The committee found, as others before them, that the single most significant impediment to achieving a better understanding of the problem was the lack of a clear, commonly agreed-upon definition of clinical research. This lack codifies the inability to set standard data definitions and will continue to hobble future attempts to understand and characterize the clinical research workforce.

Thus, the collection and analysis of data on the clinical research workforce—and clinical research overall—continues to be a challenge. More data are needed to monitor progress on the clinical research workforce; the use of standard definitions among federal agencies, careful tracking of the subsets of clinical research, and systematic evaluation of existing training efforts would be beneficial. Data standardization would also allow a better review of the composition and outcomes of study sections, which would ensure that women and minority clinical researchers are appropriately represented.

Greater numbers of physician-scientists and nurses are needed in the coming years to sustain the clinical research enterprise. Achieving these greater numbers requires examining the training and career paths for clinical research. Leaders in the field have continued to point out that the lack of a defined career path and the lengthy and costly training necessary to conduct clinical research are deterrents to entering the field. Many feel that a major and persistent obstacle to increasing the numbers of clinical researchers is the lack of regard for clinical research as a discipline in academic settings. Students who face numerous challenges to achieving career success—women and minority students face still additional challenges—may find other career paths less daunting.

More vigorous recruiting of students at earlier stages is needed to replenish the pipeline to clinical careers and in particular to reach minority populations. Various types of training programs and career tracks foster the development and retention of women and minorities in the clinical research workforce, but more programs are needed for significant improvement. Just as there are not enough data on the clinical workforce to fully understand its supply and demand, there is also not enough evaluation of existing programs to identify which ones most successfully train clinical researchers. Leaders in this field need to expand and evaluate the existing mechanisms for developing new clinical investigators, retaining investigators, and supporting mentors. They should encourage flexibility of career paths in the academic setting, as well as collaboration between basic and clinical researchers.

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