APPENDIX C.
UCSF Fellow-Mentor Arrangements

The development of strong preceptorial relationships is a key aspect of the Pew Health Policy Program (PHPP). The goals of such a relationship are for the fellow to (1) gain specific research skills and (2) make the transition from being a student to being an independent researcher. This is often a difficult process that requires a clear understanding of the goals and expectations for both fellows and faculty.

RESEARCH SKILLS

Health policy research is an applied field that draws upon a wide range of disciplines and methodologies including anthropology, decision analysis, economics, epidemiology, political science, and sociology. It is generally the case, however, that regardless or how well trained a fellow may be in his or her discipline, there is much to be learned about how to apply those skills to health policy questions. For example, a fellow with a background in economics and a dissertation in health economics will, in general, still have much to learn about applying the tools of economics to real-world data to arrive at conclusions that will be useful from a policy perspective. A fellow may want to gain experience with the methods and techniques used in a new field relevant to his or her chosen career path. For example, a sociologist interested in health behaviors and infectious diseases may want to learn about the methods used by epidemiologists. In cases like this, basic terminology and methods are often best learned through some formal course work, with no expectation that the fellow will become truly competent in the new field. Rather, the goal for Pew fellows is to learn how to ask the right questions of the appropriate experts and how to apply the knowledge in new situations.



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The Lessons and The Legacy of the Pew Health Policy Program APPENDIX C. UCSF Fellow-Mentor Arrangements The development of strong preceptorial relationships is a key aspect of the Pew Health Policy Program (PHPP). The goals of such a relationship are for the fellow to (1) gain specific research skills and (2) make the transition from being a student to being an independent researcher. This is often a difficult process that requires a clear understanding of the goals and expectations for both fellows and faculty. RESEARCH SKILLS Health policy research is an applied field that draws upon a wide range of disciplines and methodologies including anthropology, decision analysis, economics, epidemiology, political science, and sociology. It is generally the case, however, that regardless or how well trained a fellow may be in his or her discipline, there is much to be learned about how to apply those skills to health policy questions. For example, a fellow with a background in economics and a dissertation in health economics will, in general, still have much to learn about applying the tools of economics to real-world data to arrive at conclusions that will be useful from a policy perspective. A fellow may want to gain experience with the methods and techniques used in a new field relevant to his or her chosen career path. For example, a sociologist interested in health behaviors and infectious diseases may want to learn about the methods used by epidemiologists. In cases like this, basic terminology and methods are often best learned through some formal course work, with no expectation that the fellow will become truly competent in the new field. Rather, the goal for Pew fellows is to learn how to ask the right questions of the appropriate experts and how to apply the knowledge in new situations.

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The Lessons and The Legacy of the Pew Health Policy Program For fellows with clinical backgrounds, the appropriate research goals are somewhat different. It normally takes a PhD trainee at least five years to gain the necessary theoretical and methodological skills required to be a competent researcher and then another 2 years of postdoctoral training to know how to apply those skills to health services research problems. Thus, one cannot expect a clinician to do all this in a 2-year postdoctoral fellowship. However, someone with a clinical background can learn how to become a collaborator with other formally trained health policy researchers. This requires both learning the basic terminology and methods and, more importantly, developing an appreciation of how people in a specific field (e.g., economics or sociology) address a problem, pose questions, and undertake the research. Although some of this knowledge can be acquired through introductory courses, one of the most effective methods is collaboration with skilled investigators on specific projects. BECOMING AN INDEPENDENT RESEARCHER Although one can acquire specific research skills in various ways, ranging from course work to learning by doing, becoming an independent researcher is a process that requires active involvement of the fellow and the support of the faculty. The academic and policy researcher needs to understand a set of activities, including formulating problems, developing research proposals and writing grants, investigating specific research questions, interpreting findings, preparing papers for publication, understanding the publication review process, and presenting results at professional meetings. Although a fellow might be able to do all this in a 2-year period, it is not likely to happen without careful consideration of the fellow's roles in specific research projects. Given the time frames involved in grant writing and research, it is impossible for a fellow to follow a project from its inception to completion within a 2-year period. However, it is possible for the fellow to experience the various elements through involvement in multiple projects. The following is an example of this: Upon arrival, the fellow identifies a preceptor with an ongoing research project that has the potential for some independent investigations. The fellow can then become a member of the project team and observe the principal investigator (PI) managing the main study, leading the analysis, and writing up the findings. The greatest problems faced by fellows often involve knowing how to write up results and deter-

