Meeting the Nation's Needs for Biomedical and Behavioral Scientists: Summary of the 1993 Public Hearings (1994)

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APPENDIX D 41 social sciences for the trainee who plans to pursue patient-oriented, outcomes research. Second, I believe that the mentorship system should be more formal and structured. For example, NRSA renewals might require submission of a 250 word evaluation of the progress of each individual trainee, in addition to the usual compilation of abstracts and presentations. This formal evaluation, which the program will be required to share with the trainee, would help the trainee and would serve as a “reality check” for both the program and the sponsoring agency. 3. Our primary care NRSA has had no difficulty attracting top quality female applicants, but minority applicants have been much less plentiful. One of the major problems is that most career decisions have occurred at an earlier phase, so that the ability of NRSA fellowships to alter plans is limited. At the current time, minority recruitment efforts of individual programs simply foster competition to recruit from among the small pool of available applicants. Unless the pool is expanded, minority recruitment efforts are simply “reshuffling the deck.” Thus, I believe that a coordinated effort, led by the NIH and other similar organizations, must attempt to enrich the pool of female and minority trainees who are interested in research careers. For example, the principal investigator of each institutional NRSA might be required (and funded) to attend one meeting during every five year cycle specifically to recruit female and minority medical students or housestaff into research careers. 4. As noted above, I would suggest a strengthening of the requirements for formal coursework in state-of- the-art scientific disciplines broadly relevant to medical research. As a result, trainees would be better prepared to integrate various scientific approaches and to learn new approaches. I am also concerned that the current institutional NRSA environment may sometimes be too laissez-faire, so that trainees do not receive clear feedback regarding their research progress. A more formal evaluation requirement, shared both with the trainee and with the funding agency, could provide an explicit set of expectations as well as indications as to whether these expectations are being met. Programs and individual trainees could then be evaluated not only on whether expectations were met, but also on whether the program directors have established appropriate expectations. 5. I agree that a variety of opportunities are emerging for research scientists in industry and other new settings. However, such opportunities will only increase the need for entry-level training, such as is provided by NRSA programs. Emerging research opportunities will make it increasingly necessary for trainees to have broad-based scientific training, in addition to their precepted research experience. NRSA programs must be designed to train the full range of biomedical and healthcare scientists who will be needed for the future. As patient-oriented outcomes research and research at the interface between laboratory discoveries and clinical applications become more important, NRSA programs must include training in these skills as well as basic “wet lab” skills. STATEMENT BY RICHARD J. GRAND, M.D. I am extremely grateful for the opportunity to share some of my ideas regarding biomedical research training with so many distinguished colleagues. The challenges are great, and, regretfully, the national political agenda seems unpropitious. How to continue to fund training in biomedical sciences? Established programs for the support of training in biomedical research, such as the Research Training and Career Development Programs at the National Institutes of Health, represent valuable resources which must be preserved and enriched. The Institutional and Individual National Research Service Awards are currently virtually the only available mechanisms for research training of M.D. and pre- and post-doctoral Ph.D. young investigators. Even these Awards have unsolved problems; nevertheless, their loss would produce incalculable damage to progress in the biomedical sciences. Current problems with these awards are as follows: 1. NRSA stipends have not kept pace with the salaries offered M.D.s moving from residency into full-time practice, or Ph.D.s recruited into industry. With the debt load on today’s residents, there need to be financial incentives to offset the temptations of 

APPENDIX D 42 practice. Future commitment to research careers needs to be rewarded early. 2. The number of NRSAs funded annually are too few to secure an adequate pool of young investigators. 3. After graduation from a training program, competition for “bridge” grants, the CIA and the FIRST awards, is keen, and inadequate numbers of these are offered. Investing in the scientific training of young investigators seems to me to be a national priority of high value to society. How to maintain an adequate pool of qualified scientists? The most significant challenge to an adequate supply of qualified scientists is the maintenance of an adequate pool of M.D. physician scientists. During my term as Chairman of the GMA-2 Study Section at NIH (and my experience as an ad hoc reviewer in the last cycle of this study section), it has become apparent that a majority of new and competing RO1 applications is submitted by Ph.D. applicants. Furthermore, the number of M.D. graduates from medical school interested in careers in academic medicine is shrinking, more in some specialties (e.g. pediatrics) than others. The reasons for this are obvious: a) increasing financial burdens on medical students b) the view that biomedical research is a risky enterprise in times of inadequate support c) the rigors of and competition in academic careers The joys of academic medicine can only be transmitted by enthusiastic faculty and innovative programs. Improvements in the National Research Service Awards Program, directed at M.D. candidates and young physicians in training might begin to stimulate interest in academic careers. My colleagues, Dr. Philip Rosoff and Dr. Jane Schaller, and I have been discussing a model program which may be of interest to you. Under the auspices of the NRSA Program, medical schools could compete for small grants to support short and longer term research experiences for medical students. We would suggest a one year research support program during which the student would receive: • credit for research performed • living expenses • support for interest due on loans, and • a modest amount for lab fees Shorter “summer quarter” research experiences could be supported pro-rata. In the setting of a medical school honors program, this would be an important mechanism for drawing young people into laboratories. I should state that we have also considered developing a similar program for residents, in order to continue to rekindle their interest in research careers. I realize that this would require an infusion of new dollars into the NRSA program, but I doubt innovative change can be accomplished with current dollars. In order to improve effectiveness of the NRSA programs for minority groups, an early intervention program is necessary. Specific numbers of awards could be targeted for this area as I have already described. Can anything be learned by the way in which we train Ph.D.s in science? One of the differences between M.D. training and Ph.D. training is that M.D. training is often principal investigator generated, while Ph.D. training is discipline generated and involves core curriculum as well as research. I think that the overall quality of the training provided to M.D.s can be assessed by the “use” of the trainees. For example, if in a given training grant, all of the trainees work for a single mentor, I would be concerned that the trainees were being “enslaved” rather than educated. It seems to me unlikely that all trainees in a single program would have the same research interests. Secondly, for M.D. investigators, a core curriculum, which is mandatory and offered on an annual basis, could help to supplement course material in specific areas. The core curriculum would contain a focus on research methodology, biostatistics, study design, scientific writing, and the NIH/NSF Award Programs. The topic of scientific integrity could be included in the core curriculum, but it is already mandated in the NRSA Program. In the Department of Pediatrics at Tufts University School of Medicine, we have offered such a course for several years, and it has