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1986-03-03 Interview with Roy Jarecky, March 3, 1986 1986OH095 UKMC 28 01:16:33 UKMC001 University of Kentucky Medical Center Oral History Project Louie B. Nunn Center for Oral History, University of Kentucky Libraries Jarecky, Roy -- Interviews University of Kentucky. Medical Center -- History Medicine--Study and teaching Clinical clerkship Medicine -- Study and teaching (Continuing education) -- Social aspects Roy Jarecky; interviewee Richard C. Smoot; interviewer 1986OH095_UKMC28_Jarecky 1:|11(1)|21(1)|31(11)|44(1)|54(8)|67(5)|79(1)|87(5)|98(9)|109(11)|119(7)|129(6)|137(6)|149(3)|159(14)|169(8)|178(12)|185(6)|194(10)|206(5)|216(4)|226(4)|235(1)|244(2)|252(5)|260(9)|269(6)|280(10)|290(10)|301(7)|311(8)|322(4)|331(4)|342(8)|352(5)|361(8)|372(4)|381(1)|390(6)|397(6)|407(10)|425(10)|435(7)|448(4)|456(10)|469(13)|482(2)|521(12)|555(4)|581(2)|614(3)|625(7)|634(5)|647(3)|653(1)|665(2)|688(10)|697(3)|712(8)|729(15)|750(6)|780(2)|794(8)|812(16)|825(12)|835(1)|847(2)|859(7)|879(2)|895(15)|910(14)|928(7)|938(4)|957(7)|968(3)|985(2) audiotrans UKMCoh interview SMOOT: Dr. Jarecky, to begin this morning, tell me a little bit about yourself, your background, where you came from, what your upbringing was like, your educational background. JARECKY: Um-hm. I was born and brought up in, uh, New York City. My under-- my, uh, high school, preparation was at Townsend Harris, which included a preparatory school, primarily for what was then City College at New York. And I attended a couple of years at City College before World War II. In 1943, I went off to the service, spent my time in the Air Force, got out in the summer of 1946, and at that point had to make a decision about what to do with respect to returning to college. I, I thought that I was probably interested in some form of personnel work, I'm not sure why I thought that except that it sounded like a good idea at the time. And I wrote away to uh, one of the offices in Washington, DC, the office of education, I guess it was, and requested a list of schools that prepared people for what I was thinking of, which was industrial personnel work. They sent back lists of schools and for some reason-- one of the schools listed was Springfield College, a small, professional school in um, western Massachusetts. I went up to visit and discovered that, uh, they did indeed have a program in personnel work, but A, it wasn't industrial, it was student centered personnel work, and B, you didn't get to take it until you were a graduate student (Smoot laughs). However, I liked the school so much I decided to stay anyway-- which is the way great decisions are always made, (Smoot laughs) and so I did an undergraduate degree in group work in community organizations and then went on to-- student personnel-type work, both at Springfield and then later at Teachers College of Columbia University. O-- Over the years it was clear to me that the more work that I did, the more interested I really was in the student affairs aspect of, of higher education, so that once I finished my graduate work in 1952, I returned to Springfield-- I'd been invited back to teach on the faculty-- returned to Springfield-- which incidentally, I should comment here, is one of the very, very few schools in the country that prepares its students to serve in youth- serving agencies, that's its major concern. It's got a very, very strong physical education major, it's known as the home of basketball and all that other good stuff, but primarily what it does, it turns out people who work in youth-serving agencies, either as teachers or in YMCAs or in Jewish centers or whatever the case may be; it's an international reputation in that regard. In any event, their philosophy and their attitudes about individual development had a major effect on me, and uh, in the early fifties, that tradition was certainly carried on at Teachers College of Columbia, where my work was in group work-- was in the area of uh, student personnel administration. So that when I returned to Springfield, I thought it was useful to spend a few years in the classroom; I didn't see now anybody could do student affairs work unless they'd had classroom experience, so I taught for five years and bit by bit got into more and more student affairs work. Uh, and then, in 1957, quite by chance, I had an opportunity to move to a medical school to do nothing but student affairs. I didn't know the first thing about medical education except, once again, it sounded like a good idea at the time and so I was recruited to the Upstate Medical Center in Syracuse, New York; uh, went there in the summer of 1957, spent four years learning the bases of student services and student affairs work in a medical school setting and then in 1961, was invited down to the University of Kentucky College of Medicine, which had just started in 1960, to open up an office that we then called the Office of Student Services. And that's how I got down here. SMOOT: Who recruited you to go to Syracuse? JARECKY: Well, it was a combination of factors. The actual person that recruited me to Syracuse was uh, a person by the name of Davis G. Johnson. Dave ran the student affairs office at Syracuse at the time. And I think it's worth saying that in those years-- which is to say the mid fifties-- the idea of an educator trained in student personnel work was really brand new in medical schools and therefore to have somebody in the medical school doing this who was not an M.D. was virtually unheard of, which was another reason that Dave's offer appealed to me. I didn't apply for the job, I-- in the usual sense-- I-- I was at a national conference and I was walking down a dimly lit hallway and because I was looking to the right instead of the left, I noticed a three by five card on a bulletin board and it said simply that someone whose name was Dave Johnson was interviewing people for-- for whatever it was called in those days, administrative assistant in the Office of Student Services, whatever the title was, at the Upstate Medical Center in Syracuse and having nothing better to do, I went in and talked to him, and got the job. But it was clear that there was an enormous opportunity to apply some very basic principles of student affairs work in the Medical Center or, primarily here, the College of Medicine setting. Actually when I got down here, um, we had a combined- - the office was under the-- what was then the vice-president to the Medical Center and covered both medicine and dentistry as one office. And we carried on in that vein for a number of years. When I arrived here in the summer of 1961, I had been recruited by essentially Bill Willard, who was vice-president of the Medical Center, but also by a number of people who had been at Syracuse and came down here with Bill; unfortunately, Jim and Anna Halstead, who are the people I'm talking about, stayed only a year, but it was enough to attract me here. And Bill-- Jim rather-- had been a physician at the VA in Syracuse and Anna Halstead was actually Anna Roosevelt, FDR's oldest daughter was head of public relations for the medical school and when they came down here-- I had become very friendly with them-- and