Clinician-Investigator Training and the Need to Pilot New Approaches to Recruiting and Retaining This Workforce

Development, Review, and Activation of Thoracic Oncology Investigator-Initiated Trials

PURPOSE

Investigator-initiated trials (IIT) may address important biological and clinical questions that may not be prioritized by pharmaceutical sponsors. However, little is known about the process by which IIT proposals are evaluated and activated.

EXPERIMENTAL DESIGN

We performed a retrospective study of IIT concepts submitted through the Academic Thoracic Oncology Medical Investigators Consortium, which comprises 13 institutions in the United States and Canada, from consortium inception in 2014 to 2024. We compared approved and disapproved concepts using χ2 tests, Fisher exact tests, and Wilcoxon rank-sum tests.

RESULTS

Among 68 presented IIT concepts, 60 (88%) received consortium approval a median of 30 days (IQR, 31-59 days) after submission. Concepts submitted by junior faculty were more likely to be approved than those from full professors (P = 0.003). Of the 60 concepts subsequently submitted to pharmaceutical sponsors, 15 (25%) were approved, 43 (72%) were disapproved, and 2 (3%) remain under review. The median time between concept submission to a sponsor and the sponsor's decision was 61 days (IQR, 31-183 days). Concepts with shorter projected durations were more likely to be approved by the pharmaceutical sponsor (P = 0.05). For sponsor-approved IIT concepts, the median overall time from initial submission to trial activation was 18 months.

CONCLUSIONS

Only a small proportion of proposed investigator-initiated cancer clinical trials are successfully activated following a prolonged development process. Given the importance of IITs in addressing real-world, practical questions and the growing professional challenges facing clinical research physician faculty, further attention to IIT development facilitators and barriers is warranted.

An interprofessional model for training the next generation of physician-researchers

The potential for physicians, clinicians, and health professionals to contribute to the advancement of medical therapies through clinical research is significant. Yet, a lack of exposure to, or practical training in, the conduct of clinical research can inhibit health profession trainees from considering research careers, thus perpetuating the already limited influx of new talent. To enhance the sustainability of career pathways into research for all trainees, including those from traditionally underrepresented communities, trainees must experience early exposure to research concepts through robust training and hands-on opportunities. In 2015, the Duke Office of Clinical Research created a Research Immersion elective for Duke's Master in Biomedical Sciences program, which prepares students for additional health professional training. The course trained students through didactic and practical experiences, with a unique interprofessional mentorship team including both principal investigator and clinical research professional mentors. Following eight cohorts of iterative course optimization, students' confidence increased in all 24 research competencies assessed. A cross-sectional analysis of post-course outcomes in May 2024 revealed 40.4% of students had continued in research after the program and 60.6% had continued their health professions education. We attributed this success to applied learning and clear expectations and guidelines to support the mentor-student relationship.

Scholarly Concentrations: A Students' Perspective on Their Role in the Residency Selection Process and Career Trajectory

Purpose

This study examines the students' perspective on the Scholarly Concentrations Program (SCP) at Morsani College of Medicine (MCOM) with respect to developing a habit of inquiry and life-long learning in the practice of medicine, career trajectory, and residency matching. Analyzing the students' self-assessment of their SCP experience provides added insight into the overall effectiveness of the SCP.

Methods

A cross-sectional survey was administered electronically to 4th year medical students at the USF Morsani College of Medicine after Match Day between 2013 and 2022.

Results

Students from all scholarly concentrations were more likely to be asked during interviews about their participation in SCP (53%) than not, and many students not asked about their participation initiated the conversation on their own (35%). The assessment of the role of SCP participation in matching was varied. SCP participation did not influence students' choice of specialty (84%). Many students indicated that the SCP experience would help them be more successful in residency (64%). Most students sought residency programs that emphasized research (65%) and indicated a desire to practice medicine in an academic setting (70%).

Conclusion

This self-assessment shows that students value the SCP experience and that the experience motivated them to continue the pursuit of scholarship. SCP participation was a topic of conversation during most interviews across all concentrations, although students were not sure whether it contributed to successful matching. The data indicate that residency programs value participation in the SCP as well as research experiences as indicators of success in residency.

Integration of Clinical Trial Development in Hematology-Oncology Fellowship Training

PROBLEM

Several barriers to physicians becoming clinical investigators exist, including inexperience, lack of available mentors, and inconsistent instructive approaches with varying degrees of participation during training. These barriers cause fewer hematology-oncology fellows to pursue academic careers. A consensus is needed on structuring education in clinical investigation paired with active participation in development of a clinical trial guided by a mentor with the goal of increasing fellow interest in clinical research and pursuit of careers in academic medicine.

APPROACH

The clinical trial development (CTD) program was initiated at Washington University School of Medicine in St. Louis in 2002 as a hands-on learning experience for hematology and oncology fellows in the design, implementation, and publication of clinical trials. Each fellow was required to identify a mentor and propose at least 1 prospective investigator-initiated clinical trial.

OUTCOMES

At the time of data abstraction in July 2023, 118 fellows had participated in the CTD program and initiated protocols in a variety of areas according to their interests. Fellows were included in data abstraction if their fellowship began in 2002 through 2021; the program is ongoing, and the most recent class will graduate in 2024. Disease types were evenly distributed between solid tumor oncology (60 [51%]) or classic and malignant hematology (58 [49%]). Ninety-three fellows (79%) obtained institutional review board approval, and 60 (65%) published their results. Among graduating fellows, 67 (66%) secured an academic faculty appointment. Fellows with institutional review board-approved projects had significantly higher odds of obtaining an academic faculty appointment (odds ratio, 4.96; 95% confidence interval, 1.54-15.98; P = .007).

NEXT STEPS

Next steps will be to further evaluate the effect of the mentorship network on early career productivity of trainees that graduate and the feasibility of extending the program to another institution.

Expanding pathways to clinical and translational research training with stackable microcredentials: A pilot study

Introduction

The proportion of physician-investigators involved in biomedical research is shrinking even as the need for high-quality, interdisciplinary research is growing. Building the physician-investigator workforce is thus a pressing concern. Flexible, "light-weight" training modalities can help busy physician-investigators prepare for key stages of the research life cycle and personalize their learning to their own needs. Such training can also support researchers from diverse backgrounds and lighten the work of mentors.

Materials and Methods

The University of Pittsburgh's Institute for Clinical Research Education designed the Stackables Microcredentials in Clinical and Translational Research (Stackables) program to provide flexible, online training to supplement and enhance formal training programs. This training utilizes a self-paced, just-in-time format along with an interactive, storytelling approach to sustain learner engagement. Learners earn badges for completing modules and certificates for completing "stacks" in key competency areas. In this paper, we describe the genesis and development of the Stackables program and report the results of a pilot study in which we evaluated changes in confidence in key skill areas from pretest to posttest, as well as engagement and perceived effectiveness.

Results

Our Stackables pilot study showed statistically significant gains in learner confidence in all skill areas from pretest to posttest. Pilot participants reported that the module generated high levels of engagement and enhanced their skills, knowledge, and interest in the subject.

Conclusions

Stackables provide an important complement to formal coursework by focusing on discrete skill areas and allowing learners to access the training they need when they need it.

Early Initiative of Structured Mentoring and Research for Social Disadvantage Trainees to Increase Diversity and Inclusion among Clinician Scientists

Background

There is a significant lag in integrating ethnically diverse healthcare trainees as clinician scientists. Although this gap is acknowledged, it is mostly focused physician scientists with a marked lag in dental scientists and the other healthcare fields such as the physician assistant program. We report on the outcome of three cohorts of underserved and economically disadvantaged trainees from a National Institute of Health Heart and Lung Blood Institute R25 summer training program with participants from four Rutgers Health Science schools.

Objective

The goal was to support inclusivity within clinician scientist workforce through career development and education.

