Date: September 26, 2008
Place: Building 31
Conference Room 10
National Institutes of Health
Bethesda, Maryland
The 189th meeting of the National Advisory Dental and Craniofacial Research Council (NADCRC) was convened on September 26, 2008, at 8:30 a.m., in Building 31, Conference Room 10, National Institutes of Health (NIH), Bethesda, Maryland. The meeting was open to the public from 8:30 a.m. to12:00 p.m.; it was followed by the closed session for Council business and consideration of grant applications from 1:00 p.m. until adjournment at 4:00 p.m. Dr. Lawrence A. Tabak presided as Chair.
OPEN SESSION
Members Present
Dr. Carole Anderson
Dr. Augusto Elias-Boneta
Dr. Marianne Bronner-Fraser
Dr. Rena D’Souza
Dr. Cecile Feldman
Dr. Jon Levine
Dr. Anne S. Lindblad
Dr. Laurie McCauley
Dr. Harold Morris
Dr. Malcolm Snead
Dr. Philip Stashenko
Dr. Harold Morris (ex officio)
Dr. Kraig S. Vandewalle (ex officio)
Members Absent
Ms. Katherine Hammitt
Ad Hoc Participants
Dr. Matthew Doyle, Proctor and Gamble
Dr. Franklin Garcia-Godoy, NOVA
Dr. Mark Herzberg, Univ.of Minnesota
Dr. Karen Westlund High, Univ. of Kentucky
Dr. KyungMann Kim, Univ. of Wisconsin - Madison
Members of the Public Present:
Dr. Jack Bresch, ADEA
Mr. Robert Burns, ADA
Dr. Ching Chang Ko, Univ. of NC, Chapel Hill
Ms. Monette McKinnon, ADEA
Dr. Amy Pollick, Assn. for Psychological Science
Dr. Louis Terracio, NY Univ.
Dr. Yu Zhang, NY Univ.
Federal Employees Present:
National Institute of Dental and Craniofacial Research:
Dr. Lawrence A. Tabak, Director
Dr. Isabel Garcia, Deputy Director
Dr. Norman S. Braveman, Executive Secretary
Dr. Robert C. Angerer, Scientific Director, Division of Intramural Research (DIR)
Dr. Jane Atkinson, Division of Extramural Research (DER), Center for Clinical Research (CCR)
Dr. Katherine Carbone, Deputy Scientific Director, DIR
Ms. Michelle Culp, Office of the Director (OD), Office of Clinical Trials Operations Management (OCTOM)
Mr. Kevin Crist, Grants Management Branch (GMB)
Ms. Mary Daley, GMB
Mr. Bret Dean, OD, Financial Management Branch (FMB)
Dr. Alicia Dombroski, Deputy Director, Division of Extramural Activities (DEA)
Dr. James Drummond, DER, Integrative Biology and Infectious Diseases Branch (IBIDB)
Ms. Ki-Cha Flash, DEA, GMB
Ms. Sue Hamann, Office of Science Policy and Analysis (OSPA)
Dr. Holli Hamilton, DER
Dr. Kevin Hardwick, DEA, Research Training and Career Development Branch (RTCDB)
Dr. Emily Harris, DER, Translational Genomics Research Branch (TGRB)
Dr. Kathy Hayes, OD, OSPA
Dr. Victor Henriquez, DEA, Scientific Review Branch (SRB)
Mr. Justin Hentges, DEA, GMB
Ms. Delores Robinson, DEA
Ms. Mary Kelly, DEA, SRB
Dr. Lynn King, DEA, SRB
Dr. Raj Krishnaraju, DEA, SRB
Dr. John W. Kusiak, DER, IBIDB
Dr. Nadya Lumelsky, DER, IBIDB
Dr. R. D. Lunsford, DER, IBIDB
Ms. Jayne Lura-Brown, DER
Dr. Ruth Nowjack-Raymer, DER, CCR
Ms. Sandra Marks, OD, Administrative Management Branch (AMB)
Dr. Pamela McInnes, Director, DER
Dr. Marilyn Moore-Hoon, DEA, SRB
Mr. Jeff Ortiz, DER, CCR
Ms. Lisa Peng, NIDCR, Office of Information Technology (OIT)
Dr. Melissa Riddle, DER, Behavioral and Social Sciences Research Branch (BSSRB)
Dr. Isaac Rodriguez-Chavez, DER, IBIDB
Ms. Dede Rutberg, DEA, GMB
Dr. Yasaman Shirazi, DER, IBIDB
Dr. Lillian Shum, DER, IBIDB
Ms. Diane Thorpe, OD, AMB
Dr. Rebecca Wagenaar-Miller, DEA, SRB
Ms. Traci Walker, Committee Management Assistant, OD
Mr. Robert Berendt, Contractor
Dr. Alison Davis, Contractor
Other Federal Employees:
Ms. Melissa Barrett, NINR
