Addressing Gaps in Pediatric Scientist Development: The Department Chair View of Two AMSPDC-Sponsored Programs

Abstract

Pediatric physician-scientists are important members of the biomedical workforce who are instrumental in translating research advances into novel patient treatment strategies, yet their numbers have been declining over the past four decades. In order to increase the pipeline of pediatric physician-scientists, the Association of Medical School Pediatric Department Chairs (AMSPDC) leads the Frontiers in Science (FIS) and Pediatric Scientist Development Program (PSDP). These programs provide mentorship, networking, and funding opportunities for pediatric residents and fellows who are interested in pursuing research careers.

To assess perceptions of program accessibility and efficacy, FIS and PSDP leadership surveyed AMSPDC membership between November 2018 and April 2019; 66 active department chairs responded. The decline in pediatric physician-scientists was identified as a common concern, and responding chairs identified several individual and institutional barriers to the physician-scientist career pathway and to participation in FIS and PSDP. Common barriers to participation included: undefined career paths for physician-scientists, a limited number of FIS slots annually, a perception that these programs support primarily basic science rather than other types of research, and competing funding through institutional T32 and K12 programs.

To address these barriers, FIS and PSDP leadership will work with AMSPDC to explore ways to increase access to FIS, promote PSDP alumni mentoring of participating residents and fellows, and expand the scope of research supported by these programs. Assessments of FIS and PSDP will be ongoing, with the goal of improving program access in order to increase and diversify the pediatric physician-scientist workforce.

INTRODUCTION

Pediatric physician-scientists (also known as pediatric scientists) are critical members of the biomedical workforce. These individuals hold medical degrees (MD, DO, or equivalent), are trained in pediatrics, and conduct basic, clinical, or translational research. Their unique clinical and research perspectives allow them to translate advances in scientific research, health informatics and engineering into the development of new patient treatment strategies, leading to improved health care for children.

Unfortunately, the pediatric-scientist workforce is waning.¹ Although the number of subspecialty-trained pediatricians has variably increased over the past two decades (modestly in some subspecialties and has even declined recently in others), the proportion of dedicated effort to formal research training has remained relatively flat and inconsistent.^2–4 Subspecialties that traditionally attracted pediatric scientists have experienced stagnating fellowship applicant pools.⁵ Further, many potential pediatric scientists feel discouraged by a deteriorating pediatric funding landscape.^2,5–7 A consequence of this funding decline is a decreasing number of research-active mentors who can train the next generation of pediatric scientists.

Fostering the pipeline of pediatric researchers is important for improving care for children, particularly in fields where there are needs for improved—or any—therapies. To do this, the Association of Medical School Pediatric Department Chairs (AMSPDC)-led Frontiers in Science (FIS) and the Pediatric Scientist Development Program (PSDP) aimed to enhance research training of pediatric trainees in order to develop a robust group of pediatric scientists who can stimulate new knowledge and vitalize areas where there are deficiencies in the biomedical workforce. To assess FIS and PSDP program access, efficacy, and suggestions for improvement, we surveyed the current members of AMSPDC on their interaction with and opinions of these programs. Herein we describe the FIS and PSDP programs, survey results, and implications for future directions of these programs.

PROGRAM SUMMARIES

AMSPDC’s overall mission is to improve the health and wellbeing of children through the professional development of the chairs of academic pediatric departments and support of their clinical, research, education, and advocacy missions. The annual meeting accomplishes this by joining the FIS and PSDP programs from the United States and Canada under one roof in order to maximize collaborations and advance pediatric research efforts. In doing so, AMSPDC intends to: 1) motivate pediatric trainees to pursue their own research training pathways and 2) build a pipeline of future pediatric scientists.

Frontiers in Science

The FIS program was introduced in 1987 by Joseph B. Warshaw, MD, a leader dedicated to nurturing pediatric scientists. This was conceived as one approach to ensuring the continuing talent of pediatric physician-scientists. FIS, which is funded by an R13 from the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) and by an educational grant from Abbott pharmaceuticals, promotes research and networking opportunities for pediatric trainees interested in investigative careers by facilitating interactions among pediatric residents, pediatric researchers, and department chairs. This day-long program is integrated into the AMSPDC annual meeting and allows department chairs to invite one academically-oriented pediatric resident to participate in the FIS Symposium. The participating department chairs rotate such that approximately one-half of members are offered an opportunity to sponsor a resident each year, totaling approximately 40 residents per year. To promote diversity in attendance and perspectives, there is an emphasis on inclusion of those underrepresented in medicine (URiM) for this opportunity. New in 2018, the FIS conducted a pilot experiment to engage URiM residents by issuing a special call for URiM applicants. This a success as 65–70% of the 2018 and 2019 FIS attendees identified as URiM (Table 1).^a

Table I.

