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EXECUTIVE SUMMARY The subject of this report is He nation's future need for biomedical and behavioral research scientists and the role the National Research Service Awards CURSE) program can play in meeting those needs. The report has been prepared under the auspices of P.L. 93-348 (as emended), the Na- tional Research Act of 1974, which specifies that the Secre- tary of the Department of Health and Human Services shall request that the National Academy of Sciences conduct a continuing study of the nation's need for biomedical and behavioral scientists, the subject areas in which they are needed, and the kinds and extent of training which should be provided them. This is the tenth in the continuing series of reports to the National Institutes of Health (NIH) and the U.S. Congress on this subject. The committee's deliberations and recommendations centered on three major activities. First, a Panel on Estima- tion Procedures was established to provide numerical analy- sis of educational and employment prospects and national needs for biomedical and behavioral research personnel. The panel concluded that existing mathematical models are inadequate to predict need and their recommendations for alternative strategies are presented in Chapter 2. Second, the committee convened a public hearing to gather views from a broad constituency associated with NRSA programs. Both written and oral testimony were considered by the committee and our conclusions are reflected in the recom- mendations that follow.) Third, the committee met as a group on four separate occasions and, as a panel of experts, discussed and debated information and recommendations. The consensus of these meetings forms the basis for the recommendations included in this report. Through all He deliberations, one theme was constant: although the NRSA program may be relatively small as re- gards total numbers of trainees (less Can 15 percent of the total number of graduate students training in the biomedical and behavioral sciences are supported by NRSA funds in any year), it is enormously powerful in its ability to change research emphases and to attract the highest quality individu- als to research careers. It is viewed as a prestigious, highly competitive program. It is clear that initiatives, if introduced through the NRSA program, could have a powerful impact on intended new research directions or constituencies. In other words, the force of the NRSA program in determining re- search initiatives and directions in programs is enormous and clearly out of proportion to He relatively small place it occu- pies in the total research training portfolio. ESTIMATING NATIONAL NEEDS FOR RESEARCH SCIENTISTS The committee recognized early in its work that defining the nation's needs for biomedical and behavioral scientists is difficult and imprecise. However, the committee also recognized there are certain forces and opportunities that will have an impact on the needs for research personnel and, therefore, cannot be ignored. These include health care reform, major advances in fundamental research, and the demands of the marketplace. Recommendations for estab- lishing the size and scope of He NRSA program represent the committee's best judgment concerning the continuation of a strong, health-related, scientific work force based on a consideration of these forces and opportunities. Health Research as a National Priority The expansion of national support for health research that occurred over He past few decades may be expected to continue although at a slower rate. Reapportionment of research and development funding between academia and industry has had and will continue to have an important

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MEETING THE NATION' S NEEDS FOR BIOMEDICAL AND BEHAVIORAL SCIENTISTS effect on employment prospects for biomedical and behav- ioral scientists, although the effect will vary by field, as we discuss elsewhere in this report. We expect continued national support for basic biomedi- cal and behavioral research. However, research supported by federal funds may be expected to be closely relevant to social and economic needs and more readily adaptable for use in the private industrial sector. Furthermore, as society shifts away from product-intensive industries toward a ser- vice-oriented industrial base, He role of research in ~mprov- ing the quality and reducing the costs of health services will be closely scrutinized. Unknown Effects of Health Care Reform As forces converge to shape and change the delivery of health care in the United States, we expect a dramatic effect on research training. On He one hand, the potential flatten- ing of reimbursement for clinical care will curtail a revenue stream (clinical income) that, in many medical schools and academic health centers, subsidizes the support for research training. A reduction in this revenue stream may