Vision, Identity, and Career in the Clinical and Translational Sciences: Building upon the Formative Years

Abstract

This paper is the second in a five‐part series on the clinical and translational science educational pipeline. It focuses on the role that Clinical and Translational Science Award (CTSA) programs can play in supporting science, technology, engineering, and math (STEM) education in primary and secondary schools, as well as in facilitating these interests during transition to undergraduate training. Special emphasis should be placed on helping to form and sustain an identity as a scientist, and on instilling the persistence necessary to overcome numerous barriers to its actualization. CTSAs can contribute to cementing this sense of self by facilitating peer support, mentorship, and family involvement that will reinforce early educational decisions leading to clinical and translational science research careers. Meanwhile, the interests, skills, and motivation induced by participation in STEM programs must be sustained in transition to the next level in the educational pipeline, typically undergraduate study. Examples of CTSA collaborations with local schools, businesses, interest groups, and communities at large illustrate the emerging possibilities and promising directions with respect to each of these challenges.

Introduction

The National Institutes of Health created the Clinical and Translational Science Award (CTSA) program to bring new perspectives, methodologies, and technologies to the biomedical research enterprise. A more “robust translational research workforce” is central to this initiative, and has encouraged renewed attention to education, training, and career development opportunities at various levels of preparation.1 The present paper is the second in a five‐part series that explores strategies for supporting recruitment and retention across an expanded pipeline intended to create diverse pathways into clinical and translational research.2 Here, we focus on a crucial step early in the educational process: namely, the recruitment, retention, and advancement of promising middle and high school students to relevant career tracks.

The discussion opens by reviewing the assumptions, history, and progress of science, technology, engineering, and math (STEM) education in the U.S. and its relationship to increasing clinical translational research capacity. We then turn to the challenges of building such programs within the context of primary and secondary schools, with special emphasis on forming an identity as a scientist. The discussion next considers the important role of peer support and mentorship in cementing this sense of self and instilling the persistence necessary to overcome numerous barriers to its actualization. Lastly, we highlight ways in which the interests, skills, and motivation induced by participation in STEM programs can be sustained in transition to the next level in the educational pipeline, typically undergraduate study. Throughout the discussion, we draw upon examples from CTSA collaborations across the country to illustrate promising directions and continuing challenges.

Assumptions, History, and Progress of STEM Programs

Raytheon Chairman William Swanson succinctly articulated the driving force behind the nation's commitment to STEM programming: “Science, technology, engineering and math form the foundation of the global economy.”3 Yet, by virtually every measure, the U.S. lags worldwide in the percentage of STEM‐trained professionals among its workforce, and in training future generations of such experts.4 International comparisons of educational achievement among 15‐year‐old students reveal that the U.S. ranks 28th in math literacy and 24th in science literacy. Moreover, the U.S. ranks 20th among all nations in the proportion of 24‐year‐olds who earn degrees in the natural sciences or engineering.4 The same trends are evident with respect to the disciplines at the core of clinical translational research.5 It comes as no surprise, then, that in terms of new, creative advances in biomedical research, the gap between the U.S. and other countries has narrowed substantially since World War II.4 The consequences for knowledge acquisition and application are well documented not only with respect to the health and well‐being of American citizens, but also for scientific innovation, competitive edge, market share, revenue, and gross domestic product. Swanson's reference to the global economy applies equally in this instance.

