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mentored and led by more experienced investigators in specialized centers that focus on the problems related to preterm birth. This will require a higher level of funding than is currently available and funding sustained over a period of time that allows a research infrastructure to be created and sustained so that new knowledge can be developed. Medical schools and academic medical centers should facilitate and encourage research programs in their obstetrics departments. In addition, obtaining R01 grants are seen as critical for judging junior faculty for appointments and promotions. Given the importance of multidisciplinary approaches in research and availability of other funding sources such as U grants, K grants, and other contracts, these should also be viewed as important in the promotion process.

A few universities have built active research programs by reallocating research dollars obtained from clinical revenues. This approach allows the creation of an infrastructure that can focus on obtaining future funds through grants. This is essential to identifying and recruiting basic scientists and physician scientists with expertise in statistics, epidemiology, nutrition, immunology, muscle physiology, molecular biology, microbiology, and other relevant disciplines. Building such a program requires a sustained commitment on the part of the department chair. Once the program is established, clinical data sets must be created and maintained. These data sets can then be used for the preparation of grant applications. The collection of baseline data provides resources for analysis by young investigators, which facilitates the development of new ideas. This may involve relationships with large clinical care providers to provide access to more data. A few programs have advanced from a retrospective database or chart review approach to include analysis of existing biological samples, prospective cohort studies, randomized trials, and multidisciplinary, multicenter studies. Trainees are more likely to be drawn to such centers because of the strength and vitality of the clinical research program.

Challenges in Building a Sustainable Research Enterprise

Research progress on preterm birth and infants born preterm will require scientists from many disciplines working in concert. Physician scientists from obstetrics and gynecology are an important component of such teams. What is needed is a paradigm shift in the field of obstetrics and gynecology to provide clinical investigators who can translate the research findings that come from basic science laboratories or pharmaceutical companies into new clinical diagnostic and treatment knowledge. The research training of such individuals is a high priority. It is estimated that only 50 physicians in departments of obstetrics and gynecology received NIH training or career development support between 1980 and 1990. During that same time period, 112 obstetricians and gynecologists were funded with



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