The changing landscape of veterinary medicine has prompted a national dialogue in areas like stress and burnout,1–4 market growth,5–8 and retention.7,9 A report7 commissioned by the Mars Veterinary Group indicates 40,959 veterinarians will need to enter companion animal practice by 2030 to account for both market growth (22,909 positions) and retirements (18,050 positions).9 This is slightly higher than the Bureau of Labor Statistics' anticipated job growth rate of 19% (16,800 positions) between 2021 and 2031.6 The estimate of new veterinarians in this same period is 26,000, indicating a potential 16% shortage based on demand. Further, turnover rates have increased since the COVID-19 pandemic, with an annual turnover rate of 16% in 2021,5 due in part to an increasingly competitive labor market.
Academic veterinary medicine is under pressure, attempting to educate future veterinarians in the context of high market demand and serving interrelated missions including research, outreach, and patient care. Clinical faculty shortages have been an ongoing challenge due to turnover and low numbers of applicants for open positions. Few studies have addressed what factors motivate veterinary clinical residents and early-career faculty to seek or remain in academic positions; studies10–16 in several academic career fields, including veterinary medicine, highlight the importance of lifestyle and work-life balance, mentorship, research opportunities, desire to teach, and professional development. Salary has been a strong driver of career-related decisions for human medical residents with high educational debt.12,17–21 Additionally,10–12 issues of departmental culture, work-life balance, administrative support of clinical medicine, compensation, and excessive research expectations were cited as reasons for leaving academic veterinary medicine.
One limitation of veterinary studies focused on recruitment and retention of clinical faculty is the overreliance on quantitative data, which allows for larger sample sizes and easy comparisons among factors but also reduces the depth of information that respondents provide. We use a mixed methods approach incorporating both quantitative data and qualitative, free-text responses to better understand veterinary career choices by contextualizing factors associated with academic medicine. For example, when someone indicates that geographic location matters quantitatively, their free-text response qualitatively contextualizes what specifically they are considering.
Here we describe a large-scale, survey-based study assessing factors associated with academic career choice among clinical veterinary residents and early-career faculty. We hypothesize that for both groups, work-life balance and workplace climate and culture are stronger motivators than financial considerations, regardless of demographic factors such as gender, race/ethnicity, and area of specialization. This hypothesis is supported by the Self-Determination Theory22 and Employee Engagement Theory.23 The Employee Engagement Theory posits that meaningfulness, safety, and availability within the work role predict employee engagement, with meaning derived from the work role as the primary motivator. The Self-Determination Theory posits that people engage in activities (including work) for a variety of reasons and will be more fulfilled and mentally healthy when environmental conditions support self-determination (ie, experienced as originating by the actor) of activities.
Methods
Survey development
The American Association of Veterinary Clinicians (AAVC) approved the development of a survey to assess factors associated with academic career selection among residents and early-stage faculty (Table 1). The survey was created by individuals (KF, MEB, and JML) (Supplementary Material S1) with expertise in the areas of academic veterinary medicine, psychology, education, and organizational change and received Texas A&M University IRB exemption. Engaging individuals with expertise in multiple fields established face validity, and feedback from others in the field of academic veterinary medicine ensured content validity. Survey questions were developed around categories of concern referenced by leaders across academic veterinary medicine, and clarification was sought to ensure that the survey reflected the areas referenced. Qualtrics software was utilized as a delivery instrument. This study utilized a convergent mixed methods design with a questionnaire variant, with the variant due to whether the respondent was a resident or an early-stage faculty member. Closed-ended (quantitative) survey questions promoted data collection from a larger representative sample (n = 541), while open-ended (qualitative) survey questions expanded on these responses to develop a deeper understanding of the quantitative questions. Respondents were asked to provide demographic information and characteristics of their specialty area and classification at the time of the survey. The remaining survey questions sought feedback regarding factors contributing to career-related decisions, academic career interest, and factors affecting decisions to pursue veterinary private practice or academic careers. Residents were asked to rate their interest in pursuing an academic career on a 1 to 5 scale (not at all interested to very interested), and all respondents were asked to rate seven items for making career-related decisions on a 1 to 5 Likert scale (not at all important to extremely important). Open-ended questions allowed respondents to expand on their responses and to provide feedback on perceived strengths and challenges of veterinary academic careers.
