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SUPPLEMENT 4 SUMMARY OF FINDINGS AND RECOMMENDATIONS FROM 19 76 REPORT Basic Biomedical Sciences The Committee recommended a modest but signif icant reduction of about J O percent from the EY 1975 level {6, 000) in the number of federally funded predoctoral positions. It was recommended that the number of postdoctoral positions be maintained at the FY 1975 levee (3, 200) ~ Training grants were urged as the pref erable mechanism of support at the predoctora, level, whereas fed ~ owshiPs were recommended for postdoctoral training. Behaviora ~ Sciences Fo r the behav iora ~ s ci enc ~ s the Committee r e coarse nde d that a gradual but significant reorientation of training ef fort should be initiated because of the growing need for more specialized behavioral science training resulting from increasingly complex research questions in the area of behavior and health. Specifically, the Committee r~co~r~nended that the existing ratio of 90 percent predoctorals and ~ O percent postdoctorals should be inverted, over a period of years, we th the us timate ob deceive of a ra Rio of 30 percent predoctorals and 70 percent postdoctoral s. The Committee recommended that this reorientation be achieved gradually in order to minimize institutional dislocation. The levels recommended by FY 1978 were 55 percent predoctoral s and 45 postOc~ctorals. For EY ~ 977 and EY ~ 978 the Committee recommended that the total doll ar investment in behavioral science research training stay constant. Thus, for FY ~ 977, it was recommended that 550 fewer predoctorals be supported than in FY 1975 ~1, 200 as compared with 1, 7 50) and that 3 2 ~ more postdoctoral awards be supported then in FY ~ 975 (540 as compared with 2 ~ 2} . For training at both the predoctoral and postdoctoral leve ~ it was recommended that the current ratio Of 82 percent traineeships to ~ ~ percent fellowships be ma intained. 207

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Clinical Sciences The committee recommended that 2, 800 trainees and fell ows at the pose doctoral Revel be funded in FY 1977 and that this level be maintained through FY ~ 978. This represented a one--hird decrease from the peak level of postdoctoral s funded ~ n PY ~ 9 69 (about 4, 20 0), when clinical special ty traineeships and some clinical residencies were also being funded, but a ~ O percent increase over the number funded by NIH in FY 1975 (about 2, 550) . Training grants were recommended as the support mechanism of choice, e' though 20 percent total support through fellowships was considered appropriate to provide needed fl exibi~ ity. The Committee recommended that the Medical Scientist Trai ring Program of NIH be expanded slightly to provide for 600 trainees in FY ~ 977 (an increase from 581 positions authorized in FY 1976 and 500 trainees supported in FY ~ 975) . Health Services Research The Committee recommer~d the maintenance of the current prog rams for hea Ith s e rvice s re sea rch trai Ding reported by the NTH and ADAMHA. However, the Committee urged that the HRA continue to serve as the primary locus for hea Ith service s res march training and recommended that the emphasi s in this area be shifted f rom predoc~oral to postdoctoral training. It was recommended that training be provided primarily through the training grant mechanism. Announcement Fi elds In view of the absence of pubs ished criteria, the Committee questioned the validity of the distinction drawn by the NIH in its announcements between fields that a re appropriate for training grants and fields that are appropriate for fell owships anti recommended that this practice be discontinued. The Committee also took the position that NRSA awards fo r f el lowships and tra ining grants should be made solely on the basis of qua lity within program cafgories deemed re le vent to the nag i one 1 irate re st . The committee coul ~ f ind no basis for determining that any particular sub ject matter was not appropriate for funding. The Committee therefore emphasized that i ts recommended reductions in certain areas summarized above should not be achieved by categorical exclusion or ~ imitator of specific fie, ds. 208

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Identification of Priority Training ]?i=~ds After a careful review of the issue of identifying high- priority tra in ing f ields, the Commi+-ee conch uded that ( 1 ~ on the basis of the information then availab~ e, designation of special ty fields at the predoctora, level in the biomedical s ciences was not warranted, ~ 2) greater emphasis should b" placed on postdoctoral training ~ n research relevant to the role of behavior in physical illness and health, (3} primary emphasis in clinical sciences ~ ra ~ ning should be given to training f or research on the etiology and pathogenesis of disease, and (4 ~ the area of health services re search receive emphasis across the end ire spectrum of relevant training fields. 209