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H I4 II I\ “In 'I‘II'I’ III In" N‘ITIII WHEN“; V ?|- ' RY “3Nmzssmll1nocl>saw23'| L- Jig: Sate Univemty This is to certify that the ‘ thesis entitled AN ANALYSIS OF FACULTY MEMBERS' ATTITUDES TOWARD CONTINUING PROFESSIONAL EDUCATION: A STUDY OF FOURPROFESSIONAL SCHOOLS AT THE UNIVERSITY OF LOUISVILLE presented by PATRICIA BELL has been accepted towards fulfillment of the requirements for JILL—degree in _E_d_u_C_QIiQn Major professor I Date 2'13’79 0-7639 ovmua FINES ARE 25" PER DAY pan ITEM 1;. drop t0 rem” Return ‘10 b°° roll! 79‘“ recordo this checkw‘ f g} ® Copyright by MARY PATRICIA LAUDERDALE BELL 1979 AN ANALYSIS OF FACULTY MEMBERS' ATTITUDES TOWARDS CONTINUING PROFESSIONAL EDUCATION: A STUDY OF FOUR PROFESSIONAL SCHOOLS AT THE UNIVERSITY OF LOUISVILLE By Patricia Beii A DISSERTATION Submitted to Michigan State University in partial fulfiiiment of the requirements for the degree of DOCTOR OF PHILOSOPHY Department of Administration and Higher Education 1979 ABSTRACT AN ANALYSIS OF FACULTY MEMBERS' ATTITUDES TOWARDS CONTINUING PROFESSIONAL EDUCATION: A STUDY OF FOUR PROFESSIONAL SCHOOLS AT THE UNIVERSITY OF LOUISVILLE By Patricia Bell Purpose of the Study The purpose of this study was to analyze the attitudes of faculty members in the School of Dentistry, the School of Law, the School of Medicine, and the Speed Scientific School (the School of Engineering and Applied Science), four professional schools at the University of Louisville toward elective and mandatory continuing professional education. Nine research questions provided the guidelines for the research. Procedures A questionnaire was constructed to determine faculty attitudes toward elective and mandatory continuing professional education. Seventy-three percent of the two hundred eighty-one full time faculty members responded to the questionnaire. The study received the endorsement and assistance of the Vice President of Academic Affairs and the Directors of Continuing Education in the four professional schools. Patricia Bell Pearson's Product Moment Correlation was used to see if there was a relationship between the respondents' attitude towards elective continuing professional education and their age, years of professional service prior to the University of Louisville, and at the University of Louisville. The same procedure was used for mandatory continuing professional education. An analysis of covariance (with years of professional service at the University of Louisville and years of professional service prior to the University of Louisville being covaried out) was used to find if differences existed between the respondents' attitudes toward elective continuing professional education (ECPE) and mandatory continuing professional education (MCPE). ‘ A randomized block analysis of covariance was used to find if there were any differences between the four schools respondents' overall attitudes toward continuing professional education. The amount of involvement in EPCE, MCPE, and ECPE-MCPE was broken down by school. A breakdown of how the respondents wanted to be involved and where they wanted to be involved was done by school. Major Findings 1. The respondents were more in favor of elective continu- ing professional education than mandatory continuing professional education. 2. The respondents from the engineering and medical schools were less in favor of continuing professional education than respondents from the law and dental schools. Patricia Bell 3. An interaction between the attitudinal measures was found. Respondents from the four schools appeared to have similar attitudes toward ECPE. The medical school, engineering school and dental school had less favorable attitudes toward MCPE than ECPE. However, the law school seemed to be slightly more in favor of MCPE as compared to ECPE. 4. Five aspects of involvement were investigated: planning, research, evaluation, advisory capacity, and teaching. Approxi- mately 25% of the respondents indicated no interest in any of the five aspects of ECPE while over 9% indicated interest in all five aspects of it. Some 46% of the respondents indicated no interest in any of these five aspects of MCPE while 5% indicated interest in all five aspects of it. 5. 0f the respondents indicating an interest in being involved in ECPE, 55% were willing to be involved in planning, 37% in research, 37% in evaluation, 51% in an advisory capacity, and 91% in teaching. 0f the respondents interested in ECPE, 31% indicated interest in being involved on a released time basis, 69% with over- load pay, 63% in on-campus work, and 36% in off-campus work. Of those respondents indicating an interest in being involved in MCPE, 46% were willing to be involved in planning, 32% in research, 40% in evaluation, 51% in an advisory capacity, and 87% in teaching. Of the respondents interested in MCPE, 25% indicated interest in being involved on a released time basis, 76% on overload pay, 57% in on- campus work, and 29% in off-campus work. In Memory of My Husband, Hugh Clay Bell, Jr. 1923-1974 ii ACKNOWLEDGEMENTS During the course of this study, the writer received and appreciated meaningful and genuine suggestions and assistance from many friends, relatives, colleagues, and professors. Without the assistance of those who gave so freely of themselves during the research period, the study would not have been completed. I am deeply grateful to Dr. Howard Hickey, my major advisor, for his friendship, interest, dedication, constructive criticism throughout my doctoral program. I am also grateful to the other members of my committee for their helpful suggestions, Dr. Lois Bader, Dr. Sheldon Cherney, Dr. Richard Gardner; to Mr. Leonard Bianchi for his technical help as research consultant and friend, and to Mrs. Virginia Wiseman, master guide through the doctoral labyrinth. Gratitude is also expressed to: Dr. James Grier Miller, Dr. John A. Dillon, Jr., Dr. Joseph H. McMillan, Dr. Wendell G. Rayburn, Dr. Edward J. Hayes, Rev. Francis Cusack, C.P., Dr. Eleanor Y. Love, Dr. J. Frank Yeager, Prof. Russell Kleis, Rev. Philip Shaffer, C.P., the Hon. Julian Carroll, Drs. Dee and Lilialyce Akers, Hon. Romano Mazzoli, Rev. Paul Bechtel, C.P., Dr. Stan Frager, Dr. Edwin Paul, Richard and Ann Caslin, Bill and Mary Ann Rickert, Mr. Chris Hagen, Ray and Karen Jackson, Mrs. Janice Brown, Otis and Ann Huddleston, Dr. David A. Conner, Dr. D. Joseph Hagerty, Dr. Harry C. Saxe, Dr. Donald F. Linton, Prof. Donald L. Cole, Dr. Robert Wubbolding, Mrs. Elinore Beyerle, Mrs. Ruby Montgomery, Dr. Gerald D. Swim, Dr. Medhi Ghods, Prof. Marlin Volz, Fred and Rowena Williams, Jose A. Zellers, Dr. Leo B. Jenkins, Jr., Mrs. Juanita Rucker Chatman, Dr. Thomas E. Mullin, Dr. Charles Plank, Dr. Harold Wren, Mr. William J. Cox, Jr., Dr. Edward H. Hammond, Dr. Theodore E. Logan, Jr., Mr. Joseph G. Glass, Mr. Walker R. Reynolds, Dr. and Mrs. A. L. Rosenblatt, and Dr. F. Lee Van Horn. My sincere appreciation is also extended to my dear friend and typist, Mrs. Roxie A. Zellers, for her tireless effort and to my parents, Harry E. and Mary T. Lauderdale, my sisters, Gloria T. Brookter, Yerva E. Irving, and my brother, Harry E. Lauderdale, Jr. Finally to my dearest children, Gordon Edwin, Joanne Marie and Gloria Patricia-Leigh, for their sacrifices and understanding throughout the course of this study. iv TABLE OF CONTENTS Page LIST OF TABLES ........................ vii LIST OF FIGURES ....................... xi Chapter I. PURPOSE OF THE STUDY ................. 1 INTRODUCTION ..................... 1 THE DEVELOPING AWARENESS OF THE NEED FOR CONTINUING PROFESSIONAL EDUCATION ......... 2 Continuing Dental Education ............ 2 Continuing Legal Education ............. 5 Continuing Medical Education ............ 6 Continuing Engineering Education .......... 8 Research Questions ................. 10 Definition of Terms ................ 11 Instrumentation .................. 12 Assumptions of the Study .............. 12 Delimitation of the Study ............. 13 Significance of the Problem ............ 13 Overview of Dissertation .............. 14 II. SELECTED REVIEW OF THE LITERATURE ........... 16 Elective Continuing Dental Education ........ 16 Mandatory Continuing Dental Education ....... 19 Continuing Dental Education-- , Professional Attitudes ............. 3O Continuing Dental Education--Summary ........ 42 Elective Continuing Legal Education ........ 43 Mandatory Continuing Legal Education ........ 53 Continuing Legal Education-- Professional Attitudes ............. 56 Continuing Legal Education-~Summary ........ 69 Elective Continuing Medical Education ....... 7O Mandatory Continuing Medical Education . . . . . . . 87 Continuing Medical Education-- Professional Attitudes ............. 99 V III. IV. V. Continuing Medical Education--Summary ........ Elective Continuing Engineering Education ...... Mandatory Continuing Engineering Education ..... Continuing Engineering Education-- Professional Attitudes .............. Continuing Engineering Education--Summary ...... Summary ....................... DESIGN AND PROCEDURE .................. Setting for the Study ................ The Community Serviced by the University ...... History of the University of Louisville ....... The University's Role in Continuing Education . . . . Research Questions ................. The Population ................... Description of the Instrument ............ Validation of the Instrument (Pre-Testing the Questionnaire) ................ Data Collection ................... Statistical Treatment of the Data .......... Summary ....................... ANALYSIS OF THE DATA .................. Research Questions One and Two ........... Research Questions Three and Four .......... Research Questions Five and Six ........... Research Question Seven ............... Research Questions Eight and Nine .......... Summary ....................... SUMMARY, CONCLUSIONS AND IMPLICATIONS .......... Purpose of the Study ................ Review of the Literature .............. Design of the Study ................. Findings of the Study ................ Conclusions and Discussion ............. Implications for Professional Education ....... Recommendations for Further Research ........ APPENDICES A. B. C. B-SURVEY TOWARD CONTINUING PROFESSIONAL EDUCATION AND MANDATORY CONTINUING PROFESSIONAL EDUCATION ..... COVER LETTER SENT TO RESPONDENTS ............ TABLES--CONTINUING PROFESSIONAL EDUCATION ........ SELECTED BIBLIOGRAPHY ..................... vi Page 102 104 117 118 120 120 120 121 123 129 130 132 138 138 141 146 149 151 158 159 167 170 173 174 176 181 183 210 bth-D-fi uooowm .10 .11 LIST OF TABLES Number and percentages of responses by professional school ................ Correlation between ECPE, MCPE and age; years of service at the University of Louisville and years of service prior to the University of Louisville ................... Randomized block analysis of variance ....... Analysis of Covariance of the four schools' attitudes toward ECPE, using "years of professional service at the University of Louisville" and "years of professional service prior to the University of Louisville" as covariates .................... Analysis of Covariance of the four schools' attitudes toward MCPE, using "years of professional service at the University of Louisville" and "years of professional service prior to the University of Louisville" as -covariates .................... Scheffé's post hoc test of all pairwise comparisons of the MCPE Attitude Measure of the four schools ............ Interest in involvement in aspects of ECPE . . . . Interest in involvement in aspects of MCPE . . . . Interest in aspects of ECPE ............ How and where respondents chose to be involved Interest in aspects of MCPE ............ How and where respondents chose to be involved vii Page 133 144 145 147 148 148 150 151 152 152 153 154 Table Area of involvement-—either ECPE, MCPE, or both ECPE and MCPE ................. Respondents who replied to question five-- breakdown by school .............. Breakdown of responses to Part V of the questionnaire ................. Years of professional employment at the University of Louisville ............ Years of professional employment prior to the University of Louisville .......... Prior exposure to continuing professional education ............... Prior exposure to mandatory continuing professional education ......... Experience as a practitioner (non-teaching) in my field number of years .......... Continuing professional education (professional enhancement) has a strong attraction for me . . . . Mandatory continuing professional education (required for relicensure) has a strong attraction for me ................. Continuing professional education (professional enhancement) serves a good purpose ......... Mandatory continuing professional education (required for relicensure) serves a good purpose . . . . Continuing professional education (professional enhancement) promotes cooperation between the practitioner and university faculty ........ Mandatory continuing professional education (required for relicensure) promotes cooperation between the practitioner and university faculty Continuing professional education (professional enhancement) should be used by more practitioners in my field .................... viii Page 155 157 158 183 184 185 186 187 188 189 190 191 192 193 194 Table C.13 Mandatory continuing professional education (required for relicensure) should be used by more practitioners in my field ........ Continuing professional education (professional enhancement) has advantages in it for me ........... Mandatory continuing professional education (required for relicensure) has advantages in it for me ......... Continuing professional education (professional enhancement) is a good thing for the clients of professional practitioners .......... Mandatory continuing professional education (required for relicensure) is a good thing for the clients of professional practitioners .......... Continuing professional education (professional enhancement) is a good way for me to keep current with the practical application of new theories in my profession ........ Mandatory continuing professional education (required for relicensure) is a good way for me to keep current with the practical application of new theories in my profession ........ Continuing professional education (professional enhancement): dislike this idea, but do not object to others liking it ............... Mandatory continuing professional education (required for relicensure): dislike this idea, but do not object to others liking it ............. Continuing professional education (professional enhancement) sounds good, but it would be too time consuming ........ Mandatory continuing professional education (required for relicensure) sounds good, but it would be too time consuming ................ ix Page 195 198 199 202 204 205 Table C.24 0.25 C.26 C.27 Continuing professional education (professional enhancement) is a waste of both time and money ......... Mandatory continuing professional education (required for relicensure) is a waste of both time and money ...... Continuing professional education (professional enhancement): nothing to be gained from this activity either by society or the individual .................. Mandatory continuing professional education (required for relicensure): nothing to be gained from this activity either by society or the individual .................. Page 206 Figure 3.1 3.2 3.3 3.4 3.5 3.6 3.7 4.1 LIST OF FIGURES Characteristics of the respondents by sex ....... Characteristics of the respondents by age ....... Characteristics of the respondents by academic rank . . . . Demographic data for (pre-test sample) by Demographic data for (pre-test sample) by Demographic data for (pre-test sample) by Demographic data for (pre-test sample) by Means of attitudinal the questionnaire sex ............... the questionnaire age ............... the questionnaire highest earned degree the questionnaire profession ............ measure by school ........ xi Page 133 134 134 136 137 137 138 146 "No one man can hope to be master of all knowledge, but he has a professional obligation to try to keep abreast of those portions which are essential to his practice. He cannot do so without continued reading and study. The knowledge he acquires in professional school may be sadly out-of-date long before he reaches retirement. He must not run the risk of subjecting his patients or clients to the dangers of obsolete knowledge. He must continue to be a scholar, even in the press of practice. . . A professional person is a lifelong learner."1 1William J. McGlothlin, Past Vice-President, University of Louisville, The Professional Schools (New York: The Center for Applied Research in Education, Inc., 1968), p. 28. xii CHAPTER I PURPOSE OF THE STUDY The purpose of this study was to analyze the attitudes of faculty members in the School of Dentistry, the School of Law, the School of Medicine, and the Speed Scientific School (the School of Engineering and Applied Science), four professional schools at the University of Louisville toward elective and mandatory continuing professional education. Nine research questions provided the guidelines for the research. INTRODUCTION Obsolescence stemming from the accelerated growth and expansion of knowledge and technology is a central concept and concern in discussing continuing professional education. In order to maintain their job effectiveness, all professionals need to acquire new knowledge after receiving their last degree. “Ten or fifteen years ago, many colleges and universities regarded continuing education with con- descension, if not outright neglect. Many schools viewed as almost their sole responsibility the training of young people for academic degrees. Once the students received degrees, they were on their own. That attitude has changed significantly in recent years. More colleges and universities are stressing continuing education. One reason is that schools are appreciating the fact that students can become seriously out of date in their professional knowledge and skills within a decade or more after graduation." A review of the literature in continuing professional education shows that the rapid growth of knowledge, human forget- fulness, the introduction of new technologies, changing national needs, changing societal and social values, individuals changing jobs, and job responsibilities means that the responsibility for lifelong learning can no longer be left solely to the professional-- it is a responsibility that must be shared by the professional and the public. THE DEVELOPING AWARENESS OF THE NEED FOR CONTINUING PROFESSIONAL EDUCATION The following sections will describe some developments that have taken place in the movement toward continuing education in the four professions involved in this study: dentistry, law, medicine, and engineering. Continuing Dental Education Shortly after the enactment of Title XIX of the Social Security Act (Medicaid) in 1965, the concept of continuing education as a requirement for relicensure became a focal point of the dental 2Howard J. Sanders, Continuing Education, Two—Part Report (reprinted from Chemical Engineering News, May 13 & 20, 1974), pp. 26-38. profession's attention.3 In 1966, New York State's Department of Welfare proposed regulations that would require all dentists seeking reimbursement for services rendered under the Medicaid program to meet certain standards of continuing education. The standards were to be set by the Department of Welfare, State of New York.4 The American Dental Association's House of Delegates responded to New York's Proposal via a policy statement reflecting the association's opposition to an outside agency setting the standards for the profession in publicly funded health programs.5 Following the 1966 annual session of ADA House of Delegates, the Council on Dental Education considered the implications of the action of the New York State Department of Welfare and also reviewed the repOrt of the National Advisory Commission on Health Manpower which commented at some length on the need to develop effective programs to assure the continued competence of health practitioners. The report identified the difficult problems that would be involved in any program to relicense professional practitioners. Nonetheless, the National Advisory Committee recommended that professional societies and state governments explore the possibility of periodic relicensing of physicians and other health professionals.6 3Continuing_Dental Education Requirements for State Dental Relicensure and Constituent Society Membership, Division of Educa- tional Measurements, Council on Dental Education, American Dental Association (211 East Chicago Avenue, Chicago, Illinois, 60611),17 pp. 41bid. 51bid. 51m. "In response to these developments and in the firm belief that the determination of all educa- tional standards for practice should be the responsibility of agencies of the dental profession, the Council on Dental Education submitted a resolu- tion to the 1967 House of Delegates urging that constituent dental societies, in consultation with state boards of dentistry, take steps to develop mechanisms to insure the continued competence of all dentists licensed in their jurisdiction. The House of Delegates voted to recommit the resolution to the Council for further study and report to the 1968 House." In 1968, the Council submitted a resolution of a more general nature which, after amendment, was adopted. This reso- lution urged that mechanisms be developed to foster continued education of dentists.8 Minnesota became in 1969 the first state to require continuing education for relicensure of dentists. Shortly after- ward, other state boards were faced with the administrative task of a continuing education requirement and constituent societies 'began to study the feasibility of continuing education for main- taining memberships.9 By May, 1970, Kansas had become the second state to institute mandatory continuing dental education. In September of the same year, Kentucky followed suit.10 North Dakota and South Dakota adopted continuing education as a necessary requirement for relicensure in the summer of 1971. 71bid., p. 2. 8mm. 91bid. IOIbid. Three years later (1974), California became the sixth state with such a requirement.11 By 1974, seven state dental associations and the District of Columbia Dental Society required continuing education in order to maintain membership: Colorado (1970), Washington State (January, 1971), Nevada (September, 1971), Arizona (January, 1972), Florida (1972), Louisiana (May, 1973), and South Carolina (May, 1974).12 Continuing Legal Education In 1974, the National Committee on Legal Education and Admissions to the Bar of the American Bar Association (ABA) recommended that the American Law Institute (ALI), in cooperation with the American Bar Association, assume the task of providing continuing legal education. The ALI-ABA Committee on Continuing Professional Education is the result of that action. Since its establishment in 1947, the work of the Committee has been to pro- vide members of the legal profession with continuing education opportunities in order to maintain and advance their professional competence on a voluntary basis.13 The Committee makes its publications available as course materials for local programs; it helps suggest speakers and lectures. The Committee furnishes assistance in the starting up of new continuing legal education organizations and it creates model 11Ibid. lzlbid. 13"Annual Report, ALI-ABA Committee on Continuing Profes- sional Education," ALI-ABA/CLE Review, Vol. 6, No. 34 (August 29, 1975), p. 4. courses for use by others.14 On April 3, 1975, the Minnesota Supreme Court approved mandatory continuing legal education. Six days later, the Iowa Supreme Court also approved Mandatory Continuing Legal Education. These decisions meant that lawyers and in some cases, members of the judiciary were, and are, required to attend a fixed number of hours of continuing legal education programs over a one or three- year period. Non-compliance means that a lawyer could have his right to practice limited or suspended.15 Currently, California, Wisconsin, Kansas, Maryland, Michigan, and Kentucky are studying the issue. In October, 1975, the Michigan State Bar Journal devoted its entire issue to mandatory continuing legal education.16 Continuing Medical Education In 1961, in recognition of the need for coordination and leadership in the continuing education of physicians, the Joint Study Committee in Continuing Medical Education was formed.17 14Ibid., Vol. 6, No. 31 (August 1, 1975), p. 3. 15"Annual Report, ALI-ABA Committee on Continuing Profes- sional Education," ALI-ABA/CLE Review, Vol. 6, No. 29 (July 18, 1975 . 16"Mandatory Continuing Legal Education: What Where, How, When, Why, Why Not and Whether," Michigan State Bar Journal, Vol. 54, No. 10 (October, 1975), pp. 745-824. 17Bernard V. Dryer, "Lifetime Learning for Physicians-- Principles, Practices, Proposals: Summary of the Report of the Joint Study Committee in Continuing Medical Education," Journal of the American Medical Association, 37 (May 26, 1962), pp. 676-679. The Committee was composed of members from major medical organizations. The purpose of the committee was to consider the formation of a national agency for continuing medical education. The agency, if formed, was to be under the sponsorship of the major medical organizations. From this committee, Dr. Bernard V. Dryer was chosen Study Director. In 1962, Dr. Dryer presented the committee report, "Life- time Learning for Physicians--Principles, Practices, Proposals,“ to the medical community. This comprehensive "landmark" report emphasized the necessity of cooperative, long range planning by all concerned professional groups if lifetime professional education is to be achieved within a profession. The report covers the following topics: assumptions on which the report was based; the objectives, curriculum and evaluation procedures of a university without walls, curriculum and teaching materials; presentation and distribution system; elective participation; international extension and organi- zational structure. Eight health related national professional associations sponsored and joined in developing the study.18 In 1965, the Congress of the United States passed Public Law 89-239, in order to provide an approach for improving health care. The purpose of Public Law 89-239 was to provide monies by which professional staffs and supporting staffs could be obtained, and provide the means to support "people activities" in planning, to secure consultation, and to support operational programs, projects, 18Bernard V. Dryer, editor, "Lifetime Learning for Physicians: Principles, Practices, Proposals," Journal of Medical Education, 37 (June, 1962), pp. i-134. and activities. Medical continuing education has increased at a rapid rate, as a result of this law.19 Continuing Engineering Education A central concern in continuing engineering education is that of obsolescence, as a result of the accelerated growth and expansion of knowledge and technology. Professional engineering societies have tried to deal with the problem of obsolescence by making the individual member in the society aware of this problem and possible solutions through journals and regularly scheduled professional meetings. Realizing that this approach to stem obsolescence was not enough, the American Engineers Council for Professional Develop- ment set up a joint advisory committee to study the problem of continuing engineering studies. In 1964, the American Engineers Council for Professional Development, the American Society for Engineering Education, the Engineers Joint Council, and the National Society of Professional Engineers published a joint re- port titled, Continuing Engineering Studies to deal with the 20 problem. 