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APPENDIXES
i
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APPENDIX A
-
HISTORICAL OVERVIEW1
For nearly 20 years, the National Research Council
(NRC) has played an active role in the ongoing review of
training opportunities available to individuals seeking ad-
vanced preparation in the biomedical and behavioral sci-
ences. During this time, the NRC has issued nine reports
which describe the optimal structure of the National Re-
search Service Awards Program (NRSA) given national re-
quirements for health-related research scientists and avail-
able training opportunities.
The historical summary that follows reports information
in three areas: (1) a brief history of NIH support for re-
search training in the biomedical and behavioral sciences,
including trends in support of the NRSA program; (2) an
overview of the analytic contributions of previous NRC
study committees; and (3) a summary of findings from stud-
ies evaluating the outcomes of the NRSA program con-
ducted under the auspices of previous NRC committees.
LINKING HEALTH RESEARCH WITH TRAINING
The National Institutes of Health (NIH) were authorized
as early as 1930 to support the training of health scientists.
Specifically, Public Law 71-251, the "Ransdell Act", for-
mally established the "National Institute of Health" as a
federal agency and directed the agency to recognize the
training of scientists as one of its major responsibilities.
Under the terms of the Act, individual scientists could be
designated to receive "fellowships" for duty at the National
Institute of Health or to conduct investigations at "other
localities or institutions in this and other countries"
(Lenfant, 19894.
It was the enactment of the National Cancer Act of 1937
(P.L. 75-244) that established the first disease-specif~c in-
stitute at NIH and led to the formation of the fast major
program of fellowship support by the U.S. government. The
95
National Cancer Act instructed the NIH to provide stipends
or allowances to "the most brilliant and promising research
fellows from the United States or abroad ... for training and
instruction in technical matters relating to the diagnosis and
treatment of cancer" (P.L. 75-244~. Initial training efforts
focused on postdoctoral research fellows and clinical train-
ing for physicians "to improve their capability in diagnosis
and therapy" (Ahrens, 1992~.
Federal interest and involvement in biomedical and be-
havioral research increased dramatically after World War II
largely as a result of the demonstration during the war of
the immediate and beneficial impact of well-organized ba-
sic and clinical research in meeting "national needs" (NRC,
1976~. Congress concluded that human health and well-
being of all Americans would benefit from the infusion of
substantial sums to support research conducted by highly
skilled investigators, and the Public Health Service Act of
1946 (P.L. 79-487) provided explicit authority for grants to
support the training of research scientists. Thus, with the
establishment of each institute, the authority was granted
for the institute to train individuals in the diagnosis, preven-
tion and treatment of disease. The fundamental assumption
which links federal responsibility for research to a responsi-
bility for training is that the quality of research depends on
the talents of individuals attracted to a career in research.
Initially, the scientists needed for the health research ef-
fort were trained at the postdoctoral level, either as a result
of attracting scientists from other fields to new subject areas
or as a result of a need to further hone the skills of talented
graduates. However, owing to the increasing demand for
well-prepared research scientists, federal interest in the
training of biomedical and behavioral scientists expanded
in the 1950s to include the support of graduate students at
the predoctoral level. "Grantee institutions" were permitted
significant latitude in the management of predoctoral train
OCR for page 96
APPENDIX A
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96
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OCR for page 97
APPENDIX A
ing grants being allowed to select trainees without prior
review by the National Institutes of Health. Thus, in the
1950s, the basic pattern of the "institutional training grant"
was developed. Over the years, the expansion of the na-
tional biomedical and behavioral research effort and the at-
tendant demand for scientists and teachers led the NIH train-
ing effort to expand even further. By 1969, the number of
trainees supported under the original training authority
reached 16,000 in that year alone:
By 1971,19IH training grants and fellowships supported or
assisted 37.5 percent of the nation's full-time graduate stu-
dents in the medical sciences and 21 percent in the life sci-
ences. However, in its presentation of the fiscal year (FY)
1974 budget, the administration made an attempt to elimi-
nate the award of all new training and fellowship grants
(Lenfant, 1989~.