Results for demographic characteristics for early career faculty respondents, including number of responses and percentage of total responses by category.
| Demographic characteristics | n | (%) |
|---|---|---|
| Race | ||
| Asian | 10 | 3.4 |
| Black or African American | 5 | 1.7 |
| White | 270 | 90.9 |
| American Indian or Alaska Native | 0 | 0.0 |
| Native Hawaiian or Other Pacific Islander | 0 | 0.0 |
| Prefer to self-describe | 12 | 4.0 |
| Mixed | 2 | |
| American | 1 | |
| Mexican | 1 | |
| South Asian (Indian) | 1 | |
| Hispanic | 2 | |
| Middle Eastern/North African | 1 | |
| White and Indigenous American | 1 | |
| Not indicated | 3 | |
| Hispanic, Latinx, Spanish origin | ||
| Yes | 14 | 4.8 |
| No | 278 | 94.5 |
| Prefer not to respond | 2 | 0.7 |
| Gender | ||
| Male | 74 | 25.3 |
| Female | 218 | 74.4 |
| Nonbinary/third gender | 0 | 0.0 |
| Prefer to self-describe | 1 | 0.3 |
Eligibility criteria and distribution
Individuals eligible to complete the survey included clinical faculty within the first 5 years of their academic appointment (early career) at a US or Canadian School or College of Veterinary Medicine and veterinary residents in private or academic practice. The survey was distributed in April 2023 by email through an AAVC-generated list of clinical faculty and a separate list of candidates who were selected through the Veterinary Internship and Residency Matching Program in 2020. A second recruitment email was sent in late April 2023 to the AAVC list of current US and Canadian veterinary teaching hospital directors and clinical department heads with the intent that these individuals would distribute the survey to eligible faculty and residents at their home institutions.
Data collection and analysis
The survey was designed so qualitative and quantitative questions were paralleled to facilitate data integration. This allowed for the comparison of data points for emergent themes and an understanding of variation among responses. Using one survey consisting of both quantitative and qualitative questions resulted in the same sample for each method. Differences in sample size can be explained by a lower response rate to open-ended survey questions among respondents.23,24
Early-stage data analysis was conducted individually for both data collection methods, followed by data integration for interpretation. The Qualtrics survey system (Qualtrics XM; Qualtrics International Inc) was used for statistical computations (eg, mean, median, range, SD), which were confirmed by manual data analysis. ANOVA tests were used to determine if there were statistically significant differences in responses by demographic based on the ability of ANOVA to compare variations between group means to the variation within the groups. For all comparisons, a P value of .05 was accepted for statistical significance.
Qualitative data were organized using ATLAS.ti (ATLAS.ti Scientific Software Development), a qualitative analysis software to aid in developing codes and creating a codebook to organize emergent themes. Open (ie, identifying important ideas and phrases) and axial (ie, identifying connections among these ideas) coding22 allowed for code group organization for comparison of qualitative findings with quantitative data responses. This comparison informed a deeper understanding of the quantitative survey data.
Results
Of the approximately 2,000 individuals contacted, 563 individuals participated in this study. After review, 541 were included in the data analysis. The remaining 22 responses were excluded based on qualitative responses indicating that respondents did not identify either as a resident or early-career clinical faculty member. Of the 541 respondents, 54% (n = 294) were early-career faculty and 46% (247) were residents. Resident responses included 227 academic residents and 20 private practice residents.
Quantitative responses
Faculty
Among faculty respondents, the median age was 42 (range, 27 to 69), and most respondents were White (92%) and female (74%). Detailed demographic data are outlined (Table 2). Forty-six percent of respondents were small animal exclusive, 29% were predominately small animal, 9% were food animal/mixed practice, and 13% were predominately equine. The top 3 disciplines represented were small animal surgery (10.2%; n = 30), small animal internal medicine (8.8%; 26), and small animal primary care (7.5%; 22).
