(소아 질병 연구의) 차세대 의사-과학자 양성을 위하여 필요한 것

(출처 : http://www.mayo.edu/research/centers-programs/pediatric-research-center/overview)

소아과학이라는 학문을 발전시켜온 원동력은

'내일의 아이들은 오늘의 아이들보다 건강할 것이다'라는 비전이다. 

그러나 지난 30년간 소아의 질병과 건강에 대해 연구하는 사람은 점차 줄고 있다. 

왜 그럴까?

ACADEMIC PEDIATRICS IS MOTIVATED BY A VISION 

wherein the children of tomorrow are healthier than those of today. 

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ACADEMIC PEDIATRICS IS MOTIVATED BY A VISION wherein the children of tomorrow are healthier than those of today. The physician-scientist is uniquely well positioned to create and translate discoveries into care.

Since the 1980s, the percentage of physicians dedicating significant components of a professional life to research has declined from approximately 5%to 1.5%.1

Despite more trainees, the population of physician-scientists is aging and the absolute number is declining.2 In 1980, 25% of research program grants were awarded to physicians older than 50 years, compared with 50% at present.1

Holes in the Pipeline

Decreasing resources for research compromises the research pipeline. 

Federal and foundation dollars are increasingly constrained.

Medical schools and clinical departments seem unwilling or unable to support unfunded research by early-career clinician-scientists.

Requirements for resident and fellow education may further compromise the development of physician-scientists. For example, Accreditation Council for Graduate Medical Education requirements now mandate engagement in “quality assurance” programs and continuity clinics, irrespective of career path

Aspiring physician-scientists are generally at a disadvantage when competing with PhD scientists for grant funding. A research trainee with an MD degree has just 2 years of incompletely protected research training during fellowship. Trainees recognize this competitive disadvantage

The high percentage of women in pediatrics is arguably the most distinctive factor in developing the next generation of physician-scientists. 

Indebtedness is a significant obstacle to the development of physician-scientists.6

Tenure standards that require immediate academic productivity are problematic,7 especially given the compressed research training of most clinician-scientists. The expectations and process for promotion and tenure are often unknown to trainees.

Lack of sufficient institutional infrastructure, including financial resources and mentoring, further dampens enthusiasm for a research career.8 

Proposed Pipeline Patches

To develop physician-scientists, it is imperative that departments, children’s hospitals, and medical schools explicitly acknowledge the importance of physicians with fluency in the language of discovery and the capacity to translate discoveries into clinical medicine. There is no substitute for this recognition. Fundamentally, creation and retention of the next generation of physician-scientists also will require

(1) a respectful and family-friendly workplace that includes flexible work hours, promotion clocks, and family support policies; 

(2) responsibilities that promote a sense of fulfillment and success, with greater than 75% dedicated research time and complementary clinical work; 

(3) promotion tracks that recognize both individual and teambased science; 

and (4) mentorship that is diverse, multigenerational, and multidisciplinary.

Conclusions

Development of the pediatric physician-scientist pathway can be facilitated by relatively straightforward and resource-efficient investments. Motivating even this relatively modest investment demands explicit acknowledgment of the value of the clinician-scientist. Children will be well-served when more children’s hospitals and pediatric departmental resources are focused on creation, retention,and promotion of the engine that has powered their growth and increasing prominence—ie,physician-scientists creating and translating knowledge into care.

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JAMA. 2013 May 1;309(17):1781-2. doi: 10.1001/jama.2013.2258.

Creation and retention of the next generation of physician-scientists for child health research.

Cornfield DN, Lane R, Abman SH.

Source

Department of Pediatrics, Stanford University School of Medicine, 701 Welch Rd, Bldg B, Ste 310, Stanford, CA 94305, USA. cornfield@stanford.edu