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CHAPTER 1 THE ROLE OF NRSA PROGRAMS IN THE EDUCATION PIPELINE OVERVIEW The "pipeline" to a career in the biomedical and behavioral sciences starts early, and each stage is dependent on the stage before it. Unfortunately, it is far easier to leave the pipeline than to get into it at a later stage. As a result, there are fewer and fewer young people at each successive stage. The pipeline leaks. The National Research Service Act (NRSA) supports a number of programs that are designed to maintain an adequate supply of biomedical and behavioral personnel, with the quality and skills needed to support increasingly sophisticated biomedical research. The effectiveness of the NRSA programs, which are primarily aimed at postbaccalaureate training, is constrained by the level and quality of students at that stage in the pipeline. The most important of these programs are training grants, given to institutions, and fellowships, awarded to individuals. A smaller number of non-NRSA career award grants provide clinical research support and experience for young physician/scientists and others. The total number of NRSA training positions supported by NIH and ADAMHA has remained steady, at between 10,000 and 11,000 per year, since 1978. Trends within that total, however, show that support has been shifting from predoctoral to postdoctoral training. Biomedical sciences dominate these programs, with 70 percent of all positions in 1987, equally distributed between pro- and postdoctoral. In the behavioral sciences, support for predoctoral positions has declined since 1982 but still outweighs that for postdoctoral positions. Clinical sciences received only 20 percent of NRSA support in 1987, with most of it going to postdoctoral positions. THE EDUCATION/EMPLOYMENT PIPELINE The charge of this committee requires it to examine the United States' work force of biomedical and behavioral scientists not merely as sets of numbers, but also as human beings, some of whom have extremely productive careers, others who have less so, and still others who drop out altogether. To gain some understanding of this variability--and to determine whether the many millions of dollars that NIH/ADAMHA annually invests in the training of scientists makes any difference--it is necessary to think longitudinally about scientists' training and careers. All education systems can be considered in terms of a conceptual pipeline that students enter after meeting certain requirements and through which they pass from one stage to the next based on individual preferences, abilities, and responses to institutional circumstances and public policies. The pipeline leading to Ph.D. and M.D. degrees and entry into the scientific work force can be thought of as a series of interconnected pools. Figure 1-1 shows the rates of recruitment, retention, and graduation for white and black students as they progress from elementary and high school, to undergraduate college, graduate and professional schools (medical, dental, etc.), and finally to the receipt of doctorates. This figure demonstrates the length of the process that produces a qualified 11

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scientific work force--at least 23 years, including elementary and secondary schools. It follows from the extreme length of this process that: 2. the market-ready scientists of the year 2000 are now college sophomores; and early intervention is required to change significantly the flow of individuals to specific science programs. Three basic forces determine the movement of students into and through the pipeline into science: o Readiness: At every level of the pipeline, readiness to move ahead is determined by the individual's capacity to-construct, transmit, and receive ideas that are formulated mathematically. Mastery of an appropriate level of mathematics is necessary, but clearly not sufficient, to entering and remaining in the pipeline.3 Increasingly, a detailed knowledge of the substance and methods of science is also a necessary characteristic of readiness. In addition, readiness of an individual is influenced by a large set of factors, chief among them probably being one's innate ability and family values regarding education and knowledge. Recruitment: Given that one is ready to enter the pipeline to science, whether one actually does so is the result of a complex set of circumstances. While family values concerning the worth of science are critical in reaching the decision to pursue a scientific career, the quality of precollege science and mathematics instruction is equally important to the recruitment of capable students into the science pipeline. Some studies have indicated that the decision to enter the science pipeline is made in high school or even earlier, but that "by college graduation only 35 percent of the high school seniors who planned mathematics, science, or engineering (MSE) majors have stayed with their plans."4 These losses may be important, but it may also be unreasonable to expect binding career commitments by the final year of high school. Retention: It is probably fruitless to examine retention in the science pipeline earlier than the junior year of college, when majors usually are declared. By that time, in addition to family, peer, faculty, and other significant influences, another factor taking on great significance is the availability of financial support. Money serves both as a barrier to acquiring the advanced iIndeed, in the cases of those whose education includes obtaining M.D. and Ph.D. degrees and a substantial period of postdoctoral study, the time from entry into the school - system to entry into the work force can be as long as 30 years. It' should be noted, however, that during the last 10-12 years, such students are contributors to the nation's research productivity. 2For instance, only those college students who have obtained mathematics and quantitative science credits in high school can opt for scientific careers. 3See P. R. Rever, Scientific and Technical Careers: Factors Influencing Developing During the Educational Years, Iowa City: The American College Testing Program, 1973. 4Government-University-Industry Research Roundtable, Nurturing Science and Engineering Talent: A Discussion Paper, Washington, D.C.: National Academy Press, 1987, p. 29. 13

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training needed for a scientific career and as a force motivating one to drop out of the pipeline in favor of more lucrative alternatives. As Figure 1-2 makes clear, retention rates are so poor in biomedical and behavioral graduate programs that there is a potential for significant improvements, with consequent increases in the numbers of new doctoral scientists each year. It is clear that many factors influence the size of the cohorts in each pool of the education/employment pipeline. Decisions made by individuals are combinations of personal, financial, and contextual elements--influenced by the behavior of individuals, the advice and guidance of counselors and mentors, and individual perceptions of the status of a scientific career and national priorities. Assessments of how to influence the flow of individuals through this system must take into account such factors. A high school graduate may choose to enter the work force immediately, enroll in a junior college before entering a four-year university, or matriculate at a university directly from high school. But the availability of these options is altogether contingent on the level of readiness. Only with adequate mathematics and science preparation in high school does the student have the option to enter college science programs that can lead to subsequent graduate or professional school work. Inadequate science and mathematics performance in middle school frequently reduces the options and shunts the high school student to a noncollege program or to a delay of college entry for remedial work. This path is particularly common for minority students, who frequently lack crucial information and institutional attention early in their careers. The Pipeline into the Basic Biomedical Sciences Entry into college is the point at which the data permit us to focus on the fields of concern here. Figure 1-2 shows the current pipeline from the point of college matriculation. This figure again emphasizes the fact that the pipeline is extremely "leaky." The number of B.A./B.S. degrees in biomedical science is much less than the number of freshmen who four years earlier expressed the intention of earning such a degree. Far more of the leakage is into other fields, especially those that are business-related, than out of college. The number of baccalaureate degrees with majors in the biological sciences rose steadily to a peak of 52,000 in 1976 but then declined until 1984, when a new upward trend began. Currently, about 37,000 bachelor's degrees in the biological sciences are awarded annually by U.S. institutions (see Volume II of this report, Table 2~. At the next stage of the pipeline, entry into graduate or professional school, individual preferences and responses to environmental factors greatly influence the decision to pursue and complete a graduate or professional program and to enter a career in science. Students completing graduate programs, as well as a small proportion of those completing the M.D. or another professional biomedical program, can move directly into the work force,5 choosing careers in academe, industry, or government.6 Others opt forpostdoctoral training, a percentage that approximately doubled between 1972 and 1982 5Those pursuing a career in basic research would probably undertake postdoctoral training first. A relatively small proportion of those completing graduate programs move to professional training. 6The length of time spent in research careers is highly variable, but attrition rates from the work force have been relatively low--amounting to 2-3 percent per year in biomedical science and not quite 5 percent in behavioral fields. Because the average age of the work force has increased steadily, however, attrition rates are projected to increase within the next decade. 14

