The mission of the National Institute of Dental and Craniofacial Research (NIDCR) is to improve oral, dental and craniofacial health through research, research training, and the dissemination of health information. The extramural research training and career development programs at the NIDCR are intended to prepare investigators for careers in oral, dental, or craniofacial research and to ensure that a sufficient number of talented and well-prepared investigators are available to meet the workforce needs of the research community.
The NIDCR currently offers individual pre-doctoral NRSA fellowships for PhD students (F31) and for dental scientists obtaining a PhD in addition to a DDS/DMD (F30). Institutional NRSA research training grants (T32) provide support for both PhD students and dual-degree trainees. Postdoctoral and postgraduate support is offered through individual postdoctoral NRSA fellowships (F32), institutional NRSA fellowships (T32), mentored career development awards (K08, K23, K25), and the Pathway to Independence Award (K99/R00), which replaces the K22 career transition award. Programs are also available for independent scientists to update their skills or make career changes (F33), to provide salary support (K02), or to provide protected time in order to focus on research (K24). This analysis focuses on the NRSA awards (T32, F30, F31, F32, F33) and mentored K awards (K08, K16, K22, K23, and K25).
We have reviewed the Research Training and Career Development programs supported by NIDCR to gain insight into their effectiveness in preparing scientists and dentist-scientists for research careers as evidenced by their successfully competing for independent research funding. This report summarizes our findings and makes recommendations for future training and career development efforts at the NIDCR.
The NRSA Training Program (T32), the NRSA Fellowship Program (F), and the Career Development Program (K)
An initial study of the NIDCR NRSA programs was conducted to compare the institutional training (T32) and individual fellowship (F) programs with respect to subsequent funding and professional career outcomes for former trainees. Using the NIH database, we determined the number of individuals who were supported by the T32 and F programs between 1995 and 2003, the number of subsequent research project grant (RPG) applications (including any R grant mechanism), the number of R01 or R01-equivalent applications, and the number of subsequent research grant awards (RPG and R01/R01-equivalent) for each former trainee. We also located as many individuals as possible with respect to their current professional positions using the NIH database, as well as PubMed and Google. Dr. Kevin Hardwick (Chief of the Research Training and Career Development Branch) presented these results at the National Advisory Dental and Craniofacial Research Council meeting held on June 23, 2008 (PowerPoint presentation appended). We have extended this study to include the Career Development (K) programs supported by NIDCR. The combined findings for both the NRSA and Career Development programs are summarized below. In addition, we have determined the current status of trainees who have completed dental scientist training programs (DSTP), and we have compiled training histories of current NIDCR R01 Principal Investigators (PIs).
Current professional positions of NRSA Award Recipients
A total of 691 individuals were supported by NIDCR NRSA awards (Ts and Fs) over the time period 1995-2003. Of those, 46 are still in training and 79 could not be located, resulting in inclusion of 566 individuals for this study. The fraction of those holding full-time positions in academia or industry was compared to those in private practice or “other” occupations, including consulting, working for non-profit organizations, and attending medical school. We found that 75% of all NIDCR NRSA recipients are currently engaged in academic/industrial activities, while 55% of those with a dental degree fell into that category. These data did not address how many individuals are conducting independent research equivalent to an academic tenured, or tenure-track position.
To obtain additional information on the career outcomes of former trainees, we took advantage of data from the annual survey of US dental schools conducted by the American Dental Education Association (ADEA). These surveys report on the professional status of faculty members with regard to a number of parameters including employment level and tenure. Working with ADEA, we compared the names of NIDCR trainees (T, F, and K) who were supported between 1995 and 2006 to the ADEA survey data (1995 to 2006). We identified a total of 312 matching names representing the subset of our T, F, and K trainees who were members of dental school faculty during that time period. Where there was a match in more than one year, the most recent information was used. This information provided a general indication of how those trainees have fared in academic careers. A total of 122 T32 recipients, 22 F recipients, and 88 K recipients had matches in the ADEA database for employment status. Figure 1A shows the percentage of dental school faculty with a history of NIDCR training support from each of these groups who were employed full time, part time, or as volunteer/adjunct faculty members. A higher proportion of faculty with prior K awards (82%) were in full-time employment as compared with faculty who had prior T (64%) or F (59%) support. Faculty members who had prior T support were those most frequently employed part-time (30%). Tenure status was also analyzed from the survey data for a total of 114 former T32 trainees, 21 F fellows, and 83 K awardees. Figure 1B shows that 56% of the K awardees, 42% of the F awardees and 35% of the T awardees occupied tenured or tenure-track positions. Thus, faculty who are former K awardees have been the most successful as judged by full-time tenured/tenure-track employment, followed by the F fellows, then the T trainees.
