ABSTRACT
Purpose
To identify and disseminate the organizational characteristics of “top performing” National Institute of Health (NIH) Clinical and Translational Science Awards (CTSA) institutions in regards to career development, using the number of new K awards received per year to rank institutions and comparing these with non‐CTSA institutions.
Methods
The authors analyzed the organizational characteristics of all 61 CTSA institutions from 2006 to 2013 using the American Association of Medical Colleges Organizational Characteristics Database and K Award funding details using NIH RePORT.
Results
Five of the “top 10 performing” institutions are in the western region, and six out of the ten are public schools. Three of the “top 10 performing” institutions receive most of their K awards through two funding mechanisms—the K08 (mentored clinical scientist research award) and K23 (mentored patient‐oriented research career development awards). Notably, these three institutions lack a KL2 program.
Conclusion
The CTSA network of institutions is committed to developing the next generation of physician scientists in order to meet the pressing health needs of society. Educators and evaluators within this network may need to provide training to junior investigators beyond the traditional KL2 programs in order to advance their career development as physician scientists and clinical translational researchers.
Keywords: translational research, evaluation, CTSA
Introduction
In order to bridge the gap between basic, clinical, and population research, there is a need to support the career development of clinical and translational scholars.1, 2, 3 The Clinical and Translational Science Awards (CTSA) of the National Institute of Health (NIH) Center for Advancing Translational Sciences (NCATS) are focused on developing the next generation of physician scientists that can meet the pressing health needs of society. Traditionally, receipt of a career development award (K awards) from the NIH has been critical to the career trajectory of health professions scholars and physician scientists.4
The CTSA was launched in 2006 to enable institutions to restructure and create a definable academic home for clinical and translational research, provide investigators and research teams with research cores, to conduct clinical and translational research, and to train the scientific workforce needed for the translational sciences.5 In 2013, there were 61 institutions throughout the United States.
The NIH and its related centers provide career development (K) awards to individuals with research degrees and to those with health‐professional doctorates. These awards include the following mechanisms:
| NIH K Funding Mechanisms | Description |
|---|---|
| K01 | Mentored research scientist development award for scientists in need of both research training and experience |
| K02 | Independent scientist awards |
| K05 | Established investigator award in cancer prevention and control |
| K07 | Academic career award and cancer prevention, control, behavioral, and populations sciences career development |
| K08 | Mentored clinical scientist research award |
| K12 | Mentored clinical scientist development award for institutions |
| K18 | Career enhancement awards for established investigators |
| K22 | Career transition awards to support individual postdoctoral fellows transition into faculty positions |
| K23 | Mentored patient‐oriented research career development awards |
| K24 | Midcareer investigator award in patient oriented research |
| K25 | Mentored quantitative research development award |
| K30 | Clinical research curriculum development |
| K99 | Career/research transition award program that provides 1–2 years of mentored support |
| KL2 | Institutional support for mentored research career development awards to clinical investigators who are commencing basic, translational and/or clinical research |
Although all the awards could be supportive of clinical and translational scientists’ careers, the ones most relevant to physician scientists include the K08, K12, and K23. In addition, institutions with CTS awards have access to KL2 funding, which supports the institutional development and implementation of a specific career development program in clinical and translational science.
The CTSA literature regarding the career development of clinical and translational scholars has focused on mentoring physician scientists, as mentoring plays a vital role in the career development of researchers6, 7, 8, 9, 10, 11 and on educational programs to ensure a their training.12, 13 The career success of physician scientists has not been broadly addressed, and though definitions beyond grants and publications have been suggested, this has been determined by traditional measures of productivity.4, 14 Hence, there is a need to better understand the role of K awards at CTSAs throughout the country as a means of strengthening the physician scientist pipeline.15, 16
The broader literature regarding NIH funding of physician scientists notes that there has been a decline in funding for investigators proposing clinical research17 and that K awardees across specialties are more likely to: (1) apply and secure subsequent research funding from the NIH, (2) transition to become independent investigators, and (3) show engagement in the biomedical research enterprise.18, 19, 20 The purpose of this study is to understand the overall trend (2006–2013) in new K awards among the NCATS CTSA Institutions and identify the key institutional characteristics of CTSAs with successful K programs. The intent is to share the findings from this analysis as a means to increase success of clinical and translational scholars at all CTSAs nationwide. This is the first study that we are aware of that conducts this type of analysis.