Mr. Nasreen Jahed, SSS/Acct
Ms. Linda Naini, SSS/Acct
Mr. William Maas, CDC
Dr. Kraig Vandewalle, USAF
OPEN SESSION
I. WELCOME AND INTRODUCTIONS
Dr. Lawrence Tabak called the 189th meeting of the Council to order and invited guests to introduce themselves. He announced that three Council members would be retiring: Dr. Augusto Elias-Boneta, Dr. Anne Lindblad, and Dr. Jon Levine. Dr. Tabak thanked each retiring member for exceptional service to the Council, and presented them with gifts of appreciation.
He welcomed four incoming members who would be joining the Council at the next meeting: Dr. Franklin Garcia-Godoy, Professor and Associate Dean for research at the College of Dental Medicine at NOVA Southeastern University, who is an expert in materials science; Dr. Kyungmann Kim, Professor and Associate Chair of the Department of Biostatistics and Medical Informatics at the University of Wisconsin; Colonel Kraig Vandewalle, whose expertise is in dental medicine, engineering, and dental materials, will be an ex officio member of the Council representing the Department of Defense; and Dr. Karin Westlund High, Professor, Department of Neuroscience and Cell Biology at the University of Kentucky an expert in pain research.
Dr. Tabak noted staff changes at NIDCR and invited Dr. McInnes to introduce four new staff members in the Division of Extramural Research: Dr. Emily Harris, an epidemiologist and geneticist, came from NHGRI to be the Chief of the new Translational Genomics Research Branch. Dr. Holli Hamilton, a board-certified infectious disease physician, who worked previously at FDA, NIAID, and the private sector, has returned to NIH to serve as the Medical Officer at NIDCR. Dr. James Drummond, an expert in materials science, came to NIDCR from the University of Illinois, and is the Director of the Dental and Biomaterials Program in the Integrative Biology and Infectious Diseases Branch. Finally, Dr. Isaac Rodriguez-Chavez, a virologist, also comes from the private sector and has previous service at NIAID. He has extensive experience in infectious diseases and will head the NIDCR HIV/AIDS and Immunosuppression Program in the Integrative Biology and Infectious Diseases Branch.
Dr. Alicia Dombroski introduced two new Scientific Review Officers: Dr. Marilyn Moore-Hoon received her Ph.D. from the Swiss Federal Institute of Technology, and worked in the NIDCR intramural program from which she was recruited to be a Scientific Review Officer. Also appointed Scientific Review Officer was Dr. Victor Henriquez who earned a Ph.D. at the State University of New York - Stony Brook, followed by postdoctoral work in the NINDS intramural program.
Dr. Tabak announced that Dr. Jane Atkinson was appointed Director of the Center for Clinical Research in the Division of Extramural Research. She came to NIDCR in 1985, left in 2004 to become Professor of Oral Medicine and Assistant Dean for Clinical Affairs at the University of Maryland Dental School, and returned to the NIDCR as Program Director for the Clinical Trials Program.
Dr. Tabak also announced that the Executive Secretary of the Council, Dr. Norman Braveman, will retire in December. Dr. Tabak briefly described Dr. Braveman’s career including ten years in academia, followed by service to NIH in a variety of positions beginning in 1980. Dr. Braveman served in NIA, NHLBI, the Office of the NIH Director and came to NIDCR in 1992. Dr. Tabak expressed his appreciation for Dr. Braveman’s exceptionally valuable service to the Institute.
