Program Director: Alan Garber

Associate Directors: Mark Hlatky, Douglas Owens

Steering Committee: Mary K. Goldstein, Jay Bhattacharya, Laurence Baker, M. Kate Bundorf

Stanford University's Health Care Research and Health Policy Fellowship offers graduate students, medical students, and postdoctoral trainees advanced preparation for a career in health care research. The fellowship program is supported by a National Research Service Award training grant from the Agency for Healthcare Research and Quality (AHRQ).

During their fellowship, trainees will gain knowledge in several non-biomedical fields of inquiry, undertake advanced learning in a specialized field, and perform original research under close supervision by a member of the faculty. The exceptional opportunities to combine formal instruction with supervised research distinguish this program from other training programs in health services research. The program's structure reflects the belief that the growing sophistication and importance of health services research makes broad knowledge of the field and skill in the application and development of appropriate methodology essential. Trainees who complete this structured but flexible program will be exceptionally well prepared to become the leading investigators in one of the most challenging fields of modern health care.

Background

Stanford University has long recognized that policymakers and health care providers must take a wider view of the patient than as simply an object for curative medicine. Prevention and treatment of disease are necessarily incomplete when the social and economic environment and societal needs are ignored. The study of health must engage the attention of scholars representing many disciplines. A major strength of Stanford University is its heritage of interdisciplinary health-related research.

This strength has been one of the rewards of the close connections between the medical school and other schools in the University. Stanford is one of the few universities that have a medical school located on its central campus. Students and postdoctoral fellows frequently call on faculty members in other departments or schools for advice, and collaboration between researchers in different departments is encouraged. Such interdisciplinary programs as the Stanford Center for Research in Disease Prevention and the Medical Information Sciences Program have flourished in the Stanford environment. The Health Care Research and Health Policy Fellowship draws upon the strengths of Stanford in facilitating collaboration across multiple schools and academic disciplines. The interdisciplinary nature of the fellowship is apparent in the diversity of its faculty, who are drawn from the departments of Medicine, Economics, Health Research and Policy, and the Graduate School of Business.

The Fellowship in Health Care Research and Health Policy is administered by the Department of Medicine through the Center for Primary Care and Outcomes Research, and in cooperation with the Department of Health Research and Policy. Research interests of the core faculty include medical decision making, health economics, medical education, medical computer science, disease prevention, technology assessment, and health policy.

The Department of Health Research and Policy offers training and research opportunities in health services research, epidemiology and preventive medicine, and biostatistics.

Admission to the Program

We seek individuals who show great promise as investigators, teachers, and leaders in health care research. Stanford University School of Medicine is committed to increasing representation of women and members of minority groups among its students, postdoctoral trainees, and faculty, and we particularly encourage applications from such candidates.

Eligibility Requirements

Under the terms of the program's funding, a trainee must be a citizen, non-citizen national, or lawful permanent resident of the United States (i.e., possess the Alien Registration Receipt Card I-551 or I-151) at the time of appointment. Holders of temporary or student visas are not eligible.

Admission Deadlines

Applications for the fellowship in Health Care Research and Health Policy for 2007 are due by April 15, 2007.

We are occasionally able to fund one position for individuals applying within a year of the anticipated matriculation date. If you are interested in applying to the fellowship after the listed deadline dates, please contact Mary Herda.

Postdoctoral Training

Physicians who will have completed their residency training by the time of matriculation and individuals who have received the PhD degree within three years of matriculation are encouraged to apply. Decisions will be based on the quality of supporting material in the application, letters of reference, and interviews with the program faculty and current trainees.

Physician-trainees will be required to complete a master's degree in a field approved by the Program Committee. Separate application must be made to the master's program of choice. Decisions about admission to the fellowship program will ordinarily be made prior to the deadline for admission to the Graduate Program at Stanford University. Physician-trainees will receive a stipend for two to three years and tuition support sufficient for 45 quarter units of coursework, which is the usual minimum requirement for the master's degree at Stanford University. The exact number of units covered and duration of support are subject to change.

Overview of the Program

The program ordinarily provides three years of support. The period of support can sometimes be extended for trainees who pursue PhD degrees.

Core Curriculum

The purpose of the core curriculum is to provide a working knowledge of several methods and the rationale of health care research. The requirements are not extensive, since each trainee is expected to acquire a knowledge of research methods while studying for a master's degree in a department of the university. Some or all of the requirements may be waived if equivalent courses are taken to satisfy departmental degree requirements. The core curriculum consists of the following courses:

MGTECON 332/HRP 392: Analysis of Costs, Risks and Benefits of Health Care. Garber, Owens, and Sanders (4 Units). Examines the application of cost-benefit analysis and related economic evaluation techniques to products and services, like medical care, whose "output" is difficult to measure. The emphasis will be on insights into the practical application and the state of the art in research on this issue.

 

HRP 202: Introduction to Clinical Research. Lavori and Parsonnet (4 Units). Introduces epidemiological concepts, techniques, and studies: statistical reasoning and the application of common statistical procedures used in lab and clinical investigations.

HRP 283: Health Services Research in Progress Core Seminar. Baker, Bundorf, Garber, Hlatky, Owens (1 Unit). Presentation of research in progress and tutorials in the field of health services research.

Statistics At least six units of approved graduate level statistics courses.

One of the two following:

ECON 256/HRP 256: Economics of Health and Medical Care. Bundorf (5 Units). Topics include descriptions of problems and institutions, reviews of analytical studies, and discussions of policy issues. Specific topics include the relationship between health care and mortality and morbidity, physicians and other health personnel, hospitals, the drug industry, national health insurance, and health maintenance organizations.