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but has since remained level. About 8,200 individuals currently are engaged in postdoctoral training in the biomedical sciences. The professional and graduate biomedical degree programs have significantly different attrition rates: whereas attrition from professional programs seems relatively minor,7 that from graduate programs appears to bee as high as 58 percent.8 High attrition rates may be influenced by the length of postdoctoral training and/or the availability of federal funds in the biomedical sciences. The data may also be unintentionally misleading --some proportion of the first-year graduate students may successfully attain the terminal master's degree that they had intended and thus blur the comparison between first-year graduate students and doctorate recipients eight years later. Even if this proportion were large, however, the amount of leakage during graduate school would remain high enough to merit careful analysis. The steadily increasing size of the pool of postdoctoral biomedical scientists has raised concern for many years.9 However, funds to support postdoctoral training come largely from federal grants, contracts, and fellowships. The size of the pool therefore reflects directly the national priority for biomedical research: the postdoctoral pool, as well as the graduate pool, is a major contributor to the research programs of granting agencies. The ways in which federal support is provided, the criteria used to evaluate programs, and the success of individual participants are discussed in Chapter 4. Finally, annual attrition from the biomedical science work force (due to death and retirement) has been approximately 1,200 recently and is expected to increase to nearly 1,700 within the next decade. Recognizing this, as well as the fact that only approximately 1.1 percent of individuals with doctorates in the biomedical sciences are unemployed, the committee stresses that the present production rates are inadequate to meet current national needs. The Pipeline into Behavioral Sciences Figure 1-2 also illustrates pool sizes and leakages from the pipeline into the behavioral sciences following high school. In some respects, the picture is similar to that for the biomedical sciences, but more extreme. The initial numbers of freshmen expressing interest in majoring in a behavioral science are considerably greater than for biomedical fields, but their retention rate is much lower. The differential attrition continues until the point of awarding doctorates, by which time the initially large numeric difference between the two fields has become trivial. At this point, furthermore, a substantial fraction of new biomedical Ph.D.s go on to a period of postdoctoral training. Very few behavioral - 'Exact numbers are not available. The numbers used in Figure 1-2 are taken from Appendix Table 3-1 in Volume II of this report and are averages over several years. The attrition rate may in fact be due in part to a lengthening of the time spent in graduate study. Nonetheless, even if this is taken into account, the attrition rate for biomedical scientists is very high and points to the possibility that either selection processes or retention efforts could be improved in order to enhance the efficiency of the system and to increase productivity. 9Very little information is available about the extent to which trainees leave the postdoctoral training pool to pursue different careers in or out of science. The imbalance between inputs and outputs cannot be taken as projecting the growth rate of the pool, since to some extent the discrepancies reflect the varying quality of information available for analysis. 16

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scientists do postdoctoral work, and their numbers are not increasing materially, despite the recommendations of earlier committees. THE STRUCTURE OF NRSA TRAINING PROGRAMS The National Research Service Act (NRSA) supports a great variety of training activities, all fields of biomedical and behavioral sciences, as well as interdisciplinary programs related to specific disease problems and health services research. This training is available at many points in the education pipeline: to some undergraduate students, graduate students studying for their Ph.D.s, postdoctoral students, and persons who have already received an M.D. or other professional degree. In addition, the Medical Scientist Training Program (MSTP? supports courses of study leading to a combined ~D./Ph.D. degree. The Minority Access to Research Careers (MARC) program is designed to increase minority participation in research. Training grants and fellowships are the principal vehicles used by public agencies to influence the production of Ph.D. and M:D. biomedical and behavioral scientists Almost all of the institutes at NIH/ADAMHA support training through one or both vehicles, each program having been created in response to a perceived national need. Awards are made on the basis of national competition and the responsiveness of proposals to criteria established by the granting agency. The overall goals of these biomedical and behavioral training programs are threefold: 1. to provide for a supply of personnel sufficient to meet demand; 2. to ensure that their quality is high enough to carry on increasingly sophisticated biomedical and behavioral research; and to make sure that the pool of skills responds to shifts in demand for various kinds of specialized personnel. To reach these goals, a number of mechanisms are employed, the adoption of which is based on assumptions (explicit or implicit) concerning how occupational choices are made, how biomedical and behavioral research skills are acquired, and what the market will be for personnel having such skills. (Chapter 4 provides an extended discussion of the goals, mechanisms, and outcomes of these training programs.) The two major activities supported by NRSA are training grants and fellowships. Training Grants Institutional training grants are awarded to academic departments and programs rather than to individuals. The peer review groups examine the training plan, but the trainees are selected by the training institution. While each training grant award can be perceived to be unique, major differences exist between those provided to support graduate education and training and those supporting postdoctoral education. Predoctoral Training Grants: Covering tuition and a small factor of support to the training group, these grants are awarded mainly by the National Institute of General Medical Sciences (NIGMS) in a number of interdisciplinary and disciplinary fields, based on an intensive review of the quality of the existing academic graduate program of the 17

