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Research Training in Otolaryngology: Is It Time to Refocus Our Efforts?

Research Training in Otolaryngology: Is It Time to Refocus Our Efforts? Although we have redoubled our efforts, we have lost sight of our objective.—Pentagon insider on the Vietnam Conflict, 1966 In a recent commentary, Drs Wolf and Weymuller1 present a timely discussion of a looming crisis in otolaryngology research. The article correctly identifies many of the challenges facing clinician-scientists but only touches on possible solutions to this problem. The problem with the current T32 program is not one of intent but of focus. The laudable intent of the T32 grant is to provide up to 2 years of funded research time for otolaryngology residents in the hope of producing clinician-scientists who can effectively compete for research funding while mentoring the next generation of clinician-scientists. Currently, research rotations for most otolaryngology residents and fellows consist of spending several months in a laboratory performing basic science research. Likewise, the T32 programs at most academic medical centers have promoted basic "bench" research at the expense of clinical "human" research. Reasons for this phenomenon include (1) a historical funding bias at the National Institutes of Health (NIH) in favor of basic science, (2) the perceived prestige of a viable basic science division, (3) a need to support the manpower needs of basic science faculty, and (4) a dearth of clinical research mentors. The tide, however, is beginning to turn. In recognition of the critical shortage of clinical researchers who will be needed to carry the discoveries of the genetic revolution from bench to bedside, the NIH augmented its K awards for clinical research in 1999 and began a generous education loan repayment program for clinical researchers in 2002 ($35 000 per year for 3 years for 20 hours of research a week). The great advances of the surgical sciences in the 20th century were largely achieved by dedicated surgeons who developed innovative surgical techniques in animal laboratories largely funded by their own clinical endeavors. This mid–20th-century model of the triple threat—outstanding surgeon, basic science investigator, and excellent teacher—is in need of repair. Basic science in the molecular age is more time-consuming, complex, and expensive to perform. Clinical activity is likewise more demanding owing to falling reimbursement, increasing regulatory requirements, and growing malpractice concerns. Is there a way for us to remain excellent clinicians, contribute to medical science, and still have time to teach the huddled masses of medical students? The answer may lie in the rediscovery of clinical research. Consider the following: Most residents choose medicine as a career because they enjoy caring for patients. Clinical research maintains the human bond and may therefore be of greater interest to otolaryngology residents who want to perform excellent research without sacrificing their clinical skills. Otolaryngology residents are accustomed to success. The potential for failure when competing for basic science funding against full-time researchers is very real. Residents may therefore view 2 years in a basic science laboratory as an exercise in futility. The results of clinical research are often more immediate and applicable to patient care, whereas the clinical payoff of basic science is often years away. Clinical research may be more satisfying to the surgical personality because of its short-term impact on patient health. Clinical research does not require laboratory space and is therefore available to all otolaryngology residency training programs. Clinical research does require time, creativity, a solid background in biostatistics and epidemiology, and good computer and writing skills. Clinical research can be performed in most instances with only modest decreases in clinical and teaching productivity. Funds for clinical research are available from a variety of sources including the NIH, the Department of Veterans Affairs, and industry and may therefore be more accessible to the clinician-scientist. Reductions in training time and resident work hours may adversely effect clinical training. A clinical research curriculum can be mastered while engaged in clinical activity, thereby avoiding inordinate time spent in a laboratory away from patient care. Residents could design, implement, and publish a quality clinical research project as a graduation requirement. Training in the methods of basic science is not necessarily transferable to clinical research. Research involving human subjects has unique nuances, statistical methods, regulatory requirements, and ethical obligations. Clinical research methodology can be applied to any clinical research question. Therefore, clinical research training can occur early in training without concern of divergence of research and clinical interests. Clinical research provides residents with a firm foundation in the practice of evidence-based medicine. This will be increasingly important in an era in which limited resources will be allocated on the basis of demonstrable patient outcomes. Clinical research addresses basic questions of patient care of interest to private practitioners (eg, what is the value of a positron emission tomographic scan in the workup of head and neck cancer?). This 2-way dialogue will likely strengthen the ties between academic and private physicians. Better training in clinical research will raise the quality of otolaryngology literature to that found in many medical journals. Most articles in JAMA and The New England Journal of Medicine involve clinical research. Improved peer review will improve study design, decrease bias, and increase the validity of otolaryngology articles. If the above statements are taken into consideration, what can be done now to improve the prospects of T32 programs and clinician-scientists? Allow T32 participants to obtain clinical research training and experience during the 2 years of dedicated research time. Many academic medical centers have departments of biostatistics and epidemiology that offer master's and doctoral level degrees in clinical research. Otolaryngology departments should provide time and tuition support to faculty willing to pursue advanced degrees in clinical research. Every academic program will benefit from having a formally trained clinical researcher on staff to create an evidence-based medical curriculum and to help faculty and residents in the design and execution of clinical research projects. Improve and strengthen the introduction to clinical research provided by the Daiichi Clinical Scholars Program. Provide equal funding for resident travel and awards for quality clinical research projects. Focus additional seed grants from CORE (Central Otolaryngology Research Efforts) on clinical research projects. Since the rub of clinical research is the need for sufficient sample size, seed grants should be made available for multi-institutional efforts to find answers to pressing clinical questions in otolaryngology. Finally, a system of academic promotion that considers the quality of research in addition to the prolificacy needs to be pursued. Drs Wolf and Weymuller1 have carried the torch of clinical research. Their careers are indeed monuments to the very real impact that clinical research can have on the lives of our patients. Their reluctance to state the obvious is perhaps due to a desire not to weaken the critical bonds that otolaryngology departments have formed with basic science divisions over the past half century. This bond, however, will only be strengthened if academic clinicians finally find their place at the bountiful table of scientific discovery. References 1. Wolf GTWeymuller EA Research training in otolaryngology: an impending crisis? Arch Otolaryngol Head Neck Surg.2002;128:1239-1241.PubMedGoogle Scholar http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Otolaryngology - Head & Neck Surgery American Medical Association