Success in obtaining subsequent NIH grant support
One significant measure of success as an independent research scientist is the ability to obtain independent research funding. We examined the success of our trainees in obtaining any subsequent research project grant (RPG) support from NIH, or success in obtaining an NIH-funded R01 or R01-equivalent grant. For all NRSA (T, F) recipients from 1995-2003, 5% have been successful in obtaining a subsequent R01/R01-equivalent award. Comparison of the training, fellowship, and career development programs shows that 10% of the trainees (T32) obtained a subsequent RPG from NIH, and 4% obtained an R01 (Table 1). Those supported by individual fellowships were more successful, with 24% obtaining subsequent RPG NIH support, and 13% obtaining an R01. Career development award recipients (1997-2008) were the most successful, with 51% receiving a subsequent RPG and 29% receiving an R01.
Table 1 also divides each of these groups into those earning DDS, DMD, or dual degrees (DDS or DMD/PhD) and those who have not received a dental degree. For former T32 trainees, 3% of those earning a dental degree and 5% of those who have not received a dental degree have received R01 awards. For individual fellows, the data showed again that 3% of those receiving a dental degree were successful in obtaining a subsequent R01 award, in contrast to 19% of those not receiving a dental degree. For the career development trainees, 21% of those receiving a dental degree and 48% of those not receiving a dental degree have competed successfully for an R01.
We looked at the K16 Dental Scientist Award (DSA) recipients separately because this program was an institutional award used to support development of clinician research scientists through doctoral-level (Ph.D.) and clinical specialty training for individuals with dental degrees. This award mechanism is no longer active, but 185 candidates completed the program between 1985 and 2002. Twenty-five percent were subsequently successful in obtaining an RPG, 16% obtained an R01, which is similar to the percentage for other career development trainees, who have earned a dental degree, in obtaining R01 support (21%).
NIDCR Investment in Training and Career Development
From a broader perspective, since the purpose of the training and career development programs is to produce oral and craniofacial investigators with independent funding, the success of the training and career development programs was examined in terms of the Institute’s budgetary investment in the T32, F and K programs. In fiscal year 2007 (FY07) the NIDCR spent 3.9% of the total NIDCR extramural budget on T32s, 0.5% on Fs, and 3.2% on Ks (Table 2). The comparable mean values across all NIH Institutes are 2.8% on T32s, 0.5% on Fs, and 2.7% on Ks. The National Institute on Deafness and Other Communication Disorders (NIDCD) spent 2.3, 1.7, and 2.2%, while the National Institute on Alcohol Abuse and Alcoholism (NIAAA) spent 2.3, 0.8, and 3.3%. Thus, the NIDCR commits a higher proportion of its extramural budget to training than does NIH overall or do other Institutes with similarly sized annual budgets. The NIDCR devotes about the same fraction of its budget to fellowships as does NIH overall (and somewhat less than NIDCD and NIAAA), while spending slightly more on career development awards than NIH overall (1% more than NIDCD and 0.1% less than NIAAA). The amount budgeted to these programs is, of course, dependent on several factors, including the respective missions of the institutes and the expectations for eventual career outcomes for the recipients.
The Dental Scientist Training Program (DSTP)
Opportunities for combined (simultaneous) DDS/PhD training have been provided largely on an ad hoc basis since the early 1960’s. There is evidence that at least 21 U.S. dental schools offered some type of combined D.D.S./D.M.D.-Ph.D. program in the early 1990s. More formal support was initiated in 1995, when institutional T32 support for an integrated dental and graduate research training program leading to both the DDS/DMD and PhD degrees began. The NIDCR Individual NRSA Predoctoral Dental Scientist Fellowship (F30) was introduced in 1997. These fellowships broadened the reach of the program by providing individual fellowships to dental scientists at any dental school in the US, rather than restricting support to those at institute holding an institutional T32.
In 2000, a Dental Scientist Training Program (DSTP) was incorporated into the Comprehensive T32 Institutional Training Program. The overall goal of the Comprehensive T32 program is to support flexible, cross-disciplinary, comprehensive training for pre-doctoral, post-doctoral and short-term trainees. The objective of the DSTP program is to train and develop clinician-scientists capable of understanding and pursuing oral health research from both the basic and clinical perspectives. The DSTP is envisioned as providing an alternative approach to expanding the cadre of well-trained oral health researchers by stimulating and supporting early commitment to research careers by outstanding dental students. The approach was modeled after the highly successful Medical Scientist Training Program (MSTP) (supported by the National Institute of General Medical Sciences, NIGMS), which enables trainees to pursue the MD and PhD degrees concurrently in an integrated, interdisciplinary program.
