PRIDE-FTG advances academic careers of underrepresented early-stage investigators performing blood disorders research Open Access

Despite efforts to expand the diversity of the US biomedical research workforce, inequities remain; individuals from different racial/ethnic groups are not proportionally represented.¹ Although 30.8% of the US population are Black/African American and Hispanic, these groups are awarded only 4.6% of National Institutes of Health (NIH) grants.² Indeed, compared to White investigators, grant applications from Black/African Americans are 10% less likely to receive NIH Research Project Grant Program (R01) funding.³ Furthermore, racial/ethnic underrepresentation affects research questions and hypotheses relevant to at-risk populations and limits translating research findings into healthy outcomes for all. To improve the entire nation’s health, innovative strategies are needed to promote diversity and enhance the success of underrepresented biomedical researchers.

In 2007, the National Heart, Lung, and Blood Institute (NHLBI) funded the Summer Institute Programs to Increase Diversity (SIPID). Spurred by diversity efforts that followed the NIH Advisory Committee Working Group on Diversity,⁴ NHLBI gradually expanded this program to 9 academic institutions. In 2010, SIPID was renamed the Programs to Increase Diversity Among Individuals Engaged in Health-Related Research (PRIDE)⁵ and the National PRIDE Coordination Core was officially funded.⁶ The scientific focus of each program aligns with the NHLBI research priorities—heart, lung, blood, and sleep disorders and health disparities.⁷ As of 2023, a total of 727 mentees have been trained in SIPID and PRIDE programs across the nation.

In 2017, we published favorable outcomes for 34 hematologists trained in our program.⁸ These early findings demonstrated that the PRIDE–Functional and Translational Genomics of Blood Disorders (PRIDE-FTG) program effectively contributed to a diverse pool of successful early-stage investigators engaged in blood disorders research. More recently, we published data related to our peer-mentoring component established in 2015, which showed significant increases in the mentees’ confidence across 4 domains: effective communication, aligning expectations, assessing understanding, and addressing diversity.⁹ However, when comparing themselves with their peer mentor, the most significant differences were observed in how mentees self-scored for promoting career development.

In this follow-up report, the outcomes related to grant funding, publications, and academic promotions are presented for the entire program since 2007. With these data, we discuss the implications of expanding structured mentoring programs to improve access to training and academic advancement, thus enhancing the diversity of early-stage investigators conducting research in blood disorders.

In 2007, NHLBI launched the SIPID program at 3 institutions and the program directors established a centralized REDCap database at Washington University in St. Louis. After renaming the program to PRIDE in 2011, using the same program design, NHLBI gradually expanded to 9 sites and funded the National Coordination Center at Washington University. The Coordination Core collects and assesses longitudinal data, evaluates individual PRIDE program efficacy, and tracks across-program mentor/mentee success, grant funding, peer-reviewed publications, and academic promotions for 10 years of follow-up.¹⁰ 

The recruitment strategy involved direct email contact with alumni, mentors, and teaching faculty for referrals; bulk emails to organizations and educational institutions; advertisements at national meetings; and visits to the Coordination Core (https://pridecc.wustl.edu/) and PRIDE-FTG websites (https://www.augusta.edu/mcg/pride/). The admissions application involved a 2-step process; first, the Coordination Core screened applicants for general eligibility criteria—faculty appointment, previous funding, race/ethnicity, US citizenship, and research focus. Applicants of nonunderrepresented backgrounds applied based on disability, low socioeconomic, or disadvantaged status. Qualified applicants were accepted for training across the different PRIDE programs. Subsequently, applicants were invited to complete the full application, provide 2 letters of recommendation, and participate in a telephone or Zoom interview. Finally, the admissions committee reviewed the full application and submitted recommendations to the program director for a final decision.

The PRIDE program is a yearlong initiative designed to attract underrepresented, disadvantaged, or disabled early-stage investigators to 2 consecutive summer institutes (SIs) with structured mentoring in between. After SI2, the mentees received an official certificate of completion signed by the NHLBI director. Building on the collective success of SIPID and 3 funding cycles of PRIDE-FTG, herein we focus on the outcomes of the entire group. Given that the program design and outcome metrics have remained the same since inception, henceforth, both SIPID and PRIDE cohorts combined will be referred to as “PRIDE-FTG mentees.” Because there were 3 PRIDE funding cycles evaluated, we identified each cycle as PRIDE-FTG1, PRIDE-FTG2, and PRIDE-FTG3.

