If you don't remember your password, you can reset it by entering your email address and clicking the Reset Password button. You will then receive an email that contains a secure link for resetting your password
If the address matches a valid account an email will be sent to __email__ with instructions for resetting your password
Address for reprints: Jack H. Boyd, MD, Department of Cardiothoracic Surgery, Falk Cardiovascular Research Building, CV-229, 300 Pasteur Dr, Stanford, CA 94305
Cardiothoracic (CT) surgeons with National Institutes of Health (NIH) R01 funding face a highly competitive renewal process. The factors that contribute to successful grant renewal for CT surgeons remain poorly defined. We hypothesized that renewed basic science grants are associated with high research output and scholarly impact during the preceding award cycle.
Methods
Using a database of academic CT surgeons (n = 992) at accredited training institutions in 2018, we identified basic science R01 grants awarded to CT surgeon principal investigators since 1985. Data for each award were obtained from publicly available online sources. Scholarly impact was evaluated using the NIH-validated relative citation ratio (RCR), defined as an article's citation rate divided by that of R01-funded publications in the same field. Continuous data are presented as medians and analyzed using the Mann–Whitney test.
Results
We identified 102 basic science R01 award cycles, including 33 that were renewed (32.4%). Renewed and nonrenewed awards had a similar start year and funding period. Principal investigators of renewed versus nonrenewed awards were similar in surgical subspecialty, research training, attending experience, academic rank, and previous NIH funding. Renewed awards produced more publications per year over the funding cycle (3.4 vs 1.5; P = .0010) and exhibited a greater median RCR during the funding cycle (0.84 vs 0.66; P = .0183).
Conclusions
CT surgery basic science R01 grants are associated with high research output and scholarly impact. At the 50th percentile among renewed grants, CT surgeons published 3.4 funded manuscripts per year with a median RCR of 0.84 during the previous award cycle.
At the 50th percentile among renewed basic science R01 grants, surgeons published 3.4 funded articles per year with a median relative citation ratio of 0.84 during the previous award cycle.
Cardiothoracic surgeons pursuing basic science research face a highly competitive extramural funding environment. Aside from supporting surgeons in the grant acquisition process, it is also important to optimize grant renewal. Herein, we quantify the research output and scholarly impact of renewed versus nonrenewed basic science R01 grants to help guide surgeons in the renewal process.
See Commentaries on pages 176 and 178.
Clinical advances in cardiothoracic (CT) surgery are driven by research and innovation, but concerns have been raised regarding the attrition of CT surgeon-scientists,
Furthermore, NIH R01 grants historically account for most research funding for cardiac surgeons, but the number of active cardiac surgery R01 grants has plateaued over the past 2 decades.
In response, considerable attention has been focused on supporting CT surgeon-scientists endeavoring to achieve the extramural funding needed to maintain an independent research enterprise, for which the R01 grant remains the standard. To this end, the importance of research training,
and academic development programs cannot be understated.
In addition to supporting surgeon-scientists on grant acquisition, it is also essential to optimize strategies for grant renewal to sustain funding in the long term. Indeed, the number of competitive renewal awards issued by the NIH to all surgeons declined by 60% between 2003 and 2013, representing a greater decrease than that for other specialties including medicine, pathology, pediatrics, and psychiatry.
Successful grant renewal plays an important role in long-term funding longevity, but the factors affecting R01 renewal for CT surgeons have not been explored in detail. Herein, we quantify the research output and scholarly impact of renewed versus nonrenewed CT surgery basic science R01 grants to help guide surgeons in the renewal process. We hypothesized that renewed grants are associated with high research output and scholarly impact during the preceding award cycle.
Methods
In this study, we used a biographical database of 992 academic CT surgeons who were on faculty at the university hospital of the 77 accredited United States CT surgery training programs in 2018, as previously described.
National Institutes of Health R01 grant funding is associated with enhanced research productivity and career advancement among academic cardiothoracic surgeons.
Emeritus professors, nonsurgical faculty (eg, PhD researchers), and surgeons working at affiliated satellite hospitals were excluded from our database. Data regarding each surgeon's training and professional career were obtained from department webpages, CTSNet (https://www.ctsnet.org), LinkedIn (https://www.linkedin.com), and other online sources. Each surgeon's career publication record was obtained using Scopus (https://www.scopus.com). The NIH funding rank of each surgeon's institution was determined using NIH Research Portfolio Online Reporting Tools (https://report.nih.gov).
