From Imaging to Impact: A Multi-Disciplinary T32 Program Framework and Initial Insights for Training in Image-Guided Cancer Therapy [Advance Publication]

Abstract

As multi-disciplinary image-guided assessment and therapies become increasingly important for precision oncology, the need for comprehensive training opportunities that effectively prepare the next generation of clinician-scientists and scientists is evident. We present an innovative, evidence-based research training framework that integrates the following critical features: 1) intentional and personalized mentoring and career development, 2) immersive research in image-guided cancer therapy, 3) strategic mentored clinical exposure, 4) structured didactic learning and professional development opportunities, and 5) mentored grant writing. Designed to foster scientific rigor, translational thinking, and multi-disciplinary collaboration, the Image-Guided Cancer Therapy T32 Training Program (IGCT-T32) aims to prepare postdoctoral fellows from MD, MD/PhD, and PhD backgrounds for successful careers in image-guided cancer therapy research. Additionally, we describe programmatic enhancements driven by trainee feedback, including improved flexibility and customization of training plans, and the establishment of an open-access educational repository, enabling on-demand access to didactic learning materials. Through this repository, IGCT-T32 can broadly disseminate educational resources, allowing learners and educators beyond the program to integrate these critical resources into their own training in image-guided cancer therapy.

Preliminary data from the initial program trainee cohort (n=3) indicates strong research productivity, with trainees averaging 3.2 presentations and 1.8 invited talks per year in training. When compared with non-T32 peers, IGCT-T32 trainees published substantially more first and co-authored peer-reviewed manuscripts, averaging 1.6 vs. 0.36 first authored manuscripts per trainee for each year in training and 6.0 vs. 0.26 co-authored manuscripts per trainee for each year in training, respectively. IGCT-T32 fellows published 77.1% of their peer-reviewed manuscripts in top quartile journals in their fields compared with only 55.6% of manuscripts from their non-T32 peers. Further, IGCT-T32 trainees were ~10% more likely to utilize preprints (such MedRxiv) for early dissemination of research. Together, these data provide promising early indicators of the effectiveness of the IGCT-T32 training program and its design.

We offer here a descriptive framework for the development of training curricula in image-guided cancer therapy that could be adapted for other sites and stakeholders. While preliminary insights into program effectiveness are promising, continued evaluation and longitudinal data are needed with additional trainees to fully access its impact and generalizability.

Introduction

Imaging plays a pivotal role in the detection, characterization, and treatment of cancer.^1–6 The rich informational capacity of advanced imaging modalities, coupled with the growing capability to acquire diverse image types from various sources at multiple time points throughout therapy, presents an exciting opportunity for image-guided assessment and intervention in radiation oncology, surgery, and interventional radiology.^7–9 The identification of imaging-based biomarkers and quantitative assessment of therapeutic response for single timepoints, coupled with longitudinal imaging for assessment across multiple timepoints, has significant potential to improve local control, reduce toxicity, and improve patient outcomes and quality of life.^10–14 Likewise, the development of tools and technologies to improve the accuracy and precision of image-guided interventions, such as biopsy, surgery, ablation, and radiation treatment planning and delivery, have exciting potential for clinical impact in cancer care.^15–17 Research to develop and validate these novel imaging techniques, technologies, and tools is critical for successful clinical translation and holds great promise for significant impact on patient care and outcomes.^14,15,18,19

Although the value of research and translation in image-guided cancer therapies is well established, a critical gap in training opportunities to effectively prepare the next generation of investigators remains. To meet this need, we established the Image-Guided Cancer Therapy (IGCT) T32 Training Program at The University of Texas MD Anderson Cancer Center (MD Anderson). The IGCT-T32 Program provides comprehensive, multi-disciplinary research training for clinicians and scientists in the field of image-guided cancer therapy. Guided by established best practices,^19–24 the program design builds on a strong team science culture and offers highly customizable and individualized training plans comprising five critical features: 1) intentional personalized mentoring and development, 2) impactful multi-disciplinary scientific research, 3) strategic clinical shadowing to gain clinical knowledge and insights, 4) formal coursework and training activities, and 5) training and mentoring in scientific and grant writing and multi-disciplinary communication skills. As science and medicine become increasingly data-intensive and specialized, we hypothesize that IGCT-T32 trainees will be well positioned as emerging leaders, having acquired and sharpened the skills required to lead productive, multi-disciplinary teams to address evolving and complex challenges to enable image-guided cancer therapy.

