Health Disparities Research Curricula and Training Development
Recommendations From a National Institute of Neurological Disorders and Stroke Workgroup
Abstract
The national mandate to improve health equity in the United Sates is advancing. Racial and ethnic disparities in various aspects of health care have been clearly delineated, and sources of such disparities have been identified. However, implementing solution-focused interventions to eradicate such disparities, thereby achieving health equity in all US communities, has remained a daunting challenge, and no area more so, than with neurologic diseases. To assure success with bridging prominent disparities in neurologic outcomes, the pipeline of neurologic disparities researchers needs to be broadened, numbers of mid-career and senior disparities scientists sustained, partnerships with community stakeholders enhanced, incentivization of academic organizations pursued, education of all neurologic researchers conducted, and exemplary training of funding agency staff prioritized. To improve the current state of neurologic disparities, the National Institute of Neurological Disorders and Stroke assembled a working group of its advisory council. (2020–2022) to examine the state of health disparity training and research. Through consensus building, we present identified gaps and recommendations to the current state of underrepresented groups in medicine in health disparity research and its training and curricula in the United States.
Introduction
Healthy People 2020 defines a health disparity as “a particular type of health difference that is closely linked with social, economic, and/or environmental disadvantage.”1 On the contrary, the National Academies describe health equity as “the state in which everyone has the opportunity to attain full health potential and no one is disadvantaged from achieving this potential because of social position or any other socially defined circumstance.”2 Indeed, health equity requires targeted societal interventions to address previous and ongoing injustices and end health disparities. Health equity research investigates the contributions of the environment, social determinants, and other factors, which lead to differences in health outcomes.3 Such research seeks to identify evidence-based solutions to mitigate the unequal tolls of morbidity and mortality among underserved and vulnerable populations typically defined as racial and ethnic minorities, persons of low socioeconomic status, rural dwellers, and sexual and gender minority populations in the United States.3
Historically, Black or African American, Hispanic or Latinx, American Indian and Alaska Native, Native Hawaiian, and other Pacific Islanders have been continually underrepresented in the medical and biomedical sciences.4 The Association of American Medical Colleges reports that nationally underrepresented groups in medicine (URM) comprise approximately 8% of the US physician workforce (4% African American, 4% Hispanic, 0.2% American Indian and Alaska Native, and 0.1% Hawaiian/Pacific Islander).5 Among those with a medical degree, only approximately 2% report a career in research, and among MDs (or MD–PhDs) with NIH research grants, approximately 7% were awarded to URM. Only a 1.1% increase in African American matriculants has been observed between 1980 and 2016, falling short of reaching diversity in the physician workforce and clinical or biomedical concordance for URM.6 Demographic trends in medical student applicants and matriculants from 1978 to 2019 found URM remain well below the national Census.7,8
Gender diversity is also a recalcitrant problem in academia and could lead to missed opportunities in the retention of URM and training in health disparity research (HDR).9-11 Current trends to diversify the workforce in academia at the professor level estimate that parity between women and their male counterparts will take 50 years.5,12 Women make up more than 50% of PhD graduates in biomedical science disciplines, but make up only 40.6% of US biomedical tenure-track faculty, 27% of tenured faculty, and approximately a third of principal investigators on NIH-funded research grants.13,14 Furthermore, the Association of American Medical Colleges roster data show that Black and Hispanic women, collectively, make up only 3.7% of faculty across ranks and only 1.5% of full professors.15 Several studies have shown that more often than not, strong mentoring opportunities go to White men (the “rising star”) before women and URM faculty.11,16,17 Fostering a sense of connection and belonging and diversifying the academic medical centers have been shown to be supportive of URM minority women.18,19
In addition, recognition and increasing representation of URM women in journal editorial board, academic conference leadership committees, scientific journal publications, and scientific conference presentations is needed.20,21 This enhancement would create the opportunity for more diverse perspectives, provide more attention to issues that disproportionately affect women, and provide role models for younger generations, just to name a few benefits. Hence, the objective of this working group is to enhance concerted efforts to retain and provide opportunities for recruiting and training in health disparities research and in parallel to increasing individuals who have been URM to train in HDR.22 Addressing these important concerns is important not only from a social justice standpoint but for improving the overall health in neurologic conditions.
