Developing a Sustainable Research Culture in an Independent Academic Medical Center

By Joyce, Jeffrey N. | Journal of Research Administration, Spring 2013 | Go to article overview

Developing a Sustainable Research Culture in an Independent Academic Medical Center


Joyce, Jeffrey N., Journal of Research Administration


Introduction

Traditional academic medical centers (AMCs), with a teaching hospital associated with a medical school, have been the home for clinical and translational research for several decades. However, independent academic medical centers (IAMC) which are free-standing hospitals providing residency training are increasingly engaged in translational research. As proposed by Melese (2006, page 2) "AMCs accept a remarkable challenge: to integrate and achieve with excellence four core missions: delivery of healthcare; education and training of future generations of clinicians and investigators; discovery of new knowledge through incisive, decisive research; and the export of knowledge through effective interactions with industry and government. Each mission is critical, and each must be interactive with and respectful of the others". While the addition of the Teaching and Research components is essential to the overall mission of AMCs and IAMCs, these two components also have an impact on their financial and credit profiles. It has been evident for many years that clinical research activities are secondary to the delivery of healthcare in IAMCs, and administrative structures and policies do not support development of the research enterprise (Campbell, Weissman Moy, & Blumenthal, 2001; Oinonen, Crowley, Moskowitz, & Vlasses, 2001). As a consequence these counter balancing needs and values that challenge the ability of IAMCs to grow their research enterprise. It is recognized, therefore, that new strategies are needed in "maintaining academic medicine's integrity and effectiveness in pursuing its vital research mission" (Cohen & Siegel, 2005).

Academic medical centers and teaching hospitals are indispensible to promoting translational research, because of the preponderance of clinical research conducted in these institutions (Dickleret, Korn, D., & Gabbe, 2006; Goldhamer et al., 2009). The clinical research enterprise has been stimulated in academic medical centers through a number of formal and informal mechanisms, but evidence of effectiveness of these mechanisms has been limited to recognition of institutions that rank in the top level of National Institutes of Health (NIH) funding. Even within these institutions, where there is typically protected time for research, a small number of faculty are engaged in clinical trials research (Weston, Bass, E.B., Ford, D.E., & Segal, 2010; Zinner & Campbell, 2009). Despite widely recognized barriers to creating translational research endeavors, the design of systematic approaches to promoting clinical research has been largely limited to these same research-intensive institutions (Rosenblum & Alving, 2011). In two papers, which explored attitudes and beliefs about participation in clinical trials at nonacademic healthcare delivery systems by physicians, Somkin et al. (2005; 2008) also identified barriers that led to a significant mismatch between perceived value of clinical research by physicians and actual participation by physicians in clinical trials. While almost three quarters of cardiologists and oncologists viewed participation in clinical trials as important and valuable, less than 30% actually participated as a clinical trial principal investigator. Barriers to participation included: (1) a mismatch between beliefs of the institutional leaders and clinicians about value of clinical research, (2) lack of adequate skilled support staff (e.g., nurse clinical coordinators), (3) lack of or noninvolvement of research department in clinical trials, (4) lack of dedicated research time for physicians, and (5) lack of secondary support staff (pharmacists, data mangers, statisticians, etc.). The authors did not address strategies to increase clinician principal investigators in clinical trials, or how institutions could support an environment conducive to physician involvement in clinical trials.

This article describes the processes by which a newly established Department of Research focused on promoting research collaborations as a tool to help the a research enterprise grow at an independent academic medical center. …

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