PRIMARY HEALTH RESEARCH TRAINING   PROGRAM: DISCOVERY  THROUGH DIVERSITY
A description of the structure, expectations, and timeline of the combined Primary Care Research Institute and the HDRC Trainee Program – a training program under the HFHS Diversity, Equity, and Inclusion Initiative

Christine LM Joseph, PHD, MPH Director
cjoseph1@hfhs.org

Christine Cole Johnson, PhD, MPH Chair
Department of Public Health Sciences

Cheryl Miree, MS Administrative Director cmiree1@hfhs.org

A.	Description

Henry Ford Health (HFH) Health Disparities Research Collaborative (HDRC) Scholar Award (HDRC Scholar) is a two-year new investigator award for postdoctoral fellows and physicians-in-training (see Section C1) in epidemiology, behavioral science, health services research, social sciences, or relevant fields. The program is designed to increase the pool of new investigators from populations typically under-represented in biomedical research who have an interest in population health and health inequities. Working with the Department of Public Health Sciences (PHS) and HDRC members from other departments and institutions, HDRC Scholar will gain an in-depth understanding of research addressing existing inequities in health care and health outcomes. With the guidance of experienced HDRC researchers, the HDRC Scholar will be exposed to grant writing and proposal development, research methods, and manuscript development. The proposed funding cycle of two years means that program emphasis can change from cycle to cycle and will be based on the mentors available and their areas of expertise. Potential topics must fall under the umbrella of health disparities/inequities (including perceived racism, structural racism, and social determinants of health) and may focus on health behavior and behavior change, patient-centered outcomes research, health services research, research methods, patient/provider communication, and bioinformatics. These topics can be addressed within the context of specific disease areas, such as asthma and allergy, cancer, cardiology, HIV/AIDS, cancer or through a focus on specific areas, such as environmental health, infectious disease, primary care, pediatrics, and maternal and infant health.

B.	Henry Ford Health (HFH)

Henry Ford is based in Detroit, Michigan but since the 1970s HFH has developed clinical major (with Emergency Rooms) and minor satellites throughout the Detroit Metropolitan area, also bought or built hospitals that geographically cover the entire metropolitan marketplace. Metropolitan Detroit represents the social and medical challenges and opportunities faced by most US major cities with a population that is extraordinarily diverse in socioeconomic status, race, ethnicity, culture, education level, values, and religious beliefs with notably large numbers of African Americans, Eastern Europeans, Arab Americans, and a rapidly growing community of Hispanic/Latino Americans. Henry Ford investigators have capitalized on these resources for years.
HFH owns one of the largest Health Maintenance Organization (HMO) in southeastern Michigan, the Health Alliance Plan (HAP). Beginning in the 1980s, Henry Ford had the foresight to recruit a cadre of public health/population scientists who now have the largest amount of research dollars of any group in the institution. These scientists are also well connected nationally being among the founding members of such groups as the Health Care Systems Research Network, the Cancer Research Network, the Cardiovascular Research Network, and the Mental Health Research Network. The biostatisticians have also taken the lead as the Coordinating Center in major trials. HFH is a leading site for the Environmental Influences on Child Health Outcomes (ECHO) as part of the Children’s Respiratory and Environmental Workgroup (CREW) and is a site for the NIH All of Us Program. The Department of Public Health Sciences has a long history and commitment to community-based and clinical research.
Since 1915, all patients have received one medical record number that follows them for life. Henry Ford has had an electronic medical record since the 1990s and computerized databases with patient data since the 1980s. Thus, for many years we have been able with relative ease to define large patient groups by demographics and residence, or by disease. For our health plan members, we have all medical claims and pharmacy claims. The installation of EPIC, initiated and being completed in May 2014, has provided additional opportunities to improve research processes at HFH.
HFH already has a state-of-the-art single database and data management system with common data elements for various study projects, remote data capture (RDC) capability, and integration with electronic medical records (EMRs).
There has also been unfailing System investment in safety, quality, coordinated care, evidence-based medicine, and outcomes research at HFH. The vision for the System focuses on the individual patient and wellness. We believe HFH is an outstanding environment for training and developing investigators of the future. We are dedicated to the elimination of health disparities in our communities, and beyond.

