National Academies Press: OpenBook

Strengthening Research in Academic OB/GYN Departments (1992)

Chapter: APPENDIX A - PREPARING FOR THE TWENTY-FIRST CENTURY IN THE REPRODUCTIVE SCIENCES

« Previous: 6 A RESEARCH AGENDA FOR DEPARTMENTS OF OBSTETRICS AND GYNECOLOGY
Suggested Citation:"APPENDIX A - PREPARING FOR THE TWENTY-FIRST CENTURY IN THE REPRODUCTIVE SCIENCES." Institute of Medicine. 1992. Strengthening Research in Academic OB/GYN Departments. Washington, DC: The National Academies Press. doi: 10.17226/1970.
×

APPENDIX A
PREPARING FOR THE TWENTY-FIRST CENTURY IN THE REPRODUCTIVE SCIENCES:

The History and Present Status of Research Training in Obstetrics and Gynecology

LAWRENCE D. LONGO*

Division of Perinatal Biology

Departments of Obstetrics, Gynecology, and Physiology

Loma Linda University School of Medicine

". . . the development of our departments [of obstetrics and gynecology] has demonstrated beyond question the critical importance of research efforts and the presence of investigators, for the intellectual health and successful function of our teaching programs"

(Douglas, 1976).

Above the mantel at his home at 13 Norham Gardens, Oxford, Sir William Osler, Regius Professor of Medicine at Oxford University, had a tryptych with paintings of three great physicians: Thomas Linacre, Thomas Sydenham, and William Harvey. Linacre stood for learning in the classics, Sydenham for practice, and Harvey for science (Cushing, 1925). The physician-scientist embodies these three facets of the scientifically educated clinician, who in addition to his role as a healer, advances the scientific frontiers of medicine.

Today, biomedical research is in the midst of an era of discoveries focused on the cellular and molecular basis of living systems and disease states. Advances at the molecular level in genetics, regulation of cell function,

*  

 Prepared for the Institute of Medicine Committee on Research Capabilities of Academic Departments of Obstetrics and Gynecology.

Suggested Citation:"APPENDIX A - PREPARING FOR THE TWENTY-FIRST CENTURY IN THE REPRODUCTIVE SCIENCES." Institute of Medicine. 1992. Strengthening Research in Academic OB/GYN Departments. Washington, DC: The National Academies Press. doi: 10.17226/1970.
×

immunology, and developmental biology have created opportunities in the reproductive sciences. In addition, novel approaches to the prevention, diagnosis, and treatment of reproductive diseases are appearing.

Despite conceptual and technological developments, however, there exists a crisis in academic obstetrics and gynecology in both research and in research training. In part, this is due to forces external to the specialty–economic, ethical, political, and social. But there is also a dearth of physician-scientists and clinical investigators who can contribute to advances in the reproductive sciences and serve as role models for students, house staff, and others. In sum, too few obstetricians and gynecologist are being adequately trained to pursue research opportunities.

Thus, for academic obstetrics and gynecology, current circumstances present a paradox. Never before have the opportunities been so great–and the resources so limited (Martin, 1991). Departments of obstetrics and gynecology are increasingly confronted by the need to provide highly technical clinical care, to perform manifold social functions, and to maintain large, private practices to generate income. Biomedical scientists in these departments are coming under growing pressure to justify their research. As obstetrics and gynecology approach the twenty-first century, the clinical investigator, particularly the physician-scientist, is seriously threatened by an increasingly sophisticated research enterprise, decreased time for careful thought and work, and diminishing federal and private resources for support.

In the coming years, the future of obstetrics and gynecology as a whole will depend, in great part, on the health and well-being of its academic departments. In turn, the state of these departments depends, in considerable measure, on their role in research in the reproductive sciences. As Jack Masur, former director of the Clinical Center at the National Institutes of Health, (NIH) observed, "Hospitals with long traditions of excellence have demonstrated abundantly that Research enhances the vitality of teaching. Teaching lifts the standards of service, and Service opens new avenues of investigation." (This statement appears at the entrance to the main auditorium in the NIH Clinical Center.)

This paper explores the roles of the private sector and more briefly those of the National Institutes of Health in helping to produce research leaders in obstetrics and gynecology.

Suggested Citation:"APPENDIX A - PREPARING FOR THE TWENTY-FIRST CENTURY IN THE REPRODUCTIVE SCIENCES." Institute of Medicine. 1992. Strengthening Research in Academic OB/GYN Departments. Washington, DC: The National Academies Press. doi: 10.17226/1970.
×

Training Paths

Innovative developments and advances in obstetrics and gynecology have resulted from research in the basic sciences. During the 1950s and 1960s, following their residency training, many individuals who sought academic careers spent several years in a basic science department or a research-oriented clinical department. A few of these individuals were supported by the Markle Scholar Program or the Macy Foundation; many were funded by the National Institutes of Health (see the later discussion below). In the 1970s, with the advent of subspecialty programs (gynecologic oncology—1972; maternal and fetal medicine—1973; reproductive endocrinology—1973; [Randall, 1989]), many individuals completed 2 or 3-year programs in these fields before joining academic departments. In a few cases, they also spent a year or two in research. Thus, a generation of well-trained clinical subspecialists joined academic departments with little or no experience in either laboratory or clinical research.

For physicians-scientists, it has become increasingly important to spend 2 or 3 years in basic research training (IOM, 1985). Some individuals participate in basic research as part of their M.D./Ph.D. physician-scientist training program. Recent reports have described some aspects and relatively long-term results of the Duke (Bradford et al., 1986), Washington University (Frieden and Fox, 1991), and other (Martin, 1991) M.D./Ph.D. programs.

Private Foundation Funding for Research Training: 1950 to 1985

The Markle Scholar Program: A Case Study

Between 1948 and 1974, the John and Mary R. Markle Foundation supported the Program of Scholars in Medical Science.*

The foundation itself was begun in 1927 by John and Mary R. Markle "to promote the advancemeat and diffusion of knowledge … and promote the general good." From 1936 to 1947, the foundation's chief activity was to provide small grants-in-aid for medical research. With the end of World War II, expenditures for medical research by the federal government increased dramatically, dominating national research funding. Thus, in 1946, the newly

*  

 The discussion of the Markle Scholars Program is based on Strickland and Strickland (1976).

Suggested Citation:"APPENDIX A - PREPARING FOR THE TWENTY-FIRST CENTURY IN THE REPRODUCTIVE SCIENCES." Institute of Medicine. 1992. Strengthening Research in Academic OB/GYN Departments. Washington, DC: The National Academies Press. doi: 10.17226/1970.
×

appointed executive director, John McFarlane Russell, after spending a year visiting 30 medical schools in the United States and Canada and consulting with other educators and scientists, concluded that the foundation could provide a unique service and contribute to medical science by supporting people who wanted to remain in academic medicine. The scholarship would permit a young medical researcher to ''earn a bit more, have tenure long enough to prove his worth, ... have a respectable academic appointment and a nationally recognized title, [and] adequate laboratory facilities and equipment for his research'' (Russell, 1947). The concept of the program was support of outstanding young academicians who showed great promise, rather than the funding of research projects. Initially, the foundation provided $5,000 per annum for up to 5 years to supplement support by the scholar's institution.

The purpose of the program was "to improve medical education and research by giving both recognition and financial support to bright young teachers, investigators, and administrators, and helping them to prepare for positions of leadership in academic medicine." By providing funds so that the medical school, in a variety of ways, could enrich the opportunities and resource of those selected, the foundation hoped to contribute toward the improvement of medical school faculties. Of the 506 individuals selected, only 17 were obstetrician/gynecologists (Table A-1). This figure contrasts with 162 in internal medicine and subspecialties, 110 in surgery, and 61 in pediatrics.

The selection process had three steps: (1) initial nomination by the medical school; (2) selection of finalists by regional committees of distinguished laymen, who evaluated individuals on the basis of values and motivation; and (3) final appointment of the scholars by the foundation's board of directors. The medical schools nominated one person per year, choosing an individual who was considered truly committed to research and/or teaching in clinical or basic science. Schools nominated their brightest and best young "stars." The sponsoring institution was also required to make a significant and continuing commitment to the scholar.

The selection committee was chosen for its perceived abilities in picking individuals who would be leaders and in "judging them as human beings." At the annual 3-day selection meeting, candidates were evaluated on "breadth of character, personality, and potential leadership." This selection process, which was thought by some to be a great strength of the program, would today probably be seen as placing an excessive emphasis on personal qualities.

Suggested Citation:"APPENDIX A - PREPARING FOR THE TWENTY-FIRST CENTURY IN THE REPRODUCTIVE SCIENCES." Institute of Medicine. 1992. Strengthening Research in Academic OB/GYN Departments. Washington, DC: The National Academies Press. doi: 10.17226/1970.
×

TABLE A-1: Markle Scholars in Obstetrics and Gynecology: 1951–1974

Name

Institution

Year Commenced

Gordon W. Douglas, M.D.

New York University

1952

Leo J. Dunn, M.D.

Medical College of Virginia

1964

John R.G. Gosling, M.D.

University of Michigan

1960

Perry A. Henderson, M.D.

University of New Mexico

1969

Edward H. Hon, M.D.

University of Southern CA

1955

John B. Josimovich, M.D.

University of Pittsburgh

1964

Theodore M. King, M.D., Ph.D.

Johns Hopkins University

1967

Kermit E. Krantz, M.D., Litt D.

University of Kansas

1957

William A. Little, M.D.

University of Miami

1962

James A. Merrill, M.D.

University of Oklahoma

1957

Robert W. Noyes, M.D.

Stanford University

1953

Robert I. Merritt, M.D.

Saint Catharines Hospital

1956

Landrum B. Sherries, M.D., Ph.D.

Columbia University

1951

Donald P. Swartz, M.D.

Albany Medical College

1958

John D. Thompson, M.D.

Emory University

1957

James C. Warren, M.D., Ph.D.

Washington University

1961

Richard Wilson, M.D.

University of Toronto

1962

 

SOURCE: Strickland and Strickland (1976).

Although initially intended for only 10 scholars per year, the program proved so popular that within a few years, 20 to 25 individuals were being appointed annually. In 1950, the annual stipend was raised to $6,000, and in 1958 it was raised to $7,500. Grant money was often used for partial salary support, laboratory and library expenses, and travel. In general, the foundation required only brief annual financial statements from the institution and reports by the scholar at the end of the second and fifth years. At the end of an individual's 5-year scholarship, the executive director of the program or his associate, visited the young academician and prepared a report on his or her progress and contributions. Because the overall purpose of the Markle Awards was to improve the standards of academic medicine, considerable attention was given to medical education. Thus, although many scholars spent much of their time in research, the majority devoted 25 to 50 percent of their time to teaching.

A feature of the Markle program was a series of annual 2-day meetings in which the scholars and other educators discussed key issues related to medical education. These meetings, organized and run by the scholars themselves,

Suggested Citation:"APPENDIX A - PREPARING FOR THE TWENTY-FIRST CENTURY IN THE REPRODUCTIVE SCIENCES." Institute of Medicine. 1992. Strengthening Research in Academic OB/GYN Departments. Washington, DC: The National Academies Press. doi: 10.17226/1970.
×

considered such topics as "The Teacher in Medical Education," "Science and the Humanities," ''Academic Medicine and Public Policy," "Medicine in a Changing Society," and ''Scholarship Versus Society's Needs: A Conflict in Academic Medicine." Because these presentations and discussions were not published, it is difficult to ascertain their impact on medical education or academic medicine.

Although originally intended as a postfellowship program in medical research, by the 1960s, the program's emphasis had evolved to one of nurturing individuals for leadership in medical education. In 1961, NIH initiated its program of Research Career Development Awards (RCDA) and Research Career Awards. Some have suggested that the 5-year RCDA program was modeled after the Markle scholarships.