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The Lessons and The Legacy of the Pew Health Policy Program mining when papers are ready for submission. Observing the PI in the process is a key aspect of the learning experience. In the normal course of events, most large projects generate potential subsidiary studies that can use the data of the main project but that are not integral aspects of the project. The fellow can help develop these ideas, undertake the analysis, write up the results, and be first author on this subsidiary project. Since the PI typically has intimate knowledge of the data and analytic issues, it should be relatively easy to involve him or her as a collaborator. However, the goal of the fellowship is to let the fellow acquire experience, which means letting him or her take responsibility and the credit for this piece of work. The subsidiary project requires careful design, in that it should be doable within a relatively short period of time so that the fellow can write one or more papers based on it for submission before the end of the fellowship period. Given the normal delays, the project should be doable within a year, which would imply submitting papers by early winter of the fellow's second year. Learning how to design a project and write a grant are two additional goals of the fellowship. Again, it is probably best to follow a ''see one, do one'' pattern. This means that the fellow should work with an experienced faculty member who is developing a proposal for submission. This will allow the fellow to see how an idea is developed, honed, and structured to fit within the constraints of the granting agency. Learning how to develop budgets and work plans is a key part of this experience. Although the fellow should be a part of the process, the fellow's lack of experience means that the PI or a senior research associate will have the primary responsibility for designing and writing the proposal. It is one thing to work on someone else's proposal and quite another to write one's own. The fellow should also have the experience of developing a proposal for a small project on which he or she would be the major researcher. University and agency guidelines typically do not allow fellows to be PIs; however, a senior faculty member will often be willing to be the PI for a small percentage of time, with most of the work to be done by the fellow. In the ideal situation, the fellow would be able to transfer the grant to his or her new institution after completing the fellowship. FELLOW-PRECEPTOR RELATIONSHIPS Although the preceptorial model has many advantages, its highly decentralized structure requires careful monitoring to

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The Lessons and The Legacy of the Pew Health Policy Program be sure that specific pairings are working well for both faculty member and the fellow. The preceptorship model has certain potential points of friction. Teaching research skills on a one-to-one basis can be time-consuming and frustrating for the faculty, especially since there is no course credit given for such instruction and the program has no funds available for faculty support. On the other hand, fellows may feel that they are receiving too little guidance and are asked to do too much "scut work." Careful delineation of fellow-preceptor relationships can avoid many of these problems. This involves well-defined expectations for both fellows and faculty. During the interview process faculty will attempt to identify potential preceptors and projects for each applicant. If it is impossible to identify a faculty member on either campus who could serve as a preceptor, acceptance of the fellow would be unwise. Situations can change, however, between the time of interview and arrival in the Bay Area. Thus, during the first 2 months after joining the program, the fellow will be expected to meet with at least six faculty members to discuss potential areas of mutual interest that may result in either major or minor preceptorial relationships. Preceptorial relationships should be beneficial for both the faculty and the fellow. The faculty member is offering both hands-on training and an introduction to the real world of health policy research. In addition, the faculty member can usually provide access to the data and computer resources of a large project as well as space and membership in a larger working group. Affiliation with a project may also lead to the presentation of results at professional meetings, with travel costs covered by the project. In turn, the fellow is offering enthusiastic assistance in carrying out the main project and undertaking supplementary projects, with salary support covered by the fellowship. The primary goal of the preceptorships is educational, and this goal is sometimes best met by involvement with more than one preceptor. Usually this is accomplished by having a major involvement with one project and smaller commitments with one or more other projects. Multiple affiliations are encouraged because they allow more experience with both a wider variety of disciplines and faculty with different styles. Involvement in multiple professional networks is also a major advantage. On the other hand, multiple involvements may lead to conflicting demands on a fellow's time. If this becomes a problem, or if any other problems arise with a preceptorial relationship, the fellow or faculty member may raise the issue with any member of the Executive Committee of the fellowship program.

