Pathway for a Diverse and Sustainable Emergency Medicine Clinician–Scientist Workforce: Recommendations From the 2024 SAEM Consensus Conference

ABSTRACT

Objectives

The 2024 Society for Academic Emergency Medicine Consensus Conference focused on developing a pathway to build and support a diverse and sustainable emergency medicine (EM) clinician‐scientist workforce. The underlying premise is that the specialty of EM needs a robust clinician‐scientist workforce to fulfill its research mission of creating new knowledge to improve patient care and outcomes.

Methods

Preconference workgroups assessed existing pathways to develop and support EM clinician‐scientists and generated unranked lists of strategies to holistically and comprehensively grow the clinician‐scientist workforce. These strategies were refined and prioritized during a one‐day, in‐person conference, which was followed by a virtual conference to reach consensus on metrics, goals, and timelines for implementation.

Results

Overarching strategies included fostering a departmental culture that values research, addressing barriers to recruiting and retaining a diverse research work force, and enhancing the national reputation of EM research. At the undergraduate and medical school stage, creating a portfolio of medium‐ and long‐term research training opportunities with EM faculty mentors was the highest priority. At the resident and fellow stage, top priorities were dedicated research training built into EM residencies and clinical fellowships. Early‐career faculty strategies prioritized departmental support for federally funded K awards. Mid‐career faculty strategies prioritized securing federal support for research mentoring, leading institutional training grants, and building research teams that include PhD scientists. At all stages, we addressed recruitment and retention of trainees and faculty from disadvantaged and underserved groups.

Conclusions

These prioritized strategies with respective metrics, goals, timelines, and responsible parties provide a roadmap for EM to build a broadly inclusive and sustainable clinician‐scientist workforce, capable of creating the new knowledge needed to advance emergency medical care. Successful implementation will require substantial commitment and investment from national EM organizations and academic department chairs. The result will be improved care and outcomes for the patients and communities we serve.

1. Introduction

The 2024 Society for Academic Emergency Medicine (SAEM) Consensus Conference addressed the critical need to build and sustain a diverse Emergency Medicine (EM) clinician–scientist workforce. As stated in the 2021 publication entitled Emergency Medicine Research: 2030 Strategic Goals, “All academic medical specialties have the obligation to continuously create new knowledge that will improve patient care and outcomes. Emergency medicine is no exception.” [1] Since becoming a specialty in 1979, EM has made important research advancements but remains far from achieving its full potential. In 2019, only 1.7% of full‐time medical school faculty in US departments of EM were National Institutes of Health (NIH)‐funded principal investigators (PIs) compared to an average of 8.1% for all specialties. As such, EM is the lowest ranked among all clinical specialties in the number of NIH‐funded PIs [1]. Substantial growth in federal funding can only be achieved by increasing the number of faculty capable of submitting competitive grant applications and successfully conducting the proposed research.

The challenges created by the relatively low number of clinician–scientists in academic EM are amplified by the limited diversity of the research workforce. This is in part driven by the homogeneity of the overall academic EM workforce. Specifically, individuals from disadvantaged and underserved groups, including women, are present in lower proportions among EM faculty compared to their representation in the broader population. A shortage of perspectives undermines both the quality and scope of the EM research enterprise and limits its ability to identify and study inequities in EM care, as well as engage and serve the varied patient demographics encountered in emergency departments nationwide. Diversity within the biomedical research workforce has benefits. Inclusive teams can solve complex problems more effectively by their ability to investigate issues through different lenses and produce higher quality science [2, 3, 4, 5]. They also play pivotal roles in expanding clinical trial participation among marginalized populations, addressing longstanding disparities in clinical research enrollment.

The SAEM24 Consensus Conference aimed to display a pathway that will catalyze the growth of a holistic and sustainable EM clinician–scientist workforce. The envisioned future state includes a research workforce that has at least doubled in size by 2035 and incorporates a wide range of lived experiences and perspectives. Achieving this goal not only promises superior scientific outputs but also a national research agenda more attuned to the healthcare needs of underserved populations. Ultimately, a well‐supported EM clinician–scientist workforce will drive innovation and foster advancements beneficial to the entire EM patient population.

2. Conference Proceedings

The 2024 SAEM Consensus Conference focused on three main objectives:

1. Developing a thorough understanding of the barriers and facilitators in creating a broad, inclusive, and sustainable clinician‐investigator pathway in EM.

