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Suggested Citation:"Index." Institute of Medicine. 1994. Careers in Clinical Research: Obstacles and Opportunities. Washington, DC: The National Academies Press. doi: 10.17226/2142.
×

Index

A

Academic health centers

career path of researchers in, 5, 13-14

clinical care component in, 21, 28, 53

in clinical research oversight, 6

cost of graduate medical education, 21, 28

definition, 13

disincentives for clinical research in, 53-55

faculty demographics, 45-50

faculty growth in, 43-44

faculty tracks in, 55-57

funding for research in, 20-21

growth of, 28

in health care plan benefit design, 21

health care reform and, 5, 8

health research spending by, 63

historical development, 43-44

number of, 43, 44

patient access, 21

recognition for researchers in, 13-14, 28-29, 50-55, 60

recommendations, 13-16, 20-21

research infrastructure, 14-15, 60-61

research involvement of faculty, 50

role of, 2, 21

technology assessment in, 21

See also Medical school(s)

Academic-industry linkages, 110

benefits for academic institutions, 209

commercialization of research findings, 205-206

concerns about, 210, 216, 217

conflict of commitment in, 214-215

conflict of interest in, 20, 213-214

current context, 199-200, 216-217

exclusivity of research findings, 212-213

history of, 197-199

industry benefits, 207-209

management of, 215

objections to, 200

objectives of, 20, 200

prevalence, 206-207

proprietary rights issues in, 210-212

recommendations, 20

research culture in, 201-202

research goals and, 211

types of, 202-205

Accreditation/certification

agencies, 16

in clinical psychology, 277-278

Suggested Citation:"Index." Institute of Medicine. 1994. Careers in Clinical Research: Obstacles and Opportunities. Washington, DC: The National Academies Press. doi: 10.17226/2142.
×

as disincentive to research, 18, 57, 166-167

of medical schools, 167

problems in, 4

recommendations, 16-18

residency review committees, 17, 164-165

specialty board certification, 18, 166-167

Accreditation Committee for Graduate Medical Education, 16, 17

Agency for Health Care Policy and Research, 27

budget, 101, 188

outcomes research, 100-101

role of, 99

AIDS, 67, 97, 99

AIDS Research Debt Relief Program, 12, 190

Alcohol, Drug Abuse and Mental Health Administration (ADAMHA), 64, 69, 73-76, 136

Alliance for Aging Research, 19, 119

American Academy of Orthopaedic Surgeons, 284-285, 300

American Association for the Advancement of Science, 137

American Association of Physicians, 56

American Board of Internal Medicine, 166

American Board of Medical Specialties, 16, 18, 166

American Cancer Society, 107, 189

American College of Surgeons, 294-295

American Federation of Clinical Research, 56

American Heart Association, 107, 189

American Lung Association, 107

American Society for Clinical Investigation, 24, 56

Anesthesiology, 166

Armed Services Health Professional Scholarship, 157-159

Association of American Medical Colleges, 147, 214

Atherogenesis, 26

Autologous bone marrow transplantation, 114

B

Basic science research

clinical research and, 27, 28-29, 35, 55-57

disease-related, 34

in medical schools, 28-29, 55-57

medical student interest in, 147

NIH grants, 93-94

surgical research, 284, 294

Biomedical and Behavioral Research Scientists: Their Training and Supply, 30

Biomedical Research and Development Price Index, 76

Biotechnology research, 110-111, 199

Breast cancer, 26

autologous bone marrow transplantation for, 114

C

California Institute of Technology, 133

Carnegie Mellon University, 133

Centers for Disease Control and Prevention, 12, 67

research spending, 98-99

research training in, 187-188

role of, 98

Clinical Associate Physician program, 12, 186

Clinical research

background papers for evaluation of, 38

classification of activities in, 7, 32-34, 88

contribution of, 1, 24, 41-42

cost of, 79

data collection/analysis for evaluation of, 7, 29, 44

definition, 3, 30-31, 32, 34-35, 87-88, 92-93

evaluation strategy, 29-31, 36-40

future challenges to, 4-6, 41-42

future needs in, 3-4, 6, 25-27, 35, 41, 216-217

historical development, 24-29

Suggested Citation:"Index." Institute of Medicine. 1994. Careers in Clinical Research: Obstacles and Opportunities. Washington, DC: The National Academies Press. doi: 10.17226/2142.
×

institutional obstacles to, 5

oversight, 5, 6, 7, 18-20

researcher demographics, 44-50

role of, 27, 193-194

scope of, 24-29, 34, 36

supply of researchers, 2, 4, 6, 27, 29

See also Human research;

