Journal of Clinical and Translational Science

Abstract Objective: Physician-scientists are a diminishing subset of the pediatrician work force, uniquely trained to advance child health through scientific discovery. The current financial landscape of academic medical centers makes traditional resource-intensive training programs untenable. Continued renewal of this critical pediatric workforce requires new resource-efficient methodologies. Thus, we evaluated the impact of the NICHD supported Vanderbilt K12 program, a personalized, intensive training program. Study Design: We tracked academic outcomes for scholars with K12 appointments between January 2015 and December 2022. Our primary outcome was receipt of a mentored career development award (K08 or K23). Successful transition from mentored to independent NIH funding (K to R transition) was used as a secondary outcome. Academic outcomes for faculty participating in a large, institutional training program, the Vanderbilt Faculty Research Scholars program (VFRS), served as a comparison cohort. A complementary qualitative evaluation of the K12 program was performed. Results: K12 scholars earned career development awards (73%) at an equivalent rate to VFRS faculty (71%) and transitioned K to R funding at equivalent rates, 45% of K12 scholars compared to 50% for VFRS. Qualitative analysis demonstrated K12 scholars valued a personalized training program that incorporated self-efficacy and adaptability, key tenets of Social Cognitive Career Theory. Conclusion: Personalized physician-scientist training programs may enhance efficient utilization of research resources in Pediatric academic departments and serve as a viable alternative to traditional programs. Our qualitative evaluation suggests scholar self-efficacy and adaptability can be achieved through a personalized training program.

Introduction: Academic health centers have invested in academies and related structures to promote health professions education (HPE) scholarship, yet many struggle to sustain vibrant scholarly communities. We aimed to identify lessons for building and sustaining scholarly communities that support HPE scholarship. Methods: Using a constructivist approach, we conducted a qualitative interview study in 2025 with leaders from across all four geographic regions of the U.S. Inclusion criteria required that participants direct an academy or other institutional structure intended to promote educational scholarship, and that they could speak to building and sustaining scholarly communities of practice in their local context. The Communities of Practice framework informed interview guide development and data interpretation. Interviews were audio-recorded, transcribed, de-identified, and analyzed using a six-phase thematic analysis process. Results: Twenty-one academy leaders described five interrelated forms of leadership work that shaped sustainable scholarly communities: (1) building foundations that legitimize educational scholarship by securing institutional investment, leadership buy-in, succession planning, and guiding frameworks; (2) cultivating scholarly sanctuary to counter isolation through psychologically safe, inclusive communities; (3) making scholarship feasible under constraints by creating low-barrier entry points, translating value to leaders, and addressing time, productivity, and infrastructure barriers; (4) tending growth through layered, incremental development, including cohort programs, consultation, mentoring, grants, and flexible participation; and (5) making educational scholarship visible and valued through recognition, dissemination, and outcome tracking. Discussion: Viewed through the Communities of Practice framework, the themes illuminate how leaders cultivated a shared domain of legitimate educational scholarship, a community of relational support, and a practice of tools, routines, and developmental infrastructure. The themes also reveal that sustainable communities of practice do not emerge from any single academy model, but from context-sensitive alignment of structure, culture, and incentives. Institutions seeking to strengthen HPE scholarship should invest in foundational resources, cultivate psychologically safe communities, adopt incremental growth strategies, and create pathways for recognition and dissemination that legitimize educational scholarship.