Methods
In 2020, a multidisciplinary expert panel of clinical and translational health disparity researchers across the United States was convened, as a working group of the National Advisory Neurological Disorders and Stroke (NANDS) Council, to examine the state of health disparity training and research through a series of structured remote working group meetings (2020–2022). The objectives of the working group were to advise, evaluate, and refine past recommendations made by a previous working group of the National Advisory Neurological Disorders and Stroke (NANDS) Council in 2010. The NINDS 2010 Strategic Plan had determined (1) specific request for applications, (2) sponsored workshops, (3) NINDS staff support, and (4) harnessing existing training mechanisms to train both early and midcareer investigators in health disparities research was needed.23 Review of the past strategic plan included examining the landscape of URM in HDR in neurology, available training and mentoring, retention, and the institutions that support it. The overarching purpose of the HD research training subgroup was to develop global guidance to national stakeholders dedicated to improving health disparity training and mentorship and increasing URM in HDR. This article reports the gaps found and agreed-upon consensus recommendations and suggestions by the working group to the NINDS.
Findings, Objectives, and Recommendations
Sections were conceptualized through consensus building. We outlined and organized our key objectives and recommendations into (1) Training and Mentoring Early Career Researchers, (2) Sustaining Mid-Career and Senior Researchers, (3) Incorporating Health Equity in the Conduct of Research, (4) Institutions and Organizations, (5) Historically Minority-Serving Institutions, (6) Community Partners and Stakeholders, and the (7) NIH.
Training and Mentoring Early Career Researchers
Objective: To develop earlier training opportunities that foster training in health disparities research and mentoring of URM.
The working group agreed that there is a persistent gap in training and mentorship of URM and as such should be top priority. This may be rooted in the timing of exposure to health disparity in medical school or graduate training. The current NIH definition of an Early-Stage Investigator is a new investigator who is within 10 years of completing the terminal research degree or within 10 years of completing medical residency or equivalent (grants.nih.gov/policy/early-stage/index.htm). The current definition bypasses interested individuals who are still undergoing medical or research training (i.e., medical school, residency, fellowship, or graduate). Our working group identified that earlier outreach is needed. Hence, the working group recommended the development of a new category, Very Early-Stage Investigator, which would allow opportunity for training and mentorship before terminal degree.
Many studies have shown that appropriate mentoring is foundational to URM faculty success, and it requires multilevel approaches.24,25 The working group agreed that effective mentoring must take into account the goals of the URM faculty and congruence to their personal needs, experiences, and goals. Mentors must address cultural values and life experiences in ways that build trust, equity, and transparency. Hence, the mentoring of URM expands beyond traditional mentor training. It not only requires mentor training but also institutional accountability.26,27
Enhancing physician and academic diversity should also parallel efforts in training and exposure to health disparities, social determinants of health, service learning, and cultural competence/humility. Consortia that engage students early in research in health disparities could be valuable in motivating both participation and seeking careers and mentorship in health disparities. Studies suggest that health disparities research education is best facilitated when there is congruence between research mentor and trainee.5 In addition, cross-cultural care training has been identified as an important strategy to help medical trainees deliver higher-quality care to socioculturally diverse patients.28
