Program directors' perspectives on federally funded fellowship training in primary care research.
OBJECTIVE
To describe the organization, models of training, and institutional impact of National Research Service Award fellowship programs in primary care research.


METHODS
Survey of 25 directors of currently-funded and former training sites.


RESULTS
Twenty-four program directors (96%) completed the survey. Programs allocated 39% of fellows' time to course work leading to an advanced degree or other didactic instruction, and 40% of time to the conduct of research. Collaborations with other training programs within the institution occurred at 83% of sites. Programs commonly (54%) or exclusively (42%) relied on a research model of "early research independence" in which the fellow defined an area of research interest, rather than an "apprenticeship" model in which the fellow worked in a senior investigator's research area. These programs enriched the local academic environment, but required extensive financial subsidies. The high costs of training often had adverse impacts on recruitment and other components of the training process.


CONCLUSIONS
Research training programs in primary care often substitute acquisition of advanced degrees for early immersion in research. The "early independence" model of research differs from fellowships in the medical specialties, and requires further study to assess its effectiveness. The need to subsidize training costs poses substantial problems for the institutions that host these fellowship programs.
Steiner
J F
JF
Department of Medicine, University of Colorado Health Sciences Center, Denver 80262, USA. john.steiner@uchsc.edu
Curtis
P
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Lanphear
B P
BP
Vu
K O
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Reid
A
A
D001291:Attitude of Health Personnel; D003365:Costs and Cost Analysis; D004470:Economics, Medical; D004501:Education, Medical / Q000191:economics; D005257:Fellowships and Scholarships; D005380:Financing, Government; D006302:Health Services Research / Q000191:economics*; D006801:Humans; D010560:Personnel Selection; D008486:Physician Executives; D011320:Primary Health Care / Q000191:economics; D015203:Reproducibility of Results; D013038:Specialization; D013997:Time Factors; D014481:United States; D014488:United States Health Resources and Services Administration