Importance: Physician-scientist careers depend on sustained research funding, protected time, and institutional resources. However, data on career-retention attitudes across career stages are limited. Objective: To characterize career intentions and associated research-environment factors among MD-PhD students and early-career physician-scientists. Design: Two independent, national cross-sectional surveys were conducted during nonoverlapping periods in 2025; MD-PhD applicant and matriculant trends were also examined. Setting: Medical schools and academic health centers in the United States. Participants: MD-PhD students and early-career physician-scientists (ECPS). Exposures: MD-PhD exposures included perceived institutional support, training-related mental health impact, and research disruption. ECPS exposures included institutional support, adverse funding-related wellbeing, and direct National Institutes of Health funding-process disruption. Main Outcome and Measures: Primary outcomes were consideration of leaving the physician-scientist pathway among MD-PhD students and consideration of leaving academic medicine or research among ECPS. Secondary outcomes included likelihood of staying in academic medicine, research-intensive career preference, and consideration for leaving the US to continue research. Results: Among MD-PhD programs confirmed to have distributed the survey, 838 student responses were received (estimated response rate of 19.3%); 175 ECPS responses were received, with no calculable individual-level response rate. Among MD-PhD students, 423 of 835 (50.7%) reported considering leaving the physician-scientist pathway; 712 of 837 (85.1%) reported a high likelihood of remaining in academic medicine, and 664 of 836 (79.4%) preferred a research-intensive career. Adequate institutional support was associated with lower odds of considering leaving (adjusted odds ratio [aOR], 0.28; 95% CI, 0.14-0.54) and higher odds of staying in academic medicine (aOR, 5.65; 95% CI, 2.91-10.98). Training-related mental health impact (aOR, 2.34; 95% CI, 1.72-3.19) and research disruption (aOR, 1.83; 95% CI, 1.35-2.48) were associated with greater odds of considering leaving. Among ECPS, 57.7% considered leaving, 52.6% reported a high likelihood of staying, and 42.9% considered leaving the United States to continue research. Adverse funding-related well-being was associated with considering leaving academic medicine (aOR, 3.13; 95% CI, 1.52-6.63) and leaving the United States to continue research (aOR, 5.29; 95% CI, 2.35-13.12). Conclusions and Relevance: Consideration of leaving was common despite continued interest in academic and research-intensive careers. Institutional support, adverse well-being, and research disruptions were associated with career intentions.

Background Scientific mistrust contributes to lower participation and underrepresentation of Black Americans in genomics studies limiting understanding of how genomic variation and environmental exposures influence health disparities. Community-engaged research requires rebuilding scientific trust; however, there is a need for practical models that operationalize guidance for researchers without community-engaged research training. Therefore, we developed an educational intervention for genomics researchers initiating partnerships with Black American communities. Our intervention creates a bidirectional teaching environment that allows potential community and academic partners to discuss areas of expertise for each stakeholder, partnership perspectives and needs, while exploring modules related to genomics research and community-academic partnership. We report a novel and structured approach for prospective academic and community partners to mutually orient one another and assess partnership practicability. Methods Ten participants, recruited through established community channels, attended a four-hour workshop containing nine interactive modules about scientific mistrust, research safeguards, community-engaged research, genomics, and research for community-defined goals. We also experimented with humor to enhance engagement and trust. We used mixed-methods, single-arm research design and assessed feasibility through recruitment success and retention. Using inductive rapid thematic analyses, we assessed participant responses to eight workshop prompts. Preliminary quantitative data, used for descriptive purposes due to low sample size, were analyzed from pre- and post-Likert scale surveys assessing associations between the intervention and four domains, including scientific trust. Results All 10 enrolled participants completed the study, meeting a priori criteria of 100% for recruitment and show rate. Engagement was strongest during early workshop modules and declined in later modules. Survey data completeness was limited by missing responses. Survey instrument design limitations were identified for modification in future studies. Participants articulated expectations for partnership that aligned with community-based participatory research principles. Conclusions The intervention is feasible to deliver as a bidirectional educational experience in partnership with a community organization. The strongest implementation refinements needed were workshop duration, module prioritization, and survey instrument design, particularly the trust domain. A community advisory board is co-developing modules and refining the intervention to evaluate in a pilot version of the study with a larger sample.