We defined “grant” as the overarching R01 funding mechanism, encompassing 1 or more funding cycles, whereas “award” or “award cycle” refers to the individual funding cycles that comprise a grant. To identify R01 grants awarded to the CT surgeons in our database, each surgeon's NIH funding history was obtained using Grantome (https://grantome.com) and NIH Research Portfolio Online Reporting Tools Expenditures and Results (RePORTER; https://reporter.nih.gov). All basic science R01 grants awarded since 1985 (ie, the earliest year included in NIH RePORTER), in which a CT surgeon in our database served as principal investigator (PI) for the entire duration of the funding cycle, were included for analysis. Each grant was assessed for potential renewal through the year 2019. Grants with award cycles that had not been completed by the year 2019 or that had been terminated early (and therefore were not subject to potential renewal at the time of analysis) were excluded. Funding data and articles published during each award cycle were obtained from NIH RePORTER.
Scholarly impact was assessed using the relative citation ratio (RCR), a field-normalized metric developed and validated by the NIH.
Briefly, the RCR represents the citation rate of an article divided by the citation rate of R01-funded articles in the same field. Thus, an article with an RCR of 1.00 has an equal number of citations per year as other R01-funded papers in the same field, whereas an article with an RCR of 2.00 has twice the number of citations per year, reflecting greater impact. The RCR of each individual publication was calculated using the NIH iCite database (https://icite.od.nih.gov), and the median and maximum RCR among the publications linked to each R01 award cycle was determined.
All data used in this study were obtained from publicly available online sources. Statistical analyses were performed using GraphPad Prism version 9.0.0 (Graph Pad Software). The D'Agostino–Pearson test was used to assess normality. Continuous data were non-normally distributed and presented as median with interquartile range and analyzed using the Mann–Whitney test. Categorical data are presented as counts with percentages and analyzed using Fisher exact test, or the χ2 test when more than 2 categories were involved.
Results
R01 Award Characteristics
A total of 76 basic science R01 grants were identified (Table E1), encompassing 102 award cycles, of which 33 (32.4%) were subsequently renewed and 69 (67.6%) were not renewed. Among the 992 CT surgeons in our database, 49 (4.9%) had completed a basic science R01 funding cycle as PI, among whom 20 (40.8%) had renewed a basic science R01 grant.
As presented in Table 1, the characteristics of R01 award cycles that were renewed were similar to those that were not renewed. Renewed and nonrenewed awards exhibited a similar median starting year (2001 vs 2003; P = .4680) and were disbursed over a similar funding period (4.0 years each; P = .7042). Renewed awards were associated with greater 2020 inflation-adjusted funding per year ($494,808 vs $453,676; P = .0799). Renewed awards were also associated predominantly with the National Heart, Lung, and Blood Institute (NHLBI; n = 31; 93.9%; Figure 1, A), and all other renewed awards were associated with the National Cancer Institute (n = 2; 6.1%). Among renewed awards in the NHLBI (Figure 1, B), the most common study sections were Surgery and Bioengineering (n = 12; 38.7%), Bioengineering, Technology, and Surgical Sciences (n = 9; 29.0%), and Surgery, Anesthesiology, and Trauma (n = 6; 19.4%). A similar distribution of NIH institutes (P = .6659) and NHLBI study sections (P = .4309) was observed for the renewed versus nonrenewed award cycles.
