Improving Adolescent/Young Adult Health –
Training the Next Generation of Clinician
Scientists in Transdisciplinary Research
S. Jean Emans, MD
Professor of Pediatrics, HMS
Director, Office of Faculty Development
Chief, Division of Adolescent Medicine,
Vice Chair for Clinical Affairs, Dept of Medicine
Children’s Hospital Boston
PI, Boston LEAH
The Trajectory of Physician Scientists in
Adolescent Medicine – a case example
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Nov 2008 – meeting hosted by WT Grant Foundation
(Granger, Emans, Haggerty)
Participants
LEAH – S. Jean Emans, MD, Bryn Austin, ScD, Charles Irwin, MD,
Richard Kreipe, MD, Donald Orr, MD
MCH/HRSA - Laura Kavanagh, MPP; Trina Anglin MD, PhD
NIH – Aria Crump, ScD, Robert Freeman, PhD, Lynne Haverkos, MD,
Susan Newcomer PhD, Belinda Sims, PhD, David Stoff, PhD
Foundations - Robert Granger, EdD, Lauren Hammer Breslow, Sally
Klingenstein Martell, George Thibault, MD, John Van Gorder
Other - Robert Haggerty, MD, Dale Garell, MD, Elizabeth Goodman,
MD, Iris Litt, MD, Mark Schuster, MD, PhD, James Stockman, III, MD
Adolescent/Young Adult Health
Improving the health of youth requires high
quality research by investigators across the
disciplines of medicine, mental health, public
health, nursing, education, sociology,
epidemiology, and biostatistics
 Expert clinician educators, scholars, and
investigators (MCH leaders) are needed to train
health professionals in care delivery and quality
improvement and create new knowledge and
policy, including models of care.
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The Ideal Contribution of Adolescent
Health Scientists
Clinician scientists can ideally combine
practical experiences in the delivery of mental
and physical health services, a focus on the
developmental trajectory of adolescents, and
knowledge of the education and public health
systems in formulating research questions
 Physician scientists, trained in transdisciplinary
research, need to be able to bridge from the
one-on-one patient encounter to collaborations
with the investigators across disciplines
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The Challenge of Training
Physician Scientists
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Adolescent Medicine fellowships are 3 yrs in
pediatrics, 2 yrs in internal med, family practice
26 ACGME programs
– Clinical and research training: curriculum with
stats, research design, ethics, teaching, and for
pediatrics a scholarship project under a
Scholarship Oversight Committee
– May include advanced degree MPH, MSc
– May also receive credit for 2 years in RWJ
program plus clinical experience
Current Crisis in Number of New Adolescent
Medicine (AM) Physician Scientists
20-28 physicians graduate each year from AM
Fellowships; most clinician educators
 An informal survey of 6/7 MCH funded
Leadership Education in Adolescent Health
(LEAH) Programs for the trajectory of
graduates past 5 years: 10/56 (18%) were
spending more than 50% of time in research. A
crisis for future research
 Facilitators: research environment (MCH
support), mentoring, funding extending beyond
fellowship, NIH Loan Repayment
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The Trajectory of the AM
Physician Scientist
Critical periods to spark interest and build
competencies
 Additional research training and mentorship
along the pathway
 Structured research time and feedback from
national experts and peers; models from
RWJCSP and WT Grant Scholars
 Funding – NIH, LRP, Foundations,
Institutions
 Departmental research environment
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Pathway to Becoming an Independent
Adolescent Medicine Physician
Scientist
NIH loan repayment
can make research
career viable.
Typical Time in Training:
4 years
4+ years
3 years
3 years
1-3 years
3-5 years
Additional research training, degrees, thesis.
Clinical Training
Undergraduate
education
Medical school
Residency
Fellowship
Research Training
Postdoc
or first
faculty
position
Mentored
career
development
award
Critical periods: Opportunities to spark interest, build competence in adolescent health research
Projects in clinical
and translational
research,
adolescent health
Volunteer work
in adolescent
services
Research
opportunities
Block
research
time
Structured research
mentorship,
coursework, degree
programs; T71 or T32,
or RWJ Clinical
Scholars
departmental
research environment
Departmental
coverage for 1-3 years
for candidate to
become viable for
mentored career
development awards;
mentorship by
investigators with
external research
funding
Independent
research
scientist
NIH and other
federal funding,
private foundation
funding, or similar
substantial career
level award
Challenges
Short duration and variability of content and
quality of research training; often little prior
research experience
 Support for stipends – MCH T71 LEAH primary
mechanism (broader goals); T32 funding unusual
 Lack of protected time in first two years of
faculty position; mentoring may be inadequate;
research environment may not have funded
investigators
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Challenges
New faculty may not be competitive for K’s,
foundation young investigator programs
 Few unique funding mechanisms for those in
adolescent medicine, unlike GI, cardiology, etc
which often have society or foundation
programs
 85-90% of AM fellows are women - gender
disparities in grant funding and academic
outcomes
 Debt often high which may lead MDs to
choose safer clinical trajectories
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What are some next steps?
Develop ideal trajectories for medicine and
other disciplines to create leaders who are
clinician educators or investigators
 Propose the elements of the transformative
transdisciplinary education that successful AM
clinician scientists need for 2020 to be
competitive for extramural funding (e.g. course
work in other disciplines, collaborative
projects, mentoring, critical feedback from
senior investigators nationally).
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Recommendations for Adolescent
Medicine Physician Scientists
Transform medical student/residency education
adding research content (courses, projects, MPH,
PhD/MD, posters), summer stipends (eg SPR),
mentorship, scholarships to meetings
 Broaden the research training of fellows with a
research trajectory (course work, mentorship,
environment); collaborate with programs such as
RWJ CSP and Health Services Research
Programs to develop a pipeline for some fellows
to enter research intensive programs
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Recommendations
Redesign the transition from fellow to faculty
for those in transdisciplinary research:
support, research environment, mentoring
 Partner with NIH, HRSA/MCH, CDC,
foundations funders to create summer
institutes on grantsmanship, enhance
networking and research support (LRP, Ks,
cross institute T32s, etc), target areas from
NRC/IOM report on health services research
(including models of care and “ehealth”).
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Recommendations
Develop research forums and opportunities for
mentoring, collaboration, and critical feedback
from senior faculty, sponsored by MCH, NIH,
CDC, or foundations, using model of WT Grant
and RWJCSP.
 Educate IRBs about adolescent health issues and
integrate into CTSAs.
 Address gender/minority trainee/faculty
development to enhance academic success.
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Thanks
To the WT Grant Foundation, Bob Granger,
Bob Haggerty, and all the participants for
defining new pathways to train the next
generation of physician scientists.
 To the participants today and the IOM for
continuing this important dialogue. Improving
adolescent/young adult health in the U.S. and
beyond will require the committed action of
clinician educators and investigators across all
the disciplines serving adolescents, and
importantly adolescents and their families.
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