Methods
We looked at the distribution of K awards over time (2000–2013), the type of institutions receiving K awards over time (including domestic higher education, independent hospitals, research centers and other nonprofits), and compared these with the trends and characteristics of K distribution at institutions with CTSAs. We examined trend data of all institutions and the 61 CTSA institutions from 2006 to 2013 to assess the number of new K awards received. We accessed information through: (1) NIH Research Portfolio Online Reporting Tools (RePORT), which provides access to reports, data, and analyses of NIH research activities, including information on NIH expenditures and the results of NIH supported research and (2) the American Association of Medical Colleges (AAMC) Organizational Characteristics database, which provides information on fully accredited medical schools.
We analyzed the characteristics of all 61 CTSA sites from 2006 through 2013, including number of NIH K awards received by year and over time, location of the institutions (region), type of institution (private/public/mixed), and year of initial National Center for Research Resources (NCRR) or NCATS funding. Additionally, within the universe of the 61 CTSA institutions, we analyzed the top funding NIH Institute Centers (ICs) and the top K award mechanisms received.
We used SAS (version 9.3, SAS Institute, Cary, NC, USA) to conduct all analyses. Frequencies and distributions of the study variables were examined first. We then conducted cross tabulations of sites by number of new K awards by year and by K award type. We used chi square to determine statistical significance between variables, and a p value of <0.05 to determine statistical significance.
Results
Characteristics of K awards nationwide, 2000–2013
Analysis of the K award data from 2000 to 2013 revealed that the top funding mechanisms have changed over time (Figure 1 ). The K08 mechanism had the highest funded grants overall, but these have decreased since 2009. The number of K08 grants ranged from 293 in 2002 to 124 in 2013. The K23 mechanism had the second highest number of overall funded grants. The range of K23 grants ran from 232 in 2005 to 178 in 2013. The third highest funding mechanism was the K01 mechanism. Grants in this category ranged from 216 in 2003 to 137 in 2000. In 2013, the top funded K mechanism was the K99, which did not exist prior to 2006. The total number of K99's awarded in 2013 was 203.
Figure 1.
New K awards at all institutions, 2000–2013.
Characteristics of CTSA institutions
All 61 CTSAs in the US received new K Award funding between 2006 and 2013, ranging from a minimum of 1 to maximum of 350 per site. Table 1 shows the characteristics of these sites by: (1) year joined CTSA, (2) region, (3) research intensity, and (4) ownership. Mean and median number of total new K awards received between 2006 and 2013 were greater for those sites which embarked on the CTSA program early on (2006–2008), compared to those who joined later (2009–2012), with a correlation coefficient of r = –0.46 (p = 0.002) between CTSA year and number of awards from 2006 to 2013. Schools in the western region had more new K awards compared to the other three regions, ranging from a mean/median of 105/65 versus a mean of 82/67/66 and a median of 59/58/39 for the northeastern, midwestern and southern regions, respectively. As might be expected, sites with greater research intensity resulted in more new K awards between 2006 and 2013, ranging from a mean/median of 170/164 for those in the top quartile (score of 1–14) compared to 22/21 for those in the bottom quartile (score of 52–113). Finally, private schools had slightly more new K awards compared to public schools (mean/median of 86/64 vs. 71/51, respectively).
Table 1.
Characteristics of CTSA institutions with new K awards (n = 61), 2006–2013
| Characteristics | No. of sites | New K awards | |||
|---|---|---|---|---|---|
| Mean | Median | Min | Max | ||
| Year joined CTSA | |||||
| 2006 | 12 | 121 | 102 | 23 | 350 |
| 2007 | 12 | 115 | 93 | 47 | 251 |
| 2008 | 14 | 71 | 50 | 12 | 196 |
| 2009 | 8 | 45 | 53 | 5 | 70 |
| 2010 | 9 | 32 | 24 | 1 | 109 |
| 2011 | 5 | 54 | 21 | 17 | 154 |
| 2012 | 1 | 31 | 31 | 31 | 31 |
| Region | |||||
| Northeast | 15 | 82 | 59 | 12 | 203 |
| Midwest | 15 | 67 | 58 | 21 | 184 |
| South | 18 | 66 | 39 | 1 | 251 |
| West | 13 | 105 | 65 | 18 | 350 |
| Research intensity*(quartiles) | |||||
| 1–14 | 14 | 170 | 164 | 49 | 350 |
| 15–31 | 15 | 86 | 68 | 35 | 184 |
| 32–51 | 15 | 48 | 47 | 22 | 71 |
| 52–113 | 15 | 22 | 21 | 1 | 47 |
| Ownership | |||||
| Public | 31 | 71 | 51 | 5 | 350 |
| Private | 30 | 86 | 64 | 1 | 251 |
*Federal research expenditures used to determine research intensity are based on direct federal grants and contracts expenditures for organized research as reported on the FY2011 LCME Part I‐A Annual Financial Questionnaire and include expenditures recorded and not recorded on the books of medical schools. These data are reported only for medical programs with LCME Full Accreditation Status.
