PANEL

Differences Between Basic and Clinical Disciplines

PANELISTS:

W. SUE SHAFER, PH.D., INSTITUTE FOR QUANTITATIVE BIOMEDICAL RESEARCH

HERBERT PARDES, M.D., NEW YORK PRESBYTERIAN HOSPITAL

JEANNE SINKFORD, D.D.S., PH.D., AMERICAN DENTAL EDUCATION ASSOCIATION

MODERATOR:

SALLY SHAYWITZ, M.D., CHAIR, AXXS STEERING COMMITTEE

DR. SHAYWITZ: In this session, our distinguished panel will discuss the differences between the basic and clinical disciplines. A major goal of this workshop is to increase the representation of women in the leadership ranks of clinical research in American medicine. Procedurally, we hope to extend and adapt the recommendations of this workshop’s predecessor, the AXXS ’99 workshop that focused on women in the basic sciences. The issues facing women in clinical research differ from those affecting women in basic science research. Our belief is that by better understanding these differences, we’ll provide a clearer understanding of the unique issues facing women in clinical research.

So one of our goals today is to delineate those differences, and their impact, and then to determine how to address them. For example, the path for basic science research training is much clearer and shorter than that for clinical research training: college, graduate school, and postdoctoral training—a straight line with no or few professional diversions. For men and women, physicians and dentists, clinical research training is anything but direct. They must contend with four and sometimes more years of medical or dental school where there is little if any focus on research, training, or mentorship or experience in research. Then comes



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Achieving XXCellence in Science: Role of Professional Societies in Advancing Women in Science - Proceedings of a Workshop AXXS 2002 PANEL Differences Between Basic and Clinical Disciplines PANELISTS: W. SUE SHAFER, PH.D., INSTITUTE FOR QUANTITATIVE BIOMEDICAL RESEARCH HERBERT PARDES, M.D., NEW YORK PRESBYTERIAN HOSPITAL JEANNE SINKFORD, D.D.S., PH.D., AMERICAN DENTAL EDUCATION ASSOCIATION MODERATOR: SALLY SHAYWITZ, M.D., CHAIR, AXXS STEERING COMMITTEE DR. SHAYWITZ: In this session, our distinguished panel will discuss the differences between the basic and clinical disciplines. A major goal of this workshop is to increase the representation of women in the leadership ranks of clinical research in American medicine. Procedurally, we hope to extend and adapt the recommendations of this workshop’s predecessor, the AXXS ’99 workshop that focused on women in the basic sciences. The issues facing women in clinical research differ from those affecting women in basic science research. Our belief is that by better understanding these differences, we’ll provide a clearer understanding of the unique issues facing women in clinical research. So one of our goals today is to delineate those differences, and their impact, and then to determine how to address them. For example, the path for basic science research training is much clearer and shorter than that for clinical research training: college, graduate school, and postdoctoral training—a straight line with no or few professional diversions. For men and women, physicians and dentists, clinical research training is anything but direct. They must contend with four and sometimes more years of medical or dental school where there is little if any focus on research, training, or mentorship or experience in research. Then comes