Results for demographic characteristics for resident respondents, including number of responses and percentage of total responses by category.
| Demographic characteristics | n | (%) |
|---|---|---|
| Race | ||
| Asian | 22 | 8.9 |
| Black or African American | 6 | 2.4 |
| White | 210 | 84.7 |
| American Indian or Alaska Native | 0 | 0.0 |
| Native Hawaiian or Other Pacific Islander | 1 | 0.4 |
| Prefer to self-describe | 9 | 3.6 |
| Latin | 1 | |
| Latino | 1 | |
| Latin American | 2 | |
| Caucasian | 1 | |
| European and Central America | 1 | |
| Hispanic | 1 | |
| Multiracial | 1 | |
| Not identified | 1 | |
| Hispanic, Latinx, Spanish origin | ||
| Yes | 23 | 9.3 |
| No | 221 | 89.8 |
| Prefer not to respond | 2 | 0.9 |
| Gender | ||
| Male | 61 | 24.8 |
| Female | 185 | 75.2 |
| Nonbinary/third gender | 0 | 0.0 |
| Prefer to self-describe | 0 | 0.0 |
Factors underpinning career-related decision-making were ranked by level of importance as (1) workplace environment/culture (
Ratings of factors related to career decision-making by quantitative category, separated by early career faculty and resident.
Citation: American Journal of Veterinary Research 85, 9; 10.2460/ajvr.24.03.0082
Residents
Among resident respondents, the median age was 31 (range, 23 to 51), and most respondents were White (85%) and female (75%). Detailed demographic data are outlined (Table 2). Forty-five percent of respondents were small animal exclusive, 24% were predominately small animal, 12% were food animal/mixed practice, and 18% were predominately equine. The top 3 service areas represented were emergency and critical care (11%; n = 27; inclusive of large animal and small animal), small animal surgery (9.3%; 23), and small animal internal medicine (8.5%; 21).
Factors underpinning career-related decision-making were ranked by level of importance as (1) workplace environment/culture (
Residents were asked to rate their interest in pursuing an academic career from 1 (not at all) to 5 (very interested). When asked if they have ever considered pursuing an academic career, 213 residents responded with 57 (27%) indicating they have not considered it and 156 (73%) indicated that they have. However, responses to a Likert scale question regarding current interest in pursuing an academic career (1, not at all interested; 3, neutral; and 5, very interested) received a mean score of 2.8 (SD, 1.36), indicating a low level of interest in pursuing an academic career among the respondent group. Female respondents were slightly more interested in pursuing an academic career (
Qualitative response data, factors impacting career choices
Salary and benefits
Faculty noted that although they expected academia to offer lower salaries than practice, the gap has recently increased, and academic institutions need to be more salary competitive. Many faculty referenced cost-of-living increases, more consistent merit raises, and production bonuses (including for emergency duty) as steps academic institutions should consider to address salary disparity between academic and private practice. In contrast, residents indicated that academic institutions need to significantly raise base salaries for faculty without a loss of perceived benefits associated with an academic position. Many residents viewed the higher salary seen in private practice as a reflection of the value of their education and contribution to the institution. Several residents referenced the opportunity for production in addition to salary as a draw to private practice.
In addition to salary, benefits were seen as a primary contributor to decision-making regarding a career. These included student loan forgiveness or assistance, paid time off, retirement, and insurance (medical, dental, etc). Several respondents noted that some difference in salary between private practice and academia is buffered by more robust benefits packages at academic institutions.
Organizational culture
Both resident and faculty respondents provided similar responses referencing organizational culture. These responses indicated a need for a positive organizational culture characterized by a noncompetitive, collegial environment. Concerns about hierarchies and the politicized nature of academic institutions were major themes in respondent comments. Several respondents indicated a concern over entrenched behaviors in academic institutions that perpetuated a toxic environment and bullying behaviors.
Faculty and resident respondents indicated that leadership and administration within both private practice and academia were considerations in making career decisions. This included the reputation of leadership, honest and transparent communication, and advocacy for employees. Leaders were seen as critical to establishing a collaborative environment and support network that promoted team cohesion, respect, and accountability. This was of particular concern for academia owing to its complex organizational structure that potentially limits effective communication and reporting channels.
Some resident respondents indicated they decided not to pursue an academic career based on their experience in an academic training program or during their degree program. Reasons given included burnout, decreased well-being and mental health, lack of research or teaching interest, and a perception that institutions do not value faculty.
Meaningfulness and fulfillment
Both respondent groups also provided similar responses highlighting the importance of meaningfulness and fulfillment. Both respondent groups referenced a desire to impact the next generation of veterinarians and the profession through teaching and mentoring, as well as consistent intellectual stimulation and continued learning. It was also noted that mission and vision alignment with personal and professional goals and values was important in making career decisions. Contributing to outreach efforts, decision-making, and positive change was seen as an antecedent to this goal.
