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RECOMMENDATIONS In developing its recommendations, the Committee was guided by the principles described on pages 37 through 40 and its experience with bio- medical and behavioral training. The available quantitative data were studied, but at the present time it is not possible to derive needed train- ing levels (numbers of people to be trained) simply from quantitative in- formation. More can, and will, be done to improve the data base and its interpretation. Some directions that this effort will take are described in the last two sections of this chapter and in Appendix D. In addition, the Committee is looking forward in the year ahead to obtaining informa- tion about recommended future levels of biomedical and behavioral research support from the report of the President's Panel on Biomedical Research. In the view of the Committee, the most important principle under- lying its recommendations concerning training is the importance of main- taining or increasing the quality of biomedical and behavioral research. It is important to attract able people into these-research fields and to make it possible for the most promising to obtain the best possible educa- tion and research experience at pre- and postdoctoral levels, independent of their own personal resources. In order to maintain high-quality train- ing environments, it is also necessary for the universities, as well as the students, to have sufficient stability to make sound plans. The country also has a large stake in the quality of the postdoctorate in the pool, supported as trainees and fellows, and must be careful in developing plans that would alter the nature and size of this pool. A. TRAINING RECOMMENDATIONS The Committee recommends that federal training support be maintained in FY 1976 across the fields of the biomedical and behavioral sciences at the levels that prevailed in them in FY 1975. By "levels" we mean numbers of people to be trained. Points 1-8 deal with the special requirements for training in the four broad fields, by predoctoral and postdoctoral categories. Point 9 summarizes the Committee's understanding of the numbers of trainees and fellows that its general recommendation calls for. Point 10 concerns the division of support between fellowships and training grants.1 resee page 20 for definitions of such terms as "fellowship," "training grant," etc. 1

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1. Predoctoral training in the basic biomedical sciences Since the training of graduate students adds to the nation's stock of basic bioscience research personnel, the Committee has addressed the question of the appropriate rate of training of doctoral candidates in these fields. The demand for additional doctoral scientists is going to depend upon the research programs of the National Institutes of Health and other government agencies, expansion of research in industry, the development of government programs for improvement of the environment, and personnel requirements related to quality standards on food, drugs, water, and medical treatment. Some guidance as to appropriate levels will come from the recommendations of the President's Panel on Biomedical Research concerning future levels of biomedical research. However, it appears now that unless there is significant expansion of biomedical research supported by government and industry and significant rates of departure of individuals from biomedical research into teaching, admini- stration, and other non-research activities, future predoctoral train- ing levels may need to be reduced from current levels in some of the basic bioscience fields. The Committee does not feel that it can make specific recommendations about~predoctoral training levels in specific fields of the basic biosci- ences until these matters have been studied in greater detail during the next year. It does not believe that the aggregate predoctoral training levels in these fields should~be increased above the levels of FY 1975, although there may be need for flexibility in adjusting among subfields. Some suLfields may need somewhat higher levels of training, to be com- pensated by somewhat lower levels in the other subfields. The NIH Medical Scientist Program, under which support is given to persons who wish to acquire both M.D. and Ph.D. training in preparation for medical research, deserves special note. Although this is still a relatively small program, it gives evidence of being an important component of the training spectrum. The program provides an im- portant "middle ground" in the training spectrum. The Committee believes that support for this program should be maintained and the feasibility of its expansion, under present high standards of excellence, should be explored by NIH so that that possibility can be considered by the Com- mittee in preparation for the 1976 report. 2. Postdoctoral training in the basic biomedical sciences - The Committee emphasizes the importance of postdoctoral training support in the basic biomedical sciences. Postdoctoral training for Ph.D's is essential for the quality of the present and future biomedical 2