Training for research

Clinical Scholars Program, 190

Clinical trials, 5

consortia for conduct of, 204

historical development, 25

third-party payers and, 115-116

Compensation for researchers, 12

in academic-industry collaboration, 203, 204, 213

in academic settings, 13-14

as career path disincentive, 59-60

in clinical psychology, 272-273

in Department of Veterans Affairs, 103

educational debt burden and, 160, 190

Conflict of interest issues, 20, 213-214

Consulting, 203

Cost of training

in academic health centers, 21-22

as disincentive to research career, 4, 42, 60, 156, 159-160

recommendations, 12-13

tuition debt relief program, 12-13, 189

See also Funding/funding issues

Cystic fibrosis, 26

D

Dentistry, 3, 142

clinical research in, 239-251

curriculum, 124

human research training, 11

recommendations, 240, 243-244, 245-247, 249-250

schools, 248-250

Department of Agriculture, 12, 67

Department of Defense, 12, 67, 105, 131, 286-287, 296

Department of Education, 12, 67, 105

Department of Energy, 12, 67

Department of Health and Human Services, 12, 73

health research spending, 67

Department of Veterans Affairs, 12, 67, 282

budget, 102, 103-104

organizational structure, 101

research activities, 101-103

research training in, 188

Dermatology, 166

Disabilities, students with, 137

Disincentives for research career, 42-43

career compensation as, 12, 59-60

clinical care responsibilities as, 170

in clinical psychology, 272-278

duration of training as, 4, 12, 42, 55, 150, 162

educational costs as, 4, 12, 42, 60, 156, 159-160, 190

evaluation of, 29-31

lack of exposure to research practice as, 167-168

lack of role models or mentors as, 4, 29, 58-59

lifestyle factors, 29, 42, 59-60

in medical education, 53-55, 144-145, 167-170

for newly independent investigators, 8, 53

professional status of research as, 4, 12, 28-29, 42, 55, 194

recertification requirements, 18, 57, 166-167

timing of training and, 169

Doctor-patient relationship, 113, 203

Duke University, 151

E

Ethics, 155, 192, 203

F

F32 awards, 170, 171, 173-175, 178

Federal Coordinating Council on Science, Engineering and Technology , 128, 130, 131

Suggested Citation:"Index." Institute of Medicine. 1994. Careers in Clinical Research: Obstacles and Opportunities. Washington, DC: The National Academies Press. doi: 10.17226/2142.
×

