Training clinical researchers in neurology - We must do better

The pace of scientific discoveries, the increasing complexity of managing p atients, and the runaway cost of neurological services have created an urge nt need for a wide range of clinical research in neurology. Despite increas ing recognition of this need and recent increases in funding for training c linical investigators, neurologists conducting cellular and molecular inves tigations are more likely to join faculties, maintain research careers, and attain academic advancement. Because academic departments of neurology are successful in producing and nurturing basic science researchers, why aren' t they just as triumphant in spawning clinical investigators? This crisis i n the preparation of clinical investigators has been brought about by many factors: competing time demands for clinical service, lack of methodologica lly rigorous training in the disciplines necessary to conduct clinical rese arch, and lack of mentorship. Neurology residents contemplating a clinical research career may observe junior faculty who lack career guidance, are il l-prepared as independent investigators, and must juggle patient demands wh ile trying to write a research grant or conduct a study. Already burdened b y medical school debts, is it any wonder that our neurology graduates don't leap to a career with a future that seems so insecure? Academic department s of neurology must develop full-scale clinical research training programs if they are to meet the pressing need for clinical research. As a starting point, they must free themselves from their dependence on providing clinica l services to generate income. Following the model which has produced succe ssful basic researchers, much greater effort must be given to establishing rigorous methodological training in collaboration with other departments, c reating senior role models, and protecting time for clinical investigators to conduct research. Unless we create incentives to careers in clinical res earch, we will never answer the growing number of clinical research questio ns we face today.