Strengthening Research in Academic OB/GYN Departments (1992) / Chapter Skim
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2 IS THERE A PROBLEM?
2 IS THERE A PROBLEM?
Pages 51-86
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From page 51... ...
include questions In their joins survey of academic Manpower Cat enabled the coffee to gaul an understanding of Be overall level of research s~port in departments of OBIGYN and the relative contribudon of mch of the above satyrs. Responses from all 136 approved U.S.
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From page 52... ...
. Many population research projects arc conducted in den_ other In OB/GYN.
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From page 53... ...
~ the 1950s and 1960s, fiends flowed into selected medical schools and to individuals ~ Pudency program. There were also feds for m£erdisciplinary research.
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From page 54... ...
1h 1980, the Mellon Foundation also Cam providing reproductive research project grants, often to Lions mth Mellon reproductive biology cuter grants. Roughly $1.2 million- per yew was allocated to these grants, which were discontinued in 1989.
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From page 55... ...
Markey C~itable Trust, which supports 16 individuals per year, and We David and Lucille Packard Foundation and the Pew Charitable Trusts, each of which supports 20 individuals per year.~° Other Private Sector Toning Support Today, much priva~s~tor support of OB/GYN training comes from industry, although OBtGYN professional ~cianons and their foundations also contribute. ACOG has identified a total of 14 aids cu~dy being made by the pnvate sector, including some substantial fellowships: · The Jams Kennedy Fellowship Award of the Wench Association of Obstetricians and Gynecolo ists Foumdaelon (the fi=dillg arm of the American Gynecological and Obstetrical Society)
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From page 56... ...
Voluntary Health Agencies Voluntary heals agencies founded by the friends and Amities of individuals with a particular diseas~somet~mes use-~e~r funds for dis~erelated research and training. They can make important contributions to the careers of Dentists by suppordug fellowships, initial research, and other career development awards.
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From page 57... ...
rein support of training and research could play at this crucial time in the development of OB/GYN ~earclL The committee also recommends that the American Collie of Obs~ri~nc and GynecDIog~sts and the Association of Professors of Gynecology and O~rics continue to include ~ their manpower survey questions on source of Church support Awed by d~ents of OB/GYN. This infosmabon will for the first time allow tracl~g of the level of research activity ~ departments of OBIGYN.
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From page 58... ...
OB/GYN departs Stained Heir share of NIH medical school support 1.4 to 1.5 percent between 1968 "d 1989, although they received less ~n might be expected on the basis of faulty size: 3.8 percent of all medical school faculty are in deparunents of OB/GYN, but they wem awarded only 1.5 percent of the N1H Finds going to medical schools. Uhc following "cusmon of the i role is, Moss Dowd o~c~, based on a background paper by Robert A
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From page 59... ...
Historically, the National 1bstih~te of Child Heals and Human Development (NICHD) has been He major NIH supporter of departments of OB/GYN, providing between SS percent and 70 percent of NIH s~port since 1968.
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From page 60... ...
is skill by far the largest Aviate, accounting for more khan 20 peat Of NlH's 1989 fit MH offers many types of research and research training awards. Research grants absorb He largest proportion of HI fields, a proportion Bat has nsen from 77 percent of total NIH support awarded in 1980 to 84 percent in 1989.
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From page 61... ...
The low relative success ~ of OBIGYN departments became more acute Card the end of the decade. Analysis by degree reveals that He success Me of applications from Ph.D.s in departments of OB/GYN was si-ficantly lower akin the success rates of Ph.D.s in departments of medicine and radiology.
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From page 62... ...
62 S~NING PRESENCE IONIC OB/G~DEP~ TABLE 2-1: Success Rues of Coming Applications Submitted to NIH by Dots of Obstetrics and Gynecology, lh=Dai Medicine, Pediatrics, Radiology, and Surgery, 198~1989 Department Number of Number of Success Applications Awards Rate (%) All Applicants Obstetrics/ Gynecology2,669706 26.5 Medicine27,24010,242 37.6*
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From page 63... ...
