MOUNT SINAI JOURNAL OF MEDICINE 76:387–391, 2009 387

INSPIRE: The Individual Scholarly Projectand Independent Research Experience in

Undergraduate Medical EducationKaren Zier, PhD, and Lisa D. Coplit, MD

Department of Medical Education, Mount Sinai School of Medicine, New York, NY

ABSTRACT

Individualized learning is a fundamental tenet ofthe Carnegie Foundation’s new recommendations forphysician training. A primary goal of Mount SinaiSchool of Medicine’s new curriculum is to trainself-directed physicians who have mastered lifelonglearning skills. The Individual Scholarly Projectand Independent Research Experience (INSPIRE)was created to enable fourth-year students toconduct mentored, independent scholarly projectsto develop critical thinking skills and intellectualindependence. Four students were accepted intothe 2008 12-week pilot. Two did clinical research,1 conducted medical education research, and 1continued a basic science project. INSPIRE featuredweekly sessions in which students shared theirprogress, heard about the careers of physician-scientists, and participated in presentation skillsworkshops. Mentors gave feedback using a formbased on the program goals. Anonymous evaluationsshowed that all participants believed their goalswere successfully fulfilled, that the likelihood ofincluding research in their careers increased, andthat they felt more skilled at writing abstracts andpresenting their work orally. Students agreed thatINSPIRE was a valuable opportunity for acquiring in-depth knowledge on a topic and building researchand presentation skills. Helping students shape anindividualized scholarly experience may help toproduce doctors who are self-directed, are personallyfulfilled, are able to serve society with diverseexpertise, and have the tools to become leaders

Address Correspondence to:

Karen Zier, PhDDepartment of Medical

Education, Mount Sinai Schoolof Medicine New York, NYEmail: karen.zier@mssm.edu

in their fields. Mt Sinai J Med 76:387–391,2009. 2009 Mount Sinai School of Medicine

Key Words: individualized learning, independentresearch, INSPIRE, undergraduate medical education.

Individualized learning, integration of knowledge,identity formation, and the pursuit of excellence,including advancing the field of medicine throughscholarship, are key to the Carnegie Foundation’snew recommendations for physician training.1 Con-sistent with these goals, the Association of AmericanMedical Colleges’ Task Force II on Clinical Researchhas called for medical schools to educate students inthe basic principles of clinical-translational research,develop their ability to critique published studies,and enable them to participate actively in studies thatwould nurture their interest in clinical research.2 Suc-cessful fulfillment of these goals would help studentsto sharpen their critical thinking skills and expresstheir individual creativity and might encourage stu-dents to pursue careers as physician-scholars.

Many leading medical schools devote curriculartime to required or elective scholarly experiences,although the time available varies greatly. Mostof these schools require that students completesome coursework and that they produce a scholarlyproject, such as a written thesis, poster, or oral talkbased on their projects. Schools including Yale, theUniversity of Pittsburgh, Stanford, and Duke areamong those that require students to conduct ascholarly project.3–6 In contrast, the University ofCalifornia San Francisco, Brown, and the University ofPennsylvania offer students the choice of an electivescholarly program.7–9 At each of the schools, studentscan complete their projects within 4 years of school,although many elect to devote an entire year to theirprojects in order to be able to perform a more in-depth study, thus adding a year to their medicaleducation.

Published online in Wiley InterScience (www.interscience.wiley.com).DOI:10.1002/msj.20121

2009 Mount Sinai School of Medicine

388 K. ZIER AND L. D. COPLIT: INTRODUCING INSPIRE

MEDICAL STUDENT RESEARCH ATMOUNT SINAI

Medical students at Mount Sinai have long demon-strated interest in scholarship.10 Participation in theSummer Research Scholars Program, which supportsclinical, translational, basic, outcome, community-based, and global health projects, has ranged from56 for the class of 2004 to 100 for the class of2011. In addition, the number of students choosingto do a scholarly year, a year-long pullout pro-gram most often supported by foundations includingthe Howard Hughes Medical Institute and the DorisDuke Charitable Foundation or the National Insti-tutes of Health, has increased from 5 in 1997 to 30 in2008. Students are encouraged to present the resultsof their scholarship at the annual Medical StudentResearch Day, and participation is very strong, withthe number of student participants ranging from 19in 1997 to 115 in 2008. In the Mount Sinai School ofMedicine (MSSM) 2007 graduation survey, of the 80%of respondents who participated in research duringmedical school, 67% recommended that students pur-sue research during medical school. Fifty-two percentreported a positive impact of their research on theircareer, and 86% reported that their research experi-ence had enhanced their understanding of the role ofresearch in patient management. These data suggestthat students value their research experiences andthat they affect their clinical careers.