Finally, Dr. Tabak announced the appointment of Dr. Alicia Dombroski to the position of Director of the Division of Extramural Activities. He noted that after a number of years at the University of Texas Health Sciences Center-Houston, where she achieved the position of tenured Associate Professor, she joined the Center for Scientific Review at NIH as a Scientific Review Officer, then moved to NIAID to become a Program Director in the Division of Microbiology and Infectious Diseases. Dr. Dombroski came to NIDCR in 2006 to become Deputy Director of the Division of Extramural Activities.
II. APPROVAL OF MINUTES
Dr. Norman Braveman, Executive Secretary of the Council, invited approval of the minutes of the June 23, 2008 Council meeting. On motion duly made and seconded, the minutes were unanimously approved.
III. REPORT OF THE DIRECTOR
Dr. Braveman announced that, instead of Dr. Tabak’s verbal presentation of the report, it was distributed in written form to the Council members before the meeting and would be available to others on request.
IV: UPDATE ON ENHANCING NIH PEER REVIEW AND ON THE NIH REFORM ACT
Dr. Lawrence Tabak
Dr. Tabak described the process leading up to the implementation of the recommendations of the Enhancing Peer Review effort. The initial year-long process took advantage of a wide variety of resources within NIH, other federal agencies, the academic research community and the public and resulted in a set of recommendations and an implementation plan. That plan was also widely reviewed by various stakeholders. From that process, three key recommendations, also titled “priority areas,” emerged which were assigned to three working groups with the objective of developing a detailed plan to support the implementation of the recommendations.
The first priority area was to develop a plan to engage the best reviewers. In 2009, new reviewers will be offered more flexibility in terms of their tours of duty, and efforts will be made to improve retention in current study sections. A tool kit containing best practices for recruitment will be available to all ICs, and training programs will be offered for reviewers and SROs in the spring of 2009 to familiarize them with the changes in the peer review process. Finally, pilot projects will be initiated to explore the potential of high-bandwidth technologies as alternatives for in-person meetings.
Priority area 2 involves improvement of the quality and transparency of the review process. Scoring of grant applications will change beginning in May with a 7-point system to accompany the narrative summary statement. Sometime in 2009 streamlined applications will receive a preliminary score, and in January 2010 a shorter R01 application, with a 12-page research plan, will be implemented. Applications for other categories of research will be scaled down proportionately.
Finally, priority area 3 will focus on a balanced and fair review across scientific fields and a reduction of administrative burden. To that end, new and resubmitted applications may be subject to separate percentiling, and applicants may submit only one amended application. Finally, similar applications will be reviewed together, especially those submitted by early stage investigators, which includes those within ten years of their final degree or specialty training.
Dr. Tabak provided a brief update of the NIH Reform Act. In 2006 there was reauthorization legislation passed for NIH. As part of that legislation, a new NIH-wide tracking and reporting system called Research Conditions and Disease Categorization (RCDC) was established, to identify and release information to the public on how NIH spending is distributed. The RCDC reports will be available in the spring of 2009. The legislation also required the formation of a Scientific Management Review Board, which will look at NIH structure, best business practices, and other organizational issues, and provide a periodic report to the NIH Director and to Congress. Members of that board have been appointed and it should be operational soon.
V. UPDATE ON THE NIDCR STRATEGIC PLANNING PROCESS
Dr. Isabel Garcia.
Dr. Garcia discussed the strategic planning process, which began at about the time the Council met in January. The first phase, which focused on gathering input from outside stakeholders, researchers, patient advocates and others, has concluded. There were listening sessions at AADR and IADR meetings, and one in conjunction with the NIDCR Patient Advocates Forum on campus. A large number of recommendations and observations were received via the NIDCR website on issues such as future research, areas of importance, needs and opportunities. The second phase will involve working sessions with professional staff at NIDCR, consolidating and analyzing the data gathered in the first phase, analyzing trends in the NIDCR portfolio in relation to providing the gist that will be required to move to the third phase --actually laying out the plan, identifying strategic initiatives, and areas of emphasis.
