Are key stakeholders in obstetrics and gynecology interested in an early result acceptance program, and what are possible outcomes of such a program?This survey study of 879 applicants, 143 program directors, 94 clerkship directors, and 51 student affairs deans revealed broad support for an early result acceptance program, with respondents indicating support for allowing 3 early applications and offering 25% to 50% of first-year resident positions. Based on survey responses, an early result acceptance program could reduce the number of applications in the regular cycle by 26 280 to 52 560 applications.The findings of this study suggest broad support for an early result acceptance program in obstetrics and gynecology, which could provide the opportunity to improve the application experience for applicants and program directors. This survey study examines perspectives among stakeholders in obstetrics and gynecology regarding the potential for an early decision process to complement the current residency match process. The residency application process is flawed, costly, and distracts from the preparation for residency. Disruptive change is needed to improve the inefficiencies in current selection processes.To determine interest in an early result acceptance program (ERAP) among stakeholders in obstetrics and gynecology (OBGYN), and to estimate its outcome in future application cycles.Surveys of stakeholders in March 2021 queried interest in ERAP across the US. Respondents included OBGYN residency applicants, members of the Association of American Medical Colleges Group on Student Affairs, OBGYN clerkship directors, and residency program directors. Statistical analysis was performed from March to April 2021.Respondents completed surveys sent by email from the Association of American Medical Colleges (to OBGYN applicants and members of the Group on Student Affairs), the Association of Professors of Gynecology and Obstetrics (to clerkship directors), and the Council on Resident Education in Obstetrics and Gynecology (to program directors).Applicants and program directors indicated their interest in participating in ERAP, and clerkship directors and members of the Group on Student Affairs indicated their likelihood of recommending ERAP using a 5-point Likert scale.Respondents included 879 (34.0%) of 2579 applicants to OBGYN, 143 (50.3%) of 284 residency program directors, 94 (41.8%) of 225 clerkship directors, and 51 (32.9%) of 155 student affairs deans. The majority of respondents reported being either somewhat or extremely likely to participate in ERAP, including 622 applicants (70.7%) and 87 program directors (60.8%). Interest in ERAP was independent of an applicant’s reported board scores, medical school type, race, number of applications submitted, or number of interviews completed. Among program directors, those at university programs were more likely to participate. Stakeholders supported a limit of 3 applications for ERAP, to fill 25% to 50% of residency positions. Estimating the outcome of ERAP using these data suggests 26 280 to 52 560 fewer applications could be submitted in the regular match cycle.Stakeholders in the OBGYN application process expressed broad support for the concept of ERAP. The majority of applicants and programs indicated that they would participate, with potentially substantial positive impact on the application process. Careful pilot testing and research regarding implementation are essential to avoid worsening an already dysfunctional application process. Efforts to match into residency displace educational efforts during the last year of medical school, which could ensure an effective transition from student to resident.4 Increasing numbers of applications strains programs and forces them to rely on numerical metrics rather than performing holistic reviews. According to the 2020 Program Director Survey conducted by the National Resident Matching Program (NRMP), 45% of applications are rejected based on screening metrics alone.5 For students who identify their top programs before submitting applications—a program at their own medical school, where they did a visiting elective, or where they want to live—little is gained through excessive applications and interviews. Geography itself is a key determinant in applicants’ final ranking, a decision likely made independent of the application process.6 Some suggest that students matching into their medical school’s own residency programs could improve their training and the care of their future patients through an enhanced transition to residency.7 If some students matched early into their top programs, this could leave other applicants and programs the opportunity to adopt a more thoughtful approach for the regular application cycle.The residency application process has become increasingly problematic, with heavy burdens facing applicants and residency programs.8 Early applications to undergraduate colleges is a well-established part of college admissions, widely embraced by students and colleges.9 Residency applications for neurology, neurosurgery, ophthalmology, and urology occur prior to the NRMP main residency match.10 An optional early result acceptance program (ERAP) has been proposed to allow for a 2-stage match with a limited group of applicants matching prior to the regular application cycle.11 A qualitative study of stakeholders in the match process proposed a summer match as a means of reducing cost and other negative consequences of application inflation.12The Coalition for Physician Accountability proposed recommendations to improve the transition from undergraduate medical education (UME) to GME, citing application inflation as a “root cause of the current dysfunction in the UME-GME transition.”The aim of this study is to explore the opinions of stakeholders in obstetrics and gynecology to determine their interest in participation in an ERAP, determine ideal parameters for a proposed ERAP in terms of application numbers and available positions, and use these numbers to estimate the potential impact of ERAP on the application process.Stakeholders in the OBGYN application process were queried using an electronic survey about their interest in an ERAP as part of the Right Resident, Right Program, Ready Day One (RRR) initiative led by the Association of Professors in Gynecology and Obstetrics (APGO) and funded by the American Medical Association Reimagining Residency initiative. Informed consent was not included in the surveys as the University of Michigan institutional review board determined that the study was exempt from continuing review because it carried no more than minimal risk to participants. Surveys queried stakeholder demographics and application and interview experiences (eAppendix in the AAPOR) reporting guideline.13Surveys were distributed electronically to medical students and members of the Group on Student Affairs (GSA) by the Association of American Medical Colleges, to medical school clerkship directors (CDs) by APGO, and to residency program directors (PDs) by the Council on Resident Education in Obstetrics and Gynecology. Surveys were distributed in March 2021 after the submission deadlines for applicant and program match rank lists, and prior to the results of the 2021 NRMP match being released to ensure rank lists and match results did not influence the answers to the survey. Applicants provided demographic information including self-reported race and ethnicity on the survey using predefined options and free-text options. Gender and age demographic information were not collected. The overall response rate was 36.0% (1167 of 3243). This study followed the American Association for Public Opinion Research  or recommending ERAP to students (CDs and GSA members) using a 5-point Likert scale. Respondents suggested the number of applications and available residency positions they believed should be included.5 using χ2 tests. The association between PD and applicant characteristics and interest in participating in ERAP were assessed using χ2 tests and Kruskal-Wallis tests for categorical data, and 1-way analysis of variance tests for interval data (numbers of applications and interviews). Using the proposed numbers of applications and percentage of positions recommended by the stakeholder groups, we estimated the outcome of an ERAP on the number of applications in the regular match. Two reviewers (E.N. and H.K.M.) analyzed free-text comments by examining comments, identifying recurring themes, and organizing them into categories. Serial review of comments, discussions among the authorship team, examination of trends and quantitative data findings helped to delineate opportunities and challenges presented by ERAP.Descriptive statistics explored the demographics of each stakeholder group and their interest in ERAP. Applicant characteristics for survey respondents were compared with the overall population of applicants in OBGYN in 2020P < .05.Statistical analysis was performed using SPSS Statistics version 25 (IBM Corp) from March to April 2021. The threshold for statistical significance was Respondents to the survey included 879 (34.0%) of 2579 applicants to OBGYN residency, 143 (50.3%) of 284 OBGYN residency PDs, 94 (41.8%) of 225 CDs, and 51 (32.9%) of 155 student affairs deans after removing incomplete responses. Applicant respondents included 564 (66%) from US allopathic medical schools, 149 (17%) from US osteopathic schools, and 145 (16%) from international schools. Most undergraduate medical education faculty came from MD programs, including 91 clerkship directors (97%) and 51 deans (100%). Among PDs, 76 (53%) were at university programs, 43 (30%) were at community-based/university affiliated programs, 22 (15%) were at community programs and 1 (1%) was at a military program. Among applicants, 489 (56%) were White. Demographics of the groups are outlined in H[4] = 5.2; P = .28), identifying as White compared with applicants identifying as other races and ethnicities , number of applications submitted  or number of interviews received . Students from US allopathic, osteopathic, and international medical schools expressed similar likelihood of participation in ERAP . Among 59 applicants participating in the match as a couple, 34 (57.6%) were somewhat or extremely likely to participate in ERAP, compared with 588 (71.7%) of the 820 applicants not participating in the match as a couple .For applicants, there was no