Federal government

in clinical research oversight, 6, 18-19

commercial use of research funded by, 212-213

departmental support for human research, 12, 67, 101-105

in development of academic medical centers, 44

health research support, 9-10, 63, 65, 67, 120, 197, 198-199, 202

in improvement of research training, 194-195

legislative encouragement of research, 198-199

medical school scholarships, 158

postdoctoral training funded by, 170

in precollege science preparation, 131

training program outcomes, 188-189

undergraduate science programs, 134-136

See also specific agency or department

First Investigator Research Support and Transition, 8

Food and Drug Administration, 115, 188, 200

Foundations, 106-107, 189, 190

Four Schools Physician-Scientist Program in Internal Medicine, 151

Funding/funding issues

academic health centers, 20-21

academic-industry collaborations, 203, 204, 205

average cost of research grant, 102

basic research, clinical research vs., 28-29

in Centers for Disease Control and Prevention, 98-99

central management of, 19

clinical psychology, 270-271

comparative cost of human research, 79

in cooperative model of research management, 118-121

cost of medical education, 156-160

data for evaluation of, 5, 64

Department of Defense research spending, 105

Department of Education research spending, 105

in Department of Veterans Affairs, 102, 103-104

faculty, support for, 193-194

in General Clinical Research Centers, 97

government support, 9-10, 64-67, 197, 198-199

grant size, 76

grant writing skills, 10

health research spending, 63

historical development, 27-28, 64-65, 197

human research programs, 58

industry-sponsored research, 109-111, 197, 198

Medical Scientist Training Program, 11, 12, 152

minority access to science careers, 134-136

NIH extramural research, 72-77

NIH human research, 81-95

NIH research centers, 95-96

nonprofit organizations, research spending in, 106, 107, 108

postdoctoral research training, 171-178

precollege science preparation, 130-131

privately supported research training, 189

research career development awards, 184-185

research training programs, 11, 151, 192

social context, 202

support of newly independent investigators, 8, 53

in surgical career, 291-292

third-party payers in clinical research, 112-118

training in, 192

training related to subsequent grant success, 178, 182-184, 186

tuition debt relief, 12-13, 189

undergraduate science preparation, 134-136

Funding Health Sciences Research: A Strategy to Restore Balance, 31

Suggested Citation:"Index." Institute of Medicine. 1994. Careers in Clinical Research: Obstacles and Opportunities. Washington, DC: The National Academies Press. doi: 10.17226/2142.
×

G

General Clinical Research Centers

evaluation of, 194

funding, 97

future of, 97

historical development, 96, 97

number of, 9

organizational structure, 96

recommendations, 9, 12

research activities in, 97

role of, 96

training of researchers in, 97, 186

Genetic engineering, 1-2, 26

Genome mapping, 1, 23, 26

Government-University-Industry Research Roundtable, 119

Grant preparation, 10

as distraction from research, 74-76

training in, 192

H

Harvard Clinical Effectiveness Program, 189, 191

Health care reform, 23-24

clinical research and, 2, 5, 8, 18, 41-42

medical innovation and, 110

support for clinical research and, 118

Howard Hughes Medical Center, 108-109, 151

Human immunodeficiency virus, 2, 24, 97, 98, 99

Human research

activities in, 36, 93

cost of, 79

data needs, 7

definition, 3, 93

diversity of, 3

in F32 awards, 173-175

in K awards, 185

in NIH, 81-95

R01 grants for, 5, 39, 185

recommendations for NIH in, 6-7, 8, 9-11, 12-13

resources assessment, 29-30

See also Clinical research

I

Imaging technology, 23

Incentives for research career

in development of research infrastructure, 14-15, 28

mentor role, 58-59, 168-169

need for, 6

professional recognition, 13-14

recommendations, 12-13

tuition debt relief, 12-13, 190

See also Disincentives for research career

Intellectual property rights, 199, 204, 207

in academic-industry linkages, 210-212

corporations owned by academic institutions, 206

Internal medicine, 166

J

J. David Gladstone Foundation Laboratories for Cardiovascular Disease , 108

Johns Hopkins University, 56, 151, 192

Joint Commission for Accreditation of Health Care Organizations, 16

K

K awards, 10, 170, 184-185

L

Legal issues

in academic-industry linkages, 212

antitrust law and cooperative research, 119

intellectual property rights, 199, 204, 207, 210-212

reimbursement issues, 113-114

Liaison Committee for Medical Education, 16, 17, 167

Suggested Citation:"Index." Institute of Medicine. 1994. Careers in Clinical Research: Obstacles and Opportunities. Washington, DC: The National Academies Press. doi: 10.17226/2142.
×

M

Managed care, 110

Managed competition, 5

March of Dimes-Birth Defects Foundation, 107

Mayo Clinic, 191

McMaster University, 192

M.D.s

dual-degree program, 151-152

laboratory-research training, 150

medical school faculty, 44-46, 50

in Medical Scientist Training Program, 154

as NIH grant recipients, 28, 77-79, 85, 172, 173, 175-176, 178

in NIH peer review groups, 82

number of, 44-45

postdoctoral training, 182-184

research training after medical school, 163

See also Postgraduate medical education

Medicaid, 112

Medical research organizations, 108-109

Medical school(s)