Beyond its direct benefits to trainee development, the IGCT-T32 program is structured to enhance multi-disciplinary research by cultivating a collaborative environment and to support early dissemination of research products and open-access to educational resources through the creation of an educational repository. This free and publicly accessible resource offers on-demand seminars, workshops, and lectures that provide didactic learning opportunities in image-guided cancer therapy to IGCT-T32 trainees and the broader scientific community. Here, we detail the evidence-based programmatic design and conceptual framework of the IGCT-T32 training program, present early indicators of its effectiveness in fostering trainee productivity and describe the development of an educational repository to support training plan customization and broad dissemination of open-access materials for education in image-guided cancer therapy.

Program Structure

Trainee Overview

The IGCT-T32 Training program is a 2-year postdoctoral fellowship training program that provides multidisciplinary research training for clinicians and scientists in the field of image-guided cancer therapies, including surgery, interventional and diagnostic radiology, radiation oncology, and correlative pathology. At the time of appointment, trainees have completed terminal research or medical degrees (e.g., MD, PhD, MD/PhD) within the past 7 years. The program employs a comprehensive admissions approach to identify postdoctoral fellows who have demonstrated academic excellence, are passionate about multi-disciplinary research, and are committed to advancing the field of image-guided cancer therapy. The applicant review considers academic background, prior research experience, motivation for training program participation and pursuing a career in image-guided cancer therapy, and an optional personal essay. Applications are accepted on a rolling basis and reviewed first by program leadership and then by a faculty-led selection committee. Well-reviewed candidates are invited to present a research talk to program leadership, prospective faculty mentors, and current IGCT-T32 trainees. Admissions decisions are issued following review of attendee feedback.

Faculty Overview

IGCT-T32 faculty mentors (n=19) represent 10 diverse departments at MD Anderson and are engaged in the development and clinical translation of novel imaging to guide cancer therapy, including guidance of personalized and precise radiation, focal ablation of tumors, accurate planning and guidance for tumor resection, and pathological validation of imaging findings. Additional faculty mentors were added as needed to broaden the scope of expertise in response to trainee needs and interests. R01-level extramural funding was an inclusion requirement of all faculty at the time they joined the program and is re-evaluated every 5 years. Faculty mentors play a pivotal role in postdoctoral training, helping to develop and tailor trainee individual development plans, guiding them through immersive research experiences, and supporting their progress and growth through personalized mentoring, multidisciplinary research collaboration, career exploration and networking, and professional growth and development skills, such as grant writing.

Key Program Components

The IGCT-T32 Training Program provides rigorous and comprehensive training to prepare clinicians and scientists for careers and research in image-guided cancer therapy. Since its launch, and consistent with emerging best practices,^19,25,26 the program has evolved through a series of deliberate and responsive enhancements that prioritize flexibility and personalization of the training plan and program activities to better meet the unique needs of each trainee. These refinements have been informed by continuous feedback from program trainees, faculty mentors, and experts serving on the Program Advisory Board, ensuring that the program remains responsive, dynamic, adaptive, trainee-centered, and aligned with the evolving landscape of image-guided cancer therapy research and practices.

In line with the overarching goal to provide multi-disciplinary research training in the field of image-guided cancer therapy, formal education and key programmatic components are focused in five primary areas: 1) intentional personalized mentoring and development, 2) impactful multi-disciplinary scientific research, 3) strategic clinical shadowing, 4) formal coursework and training activities, and 5) training in scientific writing and multi-disciplinary communication skills (Figure 1).

Figure 1.

Novel curricular framework for the IGCT T32 Training program features a multi-pronged approach to comprehensive training in image-guided cancer therapy.