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The Lessons and The Legacy of the Pew Health Policy Program SUMMARY As outlined above, it is expected that each fellow will become involved in one or more research projects, publish one or more papers based on a subsidiary project for which he or she takes primary responsibility and is first author, be a coauthor on one or more papers that are part of a large project, collaborate on a faculty member's grant proposal, and design and submit his or her own proposal. Fellows who have recently completed a dissertation will also be expected to prepare for publication articles or a book from that work. Fellows with a clinical background may focus part of their time on specific methods courses. In addition, all fellows will attend core writing and policy seminars and the journal club. After a general orientation meeting with the faculty, the fellow will begin the program with a series of meetings with faculty members on both campuses to identify potential research projects and preceptorial relationships. Although it is certainly possible that new opportunities will develop over time and relationships will be renegotiated, at the end of the fellow's second month he or she will prepare a memorandum outlining the projects on which he or she will be working and the expected products. Thereafter, fellows will prepare a progress report on their activities every 3 months. Preceptors will provide an evaluation of the fellow every 6 months. The Executive Committee will provide semiannual feedback to the fellows on their progress and continued eligibility for support. QUESTIONS TO ASK OF A MENTOR Who are the powerful and important people in the department, the institution, and the discipline worldwide? Who has their ear? How do you write a successful grant application? Where should you apply? How do people in the field find out about, get nominated for, and win awards and prizes. What are the leading journals in the field? How should coauthorships be handled? What scientific organizations are the most important to join? What conferences are the ones to attend? Who can help a person get on the program? What is the best way of getting feedback on a manuscript? To whom should drafts be circulated? What are appropriate and accepted ways to raise different kinds of concerns, issues, and problems (e.g., verbally or by memo) and with whom?

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The Lessons and The Legacy of the Pew Health Policy Program What are the department's formal and informal criteria for promotion and tenure? Who can clarify these criteria? How does one build a promotion packet? Who can influence these decisions? What departmental and institutional decisions that might affect positions in the department are pending? Who can influence these decisions? How can I attract graduate students and postdoctoral fellows to work with me? BENEFITS OF MENTORING FOR THE PROTÉGÉ Protégés can gain a host of benefits from a single mentor and can also form more limited relationships that address specific needs for skills or information. These include: individual recognition and encouragement; honest criticism and informal feedback; advice on how to balance teaching, research, and other responsibilities and how to set professional priorities; knowledge of the informal rules for advancement as well as political and substantive pitfalls to be avoided; information on how to "behave" in a variety of professional settings; appropriate ways of making contact with authorities in a discipline; skills for showcasing one's own work; an understanding of how to build a circle of friends and contacts both within and outside one's institution; and a perspective on long-term career planning. WHAT TO LOOK FOR IN MENTORS What a newcomer looks for in mentors depends on the novice's particular needs in a given field; here are some questions to consider: What is the mentor's own achievement in key areas? Does the mentor know what is excellent in a given area and set high standards for him or herself? Is the mentor someone who believes wholeheartedly in your abilities? What has happened to this person's former protégés in terms of positions, grants, publications, etc.? Are there significant differences between what has happened to male and female protégés? To minority and nonminority protégés?

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The Lessons and The Legacy of the Pew Health Policy Program What is the mentor's relationship to various groups and networks in the department, school, and discipline on campus? Is the mentor not only good at giving advice and direction but also able to understand your own views about your needs and goals? If he or she is unable to provide you with the information, skills, and knowledge you need, will the mentor help you find someone who can? Are you comfortable interacting with this individual? HOW TO GET TO KNOW POTENTIAL MENTORS Individuals can do more than merely wait for a senior person to notice their achievements and choose them. By actively seeking mentors, you can make yourself more visible as a potential protégé: Introduce yourself and make the first contact in relation to a professional subject. Begin to ask for help regarding the strengths and weaknesses in your work. Take the initiative in putting the relationship on a more collegial basis if it seems appropriate. Ask a colleague to mention you or your work to a potential mentor. Volunteer to serve on a task force, committee, or project on which your potential mentor is also a mentor. Invite your potential mentor to be a guest lecturer in your class. PRACTICAL SUGGESTIONS FOR A SUCCESSFUL MENTORING RELATIONSHIP FOR THE PROTÉGÉ Set up regular lunch meetings on a monthly basis. Come prepared to discuss specific agenda items on a prearranged basis. This agenda may span a year and would function like a curriculum in regard to the relationship. As much as possible, adhere to the schedule agreed upon. Seek the mentor's assistance and sponsorship for the identification of special research projects, committee, or other university-related tasks. Share examples of your own written documents (e.g., letters, reports, manuscripts, grant submissions, and curriculum vitae with your mentor and solicit comments for improvement. Ask your mentor to provide you with insights on the structure of the university and the roles and personalities

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The Lessons and The Legacy of the Pew Health Policy Program of university officials and the types of work that they perform. When feasible, indicate a willingness to attend meetings or lunch so that you can meet and observe some of these people. Ask to be introduced to people you might not otherwise meet. Ask your mentor to introduce you to other scientists whose work you would like to know better. Have your mentor set up the interviews or visits for you. Ask your mentor for advice on obtaining departmental support and resources for specific projects. Ask your mentor to identify faculty who have excellent reputations in teaching, how to effectively teach particular materials, and how to be assigned to teach courses in your preferred area of interest.