Presidential address. Science as a way of life: perplexities of a physician-scientist

Academic anaesthesiology: a global perspective on training, support, and future development of early career researchers

As anaesthesiologists face increasing clinical demands and a limited and competitive funding environment for academic work, the sustainability of academic anaesthesiologists has never been more tenuous. Yet, the speciality needs academic anaesthesiologists in many roles, extending beyond routine clinical duties. Anaesthesiologist educators, researchers, and administrators are required not only to train future generations but also to lead innovation and expansion of anaesthesiology and related specialities, all to improve patient care. This group of early career researchers with geographically distinct training and practice backgrounds aim to highlight the diversity in clinical and academic training and career development pathways for anaesthesiologists globally. Although multiple routes to success exist, one common thread is the need for consistent support of strong mentors and sponsors. Moreover, to address inequitable opportunities, we emphasise the need for diversity and inclusivity through global collaboration and exchange that aims to improve access to research training and participation. We are optimistic that by focusing on these fundamental principles, we can help build a more resilient and sustainable future for academic anaesthesiologists around the world.

Discovering Factors that Influence Physician Scientist Success in Academic Medical Centers

This study investigated factors influencing success of physician scientists in Academic Medical Centers. These organizations and individuals drive healthcare in the United States. Translation of scientific discovery to medical practice moves at an astoundingly slow and ineffective rate. We must understand what contributes to physician scientist success to speed up translation. Through a lens of dialectic process theory, a grounded theory approach identified emergent factors from lived experiences of 31 individuals, at various experience levels, with MD and PhD degrees. Role balance, autonomy, organizational support, teamwork, life-cycle mentorship, and relational capacity were relevant factors impacting success. Role balance was important for success. Teamwork, organizational support, and life-cycle mentorship helped individuals grow, achieve balance, and respect, but relational capacity emerged as a critical driver for realizing both individual and organizational success. One person cannot execute these complex roles on their own, but development of deep and meaningful relationships through teamwork, collaboration, and life-cycle mentorship are essential for life satisfaction and success.

Managing hospital databases: can large hospitals really protect patient data?

Between 1998 and 2003 a number of European countries, the UK, Canada, Australia and the US all introduced data privacy legislation that sought to comply with the European Data Privacy Directive of 1995 in protecting the privacy of individuals undergoing treatment in large hospitals. In 2004 we find that hospital administrators within these jurisdictions are still struggling to find ways to implement and maintain hospital databases while complying with the given legislation - where compliance seems to require a whole new approach to database management. This research examines the UK Data Protection Act 1998 and considers whether current database management systems allow the EU Directives contained in the Act to be followed in practice. It finds a number of recurrent problems with hospital systems that would make compliance with the Act difficult. These findings have significant implications for hospital information systems development and design.

Commentary: physician-scientist's frustrations fester

A growing problem of major proportions had been confronting biomedical scientists for many decades. Until solved, this long-neglected problem, the abject failure of the American health care system, presents a gigantic obstacle to the application of the discoveries flowing from neuropsychopharmacological research into deliverable medications utilized by medical practitioners. Although it is recognized that such advances could benefit all of society, both in the United States and globally, progress toward this important goal has not happened. As I noted 5 years ago, 'Unless steps are taken soon to undertake a comprehensive restoration of our system, the profound advances in bio-medical research so rapidly accruing today may never be effectively transformed into meaningful advances in health care for society.' I remain perplexed and frustrated by the reluctance of scientific research societies such as our ACNP to engage their energies and intellect into this most serious issue.

Toward Revitalizing the role of Physician-Scientists in Academic Medicine

There has been a growing recognition over the past 25 years that it is increasingly difficult for physicians to develop careers as physician-scientists. This commentary reviews the traditional culture of academic medicine, factors that are altering that culture, and several grassroots suggestions for revitalizing academic medicine in our departmental programs. It is based on a presentation, “Basic Scientist or Translational Scientist? Changing Roles of Physician-Scientists in Biomedical Research,” delivered in the President's Symposium at the Thirty-First Midwinter Meeting of the Association for Research in Otolaryngology on February 17, 2008.

A challenge for the 21st century: whither physician-scientists in obstetrics, gynecology, and the reproductive sciences?

As we begin a new century, research in obstetrics and gynecology and its subspecialties face a crisis. Federal support to academic departments of obstetrics and gynecology through the National Institutes of Health is distressingly low in relation to that for other major specialties. In addition, academic departments face a shortage of clinically trained investigators and physician-scientists who will respond to the challenge of contributing to a greater understanding of the reproductive sciences and to the amelioration of diseases of women.

Solutions and strategies from medical and nursing school leadership for the challenges facing the clinical research enterprise

PURPOSE

For decades, the U.S. clinical research enterprise and its workforce have faced diminishing numbers and significant challenges. This study, conducted by the Institute of Medicine's Clinical Research Roundtable (CRR), sought to learn about the perceptions by medical and nursing school deans of these challenges or the efforts and strategies needed to address them.

METHOD

The authors mailed structured questionnaires about clinical research and workforce issues to medical and nursing school deans in the continental United States in the fall of 2003, and on October 16 and 17, 2003, the CRR held a two-day workshop with deans and their representatives to discuss the survey findings and to propose solutions.

