Michigan RWJF Clinical Scholars Program Curriculum Overview

Completion of courses leads to a Master's in Health & Health Care Research. For those interested in the Master's course only, please review the information for applicants.

An In-State/Out-of-State Tuition Supplement is available to qualified applicants.

Preparatory Summer Seminars
(non-credit courses taken before the fall term begins, usually starting the first week of July):

First Year Courses

Course Name Instructor(s) Total Credits
Social & Cultural Aspects of Research on Health & Society Howell & Heisler
3/3
Research Design & Analysis Forman, Hofer & Richardson
3/3
Laboratory in Research Methods & Analysis Hayward
2/2
Leadership & Career Development Tsai/Volk
1/1
Research on Health Care Delivery, Financing & Policy Davis
3/3
Research Practica (due by):
1. Lit review paper (late Feb)
2. Data analysis talk (late May)
3. Project proposal (late June)
Hayward & Saint
4/4

Second and Third Year Curriculum

“The curriculum was well thought out and tailored to our needs.  It is based on adult learning theory – no useless homework!  The emphasis on learning through doing our research is more interesting and effective, and helps us to accomplish early. CSP faculty are impressively intelligent and highly regarded, and at the same time down to earth and approachable.”

Ann-Marie Rosland, Internal Medicine

Overall Curriculum Outline

The curriculum of the RWJF CSP at The University of Michigan is based on modern learning theory, integrating research theory and practical applications. The curriculum is designed to enable Scholars to master state-of-the art research methods while also beginning productive scholarly work early in their fellowship. This approach is grounded in a keen appreciation for the value of the two (or three) years that a fellow spends as a Clinical Scholar and a desire to ensure that this time is used as effectively as possible. Trainees who begin to engage in research early in their fellowship generally acquire stronger methodological skills and expertise — expertise that is rarely acquired through a coursework dominated curriculum. Adult learning theory suggests that learning occurs more effectively when material is demonstrated within a logical, familiar context. Skills develop more quickly through critical thinking and problem solving (as opposed to more passive teaching methods). Future learning and success are enhanced when the approach to, and environment for, learning parallels the real world circumstances in which future learning will occur. Finally, and perhaps most important, information and skills are better mastered and maintained when there is greater emotional engagement in skill development and when skills are learned and rehearsed within the context in which they will be later applied, such as when fellows learn new methods while applying them to their own publishable work.

This approach, “learning while doing”, has been extremely successful, with our Clinical Scholars both gaining strong methodological skills and completing excellent research projects. The CSP starts with a two-month series of preparatory seminars. The first academic year includes a course on research design and analysis with a separate laboratory, a pair of yearlong courses on research approaches to health and health care, and a series of seminars on leadership and career development. The heart of the first year is a set of three “Research Practica,” which integrate curricular content with specific research projects for each Scholar. The second (and third) year are largely devoted to research and policy experiences.
 
Preparatory Summer Seminars
Because people enter the RWJF CSP with a diverse range of backgrounds and skills, a series of summer seminars provides Scholars with a common foundation in fundamental concepts about health and health care before starting the intensive fall curriculum. Our existing, very successful CSP summer course will be revised to serve as a prologue to first year coursework. This seminar models interdisciplinary collaboration to introduce Scholars to the key elements of the health care system and to a basic outline of essential research methods.

Introduction to Health and Society, 1 week. (Joel Howell) A brief overview of the history and sociology of health and health care. Special attention will be given to the importance of culture in the conceptualization of health care.

Introduction to Health Care Delivery, Financing and Policy, 2 weeks. (Richard Lichtenstein) This seminar provides a broad overview of the US health care system. Special emphasis is given to current trends in the organization and delivery of health care as well as to proposed legislative or regulatory changes that are salient at the time the course is offered. Discussions will cover health disparities, access to care, population health, and measurement of health status.

Introduction to Evidence Based Medicine, 1 week. (Sandeep Vijan) This seminar includes an initial overview of critical appraisal of the clinical literature, including reviewing clinical trials, observational studies and studies of diagnostic tests. Emphasis is on becoming expert enough to lead medical student and resident discussions of the medical literature.