Methods

We tested the hypothesis that early formal training with structured mentoring, research, career development, and didactic lectures will inspire trainees towards careers as clinician scientists. Trainees learned from the integration of research within the four health profession schools. We used a survey to assess how mentorship, research and career/educational development influence trainees' attitude for careers as clinician scientists. Career development included science communication, mentoring, data reproducibility, authorship, ethics in research, and models of healthcare institutional leadership.

Results

>80% of the trainees continued their engagement in research with peer-reviewed publications, with confidence to engage in scientific discussion. Trainees developed a sense of belonging and a psychological safety net as they integrate with other groups of academic fields with confidence. Among 29 contacts, 87% responded. Less than 10% of incoming trainees indicated research in their career plans, which changed to >90% after one summer.

Conclusions

Overall, this training program could serve as a `blueprint' for other programs to enhance careers in research, and to narrow the diversity gap among clinician scientists. Diversity among clinician scientists will enhance healthcare and disparities, and scientific innovation. Success would narrow the diversity gap among clinician scientists.

Launching IDeA state early career clinician-scientists with mentored just-in-time grant-writing support

Institutional Development Award (IDeA) programs build research infrastructure in regions with historically low access to NIH funds. The Mentored Research Development Award (MRDA), a professional development program embedded in our IDeA-funded center, provides junior investigators with mentorship and effort offset to write a grant. We evaluated outcomes from the first eight years (2013-2021; N = 55) using administrative records, publicly available data, and a self-report survey (n = 46, 84% response rate). Fifteen MRDA recipients (27%) went on to receive NIH funding. Providing just-in-time grant-writing support may launch early career clinician-scientists in an IDeA state context.

Predictors of academic career progression among early career physician-scientists via an intensive research training program abroad: a case study

BACKGROUND

Despite extensive efforts to revitalize the physician-scientist pipeline, attrition has been observed along the physician-scientist developmental pathway. Research exposure during clinical training is considered an important factor favoring the decision to pursue an academic career pathway.

METHODS

The authors sought to identify factors associated with academic career progression among junior physician-scientists following the completion of an intensive research training program, using the framework of the Social Cognitive Career Theory (SCCT), to benefit the design of efforts to revitalize the physician-scientist career pipeline. We conducted a retrospective study of 108 physicians who completed a long-term research training program abroad during residency, or within a few years post-residency completion, between 2010 and 2017. With potential predictors of academic career progression prioritized by SCCT, multivariable logistic regression was used to identify predictors of sustained research involvement, high productivity and high research competency after training, respectively. The SCCT was used to illuminate our findings.

RESULTS

Co-publications with training supervisors abroad and medical oncology/pediatric oncology as a clinical specialty were positively associated with sustained research involvement and high productivity. Joining the training program after the age of 36 was negatively associated with high research competency. All of the predictors shared a common feature of high correlation with both self-efficacy and environmental elements, the reciprocal interactions of which may affect the career progression of physician-scientists.

CONCLUSIONS

Insights gained through this analysis provide policy recommendations for the designing of efforts to revitalize the physician-scientist career pipeline. Priorities should be given to institutional oversight to ensure strengthened self-efficacy at the beginning of one's academic career, by providing long-term research training opportunities to young residents and promoting co-publications with their training supervisors during the training. In order to avoid the negative impact to self-efficacy caused by patient-related burnout or academic isolation, academic medical centers should take measures to guarantee protected research time, and to develop a positive culture encouraging mentoring relationships between junior and experienced physician-scientists in medical departments.

Optimizing team science in an academic medical center: A qualitative examination of investigator perspectives

Introduction

Optimizing the effectiveness of a team-based approach to unite multiple disciplines in advancing specific translational areas of research is foundational to improving clinical practice. The current study was undertaken to examine investigators' experiences of participation in transdisciplinary team science initiatives, with a focus on challenges and recommendations for improving effectiveness.

Methods

Qualitative interviews were conducted with investigators from twelve multidisciplinary teams awarded pilot research funding by the University of Kentucky College of Medicine to better understand the barriers and facilitators to effective team science within an academic medical center. An experienced qualitative researcher facilitated one-on-one interviews, which lasted about one hour. Structured consensus coding and thematic analysis were conducted.

Results

The sample was balanced by gender, career stage (five were assistant professor at the time of the award, seven were senior faculty), and training (six were PhDs; six were MD physicians). Key themes at the team-level centered on the tension between clinical commitments and research pursuits and the limitations for effective team functioning. Access to tangible support from home departments and key university centers was identified as a critical organizational facilitator of successful project completion. Organizational barriers centered on operationalizing protected time for physicians, gaps in effective mentoring, and limitations in operational support.

Conclusions

Prioritizing tailored mentoring and career development support for early career faculty, and particularly physician faculty, emerged as a key recommendation for improving team science in academic medical centers. The findings contribute to establishing best practices and policies for team science in academic medical centers.

Design and Transition of an Emergency E-Learning Pathology Course for Medical Students-Evaluation of a Novel Course Concept

BACKGROUND

Around the world, the emergency brought about by the COVID-19 pandemic forced medical schools to create numerous e-learning supplements to provide instruction during this crisis. The question now is to determine a way in which to capitalize on this momentum of digitization and harness the medical e-learning content created for the future. We have analyzed the transition of a pathology course to an emergency remote education online course and, in the second step, applied a flipped classroom approach including research skills training.

METHODS

In the summer semester of 2020, the pathology course at the Technical University of Munich was completely converted to an asynchronous online course. Its content was adapted in winter 2021 and incorporated into a flipped classroom concept in which research skills were taught at the same time.

RESULTS

Screencasts and lecture recordings were the most popular asynchronous teaching formats. Students reported developing a higher interest in pathology and research through group work. The amount of content was very challenging for some students.

CONCLUSION

Flipped classroom formats are a viable option when using pre-existing content. We recommend checking such content for technical and didactic quality and optimizing it if necessary. Content on research skills can be combined very well with clinical teaching content.

Research in orthopaedic trauma surgery: approaches of basic scientists and clinicians and the relevance of interprofessional research teams

BACKGROUND

An increasing clinical workload and growing financial, administrative and legal burdens as well as changing demands regarding work-life balance have resulted in an increased emphasis on clinical practice at the expense of research activities by orthopaedic trauma surgeons. This has led to an overall decrease in the number of scientifically active clinicians in orthopaedic trauma surgery, which represents a serious burden on research in this field. In order to guarantee that the clinical relevance of this discipline is also mirrored in the scientific field, new concepts are needed to keep clinicians involved in research.

METHODS

Literature review and discussion of the results of a survey.

RESULTS/CONCLUSION

An interdisciplinary and -professional team approach involving clinicians and basic scientists with different fields of expertise appears to be a promising method. Although differences regarding motivation, research focuses, funding rates and sources as well as inhibitory factors for research activities between basic scientists and clinicians exist, successful and long-lasting collaborations have already proven fruitful. For further implementation of the team approach, diverse prerequisites are necessary. Among those measures, institutions (e.g. societies, universities etc.) must shift the focus of their support mechanisms from independent scientist models to research team performances.

Clinician-Scientist Faculty Mentoring Program (FAME) - A New Inclusive Training Model at Penn State Increases Scholarly Productivity and Extramural Grant Funding

PURPOSE

Clinician-scientists have a high attrition rate at the junior-faculty level, before they gain independent funding. We identified the lack of skill set, clinician-scientist community and collaboration between clinician-scientists and clinicians with predominantly clinical duties, as key problems in our medium-size college of medicine.

METHODS

We designed a novel two-year educational program, the Clinician-scientist Faculty Mentoring program (FAME) specifically to target junior clinician-scientists. The program enrollment included both lab-based, "traditional" and "non-traditional" clinician-scientists, with predominantly clinical duties and limited time for research. The curriculum included the novel educational tools: Emerging technology seminars and mentored work-in-progress research seminars, integrated with mock grant review.