1. Intentional Personalized Mentoring is a critical component of career development in science and medicine, providing tailored guidance, targeted skill-building, strategic networking, and support that aligns with a trainee’s research interests, professional goals, and evolving needs within a complex and competitive academic landscape.^25,26 IGCT-T32 trainees assemble a mentoring team consisting of a primary research mentor and two co-mentors with cross-disciplinary expertise. For example, a mentoring team may include a primary mentor in liver radiation oncology and cross-disciplinary co-mentors in liver surgery, interventional radiology, or imaging physics. Primary and co-mentors meet regularly (weekly/bimonthly and monthly/quarterly, respectively) with their IGCT-T32 fellows to define research aims; assess potential for clinical impact; discuss experimental design, data interpretation, and manuscript preparation; and help navigate and troubleshoot roadblocks in research that arise. Mentoring also incorporates structure and intentional skills building and career development and guidance, including brokering introductions with interdisciplinary collaborators and influential field leaders. If a trainee has not yet determined their future career path, mentors encourage them to explore a wide variety of potential career paths and may connect them with individuals in paths of interest for discussion and supplemental mentoring. Mentors support participation in journal clubs, seminars and workshops, program activities, and supplemental training opportunities. They provide opportunities for growth in targeted areas, such as lab management, research finance, clinical trial design, protocol writing (e.g., institutional review board), and submission of material transfer agreements needed for multi-institutional team science projects.

Guiding the highly personalized approach to mentoring is an individualized development plan (IDP), which is constructed by the postdoctoral fellow and mentoring team shortly after their appointment begins and is reviewed and updated together on a regular basis thereafter. IDPs provide a structured framework for identifying a trainee’s goals and customizing their scientific, professional, and career development and training experiences.²⁷ By aligning training activities with these goals, IDPs help mentors to tailor guidance to the trainee’s unique goals, while setting clear expectations, promoting accountability, and facilitating long-term success.

Program leadership plays an integral role in the structured oversight, support, and enrichment of trainee development and mentoring. Meeting together with trainees and their multi-disciplinary mentoring team every 6 months, program leaders review IDPs, ensuring activities remain aligned with trainee goals. These “check-ins” are consistent with published best practices.¹⁹ Program leaders share opportunities and facilitate access to institutional resources for faculty mentors (e.g., mentorship training, team science networking) and trainees (e.g., trainee grant writing groups, career exploration seminars, opportunities to meet thought leaders), organize T32-specific training activities such as the IGCT-T32 seminar course and technical and grant writing workshops, and host a seminar series where fellows present their research on an institutional stage. They also facilitate regular communication, hold monthly open office hours, and provide structured channels for feedback supporting continuous assessment and iterative refinement of programmatic elements in response to trainee needs.

2. Impactful Multidisciplinary Scientific Research is a foundation of the IGCT-T32 Program, providing scientific rigor, critical thinking, and development of the skills necessary to become successful and independent investigators. Under the guidance of their multi-disciplinary mentoring team, IGCT-T32 trainees engage in full-time, hands-on research across the many facets of image-guided cancer therapy. Trainees take an active role in leading the planning and design of their projects, gaining critical experience in the development of hypothesis-driven aims, troubleshooting and formulation of alternative strategies, and project execution that deepens their understanding of scientific principles and prepares them for independent research careers. Through cross-disciplinary engagement with their multi-disciplinary mentoring team, trainees initiate new team science research, furthering the collaborative nature of their training and helping to unite diverse groups of investigators for novel projects in image-guided cancer therapy. Training in the responsible conduct of research as well as rigor and reproducibility is required of all trainees and are available via in person institutional seminars and via on-demand virtual modules. The expectation is that IGCT-T32 fellows will publish at least one paper and present their research at a national conference or meeting annually.

3. Strategic Clinical Shadowing is a fundamental component IGCT-T32 program, offering trainees invaluable, firsthand exposure and insights into the complexities of clinical practice while emphasizing the significant potential to enhance patient care by translating image-guided cancer therapy research into clinical application. Fellows shadow expert clinicians in a minimum of three anatomical sites and across at least three distinctive disciplines of image-guided cancer therapy (e.g., interventional or diagnostic radiology, surgery, radiation oncology, or pathology). Fellows observe diagnostic and interventional procedures (e.g., biopsies, ablations), surgeries, radiation planning and treatment, and participate in the multidisciplinary tumor board, where they are paired with a clinical fellow or resident as a “tumor board buddy” with whom can discuss cases and ask questions. Through these clinical experiences, trainees improve multidisciplinary communication skills and gain diverse perspectives that foster a deeper appreciation of clinical challenges and patient needs, informing their research for enhanced translational impact, and empowering trainees to recognize opportunities for impact and develop more relevant, effective, and patient-centric research solutions.