Background As medical education transitions toward competency-based models, longitudinal programs emphasizing deliberate practice and repeated assessment are essential for mastery of complex concepts. Frequent formative assessment requirements, limited expert pools, and growing cohorts that outpace traditional infrastructure create substantial scalability constraints. Preceptorial programs, in which learners demonstrate mastery to expert educators, are particularly vulnerable. As enrollment expands, administrative demands for portfolio tracking, examination logistics, and case development fall disproportionately on the volunteer expert educators who sustain them. Objective We sought to implement a unified, zero-cost digital infrastructure to support scalable formative and summative assessment of a multi-center year-long mechanical ventilation preceptorial program while minimizing administrative burden for expert educators. Methods We implemented two complementary digital systems built on the Google ecosystem, requiring no institutional licensing or IT support. For formative tracking, we first deployed a standardized WP with defined milestone deadlines and a zero-cost automated tracking and reminder system. Completion of the fall milestone was compared between Fall 2024 (manual educator-dependent tracking and reminders) and Fall 2025 (standardized requirements plus automated tracking). For summative assessment, we also deployed an automatically graded multiple-choice case-based waveform examination (CBWE), operationalizing an expert-defined partial-credit scoring rubric. Results There was a 7.7-fold increase in the total number of waveforms submitted (194 images in Fall 2024 to 1498 images in Fall 2025). Portfolio submission rate rose from 45.6% (31/68 learners) in Fall 2024 to 68.5% (63/92 learners) in Fall 2025. Among learners who submitted their portfolios, the proportion submitting all required waveforms increased from 29.0% to 55.6%. Proof-of-concept automated CBWE grading confirmed scoring accuracy, eliminated 8.5 hours of manual grading per grader per cycle, generated item-level analytics, and demonstrated capacity for immediate individualized learner feedback. Conclusion A unified, zero-cost digital infrastructure addressed parallel administrative and content scarcity constraints limiting scalability of a national MV preceptorial program. By reallocating administrative burden away from expert faculty, these tools preserve the high-fidelity teaching relationship at the core of the preceptorial model while enabling it to operate at scale, ultimately providing a replicable model for competency-based assessment in diverse training environments.

Research Objectives: To evaluate whether publicly available institutional guidance supports patient-information decisions across scenarios and schools, and characterize document synthesis and evaluation consistency. Methods: We conducted an exploratory, vignette-based document analysis of a geographically diverse nonprobability sample of 20 U.S. osteopathic medical schools. Eight educational vignettes yielded 160 school-vignette pairs. Each pair underwent three separate AI-assisted retrieval-and-evaluation runs, classifying decision support as Explicitly Supported, Inferable, Ambiguous, or Not Addressed. Response selection prioritized greater support for discordant pairs, followed by fewer contributing documents and run order. One investigator verified or revised selected discordant classifications against cited evidence. Explicitly Supported and Inferable were grouped post hoc as sufficient decision support. Analyses were descriptive and included an exploratory two-school model-investigator comparison. Results: At least one eligible source was retrieved for 159 of 160 pairs (99.4%). Final classifications were Explicitly Supported for 18 pairs (11.3%), Inferable for 3 (1.9%), Ambiguous for 132 (82.5%), and Not Addressed for 7 (4.4%). Sufficient support occurred in 21 pairs (13.1%), most frequently for generative AI-assisted reflective writing (7/20 schools, 35%), and in none for personal cloud notes or official clinical logs. Ten schools had no sufficiently supported vignette; the maximum was four of eight. Multiple documents contributed to 111 evaluations (69.4%). Three-run ratings were unanimous for 113 pairs (70.6%), with 80.2% pairwise exact agreement. Investigator review retained 44 of 47 selected discordant ratings and revised three upward. In the two-school comparison, the investigator more frequently judged evidence sufficient when models judged it insufficient than the reverse. Conclusions: Relevant public guidance was frequently retrieved, but few school-vignette pairs were classified as providing sufficient scenario-specific decision support. These findings highlight a gap between identifying relevant guidance and determining an appropriate course of action within this evaluation framework. They support institutional review of how student-facing materials explain information use, storage, sharing, and approval requirements. Vignette-based review identifies questions requiring clarification. Evaluation with learners and assessment of internal and clinical-site guidance would help determine how these findings translate to students' decisions.

Introduction No widely adopted guidelines exist for collecting and reporting donor-level metadata in tissue-based research, limiting interpretability, reproducibility, and potentially introducing bias. This study aimed to inform ethical and appropriate metadata practices. Methods Semi-structured interviews were conducted with 16 investigators from the Human BioMolecular Atlas Program. Thematic analysis using inductively derived codes identified metadata elements and perspectives on their collection and reporting. Results Participants identified 80 metadata variables across six domains: demographic, sociodemographic, medical history, personally identifying information, cause of death, and tissue/organ data. Most supported routine collection and reporting of demographics and medical history, whereas views on cause of death and sociodemographic data were mixed. Conclusion We recommend routinely collecting and reporting demographics and medical history, while restricting cause of death and sociodemographic variables to situations with explicit consent or justification. These findings provide initial evidence to inform ethical donor metadata guidelines, with further stakeholder engagement and consensus-building needed.

