SUMMARY/ABSTRACT The exodus from academic to careers in industry, government and other sectors has been expedited by the COVID-19 pandemic. Given tight funding pay lines, a shortage and fierce completion for tenured and tenure- track university/academic medical institution positions and a ‘publish or perish’ mindset, more and more graduate students, postdoctoral fellows and even residents are looking to leave academic medicine in the pursuit of more stable and lucrative careers. Junior investigators require support, guidance and training opportunities to plant the seeds to develop into- and retain established pain scientists. Unfortunately the current algorithm for mid-career and senior faculty success does not include developing the next generation of leaders within our challenging field of academic medicine. The current funding mechanism is an outstanding opportunity for mentors to devote time, effort and funds towards junior investigators interested in a career in pain scholarship. The current application seeks to provide protected mentorship-focused time for Dr. Claudia Campbell, an MPI on the ‘SKOAP’ phase III clinical trial. The SKOAP study, a Sequenced-strategy for improving outcomes in people with Knee OsteoArthritis Pain, is a sequential large-scale HEAL Effectiveness Research Network study evaluating conservative and nonsurgical procedural interventions for reducing pain and improving function in patients with KOA. The trial is an excellent platform for the training of junior investigators from varied disciplines. The SKOAP trial is designed to mimic clinical care by first testing the effectiveness of conservative treatment and nonsurgical interventional procedures. This large-scale, pragmatic, comparative-effectiveness study involves comprehensive and innovative approaches that have never before been employed in this context, providing an exciting learning platform in multiple domains, including: a multidisciplinary cadre of investigators conducting the largest randomized trial to date to evaluate behavioral, pharmacologic, and procedural interventions for KOA; a step-care, factorial design model that allows for more than two dozen pair-wise treatment comparisons; phenotyping to improve selection for each therapy (i.e., precision medicine), which is expected to refine outcomes and reduce unnecessary interventions; integration of a psychosocial intervention WITH medication treatment; a novel design; longitudinal follow-up period; personalized medicine approach; an innovative flexible approach to sample size; deep integration into standard of care and the clinical environment; multiple recruitment sites and a collaboration with multiple groups to support the study, including a number of ICs at NIH, primarily NIAMS and NCATS, a Clinical Coordinating Center (at Duke), Data Coordinating Center (at Utah), Recruitment and Retention support (via Vanderbilt and the Duke Call Center) and startup support within Johns Hopkins (Bios/Trials Innovation center), which provide incredibly rich and varied learning opportunities.

NARRATIVE The pipeline of emerging pain scientists is dwindling and there is an urgent need to bolster junior investigators and provide training and experience to propel them into academic careers. Mentoring the next generation of leaders has taken a back seat to the pressures placed on mid-career and senior scientists. The SKOAP clinical trial is an ideal training opportunity, with a novel design and multidisciplinary treatments, the project will support a rich and collaborative environment to successfully launch trainees into pain clinical trials.