association between an applicant’s likelihood of participating in ERAP and their USMLE or COMLEX scores , number of applications received , or interviews offered . Among PDs, a greater proportion of university PDs (51 [67.1%]) were somewhat or extremely likely to participate in ERAP compared with PDs at community programs (9 [40.9%]) and PDs at community-based, university-affiliated programs (25 [59.5%]) .For PDs, interest in ERAP was not associated with program size,  of 3.7 (1.2) applications, clerkship directors favored 3.1 (1.1) applications and student affairs deans favored 3.8 (1.4) applications. PDs provided free-text responses to the number of positions they felt should be offered in ERAP, and these ranged from 25% to 100% of slots .Applicants in our survey submitted a mean (SD) of 72.4 (40.6) applications and a median (IQR) of 61 (18-104) applications; and applicants received a mean (SD) of 11.8 (8.5) interviews and a median (IQR) of 11 (1-21) interviews. When asked about the top 3 programs they had identified before the application process, 673 applicants (76.6%) reported getting an interview with at least 1 of these programs, and 124 applicants (14%) reported getting interviews at all of their top 3 programs. Among applicants who received at least 1 interview at their original top 3 programs, 618 (91.8%) ranked at least 1 of these programs in their final list. Among applicants receiving interviews at their top 3 programs, there were 1155 interviews and 1014 positions later ranked in the top 3, suggesting that 87.8% of these interviews confirmed initial interest in applicants’ top choices for residency.14 If stakeholders participated as indicated in this survey, we estimated outcomes with ERAP in a future cycle. Among 1873 applicants, 1311 (70%) would participate in ERAP, and 996 (76%) would receive at least 1 interview in their top 3 programs. If 60% of 279 residency programs participated, offering 25% to 50% of first-year resident positions, 365 to 730 positions would be available through ERAP. Because 91% of applicants ranked top programs where they interviewed on their final list, with 1430 applicants, we assumed all positions in ERAP would fill. This would remove 365 to 730 applicants from the regular cycle. With applicants submitting a mean of approximately 72 applications, this could result in 26 280 to 52 560 fewer applications overall, or a mean of 92 to 188 fewer applications to each program. Those applicants receiving interviews at all 3 of their top choice residency programs, applied to a mean (SD) of 59 (17) programs. Estimates of the impact of ERAP on the competitiveness of the application cycle for applicants as well as the administrative burden on programs are presented in Using the respondents of this survey as a guide, we modeled how an ERAP would impact the available interview positions in the regular application cycle, depicted in the Qualitative analysis of survey respondents revealed positive sentiments regarding the need for organized action within the specialty and substantial change. As one PD stated, “the whole process needs an overhaul.” Stakeholders’ concerns categorized into 3 themes centering on the challenges of implementation. These were (1) fears of introducing additional administrative burden onto programs, (2) increasing applicants’ anxiety, or (3) worsening inequities in the application process. Based on the comments shared and the quantitative analyses performed, the barriers and opportunities presented with ERAP are outlined in Stakeholders in the OBGYN residency application process expressed broad support for an ERAP in this survey study. This study suggests that the majority of respondents would participate, and the majority of them would be successful. Applicants and PDs: those most directly affected by the process, displayed the most pronounced enthusiasm for ERAP. The proposed ERAP should include a limit of 3 applications per applicant, and allow programs to make 25% to 50% of positions available in the first stage of the match. The estimated impact of an ERAP based on these survey data would be a significant decrease in applications in the main match, decreasing costs and anxiety and allowing these applicants to focus on their education. In addition, hundreds of unnecessary applications by competitive applicants would be removed from the pool, facilitating holistic review of applications in the main match. In addition, applying through ERAP would serve as a signaling mechanism to their programs of interest, even for students who did not match through ERAP.In this study, 76% of applicants received interviews at one of their top 3 program choices, which may translate into the proportion receiving interviews through ERAP. It is reassuring that such a large portion of applicants identify programs where they are viable candidates for a successful match. Applicants’ interest in ERAP was not associated with medical school background, race, board scores or interviews received. Fewer positions per applicant would be available in ERAP than the regular match cycle, and the number of positions per applicant in the main match would be similar after ERAP to the current state. These estimates should alleviate concerns that applicants perceive that participating in ERAP would be necessary for a desirable match. However, matching highly competitive applicants and those with strong preferences through ERAP could result in similar or improved match outcomes for the remaining students. Students in participating in couples match were less likely to participate in ERAP. In this study, university programs were more likely to participate in ERAP than community-based programs. However, it’s possible those programs could benefit if ERAP decreased unnecessary applications to their programs. Early concerns about the practicality of a staged match have been allayed by successful implementation of virtual interviews and a compressed application timeline, changes necessitated in the 2020 to 2021 cycle due to the COVID-19 pandemic.15,16 Estimating $400 per interview in OBGYN, each applicant matching in ERAP who completes 3 interviews instead of the average 12 would save $3600. If between 365 to 730 applicants match using ERAP, this would save $1 314 000 to $2 628 000 overall. Although ERAP prolongs the application cycle, the overall reduction in applications and interviews would significantly reduce administrative burden for programs. Residency program costs for interviews may be as high as $190/applicant in terms of faculty time, not to mention expenditures on materials and receptions.17 Across all programs, the estimated savings for 6570 interviews—the number of interviews saved with all programs participating and 50% of positions filling in ERAP—is $1 282 500.The cost to applicants could be significantly reduced through ERAP. Residency applicants spend an estimated $340 to $450 per interview.The parameters for ERAP supported by respondents to this survey include a limited ERAP focused on those applicants with strong early preferences and high likelihood of matching in those programs. Careful study must be undertaken to ensure there are no undesired effects of ERAP on underrepresented groups and certain programs. Some fear that applicants who did not match in ERAP would have heightened anxiety and increase the number of applications submitted to the regular cycle. We argue an unsuccessful ERAP application might prompt an applicant to focus their applications on programs they are more likely to match. Our respondents reported submitted an average of 72 applications. There may be a ceiling to the number of programs applicants will apply to as students applying to the most competitive specialties such as dermatology or orthopedic surgery already submit 60 to 80 applications. In weighing the advantages and disadvantages of taking steps toward change, the status quo may be the worst-case scenario.18 Capping applications disadvantages applicants by forcing them to limit their choices. Although ERAP effectively introduces a cap in the first stage, it is optional and allows all applicants the opportunity of unrestricted applications in the second stage if desired while sending a signal in the first round.Other interventions to improve application inflation have been suggested, such as applicants signaling their preference to a limited number of programs. This approach offers promise, but would not reduce the number of applications.This study had strengths and limitations. The strengths of this study are its sampling across stakeholders in the OBGYN application process. Despite a lower response rate, the demographics of the respondents are similar to the NRMP data, and the distribution of applicants’ medical school status and USMLE or COMLEX scores mimics the breakdown of applicants applying nationally. The population of institutional stakeholders is less representative, with more MD-granting programs represented among GSA and CD respondents, and more university PDs responding. We compared only applicants identifying as White to all other races, because applicants could select several racial and ethnic identities, limiting the ability to explore associations that are more specific between racial/ethnic identity and ERAP interest. A pilot of ERAP is necessary to understand the true response to the opportunity among stakeholders. Pilot testing should include assessment of outcomes for residents who match via ERAP across the years of their residency training to measure the quality of the match beyond match rates. ERAP implementation must include careful monitoring of outcomes in order to make necessary changes and mitigate undesired effects on administrative burden, anxiety or inequities for underrepresented groups.The current application process drains resources from applicants and programs. A binding early match could reduce congestion within the application cycle, reduce waste, and allow programs and applicants to refocus their efforts during the final year of medical school. Insights gained from an ERAP pilot in OBGYN could inform efforts in other specialties and programs that include specialized tracks, match for postgraduate year 2 positions and other scenarios. Piloting an ERAP with an iterative, continuous quality improvement practice in a single specialty could be very informative to suggesting changes to the current system which would improve the application and match process for all stakeholders.


