Ensuring the survival of the clinician-scientist

Abstract

Many forces threaten the survival of the clinician-scientist as an academic species, among them: (1) the changing health environment; (2) the complexity of and rapid advances in biomedical science, which necessitate that MD-PhD graduates "retool" after completing their clinical training; (3) the length and rigor of the research training required to train clinician-scientists adequately; (4) the scarcity of funding for subspecialty training positions; (5) the perception that the successful clinician-scientists in academic medicine are those who focus on basic, rather than clinical, research; (6) the indebtedness of young physicians when they complete medical schools; (7) the fierce competition for research funding; and (8) pessimism among senior faculty about the clinician-scientist's potential for survival. There are solutions to these issues that must be vigorously pursued to ensure the survival of the clinician-scientist: (1) Rigorous six- to seven-year programs (e.g., two in internal medicine, four to five in a subspecialty) for physicians must be established. They should include a minimum of three years of research and should lead to board certification in internal medicine, pediatrics, psychiatry, etc., board certification in a subspecialty, and a PhD in clinical science. (2) These programs must have a choice of three tracks, (a) disease-oriented basic research, (b) clinical investigation in patients, and (c) health services research. Such a program--the PhD in Clinical Science program--has recently been approved and begun at the University of Colorado. (3) Funding organizations such as the National Institutes of Health should designate their training resources primarily for programs with a minimum of three years of formal and rigorous research training. (4) These rigorous research training programs must be integrated with young-faculty awards for clinician-scientists to ensure continuity in their investigative careers. (5) Loan-repayment programs must be developed to repay student loans of clinician-scientists during their first five years as faculty members. (6) Against the background of these changes, senior faculty as mentors must articulate to emerging clinician-scientists the excitement of being involved in future discoveries in biomedical science.

Effectiveness of a 1-Year Resident Training Program in Clinical Research: A Controlled Before-and-After Study

“…However, in the United States as well as in Europe, medical education provides only limited training in clinical research, and a decline in the number of physicianscientists has been identified for at least 2 decades. [1][2][3][4][5][6][7] Therefore, the National Institute of Health has recently made substantial investments in training programs and career development awards for junior investigators. 3,8 A wide range of clinical research programs is now accessible, [9][10][11] including feasible types of scaled-down programs in settings where funding is not available.…”

“…A 1-year period was chosen to provide rigorous research training without excessive length. 2 This study investigates the effectiveness of the structured 1-year resident training program in clinical research using a controlled before-and-after study design. In addition to the primary outcomes of research knowledge and productivity, participant evaluation of the training program was assessed.…”

Dual training as clinician-scientist in child and adolescent psychiatry: are we there yet?

“…In recent years, a general decline has been observed in the number of medical trainees who choose to combine patient care and a scientific career [2]. Many factors have been proposed to explain this decline: economic constraints, duration of training, complexity of techniques used in biomedical research (from neuroimaging and genetics to informatics), and rapid pace of advances [3], but also complexity of the care for patients, cost reductions, increasing workload, and social changes (personal interest, level of pay, quality of life, and work-life balance in particular). At a deeper level, some authors have even questioned the possibility to reconcile research and clinical activity [4].…”

Identifyng barriers to successful research during medical school

“…9,10,13,14 Thus, careful attention to the creation of a supportive environment through the use of a needs assessment may provide the greatest influence on the development of qualified medical researchers. 6,9,[15][16][17][18][19] To develop this needs assessment, we surveyed medical students with the aim of identifying factors that allowed for successful student research and barriers preventing scholarly activities in light of their institution's attempts at providing support. It may be that formal curricula designed to engage students in research are still off the mark, and students in institutions with well-developed curricula still face barriers.…”