Work Group on Research Training and Career Development (WGRTCD) Final Report - January 21, 2000

[*Following review by the National Deafness and Other Communication Disorders Advisory Council.]

Bethesda, MD
December 8 - 9, 1999

On this page:

• Section I. Individual Fellowships and Institutional Training Grants
• Section II. Recruitment and Nurturing of Clinician-Scientists
• Section III. Transitioning from Postdoctoral Career to New Independent Investigator Career Stage

Background
The Work Group on Research Training and Career Development (WGRTCD) met in Bethesda, MD on December 8 and 9, 1999, to discuss research training and career development relevant to the mission areas of the National Institute on Deafness and other Communication Disorders (NIDCD). The WGRTCD was provided with information on research trainees supported in the past by the NIDCD, and on NIH-trained individuals who had made the transition from training to independent support. Additional information was gathered from individuals who had made this transition without NIH training support. The WGRTCD agreed that goals of the NIDCD should include enhanced efforts to recruit promising students into research areas relevant to the Institute. The NIDCD should provide the highest possible quality of research training within its mission areas. The Institute should also encourage the research training of health professionals working within its mission areas. Finally, the Institute should encourage the transition of trainees to independent investigator status, and enhance the prospects of its trainees to obtain research positions of the highest quality. To accomplish these goals, the WGRTCD developed the following recommendations.

Section I. Individual Fellowships and Institutional Training Grants

Introduction 
While fellowship training at the NIDCD is generally regarded as successful, it was felt that current support mechanisms could be more flexible, to increase recruitment of students into the mission areas of the NIDCD. In addition, the current system for pre- and postdoctoral research training appears to rely too heavily on institutional training grants. This does not provide trainees with valuable early experience in grant writing, as is provided by preparing an individual application. The WGRTCD recommended a number of changes to the NIDCD’s existing training mechanisms, and the addition of mechanisms that will be new to the Institute. The overall goal of these changes and additions is to create a portfolio of funding options to enhance training opportunities at every level. The flexible application of these mechanisms to the differing needs of trainees with various academic backgrounds is intended to maximize the entry of new scientists into research in the mission areas of the Institute.

Predoctoral Training 
It was agreed that a variety of models for the support of graduate students is beneficial, to increase the ability to attract and train high quality students. These include institutional and individual fellowships, as well as support of students on research grants.

1. Continued support of Institutional Training Grants (T32) is recommended as an important means of attracting students into research in the communication sciences. T32 support should include the possibility of short-term or discontinuous support of students in appropriate situations, and should be extended to include research experiences for medical and other health professional students who are not yet enrolled in PhD programs. Such research opportunities should be made available only to students who submit an internal application outlining their aims for the funding period, which is reviewed and approved by the training grant faculty. The rationale underlying such creative uses of T32 support should be clearly delineated in grant applications.It is recommended that the Institute inaugurate a program for individual predoctoral research fellowships (F31), to be used primarily for support during the dissertation period. These fellowships should also be made available to support a one-year research experience for clinical students. The F31 program should be administered to allow expedited review and award.
2. It is recommended that the Institute implement an F30 program, used to support individual students in MD/PhD programs, and to investigate the possibility of support for health professionals other than medical students to pursue the PhD. The intention is to create a highly competitive program of awards that supports student applicants who are involved in health professional training (e.g., medicine, speech/language pathology) who wish to pursue cross-disciplinary doctoral study in relevant disciplines.

Postdoctoral Training 
There was broad support for continued use of both T32 and F32 mechanisms to support postdoctoral fellows and trainees in different areas of the NIDCD portfolio.

1. The individual postdoctoral fellowship (F32) is considered to be the “gold standard” for NIDCD supported postdoctoral research training. More individuals should be encouraged to use this mechanism.In general, trainees supported on institutional training grants (T32) should be encouraged to transition to individual postdoctoral support (F32) as soon as possible, typically during the first year of T32 support. Individual postdoctoral training (F32) applications should receive expedited review and award. Success in transitioning trainees from the T32 to the F32 mechanism should be considered a positive feature in the review of T32 renewal applications.It is also recognized that some T32 programs require trainees to obtain several different types of training experience in a highly interdisciplinary environment. In such cases, a longer period of support from the institutional training grant may be appropriate before application is made for individual postdoctoral support.
2. Considerable discussion was devoted to the concept of adding a training component to the P30 Core Centers, to partially offset the loss of research training support in center and program project grants. Such a training component might provide limited-term support for undergraduate, graduate or postdoctoral trainees. This could provide a mechanism with more flexibility than is available in the NRSA program to recruit trainees into research in the Institute’s mission areas. It was decided that recommending a P30 training component was premature. However, the NIDCD should monitor P30s and may wish to consider this in the future.

