Author + information
- Mohamed Boutjdir, PhDa,b,c,∗ (, )@nih_nhlbi,
- Ademuyiwa S. Aromolaran, PhDa,b,
- Lisa de las Fuentes, MDd,e,
- Josephine E.A. Boyington, PhDf,
- Sonia S. Arteaga, PhDf,
- Jared Jobe, PhDg,
- Donna B. Jeffe, PhDh,
- D.C. Rao, PhDd,
- Treva K. Rice, PhDd and
- Victor G. Davila-Roman, MDe
- aDepartments of Medicine, Cell Biology and Pharmacology, State University of New York, New York, New York
- bVA New York Harbor Healthcare System, New York, New York
- cDepartment of Medicine, New York University, New York, New York
- dDivision of Biostatistics, Washington University in St. Louis School of Medicine, St. Louis, Missouri
- eCardiovascular Division, Washington University in St. Louis School of Medicine, St. Louis, Missouri
- fDivision of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, Bethesda, Maryland
- gDivision of Cardiovascular Sciences (Retired), National Heart, Lung, and Blood Institute, Bethesda, Maryland
- hDivision of General Medical Sciences, Department of Medicine, Washington University in St. Louis School of Medicine, St. Louis, Missouri
- ↵∗Address for correspondence:
Dr. Mohamed Boutjdir, State University of New York Downstate Medical Center, VA New York Harbor Healthcare System, Research and Development Office (151), 800 Poly Place, Brooklyn, New York 11209.
The percentage of biomedical, behavioral, and clinical under-represented minority (URM) junior faculty is lower than their respective populations in the United States; whereas racial and ethnic minorities (African Americans, Hispanic Americans/Latinos, American Indians, Alaska Natives, Native Hawaiian, Pacific Islanders) comprise 32% of U.S. residents, they represent only 8% of medical school faculty (1,2). As URM faculty play a “distinctive and fundamental role in the teaching, research, and service missions of higher education,” the lack of academic diversity in biomedical science and medicine hinders efforts to address inequities in health outcomes (3). Cardiovascular disease (CVD) is the leading cause of death in United States and globally (4). Furthermore, racial/ethnic groups in the United States are disproportionately burdened by CVD, resulting in major health disparities.
Herein, we report the 12-year outcomes of a National Heart, Lung, and Blood Institute (NHLBI) program (Summer Institute Program to Increase Diversity [SIPID], renamed “Programs to Increase Diversity Among Individuals Engaged in Health Related Research” [PRIDE]) focused on CVD at 2 academic institutions: State University of New York Downstate Medical Center at Brooklyn (SUNY-Downstate) and Washington University School of Medicine (WUSM) in St. Louis, Missouri (1,5–9).
Participants and program structure
Selected URM and/or disabled doctoral-level junior faculty from U.S. academic and/or health care institutions applied and were selected to participate in the SIPID/PRIDE program, which consists of 2 consecutive summers, the intervening academic year, a midyear meeting, and a workshop at the National Institutes of Health (NIH) (Figure 1). Summer training focused on 3 major areas: 1) didactic CVD courses; 2) mentoring, career development, academic promotion, and networking; and 3) grant proposal development, review, and funding strategies. Multidisciplinary didactic methods included seminars, group discussions, mentee presentations of research projects with mentor feedback, individual mentor-mentee and NHLBI program officials’ meetings, and peer-review NIH-style mock study sections.
Data collection and primary and secondary outcomes
Prospectively obtained longitudinal primary outcomes were: 1) grants submitted/awarded within 2 years post-training; 2) peer-reviewed publications; and 3) academic promotions. Secondary outcomes were: 1) Ragins-McFarlin-Mentor-Role-Instrument (RMMRI); 2) Clinical Research Appraisal Inventory (CRAI); and 3) program-specific satisfaction scores. Data were collected directly from mentees via online surveys at enrollment, during training, and annually. Analysis of grants funded based on degree (MD vs. PhD) and home institution focus (highest research activity vs. nonhighest research activity) was performed using the Carnegie Classification of higher education institutions.
Of the 297 applicants, 136 junior faculty from 93 U.S. institutions matriculated during 2006 to 2018 and were: African Americans (n = 107; 79%), Hispanic Americans (n = 26; 19%), or Native Americans (n = 3; 2%); of these, 90 (66%) were women; 96 (70%) PhDs (or equivalent doctoral degree), 36 (26%) MDs, and 4 (3%) MD/PhDs.
