Research
Lloyd Cantley, MD, Vice Chair, Basic Research
Robert Soufer, MD, Vice Chair, Clinical Research
During the last academic year, there was an expansion of the Department of Internal Medicine research portfolio with recruitment of 11 new researchers across its 11 sections. Our research scope has expanded during COVID-19 despite the increased clinical demands and social/regulatory concerns associated with research across a variety of settings. Despite the constraints imposed by the pandemic, research productivity has been tremendous during this period, with an overall increase of 7.7% in National Institutes of Health (NIH) grant funding from fiscal year 2020 to fiscal year 2021. This sum is predicted to increase even further as the virtual programs identified during two department-wide research retreats described herein create new opportunities for basic scientists to interact with clinical researchers and educators to identify treatment targets of clinical disease presentations.
The challenges to medical research in the COVID era have provided opportunities for the faculty in our department to shine, with high publication and grant productivity despite the increased stress. In turn, department leaders have deepened commitments to research growth, with emphasis on providing junior faculty with the guidance, tools, and opportunities to address large biomedical domains.
To advance the department’s research, the leadership sought detailed written feedback regarding the experience of conducting research across campuses. The unedited feedback was collated and shared in department-wide forums to develop appropriate responses and directions. These discussions predominantly occurred during the course of two research retreats.
The goal of Retreat 1 (June 2021) was to outline the department’s vision for future research directions, particularly with the goal of aligning departmental research growth with the University Science Strategy Committee’s top scientific priorities for the next decade. This outline led to a selection of the highest priorities with subcommittees created to discuss implementation and business plans. Retreat 2 (July 2021) sought to identify the long-standing infrastructural concerns within the clinical research domain and the steps needed to make the future department research initiatives chosen in Retreat 1 a reality.
Basic Research
In the fall of 2020, labs across the school reopened with social distancing regulations to prevent the on-site spread of COVID-19. Although personnel were initially limited to one person per bay, basic researchers were again able to collaborate with their colleagues and reactivate their most critical research portfolios. These guidelines stayed in place through the spring of 2021. In the first department research retreat, faculty from all sections representing the full spectrum of rank and research expertise shared their vision for future research growth and collaborative interactions within their sections as well as across sections, departments, and schools at the University. Department Chair Gary V. Désir MD, began with an overview of the department and school of medicine, followed by presentations by each of the department’s 11 section chiefs highlighting the current research achievements and future opportunities for research growth and collaborations. During the second session, Cantley and Soufer, along with subject matter experts, led discussions of integration opportunities across the department, university, and school.
To further support the department’s research infrastructure, several major themes emerged from these discussions as important department-level initiatives: a biostatistics core; a biostatistics program; an integrated electronic health record (EHR) / genomic / biospecimen collection; and improved clinical research infrastructure. The biostatistics core would support a group of statisticians who would be available to department faculty. The bioinformatics program would provide faculty, trainees, and staff across all sections interested in analysis of large datasets with leadership, supervision, teaching, and camaraderie to support analytical pipelines and best practices in analyzing large datasets. Leadership would be recruited for this role.
The goal of the EHR / genomic / biospecimen collection would be to fully integrate the three systems for research use. This might include an expansion of JDAT and the COVID Data Explorer (DOM-CovX), as well as genomic collaboration at YSM and Yale New Haven Health levels. For biospecimens, the department would partner more closely with the school biobanking initiative led by the Department of Pathology. An approach was recommended that would provide department members with access to research coordinators when available, along with improved post-award grant management.
Thematic program development was an integral part of the meeting. Existing research strengths across all sections were identified in order to develop virtual programs to align with Yale’s top research priorities of integrative data science and ITS mathematical foundations; environmental and evolutionary sciences; quantum science, engineering, and materials; neuroscience from molecules to mind; and inflammation science. The four-hour virtual retreat concluded with a general discussion of the advantages and disadvantages of prioritizing a finite number of the multiple initiatives proposed.
It was agreed that those research faculty interested in specific initiatives should be supported in the development of a virtual program in their area of interest, and then approach the department for additional resources that might be needed. Several of the initiatives that received the greatest interest included:
- Applied Data Science and Precision Medicine: proposed by Naftali Kaminski, MD; F. Perry Wilson, MD; Jose Villalobos, MD.
- Metabolic Contributions to Disease States: proposed by John Wysolmerski, MD; Richard Kibbey, MD/PhD.
- Translational Geroscience: proposed by Thomas M. Gill, MD; Terri Fried, MD; Mary Tinetti, MD.
- Cognitive Neuroscience: proposed by Robert Soufer, MD.
- Inflammation and Fibrosis: proposed by Lloyd Cantley, MD; Wajahat Mehal, PhD, MD; Erica Herzog, MD, PhD; Andrew Wang, MD/PhD; Kevan Herold, MD.
- Health Disparities: proposed by Marcella Nunez-Smith, MD.
- Global Biomedicine: proposed by Erol Fikrig, MD.
