Decline of clinical research in academic medical centers

Research Exposure and Training Among Pediatric Cardiology Fellows in the United States: A National Survey

Pediatric cardiology fellowship programs in the United States (U.S.) follow the Accreditation Council for Graduate Medical Education (ACGME) guidelines, requiring scholarly activities for completion. However, detailed data on research experiences within these programs are scarce. This study sought to describe the state of research training and exposure in U.S. pediatric cardiology fellowship programs. An electronic survey was sent to 350 pediatric cardiology fellows across the U.S (Initially sent on 11/16/23 with a second request on 12/12/23). The survey assessed demographics, availability of research training resources, perceived barriers to research, expected research output, and satisfaction with research exposure. Fellowship programs were classified by size: small (1-5 fellows), medium (6-9 fellows), and large (10 + fellows). Statistical analyses included comparisons and logistic regression. We received 103 complete survey responses. Most respondents (89%) agreed with the statement: "I have been encouraged to pursue research training and experiences during my fellowship." However, only 31% agreed with the statement: "I am satisfied with the training on research methodology and statistics provided by my fellowship program." Commonly endorsed barriers to completing research projects included lack of statistical support (37%), lack of protected time for faculty to support fellow research (56%), lack of a formal research curriculum (38%), and lack of funding for fellow research (26%). Research training and experiences differed by program size, with larger programs providing more protected time and greater encouragement for research, while smaller programs were more likely to rely on online resources. Despite strong encouragement for research, satisfaction with research training in pediatric cardiology fellowship programs is limited. Addressing barriers such as statistical support, protected faculty time, and formal research curricula could enhance the research experience and outcomes for fellows.

An Investigation into the Current Landscape, Challenges, and Training Imperatives of Clinical Research Among Anesthesiologists in China

Objective

This study aimed to investigate the status of anesthesiologists in clinical research in China, identify challenges, and propose strategies to improve research quality and anesthesiology services.

Materials and Methods

A cross-sectional online survey was conducted among registered clinical anesthesiologists in China from April to May 2023. The questionnaire, which was developed by a multidisciplinary team following a workshop, covered sociodemographic characteristics, clinical research status, skills, motivations, challenges, and training needs. Data were analyzed using descriptive statistics, chi-square tests, and logistic regression to examine the factors associated with research publications.

Results

Of the 878 analyzed respondents, 85.08% showed positive attitudes towards clinical research, yet the publication rates were low (59.68% in Chinese, 14.24% in English). Professional title promotions (78.70%) and solving clinical problems (69.48%) were the primary motivators. The respondents reported needing training in statistical analysis (74.69%), research design (73.86%), and topic selection (72.34%). The self-reported deficiencies included ability (73.01%), time (69.93%), and funding (60.71%). Significant differences (P<0.01) existed between publishers and non-publishers regarding age, education, title, research experience, training, and hospital characteristics. Educational background, professional title, research experience, and training were identified as independent factors that influenced publication rates.

Conclusion

This study identified major obstacles in anesthesiologists' research engagement, including time constraints, skill deficits, and funding issues, despite high interest. Career advancement was the primary motivation for the study. This study emphasizes the need for enhanced training in statistics and research designs. Factors such as education, title, experience, and training independently impact publication output.

Creative Arts Therapy Reduces Psychological Distress in Nonpatient-Facing Healthcare Workers

BACKGROUND

Our aim was to assess the feasibility, acceptability, and efficacy of a 12-week in-person Creative Arts Therapy intervention in reducing psychological distress and burnout symptoms in nonpatient-facing healthcare workers. Burnout and psychological distress among nonpatient-facing healthcare workers are significant and understudied problems in healthcare systems.

