Cardiovascular disease remains the leading cause of death worldwide. Cardiovascular research has therefore never been more crucial. Cardiovascular researchers must be provided with a research environment that enables them to perform at their highest level, maximizing their opportunities to work effectively with key stakeholders to address this global issue. At present, cardiovascular researchers face a range of challenges and barriers, including a decline in funding, job insecurity and a lack of diversity at senior leadership levels. Indeed, many cardiovascular researchers, particularly women, have considered leaving the sector, highlighting a crucial need to develop strategies to support and retain researchers working in the cardiovascular field. In this Roadmap article, we present solutions to problems relevant to cardiovascular researchers worldwide that are broadly classified across three key areas: capacity building, research funding and fostering diversity and equity. This Roadmap provides opportunities for research institutions, as well as governments and funding bodies, to implement changes from policy to practice, to address the most important factors restricting the career progression of cardiovascular researchers.
Diversity is key to innovation, but the current system and culture of the cardiovascular research sector are driving researchers, particularly those from under-represented groups, out of the sector.
Our team conducted research to identify the key short-term, medium-term and long-term solutions to addressing issues faced by early-career and mid-career researchers, focusing on three key areas: capacity building, research funding and fostering diversity and equity.
Capacity building needs to support collaboration and team-based research, improve and incentivize mentorship, and provide training to cardiovascular researchers to develop management, financial and communication skills.
Research funding needs to be used to improve job security and the assessment of career disruptions and opportunities and to support early-career and mid-career cardiovascular researchers to prepare for leadership roles.
To improve diversity and equity in cardiovascular research, working parents, women and individuals from other under-represented groups need additional support.
At present, cardiovascular disease (CVD) remains the main cause of morbidity and death worldwide1. In addition to new therapies, cost-effective policies and practices are urgently needed to prevent avoidable deaths from CVD. Research has shown that diversity in the workforce — which refers to involvement of individuals across the spectrum of gender, race or ethnicity, disability status, nationality, religious affiliation, sexual orientation and socioeconomic background in the workplace — drives innovation and performance2. Therefore, a diverse and stable cardiovascular research workforce is essential to identify solutions to tackle the global CVD burden. This diversity is particularly important to ensure that the solutions identified address the issues faced by the vast majority of the population, particularly those who are currently under-served by the existing health-care system3,4.
Some progress has been made in the past decade in improving diversity and equity in the sector, with several countries implementing national programmes to address these issues in research and academia. However, some evidence suggests that the cardiovascular research workforce is at imminent risk from low staff retention. In a 2019 survey involving >500 cardiovascular researchers in Australia, two-thirds of the participants had considered leaving the cardiovascular research sector or did not feel that they had long-term career prospects in cardiovascular research owing to the lack of long-term job security and funding5. Worryingly, these and other issues were twice as prevalent in women than in men5. Indirect evidence from other countries demonstrates that Australian cardiovascular researchers are not alone6,7,8. Although these concerns might reflect a broader issue affecting the biomedical research sector as a whole, such issues seem to be exacerbated in the cardiovascular research field owing to insufficient funding for cardiovascular research and development in the USA and Europe6,7, particularly for discovery research8. Moreover, a shortage in the cardiology workforce has remained for nearly two decades9, and women continue to be under-represented among cardiologists10. On the basis of this information and data from other areas of research11,12, these workforce challenges are likely to be occurring elsewhere in the world. Such challenges have been exacerbated by the coronavirus disease 2019 (COVID-19) pandemic, with evidence that the pandemic is worsening the gender and race or ethnicity disparities among researchers13,14 and is driving an overall phenomenon called ‘the great resignation’, particularly among mid-career employees15. Consequently, solutions to stop the ‘brain drain’ of cardiovascular researchers and to improve retention and increase diversity are immediately needed.
To address this issue and identify potential solutions, focus groups involving 34 Australia-based early-career and mid-career researchers (EMCRs) working in cardiovascular research were formed in 2021 (ref.16). These researchers were involved in different fields of cardiovascular research and represented different ethnicities, genders and LGBTIQA+ (lesbian, gay, bisexual, transgender, gender diverse, intersex, queer, asexual or questioning) identities, as well as differing levels of caregiving responsibilities. These focus groups resulted in 92 proposed solutions across three key areas: capacity building, research funding, and fostering of diversity and equity17 (Table 1). By undertaking a review of the international literature, we have extended these solutions with practical examples from the global community. In this Roadmap article, we present short-term, medium-term and long-term strategies that could be implemented at an individual, organizational and sector level, from policy to practice, to support the careers of cardiovascular researchers worldwide (Fig. 1).
Roadmap for capacity building
Reducing the burden of CVD globally in the short-term (<1 year), medium-term (1–5 years) and long-term (>5 years) requires a strong and secure pipeline of biomedical, clinical and public health researchers. Therefore, targeted investment in the career development of EMCRs is key to capacity building. In this section, we highlight strategies for building capacity with a specific focus on supporting collaborations, mentorship and training. Although the resources available to support and improve the career development of EMCRs might differ between low-income, middle-income and high-income countries16,18, many of the strategies suggested can be implemented without cost or are low cost and can be facilitated through local and international networks and societies.
Support multidisciplinary collaborations
EMCRs could be supported to organize and attend regular meetings where clinical, biomedical and public health researchers can interact and share ideas. This approach would inform the direction of research and might lead to new research interests and collaborative projects. EMCRs could promote their research interests and skillset and identify potential collaborations through online platforms that allow cardiovascular researchers to connect and share ideas. For example, the Trainee Advocacy Committee of the American Heart Association (AHA) Council on Hypertension comprises EMCRs who contribute to all aspects of the organization of their annual scientific meeting, allowing them the opportunity to collaborate with researchers across different cardiovascular fields and levels of seniority19. Another example is the Global Cardiovascular Research Funders Forum, founded by 11 cardiovascular research bodies from Australia, Canada, Europe, New Zealand and the USA20. The forum aims to accelerate the pace of research progress by creating opportunities for cross-border coordination and collaboration between world-leading cardiovascular researchers and organizations to advance the prevention, diagnosis and treatment of CVD. Similar forums could be conducted at national and international levels through professional societies and organizations and could operate on an opt-in basis for EMCRs.