During discussion, Dr. Garcia responded to a question about the previous strategic plan, noting that there was a review done about halfway through the previous strategic plan timeframe which incorporated some revisions, one of which was a result of the rapid advancements in nanotechnology at the time.
VI. CONCEPT CLEARANCE -- Support for NIDCR Salivary Gland Tumor Biorepository
Dr. Yasaman Shirazi
Dr. Shirazi explained that salivary gland tumors are rare head and neck cancers and that research in pathogenesis, diagnosis and treatment depends on a supply of tissue samples that, without a biorepository, would be lost. Following an NIDCR-sponsored workshop on such research, it was clear that there were serious gaps in the basic resources that support research -- lack of tissue repositories, few available cells lines, and a scarcity of researchers interested in this area.
NIDCR supported a grant to MD Anderson Cancer Center to establish a biorepository with the ultimate goal of making tissue samples available to the broad research community. Dr. Shirazi stated that the presentation requests approval by the Council of a research and development contract to replace the current grant, which would assure continuity of the program, as well as secure these resources for the government and consequently for the public. The proposal was reviewed by Council members, Drs. Lindblad and Snead.
Dr. Lindblad recommended approval of the request to establish a sole source contract. She recommended that the original contract be three years, with benchmark requirements for either two one-year extensions or one two-year extension. Dr. Shirazi noted that the contract terms would allow termination if appropriate progress is not achieved.
Dr. Snead agreed that the biorepository would be a valuable resource, but that the grant mechanism would not assure availability of the tissues to the research community. Since a contract would assure that availability to the broader research community, he endorsed the proposal to negotiate a sole source contract.
Asked about whether the NCI head and neck Specialized Program of Research Excellence (SPORE) program was consulted, Dr. Shirazi stated that the NCI was involved in the support of the original grant supplement. The pathologist responsible for managing the repository under the grant also would be responsible for management under the contract. She added that the proposal includes recommendations for benchmarks to monitor performance -- publications, number of requests for samples, and a log of research purposes for each sample distributed. Concerning benchmarking and monitoring, there was a suggestion that the horizon for the project should probably be longer than five years to determine whether the project is a success and whether future repositories would be worthwhile investments. Finally, it was noted that there is an interest in expanding the program to include international collaborators.
Dr. Braveman invited a motion to accept the concept clearance proposal. On motion duly made and seconded, the proposal to support the concept clearance was unanimously approved.
VII. SUMMARY REPORT OF RESEARCH TRAINING AND CAREER DEVELOPMENT EVALUATION Dr. Kevin Hardwick
Dr. Hardwick began by reminding Council members that the NIDCR mission statement includes the support of research training and career development programs to insure an adequate number of talented, well-prepared and diverse investigators. In order to try to meet that mission, NIDCR participates in several kinds of NIH training and career development mechanisms and in 2008, invested approximately $22 million through the T, F and K grant programs, which represents about 7.6% of the extramural program budget, higher than the overall NIH average of 6.1%.
To evaluate the success of the program, there are two key questions: What are the professional outcomes of trainees who have been supported by the various programs, and what percentage of trainees ultimately obtain NIH research grants? One indication is the fact that 75% of all NRSA trainees supported between 1995 and 2003 are in full-time research or academic positions, either training, research or clinical. In that group, 90% of non-dentists are in full-time research or academic positions while only 55% of dentists are.
In an effort to further assess professional outcomes of supported trainees, NIDCR collaborated with the American Association of Dental Education (ADEA) to compare NIDCR trainee names against a database of respondents to ADEA’s Survey of Dental Educators. Among other information, this survey captures employment status and tenure track experience among dental school faculty nationwide. Comparing databases resulted in a common list of 312 individuals from the NRSA cohort that had had some type of dental school faculty job at some point. Of these, 64 percent of the T32 trainees, 58 percent of F fellows and 82 percent of K awardees were in full-time faculty positions at the time of the survey. Previous K awardees were also more likely than fellows and trainees to be in tenured or tenure-track positions (57 percent of K awardees, 43 percent of F fellows and 35 percent of T32 trainees).