Of the 13,000 NRSA positions that were awarded in FY
1992 by NIH and ADAMHA, the great preponderance were
as trainees on NRSA institutional training grants (84 per-
cent) (Figure A-1~. Only 2,200 or 16 percent of the awards
were made as fellowships.4
Predoctoral fellowship support was restricted to just over
500 recipients and these primarily in the behavioral sci-
ences and health services research. At the postdoctoral level
fellowships represent about one-quarter of all awards ~ig-
ure Am.
The overall budget for NRSA support has grown in real
or current dollars (Figure A-3) but remained steady in con-
stant dollars. As a share of the NIH/ADAMHA R&D bud-
get, NRSA support has declined from a high of about 9
percent in 1980 to about 5 percent in 1993 (Figure A-4.
Total Positions = 13,890
Congress responded by creating a new training author
ity: the National Research Service Award Act of 1974 (P.L.
93-3484. With this act, Congress established a new pro
gram of support for advanced study in the biomedical and Fellow_
behavioral sciences. This program differs from otherpro- (2;6%
grams of federal support in important ways. Perhaps most
important is the notion that the National Research Service
Award (NRSA) augments federal support for "graduate re
search assistance" by restricting awards to "only those sub
ject areas for which there is a need for personnel". Thus,
the NRSA program did not spring full-blown in 1974; it
represented a dramatic new direction in a long history of
federal support for the training of health scientists. Total - 7,495
The NRSA Program Fellows~
in.. ,,. ~ ....
When the National Research Service Awards program
was established in 1974, a "novel element" (NRC, 1975)
was introduced into federal programs of support: the legis-
lation stipulated that these awards should be restricted to
subject areas for which there is a need for personnel. Sub-
sequently, amendments to the National Research Act of
1974 and administrative reorganization led to the addition
of such fields of advanced research preparation as nursing
research and primary care research.
In 1976, the National Institutes of Health and the Alcohol,
Drug Abuse and Mental Health Administration (ADAMHA)
together provided 11,550 research training positions through
the NRSA program (Table A-1. The program peaked ini-
tially at 12,830 awards (in FY 1978) and declined to a low
of 11,450 awards in 1986. Since 1986, the program has
expanded to its current estimated level of 14,000 awards in
FY 1993. Recommendations from He National Research
Council throughout this period have generally called for a
larger program of support than that provided by the U.S.
Congress, although certain detailed recommendations have
often been adopted by NIH/ADAMHA.3
97
1 1~ Fellows (2,201 )
| HI Trainees (11,689) |
FIGURE A-1 Number of research training positions on NIH and
ADAMHA fellowships and training grants, FY 1992. SOURCE:
National Institutes of Health, special tabulations, 1993.
Fellows f ~$ ~-
( 1, 674) go I; ~ $:
26% ~ ~ ~
\~ ~ Trainees ~ ~ ~ Trainees
\: ~ ~ (6 989) ~ ~ ~ ~ ~ ~ ~ ~? (4 721 )
a 93 % ~~ ~ 74 %
FIGURE A-2 Number of fellows and trainees as a proportion of
all predoctoral and postdoctoral NIH and ADAMHA training po-
sitions, FY 1992. SOURCE: National Institutes of Health, special
tabulations, 1993.
$300
~ _
._ /~
.~$200 ~ ~ /~~~ constant dollars
$100 - -
$0 ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~me
'76 '77 '78 '79 '80 '81 '82 '83 '84 '85 '86 '87 '88 '89 '90 '91 '92 '93
FIGURE A-3 NIH and ADAMHA research training budget, FY
1976-1993. NOTE: Current dollars are estimated. Constant dol-
lars are based on the Biomedical Research and Development Price
Index. SOURCE: National Institutes of Health, special tabula-
tions, 1993.