But success rates only tell part of die story. To ~ awards, applications must be submitted, and physicians in departments of OB/GYN submit relatively sow numbers of applications per capita.
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From page 64... ...
Departs of OB/GYN submitted few applications a total of 165 for FIRST awards between 1980 and 1989; only 51 of Me applications won from M.D.s. Since the success rate was si=ficandy worse then that of each of the comparison departments, OB/GYN also received only a knell Ember of FIRST awards 29 in total, 4 for M.D.s.
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From page 65... ...
The total number of investigators winning cared development awards has not changed much over the past decade; however, there has teem a shift away from Ph.D.s. toward M.D.s through an expansion of clinical mves~gator awards, which provide opposes for medical scientists who will pursue research in areas of interest to the fig institute.
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From page 66... ...
Although NIH data do not document the numb" of physicians in d~arUnents of OBIGYN who received research Gaining and career development support from N1H in the past decade, according to one Amaze the total for He decade is only 50 people.~9 Dig the past year NICHD has changed the terms under which it grants He Clinical Investigator Award, an award for physicians who have completed clinical rosining and have had between Free and seven years of postdoctoral training. Providing salary support of up to S50,000 per year, plus S10,000 for supplies, He award is designed to help an in`res~gator work on a defined problem under the apices of a sponsor and to assist in the mve~ga~r's Rangoon to independence.= Previously RICH grant~xl He Clinical Inves6gator Award for only three yews; now up to five years of support may be awarded.
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From page 67... ...
Thus He holder of He award may integram Iesmrch and subspecialt~r clinical training, interrupt the grant to continue clinical Gaining, or develop a program that is suited to his or her level of research expenence.~ The ability of HI institutes to crudely tailor awards to lay to accomplish specific outcomes, not only for career development awards but also for Gaining and research grants, should not be unde~ted. nUm5~Ra n Gums These mul~project grants include research center, such as He General Clinical Research Centens (GCRCs)
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From page 68... ...
OB/GYN d~parUnents submitted only 28 Program Project Grant applications dig the decade (one~uar~ the number submitted by radiology, the department with He next fewest number of applica$ions3 and were awarded 13 grants. However, of He 33 applications for research center grants Cat wom submitted by OB/GYN departments, 24 gained awards, for a success me of nearly 72 percent-the highest Tong the five comparison deponents.
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From page 69... ...
Ph.D.s in d~runents of OB/GYN who apply for NEI fimdiIlg have success rates comparable to the As of Ph.D.s from some other clinical dots, but the submissions mom physician in departments of OB/GYN are sparse and fare poorly in He competidon for NIH Ads. :~ response to this wetness, the committee focused its recommendations on Ways of developing "d streng~emng physician inves~gamrs ~ documents of OBIGYN, enabling Hem to compem more successfully for NIEI fimds in the fixture.
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From page 70... ...
It docu~ncots an inctcasc in faculty of 90 percent ~ 1977 and 22 percent between 1986 and l990a higher rate of growth the that shown by data from the Association of American Medical Colleges (AAIdC) disco ~ the text.
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From page 71... ...
Medical School Fat, the Nianber~ BoaL,. Washy D.C., Association of Agency Medical Colleges, 1989.
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From page 72... ...
Medical School ~¢~ - y, Sac cry Boot,. WMJDg~n, D.C., Association of Amcmcan Medical Colleges, 1989.
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From page 73... ...
indigos tart ~e age dis~ibudon of physicals in departments of OBIGYN is similar to that of all physician clinical faculty. Indeed' the age distribution of the physics facula of each of the five clinical departments analyzed is remarkably similar, suggesting chat any differences ~ the research productivity of departments are not due to the age of physician faculty.
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From page 74... ...
