RE-INVENTING THE MEDICAL BOARD

The changing face of the Clinical Center (CC) is also bringing changes to its Medical Board, giving the body a more prominent, dynamic role in the decision-making process for clinical research at NIH. Traditionally, the mission of the Medical Board, which represents and acts for the Medical Staff, has been to advise the Director of the CC and help develop policies governing standards of medical care. Until recently, the expertise of the advisory panel in other areas has gone largely untapped. However, the new challenges and opportunities for intramural research have prompted the Board to take a hard look at both its makeup and its mission.

The Medical Board is currently composed of the Clinical Directors of the Institutes and Centers that have intramural clinical research programs, the CC's Deputy Directors, the CC's Associate Director for Nursing, a representative of the CC Department Heads, and a representative of the Junior Staff. The Board met Jan. 12-13 in Annapolis, Md., to review the issues that currently confront investigators interested in clinical research at NIH. The Board drew up the following list of goals that it plans to pursue over the next year:

• Achieve an improved Clinical Center. This includes providing input to the CC Director on the type of new hospital that will be needed, helping develop guidelines to ensure the quality of the services delivered within the CC, improving the budgetary process, and establishing clear linkages between bench- and patient-oriented research.

• Identify and reduce obstacles to clinical research. As was pointed out at the organizational meeting of the Clinical Research Interest Group on Jan. 11, an increasing number of forms and committees need to be cleared before a clinical trial is initiated. Although the protection of human subjects remains foremost in our concerns, it is also important to facilitate the rapid implementation of clinical research projects.

• Promote education, training, and career development for individuals who have an interest in clinical investigation. This includes establishing incentives for retention, such as the recently approved Title 38 pay scales, as well as developing educational programs for clinical associates and senior staff.

• Improve the efficiency of CC operations, including an evaluation of the current satellite clinical programs, the CC consultative services, and shared support services such as DCRT, BEIP, DES, and Ober United Travel Management, NIH's contract travel agency.

• Develop guidelines to ensure that appropriate standards are met by those who conduct and support clinical research programs.

• Redefine the roles of the Clinical Directors and the Medical Board. It is not clear whether the Board, as currently configured, is best suited to carry out its mission and whether the mission as originally stated is appropriate in the current environment.

• Improve the public relations image of NIH, in particular, the research conducted in the CC. These efforts should be linked with efforts to improve the recruitment of patients and fellows.

• Develop a state-of-the-art medical information system that can keep accurate and complete medical records and meet the evolving needs of investigators to store, retrieve, and analyze data.