Regarding success in receiving R01 grants, Dr. Hardwick repeated from the last Council meeting that in the cohort of NRSA-supported trainees, the percentage who have received at least one NIH R01 award is only 5 percent. Only four percent of T32 trainees had received an R01, while 13 percent of F fellows had received R01 grants. K awardees were much more successful in this area, with 29 percent of mentored K awardees subsequently receiving R01 grants.
Dr. Hardwick discussed the Dental Science Training Program (DSTP), which supports dual degree training, established by NIDCR in 1995. Twenty-nine individuals have completed the program. Six are in private practice, 14 are in clinical specialty residency training (with or without a combined research postdoc), 8 are in academia and one is enrolled in medical school as part of an oral and maxillofacial surgery residency. None has applied for an R01 grant. NIDCR is currently supporting approximately 75 DSTP trainees and another 25 dentists getting PhDs. Dr. Hardwick reminded the Council that DSTP training is just one component of the broader training and career development mission.
In response to an inquiry at the last Council meeting, Dr. Hardwick provided a profile of FY 2007 NIDCR R01 principal investigators and their previous NIH training support. Of all such PIs (391), 44% had received training support from any NIH Institute and 18% had received training support from NIDCR. The data show that nearly all those with dental degrees had received training support from NIDCR. Also notable is that 74 percent of all R01 PIs were non-dentists.
In summary, Dr. Hardwick highlighted the following: Only 5% of NIDCR NRSA grant recipients have obtained an R01 award; K awardees are significantly more successful in obtaining subsequent R01 support, followed by F fellows, followed by T32 trainees; K awardees are more likely to be full-time dental school faculty and to be either tenured or in tenure track positions; and NIDCR is the main source of training support for R01 PIs who have dental degrees. Finally, although NIDCR spends a larger percentage of its extramural budget on training than the NIH average, NIDCR R01 grantees are more likely to have received training support from another institute.
Since there are clearly some challenges in these statistics, Dr. Hardwick presented several proposals for consideration:
VIII. COUNCIL DISCUSSION
During discussion, when asked about the length of time between the end of training and first R grant award, Dr. Hardwick answered that it had not been extracted from the data but was available. He noted that in a study of NIH NRSA trainees who received PhD degrees in 2006, the median time to earn the degree was 5.9 years and the median age at PhD was 31. There was an observation that gender and number of children might have a significant effect on those numbers, making time to degree longer and age at PhD greater for females, but that analysis showed about equal distribution of male and female degree earners.
There was a comment that the NIDCR mission includes supporting diverse investigators. Dr. Tabak noted that in terms of gender, NIDCR and NIH are similar; in terms of racial diversity, challenges remain. Although Hispanic and Asian enrollment in dental schools has increased, African American enrollment has remained the same for a number of years.
Asked about whether the outcome data had been analyzed on the basis of specific training sites, Dr. Hardwick indicated that the data were available but not yet analyzed. Dr. Tabak indicated that institutions are typically very similar, with no single institution standing out as exceptionally productive.
Asked about the T90/R90, Dr. Hardwick explained that neither a T nor an F is available to individuals who are not US citizens or permanent residents. Therefore the R90 was developed by taking the authority of the R award, which has no restrictions on who can be supported, and integrating it with the authority in the National Research Service Award, which makes the institutional awards available to foreign nationals.
Concerning publications, there was a comment that it might be helpful to look at an individual’s publications as a measure of productivity (versus focusing on R01 awards alone). Dr. Hardwick suggested it might be logistically challenging to do such an analysis. Matching actual trainees to publications through name searches can be difficult, especially for common names and women who change their names due to marriage. In addition, determining the relative value of first or last versus middle authorship is also a question.