Research Training in Otolaryngology: Is It Time to Refocus Our Efforts?

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References (1)

Publisher
American Medical Association
Copyright
Copyright © 2003 American Medical Association. All Rights Reserved.
ISSN
0886-4470
eISSN
1538-361X
DOI
10.1001/archotol.129.12.1349
Publisher site
See Article on Publisher Site

Abstract

Although we have redoubled our efforts, we have lost sight of our objective.—Pentagon insider on the Vietnam Conflict, 1966 In a recent commentary, Drs Wolf and Weymuller1 present a timely discussion of a looming crisis in otolaryngology research. The article correctly identifies many of the challenges facing clinician-scientists but only touches on possible solutions to this problem. The problem with the current T32 program is not one of intent but of focus. The laudable intent of the T32 grant is to provide up to 2 years of funded research time for otolaryngology residents in the hope of producing clinician-scientists who can effectively compete for research funding while mentoring the next generation of clinician-scientists. Currently, research rotations for most otolaryngology residents and fellows consist of spending several months in a laboratory performing basic science research. Likewise, the T32 programs at most academic medical centers have promoted basic "bench" research at the expense of clinical "human" research. Reasons for this phenomenon include (1) a historical funding bias at the National Institutes of Health (NIH) in favor of basic science, (2) the perceived prestige of a viable basic science division, (3) a need to support the manpower needs of basic science faculty, and (4) a dearth of clinical research mentors. The tide, however, is beginning to turn. In recognition of the critical shortage of clinical researchers who will be needed to carry the discoveries of the genetic revolution from bench to bedside, the NIH augmented its K awards for clinical research in 1999 and began a generous education loan repayment program for clinical researchers in 2002 ($35 000 per year for 3 years for 20 hours of research a week). The great advances of the surgical sciences in the 20th century were largely achieved by dedicated surgeons who developed innovative surgical techniques in animal laboratories largely funded by their own clinical endeavors. This mid–20th-century model of the triple threat—outstanding surgeon, basic science investigator, and excellent teacher—is in need of repair. Basic science in the molecular age is more time-consuming, complex, and expensive to perform. Clinical activity is likewise more demanding owing to falling reimbursement, increasing regulatory requirements, and growing malpractice concerns. Is there a way for us to remain excellent clinicians, contribute to medical science, and still have time to teach the huddled masses of medical students? The answer may lie in the rediscovery of clinical research. Consider the following: Most residents choose medicine as a career because they enjoy caring for patients. Clinical research maintains the human bond and may therefore be of greater interest to otolaryngology residents who want to perform excellent research without sacrificing their clinical skills. Otolaryngology residents are accustomed to success. The potential for failure when competing for basic science funding against full-time researchers is very real. Residents may therefore view 2 years in a basic science laboratory as an exercise in futility. The results of clinical research are often more immediate and applicable to patient care, whereas the clinical payoff of basic science is often years away. Clinical research may be more satisfying to the surgical personality because of its short-term impact on patient health. Clinical research does not require laboratory space and is therefore available to all otolaryngology residency training programs. Clinical research does require time, creativity, a solid background in biostatistics and epidemiology, and good computer and writing skills. Clinical research can be performed in most instances with only modest decreases in clinical and teaching