Variations of a group coaching intervention to support early-career biomedical researchers in Grant proposal development: a pragmatic, four-arm, group-randomized trial.

BACKGROUND: Funded grant proposals provide biomedical researchers with the resources needed to build their research programs, support trainees, and advance public health. Studies using National Institutes of Health (NIH) data have found that investigators from underrepresented groups in the biomedical workforce are awarded NIH research grants at disproportionately lower rates. Grant writing training initiatives are available, but there is a dearth of rigorous research to determine the effectiveness of such interventions and to discern their essential features. METHODS: This 2 × 2, unblinded, group-randomized study compares the effectiveness of variations of an NIH-focused, grant writing, group coaching intervention for biomedical postdoctoral fellows and early-career faculty. The key study outcomes are proposal submission rates and funding rates. Participants, drawn from across the United States, are enrolled as dyads with a self-selected scientific advisor in their content area, then placed into coaching groups led by senior NIH-funded investigators who are trained in the intervention's coaching practices. Target enrollment is 72 coaching groups of 4-5 dyads each. Groups are randomized to one of four intervention arms that differ on two factors: [1] duration of coaching support (regular dose = 5 months of group coaching, versus extended dose = regular dose plus an additional 18 months of one-on-one coaching); and [2] mode of engaging scientific advisors with the regular dose group coaching process (unstructured versus structured engagement). Intervention variations were informed by programs previously offered by the NIH National Research Mentoring Network. Participant data are collected via written surveys (baseline and 6, 12, 18, and 24 months after start of the regular dose) and semi-structured interviews (end of regular dose and 24 months). Quantitative analyses will be intention-to-treat, using a 2-sided test of equality of the effects of each factor. An inductive, constant comparison analysis of interview transcripts will be used to identify contextual factors -- associated with individual participants, their engagement with the coaching intervention, and their institutional setting - that influence intervention effectiveness. DISCUSSION: Results of this study will provide an empirical basis for a readily translatable coaching approach to supporting the essential grant writing activities of faculty, fellows, and other research trainees, including those from underrepresented groups.

Use of automated reminder letters to improve diabetes management in primary care: outcomes of a quality improvement initiative.

BACKGROUND: Effective management of patients with diabetes mellitus (DM) can be time-consuming and costly. One patient-centred quality improvement strategy is to generate reminder letters to prompt patient action(s), but this strategy's effect on DM outcomes is uncertain. AIM: To determine whether using the electronic medical record to automatically generate reminder letters for patients not meeting recommended DM targets is associated with improvement in practice level quality metrics for DM management. METHODS: Over 15 months, letters were sent monthly to all patients with DM in a large, urban, primary care teaching practice whose records for haemoglobin A1c (HbA1c), low-density lipoprotein (LDL) or blood pressure (BP) indicated non-compliance with recommended levels and testing intervals. Logistic regression was used to analyse cross-sectional, practice-level differences in the proportion of patients meeting DM quality metrics (HbA1c < 7%, LDL < 100 mg/dl and BP < 130/80 mmHg; rates of checking each value within the last 12 months; and a composite of these five measures) across four time points: six months before the intervention, start of the intervention, end of the 15-month intervention period and six months after the intervention. RESULTS: The number of letters sent per month ranged from 284 to 392, representing 28-38% of all patients with DM. At the end of the intervention, patients' odds of being at goal were higher than before the intervention began for LDL < 100 mg/dl, and for HbA1c and LDL tested once within the last 12 months (or 1.24, P = 0.005; or 1.35, P = 0.03; or 1.48, P < 0.001, respectively). Post intervention, declines were seen in LDL checked within the last 12 months (or 0.76, P = 0.003) and in the composite endpoint (or 0.78, P = 0.005). CONCLUSIONS: The automated patient-reminder letter intervention was associated with modest improvements in several, but not all DM measures. This approach may be an effective tool for improving quality of care for patients with DM.

The Proposal Preparation Program: A Group Mentoring, Faculty Development Model to Facilitate the Submission and Funding of NIH Grant Applications.