RESULTS

The first class enrolled 17 clinician-scientists with diverse clinical subspecialty, previous research training, and protected research time. After two years in the program, the self-assessment of FAME scholars demonstrated strong improvement in grantsmanship skills, career development, emerging technologies, and the sense of community and collaboration. Compared to the period before initiating FAME, scholars increased annual scholarly output by 65% and new extramural funding by >20-fold ($0.189 vs $4.0 million) following completion of FAME. The "traditional" clinician-scientists, who had >50% research time, increased new extramural funding by ~25-fold ($0.134 vs $3.336 million), whereas "non-traditional" clinician-scientists who had ≤50% research time increased new extramural funding by >13-fold.

CONCLUSION

Results suggest that a training program tailored specifically to clinician-scientists leads to increased scholarly productivity and grant funding regardless of research background. Implementing this type of training program nationally, with inclusion of clinician-scientists with various amounts of protected time for research, will help both "traditional" and "non-traditional" clinician-scientists to obtain a substantial independent extramural funding, fulfill their scholarly potential, and enhance their sense of community. Our model would be particularly useful for small-to-medium sized academic institutions, who have a limited clinician-scientist workforce facing competing health care system needs.

The Drug Abuse Research Training (DART) Program for Psychiatry Residents and Summer Fellows: 15-Year Outcomes

OBJECTIVE

To increase the number of physician-scientists in research, the Drug Abuse Research Training (DART) program at the Medical University of South Carolina offers a 2-year research track for psychiatry residents and a 10-week summer fellowship for students. The goal of this study was to examine program outcomes and alumni diversity levels over DART's 15-year history.

METHODS

To date, 215 trainees (44 residents, 171 summer fellows) have completed the program. An anonymous online survey was sent to the 143 program alumni with valid contact information. Survey data included demographic characteristics, post-program research involvement, and self-reported barriers to continued research engagement.

RESULTS

Overall survey completion response was 83.5% (N = 122). The alumni included 59.0% women, and 36.1% of respondents identified as a member of a minority racial/ethnic group. Following program completion, 77.0% of the alumni reported continued research involvement. More than half of the alumni reported scientific publications (57.4%) and conference presentations (63.1%) since completing DART. Among respondents who did not subsequently engage in research, the most common modifiable barriers included difficulty finding a mentor, self-perceived deficits in statistical skills and research methodology, and overall lack of confidence in research ability.

CONCLUSIONS

Over the past 15 years, the DART program has established a diverse research training program that now spans the educational spectrum from undergraduate to residency training. Future program goals include additional training to address self-reported modifiable research barriers. This program provides a model for other training programs designed to cultivate research interests and promote the diversity of clinical researchers.

The Congressionally Directed Medical Research Programs’ Ovarian Cancer Academy: A New Approach to Training in Biomedical Research

Introduction:

Researchers have begun to change their approach to training in the biomedical sciences through the development of communities of practice (CoPs). CoPs share knowledge across clinical and laboratory contexts to promote the progress of clinical and translational science. The Congressionally Directed Medical Research Programs’ (CDMRP) Ovarian Cancer Academy (OCA) was designed as a virtual CoP to promote interactions among early career investigators (ECIs) and their mentors with the goal of eliminating ovarian cancer.

Methods:

A mixed-methods approach (surveys and interviews) was used to evaluate the effectiveness of the OCA for the eight ECIs and five mentors. Quantitative analysis included internal reliability of scales and descriptive statistics for each measure, as well as paired sample t-tests for Time 1 and Time 2. Qualitative data were analyzed for themes to discern which aspects of the program were useful and where more attention is needed.

Results:

Preliminary analyses reveal several trends, including the importance of training in grant writing to the ECI’s productivity, as well as the value of peer mentorship.

Conclusion:

The results show that the OCA was an innovative and effective way to create a CoP with broad implications for the field of ovarian cancer research, as well as for the future of biomedical research training.

Exploring reasons for MD-PhD trainees' experiences of impostor phenomenon

BACKGROUND

Acceptance into U.S. MD-PhD dual-degree programs is highly competitive, and the lengthy training program requires transitioning between multiple phases (pre-clinical-, PhD-research-, and clinical-training phases), which can be stressful. Challenges faced during MD-PhD training could exacerbate self-doubt and anxiety. Impostor phenomenon is the experience of feeling like a fraud, with some high-achieving, competent individuals attributing their successes to luck or other factors rather than their own ability and hard work. To our knowledge, impostor phenomenon among MD-PhD trainees has not been described. This study examined impostor phenomenon experiences during MD-PhD training and reasons trainees attributed to these feelings.

METHODS

Individuals in science and medicine fields participated in an online survey that included the 20-item Clance Impostor Phenomenon Scale (CIPS); higher scores (range 20-100) indicate more frequent impostor phenomenon. Some respondents who reported experiencing impostor phenomenon also voluntarily completed a semi-structured interview, sharing experiences during training that contributed to feelings of impostor phenomenon. Interview transcripts were coded and analysed using the constant comparative method and analytic induction to identify themes.

RESULTS

Of 959 survey respondents (students and professionals in science and medicine), 13 MD-PhD students and residents completed the survey, nine of whom (five male, four female; four white, five other race-ethnicity) also completed an interview. These participants experienced moderate-to-intense scores on the CIPS (range: 46-96). Four themes emerged from the interview narratives that described participants' experiences of IP: professional identity formation, fear of evaluation, minority status, and, program-transition experiences. All reported struggling to develop a physician-scientist identity and lacking a sense of belonging in medicine or research.

CONCLUSIONS

Impostor experiences that MD-PhD participants attributed to bias and micro-aggressions in social interactions with peers, faculty, and patients challenged their professional identity formation as physician-scientists. It is important to further examine how MD-PhD-program structures, cultures, and social interactions can lead to feelings of alienation and experiences of impostor phenomenon, particularly for students from diverse and underrepresented populations in medicine.

Society for Maternal-Fetal Medicine Special Statement: Race in maternal-fetal medicine research- Dispelling myths and taking an accurate, antiracist approach

Profound inequities in maternal and infant outcomes based on race exist, and the maternal-fetal medicine community has an important role in eliminating these disparities. Accurately employing race and ethnicity as social constructs within research that guides clinical practice is essential to achieving health equity. We must abandon commonly propagated myths that race is a surrogate for genetics or economic status and that data are exempt from potential bias. These myths can lead to harmful misconceptions that exacerbate racial disparities in maternal and infant health outcomes. Furthermore, these myths obscure racism as the true underlying etiology of racial disparities. Understanding that race is a social construct and using an antiracist approach to research are essential in combating racism and eliminating unacceptable disparities in maternal and infant health. This document provides specific suggestions to approach the research process with an antiracist framework.

Physician-scientists in the United States at 2020: Trends and concerns

Physician‐scientists comprise a unique and valuable part of the biomedical workforce, but for decades there has been concern about the number of physicians actively engaged in research. Reports have outlined the challenges facing physician‐scientists, and programs have been initiated to encourage and facilitate research careers for medically trained scientists. Many of these initiatives have demonstrated successful outcomes, but there has not been a recent summary of the impact of the past decade of effort. This report compiles available data from surveys of medical education and physician research participation to assess changes in the physician‐scientist workforce from 2011–2020. Several trends are positive: rising enrollments in MD‐PhD programs, greater levels of interest in research careers among matriculating medical students, more research experience during medical school and rising numbers of physicians in academic medicine, and an increase in first R01 grants to physician‐scientists. However, there are now decreased levels of interest in research careers among graduating medical students, a steady decline in MDs applying for NIH loan repayment program support, an increased age at first R01 grant success for physicians, and fewer physicians reporting research as their primary work activity: all of these indicators create concern for the stability of the career path. Despite a recommendation by the Physician‐Scientist Workforce in 2014 to create “real‐time” reporting on NIH grants and grantees to help the public assess trends, this initiative has not been completed. Better information is still needed to fully understand the status of the physician‐scientist workforce, and to assess efforts to stabilize this vulnerable career path.

