Goals and objectives
The goal of the APA Fellowship Program in PEH is to train a select cadre of pediatricians who will become the next generation of physician-scientists and academic leaders in pediatric environmental medicine. To guide development of the program, the APA formed a Fellowship Oversight Committee that is composed of academic leaders in PEH from across the United States and that reports directly to the APA Board of Directors. In 2001, this committee secured two founding grants on behalf of the APA from the New York Community Trust and the Educational Foundation of America to support the launch of the PEH fellowship program.
To announce the program, the oversight committee developed a request for proposals that was sent to the chairs of all Accreditation Council for Graduate Medical Education–accredited Departments of Pediatrics at U.S. medical schools. Eight programs returned applications, and these applications were reviewed and ranked by a group of four nationally recognized experts in PEH and the then-president of the APA. The oversight committee then conducted a second-tier review. Through this process, three training sites were selected: Harvard Medical School/ Boston Children’s Hospital, Mount Sinai School of Medicine, and George Washington University Medical Center. Additional training sites were established at the University of Cincinnati [supported by a National Research Service Award from the Health Resources and Services Administration (HRSA)] and at the University of Washington (supported by a training grant in environmental epidemiology from the National Institute of Environmental Health Sciences). The program was announced nationally, and pediatricians across the United States were invited to apply for fellowship positions.
To guide the development of curricula and the training of fellows, the Fellowship Oversight Committee developed a set of competency-based training objectives in PEH (Etzel et al. 2003
). These competencies were unanimously approved by the Committee on Environmental Health of the American Academy of Pediatrics.
Because the American Board of Pediatrics requires that all fellowship programs be 3 years in duration, the PEH fellowship is designed as an intensive 3-year academic experience. It is comprised of didactic training leading to an MPH, MS, or PhD degree (40% of time), mentored research (40% of time), and training in clinical environmental medicine and community advocacy (20% of time). All fellows are expected to write a thesis. Curricula are coordinated and approved by the Fellowship Oversight Committee.
Each training site has organized an internal advisory board that works with the program director to oversee the selection of faculty mentors, the recruitment and selection of new fellows, the evaluation of each fellow’s progress, and the assessment of overall program quality. Selection of new fellows of high academic caliber and strong leadership potential is a key responsibility of the internal advisory board, and to secure the best available candidates, program advertisements are distributed widely, and fellows are chosen through a competitive, peer-reviewed process. Each site also has established an external advisory committee. Each program director reports annually to the APA Fellowship Oversight Committee.
All fellows receive didactic training in epidemiology, biostatistics, study design, data management, data analysis, environmental medicine, toxicology, exposure assessment, research ethics, policy analysis, and community outreach. They receive instruction in grant writing and practical guidance in career building and in obtaining research funding. The bulk of the formal didactic training is completed in the first 2 years of fellowship.
A key component of the fellowship is a flexible, individually tailored, closely mentored research experience. This experience is the principal vehicle through which fellows gain the skills and experience that they need to move from traineeship to independent investigator status.
The mentored research experience begins early in the fellowship in July–September of the first year. During these initial months, the program director and co-directors introduce each fellow broadly to faculty members, and they encourage fellows to meet with multiple faculty to explore their ideas and to identify a primary mentor and advisors. By the end of September of the first year, each fellow is expected, in consultation with the program director and the internal advisory committee, to have chosen a mentor and developed the preliminary outline of a research proposal. In some programs, the mentor is selected before a candidate is offered a position. By the end of December of the first year, each fellow is expected to produce a preliminary research proposal. Each fellow has weekly or bi-weekly meetings throughout this year with his or her mentor and advisors to ensure that the fellow’s time is properly protected and that the mentored research project is on schedule. In the latter half of the first year and at an accelerating pace in the second year, the fellow begins to implement the research protocol. The fellow collects research data, designs and implements a data management plan, begins to analyze the data with assistance from the research mentor(s) and program faculty, and prepares an abstract and presentation of the research.
Each fellow is expected by the end of the 3-year fellowship program to have completed the research project and prepared a first-authored research manuscript suitable for submission to a peer-reviewed journal. The fellows are also expected to submit an abstract of their research for presentation at the annual meeting of the APA.
Each fellow is expected to participate in supervised clinical activities in environmental pediatrics during the fellowship. At Mount Sinai and at the University of Washington, this requirement is met through service in the CDC/ATSDR-supported PEHSUs. At the University of Cincinnati, it is met by one half-day of service each week in the Lead Treatment Clinic or by another relevant clinical experience. At Boston Children’s Hospital, PEH fellows fulfill the clinical requirement by performing clinical work in the Pediatric Environmental Health Center, which is linked closely to the Massachusetts/ Rhode Island Poison Control Center (Shannon et al. 2003
Acquisition of skill in evidence-based advocacy and in the translation of medical findings to public policy is an essential component of the APA fellowship program. At Boston Children’s Hospital, fellows learn the skills of evidence-based advocacy through collaboration with the Harvard School of Public Health’s Center for Children’s Environmental Health; this center studies exposures to metals among Native American children living near former mining sites. At Mount Sinai, fellows had a unique opportunity to perform evidence-based advocacy in the aftermath of the attacks on the World Trade Center. They provided guidance to community groups in lower Manhattan, to the New York City Department of Health, and to the Board of Education on protecting children from the toxic chemicals released into the environment by the destruction of the towers. At the University of Washington, fellows gain experience in advocacy through interaction with the Region 10 PEHSU.
To assess each fellow’s progress, a rigorous evaluation process has been established at each training site. Each fellow provides a written assessment of progress every 6 months and meets with the program director at least every 3 months. Key mentors complete annual written evaluations of each fellow’s performance. Each fellow’s program is continuously retailored as required.
Each year the APA convenes a 3-day retreat of fellows and faculty from all of the training sites, modeled after the annual retreat of the Robert Wood Johnson Clinical Scholars’ Program. At these retreats, fellows and faculty have an opportunity to present and review each other’s research, to hear lectures and participate in roundtables convened by leading scientists, physicians, and policy makers, and to discuss future development of PEH.
Conclusion of funding
Funding for the APA Fellowship in PEH has now concluded, because support for the program was based on two nonrenewable foundation grants. APA continues to host the annual fellows' retreat and to encourage academic health centers to acquire independent funding to further sustain training in PEH. To date, two sites—the Mount Sinai School of Medicine and the University of Cincinnati—have secured independent funding and are continuing to train fellows.