THE DEVELOPMENT OF A MEDBCAL SECRETARIAL CURRICULUM AT NORTHWESTERN MlCHIGAN COLLEGE Thai: for tho Dog!» cf M. A. MICHiGAN STATE UNWERSITY Jacqueiino krone Tompkins 1958 L I BR A R YQL Michigan Stan University THE DEVELOPMENT OF A MEDICAL SECRETARIAL CURRICULUM AT NORTHWESTERN MICHIGAN COLLEQ THESIS Presented in Partial halfillnent of the Requirements for the Degree Master of Arts in the Graduate School of Michigan Stete University JACQUELINE IRENE TCHPKINS, 3.3. Michigan State University 1958 Approved by: I Al.‘ -1 [I .4 .4 14:1,. / . . . ”a..- / I; vieear G {.1} fax 3:3 $‘—/i" L 9 ACKNOWLEDGM'N TS The writer expresses sincere appreciation for the guidance and encouragement of her advisers, Dr. Lyle Maxwell and Dr. Mary Virginia Moore, throughout the development and completion of the study. Special acknowledgment is also due Miss Pauline Baver for her valuable criticisms and suggestions related to the study. Dr. Frank Power was the originator of the idea of Medical Secretarial Training at Northwestern Michigan College. His interest in the program, continued assistance, and valuable criticisms are especially appreciated. It would be impossible to express appreciation to each person who assisted in some way in the development of the Medical Secretarial Curri— culum at Northwestern Michigan College; however, the writer is grateful for the continued interest of Mr. Preston Tania, Mr. Ernest Gaunt, Dr. T. N. Cline, Dr. Warren Cline, Dr. Richard Thirlby, Dr. Robert Lossman, Mrs. Willa Flynn, Dr. Bernard Sweeney, Dr. Marcus Shaffer, Dr. Barry Waits, Mrs. Jean Jacobus, the doctors and medical secretaries in Traverse City and the laboratory and X-ray personnel at James Decker Manson Hospital. J.A.T. ii TABLE OF CONTENTS Chapter I. THEPROBIIEMassessessoosseeosses BackgroundoftheProblen............ DelimitationofProblem............. Inporta-DCGOfStUdyossosessssasses II. PRELIMINARY INVESTIGATION . . . . . . . '. . . . . Medical Society Endorsement of Program . . .. . . Survey of Beginning Salaries in Medical Offices DTraveraeGity............... Beginning Salaries in Sixty Offices in TranrsoCity................. “Vino” cmtue O O O O O O O O O O O O O O 0 III . CWCULUM DEWMNT . O O O O O O O O O O O O O 0 IV. STUDENTDATAANDFOLLOU'UPseeoesseseoso Student Follow-up . . . v. PUBLICITY O O O O O O O O O O O O O C O O O 0 O O 0 v1. SUMMARY, CONCLUSIONS, AND RECOMMENDATIONS 3mm 0 e e e s e a o e s e e e e e s e s s e e concIUS1on3 e o e o e o e s e e o e e s e s e e o Recommendat iona e o e s e e o s s e e s s o o o s BBLIW O O O O O O O O O O O O O O O O O O O O O O O 0 mn A O O O O O I O O O O O O O O O O O O O O O O O O 0 Letter to Schools Asking for Curriculum Information . . Letter to Schools Thanking Them for Curriculum Information Letter to Participating Physicians Explaining Observation Program........................ APPENDIXB000.000.00.000000000000000 course Fraquency T‘ble o o a e o e s ‘PPENDIX c O O O O O O O O O O O O O 0 Medical Secretarial Reference Books Medical Shorthand Reference Books . Medical and Clinical Reference Books Nursing Arts Reference Books . . . . Supplementary Reading References . . Vim Aid! 0 O O O O O O O O O O 0 iii 0 O O O O O O O O O O O O O O O O O O O O O . O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O 0 536‘ t" 1115' sou-nu g |-‘ O\ Figure I . II. III. IV. V. VII. VIII. LIS‘I.I CF FIGURES Medical Secretaries' Observation Schedule During Sprinng,l956-57eeeeeee'eeeeeeeee Date, Speaker, and Lecture Tepic; Medical Secretarial Trming,l956-57................. Date, Speaker, and Lecture Topic; Medical Laboratory Procedures, Winter Tam, 1956-57 e e e e e e e e e e Traverse City, Michigan Medical and Hospital Personnel Who Participated in Medical Secretarial Training, 1956-57oeeeeeeeoeooeooeeeeoee Duties Performed by Five Students Now Secretaries in Mad—13‘]. Officea, September, 1957 e e e e s e e e e 0 Medical Secretarial Students in Various Stages of the Training Program, 1956.57 e e e e e e e e e e e Medical Secretarial Students in Various Stages of thQTrainj-ngprogm,l956-57 eeoeeeeeeee Medical Secretarial Students in Various Stages of theTrainingProgram, 1956-57 . . . . . . . . . . . Medical Secretarial Program Listed in 1957-58 College Catalogue..................... iv Page 23 25 31 33 34 35 CHAPTER I THE PROBLEM This study was concerned with the development of a Medical Secretarial Curriculum at Northwestern Michigan College, Traverse City, “10111ng BACKGROUND OF THE PROBLEM Laverne 9.1401. flatness Traverse City, Michigan,is a mall city in northwestern Michigan in the lower peninsula. It is situated between two arms of Lake Michigan which are called East and west Grand Traverse Bays. A Chamber of Commerce Surveyl placed the population at 18,5m in 1957. According to the 1950 ‘ official census the population was 16,971.. Until the turn of the century, Traverse City was a lumbering center in northern Michigan. Its people found employment in the lumbering camps and samills in the area. When the timber ran out and the sawmills were closed, the inhabitants of Traverse City sought other means of swing a livelihood. The sandy, loamy soil of Old Mission Peninsula was found to be especially suited to the raising of cherries. General farming and the raising of fruit provided employment for thousands of l’rrazgrse City 9mg; 9;, Qommercg m Census, 1957-58, a bul- letin of the Chamber of Comerce, Traverse City, Michigan, (Mimeographed) . 2 people. Thousands more were employed when the first fruit processing plant was opened in 1912. The townspeople now find their chief employment in resort trade, agriculture (primarily the raising of cherries and apples), fruit processing, manufacturing, retail and wholesale distribution, and medi- cine with its related practices. Traverse City is rapidly hecming known as a medical center in northern Michigan and benefits from the practice of seven general prac- tioners and thirty specialists. These physicians employ fifteen regis- tered nurses, four practical nurses and nineteen medical secretaries.2 The State Mental Hospital (3,000 beds), the Osteopathic Hospital (34.beds), and James Decker Manson Hospital (182 beds), all located in the city, together employ an additional fifteen medical secretaries, stenographers, and typists.3 .Traverse City, Michigan is a small city that has experienced good times as well as had. The people of Traverse City, however, display unusual creativity in utilising natural and human resources for the benefit of their community. Cooperation is a keyword, and it was this spirit of cooperation and continued interest that’made the founding of a community college possible and that gave impetus to this study. 2Marcus Shaffer, 'Survey of Practicing Physicians and hployees in Related Practices in Traverse City, Michigan' (unpublished manuscript, July, 1956). 