2. Creating a consensus‐based, prioritized list of strategies to foster the development and support of EM clinician‐scientists at various career stages.

3. Proposing implementation mechanisms, including responsible parties, metrics, goals, and timelines, to maximize and monitor the impact of these strategies, thereby expanding, sustaining, and diversifying the EM clinician‐investigator workforce.

Spanning the pathway from undergraduate through mid‐career faculty, the conference's objectives received approval from the SAEM Board of Directors and were funded by a grant from the Agency for Healthcare Research and Quality (AHRQ). To ensure a comprehensive and inclusive approach, the conference planning committee issued a nationwide call for volunteers to participate in the planning process and pre‐conference workgroups. Workgroup membership was solicited by a call for volunteers to SAEM's membership through the SAEM Weekly newsletter and through the SAEM communities including the academies, committees like the SAEM Research Committee, interest groups, and Residents and Medical Students (RAMS). Similarly, the in‐person and virtual conferences were advertised through SAEM Weekly to all SAEM members, on social media via Facebook, LinkedIn, Instagram, and X, SAEM's digital magazine, and on SAEM.org.

Three specific workgroups were formed, each focusing on different career stages: (1) undergraduate and medical students, (2) residents and fellows, and (3) early and mid‐career faculty. These workgroups were tasked with assessing the current state of clinician–scientist research training within and outside EM, identifying barriers to success within EM, and generating preliminary, unranked lists of strategies along with responsible parties, metrics, goals, and timelines. These workgroups were also charged with identifying research opportunities pertaining to clinician–scientist training and with opportunities and strategies for advancing diversity in the EM research workforce.

The first phase of the conference, an in‐person meeting, was held on May 14, 2024, in Phoenix, Arizona, immediately before the SAEM national conference, and was open for national registration. Registered attendees received pre‐conference materials produced by each workgroup. During the conference, workgroup leaders provided overviews of the clinician scientist workforce including the current state, barriers to diversification and sustainment, and an unranked list of strategies to enhance the workforce within their domains. Attendees then participated in breakout table discussions, which were followed by full‐group report‐outs and real‐time anonymous electronic voting to prioritize the strategies. Volunteers from the SAEM RAMS group assisted as scribes. The primary outcome was a prioritized list of strategies with designated responsible parties across the three career stages, and several overarching strategies applicable across all stages, including strategies for developing a robust and diverse EM research workforce.

The second phase, a virtual conference, took place on August 29, 2024, and was also open for national registration. During this conference, workgroup leaders presented proposed metrics, goals, and timelines for the prioritized strategies to create a broad, inclusive, and sustainable EM clinician–scientist workforce. These were discussed in virtual breakout groups, and modifications, additions, and removals were proposed and discussed. Consensus voting helped finalize the metrics, goals, and timelines.

The Conference Planning Committee, along with the workgroup members, compiled the proceedings, ensuring a comprehensive and detailed account of the conferences. This comprehensive and collaborative approach underscores the concerted effort by SAEM to foster a robust and sustainable pathway for clinician‐investigators in EM, aiming to address current challenges and build a strong foundation for future advancements in the specialty. A list of program committee members, workgroup members, and conference participants is provided in Supporting Information.

3. Overarching Strategies

Three highly prioritized strategies emerged during the in‐person conference that encompass all career stages and serve as overarching themes. These strategies along with their associated owners, metrics, goals, and timelines are presented in Table 1.

TABLE 1.

Overarching strategies.

3.1. Building a Culture Within Academic Departments That Supports EM Research and Researchers

Conference participants noted that research is often underemphasized as a core mission of their departments, and investments needed to build and sustain impactful research programs are not being made or prioritized. However, a comprehensive assessment of EM departments focused on building a culture that supports research and researchers was not a specific focus of the pre‐work by conference working groups. In‐person breakout discussions focused on the key role that department chairs play in setting priorities, making necessary investments, and celebrating research accomplishments. The importance of research‐focused faculty being engaged and highly visible in departmental meetings and communications was also highlighted. Participants noted that there are risks to overemphasizing federal funding in a way that clinician–scientists with internal, foundation, and industry funding could feel undervalued. Similarly, individual contributions to team science (if not first or last author) as well as innovation and entrepreneurship are often undervalued in academic settings. Moving forward, academic EM departments should assess and optimize their research investments based on the proportion of their annual operating budget and full‐time equivalents (FTEs) allocated to the research mission. This data could be collected and reported using Association of Academic Chairs of Emergency Medicine (AACEM)/ Academy of Administrators in Academic Emergency Medicine (AAAEM) annual benchmarking survey. AACEM/AAAEM should increase the proportion of their annual retreat dedicated to advancing the research mission and the breadth of the research workforce. This time could be used to help department chairs, especially those without significant firsthand experience, to gain expertise in obtaining resources to support the research mission and the most impactful way to invest in those resources.