Background: Parenthood in medicine is an experience fraught with challenges that begin in the pre-conception phase and persist as physician-parents navigate their dual role. Methods: This study aims to understand the experiences of physician-parents (both childbearing and non-childbearing) returning to work after parental leave. Physicians, including residents, affiliated with the University of Toronto Department of Medicine internal medicine division who had a child within the last ten years were invited to participate in a self-administered electronic survey from June2022 to 30June 2023. Data were summarized using descriptive statistics. Results: Twenty-nine respondents took part in the survey; 79% were staff physicians while the remaining were trainees at the time of the survey. At the time their first child was born, 48% were staff members and 52% were trainees. The median duration of parental leave was 5 months (range 1-12 months). Among those for whom lactation was applicable, 76% reported that they continued their lactation efforts on returning to work, while 24% chose not to. Thirty five percent (35%, n=6/17) of respondents cited that they were not provided with duty hour modifications when required. Many respondents (46%) felt guilty about burdening their co-workers for requesting accommodations for childcare. When requested to rate their experiences of balancing their personal and professional lives on a scale of 1-10 (1 being impossible to maintain and 10 being extremely easy to maintain), most respondents (66%) chose a rating of 5 or less. Conclusion: This study supports previous findings that physician-parents face a myriad of challenges integrating their roles in medicine and parenthood. A change in culture is required to support and normalize parenthood for physicians and foster sustainability and productivity in academic medicine.

Returning individual results to research participants is increasingly expected in genomic studies. Yet, genomic dietary data have unique characteristics. New DNA sequencing techniques reconstruct diet from the residual plant and animal DNA recoverable in stool, reporting not nutrients or calories but a list of the species a person ate. Turning that list into something a participant can understand does not yet have an established framework. The Everyone EATS (Edible Atlas Through Sequencing) study returned personalized genomic dietary profiles to a non-clinical pilot cohort. Participants collected a stool sample at home, samples were processed with FoodSeq, and each participant received an interactive Diet Data Return Report that translated detected taxa into familiar food groups and benchmarked them against prior FoodSeq cohorts. No monetary compensation was offered, and the Diet Data Return Report was the sole incentive. Of 111 kits mailed, 80 were returned (72.1%) and sequenced (100% sequencing success for plant DNA; 98.7% for animal). Among report recipients with engagement data (n = 73), all accessed their report and 74% engaged interactively with its content. Among 16 feedback survey completers, 13/16 (81.2%) found the report easy to understand, 13/16 (81.2%) reported improved understanding of their dietary variety, and 5/16 (31.2%) reported a dietary behavior change. Curiosity about personal dietary data and supporting broader research goals were the most common reasons for enrolling (79.8%, respectively). Notably, the foods participants flagged as missing or unexpected clustered among herbs, spices, seafood, and processed items, the foods most easily forgotten in self-report and least readily assigned from sequence. Overall, our results suggest that genomic dietary data can be returned in a form participants find understandable and engaging, and that curiosity alone can motivate participation without payment.

The iTHRIV Scholars Mentored Career Development Program initiated an Internal Grant Review (IGR) program in 2020 for current and recently graduated Scholars seeking funding through K and R awards from the NIH. The IGR program is designed to replicate the NIH review process and provide Scholars the opportunity to receive valuable feedback on their applications prior to NIH submission. A key characteristic of the program is the integration of REDCap, enabling automation and year-round offering while improving tracking and reporting efforts and capabilities. Results of the program have been overall positive, both in proposal development and participant feedback. IGR is a sustainable, valuable resource for early-career faculty competing for limited resources in the pursuit to become independently funded clinical translational scientists.