Association of off-the-job training with work performance and work-family conflict among physicians: a cross-sectional study in China

OBJECTIVES

To determine whether experiences of off-the-job training in domestic (DT) and overseas study (OS) settings are associated with work performance and work-family conflict in physicians.

DESIGN, SETTING AND PARTICIPANTS

We conducted a national cross-sectional survey in 77 public hospitals across seven provinces in China between July 2014 and April 2015. Participants were 3182 physicians.

EXPOSURE

Participants were categorised into four groups: none, DT only, OS only and DT and OS.

PRIMARY OUTCOME MEASURES

Work performance was assessed by work engagement, career attrition and patient-centred care. Work-family conflict was assessed by affecting care for family, feeling guilty towards family and receiving complaints from family.

RESULTS

A total of 25.89% participants had experienced DT only, 8.71% OS only and 8.47% DT and OS. After adjustment for potential confounders, participants who had experiences of DT and OS compared with those with no training were more likely to report positive work performance (pride in work: OR=2.11, 95% CI: 1.43 to 3.10; enjoyment of work: OR=1.67, 95% CI: 1.11 to 2.51; turnover intention: OR=0.54, 95% CI: 0.38 to 0.77; early retirement: OR=0.63, 95% CI: 0.45 to 0.89; and exhaustion: OR=0.66, 95% CI: 0.45 to 0.98) and less work-family conflicts (feeling guilty towards family: OR=0.51, 95% CI: 0.35 to 0.74; and complaints from family: OR=0.66, 95% CI: 0.47 to 0.91). We found no obvious association between DT/OS experience with patient-centred care.

CONCLUSIONS

Physicians with DT and OS experiences are more likely to have better work performance and less work-family conflict than those without such experience. Physicians face increasing pressure to pursue continuing education and experience associated distress. Therefore, hospitals and government policy-makers should promote DT and OS.

Rethinking Health Professionals’ Motivation to Do Research: A Systematic Review

Background

Health professionals’ engagement in translational health and medical research (HMR) is fundamental to evidence-based practice leading to better patient health outcomes. However, there is a decline in the number of health professionals undertaking research which has implications for patient health and the economy. Informed by the motivation-based expectancy-value-cost (EVC) and self determination theories (SDT), this systematic literature review examined the barriers and facilitators of health professionals’ (HPs) motivation to undertake research.

Methods

The literature was searched between 2011 and 2021 for relevant peer-reviewed articles written in English, using CINAHL Complete, Informit, Medline Ovid, Medline (PubMed), Scopus, Web of Science and Google Scholar databases. This systematic review was performed and reported in accordance with the PRISMA guidelines.

Results

Identified barriers to HPs’ engagement with research included the lack of knowledge, skills, and competence to conduct research, lack of protected research time, lack of funding and lack of organisational support. Integration of the findings of this review based on the EVC and SDT theories indicate that research capacity, ie, expectancy and competence is highly influenced by attitude, ie, the type of value (attainment, intrinsic or utility) and connection attributed to research. HPs who had very positive attitude towards research demonstrated all three values and were keen to take up research despite the barriers. Those who had a positive attitude were only motivated to do research because of its utility value and did not necessarily see it as having personal relevance for themselves. HPs who were unmotivated did not see any personal connection or relatedness to the research experience and saw no value in research.

Conclusion

The attitude HPs hold in their value of research is a catalyst for motivation or amotivation to engage in research as it directly influences the relevance of barriers. Facilitators that expedite the research journey have been attributed to research training, mentorship programs and supportive organisational research culture. Motivation of HPs explored through EVC and SDT is critical to the maintenance of a research culture and the clinician-researcher development pipeline.

The importance of motivation in selecting undergraduate medical students for extracurricular research programmes

INTRODUCTION

Extracurricular research programmes (ERPs) may contribute to reducing the current shortage in physician-scientists, but usually select students based on grades only. The question arises if students should be selected based on their motivation, regardless of their previous academic performance. Focusing on grades and lacking to take motivation into account when selecting students for ERPs might exclude an important target group when aiming to cultivate future physician-scientists. Therefore, this study compared ERP students with lower and higher previous academic performance on subsequent academic performance, ERP performance, and motivational factors.

METHODS

Prospective cohort study with undergraduate medical students who filled in a yearly questionnaire on motivational factors. Two student groups participating in an ERP were compared: students with first-year grade point average (GPA) ≥7 versus <7 on a 10-point grading scale. Linear and logistic regressions analyses were used to compare groups on subsequent academic performance (i.e. third-year GPA, in-time bachelor completion), ERP performance (i.e. drop-out, number of credits), and motivational factors (i.e. intrinsic motivation for research, research self-efficacy beliefs, perceptions of research, curiosity), while adjusting for gender and motivational factors at baseline.

RESULTS

The <7 group had significantly lower third-year GPA, and significantly higher odds for ERP drop-out than the ≥7 group. However, there was no significant between-group difference on in-time bachelor completion and the <7 group was not inferior to the ≥7 group in terms of intrinsic motivation for research, perceptions of research, and curiosity.

CONCLUSIONS

Since intrinsic motivation for research, perceptions of research, and curiosity are prerequisites of future research involvement, it seems beneficial to focus on motivation when selecting students for ERPS, allowing students with lower current academic performance to participate in ERPs as well.

Evaluation of an early career clinical academic training programme using the CIPP model

OBJECTIVES

This study describes the successful implementation and outputs of a combined clinical academic training programme for doctors in their first postgraduate year in Ireland, the Academic Internship Track (AIT).

DESIGN

The AIT was evaluated using the Context, Input, Process and Product model. Literature reviews, meetings with key stakeholders, reviews of similar established programmes overseas, a survey of undergraduate medical students, exit survey, scientific outputs and career trajectory monitoring were all implemented in the programme evaluation.

SETTING

The AIT represents collaboration amongst all six intern training networks in Ireland.

RESULTS

Key stakeholders indicated support and significant interest in establishing the AIT. The input evaluation informed programme design which incorporates protected time to carry out a research project, a named supervisor, a bursary and access to dedicated study days. Since the programme's launch in 2017, there has been 100% uptake of posts and 0% attrition. Exiting participants indicate high levels of satisfaction with the programme; 92% reported having benefited from participation. Over 90% intend remaining in Ireland in both the immediate and longer terms. Fifty-seven per cent of participants in the first 3 years of the programme had succeeded in publishing a research article or review paper in a peer-reviewed journal.

CONCLUSIONS

Now in its fourth year, AIT remains a highly sought-after programme and is perceived to be beneficial to one's career. Participants in the programme have contributed significantly to their field of interest despite being in the earliest career stages. The programme has the potential to help retain medical talent in Ireland.

Portuguese Medical Students' Interest for Science and Research Declines after Freshman Year

The integration of scientific research into medical curricula remains insufficient despite its advantages for medical students' professional development and the advancement of medicine. This study aimed to evaluate the impact of first-year medical course attendance on medical students' attitudes and perceptions towards scientific research and clinical practice, while also assessing the contribution of sociodemographic and academic factors. Two hundred and thirteen medical students self-administrated a questionnaire at the beginning and at the end of the first school year. Their responses were compared and two regression models were calculated to assess factors influencing students' attitudes and perceptions. After freshman year, students displayed significantly lower positive attitudes towards science and research. Their motivation to perform research and to integrate it into the curriculum also decreased, while the importance attributed to research skills for clinical practice increased. Motivation to perform research and negative attitudes were positively and negatively associated with grade point average (GPA), respectively. Female students and those who attended public secondary schools attributed greater importance to communication skills. This study reinforces the need to early develop research skills and positive attitudes in medical students, motivating them to become physician-scientists. Additional follow-up studies may offer further contributions to the integration of research into medical curricula.

