In 2009, Mary Bird Perkins Cancer Center (MBPCC) established a Radiation Oncology Physics Residency Program to provide opportunities for medical physics residency training to MS and PhD graduates of the CAMPEP‐accredited Louisiana State University (LSU)‐MBPCC Medical Physics Graduate Program. The LSU‐MBPCC Program graduates approximately six students yearly, which equates to a need for up to twelve residency positions in a two‐year program. To address this need for residency positions, MBPCC has expanded its Program by developing a Consortium consisting of partnerships with medical physics groups located at other nearby clinical institutions. The consortium model offers the residents exposure to a broader range of procedures, technology, and faculty than available at the individual institutions. The Consortium institutions have shown a great deal of support from their medical physics groups and administrations in developing these partnerships. Details of these partnerships are specified within affiliation agreements between MBPCC and each participating institution. All partner sites began resident training in 2011. The Consortium is a network of for‐profit, nonprofit, academic, community, and private entities. We feel that these types of collaborative endeavors will be required nationally to reach the number of residency positions needed to meet the 2014 ABR certification requirements and to maintain graduate medical physics training programs.PACS numbers: 01.40.Fk, 01.40.gb I.In October 2007, the American Board of Radiology (ABR) Board of Trustees approved a policy that will require completion of a CAMPEP‐approved residency program for candidates to be eligible for board certification. Known as the “2014 initiative”, the policy states: “Candidates taking Part 1 for the first time in 2014 or later also must have completed a CAMPEP‐accredited residency program before being eligible to take the Part 2 examination in Medical Physics.”In January 2009, the American Association of Physicists in Medicine (AAPM) sponsored a study, to be conducted by the Center for Health Workforce Studies at the School of Public Health at the State University of New York (SUNY) — Albany, of the medical physics workforce to better understand current supply and demand for the profession. The SUNY report calculated that the number of new radiation oncology medical physicists required to meet demand is projected to increase from 158 in 2010 to more than 190 by 2030.As of February 2013, there were 60 CAMPEP‐accredited radiation oncology physics residency programs with a total of approximately 84 new annual residency positions (approximately 1.4 new residency positions per program) . Assuming a need of 180 new radiation oncology physicists per year, there is currently a shortage of approximately 96 new annual positions. At 1.4 new annual positions per residency program, this equates to a need for 68 new residency programs.There are also potential ethical issues with admitting students to graduate programs with no reasonable expectation that they will be able to find residency positions after graduation. This issue could impact graduate program recruiting and threaten the existence of some graduate programs in that students may elect to focus only on programs that offer real opportunities for residency positions. Hence, we have anticipated that some graduate programs will begin to align with residency programs.Therefore, MBPCC made the strategic decision to establish a Radiation Oncology Physics Residency Program that could provide opportunities for resident positions to the graduates of the CAMPEP‐accredited LSU‐MBPCC graduate program in medical physics. This strategy was meant to protect its program from decline and possible demise, while helping ensure that it maintains the highest quality of matriculating students. However, since the American Association of Physicists in Medicine (AAPM) Report 90 recommends a physicist‐to‐resident ratio of 2:1,II.A.MBPCC  established a Residency Consortium with medical physics groups at external regional institutions to provide clinical residency training. The Consortium structure is similar to the dependent affiliate model described in AAPM Report 133.To establish the Consortium, MBPCC first initiated its Residency Program in 2009, then it began approaching potential partners in early 2010. There was a high level of interest and resulting action from both the medical physicists and administrators at most of the targeted institutions to participate in radiation oncology physics resident training. The Consortium was established in late 2010 with a total of four institutions, MBPCC and three partner institutions. These partner institutions currently include e+ OncoLogics, Inc. , Willis‐Knighton Cancer Center , and the University of Mississippi Medical Center . The current Consortium membership includes private, community, for‐profit, nonprofit, and academic institutions. All current partner sites are within a four‐hour drive (250 miles) of MBPCC.Institutions for each of the affiliate programs have an agreement with MBPCC. The agreement covers several areas, including MBPCC and affiliate responsibilities, resident program governance and marketing, resident placement, funding and insurance coverage, indemnification, and amendments or termination of agreement. Each agreement is signed by the MBPCC chief executive officer and an authorized representative from the affiliate site. A copy of a boiler‐plate agreement is available from MBPCC upon request.B.The Consortium is governed by the Radiation Oncology Physics Residency Training Program Committee. The Program Committee is comprised of the Program Director, Deputy Program Director, the LSU Medical Physics Graduate Program Director , an ABR‐certified radiation oncologist, a Medical Dosimetrist Certification Board (MDCB)‐certified medical dosimetrist, and an American Registry of Radiologic Technologists (ARRT)‐certified radiation therapist from MBPCC, as well as the affiliate Program Directors from each partner institution.The Program Committee meets approximately once a month and provides input on a wide variety of issues regarding program operation. The affiliate Program Directors join the meeting via Skype  video conferencing. At each meeting, the Committee initially meets with the program's senior resident to discuss any concerns among the program residents. Afterwards, the resident is excused, and the Program Committee discusses other issues in the program. These include resident admissions and placement, resident progress and evaluations, program curriculum, budget , accreditation, and promotion .Additionally, each partner location has a local residency program committee that is responsible for training issues at the partner site. These local partner committees are chaired by the affiliate Program Director and are responsible for organizing the training schedules for the residents at each site. This also includes ensuring that resident progress is maintained in accordance to the Consortium training plan and curriculum.C.The program is designed to accept MS and PhD graduates of the Commission on Accreditation of Medical Physics Education Programs (CAMPEP)‐accredited, LSU‐MBPCC Medical Physics Program and post‐doctoral fellows who have completed a two‐to‐three‐year fellowship in radiation oncology physics and appropriate medical physics classes.Initially, first priority applicants are matched to a Consortium training site based on the same algorithm used by the National Residency Matching Program (NRMP) for physician residents.The NRMP algorithm is then applied to the rank lists to produce the best match of residents to training sites. Like the NRMP model, residents are not eligible to be matched to sites where they did not interview. Use of the NRMP algorithm ensures that the match process is unbiased and fair to all Consortium training sites. Results of the internal match are communicated to the applicants in mid‐January for positions starting on July 1. The matched applicants are then given 48 hours to accept, reject, or defer the offered position. Deferment indicates the candidate wishes to be reconsidered for this position (without priority) on the national offer date, if the position remains unfilled. Unfilled positions remaining after the acceptance period are then offered to the remaining internal candidates who have not been offered any positions, who are given 48 hours to decide. This process continues until all positions are filled or all internal candidates have reached a decision.If any unfilled positions remain upon completion of the above process, they are opened to outside applicants. Outside applicants are interviewed and ranked along with internal candidates who elected to defer. These offers are extended on the national offer date in concordance with the current AAPM Working Group of Coordination of Medical Physics Residency Program's gentleman's agreement.Once the Consortium reaches full operating capacity of six new residents per year, it will be large enough to accommodate