In the years that followed the establishment of the NIH awards, it became increasingly clear that the Markle program no longer played the key role it once had in keeping first-class minds in research. This change was reflected in the modification of the title of the program in 1962: from "Scholars in Medical Science" to "Scholars in Academic Medicine." One impetus for this shift was a perception that, with the development of federal programs to support young investigators, there was perhaps an overabundance of researchers. Thus, before his retirement from the foundation, Russell elected to terminate the program. The last group of scholars was chosen in 1969 (their awards continued until 1974).

In assessing the strengths of the program, in addition to the financial support, important elements that have been identified by some observers include the program's flexibility and the unresricted nature of the money. Overall, the awards provided a stimulus to excellence and achievement. For the scholar and the institution he or she represents, the Markle Award was a major recognition and a key to growth and stability in academic medicine.

Russell himself did not believe that the true impact of the awards could ever be assessed. Near the program's end, it was determined that 96 percent of the scholars had remained in academic medicine. Merlin K. Duval, a Markle scholar (1956–1961) who served as assistant secretary for health and scientific affairs in the Department of Health, Education, and Welfare, was quoted as saying, "The greatest strength of the Markle Program was that it served as an example of a premise that has subsequently been adopted by both private foundations and the Federal Government: to wit, one gets a great deal more out of investing in a man than in a subject".

The Markle program is said to be a model for the Milbank Memorial Foundation Awards (given from 1964 to 1969), and the Robert Wood Johnson Foundation Clinical Scholars and Health Policy Fellowship programs, as well as the programs of the Commonwealth Fund and Carnegie Corporation.

Suggested Citation:"APPENDIX A - PREPARING FOR THE TWENTY-FIRST CENTURY IN THE REPRODUCTIVE SCIENCES." Institute of Medicine. 1992. Strengthening Research in Academic OB/GYN Departments. Washington, DC: The National Academies Press. doi: 10.17226/1970.
×

A measure of the program's import is the variety of leadership positions that the scholars assumed. For instance, as of 1975, the Markle ranks included a Nobel laureate, 3 university presidents, 7 vice presidents, 2 vice-chancellors, 1 provost, 11 medical school deans, 14 associate deans, 134 departmental chairpersons, and numerous other top administrators. However, the nominees who were not selected for the program but who remained in academic medicine advanced up the academic ladder as rapidly as the Markle scholars in rank and salary. Almost 80 percent of the scholars interviewed maintained that they would have remained in academic medicine even without the Markle Award. It might be questioned, therefore, to what extent the program had a major impact on the entry of young scientists into academic medicine, or their retention or advancement.

For more than a quarter of a century, Markle scholars have symbolized leadership in American medical education. Many believe that the program has also made an impact on medical research, although quantifying that contribution is impossible. In sum, it is believed that the program benefited academic medicine and medicine in general "far in excess of the small amount of money the Foundation [contributed] to this large field".

Josiah Macy, Jr. Foundation

In 1955, the Josiah Macy, Jr., Foundation. recognizing the need for a scientific approach to obstetrics and gynecology and the requirement of laboratory training for full-time academicians elected to devote "at least the next ten years" to the area of reproduction. The goal was to develop reproductive biology as the basic science of academic obstetrics. A key figure in this decision was Howard Canning Taylor, Jr., chairman of Columbia University's College of Physicians and Surgeons and a figure of wide influence both within and outside the specialty (Bowers and Purcell, 1980). This program initially sponsored training at three centers: Columbia, Harvard, and Washington universities. Later, the departments of obstetrics and gynecology at Boston University, Cornell, Johns Hopkins, Michigan, Northwestern, Oregon, Pennsylvania, Yale, and the University of Uruguay (Montevideo) were included in the program. To accomplish its goals for reproductive science, the foundation established a program of faculty development, conferences and seminars, and medical student research.

The three original departments of obstetrics and gynecology chosen for the program were encouraged to expand r search in the reproductive sciences. To achieve this, the Macy foundation provided the following to selected individuals

Suggested Citation:"APPENDIX A - PREPARING FOR THE TWENTY-FIRST CENTURY IN THE REPRODUCTIVE SCIENCES." Institute of Medicine. 1992. Strengthening Research in Academic OB/GYN Departments. Washington, DC: The National Academies Press. doi: 10.17226/1970.
×

in a residency program: (1) salaries and research expenses for 2 years of research training in the basic sciences; (2) supplemental salary support on completion of that 2 year period and during completion of the residency; (3) and on completion of the residency, salary and funds for research while launching an investigative career. In addition, the foundation provided support for basic scientists to participate with obstetricians and gynecologists in multidisciplinary research. Ten individuals were chosen as Macy Faculty Fellows m Reproductive Biology (Table A-2), and about 30 Macy Postdoctoral Fellows in Obstetrics and Gynecology were partially supported at various schools (Table A-3). Fellowship awards were $15,000 per year for 3 years. In 1963, the Macy Foundation endowed professorships in obstetrics at both Columbia's College of Physicians and Surgeons and the Harvard Medical School (Macy Foundation, 1965 Annual Report). By 1966, when the Macy program ended, about 50 individuals had received some training support for an academic career in obstetrics and gynecology. By 1979 15 of them has become departmental chairmen (Bowers and Purcell, 1980).

TABLE A-2: Macy Faculty Fellows in Obstetrics and Gynecology

Fellow

Institution

John W. Choate

University of Rochester

Carlyle Crenshaw, Jr.

Duke University

John P. GustIon, Jr.

Western Reserve Univ.

Richard J. Hildebrandt

University of Florida

Cecil Jacobson

George Washington University

Robert B. Jaffe

University of Michigan

Theodore M. King

University of Missouri

Emmet J. Lamb

Stanford University

Jacques F. Roux

Albert Einstein

William Spellacy

University of Miannesota

 

SOURCE: Josiah Macy, Jr., Foundation (1966).

Suggested Citation:"APPENDIX A - PREPARING FOR THE TWENTY-FIRST CENTURY IN THE REPRODUCTIVE SCIENCES." Institute of Medicine. 1992. Strengthening Research in Academic OB/GYN Departments. Washington, DC: The National Academies Press. doi: 10.17226/1970.
×

TABLE A-3: Macy Postdoctoral Fellows in Obstetrics

Name

Institution

Karlis Adamsons, Jr.

Columbia University

Joseph J. Barlow

Harvard Medical School

Theodore C. Barton

Harvard Medical School

Jack N. Blechner

University of Florida

Arthur C. Christakos

Duke University

Charles Donald Christian

University of Arizona

Philip A. Coffman

Center for Population Research/NICHD

Robert Duemler

Washington University

Theodore Fainstat

Northwestern University

Ira C. Gall

Washington University

Donald Peter Goldstein

Harvard Medical School

Donald A. Goss

Vanderbilt University

John W. Grover

Harvard Medical School

Samir Hajj

American University of Beirut

Dennis Hawkins

University of London

Andre Hellegers

Georgetown University

Arthur Herbst

Harvard Medical School

Jaroslav F. Hulka

University of North Carolina

Howard N. Jacobson

Harvard Medical School

John B. Josimovich

University of Pittsburgh

Theodore M. King

Albany Medical College

Michael M. Levi

Columbia University

John L. Lewis, Jr.

Cornell Medical College

A. Brian Little

Case Western Reserve Univ.

William A. Little

University of Miami

Paul C. MacDonald

University of Texas/Southwestern Med School

Girgis Mikhail

Jefferson Medical College

Horst Naujoks

Genetic Research Laboratory/University of Frankfurt

Suggested Citation:"APPENDIX A - PREPARING FOR THE TWENTY-FIRST CENTURY IN THE REPRODUCTIVE SCIENCES." Institute of Medicine. 1992. Strengthening Research in Academic OB/GYN Departments. Washington, DC: The National Academies Press. doi: 10.17226/1970.
×

Name

Institution

Harry Prystowsky

University of Florida

Ralph M. Richart

Columbia University

John G. Robertson

University of Edinburgh

Seymour L. Romney

Albert Einstein School of Meal.

Kenneth J. Ryan

Case Western Reserve Univ.

Hilton A. Salhanick

Harvard Medical School

Eugene C. Sandberg

Stanford University

John Joseph Sciarra

University of Minnesota

Wolfgang Tretter

Columbia University

John Urquhart

University of Pittsburgh

Raymond L. Vande Wiele

Columbia University

A. Stark Wolkoff

University of Kansas

David WuTakau

Medical College, Taiwan

Richard Wurtman

Massachusetts institute of Technology

Clement Yahia

Harvard Medical School

 

SOURCE: Josiah Macy, Jr., Foundation (1966).

An additional Macy contribution was a Summer Scholarship Program for medical student research in reproduction. Sixteen of these awards were made available annually to each of the 15 medical schools (Macy Foundation, 1956–60; 1980 Annual Reports).

The Macy Foundation also sponsored an interdisciplinary conference program to facilitate communication among various fields and specialties. Over the course of two decades, the foundation organized more than 20 conference groups, each group holding five annual meetings (Fremont-Smith, 1957). Conference participants were limited to 25 individuals: 15 to 20 regular members attended the five annual conferences, and the balance were guests. In addition to conferences held on gestation during the 1950s, the Macy Foundation supported conferences on "Teaching the Biological and Medical Aspects of Reproduction to Medical Students" (Macy Foundation, 1966) and "Teaching Family Planning to Medical Students" (Macy Foundation, 1968).

Suggested Citation:"APPENDIX A - PREPARING FOR THE TWENTY-FIRST CENTURY IN THE REPRODUCTIVE SCIENCES." Institute of Medicine. 1992. Strengthening Research in Academic OB/GYN Departments. Washington, DC: The National Academies Press. doi: 10.17226/1970.
×

A conference hosted jointly by the Macy Foundation and the National Institute on Child Health and Human Development (NICHD), "The Current Status and Future of Academic Obstetrics," was of interest from the standpoint of research training in obstetrics and gynecology (Bowers and Purcess, 1980). In report after report, leaders in academic medicine in general and in obstetrics and gynecology in particular stressed (1) the extent of research opportunities in the reproductive sciences, (2) the paucity of well-trained physician-scientists in the specialty, and (3) the need to correct this imbalance. Norman Kretchmer, then director of NICHD, sum the situation: "Reproductive research and departments of obstetrics and gynecology would benefit mutually from more emphasis on training young investigators and on fostering cooperation and collaboration among diverse research areas" (Bowers and Purcell, 1980, pp. 55–57; see also pp. 33–39 and 164–167).

Overall, between 1955 to 1965, the Macy Foundation allocated $5.37 million to develop talent in academic obstetrics and gynecology. From 1965 to 1970, it awarded an additional $1 million to help develop the field of reproductive biology and improve instruction in obstetrics and gynecology.

Ford Foundation

Increased interest in and enthusiasm for the reproductive sciences were spurred in the late 1950s and early 1960s by awareness of the problem of world population growth and by optimism about the potential contribution of the biological sciences to its solution. This optimism was base in large part on the successful development of oral contraceptives and the intrauterine device. During this period, the World Health Organization began its population program, the Population Council was founded, and NIH developed specific programs to support research in reproductive biology and fertility.

Beginning in 1952, the Ford Foundation began to support research in the reproductive sciences, particularly in contraceptive development and safety; it also supported research and training in the social sciences relating to population issues and family planning programs in developing countries. At the end of that decade, it appointed a committee to determine the steps it should take to develop the scientific basis for a program in population control. The work of the committee led to the establishment of centers for studies in reproductive endocrinology and neuroendocrinology at several major universities. The foundation also provided considerable monies to the Population Council to support contraceptive development and demographic studies.

Suggested Citation:"APPENDIX A - PREPARING FOR THE TWENTY-FIRST CENTURY IN THE REPRODUCTIVE SCIENCES." Institute of Medicine. 1992. Strengthening Research in Academic OB/GYN Departments. Washington, DC: The National Academies Press. doi: 10.17226/1970.
×

In addition to research, the Ford Foundation sponsored several hundred preand postdoctoral research fellowships in the United States and Europe (Bowers and Purcell, 1980). For 3 years, from 1980 to 1983, the foundation also joined with the Rockefeller and Andrew W. Mellon foundations to fund reproductive research in fertility regulation, providing about $1 million per year to this effort (Ford Foundation, 1982). In 1990, however the foundation's population program was reorganized to place increased emphasis on the social science aspects of reproductive health (Ford Foundation, 1990).

