Pediatric Physician-scientists Research Articles

Nurturing the next generation of pediatric physician scientists: the Padova Physician Scientist Research Training for pediatric residents

Less than 2% of physicians complete a research training (PhD) after the residency with a declining trend in those pursuing a clinical scientist pathway in pediatrics. The exposure to research methodology during the clinical training may play a role in engaging the next generations of pediatric physician scientist. Herein, we describe the experience of the Padova Physician Scientist Research Training (PPSRT) of the pediatric residency program at the University of Padova. The PPSRT was addressed to residents attending PGY2 to PGY4 of the pediatric program and consisted of two cores: a general one including in person or virtual lectures about research methodology in pediatrics including design of a clinical trial, writing of a scientific paper and statistical methods, and a subspecialties core for the discussion of research challenges in each area and the scientific writing activities. The perceived barriers to a research training and an evaluation of the program were assessed by an anonymized questionnaire. Sixty-four out 150 residents registered for the research training with 62/64 completing the two cores. The major perceived barrier to research during clinical training was the absence of protected time (89%) followed by the lack of specific funds (37%). The group activities lead to the publication of 24 papers. Conclusion: This is the first experience in the Italian pediatric training of a dedicated research program within the frame of postgraduate medical education. Our report highlights the need for protected time to promote research interest and nurture a new generation of physician scientists.What is Known:• Training to medical research is not part of residency program.• The declining trend of physician scientists might be reverted by early exposure to research methodology and challenges during residency.What is New:• An early exposure to research training during pediatric residency increases the research engagement of pediatric residents.• The lack of protected time for research is perceived as the major barrier to research training during residency.

National Pediatrician-Scientist Collaborative Workgroup comment on new ACGME requirements' impact on pediatric physician-scientists.

The ACGME recently released its recommendation for updates to the program requirements for pediatrics. These updates proposed changes to allocation of resident clinical time and a greater emphasis on individualization. The potential impact of these changes on the training of physician-scientists is discussed. Discussion of the proposed changes was held within the members of the National Pediatrician-Scientist Collaborative Workgroup, a group that represents scientists, trainees, program directors, chairs, and physician-scientist educators at nearly 30 residency programs from across the US with a focus on understanding and developing optimal approaches to physician-scientist training. Consideration was given to the both the personal and institutional impact of the proposal for physician-scientist development. Both threats and opportunities were identified. Key opportunities include the enhanced individualized training time that could be used to explore research. Threats include re-allocation of clinical training time that may strain institutions financially, expand clinical service requirements for other early career stage individuals, and alter exposure to a broad range of pediatric specialists and sub-specialists that impact career development. The NPSCW encourages consideration of the impact of changing program requirements on physician-scientist development to include ongoing discussion amongst mentors, programs, and trainees to understand and mitigate impact of new program requirements on the development of pediatrician-scientists.

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Can We Prime the Pump for Developing Pediatric Physician-Scientists?

* Abbreviations: ABP — : American Board of Pediatrics DRSP — : Duke Pediatric Research Scientist Program NIH — : National Institutes of Health Who will become the next generation of pediatric physician-scientists? This question has provoked increasing calls of alarm because a robust cadre of well-trained, clinically knowledgeable pediatric physician-scientists is critical to fully capture the immense potential of scientific advancements to improve child health. The evidence, however, suggests that fewer, rather than more, young pediatricians are entering scientific careers.1–4 A number of factors are generally accepted as current problems for someone who is considering, and later succeeding, in a career as a physician-scientist. Factors considered to negatively influence those who are considering a career as physician-scientists include the following: lack of exposure to research as undergraduates, medical students, or residents; a paucity of mentors at all levels of education; a lack of a diverse scientific workforce; and exorbitant educational debt. Once a physician embarks on a research career, additional hurdles to becoming successful include excessive clinical demands, time constraints, lack of mentors, limited initial funding for salary and laboratory support, and the lengthy period to obtain independent funding. In this issue of Pediatrics , Hurst et al5 describe the … Address correspondence to F. Bruder Stapleton, MD, Seattle Children’s Research Institute, 818 Stewart St, Suite 603, Seattle, WA 98101. E-mail: bruder.stapleton{at}seattlechildrens.org

