Abstract
Background: Long-term follow-up for clinician–scientist training programs is sparse. We describe the outcomes of clinician–scientist scholars in the National Heart Lung and Blood Institute (NHLBI) K12 program in emergency care research up to 8.7 years after matriculation in the program. Methods: This was a cohort study of faculty clinician–scientist scholars enrolled in a NHLBI K12 research training program at 6 sites across the US, with median follow-up 7.7 years (range 5.7–8.7 years) from the date of matriculation. Scholars completed electronic surveys in 2017 and 2019, with the 2019 survey collecting information for their current work setting, percent time for research, and grant funding from all sources. We used NIH RePorter and online resources to verify federal grants through March 2021. The primary outcome was a funded career development award (CDA) or research project grant (RPG) where the scholar was principal investigator. We included funding from all federal sources and national foundations. Results: There were 43 scholars, including 16 (37%) women. Over the follow-up period, 32 (74%) received an individual CDA or RPG, with a median of 36 months (range 9–83 months) after entering the program. Of the 43 scholars, 23 (54%) received a CDA and 22 (51%) received an RPG, 7 (16%) of which were R01s. Of the 23 scholars who received a CDA, 13 (56%) subsequently had an RPG funded. Time to CDA or RPG did not differ by sex (women vs. men log-rank test p = 0.27) or specialty training (emergency medicine versus other specialties, p = 0.59). Conclusions: After 7 years of follow-up for this NHLBI K12 emergency care research training program, three quarters of clinician–scientist scholars had obtained CDA or RPG funding, with no notable differences by sex or clinical training.
| Original language | English |
|---|---|
| Pages (from-to) | 1197-1204 |
| Number of pages | 8 |
| Journal | Academic Emergency Medicine |
| Volume | 29 |
| Issue number | 10 |
| DOIs | |
| State | Published - Oct 2022 |
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In: Academic Emergency Medicine, Vol. 29, No. 10, 10.2022, p. 1197-1204.
Research output: Contribution to journal › Article › peer-review
TY - JOUR
T1 - Outcomes of the National Heart, Lung, and Blood Institute K12 program in emergency care research
T2 - 7-year follow-up
AU - Morris, Cynthia D.
AU - Cook, Jennifer N.B.
AU - Lin, Amber
AU - Scott, Jane D.
AU - Kuppermann, Nathan
AU - Callaway, Clifton W.
AU - Yealy, Donald M.
AU - Lowe, Robert A.
AU - Richardson, Lynne D.
AU - Kimmel, Stephen
AU - Holmes, James F.
AU - Collins, Sean
AU - Becker, Lance B.
AU - Storrow, Alan B.
AU - Newgard, Harrison J.
AU - Baren, Jill
AU - Newgard, Craig D.
N1 - Funding Information: A 2014 Physician-Scientist Workforce Report from the National Institutes of Health (NIH) showed that the proportion of physician-scientists comprising the biomedical workforce has been declining since the 1970’s.1 The same report noted 13,700 active physician-scientists in the US, just over 1% of all American physicians.1 There have been a number of articles detailing the virtues of physician-scientists in the biomedical workforce, recommendations for increasing the pipeline, methods to decrease attrition, and unique threats to physician-scientists during the COVID-19 pandemic.2–5 These issues are particularly poignant for emergency care research, which has historically received a relatively small proportion of NIH research funding6 and has lacked a robust research workforce to translate clinical questions into high-quality and actionable research protocols.7,8 In recognition of the decline in the physician-scientist workforce, the NIH launched two career development programs targeting clinician-scientists in the 1990’s (i.e., the K08 and K23 individual mentored career development programs). The NIH also uses the K12 Clinical Scientist Institutional Career Development program as another mechanism for research training within distinct fields. Under the K12 mechanism, institutions (rather than individuals) are awarded based on the training environment, with potential scholars applying to the institutions (rather than directly to the NIH) for consideration. The K12 mechanism is often targeted by an institute for areas or specialties needing a catalyst to expand the scientific workforce. The success of these institutional awards, as evidenced by the success of individual clinician-scientists selected for the programs, are typically measured by the proportion of scholars subsequently obtaining an individual career development award (CDA) or a research project grant (RPG).9 There are limited studies tracking outcomes for K12 programs because such analyses typically require many years of follow-up. In 2018, we reported short-term scholar outcomes from the National Heart, Lung, and Blood Institute (NHLBI) K12 career development program in emergency care research.10 The NHLBI K12 program was the first large federal investment in emergency care research training, representing a $21.6 million investment in six sites across the US.11 In that report, we showed that 60% of scholars had secured independent CDA or RPG funding within 3 to 5 years of starting the K12 program,10 yet not all scholars had finished the program by the end of the follow-up period. Because successfully competing for research funding can take many years, particularly for RPG awards, longer duration follow-up would provide a better assessment of the impact of the K12 program. In this study, we describe the outcomes of scholars from the NHLBI K12 in emergency care research up