Inspiring Undergraduate Student Training in Alzheimer's Research (USTAR): Training the Next Generation of Aging Scientists

Abstract

Inspiring Undergraduate Student Training in Alzheimer's Research (USTAR) aims to provide Underrepresented Minority (URM) undergraduate students with mentored didactic, clinical, and research experiences to stimulate interest in research related to Alzheimer’s Disease and Related Dementias (ADRD). USTAR specifically focuses on social determinants of health as risk factors for ADRD minoritized populations. USTAR’s scientific rationale is that URM undergraduates are less likely to enter the biomedical workforce. Addressing this disparity is important since minorities are disproportionally affected by ADRD, and URM scientists may deeply appreciate the sociocultural forces that create racial health disparities. USTAR unites faculty expertise from Thomas Jefferson University (TJU) and Delaware State University (DSU), a Historically Black College and University (HBCU). The faculty’s work spans the full spectrum of ADRD research and care, including neuroscience, biology, gerontology, geriatrics, neurology, and geriatric psychiatry. The 20-month USTAR program will train two cohorts of ten students. Across all USTAR activities, we emphasize the relationship between social determinants of health and cognition. USTAR’s goals are to: 1) Provide interdisciplinary ADRD-related research, educational, clinical, and community experiences; 2) Enhance research skills via group research projects; 3) Facilitate transition from undergraduate to graduate studies in science; and 4) Evaluate USTAR’s effectiveness. USTAR has the potential to increase diversity in the national workforce that conducts health disparities research pertaining to ADRD. This goal aligns with the National Institute on Aging’s (NIA) mission to meet the nation’s biomedical, behavioral, and clinical research needs and to ensure health equity for all Americans.

INTRODUCTION

The prevalence of Alzheimer’s Disease and Related Dementias (ADRD) in the U.S. is rising due to aging of the population.⁽¹⁾ The rate is twice as high in Black patients than White patients due to greater exposure to social and medical factors that increase risk.⁽²⁾ Low education level and obstacles to care also increase risk, as does stress related to racism, crime, poverty, and neighborhood deprivation.^(3-5) These social determinants of health (SDOH), sometimes referred to as health-related social needs, reduce cognitive reserve, lowering the threshold for emergent cognitive deficits.⁽⁶⁾ Targeting SDOH may, therefore, reduce racialized disparities in ADRD.⁽⁶⁾ Progress towards this goal is slowed by the paucity of Underrepresented Minority (URM) scientists who study ADRD.⁽⁷⁾ In fact, the social forces that create health disparities also prevent URM students from pursuing science careers.⁽⁸⁾ This disparity perpetuates racialized bias in science training and limits the number of URM scientists who may be better equipped to engage minority communities, more deeply appreciate sociocultural forces that create health disparities, and have greater motivation to redress health inequities.⁽⁹⁾ These principles guided the development of Inspiring Undergraduate Student Training in Alzheimer's Research (USTAR).

The National Institute on Aging’s (NIA) Advancing Diversity in Aging Research through Undergraduate Education (ADAR) initiative sponsors aging-focused educational programs for URM undergraduates majoring in medicine, science, technology, engineering or math (MSTEM). ADAR’s goal is to expand and diversify the workforce that conducts aging research.⁽¹⁰⁾ Our ADAR program, USTAR, aims to stimulate interest ADRD research in URM students. This report describes USTAR’s theoretical underpinnings, programmatic components, and evaluation plan.

USTAR is a collaboration between Thomas Jefferson University (TJU), a major academic medical center, and Delaware State University (DSU), a Historically Black College and University (HBCU). USTAR aims to provide a comprehensive educational and research experience to bolster students’ interest and expertise in ADRD, leading to an increase in the number of URM undergraduates who pursue research careers in ADRD.

THEORETICAL UNDERPINNINGS

USTAR is grounded in Social Cognitive Career Theory (SCCT) and Syndemic Theory. SCCT posits dynamic interactions of self-efficacy beliefs, outcome expectations, and environmental support with academic career interests, choices, and success.⁽⁷⁾ Students tend to pursue careers that align with self-efficacy beliefs, abilities, and valued goals. Optimal learning environments provide enactive mastery experiences (actual task performance), vicarious experiences (seeing similar-appearing individuals engage in the task), and persuasive experiences (mentor encouragement) that together engender a self-image as an effective scientist.^(11-14) The transition from undergraduate to graduate studies in science is mediated in part by science self-efficacy. This model recognizes the role of socialization into science as key to building science self-efficacy. USTAR mentors catalyze this process by shaping the narrative that students tell of themselves about who they are and how they fit into the science world. Shared experiences with mentors, peers, and role models in journal clubs, research projects, and clinical activities reinforce a sense of belonging in the science community.

