ORIENTATION
A Rigorous Foundation for a Productive Year
“Orientation was invaluable. At the time we didn’t realize how valuable it was to be.
As it turns out, our orientation is the envy of all those who work on the Hill.”
—Dan Clouser, 1986-87 fellow
From Concept to Structure
The RWJF Health Policy Fellows orientation is a meticulously crafted training experience, designed to prepare its fellows for a pivotal role in shaping the nation’s health policy. From the program’s first conception, a core training component was a critical piece of the proposal. Yet, what this training program would look like — who would lead it, what content would it focus on, and how long it would last — was an open question.
The original July 1972 proposal stated, “Fellows will enjoy a planned group educational experience which should systematically explore the interrelationships among the various arms of the Health Enterprise (or Industry) and all those governmental and non-governmental agencies and organizations which significantly influence public policy. It is likely that much can be learned in this area from the experience of the White House Fellows program which has been in existence for more than 5 years.”
Orientation session in November 1975. NASEM Archives.
Orientation session in November 1975. NASEM Archives.
A document to the Robert Wood Johnson Foundation Trustees later that year gave more explicit recommendations. It proposed a two-part training program:
“[U]nder the first part the fellows would be enrolled in the Congressional Fellowship Program sponsored by the American Political Science Association, the principal scholarly society in the public affairs disciplines. The Congressional Fellowship Program provides the best practical learning experience now available in the country of how public policy is determined.
The second part of the proposed Foundation fellowship program would be seminars organized by the independent board established by the Foundation, and would take place during the fellows’ Congressional staff assignments. The board would be responsible for the development of a series of seminar sessions on issues in medicine and public policy, which would include participants from organizations such as the Institute of Medicine, the executive branch health agencies, and academic researchers in the public policy field.
Finally, in the March 1973 proposal to establish, the planning committee landed on a training plan that the program still follows today:
“Fellows would be expected to mọve to Washington, D.C. in time for the opening sessions, and to spend a period of six to eight weeks in an orientation program centered on matters of health and health policy organized by a staff based at the Institute of Medicine. This portion might include seminars to familiarize fellows with health agencies in government, congressional committees responsible for health affairs and the areas covered by each, problems and opportunities in health policy as viewed by the IOM staff and various IOM members, guest experts, HEW staff and congressional staff. Site visits to the various agencies might be scheduled. Insofar as it would be possible and consistent with the development of seminars, the preliminary program should be tailored to each fellow’s individual interests.
Following the IOM-sponsored period, the fellows would join the regular [American Political Science Association (APSA)] Congressional Fellows Program. They would be incorporated in the program along with fellows from the fields of political science and journalism. The Congressional Fellowship Program begins with a period of introduction to the Federal government and how it functions.”
Today, orientation includes over 200 meetings with national leaders in health policy, think tanks and interest groups, key executive branch officials, and members of Congress and their staffs. The immersive orientation process covers health economics, the congressional budget process, priority health policy topics, and federal decision-making. The fellows also participate in activities, including executive coaching and media training sessions to help prepare them for their placements and future work in health policy. The briefers and schedule change every year in response to the changing health policy landscape and recommendations from the previous fellowship cohort.
On September 16, 1974, the first six fellows gathered for their first day of the program’s three month orientation. Little did they know how much they would learn over the next three months and that they were embarking on a program that would become the envy of health policy practitioners across the nation.
Explore a sampling of historical orientation schedules
In 1985, the Board evaluated the orientation program to ensure it was meeting the needs of the fellows. After reviewing past fellows’ evaluation reports and discussing internally, the Board concluded that an 8-week orientation program was ideal and that it would neither shorten nor lengthen this portion of orientation, both of which had been recommended. The statement also stressed that “the basic purposes of the IOM orientation phase are to expose the Fellows as much as possible to all aspects of the decision-making process for developing and implementing public policy and to acquaint them with the full range of health policy issues which are under consideration. Since Fellows are generally expected to take work assignments in Congress for nine months of the Fellowship year and the APSA orientation focuses heavily on Congress, the IOM orientation necessarily places major emphasis on the Executive Branch.”
Orientation Schedule 1974
Orientation Schedule 1981
Orientation Schedule 1990
1976
Stories from our fellows
Charles Clark
“Certain rules (which I am sure Dick [Seggel] will agree with) apply to this phase in order to make it most profitable...
[For example], never let anybody get to their slides. Unless questions come up fairly quickly in an interview you will get a canned lecture starting something like ‘In 1786 the Public Health Service was founded.’ We usually let them go on somewhere between five and ten minutes and then asked them something like, ‘Who determines your budget?’ and ‘When was the last time you met with Ted Cooper?’
“Most of them were very candid: we were quite careful to keep things off the record so that nobody got into trouble from telling the truth. The best opening question was, ‘How did you get from there to here?’ Then ask them what their major problems were and why they couldn’t be solved. Another good question is to ask them what their three wishes would be.”
Margaret Heagarty
“Another fellow had a very different experience during this time...”
He recalled how his journey through public service shaped his views on policy and collaboration. His answers often revealed unexpected insights into leadership and decision making.