to 8.7 years after matriculation into the program, including continued participation in research, a comprehensive assessment of subsequent independent grant funding, and time to funding. The K12 emergency care research training program included 43 clinician-scientists across the 6 sites (Table 1). We obtained follow-up information directly from 41 of 43 (95%) scholars. For the two scholars who did not respond, we confirmed the presence versus absence of research grants through NIH RePorter and publicly-available on-line sources. The median follow-up period was 7.7 years from the date of matriculation into the K12 program (range 5.7–8.7 years). The demographics of scholars are shown in Table 1. The mean age was 37 years, 37% were female, 11% were Black, and 8% were Hispanic. The majority of scholars (25 of 43, 58%) continued to participate in research for at least 50% of their professional time. Eight (19%) scholars reported spending 25–50% time on research, and 5 (12%) reported spending up to 25% time performing research (one scholar reported no research activity and four provided no estimate). One scholar trained in neurology and critical care. Many of the cohort characteristics were published in the 3–5 year outcome assessment.10 We considered the research grant outcomes (CDA or RPG) of scholars as a measure of successful funding as PI. Of the 43 scholars, 32 (74%) received a CDA or RPG as PI during the follow-up period (Table 2, Figure 1). The time to first CDA or RPG occurred a median 36 months (range 9–83 months) after entering the K12 program. During follow-up of the 43 scholars, 23 (54%) received a CDA and 22 (51%) received an RPG, 7 (16%) of which were R01s (Table 2). Table 3 shows the grant type and funding agencies for CDAs and RPGs. Of the 23 scholars who received a CDA, 13 (56%) subsequently had an RPG funded, which occurred a median of 32 months (inter-quartile range 23 to 44 months) after the award date for the CDA. In contrast, 9 of 20 (45%) scholars who did not receive a CDA obtained RPGs (median 38 months from the start of the K12 program, IQR 30–47 months). Of the 9 scholars who obtained RPGs without a CDA, two of the RPGs were R01 awards. Although the change in rate in Figure 1 begins to plateau at approximately 50 months from entry to the K12 program, there were scholars who continued to receive grant awards after 80 months. In Figure 2, we show Kaplan–Meier curves for time-to-funding, separated by CDA versus RPG grants. CDA, career development award; RPG, research project grant. Time to receipt of first individual career development award or research project grant as principal investigator since beginning the K12 program (n = 43) *95% CI shown. CDA, career development award; RPG, research project grant. Abbreviations: NHLBI, National Heart, Lung, and Blood Institute; NINDS, National Institute of Neurological Disorders and Stroke; NICHD, National Institute of Child Health and Human Development; NIGMS, National Institute of General Medical Sciences; NIDDK, National Institute of Diabetes and Digestive and Kidney Diseases; NIMHD, National Institute on Minority Health and Health Disparities; NIA, National Institute on Aging. Time to receipt of first career development award and (separately) first research project grant as principal investigator since beginning the K12 program (n = 43) *95% CI shown. CDA, career development award; RPG, research project grant. We investigated whether time to receipt of a CDA or RPG differed by scholar sex or specialty training. In Figure 3, we show that time to receipt of first CDA or RPG grant appeared longer for women (women median 37.5 months [IQR 34.1–49.1]; men median 30 months [IQR 26.1–38.1 months], p = 0.14), but the curves eventually align (log-rank test p = 0.27). When we evaluated time to grant funding by specialty training (emergency medicine versus other specialties, Figure 4), there was no difference between the groups (p = 0.59). Time to receipt of first individual career development award or research project grant as principal investigator since beginning the K12 program, by scholar sex (n = 43) *Log-rank test for difference in time to receipt by sex, p = 0.27. 95% CI shown. Time to receipt of first individual career development award or research project grant as principal investigator since beginning the K12 program, by specialty training (n = 43). EM, emergency medicine. *Log-rank test for difference in time to receipt by training, p = 0.59. 95% CI shown. The six sites funded in 2011 for the NHLBI K12 Program in Emergency Care Research11 included: Icahn School of Medicine at Mount Sinai (New York, NY); Oregon Health & Science University (Portland, OR); University of California, Davis School of Medicine (Sacramento, CA); University of Pennsylvania (Philadelphia, PA); University of Pittsburgh (Pittsburgh, PA); and Vanderbilt University Medical Center (Nashville, TN). While there was a separate, distinct 5-year trans-NIH K12 program starting in 2016, we report on the initial K12 program in emergency care research11 to provide a longer follow-up period. We conducted a prospective cohort study of scholars in the NHLBI K12 program in emergency care research using a participant survey, updated scholar curriculum vitaes (CVs), publicly available databases and on-line resources for subsequent grant funding. Each participant provided consent for inclusion and the Oregon Health & Science University institutional review board approved the study. The six sites funded in 2011 for the NHLBI K12 Program in Emergency Care Research11 included: Icahn School of Medicine at Mount Sinai (New