EMCR-specific seed funding is invaluable in establishing job independence and collaborative research. Existing funding schemes could be redesigned to promote cross-disciplinary collaborations, support EMCR-only or EMCR-majority teams, encourage clinician–scientist collaborations, and stipulate mandatory inclusion of an EMCR as part of the principal investigator team or even as a co-lead investigator. Although some grant schemes focus on funding EMCRs, such as the NIH Pathway to Independence Award (K99/R00) programme21 and the European Research Council starting grants (for early-career researchers) and consolidator grants (for mid-career researchers), these funding schemes target only individual researchers, rather than promote collaborations or team-based research. An innovative training programme called MINDSHIFT, funded by the European Commission for the years 2021–2026, aims to promote an interdisciplinary research programme across Europe to bridge knowledge gaps in hypertension research. This funding model could be adapted elsewhere in the world to improve collaborative efforts. Another important aspect of cardiovascular research is engagement with patients, who are experts by experience and can improve the relevance and applicability of research22,23. Facilitating connections between patients and EMCRs would increase awareness about the barriers faced by patients and their families, and cardiovascular researchers, and improve study design and effectiveness.
The development of infrastructure that facilitates the co-location of clinicians and non-clinician biomedical researchers might promote further cross-pollination of research interests and perspectives (Box 1). Capacity-building efforts should include collaboration between researchers at all levels of seniority, funding bodies and stakeholders (patients, programme organizers and policymakers) at the local, state, national and international levels18. The changes needed to reduce the burden of CVD require sustained awareness and advocacy among all stakeholders24. One example of an effective and broad collaborative effort is the regional cardiovascular research networks across Australia, such as the New South Wales Cardiovascular Research Network (Box 2). Moreover, the stagnation of cardiovascular drug development over the past two decades is a well-known issue25, which could be at least partially addressed by stronger partnerships between academia and industry. Such collaborations have already been established in other fields in the UK26, with Novo Nordisk investing up to £115 million in a new research centre at the University of Oxford for the development of innovative approaches to the treatment of type 2 diabetes mellitus27, and AstraZeneca locating one of its global research and development centres at the University of Cambridge28. In addition, India has approved its first industry–academia partnership programme (the Biopharma Mission) to accelerate discovery research and facilitate the development of products, including vaccines and medical devices29. The Biopharma Mission aims to improve technology transfer capabilities in the public and private sectors and to support start-up companies and small-sized and medium-sized enterprises to build the capacity for sharing innovative research29. Similar partnerships in the cardiovascular research sector would generate new opportunities for EMCRs, including more industry-funded fellowships.
Incentivize mentorship and sponsorship
Effective mentorship is a key factor in the development, success and retention of EMCRs in research settings30,31. At present, more investment in mentorship and sponsorship is needed to support career advancement for women and other under-represented groups32,33. Academic sponsors who advocate for the career development of EMCRs are crucial, particularly to bridge the equity gap by increasing the number of cardiovascular researchers from under-represented groups to be promoted to senior leadership positions33,34.
Cardiovascular institutions, networks and societies could establish small peer-mentoring groups made up of EMCRs who can provide support for each other. Importantly, all EMCRs should be encouraged to join mentoring programmes at institutional, national and international levels, such as the AHA Mentoring for Professionals35 scheme and the International Society of Hypertension (ISH) Mentorship programme36. The MINDSHIFT programme also partners researchers with at least two independent research institutions across Europe to increase mentoring opportunities. Moreover, cross-sector mentoring programmes can provide opportunities to facilitate translation of basic science research to the clinic. For example, the Australian Cardiovascular Alliance offers a cross-sector mentoring programme that connects biomedical scientists, clinical researchers, health services and public health researchers, clinicians, policymakers and industry leaders37. EMCR mentees and mentors should undergo formal mentorship training to learn how to navigate and gain the most value from the mentor–mentee relationship. In particular, mentors should be provided with training to increase their awareness of diversity. At present, formal mentorship training programmes for academic researchers are scarce, particularly in low-income and middle-income countries (LMICs)31,38. A notable example is the Fogarty Global Health Program for Fellows and Scholars, which includes a mentorship workshop to train mid-level and senior-level investigators working in public health and clinical and basic science research across multiple academic institutions in LMICs31.
To encourage involvement from supervisors and senior mentors, funding bodies could build mentorship requirements into grant applications, whereby senior applicants would be required to describe how they will build research capacity and mentor EMCRs within and, importantly, across research groups. Additionally, institutions could provide career coaching and secondment opportunities to develop and improve mentoring skills. Career coaching, as distinct from mentorship, is designed to help individuals to set and reach personal goals and is advantageous for career planning and leadership training.
Periodic evaluation of mentoring and sponsorship schemes is crucial to ensure that these programmes are effective and are having a positive effect on the career development of cardiovascular researchers. Furthermore, a robust review of mentoring programmes encourages institutional leadership support and creates local ownership of the initiative29. In this regard, a six-point framework to review and evaluate mentorship programmes has been proposed, which encompasses aspects of the mentor–mentee relationship, career guidance, academic productivity, networking, wellness and organizational capacity39.
Provide training to improve professional skills
Early in their career, EMCRs are trained to become good scientists who are proficient at collecting, analysing and discussing their research. As EMCRs transition from postdoctoral fellows to independent research leaders, they are suddenly faced with a myriad of new challenges with little-to-no formal training. These new challenges can include recruitment and management of staff, finance administration, science communication and the balancing of clinical or teaching loads with research, while simultaneously trying to build their research programmes and secure research funding to establish themselves as leaders in their respective fields. Indeed, results from a survey of 3,200 scientists revealed that two-thirds of laboratory heads had not received any training on the managing and mentoring of staff and students40. The training and development of EMCRs, in both a research and a professional capacity, are crucial to provide a strong foundation on which to build an independent and sustainable research career in cardiovascular research.