3:14.. The people of this area have known periods of prosperity and suffering, of uncertainty, and of hope, and have shown themselves capable of creating work and opportunities for themselves. This was particularly true in the transition period when the lumbering industry declined and a new economy had to be found. They succeeded in establishing a strong and prosperous fruit and resort industry which promises to equal or surpass the prosperity in evidence during the heights of the lumber industry. It is these same people or their descendants who have worked and struggled together to found Northwestern Michigan College. Their initiative and determination are emphasized because they are, without doubt, one of the few peoples who from Igrass roots" beginnings have dreamed, planned, and establiShed a community college. it is a story unique in the history of Michigan education. Eatihlssiszadhishissa.9211282 Herthwestern Michigan College opened its doors to sixtybfive students in 1951. By 1956 the enrollment had increased to two hundred fifty students. Approximately 66 per cent of these students live in Grand Traverse County and 22 per cent are from.the surrounding four counties (Leelanau, Antrim, KalkaSka, and Bennie) which aided initially in raising funds fer the establishment of the College. The College strives to ful- fill its responsibility to these communities by providing liberal educa- tion and by expanding its curriculum in areas where there is evidence of a need of justifiable post high school training. , The purpose of Herthwestern Michigan College is to bring liberal and vocational studies on the college level to people of all ages in northwestern Michigan. Regionally controlled William J. Valade, in Study of the Origin, Development, and Trends of Selected Community Colleges of Michigan“ (unpublished Doctor's disser- tation, Mayne university, Detroit, Michigan, 1956), p. 99. and supported, this institution is shaping its future around the needs of the area it serves. The College proposes to serve (1) students who wish to begin a liberal arts or pre- professional program, (2) students who wish to complete a two-year course combining general and vocational studies, (3) part-time students who wish to develop particular skills or cultural interests with or without acquiring college credit in the process. The purpose of the College is also to serve as an educa- tional and cultural center. It carries out these aims by providing leadership, technical aid, and facilities for groups engaged in community service, research, or cultural develop- ment by encouraging other Michigan schools to operate college extension courses on its campus; and finally, by standing ready to offer its own courses and services at off ampus points throughout the region when such needs arise. Mhny students who attend Northwestern Michigan College do so because limited finances prevent their attendance at other institutions of higher learning, and others prefer to attend school in their home community and eventually find employment there. Approximately two-thirds of the students come from.families whose incomes are under $5,000, and it is logical to assume that a number of students would not engage in post high school training if they were forced to bear the additional expense of living away from home. Egg Need £9; Medigal Secretarial Training From the time the college opened in 1951, a number of students in the secretarial curriculum at Northwestern Michigan College indicated to their instructors their desire for additional secretarial training in the specialised field of medicine. One of the major factors influencing 5Northwestern Michigan Collegg Catalogge, 1956-57, p. 8. their preference for the specialized training was their desire to be associated with the service of nedicine. Minstion of college cats- 1ogues indicated that few schools in Michigan listed the type of training the students wanted, and tilt the necest school was one hundred miles from Traverse City. An effort was node to provide training for the students by adding nedical shorthand books to the College library and by nedical dictation given by the regular shorthand teacher. In adult education class in shorthand was offered in which nedical dictation was given, and interested students were encouraged to use nedical shorthand textbooks. Physicians in the omnity had, from time to tine, voiced an increasing need for trained medical secretaries in tlnir offices to relieve the registered nurses of their clerical work and routine-assisting duties and to replace the fluctuating supply of in-servi ce trained medical secretaries who frequently left their jobs (ordinarily for such reasons as narriage and premcy) at the very tine that they had beoone valuable to the practice. It and apparent that training fer medical secretaries at the college level was desirable, and in March, 1956, Dr. Frank Power, a Isnber of the Grand Traverse, Bennie and Leelanau Counties Medical Society who was also serving as mayor of Traverse City at that tine, was consulted by the investigator. Dr. Power was asked fer suggestions relative to specialised training that the business instructors at tb College might give students who were interested in becoming medical secretaries. He 6 showed keen interest and, after a considerable amount of reflection, posed the question of offering a medical secretarial training program.at the College. This would be dependent, of course, upon the endorsement of the administration and the cooperation of the physicians in the area. Tele- phone calls made by Dr. Power to other physicians in the city to note their immediate reaction to such a plan resulted in votes of confidence. After discussion with representatives of the medical profession, the Director of the College was asked for his opinion concerning a cur- riculum which would provide for the training of medical secretaries. The Director, who was aware of the interest of students in such a program, agreed to work with Dr. Power and the investigator in a preliminary analysis of the problem. The procedures that were followed in the preliminary investigation, development of the curriculum, and carrying out classroom activities are discussed in Chapters II and III. Administrative and instructional difficulties which were encountered, and recommendations for other institu- tions interested in establishing medical secretarial training programs are discussed in Chapter VI. DELIMITATION CF PROBLEM The problems involved in establishing a Medical Secretarial Training Curriculum at Northwestern Michigan College at Traverse City, Michigan, were peculiar to the sire of the school, its staff, facilities, and existing curriculum, as well as to the facilities afforded hy interested local.nedical personnel. The enrollment in the course was expected to '7 be small. (hly essential specialised courses could be added to the already full schedules of the two College business teachers who participated in the program. Local physicians indicated their willingness to cooperate in the planning and instruction of the program, thus eliminating the need to involve College biology personnel or to purchase costly equipment until the time that the enrollment in the progru would Justify the expenditure. IMPQTANC! Cl" STUD! A Community College serves its people by providing education and by expanding its curriculum in areas where there is a justifiable need. The basic objective of Northwestern Michigan College is to bring liberal and vocational s’mdies on the college level to people of all ages in northern Hichiganf’ This particular institution is shaping its future around the needs of the area it serves. More and more effort is being aade to extend the college field of service to adults of the area who want training to enable them to effect adjustments to conditions of modern life.7 With medical care being made available to more and more people, the demand for medical secretaries is increasing and is evidenced throughout Wmmm.m.ma 7Preston Tania, "Northwestern Michigan College“ (Traverse City: Histay, Program, and hrollment Trends and Expectancy of Northwestern Michigan College, 1956). p. 2. (Kinsey-spied.) 