they presented my name to Bill Williard and that's how the thing went. So that's how I got here. SMOOT: (laughs) What were your impressions of the Medical Center here in its early stages- the personnel, the physical plant, the Lexington setting, the University of Kentucky setting? What were your first impressions? JARECKY: I was most immediately amazed at the amount of involvement that the then faculty seemed to have with everything that the students did, thought, felt, might have did-- might have done-- might have thought, (laughs) might have felt. It was a new school and everybody wanted the thing to get off on the right foot. Now, I had come from a very, very conservative medical school where the notion that a professor in a particular department would have any particular concern about what happened to any one individual student was almost unheard of. They taught, the students (laughs) came to class, took examinations and that was about it, it was almost like The Paper Chase situation. Down here, uh, I immediately discovered that uh, the students couldn't make a more-- or nothing could happen to any given student-- without a couple of hours worth of committee meetings to discuss the event. Of course, that didn't last very long, but that was reflective of the concern that the faculty had about what was happening to each individual student. Now of course such events might take a, a sentence or two, if-- if that, or a moment of two of discussion or-- but usually not at all on faculty part. Um, I think the most important thing really, however, was the desire that Bill Willard had for a coordinated Office of Student Services. In a great many medical schools, there were many services, but they were just that, uh, they were services that were presented in a rather insular fashion; the admissions was here, the financial aid was there, a couple of good guys do some counseling and when you find them, the record keeping was not infrequently done by the university and might or might not have something to do with the college directly. Um, there was therefore a-- the services were spread out in a variety of different offices, this was, as I say, were in the late fifties and early sixties. However, a variety of forces were operating at the time. The AAMC, Association of American Medical Colleges, was becoming much much more active in the whole overview of medical education. The Group on Student Affairs had just been begun, in those days called A Continuing Group on Student Affairs, in 1956, and I joined in 1957, so I've been fairly close to the thing since it got underway. Um, and there was a strong view that it was very important to work individually with students so that their talents could be developed so that such problems as devel-- as-- as came about could be resolved in a productive kind of way, in an organized kind of way, rather than a sort of an off the cuff manner if the student got to the right person at the right time, something might be done. But here the idea was, they were going to try and cover the whole thing-- would try-- were going to try very hard not to let students slip through the sieve. Now, of course once you do A, there is the inevitable reaction of B and in doing this on the part of some faculty members looked like over-care. If, you know, students had to be big and tough and macho and I didn't have that when I was a student (Smoot laughs), but I think what we tried to do was to enlist the help, of even those faculty members in ways that they could see themselves being helpful and I think we were reasonably successful in that regard. In any event, over a period of time in the early sixties, the office, which started as a student affairs office, bit by bit, picked up many of the responsibilities of an academic affairs office. Uh, it was a simple thing, if you were dealing with the recruitment and admissions of students, if you were concerned with their counseling, with their well-being in every regard, you could hardly discount the importance of the curriculum (laughs). And so, bit by bit, we became the keepers of the curriculum and staff the various promotion committees and everything that had to do with curriculum development and curriculum change. I can't remember that anyone said we ought to do that, it was simply that no one else was doing it and so we did. I kind of think it's of some interest there some years later-- whenever this occurred, I can't remember quite when, probably in the early seventies sometime, the office took on a new name, it was the Office of Academic Affairs, I guess, instead of the Office of Student Services. As I say, I can't remember quite when it occurred, probably the early seventies. The other aspect, I think, of working with students that occurred at the time that I felt was important, was trying to establish a bridge between the students and the faculty, not in the usual sense of "we're the teachers and you're the students," but at the time-- the early sixties-- we almost had a two culture syndrome operating; a large number of our students were from eastern Kentucky and a large number of our faculty were from everywhere else but eastern Kentucky, a few were, but most were not. And, for a while at least, there was a, an inability to understand the one group of the other. The students-- many of them I thin -- felt that they and their cultural heritage were not particularly appreciated by the faculty and the faculty-- some of them-- felt that the students simply did not have the kind of intellectual background that they were used to in universities from which they had come. And this dissonance showed itself in a variety of ways and therefore required a (laughs) continuous ameliorative attention. And I think, once again to some degree, over a period of time-- not right away-- but there were probably after a while more recognition on each parties' part what the other was all about. Initially, the school concerned itself with securing physicians who were going to practice in Kentucky. That was fine, except for the fact that medical education was absolutely exploding; there was an enormous lack of physicians over country and it was very hard, in fact there was no way to say to a student, "When you graduate from the University of Kentucky College of Medicine you're going to go back down to uh, uh, Slow Creek and do your uh-- do your family practice thing there." And a great many students at the time suddenly saw an entire world opening up to them; they could go anywhere, they could be anything. And I think this was-- it was difficult for many people in the Commonwealth who presumed that once this enormous edifice, which for many of them was kind of a Taj Mahal, was not producing, literally thousands of, um, physicians who were going to come back into every hollow in the eastern part of the state primarily, as well as central Kentucky and take care of them. Of course, that didn't really quite happen and so this created some degree of difficulty too. People at the time-- the population, had-- were, were unaware of things like residency, that when you got an M.D. degree all you had was an M.D. degree, that you really (laughs) weren't prepared to practice medicine and that