Background: The rapidly evolving United States (U.S.) health and science policy landscape in 2025 may have heterogeneous effects on academic medicine, biomedical research, physician workforce development and patient care. Research Question: How do academic pulmonary and critical care medicine (PCCM) physicians perceive U.S. health and science policy changes and which changes do they consider most influential on research, trainee education and clinical care? Study Design and Methods: We conducted a prospective survey from March 27, 2026 through April 29, 2026 among selected faculty at U.S. academic PCCM programs as part of the Alliance of Scholars and Professionals for Innovation, Research, and Education in Pulmonary and Critical Care Medicine (ASPIRE-PCCM). Results: Ninety-four of 99 ASPIRE-PCCM panel members completed the survey (response rate 95%), representing 18 of 19 ASPIRE-PCCM wave 1 institutions. All respondents reported the rate of changes in U.S. federal health and science policy in the first half of 2025 as 6 or higher on a scale of 1 ("typical pace of change") to 10 ("most change in my lifetime"), with 89 (96%) evaluating the changes as harmful or very harmful. Respondents identified cancellation of research grants, disruptions and changes to NIH scientific review processes, and changes to visa and immigration policies as key factors affecting early career recruitment. Reported negative effects on quality of care included increased vaccine hesitancy, changing reimbursement structures, and diminished research capacity. State-level and non-governmental efforts, including professional society advocacy, institutional bridge funding and personal advocacy efforts were identified as partially mitigating harms. Despite these concerns, 72% of respondents reported that would still pursue careers in PCCM. Interpretation: Academic pulmonary and critical care physicians reported challenges following recent U.S. health and science policy changes that may be mitigated, but not neutralized, by institutional, professional-society, and individual actions.

Despite the numerous benefits associated with higher dietary quality, many older Veterans do not meet national dietary recommendations. Existing programs are not typically tailored for older Veterans who may experience physical and environmental limitations that hinder their ability to access and prepare healthy foods. This project piloted the incorporation of age-friendly, tailored, virtual nutrition education into an existing health promotion program for older Veterans. Programming followed an iterative design process over two years. Year 1 included 14 weeks of virtual nutrition education on healthy aging paired with weekly produce bags and recipe suggestions. In Year 2, virtual nutrition education shifted to more hands-on learning emphasizing basic meal preparation and adaptive cooking strategies for mobility limitations. Produce distribution in Year 2 shifted to a farmer's market model, based on feedback from year 1, allowing participants to self-select items. Primary outcomes included program satisfaction, dietary intake assessed via 24-hour recall to calculate the Healthy Eating Index (HEI-2015), and health-related quality of life (PROMIS Global Health). Findings demonstrate the feasibility and acceptability of a virtual nutrition program incorporating age-friendly cooking instruction and adaptive strategies to improve dietary quality among older Veterans.

Background: Since 2025, US states have rapidly adopted waivers to restrict the purchase of "non-nutritious items" like soda and candy with Supplemental Nutrition Assistance Program (SNAP) benefits. States have proposed various approaches in terms of food categories restricted and implementation strategies, which may influence the downstream effects of waivers on program participation and participants diets and health. Objective: To examine and describe contextual information related to the adoption and implementation of state-level SNAP food restriction waivers. Design: A content analysis was conducted including publicly available state-level: (1) bills introduced related to SNAP food restriction waivers (2025 to early 2026), (2) waiver requests, and (3) waiver approvals (up to June 2026). Codebooks that captured key elements, such as food and beverage group restrictions and definitions, rationale for restrictions, implementation supports, and evaluation plans, were applied independently by two coders, and discrepancies were resolved through consensus. Participants/setting: United States Intervention: N/A Main outcome measures: N/A Statistical analyses performed: Descriptive statistics were used to summarize the presence of coded elements in documents. Results: Seventy-one bills, 22 waiver requests, and 23 waiver approvals were included. Bills mostly proposed restricting candy (65%) and soft drinks (59%). Of the approved waivers, all restrict the purchase of specific beverage groups with SNAP benefits and 65% restrict the purchase of specific food groups with SNAP benefits. There is a high level of variability in how the same food or beverage groups (e.g., soda) are defined across states. States varied in the implementation supports described in waiver requests, describing strategies like communications plans, nutrition education, and staff training. Conclusions: The current state of SNAP food restriction waivers is highly variable and shifting rapidly. Understanding characteristics of early-adopting states can inform future impact and implementation evaluations of waivers and efforts of additional states that may pursue SNAP food restriction waivers.

