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CHAPTER ONE INTRODUCTION Every year a fraction of freshmen at U.S. colleges and universities indicate their interest in becoming research sci- entists (Dey et al., 1991~. Fluctuating between 1 and 3 percent of each entering class since 1979, these students represent a small but important component of the talent pool from which the future leaders of U.S. science and technol- ogy will emerge. The early expression of interest in a sci- ence career comes after many years of exposure to science and mathematics in primary and secondly schools. It will be followed by many more years of careful preparation cul- minating in the attainment of a Doctor of Philosophy (Ph.D.) degree or other research doctorate. Given the lengthy process of converting aspirants into researchers, it should come as no surprise that many changes take place in the size and composition of that talent pool as these students, and others, move into and out of the research training and career track. It is the fluid nature of this path toward a scientific career that has led the federal govern- ment to initiate programs and policies aimed at fostering the development of the human resource base in science and technology. Among the numerous sources of graduate and postdoctoral support, the National Research Service Awards DORSAL program is unique. Through a competitive pro- gram of individual and institutional support, the NRSA pro- gram promotes He development of a pool of skilled scien- tists in specific areas of "national need." It is a program of support that traces its roots to early efforts by the federal government to link the development of research areas with Gaining, the fundamental assumption being Hat the quality of the research enterprise depends on the talents of indi- viduals attracted to a career in research (Lenfant, 1989~. (See Appendix A for a brief history of He NRSA program.) The subject of this report is He future direction of that pro- gram given anticipated changes in the delivery of health care, exciting developments in health research, and impor 11 tent changes in the composition of the biomedical and be- havioral sciences work force. ORIGINS OF THE STUDY For nearly 20 years, the National Research Council (NRC) has played an active role in the ongoing review of training opportunities available to individuals seeking ad- vanced preparation in He biomedical and behavioral sci- ences. During this time, NRC has issued nine reports de- scribing the optimal structure of the NRSA program given national requirements for heal~-related research scientists and available training opportunities. The involvement of the NRC in the assessment of na- tional needs for biomedical and behavioral research scien- tists originates in the National Research Service Award Act of 1974 (P.L. 93-348), which abolished all previous train- ing authorities of the National Institutes of Health (NIH) and consolidated Raining into a single Gaining authority. The legislation stipulated that these awards should be re- stricted to subject areas for which Here is a need for per- sonnel (see Box 1-1~. The same legislation directed the Secretary of Health and Human Services (as He department is known today) to ar- range for a continuing study of "national needs" and to re- quest that the National Academy of Sciences conduct a study that would, in part, establish the subject areas in which such personnel are needed (see Box 1-2~. Since 1975, the NRC the principal operating arm of the National Academy of Sciences, the Institute of Medi- cine, and He National Academy of Engineering-has sub- mitted nine reports to the Secretary in response to this re- quest for advice. This report, the tenth in the series, responds to the Congressional charge and provides addi- tional information requested by NIH.

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MEETING ME NATIONS NEEDS FOR BIOMEDICAL AND BEHAVIORAL SCIENTISTS BOX 1-1 The National Research Service Award Act of 1974 (P.L. 93-348) FINDINGS AND DECLARATION OF PURPOSE Sec. 102. (a) Congress finds and declares that- (1) the success and continued viability of the Federal biomedical and behavioral research effort de- pends on the availability of excellent scientists and a network of institutions of excellence capable of producing superior research personnel; (2) direct support of the training of scientists for careers in biomedical and behavioral research is an appropriate and necessary role for the Federal Government; and (3) graduate research assistance programs should be the key elements in the training programs of the institutes of the National Institutes of Health and the Alcohol, Drug Abuse, and Mental Health Ad- ministration. (b) It is the purpose of this title to increase the capability of the institutes of the National Institutes of Health and the Alcohol, Drug Abuse, and Mental Health Administration to carry out their responsibility of maintaining a superior national program of research into the physical and mental disease and impair ments of man ... NATIONAL RESEARCH SERVICE AWARDS Sec. 472. (a) a. (3) Effective July 1, 1975, National Research Service Awards may be made for research or research training in only those subject areas for which' as determined under section 473, there is a need for personnel ... CHARGE TO TO COMMITTEE Previous NRC reports have provided guidance to NIH and the Alcohol, Drug Abuse and Mental Heals Adminis- tration (ADAMHA) relative to the appropriate size and composition of the NRSA program. Recommendations have been made on the number of research training posi- tions to be supported, and these recommendations have been used by NIH and ADAMHA staff during the budget formu- lation and by the U.S. Congress during the appropriations process (NIH, 1992~. Once again the agency requested that NRC estimate the future demand for researchers, estimate the current supply, and, using estimates of the future de- mand and knowledge of He current balance between supply and demand, make recommendations on the appropriate size of the NRSA program. In addition to these core activities, NIH also requested assistance in assessing the effectiveness of the NRSA pro- gram by gathering and analyzing information on such is- sues as the adequacy of current stipends to attract talented individuals into research careers in the biomedical and be havioral sciences. Furthermore, the agency directed NRC to review the mathematical projection models of supply and demand used by previous NRC study committees and to establish their adequacy in addressing "national needs" is- sues in the 1990s. In response to this request, the commit- tee developed a f~ve-part study plan. THE COMMlTTEE,S STUDY PLAN DeHmition of the Study Population The first step in undertaking this study was to develop a list of fields that were understood to define each of six broad areas of training. The definition of the study population is critical to the success of this analytic effort because He field taxonomy (see Appendix B) establishes He categories for data analysis. Thus, the basic biomedical sciences are understood to include biochemistry, molecular biology, and the like, whereas the behavioral sciences include psychology, soci- ology, anthropology, and speech and hearing sciences. Field matching was Hen made possible among data bases main- tained by NIH, He National Science Foundation, NRC, He Association of American Medical Colleges, and American Association of Colleges of Nursing, among others. Field matching in He clinical sciences proved more dif- ficult. As we embarked on He study, representatives of the dental research community indicated to us that they consid- ered their field code too restrictive, not accurately reflecting the diverse nature of Heir research base. The committee, Trough its staff representatives, conducted extensive con- sultative sessions win staff of the National Institute for Dental Research (NIDR), and from these sessions the con- cept of "oral health research" emerged. A workshop was organized to assess the market for oral health research per- sonnel and the results were incorporated in the committee' s 12 I! :` Pi l 1 1 1 1