most students, if not all of them, were-- would be out doing a three or four year residency. And I tried to explain to individuals in the state at the time, which was very hard for them, that from a standing start it was going to be about two decades; in other words, if we started-- took 1960 as the starting date and-- and your first class didn't graduate until 1964 and those very few, because our initial class I think graduated thirty-two if I remember correctly, that uh, until 1970 or indeed 1980 rolled around, you weren't going to see a significant number of graduates populating the area. Now, I think it's-- it's of some interest that just about now, which is twenty-five years later, we are beginning to see lots and lots and lots of Kentucky graduates all over the place. Uh, I think, last time I looked, 41 percent of our graduates are practicing or are residents here in the Commonwealth. And that's a rather unusually-- a lar-- high figure compared with the national averages which has a number of percentage points less. It's kind of interesting in that regard, because when a student graduates they feel they need to try their wings somewhere else, they want to go somewhere else. But the fact that we can these people back, I think speaks well for the training that they got here and their desire to return to their roots so to speak. In any event, that was a problem, to try and explain to the population of the Commonwealth why we didn't immediately have platoon upon platoon of physicians who were going back and taking care of folks in the-- in this state. Um, another thing that I think happened early on was that because there was essentially no Department of Family Practice or anything remotely close to it, virtually all of the students that we had looked to a specialty to express themselves professionally. And it wasn't until uh, a decade or so had gone by and Department of Family Practice came into the picture that more and more students-- obviously because there was now an entity here-- began seeing that as a possible approach to uh, medical care that-- that they would want to be a part of. But until then, most everybody went into some form of-- of specialty-- specialty work. In the school itself, while all of this was going on, Bill Willard's concern for maintaining an integrated curriculum, for maintaining a school focused on teaching, focused on service was coming under more and more pressure as the years rolled along. And the reason for that was that we were of course not isolated by any stretch of the imagination; we suffered the same pressures and demands and requirements that every other medical school in the country, uh, was heir to in those years and therefore to get and hold faculty meant that you had to have a situation in which they felt they would be happy in, and certainly in the sixties and well into the seventies that meant a research opportunity, that meant development in one's specialty and that meant great competition to get, quote, unquote, "good people" in that regard. And therefore things such as the practice plan were modified in order to be able to meet those-- those requirements. When we started out, everyone was pretty much on straight salary, with a little bonus in the old PSP plan to keep uh, to keep folks happy, but as the years went along that did not turn out to be a very satisfactory arrangement and of course it was eventually modified considerably. Uh, what also happened-- what also happened was that in-- in the long run, the kinds of people who were recruited tended to be what was typical of the times. They were very departmentally oriented, they were not uh, institutionally oriented necessarily, their interest in coordinated activity, their interest in service, their interest in uh, uh, community rapport, their interest in Kentucky as-- as such, was-- took I think something of a backseat to their development as highly proficient professionals and as having the oppert-opportunity to achieve recognition regionally and certainly nationally and in some cases internationally. So that as time went along, uh, there tended to be a fractionalization of the organizations, instead of what-- when we (laughs)-- back up a few words here. When the school started everyone had the great dream, and as the years progressed, every additional concentric ring of faculty was a little less committed to the burning light of Bill Willard's motivation and-- and-- and his-- his goal, if you will, for the medical center. So we had people who came to make their department the best, their division the best, their uh, residency training program the best; and if that in some way was good for Kentucky well, that was a nice fallout. So that, as the years went along the curriculum for example, which had started with coordinated, uh, programs-- everything was a conjoined course, for example in the basic science years and a conjoined course in the clinical years-- bit by bit that came unglued and instead of having, for example the adult clerkship in the junior year which was medicine, surgery and psychiatry, within X number of years we had the clerkship in medicine, the clerkship in surgery, the clerkship in psychiatry, there was no longer a relationship, and a close relationship, of all three. The same was true in pediatrics, there was a children's clerkship which included two or three different departments jointly giving this thing. After a few years that collapsed, and uh, we were back to the very conventional-- now-- a very, very conventional mode of presentation. Now, there were some things, on the other hand, that remained unique. Uh, certainly the emphasis on behavioral science, which most schools did not have in the early sixties, was very important. Most of the students who came, uh, were not particularly excited about the course until years after they graduated, then it became very much a matter of, gee whiz, I wish I had paid more attention. Because once into uh, the actual part of doctoring, what behavioral science meant in the most sophisticated sense was then apparent to them, but then again, there's nothing new, education is filled with examples of this sort. Um, the original Department of Community Medicine, headed by Kurt Deuschle, was another example; Kurt was way ahead of his time. In the early sixties he was talking about the importance of understanding disease in a group and community settings, and in turn he was uh, trying to present understanding medical problems in a-- in a broad sense rather than idiosyncratically, and he had an amazing, an enormous effect on quite a few students who went through the school in those early years and many of them today, uh, have carried on their tradition of community medicine in the best sense of that term. Dave Lawerrence on the west coast and Tony Veturo, in-- in Arizona, a number in California, uh, Rice Leach, working on the Indian reservations-- I guess he still is-- in, I think in Arizona-- New Mexico, wherever. But it was out of sync with the times and it was also, interestingly enough, not something that the communities particularly wanted. Our seniors would run up to a town, they'd study the medical problems of the town, they would make a report on what