摘要：Objectives. We have described and evaluated the impact of a unique fellowship program designed to train postdoctoral, physician fellows in research at the interface of medicine and public health. Methods. We developed a rigorous curriculum in public health content and research methods and fostered linkages with research mentors and local public health agencies. Didactic training provided the foundation for fellows’ mentored research initiatives, which addressed real-world challenges in advancing the health status of vulnerable urban populations. Results. Two multidisciplinary cohorts (6 per cohort) completed this 2-year degree-granting program and engaged in diverse public health research initiatives on topics such as improving pediatric care outcomes through health literacy interventions, reducing hospital readmission rates among urban poor with multiple comorbidities, increasing cancer screening uptake, and broadening the reach of addiction screening and intervention. The majority of fellows (10/12) published their fellowship work and currently have a career focused in public health–related research or practice (9/12). Conclusions. A fellowship training program can prepare physician investigators for research careers that bridge the divide between medicine and public health. Translation of scientific advances into measurable public health improvements is unacceptably slow. The schism between “public health” and “medicine” is responsible for staggering shortfalls in achieving advances in population health. Despite its heavy per capita spending on health care, the United States’ performance is mediocre when population-level health outcomes are compared with those of other countries. 1 High quality research addressing how best to apply proven strategies to large and diverse populations is in short supply, with the result that resource allocation is only weakly driven by population-based science. Acute care receives disproportionate emphasis relative to preventing and managing the common, chronic diseases responsible for the greatest burden of morbidity and mortality. 2 Simple interventions known to improve health outcomes are applied only erratically in everyday practice. 3 The divergence of medicine and public health has resulted in practitioners and researchers from these fields working too often in parallel rather than in unison. 4 Although diverse disciplines must contribute to research dedicated to advancing population health, physician investigators are vital to advancing pragmatic solutions at the medicine–public health interface because their grounding in real-world practice settings can focus efforts to improve health systems’ impact on health promotion, prevention, patient safety, and management of chronic disease. 5 However, only 385 US physicians graduated from formal public health training programs with masters or doctoral degrees in 2008 to 2009, and public health expertise among physicians is generally lacking. 6 The supply of physician scientists with the requisite skills to advance pragmatic research at the interface of medicine and public health is simply inadequate to the nation’s health challenges. 7 The current climate of health care reform, as well as evolving national research priorities, lends urgency to developing physicians’ expertise in population health-focused investigation. First, effective study of the impact of alternative models of care delivery, such as the Patient Centered Medical Home and Accountable Care Organizations, requires investigators grounded in health services and population health–oriented research methods. Second, national research funding priorities emphasize research that translates scientific advances into measurable gains in patient and population health. However, scant training is available to physician investigators in the science of implementation, diffusion, and sustainability, which is a critical foundation for careers focusing on the effectiveness and population-oriented end of the translational research spectrum (also referred to as “T3”-oriented research). 8 Finally, health care and policy advances require that physicians are grounded in health economics and preparedness. To address these needs, we therefore established an innovative postgraduate fellowship training program to develop a cadre of physician investigators with the research skills to translate and scale up advances in health to the population level. We describe this program and the initial outcomes from the first 2 cohorts of trainees.
