APPENDIX B.
Curriculum and Course Offerings7

CURRICULUM AT THE UNIVERSITY OF MICHIGAN

The University of Michigan curriculum consists of approximately 50 credit hours of course work. The overall goal of the curriculum is to ensure that at the completion of the program every student has a high level of literacy in the concepts and methods that are basic to health policy analysis and research. Because of the nonresidential nature of the program, in which the students come to campus once a month for 4 days, all Pew students take the same courses in lockstep fashion. All courses in the curriculum are required, and there are no electives. The curriculum is grouped into four categories: orientational and instrumental courses, statistics and methodology, core skills and concepts, and the public health core. Several dissertation-related courses are also required.

Orientational and Instrumental Courses

Some of the instruction provided early in the program is designed to enable students to make full and efficient use of the resources and facilities available to them through the Pew program at the University of Michigan. These offerings include computer instruction.

Although there is no formal course in computers, time is set aside during the first three sessions of the program to teach students how to use key features of the university's mainframe system. This includes the electronic mail and conferencing systems that Pew students are expected to use to communicate with one another and the faculty. It also includes the university library's computerized catalog as well as relevant literature and journal databases. In addition, instruction is provided in the microcomputer statistical

7  

 Information included in this appendix comes from program narratives and interviews with program directors and faculty.



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The Lessons and The Legacy of the Pew Health Policy Program APPENDIX B. Curriculum and Course Offerings7 CURRICULUM AT THE UNIVERSITY OF MICHIGAN The University of Michigan curriculum consists of approximately 50 credit hours of course work. The overall goal of the curriculum is to ensure that at the completion of the program every student has a high level of literacy in the concepts and methods that are basic to health policy analysis and research. Because of the nonresidential nature of the program, in which the students come to campus once a month for 4 days, all Pew students take the same courses in lockstep fashion. All courses in the curriculum are required, and there are no electives. The curriculum is grouped into four categories: orientational and instrumental courses, statistics and methodology, core skills and concepts, and the public health core. Several dissertation-related courses are also required. Orientational and Instrumental Courses Some of the instruction provided early in the program is designed to enable students to make full and efficient use of the resources and facilities available to them through the Pew program at the University of Michigan. These offerings include computer instruction. Although there is no formal course in computers, time is set aside during the first three sessions of the program to teach students how to use key features of the university's mainframe system. This includes the electronic mail and conferencing systems that Pew students are expected to use to communicate with one another and the faculty. It also includes the university library's computerized catalog as well as relevant literature and journal databases. In addition, instruction is provided in the microcomputer statistical 7    Information included in this appendix comes from program narratives and interviews with program directors and faculty.

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The Lessons and The Legacy of the Pew Health Policy Program package that Pew students use in their statistics and methodology courses. Similarly, the introductory course taught at the beginning of the program aims to give students a clearer understanding of the goals and structure of the program so that as they proceed in their course work they have a solid sense of how the various components fit together. This includes an understanding of how the course work relates to the qualifying examination, which they need to take to achieve candidacy, as well as to the dissertation, and how all of these elements are intended to serve the basic goals of the program. Another part of this introductory course consists of presentations and seminars by guest lecturers, which are intended to expose students to a broad range of approaches to the analysis of health policy issues. An important goal of this series of seminars is to illustrate how several of the individual elements covered in Pew program courses are brought together by experienced analysts and researchers in addressing specific policy questions and issues. Statistics and Methodology Graduates of the Pew program at the University of Michigan are expected to have the kind of grounding in statistics and research methods that will enable them to make discerning use of the literature and to know what is required to turn out high-quality health policy research and evaluations. Since they are not being trained to be full-time researchers, the emphasis is on gaining a firm grasp of the fundamentals and of the methods and approaches most likely to be of use for health policy. This is seen as providing the necessary base for any subsequent learning of more intricate or specialized approaches that individuals may wish to pursue or for collaborating with those who have specialized knowledge about such approaches. A series of four courses is offered in this area. Each course is meant to reinforce and build upon previously acquired knowledge. In addition, the topics covered in these four courses come up again and are expanded upon in other courses, such as epidemiology, economics, and the seminar on disease prevention and the environment. Statistics is one of the areas in which the Pew students must pass a so-called prerequisite examination at the start of the program. To pass it students must demonstrate knowledge at the level of an introductory graduate course in sta-