The working group also identified that training URM in HDR would require more than just sponsored workshops. Key topics in scientific training to address disparities and inequalities include research methods and skills related to social epidemiology, multistep modeling, care delivery, team science, leadership, community-based participatory research, stakeholder engagement, and implementation science.29-32 In our review, there are several existing training programs that currently foster opportunities to train in HDR, with 4 training programs that foster URM (Health Equity and Actionable Disparities in Stroke: Understanding and Problem-Solving (HEADS-UP), Training in Research for Academic Neurologists to Sustain Careers and Enhance the Numbers of Diverse Scholars, Harold Amos Medical Faculty Development Program, and Faculty Institutional Recruitment for Sustainable Transformation) and are summarized in Table 1. There are multiple funding sources including the NIH NINDS. The HEADS-UP, for example, is a collaboration between the NINDS and the American Stroke Association. The goal of the HEADS-UP is to address major disparities in stroke and foster faster translation of scientific results into routine clinical practice, while simultaneously developing the careers of early career scholars interested in pursuing careers in stroke disparities science. This model could potentially be expanded to other neurologic diseases. The NIH Clinical and Translational Science Awards programs also provide initiatives that support formal research training, implementation science projects, and translational science programs.33 Tables 2 and 3 are developed based on a review of the literature26,27,29-32 and expert opinion. Table 2 proposes an outline for a health disparities training curriculum for early career researchers, while Table 3 suggests potential outcome metrics for training early career researchers in health disparities. Additional opportunities include designating a number of R25s to train in health disparities research, across NIH Centers and Institutes, which could increase the number of URM graduates in the biomedical science fields.34,35
Mid-career and Senior Researchers
Objective: To sustain mid-career or senior career stage researchers who are primarily engaged in the conduct of high-quality health disparities research.
URM physicians and investigators are more likely to choose to practice in minoritized communities or develop careers in health-related disparities. While the pace of NIH training of URM physicians and scientists has increased substantially over the past decade,36 it has not kept up with the demand for a qualified workforce focused on dismantling the root causes of health disparities in NINDS-relevant priorities.
Beyond the issue of bolstering the pipeline of early career individuals interested in health disparities training is the issue of sustaining the numbers of mid-career and senior scientists and physicians engaged in health equity research. A common barrier includes dedicated protected time, which limits their ability to devote time and effort to pursue HDR.22 The working group noted an important mechanism that has been useful in supporting mid-career scientists. The Mid-Career Investigator Award in Patient-Oriented Research (K24) provides protected time to devote time to both patient-oriented research and to act as research mentors to junior clinical investigators (i.e., clinical residents or junior clinical faculty). However, the mid-career requirement limits the eligibility of more established investigators to mentor junior investigators. Additional limitations of this mechanism is that the K24 award is renewable only once and not specific to individuals interested in health equity research. Hence, the working group identified that new mechanisms should be developed to promote health equity research among established scientists and physicians, particularly those of URM background who have demonstrated record in advancing such research.
In addition, the working group recommended that a new NINDS-funding mechanism be available to support health equity–oriented research and mentoring programs to support junior investigators. This novel NINDS funding mechanism would have specific stipulations about the need to mentor scientists to become successful NINDS investigators and thought leaders in health equity research. It would also be characterized by specific provisions for curricula to support immersion of the mentorship team itself in the principles of health equity and community-engaged research and proven strategies to mentor junior investigators to develop successful careers in health equity research.
Furthermore, this mechanism would also specify rigorous metrics for ascertaining success in terms of the mentorship experience and in improving health equity in NINDS-related priority areas. It would also require that applicants demonstrate that the proposed training models and new curricula in health equity and community engagement research are grounded in existing educational theories and that consider the strength of successful NINDS-funded training and educational programs. Investigators would also need to show that applications were developed in direct consultation with appropriate stakeholders (e.g., community health champions, clinicians, and patient advocacy groups), representing the minoritized community experiencing the disproportionate burden of neurologic disorders.
Incorporating Health Equity in the Conduct of Research
Objective: To incorporate health equity in the conduct of research in neurologic diseases.