This article describes the University of Minnesota Medical School Proposal Preparation Program (P3). P3 is designed to develop grant-writing skills for assistant professors preparing their first K- or R-series application to the National Institutes of Health (NIH). Three 4-month P3 cycles are conducted annually. For each cycle, a cohort of around 10 assistant professor participants and 5 regular faculty mentors meet for ten ~2-hour group sessions. Participants receive iterative oral and written feedback on their proposals in development within a small, interdisciplinary, group mentoring setting providing structure, accountability, guidance, and support. Between sessions, 1 peer and 1 mentor are assigned (on a rotating basis) to critique each participant's developing application. The sessions include a brief mentor-led presentation on a particular grant section followed by discussion of each participant's application conducted by the assigned reviewers. The cycle concludes with a mock NIH review session, in which each participant is matched with a University of Minnesota faculty content expert who critiques their completed application using NIH guidelines. In a survey sent to all past P3 participants as of 2018 (n = 194), 88% of respondents reported having submitted their P3-developed NIH grant, and 35% of these submitters reported funding success. A separate analysis of institutional data for all past P3 participants as of 2016 (n = 165) showed that 73% submitted at least 1 NIH proposal since completing P3 and that 43% of these had acquired NIH funding, for a combined total of $193 million in funding awarded. The estimated rate at which participants obtained funding for their P3-developed grant application (~35%) exceeds the national annual NIH grant funding rates (~20%) by approximately 50%. This article provides the practical information needed for other institutions to implement a P3-like program and presents a cost-benefit analysis showing the advantages of doing so.

Effect of an End-of-Life Planning Intervention on the completion of advance directives in homeless persons: a randomized trial.

BACKGROUND: Few interventions have focused on improving end-of-life care for underserved populations, such as homeless persons. OBJECTIVE: To determine whether homeless persons will complete a counseling session on advance care planning and fill out a legal advance directive designed to assess care preferences and preserve the dignity of marginalized persons. DESIGN: Prospective, single-blind, randomized trial comparing self-guided completion of an advance directive with professionally assisted advance care planning. (ClinicalTrials.gov registration number: NCT00546884) SETTING: 8 sites serving homeless persons in Minneapolis, Minnesota. PARTICIPANTS: 262 homeless persons recruited between November 2007 and August 2008. INTERVENTION: Minimal, self-guided intervention consisting of advance directive forms and written educational information versus a one-on-one advance planning intervention consisting of counseling and completing an advance directive with a social worker. MEASUREMENTS: Rate of advance directive completion, assessed by inspection of completed documents. RESULTS: The overall completion rate for advance directives was 26.7% (95% CI, 21.5% to 32.5%), with a higher rate in the counselor-guided group (37.9%) than in the self-guided group (12.8%) (CI of adjusted difference, 15.3 to 34.3 percentage points). This difference persisted across all sites and most subgroups. The advance directive's 4 clinical scenarios found a preference for surrogate decision making in 29% to 34% of written responses. LIMITATIONS: Sampling was limited to a more stable subset of the homeless population in Minneapolis and may have been subject to selection bias. Modest compensation to complete the preintervention survey could have influenced participants to complete advance directives. CONCLUSION: Both a simple and complex intervention successfully engaged a diverse sample of homeless persons in advance care planning. One-on-one assistance significantly increased the completion rate. Homeless persons can respond to an intervention to plan for end-of-life care and can express specific preferences for care or a surrogate decision maker, but additional studies are needed to assess the effect of these directives on subsequent care. PRIMARY FUNDING SOURCE: National Institute for Nursing Research and National Center on Minority Health and Health Disparities.

Grant application outcomes for biomedical researchers who participated in the National Research Mentoring Network's Grant Writing Coaching Programs.