At the start of SI1, a member of the PRIDE-FTG leadership team obtained an Institutional Review Board informed consent from mentees in person. From 2020 to 2022, during the COVID-19 pandemic, the SIs were convened by Zoom (Zoom Video Communications, Inc, San Jose, CA) and consent was obtained electronically. The SI curriculum included the establishment of structured mentoring, grant-writing workshops by teaching faculty and an NHLBI program officer, and direct laboratory experiences related to gene expression systems, proteomics, and flow cytometry. To enhance grant funding success, we instituted a one-on-one, in-person NIH-style grant review during SI2.

During SI1, we established a mentoring committee for each mentee consisting of a PRIDE-FTG research mentor, a career development mentor (at their home institution), and a peer-mentoring group. At the inception of PRIDE-FTG, the leadership team deliberately identified and recruited a cadre of blood disorders research experts to the program to serve as mentors. Remarkably, a substantial number of the original mentors have remained loyal to the program for >18 years. In cases where additional research expertise was required beyond our core group, then mentee, mentors, and teaching faculty referrals identified additional investigators in the field. The parameters used to qualify mentor selection included academic rank of associate professor or higher and expert in the research field complementary to the mentee, determined by webpage and PubMed searches. We also ascertained their record of NIH grant funding (from the curriculum vitae and NIH RePORTER). The career development mentors were not formal participants in the PRIDE-FTG program; however, we recommended monthly meetings to discuss their career development and tenure goals.

The mentoring process commenced with primary research mentor-mentee pairings on the first day, or within 1 month, of SI1. Over the 1-year training period, research mentors provided continuous support and communication with mentees. In addition to the initial in-person meeting and monthly virtual meetings, mentor-mentee pairs met in person (1) during a midyear visit to the mentor’s institution and (2) at the consortium-wide national PRIDE meeting convened annually in the spring.

To emphasize the value of collaborative learning, during PRIDE-FTG2 (2015-2018), the program leadership launched a peer-mentoring component. The concept was introduced to the mentees through didactic lectures, speed networking, and social activities. The mentees self-identified peer-mentoring pairs/groups based on research and/or social interests by the end of SI1. Subsequently, between SI1 and SI2, peer-mentoring groups organized monthly meetings by Zoom and provided a summary of their activities to the program staff.

For 10 years after enrollment, the National Coordination Core collected consortium-wide demographics, evaluations of mentoring effectiveness, and assessments of grant-writing skills confidence for each mentee. In addition, details of grant funding, publications, and academic promotions were tracked. The PRIDE-FTG program also collected evaluations of the curriculum relevancy and teaching faculty effectiveness. Overall program satisfaction was evaluated by the PRIDE-FTG mentees during exit interviews after SI2.

To evaluate the efficacy of our mentorship approach, all PRIDE programs adopted a 68-item Ragins and McFarlin Mentor Role Instrument (RMMRI).¹¹ Subsequently, the Coordination Core developed a modified 19-question RMMRI (RMMRI-19) that was validated during PRIDE-FTG1.¹² Using a 7-point Likert scale (1 = strongly disagree, 2 = somewhat disagree, 3 = disagree, 4 = neutral, 5 = somewhat agree, 6 = agree, and 7 = strongly agree), the results of the RMMRI-19 were plotted at 3, 6, 9, 24, 36, and 48 months for the following 9 mentoring areas: (1) gives me advice on attaining recognition, (2) provides support and encouragement, (3) serves as a role model, (4) someone I identify with, (5) guides my personal development, (6) serves as a sounding board, (7) accepts me as a professional, (8) thinks highly of me, and (9) sees me as competent.

