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OCR for page 101
APPENDIX
B
Survey of Health Services Research
-
Educational Programsi
OBJECTIVES AND METHOD
To obtain more information and perspectives on educational programs in
health services research, the Institute of Medicine (IOM) Committee on Health
Services Research Training and Work Force Issues decided at its first meeting
in July 1995 to canvass these programs for additional information. The IOM
then requested and received funding for this additional work from the Robert
Wood Johnson Foundation. Funds from the Baxter Foundation also helped
support this activity.
As a starting point, staff used the 121 health services research training
programs in the United States and Canada that were listed in the 1991-1992
directory compiled by the Foundation for Health Services Research (FHSR).
Although the listing is not all-inclusive, it was the most comprehensive one
available to the committee. The list included information on 45 master's
programs, 66 doctoral programs, and 26 fellowship programs for a total of 137.
The sum of program categories exceeds 121 because some programs offer both
a master's and a doctoral program.
In early December 1994, the programs listed in the FHSR directory were
mailed (1) a copy of their entry in the 1991-1992 FHSR directory for updating
and (2) a three-page, open-ended questionnaire developed by the committee. The
questionnaire asked about program structure, students' academic and work
backgrounds, curriculum, enrollment, financial aid, and post-training careers of
graduates. Nonrespondents received follow-up phone calls to encourage them to
This appendix was prepared by Jill Feasley of the project staff.
101
OCR for page 102
102 /lIEALTH SERVICES RESEARCH
return the questionnaire. Sixty-three ofthe 137 programs resumed questionnaires
for an overall response rate of 46 percent.2 (Responses were received from 18
master's, 30 doctoral, and 15 fellowship programs for response rates of 40, 45,
and 58 percent respectively.) An additional 13 programs returned only their
directory update.
FINDINGS
Program Structure
Reflecting the multidisciplinary nature of the health services research field,
the structure arid focus of health services research programs vary considerably.
Some programs are devoted explicitly to health services research whereas others
offer a health services research concentration within a distinct discipline such as
nursing, pharmacy, or social work. Some programs are housed in their own
academic departments, others draw from several departments in the university,
and a few operate under the shared or primary auspices of institutions such as
Veterans Affairs- hospitals that are not universities. Table B. 1 displays the areas
and disciplines offering programs in health services research as categorized in the
FHSR directory.
Many programs reported that they are considering changing or already have
changed their programs from the traditional fill-time, daytime, Indite format to
include alternative offerings that better accommodate students who continue to
work or are enrolled on a part-time basis. Classes are now being offered on
evenings and weekends, by mail or other distance learning arrangements, and
through summer institutes or other types of short and intensive courses. Some
programs are specifically designed for business and government executives or
midcareer professionals.
Academic and Work Backgrounds of Students
As might be expected, before entering the health services research
educational programs, students had studied a variety of academic disciplines at
both the undergraduate and graduate levels. Survey respondents most frequently
cited student backgrounds in clinical areas (e.g., nursing, dentistry), with
2The timing of the survey may have contributed to the relatively low overall response
rate; the survey was sent out just as most academic programs were finishing the first
semester and starting the winter break. Beyond the follow-up phone calls, the study
timetable did not allow for intensive follow up.
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108 / HEALTH SERVICES RESEARCH
business, administration, and social sciences the next most frequently mentioned
(Table B.2).
Survey respondents indicated that both master's and doctoral students have
often had some type of work experience in health care (Table B.39. Respondents
for doctoral programs also cited student work experiences in administration or
research. Relatively few students were described as "preservice" (i.e., entering
a program without any work experience), and most of these were master's-level
students.
Curriculum
Respondents were asked to identify the core courses for a standard health
services research curriculum. The only course cited by a majority of survey
respondents for all program levels (master's, doctoral, and fellowship) was
research methods, although majorities or near majorities also cited statistics or
biostatistics (Table Bob. Health economics was another quantitatively oriented
course cited by at least one-third of respondents in each program area. Health
care organization was mentioned by the less than one-third of respondents in
each of the program areas, although larger proportions mentioned health policy,
which may have considerable overlap in course content.
