Clinical Research Training Program Research Articles

PD02-10 THE IMPACT OF SURGEON AND HOSPITAL VOLUME ON 30-DAY OUTCOMES AND COST FOR RENAL CANCER SURGERY

You have accessJournal of UrologyKidney Cancer: Localized: Surgical Therapy I (PD02)1 Apr 2020PD02-10 THE IMPACT OF SURGEON AND HOSPITAL VOLUME ON 30-DAY OUTCOMES AND COST FOR RENAL CANCER SURGERY Julia Wainger*, Joseph Cheaib, Hiten Patel, Mitchell Huang, Michael Biles, Michael Johnson, Joseph Canner, Mohamad Allaf, and Phillip Pierorazio Julia Wainger*Julia Wainger* More articles by this author , Joseph CheaibJoseph Cheaib More articles by this author , Hiten PatelHiten Patel More articles by this author , Mitchell HuangMitchell Huang More articles by this author , Michael BilesMichael Biles More articles by this author , Michael JohnsonMichael Johnson More articles by this author , Joseph CannerJoseph Canner More articles by this author , Mohamad AllafMohamad Allaf More articles by this author , and Phillip PierorazioPhillip Pierorazio More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000000822.010AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Provider and hospital factors influence quality, but granular data is lacking to assess their impact on renal cancer surgery. The Maryland Health Service Cost Review Commission (HSCRC) is an independent state agency that promotes cost containment, access to care and accountability. Within HSCRC, we aimed to assess the impact of surgeon and hospital volume on 30-day outcomes after renal cancer surgery. METHODS: Data on renal surgery were abstracted from the Maryland HSCRC from 2000-2018. We excluded patients younger than 18, patients without a diagnosis of renal cancer, and patients concurrently receiving another major surgery. Volume categories were derived from the distribution of mean cases performed per year. We used adjusted multivariable logistic and linear regression models to identify associations of surgeon and hospital volume with length of stay, days in intensive care, cost, 30-day mortality, readmission, and complications. RESULTS: A total of 10,590 surgeries, completed by 669 surgeons at 48 hospitals, met criteria. The 25th percentile for cases per year was 1, the 50th percentile was 1.2, and the 75th percentile was 2.6. After adjusting for patient factors and cumulative surgeon experience, high volume surgeons had the greatest decrease in length of stay and mortality risk compared to rare volume surgeons. Low volume surgeons had the greatest cost decrease (Table 1). Medium volume hospitals had statistically significant lower average costs than rare volume hospitals (Table 2). There were no other clinically and statistically significant relationships between volume and measured outcomes. CONCLUSIONS: Almost half of the urologists studied performed an average of one renal cancer case per year. Greater surgeon volume was associated with shorter length of stay and decreased mortality risk. Hospital volume did not have a meaningful relationship to outcomes. Other factors such as tumor, surgeon, and hospital characteristics or case mix may associate with outcomes and could be confounders. Source of Funding: Funding for the Predoctoral Clinical Research Training Program is provided by the Johns Hopkins School of Medicine, Bloomberg School of Public Health, and Johns Hopkins Institute for Clinical and Translational Research (ICTR) by way of a Clinical and Translational Science Award (CTSA) from the National Institutes of Health (NIH) National Center for Advancing Translational Sciences (NCATS). © 2020 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 203Issue Supplement 4April 2020Page: e70-e70 Advertisement Copyright & Permissions© 2020 by American Urological Association Education and Research, Inc.MetricsAuthor Information Julia Wainger* More articles by this author Joseph Cheaib More articles by this author Hiten Patel More articles by this author Mitchell Huang More articles by this author Michael Biles More articles by this author Michael Johnson More articles by this author Joseph Canner More articles by this author Mohamad Allaf More articles by this author Phillip Pierorazio More articles by this author Expand All Advertisement PDF downloadLoading ...