Syndemic Theory posits a biosocial conception of health wherein the twinned epidemics of disease and adverse social conditions act synergistically to create a “syndemic”.⁽¹⁵⁾ For example, high ADRD rates in Black patients emerge from the pernicious interaction of biological (e.g., diabetes, hypertension) and social (e.g., low health literacy, food insecurity) epidemics. The resulting syndemic causes high morbidity and mortality. Current medical practice is ill-equipped to address syndemics, as it focuses on established disease in individuals and fails to address the structural and social forces that perpetuate disease in disadvantaged populations. Thus, the syndemic framework serves as USTAR’s thematic core, which is that diversifying the ADRD research workforce will lead to social policies that ultimately will help to preserve cognition in minority patients.

USTAR is also guided by the recognition of the outsized role that HBCUs play in educating Black students. According the National Science Foundation (NSF), less than 10% of all Black students attend HBCUs, although STEM graduates from HBCUs account for up to a third of all Black students with those degrees⁽¹⁶⁾, despite the fact that HBCU students are subject to the structural disadvantages noted above. The successes of HBCUs in educating Black students, therefore, allowed USTAR to establish a core partnership (which included a physical presence of the students on both campuses every week) through which faculty from TJU and DSU collaborate to train a diverse student cohort.

PROGRAM DESCRIPTION

Overview

USTAR’s objectives are to: (1) Provide interdisciplinary ADRD-related research, clinical, and community experiences; (2) Enhance clinical and basic science research skills; and (3) Facilitate transition from undergraduate to graduate studies. USTAR’s Principal Investigators (PIs) include a molecular biologist with specialization in neuroscience who studies molecular mechanisms of ADRD (DSU), a geriatric psychiatrist with 30+ years of NIH funding focused on health disparities (TJU), and a geriatrician who is a recognized leader in geriatric education (TJU). DSU is the hub for basic science research training while TJU is the hub for clinical research training. Faculty expertise encompasses the full spectrum of ADRD research and care, providing students with multiple opportunities to participate in ADRD research from bench to bedside. This experience ensures that students acquire an understanding of ADRD at molecular, cellular, clinical, pathological, and population levels, with an appreciation of how these processes intersect with SDOH. Other professions represented by USTAR faculty include neurology, psychology, pharmacy, gerontology, occupational therapy, nursing, emergency medicine, primary care, biostatistics, and cell biology. Faculty are diverse with respect to gender, race, and ethnicity.

USTAR is open to URM undergraduate students enrolled in an MSTEM bachelor’s program who anticipate applying to graduate/medical school. The application consists of questions about students’ background, and educational and career aspirations. Short essay prompts ask applicants to elaborate on their career plans, reasons for applying to USTAR, and program expectations. Applicants are also required to submit a transcript and a letter of recommendation. These criteria help identify a diverse cohort of students with a high potential of pursuing advanced degrees.

We will enroll two cohorts of ten students each. Cohort 1 began in Summer 2024 and will continue through April 2026. The current cohort is 80% female, 80% Black, and 10% Hispanic. Most (60%) were rising juniors at program entry. The majority (80%) attend an HBCU. All students are enrolled in a biology or pre-medicine program, and all aspire to go to medical school (80%) or dental school (20%). Cohort 2 will be enrolled from Summer 2026 through Spring 2028. We will invite Cohort 1 students to assist with recruitment for Cohort 2 (interview applicants, advise on recruitment materials).

USTAR is a 20-month program. Students participate during two consecutive summer sessions; there are monthly virtual meetings during the academic years that follow the summer sessions. USTAR provides students with on campus housing during the summer sessions. Students spend three days per week at TJU and one day per week at DSU during the summer sessions. A fifth day each week is devoted to asynchronous learning activities. Students are paid $5,000 for each summer session, and $100 per month during the academic years. The summer stipend amount is sufficient to appeal to students who may not otherwise enroll due to the need to work.

The curriculum was designed to provide foundational knowledge of research, basic science, ADRD, as well as career development support as students transition to graduate/medical school (see Figure 1). Education is provided through lectures, clinical shadowing in various settings including an outpatient geriatric practice, hands-on participation in research, and community-based learning activities.

Figure 1.

Inspiring Undergraduate Student Training in Alzheimer's Research (USTAR) Curriculum.

^a Alzheimer’s Disease and Related Dementias.

^b Statistical Product and Service Solutions.

Mentoring

Each student is assigned an Academic Mentor who advises on career planning. The mentors work closely with students to: (1) customize learning experiences; and (2) guide students as they apply to graduate/medical school. USTAR was designed to be flexible, tailoring each student’s learning experience to their individual interests and needs. While all students are exposed to core activities, they are encouraged to articulate their interests to the mentors, and experiences are customized accordingly.

