Interest in global health (GH) among medical trainees has surged in recent decades, although longer-term placements are limited. Residency programs face challenges in offering extended GH opportunities. Baylor College of Medicine/Texas Children's Hospital (BCM/TCH) created an integrated 4-year Global Child Health Residency Program (GCHRP) to train future GH leaders. This paper describes our 13-year experience implementing the GCHRP. We describe the development and implementation of the program along with curricular and training components. We summarize survey results among a sample of global health residents (GHRs) who completed the program. Finally, we describe lessons learned from program implementation. From 2010 through June 2023, 72 residents joined the GCHRP program, with 10 graduating classes, including 43 GHRs who completed a 1-year global health experience (GHE). Thirty (86%) GHRs who completed their GHE before the COVID-19 pandemic completed a survey about their GHE. Survey responses indicated high levels of satisfaction and high confidence in caring for children in GH settings. Forty percent experienced moderately difficult to difficult transitions home, and 43% experienced at least one personal safety event. Post graduation, 63% pursued pediatric subspecialty fellowships. Lessons learned, from survey results and program administrative experience, include understanding the benefits of sending GHR to established partner sites, learning the administrative, physical, and emotional needs of the GHRs, and seeing positive effects for the entire residency. Benefits of the GHE include gaining knowledge and skills to care for children in resource-limited settings. Assessing graduates' posttraining careers will be crucial to understanding the program's long-term impact.

Physician-scientists are an essential link between medical research and clinical practices and play an important role in the discovery of paradigm-shifting biological insights and life-saving therapies.1,2 Reduction of the purchasing power of National Institutes of Health (NIH) budget by double digit amounts along with decreased numbers of institutional training and individual grants has compounded complex problems of a declining pediatric physician-scientist workforce.3-7 In contrast to internal medicine physician-scientist residency training programs, little is known about what and how pediatric physician-scientist training models are used.

Purpose: Unprofessional behavior among physicians significantly increases health care costs and negatively impacts patient care. 1 Residency training serves as a formative period of clinical and professional development for physicians. Notably, the Accreditation Council for Graduate Medical Education has listed professionalism as 1 of 6 core competencies and is a required assessment competency. 2 Despite advances in defining, teaching, and, providing formative and summative assessments for resident trainees within the professionalism domain, numerous studies have extensively demonstrated the high frequency of incidences of unprofessional behavior that compromise patient safety and increase health care costs. 3 Furthermore, trainee observations of lapses in professionalism during residency report little overlap between the values stated by accreditation standards in the United States and observed behavior during training. 4 The theory of threshold concepts can serve as a paradigm-shifting framework in understanding learner difficulties or otherwise termed troublesome knowledge in continuous modeling of professional behaviors.