Grants submitted/awarded during and after 2 years post-training
After excluding data from 19 individuals from the 2017 to 2018 cohort who were still in training, 187 peer-reviewed grant applications were submitted by 117 mentees (during or after training), and 123 grants were awarded (success rate: 66%). These included 81 NIH grants (Table 1): K-awards (n = 23), R01s (n = 11), and other R-awards (n = 16; R03, R21, R34, R15, R13, and R56); and 42 non-NIH grants (i.e., American Heart Association, Robert Wood Johnson, Veterans Affairs, National Science Foundation, U.S. Department of Health and Human Services, Centers for Disease Control and Prevention). Collectively, the number of grants submitted (n = 187, or 1.6 grants/mentee) and awarded (n = 123, or 1.05 grants/mentee) is a remarkable accomplishment. Furthermore, 57% of those in the first 6 SIPID/PRIDE cohorts (n = 79) have already been awarded 1 or more grants. Together, these results suggest that the SIPID/PRIDE primary objective of grant submission within 2 years following completion of training has been met by the majority of mentees.
When the number of grants funded was analyzed as a function of degree (MD vs. PhD), there was no difference in the number of grants obtained by those with an MD compared with a PhD degree (r2 = 0.02; p = 0.45, nonpaired Student’s t-test). Analysis for home institution research activity at admission to SIPID/PRIDE program compared institutions with “highest research activity” versus “non-highest research activity” based on Carnegie classifications. Those mentees at “highest research activity” institutions received more grants compared with those from “nonhighest research activity” institutions (r2 = 0.67; p = 0.04, nonpaired Student’s t-test with unequal variances).
During and after training, 1,211 peer-reviewed papers were published by 117 mentees, representing 3.3 times the number of publications (n = 365) compared with prior to participation in SIPID/PRIDE.
A total of 41 (35%) mentees were promoted to Associate Professor or Professor; of these, 37 (27%) to Associate Professor and 4 (3%) to Professor.
The CRAI questionnaire, which measures research self-efficacy, surveyed longitudinally for 10 years, showed a consistent increase in research self-efficacy (total score: 7.0 at first year and 9.0 at tenth year); total score increase was largest during the first and second years (7.0 and 8.5, respectively). The self-efficacy ratings were significantly higher for 2 subscales (“writing papers” and “consent process”), compared with other subscales (“study design” and “collaborating on grants”).
The RMMRI mentoring assessment (surveyed during training and for 2 years after training), showed an increase in mentoring satisfaction during the first 2 years; the largest satisfaction score was for mentoring during the second year.
SIPID/PRIDE program satisfaction
Program, mentee and speaker satisfaction evaluated by use of a 6-point Likert rating (1 = strongly disagree, 6 = strongly agree) showed a high level of satisfaction (scores range: 5.5 to 5.8).
This is the largest, longest, and most comprehensive report of an NHLBI-sponsored URM training and mentoring program intended to increase diversity of the biomedical research workforce. The SIPID/PRIDE mentees were quite successful in achieving the primary and secondary outcomes of the program. The success rate for grant funding was 66% (average: 1.6 grants/mentee). Given that the 2017 overall NIH and NHLBI grant success rates were 19% and 36%, respectively, SIPID/PRIDE mentee grant funding success is impressive. Although there were no differences in the number of grants awarded across degree type (MD vs. PhD), URM mentees based at “highest research activity” home institutions were awarded more grants compared with those based at “non-highest research activity” institutions. These findings suggest potential benefits for URMs at highest-research institutions, at least early in their career potentially due to availability of institutional resources (i.e., training, mentoring, and/or infrastructure) that facilitate securing grant funding. As a result of SIPID/PRIDE training, the number of scientific publications also increased significantly (3.3 times the number of publications prior to program participation). The SIPID/PRIDE program emphasizes critical review of the scientific literature, discipline and organizational skills, and compelling/convincing writing. All of these skills likely contributed to the large number of grant applications and publications during/after training. Unfortunately, despite the high success with grant funding and scientific publications, only 34% were promoted to Associate Professor, suggesting that URM faculty continue to face challenges for academic promotions, an issue that has been previously reported (10). These findings suggest that academic promotion-specific awareness and mentoring is needed to bridge the gap of this important academic success metric.
Secondary outcomes included measures of satisfaction with the training program and mentoring and increased level of research self-efficacy during and after program participation. SIPID/PRIDE mentees expressed a high degree of satisfaction with the training program and mentoring. The primary and secondary outcomes are significant and encouraging, and likely attributed to the individualized training and mentoring program, which included periodic progress reports, networking, and NIH-style mock study sections. CRAI and RMMRI scores showed a high level of mentee research self-efficacy and satisfaction and a high level of mentor support. Furthermore, mentee self-efficacy increased over time, suggesting increased mentee research independence. Research skills in CVD are highly emphasized topics in SIPID/PRIDE programs, and as such, these finding meet program expectations. Concurrently, there was an increase in research self-efficacy over time as mentees became increasingly more confident with their critical thinking and writing skills. The NIH-style mock study sections, which are central to the NIH grant-funding process, allowed mentees to have their own grants reviewed by their peers and by senior faculty. This activity was extremely well received by mentees, and was considered an important exercise prior to submission to grant funding agencies. Finally, and equally importantly, the number of applicants (n = 297) far exceeded the number who matriculated in the program (n = 136), suggesting that there is an unmet need for additional opportunities for mentored-research training programs such as SIPID/PRIDE.