PLANNING THE INDIVIDUALSCHOLARLY PROJECT ANDINDEPENDENT RESEARCH

EXPERIENCE (INSPIRE)

MSSM is currently undergoing an exciting curriculumreform with the goal of producing physicians who arecapable of promoting change as advocates, clinicians,and scientists (Table 1). As one of the first effortstoward achieving these goals, the core curriculumplanning group decided to introduce a substantialscholarly component into the undergraduate medicalcurriculum: INSPIRE.

INSPIRE was designed to provide students withprotected time to conduct a strongly mentored projectthat would further develop critical thinking skills,inspire creativity, and promote intellectual indepen-dence. It was less important what type of scholarshipstudents pursued and more important that theylearn the value of scholarship within the study ofmedicine. In fact, students would be encouraged to

Table 1. Goals of the New Mount Sinai School ofMedicine Curriculum.

• Integration across scientific disciplines• Integration between basic science and clinical

medicine• Longitudinal clinical experiences as a focus of clinical

training• An experience that is broader and deeper than

traditional models of medical education• An educational paradigm that promotes self-directed

and lifelong learning

be true to their interests and creative in their projectchoices. In 2007, as the first step in planning, adevelopment committee composed of experts in thevarious fields in which students might pursue theirscholarly work was convened. Committee membersrepresented clinical/translational research, advocacyand community service, community medicine/healthpolicy, medical humanities, global health, and medi-cal education. The committee also included studentsfrom the second- and fourth-year classes who pro-vided insight into what students would like to havein a scholarly program or would have liked to havehad in a scholarly program, respectively. The goals ofINSPIRE were structured to contribute to the missionto provide individualized scholarly immersion experi-ences for medical students within a 4-year curriculum;to provide unique options for in-depth study, includ-ing nontraditional scholarly experiences that wouldenrich students’ future practice of medicine; and toattract students to MSSM who are self-directed andinterested in a school that offers students a chance tohave a scholarly experience. With these basics, thisgroup took on the charge of conceptualizing INSPIREfrom a broader perspective without considering theboundaries of the current curriculum.

THE INSPIRE PILOT

Initially, an almost year-long experience was envi-sioned. However, freeing such a large period oftime for individualized study will depend on com-pleting the curriculum reform. Thus, the committeeplanned a pilot program that could be inserted intothe existing curriculum while maintaining the goalsof INSPIRE. The INSPIRE pilot was created as a12-week curriculum (September to December 2008)during year 4 that included a mentored scholarlyproject and a didactic curriculum (Table 2)

Although it was anticipated that projects wouldconcentrate in areas of institutional strength, rigorousscholarship outside traditional research areas was

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Table 2. INSPIRE Didactic Curriculum.

• Introductory Meeting of Participants and Discussionof Projects

• Preparing Your Talk and Written Proposal• How to Give a Talk• Updates (brief, informal presentations on progress

and problems)• Writing an Abstract that Delivers Your Message• Presentation Skills Workshop– Part 1• Presentation Skills Workshop– Part 2• Updates• Preparing a Successful Poster• Mount Sinai Medical Student Research Day• Dress Rehearsal for INSPIRE Research Day

(videotaped)• Presentation Skills Workshop– Part 3 (debriefing of

videotapes)• INSPIRE Research Day

encouraged. Students could choose to do an in-depth study in their chosen specialty or to explorea related area that they believed would enrich theirpractice of medicine. A call for applications wassent to the third-year class, and an informationsession was held at a class meeting. The formalapplication required a project proposal, which wasprepared with the student’s mentor, and a mentor’sletter of support. Students were able to applywith carefully planned new projects or to continueprojects begun earlier in their training. Only studentswith no academic difficulties were eligible for thepilot.