Dr. Bronner-Fraser stated that, based on the data provided, the K awards clearly should be emphasized and, although it is not practical to consider eliminating the T awards, it would be appropriate to raise the bar in terms of qualification to apply and performance to continue. In all awards there should be a requirement to provide better accountability. Dr. D’Souza mentioned the need for a more detailed analysis of the career outcomes of DSTP trainees so that recruiting strategies can be developed that are more effective than those in current use. Such an analysis might help to answer the question of who should be recruited and how? It may require working with outside organizations like AADR and ADEA. She mentioned the need to emphasize more patient-oriented experiences for dental students to enhance the transition into the clinical environment. Dr. Tabak agreed that her suggestions were appropriate, although some lie outside the purview of the NIDCR. Working with outside organizations may be a way to influence some of those suggestions.
Dr. Tabak reminded the Council that dental school deans have the primary mission of developing practicing clinicians, but there are structural impediments to developing a strong research cadre from among those graduates. One is the lack of effective GME for dentists, and NIDCR is not in a position to solve that dilemma. The challenge is to develop a strategy that allows NIDCR to fulfill its mission of helping to develop that cadre of researchers while supporting the dental education system. Dr. D’Souza asked whether NIDCR could reach beyond the graduate level and support the development of science-oriented students at the high school and undergraduate levels. It was noted that NIH has begun considering that issue, but any substantive response is probably well into the future.
Dr. Bronner-Fraser commented that the issue may be cultural, that it is not part of the dental school culture to encourage students to participate in research, as it is in medical schools and in foreign dental schools. The T90 may be a useful tool in encouraging foreign dental graduates in the US to pursue research. Dr. Snead expressed doubt that trying to guide a high school student into a graduate research program is an efficient process, and that perhaps a more sophisticated selection process at the graduate level should be considered -- for example, focusing on F awards rather than T awards. He suggested the gap in dental school education, that is, the focus on practicing clinicians versus the lack of interest in supporting research clinicians, may suggest that the dental school is not the best primary source of candidates for advanced training. It might be better to look at foreign-educated dentists, PhDs interested in craniofacial research, chemists interested in dental materials, and so on, and basically cast the net wider.
Dr. Stashenko proposed looking at the desired outcome in terms of workforce, and one aspect of that is the importance of defining a research community that includes individuals who understand the clinical issues as well as the scientific issues. He suggested a reverse engineering aspect that would estimate future need and develop recruitment that responds to that need. Dr. Tabak agreed, but noted that a better understanding of the real opportunities is required, which may extend well beyond the need for dental school faculty, and include opportunities in medical schools, public health institutions, colleges of engineering and so forth.
Dr. Hardwick pointed to the frustration of not being able to characterize the necessary size and composition of the dental research workforce and the resulting inability to design the training program to meet that need. He noted that the most recent Institute of Medicine report on the needs of the biomedical work force failed to quantify the need for dental researchers. The dental section of the report instead focused on making the DSTP more effective. He noted that the NIDCR mission is not to focus on dental schools and dentist scientists, but to produce the next generation of researchers who will answer oral health research questions. DSTP is just one component of that effort.
Dr. Feldman stated that many dental school deans are passionate about research, but there is a fundamental difference between the dental and medical clinical research enterprise, partly because of the discrepancy in GME funding. The medical research enterprise generally has higher levels of funding than the dental research enterprise, which are often loss leaders for dental schools.
Dr. Doyle emphasized the importance of return on investment, citing the need to reduce the size of the T32 program, in large part because of its poor return on investment. Study sections should be working with minimum performance standards for institutions applying for grants. Second, the T90 concept is an appropriate mechanism for expanding the training program for foreign scientists. Third, the DSTP is an excellent program that should be enhanced. Many institutions are implementing the program in innovative ways. There should, however, be an interim evaluation, benchmarking should be implemented, effective models should be identified, and programs that are struggling should receive special attention. Fourth, the F program should be enhanced because it is working, and the K program has demonstrated an acceptable return on investment. The trend away from focusing on training dentists only may require a cultural change at dental schools, an event that Dr. Doyle felt would probably not happen easily. He believed that other kinds of schools have excellent human resources that can contribute to the oral health research agenda.