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applicant department and institution.~° The size of the applicant pool and the field of students accepting admissions are taken into account. The purpose of predoctoral training grants is to increase the capacity of a preexisting program to train biomedical or behavioral scientists. The success of the program is judged by peer reviewers, using such measures as diversity of course offerings, quality of the instructional group, academic standards of the group, flexibility in terms of the development of dissertation projects, time required for students to obtain a degree, success of students in accomplishing high-quality research, and the success of former students in obtaining either postdoctoral appointments in leading laboratories or first independent appointments in research universities and institutions. Reviewers also make judgments about commitment of financial and other support to the academic effort, and they usually attempt to ensure that a training grant will increase the number of trainees to the program. In some cases the award of training grants is used to leverage additional institutional support for the program. Postdoctoral Training Grants: Training grant awards for postdoctorates tend to focus more directly on research experience. Criteria similar to those for predoctoral grants are used in making postdoctoral awards in the basic biomedical and behavioral areas, although they are less commonly applied to clinical science training awards (see below). In every case, however, careful judgments are made about the quality of the training staff and their research productivity. Training grant programs account for about 76 percent of NRSA training positions funded through- NIH/ADAMHA. Fellowships Awarded on an individual basis--mostly to postdoctorates who, together with a specific research sponsor, proposed a research project to be pursued if an award is made-- fellowships are given in response to the research accomplishments of the fellow and the mentor. Most fellows seeking postdoctoral awards have already had successful careers as graduate students and can demonstrate a capacity for original research; that, together with the quality of the proposed project, determines success in obtaining the award. In a sense, research fellowship awards are small research grants, but they provide recognition and support for outstanding young scientists at an early point in their careers. Fellowships account for 17 percent of NRSA-supported positions funded through NIH/ADAMHA. NRSA Training for Physician/Scientists Fifty years ago, a physician/scientist was an individual engaged in research at the bedside or in the clinic, observing cause and effect in the human model: a substance given or withheld, and a result measured. The past several decades, however, have seen a shift in emphasis from the clinic to the biochemical laboratory, where investigations are conductecl at the cellular level. For purposes of definition, therefore, the "physician/scientist" i°Included in the review are evaluations of mentors' success in previous training of research scientists, obtaining and sustaining research support from granting agencies, publications, citations, prizes and awards, and stature in the field. Evaluation of potential trainees is based on their grade-point averages, test scores, baccalaureate institution, and undergraduate research experience. Also assessed are physical facilities, institutional commitment, and existing financial support for the program. lain addition to NRSA-supported training, NIH and ADAMHA support other programs for advanced research training. Of particular importance in this series is the Physician/Scientist Training Program, which supports researchers over a five-year period, beginning at the career stage traditionally spent in postdoctoral research training. 18

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referred to throughout this report is one who has earned the M.D. degree, has had additional training or experience in the basic sciences or held clinical fellowships, and has spent varying proportions of his or her time in both scientific investigation and clinical practice. NRSA currently supports several types of physician/scientist training programs, including the Medical Scientist Training Programs (MSTP) leading to the M.D./Ph.D. degree, institutional training grants, and other special fellowships. Because of their formal curriculum, firmly grounded in the basic sciences, MSTP and Physician/Scientist Award Program have an assumed advantage, in terms of scientific training, over the traditional institutional training grant conducted in the subspecialty divisions of clinical departments. This superiority can only be assumed, however, because of a lack of substantive evaluations of these programs (see Chapter 4~. A STATISTICAL OVERVIEW OF NRSA TRAINING PROGRAMS This section focuses on NRSA programs administered by NIH and by ADAMHA.~2 It describes the current size and budget of the various program components; it also provides an historical overview of NRSA training. The definition of NRSA training used here is the trainee ("T" programs) and fellowship ("F" programs) support programs for predoctoral and postdoctoral students-funded under NRSA. In addition, a discussion of non-NRSA research training is included. NRSA Training Programs in FY 1987 In FY 1987, NIH and ADAMHA supported a total of 11,242 NRSA full-time equivalent positions (FTEP).~3 These positions were divided into the following basic types of NIH and ADAMHA research training programs: predoctoral and postdoctoral traineeships, predoctoral and postdoctoral fellowships, and short-term training (Table 1-1~. Traineeships: Training grants are awarded to institutions, usually to academic departments, rather than individuals. While the grant applications by the institutions are subject to peer review, selection of both predoctoral and postdoctoral trainees is controlled by the institution receiving the grant. Programs are designated in the NIH data system by "activity codes;" all traineeship programs have an NIH activity code beginning with "T." In 1987, FTEP traineeships accounted for 76 percent of all NIH and ADAMHA training positions. The $192.] million spent on institutional awards in 1987 represented 80 percent of the $238.8 million total awarded for research training within NIH. 4 i2The Health Research Services Administration (HRSA) is the only other agency that provides NRSA support to students. In FY 1989, HRSA supported 69 trainees and fellows. Data for HRSA are not included in the above analysis. entraining positions are defined in terms of fulI-time equivalent positions (FTEP), i.e., the number of positions during the year calculated as if each trainee/fellow was employed for 12 months (three months for short-term training). The actual number of individuals supported was higher than the number of positions. FTEP data were computed from the NIH Trainee/Fellow File (TFF) by the National Research Council and differ from the number of appointments as reported in the NIH Data Book 1988. i4NIH Data Book 1988, Table 16. 19