4. Formal Coursework and Training Activities ensure trainees establish a strong foundation in key areas of image-guided cancer therapy. These requirements are intentionally designed to be customizable, ensuring trainees gain critical cross-disciplinary knowledge with flexibility to adapt their training plan based on prior training, research interests, and unique development needs. Didactic trainings were recorded at their first presentations and are available on-demand in a newly established educational repository, allowing for improved access, flexible scheduling, and the ability to revisit content as needed.

1. The IGCT Short Course on Imaging is a six-part lecture-based course designed to provide fundamental knowledge in imaging sciences. Modules are available on-demand and include computed tomography, ultrasound, general nuclear medicine, positron emission tomography, magnetic resonance, and cone-beam computed tomography.

2. The IGCT-T32 Seminar Course leverages didactic learning with discussion sessions and project-based interactive learning. Held annually and in person, the course consists of five-week blocks for each of three anatomical sites, which rotate annually. The first week of each block features clinicians presenting their “top five clinical challenges” for that anatomical site. In the second week, imaging scientists, medical physicists, biomedical engineers, data scientists, and computational scientists present recent technical innovations and emerging technologies related to clinical challenges. These dynamic presentations include discussion and Q&A with clinical and research experts. During weeks 3–4, postdoctoral fellows work together to construct an NIH-style set of aims that a) offers solutions to presented clinical challenges and b) leverages presented technical advances and emerging technologies. During week 5, clinical and technical experts return, and trainees present their developed aims. To enhance networking and collaboration, the course is open to postdoctoral fellows from image-guided cancer therapy–focused laboratories across the institution.

3. A Seminar and Workshop Series in image-guided cancer therapy offers a dynamic platform for multidisciplinary learning. Monthly didactic seminars feature groundbreaking work from collaborative teams at MD Anderson and global experts. Quarterly workshops provide a deep dive into key image-guided cancer therapy–related topics, such as deformable image registration and advanced imaging techniques through expert-led, interactive sessions. To maximize accessibility, many of these seminars and workshops are recorded and included in the repository for on-demand access.

4. Clinical Trials Design Training ensures trainees are equipped with skills needed for the translation of research into clinical practice. Trainees can select the area and scope of training that fits best with their unique needs, ranging from formal coursework to specialized workshops developed by the IGCT-T32 program.

5. Training in Grant Writing and Multi-Disciplinary Communication are essential elements of postdoctoral training, particularly in diverse, collaborative fields.²⁸ These skills help trainees clearly convey research findings, contribute meaningfully to multidisciplinary team discussions, and engage diverse clinical and scientific audiences.¹⁹ Cultivating strong grant writing skills is critical to securing independent research funding, articulating clear and compelling research plans, and demonstrating growing independence. IGCT-T32 trainees are expected to begin development of independent research proposals from the start of their appointments. Monthly meetings with Program Directors help to refine aims, address challenges, and provide individualized guidance. Trainees also have access to institutionally sponsored training in grant writing via the Office for Postdocs and the Research Medical Library, which offer NIH K-award training twice annually, and grant writing workshops and courses offered in person and on demand. T32 trainees also complete an on-demand workshop in grant writing created by the IGCT-T32 program.

Open Science Best Practices and Research Dissemination

Consistent with a targeted pedagogical commitment²⁹ to improve research transparency and reproducibility, IGCT-T32 trainees receive formal training on the systematic development of Open Science methods. Guided by NIH Public Access Policies, trainees learn relevant best practices and are compliant with open-access deposition of all peer-reviewed manuscripts in PubMedCentral. Even before the 2023 NIH Data Sharing Policy, the IGCT-T32 Program formally implemented open-access data deposition and publication guidance for trainees. This approach aligns with NIH reporting of preprints and other interim research products, which our trainees routinely leverage to facilitate early dissemination of research output.

Moreover, in concert with The University of Texas System-wide Momentum on OpenWorks Educational Resource effort and to provide flexibility and improve customization of IGCT-T32 training plans, a centralized educational repository was established via the MD Anderson OpenWorks platform. Educational materials, such as didactic lectures, research seminars, and workshops are recorded, a digital object identifier is assigned, and a set of descriptors are defined and added to enhance searchability. Additional resources will be added as they become available. The creation of this educational repository has established a flexible, on-demand platform through which current and future T32 trainees can acquire new knowledge and revisit previously accessed materials as needed for concept reinforcement. The open-access nature of the repository removes access barriers and supports equitable dissemination of high-quality training materials for curricular re(use) for learners and educators internally and in the broader cancer research community.

