Residents participating in our intensive 3-week elective felt they learned a great deal and were more likely to seek out other health policy opportunities and even teach basic concepts to their peers or students. Certainly, our course benefits greatly from our location in Washington D.C. and proximity to health policy experts. Nonetheless, we believe our approach to teaching health policy to residents could be modified for many other settings.
First, while having many different policy experts as instructors increases diversity of perspective, a small group of dedicated faculty with interest or experience in health policy could directly deliver or facilitate the didactic content, readings discussions, and final projects we describe. Moreover, many university-based health centers could also draw faculty from multiple disciplines (public health, history, sociology, political science, etc.) to serve as instructors, but even smaller or non-academic programs could approach leaders at local hospitals, departments of health, community organizations, and City Hall. Site visits to these locations could also be highly beneficial for the experiential course component. Similarly, we posit the use of the state capital with emphasis on state health policy issues could substitute for our visit to Capitol Hill, especially considering that most local policy is derived at the state rather than federal level. The possibility of partnering with a health policy-oriented organization or institution to develop curriculum or provide distance learning sessions might also help to build up a curriculum. Finally, ambitious programs might culminate with a visit to Washington or their state capitol as part of their curriculum in which many of the site visit aspects of the GW program could be replicated.
We also encountered several challenges that would likely be encountered at any institution attempting to expose residents to health policy. First, we encountered some resistance from program directors who didn’t believe that health policy had relevance to their trainees. Some of these attitudes have softened over time and following positive experiences by trainees in their program. Schedule conflicts such as job/fellowship interviews, “backup” coverage, etc., represent another challenge. These have been managed on a case-by-case basis, but they point to the underlying problem of inadequate time for non-clinical activities that characterize most residency programs. Finally, while it has at times been challenging to recruit and retain instructors to teach our broad range of topics, these health policy experts are typically very “networked” and usually refer us to suitable substitutes when unable to teach for a given session. This, in fact, has helped us to maintain a high degree of diversity in perspectives and helps keep the course content “fresh” over the years.
Our course evaluation has several limitations. First, self-selection by some residents may have exaggerated the perceived course impact although several programs have required some or all of their residents to take the course over the 3-year period described. Second, we did not use a validated survey instrument, and our knowledge-assessment questions were inherently subjective as course content changes in step with participant interests. Third, residents’ perceptions of their pre-course attitudes are subject to recall bias. Finally, follow-up assessments of both participating and non-participating residents will be necessary to determine long-term impact.
In summary, we have created an innovative opportunity for residents to learn about health policy. While our course is uniquely poised to expose residents to national health policy aspects, we believe our model of education, exposure, and engagement with emphasis on local policy resources can be replicated at many programs outside the Washington D.C. area.