Migrant communities are often underserved by mainstream mental health services resulting in high rates of untreated psychological distress. This collaborative study built on evidence that mindfulness-based interventions delivered in-language and culturally tailored were acceptable and clinically effective for Arabic speakers in Australia. It aimed to establish whether a group mindfulness program produced expected outcomes under normal operational conditions, and to test its scalability and its transferability to Bangla speakers.A 5-week mindfulness program was delivered to 15 Arabic-speaking and 8 Bangla-speaking groups in community settings. The mixed-methods evaluation incorporated a pre-post study. Descriptive statistics were used to summarise the socio-demographic data, group attendance and home practice. Differences in DASS 21 and K10 scores from pre to post-intervention were tested using the nonparametric sign test for paired samples (two-sided). Multiple linear regression analysis was performed to determine the effects of selected sociodemographic variables, group attendance and home practice on clinical outcomes, based on intention to treat. Content analysis was used to examine the qualitative data.The program attracted 168 Arabic speakers and 103 Bangla speakers aged 16 years and over, mostly women. Cultural acceptability was evident in the overall 80% completion rate, with 78% of Arabic speakers and 84% of Bangla speakers retained. Both language groups showed clinically and statistically significant improvements in mental health outcomes on the DASS21 and K10. Thirty new referrals were made to mental health services. Participant feedback emphasised the benefits for their everyday lives. All but one participant reported sharing the mindfulness skills with others.Across multiple and diverse groups of Arabic and Bangla speakers in Sydney, the community-based group mindfulness program was shown to have high levels of cultural acceptability and relevance. It resulted in clinically and statistically significant improvements in mental health outcomes, facilitated access to mental health care and boosted mental health literacy. This innovative, low-intensity, in-language mental health intervention that was originally developed for Arabic speakers is scalable. It is also transferable—with cultural tailoring—to Bangla speakers.The online version contains supplementary material available at 10.1186/s13033-021-00456-0. Australia today is home to people who come from over 190 countries and speak more than 300 languages; it is a strong and successful multicultural society , 3. DespIn New South Wales (NSW), Australia’s most populous state, 28% of residents were born overseas, 47% have at least one parent who was born overseas and 25% speak a language other than English at home . Arabic This paper reports on the third phase of an ongoing program of research into translated and culturally adapted mindfulness-based interventions, conducted in 2017–19. Earlier studies with Arabic-speaking community members  demBased on these promising results, the Central and Eastern Sydney Primary Health Network (CESPHN), whose boundaries align with SESLHD and SLHD, commissioned the SESLHD Multicultural Health Service to deliver the group mindfulness program to Arabic- and Bangla-speaking communities in their region, and evaluate process and outcomes (Phase 3). This collaborative multi-site project brought together a large primary care organisation, two mental health services and many community groups. The broader project objectives included delivering the program to the target communities in order to reduce psychological distress, depression, anxiety and stress; developing in-language resources to support the program; and training bilingual mental health clinicians and community workers in mindfulness-based interventions. As in the earlier studies, the main evaluation questions concerned the acceptability and clinical utility of the group mindfulness program for each community. We also examined the combined dataset to determine the effects of selected sociodemographic variables and intervention exposure on mental health outcomes.In terms of the Sax Institute’s Translational Research Framework , Phase 3The group mindfulness program, which targeted Arabic- and Bangla-speaking community members aged 16–65 years, was widely advertised within health and community networks through flyers, social media and word of mouth. It was delivered in suburbs with high numbers of Arabic-speaking or Bangla-speaking residents at venues regularly used by the target population, such as migrant resource centres and community facilities attached to mosques and churches. Most groups were held in the morning; a couple in the evening. Refreshments were provided for all groups. Child minding was provided when required.Box Participants were required to attend group sessions once a week for five weeks, with home practice in between. Sessions were conducted in Arabic, Bangla, or the group language and English. They were co-facilitated by bilingual psychologists and trained community workers who emphasised the cultural and spiritual relevance of mindfulness practice in their explanations and examples, tailoring the content according to the needs of each group . The co-facilitators maintained weekly contact with all participants, providing telephone support between sessions as required. All groups were overseen by the clinical lead  who provided ongoing supervision for the co-facilitators and coordinated referrals for additional mental health care.Participants who indicated a high level of psychological distress at the start or during the program were followed up by the bilingual psychologist and referred for further support to mental health services, psychologists or the NSW Service for the Treatment and Rehabilitation of Torture and Trauma Survivors (STARTTS).The mixed-methods evaluation incorporated a pre-post study. Quantitative data were collected at the first and final group sessions. Participants completed a feedback form with open-ended questions at the end of each weekly session. The co-facilitators kept a record of group attendance and referrals and made notes on group processes and participants’ comments during the sessions and afterwards.The data collection tools comprised a questionnaire capturing sociodemographic data and knowledge and perception of mindfulness, and two standardised psychometric instruments—the K10 + and DASS21. Both instruments are widely used in the Australian context, where the K10 + forms part of the National Outcomes and Casemix Collection . The K10Quantitative analyses were conducted using IBM SPSS Statistics V26 and SAS 9.4. Descriptive statistics were used to summarise the socio-demographic data, group attendance and home practice. Pre and post-measures of mental health on the K10 + and the DASS21 subscales were compared using the paired-sample sign test (two-sided), as the data were not normally distributed. The null hypothesis for the sign test is the median difference is zero. Multiple linear regression analysis was performed to determine the effects of age, years in Australia, education, language spoken at home, gender, group language, home practice and group attendance on differences between post and pre-measures of mental health. The analysis was conducted with the main effects of the predictors only and with the main effects plus the home practice x group attendance interaction or joint effect. Intention to treat analysis involved multiple imputation all missing data; it was performed 25 times. Multiple linear regression analysis was performed using each imputed data set and the results combined to obtain pooled estimates of regression coefficients and their 95% confidence intervals. Higher scores on both psychometric instruments indicate higher distress, thus a negative post–pre difference indicates improvement in mental health.Participant feedback in Arabic and Bangla was translated into English by the bilingual co-facilitators for examination. Qualitative content analysis of the data was undertaken manually by two researchers who worked collaboratively .Ethics approval was obtained from the SESLHD Human Research Ethics Committee. Written consent was obtained by the co-facilitators who went through the Participant Information Sheet (available in Arabic/Bangla and English) and answered any questions. The study was monitored by a steering committee comprising the principal investigators  and staff and managers from the health services involved.The evaluation findings are organised under five main headings: (1) Participant characteristics, (2) Program adherence, (3) Mental health outcomes, (4) Referrals and (5) Participant experiences.Over a two-year period, 23 group mindfulness programs were facilitated across the region: 15 for Arabic speakers and 8 for Bangla speakers. Fifteen groups were women only, 1 was men only (Arabic) and 7 were mixed. They attracted a total of 271 participants aged 16 years and over, of whom 218 (80%) completed the program: 131 (78%) Arabic speakers