Recent FIS participants (2016–2019)

Participants	2016	2017	2018	2019
Women, n (%)	22 (65)	22 (55)	29 (73)	30 (75)
Men, n (%)	12 (35)	18 (45)	11 (27)	10 (25)
URiM, n (%)*	N/A	N/A	28 (70)	26 (65)

^*Information on URiM participants has been collected only since 2018. Information for previous years is unavailable.

During the FIS Symposium, residents meet with their peers from other institutions, hear presentations from and interact with current PSDP fellows, and meet chairs and senior physician scientists from pediatrics departments across the United States and Canada. FIS participants from the 2019 meeting reported positive outcomes from participating in the Symposium, including the opportunity to network, establish future mentors, and gain invaluable information on various physician-scientist career paths. At the conclusion of the annual meeting, 27.5% of participating residents requested external mentorship from the PSDP alumni mentorship program, demonstrating the physician-scientist pipeline is strengthened by the joint efforts of the two programs. Although historically few FIS participants have gone on to apply to PSDP (5–7% overall), FIS is an important pipeline for the PSDP program, as 40% of PSDP awardees were introduced to PSDP through FIS.

Pediatric Scientist Development Program

The PSDP was also founded in 1987 as a collaborative venture between the NICHD and AMSPDC.⁸ The collaboration aimed to address concerns about the declining number of trained pediatric physicians who went on to become independent scientists. Since the program’s inception, PSDP has offered research support to MD, MD/PhD, DO, and DO/PhD pediatricians who aim to address central problems in child health. The program maintains its top-notch training and continues to produce a high proportion of independently funded physician-scientists due to continued support from the NICHD, the American Pediatric Society (APS), the American Academy of Pediatrics (AAP), March of Dimes, and the PSDP’s parent organization, AMSPDC.

The PSDP uniquely constitutes a national network of mentors and scholars who are selected based on the scientific merits of their research in basic, translational, or clinical investigation. Potential scholars are nominated by their department chair either during their final year in residency or during their first year of fellowship for subspecialties that have more than 12 months of clinical requirements. A Selection Committee comprised of pediatric department chairs and other senior pediatric investigators reviews the applications and identifies the next cohort of PSDP scholars. The program selects pediatric trainees with promising research potential and established research mentors and then matches them with established external mentors on the PSDP Steering Committee who represent leaders in top-tier research environments. PSDP scholars receive up to three years of mentoring and career development opportunities that promote the successful transition to independent academic research careers. The scholars’ first two years are funded by the NICHD and have traditionally been required to be free of clinical activities (i.e., 100% research effort). During the second year of PSDP support, scholars have the option of applying for a third year of research support from their sponsoring departments, in which up to 15% of clinical time is permitted.

Trajectory of PSDP Scholars

The PSDP has trained some of the brightest physician scientists throughout North America. As of June 2019, 92% of the 211 PSDP graduates work in academic pediatrics, and many lead their divisions, departments and institutes. Collectively, PSDP alumni have secured $533 million in NIH awards as principal or co-principal investigators, which represents an 8.8-fold return on the NICHD investment.⁹ As of 2017, 49% of PSDP graduates have been NIH-funded principal investigators. A summary of recent award types is presented in Table 2. Although data on other types of research funding are not yet available, the PSDP administration will launch an alumni survey which will capture current NIH support, rank, institutional and national leadership positions as well as non-NIH support such as foundation grants and other federal funding.

Table II.

Summary of NIH successes among PSDP alumni

Award type	Number (%)
Total number of graduates as of 2019	211
NIH-funded principal investigators	109 (52)
K Award recipients	77 (37)
Active awards	13 (17)
Completed awards	64 (83)
K-to-R conversion rate*	40 (52)
K-to-R01 conversion rate*	30 (39)
Among scholars who entered the PSDP during or after 2008
Total number of graduated scholars	62
DP2 NIH Director’s New Innovator	1 (2)
K02 Independent Scientist	1 (2)
K08 Clinical Investigator	13 (21)
K23 Mentored Patient-Oriented Research	1 (2)
K99 NIH Pathway to Independence	1 (2)
R01 Research Project Grant Program	4 (6)
R03 Small Grant Program	1 (2)
R56 High Priority, Short-Term Project	1 (2)
% NIH-funded PSDP alumni	20 (32)

^*Based on the number of completed K awards.

