September 30, 2008
The National Heart, Lung, and Blood Institute (NHLBI), Strategic Plan Training and Career Development Implementation Workgroup meeting was held July 30-31, 2008 in Bethesda, Maryland. Drs. Linda Van Horn, Chairperson, and Helena Mishoe opened the meeting both expressing sincere gratitude to all members who were able to attend. Dr. Susan Shurin, Deputy Director, NHLBI, provided opening comments and extended a welcome on behalf of Dr. Elizabeth Nabel, Director, NHLBI.
The workgroup provided insight regarding how to begin implementing the training Strategic Plan recommendations provided within the NHLBI Strategic Plan. The complete Strategic Plan is the culmination of over a two year period in conjunction with over 600 individuals and feedback from the NHLBI's many intermediary groups. Dr. Shurin charged the workgroup and asked that they also take into consideration the Strategic Plan recommendations that were provided as additional guidance to further ensure that the NHLBI scientific and professional training programs are well aligned with the research needs and opportunities for the future. As part of the research agenda, Dr. Shurin stressed the critical importance of including racial and ethnic groups and gender diversity in our training efforts.
Dr. Mishoe acknowledged the challenges ahead wherein the National Institutes of Health (NIH) must make a strategic shift to manage resources over the next several years while funding levels are not likely to change significantly. She stressed the importance of keeping a clear strategic vision when making recommendations regarding training resource allocation. She urged the group to help set priorities as the NHLBI moves forward to implement the training and career development Strategic Plan recommendations.
The workgroup encompassed a distinguished group of individuals with expertise in research training, clinical medicine, basic and translation research, clinical research, and the quantitative sciences. In addition, Drs. Helena Mishoe, Melissa Antman, Rina Das and Carl Roth, NHLBI staff members, made presentations to provide background and framework for several discussion questions that were addressed by the workgroup.
We anticipate that the complete program book will be made available in an electronic format in the near future. However, to provide context for this summary document the following materials were provided in the program book.
- Agenda and Invited Participants - (Pages 1-2, and Pages 14-15, respectively )
- NIH and NHLBI Research Training Applications and Awards Data (1999-2007)
- (Presentation made by Dr. Rina Das for Dr. Blaine Moore)
- NHLBI Training and Strategic Plan Recommendations considered by workgroup (Pages 11-13)
- (Presentation made by Dr. Helena O. Mishoe)
- Pilot Analysis of F, T, and K Awards Using the Functions of the Research, Condition, and Disease Categorization (RCDC) System
- (Presentation made by Dr. Melissa Antman)
- NHLBI Training Efforts in Epidemiology
- Special Research Training Initiatives and CTSA Training Opportunities
- Diversity Research Training Programs and Global Health Training Efforts
- New NHLBI Training Initiatives
- NHLBI Training Committee
- Slide set: Dr. Carl Roth Presentation entitled "NHLBI Training Grants: Funding Recommendations Received Council Concurrence"
- Definitions of Activity Codes: Training and Career Development Programs
- FY 2008 Funding and Operating Guidelines, NRSA and Career Development Awards, NHLBI
The workgroup was asked to provide input on six questions that focused on NHLBI research training priorities and professional competencies needed for the future. Discussions included approaches to training the best and the brightest scientists capable of rapidly bringing new information to the bedside as well as to communities, ensuring a future diverse research workforce, best approaches to mentoring, and exploring training policies that may enhance our training and career development efforts. The discussions often overlapped the various questions, but helped to sharpen the focus of specific topics and recommendations.
Questions 1 and 2
1. What are the 3-5 highest priority cross-cutting recommendations listed under Training Strategic Plan Recommendation? How should we move forward to implement the recommendations? Are there 'low hanging fruit' to be implemented now that will have an impact on trainees? Are there additional priority training needs that we have not identified? How can they be implemented in the most efficient manner?
2. What are the best approaches (strategies or mechanisms) to ensure that the scientific and professional competencies that will come to predominate are introduced into our training programs? Are there specific programs/partnerships that we should leverage to address strategic plan recommendations?