3.2. Address the Challenges to Building and Maintaining a Diverse and Robust EM Research Workforce and EM Research Enterprise

Assessment of programs promoting inclusive ideals was a specific focus of the pre‐work by conference working groups in 2024. Conference participants highlighted the homogeneity of the EM clinician–scientist workforce and the resultant impact this has on the breadth of research programs. Barriers to the expansion of the research workforce were identified at every career stage. As an overarching theme, conference participants noted that national and local programs are underused within the specialty of EM, and additional EM‐specific programs are needed (see subsequent sections for specific examples). It was emphasized that all goals proposed by the consensus conference should measure and support workforce inclusivity.

3.3. Improve the Branding of Academic EM and EM Research

Participants highlighted the perception that undergraduate and medical students interested in careers as clinician–scientists may be directed away from EM as a clinical specialty choice or have limited opportunities to be exposed to or mentored by EM clinician–scientists as role models. This is likely due to old misperceptions that the field of EM is not “academic” and does not support research‐oriented careers. Therefore, branding of EM as a robust research‐oriented specialty is needed in their early education. A comprehensive assessment of existing EM programs and their focus on branding EM research, however, was not a specific focus of the pre‐work by conference working groups. Conference participants highlighted that the accomplishments and impact of clinician–scientists are underpublicized, undercelebrated, and often undervalued. Programmatic concepts proposed during the in‐person breakout sessions included using highly subscribed social media platforms to publicize EM research accomplishments as well as individual clinician–scientists and their research teams. Addressing the lack of awareness among the general public and policymakers about the importance and value of improving emergency medical care through research was also recommended. Measures of success would include increasing the number of research‐focused medical students matching in EM and increasing the number of graduating EM residents planning to pursue research‐focused careers.

4. Undergraduate and Medical Student Pathways

4.1. Why Is This Important?

A sustainable pathway to support a robust and diverse EM clinician–scientist workforce begins with early exposure and engagement. Attracting research‐oriented students from all backgrounds into the specialty of EM is essential to this process. These early research opportunities will cultivate students' passion for EM and stimulate the knowledge and skill acquisition needed to have successful careers as EM clinician–scientists.

4.2. Challenges and Barriers

Major challenges for recruiting students into academic EM careers include the lack of branding and visibility of EM as an academic specialty (addressed in the previous section). Research‐oriented students may be steered away from EM as a clinical specialty by advisors due to a lack of awareness (their own or from poorly informed mentors and advisors) of the depth and breadth of EM research career opportunities across the research spectrum, including basic science, clinical research, public health, community health, health services, and health disparities. Departmental barriers include limited funding for engagement of students in student‐research relative to other departmental priorities. Additionally, there is a lack of EM representation in the recruitment of students into Medical Scientist Training Programs (MSTP) and predoctoral T32 programs due to a lack of faculty trainers to serve as primary mentors. Medical student access to EM clinician–scientist research mentorship may be limited based on faculty availability and alignment of research interests. Some institutions do not allow undergraduate research activities or do not have active EM research programs despite interested undergraduates and medical students. Existing institutional resources for students who wish to pursue investigative careers, such as short‐term training programs supported by institutional, foundation, or federal funding, are underused by EM or even unknown to many EM programs and investigators. Increasing EM access to these resources may require increased representation of EM on institutional federal grant review committees, NIH‐funded programs, and other venues.

4.3. Recommended Strategies

A prioritized list of recommended strategies with associated goals, timeline, and parties responsible for implementation is provided in Table 2.

TABLE 2.

Undergraduate and Medical Student strategies.