19Donald L. Erickson, Martha Nichols, editors, Learning How to Learn--Know Why and How Seminar on the Process of Continuing Education,(February 12-14, 1970,'Laramie, Wyoming [WICHE--Mountain States Regional Medical Program, Wyoming Division, 3100 Henderson Drive, Cheyenne, Wyoming, 82001, August, 1969]), p. 1. 20Engineer's Council for Professional Development, Report of the Joint Advisory Committee, Continuing Engineering Studies (New York, April, 1965). In 1965, the Engineers Joint Council for Professional Development (the council is composed of the nine major engineering societies) established a permanent committee on continuing educa- tion with a full-time director. In 1968, the American Society for Engineering Education (ASEE) published a landmark comprehensive report entitled, "Goals of Engineering Education."21 The report was the result of five (5) years of intensive surveys and analysis, and the accumulation of a large mass of data from other professions by the Goals of Engineering Education Committee of ASEE. The purpose of the re- port was to evaluate current programs, practices, and proposals in the light of their applicability ten or twenty years from then. 0n the basis of this report, the Committee proposed some broad goals for future engineering education. The report discussed the importance of continuing education as a distinct category in the engineering curriculum. It went on to say that the recommendations in the report were more than dealing with the problem of obso- lescence, it was also a matter of establishing and maintaining an entirely new dimension of personal development throughout the engineer's career (lifelong learning). During that same year, the British Institution of Chemical Engineers began a study of contin- uing engineering education in the field of Chemical Engineering. In 1972, UNESCO published the Proceedings of the FEANI-UNESCO Seminar entitled, "The Continuing Education of Engineers." This 21American Society for Engineering Education Goals Com- mittee, "Goals of Engineering Education," Journal of Eggineering Education, 58 (January, 1968), pp. 369-446. 10 report looked at the problem of continuing engineering education from an international perspective.22 Researchgguestions The purpose of this study was to analyze the attitudes of faculty members in four professional schools*, at the University of Louisville toward elective and mandatory continuing professional education. The following research questions will be investigated: 1. Is there a relationship between the attitude of faculty members on elective continuigg professional education and age, years of professional experience prior to the University of Louisville, and years of professional experience at the University of Louisville? 2. Is there a relationship between the attitude of faculty members on mandatory continuinggprofessional education and age, years of professional experience prior to the University of Louisville, and years of professional experience at the University of Louisville? 3. Is there a difference in the attitude of the faculty members toward elective continuing professional education and mandatory continuing professional education? 4. Is there a difference in the overall attitude of the faculty members in the four schools toward elective continuing professional education and mandatory continuing professional education? 5. Do faculty attitudes toward elective continuing professional education differ according to schoOl? 6. 00 faculty attitudes toward mandatory continuing professional education differ according to school? * The four schools in this study are: Dentistry, Law, Medicine, and the Speed Scientific School (the School of Engineering and Applied Science). 2ZSir Frederick Warner and Dr. R. Edgeworth Johnstone, Studies in Engineering Education: The Continuing Education of Engineers, Proceedings of the FEANIiUNESCO Seminar (Helsinki, 1972), 154 pp. 11 7. What percent of their time do faculty want to be involved in elective continuing professional education and/or mandatory continuing professional education? 8. For those professionals interested in elective continuing professional education, what type of involvement would they prefer? 9. For those professionals interested in mandatory continuing professional education, what type of involvement would they prefer? Definition of Terms Words and phrases have long created semantic problems. Depending on the content in which they are used, they could have different meanings. For the purpose of this study and in the interest of providing a more common understanding of terminology, the following definition of terms were used: 1. An Attitude is the predisposition or tendency to react specificalgy towards an object.. . . by feelings and emotions. 2. A Professional is one who has acquired knowledge through academic training or experience, which is practical in nature, is strongly organized, can be applied to solve problems of mankind and whose conduct is governed by a code of ethics. 3. Professional Learning is a procedure designed to screen candidates for admission to a profession and in some instances, to review periodically the qualifications of existing practitioners in order to protect the public through an effort to assure and certify minimum competence for the practice of the profession. 23Dictionary of Education, 3rd ed., s.v. attitude. 24The definition was adopted from the source: G. Lester Anderson and Merton W. Ertell, "Extra-institutional Forces Affect- ing Professional Education," Education for the Professions, The Sixty-First Yearbook of the National Society for the Study of Edu- cation, Part II (Chicago, Illinois: The University of Chicago Press, 1962). p. 237. 12 4. ContinuinggEducation is "any kind of learning or teaching which extends or builds upon previous experience in the same general realm of knowledge and whose specific goali are not intended to terminate all study in that realm." 5 5. Elective Continuing Professional Education is an organized educational program designed to keep the professional's learned skills up-to-date, to advance in his/her field and to learn about new problems to be solved, and which is voluntary in nature. 6. Mandatory Continuing Professional Education is continuing education for the professional worker which is required by law as a condition for certification or relicensure or by rule by a particular professional society or organization. Instrumentation A specially prepared generalized attitudinal scale will be used to measure faculty attitudes toward elective continuing professional education and mandatory continuing professional education. A detailed description of the instrument and the areas which it will seek data is presented in Chapter III. A copy of the questionnaire can be found in Appendix A. Assumptions of the Study This dissertation has proceeded with the following assumptions: 1. Faculty members in this study are interested in and concerned about elective continuing professional education. 25Cyril O. Houle, "What is Continuing Education," discussion 'paper for Seminar on Continuing Professional Education, University of Chicago, August, 1969. (Mimeographed.) 13 2. Faculty members in this study are interested in and concerned about mandatory continuing profes- sional education as it relates to relicensure. 3. The respondents' answers to the survey questions represent honest appraisals. 4. Confidentiality to the respondents was suffi- ciently assured so that the lack of anonymity in some instances will not bias their response. Delimitation of the Study While this study is not universally applicable, the study can be generalized to some extent to institutions with similar characteristics or to professional schools within larger or smaller institutions. This dissertation did not weigh individual questions toward their total attitude of the respondents. Significance of the Problem Continuing education literature emphasizes the concept of obsolescence stemming from the accelerated growth and expansion of knowledge and technology, and the concern to find suitable remedies. Some of the literature goes on to say that in order for professionals to maintain their job effectiveness, all_profes- sionals need to acquire new knowledge after receiving their last degree. Jesse H. Shera aptly states, "that degrees themselves are in part obsolescent because the knowledge the degree represents is 14 itself partly obsolete."26 At the present time, several of the professional boards of registration in the Commonwealth of Kentucky have studies underway relative to the position of mandatory professional continuing education in the licensing process. The results of this disser- tation will afford meaningful input to those evaluations. The University of Louisville, at the direction of the Kentucky Council for Public Higher Education, has developed an academic master plan for the University. The results of this dis- sertation may provide significant data toward a revision of this master plan in the area of continuing professional education.* The results of this investigation might be used as a reference source for adult educators in the field of continuing professional education and provide data that can be used in con- . junction with other studies in continuing professional education. Overview of Dissertation This study is organized into five chapters. The first chapter, the introduction, includes: the purpose of the study, the developing awareness of the need for continuing professional education, the research questions the study will investigate, the definition of terms, instrumentation, assumptions, delimitation, and the significance of the problem. * The master plan will be under continual revision. 26Jesse H. Shera, "The Self-Destructing Diploma," Ohio Library Association Bulletin, 42 (October, 1972), pp. 4-8. 15 In Chapter II, the literature pertinent to the study is reviewed. This review will focus on elective continuing profes— sional education and mandatory continuing professional education in the following professions: dentistry, law, medicine, and engineering. Chapter III will present a methodology for answering the research questions posed in Chapter 1. Chapter IV will present the findings of the research. Chapter V will present conclusions and make recommen- ‘ dations for further research. CHAPTER II SELECTED REVIEW OF THE LITERATURE The related literature examines: (1) elective and mandatory continuing professional education in dentistry, law, medicine, and engineering and (2) how professionals in those fields feel about elective and mandatory continuing professional education. This review is not presented with the intention of providing a detailed description of elective and mandatory continuing professional education in these professions but rather is offered as representative of the literature in order to pro- vide a better understanding of the conditions in which the investigation of the study was undertaken. Elective Continuing Dental Education Over the years the American Dental Association has been steadfast in its position that continuing study is the fundamental and lifelong responsibility of the professional man. Indeed, the first section of the American Dental Association's Principles of Ethig§_clearly affirms the responsibility of the dentist to keep himself abreast of scientific discoveries and developments which will assist him in his practice and enable him to render better care. "Education Beyond the Usual Level. The right of a dentist to professional status rests in the knowledge, skill, and experience 16 17 with which he serves his patients and society. Every dentist has the obligation of keeping his knowledge and skill freshened by continuing education through all of his professional life."1 In recent years the dental profession's interest in con- tinuing education has accelerated. Technological change through research, innovations in the patterns of health care delivery, new clinical procedures, and an increasing social awareness has accentuated the need for dentists to remain professionally current. The first dental society was the Society of the Surgeon Dentists of the City and State of New York. The Society was or- ganized on December 3, 1834.2 "This was a local organization, most of whose membership was composed of medically trained practitioners, and it was their philosophy that dentistry was a branch of ‘ medicine. Perhaps it suffered some isolation from the medical pro- fession and thus sought to establish a surgeon-dentist group.3 The world's first dental association was started by Horace W. Hayden of Baltimore. After several failures, he finally succeeded in getting dentists organized on August 10, 1840 in New York City.4 Or. Hayden went from city to city to induce den- tists to come together and interchange their opinions for the bene- fit of each other; he talked and wrote incessantly. In Boston, he 1Principles of Ethics of the American Dental Association. 2Milton B. Asbell, "Horace H. Hayden (1769-1884), Father of Professional Dentistry," New York Journal of Dentistry, Vol. 39, No. 7 (August-September, 1969), p. 227. 