promote research careers have demonstrated positive results, and the committee encourages their expansion if they are proven to be effective. Medical schools have demonstrated their support for such programs, as evidenced by investing their own resources to fund nearly 50 percent of the M.D.-Ph.D. slots in the country. The committee believes strongly that mechanisms should be found to develop a funding base to underwrite a debt relief program for individuals who are committed to a career in clinical investigation. Although resources for supporting such program areas most likely must come from some new funds, the committee feels that a growing investment should begin now to ensure the availability of talent in the next several years. The committee believes that NIH is best equipped to implement these programs for the federal government and recommends that NIH be empowered to develop the appropriate organization and infrastructure. The committee urges the sponsors of clinical research and clinical research training to act independently to initiate programs of debt relief for these individuals.

UNIVERSITIES AND ACADEMIC MEDICAL CENTERS

The key to the success of individual clinical investigators is the university academic health center where most are likely to have acquired their research skills and where many conduct clinical investigation studies during a significant portion of their careers. The academic medical center is defined as the medical school and its related university hospital(s). The attractiveness of careers in clinical research can be enhanced substantially by the leadership at many levels within these institutions. The institutions and their leadership are now under considerable stress as a result of health care reform. Nevertheless, the support of teaching and research must continue to be among the highest priorities.

Academic Recognition and Rewards

The committee recommends that academic institutions where clinical research is conducted review their promotion guidelines to prevent bias against clinical investigators and establish reward mechanisms to acknowledge the scholarly contributions of clinical investigators.

The scholarship of the successful clinical investigator should be appropriately recognized in the academic setting. This would include recognition that the nature of their research, the sources of their funding, and the journals in which they publish may differ substantially from those of the investigators in fundamental research. Some institutions have chosen multiple pathways for



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