One possibility is that, to the e~ct~t that Anemic advancement is based on research productivity, women are not squalling men. An analysis of illterDa1 medicine faculty membe~tihe only available analysis of gender differenc~indic~t~ Cat in 1982 and 1983, 19 percent of men and 29 percent of women reported no research involvement; women were also 1~ likely then men to have outside research fading and assigned research ppace.3~ Moreover, 16 percent of the men and 29 percent of He women had not had research training, and 44 percent of the men and 55 pert of the women had not been He fort author of an original arUcle.32
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From page 75... ...
The only deparun~ts with a higher proportion of women faculty In OB/GYN are pediatrics, public health, and physical medicine; He proportion of women faculty in fly medicine is simile to ~ of OB/GYN. ~ tradition, nearly 55 percent of i~tors in d~arun~ts of OBIGYN am women; thus tibe future ranks of for faculty will be pulled from a pool in which women are in the majont~r.
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From page 76... ...
Medical Stool Famed, 7hc N - fibers Book, ' Wagon, D.C., Association of American Medical Colleges, 1989.
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From page 77... ...
Nevertheless, the disparity between We two departments in research activity of physicians is suggestive. Departments of jitter medicine, acknowledged leaders in research activity among clinical departments, appear to engage Heir physician faculty more heavily ~ research, which also reflects their relatively high success rate in competing for NIH funds (s" above)
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From page 78... ...
However, 10 d~parunents received approxin~amly 50 percent of the fimds, and in 1989 only 4 Tents had more ~ ten awards, while 15 ha`1 only one award. This cone - Lion of funds In a ~11 number of documents is somewhat more acute than genemlly occurs for NIH fimds going to medical schools, where 20 schools received 50 percent of NIH funds in 1989.39 These indicators of research intensity suggest a weakness in departments of OB/GYN Compaq win over clini=1 documents, both in Alms of He proportion of faculty Bat are PIs and in He concentration of research activity ~ a sow number of diets.
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From page 79... ...
IS MERE ~ PROD? 79 that only a small number of departments of OBIGYN support a Dial research effort or provide the necessary environment for the generation~of new investigators.
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From page 80... ...
Med/Rehab.18 5.697 6.2 Family Medicine25 0.0265 6.8 TOta1/AVerage2,589 24.37,327 26.9 SOURCE: American A=ociadon of Medical Colleges, Medical School Faculty Roster (1988) , linked with I6formationManagem~t Pig, Amlysm Ed Coordination records of ~cl~ gums AH am ADA~A)
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From page 81... ...
provides a different sort of evidence of He need for expanded research efforts ~ OBIGYN, Pause it identifies areas of investigation likely to repay investment with improvements ~ ~e reproductive health of won and in the results of pregnancy.* To ensure that the research agenda fulfills its purposes, He folly criteria were ~plied: The rese~rciz should confute to the resol=`on of an important hash probl`~rn.
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From page 82... ...
- Sexually ~smi~d diseases incl~g preventing sexually transmitted diseases by developing clinically effective and safe vaccines; developing cost-effecEve tests for early diagnosis of SlDs; developing new Series where needed and new cost~ffective antibiotics Cat are easily administered and sufficiency acceptable to maximize compliance; clan g the natural history of genital infections; defining behaviors associated with the acquisition and spread of STDs; and chafing the role of SI~Ds in adverse pregnancy outcomes.
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From page 83... ...
No one entity beds the re~oDs~bility for this effort; ~her, players to implement the co~ttee's recom mdations me to be found at N1H, ~ tibe d~arunents of OB/GYN, In over loci ~ the medical schools, in foundations, and, importandy, in He profession of OB/GYN itself from which must flow the leaders}~ip that is a prerequisite to the development of a strong research comm~ty in OBJGYN. Reference 1.
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From page 84... ...
ct al. On the Slams of Medical School Faculty and Clinical Research Manpower: 196~1998.
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From page 85... ...
Rescawh Activity of Full-~mc Faculty ~ Depar~n~ of Mcdicinc. Washington, D.C.: Association of Profcmors of Medico Ad Association of Amidic" Medical Colleges, 1987.
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