By the middle of the previous decade, the national response to this “crisis” had generated 207 distinct federal STEM education programs representing an investment of $3 billion in FY2004.4 Nearly three‐quarters of these funds and almost half of all STEM programs were housed in two agencies: the National Institutes of Health and the National Science Foundation. This initiative focused on supporting college students and sought to increase both their interest as well as academic competence in STEM subject areas. Disappointing results led to introducing these efforts earlier in the educational process, giving rise to a large array of state and federal initiatives that seeks to increase the number of high school graduates prepared to continue in the STEM pipeline.4

We await publication of longitudinal studies of the impact of high school‐based STEM programs on the number of STEM‐trained college graduates. Yet, the STEM index—a comprehensive tool developed by U.S. News and Raytheon to track key indicators of science, technology, engineering, and mathematics activity in the U.S. over time—suggests, that if current educational trends continue, despite attention to earlier stages in the pipeline, fewer qualified candidates will be available to support growth in these areas.3

Evaluations of STEM high school programs find that enhanced exposure to science, technology, engineering, and math content increases academic competence in these subject areas and increases interest in related career opportunities: substantially so in both cases. But curiously, neither of these gains survives transition into undergraduate education at the levels one would anticipate.6 Why? The answer is critical as these two objectives underpin the basic program assumptions that guide our efforts at this stage in the pipeline. Redressing this falloff becomes essential to success at each subsequent point of educational preparation and to achieving the ultimate goal of increasing clinical translational workforce capacity.

Self as Scientist: Recognizing the Possibilities

“Middle school is a crucial time when students grow their hopes and commitments for success in school, in future work, in family and community life—or not.”7 There is growing consensus that college planning needs to occur before 8th grade in order to develop and sustain college aspirations.8 Outreach to middle school students increases the likelihood of success in obtaining a future degree in higher education.

Interest in a science‐based career emerges as early as the 8th grade, and predicts participation in later STEM coursework. But these aspirations do not fully form until late in high school.7 Though most college students studying for degrees in science, technology, engineering, or math cite this time as formative, only 20% feel they had been supported and encouraged to pursue this route.8

The loss of initial interest in STEM disciplines frequently is attributed to poor preparation and shortage of qualified teachers, lack of investment in teacher development, poor content preparation and delivery, and inadequate instructional facilities.8 While important, such barriers can be surmounted by the more targeted, sustained allocation of resources. Other factors have emerged as equally important, but are more subtle and less amenable to easy solution, falling beyond simply needing more money to improve pedagogic techniques.

Consider, for example, the influence of media, parents, and peers both within and outside of the school environment, career advising, and the nature as well as extent to which students interact with science. Until recently, these elements have been ignored. As a consequence, students often experience STEM curriculum as “boring” or irrelevant.9 It is decontextualized, lacks connection to their everyday life, and thus wants for personal meaning.6 A close corollary of “boring” is the widespread image that someone who enjoys STEM subjects is a geek or nerd, and that the content is “not cool.” Robert Downing Jr.'s portrayal of Ironman in Marvel's movie series is a recent exception, as is Bill Nye, educator and comedic host of the Disney/PBS children's show “The Science Guy.” But otherwise negative views are dominant, widespread, powerful, largely unflattering, and reinforced by the media.

The NIH should encourage CTSA educational cores to support STEM preparatory programs, and can draw upon successful examples from within its own ranks for inspiration. In partnership with local schools, the examples that follow anchor this subject matter in students’ lives by carefully exposing them to young or prominent role models, by providing them with rare glimpses of what lies behind the curtain of healthcare, and by rebranding STEM careers as enticing, stimulating, and dynamic rather than uninteresting or esoteric.

Since 2011, the University of Colorado Denver at the Anschutz Medical Campus has exposed high school students from underrepresented backgrounds to clinical translational science and biomedical fields through its Denver—Student Training in Research Science (STaRS) program.10 This program introduces students to biomedical and translational research through two tracks. The Research Track pairs students with a CTSA investigator 8–10 hours per week for 10 weeks in a laboratory research experience. Participants learn basic laboratory skills and gain insight into active biomedical and translational research. CTSA investigators introduce students to the essential skills as well as guide them through the questions asked and laboratory techniques used in their search for answers. The Workshop Track includes exploratory workshops revolving around various types of research, field trips to the University of Colorado Anschutz Medical Campus, and workshops on educational paths to medical and research careers.

