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APPENDIX D 40 (who also thought âscience is neatâ), will be talent lost to science. The economic disincentives to research careers are great; the opportunities appear much better elsewhere. I believe the most important step to strengthening the NRSA training grant is to ensure that it is economically fair. Graduate students should not be denied basic benefits, such as health insurance, including coverage for their families. Graduate students should be guaranteed a fair wage, commensurate with their years of experience, for their countless hours of toil. A reasonable income is especially important because many of the best training opportunities are in expensive cities such as New York, Boston, and San Francisco, but students and post-docs receiving small stipends and salaries often find it difficult to live comfortably and safely in these cities. Furthermore, several graduate students I know take on additional responsibilities (e.g., teaching classes) to earn extra money. These duties detract from their research training. I do not believe that there is anything we can do to motivate young people to choose scientific careers more strongly than can their own desires to explore previously unanswered questions. What we must do, then, is to remove the economic hardships of the long training periods required for careers in the sciences. STATEMENT BY LEE GOLDMAN, M.D. As you presumably know, I have been the principal investigator on one of the few institutional NRSAs awarded for primary care disciplines, and this award has recently been renewed for another five years at twice its additional size. I am also a listed faculty member on other institutional NRSAs in cardiology, health services research, and AIDS, and I have precepted several individual NRSAs. While this prior experience undoubtedly biases my viewpoint, it has also provided me with a substantial opportunity to observe the virtues of the NRSA program. At the outset, I should emphasize that I fully support institutional NRSAs, because they provide an opportunity for bright young trainees to begin research without being forced to commit prematurely to a detailed project. It is important to retain a balance between institutional NRSAs, which by definition attract researchers at a less differentiated phase, and individual NRSAs, which require substantially more preparation by the applicant but make it difficult for individuals to begin research at the postdoctoral level. In response to your specific questions: 1. I believe that the most serious challenge that we face for maintaining an adequate supply of qualified scientists in health research is to find the appropriate balance between security and competitiveness. On the one hand, careers in health sciences are and should be subject to the classic pressures of social Darwinism. Limited research funds should be targeted selectively to the most promising and productive researchers and fields. Although such a research âpyramidâ will not optimize the job security of health care researchers, any other system would represent a relative waste of limited resources. Nevertheless, this social Darwinistic pyramid will be counterproductive if successful researchers do not have adequate assurances at each career stage that they will be successful and progress to subsequent stages. 2. Our growing understanding of training and mentoring suggest several specific improvements to strengthen NRSAs in the future. First, many programs incorrectly assume that the apprenticeship model is the ideal way to train a researcher. In this model, a trainee commits to an individual laboratory and learns the techniques of the laboratory director. If the training program is successful, the trainee is then prepared to continue to work in the mentorâs laboratory or to recreate a similar laboratory elsewhere. This approach can be contrasted to most Ph.D. programs, in which young trainees learn a broad base of up-to- date scientific skills in a structured curriculum before committing to a focused research project. The Ph.D. trainee is much better prepared to integrate several scientific disciplines and to enhance, not just reproduce, the work of the mentor. I would suggest that all NRSA programs be required to have more structured and formal coursework, preferably in conjunction with basic scientists outside the clinical department, to teach trainees the fundamentals of biomedical science and the full range of quantitative and other skills that are required for research. Ideally, an institutional NRSA would have two tracks: one to emphasize basic biomedical laboratory science for the âwet labâ researcher, and the other to emphasize quantitative and
