|A National Health Careers Website|
|A grant to design, program, publicize and operate a national health careers website.|
Associated Medical Schools of New York
Principal Investigator: Marc Nivet, M.S.
A meeting of health professionals sponsored by the Macy Foundation in June of 2002 identified a number of barriers to existing efforts to increase the representation of minorities in the health professions. These included deteriorating school systems, a lack of appropriate incentives and/or perceived opportunities, difficulties with access, and a shortage of well-trained mentors and advisors to encourage and guide minority students.
What was needed, participants suggested, was a single or central information source where advisors and students could learn about health career and educational opportunities, educational requirements, and potential sources of financial assistance. This led them to endorse the creation of a comprehensive, interactive health careers website that could be used by both undergraduates and their advisors.
In response, the Associated Medical Schools of New York proposed creating a website that would serve as a national resource for students interested in health careers as well as for their counselors. Features envisioned for the site include:
The site will also include information on financial aid with regularly updated information from health professional schools and organizations as well as useful links and glossary assistance.
An advisory board is working with health professional organizations to develop the content and linkages for the site and also offer new ideas for content and marketing for the website. The launch of the site is expected in the summer of 2004. The two subsequent years are designated for marketing, expansion and maintenance and developing plans for self-sufficiency.
|The Harold Amos Graduate Student Fellowship Fund|
|A grant to contribute to the endowment of the Harold Amos Graduate Student Fellowship Fund of the Harvard Medical School to support doctoral training of minority scholars in the division of medical sciences.|
Prior to the death of Macy Trustee Emeritus Harold Amos, M.D., three separate funds had been established in his name at the Harvard Medical School in recognition of his exceptional contributions to that institution. Subsequently the funds were consolidated into two, one of which is intended for the support of minority scholars in the division of medical sciences. The goal of this fund is to create an endowment with sufficient income to support four exceptional, but needy minority scholars in the department of microbiology and molecular genetics. Recipients will be known as the Harold Amos Fellows.
This one-time grant is consistent with Macy Foundation efforts to enhance minority representation in the health professions.
|The Macy Initiatives in Health Communication|
|Initiatives to disseminate the communications curriculum at University of Massachusetts-Worcester|
University of Massachusetts-Worcester
Principal Investigator: Aaron Lazare, M.D.
Drawing upon an existing regional network of medical schools participating in a consortium known as the UMASS Community Faculty Development Center, the UMASS team has selected Brown and Boston University to participate in an eight-month pilot project to develop and test modules for the proposed Macy Mentorship Program in Health Communications. Eight more medical schools will be enrolled for the second phase, from September 2004 through December 2005, prior to evaluation of the program. Other members of the consortium are Harvard, Yale, Dartmouth, University of Vermont, Tufts, CUNY, University of Connecticut, SUNY-Albany, New York Medical College and University of New England College of Medicine.
A team of "change agents" will be identified within each participating school. These team members first will expand their own knowledge and skills in health communication education, then develop, implement and evaluate a program to enhance health communication training in their own institution. The year-long training program for teams from the enrolled schools will involve three two-day workshops, held approximately four months apart, supplemented by consultations and other activities between workshops. Each workshop will cover innovative educational methods and communications curriculum content, as well as approaches for faculty development.
During the periods between the workshops, faculty from UMASS will conduct activities to meet the specific needs of each institution's plan for enhancing training in communications. Teams will also gather data needed for program evaluation. Those data will be entered in a central data bank at UMASS and will provide the basis for objective assessment.
|Health Communications Dissemination Phase|
|A grant to support dissemination of materials developed through the Macy Initiative in Health Communications to at least ten additional medical schools|
Case Western Reserve University School of Medicine
Co-Principal Investigators: Ted Parran, Jr. M.D.; and Susan Wentz, M.D.
The Case Western Reserve University School of Medicine (CWRU) team plans workshops for faculty from medical schools in the midwest and south, offering instruction in health communications skills in undergraduate and graduate medical education. The CWRU faculty will also develop a course in health communications suitable for continuing medical education programs.