The discussion began in response to a comment made by NIH leadership in another forum that approximately 5 percent of the NIH grantees have a funded research career that spans 20 plus years. No data was available for consideration. Several workgroup members commented that the Training Strategic Plan recommendations focus predominately on recruitment efforts of young investigators into research careers. It must be acknowledged that we are clearly challenged with retaining research scientists that have a sustainable career, which is likely due in large part to the shortage and high competition for limited funds.
- With our inability to offer young scientists a long term career, we appear to have a "Darwinian Model: The Survival of the Fittest". Is this cost effective for the NIH to invest so significantly into training programs at the beginning of the pipeline (loan repayment, K awards, priority funding for first time R01 new investigators) with such a limited number of scientists coming out on the 'other end' i.e., a full career in medical research, terminating in retirement? It is recognized that the lack of stable soft-money-based careers is a major impediment to attracting the best and the brightest into biomedical research.
- New investigators must be brought in and mid-career scientists must be sustained. New physician investigators are often performing extended clinical training when they should be conducting their most productive research. The current system takes too long for funding, especially K awards since physicians generally do not have the luxury of several resubmissions.
- In addition, the U.S. will likely continue to face competition for its best and brightest scientists. The decline in the U.S. economy relative to those in the rest of the world is facilitating the strengthening of science elsewhere. New investigators often see their mentors challenged to maintain research support and funded lab personnel and even their own salaries. Finances and quality of life may likely be an important consideration for the current and next generation of scientists. Also, Business and Law are formidable competitors for current and future researchers. The workgroup commented that we must commit to creating an environment that affords the next generation of scientists a productive and sustained research career in this country if so desired. The following recommendations were provided.
- Invest in K-12 programs that promote science and mathematics, establish role model programs, and develop strategies to engage early.
- Consider increasing salary for K awards to make salaries comparable to those paths otherwise open to physician scientists. There is a high financial penalty for those who go into research.
- Must work to maintain current research investment, sustainability is critical. Provide funding advantage for at least first and second competing renewals while developing more long-term strategies to help sustain individuals that choose a research career. There was considerable discussion that there had to be better ways to achieve stability in mid-career.
- Consider increasing salary for F33 to make it more attractive to mid-career or more senior scientists that need to 'retool' their research skill sets and allow re-training in new areas.
- Encourage institutions to provide bridge funding.
- Consider one year bridge award or 'retooling award' to help sustain mid-career investigators.
The workgroup applauded the NHLBI for their longstanding commitment and significant efforts to support new investigators and they encourage the NHLBI to continue.
High Priority Research Training Areas
The workgroup concurred with the training Strategic Plan recommendations and identified several emphasis areas and specific approaches.
Translational research training is a timely and high priority area. The NHLBI should not 'recreate the wheel'. The CTSA infrastructure was designed for this purpose and a partnership should be forged. Questions were raised regarding: (1) How CTSA resources can be made available for non-CTSA institutions? and (2) How the mid-career and PhD scientists can fit into the CTSA program? The workgroup recommended targeted support for translational research training in the following manner:
- Provide at least 30 supplements (slots) to the CTSA program specifically for translational research for two years support. The NHLBI should consider using a mechanism similar to the Diversity Supplements Program or the NHLBI-NIGMS MSTP model used to support MD/PhD training slots.
In addition to translational research, training in the quantitative sciences was identified as a high priority area. Upcoming scientists must be knowledgeable and have a fundamental skill set in the quantitative sciences.
- Training programs should include courses such as Bioinformatics, Systems Biology, Analysis of Biological Networks, Foundations of Algorithms, Computational Techniques in Systems Biology, and Linear Algebra.
Since some institutions may currently be limited in the above or related course offerings, the NHLBI should strongly encourage virtual training in the quantitative sciences for its trainees. The workgroup encouraged new scientific vibrancy in the NHLBI T32 training programs to ensure training is kept up to date. To ensure the training structure is nimble and has the ability to move quickly into new directions, an assessment of the current training structure was encouraged.
