- Email: [email protected]
An Evaluation of Postdoctoral Research Training and Trainees Supported by the National Institutes of Health in the Division of Kidney, Urologic and Hematologic Diseases
(Editor's Note: The Editor encourages submission of editorials and articles on political. ethical. and educational issues related to the practice of the subspecialty of Nephrology.)
An Evaluation of Postdoctoral Research Training and Trainees Supported by the National Institutes of Health in the Division of Kidney, Urologic and Hematologic Diseases Charles H. Rodgers, PhD, and M. James Scherbenske, PhD • The interest of young MDs and PhDs in research careers was assessed by determining the number of former trainees who applied for and (or) received research support from the Public Health Service. Thirty-two percent of trainees supported by Institutional Training Grants between 1977 and 1981 made a subsequent application. Seventy-six percent of all those who submitted applications to the National Institutes of Health (NIH) for research project support received awards. Examination of the success rate for individual applications submitted by former trainees showed that 56% of all applications submitted by MD scientists were awarded, and 57% of all applications submitted by PhD scientists were awarded. This compares to an NIH-wide average of 33.3% for the same period. The number of appointments made to Institutional Training Grants for a full year remained fairly constant over a 6year period, as did the number appointed to individual fellowships over an 8-year period. The dollars expended on Institutional Training Grants increased 33% from 1982 to 1986 for a similar number of trainees, and increased 30% from 1981 to 1988 for a similar number of individual fellowships. The number of Research Career Development Award (RCDA) applications declined by 66% for MDs and by 53% for PhDs, accounting for a 32% reduction in the number of active RCDAs held by MDs and a 60% reduction in active RCDAs held by PhDs from 1985 to 1988. MD scientists submitted more applications, had higher award rates, and received more RCDA awards than did PhD scientists. Currently, 42% of all who received training through an Institutional Training Grant in the Division of Kidney, Urologic and Hematologic Diseases (DKUHD) are engaged in research activities. In summary, applicants who were former trainees supported by an Institutional Training Grant in DKUHD had higher success rates than other applicants assigned to the DKUHD (P< 0.0044), or the NIH in general. Too few trainees submit research grant applications after completing their training. These data may be encouraging to trainees and trainers. © 1990 by the National Kidney Foundation, Inc. INDEX WORDS: Training; MD trainees; PhD trainees; Research Career Development Award; individual fellowships; Institutional Training Grants.
T
HERE HAS BEEN a decline in the proportion of senior medical students expressing an interest in a research career even though the success rates (number of awards/number of applications) for new National Institutes of Health (NIH) research grants were comparable between physician and PhD scientists. l The proportion of physician scientists as Principal Investigators on NIH research grants has declined as has the proportion of physicians reporting research as a primary activity between 1966 and 1975. 2 A similar decline was noted in the proportion of individual postdoctoral fellowships and (or) Research Career Development Awards (RCDAs) supporting physician scientists when compared with those supporting PhD scientists during a similar time interval,3 The relative lack of interest of medical students in research and the apparent loss of physicians in research activity has fostered the view that part of the problem results from increased competition for limited research funds. 2 However, survey data from senior medical students in 1980 failed to show that pay back of time spent on training
grants, relative lack of faculty positIOns, or increased competition for research funds served to discourage medical students in choosing a career in research. l Recent data from the NIH demonstrated that success in obtaining new research grants is comparable between MD and PhD scientists. In two successive 4 fiscal year periods, 1980 to 1983 and 1984 to 1987, the success rate for physician scientists-23.0% and 24.1 %-was comparable to 24.2% and 24.9% for PhD scientists (success rate = number of applications awarded/ number of applications submitted). The similar success rates were more notable when considering that PhD scientists submit more than three times the number of applications than do physician From the Division of Kidney. Urologic and Hematologic Diseases. National Institute of Diabetes and Digestive and Kidney Diseases. National Institutes of Health. Bethesda. MD. Address reprint requests to Charles H. Rodgers. MD. Manpower Program Director. DKUHDINIDDKINIH. Westwood Bldg. Room 621. 5333 Westbard Ave. Bethesda. MD 20892. © 1990 by the National Kidney Foundation. Inc. 0272-638619011602-0011 $3.0010
American Journal of Kidney Diseases, Vol XVI. No 2 (August), 1990: pp 147-153
147
148
RODGERSANDSCHERBENSKE
scientists for each of the 4-year intervals (unpublished NIH data, I.A. Brackett and R.F. Moore, Division of Research Grants, NIH). Over the past several decades, a decline in medical student interest in research careers would appear to be reflected in a decline in the number of individual postdoctoral research fellowships and career development awards that were awarded. 1·3 Fewer physicians being trained as physician scientists could result in a commensurate decline in physician Principal Investigators on NIH grants. These data do not provide data on specific medical subspecialities served by the Division of Kidney, Urologic and Hematologic Diseases (DKUHD, National Institute of Diabetes and Digestive and Kidney Diseases [NIDDK]). The purpose of this study was to evaluate research training activity in DKUHD. The first part of the study summarizes the number of individuals supported on institutional training grants, individual fellowships , and RCDAs. The second part examines the question of whether those individuals who trained on institutional training grants applied to and (or) received support from NIH for research project grants. Finally, other evidence of research activity such as publication in peer-reviewed journals was assessed. The evaluation of manpower programs in the DKUHD may be expected to provide an indication of research training activity in areas of the medical community served by the DKUHD division, and may contrast with earlier reviews based on broad physician scientist populations. METHODS The data on postdoctoral trainees supported by Institutional Training Grants (T32s), Individual Research Fellowships (F32s) , and RCDAs (K04s) were obtained from the NIH Information for Management Planning, Analysis and Coordination (lMPAC) system. The data concerning individual fellowships and RCDAs covered the fiscal years (hereafter referred to as years) 1981 to 1988. The institutional training grant data were obtained for years 1981 to 1986, a shorter duration because it was not available. A minimum of I additional year is required to obtain and enter data into the system from the appointment forms. Several measures were used to quantify the success of the research career of those supported on an institutional training grant. The primary measure was whether the former trainee had applied to the NIH/Public Health Service for research support, and whether it was funded. Second , success was quantified by research publications.