In 2014, the Baylor College of Medicine (BCM) and Texas Children's Hospital (TCH) made an institutional commitment to address concerns over the paucity of longitudinal support for physician-scientist career development and sustainability.1Cornfield D.N. Lane R. Rosenblum N.D. Hostetter M. Jobe A. Albertine K. et al.Patching the pipeline: creation and retention of the next generation of physician-scientists for child health research.J Pediatr. 2014; 165: 882-884Abstract Full Text Full Text PDF PubMed Scopus (12) Google Scholar, 2Schwartz A.L. Commentary: physician-scientist attrition: stemming the tide through national networks for training and development.Acad Med. 2011; 86: 1071-1072Crossref PubMed Scopus (9) Google Scholar Using the American Board of Pediatrics' Integrated Research Pathway framework, the Pediatrician-Scientist Training and Development Program (PSTDP) was developed at BCM and TCH.3Burns A.M. Kushner J.A. Ward M.A. Turner T.L. Kline M.W. Orange J.S. Strengthening the pipeline for clinician-scientists: the Pediatrician-Scientist Training and Development Program at Texas Children's Hospital.J Pediatr. 2016; 172 (5-6.e5)Abstract Full Text Full Text PDF PubMed Scopus (6) Google Scholar The program's goal was to produce research-oriented scholars who cultivate and sustain excellent clinical and research training through the tenets of mentorship, alternative didactic training, and academic advancement activities. To this end, the PSTDP was envisioned as a program that went beyond fulfilling the curricular requirements for the American Board of Pediatrics' Integrated Research Pathway (ie, allocating time to specific clinical and research activities) and fostered professional identity formation (PIF) as a pediatrician-scientist. Professional identity has been defined as the "sense of affiliation and values" that one develops within a profession.4Cruess R.L. Cruess S.R. Boudreau J.D. Snell L. Steinert Y. A schematic representation of the professional identity formation and socialization of medical students and residents: a guide for medical educators.Acad Med. 2015; 90: 718-725Crossref PubMed Scopus (390) Google Scholar In this case, professional development in both clinical and scientific domains should allow for formation of a pediatrician-scientist as a single identity and not a dual identity.5Ibarra H. Provisional selves: experimenting with image and identity in professional adaptation.Adm Sci Q. 1999; 44: 764-791Crossref Scopus (1434) Google Scholar Using PIF as a conceptual framework, we incorporated existing literature pertaining to PIF for clinician-scientists,4Cruess R.L. Cruess S.R. Boudreau J.D. Snell L. Steinert Y. A schematic representation of the professional identity formation and socialization of medical students and residents: a guide for medical educators.Acad Med. 2015; 90: 718-725Crossref PubMed Scopus (390) Google Scholar, 6Rosenblum N.D. Kluijtmans M. Ten Cate O. Professional identity formation and the clinician-scientist: a paradigm for a clinical career combining two distinct disciplines.Acad Med. 2016; 91: 1612-1617Crossref PubMed Scopus (42) Google Scholar iterative input from local successful pediatrician-scientists, and successful strategies from the acclaimed national Pediatric Scientist Development Program (PSDP).3Burns A.M. Kushner J.A. Ward M.A. Turner T.L. Kline M.W. Orange J.S. Strengthening the pipeline for clinician-scientists: the Pediatrician-Scientist Training and Development Program at Texas Children's Hospital.J Pediatr. 2016; 172 (5-6.e5)Abstract Full Text Full Text PDF PubMed Scopus (6) Google Scholar, 7Hostetter M.K. Career development for physician-scientists: the model of the Pediatric Scientist Development Program.J Pediatr. 2002; 140: 143-144Abstract Full Text Full Text PDF PubMed Scopus (18) Google Scholar, 8Brown A.M., Morrow J.D. Limbird L.E. Byrne D.W. Gabbe S.G. Balser J.R. et al.Centralized oversight of physician-scientist faculty development at Vanderbilt: early outcomes.Acad Med. 2008; 83: 969-975Crossref PubMed Scopus (35) Google Scholar Here we describe the PSTDP structure grounded within the PIF framework and report early program outcomes from implementation of the curriculum in the hope for continued dialog around best practices and acceleration for clinician-scientist development. The PSTDP structured curriculum (Appendix; available at www.jpeds.com) fosters the development of the pediatrician-scientist through the merger model for PIF in which the 2 separate career trajectories of a clinician and scientist are integrated. The overarching goal is to create synergy in integration to provide a strong foundation for the development of pediatrician-scientists who will sustain career advancement in academia through increasingly demanding scientific and clinical practice environments postresidency.6Rosenblum N.D. Kluijtmans M. Ten Cate O. Professional identity formation and the clinician-scientist: a paradigm for a clinical career combining two distinct disciplines.Acad Med. 2016; 91: 1612-1617Crossref PubMed Scopus (42) Google Scholar Figure 1 (available at www.jpeds.com) illustrates the proposed PIF model, which focuses on continuous engagement with clinical and research mentors to support the codevelopment of clinical and scientific training and experiences. Beyond required clinical rotations, additional learning experiences occur in both scientific and clinical practice environments (eg, workshops, seminars, symposia). These experiences are detailed in a postgraduate year-specific curriculum that includes roadmaps, timelines, checklists, and progress forms (Appendix) and their overall structure and overarching philosophy have been described previously.3Burns A.M. Kushner J.A. Ward M.A. Turner T.L. Kline M.W. Orange J.S. Strengthening the pipeline for clinician-scientists: the Pediatrician-Scientist Training and Development Program at Texas Children's Hospital.J Pediatr. 2016; 172 (5-6.e5)Abstract Full Text Full Text PDF PubMed Scopus (6) Google Scholar Components identified to promote research success have been reported previously9Abramson E.L. Naifeh M.M. Stevenson M.D. Todd C. Henry E.D. Chiu Y.L. et al.Research training among pediatric residency programs: a national assessment.Acad Med. 2014; 89: 1674-1680Crossref PubMed Scopus (38) Google Scholar, 10Rothberg M.B. Kleppel R. Friderici J.L. Hinchey K. Implementing a resident research program to overcome barriers to resident research.Acad Med. 2014; 89: 1133-1139Crossref PubMed Scopus (45) Google Scholar and were intentionally integrated into the PSTDP curriculum, approach, and philosophy. One of the initial short-term goals of the PSTDP was to increase matriculation of MD or MD/PhD scholars with a passion for becoming a clinician-scientist through the program's 3 slots per match. Historically, despite an average of 1043 applicants per year from 2006 to 2014 to the BCM categorical pediatric residency program, the total number of MD/PhD applicants was <35 annually (Figure 2, A). Since inception of the PSTDP in 2015, the number of MD/PhD resident candidates has increased (Figure 2, B). There are currently 10 PSTDP residents, all of whom are MD/PhD graduates. This is nearly equal to the total number of MD/PhD residents that matriculated during the 8-year period before inception of the PSTDP (Figure 2, C) and has resulted in a 2.5-fold increase in the number of MD/PhD residents in Pediatrics at BCM (Figure 2, D). One long-term goal is to increase the number of pediatrician-scientist faculty at BCM; from the first graduating class of PSTDP residents, 100% have committed to pursuing subspecialty training, with 75% matching to fellowships at TCH. Residents reported that they identified multiple mentor assignments as being central to helping them identify an area of clinical and research focus. Furthermore, they identified opportunities to engage with other residents with common career interests from other departments as an opportunity for improvement. Residents have a postgraduate year-specific curriculum that links to a scholarly activity.3Burns A.M. Kushner J.A. Ward M.A. Turner T.L. Kline M.W. Orange J.S. Strengthening the pipeline for clinician-scientists: the Pediatrician-Scientist Training and Development Program at Texas Children's Hospital.J Pediatr. 2016; 172 (5-6.e5)Abstract Full Text Full Text PDF PubMed Scopus (6) Google Scholar The goal is to provide curricular activities that most closely align with their predominant clinical practice environment while promoting application of previously acquired scientific skills (Figure 1). A 2-week workshop series has been created (Appendix) that aims to instruct residents how to scientifically approach patients within a clinical setting. This includes a case report activity that has opened unanticipated scholarship opportunities within their respective targeted subspecialty and has allowed PSTDP residents to continue scholarship productivity in residency surpassing residents in the categorical program (Figure 3). All (100%) PL-2 and PL-3 residents completed a professionally edited first draft that has been submitted to a peer-reviewed journal midway through the PL-2 year. It has been suggested that previous research experience enhances scholarly output during residency,11Ullrich N. Botelho C.A. Hibberd P. Bernstein H.H. Research during pediatric residency: predictors and resident-determined influences.Acad Med. 2003; 78: 1253-1258Crossref PubMed Scopus (38) Google Scholar and we also have reported similar positive early experiences with establishing a clinical case report curriculum.12Stephens J. Wardrop R. Scholarship improved by case report curriculum.Clin Teach. 2016; 13: 411-414Crossref PubMed Scopus (4) Google Scholar This curriculum has been perceived to be a useful tool for helping our residents become scientifically engaged in their selected clinical practice. It has also helped to accelerate or even alter the clinical differentiation of our trainees. Residents use the sole block of protected research time during year 2, developing a PSTDP pilot grant proposal based on the National Institutes of Health's Career Development Award K application. This experience is critical for providing a clear framework for the research months.13Hostetter M.K. Success for the physician-scientist in a resource-limited environment.J Pediatr. 2012; 161 (1-2.e1)Abstract Full Text Full Text PDF PubMed Scopus (7) Google Scholar, 14Farrokhyar F. Amin N. Dath D. Bhandari M. Kelly S. Kolkin A.M. et al.Impact of the Surgical Research Methodology Program on surgical residents' research profiles.J Surg Educ. 2014; 71: 513-520Abstract Full Text Full Text PDF PubMed Scopus (17) Google Scholar On completion of the block, all PSTDP residents submit a pilot grant that has been reviewed in a model study section as detailed in the curriculum (Appendix), along with a realistic timeline for completing experiments during the remainder of the research months in year 3. We believe that this approach will help position our residents for successful early K award applications. Along with writing a primary research national meeting abstract and a peer-reviewed research article around their projects, another unique activity promotes resident scholar PIF within the final year. Residents complete the candidate section of an NIH career development award grant application (which was intentionally not included in the year 2 pilot grant), to allow for deep reflection on their experiences in both clinical and scientific practice environments and how their emerging identity shapes their ability to complete "bench to bedside research." Dialog and review occur in a model study section in which senior pediatrician-scientist faculty review the candidate's application and reflect on his or her growth during residency and the potential for becoming a successful clinician-investigator. A debriefing of the activity with the resident immediately follows this activity. In addition, we are developing a writing exercise to further promote PIF. In the final year of training, residents reflect with program leadership on their clinical and research work since starting residency training. The session includes both a written session and a verbal session, with the aim of having the resident in outlining his or her development as a clinician-scientist and identifying areas for future growth. PSTDP leadership is currently engaging with experienced faculty for ongoing training around narrative reflective writing for further development of this curriculum component. An overarching objective is to create a pathway to early K award competitiveness for PSTDP graduates. Given the expense to pediatric departments of supporting junior faculty, even limited success in achieving this objective could offset PSTDP program costs. Through the tailored curriculum for PSTDP residents that fosters PIF, we are continuing to develop a cultivating environment for developing a complex and unique identity of a pediatrician-scientist through the BCM PSTDP. Increasing interest from residents in the categorical program regarding engagement in PSTDP components has allowed for a variety of entry points for those who would like or might be able to engage in only discrete components of the curriculum. It is our aspiration that the PSTDP will serve as a nucleus for accelerating a culture of physician-investigators in the Department of Pediatrics at BCM. Hopefully, continued data collection will allow for additional testing of the hypotheses surrounding the PSTDP and will contribute to strategies to improve the viability and success of pediatrician-scientists, who are central to the future of innovation in child health. We acknowledge the mentorship provided by the AMSPDC Pediatric Leadership Development Program and the generous support of TCH. Download .docx (1.2 MB) Help with docx files AppendixCurriculum guide.