Table 1Characteristics of cardiothoracic surgery basic science R01 awards that were renewed or not renewed
R01 award characteristic
Renewed (n = 33)
Not renewed (n = 69)
P value
95% CI of difference
Award start year
2001 (1996-2009)
2003 (2000-2009)
.4680
−5.0 to 2.0
Length of funding period, years
4.0 (4.0-5.0)
4.0 (4.0-5.0)
.7042
0.0-0.0
2020 Inflation-adjusted funding per year, $
494,808 (428,521-601,583)
453,676 (402,501-539,975)
.0799
−4088 to 107,708
NIH Institute
.6659
NHLBI
31 (93.9)
58 (84.1)
NCI
2 (6.1)
8 (11.6)
National Institute on Aging
0 (0)
1 (1.4)
National Institute of Allergy and Infectious Diseases
0 (0)
1 (1.4)
National Institute of Neurological Disorders and Stroke
0 (0)
1 (1.4)
NHLBI study section
.4309
Surgery and Bioengineering
12 (38.7)
22 (37.9)
Bioengineering, Technology and Surgical Sciences
9 (29.0)
11 (19.0)
Surgery, Anesthesiology, and Trauma
6 (19.4)
9 (15.5)
Special Emphasis Panel
2 (6.5)
9 (15.5)
Cardiac Contractility, Hypertrophy, and Failure
1 (3.2)
2 (3.4)
Lung Biology and Pathology
1 (3.2)
0 (0)
Clinical and Integrative Cardiovascular Sciences
0 (0)
3 (5.2)
Respiratory Integrative Biology and Translational Research
0 (0)
2 (3.4)
NCI study section
.5044
Clinical Oncology
1 (50.0)
0 (0)
Special Emphasis Panel
1 (50.0)
3 (37.5)
Medical Imaging
0 (0)
1 (12.5)
Biomaterials and Biointerfaces
0 (0)
1 (12.5)
Tumor Progression and Metastasis
0 (0)
1 (12.5)
Cancer Etiology
0 (0)
1 (12.5)
Experimental Therapeutics Subcommittee
0 (0)
1 (12.5)
Data are presented as median (interquartile range) or n (%). Percentages might not sum to 100% because of rounding.
NIH, National Institutes of Health; NHLBI, National Heart, Lung, and Blood Institute; NCI, National Cancer Institute.
Figure 1Distribution of (A) National Institutes of Health (NIH) Institutes and (B) National Heart, Lung, and Blood Institute (NHLBI) study sections among renewed cardiothoracic surgery basic science R01 awards (n = 33). Renewed awards were predominantly associated with the NHLBI (n = 31), whereas the remainder were associated with the National Cancer Institute (NCI; n = 2). The NHLBI study sections among renewed R01 awards included the Surgery and Bioengineering study section (SB; n = 12), the Bioengineering, Technology and Surgical Sciences study section (BTSS; n = 9), the Surgery, Anesthesiology and Trauma study section (SAT; n = 6), the Cardiac Contractility, Hypertrophy, and Failure study section (CCHF; n = 1), the Lung Biology and Pathology study section (LBPA; n = 1), and Special Emphasis Panels (SEP; n = 2).
The characteristics of CT surgeon PIs of award cycles that were renewed were similar to those of award cycles that were not renewed (Table 2). Men accounted for nearly all PIs in both groups (97.0% vs 91.3%; P = .4233, respectively (Figure 2, A), and only 1 woman was PI of a renewed basic science R01 grant. The distribution of cardiac (60.6% vs 56.5%), thoracic (24.2% vs 27.5%), and congenital surgeons (15.2% vs 15.9%) serving as PI was similar among the renewed and nonrenewed awards (P = .9209). The PIs of the renewed and nonrenewed awards had also served as attending surgeons for a similar duration (13.0 vs 11.0 years; P = .6495), and represented a similar distribution of full professors (69.7% vs 66.7%; P = .3976) and department/division chairs (42.4% vs 34.8%; P = .5144), respectively.
Table 2CT surgeon PI characteristics for basic science R01 awards that were renewed or not renewed
CT surgeon PI characteristic
Renewed (n = 33)
Not renewed (n = 69)
P value
95% CI of difference
Sex
.4233
Male
32 (97.0)
63 (91.3)
Female
1 (3.0)
6 (8.7)
Surgeon Subspecialty
.9209
Cardiac
20 (60.6)
39 (56.5)
Thoracic
8 (24.2)
19 (27.5)
Congenital
5 (15.2)
11 (15.9)
Dedicated research training
20 (60.6)
47 (68.1)
.5072
PhD degree
5 (15.2)
12 (17.4)
>.9999
First author basic science publication during training
23 (69.7)
52 (75.4)
.5440
Start year as attending
1988 (1979-1999)
1990 (1984-1999)
.3413
−7.0 to 2.0
Total years as attending
13.0 (7.0-19.0)
11.0 (7.5-18.0)
.6495
−2.0 to 4.0
Academic rank
.3976
Unknown
4 (12.1)
15 (21.7)
Associate professor
6 (18.2)
8 (11.6)
Full professor
23 (69.7)
46 (66.7)
Department or division chair
14 (42.4)
24 (34.8)
.5144
Previous NIH K grant
5 (15.2)
6 (8.7)
.3282
Previous NIH R grant (non-R01)
7 (21.2)
20 (29.0)
.4777
Previous NIH R01 grant
21 (63.6)
37 (53.6)
.3964
Top 25 NIH-funded institution
23 (69.7)
37 (53.6)
.1228
Career first-author publications
33.0 (21.5-40.0)
27.0 (19.0-43.5)
.3348
−4.0 to 9.0
Career last-author publications
69.0 (28.5-116.5)
40.0 (20.5-95.0)
.1368
−4.0 to 36.0
Career total publications
170.0 (131.0-277.5)
140.0 (87.0-241.5)
.2385
−17.0 to 71.0
Publications per year as attending
10.0 (7.6-12.3)
7.7 (5.2-11.7)
.0745
−0.18 to 3.46
Changed institution during grant
3 (9.1)
7 (10.1)
>.9999
Co-PI
0 (0.0)
1 (1.4)
>.9999
Data are presented as median (interquartile range) or n (%). Percentages might not sum to 100% because of rounding.