The names of trainees were obtained from the Trainee Appointment Forms submitted by the Program Directors of Institutional Training Grants for years 1977 through 1981. The names and social security numbers of 330 former trainees were subsequently checked through IMPAC to determine if an application had been made to any of the Public Health Service agencies for research support, and the success/status of that application. If an application was pending review or pending a funding decision for fiscal year 1989, it was excluded from consideration. Trainees without a record of an application in IMPAC were cross-checked with the Research Awards Index, Volume II, 1986. The awards index is generated by the Computer Retrieval of Information on Scientific Projects (CRISP) system, and lists all active projects and SUbprojects of Research Progam Projects, Research Projects , Specialized or Comprehensive Centers, Center Core Grants and General Clinical Research Centers. Subproject components in General Clinical Research Centers were counted separately because not all subprojects are peer-reviewed and it was not possible to determine whether a specific SUbproject had been peer-reviewed. Searches of IMPAC and CRISP constituted the primary measure of success of former trainees for purposes of this study. Nineteen Institutional Training Grants were assessed in the field of Kidney / Nephrology, and 10 in the field of Hematology. The length of the training period on an Institutional Training Grant was verified for each trainee. If a trainee was supported during 1977 to 1978, the previous 5-year period 1972 to 1976 was checked to be sure of the total number of months of training. Similarly, if a trainee was supported during 1981 to 1982, the succeeding 5-year period 1982 to 1986 was checked to be sure of the total number of months of training. This procedure ensured that trainees in programs at the beginning and end of the 1977 to 1981 period were attributed the proper amount of time in research training. Baseline data for comparing the success of the former trainees who submitted competing applications was provided by considering the success rate (number of applications awarded/number of applications submitted) of all kidney and hematology applications assigned to the DKUHD during the years 1983 through 1987. The number of applications considered by the DKUHD was adjusted by subtracting the number of applications submitted by former trainees who were funded within the DKUHD, thus insuring that the two groups were independent samples of applicants applying to the NIH for research support. The 1983 to 1987 time interval was considered an appropriate one with which to compare those who had trained during the 1977 to 1981 interval. The following procedures were used to determine if former trainees who had not submitted an application to the NIH for research project support contributed to the research literature. Using a Table of Random Numbers, a subsample of training programs was selected from the original pool of 29 programs. A list was made of trainees from these programs who had not applied for NIH research support according to the IMPAC and CRISP searches , and 55 names were randomly selected from this list. A Medline search was then made for the years 1986 to 1988. At least three bibliographic citations were reviewed to determine if the subject matter coincided with the training program area, and to eliminate letters and (or) review articles from consideration. The data represent one or more publications. Statistical comparisons were made by the chi-square test.
149
POSTDOCTORAL RESEARCH TRAINING
Table 1. Institutional Training Grants 1981 to 1986: Encumbered Dollars for Institutional Training Grants, Allocated Training Slots, and Number of Trainees Appointed in the DKUHD Kidney Program Fiscal Year
1981 1982 1983 1984 1985 1986
Encumbered Dollars'
$2,159 $1,943 $2,271 $2,266 $2,763 $2,895
(94) (104) (106) (115) (107) (111)
Total Trainee Appointments
Trainee Appointments 9·12 Months' Duration
102 108 104 102 93 94
90 95 89 91 76 93
'Number of allocated training slots in parentheses based on encumbered dollars (in thousands) .
RESULTS
Postdoctoral training on the Institutional Training Grant is summarized in Table 1. The actual dollars (encumbered amounts) expended for National Research Service Award (NRSA) institutional training grants is provided for each year from 1981 to 1986. The number of allocated training slots is a theoretical number based on a formula using the average NIDDK training stipend, the 8 % indirect cost allowance , and all other trainee-related expenses (health insurance, tuition, etc). The dollar figure provided by the formula is then used to calculate the theoretical number of training slots. Total trainee appointments show how many named individuals were appointed in a given year whether for 3 months or for 12 months. Individuals appointed for 9 to 12 months represent full-year appointments. The three methods of counting trainees were expected to be at variance inasmuch as the official slot allocation is a theoretical number, whereas all of the individuals appointed during a particular year included appointments irrespective of the duration of the appointment. Interestingly, there was an 8 % decline in the total number of appointments from Table 2.
1981 through 1986. Thus, fewer individuals were appointed for periods less than 9 months in 1985 and 1986 than in earlier years. The dollar expenditures increased between 1982 and 1986 by 33 %, yet the number of appointments for a full year remained about the same. Table 2 provides official data on the funds used to support NRSA individual fellowships, the number of allocated fellowships and the number of named individuals supported by the NRSA award. The encumbered amounts fluctuated from year to year, reflecting variations in the yearly NRSA budget. Similarly, the number of allocated fellowships and named fellows varied depending on the available budget. While there was a slight growth in the number of individual fellows supported by NRSA funds between 1982 and 1986, the number of appointments in 1988 are about the same as the number of appointments in 1981 . However, it cost $183 ,000 (30%) more to support approximately the same number of individuals in 1988 as in 1981 as a result of increased stipend levels. The actual number of MDs and PhDs who applied for the NRSA individual fellowship and the number of awards is shown in Table 3. MDs made
NRSA Individual Fellowships 1981 to 1986: Encumbered Dollars for Fellowships, Allocated Fellowships, and Number of Fellows Appointed in the DKUHD Kidney Program
Fiscal Year
Encumbered Dollars'
Allocated Fellowships
Fellows Appointedt
1981 1982 1983 1984 1985 1986 1987 1988
$434 $498 $500 $459 $693 $876 $676 $617
21 27 25 24 27 32 24 22
21 27 25 24 27 32 24 22
'Encumbered dollars are in thousands. tThis number includes new (year 1) and continuing (year 2 and/or year 3) appointments .
