Robert Wood Johnson Foundation to Foster Anesthesiology Residents

Jill M. Mhyre, M.D., Co-Editor
Residents’ Review

aking the transition from an anesthesiology residency to an academic faculty position is challenging. Although the first step has traditionally been a clinical subspecialty fellowship, there are other options available. This article highlights one alternative or additional opportunity, the Robert Wood Johnson Clinical Scholars Program (RWJ CSP).

The RWJ CSP is a funded two-year fellowship in research methodology and health care policy that is ideal for physicians interested in health services research. Through coursework and practical research experiences, scholars learn how to ask answerable questions about health care delivery and how to design, execute and fund research that addresses those questions.

A number of anesthesiology departments offer excellent health service research fellowships. The RWJ CSP may be unique in the amount of protected time for education and research, in the interdisciplinary structure and in the expanded emphasis on health care leadership and policy development. For inexperienced but highly motivated and independent researchers, the RWJ CSP is one way to start pursuing a novel and interdisciplinary line of inquiry with instruction, mentorship and support.

The program offers a common curriculum in the fundamentals of evidence-based medicine, epidemiology, biostatistics, health economics, health care policy and clinical research design. Although two years is not enough time to acquire expertise in the full range of possibly relevant qualitative and quantitative methods, scholars do gain a basic understanding of the structure, function, strengths and limitations of alternative research approaches. Scholars finish the program prepared to evaluate and choose the most appropriate methodology for a given question and to collaborate across disciplines to conduct creative, relevant and rigorous investigations.

Scholar projects are comprehensive. Independent project work includes: developing relevant clinical expertise around a specific clinical concern; identifying appropriate research mentors; defining the specific research question; evaluating and choosing between alternative methods for addressing the question; writing the project proposal; designing and defending a research budget; navigating the research regulatory process; hiring, training and leading a research team; monitoring data quality, data management, programming and statistical analysis; and data presentation and manuscript preparation. A word to the wise: there is no such thing as just a little research project!

Finally the program offers very practical advice about the work-life balance and the academic-teaching-clinical balance, both of which are particularly acute for anyone in this stage of his/her career. The key seems to rest in identifying personal strengths, maintaining focus, maximizing effort on those activities that bring enjoyment and delegating out those activities that compound stress. Like anything else, this balance takes practice.

The CSP seems to work. Over the past 30 years, the program has trained almost 1,000 physicians representing a variety of disciplines, including internal medicine, pediatrics, surgery and anesthesiology. Approximately half of the former scholars have joined the ranks of academic medicine, some 162 alumni are full professors and 25 are chairs of medical school departments. Eighteen former scholars have been elected to the Institute of Medicine of the National Academy of Sciences. Others have found positions with the government, the National Institutes of Health and in major policy organizations such as the Robert Wood Johnson Foundation, the RAND Corporation and the Agency for Healthcare Research and Quality. Several anesthesiologists have participated in the program. Donna A. Kalauokalani, M.D., is a pain medicine physician at the University of California-Davis, Sacramento, California. Andrew L. Rosenberg, M.D., is an intensivist at the University of Michigan, Ann Arbor, pursuing research in critical care outcomes and quality measures.

If this program sounds interesting, the application process begins 18 months before candidates seek entrance into the program. So potential scholars for July 2006 will need to apply by February 15, 2005. Participating universities for the cohort entering in 2006 will include: the University of California-Los Angeles, the University of Michigan, the University of Pennsylvania and Yale University. Beginning in 2005, all scholars will earn a master’s degree in health and health services research and will have the opportunity to apply for a third year of funding. More information can be found at <http://rwjcsp.stanford.edu>.

The Robert Wood Johnson Foundation, based in Princeton, New Jersey, is the nation’s largest philanthropic organization devoted exclusively to health and health care. It concentrates on four goal areas: 1) to assure that all Americans have access to quality health care at reasonable cost; 2) to improve the quality of care and support for people with chronic health conditions; 3) to promote healthy communities and lifestyles; and 4) to reduce the personal, social and economic harm caused by substance abuse in the form of tobacco, alcohol and illicit drugs.

Anesthesiologists have led developments in patient safety, health care economics, perioperative care, pain medicine, palliative medicine and substance abuse, among other areas. Expanding our training opportunities to external programs such as the Robert Wood Johnson CSP will facilitate collaboration across disciplines and will help to disseminate innovations both within and beyond our profession.

“Health services research examines how people get access to health care, how much care costs and what happens to patients as a result of this care. The main goals of health services research are to identify the most effective ways to organize, manage, finance and deliver high-quality care, reduce medical errors and improve patient safety.”

— Agency for Healthcare Research and Quality, 2002

Please send any topic ideas, sample articles or questions to the editors of “Residents’ Review” at <residents.review@ ASAhq.org>.

Jill M. Mhyre, M.D., is a CA-3 anesthesiology resident at the University of Michigan, Ann Arbor, Michigan.