shrink research training opportunities in academic health centers. On the over hand, increased emphasis on the maintenance of health, the outcome and quality of care, and the assess- ment of the impact of technology provide unique opportuni- ties for prevention and health services research. Over changes in health care reform stress the need for increased activity in areas related to behavioral, nursing, and health services research. Advances in Research It is difficult, of course, to gauge He effect of the ad- vancement of science on personnel needs. On He basis of our familiarity win the goals of He NRSA program, the range of expertise among our committee members, and the contributions of many individuals participating in our delib- erations throughout the year, we have identified some fruit- ful areas of inquiry Hat also have the potential of engaging young scientists in careers that are both productive and re- warding. Major advances in basic biomedical and behavioral re- search are ripe for application to address the causes, diag- nosis, and treannent of human disease. These major re- search findings also provide the opportunity to bring new technologies to the marketplace. Demand of the Marketplace Employment conditions for biomedical and behavioral scientists were relatively robust throughout the 1980s. Dra 2 matic changes have occurred, however, with regard to sec- tor of employment with a greater fraction of Ph.D.s em- ployed in industry and other nonacademic jobs than in ear- lier years. The nation's need for research scientists has also been affected by demographic changes: He number of individu- als from racial and ethnic minority groups is increasing but not as fast as might be expected given federal efforts to encourage He participation of minorities in this area. The work force of He future will consist of an increasing pro- portion of women and minorities; it is important that these changes are reflected in the biomedical and behavioral sci- ence work force. RECOMMENDATIONS Considering the major forces that have an impact on na- tional needs for research and the unfolding of the research career, the committee recommends the following changes in He NRSA program to meet those needs. Stipends Raise the real value of stipends to more competitive levels by fiscal 1996: approximately $12,000 per year for predoctoral clwardees and approximately $25,000 for postdoctoral awardees with less than 2 years of research experience. Maintain the real value of these stipends (i.e., the nominal value adjustedfor ink ationJ through annual increases of 3 percent per year (the assumed annual rate of inflations. It is disturbing to note that stipend levels for predoctoral trainees in the NRSA program have remained unchanged since 1991 at $8,800 taxable salary per year. The existing structure of a $700 monthly stipend is simply not sufficient. Many state university stipends start at $11,000 and He Na- tional Science Foundation currently pays $14,000. Hence, we recommend an increase in the inflation-adjusted value of predoctoral stipends to $12,000 by fiscal 1996 to provide an incentive for graduate students not only to seek but also to complete training at the doctoral level. Postdoctoral NRSA awarders do not fare much better, earning approximately $18,600 in their first year of train- ing and $19,700 in their second. It becomes very difficult at this important period of training to entice a clinician or Ph.D., already burdened with debt, into research training. Thus, the committee recommends that the NRSA stipends at the first-year postdoctoral level be increased to $25,000 in inflation-adjusted dollars by fiscal 1996. This expan- sion in stipend support should be achieved through the addition of funds to the current NRSA training budget (Appendix H).

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EXECUTIVE SUMMARY Numerical Recommendations Between fiscal 1991 and 1993, the total number of NRSA awards grew from just over 14,000 to over 15,000 (Sum- mary Table 1~. The basic biomedical sciences were esti- mated to have the largest fraction of support in fiscal 1993 at about 9,633 awards, followed by 3,000 awards in the clinical sciences [excluding 822 awards for combined M.D.