Thinking nationally, acting locally

n 1973 Yale was one of the founding sites for the Robert Wood Johnson Foundation’s (RWJF) Clinical Scholars Program, a two-year fellowship with rigorous methodological training, a strong mentoring component and work in disciplines such as clinical epidemiology and health policy. The program teaches research skills, health policy, leadership, media/communication skills and community health. Founded under the direction of the late Alvan R. Feinstein, M.D., HS ’54, the program has seen more than 100 physicians complete research projects.

In 1995, when Yale’s participation in the national program received a 10-year renewal, there was change in the air at the RWJF. Four sites remained in the program and three new sites were added. “We knew for some time that there would be a new competition at the end of that funding cycle,” said Harlan M. Krumholz, M.D., director of the program at Yale.

Early in 2002, the RWJF announced how the program would change—although about the same number of scholars would receive training, the number of participating institutions would drop from seven to four in 2005. Other programs offered similar training, and the foundation decided to emphasize community-based research by scholars.

Yale applied for a renewed grant in the new program.

The application process came at a difficult time for Yale. Feinstein, who had served as director or co-director until 1997 when he became director emeritus, had recently died. And shortly after the application process, the program’s co-director and chair of internal medicine, Ralph I. Horwitz, M.D., FW ’77, a former clinical scholar himself, announced he would leave Yale to become dean of the medical school at Case Western Reserve University in Ohio. “The program owes a great debt to Alvan and Ralph,” Krumholz said. “Fortunately it had already undergone a transition in leadership at the time of the application. Alvan and Ralph were instrumental in setting up the program for the future and ensuring its future success. The dean also played a critical role in demonstrating Yale’s commitment to the program.”

In April the RWJF announced that Yale would be one of the four sites—along with medical schools at UCLA, the University of Michigan and the University of Pennsylvania—in the program’s new configuration. Annie Lea Shuster, the RWJF’s national program director, said that the foundation was looking for institutions that had a curriculum designed specifically for clinical scholars and the ability to do research based in the local community. Yale had both.

“This emphasis on participatory community-based research distinguishes our program,” said Shuster. “There has to be a lot of planning and work in establishing relationships with the community.”

Much of that effort was already under way at Yale. Then-Dean David A. Kessler, M.D., established the Office of Community-Based Research to provide clinical scholars with opportunities to participate in projects with community organizations and Yale faculty. Krumholz hopes that the new office will help unify “a great fragmentation of effort” by coordinating the school’s myriad projects in New Haven.

The RWJF is also requiring participating programs to provide a self-contained curriculum specifically designed for the clinical scholars, rather than send scholars elsewhere within the university for course work. Both Krumholz and Shuster noted that Feinstein had been adamant about doing just that. “He always thought that the Clinical Scholars Program should be a real center of gravity, not just an administration office. So from the outset, we have taken on the commitment to develop a program that is most likely to foster the professional growth of each scholar,” said Krumholz.