摘要：Objectives. We developed and evaluated a novel National Institutes of Health–sponsored Research and Mentorship Program for African American and Hispanic medical students embedded within the international, multisite HIV Vaccine Trials Network, and explored its impact on scientific knowledge, acquired skills, and future career plans. Methods. Scholars conducted social, behavioral, clinical, or laboratory-based research projects with HIV Vaccine Trials Network investigators over 8 to 16 weeks (track 1) or 9 to 12 months (track 2). We conducted an in-depth, mixed-methods evaluation of the first 2 cohorts (2011–2013) to identify program strengths, areas for improvement, and influence on professional development. Results. A pre–post program assessment demonstrated increases in self-reported knowledge, professional skills, and interest in future HIV vaccine research. During in-depth interviews, scholars reported that a supportive, centrally administered program; available funding; and highly involved mentors and staff were keys to the program’s early success. Conclusions. A multicomponent, mentored research experience that engages medical students from underrepresented communities and is organized within a clinical trials network may expand the pool of diverse public health scientists. Efforts to sustain scholar interest over time and track career trajectories are warranted. African Americans and Hispanics are underrepresented in the research workforce, but these groups are disproportionately affected by a number of conditions and diseases, in particular the HIV/AIDS epidemic in the United States. 1 African Americans account for approximately 13% of the US population 2 and 44% of new HIV infections 3 but only represent 7% of newly enrolled US medical students 4 and 1% of US medical school full professors. 5 Likewise, Hispanics represent 16% of the US population 6 and 21% of new HIV infections, 3 but only 9% of newly enrolled medical students, 4 and 3% of medical school full professors. 5 In addition, the low success rate for many minority subpopulations in securing research funding is thought to be associated with inadequate mentoring as determined by sophisticated methods of statistical concept mapping. 7 A key goal of the pilot program described herein is to develop mentoring strategies to enhance HIV science and career development of medical students early in their training. Despite high HIV/AIDS rates among African Americans and Hispanics, these groups are underrepresented in clinical trials of HIV prevention and treatment strategies. 8–10 Including African Americans and Hispanics in clinical trials is important because it is possible that immune responses to an HIV vaccine may vary according to race and ethnicity and underrepresentation may limit the generalizability of trial results in these populations. 11–14 In addition, increased participation may ultimately translate to greater acceptability and uptake of newly available products for the prevention and treatment of HIV/AIDS. One way to address the lack of African American and Hispanic participation in clinical trials is to increase representation of physician scientists from these communities. In one survey, 51% of African American and 57% of Hispanic physicians considered their race/ethnicity an important factor in helping patients overcome their reluctance to participate in clinical trials, compared with only 9% of Whites and 21% of Asians. 15 Underrepresented minority researchers are in a unique position to help address health disparities, enhance results dissemination strategies, and strengthen the public health impact of HIV/AIDS research. They may also have a better understanding of the participation barriers specific to underserved communities and may be more likely than their White counterparts to focus on issues that have disproportionate impacts on minority populations. In addition, these researchers are more likely to serve underrepresented minority populations in their careers 15 and are important role models for future minority physicians and scientists. Minority researchers are often able to identify pertinent research topics and unique interventions for their communities of origin 16 and can bring diverse perspectives, experiences, and values to research. There is evidence suggesting that diverse groups comprising members with varying perspectives outperform those that have members with more similar backgrounds and perspectives. 17 Capitalizing on the advantages that a diverse group of scientists can provide is particularly important in a field like HIV vaccine research because of its various challenges and complexities. Because racial and ethnic minorities are underrepresented in medical schools, health professions, 18 and in research careers, 19 scientists, educators, and policymakers have addressed potential barriers and possible solutions to overcome them to build the pipeline toward career development. 20 Despite recent improvements, research indicates that underrepresented minority students are still lost at every key transition point along the academic pipeline. 