those medical problems were all about and then they would disappear and the town was left essentially with its old political system, its old problems and a feeling of frustration that they had had all of this attention, but nothing much had happened. So eventually the uh, uh, department died a rather agonizing death and (laughs) and it is now replaced by a different format all together under Art Frank, which is not to say it's any better any worse, it's just different. But those unique concerns brought by the Departments of Behavioral Science, the Department of Community Medicine, the attempt on the part of many people in many different departments to establish clinics out in the state, from the beginning, uh, Mac Vandiviere is still doing it, Jackie Noonan is still doing it. Those are people who are still trying to expand the effect of the Medical Center. And community medicine was also the basis, uh, for what eventually became the AHEC program which is alive and well today -- Area Health Education Center Program -- that Tony Goetz is concerned with. So that those were I think some of-- some of the high points. Then I think there is another point which we frequently overlooked-- and this is a bit tender-- students from Kentucky had been told for many, many years that obviously they were inferior to the Michigans, the Vanderbilts, the Minnesota, the UCLAs, to say nothing of the Harvards and the Yales, the big universities of the nation, that they obviously couldn't quite compete at the level that all these other folks and all these other name-brand medical schools were competing at. And over the years, bit by bit, students began to be aware that that wasn't really quite the case, that they could indeed go out, that their preparation was effective, that they knew quite a bit about hands on medicine, they were not perhaps as competitive in the intellectual sense of the term-- could they quote from Schmodgsky's paper of 1923, where he clearly indicated blah, blah, blah, but they knew a lot about hands on medicine. They knew a great deal about how to interact well with patients. They were very sensitive to patients from different cultural backgrounds; that they knew quite a bit about. And bit by bit, as the years rolled by, uh, I think students have become surer-- medical students-- have become surer of their training, their background, their preparation, their ability to compete-- if you will-- in a very competitive profession. One of the problems that the school faced, I think, over the years is that it didn't really have the holding power for crucial faculty members that it might have had. It went into business at a time when most medical faculty members were like a band of gypsies "You're in Minnesota, hey, we're starting a new program in Seattle, want to come?" "Sure." And up, up and away. That was the way in which things worked. It doesn't work that way now because of economic limitations, but it worked that way then. And therefore, absolutely superb people that we had here-- I mentioned earlier on, that was one of the problems, they would come because they would be recruited by a guy with a name essentially uh, pounded out in gold and they'd be here a few years and they'd make a reputation for themselves and off they'd go. I remember one year, early on, we had four or five members of the department of surgery and within a few years after they'd come, they were all chairmen somewhere else. Ben Rush is in-- still in New Jersey, Frank Spencer is still at NYU in New York, oh, there's a whole raft of them; it's not important to list the names, but just to make the point, so that there was, in my view at least, a larger turnover than one would have liked to have seen for a psychological stability in the school. For the individual students to be taught by these individuals was great as long as the individual was here, but they were here, then they were not here and that created a problem. I think another issue over the years was the recognition of the state of what a first class medical center was all about, what it should do, what it could do, what programs it ought to involve itself in-- I think they saw it originally as turning out physicians to practice in Kentucky, as long as there wasn't much competition with the, uh, local folks here in town or in the area. But of course that's not what a first-rate medical center does, they have programs that effect areas, regionally and in many respects nationally, such as the Sanders-Brown Aging program is doing right now. Um, so that there was some, I think, difficulty in trying to interpret to the state, what the uh, medical center was all about. On the other hand, there was enormous support for the place. Certainly you couldn't have asked for more concern than for what one got out of the Happy Chandlers of Kentucky and there were quite a few of those and they stuck with us, through thick and thin. Well, I think that as far as students are concerned-- to return to that for a moment-- the individual orientation, the concern for enabling the student to grow, to become, um, to not let any student get lost in, in the shuffle continues now as it did then. I think that integrating informa--- integrating student services and all the information that relates to student services, student counseling, all the rest of it, is now institutionalized and one doesn't see that as unusual anymore, that's simply what you do. I think that in all likelihood we're-- as these things always go-- into the next rung up of organization in which we're now very heavily into the whole business of patient care as a-- an almost HMO, if not an HMO, I-- and I think this is going to have a major effect on the preparation of medical students. Uh, I think finally that in all likelihood, Bill Willard probably succeeded as well as anyone could hope to succeed under the circumstances. He did put his stamp, his personal philosophy, his-- his humanity on the place, and that sense of humanity, that sense of concern for the individual has really never faltered over the years and I suspect, uh, will continue. I think that his desire that we have a genuine concern for the total health care scheme in Kentucky is just now beginning to evolve appropriately. I think it is very true that he was light years ahead of his time. I don't think a half a dozen people really understood what he was about when he started, I think everyone perceived it in their own terms and their own needs in-- in the world of the early sixties. But I think his foresight is what has enabled the school to achieve, uh, perhaps more significantly than might have been expected. Our students, as I say, a majority of them in terms of what we-- wh--- what one would expect nationally, practice in Kentucky and they are effectively practicing, as a matter of fact, in all fifty states of the union. There isn't a state that doesn't have a Kentucky graduate in it, including North Dakota (Smoot laughs) and a surprisingly large percent are in-- seven or eight percent, that's a little above the national average-- are in academic medicine. And for a school where no one expected that we would ever make our mark academically in the sense of the um, top ten, that I think