We have reviewed the status of the NIDCR-supported dual-degree trainees and fellows. To date, 29 individuals have completed their DDS and PhD training. Of those 29 individuals, 11 were supported solely by NIDCR institutional training grants, 12 were supported by individual fellowships, and six started on a T32 and then were successful in obtaining individual F30 funding. We determined the current position of each trainee and subsequent grant application history (Table 3). Six are now in private practice, fourteen are either in residency training or in a combined residency/postdoctoral program, eight hold academic research and/or faculty positions with at least part-time research, and one is in medical school for oral and maxillofacial surgery. Three of these individuals have applied for career development (K) awards and two have been successful. None has applied for any type of NIH research project grant.
The Training History of Current NIDCR R01 Principal Investigators
If we define success in establishing a research career as the ability to successfully compete for R01 funding from NIH, then the research training history of current NIDCR R01 PIs may indicate what types of programs lead to the most successful independent researchers. Therefore, for all principal investigators (PIs) of NIDCR R01 grants in FY2007, we determined whether they were formerly supported by any NIH training mechanisms and, if so, whether they were supported by NIDCR training or career development awards.
Table 4A shows that there were 391 PIs holding R01 grants funded by NIDCR in 2007. Of those, 173, or 44%, had previously been supported by any NIH training program (Table 4A), and 69, or 18%, had been supported by NIDCR training programs (Table 4B). Thus, the majority of current NIDCR R01 investigators are not alumni of NIH or NIDCR training programs. In order to establish whether NIDCR training and career development programs have had a differential impact on those with an earned dental degree compared to those without, we analyzed separately the data for those R01 PIs who hold a DDS/DMD, with or without a PhD. Our findings show that there were 104 dentists, 84 of whom also hold a research doctorate (Table 4B). Forty-six (Table 4A, column 2), or 44%, of dentist PIs were formerly supported by NIH training mechanisms, and almost all of those, 44 (Table 4B, column 2), or 96%, came from NIDCR training programs. Table 4C a shows the percentage of total NIH training or career development award recipients, among current NIDCR R01 holders, who were supported by the NIDCR for training or career development activities. For non-dentists (PhDs, MDs, DVMs), 12% of T recipients, 15% of F recipients, and 38% of K recipients were supported by the NIDCR for some or all of their training, while for dentists or dual degree (DDS or DMD/PhD) holders, 81-85% of former T recipients, and 100% of F and K recipients were supported by NIDCR for some or all of their training.
Summary and Conclusions
Based on the data that we have collected for the institutional (T) and individual (F) training awards, it is clear that those trainees who are supported by an individual fellowship are more likely to experience subsequent success in obtaining independent NIH research funding, particularly with respect to R01s, than those supported by an institutional training grant. This finding is consistent with historical NIH-wide data. The mentored career development (K) trainees are even more likely to go on to future success with independent funding, which is not surprising since they have been selected at a later stage of their training and are more committed to research careers. Thus, from the perspective of likelihood of future success in securing NIH funding, the K recipients are generally the most successful followed by the F recipients, then the T recipients.
The ADEA faculty surveys provided additional information on the professional status of a subset of the individuals supported by the NIDCR training and career development programs, specifically those faculty members from dental schools responding to the annual ADEA survey. In agreement with the trend observed for the subsequent funding of NIDCR trainees, those formerly supported by K awards are the most likely to be employed full-time in a tenured or tenure-track position at a dental school, followed by those supported by Fs, and then those supported by Ts.
The NIDCR spends a larger percentage (1.1% of budget above the NIH average) of its extramural budget on institutional training grants than do most of the other NIH institutes and centers, while spending an average percentage on individual fellowships, and a moderately larger percentage (0.5% of budget above the NIH average) on career development awards. Taken together, the relative likelihood of success and the proportion of the NIDCR extramural budget devoted to these programs argue in favor of expanding the individual fellowship (F) and career development (K) programs, while scaling back and refocusing the T32 program.
