Health Services Research Work Force and Educational Issues (1995) / Chapter Skim
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4 Educational Programs, Resources, and Issues
4 Educational Programs, Resources, and Issues
Pages 55-76
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From page 55... ...
This chapter describes the major types of health services research educational programs and key issues or concerns about the nature and funding of education for health services research. The latter discussion pursues themes raised in Chapters 2 and 3.
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From page 56... ...
Types of Programs Given the number of disciplines involved in the field of health services research, counting and categorizing the programs that train health services researchers are not straightforward tasks. The diversity of the programs listed in the FHSR directory illustrates the point.
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From page 57... ...
Thirteen of the AHCPR-supported programs provide both pre- and postdoctoral training in health services research; one university separately sponsors and funds both a predoctoral and a postdoctoral program. Of the seven programs offering only postdoctoral training, five limit the program to clinicians (primarily physicians)
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X University of California, San Francisco University of Medicine and Dentistry of New Jersey University of Michigan University of Minnesota University of North Carolina University of Pennsylvania University of Rochester University of Washington Yale University X X X X X X X X X X X X X X X X X X X X X X X X X X aNot listed in the 1991-1992 Foundation for Health Services Research directory of training programs. SOURCE: Data provided to the committee by AHCPR, Division of Education, Evaluation, and Demonstrations, January 1995.
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From page 59... ...
The committee identified a number of multidisciplinary graduate programs in health services research, although it could not determine the extent to which they were interdisciplinary (as that term is defined in Chapter 1~. It is the committee's sense that the most focused, comprehensive, and intensive health services research educational programs offer a doctoral degree in health services research itself and that they use a multidisciplinary faculty, many or most of whom identify themselves as health services researchers.
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From page 60... ...
Other postdoctoral programs. Other postdoctoral programs provide an opportunity for those with recent doctorates in health services research and related fields to concentrate on specific research interests and to develop experience that will increase their likelihood of securing research funding.
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Strategies for achieving this objective generally call for cooperation among educational institutions, governments, corporations, and private foundations in developing college and career information resources, curriculum guidance and support programs for schools, mentoring programs for individual students, and similar activities. At the undergraduate and graduate levels, affordable tuition and financial assistance are important, as is a supportive learning environment.
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Given the committee's own judgments as well as what it learned about the demand for researcher capabilities, it agreed that these areas should generally be part of the core curriculum. The committee noted with some concern that health care organization was mentioned as a core course by less than one-third of respondents in each of the program areas, although larger proportions mentioned health policy, a subject that may have considerable overlap with health care organization.
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From page 63... ...
These include opportunities for coursework in several disciplines and methodological techniques, practical experience in research and policy analysis, development of skills in teamwork and communication, and exposure to differences in expectations for researchers held by academic, government, and industry employers. Health services researchers have versatile and marketable skills in such areas as conducting oral interviews and focus groups, locating information sources, interpreting published reports and data, and synthesizing information.
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In 1972, the report Improving Health Care through Research and Development noted "constant pressure ton NCHSR] to curtail research training 2Congress first granted the Public Health Service authority to train health researchers in 1930 in the Ransdell Act (P.L.
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From page 65... ...
Through the early 1980s, NCHSR provided only minor and somewhat indirect training support that covered a few research fellows in the agency's intramural research program (which were equivalent to postdoctoral fellowships for new or established researchers) , an unknown number of research assistants (as part of project grants)
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3 NRSA awards from some NIH institutes, including the National Institute of Alcohol Abuse and Alcoholism, the National Institute on Drug Abuse, and the National Institute of Mental Health, also support the training of health services researchers as well as clinical and basic science researchers. However, because the institutes do not classify their awards as health services research, the number of awardees receiving training in health services research through these agencies cannot be determined.
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20 110 4 114 No Awards Were Granted 1977-1985 1986 7 33 7 40 1987 8 39 7 46 1988 8 40 6 46 1989 10 36 7 43 1990 10 73 14 87 1991 11 65 12 77 1992 13 92 12 104 1993 16 95 17 112 1994 22 114 19 133 NOTE: Awards given during the period FY 1969-1989 were from the National Center for Health Services Research; those for FY 1990-1994 were from the Agency for Health Care Policy and Research (AHCPR)
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1994 NRCd 1994, 1995, 1996 - 1999 115 240 360e a This recommendation is for Alcohol, Drug Abuse, and Mental Health Administration (ADAMHA) slots only.
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received 0.5 percent of the total NRSA assessment appropriated to the National Institutes of Health (NIH)
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, ////// $4,31 0,662 $3,645,090 $3,14 1 ,342 '//////, //////, _ ~ . //////, 1987 1988 1989 1990 1991 1992 1993 1994 Year ~ NIH Assessment OAHCPR Supplement Figure 4.1 Funding for National Research Service Awards in health service research, FY 1986 through 1994.
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19,608 20,700 25,600 26,900 28,200 29,500 30,800 32,300 Indirect costs Equal to 8% of the institution's total None allowable direct costs or the institution's actual indirect cost rate, whichever is less. Trainee tuition, Can be reimbursed NA fees, travel, and health insurance Other training costs $ 1,500 per predoctoral trainee $2,500 per postdoctoral trainee $3,000 per fellow (Fellows at for profit institutions receive only $2,000.)
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From page 72... ...
Institutions offering postdoctoral fellowship positions typically receive no NRSA payments and must cover all their costs through research grants or other sources, which creates some problems. In basic science research, postdoctoral fellows tend to fit readily into their mentors' laboratories and can begin immediately to carry out part of their mentors' basic programs of research.
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From page 73... ...
Several state governments directly and indirectly support health services research education by subsidizing the programs offered through their state universities and by providing some grants for research and, less commonly, training. Some foundations and private companies also offer training support to health services researchers, although support more often comes indirectly through grants for research.
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From page 74... ...
The Robert Wood Johnson Foundation also supports education in health services research through its Scholars in Health Policy Research Program, which offers two-year postdoctoral training to recent graduates in economics, political science, and sociology to advance their involvement in health policy research. The foundation also sponsors the Clinical Scholars Program, which provides postdoctoral fellowships specifically for young physicians to help them develop research skills in nonbiological disciplines that are relevant to medical care.
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From page 75... ...
EDUCATIONAL PROGRAMS, RESOURCES, AND ISSUES / 75 The committee noted that funding for education in health services research has been unstable and generally limited. Although funding has increased in recent years, it is still below levels achieved in the early 1970s.
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