Telemedicine has significant potential to address many of the challenges facing primary care in today's healthcare environment. Challenges still remain in validating its impact on clinical outcomes with scientific rigor, as well as in standardizing methods to assess cost, but patient and provider acceptance is increasingly making telemedicine a viable and integral component of primary care around the world.

"And let it be noted that there is no more delicate matter to take in hand, nor more dangerous to conduct, nor more doubtful in its success, that to set up as a leader in the introduction of changes. For he who innovates will have for his enemies all those who are well off under the existing order of things, and only lukewarm supporters in those who might be better off under the new." -Niccolo Machiavelli, The Prince (1513) A few centuries after Machiavelli offered his advice about how to effect change, a young, smart -and admittedly brash -physician took a new position in a famous European hospital. He quickly became dismayed at the unacceptably high mortality rate. After carefully considering many possible causes for the deaths, he proposed a relatively simple solution. By implementing his idea he demonstrated a dramatic decrease in mortality. He then attempted to spread his ideas and implement his simple solution elsewhere but was (mostly) ignored, ridiculed, and rejected. Defenders of the status quo forced him from his job. He confirmed his findings in a different hospital in a different European city, but practice elsewhere continued as before. His behavior became increasingly erratic, and he died at 47 in an insane asylum.Thus ended the life of the famous Hungarian obstetrician, Ignaz Semmelweis (1818 -1865). Semmelweis found that when medical personnel washed their hands with a chlorinated lime solution before examining women during childbirth, the incidence of puerperal sepsis and maternal death fell dramatically. Given the importance of the problem, the simplicity of his innovation, and the empiric findings demonstrating its efficacy, it is instructive to briefly consider possible causes for the non-adoption of findings. 1, 2 First, he did not publish his data in a timely manner. Some13 years elapsed between his initial observations and his publication of a monograph containing those same findings. The implications for us are obvious -disseminated research in the peer-reviewed literature is today the coin of the realm. Second, his approach to those who disagreed with him was rather offensive. He wrote to one "you, Herr professor, have been a partner in this massacre" and to another that if he did not agree with Semmelweis, "I declare before God and the

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To improve health and reduce disparities through health services research, investigators are increasingly turning to techniques that actively involve individuals and institutions who would be affected by the research. In one such approach, community-based participatory research (CBPR), community members participate in every aspect of designing and implementing research with the expectation that this process will enhance the translation of research into practice in communities. Because few physician researchers have expertise in such community-based approaches to research, the Robert Wood Johnson Foundation leadership expanded the mission of the Robert Wood Johnson Clinical Scholars Program (RWJCSP), which historically focused on health services and clinical research, to include training and mentored experiences in community-based health research. The three years of experience (2005-2008) implementing the new community research curricula at the four RWJCSP sites, University of California at Los Angeles, University of Pennsylvania in Philadelphia, University of Michigan in Ann Arbor, and Yale University in New Haven, form the basis for this paper. The authors describe how, with common goals and objectives, each site has taken different approaches to teaching CBPR based on the unique nature of existing community and academic environments. The authors use illustrative quotes to exemplify three key challenges that training programs face when integrating community-partnered approaches into traditional research training: relationship building; balancing goals of education/scholarship/relationships/product; and sustainability. Finally, the authors offer insights and implications for those who may wish to integrate CBPR training into their research training curricula.