4.4. Implementation

The top two recommended strategies are for EM Foundations to create and support national medium‐term (8–12 weeks) or long‐term (1 year) medical student EM research training programs. The case example for a medium‐term program is the Medical Student Training in Aging Research (MSTAR) [6] program funded by the National Institute of Aging, and the case example for the long‐term program is the Sarnoff Cardiovascular Research Foundation Fellowship Program funded by the Sarnoff Cardiovascular Research Foundation [7, 8]. Implementation of either model would provide research‐oriented medical students the opportunity to access training and mentorship by some of the leading EM clinician–scientists in the nation. This is particularly beneficial if such mentorship is not available at the student's home institution and provides access to all potential applicants. Additionally, national programs of this type send a clear message to medical schools and medical students that the specialty of EM is investing in clinician–scientist training and supports this career pathway. Trainees would be expected to present their work at national EM research meetings, providing an important opportunity for networking and additional mentorship. Challenges to implementation include the cost and the need for administrative oversight beyond the scope of current EM foundations. The cost per trainee is estimated to be in the $5–10 K range for the 8‐ to 12‐week program and ~ $50–75 K range for the 1‐year program. Programs could be supported by targeted fundraising or named endowments and be administered by national EM societies affiliated with the funding foundation. A potential limitation of these programs is the possibility that not all trainees will choose EM as their clinical specialty. However, the net benefits far outweigh this risk, and participants who do not choose EM as their clinical specialty will have gained an advanced understanding of emergency care research, a network of potential EM research collaborators, and the ability to advocate for emergency care research within other clinical specialties.

The third highest ranked strategy is EM research exposure in required or elective medical school EM curriculum and EM rotations. This could be as simple as one didactic session facilitated by a recorded national curriculum created by EM specialty societies. For programs with clinician–scientist faculty, sessions could be augmented by brief presentations of recent or ongoing local EM research projects. Institutions that do not have faculty clinician–scientists could partner with those that do and have those faculty provide virtual research presentations. Overall, this approach provides a structured opportunity for EM clinician–scientists to serve as role models and engage medical students in their work. A limitation of this approach is that many required and elective EM rotations occur in the later stages of medical school training after many students have already made their specialty decisions. Therefore, additional strategies aimed at earlier engagement with EM would be complementary.

Most of the remaining strategies focus on EM clinician–scientists engaging as mentors in existing undergraduate and medical student research training programs and infrastructures. At the national level, examples include the National Medical Fellowships‐Service‐Learning Programs (NMF) and the Leon Haley Bridges to EM Academy [9, 10]. NMF provides students opportunities to gain experience with enhancing the delivery of health care in areas of critical clinical/public health need. The goal of these programs is to enhance the delivery of healthcare in underserved communities and to provide learning opportunities for students from a range of backgrounds [11]. The Haley Academy provides a 2‐week mentorship program for rising second‐year medical students to increase interest in EM. During the program, the students participate in didactics that focus on health care issues in a variety of communities, reducing health disparities among all populations, and applying to residency programs. Additionally, these students are exposed to academic/research careers as a potential career pathway in emergency medicine. The program is currently only able to host 12 participants annually.

At the local level, relevant student programs include Medical Scientist Training Programs (MSTPs) [12], as well as predoctoral training programs within NIH T32, TL1, and R25 institutional training grants. Participation in the MSTP allows trainees to obtain institutional support for pursuing dual clinical and research doctorates. Overall, most MSTP graduates pursue research‐related careers [12]. However, MSTP and other predoctoral programs may not be available at all EM training sites. The NIH predoctoral research training grants T32, TL1, and R25 provide an opportunity for participants to obtain training and career development to produce high‐quality translational science [13]. Implementation will require EM clinician–scientist faculty to actively engage in these programs, which often requires being listed as faculty trainers. These training grants can also enhance the diversity of the workforce, including by trainees from all backgrounds [13]. However, many institutions may not have the infrastructure to financially support these training grants. The NIH diversity supplements previously provided additional funding to existing grants so that the principal investigator could sponsor eligible candidates from diverse backgrounds and those with socioeconomic disadvantage or disabilities, at all levels from undergraduates through faculty appointments, for research opportunities [14]. These supplements are currently suspended, but if they are offered in the future, academic departments of EM should encourage faculty PIs to apply for them to fund dedicated research training and experiences for undergraduate and medical students.

Academic Associate Programs are educational programs that are a collaboration between EM departments and undergraduate institutions where the undergraduate students work as research assistants in the ED. Departments that have implemented these programs document increased scholarly output for their faculty [15, 16]. These programs allow for the expansion of research infrastructure at a lower cost but can be challenged by the recruitment and retention of students. Additionally, managing and funding these programs may be difficult given the high number and turnover of students. Furthermore, many EM departments do not always have a sufficient number of appropriate research projects to justify the investment in sustaining an Academic Associate workforce.