Caseload and task variety fall within this category; many respondents noted their interest in an academic career was driven by a desire to see a variety of cases, including complex or challenging cases. Academic medicine was perceived as promoting fulfillment through access to resources and colleagues across multiple specialties which encouraged these types of advanced cases. These respondents referenced this as synonymous with the chance to practice leading-edge, evidence-based, quality patient care, which was a priority for them in selecting a career path.
Mentorship and collaboration
Both faculty and residents indicated a desire to have consistent mentorship and collaboration with others in the institution. Mentoring was most often referenced in the context of learning how to navigate academia, while collaboration was highlighted as the opportunity to work with colleagues from within the respondent's specialty as well as other specialties within the same hospital environment. This factor also did not appear as an option in the quantitative ratings, and thus, the qualitative questions provided additional insight regarding academic considerations made by faculty and residents. This theme is an example of the power of mixed methods research, as it was not 1 of the 7 factors listed in the quantitative ratings.
Professional growth and development
An additional emergent theme focused on institutional investment in professional development opportunities and resources as a positive factor for academic veterinary medicine compared to private practice, which was a consistent theme across respondent comments. Some respondents referenced research as a driving force, encouraging clinicians to contribute to advances and discoveries through research projects while, in turn, participating in knowledge and skill-building through their own and colleagues' research. Many respondents also noted additional opportunities for continuing education and training that can be less accessible in private practice.
Personal considerations
Both residents and early-career faculty noted similar personal considerations as factors in making career choices. Geographic location was frequently referenced, specifically a desire for access to urban/metropolitan areas. For many, this was seen as a deterrent to entering academic medicine, as many institutions are based in smaller towns or more rural areas. Aligned with this were references to available opportunities within the community, strong educational opportunities for children, and a political and cultural climate that paralleled individuals' values. Several respondents also indicated a need to accommodate partners' career needs and proximity to extended family or other support networks.
Recognition and respect
A desire for respect and recognition was voiced by both residents and faculty; again, this theme emerged and did not have a parallel in the quantitative data. Faculty and resident respondents indicated a desire to feel supported by institutional leadership and their colleagues and to be recognized for their efforts in teaching, research, and patient care. Faculty also voiced a desire for greater understanding and acknowledgment of veterinary academic medicine by campus leadership and administration, particularly given the unique nature of practicing veterinary medicine within academic institutions.
Support and team environment
Respondents noted the importance of access to libraries, research facilities, equipment, travel opportunities, training, and professional development. Those who referenced these factors most often associated these resources with academic veterinary medicine, viewing this as a positive contributor to considering a career in academia. These examples provide further depth to our understanding of the facilities and resources factor in the quantitative ratings.
One factor noted by early-career faculty was the desire for adequate administrative support to complete clerical tasks and requirements (eg, scheduling meetings, reminder emails, evaluations, and promotion documents), as well as support for administrative research tasks (eg, grant writing, IACUC protocols, and consent documentation).
Respondents consistently addressed the need to maintain an adequate number of well-trained support staff, limit attrition, and plan to address staffing shortages. Several respondents noted the need for an adequate number of faculty, while the majority noted the need for strong technical, administrative, and research staff support. These staff were seen as critical to success in a faculty role, and respondents referenced the need to address well-being, burnout, and salary rates for these groups.
Politics and bureaucracy
Respondents noted that politics and bureaucracy were concerns when deciding between private practice and academia. Factors cited in academia included a lack of accountability, inefficiency, a slow rate of change, institutional politics, and barriers or restrictions to accomplishing goals. Factors reported in private practice included increased corporatization, money-making strategies, contract terms and noncompetes, and expectations for productivity and revenue generation.
Both early-career faculty and residents noted bureaucracy within academic institutions as a potential barrier to individual autonomy. Respondents referenced a desire to contribute to decision-making in program curriculum and unit operations. On an individual level, there was a desire for flexible work options, participation in external consulting, autonomy in research, and setting career goals.
Workload and work-life balance
The workload and work-life balance affiliated with roles in private practice or academic medicine were consistently referenced by respondents throughout the survey. Referenced topics included balanced effort allocations, novelty and variety in the workday, caseload expectations, and requirements outside of the primary role.