Historically, all investigators and key personnel complete Human Subjects training through the Health and Human Services (HHS) Office for Human Research Protections (OHRP),37 the Collaborative Institutional Training Initiative (CITI),38 or other approved training course. The HHS OHRP also offers other resources and frequently asked questions (FAQs) related to the inclusion of women, minorities, and individuals across the life span as participants in research involving human subjects.37
To enhance health equity, the working group recommends a required minimum course related to an overview of health disparities elements to consider in the design and conduct of human subjects' research. Lesson 1 of the HHS OHRP Human Research Protection Training is entitled “When HHS Regulations Apply” and lesson 2 is “What is Human Subjects Research?” Both modules offer insight into current regulations and when they apply and the definition of HDR. Additional recommended resources, FAQs, and training options would be specific to the type of research or type of neurologic disorder.
Some examples of methodology seminars include the following: developing projections of the number of participants by sex and race and ethnicity expected to be screened for eligibility for an observational study of a particular neurologic disorder based on estimated prevalence of that disorder by sex and race and ethnicity; what is a certificate of confidentiality and when/how can it be used; elements of community-based research and how to support and engage with a community advisory board; budgeting for and developing recruitment and retention strategies associated with special populations, for example, rural and urban communities, lower socioeconomic status, transgender and gender diverse, etc.39 For cultural competence in research training, the Good Clinical Practice training module “Cultural Competence in Research” (CITI program) could be helpful.38 The module is set to enhance the engagement of diverse populations and communities in research by presenting historical perspectives that have contributed to the challenges that researchers face today and ways to enhance healthy engagement.
All researchers would be directed to an NINDS website where webinars of interest led by other organizations would be posted, for example, the recent National Academies of Sciences, Engineering and Medicine Committee on Women in Science, Engineering, and Medicine's “Overcoming Barriers to Diversifying Clinical Trials.”40 These would include specific training opportunities and resources from such groups as the Society for Clinical Trials, other NIH institutes, HHS, Office of Women's Health, and American Academy of Neurology, among others. In addition, the HHS OHRP and CITI program may be able to develop and provide some training modules for all researchers. Joint modules could be created with the Patient-Centered Outcomes Research Institute.
Institutions and Organizations
Objective: To enhance the ability of institutions and organizations to develop and maintain an environment conducive to the growth and success of URM researchers engaged in health disparities research.
There is a paucity of well-known national comprehensive programs that seek to create sustainable health disparities research cultures at academic and medical institutions around the country.22 The Massachusetts General Hospital Disparities Leadership Program, for example, is an ongoing yearlong executive education initiative in the United States aimed at bringing healthcare leaders from around the country to improve quality, eliminate disparities, and achieve equity.41 The program involves an initial 2-day intensive training session focused on defining disparities and root causes, developing avenues to identify and eliminate disparities, and imparting leadership and change management skills. For the duration of the yearlong program, leaders work on health equity projects, diversity development issues, and community engagement challenges at their home locations. At the end of the program, there is an in-person closing meeting during which participants present their work and lessons learned and receive additional skill-building assistance. The American Academy of Neurology also provides specific opportunities to URM, which includes the Diversity Leadership Program. The program is designed to promote professional developmental experience and the development of critical leadership skills with the goal to enhance health disparity work (aan.com/education/diversity-leadership). The NINDS could develop and offer workshops for organization leaders and its funded PIs to learn best practices for developing and sustaining environments and cultures conducive for URM to fully engage in health disparities research. Moreover, the NINDS could partner with institutions to provide pilot funding opportunities, which incorporate expectations and milestones aimed at enhancing intracollaboration of investigators engaged in health disparities. Finally, the NINDS could routinely issue public recognitions of exemplary institutions and organizations making steady progress in developing HDR researchers and leaders or consider creating national scorecards that assess how well institutions receiving NINDS funding are doing regarding recruiting and retaining URM researchers engaged in health disparities research.
Historically Minority-Serving Institutions
Objective: To align historical minority-serving institutions HDR training curriculum with highly research-intensive institutions.