is also an unexpected and significant achie-- achievement. Anyway, those are a few remarks for whatever they're worth to you. SMOOT: Thank you very much. Let's, let's pause a moment. [Pause in Recording.] SMOOT: We've talked a good deal about curriculum and the development of curriculum; uh, it's changed obviously over the years. Could you just kind of give me a, a beginning to the present pattern of curriculum development and change as you have been involved with it? JARECKY: (coughs) I guess I would say that it started as a very coordinated operation, moved to a highly departmentally oriented operation and is now moving back to a coordinated, conjoint, problem- oriented type presentation of the curriculum. To some extent a lot of this reflects the tenor of the times. Uh, in the seventies and eighties, early eighties, mostly the late seventies, curriculum change was the big thing. If you weren't changing a curriculum, you weren't doing anything. One of the problems however, with changing curriculum is that that essentially means a major change in behavior and in all-- in order to accomplish that, you have to enable the behavior of your faculty to change and you have to enable the behavior of your students to change. Most students are simply used to sitting in a classroom listening to someone talk at them, um, and they don't do a lot of original thinking, if you will, they don't a lot of-- they don't hone their skills in problem solving; if they do, it's not in the classroom, it's-- it's somewhere else. And uh, in order to deal with that problem, when I went off on sabbatical in '67 and '68, I was charged by Bill Willard to come back with a plan for an office of research in medical education, which I did-- came back with a plan; we set the thing up and it eventually became the office that Lynn Heller ran for a few years. And its concern essentially was not only evaluation, which those offices do, but it was also very much concerned with uh, the modification of faculty behavior, uh, uh-- and Lynn and his group did quite a bit to achieve that change. But it's not something that you can do one day and then not the next, its got to be a consistent, on-going effort and I guess I am at the point now where I believe that if you really want to run a medical school differently in terms of how the teaching and learning milieu is established, you gotta to start with people who want to do it that way to begin with. You don't have the time to get an entire faculty and change them. If you think that things ought to be-- that a curriculum ought to be presented in a problem-solving mode, then you do what McMaster in Canada did and you get guys that want to do that in the first place and you set the thing up and they do it 'cause that's what they want to do; you do the same thing that Southern Illinois University does, they wanted to do it that way, they got guys who what to do it that way and no one goes there who really doesn't want to teach that way. And I think now that you can have an office of faculty development or research in medical education, whatever you want to call it, and they will have some effect, but they will not have a major effect in the degree to which change takes place. Most of the time change in medical schools-- and this is hard on the ego of faculty members-- has nothing to do with their wants or their likes or their dislikes. It happens in terms of outside forces above and beyond their control. Um, if we have more physicians than we need in certain areas that's going to affect graduate medical education whether faculty likes it or not. If there's a tumble in the economy, that's going to affect how medical education goes, whether they like it or not. If um, it turns out that these places have gotten so expensive-- that healthcare has gotten so expensive-- that the clinical faculty has to support itself, then that is going to effect change, whether the rest of the faculty, academicians, like it or not. So these are outside forces that I think for the most part-- what you modify are things internally over which you, yes, have some control, but the major events-- for instance right now, we're talking about setting up a nontenure line for clinical faculty members; that would have been unthinkable a few years back, but now it's absolutely necessary, so all of a sudden the unthinkable becomes the thinkable and you think it, and you decide how it can be done, just simple as that. SMOOT: Hmm. JARECKY: Anyway, go ahead. SMOOT: In the beginning of-- one of the, I guess, uniqueness-- distinctiveness -- of-- of this institution was the fact that-- [telephone rings] let's stop-- [Pause in Recording.] SMOOT: As I was saying, the uniqueness, distinctiveness, of this institution-- JARECKY: Is that thing off or on? SMOOT: It's on now. JARECKY: Oh, okay. SMOOT: (laughs) Part of that was really because of-- of innovations that were taking place here-- JARECKY: Um-hm. SMOOT: --If we've already mentioned the behavioral sciences with community medicine, some of the curriculum changes taking place in the College of Dentistry in particular-- JARECKY: Um-hm-- SMOOT: --were very innovative, and it was all kind of a-- a gigantic flurry it seems at the very beginning, it was very strong: national recognition-- everybody was saying, "Wow, look what they're doing." It seems to slow-- JARECKY: Um-hm. SMOOT: --as you go on into the sixties and certainly into the seventies, you know you don't even hear-- JARECKY: Um-hm. SMOOT: --too many uh, people talk about-- JARECKY: Yeah. SMOOT: --some of the things that are going on there. Perhaps you can clarify some of these problems, if they were problems-- or if it was just the development of an institution along-- well, say that is becoming more traditionalized. JARECKY: Well, of course this is what I-- this is exactly what I tried to talk about in my earlier statement. SMOOT: Um-hm. JARECKY:It did become-- indeed became traditionalized and as I tried to explain this-- SMOOT: Um-hm. JARECKY: --with each new contemporary ring of faculty members, the original purposes were lost and the individuals who came in were much more oriented to their own personal development and-- and to medical education as a function of the department. SMOOT: Um-hm. JARECKY: If you were in a hot-shot department, you'd arrived. Whether or not the institution in itself-- in and of itself-- was at the same level was not quite as important as whether your department was viewed-- SMOOT: Um-hm. JARECKY: --in that regard. And I think that sort of thing-- and this was particularly true because of the enormous amount of grant money available-- SMOOT: Um-hm. JARECKY: --in the sixties and seventies. You could do almost anything you wanted to do (claps) because the money was there to do it, I was very involved, for example, in the late 1960's and through the 1970's in issues relating to minority affairs-- SMOOT: Um-hm. JARECKY: --and I remember going over to Washington once, as chairman of a committee, and handing out one and a half, two million dollars worth of grants in one afternoon and no one thought that was strange. Uh, that's just-- it was a different world. SMOOT: Yes. (laughs) Well, I asked that to bring-- to kind of move