York, NY); Oregon Health & Science University (Portland, OR); University of California, Davis School of Medicine (Sacramento, CA); University of Pennsylvania (Philadelphia, PA); University of Pittsburgh (Pittsburgh, PA); and Vanderbilt University Medical Center (Nashville, TN). While there was a separate, distinct 5-year trans-NIH K12 program starting in 2016, we report on the initial K12 program in emergency care research11 to provide a longer follow-up period. We obtained the names of K12 scholars affiliated with the six program sites throughout the duration of the program. The first scholar entered the program July 1, 2012 and the last scholar finished on November 8, 2017. The K12 program provided up to 3 years of support for each scholar, including salary support, comprehensive mentorship, formal research didactic training, and research expenses and education up to $25,000 annually. Programs guaranteed that each scholar had at least 75% protected time for research. There was also an annual meeting at the NIH for all sites, including K12 scholars, program directors, and program administrators from each site. Scholars completed an initial electronic survey in 2017 and a subsequent survey in 2019 using REDCap®. The initial survey included demographics (age, gender, race, and ethnicity), education, clinical training, primary academic appointment, post-K12 time spent on research, and grant applications submitted as a principal investigator (PI) following entry to the K12 program. These results were supplemented by qualitative data from interviews and reported in the initial evaluation of K12 scholar outcomes.10 Scholars completed a subsequent survey in July 2019, which included two questions (current work setting [academic versus clinical] and percent time for research) and a request to upload an updated CV. We abstracted all funded grants (including their role and funding sources) since the date of matriculation into the K12 program from the CVs. We used NIH RePorter (NIH, AHRQ and VA funding), the PCORI website, Grantome (https://grantome.com/), Google, and websites at the academic programs represented by scholars to verify grants through March 2021. To measure scholar productivity, we categorized funded grants with the scholar as PI as CDAs (including K01, K08, K23, VA CDA2, and similar multi-year grants from professional or research foundations) and RPGs9 (including R01, R03, R21, R33, R34, R61, VA Merit awards, and similar multi-year grant awards from professional or research foundations). As a subset of RPGs, we also examined R01 and equivalent awards (e.g., VA Merit awards). We did not consider industry funding for scholars, given the difficulty of differentiating investigator-initiated research from industry-led research. We only considered grants with scholars listed as PI (including multiple-PI grants) to focus on a scholar's achievement of independent research grant funding and the reporting capabilities of NIH RePorter and similar online websites. We used descriptive statistics to characterize the K12 scholars. For each scholar, we identified their first CDA or RPG in relation to the date they started the K12 program, which provided a consistent time zero for all scholars. We calculated the time interval from the date of the K12 appointment to the date of the first CDA and RPG grant and illustrated these intervals using Kaplan–Meier curves. We also compared Kaplan–Meier curves by sex and clinical specialty (emergency medicine versus other specialties) using the log-rank test. We conducted all analyses in Stata 16.1 (StataCorp, College Station, TX, USA) and considered a p value ≤0.05 to represent statistical significance. We conducted a prospective cohort study of scholars in the NHLBI K12 program in emergency care research using a participant survey, updated scholar curriculum vitaes (CVs), publicly available databases and on-line resources for subsequent grant funding. Each participant provided consent for inclusion and the Oregon Health & Science University institutional review board approved the study. Funding Information: This project was supported by NIH/NHLBI K12 awards at: Icahn School of Medicine at Mount Sinai (#K12 HL109005); Oregon Health & Science University (#K12HL108974); University of California, Davis Medical Center (#K12 HL108964); University of Pennsylvania (#K12 HL109009); University of Pittsburgh (#K12 HL109068); and Vanderbilt University Medical Center (#K12 HL109019). The views expressed in this manuscript are those of the authors and do not necessarily represent the views of the National Heart, Lung, and Blood Institute, the National Institutes of Health, or the U.S. Department of Health and Human Services. Funding Information: To measure scholar productivity, we categorized funded grants with the scholar as PI as CDAs (including K01, K08, K23, VA CDA2, and similar multi‐year grants from professional or research foundations) and RPGs (including R01, R03, R21, R33, R34, R61, VA Merit awards, and similar multi‐year grant awards from professional or research foundations). As a subset of RPGs, we also examined R01 and equivalent awards (e.g., VA Merit awards). We did not consider industry funding for scholars, given the difficulty of differentiating investigator‐initiated research from industry‐led research. We only considered grants with scholars listed as PI (including multiple‐PI grants) to focus on a scholar's achievement of independent research grant funding and the reporting capabilities of NIH RePorter and similar online websites. 9 Publisher Copyright: © 2022 Society for Academic Emergency Medicine.