21 A recent study of medical students found that those from racial and ethnic minority backgrounds perceived having greater difficulty succeeding in academia, and desired more coordinated exposure to academic career paths and research training as well as enhanced infrastructure to support diversity and mentoring. 22 Although strong mentorship is critical to the success of trainees in academic settings, 23 formal mentoring programs for medical students are limited. 24 To the best of our knowledge there are only a few published reports describing mentoring programs for minorities in HIV science: an Internet-based program on NeuroAIDS translational research for pre- and postdoctoral fellows, 25 a research education training program on behavioral prevention targeting early career faculty, 16,26 and a training program for early career minority scientists in HIV prevention research. 27 This represents the first report of a mentoring program in HIV science for medical students from underrepresented diverse racial and ethnic groups. The HIV Vaccine Trials Network (HVTN), a National Institutes of Health (NIH)–sponsored clinical trials network dedicated to the search for a safe and effective HIV vaccine since 1999, focused on medical students for its first diversity pipeline initiative—a group at an important formative stage of training that may benefit the most from high-quality mentored research experiences as a way to spark interest in future research careers. 22 It is important for the HVTN to invest in the career development pipeline of future African American and Hispanic physician scientists with the goal of attracting them to careers in HIV vaccine research so they can inform the search for a safe and effective vaccine. We hypothesize that by leveraging existing HVTN resources and engaging with medical students early in their training and career development, we will be better able to attract and retain them into the HIV vaccine research field. In light of the fact that pressing biomedical challenges are increasingly being addressed by large, multidisciplinary scientific consortia, clinical trial networks are poised to offer student scholars a wide range of research projects under the guidance of their collaborating investigators. Network-based mentored research programs also promise research placements in diverse geographic settings, access to several ongoing research protocols and available data for analysis, basic science– as well as social and behavioral science–focused projects, and sufficient network administrative infrastructure and coordination to orient the students to HIV research and support them throughout their experiences. We describe the NIH-supported Research and Mentorship Program (RAMP) for African American and Hispanic medical students and present evaluation data to inform future program development. In 2005, the HVTN formed the Legacy Project with the goal of identifying and addressing barriers to increased participation of African American and Hispanics in HIV vaccine clinical trials. A Legacy Project external advisory committee postulated that a more representative scientific workforce could be beneficial, and recommended that the HVTN develop a program to attract a more diverse pool of researchers into the field at an early stage in their career development. The aim of RAMP is to attract African American and Hispanic medical students to the field of HIV vaccine research through a multicomponent strategy ( Figure 1 ). The development of RAMP was guided by formative in-depth interviews with 7 HIV/AIDS prevention researchers of color (Neva Pemberton et al., unpublished data presented at RAMP Advisory Board Meeting, November 3, 2010). This exploratory study identified factors that facilitated their career choices, emphasizing the need for strong mentorship and acknowledging the importance of building mentee self-efficacy, setting clear goals, and defining outcome expectations—central tenets of social cognitive career theory. 28 From its inception, RAMP has aimed to integrate the scholars into the academic and social systems of the HVTN and affiliated trial sites as a way to strengthen their commitment to future HIV research careers. The program actively encourages mentors to give mentees opportunities to build skills and achieve “early wins,” to clarify expectations, and to revisit goal setting by completing an individual development plan. Open in a separate window FIGURE 1— Program schema of the HIV Vaccine Trials Network (HVTN) Research and Mentorship Program (RAMP) for African American and Hispanic medical students. Note . (1) RAMP for African American and Hispanic medical students was advertised through all accredited US medical schools. (2) Mentor matching was based on scientific field of interest, geography, and other factors (e.g., personal attributes, academic performance). (3) Mentors and applicants developed a feasible research project aligned with the HVTN research agenda and wrote proposal with budget. (4) Scholars completed a baseline survey before beginning work or participating in training activities. (5) Projects were conducted at an HVTN domestic or international research site and were laboratory, social, or behaviorally based. (6) A signed individual development plan by scholars