Hugh S. Pratt, M.D. September 6, 1979 Page 4 es, diseas s lens that ecticu prob ical ogy, wedinf tolthe Ling 1 gy, de rma in such specialties as pediatrics, gynecolo in attac and general medicine could be invaluable most cormonly plague the Marshallese. cers ies for szudents and house offi Such a program would provide unique opportunit ” cine medi tto "ghe in a form of (as well as interested faculty members) to engage y olog path of They would be exposed to ‘a broad spectrum unobtainable elsewhere. eously at UCLA, while sicultan considerably beyond what they generally encounter setting. providing adistinct public service in an unusual Further, rane . expanded to a significan in especially important if the program is soon to be large amount of. tine-consum g degree), they would free you and your staff of a ive aspects of the program. routine field work to concentrate on the investigat that the survey As the program has evolved over recent years, I have noticed general medica team has really had to perform dual functions: the provision of ion related care and the clinical detection, evaluation and treatment of radiat training by equiped best those that follow arily necess pathology. It doesn't and inclination to serve in one capacity are necessarily ideal for the other. : Sophisticated geneticists, endocrinologists and other investigators who are interested in defining the late effects of radiation are not being utilized optimally if they are burdened with large numbers of routine physical examinations, eventhough they may enjoy doing them, and I also suspect that examinations by such individuals might not be as comprehensive as those performed by advanced medical students and house staff. essential if we assume medical responsibilities for the Bikinians ard others on a routine basis. That possibility would of course mean the addition of a substantial control population to provide valid comparisons, so that annual examinations required might number in the thousands rather than hundreds. The advantage of an affiliate elective program is that it should provide a ready, reliable, and flexible pool of clinical talent. If the program is extended, we simply offer the elective to two or uore residents in a given discipline rather than one. If particular problems emerge that are deemed worthy of more intensive pursuit, we merely adjust the composition to include personnel from appropriate clinical disciplines. This is essentially what has been done in the past in recruiting physicians for the specific investigations of radiation effects, so a similar approach to the general medical care problems should be equally feasible. The success of such a program would be dependent " upon several critical points: (1) Routine field trips must be scheduled rigidly and sufficiently in advance to permit student assignments and in a manner to avoid predictable conflicts with curricula and residency training programs, such as examination periods, National Board exams, and the onset and terminus of academic years when faculty as well as students aze trainees are generally commited. (2) Mechanisms for insuring consistent followup care must be established and approved by responsible agencies. As we experienced in the Spring survey, nothing is more prortessionally frustrating than detecting Significant clinical problens in patients only to abandon them to whatever medical resources may be available after departure of the team. Diagnosis <3 awl a! “og ofp owe An elective program such as I have briefly outlined hopefully could provide the reservoir of general clinicians that I think we need to free the core personnel for the important clinical investigative aspects, a distinction that will be