The fellowship is based in the Division of General Pediatrics at Boston University School of Medicine and Boston Medical Center.  As you may know, BMC has over a 100-year history of caring for poor, urban, and immigrant children.  Much of our research, and many of our programs focus on improving the lives of these children.  The clinical service has approximately 2000 admissions and 75,000 ambulatory visits each year.  The residency is combined with Children’s Hospital, Boston.

An Institutional National Research Service Award (NRSA) and a Faculty Development Award from the Bureau of Health Professions support the fellowship.  The training program is 2-3 years in length.  Approximately half of the 25 trainees have stayed in the program 3 years.

The primary objective of the fellowship is to develop research competency, so that trainees can become successful independently supported physician-scientists.  The specific objectives are to:

1.     Gain experience and knowledge in research design;

2.     Master statistical methods used in research and the interpretation of the medical literature;

3.     Understand the importance of appropriate statistical consultation;

4.     Become familiar with the problems and challenges of performing research;

5.     Conduct, analyze, present, and publish the results of independent research projects in areas reflecting the objectives of Healthy People 2010;

6.     Complete at least one research project, culminating in a presentation and publication;

7.     Prepare a grant application prior to completion of the training program; and

8.     Develop skills in other areas that contribute to academic success, such as teaching and communication.

The development of research competency is accomplished through intensive mentoring and by course work at Boston University School of Public Health leading to either a Masters of Public Health or Masters of Science of Epidemiology or Biostatistics.  Research seminars, participation in the CREST (K30) BUSM training program, completion of both directed and independently developed research projects, participation in the Learning To Teach and Communicate Seminar, and attendance of regional and national research/scientific meetings are also part of the curriculum.     

Mentoring

We believe that mentoring is one of the keys to success of any training program.  In addition, we believe that mentorship can generally be conceptualized as involving both career counseling and intensive support around research.  This type of dual mentorship is important, since many of the issues that trainees deal with are not only related to research projects, but also career issues.  Our goal is to ensure that fellows have both a research and career mentor.

Boston University School of Public Health 

Fellows can obtain either their MPH degree, which requires 48 credits, or a relatively new degree, the MSc, which requires only 32 credits.  Fellows can qualify for up to 8 credits of independent study for the MPH and 4 credits for Masters in Epidemiology or Biostatistics. Since most of the current core research faculty have joint appointments with BUSPH, faculty members can sponsor these credits.  Both Master programs require a thesis.  Although the MSc requires less credits, some of the fellows are interested in many of the classes in other areas of concentration, so the majority have continued to pursue their MPH degree. Current areas of concentrations at BUSPH include: environmental health, epidemiology, biostatistics, health law, health services, international health, maternal and child health, and social and behavioral sciences.  Of the 48 credits of coursework for the MPH, 16 credits are from core courses, between 16 and 20 credits are in concentration courses, and the remaining is elective.  Of the 32 credits for the MSc degree, students complete 8 courses, five of which are required biostatistics courses, two are additional biostatistics courses, and the remaining course is elective. 

Over the first summer, each fellow takes two courses – one in introductory biostatistics and the other introductory epidemiology.  They are taught in parallel with one another.  These courses were extensively revised in 2000 under the auspices of the K30/CREST program (NIH campus wide training program).  We believe they represent an important aspect of the training program, providing the fellows with an excellent starting point in biostatistics and epidemiology as they consider their research projects.

Participation in Divisional Seminars

The fellows participate in two Divisional Seminars.  The first is directed by Drs. Bauchner, Cook, and Adams, entitled the Fellows Seminar and includes research presentations by fellows and a discussion of topics related to academic success, but which are often not taught in schools of public health.  The seminar is held every other week for 60-90 minutes, with research presentations by fellows alternating with didactic presentations.  Each fellow is expected to present at least twice each year for approximately 20 minutes.  The remainder of the time is left for discussion.  In order to ensure that fellows have ample guidance around their research projects, in addition, each of the didactic presentations last only 45 minutes, leaving the remaining time to review any research questions that fellows may have about their projects. 

