complexities of the U.S. health care system and its burgeoning problems, medical students are expected to become increasingly compassionate and caring as well as more aware and knowledgeable about patients' insurance coverage, case law, and ethics.

Dentistry, nursing, and other health professional groups also encounter barriers to clinical research careers that may or may not be similar to the barriers found in medicine. For example, unlike medicine, where there is extensive graduate medical education, the dental school curriculum is designed to prepare dentists who can practice dentistry upon graduation—after four years of graduate education. The dentistry curriculum thus combines didactic course work and clinical skills development during those four years, which brings into question the amount of time that dental students can commit to developing research skills (Appendix A). Although nurses, pharmacists, and allied health professionals generally acquire their clinical practice skills at the undergraduate level, most acquire their research skills in doctoral programs. In the past, many of these doctoral programs have been in other fields, such as education or psychology. New doctoral programs in nursing and allied health disciplines are being created, however (Appendix B; Selker, 1994).

The committee did not have the expertise to judge the effectiveness or the quality of programs in dentistry, nursing, and the allied health professions. The committee therefore sought input from the appropriate professional groups through task forces, commissioned papers, or written comments. Most groups felt that there were obstacles in the training pathways leading to careers in patient-oriented clinical research. Some of these were seen as peculiar to a given profession, whereas others were viewed as generic to all health care groups. The complete task force reports on dentistry and on nursing and clinical psychology can be found in Appendixes A and B, respectively, and the background paper by Dr. Selker elaborates on clinical research in the allied health professions (1994). Where appropriate, however, the concerns of those groups will be noted in the text.

The committee believes that health care professionals in all fields should be well-versed in the sciences underpinning the practice of health care. Sophisticated scientific and quantitative preparation empowers health care practitioners to pose insightful questions about human biology and behavior, to retrieve and critically analyze information for use in solving clinical problems, and to remain open to unexpected new possibilities. The diverse responsibilities in the various professional groups engaged in clinical research require that they have different kinds and levels of educational and scientific backgrounds. Unlike doctoral programs, in which the goal is to train highly skilled research scientists, the primary goal of health professional schools is to blend the scientific knowledge base with clinical skills to prepare highly qualified and competent practitioners of health care. In a health care environment in which health care knowledge and technology are accelerating rapidly and new discoveries are reported almost daily,



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