Characteristics of new K awards at CTSA institutions, 2006–2013
Table 2 shows the characteristics of the n = 4,783 new K awards received from 2006 to 2013 by the 61 CTSA sites that received awards. There is an almost equal distribution of awards received each year, ranging from a minimum of 530 in 2006 to 660 in 2007. The top ten NIH Institutes providing 78% of the funding were (1) National Heart, Lung and Blood (14%), (2) Diabetes and Digestive and Kidney Diseases (12%), (3) National Cancer Institute (10%), (4) Mental Health (9%), (5) Allergy and Infectious Diseases (7%), (6) Child Health and Human Development (6%), (7) Aging (5%), (8) Neurological Disorders and Stroke (6%), (9) Drug Abuse (5%), and (10) Arthritis and Musculoskeletal and Skin Diseases (4%). Four K‐award types comprised 82% of the career development mechanisms: (1) K23 (23%), (2) K99 (18%), (3) K08 (22%), and (4) K01 (19%). Overall, there was an increase in the number/proportion of K99 awards and a decrease in K08 awards among the CTSA sites over time (numbers not shown).
Table 2.
Characteristics of overall new K awards at CTSAs (n = 4783), 2006–2013
| Characteristics | No. of awards | Percent |
|---|---|---|
| Fiscal year awarded | ||
| 2006 | 530 | 11 |
| 2007 | 660 | 14 |
| 2008 | 616 | 13 |
| 2009 | 636 | 13 |
| 2010 | 629 | 13 |
| 2011 | 565 | 12 |
| 2012 | 566 | 12 |
| 2013 | 581 | 12 |
| Top ten NIH funding institutes/centers (78%)* | ||
| NHLBI | 648 | 14 |
| NIDDK | 595 | 12 |
| NCI | 473 | 10 |
| NIMH | 424 | 9 |
| NIAID | 355 | 7 |
| NINDS | 280 | 6 |
| NICHD | 279 | 6 |
| NIA | 261 | 5 |
| NIDA | 234 | 5 |
| NIAMS | 192 | 4 |
| Top four K‐award types (82%)† | ||
| K23 | 1,105 | 23 |
| K08 | 1,045 | 22 |
| K01 | 889 | 19 |
| K99 | 873 | 18 |
*NHLBI = National Heart, Lung and Blood; NIDDK = Diabetes and Digestive and Kidney Diseases; NCI = National Cancer Institute; NIMH = Mental Health; NIAID = Allergy and Infectious Diseases; NICHD = Child Health and Human Development; NIA = Aging; NINDS = Neurological Disorders and Stroke; NIDA = Drug Abuse; NIAMS = Arthritis and Musculoskeletal and Skin Diseases.
†K23 = mentored patient‐oriented research career development awards; K08 = mentored clinical scientist research award; K01= mentored research scientist development award for scientists in need of both research training and experience; K99 = career/research transition award program that provides 1–2 years of mentored support.
Number of new K awards at “top 10 performing” CTSA institutions, 2006–2013
The “top 10 performing” CTSA's are those ten institutions with the highest number of new K awards over the last seven years. Table 3 shows that the annual number of K awards for the top 10 CTSAs ranged from 50 to 11 in all years, 2006–2013. The University of California, San Francisco was the top performing CTSA with new K awards ranging from 26 to 50, 2006–2013, followed by Johns Hopkins, the University of Pennsylvania, Stanford, and University of Pittsburgh. These top five CTSA institutions had an aggregate number of new K awards ranging from 194 to 350. The other five “top performing” CTSAs included the University of Michigan, the University of Washington, Yale, Washington University and the University of California, Los Angeles
Table 3.