CT, Cardiothoracic; PI, principal investigator; NIH, National Institutes of Health.
Figure 2The characteristics of cardiothoracic surgeon principal investigators are compared for basic science R01 awards that were renewed (n = 33) versus not renewed (n = 69). Similar distributions were observed with regard to (A) surgeon gender (renewed n = 1/33 women vs nonrenewed n = 6/69 women), (B) history of previous R01 grant funding (renewed n = 21/33 vs nonrenewed n = 37/69), or (C) faculty position at a top-25 National Institutes of Health (NIH)-funded institution (renewed n = 23/33 vs nonrenewed n = 37/69).
A similar large percentage of PIs for the renewed and nonrenewed award cycles had pursued a dedicated research fellowship during training (60.6% vs 68.1%; P = .5072) and published a first-author basic science article during training (69.7% vs 75.4%; P = .5440), although only a small percentage in each group had earned a PhD degree (15.2% vs 17.4%, respectively; P > .9999). There was no difference in the proportion of PIs for renewed and nonrenewed awards who had previously received an NIH K grant (15.2% vs 8.7%; P = .3282), an NIH R grant other than an R01 (21.2% vs 29.0%; P = .4777), or a previous R01 grant (63.6% vs 53.6%; P = .3964; Figure 2, B). The PIs for renewed awards more often represented a top-25 NIH-funded institution (69.7% vs 53.6%; P = .1228; Figure 2, C). At the end of the funding cycle (ie, at the time of potential grant renewal), the PIs for renewed awards had been more prolific over their careers (170.0 vs 140.0 total publications; P = .2385) and published more frequently as an attending (10.0 vs 7.7 publications per year; P = .0745). Finally, a similar proportion of renewed and nonrenewed awards involved a CT surgeon PI who changed institutions during the funding cycle (9.1% vs 10.1%; P > .9999), and a similar proportion of renewed and nonrenewed awards were led by a co-PI in addition to the CT surgeon (0.0% vs 1.4%, respectively; P > .9999).
Research Output and Scholarly Impact During the R01 Funding Cycle
Research output and scholarly impact during the R01 funding cycle are presented in Table 3. Awards that were renewed produced more total publications over the funding cycle than awards that were not renewed (16.0 vs 8.0 publications; P = .0058; Figure 3, A), as well as more publications per year over the funding cycle (3.4 vs 1.5 publications per year; P = .0010; Figure 3, B). The publications linked to renewed awards also exhibited greater scholarly impact, in terms of median RCR for the funding cycle (0.84 vs 0.66; P = .0183; Figure 4, A) and maximum RCR for the funding cycle (3.22 vs 2.02; P = .0259; Figure 4, B).
Table 3Research output and scholarly impact during the funding cycle of cardiothoracic surgery basic science R01 awards that were renewed or not renewed
Research output and scholarly impact during funding cycle
Renewed (n = 33)
Not renewed (n = 69)
P value
95% CI of difference
Total publications
16.0 (6.0-26.0)
8.0 (3.0-14.5)
.0058
2.00-11.00
Publications per year
3.4 (1.6-5.5)
1.5 (0.6-3.1)
.0010
0.58-2.50
Median RCR
0.84 (0.67-1.29)
0.66 (0.40-0.98)
.0183
0.03-0.39
Maximum RCR
3.22 (2.00-5.91)
2.02 (0.70-4.81)
.0259
0.20-1.99
Data are presented as median (interquartile range).
