Speaking before legislators, regional health system directors, higher education commissioners and other WWAMI state leaders Nov. 1 at the 1999 WWAMI Conference, UW Vice President for Medical Affairs and School of Medicine Dean Paul Ramsey outlined successes, future directions and challenges in his state-of-the-school address.

The afternoon talk helped set the stage for dialogue with attendees at a round of state-specific sessions the next day.

Describing WWAMI as a vibrant environment for experimentation, Ramsey said the program gives the medical school a greater diversity of students and learning opportunities, innovations in program structure, and an economy of scale through shared resources.

Ramsey presented several national measures of the medical school's success. In admissions, for example, the ratio of applicants for UW medical school slots is more than twice the national average. In residency placement, 96 percent of the 1999 graduates entered one of their top five residency choices. More than 55 percent of the graduates elected primary-care fields.

Faculty continue to be among the nation's top competitors for NIH grants, while maintaining the medical school's reputation as the country's leader in primary-care teaching. Ramsey also mentioned the excellent reputation that UW-affiliated clinicians have among their peers in the survey, "Best Doctors in America."

Ramsey went on to talk about the status of the curriculum review. The first phase -- the assessment of the current curriculum -- has just been completed. The Phase I report concluded, through extensive analysis and comparison with other leading medical schools, that the curriculum is sound and up-to-date. The report also confirmed enthusiasm for exploring several major areas:

1. Engaging students more in active learning without diminishing the acquisition of fundamental scientific knowledge
2. Enhancing students' clinical and analytical skills development
3. Designing ways to continuously improve curriculum content and management
4. Helping faculty grow as educators
5. Addressing several specific content issues

A goal of medical education is to prepare students to meet the changes ahead in their practices. Ramsey reported that interviews with students, department chairs and WWAMI physicians lead to a consensus on changes that can be expected in 21st century medicine. These include dramatic changes in the scientific foundations of medical practice; increased patient access to accurate and inaccurate health information, mainly through the Internet; a broader and more diverse health-care team; and continued pressure to control health-care costs.

The dean concluded with information about the effects of the Balanced Budget Act (BBA) of 1997 on medical schools and teaching hospitals if Medicare provisions of the Act are not revised. Academic medical centers are disadvantaged because Medicare reductions in the BBA include direct graduate training costs and indirect medical education expenses. Reductions in these payments, coupled with reduced Medicare payments overall, will have a severe impact on academic medical centers and teaching hospitals generally.

The WWAMI region is more vulnerable to these effects because of its fiscally conservative practice profile. The region has a lower-than-average use of hospitalization, and lower-than-average cost per unit of service. The across-the-board reductions of the BBA would penalize good stewardship of Medicare resources.

The UW, along with academic medical centers and hospitals throughout the nation, seeks a freeze on the implementation of the BBA. If such a freeze goes into effect, the UW would then strive for Medicare funding solutions that recognize those institutions that are doing an exemplary job of keeping costs under control.

Ramsey closed by thanking the legislators and other leaders for their commitment to working together to sustain WWAMI as a strong, creative partnership.

The WWAMI Conference is held to keep legislators and public officials from the school's partner states informed about the regional medical education effort. This annual report is a tradition of the WWAMI Program.