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The Lessons and The Legacy of the Pew Health Policy Program tistics. The biostatistics course that is given early in the program (BIOS 524) starts with a brief review of the basic material in probability theory and statistical methods that the qualifying examination covers. The biostatistics course itself concentrates on regression methods and analysis of variance and covariance. Also taught early in the program is a course that deals with research and evaluation methods (HSMP 854). These two initial courses in statistics and methods focus heavily on the nature and use of key concepts and tools. Two other courses taught in the latter part of the program, applied statistics and applied methodology, focus on the hands-on, actual application to specific health policy issues of the concepts and tools taught in the initial two courses. These two applications-oriented courses run concurrently, and their coverage of topics is coordinated as to be mutually supportive and reinforcing. Core Skills and Concepts Central to the Pew program's curriculum is a set of courses, each of which deals with the concepts and frameworks from a specific discipline or area and with the application of these to the analysis of health policy issues. To ensure that these courses are taught at the appropriate doctoral level and can devote the necessary time to health policy applications rather than to teaching of basic concepts, students must demonstrate mastery of the basics in three areas: economics, political science, and organizational behavior. Similarly, the medical care organization course assumes a basic knowledge of how the U.S. health care system is structured and how it operates. Students with deficiencies in this area are provided with resources and guidance to remedy this through self-study prior to the start of the course. Public Health Core The degree that Pew fellows earn from Michigan is a doctorate in public health. Like all other programs leading to a public health degree awarded by the university's School of Public Health, the Pew program must include in its curriculum certain basic public health courses. The courses in this set are the only ones that were not specifically created for the Pew program. Nonetheless, as offered in the Pew program construct, each of these courses emphasizes policy applications and implications.

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The Lessons and The Legacy of the Pew Health Policy Program Dissertation Courses As part of the strategies developed over time to help students in the Pew program make timely and satisfactory progress toward their dissertations, a formal dissertation seminar was established as part of the curriculum. Its purpose is to provide, systematically and concisely, information of what is known about effective ways to structure and manage the dissertation. It also serves as a forum for the discussion of generic and specific problems related to the dissertation and their solutions, as well as a forum for students to present preliminary topics to their fellow classmates, which have been proven to be useful exercises. In addition, during the final stage of the program, each student must sign up with a faculty member of the student's choosing for an independent study course focusing on the dissertation. In the context of this course the student works with the faculty adviser to select a topic, prepare a dissertation proposal, and identify the proposed membership for the student's dissertation committee. To help sustain the momentum toward the dissertation that these courses are expected to generate during the second year of the program, students are brought back to Ann Arbor on three separate occasions during the third year of the program. At each of these sessions students are expected to meet with their dissertation advisers. They also meet as a group at the dissertation seminar, where they report back to the group and leading faculty member on their progress, and receive feedback from them. Lessons Learned Over time, some lessons were learned regarding the curriculum, over time. Leon Wyszewianski explained that at the beginning there was a division between the more didactic courses and the policy seminars. At the seminars the emphasis was on discussion and on interaction. However, what the program directors learned was that the fellows really did not want free-form seminar discussion; rather, they wanted discussion in the context of much ''harder-hitting'' didactic material. Other changes included increasing the depth of the methodological aspects of the curriculum. One way this was done was to require that the fellows have some minimum level of competence, as determined by an entrance examination, prior to beginning the courses. This helped the faculty gear their lectures to the middle of the class rather than to the lowest denominator. The formal dissertation seminars

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The Lessons and The Legacy of the Pew Health Policy Program were also brought about through curriculum reform. As discussed at length in the main body of the report, the program learned that just because its fellows excelled in the field and at being students, these factors did not mean that they could just automatically write a dissertation on their own. Formal structures that helped the fellows move through the complex dissertation process were instituted. Leon Wyszewianski also discussed the early problems related to the multiple incompletes that were being accumulated by the fellows. The faculty were discouraged from assigning a major paper due at the end of the term; rather, pieces of a term paper were required to be handed in throughout the semester. Having frequent and smaller deliverables was found to greatly assist the fellows in completing the required course work. COURSE OFFERINGS AT THE UNIVERSITY OF MICHIGAN Course Requirements Orientation and Instrumental Courses Computer Instruction. Although there is no formal course in computers, time is set aside during the first three sessions of the program to reach students how to use key features of the university's mainframe computer system (including electronic mail and conferencing systems, the library's computerized catalog, and relevant literature and journal databases). Instruction is also provided in the microcomputer statistical package that Pew students use in their statistics and methodology courses. Introduction to Health Policy and Research. This course gives students an understanding of the goals and structure of the Pew Doctoral Program in Health Policy and to the health policy field in general. The balance of the course is devoted to an examination of how health policy research is conducted, and a varied group of guests who are active in policy research and analysis are invited to make presentations and conduct seminars. Statistics and Methodology Biostatistics for Clinical Researchers. This course reviews the basic probability theory and statistical methods, including design of experiments, observational studies, point and interval estimation, and hypothesis testing. The topics for this course are simple and multiple regression analyses and analysis of variance and covariance.