Areas of training for EMCRs could include communication, leadership, and financial and project management. Such training programmes can improve general skills and are helpful in building a people-centred research culture. Training programmes should also extend beyond intra-institutional and inter-institutional opportunities to include local, regional and national agencies. For example, a training initiative for early-career researchers from LMICs that was developed by the National Heart, Lung, and Blood Institute–UnitedHealth Collaborating Centers of Excellence includes training in project management21,41,42. In addition, the World Heart Federation Salim Yusuf Emerging Leaders Programme provides professional development and mentoring opportunities alongside research capacity building activities43. However, these programmes are usually extremely competitive, with only a small number of researchers who can participate. Advocacy and support of these training programmes for a wider range of EMCRs are vital and should be prioritized by institutions to ensure they remain sustainable. Many societies and organizations offer training webinars involving established researchers who share their experience. The design of such sessions to have a clear learning outcome focused on professional development would provide accessible training that is currently not widely available to cardiovascular researchers.
Institutions should consider offering specific training to early-career researchers to support their transition from a PhD graduate to a postdoctoral scientist, and from postdoctoral to leadership positions. The responsibilities of postdoctoral fellows differ between countries, but commonly include tasks such as finance management, grant administration and staff recruitment, which are often expected of these researchers without provision of additional training. Institutions should also be encouraged to integrate professional skills training into Masters and PhD programmes to fully equip graduates with the skillset required as they transition into their next academic or non-academic role, or as part of an on-boarding programme during postdoctoral training.
Instituting training of professional skills across the short-term and medium-term, as described above, should help to build leadership capacity in EMCRs. This training should be made compulsory as part of the promotion process, so that future leaders are well equipped with the skills necessary to succeed in cardiovascular research and beyond. Of note, professional development and leadership training programmes must be well designed and have the backing of a strong and supportive institutional culture44. Therefore, the training should optimally be delivered by external parties or collaboratively between broad stakeholders and designed to suit local research environments.
Roadmap for research funding
The cardiovascular research sector is seeing lower success rates for competitive funding schemes than in previous decades, with overall less funding available for cardiovascular research and development6,7,8. Moreover, the average age of awardees is increasing. For example, in the USA, the average age at which a scientist secured their first NIH R01 grant increased from 40 years in 1995 to 44 years in 2020 (ref.45). The distribution of NIH funding support is also highly skewed, with 10% of NIH-funded researchers receiving 40% of the total funding available45. This finding is particularly relevant given the reports suggesting that innovative research is driven by EMCRs46, who are disproportionately affected by lack of funding owing, in part, to biases against junior scientists46. To address these longstanding issues, the NIH launched an EMCR-specific biomedical scheme, the Next Generation Researchers Initiative45. Considering that cardiovascular research has one of the highest cost–benefit ratios of all biomedical research fields (Australian $9.8 return for every dollar invested in Australia47 and a 20.6% internal rate of return in Canada48), investing in funding that specifically benefits cardiovascular EMCRs should be an obvious choice. In this section, we discuss the major barriers faced by cardiovascular EMCRs in securing competitive funding and how these challenges can be overcome. An example of a well-designed and well-implemented funding scheme is described in Box 2.
Increase job security
Many outstanding researchers with strong track records and notable contributions to health and medical research are appointed on short-term (6-month to 18-month) contracts5. This situation has evolved owing to many complex, interrelated factors, such as short-term research funding, and will not be improved quickly or without strong leadership and advocacy, underscoring the societal and economic cost of the lack of support for cardiovascular research to address our CVD burden.
EMCRs should be provided with access to objective and critical career development advice to increase awareness of different career pathways, including industry roles and entrepreneurship.
Mid-career researchers have a specific set of career challenges; they are expected to compete with established senior researchers for grant funding, while having a large administrative burden as they try to maintain research independence and acquire international recognition49. In this regard, funding schemes have been developed to specifically cater to mid-career researchers, such as the NIH Next Generation Researchers Initiative45 and the European Research Council consolidator grant. The development of strong connections and formal collaborations with industry and policymakers is essential for the continuity of the cardiovascular research pipeline, including opportunities to develop co-funded, longer-term postdoctoral roles between research institutions, industry and the government. Such conjoint roles are essential in improving management and policy and to shift biomedical discoveries along the translational pipeline. In addition, little support exists for a team-based approach to research for mid-career researchers who are willing to contribute to a research programme, but are not necessarily ready to lead a research team. Grant schemes could be improved by better recognizing the team-based approach that is required to conduct high-quality research, rather than recognizing only an individual lead investigator.
Funding agencies can contribute to improving job security for researchers by requiring research institutions to set a minimum duration of employment contracts for research staff. Employers of grant recipients should also be contractually obliged to ensure that a predefined number of staff employed through the grant are provided with an employment contract that aligns with or extends beyond the term of the grant. Longer-term goals such as an extension in the research project, dissemination of results, applications for the next stage of research funding and investment in the translation or implementation of findings are all contingent on the researcher’s job security. Moreover, creating long-term research opportunities for professional researchers who provide essential training and increase the overall capacity of institutions would allow further employment opportunities while retaining expertise. For example, in France, a tenured research position with INSERM (the National Institute of Health and Medical Research) is possible by way of a nationally competitive examination. A nationally relevant set of expectations or minimum standards to secure ongoing employment would dramatically shift the research culture towards innovation that comes with job security. Finally, in a post-COVID-19 world, with new and re-imagined workplace practices and a greater understanding of career opportunities and disruptions, researchers who want to work part-time should be treated equitably with regard to expectations on output and workload compared with those in equivalent full-time positions.
Improve assessment of career opportunity
Australia’s major medical research funding body, the National Health and Medical Research Council (NHMRC), introduced the policy ‘relative to opportunity’ in recognition of the fact that over a given period of time, researchers might not have equitable opportunities to advance their career. This term is used to acknowledge that career breaks, carer responsibilities, stage of career, time dedicated to research and access to resources can all have an effect on scientific track record and productivity. Therefore, consideration of a researcher’s achievements relative to opportunity should take into account the differences in career progression and opportunity owing to differences in life circumstances. However, no formal infrastructure exists to guide peer-reviewers in the assessment of achievements that are relative to opportunity within funding applications. The solutions below describe how such a relative-to-opportunity policy could be fairly implemented and assessed, offering valuable guidance for other countries.