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Achieving XXCellence in Science: Role of Professional Societies in Advancing Women in Science - Proceedings of a Workshop AXXS 2002 another three to five years or more of residency training—again, typically with meager opportunities or exposure to clinical research. Just this weekend I spoke to a young woman who is completing her endocrinology fellowship. I asked her what she was planning to do next. She responded that much to her surprise she planned to pursue a career in clinical research. She said, “Through all my years of medical school and residency, no one ever mentioned or spoke of the possibility of a research career. I was never exposed to it, never thought of it. Perhaps if I did, I would have planned better and done things somewhat differently.” So the question is, is her experience typical? Do these perceived differences affect women differentially? How early can clinical societies reach trainees? What can clinical societies do to foster women’s interest in clinical research earlier? Can what appear to be structural problems be addressed? Before going on, let me introduce our distinguished panel. Dr. Sue Shafer is deputy director, Institute for Quantitative Biomedical Research, and former deputy director of the National Institute of General Medical Sciences. Her current interests include biomedical research policy, biomedical ethics, the responsible conduct of research, and enhancing the careers in science of women and minorities. Dr. Herbert Pardes is president and chief executive officer of New York Presbyterian Hospital and its health care system. Dr. Pardes served as U.S. assistant surgeon general and director of the National Institutes of Mental Health during the Carter and Reagan administrations, and has served as vice president for health sciences at Columbia University and dean of the faculty of medicine of Columbia’s College of Physicians and Surgeons. Dr. Pardes has overseen major changes in the education of physicians and enhanced clinical and basic science research. He also has assumed a national role as an advocate for education, health care reimbursement reform, and support of biomedical research. Finally, but certainly not least, Dr. Jeanne Sinkford is professor and dean emeritus of the Howard University College of Dentistry. Dr. Sinkford has the distinction of being the first woman to serve as chair of a major department in a school of dentistry and was the first African American woman dentist inducted into the USA section of the International College of Dentists. Since 1991, she has been director of the Office of Women and Minority Affairs of the American Association of Dental Schools. I’m going to ask our panel to consider the differences between basic and clinical research pathways, and their ramifications. There is a difference between how long the pathways take, and how direct the pathways are. There’s also a difference in community. Those in graduate training are part of a community of researchers. When those in M.D. training suddenly decide to go into research, they don’t have that history of collaboration or community to bring with them. And then there are differences in mentorship and also perhaps in financial encumbrances. So I would like to start by asking our panel to reflect on some of these

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Achieving XXCellence in Science: Role of Professional Societies in Advancing Women in Science - Proceedings of a Workshop AXXS 2002 issues and what they think are the most critical issues differentiating basic and clinical research pathways. DR. SHAFER: Two images from my recent experience at the University of California–San Francisco draw the contrast between basic research and clinical research in a way that is etched in my mind. At UCSF, I go to the Program in Biological Sciences seminars held every Friday at noon mainly for the basic sciences faculty. The faculty are supposed to present their work in ways that will promote dialogue, and so they’re not supposed to talk about what buffer they used. Rather, they’re supposed to talk about the concepts they’re trying to deal with. For the last two Fridays one of the more junior faculty members has been at the seminar with her baby. Afterward, half the room sort of surrounds her and talks about how she’s doing and admires the baby. That’s a picture of the kind of community that surrounds someone who has taken the opportunity, even before she has tenure, to have a child and be very open about that. By contrast, I went to a talk by Ann Crittenden, who wrote the book called The Price of Motherhood. In a discussion after the talk one young clinician was practically in tears. She said, “I’m ready to get out of research. I don’t know any woman who has managed to have a clinical research career, see patients, and also have kids. And I want kids.” So we immediately put her in touch with a few people like Diane Wara and others to say it is possible. But she was feeling totally isolated and unable to have the kind of life that she wanted, balanced between research and her own life. Those two images for me are the extremes of acceptance and community, and isolation and despair. DR. SHAYWITZ: Any comments? Our focus here, too, is to see how clinical societies can play a role. Are clinical societies able to intervene at an early stage, helping women who are engaged in clinical research? DR. SHAFER: Clinical societies have a crucial role to play. In my own home society, the American Society for Cell Biology, women are on par with men in terms of leadership on the council, on program committees, and throughout the society’s activities. I know that some clinical societies have started down that pathway. But my observation is that there is much less of that in the clinical world. A society can help to create an atmosphere and take steps to intervene at institutions to place women before search committees and other such things. So I think there is a very strong role for scientific societies in this realm. The trick is to take the lessons we learn today back not just to the choir, the women’s committees, but also to the leadership of the societies we’re trying to influence. DR. SHAYWITZ: Does anyone in the audience have experience with a clinical society that can serve as a model because it has done just what Dr. Shafer described?