3Ibid. 41m. 18 was very discouraged; however, in New York he found fifteen interested men and five from other cities, principally Baltimore, who organized an association of dentists.5 As time passed, " . . . medical faculties found it incom- patible for dentistry to be taught as a medical discipline; dentistry needed separate facilities which were not available at medical institutions. Thus, it was that dental education became independent insofar as it was practical to arrange a dental curri- culum that would provide the study of the biological sciences together with dental technological training."6 Drs. Hayden and Chapin A. Harris founded the first dental college in the world, the Baltimore College of Dental Surgery. They were also instrumental in the formation of the first dental periodical in the world--the American Journal of Dental Science.7 Continuing education in dentistry as it is now consti- tuted, developed after World War II in response to the expressed needs of dentists returning from their tour of duty. These den- tists needed to "refresh" themselves on the "new technics" and materials developed during their absence. As a result, there was a wave of demand for the dental schools to offer short refresher courses.8 Since the middle 1940's dental education has shifted from a technical orientation to an emphasis on the biological sciences. 51bid. 61bid., p. 229. 7Ibid. 8Joseph L. Hozid, "Role of Continuing Education in Dental Obsolescence," Journal of the American Dental Association, Vol. 78 (June, 1969), p. 1300. 19 Today's rapid proliferation of scientific, professional, and technical knowledge requires that professional expertise be con- tinually updated.9 By 1974, the following Constituent Dental Societies had instituted voluntary continuing education programs: Alabama, Alaska, Arkansas, Connecticut, Delaware, Georgia, Hawaii, Idaho, Indiana, Maine, Massachusetts, Michigan, Mississippi, Nebraska, New Hampshire, New Jersey, New Mexico, New York, North Carolina, Ohio, Oklahoma, Pennsylvania, Rhode Island, South Carolina, Tennessee, Utah, Vermont, Virginia, Wisconsin, and Puerto Rico.10 Mandatory Continuing Dental Education The 1964 Workshop of Dental Examiners and Educators pro- vided the first real forum for the discussion of mandatory contin- uing education for dentists. The consensus of the workshop groups was that mandatory continuing education governed by law was un- desirable and unfeasible. The workshop participants suggested that dental societies and dental educators be the prime motivators for dentists to attend courses and that perhaps course attendance should be established as a criterion for society membership. More- over, it was the consensus that voluntary, rather than mandatory attendance was advisable.11 91bid. 10Continuing Dental Education Requirements for State Dental Relicensure and Constituent Society Membership, Division of Educa- tional Measurements, Council on Dental Education, American Dental Association (211 East Chicago Avenue, Chicago, Illinois, 60611),p. 6. 11John A. DiBiaggio, "Developments in Mandatory Continuing Education," Journal of Dental Education, Vol. 34 (June, 1970), p. 141. 20 In 1966, the attention of the House of Delegates centered on the proposed regulations related to the participation of den- tists in publicly funded programs (Title XIX) in the State of New York. As a result of this concern, a resolution was presented to the House of Delegates which, after discussion and revision by the House, was adopted in the following form: "Resolved, That the American Dental Association support the position that the determination of the qualifications of the individual dentists participat- ing in publicly funded health programs should be prerogative of governing bodies of component and constituent dintal societies and state dental examin- ing bodies." Two events in 1967 forced the dental profession to reassess its stand about mandated continuing education. The first was the establishment by the New York State Department of Health of a set of qualifications that dentists had to satisfy if they were to participate in the Medical Assistance Program (Medicaid) in New York State. The New York State Department of Social Welfare was to implement these standards. A requirement was included that the practitioners give "satisfactory evidence of completion of a total of seventy-five hours of continuing education over a three-year period."13 12Reginald H. Sullens, "What is the Present ADA Situation? What Will it Ask the House of Delegates to Do With Pending Resolu- tions to be Submitted?" Journal of the American College of Dentists, Vol. 36 (July, 1969), pp. 191-192. 13John A. DiBiaggio, "Developments in Mandatory Continuing Education," Journal of Dental Education, Vol. 34 (June, 1970), p. 141. 21 This action by the State Department of New York, established a precedent which could be followed by states through- out the country. Before this time, a dentist needed only to be licensed to practice in New York to qualify for patient care under New York's Medical Assistance Program. In 1967, the State Department of Health listed three pages of qualifications in the New York State Policies and Standards for Dental Services.14 Equally important was the publication of the Report of the National Advisory Commission on Health Manpower. Noting a "quality gap" in the health care delivery system, the committee stressed that the "first requirement for assuring that health care approaches its potential quality is to make licensure effective to the limit of its capabilities."15 The commission recommended that "professional societies and state governments explore the possibility of periodic reli- censing of health professionals. Relicensure should be granted either upon certification of acceptable performance in continuing education programs or upon the basis of challenge examinations in the practitioner's specialty. These actions rekindled the interest in mandatory continuing education and this became the topic of discussion for the Workshop of Dental Examiners and Dental Educators in 1968.16 14Rexford E. Hardin, "Continuing Education Has Many Unresolved Questions," Ohio Dental Journal (September, 1970), p. 309. 15 Ibid., p. 308. 16John A. DiBiaggio, "DevelOpments in Mandatory Continuing Education," Journal of Dental Education, Vol. 34 (June, 1970), p. 141. 22 The harsh reality of the need for planning became apparent. The participants at this Workshop agreed that mandatory continuing education, governed by state boards of dentistry, be established as a requirement for relicensure. They also felt that the deter- mination of regulations should be a function of the boards with recommendations from all professional and governmental agencies.17 The Council on Dental Education of the American Dental Association in its report to the American Association of Dental Schools stated that state boards of dentistry, in consultation with constituent dental societies, be urged to develop mechanisms to insure continued competence of all dentists licensed in their juris- diction. Two important resolutions were proposed and approved by the 1968 House of Delegates: 1) to give continuing consideration to methods of determining the qualifications of candidates for licensure, and 2) to develop mechanisms to foster the continued education of dentists in their jurisdiction.18 A questionnaire was sent to all state boards asking if the dental laws had been changed or if changes were contemplated in the near future in the areas of continuing education and licensure, expanded duties for auxiliaries and recipriocity.19 The responses from this questionnaire showed that thirteen states had made changes in at least one of these areas, and that thirty-three others were contemplating changes. Proposed changes in dental laws of California, Minnesota, Missouri, and New Mexico would 171bid., p. 142. 18Ibid. 191pid., p. 143. 23 require a specified amount of continuing education for relicensure or registry renewal.20 The Pennsylvania State Dental Council and Examining Board adopted a resolution which required as a condition prior to each biannual registration: the satisfactory completion of continuing education courses and/or attendance at a scientific dental meeting either to be approved by the State Dental Council and Examining Board. The Kentucky State Board of Dentistry and the Kentucky Dental Association was also giving the matter considerable attention.21 The 1967 Reference Committee on Dental Education and Hos- pitals support the desirability of dental boards and constituent dental societies developing mechanisms to insure the continued competence of dental practitioners but expresSed concern about the suggestion that continuing education be considered as a condition for relicensure.22 In response to these developments, the Council on Dental Education presented to the House of Delegates a "Statement on Dental and Dental Hygiene Licensure," which included a recom- mendation that constituent dental societies in consultation with State Boards of Dentistry should take immediate and aggressive steps to develop mechanisms to insure the continued competence of 2°Ibid. 21Ibid. 22Reginald H. Sullens, "What is the Present ADA Situation? What Will it Ask the House of Delegates to Do With Pending Resolu- tions to be Submitted?" Journal of the American College of Dentists, Vol. 36 (June, 1969), p. 192. 24 all dentists licensed in their jurisdiction." It was further sug- gested that such steps might include consideration of requiring continuing education for licensure renewal under provisions de- veloped within each of the individual states.23 After extensive debate, the House of Delegates voted to recommit the resolution to the Council on Dental Education for further study and to report to the 1968 House.24 In 1968, the House of Delegates of the American Dental Association passed a resolution submitted by the Council on Dental Education to the effect that dental societies, in consultation with state boards of dentistry, are urged to develop mechanisms to foster the continued education of dentists licensed in their jurisdiction. During the 1968 Annual Session, a proposal was introduced that would amend the By-laws of the Association to permit constituent societies to require reasonable standards of continuing education for the maintenance of membership. The Council on Dental Education prepared the necessary by-law amendment changes, which were approved at the 1969 session of the House of Delegates.25 In December, 1968, a special session of the House of Dele- gates of the Minnesota Dental Association was called, and the pro- posed dental act after careful consideration and minor revision was adopted by the state dental association. The bill was introduced during the 1969 state legislature session and became law on 23Ibid. 24Ibid. 25Emanuel H. Malamed, "Continuing Education and Renewal of the Dental License: A Conference," Journal of the American Dental Association, Vol. 80 (February, 1970), p. 121. 25 June 6, 1969. The initiative for this legislation came from the Minnesota Dental Association.26 Minnesota had no models to follow, since it was the first state to require continuing education for the relicensure of its dentists. The requirements were: seventy-five clock hours continuing education for a five-year period, 1974-79. The reasoning for the five-year period rather than a one or two-year period was that the longer requirement period would protect the individual dentist from undue hardship in meeting the requirement because of temporary illness or disablement.27 In 1969, the American Dental Association's House of Dele- gates amended the By-laws, Chpater I, Section 30, Definition of "Good Standing:" "A member of this Association whose dues for the current year have been paid shall be in good standing, who is under disciplinary sentence of suspension shall be designed as a 'member in good standing temporarily under suspension' until his disciplinary sentence has terminated and provided further that a member engaged in practice, to remain in good standing, may be required to meet standards of continuing education established within the by-laws of his constituent society." This passage allowed constituent societies to link a continuing education requirement to membership.28 26Robert E. McDonnell, "The Minnesota Experience: Imple- menting Mandatory Continuing Education,” Journal of the American Dental Association, Vol. 92 (June, 1976), p. 1223. 271bid., p. 1224. ~ 28Rexford E. Hardin, "Continuing Education Has Many Unre- solved Questions," Ohio Dental Journal (September, 1970), p. 309. 26 By May, 1970, Kansas became the second state to institute mandatory continuing education. Kansas' requirement was: ninety hours of continuing education over a three-year period.29 On September 2, 1970, Kentucky became the third state to require continuing education for relicensure. Twenty points every two years was the requirement.30 During the same period, the District of Columbia Dental Society added continuing education requirements to its By-laws.31 In 1970, the Colorado Dental Association made mandatory continuing education a requirement for membership. It stipulated that continuing education report forms be submitted by component societies with dues.32 At the same time, the Board of Governors of the Dental Society of the State of New York met in Buffalo and decided to support legislation which would make continuing education mandatory for re-registration. This was to be administered by the Department of Education and was to be for all health professions and was not to single out dentists.33 January 1, 1971, the Washington State Dental Association 29Continuing Dental Education Requirements for State Dental Relicensure andiConstituent Society Membership, Division of Educa- tional Measurements, Council on Dental Education, American Dental Association (211 East Chicago Avenue, Chicago, Illinois, 60611),p. 11. 