Outer ring (left to right): Steve Alves, Education Program coordinator; Vicki Malick, then assistant director for clinical training, now with NIDDK; Jim Alexander, deputy director; Ione Lagasse, program coordinator, Continuing Medical Education; center row: LaShawn Drew, acting director, NIH Academy; Sylvia Scherr, executive director, Continuing Medical Education; Shirley Forehand, assistant director for administrative services; Brenda Hanning, acting director; Donna Stewart, administrative assistant; Kenny Williams, Education Program coordinator; front row: Valerie McCaffrey, NIH Academy program coordinator, NIH Academy; and Debbie Cohen, Education Programs officer; not shown: Marian McDonald, program assistant

They seem to have been woven into the fabric of NIH from the beginning—subspecialty accreditation for medical fellows, the poster day for summer students (see "Dreams on Display"), the annual postdoc Job Fair, the Clinical Research Training Program (CRTP), the FARE (Fellows Award for Research Excellence) competition.

But they weren’t.

None of these NIH "institutions" had their origins before the creation of the NIH Office of Education (OE), which, much like the Internet, seems to have always been here but, in fact, was not even an entity on paper until 1990. The OE celebrated its 10th anniversary only last spring—actually a year beyond its 10th.

"A 10th anniversary is worth waiting for," quips OE Acting Director Brenda Hanning, explaining the delayed celebration. Part of that extra year, she said, was spent producing an OE video—"The Investigators at NIH"—to commemorate the anniversary and convey the accomplishments of the OE through the exhilarated narratives of young clinical and basic research trainees and their NIH mentors.

Central Casting

OE was originally the brainchild of NIH scientific directors (SDs) looking for an answer to concerns raised in a 1988 Institute of Medicine report (see "Where Have All the Fellows Gone?" below) that cited a "troublesome trend in recruitment into NIH training programs in what had become the post-Vietnam era," recalls OE Deputy Director Jim Alexander.

"The intent behind creating OE was to reverse that trend, and the SDs felt that centralized recruitment would serve NIH well," said Alexander, who, like a lawyer taking his clients with him, brought to the new OE office a briefcase of programs he had run as chief of the Clinical Center’s special programs—recruiting clinical associates and administering the clinical electives and summer research programs for medical students. Responsibility for CME (continuing medical education) and GME (graduate medical education) program accreditation also moved from the Clinical Center to OE.

From day one, when OE began with three on the staff, to the present, nothing has remained static. Staff and programs have grown apace. Though there was no "barometer of superior quality that could withstand close scrutiny," OE set out to quell concerns that the quality of trainees attracted to NIH might be declining by devising means to enhance competition for NIH slots and to inspire the best efforts of those selected.

Learning Curves

There was an early emphasis on student programs—to develop an IRP pipeline from undergraduate to postbac to doctoral candidates—but that did not detract from the drive to advance the abilities of NIH’s physician researchers and postdocs.

A Resident Awards program that offered $2,000 for the best abstract was an early attempt to attract the most academically gifted to NIH for subspecialty and fellowship training. It was discontinued after two years. The FARE competition, on the other hand—launched in collaboration with the NIH Fellows Committee—has persisted and thrived, generating increasing numbers of participants, winners, and outstanding research efforts since its inception in 1994. The FARE travel awards to present winning research papers at scientific meetings have boosted both the fellows and NIH.

A drive to enhance NIH’s GME status began in 1991, with OE’s securing accreditation of six internal medicine subspecialty training programs: critical care medicine, endocrinology-metabolism, hematology, medical oncology, infectious diseases, and rheumatology.

Today, notes Hanning, that number has tripled, with additions not only in internal medicine but also pediatric subspecialties, bloodbanking and transfusion medicine, clinical and laboratory immunology, cytopathology, hematopathology, and medical genetics. There is also residency training in anatomic pathology, dermatology, and psychiatry. More accredited subspecialty programs are anticipated, Hanning notes, adding that on the GME horizon is a project to establish outcome measures of physician competencies—part of a national initiative that will be phased into the accreditation process in 2002.

By all accounts, among the most valuable OE projects are those that equip NIH trainees for the world beyond NIH—where the large majority of postdocs who do not travel the NIH tenure track are headed. Among these are the annual Job Fair, which OE began in 1996, and the series of workshops and seminars variously cohosted by the Office of Research on Women’s Health and the Fellows Committee to impart such survival skills as grant writing, debt management, and public speaking.