Section II. Recruitment and Nurturing of Clinician-Scientists

Introduction 
A goal of the NIDCD is to promote and maintain the academic careers of talented clinician-investigators whose research interests match those of the Institute. Although some successes exist, supported by existing mechanisms, there has been a dramatic decline over recent years in new clinician-scientists entering the communication sciences. The reasons for this decline are complex. However, a major factor may be insufficient recruitment of research-oriented clinical trainees into the mission areas of the NIDCD. Another factor appears to be insufficient research training prior to and during clinical training. In addition, it is difficult for young clinical faculty members to obtain protected research time early in the academic career due to financial constraints and pressure to build a clinical practice Recommendations are provided below to address the overall need for catalyzing and maintaining the careers of clinician-scientists, including novel suggestions as well as modifications of existing programs. These recommendations apply at all levels of the training process: early exposure (premedical education), medical/clinical graduate school (including the MD-PhD program), clinical residency, post-residency fellowship, and early faculty stages of career development. Implementation of these recommendations should enhance the scope and efficiency of opportunities for budding clinician-scientists to achieve their goals in obtaining academic careers, as well as to attract individuals into this career path. In so doing, the overall goals of the NIDCD will be enhanced.

Early Research Exposure: Undergraduate and Medical/Clinical Graduate School 
One means of initiating an interest in academic clinical careers in communication disorders is to foster exposure to the field during college (premedical/clinical years), as well as the early years of medical/clinical graduate school, in the form of short-term laboratory experiences.

1. The T32 mechanism should include and promote an option to support short-term (two months to one year) support for promising undergraduate or medical students to join a research laboratory working in areas within the purview of the NIDCD. The F31 mechanism should be modified to allow the opportunity to support a one-year effort, as described above. When feasible, a full year of research time away from the clinical curriculum should be encouraged.

Combined Degree (MD-PhD) Training 
Students that enter a MD-PhD Program are generally acknowledged to represent a highly talented and committed group whose career interests are most likely to lead them to choose careers that combine clinical and competitive research activities.

1. An F30 mechanism should be instituted by the NIDCD to identify and support students early in medical school (years 1 – 2) who wish to include PhD training. This program would be limited to individuals already accepted into an MD/PhD program, but not necessarily restricted to Medical School Training Program (MSTP) schools. Support should include stipend, tuition, and ancillary funds that match the MSTP for the remainder of MD/PhD training, up to a maximum of six years. Students should be selected based upon interest in thesis research in an area within communication sciences.

Residency Research Training 
An effective means of nurturing future clinician-scientists is to provide an academic track within residency training, across different medical and surgical specialties, that includes an intensive research experience.

1. It is recommended that at least two years be committed to full-time research within an academic residency-training track, with rare exceptions (e.g., MD-PhD graduate who might spend less than two years). The T32 mechanism is well suited to support these research years. An F32 application should be encouraged when possible and should include a one-year option, as noted above for the undergraduate and medical school years.
2. Residency programs should consider a postgraduate MSTP program for recruitment of MD-PhD graduates entering clinical residencies and seeking a combined residency/postdoctoral fellowship experience. The T32 and F32 mechanisms are well suited to support the research years.

Post-Residency Research Training 
This critical and vulnerable stage of academic career development remains inadequately represented among support options.

1. A new support mechanism has been initiated within the Division of Intramural Research at the NIDCD. The Research Training Fellowship (RTF) is a two-to-three year individual research fellowship following residency training, where the trainee spends at least 75% time in an intramural laboratory. This fellowship opportunity should be carefully monitored by the NIDCD and considered for expansion to the extramural community if it is successful in generating new independent investigators.The KO8 /K23  programs should be modified to include review by an external advisory committee consisting of two scientists, not from the applicant’s institution, who are experts in the field of proposed research training. The members of the committee would be available to the candidate for consultation and advice on a timely basis. The external advisory committee would be required to visit the institution at least twice, at the end of the first and third years of the award, to assess the research environment, time commitment, and progress of research training. Additional visits could be built into the application if desired by the applicant and mentor. In addition, the committee should receive written reports detailing progress at the end of each year of the award.Salary within the K-program should be up to 75% of the NIH Cap, commensurate with a 75% research commitment. Selection criteria should require evidence of research experience (e.g., at least 2 years of prior research).
2. It is recommended that the R03 mechanism be allowed to run concurrently with the last two years of a K Award, to provide additional resources for the transition to independence.