Dr. D’Souza mentioned that the proposed required transition from a T32 grant to an F grant within a specific timeframe was a positive development, which suggested the possibility of hybrid grants that would alleviate some of the challenges that exist in transitioning from a T grant to a K grant. An integral part of the hybrid could be the requirement that the grantee is mentored in the later years of a K award to obtain an R01. Dr. Hardwick noted that K recipients are encouraged to work towards an R01 application in the latter part of the grant, but it is not possible to mandate subsequent applications. Dr. D’Souza commented that the DSTP program was apparently flawed in its design since none of the 29 trainees who completed the program has obtained an R01. Dr. Tabak noted that there is little homogeneity in the DSTP program, and every institution develops its own design. Guidelines were not refined until 2001, so it may be premature to judge the program. It is an issue that must be addressed.
Dr. Bronner suggested that an option that should be more effectively advertised is the ability for an R01 PI to apply for a minority supplement. It might be a method to enhance diversity. It is also clear that individuals trained later tend to do better, so increasing the number of postdoc slots to grad slots should increase success. Dr. Tabak noted that many ICs do not provide support for predoctoral training. NIDCR is one of the few institutes that do support predoc training.
Dr. Lindblad questioned whether or not the primary outcome should be placing graduate researchers in academia. Even though the data show that 55% of dentists went into academia, the remaining 45% have still had a research-based experience in the NIDCR training programs and could be a rich resource for programs like Practice-Based Research Networks. Secondly, although the data presented suggest that only 32 of 645 NSRA recipients had R01s, perhaps further research of their publications would reveal that they are actually involved in other sorts of research, like industry grants. Dr. Hardwick added that he had reviewed many private practice web sites and very few referred to any research activity, although if he discovered that any were involved in such research they would have been counted as a success in terms of the primary outcome of the training study. Finally Dr. Lindblad commended the recommendation to involve PhDs in oral pathobiology training. She also suggested that a K-like transition program in private industry mandates a period of postdoc training followed by a period in a dental school program. Dr. Hardwick explained that there are transitional opportunities (the K99/R00) for dentist scientists. He added that whether the oral pathobiology training for PhDs would be an institutional program or a K or F grant is still under consideration. Dr. Tabak observed that, because of the challenge of meeting the minimum research requirement of K awards, some institutions with a limited research faculty core are less inclined to the K mechanism than other opportunities.
Dr. Herzberg endorsed the concept of reverse engineering the work force, to first try to identify what the workforce will look like at some future point and then work backwards to determine what training is required to support that workforce. He added that, although the success rate for dentists obtaining R01s is very low, so is the rate of applications, and that the success rate in that cohort of dentists who do apply is actually very good.
Dr. Bresch (ADEA) questioned whether resources should be directed to encourage dentists to accumulate training that they will eventually not use, as evidenced by the current lack of interest in R01s, or whether the identification of the future work force would provide a clue to the kinds of programs that would support the research needs of dentists in that workforce.
Dr. Bresch commented that the ADA, AADR and ADEA had submitted a letter to the Director applauding the effort to understand the future needs of the training programs, but also expressing concern about the outcome measures and methodology of the training study. The letter urged delay in making major policy decisions based only on that analysis. Dr. Tabak responded that some issues must be addressed promptly (such as revising the T32 program announcement which has now expired). Nonetheless, NIDCR continues to be amenable to working with the professional organizations as the process continues.
Dr. Barabino endorsed the concept of shifting emphasis to F grants, but expressed concern that there should also be emphasis on promoting those grants. She felt there were fundamental issues related to the difficulty of attracting applicants to the research track that must be addressed and some proactive program developed to improve that situation.
Dr. Stashenko suggested that the Harvard-MIT Division of Health Sciences and Technology (HST) has an excellent program for exposing PhDs to medical school experience which has produced an outstanding cadre of researchers. It would be good model for the dental schools. Dr. D’Souza suggested that dental schools are missing out on the opportunities provided by the CTSA program that came out of the Roadmap initiative, and there should be some mechanism to develop a dental component to the program. Dr. Tabak commented that he was involved with the NCRR oversight committee that monitors the CTSA program, and it was evident that although some dental schools had embraced the program many had not, some for budgetary reasons, some for cultural reasons. Noting that there were even subspecialties in medicine that were not participating fully, Dr. Tabak agreed that the issue should be addressed.