The FIS and PSDP program leadership team hopes to continue these successes. Yet, we recognize these programs must adapt to meet stakeholders’ needs and to diversify and expand the pipeline of pediatric researchers amid the changing funding and research landscapes. As an early step in this process, we set out to understand from pediatric department chairs how these programs currently serve their trainees, and how we might improve access to and participation in FIS and PSDP.

METHODS

FIS and PSDP program leaders developed a 38-item survey to assess the perceptions of the FIS and PSDP programs and barriers to participation. The survey was created in SurveyMonkey (www.surveymonkey.com; SurveyMonkey Inc.; San Mateo, California) and distributed via email to all AMSPDC members (N=168; 12 members in Canada, 156 members in the United States). The survey link was sent 11 times via email or e-newsletter between November 2018 and April 2019. Participation was voluntary, and respondents had the ability to skip questions and/or discontinue the survey at any time. Respondents had the option to submit their organization’s name in a separate survey for tracking purposes. To ensure each institution was represented only once, six responses were excluded from analyses: one response was from a self-identified emeritus chair, and five responses were duplicates based on IP address and department characteristics. In the case of duplicates, the most recent response in each set was included in analyses. Statistical analyses were completed in SAS Version 9.4 (SAS Institute Inc., Cary, North Carolina). Bivariate associations were tested using Pearson’s Chi-Square. Results were considered significant at p<.05. Exact p-values are presented because of small cell counts. This study was determined exempt by the Duke University Health System Institutional Review Board.

RESULTS

The survey was emailed to 168 active AMSPDC members. There were 66 participants, yielding a response rate of 42%. The mean tenure of responding chairs was 6.2 years (SD 5.0, range 0.5–26.0 years), and the median tenure was 4.2 years. A full summary of closed-ended responses is included in Table 3 and Table 4. Responses were not reported if fewer than 20% of participants responded (Supplemental Table 3). Sample characteristics are described in Table 3. More than half (65%) of responding department chairs identified as physician-scientists, and the remaining respondents (35%) identified as clinician-administrators or clinician-educators. The plurality of respondents chaired departments with large residency programs (39% had more than 25 new residents annually). Departments with larger faculty (p=.01), larger residency and fellowship programs (p<.001 and p<.001 respectively), and more research dollars (p=.02) were more likely to be chaired by a self-described physician-scientist (Supplemental Table 4).

Chairs were asked about their general perceptions of the decline in physician-scientists among pediatricians. More than 90% of respondents reported that this decline was concerning (32%) or very concerning (59%). The most commonly reported challenges for physician-scientist development were clinical demands (74%), lack of trainee desire (67%), and lack of departmental or institutional research funding (53%). There were some differences by department characteristics (Table 4). Lack of institutional infrastructure was less likely to be reported as a barrier by chairs who identified as physician-scientists and more likely to be reported as a barrier by chairs of departments with smaller faculty and fewer research dollars. Lack of mentorship was more likely to be reported by chairs of departments with smaller faculty size and fewer research dollars. Lack of ability to carve out research time during clinical training was more likely to be reported by chairs who identified as physician-scientists and those with less than $100 million in research dollars.

Chairs were also asked about their utilization and perceptions of the FIS program. Most responding chairs (77%) had nominated residents to FIS at least once. Nominations to FIS were not associated with having a physician-scientist chair or size of the faculty (Table 5). Although chairs of departments with larger residency programs and more research dollars were more likely to nominate residents to FIS, a high proportion of chairs from nearly all subsets had nominated residents. The most commonly cited barriers to resident participation in FIS were undefined physician-scientist career paths (47%) and lack of resident interest in research (32%). Several chairs also commented that the limited number of annual FIS slots (N=40) is a barrier to nominations and participation. To encourage participation, most responding chairs felt that FIS should expand the scope of its content to include more clinical (65%), health services (71%), and translational (70%) research.

Historically, few FIS participants (5–7%) have gone onto apply to PSDP. Chairs’ most commonly reported reasons for this low application rate from the FIS pool were the uncertainty of the physician-scientist career path (71%) and the belief that PSDP does not support the type of research residents wish to pursue (51%). Chairs were asked whether they believed that applications to PSDP might increase if FIS participants received mentorship from PSDP alumni. Nearly 70% of responding chairs believed that alumni mentorship could increase applications.