RESULTS

Survey participation was 55 (45%) for medical school deans and 37 (46%) for nursing school deans. Various efforts exist at individual schools for recruitment, training, and retention of clinical researchers. Most of the responding medical (53; 96.7%) and nursing (28; 75.4%) school deans reported that demand for clinical researchers exceeded or sharply exceeded supply, and about half of these institutions had a formal mentor program for their students. The percentage of graduates with methodological training in clinical research varied widely, with a mode of 10% and 100% for medical and nursing schools, respectively. Most medical school deans (47; 85.5%) rated their basic research enterprises good to excellent, whereas only a third (19; 34.6%) rated their clinical research programs similarly. Likewise, nursing school deans rated their basic research programs more favorably (23; 62.2%) than they rated their clinical research enterprises (17; 46.0%). However, prioritization of changes needed to address the challenges facing clinical research and its workforce were similar for medical and nursing school deans.

CONCLUSIONS

Clinical research is underdeveloped and underrepresented within the clinical research enterprise. There is a need to develop and execute uniform strategies to grow and expand the clinical research workforce. Workshop participants, including 14 deans or their representatives as panelists and CRR members, proposed solutions and strategies.

Meeting the challenges facing clinical research: solutions proposed by leaders of medical specialty and clinical research societies

The development of a robust national clinical research enterprise is needed to improve health care, but faces formidable challenges. To define the impediments and formulate solutions, the Institute of Medicine's Clinical Research Roundtable convened leaders from medical specialty and clinical research societies in 2003. Participants considered how to influence clinical research funding priorities, promote mechanisms to train physicians and other health care professionals to conduct clinical research, and how to encourage health care providers to follow evidence-based medical practice. Consensus emerged on multiple issues, including intersociety collaboration, the need for a core clinical research curriculum for training the new cadre of clinical researchers, joint advocacy for increased funding of clinical research and for the education of policymakers and the public on the benefits of clinical research. Specific recommendations were made on mechanisms for recruitment, training, and retention of clinical research trainees and mentors. Steps were outlined (1) to overcome career disincentives and develop appropriate reward systems for mentors and trainees, (2) to encourage use of web-based and continuing-medical-education-based mechanisms to bring practitioners up to date on issues in and results of clinical research, and (3) to create incentives for individuals, clinics, and hospitals to practice evidence-based medicine (EBM). Collectively, the response and proposed strategies can serve as a roadmap to improve clinical research funding and training, evidence-based medical practice, and health care quality.

Breaking the Translational Barriers: The Value of Integrating Biomedical Informatics and Translational Research

The conduct of translational health research has become a vital national enterprise. However, multiple barriers prevent the effective translation of basic science discoveries into clinical and community practice. New information technology (IT) applications could help address these barriers. Unfortunately, owing to a combination of organizational, technical, and social factors, neither physician-investigators and research staff nor their clinical and community counterparts have harnessed such applications. Recently, at the request of the Institute of Medicine's Clinical Research Roundtable, a qualitative study of these factors was conducted at several leading academic medical centers. We explore the current status of IT in the translational research domain, describe the qualitative results, and conclude with a proposed set of initiatives to further increase the integration of IT into translational research.

Towards a dynamic definition of health and disease

A multifactorial and growing crisis of health care systems in the developed world has affected medicine. In order to provide rational responses, some central concepts of the past, such as the definitions of health and disease, need to be updated. For this purpose physicians should initiate a new debate. As a point of departure the following definitions are proposed: Health is a dynamic state of wellbeing characterized by a physical, mental and social potential, which satisfies the demands of a life commensurate with age, culture, and personal responsibility. If the potential is insufficient to satisfy these demands the state is disease. This term includes sickness, illness, ill health, and malady. The described potential is divided into a biologically given and a personally acquired partial potential. Their proportions vary throughout the life cycle. The proposed definitions render it empirically possible to diagnose persons as healthy or diseased and to apportion some of the responsibility for their state of health to individuals themselves. Treatment strategies should always consider three therapeutic routes: improvements of the biologically given and of the personally acquired partial potentials and adaptations of the demands of life. These consequences favourably contrast with those resulting from the WHO-definition of health.

The Implications of Data Privacy Legislation for the Development of Hospital Information Systems

This research provides an analysis of the implementation of medical data privacy law in Australia, with emphasis on the Victorian Health Records Act 2001 (HRA). We examine the ability of health organisations to respond to the requirements of this legislation, and similar health privacy legislation elsewhere, and illustrate that this ability is affected by the quality of their patient data and the structure and security of their databases. This article suggests that compliance with the legislative provisions creates implications for information systems development and design, which large public and private hospitals have so far failed to consider or act upon.

Translational research in immunology: Japanese perspectives

Japan has a formidable tradition in immunological research, starting with Shibasaburo Kitasato (1852-1931), who, after returning to Japan from his studies with Robert Koch, went on to build almost single-handedly a research tradition in investigative medical research, while engaging himself in the fight against infectious diseases. Over the past few decades, Japanese immunologists have been involved in many important discoveries at the forefront of immunological research, yet, when it comes to the translation of new discoveries into clinical innovations and new therapies, Japan's track record seems more modest.