Interian, Alejandro PhD; Escobar, Javier I. MD
Our nation’s racial and ethnic minority groups, relative to white non-Hispanic populations, continue to face significant health disparities1 that need to be priorities for education and research.2,3 A key component underlying these disparities is the underrepresentation of racial and ethnic minorities among professionals serving these populations, particularly among researchers.4 The result is an adverse effect on the productivity of research that is relevant to these groups. This insufficient amount of research has prompted many investigators across several areas to articulate strategies for boosting the cultural diversity of scientists, particularly those from underrepresented racial and ethnic minorities.5 As with many areas, leaders within the field of Latino mental health have made suggestions to increase the number of racial/ethnic minorities conducting research, particularly research focusing on minority populations.
To help meet this long-term goal, we have used a conference platform that has gradually evolved over a period of several years. Our major objective has been to stimulate the number of new investigators entering the field of Latino mental health research and to mentor them when they do. Given the growing need for career stimulation across a range of disciplines, this manuscript describes the development and current format of a mentoring-based conference in order to help generate new ideas for career stimulation approaches. On the basis of our experience, our tracking of new investigators’ career progress, and ample feedback from participants, we believe that the mentoring-based conference strategy outlined herein has some unique and effective ingredients for stimulating and empowering new investigators entering the field.
A major impetus for the mentoring-based conference was data pointing to the embarrassingly low number of Latino investigators and the scant research on Latino mental health issues. Further, reports from the Institute of Medicine (IOM) and the Surgeon General2,6 highlighted wide-ranging health disparities. The IOM report outlined several disparities for African American and Latino patients, relative to non-Latino whites, including disparities in cardiac care, risk for HIV infection, and, within mental health, access and quality of care issues.6 The Surgeon General’s report summarized randomized controlled trials (RCTs) conducted during a 10-year period since 1986 for four major psychiatric disorders.2 According to this report, of the nearly 10,000 patients who participated in RCTs for bipolar disorder, major depression, schizophrenia, and attention-deficit/hyperactivity disorder, the proportion of minority participants was extremely low. Furthermore, none of the studies included ethnic-specific analyses that generated specific data on treatment response as it related to racial or ethnic background.2 These disparities and the paucity of Latin American researchers and studies prompted a handful of senior researchers interested in Latino mental health to collaborate in forming a consortium in the early 1990s.
Shortly after the publication of the Surgeon General’s report, a subcommittee of the National Advisory Council to the director of the National Institute of Mental Health (NIMH) highlighted the underrepresentation of racial/ethnic minority researchers among National Institutes of Health (NIH)/NIMH grant applicants.4 This NIMH Advisory Council report noted that in 1999 only about 5% of research applications submitted to and funded by NIMH came from racial/ethnic minority applicants (African Americans, Latinos, Native Americans), even though these groups accounted for about one fourth of the total U.S. population. This type of disparity was also found in medical schools and other academic settings. For example, the report showed that 1997 graduate and professional school enrollment for Latinos was only 4.5%. Unfortunately, this pipeline problem still persists today. The Association of American Medical Colleges reported that only about 7% of U.S. medical school enrollees in 2007 were Latino.7 A similarly low rate (7%) was found among psychology doctoral students matching for an internship.8 These rates contrast with U.S. population rates showing that Latinos represent about 13% of the U.S. population.9 The NIMH Advisory Council therefore outlined a strategy for addressing these disparities.10 A major focus of their recommendations centered on stimulating research on minority mental health issues by increasing the pipeline of racially and ethnically diverse professionals who conduct research. The Advisory Council also encouraged NIMH to develop programs that would effectively prepare talented minorities for careers in biomedical research.
The NIMH Advisory Council report also provided information on barriers that new minority investigators faced during their career development. One notable barrier was the very limited access to qualified mentors and the lack of minority role models in their academic institutions. Aiming to improve the pipeline of professionals who enter research careers, the Advisory Council recommended that “a national mental health research mentorship program be devoted to training racial/ethnic minority investigators.”4(p44)
Quality mentoring and stimulation of new research careers
Mentoring is generally described as a personal and professional relationship between a senior and a junior professional, through which the senior professional provides guidance on matters pertaining to developing skills and making career-advancing decisions. Many times, the mentor is in a position to help match the mentee with career-enhancing opportunities. In addition to assisting with skills, opportunities, and training, mentors also provide encouragement and support that stimulate new investigators’ motivation for progressing through the challenges of establishing a research career.