accreditation, 167

costs, 21, 156-160

curriculum, 15, 17, 145-147

dual-degree programs, 151-152

faculty, clinical or preclinical distribution of, 45-46

faculty degrees, 45

faculty demographics, 46-48

faculty growth, 28, 43-44

faculty research activity, 50

historical development, 42-43, 142-143

laboratory training in, 146

Medical Scientist Training Program in, 152-155

model training programs, 189-192

postgraduate research training, 160-170

in promoting research careers, 144-145

research training programs in, 151

student demographics, 143-144

student exposure to research, 15, 148-150

student interest in research, 145, 147-148

time demands in, and research, 150

tuition debt relief, 12-13, 189

See also Academic health centers

Medical Scientist Training Program, 11, 12, 152-155

Medicare, 21, 64, 110, 112

Minorities

in clinical psychology, 270, 276

in medical school, 143-144

on medical school faculty, 49-50

in medicine, 127

in surgical science, 289-290, 297-298

in undergraduate science, 134, 136, 137

Molecular biology, 1-2, 25

Multidisciplinary research, 8, 61

Muscular Dystrophy Association, 107

N

National Center for Health Statistics, 99

National Center for Nursing Research, 3

National Easter Seal Society, 107

National Health Service Corps, 157-159

National Institute of Mental Health, 271

National Institute of Occupational Safety and Health, 98-99

National Institute on Disability and Rehabilitation Research, 104

National Institutes of Health (NIH), 131

appropriations to, 9-10

biotechnology research, 111

budget history, 67, 76-77

Computerized Retrieval of Information on Research Projects, 88-90

data collection, 7, 82-84

degrees of grant recipients, 77-79, 85

in evaluation of training programs, 10, 11

extramural research, 67-69, 72-77

Suggested Citation:"Index." Institute of Medicine. 1994. Careers in Clinical Research: Obstacles and Opportunities. Washington, DC: The National Academies Press. doi: 10.17226/2142.
×

General Clinical Research Centers, 96-97

grant applications received by, 78, 84-85

human research funding, 81-95

intramural research, 67, 69-72

Medical Scientist Training Program, 152-155

Minority Access to Research Careers program, 134

Minority Biomedical Research Support, 136

multidisciplinary research in, 8

Office of Medical Applications of Research data, 87-88

oversight role, 7

peer review process, 77, 79-82, 282, 285-286, 295-296

postdoctoral research training in, 170, 171-176, 180-184

recommendations for, 6-7, 8, 9-11, 12-13

research career development awards, 10, 184-185

research settings, 8, 95-98

Research Supplements for Underrepresented Minorities, 136

study sections, 7, 81-82, 282, 285-286, 295-296

surgical research in, 285-286, 290, 298-299

in training of researchers, 71, 178-180

National Oceanic and Atmospheric Administration, 131

National Research Service Awards, 30, 170

National Science Foundation, 12, 67, 131, 136, 137

Research Experiences for Undergraduates, 134-136

New investigators, 8, 53

Nonprofit organizations, 106-109

Nursing

clinical research in, 3, 253-264

doctoral programs, 124

training, 142

O

Outcomes research

in Agency for Health Care Policy and Research, 100-101

in dentistry, 250

General Clinical Research Centers for, 9

in human research, 81

role of, 2, 27

status of, 41

third-party payers in, 116

Oversight

of academic-industry linkages, 20, 215

current problems in, 5, 18-19

interorganizational interdisciplinary group for, 117

model of, 118-121

of NIH study sections, 7

recommendations, 6, 19-20

P

Patent & Trademarks Act, 199

Patient-oriented clinical research. See Human research

Peer Evaluation of Extramural Research, 7

Peer review, NIH, 7, 77, 79-82, 282, 285-286, 295-296

Pharmaceutical industry

corporations owned by academic institutions, 206

new drug development, 109, 110

reimbursement concerns, 115

research spending, 109, 110, 197, 209

Ph.D.s

dual-degree programs, 151

educational debt, 189

on medical school faculty, 45-46, 50, 55

as NIH grant recipients, 28, 77-79, 85, 172-176, 178, 182

in nursing, 257-259

training, 150, 161-162, 182-184

Positional cloning, 1

Suggested Citation:"Index." Institute of Medicine. 1994. Careers in Clinical Research: Obstacles and Opportunities. Washington, DC: The National Academies Press. doi: 10.17226/2142.
×