into another question. I-- JARECKY: Um-hm. SMOOT: You had covered that, but I wanted something of a synopsis. Uh, you know, looking at these departments as they were developing along these lines. JARECKY: Um-hm. SMOOT: You mentioned surgery earlier. JARECKY: Yeah. SMOOT: They dispersed as department chairmen all over the county, you know, outstanding department-- JARECKY: Um-hm. SMOOT: --had some great surgeons over there. As teachers, as researchers-- JARECKY: Um-hm. SMOOT: --what did they do that was so special? Let's just use that department as an example, if we may-- or any other department for that matter-- uh, what I'm looking for is what made this institution, these departments strong and special and important, nationally-- aside from just the competency of-- JARECKY: For surgery, total saturation. Their-- everything they did was intense. Their teaching was intense, their research was intense, their management of problems was intense; it was kind of like The Force. SMOOT: (laughs) Okay. JARECKY: And these guys, uh, hell, they even had a-- a club tie they all wore (Smoot laughs) and I say that simply to reflect the intense sense of loyalty, the intense sense of participation and involvement that they had. They were all readers. Let me - give you an example. I mentioned Frank Spencer's name before. When Frank left here and went to NYU, there's a story, probably apocryphal-- but he got there, I guess on a Sunday or whenever it was, and-- late in the afternoon-- and we went up and by the time he was done he knew precisely- precisely- the situation of all hundred and twenty-five or fifty patients on the surgical ward. And the next day, at morning rounds he was quizzing every resident about their patients. Now, that's an example of what I'm talking about. This was the kind of intensity, the kind of drive, the kind of uh, desire for success that was typical of that department in the-- in the sixties. The department of medicine took a somewhat different tack. Under Ed Pellegrino they were very humanisticly oriented, they had a philosophical bend to them, they concerned themselves, with um, issues of health care that, once again, were probably a little bit ahead of the time. The surgeons were interested in solving a problem right then and there,he medicine guys were sort of interested in thinking about what was going to happen X years down the road -- if we do A-- SMOOT: Um-hm. JARECKY: --what will eventual outcome be? So they were uh, into that. Most of the rest of the departments, at least in my view as I recall them, were straightforward, solid, productive kinds of things-- kinds of organizations rather. Under Jack Githens, the first chairman of pediatrics, followed by Dr. Wheeler, once again, there was a big emphasis on the humanity of-- of the care of sick children, a lot of work outside the Medical Center in the various uh, clinics held in different parts of the state, particularly in southeastern Kentucky. The-- the departments, I think, uh, tended to strive towards their own uniqueness because Bill Willard was spending a lot of his time trying to grapple with big issues at a medical center level and there wasn't a-- he was the dean of the college of medicine at the time there and so he had a-- it was like a split week at the palace. (both laughs) He had a couple of different acts going on simultaneously and probably that cost us. I think that the departments, many of them as strong as they were, but they tended to go off in whatever direction they wanted to go off and then Bill didn't have the time or the perhaps necessary energy to bring them back in line. And Bill was always a great believer in-- in-- in the goodness of things, in the goodness of humanity (laughs) and of course that doesn't always work out quite that way. He assumed that because he was in here at six a.m. and worked every night until two in the morning that everybody else was going to do the same thing and of course, that's not quite the way it goes. SMOOT: Um-hm. You've mentioned the um-- the students. Of course you've-- you've had a good, important relationship with the students that have gone through this institution-- JARECKY: Um-hm. SMOOT: --and they're everywhere now, throughout the country. Uh, I want to play a devil's advocate for a moment because I've heard people say, "Well, yes, the University of Kentucky is turning out medical students, they're going into Eastern Kentucky, and they're staying in Kentucky--" JARECKY: Um-hm. SMOOT: "--some of them aren't so good." JARECKY: Um-hm. SMOOT: Your reaction to that? JARECKY: Oh, I think that, uh, any medical school class is determined by the quality of the pool from which you draw. Now, if, as was almost always true of Kentucky, the pool was in the neighborhood of 400, 425 applicants, at least it was during the sixties and seventies and maybe into the eighties, if-- and-- and this was established, this is what-- in terms of class size, this is what apparently the Commonwealth wanted. So 125 of them go to Louisville and -- what, a hundred and some odd come here, which was the eventual number, 108, you're talking about 225 people out of a pool of 400 or a little over 400, give or take within any given year, of which maybe a hundred aren't real candidates to start with. So that narrows down what you've got left. So the answer is very simple. If you want to avoid having a bottom third, then you say, okay, we're not going to take a hundred and eight anymore, we're going to take seventy-five and we're going to make sure that ten or fifteen of those are the best we can get from out of state and the rest are in state. And then your selection process changes. So that, I was never very patient with-- with people who came up with this. I said as long as you require a large class where the size of the pool doesn't get larger-- if you say-- see we started-- the-- originally the idea was that we would have a class of eighty. SMOOT: Um-hm. JARECKY: And that was very simple, the reason it was eighty was because we had five student labs on two or three floors and they had fifteen places per lab and fifteen times-- you know, there you are-- or sixteen places, so-- yeah, sixteen places per lab, so is that right, my math okay? Thir--- yeah, eighty. (Smoot laughs) Okay. But that was were the eighty came from. SMOOT: Um-hm. JARECKY: It was just the number of places available in the student lab. And surprisingly, eighty or seventy-five really kind of fit the pool. I'm mean you've got-- see if you want to go to medical school, Kentucky is a damn good place to be, because your chances are better than fifty/fifty you'll get in. That's certainly not true in a lot of other places in the country. We have two, what are now public, medical schools so the vast majority of students who come have to be from Kentucky -- 90 percent according to the Council on Higher Education -- have to be from Kentucky. So it's a-- it's a guarantee. So you can't then on the other hand say, well, some of your kids aren't all that-- that good. I'm sure a few of them aren't, but it-- it's easy to fix. You say, okay, we drop the number back down to seventy-five or eighty, which much better fits our needs today and the pool available and you