Introduction to Clinical Epidemiology and Basic Biostatistics, 2.5 weeks. (Rodney Hayward, Timothy Hofer, Jane Forman) This seminar is an intensive survey of commonly used study designs (experimental, quasi-experimental, cohort, and case-control designs), and hands-on experience with statistical testing (including univariable, bivariable and multivariable statistics). Using a standard statistical program (Stata), students will learn basic data management and statistical programming.

First Year Courses Leading to a Masters Degree
The following courses are part a Master of Science degree in Health & Health Care Research. This degree program is design to meet the special needs of clinicians interested in academic or policy careers related to improving health and healthcare. This curriculum is designed specifically to meet the needs of Clinical Scholars, however, we allow a limited number of additional clinicians to enroll.

Research Design and Analysis
(Rodney Hayward and Jane Forman) (2 semesters, 6 units total).

Students will develop competency in research design and data analysis using state-of-the-art methods for health services research and health policy research. This course will be based upon three key principles. First, Scholars should have a basic understanding of the broad spectrum of both qualitative and quantitative methods, coupled with in-depth expertise in specific methods relevant to their particular area of research. Second, a carefully coordinated mixture of classroom, experiential/hands-on and self-directed learning is the most efficient and effective approach to developing superior methodological expertise. Third, methods are not ends in their own right, but are tools that should be carefully selected to pursue new knowledge that will advance our understanding of important health and health care issues. The research question should drive the selection of the most appropriate method. The foundation for the methods curriculum will be laid in the Summer Seminar, reinforced and greatly expanded during this year-long course (with its companion laboratory), and further expanded and solidified through advanced seminars and close mentoring during the second and third years.
Early in the fall semester the course will cover an overview of the basics of standard study design and study analysis, with content selected to support the critical literature review required for Practicum 1. Content will then move on to the skills necessary for the secondary data analysis required for Practicum 2. Midway in the winter semester, methods and skills important for primary data collection will be covered, as Scholars are also working on Practicum 3. Specifically, the fall semester will include 1) study designs and their applications, 2) population sampling, 3) systematic reviews, including teaching critical appraisal of the medical literature, 4) meta-analysis, 5) simulations and decision-analytic models (Markov and Monte Carlo methods), 6) applications of basic biostatistics (including parametric and non-parametric statistics and an introduction to multivariable modeling). Winter semester will include: 1) multivariable regression, 2) scientific and pragmatic issues in data collection, including qualitative methods (such as unstructured interviews, group interviews, and direct observation), 3) survey and interviewing methods, 4) measurement science, including psychometrics, 5) selected qualitative analytic methods (such as coding schemes and constant comparative methods), and 6) selected topics in advanced biostatistics (such as multiple imputation, multi-level modeling and basic econometrics).

Laboratory in Research Methods & Analysis
(Rodney Hayward and Tim Hofer) (2 semesters, 4 units total).

This series of practical exercises parallels the lectures in Research Design and Analysis . This laboratory will enable Scholars to master use of a statistical and a qualitative methods software package. Most laboratory sessions emphasize independent problem solving and generating an analysis plan. Emphasis is placed on developing skill in converting study objectives/questions into a specific and actionable analytic design. Most work will be done out of class; formal class time will be limited and mainly include discussions and demonstrations of research design and analysis examples. Classroom sessions will often be devoted to discussion and review of hands-on laboratory assignments.

Social and Cultural Aspects of Research on Health and Society
(Joel Howell and Michele Heisler) (2 semesters, 6 units total).

