leadership roles in health policy and management. Six Fellows are selected on a competitive basis each year to participate in a 1-year program of orientation and full-time work experience in the nation 's capital. Fellows are selected from academic faculties in medicine, dentistry, the biomedical sciences, nursing, public health, health services administration, the allied health professions, economics, and other social sciences. Candidates must be nominated by the deans or chief executive officers of their institutions. To reflect the changing health care marketplace, eligibility for the program was broadened in 1994 beyond academic health centers to include other providers and institutions in the health care system, such as HMOs and related community-based organizations. Including the current 1994–1995 class, 127 Fellows from 65 academic institutions have participated in the program.

The RWJ Fellows arrive in Washington, D.C., in early September to begin an 8-week orientation period arranged by the IOM. Fellows meet with key White House advisers; top administrators of agencies responsible for health activities; congressional committee staff members; and representatives of health policy think tanks, research, and interest groups. Also included during this period are seminars on health economics, the budget process, and the politics and process of federal decision-making.

In subsequent weeks the RWJ Fellows join with the American Political Science Association Congressional Fellows for sessions with senators, representatives, and other experts on the national, political, and governmental processes. During this time, Fellows contact congressional offices that have an active interest in health issues and, in consultation with the program director, negotiate their working assignments. Most of the Fellows decide to work in Congress, particularly in the Senate, but assignments in the executive branch also are possible (see Table 1).

THE PEW HEALTH POLICY PROGRAM

The Pew Charitable Trusts established the Pew Health Policy Program in 1982 to train leaders in health care. It was the foundation's first Trust-initiated program. The program was developed in response to the realization that the growing scope and complexity of the U.S. health care system called for an expanded effort in health policy education and research. At the time, a special advisory group to the Trusts identified the importance of enhancing opportunities for advanced-level interdisciplinary training to include academicians, economists, lawyers, managers, physicians, politicians, and other health professionals. The Trusts and the advisory group believed that in order to develop



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