150
RODGERSANDSCHERBENSKE Table 3. Application and Award Rates for NRSA Individual Fellowships by Fiscal Year and Degree in the DKUHD Kidney Program No. of Applications
No. of Awards'
Fiscal Years
MD
PhD
MD
PhD
1981 1982 1983 1984 Mean 1981-1984
12 14 15 10 12.8
6 18 6 10 10.0
5 6 11 5 6.8
3 11 3 4 5.3
1985 1986 1987 1988 Mean 1985-1988
13 25 17 28 20.8
11 10 5 7 8.3
9 10 5 10 8.5
5 6 2 4 4.3
'Number of new (year 1) fellowship appointments made for each designated fiscal year.
more applications and received more awards than did PhDs in both the 1981 to 1984 and 1985 to 1988 time intervals. In fact, MDs showed a 38% increase in the number of submitted applications between the 1981 to 1984 and the 1985 to 1988 interval, whereas PhD applicants submitted fewer in the 1985 to 1988 than in the 1981 to 1984 interval. The actual number of awards is similar in the 1981 to 1984 interval for the MD and the PhD, but the increased number of applications by MDs during the 1985 to 1988 interval resulted in an increased number of awards compared with PhDs. The RCDA is available to both the PhD and the MD applicant. More MDs applied for and received career awards than did PhDs. Increased numbers of applications and resulting awards ac-
count for MDs having a larger number of active awards than PhDs (Table 4). In the 1985 to 1988 interval, MD and PhD application rates declined by 66 % and 53 %, respectively. The reduced application rates have caused a 32 % reduction in the number of career awards held by MDs and a 60 % reduction in the number of career awards held by PhDs in the 1985 to 1988 compared with the 1981 to 1984 interval. One hundred five of the 330 former trainees (32 %) applied to the NIH for research support (Table 5). There were 51 MD and 29 PhD awardees. Of the 151 applications submitted by MDs, 84 (56%) were funded. PhDs submitted 95 applications, and 54 (57%) were funded. There were 80 awardees of 105 applicants for research grant sup-
Table 4. RCDAs in Kidney 1981 to 1988: Number of Applications, Funding Rates, and Active Awards in DKUHD by Fiscal Year and Degree No. of Awards'
No. of Applications
Total Active Grantst
Fiscal Year
MD
PhD
MD
PhD
MD
PhD
1981 1982 1983 1984 Mean 1981-1984
7 8 9 5 7.3
3 6 5 3 4.3
3 3 5 4.5
1 2 1 0 1.0
10 13 14 12 12.3
6 6 7 6 6.3
1985 1986 1987 1988 Mean 1985-1988
5
3 3
2 0 0 0 0.5
0 0 1 0 0.3
13 10 7 3 8.3
4 3 2
4 0 2.5
1 2.0
'Number of new (year 1) career awards made for each designated fiscal year. tNumber includes new (year 1) and continuing (year 2 to year 5) awards.
2.5
151
POSTDOCTORAL RESEARCH TRAINING Table 5.
NIH Research Grant Activity of Former Trainees (N 330) Supported on NRSA Institutional Training Grants in Kidney and Hematology During Fiscal Years 1977 to 1981 by DKUHD
Program
Kidney Hematology Totals
Applications
Awardees
Trainees Applying
Applications Funded
Applications Not Funded
MD
PhD
MD
PhD
MD
PhD
MD
PhD
72 33
36 15
16 13
107 44
59 36
58 26
30 24
49 18
29 12
105
51
29
151
95
84
54
67
41
port, thus 76% of all applicants became awardees. These calculations do not include six former trainees who were responsible for one or more subprojects on NIH-funded General Clinical Research Centers. The percentages of MDs and PhDs who applied for NIH research support and those who did not, according to duration of training, are shown in Table 6. Twenty-six percent of PhD applicants and six percent of MD applicants were supported for 1 to 11 months on Institutional Training Grants. The proportion of MD applicants and nonapplicants who were supported for 12 to 35 months on Institutional Training Grants was similar: 85 % of applicants and 88% of nonapplicants. While PhDs appeared to be supported for less time on Institutional Training Grants, the proportion supported for 12 to 35 months also was similar: 64% of applicants and 68 % of nonapplicants. The range in total months spent in research training supported by an Institutional Training Grant also was similar for both the MDs and PhDs whether or not application was made for research support: MD applicants, 6 to 42 months; MD nonapplicants, 2 to 41 months; PhD applicants, 2 to 36 months; PhD nonapplicants, 1 to 42 months. The success rate of applications submitted to the
NIH by former trainees was compared with that of applications assigned to the DKUHD for funding consideration during the 1983 to 1987 interval (Table 7). The mean number of applications funded by DKUHD was 162 out of a total of 473 submitted applications for the 5-year period, providing a success rate of 34 %. The success rate was 35 % (172/494) if the baseline data were not adjusted by subtracting the number of applications submitted by former trainees that were assigned to the NIDDK for funding consideration. The success rate of 34 % to 35 % is comparable to the NIH rate for years 1979 to 1988, which averaged 33.3% (range, 29.4 to 40.2 [1979]).4 The success rate for the trainees was 55 % compared with 34 % of the baseline applications. This is a significant difference (X 2 = 8.098, 1 df, P = .0044). The secondary measure of research success by former trainees who did not apply to the NIH for research grant support was contributions to the research literature. Of the 55 randomly selected trainees from this group, 27 (49%) had at least one publication in the research literature during the years 1986 to 1988. No citations were noted for 28 (51 %) of the trainees. The length of support on an Institutional Training Grant was similar for those publishing and not publishing: 78 % of those pub-
Table 6. Applicants and Nonapplicants for NIH Research Grants by Duration of Training and by Degree for Trainees Supported by DKUHD Duration of Training (mos) Degree/Status
MDs Applications No applications Ph Os Applications No applications
N
1-11
12-23
24-35
36 or more
66 163
4 (6%) 10 (6%)
29 (44%) 87 (53%)
27 (41%) 58 (35%)
6 (9%) 8 (5%)
39 62
10 (26%) 12 (19%)
10 (26%) 21 (34%)
15 (38%) 21 (34%)
4 (10%) 8 (13%)
RODGERS AND SCHERBENSKE
152
Table 7. DKUHD 1983 to 1987: Mean Number of Research Grant Applications Submitted, Funded, and Not Funded Adjusted for Trainee Applications Assigned to the DKUHD Funded
Not Funded
Program Area
Applications
Kidney Hematology
335 138
108
227
54
84
Totals
473
162 (34%)'
311
'Success rate = no. funded/no. applications.