Postdoctoral fellows in the IGCT-T32 Training Program engage in a thoughtfully designed and comprehensive program to acquire the skills and knowledge required to form the foundations for successful careers in the image-guided cancer therapy field. Paramount to this training is immersive, multidisciplinary research and personalized mentoring by a dedicated cross-disciplinary faculty mentoring team with whom a personalized and adaptable training plan is crafted to align with their specific career goals. Through clinical shadowing, didactic learning, and seminars, trainees gain diverse perspectives across modalities and anatomical sites. Lastly, the program provides mentorship and support in grant writing to prepare trainees for independent research careers. Designed to incorporate established best practices from the literature, and enhanced in response to trainee, faculty, and advisory board feedback, first indications show that the IGCT-T32 program is highly effective and can serve as a framework for other translational training programs.

Methods

Trainee Cohorts

IGCT-T32 fellows (n=3) who had completed at least 12 months in the program were included in this study. Each T32 fellow was mentored by a team comprised of one primary mentor and two co-mentors, resulting in eight faculty mentors between the three trainees; one faculty served as the primary for one fellow and co-mentor to a second fellow. To identify a matched cohort for comparison, we included all postdoctoral fellows who were appointed under the mentorship these eight T32 faculty mentors but who did not matriculate into the IGCT-T32 Program and who had completed at least 12 months of a postdoctoral fellowship under that faculty mentor. This approach aimed to mitigate the effects of cofounding variables related to differences in mentoring, research discipline novelty, training environment, and departmental/institutional resource access. All postdoctoral fellows in each cohort who were appointed from program initiation (April 2022) to present (June 2025) and who had been appointed for 12 or more months were included (n=3 IGCT-T32 fellows and n=14 non-T32 fellows).

Publications

Data for publications were extracted using the National Library of Medicine PubMed database for all publications through June 2025. Publications prior to matriculation into the primary mentor’s lab (non-T32 postdoctoral fellows) or into the T32 program (IGCT-T32 fellows) were excluded. Manuscripts published within 12 months following the conclusion of the postdoctoral or T32 program appointment and that included the primary mentor were also included as products of the postdoctoral or T32 fellowship period. The Clarivate Journal Citation Reports database was accessed to obtain journal impact factor (JIF) quartile data for peer-reviewed publications for the appropriate year of publication; 2024 data were used for publications in 2025 as data are not yet available. Preprints and journals not included in the database were excluded for JIF quartile reporting (n=3 for T32 fellows and n=1 for non-T32 fellows). If a journal was ranked in more than one specialty area, the highest ranked area was selected for inclusion. To ensure an accurate comparison, publication counts were averaged over the duration of each trainee’s appointment, accounting for the longer and more variable training periods often observed among non-T32 fellows versus T32 fellows, who are appointed only 2 years.

Results

Initial Insights on Trainee Productivity

Since its inception in 2022, three IGCT-T32 postdoctoral fellows have completed one or more year of training and were eligible for inclusion in this study; two additional trainees have matriculated but not yet completed one year of training and were therefore excluded. Initial insights demonstrate exceptional research productivity. Since 2022, IGCT-T32 fellows have authored 65 manuscripts and 2 book chapters. These include 38 peer-reviewed publications (8 as first author), 20 preprints in MedRxiv or ArXiv (5 as first author), 2 conference papers (1 as first author), and 3 editorials (all as first author). Accounting for manuscripts that were released first as a preprint and then in a peer-reviewed journal, a total of 50 unique manuscripts and book chapters have been authored by IGCT-T32 fellows.