Section III. Transitioning from Postdoctoral Career to New Independent Investigator Career Stage

Introduction 
The number of new investigators competing successfully for NIH grants is declining. For example, the number of investigators receiving their first R01 or R29 award from NIDCD has declined from 41 per year in FY 1991 to 21 in FY 1999. This problem is particularly critical at this time because of the end of the R29 (FIRST Award) program. Also, the future success of the “new investigator” R01 is unknown. The WGRTCD is interested in encouraging research support for new investigators by facilitating transition to sustained independent research programs. Several steps to achieve this goal are recommended. The transition from training to true independence is often a graded process, that includes both intellectual independence and the establishment of investigator-controlled research space and resources. The NIDCD should encourage elements of granting mechanisms that reflect this reality, and allow gradual changes from postdoctoral fellowships to small research grants, and, ultimately to RO1 research awards.

The NIDCD Small Grant (R03) Award 
The R03 has been a useful grant mechanism. Since the initiation of the current R03 program in 1992, the overall success rate (number awarded divided by number reviewed) is 29%. Moreover, for the three earliest years of the program, for which sufficient time has elapsed, R03 recipients were generally successful in obtaining subsequent awards, with an average of 50% obtaining an R29 or an R01 after completing their R03. Given this success, the WGRTCD recommends the following:

1. The three-year, $50,000 direct costs per year level of funding for the R03 should be maintained. However, flexibility in utilizing this mechanism should be increased.R03 awards should continue to be available to support research or salary costs for investigators making the transition from postdoctoral fellowships to their first academic position. However, to aid the transition, it is necessary that these grants be awarded based on the quality of the research and not on the requirement for independent space or equipment. Clinically trained investigators should be permitted to apply for R03 awards to support collection of preliminary data prior to their application for K08/K23 awards. This is similar to the way R03 funding may be used prior to applying for other investigator-initiated awards. The opportunity to apply for an R03 should be made available to K08/K23 awardees in the 4th and 5th years of the K award for supporting research costs beyond the limits of the mentored award. The R03 application may cover aims that are related to the aims of the K08/K23, but may not duplicate those aims.An individual may apply for more than one R03 grant (e.g., before the K08/K23 to allow collection of preliminary data and in the later years of the K08/K23), but the total number of years of R03 support may not exceed three years.
2. The NIDCD should continue to monitor the success of the R03 program in meeting the needs of investigators transitioning from postdoctoral training to independent careers.

Transition to Independent Research Career Development (K22) Program 
A new mechanism that is designed to support the transition period from postdoctoral training to independent investigator is the K22, a Transition to Independence Research Career Development Program. This mechanism is currently offered by several NIH Institutes (including NEI and NCI), and presumably assists trainees in their mission areas to compete successfully for academic positions. The WGRTCD recommends that a two-phase K22 mechanism be adopted by the NIDCD as a carefully monitored pilot program.

1. The first phase of the K22 should begin after three years of postdoctoral training (not limited to NRSA) and should provide a maximum of $75,000 per year direct costs, which includes salary, fringe benefits, and research-related expenses. The first phase may last up to three years.To maintain the K22 award beyond the first phase (and to begin the second phase), applicants should establish their own laboratories, which the WGRTCD strongly felt should be in a different department within the postdoctoral institution or, preferably, within a new institution. A letter from the chair of the new department describing the position and the resources to be made available to the K22 awardee would be required to advance to the second phase. The second phase of the K22 may be as long as three years, but the total length of the award should not exceed five years. During the second phase, total support should not exceed $100,000 per year, including salary, fringe benefits, and research-related expenses. A maximum of $50,000 (or 50% effort, whichever is lower) could be used for salary support.The number of K22 awards per year should be limited, so that the program is highly competitive.
2. The K22 application should require letters of recommendation, including letters from scientists other than the candidate’s advisors, and the review of the application should place considerable weight on the candidate’s publication record.