The schedule for the seminar is flexible.  For example, if a fellow has an oral research presentation or a resident teaching conference to do, the seminar schedule is adjusted so that it is immediately relevant for the fellow.  We believe this flexibility has made the seminar more interesting for the fellow.

The second research seminar is led by Drs. Smith and Zuckerman and is entitled Social Epidemiology Research Group (SERG).  It meets biweekly.  Many junior faculty in the Department also attend this seminar.  The purpose of this seminar is to help fellows and faculty network with each other, and have a forum to present their research in progress and receive feedback from their colleagues and senior research faculty.  The seminar is attended by a broad range of faculty, including those from BUSPH, and the various divisions in the Department of Pediatrics that conduct clinical research.  This ensures input from various disciplines and different perspectives.    

Participation in the CREST program

The Boston University Clinical Research Training (CREST) program was established in 1999, as part of the NIH K30 initiative, under the direction of David Felson, M.D.  The purpose of this program is to enhance training in patient-oriented research through formal course work and mentoring of fellows on the BUSM campus.  Since its establishment, the fellows in the NRSA training program have become part of the CREST program.  Under Dr. Felson’s direction, the summer course in biostatistics and epidemiology was extensively revised and improved.  Second, a biweekly CREST seminar was begun.  Fellows present at least once year, with senior leadership of the CREST program in attendance.  In addition, other critically important issues, such as IRB approval, mentoring, the relationship of the genome project to clinical research, writing a grant, and data management, are also presented.  This seminar augments the Fellows and SERG Seminars discussed above.  Although we are just beginning to obtain information from our trainees, we believe that participation in the CREST seminar has further enhanced our training program.  The fellows are exposed to research projects from other disciplines, and senior faculty presents the didactic topics from the BUSM campus.

Independent Research Projects

One of the primary objectives of the training program is the completion of an independent research project.  This objective is imbedded in and emphasized in all aspects of the program, including: the interview and selection process; mentoring; course work at BUSPH; and the various research seminars.  During the interview and selection process, emphasis is placed on the program as preparing trainees for an independent research career.  Virtually all of the fellows have chosen research areas that they are interested in.  We believe that by encouraging fellows to pursue research of their interest, that they remain more committed to the project.

Curriculum Related to Preparation and Submission of Grants

Over the past four years we have begun to emphasize the preparation and submission of a grant during the later part of the fellowship.  We have done this for a number of reasons.  First, feedback from previous trainees have indicated that the amount and length of so-called “protected-time” early in their research careers is diminishing and that extramural funding is critical in ensuring their success.  Second, the senior leadership of the program recognizes that primary care medical researchers need to follow the same career path as other physician-scientists, that is, in order to ensure their success as investigators, they must secure extramural funding.

The fellows are exposed to information about grants in a number of forums.  Both in the Fellows and CREST Seminars they receive instruction in how to write a grant. In addition, in the CREST Seminar there is also a presentation about potential grant sources, including, career development awards sponsored by professional societies, industry, and the NIH (K awards).  The NIH review process for other types of awards is also discussed.  In the SERG Seminar actual grant submissions are discussed, including potential funders and collaborators.

Within the Department of Pediatrics we are also fortunate to have the Alpert Endowment.  This Endowment awards 5-6 small grants ($5-10,000) each year.  Approximately half of our fellows have successfully competed for these awards.

Pedagogy of Teaching and Communication

The majority of academic faculty, including primary care medical researchers, teach and communicate with other professionals.  For the past eight years, during their first year, the fellows have participated in the Learning to Teach and Communicate seminar. The seminar focuses on the pedagogy of teaching and the development of communication and teaching skills.  The seminar was significantly modified three years ago.  The seminar was shortened from 12 months to nine months.  The first six months are devoted to specific skills development. The remaining three months are devoted to the planning and implementation a faculty development workshop.  The seminar meets 3-4 times per month for two hours.  It culminates in a faculty development workshop for community physicians, junior faculty, and other fellows, with the trainees acting as faculty.  The seminar attendees practice their teaching skills as they implement the workshop.

