The 1960s saw an increasing “brain drain” of newly graduating physicians from the Indiana University School of Medicine. The university and the statewide medical community recognized that more had to be done to retain bright young doctors in Indiana. In 1967, the Indiana General Assembly passed The Medical Education Act (Senate Bill 359), enabling legislation that authorized a $2.5 million fund for the IU School of Medicine to strengthen internships, residencies and continuing medical education programs in community hospitals across the state. The legislation helped establish a telecommunications network to connect the IU School of Medicine with other institutions and facilitate statewide medical education. After being tasked with establishing and overseeing a statewide medical education system, the IU School of Medicine identified potential locations for community teaching and training programs and established a Medical Education Board to recommend policies regarding intern and residency programs and allocate funds for those programs.
One of the major accomplishments of Glenn W. Irwin, Jr., MD, who was named the fifth dean of the IU School of Medicine in 1965, was the creation of the Indiana Program for Statewide Medical Education (Indiana Plan) in 1967. The Indiana Plan, as presented to the state legislature, had a primary goal of reducing the number of newly graduating IU School of Medicine doctors leaving the state each year. The plan outlined multiple initiatives for improving the quantity and quality of educational opportunities for interns, resident physicians and practicing physicians.
The Indiana Plan integrated medical education resources across the state, increased medical students and residency opportunities, and prevented new medical schools in Indiana from being established so that the IU School of Medicine remained Indiana’s primary medical institution. As Indiana faced a growing shortage of doctors in the 1960s, the Indiana Plan established medical education centers in Evansville, Terre Haute, Lafayette, Muncie, Fort Wayne, Gary and South Bend. Medical classes for undergraduate students were provided at universities in these cities with IU School of Medicine faculty teaching graduate classes and providing oversight for residency programs at these centers. In 1971, House Bill 1439 was passed to formally implement the Indiana Plan and appropriated $1.75 million to support the anticipated increasing enrollment and operation of the “Seven Center” program.
A key component of The Indiana Plan was that the IU School of Medicine would establish a media production unit that would develop medical school curriculum enhancement materials as well as one of the nation’s largest closed circuit medical television networks for the dissemination of continuing medical education programing statewide. That media production unit was established as the Medical Educational Resources Program (MERP) within months of the Indiana General Assembly passing the legislation in 1967.
Television and 16mm film production for curriculum support began on a very limited basis in 1968. The convenience of videotaping — being able to shoot, playback immediately, reshoot if necessary and/or edit quickly — soon outpaced the demand for film production. The MERP television facility’s workload first began to increase by supporting the basic sciences and later exploded with projects for the sophomore Introduction to Medicine course.
After a year of basic science courses, sophomore students were always eager to finally see patients. Introduction to Medicine faculty soon saw the benefits of using MERP’s television facility to videotape cases that were common and, especially, those that were rare. Students did see patients, not just tapes, but the ability to capture a condition on tape that a physician might encounter only once, if ever, in a long career was a benefit for both current and future medical students. Most medical disciplines were represented in that second-year curriculum; some for a few days and some for a week.
Nancy C.A. Roeske, MD, director of undergraduate curriculum in the Department of Psychiatry, was quick to take advantage of MERP’s consultation and television production services beginning in 1973. She became one of MERP’s most ardent advocates, blazing a trail for clinical faculty who were faced with more responsibilities than time to adequately fulfill them.
Based on the premise that physicians should never omit the mental status examination just because a patient presents with a medical problem, Roeske developed a nine-hour interactive learning package on the psychological evaluation of patients. Her book, “Examination of the Personality,” was the foundation of the course, also named Examination of the Personality.
Five professional actors from the Indiana Repertory Theatre were contracted to study videotapes of 15 actual patients for two months. The actors were coached by Roeske and MERP TV producer Don Greene during the tapings in MERP’s studio. They portrayed a variety of major psychiatric syndromes and common reactions to physical illness. During classroom playbacks, tapes were stopped after each patient for students to write their individual assessments of that patient before moving on to the next. There was always class discussion with Roeske as well.
Later, Roeske made a concentrated effort to ensure second-year students at the various centers for medical education received the same comprehensive and uniform training for conducting the mental status examination as those on the medical center campus. She conducted a one-day workshop in MERP’s television studio for teachers from the other centers and shared excerpts from the tapes.
In a follow-up letter to Don Greene, she said: “The videotapes have been used in teaching the students in Evansville. I received a very positive letter from Dr. Thomas Liffick commenting on how much the students enjoyed the program, as did he, in teaching it. Recently I was teaching at IU Northwest in Gary. I went over the program and tapes with Dr. Galanti who will be teaching the course there in the next two weeks. She is very excited about using the material. She was one of the instructors who attended the workshop at MERP last year. It is obvious that this material is of tremendous benefit for other teachers of this course.”
Roeske’s article, “The Medium and the Message: Development of Videotapes for Teaching Psychiatry,” was the lead article in the November 1979 edition of the American Journal of Psychiatry. Requests for more information came from all over the world, including Australia, New Zealand and Japan. Several U.S. medical schools and hospitals purchased “Examination of the Personality” for their curriculum or continuing medical education programs.
While learning to do a mental status examination was important, the IU School of Medicine’s Introduction to Medicine course primarily focused on diagnosis and treatment of physical illness. Richard Powell, MD, professor of medicine, was the Department of Medicine’s coordinator for the course and led the way to use the video in the classroom. His specialty was endocrine disorders. Each year, more and more clinical faculty used MERP’s videotaping services to enhance their live lectures.