Denver STaRS has served 141 diverse, high‐ability high school juniors interested and excelling in the sciences. Of the 71 participants involved in the Research Track, 69% were from underrepresented backgrounds, as were 89% of the 70 participants in the Workshop Track. Participants strongly agreed that they knew more about career options in science and research because of this experience (75%) and that it helped them understand more about the skills needed to do research (66.7%). Over 90% of respondents agreed/strongly agreed that the program taught them important research skills (91.7%) and helped them understand how research is conducted (100%).

Similarly, the award‐winning University of Pittsburgh Cancer Institute Academy offers 8‐week sessions of experiential and didactic activities designed specifically for high school students.11 Each young scholar is placed in an individual mentor's research laboratory, spends substantial time with professionals in cancer care and basic research, joins other students in extended visits to local organizations dedicated to scientific advancement, and attends weekly instructional sessions led by qualified graduate students, medical students, postdoctoral fellows, and faculty. The results consistently document increased knowledge of STEM careers in cancer care and research, a deeper understanding of cancer biology and therapeutic strategies, and enhanced research and communications skills, which the founders refer to as “science as a performing art.”

The Northwest Association for Biomedical Research, comprised of a diverse array of academic organizations including the University of Washington, seeks to promote the understanding of biomedical research and its ethical conduct among youth. Camp BIOmed, one of its most popular programs, offers three intensive weeklong summer camps for high school students.12 Participants in the Do‐It‐Yourself Scientific Laboratory gain hands‐on laboratory experience by manipulating tools and technology. The Origami of Life with Bioinformatics camp blends wet and dry laboratory experiences, yielding insight into protein sequences. Personal experience with Foldit, an online video game developed by the University of Washington, illuminates the functional elements of specialized proteins through the process of puzzle solving. The Crime Scene Investigation camp teaches students scientific techniques used in processing a crime scene to obtain and analyze evidence. These educational opportunities are supplemented by participating in experiments at local biomedical businesses and research facilities as well as tours of Seattle biomedical organizations, and conclude with an expo at Puget Sound Blood Center Research Institute. Eighty‐two students presented their work through Poster or Power Point presentations at the inaugural 2014 event. Participants increased their knowledge of research professions, of the skills needed for and paths to becoming a scientist, of how research is conducted, and connected with professionals who opened their eyes to the possibility of a STEM career.

For many middle and high school students, their future careers are an uncertain reality that often coincides with when images and attitudes toward STEM are least formed, negative, or waning in appeal. They are unlikely to see scientists as people they could grow up to be.7 Science does not appear to offer lucrative, satisfying careers.9 Nor are these young people aware that science can equip them with meaningful skills that apply beyond the narrow world of a laboratory, which is most students’ vision of where scientists live and work. Programs like Colorado's Denver STaRS, the University of Pittsburgh Cancer Institute Academy, and the Northwest Association for Biomedical Research's Camp BIOmed illustrate how we can reshape these images and attitudes, how a scientist as person and science as a career can be seen as possible, desirable, and rewarding.

Vision and Persistence: The Role of Mentorship and Peer Support

A key component of successful STEM education is role models at institutions of higher education to advise, mentor, and support program participants. Effective mentoring contributes to retention in STEM programs, to academic competence in the subject matter, to the ability to envision a career in related fields, to sustained interest in pursuing that career, and is strongly associated with completing undergraduate and graduate STEM degrees.6 The causal mechanisms include added exposure to the materials, diverse approaches to their analysis and comprehension, consistent one‐on‐one positive attention, role models who affirm the possibility of a career in science as well as its rewards, and interactions that enhance communication and collaboration skills.13 Our challenge is that few of these mentors represent the clinical and translational endeavor, much less the research that drives it.

CTSAs are deeply committed to mentoring, but largely with respect to postdoctoral fellows and early stage investigators. Some programs have extended this commitment to undergraduate and graduate levels of preparation. Rarely have they done so earlier in the educational pipeline. However, the possibilities are instructive, as demonstrated by the following examples.

