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APPENDIX D 82 directors must also be encouraged to expand their outreach to minority students. It should not escape our attention that the most endangered species of biomedical and behavioral sciences investigator is the individual who is emotionally and intellectually prepared to pursue at least seven years to attain the combined M.D./Ph.D. degree. There is a desperate need to encourage the best of our students to prepare themselves for academic careers in medicine particularly in the transfer of new knowledge from the bench to the bedside or whatever setting will be forthcoming in the future. American medicine is in the throes of a âHealthquakeâ of Richter 7-8 proportions and there is the danger that biomedical research involving M.D./ Ph.D.s will be trapped in the rubble. Attention must be paid to this problem lest we bear witness to the withering away of the most successful program for creating a cadre of physician-scientists the world has ever seen. I am proud to note that several of the M.D./Ph.D. students trained in our neuroscience program at Einstein have attained Professorial rank including Chairmanship status. Similar successes have been recorded in other M.D./ Ph.D. programs throughout the nation. In this era of special concern for transforming the benefits of basic laboratory research to the clinical domain the well-trained physician scientist will play an ever-increasing and important role. Finally, the Committee has solicited opinion as to whether enhanced employment opportunities in industry might require new research training strategies in neuroscience. There has indeed been a proliferation of variable size start-up companies aimed at the development and production of neuroscience related pharmaceuticals and other treatment modalities. Highly skilled molecular or integrative neuroscientists are being sought for these companies, including the more established pharmaceutical houses. In-depth, highly focussed post-doctoral training should prepare most trainees for these positions. But there should be no attempt to bias the predoctoral or postdoctoral training experience in relation to the potential for industry-based employment. A well-rounded, motivated, and skilled neuroscientist should be the product of an NRSA program. Whether a trainee elects academic or industrial employment should not be preordained by the nature of the training program, per se. Even in a post-Marxist world, economics will remain a powerful determinant of human behaviors. STATEMENT BY IRWIN SANDLER, Ph.D. Iâd like to address training needs in a newly emerging multidisciplinary area, prevention research. Over the past several years I chaired a panel on training needs in the area of prevention for the NIMH sponsored National Conferences on Prevention Research. Our panel was impressed with the exciting promise of this field and with the considerable needs for training researchers in this area. The issues we considered overlap with many of the questions you are addressing, and I believe that it is important that you consider them in your deliberations. I am also co-Principal Investigator on an NIMH funded Institutional Training Grant in Prevention Research. My comments will also reflect this experience.1 Research on the development of preventive approaches to mental health problems has emerged as an exciting part of the countryâs biomedical and behavioral sciences agenda. The need for a preventive approach has been stimulated in part by the high prevalence of mental health problems. For example, 12 percent of children under the age of 18 are conservatively estimated to suffer from a mental disorder; 2 22 percent of pediatric patients seen at a health maintenance organization are found to have one or more clinical-level DSMIII disorders.3 There is also encouraging evidence that well conceptualized prevention programs can be rigorously tested and found to have positive benefits to prevent mental health problems. 4 , 5 Research in prevention presents numerous scientific challenges. The skills of multiple disciplines are required to study the biopsychosocial factors which lead to the development of mental health problems over time and to design and evaluate scientifically rigorous trials of approaches to prevent these problems. Evidence for the emerging significance of prevention research can be seen in the fact that the National Institute of Mental Health has sponsored three National Conferences on Prevention Research over the past three years and the Institute of Medicine is currently conducting a comprehensive review of the status of prevention research. One of the central needs that emerged from the National Conferences on Prevention Research is the critical need for increased training of scientific manpower in this area. Currently there are only two training programs in prevention research funded by NIMH, which currently support a
APPENDIX D 83 total of five postdoctoral fellows and one predoctoral trainee. We are in danger of failing to train the needed scientific manpower for prevention research. Iâd like to briefly address four issues concerning the need for training of prevention research scientists. What do prevention researchers need to know? Who should we be training to pursue prevention research? What kinds of National Research Service Awards are needed to meet the training objectives? What steps are needed to improve the effectiveness of the NRSA program to recruit minority researchers? What do prevention researchers need to know? Prevention research is intrinsically a multidisciplinary effort. The conduct of prevention research requires a wide range of substantive knowledge, methodological sophistication and practical skill in working with community settings. Prevention researchers need conceptual and theoretical sophistication in the development of mental health competencies and mental health problems. This understanding needs to be well grounded in an epidemiological perspective and in an understanding of normal and abnormal developmental processes. This knowledge base forms the theoretical underpinnings for the design of preventive interventions. Prevention research must involve the design and evaluation of new models of intervention to correct pathological development processes, thereby reducing the incidence of mental health problems. In order to develop and apply effective interventions, researchers must be knowledgeable about the ecology and culture of the settings in which their interventions take place. Prevention researchers must be able to develop collaborative relations with community settings so that the interventions, if successful, will be continued. Prevention research requires the use of the most sophisticated methodological and statistical techniques in order to reach valid inferences. Methodologists are needed who can develop the new statistical techniques to solve problems in data analysis and who can bridge the gap between developments in mathematical statistics and applications to prevention research questions. Since prevention research is usually conducted by teams of researchers, it is not necessary (or possible) for all scientists to be equally strong in all areas. However, it is often necessary for a researcher to have a superior background in several of these areas. Who should we be training to do prevention research? Training in prevention research should occur across disciplines and across predoctoral, postdoctoral and mid-career levels. Predoctoral training in prevention can occur in a wide range of fields such as public health, social sciences (e.g., clinical, community and developmental psychology, sociology), quantitative methods in the social sciences and biostatistics, psychiatry, family studies, nursing, or social work. These fields provide an excellent disciplinary base from which scientists can develop careers in prevention research. Postdoctoral training is an important way in which individuals who receive traditional training in a discipline can develop a special focus on prevention after their degree. The expected result should be the development of prevention specialists within multiple disciplines and the cross-fertilization of the skills and perspective of multiple disciplines in prevention research. A very important alternative to early training is to involve mature scholars from related fields to integrate their expertise with prevention research. The training of mature scholars in prevention can provide a rapid mechanism to apply important concepts and methods from multiple disciplines to critical prevention research issues. Such individuals need immersion experiences in prevention research to increase their understanding of the issues and to draw them into the field. They should be offered flexible training opportunities, uniquely tailored to their own strengths and limitations. Finally, there is a need for ongoing training of prevention researchers across their career. The prevention field is rapidly developing, and new research methodologies must be rapidly disseminated to active researchers. For example new approaches to measurement, data analysis, and new models of intervention are improving the scientific rigor of prevention studies. Several areas in which there is a particular scarcity of research scientists can be identified. 1) Few researchers are now being trained in the emerging methodological and statistical skills necessary for prevention research. The methodological and statistical challenges of this research are formidable, and new approaches are being developed to meet them. However, graduate programs in core social sciences, such as psychology, are not training sufficient numbers of researchers who are sophisticated in these