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research enterprise. Support of postdoctorate does not increase the man- power pool, but provides for its improvement and for diversification into more applied areas of special importance. In many of the basic biomedical sciences, long training experience is required for those who will make significant contributions in specialized fields, and for others, post- doctoral training provides the breadth needed for research in more applied areas. In particular, this mechanism provides a way of supporting ne- glected or emerging fields which may, in fact, have great potential for new approaches to the solution of important recalcitrant medical problems. Postdoctoral training for M.D.'s provides them the opportunity to enter areas of basic bioscience research with the perspective of a medical education and health-care experience. Predoctoral training in the basic bio- sciences usually lasts about seven years, but postdoctorate often achieve their training goals in two years. Thus postdoctoral training programs pro- vide the means for preparing researchers more rapidly for emerging and re- cently recognized priority areas. In addition, postdoctorals do research and add to knowledge in their fields. 3. Predoctoral training in the behavioral sciences NIH and ADAMHA training grant programs have a relatively modest effect on the total numbers of research doctorates produced each year in psychology and other behavioral sciences because only a small percentage of the current doctoral candidates are supported in this way. However, NIH and ADAMHA train- ing grants support a large fraction of the doctoral candidates in certain areas of the behavioral sciences such as anthropology, behavior/ethology, and soci- ology that are of special interest for the objectives of certain programs of NIH, ADAMHA, and HRA. The needs for federal research training support in the behavioral sciences should therefore be judged in relation to the requirements for behavioral research in areas relevant to current national health objectives e ~ . . In order to have strong national research programs In areas sucn as drug abuse, alcoholism, and mental health, predoctoral training should be provided in areas that are especially important for these national pro- grams. In addition, there should be training for the purpose of increas- ing the application of behavioral science methodology to general medical problem areas and the delivery of health care as more emphasis is directed properly to long-term degenerative processes and to effective societal adjustment. Such training grants can attract able students into basic areas that are important for future research on this class of national problems 4. Postdoctoral training in the behavioral sciences . Postdoctoral training provides the opportunity to attract Ph.D's and 3

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M.D.'s into behavioral research basic to improving mental health and attacking effectively problems of drug abuse and alcoholism, and to give training in applied or problem-oriented research to basic behav- ioral scientists. Further studies will be made of the needs for be- havioral scientists in research programs of interest to NIH and ADAMHA. 5. Predoctoral training in the clinical sciences This is a small and rather specialized form of training but provides an opportunity to involve pre-Ph.D. as well as pre-M.D. students in work on clinical research problems. Because of difficulties of classifica- tion, this area of predoctoral research training is not clearly separable from predoctoral basic biomedical science research training and so will not be considered separately here. 6. Postdoctoral training in the clinical sciences The National Research Service Award Act is designed primarily to provide training for research and is not intended for the specialty training of clinicians for the practice of medicine. This limitation may make it possible to reduce the number of trainees in this area, but the facts are not yet sufficiently clear to the Committee that it can feel confident of specific recommendations for reductions. At the pres- ent time, medical students are showing increased interest in medical prac- tice rather than careers in research, and so current programs for research training in clinical sciences may be undersubscribed as compared with re- cent past training levels, and there may be no need for deliberate re- straining action. There is a common misconception that the number of M.D. researchers is excessively large; the Committee can find no evidence to support this notion. In view of the importance of clinical research and the need to attract capable M.D.'s into the field, the Committee is not prepared to suggest spe- cific reductions at this time. 7. Predoctoral training in health services research This relatively new area, 2 represented primarily but not exclusively by the HRA, has special importance for national health policy. It involves 2Improving Health Care through Research and Development. A report of the Panel on Health Services Research and Development of the President's Sci- ence Advisory Committee, Office of Science and Technology. U. S. Govern- ment Printing Office, March 1972. 4