Peer-reviewers, promotion panels and institution leaders involved in the grant review process should receive training on how to assess the effect of relative opportunity and other factors contributing to scientific track record; this training needs to be developed, implemented and legislated. Just as a Good Clinical Practice certification is required to conduct clinical research, or a higher degree in research supervision training is required before being able to oversee doctoral students, grant reviewer training or certification should become compulsory for peer-reviewers involved in the assessment of funding applications and for all institutional leaders. National and international research organizations should provide leadership to develop and implement consistent cross-sector training and certification programmes, providing one course that is relevant to all funding bodies in the country.
Relative-to-opportunity considerations should involve a formalized, documented and standardized process during the application for grants, employment, promotion or leadership opportunities that are offered by research institutions and funding agencies. For applicants, this process could include mention of career disruptions and other factors affecting relative opportunity. At the peer-review stage, a standardized protocol should be developed to acknowledge that relative-to-opportunity considerations have been examined and considered for each applicant.
Relative-to-opportunity considerations can be quantified by quartiles or tertiles on the basis of full-time-equivalent research time, with peer-review scores weighted accordingly. The allocation of additional funding to support near-miss funding applications from researchers who have experienced substantial career disruption and relative-to-opportunity barriers might also address existing inequalities in funding distribution.
EMCR leadership opportunities
Leadership in the research sector can be formal (such as on committees and boards or in institutional leadership positions) or less formal (as in grant and manuscript preparation in team and group roles). In this section, we describe how current cardiovascular research leaders can create opportunities for future leaders.
Access to opportunities for leadership roles are often reliant on supportive senior researchers and personal factors such as confidence, skills and capacity. However, many EMCRs struggle during the transition to a lead investigator role50. Measurable performance expectations need to be established to enable senior leaders to provide opportunities for the next generation of cardiovascular research leaders, such as co-supervision of students and a co-leadership role in preparing research grants or papers, with proper acknowledgement of the contribution by the EMCR (such as co-senior or co-corresponding authorship). These achievements have only a marginal value for the track record of senior leaders, but have an enormous effect on the career development of EMCRs.
Given the fiscal pressures on research funding, grants should be scaled to ensure EMCRs are encouraged and supported to be named as principal investigators or co-principal investigators in research projects. Indeed, funding agencies need policies that specify mandatory inclusion of EMCRs in grants.
Any instances of senior research leaders promoting EMCRs to research leadership positions, primarily through research funding opportunities, should be formally acknowledged through prestigious awards for research mentoring, such as those from the ISH51. Moreover, we propose that mentorship of more junior staff, particularly EMCRs, should be included as key performance indicators in annual and promotion reviews of senior cardiovascular researchers.
Diversify funding evaluation
Many high-income countries such as France52, Germany53 and the USA54 have announced boosts to their research budget in the next 5–10 years. However, research funding continues to be limited in most regions of the world, particularly for the cardiovascular sector6,7,8, and remains a major reason why cardiovascular researchers leave the sector5. Therefore, ensuring fair distribution of funding is crucial for retention of expertise.
To minimize the effect of unconscious bias and ensure alignment with funding priorities, peer-review panels need to be gender-balanced and include patients and carers, and industry-based experts, as well as researchers from different disciplines and ethnicities, career stage and backgrounds (including those from under-represented groups, such as indigenous persons, and culturally and linguistically diverse individuals). In addition, where possible, applications should be de-identified to reduce bias.
Ideas-based funding, whereby the applicant’s track record is peer-reviewed only to assess feasibility and not to rank applications, might help to overcome some of the biases experienced by women and individuals from other under-represented groups. Moreover, the outcomes of these funding schemes should be carefully reviewed to ensure they result in knowledge gain and are indeed distributed equitably. The NHMRC in Australia found that although the percentages of men and women awarded ideas-based funding in 2019–2021 were similar, female principal investigators received a total of Australian $44 million less per year than male counterparts55. Data on other under-represented groups or specific to the cardiovascular field are not available. With success rates in funding schemes as low as 5–15% in many instances (for the years 2019–2021), careful review of the value proposition to researchers of applying for several grants throughout the year needs to be considered. Streamlining the grant process and consolidating funding requirements across different funding schemes will improve efficiency. For example, shorter preliminary applications that are peer-reviewed, in which only a proportion (30–50%) of candidates are invited to submit a full application, might also improve efficiency. Furthermore, by staggering funding rounds throughout the year and restricting eligibility to those who have not already received funding in that year will result in more equitable distribution of research funding (Box 2).
Although national research priorities are often mentioned in calls for research funding applications, to what extent funding is awarded on the basis of alignment with research priorities, disease burden, contribution to health outcomes or delivery of care is unclear. For example, a 2021 international analysis of support for nursing and allied health research indicates that in the UK, nurses, midwives and allied health professionals account for more than two-thirds of the health-care workforce, yet only 1%, <1% and 4% of trainees from these professions, respectively, are supported by the National Institute of Health Research56. Similarly, in Australia, only 0.4% of NHMRC fellowships in 2020 were awarded to midwifery, 3% to nursing and 7% to allied health departments, despite these professions representing 80% of the registered health practitioner workforce56. Lottery-style funding programmes, especially for ideas-based grants, might be appropriate in settings with limited research funding to target applications that are deemed by peer-review to be worthy of funding, despite failure to secure funding. This approach has been adopted by the Health Research Council of New Zealand57. Although perhaps a controversial idea, if all research proposals and their feasibility are peer-reviewed and deemed fundable or not fundable, all those deemed fundable should have an equal chance of being funded, irrespective of other factors that might bias the ranking of funding applications. After a trial period, the outcomes of these funding schemes should be assessed to determine whether they deliver value, lead to knowledge gain and are distributed equitably.
Roadmap for diversity and equity
Equity is the acknowledgement that individuals with diverse circumstances require specific resources and opportunities to reach an equal outcome58. Growing evidence indicates that more diverse and equitable workplaces will achieve greater innovation, discovery and benefit3,59. Notably, historically excluded and marginalized groups continue to be under-represented and under-supported in cardiovascular research. Despite calls for change, the research sector still lacks leadership, policies and strategies to provide equitable access to opportunities. Cardiology is a male-dominated profession, and cardiovascular research, like many areas of academia, has disproportionately fewer women and individuals in ethnic minority groups in training fellowships, clinical roles and leadership positions60,61,62,63. Women are also under-represented in leadership roles, such as membership in cardiovascular guideline-writing committees64 and cardiovascular clinical trial leadership committees65. Therefore, solutions to meaningfully tackle and reduce inequity and improve diversity are urgently needed. Some national programmes have been specifically designed to address this issue (Box 3), but the benefits imparted by these programmes remain to be seen. In this section, we present possible strategies and solutions to support diversity, equity and inclusivity in the cardiovascular research sector (Table 2).