and mentors defined mentoring expectations and meeting frequency. (7) Scholars participated in several centrally organized trainings throughout RAMP on topics such as HIV vaccine science, cultural responsiveness, biostatistics, and article writing. (8) Scholars gave oral and poster presentations at HVTN conferences. (9) Follow-up surveys and interviews were conducted shortly after final presentations. Medical students in the United States receive support from RAMP to conduct research projects under the mentorship of HVTN-affiliated investigators on a variety of topics aligned with the HVTN’s scientific agenda. All RAMP scholars conduct their projects at a domestic or international HVTN research site and are encouraged to participate in site research activities, meetings, and trainings. Most students conduct projects in the summer between their first and second year of medical school or as a research elective during their fourth year (track 1) or as a dedicated research year either as a standalone research experience or as a component of a master’s or doctoral program (track 2). Scholars are awarded up to $20 000 for 8- to 16-week projects and up to $60 000 for 9- to 12-month projects. Funding supports research project costs, living stipend, travel, and conference attendance. Scholars also participate in several in-person workshops and webinars organized by the HVTN’s training program. Topics include cultural responsiveness in academic settings, professional development (e.g., manuscript writing, effective oral presentations), and scientific areas relevant to HIV vaccine research. All scholars are expected to present their research at an HVTN semiannual conference and are highly encouraged to submit abstracts and prepare manuscripts for submission to peer-reviewed journals. African American and Hispanic medical students who are US citizens or permanent residents and have matriculated at an accredited US medical school are eligible to apply for RAMP. A dedicated project manager who is extensively networked with HVTN-affiliated research mentors advertises the program, fields student inquiries, and works with applicants to identify the type of research they are interested in pursuing, discuss project ideas, and match them with mentors. Applications are reviewed and selected by a 13-member review board comprising program staff, HVTN investigators, research site coordinators, NIH project officers, and RAMP alumni. Reviews are based on several criteria including the merit of their research proposal originated jointly with their network-affiliated mentors, academic standing, and motivations to pursue a future career in HIV research. The HVTN Core Operations Center in Seattle, Washington, administers RAMP. A program leadership team with research, training, and mentoring expertise meets regularly to guide the implementation of RAMP. The RAMP project manager provides scholars and mentors information, guidance, and project support throughout the program. An HVTN evaluation project manager oversees evaluation activities. The HVTN investigator mentors are responsible for working with student applicants to define a project and write a research proposal application. Mentors receive training in best mentoring practices such as structuring mentor encounters and reviewing individual development plans. Mentors are also responsible for overseeing all aspects of the scholars’ research projects. Although the primary focus of the mentoring is research and training, most mentors also offer career advice, and discuss with mentees work–life balance and the value of professional networking. Primary mentors receive stipends of $1500 for 8- to 16-week projects and $10 000 for 9- to 12-month projects. Mentors represent several academic disciplines including social and behavioral science, laboratory science, clinical research, and clinical practice. Through RAMP, scholars are provided with an experience that mirrors that of applying for and conducting NIH-sponsored research (proposal development, competitive review, institutional review board submission, research implementation, etc.). Skills developed through this process will benefit scholars should they apply for NIH or other sponsor funding in the future. In addition, some projects involve the secondary analysis of data obtained through HVTN-conducted studies, providing scholars the opportunity to navigate the review and approval of research concepts by HVTN committees. Because HIV vaccine research requires multidisciplinary approaches, scholars have a variety of project options including social, behavioral, clinical, and laboratory-based projects. To date, scholars have conducted projects in basic science research (n = 3); HIV vaccine trial recruitment, participation, and retention (n = 6); and behavioral or psychosocial research (n = 4). It is notable that the majority of scholar projects focused on social and behavioral research questions. Scholar project selection may underscore the value of social and behavioral science for minority medical students interested in working in HIV/AIDS research, and the need to engage more investigators with social and behavioral science expertise as RAMP mentors.
