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Anesthesiology:
doi: 10.1097/ALN.0b013e31821bdbc7
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Beyond Foundation for Anesthesia Education and Research: Selected Fellowship Programs Sponsored by The Robert Wood Johnson Foundation

Orkin, Fredrick K. M.D., M.B.A., S.M.

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IN addition to Foundation for Anesthesia Education and Research support for training and research, academic anesthesiologists can benefit from programs offered by the Robert Wood Johnson Foundation (RWJF), the nation's largest philanthropic organization devoted exclusively to “improving the health and health care of all Americans.”
“Anesthesiologist-alumni of these programs stand ready to help those interested in applying to these excellent programs.”
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Established in 1972 from the estate of Robert Wood Johnson, former head of Johnson & Johnson (New Brunswick, NJ), RWJF made grants totaling more than $350 million in 2009 from an endowment of $8 billion. While its early successes include helping to establish the fields of emergency care and end-of-life care, current program areas are developing human capital for leadership, reversing the childhood-obesity epidemic, expanding affordable healthcare coverage, supporting innovative “pioneers,” ensuring quality public health, improving healthcare quality, and addressing the needs of vulnerable populations.
Table 1
Table 1
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Three fellowships especially relevant to academic anesthesiologists are the RWJF Clinical Scholars Program, The Harold Amos Medical Faculty Development Program, and the RWJF Health Policy Fellowship Program. Each program is administered by an external national program office and overseen by a national advisory board that functions as the program's admissions committee (see table 1 for program details).
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Clinical Scholars Program

Among the oldest RWJF programs (from 1972), the Clinical Scholars Program fosters development of physicians to transform US healthcare through “innovative research and work with communities, organizations, practitioners and policy makers on issues important to the health and well-being of all Americans.” It is the preeminent training program for young physicians interested in health services research, community-based research, and related fields (e.g., clinical epidemiology, clinical decision-making, health economics, bioethics, history of medicine, medical sociology, health policy). With more than 1,100 alumni, this program has largely created academic primary care. Although most clinical scholars have come from primary care, its trainees represent all disciplines, many of whom have made important research contributions during their fellowships (e.g., William A. Knaus, M.D., APACHE [Acute Physiology and Chronic Health Evaluation] critical care score1; Jeffrey H. Silber, M.D., Ph.D., failure-to-rescue clinical outcomes metric2).
“The program offers master's degree graduate-level study and research in a university-based, postresidency training program” with a stipend covering research training and meeting expenses, for “two years of study with generous protected time for research,” which may be extended for a third year. Whereas the program is conducted at four to six sites at any time, and 15 US and Canadian universities have hosted the program, current sites are University of California, Los Angeles; University of Michigan (Ann Arbor); University of Pennsylvania (Philadelphia); and Yale University (New Haven, Connecticut). Program sites “vary in design and emphasis, [but] each institution has developed a core structure that introduces scholars to the methods used in health care research, and each offers formal coursework, individual mentorship [by members of the national advisory board as well as faculty at the program site] and guidance in project development.” There is remarkable flexibility in curriculum development for each scholar. Scholars may present their research at the program's annual meeting.
Currently, half of the positions are funded by RWJF, with the others funded by the US Department of Veterans Affairs. Applications go to the national program office with a general project in mind. Semifinalists are interviewed, and those selected are assigned to sites by the national program office. There is a 17-month lead-time between application deadline and program entry date. In addition to me (1974–1977), the following anesthesiologists have completed the program:
Patricia Russell, M.D. (1975–1977)
Robert Hirsh, M.D., M.S. (1977–1979)
Stephen Leventhal, M.D., M.B.A. (1979–1981)
Donna Kalauokalani, M.D., M.P.H. (1997–1999)
Jill Mhyre, M.D. (2003–2005)
Mark Neuman, M.D. (2008–2010)
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The Harold Amos Medical Faculty Development Program