Figure 3Research output for cardiothoracic surgery basic science R01 awards that were renewed (n = 33) versus not renewed (n = 69). A, Renewed awards yielded a greater number of total publications during the funding cycle compared with nonrenewed awards. B, Renewed awards yielded a greater number of publications per year of the funding cycle compared with nonrenewed awards. The upper and lower borders of the box define the interquartile range with the middle horizontal line representing the median. The upper and lower whiskers define the maximum and minimum values of nonoutliers, with additional dots representing outliers.
Figure 4Scholarly impact of manuscripts published during the funding cycle of cardiothoracic surgery basic science R01 awards that were renewed (n = 33) or not renewed (n = 69). An article with a relative citation ratio (RCR) of 1.00 indicates equal impact as other R01-funded publications in the same field. A, Renewed awards exhibited a greater median RCR among publications linked to the funding cycle compared with nonrenewed awards. B, Renewed awards exhibited a greater maximum RCR among publications linked to the funding cycle compared with nonrenewed awards. The upper and lower borders of the box define the interquartile range with the middle horizontal line representing the median. The upper and lower whiskers define the maximum and minimum values of nonoutliers, with additional dots representing outliers.
In this study, we compared the award characteristics, the surgeon PIs, and the publications funded by basic science CT surgery R01 awards that were renewed versus those that were not renewed. We observed similar attributes among the CT surgeon PIs of renewed versus nonrenewed awards, including subspecialty type, research training, clinical experience, academic rank, and history of previous NIH funding, although renewed awards tended to be associated with a PI with greater career research output at a top NIH-funded institution. We also observed, however, that renewed awards were associated with more publications during the funding period, and that these funded publications also exhibited a greater scholarly impact. These findings suggest that research output and scholarly impact during the preceding award cycle might represent important factors for R01 grant renewal (Figure 5).
Figure 5On the basis of data regarding research output and scholarly impact for 102 National Institutes of Health (NIH) basic science R01 funding cycles awarded to cardiothoracic (CT) surgeons, we observed that surgeon-scientists should aim to publish 3.4 articles per year during the R01 funding cycle while maintaining a goal median relative citation ratio (RCR) of 0.84 to be at the 50th percentile among CT surgeons in the renewal process. A publication with an RCR of 1.00 indicates equal impact as a R01-funded publication in the same field. The upper and lower borders of the box define the interquartile range with the middle horizontal line representing the median. The upper and lower whiskers define the maximum and minimum values of nonoutliers, with additional dots representing outliers.
In the first round, reviewers from a scientific review group, also known as a study section, evaluate the scientific and technical merit of the proposal and assign a criterion score in each of 5 areas: significance, investigator, innovation, approach, and environment. Renewal status (as opposed to a first-time application) is considered as an additional review criteria at this stage. An overall impact score is then determined for the grant application. Subsequently, a second round of review is conducted by the appropriate NIH institute, which considers the relevance of each application according to the institute's mission, goals, and priorities when determining the final funding decision.
Analyses conducted by the NIH have shown that each of the 5 criterion scores is an important contributor to an R01 application's overall impact score.
Interestingly, the approach score appears to be the most important predictor of the overall impact score and the likelihood of funding, followed by the significance and innovation scores.
In contrast, the environment score had the lowest association, followed by the investigator score. A follow-up analysis by the NIH, focusing exclusively on R01 renewal applications, confirmed that the approach and significance scores were the strongest predictors of the overall impact score and the ultimate renewal result, and that PI characteristics (eg, age, gender, research training background) were not correlated with success.
On the basis of these data, the NIH has emphasized that a well designed and clearly described experimental strategy for continued high-impact research is central to a successful R01 grant renewal application.
In parallel with the NIH data showing that the investigator and environment scores might be least influential among the 5 criterion scores, we noted similar CT surgeon PI characteristics among the renewed versus nonrenewed award cycles. However, we acknowledge the small sample size of our study, and we nevertheless observed that PIs of renewed grants tended to have a higher career publication rate and may be more likely to represent a top-25 NIH-funded institution. As such, the surgeon's academic record and the strength of the institution's research environment might be less influential than the overall impact and strategy of the proposed research, but they are nevertheless important.