all MS and PhD graduates of the LSU‐MBPCC Medical Physics Program. While graduates of the LSU‐MBPCC Medical Physics Program receive top priority in filling open residency positions, they are only guaranteed the opportunity for a residency position. The students must still demonstrate adequate performance in the graduate program, complete all degree requirements prior to beginning the residency program, and be acceptable to the offering institutions.D.Each resident is located at his matched training site for the duration of the two‐year residency. During this time, the Consortium sites fund their residents as employees of the institution.Residents are currently funded at the same level as Post Graduate Years 1 and 2 (PGY‐1 and PGY‐2) in regional LSU system medical residencies, as originally recommended by AAPM Report 36.We estimate that the average resident clinical support contribution is 0.375 full‐time equivalent (FTE) clinical physicists. This was determined assuming 0.25 FTE for a first‐year resident and 0.5 FTE for a second‐year resident. This is slightly higher than the 0.25 FTe use in the study by Mills et al.Residents are credentialed at their training institutions after completing their first year of training. At this time, they are allowed to perform duties of a non‐ABR‐certified clinical physicist. Prior to credentialing, each resident must demonstrate competency for each task he/she will be performing independently. This competency evaluation is performed by the program faculty members who have been involved in the resident's training and must be approved by the chief clinical physicist at the site where the resident is located. Competency is demonstrated by successful completion of at least two one‐month rotations and passing an oral exam on the subject matter. Credentialing of second‐year residents serves two purposes. First, resident training is more cost‐effective, as the resident can contribute 0.5 FTE to clinical physics support; second, this allows the resident to become more comfortable with performing independent work. We feel that this provides an environment that more closely resembles the work environment in which the resident will be expected to function after entering the workforce.In addition to institution funding, external funding has been received or is being sought. MBPCC was a recipient of the 2009 ASTRO/AAPM Radiation Oncology Physics Residency Training Program Grant. This provided seed funding for establishment of the residency program at MBPCC. The Consortium has also received funding from the Patrick Taylor Foundation,E.As part of the Consortium, residents follow the same training plan regardless of training location. To ensure consistency in training across institutions, the Consortium has implemented a commercial software product  to monitor resident performance and progress. The Typhon Group Allied Health Student Tracking module and its uses for medical physics residency program performance tracking have been previously described in detail by Zacarias and Mills.Tracking of resident time, tasks, clinical experiences, completed competencies, reports, and most evaluations is performed using the software from Typhon Group. The Program Director or his designee is responsible for managing the software, including updating the curriculum as needed. Residents are able to access the system and enter information on their program training requirements . Program faculty have access to these data, as well as many reporting tools to analyze and approve entries.Each resident typically meets daily with the staff physicist with whom they are rotating to discuss clinical duties for that day. Additionally, each resident is evaluated monthly by the program faculty member mentoring the resident on the project assignment. The project or rotation mentor meets with the resident each month to rview the topics covered during that month and to determine if any remediation is required. This prevents the resident from falling behind in his/her training. An evaluation survey has been created within the Typhon Group software to allow faculty members to evaluate resident performance for each clinical rotation or project that the faculty member supervises. The results of these monthly surveys are maintained within the Typhon software as part of the resident's permanent record.Additionally, an evaluation survey has been created for residents to evaluate the assigned faculty member for each month of clinical rotation and for each assigned project. These surveys allow the Program Director to assess the need to assist faculty members in improving their resident training performance. Only the Program Director has access to the results of these surveys. Residents' names are not disclosed when the results of these surveys are communicated to faculty members. The results are also retained within the Typhon Group software as part of ongoing quality assurance of faculty performance and program training.In addition to regular review by the faculty mentors, residents are evaluated by oral examination. The residents are examined by representatives from the host site and from two or more other Consortium sites via Skype video conferencing. The examinations ensure that residents are being held to the same training standards, regardless of location within the Consortium. Additionally, the oral examinations identify any deficiencies in resident knowledge so they may be addressed immediately. Currently, each resident is examined every four months, covering each of the independent projects and clinical rotations.III.A.The program growth was designed to reach the maximum of 12 total residents by 2016. This decision was made based on the fact that students entering the LSU graduate program in Fall 2012 would be able to enter the ABR certification pathway prior to the 2014 ABR mandate for completion of a residency program. Students entering the graduate program in Fall 2013 and completing degree requirement in Spring 2016  would be required to complete a residency program. Thus, by 2016 the Consortium would have to be able to accommodate all students completing the graduate program.In reality, the Consortium has grown faster than expected due to strong support by administrations and medical physics departments of the partner sites. All current partner sites began resident training in 2011. Predicted program growth indicates that the Consortium will reach full program capacity by July 2014, two years ahead of schedule. B.The residency program self‐study from the MBPCC Program was initially submitted to CAMPEP in October 2011. After discussions with CAMPEP, it was decided to submit the entire Consortium Program for accreditation at one time, rather than each affiliate site individually. The initial CAMPEP review of the self‐study primarily asked for additional documentation from the affiliate sites. A response was sent in February 2012, which included additional affiliate site materials and signed affiliate agreements. The CAMPEP site visit took place in June 2012.This was the first residency model of this type to be reviewed by CAMPEP, and there was considerable discussion as to how best to site‐visit the program. As such, it was decided to have the three members of the site‐visit team spend one day at MBPCC, then split up the following day to visit a different affiliate site. The team then reconvened at the end of the second day in Baton Rouge and wrote the first draft of the report. The team reported its findings on the morning of the third day, before departing.The program received full accreditation  in August 2012. MBPCC and its affiliate sites each received individual certificates of accreditation and are listed on the CAMPEP website.IV.A consortium of regional medical physics groups has been formed to address a national short‐age of radiation oncology physics residency positions. This Consortium consists of Mary Bird Perkins Cancer Center, e+ OncoLogics, Inc., Willis‐Knighton Cancer Center, and the University of Mississippi Medical Center. The Consortium institutions have shown a great deal of support, both from their medical physics groups and administrations, in developing these partnerships. The details of these partnerships were finalized through affiliate agreements, signed by representatives from MBPCC and each affiliate institution. The Consortium is a network of for‐profit, nonprofit, academic, community, and private entities. We feel that these types of collaborative endeavors provide excellent residency training, and will be required to reach the number of residency positions needed to meet the 2014 ABR mandate and to maintain graduate medical physics training programs.The authors acknowledge the contributions from other current and former members of the Program Committee, including Frank Apollo, CMD, Yolanda Augustus, RTT, Joseph Dugas, PhD, Kara Ferachi, MS, Wayne Newhauser, PhD, and Mary Ella Sanders, MD. The Consortium would not be possible without the ongoing enthusiastic contribution of professional staff  at MBPCC and affiliate sites.


