Intensive summer program helps physicians build clinical research careers

March 25, 2009

Graduates of the Program in Clinical Effectiveness (PCE), which has trained almost 1,900 physicians to be clinical investigators since 1986, have achieved significant success in receiving grant support from the National Institutes of Health (NIH) and other funders, along with other accomplishments considered key to establishing a research career. A report on the PCE - a joint program of Brigham and Women's Hospital (BWH) and Harvard School of Public Health (HSPH) with strong input from the Massachusetts General Hospital (MGH) - from a team of investigators at the three institutions appears in the April issue of Academic Medicine, along with several other articles addressing the NIH vision for clinical and translational research.

"Our survey found that graduates of the Program in Clinical Effectiveness have been able to successfully obtain grant funding, publish, gain promotions, negotiate protected research time and rise to leadership roles in public health, academic medicine and the private sector," says Mary Ellen Goldhamer, MD, MPH, an MGH physician and PCE graduate who led the study. "As far as we know, the PCE is the original and largest program focusing on clinical research training for physicians and is distinctive in providing research training - with a particular emphasis on clinical trials, clinical epidemiology and health services research - concurrent with clinical training."

The authors note that the number of physician investigators is dropping nationally due to factors such as heavy educational debt, the lengthy training required, and the challenges of securing grant funding along with time to conduct research. But at the same time, research focused on translating basic scientific discoveries into clinical treatments is more important than ever.

"The scientific knowledge gained through unraveling the genome and deciphering cellular mechanisms in great detail has not led to commensurate improvement in disease prevention and treatment," says study co-author Daniel E. Singer, MD, associate director of the PCE and director of the General Medicine Fellowship at MGH. "Information generated from clinical trials is often not widely applied to producing safer and more effective medical care. Physician-researchers knowledgeable about biology, clinical medicine and population health who are trained in rigorous research methods are essential to conduct the studies needed to speed translation of knowledge into beneficial medical and public health advances."

Established in 1986, the PCE is an intensive six-and-a-half week summer program based at HSPH that includes core courses in epidemiology and biostatistics along with electives. The epidemiology course requires students to prepare and submit a grant proposal as the final course project, and several electives have added a similar requirement in recent years. Many participants have gone on to pursue advanced degrees after completing the PCE. Most of the almost 1,500 physicians who completed the program during its first two decades enrolled during their post-residency fellowship training.

The Academic Medicine paper describes results of a 20th anniversary survey sent to all PCE graduates in 2006. The survey was designed to evaluate graduates' success and identify features predicting who would achieve successful NIH funding. Among the almost 1,000 graduates responding to the survey, 65 percent indicated that their epidemiology grant proposal led to an actual research project; and of those studies, 64 percent were published and 43 percent received funding. In recent years, real-world projects applying course concepts have been required for completion of elective courses, which led to published studies for 30 percent of all graduates, 14 percent of whom received funding for the projects.

Overall, 34 percent of survey respondents reported receiving NIH support, and 63 percent received support from nonfederal sources. Nearly one-third of respondents are currently academic researchers pursuing investigations in epidemiology, clinical trials and health services. Factors most predictive of future success in obtaining NIH funding were being age 40 or less when attending the PCE, being a generalist rather than a specialist and publishing a PCE coursework project.

"Certainly older enrollees achieved federal funding success as well, but it could be that older participants are more likely to have distracting personal and professional responsibilities that compete with a research career," Goldhamer notes. "The favorable impact of being a generalist was unexpected and may simply reflect that generalists enrolled in the PCE as part of dedicated research fellowships, while some of the specialists were taking a research component of largely clinical fellowships. The association between publishing PCE research projects and NIH grant funding suggests that the opportunity to pursue real-world practical projects during clinical research training, coupled with close mentoring, can serve as a springboard to a career as an independent investigator."
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Goldhamer is an instructor in Medicine at Harvard Medical School (HMS), and Singer is a professor of Medicine at HMS and professor in the Department of Epidemiology at HSPH. Additional co-authors of the Academic Medicine article are E. Francis Cook, ScD, of HSPH, co-director of the PCE; Amy Cohen, HSPH; David Bates, MD, MSc, Brigham and Women's Hospital, director of the PCE; Roger Davis, ScD, Beth Israel Deaconess Medical Center; and Steven Simon, MD, MPH, Harvard Pilgrim Health Care, the senior author of the study. The study was supported by a National Research Service Award and by the Program in Clinical Effectiveness.

Massachusetts General Hospital (www.massgeneral.org), established in 1811, is the original and largest teaching hospital of Harvard Medical School. The MGH conducts the largest hospital-based research program in the United States, with an annual research budget of more than $500 million and major research centers in AIDS, cardiovascular research, cancer, computational and integrative biology, cutaneous biology, human genetics, medical imaging, neurodegenerative disorders, regenerative medicine, systems biology, transplantation biology and photomedicine.

Harvard School of Public Health (www.hsph.harvard.edu ) is dedicated to advancing the public's health through learning, discovery, and communication. More than 400 faculty members are engaged in teaching and training the 1,000-plus student body in a broad spectrum of disciplines crucial to the health and well being of individuals and populations around the world. Programs and projects range from the molecular biology of AIDS vaccines to the epidemiology of cancer; from risk analysis to violence prevention; from maternal and children's health to quality of care measurement; from health care management to international health and human rights.

Massachusetts General Hospital

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