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APPENDIX A
lo%
8%
' it\
'80 '81 '82 '83 '84 '85 '86 '87 '88 '89 '90 '91 '92 '93
FIGURE A-4 NIH and ADAMHA Paining budget as a percent-
age of the budget for extramural research and development grants
(estimates). SOURCE: National Institutes of Health, special tab-
ulations, 1993.
ESTABLISHING TEIE SCOPE
OF TEIE NRSA PROGRAM
The National Research Council has played an active role
in advising the National Institutes of Health and the U.S.
Congress on the appropriate mix of NRSA support given
national needs for research scientists and employment op-
portunities. The NRC has provided this advice since the
enactment of the National Research Act of 1974. Nine re-
ports were issued between 1975 and 1989.
The 1975 report provided definitions for He key con-
cepts basic to this study training grants, fellowships, insti-
tutional support, end predoctoral end postdoctoral training-
and discussed their relationship with the quality of
biomedical and behavioral research conducted in this coun-
try. A short history of the relevant federally supported pro-
grams was provided along with a summary of career out-
comes of former trainees and fellows who participated in
them.
The committee's second report (1976) assessed the cur-
rent academic labor market and near-term outlook for bio-
medical and behavioral scientists. In most of these fields,
the committee found that an ample supply of Ph.D.s was
available. In fact, because the rate of grown in biomedical
and behavioral research and development (R&D) expendi-
tures had slowed perceptibly since 1968, and because col-
lege enrollments were expected to stabilize by 1980 while
Ph.D. production continued at a high level, the committee
concluded that a slower rate of growth in labor force in
these fields was advisable. Accordingly, the committee rec-
ommended a modest reduction in the number of federally
supported predoctoral students in the basic biomedical and
behavioral areas.
Postdoctoral support, the committee believed, should be
held constant in the basic biomedical sciences and increased
in other areas. In the behavioral sciences, the recommended
shift to predominantly postdoctoral training represented a
significant reorientation of federal support and graduate
Gaining patterns in this area. This recommendation was
98
developed partly in response to the growing need for more
specialized investigators capable of dealing with He increas-
ingly complex research questions in the area of behavior
and health. On the other hand, the clinical sciences area
was seen as needing increased support to help stimulate the
flow of M.D.s into clinical research careers. These initial
recommendations were intended to remain in effect until
the committee' s impressions about the market could be con-
f~ed or modified by further analyses and additional data.
In 1977, the committee found evidence that newly trained
biomedical and behavioral Ph.D.s were encountering in-
creasing difficulty in obtaining permanent faculty positions.
The number of these Ph.D.s on postdoctoral appointments
(which the committee considers to be temporary positions)
had been rising at a rate of over 13 percent per year between
1972 and 1975 in He biomedical sciences. Furthermore,
the committee's 1977 Survey of Recent Doctorate Recipi-
ents showed that more than 40 percent of these postdoctoral
appointees in biomedical fields had prolonged their appoint-
ments because they could not find suitable employment.
These indications of a tight job market facing new Ph.D.s in
these fields prompted He committee to recommend an addi-
tional 10 percent reduction from the number of predoctoral
trainees in the biomedical sciences supported by He federal
government in 1976. The postdoctoral recommendation
was unchanged.
Certain fields within the basic biomedical sciences ex-
hibited evidence of better-than-average employment pros-
pects and were cited as exceptions to the recommendation
for reduced predoctoral support. The fields of biostatistics/
biomathematics and epidemiology showed no postdoctoral
holding pattern and appeared to be attracting people from
closely related fields, such as statistics, that are outside the
biomedical sciences. For these fields, the committee rec-
ommended no reduction in predoctoral support levels.
In its 1977 report, the committee presented for the first
time a systematic treatment of health services research train-
ing needs, providing a definition for this emerging research
area and a preliminary list of training difficulties that face
it. In addition to calling for a continued expansion of mental
heals services research Gaining, primarily at He predoctoral
level Trough the programs of Alcohol, Drug Abuse, and
Mental Health Administration (ADAMHA), the committee
called for an extension of He NRSA authority to permit
training in the general area of health services research espe-
cially through the programs once provided by the National
Center for Health Services Research (NCHSR).
