- CIHR-IRCH, The Clinician Scientist: Yesterday, Today and Tomorrow: 2002

Transcription

1 As it stands now, most young trainees who are exposed to the clinician-scientist model come away saying why would anyone in their right mind ever want a career where they make a lot less money, work in a miserable clinical environment, write grants year round to support themselves and their laboratories, work tremendously long hours, and be under constant pressure to excel at two difficult careers, all the while being pressured to do "more with less". Currently there are very few incentives for young people to join our ranks. - CIHR-IRCH, The Clinician Scientist: Yesterday, Today and Tomorrow: 2002

2 Health Research Human Resources Planning for the future for clinician scientists Michelle Campbell

3 HEALTH RESEARCH: TRENDS

4 Research is changing fast Breakthroughs and innovation increasingly coming from complex teams, capable of addressing complex questions Increasing need to be able to understand how to integrate vast data sets into work Growing expectations for linkages across pillars, with decision makers Focus on impact on health outcomes Demand for research in non-traditional settings

5 Has training kept up? Best outcomes are associated with: Breadth of experience Networking/ exchange with peers and range of researchers Strong, varied mentors and environments Hands-on practice in broad skills areas Independent research for senior trainees

6 HEALTH RESEARCH: CAREERS OPPORTUNITIES?

7 The training path Number of new PhDs growing rapidly Canada identified need for more science PhDs, ramped up support Phase I alone increased graduates 67% ( ) Post-doc period lengthening Number of faculty positions stagnating 90% of CIHR PhDs seek an academic career 10 20% will start one Most lack key skills for academia success

8 The career path A growing portion are soft-funded Age of new investigators growing Age of first grant adds five more years % grants to young investigators shrinking Innovation and creativity are stifled Attrition among new investigators is growing

9 Employment Canada s PhDs have high-unemployment 3x average in an OECD study Salary goes down with a life science PhD Life sciences PhDs earn less than other PhDs 30% of employed aren t using their degrees Life sciences industry experiencing skills shortage

10 One of our trainees has four kids, one with a disability, so his wife is at home full time. They re living on a CIHR stipend How will he respond to an offer of a post-doc when he s 35? - MD/ PhD Program Director

11 BEST PRACTICES IN TRAINING SUPPORT

12 Implications for training A fundamental rethink of how and why we train, including shifting emphasis from: Focus on quantity Increasing supply Investing in individuals quality meeting demand environments Narrow training broader skills Uni- multi-dimensional experiences (multiple mentors, sites, technologies, disciplines, sectors)

13 CIHR AND CANADA S STRATEGY FOR PATIENT-ORIENTED RESEARCH

14 Strategy for Patient-Oriented Research SPOR is about ensuring that the right patient receives the right intervention at the right time Coalition of federal, provincial, territorial partners Launched/ supported by CIHR Key elements include: Networks SUPPORT units Developing capacity - Advisory Committee report, June 2013 Enhancing clinical trials Patient engagement

15 Strategy for Patient-Oriented Research SPOR is about ensuring that the One of the goals of SPOR right is: patient receives the right intervention at the right time To grow Canada's capacity to attract, train Coalition of federal, provincial, territorial partners and mentor health researchers, as well as to Launched/ supported by CIHR Key elements include: Networks SUPPORT units Developing capacity - Advisory Committee report, June 2013 Enhancing clinical trials Patient engagement create sustainable career paths in patientoriented research.

16 Major data gaps 1. Performance data and comparative outcomes for existing supports especially POR-related awards, and STIHRs 2. Data on POR human resource needs and capacity goals 3. How SPOR elements will interact

17 Conclusion: need more, and more kinds 1. Clinician scientists (excluding MD) 2. Non-clinical POR investigators 3. Clinician scientists (MD)

18 Clinician scientists (MD) Need to stabilize cadre, and expand capacity in primary care, community, and other non-tertiary settings Debt; very long and expensive training path, leading to undependable research support and poor compensation compared to peers Major barrier: decreasing numbers willing to take the job

19 Clinician scientists (excluding MD) Need more, including: nurses, occupational therapists, pharmacists, social workers, physiotherapists, psychologists Tend to have multiple bosses across multiple sites, competing priorities and accountabilities, high patient needs and low clinical resources Major barrier: lack of jobs which integrate research and clinical practice

20 Non-clinical POR investigators Need more, including: methodologists, health economists, behavioral scientists, biostatisticians, implementation scientists, health policy researchers Few opportunities to experience POR in training, or work in POR environments, or share POR leadership Major barrier: lack of training and jobs incorporating POR settings

21 What do we know about best practices? POR training environments should: be equally accessible to all trainees integrate across mentors, disciplines, professions, academic and varied clinical sites incorporate POR-specific and broader skills provide central focus on connection to patients POR training supports should: emphasize programmatic approaches (over individual awards) require, support and reward best practice environments and mentoring be accountable environments created and outcomes achieved POR work environments should: have explicit agreement among the multiple funding partners that defines shared research and clinical roles, resources and mentoring embed within a broader program/ team incorporate patient interactions enable non-clinicians to participate in POR in leadership roles expand in primary care and community settings

22 Major barriers to POR capacity Institutional Environment Limited jobs and viable career opportunities Even fewer jobs integrate research and clinical in practice Silos and isolation within and among sites Mentorship ad hoc and poorly supported Governance and Investment Lack of strategic coherence among multiple bosses with competing agendas Institutions have limited funds for salary and supports Lengthy and costly training, loss of income during training Training and career development models Need training that integrates research with clinical pathways including for non-clinician POR scientists! Broader training addressing implementation, practice, policy

23 Major barriers to POR capacity Institutional Environment Limited jobs Even fewer jobs integrate research and clinical in practice Silos and isolation within and among sites Mentorship ad hoc and poorly supported Governance and Investment Lack of strategic coherence among multiple bosses with competing agendas Lengthy and costly training Training and career development models Need training that integrates research with clinical pathways including for non-clinician POR scientists! Broader training addressing implementation, practice, policy

24 National consultation System leaders concluded that we need: 1.Shared vision, leadership, responsibility 2.Longitudinal strategy 3.Integrated, best practice training models

25 How do we align.

26 So - How can we.? Improve patient and health system outcomes by creating, sustaining and integrating the necessary larger and more diverse cadre of POR human resources Objectives 1.To get the right people around the table to address the cultural, policy, structural and funding barriers to POR embedded in the health and research systems 2.To undertake transformative change across the POR lifecycle, rather than marginal adjustments to isolated programs 3.To set standards and get POR training and career development best practices implemented widely, with excellence scaled-up and duplication minimized 4.To create a highly-accountable funding system with the data required to create priorities and monitor, evaluate and improve outcomes, both ongoing and long term

27 Questions: human resources need What kind of patient-oriented researchers do you need, and why? What kind of role do you see for your organization in supporting POR training and work environments? What do you expect from the other players? Is a national HR strategy for POR possible? Desirable? What kind of data could you get on POR HR? What would you do with it? What do you need most?

28 Questions: What is success What does an excellent clinician scientist look like? Is there more than one model? What is your definition of success? What kinds of success do you currently reward? If we want to know if what we are doing is helping human health, what metrics would answer this question? What is a successful training outcome? How can you connect your trainees into the kinds of environments, with the mentors and varied experience they need to succeed?

29 I can get further faster by working in this group, but as a new person, it s important to separate myself from the PI. My Chair likes to see my name by itself on papers. - (Team-based new investigator)