When asked about PSDP applications more generally, nearly one-third (N=21) of responding chairs have nominated trainees to PSDP, and of those more than half (N=13) have had funded trainees. Chairs of departments with large residency and large fellowship programs were more likely to nominate trainees to PSDP. However, nominees from departments with large residency and fellowship programs were not more likely to be funded (p=.84 and p=.17 respectively). When asked about barriers to nominations, a few responding chairs reported perceptions that PSDP fellows tend to be selected repeatedly from the same programs. Although more than half (56%) of responding chairs felt that the PSDP “no clinical time” requirement in the first two years of the program does not prohibit nominations, 43% of chairs did perceive it as a barrier, specifically because of the demands of clinical training (29%) and clinical coverage (29%), and because the requirement does not appeal to applicants (26%). Chairs responded that the subspecialties most commonly affected include neonatal-perinatal medicine (18%), critical care medicine (14%), and emergency medicine (11%). Furthermore, some chairs reported that access to their own institutional T32 and K12 programs preclude some PSDP nominations.

DISCUSSION

Emerging physician-scientists today must overcome multiple compounding hurdles to be successful. These issues are well recognized by trainees and represent barriers for career selection. Trainees are competing for limited resources with PhD colleagues who frequently have 6–8 years of professional research training, while they are closing their own research training gap after residency. A significant majority of MD-only trainees have at least some debt and often as much as a house mortgage. Family and caregiving obligations can interrupt research and career development for many physician-scientists, and women are disproportionately affected. Finally, though not restricted to physician-scientists, nearly all pediatric subspecialty trainees experience significantly lower salaries than general pediatricians, and the extended timeline of physician-scientist training and generally lower pay as assistant professors further accentuate this challenge. The survey findings here provided many valuable insights and actionable suggestions. The decline in pediatric physician-scientists is a common concern, and understanding the institutional and individual barriers to this career pathway is critical for reversing the trend. Although most chairs have nominated residents to FIS, there is a desire for expansion of the number of available slots and the scope of research represented. Similarly, the perception that PSDP supports primarily basic science research is another important barrier to address and may be mitigated by instituting PSDP alumni mentorship. Finally, there may be additional opportunities for the Steering Committee to address other programmatic and institutional barriers to PSDP nominations.

The majority of responding chairs expressed concern in the decline in pediatric physician-scientists. Although clinical demands present a major challenge to physician-scientist development, this is a complex problem that requires collaboration across research, clinical, and administrative leadership to design and implement creative solutions.¹⁰ Interestingly, though the size of the academic department was not associated with ability to carve out time during training, departments with research-intensive programs (greater than $100 million in total research funding) appeared better poised to meet this challenge. Our programming seeks to address the next common challenge—lack of trainee desire—through the FIS program by engaging academically-oriented trainees with peer and senior pediatrician-scientists and encouraging them to pursue research careers. Through our programming, we strive to engage trainees in addressing commonly expressed concerns about training duration, educational debt, strategies to choose strong laboratories and mentors and subsequently securing funding in the face of an increasingly competitive NIH landscape.^11,12 We address the third major challenge—funding—through PSDP by providing salary support during fellows’ first two research years. AMSPDC member institutions provide funding to third-year PSDP fellows in the critical fellow-to-faculty transition year, and PSDP continues to seek funding from partner organizations to support departments that may otherwise find it difficult to fund this important transition year. Finally, lack of mentorship was reported as a significant barrier by chairs of departments with smaller faculty and fewer research dollars. Both FIS and PSDP facilitate opportunities for trainees to connect with physician-scientists across North America in order to ensure trainees have access to leaders in their chosen field of research. Furthermore, PSDP can facilitate research training at an institution outside home institution, which could broaden the research base of pediatric departments nationally.

Through the FIS program, we aim to build the physician-scientist pipeline by generating interest in research careers. Although the program is widely utilized by the responding chairs, we still have an opportunity to bolster the physician-scientist pipeline across program size. As several chairs suggested, one way to do this would be to expand FIS so that more residents can participate, ideally one candidate annually for each residency program. Furthermore, we are working to address the perception that the scope of research should be broadened by diversifying the topics that pediatrician researchers will present. Moving forward, we will continue to invite speakers who engage in multidisciplinary research areas, including implementation sciences, and represent a diverse array of physician-scientist career paths as well as those who are typically underrepresented in research.

