classmates who do not have NRSA support, because this funding allows them to concentrate on their studies, rather than on teaching duties or their mentor's research.

NRSA fellowship holders, whether at the pre- or postdoctoral level, are provided a level of independence not generally experienced with other mechanisms of support. Applicants for fellowships choose their own mentors and projects, and those who ultimately receive awards have greater control over their time than do their counterparts who work on research grants. Applying for a fellowship, furthermore, provides students and postdoctorates the opportunity to gain experience in preparing a proposal and to become familiar with the application process itself—an important preview of life as an independent investigator.

On the whole, respondents believed that the NRSA program provides its participants with a good start on a research career. As one letter writer reported, “We can place trainees in the very best postgraduate programs or faculty positions.” Another maintained that most trainees go into academic research careers and that NRSA recipients in clinical fields often stayed in research, even if only part-time.

Beyond the direct effect on funding recipients, the NRSA program is widely thought to enhance the overall quality of training in the biomedical and behavioral sciences. The requirement for instruction in the responsible conduct of research, for example, often prompts institutions to provide ethics training to all students. Likewise, training grants may provide funds for retreats, seminars, and other activities that benefit all students and contribute to creating a “community of scholars.” The prospect of competing for training grants and fellowships, furthermore, motivates all applicants to strive for excellence, even if they do not obtain an award.

PROGRAM IMPROVEMENTS

While respondents praised the NRSA program on the whole, they also had suggestions for improvement, most of which centered on program funding. The most common recommendation was that stipends be increased. [Note: In November of 1998, following the completion of the public comment process, the National Institutes of Health, the Agency for Healthcare Research and Quality, and the Health Resources and Services Administration announced that stipends for NRSA awards made in fiscal year 1999 would increase by approximately 25 percent for trainees and fellows at all levels of experience.] Respondents also suggested that the number of trainees and fellows be expanded, that the length of awards be increased, and that funding for various aspects of the program (e.g., health insurance and tuition) be improved.

In making the case for a stipend increase, respondents often cited the other research training options and career paths available to students and fellows. Outside the NRSA program, graduate students receive higher stipends with a National Science Foundation Graduate Research Fellowship and may earn more and receive greater benefits working as a research assistant. One respondent noted that students in his department generally prefer research assistantships to NRSA funding because their compensation as a research assistant is higher.

At the postdoctoral level, one respondent called for stipends to be increased to the level of salaries for postdoctorates working on the National Institutes of Health (NIH) campus. Others recommended that stipends for health care professionals should be comparable to what M.D.s earn as residents, for example, or what nurses earn in practice. In addition to increased stipends, a number of respondents suggested loan forgiveness for physicians and dentists, so that they would not feel compelled to forgo a research career in order to pay back their educational debt.

A number of respondents called for stipends to be indexed to inflation or the cost of living in a particular area. One writer complained that stipends were too low to support someone living in Los Angeles; another made the same observation about the difference between the stipends and the cost of living in New York City.

The comments about educational payments for NRSA trainees and fellows echoed those made about stipends: They should be increased. Most respondents believed that NRSA reimbursement for tuition is too low, which forces institutions to accept significant cost sharing. On this point, however, there was less consensus than on the subject of stipends. A few commentators suggested that universities have a responsibility to support some tuition costs or even waive tuition for NRSA recipients.

In addition to increasing stipends and tuition reimbursement, another common suggestion was to increase the number of participants and extend the length of their tenure. In particular, some thought that training grants and fellowships should be granted to a wider range of



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