Background: The Medical Student Performance Evaluation (MSPE) is a primary source of information used by residency programs in their selection of trainees. The MSPE contains a narrative description of the applicant's performance during medical school. In 2002, the Association of American Medical Colleges' guideline for preparation of the MSPE recommended inclusion of a comparative summative assessment of the student's overall performance relative to his/her peers (final adjective). Objective: We hypothesize that the inclusion of a final adjective in the MSPE affects a reviewer's assessment of the applicant's desirability more than the narrative description of performance and designed a study to evaluate this hypothesis. Design: Fifty-six faculty members from the Departments of Pediatrics and Medicine with experience reviewing MSPEs as part of the intern selection process reviewed two pairs of mock MSPE letters. In each pair, the narrative in one letter was superior to that in the other. Two final adjectives describing relative class ranks were created. Each subject was first presented with a pair of letters with mismatched final adjective (study), i.e., the letter with the stronger narrative was presented with the weaker final adjective and vice versa. The subject was then presented with a second pair of letters without final adjectives (control). Subjects ranked the relative desirability of the two applicants in each pair. Results: The proportion of rankings congruent with the strength of the narratives under study and control conditions were compared. Subjects were significantly less likely to rank the applicants congruent with the strength of the narratives when the strength of the final adjectives conflicted with the strength of the narrative; 42.9% of study letters were ranked congruent with the narrative versus 82.1% of controls (p =0.0001). Conclusion: The MSPE final adjective had a greater impact than the narrative description of performance on the determination of applicant desirability.

Background: In an effort to strengthen the physician-scientist pipeline, Baylor College of Medicine (BCM) and Texas Children's Hospital (TCH) implemented the Pediatrician-Scientist Training & Development Program (PSTDP). Embedded in the mission of the PSTDP is development of research-oriented scholars who cultivate excellent clinical and research training through the tenets of mentorship, didactic training, and interdisciplinary reflective experiences. The BCM PSTDP has developed a programmatic structure that is founded upon an established conceptual framework of Professional Identity Formation (PIF) based on findings from Rosenblum et al. We report early outcomes along with curriculum implementation grounded in PIF.