METHODS

Nonpatient-facing healthcare workers with burnout symptoms were randomly assigned to one of 4 Creative Arts Therapy modalities (art, music, creative writing, or dance/movement) or a control group. The intervention consisted of 12 weekly 90-minute sessions. All participants completed baseline and follow-up assessments postintervention and at 4-, 8-, and 12-months. Primary outcomes were feasibility (session attendance) and acceptability (Client Satisfaction Questionnaire, CSQ-8). Secondary outcomes included changes in psychological distress; symptoms of burnout, anxiety, and depression; and turnover intention.

RESULTS

Of 168 active participants, 164 (98%) completed postintervention surveys, with 90% follow-up at 12 months. Participants attended a mean of 10.7 sessions (SD = 3.2). The median CSQ-8 score for the program was 31 (17-32). Intervention group participants demonstrated significant improvements in symptoms of anxiety (-40.6%), depression (-29.0%), emotional exhaustion (-15.0%), and depersonalization (-14.3%), and reduced turnover intention (-6.1%) compared to the control group. At 12-months, improvements in depressive and anxiety symptoms persisted.

CONCLUSIONS

The Creative Arts Therapy intervention was feasible, acceptable, and effective in reducing psychological distress and burnout symptoms among nonpatient-facing healthcare workers.

Challenges in teacher-student communication during family medicine residency: A qualitative study

BACKGROUND

Deficiencies in communication among healthcare professionals, recognized by medical educators and healthcare institutions, can negatively impact medical education and clinical practice. Analyzing teacher-resident communication difficulties shed light on this issue and propose practical strategies for its mitigation.

OBJECTIVE

To identify common communication challenges between teacher and residents during Family Medicine residency and to analyze their impact on interactions with peers, the work team, and patients.

DESIGN

Qualitative study, the critical incident technique was used to collect information of interest.

PARTICIPANTS

Seventy teachers, and fifty third-year residents from the Mexican Republic described critical incidents related to their communication experiences during Family Medicine residency.

RESULTS

192 critical incidents were collected (several participants reported more than one incident), comprising 127 reports from teachers, and 65 from residents. Four themes were identified: 1) asymmetric communication, 2) assertive communication, 3) organizational communication, and 4) effective communication. The main challenges identified were abuse of power in communication, lack of communication skills, and the absence of institutional communication channels. These issues significantly impacted learning, work environment, interpersonal relationships, and medical care.

CONCLUSION

This study highlights communication issues within Family Medicine residency in Mexico. The issues detected hindered learning and effective collaboration and negatively impacted the work environment, interpersonal relationships, and the quality of medical care. These findings underscore the urgent need to reorient the medical specialty curriculum towards an approach that includes communication skills.

The Growth and Development of a Research Division in the Plastic Surgery Department of a Large Urban Academic Medical Center

INTRODUCTION

Research is a critical component of academic medicine that may or may not be prioritized in centers with high clinical volumes. The benefits of research expansion go beyond notoriety and industry partnerships, expanding into resident training and preparation of the next generation of physician-scientists. Improving a division or department's research portfolio requires a commitment to reorganizing structure, personnel, resources, and a dedication to innovative funding models. To improve research productivity and quality, our group placed several initiatives into motion beginning in August 2017 that we have outlined and evaluated in the present study. Some of these initiatives included restructuring leadership, resourcing both bench and clinical outcomes research, providing initial funding directly from clinical profits and rewarding research fiscally.

METHODS

Reviews of hiring records, publications, grant allocations, and interviews with key personnel were used to generate a road map of initiatives. Average impact factor was calculated by averaging journal impact factors for all publications from the department each year, excluding any publications with greater than 5 times the raw average, and creating a corrected average that more accurately represented the work. Student t tests were used to compare mean number of publications and impact factors from 2010 to 2017 to those from 2018 to 2022.