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The Lessons and The Legacy of the Pew Health Policy Program Research and Evaluation Methods in Health Policy. This course aims to acquaint students with major analytical and methodological issues in understanding, criticizing, and designing formal research and evaluation programs in the health policy field, including the design and use of experiments and quasiexperiments; choice and operationalization of measures and hypotheses in health policy studies; randomized clinical trails and their bearing on policy; methods and limits of technology assessment; and Delphi techniques and consensus methods. Applied Statistics. This course begins with a review of simple and multiple regression analyses and analysis of variance and covariance. The course itself centers on the application of these and other statistical tools to the analysis of health policy questions. Applied Methodology. This course is designed to reinforce and expand upon the material covered in the Research and Evaluation Methods in Health Policy course. The course uses actual studies and data sets to provide hands-on experience in the use of methodological and design approaches to address specific policy issues and questions. The structure includes a module on survey research methods. Core Skills and Concepts Organizational Issues in Health Policy. This course offers application of current theory and research to health policy-relevant cases in organizational design, organizational environments, boundary setting and boundary spanning, organizational conflict, and organizational change. The structure emphasizes theoretical formulations; critical analysis of current research, especially its utility for organizational policies and practices; and application of theory and research to complex case material. Economics of Health Policies. This course offers an application of microeconomic concepts and methods to health care policy formulation, implementation, and evaluation. The structure emphasizes applicability of market analyses, cost-benefit and cost-effectiveness analyses, allocational and distributional considerations, and design and implementation of incentives and regulation. Legal Issues in Health Care Policy. This course analyzes selected legal issues demonstrating the role of law and the

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The Lessons and The Legacy of the Pew Health Policy Program Anglo-American legal system in the implementation of health care policy. Emphasis is placed on issues of current significance including health planning, antitrust legislation, rights to access to care, the government's role in environmental and occupational health, taxation and regulation of providers, the status of allied health professionals, and the legal aspects of termination of care. Each subject is considered in the context of the political, economic, administrative, and ethical/moral values that shape the development of law. Issues in Medical Care Organization and Delivery. This course offers analysis and description of selected issues, problems, and tasks in the financing, organization, and evaluation of personal health care services. Topics include social values and objectives, assessment of the need for health services, assessment of health care resources, features of system design that influence key aspects of performance, and assessing, monitoring, and enhancing the quality of care. The course emphasizes the use of concepts and frameworks in analyzing policy issues related to these topics. Politics in Health Care Policy. This course focuses on the political aspects of health care policy. The emphasis is placed on the processes by which decisions are made about the allocation of key resources and the institutions and forces affecting these processes, including the president, the U.S. Congress, the bureaucracy, interest groups, the professions, and state and local governments. The course aims to show fellows how to make effective use of political science concepts and frameworks to analyze health policy issues. Policy Seminar in Disease Prevention and the Environment. This course reviews concepts of disease prevention in a policy context, with consideration of prevention as a social health care strategy and of the political economy of prevention. Emphasis is placed on the application of policy analytic tools to contemporary behavioral and environmental issues of disease prevention, relying heavily on case studies and recent and ongoing research. Public Health Core Strategies and Uses of Epidemiology. The course reviews basic epidemiology for the public health professional, with a review of the fundamental principles and concepts and application of these principles and concepts to selected examples

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The Lessons and The Legacy of the Pew Health Policy Program of communicable diseases and chronic degenerative diseases. A strong emphasis is placed on the policy aspects of the examples discussed. Principles of Health Behavior. This course provides an overview of psychosocial factors related to health and illness behavior and to processes of belief and behavior change in relation to health, including strategies for change at the individual, group, and community levels. Again, a strong emphasis is placed on the policy implications of the issues discussed. Principles of Environmental Health Sciences. This course focuses on giving the fellows basic knowledge and skills required to assess the impacts of environmental health contaminants. The teaching format uses representative examples of environmental health problems. Environmental interactions, health effects, risk assessment, and control measures are assessed for each example. Dissertation Dissertation Seminar. This course is intended to help the fellows structure their work on the dissertation and thereby facilitate a satisfactory and timely completion of a critical requirement for the DrPH. Strategies for structuring and managing the dissertation are presented and discussed, along with ways to deal with common problems and pitfalls. Dissertation Research for Precandidates. This consists of independent study with a faculty member of the student's choosing. The goal is to select a topic, prepare a prospectus, and identify the proposed membership of the dissertation committee. Dissertation Research for Doctoral Students. This consists of a series of three visits to the University of Michigan campus during the third year of the program, during which fellows meet with their dissertation advisers. CURRICULUM AT UCSF The University of California at San Francisco (UCSF) Pew program curriculum consists of seminars, formal courses, faculty-fellow interaction and mentoring, research experiences, and field placement experiences in federal, state, or local government or in other policy-relevant organizations. Seminars and courses introduce fellows to a broad range of

