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Readers unfamiliar with the Canadian health care system may wish to refer to Appendix 1, "Training the clinician scientist: the players and their regulations."
Introduction Over the last 50 years, the academic "heart" of North American teaching hospitals has been a core of full-time physicians who have taken on the major responsibility for teaching and research, in addition to sharing in patient care. The most successful health science teaching complexes have been those that have been able to integrate all 3 activities, usually by relying on a set of highly trained individuals who can function effectively in all 3 domains - as "clinician scientists." Since every physician with a medical school teaching hospital appointment is expected to participate in teaching, what distinguishes clinician scientists is that, in addition to carrying out clinical duties, they are also expected to spend a substantial part of their time in biomedical research. Typically, their investigation focuses on disease mechanisms and treatment. The clinician scientist is expected to play a crucial role in translating this new knowledge to his or her patients and students - fulfilling the "bench-to-bedside" paradigm.
With time, the demands of research have escalated to such a degree that by the mid-1990s the job description for clinician scientists involved a minimum of 50% of their time devoted to research. In fact, for clinician scientists supported by career investigatorships the figure is even higher: they are expected to have at least 75% of their time "protected" for research activities. This increased time commitment to research has been necessitated by the explosive pace of discovery of new scientific knowledge and technology and by the requirement to master this knowledge to remain competitive in seeking research funding.
Not surprisingly, it has become more and more challenging to design appropriate training models to prepare prospective clinician scientists for careers involving both independent research and clinical responsibility. In the past the most common strategy was to identify interested and talented individuals and then "tack on" several years of research fellowship after completion of clinical training. With time, it has been recognized that more formal and rigorous research training programs are required. Over the last 15 to 20 years, much time, money and effort...