don't have to then worry about taking students about whom you have some, some question. SMOOT: Um-hm. Why was it raised? JARECKY: Oh, it was raised at the time in the early eighties -- late seventies, early eighties -- because a Federal mandate said if you want funding you're going to have to turn out more students and you're going to have to do a few things in terms of program and everyone said, "Wow, let's have-- let's get the-- the bucks," and so we went up to a hundred and eight. SMOOT: So it had nothing to do with internal pressures or state pressures? JARECKY: Oh, to some degree it did. A lot of-- a lot of people in state thought this was a good thing because this would -- quote, unquote -- "force us," to require students to practice in Kentucky. They didn't quite understand (laughs) how the system worked and of course things don't go that way. As I said in my first statement, that's just not the way it happens. But the number went up to a hundred and eight and now I gather it's on it's way back down again. We're back down to ninety-five or whatever the new incoming number is. SMOOT: Um-hm. JARECKY: My own personal view is we're probably still ten or fifteen over where we ought to be. SMOOT: Um-hm. JARECKY: If we're perceiving where, what the state needs will be in 1990 or the year 2000, then it's a question of whether ninety-five is a good number or some other number is a good number. But sooner or later someone will do a study and find out. SMOOT: I noticed-- and you mentioned that you had done a good deal of work, particularly in the late sixties, on minority groups-- JARECKY: Um-hm. SMOOT: --and medical education. I noticed in some background that was particularly racial minority groups. JARECKY: Right. SMOOT: How has Kentucky done with recruiting-- JARECKY: So - so. SMOOT: --some of the minorities. JARECKY: We had-- I can make a few comments on this because I've been fairly closely connected to it over the years. Let me start in a way that doesn't sound as if I'm going to talk about minorities, but I really am. Um, in the mid sixties we had a situation, as I mentioned on the first tape, where faculty were feeling the students weren't really all that academically sharp, as sharp as they ought to be; write as well as they should write, all that sort of thing, speak as well as they should speak. And I got tired of hearing the criticism and so I hired somebody who had an excellent reputation as an English teacher in a local high school to come in and see what she could do with some of our students who apparently had these deficiency-- basic deficiencies. And she was pretty successful with a good many of them and it turned out that really what it was, was inability to study effectively. They really didn't know how to deal with these large masses of information. They-- they could handle it-- they were bright enough to handle it as undergraduates, but you get into medical school and it's usually-- someone pulls the hopper and dumps all over you an enormous numbers of facts and how to deal with all that. So she went ahead with that and was successful. And then I thought, well, if-- if she can do it, maybe we can-- she can train three or four other people who can do the same thing. SMOOT: Um-hm. JARECKY: And so to make a long story short, we recruited four ladies who had been out of school for quite some time and said, "We want you to, we'll pay the tuition, we want you take one science course, one non- science course over here at the University, we want you to do nothing in terms of studying, but what Leah tells you to do and we want to see how this comes out." And the all had kind of tough egos so they went in there and did and they all passed, passed rather well. And now, you have to keep in mind, these ladies had not been in undergraduate school for-- some of them-- for almost a decade, they'd been out for a long, long time. So we said, "Well, okay, it's more than personality, there must be something in the system if-- if-- if-- if she can take four women who haven't been in school in a long time and they can do well in both the science and a non-science course, perhaps there's something that's applicable over here." So we started uh, a program, a student development program, in the College of Medicine and in Allied Health -- I spread these ladies around to all the colleges -- Dentistry and some of them are still at work doing the same thing. I might add my wife's one of them. Now, it occurred to me-- and this was consonant with the whole business of black students attracted to or being-- and able to-- go to medical school and all the rest of it. We had always had one or two black students in every class or virtually every class. But one of our problems was that there was a relatively small pool of black students in Kentucky and if they were very, very good they were heavily recruited like football players-- elsewhere. In any event, I felt very strongly that as we attracted more black students and if they needed it, utilizing uh, these techniques of improvement in study, in test taking skills, that that should be available to any student who wanted it. I said, the minute we say this is only for black students, we give them a deficit right then and there. So that we set up an office, which in a sense is-- in-- in its own little way is still working, which concerned itself with providing study skill improvement, test taking skill improvement and then that branched off and did a bunch of other things. But we never said, this is for minority students, because we would get black students who would come in beautifully prepared and I'd have kids who happened to be white, but from small school systems in southeastern Kentucky who were much more in need of this kind of activity than some of the black students we were getting. So to do it on the basis of pigmentation was-- was obviously a very foolish thing. So we had the usual run of programs of one kind or another to attract more black students here. And as it always turns out, if-- if you-- if you want any group of students for any reason -- if I want to get a Lutz from Alaska, if I have enough tuition money I can get them -- and it was no different with that. So we had a hard time because the University of Kentucky, unfortunately, was not perceived as a school hospitable to blacks and the reason it wasn't perceived as a school hospitable to blacks was that in those years no s--- no black students were playing on the basketball team -- and that was the whole thing. And as soon as blacks began their emergence as-- as basketball players and bit by bit, more and more of them were on the Kentucky team, the notion that Kentucky was lily white changed. And this was, once again, a late sixties, early seventies phenomena and we- - it was easier for us to attract black students. But I guess the point I want to make is that black students-- no-- students who were black were admitted because they were good and capable students and that was always the basis on which we took them or anybody else. SMOOT: Um-hm. JARECKY: It was no different with women. I remember in the class of-- in one class I admitted to in the-- in the mid sixties had sixteen women and got phone calls from all