Importance: Dyslipidemia, hypertension, and diabetes are highly prevalent conditions for which medical nutrition therapy (MNT) is guideline-recommended, yet access remains limited, and real-world evidence on technology-enabled MNT models at scale is sparse. Objective: To characterize lipid, blood pressure, and glycemic outcomes among adults receiving virtual MNT (vMNT) across three cardiometabolic conditions. Design: Retrospective cohort study of adults with a first Nourish appointment before November 2025, followed for 6 months. Setting: National vMNT platform. Participants: Adults meeting enrollment criteria for dyslipidemia, hypertension, or diabetes and remaining engaged in care with [&ge;]1 follow-up measurement at 3 or 6 months. Final cohorts: dyslipidemia (n=6,501), hypertension (n=13,704), diabetes (n=2,444); 18,965 unique patients overall. Exposure: vMNT delivered by a registered dietitian via telehealth visits, with technology-enabled support between visits. Main Outcomes and Measures: Outcomes were LDL cholesterol, total cholesterol, HDL cholesterol, and triglycerides (dyslipidemia); systolic and diastolic blood pressure (SBP, DBP) (hypertension); and HbA1c (diabetes), assessed at enrollment, 3, and 6 months. Weight was a secondary outcome. The proportion achieving guideline-recommended targets (HbA1c <7.0%, SBP <130 mmHg) was also assessed. Results: Among 18,965 patients (mean [SD] age, 42.9 [11.6] years; 15,770 [83.2%] female), significant changes from baseline to 6 months included: LDL cholesterol (-14.0 mg/dL [SE, 0.56]); total cholesterol (-19.4 mg/dL [SE, 0.61]); HDL cholesterol (-0.5 mg/dL [SE, 0.15]); triglycerides (-28.6 mg/dL [SE, 1.06]); SBP (-5.5 mmHg [SE, 0.16]); DBP (-4.5 mmHg [SE, 0.11]); and HbA1c (-1.37 percentage points [SE, 0.04]) (all P<.001). Among those with elevated SBP, 57.3% achieved <130 mmHg by 6 months; among those with elevated HbA1c, 54.7% achieved <7.0%. Outcomes among patients with stable medication regimens were similar to the full cohort. Conclusions and Relevance: In this study of 18,965 patients, vMNT delivered through a technology-enabled care model was associated with clinically meaningful improvement across three prevalent cardiometabolic conditions. These findings support technology-enabled virtual care as a scalable approach to delivering effective MNT.

IntroductionThe acquisition of National Institutes of Health (NIH) grants is an increasingly competitive undertaking. Many early-career biomedical investigators lack sufficient grant writing skills. This pragmatic, 2x2 factorial, group-randomized trial tested the effects of coaching duration and mode of engagement of participants scientific mentors in a grant writing coaching group intervention on grant application outcomes. MethodsA national US sample of 367 faculty and postdoctoral fellows, organized into 76 coaching groups across 6 cohorts (2020-2022), was randomized to 1 of 4 arms that differed by coaching duration (5 months vs 5 months plus 18 months of access to 1:1 coaching) and mode of scientific mentor engagement (structured vs unstructured). Primary outcomes were national-level grant application submissions and awards, and success rate among submitters, assessed via surveys and verified through award databases 30 months after study initiation. ResultsAmong 271 faculty and 96 postdoctoral fellows, 69% submitted at least 1 national application and 32% were awarded at least 1 grant. Submission rates did not differ by experimental arm. Among faculty, the structured engagement of a mentor in coaching was associated with significantly higher odds of any award (adjusted OR = 1.87) and any NIH mentored career development (K) award (adjusted OR = 3.32), and with higher success rates for these proposal types. Extended coaching duration showed a positive but not statistically significant association with faculty awards after adjustment. Neither factor significantly affected outcomes for postdoctoral fellows. Faculty success rates exceeded national NIH-reported success rates for research project grants equivalent to the R01 mechanism (43% vs 17.6%) and K awards (51% vs 36.5%). ConclusionParticipation in a national, cross-institutional, group coaching model yielded high grant submission outcomes, and award rates were higher relative to NIH benchmarks. Structured integration of scientific mentors with the coaching intervention had a greater effect than extended coaching duration on faculty outcomes.