Notably, we identified only 1 renewed basic science R01 grant for which a woman in our database served as PI. Krebs and colleagues
recently showed that women constitute a greater than anticipated proportion of surgeon-scientists with R01 funding, and that female surgeons with R01 grants were more likely to be first-time awardees with no previous NIH funding. Although women obtain new R01 or equivalent grants with comparable success rates as men, women historically have experienced lower success rates for renewal applications,
Analysis of National Institutes of Health R01 application critiques, impact, and criteria scores: does the sex of the principal investigator make a difference?.
To sustain the women who represent an essential, enlarging group of surgeon-scientists, additional support and attention must be directed toward facilitating research training opportunities and expanding mentorship and sponsorship networks for women in CT surgery.
The correction of these gender disparities at the level of local and national leadership might further help female surgeon-scientists maintain long-term research funding.
Importantly, our analysis of publications linked to each R01 funding cycle provides a new quantitative dimension of the R01 renewal application not captured by the 5 criterion scores. Awards that were renewed produced a median of 3.4 publications per year during the funding cycle, translating to a median of 16.0 publications over the course of the award. Although nonrenewed awards were also highly productive in terms of research output, our data suggest that CT surgeons should aim to publish 3.4 funded manuscripts per year during the R01 funding cycle to be at the 50th percentile in the renewal process.
In addition to quantity, we also observed that the impact of research published during an R01 funding cycle might be an important factor distinguishing renewed and nonrenewed awards. Compared with a reference RCR of 1.00 for other R01-funded articles in the same field, we calculated a median RCR of 0.84 among publications linked to each renewed CT surgery R01 award. This result indicates that the scholarly impact of articles funded by renewed CT surgery basic science R01 grants was approximately on par with the expected impact of R01-funded articles in the field, and that CT surgeons should aim to maintain a median RCR at least 0.84 during the R01 funding cycle to be at the 50th percentile in the renewal process.
In our study, the overall R01 renewal rate for CT surgeons was 32.4%, whereas the success rate for renewal applications across the entire NIH was as high as 45% in recent years.
However, of the 14 CT surgery R01 awards that published at least 3.4 articles per year with a median RCR at least 0.84, 10 were renewed, yielding an impressive renewal rate of 71.4%. In contrast, the renewal rate for awards with at least 3.4 papers per year but median RCR <0.84 was 7 of 15 (46.7%), on par with the NIH average, whereas the renewal rate for awards with <3.4 articles per year but median RCR of at least 0.84 was 7 of 25 (28.0%). Among the remaining 48 awards with research output of <3.4 articles per year and a median RCR of <0.84, only 9 were renewed (18.8%). These data suggest that high research output alone might be insufficient to enhance the likelihood of renewal compared with the NIH average. Instead, both research output and scholarly impact appear to be important, as high-impact research proposals might have stronger significance, innovation, and approach criterion scores.
Awareness of how research output and scholarly impact relate to R01 grant renewal might help CT surgeon-scientists develop a multiyear research plan that optimizes the balance of output and impact. Such planning might be particularly important in basic science research, in which the highest-impact studies might require substantial time to complete supporting experiments to confirm an initial discovery. As a result, pursuing only the highest-impact experiments might result in fewer publications, whereas aiming to publish prolifically but with lower scholarly impact might risk an unfavorable overall impact score.
It is important to note that the research produced by CT surgery basic science R01 grants was highly impactful regardless of renewal status, as the 50th percentile of maximum RCR among nonrenewed award cycles was 2.02, which compares favorably to the reference value of 1.00 for other R01-funded publications in the same field. Renewed awards exhibited an even greater maximum RCR of 3.22 at the 50th percentile. To maintain the high impact of CT surgery basic science research in the future, support for residents and early-career surgeons who represent the next generation of independent surgeon-scientists must be a top priority, at the institutional and national levels.
Aside from providing laboratory training, mentorship, protected research time, career advancement incentives, and recognition of research accomplishments, institutional leaders should facilitate multidisciplinary collaborations to encourage the exchange of innovative ideas and novel experimental techniques. In addition, through scholarships and fellowships, national organizations such as the American Association for Thoracic Surgery (AATS; https://www.aats.org/aatsimis/AATSWeb/Scholarships/AATSWeb/Scholarships/Scholarship_Overview.aspx) and the Society of Thoracic Surgeons and Thoracic Surgery Foundation (https://thoracicsurgeryfoundation.org/awards) are actively supporting high-impact CT surgery research and are working to further expand funding for CT surgeon-scientists by hosting communications with the NIH and other funding sources (eg, through the AATS Scientific Affairs and Government Relations Committee), and by continuing to feature academic development programs (eg, AATS Grant Writing Workshop, Clinical Trials Methods Course, and Innovation Summit) and dedicated conference sessions focused on academic career development during the annual AATS and Society of Thoracic Surgeons meetings.