PD49-11 NEPHROLOGY REFERRAL PRACTICES SURROUNDING RENAL CANCER SURGERY

You have accessJournal of UrologyKidney Cancer: Localized: Surgical Therapy V (PD49)1 Apr 2020PD49-11 NEPHROLOGY REFERRAL PRACTICES SURROUNDING RENAL CANCER SURGERY Julia Wainger*, Joseph Cheaib, Hiten Patel, Mitchell Huang, Michael Biles, Meredith Metcalf, Joseph Canner, Michael Johnson, Mohamad Allaf, and Phillip Pierorazio Julia Wainger*Julia Wainger* More articles by this author , Joseph CheaibJoseph Cheaib More articles by this author , Hiten PatelHiten Patel More articles by this author , Mitchell HuangMitchell Huang More articles by this author , Michael BilesMichael Biles More articles by this author , Meredith MetcalfMeredith Metcalf More articles by this author , Joseph CannerJoseph Canner More articles by this author , Michael JohnsonMichael Johnson More articles by this author , Mohamad AllafMohamad Allaf More articles by this author , and Phillip PierorazioPhillip Pierorazio More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000000943.011AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Chronic kidney disease (CKD) is a sequela of renal surgery. Data are limited describing nephrology referral for at-risk patients per 2017 American Urologic Association guidelines. We examined nephrology referral rates amongst renal cancer nephrectomy patients to assess referral predictors and study associations of nephrology referral and survival. METHODS: We obtained data from the SEER-Medicare database for patients ≥66 years old who received nephrectomies for malignancy from 1999-2014 (N=25,641). Referral data were based on nephrology claims. We identified if and when patients were referred by CKD disease status and surgery type, used logistic regression to identify associated patient factors and used a Cox proportional hazard regression model to assess associations with survival. Logistic regression and survival analyses were conducted for cases from 2004-2014 with available comorbidity data (N=16,612). RESULTS: Of 25,641 patients from 1999-2014, 16.3% had pre-operative CKD and 43.4% of patients developed post-operative CKD. Of post-operative CKD patients, 4.8% were referred pre-operatively and 50.2% post-operatively. Figure 1 shows referrals by CKD status and surgery type. Stage III disease (OR: 1.27, CI: 1.10-1.48), higher Charlson Comorbidity Index scores (OR: 1.70, 95% CI: 1.40-2.05), and all stages of pre-operative CKD diagnosis, peaking with Stage 4 disease, (OR: 17.4, 95% CI: 8.72-34.74) were associated with pre-operative referral. For post-operative CKD patients, post-operative referrals by twelve months were associated with diabetes (OR: 1.35, 95% CI: 1.17-1.56), radical nephrectomy (OR: 1.80, 95% CI: 1.43-2.26), and CKD stage at 12 months, with peak odds of nephrology referral associated with stage 4 CKD (OR: 21.84, 95% CI: 12.1-39.5). There was no survival difference (HR= 0.97, 95% CI: 0.88-1.08) for patients with pre-operative referral or post-operative referral by twelve months (HR: 1.04, 95% CI: 0.96-1.13). CONCLUSIONS: Few renal cancer patients at risk for CKD progression or development present with an established nephrologist or receive pre-operative referral, suggesting missed opportunities to refer high risk patients. Pre-operative referral does not appear to improve survival; however, referred patients may represent a higher risk subset, and other patients who may benefit appear under-referred. Source of Funding: Funding for the Predoctoral Clinical Research Training Program is provided by the Johns Hopkins School of Medicine, Bloomberg School of Public Health, and Johns Hopkins Institute for Clinical and Translational Research (ICTR) by way of a Clinical and Translational Science Award (CTSA) from the National Institutes of Health (NIH) National Center for Advancing Translational Sciences (NCATS). © 2020 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 203Issue Supplement 4April 2020Page: e1005-e1005 Advertisement Copyright & Permissions© 2020 by American Urological Association Education and Research, Inc.MetricsAuthor Information Julia Wainger* More articles by this author Joseph Cheaib More articles by this author Hiten Patel More articles by this author Mitchell Huang More articles by this author Michael Biles More articles by this author Meredith Metcalf More articles by this author Joseph Canner More articles by this author Michael Johnson More articles by this author Mohamad Allaf More articles by this author Phillip Pierorazio More articles by this author Expand All Advertisement PDF downloadLoading ...