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INTRODUCTION deliberations (see Chapter 6 of this report). Thus, individu- als familiar with He taxonomy used by earlier NRC study committees should be aware that a new field designation has been developed for the area of research training for- merly designated "dental science" research training. With regard to He clinical sciences more broadly de- f~ned, the committee has concentrated its attention this year on the continuing need to recruit physician-scientists into the research career paw. This critical group of scientific workers includes individuals holding medical doctorates and those with combined medical and research doctorates (see Chapter 5~. Because of the special market for nurses who pursue ad- vanced preparation in research, this report includes a sepa- rate assessment of research training needs in nursing re- search (see Chapter 7~. Nursing research personnel are generally defined as individuals holding both a degree in nursing and a Ph.D. Because of the wide variety of doctoral specialties pursued by these investigators, we have not specified degree or employment specialties of these re- searchers. Rather, we consider nursing research personnel to include individuals holding both a degree in nursing and a research doctorate in a wide variety of areas. Finally, we have devoted a chapter in this report (Chap- ter 8) to a consideration of health services research person- nel. Certain of the institutes of health provide research train- ing in areas related to the improvement of health care delivery, such as drug abuse prevention studies. Our report concentrates, however, on the newly emerging market for research scientists stimulated by the establishment of He Agency for Heals Care Policy and Research (AHCPR) in 1989. This agency now serves as He organizational locus within the federal government for studies of such health care reform issues as He reduction of heals care costs, the quality of care for He aged, and the overall health status of Americans, drawing investigators from a wide variety of disciplines. Unfortunately, detailed information about the population of heals services research personnel in the BOX 1-2 Stuclies Regarding Biomedical and Behavioral Research Personnel (P.~. 93-348) Sec. 473. (2) The Secretary shall, in accordance with subsection (b), arrange for the conduct of a continuing study to- (1) establish (A) the Nation's overall need for biomedical and behavioral research personnel, (B) the subject areas in which such personnel are needed and the number of such personnel needed in each such area, and (C) the kinds and extent of training which should be provided such personnel; (2) assess (A) current training programs available for the training of biomedical and behavioral research personnel which are conducted under this Act at orthrough institutes under the National Institutes of Health and the Alcohol, Drug Abuse, and Mental Health Administration, and (B) other current train- ing programs available for the training of such personnel; (3) identify the kinds of research positions available to and held by individuals completing such pro- grams; (4) determine, to the extent feasible, whether the programs referred to in clause (B) or paragraph (2) would be adequate to meet the needs established under paragraph (1 ) if the programs referred to in clause (A) of paragraph (2) were terminated; and (5) determine what modifications in the programs referred to in paragraph (2) are required to meet the needs established under paragraph (1~. (b) (1) The Secretary shall request the National Academy of Sciences to conduct the study required by subsection (a) under an arrangement under which the actual expenses incurred by such Academy in conducting such study will be paid by the Secretary. If the National Academy of Sciences is willing to do so, the Secretary shall enter into such an arrangement with such Academy for the conduct of such study. (2) If the National Academy of Sciences is unwilling to conduct such study under such an arrangement, then the Secretary shall enter into a similar arrangement with other appropriate nonprofit private groups or associations under which such groups or associations will conduct such study and pre- pare and submit the reports thereon as provided in subsection (c). (c) A report on the results of such study shall be submitted by the Secretary to the Committee on Interstate and Foreign Commerce of the House of Representative and the Committee on Labor and Public Wel fare of the Senate not later than March 31 of each year... 13