Limitations
Our study has several limitations that must be carefully considered. First, because our analysis is focused only on NIH basic science R01 funding, our study does not represent a comprehensive assessment of CT surgery research funding, because other funding sources (eg, National Science Foundation, American Cancer Society, Department of Defense, Veterans Affairs) were not included. Future studies will endeavor to incorporate non-NIH funding sources as data become available. Next, our database of CT surgeons is derived from the university faculty at accredited CT surgery training hospitals, excluding surgeons working at affiliated satellite hospitals (eg, Veterans Affairs hospitals, county/community hospitals) and those working at university hospitals without accredited CT surgery training programs. As a result, our database does not include all of the academic CT surgeons in the country, does not include a control group of other surgeons or physician-scientists to which to compare our results, and does not capture every NIH R01 grant awarded to CT surgeons. Because clinical research grants often are not renewed after project completion, we chose to focus our analysis only on basic science R01 grants. With 102 award cycles identified, of which only 33 were renewed, it is possible that our sample size limited the statistical power of some analyses, although our findings regarding the association of high research output and scholarly impact to grant renewal would not be expected to change. Nevertheless, we recognize that during the NIH's evaluation process, the determination of which grants are renewed is on the basis of numerous factors beyond simply the research output and scholarly impact of the previous funding cycle. Thus, further studies with multivariable models including the criterion scores from peer review are required to clarify the relative weight of these factors during R01 renewal evaluation. In addition, we assumed that all R01 awards were intended for renewal, whereas some might have been intended only for a single cycle, leading to an underestimated overall renewal rate. Unfortunately, with the publicly available resources at our disposal, we have access only to data for funded grants and not the full list of grant applications. Finally, we determined the research output of each R01 award cycle using NIH RePORTER, which links publications to the grant on the basis of documentation of funding in each article or by direct PI reporting. Thus, it is possible that some publications supported by an R01 grant were not linked to the funding cycle, leading to underestimates for research output.
Conclusions
Overall, we observed that CT surgery basic science R01 awards are associated with high research output and scholarly impact. At the 50th percentile among renewed basic science R01 grants, CT surgeons published 3.4 funded manuscripts per year with a median RCR of 0.84 during the previous award cycle. These goals for research output and scholarly impact might help guide CT surgeon-scientists aiming to renew a basic science R01 grant.
The Journal policy requires editors and reviewers to disclose conflicts of interest and to decline handling or reviewing manuscripts for which they may have a conflict of interest. The editors and reviewers of this article have no conflicts of interest.
The authors thank Dr Christian T. O'Donnell, Joshua M. Pickering, Keerthi Manjunatha, and Mark Sanchez for their assistance with data collection for our database of CT surgeons.
Appendix
Table E1List of 76 National Institutes of Health R01 grants included for analysis, with the corresponding cardiothoracic surgeon principal investigator(s)
Grant identification number
Principal investigator(s)
1
R01AG036954
Ikonomidis, John S.
2
R01AI044078
Pierson, Richard N.
3
R01CA045187
Roth, Jack
4
R01CA090665
Luketich, James D.
5
R01CA093708
Jablons, David M.
6
R01CA131044
Colson, Yolonda L.
7
R01CA132566
Jablons, David M.
8
R01CA136705
Jones, David R.
9
R01CA149561
Colson, Yolonda L.
10
R01CA163256
Singhal, Sunil
11
R01CA176568
Roth, Jack
12
R01HL026640
Foker, John E.
13
R01HL029589
Miller, D. Craig
14
R01HL032257
Damiano, Ralph J.
15
R01HL037499
Miller, D. Craig
16
R01HL038078
Magovern, George J.
17
R01HL038791
Verrier, Edward Donald
18
R01HL041163
Spotnitz, Henry Michael
19
R01HL041281
Patterson, George Alexander
20
R01HL043357
Hanley, Frank
21
R01HL046207
Del Nido, Pedro
22
R01HL046242
Glower, Donald D.
23
R01HL047078
Mentzer, Steven J.
24
R01HL047191
Cameron, Duke
25
R01HL047604
Pasque, Michael K.