From extensive experience in creating medicalstudent research experiences at MSSM, it seemedclear that excellent mentorship and a project withrealistic goals would be keys to the students’ success.Students interested in applying to INSPIRE met withthe program directors months or weeks before thedue date to get help in identifying outstandingpotential mentors and to discuss the feasibility of theirproposed projects. One program director, who is aPhD, is a translational scientist and medical educator,and the other, who is an MD, is a clinician-educator.Thus, program advisors were available who were ableto discuss the various types of research projects thatstudents were considering. INSPIRE took place early

in the academic year. This scheduling undoubtedlyreduced the potential number of applications becauseparticipation meant that there would be little time todo electives at other institutions before residencyapplications were due. Moreover, with the currentrequired clerkships in the fourth year and timeneeded for interviews, students who participatedin INSPIRE were unable to accommodate manyadditional clinical electives. Four students applied,and all were accepted. This small first class hadthe advantage of permitting close monitoring of thenew program. Each application proposed a projectthat was rigorous, was feasible for completion within12 weeks, and asked an important, novel, and ethicalquestion. Three students began new projects, and 1continued a project that she had begun during ascholarly year (Table 3).

Two projects were in clinical research, 1 wasin basic science, and 1 was in medical education.An interactive curriculum was created to introduceparticipants to the career path of the physician-scholar and teach important writing and presentationskills (Table 2). Weekly 1-hour meetings providedstudents with support from the program directors,allowed students to establish a group identity,enabled them to meet faculty members who wereclinician-scholars and role models, and gave themthe opportunity to present progress reports on theirprojects. Students received in-depth feedback at thesesessions on abstracts and posters that they hadpreviously prepared for Medical Student ResearchDay and on the video-taped oral presentations givenduring INSPIRE. In addition, program mentors gavestudents structured feedback at the midway point andat the end, using a standard form based on the goalsof the program. At the conclusion of the program,students presented their work as 20-minute oral talkson INSPIRE Research Day. These final presentationswere evaluated by 2 experienced faculty researchmembers not involved with INSPIRE who usedcriteria taught during their presentation workshops.Students were graded with a pass/fail system, andthey earned 12 weeks toward their elective creditrequirement.

Table 3. INSPIRE Projects and Supporting Departments.

1. Secondary Hyperparathyroidism in Patients Taking Tenofovir (Department of Medicine/Division of Liver Disease)2. Stress Testing and Biomarkers for the Evaluation of Intermediate Risk ACS (Department of Medicine/Division of

Cardiology)3. Evaluating the Merits of Course Review: A Qualitative Analysis of 20 Educators’ Experiences (Department of Medical

Education)4. Project FAT10: A Key Mediator of HIV Viral Protein R in HIV-Associated Nephropathy (Department of

Medicine/Division of Nephrology)

Abbreviation: ACS, acute coronary disease; HIV, human immunodeficiency virus

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390 K. ZIER AND L. D. COPLIT: INTRODUCING INSPIRE

EVALUATION OFTHE 2008 INSPIRE PILOT

Students completed an anonymous online evaluationof the program. Evaluations of the mentors weretreated as confidential but could not be anonymousbecause only 1 student worked with each men-tor. A 1-hour session after the program ended wasdedicated to receiving in-person feedback from thestudents to improve the program for future partic-ipants. Because only 4 students participated in thepilot program, the quantitative data are limited, andthe feedback obtained is preliminary. However, theevaluations are useful as they provide direction tothe program leadership about how to better meet thestudents’ needs.

All 4 students assessed their INSPIRE expe-rience as excellent. Three felt that their goalsfor INSPIRE were fulfilled very successfully,and 1 felt that they were fulfilled successfully(Table 4).

Two students strongly agreed and 2 agreed thatparticipation in INSPIRE increased the likelihood thatthey would include a research component in theircareers. All 4 students agreed that they were better

able to write an abstract describing the results of aresearch study. Three strongly agreed and 1 agreedthat they were better prepared to give an oral researchpresentation. Responses to open-ended questionsrevealed that the students felt INSPIRE was valuablebecause it offered them the opportunity to carry outan independent scholarly project toward the end oftheir medical education after they had exposure toboth basic science courses and clinical clerkships,because they had the chance to acquire in-depthknowledge in a focused area, because they couldbenefit from sharing the progress and experiencesof their peers in the program, and because itprovided a chance to work closely with a mentor(Table 5). In the evaluation and in an in-persondebriefing session, students were asked to providesuggestions to improve the program and to describethe impact of the experience on their current andfuture careers. Suggestions for improvement wereconsistent and included increasing the length ofthe program, adding didactic sessions on designinga research study, and providing more statisticalsupport to help with data analysis. In 2009, on thebasis of student feedback, a module on researchmethodology will be incorporated into the didacticcurriculum.

