Academic Medicine : Journal of the Association of American Medical Colleges
Biomedical Research; Female; Health Personnel; Humans; Minority Groups; Personnel Selection; Pilot Projects; Research Personnel; United States
Clinician–investigators, also called physician–scientists, offer critical knowledge and perspectives that benefit research on basic science mechanisms, improved diagnostic and therapeutic approaches, population and outcomes medicine, health policy, and health services, yet few clinically trained health professionals pursue a research career. Sustaining this workforce requires attention to the unique challenges faced by investigators who must achieve clinical and research competence during training and their careers. These challenges include the duration of required clinical training, limited or discontinuous research opportunities, high levels of educational debt, balancing the dual obligations and rewards of clinical care and research, competition for research funding, and the need for leadership development after training. Women and individuals from underrepresented racial and ethnic groups comprise a small percentage of this workforce.
The authors summarize the recent literature on training for clinician–investigators, emphasizing approaches with encouraging outcomes that warrant broader implementation. Using this overview as background, they convened three workshops at the National Institutes of Health in 2016 to identify and refine key priorities for potential new pilot programs to recruit and retain the clinician–investigator workforce. From these workshops emerged three priorities for future pilot programs: (1) support for research in residency, (2) new research on-ramps for health professionals at multiple career stages, and (3) national networks to diversify and sustain clinician–investigator faculty. Implementation of any pilot program will require coordinated commitment from academic health centers, medical licensing/certification boards, professional societies, and clinician–investigators themselves, in addition to support from the National Institutes of Health.
Despite unprecedented opportunities for conducting research in basic science, mechanisms of disease, diagnostic and therapeutic approaches, population and outcomes medicine, health policy, and health services, few clinically trained health professionals elect to pursue a research career.1,2 In 2014, the National Institutes of Health (NIH) Advisory Committee to the Director Physician–Scientist Workforce (PSW) Working Group made a number of recommendations to strengthen this workforce, including suggesting changes to grant funding and training approaches.3 Several PSW recommendations focused on the training of clinician–investigators, also called physician–scientists, including calls to support dual-degree training, to enhance diversity in the workforce, and of particular interest to our work here, to test new approaches to recruiting and retaining this workforce. The PSW recommendations join others calling for transformative approaches to education and training in science, medicine, and research.4
In this article, we describe recent efforts at the NIH to identify potential new pilot programs to enhance the clinician–investigator workforce. We first provide an overview of the current literature on the state of this workforce, including the challenges for clinician–investigators who must achieve both clinical and research competence, and current strategies for training these investigators. Using this information, we identified strategies with encouraging outcomes that may be implemented more broadly, and we conceptualized several potential pilot programs that might be considered for NIH support.
We then describe several workshops held in 2016 at the NIH to help refine these ideas and to identify new ones. Each workshop included extramural stakeholders, experts, and representatives and leaders from different NIH institutes. Stakeholder input refined our understanding of how the NIH might add value to new pilot programs with the goals of training and sustaining the clinician–investigator workforce. In the final part of this article, we describe key priorities for these pilot programs and emphasize that NIH support will need to be coupled with strong participation from academic institutions, medical boards, and professional societies for these approaches to be successfully implemented.
Hall, A., Mills, S., & Lund, P. (2017). Clinician-Investigator Training and the Need to Pilot New Approaches to Recruiting and Retaining This Workforce.. Academic Medicine : Journal of the Association of American Medical Colleges, 92 (10). http://dx.doi.org/10.1097/ACM.0000000000001859