IGCT-T32 postdoctoral fellows (n=3) and matched-mentor non-T32 postdoctoral fellows (n=14) were evaluated for research productivity by the quantity and JIF quartile of publications during training. T32 fellows produced >10 times the number of unique manuscripts and book chapters per year of training compared to their non-T32 peers. Notably, T32 fellows were more likely to publish their research for early dissemination as preprints (e.g., in MedRxiv or ArXiv) than non-T32 fellows with preprints, comprising 33.9% and 23.1% of reported publications, respectively. When comparing only peer-reviewed publications (excluding preprints, editorials, book chapters, and conference papers), T32 postdoctoral fellows demonstrated markedly higher research productivity (Table 1), authoring an average of 4.4 times more first authored papers than their non-T32 postdoctoral fellow counterparts per year in training (averaging 1.6 and 0.36 per year in training, respectively). Overall, T32 trainees co-authored 22.7 times more publications than their non-T32 peers (6.0 and 0.26 per year in training, respectively). Although these are only initial insights from a few trainees, these data suggest enhanced scholarly output by program trainees.

Table 1.

IGCT-T32 postdoctoral fellows publish more first and co-authored manuscripts per year of training (total (average per trainee, min-max)) and are more likely to publish in top-quartile journals than matched mentor non-T32 postdoctoral fellows.

	IGCT-T32 Postdoctoral Fellows	Matched Mentor Non-T32 Postdoctoral Fellows
Trainees	3	14
Aggregate Years in IGCT-T32 or Postdoctoral Appointment	5.0 (1.67, 1–2)	30.25 (2.16, 1–7)
Average First Author Peer-Reviewed Publications per Year in Training	1.6	0.36
Average Co-Author Peer-Reviewed Publications per Year in Training	6	0.26
Manuscripts Published in Top Quartile Journals	77.1% (27/35)	55.6% (10/18)

To effectively compare publication impact, we leveraged JIF quartiles as reported by the Clarivate database, as impact factors for top journals in each of the diverse areas in image-guided cancer therapy can vary greatly. IGCT-T32 fellows published 77.1% (n=27 of 35) of their peer-reviewed manuscripts in top quartile journals in their respective subject areas, a substantial increase over the 55.6% of manuscripts (n=10 of 18) published in top quartile journals by non-T32 fellows. Taken together, these data suggest that T32 fellows have increased research productivity, engage more in productive team science, and embrace early dissemination of research findings via preprints more than their non-T32 fellow peers, even those in matched-mentor laboratories.

In addition to prolific manuscript publication, IGCT-T32 fellows averaged 3.2 presentations at national/international scientific meetings, and 1.8 invited research talks per year in training, including annual presentation of their research at an institutional seminar series. IGCT-T32 fellows have won numerous awards, including honors at trainee research days, top prizes at national datathon competitions, conference travel awards, editor’s recognition awards for journal editorial service, honored educator awards for their education contributions to national organizations, and trainee peer-to-peer mentoring awards, further highlighting the critical role of mentoring in research training. Further, IGCT-T32 fellows demonstrated successful grant writing skills, with 67% of trainees having secured independent research funding for their work.

To date, three fellows have completed their IGCT-T32 Program appointments. All are presently in further training, including 1 MD in clinical residency, 1 PhD in clinical residency for therapeutic medical physics, and 1 PhD completing a final year in their MD program. All are currently planning to pursue careers in academic medicine with a focus on image-guided cancer therapies. Plans for continued collection and analysis of outcomes data are underway for IGCT-T32 trainees and alumni.

Lessons Learned

The design and implementation of a comprehensive training program framework in image-guided cancer therapy and initial insights into program effectiveness are reported. Since the program’s initiation, feedback has been solicited regularly from faculty, trainees, and Advisory Board members. Leveraging this feedback, several programmatic enhancements have been implemented to 1) add flexibility to didactic training requirements and reduce redundancy in training, 2) enable customization of individual training plans to meet learner-specific career development aims, and 3) expand the global impact of the IGCT-T32 program via establishment of an educational repository for FAIR (Findable, Accessible, Interoperable)³⁰ Open Educational Resources.

A series of strategic, trainee-informed curricular enhancements added significant flexibility, enabling fellows to better customize IDPs while maintaining high standards for completion of required programmatic components. These changes are consistent with literature-derived best practices that indicate a flexible, tailored training approach is ideal for research training.^19,26 First, flexibility was added to clinical shadowing requirements, allowing trainees to focus on deeper level learning for a reduced number of anatomical sites of interest, rather than a more cursory experience in more areas of focus. Additionally, specialized clinical rotations were added to meet trainee needs. For example, a customized “deep-dive” clinical experience in radiation oncology was created for a fellow pursuing a clinician-scientist career in that area. Interdisciplinary discussion of clinical cases (e.g., tumor boards) is important^22,31 but fast-paced and complex. We created “tumor board buddies” to pair clinical fellows/residents with IGCT-T32 fellows for real-time inquiry and discussions during these fast-paced sessions.