Applications from the 30 highest NIH-funded institutions have a higher likelihood of funding than those from institutions ranked 31 to 200.42 Applications from the 31 to 200 institutions are more likely to be funded than those from institutions ranked 201 and beyond. In all groups, a disparity is observed for Black applicants vs Non-Hispanic White and Asian applicants in the same institutional rank group.42 The NINDS could develop initiatives that facilitate partnerships between historical minority colleges and universities with highly research-intensive institutions (HMCU-HRIIs) around the country to allow a mutually beneficial exchange of information, expertise, and experience to generate health disparities research solutions for neurologic diseases, which disproportionately affect racial and ethnic minorities. There are several research gaps to be potentially filled. Just 2 of several examples include (1) the successful aging of racial/ethnic minority older individuals (especially those living in urban areas burdened by “geographic racism” in housing and medical care facilities) and (2) identification of the most common symptoms seen with Postacute Sequelae of severe acute respiratory syndrome coronavirus 2 by healthcare workers who serve minority populations. These include fatigue, gastrointestinal problems, mental health issues, sleep difficulties, impaired lung capacity, and what has been called “COVID Brain Fog” and loss of smell.
This NINDS HMCU-HRII initiative could be modeled after several previous successful or promising initiatives. First, the Research Centers in Minority Institutions (RCMI) program was established by the US Congress and implemented by the NIH's National Institute of Minority Health and Health Disparities to assist the implementation of biomedical research frameworks at minority-serving institutions providing doctoral degrees in a health-related science.43 RCMI institutions also engage in research on diseases, which disproportionately affect racial and ethnic minorities, people of low socioeconomic status, and rural dwellers.43 With coordinated assistance from the RCMI Translational Research Network (RTRN), the RCMI community is well placed to mitigate health disparities through its strategic liaisons with non-RCMI institutions. An evaluation showed enhanced links after RTRN, vs before RTRN. Interinstitutional coauthorship information revealed greater collaborations throughout the Network.43 Funding agencies could potentially incentivize these alliances and include benchmarks for research support that involves health workforce diversity and equity.
Other exemplary initiatives include the Marion Merrell Dow Visiting Scholars,44 which was a mentored travel scholarship for medical students funded by the American Academy of Neurology (e.g., Drew College of Medicine and University of California, Los Angeles) to attend and take free courses at the AAN annual meeting. An NINDS “Health Disparities Neuroscientists without Borders” initiative could invite previously funded SPIRP U-54 Principal Investigators (who are all at HRIIs),45 and all other currently or previously NINDS-funded investigators working on health disparities research, to serve as volunteer mentors for all junior faculty (Instructors and Assistant Professors) in both the basic and clinical science Departments of selected HMCUs. These junior scientists from URM minority racial and ethnic backgrounds would choose a mentor who most closely fits their research vision and challenges and then go on to apply for NINDS grants.
All the aforementioned initiatives would require the involvement of academic leaders at the historical minority colleges and universities and neurologic and other biomedical science department leadership at the highly intensive research institutions. NIH leadership and staff would have to determine the most appropriate funding levers for this type of initiative. To advertise and communicate the initiative properly, channels to consider could be Student Interest Group in Neurology chapters at HBCU Medical Schools; Student National Medical Association; American Board of Psychiatry and Neurology; American Academy of Neurology; American Neurological Association; members of national minority “Greek” Sororities and Fraternities; leaders from ALL minority-serving faith community organizations; the Montague Cobb Institute; National Medical Association; National Hispanic Association; US Public Health Service; and the National Black Nurses Association. Key outcome metrics to be evaluated would be the number of new race-ethnic minority individuals at the historical minority institution who apply for HDR grants, number of new race and ethnic minority individuals at the historical minority institution who obtain HDR grants, and type(s) of new HDR grants received by race and ethnic minority individuals at the historical minority institutions. All these efforts will require tailor-made infrastructure support and system-based changes based on level of involvement, nature of the networks, and availability of and access to appropriate resources.