Students and their mentors create an Individualized Development Plan (IDP). The IDP is a dynamic and evolving document that reflects the mentor-student dyad’s shared commitment, contains action plans to obtain desired skills and knowledge, and records progress with graduate/medical school applications. Academic Mentors help prepare for graduate/medical school by: (1) discussing academic and career goals; (2) reevaluating USTAR’s influence on career plans; (3) researching graduate/medical schools; and (4) completing applications (and providing support with resumes and personal statements). Mentors will continue to provide support after USTAR ends. This may be especially important for students who take a gap year.⁽¹⁷⁾

In addition to their Academic Mentors, each student has a complementary basic science research faculty mentor at DSU. This individual trains and advises the student in basic laboratory skills and practices. An additional layer of basic science mentoring is provided by DSU graduate students who help them acquire laboratory skills and/or advise them about graduate training.

Model Research Study

An innovative feature of USTAR is the model research study, called CHARMS (Center for Healthy Aging: Research on Minority Health Study). This immersive learning experience provides students with clinical research skills as they investigate relationships among cognitive functioning and SDOH. The students function as an investigative team, engaging all aspects of the research from recruitment through presenting results.

Data for CHARMS are collected from patients who receive care at TJU’s Center for Healthy Aging (CHA); one of the PIs is medical director. There are two groups of patients for CHARMS: (1) Annual Wellness Visit (AWV) group; and (2) patient volunteer group. AWV group: All CHA patients (~1,600) complete the Medicare AWV questionnaire, which inquires about lifestyle behaviors, SDOH, social support, health literacy, and daily activities. Volunteer group: CHA patients (and caregivers if the patient has dementia) volunteer to participate in annual interviews with students. We employ purposeful sampling to ensure heterogeneity regarding sex, race, and cognitive status. Students contact patients to explain the study, ascertain interest, and schedule research visits. The students then consent patients, and administer neuropsychological tests and self-reported questionnaires. For patients with dementia, their caregivers are asked questions regarding caregiver burden. The interviews are highly supervised. They are audio recorded for quality control purposes, USTAR staff are available for assistance, and the PI geriatrician is available if there is a medical emergency. Students meet with USTAR staff after each interview to debrief. Students also obtain information from patients’ electronic medical records (medications, vitals, sensory impairments). In addition, students utilize an interactive map to obtain Area Deprivation Index (ADI) scores to characterize the relative socioeconomic disadvantage of the neighborhood in which each patient lives.⁽¹⁸⁾.

Prior to interacting with patients, students were trained on research ethics, obtained their Collaborative Institutional Training Initiative (CITI) certification, and underwent extensive training on informed consent, conducting neuropsychological tests, administering research questionnaires, medical record review, and data entry. Students were also provided with general training on interviewing patients, communicating with patients who have dementia, confidentiality, and responding to concerning situations.

Group Research Project

Students formed groups to investigate a novel research question based on CHARMS data. Example projects include exploring relationships between ADI and physical activity, examining racial group differences in cognition, and determining whether social interaction is associated with cognition. To familiarize students with the SDOH and cognition literature, USTAR faculty lead weekly journal clubs. This experience not only exposes students to research using other populations and methodologies, but also reinforces critical thinking skills.

Each research group is led by a USTAR faculty member who serves as a Research Mentor. Groups meet regularly with their mentors. The 18-month project is completed in stages that include brainstorming research questions, searching the literature, synthesizing the literature and identifying novel points of inquiry, generating research hypotheses, analyzing data, and communicating study results. The project will culminate in a seminar where each group will present their results. Students will be encouraged to submit abstracts of their work to conferences.

To facilitate science literacy, faculty hold lectures on research design and clinical research. There are also lectures on statistics and a series of instructional workshops on SPSS. A biostatistician is available to assist with statistical analyses. We engage librarians to show students how to conduct literature searches. In addition, writing instructors hold workshops on scientific writing and presenting results.

Clinical Shadowing

Students participate in clinical shadowing during the summers to: (1) build patient empathy, particularly with respect to older people; (2) interact with interprofessional care teams; and (3) observe the complexities of treating patients with multiple comorbidities. Most shadowing occurs at CHA, where students observe an interprofessional team deliver coordinated care to older patients. Students also shadowed neuropsychologists as they evaluated patients with memory problems. We also arranged shadowing experiences to meet individual student interests (e.g., anesthesiology). Forthcoming shadowing experiences will include neuropathology, neurology, geriatric psychiatry, and emergency medicine.

Community Engagement Activities

Students participate in outreach activities designed to address and prevent ADRD risk factors at the community level. The activities are sponsored by TJU hospital’s stroke center, which promotes the health of the community through a multifaceted program aimed at reducing stroke incidence. Student activities include diabetes self-management and computer literacy classes, nutrition lunch and learns, disease screening and food distribution events.

