Defining the future in medical education.
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Biomedical subjects
Publications and source records attributed to H Pardes.
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The author notes the current extraordinary excitement and opportunity in biomedical research that, oddly, exist within a context of economic constraint for researchers. Also, there is much negative publicity about biomedical science that threatens efforts to obtain adequate funding and responsible handling of science policy in an era where there is relatively little money available for research. The author reviews past instances of damaging public disunity and squabbles by groups in the biomedical research community and then proposes various policy guidelines and strategies to best ensure adequate research funding in the future. For such policies and guidelines to be effective, he stresses the necessity of efforts to heal the past divisions within the biomedical research community and to present a united position that is clear and understandable to Congress and others.
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Family, twin, and adoption studies have suggested an important role for hereditary factors in the etiology and pathogenesis of several psychiatric disorders. Advances in molecular and statistical genetics may very well reveal the identity of these factors, which may include single genes. Linked markers, critical to the discovery of abnormal genes in several medical conditions, have been reported for Huntington's disease, Alzheimer's disease, bipolar disorder, and schizophrenia. Psychiatric disorders pose particular problems (etiologic heterogeneity, incomplete penetrance, variable expressivity) for genetic research. New practical and ethical questions also arise. Nevertheless, knowledge may emerge that will suggest new approaches to diagnosis, prevention, and treatment.
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Psychiatry, which has experienced the influence of many thrusts in its history, is currently experiencing the impact of neuroscience. Clinicians view the impact with excitement and with apprehension. The author reviews examples of the excitement of scientific developments related to psychiatry. He traces the coexisting evolution of a more differentiated clinical psychiatry and deals with questions of reconciling neuroscience and behavioral approaches. The author's contention is that neuroscience will strengthen psychiatry and that biological and psychological integration will thus be enhanced.
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As clinical research in psychiatry has grown in importance and promise in the past decade, the need for a growing pool of skilled clinician-researchers has been increasingly recognized. Compared with physicians in other specialties, psychiatrists in academic positions have less training in research and devote less time to it, which is reflected in the growing concentration of research funds from the National Institute of Mental Health in just a few of the strongest medical school departments. To focus attention on the need for developing the role of clinician-researchers, the authors examine four major tasks faced by clinician-researchers and present a developmental perspective on the transition to research.
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Approximately 15% of the population suffers a diagnosable mental disorder, and with the increasing availability of community-based mental health services, growing demand is placed on the mental health specialty sector. Though the general health sector and nonmedical mental health specialists provide services to a large proportion of this case load, psychiatrists possess unique skills for the diagnosis and treatment of mental disorder and for the provision of consultation and liaison services to nonpsychiatric physicians. In spite of the need, a number of factors, including restrictions on foreign medical graduates and federal emphasis on the primary care specialties, have created an accelerating reduction in the production of psychiatrists. The federal government and medical schools are encouraged to devise strategies collaboratively to address issues to ensure an adequate supply of psychiatrists for the future.