productivity. Funds for clinical research are available from a variety of sources including the NIH, the Department of Veterans Affairs, and industry and may therefore be more accessible to the clinician-scientist. Reductions in training time and resident work hours may adversely effect clinical training. A clinical research curriculum can be mastered while engaged in clinical activity, thereby avoiding inordinate time spent in a laboratory away from patient care. Residents could design, implement, and publish a quality clinical research project as a graduation requirement. Training in the methods of basic science is not necessarily transferable to clinical research. Research involving human subjects has unique nuances, statistical methods, regulatory requirements, and ethical obligations. Clinical research methodology can be applied to any clinical research question. Therefore, clinical research training can occur early in training without concern of divergence of research and clinical interests. Clinical research provides residents with a firm foundation in the practice of evidence-based medicine. This will be increasingly important in an era in which limited resources will be allocated on the basis of demonstrable patient outcomes. Clinical research addresses basic questions of patient care of interest to private practitioners (eg, what is the value of a positron emission tomographic scan in the workup of head and neck cancer?). This 2-way dialogue will likely strengthen the ties between academic and private physicians. Better training in clinical research will raise the quality of otolaryngology literature to that found in many medical journals. Most articles in JAMA and The New England Journal of Medicine involve clinical research. Improved peer review will improve study design, decrease bias, and increase the validity of otolaryngology articles. If the above statements are taken into consideration, what can be done now to improve the prospects of T32 programs and clinician-scientists? Allow T32 participants to obtain clinical research training and experience during the 2 years of dedicated research time. Many academic medical centers have departments of biostatistics and epidemiology that offer master's and doctoral level degrees in clinical research. Otolaryngology departments should provide time and tuition support to faculty willing to pursue advanced degrees in clinical research. Every academic program will benefit from having a formally trained clinical researcher on staff to create an evidence-based medical curriculum and to help faculty and residents in the design and execution of clinical research projects. Improve and strengthen the introduction to clinical research provided by the Daiichi Clinical Scholars Program. Provide equal funding for resident travel and awards for quality clinical research projects. Focus additional seed grants from CORE (Central Otolaryngology Research Efforts) on clinical research projects. Since the rub of clinical research is the need for sufficient sample size, seed grants should be made available for multi-institutional efforts to find answers to pressing clinical questions in otolaryngology. Finally, a system of academic promotion that considers the quality of research in addition to the prolificacy needs to be pursued. Drs Wolf and Weymuller1 have carried the torch of clinical research. Their careers are indeed monuments to the very real impact that clinical research can have on the lives of our patients. Their reluctance to state the obvious is perhaps due to a desire not to weaken the critical bonds that otolaryngology departments have formed with basic science divisions over the past half century. This bond, however, will only be strengthened if academic clinicians finally find their place at the bountiful table of scientific discovery. References 1. Wolf GTWeymuller EA Research training in otolaryngology: an impending crisis? Arch Otolaryngol Head Neck Surg.2002;128:1239-1241.PubMedGoogle Scholar

Journal

Archives of Otolaryngology - Head & Neck SurgeryAmerican Medical Association

Published: Dec 1, 2003

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