Community Partners and Stakeholders
Objective: To train key stakeholders in the community who are integral to the successful conduct and dissemination of neurological disease disparities research.
It will be important to develop funding processes that address health disparities and community-engaged research, which actively involve community members as partners in the research planning, execution, and dissemination activities. Stakeholders in the community to be considered for training could be formal and informal leaders in medically underserved racial and ethnic minority communities, neurologic nonprofit organizations, and relevant staff within institutions managing overall research funding (e.g., ethics/institutional review board).
Current gaps related to the training of community partners as key research stakeholders include the following: funding for academic/community partnerships and training; length of time between application and funding; salaries/payment for time spent in training; available comprehensive training model and curriculum for training; research in the effectiveness of training community partners as “active researchers”; and knowledge and practices of institution—research offices, financial offices, institutional review boards (ethics), leaders of institutions, department chairs, researchers, research staff, and community partners.
There are several training models (Table 4) that could be adopted and adapted to train community partners in neurologic disparities research processes including the Community Engaged Scholars Program (CESP) at the Medical University of South Carolina South Carolina Translational Research Institute that was recognized as a “best practice” by the National Academy of Medicine.46 This program solicits small grant proposals from researchers and their community partners. The grants are scored by academic and community members and 2–6 are selected for funding each year. Before obtaining the funding, the academic and community partners participate in 10–15 training sessions related to research and community-based participatory research focused on working effectively together and with the proposed communities. Other colleges and universities have modeled programs based on CESP such as University of Delaware Clinical and Translational Research Center, Howard University and Xavier University in Louisiana in the United States, and University of Galway in Ireland. In addition, the CESP team has worked collaboratively with Community-Campus Partnerships for Health (ccphealth.org) and other Clinical and Translational Science Award Centers to encourage students and faculty to engage in community-based participatory research education and activities to address health disparities. Other academic institutions such as the University of Louisville and the University of South Florida offer faculty a guide (Community-Engaged Scholarship: A Faculty Handbook) for working with communities and students to develop community-engaged research and scholarship (usf.edu/engagement/faculty/facultyhandbook.pdf), while the Are We Ready? Toolkit: A Toolkit for Academic-Community Partnerships in preparation for Community-Based Participatory Research from the Medical University of South Carolina South Carolina Translational Research Institute (research.musc.edu/resources/sctr/programs/community-engagement/engaged-scholars) offers step-by-step methods for working collaboratively with communities on a specific research project.
NIH
Objective: To develop and sustain training of the entire ecosystem of NIH NINDS personnel in health disparities research
To truly make health disparities research a visible high priority and provide an example, it will be crucial for all NINDS personnel to be routinely exposed to formal training in the importance, principles, and practices of health disparities research. An NINDS staff health disparities research training curriculum, which incorporates self-assessment of cultural competence and implicit bias evaluation, would affirm the commitment of NIH to addressing structural racism in the biomedical research enterprise. In particular, bias awareness training for scientific review officers, reviewers, and study section chairs would be important, and the curriculum may include a range of nuanced case studies to raise awareness of potential biases and mitigation strategies for bystanders.47 These efforts would allow NINDS personnel to better draft program announcements, retain a diverse pool of study section members with pertinent expertise, partner with PIs on cooperative agreement funding mechanisms,48 and bolster recognition by the NINDS for work in health disparities research. Such training in health disparities research should be in the areas of clinical, translational, and basic neuroscience with dedicated workshops and online resources to support this endeavor. Encouragingly, in 2020, a health equity workgroup was created to educate the NINDS staff about issues related to health disparities and health equity. This group is composed of extramural and intramural NINDS staff, which meet every 2 months and host journal club discussions, invited talks (federal and nonfederal speakers), and reviews new NINDS initiatives and policies related to health equity. This laudable initiative should be formalized, expanded, and sustained.