Insufficient mentoring is a critical deficiency in many settings that is often cited as a barrier for entering a career in research, particularly among racial and ethnic minorities.11 In a qualitative study of junior faculty in academic medicine, the respondents often cited a lack of mentoring as one of the top two issues hindering their academic career development.12 Although limited empirical data exist documenting the value of quality mentorship, one study showed that medical specialty fellows who had a mentor or advisor were more likely to complete a thesis and enter academic practice compared with those without mentoring.13 Thus, the strategy of stimulating career development through active mentoring seems an important priority across specialties. Accordingly, a number of recommendations for research career stimulation emphasize the objective of enhanced mentorship.6,13–18
In this report, we first describe the various steps in the development of a national network of mentors for Latino mental health researchers. These steps eventually led to the preparation and successful funding of an NIH conference grant (R13), which has now received ongoing funding for more than five years. The primary aim of these annual conferences is to stimulate the pipeline of researchers whose work focuses on Latino mental health, which is intended, in turn, to help reduce inequities in mental health care. We then provide preliminary results on outcomes using both quantitative and qualitative data obtained during the first four years of the R13 award.
Development of the mentoring-based conference
The closure in 1997 by NIMH of the few existing minority mental health center grants for research relevant to Latinos served to catalyze the formation of a consortium of Latino and non-Latino investigators interested in Latino mental health research. Those of us forming the consortium felt that although the low research productivity resulting from the grants may have justified this closure, it led to further isolation of the few Latino mental health researchers from the mainstream of biomedical studies at NIMH. The consortium was formed in the early 1990s, and one of us (J.I.E.) took a leadership role in its initiation. From the outset, NIMH administrators and many other NIH-funded Latino researchers warmly received the idea of the consortium. The major goals of the consortium were to stimulate new research focused on Latino populations and to facilitate the entry of new investigators into the field.
Next, discussions with NIMH leadership resulted in support for a series of four yearly conferences as the platform to foster intensive networking and to solidify a group of mentors interested in Latino mental health. Toward this end, a list of Latino and non-Latino investigators interested in Latino mental health was created. It took a number of formal and informal contacts with leading investigators in the field to finally assemble an initial group to brainstorm solutions to this problem. Next, NIMH contributed funds for the consortium to hold four working conferences in different areas of the country. These conferences took place in Princeton, New Jersey, in 1998 (approximately 60 participants); San Antonio, Texas, in 1999 (approximately 40 participants); Los Angeles, California, in 2000 (approximately 50 participants); and San Juan, Puerto Rico, in 2001 (approximately 70 participants). The first three meetings focused on reviewing the state of Latino mental health research. The serious problems and resource deficiencies highlighted at these conferences made the participants aware of the urgent need to achieve the objectives of (1) increasing the number of NIMH-funded research projects, (2) translating research findings into policy and practice, and (3) stimulating the entry of new researchers to the field. Notably, these three conferences also served as a platform to allow the emergence of intensive networking and the establishment of a solid network of senior Latino mental health researchers. The regularity of the annual meetings facilitated the momentum for moving these objectives and the research agenda forward. The first three meetings consisted of scholarly presentations and discussions led exclusively by senior researchers in the field, which helped solidify the objective of supporting a new generation of Latino mental health researchers.
The fourth conference, in San Juan, shifted the focus from the senior presenters to the new investigators and helped establish the model for the conference as it stands today (description below). We realized, after discussions with NIMH staff, that to continue the momentum of the San Juan conference, a formal funding mechanism would be necessary for more predictable planning and support for these gatherings. This led to the preparation of a formal conference application using the R13 grant mechanism.
The NIMH conference mechanism (R13)
The R13 grant mechanism is available from the various institutes within NIH and is used to support scientific meetings that address the respective research priorities of the various NIH institutes. Although a formal application is needed and the process is competitive, the R13 application is much less involved than that required for RO1s and other traditional funding mechanisms. In our R13 application, we proposed a series of five annual conferences to mentor new investigators. The proposal included assembling senior researchers with expertise in different areas relevant to Latino health research. All pledged to serve as mentors. These conferences pursued a number of aims: (1) to identify talented new investigators in the field of Latino mental health, (2) to facilitate new investigator retention in Latino mental health research careers, (3) to facilitate the publication of new investigators’ manuscripts, and (4) to stimulate applications for research funding among new investigator participants. The yearly meetings emphasized the forging of strong mentor-mentee relationships as a key component. The conferences were organized around specific themes relevant to mental health and Latinos: mood disorders (2002), culture and diagnosis (2003), mental health and addictions (2004), biological and psychosocial influences on mental disorders (2005), and special issues in Latino mental health—children, HIV, and comorbid medical disorders (2006). The conference organizers used these themes in an effort to recruit additional new investigators from areas deemed critical and underrepresented; the conference stimulated representation of these areas within the network. The data presented here were gathered during the first four years of the conference.