To assess the efficacy of grant-writing workshops, the PRIDE-FTG data were analyzed for (1) confidence in writing grants, (2) number of grants submitted, and (3) number of grants funded before, during, and after training. Grant-writing confidence was formally evaluated with the Clinical Research Appraisal Inventory (CRAI) survey tool using a 10-point scale (0 = no confidence to 10 = total confident) administered at matriculation, 6 months, and then annually in years 2 to 10.¹³ In the PRIDE-FTG1 funding cycle, the Coordination Core modified and validated the CRAI survey to include 19 items (CRAI-19).¹² Each CRAI-19 item was used to derive 4 factors: factor 1, chooses an appropriate research design to answer questions and test hypotheses; factor 2, prepares a research proposal suitable for submission; factor 3, writing a literature review that critically synthesizes the literature relevant to your research question; and factor 4, applying the appropriate process for obtaining an informed consent from research subjects.

For all PRIDE programs, the primary outcome metric of success was submitting an extramural NIH or equivalent grant application within 2 years of training completion. Secondary outcomes included grant funding, peer-reviewed publications, and academic promotion. To confirm grant awards as principal investigator, we queried several databases including NIH RePORTER,¹⁴ Robert Wood Johnson Foundation/Harold Amos Medical Faculty Development Program,¹⁵ Patient-Centered Outcomes Research Institute,¹⁶ and Health Resources and Services Administration.¹⁷ For the remaining 4 extramural grants reported by mentees, the PRIDE-FTG staff confirmed them by public announcements or documentation from mentees.

Data were analyzed using Excel (Microsoft Corporation, 2016) for the variables of interest and descriptive statistics tracked including count/frequency, percentages, and means. Linear trends in repeated data measures with correlated errors were analyzed using the SAS/MIXED software (version 9.1).¹⁸ To determine the proportion of K-award to R01 conversions, a 95% confidence interval (CI) was calculated using the normal approximation method, with a total sample size of n = 13 (number of K awards 5 years from grant activation) and x = 6 (the number of successful conversions to R01s). The sample proportion (p-hat) was calculated as x/n. For peer-reviewed publications, the significant difference between the means at different time periods was calculated using the 2-tailed, paired Student’s t test. Data were presented as the mean ± standard error of the mean, and results were considered statistically significant at P < .05.

Institutional Review Board approval at Augusta University is current.

Over the initial 4-year funding period of SIPID at the University of Texas at Dallas (2007-2010), 123 applicants competed for 30 training positions. A total of 25 mentees matriculated but 1 mentee did not complete training (supplemental Table 1). Subsequently, through joint recruitment efforts of the Coordination Core and staff, 165 applications were submitted during the 3 PRIDE-FTG funding cycles. The program leadership enrolled 89 additional mentees, but 1 mentee did not complete training. Therefore, a total of 114 mentees matriculated into SIPID (25) and PRIDE-FTG (89) with an overall retention rate of 98.2% (112/114 mentees completed training).

Over time, the reach of the program expanded from academic institutions in Texas and other southern states to encompass the entire continental United States (supplemental Figure 1). The demographic characteristics of the 114 mentees are presented in Table 1. Ninety-four (82.5%) mentees were from Black/African American backgrounds, and 10 (8.7%) were from Hispanic racial/ethnic backgrounds; moreover, 91 mentees (79.8%) were women. The training cohorts comprised 14 (12.3%) instructors, 87 (76.3%) assistant professors, and 6 (5.2%) associate professors; the most common degree earned was PhD (59) or MD (47) for 106 participants (93%). As shown in Table 2, for health care professionals, 39 of 47 (83%) MDs were pediatric (22) or adult classical hematologists (17). Of note, 65 (57%) mentees led basic science, clinical, and public health/health disparities research related to sickle cell disease. Mentees also conducted blood disorders research related to messenger RNA stability, myelodysplastic syndrome, and transfusion medicine.

On the first day of SI1, the mentoring process commenced with ∼75% of primary research mentor-mentee pairings established by in-person meetings. The remaining 25% of pairings occurred within a month after SI1, with the mentee traveling to the mentor’s institution. Overall, effective mentee-mentor pairings were established. However, the program leadership intervened in 6 pairings owing to a change in mentee research focus or a mentor’s inability to meet program expectations. For all cases, the program leadership identified alternative research mentors.