Improving physician research training: understanding the student perspective

PurposeUsing a mixed-methods approach, this study evaluated a Master of Science program in Clinical and Translational Research (MSCTR) geared toward training physicians in research methodology. The purpose of this study is to allow trainees to articulate their expectations, needs and experiences in the MSCTR and to develop novel training methods and/or curriculum modifications to improve physician-scholar training.Design/methodology/approachThe mixed-method study design with qualitative emphasis included interviews, participant journal entries and a survey. Interview and journal entry data were analyzed using a modified seven-stage hermeneutic analysis and survey data were analyzed using descriptive statistics.FindingsFindings suggest three major areas for improvement, namely, curriculum, mentorship/relationships and instructional methods. Concluding recommendations to address these three areas include: make ongoing curriculum updates to provide a sequential pathway but also allow for flexibility, improve statistical training, invest in online courses and create a more structured mentorship program.Originality/valueExtant research, though minimal, has evaluated clinical research training programs in terms of alumni productivity. However, this is the first study of its kind to examine a clinical research training program primarily qualitatively and from the perspective of its students and alumni.

Training methods that improve MD-PhD student self-efficacy for clinical research skills.

MD-PhD training programs train physician-scientists to pursue careers involving both clinical care and research, but decreasing numbers of physician-scientists stay engaged in clinical research. We sought to identify current clinical research training methods utilized by MD-PhD programs and to assess how effective they are in promoting self-efficacy for clinical research. The US MD-PhD students were surveyed in April-May 2018. Students identified the clinical research training methods they participated in, and self-efficacy in clinical research was determined using a modified 12-item Clinical Research Appraisal Inventory. Responses were received from 61 of 108 MD-PhD institutions. Responses were obtained from 647 MD-PhD students in all years of training. The primary methods of clinical research training included no clinical research training, and various combinations of didactics, mentored clinical research, and a clinical research practicum. Students with didactics plus mentored clinical research had similar self-efficacy as those with didactics plus clinical research practicum. Training activities that differentiated students who did and did not have the clinical research practicum experience and were associated with higher self-efficacy included exposure to Institutional Review Boards and participation in human subject recruitment. A clinical research practicum was found to be an effective option for MD-PhD students conducting basic science research to gain experience in clinical research skills. Clinical research self-efficacy was correlated with the amount of clinical research training and specific clinical research tasks, which may inform curriculum development for a variety of clinical and translational research training programs, for example, MD-PhD, TL1, and KL2.

Indices of Clinical Research Coordinators' Competence.

There is a clear need to educate and train the clinical research workforce to conduct scientifically sound clinical research. Meeting this need requires the creation of tools to assess both an individual's preparedness to function efficiently in the clinical research enterprise as well as tools to evaluate the quality and effectiveness of programs that are designed to educate and train clinical research professionals. Here we report the development and validation of a competency self-assessment entitled the Competency Index for Clinical Research Professionals, version II (CICRP-II). CICRP-II was developed using data collected from clinical research coordinators (CRCs) participating in the "Development, Implementation and Assessment of Novel Training In Domain-Based Competencies" project at four clinical and translational science award (CTSA) hubs and partnering institutions. An exploratory factor analysis identified a two-factor structure: the first factor measures self-reported competence to perform routine clinical research functions while the second factor measures competence to perform advanced clinical functions. We demonstrate the between groups validity by comparing CRCs working in different research settings. The excellent psychometric properties of CICRP-II, its ability to distinguish between experienced CRCs at research intensive CTSA hubs and CRCs working in less intensive community-based sites coupled with the simplicity of alternative methods for scoring respondents make it a valuable tool for gauging an individual's perceived preparedness to function in the role of CRC as well as an equally valuable tool to evaluate the value and effectiveness of clinical research education and training programs.

Design of a Multidisciplinary Training Program in Complementary and Integrative Health Clinical Research: Building Research Across Interdisciplinary Gaps.