Support primary caregivers
Primary caregivers, both male and female, should be supported to maintain research engagement during parental and carer’s leave, upon return to work and for the long-term. Workplace policies should consider whether the timing of meetings and conferences is suitable for parents and carers and should optimally provide targeted support for parents and carers, such as financial support for childcare or an option of virtual meeting attendance. Practical support is required to allow the continuation of work during periods of leave, such as funds to employ a research assistant17,66. Parental leave, in particular, is a crucial period of high researcher attrition, with a survey of researchers in the USA revealing that 43% of new mothers and 23% of new fathers who were employed full-time before having children either did not return to academia or returned part-time after having children67.
To support the transition of parents and carers back to the workforce, flexibility is required in the duration of the secured grant funding period to allow for the time absent from research, as well as in allowing researchers to work part-time. Workplaces that provide such flexibility are more likely to retain employees with caregiving responsibilities68.
To shift the status quo, greater incentives are required to encourage more equitable sharing of parental leave, such as gender-neutral leave policies that encourage leave arrangements to be split between carers. Importantly, creating policies that increase opportunities for both men and women to combine paid employment with unpaid caring responsibilities can help to recalibrate gender roles69. Organizations that provide strong parental leave schemes have greater recruitment and retention of staff70. Sweden has been a long-standing leader in such progressive parental leave policies71. Further to these changes, an acknowledgement of the effect of carer responsibilities on career disruptions during grant funding reviews is also important.
Increasing the visibility of women and celebrating their research accomplishments are key in demonstrating to female EMCRs the possibility of a successful career as a female cardiovascular researcher. The Organization for Women in Science for the Developing World aims to increase the participation, opportunities for collaboration and leadership skills of women from LMICs72. Furthermore, the Future Professors Programme in South Africa focuses on supporting Black and female researchers to achieve professorial level by providing mentorship and skills training and fostering collaborative efforts73. Women-focused and structured mentoring programmes, such as those led by Franklin Women in Australia74, have been shown to improve the participants’ knowledge, skills and research metrics required for promotion. The framework of such initiatives could be implemented by cardiovascular research societies globally.
Grant and publication review processes need to be re-evaluated to minimize unconscious reviewer bias, such as by removing identifiable information from the applicants and authors (such as gender and region of origin) and through the use of gender-neutral language17. To extend this goal further, grant committees should aim to fund male-led and female-led projects equally and ensure that gender-specific data on grant success are collected and reported publicly. The South African government has developed projects, such as the Black Academics Advancement Programme75, to prioritize women and other under-represented groups in funding applications, resulting in the greater success of female-led initiatives across all career stages.
To unpick long-standing gender biases, group coaching and reverse mentoring (that is, when a female EMCR mentors a senior leader on the issues that EMCRs face)76 are required to increase awareness of gender bias. Moreover, a study has shown that female faculty dedicate more time to service (such as service to the university, campus, or local and international communities) than male faculty77. Therefore, strategies should be in place to ensure service and social roles are distributed evenly across genders.
Support under-represented groups
In response to continued issues of racism in society, many institutions have mandated diversity and bias awareness training for all staff and students. Importantly, these training modules should not be undertaken as a one-off exercise, because evidence suggests that such modules result in limited behaviour change78. Therefore, training should be carefully designed and, if possible, undertaken at regular intervals, with outcomes assessed79. Scientific societies could also increase visibility of under-represented researchers, such as the Black in Cardio campaign, which celebrates exceptional Black cardiovascular researchers80, and Black in Physiology, which is associated with the American Physiological Society.
To address barriers to career progression and workplace participation for researchers from under-represented groups, grant schemes that fund discretionary items such as parental or carer support, visa fees or conference registration should be considered. Financial barriers associated with opportunities that are advantageous for career progression are often a limiting factor for those from low socioeconomic backgrounds and single-income households, as well as those with carer’s responsibilities.
Research produced by more ethnically diverse teams has been shown to have increased value compared with that from less ethnically diverse teams59. Given the globally connected nature of research, national funding bodies should consider funding schemes to attract and retain international talent. In Australia, most nationally competitive funding schemes will fund permanent residents or citizens, but not individuals on temporary work visas17. In addition, strategic partnerships with international institutions need to be carefully considered and developed to build capacity between and within high-income and low-income countries. Lastly, individuals with disabilities should be provided with a safe and accessible workplace.
We acknowledge that several of the issues highlighted in this Roadmap article are not exclusive to the cardiovascular research sector. However, considering the reduced funding investment into cardiovascular research globally, these issues might be of increased relevance in this sector. The solutions proposed in this Roadmap article were identified by cardiovascular researchers from diverse backgrounds. Of note, however, these solutions originated in Australia and might not necessarily reflect the needs and views of cardiovascular researchers in LMICs and in some under-represented groups. To broaden the relevance of the solutions that we have proposed, we engaged with eight cardiovascular researchers who are a part of institutions in nine countries (see Acknowledgements). The researchers from high-income countries (Canada, Italy, New Zealand, the UK and the USA) agreed that our proposed roadmap accurately presents the major issues faced by EMCRs in their regions. Overall, those from LMICs (Brazil, India and South Africa) commented that although cardiovascular researchers from LMICs would benefit from the solutions proposed, these researchers also face other major issues specific to the region. In particular, they mention that inadequate research funding in their region limits conference participation and research publication and therefore does not support a sustainable research culture81. This issue might be addressed by increased international investment into local infrastructure and resources (such as local biobanks) and more international collaborations. Strategic and immediate solutions to support the inclusion of cardiovascular researchers from LMICs include free membership to professional societies, waived fees for online conferences and publications, training grants for doctoral and postdoctoral researchers, local mentoring programmes, and inclusion on editorial boards of journals and committees of professional societies. Given that LMICs are disproportionately affected by CVD2, inclusion of researchers from these regions in global research is key to reducing the global burden of CVD.
