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Training Opportunities for Medical Students
at the NIH
Frederick P. Ognibene, M.D.Deputy Director, Educational Affairs and Strategic
Partnerships, NIH Clinical Center Director, NIH Clinical Research Training Program
April 23, 2011
Spectrum of Clinical Research
Ph.D.
Biostatisticians, Research Nurses, Study Coordinators, Project Managers, Administrators,
Educators, Informatics Specialists
Ph.D.
M.D.
M.D. – Ph.D.
Basic Science
Translational Research
Patient-Oriented Research
Public Health
Why is the Need for Physician-Scientists So Critical?
–Translational research–Clinical research informatics–Integrated clinical research networks–Training–New technologies, harmonizing regulatory processes –Establishing public trust
Immediate Past NIH Director Elias A. Zerhouni, M.D.NIH Roadmap Initiative Reengineering the
Clinical Research Enterprise A more efficient national clinical research system is needed to make rapid medical progress:
Best Guess: Healthcare in 2020
• Almost everyone will know their genotype
• Treatments will include gene therapy and stem cells
• Many of today’s common diseases will be rare diseases with tailored therapy
• Emphasis on chronic diseases
What Are the Opportunities?• Integration of the human genome project
into medicine/state-of-the-art clinical care• Understanding genome-environment
interactions• Information technology • Role of microbiome in health and disease• Imaging technology to study/treat disease
o Molecular approacheso Nanotechnology
More About the NIH Campus and the NIH
Clinical Center
NIH Clinical Center
• Opened in 1953 • More than 400,000 patients
since opening• New Clinical Research Center
opened in April 2005• 240 beds• 2,256 CC employees• 1,255 credentialed physicians• Over 1,400 active protocols• 2010 CC Budget: $377.5M
The NIH Clinical Center“A Laboratory for Clinical Research”
CC Motto: “There’s No Other Hospital Like It”
• All patients are on a protocol• No charge to patients and travel expenses supplemented• Highly educated nurses familiar with clinical research• Patient investment in clinical research process• Unique cohorts of patients • Long term and high risk studies • Specialized infrastructure
Mission
Science
Patient Care
Training
• Chemotherapy and immunotherapy for cancer• 1st platelet and granulocyte transfusions; 1st continuous
flow blood cell separator• Lithium for bipolar disorders• Blood tests for AIDS, hepatitis• 1st gene therapy (ADA Deficiency)• Pathogenesis and treatment of AIDS• 1st successful artificial mitral heart valve• Immunosuppressive therapy for nonmalignant diseases • 1st fluoride gels to treat dental caries as an infectious
disease
Selected Historical Accomplishments
• Cardiac MRI in patients with chest pain to identify high-risk versus low-risk individuals
• Use of adoptive transfer as immunotherapy for metastatic melanoma
• First use of an immunotoxin to treat malignancy (hairy cell leukemia)
• Demonstrated PET scans clarify some of the abnormalities in schizophrenia
• Discovery of autoinflammatory diseases• Developed technology which led to vaccine for human
papilloma virus
Recent Accomplishments
Interventional/Clinical Trials 655 (45%)
Natural History 700 (49%)
Screening 67 (5%)
Training 21 (1%)
TOTAL 1,443
Warren Grant Magnuson Clinical CenterProtocols by Research Type
March 2011
Phase I (toxicity) 224 (34%)
Phase II (activity) 377 (57%)
Phase III (efficacy) 39 (6%)
Phase IV (safety) 15 (3%)
TOTAL 655
Warren Grant Magnuson Clinical CenterInterventional/Clinical Trials by Phase
March 2011
SpecializedInfrastructure
• GMP facility for producing candidate drugs• Manufacturing capability (8 hour day)• Imaging equipment
• 3 cyclotrons• MRI center
• Biomechanics laboratory
• Blood products; stem cell technology
• Phenotyping
• IT Technology
Multi-modality minimally-invasive procedural suite
CC Pharmaceutical Development Section producing capsules of green tea for a study
• 75,000 capsules
• 150,000 tablets
• 220 liters
• 5,000 syringes
• 8,000 vials (includes vaccines and biologics biologics)
Specialized Services and Infrastructure
Phenotyping
• Metabolic Unit• 10 beds - obesity• 3 metabolic suites• 1 body composition testing room
• Patients with Rare Diseases
Warren Grant Magnuson Clinical CenterSome Rare Diseases Studied at NIH
• Ankylosing Spondylitis• Autoimmune
LymphoproliferativeSyndrome (ALPS)