Basic Science Training

At DSU students participate in neuroscience research laboratories as well as professional development activities. Students are paired with faculty members with ongoing neuroscience-related projects. Students shadow and take part in basic science laboratory techniques, read current literature, and attend weekly lab meetings. The range of techniques varied, but included cellular and molecular studies, AI-related data analysis, and specimen preparation from model organisms.

A key feature of the DSU day is weekly “lunch and learn” sessions. During this two-part session, there is group mentoring, where students reflect on what they had learned that week, allowing faculty to gain insight into student perceptions of their experiences. Faculty also discussed historical URM figures in science. For this segment, USTAR students were paired with students from a summer REU (Research Experiences for Undergraduates) program, which comprised HBCU students. Student groups were asked to research a historical minority figure from science or medicine. Groups worked together to create a presentation in which they presented an overview of their selected figure and then led a group discussion stemming from the topic. These sessions were impactful and led to fruitful discussions about historical inequities, contributions to science, as well as identifying current-day ways to honor these historical figures, while reinforcing the need for URM scientists.

At the end of the first summer session, students participated in a virtual symposium in which students delivered brief presentations summarizing their research and clinical experiences during USTAR. The symposium served as a reflective exercise after completing several basic science and clinical activities. Reflection is a core component of any experiential learning activity including internships. Formalizing their reflective experience from this enriching summer experience allowed students to gauge and process what they learned and how it fits into the cycle of learning as an undergraduate preparing for a future in science.

EVALUATION PLAN

To assess the recruitment process, we will compile cohort data on the number of applicants, background characteristics, and career aspirations. To assess students’ perception of the program, students complete the Student Satisfaction Form to rate various aspects of USTAR and to provide suggestions for improvement. They also complete a rating form after each lecture and workshop. This information will be used to identify areas of weakness and develop remedial plans accordingly to continually refine the program. At the end of each program year, we will formally assess acquisition of core knowledge and concepts of ADRD, SDOH, and research methodology. We will provide remedial education as necessary based on students’ knowledge scores. Students also complete questionnaires regarding commitment to a science career⁽¹³⁾, which measures intentions to work in MSTEM fields. Responses will allow us to examine changes in intention and commitment. Students will also complete surveys regarding science self-efficacy, and their self-efficacy concerning leadership and teamwork.

We will continuously assess retention. The IDP review process will identify students at risk for leaving and will prompt efforts to maximize program satisfaction to prevent attrition. We will ask students who leave the program to have an exit interview with the PIs to inquire about reasons for leaving the program and for suggested program improvements.

We will prepare annual reports of USTAR progress to be reviewed by an Internal Advisory Board (IAB) comprised of leaders at DSU and TJU. The IAB will review the reports and prepare written evaluations that may include recommendations for improvement, and subsequent reviews will evaluate adherence to those recommendations. An IAB executive summary will be provided to an External Advisory Board (EAB), comprised of three national leaders in geriatric research. The EAB will conduct high-level reviews of USTAR policies and procedures, curricula, student research and clinical experiences, mentors, and program metrics, to ensure that USTAR aligns with national trends in education and research on ADRD and racialized health disparities.

To assess long-term program impacts, students will be asked to complete an annual survey for ten years to track post-undergraduate educational plans; status of graduate/medical school applications; research experiences outside of USTAR; conference presentations and publications that result from USTAR or other research projects; and intention to pursue a career in aging, ADRD, or health disparities research. Later versions of the annual survey will ask about career milestones (e.g., faculty positions, post-doctoral work), grants submitted and funded, and publications.

As an innovative, highly structured, and supportive research training program for URM undergraduate students, USTAR has strong potential to increase the quality and diversity of the national workforce that conducts ADRD research. We anticipate USTAR can be modeled in other institutions to promote diversity in ADRD research. This goal aligns with the NIA mission to meet the nation’s biomedical, behavioral, and clinical research needs and to ensure health equity for all Americans.

Key Points.

• The workforce that conducts research on Alzheimer’s Disease and Related Dementias (ADRD) needs to be expanded and diversified to meet the needs of the population affected by ADRD.

• Undergraduate Student Training in Alzheimer's Research (USTAR) aims to stimulate interest in ADRD research among Underrepresented Minority (URM) undergraduates who plan to pursue a graduate or medical degree.

• USTAR is an intensive 20-month program that exposes students to interdisciplinary ADRD-related research, educational, clinical and community experiences from bench to bedside.

• USTAR promotes socialization into science as a way to build science self-efficacy.

Why does this paper matter?

USTAR aims to increase the quality and diversity of the national workforce that conducts ADRD research. This aligns with National Institute on Aging’s (NIA) mission to ensure health equity for all Americans.