- Ph.D. training through the Medical Scientist Training Pro- gram (MSTP)~. To meet the nation's future needs for bio- medical and behavioral scientists, we believe the overall NRSA program should expand from 15,112 slots in fiscal 1993 to 16,260 slots in fiscal 1996, with that growth occur- ring mainly through modest expansion of NRSA support for research training through the MSTP program, in the be- havioral sciences, oral health research, nursing research, and health services research (Summary Table 2~. With full implementation of the recommendations that follow the number of NRSA awards would have expanded by about 10 percent between 1993 and 1996 with support for basic bio- medical sciences representing 59 percent of the total in 1996, behavioral sciences about 9 percent of the total, the MSTP-program 6 percent, other clinical sciences (including oral health research) 20 percent, nursing research 3 percent, and health services research 2 percent. Recommended changes in the size and scope of theNRSA program within each broad field are summarized below. Basic Biomedical Sciences Maintain the annual number of predoctoral awards in the basic biomedical sciences at 1993 levels, or ap- proximately 5,175 awards, clad the number of post- doctoral awards at 3,835. On the basis of input from a wide variety of sources about current and anticipated market conditions and in con- sideration of pressing national research needs, the commit- tee endorses the continuation of federal support through predoctoral awards in He basic biomedical sciences (see Chapter 34. The committee is concerned, however, that the current low levels of stipend support will not attract the most talented students to careers in research. To under- score the depth of our concerns, we recommend that predoctoral awards in the basic biomedical sciences be maintained at fiscal 1993 levels until further assessment of funding priorities and national needs can be made. The committee recognizes Hat these recommendations are made in an era of fiscal restraint. Should additional funds be- come available for predoctoral research training in the basic biomedical sciences, NIH might wish to consider expand- ing NRSA support in this area. Postdoctoral research training is also an important com ponent in the preparation of productive investigators in the basic biomedical sciences. Postdoctoral training increases the technical skills of the doctoral-level scientist and en- sures the success of Heir independent research careers. Here, too, the committee is concerned that persistent low- level stipends may discourage qualified applicants from seeking postdoctoral training through the NRSA support. Thus, to permit NIH to introduce further and more realistic changes in stipend levels at the postdoctoral level, the com- mittee recommends that the number of postdoctoral awards be maintained at fiscal 1993 levels. Again, however, should additional program funds become available for postdoctoral research training in the basic biomedical sciences, NIH might wish to increase the number of these awards. Behavioral Sciences Increase the clanual number of NRSA awards for re- search training in the behavioral sciences from 1,069 to 1,450 between 1993 and 1996. On He basis of continuing gains being made by behav- ioral scientists in areas of national interest and on antici- pated demand for behavioral research relative to heals goals, He committee urges He continued expansion of fed- eral support through predoctoral awards in the behavioral sciences (see Chapter 44. Predoctoral awards permit the preparation of investigators familiar with the broad range of research techniques and theories Hat characterize doctoral preparation in the behavioral sciences. As is ache case in other areas, the committee is concerned that current low stipend levels for NRSA awardees do not attract the most able scientists to research careers in health-related fields. Thus, the committee has tempered its call for expansion in total support from 672 predoctoral awards in fiscal 1993 to 900 by fiscal 1996 in recognition of He competing need to increase stipend support. Postdoctoral research training Trough He NRSA pro- vides the nation with an unusual mechanism for attracting He most skilled scientists to address areas of national need. Because of differences in He evolution of research careers, postdoctoral research Gaining has played a greater role in some behavioral science fields than others. Nonetheless, postdoctoral study increases He technical skills of the in- vestigator and strengthens the pool of talent available to the nation for research. Thus, the committee recommends that the number of postdoctoral trainees and fellows supported annually in the behavioral sciences increase from approxi- mately 349 awardees in fiscal 1993 to 500 in fiscal 1996. Clinical Sciences Increase the number of MSTP awards from 822 in 1993 to 1,020 by 1996 and the number of postdoctoral 3