8 the country.8 Physicians have increasingly realised in recent years the importance of good public relations and efficient business methods in connection with their aedical practices.9 The belief is held by my physicians that a physician can reduce his work load per patient by dele- gating certain activities in his office to preperly trained personnel.]'0 A recent study made by Dr. Harold Mickelson of Northeast Missouri State Teachers College, Iirksville, Missouri, with the cooperation of the American Medical Association, amplified the interest of the A. M. A. in providing a basis for the development and improvement of the educa- tional'prograns in schools for the training at a high level of secretaries for plvsicians' offices.1l All schools, particularly commity colleges, should be interested in serving the needs of their connunities and students. Business educa- tors and medical personnel are concerned with developing programs for training medical secretaries. Such progress as those identified below are indicative of this concern. Dodge Vocationfl. High School in New York is pioneering in a york-study progrm for medical assistmts on the high school level. The reactions on the Imrt of physicians, hospitals, sum-91 n. Cook, Ire. Medical Secretary," Northwestern University SmerCatalogae (Chicago: 1955), p. 2. 9Barold Mickelson. "The Medical Seoretmy.‘I Preface by Leo B. Brown. A brochure published by the herican Medical Association from a Doctor 's dissertation, Northeastern Missouri State Teachers College, Kirksville, Missouri, 1957. ”his. “use 9 and other employers have been highly favorable.12 Highland Park Junior College offers a oneqyear medical program I'which provides an execllent opportunity for adults as well as students who can't afford the time or money for a fouriyear training program. This programLuhich was launched in 1951 is rapidly gaining prestige on both the national and international level."13 Green Mountain Junior College, Poultney, Vbrmont, is now in its twelfth year of training medical secretaries. Doctors were consulted by Dr. Evangeline Merkwick in the development of the curriculum for medical secretaries at Green Mountain Junior College.14 Medical Secretarial Training had a "grass roots beginning“ in Traverse City. The program evolved from the need of physicians in the community for trained medical secretaries and the desire of students to become medical secretaries. very little information concerning the subject was available prior to the establishment of the program. It is hoped that this study concerning the procedures followed and the diffi- culties encountered in the organisation of the curriculum.at Northwestern Michigan College will prove helpful to institutions who are interested in developing comparable programs. JJenn-on Buchwald, “High School Yields Trained Assistants for MDs," Scopg fleeklz, November 28, 1956, p. 14. 13Corinne Smith, dMOds-Afledical Office Assistants Solve Doctor's Dilemma,I The Detroit Times, March 24, 1957, p. l. v14nvangeline Markwick, 'ThelMD's Criteria for His Aide-—and Her Own,“ dam Heath. January 30, 1957, p. 1. CHAPTER II PRELIMINARY INVESTIGATION A preliminary investigation was conducted by the writer and local physicians before any plans were made regarding the proposed program. The investigation related to: (1) course content of similar curricula at other colleges, (2) endorsement of the program by the (hand Traverse, Bennie, and Leelanau Counties Medical Society, (3) starting salaries for medical secretaries in Traverse City, and (4) starting salaries for secretaries in business offices in Traverse City. more: 2: arms mo ms Catalogues from institutions offering training for medical secre- taries were examined. The programs of seven junior colleges were smdied because their sin was comparable and their programs were similar to that of Northwestern Michigan College. (b April 17, 1956, a letter requesting course descriptions and textbook lists was sent to seven schools, namely: Bay City Junior College, Bay City, Michigan; Everett Junior College, Everett, Washington; Gray's Harbor Junior College, Aberdeen, Washington; Flint Junior College, Flint, Michigan; Ferris Institute, Big Rapids, Michigan; Highland Park Junior College, Highland Park, Michigan; and Jackson Junior College, Jackson, Michigan. All of the schools with one exception answered promptly with the requested information. Typical comments included: "The difficulty of the medical secretarial training may limit the sise of the enrollment." 11 “Small enrollment may prevent offering specialised technical classes.” 'Chly top secretarial students should be permitted to enroll in the program,‘ and ”The prey- should be carefully planned if it is to be successful.” A letter was mailed to these schools on May 11, 1956, thanking them for their cooperation. The course descriptions which were obtained were checked for the content and the textbooks used. Individual courses of stub were checked for similarity of subject matter, and then were condmsed into a Course Frequency Table. This Table, individual courses of study, and course descriptions were duplicated for future use in curriculum developmt. The Course Frequency Table appears as Appendix B. MICAL SOCIETY WM or PROM At a regular meeting of the Grand Traverse, Dennis, and Inelanau Counties Medical Society on April 3, 1956, Dr. Power discussed the proposed training program and asked the mnbers if they would cooperate in its development and in active participation in web a prograa. The members endorsed the proposed progru and appointed a committee of three physicians to work with the writer in further investigation. scam C? WINNING SALARIES IN MEDICAL MICE IN mm CIT! In an attupt to determine the possible financial reward to students participating in additional technical training, one of the members of the medical cmittee canvassed local physicians to determine the salary paid to medical secretaries. Although there was no positive agreaseut, 12 most of the physicians felt that they would be willing to start a college-trained medical secretary at a salary of $55 to $65 per week with substantial merit increases after six months. The maximum salary a medical secretary could earn would depend upon the length of service and the initiative of the individual. BEGINNING SALARIES IN SIXTY CFFICES IN TRAVERSE CIT! According to a Wage Survey of sixty fires in Traverse City, the maxim weekly salary for secretaries was $82.43.l No figures were included in the Survey for beginning secretaries; however, college placement follow-up studies indicated that the salaries. most commonly paid beginning college-trained stenographers and secretaries were {rm 350 to $55 per week and that students were frequently employed at a beginning rate of $1 per hour. ADVISQU COMM A meeting of physicians, and school personnel was held at James Decker Henson Hospital in June, 1956. The purpose of the meeting was to discuss the results of the preliminary investigation and to answer the following questions: (1) Was a medical secretarial program needed in Traverse City? (2) Has it practical to offer such a program? (3) If such training was both needed and practical, how could it be taught with a minimum of financial outlay for teaching staff and equipnent? 