Efforts to diversify the biomedical workforce abound; yet, relatively little progress has been made to increase the number of URM faculty who are promoted and retained at the higher academic ranks. Career-based differences in research funding mentoring and academic promotion hinder URM faculty career-advancement through the academic ranks. In a national study of the career trajectories of academic medicine junior faculty first appointed to full-time instructor or Assistant Professor positions, 10-year probability of first promotion was lower and probability of attrition without promotion was higher for junior URM faculty compared with non-URM faculty (10). Furthermore, junior faculty who receive mentored K-awards have higher probability of promotion and lower probability of attrition compared with those who do not receive K-awards.
The lack of career advancement is a major reason for URM faculty attrition from research and/or academic careers. Compared with attrition among non-URM faculty, URM faculty attrition is higher at both junior and senior levels. Important contributors of URM faculty attrition include poor job satisfaction, perceived lack of opportunities and/or discrimination, overburdening with administrative responsibilities leading to lack of productivity, increased burnout, and a sense of isolation (3). On the other hand, formal training, mentorship, community building, networking and faculty connectivity, and increased availability of research and academic opportunities may mitigate attrition (2). Data on attrition from academia was not obtained on these cohorts. Even among those who have similar grant support, leadership roles, compensation, and career satisfaction, URM faculty have fewer publications and are less likely to be promoted and/or retained in academic careers compared to their non-URM peers (1). Successful retention of URM faculty requires comprehensive institutional commitment to changing the academic climate and deliberative programming to support productivity and advancement. All of these challenges were addressed in our SIPID/PRIDE programs.
The SIPID/PRIDE program is the largest, longest, and most successful URM research education and mentoring program in United States. In addition to focusing on CVD, instruction and mentoring from an experienced multidisciplinary faculty emphasized areas such as research methodology, grant writing and funding opportunities, grant peer-review process, academic career development, and networking. Findings from the present study show that the SIPID/PRIDE program exceeded expectations in key metrics of success used in academic medicine (i.e., grant funding, scientific publications and academic promotions), suggesting that the program represents a good investment to further develop a diverse biomedical workforce to improve the nation’s health.
The authors express appreciation and gratitude to the SIPID/PRIDE mentees, mentors, and faculty who contributed to this training program. The authors also thank the program staff for their valuable contributions: at SUNY-Downstate: Mr. Frank Fabris, Dr. Luther Clark, Dr. Girardin Jean-Louis, Dr. Judith Mitchell, and Mr. Freddy Zizi; and at WUSM: Ms. Linda Schreier, Dr. Susan Racette, Dr. Mario Castro, Dr. Michael Province, Dr. Aldi Kraja; as well as the coordination core staff: Ms. Tessa Gauzy.
This work was supported by National Heart, Lung, and Blood Institute grants R25 HL105446 and R25 HL085042 (to Dr. Boutjdir), R25 HL085040 and R25 HL105400 (to Drs. Rao and Davila-Roman), and R01-HL10-5408 (to Dr. Rice); and by National Institutes of Health/National Institute of General Medical Sciences grant R01 GM085350 and National Institutes of Health/National Human Genome Research Institute grant U24 HG009158 (both to Dr. Jeffe). The views expressed in this paper are those of the authors and do not necessarily represent the views of the National Heart, Lung, and Blood Institute, National Institutes of Health, or the Department of Health and Human Services. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Abbreviations and Acronyms
- clinical research appraisal inventory
- cardiovascular disease
- National Heart, Lung, and Blood Institute
- National Institutes of Health
- Program to Increase Diversity Among Individuals Engaged in Health-Related Research
- Ragins and McFarlin Mentor Role Instrument
- Summer Institute Program to Increase Diversity
- under-represented minority
- Received December 29, 2018.
- Accepted January 15, 2019.
- Boyington J.E.,
- Maihle N.J.,
- Rice T.K.,
- et al.
- Kaplan S.E.,
- Raj A.,
- Carr P.L.,
- Terrin N.,
- Breeze J.L.,
- Freund K.M.
- Benjamin E.J.,
- Virani S.S.,
- Callaway C.W.,
- et al.
- Rice T.K.,
- Liu L.,
- Jeffe D.B.,
- et al.
- Jean-Louis G.,
- Ayappa I.,
- Rapoport D.,
- et al.
- Fabris F.,
- Rice T.K.,
- Jeffe D.B.,
- Czajkowski S.M.,
- Boyington J.,
- Boutjdir M.
- Rice T.K.,
- Jeffe D.B.,
- Boyington J.E.A.,
- et al.
- Pace B.S.,
- Makala L.H.,
- Sarkar R.,
- et al.
- Jeffe D.B.,
- Yan Y.,
- Andriole D.A.