First steps in the physician-scientist pipeline: a longitudinal study to examine the effects of an undergraduate extracurricular research programme

OBJECTIVES

Medicine is facing a physician-scientist shortage. By offering extracurricular research programmes (ERPs), the physician-scientist training pipeline could already start in undergraduate phases of medical training. However, previous studies into the effects of ERPs are mainly retrospective and lack baseline measurements and control groups. Therefore, the current study mimics a randomised controlled trial to examine the effects of an ERP.

DESIGN

Prospective cohort study with baseline measurement and comparable control group.

SETTING

One cohort of 315 medical undergraduates in one Dutch University Medical Center are surveyed yearly. To examine the effects of the ERP on academic achievement and motivational factors, regression analyses were used to compare ERP students to students showing ERP-interest only, adjusted for relevant baseline scores.

PARTICIPANTS

Out of the 315 students of the whole cohort, 56 participated within the ERP and are thus included. These ERP students are compared with 38 students showing ERP-interest only (ie, control group).

PRIMARY OUTCOME MEASURE

Academic achievement after 2 years (ie, in-time bachelor completion, bachelor grade point average (GPA)) and motivational factors after 18 months (ie, intrinsic motivation for research, research self-efficacy, perceptions of research, curiosity).

RESULTS

ERP participation is related to a higher odds of obtaining a bachelor degree in the appointed amount of time (adjusted OR=2.95, 95% CI 0.83 to 10.52). Furthermore, starting the ERP resulted in higher levels of intrinsic motivation for research, also after adjusting for gender, age, first-year GPA and motivational baseline scores (β=0.33, 95% CI 0.04 to 0.63). No effect was found on research self-efficacy beliefs, perceptions of research and curiosity.

CONCLUSIONS

Previous research suggested that intrinsic motivation is related to short-term and long-term research engagement. As our findings indicate that starting the ERP is related to increased levels of intrinsic motivation for research, ERPs for undergraduates could be seen as an important first step in the physician-scientist pipeline.

Academic Success Experiences: Promoting Research Motivation andSelf-Efficacy Beliefs among Medical Students

THEORY

Medicine is facing a physician-scientist shortage. Medical training could contribute to developing physician-scientists by stimulating student research involvement, as previous studies showed this is related to research involvement in professional practice. Motivation for research and research self-efficacy beliefs are related to student research involvement. Based on social cognitive theory, success experiences in doing research may enhance research motivation and self-efficacy beliefs. However, the role and type of success experiences in promoting research self-efficacy beliefs and motivation especially early in medical training has not yet been investigated. Therefore, we examined if academic success experiences within an undergraduate course in academic and scientific skills increased research motivation and self-efficacy beliefs among medical students. Furthermore, type of success experience was taken into account by looking at the effects of academic success experiences within standard (i.e., exam) versus authentic (i.e., research report and oral presentation) assessments.

HYPOTHESES

It was hypothesized that academic success experiences increase intrinsic motivation for research and self-efficacy beliefs. Furthermore, we hypothesized that authentic assessments influence intrinsic motivation for research and self-efficacy beliefs to a larger degree than standard assessments, as the authentic assessments mirror real-world practices of researchers.

METHOD

First-year undergraduate medicine students followed a course in academic and scientific skills in which they conducted research individually. Their academic success experiences were operationalized as their grades on two authentic research assessments (written report and oral presentation) and one less authentic assessment (written exam). We surveyed students before the course when entering medical school (i.e., baseline measure) and 1 year after the course in their 2nd year (i.e., postmeasure). Both the baseline and postmeasure surveys measured intrinsic motivation for research, extrinsic motivation for research, and research self-efficacy beliefs. Linear regression analyses were used to examine the relationship between academic success experiences and intrinsic motivation for research, extrinsic motivation for research, and research self-efficacy beliefs on the postmeasure. We adjusted for prior research motivation and self-efficacy beliefs at baseline. Therefore, this adjusted effect can be interpreted as an increase or decrease in motivation. In addition, we adjusted for age, gender, and grade point average (GPA) of the first 4 months, as these variables were seen as possible confounders.

RESULTS

In total, 243 of 275 students participated (88.4%). Academic success experiences in writing and presenting research were related to a significant increase in intrinsic motivation for research. After adjusting for prior GPA, only the effect of presenting remained. Experiencing success in presenting enhanced research self-efficacy beliefs, also after adjusting for prior GPA. Higher grades on the exam did not affect intrinsic motivation for research or research self-efficacy significantly. Also, none of the success experiences influenced extrinsic motivation for research.

CONCLUSIONS

Academic success experiences on authentic research tasks, especially presenting research, may be a good way to enhance intrinsic motivation for research and research self-efficacy beliefs. In turn, research motivation and self-efficacy beliefs promote research involvement, which is a first step in the physician-scientist pipeline. Furthermore, this study established the applicability of the social cognitive theory in a research context within the medical domain.

Development of research methods curriculum for an integrated care fellowship

OBJECTIVE

To describe the design and delivery of a curriculum in research methods for clinical fellows in integrated care.

METHOD

To design the curriculum, a standard curriculum development approach was applied through an iterative improvement process with input from researchers, clinical educators, and the first cohort of fellows. The curriculum has three central goals: (1) develop fellows' capacity to interpret the integrated care literature and apply findings in practice; (2) develop fellows' capacity for conducting quality improvement programs informed by knowledge of clinical research methods; and (3) enhance workforce capacity for practice-based research partnerships by increasing research understanding among clinical providers. A variety of educational strategies were employed to introduce each research method and apply these to the integrated care literature.

RESULTS

A description, rationale, and resources for each content domain is presented. The curriculum was delivered to two cohorts of fellows. Evaluation data supports the curriculum's relevance and quality.

CONCLUSIONS

A rigorous development process yielded a brief research curriculum targeting the needs of clinical fellows in integrated care. The curriculum is well-received by fellows and adaptable for other subspecialties. It may serve as a model for other clinical training programs seeking to enhance their fellows' fluency in research methods.

Preliminary results of a clinical research and innovation scholarship to prepare medical students to lead innovations in health care

There is consensus amongst national organizations to integrate health innovation and augmented intelligence (AI) into medical education. However, there is scant evidence to guide policymakers and medical educators working to revise curricula. This study presents academic, operational, and domain understanding outcomes for the first three cohorts of participants in a clinical research and innovation scholarship program.

Physician-scientist or basic scientist? Exploring the nature of clinicians' research engagement

Theoretical understanding of what motivates clinician researchers has met with some success in launching research careers, but it does not account for professional identification as a factor determining sustained research engagement over the long-term. Deeper understanding of clinicians' research-related motivation may better foster their sustained research engagement post-training and, by extension, the advancement of medicine and health outcomes. This study used an integrated theoretical framework (Social Cognitive Career Theory and Professional Identity Formation) and appreciative inquiry to explore the interplay of professional identification and research context in shaping post-training research success narratives. To foreground professional identification, 19 research-active clinicians and 17 basic scientists served as interviewees. A multi-institutional, multi-national design was used to explore how contextual factors shape external valuation of research success. The findings suggest that research-active clinicians do not identify as the career scientists implied by the modern physician-scientist construct and the goal of many clinician research-training programs. Their primary identification as care providers shapes their definition of research success around extending their clinical impact; institutional expectations and prevailing healthcare concerns that value this aim facilitate their sustained research engagement. Integrated developmental and organizational interventions adaptive to research context and conducive to a wider range of medical inquiry may better leverage clinicians' direct involvement in patient care and advance progress toward human health and well-being.