5. Resident and Fellow Pathway

5.1. Why Is This Important?

At this stage of career development, it is critical to nurture and develop trainees with previous research experience and interest, as well as provide a pathway for those who become interested in research after they begin their EM training. It is also vital that we strive to provide access to these training opportunities and particularly encourage those who may not otherwise have knowledge or access to these programs. This requires sustainable programs and a culture that both values investment in the research mission and builds a broad and inclusive EM research workforce. The training and opportunities provided at this stage play a pivotal role in shaping the trainee's ability to subsequently pursue a clinician–scientist career path.

5.2. Challenges and Barriers

Barriers for EM residents and fellows to pursue clinician–scientist careers exist at the individual, programmatic, and departmental levels. On the individual level, residents and fellows face demanding clinical workloads, limited dedicated research time, unfamiliar and often challenging institutional processes, and limited publication options, making it challenging to pursue scholarly activity [17, 18]. Explicit and implicit bias notably impact disadvantaged and underserved groups, who encounter added barriers around support and lack of culturally competent mentorship [19]. These systemic barriers have contributed to homogeneity among EM trainees and mentors, contributing to a cycle of exclusion [20]. At the program level, residencies and fellowships contend with limited numbers of research faculty, constrained elective research time, and competition for departmental resources and funding [21, 22]. These issues constrain research opportunities, especially in smaller or under‐resourced programs, with few programs able to provide the required protected time and research infrastructure. On the departmental level, funding shortages for research faculty, statisticians, methodologists, and research support staff restrict research development. High‐cost resources for data analysis and administrative support are often unmet, creating challenges in sustaining interdepartmental collaborations. Funded mentorship support is particularly essential to support residents in meaningful research endeavors [23, 24].

5.3. Recommended Strategies

A prioritized list of recommended strategies pertaining to residents and fellows with associated metrics, goals, timeline, and parties responsible for implementation is provided in Table 3.

TABLE 3.

Resident and Fellow strategies.

5.4. Implementation

The top three ranked recommendations for this career stage focused on dedicated resident or combined resident‐fellow research training programs of 1 or more years in duration, specifically allowing the completion of the residency and obtaining an advanced degree in research. Examples of NIH‐funded institutional training grants that provide funding for dedicated research training during clinical residencies include R38 Stimulating Access to Research in Residency (StARR) and R25 research awards. In FY24 there were 33 active StARR programs at 26 different academic institutions, with most being held in departments of internal medicine, surgery and pediatrics [25]. There are examples, however, of these programs being accessed by trainees from EM residencies. Importantly, R38 trainees are uniquely eligible for subsequent K38 funding as fellows or early career faculty [26]. The R25 is a broader research training grant category, within which many Institutes provide funding for clinician–scientists pursuing research training during clinical residencies. A relevant example is the NINDS Research Education Programs for Residents and Fellows in Neurological Disorders and Stroke program (recently re‐issued as a UE5 program) [27] Academic institutions are eligible for only one award that is most commonly held by a department of Neurology or Neurosurgery. Importantly, in the most recent reissue of this program, the Notice of Funding Opportunity (NOFO) specifically listed EM residents among those who should be encouraged to participate as long as they are conducting research clearly within the mission of NINDS and are committed to fulfilling all requirements of the program. Therefore, qualified EM candidates and their mentors should contact local program directors to discuss applying for this research training opportunity. These programs require flexibility in clinical staffing schedules to allow the awardee dedicated time for research.

Physician‐scientist training programs (PSTP) allow residents to follow a combined research and clinical training pathway, fostering early engagement in research. Emergency Medicine‐Based PSTP programs, the Yale Emergency Scholars (YES) Program, and the Duke EM Resident Research Fellowship combine clinical residency with dedicated research time to promote research literacy and academic productivity [28, 29, 30]. These programs require additional years of commitment and substantial funding, which may deter some trainees, and are often limited to institutions where research is a major priority.

For departments with sufficient NIH‐funded faculty, having dedicated postdoctoral T32 training slots for residents and fellows provides valuable research exposure and pays tuition for a research degree. Programs at the Icahn School of Medicine at Mount Sinai and the University of Pittsburgh have been longstanding and have gone through successful 5‐year renewals. Newer T32 programs with EM contact PIs include those at Beth Israel Deaconess, the University of Michigan, and the University of New Mexico. It is important to note that T32 slots can be challenging to fill due to limited awareness among trainees. At many institutions, EM residents or fellows could potentially have access to T32 postdoctoral training slots that are held in other departments but whose research scope includes aspects of emergency care. Medical school research offices can provide a list of local institutional T32 programs and program directors. Academic departments of EM have the potential opportunity to integrate their non‐research fellowships (e.g., EMS, PEM, Critical Care, and Ultrasound) with T32 programs to offer rigorous research training to EM ACGME fellows and non‐ACGME clinical fellows.