and 87 (84%) Bangla speakers. The group size ranged from 8 to 18 with a mean, median and mode of 13. Those who dropped out mostly did so after one or two sessions. Common reasons included overseas travel, family sickness and the time conflicting with English classes. Using logistic regression, we found there were no differences between dropouts and participants retained on baseline DASS21 and K10 + scores (results not given).Across all the Arabic-speaking groups168 participants were recruited; 83% female. Most fell into the 26–35 and 56–65 age groups. Seventy-nine per cent were overseas-born, mostly in Lebanon, Egypt or Iraq; just over half had lived in Australia for eleven or more years. Overall, 42% spoke only Arabic at home and 48% Arabic and English. Sixty-two per cent were Muslims and 54% possessed a post-school qualification. , ‘moderate’ (25–29), or ‘severe’ 30–50) on the K10. , 98% attended at least three group sessions and 88% reported at least three weeks of home practice (Table .All of the 87 participants retained (84% retention rate) attended at least three group sessions and 93% reported at least three weeks of home practice Table . There wFor both Arabic and Bangla speakers, post-program measures on the DASS21 subscales and the K10 + showed improvement. The median differences in depression, anxiety and stress were statistically significant  . Overall, there was little that was considered unhelpful. The material was “clearly presented” and “understandable” and the facilitators engaged the group well. When present, as was the case in two groups, children were a distraction, as were interruptions and background noise. Most participants wanted more information and more sessions, or an opportunity to take part in future programs.Participant feedback on home practice across the five weeks was particularly instructive. After the first group session, participants were highly motivated (“will try to practice”). As they practiced the mindfulness exercises and experienced the benefits , they grew in confidence and increasingly applied the new skills in everyday life  and shared them with others. By the third week, many participants were practicing with family or a friend. Both Arabic and Bangla speakers reported improved family relationships as well as improvements in their own wellbeing. Some noted that it was difficult to find the opportunity to practice or to carry out the exercises . Despite the challenges, they continued trying to practice (“needs to be a habit”).Content analysis of all the qualitative data, including both written and verbal feedback, highlighted the main benefits experienced by participants: skills development and personal growth, increased ability to cope with ongoing stressors, and improved wellbeing and relationships. The quotations in Box Box 2. Participant-reported benefits“I’m happy that I’ve done the mindfulness program as I learnt about myself. I enjoyed the exercises and I practice the breathing exercise daily. It has made me more thoughtful, compassionate and wise.” (Bangla speaker).“I wish I had attended all sessions. Having sick children and no one to look after them limited my attendance. I am more mindful when I talk to my children. I am more mindful in my prayers. Trying to practice the skills whenever I can.” (Arabic speaker).“The program restored my confidence in myself and others. My outlook on the world has improved so much. I have more acceptance of things that are out of my control. My relationship with myself is much better and I want to do a lot of things for myself.” (Arabic speaker).“It’s great information. Very important to know because there is a way to deal with stress and taking care of myself.” (Arabic speaker).“Mindfulness skills have helped me calm down during stressful situations with my family. I have also shared these skills with my mum.” (Arabic speaker).“This course taught me to manage my tough situation in life while experiencing a health condition. The skills I learnt will help me for a lifetime.” (Bangla speaker).“The exercises helped me reduce stress related to assignments and schoolwork.” (Arabic speaker).“I practice mindfulness in the evening and they help me sleep well at night.” (Bangla speaker).“Being aware in my prayer allowed me to have a deeper and more meaningful connection with God.” (Arabic speaker).“I used to think a lot about my past but now I think about the present.” (Arabic speaker).“I did the breathing exercise with my 6-year-old. It is helping to promote positive behaviour and time management for both of us.” (Bangla speaker).“The program has taught me to cope with negativity I hear from people and since attending the program I have started feeling good about myself and now I go outside to meet people.” (Bangla speaker).Despite a growing evidence base and wide-spread acceptance among the general population, there has been limited mindfulness-based research in ethnic minorities in western immigrant countries , 23. PhaThe widespread underutilisation of mental health services by people from CALD communities in Australia is well-documented . BarrierThe program was delivered by bilingual co-facilitators  at various community venues. Program materials were translated into Arabic and Bangla, and all groups were facilitated in the community language, sometimes with supplementary English. Importantly, the experienced facilitators were able to respond to the needs of different groups without compromising its fidelity or effectiveness. Concepts were explained and exercises were introduced in accordance with group members’ backgrounds and understanding.Participant retention was high despite the time commitment involved (2.5 h a week for five weeks), as was engagement in home practice. Active participation, including completion of homework assignments or practice between sessions, enhances cognitive and behavioural therapy outcomes . Time spCultural acceptability was evident in the high retention rates for both language groups, and in post-program responses to the mindfulness knowledge and attitudes questionnaire. It was also reflected in the weekly feedback forms and comments to the group facilitators, and the extensive sharing with family, friends and other community members.In both language groups, levels of psychological distress, depression, anxiety and stress were reduced after four weeks with fewer people in the ‘severe’ and ‘extremely severe’ categories. Median differences on the psychometric measures pre and post-program were statistically significant; replicating findings from Phases 1 and 2 of this research –11. PartAnalysis of the effects of sociodemographic variables  and intervention exposure (home practice and group attendance) on mental health outcomes produced few significant results. Regressions including main effects only and main effects plus the joint effect of home practice x group attendance produced similar findings. Compared to participants under 26 years, those aged 56–65 showed significantly greater improvement on the K10 +  and those aged 46–55 and 56–65 showed significantly greater improvement on the DASS21 stress subscale. When the joint effect of home practice x group attendance was factored in, those aged 46–55 and 56–65 also showed significantly greater improvement on the anxiety subscale. It is not obvious why this should be so; possibly the older women have reached a life stage where they are more ready and able to focus on their mental health and wellbeing. Nevertheless, these results suggest additional attention should be paid to targeting the younger population.Years living in Australia (possibly an indicator of acculturation) was significantly associated with a reduction in stress in the main effects model. Attending a Bangla-speaking group, rather than an Arabic-speaking group, was significantly associated with an increase in anxiety, depression and stress. Again, the reason is not obvious. The Bangla speakers were generally younger, better educated and had spent fewer years in Australia. As a new and emerging community, the Bangla community has a much smaller population, significant settlement issues and less community infrastructure than the Arabic community .Qualitative data confirmed the program’s clinical utility, with participants reporting that they learned a lot and that mindfulness practice enhanced daily functioning and contributed to improved family relationships. Participants most commonly reported applying mindfulness in family interactions and prayer, activities of high importance within the Arabic and Bangla-speaking communities. Group discussion was seen as a positive feature. Encouraged by the group facilitators and early benefits, they took their home practice seriously and shared the new skills with their social networks. Although we did not measure this, sharing the program information and materials and practicing mindfulness with others undoubtedly increased community mental health literacy, i.e. “knowledge about mental disorders that are associated with their recognition, management and prevention” . These fThe broader project