Improving the Fellow's Teaching Skills

Fellows acquire their teaching skills in a variety of venues. Fellows participate in the Division's bi-annual Faculty development retreat
at which five key specific areas are addressed: lecturing, facilitating learner-centered learning in the out-patient setting, case-based
teaching in the out-patient setting, small group interactive teaching, and case-based teaching in the in-patient setting. Fellows precept
residents in continuity clinic once a week under the supervision of a senior clinician-educator who provides the fellows with feedback on
clinical and educational issues. Each fellow is also responsible for three clinical presentations per year at the Divisions weekly clinical
conference. In partnership with a senior member of the Department of Medicine, fellows also spend a month in their second year as
teaching attendings in the medical wards. Lastly, fellows are also frequently called upon to volunteer as preceptors in special-interest
courss in the Schools of Medicine and Public health.

Completing a Master's Degree

Unlike the ABIM-approved fellowships in the medical subspecialties, there are no formal delineations of training requirements for programs
in academic general internal medicine, and no certification process for physicians completing such fellowship programs. However, some
programs offer structured course work through affiliated graduate schools (i.e. Schools of Public Health), and a master's degree may be as
good or better an alternative to double board certification. In addition, graduate school gives plenty of opportunities for interdisciplinary
collaborations and new friendships.

In this program, fellows may choose to complete a master's degree in one of several disciplines at Columbia University, specifically:
Epidemiology or Health Policy and Management (School of Public Health); Nutrition (Institute of Human Nutrition); Geriatrics (Center for
Geriatrics and Gerontology in the School of Public Health); Health Promotion and Disease Prevention (Teachers College). Most fellows at
our program have elected to complete M.P.H. degress in the School of Public Health, in Epidemiology. or Health Policy and Management.

Candidates who accept a position in our fellowship must apply to the School of Public Health (or other equivalent program) no later than the
Spring prior to the date of their appointment, especially if interested in the summer courses. Tuition is covered by the fellowship program
including related expenses such as textbooks.

Improving the Fellow's Knowledge of Clinical Epidemiology and Biostatistics

Fellows are required to take three sequential methods courses in epidemiology, an introductory course in biostatistics and two middle level
statistics courses, one on the analysis of categorical data and the other on regression and multivariate modeling. Fellows are also strongly
encouraged to take a course on measurement, which covers basic topics such as the reliability and validity of measures, scaling,
questionnaire design, factor analysis and data coding.   In addition to these methods courses, students may choose from a wide array of
substantive epidemiology courses in areas such as infectious disease epidemiology, AIDS, environmental health, cancer, cardiovascular
disease, and perinatal epidemiology.

The weekly Division of General Medicine clinical research meetings offer a practical application of these methodologies.  These are group
discussions in which fellows and faculty think aloud about current research plans and the group responds with constructive criticism.  The
methodological discussions of statistical and epidemiologic techniques are focused at the level of research implementation as opposed to
the journal club in which the focus is interpretation of research results. The diversity of backgrounds and research interests of this group
provides a broad experience for the trainee which tends to pique research interests and foster collaborative efforts between division
members.  Lastly, fellows also serve as junior faculty in the residents weekly Journal Club which has been consistently rated by housestaff
as one of the most valuable experiences of their training at Presbyterian Hospital.  In journal club the focus is interpretation of research
results and each week fellows take turns leading the discussion in collaboration with a more senior epidemiology trained clinician.

Improving the Fellow's Research Skills

Each trainee will be expected to formulate and conduct at least one and preferably two research projects during their fellowship.  Few
fellows start the program with a mature research project at the outset. During the first two months, fellows usually familiarize themselves
with the new environment, sit for their Board examination, take up the panel of new patients and start core courses at the School of Public
Health.  This format gives new fellows a framework to interact with the faculty and identify a suitable mentor, and  to explore research
subjects.  An essential initial step in the fellows' research endeavor is the selection of an area of interest, both substantive (e.g.
cardiovascular disease, diabetes, health access and utilization) and disciplinary (e.g. epidemiology, health policy.)

By the fall, trainees are expected to have identified a research project, submitted a written research proposal following the outline of an NIH
grant, and after acceptance of the proposal by the fellowship faculty, begin their project.  By the spring of the first year fellows are expected to
submit an abstract of their work to the meeting of the Society of General Internal Medicine or the NRSA trainees conference.  By fall of the
second year, it is expected that a manuscript of the project be completed and submitted to a peer-reviewed journal and work begun on a
second fellowship project by winter of the second year.