26
R01HL048091
Griffith, Bartley Perry
27
R01HL048109
Spotnitz, Henry Michael
28
R01HL051032
Damiano, Ralph J.
29
R01HL056227
Glower, Donald D.
30
R01HL057310
Jessen, Michael E.
31
R01HL057431
Cochran, Richard P.
32
R01HL058781
Bolling, Steven F.
33
R01HL060463
Mayer, John E.
34
R01HL061762
Verrier, Edward Donald
35
R01HL063095
Del Nido, Pedro
36
R01HL063159
Egan, Thomas M.
37
R01HL064950
Griffith, Bartley Perry
38
R01HL066015
Holman, William L.
39
R01HL066981
Rosengart, Todd K.
40
R01HL067025
Miller, D. Craig
41
R01HL067110
Allan, James S.
42
R01HL069949
Moon, Marc R.
43
R01HL070852
Thistlethwaite, Patricia A.
44
R01HL071128
Del Nido, Pedro
45
R01HL071541
Bull, David Andrew
46
R01HL072183
Milano, Carmelo A.
47
R01HL073647
Del Nido, Pedro
48
R01HL074150
Colson, Yolonda L.
49
R01HL075426
Mentzer, Steven J.
50
R01HL075488
Ikonomidis, John S.
51
R01HL080152
Spotnitz, Henry Michael
52
R01HL081106
Griffith, Bartley Perry
53
R01HL082631
Griffith, Bartley Perry
54
R01HL083118
Mann, Michael J.
55
R01HL085095
Rosengart, Todd K.
56
R01HL085341
Coselli, Joseph S.; Lemaire, Scott A.
57
R01HL089269
Del Nido, Pedro
58
R01HL089315
Woo, Y. Joseph
59
R01HL089592
Selzman, Craig Harold
60
R01HL090862
Chen, Frederick Y.
61
R01HL092088
Moon, Marc R.
62
R01HL093097
Mulligan, Michael Scott
63
R01HL094567
Mentzer, Steven J.
64
R01HL094601
Kreisel, Daniel
65
R01HL098182
Lawton, Jennifer S.
66
R01HL098353
Rodefeld, Mark D.
67
R01HL098634
Eghtesady, Pirooz
68
R01HL102121
Ikonomidis, John S.
69
R01HL109132
Gleason, Thomas Gillette
70
R01HL110997
Del Nido, Pedro
71
R01HL113931
Kreisel, Daniel; Krupnick, Alexander
72
R01HL118372
Griffith, Bartley Perry
73
R01HL118491
Kaushal, Sunjay
74
R01HL119543
Thistlethwaite, Patricia A.
75
R01HL124170
Griffith, Bartley Perry
76
R01NS039499
Kern, John A.
Grants are listed in alphabetical order according to identification number.
National Institutes of Health R01 grant funding is associated with enhanced research productivity and career advancement among academic cardiothoracic surgeons.
Analysis of National Institutes of Health R01 application critiques, impact, and criteria scores: does the sex of the principal investigator make a difference?.
Obtaining an RO1 grant from the National Institutes of Health (NIH) is a rite of passage for many research scientists and academic physicians. Unfortunately, it is a goal that most do not attain. If one is fortunate enough to be awarded such a grant from the NIH, it is not much easier to keep it past the initial 3 to 5 years than it was getting it in the first place. When the review panel, or “study section,” evaluates the merit of a renewal application, there are factors that are taken into consideration.
Advances in cardiothoracic surgery are rooted in basic science discoveries, such as use of cross-circulation developed by C. Walt Lillehei, brought from the proverbial bench to the bedside (Figure 1). The most prestigious source for extramural basic science research funding for independent investigators has been the National Institutes of Health (NIH) R01 program. However, obtaining and maintaining R01 funding is extremely challenging for cardiothoracic surgeons for several reasons. In the present study, Wang and colleagues1 used publicly available data from NIH online sources to detail the chances of R01 grant renewal, and most importantly, they identify factors associated with R01 grant renewal.
00059-6&id=fx1.jpg){kind=link}
00059-6&id=fx2.jpg){kind=link}
00059-6&id=gr1.jpg){kind=link}
00059-6&id=gr2.jpg){kind=link}
00059-6&id=gr3.jpg){kind=link}
00059-6&id=gr4.jpg){kind=link}
00059-6&id=gr5.jpg){kind=link}
00059-6&id=fx3.jpg){kind=link}