For programs with limited resources, resident specialty tracks offer a feasible way to integrate clinical expertise with research skills acquisition. Programs like Drexel's “Think, Do, Write” model and Johns Hopkins Focused Advanced Specialty Training (FAST) programs provide longitudinal support for EM residents' research skills, increasing scholarly output [21, 31]. These tracks are valuable for increasing research literacy but often lack access to dedicated mentors, funding, and regulatory support.

EM foundations and specialty societies could provide grant funding to support a dedicated year of research training during residency, with the opportunity to develop and/or fund programs in residency and fellowship research training. These programs could also promote collaboration between research‐intensive institutions and those with limited resources and mentors.

EM foundations and specialty societies expand programs to provide formal training in research for residents and fellows. Training programs such as ARMED (Advanced Research Methodology Evaluation and Design) and EMBRS (Emergency Medicine Basic Research Skills) provide additional research methodology training but are limited by participant capacity [32]. An important limitation is the lack of a centralized mentorship network [33], requiring participants to seek mentors on their own without institutional support, which can be a substantial barrier. The consensus group discussions emphasized the need for centralized mentorship and collaborative learning.

6. Early and Mid‐Career Faculty Pathway

6.1. Why Is This Important?

Recently developed pathways for early career faculty training in emergency care research from federal and foundation‐based sponsors have accelerated a generation of independent investigators in EM. However, this pathway needs sustainable initiatives to create longevity and investment for continued faculty research training in emergency care. Resources are needed from early‐ to mid‐career and even established investigators pivoting to new/different fields of research. EM remains a specialty in which faculty may enter research pathways at different stages of their careers. Clusters of like‐minded investigators both within and outside of the department of EM are essential for both mentoring and idea generation. However, the department must invest in individuals knowing that the path to research independence is often long and arduous, requiring investment of financial and human resources along the way.

6.2. Challenges and Barriers

The increasing complexity of the emergency department's clinical environment in conjunction with hospital and health system finance allocation, focusing on the clinical mission, has endangered the development and sustainability of supporting early and mid‐career EM physician scientists. Enhancing strategies to increase the pathway for EM investigators and supporting emerging scientists is essential to assure that EM science continues to be created, investigators continue to be developed, and patient outcomes continue to improve. Specific challenges include the necessity for chairs to cost‐share the faculty members' salaries on K and T training grants, which can amount to substantial sums. Also, there are limited research project funds available for scholars on K and T awards, minimal or no support for program directors of institutional K or T awards, and no funds available for faculty mentors. Furthermore, the transition from career development K funding to independent R funding can take several years, resulting in a funding gap that requires departmental bridge funding. Finally, even an EM faculty member who is a PI on a NIH R01 will need financial resources to maintain the portion of their salary supported by the NIH if their salary is above the NIH salary cap. The NIH salary cap limits the direct salary an individual can receive from an NIH grant, cooperative agreement, or contract. For the current fiscal year (FY2025), the cap is set at $225,700.

6.3. Recommended Strategies

A prioritized list of recommended strategies with associated metrics, goals, timeline, and parties responsible for implementation is provided in Table 4

TABLE 4.

Early and Mid‐Career strategies.

6.4. Implementation

The highest priority strategy is for academic departments and chairs to dedicate financial and mentorship resources to support early‐career faculty submission of NIH and AHRQ K08 and K23 career development awards. According to the NIH reporter, there were 30 NIH‐funded K08 or K23 award EM PIs and 3 AHRQ K08 award EM PIs in FY24 [34]. These awards support up to 5 years of mentored research and research training at 75% effort with $30–50 K annual research project funding. Requirements for successful applications include well‐funded primary mentors (or mentorship team) with content expertise and successful research mentoring track records, robust career development plans, well‐designed and highly feasible research projects, and strong institutional research infrastructure and support.