Despite wide use by the public, limited evidence is available for many complementary and integrative health (CIH) practices. Thus, clinical researchers knowledgeable about CIH disciplines are necessary to study the efficacy and effectiveness of CIH practices to benefit the public health. To partially address the need for clinical researchers versed in CIH, the authors of this study report the design of an interprofessional clinical research training program focused on CIH, the Building Research across Interdisciplinary Gaps (BRIDG) program, supported by a 5-year T90/R90 grant from the National Center for Complementary and Integrative Health. The T90-supported arm of the program trains doctoral-level CIH providers in clinical research at the research-intensive University of Washington. The R90-supported arm of the program trains researchers with conventional backgrounds in the practices of CIH at the clinic-intensive National University of Natural Medicine. The "Translational Science Spectrum" provides a common conceptual framework for both programs. Specific program elements include: individualized didactic training in clinical research and CIH disciplines; placement with clinical research mentors; placement with clinical mentors in CIH disciplines; shared and independent research project development; and interdisciplinary experiences through seminars and retreats. Program evaluation includes annual completion of the Clinical Research Appraisal Inventory (CRAI), which queries confidence in research skills and methods and periodic evaluation of training elements using the Supplemental Kellogg Logic-World Health Organization model, which emphasizes relevance, adequacy, efficiency, effectiveness, process, impact, equity, and sustainability. The BRIDG program exemplifies a new standard in interprofessional clinical research training, made possible through strong collaboration between disparate research- and clinically intensive institutions.

A multimodal international collaborative clinical research training program in China

ABSTRACTBackground: There is a strong need to include training of research methods in training programs for physicians. International clinical research training programs (CRTP) that comprehensively introduce the methodology of clinical research and combined with practice should be a priority. However, few studies have reported a multimodal international CRTP that provides clinicians with an introduction to the quantitative and methodological principles of clinical research.Objective: This manuscript is intended to comprehensively describe the development process and the structure of this multimodal training program.Methods: The CRTP was comprised of three distinct, sequential learning components: part 1 – a six-week online eLearning self-study; part 2 – a series of three weekly interactive synchronous webinars conducted between Durham, North Carolina, USA and Beijing, China; and part 3 – a five-day in-person workshop held at Beijing Friendship Hospital, Capital Medical University (BFH-CMU). Self-assessment quiz scores and participation rates were used to evaluate effectiveness of the training program. Participants’ demographic characteristics, research experience, satisfaction and feedback on the program were collected using questionnaires.Results: A total of 50 participants joined the CRTP. Forty-four participants (88%) completed the program satisfaction questionnaires. The average quiz score of the six eLearning units varied from 31% to 73%. Among the three components of the program, the online eLearning self-study was felt to be the most challenging. Thirty-nine (89%) of the surveyed respondents were satisfied with all components of the training program. Among the respondents, 43 (98%) felt the training was helpful in preparing them for future clinical research projects and expressed willingness to recommend the program to other colleagues.Conclusions: We established a multimodal international collaborative training program. The program demonstrated acceptable participation rates and high satisfaction among Chinese clinicians. It provides a model that may be used by others developing similar international clinical research training programs for physicians.

Learning best-practices in journalology: course description and attendee insights into the inaugural EQUATOR Canada Publication School

Background and purposeDissemination of research results is a key component of the research continuum and is commonly achieved through publication in peer-reviewed academic journals. However, issues of poor quality reporting in the research literature are well documented. A lack of formal training in journalology (i.e., publication science) may contribute to this problem. To help address this gap in training, the Enhancing the QUAlity and Transparency Of health Research (EQUATOR) Canada Publication School was developed and facilitated by internationally-renowned faculty to train researchers and clinicians in reporting and publication best practices. This article describes the structure of the inaugural course and provides an overview of attendee evaluations and perspectives.Key highlightsAttendees perceived the content of this two-day intensive course as highly informative. They noted that the course helped them learn skills that were relevant to academic publishing (e.g., using reporting guidelines in all phases of the research process; using scholarly metrics beyond the journal impact factor; open-access publication models; and engaging patients in the research process). The course provided an opportunity for researchers to share their challenges faced during the publication process and to learn skills for improving reproducibility, completeness, transparency, and dissemination of research results. There was some suggestion that this type of course should be offered and integrated into formal training and course curricula.ImplicationsIn light of the importance of academic publishing in the scientific process, there is a need to train and prepare researchers with skills in Journalology. The EQUATOR Canada Publication School provides an example of a successful program that addressed the needs of researchers across career trajectories and provided them with resources to be successful in the publication process. This approach can be used, modified, and/or adapted by curriculum developers interested in designing similar programs, and could be incorporated into academic and clinical research training programs.