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The Lessons and The Legacy of the Pew Health Policy Program issues and a multidisciplinary understanding of the policy-making process. Courses designed to strengthen research skills are also made available. For fellows wishing to pursue a research career, participation in a multidisciplinary research team on one or more research projects is required. For fellows pursuing a career in health policy practice, field placements, mentoring, and networking become relatively more important elements. Defining and refining the curricula are complex and ongoing tasks that include formal course evaluations, a panel discussion of each health policy seminar series, and interviews with former fellows. Each element of the UCSF program, the courses, seminars, faculty-fellow mentoring relationship, learning-by-doing model, field placement, and participation in multidisciplinary research, is geared toward the highly diverse backgrounds and range of needs of both the postdoctoral and the midcareer fellows (UCSF Lessons Learned, 1992–1993). Thus, the UCSF program curricula underwent continual revisions and reformations throughout the tenure of the Pew program. The program directors stated that one of the most valuable tools used to shape the curriculum was the input of current and former fellows. Alumni maintain contact with the faculty long after the program has been completed, and through this continued interaction the program directors learn which aspects of the program are most helpful for the fellows. The process for gathering information about the program from the fellows and alumni has been formalized over the years with the addition of written evaluations and a panel discussion of each health policy seminar series. During 1991 and 1992, the Pew program faculty, as part of the review of the program, conducted telephone interviews with former fellows to evaluate the fellows' introduction to, experience with, and continuing ties with the program and to make suggestions for improvements (Lessons Learned, 92–93). Furthermore, the Fellowship Committee includes two current faculty who were former fellows, as well as a representative of current fellows, further strengthening the input of past and present fellows. The varied teaching and training experiences of the Fellowship Committee members have stimulated curriculum development. Each member brings the best aspects of his or her training to bear on the curriculum. Members also made suggestions based on what they thought was missing from their own training. In addition, the committee members who teach program courses are willing to experiment with novel teaching methods. In 1991 and 1992, a more structured core curriculum was implemented. This curriculum was required for all full-

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The Lessons and The Legacy of the Pew Health Policy Program time fellows and was recommended for part-time fellows. Program seminars are organized into four general topics: introduction to health policy, methodology for health policy research, health policy processes, and health policy issues. The Health Policy Seminar, Writing Seminar, and Journal Club are held weekly throughout the year (11 months), and all fellows attend and participate in the seminars. In addition, a research methods course is required of all physicians and others with limited research training. A rich roster of other courses is offered to fellows, with timely information on available courses and advice on which courses would best fill educational needs being provided. For fellows with particular interests in health policy and the elderly, the Department of Social and Behavioral Sciences of the School of Nursing offers special courses. Institute seminars and courses have proven to be important in achieving three overall training objectives: proving an educational experience for the fellows addressing both policy issues and research applied to policy, offering fellows the opportunity to interact with researchers and policy makers from a variety of settings, and providing an excellent means to create a social support system for the fellows and to assist in their socialization into the world of public policy. Assistance in career planning and placement is also provided. Initially, this assistance was provided on an informal basis, but it is provided in a more formalized structure as the program has evolved. The faculty systematically distribute descriptions of job openings to fellows, discuss job seeking with them beginning in the first year of the fellowship, and provide fellows with general information on preparing a curriculum vitae, interviewing, and other aspects of job hunting. Career counseling is made a specific responsibility of the fellow's mentor, and progress is reviewed periodically by the faculty fellowship committee. Lessons Learned Hal Luft discussed the ongoing tension over how much curriculum structure was too much and how much was too little. He explained that it was in fact the Pew Charitable Trusts that encouraged UCSF to add more structure in terms of the seminars and courses offered. Hal Luft stated that although the Health Policy Seminar had always been successful, making it more formal by structuring internal sequences increased its effectiveness. Nonetheless, Hal Luft stated that the program was continually being further struc-