BACKGROUND: A diverse research workforce is essential for catalyzing biomedical advancements, but this workforce goal is hindered by persistent sex and racial/ethnic disparities among investigators receiving research grants from the National Institutes of Health (NIH). In response, the NIH-funded National Research Mentoring Network implemented a Grant Writing Coaching Program (GCP) to provide diverse cohorts of early-career investigators across the United States with intensive coaching throughout the proposal development process. We evaluated the GCP's national reach and short-term impact on participants' proposal submissions and funding outcomes. METHODS: The GCP was delivered as six similar but distinct models. All models began with an in-person group session, followed by a series of coaching sessions over 4 to 12 months. Participants were surveyed at 6-, 12- and 18-months after program completion to assess proposal outcomes (submissions, awards). Self-reported data were verified and supplemented by searches of public repositories of awarded grants when available. Submission and award rates were derived from counts of participants who submitted or were awarded at least one grant proposal in a category (NIH, other federal, non-federal). RESULTS: From June 2015 through March 2019, 545 investigators (67% female, 61% under-represented racial/ethnic minority, URM) from 187 different institutions participated in the GCP. Among them, 324 (59% of participants) submitted at least one grant application and 134 (41% of submitters) received funding. A total of 164 grants were awarded, the majority being from the NIH (93, 56%). Of the 74 R01 (or similar) NIH research proposals submitted by GCP participants, 16 have been funded thus far (56% to URM, 75% to women). This 22% award rate exceeded the 2016-2018 NIH success rates for new R01s. CONCLUSION: Inter- and intra-institutional grant writing coaching groups are a feasible and effective approach to supporting the grant acquisition efforts of early-career biomedical investigators, including women and those from URM groups.

A randomized controlled pilot study of the University of Minnesota mentoring excellence training academy: A hybrid learning approach to research mentor training.

INTRODUCTION: Research mentor training is a valuable professional development activity. Options for training customization (by delivery mode, dosage, content) are needed to address the many critical attributes of effective mentoring relationships and to support mentors in different institutional settings. METHODS: We conducted a pilot randomized controlled trial to evaluate a hybrid mentor training approach consisting of an innovative, 90-minute, self-paced, online module (Optimizing the Practice of Mentoring, OPM) followed by workshops based on the Entering Mentoring (EM) curriculum. Mentors (n = 59) were randomized to intervention or control arms; the control condition was receipt of a two-page mentoring tip sheet. Surveys (pre, post, 3-month follow up) and focus groups assessed training impact (self-appraised knowledge, skills, behavior change) and participants' perceptions of the blended training model. RESULTS: The intervention (∼6.5 hours) produced significant improvements in all outcomes, including skills gains on par with those reported previously for the 8-hour EM model. Knowledge gains and intention-to-change mentoring practices were realized after completion of OPM and augmented by the in-person sessions. Mentors valued the synergy of the blended learning format, noting the unique strengths of each modality and specific benefits to completing a foundational online module before in-person engagement. CONCLUSIONS: Findings from this pilot trial support the value of e-learning approaches, both as standalone curricula or as a component of hybrid implementation models, for the professional development of research mentors.

Changes in Health Professional Students' Attitudes Toward the Underserved: Impact of Extended Participation in an Interprofessional Student-Run Free Clinic.

This study assessed the impact of volunteering for 2 years in an interprofessional student-run free clinic (SRFC) on the attitudes of health professional students toward the medically underserved. The Health Professionals' Attitudes Toward the Homeless Inventory was administered to students from six different health professions at three time points: before, after 1 year, and after 2 years of volunteering in an SRFC. The results were compared to students who never applied to the SRFC and those who applied but were not accepted. Students who applied had similar attitude scores at baseline and differed significantly from those who did not apply. Although all three groups showed declining attitudes after the first year, students who volunteered had more favorable attitudes than the other two groups from this point forward. These results suggest that SRFCs have a protective effect against the declining attitudes toward the underserved that can occur as training progresses.

Enhancing research careers: an example of a US national diversity-focused, grant-writing training and coaching experiment.