1Michigan Bell Telephone Company 1956 Wage Survey, (Detroit: 1956.) (MimeographedJ 13 Eight people representing the College and the Medical Society met for the first time in June, 1956, to discuss the possibility of develop- ing a grogram for medical secretaries. The College was represented by the Director and Assistant Director of the College, the College Business Manager, and two College business teachers including the investigator. The physicians in the conunity were represented by the medical committee of three doctors who had been appointed in April, 1956. It was decided that Medical Secretarial Training was needed in the ctmnunity and that it could be practical if the program were carefully planned. The individuals to attended the planning meeting agreed to be known as the Advisory Omittee for Nedical Secretarial Training and to share the responsibility of planning the progrn. The curriculum was to be developed by the currimlun comnittee at the College. The investigator was a muber of the curriculum oo-ittee. This committee would also handle catalogue publicity and determine course credit. The Business Departsent was given the reeponsihility of examining and selecting books to be used in the courses and the responeihllity of starting a reference library. The physicians agreed to detenins tlm medical contut of the program which tlmy and other city physicians would instruct in evening lectures. These lectures were to be closely correlated with the pogr- set up by the College. In order to acquire an understanding of the technical subject matter to be covered in the program and to appreciate its dif- ficulty, the investigate: and the second College hminess instructor 14 planned to attend all of the evening lectures and go through the labora- tory training with the students. The Committee agreed that medical Secretarial Training should be one year in length. and that a certificate should be awarded to those students who successfully completed the year's training. It was decided that students who enrolled in Medical Secretarial Training would follow the course requirements for a two-year secretarial program as defined in the College catalogue and that specialised medical classes could be taken in lieu of elective business subjects. The program would be on a trial basis during 1956-57, and if it proved successful, would be included in the school's course of study. Until that time, the College catalogue would not list a definite program, but would include the following notation: A.Medical Secretarial.Progran will be available to secretarial students beginning in the Fall Term of 1956. Students interested should consult with advisers regarding the subjects to be chosen to meet the specific requiruents of the program.2 It was agreed that.nedical equipment and reference books for the progran.would be borrowed from.private practices in the city and the facilities of local doctor! offices as well as those of James Decker Munson Hospital would be utilised whenever necessary. Two transcribing units and one dictatingbtranscribing unit at the College Business Depart- ment would be used for case history and letter transcription, and any when 592011—1139 Eel-SL222 m. iii-.51. Po 22- 15 other expenditures for the progru would be carefully evaluated before approved. Advisory Committee meetings would be held periodically during the year to evaluate course content and instruction and to make changes in procedure whenever necessary. CHAPTER III CURRICULUM DEVELOPMENT Msééssl §22£22££l£l.2:§l2$£fi.2:23!!! A definite program for.Medical Secretarial Training was not listed in the College catalogue for 1956-57; however, using the Course Frequency Table (Appendix B) as a reference, and the minimum budget as a yardstick, the following required subjects were offered. 3 Terms Medical Dictation and Transcription 1. credit hours 3 Terms Office Procedures 2 credit hours 3 Terms Medical Office Procedures 2 credit hours 1 Term Medical Laboratory Procedures 2 credit hours It was decided that Medical Dictation and Transcription, Office Procedures, and Medical Office Procedures would be taught as regular day classes for three terms at the College; and Medical storstcry Procedures would be taught by laboratory personnel of the James Decker Munson Hos- pital and local physicians in a series of ten 2-hour lectures. These lectures would be conducted at the Hospital. In addition to the lectures, students would spend thirty hours at Munson Hospital, under the super- vision of the Supervisor of the XéRay Department administering Electrocar- diograph and Basal Metabolism tests to each other and practicing routine laboratory tests under the supervision of the Head Laboratory Technician. Eortflgstern W College Course Qntent The Medical Secretarial Training Program at Northwestern Michigan College in 1956-57 consisted of three specialised classes: (1) Medical 1'7 Dictation and Transcription, (2) Medical Office Procedures, and (3) Med- ical Laboratory Procedures. Each of these courses was offered for the first time in 1956-57. Catalogue descriptions of the specialised classes appear below: c Elefition 33; W. Parallels Dictation and Tran- scription with special aphasia on medical dictation for students pre- paring to be secretaries in medical offices, hospitals and other institu- tions. 3 terms, 1. credits, 5 hrs. per weds. M m W. Parallels Office Procedures2 aiming to give students practical wrking knowledge of desirable procedures and attitudes for medical offices. 3 terms, 2 credits, 2 hrs. per week. w laboratog W. Designed to train medical secretarial students in the basic procedures of laboratory work and to prepare them in certain techniques that will be useful to medical assistants. Lectures by members of the medical profession. 1 term (Winter), 2 credits, 2 hrs. per week. More; mas—ht tic 5% W This course was taight by the regular Dictation and Transcription teacher. The medical diorthand students not as a separate class three hours per week. Because the small enrollment in Medical Dictation and Transcription did not justify a separate transcription period, medical shorthand students met with the Dictation and Transcription students for two hours, one day each week fer transcription. The text used for the medical secretaries was Dictatiop Lo; _t_l_1_g M m by Berger and Byers, with supplementary materials taken W signer Mlle Mule ., 12m. pp. 29-30. 