Rockefeller Foundation

In its early years, the Rockefeller Foundation programs concentrated on public health and helped to support full-time faculty at several medical schools, in particular, Johns Hopkins, Rochester, and Iowa (Comer, 1964). It funded research in the reproductive sciences through the National Academy of Sciences/National Research Council Committee on Research in Problems of Sex, as well as through grants to selected research groups. In 1965, the foundation instituted a program to study problems associated with population growth.

In addition to grants to major research centers, the Rockefeller Foundation supported a program of 1 to 3 year fellowships for research training. Of eight such awards per year, "two or three went to physicians in academic obstetrics" (Bowers and Purcell, p. 61). In 1977, the foundation established a division of population sciences, led by Sheldon Jerome Segal.

Andrew W. Mellon Foundation

Beginning in 1977, the Andrew W. Mellon Foundation joined in the support of research and research training in the reproductive sciences. To carry out its objectives, the foundation mounted a multifaceted program that included support for fundamental research and research training, in addition to support for research and training in demography, policy analysis with respect to family planning, and technical assistance to developing countries.

The Mellon "young investigators" program in reproductive biology has provided support to promising young scientists both U.S. and foreign citizens, during their postdoctoral research training. It has also provided some start-up funds to help support junior faculty.

The overall program goal has been "to foster the development of excellent young investigators..." (Mellon Foundation, 1985). Initial awards from the

Suggested Citation:"APPENDIX A - PREPARING FOR THE TWENTY-FIRST CENTURY IN THE REPRODUCTIVE SCIENCES." Institute of Medicine. 1992. Strengthening Research in Academic OB/GYN Departments. Washington, DC: The National Academies Press. doi: 10.17226/1970.
×

program went to Columbia and Harvard universities and to the Population Council. The following year (1978), awards were made to Baylor College of Medicine, Johns Hopkins, Mayo Clinic, University of California, San Francisco, and the University of Pennsylvania. Subsequently, several other institutions were added. To date, 17 centers have been supported in part by this program; the 4 centers receiving the largest amounts for reproductive biology have been the Population Council, University of California at San Francisco, University of Pennsylvania, and Baylor College of Medicine.

In 1980, Mellon joined with the Ford and Rockefeller foundations in joint support of focused research projects in reproduction. After 3 years, however, the Ford Foundation withdrew from this effort following a shift in program emphasis (Mellon Foundation, 1985). By the end of 1989, when the program was discontinued, the Mellon Foundation had contributed $9.3 million to the research effort. From 1977 to 1988, Mellon Foundation appropriations for population totaled $73.8 million. Of this, about half ($27.5 million, or about $2.4 million per year) was used to support promising young investigators in reproductive biology (Mellon Foundation, 1990). As of 1991, the Mellon Foundation has continued to fund some research and research training in the reproductive sciences. Much of this support is directed toward demographic and applied contraceptive research (Mellon Foundation, 1990).

A 1986 study of the impact of Mellon Foundation funds in research training found that although it was premature to evaluate the program's full impact, productivity measured in terms of publication records was "outstanding." Mellon-supported investigators were also successful in securing subsequent NIH funding; their rate of funding was comparable to that of NIH-supported trainees (Haseltine and Campbell, 1986).

Federal Support for Research Training

The National Institutes of Health and the National Institute of Child Health and Human Development

In 1945, at the end of World War II, Vannevar Bush, President Roosevelt's science advisor, outlined his visionary policies for federal support of peacetime health research in Science—The Endless Frontier (Bush, 1945). Bush foresaw both the need for fundamental biomedical research and the key role that

Suggested Citation:"APPENDIX A - PREPARING FOR THE TWENTY-FIRST CENTURY IN THE REPRODUCTIVE SCIENCES." Institute of Medicine. 1992. Strengthening Research in Academic OB/GYN Departments. Washington, DC: The National Academies Press. doi: 10.17226/1970.
×

universities and colleges could play in advancing knowledge in the health sciences.

The forerunner of the National Institutes of Health, the Laboratory of Hygiene, opened in 1887 as a one-room attic laboratory at the Marine Health Service Hospital on Staten Island in New York. This was reorganized into the National Institute of Health in 1930 (National Institutes of Health, 1930), and in 1938 moved to its current location in Bethesda, Maryland. By 1961, a Center for Research in Child Health had been established in the Division of General Medical Sciences. In addition, a task force reported that year to President John F. Kennedy that research into the physical, intellectual, and emotional growth of children was severely handicapped by not having a centralized organizational structure. This group called for a new institute to launch a concentrated attack against disorders of development.

NIH Research Training Programs

Over the past several decades, NIH has developed a number of mechanisms for the support of research training (Table A-4). In the 1950s, the training grant mechanism emerged as a vehicle for the development of academic physicians. Originally, its purpose was not only to develop research but to train clinical specialists and subspecialists in underrepresented fields such as cardiology. Individual fellowship awards originated at about the same time. These awards (the F series) and institutional training grants (the T series) provide support for 2 to 3 years through National Research Service Award (NRSA) funds. Career development awards (the K series), such as those for clinical investigators (K08) and physician-scientists (K11, K12), are made for 3 to 5 years in support of clinical or basic science research training (Table A-4). In addition, individuals with more advanced research experience may compete for independent research funding through a First Independent Research Support and Transition (FIRST) Award (R29) or a research project grant award (RO1). Another funding mechanism is the Research Career Development Award (IO4), a 5-year award with partial salary support.

In 1958, NIH expanded research training programs in embryology and developmental physiology (Taylor, 1961). During the 1960s, routine clinical training was excluded from NIH-funded training mechanisms. In 1973, under the Nixon administration, all training grants and fellowships were discontinued, but because Congress was persuaded of the vital role of federal support in producing researchers to meet national goals in health research, it passed the National Research Service Award Act (P.L. 93–348) in 1974 which reinstated

Suggested Citation:"APPENDIX A - PREPARING FOR THE TWENTY-FIRST CENTURY IN THE REPRODUCTIVE SCIENCES." Institute of Medicine. 1992. Strengthening Research in Academic OB/GYN Departments. Washington, DC: The National Academies Press. doi: 10.17226/1970.
×

training grants and fellowships. However, in an attempt to ensure that trainees who accepted federal support rotended to enter a career in research, it included a payback requirement of service.

While NIH support for research training has benefited medicine in general, and obstetrics and gynecology in particular, it has also undoubtedly played a role in the shift of such support by private foundations to other endeavors, in which their directors perceived that their presence would have a greater impact.

TABLE A-4: NIH Research Training and Research Mechanisms

Mechanism

Requirement

Duration Years

Purpose

F3, Postdoctoral fellowship (individual

Doctoral degree

2

Allow development of basic science expertise

T32, Postdoctoral Training grant (institutional)

Doctoral degree

2

Allow development of basic science expertise

K08, Clinical Investigator Award (CIA)

M.D.

5

Prepare clinicians for career as independent investigators

K11, Physician Scientist Award (PSA; (individual)

M.D.

5

Allow individuals with clinical training to develop independent basic research skills

K12, Physician Scientist Award (institutional)

M.D.

5

RO1, Research project Grant

Doctoral degree

5

Support further development of junior faculty to maximize research efforts

R29, First Independent Research Support and Transition (FIRST) Award

Doctoral degree

5

Support newly independent investigators with no more than 5 years research experience since completing postdoctoral training or equivalent

Suggested Citation:"APPENDIX A - PREPARING FOR THE TWENTY-FIRST CENTURY IN THE REPRODUCTIVE SCIENCES." Institute of Medicine. 1992. Strengthening Research in Academic OB/GYN Departments. Washington, DC: The National Academies Press. doi: 10.17226/1970.
×

Mechanism

Requirement

Duration Years

Purpose

K04, Research Career Development Award (RCDA)

Doctoral degree, independent research support

5

Support development of independent program research program

F33, Senior fellowship

Doctoral degree

 

Obstetrics and Gynecology Research Training: 1985 to the Present

American Gynecological Society

At its 1953 annual meeting, the American Gynecological Society (AGS) appointed a committee to determine whether the field of obstetrics and gynecology was attracting its share of first-rate students. The following year the committee reported its findings. As a result, the society passed a resolution which stated in part:

Whereas the committee report indicates that there is in fact a disproportionately small number of ''talented'' men (i.e., men talented with respect to research and scientific investigation) entering Obstetrics and Gynecology and

Whereas the American Gynecological Society is composed of men largely responsible for academic and scientific standards m this profession, therefore

Be it resolved that the study be continued with committees or subcommittees of the following general character:

Suggested Citation:"APPENDIX A - PREPARING FOR THE TWENTY-FIRST CENTURY IN THE REPRODUCTIVE SCIENCES." Institute of Medicine. 1992. Strengthening Research in Academic OB/GYN Departments. Washington, DC: The National Academies Press. doi: 10.17226/1970.
×
  1. A Committee on the Undergraduate Curriculum.

  2. A Committee on the Residency Program.

  3. Committee on the Development of Research. (Taylor, 1961, p. 9)

These subcommittees were appointed, and circulated a questionnaire to obstetrics and gynecology departmental chairmen. In addition, because it recognized the limitations of this approach, the society obtained financial assistance from the Josiah Macy, Jr., Foundation to support a more complete survey by a professional educator.

Earle T. Engle, professor of anatomy at Columbia's College of Physicians and Surgeons and an outstanding reproductive physiologist, was selected for this task. From October 1956 to December 1957, he visited departments of obstetrics and gynecology in 44 medical schools, spending 1 to 3 days at each, interviewing faculty, house staff, students, and others. Just after completing his survey, Engle died. Over the next several years, drafts of his report, his notebooks, and his daily log were reviewed and organized into a document entitled "Recruitment of Talent for a Medical Specialty" (Taylor, 1961); the material was mainly devoted to problems in undergraduate medical education in obstetrics and gynecology and in the residency training programs. Because of a perception of the inadequacy of research in obstetrics and gynecology, as compared with other clinical departments, and the realization that the specialty could not truly progress without strengthening its knowledge base, the report also considered problems related to research and research training.

The AGS questionnaire to departmental chairmen included questions on whether departments of obstetrics and gynecology received their share of research monies, space, and facilities. Although about half of the respondents believed there was no limitation on their facilities, there were also no criteria to judge what was adequate. In addition to these questions, the committee asked whether talented students were deterred from entering the field because of a perceived lack of research opportunities. Only 3 percent of the 559 medical students and 14 residents interviewed stated that they had based their selection of specialty on the challenging nature of research problems in the field. Thus, a perceived lack of research opportunities in obstetrics and gynecology apparently played little role in the choice of that specialty.

Engle noted that despite good retentions, what was too often lacking were two essential ingredients: "adequate facilities … and investigators skilled in the application of experimental methods" (Taylor, 1961, p. 111). Of the 44 departments he visited, 29 had no or inadequate laboratory space. Of the 15 departments whose facilities were judged to be adequate, all but one had a

Suggested Citation:"APPENDIX A - PREPARING FOR THE TWENTY-FIRST CENTURY IN THE REPRODUCTIVE SCIENCES." Institute of Medicine. 1992. Strengthening Research in Academic OB/GYN Departments. Washington, DC: The National Academies Press. doi: 10.17226/1970.
×

full-time staff including basic scientists. Some of these departments included clinicians with research training. Although Engle found that "few mean with these backgrounds are yet ready ... theirs is the promise for the future" (Taylor, 1961, p. 116).

In an attempt to determine what changes had occurred since its original survey 5 years previously, in 1959, the AGS committee sent a second questionnaire to 106 departmental chairmen. Eighty-five percent of respondents replied that their department was actively engaged in developing future workers and/or investigators in obstetrics and gynecology (Taylor, 1961) but the number of investigators was not given. Half of the chairmen agreed about the need for basic science fellowships, and two-thirds believed that there should be more space and money for research. Overall, the consensus was that they needed "more and better basic research" and "more facilities" (Taylor, 1961).