This study examined the perceptions of benefits of and barriers to participating in a community-based diabetes program to improve program effectiveness. The Diabetes Prevention and Management (DPM) program was a twenty-two session, 1-year program, modeled after the evidence-based National Diabetes Prevention Program and AADE7 Self-Care Behaviors framework. Community-based participatory research approach was used to culturally tailor the curriculum. Participants included overweight or obese adults with dysglycemia. A benefits and barriers survey was developed to gather information on participants’ perception of the program, as well as information on demographics and health literacy levels. Eighty-nine adults participated in the DPM program ; 79% of participants completed the benefits and barriers survey. Principal component analysis indicated two components representing benefits (Cronbach’s α = 0.83) and barriers (α = 0.65). The majority perceived high benefits and low barriers to program participation; benefits included helpful interaction with health coach or program leader (73%), improved lifestyle modification (65%) due to the program, and satisfaction with the program (75%). Open-ended questions confirmed themes related to benefits of program participation, suggestion for programmatic improvements as well as barriers to participation. Participant feedback could be used to guide interventions and tailor future program implementation. Diabetes affects 30.3 million Americans (9.4% of the population) and contributes to early morbidity and mortality . In addiDysglycemia presents a significant challenge for individuals, communities, and healthcare systems due to increased risk for disease and comorbid conditions associated with health care costs ,10,11. MWhile the translation of lifestyle interventions is often recommended for reducing the risk for diabetes and its complications, adequate dissemination of diabetes prevention and management programs in WV , and Diabetes Self-Management Program (DSMP), and Diabetes Self-Management Education) is less than desired . UnderstExamining the role of benefits and barriers is important in understanding the effectiveness of community-based diabetes programs. Hence, the purpose of this exploratory study was to develop an instrument for assessing the benefits of a community-based diabetes prevention and management (DPM) program. These results can be used to tailor the curriculum for Appalachian culture, and can help with accessibility to diabetes programs in community settings, which may represent a novel way of improving and implementing effective programs in WV. Furthermore, results from this research can be used to tailor new and available programs for improved program adherence, utilization, and behavior changes as well as increase health provider referrals to lifestyle programs in West Virginia communities. The purpose of the study was to: (1) Determine the participants’ perceived barriers for engaging in the DPM program; (2) Determine the benefits of program participation; and (3) Assess the satisfaction with various components of the program (if any).2, and had to be motivated to meet the Surgeon General’s recommended physical activity of at least 150 min per week. Potentially eligible participants were recruited from the greater Morgantown and Charleston, WV areas using convenience and snowball sampling due to the nature of the program. These two areas have several hospitals, Federally Qualified Health Centers, free clinics, churches and other community-based organizations  from which participants were successfully recruited for the program. Participants were also recruited through community advertisements such as flyers, church bulletins, email lists, and community presentations. The study protocol was approved by West Virginia University Institutional Review Board.The original data source was the Diabetes Prevention and Management (DPM) program from 2014 through 2016. The DPM was implemented in twenty-two sessions over 12 months in two Appalachian churches, and was modeled after the evidence-based National DPP and modified to include diabetes management sessions using the American Association of Diabetes Educators Self-Care Behaviors framework (AADE7) ,20. The Benefits and barriers were assessed using a 33-item survey questionnaire developed by the researchers. The survey examined participants’ perception of benefits of and barriers to participation in the DPM program. The survey questions sought information on the following: barriers to engaging in the program, benefits reported for program participation, satisfaction with various components of the program (if any), and demographic information of the participants . In addition, individuals had the opportunity to respond, using open-ended questions, on specific benefits and barriers, provide suggested improvements for the program, and identify the most interesting components that may lead to improvement of community-based diabetes lifestyle programs.We used a modified Centers for Disease Control clinical data form to identify the medical history of diseases, including prediabetes, diabetes and heart disease . Self-raThe remainder of the survey questions were developed and modified from two reliable and valid surveys which were the Community Health Awareness of Diabetes (CHAD) and the Summary of Diabetes Self-Care Activities (SDSCA) measure, along with previous lifestyle programming experience ,27. ThesData were analyzed using SPSS  All data was double entered and compared for missingness. While 89 participants (unduplicated) were enrolled in the DPM program, the current analyses included 70 participants with complete data. Descriptive characteristics for the total sample are provided. Cronbach’s alpha of this new scale was used to assess reliability or internal consistency, and principal component analysis (PCA) with a varimax rotation was conducted to examine the factorial structure of the constructs, with eigenvalues greater than 1. An eigenvalue of 1 or greater indicates that the factor possesses at least as much total variance as is contained in a single item. PCA was computed by correlating the score for each scale item with the total score for each observation, and by comparing that to the variance for all individual item scores. Model refinement and assessment were carried out iteratively. Following the PCA, findings were quantified and assessed through descriptive analyses. Additionally, the open-ended format for some questions allowed triangulation of the quantitative and qualitative feedback on participants’ perceived program benefits and barriers.With respect to participants who had a genetic predisposition to diabetes; 64% indicated a family history, and over half (56%) knew someone who had been diagnosed with heart disease. Likewise, hypertension (55%) and high cholesterol (54%) were major comorbidities for this study sample. However, over 50% of participants self-rated their overall physical and mental health status to be good or excellent, and more than 77% of participants had adequate health literacy.Additionally, the rate of program completion for participants was 82%. Dropout was defined as those participants who informed the team that they were withdrawing from the study or when they were unable to be contacted after missing a scheduled assessment and/or follow-up phone calls. Attendance was taken at every educational session. Several individuals started the program, but dropped out in the first 4 weeks due to instrumental reasons such as changes in health and mobility, competing family responsibilities, transportation issues, change in job, etc. Based on attendance, taken at every educational session, the average number of sessions attended was 75% (or 14 sessions). No significant difference was noted based on diabetes and pre-diabetes status.PCA identified clustering of five constructs as follows: screening/risk, location, fasting blood work, benefits and barriers. The two factors of importance for this study were benefits and barriers; eight questions loaded for benefits and five questions loaded for barriers. The benefits and barriers components were then placed in a two-component PCA analysis to further assess reliability of the scale, which is presented in For the main variables , the mean response was 43.6 ± 3.91 and 21.5 ± 4.62, respectively. The mean scores for these two constructs indicated high benefits and low barriers with the DPM program. DPM program aided in implementing lifestyle changes for participants and educational sessions provided a positive experience for support, discussion and learning opportunities. The benefit item-mean scores ranged from 5.03 to 5.64 on a 1–6 scale . OverallOver 70% indicated that the interaction with their personal health coach or program leaders, as well as program materials/demonstrations, were helpful and informative. The program was successful in helping 65% of individuals to modify their health behavior and make positive lifestyle changes as a result of the program. In addition, 70% used the results of blood tests completed during the program to discuss with their healthcare provider and family/friends. The majority (74%) of participants indicated that the program helped them understand the risks associated with dysglycemia and how to prevent/manage diabetes. Overall, about 75% of respondents were satisfied with the program. Specifically, transportation was not identified as a barrier for the majority of participants. While some educational sessions were done during winter months, over half of the individuals (53%) reported they did not miss a session due to weather and work priorities, family activities and personal health issues did not deter their attendance.r = 0.29, p = 0.015 & r = 0.366, p = 0.002, respectively) indicating individuals with good health perceived greater program benefits and lower barriers to participation. Interestingly, adequate health literacy was not associated with either benefits and barriers of the program.As mentioned previously, the constructs that were excluded from