Each year, 15 to 20 new investigators participated in the meeting and conference organizers paired them with mentors, all senior researchers. Keynote speakers also gave presentations to highlight particular areas of research (e.g., neurobiology of suicide) and career development (e.g., “Career Planning in the Context of Life Planning”). NIH program staff, chairs of academic departments of psychiatry, and members from relevant agencies (e.g., American Society of Hispanic Psychiatry, the Robert Wood Johnson Foundation, New Jersey Mental Health Institute, Latino Behavioral Health Institute) also participated. The presence of representatives from these agencies was critical to stimulate networking as well as to present information. Each year at the conference, NIH program staff presented a grant-writing workshop, at which attendees discussed grant opportunities and mechanisms within NIH. These workshops also focused on grant-writing strategies. Program staff from other agencies networked with participants and informally discussed opportunities that their agencies made available. For example, the Robert Wood Johnson Foundation discussed funding opportunities specifically for new investigators.
Recruitment of trainees.
The recruitment process included yearly calls-for-papers for the conference that invited new investigators to submit abstracts. The circulation of the call-for-papers occurred within the network, but it also included other various organizations and agencies (e.g., NIMH, American Society of Hispanic Psychiatry, and the Pan American Health Organization). Senior researchers reviewed and rated the abstract submissions (each abstract was reviewed by multiple senior researchers). The junior researchers whose abstracts earned the highest average ratings were chosen to present at the meeting and were paired, almost always one-on-one, with a senior researcher with compatible areas of interest.
Mentors were typically chosen from within the network. Occasionally, senior researchers were selected from outside the network if their area of expertise matched that of a new investigator. For practical reasons, we also recruited senior researchers based in the region of the conference each particular year. This helped decrease travel expenditures and contributed to further expanding our network of mentors.
The format of the conference was shaped to maximize the amount and quality of feedback that new investigators received, both from their mentors and other senior researchers in the audience. The mentor-mentee dyads formed approximately two to three months before the conference, which led to a greater amount of contact and exchange. Before the conference, the mentors reviewed the mentees’ presentations in either manuscript or PowerPoint format. Typically, the dyads engaged in e-mail and/or telephone contact to work on the feedback. In turn, this allowed mentors to help new investigators solidify the quality of their presentations. The mentors then served as formal discussants during the event. The typical format comprised a 20-minute presentation given by the new investigator, followed by a 15-minute discussion by the mentor/discussant, and then another 15 minutes for questions and comments from the audience (both senior and new investigators). The poster sessions followed a similar format: new investigators provided a brief oral presentation summarizing their poster, which was followed by a brief discussion from the mentor, and then questions and comments from the senior and new investigators in the audience. This format enhanced mentor-mentee interactions as well as the exchange between the new investigator and their peers and senior researchers in the audience.
We used attendance data, career tracking data, and data from conference feedback questionnaires to assess the conferences’ effectiveness. We used attendance data to describe the level of participation in the events. Career tracking data consisted of the number of peer-review publications and research grant applications submitted by each new investigator who presented at the conferences. We tracked career progress for a two-year period following participants’ involvement in the conference. Each participant returned a questionnaire that inquired about these indicators and the degree to which he or she attributed his or her publication(s) or grant application(s) to participation in the conference. Finally, all participants (new investigators, senior investigators, and funding agency staff) completed conference feedback questionnaires after each conference. We qualitatively analyzed their feedback to summarize the strengths of the program. Specifically, we developed a list of categories by reviewing each feedback comment. We present a description of these categories as well as their frequency.
The reporting of these existing data received approval for exempt review by the institutional review board of the University of Medicine and Dentistry of New Jersey-Robert Wood Johnson Medical School.
Fifty-three new investigators participated in the program during the first four years (2002-2005) of the R13 award and are the subject of this report. Of these, 44 were Latino-origin investigators and 9 were non-Latino investigators. With the exception of one Latino investigator, all new investigators presented work related to Latino mental health. The new investigator participants represented a total of 32 different universities, four of which were international institutions from Brazil, Colombia, and Mexico.
A total of 41 senior researchers served as mentors during this four-year period; some attended more than once. They were faculty members from 20 U.S. academic institutions and from two international research institutions (i.e., the Pan American Health Organization and Inter-American Drug Abuse Control Commission). Mentors from NIMH also participated. All of these mentors were active in research, particularly research related to Latino mental health. An absolute majority of these mentors (40 out of 41) had served as principal investigators of at least one NIH grant. Also, three of the mentors were members of the IOM; three others served on the National Advisory Mental Health Council for NIMH, five were chairs of academic departments, and five were directors of research institutes.