in which this study was nestled included two other components designed to extend the program’s reach and improve access to evidence-based mental health care for CALD community members: development of in-language audio resources and a facilitator training program. Audio resources in Arabic, Bangla and English were made available on USB to past and future participants in order to assist with their ongoing mindfulness practice. Since December 2019, they have also been available on the NSW Multicultural Health Communication Service website . The facThe demonstrated clinical utility of the group mindfulness program with Arabic and Bangla speakers, and the cultural acceptability of the program materials, resulted in further funding to continue roll-out to these community groups. In March 2020, in response to the novel coronavirus, COVID-19, Australia closed its international borders, introduced social distancing and placed limits on the number of people who could gather. As health services were not able to offer face-to-face groups, the clinical lead adapted program resources to support the Arabic-speaking community through regular text messages via established community networks. These messages encouraged mindfulness practice at a time of changing and challenging circumstances. The clinical lead also recorded a 5-min video (in Arabic and English) to introduce mindfulness concepts and link people with the audio resources, which was disseminated through social media and community networks. Subsequently, the mindfulness program was adapted for delivery via videoconferencing and offered as a one-off session to previous participants or as a shortened multi-session program for new and returning participants. A similar virtual group program has been implemented with the Bangla-speaking community. Accelerated by COVID19, there is emerging international research on the use and effectiveness of mindfulness interventions delivered via telemedicine and online –35.As an effectiveness study , bringinTranslation and cultural adaptation of evidence-based interventions which are then delivered in community settings enables engagement with CALD community members who would not otherwise access mental health services, as well as high retention rates and positive mental health outcomes. Across multiple and diverse groups of Arabic and Bangla speakers in Sydney, the community-based group mindfulness program was shown to have high levels of cultural acceptability and relevance. It resulted in clinically and statistically significant improvements in mental health outcomes, facilitated access to mental health care and boosted mental health literacy. This innovative, low-intensity, in-language mental health intervention that was originally developed for Arabic speakers is scalable and transferable—with cultural tailoring—to Bangla speakers. Future directions include further experimentation with technology-mediated mindfulness interventions.Additional file 1. Sociodemographic characteristics by language group – Participants recruited.Additional file 2. Pre and post-program K10 and DASS21 categories by language group – Participants retained.Additional file 3. Pre and post-program mindfulness knowledge and attitudes by language group – Participants retained.


Background: There is a critical need to address mental health needs across the globe, especially in low and middle-income countries where mental health disparities are pervasive, including among children. The global mental health disparities suggest an imperative for culturally and contextually-congruent mental health services models that expand upon the existing services and interventions for these groups. Rigorous research is a key tool in providing the scientific evidence to inform public policy and practice efforts to effectively address these needs. Yet, there is a limited number of researchers, especially those from diverse backgrounds, who study these issues. In this paper, we describe the “TrainingLEADers to Accelerate Global Mental Health Disparities Research” (LEAD) program, a research training program funded by the National Institute on Minority Health and Health Disparities and focused on global mental health disparities research for early career researchers from under-represented minority groups.Methods: The LEAD program is designed as a two-phase training program for advanced pre-doctoral students, postdoctoral fellows, and junior faculty from diverse backgrounds in the U.S., including groups underrepresented in biomedical, behavioral, clinical and social sciences research, interested in global mental health disparities research. Trainees are matched with mentors and participate in an intensive 12-week program.Discussion: The LEAD program seeks to provide a robust platform for the development, implementation and expansion of evidence-based culturally and contextually-congruent interventions and services models addressing global mental health disparities across the life cycle, especially in low-resource communities in the global context. By producing a sustainable network of well-trained investigators from underrepresented backgrounds, LEAD will potentially contribute to the shared lessons and efforts relevant to addressing global mental health disparities and improving care for vulnerable populations in low-resource settings. There is a critical need to address mental health needs across the globe, especially in low and middle-income countries where mental health disparities are pervasive, including among children. For instance, 90% of randomized clinical trials testing mental health interventions for children have been conducted in high-income countries , while 9There are several compelling reasons to increase the number of underrepresented researchers conducting mental health disparity research, including mental health in low-resource communities in the global context. First, the National Healthcare Disparities Report 2018 found that minority and low-income groups continue to struggle with healthcare quality and access . HealthcIn addition, mental disorders are among the leading causes of disability in the world . Thus, iWithin this context, child and adolescent mental health are particularly critical. Globally, 10–20% of children and adolescents experience mental health conditions . ChildreThe continued global mental health disparities suggest an imperative for culturally and contextually-congruent mental health services models that expand upon the existing services and interventions typically used with these groups. Against that backdrop, trainees and mental health practitioners have called for shared lessons and efforts, arguing that lessons learned from global mental health efforts in low and middle-income countries dominated by the global south, including SSA, may be relevant to addressing global mental health disparities, and improving overall care for vulnerable populations in high-income countries, including the U.S. .TrainingLEADers to Accelerate Global Mental Health Disparities Research”  as an example of research training programs that have promise in effectively strengthening the pipeline of underrepresented minority scientists to advance research in global mental health disparities. The training program has the following specific aims:In this paper, we describe the training program in minority health and health disparities research, funded by the National Institute on Minority Health and Health Disparities entitled “Aim 1: To provide a research training program to five cohorts of advanced MD and PhD students, postdoctoral fellows, and junior faculty that equips trainees with foundational global research skills and knowledge through experiential learning, mentoring, “hands-on” immersion in domestic and international mental health studies, individualized consultation, feedback, goal setting and monitoring and web-based support across time.Aim 2: To recruit five cohorts of advanced MD and PhD students, postdoctoral fellows, and junior faculty from underrepresented groups in the U.S. committed to conducting health disparities research, including a specific focus on global mental health prevention, intervention, services and implementation research within resource-constrained settings.Aim 3: To evaluate the short-term and longitudinal outcomes of LEAD training program.LEAD is designed as a two-phase training program for advanced pre-doctoral students, post-doctoral trainees, and junior faculty from diverse backgrounds in the U.S., including groups underrepresented in biomedical, behavioral, clinical and social sciences research, interested in global mental health disparities research. All trainees are recruited from universities across the U.S. and are trained over an intensive 12-week program.Phase 1 of LEAD consists of 4 weeks at Washington University in St. Louis for targeted skills and knowledge-building didactic seminars plus field-based research experiences within the St. Louis community. Phase 2 of LEAD consists of 8 weeks in a selected global site in a SSA country with research funded by the National Institutes of Health (NIH) that meets a trainee's research interest.Each year, one to two postdoctoral LEAD trainees complete the 12-week training phases and transition into a 9-month fellowship at Washington University in St. Louis, with a potential for extension to a 2 year. The program uses a team based mentoring approach. Each trainee is matched with one U.S.