Career paths for clinical scientists.

Abstract

In the 16 years since James Wyngaarden proclaimed the clinical investigator to be an endangered species, attempts to revive this fragile beast have met with limited success in North America, the UK and Australia. The situation may be more healthy in some western European countries and Japan, but in many parts of Asia clinical investigators have vanished without trace. An analysis of the Australian context during the past 16 years suggests a gradual decline in absolute numbers of clinical scientists reaching maturation, coupled with an extraordinary diminution of their research fertility relative to that of basic scientists. In the present review, it is argued that clinical scientists have a vital role to play in medical research and, particularly, in clinical research. The reason why fewer medical graduates are entering and even fewer are being retained in medical research careers cannot be attributed to restrictions at entry, according to the availability of and competition for training scholarships. Other possible explanations include the late age of entry and the negative influence of role modelling. The latter operates directly by the attitudes and pathways of peers and indirectly through the biases of peer review. There is also a perception, possibly a realistic one, that insuperable barriers exist to obtaining a stable career position at the end of training. Finally, there is real concern about whether clinical investigators will be able to compete successfully with basic researchers for research grants. If this summations is correct, the solutions include active recruitment for research training at an earlier age, simultaneous research and medical training and truncation of postgraduate clinical training in the medical specialties with earlier introduction of medical research. In addition to these strategies, the proper training of clinical scientists must afford them generic research skills and social adaptation to a team approach with basic scientists.