• Chediak-Higashi Syndrome • Chronic Granulomatous
Disease• Cushing Syndrome • Familial Hypereosinophilia• Familial Mediterranean Fever • Hutchison-Gilford Progeria
Syndrome
• Hyper IgE (Job) Syndrome • Muenke Syndrome • Neurofibromatosis Type 1• Niemann-Pick Disease,
Type C • Neonatal Onset Multi-system
Inflammatory Disease• Osteogenesis Imperfecta• Pyogenic Arthritis,
Pyoderma Gangrenosumand Acne (PAPA) Syndrome
• Smith-Lemli-Opitz Syndrome• Smith-Magenis Syndrome
Training
Students in high school, college, graduate programs, and nursing and medical schools are eligible to apply for paid
summer research opportunities at the NIH Clinical Center and other Institutes/Centers
in Bethesda, Maryland
•Application deadline was March 1st
Summer Internships
•Students work with research mentors, who include physicians and allied health professionals• Participate in the NIH Research Poster Festival-results generated by their work in the summer program•Attend weekly lectures presented by NIH investigators.
Summer Internships
•Exciting research opportunities in:•laboratory medicine•imaging sciences and radiology •nursing •rehabilitation medicine •anesthesiology •transfusion medicine and blood banking•critical care
Clinical Center Summer Internships
A public-private partnership established in 1997 and supported jointly by the
National Institutes of Health (NIH) through its Roadmap initiative and the Foundation for the NIH (FNIH) with a
grant from Pfizer Inc
Clinical Research Training Program
•Established in 1997 to train medical and dental students in clinical or translational research after completion of their clinical rotations •In 1998, Pfizer Inc became a partner with the NIH to support CRTP; 13th year of this public-private partnership.
Clinical Research Training Program
Clinical Research Training Program
• Students are assigned a tutor, in their field of interest, who guides them in choosing a mentor for their research project. In addition, the tutor serves as an advisor for the academic year
• Each student works with an established clinical and translational researcher who serves as a mentor for their year-long clinical or translational research projects.
•Twice a month seminar and journal club with clinical research discussions •Twice a month clinical teaching rounds•“Introduction to the Principles and Practice of Clinical Research” course•“Ethical and Regulatory Aspects of Human Subjects Research” course
Clinical Research Training Program: Didactics
•Great Teachers Grand Rounds Series•Lectures with the HHMI-NIH Research Scholars (Cloister Program)
•CRTP scientific presentations at end of academic year
•CRTP poster sessions
•Clinical or laboratory meetings with mentor and team
Clinical Research Training Program
•12-month stipend of $33,700•Relocation expenses to and from Bethesda•Residential housing provided•Domestic conference travel expenses•Health insurance•Tuition support for scientific courses and textbooks•Dinners at CRTP clinical research seminar and journal clubs
Clinical Research Training Program: 2011-2012 Benefits
•Furnished accommodations, with utilities included, convenient to the NIH campus (no pets allowed)
two-bedroom, two-bath apartment for two single students orone-bedroom, one-bath apartment for engaged or married couples
•Parking expenses covered by CRTP•Close to public transportation•Affordable (average monthly rent for furnished two bedroom/two bath apartments in Bethesda, MD is approximately $2500)•CRTP fellows are required to live in the assigned residential housing for the entire 12-month period
Clinical Research Training Program: Housing
Furnished Living Room and Bedroom
Kitchen and Dining Room
•Candidates must be U.S. citizens or permanent residents•Candidates must be in good standing in medical, dental, or osteopathic school•Students must have approval from their Dean of Student Affairs to participate in this program
Clinical Research Training Program: Eligibility Criteria
•Candidates in M.D./Ph.D. programs are eligible to apply •Prior publications and research are desirable but not required
Clinical Research Training Program: Eligibility Criteria
All 4th year applicants who are selected to participate in the CRTP must make arrangements with their medical school to defer graduation until after completing the CRTP fellowship. This requirement must be met prior to starting the CRTP at NIH.