In each of the two years, three two-and-a-half day workshops will be offered to a limited number of fellows, perhaps two to four, from each of the participating medical schools, for a total of 10 to 25 fellows in each group. The first two workshops will concentrate on the identified core competencies and basic strategies for teaching and evaluating communication skills. Participants will then test their newly acquired skills at their home institutions and, during the third workshop, report the results of their efforts and receive assessment and feedback from faculty and other participants.
For the two-year duration of the Macy grant, participants will attend workshops tuition-free but pay their own expenses with the expectation that that tuition will be charged for participation in subsequent years.
Though similar to the UMass program, the Case Western program focuses more directly on resident and practitioner training, features that are essential to further dissemination. This focus is particularly timely because the Accred-itation Council for Graduate Medical Education (ACGME) requirements for residency training now include communication skills and many group practices are including communication skills in their rating of members, which has increased the demand for continuing medical education.
The preceding two grants reflect proposals from 2 of the 3 consortium schools involved in the extremely successful Macy Health Communications Initiative now in its fourth and final year. New York University, the third consortium school is conducting two three-day courses for medical schools in the mid-Atlantic region with funding from the original grant. They are also coordinating publication of the results in peer-reviewed journals.
The results of the Health Communications Initiative have already been reported upon in numerous publications and at national meetings. Members of the consortium have also responded to numerous requests from other institutions seeking information hoping to duplicate the initiative. The consortia schools will continue to collaborate on major journal articles.
|Training For the Use of Computerized Mannequins|
|A grant to train medical educators in the use of realistic computerized mannequins in the instruction of medical students and residents |
Massachusetts Institute of Technology
Principal Investigator: Martha L. Gray, Ph.D.
Three years ago the Macy Board awarded a grant to the Massachusetts Institute of Technology to fund the Macy Simulator Project to explore the potential for using realistic patient simulation in critical care and emergency medicine training. Through the collaborative efforts of the Harvard-MIT Division of Health Sciences and Technology (HST) and the Boston-based Center for Medical Simulation (CMS), that project developed and tested pilot cases, established a system for case documentation, implementation and integration of simulator use into existing curricula, and provided free worldwide dissemination of the pilot.
The success of the program, to date, can be attributed to a small group of well-trained operators and users. It has become clear, however, if the use of simulation-based teaching modules is to spread and realize its full potential, that a critical component "training the trainers" is still missing. Initial experience has shown that the effective use of patient simulators depends upon the availability of well-trained operators and instructors.
This grant is designed to increase the number of trained operators and instructors to ensure that this promising training technology now with approximately 400 patient simulators or mannequins in use worldwide expands effectively. The grant also addresses the need for standards-based documentation and easy dissemination of training materials. Building on the successful example of the Harvard-Macy Institute, the investigators intend to support a HST/CMS Institute for Medical Simulation with tuition paid by instructors accepted into the program. For the short term, the institute will solicit applicants nationally and use Macy Foundation support to provide competitive training fellowships.
Grant money for the first year will focus on designing the "training the trainer" modules and conducting pilot-programs with participants from outside of the Harvard/MIT community. Those modules will be refined during the second year, with two or three groups of 10 trainees each recruited for three-day sessions. Site visits will be made to centers involved in the pilot-program to assess the effectiveness of the training one year after participation. In the third year, not funded by the Macy Foundation, the Institute will begin a series of sessions requiring tuition payments by trainees, in addition to conducting on-going assessment and making any needed refinements.
|A Study of International Medical Graduates|
|A grant to support the study of "International Medical Graduates in the United States: the Hidden Workforce"|
Health Affairs/Project Hope
Principal Investigator: Fitzhugh Mullan, M.D.
One in four practicing physicians and one in four medical residents are graduates of foreign medical schools, either foreign born and trained or Americans who have gone to medical schools in other countries and returned for residency training. Because these international medical graduates have been available to fill gaps in the U.S. health care system, these physicians have had considerable impact on care both in the United States and in other countries. To date, though, little effort has been made to look at where they practice, their specialties, or the extent of their acculturation.