2494 Selectives: Implementing self-directed collaborative selectives as part of a curriculum for pre-health care professional students

OBJECTIVES/SPECIFIC AIMS: To provide students an opportunity to select health care-oriented course work that reflects both their interests and the increasingly diverse spectrum of health professions education and health care careers. To increase the opportunity for students to enter professional schools and health care professions with enhanced engagement and experience. METHODS/STUDY POPULATION: The 4-credit elective (Selective) curriculum is a component of the 38 credit Duke School of Medicine Master of Science in Biomedical Sciences (MBS) program which is completed over 10.5 months. Students work closely with their advisors to choose activities that reflect their interests. Selectives are offered by an array of schools, institutes, and programs within Duke University, including: the School of Medicine, School of Law, Global Health Institute, Bioethics and Science Policy Master Program, Clinical Research Training Program, Center for Documentary Studies, and Medical Informatics. Students may also pursue directed studies in areas such as health policy, or an inter-professional trip to Honduras. In addition to the course-based Selectives, three research practicum options are offered: Community Engagement, Clinical Research (Duke Office of Clinical Research), and a self-selected mentored research experience. Finally, the MBS program offers 2 in-house specific Selectives: Fundamentals of Learning: Theory and Practice, and Planning for Health Professions Education. RESULTS/ANTICIPATED RESULTS: The MBS program accepted its first cohort of students in June 2015. Two cohorts have graduated and the third has begun (n=30, 2016; n=42, 2017; n=43 enrolled, 2018). Our students come from diverse background with a third from populations historically underrepresented in STEM due to race/ethnicity, and another third underrepresented due to other factors such as low socioeconomic status, first generation to college, LGBQT, and those from rural and immigrant communities. Thus far, Selective distribution has been: Clinical research practicum (7, 2016; 14, 2017; 9, 2018); Mentored research practicum (2, 2016; 1, 2017); Community engagement practicum (7, 2016; 4, 2017; 5, 2018); Planning for health professions educations (14, 2016; 32, 2017; 33, 2018), Fundamentals of learning: Theory and Practice (7, 2016; 17, 2017; 18, 2018); documentary film (1, 2016); inter-professional trip to Honduras (2, 2016, 2, 2017). Since the implementation of the curriculum, at least 53 of 70 students who have applied (76%) were admitted to health professions or other graduate schools despite having lower initial MCAT and undergraduate GPAs in aggregate than the average of students who matriculate to allopathic medical school programs: 41 to medical schools, 3 to dental school, 2 each to osteopathic and physician assistant schools and 1 each to physical therapy, business school and law school. Eighteen of the 2016 graduates, and 21 of the 2017 graduates work in research for their gap year following graduation, the majority being employed in our institution’s research programs providing a pipeline of trained research assistants and coordinators. DISCUSSION/SIGNIFICANCE OF IMPACT: Lessons learned by implementing our curriculum include the following: (1) students are eager to explore different areas of health care; (2) collaboration across schools, centers, departments, institutes, and offices increases our ability to identify common areas of interest; (3) implementing a diverse curriculum can be challenging due to the need for significant organization and planning; (4) the diversity of courses can be a source of confusion when there is a lack of standardization in learner expectations; (5) continued collaboration across, schools, centers, institutes programs, health professions and sections requires a significant amount of time and expertise. However, our programs demonstrate significant positive impacts both on students and at the institutional level. Our program shows that a diverse curriculum leads to a high number of students engaged in pursuing and successfully continuing a health profession education. Institutional benefits include a robust pipeline for a diverse research workforce.

How can we improve clinical research in pneumonia?

The primary challenges in the field of clinical research include a lack of support within existing infrastructure, insufficient number of clinical research training programs and a paucity of qualified mentors. Most medical centers offer infrastructure support for investigators working with industry sponsors or government-funded clinical trials, yet there are a significant amount of clinical studies performed in the field of pneumonia which are observational studies. For this type of research, which is frequently unfunded, support is usually lacking. In an attempt to optimize clinical research in pneumonia, at the University of Louisville, we developed a clinical research coordinating center (CRCC). The center manages clinical studies in the field of respiratory infections, with the primary focus being pneumonia. Other activities of the CRCC include the organization of an annual clinical research training course for physicians and other healthcare workers, and the facilitation of international research mentoring by a process of connecting new pneumonia investigators with established clinical investigators. To improve clinical research in pneumonia, institutions need to have the appropriate infrastructure in place to support investigators in all aspects of the clinical research process.