Postgraduate medical education

design of research programs in, 161-163

mentoring in, 168-169

quality of research training in, 167-168

recommendations, 16

residency review committees in, 164-165

role of research training in, 160-161

specialty certification, 166-167

timing of research training in, 169-170

Primary and secondary school science, 125, 126

classroom experience, 127-129

evaluation of, 132

federal programs, 131

role of, 127

science fairs, 129

special initiatives, 129-130

teacher preparation, 128

trends, 130-131

Private sector

in clinical research oversight, 6, 18-19

clinical researchers in, 42, 208-209

corporations owned by academic institutions, 206

in funding of evaluative science centers, 11

in funding of research training, 11

health research spending, 63, 65

industry-sponsored research, 63, 109-111, 197-198

medical research organizations, 108-109

medical school research programs funded by, 151

nonprofit organizations, 106-109

research culture in, 201-202

research training in, 170-171, 189-190

voluntary health agencies, 107

See also Academic-industry linkages

Prostate hypertrophy, 27

Psychology

clinical research in, 265-278

training, 142

R

R01 grants, 72

award size, 76

distribution of, 84-95

duration of, 74-76

evaluation of, 39

human research in, 5, 39, 185

Research design

historical development, 25

human studies, unique features of, 79-81

obstacles in clinical studies, 55, 57

resource demands, 5

subject enrollment, 42

third-party payers in, 116

training in, 162-163, 167, 191-192

Research infrastructure

in academic settings, 14-15, 60-61

as career path incentive, 60

Residency review committees, 17, 164-165

Resources for Clinical Investigation, 30

Review of the National Institutes of Health Biomedical Research Training Programs, 176-177

Robert Wood Johnson Clinical Scholars Program, 189, 190

Role model or mentoring relationships, 4

faculty responsibility and, 193

good qualities in, 59

institutional recognition of, 14

postgraduate medical education, 168-169

role of, 58-59

in surgical careers, 291, 296

Rush Medical College, 146

S

Science fairs and competitions, 129

SEMATECH, 119-120, 205

Stanford University, 191

Surgical research

barriers to, 287-290

current status of, 281

Suggested Citation:"Index." Institute of Medicine. 1994. Careers in Clinical Research: Obstacles and Opportunities. Washington, DC: The National Academies Press. doi: 10.17226/2142.
×

Medical Scientist Training Program and, 154

resource base, 284-287

strategies for improving, 281-283, 293-299

types of, 283-284

T

T32 awards, 10, 170, 171, 178

T35 grants, 151

Technology assessment, 21, 114-115

Technology development, 1-2, 23, 123

academic health centers in, 21

in academic research culture, 201

clinical research and, 2

in commercial research culture, 201-202

commercialization of academic research, 205-206

health care reform and, 110

intellectual property rights, 199

outcomes research and, 2, 21

regionalization of, 21

Technology transfer, 20

academic-industry collaboration, 20, 205

biotechnology, 199

federal initiatives, 198

training for, 28, 216

Third-party payers

clinical research and, 64, 112-114, 117-118, 121

concerns of, 114-116

data collection by, 116-117

in research design and data analysis, 116-117

support for academic health centers, 20-21

Training for research

in clinical psychology, 265-266, 269-278

in dentistry, 124, 244-247

in Department of Veterans Affairs, 103

in dual-degree programs, 151-152

duration of, 4, 12, 42, 150, 161-163, 169-170, 183

effecting change in, 194-195

faculty needs, 193-194

federally supported non-NIH, 188-189

in General Clinical Research Centers, 97

goals of, 124-125

historical development, 43-44

importance of, 193-194

laboratory-based model, 57-58

laboratory experience, 150

in medical school, 123-124, 145-147, 151, 191-192

in Medical Scientist Training Program, 152-155

medical student interest in, 145, 147-148

model programs, 10-11, 188, 190-192

NIH intramural programs in, 71

in nursing, 257-264

obstacles to, 125-126, 168-170

postdoctoral, 161-163, 170-176, 180-184

postgraduate, 16, 160-170

primary and secondary school preparation, 125, 126, 127-132

in private sector, 170-171

privately funded, 189-190

program evaluation, 10-11, 12, 17, 18, 176-180, 194

recommendations, 10-11

recruitment for, 176-177

research methodology, 162-163, 191-192

residency review committee requirements, 264-265

scientific ethics as element of, 155, 192

social demographic context, 125, 126-127

specialty board certification and, 166-167

status of, 4, 5

subsequent grant success and, 178, 182-184, 186

in surgery, 287-292, 298-299

Suggested Citation:"Index." Institute of Medicine. 1994. Careers in Clinical Research: Obstacles and Opportunities. Washington, DC: The National Academies Press. doi: 10.17226/2142.
×