NIH career‐development (K) awards, although highly valued because of subsequent success rates in obtaining independent funding, can be a challenge for EM Chairs due to the limited annual salary support ($100‐$125 K) relative to the expectation of 75% research effort. This requires EM chairs to supplement salary support to maintain the pre‐award salaries and annual salary increases of the K awardees. In addition, the K award research project funds are limited and often require departmental and institutional supplementation to assure a successful transition to independent R level funding. Bridge funding after the completion of the K award is sometimes required before significant R‐equivalent funding is secured. Finally, some departments of EM may not have the mentors to support a K award application. Looking outside the department or institution to build a mentorship team can be an effective strategy as long as a robust mentoring relationship can be established.

Supplementing the individual federal K award programs is the recently launched Neuro‐EM K12 scholar program, which is the first national NIH career development program dedicated to the training of EM clinician–scientists [35]. The program is primarily supported by NINDS with optional supplemental support by NIA and NIDA and focused on research in neurological sciences. Neuro‐EM K12 Scholars receive up to 3 years of mentored research training at 75% effort with $40 K annual research project funding. There is also a requirement that the Department Chair guarantees a minimum of 50% research effort for the 2 years following the award if not already achieved by other intramural and extramural research funding. Neuro‐EM scholars also benefit from ongoing programmatic and mentorship support at the national level, including an annual retreat. Conference participants also recommended that EM societies advocate for additional national and institutional K12 programs focused on training EM clinician–scientists similar to the Neuro‐EM K12.

At the local level, academic departments of EM should also encourage early career EM faculty to apply for training slots in institutional NIH CTSA KL2 and K12 training programs. These are typically awarded through an internal competitive process. In FY24, there was one institutional K12 program led by an EM PI at Yale University [36].

National EM‐focused clinical research networks provide outstanding opportunities for early career EM clinician scientists to gain expertise in large scale clinical research through training grants, funded fellowships, and structured mentorship programs. Examples include the Strategies to Innovate Emergency Care Clinical Trials Network (SIREN) [37], the Pediatric Emergency Care Applied Research Network (PECARN) [38], StrokeNet [39], and the National Institute on Drug Abuse (NIDA) Clinical Trials Network (CTN) [40, 41, 42].

In addition to federal funding mechanisms, conference participants recommended encouraging submission of applications for SAEMF and EMF research training grants, ideally to support dedicated research fellowships with faculty appointments that include advanced research degrees [43]. Both SAEMF and EMF Career development awards support 2 years of research training that are amendable to obtaining a research‐oriented master's degree. Challenges include timing of enrollment, potential conflicts with didactic and clinical schedules, and tuition. The major limitation of this approach is that each foundation funds only one award annually.

Conference participants recommended four strategies focused on mid‐career faculty. EM clinician–scientist faculty with strong research and mentoring track records should apply for NIH K24 awards, which provide effort support for research mentoring. According to NIH reporter, there were only two active K24 awardees in Departments of Emergency Medicine in FY24 [44]. Clinician‐scientists with strong research, mentoring, and administrative track records should consider applying for T32 institutional training grants [45]. These awards provide dedicated short‐term, pre‐doctoral, and/or post‐doctoral training slots focused on a research theme within the mission of specific NIH Institutes. A commentary highlighting the benefits and keys to success for EM T32 applicants was recently published [46]. According to NIH Reporter, five NIH and one AHRQ T32 awards were led by EM faculty in FY24, which is a substantial advance since the first EM T32 award in 2016 [47]. Additional strategies for mid‐career EM faculty include recruiting and hiring non‐MD post‐docs and/or research‐track faculty to expand the capabilities and sustainability of their research programs. These post‐doctoral or specific research‐track faculty members strengthen collaborative grant submissions by bringing diverse skills into the department. Some examples include PhD statisticians, basic and translational scientists, and biomedical data science experts. In addition, mid‐career EM faculty should obtain joint appointments in non‐clinical departments, join graduate groups, and serve as trainers on institutional training grants to facilitate engagement with graduate students in their research programs, but from different departments to facilitate inter‐departmental collaborations and grant submissions.

7. Summary and Conclusions

The SAEM24 Consensus Conference represents a transformative step towards achieving a sustainable pathway to grow a diverse EM clinician–scientist workforce. By addressing the gaps in our current pathways and fostering a research environment that values excellence and inclusion, the conference has produced actionable strategies and a long‐term plan to enhance the inclusivity and quality of EM research. It is important to acknowledge that many of the proposed metrics are not currently measured or reported, which we acknowledge are important knowledge gaps regarding our current state that will need to be addressed moving forward. Broad representation has been shown to improve healthcare outcomes and can help optimize research to better serve the entire population.