lishing spent 24 or fewer months, and 79 % of those not publishing spent 24 or fewer months as trainees on an Institutional Training Grant. DISCUSSION
The number of individuals appointed to NRSA Institutional Training Grants and to individual fellowships has remained fairly constant. Both NRSA programs show year-by-year fluctuations in the budget. There were increased costs of 33 % for the support of trainees on Institutional Training Grants (Table 1) and of 30% for the support of individual fellowships (Table 2). The increased costs are associated with increases in stipend levels, and have not allowed growth in these two programs during the 1980s. Since 1985, RCDA application rates for MDs decreased by 66 %, and for PhDs by 53 %. The reduced number of applications are responsible for a 32 % and a 60% reduction in active awards since 1985 for MDs and PhDs, respectively (Table 4) . These data are consistent with previous reports of reduced physician scientist RCDAs,3 and provide data showing the same is true for holders of the PhD. The decreased number of RCDAs held by MDs is thus not the result of PhDs being more successful, but the result of decreased application rates. Similarly, PhD scientists have not made use of the RCDA mechanism. The data concerning trainees on NRSA Institutional Training Grants and individual fellowships do not clearly suggest a reduced interest in research training by MDs as have other data. 13 The number of named individuals on Institutional Training Grants for full-year appointments has remained fairly constant between 1981 and 1986, albeit total appointment activity has decreased from a high of 108 in 1982 to a low of 93 in 1985 and 94 in 1986 (Table 1). Individual fellowship appointments also show a consistent number between 1981 and 1988, even though PhDs are making
fewer and MDs are making more applications (Tables 2 and 3). The reduction in the number of active RCDA awards both by MDs and PhDs (Table 4) is troublesome in an era requiring more and longer periods of training to master highly complicated and changing methodologies. Relatively small numbers of former trainees of NRSA institutional research programs applied to the NIH for research support (Table 5). These data are conservative measures of individuals engaged in peer-reviewed research for both the MD and the PhD, since they do not include applications to other agencies. One might have expected a higher number applying to the NIH than was observed. Applicants who have received some training under the NRSA mechanism and who apply to the NIH are more successful than a group of applicants without such training who made application during a similar time interval. This was true both for applications to the DKUHD/NIDDK or the NIH (Table 6).4 Forty-two percent of the trainees meet the criteria of being active in research if one considers the number of former trainees who did not apply to the NIH but were publishing in the research literature, and the six who were responsible for research subprojects in the General Clinical Research Centers. The authors are aware of a number of trainees without an identified record of applying to the NIH who have been successful in obtaining research support from other sources. Thus, the proportion of trainees active in research is undoubtedly higher than the 42 % reported in this study. These data provide evidence that NRSA Institutional Training Grants provide adequate training for those who are interested in research and research-related activities. It is difficult to account for the lack of applications to the NIH for research support (32 %) in view of the overall success rate of submitted applications (76 %; Table 5). Since this is a conservative criterion of success, the data
153
POSTDOCTORAL RESEARCH TRAINING
suggest that the former trainees are capable of successful competition for NIH research grants (Tables 5 and 7) and that their high success rate should encourage additional trainees to submit applications to the NIH. Perhaps the relatively small number of applications may, in part, be attributed to the candidate selection process for postdoctoral training on the NRSA Institutional Training Grant. Some candidates/program directors may still be using training slots to determine if the physician is interested in a research career, rather than selecting candidates who are highly motivated for careers as physician scientists. The lack of a clearly formed interest in research career would also be reflected in a reduction of the size of the candidate pool available to program directors attempting to recruit trainees for their NRSA institutional training grants. Program directors may thus be more willing to take chances on candidates without clearly formed research interests in the hope that given several years exposure to research , the candidate may become stimulated to be a physician scientist. A larger survey of trainees who were "active researchers" showed that the length of the training experience was highly related to successful research activity.5 Levey et al disclosed that 51 % of MDs who had postdoctoral training became researchers (20 % or more time in research activity ; at least one original publication in 2 years preceding the survey; and external funding or assigned space for research) , and that 71.8% who received at least 24 months of training "are or were principal investigators." 5 The source of funding obtained by the former trainees was not noted. The data in this study (Table 6) do not show a clear relationship between the amount of time on a training grant and whether or not the individual is a successful principal investigator. The differences between the two studies may in part be the result
of one or more factors: smaller sample size in this study, a more selective sample of subspecialities in this study, the time interval chosen for assessment in this study, trainees in kidney/nephrology and hematology obtain research training from other sources as well as the T32 thus less time is required on the latter, and (or) length of training time on the T32 is not a reliable predictor in medical subspecialities served by the DKUHD . In summary, review of the NRSA training programs enabling young MDs and PhDs to receive research training shows that the number of training positions has remained fairly stable throughout most of the 1980s. Budget increases have been able to pay for higher stipends , but have not been adequate to allow growth in research training. Alternately, there have been pronounced reductions in the application and resulting award rates for additional research career development training. Fewer RCDA awards are held both by MDs and PhDs. The relatively low percentage of applications for research grants to the NIH by former MD trainees may be more a function of candidate selection for training slots than a function of poor/ inadequate training. However, it must be emphasized that the definition of success in this study, application to the NIH for research project support, is very conservative. The proportion of former trainees who support their research from all funding sources using peer review is undoubtedly higher than that suggested by NIH application data alone. ACKNOWLEDGMENT We express our gratitude to Walter Stolz, Joseph Brackett, James Schafer, and C. Craig Tisher who read early drafts of the manu script and provided many valuable comments and criticisms . W e especially thank Gary Striker who made many valuable suggestions concerning the study and the manuscript. and encouraged us to undertake this effort and share it with the community served by the DKUHD .