Objective: To assess the efficacy of an executive peer coaching program, Charting Champions Program (CCP), in helping physicians manage their administrative workload, thereby improving time management, workflow and well-being. Findings: In this longitudinal survey study, physicians self-reported significant improvements in completing charting and administrative paperwork during their clinical day. Physicians reported significant improvements in mental, cognitive and emotional states after the program. Meaning: The Charting Champions Program is an effective intervention that supports physicians in problem-solving the administrative burden of their clinical day, improving workflow efficiency, completing administrative requirements during clinical hours, and enhancing work-life balance and personal satisfaction. Background: Physicians are subject to high levels of mental, physical, and emotional stress, partly due to increasing administrative burdens. Online coaching is a proven intervention to help physicians improve workflow efficiency, reduce administrative burden and improve job satisfaction. Design: This voluntary longitudinal survey took place between 2020 and 2023. Physicians were asked to complete a survey at program entry and again 30-90 days after program completion. The survey consisted of 14 Likert scale questions, and a final sample of 280 physicians completed both surveys. Intervention: CCP contains modules that teach workflow improvements for clinical days, including timely charting, administrative task workflow, managing patient consultations and reducing interruptions. Interventions include self-paced modules, live coaching, recordings and an online peer community. Results: Post-CCP physicians reported a significant decrease in hours spent charting (P<0.0001) and completing clinical paperwork outside of clinical hours (P<0.006). Physicians also reported a decrease in work-related dread (P<0.001), feelings of burnout (P<0.001), and thoughts of quitting due to administrative burdens (P<0.001). Physicians felt more focused at work (P<0.001), felt more in control of the clinical day (P<0.001), and rated their mental energy at work higher (P<0.001). The program did not affect the number of patients seen in a full clinical day (P > 0.918). Conclusion and Relevance: The CCP reduces the time physicians spend on tasks outside of clinical hours, increasing free time without decreasing the number of patients seen per day.

Within our synchronous, online global health-focused upper-level microbiology course, we find that students struggle to translate learning to real-world applications. For examples, consider the recent measles outbreaks and major events such as the COVID-19 pandemic, which prompt many questions about how basic microbiological information is used by public health professionals. To address these points, we created a simulation-based curriculum that places students in an action role during an infectious disease outbreak. Our stand-alone curriculum walks through a historical measles outbreak that introduces outbreak investigation, community communication, and how these depend on microbiological knowledge. By using breakout groups, students have an opportunity to decide classifications, public messaging, and intervention metrics. We provide students with an outbreak investigation reference worksheet and interweave breakout rooms with didactic vignettes covering background information while revealing actual responses to outbreaks in conjunction with data obtained by responding scientists. Students synthesize material and apply it in real-time - allowing them to exercise critical thinking while bolstering relevance of microbiology and public health to popular media.

Introduction Inappropriate use of echocardiograms and stress tests with nuclear components in the evaluation of cardiopulmonary complaints (chest pain, dyspnea/shortness of breath (SOB), dizziness, and syncope) is common, despite Cardiology society guidelines for appropriate use. Such overuse raises healthcare costs, impairs the availability of resources for other patients, and exposes patients to radiation unnecessarily. Our Emergency Department (ED) runs an observation unit that sees thousands of patients annually with cardiopulmonary complaints. We observed many have echocardiograms and stress tests with nuclear components without indications for either. Working with our Department of Cardiology, we promoted guidelines for appropriate use of echocardiograms and stress tests with nuclear components in the evaluation of such patients. Methods We collected 2024 and 2025 data regarding OU admissions. Patents were included if they were [&ge;]18 years, in the ED OU between 1/1/24 and 12/31/25, aad an OU admission complaint of chest pain, dyspnea/SOB, dizziness, and syncope. We calculated the percent of patients with such presentations who received either an echocardiogram or a stress test with a nuclear component. We then compared the 2024 (pre-implementation) data with full-year data from the first full year of implementation (2025). Results After introducing educational guidelines, there were statistically-significant reductions in nuclear stress tests ordered for dyspnea/SOB (absolute reduction 9.3%; p = 0.0009) and overall usage of nuclear stress tests (absolute reduction 2.4%; p = 0.0095). This was offset by increases in echocardiograms ordered for chest pain (absolute increase 3.7%; p = 0.005) and overall usage of echocardiograms (absolute increase 2.0%; p = 0.0454). There was no net change in the overall use of echocardiograms and nuclear stress tests when considered together: 85.2% of patients had one or the other study in 2024 vs. 84.8% in 2025; p = 0.5768. Discussion Introducing and promoting appropriate-use guidelines for echocardiograms and stress tests with nuclear components in the evaluation of cardiopulmonary complaints was associated with a reduction in unnecessary nuclear stress tests, but not echocardiograms. Success of this program to reduce nuclear stress tests may be attributed to several factors. First, the relevant specialties (emergency medicine, cardiology) were engaged. Second, we relied on guidelines adopted by professional organizations. Third, the initiative corresponds to nationwide efforts to decrease cost of care by providing evidence-based diagnostic and treatment management. Failure to reduce echocardiograms may be due to a well-documented multi-year time lag between changes in medical knowledge and wide-scale adoption; failure to develop the guidelines in collaboration with house staff and mid-level providers and promote them at multiple times and venues in a multi-modal manner; and utilize Department leadership to promote their usage.