- Translational Cardiovascular Biomedicine: proposed by Eric Velazquez, MD.
Clinical Research
While the department’s basic science labs were back to full staff, much clinical research was limited by not allowing face-to-face contact for an additional six months. Despite these global setbacks, the Department of Internal Medicine was proactive in establishing its scientific focus and strength through its two retreats. The first retreat was organized to discuss a basis for developing programs in domains that connect researchers across multiple sections and interface with school and university initiatives.
This event served to focus priorities and concerns for the second research gathering, held on July 9. With over 200+ department faculty attending the virtual event, participants discussed infrastructure and collaboration, community, and intellectual interests. The key infrastructure concerns were identified by a survey with detailed feedback prior to the retreat. The top three priorities chosen were related to data access and biostatistical support. The topics chosen were presented, discussed, and prioritized:
- Data Access
- Biostatistical Science
- Patient-Reported Outcomes
- Hospital Research Unit (HRU)
- Biorepository
Feedback regarding infrastructure converged upon the increased importance of data access, informatics, and biostatistics because patient-reported outcome measures (PROM) are unfolding as determinative variables in the global clinical research enterprise. The need to learn from other colleagues was repeated in several feedback sessions. The latter may be interpreted as a call to enhance our esteem for others’ intellectual interests as well as promote collaboration and community. There are also calls for an accounting of resources within appropriate domains within the department and evaluate circumstances where centralization to scale to a broader number of investigators was also mentioned. This information could be used for growth within a particular group, (e.g., Biostatistics) or growth outside those groups as a resource within the department. Regarding informatics and biostatistics, many thought that data management and biostatistics support infrastructure should be explicitly available to faculty and general consultative support available to all investigators early in project development (e.g., particularly for those who may have limited questions or need direction). Levels of engagement for such resources from the preliminary to methodological integration should be determined. An accounting of available data science working groups within the department should be completed, along with considering strategies as consolidation and/or additional expansion for department faculty outside such working groups.
The feedback regarding data access centered upon the expansion of the DOM-CovX in concert with the development of patient-centered outcomes to support various aspect of disease presentations in internal medicine. The importance of integrating non-Epic database sources and exploring crossover with the database of the Department of Veterans Affairs were set as goals. Comments regarding data access as a key tool in translational science with a positive impact on basic science, in that promising signals can be rapidly evaluated in human populations.
The expansion of data access would enhance collaboration with stakeholders throughout and beyond the medical school within the priorities for Department of Internal Medicine research that are aligned with the university strategic science initiatives.
The importance of PROMs in relationship to scholarship in clinical research, funding and phenotype tracking was reinforced. The expansion of the discussion from a portion of committed faculty to a greater number of peers was helpful in fostering a discussion that identified key determinants of quality control and standardization of PROMs: validation, consistency, and implementation. There is support for greater efforts to work with hospital to integrate PROMs into Epic.
NIH funding for HRU facilities from the Clinical and Translational Science Award (CTSA) did not recur; thus financial liabilities for such units has increased. Plans for inpatient and outpatient HRUs are currently moving forward from the Dean's Office. Comments regarding a needed culture shift of research offices (Yale University Institutional Review Board, Yale Center for Clinical Investigation (YCCI), Office of Sponsored Projects, business offices) from an “enforcement mindset” to a “service mindset” to help investigators complete requirements in a timely and efficient manner was mentioned by several faculty.
Last, the implementation of a biorepository with a common system to barcode and manage samples so they can be easily tracked was discussed. The interplay between disease-specific versus global information could be centrally curated, stored, and sample located if needed was discussed.
Since this retreat, a group of faculty was organized for prioritization and strategy for research infrastructure. The group has met several times and is in the process of crafting recommendations for Department Chair Gary V. Désir, MD.
Department Funding Sources and Interdepartmental Collaborations Across Yale School of Medicine and Yale School of Public Health
Department Funding Sources
- Department of Internal Medicine Total Grant Funding: $170,221,552
- Federal Grants: $127,558,296
- Industry Funding: $22,551,701
- Foundations/Public Organizations: $12,309,876
- Other: $7,801,679
Interdepartmental Collaborations
- YSM Cell and Molecular Physiology: $3,800,744
- YSM Microbial Pathogenesis: $2,491,533
- YSM Molecular Cellular & Developmental Biology: $2,275,452
- YSM Anesthesiology: $1,663,392
- YSM Genetics: $840,018
- YSPH Biostatistics: $728,189
- YSM Immunobiology: $649,609
- YSM Pathology: $563,957
- YSPH Epidemiology of Microbial Diseases: $480,117
- YSM Neurology: $473,856
- YSM Transplant Surgery: $134,000
- YSPH Chronic Disease Epidemiology: $63,025
- YSM Emergency Medicine: $48,600
- YSM Orthopaedics: $32,908
- YSPH Health Policy and Management: $14,829
The inner circle represents external funding of research efforts within the department, whereas the satellite circles represent funding acquired collaboratively with researchers in other departments across Yale School of Medicine and Yale School of Public Health.
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