technology transfer as element of, 216

trends, 28-29

undergraduate student preparation, 132-142

Tufts University, 56

U

Undergraduate science preparation

criticisms of, 136-137

design of, 138-140

effectiveness of, 137-138

federal programs, 134-136

improvements in, 141-142

institutional efforts, 133

role of, 140-141

science majors, 132

University of California, 191

University of Kentucky, 133, 140

University of Michigan, 55, 190-191

University of Pennsylvania, 151

University of Puerto Rico, 140

V

Voluntary health agencies, 107

W

Washington University, 151

Women

in clinical psychology, 270, 275-276

in clinical research, 48-49

on medical school faculty, 46-48, 49-50

physicians, 44-45, 48-49, 127, 143

in surgical science, 282-283, 289, 297

in undergraduate science, 136-137

Suggested Citation:"Index." Institute of Medicine. 1994. Careers in Clinical Research: Obstacles and Opportunities. Washington, DC: The National Academies Press. doi: 10.17226/2142.
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Suggested Citation:"Index." Institute of Medicine. 1994. Careers in Clinical Research: Obstacles and Opportunities. Washington, DC: The National Academies Press. doi: 10.17226/2142.
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Suggested Citation:"Index." Institute of Medicine. 1994. Careers in Clinical Research: Obstacles and Opportunities. Washington, DC: The National Academies Press. doi: 10.17226/2142.
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Suggested Citation:"Index." Institute of Medicine. 1994. Careers in Clinical Research: Obstacles and Opportunities. Washington, DC: The National Academies Press. doi: 10.17226/2142.
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Suggested Citation:"Index." Institute of Medicine. 1994. Careers in Clinical Research: Obstacles and Opportunities. Washington, DC: The National Academies Press. doi: 10.17226/2142.
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Suggested Citation:"Index." Institute of Medicine. 1994. Careers in Clinical Research: Obstacles and Opportunities. Washington, DC: The National Academies Press. doi: 10.17226/2142.
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Suggested Citation:"Index." Institute of Medicine. 1994. Careers in Clinical Research: Obstacles and Opportunities. Washington, DC: The National Academies Press. doi: 10.17226/2142.
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Suggested Citation:"Index." Institute of Medicine. 1994. Careers in Clinical Research: Obstacles and Opportunities. Washington, DC: The National Academies Press. doi: 10.17226/2142.
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Suggested Citation:"Index." Institute of Medicine. 1994. Careers in Clinical Research: Obstacles and Opportunities. Washington, DC: The National Academies Press. doi: 10.17226/2142.
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Suggested Citation:"Index." Institute of Medicine. 1994. Careers in Clinical Research: Obstacles and Opportunities. Washington, DC: The National Academies Press. doi: 10.17226/2142.
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Careers in Clinical Research: Obstacles and Opportunities Get This Book
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Transforming biological discoveries into medical treatment calls for a cadre of health professionals skilled in patient-oriented research. Yet many factors discourage talented persons from choosing clinical research as a profession.

This new volume lays out the problem in detail, with specific recommendations to the federal government, the biotechnology and pharmaceutical industries, professional organizations, the health care industry, organized medicine, and the nation's universities and academic health centers.

The volume explores

  • How clinical research is conducted, what human resources are available, and what research opportunities lie ahead.
  • Why health professionals become discouraged about clinical research.
  • How the educational system has failed in this area and what programs stand out as models.
  • How funding affects the supply of researchers.

This practical book will be of immediate interest to public and private agencies funding research, research administrators, medical educators, health professionals, and those pursuing a career in clinical investigation.

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