This project proposes to fill that gap. Dr. Fitzhugh Mullan, a long-time analyst of health care workforce issues and now affiliated with Project Hope, will dedicate about one fifth of his time over the next two years to updating and improving available data about these international medical graduates and assessing the considerable policy implications raised by this sizable workforce.
Dr. Mullan will work with the Educational Commission for Foreign Medical Graduates, the Robert Graham Center, which is the research arm of the American Academy of Family Practice, and the Health Resources and Services Administration. He will conclude his study with the publication of two articles based on data he compiles, focusing on policy issues raised by this workforce, its impact on graduate medical education, and the future of the physician workforce.
|Bridging the Gap in Psychotherapy|
|A grant to fund a project entitled "Bridging the gap between research and clinical practice in modern psychotherapy" |
New York Psychiatric Institute Research Foundation of Columbia University
Principal Investigator: Myrna M. Weissman, Ph.D.
A key recommendation from the October, 2001 Macy Foundation Conference on Psychiatry emphasized the need to bridge the gap between new research technologies and clinical practice in psychotherapy. The recommendation was inspired by a paper presented by Dr. Myrna Weissman which provided an overview of the new and effective evidence-based therapies which are relatively inaccessible to psychiatrists, psychologists and social workers who practice psychotherapy.
In her paper, Dr. Weissman reported that the 3 percent of adult patients who use psychotherapy remained constant over the decade between 1987 and 1997, even though the providers and the use of psychotherapy have changed. During that period, treatment has become shorter, most patients also receive medication in addition to psycho-therapy, and the proportion of older, less affluent patients has increased.
Over the same time, a number of controlled clinical trials documented the efficacy of various psychotherapeutic approaches, creating a significant gap between the availability of evidence-based psychotherapy and the training of the clinicians who actually provide psychotherapy.
For this project, investigators will compile and document, in detail, currently available evidence-based psychotherapies as well as survey a number of training programs in psychiatry, psychology and social work to determine the extent of training in these evidence-based approaches. Ultimately they will present their findings to training directors and professional organizations and through professional journals in the three fields.
The investigators believe this work is especially timely as the ever strengthening evidence-base for psychotherapy, combined with continuing demand for treatment, highlight the need for developing training models in these evidence-based approaches, if those research advances are to be translated into improved treatment for greater numbers of patients.
|A Study of Four State Public Health Departments|
|A grant to support a comparative study of four state public health departments with attention to their history, their infrastructure and their potential responsiveness to public health needs|
Principal Investigator: Laura Kahn, M.D., M.P.H., M.P.P.
The proposal for this study was developed by faculty members at Princeton University's Woodrow Wilson School who saw a need to assess the relationship between the structure of state health departments and their ability to respond to public health needs. The study will be conducted by faculty in the Program on Science and Global Security which has recently expanded its purview to include biological security with the long-standing issues of nuclear policy and security.
Dr. Laura Kahn, a new member of the program staff, will direct this project. She has chosen New Jersey, New York, Pennsylvania and New Hampshire for the study because of substantial differences both in local health department structure and in leadership. For example, state health commissioners in New Hampshire and Pennsylvania are not physicians though those in New York and New Jersey are, while New Hampshire and New Jersey have no physicians employed by local health departments. Departments also differ in the number of local departments, with three for New Hampshire and 115 for New Jersey, and in funding sources, with New York's departments supported by state funds while New Jersey's funding comes primarily from local taxes.
A major impetus for this study was provided by the ten-fold increase in federal spending for bioterrorism preparedness from 2001 to 2002, with more than $1 billion targeted to help states and major cities enhance local preparedness and improve regional cooperation and coordination. The investigators plan to examine how these funds are being used by the different departments to determine if they are being allocated in the most effective ways. Many states and local governments are facing severe budget constraints, and want to examine the possibility that these targeted funds are being used to replace rather than supplement existing public health services, which could signal no net gain in preparedness capabilities, or in public health.