over the state complaining about how I'd wasted all those spaces (Smoot laughs) on all these women who obviously weren't going to practice medicine. Well-- SMOOT: Um-hm. JARECKY: --of course I-- my-- my comeback to that was, what percentage of men are no longer practicing medicine who started? Well, of course no one knew the number and it turns out that for a variety of reasons most of the women are still practicing and frequently are-- are-- are doing things in medicine that men traditionally haven't wanted to do. But now it's-- it's no longer a matter of, of concern because everyone's doing the same thing the same way. SMOOT: Um-hm. JARECKY: So, I think the answer to your question is, it isn't just a matter of talking about minority students or women or students from Eastern Kentucky. It's a matter of saying we have a variety of students, they're all unique, they all have-- they all need opportunities for development and we simply want to have the-- the kinds of programs that will take care of a given student with a given need at such time as that need emerges and that's what we try to do. SMOOT: You work-- you've worked with continuing education, have you not? JARECKY: Oh, one year-- just because Frank left and Dean needed somebody to fill in until they appointed a new director, so I-- I just did that for one year. SMOOT: Okay, could you make any comments on any, any innovations that were forthcoming from continuing education? JARECKY: Oh, I don't think I'm really in a position to-- to do that. All of the success of that program, which is considerable, which focuses really around the family practice review- they give four of those a year - is pretty much what Frank Lemon established over a decade of time and is-- is continuing now. But the-- the high quality of those programs, in the face of incredible competition, you know, when you say, hey, we want you to come to Lexington, Kentucky and spend $475 plus transportation, plus hotel and give up your income for five days so you can do this, when you have a choice of getting on a boat and doing it between here and Bermuda on a cruise, it takes a lot of-- you have to have an absolutely first-rate reputation to accomplish that. So. SMOOT: Do you think that the state has given adequate support to the Medical Center? JARECKY: Well, no one ever thinks that. SMOOT: Right. (laughs) JARECKY: The-- the-- the support has always been in the neighborhood of a third of the budget could roughly state support. Even now, and this is not my area so I-- I comment on it only very briefly, any extra support that comes in will be some, I guess some additional support from the state, but I think that primarily it's going to be what the faculty generates for itself. See ordinarily you work on a third from the state, a third from your practice plan and a third from, uh, research and other contracts -- is where the money comes from. SMOOT: What do you think has been the impact of the Medical Center on the community, the state, perhaps even the nation? JARECKY: I have little doubt that it's enhanced the quality of care-- medical care, enormously. You can't have a medical center that continues to concern itself with research, that continues to try to present the most update-- updated-- care and organization for care and-- and not have it have some effect on the community. I think it's probably-- the best that can be said is that it's had a very positive effect regionally. I don't-- I'm not sure that with the original-- other than the original-- notions of community medicine and-- and-- and behavioral science that's it's had much of a national impact. I-- I don't think that-- lots of schools have had AHEC programs, North Carolina for example. Lots of schools have tried all kinds of curriculum variations, we're just-- SMOOT: Um-hm. JARECKY: --one of many that have done that. SMOOT: What do think the future of medical education looks like? JARECKY: Oh, it's going to continue on. I think it's going to tighten it's belt. I think they're going to run down the number of students. I figure they don't need a-- they're already doing that-- they don't need to spend that amount of money on the thing anymore. There's already a lot of discussion about reducing the support for graduate medical education. If you want all those docs out there-- it's expensive people to have around. Um, but I think the crucial-- the crucial element to the whole thing is that there will continue to be a melding of science and the human application of that science in biomedical settings. Students will do things hopefully on the basis of a thought process, not on a cookbook basis that-- I really don't understand why it works this way, but-- you know, I've heard someone's doing it with good results so we'll do it. I think most of our students come out now much concerned with the idea of thinking well, thinking efficiently, thinking effectively about medical problems. And then added to that, are all the other philosophical and ethical issues that are-- which medicine is heir these days. But I-- I think that we're going to continue to do that. I think all of medical education is going to continue to do that. We have to keep in mind that everything works in cycles. When I first entered medical education, we were desperate to recruit people to go to medical school because we weren't getting enough applicants-- people have forgotten that. In the late fifties and the very early sixties everyone was worried about whether we were going to have enough applicants to fill the damn class. So one can assume every thirty or forty years there's a major revolving trend. Anyway! No, I think it's all going to go ahead and modify itself to the needs of the times. I-- I suspect some medical schools will eventually close simply because we have too many. We don't need a hundred and twenty-three medical schools. But then again, when we didn't have enough we built them, so we'll find something to do with the ones we don't need and they'll adopt some other form and continue on some way or other. SMOOT: Is there anything else you would like to add or think should be added to this interview regarding the history of the Medical Center? JARECKY: No, I don't think so. I think that covers my biased perception of it. (laughs) SMOOT: Well, I appreciate it. Thank you on behalf of the Medical Center and the library and myself. JARECKY: Not at all. It was kind of fun to do. [End of interview] 1 Roy Jarecky (Associate Dean of Admission and Student Personnel, Associate Dean for Academic Affairs, and Co-Dean of Med School, UK, 1961-1971, 1973-unknown) discusses his own personal history, and how he came to be associated with the UKMC. He explores Medical center development and expansion and the changing student teacher relationship. He also explains the delays inherent in attempting to immediately populate a state with doctors. Jarecky points out the distinctive nature of the UKMC, and the gradual segmentation of the MC faculty units into departmental rather than institutionally focus, and the detriment which this change had on the MC in general. Jarecky also discusses the quality of medical students and the selection process which goes into student selection. insert here