Matriculating trainees hail from a diverse range of backgrounds and expertise, necessitating enhancements to better support unique trainee needs, offering supplemental training, eliminating redundancy in training, and improving flexibility. First, much of the required programmatic curriculum was recorded for on-demand playback, affording trainees added flexibility while simultaneously reducing the workload for faculty presenters. Redundancy in training was identified for trainees who had previously completed core curricular requirements during graduate training. Flexibility was added to allow trainees who had previously “mastered” skills/knowledge in a given area to opt out of further training with Program Director approval. Trainees needing supplemental training were provided opportunities from within program resources, and through leveraging institutional offerings and through partnerships with other training programs (e.g., in biostatistics, manuscript writing, career exploration). Together, these programmatic enhancements created flexibility and customization without compromising fundamental programmatic requirements.

The decision to enhance our didactic learning approach by moving to asynchronous, on-demand training prompted the establishment of an educational repository via the MD Anderson OpenWorks platform. Such repositories have been successfully leveraged to provide educational training materials for educators and learners alike over the past two decades,^25,32–36 and flexibility in training has shown to be a driver of trainee success.^26,37 It supports flexibility and individualized learning³³ and is associated with both high learner satisfaction and improvements in knowledge for surgeons and proceduralists for continued professional development.³⁴ A 2015 report from the Cancer Biology Training Consortium calls for open access to cancer educational materials that are primed for broad dissemination such that all interested can learn.¹⁹ Importantly, the broad dissemination of educational content via an open access repository amplifies program impacts and ensures broad and equitable access to image-guided cancer therapy–related content to enable advances in the field.³²

Structured and immersive research engagement is critical to training the next generations of clinicians and scientists, as it provides the knowledge, skills, and critical thinking required for independent research investigation.^36,38 For clinician-scientists, a dedicated period of post-graduate research training has been shown to be especially important,²¹ leading many clinical fellowship and residency programs to add dedicated research years to their programs^25–27 and to the establishment of nationally recognized programs³⁹ and pathways that incorporate research training, such as the Holman Pathway for radiation oncologists.⁴⁰ Likewise, the postdoctoral phase of a PhD-trained scientist is a time for fellows to delve deeper into their areas of research, developing the knowledge and skills to develop and lead independent research projects.⁴¹ Consistent with the literature, we found that participation in structured research training and mentoring programs had rapid and measurable impacts,⁴² with IGCT-T32 postdoctoral fellows publishing substantially more peer-reviewed publications per year than their peers.⁴³ IGCT-T32 fellows have gained grant writing skills and experience, evidenced by two-thirds of trainees earning peer-reviewed extramural funding for their research to date. While it is too soon to draw conclusions about IGCT-T32 Program effectiveness in preparing fellows to secure long-term funding, fellows who participate in a structured research training program such as ours are more likely to obtain subsequent NIH funding than their peers.^40,43–45

Likewise, clinical exposure is critical for PhD-trained scientists to gain understanding of clinical context, identify and address unmet needs with relevant research, and translate results to the clinic in a way that is both clinically useful and feasible.²⁰ Further, interaction with cancer patients provides diverse perspectives and can renew motivation and urgency for the translation of effective research into the clinic.¹⁹ IGCT-T32 fellows completed a minimum of three anatomical sites, equating to nine or more clinical experiences across a variety of disciplines. While it is too soon to evaluate the effectiveness of these experiences, trainees have anecdotally reported improved understanding of clinical challenges and workflows, and satisfaction with their clinical immersion experiences.