In 2027, the National Institutes of Health (NIH) will no longer support costs associated with clinical trials (CT) for career development (K) awards. NIH's CT definition encompasses many types of research, from early-stage pilot work through definitive studies. The types and sizes of trials K awardees conduct have not been described, which could inform ongoing policy changes relevant to the next generation of clinical trialists. We conducted a cross-sectional analysis of NIH RePORTER data to characterize the types and sizes of CTs supported by NIH K01, K08, and K23 awards funded in fiscal years 2024-2025 under a CT Required or CT Optional funding opportunity announcement (FOA), with non-missing abstract text. A rule-based classification scheme applied to free-text abstracts categorized each award into 5 mutually exclusive trial types: pilot/feasibility/proof-of-concept, efficacy/effectiveness, trial confirmed with type unclear, other (mechanistic, ancillary, or phase I/II), or no trial-specific language identified. Trial size was assessed among abstracts reporting an explicit, manually verified sample size. Of 1336 unique awards funded under CT Required (n=1051) or CT Optional (n=285) FOAs, 815 (61.0%) were classified as pilot, feasibility, or proof-of-concept studies, and 55 (4.1%) as efficacy or effectiveness studies; 204 (15.3%) had a confirmed trial of unclear type, 41 (3.1%) were other, and 221 (16.5%) had no trial-specific language. Among CT Required awards, 730 (69.5%) were pilot, feasibility, or proof-of-concept work. Among 273 awards (20.4%) with a verified sample size, the median was 60 participants (IQR, 44-80), with 236 (86.4%) enrolling [&le;]100 participants. Given these findings that CT within NIH K awards are generally small and early-stage, NIH's decision to no longer support trial costs may adversely affect the scientist development pipeline.

Background Training in grant proposal writing is an essential component of professional development for academic scientists in the biomedical and behavioral sciences. Despite the expansion of inter- and intra-institutional grant writing coaching groups as an approach to honing these skills, specific features that enhance or limit coaching group effectiveness have not been rigorously studied. Methods Qualitative inerviews were conducted with a subset of early-career investigators (n=204 and coaches (n=36) engaged in a national, U.S. based, group-randomized trial of grant writing coaching groups to test the effects of two variables on submission and funding of national-level proposals: (1) coaching duration (regular/extended dose) and (2) mode of engaging a scientific advisor (someone with content-aligned expertise) in the coaching process. This report focuses on interviews conducted upon completion of the regular coaching dose - 5 months of biweekly, group-based coaching sessions to support active proposal writing. Interviews were designed to identify which coaching group elements were perceived to be the most critical. Transcribed interviews were analyzed using deductive (participants) or open (coaches) coding to identify themes. Results Triangulation of results from participant and coach interviews showed strong concordance that coaches, peers, and scientific advisors all played key roles in supporting intervention efficacy. Sufficient alignment of scientific fields and/or methodologies among group members was important, although breadth of perspectives was also valued. Other critical group features were skilled and well-organized coaches, detailed feedback, peer-to-peer support (technical and psychosocial), and clear expectations for group functioning. Factors attenuating impact included variation in participants' engagement and "readiness to write," within-group mismatches of expertise or grant mechanisms, and limited research support at some participants' home institutions. Conclusion This study identified key elements of successful grant writing coaching groups and potential barriers to their effectiveness, while yielding insights about tailoring this approach for individuals at different stages of proposal development.