Table 4. Evaluation of INSPIRE by Participants.

Strongly Agree Agree Disagree Strongly Disagree

Goals for INSPIRE were fulfilled 3 1 0 0Increased likelihood of a research

component in career2 2 0 0

Better able to write an abstract on research 4 0 0 0Better able to give an oral research talk 3 1 0 0

Table 5. Student Comments: The Value of INSPIRE for Future Applicants.

• [It] provides time to pursue scholarly work outside of the usual research elective.

• This program is very important for people in [their] fourth year who have begun to develop specific interests in a fieldand want to get a better sense of what it means to do research/how important it will be to them to incorporate thisinto their career. Selecting a residency program is the first of many forks in the road, and it’s timely for students tolearn something about their own priorities before going through this process. Furthermore, there’s definite value inacquiring in-depth knowledge on a topic of interest (both personally and professionally) before plunging intoresidency. Since not everyone will take a year off, it’s very important for people to have the option to explore this at amore ‘‘mature’’ phase of their training, as opposed to just the summer after first year.

• INSPIRE in its current form teaches students how to present existing data, in the form of abstract and oral presentation,with an emphasis on the latter. It fosters helpful discussion about diverse projects that the other students areconducting. INSPIRE gives a brief but important glimpse into the realities– including the rewards and challenges(hard work but slow progress)– of conducting research, whether clinical or laboratory-based.

• I think INSPIRE is really valuable for continuing a project in an area of interest or for creating a brief clinical oreducational research study, and it was of particular value for me since this was my first real research project. I felt likethat was definitely a missing piece to my medical school experience, and this allowed me the opportunity to designand pursue my own research without having to give up a whole year to do so. The didactic curriculum is of particularvalue to hone presentation and teaching skills, which is definitely not found in other parts of the general curriculum. Ithink it’s also really valuable to help cultivate mentorships during application season– a very formative time whenpersonal career advice is always welcome.

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For 2009, 8 students have been accepted. As in2008, several more students were interested in partici-pating, but current limitations on the ability to do clin-ical electives, as discussed previously, prevented this.

CONCLUSIONS AND FUTURE PLANS

Focusing on scholarship from the undergraduatelevel is consistent with a culture that valuesdiscovery and its application for the best care ofpatients. INSPIRE is the first research experienceat MSSM to be part of the 4-year undergraduatemedical curriculum. The program provides studentswith research skill building, 360-degree feedback,oversight, and mentorship. INSPIRE also offerstraining in clinical and translational research withinthe curriculum, thereby addressing the new LiaisonCommittee on Medical Education requirement that‘‘the curriculum must introduce students to thebasic principles of clinical and translational research,including how such research is conducted, evaluated,explained to patients, and applied to patient care.’’

INSPIRE has the potential to revamp the fourth-year medical student curriculum at MSSM, making itmore meaningful and providing important additionalcompetencies that will enrich our students’ practice ofmedicine. This is reflected in the productivity of theparticipants, 3 of whom had peer-reviewed abstractsaccepted for presentation and 1 of whom submitteda manuscript for publication. The program is in itsinfancy, but once the new curriculum for years 1 to 3is in place, we plan to structure it as a requiredlongitudinal track that begins early in students’education, perhaps as early as the summer followingthe first year, and one that fosters mastery of essentialresearch skills. As such, it will transform our medicalstudents’ training. This, however, will require thedevelopment of medical student competencies inorder to identify which students will be able todevote a year to INSPIRE and which will need thatyear for continued study. An initiative to define thesecompetencies is currently underway at MSSM.

Including scholarly activities in undergraduatemedical education offers students the means to expe-rience expanded mentored research opportunities,to increase their awareness of the importance ofcritical thinking skills, to improve their mastery ofthe basic vocabulary and skills required to conductresearch, and to help them understand why researchis important for clinical care and how it is accom-plished. This training may encourage students topursue an academic career that includes a research

component, which may also address the reporteddecrease in R01s received by MDs.11 The institutionbenefits as well by identifying and nurturing talentedfuture physicians and physician-scholars. Scholarlyprograms such as INSPIRE may contribute to thecontinued recruitment of the best applicants andhelp to attract the best students to continue trainingat MSSM as residents, fellows, and faculty, enhancingdepartmental and institutional growth and enhancingMount Sinai’s academic and community missions.

DISCLOSURES

Potential conflict of interest: Nothing to report.

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