RESULTS

Prior to restructuring (2010-2017), the department published an average of 9 articles annually, which increased to an average of 42 articles since that time (P < 0.01). Average impact increased from 0 in 2010 to 4.02 in 2022, with the number of publications in top 10 plastic surgery journals following a similar trajectory with 1 publication in 2010 and 31 in 2023. Following an initial $1 million investment to create an institutionally directed fund in 2018, the department leveraged its research to earn $3 million in endowments, $1.25 million in industry partnerships, $3.23 million in Department of Defense funding, and $1.65 million from a multi-institutional National Institutes of Health grant.

CONCLUSION

Deliberate prioritization of research initiatives as noted above has led to remarkable growth in academic output.

Research Initiative Supporting Excellence at the University of Cincinnati (RISE-UC): A Program to Develop and Support Research-Active Faculty Members

A combination of forces have markedly increased challenges to research-active faculty achieving sustained success. This article describes how one department at the University of Cincinnati College of Medicine (UCCOM) implemented a strategic plan, the Research Initiative Supporting Excellence at the University of Cincinnati (RISE-UC), to promote the research activity of its research-active faculty, fiscal year (FY) 2011-FY 2021. RISE-UC was implemented and regularly updated to address evolving needs. RISE-UC supported faculty members pursuing research via fiscal and administrative services to grow a critical mass of investigators; establish a shared governance model; create pathways for developing physician-scientists; develop discrete and targeted internal research funding; establish an Academic Research Service (ARS) unit (as infrastructure to support research); enhance faculty member mentorship; and recognize, celebrate, and reward research success. RISE-UC was informed by shared governance and resulted in substantial increases in total size of the faculty and external funding. More than 50% of Physician-Scientist Training Program graduates are active researchers at UCCOM. The internal awards program realized a return on investment of ~16.4-fold, and total external direct cost research funds increased from ~$55,400,000 (FY 2015) to ~$114,500,000 (FY 2021). The ARS assisted in the submission of 57 grant proposals and provided services faculty members generally found very helpful or helpful. The peer-mentoring group for early-career faculty members resulted in 12 of 23 participants receiving major grant funding (≥ $100,000; spring 2017-spring 2021) from sources including National Institutes of Health awards, Department of Defense funding, Veterans Affairs funding, and foundation awards. Research recognition included ~$77,000/year in incentive payments to faculty members for grant submissions and grants awarded. RISE-UC is an example of a comprehensive approach to promote research faculty member success and may serve as a model for other institutions with similar aspirations.

Musings from a Bent Arrow: The Road from Private Practice to Academics

This biographical article takes the reader on the unlikely journey of a small-town dermatologist, Robert T. Brodell MD, from private practice to academics. It is designed to demonstrate that the road less traveled may be of interest to many other "regular" dermatologists in private practice… particularly those who enjoy teaching. The themes of hard work, dedication, overcoming failure, optimism, and passion are apparent. Life experiences are the basis for recommendations that may help others develop and then reach their academic goals. We hope that this will serve as a guide for physicians who aspire to take this leap.

Challenges and opportunities for research clinicians interested in pain: results of a survey

The National Institutes of Health and its independent advisors recognize the need to develop a strong pain research workforce and provide opportunities, particularly for clinicians, to pursue research careers. A survey was conducted to better understand the challenges facing the clinical pain research community. Respondents reported that time and funding to pursue research were the most critical factors either enabling or holding them back from a research career. Respondents who received some kind of formal research training or mentorship were more likely than those who did not to have federal research funding and to be at more advanced stages of their careers. The findings point to a need for all stakeholders in the pain research community to help formalize research training and provide funding or protected time to support the ambitions of aspiring researchers.