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MEETING THE NATION'S NEEDS FOR BIOMEDICAL AND BEHAVIORAL SCIENTISTS SUMMARY TABLE 1 Aggregated numbers of NRSA supported trainees Ad fellows for FY 1991, I;Y 1992, Ad FY 1993.a Fleck Type Year of Program TOTAL Basic Medical Oral Health ALL Biomedical Behavioral Clinical Scientist b Health c Nursing d Services C 0 ~FIELDS Sciences Sciences Sciences Truning Research Research Research 1991 TOTAL Total14,0859,0219022,894783218255 12 Predoctoral6,9484,59351975578378220 0 Postdoctoral6,5253,8613382,139014035 12 MARC Undergraduate612567450000 0 Trainees Total11,8507,1997752,81478318693 0 Predoctoral6,4494,3134727367837867 0 Postdoctoral4,7892,3192582,078010826 0 MARC Undergraduate612567450000 0 Fellows Total2,2351,82212780032162 12 Predoctoral499280471900153 0 Postdoctoral1,7361,54280610329 12 _ 1992 TOTAL Total14,6079,3179082,970806213257 94 Predoctoral7,2654,77753481980677217 35 Postdoctoral6,6613,9103232,151013640 59 MARC Undergraduate681630510000 0 Trainees Total12,3657,4777902,887806178103 82 Predoctord6,7614,4874818008067775 35 Postdoctoral4,923 f2,3602582,087010128 47 MARC Undergraduate681630510000 0 Fellows Total2,2421,840118830351S4 t2 Predoctoral504290531900142 0 Postdoctoral1,7381,550656403512 12 1993 TOTAL Total15,1129,6331,0692,974822224236 96 Predoctoral7,8355,17167285582297188 30 Postdoctoral6,6033,8363492,119012748 66 MARC Undergraduate674626480000 0 Trainees Total12,8197,7409302,877822201112 79 Predoctoral7,2654,8116048268229676 30 Postdoctoral4,880g2,3032782,051010536 49 MARC Undergraduate67462648O000 O Fellows Total2,2931,89313997023124 17 PredoctoralS70360682901112 0 Postdoctoral1,7231,533716802212 17 - NOTE: Data from IMPAC data system was prepared by the information and Statistics Branch, Division of Research Grants, and the National Institues of Health, RTSPO/OEP/OER. About 230 positions in FY 1991 and 576 positions in FY 1992 were not coded for disciplines in IMPAC datafiles. These positions were assigned to cluster disciplines using departmental affiliations and grant titles. a Units are full time training positions (FTTPe). Short term training positions are included, but the number of appointments have been divided by four to convert to F T1 Ps. b Positions designated as Medical Scientist Training Program (MSTP) for purposes of this table are all considered to be in biomedical disciplines. c Positions supported by the National Institute of Dental Research MAR). d Positions supported by the National Institute of Nursing Research (NINR). e Positions supported by the Agency for Health Care Policy and Research (AHCPR). f Includes 42 postdoctoral kaineeship8 in 1992 for training in Primary Care Research supported through the Health Resources and Services Agency (HRSA). g Includes 58 postdoctoral traineeships in 1993 for training in Primary Care Research supported through the Health Resources and Services Agency (HRSA). 4

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EXECUTIVE SUMMARY fellows in the clinical sciences from 68 in 1993 to 160 in 1996. To achieve this expansion, we recommend that the annual number of postdoctoral trainees in the clinical sciences be decreased slightly from 2,051 to ,805 between 1993 and 1996. Studies have consistently shown that a substantial frac- tion of graduates from the MSTP program remain produc- tively engaged in research, often with greater success in securing research support than those M.D.s who pursue post-M.D. research training not leading to a doctorate (see Chapter 5~. Current support for MSTP training provides for about 820 awards. Given the success of this program in contributing workers to the national research effort, we be- lieve this program should be expanded to provide 1,020 awards by fiscal 1996. Furthermore, because of the urgent need for clinical sci- entists familiar with patient-based research techniques we urge the NIH to increase the number of postdoctoral NRSA fellowship awards from 68 in fiscal 1993 to 160 by fiscal 1996 to permit the preparation of patient-based investiga- tors. To permit the expansion of the pool of MSTP trainees and postdoctoral fellows, we believe modest reductions should be made in the number of postdoctoral awards made through institutional training grants in the clinical sciences. NIH reports that 2,051 awarders were supported in fiscal 1993 through this mechanism. We believe a gradual de- crease in the number of awards to 1,805 should occur by fiscal 1996. Remaining Fields Increase the number of awards in oral health research to 430 by 1996, in nursing research to 500 by 1996, and in health services research to 360 by 1996, to allow for their efficient absorption by the system crater which the number of awards is stabilized cat the new levels. Oral Health Research. There is an acute need for clini- cal dental researchers and oral health research workers in general. The National Research Council's 1985 report called for 320-400 new clinical dental research trainees an- nually, but the National Institute of Dental Research (NIDR) has been unable to carry out this recommendation because funds have not been available. A significant increment in training would substantially alleviate the shortage of oral health research personnel. There is need and rationale for a tripling or quadrupling the training of oral health research- ers. Realistically, however, the need is better met incre- mentally rather than abruptly. The committee recommends, therefore, Hat the total number of training positions avail- able for preparation in oral health research increase from s approximately 224 positions in fiscal 1993 to 430 positions in fiscal 1996 and remain steady