REFERENCES I . Wyngaarden 1B: Encouraging young physicians to pursue a career in clinical research. Cl in Res 31:115-118, 1983 2. DiBona GF: Whence cometh tomorrow's clinical investigators? Clin Res 27:253-256, 1979 3. Wyngaarden JB: The clinical investigator as an en dangered species. N Engl J Med 301:1254- 1259, 1979
4. Extramural Trends, FY 1978-1987 , Information Systems Branch , Division of Research Grants, NIH , IMPAC, 1988 5. Levey GS, Sherman CR, Gentile NO, et al: Postdoctoral research training of full-time faculty in academic departments of medicine . Ann Intern Med 109:414-418 , 1988
An Evaluation of Postdoctoral Research Training and Trainees Supported by the National Institutes of Health in the Division of Kidney, Urologic and Hematologic Diseases Charles H. Rodgers, PhD, and M. James Scherbenske, PhD • The interest of young MDs and PhDs in research careers was assessed by determining the number of former trainees who applied for and (or) received research support from the Public Health Service. Thirty-two percent of trainees supported by Institutional Training Grants between 1977 and 1981 made a subsequent application. Seventy-six percent of all those who submitted applications to the National Institutes of Health (NIH) for research project support received awards. Examination of the success rate for individual applications submitted by former trainees showed that 56% of all applications submitted by MD scientists were awarded, and 57% of all applications submitted by PhD scientists were awarded. This compares to an NIH-wide average of 33.3% for the same period. The number of appointments made to Institutional Training Grants for a full year remained fairly constant over a 6year period, as did the number appointed to individual fellowships over an 8-year period. The dollars expended on Institutional Training Grants increased 33% from 1982 to 1986 for a similar number of trainees, and increased 30% from 1981 to 1988 for a similar number of individual fellowships. The number of Research Career Development Award (RCDA) applications declined by 66% for MDs and by 53% for PhDs, accounting for a 32% reduction in the number of active RCDAs held by MDs and a 60% reduction in active RCDAs held by PhDs from 1985 to 1988. MD scientists submitted more applications, had higher award rates, and received more RCDA awards than did PhD scientists. Currently, 42% of all who received training through an Institutional Training Grant in the Division of Kidney, Urologic and Hematologic Diseases (DKUHD) are engaged in research activities. In summary, applicants who were former trainees supported by an Institutional Training Grant in DKUHD had higher success rates than other applicants assigned to the DKUHD (P< 0.0044), or the NIH in general. Too few trainees submit research grant applications after completing their training. These data may be encouraging to trainees and trainers. © 1990 by the National Kidney Foundation, Inc. INDEX WORDS: Training; MD trainees; PhD trainees; Research Career Development Award; individual fellowships; Institutional Training Grants.
T
HERE HAS BEEN a decline in the proportion of senior medical students expressing an interest in a research career even though the success rates (number of awards/number of applications) for new National Institutes of Health (NIH) research grants were comparable between physician and PhD scientists. l The proportion of physician scientists as Principal Investigators on NIH research grants has declined as has the proportion of physicians reporting research as a primary activity between 1966 and 1975. 2 A similar decline was noted in the proportion of individual postdoctoral fellowships and (or) Research Career Development Awards (RCDAs) supporting physician scientists when compared with those supporting PhD scientists during a similar time interval,3 The relative lack of interest of medical students in research and the apparent loss of physicians in research activity has fostered the view that part of the problem results from increased competition for limited research funds. 2 However, survey data from senior medical students in 1980 failed to show that pay back of time spent on training
grants, relative lack of faculty positIOns, or increased competition for research funds served to discourage medical students in choosing a career in research. l Recent data from the NIH demonstrated that success in obtaining new research grants is comparable between MD and PhD scientists. In two successive 4 fiscal year periods, 1980 to 1983 and 1984 to 1987, the success rate for physician scientists-23.0% and 24.1 %-was comparable to 24.2% and 24.9% for PhD scientists (success rate = number of applications awarded/ number of applications submitted). The similar success rates were more notable when considering that PhD scientists submit more than three times the number of applications than do physician From the Division of Kidney. Urologic and Hematologic Diseases. National Institute of Diabetes and Digestive and Kidney Diseases. National Institutes of Health. Bethesda. MD. Address reprint requests to Charles H. Rodgers. MD. Manpower Program Director. DKUHDINIDDKINIH. Westwood Bldg. Room 621. 5333 Westbard Ave. Bethesda. MD 20892. © 1990 by the National Kidney Foundation. Inc. 0272-638619011602-0011 $3.0010
American Journal of Kidney Diseases, Vol XVI. No 2 (August), 1990: pp 147-153
147
148
RODGERSANDSCHERBENSKE
scientists for each of the 4-year intervals (unpublished NIH data, I.A. Brackett and R.F. Moore, Division of Research Grants, NIH). Over the past several decades, a decline in medical student interest in research careers would appear to be reflected in a decline in the number of individual postdoctoral research fellowships and career development awards that were awarded. 1·3 Fewer physicians being trained as physician scientists could result in a commensurate decline in physician Principal Investigators on NIH grants. These data do not provide data on specific medical subspecialities served by the Division of Kidney, Urologic and Hematologic Diseases (DKUHD, National Institute of Diabetes and Digestive and Kidney Diseases [NIDDK]). The purpose of this study was to evaluate research training activity in DKUHD. The first part of the study summarizes the number of individuals supported on institutional training grants, individual fellowships , and RCDAs. The second part examines the question of whether those individuals who trained on institutional training grants applied to and (or) received support from NIH for research project grants. Finally, other evidence of research activity such as publication in peer-reviewed journals was assessed. The evaluation of manpower programs in the DKUHD may be expected to provide an indication of research training activity in areas of the medical community served by the DKUHD division, and may contrast with earlier reviews based on broad physician scientist populations. METHODS The data on postdoctoral trainees supported by Institutional Training Grants (T32s), Individual Research Fellowships (F32s) , and RCDAs (K04s) were obtained from the NIH Information for Management Planning, Analysis and Coordination (lMPAC) system. The data concerning individual fellowships and RCDAs covered the fiscal years (hereafter referred to as years) 1981 to 1988. The institutional training grant data were obtained for years 1981 to 1986, a shorter duration because it was not available. A minimum of I additional year is required to obtain and enter data into the system from the appointment forms. Several measures were used to quantify the success of the research career of those supported on an institutional training grant. The primary measure was whether the former trainee had applied to the NIH/Public Health Service for research support, and whether it was funded. Second , success was quantified by research publications.
