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Electronic letters published:
![[Read Comment]](/icons/misc/sectionDOWN.gif){kind=icon}
Building Research Capacity in Family Medicine: Various Strategies are Required
An Enviable Record
Grant programs for General Practice in Germany
What counts when you measure research productivity?
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Daniel R. Longo, ScD, Richmond, Virginia Professor of Family Medine, Virginia Commonwealth University
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Concerns about the research capability and strategies to improve and enhance them in academic medicine at large and family medicine in particular have been a topic of great discussion for at least a decade. As physicians and their academic departments are caught between the competing demands of clinical practice and the academic requirements of their home institutions, it seems many will opt for more clinical work out of a valid concern for financial support. In Research Productivity Among Recipients of AAFP Foundation Grants, Mahoney, Verma, and Morantz reached an accurate conclusion that “the JGAP has aided the development of successful senior and mid-career family medicine researchers by serving as a foundation upon which to build a research career. The numbers of publications, presentations, and grant applications derived from JGAP-supported research projects suggests JGAP plays a positive role in the development of family medicine researchers.” However, to better understand the extent of the “family of family medicine organizations” research capacity strategies one must also place JGAP within the larger context of various initiatives undertaken. Included among these is the Grant Generating Projects (GGP) begun in the 1995-1996 academic year through the efforts of the North American Primary Care Research Group (NAPCRG) Committee on Building Research Capacity (BRC). The Grant Generating Project seeks to equip family medicine researchers with the skills they need to successfully develop and submit grants for research funding. Since that time funding has expanded to include the generosity of funding by the American Academy of Family Physicians, NAPCRG, Society of Teachers of Family Medicine, and Canadian College of Family Physicians - Le Collčge des médecins de famille du Canada. Additional funding is generated from a participation fee for GGP fellows, typically paid by their home department. As of December 31, 2006, Grant Generating Project alumni from the first 11 classes (1996 through 2006) have reported 292 grants funded, for an aggregate total of nearly $102 million, since their year of participation in the program. Of that number, 220 are grants on which the former GGP fellow is principal investigator or the equivalent (e.g., project director); total value of grants received as PI is $63,815,841. Seventy-two grants on which the fellow’s role is co-investigator or other (e.g., consultant), account for an additional $41,843,474 in funding for family medicine research and training; this brings GGP’s total to over $100,000,000. While these programs are helping build research capacity more is needed if family medicine research nationally and internationally is to find its place among other academic specialties. Competing interests: I am the director of the Grant Generating Project (GGP) which has many goals in common with the program described in this article. |
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James J Diamond, Philadelphia, USA Research Professor, Department of Family and Community Medicine, Jefferson Medical College
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Having received a JGAP award after 2000, this article caught my eye. (Please use this sentence as an example of a dangling participle!!) Looking at the sentence about the 39 grant applications submitted by JGAP PIs, I did a little back of the envelope calculation, and it turns out that a minimum of 7 of the applications to the NIH out of the 20 submitted were funded. This is 35% and an enviable record in the current funding climate. This assumes that both submissions to the AAFP and all 17 to the nonfederal agencies were funded. Congratulations to all! Competing interests: None declared |
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Thomas Rosemann, Heidelberg, Germany University Hospital of Heidelberg, Department of General Practice and Health
