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Cardiovascular Health Research Training and Mentorship in Argentina
1. Lisandro Colantonio, MD MSc
Fogarty International Clinical Research Fellow 2009-2010
Lecturer, School of Public Health, University of Buenos Aires
Consultant, National Ministry of Health, Argentina
Cardiovascular Health
Research Training and
Mentorship in Argentina
2. Health Research in Argentina
“…adequate technology-
communications
infrastructure, as well as
highly qualified health and
academic human
resources…”
“…added to the low cost of
conducting research in the
region compared with the
costs in developed
countries, have been used
by pharmaceutical
companies to actively recruit
LAC populations into
randomized clinical trials.”
Perel P. PLoS Med 2006; 3(9): e344 2
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Health Research in Argentina
55,424,300 international
dollars (PPP) expended
from public funds in 2006
32.5% in basic research
40.9% in non-
communicable diseases
9%
8%
83%
Distribution by type
Clinical research
Public health research
Other
Maceira D. Rev Panam Salud Publica 2010; 27(6): 442-51.
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Clinical Training
Minimal training in
epidemiology, clinical research or
research methods
Universities do not usually
conduct epidemiological research
Research activities in internships
are limited and developed using
free time for both Fellows and
Staff
Minimal tradition on formal
mentorship programs Dr. Emilio Cermignani
5. Formal Education Research Funding
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Local Research Training
There are no MSc or PhD
programs in epidemiology
or clinical research
Several MSc programs
related to management of
health systems and health
policies that include
education on clinical and
public health research
Local funding for clinical
and epidemiological
research is limited
In general not aimed to
fund complete projects
Primarily salary support
Other expenses excluding
salary
In general does not include
expenses for training or
education
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Local Research Training
Small organizations
Provide training and staff
positions for junior and
senior researchers
Mixed funding
(public, private, national, int
ernational)
NGOs and private organization
Dr. Raúl Mejía
7. Training Researcher Career
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Argentinean Board of Science and
Technology Research
To complete a local PhD
program (no PhD programs
available in epidemiology)
Full-time dedication
Small salary to the Fellow
(initial position) without
budget for research
A PhD degree is highly
recommendable
The researcher career
implies some restrictions to
receive external funding
Honorary clinical
researcher position
available (no salary)
8. International Training
Several opportunities aimed to build research capacity in
developing countries
Includes research training, but also training for projects
management and local advocacy
Most include formal mentoring programs
Opportunities to build-up collaborative networks
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Dr. Lydia Bazzano Dr. Jiang He Dr. José Belizán
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Reaching Independence
Be proactive
Begin with the end on mind
Put first things first
Covey SR. The 7 habits of highly effective people. Free
Press, 2004.
10. Paid activities Unpaid activities
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Balancing Multiple Activities
Consultancy to the Ministry
of Health
Independent consultancies
Teaching
Research
Research
Teaching
Mentoring
Advocacy
11. Beyond independence…
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Certificate Program in Global Tobacco Control
Bloomberg SPH, JHU, 2011
Fogarty International Clinical Research Scholars
and Fellows Symposium, Potomac MD, 2010
12. Thanks to my mentors
Dr. Emilio Cermignani, Chair and Professor, Department of
Pharmacology, School of Medicine, University of La Plata
Dr. Raúl Mejía, Director, Research Training Program on
Tobacco Control in Argentina
Dr. Lydia Bazzano, Assistant Professor of
Epidemiology, Department of Epidemiology, Tulane
University School of Public Health and Tropical Medicine
Dr. Jiang He, Joseph S. Copes Chair and
Professor, Department of Epidemiology, Tulane University
School of Public Health and Tropical Medicine
Dr. José Belizán, Department of Mother and Child Health
Research. Institute for Clinical Effectiveness and Health
Policy (IECS), Argentina
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13. Thanks for his/her critical review
Dr. Raúl Mejía, Director, Research Training Program on
Tobacco Control in Argentina
Dr. Adriana Alberti, Lecturer, School of Public
Health, University of Buenos Aires
Dr. Sergio Sosa Estani, Director, Argentine Institute of
Parasitology Dr. Mario Fatala Chaben
Dr. Gerald Bloomfield, Assistant Professor of Medicine &
Global Health, Division of Cardiology, Duke University
Medical Center
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Editor's Notes
But fist I would like to mention some facts. It has been stated that Argentina, as well as other LA countries, is in a privileged position to conduct clinical and epidemiological studies because it has an adequate technology-communications infrastructure, there are well qualified human resources, and the cost required is lower than in developed countries. Pharmaceuticals have taken advantage of these conditions and the number of multicentric clinical trials as well as the number of clinical research organizations CROs has increased in the last decade in Argentina, along with the economic development that we have had since the last economic crisis in 2001.
On the other hand, public resources for health research, although increasing, are still limited, in particular in some areas or issues such as non-communicable diseases in particular or clinical and public health research in general. More that 55 millions international dollars from public resources were expended in health research in Argentina 2006. About 41% of these funds were destined to non-communicable diseases,although this group of diseasesrepresents the 75% of all disability adjusted life year lost in the country. Regarding clinical and public health research in general, they represented the 9% and 8% respectively of all public funds for health research. We have to consider that these types of research are important for developing countries since they are expected to translate health research investment in practice quickly as compared to basis research for instance.
