BOX 5-1

Recommendations from the Association of American Medical Colleges Task Force II Report, Promoting Translational and Clinical Science: The Critical Role of Medical Schools and Teaching Hospitals

Recommendation 1: Every future physician should receive a thorough education in the basic principles of translational and clinical research, both in medical school and during residency training.

Recommendation 2: The Liaison Committee on Medical Education (LCME) should add education in translational and clinical research to the requirements for medical school accreditation, and the Accreditation Council for Graduate Medical Education (ACGME) should embed understanding of translational and clinical research within its required core competencies.

Recommendation 3: Training for translational and clinical investigators should comprise completion of an advanced degree with a thesis project (or an equivalent educational experience), tutelage by an appropriate mentor, and a substantive postdoctoral training experience.

Recommendation 4: Sufficient support should be given to new junior faculty who are translational and clinical investigators to maximize their probability of success.

Recommendation 5: Training in translational and clinical research should be accelerated through comprehensive re-structuring so that these scientists can become independent clinicians and investigators at the earliest possible time.

Recommendation 6: Institutions, journals, the NIH, and other research sponsors should take steps to facilitate appropriate academic recognition of translational and clinical scientists for their contributions to collaborative research.

Recommendation 7: The NIH should modify the K23 and K24 awards to enhance their value in supporting clinical and translational research training and mentoring.

the proceeding two decades had remained largely constant at about 34 percent of total extramural research dollars, the NIH has now launched several well-received training awards for junior and mid-career physician scientists. There are also other support mechanisms, most notably the Clinical and Translational Science Awards (CTSAs), directed by the National Center for Research Resources (NCRR) and launched in 2006, all of which are transforming the quality and quantity of support of physician-scientists in universities and academic health centers. Much of the NIH funding for the CTSA has been recovered from closing down the General Clinical Research Centers (GCRC) program, begun in the 1960s to create a national network of such centers, situated primarily in academic health centers, and targeted initially to support what was then cutting-edge studies of metabolic diseases in human research subjects.

As of July 2010, 55 CTSAs had been funded in universities and academic health centers across the country, creating local, regional, and national systems to increase the efficiency and productivity of clinical and translational research and to develop ways to reduce the time it takes for clinical research to become available for use in treatments for patients. The NIH intends that there will be 60 centers when this program becomes fully implemented in 2012, although that number may increase. The CTSA—which require partnerships not only among academic medical institutions and health centers with other components of universities, but also with community hospitals, clinics, and health care practices—are truly creating increasing interest and excitement in clinical research across universities and their community partners, as well as attracting non-biomedical investigators from across universities into multidisciplinary clinical research programs. However, it is too early to predict the ultimate success of this program or whether it will achieve its ambitious goals.

Notwithstanding these positive steps to enhance training and support for physician-researchers in the clinical sciences, the past two decades have been particularly challenging for the funding of all academic health professionals and especially for the support of research activities in the clinical environment that are not clearly tied to specified funding streams. Clinical research, broadly defined, has yet to achieve the breadth and depth of currency it deserves.

To develop the nation’s clinical research capacity will require a sufficient workforce of highly trained clinician investigators in the several health research professions as well as Ph.D.s in the diverse areas of knowledge that are encompassed in the expansive definition of “clinical research.” Building this workforce will require enhanced support across the clinical research disciplines and will especially require supporting clinician-scientists, who must be accomplished in both their clinical and their scientific disciplines.

DEFINING THE CLINICAL RESEARCH WORKFORCE

The clinical research workforce is as varied as the definition of the field. It consists of individuals with doctorates in the basic sciences, graduates of professional degree programs (mostly M.D.s), graduates of health sciences and public



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