Physician Post Resident Fellowship

The VA Physician HSR&D Fellowship is a core training program of the VA HSR&D Center of Excellence on Implementing Evidence-Based Practice at the Indianapolis VAMC, www.ciebp.va.gov.

Program Overview

The fellowship provides two years of post-residency research, education, and clinical learning opportunities to eligible physicians. Fellows spend approximately 75 percent of their time in research and education and 25 percent in clinical care at the Roudebush VAMC. Mentors of national stature provide guidance to fellows in rich learning environments. Graduates are expected to be role models in leading, developing, conducting, and evaluating innovative health services and systems transformation research in a variety of clinical settings.

Fellowship Requirements

Eligible physicians must have graduated from an Accreditation Council for Graduate Medical Education (ACGME) accredited residency; be board certified or board eligible; be a U.S. citizen; and have an active, unrestricted U.S. medical license.  They must desire to lead and shephard health services research, system redesign or health system transformation in rapidly changing health care settings.  International medical graduates must also have an Educational Commission for Foreign Medical Graduates (ECFMG) certificate that is valid indefinitely.

Definitions of Relevant Disciplines

• Health services research -- the multidisciplinary field of scientific investigation that studies how social factors, financing systems, organizational structures and processes, health technologies, and personal behaviors affect access to health care, the quality and cost of health care, and ultimately our health and well-being. Its research domains are individuals, families, organizations, institutions, communities, and populations. -- AcademyHealth, 2000
  
• 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
  
• Implementation--Putting a guideline in place; involves effective communication strategies and identifies and overcomes barriers to change by using administrative and educational techniques effective in the practice setting.
  Implementation research is a new science that utilizes strategies to introduce or propagate evidence-based health interventions within specific settings. (Titler)
  
• Implementation research consists of scientific investigations that support movement of evidence-based, effective health care approaches (e.g., as embodied in guidelines) from the clinical knowledge base into routine use. (Rubenstein & Pugh)
  
• Dissemination is the targeted distribution of information and intervention materials to a specific clinical practice or public health audience, to spread knowledge and evidence-based interventions.
  
• Systems redesign is the modification of the healthcare delivery to achieve optimum results from disseminated new evidence-based knowledge.

Program Goals:

The goal of this fellowship training program is to prepare graduates for careers in health services, implementation and systems redesign research, with particular research skills in transforming healthcare delivery and organizations. Our VA Physician HSR&D Fellowship provide opportunities using VA’s internationally recognized medical informatics and quality improvement infrastructure and our research faculty and campus partners to provide outstanding training opportunities and to contribute to the improvement of clinical and management practice, scholarly pursuit of quality improvement, and Veterans Health Administration’s (VHA) recruitment and retention of health services and implementation researchers.

The VA Physician HSR&D fellowship will train post-residency physicians to (1) understand basic health services and implementation research methods; (2) understand health services and implementation research in great detail; (3) extract, analyze, and interpret information, both clinical and patient-centered, from electronic medical records and directly from patients; (4) develop, carry out, analyze, and report the results from a prospective research project; and (5) develop productive careers in academic medicine and/or serving the VA.

Each fellow will select a primary mentor, who along with the fellow, will create a Mentor Panel of content and methodologic experts from our Center, the Regenstrief Institute, Inc., IUPUI or Purdue RCHE, that will meet at least quarterly to assess the fellow's progress in attaining his or her research goals.

Program Overview:

The fellowship provides two years of research and educational learning opportunities.  Mentors of national stature provide guidance to fellows in rich learning environments.

Curriculum.  The two-year curriculum includes an orientation to VA, a general research methodology, written and oral communication skills, and implementation science. There are opportunities to pursue more intensive training in areas such as: health services research, implementation science, operations research, decision science, system redesign, clinical information systems, decision support, evidence based medicine, organizational behavior and change management, clinical bioinformatics, computer science, health services research, research methods, and project management through Indiana University and Purdue University. In addition, the curriculum includes such content areas as quality improvement methods, leadership skills, patient safety, organizational change, leadership and other areas of significant interest to VHA. 

Fellows.  Physician fellows shall spend at least 75 percent of their time on projects relevant to the VA and no more than 25 percent in clinical care, teaching or administration. Fellows are expected to work with a research team and their mentors to play an important role in developing and implementing several HSR&D research projects and submit at least two (preferably more) manuscript(s) to a peer-reviewed journal. As a result of their work, they should accomplish at least one of the following: lead interprofessional teams, present at two or more national meetings and/or actively participate in and contribute to organizational change or system redesign initiatives at the Roudebush VAMC or VHA nationally.

