Federal sponsors of clinical research should amplify the existing funding mechanisms and create new ones that allow flexibility in career training, such as second-career programs, reentry mechanisms, and service payback agreements. These programs should be described on the NIH training website. In addition, other entry routes into the clinical research path, including short-term training programs, should be developed.

Given the length of time required for training, the clinical research career pathway is fixed, with little latitude for alternative entry points. This situation may filter out well-qualified candidates from other biomedical research career tracks who could enter clinical research in shorter training programs (e.g., one-year programs for medical students). Career paths for women and minorities may not follow the conventional, rigid model because of considerations such as family responsibilities, debt- and risk-aversive trends, and differential debt burdens among different communities. Flexibility in career training is essential if diverse candidates are to thrive in clinical research careers.


Academic institutions should develop strategies to attract mentors and reward mentorship in clinical research training. A special emphasis should be placed on the women and minorities who carry the greatest burden of mentorship responsibilities for women and minority scientists.

Academic institutions should develop flexibility so that the time required for tenure reflects the time course for research, particularly for physician-scientists. The process should also recognize individual differences, academic contribution, and academic service, including mentoring, and where possible should use quantifiable measures of excellence. Academic service (e.g., institutional review boards and other committee service) should count as a significant positive factor in decisions relating to promotion and tenure. Efforts should be made to improve the composition of promotion and tenure committees so that women and minority clinical researchers are represented.

Individuals in clinical research pathways should be given the necessary infrastructure to achieve success, including clearly defined benchmarks.

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