the two-construct PCA were screening/risk, location and fasting bloodwork. Among these were some interesting conclusions that helped confirm the assumption of high benefits and low barriers. For example, over half  of the participants had been screened for diabetes and had been informed of their risk for diabetes by their health provider. Approximately 69% of respondents indicated that the church location used for program implementation was convenient. Furthermore, fasting blood work done at the churches during weekend mornings was not challenging for approximately 71% of individuals; over half of participants (54%) felt comfortable giving blood. The benefits and barriers constructs correlated significantly with participant’s self-rated physical health  and a genetic predisposition to chronic diseases (based on their family history). Additionally, participants reported adequate literacy levels and socioeconomic status than most areas of WV and were confident in reading and understanding information about their health and disease condition. The program participants were similar in demographic characteristics  to the state, but were more educated (70% with Bachelor’s degree) and had a higher percent of females . Hence, The program length of one-year was not regarded as a barrier, as has been reported for the National Diabetes Prevention Program, and participants conveyed the satisfaction resulting from peer and program support as they could share their feelings, issues and struggles in a non-judgmental environment, foster peer support and encouragement, and accountability from Health Coaches . The benDespite the positive feedback received on the program, there were some limitations with this study. For example, all study variables were self-reported and could have led to measurement error and misclassification bias. Specifically, determination of benefits and barriers scores were based on a self-report measure that was developed for this study. In addition, the study is limited by the small sample size and missingness in the data.Our findings provide evidence that the DPM program is successful in helping individuals with dysglycemia to make positive lifestyle changes and self-manage their chronic conditions. Hence, the use of Health Coaches and community-based models such as the DPM program can be successful and sustainable in WV. However, while the overall benefits were identified, suggestions for improvements such as to offer more sessions, provide recipes, food demonstrations, and bringing experts can be used to tailor future diabetes prevention and management programs.Findings highlight two implications for public health. First, there is a general lack of participant perceptions of community-based diabetes programs, and this study fills a gap in diabetes intervention research in Appalachia, especially in WV. Second, participation in the DPM program improved lifestyle modification while allowing for interventions to become more tailored to the community’s needs. By identifying these benefits and barriers, the program effectiveness can be improved resulting in a better quality of life for WV communities.


Raccoon rabies is endemic in the eastern U.S.; however, an epizootic had not been confirmed on Long Island, New York until 2004. An oral rabies vaccination (ORV) program was initiated soon after the first rabies-positive raccoon was discovered, and continued until raccoon rabies was eliminated from the vaccination zone. The cost-effectiveness and economic impact of this rabies control program were unknown. A public health surveillance data set was evaluated following the ORV program on Long Island, and is used here as a case study in the health economics of rabies prevention and control efforts. A benefit-cost analysis was performed to determine the cost-effectiveness of the program, and a regional economic model was used to estimate the macroeconomic impacts of raccoon rabies elimination to New York State. The cost of the program, approximately $2.6 million, was recovered within eight years by reducing costs associated with post-exposure prophylaxis (PEP) and veterinary diagnostic testing of rabies suspect animals. By 2019, the State of New York is projected to benefit from the ORV program by almost $27 million. The benefit-cost ratio will reach 1.71 in 2019, meaning that for every dollar spent on the program $1.71 will be saved. Regional economic modeling estimated employment growth of over 100 jobs and a Gross Domestic Product (GDP) increase of $9.2 million through 2019. This analysis suggests that baiting to eliminate rabies in a geographically constrained area can provide positive economic returns. Raccoon rabies, a type of rabies found most frequently in raccoons, is common in the eastern U.S. Raccoon rabies is at times controlled through oral rabies vaccination (ORV) programs, in which baits containing rabies vaccine are distributed throughout the affected area to be consumed by wildlife, which then develop immunity limiting their ability to spread the disease in the population. A rabies outbreak was not detected in Nassau and Suffolk Counties on Long Island until 2004, when an ORV program was rapidly initiated in response to the discovery of a rabies-positive raccoon. As a result, raccoon rabies was eliminated in January 2009. Some questioned whether the benefits of the ORV program outweighed its costs. To find out, we performed a benefit-cost analysis of the program using avoided medical and animal testing costs to value the benefits. We also used a regional economic model to estimate the effect of the program on the economy of New York State. The results of both analyses indicated that the program had a positive economic impact, increasing employment and income in the region. The ORV program also benefited public health by reducing the need for medical treatment after possible rabies exposures. This study provides insight into the economic value of a program to eliminate rabies from an isolated area. The raccoon variant of rabies virus (raccoon rabies) is endemic throughout most of the eastern seaboard of the U.S. In New York, raccoon rabies was first reported in 1990. The epizootic was undetected in Long Island (Nassau County) until August 2004 [2 during September applications. Additional research activities performed from 2007 to 2009 in approximately 20% of the ORV zone also incorporated the evaluations of semi-annual  ORV campaigns and greater, cumulative bait densities ranging up to 1,000 baits/km2. The data generated from the intensive ORV strategies did not support continuation of the experimental methodologies on Long Island. However, 100% of the vaccine costs  have been included in our cost analysis, thereby inflating ORV expenses and decreasing estimated benefits. Raccoon rabies was eliminated from the ORV zone in 2009, reducing its impacts to human and animal health and the economy of New York State.The number of rabies-positive raccoons in Nassau and Suffolk Counties  increased from zero in 2003 to ten in 2004 and 35 in 2005. To combat the growing number of rabid raccoons, the New York State Department of Health initiated an immediate response strategy to control rabies when rabid raccoons were first detected in Nassau County during August 2004. Rabies control was not achieved, as was evidenced by the increased number of rabid animals (N = 35) that were reported in Nassau County in 2005, as well as viral advance into Suffolk County by March 2006 . In SeptIn the U.S., interactions between people and companion animals are an important cause of human rabies exposure . CompaniMacroeconomic impacts of endemic disease burdens such as rabies can be estimated by examining changes in different economic sectors that result from the direct and indirect impacts of the disease . For exaThe purpose of this study is to quantify the costs associated with the Long Island ORV program and the benefits gained from the resulting decrease in human and animal rabies exposure. Additionally, a regional economic model is used to estimate the macroeconomic impacts of the program in New York State. This study provides an assessment of the economic impacts of rabies and an estimate of the potential benefits that could be realized if the prevalence of raccoon rabies was reduced or eliminated in other regions of the U.S.Benefit-cost analysis (BCA) is a tool frequently used by economists to evaluate the efficiency of projects and government programs. Valuation of the benefits of projects that prevent disease spread is generally based on estimation of the damages avoided. It is posited that the ORV program described here decreased the prevalence of (and ultimately eliminated) raccoon rabies. The benefits of this ORV program were calculated as the savings from reducing the number of PEP and animal testing (AT) necessary, and the associated costs borne by individuals as a result of human rabies exposure . These avoided costs make up the majority of benefits derived from rabies control programs –9, and aTB) equal PEP and AT costs avoided due to raccoon rabies cases avoided. To determine cost savings it was necessary to estimate the extent to which raccoon rabies was likely to spread on Long Island. For this analysis, it was assumed that the disease would not severely impact Queens and Kings Counties due to the high level of urbanization, but would have spread east through Nassau and Suffolk Counties (HPRbaseline) comprises the populations of both Nassau and Suffolk Counties  of rabies exposure due to the ORV program. TB of the program in a specific year was calculated asPEPest and ATest are estimates of the average rate of incidence of PEP and AT respectively per 100,000 people based on documented previous rabies epizootics in New Jersey [PEPcost represents the total cost of rabies exposure per case, including direct and indirect costs, and was $4,203 [ATcost reflects the costs associated with capture and testing of a suspected rabid animal and was estimated as $483 [The difference between w Jersey , New Yorw Jersey , and Neww Jersey , and adjw Jersey . New JerTC) of the ORV