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In summary, I have suggested several problems and areas of concern, complementing those raised by Swisher. If progress can be made in these areas within the foreseeable future, I am confident that many of our concerns about the adequacy of the manpower pool for clinical investigators will diminish sharply. Trainingfor Research: Notesfrom the Discussion Swisher asked, "What is training for research?" We have not defined it, and we need to reposture ourselves as educators rather than simply as trainers. The university should take the responsibility for the creation of a deeply educated person who has the attributes of both the good physician and the scientist. However, we tend to overestimate the role and power of education. In practice, one forgets most ofwhat one learned in school. Swisher thought that research would likely show that the absence of a research orientation in medical school leads to a dysfunctioning physician. Berliner took issue with Swisher about the apprentice system of training for research. He thought that the system works quite well: "I think it is true that some of the people who have apprentices do not deserve to have them, because, as preceptors, they are not sufficiently devoted to training responsibility or even not sufficiently competent as investigators . However, there are many competent research preceptors, and the people who go through the apprentice experience very frequently come out very well. We are rather fortunate in the training of M.D.'s for clinical research as opposed to Ph.D.'s in that the Ph.D. has very few options when he is through. We can afford to be much more wasteful in preparing M.D.'s for research. Those who drop out probably are somewhat better physicians than they would have been otherwise, and little has been lost except, perhaps, that they have settled for a reduced income for a few additional years." Schreiner made a plea for broadening the issue. It might well be a good thing to train fewer people, but the system should not be dismantled . He pointed out that one of our debts to the less developed nations is helping to educate their young people to be competent medical scientists, and the apprentice system is quite effective in this regard. S82 fohn F. Sherman ยท Clinical Investigators ...


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