With limited resources, the NHLBI should seek new partners to help support research training efforts. The goal is to leverage all available resources to increase the number of highly trained investigators.
- The workgroup recommended that the NHLBI sponsor a summit to explore financial partnerships with various entities to support research training. Among the partners are the professional societies, industry, pharmaceutical companies, other government agencies, and ACGME (Accreditation Council for Graduate Medical Education).
It has become increasingly clear that Science must be done in teams. Not everyone on the team will be a Principal Investigator on an NIH grant. Members on a research team have different roles, none that are less important. NIH should consider supporting team science that includes research training and support for various levels of a research team (i.e., non-research associates).
- K awards submissions should be encouraged. Team science in individual K awards (K23, K08) should include a team of mentors with multidisciplinary research backgrounds. K24 programs are especially poised to encourage team science and cross disciplinary training. Inclusion of computational/quantitative research training must be done early in the program and is strongly encouraged.
What are the most critical parameters that must be in place to ensure we train a cadre of clinical scientists capable of rapidly bringing new information to the bedside?
Clinical Training is expanding at an increased rate and requires more time commitment. The workgroup raised the question, "How do we build a career path for physician scientists? Clinical training and research currently are separate efforts. The workgroup discussed the potential value of linking these efforts for continuity which will help maintain the clinicians" skill set as well as their interest in research.
It is critically important to maintain the foundation of basic science in clinical education. Basic scientists and clinical mentors must function as a team with frequent meetings and discussions of interdisciplinary approaches to their trainee's project.
Is the answer to decouple research training from clinical training and create a research track for clinically trained scientists? There was significant discussion comparing two types of T32 programs: (1) those in which clinical training, supported by the hospital, and research training, supported by T32, are fully integrated; and (2) programs that completely unlink clinical training and T32-supported research training. Data is not available to help determine which of the two training models are the most effective. The group acknowledged that being a successful researcher, who is competitive for grants, requires significant laboratory time. Physician scientists cannot build their career without dedicated research time. To this end, some workgroup members expressed support for a physician scientist track or the unlinked model (like K awards) as a better approach to invest limited resources into research training.
The physician scientist's track would allow strong research competency with narrowed clinical responsibilities. This track would allow physicians to make research their career and eliminate the need to constantly balance between clinical and research obligations. The workgroup agreed that this is quite a difficult challenge that would require medical schools to sanction this kind of effort. Other organizations must also be a part of the solution.The workgroup commented that the NIH cannot do this alone and that perhaps the IOM (Institute of Medicine) should explore this new paradigm in a more comprehensive manner. Data is clearly needed to appropriately assess the best models for research training.
Graduate training generally is too narrow and should be broadened. There is a need for more clinically trained PhDs. Therefore, graduate students should take medical school courses to ensure a comprehensive knowledge of disease mechanisms and enhance their ability to interact with physicians on clinical projects. Clinically trained PhDs should be allowed and strongly encouraged to apply for the K23 and K08 mechanisms.
How do you introduce clinical research early in one's career? How do we impart the creativity of science to the next generation? The working group commented that while they are aware of new and potentially excellent models out there; they also recognized that the winning strategies of the past will not be those of the future. Currently, we need to determine best practices, identify gaps, and strategies that will best facilitate the emerging scientists of the future.
The following recommendations were made:
- Convene a workgroup of the best and brightest medical students, fellows, and young investigators, to help identify best practice approaches and current needs in the area of early basic-clinical research engagement.
- Follow the workgroup with an RFA for a K07 mechanism that includes support for a coordinating center to support the most innovative best practice approaches.
- Support a modified training mechanism to implement these best practice approaches.
- Reinvest at the undergraduate level and include summer research programs such as summer science camps to engender early buy in and intrigue long term commitment.
What strategies can be implemented to help ensure we develop a research workforce of the highest quality based on our nation's diversity?
