Project Summary/Abstract Individual differences in the safety and efficacy of pharmaceuticals are a significant barrier to treatment in pain medicine, where clinicians must balance safety concerns, particularly around opioids, with the undertreatment of pain. Pharmacogenomics aims to improve safety and reduce trial-and-error with medications by providing critical information about an individual’s genetic risk for adverse drug reactions and medication failure. However, despite institutional support for testing, studies indicate that pharmacogenomic testing is rarely ordered for pain medication. To improve access to genomic medicine, we need to understand the reason for this gap, as well as key clinical and ethical considerations to guide patient-centered use. This K99/R00 Award is a five-year training and research project that will use an exploratory sequential mixed methods design to improve our understanding of pain physicians’ knowledge, views, and practices with pharmacogenomics. Physicians impact patient access through their use and interpretation of tests. Board-certified pain physicians are an understudied group of expert stakeholders who undergo specialized training in the treatment of chronic pain and the management of medications. Studies have identified system-level educational and administrative barriers to the use of pharmacogenomics; however, these studies do not account for why some medical specialties have adopted pharmacogenomic education and testing more quickly than others. Medical specialties shape physician knowledge, views, and practices through fellowship training, ongoing professionalization, and clinical guidelines. The specific aims are to 1) Characterize professional discussions in pain medicine about pharmacogenomics using ethnographic methods. 2) Assess pain physicians’ knowledge, views, and use of pharmacogenomics using a national survey. 3) Identify a) key barriers and facilitators and b) clinical and ethical considerations to guide the use of pharmacogenomics in chronic pain care via a synthetic analysis of ethnographic and quantitative data. The K99 phase of this grant includes a combination of didactic coursework, directed readings, and clinical immersion to develop the skills and expertise of the candidate in a) survey design, statistical sampling, and mixed methods analysis, b) pharmacogenomics of pain medications, c) clinical issues for medication management in chronic pain care, and d) collaborative research and publications. Through the protected time and mentorship of the proposed Pathway to Independence Award, the candidate will be able to secure a tenure track position and to fulfill their long-term goal of being an independent scientist dedicated to examining the ethical, legal, and social implications of the use of genomics in clinical care.