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economics, sociology, statistics, and other disciplines, but the needs for predoctoral training programs cannot be judged simply in terms of the annual doctorate productions in these fields. Health services re- search necessarily requires a multidisciplinary approach. In order to assure that training in this area is of high quality, there is a need for a limited number of oredoctoral training programs. Since this is a new area of recognized national need, there is the temptation to build up programs too rapidly. The Committee suggests that training programs emphasize postdoctoral training somewhat more than predoctoral until the future demands for such research personnel become clearer. This is not a single field, and a wide diversity of training grant programs needs to be developed. HRA and professionals in this area have an obligation to develop plans and objectives which can be examined in terms of needs for training programs. 8. Postdoctoral training in health services research Postdoctoral training programs offer the opportunity for attracting Ph.D.'s from areas such as sociology, psychology, economics, - pology into research on the quality and efficiency of health _ . . . . . . and anthro- services. Ounce postuoctora~s can be trained in less time than doctoral candidates, postdoctoral programs offer a special opportunity for the development of this field without overstimulating the production of new doctorates. The Committee's present impression, based on incomplete data, is that there are a few fields in health services research that are in short supply. 9. Numerical recommendations Applied to the eight broad training areas, the recommendations given above yield approximate numbers of full-time trainees and fellows for sup- port in FY 1976. The reader is reminded that these numbers are based on estimates of training levels in FY 1975 (TABLE 3) and are not indepen- dently derived. The numbers are as follows: Predoctoral Postdoctoral Total - Basic Biomedical Sciences 5,700 3,100 8,800 - Behavioral Sciences 1,800 260 2,060 - Clinical Sciences 140 3,200 3,340 - Health Services Research 640 90 730 Total 8,280 6,650 14,930 5

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These numerical recommendations, according to the information available to the Committee, approximate the numbers of awards made in these fields in FY 1975. The recommendations are made subject to the following condi- tions: a) The distribution of federal training support should be divided among NIH, ADAMHA, and HRA according to the FY 1975 pattern. b) Distribution of the above numbers among subfields of the foul broad training fields should approxi- mate the distribution that prevailed in FY 1975. Pages 23-24 contain a list of the subfields that the Committee, for the purposes of the present re- port, considers to be associated with these broad training areas. The taxonomy is far from satis- factory, however, and will be the subject of further study in preparation for the 1976 report. c) The Medical Scientist Program should be supported at its FY 1975 level of approximately 450 persons. d) A somewhat greater emphasis should be Placed on . ~ . . Dora ~ Braining cnan on predoctoral in the behavioral sciences and especially in health ser- vices research over the next several years not a marked discontinuity, but a gradual shift toward postdoctoral training. The proposed reduction in postdoctoral awards in health services research in the President's FY 1976 budget (see TABLE 3) seems unwise in view of the need to support the training of those who wish to transfer to this field. This simple classification of all NIH, ADAMHA, and HRA research training programs in the biomedical and behavioral sciences is not intended to inhibit innovation of new types of training grant and fellowship support or of new areas or concepts of training. Interdis- ciplinary fields are often important for developments which are relevant for health problems and should be encouraged. No classification scheme is rigorously and invariably applicable. 6

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10. Training grants versus fellowships The National Research Service Award Act specifies that not less than 25 percent of the training funds should be used for awards to individuals. The Committee, in general, favors training grants to in- stitutions over fellowships awarded to individual students. Training grants have the advantage that they provide for the development of a training environment in which a group of faculty members, graduate students, and postdoctorate work together toward a common objective. The Committee recommends, while recognizing the importance of predoc- toral fellowships in certain instances, that predoctoral training of NIH, ADAMHA, and HRA be supported through training grants. At the postdoctoral level there is more need for fellowships because of the much wider variety of fields and the fact that some of the postdoctorate need the opportunity to seek training in smaller departments, laboratories, or institutes that might not be able to sus- tain training programs. The percentage specified in the Act as a lower licit for awards to individuals may be an appropriate upper limit as well for postdoctoral awards through fellowships to individuals. Until the Committee has had an opportunity to examine the situation more care- fullY, it recommends that the proportion- of postdoctoral training given in the form of fellowships be essentially similar in FY 1976 to what it was in FY 1975. Further study will be given in the year ahead to this important issue. Such further study may lead to recommendations for changes in this aspect of the Act. B. RECOMMENDATIONS CONCERNING DATA ADD METHoDOLOGY3 1. Data The Committee recommends that the NIH, ADAMHA, and HRA work with the Committee's own staff, the Panel on Data and Studies, and other organiza- t~ons to remedy deficiencies in data as a matter of high priority. Spe- cif~cally: a) The field structure used in the Doctorate Records File (DRF) and the Comprehensive Roster of Doctoral Scientists and Engineers (CR) of the Commission on Human Resources 3 See also Appendix D. 7