Hereafter (see Chapter 6~. The MSTP program offers an integrated program of medical and graduate research training leading to the com- bined M.D. and Ph.D. degrees. The success of that pro- gram, coupled with the demonstrated success of such joint degrees as the D.D.S./Ph.D. and D.M.D./Ph.D., suggests that oral health research would benefit from the develop- ment of a Dental Scientist Training Program (DSTP) that is analogous to the MSTP under the auspices of the NRSA legislation. The committee recommends, therefore, that one-quarter to one-half of the new positions available for training in oral health research in fiscal 1994 and beyond be used by NIDR to establish a DSTP program under the NRSA act. Nursing. Win the proposed changes in health care re- form, continued development of a strong scientific base in nursing research for practice is essential to prepare advanced practice specialists to care for the rapidly changing needs of high-risk and underserved patient populations (see Chapter 74. The committee recommends that the number of posi- tions available for preparation in nursing research increase from approximately 236 awards in fiscal 1993 to 500 in fiscal 1996. These positions should be phased in on a yearly basis as properly qualified candidates and training sites present themselves. Because nursing research is a developing field of sci- ence, Here is a critical need to have an increased number of highly trained nurse researchers at He cutting edge for nurs- ing practice and health care. Support for research training must be expanded at the predoctoral level to allow further expansion at the postdoctoral level. As the number of NRSA positions increase by the year 1996, Here should be a progressive shift toward an eventual balance between the proportion of funding for predoctoral and postdoctoral sup- port. Health Serrices Research. Health services research is a relatively young field that uses interdisciplinary approaches to examine the impact of organization, finance, and use of technology on the utilization, cost, and quality of care (see Chapter 84. This field of research will need to grow sub- stantially to meet He ever-expanding demands for informa- tion by policymakers, administrators, providers, and con- sumers. The questions raised regarding what impact different proposals for health care reform will have on ac- cess, cost, and quality of care are largely questions Hat will be addressed by this field of research. To meet these needs, the committee recommends that the number of NRSA posi- tions allocated to He Agency for Health Care Policy and Research (AHCPR) increase from about 96 in fiscal 1993 to 360 in fiscal 1996. Institutional training grants permit He development of

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MEETING THE NATION' S NEEDS FOR BIOMEDICAL AND BEHAVIORAL SCIENTISTS SUMMARY TABLE 2 Committee Recommendations for NRSA Trainees and Fellows for FY 1994 through 1999. Fiscal Year TOTAL Basic Medical Oral Health Type ALL Biomedical Behavioral Clinical Scientist b Heals c Nursing d Services e of Program FIELDS Sciences Sciences Sciences Training Research Research Research 1994 RECo Total15,4159,6401,1952,975890260340 115 Predoctoral8,1755,175745895890125290 55 Postdoctoral6,5603,8354002,080013550 60 MARC Undergraduate680630500000 0 Trainees Total12,9757,7451,0402,875890200130 95 Predoctoral?,4904,81567087589010095 45 Postdoctoral4,8052,3003202,000010035 50 MARC Undergraduate680630500000 0 Fellows Total 2,440 1,895 155 100 0 60 210 20 Predoctoral 685 360 75 20 0 25 195 10 Postdoctoral 1,755 1,535 80 80 0 35 15 10 . . 1995 REC. Total 15,835 9,640 1,325 2,910 955 345 420 240 Predoctoral 8,600 5,175 825 895 955 210 360 180 Postdoctoral 6,555 3,835 450 2,015 0 135 60 60 MARC Undergraduate 680 630 50 0 0 0 0 0 Trainees Total 13,165 7,745 1,150 2,780 955 230 160 145 Predoctoral 7,730 4,815 740 875 955 130 120 95 Postdoctoral 4,755 2,300 360 1,905 0 100 40 50 MARC Undergraduate 680 630 50 0 0 0 0 0 Fellows Total 2,670 1,895 175 130 0 115 260 95 Predoctoral 870 360 85 20 0 80 240 85 Postdoctoral 1,800 1,535 90 110 0 35 20 10 1996 REC. Total 16,260 9,640 1,450 2,860 1,020 430 500 360 Predoctoral 9,010 5,175 900 895 1,020 290 430 300 Postdoctoral 6,570 3,835 500 1,965 0 140 70 60 MARC Undergraduate 680 630 SO O O O O O Trainees Total 13,355 7,745 1,260 2,680 1,020 265 195 190 Predoctoral 7,965 4,815 810 875 1,020 160 145 140 Postdoctoral 4,710 2,300 400 1,805 0 105 50 50 MARC Undergraduate 680 630 SO O O O O O Fellows Total 2,905 1,895 190 180 0 165 305 170 Predoctoral 1,045 360 90 20 0 130 285 160 Postdoctoral 1,860 1,535 100 160 0 35 20 10 a Units are full time training positions (FITPs). Short term training positions are included, but the number of appointments have been divided by four to convert to ~-~~~-rs. b Positions designated as Medical Scientist Training Program (MSTP) for purpose of this table are all considered to be in biomedical disciplines.