- NHLBI should explore model programs such as those supported by the NIGMS to engage young students from diverse backgrounds in the sciences early. Partnerships with the National Science Foundation and the Department of Education are encouraged.
Gender equity is an important issue. The working group applauded the NHLBI for the new K01 Re-Entry Biomedical Sciences and participation in the recent NIGMS RFA entitled: Research on Causal Factors and Interventions that Promote and Support the Careers of Women in Biomedical and Behavioral Science and Engineering
What are the best approaches to mentoring in a multidisciplinary training environment and how should they be evaluated?
Mentoring is viewed as one of the most important aspects of training new investigators. The NHLBI should ramp up the importance of mentoring and promote a standardized approach for trainees to secure survival skills that also includes leadership and communication, realizing that the new world of team science, multiple Principal Investigators and interdisciplinary, translational medicine may require an entirely new concept of mentorship.
The workgroup provided several recommendations.
- Institutions should consider sponsoring a survival skill/mentoring core to be utilized by all T32s at their institution.
- Team mentorship (interdisciplinary) is critically important. The NHLBI should require interdisciplinary mentoring teams.
- Protected time for K awardees is essential (e.g., K08/K23 awardees). A letter should be sent out every quarter as an audit for compliance with 75% protected time and a statement should be included on a progress report to be signed by the Principal Investigator confirming that the trainee has been afforded 75% time to conduct research. The loan repayment program uses a similar approach. NHLBI must hold mentors accountable. Often the clinical supervisor is not among the K awardees' mentors and is often distant from the training experience.
- Consider supporting a mentoring core, lab management, as part of the T32 program
- Institutions should be encouraged to integrate a pool of research mentors across training mechanisms.
- Mentoring is critically important but requires a significant time commitment. Mentors should be paid similar to what takes place under the K24 mechanism.
Comments/questions on policy update presentation? Are there new or modified policy suggestions that we should consider to enhance our training and career development efforts?
The NHLBI made several significant policy changes in the T32 programs in FY07. The goal is to continue to support the most meritorious training grants while ensuring funds are available to support new training grants. Dr. Carl Roth presented the recommendations that received Council concurrence. After the presentation, a lengthy discussion took place regarding the significant investment the NHLBI has in ongoing T32 programs versus new programs.
How does the institute ensure the latest technologies and the most up-to-date research training is taking place on its training programs? The workgroup recommended continued encouragement and support for new training programs. With the significant investment in continuation programs, the working group felt that it is critically important to ensure innovative scientific vibrancy in the training programs and recommended the following:
- Introduce a new review criterion or identify a review emphasis for the training study section on the program relevance with respect to maintaining currency with the latest developments in biomedical research (e.g., computational sciences, systems biology).
- Supports Master's degree on T32 to maintain research skill set and keep clinically trained individuals engaged in research.
The workgroup acknowledged that the proposed training and career development recommendations include both short and long-term proposals that will require programmatic and fiscal collaborations with other government entities, as well as other public and private sectors.
The workgroup agreed that a high priority area for the NIH and its partners is to establish an environment that affords the current and future generation of research scientists a productive and sustained research career. To this end, the NHLBI should gather data on best practices and current needs in the area of early basic and clinical research engagement to recruit and retain the best and brightest diverse research workforce. In addition, data should be collected on various research training models to help determine the most effective strategy to recruit and retain scientists, with a particular emphasis on clinical scientists.
The NHLBI must help ensure multidisciplinary mentoring for trainees, including survival skills mentoring, and explore ways to compensate mentors. Accountability strategies should be put into place to make certain trainees are afforded the designated protected time on career development awards.
Research training in new and expanded scientific areas will likely include novel program development, and the ability to leverage and target efforts on new and ongoing training programs. The NHLBI should partner with the NCRR (National Center for Research Resources) to take full advantage of the CTSA program to expand and sharpen their efforts in translational research. In addition to translational research, the workgroup identified training in the quantitative sciences as a high priority area. Research training programs should include courses such as Bioinformatics, Systems Biology, Analysis of Biological Networks, Foundations of Algorithms, Computational Techniques in Systems Biology, and Linear Algebra. Innovative scientific vibrancy in training programs must be maintained through the peer review process, areas of emphasis designated by the NHLBI, and restructuring of training programs as appropriate.