-based mentor affiliated with LEAD and one SSA-based mentor, both of which will provide technical, research-focused support, but also ongoing career development guidance and support as well. Specifically, the proposed training program capitalizes on the rich resources for U.S. local and global health disparities  available at Washington University in St. Louis, to provide trainees with the skills and experiences needed to lead multi- disciplinary, collaborative research teams focused on health disparities research in low-resource communities. The training program meets the non-human subjects research criterion.During Phase 1 of LEAD, all trainees participate in targeted skills and knowledge-building didactic training and seminars. Because trainees enter the program with different skills, strengths, and career levels, they are able to select from elective coursework that is currently being offered through summer programming at Washington University in St. Louis. Prior to the program, trainees work with their U.S. faculty mentors, to develop an Individual Development Plan to identify the most appropriate elective coursework for their career development. In addition to this tailored research experience, trainees are required to attend core seminars on various health disparity research topics, mental health seminars  as well as career development workshops and seminars .via frontline fieldwork experiences. The St. Louis region is among the worst in the nation in regard to racial/ethnic and health disparities  to take advantage of the opportunities offered by three NIH-funded global research hubs across eight SSA countries. These three hubs are focused on scaling up mental health interventions in low-resource communities. Each of these hubs will provide opportunities for LEAD trainees to engage with and learn about global mental health disparities research, including but not limited to community engagement, instrument/intervention adaptation, intervention implementation, and data collection. It is important to note that all the SSA countries included as potential sites for the trainees are characterized by poverty, poor mental health services, a dearth of mental health researchers and practitioners, community violence, and civil unrest –21. CombStrengthening Mental Health and Research Training in Sub-saharan Africa (SMART AFRICA) : SMART Africa Center is a transdisciplinary research center aimed at reducing gaps in child mental health service and research using a population approach. SMART Africa Center is one of the first child mental health implementation research partnerships located in SSA. The SMART Africa Center has a scale-up study in Uganda and pilot studies in Ghana and Kenya that examine the impact of an evidence-based multiple family group intervention that addresses serious child disruptive behavioral challenges as well as the multi-level  influences on the uptake, implementation, effectiveness, and sustainability of evidence-based practices.Youth FORWARD: Capacity Building in Alternate Delivery Platforms and Implementation Models for Bringing Evidence-based Behavioral Interventions to Scale for Youth Facing Adversity in West Africa: : Youth Functioning and Organizational Success for West African Regional Development (Youth FORWARD) is a mental health services research/ implementation science initiative involving local governments, non-governmental organizations, and academic institutions. Its dual focus is the science of scaling up evidence-based mental health care for high- risk youth in Sierra Leone and Liberia, and the expansion of local capacity to conduct and use further research. An implementation study takes place in Sierra Leone. Capacity-building activities occur in both countries. The scale-up study in Sierra Leone uses a hybrid implementation-effectiveness trial design across several youth entrepreneurship programs to evaluate an innovative approach to training and supervision and their influence on integration, fidelity, cost and sustainment of the Youth Readiness Intervention into a national youth employment program which is supported by major development actors in close coordination with local District Youth Councils.Southern African Research Consortium for Mental Health Integration (S-MhINT): Research and Capacity Building Consortium to Strengthen Mental Health Integration in South Africa, Mozambique and Tanzania : S-MhINT is a research and capacity building consortium in Southern Africa that aims to strengthen regional mental health integration into primary health, antenatal, and chronic care platforms using implementation science in under-resourced areas of eastern South Africa, central Mozambique, and southern Tanzania. S-MhINT examines the multi-level influences on the uptake, implementation, effectiveness, and sustainability of an existing scale up of an integrated mental health package for chronic disorders at the primary health care level in two different districts having different resource capacities in South Africa. The project also aims at building implementation science and dissemination research capacity in the region, recruiting service providers, managers, and policy makers as trainees, providing real world opportunities, mentorship, and necessary knowledge to conduct optimal scale-up of evidence-based integrated mental health care.Due to COVID-19, the LEAD curriculum shifted from a 4-week in-person training at Washington University in St. Louis to an online 10-week series of didactic training, program cohort meetings, and meetings with mentors. In addition, all travel was suspended. Hence, Phase 2 of the program was not implemented as described, but instead, trainees were able to work with their mentors to develop manuscripts out of existing data sets, work with mentors on COVID-related revisions to existing Institutional Review Boards, and attend community collaborative board meetings that were held virtually. In addition, we used this opportunity to expand research projects beyond the original proposed sites to include domestic mental health disparity studies.The online format allowed us to expand our lecturing network to invite guest lecturers from across the U.S. and Uganda, resulting in a wider range of topics and perspectives. This format also enabled us to be responsive to feedback from the trainees in real time to incorporate additional research methodology content as needed for trainees and provided opportunities to discuss and develop curriculum around current event topics such as the COVID-19 pandemic.Through the online platform, we brought the LEAD program together with our two other NIH-funded mental health-focused training programs  that ran concurrently. Bridging the three programs allowed our team to leverage additional resources, create additional opportunities for networking, bi-directional peer feedback and support from a larger cohort of trainees and faculty mentors. This additional cross-program collaboration resulted in one manuscript and two grant submissions involving trainees from different programs. Moreover, LEAD trainees had the opportunity to participate in an NIH mock review session as observers and peer reviewers for pilot grant applications from Researcher Resilience Training Program (R25MH118935) fellows, allowing them to gain valuable insight into the NIH review process and practice their own review skills as reviewers during the summer training period.We anticipate using a hybrid didactic curriculum in the future, where we can add additional web-based programing, including useful skills-based seminars and supplemental group check-ins with all our trainees at various sites throughout Phase 2 of the program. These enhancements would not have been possible without the increased technological advancements at our program sites due to COVID-19 pandemic.via the following mechanisms: (1) Working with their mentor on an agreed upon research project in their Individual Development Plan; (2) Regular communication with faculty mentors at weekly meetings to conceptualize research questions, analyze datasets, and discuss results; (3) Establishing collaborative research projects with other research programs as well as networking with other postdocs at Washington University in St. Louis; (4) Regular career advice via mentorship meetings and more formal seminars; and (5) National networking opportunities through conference presentation opportunities.In addition to participating in the 12-week program, the year-long postdoctoral training experience focuses primarily on research experiences in individual research laboratories, and the primary responsibility for the organization of the postdoctoral experience rests with the faculty mentor. Training of our