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EXECUTIVE SUMMARY SUMMARY TABLE 2 (continued). TOTAL Basic MedicalOral Health Fiscal Type ALL Biomedical Behavioral Clinical Scientistb Health C Nursing Services c Year of Program FIELDSSciences Sciences Sciences Training Research Research Research 1997 REC. Total 16,260 9,6401,4502,8601,020 430 500 360 Predoctoral 9,010 5,1759008951,020 290 430 300 Postdoctoral 6,570 3,8355001,9650 140 70 60 MARC Undergraduate 680 6305000 0 0 0 Trainees Total 13,355 7,745 1,260 2,680 1,020 265 195 190 Predoctoral 7,965 4,815 810 875 1,020 160 145 140 Postdoctoral 4,710 2,300 400 1,805 0 105 50 50 MARC Undergraduate 680 630 50 0 0 0 0 0 Pellowe Total 2,905 1,89S 190 180 0 165 305 170 Predoctoral 1,045 360 90 20 0 130 285 160 Postdoctoral 1,860 1,535 100 160 0 35 20 10 1998 REC. Total 16,260 9,640 1,450 2,860 1,020 430 500 360 Predoctoral 9,010 5,175 900 895 1,020 290 430 300 Postdoctoral 6,570 3,835 500 1,965 0 140 70 60 MARC Undergraduate 680 630 50 0 0 0 0 0 Trainees Total 13,355 7,745 1,260 2,680 1,020 265 195 190 Predoctoral 7,965 4,815 810 875 1,020 160 145 140 Postdoctoral 4,710 2,300 400 1,805 0 105 50 50 MARC Undergraduate 680 630 50 0 0 0 0 0 Fellows Total 2,905 1,895 190 180 0 165 305 170 Predoctoral 1,045 360 90 20 0 130 285 160 Postdoctoral 1,860 1,535 100 160 0 35 20 10 1999 REC. Total16,2609,6401,4502,8601,020430 500 360 Predoctoral9,0105,1759008951,020290 430 300 Postdoctoral6,5703,8355001,9650140 70 60 MARC Undergraduate68063050000 0 0 Trainees Total 13,355 7,745 1,260 2,680 1,020 265 195 190 Predoctoral 7,965 4,815 810 875 1,020 160 145 140 Postdoctoral 4,710 2,300 400 1,805 0 105 50 50 MARC Undergraduate 680 630 50 0 0 0 0 0 Fellows Total 2,905 1,895 190 180 0 165 305 170 Predoctoral 1,045 360 90 20 0 130 285 - 160 Postdoctoral 1,860 1,535 100 160 0 35 20 10 c Positions supported by the National Institute of Dental Research (NIDR). d Positions supported by the National Institute of Nursing Research (NINR). e Positions supported by the Agency for Health Care Policy and Research (AHCPR). 7

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MEETING THE NATION' S NEEDS FOR BIOMEDICAL AND BEHAVIORAL SCIENTISTS innovative interdisciplinary research Gaining programs, an essential feature of research in this area. However, given the anticipated growing demand for skilled specialists in health services research, the committee concludes that AHCPR should place emphasis on the award of individual fellowships in the next few years in order to encourage qualified individuals with some experience in the area of health care policy to pursue advanced training. Minority Access to Research Careers Hold Minority Access to Research Careers (MAR CJ awards constant atpscal 1993 levels, or approximate ly 680 awards, pending the outcome of the present NIH evaluation study. The NRSA program plays an important role in attracting minority group members to careers in the basic biomedical and behavioral sciences. This is achieved primarily through the MARC program (see Chapters 3 and 4~. The core of this program is the Honors Undergraduate Program launched in fiscal 1977 to support college juniors and se- niors (see, for example, Garrison et al., 1985~. In fiscal 1993 about 674 slots were set aside by NIH for preparing of MARC undergraduates, most for training in the basic bio- medical sciences. The committee is aware that NIH re- cently launched an 18-month study of the career outcomes of MARC program graduates. The committee endorses this effort and recommends a continuation of support for the MARC program at fiscal 1993 levels until the NIH assess- ment is complete. It is well documented that certain minority groups (Afri- can Americans, Hispanics, Native Americans) are vastly underrepresented in the biomedical and behavioral sciences. To address this problem, He obvious solution should be to increase opportunities for these groups to receive Gaining in biomedical and behavioral sciences. This can only be ac- complished by providing research training opportunities through such programs as MARC. It will be important that the NIH act swiftly to review and modify the size and scope of the MARC program in light of its findings. In recent years, the NIH has undertaken a number of important studies of minority research and Gaining. For example, the Office of Minority Health in 1993 reported on Phase I of an assessment of minority training programs (NIH, 1993~. This report lays out a plan of action for re- viewing NIH programs in this area and discusses the limita- tions of current NIH data collection procedures for tracking individuals who receive research and/or Raining support.3 The range of programs to be addressed by this assessment is impressive, and includes such programs as: Minority Bio- medical Research Support (MBRS), National Predoctoral Fellowship Awards for Minority Students, Minority Access 8 to Research Careers (MARC), Research