The names of trainees were obtained from the Trainee Appointment Forms submitted by the Program Directors of Institutional Training Grants for years 1977 through 1981. The names and social security numbers of 330 former trainees were subsequently checked through IMPAC to determine if an application had been made to any of the Public Health Service agencies for research support, and the success/status of that application. If an application was pending review or pending a funding decision for fiscal year 1989, it was excluded from consideration. Trainees without a record of an application in IMPAC were cross-checked with the Research Awards Index, Volume II, 1986. The awards index is generated by the Computer Retrieval of Information on Scientific Projects (CRISP) system, and lists all active projects and SUbprojects of Research Progam Projects, Research Projects , Specialized or Comprehensive Centers, Center Core Grants and General Clinical Research Centers. Subproject components in General Clinical Research Centers were counted separately because not all subprojects are peer-reviewed and it was not possible to determine whether a specific SUbproject had been peer-reviewed. Searches of IMPAC and CRISP constituted the primary measure of success of former trainees for purposes of this study. Nineteen Institutional Training Grants were assessed in the field of Kidney / Nephrology, and 10 in the field of Hematology. The length of the training period on an Institutional Training Grant was verified for each trainee. If a trainee was supported during 1977 to 1978, the previous 5-year period 1972 to 1976 was checked to be sure of the total number of months of training. Similarly, if a trainee was supported during 1981 to 1982, the succeeding 5-year period 1982 to 1986 was checked to be sure of the total number of months of training. This procedure ensured that trainees in programs at the beginning and end of the 1977 to 1981 period were attributed the proper amount of time in research training. Baseline data for comparing the success of the former trainees who submitted competing applications was provided by considering the success rate (number of applications awarded/number of applications submitted) of all kidney and hematology applications assigned to the DKUHD during the years 1983 through 1987. The number of applications considered by the DKUHD was adjusted by subtracting the number of applications submitted by former trainees who were funded within the DKUHD, thus insuring that the two groups were independent samples of applicants applying to the NIH for research support. The 1983 to 1987 time interval was considered an appropriate one with which to compare those who had trained during the 1977 to 1981 interval. The following procedures were used to determine if former trainees who had not submitted an application to the NIH for research project support contributed to the research literature. Using a Table of Random Numbers, a subsample of training programs was selected from the original pool of 29 programs. A list was made of trainees from these programs who had not applied for NIH research support according to the IMPAC and CRISP searches , and 55 names were randomly selected from this list. A Medline search was then made for the years 1986 to 1988. At least three bibliographic citations were reviewed to determine if the subject matter coincided with the training program area, and to eliminate letters and (or) review articles from consideration. The data represent one or more publications. Statistical comparisons were made by the chi-square test.
149
POSTDOCTORAL RESEARCH TRAINING
Table 1. Institutional Training Grants 1981 to 1986: Encumbered Dollars for Institutional Training Grants, Allocated Training Slots, and Number of Trainees Appointed in the DKUHD Kidney Program Fiscal Year
1981 1982 1983 1984 1985 1986
Encumbered Dollars'
$2,159 $1,943 $2,271 $2,266 $2,763 $2,895
(94) (104) (106) (115) (107) (111)
Total Trainee Appointments
Trainee Appointments 9·12 Months' Duration
102 108 104 102 93 94
90 95 89 91 76 93
'Number of allocated training slots in parentheses based on encumbered dollars (in thousands) .
RESULTS
Postdoctoral training on the Institutional Training Grant is summarized in Table 1. The actual dollars (encumbered amounts) expended for National Research Service Award (NRSA) institutional training grants is provided for each year from 1981 to 1986. The number of allocated training slots is a theoretical number based on a formula using the average NIDDK training stipend, the 8 % indirect cost allowance , and all other trainee-related expenses (health insurance, tuition, etc). The dollar figure provided by the formula is then used to calculate the theoretical number of training slots. Total trainee appointments show how many named individuals were appointed in a given year whether for 3 months or for 12 months. Individuals appointed for 9 to 12 months represent full-year appointments. The three methods of counting trainees were expected to be at variance inasmuch as the official slot allocation is a theoretical number, whereas all of the individuals appointed during a particular year included appointments irrespective of the duration of the appointment. Interestingly, there was an 8 % decline in the total number of appointments from Table 2.
1981 through 1986. Thus, fewer individuals were appointed for periods less than 9 months in 1985 and 1986 than in earlier years. The dollar expenditures increased between 1982 and 1986 by 33 %, yet the number of appointments for a full year remained about the same. Table 2 provides official data on the funds used to support NRSA individual fellowships, the number of allocated fellowships and the number of named individuals supported by the NRSA award. The encumbered amounts fluctuated from year to year, reflecting variations in the yearly NRSA budget. Similarly, the number of allocated fellowships and named fellows varied depending on the available budget. While there was a slight growth in the number of individual fellows supported by NRSA funds between 1982 and 1986, the number of appointments in 1988 are about the same as the number of appointments in 1981 . However, it cost $183 ,000 (30%) more to support approximately the same number of individuals in 1988 as in 1981 as a result of increased stipend levels. The actual number of MDs and PhDs who applied for the NRSA individual fellowship and the number of awards is shown in Table 3. MDs made
NRSA Individual Fellowships 1981 to 1986: Encumbered Dollars for Fellowships, Allocated Fellowships, and Number of Fellows Appointed in the DKUHD Kidney Program
Fiscal Year
Encumbered Dollars'
Allocated Fellowships
Fellows Appointedt
1981 1982 1983 1984 1985 1986 1987 1988
$434 $498 $500 $459 $693 $876 $676 $617
21 27 25 24 27 32 24 22
21 27 25 24 27 32 24 22
'Encumbered dollars are in thousands. tThis number includes new (year 1) and continuing (year 2 and/or year 3) appointments .