PY - 2022/10
Y1 - 2022/10
N2 - Background: Long-term follow-up for clinician–scientist training programs is sparse. We describe the outcomes of clinician–scientist scholars in the National Heart Lung and Blood Institute (NHLBI) K12 program in emergency care research up to 8.7 years after matriculation in the program. Methods: This was a cohort study of faculty clinician–scientist scholars enrolled in a NHLBI K12 research training program at 6 sites across the US, with median follow-up 7.7 years (range 5.7–8.7 years) from the date of matriculation. Scholars completed electronic surveys in 2017 and 2019, with the 2019 survey collecting information for their current work setting, percent time for research, and grant funding from all sources. We used NIH RePorter and online resources to verify federal grants through March 2021. The primary outcome was a funded career development award (CDA) or research project grant (RPG) where the scholar was principal investigator. We included funding from all federal sources and national foundations. Results: There were 43 scholars, including 16 (37%) women. Over the follow-up period, 32 (74%) received an individual CDA or RPG, with a median of 36 months (range 9–83 months) after entering the program. Of the 43 scholars, 23 (54%) received a CDA and 22 (51%) received an RPG, 7 (16%) of which were R01s. Of the 23 scholars who received a CDA, 13 (56%) subsequently had an RPG funded. Time to CDA or RPG did not differ by sex (women vs. men log-rank test p = 0.27) or specialty training (emergency medicine versus other specialties, p = 0.59). Conclusions: After 7 years of follow-up for this NHLBI K12 emergency care research training program, three quarters of clinician–scientist scholars had obtained CDA or RPG funding, with no notable differences by sex or clinical training.
AB - Background: Long-term follow-up for clinician–scientist training programs is sparse. We describe the outcomes of clinician–scientist scholars in the National Heart Lung and Blood Institute (NHLBI) K12 program in emergency care research up to 8.7 years after matriculation in the program. Methods: This was a cohort study of faculty clinician–scientist scholars enrolled in a NHLBI K12 research training program at 6 sites across the US, with median follow-up 7.7 years (range 5.7–8.7 years) from the date of matriculation. Scholars completed electronic surveys in 2017 and 2019, with the 2019 survey collecting information for their current work setting, percent time for research, and grant funding from all sources. We used NIH RePorter and online resources to verify federal grants through March 2021. The primary outcome was a funded career development award (CDA) or research project grant (RPG) where the scholar was principal investigator. We included funding from all federal sources and national foundations. Results: There were 43 scholars, including 16 (37%) women. Over the follow-up period, 32 (74%) received an individual CDA or RPG, with a median of 36 months (range 9–83 months) after entering the program. Of the 43 scholars, 23 (54%) received a CDA and 22 (51%) received an RPG, 7 (16%) of which were R01s. Of the 23 scholars who received a CDA, 13 (56%) subsequently had an RPG funded. Time to CDA or RPG did not differ by sex (women vs. men log-rank test p = 0.27) or specialty training (emergency medicine versus other specialties, p = 0.59). Conclusions: After 7 years of follow-up for this NHLBI K12 emergency care research training program, three quarters of clinician–scientist scholars had obtained CDA or RPG funding, with no notable differences by sex or clinical training.
UR - http://www.scopus.com/inward/record.url?scp=85135870882&partnerID=8YFLogxK
U2 - 10.1111/acem.14563
DO - 10.1111/acem.14563
M3 - Article
C2 - 35848052
AN - SCOPUS:85135870882
SN - 1069-6563
VL - 29
SP - 1197
EP - 1204
JO - Academic Emergency Medicine
JF - Academic Emergency Medicine
IS - 10
ER -