Clinical Research Training Program: Eligibility Criteria
SNMA Leaders and the CRTP
Brandi K. Freeman, M.D.Pediatrics Resident, Johns Hopkins UniversitySNMA National President 2006-2007CRTP Fellow 2006-2007
Michael G. Knight4th year Cleveland Clinic Lerner
College of Medicine of Case Western Reserve
SNMA National President 2011-2012CRTP Fellow 2010-2011
Lisa Green, M.D.OB/GYN Resident, Howard University
SNMA National President 2008-2009
CRTP Fellow 2008-2009
SNMA Leaders and the CRTP
Past and present SNMA leaders and CRTP administrator and director at last year’s SNMA annual conference with Dr. Freda Lewis-Hall, Executive Vice President, Chief Medical Officer,
Pfizer Inc
2010-2011 Clinical Research Training Program Fellows
Active SNMA Members•Michael Knight•Nnenaya Agochukwu•Nneamaka Agochukwu•Martha Amoako•Candace Mainor
2010-2011 CRTP Medical Schools Represented
• Boston University School of Medicine
• Case Western Reserve University School of Medicine
• Cleveland Clinic Lerner College of Medicine of Case Western Reserve University
• David Geffen School of Medicine at UCLA
• Duke University School of Medicine
• Finch University-Chicago Medical School
• Johns Hopkins University School of Medicine
• Louisiana State University School of Medicine (Shreveport)
• Medical College of Georgia
• New York University School of Medicine
2010-2011 CRTP Medical Schools Represented
• UMDNJ-Robert Wood Johnson Medical School
• University of Arkansas School of Medicine
• University at Buffalo State University of New York School of Medicine & Biomedical Sciences
• University of California, San Diego School of Medicine
• University of California, San Francisco School of Medicine
• University of Kentucky College of Medicine
• University of Maryland School of Medicine
• University of Miami Leonard M. Miller School of Medicine
• University of Michigan Medical School
• University of North Carolina at Chapel Hill School of Medicine
• Vanderbilt University School of Medicine
Examples of 2010-2011 Clinical Research Projects
Correlation of Early MRI Biomarkers with Clinical Outcomes in Patients with Recurrent Malignant (Grade III/IV) Gliomas Treated with Bevacizumab
The Role of Patellofemoral Kinematic and Kinetic Parameters in PatellofemoralPain Syndrome
Longitudinal Study of Retinal Angiomatosis and Visual Function in Ocular von Hippel-Lindau Disease
2009-2010 Clinical Research Training Program Fellows
Active SNMA Members•McKinley Glover•Chika Obele
Dermatology
Diagnostic Radiology
Emergency Medicine
Internal Medicine
Internal Medicine / Pediatrics
Ophthalmology
Orthopaedic Surgery
Otolaryngology – Head and Neck Surgery
Pediatrics
Psychiatry
Radiation Oncology
Urology
Min DengUniversity of Chicago Medical Center
McKinley GloverMassachusetts General Hospital
Bobbak MansouriUniversity of California,San Francisco School of Medicine
Thomas McCannYale-New Haven Hospital
Chika ObeleNew York University School of Medicine
Zachary DezmanUniversity of Maryland Medical Center
So Yeon PaekHenry Ford Hospital (Detroit, MI)
Tu DanThomas Jefferson University Hospital (Philadelphia, PA)
Jeremy ForceIndiana University School of Medicine
Robert HuangStanford Hospital and Clinics
Sravan Kakani & Adam WaxmanUniversity of Pennsylvania Hospital
Berenice NavaJohns Hopkins University School of Medicine / Bayview Medical Center
Justin Taylor & Emily MaxsonBrigham & Women's Hospital
Lueng (Sophia) TcheungCedars Sinai Medical Center
Marc HeikensUniversity of Maryland Medical Center
Euna KooUniversity of California,San Francisco School of Medicine
Daniel BlandUniversity of Texas Southwestern Medical Center at Dallas
Stephanie ContagMayo Clinic (Rochester, MN)
Vishnu KannabiranBoston University Medical Center
Julianna PesceDavid Geffen School of Medicine / UCLA Medical Center
Paulomi MehtaYale-New Haven Hospital
Ellen LeeUniversity of Maryland Medical Center / Sheppard Pratt Health System
Paul ChungUniversity of Texas Southwestern Medical Center at Dallas
Jennifer RoblesWashington University in
St. Louis School of Medicine
Horacio DuarteUniversity of Washington School of Medicine
2009-2010 Clinical Research Training Program Match Results Graph