To monitor mentoring engagement, the Coordination Core tracked the number of encounters during training. Between SI1 and SI2, 71% of mentees made at least 6 to 12 contacts with their mentor (Figure 1A). Of note, 29.6% of mentor-mentee pairings made contact from 14 to >30 times. As shown in Figure 1B, using a 7-point Likert scale to evaluate mentoring efficacy, we observed favorable responses for 3 areas: (1) satisfaction with their mentor (6.29 ± 0.25), (2) ability to move forward with their research (6.25 ± 0.26), and (3) ability to find mentoring resources (5.92 ± 0.29). We formally assessed the effectiveness of our mentoring approach using the RMMRI-19 starting with PRIDE-FTG2 in 2015. The mean total scores at 3 months (n = 35) and 48 months (n = 35) were 5.9 ± 0.16 and 6.1 ± 0.15, respectively (Figure 1C). The effective and satisfied scores peaked by 6 and 9 months; however, only the effectiveness of mentoring was significantly increased from 3 months to 6 months (P = .0079) and 9 months (P = .0118).

PRIDE-FTG mentees achieved competitive grant-writing and extramural funding success.

The CRAI-19 instrument collected data for the assessment of long-term confidence in writing grants using annual evaluations of mentees for 10 years. As shown in Figure 2, the CRAI-19 overall score increased from SI1 to 10 years from 5.5 ± 0.1 to 8.3 ± 0.09 (P = .021). Similar significant increases occurred in the 4 domains tracked over 10 years.

The primary outcome metric of the PRIDE-FTG program was the submission of an extramural NIH or equivalent grant proposal within 2 years of completing training. Of the 90 mentees reaching this benchmark, 63 (70.0%) achieved the primary outcome metric. Of these grants submitted, 48 of 63 (76.2%) were funded as principal investigators (supplemental Figure 2). The outcomes included 55 K-award applications submitted with 17 grants (30.9%) awarded. Analysis of the data showed that 4 K awards are in progress (supplemental Table 2); 6 of the 13 completed K awards, or 46% (95% CI, 19-73), transitioned to R01 grants by 5 years of K-award activation. In a similar analysis of 116 R-type grants submitted, 31 were funded (26.7%), including 13 R01 grants and 18 other R-type grants. There were 7 mentees who did not qualify for K-award funding who obtained R01s as their first grant.

To gain additional insights into the impact of PRIDE-FTG training, we assessed grant funding rates before, during, and after training (Figure 3A). For the 65 extramural grants awarded to 40 mentees as principal investigators, the most common grants funded were K awards (K01, K07, K08, and K23) and R-type grants (R01, R03, R13, R18, R21, and R25). When we compared the number of grants awarded before with during/after PRIDE-FTG training, extramural funding increased fivefold (P < .01). The top factors cited by mentees as critical for achieving the primary success metric were (1) the consistency of support from mentors and (2) the SI2 one-on-one grant review activity, which rated 4.5 ± 0.23 of 5 points.

Mentees achieved academic promotion and made contributions to literature.

For the 90 mentees evaluated herein, the second major parameter tracked by the Coordination Core was academic advancement. Over the 10-year follow-up period, there were 55 promotions: 9 instructors to assistant professor, 35 assistant professors to associate professor, and 11 associate professors to full professor (Figure 3B); moreover, 11 mentees achieved tenure. Of note, 4 MDs left academic medicine for employment with pharmaceutical companies targeting research focused on sickle cell disease; 1 MD joined the US Food and Drug Administration, and 3 PhD-trained mentees joined NHLBI, the NIH Center for Scientific Review, and the National Science Foundation.

Although we did not formally track administrative titles, PRIDE-FTG alums have served as dean (University of Mississippi, Tougaloo College) and department chairs (Department of Environmental and Occupational Health, Indiana University School of Public Health, and Department of Biology, Manhattan College). There is a chief, Pediatric Hematology/Oncology at East Carolina University, and a director, Office of Health Equity and Community Engagement at Georgia Southern University. One alum is the Delta Sigma Theta Distinguished Endowed Professor at Dillard University. Other alums serve as medical directors of sickle cell programs at the University of Michigan, East Carolina University, and the Kennedy Krieger Institute, Sickle Cell Disease Neurodevelopmental Clinic at Johns Hopkins University.

Finally, we assessed the mentees’ contributions to scientific literature. The peer-reviewed publications for the 90 trainees are presented in Table 3. Compared with 437 papers published before training, 1465 papers were published during/after PRIDE-FTG training (3.4-fold increase; P < .01). These contributions to the literature focused on sickle cell disease and other topics.