The University of Pittsburgh exposes K‐12 students to research and science careers through several innovative programs. Their efforts begin early, through a series of highly interactive, engaging lectures by Pitt undergraduate and graduate students to 3rd through 12th grade students. The ensuing interest is sustained through science outreach that consists of 6–12 sessions, again highly interactive, targeting 4th–6th grade students during and after school, as well as through summer camps. University of Pittsburgh students serve as science advisors, providing cross‐age mentoring and peer support. This effort, in turn, is augmented by “Pathway to STEM” offerings to parents to reinforce and sustain their children's interest.14 The Pitt Mobile Science Lab delivers science experiences to schools and community events throughout Western Pennsylvania with an 80‐foot tractor‐trailer equipped as a state‐of‐the‐art student science laboratory.15 Through partnerships with physicians and researchers as well as established outreach programs, students learn to define and test hypotheses, graph, and analyze results, bringing novel, hands‐on, real world, laboratory investigations to middle school and high school students.

As evidenced by Pittsburgh's “Pathway to STEM” offerings to parents, the resources offered through early pipeline programs should not only be for students, but for families and the surrounding community. A proactive approach to engaging peers and parents in afterschool activities, community outreach, and pipeline programs fosters intellectual development and understanding of the nature of scientific research and teaches parents how to help their children succeed in higher education.16

Peer support facilitates academic and social integration by connecting individuals who share similar academic goals, research interests, sense of purpose, as well as backgrounds.6 Peer networks can enhance the support available to individuals who may otherwise lack access to information, other types of resources, and emotional support. In this context, it can be compared to the practices often referred to as cooperative learning. Whether it takes place in a formal or informal learning context, peer learning encourages aspects of self‐organization that are largely absent from pedagogical models of teaching and learning. Establishing affinity groups and peer networks has proven to be an especially important, effective way to engage more marginal students and to address feelings of isolation.17 Providing mechanisms and structures to link students and to develop peer support can affirm a sense of belonging.6, 17 Successful examples are readily evident.

The University of Pittsburgh's DataJam introduces high school students to big data sets and teaches them how to visualize their contribution to our understanding of the world in which we live.18 Teams of high school students choose a question they can answer by big data analysis. Pitt students serve as ‘science mentors’ to the high school teams, teach them computer programs to visualize big data sets, and help them use the scientific method to answer questions. The science mentors also teach each team presentation skills and assist them in preparing for a final presentation at the DataJam at which each team presents a poster and slide presentation of their work.

The University of Washington's Alliances for Learning and Vision for Underrepresented Americans (ALVA) programs reach out to underrepresented high school students.19 Its eScience High School ALVA program offers them a head start in the university research setting and helps to build relationships with other students also are interested in pursuing higher education. ALVA High School students take daily math and Java programming courses for the duration of the program. They also participate in a seminar on research ethics. The purpose of these courses is to prepare students for careers in the growing field of Big Data and Data Science. The student belongs to a team consisting of a project lead, a data science mentor from the eScience Institute, a stakeholder, and four undergraduate students. Each project involves the analysis and visualization of data in topics such as public health, sustainable urban planning, environmental protection, disaster response, crime prevention, education, transportation, governance, commerce, and social justice.

These approaches to enhancing academic achievement among students early in their education are just a few of the opportunities available to increase access to and persistence in higher education.

Sustaining Interest into Higher Education: Transitions

Connecting institutions of higher education, specifically through precollegiate as well as pipeline programs, increases access to resources, mentorships, and internships otherwise unavailable to STEM students.13, 16 For example, increasing the time they spend on a college campus early in life has been shown to increase graduation rates and future career or schooling options. These partnerships and collaborations have proven to be vital to the success of enrichment programs at both an institutional level and an external level.