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Achieving XXCellence in Science: Role of Professional Societies in Advancing Women in Science - Proceedings of a Workshop AXXS 2002 DR. ROBERTA L. HINES (YALE UNIVERSITY SCHOOL OF MEDICINE): I’m not sure I can answer that last question, although again, the Association of Women Surgeons has tried. We do have a little bit of an entrance through the back door, which is the American College of Surgeons. The current executive director of the American College of Surgeons is very friendly, shall we say, and has formally invited the Association of Women Surgeons to participate in programs. So I’m very hopeful that this will be our way into the big boys’ organization. But I do have a question. At my home institution, I’ve seen some junior women interested in clinical research say, “I can’t do this. I’m a clinician; they want me to see more patients and bring in more money, because that’s where the money comes from. If I do clinical research I’m taking time away from my clinician duties, and I’m never going to get promoted and tenured.” So how can the professional societies help home institutions? How can we get that little credential of having done clinical research, perhaps sponsored by one of the professional societies, to counteract the negativity of less clinical revenue at the home institution? Is there a way we can get the professional societies to interact with universities in that way? DR. PARDES: I think you’ve put your finger on a central point. The problem of adequate numbers of clinical researchers has been well documented, and the very points just made are ones heard from both women and men. The problem is, when one adds to that set of problems surrounding the clinical research career itself the other kinds of problems that are obstacles to women moving ahead in academic medicine, the difficulties are compounded. In other words, two sets of problems exacerbate one another. Now let me preempt my own comments. I was a member of a clinical research panel that Harold Varmus, former director of the National Institutes of Health, convened and David Nathan, professor of pediatrics at Harvard Medical School, chaired a few years back. The NIH has made some very good moves in trying to respond to some of the needs of clinical research. I argued at the time and I continue to argue that the clinical research panel should not have been disbanded, because this kind of issue is an ideal one for an NIH committee. I’m familiar with all the other advocacy groups, but such groups don’t cut the same way as one that’s perceived to be advising the NIH on how to proceed. The question of how to facilitate the movement of greater numbers of women into successful clinical research careers is a legitimate enough issue to ask the NIH to reconstitute its panel and put that as one of the priorities on the panel’s agenda. Now I want to segue into another point: the entire question of university attitudes toward people making accomplishments in clinical research. I am a faculty member at two universities, and at one, at least, the tendency to see clinical research as less valuable than basic research is compounded. One of the biggest problems is some of the faculty themselves. One of the thoughts we’ve had about how to solve that problem—“we”

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Achieving XXCellence in Science: Role of Professional Societies in Advancing Women in Science - Proceedings of a Workshop AXXS 2002 meaning the clinical research forum headed by Bill Crowley at the Association of Academic Health Centers—is to encourage the NIH leadership to come together with university leadership, by which I mean university presidents and deans, so that the source of funds for research, the people who control those funds, talk to the leadership of academic institutions about this problem. DR. MICHAEL LOCKSHIN (WEILL COLLEGE OF MEDICINE, CORNELL UNIVERSITY): For the past decade I’ve been on various committees about clinical research, both at the NIH and outside the NIH. One of the issues that should be on the table is the very broad definition of who goes into clinical research. It encompasses the people who take blood or other specimens from individual patients and basically never get out of a laboratory, all the way up to the people who participate in drug trials, and those sorts of things, or outcome studies. I would posit, and possibly in an inflammatory way, that the issue is not so much one of gender. It’s that the larger-scale clinical activities are always ones that require large amounts of collaboration, result in multiple names on papers, and almost never end up in the individual being the first author on one thing or another. Such activities often take a very long time to accomplish and result in one or two large-scale papers as opposed to items in the journals that publish very rapidly and primarily in the basic sciences. If there’s a positive way to look at this and to put it in a gender context, and if women are in fact the better collaborators and the better sharers of information, then putting value on collaborative research, the multidisciplinary or multi-institutional types of research, and making that value their own would be a way to do that. As Dr. Pardes brought up, to be worthwhile, that value must be recognized at the institution level by promoting people for that type of activity as well. To summarize, the issue is to define what is meant by clinical research when you’re trying to describe whether or not women are advancing in that area. Then you need to reward those components that do not necessarily lend themselves to the same measurement criteria used for promotion in basic science activities. DR. SINKFORD: I’d like to speak to several issues that have already been mentioned. Janet Bickel spoke about women in medicine, and most of the things occurring in dentistry are parallel. Female enrollment in dental schools has gone from 2 percent in 1970 to 40 percent in 2002. Twenty-five percent of the dental faculty are now women. If we were to lose those 25 percent, with 200 vacant faculty funded positions available in dental schools, we would really be in trouble. So we see women as a very critical resource for the future development of faculty, research, and community programs. Our advanced programs for dentistry are similar to those in medicine, except that there is no required residency program. So about 36 percent of our students go into advanced training programs in the specialty areas such as orthodontics, periodontics, and prosthodontics. Those programs usually include some research

