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NHLBI Strategic Plan Training and Career Development
September 30, 2008
The National Heart, Lung, and Blood Institute (NHLBI), Strategic Plan Training and Career Development Implementation Workgroup meeting was held July 30-31, 2008 in Bethesda, Maryland. Drs. Linda Van Horn, Chairperson, and Helena Mishoe opened the meeting both expressing sincere gratitude to all members who were able to attend. Dr. Susan Shurin, Deputy Director, NHLBI, provided opening comments and extended a welcome on behalf of Dr. Elizabeth Nabel, Director, NHLBI.
The workgroup provided insight regarding how to begin implementing the training Strategic Plan recommendations provided within the NHLBI Strategic Plan. The complete Strategic Plan is the culmination of over a two year period in conjunction with over 600 individuals and feedback from the NHLBI's many intermediary groups. Dr. Shurin charged the workgroup and asked that they also take into consideration the Strategic Plan recommendations that were provided as additional guidance to further ensure that the NHLBI scientific and professional training programs are well aligned with the research needs and opportunities for the future. As part of the research agenda, Dr. Shurin stressed the critical importance of including racial and ethnic groups and gender diversity in our training efforts.
Dr. Mishoe acknowledged the challenges ahead wherein the National Institutes of Health (NIH) must make a strategic shift to manage resources over the next several years while funding levels are not likely to change significantly. She stressed the importance of keeping a clear strategic vision when making recommendations regarding training resource allocation. She urged the group to help set priorities as the NHLBI moves forward to implement the training and career development Strategic Plan recommendations.
The workgroup encompassed a distinguished group of individuals with expertise in research training, clinical medicine, basic and translation research, clinical research, and the quantitative sciences. In addition, Drs. Helena Mishoe, Melissa Antman, Rina Das and Carl Roth, NHLBI staff members, made presentations to provide background and framework for several discussion questions that were addressed by the workgroup.
We anticipate that the complete program book will be made available in an electronic format in the near future. However, to provide context for this summary document the following materials were provided in the program book.
The workgroup was asked to provide input on six questions that focused on NHLBI research training priorities and professional competencies needed for the future. Discussions included approaches to training the best and the brightest scientists capable of rapidly bringing new information to the bedside as well as to communities, ensuring a future diverse research workforce, best approaches to mentoring, and exploring training policies that may enhance our training and career development efforts. The discussions often overlapped the various questions, but helped to sharpen the focus of specific topics and recommendations.
Questions 1 and 2
1. What are the 3-5 highest priority cross-cutting recommendations listed under Training Strategic Plan Recommendation? How should we move forward to implement the recommendations? Are there 'low hanging fruit' to be implemented now that will have an impact on trainees? Are there additional priority training needs that we have not identified? How can they be implemented in the most efficient manner?
2. What are the best approaches (strategies or mechanisms) to ensure that the scientific and professional competencies that will come to predominate are introduced into our training programs? Are there specific programs/partnerships that we should leverage to address strategic plan recommendations?
The discussion began in response to a comment made by
NIH leadership in another forum that approximately 5 percent
of the NIH grantees have a funded research career that
spans 20 plus years. No data was available for consideration.
Several workgroup members commented that the Training
Strategic Plan recommendations focus predominately on
recruitment efforts of young investigators into research
careers. It must be acknowledged that we are clearly
challenged with retaining research scientists that have
a sustainable career, which is likely due in large part
to the shortage and high competition for limited funds.
The workgroup applauded the NHLBI for their longstanding commitment and significant efforts to support new investigators and they encourage the NHLBI to continue.
High Priority Research Training Areas
The workgroup concurred with the training Strategic Plan recommendations and identified several emphasis areas and specific approaches.
Translational research training is a timely and high priority
area. The NHLBI should not 'recreate the wheel'. The CTSA
infrastructure was designed for this purpose and a partnership
should be forged. Questions were raised regarding: (1)
How CTSA resources can be made available for non-CTSA
institutions? and (2) How the mid-career and PhD scientists
can fit into the CTSA program? The workgroup recommended
targeted support for translational research training in
the following manner:
In addition to translational research, training in the quantitative sciences was identified as a high priority area. Upcoming scientists must be knowledgeable and have a fundamental skill set in the quantitative sciences.
Since some institutions may currently be limited in the above or related course offerings, the NHLBI should strongly encourage virtual training in the quantitative sciences for its trainees. The workgroup encouraged new scientific vibrancy in the NHLBI T32 training programs to ensure training is kept up to date. To ensure the training structure is nimble and has the ability to move quickly into new directions, an assessment of the current training structure was encouraged.
With limited resources, the NHLBI should seek new partners to help support research training efforts. The goal is to leverage all available resources to increase the number of highly trained investigators.
It has become increasingly clear that Science must be done in teams. Not everyone on the team will be a Principal Investigator on an NIH grant. Members on a research team have different roles, none that are less important. NIH should consider supporting team science that includes research training and support for various levels of a research team (i.e., non-research associates).
What are the most critical parameters that must be in place to ensure we train a cadre of clinical scientists capable of rapidly bringing new information to the bedside?
Clinical Training is expanding at an increased rate and requires more time commitment. The workgroup raised the question, "How do we build a career path for physician scientists? Clinical training and research currently are separate efforts. The workgroup discussed the potential value of linking these efforts for continuity which will help maintain the clinicians" skill set as well as their interest in research.