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Table 1-1. 1987 NRSA Training by Field, Agency, and Definition Ful(-Time Equivalent Training Positions BIOMEDICAL TOtAL NIH ADAMHA Estimated Training Anointments BIOMEDICAL TOTAL NIH ADAMHA Total 7388 7009 379 Total 8436 7961 475 Predoctoral 3681 3499 182 Predoctoral 4268 4041 228 Fellow 86 67 19 Fellow 95 71 24 Trainee 3594 3431 163 Trainee 4173 3969 204 Postdoctoral 3707 3510 197 Postdoctoral 4167 3920 247 Fellow 1580 1531 49 Fellow 1692 ~ 1631 61 Trainee 2127 1979 148 Trainee 2475 2289 185 BEHAVIORAL TOTAL NIH ADAMHA BEHAVIORAL TOTAL NIH ADAMHA Total 924 402 522 Total 1112 457 655 Predoctoral 504 250 254 Predoctoral 604 285 319 Fellow 37 35 2 Fellow 40 37 3 Trainee 467 214 253 Trainee 564 248 317 Postdoctoral 420 152 268 Postdoctoral 508 172 336 Fellow 95 25 70 Fellow 114 27 88 Trainee 324 126 198 Trainee 394 146 248 CLINICAL TOTAL NIH ADAMHA CLINICAL TOTAL NIH ADAMlIA Total 2157 2080 77 Total 2493 2397 96 Predoctoral 654 638 16 Predoctoral 758 738 20 Fellow 17 1 16 Fellow 21 1 20 Trainee 637 637 0 Trainee 737 737 0 Postdoctoral 1503 1442 61 Postdoctoral 1735 1659 76 Fellow 113 102 11 Fellow 122 109 14 Trainee 1390 1340 50 Trainee 1613 1550 63 TOTAL TOTAL - NIH ADAMHA TOTAL TOTAL NIH ADAMHA Total 10469 9491 978 Total 12041 10815 1226 Predoctoral 4839 4387 452 Predoctoral 5631 5063 567 Fellow 140 103 37 Fellow 156 110 46 Trainee 4698 4282 416 Trainee 5475 4954 521 Postdoctoral 5630 5104 526 Postdoctoral 6410 5752 659 Fellow 1788 1658 130 Fellow 1929 1766 163 Trainee 3841 3445 396 Trainee 4481 3985 496 T35 Short-Term Training (not included in above figures) Total 774 752 22 774 Grand Total 11243 11243 1000 12815 7S2 22 11567 1248 NOTE: Totals may not add due to rounding. Full-time equivalent estimates are in term of trainee/fellow years, i.e., one trainee/fellow for 12 months. Actual appointments are higher due to partial year awards. Appointments are consistent with reported training figures published in the NIH Data Book 1988 and in ADAMHA NRSA Research Training Tables FY 1987. Field of traineeJfellows determined by degree/specialty/field data on individual trainee/fellow record (Form 2271). SOURCE: Estimated by National Research Council from the NIH Trainee Fellow File. 20

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Table 1-2 shows that the T32 program (institutional training grants) is the largest single training effort within NIH/ADAMHA. In 1987, there were 4,347 predoctoral and 3,824 postdoctoral positions in the T32 program, comprising 72.7 percent of the total NIH/ADAMHA training effort of 11,242 positions. The stated purpose of the T32 program is "to help ensure that highly trained scientific manpower will be available in adequate numbers and in the appropriate research areas and fields for the nation's biomedical and behavioral research agenda."~5 T32 trainees are required to devote at least 40 hours per week to research training and must be citizens or have permanent visas. Prior to appointment, trainees must sign a "payback" agreement, by which they agree to engage in biomedical/behavioral research and/or teaching for a period equal to the T32 support period in excess of 12 months. If trainees do not begin to carry out this requirement within two years of NRSA program termination, they are required to return the support funds to the federal government. Stipends are currently $S,500 per annum for predoctoral students and range from $17,000 to $31,500 per annum for postdoctoral students, depending upon experience. Appointments are made for 12 months; no trainee may receive more than five years of aggregate NRSA predoctoral support and three years of aggregate postdoctoral support without a special waiver. A significant subset of the T32 program is the Medical Scientist Training Program (MSTP), which provides training in biological, chemical, physical, and social sciences, combined with medical training, and leads to a joint D./Ph.D. degree. In FY 1987 the MSTP program was composed of 636 FTEP positions, or 14.7 percent of the total T32 predoctoral FTEPs, or 4,347.~6 All of the MSTP positions were · · · ~ - n c 1nlcal science. The T34 Minority Access to Research Careers (MARC) program is somewhat unusual in that it is aimed at undergraduates. MARC is one of several NIH/ADAMHA programs designed to increase the numbers and capabilities of biomedical and behavioral scientists from underrepresented minorities. In addition to student support, the T34 program provides funds for consultants, personnel, staff travel, and research equipment and supplies. The program also allows trainees to undertake special work at major research universities and laboratories during summer sessions. The T35 program (774 positions in FY 1987) is intended for short-term training. Although it can provide support to postdoctorates, it is designed as a vehicle to introduce students in health professional schools to a research career and/or research in an area of national need. In this program trainees usually are funded for only three months during their summer term or during an off quarter.~7 Free National Institutes of Health, "National Research Service Award Grants (T32)," mimeographed supplement to be used with T32 grant application, April 1989, p. 1. Fin addition to the MSTP program at the National Institute of General Medical Sciences (NIGMS), the National Institute of Neurological and Communicative Disorders and Strokes (NINCDS) has designed a program under the T32 umbrella that is specifically aimed at short-term training of M.D.s. This program is thus run as a de facto T35 short- term training program; NINCDS feels that M*D.s who receive exposure to research through this mechanism are more likely to pursue research careers. t7The National Heart, Lung and Blood Institute (NHLBI) runs a Minority Hypertension program within the T35 program that is not research training in the traditional T35 sense. These positions in NHL8I, numbering 404 in 1987, have been excluded from the data presented here. ADAMHA supported 22 of the T35 positions; the remaining 752 were supported by NIH. 21