A diverse and collaborative cardiovascular research workforce is crucial to finding solutions to reduce the global burden of CVD. However, the current culture of cardiovascular research is not supportive of diversity and collaboration and often inhibits the career progression of EMCRs. These factors, together with the global downward trend in available funding for cardiovascular research, are driving researchers out of the sector. Immediate action needs to be taken to prevent the loss of an entire generation of cardiovascular researchers, particularly those from under-represented groups. The effect of this loss on the burden of CVD in the future will be substantial, after well-established research leaders retire without a strong and secure pipeline of EMCRs and succession planning. The proposed roadmap of changes in this article could improve the cardiovascular research culture and support EMCR career progression, allowing the cardiovascular research sector to thrive and, in turn, to reduce the burden of CVD globally.
Roth, G. A. et al. Global burden of cardiovascular diseases and risk factors, 1990–2019: update From the GBD 2019 Study. J. Am. Coll. Cardiol. 76, 2982–3021 (2020).
Hewlett, S. A., Marshall, M. & Sherbin, L. How diversity can drive innovation. Harvard Business Review https://hbr.org/2013/12/how-diversity-can-drive-innovation? (2013).
Schnabel, R. B. & Benjamin, E. J. Diversity 4.0 in the cardiovascular health-care workforce. Nat. Rev. Cardiol. 17, 751–753 (2020).
Capers, Q. T., Johnson, A., Berlacher, K. & Douglas, P. S. The urgent and ongoing need for diversity, inclusion, and equity in the cardiology workforce in the United States. J. Am. Heart Assoc. 10, e018893 (2021).
Climie, R. E. et al. Lack of strategic funding and long-term job security threaten to have profound effects on cardiovascular researcher retention in Australia. Heart Lung Circ. 29, 1588–1595 (2020).
Garcia-Dorado, D. Insufficient cardiovascular research & development funding. Eur. Heart J. 38, 10–11 (2017).
Nicholls, M. Funding of cardiovascular research in the USA: Robert Califf and Peter Libby – speak about cardiovascular research funding in the United States and what the latest trends are with Mark Nicholls. Eur. Heart J. 39, 3629–3631 (2018).
Nicholls, M. Funding cardiovascular research in Europe. Eur. Heart J. 40, 80–82 (2019).
Fye, W. B. Cardiology’s workforce shortage: implications for patient care and research. Circulation 109, 813–816 (2004).
Narang, A. et al. The supply and demand of the cardiovascular workforce: striking the right balance. J. Am. Coll. Cardiol. 68, 1680–1689 (2016).
Milojevic, S., Radicchi, F. & Walsh, J. P. Changing demographics of scientific careers: the rise of the temporary workforce. Proc. Natl Acad. Sci. USA 115, 12616–12623 (2018).
Wellcome Trust. What researchers think about the culture they work in (Wellcome, 2020).
Muric, G., Lerman, K. & Ferrara, E. Gender disparity in the authorship of biomedical research publications during the COVID-19 pandemic: retrospective observational study. J. Med. Internet Res. 23, e2537 (2021).
Staniscuaski, F. et al. Gender, race and parenthood impact academic productivity during the COVID-19 pandemic: from survey to action. Front. Psychol. 12, 663252 (2021).
Cook, I. Who is driving the great resignation? Harvard Business Review https://hbr.org/2021/09/who-is-driving-the-great-resignation (2021).
Malekzadeh, A., Michels, K., Wolfman, C., Anand, N. & Sturke, R. Strengthening research capacity in LMICs to address the global NCD burden. Glob. Health Action. 13, 1846904 (2020).
Thomas, E. E. et al. Strategies to support early- and mid-career cardiovascular researchers to thrive. Preprint at medRxiv https://doi.org/10.1101/2022.02.06.22270563 (2022).
Bloomfield, G. S. et al. Training and capacity building in LMIC for research in heart and lung diseases: the NHLBI–UnitedHealth Global Health Centers of Excellence program. Glob. Heart 11, 17–25 (2016).
American Heart Association. Council hypertension trainee advocacy resources. Professional Heart Daily https://professional.heart.org/en/partners/scientific-councils/hypertension/trainee-advocacy-resources (2022).
National Heart, Lung, and Blood Institute. Global cardiovascular research funders forum. NHLBI https://www.nhlbi.nih.gov/funding/global-cardiovascular-research (2021).
National Institutes of Health. Early stage investigator policies. Grants and Funding https://grants.nih.gov/policy/early-stage/index.htm (2019).
Fitzsimons, D. Patient engagement at the heart of all European Society of Cardiology activities. Cardiovasc. Res. 115, e99–e101 (2019).
Vandigo, J. et al. Continuous patient engagement in cardiovascular disease clinical comparative effectiveness research. Expert Rev. Pharmacoecon. Outcomes Res. 16, 193–198 (2016).
Shilton, T., Champagne, B., Blanchard, C., Ibarra, L. & Kasesmup, V. Towards a global framework for capacity building for non-communicable disease advocacy in low- and middle-income countries. Glob. Health Promot. 20, 6–19 (2013).
Fordyce, C. B. et al. Cardiovascular drug development: is it dead or just hibernating? J. Am. Coll. Cardiol. 65, 1567–1582 (2015).
Schwartz, D. University-industry collaborations aspire to pharmaceutical innovation. Tech Transfer Central https://techtransfercentral.com/staged.techtransfercentral.com/2017/02/21/university-industry-collaborations-aspire-to-pharmaceutical-innovation/ (2017).
Novo Nordisk Global. Novo Nordisk Research Centre Oxford (NNRCO). Novo Nordisk https://www.novonordisk.com/science-and-technology/research-and-technology-centres/oxford-research-centre.html (2022).
AstraZeneca. AstraZeneca in Cambridge. AstraZeneca https://www.astrazeneca.com/our-company/our-locations/cambridge.html (2021).
Venkatasubramanian, K. V. India promotes industry-academia R&D collaborations. CEN Glob. Enterp. 95, 15 (2017).
Noormahomed, E. et al. The evolution of mentorship capacity development in low- and middle-income countries: case studies from Peru, Kenya, India, and Mozambique. Am. J. Trop. Med. Hyg. 100, 29–35 (2019).