program were calculated as the sum of bait and distribution costs. The program was funded by New York State and Nassau and Suffolk Counties. Actual costs were available for baits and a portion of the air distribution. However, the remaining air distribution and all of the ground distribution costs were provided by in-kind donations to the program and were not tracked. As a proxy, we used estimates of ground and air distribution costs of $20.43/km2 and $28.09/km2, respectively [Total costs (ectively . It shouProgram efficiency can be measured in two ways: benefit-cost ratios (BCRs) and net benefits. BCRs were calculated as total benefits divided by total costs, providing an indication of the returns for every dollar spent. Thus, a BCR greater than one indicates an efficient use of resources because the program’s benefits outweigh the costs. Similar information is provided by the measurement of net benefits, which is simply the total benefit minus the total cost.A sensitivity analysis was performed to evaluate the effect of a range of PEP and AT rate estimates on the total benefits of the program. Rates were allowed to vary by as much as 70% and resulting benefits and BCRs were calculated.Reducing human exposure to raccoon rabies can produce regional macroeconomic impacts including changes in income and employment that arise from multiple sources. Macroeconomic impacts illustrate how reducing the prevalence of rabies affects people who were not at direct risk of the disease. Macroeconomic models, such as REMI PI+ , allow the estimation of impacts in terms such as income and employment, which are important to the general public. We estimated macroeconomic impacts arising from two sources: less income lost due to fewer people receiving PEP and shifts from healthcare spending to spending in other sectors of the economy.The loss of income while seeking PEP reduces consumer spending throughout other sectors of the economy and leads to income and employment declines in those sectors. Thus, when the prevalence of the disease is reduced this harmful impact is lessened and regional income and employment will rise. Positive macroeconomic effects associated with a decrease in spending on PEP arise because a large portion of spending on PEP immediately leaves the state (rabies vaccines and human rabies immune globulin (HRIG) are produced outside New York State). Based on prices obtained from rabies vaccine and HRIG manufacturers, it was estimated that 84% of the direct costs of PEP are for vaccine/HRIG and the remaining 16% are for other medical costs . Therefore, when PEP spending is reduced there will be a significant shift in spending to in-state businesses, ultimately resulting in an increase in income and employment in those industries. However, this positive impact is partially offset by a decrease in spending in the healthcare sector in New York, equal to the non-vaccine/HRIG portion of PEP costs.The REMI model that was used to estimate the impact of the ORV program on New York State’s economy was a 70-sector REMI PI+ model of the New York economy. REMI is a computer-based simulation model of the US economy that allows modeling at both the national and sub-national scales. This structural economic forecasting model uses a non-survey based input-output (I-O) table like other widely-used, ready-made models, but links its I-O table to thousands of simultaneous equations to overcome the rigidness of static I-O models . By incoTotal benefits resulting from the ORV program were the savings from avoided PEPs and ATs over the course of the program (2005–10) and projected nine years into the future . The firNet benefits are the total benefits minus the total costs. As of 2016, cumulative benefits for New York exceeded $14 million . CumulatSensitivity analysis revealed positive benefits and BCRs greater than one , even whRegional economic modeling predicted employment growth of 106 jobs and a Gross Domestic Product (GDP) increase of $9.2 million through 2019 due to increased consumer spending resulting from avoided PEPs and ATs . This taThis study provided a retrospective examination of the benefits and costs of a wildlife rabies elimination program on Long Island that incorporated, for the first time, the macroeconomic impacts of reduced rabies burden to the New York State economy. Other studies examining the benefits and costs of successful elimination of rabies from an area have been conducted but have never estimated the broader macroeconomic implications , 13. TheRegional economic modeling was used to estimate the macroeconomic effects of the ORV program on the New York economy in terms of employment and GDP (income). As the ORV program protected individuals in Suffolk and Nassau counties, fewer individuals had to receive PEP. Avoided expenditures on PEP were reflected as increased consumer spending. While some of the gain to individuals was offset by a loss to the medical sector, the REMI model predicted positive impacts on jobs and income in New York as a result of the program. Estimating the impact on employment and state GDP of controlling a primarily wildlife-based disease is largely absent in the literature. This is the first estimation of the broader implication of rabies to the macroeconomy. This type of analysis is important because it links the impacts of the disease control (ORV) program to individuals who were otherwise not involved in the program through tangible concepts such as changes in employment and income. These individuals may have been aware that a program was being conducted in their area, but may not have been able to discern any personal benefit.A challenge of this study was determining the hypothetical annual frequencies of public health interventions (PEP and AT) that would have existed in the absence of a raccoon rabies control program. These data were needed to calculate damages avoided in the economic analysis. Because rabies control tactics were initiated within days of identification of the first terrestrial case in 2004, the estimated frequencies were based on information from previous raccoon rabies epizootics occurring in New Brunswick, New Jersey and New York. The use of these average and adjusted frequencies reduces uncertainty of the monetary value of damages avoided. In addition, a sensitivity analysis revealed that large changes in estimated PEP and AT rates would still result in BCRs greater than one. The effect of public perception of risk on PEP rates is not fully understood. However, we do know that a decrease in rabies prevalence does not result in an immediate decrease in the number of PEP sought, indicating that public perception of rabies risk is not acutely responsive to actual rabies risk. Consequently, minor changes in actual rabies prevalence  are not likely to have a significant effect on PEP and AT rates.The potential for rabies to advance into pre-epizootic areas that are located beyond existing ORV-barrier zones, as well as viral emergence within previously-vaccinated areas where the virus appears to be extirpated, will continue through long distance raccoon dispersals, as well as human-assisted animal translocations that are purposeful or accidental. A rabid juvenile male raccoon was dispatched and submitted by a police officer in Nassau County on 23 March 2016, with subsequent raccoon variant determination at the NY State Health Department Rabies Laboratory on 24 March. The animal was located approximately 750m from the southern-most rabid raccoon that was previously reported 11 years earlier during October 2005. The most recent historical case of terrestrial rabies in Nassau County was confirmed on 2 November 2007. The first phases of a contingency response plan were effected immediately following detection of the March 2016 case. Local cooperators  were notified and enhanced surveillance for sick and abnormally-acting raccoons was increased in Nassau and Suffolk Counties. Resources were also in place for the planning and execution of an ORV campaign. Only the single, juvenile raccoon was confirmed rabid during subsequent spring and summer months. Accordingly, discussions with county and state agency personnel resulted in a decision to delay the proposed ORV campaign indefinitely, pending detection of additional viral activity. In comparison, enhanced rabies surveillance efforts during the initial 2004 epizootic yielded the confirmation of seven rabid raccoons during the first 35 days. ORV managers will continue to react and make informed decisions on a case-by-case basis, until the raccoon rabies variant is eradicated from the extent of its range in North America.A comprehensive picture of the economic impacts resulting from elimination of wildlife diseases is crucial to understanding the benefits of control programs. Vaccination of wildlife, companion animals, and livestock against rabies is critical for elimination of the disease. The next step is choosing the most efficient and effective method available. This analysis suggests that baiting to eliminate rabies in a geographically constrained area can provide positive economic returns despite a five-year temporal delay before financial benefits start to accrue. The real and perceived risks associated with rabies exposure and PEP in small intervention areas must ultimately be compared to large-scale vaccination programs that are designed with the goal of regional rabies elimination within extensive land areas. Financial benefits to society may be negatively impacted if public and professional anxieties remain at a heightened level in narrow disease elimination zones where the threat of rabies exposure persists in close proximity. The estimated macroeconomic impacts over time demonstrate the societal value of rabies elimination in a wildlife reservoir species. Such programs are often perceived as too costly or lacking a measurable public health impact. Quantitative analyses as performed in this study are important for public health policy makers at both local and national levels. The results from this study can be used in future ORV and rabies elimination planning.