Referring to the proposal that grants include a mandatory patient-centered research component, Dr. Herzberg suggested that, like clinical and translational research, such research is a set of tools. He expressed the opinion that an individual writing a grant or thesis proposal should be allowed to choose the best tools available and not be mandated to use a tool they might not otherwise choose. Concerning the T32 grant, Dr. Herzberg felt that it serves as an important entry point and should not be de-emphasized, even though at some future time there may be limitations on how long an individual can continue in a T32. In addition, the T32 could combine pathobiology training for non-dentist PhDs and thereby contribute to a more intellectually diverse training cohort at a given institution. Dr. Hardwick observed that T grants are an appropriate entry point and that the suggestion to limit the duration of a T grant was also appropriate. There were also suggestions to expand the institutional eligibility to non-dental schools, but historically NIDCR T-grants have been limited to dental schools. Dr. Herzberg felt that the restriction might not be appropriate if candidates at other institutions demonstrate that they meet the criteria for quality of training and fit the profile of the type of person needed in the future workforce. Finally, asked about the fact that some institutes have small, narrowly-focused T-grant programs, Dr. Herzberg suggested that larger T grant programs offer a greater opportunity for demonstrating the opportunities in dental research and for developing a career path infrastructure and a critical mass that is needed for a successful program.
Dr. Levine observed that the current efforts seem to be looking for small modifications to improve outcomes mainly related to dental schools, when perhaps the focus should be on the mission of the NIDCR to develop the cadre of researchers to address the public health issues related to oral and craniofacial research, whether those researchers are in academia, industry or elsewhere. And that may require a more significant intervention than simply tweaking current programs.
Dr. Tabak noted that the ideal product of the training programs is the individual who has an inborn scientific curiosity, who is attractive to an institution that can provide an environment with like-minded individuals to form the critical mass that results in research results. Dr. Stashenko added that it is important to try to develop such individuals who will retain at least some commitment to dental research, even if they are involved with other fields of research. Dr. Snead suggested the need to develop an awareness of whether alumni of NIDCR training programs are involved in areas of research other than the dental research academic environment -- such as PBRNs.
Dr. Tabak commented that it has been revealed that practitioners are more apt to adopt new procedures when they are able to experience the procedures hands on. The research question then is whether PBRNs allow that to happen more effectively than the traditional academic process of publishing research results? Dr. Snead suggested that an objective should be to close the gap between the NIDCR mission and its compatibility with the real world business model of dentistry. Dr. Tabak agreed that to achieve that requires communication, an understanding of common ground, and to that end the NIDCR will continue to dialog with the professional organizations. He briefly discussed next steps, including digesting the information discussed during the meeting and further communications with the professional organizations, after which a report will be prepared for the Council. If additional issues emerge, a subset of the Council may be engaged to consider them. Finally, he reiterated his appreciation for the important contributions made by both Dr. Hardwick and Dr. Dombroski.
ADJOURNMENT
Dr. Braveman adjourned the open session.
CLOSED SESSION
This portion of the meeting was closed to the public in accordance with the determination that it was concerned with matters exempt from mandatory disclosure under Sections 552b(c)(4) and 552b(c)(6), Title 5, U.S. Code and Section 10(d) of the Federal Advisory Committee Act, as amended (5 U.S.C. Appendix 2).
X. REVIEW OF APPLICATIONS
ADJOURNMENT
The meeting was adjourned at 4:30 p.m.
CERTIFICATION
I hereby certify that the foregoing minutes are accurate and complete.
________________________ _________________________
Dr. Lawrence A. Tabak Dr. Norman S. Braveman
Chairperson Executive Secretary
National Advisory Dental and National Advisory Dental and
Craniofacial Research Council Craniofacial Research Council
ATTACHMENTS
I. Roster of Council Members
II. Table of Council Actions
III. Director’s Report to the NADCRC, September 2008
NOTE: A complete set of open-portion handouts is available
from the Executive Secretary.