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Germany has currently about 50.000 GPs, mostly working in single handed practices. Research in primary care is poorly established in Germany. Currently only 17 of the 35 medical schools have professors of General Practice and only a small number of them are performing their own research projects[1]. Financial support programs as the AAFP Joint Grant Awards Program, of which results have been evaluated in the article of Mahony et al. [2], is currently not established in Germany. To support research in primary care, the German Ministry for Education and Research (BMBF) has launched a financial support program (“Förderung der Forschung in der Allgemeinmedizin”) for three universities in Germany, including Heidelberg, Frankfurt and Göttingen. For a period of 6, years each of the universities received about 3 to 4 million Euros to perform several research projects, including qualitative research as well as large cluster -randomised controlled trials. So far no structured evaluation of this support program regarding publications has been made. However, a recent MedLine research (May 2007) performed by our study group revealed similar results as reported by Mahoney et al: The three supported universities which have received financial support published significantly more international research papers. Overall, more than two thirds of all publications reporting results of research in General Practice in Germany derived from one of these three universities. Furthermore, two of these publications were accepted by the highest ranked journal of the specific clinical field [3,4]. Based on the positive results of this support for university departments, the BMBF has launched a grant program for young researchers, not older than 35 years, in primary care. It will be soon apparent, if similar successes can be achieved as reported by Mahoney et al. Reference List 1. Baum E: Ausstattung und Lehre im Fach Allgemeinmedizin an Deutschen Hochschulen; [Equipment and Education in the subject of General Practice at Universities of Germany]. Z Allg Med 2005, 81: 405-408. 2. Mahoney MC, Verma P, Morantz S: Research productivity among recipients of AAFP foundation grants. Ann Fam Med 2007, 5: 143-145. 3. Rosemann T, Backenstrass M, Joest K, Rosemann A, Szecsenyi J, Laux G: Predictors of depression in a sample of 1,021 primary care patients with osteoarthritis. Arthritis Rheum 2007, 57: 415-422. 4. Rosemann T, Joos S, Laux G, Szecsenyi J.: Case management of arthritis patients in primary care: Cluster-randomised controlled trial [ISRCTN87252339]. Arthritis Rheum 2007 (accepted) Competing interests: None declared |
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Deborah Askew, Brisbane, Australia Senior Research Fellow, Discipline of General Practice, University of Queensland
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Internationally, a variety of strategies are being used to increase the quantity and quality of family medicine/general practice research including grant programs specifically aimed at early career researchers undertaking small scale projects, such as the Joint Grant Award Program (JGAP) evaluated by Mahoney et al.(1) Programs such as JGAP provide opportunities for piloting research concepts, designs and methods. Indeed, Mahoney et al report that the JGAP investment of less than $1 million generated $9.6 million in subsequent research funding – a greater than ten-fold return on the initial investment!(1) Unfortunately, because we are not told which agencies funded these projects we do not know if family medicine research is attracting nationally competitive research funding – a measure of research productivity. Mahoney et al also counted the number of publications of funded applicants, and compared this with some non-funded applicants. Both groups increased their publication rates over time, but the funded applicants published at a consistently higher rate.(1) This result may not be surprising, particularly if research track record was a selection criterion for the JAGP award. However, family medicine/general practice research will only start to be taken seriously when it results in improved health care delivery and health outcomes. To do this, it must be both of high scientific quality to answer the research question and also be relevant to clinicians and policy makers.(2) The scientific quality of research publications is most commonly measured by the publishing journal’s Impact Factor, despite it’s imperfections being well recognised.(3-5) Therefore it is essential that evaluations of programs aiming to build research capacity in this sector assess not only the number of publications, but where they are published and the number of times the publications are subsequently cited by other researchers. Simply counting publications is no longer enough! 1. Mahoney MC, Verma P, Morantz S. Research productivity among recipients of AAFP foundation grants. Ann Fam Med 2007;5(2):143-5. 2. van Weel C. Biomedical science matters for people--so its impact should be better assessed. Lancet 2002;360(9339):1034-5. 3. Royal Netherlands Academy of Arts and Sciences. The societal impact of applied health research - towards a quality assessment system. Amsterdam: Royal Netherlands Academy of Arts and Sciences; 2002. 4. Nakayama T, Fukui T, Fukuhara S, Tsutani K, Yamazaki S. Comparison between impact factors and citations in evidence-based practice guidelines. JAMA 2003;290(6):755-6. 5. Walter G, Bloch S, Hunt G, Fisher K. Counting on citations: a flawed way to measure quality. Med J Aust 2003;178(6):280-1. Competing interests: None declared |
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