By engaging residents who are interested in research careers and connecting them with successful pediatric scientists through the FIS program, we aim to increase the proportion of FIS residents who apply to PSDP. As with FIS, there is a perception among department chairs that PSDP favors basic science research. Because PSDP is an NIH K12 award that fosters all types of research, we are aligning the FIS and PSDP goals to include broad basic, clinical, and implementation science across both platforms. Toward this end, we are actively engaging PSDP alumni to serve as external mentors for FIS resident attendees. We are currently connecting interested FIS participants with PSDP alumni mentors, and we will endeavor to pair residents with mentors who are interested in similar research domains. More than half (9 of 16) of committed alumni mentors are women, and we are hopeful this will continue to increase the pipeline of women physician scientists by connecting female residents with accomplished women who can help them navigate their research careers during major life transitions. Moreover, 10 of 18 senior pediatric researchers and department chairs on the PSDP Steering Committee who serve as external mentors for PSDP fellows are women. Through PSDP alumni and external mentorship, we also aim to rectify disparities in nominations to the PSDP by program size. We hope that connecting interested residents with PSDP alumni will encourage more PSDP nominations from departments with smaller programs, especially given that programs of all sizes experience successful PSDP funding outcomes.

Two additional barriers to nominations were reported in this survey. Responding chairs were divided over concern about whether the “no clinical time” requirement is a barrier to applications and nominations. This requirement was originally stipulated by the NICHD, yet the current NICHD program description allows for future opportunities to permit a small amount of clinical effort in the early years of the K12 fellowship. The PSDP Steering Committee will continue to discuss the merits and challenges of this requirement both internally and with the NICHD program staff. Finally, institutional K12 and T32 awards alleviate some of the financial burden of supporting fellows and preclude some chairs from nominating trainees to the PSDP. While subsequent NIH funding is higher among NICHD-funded K12 awardees, especially compared to T32 MD-only appointees,¹³ T32 awards can provide important and consistent subsidization of costs related to subspecialty fellows.¹⁴ Furthermore, the perceived benefits and prestige of a K12 versus a T32 training grant are debated; and the function of the current K12 award is one the Steering Committee will continue to assess prospectively.

There are some limitations to interpreting these results. The results do not necessarily reflect the experiences or opinions of the majority of AMSPDC members, as the response rate was 42%. Furthermore, there is the possibility of selection bias toward chairs from research-heavy institutions. Because the survey was anonymous, we were unable to compare the characteristics between responding and non-responding department chairs. However, we are encouraged by the diversity of responses to this initial survey. We also are conducting annual follow-up surveys of FIS trainees and are longitudinally tracking their subsequent professional development in order to assess their enrollment into the PSDP or other research focused fellowships and their professional pursuits as junior faculty. Furthermore, we are augmenting our tracking of PSDP alumni outcomes. We hope that by focusing on increasing diversity in FIS and link participants with strong PSDP alumni mentors, we will increase the pipeline of women and URiM physician-scientists into the PSDP and subsequently the pediatric workforce. These metrics and participant trajectories will be tracked using the updated FIS and PSDP alumni surveys. Using data from these surveys, we will continue to work with the Steering Committee to engage AMSPDC members as we plan for the future of these two programs.

CONCLUSION

We thank the AMSPDC members who took the time to respond to this survey. We appreciate the concrete suggestions for improving FIS and PSDP. Moving forward, we will continue to explore options such as increasing access to FIS, promoting the PSDP alumni mentorship program, and actively expanding the scope of research supported by FIS and PSDP. Furthermore, we will continue to discuss and survey PSDP fellows on the pros and cons of the “no clinical time” requirement of the PSDP and merits of a K12 versus a T32 training program with the Steering Committee. We will continue to assess FIS and PSDP access and outcomes in service of increasing and diversifying the pediatric physician-scientist workforce.

Table VI.