Flexner has fallen: Transitions in medical education system across time, a gradual return to pre-Flexnerian state (de-Flexnerization)

The modern medical education system has gradually evolved starting from 1910 incorporating the suggestions by Abraham Flexner, his public disclosure of the poor conditions at many medical schools provided a means to galvanize all the constituencies needed for reform to occur. He could say what other reformers could not, due to their links to the medical education community. But now we are again going back to a pre-Flexnerian state due to multiple reasons such as gradually diminishing importance of basic science subjects for the students, the decline in the number and quality of investigator initiated research among clinical researchers, lesser emphasis to bedside training by means of detailed clinical examination and making appropriate observation of signs to reach to a diagnosis rather than over reliance on the laboratory tests and radiological modalities for the diagnosis, poor exposure to basic clinical skills starting from college throughout residency and the trend of disrespect and absenteeism from both theoretical and clinical/practical classes. The attitude of students is just to complete their required attendance so that they are not barred from appearing in examinations. This de-Flexnerization trend and regression to pre-Flexnerian era standards, ideologies, structures, processes, and attitudes, are bound to beget pre-Flexnerian outcomes, for you get what you designed for.

Waste not, want not: upcycling research data from chronic pain trials

Jacobsen SM, Moore T, Douglas A, Lester D, Johnson AL, Vassar M. Discontinuation and nonpublication analysis of chronic pain randomized controlled trials. PAIN Rep 2023;8:e1069.

Status of clinical research in neurology in Germany-A national survey

BACKGROUND AND PURPOSE

To provide an overview on the status of clinical research in neurology in Germany.

METHODS

German university hospitals, nonuniversity hospitals, and neurological medical practices were surveyed regarding their clinical research activities during the period 2013 to 2017.

RESULTS

Fifty percent of university hospitals, 10.6% of nonuniversity hospitals, and 5.2% of medical practices in Germany responded to our questionnaire. More than 80% of the clinical studies conducted have been phase III/IV and noninterventional trials (NISs), whereas <1% have been phase I and 3.5% investigator-initiated trials (IITs). University hospitals have conducted most of the phase II-IV trials. NISs have been predominantly performed by medical practices. Fifty-six percent of the university hospitals and less of the nonuniversity institutions confirmed the implementation of standard operating procedures (SOPs). In university hospitals, on average, 11 physicians had acquired a good clinical practice certificate. Overall, 43% of all trials have been performed in neuroimmunology.

CONCLUSIONS

The status of clinical research in neurology in Germany is predominated by NISs and late-phase trials, potentially due to a general lack of easily accessible funding, which leads to a highly competitive environment and fewer opportunities to perform early-phase clinical trials as well as IITs. Our results indicate that there is substantial need for structured support for creating and implementing SOPs to maintain quality standards and guarantee uniformity of performance. This survey assessed many aspects of clinical research and serves as guidance for providing ideas for structured improvement of clinical research in neurology in Germany.

Academia in cardiovascular radiology: are we doing enough for the future of the subspecialty?

AIM

To explore barriers to academic activities that cardiovascular radiology-oriented radiology trainees face worldwide.

MATERIALS AND METHODS

An international call for participation in an online survey was distributed via social media and radiological societies to radiology trainees. Questions covered barriers and involvement in academic activities during radiology training. Participants interested in cardiovascular radiology were selected for analysis with appropriate statistical methods.

RESULTS

Of the 892 respondents, 120 (13.5%) reported an interest in cardiovascular imaging. The majority (63.3%, 76/120) were from Europe and 57.5% (69/120) were men. There were gender discrepancies in academic involvement and in perceived gender-related barriers (perceived gender barrier in academic work between women and men: 15/48 versus 5/69, respectively, p=0.001). The main barriers were lack of time, mentorship, and support. Most did not have protected academic time for research nor for teaching (61.7%, 74/120 and 57.5%, 69/120, respectively). Nonetheless, 40% (48/120) published as first authors, 77.5% (91/120) were involved academically in conferences, 71.7% (85/120) were positive about academic activities, 70.8% plan working in an academic setting, and 78.3% (94/120) would consider research training abroad.

CONCLUSION

Although the majority of respondents are positive about academic activities and plan to continue in the future, most do not have protected time. Lack of time, mentorship, and support were the main barriers. Fewer women declare involvement in academic work and output. There are significant perceived gender barriers to academic activities.