During my clinical training I received minimal training in health research. This is the current situation of most schools of medicine in Argentina, for instance the University of Buenos Aires of which I am lecturer, since they do not have specific courses on clinical research, epidemiology or research methods. In fact, schools of medicine do not usually conduct epidemiological studies. Almost all the money Universities expends on research are allocated to university’s labs for basic research. When I attendedmy internship in Internal Medicine, we were not required to devote time to do research, and this is the common situation in most of clinical Internships. In general, research activities were limited to case studies and case series studies, and conducted during free time for both Fellows and Staff.In Argentina there is no tradition on formal mentorship programs. However, informal mentorship occurs frequently, and it was particularly important in my career. When I was at the School of Medicine, I met Dr. Cermignani from the Department of Pharmacology, who was working on a epidemiologic study regarding accessibility to prescribed medication on a pediatric population. To informally collaborate with his project was probably the most important research training that I received during my clinical education.
Regarding local research training opportunities in Argentina it is possible to identify different types for instance formal education, research grants or research positions. Regarding formal education, courses related to epidemiology or research methodology are limited to pos-graduated, master or PhD programs (for instance the master program in Clinical Effectiveness that I completed, or the Master Program on Health Systems Management of which I am Lecturer currently). However, there are not specific Master or PhD programs in clinical research or epidemiology.Local public research funds for clinical or public health research are limited, as I have mentioned. The most important grant in these areais the Carrillo Oñativia grant of the Argentine Ministry of Health, which provide about 6000 dollars per year for and individual study (including 1 fellow)and about 45000 dollars for a multicentric study (including 7 fellows). However, this include primarily salary support (about a 90% is for salaries), and do not include expenses for training or education.
Since Universities do not usually conduct epidemiological studies, most of researchers fall back on non governmental or private organizations to manage their funds and to conduct their studies. These NGOs can provide a Staff position for Junior and senior researchers, and in some cases research training fellowships. Cristina Rabadan Diehl has mentioned the Centers of Excellence in non communicable diseases, and the Center in Argentina provide opportunities to complete the Master Program in clinical effectiveness from the University of Buenos Aires and to obtain post-doctoral training at the department of Epidemiology, at the Tulane School of public health. Currently I am Fellow of a research training program on tobacco control at CEDES, of which Dr. Raúl Mejía is the Director and my mentor. This program is funded by the International Development Research Centre (IDRC) from Canada. The main objective of this program is to provide training on research and formal mentoring.
Finally, I would like to talk about theArgentinean Board of Science and Technology Research or CONICET. This institution provides training and staff positions for researchers in all scientific disciplines. However, the proportion of researchers from clinical or public health is relatively low. Regarding training positions, they are aimed to complete a local PhD program and there are not specific PhD programs in Epidemiology or Clinical research as I have mentioned before. In addition, to have a PhD degree is a requirement to apply for a Staff position, degree that is used to take longer to achieve for clinical researchers than for researchers in other disciplines.
Off course, there are great opportunities for research training from international training programs. StenVermunt has mentioned the Fogarty International Clinical Research Fellowship which had a big impact on my career. This program gave me the chance to lead a project by first time, and also to be in contact with well known clinical researchers. These are the Mentors that I had during my Fogarty Fellowship, from the Department of Epidemiology of Tulane School of Public Health, and from the Institute for Clinical Effectiveness and Health Policy from Buenos Aires. Regarding international training opportunities I have recently applied to the Argentine Fulbright Commission which provide economic and administrative support to complete a Master or PhD program here in US and I have been selected as candidate to complete a PhD program in Epidemiology.I hope this will allow me to complete my training but also I hope to be able to work as research assistant in a cardiovascular research project, increasing my future collaborative network. This will also allow me to apply for a Staff research position at the CONICET after returning to Argentina.
To end this presentation I would like to share with you this model regarding professional maturity which I think that summarize well my experience. Going from dependence to independence, the first habit in a research career is to be proactive. In my case I needed to be very proactive for instance in order to obtain the research training that I did not obtain from the School of Medicine or the Internship. The second habit is to have the end on mind. Of course this depend of the personal expectations, but I think that to have a good mentor is very important since he can provide an honest vision about what the end is or mean, and about training and research opportunities (the path to arrive to this end). Finally, putting first things first. This is the problem that I am currentlyfacing.
I am currently working for different institutions with different bosses (the National Program on Chagas Control at the Ministry of Health, the Buenos Aires University School of Public Health among others). Some of those activities are paid, other are unpaid but important for my career. So I need to balance the time devoted to paid activities (in general less related to research) in order to have free (unpaid) time to write papers, protocols, conduct some projects, and to have a family life.
And off course, I am always considering collaborative opportunities, as for instance with some of the fellows with whom I attended some research training programs. To build collaborative networks is another important advantage of these kind programs.