Sample characteristics

Characteristics	Number (%)
Total number of responses	66
Department chair career path
Physician-scientist (active)	22 (33.3)
Physician-scientist (former)	21 (31.8)
Clinician-administrator	11 (16.7)
Clinician-educator	12 (18.2)
Affiliation type
Academic health center	47 (71.2)
Free-standing children’s hospital	18 (27.3)
Number of full-time faculty
<50	3 (4.5)
50–99	15 (22.7)
100–149	13 (19.7)
150–200	11 (16.7)
201–300	8 (12.1)
>300	16 (24.2)
Number of new residents annually
<10	10 (15.2)
11–15	11 (16.7)
16–20	11 (16.7)
21–25	8 (12.1)
>25	26 (39.4)
Number of new fellows annually
<10	29 (43.9)
11–15	10 (15.2)
16–20	3 (4.5)
21–25	6 (9.1)
>25	18 (27.3)
Total departmental research dollars
<$1 million	9 (13.6)
$1–10 million	20 (30.3)
$11–50 million	24 (36.4)
$51–100 million	9 (13.6)
>$100 million	4 (6.1)
Departments with former PSDP fellows on faculty
Former PSDP fellows	14 (21.2)
No former PSDP fellows	50 (75.8)
Roles of former PSDP fellows
Active clinician	7 (10.6)
Active researcher	13 (19.7)
Division or section leadership	9 (13.6)
Department leadership	7 (10.6)
Organization leadership	3 (4.5)

Table VIII.

Proportion of departments that have nominated residents to the FIS and PSDP

Parameter	Nominated to FIS		Nominated to PSDP
	n (%)	P value	n (%)	P value
Total responding department chairs (N = 66)
Department chair career path		.14		<.0001
Physician-scientist (active or former) (N = 43)	38 (88.4)		21 (48.8)
Clinician-administrator/educator (N = 23)	13 (56.5)		0 (0.0)
Number of full-time faculty		.14		.004
<50	2 (66.7)		0 (0.0)
50–99	9 (60.0)		0 (0.0)
100–149	10 (76.9)		3 (23.1)
150–200	9 (81.8)		4 (36.4)
201–300	7 (87.5)		5 (62.5)
>300	15 (93.7)		9 (56.2)
Number of new residents annually		.04		.0007
<10	6 (60.0)		0 (0.0)
11–15	6 (54.5)		1 (9.1)
16–20	7 (63.6)		2 (18.2)
21–25	7 (87.5)		2 (25.0)
>25	25 (96.1)		16 (61.5)
Number of new fellows annually		.19		<.0001
<10	17 (58.6)		0 (0.0)
11–15	8 (80.0)		4 (40.0)
16–20	3 (100.0)		1 (33.3)
21–25	6 (100.0)		2 (33.3)
>25	17 (94.4)		14 (77.8)
Total departmental research dollars		.04		<.0001
<$1 million	3 (33.3)		0 (0.0)
$1–10 million	13 (65.0)		2 (10.0)
$11–50 million	22 (91.7)		9 (37.5)
$51–100 million	9 (100.0)		6 (66.7)
>$100 million	4 (100.0)		4 (100.0)

Table IX.

Departments that have nominated residents to the FIS and PSDP

Parameters	Total number	Nominated to FIS		Nominated to PSDP
		n (%)	P value	n (%)	P value
Total number of responses	66
Department chair career path			.14		<.0001
Physician-scientist (active or former)	43	38 (88.4)		21 (48.8)
Clinician-administrator/educator	23	13 (56.5)		0 (0.0)
Number of full-time faculty			.14		.004
<50	3	2 (66.7)		0 (0.0)
50–99	15	9 (60.0)		0 (0.0)
100–149	13	10 (76.9)		3 (23.1)
150–200	11	9 (81.8)		4 (36.4)
201–300	8	7 (87.5)		5 (62.5)
>300	16	15 (93.7)		9 (56.2)
Number of new residents annually			.04		.0007
<10	10	6 (60.0)		0 (0.0)
11–15	11	6 (54.5)		1 (9.1)
16–20	11	7 (63.6)		2 (18.2)
21–25	8	7 (87.5)		2 (25.0)
>25	26	25 (96.1)		16 (61.5)
Number of new fellows annually			.19		<.0001
<10	29	17 (58.6)		0 (0.0)
11–15	10	8 (80.0)		4 (40.0)
16–20	3	3 (100.0)		1 (33.3)
21–25	6	6 (100.0)		2 (33.3)
>25	18	17 (94.4)		14 (77.8)
Total departmental research dollars			.04		<.0001
<$1 million	9	3 (33.3)		0 (0.0)
$1–10 million	20	13 (65.0)		2 (10.0)
$11–50 million	24	22 (91.7)		9 (37.5)
$51–100 million	9	9 (100.0)		6 (66.7)
>$100 million	4	4 (100.0)		4 (100.0)

Abbreviations and Acronyms:

AMSPDC

Association of Medical School Pediatric Department Chairs

FIS

Frontiers in Science

NICHD

Eunice Kennedy Shriver National Institute for Child Health and Development

PSDP

Pediatric Scientist Development Program