Recent advances in our understanding of tau pathophysiology, in particular “prion-like” spread of tau, have only highlighted pathological tau as a prime therapeutic target for Alzheimer's disease (AD) and other tauopathies. Tau aggregates can act as ‘seeds’ that promote further tau aggregation and spread to structurally connected brain regions; a process termed tau propagation. Although the exact mechanism(s) involved are not fully understood, numerous in vivo models of tau propagation have been developed. These models rely on either discrete regional tau over-expression or intracerebral infusion of tau aggregates; however, are these models relevant to human disease and preclinical drug-discovery? In this study we compare and contrast a range of in vivo models we have developed and optimised for pre-clinical drug-discovery. Tau transgenic (P301S and hTau) and wild-type (C57/BL6) mice were stereotaxically infused with tau protein extracted from mouse brain (P301S and C57/BL6) or post-mortem AD brain tissue. Mice were analysed neuropathologically at defined time-points post-infusion to analyse the accumulation and spread of tau pathology. Tau extracts prepared from C57/BL6 mice did not induce tau propagation in vivo. In contrast, rapid and robust tau propagation was observed when P301S mice were infused with tau extracts derived from symptomatic P301S mice; however, such accumulation and spread of tau pathology was not observed when the same seed was infused into hTau mice. Interestingly, tau protein extracts derived from post-mortem AD brain tissue had variable results on the distribution, progression and severity of tau pathology when infused into different transgenic and wild-type mice. Immunodepletion of pathological tau from the extract prevented any tau accumulation or spread. We have developed and optimised a range of in vivo tau propagation models that demonstrate seeded-aggregation and spread of tau pathology. The severity, distribution and progression of tau pathology were different in these models and therefore will affect their utility and relevance for pre-clinical drug-discovery.

In Alzheimer's disease (AD), the regional spread and intensity of tau correlates with clinical progression. Mechanistically, the spread of tau pathology has been proposed to be via a prion-like mechanism. As such, effectively neutralizing extracellular transmissible tau (“seeds”), for example via an antagonistic antibody, may block tau propagation. We have previously shown positive in vivo effect of immunotherapy with anti-tau antibodies MC-1 and PHF-1 (Chai et al. 2011 J Biol Chem). To determine targeting which tau epitope may be most effective, we compared activities of a series of tau antibodies targeting various epitopes, including aggregated tau (MC-1), phosphorylated tau (PHF-1, AT-8) and all tau forms (DA-9). We established several cell-based and in vivo tau propagation models to determine and rank the antibody's ability to neutralize tau seeds and reduce tau pathology. We further tested the antibodies in an in vivo chronic efficacy model where each antibody was peripherally administered for four months in JNPL3 mice. In the in vivo neutralization model, where antibody and tau seeds were co-injected into the brain of P301S mice, aggregate-selective antibody MC-1 blocked pathology induced by injected tau seeds. Similar results were obtained in a HEK293-P301S cell model where MC-1 showed the highest Emax (maximum effect) to block tau propagation. To investigate why MC-1 was showed the highest Emax, each antibody was conjugated to beads and incubated with tau seeds, and antibody-depleted seeds were tested for their seeding capability. All tau antibodies had significant effect to reduce seeding activity, however, only MC-1 showed near complete removal of the seeding activity. Biochemically, the MC-1-depleted seeds showed the lowest levels of remaining high-molecular-weight tau aggregates. In JNPL3 mice, MC-1 demonstrated consistent activity to reduce tau pathology. Among antibodies tested that target various tau epitopes, aggregate-selective antibody MC-1 demonstrated superior in vitro activity to neutralize transimissible tau and consistent in vivo activity to reduce tau pathology in the JNPL3 mouse model. Our results suggest a potential therapeutic efficacy of an aggregate-selective tau antibody for AD treatment.

It has been well established that the development of clinician scholars is most successful through continued mentorship, protected research time, and tailored didactic instruction throughout residency. To continue the support of research-oriented MD or MD/PhD students as they transition to intern year, the Baylor College of Medicine Pediatrician-Scientist Training and Development Program (PSTDP), a new track within the Department of Pediatrics, has created a tailored curriculum for residents interested in a career in academic pediatrics.

Synapse loss is a key feature of dementia, but it is unclear whether synaptic dysfunction precedes degenerative phases of the disease. Here, we show that even before any decrease in synapse density, there is abnormal turnover of cortical axonal boutons and dendritic spines in a mouse model of tauopathy-associated dementia. Strikingly, tauopathy drives a mismatch in synapse turnover; postsynaptic spines turn over more rapidly, whereas presynaptic boutons are stabilized. This imbalance between pre- and post-synaptic stability coincides with reduced synaptically driven neuronal activity in pre-degenerative stages of the disease.