In addition to the standard coursework, respondents noted the need for
students to be involved in "real world" research under the supervision of a
mentor. Ideally, the student should be involved with all phases of the
research from initial development to final dissemination. If students plan a
career in academia, they should also write articles for scholarly journals and
present academic papers at professional conferences. Students who will go on
to conduct research should be involved with proposal writing and fundraising.
Enrollment
Building on information from the 1991-1992 FHSR directory and the
responses to the canvass of educational programs, the committee attempted to
develop a rough estimate of the health services research pipeline, that is, those
who are students in health services research educational programs. For the 76
respondents who submitted an update of the FHSR directory information, the
committee used their report of the number of students enrolled in each class. For
the 45 respondents who did not return the update, the committee used the
enrollment information reported in the 1991-1992 FHSR directory. For the
former group, the committee compared their updated and earlier figures and
APPENDIX B / 109
found little change in enrollments for most programs, but the pattern for
nonrespondents might be different.
TABLE B.2 Number and Percentage of Survey Respondents Indicating
Typical Academic Backgrounds of Their Health Services Research Students
Academic
Discipline
Master's
Programs
No. (%)
Doctoral
Programs
No. (%)
Fellowship
Programs
No. (%)
Clinical sciences 14 (82) 15 (58) 9 (64)
Business/administration 4 (24) 11 (42) 1 (7)
Social sciences 3 (18) 4 (15) 3 (21)
Public health 1 (6) 4 (15) 2 (14)
Other 4 (24) 6 (23) 7 (50)
NOTE: Number of programs responding to this question were as follows: master's,
17; doctoral, 26; and fellowship, 14. The percentages given are based on the number
of programs responding to this question, not on the total number of programs
responding to the survey. Respondents could list more than one response.
The combined figures on enrollment in each class Dom the two data sources
show approximately 1,015 master's students, 511 doctoral students, arid 197
postdoctoral fellows. As an estimate of the health services research pipeline, this
number must be interpreted cautiously. On the one hand, for the master's level
and other programs that offer concentrations in areas in addition to health
services research, the numbers may include students who have concentrations
other than health services research. On the other hand, the numbers refer to
enrollments in each class, not to total enrollments.3
3To obtain an estimate of total enrollment, the committee considered multiplying the
enrollment figure for each program by the reported years to complete a degree (two years
for most master' e-level programs and four to five years for doctoral programs). If the
latter average were applied to the figure for doctoral enrollment reported in the text (51 1),
it would yield an estimated 2,555 doctoral students in the pipeline. Based on committee
members' involvement in the field, this number seemed implausibly high, presumably
because it would not account for attrition. By way of contrast, for medical and dental
school, enrollments are reported for the first through fourth years of school as well as for
those graduating in a year (IOM, 1995~.
1 10 / HEALTH SER VICES RESEARCH
TABLE B.3 Number and Percentage of Survey Respondents Indicating
Typical Work Backgrounds of Their Health Services Research Students
Master's Doctoral Fellowship
Work Programs Programs Programs
Experience No. (%) No. (DO) No. (%)
-
Health care 16 (94) 20 (80) 7 (50)
Research 1 (6) 6 (24) 3 (21 )
Preservicea 5 (29) 1 (4) 2 (14)
Administration 0 (0) 7 (28) 0 (0)
Academia 0 (0) 0 (0) 4 (29)
Other 2 (12) 6 (24) 3 (21)
NOTE: Number of programs responding to this question were as follows: master's,
17; doctoral, 25; and fellowship, 14. The percentages given are based on the number
of programs responding to this question, not on the total number of programs
responding to the survey. Respondents could list more than one response.
aThe student had no prior work experience before entering the program.
Financial Aid
All of the doctoral and fellowship training programs reported offering some
type of financial aid to some or all of their students, as do almost all of the
master' e-level programs. The amount of aid, however, varies considerably from
program to program. For example, some doctoral programs reported offering a
$15,000 stipend and free tuition to all students. Others can only waive the
tuition for a few students in each class. In general, the fellowship programs are
able to provide a higher stipend (the amounts reported ranged from $17,000 to
$40,000), but usually the stipend is considerably less than the participant could
be earning in his or her chosen field. The amount of support provided to
master's-level students ranges from none to $14,000 plus a tuition waiver.
