A Word From the President

Entering the Era of Multidisciplinary Collaboration

In this column a few years ago, I opined that interdisciplinary collaboration was not only the "wave of the future," but the "order of the day." Although I was specifically referring at that time to the need for teamwork in the provision of health care, what has become increasingly clear in the interim is that collaboration should be the watch cry for virtually all of the missions of academic medicine. And nowhere is that more true than in our research mission. The accelerating pace of discovery, the frequent need for very expensive equipment, the essential role of scientists from other disciplines, and the required access to large groups of patients for clinical trials and outcome studies all argue persuasively for a more collaborative approach to the organization and implementation of research programs.

With that thought in mind, I was delighted to read the "Road Map for Medical Research" released by the NIH in October. A collection of strategic initiatives, this provocative document identifies "major opportunities and gaps in biomedical research that no single institute at NIH could tackle alone but that the agency as a whole must address to make the biggest impact on the progress of medical research." Through these initiatives, the NIH aims to significantly transform the nation's medical research capabilities and speed the translation of research discoveries into public benefits.

As part of this far-reaching plan, the agency's institute and center directors have agreed to work together on trans-NIH goals, which is not a trivial commitment considering the agency's organizational structure and political underpinnings. To have fiercely independent centers and institutes -- which have their own congressional appropriations and ties to patient and scientific support groups -- agreeing to work together on goals not necessarily related to their more narrowly defined interests is a remarkable feat on the part of Dr. Zerhouni, and of the entire NIH leadership.

Our community has a lot to learn from the NIH Road Map. And I'm not referring just to the tactical guidance it provides for new funding opportunities, as important as that may be. More important still is the strategic guidance it provides for how we should think about linking scientific advances with improvements in health. In order for clinical medicine to take full advantage of the enormous potential of modern science -- in order for the bench to truly benefit the bedside -- thoroughgoing collaboration among ourselves and across disciplines is absolutely essential. All the groundbreaking developments of recent years in genetics, bioengineering, neuroscience, and molecular and structural biology will amount to little in practical terms if researchers are unable to translate those scientific developments into safer and more effective clinical practices. Although our community is strategically positioned to ease the flow of scientific developments through the "neck of the scientific bottle," several obstacles remain.

First, we need to create incentives for greater participation in multidisciplinary research by moving away from a hierarchical construct that gives special emphasis to the role of single principal investigators, and by adopting policies that reflect appreciation for the roles of all members of the research team. Clinical researchers need assurances that they will be rewarded appropriately when they choose to participate in large teams led by someone else. Faculty appointment and tenure decisions made in this new environment must credit the contribution of each individual to the team's effort, and abandon the tendency to automatically give more weight to the contributions of the first and last authors on papers.

Second, in addition to collaboration among individual investigators, rapid and effective translation of research advances into public benefit calls for inter-organizational collaboration, as well. A central tenet of the Road Map's theme of "re-engineering clinical research" is the need to develop new partnerships among organized patient communities, community-based physicians, and academic researchers. The NIH intends to "promote the creation of better integrated networks of academic centers that work jointly on clinical trials and that include community-based physicians who care for sufficiently large groups of well-characterized patients." That vision of the future of clinical research creates unprecedented opportunities for implementing high-quality, large-scale clinical trials by academic medical centers and for contributing collectively to the advancement of evidence-based medicine.

And finally, the NIH's grand vision will become reality only if we can produce a steady supply of well-trained physician-scientists who are both clinically and scientifically competent, and offer them attractive, stable career pathways. At a minimum, we need to expand dual-degree programs designed for clinical research careers, embed sound scientific methodology throughout the continuum of medical education, and ensure that all physicians understand, and are prepared to participate in, clinical research. By the same token, other health professions schools need to incorporate related materials into their curricula so the interdisciplinary healthcare teams of the future can function smoothly and efficiently.

The Road Map created by the NIH represents a landmark achievement. I note with particular pride that many of the initiative's clinical research proposals, including the core construct of a "Clinical Research Enterprise," parallel the recommendations developed and articulated by the 1998 Clinical Research Summit, a joint effort of the AAMC, the American Medical Association, and Wake Forest University School of Medicine. The NIH's daring effort is sure to help us accomplish many of our cherished objectives and presents us with exciting new opportunities as we enter the era of multidisciplinary collaboration.

Jordan J. Cohen, M.D.
AAMC President

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