MD-PhD Program Graduates' Engagement in Research: Results of a National Study

PURPOSE

To determine if specialty, among other professional development and demographic variables, predicted MD-PhD program graduates' research engagement.

METHOD

The authors merged the 2015 Association of American Medical Colleges (AAMC) National MD-PhD Program Outcomes Survey database with selected data from the AAMC Student Records System, Graduation Questionnaire, and Graduate Medical Education (GME) Track Resident Survey. At the person level, they tested variables of interest for independent associations with MD-PhD graduates' research engagement using chi-square, Pearson correlations, and analysis of variance tests and logistic and linear regressions.

RESULTS

Of 3,297 MD-PhD graduates from 1991-2010 who were no longer in GME training in 2015, 78.0% (2,572/3,297) reported research engagement. In models controlling for several variables, a neurology (vs internal medicine; adjusted odds ratio [AOR]: 2.48; 95% confidence interval [CI]: 1.60-3.86) or pathology (vs internal medicine; AOR: 1.89; 95% CI: 1.33-2.68) specialty, full-time faculty/research scientist career intention at graduation (vs all other career intentions; AOR: 3.04; 95% CI: 2.16-4.28), and ≥ 1 year of GME research (vs no GME research year[s]; AOR: 2.45; 95% CI: 1.96-3.06) predicted a greater likelihood of research engagement. Among graduates engaged in research, the mean percentage of research time was 49.9% (standard deviation 30.1%). Participation in ≥ 1 year of GME research (beta [β] coefficient: 7.99, P < .001) predicted a higher percentage of research time, whereas a radiation oncology (β: -28.70), diagnostic radiology (β: -32.92), or surgery (β: -29.61) specialty, among others, predicted a lower percentage of research time (each P < .001 vs internal medicine).

CONCLUSIONS

Most MD-PhD graduates were engaged in research, but the extent of their engagement varied substantially among specialties. Across specialties, participation in research during GME may be one factor that sustains MD-PhD graduates' subsequent early- to midcareer research engagement.

Building a System to Engage and Sustain Research Careers for Physicians

There are increasing needs for physician-investigators to translate the rapid expansion of knowledge, technology/interventions, and big data into the clinical realm at a time of increasing age-related disabilities and communicable diseases. Yet, the number of physician-investigators has continued to decline, and only a small number of medical school graduates in the United States are actively engaged in research. This problem may be particularly pronounced in small- and medium-sized academic institutions due to more limited educational and mentoring infrastructure. Neither efforts by the federal government nor isolated institutional programs alone have been effective yet in solving this problem. This article describes an integrated institutional strategy undertaken at Penn State College of Medicine that is focused on developing and sustaining a physician-investigator workforce. Key elements of this strategy are new programs to close gaps in the professional life cycle of physician-investigators, dedicated senior leaders collaborating with an experienced and diverse advisory committee, and a data-driven approach to programmatic evaluation. In this article, the implementation of integrated institutional programs including Institutional Mock Review for evaluation of grant proposals before submission, physician-scientist faculty mentoring, and effort matching programs are described. Detailed tactics are offered for tailoring these programs to a particular institution's background to maximize both efficiency and sustainability. The overarching strategy includes engaging multidisciplinary faculty as mentors and mentees, partnering with both clinical and basic science departments, integrating new programs with established approaches, and cultivating an emerging generation of physician-investigators as near-peer mentors and future leaders. This approach may serve as a useful paradigm for building an environment to nurture junior physician-investigators at other mid-sized academic institutions and may also have value for larger institutions in which there is fragmentation of the efforts to sustain the research careers of physicians.

Breaking Tradition to Bridge Bench and Bedside: Accelerating the MD-PhD-Residency Pathway

PROBLEM

Physician-scientists are individuals trained in both clinical practice and scientific research. Often, the goal of physician-scientist training is to address pressing questions in biomedical research. The established pathways to formally train such individuals are mainly MD-PhD programs and physician-scientist track residencies. Although graduates of these pathways are well equipped to be physician-scientists, numerous factors, including funding and length of training, discourage application to such programs and impede success rates.

APPROACH

To address some of the pressing challenges in training and retaining burgeoning physician-scientists, New York University Grossman School of Medicine formed the Accelerated MD-PhD-Residency Pathway in 2016. This pathway builds on the previously established accelerated 3-year MD pathway to residency at the same institution. The Accelerated MD-PhD-Residency Pathway conditionally accepts MD-PhD trainees to a residency position at the same institution through the National Resident Matching Program.

OUTCOMES

Since its inception, 2 students have joined the Accelerated MD-PhD-Residency Pathway, which provides protected research time in their chosen residency. The pathway reduces the time to earn an MD and PhD by 1 year and reduces the MD training phase to 3 years, reducing the cost and lowering socioeconomic barriers. Remaining at the same institution for residency allows for the growth of strong research collaborations and mentoring opportunities, which foster success.

NEXT STEPS

The authors and institutional leaders plan to increase the number of trainees who are accepted into the Accelerated MD-PhD-Residency Pathway and track the success of these students through residency and into practice to determine if the pathway is meeting its goal of increasing the number of practicing physician-scientists. The authors hope this model can serve as an example to leaders at other institutions who may wish to adopt this pathway for the training of their MD-PhD students.

Participant perspectives on a seminar-based research career development program and its role in career independence

Health science researchers need training and support to effectively pursue independence in their research careers. Little data exist regarding the specific resources that faculty researchers have found or would find useful. In this study, we aimed to better understand the needs of health science researchers to develop recommendations for effective career development programming. The authors conducted a multi-method evaluation of early-career researcher faculty needs beginning by using post-session satisfaction surveys to assess the value of a long-standing "K-Club" seminar, which educates and supports those pursuing NIH Career Development (K) awards or similar. The authors then collected in-depth views on career development needs through a series of focus groups conducted with health science researchers at three career stages: early career, award-seeking junior faculty; mid-career faculty who have obtained some extramural funding; senior faculty who serve as mentors for early/mid-career faculty. Participants who attended the existing K-Club strongly endorse the program in supporting their career goals. Focus group participants described specific areas for program expansion that would add value across career stages: more flexible training options, conducted in smaller group settings with immediate feedback provided; more formalized training and resources for senior research mentors; in-depth guidance on individualized grantsmanship. The authors propose program development guidelines for helping researchers achieve research independence and success. Findings indicate that a broad-reaching K-Club style educational seminar can serve as a valuable foundation supporting professional development. The addition of tailored programs delivered across diverse platforms are predicted to heighten career development success.

Status of the Clinician Investigator in America: An Essential Healthcare Provider Driving Advances in Cancer Care

BACKGROUND

Translation of basic discoveries to clinical care for patients with cancer is a difficult process greatly enabled by physician-trained researchers. Three categories of physicians, with responsibilities spanning from laboratory and preclinical research to direct patient care, are involved in the translational research continuum: physician-scientist (PS), clinician investigator (CI), and academic clinician (AC).

METHODS

To define how protected time for research efforts is supported, the Association of American Cancer Institutes (AACI) conducted a survey of their member institutions, obtaining 56 responses documenting time spent in research and clinical activities across multiple cancer disciplines, and providing information about funding streams for the different categories of cancer physicians.

RESULTS

Responses showed that PSs and ACs are minimally involved in clinical research activities; the driver or clinical research in academic cancer centers is the CI. A significant concern was a lack of stable funding streams for nonbillable clinical research activities, putting the sustainability of the CI in jeopardy. Limited funding was derived from hospital sources, with most support derived from cancer center sources.

CONCLUSIONS

This study highlights the importance of the CI in translational cancer medicine and represents a call to action for institutions and research funding agencies to develop new programs targeted toward CI support to ensure continued progress against cancer.