The paper presents a systematic review and metasynthesis of findings from qualitative evaluations of community reentry programs. The programs sought to engage recently released adult prison inmates with either problematic drug use or a mental health disorder.Seven biomedical and social science databases, Cinahl, Pubmed, Scopus, Proquest, Medline, Sociological abstracts and Web of Science and publisher database Taylor and Francis were searched in 2016 resulting in 2373 potential papers. Abstract reviews left 140 papers of which 8 were included after detailed review. Major themes and subthemes were identified through grounded theory inductive analysis of results from the eight papers. Of the final eight papers the majority (6) were from the United States. In total, the papers covered 405 interviews and included 121 (30%) females and 284 (70%) males.Findings suggest that the interpersonal skills of case workers; access to social support and housing; and continuity of case worker relationships throughout the pre-release and post-release period are key social and structural factors in program success.Evaluation of community reentry programs requires qualitative data to contextualize statistical findings and identify social and structural factors that impact on reducing incarceration and improving participant health. These aspects of program efficacy have implications for reentry program development and staff training and broader social and health policy and services. Effective community reentry programs are one component in strategies to reduce recidivism and assist in the successful transition of prison inmates to community. The rising rate of adult incarceration is a major public health and societal problem worldwide. Globally, there are an estimated 10.35 million people in custody Walmsley . Prison Reentry to the community is known to be highly stressful. This is attributable to the complexity of health problems and poor engagement with health and social services , housing (n = 1) and college programs (n = 2) or specifically addressing a health condition, i.e. HIV (n = 1). The review then excluded those that were not qualitative (n = 2), not evaluating a program (n = 17), not concerned with prison inmates (n = 5) did not extend to community post-release (n = 12 focused on in-prison programs only), or were concerned with a specific group such as young or long term prison inmates  (n = 16). See PRISMA diagram for reasons for exclusion and Table The search resulted in 2373 papers including duplicates. The most productive databases were Scopus, Proquest and Taylor and Francis, which yielded 2025 between them. Abstract reviews resulted in the selection of 140 papers. Of these, 66 appeared to relate prison inmates’ experiences of reentry programs. An iterative process then followed in which these papers were reviewed by the team of three researchers using a summary spreadsheet which included publication details, the focus of the paper and the abstract. Those relating primarily to substance use and mental health disorder were selected for review. This excluded papers focusing specifically on employment  were from the United States, one was from the United Kingdom, and one was from New Zealand. In six studies it was stated that interviews were semi-structured, in one interviews were structured though there was opportunity for individual program participants to expand upon information gathered through the questionnaire by giving personal, narrative accounts, and one study used focus groups only. The number of interview or focus group participants ranged from 10 to 226. In total, the papers covered 405 interviews (including 24 in focus groups). Three papers focused on female participants only, four included males only and one included both. A total of 121 (30%) female and 284 (70%) male participants were included in the studies. Ages were provided as a range or as an average with a minimum 19 years and a maximum 56 years. One paper did not include information on age or ethnicity/race and three papers provided an age range but not ethnicity/race. In all studies participants were invited to be part of the research and voluntarily attended the program being evaluated. In three studies a carefully matched control group of those who chose not to or were unable to participate in the program due to their imminent release was used  structural context; 2) supportive relationships and 3) continuity of care including pre-release planning. The themes shown in Table The importance of structural context was identified in all of the papers reviewed. The structural context, identified as the systems that govern an individual’s engagement with, or access to services includes aspects of the social system impacting on the individual’s health and wellbeing and capacity to avoid re-arrest. In the studies reviewed, structural context translated into specific forms of practical support provided via the program or relational and psychological factors associated with service provision.Housing and employment were identified in all studies as the most critical forms of practical support or ‘recovery capital’  Small sample sizes; 2) Unable to establish causality because the focus was on eliciting participant experiences; and 3) Non-generalizability of findings. Non-generalizability of findings is relevant in that most of the studies are from the United States and results may not translate elsewhere due to differences in prison systems but also applies at the program level, i.e. the experiences of one set of participants cannot be generalised to other potential program users.Selection bias is also a limitation across many of the studies. For example, Pleggenkuhle et al.  note thaDescription of method of analysis varied between papers and in one case was absent (Gilbert and Elley There is limited qualitative program evaluation research available and standardization of qualitative evaluation and inclusion is a work in progress. There were some differences in programs that have not been examined in detail in our analysis though we did find similar elements in the program evaluations included. Data analysis methods applied in the qualitative evaluations reviewed were forms of thematic or grounded theory analysis. Our systematic review analysis has treated all methods similarly and focused on reported results. More consistency is needed in qualitative methods used in evaluation studies to enable comparisons and review of the literature.This is the first systematic review of qualitative evaluations of reentry programs. Findings suggest that access to social support, housing and employment; the interpersonal skills of case workers; personalized approaches to case management; and continuity of care throughout the pre-release and post-release period are the key social and structural factors in program success. These factors impact on other measures of program efficacy such as reduced substance use and protecting against re-incarceration. The role of caseworkers as an advocate and advisor for program participants plays an important role in program success, as respectful communication combined with practical support was identified as beneficial in all papers. For women, the relational aspects of caseworker support such as trust and rapport are critical to program participation and relapse prevention. Continuity of individualised care goes some way to addressing the risk factors associated with reentry by assisting clients in establishing ‘recovery capital’. This includes accessing and maintaining housing and employment and providing an ongoing therapeutic relationship and connection to pro-social relationships. Where sustainable recovery is achieved, this can be transformative, resulting in reintegration into the community, long term desistance from substance use and crime and improved psychological health (Gilbert and Elley The review indicates that comprehensive reentry programs that address the full range of social and structural issues via individualised support from case managers can be effective. Participants report benefit from reentry programs where a combination of practical resources and empathic support is provided spanning from the pre-release to the post-release period. The need for integrated, rather than crisis-driven support, and gender specific health and social support services to support reentry is also indicated.