“It was fascinating to see how individuals approached challenges differently — some were pragmatic, others more idealistic. Asking the right questions always revealed the truth.”
Charles Clark
“Frequently we rehearsed questions. There was usually one of us who knew more than the others about the subject. We had him background one or more of us. If one of us was embarrassed to ask pointed questions because of our past or potential future relationships with an individual, the others would ask his questions. So, for example, the NIH people were asked the hard questions by our public health dentist and the Chief Dentist of the Commonwealth was asked the hard questions by our pediatrician. We also set up signals to control the sessions. When Margaret took off her glasses, it was time to start asking questions. When anyone pulled his ear, it was time to end the session and we all stopped asking questions.”
Margaret Heagarty
“The first phase of the fellowship, besides providing time for orientation to the language, organization and mores of the place also has another and perhaps more important asset. In those first few weeks while we were spending long days together, we had the time to take social histories and to make diagnoses on one another. We found that we enjoyed, liked and could learn from each other. But this discovery required at the minimum the effort of taking time at the end of the day to compare impressions, to hold postmortems on what we had seen and heard. These were the times for giggling, for finding out who was the wine expert, who could sing barbershop harmony and who would invariably invoke St. Anthony when we needed help. From this sharing we began to weave the tapestry of trust and affection called friendship.”
The Reading List
Every summer before the fellowship officially begins in September, the incoming fellows receive a reading list and a stack of books and articles either mailed to their homes or shared electronically. The list, like orientation itself, changes every year based on the recommendations of the past cohort and the evolving policy landscape.
The 1974 reading list included 27 articles, books, and documents. In 2024, it boasted 11 required books and one recommended reference book.
Explore the reading lists from the first year and the 50th year:
Reading List 1974
Reading List 2024
A Day in the Life
The IOM orientation schedule was hectic, often involving traveling across town. I was surprised to discover that all of the fellows were able to maintain their enthusiasm and interest in the orientation over the entire two months. Furthermore, it provided an opportunity for us to become familiar with Washington’s geography.
—Edward Wimberley, 1989-90 fellow
About half the meetings were held at the IOM, and half at the offices of the relevant agency. This worked out quite well, as it allowed for efficient use of time (IOM site) and becoming familiar with the city (outside sites). Refreshments and health snacks were provided at the meetings (and lunch when appropriate). This alleviate gastric obstacles to paying attention during the meetings, and made me feel that the IOM staff were very concerned about our welfare.
—Philip Goodman, 1989-90 fellow
Field Trips
From the start of the fellowship, the orientation program included a field trip to Atlanta, Georgia to visit the Center for Disease Control (CDC) and a Department of Health, Education, and Welfare (HEW) (reorganized into the Department of Health and Human Services (HHS) in 1980) regional office.
In 19**, the program added trips to two states, often with contrastiing approaches to health policy, to the orientation schedule. Each cohort has the opportunity to select which states they visit, and they typically meet with the state’s Medicaid officials, academic leaders, and key decision-makers across the health and healthcare landscape. These hands-on experiences help prepare fellows to become health policy leaders at every level.
An Ode to Our Fearless Leaders
“The preparations for the orientation phase must be likened to the preparations by General Eisenhower for D-Day.”
—Charles Clark, 1976-1977 fellow
“It is the IOM’s orientation to the fellowship that distinguishes this program from the other Congressional fellowship programs. It is insufficient to say that we had an opportunity to meet the most influential and knowledgeable of the nation’s health care elite (being tutored in health care economics by Gail Wilensky comes to mind). More to the point is how access to these leaders was achieved. In our case, access was provided by Marion Ein Lewin. It is inconceivable to me how IOM and the Robert Wood Johnson Foundation could have found a more knowledgeable, talented, and “connected” person than Marion. Without doubt, many of those from the association, Congressional committees and staffs, and the like participated in the orientation due to Marion’s influence. Not only did Marion make this portion of the fellowship year happen for us, she proved to be so knowledgeable in her own right that she was able to help us synthesize the vast amounts of information that we had gleaned over two months.”
— Edward Wimberley, 1989-1990 Fellow
“In reviewing the orientation schedule, a quick tally resulted in some useful statistics. Out of the more than seventy-five individuals and organizations we had the opportunity to visit, forty five (60%) proved to be central to the conduct of my fellowship responsibilities. At least 19 (25%) of the total became regular contacts, meaning weekly phone or in person meetings. Mr. Seggel knew what he was doing when he put together the orientation.”
— Marie Michnich, 1985-1986 Fellow
“Dick Seggel’s extensive knowledge of where the skeletons were buried and where the power really lies was most helpful in penetrating any tendency on the part of the speakers to be devious.”
— Michael Till, 1975-1976 Fellow
By the end of orientation, fellows are stuffed to the brim with health policy knowledge and contacts, and they are ready to start contributing. But before they can enter their placement offices and start working, they have to interview. Select the XXXX button to learn about the placement office interview process and 50 years of fellows’ experiences interviewing for Congressional and Executive office positions.