STAR-EM: An innovative summer research program for medical students

We describe a novel 10-week summer research program aimed at developing academic emergency medicine (EM) interest among medical students. A cohort of students was recruited to participate in the Summer Training and Research in Emergency Medicine (STAR-EM) program with the primary goal of completing and disseminating a scholarly project. Curriculum development and program evaluation were informed by Kern's model and Kirkpatrick's hierarchy, respectively. Students and faculty demonstrated interest in academic EM and research productivity during the curriculum. This program provides a model for other emergency departments seeking to foster the development of academic EM at their institution.

Promoting positive perceptions of and motivation for research among undergraduate medical students to stimulate future research involvement: a grounded theory study

BACKGROUND

Research is of great value to make advancements within the medical field and, ultimately, offer the best possible patient care. Physician-scientists are key in contributing to the development of medicine, as they can bridge the gap between research and practice. However, medicine currently faces a physician-scientist shortage. A possible solution to cultivate physician-scientists is to engage medical students in research in early phases of medical school. Evidence-based strategies to stimulate positive perceptions of and motivation for research among students could help to enhance research engagement. Consequently, understanding of students' perceptions of and motivation for research is needed. Therefore, this study aimed to identify conditions under which students develop positive perceptions of and motivation for research by answering the following sub-questions: 1) how do first-year medical students perceive research? and 2) which factors contribute to motivation or demotivation for conducting research?

METHODS

We conducted a qualitative study with individual interviews using a grounded theory approach, involving 13 purposively sampled first-year medical students at Leiden University Medical Center.

RESULTS

Our results suggest that first-year students are already able to identify many aspects of research. Students elaborated on the relevance of research for professional practice and personal development. Furthermore, our results suggest a relationship between perceptions of and motivation for research. Some perceptions were identical to motivating or demotivating factors to conduct research, like the relevance of research for practice and performing statistics respectively. Other motivating factors were, among others, acknowledgment, autonomy, and inspiring role models. Demotivating factors were, among others, lack of autonomy and relevance, and inadequate collaboration.

CONCLUSIONS

Our results contribute to the idea that perceptions of research are related to motivation for research, which offers possibilities for interventions to promote motivation for research by making use of student perceptions of research. Consequently, practical implications to stimulate research engagement in early phases of medical school are provided. Moreover, the results contribute to existing motivational theories like Theory of Planned Behavior and Self-Determination Theory within this specific domain.

Impact of a Respiratory Disease Young Investigators' Forum on the Career Development of Physician-Scientists

Background: To reverse the dramatic decline in the U.S. physician-scientist workforce, interventions are necessary to retain physicians in research careers.

Objective: To evaluate the impact of an annual 3-day symposium, the Respiratory Disease Young Investigators' Forum (RDYIF), designed to guide fellows and junior faculty into successful physician-scientist careers.

Methods: In this retrospective, observational study, a questionnaire was e-mailed to 308 physicians who participated in the RDYIF between 2005 and 2018. The questionnaire was administered by National Jewish Health study personnel in the spring of 2019. Responses were primarily analyzed using descriptive and qualitative approaches.

Results: The response rate was 39.3% (n = 121), with 107 of responders (88.4%) completing the full survey. The majority of survey completers currently worked as physician-scientists (76.6%; n = 82), held faculty positions (88.8%; n = 95) in an academic center (90.6%; n = 97), and were currently involved in research (93.4%; n = 100). The majority had been an author on ≥10 peer-reviewed publications (61.3%, n = 65) and had been awarded research grants (71.7%; n = 76). Thirty completers (28.3%) had served as a principal investigator on one or more clinical trials. Completers indicated that participation in the RDYIF had a "strong impact" or "very strong impact" on their career development as physician-scientists.

Conclusion: Participation in the RDYIF strengthened participants' interest in physician-scientist careers and appeared to track with successful career development. Young Investigator Forums such as the RDYIF may be an effective intervention to support the declining supply of physician-scientists in North America.

Past, present and future of university hospitals

Objectives: Health care systems worldwide are changing and taking new forms. The old, more hierarchically oriented, model with individual institutional and bilateral interactions between primary, secondary, tertiary and quaternary care is being replaced by an integrated and dynamic network model. We aim to look at what role university hospitals will play in this future organization of health care.Method: In this paper, we look at the relevant literature on the history of academic medicine and university hospitals. Subsequently, we look at the challenges university hospitals are facing according to contemporary literature on the topic.Results: Our current model of academic medicine with its university hospitals finds its origin in the institutionalization of the academic mission in the late 18^th century. Currently, the sustainability of the model is under immense pressure. University hospitals are facing economic challenges, teaching challenges and research challenges. However, there is reason to believe that they can continue to play a role of importance in tomorrow's medicine. The organization of health care is undergoing two important changes. The first is the evolution towards a more dynamic and integrated network model. University hospitals can become an important hub within this network. The second change is an evolution towards evidence based medicine and translational research.Conclusion: Due to their unique tripartite mission, we argue that university hospitals can continue to play an important and critical role in promoting evidence-based medicine and speedy translation of new evidence.

Integrating clinical and research training in child psychiatry: fifteen-year outcomes of a federally supported program

BACKGROUND

The Albert J. Solnit Integrated Training Program (AJSP) is an educational initiative designed to prepare physician-scientists for independent careers in the investigation and treatment of childhood psychiatric disorders.

METHODS

We compared fifteen cohorts (each representing a consecutive year of matriculation) of AJSP trainees and graduates (n = 30) to peers who were comparably ranked in our original match lists but ultimately pursued residency programs elsewhere (n = 60). Outcomes of interest between the two groups included professional affiliation, as measured by: (1) membership in the American Academy of Child and Adolescent Psychiatry (AACAP); and (2) certification by the American Board of Psychiatry and Neurology (ABPN), as well as three domains of research productivity: (1) Competitive awards received from AACAP; (2) Publication-related metrics derived from the National Library of Medicine (NLM); and (3) Federal grant funding from the National Institutes of Health (NIH).

RESULTS

AJSP participants were more commonly affiliated with AACAP and board certified in CAP. AJSP graduates and trainees outperformed their control group peers in several research outcomes: (1) Receipt of AACAP awards and number of awards per recipient were higher, and time to first award shorter in the AJSP than in the control group; (2) AJSP participants had more publications in PubMed, more first-authored publications, a higher h-index, and a shorter time to first publication than participants in the control group; and (3) NIH K- or R-series funding success rate was higher among AJSP participants (p < 0.05 for all comparisons).

CONCLUSIONS

A program designed to support the development of clinician-scientists specifically dedicated to childhood mental health needs has been successful in fostering scientific creativity, productivity and independence. The expansion and replication of similar training initiatives will be an in important step forward to address the high level of morbidity and mortality associated with child and adolescent psychiatric disorders.

Is Dedicated Research Time During Surgery Residency Associated With Surgeons' Future Career Paths?: A National Study

OBJECTIVE

We examined associations between participation in ≥1 year of research during general surgery residency and each of full-time academic-medicine faculty appointment and mentored-K and/or Research Project Grant (RPG, including R01 and other) awards.

SUMMARY BACKGROUND DATA

Many surgeons participate in ≥1 year of research during residency; however, the relationship between such dedicated research during general surgery residency and surgeons' career paths has not been investigated in a national study.

METHODS

We analyzed deidentified data through August 2014 from the Association of American Medical Colleges, American Board of Medical Specialties, and the National Institutes of Health Information for Management, Planning, Analysis, and Coordination II grants database for 1997 to 2004 US medical-school graduates who completed ≥5 years of general surgery graduate medical education (GME) and became board-certified surgeons. Using multivariable logistic regression models, we identified independent predictors of faculty appointment and K/RPG award, reporting adjusted odds ratios (AOR) and 95% confidence intervals (CI) significant at P < 0.05.