Preceptors (mentors).  In order to select relevant projects to improving health care, fellows are encouraged to meet with institutional leaders within our VAMC and senior Center faculty. Fellows are to develop individualized learning plans in collaboration with their preceptors (mentors). Mentors should provide assistance with project and research methodology and content, as well as guidance in personal and professional development.  For these reasons, several mentors are often needed. These individuals are expected to meet regularly with the fellows to assess their progress, serve as role models, and provide constructive feedback and assistance in meeting the fellows’ goals. Mentors are expected to participate in formative and summative evaluation of fellows and the fellowship program. Mentorship opportunities include faculty of the VA Center of Excellence in Implementing Evidence-based Practice, as well as partners, the Regenstrief Institute, Inc. (http://www.regenstrief.org/) and Regenstrief Center for Healthcare Engineering (RCHE) (http://discoverypark.purdue.edu/wps/portal/rche), Indiana University, Indiana University-Purdue University Indianapolis-Indianapolis (IUPUI) and Purdue University.

Project.  All fellows will participate in at least one research project to which they make a substantive, independent, and identifiable contribution. The topic of the project should be of direct relevance to VHA's mission, although VA medical facilities do not necessarily have to be the sole sites of the research.

Career Development Award.  All fellows should develop a VA and/or NIH Research Career Development Award during their fellowship, working closely with their mentorship panel.  See Gill, T.M., McDermott, M.M., Ibrahim, S.A., Petersen, L.A., Doebbeling, B.N.  Getting Funded: Career Development Awards for Aspiring Generalist Investigators.  J Gen Intern Med 19:472-478, 2004.

Seminars and Lectures

Fellows are expected to attend weekly research seminars at the VA HSR&D Center of Excellence and the Regenstrief Institute. Fellows are also expected to organize and participate in a Fellows Conference, to help supplement experiential learning in desired areas of development.

Faculty scientists and fellows present their research at the weekly seminars, which provides an outstanding forum for interdisciplinary learning and dialogue on the latest methods and topics related to health services research, implementation sciences, geriatrics, and other related disciplines. Fellows are expected to present their research findings at our VA Center works-in-progress seminar and/or the Regenstrief Institute seminar at least once each year during the fellowship training program.

All VA post-doctoral fellows are expected to complete the “Implementation Research” course during their fellowship and the Patient Safety (SPEA-H 615, PBHL-H 615, and School of Nursing J 692).  This is a new course taught by Center and campus faculty, including topics such as Observing and Creating a Culture of Safety, Communication and Complexity, Reliability and Design, Methods and Tools To Reduce Harm, Reducing Harm in Specific Areas of Risk, Leadership for Patient Safety, and health Policy Perspective.

Master of Science in Clinical Research

Post-doctoral fellows with limited research experience or training have the opportunity to complete a Masters of Science in Clinical Research through the Clinical Investigator Training Enhancement (CITE) Program.  The CITE program is a K-30 funded grant through the National Institute of Health and prepares health care professionals for a career in clinical research.  Following completion of this program, graduates can embark on a career in clinical research with the skills necessary to successfully compete for grant funding, conduct and analyze research findings, and publish their work in scientific journals. 

Eligibility and Application

Interested candidates should: 1) be a US citizen or permanent resident; 2) have completed clinical training terminal degree (e.g., nursing, pharmacy, etc) or a PhD in computer science, medical informatics, decision science, economics or related fields, and 3) Demonstrate a special interest in implementation and health services research.

Interested candidates must submit a cover letter describing their research interests, fellowship goals and career goals, curriculum vitae and three letters of recommendation.

Contact Information

Brad Doebbeling, MD, MSc
Director, VA Center on Implementing Evidence-based Practice
Dept. Medicine Professor of Health Services Research & Medicine
IU Center for Health Services & Outcomes Research, Regenstrief Institute, Inc.

Mail to:
HSR&D Center of Excellence
Roudebush VA Medical Center
1481 W. 10th Street, 11H
Indianapolis, IN  46202-2884
317-988-4993

In accordance with Federal law, the VA HSR&D Center of Excellence and IU School of Medicine do not discriminate against any person on the basis of race, ethnicity, color, sex, religion, or disability in admission to, access to, or treatment in the Fellowship Programs.

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