An exploratory study of Clinical and Translational Science Award community-engaged research training programs.

The Clinical and Translational Science Award (CTSA) institutions are increasing development of training programs in community-engaged research (CEnR) to support translational science. This study sampled posters at CTSA national meetings to identify CEnR training approaches, topics, and outcomes. Qualitative analysis of 30 posters revealed training topics and outcomes focused primarily on CEnR capacity building, overcoming barriers, systems change, and sustainability. Further research should focus on development and results of CTSA CEnR training program metrics.

The 2nd Annual Clinical Scientist Trainee Symposium, August 22, 2017, London, Canada.

Clinician scientists play a critical role in bridging research and clinical practice. Unfortunately, the neglect of research training in medical schools has created clinicians who are unable to translate evidence from literature to practice. Furthermore, the erosion of research training in medical education has resulted in clinicians who lack the skills required for successful scientific investigation. To counteract this, the Schulich School of Medicine & Dentistry has made an effort to engage trainees, at all levels, in the research process. The 2nd Annual Clinician Scientist Trainee Symposium was held in London, Ontario, Canada on August 22, 2017. Organized each year since 2016 by the Schulich Research Office, the symposium features research being conducted by trainees in Schulich's Clinical Research Training Program. The focus this year was on the current state of clinician-scientist training in Canada and visions for the path ahead.

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OBJECTIVES/SPECIFIC AIMS: The first goal of this project is to test the reliability and validity of an objective structured clinical exam (OSCE) that was designed to assess competency in clinical and translational research. The second goal is to evaluate the impact of MICHR’s Summer Research Program on the participating trainee’s competency development. METHODS/STUDY POPULATION: The methodology used for this study was reviewed and exempted from oversight by the U-M Institutional Review Board (HUM00113293). The participants in the study include 17 pre-doctoral students in health professions programs at U-M who participated MICHR’s Summer Research Program. The Research OSCE was administered using a pretest, post-test design. The pretest was administered once during the 1st week of program in the Summer of 2016 and the post-test during the 10th week of the program. The Research OSCE was proctored and rated by trained staff members. We will assess the reliability of the Research OSCE using Generalizability Theory (Webb et al., 2006). And the construct validity of the Research OSCE will be tested using factor analysis and other statistical analyses. Growth in the competence of the trainees participating in the Summer Research program will be evaluated by testing for significant differences between their pretest and post-test scores. RESULTS/ANTICIPATED RESULTS: We anticipate that this study will show that the Research OSCE is a reliable competency assessment with proven construct validity. We also anticipate that the use of the Research OSCE will show the trainees participating in the Summer Research program experienced a gain in competence during the course of the 10-week program. DISCUSSION/SIGNIFICANCE OF IMPACT: This project uses a common and standardized testing approach. The primary goal of this project is to evaluate the reliability and validity of an OSCE to assess competency in clinical and translational research. It represents a new application for a well-studied testing method used extensively in the health professions to assess the clinical competency of health practitioners. This project will lead to a better understanding of (a) the reliability and validity of the Research OSCE designed to test research competency and (b) the effectiveness of the Summer Research Program curriculum in better preparing participants to conduct clinical and translational research. Showing how a specific competency assessment can be used for this purpose will provide the administrators, evaluators, and other stakeholders of clinical and translational research training programs with information that can be used to design more rigorous and relevant evaluations of their research training programs.