A handicap that had been noted in the development of first-rate research programs in departments of obstetrics and gynecology was the scholastic standing of students choosing the specialty. The report included an independent study of students' specialty selection. Students entering obstetrics and gynecology tended to be "intellectually less able than those attracted to the other major [specialties]" (Taylor, 1961, p. 39). In addition, a questionnaire sent to 515 students at 11 medical schools who were to graduate in 1959 revealed that half of the students entering obstetrics and gynecology were from the lower third of their class, with few candidates (15 percent) from the upper third and only the rare individual from the top 10 percent (Taylor, 1961). Moreover, 40 percent of departmental chairmen said that lack of ideas, energy, and motivation were the chief factors limiting the research efforts of their departments (Taylor, 1961).

The AGS committee consequently recommended the following: (1) more emphasis on research, improved facilities, and increased funding; (2) creation of research professorships in obstetrics and gynecology; and (3) "the development of large numbers of individuals skilled in clinical obstetrics and gynecology and in the technique of laboratory research" (Taylor, 1961. p 243). Committee members noted that their emphasis on research was not originally intended but that they had found that research was the area in which the range of excellence was "perhaps the greatest, and it is in respect to research that comparisons can be most easily made." In addition, they stated that "it is upon the success or failure in this field that the prestige of academic obstetrics and gynecology most depends'' (Taylor, 1961, p. 144).

The long-term impact of this report is not easy to assess. On the one hand, the departments at Columbia University and the University of California at Los Angeles (where two of the three subcommittee chairs were chairmen) continued

Suggested Citation:"APPENDIX A - PREPARING FOR THE TWENTY-FIRST CENTURY IN THE REPRODUCTIVE SCIENCES." Institute of Medicine. 1992. Strengthening Research in Academic OB/GYN Departments. Washington, DC: The National Academies Press. doi: 10.17226/1970.
×

to grow and prosper. In addition, obstetrics and gynecology departments m other research-intensive institutions, such as Johns Hopkins, the University of California at San Francisco, the University of Texas Southwestern, Yale, and several others, flourished. The report also played a vital role in the establishment, two decades later, of the Kennedy-Dannreuther fellowship program. On the other hand, it would appear that in most departments of obstetrics and gynecology, the conclusions of the report fell on deaf ears.

American Association of Obstetricians and Gynecologists Foundation Scholarship Program

Since 1984, the American Association of Obstetricians and Gynecologists Foundation (AAOGF), the philanthropic arm of the American Gynecological and Obstetrical Society (AGOS), has supported outstanding young obstetrician-gynecologists for 2 years of postresidency (and/or postfellowship) research training. The Foundation of the American Association of Obstetricians, Gynecologists, and Abdominal Surgeons (as the organization was originally called) was established in 1929 with funds raised by members. Subsequent bequests to the foundation by James Kennedy of Philadelphia and Walter T. Dannreuther of New York increased the endowment substantially. In 1981, the American Association of Obstetricians and Gynecologists merged with the American Gynecological Society to form AGOS, with the AAOG Foundation continuing as an independent entity. Donations by AGOS members, as well as a substantial bequest from the estate of J. Bay Jacobs, have further increased the foundation's endowment.

In the 1970s, the foundation worked to improve undergraduate and resident education in obstetrics and gynecology, and in 1983, it began to support research training in the specialty. The purpose was to help individuals who would conduct research, serve as role models to other potential investigators, attract more search funds, and improve the status of academic obstetrics and gynecology (Mitchell, 1990). Initially (in 1984), the foundation supported one Kennedy-Dannreuther fellow for two years. From 1985 to 1987, it annually supported two trainees, and since 1988 it has supported three trainees per year. In 1987, the Burroughs Wellcome Fund joined the AAOG Foundation in helping to support one fellow for 2 years. In 1989, the appellation AAOG Foundation Scholar was given to individuals in the program.

Initially, fellows received a stipend of $35,000 per year. In 1990, this was raised to $40,000 per annum, with the stipulation that the institution add at least

Suggested Citation:"APPENDIX A - PREPARING FOR THE TWENTY-FIRST CENTURY IN THE REPRODUCTIVE SCIENCES." Institute of Medicine. 1992. Strengthening Research in Academic OB/GYN Departments. Washington, DC: The National Academies Press. doi: 10.17226/1970.
×

$15,000 per year. Applicants for this 2 year award must have completed at least 1 year of their residency, be allowed to devote 90 percent of their time to laboratory or clinical investigation, and have demonstrated a long-term commitment to research and academic obstetrics and gynecology. In addition, beginning in 1988, the AAOG Foundation joined in helping to support the Reproductive Scientist Development Program (see below).

Establishment of the AAOGF Scholarship Program occurred in part because of the perceived need for research-trained obstetricians and gynecologists. Several surveys that had been conducted earlier indicated that 200 to 300 individuals per year were required to flu positions in academic obstetrics and gynecology (Messer et al., 1979; Pearse et al., 1981). In addition, some leaders recognized that increased emphasis on clinical subspecialty training was, in effect, decreasing the laboratory research expertise of young academicians. These factors, coupled with a sense that obstetrician-gynecologist investigators were becoming less competitive in obtaining research funding, helped to persuade the Kennedy-Dannreuther Committee of the need for increased emphasis on basic research in departments of obstetrics and gynecology.

Other Foundations and Pharmaceutical Companies

American College of Obstetricians and Gynecologists

The primary professional organization for obstetricians and gynecologists, the American College of Obstetricians and Gynecologists (ACOG) supports and administers several programs and fellowships for basic and clinical research training. For example, ACOG helps to support one of the Reproductive Scientist Development Program awardees (see below) and administers several fellowships sponsored by pharmaceutical companies. These include the Ciba-Geigy "Fellowship for Research in Endocrinology of the Postreproductive Woman," and two Ortho Pharmaceutical Company "Academic Training Fellowships" (see Table A-5).

Society for Gynecologic Investigation

Organized in 1953 by a small group of investigators in departments of obstetrics and gynecology, the Society for Gynecologic Investigation (SGI) has developed into probably the premier research organization in the reproductive sciences (see Longo, 1983). Throughout its history, the SGI has fostered and

Suggested Citation:"APPENDIX A - PREPARING FOR THE TWENTY-FIRST CENTURY IN THE REPRODUCTIVE SCIENCES." Institute of Medicine. 1992. Strengthening Research in Academic OB/GYN Departments. Washington, DC: The National Academies Press. doi: 10.17226/1970.
×

promoted a spirit of inquiry in departments of obstetrics and gynecology; it has also served as a forum in which young investigators in both and clinical reproductive sciences could present their work. It has not supported research projects or research training. In 1989, the SGI council voted to help support the Reproductive Scientist Development Program, and currently is working to supply matching funds (see below).

TABLE A-5: Private and Combined Private/Federal Fellowships and Awards in the Reproductive Sciences

Institution/ Foundation

Purpose

Amount (Dollars)

Duration (Years)

Number Year

American Association of Onstetricians and Gynecologists Foundation/American Gynecological Society

Basic research in reproductive sciences

40,000

2

2–3

American College of Obstetricians & Gynecologists CIBA

Study the endocrinology of the post-reproductive woman

25,000

2

1

Ethicon

Study innovations in gynecologic surgery

20,000

1

1

Ortho Academic Training Fellowship

Improve skills in basic research/training/health/care delivery

30,000

1

6

Suggested Citation:"APPENDIX A - PREPARING FOR THE TWENTY-FIRST CENTURY IN THE REPRODUCTIVE SCIENCES." Institute of Medicine. 1992. Strengthening Research in Academic OB/GYN Departments. Washington, DC: The National Academies Press. doi: 10.17226/1970.
×

Institution/ Foundation

Purpose

Amount (Dollars)

Duration (Years)

Number Year

Berlex Foundation Scholar Award

Reproductive medicine

50,000

+10,000a

1

1-2

International Research Fellowship

Human repro-reproductive research

75,000b

+15,000a

2-3

+3

3-4

Burroughs Wellcome

Support for one AAOG fellowship

35,000

2

1

Reproductive Scientist Training Program NIH/NICHD, AAOGF/ AGOS, ACOG, APGO,AFS, GynoPharma

Cell and molecular biology in the reproductive sciences

50,000

+10,000a

2-3

+3

3-4

NOTE: NIH/NICHD = National Institutes of Health/National Instituite of Child Health and Development.

a For research supplies.

b Includes travel funds.

Berlex Foundation

Beginning in 1988, the Berlex Foundation has made one or two awards per year to Berlex "scholars." The award ($60,000 per year—$50,000 in stipend monies and $10,000 in laboratory support) is made to a clinician-investigator for work on a clinically related research project in reproduction (see Table A-5). In addition, the foundation supports an annual International Research Fellowship in human reproduction for a senior investigator.

Suggested Citation:"APPENDIX A - PREPARING FOR THE TWENTY-FIRST CENTURY IN THE REPRODUCTIVE SCIENCES." Institute of Medicine. 1992. Strengthening Research in Academic OB/GYN Departments. Washington, DC: The National Academies Press. doi: 10.17226/1970.
×

Reproductive Scientist Development Program

The idea of the Reproductive Scientist Development Program arose in the mid-1980s from concerns about the quantity and quality of basic research conducted in departments of obstetrics and gynecology by clinicians. In September 1986, at the time of the annual meeting of the American Gynecological and Obstetrical Society, an ad hoc group met to discuss development of a research training program for gynecologists. This group included representatives from the American College of Obstetricians and Gynecologists (ACOG), the American Gynecological and Obstetrical Society (AGOS), the Association of Professors of Obstetrics and Gynecology (APGO), and the Society for Gynecologic Investigation (SGI). The group outlined several goals and objectives for the program: the securing of both input and financial assistance from the leading organizations in obstetrics and gynecology; training for clinicians in excellent basic science laboratories; at least 5 to 6 years of research training (2 or 3 years in the laboratory and 3 years in a department of obstetrics and gynecology to become established as an investigator); and selection of outstanding candidates who had completed a residency in obstetrics and gynecology and had a long-term commitment to research.

In May 1987, the ad hoc committee submitted an application to the National Institutes of Health (NIH) for a multidisciplinary, multi-institutional program to tram obstetrician-gynecologists as physician-scientists. The program emphasized cell and molecular biology and related fundamental sciences; its overall goal was to identify the brightest and best individuals in departments of obstetrics and gynecology and to provide them with basic science,knowledge and skills. Specific objectives of the training program were as follows: (1) to increase the awareness and the attractiveness of a career in investigative academic obstetrics and gynecology among potential academicians; (2) to facilitate research training of obstetrician-gynecologists in the basic biomedical sciences; and (3) to stimulate the retention and maximal productivity of trainees by guaranteeing their placement as faculty members in a medical school department.

Beginning in 1988, 3 to 4 individuals per year have embarked on this 5 to 6 year rigorous training program in cellular and molecular aspects of reproductive science. As of July 1991, 12 individuals were in the program (Table A-6), which is jointly funded by NIH and several private groups. These latter include the American Fertility Society, the APGO Council on Resident Education in Obstetrics and Gynecology, Ethicon, Inc., and GynoPharma, Inc. Each of these groups provide "matching" funds for one trainee.

Suggested Citation:"APPENDIX A - PREPARING FOR THE TWENTY-FIRST CENTURY IN THE REPRODUCTIVE SCIENCES." Institute of Medicine. 1992. Strengthening Research in Academic OB/GYN Departments. Washington, DC: The National Academies Press. doi: 10.17226/1970.
×

TABLE A-6: RSDP Trainees and Their Support for Full Time Laboratory Investigation: 1988 to the Present

Trainee

Year(s)

Sponsoring Inst.

Source of Supporta

Setsuko K. Chambers

1988–1990

Yale University

ACOG

Karen P. Beckerman

1988–1991

Washington Univ.

AGOS/AAOG Fdn. (1988–1990)

Thomas J. Musci

1988–1991

University of CA/SF

Gynopharma, Inc.