What progress has been made related to the diversity of the US academic faculty and biomedical workforce? Based on 2019 Association of American Medical Colleges data, compared to 60% of White male faculty, 3.6% and 5.5% of faculty were Black/African American or Hispanic, respectively.¹⁹ A significant barrier to improving these data for underrepresented faculty is the limited access to mentoring opportunities as junior faculty²⁰ and receiving less mentoring than their nonminority colleagues.^21,22 Given that mentoring significantly predicts academic advancement, self-efficacy, and career satisfaction,^23-25 underrepresented faculty need improved access to mentoring opportunities. One of the most common obstacles is pairing mentors and mentees whose skills, personalities, or goals do not align well. Moreover, a lack of institutional support, negative mentoring, and other mentoring challenges may undermine the long-term academic success of underrepresented faculty.

The PRIDE-FTG program is a 1-year training experience focusing on intense, structured mentoring and building grant-writing skills. Herein, we described the long-term outcome of 90 early-stage underrepresented faculty after training. This translated into 70% of mentees achieving the primary outcome metric of submitting an extramural grant, and 30.9% were funded as principal investigators of K awards. Our outcomes are compared with 6.0% to 8.8% overall funding rates for underrepresented faculty and a K-award funding rate of 32.4% in 2023, for all racial/ethnic groups.¹⁴ These data support a significant improvement in K-award funding for underrepresented early-stage faculty after PRIDE-FTG training. The funding success of early-stage underrepresented faculty highlights the impact of combining intense mentoring, grant-writing skills building, and expert grant review.

Although no training programs have the same design as PRIDE, similar mentoring efforts exist. At Duke University, the Path to Independence and K-Club are structured programs comprising a 20-hour curriculum of lectures, workshops, peer-mentoring groups, and an internal grant review study section.²⁶ K-Club participants achieved a 64% NIH grant success rate, whereas Path to Independence program participants had a 28% success rate. Like PRIDE-FTG mentees, both programs’ respondents reported increased feelings of support and self-ratings for different competencies after training. The Proposal Preparation Program at the University of Minnesota is a structured grant-writing workshop for promoting faculty success.²⁷ Designed to develop grant-writing skills for assistant professors submitting their first NIH K- or R-series application, the program has shown that 88% of their trainees submitted NIH grants, with a success rate of 35%. These programs highlight the effectiveness of structured workshops in promoting faculty success.

The PRIDE-FTG program is designed to produce leaders in blood disorders research and high-ranking faculty members in US academic institutions. Of the 90 mentees evaluated, 47% of assistant professors achieved promotion to associate professor. Interestingly, we enrolled 6 associate professors who were promoted to full professors; therefore, the remaining 5 professors represent assistant professors moving up the ranks within the 10-year follow-up period. These outcomes compare favorably with data from the Association of American Medical Colleges, showing 10-year promotion rates of 36% for first-time assistant professors and 48% for associate professors.²⁸ Another critical indicator of leadership in the biomedical research workforce is contributing research knowledge that improves human health. Consistent with this goal, PRIDE-FTG mentees contributed a significant number of peer-reviewed manuscripts. These long-term follow-up data demonstrate the sustained success of PRIDE-FTG alums and reinforce confidence in the program’s effectiveness.

For junior faculty undertaking blood disorders-related programs, few opportunities exist to participate in formal mentoring programs. The American Society of Hematology Clinical Research Training Institute (ASH-CRTI) is one such program.^29,30 Like PRIDE-FTG, the ASH-CRTI offers a yearlong training component with mentorship. When the authors surveyed participant responses, those who felt that ASH-CRTI training affected their careers reported a higher percentage of research effort, more publications, and excellent retention in academic careers. Programs such as ASH-CRTI and PRIDE-FTG demonstrate the importance of focused mentored research training opportunities to enhance blood disorders research and informing funding institutions about the potential impact of such programs.