Nursing research training was officially brought under
the purview of the study by amendments made to the NRSA
Act in 1976 (~e Health Research and Health Services
Amendments of 1976 or P.L. 94-278~. In its 1977 report,
He committee provided He results of its survey of nurses
who had completed Heir doctoral Gaining between 1971
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APPENDIX A
and 1975. The findings suggested that opportunities for
employment for doctorally trained nurses was favorable, and
led the committee to suggest an expansion of research train-
ing support, predominantly at We predoctoral level.
The committee's 1977 report also discussed the issues of
mid-career training and the participation of women and mi-
norities in biomedical and behavioral research; the adminis-
trative problems of the three-year limit on awards, the
payback provision, announcement fields, and
multidisciplinary awards; the education and training pro-
cess by which most biomedical and behavioral scientists are
produced; and the importance of federal support in sustain-
ing the research training system.
Most training grant programs were originally focused on
the apparent need for increasing the number of well-trained
research personnel. However, in developing a stable con-
tinuing policy for government support of training programs
in the biomedical sciences, the 1978 NRC committee con-
cluded that it is essential to consider over effects that may
be less obvious than the contribution of mere numbers.
Many experienced observers believe, for example, that
training grants have been just as important in improving the
quality of Raining as in providing for increased numbers.
The 1978 study committee identified four important uses
of the institutional training grant: first, one of He most
important uses of training grant funds is to provide research
equipment and supplies for use by the trainees. Research
training is unlike many other forms of education in that it
cannot be learned solely from books. Much biomedical
research depends also upon He availability of specialized
apparatus, costing in the tens to hundreds of thousands of
dollars.
Many of these instruments require special training for their
use, and it is the custom in good training laboratories to
assign a high level technician to protect the apparatus from
misuse and train the graduate students and visiting investi-
gators in its proper handling. Such personnel are often at
least partially paid from training grants and certainly play
an essential role in the training process (NRC, 1978~.
Second, training grants have almost certainly improved
the quality of training by providing a portion of the salaries
for additional faculty members. One of the major purposes
of training grants has been to encourage interdepartmental
training programs.
The field of genetics provides an excellent example. In
many institutions the geneticists may be found in several
departments-plant geneticists in the botany department,
animal geneticists in the zoology department, insect geneti-
cists in the department of entomology, bacterial geneticists
in the department of microbiology, and medical geneticists
in the medical school and in universities with an agricul-
tural college, they may be found additionally in the depart-
ments of agronomy and plant breeding. In many institu
99
lions, training grants have served to bring such scattered
teachers together to provide broad training to graduate stu-
dents and postdoctoral fellows in important fields that tran-
scend departmental boundaries. More often than not, how-
ever, some important disciplines may be missing, and
training grant funds may be used to fill the gap on either a
permanent or visiting basis (NRC, 1978~.
The need for such additions to faculty is particularly impor-
tant in rapidly advancing fields.
Third, training grants contribute to excellence simply by
providing an increased number of graduate students to a
high-quality department. By careful adjustments of such
support, a more equitable distribution of students may be
effected without any net overall increase in numbers.
Fourth, there has been so much discussion, bow among
the public and in the Congress itself, about improving sci-
entific communication, that perhaps one need only mention
the importance of training grants in providing for the pur-
chase of essential printed materials and forwarding the in-
formation communication which is a critical part of He sci-
entific process.
Some special issues were addressed by the committee
during the 1980s. For example, it explored the value of the
Paining system in He biomedical sciences and also the at~ac-
tion of women and minorities to the biomedical sciences.