Status of the Clinician Investigator in America: An Essential Healthcare Provider Driving Advances in Cancer Care

BACKGROUND

Translation of basic discoveries to clinical care for patients with cancer is a difficult process greatly enabled by physician-trained researchers. Three categories of physicians, with responsibilities spanning from laboratory and preclinical research to direct patient care, are involved in the translational research continuum: physician-scientist (PS), clinician investigator (CI), and academic clinician (AC).

METHODS

To define how protected time for research efforts is supported, the Association of American Cancer Institutes (AACI) conducted a survey of their member institutions, obtaining 56 responses documenting time spent in research and clinical activities across multiple cancer disciplines, and providing information about funding streams for the different categories of cancer physicians.

RESULTS

Responses showed that PSs and ACs are minimally involved in clinical research activities; the driver or clinical research in academic cancer centers is the CI. A significant concern was a lack of stable funding streams for nonbillable clinical research activities, putting the sustainability of the CI in jeopardy. Limited funding was derived from hospital sources, with most support derived from cancer center sources.

CONCLUSIONS

This study highlights the importance of the CI in translational cancer medicine and represents a call to action for institutions and research funding agencies to develop new programs targeted toward CI support to ensure continued progress against cancer.

The world needs our science: broadening the research pipeline in anesthesiology

Anesthesiologists are innovative and adaptable problem solvers. Despite these talents, our field is still working to consistently develop and support the translation of innovation and creativity into productive scientists. This article is focused on opening the discussion on identifying the gaps and move toward developing a sustainable and diverse research pipeline.

Perspectives on Research Internships for Medical Students and Young Doctors in Ghana: An Opportunity to Replenish the Stock of Physician Investigators?

The corona virus pandemic undoubtedly demonstrates the growing need for research in medical science. However, with the decline in physician scientists world-wide, innovative ways are needed to engender interest in research among medical students and young doctors to replenish the stock of physician investigators. One way of doing this is to create compulsory and elective projects for them. We describe research internships created for medical students at the Noguchi Memorial Institute for Medical Research to expose them to the rudiments of biomedical research and proposal development. We also describe research internships for doctors waiting for house job postings or keen to do research who needed mentorship. Though the response has been positive, the full impact will be realized with time. The recognition that training should be backed with a supportive environment, mentorship and clear career paths for physician scientists is also mentioned.

Teaching undergraduate students gynecological and obstetrical examination skills: the patient's opinion

Introduction

Our study assesses the patients’ opinion about gynecological examination performed by undergraduate students (UgSts). This assessment will be used in improving our undergraduate training program. A positive opinion would mean a lower chance of a patient refusing to be examined by a tutor or student, taking into account vaginal examination (VE).

Materials and methods

We performed a prospective cross-sectional survey on 1194 patients, consisting of outpatient and inpatient at the departments of obstetrics and gynecology from November 2015 to May 2016. The questionnaire consisted of 46 questions. Besides demographic data, we assessed the mindset of patients regarding the involvement of undergraduate student (UgSt) in gynecological and obstetrical examinations. We used SPSS version 23 for the statistical analysis. For reporting the data, we followed the STROBE statement of reporting observational studies.

Results

The median age was 38 years having a median of one child. 34% presented due to obstetrical problems, 38% due to gynecological complaints, and 19% due to known gynecological malignancies. Generally, we retrieved a positive opinion of patients towards the involvement of students in gynecological and obstetrical examination under supervision in 2/3 of the cases.

Conclusions

There is no reason to exclude medical UgSts from gynecological and obstetrical examinations after obtaining a written or oral consent.

Factors impacting on retention, success and equitable participation in clinical academic careers: a scoping review and meta-thematic synthesis

OBJECTIVES

To examine and synthesise current evidence on the factors that affect recruitment, retention, participation and progression within the clinical academic pathway, focusing on equitable participation across protected characteristics including gender, ethnicity and sexual orientation.