As clinical challenges become increasingly complex and multi-faceted, the importance of multi-disciplinary team science and its bidirectional influence on research training cannot be overemphasized. The team science–based approach is widely regarded as a highly effective framework for research,^46,47 especially for projects involving clinical translation.⁴⁸ The benefits of leveraging multidisciplinary expertise in a team science approach include increased research productivity, as measured by grants, publications, and patents;^43,49 enhanced scientific rigor;⁵⁰ heightened innovation and discovery;^46,51–55 and a reduction in time to translational/clinical implementation⁴⁹. Trainees learn much from participating in team science, including scientific communication skills that help them “bridge the gap” from benchtop to beside and back, diverse perspectives and approaches to scientific problem-solving, and organizational/project management skills that prepare them to lead future research teams and collaborations.³⁶ Meanwhile, trainees expand their networks beyond their immediate areas and gain a sense of “community” with a broad group of investigators, encouraging them to engage in future collaborative science pursuits.⁴³ The IGCT T32 program is committed to fostering team science for trainees and faculty.

There are several limitations to this study. The IGCT-T32 program has existed for only 3 years with only a few funded positions available annually, resulting in a small cohort size (n=3) to date, which limited the statistical power and generalizability of study findings. Plans to increase sample size are underway in both cohorts, as additional postdoctoral fellows meet inclusion criteria are critical for a more robust assessment. At present, the majority of trainees remain engaged in further research or clinical training, limiting the mid-to-long-term outcome assessment of program impacts. The longitudinal tracking and outcomes assessment for post-training employment as well as additional metrics, such as time to promotion, future independent grants and funding, fellowships and awards, leadership roles, multi-disciplinary and team science collaborations, patents, and publications, will provide further insights into the efficacy of the IGCT-T32 training program and will be evaluated once data become available.

In this study, publication history and JIF quartile rankings were examined as the sole measures of postdoctoral fellow productivity, as this information was publicly available, and rankings were standardized across Clarivate-indexed journals and disciplines. Additionally, the limited initial follow-up window (3 years) may have led to undercounting publications that were in review or that experienced other delays in the publication process. To help overcome this limitation, this study included manuscripts that were released via preprint mechanisms.

Cohorts were designed with intentional mentor overlap to limit the potential impacts of differences in mentor prestige, training environment, field of study/discipline, and access to resources by ensuring that the non-IGCT-T32 cohort included in this study received primary mentorship and training from one of the eight faculty mentors/co-mentors that provided mentorship to the IGCT-T32 cohort. However, the IGCT-T32 program is highly competitive, admitting trainees who are driven to pursue careers in image-guided cancer therapy who had prior research experience and were willing to commit 2 years of dedicated program research. Program expectations, coupled with differences in prior research experiences and a time frame limited to 2 years, may have also influenced the enhanced productivity evidenced in the IGCT-T32 cohort. To limit variability in the available time trainees were able to allocate for research, only postdoctoral fellows appointed to full-time research-based positions were included; trainees with clinical responsibilities (e.g., clinical fellows and residents) were excluded. Further, all IGCT-T32 trainees reported English as their primary language, whereas a limited number of the non-IGCT-T32 cohort reported a language other than English as their primary language, which could have influenced time to publication for articles written in English. Although collected for IGCT-T32 trainees, this study did not include qualitative data, which could have enriched the context for understanding program impact, in an effort to protect participant anonymity due to the small cohort size. Current assessment and future reporting will include such data once the cohort size is sufficient for anonymous and aggregate reporting.

Lastly, there are considerable barriers for clinician-scientists to pause their clinical trajectory to engage in full-time research with the IGCT-T32 program. These may include immediate factors, such as diminishment of clinical skills attributed to 2 years away from clinical care, delayed workforce entry, lower income-earning potential during research years, and medical school debt repayment requirement.⁵⁶ Factors may also include longer-range considerations, such as an unfavorable funding climate,^28,42,57,58 perceived lack of career stability,⁵⁷ and limited tenure-track faculty positions with sufficient protected research time.⁵⁹ These barriers may contribute to the self-selection of aspiring clinician-scientist applicants to the program. The collection of data from additional trainees over the next several years will be critical for robust, accurate, and generalizable assessment of programmatic successes and mid- to long-term outcomes of the IGCT-T32 Training Program.

This manuscript describes a novel research training framework that integrates immersive research experiences, intentional multi-disciplinary mentoring, strategic clinical shadowing, structured didactic learning, and career development. Initial insights suggest promising trainee productivity. As part of this work, we developed an educational repository to enable flexibility in didactic training requirements and made it open access to promote broader resource dissemination and program impact. This framework offers an innovative model that could be adapted for other training programs, though continued evaluation and longitudinal data are needed with additional trainees to fully access its impact and generalizability.