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tigated the type of institutions from which non-clin-ical research core hospitals would request clinical research support in conducting clinical trials.The results of our survey are summarized in Figure 1. The rate of contact requests by non-core clinical research hospitals to core clinical hospitals for each clinical research supporter is as follows: program manager (1.3%, 11/860), study manager (1.3%, 11/860), data managers (1.2%, 11/903), monitors (0.8%, 7/913), biostatisticians (6.0%, 52/860), and auditors (0.7%, 6/865). It has become clear that core clinical research hospitals have not been primarily selected as a contractor for all clin-ical research supporters, despite the officially supposed cooperation scheme. Aside from auditors, non-clinical research core hospitals requested support from the clinical research support depart-ment of their own institutions.ConclusionsThe core clinical research hospital has primarily been designated to lead clinical trials in Japan. It is important for core clinical research hospitals to conduct secure and high-quality clinical research by themselves while also supporting clinical research conducted by neighboring non-core hospitals. We believe that by channeling clinical research conducted throughout Japan through core clinical research hospitals, the quality of clinical research in Japan will improve considerably. Additionally, patients who wish to participate in clinical trials Figure 1　 The rate of contact requests by non-core clinical research hospitals and information of outsourcers for clinical research supporters.414will be guided by the existence of landmarks, namely core clinical research hospitals nationwide. Furthermore, core research hospitals with several on-going high-quality clinical research studies might effectively train and develop numerous young physicians and researchers who want to enrich their experience on clinical research in the near future. As such, there is a need to determine why the officially supposed cooperative scheme between core and non-core hospitals are still not established in Japan in order to increase the devel-opment and quality of Japanese clinical research with maximum efficiency moving forward.We speculate that one of the major causes of the lack of an established cooperation between core and non-core clinical research hospitals is a mismatch between needs and feeds. The core clinical research hospitals have built a system to provide segmented research support, including program managers, study managers, data managers, monitors, biostat-isticians, auditors, and clinical research coordina-tors. However, we infer that researchers from non-core clinical research hospitals would need multifunctional comprehensive support rather than segmented support.The authors would like to thank Enago (www.enago.jp) for the English language review.Acknowledgments