CAREER PATHS FOR CLINICAL SCIENTISTS

In the 16 years since James Wyngaarden proclaimed the clinical investi gator to be an endangered species, attempts to revive this fragile bea st have met with limited success in North America, the UK and Australi a. The situation may be more healthy in some western European countrie s and Japan, but in many parts of Asia clinical investigators have van ished without trace. An analysis of the Australian context during the past 16 years suggests a gradual decline in absolute numbers of clinic al scientists reaching maturation, coupled with an extraordinary dimin ution 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 attrib uted to restrictions at entry, according to the availability of and co mpetition for training scholarships. Other possible explanations inclu de the late age of entry and the negative influence of role modelling. The latter operates directly by the attitudes and pathways of peers a nd indirectly through the biases of peer review. There is also a perce ption, possibly a realistic one, that insuperable barriers exist to ob taining a stable career position at the end of training. Finally, ther e is real concern about whether clinical investigators will be able to compete successfully with basic researchers for research grants. If t his summation is correct, the solutions include active recruitment for research training at an earlier age, simultaneous research and medica l training and truncation of postgraduate clinical training in the med ical specialties with earlier introduction of medical research. In add ition to these strategies, the proper training of clinical scientists must afford them generic research skills and social adaptation to a te am approach with basic scientists.