Gandhi, M. et al. Mentoring the mentors: implementation and evaluation of four Fogarty-sponsored mentoring training workshops in low-and middle-income countries. Am. J. Trop. Med. Hyg. 100, 20–28 (2019).
Sharma, G., Narula, N., Ansari-Ramandi, M. M. & Mouyis, K. The importance of mentorship and sponsorship: tips for fellows-in-training and early career cardiologists. JACC Case Rep. 1, 232–234 (2019).
Ayyala, M. S. et al. Mentorship is not enough: exploring sponsorship and its role in career advancement in academic medicine. Acad. Med. 94, 94–100 (2019).
Patton, E. W. et al. Differences in mentor-mentee sponsorship in male vs female recipients of National Institutes of Health grants. JAMA Intern. Med. 177, 580–582 (2017).
American Heart Association. Mentoring for professionals. Prefessional Heart Daily https://professional.heart.org/en/partners/mentoring-for-professionals (2022).
International Society of Hypertension. Mentorship. ISH https://ish-world.com/mentorship/ (2021).
Figtree, G., Doyle, K., Hsu, M. P. & Freedman, B. The Australian Cardiovascular Alliance (ACvA). Eur. Heart J. 42, 8–10 (2021).
Cole, D. C. et al. Mentoring health researchers globally: diverse experiences, programmes, challenges and responses. Glob. Public Health 11, 1093–1108 (2016).
Chi, B. H. et al. Evaluating academic mentorship programs in low- and middle-income country institutions: proposed framework and metrics. Am. J. Trop. Med. Hyg. 100, 36–41 (2019).
Van Noorden, R. Some hard numbers on science’s leadership problems. Nature 557, 294–296 (2018).
Nabel, E. G., Stevens, S. & Smith, R. Combating chronic disease in developing countries. Lancet 373, 2004–2006 (2009).
UnitedHealth Group/National Heart, Lung, and Blood Institute Centres of Excellence. A global research network for non-communicable diseases. Lancet 383, 1446–1447 (2014).
World Heart Federation. Emerging leaders programme. WHF https://world-heart-federation.org/emerging-leaders/ (2021).
Geerts, J. M., Goodall, A. H. & Agius, S. Evidence-based leadership development for physicians: a systematic literature review. Soc. Sci. Med. 246, 112709 (2020).
Collins, F. New NIH approach to grant funding aimed at optimizing stewardship of taxpayer dollars. NIH https://www.nih.gov/about-nih/who-we-are/nih-director/statements/new-nih-approach-grant-funding-aimed-optimizing-stewardship-taxpayer-dollars (2017).
Levitt, M. & Levitt, J. M. Future of fundamental discovery in US biomedical research. Proc. Natl Acad. Sci. USA 114, 6498–6503 (2017).
Deloitte Access Economics. Australia’s health and medical research workforce: expert people providing exceptional returns (Deloitte, 2016).
de Oliveira, C. et al. Estimating the payoffs from cardiovascular disease research in Canada: an economic analysis. CMAJ Open 1, E83–E90 (2013).
Richards, G. C. et al. Challenges facing early-career and mid-career researchers: potential solutions to safeguard the future of evidence-based medicine. BMJ Evid. Based Med. 26, 8–11 (2021).
Woolston, C. Work environment: when labs go bad. Nature 525, 413–415 (2015).
Kruger, R. et al. Highlights from the International Society of Hypertension’s New Investigators Network during 2019. J. Hypertens. 38, 968–973 (2020).
Casassus, B. Scientists disappointed by plan to boost France’s research prowess. Nature https://www.nature.com/articles/d41586-020-02217-4 (2020).
Boytchev, H. How Germany retains one of the world’s strongest research reputations. Nature 587, S104–S105 (2020).
Remmel, A. Massive science-funding bill passes US Senate – but China focus worries researchers. Nature 594, 485 (2021).
National Health and Medical Research Council. Outcomes of funding rounds. NHMRC https://www.nhmrc.gov.au/funding/data-research/outcomes (2021).
Ferguson, C., Henshall, C. & Albert, N. M. Global perspectives on under-funding for clinical research training fellowships in nursing. J. Clin. Nurs. 30, e48–e50 (2021).
Adam, D. Science funders gamble on grant lotteries. Nature 594, 485 (2019).
Tan, T. Q. Principles of inclusion, diversity, access, and equity. J. Infect. Dis. 220, S30–S32 (2019).
AlShebli, B. K., Rahwan, T. & Woon, W. L. The preeminence of ethnic diversity in scientific collaboration. Nat. Commun. 9, 5163 (2018).
Jaijee, S. K., Kamau-Mitchell, C., Mikhail, G. W. & Hendry, C. Sexism experienced by consultant cardiologists in the United Kingdom. Heart 107, 895–901 (2021).
Mehran, R. Women’s voices in cardiology: an uncomfortable silence. JAMA Cardiol. 3, 676–677 (2018).
Curtis, A. B. & Rodriguez, F. Choosing a career in cardiology: where are the women? JAMA Cardiol. 3, 691–692 (2018).
Rymer, J. A. et al. Evaluation of women and underrepresented racial and ethnic group representation in a general cardiology fellowship after a systematic recruitment initiative. JAMA Netw. Open 4, e2030832 (2021).
Rai, D. et al. National trends of sex disparity in the American College of Cardiology/American Heart Association Guideline Writing Committee authors over 15 years. Circ. Cardiovasc. Qual. Outcomes 14, e007578 (2021).
Denby, K. J. et al. Representation of women in cardiovascular clinical trial leadership. JAMA Intern. Med. 180, 1382–1383 (2020).
Magliano, D. J., Macefield, V. G., Ellis, T. M. & Calkin, A. C. Addressing gender equity in senior leadership roles in translational science. ACS Pharmacol. Transl. Sci. 3, 773–779 (2020).
Cech, E. A. & Blair-Loy, M. The changing career trajectories of new parents in STEM. Proc. Natl Acad. Sci. USA 116, 4182–4187 (2019).
Pavalko, E. K. & Henderson, K. A. Combining care work and paid work: do workplace policies make a difference? Res. Aging 28, 359–374 (2006).
King, T. et al. Reordering gender systems: can COVID-19 lead to improved gender equality and health? Lancet 396, 80–81 (2020).
