This report is the twelfth assessment of the National Institutes of Health National Research Service Awards program. The research training needs of the country in basic biomedical, clinical, and behavioral and social sciences are considered. Also included are the training needs of oral health, nursing, and health services research. The report has been broadly constructed to take into account the rapidly evolving national and international health care needs. The past and present are analyzed, and predictions with regard to future needs are presented.

This book assesses the nation's future needs for biomedical and behavioral scientists and the role the National Research Service Awards (NRSA) program can play in meeting those needs. The year 1994 marks the twentieth anniversary of the National Research Act of 1974 (PL 93-348), which established the NRSA program. In its twenty years of operation, the NRSA program has made it possible for many thousands of talented individuals in the basic biomedical, behavioral, and clinical sciences to sharpen their research skills and to apply those skills to topics of special concern to the nation, such as aging, hypertension, the genetic basis of disease, acquired immune deficiency syndrome (AIDS), cancer, environmental toxicology, nutrition and health, and substance abuse.

Interdisciplinary research is a cooperative effort by a team of investigators, each an expert in the use of different methods and concepts, who have joined in an organized program to attack a challenging problem. Each investigator is responsible for the research in their area of discipline that applies to the problem, but together the investigators are responsible for the final product. The need for interdisciplinary training activities has been detailed over the last 25 years in both public and private reports. The history of science and technology has even shown the important advances that arose from interdisciplinary research, including plate tectonics which brought together geologists, oceanographers, paleomagnetists, seismologists, and geophysicists to advance the ability to forecast earthquakes and volcanic eruptions. In recognition of this, the need to train scientists who can address the highly complex problems that challenge us today and fully use new knowledge and technology, and the fact that cooperative efforts have proved difficult, the National Institute of Mental Health (NIMH), the National Institutes of Health (NIH) Office of Behavioral and Social Sciences Research (OBSSR), the National Institute on Nursing Research (NINR), and the National Institute on Aging (NIA) requested that an Institute of Medicine (IOM) Committee be created to complete several tasks including: examining the needs and strategies for interdisciplinary training in the brain, behavioral, social, and clinical sciences, defining necessary components of true interdisciplinary training in these areas, and reviewing current educational and training programs to identify elements of model programs that best facilitate interdisciplinary training. Bridging Disciplines in the Brain, Behavioral, and Clinical Sciences provides the conclusions and recommendations of this committee. Due to evaluations of the success of interdisciplinary training programs are scarce, the committee could not specify the "necessary components" or identify the elements that "best facilitate" interdisciplinary training. However, after reviewing existing programs and consulting with experts, the committee identified approaches likely to be successful in providing direction for interdisciplinary endeavors at various career stages. This report also includes interviews, training programs, and workshop agendas used.

Comprehensive research and a highly-trained workforce are essential for the improvement of health and health care both nationally and internationally. During the past 40 years the National Research Services Award (NRSA) Program has played a large role in training the workforce responsible for dramatic advances in the understanding of various diseases and new insights that have led to more effective and targeted therapies. In spite of this program, the difficulty obtaining jobs after the postdoc period has discouraged many domestic students from pursuing graduate postdoc training. In the United States, more than 50 percent of the postdoc workforce is made up of individuals who obtained their Ph.D.s from other countries. Indeed, one can make a strong argument that the influx of highly trained and creative foreigners has contributed greatly to U.S. science over the past 70 years. Research Training in the Biomedical, Behavioral, and Clinical Research Sciences discusses a number of important issues, including: the job prospects for postdocs completing their training; questions about the continued supply of international postdocs in an increasingly competitive world; the need for equal, excellent training for all graduate students who receive NIH funding; and the need to increase the diversity of trainees. The book recommends improvements in minority recruiting, more rigorous and extensive training in the responsible conduct of research and ethics, increased emphasis on career development, more attention to outcomes, and the requirement for incorporating more quantitative thinking in the biomedical curriculum.

Recent scandals and controversies, such as data fabrication in federally funded science, data manipulation and distortion in private industry, and human embryonic stem cell research, illustrate the importance of ethics in science. Responsible Conduct of Research, now in a completely updated second edition, provides an introduction to the social, ethical, and legal issues facing scientists today.

This report provides an assessment of NIH's programs for increasing the participation in biomedical science of individuals from underrepresented minority groups. The report examines, using available data and the results of a survey of NIH trainees, the characteristics and outcomes of programs at the undergraduate, graduate, postdoctoral, and junior faculty levels. The report provides recommendations for improving these programs and their administration. It also recommends how NIH can improve the data it collects on trainees in all NIH research training programs so as to enhance training program evaluation.

This is the first comprehensive guide to the design of behavioral randomized clinical trials (RCT) for chronic diseases. It includes the scientific foundations for behavioral trial methods, problems that have been encountered in past behavioral trials, advances in design that have evolved, and promising trends and opportunities for the future. The value of this book lies in its potential to foster an ability to “speak the language of medicine” through the conduct of high-quality behavioral clinical trials that match the rigor commonly seen in double-blind drug trials. It is relevant for testing any treatment aimed at improving a behavioral, social, psychosocial, environmental, or policy-level risk factor for a chronic disease including, for example, obesity, sedentary behavior, adherence to treatment, psychosocial stress, food deserts, and fragmented care. Outcomes of interest are those that are of clinical significance in the treatment of chronic diseases, including standard risk factors such as cholesterol, blood pressure, and glucose, and clinical outcomes such as hospitalizations, functional limitations, excess morbidity, quality of life, and mortality. This link between behavior and chronic disease requires innovative clinical trial methods not only from the behavioral sciences but also from medicine, epidemiology, and biostatistics. This integration does not exist in any current book, or in any training program, in either the behavioral sciences or medicine.