3°Ipid., p. 4. 311bid., p. 7. 32Ibid. 33Joseph L. Hozid, "Role of Continuing Education in Dental Obsolescence," Journal of the American Dental Association, Vol. 78 (June, 1969), p. 1300. 27 instituted continuing education as a requirement for membership.34 North and South Dakota adopted continuing education as a necessary requirement for relicensure in the summer of 1971.35 On September 18, 1971, the Nevada Dental Association also adopted continuing education as a requirement for membership.36 January 1, 1972, continuing education became a requirement for membership in the Arizona State Dental Association. The requirements were twelve hours each year.37 March 4, 1972, the California Board of Dental Examiners had the state legislature enact a bill authorizing licenses of dentists be renewed in two-year intervals after showing that the dentist had pursued one or more courses of satisfactory study. This was to be a voluntary program.38 The Florida Dental Association also adopted continuing education as a requirement for membership. The requirement was to show evidence of thirty-five hours of continuing education a year.39 34Continuing Dental Education Requirements for State Dental Relicensure and Constituent SOEiety_Membership, Division of Educa- tional Measurements, Council on Dental Education, American Dental Association (211 East Chicago Avenue, Chicago, Illinois, 60611),p. 4. 351bid. 361bid., p. 7. 37Ibid. 38Leonard S. Janofsky, "Should a Lawyer's License to Practice Be Good for Life?" California State Bar Journal, Vol. 48 (March- April, 1973), p. 123. 39Continuing Dental Education Requirements for State Dental Relicensure and Constituent Society Membership, Division of Educa- tional Measurements, Council on Dental Education, American Dental Association (211 East Chicago Avenue, Chicago, Illinois, 60611),p. 4. 28 Pennsylvania also had continuing education requirements. Pennsylvania required completion of one course and/or attendance at a scientific meeting of a dental organization every two years for relicensure. By 1972, the following states, Kansas, Kentucky, Minnesota, North Dakota and South Dakota had instituted this requirement. In four other states the dental societies made con- tinuing education a requirement for membership. Three other states passed enabling legislation and eighteen states were inves- tigating the revision of their state laws. The New York Medicaid program and the proposed Kennedy-Griffiths national health insurance plan (S3 and HR22) required evidence of continuing education. Con- tinuing education was also required for membership in the Academy of General Dentistry. Some other dental specialty groups were also considering such a requirement.40 May, 1973, the Louisiana Dental Association instituted continuing education as a requirement for membership.41 Cali- fornia and New Hampshire enacted enabling legislation to do the same and similar legislation was being considered in Alaska, the District of Columbia, New York, and Vermont.42 4OErik D. Olsen, ”Continuing Education-—The Stepchild of Dental Education," Journal of Dental Education, Vol. 36 (June, 1972), p. 24. 41ContinuingDental Education Requirements for State Dental Relicensure and Constituent Society Membership, Division of Educa- tional Measurements, Council on Dental Education, American Dental Association (211 East Chicago Avenue, Chicago, Illinois, 60611),p. 7. 42Richard A. Marsh, ”Trends in Continuing Education--Where Are We Now? Where Are We Going in North Carolina?" South Carolina Dental Journal (Fall, 1973), p. 44. 29 In 1974, the Council on Dental Education issued its "Guidelines for Continuing Dental Education." These guidelines were approved by the American Dental Association House of Dele- gates. Activities and objectives of continuing dental education were given in the guidelines and responsibilities as to sponsor- ship, administration, curriculum, education, methodology, eval- uation, faculty, facilities, and budget were outlined.43 On January 1, 1974, California required dentists to com- plete fifty hours of continuing education every two years.44 In May, 1974, South Carolina's Dental Association instituted continuing education as a requirement for membership.45 As of January, 1975, only seventeen states were ngt_considering adoption of some type of continuing education program.46 A landmark resolution introduced by the Eleventh District Dental Society was adopted by the Board of Governors at its New York meeting of December, 1975. The resolution stated, "The Dental Society of the State of New York is in favor of acceptable minimal continuing education credits to be periodically submitted by practicing dentists to the Board for Dentistry of the New York 43"Continuing Education in United States Dental Schools," Journal of the American Dental Association, Vol. 92 (June, 1976), pp. 1225-1229. 44ContinuingDental Educational Requirements for State Dental Relicensure and Constituent Society, p. 4. 451pid., p. 8. 46Joseph C. Morganelli, "Current Status of Continuing Educa- tion," Illinois Dental Journal, Vol. 44 (October, 1975), p. 657. 30 State Department of Education as a requisite for re-registration."47 ”Continuing dental education credits shall be rated for accepta- bility as to quality, quantity, and sponsoring educational agency by guidelines developed in conference between the Dental Society of the State of New York and the Board for Dentistry."48 Before 1969, continuing education was not required for relicensure or for maintaining membership in any state society. By 1977, eight states required continuing education for relicensure and twenty-six states were considering such a requirement. Eight societies required continuing education for membership and thirty had voluntary systems. Continuing Dental Education--Professional Attitudes A review of continuing dental education literature shows six surveys germane to this investigation were taken during the period, 1967-1971. The surveys' findings will be presented in chronological order. A seven-page attitudinal questionnaire was designed, tested, and mailed to all Kentucky dentists. The questions were related to the dentists' involvement in continuing education during 1967-68. Three hundred forty-four or 34% of Kentucky's dentists responded to the survey.49 The survey showed that 72% of the respondents had 47Joseph R. Valinote, "The Compulsory Continuing Education Debate-«Pro Advocate," New York State Dental Journal, Vol. 42 (February, 1976), p. 75. 481pid.. p. 76. 49John A. DiBiaggio, "Attitudes of Kentucky Dentists Toward Continuing Education: Results of a Questionnaire Survey,” Journal of the American Dental Association, Vol. 80 (May, 1970), p. 1042. 31 attended one or more continuing education courses during the nine-month academic period.50 The last part of the questionnaire asked the dentists to sum up their attitude toward continuing education. The statements and percentages of affirmative responses: "My attitude toward formal continuing education courses may best be summed up in the following manner: They are totally unnecessary. (2%) Although some individuals certainly need such courses, I feel that I am adequately competent without them. (4%) They are certainly necessary but are presented so poorly that I do not bother to attend them. (5%) They are necessary, well presented, and beneficial to my practice. (70%) I do not wish to comment on this question, since I have not attended enough courses to make a fair judgment. (19%) The following study was conducted under a contract from the Dental Health Section, State of Connecticut Department of Health. The title of the survey was, "Statistics--Continuing Education and Connecticut Dentists: A Questionnaire Survey." Goals of the survey.--1) To determine to what extent den- tists indicated a need for continuing education and to find out how interested they were in participating in continuing education programs, 2) to find out what the differences were between those ‘who did not, 3) to study the previous experience of Connecticut 50Ipid., p. 76. 511bid., p. 1043. 32 dentists with continuing education, 4) to compare those dentists who had taken continuing education courses with those who had not, and 5) to determine the specifics of how those dentists who were interested in taking courses would like the courses presented.52 Procedure.--A questionnaire was developed to cover the goals and the questionnaire was pre-tested on a sample of dentists in another state.53 The questionnaires were sent to all active dentists in Connecticut in December of 1966 with a supporting letter from the Chief of the Dental Section. A second mailing was sent to all den- tists whose names were not checked.54 Of the 1,940 active dentists in Connecticut, 1,192 (61%) responded to one of the two mailings of the questionnaires. There were 758 (39%) respondents to the first mailing and 434 (22%) respondents to the second mailing.55 In analyzing the responses of the respondents, a clear pattern emerged concerning their desire for continuing education. Ninety-four per cent of the respondents felt that there was a need for continuing education; while only 3% felt there was no need; 3% did not answer this question. Eighty-nine per cent said they would be willing to participate in continuing education programs; 4% were not willing. Seven per cent did not answer this question.56 52"Statistics--Continuing Education and Connecticut Dentists: A Questionnaire Survey," Journal of Connecticut State Dental Association, Vol. 43, No. 1 (1968), p. 29. 54 53Ibid., p. 29. Ibid. 55Ibid., p. 30. 56Ibid. 33 Those with previous continuing education experience were more willing to participate than those without such experience (95% versus 92%, which is statistically significant). It was also found that the first mailing respondents were more willing than the second mailing respondents to participate in continuing education programs (96% versus 92%, which is again significant).57 Those dentists who were younger, American Dental Association members, and specialists were more likely to respond to the ques- tionnaire than older dentists, non-American Dental Association members, and general practitioners.58 Almost all of the respondents thought that there was a need for continuing education and that they would participate in continuing education programs. Eighty per cent of the respondents had taken at least one continuing education course. Those who had taken courses tended to have more advanced training, higher incomes, and to be less isolated by virtue of their association with other dentists and membership in the American Dental Association than respondents not taking courses.59 Dentists who wanted to take continuing education courses tended to prefer courses which would have immediate application in a general practice.60 Should continuing education become compulsory as a prere- quisite for renewal of the dental license? Members of the Phila- delphia County Dental Society discussed that question in detail at 57Ibid. 58Ibid., p. 31. 591bid., p. 32. 60Ibid. 34 a conference entitled, ”Continuing Education and Renewal of the Dental License." The conference was sponsored by the Society's Council on Dental Health and took place on March 5, 1969. Six panelists addressed the conference-~three in favor of mandatory continuing dental education and three against. In addition to the panelists, there was dental historian Milton Asbell, who traced the background of dental licensure.61 The participants in the discussions that followed the presentation were invited guests who represented dental groups in the area and specialty groups: state board examiners from four surrounding states, officers and trustees of constituent societies, officers of component societies, members of dental hygienist and dental assistant groups, and dentist members of the Philadelphia . Board of Health.62 I A questionnaire was circulated and completed by participants and guests at the work conference. The form was filled out at 10 A.M. when the conference began and again toward the end of the meeting at 3 P.M. The majority of the respondents to the question- naire favored compulsory continuing education and believed that organized dentistry on the constituent level should be responsible for the continuing education of the practitioner.63 It should be noted that in answer to the first question, the majority of the group favored compulsory continuing education 61Emanual H. Malamed, "Continuing Education and Renewal of the Dental License: A Conference," Journal of the American Dental Association, Vol. 80 (February, 1970), p. 331. 62 63 Ibid., p. 332. Ibid., p. 333. 35 Questionnaire circulated at work conference. The form wa out when conference began and again at end of conference. g4filled Questionnaire 10 A.M. 3 P.M. % Yes % No % Yes % No Where do you stand? I favor compulsory continuing education 58 42 56 32 I favor voluntary continuing education 41 30 43 25 My source of continuing education: Continuing education courses 9O 65 94 54 Scientific meetings 94 68 84 51 Reading of journals 79 57 77 44 Reading of textbooks 68 49 70 41 ADA package library 16 12 22 13 Where have you seen this statement? "Every dentist has the obligation of keeping his knowledge and skill freshened by continuing education through all of his professional life." ' Code of Ethics 68 49 85 49 Constitution 0. 7 O. 2 Other 26 19 17 10 Who shall assure that the dental practitioner engages in continuing education? Organized dentistry on the constituent (state) level 50 36 57 33 Organized dentistry on the component (county) level 48 35 49 28 State board of examiners 26 19 43 25 State board of health 0. 2 0. 