DESIGN

Scoping review and meta-thematic synthesis.

DATA SOURCES

Web of Science, Google Scholar.

ARTICLE SELECTION

We conducted a scoping review of English language articles on factors affecting recruitment, retention, progression and equitable participation in clinical academic careers published in North America, Australasia and Western Europe between January 2005 and April 2019. The most recent and relevant 39 articles were selected for meta-thematic synthesis using detailed inclusion/exclusion criteria.

DATA EXTRACTION

The articles were purposively sampled to cover protected characteristics and career stages and coded for factors related to equitable participation. 17 articles were fully coded. No new themes arose after nine papers. Themes and higher level categories were derived through an iterative consensual process.

RESULTS

13 discrete themes of factors impacting on equitable participation were identified including societal attitudes and expectations; national and organisational policies, priorities and resourcing; academic and clinical workplace cultures; supportive, discriminatory and compensatory interpersonal behaviours and personal factors related to social capital, finances, competing priorities, confidence and ambition, and orientation to clinical, academic and leadership roles.

CONCLUSIONS

The broad and often interconnected nature of these factors suggests that interventions will need to address structural and cultural factors as well as individual needs. In addition to standard good practice on equality and diversity, we suggest that organisations provide equitable support towards early publication success and targeted mentoring; address financial and role insecurity; address the clinical workplace culture; mitigate clinical-academic-personal role conflicts and overload; ensure that promotional structures and processes encourage diverse applicants and promote family-friendly, coherent and transparent national career pathways.

CE: Original Research: The Clinical Research Nurse: Exploring Self-Perceptions About the Value of the Role

: Background: Clinical research nursing is an emerging specialty practice. Clinical research nurses (CRNs) work to make protocol-related care safe for the research subjects while simultaneously maintaining protocol fidelity. They must continuously balance the needs of the research subjects and the study requirements.

PURPOSE

The purpose of this qualitative study was to describe CRNs' perceptions of the value of their role.

METHODS

Two focus groups were conducted with a purposive sample of 18 CRNs. An interview guide consisting of eight open-ended items was used. Data analysis used critical elements from Krueger's systematic steps for analyzing focus group data.

RESULTS

Five major themes emerged from 168 coded statements contained within the focus group transcripts: comprehensive nursing care of research subjects, training and education of research subjects and staff, contributions to clinical science, unique combination of clinical and critical thinking skills, and CRN practice attributes. Subcategories were also identified. In general, participants felt strongly about the value they added.Clinical research nursing requires the use of a variety of abilities and skills, including critical thinking and problem solving, as well as clinical and research knowledge. The CRNs in this study described incorporating these and other elements into their practice, which they associated with their specialized role. The five themes that emerged help elucidate the importance and utility of including CRNs on research teams.

CONCLUSIONS

The unique combination of applied research knowledge and expert clinical skills sets the specialty of clinical research nursing apart. The study findings, in particular the five themes, provide an evidence-based framework that will be useful in the development of competencies for CRN specialty practice. In helping to bring research findings to bear on clinical care, the impact of CRNs' practice extends beyond the individual patient to larger patient populations.

Assessments of Research Competencies for Clinical Investigators: A Systematic Review

Although there is extensive research literature on clinical skill competencies and the use of competency-based frameworks for clinical research, the appropriate methods to assess these competencies are not as well understood. Our goal in this systematic literature review is to identify, compare, and critique assessments of clinical research competencies. Articles were included in this review if they examined clinical investigators or clinical investigators in training, focused on research-based skills, and included some form of assessment of research-based competencies. A total of 76 articles were identified as part of the initial search; 16 met the criteria for inclusion. Two types of assessments of clinical research competence were identified: subjective self-assessments (n = 13) and objective tests (n = 6). These assessments covered a wide range of competencies, but there were no competency domains common to all. Most assessments had limited validation. Training was consistently associated with self-assessed competence but had little relationship to objective measures of competence. In contrast, experience was consistently associated with objectively assessed competence but not with self-assessed competence. These findings have important implications for those interested in assessing medical education programs. We describe a recommended standard for validity for assessments used for the purposes of summative program assessment.

