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A comprehensive program of continuing medical education easily available to all practicing physicians in the United States would improve the nation's health through better medical care. What is continuing medical education? Is it a process intended to keep the practicing physician in touch with the rapid advances in medical knowledge or is it intended to extend his skills? Are our present efforts in continuing medical education easily available to all physicians? If only 25% of the practicing physicians in many areas participate in postgraduate programs we may properly question their availability. Is availability the only problem or is there a singular lack of interest in education after certification? Perhaps physicians have not acquired the life-long habits of learning which we presume to be essential to the improvement of medical care. What should be done to make continuing medical education an integral part of the life of the practicing physician? The

An international conference on the Migration of Medical Manpower, sponsored by the Josiah Macy, Jr. Foundation of New York city, met at the Villa Serbelloni, Bellagio, Italy, on Oct 4 to 9, 1970. There were 19 participants representing 14 countries —Australia, Canada, Chile, Colombia, Great Britain, India, Iran, Jamaica, Pakistan, the Philippines, Spain, Thailand, Turkey, and the United States—and the World Health Organization. The papers and discussions focused on the migration of recent medical graduates from developing (donor) to developed (recipient) countries, who go on the basis of individual choice; without government sponsorship; and who usually have no assured appointment in their homeland upon the completion of their overseas training. It was evident that sponsored visitors present no major problem. The conference participants agreed that it is important that there should be no governmental or statutory restrictions on the international movement of doctors. However, the continued and significant loss of

Recently there has been a growing interest in the economic plight of village people in distant lands. Bold new programs to increase food production, to provide opportunities for education, and to improve health have been launched with the support of the United States Government and private foundations. During the past year, I have spent about four months in India as medical advisor to the government of India and the Ford Foundation. The primary purpose of these visits was to assist in the development of a village health program that would integrate with the other aspects of the community development program in India. The health of a villager in India is the result of the interplay of a number of factors, some of which would at first glance seem far removed from health. Any endeavor to improve the health of an Indian villager must consider existing health practices and prejudices, the

THE MOUNTING CRITICISM of internship and residency programs suggests that a discussion of purposes and practices in this area is timely. Happily, the Council on Medical Education and Hospitals has determined to undertake an objective analysis of this phase of medical education, with the possibility that some significant improvements may be recommended. My comments will emphasize the divergence in career interests among interns and residents and the need for maximum flexibility in establishing standards for their programs. It is clear that education must always be our first objective in this phase of medical education. The internship has been constricted or has deteriorated to such a degree that there is serious question as to its future essentiality. If we are to achieve flexibility in our residency programs, a review of the standards set by the specialty boards is indicated. History In 1940, the Commission on Graduate Education, Dr. Willard Rappleye, Chairman

To the Editor:— Since I made every effort to present an accurate yet sympathetic picture of Filipino medical students, I should be grateful if Dr. Balagot would cite specific instances of "preconceived notions and surely outmoded ideological cliches." My historical sources designated Indochina and not Indonesia as an origin of immigrants; provincialism is still a potent but pleasant force; and usury as well as the cacique system continues to exist in the rural areas. An article in the March 14, 1965, New York Times supports my impression about the cacique system by saying "In Central Luzon, sharecroppers still yield up to half their incomes to the landlords."

Governance is defined in Webster's New International Dictionary, Second Edition , as "Act, manner, office, or power of governing; government.... Method or system of government or regulation." If we apply this definition to medical schools we are not concerned solely with the dean. We include the trustees or regents; the president and his staff; vice presidents, the dean, department chairmen, faculty and external agencies, federal and private, that influence the decision-making process. My assignment is to present the reasons why the Macy Foundation became interested in the problems of governance, what we have done, and what we plan to do in the future. The medical schools have undergone what it is not an overstatement to call wrenching changes in the last 20 years. First, there has been an explosive growth in the variety and scale of programs. Second, there have been rapid changes in the character of the medical schools. They