1 The individual dentist 33 24 22 13 Total returns 72 57 64mid. 36 and that the views changed very little even when strong arguments were presented for voluntary continuing education. In March, 1969, the Medical Foundation Incorporated with the support of six New England health departments and the cooperation of the six state dental societies conducted a study of continuing education of dentists in those states. The purpose of the study was to determine whether dentists wanted to participate in contin— uing education programs, how those dentists who wanted to partici- pate differed from those who did not, what previous experience the dentists had with continuing education, how those dentists who had taken continuing education courses differed from those who had not, and the nature of program content and presentation desired by the dentists.65 A questionnaire was developed, pre-tested, and mailed to all active dentists in New England with a supporting letter from appropriate state dental society of state division of dental health. Of the 6,749 active dentists in the six states, 4, 114 (61%) responded. On a state-by-state basis, the total response rates ranged between 56% and 81%.66 Desire for continuing education.--Almost all (94%) of those responding to the questionnaire answered the question on willingness to participate in continuing education programs. Of those respond- ing to this question, 94% indicated a willingness to participate.67 65H. Wechsler, et. al., "Continuing Education and New England Dentists: A Questionnaire Survey," Journal of the American Dental Association, Vol. 78 (March, 1969), p. 573. 661bid. 67Ibid. 37 On a state-by-state basis, the percentages of those willing to participate were: Connecticut--95%, Maine--92%, Massachusetts-- 94%, New Hampshire—-94%, Rhode Island-~96%, and Vermont--94%.68 The question about previous participation in continuing education was answered by 95% of the respondents. Of those answering this question, 77% had taken at least one continuing edu- cation course. A greater proportion of those respondents who had taken courses than those who had not indicated a willingness to participate in continuing education programs (95% versus 92%). All comparisons were analyzed by the chi-square statistic, with those who did not answer the question excluded. Differences are reported only in those instances where they reach the .05 level of 69 statistical significance. Nature of continuing education interest of respondents.-- Dentists who wanted to take continuing education courses tended to prefer courses which would have immediate application in a general practice. Almost all of the respondents said that they would participate in continuing education programs. Those who had not taken courses tended to attribute this to lack of time or distance to travel rather than to lack of interest or need.70 Most of the respondents to the questionnaire had taken at least one continuing education course. Those who had taken courses tended to have more advanced training, higher incomes, and to be less isolated by virtue of their association with other dentists and membership in the American Dental Association than respondents not 68Ibid. 691bid., p. 574 7OIbid., p. 575. 38 taking courses. In terms of these criteria, those who have taken continuing education courses may be considered to be less in need of them than those who have not.71 In August, 1969, the State University of New York at Buffalo School of Dentistry surveyed Western New York dental prac- titioners to gain insight into the effectiveness of the dental school's continuing education programs and to get suggestions about how to improve them.72 Procedure.--A mailed questionnaire with a letter of intro- duction, a postage-paid, self addressed envelope was sent to a random sample of half the almost 1,000 dentists in Western New York, an area including the counties of Erie, Niagara, Wyoming, Genesee, Allegany, Chautauqua, and Cattaraugus.73 It took six months to collect the data. Three-quarters of the active practitioners in the original sample responded. Over 90% of all the respondents had attended continuing education courses. Most of the respondents had taken three or more contin- uing education courses since graduating from dental school.74 When the respondents were asked about the importance of continuing education, almost all of them felt continuing education to be important for them "personally," 61% said continuing education was very important, 32% said fairly important, while 2% 71Ibid. 72Edward Petit and Robert O'Shea, "Participation in Contin- uing Education in Western New York--Some Survey Results," New York State Dental Journal, Vol. 37 (October, 1971), p. 485. 73 74 Ibid. Ibid., 486. 39 indicated that continuing education was of no importance to them.75 The Ohio Dental Association held a Continuing Education Conference July 25-26, 1970 in Granville, Ohio. The conference was the result of a year and a half of planning. All Ohio component societies except two were represented by at least one conferee. The theme of the conference: "Is it enough? Is the Principles of Ethics of the Ohio Dental Association a sufficient motivating force for Ohio dentists to continue their education? If not, then what action should be taken to assure continuing competency? What are the proper goals of continuing education? Should continuing education be tied to relicensure? Should it be mandatory or voluntary?“76 After the main conference, delegates assembled into three study groups to express opinions and draw conclusions. Generally, they agreed on several points: 1) The Ohio Dental Association should do something about continuing dental education. 2) Nearly all opposed legalistic or compulsory continuing education. 3) Most believed a voluntary program administered by the Ohio Dental Association would be beneficial. Coordination of the present continuing education delivery systems and greater correlation among programs presently available was urged. 4) Programs developed with reward mechanisms or merit systems were supported. 7516id., p. 487. 76"Continuing Education Conference--Is This Enough?" Ohio Dental Journal (September, 1970), p. 320. 40 5) Some conferees supported linking Ohio Dental membership to a certain continuing education requirement though the sentiment was not great.77 Other comments of importance made in the study groups: 1) To equate any degree of competency with participation in post- graduate courses is very difficult. The majority believed that such post-graduate courses would enhance the individual's know- ledge even though a standard couldn't be applied to measure the value derived. 2) The groups believed that any laws concerning a mandatory continuing education requirement as a prerequisite to relicensure would be difficult to enforce. Once delegate cited an Oregon attorney's opinion that a landslide of legal suits would be brought to any state administrative agency trying to enforce such a law. These repercussions would undoubtedly be costly to the state agency and have a far reaching effect toward repeal of the law. 3) Delegates believed tying compulsory continuing education to state dental society membership unwise. Since about 10% of Ohio's dentists aren't Ohio Dental Association members, they wouldn't be bound by any regulations established by the association. The need to motivate people to want what they need was emphasized and finally the delegates were 100% in favor of continuing education.78 The following preliminary report of the Ohio Dental Asso- ciation Continuing Education Survey was presented: 77Ibid., p. 325. 78Ibid. 41 Statistical report of component society membership response to the 1970 Continuing Education Survey, conducted in Ohio by the Ohio Dental Association's Committee on Continuing Education, Total Membership Ohio Dental Association--4,407 Total Response (July 25, 1970)--2,210 Questions in the survey germane to this study: 5. Do you feel it is necessary to make continuing education compulsory? Yes--26%; No--69% Do you feel that voluntary continuing education satisfies your needs? Yes--93%; No--5% Does voluntary continuing education satisfy the needs of the whole profession? Yes-~45%; No--40% If a continuing education program were imposed on Ohio dentists, who would you rather have sponsor and direct such a program? (a) The State Dental Board--11% (b) The State Department of Health--1% (c) The State Welfare Department--O% (d) The Federal Government—-1% (e) Organized Dentistry--80% Do you believe dentists should be re-examined periodically in order to qualify for relicensure? Yes--12%; No--84% (a) Would you object to re-examination? Yes--12%; No--38% (b) If you object, would you be willing to carry your fight to court? Yes--41%; No--19% Have you participated in some form of continuing education during the past 12 months? Yes--89%; No--9% In the spring of 1971, a workshop was held in Alabama to study dental professional development in that state. Speakers from all over the country were invited to address the issues: voluntary continuing education and mandatory continuing education. At the end of the workshop, a recommendation was made that Alabama 79"Continuing Education Conference--Is This Enough?" Ohio Dental Journal (September, 1970), pp. 322—323. 42 ppp_favor requiring mandatory continuing education but that a suggested plan for voluntary continuing education be established for dentists in the state.80 The recommendation was adopted by the House of Delegates of the Alabama Dental Association and the Council on Dental Education and Licensure was charged with the responsibility of implementing such a plan. (Alabama elected to follow Mississippi's Volunteer Plan.)81 Continuing Dental Education--Summary This section has traced the separation of dentistry from medical education. A review of the literature shows the American Dental Society via its code of ethics has long recognized the need for a 'lifetime of learning.‘ This investigation has shown that continuing dental education as it is now constituted, developed after World War II in response to the expressed needs of dentists returning from their tour of duty. The 1964 Workshop of Dental Examiners and Educators pro- vided the first real forum for the discussion of mandatory contin- uing education for dentists. Two years later, the State of New York mandated continuing education for practitioners partici- pating in Medicaid. 80Kirby Walker, Jr., "A Possible Solution to Our Continuing Education Dilemma," Journal of the Mississippi Dental Association, Vol. 28 (May, 1972), p. 26. 81 Ibid. 43 Before 1969, continuing education was not required for relicensure or for maintaining membership in any state society. By 1977, eight states required continuing education for relicensure and twenty-six states were considering such a requirement. Eight societies required continuing education for membership and thirty had voluntary systems. Finally, this investigator discussed some attitudinal surveys about continuing education (elective and mandatory). An analysis of these surveys shows that most dental practitioners agree that continuing education is necessary if they are to keep up with advances in dental research and incorporate new technics in their practice. Elective Continuing Legal Education A review of the literature shows that elective continuing legal education, which is quite common today, began in an aura of relative obscurity.82 Absence of a national organization designed to promote such programs fostered this environment. State and local bar associations had very little interest in their members' continuing education. What activity that did occur did so on a local level. On August 31, 1878, the American Bar Association (ABA) was organized at Saratoga Springs, New York, in a meeting which had a rather Small number of lawyers in attendance. Although the 82The 1975-76 Fall/Winter CLE Catalog shows there were 424 scheduled and 138 proposed continuing legal education programs reported in the United States. 44 membership continued small for a number of years, the Association was very influential. This was so because the membership was composed of prominent attorneys "who came from widely separated geographical areas."83 One of the original purposes of the ABA was the improvement of legal education and admissions to the bar. The first constitution of the American Bar Association provided for a Committee (now Section) on Legal Education and Admission to the Bar.84 Its main attention was focused on practical legal education leaving continuing legal education to local bar associations and to the law schools. These two groups shifted the burden to the practitioner.85 The first formal continuing legal education program was sponsored by the New York University School of Law in 1891.86 Its 'purpose was to supplement the course of study for the LL.B. Although the ABA Section of Legal Education and Admissions to the Bar had been established in 1893, it was not until the late 1930's that the Section itself engaged in any significant continuing legal education activities.87 83Edson R. Sunderland, History of the American Bar Asso— ciation and Its Work (Ann Arbor: Reginald H. Smith, 1953), pp. 3-13. 84Russell N. Sullivan, "The Professional Associations and Legal Education," Journal of Legal Education, Vol. 4 (1951-52),p.401. 8SIbid. 86Norris Darrell, "The Role of the Universities in Contin— uing Professional Education," Ohio State Law Journal, Vol. 32 (1971), p. 312. 87Herschel H. Friday, "Continuing Legal Education: His- torical Background, Recent DevelOpments and the Future," St. John's Law Review, Vol. 50:502 (1976), p. 503. 