Value of the Training System
In the 1983 report, the committee explored the value of
NIH ~aineeships and fellowships by surveying the careers
of past recipients. As expected, those supported by these
highly coveted competitive awards had achieved an admi-
rable level of success. In general, they attained their de-
grees in less time, won postdoctoral awards more often,
showed greater research productivity and experienced less
difficulty in He job market than other scientists. Clearly,
He committee felt, He awards programs contributed substan-
tially to developing a cadre of highly capable investigators.
Attraction of Minorities to Careers in
Biomedical Research
The Minority Access to Research Careers (MARC) pro-
gram was created by the National Institute of General Medi-
cal Sciences (NIGMS) in 1977 to attract talented minority
students to the biomedical sciences. In the 1985 report, at
He suggestion of NIGMS, the committee evaluated the
MARC Honors Undergraduate Research Training Program.
(See also Garrison, et al., 1985.) The committee reported
that the program provides special training and research op-
portunities to selected juniors and seniors at colleges and
universities with substantial minority enrollments. The 800
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APPENDIX A
alumni of Be program had achieved an excellent record of
success, including a number of publications by undergradu-
ate trainees. More Han 76 percent of MARC trainees went
on to some form of graduate training, and nearly half pur-
sued doctorates. Although most pursued medical or dental
degrees, more than a third of the trainees responding fore-
saw careers in research. All but a handful expected to pur-
sue careers related to science or engineering.
Attraction of Women to Careers in
Biomedical Research
The 1989 report expanded the committee's consideration
of groups underrepresented in Be research pool to include
women. Although the number of women receiving Ph.D.s
had increased more rapidly than any racial or ethnic minor-
ity except Asians, women remained markedly
underrepresented among full-time research scientists. Non-
Asian racial minorities showed even greater
underrepresentation, by factors as great as 6 or 7. Such
underutilization of the nation's pool of talent seemed par-
ticularly regrettable in light of the dramatic improvement in
the market for biomedical researchers, driven by rising de-
mand in industry. The committee explored various possible
reasons for these discrepancies.
EVALUATING THE NRSA PROGRAM
The National Research Service Award Act of 1974 poses
questions of program outcome as part of He continuing
study of national needs. Here the focus is on knowing what
happens to awardees (e.g., Are they engaged in health re-
search careers?. Questions concerning program effective-
ness also are implied in the legislative authority. During 20
years of study, NRC committees assessing national needs in
this area have looked occasionally at the matter of career
outcomes and questions of program effectiveness. Chief
findings are summarized in the pages that follow.
Predoctoral Training for Ph.D.s
Three major studies examined outcomes associated with
NRS A-sponsored predoctoral training (Coggeshall and
Brown, 1984; National Research Council, 1976, 1977~. In
general, He results indicated that NIH awardees distinctly
outperformed Heir comparison groups in terms of greater
involvement in research (e.g., receipt of additional
postdoctoral research training, time spent in research, and
grant application/award activity). These individuals also
had somewhat better track records in carrying out high qual-
ity research (as measured by citations). Similar to the re-
sults of previous studies on the determinants of academic
careers (Long et al., 1979; McGinnis and Long, 1988),
100
awardees did not experience any greater success in locating
academic employment, once prestige of doctoral institution
had been controlled.
A more recent study (Coggeshall and Brown, 1984) of
NIH predoctoral awards also attempted to, at least partially,
control for the heterogeneity of training experiences and
selectivity. Looking at those individuals who received their
Ph.D.s in He biomedical sciences between 1967 and 1981,
three study groups were compared: (1) those who received
at least 9 months of NIH predoctoral support; (2) Hose who
earned their degree from the same departments as the first
group but who received 0-8 months of NIH support; and (3)
those who graduated from departments that did not have
NIH training funds. This strategy permitted two important
considerations: (1) those departments receiving NIH funds,
often the top-ranked departments in the biomedical sciences,
apply the same criteria to accept students, and thus their
source of predoctoral support, may be more similar in terms
of individual differences (e.g., abilities); and (2) that stu-
dents who are in departments with NIH funding programs
but who are not supported by these funds for an extended
length of time may benefit from certain resources accruing
to NIH-supported departments.