year-long postdoctoral fellow(s) occurs This program recruits 7–9 predoctoral and/or junior faculty and 1–2 postdoctoral trainees each year from underrepresented backgrounds in biomedical, behavioral, clinical and social sciences research, who are interested in health disparity research, with an emphasis on global health disparities.Washington University in St. Louis is diligent in our efforts to recruit outstanding underrepresented minority (URM) candidates. To select the most qualified applicants, we recruit underrepresented minority trainees focused on health disparity research from a range of local and national institutions. Efforts to recruit diverse candidates are aided by the increasingly diverse ethnic and cultural background of our training faculty and by the strong representation of highly productive researchers on our faculty.We seek new recruitment sources for trainees through our large networks and at conferences. The Directors and TAC members lead targeted recruitment efforts within their own networks by contacting relevant colleagues, students, and student organizations. We also market to potential feeder programs by announcing the LEAD program in conferences, professional/academic associations, journals and newsletters with readers from under-represented populations.Further, the LEAD program advertises widely among chairs of PhD and MD programs; Deans and Associate Deans of Research; Presidents of academic and professional organizations to be circulated in listservs; linkages with NIH staff; and other professional/academic networks.The LEAD Program online application includes sections to describe the candidate, their career development plan, their preferred mentor(s), their research plan, Responsible Conduct of Research training and Human Subjects certification. In addition, applicants are required to provide two letters of reference as well as an NIH biosketch.The review committee includes investigators from diverse disciplines who have experience mentoring trainees and reviewing applications. Any reviewer with an existing relationship with an applicant is recused during the discussion and scoring of that trainee. Similar to an actual NIH review, each application is reviewed by three reviewers. Reviewers summarize the strengths and limitations of the applicant and the proposal, score each section of the proposal, and give an overall score. Scores are calculated and applicants ranked accordingly. Following this scoring process, the top 12 candidates advance to the second round consisting of a phone interview with program directors and staff. These 15-min interviews allow for program leadership to access fit for the program and give trainees an opportunity to ask questions. In the case that the review committee cannot come to a consensus following these interviews, a secondary “council” review may be held by the Advisory Committee to determine funding based on overall scores and availability of resources.Mentored research training is a critically important part of the LEAD Program. As such, we have assembled a group of established investigators with national and international recognition in global health disparities, mental health, public health, epidemiology, behavioral medicine, dissemination and implementation research, behavioral economics, and comparative effectiveness research. All LEAD program trainees are expected to have two mentors, a U.S. faculty mentor and a foreign faculty mentor see . Figure Program mentors are expected to have a close working relationship with trainees, actively participate in guiding, reviewing and tailoring trainee's individual development plans and provide coaching, feedback, and direction to guide the career development and future success of LEAD trainees. To address varied learning styles and cultures of education, the mentoring model is informed by adult learning theories: Self-directed learning , 23, andBoth U.S. and foreign faculty mentors are required to participate in a half-day web-based seminar led by the Program Directors. Key topics such as establishing expectations, effective communication, assessing understanding and fostering independence are covered and reference materials provided. In addition, mentors must sign “Mentor Agreements” describing expectations, time commitment, and requirements to participate in program development and evaluation. Mentors will be formally evaluated mid-way through the training period and following each summer session by their trainee(s) and reviewed by the Training Advisory Committee (TAC). If a problem with a mentor occurs, the LEAD Directors will intervene to facilitate the process of decision making and solutions, provide support, and arrange for new or additional mentors if necessary. Mentors with negative evaluations or whose circumstances change such that they no longer fulfill the criteria to be a mentor will be removed from the pool.biomedical, behavioral, clinical and social sciences researchers with extensive experience running training programs and/or experience in mentorship and career development (see https://sites.wustl.edu/lead/ for more details). Members of TAC are expected to serve for 5 years. They provide strategic guidance and oversight for activities of the Leadership team including candidate selection, scientific review of trainee projects, evaluation of trainees, training program progress, program development, implementation and evaluation.LEAD is led by a multidisciplinary team of accomplished investigators. Leadership is supported by 10 TAC members comprised of accomplished leaders in the field of global mental health and mental health disparities research, including practitioners, policy makers, and/or via web-conferencing to plan and develop the program content, curriculum, and competencies. In addition to providing overall strategic direction to the program, they give seminars to our trainees, assist with program marketing and candidate selection, and review our program and outcomes. Program recommendations are received both verbally and via written correspondence.The TAC meets annually via course evaluations and mentor evaluations; (3) Scholar outcomes, and scholar productivity ; and (4) Regular meetings with the TAC to critically review programs, curricula, and practices. Feedback is given in the form of suggestions for improvement. A variety of processes and outcome measures are used to determine the effectiveness of curricula and mentored research experiences. Evaluation materials include the following:To assess program effectiveness, scholars, mentors and program curricula are regularly evaluated and the results of these evaluations are used to improve our LEAD training program. The evaluation is an ongoing process and the overall impact of the LEAD program will be published once data has been collected from all cohorts recruited during the 5-year period. The program and curricula are evaluated using the following four metrics: (1) Tracking the number and types of scholars applying, accepted, matriculating, and completing the training; (2) Measuring scholar satisfaction with the training programs via direct observation by Program Directors, evaluations of final projects, and written evaluations by both trainees and their mentors. The evaluation questions assess clarity of expectations, organization and content of lectures and materials, topic relevance, instructor engagement, encouragement of critical thinking, and global assessment of the instructor. Coursework and program data also are collected from Qualtrics surveys sent out immediately following each training session and trainee exit interviews. The Qualtrics surveys consist of both quantitative and qualitative aspects and included a 5-point Likert Scale evaluating the sessions “Relevance of the topic to my research;” “Overall quality of the speaker(s) and their presentation(s);” and the “Convenience of event time/schedule.” In terms of qualitative questions, trainees were asked what they “liked and found useful” and “how the session could be improved.”Courses are evaluated via 10 open-ended questions. Examples include “How helpful were the training topics to you in the research setting? Were there aspects of research and research careers that you wish had been covered in the training webinars?” and “Please discuss your mentored research experience. What were the positives and negatives of your experience?” Surveys and exit interviews are used to evaluate quality, accessibility, coherence, additional research topics that should be added to the program, and access to research support.The exit interviews are 30-min sessions with an independent coordinator that query program strengths and weaknesses At the 5-week point and end of the summer program trainees complete online Qualtrics surveys to evaluate their relationship with their mentor. In addition to questions asking about the number of meetings and communication trainees have with their mentors each week, the evaluation includes a 7-point Likert Scale in order to gauge each mentor's time commitment, availability, and effectiveness as