19. DESIGN AND IMPLEMENTATION OF A FLEXIBLE PEDIATRIC SCIENTIST DEVELOPMENT TRACK

BackgroundCurricula for pediatric scientist development are not standardized in pediatric residency and fellowship, despite the dire need for pediatric physician scientists. We examined existing educational models and developed an integrated residency/fellowship pediatric scientist training program (PedSDP).ObjectiveOur primary objective was the development of an integrated six-year program, spanning residency and fellowship, for training of pediatric physician scientists.MethodsWe reviewed 20 existing pediatric residency tracks for scientist development. An integrated six-year program was constructed using the non-standard American Board of Pediatric pathways (Accelerated and Integrated Research Pathways) and individual components modeled on programs from other residencies. We formed a steering committee comprised of departmental leadership to support and provide input into our curriculum development. With the support of the Chair, we were able obtain approval for acceptance into fellowship programs at time of residency selection as a key obstacle to overcome. We also developed internal educational activities to support scientist development. (See Figure for overall design)ResultsFrom 2014-2018, our PedSDP recruited 8 residents, improving our overall MD PhD recruitment to 3 per year. While six of eight PedSDP trainees were MD PhD, we also recruited two MD only residents into our program. Residents have pursued fellowship in Infectious Disease and Allergy/Immunology (2 each), and Neonatology, Rheumatology, Critical Care Medicine and Cardiology (1 each). All residents have average milestones in the top half of their class.DiscussionWe successfully implemented a training program which has increased both MD PhD recruitment but also has provided opportunity for MD residents to pursue research careers. We have found new strategies for recruitment (adding a dedicated ERAS track) but continue to struggle to identify and attract MD/DO only resident applicants interested in being physician-scientists to the program. URL http://www.chp.edu/health-care-professionals/education/residencies/pedsdp Curricula for pediatric scientist development are not standardized in pediatric residency and fellowship, despite the dire need for pediatric physician scientists. We examined existing educational models and developed an integrated residency/fellowship pediatric scientist training program (PedSDP). Our primary objective was the development of an integrated six-year program, spanning residency and fellowship, for training of pediatric physician scientists. We reviewed 20 existing pediatric residency tracks for scientist development. An integrated six-year program was constructed using the non-standard American Board of Pediatric pathways (Accelerated and Integrated Research Pathways) and individual components modeled on programs from other residencies. We formed a steering committee comprised of departmental leadership to support and provide input into our curriculum development. With the support of the Chair, we were able obtain approval for acceptance into fellowship programs at time of residency selection as a key obstacle to overcome. We also developed internal educational activities to support scientist development. (See Figure for overall design) From 2014-2018, our PedSDP recruited 8 residents, improving our overall MD PhD recruitment to 3 per year. While six of eight PedSDP trainees were MD PhD, we also recruited two MD only residents into our program. Residents have pursued fellowship in Infectious Disease and Allergy/Immunology (2 each), and Neonatology, Rheumatology, Critical Care Medicine and Cardiology (1 each). All residents have average milestones in the top half of their class. We successfully implemented a training program which has increased both MD PhD recruitment but also has provided opportunity for MD residents to pursue research careers. We have found new strategies for recruitment (adding a dedicated ERAS track) but continue to struggle to identify and attract MD/DO only resident applicants interested in being physician-scientists to the program. URL http://www.chp.edu/health-care-professionals/education/residencies/pedsdp

Challenges for Today’s Pediatric Physician-Scientists

Challenges for Today’s Pediatric Physician-Scientists

Name and Characteristics of National Institutes of Health R01-Funded Pediatric Physician-Scientists

This study describes the number and characteristics of physician-scientists who are funded by National Institutes of Health independent investigator awards.

Scholarship During Fellowship: Flexibility Unrealized

* Abbreviations: ABP — : American Board of Pediatrics SOC — : Scholarship Oversight Committee What is the goal of pediatric subspecialty training, how long should the training period be, and what is the value of a scholarly activity? A committee of the American Board of Pediatrics (ABP) grappled with these and other questions from 2000 to 2003. Previously the ABP supported the view of the Federation of Pediatric Organizations that “the principal goal of fellowship training should be to develop future academic pediatricians”1 and required all applicants for subspecialty certification to have evidence of “meaningful accomplishment in research,” usually a peer-reviewed publication. A number of concerns spawned the 2000 to 2003 ABP review, including subspecialty workforce shortages, decreasing numbers of pediatric physician–scientists, and trends toward nonacademic careers among subspecialty fellowship graduates, concerns that persist today. Based on the committee’s recommendations, in 2004 the ABP issued new fellowship training requirements providing greater curricular flexibility to better prepare subspecialists with varied career aspirations.2 In place of “meaningful accomplishment in research,” the ABP embraced a variety of scholarly activities that could be tailored to individual career goals. Furthermore, fellows were to be mentored by a Scholarship Oversight Committee (SOC) that approved their scholarship work product. Examples of scholarship offered by the ABP included basic, clinical, translational, and health … Address correspondence to F. Bruder Stapleton, MD, Department of Pediatrics, Seattle Children’s Hospital, 4800 Sand Point Way NE, RB2:401, Seattle, WA 98105. E-mail: bruder.stapleton{at}seattlechildrens.org

Glucocorticoids Influence on Mesenchymal Stem Cells and Implications for Metabolic Disease

Metabolic disease is a well established major public health problem in the adult population. However, the origins of metabolic disease of adults can begin early in life. In addition, in recent years, there has been a disturbing increase in the number of children developing the full presentation of metabolic disease as a result of the increase in obesity in this population. Therefore, pediatricians and pediatric physician-scientists are essential both for instituting preventive measures and developing new therapies. This challenge has been met with a substantial increase in research into both the clinical and basic science of metabolism. A connection between glucocorticoids and the origins of metabolic disease is one enticing clue because of the clinical similarity between patients with glucocorticoid excess and those with metabolic disease. This perspective highlights one series of investigations that has advanced our understanding of the development of metabolic disease. In this work, a unifying link was found by investigating the role of glucocorticoids on cell fate and differentiation of mesenchymal stem cells. We conclude that elucidating the mechanisms by which glucocorticoids modulate cell fate decisions holds promise for developing new therapies and preventative measures.

The Future of Pediatric Research

The future of pediatric research will be enhanced by strengthening traditional biomedical approaches and embracing emerging opportunities. Biomedical discovery and translation of new knowledge, concepts, and devices into better diagnostic and therapeutic options will require more pediatric physician-scientists, rapid adoption of enabling technologies, increased funding for research and research training (including the creation of federally funded pediatric translational research centers), and a broader distribution of research activities across the academic pediatric community. Rapid improvement of child health outcomes also will be realized through robust health services research in pediatrics, including the application of rigorous quality improvement science that documents and disseminates successful interventions, leading to better access and effectiveness of care. Improving the value of pediatric care is a realistic goal. Achieving better outcomes through individually tailored (personalized) care for children should be tested experimentally. The future of pediatrics is bright, but will depend on the recognition of and response to a growing array of exciting opportunities.