Program to train underrepresented investigators for health equity research

Key takeaways:

• The program will combine mentorship with career-centered coursework.
• Research will focus on heart, lung, blood and sleep disorders.
• Participants will be able to earn a master’s degree as well.

As health systems struggle to improve outcomes in underserved populations, they are turning to scientists and physician-scientists who represent these communities. Yet these scientists also need support as they embark on their careers.

Montefiore Health System and Albert Einstein College of Medicine will use a $1.5 million grant from the NIH to teach and guide these young scientists in research related to heart, lung, blood and sleep disorders as they address disparities in care.

Representation matters

“The main goal of the training program is to enhance participation of postgraduate trainees from diverse backgrounds in cardiovascular, pulmonary, hematologic and sleep disorders research,” Marina Reznik, MD, MS, told Healio.

Reznik is principal investigator, vice chair for clinical and community-based research at Children’s Hospital at Montefiore and professor of pediatrics at Albert Einstein College of Medicine.

During the program, nearly 28 established, senior investigators from Montefiore and Einstein will train nine physicians interested in academic research as they investigate health inequities in the Bronx with a target of understanding and reducing them.

The 2-year program will enroll three trainees at a time.

“We have three main goals for the program,” Reznik said.

First, the program aims to increase these trainees’ research knowledge and skills. Next, its organizers hope to increase the number of young scientists and physician-scientists who pursue academic careers in research. The program also is designed to provide the trainees with the state-of-the art experiences and skills required to successfully compete for extramural and other funding.

But there is a lack of diversity among physician-scientists, including women, persons with disabilities and underrepresented racial and ethnic and minority groups, Reznik said.

“Only 4% of full professors at research-intensive institutions are from underrepresented racial and ethnic groups,” she continued.

In fact, Reznik said, the NIH has made improving the diversity of independent investigators a priority.

“Diverse and collaborative teams of researchers are more likely to develop new and innovative ideas. You get different perspectives,” Reznik said. “You get more generalizable results and then also, ultimately, you can improve the trust of the public.”

Reznik further noted that by 2050, nearly 50% of the U.S. population will include medically underserved and vulnerable populations.

“There is a need for physicians and physician-scientists and others to care for the vulnerable populations and contribute to the study of the diseases that affect these populations,” she said. “So, there really needs to be more effort to recruit researchers from these populations.”

Targeted diseases

With funding from the NIH’s National Heart, Lung, and Blood Institute (NHBLI), the program will target specific diseases such as COPD, sarcoidosis, sickle cell disease, and asthma, which Reznik called her primary research interest.

“Asthma affects in general more than 25 million people in the United States,” she said. “There’s just a huge economic burden from school absences and work absences and from mortality and morbidity.”

Reznik said that her work specifically includes implementation science and looks at how to improve health outcomes by studying the delivery of the best available interventions in a way that overcomes barriers and leverages individual, health system, and community assets.

Along with her colleagues, Reznik and her team go into the community to test and implement interventions including evidence-based treatment, behavioral interventions and education, all to improve asthma outcomes.

The Bronx in particular offers challenges and opportunities to both patients and physicians, she continued, as it is one of the poorest urban areas in the United States, with more than 26% of its population below the poverty line.

“Health outcomes in the Bronx populations also ranked the lowest of all 62 counties in New York State,” Reznik said. “We have the highest rates of diabetes, obesity, asthma, HIV and infant mortality of the entire United States.”

Specifically, poor housing conditions including pest exposures exacerbate asthma in the Bronx, where prevalence can reach up to 25% in some neighborhoods, Reznik said.

With a population that is about 56% Hispanic and 44% Black, Reznik continued, these patients are more likely to be hospitalized for asthma as well.

“Montefiore and CHAM (Children’s Hospital at Montefiore) specifically provide the opportunities to study, address and improve these barriers in asthma health outcomes,” Reznik said.

In a previous study, Reznik and her colleagues developed screening and decision support tools for asthma management based on NHLBI guidelines for the electronic health records used at all 18 Montefiore outpatient clinics.

The training

The mentors will include 28 senior scientists from basic translational clinical health services research and implementation science representing nine departments and six subspecialties.

“They all have a strong record of mentorship,” Reznik said.

Mentors will be matched with the nine trainees based on their areas of research interest.

“It will be one primary mentor, and then there will be other co-mentors and advisors depending on the needs of the trainees,” Reznik said.

Trainees will meet with their mentors regularly to develop short-term and long-term goals for their research, as the mentors provide guidance and feedback on these projects.

“The scope of the research stems from basic to population health. It’s pretty broad,” Reznik said.

Internal and external advisory committees will offer input and networking opportunities as well.

In addition to developing laboratory skills, trainees will learn how to develop research proposals and navigate the submission process including grant writing as they seek funding for their work. They also will learn how to share the results of their research.

“It’s important to not just have those presentation skills, but also writing skills because, for the scientific community, the expectation is that you will be publishing your work,” Reznik said.

“By the end of the 2 years, the expectation is that they will have the mentored career development proposal written up and then the goal is to submit it and get funded,” she continued.

Trainees also will participate in the Biomedical Science Leadership Program offered by the Belfer Institute for Advanced Biomedical Studies at Einstein, which includes courses and workshops in communications, management, personal resiliency, emotional intelligence, cultural competency, course design, grantsmanship and career management.

“This program really helps to prepare the participants for leadership positions in research, teaching, administration and industry,” Reznik said. “There are specific courses that help build these skills that generally you don’t gain in regular training.”

For example, Reznik said, participants will learn how to navigate their relationships with their mentors as well as how they can be effective mentors themselves. Biostatistics, epidemiology, data analysis and research ethics also are part of the individualized coursework.

Additionally, trainees will have the opportunity to earn a master of science degree in clinical research methods.

Also, trainees will be working with Bronx pathway programs to serve as outstanding role models and help inspire pre-medical students, medical students, residents and fellows to pursue careers in heart, lung, blood, and sleep disorders research, which Reznik called another important component of the program.

Montefiore Health System and Albert Einstein College of Medicine are now disseminating information about the program including its benefits both internally and externally and expect it to begin in July.

“It’s navigating different career paths and identifying skills that you need,” Reznik said. “These are really important components for being a researcher.”

Reference:

• Physician-scientists underrepresented in medicine to conduct health equity research at Montefiore and Einstein. https://www.einsteinmed.edu/news/15159/physician-scientists-underrepresented-in-medicine-to-conduct-health-equity-research-at-montefiore-and-einstein/. Published Feb. 6, 2024. Accessed March 29, 2024.