well as determine specific problems and strengths of the relationship. Questions include the following: “My mentor is supportive and encouraging;” “My mentor provides constructive and useful critiques of my work;” “My mentor is helpful in providing direction and guidance on professional issues ;” “I have access to appropriate resources ;” and “I feel challenged to extend my abilities .” There are also five open ended questions designed to summarize overall progress and potential barriers including: “List any barriers to meeting your projects goals” and “How can your mentor, the directors, and/or LEAD program staff help support your work?” If problems arise, the Program Director will schedule meetings with both parties and if necessary, propose a new mentor.Mentors will evaluate trainees both during the mid-point and at the end of the summer program using online surveys in order to identify possible problems and redirect trainee efforts when necessary. Similar to the mentor evaluations listed above, this approach uses a 7-point Likert Scale with the following questions: “Incorporates constructive and useful critiques into their work;” “Appropriately asks for direction and guidance on professional issues ;” “Responds to my questions satisfactorily ;” “Has been productive in their research;” and “Is on track to meet their IDP goals.” Mentor feedback also includes open ended questions to summarize overall progress and areas of concern. This feedback is shared with the TAC and with the trainees to help guide career development.Trainees are tracked for 15 years after completing their program to obtain long-term feedback and insights on program benefits, pitfalls and effectiveness. The program coordinators monitor scholar employment, career development, and milestones, including research positions, faculty appointments, grants awarded, presentations, publications, awards, participation in study sections, and mentoring record.Working with the CPHSS, and the Becker Library, LEAD Program Directors will use social network analysis to assess scholarly collaboration to research productivity.The results of these evaluation tools are entered into a database to generate reports and track long-term outcomes.As shown in the Program Logic Model see , programOur preliminary findings suggest that the training program has been successful and is well received by the trainees. For instance, between June 2020—September 2021, our 19 LEAD trainees have published 19 peer-reviewed manuscripts, presented at 19 academic conferences, and received two grants, including an NIH-funded R01 study. Results from our two cohorts indicate that overall, the training curriculum received very high ratings, with 83% of Summer 2020 trainees and 91% of Summer 2021 trainees ranking the “Overall quality of the speakers and their presentations” as excellent or very good. One noted, “I am very interested in qualitative research and found this very informative…. [I appreciated hearing] both a Ugandan and American perspective. Both presenters were very knowledgeable and experiences and gave examples from their research experience.” Both cohort evaluations also indicated a high level of communication between mentors and trainees, with meetings occurring at least once per week and multiple electronic communications reported by all respondents. In general, trainees indicated they had the mentor support and materials they needed to accomplish their work.The overall goal of the LEAD Global Training Program is 2-fold: (1) increase the number of underrepresented minority researchers from the U.S. trained in conducting mental health disparity research; and (2) create a cadre of rigorously trained researchers who will focus on global and U.S. mental health disparities, especially in resource-constrained settings, where mental health disparities are understudied.LEAD seeks to provide a robust platform for the development and implementation of evidence-based interventions in global mental health disparities–led by culturally-conscious investigators from underrepresented minority groups. While federal funding agencies, such as NIH, are committed to diversifying the workforce and increasing the proportion of federally-funded investigators from underrepresented populations, racial and ethnic diversity of applicants remain limited. For instance, <5% (~4.7%) of the NIH applications come from Black (1.4%), Hispanic (3.2%), and Native American (0.05%) investigators. Compared with NIH R01 applications from white investigators, applications from black investigators are 13.2 percentage points less likely to be awarded. Recent reports indicate no major improvements in these numbers, where African American/Black scientists make up only about 2% of the R01 application pool in 2020  and undeThere has been a call for shared lessons and efforts, arguing that lessons learned from global mental health efforts in low-income countries dominated by the global south, including SSA, may be relevant to addressing global mental health disparities, and improving overall care for vulnerable populations in high-income countries, including the U.S. .The LEAD program is purposefully designed to disrupt the traditional practice of researchers from the Global North “teaching” researchers from the Global South. The program recognizes and values the wealth of experience and expertise of the SSA researchers in addition to the importance and applicability of lessons learned from the region in low-resource settings in the U.S. In addition to Global South researchers leading many of the didactic training sessions and panel discussions during the summer programming, LEAD matches trainees with senior investigators from the Global South to immerse them in intensive field-based research on the continent.In short, the LEAD program aims to ultimately provide a robust platform for the development and implementation of evidence-based interventions in global mental health disparities–led by culturally conscious investigators from underrepresented minority groups.PC-R and FS are the principal investigators of the training program. OSB is a co-investigator on the training program, contributed to the conceptualization of the training program and drafted this manuscript. BA and LP are the training managers for the program and contributed to the drafting of this manuscript. PN is a co-investigator and contributed to the drafting of this manuscript. LS, TB, AB, and TE are members of the Training Advisory Committee and contributed to the drafting of this manuscript. All authors reviewed and approved the submitted manuscript.The LEAD training program was funded by the National Institute on Minority Health and Health Disparities . The training program was partially supported by the National Center For Advancing Translational Sciences . The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher.


ABSTRACT IMPACT: Through its interdisciplinary, tailored approach, the FLOW program could change the way that we approach promoting healthy lifestyle changes in the primary care field. OBJECTIVES/GOALS: The goal of this project is to assess patient outcomes associated with the implementation of the Fitness, Lifestyle, and Optimal Wellness (FLOW) Program. The ultimate aim of this program is two-fold: increasing patient-reported wellness and improving objective health measurements. METHODS/STUDY POPULATION: The FLOW program consists of a multidisciplinary team of sports medicine physicians, nutritionists, fitness trainers, and clinical psychologists. Patients who choose to participate in the program undergo a comprehensive physician-guided assessment, including lifestyle and metabolic evaluation, biomarker profile, and body composition analysis. Based on the patient’s goals and results of evaluation, he/she is then connected with other members of the FLOW team to develop a comprehensive plan and offer resources for potential improvements in physical activity, nutrition, and/or behavior. The patient will undergo follow-up assessments and questionnaires at three and six months to track their objective measurements and reported progress. RESULTS/ANTICIPATED RESULTS: The anticipated results of the FLOW program are an overall improvement in patient health and wellbeing. More specifically, we anticipate seeing increased levels of exercise from initial reported levels, as well as better nutrition habits. We expect to see improvements in follow-up body composition assessments, with gains in fat-free mass and decreased body fat, in addition to patient-reported improvements in behavioral health as measured by PHQ-9, GAD-2, and the Perceived Stress Scale. We will also assess reported sleep health with the hopes to see improvement in follow-up assessments. DISCUSSION/SIGNIFICANCE OF FINDINGS: The FLOW program is designed to address health inequities that disproportionately affect the Deep South. Through this program, we propose a new role of the primary care team in promoting healthy lifestyle habits and disease prevention through exercise, nutrition, and behavioral health services.Regulatory Science