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OBJECTIVES/SPECIFIC AIMS: Biostatistics and Epidemiology courses within clinical research or public health training programs are typically developed and taught separately. As a result, students may have trouble in their research outside the classroom, where biostatistical and epidemiological concepts must be well integrated. Case method teaching is a participant- and discussion-centered pedagogical approach that has been used in business and law schools for more than 50 years to improve student learning, yet has taken longer to be adopted in health professional schools. The case method is distinguished by presenting learners with a real-world problem without a single unique solution. Designed to mimic the constraints and incomplete information found in real life, it is an ideal approach for integrating multiple related disciplines. A team of Clinical and Translational Science (CTS) faculty from the Tufts CTSI collaborated to develop a new course that integrates epidemiology and biostatistics disciplines using the case method. METHODS/STUDY POPULATION: We developed an intermediate-level, case-based course integrating epidemiology and biostatistics topics using modern, real-world clinical examples. Recognizing the importance of technical skill building, this intermediate-level Tufts CTS course adopted a hybrid approach, incorporating lecture and in-class laboratory exercises, alongside cases. We surveyed CTS faculty to identify a set of core methodological competencies. These included randomized trials, case-control and cohort studies, confounding, effect modification, propensity scores, linear and logistic regression, and survival analysis. Faculty provided us with clinical questions and deidentified data sets corresponding to these competencies; we also reviewed publicly available data sets. RESULTS/ANTICIPATED RESULTS: CTS faculty collaborated to develop 10 cases (with accompanying data sets) from modern clinical research examples that illustrate the connections between epidemiology and biostatistical concepts. Each case contains a background section, a statement of the core problem, a data set with data dictionary, articles from the primary literature (often the publication of the data set) with discussion questions and in-class lab exercises (R programming). One case presents students with the challenge of whether acupuncture may be an effective therapy for pain associated with chronic headache. Through case activities, students gain experience weighing observational Versus experimental evidence, apply directed acyclic graph theory, and analyze clinical trial data. Qualitative evaluations in 2015 (pilot year) and 2016 indicate students preferred the integrated approach to separate courses, and found the integration facilitated application of methods to their independent research projects. Significant rewards for faculty include cross-disciplinary collaboration, sharpened teaching skills, and engaging with learners in a dynamic classroom environment. DISCUSSION/SIGNIFICANCE OF IMPACT: Despite administrative and pedagogical challenges, a case-based, integrated curriculum offers rewards for faculty and students. The case method may be a useful pedagogical strategy to integrate other closely related topics or courses in translational science to better prepare scholars for the challenges of independent research.

A Clinical Vision Research Training and Mentoring Program as a Model for Ophthalmology and Other Medical Specialties: Implementation and Evaluation

Background Over the past 50 years, there has been a decline in the number of physicians pursuing careers in clinical research. In ophthalmology, the need for clinician-investigators continues to grow with the increasing eye-care demands of the aging population. Expert panels have recommended exposing medical students early in their training to structured, didactic curricula with clinical research experience and mentoring opportunities. Methods To address this need, the Department of Research, Wills Eye Hospital, developed an 8-week Clinical Vision Research Training and Mentoring Program for undergraduate and medical students. The curriculum included an 11-hour lecture series on topics in research methods in ophthalmology and a 10-hour scientific writing workshop series. The program also involved hands-on participation in vision research projects and shadowing in one of Wills' subspecialty services. Students completed 40-question pre- and posttests on ophthalmology and research methodology. Scores were analyzed using a paired-sample t-test. The program also utilized a satisfaction survey. Results During 2014 and 2015, a total of 34 students out of 56 applicants were accepted to the Clinical Vision Research Training and Mentoring Program. Students scored significantly higher on the posttest (mean [M] = 79.78%, standard deviation [SD] = 6.25) than on the pretest (M = 71.43%, SD = 8.43); p< 0.001. Using a satisfaction survey, students strongly agreed that they were satisfied with the program and that the lecture series and manuscript writing workshops enhanced their learning. Conclusions The Wills Eye Clinical Vision Research Training and Mentoring Program provided an evidence-based foundation in research methods and manuscript development for students interested in careers in ophthalmology. Students emerged with clinical research skills and an increased understanding and appreciation of vision research. Results of the pre- and posttest analysis indicate that lecture material supplemented with hands-on experience can lead to better understanding of ophthalmology. This pilot program can serve as a research training and mentoring model for ophthalmology and other medical and surgical specialties.

Outcomes From the NIH Clinical Research Training Program: A Mentored Research Experience to Enhance Career Development of Clinician-Scientists.