Feedback from conference participants
We gained a sense of the conference’s strengths and weaknesses from the feedback questionnaires that participants completed immediately after each conference. During the first five years, 174 questionnaires were completed and analyzed. These questionnaires were completed by most, but not all participants, and therefore represented a convenience sample of all participants. The questionnaires specifically asked participants to identify the greatest strengths and weaknesses of the conference (open-ended question format). Table 1 summarizes the most frequently identified strengths and weaknesses and presents a sample of verbatim statements from participants.
The most frequently identified positive features of the conference were the opportunities for networking (32% of 161 positive comments), the availability of strong, dedicated mentors (19%), and the formation of new investigator-senior investigator dyads/conference format (27%). A number of new investigators communicated to us informally that these strengths occurred within an environment that was “friendly” and “supportive,” thereby enhancing these strengths. This feedback bolsters the conference’s main objectives. Other positive features noted included the quality of the work/talent of presenters (22%), the geographic and intellectual diversity of presenters (8%), and the dissemination of knowledge (8%).
Some of the weaknesses of the event noted by participants include “tight” scheduling of conference activities (22% of 124 negative comments), the lack of representation of certain research topics (14%), and some problems with logistics, such as date, location, facilities, etc. (10%). We felt encouraged that few participants noted weaknesses pertaining to the major objectives (e.g., mentoring) of the conference.
These critiques led us to revise the number of presentations, the duration of the event, the length of the presentations, and the geographical location of the conference. We came to realize that the optimum content of sessions has to be carefully balanced between the range of insufficient and excessive. Furthermore, our conference participants expressed interest in a wide variety of research topics within Latino mental health (e.g., treatment, epidemiology, biology). There is likely a natural limit to sufficiently, but deeply, addressing a wide range of interests. Some of the feedback we received illustrates this difficulty (Table 1, Diversity of researchers/topics). Because of the critical shortage of investigators, we felt it was critical to expose as many new investigators as possible to this experience; therefore, we decided to invite more new investigators while limiting their presentation time.
Another important, though infrequent (5%), critique pertained to the uneven quality and quantity of the mentorship provided. These suggestions focused on optimizing mentors’ feedback to mentees by having their discussions of new investigators’ work be articulated in an objective, unambiguous fashion, including specific recommendations for improving the paper and the research. Because this was quite relevant to the conference’s central aims, we responded by providing mentors with clear suggestions and models for their role as discussants. The guidelines encouraged the mentors to provide an initial evaluation of the work that was constructive and emphasized the strengths of the research (or paper), as well as highlighting the value of the work. As a next step, mentors were encouraged to provide specific suggestions for enhancing the scope of the paper and its chances of being published in a refereed journal. Finally, the mentor was asked to provide the new investigator with specific ideas about how to carry his or her research forward, with the ultimate goal of obtaining independent funding.
Tracking the progress of new investigators
We have complete data for the first four years (2002-2005) of the conference grant. During this four-year period, 53 new investigators participated in the program, worked with a mentor, and presented at the conferences. Of these 53 new investigators, we tracked the progress of 49 of them (92%) during a two-year period using annual questionnaires; we could not obtain a career progress update from four participants. Data collection for the fifth-year participants is still occurring. Questions asked participants to note any publications or grant activities that have resulted from their work. In addition, the questionnaire asked participants to rate the conference’s role in facilitating the publication/grant activity as a “significant or full role,” “partial role,” or “minimal role.”
Publications submitted and accepted.
Out of the 49 new investigators we tracked, 34 (69%) reported that they have submitted their conference papers to a journal, and 28 of these (82%) reported that the conference played a significant or partial role in their manuscript submission. Twenty-one of the 34 publication submissions (62%) have been accepted for publication. Among the 15 new investigators who had not submitted a paper for publication, some reported that they were preparing a manuscript for submission. Also, a few of the investigators who had submitted their papers indicated that they were “under review” at the time of the last career progress update.
Research applications and research funding.
Our 49 responding new investigators reported that they have submitted a total of 38 research grant applications thus far. In 25 of these applications (66%), new investigators rated the conference as playing a significant or at least partial role in the grant submission. Of the 38 grant proposals submitted, 24 (63%) were NIH grants, while others were submitted to agencies such as the National Alliance for Research on Schizophrenia and Depression and the Robert Wood Johnson Foundation. A total of 16 grants (42%) were reported as funded. As with the case of publication activity, numerous new investigators who had not submitted a grant application or did not yet have funding reported that their research grants are either in preparation or under review.
