Project summary/abstract The MD-PhD program at the University of Nebraska Medical Center (UNMC) trains physician scientists to improve health and reduce health disparities. Through doubling the program size since 2007, increasing NIH-funded F30/F31 fellowship awards from 2 to 16, maintaining time-to- degree that is better than the national average, improving anatomy test scores over 20 percentage points, and holding attrition below 10%, we have documented training success. Over a third of our trainees earn extramural fellowships (44%) and most hold student leadership roles. UNMC is ranked in the top 10 nationally for primary care training and rural practice and has research strengths in cancer biology, infection and inflammation, neuroscience, cardiovascular disease, and aging. The program curriculum provides career development that fosters critical thinking, adult learning, challenging paradigms, and using data to inform research and care. We foster a positive and inclusive culture of training for students and focus on trainee well-being and professional activities. The program objectives are: (1) Recruit diverse trainees committed to advance biomedical research; (2) Integrate medical and research training; (3) Promote productivity of students in advanced research areas; (4) Develop a cohort of mentors who promote student development; (5) Support service learning, community care, and development of clinical skills; (6) Develop student transferable and leadership skills through principles and practice; (7) Maintain appropriate time-to-degree for student success; and (8) Foster retention by preparing students to overcome potential barriers. We have applicants from 42 states and 20% of our applicants and trainees (plus 37% of program faculty) have rural backgrounds—compared to only 6% of MD applicants nationally. Our directed efforts over the last 15 years increased recruitment and representation of women trainees and brought the percent of women trainees from less than 6% to 55%. Nebraska is an IDeA state with infrastructure for clinical and translational research faculty through the Great Plains IDeA CTR and the Nebraska Pediatric Clinical Trials Unit. In this proposal, we propose the Nebraska Leading Equity and Diversity MSTP to support physician scientist training and request two funded training slots in the first year, 4 slots in year 2, and six per year after that. In this funding period, we will increase assessment sophistication, enhance alumni engagement, build our mentorship training, increase recruitment of scientists underrepresented in medicine, and provide leadership skills to all trainees. We will leverage the requested T32 funding to advance our program and change medicine.