The project will include interviews with high level state health and agriculture officials on bioterrorism preparedness and surveys of local health departments, physicians and veterinarians. Results will be published in a report on how state and local governments can most effectively utilize federal bioterrorist funds, with best practices from each state profiled. Questions of leadership, clinical capabilities, diagnostic capabilities and communication will be addressed as will such variables as rates of vaccine-preventable diseases, qualifications of local emergency response team leaders, surveillance of animal diseases, implementation of the mandate for bioterrorism surveillance; laboratory and diagnostic capabilities at both state and local levels; and plans for communication in the event of a bioterrorist attack.
The underlying goal of this project is to identify existing problem areas and help state and local agencies put funds devoted to public health to their most effective use.
|The Future of Emergency Medicine|
|A grant to provide half of the support needed for a study of "The Future of Emergency Care in the United States Health Care System"|
Institute of Medicine
Principal Investigator: Janet M. Corrigan, Ph.D., M.P.H.
The 1994 Macy Conference and subsequent monograph on "The Role of Emergency Medicine in the Future of American Medical Care" provided the first systematic evaluation of emergency medicine as a distinct field. A number of key participants in that conference, which was chaired by L. Thompson Bowles, M.D., Ph.D., are prominent and active in the field.
In the fall of 2002, one of those participants Lewis Goldfrank, M.D., proposed that the Institute of Medicine (IOM) undertake a follow-up study in view of the many changes in the health care system in general, and emergency medicine in particular, during the intervening years. A Macy staff grant to the IOM supported a planning session early in 2003. This session was attended by a number of participants from the Macy Conference as well as others active in the field.
Their deliberations once again highlighted the crucial role of emergency medicine, which not only serves as the safety net for many of the 41 million uninsured Americans but also provides an interface between the health care system and public health. Post-9/11 threats of terrorism and bioterrorism have added new dimensions to the essential role of this field.
Planning meeting participants proposed that the IOM undertake a new study of the nation's emergency care system. The study would cost an estimated $900,000 over an 18-month period. This grant will support half of the study costs; remaining funds have been provided by other health foundations and governmental agencies. The study will involve many key leaders in the field of emergency medicine and will be directed by Dr. Janet M. Corrigan, director of the IOM's Board on Health Care Services.
The study will follow the standard IOM/National Academy of Sciences format, with a committee that will meet several times over 15 months, supported by a staff to gather necessary data and arrange for pertinent testimony. The committee report will be subjected to rigorous review and then issued with the imprimatur of the IOM and the National Academies. The report is expected to have major impact both on the field of emergency medicine and on health policy.
|A Fund Responsive to 9/11 Issues|
|An internal allocation for a Post-9/11 Fund to be used for specific response to issues and needs raised by the events of 9/11/01|
At the October 4, 2001 meeting, the Macy Board discussed ways the Foundation could respond to the local and national crises initiated by the terrorist attacks in ways that were consistent with the Foundation's mission. This fund was to be used, as appropriate, to support proposals that meet that criteria.
The Macy Foundation initially responded with grants to the United Way and to the American Red Cross of Greater New York, and with a subsequent grant to the Chairman of Microbiology at the Sophie Davis School of Biomedical Sciences (CUNY), in his role of representing the national organization of microbiology department chairs, to support the addition of a module on what should be taught to medical students in preparation for bio-terrorism.
Later grants included a grant to the Health Care Chaplaincy of New York to assess the effectiveness of Post-9/11 counseling and bereavement aftercare; a grant to the American Family Therapy Academy for partial support of a conference on "Terror and Trauma: Family and Community Resilience," and a grant to the New York City Police Foundation to address post-traumatic stress disorder for policemen and their families. Finally, a grant was made to the South Street Seaport to assist the revitalization efforts for New York's Historic Downtown area. Upon depletion of this fund, additional allocations may be designated by the Board.