To achieve a robust EM clinician‐scientist workforce, we must maximize the use of existing institutional, foundation, and federal resources and supplement these with strategic investments from EM national organizations and academic departments of EM. Most importantly, this effort will necessitate commitment and investment from national EM leadership and academic department chairs to fulfill the research mission of our specialty. It is the academic department chair's responsibility to create a departmental culture in which research is a priority. They must then communicate this priority to leaders within the schools of medicine and health care systems. A key message is that EM contributes fundamentally to the medical fund of knowledge and has a significant impact on an expansive breadth of patient care outcomes. The major barrier in fulfilling our research mission is a clinician‐scientist workforce that is limited in both number and breadth of backgrounds, perspectives, and experiences that contribute to impactful research. The strategies, metrics, goals, and timelines developed through the SAEM24 Consensus Conference and reported here provide a pathway to overcome these barriers.

In addition to publishing prioritized strategies with associated responsible parties, metrics, goals, and timelines, our dissemination plan includes direct engagement by conference leadership with RAMS, EMRA, CORD, AACEM, ACEP, and SAEM Research Committees and the EMF and SAEMF. Some of the proposed metrics will use publicly available data (e.g., NIH Reporter), data accessible by request (e.g., AAMC, AAAEM/AACEM Benchmark survey), and data not currently collected. The AAAEM/AACEM Benchmark Committee will be engaged to discuss adding relevant metrics to their annual benchmarking survey. Reporting on these metrics should occur annually and publicly by national EM organizations such as SAEM and AACEM/AAAEM.

In terms of assessing the overall impact of the proposed strategies, the conference participants recommend that a comprehensive longitudinal research study be initiated that follows the demographics, career progression, and research productivity of all trainees who have engaged in one or more of the proposed strategies. Such a study could be commissioned and funded by a collaboration of key stakeholder organizations in the specialty. This will enable not only assessment and optimization of individual strategies, but more importantly, test the hypothesis that serial engagement in multiple research training programs along an individual's career pathway is the greatest predictor of long‐term career success and impact as an EM clinician‐scientist.

Our vision for the future state of the EM clinician‐scientist workforce is one where diversity and sustainability are not just goals but realities. This will be a workforce characterized by a rich tapestry of backgrounds and perspectives, fueling innovation and excellence in healthcare research and delivery. By following the strategic pathways outlined in this conference and dedicating ourselves to continuous assessment and refinement, we can create a resilient and robust clinician‐scientist workforce prepared to meet the challenges of tomorrow's healthcare landscape.

Conflicts of Interest

R.W.N.: Member, SAEM Foundation Board of Trustees; Chair, AACEM Research Workgroup; PI, Neuro EM Scholars Program K12NS137516. M.M.: Employee of Society for Academic Emergency Medicine. T.C.: Member, SAEM Foundation Board of Directors (2023–24). M.S.N.: Chair, SAEM Finance Committee; Member, SAEM Foundation Board of Trustees. J.V.: Secretary‐Treasurer and Member, SAEM Board of Directors; Member, SAEM Foundation Board of Directors. C.W.C.: PI Emergency Medicine Research Training T32HL134615; MPI, Neuro EM Scholars Program K12NS137516. A.E.P.: SAEM Board of Directors Member‐at‐Large, UT Southwestern Site Co‐Investigator National, Heart, Lung and Blood Institute and National Institutes of Health, Influence of Cooling duration on Efficacy in Cardiac Arrest Patients (ICECAP). L.R.: Chair, Review Committee for Emergency Medicine, ACGME. L.D.R.: Emergency Medicine Foundation, Board of Directors; PI, Mount Sinai Clinician Scientist Training Program in Emergency Care Research 1T32HL160513, PI, NIH FIRST Cohort Cluster Hiring Initiative at Icahn School of Medicine at Mount Sinai 1U54CA267776–01. C.R.R.: Fellowship Co‐Director, Yale Emergency Scholars Program; Scholar, Drug Addiction and HIV Prevention Research K12DA033312. O.A.: Founder, Sense Diagnostics Inc.; Multiple PI, Neuro EM Scholars Program K12NS137516. A.B.: Member, AACEM Executive Committee. N.K.: Research funded by NIH, HRSA, PCORI; Member AACEM Research workgroup. G.D.: Member of AACEM Research Workgroup, MPI Neuro‐EM K12. D.B., L.H., and C.G. authors declare no conflicts of interest.

Supporting information

Data S1.

Data Availability Statement

The data that support the findings of this study are available from the corresponding author upon reasonable request.