Deborah A. Driscoll

1989–1991

University of PA

National Institutes of Health

James H. Segars, Jr.

1989–1991

Natl. Inst. of Health

Am. Fertility Soc.

John Yeh

1989–1991

Harvard University

APGO/CREOG

Robert A. Kaufmann

1990–1992

Wayne State Univ.

ACOG

Karen K. Smith-McCune

1990–1992

University of CA/SF

AGOS/AAOGF

Susan A. Arnold-Aldea

1991–1993

Harvard University

Johnson & Johnson Medical

Kimberly K. Leslie

1991–1993

Univ. of Colorado

APGO/CREOG

John L. Mershon

1991–1993

Univ. of Cincinnati

AFS

Michael C. Snabes

1991–1993

Baylor Col. of Med.

Gynopharma, Inc.

NOTE: RSDP = Reproductive Scientist Development Program.

a The source of support for all individuals includes NIH.

Problems of Research Training

General Problems

As noted earlier, the training required to be a first-rate specialist/subspecialist in obstetrics and gynecology and to gain scientific expertise is lengthy and arduous. Some general questions include the following: To what extent does one lose research potential by the end of a residency and/or fellowship? How can one create interest among the "brightest and best" students, residents, or fellows in many departments that lack role models? In addition, it is unclear to what extent potential applicants are aware of the opportunities in academic research and the training programs that are available.

Suggested Citation:"APPENDIX A - PREPARING FOR THE TWENTY-FIRST CENTURY IN THE REPRODUCTIVE SCIENCES." Institute of Medicine. 1992. Strengthening Research in Academic OB/GYN Departments. Washington, DC: The National Academies Press. doi: 10.17226/1970.
×

Problems in Establishing a Research Program

To obtain adequate funding for research programs, departments and individuals must compete nationally. In many instances, uncertainties of funding cloud the attractiveness of an academic career.

As pointed out by Movsesian (1990), because the average duration of an NIH grant is about 4 years, new physician-scientists face the challenge of three consecutive cycles—an initial review and two competitive renewals to obtain continuous funding over a 10 year period. At NICHD, 1989–1990 success rates were 16 percent for new RO1 applications and 22 percent for competitive renewals. Of course, an investigator can increase his or her chances of success by submitting more than one application for each award. Movsesian has calculated that a minimum of 18 applications would be required to ensure a 50 percent chance of funding through three cycles. If each cycle resulted in a grant that lasted 4 years, this translates into an application submitted every 8 months (Movsesian, 1990).

With the increasing professionalization of research, one must be a full-time investigator to remain competitive. The physician-scientist will find it increasingly difficult to stay at the forefront of the field and still care for patients any more than a minimal amount of time. Thus, a critical need is a supportive environment—the departmental chair, colleagues, and the dean of the physician-scientist's institution or school must protect the beginning investigator and provide financial and moral support. The pressure to generate income too often means that the young physician-scientist or clinical investigator is required to perform services, at the expense of research. And yet, for the young investigator financial support is critical. Although the active research program is the sine qua non of an academic department, few departments can afford such a program without outside support.

Manpower in Academic Obstetrics and Gynecology Current Status and Future Needs

Recent History

Because consideration of research training in the reproductive sciences must be viewed in the context of academic obstetrics and gynecology in general, it is appropriate to consider the recent history of departmental human resources and projections for the future. Several studies provide data on the number of

Suggested Citation:"APPENDIX A - PREPARING FOR THE TWENTY-FIRST CENTURY IN THE REPRODUCTIVE SCIENCES." Institute of Medicine. 1992. Strengthening Research in Academic OB/GYN Departments. Washington, DC: The National Academies Press. doi: 10.17226/1970.
×

specialists and subspecialists in American medical schools during the past two decades. Of about 30,000 obstetricians and gynecologists in the United States in 1990, about 8 percent, or 2,500, were in academic medicine (Table A-7). For academic obstetrics and gynecology this represents an increase of about 45 percent since 1980 (Pearse et al., 1981; Pearse and Graham, 1991).

On the basis of these studies, several trends are apparent (Table A-7). The number of faculty per school shows strong, study growth from 1965 to 1975, accelerated growth from then until 1980, a relatively constant level from 1980 to 1983, and renewed growth from 1983 to 1990. Despite the 1980–1983 plateau, the overall growth rate for the last seven years has been essentially constant at 4.1 percent per annum. This correlates well with the growth from 1965 to 1980 and thus with the general increase over these years. Between 1977 and 1990, the number of academic subspecialists has grown steadily, but during the past 7 years this growth has occurred at a slower rate than that of the general faculty (Table A-7).

The data on researchers per school are not as complete or well defined. As of 1990, of the total M.D. members of departments of obstetrics and gynecology, about one-third (789 of 2,287) were engaged in research, chiefly clinical (Table A-7). Of these, perhaps 5 to 10 percent conducted basic research. The data included all those who committed 20 percent or more of their time to research and comprised both physician investigators and Ph.D.s.

The Future

The outlook for academic obstetrics and gynecology during the decade of the 1990s is mixed, and several scenarios are possible.

To what extent research in departments of obstetrics and gynecology will expand during the years ahead depends to a great degree on the funds available for clinical and basic investigation and on the manpower available to compete successfully for funds. As noted in the 1991 manpower study by Pearse and Graham, most department chairmen voice a ''need" for more researchers (a total of 436 during the next 5 years), although no distinction was made in the need for physician-scientists versus the need for clinical investigators.

The situation for physician-scientists is even less clear. On the one hand, it would appear that many more physician-scientists and clinical investigators are essential, beth now and in the future. On the other hand, slower faculty growth or limited funding may decrease the opportunities for new physician-scientists.

Assuming that, at the outside, one-third (about 40) of obstetrics and gynecology departments are research intensive; assuming each can support 5 to

Suggested Citation:"APPENDIX A - PREPARING FOR THE TWENTY-FIRST CENTURY IN THE REPRODUCTIVE SCIENCES." Institute of Medicine. 1992. Strengthening Research in Academic OB/GYN Departments. Washington, DC: The National Academies Press. doi: 10.17226/1970.
×

8 physician-scientists (to have a critical mass of such investigators), a total of 300 physician-scientists (i.e., 7.5 for each department) would be deployed in such department. In addition, if each of the 40 departments in the middle tier of research had 2 to 3 physician-scientists, that would equal another 100 such researchers (i.e., 2.5 each). This scenario projects a need for about 400 physician-scientists in departments of obstetrics and gynecology. Available data (RO1 recipients, SGI membership, etc. suggest that there are only about 70 reproductive physician-scientists in departments around the country, many of them are department chairs or division chiefs and/or soon to retire. A gap thus exists between the current supply of physician-scientists and an "ideal" number for the specialty.

The development of about 12 first-rate physician-scientists per year (the current level) would yield 120 in 10 years. Although that number would have quite an impact on departments of obstetrics and gynecology, it falls far short of the need. Moreover, not every trained individual will proceed to an investigative career. As Smith (1989) has emphasized, the creative scientist is not necessarily the one with the most intelligence or the one who works the hardest. Some very bright individuals are ineffective scientifically, while others less intellectually gifted are highly productive. This disparity may present problems in identifying and selecting for training the most promising individuals. Smith has also counseled that in view of the long training period and other variables, it is "more prudent to overshoot … than undershoot" the needed numbers (Smith, 1989, p. 111).

Lessons Learned

During the past several decades, key discoveries in fundamental and clinical research have led to a revolution in the reproductive sciences. Work on on understanding biological functions now occurs on the cellular and molecular levels, and with the technological tools now available, opportunities for further advances have never been more promising. The potential to expand knowledge and understanding of reproduction and improve health care for women and infants is enormous.

Suggested Citation:"APPENDIX A - PREPARING FOR THE TWENTY-FIRST CENTURY IN THE REPRODUCTIVE SCIENCES." Institute of Medicine. 1992. Strengthening Research in Academic OB/GYN Departments. Washington, DC: The National Academies Press. doi: 10.17226/1970.
×

TABLE A-7: Manpower in Academic Obstetrics and Gynecology: 1965–1990

Item

1965a

1970a

1975a

1977b

1980c

1983d

1986e

1990f

Number of schools

61

78

104

119

123

129

132

136

Total faculty

 

 

 

1,556

2,032

2,088

2,421

2,952

Ph.D.s

 

 

 

232

(14.9%)

270

(13.3%)

304

(14.6%)

381

(15.7%)

441

(14.9%)

Total faculty/school

6.4

8.8

11.3

13.2

16.4

16.2

18.3

21.6

Subspecialists

 

 

 

214

368

448

581

741

(% of M.D. faculty)

 

 

 

(17%)

(23%)

(28%)

(31%)

(32%)

Subspecialists/schoolsg

Maternal/fetal

 

 

 

1.3

1.8

2.0

2.5

3.1

Oncology

 

 

 

1.3

1.4

1.6

1.7

1.8

Reprod. endocrinology

 

 

 

1.2

1.4

1.6

1.7

1.8

Vacancies/school

 

 

 

2.0

1.6

1.5

2.6

2.3

Additional faculty

 

 

 

708

701

762

771

1,039

next 5 yearsh (% increase)

 

 

 

(46%)

(34%)

(36%)

(32%)

(35%)

Suggested Citation:"APPENDIX A - PREPARING FOR THE TWENTY-FIRST CENTURY IN THE REPRODUCTIVE SCIENCES." Institute of Medicine. 1992. Strengthening Research in Academic OB/GYN Departments. Washington, DC: The National Academies Press. doi: 10.17226/1970.
×

Item

1965a

1970a

1975a

1977b

1980c

1983d

1986e

1990f

Faculty involved in researchi

Total

 

 

 

 

 

998

(46%)

1,558

(64%)

1,195

(34%)

M.D.

 

 

 

 

 

 

789

Ph.D.

 

 

 

 

 

 

(100%)

(92%)

Faculty involved in research/school

 

 

 

 

 

7.7

11.7

10.3

Additional research faculty

 

 

 

 

 

525

485

436

next 5 yearsh (%increase)

 

 

 

 

 

(53 %)

(31%)

(36%)

a Spellacy et al., 1977.

b Messer et al., 1979.

c Pearse et al., 1981.

d Pearse et al., 1985.

e Pearse et al., 1987.

f Pearse and Graham, 1991.

g Figures indicate number of subspecialists per school reporting subspecialists.

h Projected increase.

i In the 1983 and 1986 studies, the amount of time was not stated. In the 1990 study, this was 20% or greater.

Suggested Citation:"APPENDIX A - PREPARING FOR THE TWENTY-FIRST CENTURY IN THE REPRODUCTIVE SCIENCES." Institute of Medicine. 1992. Strengthening Research in Academic OB/GYN Departments. Washington, DC: The National Academies Press. doi: 10.17226/1970.
×

Nonetheless, many would argue that the past and present contributions of obstetricians and gynecologists to these advances are not what they should be. In fact, many leaders in reproductive research maintain that the quantity and quality of research in departments of obstetrics and gynecology are totally inadequate, and prospects for future improvement are dim. Thus, a challenge for obstetrics and gynecology is to increase and improve research and research training in the reproductive sciences. The following is intended to outline some fairly obvious yet important points that derive from the above analysis. Although most of what follows applies to physician-scientists, much of it also applies to clinician investigators.

Importance of Research Training in the Reproductive Sciences

Research training programs contribute to the nation's scientific capital of new insights, innovations, and paradigm shifts by promoting the flow of well-trained young scientists into research careers. Such training provides unique preparation for identifying research opportunities related to human diseases. Many of the challenges of clinically related research cannot be met by M.D.s employing Ph.D.s to do their laboratory work. Neither will many of the conundrums of the field be solved by scientists who lack a clinical background. This effort will require well-trained, first-rate physician-scientists and clinical investigators who bring both their clinical perspective and insights and their scientific skills to the new challenges of reproductive science. Thus, academic obstetrics and gynecology must propagate the physician-scientist and provide an environment of nurture and support.

