clinicians, whereas others have adhered to single promotion pathways for all investigators. Whatever the pathway, it is incumbent on institutions to create a fair and equitable means for recognizing and rewarding the scholarly contributions of clinical investigators.

The committee recommends that academic institutions establish reward mechanisms to acknowledge the importance of teaching, advising, and mentoring by clinical investigators.

The existence of faculty in clinical investigation who teach, advise and mentor trainees, and serve as role models is important in attracting students to careers in clinical investigation. These faculty activities, therefore, must be recognized and rewarded. Such recognition in the academic health center includes promotion, protected time, and financial support. Leaders at all levels within these institutions must define their expectations of junior faculty and support them so that these young men and women can meet or exceed those expectations. In many institutions support has been successfully facilitated by the formation of specific clinical faculty tracks; others have developed equally successful single-track systems that are capable of recognizing the diversity of academic productivity. The committee does not endorse one system over another; rather, it encourages institutions to establish suitable means for recognizing the contributions of clinical investigators and developing appropriate reward systems.

The committee recommends that research institutions provide clinical investigators with the appropriate infrastructure in order to conduct high-quality clinical studies.

In addition to well-trained and adequately funded patient-based clinical investigators, the successful execution of clinical and especially human research requires a suitable institutional infrastructure. University-based and research-intensive medical centers should develop mechanisms to achieve the optimal infrastructure to support inpatient-and outpatient-based human research. The features of such an infrastructure may include a clinical practice that is structured to deliver health care in a scholarly and investigative fashion and the integration of students, residents, fellows, and other health care professionals into human research activities. In addition, multidisciplinary facilities are required at academic institutions to support core requirements for clinical research; these