Drs. Van Horn and Mishoe thanked the workgroup participants for offering their valuable time, enthusiasm, and candor throughout the meeting discussion. Dr. Mishoe provided a brief summary of the working group meeting and final remarks. She indicated that the workgroup members may be called upon in the future as the NHLBI moves forward in the implementation of the training and career development strategic plan effort. The NHLBI emphasized its commitment to evaluate progress as it implements strategies to ensure a future cadre of well-trained investigators to assume leadership of America's biomedical and behavioral research.
Considered by the Workgroup
The NHLBI remains committed to the training of individuals across the academic spectrum. The Institute currently supports a large portfolio of fellowships and training and career development programs conducting research related to heart, lung, blood, and blood diseases and sleep disorders. The strategic planning process presents an important and exciting opportunity to evaluate progress in training and to explore new strategies to ensure that a cadre of well-trained investigators will continue the leadership of NHLBI research into the future.
Twenty-three working groups were convened by the four NHLBI programmatic divisions during the strategic planning process. The programmatic divisions are the Division of Cardiovascular Diseases (DCVD), Division of Lung Diseases (DLD), Division of Blood Diseases and Resources (DBDR), and the Division of Prevention and Population Sciences (DPPS). To ensure a diversity of ideas and recommendations, the Institute requested that each working group include a discussion of specific and cross-cutting training needs and opportunities. Training, as used in the Program Book, encompasses fellowships (F), training (T), and career development (K). The major recommendations for the cross-cutting training areas resulting from the combined efforts of all of the working group discussions are summarized below.
- Continue NHLBI efforts to support funding for new investigators, including the current policy of more advantageous paylines.
- Enhance the training of basic researchers and clinical scientists in new, emerging areas of science and methodologies.
- Support new training opportunities in behavioral research and prevention.
- Enhance training in the most up-to-date methods within established disciplines such as the fields of epidemiology and health services research to hasten the application of emerging knowledge and technologies to combat heart, lung, and blood diseases, and sleep disorders.
B. Personalized Medicine/Genomics/Bioinformatics/Biotechnology
- Develop a personalized medicine scholars program, including ethics training.
- Expand training components in all grant mechanisms to increase -omics training across all levels of experience.
- Support short course(s) in bioinformatics, genetics, and genomics for trainees and senior level investigators.
- Enhance training opportunities in computational biology and quantitative sciences. Integrate educational activities in common with other NIH Institutes and Centers in -omics and quantitative sciences.
- Provide pre-doctoral training programs for computational biology, physiology and pathophysiology. Also, consider supplemental support to existing graduate and post-graduate training grants for training of medical students and fellows in quantitative approaches to biomedical research.
- Provide training in software development, maintenance, documentation, validation, and integration of clinical informatics systems (clinical and clinical/translational IT).
C. Multidisciplinary and Interdisciplinary Training Needs
- Develop researchers trained in multidisciplinary and interdisciplinary team science.
- Support cross-training of investigators in genomics, clinical research, and bioinformatics. Provide flexible interdisciplinary pre- and post-doctoral programs between experimental and computational biomedical sciences.
- Support the development of interdisciplinary curricula. Promote training opportunities in new, emerging technologies, including nanotechnology, imaging, -omics, analytic software development, bioengineering, and cellular therapeutics.
- Foster interdisciplinary interactions and training involving research teams. Teams of the future will include physical scientists, computational biologists, engineers, molecular biologists, geneticists, and clinicians.
- Support mini-sabbaticals to foster cross-training experiences. Develop new training mechanisms to encourage team science.
D. Promote training efforts in translational research
- Develop training opportunities in translational behavioral science research, including both Phase I (basic science discoveries to intervention) and Phase II (clinical interventions to community and clinical practice settings).