150
RODGERSANDSCHERBENSKE Table 3. Application and Award Rates for NRSA Individual Fellowships by Fiscal Year and Degree in the DKUHD Kidney Program No. of Applications
No. of Awards'
Fiscal Years
MD
PhD
MD
PhD
1981 1982 1983 1984 Mean 1981-1984
12 14 15 10 12.8
6 18 6 10 10.0
5 6 11 5 6.8
3 11 3 4 5.3
1985 1986 1987 1988 Mean 1985-1988
13 25 17 28 20.8
11 10 5 7 8.3
9 10 5 10 8.5
5 6 2 4 4.3
'Number of new (year 1) fellowship appointments made for each designated fiscal year.
more applications and received more awards than did PhDs in both the 1981 to 1984 and 1985 to 1988 time intervals. In fact, MDs showed a 38% increase in the number of submitted applications between the 1981 to 1984 and the 1985 to 1988 interval, whereas PhD applicants submitted fewer in the 1985 to 1988 than in the 1981 to 1984 interval. The actual number of awards is similar in the 1981 to 1984 interval for the MD and the PhD, but the increased number of applications by MDs during the 1985 to 1988 interval resulted in an increased number of awards compared with PhDs. The RCDA is available to both the PhD and the MD applicant. More MDs applied for and received career awards than did PhDs. Increased numbers of applications and resulting awards ac-
count for MDs having a larger number of active awards than PhDs (Table 4). In the 1985 to 1988 interval, MD and PhD application rates declined by 66 % and 53 %, respectively. The reduced application rates have caused a 32 % reduction in the number of career awards held by MDs and a 60 % reduction in the number of career awards held by PhDs in the 1985 to 1988 compared with the 1981 to 1984 interval. One hundred five of the 330 former trainees (32 %) applied to the NIH for research support (Table 5). There were 51 MD and 29 PhD awardees. Of the 151 applications submitted by MDs, 84 (56%) were funded. PhDs submitted 95 applications, and 54 (57%) were funded. There were 80 awardees of 105 applicants for research grant sup-
Table 4. RCDAs in Kidney 1981 to 1988: Number of Applications, Funding Rates, and Active Awards in DKUHD by Fiscal Year and Degree No. of Awards'
No. of Applications
Total Active Grantst
Fiscal Year
MD
PhD
MD
PhD
MD
PhD
1981 1982 1983 1984 Mean 1981-1984
7 8 9 5 7.3
3 6 5 3 4.3
3 3 5 4.5
1 2 1 0 1.0
10 13 14 12 12.3
6 6 7 6 6.3
1985 1986 1987 1988 Mean 1985-1988
5
3 3
2 0 0 0 0.5
0 0 1 0 0.3
13 10 7 3 8.3
4 3 2
4 0 2.5
1 2.0
'Number of new (year 1) career awards made for each designated fiscal year. tNumber includes new (year 1) and continuing (year 2 to year 5) awards.
2.5
151
POSTDOCTORAL RESEARCH TRAINING Table 5.
NIH Research Grant Activity of Former Trainees (N 330) Supported on NRSA Institutional Training Grants in Kidney and Hematology During Fiscal Years 1977 to 1981 by DKUHD
Program
Kidney Hematology Totals
Applications
Awardees
Trainees Applying
Applications Funded
Applications Not Funded
MD
PhD
MD
PhD
MD
PhD
MD
PhD
72 33
36 15
16 13
107 44
59 36
58 26
30 24
49 18
29 12
105
51
29
151
95
84
54
67
41
port, thus 76% of all applicants became awardees. These calculations do not include six former trainees who were responsible for one or more subprojects on NIH-funded General Clinical Research Centers. The percentages of MDs and PhDs who applied for NIH research support and those who did not, according to duration of training, are shown in Table 6. Twenty-six percent of PhD applicants and six percent of MD applicants were supported for 1 to 11 months on Institutional Training Grants. The proportion of MD applicants and nonapplicants who were supported for 12 to 35 months on Institutional Training Grants was similar: 85 % of applicants and 88% of nonapplicants. While PhDs appeared to be supported for less time on Institutional Training Grants, the proportion supported for 12 to 35 months also was similar: 64% of applicants and 68 % of nonapplicants. The range in total months spent in research training supported by an Institutional Training Grant also was similar for both the MDs and PhDs whether or not application was made for research support: MD applicants, 6 to 42 months; MD nonapplicants, 2 to 41 months; PhD applicants, 2 to 36 months; PhD nonapplicants, 1 to 42 months. The success rate of applications submitted to the
NIH by former trainees was compared with that of applications assigned to the DKUHD for funding consideration during the 1983 to 1987 interval (Table 7). The mean number of applications funded by DKUHD was 162 out of a total of 473 submitted applications for the 5-year period, providing a success rate of 34 %. The success rate was 35 % (172/494) if the baseline data were not adjusted by subtracting the number of applications submitted by former trainees that were assigned to the NIDDK for funding consideration. The success rate of 34 % to 35 % is comparable to the NIH rate for years 1979 to 1988, which averaged 33.3% (range, 29.4 to 40.2 [1979]).4 The success rate for the trainees was 55 % compared with 34 % of the baseline applications. This is a significant difference (X 2 = 8.098, 1 df, P = .0044). The secondary measure of research success by former trainees who did not apply to the NIH for research grant support was contributions to the research literature. Of the 55 randomly selected trainees from this group, 27 (49%) had at least one publication in the research literature during the years 1986 to 1988. No citations were noted for 28 (51 %) of the trainees. The length of support on an Institutional Training Grant was similar for those publishing and not publishing: 78 % of those pub-
Table 6. Applicants and Nonapplicants for NIH Research Grants by Duration of Training and by Degree for Trainees Supported by DKUHD Duration of Training (mos) Degree/Status
MDs Applications No applications Ph Os Applications No applications
N
1-11
12-23
24-35
36 or more
66 163
4 (6%) 10 (6%)
29 (44%) 87 (53%)
27 (41%) 58 (35%)
6 (9%) 8 (5%)
39 62
10 (26%) 12 (19%)
10 (26%) 21 (34%)
15 (38%) 21 (34%)
4 (10%) 8 (13%)
RODGERS AND SCHERBENSKE
152
Table 7. DKUHD 1983 to 1987: Mean Number of Research Grant Applications Submitted, Funded, and Not Funded Adjusted for Trainee Applications Assigned to the DKUHD Funded
Not Funded
Program Area
Applications
Kidney Hematology
335 138
108
227
54
84
Totals
473
162 (34%)'
311
'Success rate = no. funded/no. applications.