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The Lessons and The Legacy of the Pew Health Policy Program tured; for instance, the mentoring relationships were standardized with formal guidelines (included in Appendix C). This process was instituted to ensure that the fellows were as productive as possible. Carroll Estes underscored the importance of requiring certain courses at specific times during the program. She stated that the directors learned over time that is was very important to be explicit and to have some details and firm requirements such as the Writing Seminar and the Pew Dissertation Seminar. Participation in these seminars is required unconditionally, as with the methods courses. The faculty wanted to ensure that all fellows emerged from the program with skills in the art and science of proposal writing. On the other hand, Carroll Estes discussed the importance of having some flexibility for other aspects within the curriculum, for instance, allowing the fellows to explore new avenues and areas that they are interested in. COURSE OFFERINGS AT UCSF Core Seminar Requirements Health Policy Seminar (eight quarters). The health policy seminar introduces fellows from disparate backgrounds to a broad range of health policy topics. The seminar focuses on policy questions and how research may help answer those questions. It includes a series of four to six seminars on a specific theme (such as AIDS, women's health, or private sector reform perspectives) to give fellows a chance to immerse themselves in a topic and see how researchers or policy makers from different disciplines approach the same topic. Fellows in the UCSF postdoctoral program typically come into the program with most of the specific skills they will need for their careers. What the Pew program aims to teach these fellows is how to apply those skills to the questions that policy makers need to answer. Therefore, the core health policy seminar focuses on policy questions and how research may help answer those questions. These seminars are often held in an informal fashion, with faculty members raising various questions about topics and attempting to elicit discussion. All fellows and all key faculty take part in the weekly seminars. Exposure to faculty thinking and insights regarding the seminars strengthens the educational component of the seminar series for the fellows. The Art and Science of Health Services Research (one quarter). The emphasis of this course is on how to approach a research

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The Lessons and The Legacy of the Pew Health Policy Program Medical Uses of Statistics; Huff, How to Lie with Statistics; and Ryan/Joiner/Ryan Minitab statistical software.) Economics in Health Policy Analysis. The first half of the course reviews the aspects of price theory and welfare economics that are most pertinent to health services research and policy analysis. The review illustrates how economics apply these concepts and tools to problems of demand for medical care, insurance, and supply of physicians and services. The second half of the course focuses on selected concepts and tools of policy analysis in an attempt to understand the economic rationale for government actions in the health arena. These concepts include population models, cost-benefit analysis, discounting, and decision analysis. In this section, the course also addresses the issues of the value of lifesaving and the value of research. In both parts of the course, students work through a number of simple problems designed to illustrate the economic theories and methods under consideration. (Texts: Mansfield, Microeconomics: Theory and Applications, and various reprints of health policy articles). Social Sciences in Health Policy Analysis. This course examines the contributions of behavioral and social science concepts and methods to health policy analysis. The instructors identify and explain applied theories of individual and social behavior and critically review examples of actual applications to health policy analysis. As a rule, several sessions are devoted to each broad theoretical or methodological domain. Examples include attitudes and behavior, attribution, social inference, mass communication, behavioral analysis of incentives, environment and behavior, psychological measurement, and diffusion of innovation. (Texts: health policy and health services research reprints pertinent to topic.) CURRICULUM AT BRANDEIS Brandeis University recognized in the late 1980s and early 1990s that the field of health policy was rapidly expanding. Those areas developing most extensively were identification of social problems in health care and the changing nature of delivery systems. The Pew program at Brandeis responded to these changing trends with the creation of a curriculum that trained students with the ability to successfully draw upon a broad range of disciplines and conduct action-oriented policy research. As the curriculum became more multidisciplinary, the requirements for health specialization became much more specific (Raskin et al., 1992).

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The Lessons and The Legacy of the Pew Health Policy Program During the first phase of the program, Brandeis and Boston University (BU) had a joint program. The interdisciplinary core curriculum was initially developed by Sol Levine, a sociologist, and Stan Wallack, an economist. The four specially designed Pew courses were Health Financing, taught by Stan Wallack; Health Politics and Organization, taught by Deborah Stone; Health Sociology, taught by Sol Levine; and Health Care Utilization and Illness, taught by Dick Egdahl. A fifth course, the Pew Dissertation Seminar, was added to introduce students to how to conduct research. Initially, the dissertation seminar was led by Sol Levine and Stan Wallack. The goal was to bring Pew students from both universities together to begin thinking about their dissertation. Early on, Steve Crane became involved in teaching the seminar, and he focused on teaching students how to define a research problem and conduct the investigation that would lead to completing a dissertation within the 2-year time frame. During the second phase of the program, the focus of the curriculum shifted from acute medical care services and cost-containment to encompass a broader array of policy issues related to the most underserved and vulnerable populations. The program was moved completely to the Institute for Health Policy at the Heller School at Brandeis. Nonetheless, Brandeis maintained its ties with BU's professional schools of medicine, public health, law, and management. The curriculum during the second phase required students to take 14 courses, including 3 social science theory courses and 3 or more courses in research methods. The health specialization at the Heller School, which became required for all doctoral students interested in health policy, consisted of four required courses: Issues in National Health Policy, taught by Stanley Wallack and Stuart Altman; Health Economics, taught by Christine Bishop; Health Care Organization and Politics, taught by Deborah Stone; and Social, Ethical and Legal Issues in Health Policy, taught by George Annas and other BU faculty. These four courses have been modified since the program began to reflect changes in reimbursement and organization of health care delivery, new technology, an interest in healthier lifestyles, and policy changes that have shifted decision making from the federal level to state and local authorities. Students specializing in health policy are also required to take at least one of the courses in either the health policy core or the special populations core and to attend the Seminar in Health Policy Research led by Jon Chilingerian, codirector of the Brandeis Pew program.