2Ibide, Pe 29s 18 from M' ”2-9.2; Handbook by M. Roberts; IE Megcal Stenogaphg waiter; muommmmmww Effie B. hither. Standardised five-minute takes were given from the Masha leashes. 39.222912 Mum and missed 21.....notauo . The textbook used for Medical Dictation included the following subjects: Physical Medicine, Physical Therapy, Occupational Therapy, Corrective Therapy, niucational Therapy, and Manual Arts Therapy; General Medicine and Internal Medicine; Cardiology, Gastro-Bnterology, hdocrinology, Dermatology, Pediatrics and Paraplegiology; Surgery; Technical records and fume used by private plvsiciaus and by hospitals. At first the instructor spent time previewing the highly technical vocabularies, but with so much textual material to be covered in the one-hour class period, most of the preview of vocabularies was left as the students' responsibility. There were often short vocabulary drills with special emphasis on correct spelling and definition, and little concern with the exact shorthand outlines as they were written in the texts. Many discrepancies were found in the shorthand outlines of medical terms as they were found in the various texts—thus the tendency to put minor stress on exact copies of those found in the texts. For the final exuination students were required to write in short- hand, transcribe, and define one hundred medical terms. In addition, two 5-minute medical dictations were given for transcription. l9 {yggical Q§§i22_2;ocedgggs This course was taught by the investigator who also taught Office Procedures. Special evening lectures which are described later were correlated with the subject matter covered in Medical Office Procedures. The text used was the Handbook £93.Medical §§cretaries by'Miriam Bredow. Supplementary readings were assigned from Letters 32 g Doctor'g figgggtggy by Anna Davis Hunt, yggggl £9; h sician ' 92;;93 Attendants hy Gotten and Sprunt, Th9 Medical Secretggz by Morse, and periodicals which are described in Appendix C. The course included: a critical analysis of the personality of a medical secretary, her responsibilities to the doctor and to the patient; practice in scheduling appointments by telephone, in person, and by letter; procedure in handling fees; procedure in handling bills, pay- ments, and collections; medical insurance; filing procedures; medical assisting, chaperonage, the principles of sterilisation; office manage- ment, medical bodkkeeping; incoming and outgoing mail; procedures in working fer specialists and hospitals; nurse's arithmetic related to weights and measures; care and use of the microscope; motion and time economy in the office and examining rooms; and transcription of case histories, autopsy reports, and letters from.transcribing machines. Students' assignments included one case history and vocabulary prac- tice from transcribing units each week. Two Dictaphone belts containing special case histories for medical secretaries were obtained from the Dictaphone Corporation, and the remainder of the case histories, reports, 20 as well as legal testimonies, were dictated by the investigator and the second business teacher. A Comptometer dictation-transcription unit was used for this purpose. Medical bookkeeping was discussed in one evening lecture by a representative of the Professional Management Service of Traverse City. This state-wide organisation is camissioned by office managers, including plwsicians, to analyze their office procedures and to set up filing and bookkeeping systems. The representative developed a medical bookkeeping practice set for Northwestern Michigan College which was expanded, duplicated, and used by the students as a part of their class work. Students encountered considerable difficulty in studying technical medical and laboratory procedures because simplified texts and reference books were not available for this purpose. Therefore, the students compiled notebooks for their future use which included their notes from evening lectures and materials distributed to them in their special classes. These notes were transcribed, outlined, and checked for accur- acy. They were later duplicated and made into a syllabus which would be used as a reference for the instruction given in 1957-58. Medical equipment and trays of instruments were borrowed from local physicians for classroom demonstration. The students concluded their classroom training with ten hours of observation in selected doctors' offices during the spring term. A vari- ety of specialties were observed by the students who visited the offices 21 of: a Urologist, a Surgeon, an Internist, an Obstetrician, and an Opthal- mologist. A letter explaining the observation program (Appendix A) and a copy of the observation schedule, shown as Figure I, page 22 were taken to each of the participating doctors. The purpose of the observation program.was to familiarize the students with actual physician-secretaryb patient relationships and to observe how procedures may vary in medical offices. Evening Lectures by Physicians Evening lectures were held during the fall and winter term at the College and at the offices of two physicians. The content of these lectures was determined by the physicians who had full responsibility for presenting the material. A lecture schedule was compiled showing the lecture date, speaker, and subject. This schedule is shown as Figure II on page 23. The material covered in these lectures included: Why Be a Medical Secretary: requirements, advantages, and responsibilities; medical ethics, patient-secretary-doctor relationships, privileged communicap tions; Anatomy and Physiology: bones, joints, muscles, respiratory system; Circulatory System and Castro-intestinal System; blood con- stituents, nervous system; Disease and Treatment: trauma, infectious disease, degenerate disease, congenital abnormalities; Office Nursing Procedures: practice in taking temperature, respiration, and blood pressure; Medical Assisting: principles of asceptic technique, sterili- sation of instruments and bandages, identification and handling of mIn «IN .TN «IN «IN be. 3a b.2559 53.5 5.3.3.: 5.8.3 tufioflafifio poem Hosea scam gang eedsm unseen been seq—”wag seam sauce» senses—flu .ofi. mIn mln .TN .TN «IN house: new» e3. Accesses: nausea. Seconds: 3.5395 seen 9318 985 Hosea sophom 360m sedan and?» room 13.3.35 Fag 2303 .TN mun .TN .TN .TN have hfia hence: heeensfl. havens—E hang seemesm .68 35mg; .95 «his .53 35mg asses 33: season 33: .33» e533 .TN «IN «In mIm «In have one have can. havoc: have can. have es.