Bridging the Bed-Bench Gap Contributions of the Markey Trust (2004) / Chapter Skim
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Appendix A: Bridge Building Between Medicine and Basic Science
Appendix A: Bridge Building Between Medicine and Basic Science
Pages 43-59
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Appendixes
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W Collar _ ' have been asked to review issues surrounding the gap between basic sciences and their application to human disease, describe the history _ ~ of and relative success of approaches taken to bridge this gap, and develop scenarios for ways to enhance medical research in light of the changes occurring in training in the biomedical sciences and Me provision of health care.
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Because it is an obligation of medical science to solve longstanding disease-related problems, bridging Ws gap is arguably the major challenge confronting biomedical research. In order for medicine to progress there is need for physician-scientists who understand clinical medicine and for basic scientists who can effectively communicate and collaborate with them.
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Many Ph.D. scientists held joint appointments and worked collaboratively in clinical and basic science departments.
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· Increased financial indebtedness of medical graduates pressures them into practice and away from the risk and uncertainties of an academic career. According to the AAMC Graduation Questionnaire of 1999, medical school graduates who were indebted had an average debt of $90,000; over 13 percent of them owed $150,000 or more, and those who attended private schools owed an average of $109,000.
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These changes have imposed financial constraints on all academic health centers. To accommodate for financial shortcomings clinical faculties are pressured to see more patients and earn more of their income from clinical practice, thereby accelerating a cycle that reduces research and teaching time and thus the investigator's competitiveness for acquiring research funding.
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In contrast to He initial MSTP programs, which were entirely supported by NIH, the majority of MSTP students throughout the country are currently supported by private funds. Stuart Kornfeld reviewed the experiences at Johns Hopkins; Harvard; University of California, San Francisco; Chicago; Pennsylvania; Stanford; and Washington University schools of medicine (Kornfeld, 1999~.
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Many clinical investigators contributed to basic science by identifying key problems as well as by making original discoveries, and basic scientists have made discoveries that profoundly changed clinical practice. In 1964 Irving London commented on this distinction: "The essence of fundamental investigation lies not in whether it is done in a preclinical or in a clinical department or on a ward.
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scientists were relatively abundant in clinical departments where they usually held joint appointments in basic science departments. Even medical grand rounds were frequently shared between clinical and basic scientists who discussed patients and their illnesses.
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graduates are not attracted to a primary academic appointment in a clinical department because their scientific independence and academic tenure are limited or nonexistent. One of my students succinctly described the situation: "You work for and not with a physician." As research funding for physician-scientists declines and advances in basic science continue, medical centers are under increasing pressure to restore research efforts and solve the academic problems associated with recruitment of basic scientists into clinical departments.
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In 1979 Morris Karnovsky observed that graduate students at Harvard, although outstanding in their knowledge of basic science, knew comparatively little about organismal physiology and disease mechanisms (M. Karnovsky, personal communication, course in pathology and pathophysiology at Harvard Medical School, 1980~.
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The group invariably consists of seven or eight second- to sixth-year graduate students in different graduate programs, three to five postdoctoral fellows mainly from an NIDDK Training Grant in Molecular and Cellular Pathophysiology, and one to four basic science faculty, visiting faculty from institutions seeking to replicate the course, or biotechnology or pharmaceutical company scientists. Heterogeneity in the group has been important to group dynamics and learning.
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scientists, no other major funding source has assumed the mantle for sustaining and encouraging further development of this important component in our academic bridge or for performing outcome studies of existing programs. Whereas outcome evaluation of basic and clinical scientific studies is required for their continuing support, outcome evaluation of educational and training programs invariably lacks support from government agencies and private sources.
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Ph.D. students in medical school graduate programs seek careers that bridge with human disease, however, most students graduate with little knowledge of human clinical disease or pathology.
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Physicians-scientists and career opportunities for biomedical research. Presented at the Federation of American Societies for Experimental Biology Annual Conference, Washington, D.C.
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Physicianscientists and career opportunities for biomedical research. Presented at the Federation of American Societies for Experimental Biology Annual Conference Washington, D.C.: 1999.
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