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to describe the biomedical and behavioral fields should be reconsidered to see whether it can be made to meet the requirements of this study more adequately. Efforts to achieve a common field structure should at the same time be pursued elsewhere. b) Information items in the DRF and CR concerning the extent of research involvement of individuals should be made more precise. It is necessary not only that persons whose red search activities are a major function be separated from those who are less directly involved in research, but that the percentage of time each person spends in research be specified. c) The sample used in the CR to obtain information about bio- medical and behavioral fields should be suitably augmented to give greater statistical validity to the data in the more specialized data cells. d) Lack of comprehensive data about M.D. researchers is a major deficiency in understanding the personnel supply in the biomedical and behavioral research fields. The Committee recommends that steps be taken in cooperation with the Association of American Medical Colleges to extend the coverage of the AAMC's Roster of Medical School Faculties to include M.D.'s conducting research in research institutes, industrial laboratories, and the NIH Intramural Program and other government agencies. Other appropriate steps should also be taken so that complete data on individ- uals in this group will be available. The Alcohol, Drug Abuse, and Mental Health Administration and the Health Resources Administration should create from administrative records a comprehensive, computerized data bank concerning all persons who have been given support in their fellowship and training programs, both predoctoral and postdoctoral, from the inception of the programs to the present, and should keep these files-current in the future. Such a file has been created for the National Institutes of Health and serves an essential purpose in the administration of NIH training programs and in studies such as those of this Committee. In order to achieve this, ADAMHA and HRA should be given additional authority to collect the needed data from training-programs directors and others. 8

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f) Data sources an modes of student support other than the training and fellowship programs addressed by the National Research Service Award Act- i.e., teaching assistantships and research assistantships supported by state or institu- tional funds, research assistantships and postdoctoral associateships supported by federal research contracts, student loans, and private funds need to be developed and made available to the Committee on ~ mare =`rc-=m=~ ; - ~~ ~ ; = (See Appendix D.) ~ ,~ _ _- .,, ~ ~ ace ~ ~ g) Consideration should be given to employer surveys and other data sources for evaluating future demands for biomedical and behavioral research personnel. The cooperation of professional societies can be especially helpful in this connection. h) 2. Methodology Program data on the probable effects of new administrative procedures, budgetary provisions, and other level-determin- ing factors need to be made available to the Committee by NIH, ADAMHA, and HRA on a continuing basis. ~ _ _ it_ i_ _ _ ^aL~ ~~ The Committee joins other organizations, such as the National Science Board, in urging that greater attention be given to the development of more adequate techniques for projecting supply and utilization of per- sonnel in these fields. Specifically, the Committee recommends that consideration be . - aiven to the market model, which attempts to incorporate Behavioral characteristics of employers, training institutions, and in- dividual students and scientists, as well as to the "fixed-coefficient" methods of projection used in the past. RECOMMENDATIONS CONCERNING THE SYSTEM OF RESEARCH TRAINING AND UTILIZATION During the year ahead, the Committee will examine in greater detail the complex problems of the system with which the National Research Service Award Act is concerned. Maintenance of excellence of training, assuring the stability of the system and forestalling wide swings in the 9

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personnel supply, and avoiding the dangers of stagnation of the research cadre will all concern the Committee. Meanwhile, the Committee recommends 1. Innovative approaches to research training, such as the new program in the National Heart and Lung Institute, need to be instituted and evaluated. 2. The turnover rate of the cadre of biomedical and behavioral researchers needs special attention in an era of stasis in faculty growth and limitations on alternative opportunities for people who want to leave research for other activities. New mecha- nisms will be needed to make it possible for outflow at the "top," inflow of new talent, and exchange with other fields of endeavor throughout the normal work span. The Committee will discuss these matters in the year ahead. It urges other organizations to do so also and to share their findings with it. 10 ~ :