NRSA holders in obtaining research funding is impressive. The results of the training efforts in the nation are self-evident: this country continues to be a world leader in health-related research.

While recognizing the success of these awards in promoting research, it is important to maintain a diverse support pattern for training. Research grants not only provide a viable alternative, they also fill a special niche in their own right. They provide personnel to carry out the research specified by funding agencies. These personnel may not be eligible for the NRSA, and research grants provide an alternate entry into the research enterprise. The most obvious examples are foreign scientists. Many foreign scientists remain in this country and make important contributions to training and research. This is beneficial to both the research community and the nation. In this regard, the committee is greatly concerned that current immigration policies will make the interchange of scientists and students with the rest of the world increasingly difficult.

Based on the balance with regard to output of trained personnel, job opportunities, and overall quality, the committee’s primary recommendation for the three major areas is that the total number of NRSA positions awarded should remain at least at the fiscal year 2002 level. Furthermore, the committee recommends that future increases be commensurate with the rise in the total extramural research funding at NIH in the biomedical, clinical, and behavioral and social sciences. The year 2002 is specified because it is the most recent year for which data were available to the committee. Despite this single recommendation for the three areas, the committee recognizes that each area has considerations that merit special mention. For example, in the basic biomedical and behavioral and social sciences, it is important to maintain focus on basic research. Although the ultimate goal of NIH is improved health care, the committee believes that critical breakthroughs are usually founded on basic research rather than highly applied research. Clearly applied research has an important place in the research training portfolio, but broad training in basic concepts is essential.

The application of lessons learned from basic science to health-related problems requires training in translational areas, and this should be a focus of the clinical sciences. Ideally, physicians are best equipped to do this research but may be unlikely to pursue research because of the heavy debt load M.D.s incur in medical school. To alleviate some of the above concerns, the committee recommends that the size and scope of the Medical Scientist Training Program (MSTP) be expanded at least 20 percent and that the scope be expanded to include the clinical, health services, and behavioral and social sciences. This program has proved remarkably successful in attracting outstanding physicians into research. Although the program is expensive, a modest expansion would serve the nation well. Furthermore, expansion of the scope would permit the behavioral and social sciences, for example, to participate more fully in the program. The expansion of scope should not be at the expense of the current MSTP support for basic biomedical research. In addition, the committee recommends that training grants be established for physicians to learn the skills necessary for clinical investigation. These programs can be part-time programs for physicians that would lead to a master’s degree. The shortage of physicians to carry out clinical research is already critical and will worsen if positive steps are not taken.

The behavioral and social sciences receive considerably less research funding from NIH than the basic biomedical sciences and correspondingly less research training support. Many of the nation’s health problems are not just physiological in nature and need to be addressed by research in the behavioral and social sciences as well. Consequently, the committee recommends that each NIH institute and center incorporate the behavioral and social sciences into its training portfolio, including institutes and centers that have not emphasized these disciplines in the past.

Although the need for research in oral health and nursing is apparent, both areas have difficulty providing an environment that fosters research as a career and in finding high-quality trainees interested in pursuing a research career. The long-term solution to this problem will require significant changes in traditional schools of dentistry and nursing. To attract trainees into oral health research, the committee recommends that all required years of the D.D.S./Ph.D. program be funded by the National Institute for Dental and Craniofacial Research (NIDCR) (analogous to the highly successful MSTP) and that the loan forgiveness program require documentation of time spent in research and scholarly success. This committee also recommends that the NIDCR design and implement programs intended to increase the number and quality of dental school applicants who are committed to careers in oral health research. In the case of nursing, the committee recommends that a new institutional research training grant (T32) program be established that focuses on rapid progression into research careers. Criteria might include predoctoral trainees who are within eight years of high school graduation, not requiring a master’s degree before commencing with a Ph.D., and postdoctoral trainees who are within two years of their Ph.D. These modest recommendations for oral health and nursing are intended only as starting points for these professions to move more strongly into research and research training.

A growing need exists to shorten the interval between research advances in biomedical science and the ability to apply these advances effectively to improve the health of the public. Thus, more effective health care delivery practices are required. Because of this need, health services research training should be expanded and strengthened within each NIH institute and center. In addition, the training programs of the Agency for Healthcare Re-



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