RESULTS

Of 5328 board-certified surgeons, there were 1848 (34.7%) GME-research participants, 1658 (31.1%) faculty appointees, and 58 (1.1%) K/RPG awardees. Controlling for sex, debt, MD/PhD graduation, and other variables, GME-research participants were more likely to have received faculty appointments (AOR 1.790; 95% CI 1.573-2.037) and federal K/RPG awards (AOR 4.596; 95% CI 2.355-8.969).

CONCLUSIONS

Nationally, general surgery GME-research participation was independently associated with faculty appointment and K/RPG award receipt. These findings serve as benchmarks for general surgery residency programs aiming to prepare trainees for careers as academicians and surgeon-scientists.

The Molecular Medicine Investigation Unit: Linking Patient Care and Scientific Inquiry in Physician-Scientist Training

BACKGROUND

Medical innovation depends on translation, the process of applying clinical insights to solve biological problems, and vice versa, yet existing training programs provide few opportunities for physician-scientists to integrate their clinical and research training.

OBJECTIVE

We developed and determined the feasibility and acceptability of a rotation on the Molecular Medicine Investigation Unit (MMIU), a novel program that engages trainees in the deliberate linkage of patient care and scientific inquiry to cultivate their interest and skills in translation.

METHODS

Between July 2017 and January 2019, fourth-year medical students and internal medicine residents were offered a 4-week elective rotation on the MMIU. Supervised by 2 part-time faculty, trainees evaluated patients with unusual and perplexing presentations with the goal of generating hypotheses and a research plan to elucidate the underlying mechanisms of disease. We tracked the development of research hypotheses and resulting projects and surveyed participants about their satisfaction with the program.

RESULTS

Over 18 months, 21 trainees (11 medical students and 10 residents) participated in the program and evaluated a total of 70 patients. Trainees generated a mechanistic hypothesis in 45 (64%) cases, and this resulted in a patient-centered research project in 38 (54%) cases. Trainees unanimously agreed that the program gave them an opportunity to integrate their clinical and research training, and many expressed that it reinforced their interests in translational research.

CONCLUSIONS

With modest funding support, it was feasible to deliver authentic experiences of translational inquiry for medical students and internal medical residents, and these experiences were valued by trainees.

Gender, Race, and Grant Reviews: Translating and Responding to Research Feedback

Grant-writing and grant-getting are key to success in many academic disciplines, but research points to gender gaps in both, especially as careers progress. Using a sample of National Institutes of Health (NIH) K-Awardees-Principal Investigators of Mentored Career Development Awards-we examined gender and race effects in response to imagined negative grant reviews that emphasized either promise or inadequacy. Women translated both forms of feedback into worse NIH priority scores than did men and showed reduced motivation to reapply for funding following the review highlighting inadequacy. Translation of feedback mediated the effects of gender on motivation, changing one's research focus, and advice-seeking. Race effects were less consistent, and race did not moderate effects of gender. We suggest that gender bias in grant reviews (i.e., greater likelihood of highlighting inadequacy in reviews of women's grants), along with gender differences in responsiveness to feedback, may contribute to women's underrepresentation in academic medicine.

Critical Gaps in Understanding the Clinician-Scientist Workforce: Results of an International Expert Meeting

Clinician-scientists-health care professionals expert in research and clinical practice-can play a vital role in translating research outcomes to clinical practice. Concerns about the sustainability of the clinician-scientist workforce have been expressed in the literature for decades. Although many have made recommendations to increase the clinician-scientist workforce, there has been no substantial change. Therefore, an international expert meeting was held in March 2017 in Utrecht, the Netherlands, with the goal of discovering unidentified gaps in our understanding of challenges to the sustainability of the clinician-scientist workforce. Nineteen individuals (steering committee members; representatives from the AAMC, AFMC, and RCPSC; and physician-scientists, nurse-scientists, education scientists, deans, vice deans, undergraduate and postgraduate program directors, and a medical student) from Canada, the Netherlands, the United States, and Singapore participated in the meeting. The meeting identified 3 critical questions to be addressed: (1) What is the particular nature of the clinician-scientist role? (2) How are clinician-scientists to be recognized within the health and health research ecosystem? and (3) How can the value that clinician-scientists add to translational medicine and research be clarified to stakeholders and the public? The meeting participants identified a 3-fold agenda to address these questions: articulating the value proposition of clinician-scientists, supporting professionalization and professional identity development, and integrating clinical and research training. Addressing the 3 critical questions will likely contribute to a wider recognition of the value of clinician-scientists and be a first step in advancing from recommendations toward system-level changes to reinvigorate the clinician-scientist workforce.

Scientific activity by medical students: the relationship between academic publishing during medical school and publication careers after graduation

INTRODUCTION

Engagement of clinicians in research is important for the integration of science and clinical practice. However, at this moment, there is a shortage of clinician-scientists. Success experiences can stimulate student interest in a research career. Conducting actual research leading to publication is a potential method to gain success experience. This study assessed whether publication as a medical student is associated with publication after graduation. We determined whether medical students in the Netherlands who are involved in research, as measured by publication in international journals before graduation: 1) are more likely to publish, 2) publish a greater number of papers, and 3) have higher citation impact scores after graduation.

METHODS

We matched 2005-2008 MD graduates (with rare names, n = 4145 in total) from all eight Dutch university medical centres to their publications indexed in the Web of Science and published between 6 years before and 6 years after graduation. For sensitivity analysis we performed both automatic assignment on the whole group and manual assignment on a 10% random sample.

RESULTS

Students who had published before graduation: 1) were 1.9 times as likely to publish, 2) published more papers, and 3) had a slightly higher citation impact after graduation.

DISCUSSION

Medical students who conducted research leading to a publication before graduation were more likely to be scientifically active after graduation. While this is not a causal relationship per se, these results cautiously suggest that successful early involvement in research could influence the long-term scientific activity of clinicians.

Fostering the physician-scientist workforce: a prospective cohort study to investigate the effect of undergraduate medical students' motivation for research on actual research involvement

OBJECTIVES

The medical field is facing a physician-scientist shortage. Medical schools could contribute to developing physician-scientists by stimulating student involvement in research. Studies have examined motivation for research as a key parameter of success. However, previous studies did not investigate if students act on their self-reported motivation. The aim of this study is to examine if motivation for research of medical students is related to actual research involvement. Furthermore, this study distinguishes intrinsic (IM) and extrinsic motivation (EM) for research and aims to investigate if a type of motivation matters in the relation between research motivation and involvement.

DESIGN AND SETTING

Prospective cohort study in which students were surveyed at the start of medical school and reported IM and EM for research, self-efficacy, perceptions of research and curiosity on a 7-point Likert scale. One year later, students involved in research were identified. Logistic regression was used to examine influences of IM and EM on research involvement.

PARTICIPANTS

All undergraduate medical students starting at one medical school in the Netherlands in 2016. In total, 315 out of 316 students participated (99.7%), of whom 55 became involved in research (17.5%).

MAIN OUTCOME MEASURE

Research involvement, which was operationalised as the enrolment of students in the research-based honours programme or the involvement of students in voluntary research activities outside of the regular curriculum.

RESULTS

Students with higher levels of IM were more often involved in research (OR 3.4; 95% CI 2.08 to 5.61), also after adjusting for gender, age, extracurricular high school activities, self-efficacy, perceptions and curiosity (OR 2.5; 95% CI 1.35 to 4.78). Higher levels of EM increased the odds of research involvement (OR 1.4; 95% CI 0.96 to 2.11). However, the effect of EM disappeared after adjusting for the above-mentioned factors (OR 1.05; 95% CI 0.67 to 1.63). Furthermore, the effect of IM remained after adjusting for EM, whereas the effect of EM disappeared after adjusting for IM.

CONCLUSIONS

Our findings suggest that the type of motivation matters and IM influences research involvement. Therefore, IM could be targeted to stimulate research involvement and could be seen as the first step towards success in fostering the physician-scientist workforce.