The committee recommends that postgraduate training programs implement programmatic changes to ensure that residency and fellowship training programs include ongoing exposure to basic elements of experimental design, biostatistics, epidemiology, and decision theory in relation to measures of therapeutic effectiveness, diagnostic accuracy, prognosis, and screening and disease prevention.
The importance of expanding current model postgraduate training programs, which have proven to be successful in the training of clinical investigators, has been noted earlier and deserves reemphasis here. Ideally, these programs will be integrated with clinical teaching as well as relevant areas of investigation that emphasize the translation of research to clinical decision making and the role of the clinical appraisal of evidence in that process. Teaching and research institutions cannot rely on other sectors to effect change in clinical research and clinical research training and must begin to make the necessary changes in their own programs. The committee feels that these changes will not only produce clinical researchers with better skills but physicians who can provide better care as well.
The voluntary accrediting agencies responsible for overseeing the education and training programs for health professionals in the United States are highly developed and successful. This includes the Liaison Committee for Medical Education, the Accreditation Committee for Graduate Medical Education, the Accreditation Committee for Continuing Medical Education, the Joint Commission for Accreditation of Health Care Organizations, and the accreditation bodies for other health professions. In addition, there is a voluntary certification process to recognize individual qualifications in pursuit of specialty careers in organized medicine and dentistry. Some of these certifying bodies, such as the American Boards, are organized under the umbrella organization the American Board of Medical Specialties. Each of these organizations plays a major role in establishing standards and ensuring continuous quality improvement in the education and training process, both for the program and for the individual. Hence, evolving changes in the nature of the education and training programs that affect clinical research will, of necessity, require cooperation and participation of the accrediting and certifying bodies. Their strong support and cooperation would be extremely helpful in facilitating the entire process.