Because improved research training leads to increased scientific competence, over the long term it will lead to improved quality of research. Such career development, however, should not be left to happenstance. The number of obstetrician-gynecologists who apply for and receive NIH research grants is unacceptably low. A vital mission for the specialty is to educate additional reproductive physician-scientists.

Because of the long training period required for a physician-investigator. current and future needs must be carefully considered. Unfortunately, there are no firm data on which to make such projections.

Suggested Citation:"APPENDIX A - PREPARING FOR THE TWENTY-FIRST CENTURY IN THE REPRODUCTIVE SCIENCES." Institute of Medicine. 1992. Strengthening Research in Academic OB/GYN Departments. Washington, DC: The National Academies Press. doi: 10.17226/1970.
×

Centers of Excellence

By definition, a research-intensive department contributes important basic and clinical discoveries to the reproductive sciences. It also serves as an ''ecological habitat" for physician-scientists and clinical investigators. Finally, it is an environment in which medical students and house staff are stimulated to seek an academic career.

Because the university is the locus of most reproductive research training, the effectiveness of that experience depends on the availability of qualified faculty research mentors. Thus, the loop of mentors working with trainees who in turn become mentors must be preserved and enlarged. It is evident that, however desirable it might be, each of the 120-odd departments of obstetrics and gynecology in the country neither can nor will make a major commitment to research. Nonetheless, in addition to the current dozen or so research-intensive departments, more centers of excellence must be developed. Forty such departments would only represent one-third of the total, yet could have an enormous impact on research and research training. For such centers to develop will require the leadership of visionary, hardworking chairmen/chairwomen and division heads with research experience and a commitment to such an agenda.

Discovery of Potential Physician-Scientists

Physician-scientists and clinical investigators for the reproductive sciences are often attracted to research as medical students or residents. Indeed, many students choose their residency on the basis of possibilities in this regard. In the past, the majority of such individuals have come from a handful of research-intensive departments (see later Addemdum). Mechanisms are needed to identify potential physician-scientists and to make more college students, medical students, and residents aware of opportunities and career paths in the reproductive sciences.

Residency-Fellowship Training

The clinical training of an obstetrician gynecologist subspecialist requires 6 or 7 years after award of the M.D. degree. Postdoctoral training in basic research requires an additional 3 or more years in the laboratory. Clinical investigator training demands at least 1 or 2 years in addition to the subspecialty

Suggested Citation:"APPENDIX A - PREPARING FOR THE TWENTY-FIRST CENTURY IN THE REPRODUCTIVE SCIENCES." Institute of Medicine. 1992. Strengthening Research in Academic OB/GYN Departments. Washington, DC: The National Academies Press. doi: 10.17226/1970.
×

fellowship. Combining these learning experiences to educate a physician-scientist or clinical investigator is thus a lengthy, demanding process.

Research Training

Development of a physician-scientist requires a committed individual, an outstanding mentor, an appropriate training duration, a learning environment with increasing responsibilities, and an in-depth rigorous research experience. An effective training program requires a minimum of 2, and preferably 3, years in the laboratory with 90 percent or more time devoted to research (IOM, 1985; Lenfant, 1989). Such programs should be structured with increasing responsibility. In addition, the trainee should maintain a close relationship with his or her mentor to inculcate the value system appropriate to the conduct of scientific research. Its developers hope that the Reproductive Scientist Development Program can serve as a model in this regard.

Post-Research Training

Perhaps the most critical period for the developing physician-scientist (and clinical investigator) is that of emergence from the status of a graduate student to that of an independent investigator. Such individuals must be provided with the right conditions for growth and development. These may include relief from debt and a reasonable income, guaranteed research support for 3 to 5 years, restricted clinical responsibilities, and freedom to concentrate on one's field of interest.

Clinical Investigators

The clinical investigator plays a key role in designing, conducting, and interpreting clinical trials, metabolic studies, drug evaluations, epidemiologic studies, and related research. There is consequently a need for more and better trained clinical investigators in obstetrics and gynecology. Leaders of subspecialty training programs and those responsible for their certification should work to improve meaningful research opportunities for subspecialty fellows. This will require looking beyond the ever-expanding technological arena to

Suggested Citation:"APPENDIX A - PREPARING FOR THE TWENTY-FIRST CENTURY IN THE REPRODUCTIVE SCIENCES." Institute of Medicine. 1992. Strengthening Research in Academic OB/GYN Departments. Washington, DC: The National Academies Press. doi: 10.17226/1970.
×

increase training in epidemiology of reproductive problems, biostatistics, clinical research study design, clinical trials and protocols, and other such topics.

The Role of Private Foundations

The Markle Scholarship Program had an impact on the quality of academic medicine far out of proportion to the money it provided. Although this effect was particularly apparent in departments of internal medicine, pathology, pediatrics, and general surgery, it could also be seen in departments of obstetrics and gynecology. In addition, the Josiah Macy, Jr., Foundation and the programs of the Ford, Mellon, and Rockefeller foundations helped to strengthen some of the more research-intensive departments of obstetrics and gynecology. These programs demonstrated that a relatively small amount of money can have a significant impact in a field. As Smith (1989) has noted, the cost of training is extremely low in comparison with the ultimate investment in the scientific research of those who are supported.

Private foundations and health-related corporations must collaborate in this enterprise. Industry and pharmaceutical companies profit from the discoveries of graduates of research training programs and should help to support such research training.

Follow-Up

An essential element of training the physician-scientist is long-term evaluation. Despite the enormous effort that has been put into research training, relatively little thought has been devoted to the outcome of training, or how the process could be optimized.

Tracking mechanisms should follow the progress of trainees. In addition, a system should be established to review and assess periodically whether goals of the programs are being met. Such evaluations will build a body of knowledge in an area that, as yet, is still poorly understood.

Conclusion

As noted on a previous occasion, "the challenge that lies before us is to not rest on past achievements, but to look to the future. The problems we face are

Suggested Citation:"APPENDIX A - PREPARING FOR THE TWENTY-FIRST CENTURY IN THE REPRODUCTIVE SCIENCES." Institute of Medicine. 1992. Strengthening Research in Academic OB/GYN Departments. Washington, DC: The National Academies Press. doi: 10.17226/1970.
×

to use the future wisely, to use our talents wisely, and to use our funds wisely" (Longo, 1988). Training young obstetrician-gynecologists to pursue scientific problems at both the fundamental and clinical levels promises to continue to enlarge our understanding of all aspects of reproduction, including improved care for women and children.

Addendum:

Results of Survey of Former Scholars, Macy Fellows, and RCDA Recipients

Only a few obstetrician/gynecologists have been Markle Scholars, Macy Fellows or have received Research Career Development Awards (see Table A-4 and A-5). In general, these individuals have achieved, or are continuing to achieve distinction in the profession. To obtain additional insights into the factors that influence physician-scientists in obstetrics and gynecology to choose a career in research and to identify the ingredients of a successful research program, the author sent a short questionnaire to each living obstetrician/gynecologist who was a former Markle Scholar (MS) or Macy Fellow (MF), or who had received a Research Career Development Award (RCDA) since 1975. Survey questions are given below. About half of the total group of these individuals replied (8 of 15 MSs, 8 of 10 MFs, and 7 of 8 RCDAs) for a total of 22 (one individual was both an MS and MF). Because the responses from individuals in three groups were so similar, they will be treated together. What follows is a tram of their responses with selected excerpts.

General Background

  1. During what years did you hold your scholarship or fellowship? For Markle Scholars, this was from 1951 to 1974; for Macy Fellows, from 1956 to 1966; and for Research Career Development Award recipients, from 1975 to 1989.

  2. What was the subject of your research or scholarship during that period? Respondents were fairly evenly divided between reproductive endocrinology and maternal-fetal medicine (about 40 percent each) with a few

Suggested Citation:"APPENDIX A - PREPARING FOR THE TWENTY-FIRST CENTURY IN THE REPRODUCTIVE SCIENCES." Institute of Medicine. 1992. Strengthening Research in Academic OB/GYN Departments. Washington, DC: The National Academies Press. doi: 10.17226/1970.
×

individuals in oncology and other areas such as anatomy or immunology of reproduction.

  1. What individual or individuals was most important in affecting your decision to enter academic medicine? In what capacity did you know him or her? Almost without exception, the respondents gave the names of one or two key figures in obstetrics and gynecology who inspired them to excel. These included Allen C. Barnes, Nicholson J. Eastman, Charles H. Hendricks (mentioned by 3 persons), Arthur Hertig, William C. Keetel, Harry McGaughey, Joseph L. Seitchik, and Howard C. Taylor. In the reproductive basic sciences these included Leslie B. Arey, Donald H. Barron, and Ernst Knobil. Most of the respondents were either medical students or residents in about a dozen of the most research-intensive departments of obstetrics and gynecology when they came under the influence of these individuals.

  2. At what phase of your career did you make this decision? Again, about half of the respondents made their career decision while a medical student, and the other half while a resident. None were fellows. This result agrees with an Institute of Medicine report (1983) that decisions for a arch career are often made in medical school (see also Burns, 1984, and Cadman, 1990).

  3. What factors were most important in making that decision? The most common responses were the challenge of problems solving and intellectual stimulation and the desire to use newer approaches to solve biological questions m reproduction. One person recalled the stimulation received from Alpha Omega Alpha (national medical honor society) monthly meetings.

Scholarly Productivity

  1. Please provide names and academic appointments of research fellows (both M.D.s and Ph.D.s) whom you have trained.

  2. List your major research grants, NIH, and other.

  3. Please list your other awards, honors, and distinctions. (for the above three questions you may wish to sent me a copy of your C.V.)

  4. What do you regard as your greatest contribution to academic Obstetrics and Gynecology? Replies to this last question centered on the theme of interesting students, residents, and fellows in research in obstetrics and gynecology. One person expressed it as "fostering curiosity in young people," while another phrased it as "not killing the dreams of the young!"

Suggested Citation:"APPENDIX A - PREPARING FOR THE TWENTY-FIRST CENTURY IN THE REPRODUCTIVE SCIENCES." Institute of Medicine. 1992. Strengthening Research in Academic OB/GYN Departments. Washington, DC: The National Academies Press. doi: 10.17226/1970.
×

Research Training in Obstetrics and Gynecology

  1. Many individuals distinguish between physician-scientists doing basic research in a clinical department and clinical investigators who perform more patient-oriented research. Do you believe that distinction should be made? Among respondents to this query, 15 states yes, 5 no, and 3 were of no opinion. there were no discernible differences in response by individuals in the three groups.

  2. If so, what is your perception of the current status and future needs of physician-scientists in academic Obstetrics and Gynecology? Despite the lack of unanimity of opinion to the previous question, the overwhelming response to this query was that there is a need for more clinical and basic science researchers, and a great need for 2 to 3 year ''junior scientist" post-subspeciality fellowships in both basic science and clinical research. One individual stated the need as 400 to 600 such investigators for the 130 or so medical schools.

  3. What do you believe to be the key elements in training physician-scientists? The points mentioned by respondents included good role models, a mentor who stimulates one to excel, broad-based laboratory experience, and protected time for research. Without exception, the respondents mentioned the need for stable financial support.

    One respondent also suggested that medical schools should reserve some admission positions for applicants who already have a doctoral or at least advanced research training. He also suggested that more medical students should be exposed to physician-scientists in departments of obstetrics and gynecology, so that potential recruits will be imbued with the excitement of research, problem solving, and research opportunities in reproduction.

  4. What do you believe to be the major problems in training new reproductive physician-scientists? Again, without exception, all respondents stressed the importance of money, both increased grant monies and stable funding for the long-term in research. Other issues mentioned included: the problem of relatively few academic departments being truly committed to research, the financial disparity between research and clinical practice, inherent conflict between clinical activity and fundamental research, "time consuming academic bureaucracies," and the "Lorelei-like attraction of private practice."