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Achieving XXCellence in Science: Role of Professional Societies in Advancing Women in Science - Proceedings of a Workshop AXXS 2002 requirements, but they’re not extensive. As a result, men and women graduating from those programs are specialty qualified, but they are not clinical research qualified. That’s where we have a gap in our ability to take those individuals who have completed advanced training programs and expect them to do clinical research. They just do not have the skills to do that kind of research without preceptors. I think similar things occur in medicine. We’ve asked the National Institute of Dental and Craniofacial Research to help us secure some bridging grants so that individuals just leaving training programs and joining faculties or hospital staffs could have preceptors and therefore some kind of linkage with a research substructure that enables them to perform. We need to find ways of continuing that training and that mentorship. Those individuals do not have grantsmanship skills, which are very important. If they’re going to get money to support their research, then they must find a way to develop those skills or be able to call on the infrastructure within their institution to help them write appealing and competitive grant applications. At a summit held last year we brought together all the 55 dental school deans from across the country, with their chancellors and their presidents, to talk about enhanced clinical research within their institutions across disciplines and within the health science centers. We’re trying to have an impact on how the research capacity of our schools will develop over the next few years. That capacity doesn’t affect just women, but also male junior faculty. This meeting is a way for academic institutions to partner with our societies. Much of clinical research could be undertaken through collaborative ventures. But we have not pursued that vigorously, either in medicine or in dentistry. DR. SHAFER: I just had a comment on your discussion, Michael [Lochskin]. I see a role for scientific societies to find ways to reward junior faculty in a discipline in which the norm is large collaborative projects. Each society could consider taking a strategic look at its particular discipline and seeing how it can make recognitions externally that can be used internally. DR. LOCKSHIN: That is a good idea. I think it is appropriate to bring up and value the collaborative components. Within even large-scale projects, individuals have original contributions. I think it would be a wonderful idea for a society to give a prize or additional money to a woman who has distinguished herself in that capacity. That would work very well within the usual criteria for promotion-national recognition and that sort of thing. LYNN GERBER, M.D. (NATIONAL INSTITUTES OF HEALTH): To pick up on something Dr. Lockshin raised, I work at the NIH, but I’m representing the American Academy of Physical Medicine and Rehabilitation. It’s a very practical group of clinicians who are quite ambivalent at some level about whether a science is associated with rehabilitation. It’s a struggle that’s going on right now fairly vigorously