“ 563.3330 3.3m couch» endow ease; can seesaw anew Hos-o ussm Hosea season—em .238 «IN «IN «In “In “In heme eons houses"? have one house: henna: ginseng” seesaw emu-om season eiom pawn House sewn e398 one: .3ch can sense: m .93. co s8: 5 as: so soon om be: so to: 3 he: co s8: e O: co s8: 838 bulommd .ZE can—HEM wan—”man Eamon 29343380 .mgaflmoflm SHAH: H 55lo 23 FIGURE II mm, SPEAKER, AND LECTURE TOPIC MEDICAL smear-rm mums 19 56-57 DATE SPEAKER TOPIC October 24 Power, Thirlby Why Be a Medical Secreteer October 31 Thirlby, Cline Anatmy and Physiology ' November 7 Power, Cline Circulatory System Castro-lute stinal System November 11. Power, Thirlby Disease and Treatment November 28 Thirlby Office Nursing Procedures December 5 Cline, Power Medical Assisting December 12 Thirlby, Power, Medical Bookkeeping Robinson April 11 Neita Principles of I-Bq April 18 waits Preparation for X-Bay May 2 Shaffer Psychosomatic Disorders May 9 Shaffer Psychosomatic Disorders 21. instruments, draping and chaperonage techniques, procedure and demon- stration of injection; Medical Bookkeeping; Principles of XHRay; Preparer tion of patient for XéRay; and Psychosomatic Disorders. Mggical Laboratcgy Progedures The Medical Laboratory Procedures course was taught by two physicians, the Pathologist and the Head Laboratory Technician at James Decker.Munson Hospital. The course was offered in a series of ten 2-hour lecture and laboratory periods at Munscn Hospital. The topic fer the evening was introduced by the speaker and followed by a laboratory period in which the students practiced the procedures covered that evening. In addition, each student spent twenty hours at the Hospital practicing laboratory tests under the direction of the Head Laboratory Technician and ten hours practicing B. Mt B. and E. K. G. technique under the direction of the Supervisor of XeRay Department. A textbook was not used for this course but the following references were.used: Clinical Pathology by Wells, yggggl 9; Clinical Laboratcgy Methods by Hepler, Clinical Diagnosis by Laboratogy Methods by Todd and Sanford. Students took notes at all lectures which they later transcribed, outlined and duplicated. These notes were included in the syllabus which is described on page 20. A.lecture schedule showing the date, speaker, and topic is shown as Figure III, page 25. The material covered in these lectures included: Introduction to Laboratory Medicine: purpose, divisions, identification and care of 25 FIGURE III DATE, SPEAKER, AND LECTURE TOPIC .MEDICAL LABORATORY’PROCEDURES WINTER ran», 1956-57 DATE SPEAm TCPIC January 9 Lossman Introduction to Laboratory Medicine January 16 Lossaan Explanation of Urinalysis January 24 Flynn Urine Tests January 30 Flynn Complete Blood Count February '7 Lossnan Blood Chemistry February 11. Losslsan Laboratory Experience February 21 Flynn Blood Sugar Test February 28 Flynn Laboratory Practice March 7 Sweeney Electrocardiography Cline, U. Much ll. Sweeney Basal Metaboli-I cmO , U. 26 laboratory equipment and glassware, metric system; Explanation of Urin- alysis; Urine Tests: albumin, color, turbidity, acidity, specific gravity, acetone, microscopic study; Complete Blood Count: hemoglobin, leuko- cyte, erythrocyte, platelets, and differential smears; Blood Chemistry: blood clotting, prevention of clotting, sedimentation rate, prothrombin time, hamstccrit; Laboratory Experience in Blood Letting: veni-puncture, ‘blood count; Blood Sugar Test: explanation, demonstration and practice in making bloodpsugar tests; Laboratory Practice: sedimentation rates and microscopic studies; Electrocardiography: explanation, demonstra- tion, and preparation of patient for an electrocardiograph test; Basal Metabolism: explanation, demonstration, and preparation of patient for a basal metabolism test. The James Decker Manson Hospital Laboratory was utilised extensively in this course. Time was spent during the Medical Office Procedure class in microscopic study of urine and blood. Equip-ant including micro- scopes and glassware from the College Biology Department was used. Stue dents voiced dissatisfaction concerning the use of College monocular microscopes after they had been accustc-ed to the binocular microscopes at the Hospital. Since most private practices have monocular microscopes, perhaps this type of microscope is preferable for initial training of medical secretarial students. Eleven physicians, one laboratory technician, and one XFRay techni- cian participated with the College staff in the instruction of Medical Secretarial Training. (See Figure IV, page 27) FIGURE IV TRAVERSE CITY, MICHIGAN, MEDICAL AND HOSPITAL PERSONNEL WHO PARTICIPAM IN MEDICAL SECRETARILL MNING, 1956-1957 m PARTICIPATION SPECIAL!!! Ted Cline, M.D. wnm cm., 14.9. um. Flynn Charles Haberlein , M.D. Hobart Iceman, H.D. Jean Jacobus, R.N. Prank Power, M.D. Marcus Shaffer, M.D. Edward Stokes, M.D. Bernard Sweeney, M.D. Richard Thirlby, M.D. Harry Heits , H.D. J. G. Zimerman, M.D. Evening Lectures Observation Program Laboratory Procedures Laboratory Procedures Observation Progsm Laboratory Procedures Laboratory Procedures Evening Lectures Evening lectures Observation Program Laboratory Procedures Evening Lectures Observation Program Evening Lectures Observation Program Surgery Internal Medicine Head Lab Technician Manson Hospital Obstetrics Patholoy Dept. Manson Hospital Supervisor, I-Ray Manson Hospital Surgery Psychiatry Surgery Internal Medicine Urology Radiology Dept . Manson Hospital Ophthalmolog CHAPTER IV STUDENT DATA AND FOLLOW-UP Nine students enrolled for Medical Secretarial Training in the fall term, 1956. Five students were freshmen, three were sophomores, and one girl was a part-time student who was anployed as a secretary in a local office. All of the students with one exception were enrolled in the required courses: Office Procedures, Medical Office Procedures, and Medical Dictation and banscription. Che student who had no previous shorthand training enrolled in beginning shorthand rather than Medical Dictation and Transcription. National Registgy 2g Medics; Secretarieg During the year, several students asked the investigator about the possibility of becoming registered with the National Registry of Medical Secretaries. This question was presented to the Advisory Ccmnittee who suggested that investigation he made concerning the requirements for registration. Considerable correspondence was carried on with the Registry which asked that an outline of the training progru be submitted to them. The requirements for registry were satisfied by the course content of Medical Secretarial Training at Northwestern Michigan College. Pour students became Registered Medical Secretaries upon the completion of their training in June, 1957. 