HHMI/NIH TRAINING
EARNS KUDOS

by Rebecca Kolberg

A new report from a panel of distinguished outside experts cites the joint NIH-Howard Hughes Medical Institute research training program for medical students as a program worth copying.

In a preliminary draft of the report which will be released in November, the NIH Director's Panel on Clinical Research, a 14-member committee charged with finding ways to revitalize U.S. clinical research, singles out the joint venture between the Howard Hughes Medical Institute (HHMI) and NIH as a paradigm for recruiting talented M.D.s into clinical research.

In the 11 years since its inception, the HHMI-NIH Research Scholars Program has brought 400 medical students from 89 U.S. medical schools to the Bethesda campus for a year of intensive basic research experience that adds a year to their regular medical training. According to the panel's report, 40 percent of participants in the first two years of the program now have full-time academic appointments. Over the past decade, HHMI research scholars have also published more than 250 research papers based on their work at NIH.

NIH Director Harold Varmus with HHMI-NIH Research Scholar

"It's a wonderful model," says David Nathan, president of the Dana-Farber Cancer Institute in Boston and chair of the panel. "We feel strongly that the making of a successful physician investigator usually begins in medical school." Nathan himself was drawn into research decades ago when, as a second-year medical student at Harvard, he pursued an independent research project that began as an effort to develop a model of hepatic coma and ended with a published paper describing a method to measure ammonia. "It was a huge thrill. It made me think, 'My god, I can do this!'... Without that experience, I'd probably be practicing medicine today in Cambridge."

Currently, HHMI-NIH scholars are recruited from the ranks of U.S. medical schools and work mainly in basic research labs at NIH. The draft report recommends that a similar research program be established at NIH's Clinical Research Center (CRC). Under that recommendation, as many as 30 medical students would select a preceptor who is a clinical researcher and would also participate in the CRC's formal training courses, called the core curriculum. "Total cost is estimated to be less than $1 million per year and [the CRC program] would serve as a model for other centers," the panel states.

Assistant Director for Intramural Affairs, Richard Wyatt, NIH's liaison for the HHMI-NIH Research Scholars Program, says that he is excited that the panel of outside advisors developed the idea of a clinically oriented scholars program. Wyatt adds that such a program "should also provide an opportunity for partnership in clinical research training with other private outside organizations, modeled after the valuable relationship between NIH and HHMI."

Other aspects of NIH's physician-researcher training program that particularly impressed the outside reviewers were the CRC's new core curriculum and NIH's loan repayment programs which pay off educational and medical school loans for clinical researchers from disadvantaged backgrounds and for researchers whose projects focus on acquired immune deficiency syndrome (AIDS).

Jean Wilson, professor of internal medicine at the University of Texas Southwestern Medical Center in Dallas and chair of the panel's training subcommittee, says the Clinical Center's core curriculum is a sterling example for other institutions to follow. "There is widespread sentiment that there needs to be more rigorous training for clinical investigators," Wilson says. "That should help to ensure the same quality of research in clinical investigation as in other types of biomedical research."

However, Wilson emphasizes that training is just half of the problem confronting clinical research today. The other half is recruiting top-quality candidates into the training programs. Unlike Ph.D.s and M.D.-Ph.D.s, most of whom graduate without a heavy debt burden, M.D.s are typically saddled with significant debt when they graduate. Financial constraints prevent many from even considering a research career, Wilson says. The subcommittee chair says he hopes that the loan-repayment programs now available to intramural NIH re-searchers-which pay up to $20,000 a year of a researchers' educational debt-can be expanded to improve M.D. recruitment at extramural research institutions.

Other recommendations included in the panel's draft are

• Enhance physician-researcher training programs by offering special degrees, such as an M.D. with honor or distinction or a special master's degree.

• Establish midcareer salary awards for clinical investigators and other special awards to relieve clinical investigators from clinical duties.

• Consider programs to provide clinically oriented training for Ph.D.s who do not have M.D.s.

Next, the panel will focus on other topics, including the current state of U.S. clinical trials, the role of the NIH Clinical Research Center in shaping the overall research landscape, and the impact of managed care on clinical research.

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