Personnel Needs and Training for Biomedical and Behavioral Research 1978 Report (1978) / Chapter Skim
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4 Clinical Sciences
4 Clinical Sciences
Pages 89-110
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From page 89... ...
This is an average annual decrease of 14 percent. o Budgeted vacancies in clinical departments have grown about 11 percent per year since 1971, compared with 4 percent in basic science departments at medical schools (Table 4.~.
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From page 90... ...
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From page 91... ...
Similar investigations of disease in animals, conducted mainly by-veterinary scientists, parallel clinical research on disease in humans and could therefore be included under the clinical sciences rubric. The scientific techniques and instrumentation for clinical investigation may be similar to those in basic laboratory studies.
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From page 92... ...
Other purposes of clinical investigation are to assess the reliability, sensitivity, and specificity of diagnostic procedures; to identify the possible hazards of therapeutic drugs; and to determine the efficacy of medical and surgical procedures. It may consist of carefully controlled studies to mechanisms of disease, or field epidemiologic aimed at uncovering information about the etiology of It provides the critical link between basic science and Classification of Clinical Sciences For an operational definition of clinical sciences, the Committee has relied upon the discipline/field/specialties list used by NIH 92
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From page 93... ...
The resulting problem to the Committee in determining appropr late training levels in these areas is apparent and will be given further consideration as this study continues e THE 1 978 OUTLOOK FOR THE CLINICAL SCIENCES For last year's report, the Committee reviewed trends in the supply of, and demand for, clinical investigators and concluded that de~nand quite likely woul ~ expand somewhat faster than supply if these trends were to continue through 1982. This conclusion was based pr imarily on an analysis of the relationships among clinical faculty in medical schools, medical student enrollments, and R and D expenditures in medical schools.
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From page 94... ...
Thi s has been done by includ ing medical service funds in the monetary variable of the model. As revised, the monetary variable now is composed of the sum of medical service income and estimated expenditures for clinical R and D in medical schools.
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From page 95... ...
z en Go to ~ ~ A \ ~ ~ — ~ ~ As \ ~~ ~g \ '= ~ ~ ~ I: cC)
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From page 96... ...
The clinical faculty/medical student projections are translated into projected demand for clinical faculty by applying the projected levels of medical student enrollments. As before, h igh, middle, and low proj ections have been made for the monetary variable and medical student enrollments, reflecting the Committee's best estimate of likely future levels based on the behavior of these variable es in the recent past ~ Figures 4.
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From page 97... ...
I I J I ,/ .1 1 1 I / I I _ I I / ~ 1, 111 I' __— K_~ / 1 1 1 ' 1 1965 1970 1975 1980 1970 1975 1980 FISCAL YEAR (d) Projected Total Medical School Clinical R and D and Medical Service Incomet1967$)
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From page 98... ...
0.6 '0.5 o 0.4 lo: 0.3 0.2 o 1High Estimate _~ Middle Estimate // Low Estimate / 'I LI I I 1 1 1 1 1 1 1 62 66 70 74 78 82 FISCAL YEAR {a} Clinical Faculty/Medical Student Ratio 3 100 80 60 Z 40 ~ 20 1 1 1 1 1 1 1 1 1 1 1 o G At 111 62 66 70 74 78 82 FISCAL YEAR (b) Medical Students 60 40 20 o =1 1 1 1 62 66 70 74 78 82 FISCAL YEAR {c} Clinical Faculty in Medical Schools High Estimate , ~ _ _ Middle Estimate Low Estimate FIGURE 4.3 Medical student enrollment and clinical faculty, 1961-76, with projections to 1983.
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From page 99... ...
t ~ exp(-0.92982 - 75839.6/Ot) + 0.2, where CF ~ size of clinical faculty in medical schools' M - medical student enrollments Dt ~ a weighted average of the last 3 yearn of clinical R and D expenditures plus medical service income In medical schools, i.e., Dt ~ \(Dt ~ 2Dt-1 + Dt-2 )
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From page 100... ...
in 1977, it was found that in constant dollars, federal research training funds declined by 3 percent annually between 1972 and 1976, while funds available~to support advanced clinical training from patient care activities and other sources increased by 13 percent annually. The net result for these 12 academic medical centers is that the proportion of all advanced clinical trainees who were receiving research training on a full-time basis declined from 49 percent in 1972 to 43 percent in 1976 (AAMC, 1978~.
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From page 101... ...
Indeed, the -most productive clinical research i s general ly performed by investigators whose observations at the bedside or in the clinical laboratory have furnished the stimulus for their studies. Moreover, the investigator with a health professions background provides the role model essential for attracting students and house staff to research careers.
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From page 102... ...
For example, the federal government has initiated scholarship programs for those who will care for patients in medically underserved areas or in the military, but there have been moves to end support for research training. Federal research training awards pay less than clinical traineeships, and practitioners' earnings exceed those of faculty researchers.
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From page 103... ...
The amount of e f for t act ual 1 y ~ evoted to re se arch, per se, obvi ou sl y wi 1 1 vary wi d ely among al 1 med i cal school faculty member s e Realization of this annual output of clinical faculty is in large part a f unction of the average length of postdoctoral training needed by clinical researchers. In determining an appropriate length of research training in the clinical discipl ines, the Committee took as its model the experience of a typical "~fellow" -- a physician who has completed basic res idency training and who then elects to continue in .a postdoctoral program to acquire research skills and experience.
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From page 104... ...
e The federally supported portion of the total pool of clinical research trainees was about 67 percent in 1974-75 according to NIN and NSF.2 For purposes of its funding recommendation, the Committee has selected 50 percent of the total pool of 5,400 as the appropriate level of support under the NRSA Act. In arriving at a percentage somewhere between the two reference points, the Committee takes cognizance of the belief of many observers that clinical faculty on the whole are somewhat less likely than are basic science faculty to devote the majority of their time and effort to research pursuits.
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From page 105... ...
, the estimated requirement for trainees is understated. Thus, the Committee believes, on the basis of the information presently -- availab~e, that its previous recommendation for federal support of 2,BOO postdoctoral trainees and fellows in the clinical sciences is reasonable and should be continued.
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From page 106... ...
Supply of Clinical Researchers One of the most pressing issues for which the Committee seeks data is the number of currently active clinical investigators. The Directory of Physicians, maintained by the AMA, is a data source for estimating the full-time equivalent of M.D.ts in research in all sectors.
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From page 107... ...
holders. In the face of declining attractiveness of research careers for the health professional, it is probably unreasonable to expect that personnel needs in the clinical sciences can be met exclusively by investigators trained in the medical school/residency/research fellowship mode or in combined M.D./Ph.D.
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From page 108... ...
A pilot study involving 1, 022 students in nine medical schools has been completed for 1976-77 academic year seniors. Research-related questions will cover plans for graduate medical education, such as intention to seek a research fellowship, as well as postgraduate career plans involving academic faculty appointments or employment as a Sal ar i ed rese ar ch sc i ent i st .
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From page 109... ...
An ad hoc working group on veterinary research personnel is working with the Committee' s Pane, on Clinical Sciences to assess personnel needs in the industrial, governmental, and veterinary college sectors. Federal and state governments are major employers of D
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From page 110... ...
t = ratio of clinical faculty in medical schools to medical st udent enrol iment In year t; Dt = weighted sum of clinical R and D expenditures plus medical service income in medical schools ~ ~ t ~ in the last three,years, i.e.
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