- Foster training in translation I and II research, including creation of a new Translation Investigator Award.
- Establish formal training opportunities for lay health workers to educate the community in a culturally-appropriate manner regarding aspects of clinical trials (e.g., consent forms, safety concerns, and historical community concerns).
- Develop strategies to foster the development of interdisciplinary teams and bi-directional relationships between clinical scientists and lay communities.
E. Continue to enhance and encourage training and retention of clinical investigators
- Create funding opportunities for junior faculty finishing a fellowship and/or after the completion of the K08 and K23 awards. Awards should be coupled with loan repayment.
- Establish an NHLBI Pioneer Award to support 'start up' of new clinical scientists.
- Improve support of biostatisticians and clinical trialists to improve clinical trial methodologies.
F. Establish new and leverage existing training partnerships.
- Foster efforts to promote interactions with the CTSA program through supplements to existing grants or linking K24 awards with CTSAs.
- Increase collaboration with professional societies to improve training and cross-discipline fertilization.
G. Emphasize and promote mentoring
- Develop strategies to improve the quality and number of available mentors and promote a global approach to mentoring that includes science, career development, and best practices in research laboratory management.
The above recommendations are not to be considered all inclusive. Specific recommendations made by the Strategic Plan working groups for individual division programs are not represented in this document, but rather in the NHLBI Strategic Plan.
The NHLBI continues to explore new ways to foster the research independence of new investigators.
Rockledge II Room 9100/9104
July 30-31, 2008
Linda Van Horn, Ph.D., RD
Professor, Preventive Medicine and Associate Dean for Faculty Development
Northwestern University, Feinberg School of Medicine
680 N Lake Shore Drive, Suite 1102
Chicago, IL 60611
Donna Arnett, Ph.D.
Chair and Professor
University of Alabama at Birmingham
School of Public Health
1665 University Blvd.
Birmingham, AL 35294
David Center, M.D.
715 Albany Street
Pulmonary Center, R304
Boston, MA 02118
Sonia Flores, Ph.D.
Associate Professor of Medicine
University of Colorado
4200 E. Ninth Avenue
Denver, CO 80262
Gary Gibbons, M.D.
Cardiovascular Research Institute
Morehouse School of Medicine
720 Westview Drive, S.W.
Research Wing #228
Atlanta, GA 30310
Bruce Furie, M.D.
Beth Israel Deaconess Medical Center
Division of Hemostasis and Thrombosis
330 Brookline Ave., E/Tcc-9
Boston, MA 02215
Susan Maroney, D.V.M., Ph.D.
Research Scientist 1
Blood Center of Wisconsin, Inc.
8727 Watertown Plank Road
P.O. Box 2178
Milwaukee, WI 53201
Suzanne Oparil, M.D.
University of Alabama at Birmingham
703 19th South
Birmingham, AL 35294
Allan I. Pack, M.B., Ch.B., Ph.D.
Professor of Medicine
Chief, Division of Sleep Medicine/Department of Medicine
Director, Center for Sleep and Respiratory Neurobiology
University of Pennsylvania School of Medicine
125 South 31st Street, Suite 2100
Philadelphia, PA 19104
Julie A. Panepinto, M.D., M.S.P.H.
Assistant Professor, Pediatrics
Medical College of Wisconsin
8701 Watertown Plank Road
P.O. Box 26509
Milwaukee, WI 53226
Richard W. Pastor, Ph.D.
Laboratory of Computational Chemistry
National Heart, Lung, and Blood Institute
National Institutes of Health
5635 Fishers Lane, Room T921 MSC 9314
Bethesda, MD 20892-9314
Harvey B. Pollard, M.D., Ph.D.
Professor and Chair
Department of Anatomy, Physiology and Genetics
USU School of Medicine (USUHS)
4301 Jones Bridge Road
Bethesda, MD 20814
Edward Snyder, M.D.
Professor, Laboratory Medicine
Yale University School of Medicine
Blood Bank CB-459
Yale New Haven Hospital
20 York Street
New Haven, CT 06510