The University of Colorado Denver's Pre‐Collegiate Health Career Program motivates first generation high school students to complete a college preparatory high school curriculum and matriculate to the postsecondary institution of their choice with the academic skills necessary to succeed at that institution.20 The program enrolls up to 75 students per grade level and provides them with information regarding their health profession of interest as well as essential academic advising about high school course selections.  In addition to developing academic and interpersonal skills, students learn more about the health professions. They attend a Saturday Academy Program that includes sessions on effective time management, goal setting, as well as strategies on how to prepare financially for their college and professional education.  A summer program for sophomores is offered for a 2‐week period and for juniors, a 5‐week offering exposes students to the rigors of college life.

In 2009, the Summer Undergraduate Minority Mentoring in Translational Science (SUMMiT) program established partnerships with existing summer programs across University of Colorado's campuses.21 It brings together underrepresented scholars to create a community of leadership and learning from otherwise independent efforts. Special attention is given to entering undergraduates as they transition from high school to higher education. SUMMiT immerses participants in career development sessions ranging from a Translational Research Fair and guest lectures, to networking with campus leadership and resume development workshops. These sessions highlight the accomplishments of a diverse university faculty, and facilitate linking with and mentoring by role models.

SUMMiT 2014 convened 45 scholars from across these programs to augment the latters’ efforts. Two‐thirds ranged from 19 to 21 years of age and planned to pursue education in medicine. Frequently cited benefits of participation included networking with professionals and students, acquiring practical information about other STEM programs, a wide variety of speakers and the settings in which they pursue their work, and exposure to new career possibilities in clinical translational research. Half of respondents reported meeting researchers with whom they plan to stay in contact; over a third reported similar affiliation with students outside of their primary program.

The GenOM ALVA program targets 14 graduating seniors/incoming freshmen admitted to the University of Washington who are interested in science research. It provides an early introduction to genomic studies and valuable, participatory research experience in an academic setting, which also emphasizes the impact and role of genomics and genetics in science and society.20 During this 9‐week program, students initially receive intensive laboratory and bioethics training through interactive learning strategies, and then are placed with a mentor to conduct or participate in a research project.

GenOM ALVA participants have an undergraduate mentor, gain first‐hand, quality experience in laboratories of established researchers, learn about academic research settings, connect with peers interested in the same topics, join faculty working on cutting edge genomic and genetic research, and explore the impact of the field on science and society. Other benefits include academic training in math and life sciences, opportunities to explore the rapidly expanding field of genomics, and gaining the confidence and academic exposure that facilitates a successful transition into college.

Conclusion

The first article in this series underscored the importance of an intentional, long‐term commitment to expanding pathways to clinical and translational research careers—work that should target multiple levels.2 It argued that to be effective, such efforts must extend the pipeline to include early academic and career development to ensure there is continuity of engagement and support across the various contexts that shape persistence decisions. In our follow‐up to that article, we documented the importance of primary and secondary schools in contributing to the early formation of an identity as a scientist and to developing a vision of science as a career. We illustrated the role of peer support and mentorship in cementing this sense of self and instilling the persistence necessary to overcome barriers to its actualization. Lastly, we highlighted ways in which the interests, skills, and motivation induced by participation in STEM programs can be sustained in transition to the next level in the educational pipeline, typically undergraduate study. In each case, we drew upon examples in which NIH‐supported CTSAs have joined with other partners funded through a variety of mechanisms to bring these outcomes to fruition.

As the CTSA mission evolves in response to an increasingly uncertain funding environment, it will continue to struggle with how best to capitalize on such early gains. It must if we hope to address the challenges at each subsequent point of educational preparation to achieve the ultimate goal of increasing clinical translational workforce capacity. Recognizing the points of leverage, possible synergies, and mutual benefits across programs—regardless of private, state, or federal sponsorship—is a necessary, but insufficient condition for success in this regard. We must then determine how best to collaborate in respectful, meaningful ways that honor the contributions each has to make in advancing the careers of tomorrow's young scholars.

Sources of Financial Support

Funding support provided by NIH/NCATS Colorado CTSI Grant Number UL1 TR001082; NIAP30 AG15297 (SM Manson); NIMHDP60 MD000507 (SM Manson).