Number of new K awards at “top 10 performing” CTSA institutions, 2006–2013
| CTSA | No. of new K awards by year* | Total new 2006–2013 | |||||||
|---|---|---|---|---|---|---|---|---|---|
| 2006 | 2007 | 2008 | 2009 | 2010 | 2011 | 2012 | 2013 | ||
| University of California, San Francisco | 26 | 49 | 46 | 49 | 37 | 50 | 46 | 47 | 350 |
| John Hopkins | 28 | 27 | 40 | 37 | 36 | 32 | 34 | 17 | 251 |
| University of Pennsylvania | 15 | 28 | 25 | 25 | 22 | 24 | 38 | 26 | 203 |
| Stanford University | 12 | 32 | 17 | 24 | 27 | 21 | 31 | 32 | 196 |
| University of Pittsburgh | 24 | 24 | 31 | 40 | 18 | 28 | 13 | 16 | 194 |
| University of Michigan | 14 | 21 | 21 | 28 | 28 | 26 | 20 | 26 | 184 |
| University of Washington | 25 | 28 | 17 | 22 | 32 | 11 | 13 | 21 | 169 |
| Yale University | 22 | 17 | 30 | 11 | 28 | 20 | 23 | 16 | 167 |
| Washington University | 18 | 21 | 18 | 19 | 22 | 17 | 23 | 22 | 160 |
| University of California, Los Angeles | 18 | 27 | 15 | 24 | 21 | 21 | 14 | 14 | 154 |
*This includes all K mechanisms.
Institutional characteristics of “top 10 performing” CTSA institutions, 2006–2013
In terms of organizational characteristics, four of the “top 10 performing” institutions are in the western region, and five of the ten are private schools (Table 4). Four of the “top 10 performing” institutions received their NCATS awards in 2006, four in 2007, one in 2008, and another in 2011.
Table 4.
Institutional characteristics of “top 10 performing” CTSA institutions, 2006–2013
| CTSA | Organizational characteristics | |||
|---|---|---|---|---|
| State | Region* | Public/private | Year of initial award† | |
| University of California, San Francisco | CA | Western | Public | 2006 |
| John Hopkins | MD | Southern | Private | 2007 |
| University of Pennsylvania | PA | Northeastern | Private | 2006 |
| Stanford University | CA | Western | Private | 2008 |
| University of Pittsburgh | PA | Northeastern | Public | 2006 |
| University of Michigan | MI | Midwestern | Public | 2007 |
| University of Washington | WA | Western | Public | 2007 |
| Yale University | CT | Northeastern | Private | 2006 |
| Washington University | MO | Midwestern | Private | 2007 |
| University of California, Los Angeles | CA | Western | Public | 2011 |
*The regional location of the medical school classified as: Midwestern, Northeastern, Southern, or Western.
†Year of initial receipt of Clinical and Translational Science Award at the institution.
Characteristics of new K awards at the “top 10 performing” CTSAs, 2006–2013
The top 4 K‐award types in each of the highest performing CTSAs were: K08, K23, K99,and K01 (Table 5). As was seen for all CTSAs, there was an increase in the number/proportion of K99 awards as well as a decrease in K08 awards from 2008 through 2013 for the top 10 performing institutions (numbers not shown). All of the top performers had a KL2 (mentored career development award) program in place.
Table 5.
Characteristics of new K awards at “top 10 performing” CTSAs, 2006–2013
| CTSA institution | Top 2 awarded K mechanisms* | KL2 program† |
|---|---|---|
| University of California, San Francisco (n = 350) | K08 (n = 104) | Yes |
| K23 (n = 92) | ||
| Johns Hopkins (n = 251) | K23 (n = 92) | Yes |
| K08 (n = 53) | ||
| University of Pennsylvania (n = 203) | K08 (n = 60) | Yes |
| K23 and K99 (n = 37) | ||
| Stanford University (n = 196) | K99 (n = 80) | Yes |
| K08 (n = 45) | ||
| University of Pittsburgh (n = 194) | K01 (n = 52) | Yes |
| K23 (n = 44) | ||
| University of Michigan (n = 184) | K08 (n = 53) | Yes |
| K23 (n = 46) | ||
| University of Washington (n = 169) | K08 (n = 42) | Yes |
| K99 (n = 37) | ||
| Yale University l (n = 167) | K08 (n = 46) | Yes |
| K01 (n = 34) | ||
| Washington University (n = 160) | K08 (n = 60) | Yes |
| K23 (n = 31) | ||
| University of California, Los Angeles (n = 154) | K23 (n = 45) | Yes |
| K01 (n = 39) |
*Funding mechanisms: K01 (research scientist development award), K08 (clinical investigator award), K23 (mentored patient‐oriented research career development award), K99 (career transition award).