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~ ~ ll ~ ~ ~ a,, 11 . . , , , ~ ~ ll ~ ~ ~ — . . . ~ al — 11 · , , ~ ~ 4_ · Al 11 ~ ~ O ~—~ ~ ~ ~ ~ 1^ ~ — JJ ~ C O to 11 ~ ~ O O LO O ~ O O 1^ I ~ ~ I: Go ~ ~- ~ 0 ~ ~ ~~- 4J 11 ~ · I US `0 . O ~ O US SO ~ ' ~ ~ tY 4~. · ~ 11 ._ · ~ ~ ~ ~ ~ ~ ~ N ~ ~ ~ ~ E A 1l ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ o ~ ~ 11 . . 0 0 C ~ 0 · In 11 ' ' ' ' ' 'A 0 11 — · , ~ ~ _ ~ 11 ~ · rot on ~ , ~ ~~ on t~~ ~ ~ lo, 0 0 11 ~ · ~ ~0 U~ U~ ~ `0 0 · ~ — ~ C ~— 11 0 · ~ O `0 ~ %r O ~ ~ ~ ~ ~ — ~ ~ ~ ~ 11 ~— · ~ ' ~ ' ~ ~ ~ ~ ~ , · cn ~ 11 ~ l' ~ ~ ~ ~ ~ ~ U' ~ 4~ 9, 0 ^ O ~ 1' co . ~ ~ ~ ~ ~ N ~ . a' ~ cn ~ ~— — 11 ~ ~ ~ ~ (f~ ~ ·~ ~ ~ ·_ _ t~, ~~ 11 a, . ~ ~c ~ ~ c E ll m · . ~ O ~ ._ GS ~ 11 ~ · C~) ~ ~~~ _ . ~ ~ 11 _ . . ~ n o~ I' ~ % 0 - 0 u~ ~ O E~ 0 — 11 ~— ~ ~ 0~ 0 ~ r~u C~ 0 0 ~ O ~— C 11 . 11 ~ ~ —1 ~ 0 0 ~ ~ ~0, · ~ CO 11 ' ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ O :c 0 ~ 11 0 ~ ~ ~ ~ ~ ~} ~ , ~ ~) . ce — ~ ~ ~ _ 11 C~ ~ ' , ~ ~ _ ~ 11 ~ 0 ~~ ~S ~ ~ ~ ~ P~ ~ ~ O ~ ~ CO ~ ~ 11 ~ · ~ ~ ~ ~ ~ ~r ~t ~ %~ · :~: ~ ~. 11 ~ ~ ~ 0 ~ ~ ~ ~ r~ 0 u~ · a 11 0 ~ ~ ~ ~ ~ ~ ~ ~ ~ C 11 ~ ~ ~ ~ 0 ~ ~ 0 ~ C e. O C C 11 ~ ~ a_ ~_ ~ e_ ~_ 11 ~ · a' 0 ~J 8 11 ~ ' ' t- ~ ~ ~ ~) — · · ~ ~ ~ Q 11 ~ ~ 00 `0 ~ 0 , ~ ~o ~ ~_ , 11 ~ ~ ~ 0 ~ ~ ~ 0 ~ ~ ~ a~ o 4~ I · 11 ~— ~ `0 ~ O ~ tO O ~ ~ C ~ ~ O · 11 C ~ ~ ~ ~ ' ~ O ~— ~ C ' 11 ~— · ~ ~ ~ ~ , `_ || _ ~ ~ e~ ~ O 11 C~ ~ ~ ~= C _ 11 · ' ' ~ 0 ~— ~ 11 · ~ U! ~ a~ M- 0 11 — · · ~ ~ t_ _ · 11 eJ ~ ~ ~ J~ 4~ Cl) ~ _ c a' : 11 _: %° ~ `° ~ ~ ~o ~ ~ : cn ~ ~ ~ ~ dV 11 ~ ~ ' ~ ~ ~ ' -;t m~ ~— ~ ~ O ~ a ~J 11 ~ ~ ~ o ~J — 11 ~ ~ ~ ·— ~ C~0 4~ U) 11 41) ~ ' ~ ~ a~ cn 4" 11 ~ · ~ ~— ~ O a~ ~ ' ~ ~ ~5 ~ o _ · a' ~ 11 — ~ ' ' ' O .= ~ ~ '— · ~ ~ 11 ~ . . Q~ C · ~ ~ 11 ~ ~ ' ~ ~— cn 0 3 11 _ . 0 ~ 0 ~ o~ o~ u~ 0 ~ . ~ ~ ~ ~ ~ :x t_ ~t 11 5 . ~ ~o ~ 0 ~ ~ ~o ~ ~ ~ c ~n ~ ~ ~ 0 CL 11 ~ ~ ~ ~ ~ ~ ~ ~ 0 ~ ~ ~ ~ _ · ~ 11 ~ ~ ~ , _ _. O — ~ ~ IIJ 11 · ' ~ ~J U, ~ ~J U~ ~ ~ CO a) ~ > t~ GS e ~ _ . 0~ ~ 11 m ~ ' '- ° 3 ^ `) ~ ~ _ 11 ~ ~ ~ ~ U) a' E ~ ~ ~ ~ . ~ t~ ~ u) a' . . ’' ~ ~ ~ E , , ~ ~ ~ ~ ~ . ~ ~ ~ ~ ._ ~n . . 0 ~ 0 O7 ~n ~ 0 ~ qe? ~ ~ ~ ,C o . . ~ o~— ~ — ~ o~— . a, ct ~ ~ ~ ~ . ._ 0 c~ . Q . u, ~ ce ~ . ~ ~ ~ a, ce ~ . ~ ~ a, _ ~ >` ~ O ~ O O ~ O ~ ~ O O ~ . Q — > - , - , ,= ~ CL ~ ~ , ~ ~ ~ ~ ~ , _ ~ os ~— ' ' ~ — ~ E ~ 2 ~ ~ 4~ U) ~ 4~ t~ O o . . ~ ~ ~ ~ ~ . m — · · co ~ cn ~ O ~ ~ ~ ~ ~ C O co . . C C ~ ~ O Q C ~ E a, . 0 ~— ~ cn ~— Q ~ ~ 0 ~ 0 0 ~ ~ Q 0 ~ . QS C E — ~ ~ ~— a) c_ ~_ _ ~ ~_ _ cs cn ~ Cl) a) ~ ~— 0 . . ~ ~ co ~ a) cl) u~ 4~ ~ ce ~ ~ ~ E ~ E ~ . . ~ cn cn ~ a' ~ ~ ~ ~ . ~ a) ~ o. co . . 4~ JJ ~ ~ ~ ~ C ~ ~ ~— C ~ ~ ~ ~ ~ ~ E a) . . cn ~— ~ ~ a_ cn ~ ~ ~ — y e_ ~ ~ . .~ ~ _ e_ 4~ ~ 0 ~— ~ ~ ~ ~ a~ a~ ~ · 0 · ~ a~ ~— . . cn cn ~ ~ cn ~ ~ co 3 cn E Y ~ ~ ~5 ~ C s ~ ~ Y E ~ ~ ~n C ~ Q ~ :5 ~ ~ ~ O ~— C ~ ~ . ._ · · 03 ·_ ·_ ~ — — ~— ·— > ~— ~ 4J · 0 e~ _ ~ · ~ 4,) ~— t~ t~ 0 Q O C ~ ~ ~ 5 cl~ ~ If~ O O ~ ~ ~ 0 ~ ~ ~ ~ > cl~ ~ ~ a~ ~ a_ t_ ~ · — u) ~ X. O ~ ~ ~ ~ O 4~ ~e— O ~ ~ Q ~ ~— · ~ ~ 0 1~ (L t~ · · ~~e— Q~ ~ C ~ J c~ ~. ~ G~ ~ tt1 . . u~ 4~ cl~ C a~ ~— 4~ ~ 0 JJ ~ ~ . _ y ~ ~ ~ {,) . . ~ 0 ce— e._ ~s 0 ~ ~ ~ a, . ~.— ~ 0 ~v ~ - O) ~ ~ C O ~ ~ 4~ ~—Q ~ ~ ~ ~ (L) · (~) > ~ ~ tt · · ~ y 4-J q~ 0 15 ~— ~ ~ ~ (.) ~ a) ~ · · —s_ o.) ~ a) — ~ ~ ~ ~ X ~ 0 4J ~ ~ ~ ~ ~ C ~ 0 ~ ~ E . a' ~ ~ a, cn cn ~ ~ ~ 4~ JJ cn ~ a' ~ ._ ~ ~ ~ ~ . ~ ~ ~ ~ ~ a~ 4~ 0~> t~ ._ 4J 00 t~ 4) t~ 8~ ~ · e_ 4J e tY . . c ce -.— ~ ~ ~— ~ ~ ~ ~— cn ~— ~ ~ ~ cn · C c C ~ O ~ C ~ ~J Q e ~ u~ 4) · u) ~ ~ G~ tt~ O · _ 41~ O Q O . 0 . ._ 0 0 cn c ~ ~ ~1 ~— t) ~ ~ O ~ ~ ~ ' ~ ~ E ~— ._ . ~ Oe_ ~ r$ 0 4~ — ~ ~ ~ 4~ 4~ o Q . tn 4" ~ ~ s ~ 3 ~ ~ ~— ~ ~ ~ ~ ~ s — ~ . ~— ~ ._ o ~ · Q . - ~ ~ a~ a~ ~ ~ ~ ~ ~ ~ e5 0u E ~ cn ~ ce u~ · a~ ~ e _ ~ ~_ C3! ~ ~— ~ ~ ~ ~ r. ~ 41) ~ 4J Cl) as— ~ ~— ~ ~ O 1~ ~ ~ ~ cn 4- 4 z . ~ . ~ ~ — ~ ~ ~ ~ ~——~ ~ ~ 3 ~ ~ ~ ~ . ._ ._ , (.,, ~ _._ C ~ ~ ' ~ —: · cn ~ ~ ~ ~— c: ~ 4~ ~ O ~ ~ ~ co ~ ~ — ~ ~ ~ ~ ~ ~ C . ~ . ~ c ~ 0 z cn - ~ C ~ ~— ~— ~ 0 ~ ~ ~ 4~ Y — — ~ O ~ Y ~— ~ E > ~ ~ O ~ ~ ~ O— ~ ~ ~ ' E c~ ~ E ~ ~ cn a_ ~ ~ ~ ~ ._ y o ~ y ~ ~ ~ , o 3 ~ ~ _ ~ · ~ · ~ ~ ~ JJ dJ tO a~ 4~ ~ 0 ~ ~ ~— c/) ~—~ a~ x · ~ c · ~ 0~ e ~ 3 .— ~ _ ~ ~ > > ~ t_ se G) ~ ~ '— ~ > ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ O ~t Q e_ · _ ~ e e ~ O ~ ~ ~ _, ._ 41), ~ . l~ ~ t- a) 4= O! cc ~ =0 ~ ~ ~ ~ O 0 3 ~— O a) O ~ ~ ~ .:C t~ . ~ ~ ~ ~ ~ . z ~ ~ ~ y c' cn 22