This course introduces students to methods for evaluating critical issues in health and health care from a societal and cultural perspective. Scholars examine the use of social sciences and humanities to study health and health care, including evaluations of past research and suggestions for future work. The class is an introduction to essential themes, not a comprehensive analysis of a single discipline. It is conducted as a seminar, with outside readings including a variety of analytic approaches as well as a mix of classic publications and cutting-edge research. The fall semester concentrates on the history of medicine (focusing on the relationship of race, ethnicity, and gender for health and health care) and population health and health care issues related to social environment, culture, and community. Examples of community-based, school-based, and employment-based interventions to improve health and social well being will be discussed. A special 2-day introduction to community-based research is provided as part of a collaborative effort with the Kellogg Community Health Scholars Program. During the winter semester the course addresses legal issues relevant to public health and health care delivery, and their effects on individuals, communities and providers. Scholars will also discuss the history and ethics of human experimentation, the politics of health policy, and the use of narrative methods as well as narratives themselves to understand health and health care. Readings in the sociology and anthropology of health care will be included, with discussions led by experts in those fields.

Research on Health Care Delivery, Financing and Policy
(Matth Davis) (2 semesters, 6 units total).

This course analyzes selected topics in health care and health policy. Scholars learn how to appraise critically how health and health care policy alternatives may influence the quality and efficiency of health care. Attention will be paid to local, state, and national policy issues. Topics include: 1) comparisons of the US healthcare system with healthcare systems in other countries, 2) factors influencing behavior within healthcare organizations, 3) factors that influence the behavior of providers and professional groups, 4) economic issues related to health care delivery (including expenditures, utilization, and insurance concepts), 5) conceptualization and measurement of health status, health care costs, technology assessment, access, quality of care and efficiency, 6) health care needs and utilization, 7) regulatory, financial and market “controls” on costs, quality and efficiency, 8) effects of policy changes on population health, and 9) the health and health care needs of disadvantaged populations.
In addition to classroom experiences, this course will incorporate our successful health policy “field trips.” Scholars will visit key policy makers, alternating each year between the Michigan state capital, Lansing , and Washington DC . This experience has both demystified some of the nature of the legislative process and has enlightened Scholars about some potential ways to relate their research to health policy initiatives within a specific political system.

Leadership and Career Development Skills
(Tony Tsai/Reshma Jagsi) (2 semesters, 2 units total).

This course combines an overview of leadership theory with a selection of skills needed for career development. Various leadership strategies are examined; case studies link theory to leaders' actual practice, especially within academic medicine. Scholars gain an appreciation for the diversity of successful leadership styles and consider the influence of cultural aspects such as gender and ethnicity. Interwoven with this yearlong overview of leadership is a series of skill-building exercises. Fall semester includes 1) time management and allocation, 2) public speaking, teaching, and presentation skills, 3) effective writing for the health and health care literature, 4) running effective meetings, and 5) supervision and management of staff. Winter semester will include: 1) a survey of career opportunities, job searching, and interviewing, 2) negotiation skills, 3) working in teams and team-building, 4) working with the media, 5) self-assessment of productivity and barriers to productivity, 6) networking, and 7) balancing clinical care, research and life outside work. Scholars in their second and third year will join the seminar on occassion.

Research Practica
(Rod Hayward and Sanjay Saint) (2 semesters, 8 units total).
In this independent study course Scholars progress from crafting an initial research question to analyzing data to designing and presenting a research plan. An assigned fellowship mentor will oversee the Scholar's progress over the year. In addition, Scholars have Practica mentors for each project, and these mentors provide expertise and support tailored to the needs of the Scholars and the specific study.

Research Practicum 1 involves a critical literature review of a policy-relevant topic in health or health care, selected to serve as the springboard to the Scholar's future research interests. This literature review will focus on identifying and assessing key research methods and will be written in a format appropriate for a medical journal. Any journal style manuscript based upon a comprehensive literature review is allowable, including a meta-analysis, systematic review, narrative review, commentary, etc.  A mini-writing course and materials on critical appraisal of the medical and policy literature are offered early in the first semester of the Leadership course to integrate with this Practicum.

Research Practicum 2 requires an oral presentation of a critical analysis that uses empirical methods to address a policy-relevant  question in health or health care. In most instances, this critical analysis will include use of existing data sources and demonstrate skill in the use of rigorous methods covered in Research Design and Analysis, such as multivariable statistical modeling, psychometric scaling, simulations, mixed methods including qualitative data analysis. Practicum 2 requires a 10-15 minute oral research presentation and should generally be completed by the end of the second semester (late May). We anticipate that the Scholar will later produce a modified version of this analysis for submission to a peer-reviewed journal.