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Achieving XXCellence in Science: Role of Professional Societies in Advancing Women in Science - Proceedings of a Workshop AXXS 2002 within the academy. We’ve had lots and lots of recognition for clinicians and teachers and all kinds of people who have made enormous clinical contributions to our field, but we’re very shy on the research side. In fact, a lot of discussion is under way right now on how to pull up the research activities of the academy. With that in mind, the education and research fund has begun to target women, so that, interestingly enough, various kinds of scholarships and travel funds are available to encourage women to participate in research activities, attend conferences, and make presentations. It’s a little early to know whether this effort will reach fruition, but what has emerged, as a result of women being a little bit more prominent in our academy, is the notion that maybe our academic centers should be looking at ways of providing tenure that do not rely so heavily on research. We are not a heavy research organization. For example, could we give tenure to people for very strong track records in teaching in clinical practice? As for what clinical research is all about, it needs the clinic. Often women are the clinicians who are providing the excellent care and the excellent research information that is the fodder for the statisticians and basic researchers who come up with the outcomes of those trials. So the academy is now looking at whether we can lean a little bit less heavily on research and developing track records as first authors and look more toward the three legs of the medical school and the academic establishment, which include clinical practice and teaching. DR. KAREN ANTMAN (COLUMBIA PRESBYTERIAN MEDICAL CENTER): At least in cancer, the clinical research track is fairly well defined. A junior faculty member collaborates with a laboratory at the cancer center or university. She has an idea that she then takes to the clinic and does a Phase I trial. If the Phase I trial shows that the idea is safe, she then does a Phase II trial. If she happens to be the investigator that has a Phase II trial that looks interesting, she goes into a cooperative group and does a big Phase III trial. She gets the leadership role in that trial, and so is now first author of a national paper. Her institution is not supposed to be putting patients into the Phase III trial because she’s now supposed to be back doing the Phase I and Phase II pilots for the Phase III trial at a national level. So this process allows clinical researchers to actually take leadership roles that are well defined for promotion committees and to achieve first-author publications—not in Science and Nature, but certainly in the New England Journal of Medicine and the Journal of the American Medical Association. It’s hard to put this track in place where the culture’s not there, but the track is well defined. DR. SHAYWITZ: Do you think more women are represented in that track? DR. ANTMAN: At least in cancer, plenty of women are represented in those doing the Phase I and Phase II trials and then, if the data look interesting, moving on to a Phase III trial and being the first author.

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Achieving XXCellence in Science: Role of Professional Societies in Advancing Women in Science - Proceedings of a Workshop AXXS 2002 DR. DIANE WARA (UNIVERSITY OF CALIFORNIA–SAN FRANCISCO): Just to expand on Dr. Antman’s statement, the National Cancer Institute–sponsored/funded cancer centers have insisted on door-to-door, back-to-back clinical investigations and laboratory-based investigations—that is, they have insisted on collaboration between the two. So I give the NIH some credit for the development of, I believe, the largest body of clinical investigators in the country in cancer. DR. ANTMAN: But sometimes the laboratory investigators don’t buy into this model, even though it is the model that is funded by the National Cancer Institute [NCI]. So we’re caught between the culture of the university and the culture of the NCI, right in the middle. DR. WARA: I wanted to make a different comment, however. The NIH funds 81 clinical research centers across the country. These clinical research centers have an annual meeting and a society. For the last decade, we have brought funded junior investigators to this meeting. About three years ago, the clinical research centers brought in the K-23 and K-24 award recipients (K-23s are mentored junior investigator training grants, and so they are in the name of the recipient, the mentee; K-24s are more senior). This year, we’re going to include the K-12s, those eight who may have been funded, and we are inviting every funded K-23 investigator to the meeting to present his or her research. The Association for Patient-Oriented Research [APOR], led this year by Dr. Leon Rosenberg of Princeton University, will be coming to this meeting as well, as in past years. I think what we’ve heard today is the importance of intervening at a fairly junior level in order to nurture and expand the body of clinical investigators in this country. The meeting I described is an example of the NIH collaborating with societies, because both of the societies mentioned are NIH-based groups. It also is an example of focusing on junior investigators to ensure that we engage them early in their careers in clinical investigation. This may be the largest group of clinical investigators in the country, and we should try to engage that group. The group badly needs help, and we desperately need help in terms of a model so that we can help them. DR. PAGE MORAHAN (NATIONAL CENTER FOR LEADERSHIP IN ACADEMIC MEDICINE): I also want to amplify the talk on how to broaden the view of scholarship. It’s critically important, because scholarship has hierarchies. Applied scholarship is lower on the totem pole, as is interdisciplinary scholarship. Certainly our universities can provide one approach to broadening the view of scholarship; they could broaden their own internal rules for promotion and valuing broader scholarship. But that’s not enough, because in this day and age when faculty move from one school to another they need to know that they have the “scholarship union card” they can take with them to other universities. So I’m very much pleased to hear about the collaboration of societies and the