Trachypachus Motschulsky includes three species in the western United States (Bousquet 2012). The most widespread of the three is Trachypachus inermisMotschulsky (CANADA: AB, BC, NT, SK, YT; USA: AK, CA, CO, ID, MT, NV, OR, SD, UT, WA, WY [KS]). The range of this species, as summarized by Bousquet (2012), “extends from the Kenai Peninsula in Alaska to northwestern Saskatchewan, south to southern Colorado, southern Utah, and the Sierra Nevada and Coast Ranges in California.” Johnson (2012) added the Black Hills of South Dakota to extend the species’ easternmost USA distribution. There is an old specimen collected by J. L. LeConte of questionable provenance from Kansas (Bousquet 2012). Most recent references refer to this species as T. holmbergi Mannerheim, but the valid name is T. inermis (LeConte 1857; Bousquet 2001, 2012). We report specimens of this species from two National Park Service units, Valles Caldera National Preserve and Bandelier National Monument, in the Jemez Mountains, and from Santa Fe National Forest in the Sangre de Cristo Mountains of northcentral New Mexico. These records are the southernmost for this species in the RockyMountains and the first for the species and family in New Mexico. Searches of aggregator websites GBIF (www.gbif. org) and iDigBio (www.idigbio.org) showed no specimens from New Mexico, nor did a manual search by Jere Schweikert of the California Academy of Sciences collection. A search of the Oregon State Arthropod Collection by David Maddison, however, yielded records from New Mexico reported below. The Symbiota Collections of Arthropods Network (SCAN, symbiota4.acis.ufl.edu/ scan/portal) contains records from San Jacinto State Park in Riverside County, California, at the latitude of 33.8° N, the southernmost record for the species. We examined 59 specimens with the following locality data: New Mexico: Sandoval County, Bandelier National Monument, elevation 2,712 m, 35.852°N, 106.411°W, 8 April–12 July 1993 (2 specimens), 12 June 2000 (1 specimen), 27 April–17 June 2005 (12 specimens), 18 April–14 June 2006 (4 specimens), 14 April–20 June 2008 (2 specimens), 24 April–1 July 2009 (5 specimens), 23 October–22 April 2013 (11 specimens), 22 April–25 June 2013 (15 specimens), 25 June– August 2013 (2 specimens); Valles Caldera National Preserve, elevation 2,682 m, 35.903°N, 106.424°W, 19–28 July 2011 (1 specimen), 28 July–15 August (1 specimen), 2–23 May 2012 (1 specimen), 23 May– -13 June (2 specimens). All specimens were collected in pitfall traps. The Bandelier specimens were collected in mixed-conifer forest dominated by Douglas-fir (Pseudotsuga menziesii (Mirb.)). The Valles Caldera specimens were collected in ponderosa pine (Pinus ponderosa Lawson & C. Lawson) forest that was severely burned in a standreplacing fire (the Las Conchas fire) in 2011 prior to their collection. During the review process, we were made aware of three specimens of T. inermis housed at the Oregon State Arthropod Collection with the following locality data: New Mexico: Santa Fe County, Sangre de Cristo Mountains, Black Canyon Campground, 35.7274°N 105.8400°W, elevation 2,535 m, 5 July 1995. DRM 95.057. D.R. & W.P. Maddison, et al. The specimens were handcollected in forest (primarily Douglas-fir, with some pines and cottonwoods), under a thin layer of conifer needles, about 1–2 m from the shore of a small creek. The newly reported locations for this species occur in montane conifer forests of north-central New Mexico at elevations above 2,500 m and approach the southernmost extent of Rocky Mountain montane conifer forest, a biotic community type designated by Brown (1994). To the north, T. inermis is found at a range of elevations and in a variety of boreal and cold-temperate habitats, including anthropogenic habitats (Ball 2001). In the southwestern USA, we expect it to

The entorhinal cortex (EC) is one of the first areas to be disrupted in neurodegenerative diseases such as Alzheimer's disease and frontotemporal dementia. The responsiveness of individual neurons to electrical and environmental stimuli varies along the dorsal–ventral axis of the medial EC (mEC) in a manner that suggests this topographical organization plays a key role in neural encoding of geometric space. We examined the cellular properties of layer II mEC stellate neurons (mEC-SCs) in rTg4510 mice, a rodent model of neurodegeneration. Dorsoventral gradients in certain intrinsic membrane properties, such as membrane capacitance and afterhyperpolarizations, were flattened in rTg4510 mEC-SCs, while other cellular gradients [e.g., input resistance (Ri), action potential properties] remained intact. Specifically, the intrinsic properties of rTg4510 mEC-SCs in dorsal aspects of the mEC were preferentially affected, such that action potential firing patterns in dorsal mEC-SCs were altered, while those in ventral mEC-SCs were unaffected. We also found that neuronal oscillations in the gamma frequency band (30–80 Hz) were preferentially disrupted in the dorsal mEC of rTg4510 slices, while those in ventral regions were comparatively preserved. These alterations corresponded to a flattened dorsoventral gradient in theta-gamma cross-frequency coupling of local field potentials recorded from the mEC of freely moving rTg4510 mice. These differences were not paralleled by changes to the dorsoventral gradient in parvalbumin staining or neurodegeneration. We propose that the selective disruption to dorsal mECs, and the resultant flattening of certain dorsoventral gradients, may contribute to disturbances in spatial information processing observed in this model of dementia.SIGNIFICANCE STATEMENTThe medial entorhinal cortex (mEC) plays a key role in spatial memory and is one of the first areas to express the pathological features of dementia. Neurons of the mEC are anatomically arranged to express functional dorsoventral gradients in a variety of neuronal properties, including grid cell firing field spacing, which is thought to encode geometric scale. We have investigated the effects of tau pathology on functional dorsoventral gradients in the mEC. Using electrophysiological approaches, we have shown that, in a transgenic mouse model of dementia, the functional properties of the dorsal mEC are preferentially disrupted, resulting in a flattening of some dorsoventral gradients. Our data suggest that neural signals arising in the mEC will have a reduced spatial content in dementia.

