Manpower Training for Fundamental Clinical Research

MANPOWER TRAINING FOR FUNDAMENTAL CLINICAL RESEARCH SCOTTN. SWISHER* In my opinion, a relatively major retrenchment ofbiomedical research in this country is inevitable. We will have to get along with fewer resources while recognizing that we will still have the best-financed biomedical research establishment in the world. The implications of this retrenchment to training the central core of clinical investigators are many. Recruitment and training are two of the early and possibly limiting steps in a complex process of manpower allocation to this type of research, but they are only two of the variables subject to management within the research establishment which control its ultimate direction and productivity. Recruitment and training of manpower must be related coherently to all other aspects of our national biomedical research enterprise if we are to have an optimal outcome; one thesis of this paper is that this has not occurred in the past. Research manpower of the sort we are considering has been determined by a kind of market force, a process which now is failing. I will also suggest that to meet the future we must make two major changes if we are really dedicated to the importance ofclinical investigation : We must concentrate clinical investigation and its support into a smaller number of institutions to insure critical-sized groups of interacting investigative programs, and we must train our clinical investigators in greater breadth and depth, eventually to at least the level now represented by the M.D.-Ph.D. programs but with a broader scope. Furthermore , we must provide for periodic retraining to insure longer productive careers for the individual investigators. This pattern of training implies largely abandoning the current apprenticeship approach to training and the present use of the training rubric as a device to develop low-cost research manpower and manpower for other functions in academic centers. *Associate dean for research, College of Human Medicine, Michigan State University, East Lansing, Michigan 48824.© 1980 by The University of Chicago. 0031-5982/80/2322-0155$01.00 S62Scott N. Swisher · Manpower Training I recognize these to be controversial positions, and I take diem, in part, in the hope that they will engender constructive criticism and discussion out of which programs for the future can be developed. Life in academic medical institutions during the last 10 years has been lived in an atmosphere of impending disaster and deepening gloom. It has not been pleasant. People find change threatening, particularly major and multiple changes, and academics are no exception. Curriculum , student selection, clinical programs, and faculty organization have all been in rapid flux as externally determined social forces have impacted on these surprisingly labile institutions. By and large, medical faculties have coped reasonably well, albeit with one exception: The core research faculties of most medical schools are increasingly unable to cope with the declining real support of research, the uncertainty of the support, and their impotence in dealing with the problem. The implications seem clear: What is called change in other activities of academic medical centers threatens to become a revolutionary change for the organization and support of research. Clinical Research and Research Training This paper purportedly deals with research training. I cannot construe this charge narrowly. The development of clinical research manpower cannot be divorced from other aspects of the national biomedical research enterprise. Training for research is the most flexible of these elements; it can or should be able to adapt quickly to changing programmatic needs. Nevertheless, "quickly" in this context involves a de novo training cycle of at least 5 years. Retraining of basically trained investigators may go more rapidly. The time required to train investigators for more limited purposes can be shortened substantially, but the price is their rapid technological obsolescence and a high turnover in manpower at ultimate high cost. Thus, to discuss future research training , one must try to integrate it with the other elements of research: (1) the way in which problems in need of research are identified and placed in priority for support, (2) development of appropriate research facilities and resources, and (3) development of annual and long-term financial support. Unfortunately, these problems cannot be discussed now primarily in terms of data and information. Opinion abounds...