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In FY 1986, Ph.D.s comprised 55.4 percent of NIH postdoctoral trainees (down from 63.6 percent in 1980~; M.D.s made up the remaining 44.6 percent (up from 36.4 percent. Fellowships: Fellowships are awarded on an individual basis, primarily for postdoctoral study. They are extremely competitive and are awarded on the basis of a thorough review of proposed research with a mentor and sponsoring institution. In 1987 fellows made up 17.2 percent of all training positions, with awards allocated at a cost of $46.6 million, or 19.1 percent, of the NIH/ADAMHA research training budget. Table 1-3 provides a description of the FY 1987 NRSA fellowship programs. The F32 program is clearly the largest, in FY 1987 it supported 78.9 percent of all fellowship positions. The F32 program is designed to provide postdoctoral research training to individuals to broaden their scientific backgrounds and extend their potential for research in specified health- related areas. The F31 program is the predoctoral equivalent of the F32 program: together these two programs supported over SS percent of NRSA fellows. In 1987, Ph.D.s comprised 85.3 perc9ent of NIH postdoctoral fellowships, while M.D.s made up the remaining 14.7 percent. Other NIH Research Training Activities: In addition to the programs described above, several activities at NIH provide research experience. o o Career Award Grants:20 These awards, made on both an individual and institutional basis, provide up to five years of support for scientists early in their careers. Designed to free recipients from teaching and administrative duties such that they can devote a major effort (at least 80 percent) to research, they are widely considered to be "super-postdoctorals." Indeed, career award grants occupy a somewhat "gray" area between research and training; most individuals who receive career award grants have already proven their ability to do independent research and have embarked upon research careers. These so-called "K" programs are an important source of research experience for promising physician/scientists: as shown in Table 1- 4, awards directed toward physicians (K08 and Kit) accounted for 90 percent of the total K positions in FY 1987. The K12 and K16 programs are career development institutional grants made to medical schools (K12) and dental schools (Kim; the institutions then appoint clinicians for development of individual research skills. In 1987, the K12 program supported approximately 52 scientists at 12 different institutions; the K16 program supported approximately 39 scientists at nine different institutions. R25 Research Grants: The National Cancer Institute (NCI) administers a program for the training of doctoral students in cancer prevention; providing student laboratory research experience to high school, prebaccalaureate, and predoctoral students; curriculum development in nutrition/cancer prevention; i8See National Institutes of Health, NIH Data Book 198S, Washington, D.C.: National Institutes of Health, 1988, Table 39. Degree of postdoctoral trainee data are unavailable from ADAMHA. i9Ibid. Degree data for ADAMHA fellows are unavailable. 20It should be noted that the K programs do not fall under the NRSA program umbrella and are not funded from research training funds. 23