In 1979, Wyngaarden proclaimed the clinician-scientist an "endangered species."1Wyngaarden J.B. The clinical investigator as an endangered species.N Engl J Med. 1979; 301: 1254-1259Crossref PubMed Scopus (408) Google Scholar Decades later, despite strong national efforts, it remains challenging to secure durable futures for clinician-scientists.1Wyngaarden J.B. The clinical investigator as an endangered species.N Engl J Med. 1979; 301: 1254-1259Crossref PubMed Scopus (408) Google Scholar, 2Brass L.F. Akabas M.H. Burnley L.D. Engman D.M. Wiley C.A. Andersen O.S. Are MD-PhD programs meeting their goals? An analysis of career choices made by graduates of 24 MD-PhD programs.Acad Med. 2010; 85: 692-701PubMed Google Scholar, 3Cornfield D.N. Lane R. Rosenblum N.D. Hostetter M. Jobe A. Albertine K. et al.Patching the pipeline: creation and retention of the next generation of physician-scientists for child health research.J Pediatr. 2014; 165: 882-884.e1Abstract Full Text Full Text PDF Scopus (12) Google Scholar Only 39% of self-identified physician-scientists attain K-series grants and only 25% garner R-level funding.4Rosenberg L.E. The physician-scientist: an essential–and fragile–link in the medical research chain.J Clin Invest. 1999; 103: 1621-1626Crossref PubMed Scopus (119) Google Scholar, 5Winer K.K. Rothenberg M.E. Guimond J. Handwerger S. Boxer L.A. Grave G. et al.The Child Health Research Centers: twenty-one years of promoting the development of pediatrician scientists from 1990-2011.J Pediatr. 2012; 161: 975-976Abstract Full Text Full Text PDF PubMed Scopus (8) Google Scholar The average age at R01 funding has increased from the mid-30s to the mid-40s, and fewer physicians report research as their primary activity.5Winer K.K. Rothenberg M.E. Guimond J. Handwerger S. Boxer L.A. Grave G. et al.The Child Health Research Centers: twenty-one years of promoting the development of pediatrician scientists from 1990-2011.J Pediatr. 2012; 161: 975-976Abstract Full Text Full Text PDF PubMed Scopus (8) Google Scholar, 6Garrison H.H. Deschamps A.M. NIH research funding and early career physician scientists: continuing challenges in the 21st century.FASEB J. 2014; 28: 1049-1058Crossref PubMed Scopus (110) Google Scholar Physician-scientist challenges have particularly impacted pediatrics; in 2005, pediatric departments captured only 11.3% of National Institutes of Health (NIH) funding, 25% less than 10 years prior.7Rivkees S.A. Genel M. Association of Medical School Pediatric Department Chairs, IncAmerican pediatric academia: the looming question.J Pediatr. 2007; 151: 223-224Abstract Full Text Full Text PDF PubMed Scopus (12) Google Scholar Difficulties in pediatrician-scientist sustainability have led to the development of nationwide institutional and multi-institutional programs aimed at strengthening the physician-scientist pipeline.8Brown A.M. Morrow J.D. Limbird L.E. Byrne D.W. Gabbe S.G. Balser J.R. et al.Centralized oversight of physician-scientist faculty development at Vanderbilt: early outcomes.Acad Med. 2008; 83: 969-975Crossref PubMed Scopus (35) Google Scholar, 9Parker K. Burrows G. Nash H. Rosenblum N.D. Going beyond Kirkpatrick in evaluating a clinician scientist program: it's not "if it works" but "how it works.".Acad Med. 2011; 86: 1389-1396Crossref PubMed Scopus (41) Google Scholar Although some have been quite successful (NIH- and pediatric societies-funded Pediatric-Scientist Development Program Scholars boast higher funding rates and are more likely to hold senior-level faculty positions10Hostetter M.K. Success for the physician-scientist in a resource-limited environment.J Pediatr. 2012; 161: 1-2.e1Abstract Full Text Full Text PDF PubMed Scopus (7) Google Scholar), much remains to be done to combat declines in pediatrician-scientist funding and hiring. In 2013, established pediatric researchers in the Department of Pediatrics at BCM/TCH strategized the creation of a new program whose primary mission would be to provide a thriving sense of community and support for burgeoning pediatrician-scientists. Steering committee members carefully considered curriculum components from other successful clinician-scholar training programs8Brown A.M. Morrow J.D. Limbird L.E. Byrne D.W. Gabbe S.G. Balser J.R. et al.Centralized oversight of physician-scientist faculty development at Vanderbilt: early outcomes.Acad Med. 2008; 83: 969-975Crossref PubMed Scopus (35) Google Scholar, 10Hostetter M.K. Success for the physician-scientist in a resource-limited environment.J Pediatr. 2012; 161: 1-2.e1Abstract Full Text Full Text PDF PubMed Scopus (7) Google Scholar (Table; available at www.jpeds.com), as well as elements that had allowed them to successfully navigate their own personal career obstacles. Programmatic concepts were further refined through the Pediatric Leadership Development Program of the Association of Medical School Pediatric Department Chairs in which one of us was a fellow. Ultimately, we designed a multifaceted program that incorporates concrete opportunities for junior trainees to interact with successful senior faculty, alternative didactics, a 3-pronged mentoring approach, protected research time, engagement of all institutional pediatric specialty fellowship programs, and professional skills development. Here, we present our newly developed curriculum as one novel pathway toward sustainable pediatrician-scientist development. The Pediatrician-Scientist Training and Development Program (PSTDP) has 3 core components: the Parallel Education Program (PEP), Mentoring, and Academic Advancement Activities (Figure 1; available at www.jpeds.com). In addition, all residents commit to the American Board of Pediatrics Integrated (rather than Accelerated) Research Pathway, allowing them to perform research during the second and third year of residency while completing core pediatric clinical requirements without postponing engagement in research until fellowship (Figures 2 and 3; available at www.jpeds.com). The PEP aims to provide the knowledge and perspective necessary for a seamless career flow through the academic pipeline. In addition to regular seminars, an annual PSTDP grand rounds, and an annual PSTDP retreat, there are two concrete monthly opportunities—the Pediatrician-Scientist Forum (PSF) and the Didactic Noon Conference (DNC)—for junior trainees to engage with and learn from successful senior faculty. Monthly DNC seminars cover a range of professional development topics including work-life balance, NIH navigation, mentorship, and funds management. Open to the entire BCM/TCH community, the evening PSF seminar allows residents to learn about the research and career paths of established pediatrician-scientists in a supportive, and engaging, but casual environment. Both the PSF and DNC aim to promote collegiality and strengthen the pediatrician-scientist community. To prepare for success in K-series grant funding, PSTDP scholars set concrete yearly publication goals: year 1, a scientifically oriented clinical case report; year 2, 1 published abstract, 1 scholarly review article, attendance at 1 national meeting, and active Pilot Grants Program engagement (each resident writes a focused grant and observes their own "study section"); and year 3, 1 peer-reviewed research publication, and completion of the candidate section of an NIH K-award grant (written individually, and also reviewed in a mock "study section"; Figures 2 and 3). Structured, allocated writing time and didactic lunchtime writing seminars promote successful completion of each of these goals in alignment with resident duty hours, as well as maintaining good "writing hygiene." Structured mentoring is critical to physician-scientist success.11Lane R. Mentoring and the development of the physician-scientist.J Pediatr. 