Science and investigation are core activities in family medicine. Katerndahl reminds us: “As with Will Pickles, Edward Jenner, James MacKenzie, and Curtis Hames, we are part of a greater quest … we have a duty to question, to investigate, to increase our depth of understanding.”1 In the United States, the largest and most prestigious source of research funding comes from the National Institutes of Health (NIH). At the NIH, decisions about funding are done after an initial scientific review, but few family medicine researchers participate in scientific reviews (less than 1% of all study section members), and if we are not in the game, we can’t win.
Scientific reviews are conducted by standing and ad-hoc study section members. Each application is assigned 2 to 3 reviewers who write comments on the significance, approach, innovation, investigators, and environment of each proposed project. Although all applicants receive written comments, frequently less than one-half of the applications are discussed by the entire review group, which consists of 15 to 20 reviewers. Only applications discussed by the entire group receive a score of scientific merit. However, any study section member could request that a particular proposal be discussed and thus scored.
A working group of the advisory committee to NIH director Elias A. Zerhouni recently released recommendations to improve peer review and grant making. Among them is more emphasis on the potential to advance science and medical care and less emphasis on the fine points of a study’s methodology.2 As family medicine researchers we can provide an important perspective on the potential impact of proposals to advance science and health care because of our grounded knowledge of what is needed by our patients and communities. This commentary provides guidance for chairs and other family medicine (FM) leaders on ways to maximize our voice in the scientific review at NIH.
What support is needed for FM faculty to participate in study sections? Faculty who participate in NIH study sections need release time from other academic and clinic activities. This is a critical role that would greatly benefit our discipline’s reach and influence. FM leaders must understand that preparing reviews requires 5 to 6 hours per review ahead of scheduled meetings. Participants may have up to 10 grants to review per session. We must support this participation, even in the face of limited resources. The return on investment of study section participation may be measured in terms of exposure to advanced methods, awareness of potential pitfalls in future research proposals, ability to be exposed to successfully written proposals, and networking with other researchers. It is reasonable to expect that faculty members’ participation be contingent on their ability to produce grant proposals after participation and that continual support for participation be tied to individual, research group or departmental success in grant funding.
What skills are needed for the potential study section member? They need to have additional training or experience in scientific methodology, either quantitative or qualitative methods, and content expertise in an area demonstrated by publications in the area of research interest. Part of the scientific review process is the ability to be effective in a group setting. The faculty member needs to have familiarity with potential biases and limitations but also needs to be able to articulate the benefits of particular approaches despite some limitations. Study section members need to understand that they have an advocacy role as well as a scientific one. Study section members must translate for colleagues of other disciplines the potential benefits of the proposed studies and be able to articulate “this is the best we have in the field” (if indeed this is the case) and defend overly critical exercises in tearing projects down.
How do we prepare the next group of FM researchers to be study section members for NIH? Preparing faculty for participation in study sections is a critical faculty development need and opportunity. ADFM needs to partner with NAPCRG and STFM, as well as the CTSA programs, in preparing faculty for these tasks. The limited orientation sessions prepared by the Scientific Review Administrators are not enough. We feel that those family medicine researchers who have study section experience should share experiences with other family medicine researchers so that the learning curve can be accelerated for the benefit of the applications being considered. ADFM is supporting a lecture-discussion during the upcoming STFM meeting in Baltimore entitled “How To Be an Effective Study Section Member!” It is important that we demystify the process and mitigate the fear that sometimes inhibits participation.
Current changes in NIH that emphasize translation, implementation, and dissemination represent an excellent opportunity to fund innovative, integrative, multidisciplinary studies that have a FM perspective that will benefit the patients and communities we serve, but we have to be in to win.
- © 2008 Annals of Family Medicine, Inc.