45 In 1916, the New York City Bar conducted review courses for its members.88 These courses consisted of a series of lectures for the benefit of the general practitioner. The courses were successful and except for a hiatus during World War I, continued into the 1930's.89 The Lawyers Chatauqua was founded in Emmetsburg, Iowa, July, 1924. It was sponsored by the District Bar Association of the Fourteenth Judicial District. The three-day program included round table discussion of evidence and pleading and the effective- ness of court proceedings.90 The Minnesota State Bar Association formed a committee on professional techniques in 1929. The purpose of this committee was to arrange meetings of local bar associations to discuss legal problems.91 The institutionalization of formal programs in continuing legal education in the United States seems to have begun in the early 1930's under the direction of Mr. Harold P. Seligson, in what was to become the Practising Law Institute (PLI) of New York. 88"Once You're In: Maintaining Competence in the Bar," Nebraska Law Review, Vol. 56, No. 3 (1977), p. 679. . 89Herschel H. Friday, “Continuing Le al Education: His- torical Background, Recent Developments and he Future," St. John's Law Review, Vol. 50:502 (1976), p. 502. 90Burt J. Thompson, "Legal Institutes for Every Local Lawyer," Indiana Law Journal, Vol. 15, No. 36 (1939), pp. 45-46. 91Task Force on Mandatory Continuing Legal Education in Ohio, Report of the Task Force, MCLE: The Rule Against Perpetuity-- A Survey Research and Comparative Approach—(Ohio Northern University Law Review, Vol. 3, No. 4A, 1976), p. 929. 46 Although a series of lectures was given by Dean Roscoe Pound, under the auspices of the Cleveland Bar Association in 1931, Mr. Seligson is generally credited with the institutionalization of Continuing Legal Education.92 Mr. Seligson introduced the Practising Law courses because he realized the need for some mechanism to bridge the gap between theory and the practical aspects of the law. The initial session of these courses consisted of sixteen (16) lectures given by four (4) lawyers and was attended by fifteen (15) recent graduates.93 During this same time period, the state bars of Minnesota and Wisconsin also developed successful well-attended Continuing Legal Education Programs.94 The Minnesota Bar established the Committee on Legal Clinics. The purpose of these clinics was to foster a closer bond among attorneys and to provide professional aid and information. By 1934, the Committee had programs in fifteen (15) judicial districts. In 1931, the Cleveland Institutes were initiated by Walter L. Flory. The program was so successful that the Cleveland Bar Association continued it and by 1938, eleven (11) series of 92Neil Gold, "Continuing Legal Education: A New Direction," Ottawa Law Review, Vol. 7:62 (Winter, 1975), p. 65. 93Harold P. Seligson, "Post-Admission Education for Lawyers," American Bar Association Journal, Vol. 22 (1936), p. 231. 94Herschel H. Friday, "Continuing Legal Education: His- torical Background, Recent Developments and the Future," St. John's Law Review, Vol. 50 502 (1976), p. 503. 47 lectures were held with 400 to 600 attorneys present at each one.95 Dean Roscoe Pound was ipg_lecturer when the series was launched in 1931.96 It wasn't until 1936 at the 59th Annual Meeting in Boston, of the American Bar Association that the ABA showed any interest in Continuing Legal Education (CLE). In its 1937 report, the Section of Legal Education of the ABA recommended that the ABA sponsor and encourage a nationwide program of post-admission legal education for the benefit of the legal profession.97 Between 1937 and 1940, the ABA aided a large number of state and local bars in the presentation of well-attended programs. During this period, Herbert Wenig, a young San Francisco practitioner, prompted the Stanford Law Society to conduct a lecture series similar to Seligson's. This suggestion was implemented on March 3, 1937.98 "The introduction in 1938 of the Federal Rules of Civil Procedure (Rules) gave impetus to the Continuing Legal Education movement. The ABA Section of Legal Education and Admissions to 95Walter L. Flory, "Concerning Law Institutes--Their Organ- ization and Purpose," American Bar Association Journal, Vol. 24 (1938). p. 829. 96Herschel-H. Friday, "Continuing Legal Education: His- torical Background, Recent Developments and the Future," St. John's Law Review, Vol. 50:502 (1976), p. 502. 97Task Force on Mandatory Continuing Legal Education in Ohio, Report of the Task Force, MCLE: The Rule Against Perpetuity-- A Survey Research and Comparative Approach (Ohio Northern University Law Review, Vol. 3, No. 4A (1976), p. 931. 98Hon. Maurice T. Dooling, Jr., "The Stanford Law Society's Experiment in Post-Graduate Instruction for Lawyers," California Bar Journal, Vol. 12 (1937), p. 109. 48 the Bar and the School of Law at Case Western Reserve University sponsored a three-day program on the Rules prior to the ABA Annual Meeting in Cleveland."99 The ABA also sponsored institutes on the Rules in Washington, D.C. and New York City. The programs were so well received, that over twenty (20) cities held lectures on that topic alone in subsequent months. During the year 1938, the Illinois and Missouri Bar Associ- ation together with their law schools arranged local bar associ- ation continuing education speaker programs. Other law associa- tions began to follow suit: Buffalo, Chicago, Philadelphia, Los Angeles, and Toledo. Continuing Legal Education received its biggest boost after World War II when attorneys began returning to their practices from the armed forces and needed to refresh their skills and be updated on interim developments. The American Bar Association (ABA) cooperated with the Practising Law Institute (PLI) in presenting these courses. By mid-1945, the PLI had organized courses in twenty-four states and had planned them in ten more.100 In 1947, the ABA entered into a Memorandum of Understanding with the American Law Institute (ALI) pursuant to which the Com- mittee on Continuing Legal Education of the ALI with representation 99Herschel H. Friday, "Continuing Legal Education: His- torical Background, Recent Developments and the Future," St. John's Law Review, Vol. 50:502 (1976), p. 503. 100Neil Gold, "Continuing Legal Education: A New Direction," Ottawa Law Review, Vol. 7:62 (Winter, 1975), p. 66. 49 by the ABA was created.101 The Committee was formed to develop a national program for Continuing Legal Education and to aid in the creation of local programs in all parts of the United States.102 In 1958, the Committee was re-named the ALI-ABA Joint Committee on Continuing Legal Education, and in 1974, it was changed to the ALI-ABA Committee on Continuing Professional Education.103 The three most significant contributions made by the Com- mittee was its sponsorship of three national conferences on contin- uing legal education in 1958, 1963, and 1967.* The Illinois State Bar Association, through its Sections, sponsored many continuing legal education programs in the late 1940's and during the 1950's. The first of these were offered as refresher courses for returning veterans of World War II.104 As a result of this experience, the Illinois State Bar Association concluded that practitioners of all ages and at all levels of experience wanted continuing legal education on a * 1958 Arden House I, Harriman, New York; 1963 Arden House II, Harriman, New York; 1967 Conference on Continuing Legal Education and the Law Schools, Washington, D.C. 101Herschel H. Friday, "Continuing Legal Education: His- torical Background, Recent Developments and the Future," St. John's Law Review, Vol. 50:502 (1976), p. 504. 102Hon. Maurice T. Dooling, Jr., "The Stanford Law Society's Experiment in Post-Graduate Instruction for Lawyers," California Bar Journal, Vol. 12 (1937), p. 109. 103Herschel H. Friday, "Continuing Legal Education: His- torical Background, Recent Developments and the Future," St. John's Law Review, Vol. 50:502 (1976), p. 502. 104George A. M. Heroux, "The Institute on Continuing Educa- tion of the Illinois Bar: What's it all About," Illinois Bar Journal (January, 1968), p. 358. 50 permanent basis given locally at times and places convenient to them. This presented a problem for the bar. In order to deal with the problem, the State Bar Association decided to establish a separate entity to do such things as planning, financing, organ- izing, and presenting programs. On November 24, 1961, the Institute on Continuing Education of the Illinois Bar was estab- lished by Article VI of the by-laws of the Illinois State Bar Association Foundation. (Shortly after, this organization was re-named the Illinois Bar Foundation.)105 The first national conference dealing with the issue of continuing legal education was held at Arden House in Harriman, New York, December 16-19, 1958. The purpose of this conference was to share the experiences of states and institutions with developed continuing legal educa- tion programs, analyze the status of continuing legal education, formulate future programs, and devise a method for rapid imple- mentation of these future programs. Conclusions reached at Arden House I included allocating the responsibility for continuing legal education in each state to its bar association. This responsibility included encourage- ment and coordination of the activities of the bar, the law schools, and other groups in each state.106 105George A. M. Heroux, "The Institute on Continuing Educa- tion of the Illinois Bar: What's it all About,“ Illinois Bar Journal (January, 1968), p. 358. 106Paul Wolkin, "Annual Report ALI-ABA Committee on Contin- uing Professional Education," Part VI of a six-part article, .ALI-ABA/CLE Review, Vol. 6, No. 34 (August 29, 1975), p. 4. 51 In 1960, the Association of Continuing Legal Education Administrators (ACLEA) was formed to study more efficient means by which continuing legal education programs could be effected. By 1975, the membership of ACLEA numbered over sixty (60) and came from thirty-nine (39) different states.107 In 1963, the Second National Conference on Continuing Legal Education was held at Arden House, and was called Arden House II. The topic of the conference, "Continuing Legal Education and the Law Schools." The focus of the conference was improving the quality and expanding the reach of Continuing Legal Education Programs. Two needs were emphasized: (1) providing law school graduates with practical skills and (2) coordinating the numerous organizations offering Continuing Legal Education Programs.108 The primary conclusion reached at this conference was that the responsibility for continuing education was basically on the organized bar but that the law schools had an important contri- bution to make. The law schools, in fact, had an obligation to assist in continuing legal education.109 On May 20 and 21, 1967, the Third National Conference on Continuing Legal Education was held at the Mayflower Hotel in Washington, D.C. The central theme of the conference was how to 107Hersche1 H. Friday, "Continuing Legal Education: His- torical Background, Recent Developments and the Future," St. John's Law Review, Vol. 50:502 (1976), p. 505. 108Ibid. 109Paul Wolkin, "Annual Report ALI-ABA Committee on Contin- uing Professional Education," Part VI of a six-part article, ALI-ABA/CLE Review, Vol. 6, No. 34 (August 29, 1975), p. 4. 52 assure quality in continuing legal education programs. Repre- sentatives of all major bar associations and all other groups active in continuing legal education attended the conference. "The combined summary of views of the con- ference stated in part: There is, however, too little understanding of the fact that no lawyer adequately fulfills his role in society unless he continues his legal education throughout his entire professional career. To this end, the entire legal profession, including the organized bar, the law schools, and other groups with specialized interests should con- stantly seek new ways to prpTBte continuing legal education of high quality." "Greater interest and involvement in con- tinuing legal education by members of law school faculties would also help to improve the quality of continuing legal education. Law schools should devote more concern and recognition to continuing legal education. Accordingly, every effort should be made by all interested organizations to encourage greater interest and inyolvement by law schools and their faculties." 1 December 13, 1968, the Institute for Continuing Legal Education came into being. It was an outgrowth of the Institute on Continuing Education of the Illinois Bar which began in 1961. The Institute is now one of the best known and most suc- cessful continuing legal education organizations in the United States. Its rapid growth can be attributed directly to: (1) the excellent cooperation of Illinois-lawyers in serving as course lecturers, as practice handbook authors and editors, and as plan- ning committee members, (2) the reception of continuing legal 110Association of American Law Schools Programs and Pro- ceedings, "Report of the Committee on Continuing Legal Education,” Vol. 67 (Association of American Law Schools Programs and Pro- ceedings, 1968), p. 15. 111Ibid. 53 education as a necessary concept by the Illinois Bar in general.112 On January 1, 1975, under the aegis of the Standing Com- mittee on Continuing Education of the Bar, the American Bar Associ- ation established the new staff, Division of Professional Education for implementation of American Bar Association--Continuing Legal Education Activities. The Division of Professional Education staff took responsibility for the National Institutes program.113 Mandatory Continuing Legal Education A review of the literature shows that one of the purposes of continuing legal education is that it should offer an opportunity for a broadening of the professional base. In 1971, the California Legislature adopted a resolution requesting the California Bar to develop and submit a program for maintaining continuing professional competence.114 In 1972, a mandatory system for continuing education was recommended to the Kansas Bar Association by its Continuing Legal Education Committee.115 A proposal for mandatory continuing legal education was written by the Minnesota State Bar Association. Another report 112George A. M. Heroux, "The Responsible Lawyer's Respon- sibility: Continuing Legal Education," Chicago Bar Record, Vol. 51 (December, 1969), pp. 155-156. 