"Our office is a catalyst for students," says Hanning, pointing with pride to the NIH Academy (the newest of the NIH student programs, geared to postbacs with an interest in eliminating health disparities; see The NIH Catalyst, January–February 2001) and OE’s programmatic support and individual counseling services for all of NIH’s postbacs.

Winning Line-ups

Alexander counts the centralized recruitment mechanism built by OE among the office’s greatest gift to NIH. "If we have done anything for NIH, it’s to put this system into place," he says, clicking onto the NIH "training" website.

He calls it a "work in progress." It’s a work that has made a good deal of progress.

The website, notes Hanning, had more than 1.5 million hits in January, typically a peak month. It boasts 11 online application systems, including those for the CRTP, FARE, summer programs, and the NIH Academy.

"You can see the value in this kind of system," Alexander observes. "Investigators all over NIH can go in and find just the candidate they want by clicking. It’s all there: the major, the GPA, the cover letter, the résumé, the interests, reference letters. The investigator gets a snapshot."

The website also posts tenure-track ads and postdoc vacancies (437 posted in 2000–2001). People interested in doing research at NIH can scroll through a list of openings at NIH labs.

It also provides a tally of applicants and positions available in certain NIH training programs. Ratios of late resemble more those of the golden years the IOM panel sought to restore than the situation that prompted its 1988 report. For instance, the 2001 summer internship programs to further careers in biomedical research among high school, college, and graduate level students had 3,296 applicants—of whom 818 were offered and accepted positions. The only cohort of summer students whose numbers have not increased are medical and dental students.

Similar competition exists for postbac slots at NIH. In the last six months, 398 individuals applied for these positions; 85 new postbacs are now on campus. A look at the postbac roster reveals considerable diversity among the institutions of origin—from small liberal arts colleges to large state schools to the Ivy League. What the trainees have in common, almost universally, is superb GPAs.

"I’m not certain that the standardization of recruitment procedures in 1990 was viewed by everyone as the way to go. NIH is, after all, a confederation of disparate entities (the ICs) with significant autonomy," Alexander remarks.

Today, old and new recruitment methods coexist, but Hanning is aiming to further democratize the system by working in concert with the institutes to create the equivalent of an admissions committee to "make sure that no excellent candidate goes unnoticed" and that the best and brightest students converge on the NIH campus from every part of the country.

Hanning anticipates that such a committee will be in place in time to process summer 2002 applicants. Also on her wish list—to make a summer here a bit more feasible for out-of-towners with scarce resources—is a "patron saint of housing."

Credit Galore

Just as the applicant pool for fellowship positions has swelled, so has attendance by NIH denizens at CME activities. Indeed, OE’s CME program is a rising star.

In 1998, 6,459 physicians and 7,669 nonphysicians availed themselves of OE’s CME offerings. In 2000, those numbers rose to 34,802 and 15,573, respectively.

Sylvia Scherr, who stepped into the position of CME executive director two years ago in August 1999, credits NIH’s FAES/CME Committee with fostering the growing respect of NIH physicians for CME programs—once considered either a "nuisance" or a "rubber-stamp"—and for the excellence of the CME programs, which reflect the increasingly stringent standards of the accrediting councils.

The programs also meet the real professional needs of physicians, Scherr says, citing as an example the Great Teacher series (see The NIH Catalyst, July–August 2001), designed to fill the gaps in clinical expertise that NIH physicians pinpointed in a survey.

Another newcomer, sought by NIMH and OE, is approved sponsorship of continuing education credit in psychology.

A CME website, launched last fall and expected to be glitch-free by this fall’s end provides a comprehensive list of available CME programs and a system whereby physicians can keep track of their own CME records.

Forward Thinking

Hanning, who arrived in January 1999—just in time to see the OE through its first site visit in 20 years for reaccreditation of the CME program—reserves a special place in her heart for GME, which, she says, has flourished in the past two years under the guidance of the NIH GME Committee. She characterizes its members as "an extraordinary group of physician-scientists" committed to directing training programs as well as pursuing their own research and serving in the clinics and on the wards.

High on Hanning’s agenda is increasing awareness of NIH as a "unique training site with a unique patient population—a natural fit for physicians interested in academic medicine." In her opinion, there is no better place than NIH for training in clinical research. "The more people we attract into our graduate medical programs," she maintains, "the better it will be for clinical research nationally."

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