BUS 331/HRP 391: Political Economy of Health Care in the United States. Kessler (4 Units). Informs students about the financial and public policy context in which the health care system operates, and issues in public expenditures. The course examines health care financing and delivery in the United States, the influence of alternative financing and organizational arrangements on the allocation of resources, health care costs, hospital investment decisions, and national health insurance.

Advanced Training Leading to a Graduate Degree

In addition to acquiring skills in the core areas and detailed institutional knowledge of health services, fellows are expected to gain extensive knowledge of one non-biomedical field. They must demonstrate this knowledge by fulfilling the requirements for a master's or PhD degree in a program of the University. This expertise, built on a foundation of advanced training and close interaction with faculty and other fellows, provides graduates of the program with a valuable perspective that will enhance their potential for making important, original contributions to health care research. Predoctoral trainees will ordinarily fulfill this requirement in the process of obtaining the PhD degree. Postdoctoral trainees may fulfill this requirement in one of several ways:

• Enroll in a departmental master's or PhD degree program. To do so, the individual must meet the admission requirements of the department.
• Enroll in a multidisciplinary degree program. For example, trainees may enroll in the Medical Information Sciences Program, a non-departmental degree program in the School of Medicine, which offers master's and doctoral degrees in medical informatics. While admission to the Medical Information Sciences Program is quite competitive, the program actively seeks qualified physicians.
• Enroll in the Master of Science Program in Health Services Research. This program is sponsored by the Division of Health Services Research in the Department of Health Research and Policy. It is designed to complement training in the medical and social sciences by preparing students for careers in health care research or health policy. Coursework requirements are based on an individually designed multidisciplinary curriculum. The flexibility of the master's degree in health services research will be ideal for the needs of postdoctoral trainees whose undergraduate education has not prepared them to begin study at the graduate level in a non-biomedical discipline. Such individuals can design a curriculum that will bring them to the point of readiness for graduate-level programs. Such curricula will be formulated under the direction of a training program faculty advisor. The master's degree in health services research is also suited for trainees who wish advanced training in a discipline that does not offer a master's degree at Stanford University.

Admission to the degree program in health services research will be assured for any individual who is selected for this fellowship program. Admission to the graduate programs of the University is made through separate application to the Graduate Admissions Office of the University. The Graduate Record Examination (GRE) is required for most graduate degree programs.

Research

Experience in research is the single most important component of the Stanford Fellowship in Health Care Research and Health Policy. Each trainee should choose a research preceptor by the end of the first year of the program.

Throughout his or her tenure in the program, each trainee is required to attend the weekly Health Services Research-in-Progress Seminar. Faculty, trainees, and visiting scholars present their research at this seminar. The seminar exposes trainees to a wide range of health care research and provides an opportunity to present research at any stage from conceptualization to rehearsal for presentation at national meetings. These meetings provide an opportunity to learn how to offer and receive criticism.

Trainees frequently attend several other research seminars, which include the Biostatistics Seminar, the Applied Microeconomics Seminar, the Statistics Seminar, departmental grand rounds, and a variety of campus-wide symposia.

Stipends

Each trainee will receive a stipend commensurate with the salary schedule for applicable National Research Service Award (NRSA) postdoctoral fellowships. For postdoctoral trainees, the amount varies with the number of years of relevant experience since obtaining an MD or PhD degree. The stipend is subject to change.

Effective with all awards made on or after October 1, 2005, current postdoctoral trainee stipends range from $36,996 to $51,036 annually. For candidates who complete three years of residency training immediately after medical school, then begin the fellowship program, the annual stipend is $43,428.

As in all such NIH-funded fellowships, graduates of the program are subject to payback provisions if they do not engage in research and/or teaching upon completion of the fellowship. The following description of the payback rule is reproduced from an announcement from the Agency for Healthcare Research and Policy:

Payback Provision: Trainees must sign an agreement that they will fulfill the NRSA payback requirements. Recipients agree to engage in full-time health services research and/or teaching for a period equal to the period of NRSA support in excess of 12 months. Once an individual has had 12 months of postbaccalaureate NRSA support, all subsequent NRSA support is subject to payback.

Recipients must begin to undertake the obligated service on a continuous basis within two years after termination of NRSA support. Individuals who fail to fulfill their obligation through service must pay back the total amount of NRSA funds paid to the individual for the obligation period plus interest at a rate determined by the Secretary of the Treasury. Financial payback must be completed within three years beginning on the date the United States becomes entitled to recover such amount. Under certain conditions, the Secretary of Health and Human Services may extend the period for starting service or for repayment, permit breaks in the period of service or repayment, or otherwise waive or suspend the payback obligation of an individual.

Other Trainee Activities

Teaching activities are permitted if consistent with the overall educational goals of the trainee. Up to 10% of time may be spent teaching if approved by the Program Committee and by the AHRQ.

Many physician-trainees will find it desirable to engage in clinical activities during their fellowship in order to maintain clinical skills. Consequently, while trainees are expected to engage in research training on a nearly full-time basis, they are also allowed to devote up to 15% of their time to combined clinical and teaching activities.

Address all materials and queries to:

Mary P. Herda
CHP/PCOR
Stanford University
117 Encina Commons
Stanford, CA 94305-6019
(650) 723-1803 (voice)
(650) 723-1919 (fax)
mherda@stanford.edu