113Herschei H. Friday, "Continuing Legal Education: His- torical Background, Recent Developments and the Future," St. John's Law Review, Vol. 50:502 (1976), p. 509. 114"Mandatory Continuing Legal Education," Michigan State Bar Journal, Vol. 54 (October, 1975). 115Ibid. 54 recommending mandatory continuing legal education was discussed at meetings throughout the state from 1972 to 1974. The idea won the support of the bar. Formal approval of the plan by the Minnesota Supreme Court was announced in an order issued by the Court on April 3, 1975. Minnesota's Plan required evidence of forty-five hours of formal course work every three years.116 Earlier in 1975, the Iowa Supreme Court requested comments from members of the legal profession by March 11, 1975 on a rule of the court providing for a system of compulsory continuing legal education. The rule was adopted by the court and an order was issued on April 9, 1975. At the same time, compulsory continuing legal education plan was submitted to the Wisconsin Supreme Court by the board of governors of the State Bar Association of Wisconsin.117 1 Between May and August, 1975, mandatory continuing legal education proposals were before the State Supreme Court in Washington and the governing bodies in Alabama, Colorado, Idaho, Maryland, and Nebraska.118 At the same time, Bar Associations in Arizona, Georgia, Illinois, Kansas, Kentucky, Louisiana, Massachusetts, Michigan, Missouri, New Mexico, New York, North Carolina, Oklahoma, Oregon, South Dakota, and Texas were studying the feasibility of mandatory continuing legal education.119 116Ibid. 117Ibid. 118ALI-ABA Catalog of Continuing Legal Education Programs in the United States (Spring/Summer Supplement, 1975), p. 52. 119Ibid. 55 The only jurisdictions that had failed to report any action by September, 1975 were: Alaska, Arkansas, Connecticut, Delaware, District of Columbia, Florida, Hawaii, Indiana, Maine, Mississippi, MOntana, Nevada, New Hampshire, New Jersey, North Dakota, Ohio, Pennsylvania, Rhode Island, South Carolina, Tennessee, Utah, Vermont, Virginia, West Virginia, and Wyoming.”0 Most mandatory continuing legal education plans include the following elements: (1) Each lawyer is required to report in writing, to a supervisory agency, hours of formal course work in continuing legal education. (2) The state board of continuing legal education, which supervises the program, is approved by that state's supreme court. (This board may have lay as well as professional representation.). (3) A state administrative director of continuing legal education administers the program. (4) Cost of the program is usually passed on to each lawyer via the license fee. (5) The penalty for failure to fulfill the mandatory requirements may be probationary status and ultimately suspension from practice.121 The Fourth National Conference on Continuing Legal Educa- tion was held at the American Bar Center in Chicago on November 10-12, 1975. At this conference, judges, teachers, lawyers, administrators, and others interested in Continuing Legal Education Programs reviewed the considerations which prompted the Minnesota 120Ibid. 121"Mandatory Continuing Legal Education," Michigan State Bar Journal, Vol. 54 (October, 1975), pp. 796-797. 56 program of mandatory continuing legal education (45 hours every 3 years) and the prospects for the spread and success of such programs.122 January 1, 1976, Iowa's Mandatory Continuing Legal Educa- tion Program came into effect.123 Wisconsin's mandatory plan, effective in January, 1977, was approved by the State Supreme Court, the Bar's Board of Gov- ernors and a vote of the Bar's membership.124 By the end of 1977, the following states had mandatory continuing legal education: California, Florida, Iowa, Minnesota, Texas, Washington, and Wisconsin.125 The original impetus for Continuing Legal Education came from within the legal profession. The growth of the movement as traced through this brief review demonstrates the need for contin- uing legal education. The following section will look at atti- tudes, as expressed in surveys, toward continuing legal education. Continuing Legal Education--Professional Attitudes A review of continuing legal education literature shows 122John P. Byron, "Mandatory Continuing Legal Education in Minnesota: The First Year," St. John's Law Review, Vol. 50:512 (1976), p. 513. 123"Once You're In: Maintaining Competence in the Bar," Nebraska Law Review, Vol. 56, No. 3 (1977), p. 680. 124Paul A. Wolkin, I'On Improving the Quality of Lawyering," St. John's Law Review, Vol. 50:523 (1976), p. 526. 125Beverly T. Watkins, "Certification of Professionals: A Bonanza for Extension Programs," The Chronicle of Higher Education, April 11, 1977. 57 only three in-depth empirical studies of formalized post-graduate education at the national level and three at the state level. Additionally, three local bar associations sent questionnaires to attorneys within their jurisdictions. The three national surveys were conducted in 1961 by S. Herbert Unterberger, in 1971 by Professors Burt A. Leete and Stephen E. Loeb, and in 1976, an update of the 1961 report by Unterberger. The most significant surveys conducted by state bar assoc- iations were in Illinois (1975), Ohio (1976), and Kentucky (1977). The other state bar associations polling their members were Iowa, Wisconsin, and Nebraska.126 Although the Joint Committee on Continuing Legal Education was aware of the rapid expansion and the diversity of continuing legal education efforts, the Joint Committee felt the need for determining more quantitatively, the usefulness and effectiveness of programs and publications. The Joint Committee wanted to know the extent to which members of the bar were aware of the resources available to them, their use of these resources and their subjec- tive attitudes toward them. The Unterberger survey was designed to supply the required quantitative measurements.127 126Task Force on Mandatory Continuing Legal Education in Ohio, Report of the Task Force, MCLE: The Rule Against Perpetuity-- A Survey Research and Comparative Approach (Ohio Northern University Law Review, Vol. 3, No. 4A. 1976), p. 921. 127$. Herbert Unterberger, "The Lawyer's View of Continuing Legal Education," The Practical Lawyer, Vol. 10, No. 2 (February, 1964), p. 4. 58 A survey questionnaire was sent to a randomly selected national sample of attorneys drawn from the 1961 edition of the Martindale-Hubbell Law Directory.* This landmark survey revealed that attorneys were aware of and were attending Joint Committee- fostered continuing education programs.128 Unterberger and the Joint Committee** was pleased with the large response to the survey and with the number of respondents who supplied supplementary comments.129 The results of this study enabled the Joint Committee and other continuing legal education organizations to plan future programs and publications.130 The study by Unterberger was pre- sented at the Arden House 11 Conference. The second empirical study, the first dealing with manda- tory continuing legal education was conducted by Burt A. Leete, J.D. (Associate Professor, College of Business and Management, University of Maryland) and Stephen E. Loeb, Ph.D., C.P.A. (Associ- ate, Professor, College of Business and Management, University of Maryland). * Martindale-Hubbell Law Directory. Individual alphabetical list- ings which are published without charge or other obligation, in- clude not only lawyers admitted and located at the particular place, but also who are there although not admitted to the Bar of that jurisdiction. In the case of the latter, the fact of non-admission shows as is the State of first admission. **The Joint Committee on Continuing Legal Education of the American Law Institute and the American Bar Association. 1281bid. 129Ibid. 130"Once You're In: Maintaining Competence in the Bar," Nebraska Law Review, Vol. 56, No. 3 (1977), p. 921. 59 "In order to evaluate the feelings of attorneys toward compulsory continuing legal education, a question- naire was sent to 400 attorneys picked at random from the 1971 edition of the Martindale-Hubbell Law Directory. The sampling was done in such a manner that, without sacrificing randomness, only members in private practice were selected. Responses from individuals who indicated that they were not in private practice were excluded. As a result, 209 usable responses were received and in- cluded in thp study, a usable response rate of approxi- mately 52%.“ 3 Results.--Each person was asked if he felt an attorney should be required to demonstrate that he is continuing his pro- fessional education; 56% of those responding did not favor such a proposal. However, a substantial minority, 43.5% favored required continuing education; 0.5% gave no answer. Based on this sample, there would not appear to be a substantial consensus on this 132 issue. Conclusions.--The data gathered as a result of this survey indicates no consensus in the legal profession on mandatory contin- uing legal education. Consequently, Leete and Loeb state that it is not possible to make any positive recommendation at this time.133 With the initiation of the discussion of mandatory continuing legal education, it appeared that state bar associations would enter the continuing legal education survey field using these two studies as benchmarks for further problem analysis. Generally though, the bar associations in those states which have adopted mandatory 131Burt A. Leete and Stephen E. Loeb, "Continuing Legal Education--Should it be Compulsory," Journal of Legal Education, Vol. 27, No. 1 (1975), p. 112. 132Ibid. 133Ibid., p. 115. 60 continuing legal education plans have made only minimal contri- butions to the continuing legal education literature.134 In October, 1974, the Iowa Bar mailed a cursory ten- question survey to all the attorneys in the state. The survey instrument was patterned after the Leete and Loeb questionnaire.135 A survey was not conducted in Minnesota; the concept was ratified by an almost unanimous vote at the 1974 State Bar Associ- ation Annual Convention.136 The State Bar of Wisconsin conducted a simple "Yes-No" referendum of the attorneys in the state. The question on the referendum was: "Should rules be adopted establishing a program of compulsory education for all active lawyers licensed to practice law in Wisconsin, with the exeption of lawyers who are judges (who will 'i'2.1552133118229223.2%.p229£232.23?u1'59“ The results were: Yes-~72%, No--28%. In 1975, the Illinois Bar conducted a survey among its members to see how they felt about mandatory continuing legal edu- cation. This survey was a significant addition to the Mandatory Continuing Legal Education survey research, although only one question in the survey dealt specifically with mandatory continuing legal education.138 134Task Force on Mandatory Continuing Legal Education in Ohio, Report of the Task Force, MCLE: The Rule Against Perpetuit -- A Survey Research and ComparativegApproach (Ohio Northern University Law Review, Vol. 3, No. 4A, 1976): p. 922. 135Ibid. 136Ibid. 137Ibid., p. 923, 1051 138Ibid., p. 933. 61 The Illinois attorneys responding to the survey indicated that a slight majority, 52%, favored making continuing legal education mandatory. While those favoring mandatory continuing legal education were only slight higher, some characteristics could be noted among those opposing the adoption of a mandatory system. Those opposed to mandatory continuing legal education were also likely to oppose formal specialization. Attorneys associated with large firms, admitted to prac- tice over 20 years and earning in excess of $90,000 were also likely to be against adoption of mandatory continuing legal education.139 Early in 1976, a second national survey was conducted by 3. Herbert Unterberger.* The purpose of this survey was (1) to bring some of the early data up-to-date and trace changes in atti- tudes over the intervening thirteen years and (2) provide more detailed information on attendance at continuing legal education programs and their evaluation as well as on other matters of interest (such as the extent to which lawyers read legal publica- tions, their use and reaction to recorded self-education materials, their preference among current proposed methods for assuring the competency of lawyers, and their views on according formal recogni- tion to specialization).140 * Professor of Economics, Lehigh University, Bethlehem, Pennsylvania. 139Illinois State Bar Association, "Economics of Legal Services in Illinois--A Special Bar Survey," Illinois Bar Journal, Vol. 54 (1975), pp. 81-85, 102-110, 127-134. 140S. Herbert Unterberger, "The Lawyer's View 1976 Continu- ing Legal Education," The Practical Lawyer, Vol. 22 (Oct. 1976),p.71. 62 Questionnaires were sent to a statistically selected sample of 7,500 lawyers listed in the Martindale-Hubbell Law Directory and to all of the approximately 2,000 members of the American Law Institute. The results are summarized below, which indicates the percentage of respondents agreeing with the follow- 141 ing statements. 3 L3 3 C cu: C m .00) CD r-‘D E'O HU F': G): .J: <0 so <0 D. Q Q. m (m m OJ and) O) S-