Centers in Minor- ity Institutions (RCMI), and Research Supplements for underrepresented minority individuals. The committee looks forward to having more detailed information in the coming years on the outcome of these various assessments to facilitate the development of a fuller review of minority research Gaining needs and the role of the NRSA program in meeting those needs. ENlIANCING TO EFFECTIVENESS OF THE NRSA PROGRAM Flexibility in Career Training at the Postdoctoral Level Examine research training opportunities for women through the NRSA program and strengthen the role of postdoctoral support to assist women in establishing themselves in productive careers as research scien- tists. In May 1993 we convened a public hearing to invite suggestions for increasing the effectiveness of the NRSA program. Most of those testifying on the role of He NRSA program in recruiting women said Hat the NRSA program must be more flexible in He areas of reentry Paining, fam- ily leave, and geographic location of Raining sites. Com- mittee members have also been concerned, however, that there is a clear disparity between the number of women receiving NRSA Raining and the number of recipients of NIH research grants (see Chapter 9~. Women appear to be leaving science between He time they receive their doctorate and the time that they fully es- tablish themselves in a research career Back. The NRSA program can play a role in fostering He careers of these scientists. There is a need, then, to reshape NRSA awards at He postdoctoral level to encourage women to fully utilize Weir research talents. NRSA awards should allow re~ain- ing and career reentry to help women who have stopped out of research to update skills and move into emerging areas. Monitoring Progress Toward NRSA Goals Review NIH databases as management information systems and introduce changes in data collection, analysis, and dissemination to permit more elective tracking of NRSA award recipients. Emphasis should be given to the analysis of minority participation in research and training. New funds should be directed to the evaluation of NRSA program outcomes. Perhaps one of the most significant findings of this com- mittee is the general lack of information about He outcome of the NRSA program given almost two decades of support. Very little serious evaluation of the NRSA program has

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EXECUTIVE SUMMARY been undertaken through NIH support except for a few stu- dent outcomes studies undertaken by earlier NRC commit- tees. Nowhere is the need for accurate information more evident than in our inability to track the participation of underrepresented minorities in He biomedical and behav- ioral research effort. We cannot underscore strongly enough the need for follow-up information to assess program out- comes. In part, this involves the organization of existing files at NIH to permit the analysis of program outcomes (see Chapter 9~. In part, the analysis that is needed will require serious review of data collection and analytic capa- bilities at the NIH and the development of new strategies to assess program outcomes. Improving the effectiveness of He NRSA program will require attention to issues not new to the research commu- nity. However, with He inevitable changes that will occur with health care reform and budget deficit reduction, NIH may find itself in a position of justifying its support for Gaining programs. Well-designed career outcomes studies can provide the kind of feedback that is needed to assure that the NRSA program is both efficient and effective given constraints being placed on the federal funding effort. Fu- ture committees would benefit, furthermore, from more 9 studies of the impact of NRSA support on the recipient institution's total pattern of Raining support. NOTES 1. The public testimony from the hearing will be available in a sepa- rate report, through the National Academy Press, Washington, D.C. 2. In addition to the studies described here, the Director of the Nation- al Institutes of Health has also commissioned a study of NIH efforts to recruit and retain minority scientists among its intramural staff. A report on that topic is being prepared by the Directory NIH/EEO Executive Ad- visory Group. (Personal communication, 1994) 3. The NIH Minority Programs Evaluation Committee recommended changes in the NIH data system to permit more effective tracking of indi- viduals, similar to the changes recommended by this committee (see Chap- ter 9). REFERENCES Garrison, H.H., P.W. Brown and R.W. Hill 1985 Minority Access to Research Careers: Art Evaluation of the Honors Undergraduate Research Training Program. Wash- ington, D.C.: National Academy Press. National Institutes of Health (NIH) 1993 Assessment of NIH Minority Research/Trainir~g Programs: Phase I. Bethesda, MD: National Institutes of Health.

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