Research Practicum 3 is a 5-7-page research proposal that clearly presents the justification and methods for an original project, usually one that involves collection of primary data. We believe that primary data collection skills ought to be an important element in the training of every Clinical Scholar, but not all Scholars opt to complete a primary data collection project if they are doing the fellowship in 2-years. The option of a third CSP year allows more time for gathering primary data, especially in community settings, and the majority of Scholars opting for a 3rd year are doing research that requires extensive data collection. A draft of Practicum 3 should generally be completed by the end of February of the first year with the final defense in June.
Sample research projects noted below provide examples of content areas for these practica.

Optional Third Year: Particularly for those Scholars whose primary data collection will be labor intensive (such as Scholars doing most community-based or interventional research), or for those whose work requires particularly complex and time-consuming analytic techniques, we welcome the opportunity for a third year as a Clinical Scholar. There are enough third-year spots to allow one-half of Scholars to do a third year.

The Second and Third Year
The second and third year of the CSP is tailored to the needs of the individual Scholar. Activities may differ dramatically between those committed to an academic career vs. those committed to a policy career. Some Scholars explore a mix of activities that may include working on completing manuscripts based on work done in the first-year, working on the primary data collection project outlined in their Practica 3, writing career development awards, and gaining hands on policy experience. Formal education in the 2nd year will focus on each Scholar's specific needs. Carefully selected classes will be available to Scholars. For example, the Institute for Social Research, in addition to serving as a valuable resource for research assistance, offers an excellent set of intensive classes on specific advanced research topics that attract students and faculty from all over the world and have been attended by many previous Scholars. Other classes throughout the University will allow Scholars to benefit from the many excellent faculty and courses. There are numerous seminars available on campus, and some scholars may find especially useful the series run by the Decision Consortium, the Program in Health Policy Research, the Program in Society and Medicine, the Institute for Research on Women and Gender, and the Center for Social Epidemiology and Public Health.

Advanced Methods Seminars: Approximately every other week, the 2nd and 3rd year Scholars gather to discuss papers, works in progress and specific methodological topics. This seminar focuses on the needs of a specific Scholar or group (just-in-time learning) and facilitates their continued cohesiveness as a cohort.

Research/Policy Seminars
This weekly 1.5-hour seminar includes presentations by Scholars, faculty, or invited guests about health policy and health policy research. A list of recent and up-coming presentations can be found under Seminar Schedules. All Scholars attend this seminar each week, as well as the CSP leadership, most core faculty, and selected guests. Traditionally, this seminar has produced lively, interactive discussion involving all levels of participants, with those participants coming from a wide range of disciplines. The seminar gives Scholars the chance to observe and participate in energetic scholarly debate about the very topics and methods that they are studying.

Assessment and Organization
Each Scholar has an assigned fellowship mentor, who is selected from amongst the CSP Directors and Associate Directors. The fellowship mentor monitors the Scholars' development and progress through their 2-3 year tenure. The fellowship mentor’s chief task is to meet with the Scholar periodically to help them prioritize their projects and educational activities, provide them with advice and guidance during their fellowship and oversee their progress during fellowship. The fellowship mentor need not act as a project mentor on any of the Scholars research Practica, but should make sure that the Scholar is getting the research and career mentoring that they need, and is developing and executing a coherent training plan that will enable them to be competitive when seeking positions after fellowship.