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and T35-like training programs. In FY 1988 NCI supported approximately 400 students in the laboratory research experience part of this program.2i Minority Biomedical Research Support (MBRSJ: This program was established in 1971 to provide salaries in order to enable minority students and faculty to acquire laboratory research experience by working on their own research projects while assisting on faculty projects. The program was funded at $39 million in 1988 and involved 100 minority institutions.22 In 1988 the MBRS program supported 772 faculty, 1,095 undergraduate students, and 407 graduate students.23 Research Assistants fRAs) on NIH Research Grants: A large volume of training occurs when graduate students gain experience and knowledge through their work as RAs to faculty on research grants. NIH research grants to faculty in graduate institutions therefore serve a twofold function: expanding the biomedical/behavioral knowledge base and providing research training. Given that research and development (R&D) grants have been growing at almost twice the rate of research training expenditures for the 1978-1987 period, the role of RAs in the NIH training enterprise may also have been growing in relative importance.24 Graduate departments in the biological sciences indicated that 4,426 full-time graduate students were supported as RAs on NIH projects in 1987; this represented a 6.5 percent annual growth rate over the 2,673 NIH-supported RAs in 1979.25 In psychology, NIH supported 334 RAs in 1979 and 382 in 1987. GRANT APPLICATIONS AND AWARDS BY TRAINEES/FELLOWS One indicator of the success of a training program is the ability of former trainees/fellows to obtain research grants.26 Figure 1-3 presents 1987 percentages of postdoctoral trainees/fellows who have received NIH research grants (R01 activity code) since the scientists began NRSA research training in 1982. The committee was particularly struck by the fact that Ph.D. trainees received R01 grants at approximately three times the rate of M.D.s (10.3 percent versus 3.7 percent); for fellows, the comparable figures are 12.5 percent of M.D.s and 16.2 percent of Ph.D.s. Almost the same proportion of M.D. fellows (28.3 percent) applied for R01 grants, as did Ph.D. fellows (28.5 percent). 2iThis information was provided from a personal communication with Vincent Cairoli of NCI, August 1989. 22See Michael Fluharty, "Recruiting Minority Students For the Biomedical Sciences," The Chronicle of Higher Education, July 12, 1989, p. B3. 1989. 23Data supplied by Ciraco Gonzales, Division of Research Resources, NIH, August 25, 24Total NIH R&D grants and contracts increased from $2.1 billion in 1978 to $4.9 billion in 1987 (10.0 percent annually); NIH research training expenditures increased from $148.5 to $238.S million (5.4 percent annually) during the same period. See National Institutes of Health, NIH Data Book 1988, Table 16. 25These data are from the survey of graduate departments sponsored by the National Science Foundation and NIH, "Survey of Graduate Science and Engineering Students and Postdoctorates" (GSESP). 26See Chapter 4 for a discussion of NRSA program evaluation. 26

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16 - - ~ 14- . ~ ,4 1~ — To ',~, 10- ·; .~ ~ 6- _~ ,,., 4 PA 2- o- 18 - ~3 MD Fellows SOURCE: Appendix Table A-7. MD Trainees Ph.D. Fellows Ph.D. Trainees Figure 1-3. Percent of NRSA postdoctoral trainees/fellows who received an R01 grant within five years after initiation of NRSA research training. However, the difference is much larger for trainees: only 8.5 percent of M.D. trainees who began NRSA research training in 1982 applied for R01 grants, compared to 20.3 percent of the Ph.D. trainees. HISTORICAL TRENDS Table 1-5 contains FTEP data for the period 1978-1987 for NIH/ADAMHA NRSA training and fellowship programs. Estimates in Table 1-5 differ substantially from previous committee estimates of NRSA support levels.27 There are several reasons for this difference: The data in this report are based on the Trainee Fellow File (TFF) compiled from the records of individual trainees (Form 2271~. Data in previous committee reports were based upon the Information for Management, Planning, Analysis and Coordination (IMPAC) file, which is compiled from grant applications by institutions that cover several traineeship positions, and are based upon proposed levels of support rather than actual level of support. 27See, for example, Institute of Medicine, Personnel Needs and Training for Biomedical and Behavioral Research, Washington, D.C.: National Academy Press, 1985, Tables 1.3 and 1.4. 27