While the HDRC Scholar program has been in existence, the Primary Health Research Training program is funded through the HFH Diversity, Equity, Inclusion and Justice Initiative (DEIJ), which began in 2021, and is nested within the DEIJ Research Pillar.

C.	Program Organization and Oversight

We are proposing an extension of the HDRC Scholar Program to provide multiple research skill-building opportunities for post-doctoral students and for physicians-in-training. Trainees will develop improved research and analytic thinking skills, receive coaching on written and oral scientific presentations, and gain an in-depth knowledge of epidemiology and public health. The successful candidate is supported for a period of two years. The components of the program include the Executive Advisory Committee chaired by the Director of HDRC, from which a Selection Subcommittee will be established to review candidate applications, an Assigned Mentor who will work closely with the Trainee to help him/her achieve their goals, and a Mentoring Committee that will include content and supporting research expertise (e.g., biostatistician). The Executive Advisory Committee, the Mentoring Committee, the Assigned Mentor, the HDRC Director, and the Public Health Sciences Department Chair, are all committed to helping the successful candidates accomplish the objectives of the approved research plan.

The proposed Primary Health Research Training (PHRT) program uses the basic structure of the Mentored Scientist Award which is in practice here at HFH. The program provides 100% effort of the applicant. Our proposal is based on components of this existing and successful program.

Dr. Christine LM Joseph, Senior Staff Epidemiologist and HDRC Director will have overall supervision of the Trainees under the new PHRT Program. She will establish and Chair the Executive Advisory Committee, will make the final decision
on the Assigned Mentor, will secure the commitment of the Mentoring Committee and will provide general oversight for all financial activities. Dr. Joseph will work with the PHS Department Chair, Christine Cole Johnson, PhD, to leverage Departmental resources and support as needed and to ensure the Trainee’s success (see Letter of Support). It is possible for the HDRC Director (Dr. Joseph) to serve as an Assigned Mentor.

C1	Eligibility. Candidates will be considered who meet the following eligibility criteria:

We will accept PhDs and/or health professionals who are interested in obtaining specialized training in outcomes research and have a strong desire to develop a career as an independently funded investigator.

□	Candidates should be within 7 years of receiving a terminal degree.
□	M.D., Ph.D., D.O. D.V.M. or equivalent degree at award activation. Candidates may not hold a postdoctoral/new investigator Award while enrolled in a graduate training program. This program is not intended for individuals with faculty/staff rank.
□	M.D. or M.D./Ph.D. with clinical responsibilities who hold a title of instructor or similar due to their patient care responsibilities may be considered eligible if they devote the agreed upon FTE to research training.
□	U.S. citizen or permanent resident
□	Individuals enrolled in a degree program (e.g., an M.D. working on a master's degree in clinical science) during the tenure of the proposed Award are required to have the agreed-upon protected time for the proposed research activities as documented by a letter from the department chair, with academic coursework constituting no more than 25 percent. At the time of award activation, the HDRC Trainee cannot be pursuing a doctoral degree.
□	Candidates should be from a population under-represented in the US biomedical, clinical, behavioral, and social science research enterprise, including Blacks or African Americans, Hispanics or Latinos, American Indians or Alaska Natives, Native Hawaiians and other Pacific Islanders, according to NIH Office for Scientific Workforce Diversity1.
□	Candidates should have a demonstrated interest in research involving health disparities/health inequities (including perceived racism, structural racism, and social determinants of health and other related areas).