Publish or Perish: Research Productivity During Residency Training in Physical Medicine and Rehabilitation

Research training equips residents with the skills to consume and produce research evidence and deliver evidence-based care. Within Physical Medicine and Rehabilitation, studies have historically demonstrated low rates of resident research productivity. Although Canadian residency requirements mandate research participation, little is known about Canadian residents' research productivity. Using standard systematic review search strategies, we evaluated the rate and type of peer-reviewed publications produced by resident physicians during postgraduate medical training for a historic cohort of Physical Medicine and Rehabilitation residents who successfully passed the Canadian Royal College Fellowship examination in 2015, 2016, and 2017 (N = 74). Resident physicians produced 62 peer-reviewed publications during the study period. A total of 43.2% of resident physicians produced at least one such publication and 20.3% produced more than one. The resident physician was the first author for 51.6% of publications. Reviews were the most frequent publication type (19.4%), followed by observational studies (16.1%) and case reports (16.1%). Musculoskeletal conditions (11.3%) and stroke (9.7%) were the most frequent areas of study. Most publications were in nonrehabilitation journals. These findings demonstrate modest research productivity despite mandatory research participation; although research productivity is higher than in previous cohorts, publications of convenience, such as reviews and case reports, are similarly frequent.

Multivariable analysis of factors associated with USMLE scores across U.S. medical schools

BACKGROUND

Gauging medical education quality has always remained challenging. Many studies have examined predictors of standardized exam performance; however, data sets do not distinguish by institution or curriculum. Our objective is to present a summary of variables associated with the United States Medical Licensing Examination (USMLE) scores, and thus identify institutions (and therefore curriculums) which deviate from trend lines by producing higher USMLE scores despite having lower entrance grade point averages and medical college admissions test (MCAT) scores.

METHODS

Data was obtained from U.S. News and World Report's 2014 evaluation of allopathic U.S. medical schools. A univariate analysis was performed first for each variable using two sample t-test or Wilcoxon rank sum test for categorical variables, and Pearson or Spearman correlation coefficients for continuous variables. A multivariable linear regression model was developed to identify the factors contributing to USMLE scores. All statistical analyses were two-sided and performed using SAS software version 9.4 (SAS Institute Inc., Cary, NC).

RESULTS

Univariate analysis reveals a significant association between USMLE Step 1 and 2 scores with medical college admissions test scores, grade point averages, school type (private vs. public), full-time faculty-to-student ratio, National Institute of Health funds, residency director assessment score, peer assessment score, and class size. Of these nine variables, MCAT scores and Step 1 scores display the strongest correlation (corr = 0.72, P < .0001). Multivariable analysis also supports a significant association between MCAT scores and Step scores, meanwhile National Institute of Health funding size demonstrates a negative correlation with USMLE Step 2 scores. Although MCAT scores and National Institute of Health funds are significantly associated with USMLE performance, six outlier institutions were identified, producing higher USMLE scores than trend line predictions.

CONCLUSIONS

Outlier institutions produce USMLE scores that do not follow expected trend lines. Their performance might be explainable by differences in curriculum. Having identified these institutions, their curriculums can be further studied to determine what factors enhance student learning.

Who's Contributing Most to American Neuroscience Journals: American or Foreign Authors?

BACKGROUND AND PURPOSE

With globalization, the contributions of authors from abroad to the American published literature has increased. We sought to determine the changes with time in the proportional contributions of American and non-American authors in the American neurosciences literature. We hypothesized the following: 1) During the past 21 years, manuscript contributions of American institutions have proportionally decreased in neuroradiology, more than in neurosurgery or neurology; 2) contributions of Asian institutions have affected neuroradiology more than neurosurgery and neurology; and 3) American articles garner more citations.