Clinician-scientists are considered an endangered species for many reasons, including challenges with establishing and maintaining a career pipeline. Career outcomes from yearlong medical and dental students' research enrichment programs have not been well determined. Therefore, the authors assessed career and research outcome data from a cohort of participants in the National Institutes of Health (NIH) Clinical Research Training Program (CRTP). The CRTP provided a yearlong mentored clinical or translational research opportunity for 340 medical and dental students. Of these, 135 completed their training, including fellowships, from 1997 to January 2014. Data for 130 of 135 were analyzed: time conducting research, types of public funding (NIH grants), and publications from self-reported surveys that were verified via the NIH Research Portfolio Online Reporting Tools Web site and PubMed. Nearly two-thirds (84 of 130) indicated that they were conducting research, and over half of the 84 (approximately one-third of the total cohort) spent more than 25% of time conducting research. Of those 84, over 25% received grant support from the NIH, and those further in their careers published more scholarly manuscripts. Data suggest that the CRTP helped foster the careers of research-oriented medical and dental students as measured by time conducting research, successful competition for federal funding, and the publication of their research. Longer follow-up is warranted to assess the impact of these mentored research experiences. Investments in mentored research programs for health professional students are invaluable to support the dwindling pipeline of biomedical researchers and clinician-scientists.

AME College: a Clinical Research Training Program.

AME College: a Clinical Research Training Program.

Massachusetts General Hospital Global Psychiatric Clinical Research Training Program: A New Fellowship in Global Mental Health.

Author(s): Magidson, Jessica F; Stevenson, Anne; Ng, Lauren C; Hock, Rebecca S; Borba, Christina PC; Namey, Leah Beth; Carney, Julia; Joska, John A; Kagee, Ashraf; Fekadu, Abebaw; Bangsberg, David R; Safren, Steven A; Fricchione, Gregory L; Henderson, David C

The physician-scientist workforce in the United States.

Drs. Agren and Wetterberg conclude in their Letter to the Editor that “the declining proportion of research trained medical doctors in psychiatry is an increasing problem in Sweden.” This is concerning since physicians bring to their research the vital experience of caring for patients. This clinical “lens” enormously impacts how physician-scientists make hypotheses and design clinical research either on their own or, increasingly, in collaboration with PhD scientists. The focus of their clinical and translational research is for the benefit of the patient. Unfortunately, over the past 30 years, the number of physicians primarily engaged in research in the United States (US) has declined as the number of physicians engaged in patient care has steadily increased (1). As early as 1979, eminent physician scientists (2) and more recently in the 1990s, national organizations including the Institute of Medicine (3), the Association of American Medical Colleges (AAMC) (4) and the National Institutes of Health (NIH)(5) described challenges for the physician-scientist workforce, including barriers to attracting and retaining clinical investigators in research. Recommendations from these organizations to increase clinical research training in the US were enacted in the late 1990s at a time when the NIH annual budget doubled from $13.675 billion (1998) to $27.167 billion (2003). That period saw substantial growth in the number and types of clinical research training programs(6), many pioneered and heavily supported by the NIH itself alongside initiatives by foundations and other non-profit organizations which vitally support medical research.

Scientist–practitioner training at the internship and postdoctoral level: Reflections over three decades.

Clinical psychology training for research-oriented scientist–practitioners tends to have a gap in research training during the predoctoral internship year. In 1982, the Clinical Psychology Training Program (CPTP) at the University of California, San Francisco (UCSF) began a 2-year clinical and clinical research training program combining an American Psychology Association (APA)-accredited internship and a postdoctoral fellowship. The goal of the program is to prepare graduates for leadership roles as principal investigators who are licensed clinicians able to function as independent practitioners. This article conveys the philosophy behind the program, its structure, and the results of the program over the last 31 years. The CPTP accepted 142 trainees, of whom 46 (32%) were minorities and 78 (55%) were women. CPTP fellows have published over 250 articles, chapters, and books with their mentors and have contributed to submitting research grants with them. The vast majority continued research and academic activities after graduation. The most recent self-study for APA accreditation reported that of 43 trainees admitted in the 10 years between 1999 and 2008, 41 (95%) went on to academic positions, research, or clinical positions in academic settings or research positions in other settings; 1 obtained a clinical position; and 1 provided no information. The program serves as a model for clinical psychology nationally, allowing for uninterrupted clinical research training during the internship and postdoctoral years, nurturing clinical psychologists committed to clinical research careers, and contributing substantially to the clinical research productivity of the host department.