Careers in Clinical Research Obstacles and Opportunities (1994) / Chapter Skim
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Nurturing Clinical Researchers
Nurturing Clinical Researchers
Pages 41-62
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From page 41... ...
Furthermore, over the past two decades the measures for assessing medical practice and determining medical outcomes have been refined progressively, and this field of research stands on the crest of rapid implementation to improve the practice and delivery of effective health care (Wennberg, 1990~. Clinical investigation in the United Sates is currently threatened by fundamental changes in the organization of health care, major efforts to contain health care expenditures, the high costs of performing clinical studies, such as those associated with drug development, that add to the growing health care budget, and a perceived reduction in the number of individuals pursuing careers in patient-based research.
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In addition, some academic medical centers are closely affiliated with schools of nursing, pharmacy, or allied health. To trace the course of development to the modern academically based clinical research environment, it is useful to reflect on the history of academic medical centers.
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CLINICAL RESEARCH WORKFORCE Obtaining demographic data on the subset of academic faculty performing patient-oriented clinical research is hampered by the lack of a database for recording these data, the heterogeneity of the disciplines engaged in clinical research, and the inability to separate clinical investigator faculty from those with predominantly laboratory-based research or clinical care responsibilities. Furthermore, many faculty may be involved in more than one of these areas, possibly both laboratory and human research or human research and patient care.
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From page 45... ...
Both the AMA and the Association of American Medical Colleges (AAMC) collect data on medical school faculty, and both sets of data are useful in describing the clinical research workforce.
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The proportion of women physicians on medical school faculty exceeds their representation in the overall population of physicians—about about 23 percent versus 17 percent, respectively (see Figures 2-1 and 2-3~. Most of the women faculty, however, are clustered in the lower ranks of the faculty (Figure 24~.
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NURTURING CLINICAL RESEARCHERS TABLE 2-1 Full-time Faculty in All U.S. Medical Schools, 1961-1989 47 Number of Awards Percent in Fiscal Number Pre-clinical Clinical Clinical Year of Schools Total Departments Departments Departments 1961 86 11,224 4,023 7,201 64.2 1962 86 12,040 4,342 7,698 63.9 1963 87 13,602 4,693 8,909 66.0 1964 88 15,015 5,541 9,474 63.1 1965 89 15,882 5,233 10,649 67.1 1966 89 17,118 5,671 11,447 66.9 1967 92 19,297 5,877 13,420 69.5 1968 99 22,293 6,639 15,654 70.2 1969 101 23,034 7,048 15,986 69.4 1970 103 24,093 7,287 16,806 69.8 1971 108 27,539 8,283 19,256 69.9 1972 112 30,170 8,714 21,456 71.1 1973 114 33,265 9,381 23,884 71.8 1974 114 34,878 9,928 24,950 71.5 1975 114 37,010 10,164 26,846 72.5 1976 116 39,346 10,743 28,603 72.7 1977 122 41,650 11,031 30,349 72.9 1978 125 44,358 11,736 32,622 73.5 1979 126 46,662 12,605 34,057 73.0 1980 126 49,446 12,831 36,665 74.2 1981 126 50,532 12,816 37,716 74.6 1982 127 53,371 13,223 40,148 75.2 1983 127 55,525 13,587 41,938 75.5 1984 127 57,003 13,560 43,443 76.2 1985 127 58,774 13,767 45,007 76.6 1986 127 61,397 14,204 47,193 76.9 1987 127 63,313 14,479 48,834 77.1 1988 127 66,798 14,580 52,218 78.2 1989 127 70,308 14,832 55,476 78.9 Average 1.4% 6.7% 4.8% 7.6% Annual Growth Rate 1961-1989 Source: Reprinted with permission, from Ahrens [1992]
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From page 48... ...
For example, 36 percent of women faculty are under Me age of 39, compared with 23 percent of male faculty. Only 22 percent of the women faculty are between the ages of 50 and 69, whereas 36 percent of the male faculty are in the same age bracket (Association of American Medical Colleges, 1993~.
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medical school faculty by gender and academic rank for 1993. (Source: Reprinted, with permission, from Association of American Medical Colleges [19931, p.
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ACADEMIC RECOGNITION Promotions committees, and particularly tenure committees at competitive medical schools, require proof of a candidate's scholarly contributions.
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This also reinforces the disincentive to pursue clinical research when funding appears tenuous and encourages young investigators to pursue more secure career opportunities in bench research. The perception that laboratory-based research is more scholarly and leads more readily to promotion lures junior faculty away from padent-based research.
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Consequently, clinical research publications are frequently case reports or descriptive reviews of patients (Cadman, 1993~. FACULTY TRACKS Perceptions of second-class faculty status abound in both camps of the medical school faculty.
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At least one institution, Tufts University School of Medicine, has implemented a course to provide Ph.D.s with the perspective of clinical sciences (Arias, 1989~. The course is not intended to train Ph.D.s to become clinicians; its goal is to facilitate a dialogue between basic scientists and clinical investigators.
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From page 57... ...
The effects of the new policies regarding time-limited recertification recently implemented by many boards may have unintended negative consequences on clinical investigative careers. Clinical investigators need to be specialists in their areas of investigation and strive for academic recognition Trough scholarly contributions to the medical knowledge base.
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From page 58... ...
Although this model has been effective in allowing physicians to gain basic skills in research design and hypothesis testing, its effectiveness in providing the requisite skills for clinical research is unknown. It is believed that laboratory experience, however, is inadequate preparation for designing and conducting clinical research, which has its own set of methods, techniques, and ways of posing and answering relevant scientific questions using humans subjects (Feinstein, 1985a and 1985b; Fletcher et al., 1982; Janowsky et al., 1986; Nathan, 1988; Stolley, 1988)
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From page 59... ...
A mentor can function as a coach, counselor, teacher, advocate, protector, sponsor, guide, and confidant. To this end, a mentor's activities include teaching cognitive knowledge and technical skills; developing the protege's intellectual abilities; providing advice, encouragement, and criticism; helping their protege learn nsk-taking behavior, effective communications skills, and institutional and professional skills; fostering involvement in research and scholarly productivity; and facilitating entry into postgraduate or initial career positions and career advancement (Swazey, 1994~.
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CONCLUSIONS In conclusion, the committee believes that there are numerous hurdles confronting clinical investigators at all levels of faculty career development. Recognition in the academic health center includes promotion, protected time, and financial support.
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Creative start-up efforts through university mechanisms to establish core facilities that will seek continued funding through extramural sources represent important activities that should be strongly encouraged within the academic setting. The committee believes strongly that the translation and application of advances in research to patient care require a strong partnership between academic institutions and industry.
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