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MEETING THE NATION'S NEEDS FOR BIOMEDICAL AND BEHAVIORAL SCIENTISTS United States was last available in the 1970s when NRC conducted a number of specialized surveys of these scien- tists (see, for example, NRC, 1977~. In the absence of sys- tematic information about the study population, we have drawn on membership information from the Association of Health Services Research (AHSR) to develop a profile of selected-if not key portions of that work force. As the demand for these specialists continues to grow, we hope that future study committees will be in a better position to specify the overall size of the health services research labor force and trends in training and employment. In the mean- time, we have elected to base our training recommendations on the obvious immediate need to address current low lev- els of training in health services research through an expan- sion of the NRSA program administered by AHCPR to meet anticipated demand. Panel on Estimation Procedures To review mathematical and other models of supply and demand, the committee convened a panel of experts whose work continues beyond preparation of this report. The Panel on Estimation Procedures was formed to evaluate the ad- equacy of current models for estimating training needs in the broad fields comprising this study and to recommend new directions for enhancing models and for improving data collection needed to implement models in the future. A preliminary summary of their work may be found in the next chapter. Call for a Public Hearing Another important component of this study effort was a 1-day Public Hearing convened by the committee in Wash- ington, D.C. (Appendix C). The hearing, convened on May 3, 1993, was designed to solicit the views of colleagues in the scientific and educational communities as part of the process of developing recommendations for the future di- rection of the NRSA program. At the hearing, we posed the following four questions to our speakers: What is the most significant challenge we face today in the United States in maintaining an adequate supply of qualified scientists to sustain and advance health research? What improvements might be made in the NRSA pro- gram to ensure a continuing supply of skilled investigators in the biomedical and behavioral sciences in the coming years? What steps might be taken to improve the effective- ness of the NRSA program in recruiting women and mi- norities into scientific careers? What features of the NRSA training grant might be strengthened to ensure the maintenance of high-quality re- search training environments? 14 The public hearing provided a forum for exploring the need for biomedical and behavioral research personnel in nontraditional settings, such as industry. It also provided a forum for interested spokesmen from the scientific and edu- cational research communities to suggest modifications in the NRSA program. In preparation for the public hearing, the committee consulted with NIH and developed a com- prehensive list of about 2,000 individuals and professional organizations to whom letters of invitation were sent. These letters requested brief abstracts of proposed presentations. Approximately 200 responses to the invitation were re- ceived, and from these approximately 35 speakers were se- lected. A summary of the public hearing will be available separately. Names of respondents are listed in Appendix C. Commissioned Papers To augment the expertise of the committee in a variety of areas, we commissioned a number of papers for use dur- in~ four (Ieliherntinn.s In most cases, commissioned papers by experts within each of those broad fields addressed in this report augmented the quantitative analyses conducted under the guidance of the Panel on Estimation Procedures. Appendix D includes a list of the authors and other key contributors. Airlie House Retreat To review the information gathered by the committee through these various activities, the committee convened a three-day retreat in Airlie, Virginia, in September 1993. The purpose of the retreat was to review information gathered by the Panel on Estimation Procedures and other sources, to formulate our recommendations for refining the NRSA pro- gram, and to begin the task of organizing this report. Rep- resentatives from the Institute of Medicine, from the NRC Commission on Life Sciences, from the NRC Commission on Behavioral and Social Sciences and Education, and au- thors of the commissioned papers were present to assist the committee in their technical discussions. ORGANIZATION OF THE REPORT This report is organized into three parts. Chapter 2 sum- marizes our approach to the assessment of national need in this tenth report to the Secretary of Health and Human Ser- vices and to the U.S. Congress. This summary is followed by chapters addressing developments in the demand for re- search specialists in the basic biomedical sciences (Chapter 3), the behavioral sciences (Chapter 4), the clinical sciences (Chapter 5),

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INTRODUCTION oral heals research (Chapter 6), nursing research (Chapter 7), health services research (Chapter 84. Recommendations regarding the future direction of the NRSA program in meeting national needs are provided for each broad field (see Appendix E for a summary of the awards available through the NRSA program). The report concludes with a consideration of overall training issues, including specification of steps that might be taken to make Be NRSA program more effective in the coming years. We are aware that Mere are certain limitations to this report. For example, we have not had the opportunity to address research Gaining needs in many deserving areas, such as the clinical specialties of veterinary sciences or so- cial work. We hope that subsequent analyses of personnel and training needs by the NRC will consider these and other topics not included in this volume. Furthermore, the com- mittee was unable to collect new data about the biomedical and behavioral sciences work force given time and resource constraints. We believe, however, that this report serves the national interest by emphasizing specialty areas for which He demand for talent is great and for which informa- tion is generally available. We hope that NIH will consider collecting information in He near future needed to prepare for the next report, such as that described in Chapter 9. REFERENCES Dey, E. L., A. Astin and W. S. Korn 1991 The American Freshman: Twenty-Five Year Trends: 1966 1990. Los Angeles: Higher Education Research Institute, UCLA. Lenfant, C. 1989 Review of the National Institutes of Health Biomedical Re- search Training Programs. Bethesda, Maryland: National Institutes of Health. National Institutes of Health 1992 Statement of work to the National Research Council. Mim- eographed. March. Washington, DC. 15

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