A. INTRODUCTION AND TRANSFORMING INTENT For the past five years, the overarching mission of the Stanford University School of Medicine (SoM) has been the translation of discoveries into medical practice. A plan developed in 2001-02 has encouraged transforming efforts in clinical and translational (CT) education and research by providing the resources to support such endeavors. The vision and goals of this plan, Translating Discoveries, are closely aligned with those of the NIH Clinical and Translational Science Award (CTSA) effort. The CTSA program has given the SoM an important opportunity to reassess, refine and refocus these efforts and move to another level in our effort to transform the practice of CTR across the University. The result will be an administrative home, the Stanford Center for Clinical and Translational Education and Research (SCCTER, pronounced ske-ter), which will totally reshape and focus our efforts in enabling and accelerating translational medicine while minimizing overlap and maximizing efficiency. More specifically, we have made substantial strides in creating enhanced education and training opportunities in clinical and translational research (CTR). Three examples of new and innovative educational initiatives include our scholarly concentrations for medical students, our multidisciplinary Biodesign program for engineers, physicians and other biomedical investigators, and our Masters of Science in Medicine (MOM) degree for PhD candidates. The scholarly concentration program is embedded in our new medical student curriculum. Of the seven concentrations, the two most popular (clinical research and community health) are directly relevant to CTR education and training. Our Biodesign program represents a unique CTR training opportunity built around teams of physicians, engineers, and postgraduate students learning how to successfully invent medically useful devices. Our MOM degree affords PhD candidates at Stanford the opportunity to matriculate with our first and second year medical students, integrating their basic science training with the critical foundations of health and human disease and the practice of medicine to provide these students a more fundamental understanding of translational and clinical medicine. In addition to these three recent initiatives, we are attempting to address the future need for well-trained CT researchers by engaging students earlier in their educational pathway. For example, we host several summer science enrichment courses for gifted and disadvantaged high school students. We consider it essential to reach out specifically to low-income and ethnic minority youth, because they are often overlooked by outreach programs. We also are making efforts to encourage more Stanford University undergraduate students to enroll in seminar courses directed by faculty with research interests in CTR and to increase opportunities for these students to work on human health related research projects with our faculty. Early exposure to CT education and training programs will encourage more of these students to consider a CTR-related profession. Numerous didactic courses have been developed by many of our CTR stakeholders, including the Department of Health Research and Policy, several clinical departments, the Office of Postdoctoral Affairs, the General Clinical Research Center (GCRC, now the Clinical and Translational Research Unit, Program Function 4), the Center for Biomedical Ethics, and the Stanford/Packard Center for Translational Research in Medicine (SPCTRM, now the Support Portal, Program Function 3). In addition, our NIH-funded training programs related to CTR (Table 8.1), including 22 T32s, 4 R25s, and 3 K12s, each have developed many seminar courses and journal clubs. Furthermore, all trainees and faculty have access to Masters degree programs in Epidemiology, Health Services Research, and Public Policy, on our campus, and we have a joint MPH program with the School of Public Health in Berkeley. Other joint degree opportunities are available across the University in the School of Humanities and Science (Biological Sciences and Biophysics), the School of Engineering (Bioengineering, Biomedical Informatics, and Biomechanical Engineering), the Graduate School of Business, and the School of Law. Despite our rich educational environment and concerted efforts to develop a wide range of discipline-specific and interdisciplinary education and training programs, the preparation of this application has stimulated the development of a plan for accelerated improvement. This plan, described below, has resulted from a faculty-wide survey and deliberations of a CT Education and Training planning committee. The overall goals of our plan are: ? To utilize the considerable faculty and student talent at all seven of Stanford's Schools to improve CT research and education across the enterprise ? To recruit, educate, and train a continuum of outstanding future CT investigators ? To promote awareness of the value and necessity of multidisciplinary and interdisciplinary team research ? To facilitate and coordinate all of our education and training initiatives in the area of CTR. CTR at Stanford has been carried out primarily by faculty at the SoM, with limited but very fruitful interactions with faculty in our other Schools. Our first goal is designed to apply the expertise at Stanford's seven Schools to CTR by educating faculty and trainees at our other Schools in the importance and methodology of CTR. Conversely, we also will utilize the considerable expertise at the other Schools to help educate the next generation of CT investigators in the SoM. The CTSA will allow us to develop programs to facilitate this cross-School and cross-discipline pollination;this will be transformative for CT research and education at Stanford and, potentially, in the country. Our second goal, to support a continuum of trainees, is critical for several reasons. Engaging trainees early in their career will encourage them to pursue careers in CTR, thereby ensuring the development of a steady pipeline of CTR investigators. Trainees along the continuum will be able to assist the next tier of trainees by acting as near-to-peer role models. Trainees late in the continuum will develop leadership skills while assuming oversight responsibilities for more junior colleagues. The continuum also will provide a defined pathway, from novice to expert, affording trainees the opportunity to increase their level of knowledge and expertise as they advance academically. Our third goal is to conduct meaningful multidisciplinary exercises that include affiliated nurse scientists and allied health researches, and to build research projects that will encourage and foster collaborations both within and outside the SoM. Since translational medicine is both interdisciplinary and multidisciplinary by nature, a comprehensive educational program should include participation of students from both the MD and PhD pathways and should integrate these programs so that trainees receive maximum exposure to other disciplines. We plan to teach this multidisciplinary approach through participation in our six-week team-building practicum exercises. These teams will be composed of members from multiple disciplines with varied educational backgrounds. Our fourth goal, to facilitate and coordinate all current education and training initiatives, will be critical to supporting our continuum of trainees, building our multidisciplinary programs, and eliminating unnecessary duplication of efforts. A key component of this goal is to take advantage of "teachable moments" in the study design process (Program Function 3: Support Portal) as opportunities for training and as sources of didactic material.