†Institution has aKL2 program (institutional mentored career development award) between 2006 and 2013.
Overall success rate of most common K awards received at CTSA Institutions, 2006–2013
We analyzed the overall success rate for the top K mechanism awarded to CTSA institutions (Table 6). Per the NIH, the success rate is defined as the percentage of reviewed grant applications that receive funding. The success rates varied from 20.5% in 2007 for K99 applications to 47.7% in 2009 for K08 applications. (In 2006, there was 1 application for the K99 and it was funded, hence there was a 100% success rate). No one mechanism demonstrated either a steady increase or decrease in funding success rate.
Table 6.
Overall success rate* (2006–2013) of most common K awards received at CTSA Institutions
| K type | Description | 2006 | 2007 | 2008 | 2009 | 2010 | 2011 | 2012 | 2013 |
|---|---|---|---|---|---|---|---|---|---|
| K01 | Mentored research scientist development award for scientists in need of both research training and experience | 27.5 | 31.7 | 38.8 | 36.5 | 39.8 | 34.2 | 32.2 | 33.1 |
| K08 | Mentored clinical scientist research award | 33.9 | 36.1 | 43.6 | 47.4 | 44.0 | 41.6 | 42.3 | 35.8 |
| K23 | Mentored patient‐oriented research career development awards | 27.0 | 33.4 | 37.6 | 43.9 | 37.8 | 33.9 | 36.6 | 32.1 |
| K99 | Career/research transition award program that provides 1–2 years of mentored support | 100 | 20.5 | 22.6 | 29.0 | 24.9 | 21.6 | 23.3 | 21.9 |
*Per NIH Table #204, Career Development (K) Grants, Competing Applications, Awards, Success Rates and Total funding by NIH Institutes/Centers and Activity Code, Fiscal Years 2006–2013. Success rate defined as percentage of reviewed grant applications that receive funding.
Discussion
There is a very large range in the number of K awards received by the “top 10 performing” CTSAs across the country. It is not clear if institutions have made strategic, dedicated efforts to increase their K awards, or if there is an institutional climate that generally encourages and supports career development centered on NIH K‐award funding. Furthermore this analysis does not account for changes in NIH funding for K awards or economic conditions that effect state funded schools, especially those states hardest hit by recession. There also appears to be no correlation between the year of CTSA award and number of Ks received.
Interestingly, three of the “top 10 performing” institutions receive most of their K awards through two funding mechanisms—the K08 (clinical investigator award) and K23 (mentored patient‐oriented research career development awards). These mechanisms are clearly geared towards supporting the clinical and translational researchers. Notably, these three institutions lack a KL2 program (institutional mentored career development awards). However, there is a trend towards an increase in the number of K99s (career transition awards) across all CTSAs and in the top 10 performing CTSAs over time.
Clearly, the number of awarded Ks is not indicative of overall CTSA or institutional effort to obtain awards. The actual success rate (number of applications/number of grants obtained) of each CTSA is not gathered here, although we attempted to access this through the NIH Consolidated Grant Applicant File and a Freedom of Information Act request. Both requests were denied. There are also other career award mechanisms that are sought not captured by this analysis.
Limitations
We based our analysis solely on quantitative data obtained through public sources. There are a number of other contextual variables like institution specific missions or leadership directives that would need to be further analyzed in order to better understand organizational characteristics. For example, a moderating factor might be the level of education provided by universities with CTSAs, wherein some universities have a pipeline of undergraduate to postdoctorate, while others focus only on graduate education. Future analysis in this area will need to examine additional organizational determinants of K awards to more extensively assess factors that contribute to success.
Conclusion
Further information is needed to understand why the “top performing” CTSAs are highly focused on the K08 and K23 funding mechanisms to support their physician scientists. Educators and evaluators within the CTSA network of institutions may need to consider examining the funding mechanisms for the career development of physician scientists beyond the KL2 programs.
Acknowledgment
This study was supported by the National Center for Advancing Translational Sciences through NCATS/UCLA CTSI Grant # UL1TR000124.
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