AHRQ Post Doctoral Fellowship Program

The AHRQ Post Doctoral Fellowship Program is rooted in the premise that a biopsychosocial model is the most appropriate one to adopt in the study of chronic disease and geriatrics, and that such a model is best implemented in an interdisciplinary training program. In this program MD's and PhD's not only work together on funded projects, they also teach each other about the clinical aspects of the population and the research methods necessary to study it systematically. Further, special care is taken to ensure a good fit between the needs of each trainee and the interests, available resources, and capabilities of his or her faculty mentor.

In recent years the program has increased its emphasis on long-term care, pharmaco-epidemiology, and chronic disease management and has sharpened its methodological focus. Ties established with the departments of Economics, Sociology, and Medicine have been highly productive and feature prominently. The program also now covers geriatric pharmacoepidemiology and organizational factors influencing the delivery of health care. Furthermore, collaboration with research centers focusing on behavioral medicine offers additional opportunities for postdoctoral fellows in this program.

Program Goals

• to train both physician and non-physician researchers
• to give trainees didactic as well as "hands-on" supervised experience in health services research
• to teach health services research methods as well as content material relevant to gerontology, long term care, and chronic disease management

Program Structure

Generally speaking, this is a two-year program. Since postdoctoral fellows arrive with different backgrounds and career goals, there is both a general curriculum, which all trainees must follow, and a trainee-specific curriculum. The general curriculum includes weekly, informal meetings with the program director, bi-weekly seminars in epidemiological or health services research methods, and monthly seminars on clinical or health policy issues in geriatrics delivered by leaders in the field. The trainee-specific curriculum consists of participation in a "major" and a "minor" research project, as well as coursework either in the graduate program in epidemiology, biostatistics, and health services research or in the various
summer institute programs in research methods.

Two tracks exist to accommodate differences in background:

• For the physician who comes without prior research training, enrollment in the master of public health is desirable (see bms.brown.edu/pubhealth/mph). Over the two years of the fellowship, the physician fellow completes the MPH degree in concert with the other fellowship activities. He or she also continues seeing patients one half-day each week. Clinical activities are developed in conjunction with faculty in the affiliated hospital.
• For the non-physician, formal coursework is usually limited to specialty methods courses that provide methodological expertise.

At the beginning of each quarter throughout the fellowship, each fellow meets with his or her mentor and the program director. Goals for the coming three months are set and at each subsequent quarterly review, these are reviewed to determine whether they have been met and strategies for overcoming any barriers to achieving goals are reviewed. During the second year, major project activities continue, but fellows spend much of their time preparing manuscripts for publication and presentations for national meetings, working on grant proposals, and securing a research and/or academic position. Before the end of the second year, fellows present their research at both a departmental seminar and a fellows' seminar.

Evaluation

Evaluation of fellows is largely outcome-oriented. Given the close association with faculty, the work of all fellows is frequently reviewed and critiqued, from the specification of research questions to the writing of a manuscript. More proximate opportunities for observing fellows' performance include presentations at research seminars and national meetings and in their competition for research positions following completion of the program. Acceptance of articles for publication is another indicator of success. The ultimate measure of success is whether fellows become independently funded researchers; to date, more than 60 percent of all fellows who have completed the program have attained that goal. For physicians, an additional outcome measure is completion of the MPH degree.

Clinical Exposure

Fellows have the opportunity to do clinical work in a number of specialized settings related to the interface of psychiatry and general health care, including:

• a specialized 20-bed inpatient medical psychiatric unit
• an extensive behavioral medicine program comprising active research programs in obesity treatment and smoking cessation
• a memory disorder clinic
• a geriatric assessment rotation at a local hospital and an adjacent nursing home
• a clinical research service at a state chronic-disease hospital.

Resources

Exposure to the various technical aspects of database management systems, whether for primary data collection or for use on existing data sets, is a critical aspect of the program. Fellows have access to a state-of-the-art research environment, complete with equipment, software, programming environments, systems programming, and data processing maintained by the Center's technical staff. The Center houses an archive of computerized data sets, including studies that its faculty and associates have conducted, as well as publicly available data sets with a focus on long-term care and aging and preventive health practices, generally from national studies commissioned by governmental agencies. Center faculty and staff have years of experience working with administrative data sets such as Medicare and Medicaid claims, as well as with specialized clinical data from all U.S. nursing homes. These are available to fellows working on the relevant projects.

Stipend and Benefits

Fellows receive health benefits, vacation days and sick days. The summer is utilized as an active part of the training program; however, the academic component of the program is suspended during July and August.

The stipend amount is decided by the awarding unit, NIH, and is based on graduate status of the fellow. The stipend increases with the number of years of relevant post-doctoral experience at the time of the appointment. Please note that fellowship stipends are taxable. The annual stipend levels for all individuals receiving support through institutional or individual National Research Service Awards (NRSA) made under Section 487 of the Public Health Service Act are detailed below effective as of 10/1/11. Additional information can be found at the National Institutes of Health website.