  C2          Executive Advisory Committee.  An Executive Advisory Committee will be established for this program. Members of this Committee will include the HDRC senior advisors, faculty from HFH, and faculty from partner institutions. To serve as a member of the Executive Advisory Committee, the faculty member must be a population health scientist (or related field) with a faculty position at HFH or the partner institution at Level 2 or Level 3 (comparable to Associate or Full Professor), with an interest in health disparities/health inequities, and the willingness to commit appropriate time to Trainee development by serving on the Committee. In addition, members of the Executive Advisory Committee will ideally have a history of successfully completing, or significant involvement in, peer-reviewed funding (NIH, CDC, DOD or other funders), service as a reviewer on a review panel for one or more of these institutions, and at least 2 years formal mentoring experience. The Executive Advisory Committee will be chaired by Dr. Christine Joseph, Director, HDRC, and co-chaired by the PHS Department Chair, Dr. Christine Cole Johnson.
The Executive Advisory Committee may determine the topic areas that will be selected for recruitment of the Trainees. Ads will be posted based on the topics selected by the Executive Advisory Committee. The disciplines and content areas of interest therefore may vary from year to year. The Executive Advisory Committee also reserves the right to recommend candidates at their institution.
C3	Recruitment. To recruit candidates for the HFH-HDRC Award, we have many options available to us, including traditional strategies, such as placement of ads in population health and public health journals and on the HFH website, as well as tapping into our academic networks (e.g., Michigan State University, University of Michigan, Wayne State University, Eastern Michigan University), and our professional and social networks (e.g., LinkedIn).
C4	Process of selection. A subcommittee of the Executive Advisory Committee will review the application materials for each candidate and select no more than 5 top candidates based on (1) candidate qualifications, experience, and potential for success; (2) candidate interests in one of the health conditions/topics selected; and (3) candidate’s goals aligned with the HFH-Trainee objectives and the HDRC and HFH vision, mission, and culture. The top candidates will be interviewed virtually. The top 3 candidates may have a second interview. As a group, the Executive Advisory Committee will make a final recommendation to the HDRC Director.

D.	Program Start-Up

D1	General start-up. Upon starting in this position, the Trainee will first meet with Human Resources and PHS Administrators to review employee benefits and to sign the Confidentiality Form required for researchers in PHS. The Trainee will be oriented to personal computer facilities and resources (email, etc.).

D2	Assigned Mentor and Research Plan. The Trainees will be assigned to a faculty sponsor based on research interests. Together, the Assigned Mentor and the Trainees will develop a research plan for the two-year program with specific objectives for each year, followed by the steps that will be taken to help the Trainee achieve those goals, using the Mentoring Committee as a resource. The Assigned Mentor and the Mentoring Committee will work together to ensure the research plan is progressive and appropriate for the Trainee. The Trainee can take advantage of research already being conducted by the Mentor(s) or develop new research questions in a related area. The Trainee will be encouraged to develop manuscripts in their area of interest. (For example, once the Trainee has developed a research question under the guidance of the Assigned Mentor, the Trainee may begin with a systematic literature review and write a review article on the topic.) Items in the research plan should include an overview of the proposed research program; strategies for answering the Trainees research question, methods for implementing a specific research project (as is appropriate for the experience level of the Trainee, including an analysis plan as needed), proposed publications, and any proposed grant applications. Trainees and the Assigned Mentor may decide to develop an NIH-sponsored K- Award. The Trainee research plan will be presented to the HDRC Executive Advisory Committee and the Mentoring Committee within 90-120 days of the Trainee start date. The Executive Advisory Committee will approve the plan or request that the Trainee and Assigned Mentor incorporate recommendations from the Committee. The Trainee will have 30 days to incorporate modifications and recommendations from the Committee.

D3 Competencies. A set of core competencies will be developed for all Trainees and these competencies will be tailored to the prior experience of the Trainee. The Core Competencies will be adapted from the National Postdoctoral

Association2. Upon receiving the Award, each candidate will conduct a self-evaluation of existing skills using a straightforward assessment tool based on these Core Competencies. Along with the Assigned Mentor, the Trainee will identify areas on which the Trainee can focus to develop research skills by the end of the 2-year cycle. This will be referred to as exit competencies and will be incorporated into the Trainee’s Research Plan.

Core Competencies of the National Postdoctoral Association
1.	Discipline-specific conceptual knowledge
2.	Research skill development
3.	Communication skills
4.	Professionalism
5.	Leadership and management skills
6.	Responsible conduct of research

D4	Department Resources. Funding is requested to maintain an adequate level of resources for HDRC Trainees to develop and implement a meaningful and competitive product at the end of each year. This requires that Trainees work together with the Assigned Mentor and with the HDRC, under the auspices of the Department of Public Health Sciences, to develop the appropriate plan. Funding is requested for salaries of support staff (programmers, project coordination, statistical analysis), as well as computer facility charges (for computer resources and support), general office supplies, travel funds, and tuition. The latter is available to the Trainee for training to supplement the mentorship and support provided at HFH. This financial commitment increases the likelihood that the HDRC Trainee can successfully develop competitive products that can result in career growth and external funding.