BACKGROUND AND PURPOSE: Preparing a successful research proposal is one of the most complex skills required of professional scientists, yet this skill is rarely if ever, taught. A major goal of the National Research Mentoring Network (NRMN) in the United States (U.S.) is to support the professional advancement of postdoctoral fellows and junior faculty from diverse populations by offering intensive coaching in the development of grant proposals early in their careers. This article highlights the National Institutes of Health's (NIH) NRMN initiative to prepare diverse constituencies of early-stage biomedicine scientists for research careers by implementation of an evidence-based nationwide program of comprehensive grant writing and professional development. PROGRAM AND KEY HIGHLIGHTS: NRMN delivers four unique but complementary coaching models: the Proposal Preparation Program from the University of Minnesota (UMN); Grantwriters Coaching Groups from Northwestern University (NU); Grantwriting Uncovered: Maximizing Strategies, Help, Opportunities, Experiences from the University of Colorado Anschutz Medical Campus (UC) and Washington State University (WSU); and Steps Towards Academic Research from the University of North Texas Health Science Center (UNTHSC). Because these programs cater to scientists at different career stages, rather than employ a single approach, each is uniquely tailored to test its efficacy at the national level. The first two models prioritize scientists with reasonably well-developed research projects who are ready to write proposals for specific NIH research competitions. The other two models target postdoctoral fellows and early-career faculty who need more extensive guidance in proposal development plans. To achieve scalability, all programs also recruit faculty as Coaches-in-Training to learn approaches and acquire particular group facilitation skills required by each model. IMPLICATIONS: These efforts exemplify NRMN's potential to enhance the career development of diverse trainees on a national scale, building research skills, competitiveness for obtaining faculty positions and capacities that will result in high quality research proposals from a diverse pool of applicants, thereby advancing innovations in science and diversifying the U.S. biomedical workforce.

A new approach to mentoring for research careers: the National Research Mentoring Network.

BACKGROUND AND PURPOSE: Effective mentorship is critical to the success of early stage investigators, and has been linked to enhanced mentee productivity, self-efficacy, and career satisfaction. The mission of the National Research Mentoring Network (NRMN) is to provide all trainees across the biomedical, behavioral, clinical, and social sciences with evidence-based mentorship and professional development programming that emphasizes the benefits and challenges of diversity, inclusivity, and culture within mentoring relationships, and more broadly the research workforce. The purpose of this paper is to describe the structure and activities of NRMN. KEY HIGHLIGHTS: NRMN serves as a national training hub for mentors and mentees striving to improve their relationships by better aligning expectations, promoting professional development, maintaining effective communication, addressing equity and inclusion, assessing understanding, fostering independence, and cultivating ethical behavior. Training is offered in-person at institutions, regional training, or national meetings, as well as via synchronous and asynchronous platforms; the growing training demand is being met by a cadre of NRMN Master Facilitators. NRMN offers career stage-focused coaching models for grant writing, and other professional development programs. NRMN partners with diverse stakeholders from the NIH-sponsored Diversity Program Consortium (DPC), as well as organizations outside the DPC to work synergistically towards common diversity goals. NRMN offers a virtual portal to the Network and all NRMN program offerings for mentees and mentors across career development stages. NRMNet provides access to a wide array of mentoring experiences and resources including MyNRMN, Guided Virtual Mentorship Program, news, training calendar, videos, and workshops. National scale and sustainability are being addressed by NRMN "Coaches-in-Training" offerings for more senior researchers to implement coaching models across the nation. "Shark Tanks" provide intensive review and coaching for early career health disparities investigators, focusing on grant writing for graduate students, postdoctoral trainees, and junior faculty. IMPLICATIONS: Partners from diverse perspectives are building the national capacity and sparking the institutional changes necessary to truly diversify and transform the biomedical research workforce. NRMN works to leverage resources towards the goals of sustainability, scalability, and expanded reach.

''Quit & Win'' Contests Among College Students: Predictors of Long-Term Smoking Abstinence.

PURPOSE: To determine smoking abstinence rates and predictors of abstinence among college students enrolled in a campus-based Quit & Win contest. DESIGN: Pre-post measure with no comparison group. SETTING: Contests conducted on seven college campuses in 2007. SUBJECTS: Subjects (N = 484) were 23.7 ± 6.8 years of age, 61% female, 16.3% nonwhite, and smoked 12.5 ± 7.8 cigarettes per day on 28.0 ± 4.8 days in the past month. INTERVENTION: Participants abstinent for the 30-day contest were eligible for a lottery-based prize. Assessments were completed at baseline, end of contest, and 6 months after enrollment. MEASURES: The 6-month survey assessed retrospective abstinence during the contest period and the prior 6 months and 7- and 30-day point prevalence abstinence at the time of the survey. ANALYSIS: Chi-square test was used to compare baseline characteristics among participants from 2-versus 4-year schools. Smoking abstinence was assessed by participant self-report. Both a simple imputation method (i.e., missing = smoking) and completers-only analyses were conducted. Stepwise logistic regression was used to determine baseline predictors of abstinence. RESULTS: Thirty-day abstinence rate was 52.5% during the contest month and 20.5% at the 6-month follow-up. Baseline intention to stay quit (odds ratio [OR] = 1.56, p = .01), cigarettes smoked per day (OR = .67, p = .04), and 2-year (vs. 4-year) college (OR = 1.65, p = .05) predicted abstinence at 6 months. CONCLUSION: Intention to stay quit even without winning a prize, a measure of intrinsic motivation, predicted both short- and long-term abstinence.

