AAMC Reporter: July 2006

AAMC Task Force Calls for End to Research 'Bottleneck'

A new AAMC report makes strong recommendations about ways in which medical schools and teaching hospitals can enhance their ability to increase the number of U.S. physician scientists engaged in clinical and translational research so that new methods of diagnosing, treating, and preventing disease can be developed more quickly and effectively.

The report, created by the AAMC's Task Force II on Clinical Research and titled Promoting Translational and Clinical Science: The Critical Role of Medical Schools and Teaching Hospitals, calls on academic medicine to establish a stronger foundation for training in and support of clinical and translational research, including requirements for better mentoring, accelerated programs that shorten the time to scientific independence, improved recognition of individual contributions in team science by restructuring grant tracking systems and publication practices, and increasing resources for support of translational and clinical science, among other goals.

Data examined by the task force show that the number of new physicians pursuing research careers has not changed appreciably in the past 40 years, despite extraordinary advancements in scientific understanding and a historic increase in opportunities for translating scientific discoveries into improvements in medicine and public health. The uncertainty in obtaining research funding and the increasing length of time to become a independent investigator are perhaps two of the prime reasons deterring young physicians. The average age of investigators receiving their first National Institutes of Health (NIH) R01 grants is now 42 for Ph.D.s, and 43 for M.D.s. Evaluation of NIH training programs for clinical investigators revealed that fewer than half subsequently obtain independent NIH research funding.

"We've gone through an incredible period of research advancement over the last few years," said Steven G. Gabbe, M.D., dean of Vanderbilt University School of Medicine and chair of the task force. "We have incredible new findings in cancer, in diabetes, in heart disease, in the neurosciences. Now, we have to take this knowledge and move it into clinical research in order to find practical uses for it. In order to do that, we have to have more young investigators."

The report's authors pointed to a structural flaw in the research process — the lack of translational and clinical scientists to convert medical research into beneficial applications for patients.

"There's been a bottleneck in translating scientific discoveries into treatments," said Howard B. Dickler, M.D., the AAMC's director for clinical research and staff director of the study. "One of the reasons for this bottleneck is the relative lack of quality people who can lead these efforts."

Dickler emphasized that the report sets feasible objectives. "The recommendations are intended to be very pragmatic. They are not pie-in-the-sky," he said. "They are not easy to accomplish, and they are far-reaching, but they can be done."

The AAMC's Task Force II on Clinical Research first convened in February 2005 in response to persisting concerns in the academic medical community over the reluctance of young physicians to prepare for and enter careers in clinical research, the high attrition rate among accomplished clinical investigators within academic medical centers, and the perceived inadequacy of research environments to recruit, nurture, and retain promising clinical scientists. This panel builds on the work of the AAMC's first task force on clinical research, created in 1998 to examine aspects of the academic medical environment necessary for sustaining clinical research and make recommendations directed at the training of clinical investigators, the administration of clinical trials, and the role of academic health care delivery systems, among other factors.

Task Force II members pointed to several highlights in this latest report, including recommendations that "every future physician should receive a thorough education in the basic principles of translational and clinical research, both in medical school and during residency training," and that "the Liaison Committee on Medical Education (LCME) should add education in translational and clinical research to the requirements for medical school accreditation, and the Accreditation Council for Graduate Medical Education (ACGME) should embed understanding of translational and clinical research within its required core competencies." These recommendations are aimed at emphasizing that clinical research is part of the core mission of medical schools and teaching hospitals.

However, Dickler said a recommendation which calls for accelerating translational and clinical research training "so that these scientists can become independent clinicians and investigators at the earliest possible time" a "groundbreaking" step.

"It is suggesting a whole new track for this, so that people are not middle-aged by the time they reach this level," Dickler said.

Gabbe said the report's recommendation calling for stronger mentorship, completion of an advanced degree in clinical and translational research (with a thesis project), and a substantive postdoctoral training experience, was another crucial reform.

"Mentoring for these individuals is absolutely critical," Gabbe said. "It is so important that these young people are linked to a mentor they feel can help them."

The report's other recommendations for medical schools and teaching hospitals include increasing recognition of translational and clinical scientists who engage in collaborative research, sufficiently supporting new junior translational and clinical investigator faculty to maximize their probability of success, enhancing certain relevant NIH awards to add to their value in supporting clinical and translational research training and mentoring, and establishing clinical research collaborations with community health care providers and practice-based research networks.

David Korn, M.D., AAMC's senior vice president for biomedical and health sciences research, the division responsible for the task force, noted that the AAMC has already begun efforts to implement the task force's timely and pragmatic recommendations.

"Many of the task force's recommendations demand follow-up actions by the AAMC, which my staff and I are committed to undertake," Korn said. "Just as medical schools and teaching hospitals have played a seminal role in driving the advancements in biomedical science, so must they now step up to their responsibility to help accelerate the translation of these advancements into patient benefits and better health for all humanity. The opportunity is ripe, the mission is pressing, and the obligation of the academic medical community is clear."

To download the report, visit www.aamc.org/promotingclinicalscience.

— By Scott Harris

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