E.	Responsibilities of the Trainee, Executive Advisory Committee and Assigned Mentor(s)

E1	Responsibilities of the Trainee. The Trainee is ultimately responsible for crafting and execution of the project through all phases of the Award including the drafting, editing, and finalization of manuscripts, grants, presentations, or other research products. It is the responsibility of the Trainee to:

a.	Use the Assigned Mentor as the central point of contact for the development of ideas, selection of appropriate content for the research plan and development of early drafts; the approval point for submission of materials to the Executive Advisory Committee; and the gatekeeper of any final manuscripts or grants for submission to professional journals or funders.

b.	Meet on a regular basis with the Assigned Mentor to discuss the plan, its development and progress, and when directed/suggested and agreed upon by the Assigned Mentor, meet with members of the Mentoring Committee and/or the Executive Advisory Committee.

c.	Submit their own, original work as appropriate to the conduct of research, and properly cite the works of others that inform written work.

d.	Obtain and maintain human subjects’ research certification and complete IRB proposal paperwork as necessary and applicable.

e.	Take personal initiative to move the project forward and to discuss with the Assigned Mentor and Mentoring Committee any problems that may arise. If there are issues that arise with the Assigned Mentor that cannot be resolved or that are best discussed with another person, the Trainee may opt to discuss them with the HDRC Director and/or Executive Advisory Committee.

f.	Provide updates according to the schedule for progress reports. The HDRC Trainee is required to meet three times per year with the Executive Advisory Committee to review progress. Prior to the meeting, the Trainee should submit in writing:
□	Any changes made to the approved research plan
□	
□	A summary of goals for the year
□	A review of any remediation plans
□	A summary of accomplishments and progress to date. (i.e., grants, publications, scientific recognition and service).
□	Plans for the upcoming quarter

The following activities are available to the HDRC Trainee and are recommended under the supervision and direction of the Assigned Mentor:

a.	Some HDRC Trainees will meet the requirements of Level 1 Scientists at HFH (i.e., PhD, MD, or equivalent degree with postdoctoral research experience and peer-reviewed publications from graduate and post-graduate studies); therefore, Trainees should plan to attend Peer-Mentorship activities for Level 1 Scientists at HFH. Although some Trainees may have less experience, these events will likely be beneficial even if the Trainee does not meet Level 1 Scientist criteria. Potential meeting topics include but are not limited to grant and manuscript writing, grant management (budgeting), building and keeping collaborations, grant and publication resources available at HFH and partner institutions, internal funding opportunities, interviewing, hiring, and managing staff, mock study sections, interacting with NIH Program Officers, diversifying your research portfolio, and academic appointments at MSU, WSU, or UM.

b.	Trainees should feel welcome to attend monthly journal clubs held by the Department of Public Health Sciences and the HDRC, as well as Grand Rounds or other presentations at partner organizations relevant to the Trainees research topic or ongoing research of the Assigned Mentor.

c.	Trainees should plan to attend and present their work at national/international meetings. This activity increases national and international visibility, allows interaction with established investigators (some of whom serve on national study sections) and enhances networking with peers. Program funding supports this activity.

d.	Trainees should take advantage of opportunities for didactic training at nearby academic centers, for example, course offerings at Michigan State University, or the University of Michigan Graduate Summer Session in Epidemiology. Program funding supports this activity.

E2	Responsibilities of Assigned Mentor. The Assigned Mentor is expected to attend all Executive Advisory Committee meetings including meetings occurring throughout the recruitment and selection phase and to attend all progress and update meetings for the Trainee. The Assigned Mentor will have agreed to a 2-year commitment in the mentoring and guidance of the Trainee. Once the research plan is approved, the Trainee and Mentor will be responsible for its execution. It is required that the Trainee and Mentor work closely together and meet regularly. The Trainee and Mentor may schedule a meeting with the Department of Public Health Sciences to orient the Trainee to services provided, staff assigned to the Trainee projects, and to answer questions about the research plan, as needed. Meetings with other Departments in the health care system are also recommended as needed. The responsibilities of the Assigned Mentor are to:

