Family medicine researchers play leading roles in many of the 38 institutions that have received Clinical Translational Science Awards (CTSAs). We have described the purposes, successes, and strategies for engaging in institutional CTSA applications in past Annals columns in 2007 and 2008.1,2 We refer interested readers to those columns and the cited references for rich sources of background material. NIH plans to award 50 to 60 CTSAs and applications for the next round due in October 2009. Our purpose here is to provide an update on family medicine participation in CTSAs.
We conducted a Web-based survey of the 145 Chairs of departments (which includes allopathic, osteopathic, and large regional medical center members of ADFM) in October 2008 and received responses from 69 departments (48%). Of these 69, 22 (32%) departments were in institutions that had been awarded a CTSA. The medical school in which the department was located was the lead institution in all but 1 case, in which the department was located in a collaborating institution. Of those who have not yet been awarded a CTSA, 44 (64%) had applied for a planning grant, and 17 received a planning grant. We conclude that a majority of the medical schools in this sample would like to obtain CTSA funding.
Among our respondents, family medicine faculty have leadership positions in 12—about one-third—of all funded CTSAs. These roles include leading units devoted to engaging the community in research, leading the development and implementation of practice based research networks, and directing training units in clinical translational research. Family medicine faculty also have important roles in bioinformatics, clinical trials, epidemiology, biostatistics, and knowledge translation components. In each of these instances, family medicine faculty contributed directly to the success of their institution’s CTSA application. In several cases, participation by family medicine was instrumental in achieving funding on the first submission, and in several additional cases family medicine participation was instrumental in getting funded on a revised application.
Despite these key roles, the majority of family medicine departments do not have substantive involvement in a CTSA. Either their medical school does not have a CTSA, or the department does not have faculty with the requisite experience to contribute meaningfully. In contrast to the first 2 rounds of CTSA applications, in which we learned of several departments with valuable research track records who, by their estimation, were not sufficiently included in their institutional CTSA proposal, none of the respondents to this survey indicated that they had not been appropriately engaged. Examination of the 38 funded CTSAs reveals that areas such as community engagement and practice based research, the primary components to which family medicine has made essential contributions, are important elements for successful funding in most, though not all, instances. Many respondents indicated that their institution, department, or both lacked the infrastructure to be competitive for these awards.
The original budgets for the CTSA were reduced, which affected 71% of our responding institutions. Somewhat to our surprise, only 40% of our respondents said that the budget cuts specifically impacted components that involve family medicine faculty. The often expressed perception that community engagement and practice-based research were cut more than other CTSA components was not supported by the responses we received. Of course, we do not know what the original allocation was relative to other components, and our anecdotal impression is that only some CTSAs have managed to support community engagement and practice-based research at levels adequate to build a robust infrastructure for research in these settings.
For departments that plan to participate in future CTSA applications, our respondents made recommendations along the following themes:
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Identify strengths that the department can contribute to a successful application.
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Focus on “T2” translation, especially community engagement, community based participatory research and practice based research.
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Educate the principal investigator through personal meetings and in writing about what you have to offer.
We would add that reviewing the applications of funded CTSAs, engaging funded CSA researchers as consultants, and approaching the CTSA process as team players are all potentially productive strategies. The CTSA Web site of the National Center for Research Resources of the NIH contains a plethora of information as well as links to all currently funded CTSA Web sites.3
A final strategy that we will mention is that 8 of our respondents indicated that they would be applying as a collaborative institution rather than as a lead institution. As mentioned above, 1 family medicine department is currently participating through a collaborative arrangement. This may be a productive strategy for departments that have a distinctive contribution to make, but are located in institutions that would not otherwise be competitive for a CTSA. Collaboration across institutions and between CTSAs is strongly encouraged as part of the vision of accelerating research findings into improved outcomes for patients.
- © 2009 Annals of Family Medicine, Inc.