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Achieving XXCellence in Science: Role of Professional Societies in Advancing Women in Science - Proceedings of a Workshop AXXS 2002 efforts of societies to broaden their own views of scholarship. That’s where we need more activity. This has been done to some extent in the basic sciences, such as the American Chemical Society and others, where the American Association of Higher Education undertook a granting process to help each society develop a broader view of scholarship. We need to do the same thing through the Council of Academic Societies. NANCY SUNG (BURROUGHS WELLCOME FUND): I was very excited that Dr. Wara mentioned the clinical research meeting, and I would like to add a few more things about that meeting, perhaps as fodder for discussions at this meeting. A portion of that meeting described by Dr. Wara was sponsored by five foundations working in collaboration: the Burroughs Wellcome Fund, the Doris Duke Charitable Foundation, Howard Hughes, Robert Wood Johnson, and Juvenile Diabetes. Each foundation was receiving funding requests from multiple clinical research societies for duplicative activities. We felt that a collaborative effort might actually reach more people and be more substantial. So the clinical research meeting Dr. Wara referred to actually had a career development track in it that provided a mock study section—a session on the new NIH loan repayment program as well as networking opportunities. We discovered that many of the trainees attending those meetings were also part of smaller specialty societies that did not have a full-blown career development track for their young investigators. We believed that if the meeting could grow to include perhaps some of the smaller societies that don’t have the capacity or the funds to mount such an effort, it could act as a resource for these people similar to that provided by the Federation of American Societies for Experimental Biology for basic scientists. These funders are actively thinking about this, and they would love to hear your thoughts on it. JANINE SMITH (NATIONAL EYE INSTITUTE): Long ago there was a question about how individual societies or groups might be able to effect change within their groups. The American Academy of Ophthalmology formed a subgroup called Women in Ophthalmology, which gave women one way to get a specific forum at the academy’s national meeting and to invite speakers that covered topics from women’s health issues to things such as recognizing retinal changes associated with battering. So one approach is to form a group within your academy and then seek to place a member of that group on the board—our goal in the future. I also would like to comment on Dr. Lockshin’s and Dr. Antman’s comments on clinical research and what it is. This issue is different for every specialty. It is quite straightforward to develop an anticancer therapy—Phase I, Phase II, Phase III—and then seek the approval of the Food and Drug Administration. The outcome measures for those trials are quite clear; it’s mortality. For other fields, it is not that straightforward. For example, natural history studies—the epidemiologic studies needed to get prevalence data in order to do valid sample size

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Achieving XXCellence in Science: Role of Professional Societies in Advancing Women in Science - Proceedings of a Workshop AXXS 2002 calculations for those clinical trials—have to be done. Those are not as straightforward and take a very long time. Clinical research includes many types of studies, and I don’t think we all recognize that. In fact, there is a Society for Clinical Trials for people who are clinical trialists. That’s another meeting and another society that we should add to our list. ESA WASHINGTON (JOHNS HOPKINS UNIVERSITY, SOCIETY OF TEACHERS OF FAMILY MEDICINE): I just completed a fellowship, the Robert Wood Johnson Clinical Scholars Program. Many of my colleagues and I are concerned about the debt issue, which is very big. A woman comes out of residency with a $100,000 debt at a minimum, if not more, and she can’t defer in residency like she could have done several years ago. Does she go into a fellowship for another two to three years, at a salary of $30,000–40,000 plus minimal benefits? This situation is even more difficult when children are added to the mix. We need to figure out some way to give fellows and residents financial planning advice along with the career development advice so that they can somehow balance their situation and really believe that the short-term sacrifice they’re making will pay off in the long term. It’s one of the things that’s extremely challenging for fellows and extremely stressful. They’re trying to think of a research question and do a great project and get the papers published, all while trying to deal with large personal financial responsibilities with little support. DR. SHAYWITZ: I’m so glad you brought that up, because that’s such a prevalent issue and one that people don’t speak about. That will give us something to talk about during our breakout sessions and perhaps as we sum up. DR. ANTMAN: That’s why mentors are necessary. And to comment elsewhere, certainly clinical trials are only a small part of clinical research. I usually like to describe the continuum of research as laboratory, clinical, and public health. Public health has a whole different aspect of research. Population-based research is quite different from clinical research and quite different from laboratory research. Good health research cancer centers and medical centers need a continuum of all three, I believe. JOAN AMATNIEK (JANSSEN PHARMACEUTICALS): I do clinical research and I don’t work in an academic center; I work for a pharmaceutical company. I’m only three years out of a fellowship. The opportunities for women to do clinical research in particular in pharmaceutical companies cannot be beat by universities anywhere. My boss doesn’t just compete with the competitors for me, he competes with my family for me and he knows it. So in my work life, I get to do great research, I get to work with experts, I get to design those big trials that other people work on, plus I work for someone who doesn’t want me to abandon my family.