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The Lessons and The Legacy of the Pew Health Policy Program The Heller School offers a PhD in social welfare policy. The school has a strong commitment to providing broad interdisciplinary training in economics, political science, sociology, and research methods. As part of the effort to integrate the core curriculum of the Heller School and to have the full resources of the Health Policy Institute available to students specializing in health policy, a Pew Curriculum Planning Committee was created. The committee included the dean and four faculty members from the Heller School plus the director of the Institute for Health Policy and four senior researchers from the institute. At the same time, the Heller School was also seeing a dramatic increase in the number of other doctoral students seeking to specialize in health policy. To help accommodate the growth in the number of students specializing in health policy, the Institute for Health Policy created an Institute Fellows program beginning in the 1992–1993 academic year and selected four fellows whose course requirements and activities paralleled those of the Pew fellows. In contrast to the Pew fellows, however, Institute fellows were required to work 1 day a week at the institute in exchange for an annual stipend. From the outset, the content of the core curriculum was interdisciplinary. The doctoral program at the Heller School consists of course work in the basic social sciences, statistics and research methods, policy analysis, economics, and advanced work in substantive policy areas. Substantive areas are organized around the school's research centers and institutes. Pew fellows have studied and conducted research (including their dissertations) in a wide variety of health policy areas such as cost-containment, technology, rural health delivery, and emergency care. Some students have explored emerging issues such as violence, AIDS, substance abuse, disability, and the influence of gender on professional behavior. Students are required to attend a dissertation seminar that provides in-depth exposure to the processes of conducting research. The goal has been to bring students together to begin thinking about their dissertations. Students are taught how to define the research problem and conduct the investigation, leading to completion of a dissertation within the 2-year time frame. Lessons Learned Operating an accelerated doctoral program alongside a more traditional model was difficult at Brandeis, however, the Pew

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The Lessons and The Legacy of the Pew Health Policy Program program turned out to be a catalyst for educational reform and change. On the basis of the experience of the Pew program, adjustments and reforms were made to the policies, procedures, and curriculum of the traditional educational program. Four problems had to be resolved: initial faculty concerns about the quality of an accelerated program, the need to change educational policy and curriculum rules, requiring an early dissertation seminar, and balancing a loose versus tight curriculum structure. At the outset of the Pew program, some Heller School faculty challenged the concept of a doctoral program that was trying to produce high-quality, academically oriented students in only 2 or 3 years. The outcomes of the Pew experience allayed these fears. The faculty found that some of the best and brightest students in the program were Pew fellows, and some of the best dissertations were completed by Pew fellows in less than 3 years. Although 2 years was indeed fast, the faculty learned that there was no correlation between taking 5 more years and producing better scholars. A second problem was the inertia in educational polices and procedures that evolved around a traditional educational model. In the early years, the Pew fellows found that to complete the degree in 2 years, educational policies had to become more flexible. For example, there was a requirement that all doctoral students had to pass general examinations in January of their second year. Only after passing all exams could fellows defend their dissertation proposal. Several Pew fellows felt that waiting until that time to take the exams was an obstacle to finishing the program in 2 years. Students therefore requested to take the exams in the spring of their first year so that they could hold a dissertation proposal hearing in the fall of their second year. The faculty reexamined the policy and chose to allow some Pew fellows and other doctoral students to take their exams earlier, accommodating those on a faster track. A third problem was when should a doctoral program ask students to think about finding a dissertation topic? The Pew program required four dissertation seminars starting in the first semester of study. The seminars provided an opportunity to inculcate the goal of finishing in 2 years. On the first day of the fall seminar, the first-year doctoral students were told to think about their research interests and to winnow a list of dissertation topics. The seminar became the opportunity for Pew fellows to develop, negotiate, and formalize the idea of a 2- or 3-year target for

