Where we excel in research and where we need to grow

In my recent post assessing our education mission I said that most of us chose careers at an academic medical center because of a passion for education that is just as important to us as our call to clinical work. That education most of us provide is clinically focused. We want to address immediate patient concerns, and we want to make sure those methods of care are understood and reproducible by the next generation of physicians. But there is also a significant cohort among our faculty who are also interested in what the care of tomorrow should look like. Those methods are informed by an incredibly diverse range of research, discoveries that include immediate results from the bedside such as in clinical trials and others at the bench, unraveling mysterious biochemical mechanisms or the ways in which systems interact. The scope of research within Internal Medicine is vast. We are changing so much more than the kinds of medicine people receive with our discoveries; we even change the way in which that care is delivered, increasing patient and clinician safety in efficient ways that benefit the entire health care system.

The painstaking work of research is itself not always efficient though. Producing reliable results with rigor that hold up to peer-review can be resource-intensive, both in funds and in time. Some questions take years or even decades to resolve into the shape of an answer and sometimes all one might end a successful experiment with are new questions to answer. But that is good science, and for something as important as human health, good science—and the education of others in that work so that it continues past us—affords no shortcuts. One measure of whether a department, college, or institution is doing good science is in publications. When it comes to peer-reviewed manuscripts being accepted into circulation by respected journals with measurable impact, we are doing pretty well! Each year for about the last ten years, we add between 1,000 and 1,100 new publications into the academic discussion. That averages to almost 3 publications per faculty member per year, a rapid pace.

Of course the measure over which we are more commonly held to account are the dollars of research funding we bring in. By this score, in total dollars, we are more than holding steady. From Fiscal Year 2022 to FY23 our department increased its total extramural funding from $103.7M to $111M. That increase was largely due to a nearly $10M increase in funding for clinical trials and more than $3M in funding from the Department of Veterans Affairs. Those successes helped make up for a $1.7M drop in non-VA federal funds, most of which were NIH grants. That last number, how much we receive in funding from the National Institutes of Health, is unfortunately the most used measure when we are compared to other institutions. There is no other way to say it; in those rankings, by that measure, we are losing ground. The University of Minnesota, one of our peer institutions, may only be 5 places ahead of us in the Blue Ridge rankings, but more than $20M separates our two Departments of Medicine in NIH funding.

It can be noted that the Blue Ridge score only looks at NIH grants. They do not factor VA grants or funds from the Department of Defense, two federal agencies we have long relationships with. But protesting does not raise us higher on the list. So what are we doing well and what can we do differently to bring us closer to our peers?

Despite the slowing of research activity caused by COVID-19 and the subsequent reductions in workforce due to departures, we have held steady and even rebounded. We continue to recruit scientists to Iowa with R01s and more notably we continue to coach up scientists into successful R01 applications. Late last month we learned of an R01 recently won by Dr. Elissa Faro for a project in implementation science in collaboration with other Midwestern schools to improve new mothers’ mental health during those challenging and often lonely first months post-birth. We also checked in on Dr. Sanjana Dayal, whose R01 funding research into COVID-19 thrombosis has resulted in a new and promising publication. Each of those researchers would be the first to admit that they have benefited from strong mentoring here at Iowa. My thanks and congratulations in these two cases to Drs. Heather Reisinger and Steven Lentz, two generous scientists who continue to produce tangible results with their input.

Mentoring is an important component for how we will grow, and we have already solved this puzzle that other schools have not. In every division in our department at least one researcher currently holds either a K-award or some kind of Career Development Award, typically the last step before acquiring their own R01. There are 24 in fact within our department from various NIH groups, the VA, the American Heart Association, and the American Society for Clinical Oncology. Just this week we learned of two more, one to Dr. Wenjie Yu in the Welsh Lab and another to Dr. Mariia Kumskova in the Chauhan Lab. Congratulations! The volume of these awards speaks to our culture of support both in time and in attention to good ideas in our department. If someone wants to build a solo research career, Iowa will help them to do it. But we can do more, not only more K-awards and in more clinical research. If we really want to shift that total dollar amount, we will not do it just with R01s. We must begin to think bigger and more collaboratively in pursuit of larger consortia grants.

Models exist here of U-awards and P-awards, the programs that answer larger questions and bundles of questions. We are incredible multidisciplinary collaborators when it comes to research at Iowa, so that is not something we need to solve. What would be invaluable is assistance in assembling these large grant applications, which frequently involve extensive paperwork. Having a project manager to guide a large consortium application through the process, expertly coordinating existing resources at the ground level to create a compelling proposal, would be particularly beneficial. Additionally, support in analyzing NIH announcements—identifying emerging areas of interest likely to become program announcements or requests for applications—and alerting relevant investigators would be highly advantageous. In essence, the groundwork within Internal Medicine is well-prepared, but to achieve significantly greater success, we need to expand our efforts and sow seeds in new areas.