  5. What lessons would you care to share vis-a-vis research training in our specialty? What suggestions would you make as to how the needs for physician-scientists in obstetrics and gynecology can be met? Overall, there was a consensus on the seriousness of the problem, in that the specialty needs many more physician-scientists and clinical investigators. A key issue here was the

Suggested Citation:"APPENDIX A - PREPARING FOR THE TWENTY-FIRST CENTURY IN THE REPRODUCTIVE SCIENCES." Institute of Medicine. 1992. Strengthening Research in Academic OB/GYN Departments. Washington, DC: The National Academies Press. doi: 10.17226/1970.
×

need for increased funding for both research and research training. Several individuals suggested reviving something similar to the Markle/Macy scholarship programs to provide adequate support for the fellowships and training. One person emphasized that one must "do research you enjoy in an area that will be viable and that will sustain you for forty years, and stay current."

Others stressed the need for more centers of excellence and more department chairs who are committed to academic research. A typical reply was the following:

"Presently, most departments of obstetrics and gynecology do not have adequate research teams for training physician-scientists. The first priority should be directed toward creating such teams through developmental grants. Emphasis should be placed on encouraging young investigators to delve into new areas of research. A mix of M.D.s and Ph.D.s with dual appointments should also be encouraged. Developmental grants could be limited to 5 years or so, after which the group should apply to the regular funding agencies."

Two other issues are of significance: Deans of medical schools, chairpersons, or directors of obstetrics and gynecology departments should be sensitized to the issue of the critical shortage of physician-scientists within the specialty. They should be encouraged to support more basic research within the clinical departments.

Several respondents stressed the need to either create a separate residency-fellowship track to tram physician-scientists, with perhaps a Ph.D. option, or to modify subspecialty training by including more research. One person stated that "presently, subspecialty training emphasizes clinical competence and does not prepare the individual for competitive basic research funding. Most residents elect to pursue the recognized subspecialty, because this is the only option opened to them."

Finally, a particularly thoughtful respondent mentioned that we "need a value system that rewards academic productivity."

Suggested Citation:"APPENDIX A - PREPARING FOR THE TWENTY-FIRST CENTURY IN THE REPRODUCTIVE SCIENCES." Institute of Medicine. 1992. Strengthening Research in Academic OB/GYN Departments. Washington, DC: The National Academies Press. doi: 10.17226/1970.
×

References

Beeson, P.B. How to foster the gain of knowledge about disease. Perspect. Biol. Med. 23:S9–S24, 1980.

Bowers, J.Z., and E.F. Purcell (eds.). The Current Status and Future of Academic Obstetrics. Report of a Conference Supported Jointly by the National Institute of Child Health and Human Development and the Josiah Macy, Jr., Foundation. New York, Josiah Macy, Jr., Foundation, 1980.

Bradford, W.D., S. Pizzo, and A.C. Christakos. Careers and professional activities of graduates of a medical scientist training program. J. Med. Educ. 61:915–918, 1986.

Bush, V. Science—the endless frontier: A report to the president. Washington, DC: United States Government Printing Office, 1945.


Corner, G.W. A History of the Rockefeller Institute. 1901–1953, Origins and Growth. New York: Rockefeller Institute, 1964.

Cushing, H. The Life of Sir William Osier. 2 vols. Oxford: Clarendon Press, 1925.


Douglas, G.W. Centennial insights. Am. J. Obstet. Gynecol. 126:739–743, 1976.


Ford Foundation. Annual Report, October 1, 1981, to September 30, 1982. New York: Ford Foundation, 1982.

Ford Foundation. Annual Report, October 1, 1989 to September 30, 1990. New York: Ford Foundation, 1990.

Fremont-Smith, F. The Josiah Macy, Jr., Foundation Conference Program. In: Gestation: Transactions of the Third Conference, Villee, C.A. (ed). New York: Josiah Macy, Jr., Foundation, 1957.

Frieden, C., and B.J. Fox. Career choices of graduates from Washington University's Medical Scientist Training Program. Acad. Med. 66:162–164, 1991.


Haseltine, F.P. and A.A. Campbell. The Impact of Fellowships Supported by the Andrew W. Mellon Foundation. Center for Population Research. Washington, D.C.: National Institute of Child Health and Human Development, 1986.


IOM (Institute of Medicine). Personnel Needs and Training for Biomedical and Behavioral Research. Report of the Committee on National Needs for Biomedical and Behavioral Research Personnel. Washington, D.C.: National Academy Press, 1985.


Lenfant, C. (Chairman, Steering Committee). Review of the National Institutes of Health Biomedical Research Training Programs. Bethesda, MD: National Institutes of Health, 1989.

Longo, L.D. Fundamental and clinical research and patient care: A triad for progress in reproductive medicine. Am. J. Obstet. Gynecol. 159:6–12, 1988.

Longo, L.D. A Short History of the Society for Gynecologic Investigation, 1953–1983. Los Angeles: The Society, 1983.


Macy Foundation. Annual Reports. New York: Josiah Macy, Jr., Foundation, 1956–1960, 1965, and 1980.

Macy Foundation. Report of a Macy Conference. Teaching the Biological and Medical Aspects of Reproduction to Medical Students. New York, Hoeber Medical Division, Harper & Row, 1966.

Macy Foundation. Teaching Family Planning to Medical Students. New York: Josiah Macy, Jr., Foundation, 1968.

Martin, J.B. Training physician-scientists for the 1990s. Acad. Med. 66:123–129, 1991.

Mellon Foundation. Report of the Andrew W. Mellon Foundation, from January 1, 1985, through December 31, 1985. New York: Andrew W. Mellon Foundation, 1985.

Suggested Citation:"APPENDIX A - PREPARING FOR THE TWENTY-FIRST CENTURY IN THE REPRODUCTIVE SCIENCES." Institute of Medicine. 1992. Strengthening Research in Academic OB/GYN Departments. Washington, DC: The National Academies Press. doi: 10.17226/1970.
×

Mellon Foundation. Report of the Andrew W. Mellon Foundation, from January 1, 1990, through December 31, 1990. New York: Andrew W. Mellon Foundation, 1990.

Messer, R.H., Pearse, W.H., and J.G. Fielden. Academic Manpower for Obstetrics and Gynecology in the United States. Obstet. Gynecol. 53:649, 1979.

Mitchell, G.W. Professor of OB/GYN, University of Texas Health Science Center. Lever to Lawrence D. Longo, 2 November 1990.

Movsesian, M.A. Effect on physician-scientists of the low funding rate of NIH grant applications. N. Engl. J. Med. 322:1602–1604, 1990.

National Institutes of Health. Successor to the Hygienic Laboratory. Public Health Report 45:1409–1412, 1930.


Pearse, W.H., E.C. Davidson, Jr., and J.G. Fielden. Trends in obstetric-gynecologic academic manpower—1980 . Obstet. Gynecol. 58:233–236, 1981

Pearse, W. H., Davidson, E.C., and J.G. Fielden. Trends in Obstetric-Gynecologic Academic Manpower-1983. Obstet. Gynecol. 65:147–150, 1985.

Pearse, W.H., Fielden, J.G., and Donald M. Sherline Obstetric-Gynecologic Academic Manpower-1986. Obstet. Gynecol. 70:403–405, 1987.

Pearse, W.H., and K.K. Graham. Trends in obstetric-gynecologic academic manpower and research. Obstet. Gynecol. 78:141–143, 1991.


Randall, C.L. Developments in the Certification of Obstetricians and Gynecologists in the United States 1930–1980: The American Board of Obstetrics and Gynecology. Seattle, WA, American Board of Obstetrics and Gynecology, 1989.

Russell, J. Informal Survey of Medical Education and Research, Madre Foundation, New York, New York, May 1947, pp. 12–14.


Smith, L.H. Training of Physician/Scientists. Pp. 107–120 in Institute of Medicine: The 1989 Report of the Committee on National Needs for Biomedical and Behavioral Research Personnel, Vol. 3, Commissioned Papers. Washington, D.C: National Academy Press, 1989.

Spellacy, W.N., S.A. Birk, and W.C. Buhi. A National Survey of Medical School Obstetrics and Gynecology Departments, 1965 to 1975. J. Med. Educ. 52:901–905, 1977.

Strickland, T.G., and S.P. Strickland. The Madre Scholars: A Brief History. New York: The John & Mary R. Markle Foundation, 1976.


Taylor, H.C., Jr. (ed.). The Recruitment of Talent for a Medical Specialty. A Report to the American Gynecological Society on the Problem of Procurement of Academic and Scientific Personnel for Obstetrics and Gynecology. St Louis: C.V. Mosby Co., 1961.


Wyngaarden, J.B. The clinical investigator as an endangered species. N. Engl. J. Med. 301:1254–1259, 1979.

