Building a More Diverse Workforce

Nneoma Wamkpah, MD, MSCI (Member), Tulio Valdez, MD, MSc (Member), Allison K. Ikeda, MD, MS (Member), and Michael J. Brenner, MD (Chair), Outcomes Research and Evidence-Based Medicine Committee

The National Institutes of Health (NIH) funding plays a critical role in supporting aspiring clinician investigators capable of advancing the science of otolaryngology-head and neck surgery. The Research Education Program (R25) award includes mechanisms designed to cultivate a diverse workforce that meets national research needs.^1,2 This article outlines recent R25 offerings from the National Institute for Deafness and Communication Disorders (NIDCD) that aim to promote diversity in otolaryngology and communication-related research areas. It is the second installment of a two-part series on the new R25 programs (Part 1 “Revamping NIH Clinician-Scientist Training Pathways with T32 to R25 Transition: Expansion of Programing and Preparation for Change”)

A Need for Greater Diversity

 Clinician-scientists comprise an increasingly small percentage of the overall research landscape,¹ and there is a paucity of investigators of diverse or underrepresented backgrounds. Women and individuals belonging to underrepresented racial and ethnic backgrounds lag behind men and majority counterparts in funded research awards and research leadership positions. From 2002 to 2016, underrepresented research project grant applicants had a 7.5% lower funding rate than their majority counterparts and constituted only 2.1% of new investigators, 2.8% of early-stage investigators, and 1.0% of experienced investigators.³ Women made up 30% of all R program grant funding applicants but only a quarter of the awardees.³

These disparities reflect a constrained clinician-scientist pathway in which diversity diminishes at each successive rung on the career ladder.³ Recognizing the need to recruit and retain more clinician-scientists of diverse backgrounds, NIDCD developed programs under the NIH R25 mechanism. The program aims to address gaps through intentional mentoring and research experiences, beginning upstream with undergraduates, medical students, and graduate-level or postdoctoral students. The mechanism creates further opportunities for residents and early to mid-career faculty members who are underrepresented in biomedical research.^1,2

Overcoming Barriers to Diversifying the Clinician-Scientist Workforce

Financial hardship is a significant challenge faced by many individuals from underrepresented populations who aspire to pursue research-based academic careers. The R25 program can play a crucial role in helping overcome this hurdle by providing financial support for the duration of the research training. In addition, this program recognizes that students from underrepresented backgrounds who do not have an affluent upbringing may face pressure to start earning an income instead of pursuing an academic career. By providing financial assistance, the R25 program enables trainees to focus on their academic pursuits by mitigating concerns about financial constraints, thereby increasing their chances of success.

Limited mentorship is a major barrier to advancement of diverse clinician scientists. Improving mentorship is thus critical for recruiting and retaining diverse clinician-scientists. The Mentoring Networks program emphasizes career development, leadership, and grantsmanship lessons that allow individuals to acquire skills and experience necessary to launch a research career. The grants also support mentoring relationships.⁴ The Research Experiences program aims to support hands-on mentored research experiences with scientific developmental activities, attendance and presentation at scientific professional meetings, and individualized mentoring.⁴ Table 1 provides examples of how Mentoring Networks can increase workforce diversity.⁴

Table 1. Activities supported by NIDCD’s Mentoring Networks that enhance Clinician-Scientists’ participation in R25 Program (PAR-21-187).

Courtesy of the National Institute on Deafness and Other Communication Disorders, NIH.

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NIH R25 Programs to Promote Diversity

The NIH provides four qualitative categories to define underrepresented populations:

1. Racial and ethnic groups underrepresented in health-related sciences according to the National Science Foundation
2. Individuals with physical or mental disability that substantially limits at least one major life activity
3. Individuals from disadvantaged backgrounds
4. Women at the graduate and faculty levels, including those within any of the preceding categories.⁵

The R25 mechanism is designed to afford flexibility and create opportunities across the continuum of early career stages.² Eligible candidates include undergraduates and medical students in short-term or academic year (i.e., nine months) research experiences; resident doctors with full-time appointments at the applicant institution who can commit at least 9.6 person-months of the residency (80% research effort over 12 months); and early career faculty.¹ Institutions must have a well-established record of research and career development activities with faculty qualified to serve as mentors in biomedical, behavioral, or clinical research.¹

The NIDCD R25 programs aim to support the growth of a more diverse workforce through two programs, NIDCD’s Mentoring Networks to Enhance Clinician-Scientists’ Participation in Research (PAR-21-187) and Research Experiences to Enhance Clinician-Scientists’ Participation in NIDCD’s Research (PAR-21-188) (Figure 1). Both programs are inclusive of clinicians across career stages, varied clinical backgrounds, and diverse backgrounds; they strongly encourage partnership at institutional, regional, and national society levels. In addition, NIDCD R25 (PAR-21-185) supports Mentoring Networks to Enhance Diversity in NIDCD's Extramural Research Workforce.