Sample research projects

The development of Scholar's research projects during the first year will be tightly integrated with the formal courses, starting with a systematic review of the literature, moving to secondary analysis, and finally to primary data collection. The guidelines for Research Practica and the above timeline are meant to set a basic structure, but are not meant to be inflexible. A Scholar's Research Committee can petition the CSP Curriculum Committee for exceptions to the established timeline or curriculum.
We are very pleased to offer a site for VA Scholars. CSP Director, Rodney Hayward, also Director of the Health Services Research & Development (HSR&D) Service at the Ann Arbor VA, will serve as the VA liaison, a role he recently assumed for the existing CSP. The Ann Arbor VA will continue to play a very active role in the new CSP, and takes its commitment to the program seriously. We have learned the importance of making sure that VA scholars are well informed and frequently reminded of their VA opportunities (such as supplemental project funds through the local HSR&D) and VA responsibilities (such as conducting clinical work at the VA, conducting research that is clearly and directly relevant to veteran health and health care, and always acknowledging their VA affiliation). VA Scholars will be assigned office space at the VA as well as in the CSP office suite. Rodney Hayward will continue to discuss VA opportunities and responsibilities with CSP applicants and meet with VA Scholars at least quarterly to review their research, educational, and clinical activities.
We offer below four brief sample research projects, selected to emphasize integration of research with the proposed curriculum as well as to highlight local strengths.

Example 1 : A pediatrician interested in health promotion could fruitfully study the effects of family beliefs and physician practice patterns on the implementation of childhood vaccination policy. That Scholar could start by reviewing existing data about how parental concerns shape the use of new vaccines. (This review would fulfill the requirements for part of the first-year curriculum, Practicum 1.) She or he could then use a secondary data set to derive some preliminary hypotheses about what drives the utilization of new vaccines (Practicum 2). Such data sets could include the CDC National Immunization Survey, or data derived from a CDC-funded study by the Michigan Division of General Pediatrics that surveyed a nationally representative sample of physicians to discover their attitudes about safety issues. Finally, grounded in this preliminary work, a Scholar could propose a small interventional study (Practicum 3) while requesting a third year as a Scholar. That study could propose using a brief parent survey to personalize educational information about vaccination (an intervention that has been used successfully for smoking cessation and work place safety). The intervention could be piloted in four pediatrics clinics using an experimental or quasi-experimental design. Using mixed methods such as focus groups or unstructured interviews, the Scholar could explore the cultural and social factors related to why parents accept or refuse vaccines for their children (with or without the intervention). This information could help the Scholar modify the intervention in future research or applications, as well as improve our general understanding of health promotion. Scholars asking these questions could work with members of the Division of General Pediatrics such as the Director, Gary Freed, a former Clinical Scholar who has done extensive work on vaccine policy, or another former Scholar Matthew Davis (Chicago 2000), principal investigator on a CDC-funded immunization policy grant. Victor Strecher, PhD, Professor Health Behavior and Health Education and an international authority on health promotion and behavioral medicine, could serve as a valuable resource. Since the continued introduction of new vaccines and prophylactic treatments (including those related to bioterrorism) will be accompanied by continued questions about safety, these studies would provide an excellent start for a career in pediatric HSR.

Example 2 : A Scholar from OB/GYN could take advantage of several Michigan strengths to design and evaluate new approaches for reducing the incidence of low-birth-weight infants. That Scholar could start by reviewing the literature on predictors of low birth weight, including literature on ethnic and class differences (Practicum 1). She or he could then do a secondary data analysis, perhaps working with a mentor who is familiar with using birth certificate data for the city of Detroit that has been geocoded to indicate the census tract of each birth. The Scholar could conduct multilevel analysis of the incidence of low birth weight as a function of individual characteristics of the mother and of the social environment, including the level of poverty, the rate of unemployment, or the degree of crowding in housing in the census tract (Practicum 2). The Scholar could also analyze the effects of prenatal care across different social environments and test the hypothesis that standard prenatal care does not appreciably improve birth outcomes in areas of profound socioeconomic deprivation. Finally, the Scholar could work with community members and health care providers to design and evaluate an intervention that would focus enhanced prenatal care to areas with significant social and economic needs, tailoring the specific social intervention components to the communities' biggest needs (Practicum 3). This series of related projects would build on the strong working relationship already in place between the University of Michigan and Detroit community organizations/agencies. A scholar interested in this type of research could work with mentors such as Paula Lantz, PhD, Associate Professors of Health Management and Policy, who has studied social determinants of infant health and birth outcomes, prenatal care policy, and community interventions (and has worked with past Clinical Scholars). Jeff Morenoff, PhD, Assistant Professor of Sociology and Faculty Associate, ISR, as well as Tim Hofer, MD, MSc, could help guide the multilevel analysis of birth outcomes .