Many early-career faculty desired protected time to complete nonclinical tasks (teaching, research, training, service, and outreach), while residents were more likely to reference optional research responsibilities or a clinical-only appointment with no research expectations. Respondents also noted a perceived overload in responsibilities in academic medicine, specifically referencing committee service, meetings, nonclinical paperwork, and mentoring.
Both respondent groups referenced research as a factor in making career decisions. Respondents recognized research as a core component of a career in academia but differed on whether this was an incentive or disincentive. Many faculty respondents saw the ability to conduct research as a positive factor for academic veterinary medicine when there are resources and protected time for engaging in research. However, some resident respondents noted that requirements to publish, workload expectations, and the potential for salary to be grant dependent were detractors from interest in an academic career.
Respondents noted on-call and emergency duty as potential stressors and indicated a desire for additional compensation for emergency duty or a consistent schedule with less on-call or emergency duty. Several respondents referenced the desire for a 4-day work week, no after-hours work, and no weekend work. The majority of respondents desired support from leadership in setting boundaries and expectations around work hours. There was some variation in how this differed between private practice and academic medicine. Some respondents noted an interest in academic medicine because it allowed greater work-life balance with fewer demands outside of work hours; others noted more schedule flexibility and short work weeks in private practice, perceiving an increased workload in academia.
Discussion
In the survey described here, residents noted the following considerations in descending order of importance: (1) workplace environment and culture, (2) personal well-being and work-life balance, (3) salary and bonuses, (4) geographic location, (5) facilities and resources, (6) benefits, and (7) schedule flexibility. Early-career faculty noted considerations in descending order of importance: (1) workplace environment and culture, (2) personal well-being and work-life balance, (3) benefits, (4) facilities and resources, (5) schedule flexibility, (6) geographic location, and (7) salary and bonuses. These findings support the hypothesis that work-life balance and workplace climate and culture are stronger motivators than financial considerations among respondents. Ascertaining the emphasis placed on each factor is a necessary step in understanding decision-making surrounding an academic veterinary medicine career. The findings of this study support Furr and Raczkoski11 in the weight placed on schedule flexibility, work-life balance, and the desire to influence veterinarians and veterinary medicine. However, the findings differ in the priority placed on participation in translational research. Further, understanding the similarities and differences in responses between residents and early-career faculty can contribute to goal-setting in recruiting and retaining academic veterinary clinicians. It is important to note that different methodologies in these studies limit the opportunity for direct comparison.
Workplace environment and culture were the highest-ranked factor for career consideration among both residents and faculty. These findings align with previous studies4,10,11,13,25 noting that workplace environment is a necessary factor in addressing clinician attrition within academic medicine, ranking higher than salary among both faculty and house officers in human healthcare. This study's findings support existing research indicating that workplace culture is a key priority in academic career selection and retention,1,4,11,17,26 with mentorship,10,13,17–21,25,27 professional development,14,28–30 leadership support,10,14,31,32 team collegiality,15,33,34 and recognition of efforts all contributing to a favorable workplace culture.25
Bureaucracy in academic institutions was a detractor to academic career interest for many respondents. Barriers to goal accomplishment, inefficiency, and the hierarchical nature of universities have been shown to decrease participation in academia.10,34–37 A desire to participate in decision-making and enact meaningful change contributes to interest in pursuing an academic career. Studies indicate concerns about shared governance among faculty and the need for academic institutions to create pathways for meaningful participation among faculty resulting in actionable outcomes.15,31,37,38 As noted by several respondents, creating communication channels with campus leadership and administration could increase understanding and acknowledgement of the vital roles played by veterinary faculty. However, academic institutions have potential advantages over corporatized private practice regarding contracts, noncompetes, and stringent production expectations.
Personal well-being and work-life balance were seen as strong contributing factors to making career decisions, particularly when considering an academic career. Work-life balance was viewed both as hours spent on work-related tasks as well as the distribution of duties within that time. Respondents noted a desire for balance between clinical, teaching, and research duties that supported achievable outcomes in all areas. This is supported by existing studies that reference concerns about balancing time commitments and priorities in academic medicine.29,39–43 Academic institutions should work to outline responsibilities clearly and make efforts to limit conflict between key mission areas.
