Federal Funding in Emergency Medicine: Demographics and Perspectives of Awardees

T32 programs in emergency medicine: A report from the ACEP-SAEM Federal Research Funding Workgroup

Advancing care in Emergency Medicine (EM) requires the development of well-trained researchers, but our specialty has lower amounts of research funding compared to similar medical fields. Increasing the number of pathways available for research training supports the growth of new investigators. To address the need for more EM researchers, the Society of Academic Emergency Medicine and the American College of Emergency Physicians convened a Federal Research Funding Workgroup. Here, we report the workgroup recommendations regarding the creation of Research Training Fellowships using the T32 grant structure sponsored by the National Institutes of Health. After reviewing the history of NIH-grant supported research fellowships in EM, we outline the rationale and describe the core components of T32-supported research fellowships, including program design, fellow evaluation, and recruitment considerations.

Implementation and value of a student-run volunteer clinical research program at an academic medical center

Clinical research output in the emergency department (ED) continues to be constrained by limitations in funding for researchers, demands of patient care on ED providers, and difficulties in obtaining high-quality data. In response, several institutions have established programs in which student volunteers are integrated into department workflows to increase clinical research output and introduce pre-health students to careers in medicine. One such program, the student volunteer clinical research program, presently consists of over 40 undergraduate and post-baccalaureate student volunteers who screen, consent, and enroll patients into prospective studies in the ED of the University of California, Los Angeles (UCLA) Ronald Reagan Medical Center. The program is led by student coordinators who collaborate with departmental research staff and faculty. Our program is unique in that it is primarily run by the students themselves. Experienced student research associates facilitate recruitment through a competitive biannual application process, train new volunteers to perform on-shift research duties, and monitor participants for compliance with both hospital and program policies. Participation in the program provides students with exposure to frontline medical research, opportunities to observe clinical medicine, and access to a variety of program-specific resources including student-led committees, career development resources, and mentorship from peers, alumni, and faculty. This concept piece serves as a structural model for other institutions seeking to implement volunteer clinical research or bolster existing programs through increased student-led initiatives.

Emergency medicine faculty serving on standing NIH and AHRQ study sections from 2019 to 2020

Emergency medicine (EM) investigators lag in research funding from the National Institutes of Health (NIH) when compared to other specialties. NIH funding determinations are made in part by a process of NIH study section peer review. Low participation by EM investigators in NIH peer review could be one explanation for low levels of NIH funding by EM investigators. The objective of this study was to establish a current-state metric of EM faculty researchers serving on standing NIH study sections from 2019 to 2020. Publicly available lists of NIH study section membership rosters within the Center for Scientific Review and within individual NIH institutions were reviewed for standing members. Committee members listed as being members of a department of emergency medicine were identified as emergency care researchers. Special emphasis panels and ad hoc members were excluded. Members degrees were categorized as PhD, MD (with or without non-PhD degree), MD/PhD, and other. Similar analysis was performed of AHRQ study sections. A total of 6,113 members on NIH study sections were identified. Degrees held by committee members included PhDs 74% (4,547), MDs 14%(883), MD/PhDs 10% (584), and other (99). Twenty (0.3%) NIH study section members were identified as members of an emergency department (ED). A total of 20% (four) held PhDs, 75% (15) held MDs, and 5%(one) held MD/PhD degrees. A total of 25% (five) of EM faculty were pediatric and 75% (15) were adult. Clustering of study sections within similar institutions was noted with 40% (two) of the pediatric faculty at the same institution while 27% (four) of the adult faculty were at the same institution. AHRQ study section review identified 3% (four/127) as members of an ED. Our data show that 20 EM faculty comprised 0.3% of NIH standing study section members and four EM faculty comprised 3% of AHRQ standing study section members from 2019 to 2020 and that these members were clustered at a few institutions.

Research environment and resources to support pediatric emergency medicine fellow research

BACKGROUND

There is a need for pediatric emergency medicine (PEM) researchers, but the current state of PEM fellow research training is not well described. We sought to (1) describe resources and gaps in PEM fellowship research training and (2) assess agreement between fellow and program director (PD) perceptions of these in fellow research experience.

METHODS

Surveys were distributed electronically to U.S. PEM fellows and PDs from March to April 2020. Fellows and PDs were queried on program research infrastructure and current gaps in fellow research experience. For programs that had at least one fellow and PD response, each fellow response was compared to their PD's corresponding response (reference standard). For each binary survey item, we determined the percent of responses with agreement between the fellow and PD.

RESULTS

Of 79 fellowship programs, 70 (89%) were represented with at least one response, including responses from 59 PDs (75%) and 218 fellows (39% of all fellows, representing 80% of programs). Fellows and PDs identified mentorship and faculty engagement as the most important needs for successful fellowship research; for every one fellow there was a median of 0.8 potential faculty mentors in the division. Twenty percent of fellows were not satisfied with mentorship opportunities. There was no association between fellow career research intent (high, defined as ≥20% dedicated time, or low) with current year of training (p = 0.88), program size (p = 0.67), and area of research focus (p = 0.40). Fellows were often unaware of research being performed by division faculty.

CONCLUSION

PEM fellows were not consistently aware of resources available to support research training. To better support PEM fellows' research training, many programs may need to expand mentorship and increase fellows' awareness of local and external resources and opportunities.