• 340 students (335 medical, 5 dental)
• 81 medical schools, 4 dental schools, and 2 osteopathic schools
• 15 former CRTP fellows will have returned to the NIH for fellowships by July 2011
CRTP Composite Demographic Data
My experience at the NIH as a CRTP Fellow has been truly remarkable. As a future physician scientist, I knew that I wanted to spend additional time during medical school to strengthen my foundation in scientific inquiry. What I didn’t know was that the CRTP experience would offer all of that, and much more. This year has had a significant impact on my personal and professional development. I highly recommend this phenomenal opportunity.
Clinical Research Training Program
Michael G. Knight (2010-2011 CRTP Fellow)Cleveland Clinic Lerner College of Medicine of Case Western ReserveSNMA National President 2011-2012
As an aspiring physician scientist, becoming a CRTP fellow was one of the best decisions I have ever made. This program delivered the perfect combination of clinical medicine, research exposure, and networking opportunities. My research experience and the relationships that I formed have helped me to grow both personally and professionally. I consider myself a very proud alumnus and I am thankful for this opportunity.
Clinical Research Training Program
Lisa Green, M.D.(2008-2009 CRTP Fellow)M.D., University of Maryland School of MedicineHoward University Hospital (Obstetrics and Gynecology )
CRTP gave me a lot more than the opportunity to train at a good residency program. It allowed me to see what an exciting, fulfilling life physician scientists lead. Now, I realize the kinds of opportunities I will have to learn more about research so that one day I may be able to make a significant impact on a disease process. I remain very grateful for the opportunity I had to spend a year at the NIH.
Clinical Research Training Program
Thomas Sanford, M.D.(2008-2009 CRTP Fellow)M.D., University of Hawaii, John A. Burns School of MedicineUniversity of California, San Francisco School of Medicine (Urology)
Joshua Joseph, M.D. (2006-2007 CRTP Fellow, Boston University School of Medicine) Performing
a Cardiovascular Physiology Study
Clinical Research Training ProgramYear-end Scientific Presentations
Clinical Research Training ProgramPoster Sessions
Year of Program Applied Invited for Interview Accepted
1997-1998 76 20 91998-1999 56 23 171999-2000 78 35 172000-2001 66 36 172001-2002 72 35 152002-2003 66 36 162003-2004 60 37 152004-2005 74 60 302005-2006 81 60 302006-2007 80 60 302007-2008 86 61 302008-2009 97 64 302009-2010 118 63 302010-2011 140 61 302011-2012 141 64 30
CRTP Application Data from 1997-2011
October 1 Application Site Opens
January 17 Application Deadline
Mid February Notification of Interview
Early March Interview Day
Mid-March Notification of Selection
Early April Deadline to Accept Offer (CRTP, HHMI, Sarnoff, and Doris Duke)
Early or mid-July or Students Arrive at the NIHearly or mid-August
2012-2013 CRTP Timetable
Fourth year medical students
•The Clinical Electives Program (CEP) at the National Institutes of Health currently offers 33 rotations in a wide range of clinical disciplines as well as individualized tutorials for students who desire a total research experience.•Electives are typically either 4-or-8 weeks
•On-line application(http://www.cc.nih.gov/training/students/clinical_electives.html)
Clinical Electives Program
Clinical Electives Program: List of Rotations
•Alcoholism•Cardiology•Clinical Pharmacology and Therapeutics•Critical Care Medicine•Endocrinology and Metabolism•Gynecology Consult Service•Health Services•Hematology
•Hepatology•Infectious Diseases•Interdisciplinary Women’s Health•Internal Medicine Consult•Medical Informatics•Medical Oncology•Neurology•Nuclear Medicine•Neurosurgery•Otolaryngology
Clinical Electives Program: List of Rotations
•Pain and Palliative Care•Pathology•Pediatric Consult•Pediatric Endocrinology•Pediatric Oncology•Pediatric Psychopharmacology•Psychiatry
•Radiation Oncology•Rehabilitation Medicine•Rheumatology•Sickle Cell Anemia•Surgical Oncology•Transfusion Medicine•Urologic Oncology
FDA Clinical Pharmacology Rotation
•Coordinated by Juan Lertora, M.D., Ph.D.