Many respondents noted the desire to teach and influence the next generation of veterinarians as a strong driver for a career in academia, aligning with findings in other academic medical disciplines.11,16,28,32,44 Those interested in this area derived a sense of meaning and purpose in this work and alignment of their personal goals and values with the mission of the institution.11,25,28,32
Many resident respondents noted that requirements and expectations for research lowered their interest in an academic career and that the ability to have a clinical appointment without research expectations, or with optional research expectations, could impact their decision-making. Both faculty and resident respondents noted that additional responsibilities in academia such as committee service, meetings, and clerical tasks add to the overall workload and decrease satisfaction. One strategy for academic institutions is to establish expectations and resources during clinical-track faculty recruitment, including flexibility in requiring research as part of faculty appointments.10,11 Institutions could benefit from providing residents and faculty enhanced research support, as well as opportunities for flexibility in academic appointment requirements. Additionally, there is strong evidence to support structured academic mentoring programs for faculty and residents.11,13,20,28,33
Study respondents desired access to modern, specialized clinical equipment and novel procedures. These respondents felt that academic medicine allowed for more opportunity in this area than private practice. Building a robust infrastructure to support student training, clinical trials, benchtop research, specialty care, and clinical skills training will be necessary to attract and retain faculty in academic medicine.17,30,34,35
Schedule flexibility, referenced as 4-day work weeks and limited or no on-call expectations, was also referenced, with many respondents noting this as a strength of private practice. However, many faculty respondents indicated a belief that academic medicine allowed for greater work-life balance with fewer demands outside of work hours. Interestingly, residents ranked schedule flexibility last overall, while also noting a desire for shorter work weeks perceived as available in academia. The desire for a shorter workweek and greater schedule flexibility in academic medicine has been supported by existing studies10,17,32,34,45 across multiple fields. Further research is needed to ascertain average differences in work weeks and schedules in academia versus private practice.
Geographic location and political climate also informed personal well-being and supported existing studies10,11,35,45 indicating that most residents seek careers within metropolitan or suburban areas, with a small percentage looking to work within rural communities. This is a potential detractor for academic veterinary medicine specifically, given that many teaching hospitals are based in rural areas. Several respondents noted that local and state politics impacted their decision to live in certain areas. Future research could focus on understanding individual differences and the role of academia in supporting the needs of employees within the larger geographic and political environment.
Concerns over the increasing pay gap between private practice and academia10,11,17 were supported by the study's findings. The findings also support other studies7,10,11,14,36 noting salary as a contextual factor behind workplace environment and clinician well-being. Recommendations have been made to consider additional pay for emergency duty or a percentage of productivity like that in private practice.2,34 However, studies35,46 have also acknowledged limitations to university budgets and financial models that potentially constrain options for increasing faculty salaries.
Both faculty and resident respondents referenced student loan forgiveness as a positive contributor to an academic career. This aligns with existing studies37,41 noting that student loan forgiveness or tuition reimbursement can help to offset salary differences between academic and private practice careers. Providing information and encouraging both faculty and residents to utilize this resource are opportunities to address concerns related to compensation.
Faculty respondents noted insurance (medical, dental, vision), paid leave time, and retirement plans as positive benefits to working in academia. Some resident respondents referenced retirement benefits, but most did not address insurance or paid leave time as considerations. This aligns with the fact that faculty rated benefits more highly on the list of important considerations than residents; however, responses do not clearly highlight what drives this variation. Like student loan forgiveness, benefits are seen as a possible way to decrease the gap in compensation between academia and private practice, with academia seen as being more robust.32 However, with the growth in private practice corporatization, academic institutions may have to contend with practices that can offer competitive benefits packages as part of the recruitment process.
In conclusion, factors influencing career decision-making for resident and early-career faculty are varied. While academic institutions are somewhat limited in areas such as salary and geographic location, there are several key areas of focus that could impact a desire for an academic career. Benefits, facilities, and resources are all areas where academic medicine can continue to thrive and expand to attract and retain strong faculty clinicians. Workplace environment, work-life balance, and schedule flexibility are areas that academic institutions can address and continue to improve and that are likely to positively impact entry into academia and the desire to stay.
Supplementary Materials
Supplementary materials are posted online at the journal website: avmajournals.avma.org
Acknowledgments
None reported.
Disclosures
The authors have nothing to disclosed. No AI-assisted technologies were used in the generation of this manuscript.
Funding
The research was funded by the authors' departments.
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