MATERIALS AND METHODS

We reviewed the May issues of 2 of the highest impact American-based neurology, neurosurgery, and neuroradiology journals published from 1997 to 2017. We counted the number of articles published by nation based on the institution of origin. We looked at trends across time and compared neurology, neurosurgery, and neuroradiology journals. We also gathered data on the number of citations of each article by nationality.

RESULTS

We reviewed 3025 articles. There was a significantly lower ratio of American to non-American authorship in neuroradiology versus neurology/neurosurgery journals (odds ratio = 0.70; 95% confidence interval, 0.60-0.82). There was a significantly decreasing trend in American authorship across the 21 years in neuroradiology. Of the countries outside the United States, Japan contributed most for neuroradiology and neurosurgery journals, and the UK, for neurology. American-authored articles were cited, on average, 1.25 times more frequently than non-American-authored articles.

CONCLUSIONS

Non-American contributions have impacted neuroradiology more than other clinical neuroscience fields with Asian authorship showing the greatest impact. That impact is growing, and the causes are manifold. Nonetheless American-authored articles are cited more.

The state of clinical research in neurology

OBJECTIVE

To study and provide an update on the state of clinical research in neurology in the United States.

METHODS

US American Academy of Neurology members and chairs of departments of neurology were surveyed regarding clinical research in 2016. NIH data on the neuroscience pipeline and extramural grant funding were also collected.

RESULTS

The response rate was 32% (n = 254) for nonchair researchers and 58% (n = 67) for department chairs. Researcher respondents were on average 50 years old, 66% were men, and 81% were actively conducting clinical research, with phase II/III clinical trials and outcome measure studies being the most common type of research conducted. Time to conduct research, recruitment, and administrative burden were the major barriers reported. According to department chairs, funding and training opportunities in patient-oriented research have increased over the last 10 years. Overall, applicants to neuroscience-specific NIH institutes for extramural funding have decreased over the same time period.

CONCLUSIONS

The state of clinical research in neurology has remained relatively stable over the last 10 years, but neurologists still have barriers in conducting clinical research. There has been an interval decrease in neuroscience applicants for NIH funding, which raises concerns about the pipeline and future of clinical research in neurology. These results will serve as a reference for the development of solutions to these issues.

Clinical research challenges in the era of cardiovascular medical devices

New therapeutic alternatives, such as innovative medical devices, are frequently the only treatment options left for patients when other efficient medical modalities are lacking or insufficient. Development of novel devices, which are safe and effective, requires understanding of complex premarket and postmarket provisions, including characteristics of clinical trials. Speeding up patient access to new technologies may imply the need to make choices in terms of extent and robustness of clinical evaluation without losing the patient safety perspective. In such situations, some challenges can readily arise due to existing methodological solutions and aspects of current legislation in the field. In this context, some challenges, occurring at various stages of the device lifecycle, will be presented in order to observe the changes and hopefully to contribute to better knowledge and improvements in the area.

The forecast for future clinical trials and clinical trialists-Storms or sunshine?

Randomized controlled trials are the most unbiased way to evaluate many types of healthcare interventions. Pharmaceutical and medical technology industries play an important role in developing and testing new interventions that have commercial potential. However, many interventions for the prevention, treatment and rehabilitation of stroke are either not drugs or devices or have no commercial potential. Like many other clinicians who are uncertain about the value of existing or new treatments, we are involved in investigator-led clinical trials to resolve treatment uncertainties. There is common agreement that investigator-led clinical trials are facing increasing difficulties and that as a result clinicians may be deterred from pursuing clinical trials as a research career. In this article, we express our concerns for the future of such trials, balanced with the hope that systems to foster and sustain this important type of research in the future can be developed.