It is critically important to maintain the foundation of basic science in clinical education. Basic scientists and clinical mentors must function as a team with frequent meetings and discussions of interdisciplinary approaches to their trainee's project.
Is the answer to decouple research training from clinical training and create a research track for clinically trained scientists? There was significant discussion comparing two types of T32 programs: (1) those in which clinical training, supported by the hospital, and research training, supported by T32, are fully integrated; and (2) programs that completely unlink clinical training and T32-supported research training. Data is not available to help determine which of the two training models are the most effective. The group acknowledged that being a successful researcher, who is competitive for grants, requires significant laboratory time. Physician scientists cannot build their career without dedicated research time. To this end, some workgroup members expressed support for a physician scientist track or the unlinked model (like K awards) as a better approach to invest limited resources into research training.
The physician scientist's track would allow strong research competency with narrowed clinical responsibilities. This track would allow physicians to make research their career and eliminate the need to constantly balance between clinical and research obligations. The workgroup agreed that this is quite a difficult challenge that would require medical schools to sanction this kind of effort. Other organizations must also be a part of the solution.The workgroup commented that the NIH cannot do this alone and that perhaps the IOM (Institute of Medicine) should explore this new paradigm in a more comprehensive manner. Data is clearly needed to appropriately assess the best models for research training.
Graduate training generally is too narrow and should be broadened. There is a need for more clinically trained PhDs. Therefore, graduate students should take medical school courses to ensure a comprehensive knowledge of disease mechanisms and enhance their ability to interact with physicians on clinical projects. Clinically trained PhDs should be allowed and strongly encouraged to apply for the K23 and K08 mechanisms.
How do you introduce clinical research early in one's career? How do we impart the creativity of science to the next generation? The working group commented that while they are aware of new and potentially excellent models out there; they also recognized that the winning strategies of the past will not be those of the future. Currently, we need to determine best practices, identify gaps, and strategies that will best facilitate the emerging scientists of the future.
The following recommendations were made:
What strategies can be implemented to help ensure we develop a research workforce of the highest quality based on our nation's diversity?
Gender equity is an important issue. The working group applauded the NHLBI for the new K01 Re-Entry Biomedical Sciences and participation in the recent NIGMS RFA entitled: Research on Causal Factors and Interventions that Promote and Support the Careers of Women in Biomedical and Behavioral Science and Engineering
What are the best approaches to mentoring in a multidisciplinary training environment and how should they be evaluated?
Mentoring is viewed as one of the most important aspects of training new investigators. The NHLBI should ramp up the importance of mentoring and promote a standardized approach for trainees to secure survival skills that also includes leadership and communication, realizing that the new world of team science, multiple Principal Investigators and interdisciplinary, translational medicine may require an entirely new concept of mentorship.
The workgroup provided several recommendations.
Comments/questions on policy update presentation? Are there new or modified policy suggestions that we should consider to enhance our training and career development efforts?
The NHLBI made several significant policy changes in the T32 programs in FY07. The goal is to continue to support the most meritorious training grants while ensuring funds are available to support new training grants. Dr. Carl Roth presented the recommendations that received Council concurrence. After the presentation, a lengthy discussion took place regarding the significant investment the NHLBI has in ongoing T32 programs versus new programs.
How does the institute ensure the latest technologies and the most up-to-date research training is taking place on its training programs? The workgroup recommended continued encouragement and support for new training programs. With the significant investment in continuation programs, the working group felt that it is critically important to ensure innovative scientific vibrancy in the training programs and recommended the following:
The workgroup acknowledged that the proposed training and career development recommendations include both short and long-term proposals that will require programmatic and fiscal collaborations with other government entities, as well as other public and private sectors.
The workgroup agreed that a high priority area for the NIH and its partners is to establish an environment that affords the current and future generation of research scientists a productive and sustained research career. To this end, the NHLBI should gather data on best practices and current needs in the area of early basic and clinical research engagement to recruit and retain the best and brightest diverse research workforce. In addition, data should be collected on various research training models to help determine the most effective strategy to recruit and retain scientists, with a particular emphasis on clinical scientists.
The NHLBI must help ensure multidisciplinary mentoring for trainees, including survival skills mentoring, and explore ways to compensate mentors. Accountability strategies should be put into place to make certain trainees are afforded the designated protected time on career development awards.
Research training in new and expanded scientific areas will likely include novel program development, and the ability to leverage and target efforts on new and ongoing training programs. The NHLBI should partner with the NCRR (National Center for Research Resources) to take full advantage of the CTSA program to expand and sharpen their efforts in translational research. In addition to translational research, the workgroup identified training in the quantitative sciences as a high priority area. Research training programs should include courses such as Bioinformatics, Systems Biology, Analysis of Biological Networks, Foundations of Algorithms, Computational Techniques in Systems Biology, and Linear Algebra. Innovative scientific vibrancy in training programs must be maintained through the peer review process, areas of emphasis designated by the NHLBI, and restructuring of training programs as appropriate.
Drs. Van Horn and Mishoe thanked the workgroup participants for offering their valuable time, enthusiasm, and candor throughout the meeting discussion. Dr. Mishoe provided a brief summary of the working group meeting and final remarks. She indicated that the workgroup members may be called upon in the future as the NHLBI moves forward in the implementation of the training and career development strategic plan effort. The NHLBI emphasized its commitment to evaluate progress as it implements strategies to ensure a future cadre of well-trained investigators to assume leadership of America's biomedical and behavioral research.
Training and Career Development Recommendations