professionals render, the influence of certain variables on physician performance must be evaluated. The variables include such items as health status and demands of the population, physician and population ¦ mobility, availability and accessibility of other physician and education resources.

A series of studies initiated in 1969 and 1970 are designed to document the influence of patient demand for medical services in urban, suburban, and rural locales on the type and the number of physicians needed. Medical educators involved in the studies will evaluate results and determine the type of changes which are indicated in medical education. Studies to be initiated in 1971 will define the effect of patient mobility on physician manpower requirements.

A study initiated in 1970 will analyze the tasks involved in the practice of family medicine in order to identify the levels of proficiency required and develop a model which may be used by medical schools to modify training programs for the primary family physician.

Two types of model studies of physician manpower distribution and need will be developed in 1970. One of these will be directed toward a model plan for evaluating national distribution, components of practice, tasks and attitudes toward task delegation, components of training, and needs for additional manpower of a particular medical type. These studies are related to the planning and modification of educational and training programs for physicians.

Beginning in 1970, a series of studies will be initiated to evaluate the effect of new knowledge technology on physician proficiency. This will includes support of a study to define components of physician proficiency, taking into 1 consideration the training needs as well as level of knowledge and numbers of patients served.

In 1971, a contract together with a Division study to evaluate physician : mobility and the factors influencing mobility will be initiated. A series of contract and in-house studies concerning the training and use of physician's assistants is being initiated in 1970 and is projected in 1971.

An increase of $50,000 in contracts is for the studies mentioned above. In 1 order to further implement the professional activities effort on the physician manpower program, one additional position, doctoral level sociologist, is required.

The increase of $281,000 includes $239,000 for three positions and contract funds for program increases as described above, $1,000 for annualization of the 1970 pay increase, $9,000 for within-grade increases, $1,000 for increased costs of using the Federal telecommunications system, and $31,000 for centrally furnished services from the National Institutes of Health.