2008; 152: 296-297Abstract Full Text Full Text PDF PubMed Scopus (9) Google Scholar The 3-pronged PSTDP mentorship approach recognizes that longitudinal, clinical, and research mentoring are each important facets of optimal pediatrician-scientist development. As such, each PSTDP resident is assigned a Residency Educational Mentor (REM), a Clinical Case Mentor, and a Primary Research Mentor. The REM is a senior faculty-level steering committee member who commits to substantive, long-term mentoring throughout the course of the program and beyond. Most importantly, the REM serves as a role model for navigating and balancing an academic clinician career. The Clinical Case Mentor supports writing the pediatric level-1 clinical case report and advises toward creating a "clinical footprint" in a field of resident interest. The Primary Research Mentor provides direct guidance for the second and third year independent research project (and potentially beyond). Each PSTDP resident also has the opportunity to hone their own mentoring skills by engaging in thoughtful pairings during ward months (with an interested MD/PhD student), and in the third year, as part of the Peer Mentoring Program, which pairs a PSTDP senior resident with an incoming intern. We anticipate that the "see one, do one" approach will set the stage for future mentoring relationships as PSTDP graduates transition to junior faculty. Professional development workshops are incorporated into each year of the PSTDP curriculum. Topics include scientific writing, biostatistical and study design analyses, research study design, and targeted grant writing workshops. All residents attend an annual orientation retreat and engage in the planning of an annual PSTDP Grand Rounds. The PSTDP formally began in 2014 and is currently recruiting its second class. One objective of the PSTDP was to increase the number of MD-PhD residents at BCM/TCH and the first match provided 4 from leading US medical schools. PEP activities are in progress and widely attended by trainees of all levels and faculty, fostering a thriving culture of pediatrician-scientists. Resident progress and program curriculum are being tracked using a customized Oracle database that captures both short- and long-term progress and outcomes for each participant. Evaluation of the curriculum and program components will be assessed and reported back to the pediatric community with the hope that successful PSTDP components can be adopted by other medical schools and children's hospitals. Unlike NIH- and Pediatric Society-funded programs where there are only a few scholars per institution, the PSTDP at BCM/TCH has the potential to build a critical mass of pediatrician-scientists and derivative culture within a single institution, advancing child well-being through research not only nationally, but also locally. We expect PSTDP success to promote growth of the BCM/TCH Department of Pediatrics, catalyzing innovation and increasing institutional pediatric-designated funding.7Rivkees S.A. Genel M. Association of Medical School Pediatric Department Chairs, IncAmerican pediatric academia: the looming question.J Pediatr. 2007; 151: 223-224Abstract Full Text Full Text PDF PubMed Scopus (12) Google Scholar Recognizing this, TCH has provided significant support for PSTDP development and activities, providing a model for other institution-based programs. The goal of the PSTDP at BCM/TCH is to refuel the pediatrician-scientist pipeline. Although academic pediatricians will continue to face considerable challenges in the current funding climate, we anticipate that focused mentorship, training, and support will stem the decline of this "endangered species." Academic pediatricians are a critical link in the disease-based scientific chain of discovery. We encourage other pediatric institutions to consider how pediatric-scientists can not only survive but thrive to advance the health of children worldwide. We would like to recognize the support and guidance provided by the AMSPDC Pediatric Leadership Development Program, David Perlmutter, MD, and the PSTDP Steering Committee Members. Figure 2The PSTDP curriculum within a 3-year ABP-IRP residency. Certain components are available to continue beyond residency should a PSTDP resident decide to pursue subspecialty training at BCM/TCH. ABP, American Board of Pediatrics; PL1-3, Pediatric Level 1, 2, 3, respectively; IRP, integrated research pathway.View Large Image Figure ViewerDownload Hi-res image Download (PPT)Figure 3Detailed sample PSTDP curriculum integration within the 3-year APB-IRP framework. An expanded block schedule demonstrates how PSTDP rotations are positioned to comply with ABP-IRP requirements and fulfill the components of the PSTDP curriculum. Within each residency year, the leftmost column displays the block assignment (either clinical or research), the centermost column denotes concurrent PSTDP curriculum-specific activities, and the rightmost column shows the timing of Pediatric Scientist Development Program curriculum-specific work products. All activities are designed to fit within and comply with residency work duty hour guidelines. Clinical activities are noted in brown, research in white, PEP in dark blue and green, mentoring in purple and orange, scholarly production in light blue, and programmatic retreats in red. PGP, Pilot Grants Program; RIAC, Resident Individualized Advisory Committee; TP, thoughtful pairings; Mtg, meeting.View Large Image Figure ViewerDownload Hi-res image Download (PPT)TableComparison of American Board of Pediatrics-approved pathwaysPathwayResidencyFellowshipStandardNonstandardNonstandardCategoricalIRP-PSTDPIRP-classicARP-classicICAMSPDC PSDPPrefellowshipCompletion of ABP requirementsYesYesYesNoYesn/aClinical (blocks)37.525.5Varies24.537.5n/aResearch/scholarly activity (blocks)1.512.5<1301.5-6n/aGrants programIndividualizedRequiredIndividualizedIndividualizedIndividualizedn/aFellowshipSame institution as residencyOccasionallyEncouragedEncouragedRequiredOccasionallyContinued mentorshipIndividualizedYesIndividualizedYesIndividualizedClinical time1 yResearch/scholarly activity time3 yAMSPDC, Association of Medical School Pediatric Department Chairs; ARP, accelerated research pathway; IC, individualized curriculum; IRP, integrated research pathway; n/a, not applicable; PSDP, Pediatric Scientist Development Program; ABP, American Board of Pediatrics.Core components of both standard and nonstandard pathways are compared for residents committed to intertwining protected research time into clinical training. The pathways from left to right are as follows: standard pathway–categorical residency program; 4 nonstandard pathways: IRP via the PSTDP track; IRP-classic; ARP-classic; IC; and the PSDP as sponsored by the AMSPDC. Unlike the other pathways listed, the PSDP is focused on fellowship. Open table in a new tab AMSPDC, Association of Medical School Pediatric Department Chairs; ARP, accelerated research pathway; IC, individualized curriculum; IRP, integrated research pathway; n/a, not applicable; PSDP, Pediatric Scientist Development Program; ABP, American Board of Pediatrics. Core components of both standard and nonstandard pathways are compared for residents committed to intertwining protected research time into clinical training. The pathways from left to right are as follows: standard pathway–categorical residency program; 4 nonstandard pathways: IRP via the PSTDP track; IRP-classic; ARP-classic; IC; and the PSDP as sponsored by the AMSPDC. Unlike the other pathways listed, the PSDP is focused on fellowship.