29 STUDENT FOLLON¥UP Two students withdrew from College at the end of fall term to be married. Two students enrolled as sophomore students at Northwestern Michigan College, 1957-58. One of these students was employed part time during the 1956-57 school year as a laboratory worker at the Osteopathic Hospital. One student who was employed as a part-time medical secretary to a Traverse City Internist during the winter term of 1956-57 accepted employb ment as a full-time medical assistant in the same office. Another student who was employed part time during spring term, 1956-57, at the Northport Hospital, Northport, Michigan became a full- time medical secretary and laboratory assistant at that hospital. One student accepted employment as a receptionist to five physicians in a medical building in Traverse City. The Burns Clinic in Petoskey, Michigan, employed the fourth student, and Thirlby Clinic in Traverse City employed the fifth student who worked there part time during the 1956-57 school year. The results of an informal followwup concerning duties of the five students who are now employed in medical offices are shown in Figure V, page 31. The small number of students represented in Figure V limits its value fer curriculum evaluation, but it does serve as a guide to the duties which.may be anticipated by future medical secretarial stu- dents. Frequent correspondence and conversation with the students who are now working in medical offices indicate their enthusiasm for their 30 work. A formal follow-up of the graduates of Medical Secretarial Training at Northwestern Michigan College will be made in 1960. FIGURE V DUTIES PERFORMED BY FIVE STUDENTS NOW SECRETARIES IN MEDICAL OFFICES 3313mm, 1957 31 Duties Transcribe letters from dictation Transcribe letters from recording units Transcribe case histories from dictation Transcribe case histories from recording units Schedule appointments Answer telephone File letters, case histories, etc. Use duplicating machines Prepare and mail statements Compose collection letters Compose other letters Fill out insurance and related forms Assist with physical examinations Assist with minor surgery Drape patients for examinations Prepare and sterilize instruments Take temperature Take respiration Take blood pressure Take pulse Prepare patient for E.K.G. ,Prepare patient for B.M.R. Prepare patient for XARay Prepare injections Performlurinalyses Perform blood tests Other duties (gastric washings & analyses, bookkeeping, ordering supplies, etc.) A Note: Performance of duties listed is indicated by an "X”. NNNN NH >004»: SecretaryNo.l NNH NNN Secretary No.2 )4 NNHH N NHN NNNHHNNHNNNN NNNHNNNN $ufluymd NH Secretary No.4 N NNNN N N N N Secretary No.5 NNN CHAPTER V PUBLICITY A small enrollment in Medical Secretarial Training was expected in the school year, 1956-57; however, it was hoped that the enrollment would increase substantially the following year. Several methods of publicising the program.were used and are described below: The investigator and the second business teacher were interviewed on a weekly television program, 'Northwestern Michigan College on the Air.” The Medical Secretarial Program.was briefly outlined on this twelve- minute program in November, 1956. College and Career Days in Traverse City and four other cities in the surrounding area were attended by the investigator and the other business teacher. Displays featuring photographs of the medical secre- tarial students in various phases of their training were shown. These photographs are shown as Figures VI, VII, and VIII. A medical secre- tarial student accompanied the teachers to talk with students who were interested in the training. The investigator and a medical secretarial student presented a resume of the history and development of Medical Secretarial Training on the television program, "Limelight,“ on April 17, 1957, which features new happenings in Traverse City. The publicity was favorably received and resulted in many letters requesting additional information about the training program. 33 FIGURE VI mm“. mm swarms IN muons arms (r my mums rams, 1956-57 ~« m 2; h—c‘ e’"' ~—‘ ~ l—I_h ‘ Students preparing to transcribe case histories from (left) Dictaphone and (right) Conptoneter Transcribing Unite. 34 FIGURE VII MEDICAL SECRETARIAL STUDENTS IN VARIOUS STAGES at THE TRAINING PROGRAM, 1956-57 ~ 7 WWW ‘ w H ‘ May's. J1 Student (left) filing patienta' charts and student (right) scheduling appointments by telephone. FIGURE VIII MEDICAL SECRETARIAL STUDENTS IN VIRIOUS STAGES or THE TRAINING PROGRAM, 1956-57 Two students (left) performing urinalysis and (right) two students identifying bones in skeleton. 35 mm H 311mm, coucwsxcms, AND necwmmrrws SUMMARY The need for Medical Secretarial Training in Traverse City, Michigan was aade apparent to the investigator and to Northwestern Michigan College administrators by the interest of students and local physician s. The pro- grla was made possible through the cooperation of the Grand Traverse, Leelanau, and Bensie Counties Medical Society with Northwestern Michigan College. he program is now in its second year and is expanding in sine and scope with investigation now being made for providing additional training for secretaries already employed in medical offices who wish to continue their education. This amdy traces the developsmt of the program from its beginning to its second year, and it is hoped that it will be of value to individuals who are gven the responsibility of developing similar progrms. f m 2: m: an: The purpose of this study was to record the events related to the development and establishment of a medical secretarial curriculum in a cmnity college in a city in northern Michigan. Madam lead The following steps were taken to establish a Medical Secretarial Program at Northwestern Michigan College: (1) Investigation of the curricula at schools similar to Northwestern Michigan College thich offer 37 medical secretarial training, (2) Enlistment of the aid of professional medical personnel in Traverse City in the developnent and instruction of the program, (3) Appointment of an Advisory Committee of physicians and school personnel who would share the responsibility of establishing and continuing the program, and (1.) Development of a curriculum for file one- yeu' prop-am. 39......th 2; an m A one-year training program for medical secretaries was established at Northwestern Michigan College in 1956 in Traverse City, Michigan. The program was planned and developed under the joint auspices of the Grand Traverse, Leelanau, and Bennie Counties Medical Society and Northwestern Michigan College. Two college business instructors, eight physicians, and one hospital laboratory technician were involved in the instruction of three required subjects: Medical Dictation and Trans- cription, Medical Office Procedures, and Medical Laboratcry Procedures. Nine shadents enrolled in the fall term, 1956. Seven students completed the year's training and five of these students are currently employed in medical offices. CONCLUSIONS In June, 1957 a meeting of the Advisory Committee was held to evalu- ate the Medical Secretarial Program. Q: the basis of observations made by the medical personnel and the college instructors during the 1956-57 training, the following conclusions were made. 38 l. A one-year training program does not provide sufficient time for students to acquire related knowledges in biolog and psycholcg. 2. The requirements for graduation from the program were not clearly defined. 3. Sinplifi ed textbooks or supplements are needed for the course in Medical Laboratory Procedures. 1.. The College biology laboratory should be used to provide labora- tory experience. 