Survey respondents most frequently cited their university as a source of
funding for student stipends (Table B.5) The federal government was the next
most-often-cited source with financing coming either through explicit education
awards such as the National Research Service Award or through research grants
to the training institution that allow students to be hired for research projects.
Foundations, state government, and private industry also provide funding to
trainees. In particular, the Robert Wood Johnson Foundation and Pew Charitable
Trusts have supported health services research and related educational programs.
APPENDIX B / 111
TABLE B.4 Number and Percentage of Survey Respondents Indicating Core
Courses for a Standard Health Service Research Curriculum
.
Master's Doctoral Fellowship
Programs Programs Programs
Course No. (NO) No. (%) No. (%)
Research 11 (73) 22 (1 00) 6 (55)
methods
Statistics/ 7 (47) 11 (50) 7 (64)
Biostatistics
Health 6 (40) 12 (55) 4 (36)
economics
Health policy 4 (27) 8 (36) 6 (55)
Epidemiology 5 (33) 4 (18) 7 (64)
Health care 3 (20) 7 (32) 3 (27)
organization
Administration/ 3 (20) 3 (14) 1 (9)
Management
Ethics 1 (7) 3 (14) 1 (9)
Other 6 (40) 5 (23) 4 (36)
.
_
NOTE: Number of programs responding to this question were as follows: masters
15; doctoral, 22; and fellowship, 11. The percentages are based on the number of
programs responding to this question, not on the total number of programs responding
to the survey. Respondents could list more than one response.
Post-Training Careers
According to survey respondents, graduates of health services research
training programs will go on to work in three general capacities: as a faculty
member of an academic institution; as a researcher for an independent research
organization; or as a policy analyst or researcher with a government agency.
Others work in clinical or administrative settings, although the responses do not
make clear the extent to which they are actually involved in research rather than
patient care or management (Table B.6~. Survey respondents indicated that
graduates generally continue to hold the same types of jobs five years after
completing their academic training.
1 12 / HEALTH SERVICES SEARCH
TABLE B.5 Number and Percentage of Survey Respondents Indicating
Source of Funding for Health Service Research Students' Stipends
Source of
Funding
Master's
Programs
No. (%)
Doctoral
Programs
No. (%)
Fellowship
Programs
No. (%)
University 12 (86) 21 (81 ) 4 (27)
Federal government 6 (43) 11 (42) 12 (80)
Grants, otherwise 1 (7) 5 (19) 0 (0)
unspecified
State government 2 (14) 3 (12) 2 (13)
Foundation 3 (21) 2 (8) 4 (27)
Industry 3 (21) 2 (8) 2 (13)
Other 0 (0) 1 (4) 0 (0)
NOTE: Number of programs responding to this question were as follows: master's,
14; doctoral, 26; and fellowship, 15. The percentages given are based on the number
of programs responding to this question, not on the total number of programs
responding to the survey. Respondents could list more than one response.
TABLE B.6 Number and Percentage of Survey Respondents Indicating Post-
Training Employment Settings of Graduates in Health Services Research
-
Master's Doctoral Fellowship
Employment Programs Programs Programs
Setting No. (%) No. (%) No. (%)
Academic institution 6 (38) 23 (92) 10 (77)
Research organization 9 (56) 17 (68) 7 (54)
Government agency 6 (38) 8 (32) 6 (46)
Clinical setting 3 (19) 1 (4) 2 (15)
Administrative setting 1 (6) 4 (16) 0 (0)
Not applicable/too new to know 4 (25) 0 (0) 1 (8)
NOTE: Number of programs responding to this question were as follows: master's,
16; doctoral, 25; and fellowship, 13. The percentages given are based on the number
of programs responding to this question, not on the total number of programs
responding to the survey. Respondents could list more than one response.