lishing spent 24 or fewer months, and 79 % of those not publishing spent 24 or fewer months as trainees on an Institutional Training Grant. DISCUSSION
The number of individuals appointed to NRSA Institutional Training Grants and to individual fellowships has remained fairly constant. Both NRSA programs show year-by-year fluctuations in the budget. There were increased costs of 33 % for the support of trainees on Institutional Training Grants (Table 1) and of 30% for the support of individual fellowships (Table 2). The increased costs are associated with increases in stipend levels, and have not allowed growth in these two programs during the 1980s. Since 1985, RCDA application rates for MDs decreased by 66 %, and for PhDs by 53 %. The reduced number of applications are responsible for a 32 % and a 60% reduction in active awards since 1985 for MDs and PhDs, respectively (Table 4) . These data are consistent with previous reports of reduced physician scientist RCDAs,3 and provide data showing the same is true for holders of the PhD. The decreased number of RCDAs held by MDs is thus not the result of PhDs being more successful, but the result of decreased application rates. Similarly, PhD scientists have not made use of the RCDA mechanism. The data concerning trainees on NRSA Institutional Training Grants and individual fellowships do not clearly suggest a reduced interest in research training by MDs as have other data. 13 The number of named individuals on Institutional Training Grants for full-year appointments has remained fairly constant between 1981 and 1986, albeit total appointment activity has decreased from a high of 108 in 1982 to a low of 93 in 1985 and 94 in 1986 (Table 1). Individual fellowship appointments also show a consistent number between 1981 and 1988, even though PhDs are making
fewer and MDs are making more applications (Tables 2 and 3). The reduction in the number of active RCDA awards both by MDs and PhDs (Table 4) is troublesome in an era requiring more and longer periods of training to master highly complicated and changing methodologies. Relatively small numbers of former trainees of NRSA institutional research programs applied to the NIH for research support (Table 5). These data are conservative measures of individuals engaged in peer-reviewed research for both the MD and the PhD, since they do not include applications to other agencies. One might have expected a higher number applying to the NIH than was observed. Applicants who have received some training under the NRSA mechanism and who apply to the NIH are more successful than a group of applicants without such training who made application during a similar time interval. This was true both for applications to the DKUHD/NIDDK or the NIH (Table 6).4 Forty-two percent of the trainees meet the criteria of being active in research if one considers the number of former trainees who did not apply to the NIH but were publishing in the research literature, and the six who were responsible for research subprojects in the General Clinical Research Centers. The authors are aware of a number of trainees without an identified record of applying to the NIH who have been successful in obtaining research support from other sources. Thus, the proportion of trainees active in research is undoubtedly higher than the 42 % reported in this study. These data provide evidence that NRSA Institutional Training Grants provide adequate training for those who are interested in research and research-related activities. It is difficult to account for the lack of applications to the NIH for research support (32 %) in view of the overall success rate of submitted applications (76 %; Table 5). Since this is a conservative criterion of success, the data
153
POSTDOCTORAL RESEARCH TRAINING
suggest that the former trainees are capable of successful competition for NIH research grants (Tables 5 and 7) and that their high success rate should encourage additional trainees to submit applications to the NIH. Perhaps the relatively small number of applications may, in part, be attributed to the candidate selection process for postdoctoral training on the NRSA Institutional Training Grant. Some candidates/program directors may still be using training slots to determine if the physician is interested in a research career, rather than selecting candidates who are highly motivated for careers as physician scientists. The lack of a clearly formed interest in research career would also be reflected in a reduction of the size of the candidate pool available to program directors attempting to recruit trainees for their NRSA institutional training grants. Program directors may thus be more willing to take chances on candidates without clearly formed research interests in the hope that given several years exposure to research , the candidate may become stimulated to be a physician scientist. A larger survey of trainees who were "active researchers" showed that the length of the training experience was highly related to successful research activity.5 Levey et al disclosed that 51 % of MDs who had postdoctoral training became researchers (20 % or more time in research activity ; at least one original publication in 2 years preceding the survey; and external funding or assigned space for research) , and that 71.8% who received at least 24 months of training "are or were principal investigators." 5 The source of funding obtained by the former trainees was not noted. The data in this study (Table 6) do not show a clear relationship between the amount of time on a training grant and whether or not the individual is a successful principal investigator. The differences between the two studies may in part be the result
of one or more factors: smaller sample size in this study, a more selective sample of subspecialities in this study, the time interval chosen for assessment in this study, trainees in kidney/nephrology and hematology obtain research training from other sources as well as the T32 thus less time is required on the latter, and (or) length of training time on the T32 is not a reliable predictor in medical subspecialities served by the DKUHD . In summary, review of the NRSA training programs enabling young MDs and PhDs to receive research training shows that the number of training positions has remained fairly stable throughout most of the 1980s. Budget increases have been able to pay for higher stipends , but have not been adequate to allow growth in research training. Alternately, there have been pronounced reductions in the application and resulting award rates for additional research career development training. Fewer RCDA awards are held both by MDs and PhDs. The relatively low percentage of applications for research grants to the NIH by former MD trainees may be more a function of candidate selection for training slots than a function of poor/ inadequate training. However, it must be emphasized that the definition of success in this study, application to the NIH for research project support, is very conservative. The proportion of former trainees who support their research from all funding sources using peer review is undoubtedly higher than that suggested by NIH application data alone. ACKNOWLEDGMENT We express our gratitude to Walter Stolz, Joseph Brackett, James Schafer, and C. Craig Tisher who read early drafts of the manu script and provided many valuable comments and criticisms . W e especially thank Gary Striker who made many valuable suggestions concerning the study and the manuscript. and encouraged us to undertake this effort and share it with the community served by the DKUHD .
REFERENCES I . Wyngaarden 1B: Encouraging young physicians to pursue a career in clinical research. Cl in Res 31:115-118, 1983 2. DiBona GF: Whence cometh tomorrow's clinical investigators? Clin Res 27:253-256, 1979 3. Wyngaarden JB: The clinical investigator as an en dangered species. N Engl J Med 301:1254- 1259, 1979
4. Extramural Trends, FY 1978-1987 , Information Systems Branch , Division of Research Grants, NIH , IMPAC, 1988 5. Levey GS, Sherman CR, Gentile NO, et al: Postdoctoral research training of full-time faculty in academic departments of medicine . Ann Intern Med 109:414-418 , 1988