Example 3 : Care for patients with chronic illness is a major problem in US health care. Scholars who work in Internal Medicine could critically evaluate evidence in the literature for specific hypotheses regarding what causes deficiencies in chronic disease care. For example, the Scholar might examine what is known about the influence of having multiple comorbidities on the quality of care for a particular chronic illness (such as CHF, depression, diabetes, major psychoses, or HIV infection). While working on the critical review (Practicum 1), the Scholar could develop hypotheses that could be tested using clinically-rich national databases that are available through the Ann Arbor VA HSR&D Center. One can often add new data fields to these registries to facilitate answering specific clinical questions. Findings from Practicum 1 would help guide secondary analyses using such databases (Practicum 2). For example, based on the literature review, the Scholar might examine how self-reported health status (a measure of self-assessed health needs), number and severity of comorbidities (a measure of medical complexity and need) versus the SF-36 physical function index (a measure of physical debility) are associated with measures of quality of care and satisfaction. The data to address this question could easily be obtained by merging clinical registry data with VA patient satisfaction data, and then providing the Scholar with a completely de-identified, anonymous dataset. Using this data set, the Scholar would test hypotheses about which health factors are most associated with deficiencies in care for chronically ill patients. The richness of the data sources would increase the likelihood of robust results from such secondary analyses. However, some valuable information would be unavailable in the databases, and important issues of generalizability would remain. Therefore, in their main CSP study (Practicum 3) the Scholar would collect primary data to test the hypotheses generated by secondary data analysis. This project might compare care within one or two VA facilities with care within an HMO. This study could explore obstacles to chronic disease care using mixed quantitative and qualitative methods, such as chart review and patient and provider interviews. The skills, expertise and track-record gained from the literature review, secondary analyses, and primary research study, would position the Scholar to seek funding for an intervention study shortly after completing the CSP. Faculty resources to support such a Scholar include, Sarah Krein, PhD, RN (extensive experience with evaluating resource utilization, casemix, and quality, using VA and community medical information system data), Rodney Hayward, MD (expertise in quality improvement for chronic illness), and Julie Lowery, PhD (expertise in case-management and resource allocation).

Example 4 : We do not fully understand why race and ethnicity are associated with large variations in receipt of medical or surgical procedures. This important topic could be addressed by, among others, a Scholar trained in urology. That Scholar could begin by reviewing the literature on racial and ethnic disparities related to the receipt of invasive procedures to treat prostate cancer, perhaps contrasting this literature with the pattern of racial and ethnic disparities found for chronic illness care and prevention (Practicum 1). The Scholar could then use a database such as the American College of Surgeons prostate cancer database (combined with census tract data) to test hypotheses from the literature review. The Scholar might examine in Practicum 2 the relationship between race and the aggressiveness of prostate cancer evaluation and treatment (controlling for insurance, income, education, and community vs. tertiary setting), and assessing the extent of disparities due to within-site versus between-site variations. Finally, based upon Practica 1 and 2, the Scholar could design a study to gain further insights into reasons for disparities (Practicum 3). For example, if Practicum 2 found substantial within-site racial/ethnic disparities, the Scholar could use a combination of qualitative and quantitative interview/survey methods to explore patient and provider beliefs, attitudes, and decision-making processes. Focus groups and unstructured interviews might be followed or supplemented with a self-administered or telephone survey of prostate cancer patients. In contrast, the Scholar may feel that there is already sufficient information on the causes of disparities, and could propose conducting an interventional study and apply for a third year. Faculty support could include, John Wei, MD, MSc (expertise in prostate cancer and outcomes research, and former Michigan Clinical Scholar 1999), Peter Ubel, MD, MA (expertise in the sociology and psychology of decision making), Michele Heisler, MD, MPA (expertise in ethnic/racial disparities, and former Michigan Clinical Scholar 2002), and Steven Katz, MD, MPH (expertise in cancer care decision-making, and former Clinical Scholar, Washington 1991).