Medical education is undergoing significant transformation. Many medical schools are moving away from the concept of seat time to competency-based education and introducing flexibility in the curriculum that allows individualization. In response to rising student debt and the anticipated physician shortage, 35% of US medical schools are considering the development of accelerated pathways. The roadmap described in this paper is grounded in the experiences of the Consortium of Accelerated Medical Pathway Programs (CAMPP) members in the development, implementation, and evaluation of one type of accelerated pathway: the three-year MD program. Strategies include developing a mission that guides curricular development – meeting regulatory requirements, attaining institutional buy-in and resources necessary to support the programs, including student assessment and mentoring – and program evaluation. Accelerated programs offer opportunities to innovate and integrate a mission benefitting students and the public.Abbreviations: CAMPP: Consortium of accelerated medical pathway programs; GME: Graduate medical education; LCME: Liaison committee on medical education; NRMP: National residency matching program; UME: Undergraduate medical education Medical education is evolving as a large number of colleges of medicine are currently undergoing substantial curricular changes. Although the traditional framework of two-year didactic and two-year clinical educational has been stable since its adoption after the Flexner Report .Figure 1The Institute of Medicine, Association of American Medical Colleges (AAMC), American Medical Association, and the Josiah Macy Jr. Foundation have all called for education reform to better align medical training with 21st century healthcare needs . In 2014With support from the Josiah Macy Jr. Foundation, eight medical schools (now 12) with three-year medical pathway programs founded the Consortium of Accelerated Medical Pathway Programs (CAMPP). While the CAMPP pathways vary in size, specialty focus, mission, and curricular elements , the conThis paper provides recommendations for medical schools that wish to or are establishing accelerated curricula. An accelerated program requires a clear understanding of what it intends to accomplish, the mechanisms to be employed, and the benefits of the change. Importantly, key stakeholders should create the mission statement before the program is established so that the mission serves as the guide to program development. The mission is central to all components of the program including the development of the curricular design, admission policy, allocation support, and allocation of resources, The mission for accelerated pathways can vary but often includes intending to move from a time-based to a competency-based education model . Other mThe mission of the program should guide the recruitment, application, interview, and selection processes. A mission to educate family medicine physicians to serve rural communities will require a different admissions model compared with one designed to educate surgical subspecialists. Those programs that offer a conditional acceptance to residency programs (see below) will need to develop a process that includes Graduate Medical Education (GME) stakeholders in the decision making.There are two primary models for student admission: direct admission at matriculation or delayed admission, usually within the first months of medical school ,7. TheseWith the direct admission model, candidates can be specifically targeted with this method, particularly non-traditional second career or those with a clear pre-matriculation affinity for a given specialty. However, identifying reliable predictive factors can be difficult. More holistic information such as work and life history and a demonstrated commitment to the specialty should supplement the conventional dataset to provide a complete picture of the ideal candidate. Behavioral interviewing involving both the Undergraduate Medical Education (UME) and where relevant, GME stakeholders is necessary to assess non-quantitative qualities  that will impact student and program success ,10. The The delayed admission model provides for the selection of students during the first year of medical school. This model allows for the review of student performance in the medical education program prior to accepting the applicant into the accelerated curriculum, increasing the likelihood that the student can successfully navigate the academic rigor of the accelerated program. In this model, prospective applicants are provided opportunities to interact with the program faculty to assess student/program fit. Many schools offer early clinical experiences allowing the candidate to more substantively assess the career match. Accelerated programs can use a combination of these two admission models to optimize student recruitment, retention, and success.Two core program objectives among Liaison Committee on Medical Education (LCME) accredited medical schools are particularly relevant to three-year pathways: a curriculum with ‘sufficient breadth and depth to prepare medical students for any residency program and subsequent contemporary practice of medicine,’ and an education program that includes at least 130 weeks of instruction . It is hAccelerated pathway students should clearly and transparently meet all graduation requirements. Each institution’s governance structure has oversight to ensure compliance with graduation requirements that for all students. As with a traditional curriculum, schools need to develop explicit moments in the curriculum when determinations are made regarding student advancement. These typically occur at the end of units of curriculum or academic years but will need to be accelerated to appropriate points in the three-year or other accelerated cycle .Understanding that development will proceed at different rates for different students, programs must define the minimum pace of advancement students must achieve to progress as on track. For some CAMPP schools, a failure in a clerkship exam would necessitate the student to decelerate back to the four-year program. Timing of assessments may need to be adjusted to take into account the different timing of promotion/advancement decisions . The perThe shortened curriculum in US schools must continue to ensure that students are adequately prepared for licensing examinations. Programs must also provide opportunities to inculcate and assess Core Entrustable Professional Activities for Entering Residency, particularly in clinical clerkship training –17. For The school’s core program objectives determine what cannot be lost to acceleration. Most accelerated pathway institutions have removed curricular content related to the fourth year, e.g., away rotations, audition rotations, interview time, vacation, etc. Other schools have developed longitudinal integrated clerkships to reduce redundancies in clinical training, and others have created experiences that students choose in place of or concurrent with the non-accelerated curriculum.While accelerated students will meet the same graduation requirements as the four-year pathway students, promotion decisions may differ . Likely,Unique to accelerated pathways is the option of ‘deceleration’ to the four-year pathway. This requires curricular and assessment comparability which may not be possible after certain milestones have passed. Any number of academic or professional reasons could lead to deceleration including a preference by the student to decelerate; physical or mental health issues; pregnancy and parental leave, or career indecision requiring more exploration time ,19.Policies and practices need to govern if, when, and how students can leave the accelerated program. For students who are not succeeding in the accelerated program, careful promotions consideration will determine whether the student simply ‘decelerates’ to the four-year pathway or requires customized remediation. There may be a tendency where schools run concurrent three- and four-year curricula to use the four-year program as the back-up when students require remediation. It is important for schools to explicitly determine whether this is the best approach for all scenarios, for some pre-determined situations or whether every situation will be examined on a case-by-case basis. Where the three-year program includes a return of tuition savings, decisions about tuition repayment need to be included in the policies.Due to the compact nature of an accelerated program, there is limited flexibility for remediation. Student who fails a clerkship exam will likely need to decelerate back to the four-year program. With repeated academic difficulties, student in a four-year program may need additional time to graduate.A student who decides a different career path than the intended mission of the accelerated program may decelerate back to the traditional four-year program, which allows students to apply to any residency programs. On some occasions when a school offers multiple accelerated programs in various specialties, a student may request to transfer from one specialty program to another. For example, a student enrolled in a pediatric accelerated program may request