Postdoctoral Research Training for Ph.D.s
Three major studies have focused on identifying the out-
comes of NRSA-supported postdoctoral training, primarily
those of biomedical scientists. In general, Dose with
postdoctoral training, regardless of sponsor, outperformed
on all measures compared to Rose who were supported for
their predoctoral education but who did not choose to pur-
sue additional postdoctoral study.
More recent examinations of NIH postdoctoral training
in the biomedical sciences have been carried out for 1967-
1977 Ph.D. recipients (NIH, 1986) and for 1961, 1966,
1971, and 1976 Ph.D. recipients in the biomedical sciences
(Garrison and Brown, 1986~. Here He major comparison
groups were (1) NIH postdoctoral trainees and fellows, (2)
Ph.D.s who had likely received postdoctoral training from
other sponsors, and (3) those who reported no plans for
postdoctoral study at the time they received Heir degree.
Substantial differences emerged between NIH postdoctoral
awardees and those who indicated no plans for postdoctoral
study; for example, Garrison and Brown (1986) found that
NIH awardees were Free times as likely as the "no plans"
group to have applied for NIH/ADAMHA research grants
(56.9 percent versus 19.6 percent) and four times as likely
to have been awarded a grant (40.0 percent versus 9.2 per-
cent). This latter difference was reduced somewhat when
only those who applied for grants were considered (70.3
percent of NIH awardees versus 47.1 percent of "no plans"
groups). They also were more likely Han Hose with no
OCR for page 101
APPENDIX A
postdoctoral training to have obtained faculty appo~nunents
8-9 years after the Ph.D. (66.7 percent versus 52.7 percent)
and, depending on He specific cohort examined, to have
published more articles and received more citations per ar-
ticle. A study by NIH (1986) revealed similar findings in
terms of academic employment and research funding activity.
As Garrison and Brown (1986) found, NIH awardees
continued to outperform in terms of grant application activ-
ity those individuals whose postdoctoral training was sup-
ported via another source (56.9 percent versus 34.5 per-
cent). Also, they were more likely to have been awarded a
grant (40.0 percent versus 22.3 percent). This disparity de-
creased substantially, however, when considering only Hose
applying for such grants (70.3 percent versus 64.8 percent).
There did appear to be some advantage in terms of aca-
demic employment; tile percentage obtaining a faculty posi-
tion was 66.7 percent for NIH awardees as compared to
56.7 percent for those with other types of postdoctoral ~ain-
ing, but consonant win previous research McGinnis et al.,
1982), this relationship could be primarily accounted for by
other factors (e.g., prestige of doctoral institution). Similar
results were reported by NIH (1986~.
Postdoctoral Training for M.D.s
The role of postdoctoral training for M.D.s was exam-
ined by the three studies discussed in the preceding para-
graphs. However, He difficulty in interpreting the results
resulting from problems encountered in drawing comparison
groups resembling in both orientations and experiences
M.D.s with NRSA-supported, postdoctoral research train-
ing-is exacerbated by the fact Hat He vast majority of
physicians do not follow research careers. In addition, iden-
tifying reasonable comparison groups in these retrospective
studies is furler complicated by He fact that existing data-
bases for physicians typically are less complete than those
for Ph.D. recipients.
Differences between M.D.s with postdoctoral appoint-
ments and those without postdoctoral Paining, some of
which appear to be substantial, were found by the National
Research Council (1976) for certain outcomes: employ-
ment in medical schools and universities (40.9 percent ver-
sus 7.4 percent, respectively); the average amount of time
reported in conducting research (10.6 percent versus 2.6
percent); and numbers of publications and citations (e.g.,
586.6 citations versus 10.3 citations per person for M.D.s
aged 41-50~. By the use of additional comparison groups, a
strong relationship between the existence and length of for-
mal research training and outcomes also appeared a rela-
tionship Cat has been supported by analyses of more recent
trainees (Levey et al., 1988; Sherman, 1983a, 1983b, 1989~.