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Table 1-5. Historical Trends in NRSA Training Positions, 1978-1987 1978 1979 1980 1981 1982 1983 1984 1985 1986 1987 Biomedical 6685 7181 8362 7781 7842 7670 7820 7741 7808 7388 Predoctoral 3 On 5 3974 4153 3767 4205 4021 3997 4008 3856 . 3681 Fellow 33 50 36 20 42 52 .56 92 93 86 Trainee 3702 3924 4117 3746 4164 3969 3941 3916 3762 3594 Postdoctoral 2950 3207 4209 4014 3637 3649 3823 3733 3952 3707 Fellow 1676 .1635 2214 1981 1505 1596 . 1727 1628 1817 1580 Trainee 1275 1572 1*5 2033 2132 2053 .2096 2106 2135 2127 Behavioral 692 733 619 484 1122 1012 966 971 962 924 Predoctoral 489 483 - 327 - 290 763 603 536 530 515 504 Fellow 107 95 58 30 49 31 20 40 33 37 Trainee 382 388 270 .260 . 713 573 516 490 482 467 Postdoctoral 203 250 292 194 359 409 .430 441 447 470 . . Fel low 163 166 188 93 95 . 114 92 91 91 95 Trainee 39 84 105 101 264 294 339 356 356 324 Clinical 2356 2406 1943 1939 2100 2143 2205 2195 2229 2157 Predoctoral 733 764 674 655 680 653 651 632 687 654 Fellow 3 1 1 1 3 3 6 2 6 17 Trainee 730 763 674 654 677 650 645 630 681 . 637 MSTP 462 547 646 652 676 646 645 629 661 636 Other 269 216 28 2 1 4 0 1 20 1 Postdoctoral 1623 1642 1269 1284 1420 1490 1554 1563 1542 1503 Fellow 318 330 197 226 195 151 184 1B1 139 113 Trainee 1305 1312 1072 1057 1225 1339 1370 1382 1403 1390 Total 9733 10320 10925 10204 11064 10824 10991 10908 10999 10468 Predoctoral 4958 5221 5155 4712 5648 5277 5184 5171 5058 4839 Fellow 143 147 95 52 94 85 81 135 132 141 Trainee 4815 5074 5060 4660 5554 5192 5103 5036 4925 4698 Postdoctoral 4775 5099 5770 5492 5416 5547 5807 5737 5941 5629 Fellow 2157 2131 2599 2300 1795 1861 2002 1899 2047 1788 Trainee 2619 2967 3171 3192 3621 3686 3805 3838 3894 3841 T35 Short-Term Training Total NA NA 573 836 902 1009 1029 900 730 774 NOTE: Totals may not add due to rounding. Table includes ADAM HA NRSA positions. Estimates are in terms of trainee/fellow years, i.e., one trainee/fellow for 12 months. Actual number of awards to individuals are higher due to partial-year awards. Field of trainee/fellows determined by degree/specialty/field data on individual trainee/fellow records (Form 2Z71). T35 program estimates are in number of awards and exclude T35 nontraining awards under the NHLBI T35 Minority Hypertension program. MSTP program is a subset of total Predoctoral training for a joint Ph.D.-M.D. degree. SOURCE: Estimated by National Research Council from the NIH Trainee Fellow File. For T35 program, data are from NIH Data Book 1988, Table 39; estimates of NHLBI T35 are estimated by National Research Council from the NIH Consolidated Grant Applicant File. 28

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2. NIH constantly revises its files as information is updated. Estimates for earlier years (1984, for example) may change several times as these revisions occur. The data presented here are the most recent (August 1989) estimates available to the committee. 3. The estimates by field in this report are based on the degree/specialty/field code on the TFF. Earlier committee data were estimates of fields compiled from special tabulations developed by the NIH Division of Research Grants. In addition, the Consolidated Grant Applicant File (CGAF) records a single discipline code for all trainees, regardless of their actual field, whereas the TFF data reported here are based upon actual fields of the trainees.28 Figure 1-4 illustrates trends in predoctoral and postdoctoral FTEP support for the period 1978-1987. These are full-term (i.e., excluding T35) T and F program totals. Total years of support for postdoctoral positions have been increasing since the early l980s, while predoctoral support has been declining. Total FTEP trainee/fellow support under the NRSA program peaked in 1982 at 11,063 positions and, after remaining near that level for four years, declined to 10,468 positions in 1987. Figure 1-5 breaks out the number of FTEP positions supported in the biomedical sciences. Predoctoral positions have declined from a peak of approximately 4,200 in 1982 to approximately 3,700 FTEP in 1987. Postdoctoral positions have oscillated in the range 3,700-4,000 since 1984. Biomedical sciences have dominated the NRSA program ~ 7000 historically, with 70.6 percent o f ·° all positions in 1987. ·O Figure 1-6 illustrates trends in trainee/fellow FTEP positions in the behavioral sciences. Predoctoral positions grew rapidly in 1982, but have since fallen off to about 500 positions. Postdoctorals in the behavioral sciences increased steadily from 194 FTEP in 1981 to a high of 447 positions in 1986. Behavioral science predoctoral support has remained around 10 percent of total NRSA predoctoral support for the 1978-1987 period; behavioral postdoctorals have SOURCE: Table 1-5 Increased proportionally during this period, from 4.3 percent in 1978 to 7.5 percent in 1987. ~ Predoctoral .~ Postdoctoral 0 6000- - e_ :' 5000 4000 El 1 1978 1979 1980 1981 1982 1983 1984 1985 1986 1987 Figure 1-4. Total NIH/ADAMHA NRSA predoctoral and postdoctoral positions supported, 1978-1987. 28The disaggregation of trainees/fellows into fields is considered by some within NIH as an impossible task because of differences across institutes in program administration and definitions. The accuracy of these data is unknown. In the committee's opinion, improvement in the field classification of trainees/fellows is needed in the overall NRSA data base (see Chapter 5~. 29

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Figure 1-7 displays trend data on clinical sciences scoot trainee/fellow FTEP positions ~ for the period 1978- 1987. .° Predoctoral support in the 0 4500- cl~n~cal sciences has remained flat, at approximately 650 3 positions since 1980; o postdoctoral support increased ~ 4000. initially, but flattened out at ~ approximately 1,500 positions 3 annually in 1983. Proportional ~ 3500. support in the clinical sciences E" has been declining, from 14.8 O percent to 13.5 percent of total NRSA predoctoral and from 34.0 ,= 3000 ~ . percent to 26.6 percent of postdoctoral support during the z 1978-1987 period. 2500- , , 1 . . . . . The MSTP program has a 1/ i ~ _3~ l?redoctoral · Postdoctoral 1978 1979 1980 1981 1982 1983 1984 1985 1986 1987 shown a fairly constant level of support during the 1980s at approximately 650 positions SOURCE: Table 1-5. annually (Table 1-5~. Short-term training (T35) grew to a peak of Figure 1-5. NIH/ADAMHA predoctoral and 1,029 in 1984, but the 1987 postdoctoral trainee/fellow positions in the biomedical support in this program was sciences, 1978- 1987. 774 positions. 800 3 o - ~ 600 - cn 400- - 200 ~ 1~ 1978 1979 1980 1981 1982 1983 1984 1985 1986 1987 SOURCE: Table 1-5. Figure 1-6. NIH/ADAMHA NRSA predoctoral and postdoctoral trainee/fellow positions in the behavioral sciences, 1978-1987. 30

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1 2400 o — 2000 o 3 1600' - - - o At ~3~ Predoctoral - ~ Postdoctoral 12(~ T 4~ \ \ O- I 1 1 '1'' 1 1' - I -' I --- 1978 1979 1980 1981 1982 1983 1984 1985 1986 1987 SOURCE: Table 1-~. Figure I-7. NIH/ADAMHA NRSA predoctoral and postdoctoral trainee/fellow positions in the clinical sciences, 1978-1987. 31

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