The main objectives of this mentoring-based conference were increasing the pool of investigators in Latino mental health by increasing the number of publications and grant submissions produced by the next cadre of investigators and helping them form collaborations with senior researchers. This model has coincided with successful outcomes such as new publications, funded grant applications, and shared data. Other fields that are also seeking to increase their pool of researchers share these objectives. A key component of our model is a strong mentor-mentee dyad and an event that is new-investigator-centered. Another key component of this model is a “culture of mentorship,” which can be inferred from participants’ description of the climate as “supportive,” “nurturing,” and “generous.” Other key ingredients for the success of the conference are the hands-on experience of the new investigators, the availability of a large pool of dedicated senior researchers, and the presence of program officers from multiple funding agencies (e.g., NIMH, NIDA, Robert Wood Johnson Foundation). Finally, we believe that the new investigator focus of the conference creates excitement for new investigators that stimulates and motivates them toward the immediate next steps in their career development.
Although the conference has had a broad focus (e.g., biological, epidemiological) and has targeted various geographic areas relevant to Latino mental health, certain areas (both topical and geographic) remain underrepresented. We have employed a number of strategies for diversifying the geographical representation of researchers as well as the range of topics. A key tool for fine-tuning the representation of the conference is the careful selection of organizing committee members. Individual members of the organizing committee are in a position to use their own contacts to solicit new investigator submissions as well as mentor participants from specific research fields and geographical areas. The annual theme for the conference also facilitates recruitment from specific research areas. After we implemented these approaches, we observed a boost in representation from some fields, such as biologically oriented research and HIV-AIDS research. Finally, varying the geographical location of the conferences has also been helpful for recruiting researchers from different regions of the United States.
Finally, while lack of mentoring has been a frequently implicated barrier,11–13 research career development is multifaceted. Accordingly, efforts for increasing the number of independent researchers are likely to require other approaches, such as skill enhancements and longitudinal support. Our program emphasizes a conference model that is brief, but which significantly helps new investigators expand their mentoring/collaborative network, showcase their work, and develop their work into a publication or grant proposal. A comprehensive career stimulation strategy should combine this model with other existing programs that offer research skills training, intensive grant-writing instruction, and structured long-term mentoring.14,16,19,20
The task of increasing the number of researchers who focus on Latino mental health is complicated by pipeline issues. We have shown that having a committed group of mentors and a relatively modest investment is associated with positive outcomes, as operationalized by publications and grant submissions/awards. As noted, the vast majority of participants attributed, at least partially, their publication and grant application activity to participation in the conference. These beneficial outcomes would be extended if they served as a catalyst for more opportunities and experiences that support new investigators’ research career trajectories.
This effort was supported, in part, by a grant from the National Institute of Mental Health (R13 MH66308). The authors would like to acknowledge the organizers for the first four meetings who were, respectively, Dr. Javier Escobar (Princeton; 1988), Dr. William Vega (San Antonio; 1999), Dr. Steven Lopez (Los Angeles; 2000), and Dr. Margarita Alegria (San Juan; 2001). The authors would like to thank the many who have served in organizing, supporting, and participating in this event. We would also like to acknowledge the commitment of the mentors who have served in this effort during the period of 2002 to 2008: Sergio Aguilar-Gaxiola, MD, PhD, Renato Alarcon, MD, MPH, Margarita Alegria, PhD, Victoria Arango, PhD, Guillermo Bernal, PhD, Hector Bird, MD, Carlos Blanco, MD, Jose Caldas de Almeida, MD, PhD, Glorisa Canino, PhD, Jose Cañive, MD, Pedro Delgado, MD, Esperanza Diaz, MD, Michael Escamilla, MD, Jan Fawcett, MD, Linda Garro, PhD, Peter Guarnaccia, PhD, Robert Hendren, DO, Janis Jenkins, PhD, Marvin Karno, MD, Alex Kopelowicz, MD, Barry Lebowitz, PhD, Roberto Lewis-Fernandez, MD, Robert Like, MD, MS, Steve Lopez, PhD, Sana Loue, PhD, David Mechanic, PhD, Jeanne Miranda, PhD, Francisco Moreno, MD, Yuval Neria, PhD, Grayson Norquist, MD, Augosto Perez-Gomez, PhD, Theodore Petti, MD, MPH, Victor Reus, MD, Robert Roberts, PhD, Pedro Ruiz, MD, Patrick Shrout, PhD, Gregory Simon, MD, MPH, Manuel Trujillo, MD, William Vega, PhD, Howard Waitzkin, MD, PhD, Luis Vargas, PhD, and Luis Zayas, PhD.