Background: The Accreditation Council for Graduate Medical Education requires residency programs to provide curricula for residents to engage in scholarly activities but does not specify particular guidelines for instruction. We propose a Resident Scholarship Program that is framed by the self-determination theory (SDT) and emphasize the process of scholarly activity versus a scholarly product.Methods: The authors report on their longitudinal Resident Scholarship Program, which aimed to support psychological needs central to SDT: autonomy, competence, and relatedness. By addressing those needs in program aims and program components, the program may foster residents' intrinsic motivation to learn and to engage in scholarly activity. To this end, residents' engagement in scholarly processes, and changes in perceived autonomy, competence, and relatedness were assessed.Results: Residents engaged in a range of scholarly projects and expressed positive regard for the program. Compared to before residency, residents felt more confident in the process of scholarly activity, as determined by changes in increased perceived autonomy, competence, and relatedness. Scholarly products were accomplished in return for a focus on scholarly process.Conclusions: Based on our experience, and in line with the SDT, supporting residents' autonomy, competence, and relatedness through a process-oriented scholarship program may foster the curiosity, inquisitiveness, and internal motivation to learn that drives scholarly activity and ultimately the production of scholarly products.

As NIH funding rates have stagnated over the past several decades, it has become increasingly difficult for pediatric investigators to secure funding to sustain research efforts. Such challenges have impacted the field of pediatric research where approximately only one tenth of federal grant dollars are awarded to US pediatric departments. This has resulted in a significant increase in the average age to attain a R01 research grant and has posed difficulties for trainees to also attain K-series grants, which are obtained by less than half of self-identified pediatrician-scientists.

PURPOSE:This exploratory multisite study investigated relative proportions of residents' perceived learning across the explicit, implicit (typically called hidden or informal), and extra-curricula for six Clinical Learning Environment Review (CLER) focus areas-patient safety, health care quality, care transitions, supervision, fatigue management, and professionalism-using qualitative and numeric data.METHOD:In April through June 2013, the authors recruited and interviewed third-year categorical pediatric residents from three sites. For each CLER focus area, the authors asked residents to think aloud while they assigned a total of 60 points to the explicit, implicit, and extra-curricula, according to where they perceived their learning occurred. All interviews were audio taped and transcribed verbatim. The authors coded qualitative data from interviews using the constant comparative method, scrutinized qualitative data for themes, and reviewed qualitative and numeric data.RESULTS:A total of 28/79 (35%) residents participated. Residents perceived learning to occur most often in the implicit curriculum for five of the six CLER focus areas; the one exception being health care quality, which predominantly took place in the explicit curriculum. In the implicit curriculum, role modeling and "learning by doing" were frequently reported modes of learning. The explicit curriculum was perceived as an important baseline for understanding clinical areas. Relatively less learning was perceived to occur in the extra-curriculum.CONCLUSIONS:The authors believe that recognizing learning in "other-than-explicit" curricula could broaden the medical education community's understanding of the purview of the medical education curriculum and help educators tap into underused educational opportunities for important clinical topics.

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This exploratory multisite study investigated relative proportions of residents' perceived learning across the explicit, implicit (typically called hidden or informal), and extra-curricula for six Clinical Learning Environment Review (CLER) focus areas-patient safety, health care quality, care transitions, supervision, fatigue management, and professionalism-using qualitative and numeric data.In April through June 2013, the authors recruited and interviewed third-year categorical pediatric residents from three sites. For each CLER focus area, the authors asked residents to think aloud while they assigned a total of 60 points to the explicit, implicit, and extra-curricula, according to where they perceived their learning occurred. All interviews were audio taped and transcribed verbatim. The authors coded qualitative data from interviews using the constant comparative method, scrutinized qualitative data for themes, and reviewed qualitative and numeric data.A total of 28/79 (35%) residents participated. Residents perceived learning to occur most often in the implicit curriculum for five of the six CLER focus areas; the one exception being health care quality, which predominantly took place in the explicit curriculum. In the implicit curriculum, role modeling and "learning by doing" were frequently reported modes of learning. The explicit curriculum was perceived as an important baseline for understanding clinical areas. Relatively less learning was perceived to occur in the extra-curriculum.The authors believe that recognizing learning in "other-than-explicit" curricula could broaden the medical education community's understanding of the purview of the medical education curriculum and help educators tap into underused educational opportunities for important clinical topics.