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The Lessons and The Legacy of the Pew Health Policy Program completion. Furthermore, the seminar allowed the fellows to interact with a psychological support group that had the same educational objectives. Other doctoral students at Brandeis were not encouraged to join such a seminar until their third year, which often added 2 or 3 years onto their programs. The Pew program faculty learned that setting difficult and specific goals, such as finishing a dissertation in 3 years, may lead to higher performance. Although many Pew fellows took more than 3 years to finish, the average Pew fellow finished much faster than other Heller School doctoral students. Finally, the educational philosophy of Brandeis's social policy doctoral program posed a problem for the Pew fellows. The traditional doctoral program allowed students to design a highly individualized plan of study, which often took 6 or 7 years to complete. The program had evolved to maximize student's freedom to chose courses—hence, a more a loosely structured curriculum. For example, the core curriculum consisted of three perspective courses in sociology, economics, and political science, three courses in research methods, and a minimum of eight free electives. Some doctoral students never took any statistics courses, opting for research methods, qualitative methods, and evaluation research. The idea of graduating students in 2 to 3 years without a more stringent set of requirements made no sense for an accelerated program. Many Pew fellows found that the looser structure added time (in years) to their program. During each reapplication for Pew funding the Brandeis Pew curriculum increased its required courses, added more milestones, and worked toward a more structured curriculum and a better-integrated learning sequence. Complaints from other Heller School doctoral students who preferred the structure of the Pew curriculum resulted in the Heller School reforming its doctoral education and requiring an early dissertation seminar. In conclusion, four lessons regarding curriculum structure were learned. First, an accelerated doctoral program can produce highly qualified PhDs. Second, to accommodate an accelerated program, flexibility with respect to rules is required. Third, requiring students to think about a dissertation in the first semester may be challenging, but many students will rise to the occasion. Finally, an innovative doctoral program funded by a foundation could have a lasting impact on a school by becoming a catalyst for change.

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The Lessons and The Legacy of the Pew Health Policy Program COURSE OFFERINGS AT BRANDEIS UNIVERSITY Social Science Core Courses Economics Perspectives on Social Policy. This course has three broad objectives: (1) to introduce the economist's way of thinking; (2) to introduce alternative modes of analysis, including Marxian; and (3) to illustrate how economic analysis can be useful in analyzing areas of social behavior and policy. The course introduces basic concepts from microeconomics like the market mechanism, economic models of choice, and efficiency. It considers how alternative systems solve economic problems. It offers illustrations of how the economic concepts can be used in policy analysis. Political Perspectives an Social Policy. This course is about politics, policy analysis, and political argument. Part I is an introduction to the concepts of power, conflict, and interest in political science. Part II examines the broad goals of social policy, such as equality or security, to understand their substantive meanings and how these ideals become strategic weapons in the conduct of political disputes. Part III examines how institutions and rules of politics shape the context and effectiveness of policy. Sociological Perspectives on Social Policy. This core course selectively reviews the insights that various sociological theories and methods can bring to social policy analysis. The course features theories in sociology that are particularly relevant to the practical goals of social welfare. In addition, the course considers four key elements of society and how they change: culture, institutions, collectives and roles. Major alternative theories, research traditions, and social policies associated with them are discussed. Required Health Policy Courses Issues in National Health Policy. This seminar examines and critically analyzes the health care system in the United States, emphasizing the major issues and trends that have made it the subject of intense public concern and governmental interest. In particular, the course will concentrate on the activities of the federal government: what problems it has attempted to confront, how it has attempted to solve these problems, how successful it has been; and what types of activities are likely in the future. Health Economics. The objective of this course is to introduce students to an economic approach to analyzing