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Achieving XXCellence in Science: Role of Professional Societies in Advancing Women in Science - Proceedings of a Workshop AXXS 2002 I would like us to think about where clinical research is done. It’s not done just at the university. Think about other options and perhaps bigger strategies. Perhaps in the early part of a woman’s career, after her fellowship, it’s better that she work in industry and be able to have these leadership opportunities. Later on, when her kids are bigger, she could bring those skills back to the university. DR. PARDES: Your point’s very well taken. Sometimes we tend to think in terms of there being only one place to do research—universities. But having said that, I think that I would not want that to divert our attention from the fact that within the university culture itself there’s still a problem we have to deal with. DR. SHAYWITZ: These wonderful comments have broadened our purview, both of how much progress has been made and of the problems that still exist. Now I’d like to ask our panel to sum up their perceptions of one or two key points that they would like to leave with the audience to serve as a basis for our discussions in the next part of the workshop. DR. SINKFORD: I was struck by the comment about funding. I think some programs are now in place to help with loan repayment. We should follow up on that as a means of keeping the junior researchers in the pool and making it easy for them to make a decision about a long-term career. DR. SHAFER: The theme I heard is not on any individual point but on the need for us, as we think about what problems we’re trying to solve, to be strategic. Take a very specific problem and try to take a strategic look at it. DR. PARDES: If I could make two or three points. First, I want to go back to Dr. Marino’s data, because I think they were very instructive. She told us that about 45 percent of medical school students are women. But her 1998 figures show the percentages going down as women move up the ladder: from 41.9 percent as instructors, to 32.8 percent as assistant professors, 25.4 percent as associate professors, and 13.6 percent as full professors—substantial drops in each of the successive faculty slots. So something is happening in a continuing way and a look at it would help us focus on the problems. Second, I think mentorship should not just be mentioned, but should be the subject of a full-focus discussion unto itself. What is it? How does it get done? Why do people do it? How do we give people the incentive to do it? I was happy that at the NIH some of the new grant mechanisms they established in connection with the clinical research thrust included some faculty support for mentoring. Mentoring should be a criterion perhaps for promotion, or for tenure, or for financial incentives. I think that would help. Mentoring is a complicated business, yet most people in research careers would acknowledge that the quality of mentorship and the kind of leaders one can turn to—both immediate, ongoing

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Achieving XXCellence in Science: Role of Professional Societies in Advancing Women in Science - Proceedings of a Workshop AXXS 2002 mentors on-site and then contacts around the country through societies and such—can make all the difference in whether a person feels nurtured and is able to blossom into a real scientist. Finally, when we ask whether we should turn to societies or universities in dealing with the problems, I suggest that we look for some way to convene the leadership of several entities—the NIH, the universities, the societies, the pharmaceutical companies—to say, all right, there’s something that each one of us could do. Is there some way in which, by collaborating, we could create a fabric and have on each of our agendas people whose reward, whose gratification in life, is to address this issue and promote it? That is, they are put on the spot, if you will, for seeing that these kinds of figures move in more dramatic ways throughout the discipline.