In addition to the M.D. groups specified above, two other
groups were identified: individuals who had earned both an
101
M.D. and a Ph.D. and who had or had not received
postdoctoral Paining. With the exception of average time
spent in research, the results showed a ranking among these
groups in line win He amount of research training received.
For example, the proportions employed in academic set-
tings were 67.5 percent for M.D./Ph.D.s with postdoctoral
appointments, 60.4 percent for M.D./Ph.D.s who did not
pursue postdoctoral study, 40.9 percent for M.D.s who had
NIH-supported postdoctoral appointments, and 7.4 percent
for M.D.s with neither a Ph.D. nor postdoctoral training.
On each of He four measures used in the study, He perfor-
mance of M.D./Ph.D.s, regardless of whether they had been
engaged in postdoctoral study, was higher than for those
M.D.s who did not possess a Ph.D.
The two remaining studies tried to draw comparison
groups that addressed in some way selectivity issues. Rawer
than looking only at all M.D.s without postdoctoral ~ain-
ing, Garrison and Brown (1986) also identified another
group of M.D.s who received Heir degree in 1965 or 1974,
who reported Heir primary activities to be "research" or
"paining," but who had not received postdoctoral research
training. Looking at 1974 M.D.s only, Here were differ-
ences between this group and NIH postdoctoral trainees and
fellows. For example, those M.D.s win NIH-supported
postdoctoral Gaining also were slightly more likely to have
applied for NIH/ADAMHA research grants (18.6 percent
versus 12.0 percent) and subsequently been awarded fund-
ing (8.7 percent versus 5.5 percent).
A comparison of these outcomes between M.D.s who
had NIH postdoctoral fellowships and those who had un-
successfully applied for these fellowships was performed
by the NIH (1986~. Although both this study and He Garri-
son and Brown (1986) study demonstrated that NIH fellows
comprise a small and select group of M.D.s with NIH
postdoctoral awards, this comparison is instructive, although
still equivocal, in that it attempts to address some issues of
selectivity. Looking at 1986 and 1971 M.D. recipients, the
National Institutes of Health found that NIHfellows consis-
tently outperformed their unsuccessful applicant counter-
parts in terms of medical school faculty appointments (65.1
percent versus 43.5 percent) and NIH/ADAMHA applica-
tion activity (27.4 percent versus 19.4 percent). Of those
who applied for grants, 59.1 percent of He fellows versus
33.3 percent of He unsuccessful fellow applicants received
an award.
In general, all of the previously described studies on
predoctoral and postdoctoral training have contributed to
our knowledge about certain accomplishments of NRSA
awarders. Because of unresolved problems with selectivity
and heterogeneity of training experiences, however, no de-
finitive evaluation study has yet been undertaken to provide
strong evidence for the absolute effect of NRSA training on
career outcome.
OCR for page 102
APPENDIX A
NOTES
1. Material for this section has been drawn from a variety of sources,
including work commissioned by the study committee in 1992 and pro-
vided by Ms. Judith Grumstru~Scott and Ms. Beryl Benderly. Sections
have also been drawn from previous NRC study committee reports, most
notably that of the 1978 study committee. The last section on evaluation
issues is drawn from a paper by Dr. Georgine Pion commissioned by the
1989 NRC study committee.
2. In October 1992, the research components of the three institutes of
ADAMHA joined the National Institutes of Health.
3. For example, earlier study committees called for a shift from
predoctoral to postdoctoral support in the behavioral sciences, which has
occurred.
4. The relative diminution of the fellowship mechanism within the
NRSA program is an interesting feature of the history of the NRSA pro-
gram. The 1974 authorization specified that not less than 25 percent of
total support should be directed to fellowship support; the fraction has
declined to 15 percent in recent years.
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