Background

Physician-scientists are vital to the advancement of medicine, particularly in the translation of basic research into clinically relevant modalities that impact patient outcomes [1]. Concerns about declining physician participation in medical research were identified as early as 1979 by former NIH Director James Wyngaarden, M.D. [2, 3]. Despite corrective efforts attempted by the Institute of Medicine, the NIH, the Association of American Medical Colleges, and private foundations, data from the 1990s showed that medical students’ intentions to pursue research careers continued to decline and the number of first-time grant applications by M.D.s remained stagnant [4, 5]. After NIH funding increased in the late 1990s, institutions expanded their research capacities and training programs and conditions improved until the NIH budget came to a halt in 2004. These gains in physician involvement were lost after the curtail in funding: the number of physicians receiving first-time NIH R01 grants had not changed from 1984 to 2014 [6]. The 2014 NIH Physician-Scientist Workforce Working group and a 2018 systematic review of physician-scientist programs further identified a leaky trainee pipeline, a steady decline in M.D. representation in research, and a shortage of faculty mentors to medical students in training as barriers to physician participation in research [3, 7, 8].

Exposure to research and mentorship play critical roles in shaping medical student career paths. Medical students with influential mentorship spend more time conducting research, producing quality publications, and are more likely to be principal investigators on grants [9]. Professional development and exposure to research are also linked to greater career satisfaction and an enhanced medical school experience [10]. Finally, involvement in research during medical school increases the likelihood of successfully securing future research funding and obtaining research-oriented faculty positions [11].

During their education, Ph.D. students are mentored by their advisors to develop the capabilities and skills required to write and critically appraise grant proposals. This is essential to prepare the students as independent principal investigators. In contrast, most medical students are not exposed to grant proposals in their curriculum. Physicians without these skills are undoubtedly disadvantaged in developing competitive grant proposals and are therefore less inclined to enter the physician-scientist career pathway. To address the shortage of physician-scientist participation in research, the Hackensack Meridian School of Medicine (HMSOM) developed a research mentorship program for medical students early in their training. One of the program’s aims was to provide students with skills to critically evaluate the quality of research grants and thus have a better understanding of what constitutes a quality research proposal. The program was made possible through structured and close mentorship by faculty members with experience in writing and reviewing grants as well as performing high-quality scientific research.

Activity

This educational experience was open to all first and second year medical students at the HMSOM, and six students chose this elective. Model grant proposals were selected by medical school faculty from research applications written by investigators within the HMH network in response to a call for COVID-19 research [12]. All proposals were de-identified, with writers’ names and departmental affiliations removed. In this elective, under careful faculty supervision, students established NIH-style “study sections” for the critical review of grant proposal quality and project feasibility.

The online booklet entitled NIH Peer Review: Grants and Cooperative Agreements was used as a blueprint by faculty in structuring and teaching the peer review process to medical students (https://grants.nih.gov/grants/peerreview22713webv2.pdf). Although NIH criteria for research grants (R# series) covers five main areas (significance, investigator, innovation, approach, and environment), our review criteria did not account for investigator (since proposals were de-identified) or environment (since all were within the HMH network).

These study sections consisted of six students appraising ten total grant proposals with three faculty facilitators and one faculty member as chair. Each proposal was assigned to three student reviewers for the formal review process conducted within large group sessions. Prior to the first study section, faculty members briefed students on the NIH grant review process as well as subject matter related to the proposal under consideration. Three pre-meetings were held, each involving one faculty member and two students who together discussed assigned applications in-depth (Table 1). Students were instructed on how to perform literature reviews to understand the background of each proposal as well as to gain up-to-date knowledge about the COVID-19 pandemic. Pairs of students met with a different faculty member for each of the “pre-meetings” to gain a breadth and depth of perspectives and approaches to the peer review process.

Table 1 Training session and study section agendas
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Students and faculty met once per week in large group sessions and once per week in small group sessions over the course of 5 weeks (Table 1). The mock study section aimed to examine projects with the potential to have an immediate and significant impact on the COVID-19 pandemic. Proposals with a high likelihood to exert a sustained, powerful influence on research were prioritized during the review process.

As part of the critical appraisal of research proposals, students discussed and rated each proposal’s overall significance, innovation, and approach (Fig. 1). The numerical grading criteria and format of discussions paralleled that of the NIH in their peer review process for research grants (R# series). This educational opportunity served as a platform to discuss novel COVID-19 therapies and drug repurposing. The process also facilitated detailed discussions of relevant biochemistry of SARS-CoV-2 and pharmacology of its potential treatment modalities. For each grant, students described the strengths and weaknesses of each criteria (significance, innovation, approach). In addition, students wrote an overall impact paragraph explaining the score-driving factors for each grant, deciding on an overall impact score to summate these critiques.

Fig. 1
figure 1

The sequence of teaching elements for training medical students in the grant review process

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Results and Discussion

Each of the six students was asked to write a reflection statement about their experiences after completion of this educational initiative. The reflection statements were kept anonymous and collected by a third party. Table 2 shows excerpts from student comments including positive takeaways and suggestions for improvement. Overall, this elective was successful in providing students with training about the mechanics of the grant review process. Students found that learning the procedures for peer review also provided them with insights about how best to prepare research proposals. This first execution of this elective provided faculty with an appreciation for the value of training medical students to critically assess research proposals. Faculty were encouraged to make this elective available again as part of research training opportunities and to include grant applications covering a broader scope of fields.

Table 2 Student comments including positive takeaways and suggestions for improvement
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The COVID-19 pandemic provided a unique academic climate for an educational initiative focused on the grant review process and the formulation of high-quality research proposals. With the dramatic increase in pandemic-related scholarly activity amongst researchers in the HMH network, students had ample material for informative discussions. Educational institutions, particularly medical schools, should take advantage of climates that encourage research by looping students into the grant review process. By exposing medical students to this process early in their training, medical schools may improve career satisfaction of medical professionals, address the lack of physician-scientist participation in biomedical research, and enhance health outcomes.

Disclaimer

The opinions expressed in this article are the author’s own and do not reflect the view of the National Institutes of Health, the Department of Health and Human Services, or the US government.