A critical measure of early-to-midcareer success is the conversion of K awards to R01 grants within 5 to 7 years of award activation. Although our sample size is limited, our analysis supports a 46% K-award to R01 conversion rate (95% CI, 19-73) by 5 years of grant activation. These data compare with conversion rates of 19.1% to 22.8% of K awards from all racial and ethnic groups during 2008 to 2012.^14,31 Of note is the higher 30.2% to 48.4% conversion rate for K99/R00 grantees to R01s in this same period. These data raise questions about the current NIH model for K-award support. Given that underrepresented applicants often apply for K01 and K23 awards, another approach might be to augment support for these mechanisms by including 3 years of mentored training and R00 resources (6 years of total support). Alternatively, the NIH might consider establishing PRIDE-like programs across more institutes and centers. Specifically related to components of PRIDE-FTG, the most effective elements supporting academic success were structured mentoring by a national expert to guide the design of a competitive grant proposal, boosting grant-writing skills, and peer mentoring, fostering networking and camaraderie.

Although progress made by the PRIDE-FTG program is encouraging, limitations exist. There is a need for comprehensive comparative data (control groups) to generate reliable predictions of the long-term impact of PRIDE. Currently, our mentees serve as their controls by comparing progress over 10 years. Furthermore, the steady increase in grant-writing confidence demonstrated by the CRAI-19 survey suggests that early exposure to the correct approach for grant writing continues to build the mentees’ confidence over time. Nevertheless, ongoing efforts by the Coordination Core to identify appropriate control groups will facilitate a more rigorous evaluation of performance data in the future.

The second major limitation of our data collection is the underestimation of extramural grant support from all sources given that the REDCap database only tracks grants from NIH and a limited number of other agencies. However, mentees were funded by intramural grants, K-12 awards, NIH administrative supplements, etc. We will track and confirm all funding sources in the future to determine the total economic impact of the PRIDE-FTG program.

The outcomes from the PRIDE-FTG training are encouraging; however, the current political climate in the United States presents significant challenges to diversity, equity, and inclusion initiatives within academia and the private sector. Among institutions striving to promote diversity, recent executive orders have created an environment of uncertainty for underrepresented faculty who are already navigating systemic barriers to career progression. These policies undermine the access of underrepresented investigators to funding, mentorship opportunities, and institutional support. Despite these policies, academic institutions must maintain vigilance and be committed to fostering equitable and inclusive environments. Our charge is to minimize the negative impact on the long-term health of our nation.

In conclusion, the innovative PRIDE-FTG mentored training program supported extramural grant funding and academic advancement among underrepresented early-stage investigators. Like other successful programs, the structured mentoring and research training strategies of PRIDE-FTG dramatically boosted our mentees’ self-confidence to achieve grant funding and career advancement. These data underscore the potential of expanding the PRIDE training model to increase diversity in the US biomedical and classical hematology workforce. Thus, the PRIDE program offers hope for a more inclusive future.

National Heart, Lung, and Blood Institute grant R25HL106365 (B.S.P.) supported this work. The authors thank National Heart, Lung, and Blood Institute for its long-term vision and sponsorship. Also critical to the success of PRIDE-FTG is the invaluable leadership of the National Coordination Core in conducting comprehensive data collection and analysis. The authors thank the PRIDE-FTG leadership, including Robert Gibson and Juan González, and the incredible efforts of long-term mentors and teaching faculty. The authors also thank Natasha Alford and Mayuko Takezaki for providing boots-on-the-ground administrative leadership. They planned and executed 26 summer institutes with exceptional support from the Georgia Cancer Center for lecture space, laboratory facilities, and in-kind contributions. The authors also thank the Division of Sponsored Program Administration and the Medical College of Georgia. The authors thank other leadership support including the President of Augusta University and senior administration, the Department of Pediatrics, and the Office of Belonging and Inclusivity exemplified by attendance at PRIDE-FTG welcome ceremonies over the years.

Contribution: B.S.P. led the PRIDE-FTG summer institutes as a program director, contributed to data collection and analysis, supervised the data interpretation, and wrote sections of the manuscript; O.A.O., A.S.-D., V.H., R.-B.M., P.D., and T.R. collected and analyzed the data and wrote sections of the manuscript; and all authors edited and reviewed the manuscript and approved the final version for resubmission.

Conflict-of-interest disclosure: The authors declare no competing financial interests.

Correspondence: Betty S. Pace, Department of Pediatrics, Medical College of Georgia at Augusta University, 1410 Laney Walker Blvd, CN4112, Augusta, GA 30912; email: bpace@augusta.edu.