The retrospective training history of current NIDCR R01 PIs provides a picture of how NIDCR and/or NIH training programs have contributed to the careers of successful dentist and other principal investigators. Only 40% of all NIDCR R01 PIs who are alumni of an NIH training program were supported by the NIDCR. Of those without dental degrees, 20% were trained by the NIDCR, but for dentists, 96% of those with NIH training support were trained by the NIDCR. While the actual number of investigators is small, the results suggest that the NIDCR is the primary source of training support for our dentist PIs, despite the fact that few who are trained by the T or F programs actually progress to an R01-supported research career. This argues for the importance of continuing to provide training opportunities for those with dental degrees.
It is also clear that non-dentists emerging from NIDCR training programs are more successful than dentists in obtaining subsequent R01 awards. These candidates provide a potentially rich source of future oral health researchers. Offering new programs to recruit and train PhD students and postdoctoral fellows trained in other areas of biomedical research to dental and craniofacial research careers may be a fruitful approach to tap a robust source of new independent investigators for the NIDCR.
It is premature to draw any conclusions about the Dental Scientist Training Program (DSTP) because many of these individuals are still in residency or postdoctoral training. However, we are concerned that not one of these trainees has submitted an application for any R mechanism grant. We will continue to monitor the careers of the individuals supported.
Proposed Model for Training and Career Development Program Enhancements at the NIDCR
NRSA Institutional Training Grants (T32)
The data that we have collected support the conclusion that this training mechanism is not the most successful approach to developing new talent likely to progress to funded independent positions as principal investigators. We propose the following steps to enhance NIDCR’s overall training and career development program:
- Reduce the number of training slots in the T32 program, thereby reducing the proportion of the NIDCR budget devoted to institutional training grants, and aligning more closely with the NIH average. As the number of T32 training positions decreases, more emphasis would be placed on identifying programs with a strong record of recruiting, selecting and training individuals who are entering careers in oral, dental and craniofacial research.
- Reissue the institutional training grant program as a T90/R90 mechanism that will allow support of foreign-trained, non-US-citizen dentists for Ph.D. degree and postdoctoral training. This pool of talented young investigators has not been tapped because of restrictions on the standard NRSA programs and we believe that these individuals could significantly enhance the value and outcome of the institutional training program.
- Continue to utilize the institutional training program to support DSTP trainees and PhD training for individuals already holding a dental degree. Although it is premature to assess outcomes of the relatively new DSTP program, it is clear that the most successful dentist-PI NIDCR R01 recipients have been trained by NIDCR training mechanisms and it is important to continue to offer this type of support to dentists with the most potential for a successful research career, particularly since they have not been obtaining training support from any other NIH institutes.
NRSA Individual Fellowship Programs (F)
Our examination of individual fellowship awardees indicates the likelihood of a more favorable outcome for these trainees in terms of subsequent funding success. We have recently enhanced our efforts to provide more individual fellowship training by joining the NIH-wide Program Announcement to support predoctoral PhD trainees on F31 fellowships. We propose to increase the number of funded fellowships, to improve publicity and marketing to encourage more applications to all of the F mechanisms offered by the NIDCR, to limit the time of support on an institutional T32 to 3 years (except under exceptional cases and for DSTP trainees) and to increase the fraction of the extramural budget devoted to these programs, as appropriate.
Career Development Programs (K)
- The current mentored training programs offered through the K mechanisms are demonstrating a reasonably good outcome in terms of return on investment and eventual R01 success. Because the K99/R00 transition to independence award has only been in existence for two years, it will be several years before we can assess trainee outcome. In the meantime we will continue to provide K08, K23, K25 and K99/R00 training opportunities and encourage investigators to take advantage of these types of support.
- The majority (73%) of our current R01 PIs are not dentists and there is a much larger pool of these researchers than those with dental degrees. Thus, the larger community is a potentially valuable source of new investigators in oral health. To attract these individuals to pursue research topics relevant to the mission of the NIDCR, we propose to explore potential mechanisms for supporting non-dentist PhDs to receive two years of training in an area of oral pathobiology.
- Evidence suggests that dentists are not as successful as those without dental degrees in obtaining independent research funding. For example, many of our dual degree trainees have not been competitive in the K99/R00 program, which is open to all PhDs. One theory for the lower success rate of dentists in obtaining subsequent grant funding is that many do not have a dedicated period of postdoctoral research training, as do their non-dentist PhD counterparts. Most dentists, including dual degree dentists, combine clinical residency and postdoctoral research experiences. We propose to reintroduce the K22 award specifically for dentists to pursue a rigorous mentored postdoctoral research experience in the first phase, followed by independent tenure-track support in a second phase. Such a dedicated K22 would provide the support for dental scientists to obtain the postdoctoral training they need to be more competitive for subsequent independent awards.