Formerly known as the RWJF Minority Medical Faculty Development Program, this program was “created to increase the number of faculty from historically disadvantaged backgrounds, who can achieve senior rank in academic medicine and who will encourage and foster the development of succeeding classes of such physicians.” Since its founding in 1983, more than 225 Amos Scholars have completed the program, with more than 80% remaining in academic medicine.
The program makes 4-yr research awards, with “research” defined broadly as laboratory, clinical, or health services research. Each Amos Scholar conducts research with a senior, US-based faculty member at an academic medical center noted for faculty development. Scholars are expected to spend at least 70% of their time in research. The applicant identifies a potential mentor, and the applicant and proposed mentor jointly apply with a research plan. Semifinalists are selected for interviews. Preference is given to those who have recently completed formal clinical training. The following anesthesiologists have completed the program:
Jackie Martin, M.D. (1992–1995)
Lisa Crossley, M.D. (1992–1996)
Emery Brown, M.D., Ph.D. (1992–1996)
Errol Lobo, M.D., Ph.D. (1993–1996)
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Health Policy Fellowship

Among the oldest RWJF programs (from 1973), this fellowship is “the nation's most comprehensive experience at the nexus of health science, policy and politics in Washington, DC … [offering] an outstanding opportunity for exceptional midcareer health professionals and behavioral and social scientists … to experience and participate in the health policy processes at the federal level and to use that experience to provide leadership to improve health, health care and health policy at the national, state, or local levels.” Although health policy experiences are offered by other organizations, none match that of the RWJF program for depth and breadth.
This 1-yr fellowship, based at the Institute of Medicine (Washington, DC), begins with a 3.5-month orientation that includes, briefings with congressmen and staff prominently involved in healthcare legislation, staff from congressional support agencies, administrators and staff from executive health-related agencies, and private interest groups and think tanks. It is an experience that comprises a unique exposure to a current “Who's Who” in health policy. The fellowship continues with an 8- to 12-month, full-time work experience as a staff member for a congressman, congressional committee, or congressional support agency.
Given the paucity of individuals with equivalent healthcare expertise in Congress, Health Policy Fellows often find themselves with substantial high-level responsibility, drafting legislative proposals, arranging hearings, briefing legislators for committee sessions, and/or serving as liaison between their work site and elected officials, the executive branch, constituents, trade associations, and think tanks, among other groups. After this year in Washington, there is an option for fellows to continue a preapproved, financially supported, health policy activity at one's home university, as well as to avail oneself of other career-development options (e.g., formal leadership coaching, media training). Another track extends the stay in Washington, DC, to a second year, based at the Institute of Medicine.
The majority of applicants are physicians, but the fellowship pool includes a diverse array of health-related disciplines. The application process includes a letter from one's academic-site chief executive officer that affirms the institution's interest in the candidate's postfellowship career. Semifinalists are invited to the Institute of Medicine for interviews. In addition to myself (1984–1985), the following anesthesiologists have completed the program:
Allen Hyman, M.D. (1987–1988)
Michael Ashburn, M.D., M.P.H., M.B.A. (1995–1996)
Marc Hahn, D.O. (1998–1999)
Susan Goelzer, M.D., M.S. (2002–2003)
Roger Johns, M.D., M.H.S. (2005–2006)
Carmen Green, M.D. (2006–2007)
Admission is extremely competitive for each program, yet the paucity of anesthesiologists who apply and have participated is itself a very strong supporting factor for suitable applicants. Anesthesiologist-alumni of these programs stand ready to help those interested in applying to these excellent programs.
Fredrick K. Orkin, M.D., M.B.A., S.M., Department of Anesthesiology, Yale University School of Medicine, New Haven, Connecticut. fred.orkin68@post.harvard.edu
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References

1. Knaus WA, Zimmerman JE, Wagner DP, Draper EA, Lawrence DE: APACHE-acute physiology and chronic health evaluation: A physiologically based classification system. Crit Care Med 1981; 9:591–7

2. Silber JH, Williams SV, Krakauer H, Schwartz JS: Hospital and patient characteristics associated with death after surgery. A study of adverse occurrence and failure to rescue. Med Care 1992; 30:615–29

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