Involvement in Greater Research Community - Regional and National Meetings

The fellows participate in at least three regional and/or national research meetings, including, the regional ambulatory pediatric association meeting; the national Pediatric Academic Societies meeting; and the annual Institutional NRSA meeting.  Prior to participating in these meetings, we discuss at the Fellows Seminar how to make effective use of such meetings.

Patient care and attendance at Case of the Week and Grand Rounds

Clinical commitment averages 20-30% per year over the two-three year training program.  Clinical work is critical for two reasons: (1) the fellows are expected to pursue primary care research and clinical work helps to inform this process; (2) all of the fellows have felt it important to remain clinically competent, particularly since in virtually all academic positions they will have clinical responsibilities.  During the 3^rd year we try to focus the fellow’s clinical activities in areas in which they are conducting research.  For example, a current 2nd year trainee who is interested in nutrition has been working in our Growth and Nutrition Clinic and next year will be participating in an obesity clinic for adolescents. 

Sample Schedule

The NRSA trainees pursue their research training on a full-time basis.  This includes course work at BUSPH; attendance of the research seminars and local and national research meetings; and participation in the various seminars.  Shortly after beginning in the fellowship in July, the fellows participate in the two summer intensive courses in biostatistics and epidemiology that are run jointly by BUSPH.  The fellows also attend grand rounds, case of the week, and teach medical students and residents approximately 4 hours each month.

Overall, the fellows who spend three years in the program, average about 12-15 hours per week at BUSPH in the 1^st year, and 8-10 hours per week in the 2^nd and 3^rd year.  The vast majority of the remaining time is available to pursue their research, and attend the various research seminars.  For the trainees who spend two years in the program, they average about 15-17 hours per week at BUSPH in both years.  An example of a typical week appears below.

Table: Sample Schedule of Current First Year Fellow

	Monday	Tuesday	Wednesday	Thursday	Friday
8:00	Research time	Research time	Research time	Grand rounds	Case of the Week
9:00				Research Time	Learning to Teach & Communicate+
10:00
11:00		SERG
12:00		CREST*
1:00	Fellows Seminar*	Research time	Clinical work		Research time or teach BUSM students (once/month)
2:00	Research time
3:00
4:00		BUSPH		BUSPH
5:00
6:00
7:00		BUSPH		BUSPH
8:00

 * Biweekly seminar, + First year only 

Faculty

There are many faculty available to serve as mentors.  The majority are in the Division of General Pediatrics.  Their research interests are listed below.

Faculty	Research Interests	Role
Howard Bauchner	Clinical trials, EBM, methods, e-mail communication, oral antibiotic use	Program Director Research and Career Mentor
William Adams	Information technology, quality improvement, EMR, EBM	Co-Director Research and Career Mentor
Linda Barnes	Cultural competency	Research Mentor
John Cook	Nutritional surveillance, obesity	Research Mentor
Deborah Frank	Nutritional surveillance, FTT	Research Mentor
Paul Geltman	Immigrant health, public health	Research Mentor
Alan Meyers	Access to care, obesity	Research and Career Mentor
Barbara Philipp	Breast-feeding	Research Mentor
Ben Siegel	Teaching and evaluation	Research Mentor
Carol Simon	Health care disparities	Research Mentor
Lauren Smith	Health care disparities, impact of welfare reform on health of children	Research Mentor
Xiaobin Wang	Gene-environmental interaction	Research Mentor
Michael Silverstein	Head start as a research consortium	Research Mentor
Milt Kotelchuck	Maternal and child health issues	Research and Career Mentor
Megan Sandel	Environmental health	Research Mentor
Emily Feinberg	Mental health screening in primary care	Research Mentor
Barry Zuckerman	Behavioral pediatrics	Research and Career Mentor

Other mentors are available from the Division of Pediatric Emergency Room Services, Child Development, Adolescent Health, Infectious Diseases, and Child Psychiatry.

We are delighted with your interest in our program.  Other information is enclosed.

Please feel free to contact either Howard Bauchner (Howard.Bauchner@bmc.org) or Bill Adams (Bill.Adams@bmc.org) for more information.  In general, we conduct interviews in the fall of the year prior to beginning the program.

Last updated: July 27, 2004