A 30-year analysis of National Institutes of Health-funded cardiac transplantation research: Surgeons lead the way

Machine Learning on 50,000 Manuscripts Shows Increased Clinical Research by Academic Cardiac Surgeons

INTRODUCTION

Academic cardiac surgeons are productive researchers and innovators. We sought to perform a comprehensive machine learning (ML)-based characterization of cardiac surgery research over the past 40 y to identify trends in research pursuits.

METHODS

US-based academic websites were queried for surgeon profiles. Publications since 1980 were obtained from Web of Science, and publication classifications (e.g., "human", "animal") were collected through the National Institutes of Health iCite tool. Publications were deemed "basic or translational" if >50% of their classification was under "animal" or "molecular or cell", and "clinical" if otherwise. ML-based clustering was performed on publication titles and Medical Subject Heading terms to identify research topics.

RESULTS

A total of 944 cardiac surgeons accounted for 48,031 unique publications. Average citations per year have decreased since 1980 (P < 0.001). The percentage of basic or translational publications by cardiac surgeons has decreased over time (P < 0.001), comprising of only 8% of publications in 2022. Adult cardiac surgeons, those who received an F32, K08, or R01, and those with a PhD were more likely to publish basic or translational research. Top areas of basic or translational research were myocardial reperfusion, aortic aneurysms or remodeling, and transplant immunology. Major areas of clinical research included aortic disease, aortic valve disease, and mechanical circulatory support. Collaboration analysis revealed that 55% of publications were single-center, and the yearly percentage of these publications has decreased over time (P < 0.001).

CONCLUSIONS

Cardiac surgeons are performing less basic or translational research relative to clinical research than ever before. The majority of publications over the past 40 y did not involve cross-center collaboration. Continued support for clinical research is needed, while also encouraging collaborative basic or translational science to foster innovation in patient care.

Postdoctoral National Institutes of Health F32 Grants: Broken Pipeline in the Development of Surgeon-Scientists

OBJECTIVE

We examined trainees in surgery and internal medicine who received National Institutes of Health (NIH) F32 postdoctoral awards to determine their success rates in obtaining future NIH funding.

BACKGROUND

Trainees participate in dedicated research years during residency (surgery) and fellowship (internal medicine). They can obtain an NIH F32 grant to fund their research time and have structured mentorship.

METHODS

We collected NIH F32 grants (1992-2021) for Surgery Departments and Internal Medicine Departments from NIH RePORTER, an online database of NIH grants. Nonsurgeons and noninternal medicine physicians were excluded. We collected demographic information on each recipient, including gender, current specialty, leadership positions, graduate degrees, and any future NIH grants they received. A Mann-Whitney U test was used for continuous variables, and a χ 2 test was utilized to analyze categorical variables. An alpha value of 0.05 was used to determine significance.

RESULTS

We identified 269 surgeons and 735 internal medicine trainees who received F32 grants. A total of 48 surgeons (17.8%) and 339 internal medicine trainees (50.2%) received future NIH funding ( P < 0.0001). Similarly, 24 surgeons (8.9%) and 145 internal medicine trainees (19.7%) received an R01 in the future ( P < 0.0001). Surgeons who received F32 grants were more likely to be department chair or division chiefs ( P =0.0055 and P < 0.0001).

CONCLUSIONS

Surgery trainees who obtain NIH F32 grants during dedicated research years are less likely to receive any form of NIH funding in the future compared with their internal medicine colleagues who received F32 grants.

Longitudinal analysis of National Institutes of Health funding for academic thoracic surgeons

OBJECTIVE

National Institutes of Health (NIH) funding for academic (noncardiac) thoracic surgeons at the top-140 NIH-funded institutes in the United States was assessed. We hypothesized that thoracic surgeons have difficulty in obtaining NIH funding in a difficult funding climate.

METHODS

The top-140 NIH-funded institutes' faculty pages were searched for noncardiac thoracic surgeons. Surgeon data, including gender, academic rank, and postfellowship training were recorded. These surgeons were then queried in NIH Research Portfolio Online Reporting Tools Expenditures and Results for their funding history. Analysis of the resulting grants (1980-2019) included grant type, funding amount, project start/end dates, publications, and a citation-based Grant Impact Metric to evaluate productivity.

RESULTS

A total of 395 general thoracic surgeons were evaluated with 63 (16%) receiving NIH funding. These 63 surgeons received 136 grants totaling $228 million, resulting in 1772 publications, and generating more than 50,000 citations. Thoracic surgeons have obtained NIH funding at an increasing rate (1980-2019); however, they have a low percentage of R01 renewal (17.3%). NIH-funded thoracic surgeons were more likely to have a higher professorship level. Thoracic surgeons perform similarly to other physician-scientists in converting K-Awards into R01 funding.

CONCLUSIONS

Contrary to our hypothesis, thoracic surgeons have received more NIH funding over time. Thoracic surgeons are able to fill the roles of modern surgeon-scientists by obtaining NIH funding during an era of increasing clinical demands. The NIH should continue to support this mission.

Thoracic Surgery Foundation Research Awards: Leading the Way to Excellence

BACKGROUND

Combining clinical and research excellence has become an increasingly difficult endeavor for thoracic surgeons, with typical success rates for the NHLBI and NCI being 25.1% and 11.3% respectively. The Thoracic Surgery Foundation (TSF), which is an arm of the Society of Thoracic Surgeons, provides research awards and grants aimed at early career faculty to assist in securing federal peer reviewed funding. The aim of this study was to assess the impact of these awards.

METHODS

Faculty awardees of the TSF research awards from 1995 to 2019 were included in the study. The scholarly work of awardees was assessed using SCOPUS , MEDLINE, and google scholar for publications, citations and h-index. NIH RePorter and federal RePorter was used to search for any grants awarded to these individuals. For publications and citations associated with a TSF grant, a four-year window from the time of the research award was utilized.

RESULTS

Fifty-two research awards were given to early career faculty during this study period, 8 (15%) were awarded to MD PhDs. Six (12%) of awardees were female. Cardiac faculty were awarded 27 (52%) of awards and general thoracic faculty were awarded 25 (48%); of the cardiac faculty, 4 (17.4%) were congenital cardiac faculty. In the 4-year period following the TSF grant award, the mean number of published articles per awardee was 23 (interquartile range (IQR) 12-36) with a median citation count of 147 (IQR 32-327). The current median h-index was 26 (IQR 15-36) with 2,323 (IQR 1,173-4,568) median citations. Forty-eight percent of all awardees received at least 1 subsequent grant grant, with 40.4% being awarded from the NIH and25% having two or more NIH grants. Comparing academic position at the time of the award to current position, 54% of awardees had an advancement in their professional rank. On analyzing leadership positions, 42% of awardees were division chiefs, 21% were associate clinical directors, and 28% were clinical directors.

CONCLUSIONS

Being a recipient of the TSF award may position an individual to excel in academic medicine, with a large portion of awardees improving their academic standing with time. The rate of successful NIH grant funding after being a TSF awardee is higher than typical institutional success rates.