Workplace Gender Equality Agency. Designing and supporting gender equitable parental leave (WGEA, 2019).
Hagqvist, E., Nordenmark, M., Pérez, G., Trujillo Alemán, S. & Gillander Gådin, K. Parental leave policies and time use for mothers and fathers: a case study of Spain and Sweden. Soc. Health Vulnerability 8, 1374103 (2017).
Organization for Women in Science for the Developing World. The OWSD–Elsevier Foundation awards for early career women scientists in the developing world. OWSD https://owsd.net/awards/awards (2021).
Department of Higher Education and Training. Future professors programme 01. FPP https://futureprofessorsprogramme.co.za/programme/ (2021).
Vassallo, A., Walker, K., Georgousakis, M. & Joshi, R. Do mentoring programmes influence women’s careers in the health and medical research sector? A mixed-methods evaluation of Australia’s Franklin Women Mentoring Programme. BMJ Open 11, e052560 (2021).
Human and Infrastructure Capacity Development. Black Academics Advancement Programme (BAAP) framework (HICD, 2021).
Clarke, A. J., Burgess, A., van Diggele, C. & Mellis, C. The role of reverse mentoring in medical education: current insights. Adv. Med. Educ. Pract. 10, 693–701 (2019).
Guarino, C. M. & Borden, V. M. H. Faculty service loads and gender: are women taking care of the academic family? Res. High. Educ. 58, 672–694 (2017).
Chang, E. H. et al. The mixed effects of online diversity training. Proc. Natl Acad. Sci. USA 116, 7778–7783 (2019).
Carnes, M. et al. The effect of an intervention to break the gender bias habit for faculty at one institution: a cluster randomized, controlled trial. Acad. Med. 90, 221–230 (2015).
Saccoh, A., Tcheandjieu, C., Mukaz, D. K. & Amartey, J. #BlackInCardioWeek: How it started, what happened, and what is to come. BMC https://blogs.biomedcentral.com/on-medicine/2020/11/11/blackincardioweek-how-it-started-what-happened-and-what-is-to-come/ (2020).
Matsui, J. T. “Outsiders at the Table”–diversity lessons from the Biology Scholars Program at the University of California, Berkeley. CBE Life Sci. Educ. 17, es11 (2018).
Gill, G. K., McNally, M. J. & Berman, V. Effective diversity, equity, and inclusion practices. Healthc. Manag. Forum 31, 196–199 (2018).
Olzmann, J. A. Diversity through equity and inclusion: the responsibility belongs to all of us. Mol. Biol. Cell 31, 2757–2760 (2020).
Green, B. N. & Johnson, C. D. Interprofessional collaboration in research, education, and clinical practice: working together for a better future. J. Chiropr. Educ. 29, 1–10 (2015).
Williams, J., Craig, T. J. & Robson, D. Barriers and facilitators of clinician and researcher collaborations: a qualitative study. BMC Health Serv. Res. 20, 1126 (2020).
NSW Ministry of Health. Cardiovascular Research Capacity Program. NSW Gov https://www.medicalresearch.nsw.gov.au/cardiovascular/ (2021).
Advance HE. Athena Swan Charter members. Advance HE https://www.advance-he.ac.uk/equality-charters/athena-swan-charter/members (2020).
Advance HE. The transformed UK Athena Swan Charter. Advance HE https://www.advance-he.ac.uk/equality-charters/transformed-uk-athena-swan-charter#report (2020).
Science in Australia Gender Equity. SAGE accreditation and awards. SAGE https://sciencegenderequity.org.au/sage-accreditation-and-awards/ (2021).
Science in Australia Gender Equity. Australian HER institutions stick with gender equity and diversity journey despite COVID-19 impact. SAGE https://www.sciencegenderequity.org.au/australian-her-institutions-stick-with-gender-equity-and-diversity-journey-despite-covid-19-impact/ (2020).
American Association for the Advancement of Science. What is SEA Change? AAAS https://seachange.aaas.org/about/what-is-sea-change (2021).
Natural Sciences and Engineering Research Council. Equity, diversity and inclusion: Dimensions charter. NSERC https://www.nserc-crsng.gc.ca/InterAgency-Interorganismes/EDI-EDI/Dimensions-Charter_Dimensions-Charte_eng.asp (2019).
The authors thank the Australian Cardiovascular Alliance (ACvA) Board for their support and acknowledge that the authors were members of the ACvA Emerging Leaders Committee at the time this paper was written. The authors acknowledge the supporting roles of the ACvA President G. Figtree, ACvA Chief Executive Officer K. Doyle and ACvA Project Officer M.-P. Hsu in the facilitation of this initiative. Finally, the authors acknowledge the following international cardiovascular researchers for their honest and generous feedback: M. Bertagnolli (McGill University, Canada), E. Bianchini (Institute of Clinical Physiology, Italy), D. Casarini (Federal University of São Paulo, Brazil), L. Gafane-Matamane (North-West University, South Africa), A. Kirabo (Vanderbilt University, USA), C. McCarthy (University of South Carolina, USA), A. Montezano (University of Glasgow, UK) and M. Patel (India Association for Parenteral and Enteral Nutrition Association, India). E.T. (105215), S.C.I. (102821), R.E.C. (102484), D.S.P. (104774), L.B. (102498), S.G.W. (105622), A.C.C. (105631) and F.Z.M. (101185, 105663) are funded by fellowships from the National Heart Foundation of Australia. The National Health and Medical Research Council of Australia supports K.M.M.C. through a C.J. Martin Fellowship (1112125) and L.B. through an Emerging Leader Investigator Grant (1172987). F.Z.M. is also supported by a Senior Medical Research Fellowship from the Sylvia and Charles Viertel Charitable Foundation.
The authors declare no competing interests.
Nature Reviews Cardiology thanks Barbara Casadei, who co-reviewed with Rohan Wijesurendra, and the other, anonymous, reviewer(s) for their contribution to the peer review of this work.
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Athena Scientific Women’s Academic Network Charter: https://www.advance-he.ac.uk/equality-charters/athena-swan-charter
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Chapman, N., Thomas, E.E., Tan, J.T.M. et al. A roadmap of strategies to support cardiovascular researchers: from policy to practice. Nat Rev Cardiol (2022). https://doi.org/10.1038/s41569-022-00700-1