a.	Act as the Lead Mentor on the Trainee’s Mentoring Committee, making use of the knowledge and expertise available on the Committee.
b.	Assist the Trainee in identifying mutually beneficial research goals and provide advice and counsel in the development, implementation, and dissemination of the Trainee’s research plan.
c.	Meet weekly with the Trainee in the execution of the approved research plan.
d.	Review all work submitted (progress reports, papers, grants, etc.) to internal (Executive Advisory Committee) and external sources (all others) by the Trainee.
e.	Accompany the Trainee to all progress meetings.
f.	Develop a relationship with the Trainee founded on trust and mutual respect.
g.	Allow the Trainee’s ownership of their work and promote accountability.
a.	
h.	Regularly expose the Trainee to ongoing research occurring within the realm and direction of the Assigned Mentor, and other research projects deemed beneficial by the Assigned Mentor or the Executive Advisory Committee.

E3	Responsibilities of the Mentoring Committee. The Mentoring Committee should consist of a content expert, a biostatistician, and a methodologist. The charge of the Mentoring Committee is to provide guidance and counsel to the Mentees in alignment with that of the Assigned Mentor, contributing information on the selected topic/health condition, study design, and analytic approach. Committee members should also work with the Assigned Mentor to provide recommendations and guidance for successful implementation of the research plan, successful mentorship interactions, and professional decisions. Members of the Mentoring Committee should be prepared to assist the Assigned Mentor with problem-solving related to the mentoring process, including barriers to project implementation, or furtherance of the research plan. The Assigned Mentor and Mentoring Committee together will decide on regular meeting times.

E4	Responsibilities of the Executive Advisory Committee. Executive Advisory Committee members will be asked to attend the presentation of the research plan and at least one interim progress report meeting per year (for a total of 4 meetings over the 2-year period).
1.	In collaboration with the HDRC Director (Executive Advisory Committee Chair) and the other members of the Committee, members are required to provide timely and thorough guidance to the Trainee on the suitability and feasibility of the research plan as well as Trainee progress over the course of the two-year cycle via the avenues outlined in this document.
2.	While the review of Trainee work (e.g., manuscripts, abstracts, specific aims, proposal drafts, etc.) will be a priority of the Assigned Mentor and the Mentoring Committee, the Executive Advisory Committee members may also be asked to review these products in a timely manner.
3.	Executive Advisory Committee members will be asked to keep the HDRC Director (Executive Advisory Committee Chair) informed of feedback or guidance (from said Committee member) being provided to the Trainees
outside of the platforms outlined in this document. This is to help Trainees manage conflicting guidance or advice perceived to be outside the scope of the approved and agreed upon research plan.

F.	Timeline

Once on board, Trainees will have 3-4 months (90-120 days) to develop a research plan which is presented at the first meeting of the Advisory Committee. After presentation and feedback on the research plan, deliverables will be specified for subsequent meetings. At year end (12 months) the Trainee will present a progress report, and a review of plans and deliverables for the second year. The second year culminates with a capstone presentation to the Advisory Committee as well as invited experts, local colleagues, and guests.

Example Timeline for HFH-HDRC Trainee Program

	Written Report	
Meeting	
Month	
Year	
Attendees	
Year One						
Trainee starts			September			
Presentation of the Research Plan	√	√	December		1,2,3,4	
1st Interim progress report	√		April		2,3,	
Year-end progress report	√	√	October		1,2,3,4	
Year Two
2nd Interim progress report	

√	

√	

December		

2,3	
3rd Interim progress report	√		April		2,3,	
Final Report and Presentation	√	√	September		1,2,3,4 & invited guests	
1Executive Advisory Committee,  2Assigned Mentor, 3HDRC Director, 4PHS Department Chair or Representative

Cited:
1.	National Institutes of Health. Populations underrepresented in the extramural scientific workforce: Underrepresented populations in the U.S. biomedical, clinical, behavioral and social sciences research enterprise. 2020; https://diversity.nih.gov/about-us/population-underrepresented. Accessed March 2, 2022.
2.	Anestidou L. National Postdoctoral Association Core Competencies. https://www.nationalpostdoc.org/ Page/Organizations_Resource_Library. Accessed 03/21/2022.