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The Lessons and The Legacy of the Pew Health Policy Program resource allocation in the health care sector. The course will teach students to use economic models of demand, production, and markets for goods and services to analyze the key resource allocation questions in health care: Who receives health care?, How is health care production carried out and at what cost?, and What kind of care and how much care are produced? The course will apply economic models to questions of utilization and supply, encompassing issues of cost, efficiency, and accessibility of care. The incentives and behaviors of consumers and producers of health care will be considered by using these models. Health Care Organization and Politics. This seminar examines some of the major structural and cultural features of U.S. health policy. It focuses on four elements of health care that make it politically distinctive: labor organized around a concept of professionalism; a "product" consisting of human caring for sick people, yet driven by technological devices; financing through insurance rather than direct capitalization; and distribution through complex organizations. Social, Ethical, and Legal Issues in Health Care. This course presents contemporary issues of social justice and social choice as they arise in the U.S. health care delivery system. The course also highlights the ethical and legal problems that originate from the development of new medical technology and the rights of patients. Students are taught to think analytically about important social problems from legal and ethical perspectives. Seminar in Health Policy Research. This seminar was designed to introduce students to investigative tools and methodological approaches that would aid conceptual thinking during various stages of the research process. The seminar assists students in identifying research topics for their dissertations by the end of the first year of the program and provides psychological support for the challenging 2-year learning sequence. Health Policy Core Financing and Payment of Health Care. This seminar will examine health insurance and payment practices to health care providers, the problems with the current methods, and possible modifications. Because reimbursement policies vary widely by provider type, the course will focus only on physi-

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The Lessons and The Legacy of the Pew Health Policy Program cian services, hospital care, and prepaid plans. Also, the increasing problems of the private market in providing insurance protection and the possible universal health financing solutions will be discussed. Management of Health Care Organizations. This course introduces PhD and master's students to some management theories, analytic concepts, tools, and hands-on approaches to managing health care organizations. By the end of the course, students will understand how to research or participate in strategic management activities as well as general management situations; moreover, students will learn how to use some of the important analytic tools used by health care managers. Statistics and Research Methods Statistics. This course is designed to provide students with a working knowledge of descriptive statistics, the logic of statistical inference, the concept of standard error, confidence limits, hypothesis, analysis of variance, correlation, and simple regression analysis. Problem sets using SPSS will be integrated with classroom presentations. Research Methods. This course covers basic issues in research design beginning with an overview of conceptions of knowledge, theory design, the development of empirical research models, and basic strategies for developing knowledge through research. The research strategies reviewed include survey research, experimental designs, field observational methods, and evaluation research. Issues of sampling and measurement are emphasized. In addition to course content, class time is devoted to discussing the practical aspects of designing a research project. Each student is required to develop his or her own research design during the course. Regression Analysis. This is an applications-oriented course covering multiple regression, as well as an introduction to logit analysis and simultaneous equation methods. The course is designed to teach students how to select appropriate statistical techniques for particular applications and how to interpret the results that are obtained. Econometrics. This course is designed to provide students with an in-depth understanding of discrete choice techniques such as logit, probit, and tobit models. This is an

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The Lessons and The Legacy of the Pew Health Policy Program applications-oriented course. Students will learn how to select the appropriate statistical techniques for particular applications, how to estimate these models using the Time Series Processor statistical package, and how to interpret results. Factor Analysis and Multivariate Design. Students are introduced to multivariate methods. Assignments include the completion and report of a multivariate analysis using computer techniques. Causal Modeling. Models based on theoretical knowledge of the causal links between variables representing a social or economic system may be tested against empirical data using various computer algorithms such as LISREL modeling. Other Courses. Also offered are the courses Qualitative Research, Survey Research, Evaluation Research, Applied Research, and Social Forecasting Methodology Special Populations and Social Policy8 Race/Ethnicity, Gender and Health Care. This course explores how race/ethnicity and gender are factors in health care policies and programs in the United States. Evidence for race/ethnicity and gender differences in health care needs, utilization, and outcomes are presented for different age groups. The importance of these differences is discussed in terms of alternate concepts of justice for health care. A broad range of theoretical perspectives on the causes of race/ethnicity and gender effects on health care are reviewed. Diversity and health research opportunities and methods are described. Implications of inequitable access by race/ethnicity and gender for health care practice and policies are examined. Research and Policy Issues in Mental Retardation and Developmental Disabilities. This seminar focuses on the major policy changes during the past two decades involving both educational services and treatment programs for children and adults with disabilities. In addition to investigating these changes on the basis of reviews of court decisions, legislation, and historical accounts, selected topics will be analyzed in detail by using research reports. Students will become familiar with the current research literature on these topics and will be able to critically evaluate research findings and methods in the field. 8    Only representative examples of courses in this area are described.

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The Lessons and The Legacy of the Pew Health Policy Program Long-Term Care Policies and Planning. One of the most important health policy issues facing the nation in the 1990s is how to finance long-term care to chronically ill and disabled people. This course will acquaint students with current information on the size and characteristics of the population at risk, the nature of service delivery systems, and methods of financing and managing existing services. The primary focus will be on aged individuals, but other populations with disabilities will be considered. The performance of the current system will be evaluated against several policy objectives, and major unresolved issues will be identified. The underlying issues of values and ethics will be raised throughout the course.

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