5. Medical Office Procedures which met two hours per week with additional evening lectures and observations did not carry sufficient credit for the number of class hours involved. 6. Any variation in the skill backgrounds of the students in type- writing and shorthand should be known before the students are enrolled in the nedical secretarial program. 7. All applicants for the program should be carefully screened prior to enrollnent relative to scholastic ability, skill-subject performance, and personality traits. 8. Participation of local medical personnel was very helpful in the planning and instruction of the program. 9. The Advisory Omittee gave valuable assistance in the develop- ment of the program. BECM‘IENDATIONS As a result of the June nesting, the Advisory Committee presented the following reccmnendations to the Northwestern Michigan College 39 Administration in an effort to improve the Medical Secretarial Program for 1957‘58e Wises 29. “Northwest” Mam Mlle 4» W 1. It is recomended that the one-year training progrsn be changed to a two-year program which will provide more time to develop the cap- abilities of the students in related mbjects as well as in their tech- nical medical training. A two-year program will fulfill the reqiirelaents for graduation with an Associate of Counerce Degree and a Medical Secre- tarial Certificate. (See Figure IX, page 1.2) 2. It is recomended that the College secure simplified textbooks and supplaentary materials which will be used in Medical Laboratory Procedures. 3. It is recommended that Medical Laboratory Procedures be offered at the College biology laboratory in .a series of evening lectures. College equipment should be used and additional equipaent should be purchased for the instruction of the course. Two physicians, specialists in Internal Medicine, should instruct the class. 4.. It is remanded that the nane of Medical Office Procedures, two credits, be changed to Medical Office Techniques and carry three credits. 5. It is recommended that the applicants for Medical Secretarial Training be carefully screened prior to enrollmt in the progrsn relative to their scholastic ability, skill subject performance, and personality traits. 40 6. It is recommended that the Advisory Committee continue to function and meet whenever necessary with the investigator serving as liascn between the College and the medical personnel in Traverse City. fiecommendations 39 m Schools Inquiries from interested persons throughout the state attest the concern of other schools in similar programs. It must be observed that any school that establishes a training program for medical secretaries will encounter problems that are peculiar to the school's facilities and to the city in which the school is located. Evaluation of the program at Northwestern Michigan College points up some of the factors which appear to be necessary for success in developing similar programs. It is recommended that the following factors be considered. 1. Medical secretarial training should be carefulLy planned. The involvement of interested medical personnel in the community in curri- culum development is highly desirable. Curriculum development can also be aided by other citizens of the community. Such involvement will help insure that the curriculum of the school develops into a community program broad enough to meet the wants and needs of the participating area.1 2. The Business Department provides the core of the program since many of the subjects in the total training program are taught in this department. At least one of the business teachers should have experience in medical secretaryship or participate in the actual training program lvalade, op. cit. p. 128. 1.1 in order to gain an understanding of the nature of the subject matter and an appreciation of the difficulty of the specialized training required. 3. If the Scimce Department is not strong in its offerings, involve- ment of local medical and hospital personnel is essential. 1.. Only students who have above-average scholastic ability and desirable personal qualities should be permitted to enroll in the progrm. 5. High standards should be maintained in order to produce high- quality medical secretaries. FIGURE 11 mxm sscnrrm moons LISTED IN 1957-58 COLLEGE urnosunz FIRST YEAR. SECOND YEAR ‘ Fall Fall Sea. of Con. (LC 101) 3 Bus or SS 3 Biol. Sci. (Sci 111) 4 Office Proced. (Bus 251) 3 Beg. Typing' (Bus 131) 2 Med. Dictation (Bus 227) I. Beg. Shorthand" (Bus 121) I. Med. Office Electives 2 Techniques (Bus 256) 3 PJ. __1_ Electives _3 16 15 Minter Minter Ess. of Com. (LC 102) 3 Bus or SS 3 Biol. sci. (Sci 112) 1. Office Proced. (Bus 252) 3 Int. Typing" (Bus 132) 2 Med. Dictation (Bus 228) 4 Int. Shorthand' (Bus 122) 4. Med. Office Electives 2 Techniques (Bus 257) 3 P.E. _1_ Med. Lab. Procedures (Bus 260); 16 15 Spring Spring lss. of Com. (LC 103) 3 Bus or SS 3 Biol. Sci. (Sci 113) I. Filing Proced. (Bus 251.) 3 Adv. Typing' (Bus 133) 2 Med. Dictation (Bus 229) 4 Adv. Shorthand* (Bus 123) 1. Med. Office Electives 2 Techniques (Bus 258) 3 P.E. _; Electives _3 16 15 *If competency is demonstrated in this subject, an elective may be substituted. Recommended electives: Introduction to Business, Secretarial Machines, Accounting, Psychology. Note: The two-year Medical Secretarial Program completes require- ments for graduation with an Associate of Commerce Degree and a Medical Secretarial Certificate. 2gorth£stegg Michiggg College Catalogue, 1251-58, p. 23. BIBLIOGRAPHI BIBLIOGRAPHY A.) PERIODICAL ARTICLES Buchwald, Aaron. 'High School Yields Trained Assistants for MDs,‘ Scopg 39.23.11, November 28, 1956, 1). ll... Chap-an, Carolyn I. 'A Medical Secretarial Survey," my; ELISE! mg, December, 1956. Dalton, A. “Medical Dictation, A Highly Specialised Area,‘ EBA Iudner, Warren E. “Objectives in Training the Medical Secretary,“ HEEL—A m, 5:29.30940’ May, 1951- Markwick, Evangeline. 'The MD's Criteria for His Aide-and Her Own,“ Sm 39%, January 30, 1957, p. l. McLaughlin, A. D. I'Evaluation of a Medical Secretarial Course,“ mas: fell-n 12:12.31. 16:165-8. December. 1945. Miller, J. U. “Medical Secretarial Course," M g; M2232 g3- tio , 20322, June, 1945. hith, Corinne. I'MOAs--Medicsl Office Assistants Solve Doctor's Dilemma," Th; Detroit m, March 21., 1957, p. 1. Tooley, James 3. "Medical Shorthand and Terminology," m figcatiog M, SOPmbr, 1956, PP. 34"36e What Does It Take to Teach Medical Secretaries,‘ BEEP—3.5 Teacher, 273272-2749 1949s B. UNPUBLIS- MATERIALS Markwick, Evangeline. 'Training Medical Secretaries in Junior Colleges,“ Unpublished Doctor's dissertation, New York University, New York, New Iork, 194.3. 45 Michigg all W M 1256 flags m. Detroit: Michigan Bell Telephon; Company, Personnel Relations Departnent, 1956. (Mimeo- graphed. W Michigg College Catalogue, 1226-51. Traverse City: North- western Michigsn College, 1956. Shaffer, Marcus. "Survey of Practicing Physicians and Employees in Related Practices in Traverse City, Michigan.“ Unpublished manu- script, July, 1956. Travergg City Chamber 9_f_ m Survey Ceesus, 1957-2. A bulletin of the Chamber of Commerce. Traverse ity: 1958. (Mileographed.) Tanis, Preston. aIiist