An adaptive approach to facilitating research productivity in a primary care clinical department.

Efforts to foster the growth of a department's or school's research mission can be informed by known correlates of research productivity, but the specific strategies to be adopted will be highly context-dependent, influenced by local, national, and discipline-specific needs and resources. The authors describe a multifaceted approach-informed by a working model of organizational research productivity-by which the University of Minnesota Department of Family Medicine and Community Health (Twin Cities campus) successfully increased its collective research productivity during a 10-year period (1997-2007) and maintained these increases over time.Facing barriers to recruitment of faculty investigators, the department focused instead on nurturing high-potential investigators among their current faculty via a new, centrally coordinated research program, with provision of training, protected time, technical resources, mentoring, and a scholarly culture to support faculty research productivity. Success of these initiatives is documented by the following: substantial increases in the department's external research funding, rise to a sustained top-five ranking based on National Institutes of Health funding to U.S. family medicine departments, later-stage growth in the faculty's publishing record, increased research capacity among the faculty, and a definitive maturation of the department's research mission. The authors offer their perspectives on three apparent drivers of success with broad applicability-namely, effective leadership, systemic culture change, and the self-awareness to adapt to changes in the local, institutional, and national research environment.

Efficacy of peer-assisted learning across residencies for procedural training in dermatology.

BACKGROUND: With new care models such as the medical home, there is an expanding need for primary care providers to be trained in dermatologic procedures. Yet, many internal medicine residency program graduates feel unprepared to perform these procedures. The aim of this study was to evaluate the effect of a structured peer-assisted learning approach to improve residents' knowledge and skills related to common dermatologic assessment techniques. METHODS: Eight medicine-dermatology resident educators, with a faculty member, facilitated dermatologic procedure workshops for 28 internal medicine and medicine-pediatrics resident learners. Learners completed preworkshop and postworkshop surveys, assessing their knowledge and skill levels as well as the efficacy of the resident educators and the educational value of the workshop as a whole. RESULTS: All learners were able to properly demonstrate the techniques at the workshop's conclusion. The median sum score of self-reported knowledge increased from 3 to 9.5 (scale, 0-10; P < .001). The median sum score of self-reported skills increased from 10 to 16 (scale, 4-20; P < .001). Resident educators were favorably evaluated by their peers, and 96% of participants rated the experience as being of high educational value. CONCLUSION: Peer-assisted learning is effective in teaching dermatologic procedures in graduate medical education. Resident learners found peer-assisted learning to be beneficial and rated their peer teachers highly. Further studies should focus on outcomes in practice, looking at the number of dermatologic procedures performed by learners, as well as the effects on resident educators.

Identifying and aligning expectations in a mentoring relationship.

The mentoring relationship between a scholar and their primary mentor is a core feature of research training. Anecdotal evidence suggests this relationship is adversely affected when scholar and mentor expectations are not aligned. We examined three questions: (1) What is the value in assuring that the expectations of scholars and mentors are mutually identified and aligned? (2) What types of programmatic interventions facilitate this process? (3) What types of expectations are important to identify and align? We addressed these questions through a systematic literature review, focus group interviews of mentors and scholars, a survey of Clinical and Translational Science Award (CTSA) KL2 program directors, and review of formal programmatic mechanisms used by KL2 programs. We found broad support for the importance of identifying and aligning the expectations of scholars and mentors and evidence that mentoring contracts, agreements, and training programs facilitate this process. These tools focus on aligning expectations with respect to the scholar's research, education, professional development and career advancement as well as support, communication, and personal conduct and interpersonal relations. Research is needed to assess test the efficacy of formal alignment activities.