•Opportunity for clinical investigators to learn about
- FDA drug development procedures - Investigational New Drug Application process
•4-to 8-week clinical electives in selected medical specialties•Residents in ACGME-accredited training programs•Comprehensive experience in the care of research subjects enrolled in investigational protocols under the mentorship of NIH clinician-scientists
Resident Electives
•The NIH Clinical Center is fully accredited by the Accreditation Council of Graduate Medical Education (ACGME) as the sponsoring institution for GME on the NIH campus•18 ACGME accredited specialty or subspecialty training programs•Additional support for jointly sponsored ACGME programs•Many other non-ACGME clinical fellowships•Variable lengths of training
Graduate Medical Education at NIH
ACGME Accredited NIH Programs
• Allergy and Immunology
• Anatomic Pathology• Critical Care Medicine• Cytopathology• Endocrinology and
Metabolism• Hematology• Hematopathology• Hospice and Palliative
Medicine• Infectious Diseases
• Medical Biochemical Genetics
• Medical Genetics• Medical Oncology• Neurosurgery• Pediatric Endocrinology• Psychiatry (PGY-4)• Rheumatology• Transfusion
Medicine/Blood Banking
• Vascular Neurology
Jointly Sponsored ACGME-Accredited Programs
•Clinical Neurosciences-Clinical Neurophysiology•Gastroenterology•Pediatric Hematology-Oncology•Pediatric Medical Genetics•Radiation Oncology
Other Fellowship Options
• Alcoholism• Child Psychiatry• Clinical Neurosciences
(neurocardiology, epilepsy research, human cortical physiology, motor control, neuroimmunology, stroke, and surgical neurology)
• Reproductive Endocrinology
• Deafness and Communication Disorders
• HIV and AIDS Malignancy
• Human Genetics• Neuro-Oncology• Nephrology• Surgical Oncology• Uveitis and Ocular
Immunology
Career Transitions
•Clinical Assistant Investigator•Tenure-track•Tenured Senior Investigator•K-awards (career development awards http://grants1.nih.gov/training/careerdevelopmentawards.htm); K-08 and K-23 awards•K-99/R-00 (pathway to independence awards)-mentored and independent support
NIH Curriculum in Clinical Research
Master’s Degree in Clinical Research169 graduates since partnership began in 1998
Ethical and Regulatory Aspects of Human Subjects Research>4,258 participants since course began in 1999
Introduction to the Principles & Practice of Clinical Research>10,527 participants since course introduced in 1995
Principles of Clinical Pharmacology>6,626 registrants since course began in 1998
April 2011
NIH Contact Information
• NIH Clinical Center Homepage http://www.cc.nih.gov/
• Overview of fellowship training opportunities http://www.cc.nih.gov/training/
• NIH Homepage http://www.nih.gov/• General questions: 1.888.695.5343 or
301.496.9425 • Dr. Frederick Ognibene
[email protected]• Mr. Kenny Williams [email protected]
Thank you and enjoy Naptown!