At any given time, an NINDS staff member should be aware of the relevance of neurologic disparities research, prominent NINDS initiatives, and potential opportunities for that staff person to advance the mission in this area. Training of NINDS personnel in health disparities research should be conducted, and every new NINDS staff member should receive basic training. Program officers and major leaders may benefit from additional training specific to the area they lead.
Summary
Despite several potential target stakeholder populations for training programs to optimize health disparities research, there are too few dedicated training and career advancement opportunities in the field of health disparities research. Most suggested interventions should be aimed at the early career stage (postdoc, fellow, first few years of faculty appointment), but researchers at all stages and those who are URM need to be targeted for training opportunities. Starting early, keeping up the momentum, integrating health disparities research training into research program requirements, and involving everyone will be crucial in the battle to overcome disparities in the neurologic diseases. Key elements to be included in health disparities research training curriculum are social determinants of health; primary prevention; social epidemiology; implementation science; community-based participatory research; Team Science; Stakeholder engagement; leadership; and management. With finite resources, a deliberately thought-out plan for the next 10 years, which focuses on the highest priorities, leverages promising existing programs, adopts/adapts best practices from elsewhere, supports innovation, and incorporates tangible realistic outcomes, stands the best chance of achieving demonstrable success. While longer and more definitive outcomes are needed, there seems to be emerging evidence that early career development programs, especially for those URM, enhance the academic leadership prominence of diverse leaders doing health disparities research.49 Our subgroup of the NANDS Council Working Group for Health Disparities and Inequities in Neurological Disorders has come up with recommendations for NINDS with these issues in mind described throughout this study and summarized in Table 5.
Take-Home Points
→ As part of the 2010 NINDS strategic plan, major expert recommendations included making training in health disparities research a high priority, identifying staff members to be readily available to answer questions about training opportunities specific to health disparities research, and using existing training mechanisms to train both early and mid-career investigators in health disparities research.
→ While most current NINDS effort is targeted at the early career stage (postdoctorate fellowship and first few years of faculty appointment), there remain opportunities to target several other stages and stakeholders for dedicated and sustained training initiatives to optimize health disparities research in neurologic disease.
→ These other stages and stakeholders include very early trainees (doctoral students, clinical neuroscience house staff, mid-career/senior researchers, academic departments/heath systems, historically minority institutions, community partners, grant reviewers, and NINDS staff).
→ Moving forward, recommended key elements for inclusion into various NINDS health disparities research training curricula include information on health equity trends, social epidemiology, implementation science, community-based participatory research, multidisciplinary team science, multilevel stakeholder engagement methods, and diversity/inclusion leadership.
→ Beyond just using existing training grant mechanisms, center grants and conference grants, and partnerships with other NIH institutes, academic societies, and research-intensive institutions could be leveraged by the NINDS to create broader and more impactful training opportunities.
Glossary
- CESP
- Community-Engaged Scholars Program
- CITI
- Collaborative Institutional Training Initiative
- FAQ
- frequently asked question
- HDR
- health disparity research
- HEADS-UP
- Health Equity and Actionable Disparities in Stroke: Understanding and Problem-Solving
- HHS
- Department of Health and Human Services
- HMCU
- historical minority college
- HRII
- highly research-intensive institution
- NANDS
- National Advisory Neurological Disorders and Stroke Council
- NINDS
- National Institute of Neurological Disorders and Stroke
- OHRP
- Office for Human Research Protections
- RCMI
- Research Centers in Minority Institutions
- RTRN
- RCMI Translational Research Network
- URM
- underrepresented groups in medicine
Appendix Authors
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Copyright © 2023 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of the American Academy of Neurology. This is an open access article distributed under the terms of the Creative Commons Attribution-NonCommercial License 4.0 (CC BY-NC), which permits downloading, sharing, and reproducing the work in any medium, provided it is properly cited. The work cannot be used commercially without permission from the journal.
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Received: August 5, 2022
Accepted: May 9, 2023
Published online: August 15, 2023
Published in print: August 15, 2023
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