Suggested Citation:"APPENDIX A - PREPARING FOR THE TWENTY-FIRST CENTURY IN THE REPRODUCTIVE SCIENCES." Institute of Medicine. 1992. Strengthening Research in Academic OB/GYN Departments. Washington, DC: The National Academies Press. doi: 10.17226/1970.
×
This page in the original is blank.
Suggested Citation:"APPENDIX A - PREPARING FOR THE TWENTY-FIRST CENTURY IN THE REPRODUCTIVE SCIENCES." Institute of Medicine. 1992. Strengthening Research in Academic OB/GYN Departments. Washington, DC: The National Academies Press. doi: 10.17226/1970.
×
Page 229
Suggested Citation:"APPENDIX A - PREPARING FOR THE TWENTY-FIRST CENTURY IN THE REPRODUCTIVE SCIENCES." Institute of Medicine. 1992. Strengthening Research in Academic OB/GYN Departments. Washington, DC: The National Academies Press. doi: 10.17226/1970.
×
Page 230
Suggested Citation:"APPENDIX A - PREPARING FOR THE TWENTY-FIRST CENTURY IN THE REPRODUCTIVE SCIENCES." Institute of Medicine. 1992. Strengthening Research in Academic OB/GYN Departments. Washington, DC: The National Academies Press. doi: 10.17226/1970.
×
Page 231
Suggested Citation:"APPENDIX A - PREPARING FOR THE TWENTY-FIRST CENTURY IN THE REPRODUCTIVE SCIENCES." Institute of Medicine. 1992. Strengthening Research in Academic OB/GYN Departments. Washington, DC: The National Academies Press. doi: 10.17226/1970.
×
Page 232
Suggested Citation:"APPENDIX A - PREPARING FOR THE TWENTY-FIRST CENTURY IN THE REPRODUCTIVE SCIENCES." Institute of Medicine. 1992. Strengthening Research in Academic OB/GYN Departments. Washington, DC: The National Academies Press. doi: 10.17226/1970.
×
Page 233
Suggested Citation:"APPENDIX A - PREPARING FOR THE TWENTY-FIRST CENTURY IN THE REPRODUCTIVE SCIENCES." Institute of Medicine. 1992. Strengthening Research in Academic OB/GYN Departments. Washington, DC: The National Academies Press. doi: 10.17226/1970.
×
Page 234
Suggested Citation:"APPENDIX A - PREPARING FOR THE TWENTY-FIRST CENTURY IN THE REPRODUCTIVE SCIENCES." Institute of Medicine. 1992. Strengthening Research in Academic OB/GYN Departments. Washington, DC: The National Academies Press. doi: 10.17226/1970.
×
Page 235
Suggested Citation:"APPENDIX A - PREPARING FOR THE TWENTY-FIRST CENTURY IN THE REPRODUCTIVE SCIENCES." Institute of Medicine. 1992. Strengthening Research in Academic OB/GYN Departments. Washington, DC: The National Academies Press. doi: 10.17226/1970.
×
Page 236
Suggested Citation:"APPENDIX A - PREPARING FOR THE TWENTY-FIRST CENTURY IN THE REPRODUCTIVE SCIENCES." Institute of Medicine. 1992. Strengthening Research in Academic OB/GYN Departments. Washington, DC: The National Academies Press. doi: 10.17226/1970.
×
Page 237
Suggested Citation:"APPENDIX A - PREPARING FOR THE TWENTY-FIRST CENTURY IN THE REPRODUCTIVE SCIENCES." Institute of Medicine. 1992. Strengthening Research in Academic OB/GYN Departments. Washington, DC: The National Academies Press. doi: 10.17226/1970.
×
Page 238
Suggested Citation:"APPENDIX A - PREPARING FOR THE TWENTY-FIRST CENTURY IN THE REPRODUCTIVE SCIENCES." Institute of Medicine. 1992. Strengthening Research in Academic OB/GYN Departments. Washington, DC: The National Academies Press. doi: 10.17226/1970.
×
Page 239
Suggested Citation:"APPENDIX A - PREPARING FOR THE TWENTY-FIRST CENTURY IN THE REPRODUCTIVE SCIENCES." Institute of Medicine. 1992. Strengthening Research in Academic OB/GYN Departments. Washington, DC: The National Academies Press. doi: 10.17226/1970.
×
Page 240
Suggested Citation:"APPENDIX A - PREPARING FOR THE TWENTY-FIRST CENTURY IN THE REPRODUCTIVE SCIENCES." Institute of Medicine. 1992. Strengthening Research in Academic OB/GYN Departments. Washington, DC: The National Academies Press. doi: 10.17226/1970.
×
Page 241
Suggested Citation:"APPENDIX A - PREPARING FOR THE TWENTY-FIRST CENTURY IN THE REPRODUCTIVE SCIENCES." Institute of Medicine. 1992. Strengthening Research in Academic OB/GYN Departments. Washington, DC: The National Academies Press. doi: 10.17226/1970.
×
Page 242
Suggested Citation:"APPENDIX A - PREPARING FOR THE TWENTY-FIRST CENTURY IN THE REPRODUCTIVE SCIENCES." Institute of Medicine. 1992. Strengthening Research in Academic OB/GYN Departments. Washington, DC: The National Academies Press. doi: 10.17226/1970.
×
Page 243
Suggested Citation:"APPENDIX A - PREPARING FOR THE TWENTY-FIRST CENTURY IN THE REPRODUCTIVE SCIENCES." Institute of Medicine. 1992. Strengthening Research in Academic OB/GYN Departments. Washington, DC: The National Academies Press. doi: 10.17226/1970.
×
Page 244
Suggested Citation:"APPENDIX A - PREPARING FOR THE TWENTY-FIRST CENTURY IN THE REPRODUCTIVE SCIENCES." Institute of Medicine. 1992. Strengthening Research in Academic OB/GYN Departments. Washington, DC: The National Academies Press. doi: 10.17226/1970.
×
Page 245
Suggested Citation:"APPENDIX A - PREPARING FOR THE TWENTY-FIRST CENTURY IN THE REPRODUCTIVE SCIENCES." Institute of Medicine. 1992. Strengthening Research in Academic OB/GYN Departments. Washington, DC: The National Academies Press. doi: 10.17226/1970.
×
Page 246
Suggested Citation:"APPENDIX A - PREPARING FOR THE TWENTY-FIRST CENTURY IN THE REPRODUCTIVE SCIENCES." Institute of Medicine. 1992. Strengthening Research in Academic OB/GYN Departments. Washington, DC: The National Academies Press. doi: 10.17226/1970.
×
Page 247
Suggested Citation:"APPENDIX A - PREPARING FOR THE TWENTY-FIRST CENTURY IN THE REPRODUCTIVE SCIENCES." Institute of Medicine. 1992. Strengthening Research in Academic OB/GYN Departments. Washington, DC: The National Academies Press. doi: 10.17226/1970.
×
Page 248
Suggested Citation:"APPENDIX A - PREPARING FOR THE TWENTY-FIRST CENTURY IN THE REPRODUCTIVE SCIENCES." Institute of Medicine. 1992. Strengthening Research in Academic OB/GYN Departments. Washington, DC: The National Academies Press. doi: 10.17226/1970.
×
Page 249
Suggested Citation:"APPENDIX A - PREPARING FOR THE TWENTY-FIRST CENTURY IN THE REPRODUCTIVE SCIENCES." Institute of Medicine. 1992. Strengthening Research in Academic OB/GYN Departments. Washington, DC: The National Academies Press. doi: 10.17226/1970.
×
Page 250
Suggested Citation:"APPENDIX A - PREPARING FOR THE TWENTY-FIRST CENTURY IN THE REPRODUCTIVE SCIENCES." Institute of Medicine. 1992. Strengthening Research in Academic OB/GYN Departments. Washington, DC: The National Academies Press. doi: 10.17226/1970.
×
Page 251
Suggested Citation:"APPENDIX A - PREPARING FOR THE TWENTY-FIRST CENTURY IN THE REPRODUCTIVE SCIENCES." Institute of Medicine. 1992. Strengthening Research in Academic OB/GYN Departments. Washington, DC: The National Academies Press. doi: 10.17226/1970.
×
Page 252
Suggested Citation:"APPENDIX A - PREPARING FOR THE TWENTY-FIRST CENTURY IN THE REPRODUCTIVE SCIENCES." Institute of Medicine. 1992. Strengthening Research in Academic OB/GYN Departments. Washington, DC: The National Academies Press. doi: 10.17226/1970.
×
Page 253
Suggested Citation:"APPENDIX A - PREPARING FOR THE TWENTY-FIRST CENTURY IN THE REPRODUCTIVE SCIENCES." Institute of Medicine. 1992. Strengthening Research in Academic OB/GYN Departments. Washington, DC: The National Academies Press. doi: 10.17226/1970.
×
Page 254
Suggested Citation:"APPENDIX A - PREPARING FOR THE TWENTY-FIRST CENTURY IN THE REPRODUCTIVE SCIENCES." Institute of Medicine. 1992. Strengthening Research in Academic OB/GYN Departments. Washington, DC: The National Academies Press. doi: 10.17226/1970.
×
Page 255
Suggested Citation:"APPENDIX A - PREPARING FOR THE TWENTY-FIRST CENTURY IN THE REPRODUCTIVE SCIENCES." Institute of Medicine. 1992. Strengthening Research in Academic OB/GYN Departments. Washington, DC: The National Academies Press. doi: 10.17226/1970.
×
Page 256
Suggested Citation:"APPENDIX A - PREPARING FOR THE TWENTY-FIRST CENTURY IN THE REPRODUCTIVE SCIENCES." Institute of Medicine. 1992. Strengthening Research in Academic OB/GYN Departments. Washington, DC: The National Academies Press. doi: 10.17226/1970.
×
Page 257
Suggested Citation:"APPENDIX A - PREPARING FOR THE TWENTY-FIRST CENTURY IN THE REPRODUCTIVE SCIENCES." Institute of Medicine. 1992. Strengthening Research in Academic OB/GYN Departments. Washington, DC: The National Academies Press. doi: 10.17226/1970.
×
Page 258
Suggested Citation:"APPENDIX A - PREPARING FOR THE TWENTY-FIRST CENTURY IN THE REPRODUCTIVE SCIENCES." Institute of Medicine. 1992. Strengthening Research in Academic OB/GYN Departments. Washington, DC: The National Academies Press. doi: 10.17226/1970.
×
Page 259
Suggested Citation:"APPENDIX A - PREPARING FOR THE TWENTY-FIRST CENTURY IN THE REPRODUCTIVE SCIENCES." Institute of Medicine. 1992. Strengthening Research in Academic OB/GYN Departments. Washington, DC: The National Academies Press. doi: 10.17226/1970.
×
Page 260
Suggested Citation:"APPENDIX A - PREPARING FOR THE TWENTY-FIRST CENTURY IN THE REPRODUCTIVE SCIENCES." Institute of Medicine. 1992. Strengthening Research in Academic OB/GYN Departments. Washington, DC: The National Academies Press. doi: 10.17226/1970.
×
Page 261
Suggested Citation:"APPENDIX A - PREPARING FOR THE TWENTY-FIRST CENTURY IN THE REPRODUCTIVE SCIENCES." Institute of Medicine. 1992. Strengthening Research in Academic OB/GYN Departments. Washington, DC: The National Academies Press. doi: 10.17226/1970.
×
Page 262
Suggested Citation:"APPENDIX A - PREPARING FOR THE TWENTY-FIRST CENTURY IN THE REPRODUCTIVE SCIENCES." Institute of Medicine. 1992. Strengthening Research in Academic OB/GYN Departments. Washington, DC: The National Academies Press. doi: 10.17226/1970.
×
Page 263
Suggested Citation:"APPENDIX A - PREPARING FOR THE TWENTY-FIRST CENTURY IN THE REPRODUCTIVE SCIENCES." Institute of Medicine. 1992. Strengthening Research in Academic OB/GYN Departments. Washington, DC: The National Academies Press. doi: 10.17226/1970.
×
Page 264
Suggested Citation:"APPENDIX A - PREPARING FOR THE TWENTY-FIRST CENTURY IN THE REPRODUCTIVE SCIENCES." Institute of Medicine. 1992. Strengthening Research in Academic OB/GYN Departments. Washington, DC: The National Academies Press. doi: 10.17226/1970.
×
Page 265
Suggested Citation:"APPENDIX A - PREPARING FOR THE TWENTY-FIRST CENTURY IN THE REPRODUCTIVE SCIENCES." Institute of Medicine. 1992. Strengthening Research in Academic OB/GYN Departments. Washington, DC: The National Academies Press. doi: 10.17226/1970.
×
Page 266
Suggested Citation:"APPENDIX A - PREPARING FOR THE TWENTY-FIRST CENTURY IN THE REPRODUCTIVE SCIENCES." Institute of Medicine. 1992. Strengthening Research in Academic OB/GYN Departments. Washington, DC: The National Academies Press. doi: 10.17226/1970.
×
Page 267
Suggested Citation:"APPENDIX A - PREPARING FOR THE TWENTY-FIRST CENTURY IN THE REPRODUCTIVE SCIENCES." Institute of Medicine. 1992. Strengthening Research in Academic OB/GYN Departments. Washington, DC: The National Academies Press. doi: 10.17226/1970.
×
Page 268
Next: APPENDIX B - NATIONAL INSTITUTES OF HEALTH SUPPORT OF RESEARCH IN DEPARTMENTS OF OBSTETRICS AND GYNECOLOGY »
Strengthening Research in Academic OB/GYN Departments Get This Book
×
Buy Paperback | $55.00
MyNAP members save 10% online.
Login or Register to save!
Download Free PDF

Research conducted in academic departments of obstetrics and gynecology could result in substantial improvements in the health of women and the outcomes of pregnancy.

Strengthening Research in Academic OB/GYN Departments determines whether such departments are capable of fulfilling this promise. The committee finds that these departments have a poor track record in their ability to compete for research funds and in the extent to which their faculty contribute to research. Adding to the problem are factors that deter OB/GYNs from a research career and a dearth of dynamic research leaders in the profession.

The volume explores reasons for this situation and makes recommendations to counteract them. Also included is an agenda of needed research.

  1. ×

    Welcome to OpenBook!

    You're looking at OpenBook, NAP.edu's online reading room since 1999. Based on feedback from you, our users, we've made some improvements that make it easier than ever to read thousands of publications on our website.

    Do you want to take a quick tour of the OpenBook's features?

    No Thanks Take a Tour »
  2. ×

    Show this book's table of contents, where you can jump to any chapter by name.

    « Back Next »
  3. ×

    ...or use these buttons to go back to the previous chapter or skip to the next one.

    « Back Next »
  4. ×

    Jump up to the previous page or down to the next one. Also, you can type in a page number and press Enter to go directly to that page in the book.

    « Back Next »
  5. ×

    Switch between the Original Pages, where you can read the report as it appeared in print, and Text Pages for the web version, where you can highlight and search the text.

    « Back Next »
  6. ×

    To search the entire text of this book, type in your search term here and press Enter.

    « Back Next »
  7. ×

    Share a link to this book page on your preferred social network or via email.

    « Back Next »
  8. ×

    View our suggested citation for this chapter.

    « Back Next »
  9. ×

    Ready to take your reading offline? Click here to buy this book in print or download it as a free PDF, if available.

    « Back Next »
Stay Connected!