to transfer to the medicine accelerated program within the same school, if space is available. If the student received a scholarship for the accelerated program, deceleration or transfer may cause the scholarship to revert to a loan, depending on the school’s policy.Due to the shortened nature of an accelerated pathway program, students who require remediation may not be able to repeat a portion of the curriculum or have the additional time needed to remediate. The tight timeline for the licensing examinations may require transition out of an accelerated pathway, as described above. Each accelerated program must match the structure of the review process to the needs of the student and the resources available for remediation. A process to determine the needs of the student should be outlined to understand if the remediation needed is in the area of medical knowledge, skills, attitudes, behaviour, or professionalism. Resources available for remediation likely need to include tutoring, counseling, wellness, and academic advising ,21.The remediation review process and whether it will function independently from the standard remediation process must be defined. Using the existing process has the advantage of established protocol and experienced counsellors, but the disadvantage of no prior precedent for an accelerated student. If a new committee is to be organized, key additional members should include an Academic Program Director with experience in the accelerated track curriculum and/or a program mentor as an advocate.Mentoring is a key component of an accelerated program, especially given its increased intensity. Most programs use a group of faculty and peer mentors who focus on complementary aspects of a student’s experience . For exaGME programs and residency program directors are key partners with accelerated UME programs . To the Many accelerated UME programs offer a conditional acceptance to a partner GME program. Conditions of acceptance into GME are defined by UME and GME partners and often include academic and clinical performance expectations. Both UME and GME programs need to agree on the holistic attributes that ensure, at the time of interview for medical school, a medical student will be a good GME fit. Residency program stakeholders should contribute to advancement and deceleration decisions. Most programs build-in opportunities for GME programs to work with students during medical school.Knowing the GME program expectations of their day-one interns is helpful in designing the post-clerkship experiences for medical students, potentially easing the transition. In many of the accelerated UME programs, the post-clerkship curriculum is tailored to the students’ target GME field. GME programs must comply with National Residency Matching Program (NRMP)  guidelinAfter the regulatory requirements have been met, it is important to consider program evaluation methods in order to assess its effectiveness in achieving stated outcomes . Just asAccelerated pathways typically use the same base program evaluation metrics that are used in the traditional curriculum , includiAs schools implement accelerated pathways with defined missions and associated goals, program evaluation elements should assess the achievement of these goals. Additional elements could include pathway-specific open-ended questions on course evaluations and surveys of the pathways’ graduates and their program directors. Focus groups are beneficial and may be designed to include sessions with students selected into the accelerated pathway, students who applied but were not accepted into the pathway (if applicable), and students who chose the four-year curriculum over the accelerated pathway. This would allow for comparison of student perceptions (participant-oriented) between four-year and accelerated pathway students.Additional information about students’ experience in an accelerated pathway and the intended goals of the pathway may be gleaned through surveys measuring student characteristics like those now included on the AAMC Graduation Questionnaire – surveys assessing grit, burnout, and empathy for example. Comparing accelerated pathway students’ responses to those of students in the traditional curriculum may highlight the impact of each on students and signal if an adjustment is required.From a personnel standpoint, at a minimum all programs should identify a lead faculty or dean level individual to oversee the program and a faculty advisor for the students. A lead faculty member should dedicate at least 0.25 full time equivalent (FTE), depending on the size of the program and the number of residency programs involved. An administrative assistant to manage logistics, scheduling complexities, and non-traditional deadlines is required for bigger programs; while a smaller, less complex program may get by with less support. Programs that include multiple residency partnerships should identify department specific faculty mentors to ensure that their students are well integrated into the department .Some CAMPP programs experienced an increase in the number and complexity of applications necessitating additional staffing. Others were able to use existing resources and bring the undergraduate and residency program admissions teams together. Additional personnel may be needed to sit on a new Executive or Promotions Committees.It will be necessary to consider whether your program will have any additional curricular programming or assessments specific for the accelerated pathway. For example, additional assessments for remediation or promotion, or additional curricular content  are likely associated with additional cost.Buy-in from key stakeholders and institutional decision makers is crucial to the success of novel educational programs that can effect a paradigm shift. Key stakeholders include: the Dean, the Curriculum Committee and associated Subcommittees, the Office of Academic Affairs or Medical Education, the Residency Program Directors, the faculty, and the institution’s Finance Office. The LCME is another key early stakeholder. Standard 6 of the LCME standards requires that the faculty of the medical school be responsible for the detailed design and implementation of the components of the curriculum. The LCME’s Element 8.1 addresses curriculum management and the central role of the Curriculum Committee (a Faculty Committee) in the oversight of the medical education program . The DeaA limitation of this manuscript is that, with the exception of McMaster University, which offers a three-year program to all students, the CAMPP schools offer accelerated program to relatively small cohorts of students (range 2 to 50). As such, one should extrapolate these recommendations to large, single cohorts with caution. In particular, one would lose the built-in natural experiment that accrues when both tracks are present in a medical school.In the Medical College of Wisconsin, the regional campuses at Central Wisconsin and the Green Bay offer a three-year accelerated program to 50 students combined.Larger cohort size of students normalizes the accelerated track to students, faculty, and external stakeholders and can reduce the isolation of students in the accelerated track. The school can create standard messaging and processes for all students. A regional campus that is away from the main campus, allows some institutional flexibility to adjust to the size of the cohort.Most accelerated programs are generally viewed as a school’s innovative initiative that is designed de novo. Creation requires buy-in from key leadership of the institution. In this setting, accelerated programs have special opportunities to incorporate novel features in the education program.Accelerated pathways can illuminate the social contract of medical schools with the society at large. Several schools in the CAMPP  are using accelerated pathways as a framework to align training with the healthcare needs locally and nationally . With thSchools have created innovative new partnerships to develop their programs . With thTo enhance curricular efficiency and continuity, some schools are using longitudinal integrated clerkship (LIC) instead of the traditional block clerkships where the students complete all the clerkships longitudinally. LIC students follow a panel of patients during the clinical year, creating opportunities to foster meaningful relationships with patients and preceptors ,31.In many schools, acceleration has created a ‘natural experiment’ where two different curricular models run side-by-side. The accelerated pathway can benefit teaching and learning in the standard pathway by providing a contrast based on longitudinal time scale. For example, the benefits of fourth year electives can be more carefully delineated when there is a natural control group who proceeded to residency without them.Similarly, the extent to which individualized education can be competency-based can be assessed for a cohort of learners with early interest and commitment to a specialty. Other topics of innovation could include economic investigations as to the degree to which student debt burden is reduced and consideration of the effect on professional identity formation of the enhanced mentorship and support of the GME faculty.