Figure 1. NIH R25 programs. Programs in green aim to cultivate diverse clinician-scientists.

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Early Experience with Upstream Programs Funded by R25 Grants

The R25 mechanism supports diversity among health professionals across all mission areas of the NIDCD. Lauren Calandruccio, PhD, CCC-A, Louis D. Beaumont University Professor and associate dean for academic affairs at Case Western Reserve University College of Arts and Sciences, shared her experience as the principal investigator for an NIDCD R25 grant (PAR-21-185) titled, “The Innovative Mentoring and Professional Advancement through Cultural Training, IMPACT: Promoting Diversity and the Success of Underrepresented Minority Students in the Clinical and Research Workforce for Communication Sciences and Disorders.”⁶ The program offers students access to diverse mentors, exposure to research opportunities, and preparation for graduate school. The endeavor started as an undergraduate mentoring program in collaboration with Hampton University, a historically Black college and university.

The upstream emphasis of this program can serve as a model for diversity efforts in otolaryngology-head and neck surgery. “Funding from the NIH through the R25 award will ensure that our IMPACT program is both viable and strong for the next five years,” said Dr. Calandruccio, reflecting on their journey. “We anticipate having 42 undergraduates and 24 graduate students participate in IMPACT over the next five years. Over the past three years, we have had great success with our mentoring program. We have had several of our students receive full rides and large scholarships. Several are interested in research careers, and we have had many fellows admitted to summer research training programs. In addition, many fellows have attended and presented research at national conventions.”⁶

Complementing Existing NIH Programs that Promote Diversity

The R25 program does not operate in isolation, but rather complements other NIH programs that aim to increase diversity in research. For example, the RFA-DC-23-001 program is designed to address the underrepresentation of diverse investigators who have not yet received NIH funding. By creating potential mentors from diverse backgrounds, this program inspires a new generation of underrepresented researchers by demonstrating that an academic research career is achievable.⁷ Additionally, the NIH Research Conference Grant (R13) programs provide support for both domestic and international conferences for members of U.S. academic institutions and organizations. The R13 program allows exposure to a diverse range of scientists and potential mentors and collaborators.⁸ By working in conjunction with these programs, the R25 program can provide a comprehensive approach to increasing diversity in research, enhancing the chances of success for underrepresented populations in academic research careers.

Through a multitude of mechanisms that place mentorship, research skill development, and networking at the forefront, the NIH inspires a future generation of diverse clinician-scientists.

References

1. National Institutes of Health (NIH) National Institute on Deafness and Other Communication Disorders (NIDCD). Mentoring networks to enhance diversity in NIDCD's extramural research workforce (R25 Clinical Trial Not Allowed). Accessed Apr 24, 2023. https://grants.nih.gov/grants/guide/pa-files/PAR-21-185.html.
2. Ikeda A, Oghalai J, Piccirillo JF, Tucci DL, Brenner MJ. Out of committee: outcomes research and evidence-based medicine, revamping NIH clinician-scientist training pathways with T32 to R25 transition: expansion of programing and preparation for change. Bulletin. Accessed April 24, 2023. https://bulletin.entnet.org/home/article/22525468/out-of-committee-outcomes-research-and-evidencebased-medicine-revamping-nih-clinicianscientist-training-pathways-with-t32-to-r25-transition-expansion-of-programing-and-preparation-for-change
3. Munjal T, Nathan CA, Brenner MJ, Stankovic KM, Francis HW, Valdez TA. Re-engineering the surgeon-scientist pipeline: advancing diversity and equity to fuel scientific innovation. Laryngoscope. 2021;131(10):2161-2163.
4. National Institutes of Health (NIH). R25 programs for clinician-scientists: frequently asked questions (FAQs). Accessed April 24, 2023. https://www.nidcd.nih.gov/training/R25-clinician-scientists-frequently-asked-questions
5. National Institutes of Health (NIH). Notice of NIH's interest in diversity. Accessed April 24, 2023. https://grants.nih.gov/grants/guide/notice-files/NOT-OD-20-031.html
6. Case Western Reserve University. IMPACT Program (Innovative Mentoring & Professional Advancement through Cultural Training). Accessed May 1, 2023. https://psychsciences.case.edu/impact-program-innovative-mentoring-professional-advancement-through-cultural-training/
7. National Institutes of Health (NIH). NIDCD research opportunities for new investigators to promote workforce diversity (R01 clinical trial optional). Accessed April 30, 2023. https://grants.nih.gov/grants/guide/rfa-files/RFA-DC-23-001.html
8. National Institutes of Health (NIH). NIH support for conferences and scientific meetings (Parent R13 clinical trial not allowed). Accessed April 30, 2023. https://grants.nih.gov/grants/guide/pa-files/pa-21-151.html#:~:text=The%20purpose%20of%20the%20NIH,the%20participating%20Institutes%20and%20Centers